All 9 cases were reduced successfully regardless of the reduction methods used. FARES method was found to be popular in the studying emergency department. Six out of the 9 cases were using the FARES method at their first attempt (the rest two case using Spaso; one using traction-counter traction). No pre-medication was needed in all FARES' cases. In all 6 cases using the FARES method, the shoulder could be reduced within 2 minutes. Conclusions: Our experience concords with overseas' in which the FARES method is efficacious and fast. (Hong Kong j.emerg

Objective: To test the null hypothesis that for nurses working in emergency department, there is no difference between self-instruction and traditional method of training cast application technique, with respect to cost-effectiveness. Method: This was a prospective, single-blind, randomised, controlled trial carried out at the Accident & Emergency Department of North District Hospital from 11 November 1998 to 16 May 2000. Thirty-three full-time emergency department nurses (9 nursing officers, 20 registered nurses and 4 enrolled nurses) were randomly assigned into two groups. Sixteen were given the self-instruction training program (intervention group) and 17 were instructed by traditional training program (control group). The primary outcome measure was cost-effectiveness analysis. The predetermined relative cost ratio was compared with the relative success ratio of the two methods. The secondary outcome measures were individual skill performance, knowledge scores and attitude ranks. Results: There was no statistically significant difference between self-instruction and traditional method of training. The relative cost ratio of self-instruction to traditional method was 0.80. The relative success ratio of self-instruction to traditional method was 0.82. All nurses showed improvement in their knowledge (mean knowledge score, 38 versus 89). Trainees in the traditional method had more confidence performing cast application. Subgroup analysis showed that trainee characteristics and attitude did not predict the outcome. Conclusion: Self-instruction method and traditional method may be equally cost-effective for training cast application technique. Both methods resulted in significant improvement in knowledge of cast application. Nurses trained with the traditional method had more confidence than those trained with self-instruction method. (Hong Kong j.emerg.med. 2001;8:9-15)

A retrospective study was carried out to examine the attendance pattern on a day-of-the-week basis. Attendance data were collected from 1st April to 30th June 2010 and arranged in the days of the week for analysis. Setting: A&E of a regional hospital. Main outcome measures: Mean attendance with 95% confidence interval for different days of the week. Result: Monday was shown to have 12.2% higher attendance than non-Mondays (95% CI=8.4%, 16.0%). Conclusion: Since Monday has the highest attendance, it is necessary to take measures to reduce the "predictable workload" on Monday to ease overcrowding and reduce waiting time to deal with the anticipated attendance.

Organophosphate poisoning is a life-threatening condition. The toxicity is due to the irreversible inactivation of cholinesterase. Apart from the enhanced muscarinic and nicotinic activities, cardiac toxicity is also possible. We present a case of organophosphate poisoning in which the electrocardiogram showed QT prolongation. The literature related to the topic is also reviewed.

Chung Chin Hung, Charles, MBB S(HK), FRCS (Glas g), FH KAM (Eme rgency Medic ine) We describe a case of acute on chronic theophylline intoxication with severe headache as the chief complaint in a Chronic Obstructive Pulmonary Disease (COPD) patient. Headache is a non-specific symptom. The intensity of headache is unusually severe in our patient, and is much worse than the headache commonly encountered by an experienced emergency physician. (Hong Kong j.emerg.med.