高级智能综合模拟人ECS在急诊护理学实训教学中的应用

目的：探讨高级智能综合模拟人ECS在急诊护理学实训教学中的应用效果。方法对江西中医药大学大三护理专业学生随机分组,实验组利用ECS模拟人模拟临床急救环境进行急诊护理技能实训授课,对照组配备普通模拟人按传统教学模式授课,分别比较考核教学效果。结果实验组学生考核成绩明显优于对照组,差异有统计学意义（P＜0．05）。结论 ECS模拟人用于急诊护理学实训教学有利于提高学生实际动手能力,培养急救意识、团队合作精神及综合急救素质。     

Clinical review: impact of emergency department care on intensive care unit costs

Critical care is both expensive and increasing. Emergency department (ED) management of critically ill patients before intensive care unit (ICU) admission is an under-explored area of potential cost saving in the ICU. Although limited, current data suggest that ED care has a significant impact on ICU costs both positive and negative. ICU practices can also affect the ED, with a lack of ICU beds being the primary reason for ED overcrowding and ambulance diversion in the USA. Earlier application in the ED of intensive therapies such as goal-directed therapy and noninvasive ventilation may reduce ICU costs by decreasing length of stay and need for admission. Future critical care policies and health services research should include both the ED and ICU in their analyses.     

Evaluation of prehospital emergency care in the field and during the ambulance drive to the hospital

This study was conducted to evaluate the appropriateness of ambulance procedures and interventions in the management of patients dispatched to 2 emergency departments (EDs) of urban hospitals in Izmir. Use of trauma boards and cervical collars, airway patency, breathing, and circulation problems were recorded in both EDs. Eighty-one patients with a mean age of 47.54±2.36 years (range, 4–89) brought into the ED via ambulances were enrolled in the study. Airway maneuvers were performed in patients with airway and breathing problems. There was no significant relationship between administration of IV fluids and the presence of circulatory impairment (P=.053). A trauma board was used in 9 of 30 trauma cases (30%) and a cervical collar in 6 of 30 (20%). It was concluded that basic procedures used in the management of patients brought into the ED via ambulances were inadequate.     

细节护理在急诊休克患者护理中的应用研究

目的探讨细节护理在急诊休克患者护理中的应用。方法选择126例创伤性休克患者,按照住院顺序分为实验组与对照组各63例。对照组仅给予常规的急救护理干预措施,实验组则在对照组基础上给予细节护理干预措施,比较2组患者抢救成功率、有效救治时间、并发症情况、医疗差错、医疗纠纷情况、预后情况以及护理满意度。结果实验组抢救成功率高于对照组,有效抢救时间多于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。实验组医疗差错、医疗纠纷发生率均低于对照组,差异有统计学意义(P0.05)。实验组恢复良好者显著多于对照组,而致残率及病死率显著低于对照组,差异均有统计学意义(P0.05)。实验组护理满意率为96.83%,显著高于对照组的87.30%(P0.05)。结论对急诊休克患者实施细节护理,不仅可降低并发症发生率、医疗纠纷发生率,减少医疗差错、致残及死亡患者,还能提高抢救成功率,增加有效抢救时间,改善护理满意度及预后。     

Out‐of‐hospital emergency care providers' work and challenges in a changing care environment

Acutely ill patients are often treated on site instead of being transported to hospital, so wide‐ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out‐of‐hospital emergency care providers' competence, skills and willingness to engage in self‐development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out‐of‐hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25‐year‐olds but <10% of over 45‐years‐olds, found the work physically straining. The majority indicated that they had a sufficient theoretical–practical basis to perform their regular duties, and more than one‐third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training.     

国内外急救护理研究

从急救医疗体系、急救护理人员结构、急救护理科研方面,比较分析了国内外急救护理的发展,提出我国急救护理的发展及研究方向。     

Emergency department care: Cost awareness by health care providers

With the escalation of health care costs during the past decade, it has become increasingly important for the physician to be aware of the cost of various components of health care delivery. The following study was undertaken to ascertain the “cost awareness” of four different groups of health care providers. This was accomplished by having these groups estimate the cost of patient visits to an emergency department. Significant errors were observed in these cost estimations, and error trends were seen to occur that were independent of education and experience.     

探索成批伤员在急诊科的救护程序

作介绍了急诊科在成批伤员的抢救过程中的救护程序。抓住快速检诊和合理分工2个关键,强调救护工作的联贯性。把缩短检验分诊的时间和提高预检分诊的准确性作为救护的最初目的,把救护的分工,充分发挥医护力量作为救护的主要措施,把救护的后续工作作为救护的主要保证。对快速检诊的方法和应掌握的2个五项指标、抢救分工程序、开辟留观区等作了阐述。笔认为：急诊科对成批伤员抢救成功与否,不仅仅是医院管理与医疗水平的反映,也是贯穿始终的护理管理、护理技能的护士职业素质的体现。     

复合伤患者的急诊护理

目的：总结复合伤患者的急诊护理方法。方法：对2011年1月-2011年12月接诊的126例复合伤患者的急诊护理方法进行总结。结果：73例行手术治疗,22例脑损伤保守治疗,4例保守治疗后期手术治疗骨折内固定,余27例均保守治疗痊愈。除2例因脑出血在出院时还在恢复阶段外,余均痊愈出院。结论：复合伤患者必须准确评估伤情,方能保证患者的有效救治。     

国内外急救护理研究

从急救医疗体系、急救护理人员结构、急救护理科研方面,比较分析了国内外急救护理的发展,提出我国急救护理的发展及研究方向.     

上海市194例跨省救护病例分析

目的探讨跨省救护的特点、类型、病种与医疗救护的重点，配置跨省救护车的条件和相关急救设备。方法专人收集、汇总、统计和分析跨省救护病例的相关资料。结果跨省救护转运时间主要集中在12h以内，江浙二省病人最多，车祸和创伤占一定比例，全程医疗达429次，10例恶化和死亡。结论性能良好的救护车、新颖的急救设备和优质的服务质量是跨省救护的的可靠保证，上海应当开展航空救护。     

临床医护工作站在急诊重症监护病房的应用与效果

目的研究临床医护工作站在急诊重症监护室环境下的应用方法与效果。方法首先对病室空间及环境进行改造,在急诊重症监护室患者床旁设立临床医护工作站实施管理。结果设立临床医护工作站后,临时医嘱处理时间缩短,不良事件的发生率下降,患者满意度提升。结论临床医护工作站的设立,能够帮助护理人员快速发现急危重症患者病情变化,及时处理医嘱,发现和防范医护工作隐患,减少护理不良事件的发生。     

Prevalence of advance care directives in aged care facilities of the Northern Illawarra

Objective: To assess the prevalence of advance care directives in the residential aged care facilities within the catchment for a single ED and to assess the systems in place for development of those advance care directives with focus on documentation and communication. Methods: A de‐identified, paper‐based, mail‐out survey of all 30 residential aged care facilities potentially referring to the Wollongong Hospital ED. Results: A total of 24 of 30 surveys were returned. Thirteen facilities reported at least some proportion of their residents having documented advance care directives. The median prevalence of advance care directives was 5% of residents (interquartile range 0–10%). Discussions with residents over advance care directives were reported in 9 of 24 survey returns. Not all facilities that reported documenting advance care directives had processes for regular review or 24 h access to the documentation for carers. Ten of the survey returns reported general practitioner involvement in advance care directive development. Conclusion: The facilities surveyed reported that advance care directives are the exception rather than the rule. Where they were developed some facilities did not ensure regular review, dissemination of the information nor consistent involvement of the GP. This demonstrates low utilization and poor application, which has implications for care appropriate to patients' wishes and for resource use within the ED.     

23例高空坠落伤患者的急救护理

目的总结急诊科对23例危重高空坠落伤患者的抢救护理体会。方法分析23例高空坠落伤患者的临床资料、急救措施、护理方法等情况。结果 23例危重高空坠落伤患者,3例病情过重,出现呼吸心跳停止,送院不及时,来诊时已死亡;6例因伤势过重,或合并多器官衰竭,经抢救无效后死亡,其余14例患者经抢救病情稳定后转入院作进一步的治疗处理。结论在抢救危重高空坠落伤的患者时必须迅速、及时、到位,维持患者的基本生命支持,在保证呼吸和循环的前提下保持气道通畅,积极治疗循环衰竭及低血容量性休克,密切观察病情变化及做好抢救护理,尽最大努力挽救患者的生命及恢复患者的基本功能。