长途转运患者的护理

目的:加强长途转诊中患者的急救护理。方法:对163例长途转诊患者的院前急救护理情况进行回顾性分析。结果:163例全部由救护车转运,死亡1例,共有162例患者平安转运至目的地。结论:转运前只有做好急救物品、环境的准备和患者病情交接,尊重家属的知情权,转运途中保持静脉通路、呼吸道等管道的固定通畅,严密观察病情,做好转诊记录、保障通讯的畅通等,才能确保患者的安全转运。     

2例危重病人跨国转运的护理

随着经济的飞速发展,现代医学的进步,将危重病人在病情允许的情况下,转运至适当的医疗机构已成为危重病救护一项新的课题.本文介绍了从巴基斯坦通过飞机快速转运2例危重病人的工作准备、病情评估、运程救护方案、运送中的护理,总结了由此引发的护理体会:制订应急预案的必要性;在出发前应准备充分的资源,如药品和器械等;评估病人情况以设想可能出现的各种并发症;途中护理包括病人的体位、如何维持呼吸系统功能、密切监测生命体征、建立有效的静脉通路、对症治疗和护理、保证各引流管路的通畅、给与病人必要的心理支持、及时准确的做好护理记录;转运结束后,对全过程要进行认真总结、评价.     

风险管理在骨科病人长途转诊中的应用

总结582例骨科病人在长途转诊中存在或潜在的风险及应对措施。包括转运前做好急救物品准备和病人病情交接，增强护士的风险意识，完善相应转诊工作制度，制定系统和专科风险防范措施与预案，加大风险监控。认为加强风险管理是提高护理质量、保证护理安全的关键。     

院前远程转诊危重病483例分析

目的:探讨基层医院院前远程转诊危重病人的转送流程和应注意的问题,以提高院前急救的质量及安全性。方法:综合分析483例危重病人转诊过程的院前临床处理措施、方法。结果:483例危重病人安全成功转送到确定性专科重症监护病房,无一例途中死亡和发生医疗纠纷。结论:我们认为:做好(1)转运决定(2)病情评估、风险沟通(3)车载监护抢救设备(4)及早干预,途中严密监护(5)院前院内链式流程密切配合是保证危重病人院前远程转诊安全成功的有效措施。     

58例重型颅脑外伤院前救护体会

目的探讨颅脑外伤患者的院前救护的护理要点。方法通过对58例颅脑外伤患者在院前救护情况进行回顾性总结,主要分析病情观察情况和护理措施。结果 58例重型颅脑外伤患者在院前无1例死亡,均安全转运到院内进一步救治。结论对于颅脑外伤患者做好院前初步评估、做好现场伤情评估、呼吸支持和静脉通路、减轻脑受压、安全转运、做好心理护理,可以提高院前救护质量,降低死亡率,减少并发症的发生。     

危重新生儿转运救护

目的探讨危重新生儿转运的救护。方法通过转运系统将基层医院危重新生儿转往我院NICU治疗护理,包括现场抢救、途中连续监护和治疗。结果共转运危重新生儿1 508例,其中好转和治愈1 469例,放弃治疗32例,住院死亡28例。结论转运前充分做好抢救器材的准备,重视稳定病情,转运途中恰当实施监护治疗措施,严密观察病情变化情况是转运新生儿患者成功的关键。     

上消化道出血病人转运的观察及救护措施

上消化道出血是指屈氏韧带以上的消化道引起的出血~[1]。本文中上消化道出血病人的转运是将病人从家里或下面基层医院转至上级医院的过程。文通过分析37例上消化道出血病人转运,认为在转运前及转运途中采取恰当的救护措施,稳定病人的病情和情绪,是成功转运的关键。 1 临床资料 1.1 一般资料 我院自2000年3月至2001年3月共转运上消化道出血病人37例,其中男30例,女7例;年龄最小7岁,最大73岁,平均22岁。这些病     

2例危重病人跨国转运的护理

随着经济的飞速发展，现代医学的进步，将危重病人在病情允许的情况下。转运至适当的医疗机构已成为危重病救护一项新的课题。蕾文介绍了从巴基斯坦通过飞机快速转运2例危重病人的工作准备、病情评估、远程救护方案、运送中的护理，总结了由此引发的护理体会：制订应急预案的必要性；在出发前应准备充分的资源，如药品和器械等；评估病人情况以设想可能出现的各种并发症；途中护理包括病人的体位、如何维持呼吸系统功能、密切监测生命体征、建立有效的静脉通路、对症治疗和护理、保证各引流管路的通畅、给与病人必要的心理支持、厦时准确的做好护理记录；转运结束后，对全过程要进行认真总结、评价。     

航空救援患者转运流程的探讨和实施

【】 目的 通过我院对2例模拟病人和2例急危重患者航空转运的过程和方法,总结空中转运的护理流程。 方法 转运前病人病情及护理风险评估、随机机组人员素质及能力要求、所需物品及仪器的评估、当日飞行天气的评估及航空航道的批文;转运途中的监测与病人的应急处理;转运后空地交接。结果 4例急危重症患者,均安全抵达目的地,转运过程流畅。结论 危重病人空中转运前的准备工作,转运途中的保障工作及到达目的地的交接工作,提高转运的时效,提高患者及家属的满意度。     

救护车接诊严重创伤病人现场和转运途中救治体会

目的:探讨严重创伤病人现场和转运途中的救治措施对病人预后的影响.方法:回顾性分析2003年1月至2009年12月我科出车接诊96例严重创伤病人的院前现场抢救及转运途中救护措施的临床资料.结果:96例严重创伤患者中,安全送入医院88例,死亡8例.结论:严重多发性创伤病人,做好现场的抢救和转运途中的救护工作,是提高院内抢救成功率的重要环节.     

Effect of physician-staffed helicopter emergency medical service on blunt trauma patient survival and prehospital care.

OBJECTIVE: The aim of the study was to assess the immediate and long-term effect of a helicopter emergency physician giving advanced life support on-scene compared with conventional load and go principle in urban and rural settings in treating blunt trauma patients. METHODS: In a retrospective study, 81 blunt trauma patients treated prehospitally by a physician-staffed helicopter emergency medical service were compared with 77 patients treated before the era of the helicopter emergency medical service. The data were collected in the prehospital and hospital files and a questionnaire was sent to the survivors 3 years after the trauma. RESULTS: The physicians treated the patients more aggressively (gave drugs, intubated and cannulated) and had the patients transported directly to a university hospital. The given treatment did not delay arrival at the hospital. No statistically significant difference was found, but a trend (P = 0.065) to lower survival in the helicopter emergency medical service group. Almost half of the deaths in the helicopter emergency medical service group and none in the control group, however, occurred in the emergency department. No difference was found 3 years later between the groups in the health-related quality of life or decrease in the income owing to the accident. CONCLUSION: The physicians treated the patients more aggressively, but it did not delay the arrival at the hospital. A beneficial effect of this aggressive treatment or direct transport to a university hospital could not be seen in the immediate physiological parameters or later health-related quality of life. The physician-staffed helicopter emergency medical service was not beneficial to blunt trauma patients in this setting.     

危机干预中心在救治重症精神病病人中的作用

目的为了保证精神科急、危重症病人的护理安全,提高医疗护理质量,杜绝意外事件的发生。方法成立危机干预中心,负责全院重症精神病病人的治疗及院前急救。通过对该中心护理人员精神专科知识、技能培训,针对该专科病人病情特点,制定了相应的安全管理制度并严格执行。结果运行1年来,病人意外事件的发生率由64次/年降为13次/年(u=6.04,P<0.01),病人受攻击率由21次/年降为4次/年(u=3.40,P<0.01),医护人员受伤率由8次/年降为1次/年(u=2.33,P<0.05)。结论对重症精神病病人进行集中治疗和护理,可有效预防由于病人严重伤人、毁物行为导致的各种意外损伤,确保了病人及工作人员的安全,护理质量明显提高。     

Association between helicopter with physician versus ground emergency medical services and survival of adults with major trauma in Japan

Introduction

Helicopter emergency medical services with a physician (HEMS) has been provided in Japan since 2001. However, HEMS and its possible effect on outcomes for severe trauma patients have still been debated as helicopter services require expensive and limited resources. Our aim was to analyze the association between the use of helicopters with a physician versus ground services and survival among adults with serious traumatic injuries.

Methods

This multicenter prospective observational study involved 24,293 patients. All patients were older than 15 years of age, had sustained blunt or penetrating trauma and had an Injury Severity Score (ISS) higher than 15. All of the patient data were recorded between 2004 and 2011 in the Japan Trauma Data Bank, which includes data from 114 major emergency hospitals in Japan. The primary outcome was survival to discharge from hospitals. The intervention was either transport by helicopter with a physician or ground emergency services.

Results

A total of 2,090 patients in the sample were transported by helicopter, and 22,203 were transported by ground. Overall, 546 patients (26.1%) transported by helicopter died compared to 5,765 patients (26.0%) transported by ground emergency services. Patients transported by helicopter had higher ISSs than those transported by ground. In multivariable logistic regression, helicopter transport had an odds ratio (OR) for survival to discharge of 1.277 (95% confidence interval (CI), 1.049 to 1.556) after adjusting for age, sex, mechanism of injury, type of trauma, initial vital signs (including systolic blood pressure, heart rate and respiratory rate), ISS and prehospital treatment (including intubation, airway protection maneuver and intravenous fluid). In the propensity score–matched cohort, helicopter transport was associated with improved odds of survival compared to ground transport (OR, 1.446; 95% CI, 1.220 to 1.714). In conditional logistic regression, after adjusting for prehospital treatment (including intubation, airway protection maneuver and intravenous fluid), similar positive associations were observed (OR, 1.230; 95% CI, 1.017 to 1.488).

Conclusions

Among patients with major trauma in Japan, transport by helicopter with a physician may be associated with improved survival to hospital discharge compared to ground emergency services after controlling for multiple known confounders.     

玉树地震批量伤员救治的方法与体会

目的探讨地震后批量伤员的救治方法。方法成立领导小组,制订应急预案及后送收治流程,快速进行分检、后送转运、安置伤员,转运中严密观察生命体征,严防并发症。结果后方收治小组共收治伤员55名,无一例死亡。无并发症、差错事故及护理纠纷发生。结论医护人员具备应急能力,配备良好的急救器材,有效的应急预案,科学统筹人力资源是确保批量伤员救治成功的关键。     

Scene disposition and mode of transport following rural trauma: a prospective cohort study comparing patient costs

This prospective cohort study was performed from 1994 to 1996 to compare the impact of scene disposition on prehospital and hospital costs incurred by rural trauma patients transported to a trauma center by helicopter or ground ambulance. The study included all rural adult injury victims who arrived at the tertiary trauma center by ambulance within 24 h of injury. Inclusion criteria consisted of inpatient admission or death in the emergency department, and any traumatic injury except burns. Data collected included mortality, mode of transport, Injury Severity Score (ISS), and costs from impact to discharge or death. Of 105 study patients, 52 initially went to a rural hospital, while 53 went directly to the trauma center. There was no significant difference in survival in the two groups. The ISS was significantly higher for patients taken directly to the trauma center from the scene. The ISS of trauma patients transported from the rural hospital was highest for patients sent by ground transport. The prehospital transport costs were significantly more for patients transported to a rural hospital first. The costs incurred at the trauma center were highest for those patients transported directly from the scene. Many severely injured patients were initially transported to a rural hospital rather than directly to the trauma center. At both the scene and rural hospital, consistent use of triage criteria appeared to be lacking in determining the severity of injury, appropriate destination, and mode of transport for trauma patients. Since no significant difference in prehospital helicopter and ground transport costs was demonstrated, the decision on mode of transport should be in the best interest of patient care.     

760例"5·12"汶川地震伤员的直升机转运

汶川地震发生后第3天起,政府和军队每天出动90架直升机,大量伤员采用直升机空中转运至相距仅百余公里的成都市.四川大学华西医院于2008年5月14日至21日转运接收了来自汶川、映秀、茂县、北川、理县、绵竹等地区近30批次的伤员共760名.直升机转运患者具有快速、灵活、不受地形条件限制,与地面运送相比,空运途中的"致伤性"大为减少.但由于直升机上机舱高度低,医务人员的工作空间非常有限;飞行的不稳定性为医疗护理工作带来一定困难;起飞降落时速度迅速变化使得失重与超重给患者带来一系列生理变化,如胸腔压力的改变可能加重伤情;且汶川地处山区密林,直升机在执行任务时有飞行风险.直升机首先转运"潜在可治疗的患者"(没有受到迅速致死性创伤的患者),在转运过程中要防止发生危及生命的情况(如窒息、持续抽搐、休克),同时还要注意气道管理,观察生命体征的变化,进行必要的言语安慰等.直升机到达机场后,接机的医护人员先评价气道是否阻塞、生命体征是否平稳、有无危及伤员生命而需要紧急处理的情况.如有上述情况者在现场做紧急处理稳定后,再转送到距机场最近、有救治条件的医院急救.在救护车上除观察病情变化外,还详细登记伤员的姓名、年龄、联系方式等一般资料,在未有伤口的暴露皮肤处贴上小标签,简单描述一般资料和初步诊断.现场伤员的拣选以及接机时的紧急处置是短程直升机成功转运的重要条件.     

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。     

The use of helicopters as mobile intensive units in disaster control and rescue service in the Federal Republic

Since the establishment of a rescue helicopter service in the Federal Republic of Germany, between November, 1970 and 31st May, 1974 about 10,000 missions were flown, 7,500 patients received first aid treatment at the scene of the accident; 2,500 cases, of whom 700 were potential fatalities, were transported by the helicopter to hospital. Organization of the service is briefly described.     

住院病人对护理服务质量满意度调查与分析

目的了解住院病人对护理服务质量的满意度情况,探讨提高护理服务质量的应对措施,以适应日益激烈的市场竞争形势。方法采用问卷调查法调查540例住院病人对护理人员护理服务质量满意度情况,内容包括入院教育、对病人态度、提供护理及时、病人感受、病房环境、操作水平、住院教育、出院前教育、护患沟通共9个方面。结果入院教育、护患沟通满意率均<90%,住院教育8项内容中5项满意率<95%、3项满意率>95%,其余各方面满意率均>95%。结论开展人性化护理服务,加强管理,提高护士健康教育能力,确保健康教育质量,并以娴熟的护理操作,良好的护患沟通,舒适的病房环境全面提高病人满意度。     

多发性创伤病人院前院内急救的护理

[目的]总结多发性创伤病人院前院内的急救和护理以提高医疗护理质量.[方法]对我院急诊的80例多发性创伤病人进行现场救护、转运途中救护、急诊室救治及心理护理.[结果]80例病人中有2例在送往我院途中死亡,2例入院后因并发急性肾衰竭抢救无效死亡,2例入院后因创伤性休克抢救无效死亡,69例治愈或住院进一步治疗,5例因其他原因转院治疗.[结论]多发性创伤病人病情复杂、凶险、病死率高,早期、准确、主动采取救护措施是抢救成功的关键.急诊医护人员在抢救过程中应分秒必争,及时有效地进行院前(现场)救护,快速、安全地转运病人,为挽回病人生命赢得宝贵的抢救时机.