全麻支撑喉镜下声带息肉摘除术的围手术期护理

92例声带息肉患者在全麻支撑喉镜下行息肉摘除,通过术前、术中、术后的精心护理,建立良好的护患关系,取得了满意的效果,患者声嘶症状缓解,无一例复发。围手术期的护理对全麻治疗声带息肉的疗效起重要作用,值得重视。     

12例成人创伤性窒息患者的抢救体会

目的探讨成人创伤性窒息患者的救治。方法总结12例成人创伤性窒息病例的诊断及治疗经验,对成人创伤性窒息合并肺挫伤、脑损伤等合并伤的诊断、救治进行讨论。结果 12例成人创伤性窒息患者全部诊断明确,救治效果满意,均痊愈出院。结论成人创伤性窒息多有合并伤,救治时早期应用大剂量激素,早期应用呼吸机辅助通气,积极处理合并伤,对患者进行综合救治可获得较好的临床救治效果。     

Predictors associated with inappropriate transport of near shore spinal injuries

Purpose: Spinal injuries resulting in neurological damage cause significant morbidity. Swift neurosurgical intervention can mitigate negative outcomes. However, variable mechanisms of injury may be associated with inappropriate transport (IAT), which may delay necessary surgical interventions. Patients with near shore spinal injuries (NSSI) presented with unique mechanisms, so we investigated factors associated with IAT in patients with NSSI. Methods: We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006 - 2017. We excluded patients transferred to other facilities, and those not injured in the water. Primary outcome was IAT, defined as patients with NSSI requiring transfer to another trauma center. To avoid heterogeneity in our analysis, we further excluded patients without NSSI who were inappropriately transported to a level I trauma center. We used multivariable logistic regression to assess association of independent variables (such as demographic, environmental, and clinical factors) with outcome. Results: We analyzed 278 patients with suspected NSSI, and found 14 (5.0%) had IAT. Compared to appropriately transported patients, diving was associated with higher percentages of IAT (28.6% vs. 3.9%, p = 0.014) and more were transported by air (50.0% vs. 20.6%, p = 0.01). In multivariable regression, patients’ oxygenation saturation (odds ratio [OR] = 0.8, 95% confidence intervals [CI]: 077-0.98) and diving (OR = 7.5, 95% CI: 1.2-46) were significantly associated with IAT. Conclusion: Rate of IAT for patients with NSSI was low. However, first responders and emergency medicine providers should be aware that diving is associated with a higher likelihood of IAT.