急诊科抢救护理记录表的设计和应用

急诊科抢救护理记录表全面反映抢救患者整个救治过程，是衡量护理质量的重要资料，也是医生观察救治效果、调整治疗方案的重要依据。我科以往所用的急诊抢救护理记录表以记录生命体征和部分护理措施为主，并且记录繁琐、内容不全，不能全面反映急诊抢救患者信息、病情变化、救治措施及抢救护理程序实施过程，病情观察无连续性，记录使用纸张数量多等缺点。为了加强急诊抢救患者的管理，便于护理人员观察和记录病情，防止医疗纠纷，提高急诊科抢救护理质量，     

急诊抢救记录存在的缺陷与防范对策

护理文书是记录每一位服务对象就诊时的详细资料,是重要的法律依据,也是医疗事故技术鉴定最重要的基本材料,为护患双方提供了法律保护及举证依据。急诊室做为医疗特殊抢救之地,又是医疗纠纷的好发之地,护理文书记录的及时、准确和有效性至关重要。为此,我们抽查了2004年全年的抢救文书记录,就其中容易导致医疗纠纷的缺陷进行分析,以达到提高急诊抢救记录的书写质量,保证其法律效应的目的。现报道如下。     

急诊创伤记录表的设计与应用

急诊科是医院的高风险科室，医疗纠纷相对较多.急诊创伤病人病情进展快，救洽过程需争分夺秒。应用传统危重护理记录单，不能充分反映创伤病人的病情，并且抢救记录多数只能在抢救结束后补写，容易遗漏或与医生记录有偏差，甚至引发纠纷。为使病人得到快速救治、降低医疗机构的风险、提高急诊护理质量、     

急诊护理安全隐患与对策

急诊科是医院的窗口,是危、急病人抢救的阵地;急诊抢救护理质量是衡量每所医院整体水平、服务质量、应急能力的一个重要标准。急诊科医务人员肩负院前,院内抢救、急诊处置、留观病人、静脉输液、肌肉注射等繁重任务;医护人员超负荷劳动,精神压力大,护理队伍年轻,处理问题的能力相对薄弱,医护人员的人身安全时刻受到威胁,病人及家属对突发疾病或意外缺乏思想准备,容易发生医疗纠纷。针对急诊护理工作面临的许多问题采取了相应的对策。现介绍如下。     

急诊护理安全隐患与对策

急诊科是医院的窗口,是危、急病人抢救的阵地;急诊抢救护理质量是衡量每所医院整体水平、服务质量、应急能力的一个重要标准.急诊科医务人员肩负院前、院内抢救、急诊处置、留观病人、静脉输液,肌肉注射等繁重任务;医护人员超负荷劳动,精神压力大,护理队伍年轻,处理问题的能力相对薄弱,医护人员的人身安全时刻受到威胁,病人及家属对突发疾病或意外缺乏思想准备,容易发生医疗纠纷.针对急诊护理工作面临的许多问题采取了相应的对策.现介绍如下.     

急诊抢救护送记录单的设计与应用

针对新的医疗卫生形势下急诊抢救护送工作涉及到的潜在性法律问题，将原有的记录项目和程序优化，制定了急诊抢救护送记录单。经2年临床实践，形成了规范有序，简洁实用．责任分明的急诊抢救护送工作流程；强化了急诊护士的证据意识和全程服务意识；有效提高急诊护理质量；降低了医疗纠纷的发生率。     

急诊创伤记录表的设计与应用

急诊科是医院的高风险科室,医疗纠纷相对较多[1].急诊创伤病人病情进展快,救治过程需争分夺秒.应用传统危重护理记录单,不能充分反映创伤病人的病情,并且抢救记录多数只能在抢救结束后补写,容易遗漏或与医生记录有偏差,甚至引发纠纷.为使病人得到快速救治、降低医疗机构的风险、提高急诊护理质量、增加安全性成为日益突出的问题.     

院前急诊护理干预对创伤性休克病人抢救效果的影响

目的:探讨院前急诊护理干预对创伤性休克病人抢救成功率的影响。方法:回顾性分析总结2011年2月～2013年5月在我院就诊的273例创伤性休克病人病历资料,其中169例病人由"120"急救车送入院,均接受院前急诊护理,设为观察组;另104例病人由家属或者他人送入医院救治,均未接受院前急诊护理,设为对照组。结果:观察组住院抢救成功157例,对照组为82例,差异具有统计学意义(P0.05),此外,观察组抢救介入时间、术前准备时间均明显优于对照组,差异有统计学意义(P0.05)。结论:院前急诊护理干预能够切实提高创伤性休克病人的抢救成功率,需要加强宣教并引起民众高度重视。     

急性心肌梗死的院前急诊护理

目的 分析探讨急性心肌梗死患者的院前急诊护理方案.方法 选取本院收治的急性心肌梗死患者60例,其中42例入院前接受急诊护理作为观察组,18例入院前未接受急诊护理作为对照组.对照组18例患者突发急性心肌梗死后马上送医就诊,观察组患者在对照组接受的治疗基础上接受院前急诊护理,比较两组患者抢救成功率、进入重症加强护理病房(ICU)率.结果 观察组42例患者经过院前急诊护理、急诊抢救后38例转入内科普通病房进行治疗,占90.48％,4例转入ICU进行治疗,占9.52％,无死亡,抢救成功率高达100％;对照组18例患者经急诊抢救后,11例转入内科普通病房进行治疗,占61.11％,6例转入ICU继续治疗,占33.33％,1例因抢救无效死亡,占5.55％,两组比较,观察组抢救成功率、进入ICU治疗率均明显低于对照组(P＜0.05).结论 对急性心肌梗死患者进行院前急诊护理能有效提高患者接受入院治疗的临床效果,尽可能的保障患者生命安全,值得临床推广使用.     

基于简捷实用规范的急诊出车记录单的设计与应用

目的:探讨完善急诊出车护理记录,提高护理记录书写质量的方法,以减少医疗纠纷。方法:按照简捷实用规范的原则,针对原有急诊出车记录中存在的问题,将出车护理记录项目表格化。结果:我院从2011年1月份开始使用急诊出车记录单后,缩短了急诊出车护理记录的记录时间,提高了护理书写质量。结论:急诊护理记录单方便、快捷、实用、规范,有效地促进了急诊护理质量的提高。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.