急诊科护理管理流程再造对脑卒中患者预后的影响

目的:探讨急诊科护理管理流程再造对脑卒中患者预后的影响。方法:将2018年9月1日~2019年9月1日收治的100例脑卒中患者,按照随机数字表法分为观察组和对照组各50例,对照组实施常规护理,观察组实施护理管理流程再造;比较两组救治时间、致残率、脑损伤[采用格拉斯哥昏迷评分(GCS)、Barthel指数及美国国立卫生研究院卒中量表(NIHSS)]。结果:观察组救治等待时间、入院至疾病确诊时间、疾病确诊至开始治疗时间及绿色通道总时间均短于对照组(P<0.01);观察组致残率低于对照组(P<0.05);干预后,观察组GCS、Barthel指数及NIHSS评分均优于对照组(P<0.01)。结论:将急诊护理管理流程再造应用于脑卒中患者中,可缩短救治时间,减轻患者脑损伤,降低致残率,从而改善预后。     

医院-社区线上管理对后疫情时代高血压疾病管理的实践研究

目的探讨医院-社区线上管理对后疫情时代高血压病患者疾病管理的影响。方法组建医院-社区线上管理小组,制订实施方案,建立医院-社区-家庭联合管理微信群,开展线上指导居家微运动、互联网医院线上问诊、线上健康指导、情绪管理等对入选的高血压患者实施疾病管理。观察患者血压水平和血压变异性、患者的焦虑情况,评价实施效果。结果实施医院-社区线上管理后3个月,患者的血压水平和变异性得到改善,焦虑情绪缓解(P<0.05)。结论实施医院-社区线上管理有利于改善高血压患者血压水平,缓解患者焦虑,提高患者的疾病管理水平,对后疫情时代高血压慢性病管理起到重要作用。     

探索后疫情时代急诊急救体系的建设与完善

自2019年来,全球范围内爆发的新型冠状病毒(corona virus disease 2019,COVID-19)疫情(以下简称“新冠疫情”)给各国的医疗体系带来了前所未有的考验。在这场疫情中,急诊急救体系发挥了重要作用,它不仅为患者提供了及时有效的治疗,也承担着随时应对突发公共事件的重要责任。急诊医学作为一门新兴的独立学科,不仅是急危重症的首要救治阵地,也是传染病识别、防控的前沿。急诊科作为医院的前沿阵地,在抗击新冠疫情的这三年中,不负使命,用专业技术和担当,铸就起了一道抗击疫情的坚固长城,为疫情防控交出了满意答卷。本文将从启迪和思考两个方面对后疫情时代急诊急救体系的建设与完善进行阐述和分析。     

急诊科护理管理实践与体会

总结了新形势下急诊科护理管理的有效方法,包括物品的规范化管理,时间的管理,专科护理模式,建立以人为本的护理服务体系和加强医护合作。认为结合科室实际,运用现代管理理念和手段,对急诊科进行科学有效的管理,可使科室管理实现专业化、规范化,从而有效地增强急诊科人员的质量观念、服务意识和团队精神。     

后疫情时代急诊医学科的建设

中国急诊医学自1983年成立以来,经过40年的发展取得了卓越成绩。近3年,面对新型冠状病毒疫情的冲击,急诊医学的医护人员坚守在抗疫一线,舍己为人,保护了人民的生命和财产安全。相信在后疫情时代,急诊医学科有能力承接公共卫生的压力,继续完成医疗卫生任务,保障人民的身心健康。但是鉴于当前的急诊医学建设的不全面,考虑到后疫情时代的新型冠状病毒对急诊的冲击,进一步加强急诊医学科的建设势在必行。本文主要从急诊医学的仪器设备和信息化建设、人才培养和发展、学科互联互通和主导作用、医患关系和舆论引导五个方面进行探讨。     

预见性护理在急诊科脑卒中患者中的应用

目的 研究了急诊科脑卒中患者中预见性护理的应用.方法 选取2013年2月~2014年5月该院诊疗的脑卒中患者126例,随机分为对照组和治疗组各63例.对照组采用常规护理,治疗组采用预见性护理.观察两组的并发症发生率和患者满意度.结果 治疗组的并发症明显得到了有效地控制和消除,特别体现在肺部感染、血栓和抑郁症3个方面,其他几个主要并发症也有不错的效果.结论 预见性护理对临床脑卒中患者危险因素的控制、并发症的发展及患者病死率和治愈率的控制都具有十分重要的实践指导意义.     

急诊科脑卒中患者护理中预见性护理的运用探究

目的:探究急诊科脑卒中患者护理中预见性护理的运用效果。方法:选取本院急诊科收治的42例脑卒中患者,随机分为常规组、观察组,常规组患者进行常规护理,观察组患者进行预见性护理,比较两组并发症发生情况。结果:观察组患者并发症的发生率9.52%(2/21),显著低于常规组的23.81%(5/21)(P <0.05)。结论:预见性护理方法在急诊科脑卒中患者护理中的应用能有效降低并发症发生率,改善治疗效果。     

护理流程优化在脑卒中溶栓绿色通道中的应用

目的:探讨护理流程优化在脑卒中溶栓绿色通道中的应用效果.方法:选取2017年4月1日～2020年4月1日收治的90例脑卒中患者为研究对象,均采用溶栓绿色通道模式,根据住院号奇偶数分组;将奇数纳入观察组,采用流程优化后护理,偶数纳入对照组,采用常规护理;比较两组护理流程用时、院前院内护理衔接度、致残率、致死率.结果:相较...     

急诊科的护理质量管理

急诊科的护理质量管理６３００３７第三军医大学新桥医院王文聪，王颖随着医学护理模式及全国卫生经济体制的改革，急诊科工作如何适应社会主义市场经济体制的新形势、新特点，如何在竞争中求生存，促发展已是迫在眉捷的新课题，为了搞好急诊科护理质量管理，探讨有关急诊...     

风险管理在急诊科批量外伤患者抢救中的应用

目的探讨风险管理在急诊科批量外伤患者抢救中的应用。方法根据护理风险管理程序,找出抢救批量外伤患者的风险因素,制定各种抢救流程及风险应急预案。结果实施风险管理后,提高了急诊科患者的满意度,降低了护理缺陷和护理投诉的发生率。结论急诊科抢救批量外伤患者时应用风险管理可确保患者的安全,有效提升护理质量。     

Emergency Department Management of Shoulder Dystocia

Background

Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome.

Objective

To review multiple techniques for managing a shoulder dystocia in the ED.

Discussion

We review various techniques and approaches for achieving delivery in the setting of shoulder dystocia. These include common maneuvers, controversial interventions, and interventions of last resort.

Conclusions

Emergency physicians should be familiar with multiple techniques for managing a shoulder dystocia to reduce the chances of fetal and maternal morbidity and mortality.     

Elevated Blood Pressure in Urban Emergency Department Patients

Objectives: There has been little systematic study of emergency department (ED) patients with elevated blood pressure (BP) values. The authors sought to characterize ED patients with elevated BP values, assess presenting symptoms, and determine the prevalence of elevated BP after discharge. Methods: This was a cross‐sectional study performed in four academic EDs. Adults presenting with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg were enrolled over a one‐week equivalent period. Demographics, medical history, and symptoms were obtained by chart abstraction and structured interview. A random patient subset underwent a three‐week follow‐up interview. BP measurements were staged, using Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC‐VI) criteria, according to the greatest value noted in the ED. Results: A total of 1,396 patients were enrolled. Stage 1 BP values were noted in 44.3%, stage 2 in 25.3%, and stage 3 in 30.3%. African American patients more frequently had stage 2 and 3 BP values than other ethnic groups. BP measurements were repeated in 61.1% of patients and were the same or greater in 51.3% of patients. Dyspnea was associated with greater BP values. Among the 63.9% of patients who were interviewed, 52.7% were not being treated for hypertension, and 42.1% of those with hypertension had recently missed a medication dose. Follow‐up was obtained in 74.7% of those targeted. A visit to a medical practitioner since discharge was reported by 63.2%; of these, 26.1% reported that their BP remained elevated. Conclusions: Elevated BP is common among ED patients. African American patients are more likely than those of other ethnic groups to have greater BP values. The ED visit may be a good opportunity to identify patients with unrecognized or poorly controlled hypertension.     

Emergency Department Presentation of Patients with Conversion Disorder

Objective: To describe the presenting symptoms and other features of ED patients diagnosed as having conversion disorder.
Methods: A retrospective chart review was carried out on the records of ED patients who had had final ED or in-hospital diagnoses of conversion disorder. Cases from 1982 to 1992 at a 566-bed rural tertiary care hospital with a residency program in emergency medicine were reviewed for patient age and gender, presenting signs and symptoms, ED diagnostic evaluation, disposition, and comorbidity.
Results: Of 42 patients who had conversion disorder diagnoses, 24 were women and 18 were men. Twenty-one (50%) of the patients were diagnosed in the ED, and of those patients, ten were released home from the ED. Patient age ranged from 5 to 70 years, with a mean age of 33 years for women and 34 years for men. Most clinical symptoms mimicked neurologic disorders (weakness, pain, seizurelike activity, loss of consciousness, etc). Thirty patients (71%) received laboratory studies in the ED and two others received laboratory studies on admission. Seventeen (40%) patients had computed tomography of the head and five (12%) patients had magnetic resonance imaging of the head. Twelve (29%) patients had previous histories of psychiatric disorders, four (10%) had histories of alcohol and drug abuse, two (5%) had prior conversion reactions, three (7%) had chronic illnesses, and four (10%) had been victims of previous head trauma.
Conclusion: Patients with conversion disorder in the ED usually present with neurologic symptoms and undergo multiple diagnostic tests. Comorbidity is common. Early psychiatric evaluation may assist in the diagnosis and evaluation of patients with suspected conversion disorder in the ED.     

Hemophilia and von Willebrand Disease: A Review of Emergency Department Management

BackgroundHemophilia and von Willebrand disease (VWD) are the most common congenital coagulation factor deficiencies. Patients with these disorders who experience bleeding complications are often initially managed in the emergency department (ED).Objective of the ReviewThis review will focus on the emergency department management of patients with these disorders and provide an update on current treatment options.DiscussionThe mainstay of management is initial stabilization, control of bleeding when possible, and administration of specific factors. Early coordination of care with hematology is critical.ConclusionsEmergency medicine providers must have an understanding of the pathophysiology, clinical presentation, and management strategies in order to optimally care for these complex patients.     

Discriminative Capacity of Biomarkers for Acute Stroke in the Emergency Department

Background: Acute ischemic stroke remains largely a clinical diagnosis. Objective: To assess the potential of several biomarkers to distinguish acute ischemic stroke from mimics in the emergency department (ED). Methods: In this prospective study, 63 patients with suspected acute stroke were enrolled. Blood samples were collected at ED presentation and assayed for B-type natriuretic peptide, C-reactive protein (CRP), matrix metalloproteinase 9 (MMP-9), D-dimer, and protein S100B. Final diagnosis of stroke was rendered by blinded independent stroke experts after review of all clinical, imaging, and conventional laboratory data during admission. Logistic regression and bootstrapping models were used to evaluate the association between biomarker values and acute stroke. Results: Thirty-four patients had a final diagnosis of stroke and 29 with mimics. The initial ED values of CRP, MMP-9, and S100B (C-indices of 0.808, 0.811, and 0.719, respectively) and the National Institutes of Health Stroke Scale (NIHSS) (C-index 0.887) predicted acute cerebral ischemia. CRP levels added discriminative value over clinical variables alone in the diagnosis of stroke. When the levels of CRP were added to the NIHSS, the combination was highly predictive of stroke (bootstrap mean C-index 0.951, 90% Confidence Interval 0.903–0.991, likelihood test p = 0.004). Conclusions: Biomarker testing with CRP and potentially MMP-9 and S100B, may add valuable and time-sensitive diagnostic information in the early evaluation of patients with suspected stroke in the ED. Future prospective evaluations are necessary to validate the diagnostic capability of these biomarkers for acute ischemic stroke in the ED before they should be considered for use in clinical practice.     

Intensive Intervention Improves Primary Care Follow-up for Uninsured Emergency Department Patients

Objectives: To test an intervention designed to improve primary care use and decrease emergency department (ED) utilization for uninsured patients using the ED. Methods: Using a randomized design, an intensive case‐management intervention was tested with patients identified at a Level 1 urban trauma center from April 2002 through July 2002. Following assessment in the ED, six‐month follow‐up data were gathered from four primary care sites (two Federally Qualified Health Centers, two hospital outpatient clinics) and two area hospitals. Eligible participants were uninsured, were at least 18 years of age, and did not have a regular primary care provider. Of 281 patients approached, 273 (97.2%) agreed to participate. After 42 patients were eliminated following enrollment due to ineligibility, there were 121 intervention and 109 comparison subjects. Health Promotion Advocates (HPAs) in the ED gathered information from all study participants. On intervention shifts, HPAs assisted patients in choosing a primary care provider and faxed all information to a case worker at the selected site. Case managers attempted to contact patients and schedule appointments. On comparison shifts, patients received care as usual. Primary care contact in 60 days and subsequent ED visits in six months post‐ED assessment were the main outcome measures. Results: Intervention subjects were more likely to have a primary care contact (51.2% vs. 13.8%, p < 0.0001). There was no statistically significant difference between groups in either number of inpatient admissions or postintervention ED visits, although postintervention ED visits for the intervention group were less expensive. Conclusions: This project has demonstrated that it is possible to improve primary care follow‐up for uninsured ED patients.     

急诊科开展特色健康教育工作的做法

探讨如何构建适合急诊特点、满足急诊人群需求、优质高效且具有可操作性的急诊健康教育工作方法。在分析急诊健康教育工作特点、综合市场对健康教育需求的前提下,确立急诊健康教育服务的主体意识;针对性制定急诊科健康教育职责制度、实施方法和标准化工作程序;有的放矢地实施专职服务、提供规范服务、营造满意服务、建立互动服务、推行延伸服务等,创建出富有特色的急诊健康教育服务。经1年多的运作,主动满足急诊人群的健康需求,提高了护理质量和患者满意度,拓宽了急诊护理服务市场。     

Emergency Department Management of Pediatric Patients with Cyanotic Heart Disease and Fever

Background

Children with cyanotic congenital heart disease (CCHD) are living longer and presenting to the Emergency Department (ED) in larger numbers. A greater understanding of their diagnoses and appropriate management strategies can improve outcomes.

Objective

Our objective was to describe the ED diagnoses, management, and dispositions of pediatric CCHD patients who present with fever.

Methods

We retrospectively analyzed pediatric ED patients age 18 years or younger with a previous diagnosis of CCHD who presented with a fever from January 2000 to December 2005.

Results

Of 809 total ED encounters, 248 (30.6%) were eligible for inclusion. Of those meeting inclusion criteria, 59 (23.8%) required supplemental oxygen and 67 (27%) received intravenous fluid. ED diagnoses were febrile illness in 120 (48.4%), pneumonia in 35 (14.1%), upper respiratory infection in 19 (7.7%), viral syndrome in 17 (6.9%), gastroenteritis in 17 (6.9%), otitis media in 10 (4.0%), bronchiolitis in 5 (2.0%), pharyngitis in 3 (1.2%), croup in 3 (1.2%), bronchitis in 3 (1.2%), urinary tract infection in 3 (1.2%), mononucleosis in 2 (0.8%), pericarditis in 2 (0.8%), influenza in 1 (0.4%), cellulitis in 1 (0.4%), bacteremia in 1 (0.4%), and potential endocarditis in 1 (0.4%). In terms of patient disposition, 53.2% were discharged, 44.4% were floor admissions, and 2.4% were intensive care unit admissions.

Conclusions

A cardiac cause of fever in CCHD patients is rare. Because of limited cardiopulmonary reserve, they might require supplemental oxygen, intravenous fluids, and hospital admission.