院前急救在转运途中对生命体征支持的探讨

1997年5月至2001年5月我们院前急救危重患者1 682例,转运途中21例基本生命体征出现变化.现将经验教训总结如下.     

院前急救及其生命支持程序

随着社会的进步和医学的发展,院前急救已成为急救医学的首要环节,是保证急危重症病人在发病初期能得到及时、有效救治的前提[1].院前急救护理是院前急救的重要组成部分,如何在最短的时间内正确判断病人的病情,掌握相关的重要信息,调度相应的专业人员迅速赶赴现场,在快速询问、检查的同时,对急危重症病人进行及时、正确的抢救、治疗及转运是急救医学急需解决的问题,将护理程序运用在院前急救的生命支持中,初步达到了及时诊断、迅速抢救,为后续救治创造条件的目的.     

院前急救及其生命支持程序

随着社会的进步和医学的发展,院前急救已成为急救医学的首要环节,是保证急危重症病人在发病初期能得到及时、有效救治的前提[1]。院前急救护理是院前急救的重要组成部分,如何在最短的时间内正确判断病人的病情,掌握相关的重要信息,调度相应的专业人员迅速赶赴现场,在快速询问、检查的同时,对急危重症病人进行及时、正确的抢救、治疗及转运是急救医学急需解决的问题,将护理程序运用在院前急救的生命支持中,初步达到了及时诊断、迅速抢救,为后续救治创造条件的目的。1急救评估1.1接听120急救电话时的初步评估及指导除问清病人姓名、年龄、详细地址及联系方式外,要重点询问病人的主要症状、发病诱因、既往病史,并询问与生命体征相关的重要表现,指导现场人员进行紧急处理。1.2调度人员、器材及赶赴现场过程中的评估及指导接听120电话后,迅速调度人员及器材,保证在1min～3min内出车,10min～15min内到达20km内的现场。期间院前急救护士应与现场保持联系,确保迅速、准确赶赴现场,随时询问病人情况,指导现场人员进行现场急救[2]。1.3到达现场的评估原则:果断迅速,分秒必争,询问、检查、评估、抢救、治疗、转运,同步进行。程序:①询问病史,...     

便携式呼吸机在危重症患者转运中的应用

目的:探讨便携式呼吸机在危重症患者转运中的应用效果。方法:选取2013年6月1日～2019年6月1日在本院转运的危重症患者70例,根据转运方式的不同将患者分为对照组34例和观察组36例,两组均给予常规转运护理,对照组使用简易呼吸气囊转运,观察组使用便携式呼吸机转运;比较两组转运时期护理需要度、不良事件发生率、生命体征及血氧饱和度(SpO_2)。结果:转运中和转运后,观察组护理需要度低于对照组(P0.01);观察组不良事件发生率低于对照组(P0.05);转运中和转运后,观察组心率(HR)、自主呼吸频率(SR)、收缩压(SBP)及SpO_2均优于对照组(P0.01);转运后,两组HR、SBP均优于转运中(P0.05),对照组SpO_2优于转运前(P0.05)。结论:便携式呼吸机在危重症患者的转运过程中,能维持患者生命体征和SpO_2的稳定,降低不良事件发生率,方便及时,值得在临床上推广使用。     

院前急救及其生命支持的护理程序

目的 探讨院前急救及生命支持的护理程序和注意事项。方法 将护理程序应用于院前急救中，迅速了解病人的主诉、神志及生命体征，对病情做出及时评估，并进行必要的生命支持及安全转运。结果 运用护理程序后，院前急救生命支持的时效显著提高。结论 护理程序在提高院前急救成功率中有重要作用。     

美国国家急诊技师协会院前创伤生命支持培训课程的应用价值探讨

目的:探讨美国国家急诊技师协会(National Association of Emergency Medical Technicians,NAEMT)院前创伤生命支持(Prehospital Trauma Life Support,PHTLS)培训课程的应用价值。方法:分析2019-2020年全程参与佛山市中医院PHTLS培训中心的37名学员的一般情况、培训和考核成绩。结果:37名学员中,36名顺利通过了笔试。来自三甲医院的学员均一次性通过了笔试,平均成绩为(83.93±5.46)分,明显高于来自其他等级医院学员的(75.75±4.95)分,P<0.001。经过培训后,学员们的性别、所在科室、岗位和职称之间的笔试成绩和操作成绩无明显差异(P>0.05)。结论:通过标准化、系统化、科学化和情景化的教学,PHTLS培训课程深受广大学员喜爱和认同,使不同水平的学员均认识到了自身的不足和努力的方向,在我国有一定的推广应用价值。     

256例颅脑出血患者院前长距离转运效果与转运策略分析

目的:分析研究颅脑出血患者院前长距离转运的效果和危险因素,有针对性的加强救治措施,以求为急救人员转运此类患者提供指导,提高转运成功率.方法:回顾调查2016年1月-2020年12月期间256例颅脑出血患者由郊区医院长距离转运到市区三甲医院的流行病学特点和转运效果,将转运到目标医院时患者生命体征较转院前无明显改变的定为病...     

危重症病人院内转运的研究进展

危重症病人时常因为诊断与治疗的需要在院内发生转运行为,相关研究已证明进行院内转运的危重症病人出现不良事件的概率高于未转运的危重症病人。目前的研究热点在于如何改进与规范院内转运流程,尽量降低不良事件的发生率和最大限度地提高院内转运的安全性。本研究将从转运前准备、转运中监测和转运交接3个方面进行探讨,在此基础上对进一步开展危重症病人安全转运的研究前景进行展望。     

便携式呼吸机在院前转运急危重症患者中的应用效果

分析便携式呼吸机在院前转运急危重症患者中的应用效果。选取2015年10月~2017年9月院前转运急危重症患者70例为研究对象,随机分为对照组和观察组各35例。对照组转运过程中采用简易呼吸气囊,观察组转运过程中采用便携式呼吸机。密切观察两组患者转运过程中生命体征的变化,比较两组转运成功率。结果观察组心率、呼吸频率、收缩压、舒张压以及血氧饱和度均明显优于对照组(P0.05),差异具有统计学意义;观察组患者转运成功率显著高于对照组,死亡率低于对照组(P0.05),差异具有统计学意义。院前转运急危重症患者应用便携式呼吸机效果优于简易呼吸气囊,能够有效改善患者心率、呼吸、血压及血氧饱和度,提高转运成功率,降低死亡率,具有较高的临床应用价值。     

小儿危重症院前急救转运684例患儿疾病谱的研究

急诊医学的工作核心是提高急危重症及创伤患者的救治成功率及改善其存在质量。因此,需要建立完善的急诊医疗服务体系,院前急救转运是急诊医疗服务体系的一部分。本文通过对小儿危重症院前急救转运患儿疾病谱的研究,为完善儿科院前急救体系,提高院前急救转运质量提供依据。为此,本文对我院小儿危重症院前急救转运684例患儿的疾病谱进行了分析,现报告如下。     

Advanced life support versus basic life support in the pre-hospital setting: a meta-analysis

Background

The scientific evidence of a beneficial effect of ALS in pre-hospital treatment in trauma patients or patients with any acute illness is scarce. The objective of this systematic review of controlled studies was to examine whether ALS, as opposed to BLS, increases patient survival in pre-hospital treatment and if so, to identify the patient groups that gain benefit.

Methods

A systematic review of studies published in the databases Medline (PubMed), EMBASE, Cochrane Library and Scopus up to July 31st, 2010. Controlled studies comparing survival after the pre-hospital ALS treatment versus BLS treatment in trauma patients or patients with cardiac arrest were included.

Results

We identified 1081 studies of which 18 met our inclusion criteria. In nine of 18 studies including 16,857 trauma patients in the intervention group, ALS care did not increase survival compared to BLS treatment (pooled OR 0.892, 95% CI, 0.775-1.026). In nine of 18 studies including 7659 patients with cardiac arrest in the intervention group, ALS care increased survival compared to BLS treatment (OR 1.468, 95% CI, 1.257-1.715). Most subgroup analyses revealed no significant interactions, but data from six trials, where ALS was provided by physicians, increases the probability of survival at hospital discharge even more (OR 2.047, 95% CI 1.593-2.631).

Conclusion

Implementation of ALS care to non-traumatic cardiac arrest patients can increase survival and further research is unlikely to change our confidence in the estimate of the effect. On the contrary, in trauma patients our meta-analysis revealed that ALS care is not associated with increased survival. However, only few controlled studies of sufficient quality and strength examining survival with pre-hospital ALS treatment exist.     

Validation of a quality of life questionnaire for critically ill patients

Objective Development and validation of quality of life questionnaire for critical care patients.Design Prospective study.Setting Intensive care unit (ICU) of a general hospital and ICUs of 83 Spanish hospitals.Sample Patients admitted to the ICU>18 years of age; close family members.Method A committee of experts designed a questionnaire with characteristics judged essential for intensive care use: easy, quick administration (5–10 min); capable of completion by patient or close family member, by direct or telephone interview. Fifteen items relevant to critical care patients were grouped in three subscales: basic physiological activities, normal daily activities, and emotional state. Reproducibility of interobserver, intraobserver, patient/family member and telephone/direct interviews was analysed and also internal consistency, responsiveness, and main components.Results Internal consistency (578 patients): Cronbach's alpha coefficient=0.85. Reproducibility: intraobserver reproducibility (n=150): Spearman correlation coefficient=0.92. Interobserver (n=85); correlation=0.92. Patient/family member (n=81): correlation=0.92. Telephone/direct interview (n=54): correlation=0.96. Validity: factorial analysis confirmed that the three subscales were fundamental questionnaire components. There was good concordance between questionnaire/subscale and Glasgow Outcome Scale (GOS) results. Responsiveness: quality of life score changes between preadmission and 6 months' postdischarge correlated with GOS findings (weighted kappa index=0.56).Conclusions Questionnaire meets objectives recommended for critical care use, and fulfills essential requirements of validity and reproducibility when applied to critically ill patients.This study forms part of the PAEEC (Project for the Epidemiological Analysis of Critical Care Patients), and was supported by a grant from the Fondo de Investigaciones Sanitarias (F.I.S.-91/0703), and by the Granada University Research Group (Number 3244)     

Hypernatremia in critically ill patients

Hypernatremia is common in intensive care units. It has detrimental effects on various physiologic functions and was shown to be an independent risk factor for increased mortality in critically ill patients. Mechanisms of hypernatremia include sodium gain and/or loss of free water and can be discriminated by clinical assessment and urine electrolyte analysis. Because many critically ill patients have impaired levels of consciousness, their water balance can no longer be regulated by thirst and water uptake but is managed by the physician. Therefore, the intensivists should be very careful to provide the adequate sodium and water balance for them. Hypernatremia is treated by the administration of free water and/or diuretics, which promote renal excretion of sodium. The rate of correction is critical and must be adjusted to the rapidity of the development of hypernatremia.     

Health-related quality of life as a prognostic factor of survival in critically ill patients

Objective  To evaluate whether health-related quality of life prior to admission into an intensive care unit (ICU) is a prognostic factor of hospital and 1 year mortality. Design  Prospective cohort study. Setting  Fourteen-bed medical–surgical ICU. Patients  A total of 377 patients admitted to the ICU for more than 24 h with 1-year follow-up after discharge from the hospital. Intervention  A health-related quality of life (HRQoL) survey was conducted, using the questionnaire developed by the “Project for the Epidemiological Analysis of Critical Care Patients”, to assess patient’s quality of life 1 month before ICU hospitalization. Results  Hospital mortality was independently associated with severity assessed by APACHE II, odds ratio (OR) 1.14 [95% confidence interval (CI) 1.08–1.2; P < 0.001], high workload assessed by Nine Equivalents of Nursing Manpower Score > 30 OR 3.6 (95% CI 1.4–9.0; P = 0.006), hospital length of stay prior to ICU admission of more than 2 days OR 2.6 (95% CI 1.3–5.4; P = 0.008), and bad quality of life prior to ICU admission assessed by a HRQoL score ≥ 8 points OR 2.2 (95% CI 1.03–4.5; P = 0.04). Patients who scored ≥8 on the HRQoL survey presented a risk of demise 12 months after discharge almost twofold that of those who had good previous HRQoL (0–2 points), Hazard Ratio 1.9 (95% CI 1.3–2.8; P = 0.001). Conclusion  Bad quality of life is associated with hospital mortality and survival 12 months after hospital discharge.     

The impact of a pre-hospital critical care team on survival from out-of-hospital cardiac arrest

AimTo assess the impact of a pre-hospital critical care team (CCT) on survival from out-of-hospital cardiac arrest (OHCA).MethodsWe undertook a retrospective observational study, comparing OHCA patients attended by advanced life support (ALS) paramedics with OHCA patients attended by ALS paramedics and a CCT between April 2011 and April 2013 in a single ambulance service in Southwest England. We used multiple logistic regression to control for an anticipated imbalance of prognostic factors between the groups. The primary outcome was survival to hospital discharge. All data were collected independently of the research.Results1851 cases of OHCA were included in the analysis, of which 1686 received ALS paramedic treatment and 165 were attended by both ALS paramedics and a CCT. Unadjusted rates of survival to hospital discharge were significantly higher in the CCT group, compared to the ALS paramedic group (15.8% and 6.5%, respectively, p < 0.001). After adjustment using multiple logistic regression, the effect of CCT treatment was no longer statistically significant (OR 1.54, 95% CI 0.89–2.67, p = 0.13). Subgroup analysis of OHCA with first monitored rhythm of ventricular fibrillation or pulseless ventricular tachycardia showed similar results.ConclusionPre-hospital critical care for OHCA was not associated with significantly improved rates of survival to hospital discharge. These results are in keeping with previously published studies. Further research with a larger sample size is required to determine whether CCTs can improve outcome in OHCA.     

我国大中城市院前心脏性猝死流行病学调查分析

目的调查我国大中城市院前心脏性猝死患者流行病学情况,探讨院前心脏性猝死病例特点。方法从我国8个大中城市急救中心系统数据库中导出2008年度全部死亡数据,就其有完整记录的资料进行统计分析。结果①院前心脏性猝死的调度时间、到达时间、现场时间、返回时间、总时间、急救半径分别为（2．12±1．02）min、（14．10±7．05）min、（24．79±12．08）min、（13．79±6．61）min、（54．80±25．36）min、7．90±3．92（km）;②院前心脏性猝死的病例数以第一季度为最多,且最多时间段是8：00～10：00,最少时间段是2：00～4：00;③男性院前心脏性猝死明显多于女性,但年龄明显小于女性;④院前心脏性猝死目击者CPR为4．48％,医护人员现场CPR成功率2．26％。结论①心脏性猝死已成为我国大中城市最常见的院前死亡原因;②加强心血管病防治,提高中老年患者的常见急危重症早期识别与院前急救水平以及普及公众CPR对降低死亡有重要意义。