急诊医学研究方向的思考

经过30年的发展历程,急诊医学逐步形成了中国特色的理论体系,心肺复苏(CPR)、心脏聚停后综合征、脓毒症、多器官功能障碍综合征、多发性创伤、急性中毒等已渐渐成为急诊医学专业领域的研究热点和方向.     

急诊ABC模式实施与护理对策

急诊护理学是护理学的重要组成部分,它以研究各类急性病、急性创伤、心肺脑复苏、急性中毒、小儿急诊、慢性病急性发作等急危重症病人的抢救护理为主要内容。近年来,在全世界灾害频发的现实环境下,急诊急救护理得到更多重视和更快发展。     

中山大学《心肺脑复苏进展学习班》报名通知

近年来,心肺脑复苏(CPCR)日益成为急诊医学领域研究的热点。国际、国内心肺脑复苏的研究取得了长足的进步,临床心肺脑复苏的成功率也不断提高。为推动我国复苏医学的发展,提高广大医师在心肺脑复苏     

《中华急诊医学杂志》第三届组稿会暨急诊医学学术交流会会议纪要

由中华医学急诊医学分会,中华急诊医学杂志编辑委员会共同主办,四川省医学会急诊医学专业委员会承办的《中华急诊医学杂志》第三届组稿会暨急诊医学学术交流会,于2004年12月2日至6日在成都胜利召开,来自全国各省市自治区的专家学者260余人参加了会议。本次会议共收到全国各地稿件251篇,内容涵盖了急诊医学的各个方面,包括院前急救、心脑血管急症、心肺脑复苏、多器官功能衰竭、创伤急救、急性中毒、灾难医学与急诊流行病学、急诊学科建设等方面。     

《中华急诊医学杂志》第八届组稿会暨急诊医学首届青年论坛会议纪要

由<中华急诊医学杂志>编辑委员会、中华医学会急诊医学分会联合主办,宁夏医科大学附属医院承办的<中华急诊医学杂志>第八届组稿会暨急诊医学首届青年论坛,于2009年7月30日至2009年8月2日在银川召开,来自全国各省市自治区的专家学者170余人参加了会议.本次会议共收到全国各地稿件98篇,内容涵盖了急诊医学的各个方面,包括院前急救、心脑血管急症、心肺脑复苏、多器官功能衰竭、创伤急救、急性中毒、灾难医学与急诊流行病学、急诊学科建设等方面.中华急诊医学杂志主编江观玉教授到会并致开幕词,中华医学会急诊医学分会主委委员李春盛教授、宁夏医科大学等领导出席会议并分别致词.     

中山大学《心肺脑复苏进展学习班》报到通知

近年来,心肺脑复苏(CPCR)日益成为急诊医学领域研究的热点。国际、国内心肺脑复苏的研究取得了长足的进步,临床心肺脑复苏的成功率也不断提高。为推动我国复苏医学的发展,提高广大医务人员在心肺脑复苏的基础与临床研究水平,交流心肺脑复苏的经验。     

急诊医学进展

急诊医学是医学科学领域中的一门新兴的跨专业学科,以研究急性危重病的院前救治和输送、心肺脑复苏、危重病人的监护救治预后评价、灾害性医学和急性病的诊断治疗为主要任务。就其广泛的意义而论包括急救医学、灾害医学、危重病医学、急诊医疗体系管理学等方面。我国卫生部于1983年已承认急诊医学为独立学科,1987年正式成立中华医学会急诊医学会至今已11年,目前,学会根据专业特点分为院前急救、灾害医学、小儿急诊、危重病医学、复苏、中毒、创伤、继续教育8个专业组。共举办了7次全国急诊医学学术会议、2次国际会议以及10余次各专业组的学…     

中华急诊医学杂志第三届组稿会暨急诊医学学术交流会征文通知

为反映我国急诊医学学科建设的成果和急诊医学学术最新的进展,《中华急诊医学杂志》编辑委员会将举办“中华急诊医学杂志第三届组稿会暨急诊医学学术交流会”,欢迎广大医务人员踊跃投稿并参加学术交流。一、征文内容:脓毒症与多器官功能障碍综合征、多器官功能衰竭与脏器功能支持、心肺脑复苏、创伤急救、呼吸衰竭与呼吸支持、儿科急救、急性中毒、灾难医学与院前急救、心脑血管急症、外科危重症、急诊流行病学、急诊学科建设等方面的最新进展。二、征文要求:来稿要求是未在国内刊物上正式发表过的论文;30 0 0字左右的全文以及5 0 0字左右的…     

我国急性中毒救治现状:机遇与挑战并存

急性中毒是危害公众健康和生命安全的重要医学及社会问题.急性中毒救治作为急诊医学的重要组成部分,也是急诊医师临床诊疗实践的重要内容,其在急诊医学特色建设及学科发展中具有不可替代的作用.近年,在国家及各级政府的高度重视下,我国在中毒救治、基地建设、毒物检测、科学研究及人才培养等方面迎来快速发展,但同时也面临救治不规范、临床科研不足、基层医疗薄弱等诸多挑战.本文就我国急性中毒救治现状进行回顾,浅析存在问题,并展望未来发展方向,旨在抛砖引玉,集思广益,共同促进我国急性中毒救治专业的发展.     

《中华急诊医学杂志》第三届组稿会暨急诊医学学术交流会征文通知

为反映我国急诊医学学科建设的成果和急诊医学学术最新的进展,《中华急诊医学杂志》编辑委员会将举办“中华急诊医学杂志第三届组稿会暨急诊医学学术交流会”,欢迎广大医务人员踊跃投稿并参加学术交流。一、征文内容:脓毒症与多器官功能衰竭、多器官功能衰竭与脏器功能支持、心肺脑复苏、创伤急救、呼吸衰竭与呼吸支持、儿科急救、急性中毒、灾难医学与院前急救、心脏血管急症、外科危重症、急诊流行病学、急诊学科建设等方面的最新进展。二、征文要求:来稿要求是未在国内刊物上正式发表过的论文;30 0 0字左右的全文以及5 0 0字左右的中英文…     

急诊科心肺复苏医护配合的培训与管理

[目的]提高心肺复苏医护配合技术水平,提高抢救成功率,减少医患纠纷。[方法]根据急诊科人员结构成立医护配合心肺复苏技术培训小组,采取理论讲授和现场演练等训练模式,将自我训练与指导老师辅导相结合,并采取适当激励措施。[结果]在对心脏停搏病人进行医护配合心肺复苏技术抢救中,无一例病人家属因抢救因素引发纠纷。[结论]医护配合心肺复苏技术的培训能提高急救技术水平,减少医患纠纷的发生。     

专职化院前急救对心肺复苏成功率的影响

目的探讨专职化院前急救对心肺复苏成功率的影响。方法135例院前心肺复苏患者的资料,按非专职化院前急救与专职化院前急救两种情况进行分组,从医务人员状况、出车时间、到达现场时间、院前应用高级生命支持技术(ACLS)技术及抢救成功率等方面进行对比研究。结果专职化院前急救心肺复苏成功率达26.8%,较非专职化成功率3.7%有显著的提高(P<0.05),且出车时间、到达现场时间、车载设备的配备、现场应用高级生命支持技术等均有明显的改善。结论专职化院前急救可提高院前心肺复苏的成功率。     

急诊科心肺复苏医护配合的培训与管理

[目的]提高心肺复苏医护配合技术水平，提高抢救成功率，减少医患纠纷。[方法]根据急诊科人员结构成立医护配合心肺复苏技术培训小组，采取理论讲授和现场演练等训练模式，将自我训练与指导老师辅导相结合，并采取适当激励措施。[结果]在对心脏停搏病人进行医护配合心肺复苏技术抢救中，无一例病人家属因抢救因素引发纠纷。[结论]医护配合心肺复苏技术的培训能提高急救技术水平，减少医患纠纷的发生。     

急诊心肺复苏预后的相关因素分析

目的分析急诊心肺复苏预后的相关因素。方法回顾性分析2019年1月至2020年1月本院的120例心跳呼吸骤停患者的临床资料,分析急诊心肺复苏预后的相关因素。结果120例患者中,预后良好16例,预后不良104例,占比分别为13.3%、86.7%。急诊心肺复苏预后良好与预后不良患者的发病时间、发病地点、发病病因、发病前状态、首次监测心律、心肺复苏起始时间、心肺复苏连续时间、肾上腺素总量比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,首次监测心律、心肺复苏起始时间、心肺复苏连续时间是影响急诊心肺复苏预后的独立危险因素(P<0.05)。结论首次监测心律、心肺复苏起始时间、心肺复苏连续时间是影响急诊心肺复苏预后的独立危险因素,值得临床充分重视。     

高仿真模拟技术在五年制本科急诊医学培训中的作用

目的:评估高仿真模拟技术在五年制本科急诊医学教学中的作用。方法:对中山大学附属第三医院急诊科见习的2007级和2008级五年制本科生,分别采用不同的教学模型和教学模式进行培训,并比较其实习资格操作考试心肺复苏和气管插管项目的成绩。结果:采用高仿真模拟技术的2008级学生心肺复苏和气管插管实习资格操作考试的成绩分别为(83.25±11.25)分和(86.50±11.25)分,明显高于未采用高仿真模拟技术的2007级学生心肺复苏和气管插管实习资格操作考试的成绩(65.50±14.25)分和(78.50±16.75)分(P均0.05)。结论:高仿真模拟技术和以提出问题、解决问题为中心的教学模式在急诊医学五年制本科生培训中具有明显的优越性。     

Outcome from paediatric cardiac arrest associated with trauma

OBJECTIVE: To examine survival rates for paediatric trauma patients requiring cardiopulmonary resuscitation (CPR) in the pre-hospital setting, and to identify characteristics that may be associated with survival. DESIGN: Ten-year retrospective trauma database review. SETTING: An urban physician-led pre-hospital trauma service serving a population of approximately 7.5 million, in the United Kingdom. PATIENTS: Eighty paediatric trauma patients (15 years or less) who received pre-hospital resuscitation following cardiorespiratory arrest between July 1994 and June 2004. INTERVENTION: Pre-hospital cardiopulmonary resuscitation. MAIN OUTCOME MEASURE: Survival to hospital discharge. RESULTS: Eighty children met inclusion criteria for the study. Nineteen (23.8%) were discharged alive from the emergency department and seven children (8.75%) survived to hospital discharge. Of the seven survivors, one had spinal cord injury. Two suffered asphyxial injury associated with blunt trauma and three sustained hypoxic insults following drowning or burns/smoke inhalation. In one patient with known congenital cardiac disease the cause of cardiac arrest was likely to have been medical. CONCLUSION: This study confirms the poor outcome for children requiring pre-hospital CPR following trauma. However, the results are better in this physician-attended group than in other studies where physicians were not present. They also suggest that cardiac arrest associated with trauma in children has a better outcome than in adults. In common with adults treated in this system, those patients with hypovolaemic cardiac arrest did not survive (Ann Emerg Med 2006;48:240-4). A large proportion of the survivors suffered hypoxic or asphyxial injuries. Targeted aggressive out-of-hospital resuscitation in certain patient groups can produce good outcomes.     

188例院前心肺复苏临床分析

目的:分析院前心肺复苏(CPR)病例的抢救经过,总结其中的经验和教训,探讨提高院前心肺脑复苏成功率的途径。方法:回顾分析188例院前CPR病列的复苏开始时间,临床急救措施,心肺脑复苏的成功率等方面的资料。结果:188例患者中,31例心肺复苏成功,4例心肺脑复苏成功,心肺复苏成功率16.49%,心肺脑复苏成功率2.13%。CPR开始时间越早,除颤时间越早,心肺脑复苏的成功率越高。结论:良好齐全的急救设备,专业的院前急救水平,普及急救知识,加快CPR及除颤开始时间,及时给予基础和高级生命支持是提高院前心肺脑复苏成功率的重要途径。     

Noninvasive Intracranial Cerebral Flow Velocity Evaluation in the Emergency Department by Emergency Physicians

Transcranial Doppler (TCD) is an accepted modality for the evaluation of cerebral blood flow velocities. OBJECTIVES: The purpose of this study was to test the feasibility of bedside TCD measurement in the emergency department (ED) with critically ill, intubated patients. METHODS: A prospective convenience sample of patients presenting to a university hospital over a two-month period underwent TCD evaluation of the middle cerebral artery. Intubated patients with head trauma and any patient requiring tracheal intubation were eligible. A 2-MHz Doppler probe was positioned over the temporal bone to acquire blood flow velocities. An emergency medicine resident and research assistant obtained measurements. Continuous TCD tracings were recorded on a video cassette recorder tape for quality assurance review and data collection. Vital signs and therapeutic interventions were also recorded. Flow velocities were measured in cm/s; the peak Resistance Index (RI) was calculated for each patient. RESULTS: A total of 30 patients were enrolled in the study. Adequate tracings were obtained in 25 patients (83%) without a disruption of resuscitation. Tracings could not be obtained in five patients; they were listed as TCD failures. However, in two of these patients, adequate flow velocity tracings were obtained after resuscitation. Four patients were evaluated during tracheal intubation. One patient was monitored successfully during cardiopulmonary resuscitation. The median time required for data acquisition was 1.9 minutes. The mean highest RI for those who expired was 0.84. For those who survived, the mean highest RI was 0.52. The difference of 0.32 was statistically significant (p = 0.04). CONCLUSIONS: Noninvasive blood flow velocity monitoring of the middle cerebral artery using TCD is feasible in the ED when performed at the bedside on intubated patients with traumatic brain injury and others during tracheal intubation and resuscitation.     

Gender‐specific Issues in Traumatic Injury and Resuscitation: Consensus‐based Recommendations for Future Research

Traumatic injury remains an unacceptably high contributor to morbidity and mortality rates across the United States. Gender‐specific research in trauma and emergency resuscitation has become a rising priority. In concert with the 2014 Academic Emergency Medicine consensus conference “Gender‐specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” a consensus‐building group consisting of experts in emergency medicine, critical care, traumatology, anesthesiology, and public health convened to generate research recommendations and priority questions to be answered and thus move the field forward. Nominal group technique was used for the consensus‐building process and a combination of face‐to‐face meetings, monthly conference calls, e‐mail discussions, and preconference surveys were used to refine the research questions. The resulting research agenda focuses on opportunities to improve patient outcomes by expanding research in sex‐ and gender‐specific emergency care in the field of traumatic injury and resuscitation.     

Dispatcher-assisted telephone-guided cardiopulmonary resuscitation: an underused lifesaving system.

OBJECTIVES: Our purpose with this investigation was to (i) estimate how often telephone-guided cardiopulmonary resuscitation was offered from emergency medical service dispatchers in Stockholm, (ii) study the willingness to perform cardiopulmonary resuscitation, and (iii) assess factors that could mislead the dispatcher in identifying the patient as a cardiac arrest victim. METHODS: In this prospective study, 313 consecutive emergency calls of out-of-hospital cardiac arrest were obtained from the Swedish Cardiac Arrest Register. Seventy-six cases of out-of-hospital cardiac arrest fulfilled the inclusion criteria. All alarm calls were tape-recorded and analyzed according to a standardized protocol. RESULTS: Dispatchers offered bystanders telephone instructions for cardiopulmonary resuscitation in 47% (n=36) of the cases and, among these, cardiopulmonary resuscitation instructions were given in 69% (n=25). Only 6% (n=2) of bystanders were not willing to perform cardiopulmonary resuscitation. Signs of breathing (suspected agonal breathing) were described in 45% of the cases. Cardiopulmonary resuscitation was offered to 23% (n=10) of patients with signs of breathing versus 92% (n=23) of those who were not breathing (P<0.001). CONCLUSIONS: Despite the fact that the vast majority of bystanders are willing to take part in telephone-guided cardiopulmonary resuscitation, emergency medical service dispatchers offer telephone-guided cardiopulmonary resuscitation in about only half of cases. Signs of breathing (agonal breathing) are often mistaken for normal breathing and are a cause of delay in the diagnosis of cardiac arrest.