毒理学研究与中毒急救

１毒性与毒理学研究化学物毒性（Ｔｏｘｉｃｉｔｙ）是化学物内在固有的特性,是指引起机体损害的能力。衡量毒性的大小可以是指测量该化学物引起实验动物某种毒效应所需的剂量或浓度,通常可用剂量－反应（效应）关系表示。引起某种效应所需的化学物剂量越小,则表明该化学物毒性越大。研究化学物的毒性和毒作用机理是毒理学的重要任务,涉及毒物在体内过程、对机体的各种可能效应与机制、效应修饰因素、作用阈限等诸多内容。不同毒物的毒性、靶器官及毒作用方式相差较大。通过常规毒性研究,可以提供与之有关的资料,这在安全性评价过程中…     

循证医学理念在急救医学中的应用

现代医学从经验科学到理论科学过渡的今天，急诊医师已认识到循证医学（evidencebasedmedicine，EBM）是处理急危重症和意外伤害时应尽可能遵循科学证据，并指导制定临床处理方案的重要性。EBM的核心思想是任何医疗决策都应建立在新近详实最佳的临床科学研究证据基础上，以保证决策的科学化。为_『提高医院的急救工作质量，学习和运用EBM的理念，自觉地、理智地利用现有最好的证据实施具体患者的急救医疗决策，采用最新最先进、最有效的证据指导急救工作。急诊科医生应具有内、外、妇、儿等多学科的专业知识，需要有及时正确判断处理病人的综合能力，也需要有更确切、更可信、更实用的临床证据指导医生急诊救治。     

日本急救医学

本文介绍亚洲发达国家日本急救医学的现状和进展，包括危重医疗转运系统的组织和结构、院外救护系统和医院分级、对院外救护提供者进行各种救护水平的训练和教育等。供我国急救医学的发展参考。     

浅析心肺复苏在医学急救中的重要作用

心肺复苏（CPR）是医学急救中的重要组成部分。根据2004年WHO统计，每天患心血管疾病死亡的人数为7200人。平均每天12。就有一人因为心血管疾病导致心脏骤停0～4s。在众多病例中，有很大部分患者或急救者因为没有专业的急救知识致患者病情延误而导致患者病情加重或不治。本文旨在探讨心肺复苏的发展和现状的同时提出了相应的解决策略，以资参考。     

法国急救医学

ＮｉｋｌｃａｎｅｎＨＥ的ＥｍｅｒｇｅｎｃｙＭｅｄｉｃｉｎｅｉｎＦｒａｎｃｅ一文刊登于ＡｎｎａｌｓＯｆＥｍｅｒｇｅｎｃｙＭｅｄｉｃｉｎｅ１９９８年１期上,该文以依期摩（Ｅｓｓｏｎｎｅ）市为例,表现了法国急救医学组织,急诊部的规模,院前急救状况和未来发展的设想。     

德国急救医学

近２５年，德国急救医学疗系统发展成为遍布全国，严格依同样标准主建成的专业组织，包括具有标准化设备的救护车和救援直升飞机，调度中心和专业培训系统。目前尽管处于预算减少时期，但为了改善和发展求工作，德国仍实实了一套质量管理系统。其发展过程值得借鉴，现介绍如下，原文刊登于１９９８年３１卷期ＡｎｎａｌｓｏｆＥｍｅｒｇｅｎｃｙＭｄｉｃｉｎｅ。     

国外救护直升机在急救医疗中的作用与现状

1 绪言众所周知实施急救医疗的时间对患者来说至关重要,抢救的愈及时,时间愈短,愈能提高救治率,减少死亡率。比如,即使是最严重的心脏停止跳动,在3分钟内,若能给于适当     

ECS模拟教学在急救医学教学中的初步应用体会

ECS（emergency care simulator,ECS）是由美国医学教育科技（METI）公司设计并制造的高级生理驱动模拟系统,具有呼吸、心跳、脉搏、血压、瞬目等基本生命体征,可真实模拟患者各种病理生理变化,能够对诊疗过程中所使用的药物和采取的救治措施做出相应的反应.通过监护仪、呼吸机等仪器显示患者的生理参数变化,配合仿真的医疗场景,逼真地展现临床环境下的诊疗过程和救治效果,为学生创造一种交互式情景教学和实践的机会.苏州大学临床技能实验教学中心2005年从美国引进了目前全球最先进的医学模拟教学产品ECS,并探索应用于临床急救医学课程教学,现将应用体会总结如下.     

The emergency medicine training needs of rural general practitioners

This study aimed to identify the emergency medicine training needs of rural general practitioners (GPs) in the catchment area of the Hunter Rural Division of General Practice. The GPs were surveyed using a questionnaire in which they were asked about their confidence levels in a number of specific emergency medicine skills, and about the areas of emergency medicine that they saw as priorities for upskilling. More than a third of GPs who were responsible for on-call work at the hospital indicated that they had low levels of confidence in a number of their emergency medicine skills, in particular skills relating to paediatric emergencies, cardiovascular emergencies, and respiratory emergencies. These emergency medicine domains were also seen as high priorities for upskilling by the majority of the respondents. The study shows that rural doctors need the opportunity to access emergency medicine training that provides upskilling not only in the management of clinical problems, but also in practical procedures.     

急诊内科患者流量与时段分布相关性分析

目的 探讨急诊内科患者与时段分布的相关性,为急诊医护人员的合理配置提供参考依据。方法 通过HIS信息系统收集2013年10月1日-2016年9月30日急诊内科就诊患者,应用SPSS 20.0统计软件,采用描述性的统计方法及χ²检验对患者的就诊时段、星期、月进行分析,找出高流量和低流量时间段。结果 每日存在着2个就诊高峰,第一就诊高峰7：00-10：00,年平均就诊10 348 人次（21.9%）;第二就诊高峰16：00-20：00,年平均就诊15 104 人次（31.9%）。患者就诊量不存在星期波动,但存在月份波动,有2个高峰,12月和1月就诊量最多,分别占总体的9.8%和10.5%,最低月份为10 月（6.6%）。结论 急诊内科患者就诊量不存在明显星期波动,但日就诊量和月就诊量分别存在两个高峰,与辽宁本地的气候特点有一定的相关性。     

急救医学新模式新技术的研究与影视录像制作

目的探索急救医疗服务体系建设及运行的有效模式，创作急救医学影视教材，提高急救医疗质量和水平。方法（1）对国内外急救医疗体系的建设与发展进行调研、分析，总结特点，积累资料；（2）充分利用有效资源，创建急救医学运行模式；（3）制作现代急救医学影视教材；（4）运用实践。结果按新模式运行后各急救医疗指标均明显提高。结论该项目成果能规范急救医疗服务行为，提高急救效能，提高对危重患者救治和对突发公共卫生事件及灾害事故的应对能力和水平，具有可推广性。     

Quality management in Australian emergency medicine: translation of theory into practice.

OBJECTIVES: The primary objective was to describe the current level of implementation of quality management (QM) structures and practices with Australian emergency departments. The secondary objective was to describe the level of association between the presence of QM structures and processes and the achievement of associated improvements. DESIGN: Data were collected by mail-out of a structured survey instrument to all Australian emergency departments accredited for postgraduate training by the Australasian College for Emergency Medicine. PARTICIPANTS: Director of Emergency Medicine or delegate in each surveyed department. MAIN OUTCOME MEASURES: The presence of specific structure and process indicators of QM and the achievement of QM linked improvements. RESULTS: A response rate of 63% was achieved. Designation of a hospital quality improvement (QI) physician was reported by 40% of institutions, an emergency department (ED) QI physician by 40%, and an ED QI nurse by 67%. A structured system for QM indicator analysis was present in 67% of the departments; in 45% of the departments public reporting of performance occurred. There was a significant association between QM process indicators and the presence of (i) a hospital QI physician (P=0.02), (ii) an ED QI nurse (P=0.02), (iii) presence of a system for data analysis and reporting (P=0.01), and (iv) presence of a QM component to postgraduate education (P= 0.05). There was a significant relationship between the presence of QM process indicators and the achievement of QM linked improvements (P= 0.003). CONCLUSIONS: Demonstration of the links between QM structures, its indicators of activity (in structure and process), and the achievement of outcome improvement is fundamental to quality improvement methodology. These links are demonstrated within the context of Australian emergency medicine, providing support for the effectiveness of this approach in promoting change and performance improvement.     

Improving acute pain management in emergency medicine

Undertreatment of pain (oligoanalgesia) in the emergency department is common, and it negatively impacts patient care. Both failure of appropriate pain assessment and the potential for unsafe analgesic use contribute to the problem. As a result, achieving satisfactory analgesia while minimizing side effects remains particularly challenging for emergency physicians, both in the emergency department and after a patient is discharged. Improvements in rapid pain assessment and in evaluation of noncommunicative populations may result in a better estimation of which patients require analgesia and how much pain is present. New formulations of available treatments, such as rapidly absorbed, topical, or intranasal nonsteroidal anti-inflammatory drug formulations or intranasal opioids, may provide effective analgesia with an improved risk–benefit profile. Other pharmacological therapies have been shown to be effective for certain pain modalities, such as the use of antidepressants for musculoskeletal pain, γ-aminobutyric acid agonists for neuropathic and postsurgical pain, antipsychotics for headache, and topical capsaicin for neuropathic pain. Nonpharmacological methods of pain control include the use of electrical stimulation, relaxation therapies, psychosocial/manipulative therapies, and acupuncture. Tailoring of available treatment options to specific pain modalities, as well as improvements in pain assessment, treatment options, and formulations, may improve pain control in the emergency department setting and beyond.     

医院污水对水环境毒理学风险的研究进展

医院污水作为水环境中毒性风险的主要来源之一,其毒性污染物质进入水环境后,会对水生生态平衡和饮用水水源造成潜在的负面影响。作者介绍了医院污水中对水环境造成毒性风险的主要污染物质和这些污染物在水环境中造成潜在毒性影响的研究状况与进展。     

食品中有毒物质智能化应急筛查装备及配套试剂系统的研发

目的:为解决食品安全监管的迫切需要,针对食品安全的现场应急检测、流动执法检测等应用,开展食品中有毒有害物质智能化应急筛查装备的研制.方法:将光度比色技术、上转发光免疫技术、酶联免疫技术等不同相关先进检测技术及数字化信息模块整合于一个整体系统,并结合其核心检测模块开展配套检测试剂的研发.结果:该设备可实现理化指标和微生物指标的同机检测、现场快速检测的实时动态监控、现场分析结果和自动传输结果,满足食品安全监管的现场应急监测、流动执法检测的要求.结论:该仪器可用于食品安全相关的农业生产、食品加工、流通、消费等各环节,是集样品处理、样品检测、信息化管理功能于一体的食品中有毒有害物质智能化应急筛查装备,可以有效提升食品安全保障能力和监管水平,大幅度提高监管工作的效率.     

《国家级突发中毒事件卫生应急处置队建设规范》解读

突发中毒事件卫生应急处置队伍是卫生应急体系的重要组成部分,规范队伍建设对完善卫生应急体系具有重要意义。《国家级突发中毒事件卫生应急处置队建设规范》(团体标准T/CADERM5003—2019)于2019年5月12日实施。T/CADERM5003—2019提出了突发中毒事件卫生应急处置队伍在建设、管理、应急预案与技术方案、应急处置、培训演练等方面的规范要求,明确罗列突发中毒事件卫生应急队伍装备目录名单、常用特效解毒药品清单、个体防护装备配备要求。本文从T/CADERM5003—2019制定的背景和意义、编制原则以及主要技术内容等方面对其进行详细解读,促进标准的贯彻执行。     

一起原因不明食物中毒的调查和实验室筛查

[目的 ]　探讨一起原因不明食物中毒的中毒原因。 [方法 ]　应用病例对照研究方法和简易急性动物试验等方法 ,对不明原因食物中毒的致病因素进行多方面探讨。 [结果 ]　由病例对照研究筛选出水煮豆腐是本次中毒的可疑食物 ;急性动物试验验证了水煮豆腐是唯一有毒食物 ,小白鼠的灌注量与中毒反应呈剂量反应关系 ,小白鼠对水煮豆腐的半数致死剂量为LD50 =1.6 8mg/g体重。经气相色谱—质谱仪分析鉴定毒物为四次甲基二砜四胺。[结论 ]　该起事故是由于食用了被四次甲基二砜四胺污染的水煮豆腐引起的食物中毒 ,研究方法可用于食物中毒及其他突发事件