时间节点管理结合创伤急救护理小组干预在急诊严重创伤患者中的应用

目的分析时间节点管理结合创伤急救护理小组干预在急诊严重创伤患者中的应用效果。方法回顾性分析2020年1月至2021年12月徐州医科大学附属宿迁医院收治的84例急诊严重创伤患者的一般资料,根据其护理方式的不同分为观察组和对照组。对照组42例患者采用常规急诊抢救,观察组42例患者在常规急诊抢救的基础上采用时间节点管理结合创伤急救护理小组干预。比较2组的抢救时间、住院时间、生存率、生活质量和护理满意率。结果观察组的生存率为97.62%,高于对照组的85.71%(P<0.05)。观察组的抢救时间和住院时间均短于对照组(P均<0.05)。2组在救治后7 d和30 d的Spitzer生活质量指数均高于救治后1 d,在救治后30 d的上述评分均高于救治后7 d;观察组在救治后1 d、7 d、30 d后的评分均高于同期对照组,比较均存在统计学差异(P均<0.05)。与对照组相比,观察组的护理总满意率更高(P<0.05)。结论时间节点管理结合创伤急救护理小组干预对于有效缩短急诊严重创伤患者的抢救和住院时间,提高其生活质量和护理满意率,提升救治成功率均有积极意义。     

重度创伤急救原则的临床研究

目的探讨重度创伤(ISS评分≥16分)的急救原则。方法应用"ATP三原则"救治重度创伤:①外科主治以上医师(Attending)首诊并全权、全程指挥抢救原则;②患者入院后立即成立急救小组(Teamwork)救治原则;③抢救、检查、诊断同时进行,使抢救时间最短的并联(Parallel)原则。分析比较应用"ATP三原则"前、后各2年救治重度创伤的临床效果。结果应用"ATP三原则"前2年(2002-01-01~2003-12-31)共抢救、收治重度创伤388例,ISS评分(25.9±6.4)分,死亡152例,死亡率39.2%,抢救室抢救时间、入院至急诊手术时间分别为(102.8±16.7)min、(140.3±20.6)min。应用"ATP三原则"后2年(2004-01-01~2005-12-31)共抢救、收治重度创伤438例,ISS评分(28.6±7.8)分,死亡87例,死亡率19.9%,抢救室抢救时间、入院至急诊手术时间分别为(69.5±11.5)min、(89.6±9.3)min。两组治疗前ISS评分比较差异无统计学意义(P>0.05);两组治疗后死亡率、抢救时间、入院至手术时间比较差异均有统计学意义(P<0.05),应用"ATP三原则"后均明显降低。结论应用"ATP三原则"救治重度创伤能显著缩短抢救时间,降低创伤死亡率。     

6 sigma护理管理模式在严重创伤患者救治中的应用

目的探讨6Sigma护理管理模式在严重创伤患者救治中的应用效果。方法按入院时间先后次序,将268例严重创伤患者设为对照组,采用传统的创伤急救模式;将292例严重创伤患者设为观察组,运用6Sigma护理管理模式,即定义、测量、分析、改进和控制5个步骤,对传统的创伤急救流程和步骤进行分析,改进护理操作流程,比较两组患者抢救成功率和有效抢救时间。结果观察组患者抢救成功率较对照组高,有效抢救时间较对照组短,两组比较,差异均有统计学意义(P0.05)。结论在严重创伤患者救治中应用6 Sigma护理管理模式能提高患者抢救成功率和缩短有效抢救时间,从而提高严重创伤患者救治质量。     

创伤急救白金十分钟--快速判断伤情启动创伤小组

目的 研究在白金10min内快速判断创伤程度，并启动创伤小组救治流程。方法 回顾性总结我部1992-2005年中等严重度以上2428例创伤患者抢救的早期处置，采用①经验判断和徒手查体；②四项启动创伤小组指标（A检查生命体征和意识水平；B评价解剖创伤；C评价有证据的损伤机制和高能因素；D基础情况）；③系统查体三步骤进行快速的伤情判断。结果 按我院创伤严重度分类：中度1250例（51．5％）、重度838例（34．5％）、极重度340例（14．0％）。2428例患者中，经徒手血压判断有961例（39．6％）血压低于90mm Hg；经创伤小组启动指标A、B两项判断，92．1％的病例需要启动创伤小组救治流程。结论 可以在1 min内多部位徒手触诊迅速判断异常血压，且有一定的准确性；本研究的三步骤可大部分在1～3min内、部分在3～7min内启动创伤小组救活流程。在白金10min初步快速判断伤情在救治流程中具有重要意义。     

标准化抢救护理流程配合创伤救治原则在严重多发性创伤患者救护中的应用

目的:探讨标准化抢救护理流程配合创伤救治原则在严重多发性创伤患者救护中的应用效果。方法:选取2016年1月～2017年12月我院收治的30例严重多发性创伤患者作为观察组,采用标准化抢救护理流程配合创伤救治原则;选取2016年1月前30例严重多发性创伤患者作为对照组,根据常规护理程序进行干预。比较两组干预效果。结果:两组抢救反应时间、现场救治所用时间、转入急诊科所需时间、住院费用、住院时间、抢救时间及不良反应发生率、预后有效率比较差异均有统计学意义(P 0. 05)。结论:采用标准化抢救护理流程配合创伤救治原则进行护理,能有效提升严重多发性创伤患者的抢救率,改善预后。     

无缝衔接一体化急救护理模式在严重创伤病人中的应用

总结582例严重创伤病人采用无缝衔接一体化急救护理模式进行救治的体会,包括将120院前急救科、急诊科、ICU整合为急危重症医学科,成立专科抢救小组;建立危重医学科人员准入手册;量身定制急救设备如同ICU的＂移动ICU＂救护车;为避免院前院内交接时遗漏重要病情,节省书写与交接时间,设计了选择填写式绿色通道危重病人交接本;调度指挥中心接到急救电话后通知院前急救人员出车到现场急救,各环节在信息上提前告知下一站做好准备,为创伤急救节约宝贵时间;院内急诊科按伤情预测评估、呼吸支持、循环支持、监测生命体征、伤情处置、术前准备、检查、转送等组成急救小组分工合作;急诊科与CT室、手术室、ICU、相关专科做好相应的衔接;转运中做好病情监测与生命支持。本组病人急救有效抢救时间为（39.28&#177;6.87）min,抢救成功率85.9%。认为采用无缝衔接一体化急救护理模式对严重创伤病人进行急救与护理,使院前急救、院内急诊科救治、ICU及专科治疗一体化,较好地协调相关科室,避免了多科会诊带来的抢救时间延迟和处理上的冲突,缩短黄金抢救时间,显著提高了急救的护理质量。     

急救小组位置固定抢救流程在急性心力衰竭患者救治中的应用价值分析

目的探讨急性心力衰竭(AHF)患者救治中采用急救小组位置固定抢救流程的应用效果。方法选取我院2018年4月~2019年3月实施常规急救流程的39例AHF患者作为对照组,另选我院2019年4月~2020年3月实施急救小组位置固定抢救流程的40例AHF患者作为观察组。对比两组抢救情况、抢救效果及满意度。结果观察组疾病评估、检查、开放静脉通路、心电图检测及总抢救时间均短于对照组,差异均有统计学意义(P<0.05);观察组40min好转率较对照组高,心血管事件发生率较对照组低,差异均有统计学意义(P<0.05);观察组满意度高于对照组,差异有统计学意义(P<0.05)。结论急救小组位置固定抢救流程用于AHF患者救治中,能够有效缩短抢救时间,提升救治效果及患者满意度。     

完善急救管理体系对批量创伤患者救治效果的影响

目的:探讨完善急救管理体系对批量创伤患者救治效果的影响。方法:将2013年1月至12月收治的批量创伤患者116例为观察组,采用应急机制、分诊检诊、绿色通道、患者分流、医疗资源调配等急救管理体系进行救治;将2012年1月至12月收治批量创伤患者100例为对照组,按常规方法进行救治,比较两组救治流程的反应时间、抢救成功率和患者满意度。结果:观察组救治流程的反应时间、抢救成功率和患者满意度均明显优于对照组,P均0.05。结论:完善急救管理体系能明显提高批量创伤患者的救治效果和患者满意度。     

链式流程管理在严重创伤急救中的应用

[目的]缩短严重创伤病人的抢救时间,提高抢救成功率,规范创伤急救护理流程.[方法]将170例符合严重创伤诊断标准的病人随机分成观察组和对照组,观察组采用链式流程抢救模式计算完成基本生命支持所需最短时间,对照组则采用传统抢救模式计算完成相同操作所用的最短时间.[结果]观察组采用链式流程以并联操作的思路减少抢救的基础时间和相关时间,抢救成功率显著高于对照组.[结论]链式流程的各个环节密切配合,在严重创伤病人的抢救中具有较强的实用性和可操作性.     

初级创伤救治原则在严重创伤中的应用与效果

目的提高医务人员急诊救治水平,为严重创伤病例进行及时、规范、有效医治。方法分批对本院急诊科、麻醉科、院前急救中心、创伤外科共80名医务人员进行初级创伤救治急救技能培训,并将PTC原则运用于严重创伤患者。结果 PTC培训后近两年,全面系统检查平均用时、漏(误)诊率、死亡率、抢救成功率均明显优于接受PTC培训前。两者比较差异均有统计学意义(P0.05)。结论 PTC原则在缩短严重创伤者危险时间,提高抢救成功率中具有重要应用价值。     

Trauma teams: order from chaos

Introduction: Trauma systems based on trauma centres have become the gold standard for trauma care in North America. The epidemiology of trauma in the United Kingdom and Australasia is significantly different. The standard of care of patients with blunt injuries in British hospitals may not be as high as in North America. There is ongoing research into the best system of care. Until convincing results are available, adoption of a trauma team approach by all hospitals receiving major trauma would be appropriate. The purpose of this paper is to provide sufficient detail of an operational trauma team to allow others to develop a similar system. Methods: We introduced a trauma team approach in the Emergency Department of the Royal Brisbane Hospital, a tertiary referral teaching hospital. Laminated action cards detailed precise task allocation to four doctor-nurse pairs working simultaneously. Equipment, procedures, pathology requests, radiology and clerical duties were standardised in advance. An audit form was completed after each resuscitation. Results: In an initial review, 108 patients admitted with trauma met criteria for activation of the trauma team. Time of arrival to completion of initial resuscitation was reduced by 63 per cent and time in the department by 51 per cent. Conclusion: A major component of the success of the best American trauma systems lies in organisation. By contrast, many hospitals in the United Kingdom and Australasia still have no organised response to trauma and where trauma teams do exist, they are often ad hoc and disorganised. The absence of a defined team leader and precise task allocation leads to confusion and delay even when individual team members are highly skilled. We describe a trauma team approach to overcome these problems which could be utilised by any hospital using existing staff and resources.     

多学科合作模式在治疗创伤疑难伤口中的作用

目的 探讨多学科合作模式在治疗创伤疑难伤口中的作用.方法 组成以创伤外科、疼痛科、介入科、营养科等专业医护人员为主的多学科合作小组,对2009年5月～2010年6月创伤外科收治的132例创伤疑难伤口采用多学科合作的模式进行综合治疗,并评价其治疗效果.结果 132例创伤疑难伤口患者经多学科协作、联合治疗,其治疗效果显著,无一例伤员死亡.98例患者的创伤疑难伤口完全愈合；32例创面感染者,经扩创后植皮愈合；4例创面发生难以控制的动脉性出血,通过栓塞主干血管止血,其创面基本愈合；14例患者因创面严重感染并伴有肢体坏死而截肢.结论 采用多学科合作模式综合治疗创伤疑难伤口是行之有效的,值得临床推广.     

创伤复苏单元功能分级及配置探讨

创伤复苏单元是严重创伤患者到达医院后进行复苏及损伤控制的重要场所.不同级别的创伤中心对于创伤复苏单元的要求不尽相同,从简单固定、液体复苏到完成影像学检查和损伤控制手术,不同配置的创伤复苏单元承载不同的功能.本文就不同功能分级的创伤复苏单元相应设备配置情况进行讨论,以帮助完成创伤中心的标准化建设.     

Sensitivity and specificity of trauma team activation protocol criteria in an Italian trauma center: A retrospective observational study

BackgroundThe trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen.ObjectiveThis study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment.MethodsA retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria.ResultsData from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients’ death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%.ConclusionThis study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients’ health outcome.     

Do trauma teams make a difference? : A single centre registry study

OBJECTIVE: To evaluate the association between trauma team activation according to well-established protocols and patient survival. METHODS: Single centre, registry study of data collected prospectively from trauma patients (who were treated in a trauma resuscitation room, who died or who were admitted to ICU) of a tertiary referral trauma centre Emergency Department (ED) in Hong Kong. A 10-point protocol was used to activate rapid trauma team response to the ED. The main outcome measures were mortality, need for ICU care, or operation within 6h of injury. RESULTS: Between 1 January 2001 and 31 December 2005, 2539 consecutive trauma patients were included in our trauma registry, of which 674 patients (mean age 43 years, S.D. 22; 71% male; 94% blunt trauma) met trauma call criteria. Four hundred and eighty two (72%) correctly triggered a trauma call, and 192 (28%) were not called ('undercall'). Patients were less likely to have a trauma call despite meeting criteria if they were aged over 64 years, had sustained a fall, had a respiratory rate <10 or >29 per minute, a systolic blood pressure between 60 and 89 mm Hg, or a GCS of 9-13. In a sub-group of moderately poor probability of survival (probability of survival, P(s), 0.5-0.75), the odds ratio for mortality in the undercall group compared with the trauma call group was 7.6 (95% CI, 1.1-33.0). CONCLUSIONS: In our institution, undercalls account for 28% of patients who meet trauma call criteria and in patients with moderately poor probability of survival undercall is associated with decreased survival. Although trauma team activation does not guarantee better survival, better compliance with trauma team activation protocols optimises processes of care and may translate into improved survival.     

Maximizing the Sensitivity and Specificity of Pediatric Trauma Team Activation Criteria

BACKGROUND: Care of the severely injured child requires the rapid assembly of personnel trained in pediatric trauma care. Trauma team activation criteria, which are highly sensitive and maximally specific for identifying the child who requires resuscitation, are necessary to provide rapid care to all who need it, while using resources efficiently. OBJECTIVE: To determine the sensitivity and specificity of the standard trauma team activation (TTA) criteria for identifying patients who receive resuscitation in the emergency department. METHODS: A one-year study was conducted of all patients transported by emergency medical out-of-hospital services for a trauma-related complaint. For all patients, out-of-hospital medical control operators recorded whether patients met TTA criteria and, if so, which criteria were met. Criteria included standard physiologic, anatomic, and mechanism parameters. Sensitivity and specificity for the outcome of resuscitation (volume restoration, assisted ventilation or intubation, chest tube insertion/needle decompression, operative intervention) were calculated. RESULTS: A total of 492 patients met the case definition. Two-thirds were male, the mean age was 8 years (+/-4.8 SD), and the Injury Severity Score was > or =15 in 9.3%. Trauma team activation criteria were met by 179 patients (36. 4%) and, of these, 107 met mechanism criteria only. A resuscitative intervention was received by 54 (10.9%) of the total and none in the mechanism-only group. Sensitivity and specificity of the TTA criteria for predicting receipt of a resuscitation procedure were 98. 1% and 71.2%, respectively. When mechanism criteria were excluded, the sensitivity remained 98.1% and the specificity increased to 95. 7%. CONCLUSIONS: Criteria for TTA that include patients who meet mechanism criteria only are not specific for identifying patients who receive a resuscitative intervention. Use of anatomic and physiologic criteria only results in an increase in specificity, thereby reducing overtriage while retaining a high sensitivity.     

Near infrared spectroscopy for evaluation of the trauma patient: a technology review

Clinicians now realize the limitations of the physical examination in detecting compensated shock states, the severity of uncompensated states, and in determining the adequacy of resuscitation in order to prevent subsequent post-traumatic multisystem organ failure and death. A renewed interest has developed in interrogating the state of oxygen transport at the end-organ level in the trauma patient. Although used as a research tool and now clinically to monitor cerebral oxygenation during complex cardiovascular and neurosurgery, near infrared absorption spectroscopy (NIRS) is being more aggressively investigated and now marketed clinically as a noninvasive means to assess tissue oxygenation in the trauma patient at the end organ level. This paper will describe the principles of NIRS and the basis for its proposed use in the trauma patient to assess tissue oxygenation. This includes its known limitations, current controversies, and what will be needed in the future to make this technology a part of the initial and ongoing assessment of the trauma patient. The ultimate goal of such techniques is to prevent misassessment of patients and inadequate resuscitation, which are believed to be major initiators in the development of multisystem organ failure and death.     

急诊分诊创伤评估法应用研究

目的 为了探讨埘急诊创伤患者的快速有效评估方法,以防预检分诊时的漏检和误检,延误创伤患者救治.方法 于2006年1月1日至2006年12月31日,采用创伤评估法,即CRAMS评分和创伤评估程序相结合,应用于浙江大学医学院附属第二医院收治的4023例创伤患者的评估.结果 CRAMS<7分(为重伤):2430例;创伤评估程序发现有危及生命的解剖部位伤1979例;值得重视的是:采用创伤评估法发现,在CRAMSi≥>7分的1593例刨伤患者中,仍存在危及生命伤46例.结论 CRAMS法可作为类选;创伤评估程序可作解剖部位损伤的评估;二者结合而成的创伤评估法能弥补相互的缺陷,既能保证重伤患者及时有效的抢救,同时义可合理利用急诊资源.