OUTCOME OF ASYMPTOMATIC ELECTRIC SHOCK VICTIMS REQUESTING AN EMERGENCY AMBULANCE

Objective. To determine whether patients suffering from electric shock without significant symptoms at the point of an emergency call could be appropriately assigned a non-emergency ambulance response using the Medical Priority Dispatch System (MPDS). Methods. Welsh Ambulance Service dispatch records were searched to identify patients allocated the MPDS code of 15C01 (electric shock without priority symptoms) over a 30-month period. Ambulance and hospital records were also reviewed. Results. Records were unavailable for seven of the 52 patients identified (13%). Nine refused transport (17%, 95% CI 8.2% to 30.3%), and 36 were taken to emergency departments (69%, 95% CI 55% to 81%). Of the 52 patients, 23 were discharged shortly after arrival (44%, 95% CI 31% to 59%), 11 receiving no treatment (21%, 95% CI 11% to 35%). Thirteen patients were admitted as inpatients or were transferred to another hospital (25% of the total sample, 95% CI 14% to 39%). Fourteen had burns (27% of the total sample, 95% CI 16% to 41%). Five of these were admitted or transferred to another hospital, five were discharged after treatment, and two left without treatment (one self-discharged). Records were unavailable for two burns patients. Conclusions. The findings of this study do not justify allocating a low-priority response to victims of electric shock without significant symptoms at the point of the emergency call, since 25% require hospital admission. Further research is required to determine whether the addition of questions to the MPDS about burns and pregnancy might allow safe allocation of a nonemergency response to other asymptomatic electric shock patients.     

The effects of minimizing ambulance diversion hours on emergency departments

This study explores the effects of minimizing Emergency Department (ED) bypass on individual hospital's ED census, ambulance transports, and admissions. Five hospitals in a geographic area collected data over 3 weeks. The first and third week represented controls, whereas the second week hospitals minimized their usage of bypass. Data collected included hours on bypass, ED census, ambulance runs, hospital admissions, and inter-facility transfers. The total number of hours on bypass for all hospitals for pre-trial, trial, and post-trial weeks were 112.2, 0.3, and 47, respectively. There were several statistical shifts in the proportion of ambulance runs and admissions seen by individual hospitals. Clinically, these shifts in patients were minor and within ED capacity. Hospitals in a given geographic area may successfully reduce the number of hours on bypass with possible minor shifting in the number of ambulance runs and admissions that are within ED capacity.     

Performance of the New South Wales Ambulance Service major trauma transport protocol (T1) at an inner city trauma centre

Objective: To evaluate the performance of a newly implemented prehospital trauma triage (T1) protocol in New South Wales for patients transported to an inner city major trauma centre. Methods: An observational study was conducted over 1 year. Prehospital data and injury characteristics were collected prospectively for all hospital trauma team activations and injury presentations transported by Ambulance Service of New South Wales. Univariate comparison of T1‐ and non‐T1‐transported patients was performed and sensitivity, specificity, overtriage and undertriage rates were calculated. The outcomes studied were Injury Severity Score >15 and major outcome (composite of in‐hospital death and/or transferred from the ED to operating theatre or intensive care unit). Factors associated with undertriage were determined with univariate analysis. Results: A total of 2664 ambulance arrivals for trauma were studied with 767(29%) transported on the T1 protocol. T1‐transported patients were associated with more severe injury (23% vs 6%, P < 0.001) and major outcomes (30% vs 10%, P < 0.001) compared with non‐T1‐transported patients. The sensitivity of the T1 protocol for severe injury was 63% with a positive predictive value of 23%. The undertriage and overtriage rates for severe injury were 12% and 77%, respectively. Undertriaged patients were elderly with falls as the predominant mechanism of injury. Conclusion: The sensitivity and undertriage rates associated with the T1 protocol indicate the ongoing need for secondary triage at designated trauma centres and refinement of the protocol to include age as a criterion.     

Atrial fibrillation induced and converted by domestic supply electric shock

We present a case of persistent atrial fibrillation induced by a low-voltage electric shock reverting back to sinus rhythm after a similar repeat shock. (PACE 2012; 35:e320-e321).     

无抽搐电休克疗法治疗难治性抑郁疗效观察

目的探讨难治性抑郁症(TRD)的治疗方法,为临床治疗TRD提供新的治疗方案。方法选取2009年4月至2010年5月接收的60例TRD病例,将其随机分为研究组和对照组,各30例,研究组采用无抽搐电休克疗法治疗TRD,对照组采用常规抗抑郁药物治疗TRD,对比分析两组治疗TRD的治疗效果以及不良反应。结果研究组治疗后第1、2、4周的HAMD平均减分率分别25.1%、34.9%、64.9%,而对照组治疗后第1、2、4周的HAMD平均减分率分别为4.9%、8.5%、16.8%。研究组的HAMD平均减分率明显高于对照组的HAMD平均减分率。治疗结束后1周,研究组的总有效率为63.33%;对照组的总有效率为30.00%,研究组总有效率明显高于对照组。结论相比于常规药物治疗,无抽搐电休克疗法治疗TRD具有见效快、疗效好、不良反应少以及患者依从性好等诸多优点,是临床上治疗TRD安全、快速、有效的方法。     

电磁式冲击波结合高频电流治疗兔骨不连

目的探讨电磁式冲击波结合高频电流对兔骨不连的治疗作用 . 方法手术造成并经 X线检查证实的兔左右胫骨骨不连模型 , 随机分成 a、 b两组 , a组左侧为冲击波治疗组 , 右侧作空白对照组 ; b组左侧为冲击波结合高频电流治疗组 ; 右侧作对照组 ,只进行高频电流治疗 . 治疗后 2、 6、 12周进行 X线和组织学检查 , 观察治疗前后骨不连处的变化 . 结果 12周后 a组左侧胫骨不连基本痊愈 ; b组左侧胫骨全部痊愈 , b组左侧较 a组左侧愈合早 , a、 b组右侧均为骨不连接 . 结论冲击波能够刺激骨痂形成 , 高频电流能增强血液供应 , 两者结合能促进骨折愈合 , 有望成为一种非手术促进骨不连康复的新方法 .     

体外冲击波联合电针治疗慢性足底筋膜炎

目的:观察体外冲击波联合电针治疗慢性足底筋膜炎的临床疗效。方法:60例慢性足底筋膜炎患者随机分为电针组、冲击波组(ESWT组)及联合治疗组(联合组)各20例。电针组只接受电针治疗,ESWT组只接受ES-WT治疗,联合组同时接受电针和ESWT联合治疗,3组患者在治疗前、治疗后2周、4周及3个月行VAS疼痛评分,治疗3个月后采用VAS加权值评定临床疗效。结果:3组患者VAS评分在治疗后各时间点均较治疗前明显下降,且联合组更低于电针组及ESWT组(P<0.05);ESWT组在治疗后3月VAS改善优于电针组(P<0.05);ESWT组及联合组VAS评分逐渐下降,但电针组3月后VAS评分却有升高;联合组治愈率明显优于电针组及冲击波组,冲击波组治愈率优于电针组(P<0.05)。结论:ESWT和电针对慢性足底筋膜炎均具有临床疗效,但二者联合治疗明显优于单一治疗,具有近期及远期疗效方面的共同优势。     

Evaluation of prehospital emergency care in the field and during the ambulance drive to the hospital

This study was conducted to evaluate the appropriateness of ambulance procedures and interventions in the management of patients dispatched to 2 emergency departments (EDs) of urban hospitals in Izmir. Use of trauma boards and cervical collars, airway patency, breathing, and circulation problems were recorded in both EDs. Eighty-one patients with a mean age of 47.54±2.36 years (range, 4–89) brought into the ED via ambulances were enrolled in the study. Airway maneuvers were performed in patients with airway and breathing problems. There was no significant relationship between administration of IV fluids and the presence of circulatory impairment (P=.053). A trauma board was used in 9 of 30 trauma cases (30%) and a cervical collar in 6 of 30 (20%). It was concluded that basic procedures used in the management of patients brought into the ED via ambulances were inadequate.     

血浆代用品血定安应用于烧伤休克复苏的临床研究

目的 :验证血浆代用品 (血定安 )在烧伤休克液体复苏中的临床疗效。方法 :2 0例烧伤总体表面积( TBSA)大于 40 %且因延迟复苏导致休克的烧伤患者 ,随机分为血定安复苏组 (血定安组 ,n=11)和血浆复苏组 (血浆组 ,n=9)进行复苏 ,观察休克期心排血量 ( CO)、氧供给 ( DO2 )、血细胞比容、血液黏度、血浆黏度、乳酸( L A)含量及碱缺失 ( BD)等血流动力学、血液流变学及氧代谢指标的变化。结果 :快速补液 2 h后 ,CO和 DO2显著升高 ( P<0 .0 5或 P<0 .0 1) ,血细胞比容、血液黏度、血浆黏度、L A和动脉血 BD显著下降 ( P<0 .0 5或P<0 .0 1)。两组间比较 ,伤后 2 4h内血定安组补液后血浆黏度显著低于血浆组 ( P均 <0 .0 5 ) ,其余指标无显著性差异 ( P均 >0 .0 5 )。结论 :在烧伤后休克复苏中 ,血浆代用品血定安与血浆的疗效相近 ,可以在烧伤休克早期救治中广泛应用。     

严重烧伤早期肠黏膜组织热休克蛋白70的表达规律

目的探讨大鼠烧伤后早期肠黏膜组织热休克蛋白70(HSP70)的表达变化规律及其意义。方法采用大鼠烫伤模型,通过逆转录-聚合酶链反应(RT-PCR)、蛋白质免疫印迹(Westernblot)及免疫组化等方法,检测伤后3、6、12、24和48h不同时间点肠黏膜组织内HSP70及热休克因子1(HSF1)的表达分布情况。结果烫伤后3h肠黏膜组织内HSP70mRNA及蛋白表达均显著增加,分别在伤后6h和12h达高峰,伤后48h仍高于正常对照组(P均<0.01);伤后3h大鼠肠黏膜组织HSF1出现一过性降低,伤后6h其表达显著高于正常对照组,并呈逐渐增加的趋势直至持续到伤后48h(P均<0.01)。结论严重烧伤早期肠黏膜组织HSP70及HSF1表达均显著增加,提示严重烧伤早期即可引起肠黏膜组织细胞的应激反应,可能与细胞的自我保护机制启动有关。     

Impact of an ABCDE team triage process combined with public guidance on the division of work in an emergency department

Objective. To study the effects of applying an emergency department (ED) triage system, combined with extensive publicity in local media about the “right” use of emergency services, on the division of work between ED nurses and general practitioners (GPs). Design. An observational and quasi-experimental study based on before–after comparisons. Setting. Implementation of the ABCDE triage system in a Finnish combined ED where secondary care is adjacent, and in a traditional primary care ED where secondary care is located elsewhere. Subjects. GPs and nurses from two different primary care EDs. Main outcome measures. Numbers of monthly visits to different professional groups before and after intervention in the studied primary care EDs and numbers of monthly visits to doctors in the local secondary care ED. Results. The beginning of the triage process increased temporarily the number of independent consultations and patient record entries by ED nurses in both types of studied primary care EDs and reduced the number of patient visits to a doctor compared with previous years but had no effect on doctor visits in the adjacent secondary care ED. No further decrease in the number of nurse or GP visits was observed by inhibiting the entrance of non-urgent patients. Conclusion. The ABCDE triage system combined with public guidance may reduce non-urgent patient visits to doctors in different kinds of primary care EDs without increasing visits in the secondary care ED. However, the additional work to implement the ABCDE system is mainly directed to nurses, which may pose a challenge for staffing.     

重度烧伤不同的烧伤面积对休克期补液量的影响

目的再探讨重度烧伤不同的烧伤面积对休克期补液量的影响,对伤后第1个24 h的常规补液公式[晶体与胶体总量(mL)=1.5×体重×烧伤面积,补液系数为常数1.5]提出完善的建议。方法回顾2005年1月~2011年10月间本院收治的69例烧伤面积大于30%、年龄18~70岁、伤后到入院时间少于4 h并且平稳度过休克期的烧伤患者,记录其烧伤面积、体重及伤后第1个24 h的晶体、胶体量,计算出补液系数Y=(晶体+胶体)/体重/烧伤面积,使用SPSS 17.0统计软件对补液系数Y与烧伤面积X进行直线回归分析,求得回归方程,得到补液系数与烧伤面积的关系。结果自变量烧伤面积X与因变量补液系数Y呈直线性相关,回归方程:Y=0.0124X+1.1865,回归方程及相关系数有统计意义(P<0.001)。结论大面积烧伤患者早期补液系数不应局限于常数1.5,重度烧伤休克期补液量与烧伤面积不宜仅考虑为直线相关,而应考虑为曲线相关。传统的第1个24h烧伤补液公式可调整为:晶体与胶体补液量(mL)=(0.0124×烧伤面积+1.1865)×体重×烧伤面积。     

急救护理在严重创伤失血性休克患者中的应用体会

目的探讨急救护理在严重创伤失血性休克患者中的应用效果。方法选取2018年7月至2019年1月本院收治的20例严重创伤失血性休克患者为研究对象,回顾性分析其急救处理方法及效果。结果 20例严重创伤失血性休克患者经过有效急救护理后,好转18例、无变化1例、恶化1例,其中19例患者的失血性休克得到有效纠正,18例血压、心率恢复正常已康复出院,1例因创伤严重实质性脏器破裂性出血而死亡。本组患者的临床好转率为90.0%。结论对创伤失血性休克患者要采取迅速、及时、有效的急救措施,有助于提高临床救治成功率,降低死亡率。     

创伤性休克患者院前救治与术后急性肺损伤/急性呼吸窘迫综合征发生的相关性调查

目的 调查分析创伤性休克患者院前救治与术后急性肺损伤（ALI）／急性呼吸窘迫综合征（ARDS）的相关性及其临床意义。方法 随机双盲法抽取1995年10月-2005年10月符合调查条件的创伤性休克患者600例，其中院前进行综合治疗184例（A组），单纯液体复苏治疗305例（B组），未治疗111例（C组）。对比各组全身炎症反应综合征（SIRS）、ALI／ARDS、多器官功能障碍综合征（MODS）确诊率及预后；并以入院1h及术后24、48、96和144h相关数据进行SIRS评分。结果 600例患者中524例诊断为SIRS（占87．33％），其中A组73．37％（135／184例），B组91．48％（279／305例），C组99．10％（110／111例）；SIRS分值A组各时间点均显著低于B组和C组（P均〈O．01），B组又低于C组（P均〈O．01）；且A组术后96h基本正常，而B组术后144h才接近正常。ALI确诊率A组为5．98％（11／184例），发生ARDS1例，MODS1例，无死亡；B组为10．49％（32／305例），发生ARDS7例，MODS3例，死亡3例；C组则为20．72％（23／111例），发展为ARDS8例，MODS5例，死亡5例。结论 创伤性休克院前救治与术后ALI密切相关，院前综合治疗有助于降低术后ALI／ARDS的发生率。     

超声诊断电损伤引起的心肌损害1例

患者男,37岁,胸部闷痛半年加重10天.患者为电焊工,经常湿地作业,时常遭遇电损伤.查体:血压110/80 mmHg(1 mmHg=0.133 kpa),心率72次/min,律齐,各瓣膜听诊区未闻及病理性杂音.