Hoon Lim - Academia.edu (original) (raw)
Papers by Hoon Lim
Singapore Medical Journal, 2014
American Journal of Epidemiology, Mar 16, 2019
Western Journal of Emergency Medicine
Introduction: Supraventricular tachycardia (SVT) is commonly encountered in the emergency departm... more Introduction: Supraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM). Methods: We conducted a randomised controlled trial at an acute hospital ED. Patients presenting with SVT were randomly assigned to HDDB or modified VM in a 1:1 ratio. A block randomisation sequence was prepared by an independent biostatistician, and then serially numbered, opaque, sealed envelopes were opened just before the intervention. Patients and caregivers were not blinded. Primary outcome was cardioversion to sinus rhythm. Secondary outcome(s) included adverse effects...
Singapore Medical Journal, 2021
Online first papers have undergone full scientific review and copyediting, but have not been type... more Online first papers have undergone full scientific review and copyediting, but have not been typeset or proofread. To cite this article, use the DOIs number provided. Mandatory typesetting and proofreading will commence with regular print and online publication of the online first papers of the SMJ.
Cureus, 2019
Introduction Emergency department observation units (EDOU) have been shown to be effective in dec... more Introduction Emergency department observation units (EDOU) have been shown to be effective in decreasing hospitalization rates and length of stay (LOS) for various conditions. However, cost savings and efficacy in the management of poisoning in EDOU have not been widely studied. The objective of our study is to compare the costs and effectiveness of managing paracetamol poisoned patients in the EDOU with those treated in the inpatient wards. Methods We conducted a historical controlled observational study comparing paracetamol-poisoned patients (who received at least 21 hours of IV N-acetylcysteine [NAC]) admitted to the EDOU during 2013-2014 with similar patients admitted to inpatient ward during 2011, 2013-2014. Results We found 136 patients admitted to the inpatient ward and 95 to our EDOU due to paracetamol poisoning but only 78 and 39 patients respectively fulfilled the inclusion criteria. Between the EDOU and inpatient ward groups, we found similar demographics, poisoning presentation, treatment, and adverse event profiles. There were no fatalities and only two patients (one from each group) developed hepatotoxicity. The "medical" length of stay was 31.9 hours shorter in the EDOU group compared to the inpatient ward group (23.3 versus 55.2 hours). EDOU patients have statistically significant savings (comparing bill size) of S$784 per patient. Conclusions Admission to the EDOU resulted in significant cost savings and 58% decreased LOS when compared to inpatient wards. The EDOU is a cost-effective and safe alternative for the management of selected paracetamol poisonings requiring NAC. Further studies would be needed to verify these results.
Singapore medical journal, 2009
Ingestional naphthalene mothball poisoning leading to prolonged haemolysis and methaemoglobinaemi... more Ingestional naphthalene mothball poisoning leading to prolonged haemolysis and methaemoglobinaemia can present with diagnostic and therapeutic challenges. A 19-year-old woman ingested 12 mothballs, and presented two days later with haemolysis and methaemoglobinaemia. She was treated with red blood cell transfusions, intravenous methylene blue, N-acetylcysteine and ascorbic acid. Continuous venovenous haemofiltration was conducted for 45 hours. Haemolysis with anaemia and methaemoglobinaemia persisted even after five days post-ingestion. Clinical and biochemical parameters improved. We describe a case of ingestional naphthalene poisoning with a good outcome after treatment.
In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrill... more In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrillators and the crew is trained in their use. This is the first paper from Singapore reporting the survival rate in patients presenting to an urban public hospital with acute coronary syndrome (ACS) who developed out-of-hospital cardiac arrest (OHCA). All consecutive patients who presented to the ED of a public hospital with OHCA or ACS were surveyed from 1 April 1999 to 30 September 1999. There were 392 patients among whom 115 (28.5%) had OHCA. There was no significant difference in age and gender distribution between the OHCA and non-OHCA patients. More than 2/3 of the OHCA patients had no report of chest pain or breathlessness before they collapsed. Forty five (39.1%) of the 115 OHCA patients were noted to have initial rhythms of ventricular tachycardia (VT) or ventricular fibrillation (VF) and received pre-hospital defibrillation. The mean time from collapse to first DC shock was 12.07+/-7.2 min. Twenty (17.4%) of the OHCA patients had return of spontaneous circulation after resuscitation in the ED. Four patients (3.5%), all with an initial rhythm of VF were discharged alive from the hospital. Much remains to be done to reduce the time interval to first DC shock for the OHCA group.
This work proposes an image-guided robotic Mastoidectomy. A surgical navigation software was deve... more This work proposes an image-guided robotic Mastoidectomy. A surgical navigation software was developed to guide the robot without damaging the critical area. A forbidden- region virtual fixture is implemented for safety. A human-robot collaboration control mode is used to allow the human intervention during surgery, to compensate tremor by operator, and to protect the relevant organs. A temporal bone replica
Emergency medicine journal : EMJ, Jan 23, 2015
Identification of the J-point and measurement of ST segment elevation at the J-point are importan... more Identification of the J-point and measurement of ST segment elevation at the J-point are important for the diagnosis of ST-elevation myocardial infarction (STEMI). We conducted a study to determine the inter-rater reliability (IRR) of J-point location and measurement of the magnitude of ST elevation at the J-point on ECGs of patients with STEMI by emergency department (ED) doctors. Each participant examined 20 STEMI ECGs during a 1-month period in 2013. The participants were required to locate the J-point by selecting the small 1 mm square within which the J-point is located and measure the magnitude of ST elevation at the J-point identified (rounded up to the nearest 0.5 mm). The intraclass correlation coefficient (ICC) was calculated to assess the IRR. Thirty doctors participated. The ICC assessing the degree to which all participants provided agreement in their assessment of the location of J-points across ECGs was 0.85 (95% CI 0.75 to 0.93), which is in the excellent range. The ...
The western journal of emergency medicine, 2009
... International Perspective from Singapore on Methemoglobinemia and Sulfhemoglobinemia in Two ... more ... International Perspective from Singapore on Methemoglobinemia and Sulfhemoglobinemia in Two Pediatric Patients after Ingestion of Hydroxylamine Sulfate. Hoon Chin Lim, MBBS andHock Heng Tan, MBBS. Changi ... Ann Acad Med Singapore. 2005;34:35661. ...
KEY WORDS: 3S surge system; allocation of scarce resources; crisis standard of care; disaster med... more KEY WORDS: 3S surge system; allocation of scarce resources; crisis standard of care; disaster medicine; mass casualty event; scarce resource environment; surge capacity When medical and health needs of a disaster-stricken population exceed currently available resources, surge capacity must be created. The 3S Surge System consists of staff (personnel), stuff (supplies and equipment), and structure (physical location and incident management). Because it is not feasible to deliver health care in the usual way during a catastrophe, the goal shifts from optimizing individual to maximizing population medical and health outcomes. Allocation of scarce resources requires an evidence-based approach that encompasses national and international standards while maintaining regional and local flexibility. At some point in time following a catastrophe, it may become imperative to implement a crisis standard of care putting protocols, such as rationing of health care supplies and medications into action. In developing and defining this crisis standard of care, there are a multiple considerations, including medical, ethical, legal, and implementation/deactivation procedures. This manuscript reviews the origin of the concept of crisis standard of care with a discussion of its development, changes in health care delivery goals during emergencies, when to adopt crisis care policies and protocols, issues to address in catastrophic disaster planning, ethical and legal considerations, and directions for future research.
From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brough... more From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brought 1210 athletes and 810 officials from 43 participating countries. On 11 June, just 1 week before the Games Village Medical Centre started operations, the World Health Organization officially declared a global H1N1 2009 pandemic. Working in close partnership with the Olympic Council of Asia Medical Commission, Singapore AYG Organising Committee and other government agencies, the AYG Medical Services Committee was successful in preventing the local transmission of H1N1, which would have been a threat to the games, as it could have led to the cancellation of these games. This article describes the experience and valuable lessons learnt from managing a sports-related mass gathering during the developing pandemic.
To describe the initial experience of a group of emergency department (ED) physicians, utilizing ... more To describe the initial experience of a group of emergency department (ED) physicians, utilizing a Glidescope videolaryngoscope (GVL) for orotracheal intubations in the ED. A 6-month, single center, prospective observational study from 19 Feb 2007 to 18 Aug 2007 was conducted on all orotracheal intubations, which involved utilization of the original GVL in different emergency airway management scenarios. Overall success of GVL intubation was 15 out of 21 (71.4%) cases. The GVL was able to provide at least Cormack-Lehane grade I or II laryngoscopy views in all cases. All the operators highlighted difficulty in angulating and maneuvering the endotracheal tube for insertion through the glottis as the primary difficulty encountered. We found the GVL to be an effective device in our ED's emergency airway control repertoire. Its role in the anticipated difficult airway in the ED will need further studies.
In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrill... more In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrillators and the crew is trained in their use. This is the first paper from Singapore reporting the survival rate in patients presenting to an urban public hospital with acute coronary syndrome (ACS) who developed out-of-hospital cardiac arrest (OHCA). All consecutive patients who presented to the ED of a public hospital with OHCA or ACS were surveyed from 1 April 1999 to 30 September 1999. There were 392 patients among whom 115 (28.5%) had OHCA. There was no significant difference in age and gender distribution between the OHCA and non-OHCA patients. More than 2/3 of the OHCA patients had no report of chest pain or breathlessness before they collapsed. Forty five (39.1%) of the 115 OHCA patients were noted to have initial rhythms of ventricular tachycardia (VT) or ventricular fibrillation (VF) and received pre-hospital defibrillation. The mean time from collapse to first DC shock was 12.07+/-7.2 min. Twenty (17.4%) of the OHCA patients had return of spontaneous circulation after resuscitation in the ED. Four patients (3.5%), all with an initial rhythm of VF were discharged alive from the hospital. Much remains to be done to reduce the time interval to first DC shock for the OHCA group.
Singapore Medical Journal, 2014
American Journal of Epidemiology, Mar 16, 2019
Western Journal of Emergency Medicine
Introduction: Supraventricular tachycardia (SVT) is commonly encountered in the emergency departm... more Introduction: Supraventricular tachycardia (SVT) is commonly encountered in the emergency department (ED). Vagal manoeuvres are internationally recommended therapy in stable patients. The head down deep breathing (HDDB) technique was previously described as an acceptable vagal manoeuvre, but there are no studies comparing its efficacy to other vagal manoeuvres. Our objective in this study was to compare the rates of successful cardioversion with HDDB and the commonly practiced, modified Valsalva manoeuvre (VM). Methods: We conducted a randomised controlled trial at an acute hospital ED. Patients presenting with SVT were randomly assigned to HDDB or modified VM in a 1:1 ratio. A block randomisation sequence was prepared by an independent biostatistician, and then serially numbered, opaque, sealed envelopes were opened just before the intervention. Patients and caregivers were not blinded. Primary outcome was cardioversion to sinus rhythm. Secondary outcome(s) included adverse effects...
Singapore Medical Journal, 2021
Online first papers have undergone full scientific review and copyediting, but have not been type... more Online first papers have undergone full scientific review and copyediting, but have not been typeset or proofread. To cite this article, use the DOIs number provided. Mandatory typesetting and proofreading will commence with regular print and online publication of the online first papers of the SMJ.
Cureus, 2019
Introduction Emergency department observation units (EDOU) have been shown to be effective in dec... more Introduction Emergency department observation units (EDOU) have been shown to be effective in decreasing hospitalization rates and length of stay (LOS) for various conditions. However, cost savings and efficacy in the management of poisoning in EDOU have not been widely studied. The objective of our study is to compare the costs and effectiveness of managing paracetamol poisoned patients in the EDOU with those treated in the inpatient wards. Methods We conducted a historical controlled observational study comparing paracetamol-poisoned patients (who received at least 21 hours of IV N-acetylcysteine [NAC]) admitted to the EDOU during 2013-2014 with similar patients admitted to inpatient ward during 2011, 2013-2014. Results We found 136 patients admitted to the inpatient ward and 95 to our EDOU due to paracetamol poisoning but only 78 and 39 patients respectively fulfilled the inclusion criteria. Between the EDOU and inpatient ward groups, we found similar demographics, poisoning presentation, treatment, and adverse event profiles. There were no fatalities and only two patients (one from each group) developed hepatotoxicity. The "medical" length of stay was 31.9 hours shorter in the EDOU group compared to the inpatient ward group (23.3 versus 55.2 hours). EDOU patients have statistically significant savings (comparing bill size) of S$784 per patient. Conclusions Admission to the EDOU resulted in significant cost savings and 58% decreased LOS when compared to inpatient wards. The EDOU is a cost-effective and safe alternative for the management of selected paracetamol poisonings requiring NAC. Further studies would be needed to verify these results.
Singapore medical journal, 2009
Ingestional naphthalene mothball poisoning leading to prolonged haemolysis and methaemoglobinaemi... more Ingestional naphthalene mothball poisoning leading to prolonged haemolysis and methaemoglobinaemia can present with diagnostic and therapeutic challenges. A 19-year-old woman ingested 12 mothballs, and presented two days later with haemolysis and methaemoglobinaemia. She was treated with red blood cell transfusions, intravenous methylene blue, N-acetylcysteine and ascorbic acid. Continuous venovenous haemofiltration was conducted for 45 hours. Haemolysis with anaemia and methaemoglobinaemia persisted even after five days post-ingestion. Clinical and biochemical parameters improved. We describe a case of ingestional naphthalene poisoning with a good outcome after treatment.
In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrill... more In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrillators and the crew is trained in their use. This is the first paper from Singapore reporting the survival rate in patients presenting to an urban public hospital with acute coronary syndrome (ACS) who developed out-of-hospital cardiac arrest (OHCA). All consecutive patients who presented to the ED of a public hospital with OHCA or ACS were surveyed from 1 April 1999 to 30 September 1999. There were 392 patients among whom 115 (28.5%) had OHCA. There was no significant difference in age and gender distribution between the OHCA and non-OHCA patients. More than 2/3 of the OHCA patients had no report of chest pain or breathlessness before they collapsed. Forty five (39.1%) of the 115 OHCA patients were noted to have initial rhythms of ventricular tachycardia (VT) or ventricular fibrillation (VF) and received pre-hospital defibrillation. The mean time from collapse to first DC shock was 12.07+/-7.2 min. Twenty (17.4%) of the OHCA patients had return of spontaneous circulation after resuscitation in the ED. Four patients (3.5%), all with an initial rhythm of VF were discharged alive from the hospital. Much remains to be done to reduce the time interval to first DC shock for the OHCA group.
This work proposes an image-guided robotic Mastoidectomy. A surgical navigation software was deve... more This work proposes an image-guided robotic Mastoidectomy. A surgical navigation software was developed to guide the robot without damaging the critical area. A forbidden- region virtual fixture is implemented for safety. A human-robot collaboration control mode is used to allow the human intervention during surgery, to compensate tremor by operator, and to protect the relevant organs. A temporal bone replica
Emergency medicine journal : EMJ, Jan 23, 2015
Identification of the J-point and measurement of ST segment elevation at the J-point are importan... more Identification of the J-point and measurement of ST segment elevation at the J-point are important for the diagnosis of ST-elevation myocardial infarction (STEMI). We conducted a study to determine the inter-rater reliability (IRR) of J-point location and measurement of the magnitude of ST elevation at the J-point on ECGs of patients with STEMI by emergency department (ED) doctors. Each participant examined 20 STEMI ECGs during a 1-month period in 2013. The participants were required to locate the J-point by selecting the small 1 mm square within which the J-point is located and measure the magnitude of ST elevation at the J-point identified (rounded up to the nearest 0.5 mm). The intraclass correlation coefficient (ICC) was calculated to assess the IRR. Thirty doctors participated. The ICC assessing the degree to which all participants provided agreement in their assessment of the location of J-points across ECGs was 0.85 (95% CI 0.75 to 0.93), which is in the excellent range. The ...
The western journal of emergency medicine, 2009
... International Perspective from Singapore on Methemoglobinemia and Sulfhemoglobinemia in Two ... more ... International Perspective from Singapore on Methemoglobinemia and Sulfhemoglobinemia in Two Pediatric Patients after Ingestion of Hydroxylamine Sulfate. Hoon Chin Lim, MBBS andHock Heng Tan, MBBS. Changi ... Ann Acad Med Singapore. 2005;34:35661. ...
KEY WORDS: 3S surge system; allocation of scarce resources; crisis standard of care; disaster med... more KEY WORDS: 3S surge system; allocation of scarce resources; crisis standard of care; disaster medicine; mass casualty event; scarce resource environment; surge capacity When medical and health needs of a disaster-stricken population exceed currently available resources, surge capacity must be created. The 3S Surge System consists of staff (personnel), stuff (supplies and equipment), and structure (physical location and incident management). Because it is not feasible to deliver health care in the usual way during a catastrophe, the goal shifts from optimizing individual to maximizing population medical and health outcomes. Allocation of scarce resources requires an evidence-based approach that encompasses national and international standards while maintaining regional and local flexibility. At some point in time following a catastrophe, it may become imperative to implement a crisis standard of care putting protocols, such as rationing of health care supplies and medications into action. In developing and defining this crisis standard of care, there are a multiple considerations, including medical, ethical, legal, and implementation/deactivation procedures. This manuscript reviews the origin of the concept of crisis standard of care with a discussion of its development, changes in health care delivery goals during emergencies, when to adopt crisis care policies and protocols, issues to address in catastrophic disaster planning, ethical and legal considerations, and directions for future research.
From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brough... more From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brought 1210 athletes and 810 officials from 43 participating countries. On 11 June, just 1 week before the Games Village Medical Centre started operations, the World Health Organization officially declared a global H1N1 2009 pandemic. Working in close partnership with the Olympic Council of Asia Medical Commission, Singapore AYG Organising Committee and other government agencies, the AYG Medical Services Committee was successful in preventing the local transmission of H1N1, which would have been a threat to the games, as it could have led to the cancellation of these games. This article describes the experience and valuable lessons learnt from managing a sports-related mass gathering during the developing pandemic.
To describe the initial experience of a group of emergency department (ED) physicians, utilizing ... more To describe the initial experience of a group of emergency department (ED) physicians, utilizing a Glidescope videolaryngoscope (GVL) for orotracheal intubations in the ED. A 6-month, single center, prospective observational study from 19 Feb 2007 to 18 Aug 2007 was conducted on all orotracheal intubations, which involved utilization of the original GVL in different emergency airway management scenarios. Overall success of GVL intubation was 15 out of 21 (71.4%) cases. The GVL was able to provide at least Cormack-Lehane grade I or II laryngoscopy views in all cases. All the operators highlighted difficulty in angulating and maneuvering the endotracheal tube for insertion through the glottis as the primary difficulty encountered. We found the GVL to be an effective device in our ED's emergency airway control repertoire. Its role in the anticipated difficult airway in the ED will need further studies.
In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrill... more In Singapore, all public emergency ambulances are equipped with semi-automatic external defibrillators and the crew is trained in their use. This is the first paper from Singapore reporting the survival rate in patients presenting to an urban public hospital with acute coronary syndrome (ACS) who developed out-of-hospital cardiac arrest (OHCA). All consecutive patients who presented to the ED of a public hospital with OHCA or ACS were surveyed from 1 April 1999 to 30 September 1999. There were 392 patients among whom 115 (28.5%) had OHCA. There was no significant difference in age and gender distribution between the OHCA and non-OHCA patients. More than 2/3 of the OHCA patients had no report of chest pain or breathlessness before they collapsed. Forty five (39.1%) of the 115 OHCA patients were noted to have initial rhythms of ventricular tachycardia (VT) or ventricular fibrillation (VF) and received pre-hospital defibrillation. The mean time from collapse to first DC shock was 12.07+/-7.2 min. Twenty (17.4%) of the OHCA patients had return of spontaneous circulation after resuscitation in the ED. Four patients (3.5%), all with an initial rhythm of VF were discharged alive from the hospital. Much remains to be done to reduce the time interval to first DC shock for the OHCA group.