The emergency department management of status epilepticus

Status epilepticus (SE) may be defined as two or more seizures without full recovery of consciousness between seizures, or recurrent epileptic seizures for more than 30 minutes. Generalised convulsive, tonic-clonic status epilepticus is the form of SE with the greatest immediate threat to life, and is a medical emergency with morbidity and mortality related to duration of seizure activity. This article reviews the pathophysiology and management of SE with particular emphasis on the pharmacotherapy of generalised convulsive SE.     

New management strategies in the treatment of status epilepticus

Status epilepticus is a neurologic emergency associated with high mortality and long-term disability. Recent advances in our understanding of the pathophysiological mechanisms involved in the initiation and perpetuation of seizure activity have revealed that status epilepticus is a dynamic and evolving process. Alterations at the cellular level parallel physiological, physical, and electrical changes at the bedside. Loss of cerebral autoregulation and neuronal damage begin after 30 minutes of continuous seizure activity. This understanding has led to changes in treatments of status epilepticus, which must be multidisciplinary and occur simultaneously in many different areas. The goals of pharmacological therapy are to terminate seizures early and prevent recurrence. Two recent large clinical studies have shown the benefit of early administration of benzodiazepines to control status epilepticus. Pharmacological algorithms designed to focus medical management have trended toward earlier and more aggressive treatment. The hope is that continued exploration into the basic mechanisms involved in status epilepticus and future controlled clinical trials defining optimal medical management will produce further advances.     

Enoxaparin dosing errors in the emergency department

BACKGROUND: The study aimed to determine the frequency of enoxaparin dosing errors for patients who had a measured emergency department (ED) weight compared to those who did not have a measured ED weight, and to determine if demographic variables (e.g., weight, height, age, English-speaking, race) impact the likelihood of receiving an inappropriate dose.METHODS: This is a retrospective, electronic chart review of patients who received a dose of enoxaparin in the ED between January 1, 2008 and July 1, 2013. We identified all patients >18 years who received a dose of enoxaparin while in the ED, were admitted, and had at least one inpatient weight within the first four days of hospitalization. Patients were excluded if they received enoxaparin for prophylaxis or a dose of more than 1.25 mg/kg.RESULTS: A total of 1,944 patients were included. Patients were more likely to experience an error if they did not have a measured ED weight. Over-doses of >10 mg were more likely to occur in patients without a measured ED weight. Patients with no documented ED weight or with a staff-estimated ED weight were more likely to experience a dosing error than those with a patient-stated weight. Patients were more likely to experience an error if their first inpatient weight was more than 96 kg, they were more than 175-cm tall, or were English speaking.CONCLUSION: Dosing errors are more likely to occur when patients are not weighed in the ED. Modifications to current workflows to incorporate weighing those patients who receive weight-dosed medications may be warranted.     

成人癫痫持续状态的急救护理

目的:探讨成人癫痫持续状态的急救护理。方法:对28例癫痫持续状态的急救与护理资料进行回顾性分析。结果:治愈27例(96.43%),死亡1例(3.57%)。结论:癫痫发作时正确的急救护理可改善患者预后。     

急诊科常见护理纠纷及管理对策

急诊科面对的是病情复杂多变、生命垂危、年龄不一的各种疾病及遭受意外的人群，病情变化中交织着多种因素，是医院护理纠纷的高发区。故采取有效措施，加强对急诊科护理人员的管理，防范护理纠纷的发生是非常必要的。现将我院急诊科2000年-2006年发生的86起护理纠纷进行分析，以便采取有效的管理对策，防范护理纠纷。     

急诊科常见护理纠纷及管理对策

急诊科面对的是病情复杂多变、生命垂危、年龄不一的各种疾病及遭受意外的人群,病情变化中交织着多种因素[1],是医院护理纠纷的高发区.故采取有效措施,加强对急诊科护理人员的管理,防范护理纠纷的发生是非常必要的.现将我院急诊科2000年-2006年发生的86起护理纠纷进行分析,以便采取有效的管理对策,防范护理纠纷.     

急诊科护理风险管理存在的问题及对策

急诊科是医疗护理工作的最前线,特点是急、危、重病人多,工作节奏快,病人及家属急躁。如果护士在病人就诊、抢救过程中处理稍有不当,极易发生护患冲突和护理纠纷。为了能使病人顺利就诊,保障其生命安全,避免发生护患冲突和护理纠纷,我科于2003年3月尝试引入风险管理理论,针对预见性提出的护理风险问题,制定了一系列相应对策,取得了良好的效果,现报告如下。1急诊科护理风险管理中存在的问题1.1急诊服务需求量和医院急诊实际处理能力之间的差距[1]就我院急诊科具体情况讲,经常参与市区突发事件的处理,如大批车祸、食物中毒,“杜桥”雷击事件、…     

门急诊输液患者的护理需求及信息化管理对策

目的 评估门急诊输液患者的护理需求及希望等候的时间,革新门急诊输液管理模式.方法 采用自行设计输液患者护理需求评估表,随机抽取400例输液患者进行问卷评估.结果 绝大部分患者希望得到准确无误的用药和及时的治疗护理,同时希望提供安静、舒适的环境与一针见血的穿刺技术.结论 信息化管理模式,即无线移动门诊输液管理系统,为门急诊输液管理提供了一种技术先进、安全可靠、切实可行的解决方案,开创了门急诊输液管理的新纪元.     

Information management in the emergency department

Information system planning for the ED is complex and new to emergency medicine, despite being used in other industries for many years.It has been estimated that less than 15% of EDs have comprehensive EDIS currently in place. The manner in which administration is approached in large part determines the success in obtaining appropriate institutional support for an EDIS. Active physician and nurse involvement is essential in the process if the new system is to be accepted at the user level. In the ED, large volumes of information are collected, collated,interpreted, and acted on immediately. Effective information management therefore is key to the successful operation of any ED. Although computerized information systems have tremendous potential for improving information management, such systems are often underused or implemented in such a way that they increase the workload on caregivers and staff. This is counter productive and should be avoided. In developing and implementing EDIS one should be careful not to automate poorly designed manual processes. Examples are ED tracking systems that require staff to manually relocate patients in the system. This task probably is completed only when the ED volume is low and "worked around" when the department is busy. Information from such a system is, therefore, flawed; at best useless and at worst counter productive. Alternatively, systems are available that can track patients automatically through the ED by way of infrared sensors similar to those used in baggage-tracking systems that have been in place in airports for years. In the automated (computerized) ED, we must have zero-fault-tolerant,enterprise-wide, hospital information networked systems that prevent unnecessary duplication of tasks, assist in tracking and entering data, and ultimately help analyze the information on a minute-to-minute basis. Such systems only reach their potential when they are fully integrated, including legacy systems, rather than stand alone proprietary EDIS. Further,a modular approach in which individual components are connected to a flexible computer backbone is ideal.Finally, good clinical content is key to virtually every aspect of the EDIS. Much of this content is yet to be developed and what is available still needs to be adapted to the EDIS environment.Daunting as it may be, an EDIS implementation properly accomplished results in better patient care, improved staff productivity, and a satisfying work environment (Box 3).     

急诊科护士在接诊艾滋病病人时的防护对策

通过总结急诊接诊艾滋病(AIDS)病人的护理经验,为避免急诊护士在接诊病人时造成自身感染,提出了急诊科应对 AIDS 相应的护理对策:加强 AIDS 等传染病相关知识的学习,提高护士应对突发事件的心理素质,增强急诊护理管理者的感染控制意识。急诊科是急危重症病人救治的主要窗口,因此,采取积极有效的应对策略,降低 HIV 等造成的职业性感染,对护患双方具有保护意义。     

Fever in children less than 36 months of age--questions and strategies for management in the emergency department

Fever is a common pediatric complaint in the Emergency Department. Emergency Physicians often must be conservative in their management of febrile children, as patient follow-up is not always available. A unified approach for the management of febrile infants will be discussed in this article.     

对急诊科护士心理健康状况的调查及对策的研究

随着社会的发展,急救医学与急救护理学发展的速度日新月异,急救技术不断精益求精,急诊工作愈发重要。由于急救对象多为病情危、急、重者,且病人家属求医心切,要求很高。由于急诊科担负着院外急救、抢险救灾、危重病救护等工作,每一项工作都时间紧急,责任重大。急诊科护士长期在