Hemodialysis for Lithium Intoxication: Preliminary Guidelines for Emergency

Abstract: In Japan, 9 cases of severe lithium intoxication have been treated by hemodialysis so far, and the usefulness and indications of this procedure are not yet understood fully. We have recently experienced a case of lithium intoxication treated by hemodialysis. Considering this case together with those reported previously, we have prepared some preliminary guidelines for the application of hemodialysis to patients with lithium intoxication. The blood concentration of lithium, renal function, the severity of consciousness disturbance and clinical symptoms such as somatic complications are, of course, important indices for the application of this therapy. We think that the signs of intoxication and the time interval between the onset and the beginning of treatment also serve as useful indices for application of hemodialysis.     

Accuracy in identifying patients with loss of consciousness in a police-operated emergency call centre - first step in the chain of survival

BACKGROUND: The first link in the 'chain of survival' is the activation of Emergency Medical Services (EMS). In the major part of Denmark, police officers operate the alarm 1-1-2 centre, including calls for EMS. Our aim was to study the police 1-1-2 operators' accuracy in identifying calls concerning patients with loss of consciousness as a key symptom of life-threatening conditions. 'Unconsciousness' was defined as patients with a Glasgow Coma Scale (GCS) score of < 9, scored by the on-scene anaesthesiologist from the Mobile Emergency Care Unit (MECU). METHODS: This study was an observational cohort study based on data from the Police 1-1-2 Database and the Aarhus County Pre-hospital Database containing data from MECU cases during 6 months in 2004-05. RESULTS: Two thousand, three hundred and forty-three emergency calls with MECU dispatch were identified. In 1655 cases, both 1-1-2 data and the GCS score were recorded. Two hundred and ninety-five patients were found with a GCS score of < 9 at MECU arrival, 243 of whom were reported 'unconscious' by 1-1-2, giving a sensitivity of 82%. One thousand, three hundred and sixty patients were found with a GCS score of > or = 9, 972 of whom were reported 'awake', giving a specificity of 72%. The positive predictive value (percentage of patients found with a GCS score of < 9 at MECU arrival amongst patients reported as 'unconscious') was 39%. CONCLUSIONS: The accuracy was moderate with room for improvement. The positive predictive value was low, indicating over-triage of MECU.     

Philosophy, psychology, physics and practice of ki

Ki (in Japanese) or Qi (in Chinese) is the key concept in Eastern medicine, Eastern philosophy, as well as in martial arts. We explain the philosophical and psychological background of Ki. We emphasize that the unique aspects of Eastern philosophy are 'non-linearity' and 'holistic' approach. We then present physics aspect of Ki. Our experiments demonstrated that a 'Ki-beam' carries 'entropy' (or information), which is different from 'energy'. We introduce our experience of having taught Ki to 37 beginners in the United States through the Nishino Breathing Method. If beginners had martial arts training or a strong background in music or dance, about half of them could sense Ki within 10 weeks (1 h class per week) of practice.     

倒立位暴露后头高位倾斜联合-9.33 kPa下体负压对心血管功能的影响

目的: 观察倒立位暴露后头高位倾斜联合-9.33 kPa的下体负压对心血管功能的影响,进一步探讨下体负压倾斜床模拟航空推拉效应的效果.方法: 8名受试者在下体负压倾斜床上进行"直立位→倒立位→直立位+下体负压(-9.33 kPa)致晕厥/晕厥前状态"的模拟推拉效应试验及"单纯直立位+下体负压(-9.33 kPa) 致晕厥/晕厥前状态"的对照试验,用阻抗法测量试验过程中心率(HR)、血压(BP)、基础阻抗(Z0)、每搏心输出量(SV)、心输出量(CO)及总外周阻力(TPR)等心血管功能指标的变化.结果: 模拟推拉效应试验的下体负压耐受时间显著比对照试验的低(P<0.05).模拟推拉效应试验时,倒立位与直立位对照相比较,受试者HR、Z0显著降低(P<0.01),SV、SI、CO、CI显著升高(P<0.01);在直立位+下体负压暴露时,心血管功能指标的变化与对照试验时的变化类似,即HR、TPR较HUT值显著增高(P<0.05 or P<0.01), SV、SI、CO、SI较HUT值显著降低(P<0.05 or P<0.01).在对照试验时,SBP显著降低(P<0.01).在模拟推拉效应试验时,在直立位+下体负压暴露开始1 min内,DBP、MBP较HUT值显著增高(P<0.05 or P<0.01).结论: 倒立位后,再直立+LBNP暴露的耐受时间显著低于单纯直立+LBNP暴露的耐受时间,下体负压倾斜床可用来模拟推拉效应.     

梁贻俊教授治疗温热病昏迷的经验

梁贻俊教授治疗温热病昏迷有独到见解，疗效卓著。她临证中西相参，将温热病致成昏迷的暑温、湿温等与流脑、乙脑、中毒性痢疾等烈性传染病在诊断、辨证、治疗上有机地结合，注重温热病昏迷的主因，分辨其毒热与痰湿偏盛之不同，以分型论治为先，辨证与辨病相结合，提出了清营泄热，凉血散血，清瘟解毒，芳香化湿治疗四法；着重提出使用三宝的经验及急性热病服药的改革。梁师还提出从观察患者的被动反应、肌张力、皮肤色泽、舌脉等判断昏迷的深浅和证候的顺逆，为中医判定昏迷的程度和预后提出了新的见解     

醒脑静治疗脑卒中患者意识障碍的临床观察

目的：观察醒脑静注射液治疗脑卒中意识障碍的疗效。方法：将68例意识障碍患者随机分成治疗组（36例）和对照组（32例）,对照组予常规治疗,治疗组在常规治疗基础上予醒脑静注射液40 ml加入5%葡萄糖注射液中静脉滴注,1次/d,以治疗前后的格拉斯哥昏迷评分（GCS）作为临床疗效评价指标。结果：对患者治疗组总有效率94.4%明显高于对照组78.1%（P〈0.05）,治疗过程中两组均未出现明显不良反应。结论：醒脑静是治疗脑卒中意识障碍有效而安全的药物。     

高过载失能生理预警指标和告警技术研究进展

高过载失能即持续性正加速度引起的意识丧失(G-LOC),是指飞行员在正加速度暴露下,血液受惯性力作用迅速向下半身转移,脑组织发生急性缺血缺氧,导致意识丧失.G-LOC极易引发灾难性的后果,但目前尚无有效避免G-LOC的方法.通过实时生理监测对潜在危险发出警告,提醒飞行员及时采取措施,是解决该问题的根本策略.无线传感技术...     

脑电非线性分析用于意识障碍苏醒预测

目的：利用脑电非线性分析方法评价意识障碍程度,研究其在意识障碍苏醒预测中的作用。 方法：本研究包括37例严重颅脑外伤或脑卒中的意识障碍患者,其中持续植物状态（PVS）21例,最小意识状态（MCS）16例,均经临床及神经电生理方法评估。依次采集所有患者安静闭眼、声音刺激和疼痛刺激三种状态下的脑电信号,并计算脑电信号的复杂度、近似熵和互近似熵非线性指数。入院后6个月用格拉斯哥结局量表（GOS）评定患者预后。 结果：三种状态下,PVS组非线性指数均低于MCS组。3例PVS和7例MCS患者入院6月后GOS达到3分。苏醒患者和未苏醒患者脑干听觉诱发电位、体感诱发电位和常规脑电图无明显差异。在疼痛刺激状态下,苏醒患者脑电非线性指数明显高于未苏醒患者。结论：脑电非线性分析能够定量评估PVS和MCS患者大脑皮质受抑制的程度。脑电非线性指数可能在PVS和MCS苏醒预测中存在价值,对疼痛刺激有良好反应可能意味着预后良好。     

脑电非线性分析在意识障碍监测中的应用

目的：探讨意识障碍患者脑电非线性动力学特性的变化规律,应用脑电非线性分析来定量评估其意识障碍程度。方法：本研究包含30例严重颅脑外伤或卒中的意识障碍患者,所有患者格拉斯哥昏迷评分量表（GCS）评分≤8分。依次采集患者安静闭眼、声音刺激和痛觉刺激三种状态下的脑电信号,并计算了三种状态下的脑电信号的关联维数、近似熵和复杂度非线性指数。结果：安静闭眼状态下,关联维数、近似熵和复杂度非线性指数分别保持在2.84、0.53、0.26的低水平,声音刺激和痛觉刺激与安静闭眼状态相比,脑电非线性指数几乎无变化。结论：脑电非线性分析能够实时监测和直接度量意识障碍患者大脑皮质受抑制的程度。脑电非线性指数监测有可能成为一种观察临床促醒措施疗效的新检测手段。     

Belgian General Practitioners' Perspectives on the Use of Palliative Sedation in End-of-Life Home Care: A Qualitative Study

ContextPalliative sedation (PS) is a far-reaching palliative measure with a life-shortening potential. Guidelines provide only for a restricted use of PS and as a last resort.ObjectivesTo explore PS practice in end-of-life (EoL) home care.MethodsThis was a qualitative analysis of semi-structured interviews with 52 general practitioners (GPs) of Flanders, Belgium.ResultsApart from GPs who adhere to the existing prerequisites for PS, opinions diverge among GPs on the indication area for PS and on possible life-shortening intentions. The key to GPs' broadened view on “which suffering merits PS” is the fragile context of EoL home care, and the key to GPs' possible life-shortening intentions is their need to facilitate the dying process, when trying or lengthy. When honoring a terminally ill patient's request for euthanasia, several GPs prefer slow euthanasia using PS to a lethal injection.ConclusionPS home practice deviates from the PS guidelines' recommendations. In addition to the GPs' shortage of knowledge, the guidelines' recommendations do not always meet the particular needs of EoL home care. If one consideration of EoL home care is to respect a patient's wish to die at home, then the pre-emptive use of PS to avoid a futile transfer to the hospital in the case of an undesirable turn of events deserves more attention in the PS debate.