院前急救指导应用于小儿高热晾厥治疗的效果评价

目的探讨院前急救指导应用于小儿高热惊厥的效果,以降低高热惊厥对患儿的损伤,取得最佳的急救效果。方法2009年4月至2011年2月我院儿科共收治小儿高热惊厥急救患儿112例,对其中75例患儿家长采取院前急救护理指导,此75例患儿作为院前急救护理指导组。其余37例患儿作为非院前急救护理指导组,待医护人员赶到发病现场后对其进行常规急救护理。随后分别记录2组患儿的误吸、舌咬伤、高热惊厥再度发作以及脑损伤发生情况。结果院前急救护理指导组由于家长操作不当导致误吸的仅有1例,高热惊厥3例,无脑损伤、舌咬伤情况发生,院前急救护理指导组不良后果发生率为5．3％,低于非院前急救护理指导组的51．4％。结论在医疗急救人员还未到达患儿的发病现场之前便利用移动电话对患儿家长进行院前急救护理指导,能够显著减少患儿意外损伤,稳定患儿家长情绪,降低惊厥对患儿的影响,这对改善患儿症状及其后续治疗具有积极作用。     

The acute coronary syndrome--pre-hospital diagnostic quality

BACKGROUND AND OBJECTIVE: In the Austrian emergency medical service (EMS), emergency medical technician-staffed and physician-staffed vehicles are in operation. Patients with suspected acute coronary syndromes (ACS) are treated in the pre-hospital phase and transported to the hospital by an emergency physician (EP). This study evaluates the diagnostic performance of EPs in ACS and the impact of this emergency system on the outcome of ACS in an urban area. DESIGN: Retrospective case control study. METHODS: All protocol sheets from the emergency physicians were searched for the diagnosis of ACS. The database of the emergency department (ED) was searched for patients with ACS as an admission diagnosis or ACS as discharge diagnosis. For patients admitted to an intensive care unit (ICU), the medical history from the ICU was reviewed. According to the diagnosis and the aggressiveness of therapy, patients were divided in five categories of severity at each stage of care (pre-hospital category, ED category, ICU category). RESULTS: A total of 3585 patients was analysed. Only 17.8% of the patients with ACS as the admission diagnosis and 20.3% of the patients with ACS as the discharge diagnosis were transported by an EP. 46.8% of the ACS diagnosis by EPs were confirmed in hospital. Patients transported by EPs showed a higher all-cause mortality in hospital (1.6% vs. 0.6%; p=0.011). There was no significant correlation between the pre-hospital category of patients treated by EPs and the ED category. When a 12-lead-electrocardiogram was recorded, the correlation improved slightly (rho: 0.139; p=0.006). CONCLUSIONS: The percentage of ACS patients transported to hospital by an EP is very low, and EPs seem to be "over-aware" in the diagnosis of ACS.     

慢性阻塞性肺疾病急性加重期患者的院前急救护理

目的观察慢性阻塞性肺疾病急性加重期（acute exacerbations of chronic obstructive pulmonary disease,AECOPD）患者的院前急救护理经验。方法对实施院前急救护理的80例AECOPD患者的临床资料进行回顾性分析和总结。结果经院前急救护理,80例患者病情程度评分为（1.27±0.50）分,为轻～中度。死亡1例（1.25%）,无1例患者发生呼吸道阻塞。结论院前急救护理有助于改善AECOPD症状,降低病死率,提高救护效果。     

Massive hemoptysis requiring intensive care

OBJECTIVES: Massive hemoptysis can cause airway or hemodynamic compromise requiring intensive care. We reviewed the management and outcome of this group of patients in our institution. DESIGN: Retrospective analysis. SETTING: Medical intensive care unit (MICU) in a tertiary care hospital. PATIENTS: Patients (29 patients with 31 episodes) who were admitted to the MICU for massive hemoptysis (greater than 300 ml/24 h or requiring intubation) between August 1997 and April 2001. MANAGEMENT: Patients were intensively monitored and electively intubated if there was danger of airway compromise. Fiberoptic bronchoscopy was performed to assess the site of bleeding and patients had bronchial artery embolisation if deemed suitable. Patients in whom bleeding could not be controlled were referred for emergency surgery. RESULTS: In 26/31 (84%) episodes, patients required intubation. Bronchoscopy was more helpful in localising the bleeding (site of bleeding identified in 90%) than chest X-ray alone (identified site of bleeding in 64%). Bleeding was stopped with medical therapy in 8/31 (26%) patient; 16/31(51%) patients were successfully treated with embolisation. Only four (13%) patients went for emergency surgery, of whom one died. Overall in-hospital mortality was 4/31 patients (13%). Over a 2 year follow-up, 6/27 (22%) survivors had recurrent hemoptysis and another 4 (15%) died of unrelated causes. CONCLUSIONS: Intensive care and monitoring with endotracheal intubation, when necessary, are useful in massive hemoptysis. Bronchoscopy should be performed to help localise the bleeding site. Embolisation is a suitable first-line treatment for massive hemoptysis, reserving emergency surgery for cases where the above measures are insufficient to control bleeding.     

一体化急救护理新模式在重型颅脑损伤患者急救中的应用

目的：探讨一体化急救护理新模式在重型颅脑损伤患者急救中的应用效果。方法选择2011年6月-2013年2月96例重型颅脑损伤患者为观察组,采用一体化急救护理新模式进行救护;选择2010年1月-2011年5月104例重型颅脑损伤患者为对照组,采用传统的急救护理模式进行救护,比较两组患者护理质量、患者护理满意度以及转送意外事件发生率。结果实施一体化急救护理新模式后,观察组的院前急救反应时间和急诊科救治时间较对照组缩短;治愈率提高,患者病死率下降;患者护理满意度升高;转送意外事件发生率降低,两组间差别均有统计学意义（P〈0.05）。结论一体化急救护理新模式在重型颅脑损伤患者急救中应用,有效缩短了急救时间,提高了救治效果。     

The impact of do-not-resuscitate order on triage decisions to a medical intensive care unit

Purpose

To determine whether the presence of a do-not-resuscitate (DNR) order impacts on triage decisions to a medical intensive care unit (MICU) of an academic medical center.

Methods

Data were collected on 179 patients in whom MICU consultation was sought and included demographic, clinical information, diagnoses, ICU admission decision, Acute Physiological and Chronic Health Evaluation II (APACHE II) score, and the presence of DNR order. Functional status was determined retrospectively using the Modified Rankin Score.

Results

The only factor that influenced MICU admission was the presence of DNR order at the time of MICU consultation (odds ratio, 0.25; 95% confidence interval, 0.09-0.71, P < .006). There was no difference between the age, APACHE II scores, or functional status between admitted or refused. Medical intensive care unit admission was associated with increased length of stay without difference in mortality.

Conclusion

The presence of a DNR order at the time of MICU consultation was significantly associated with the decision to refuse a patient to the MICU.     

Outcome from paediatric cardiac arrest associated with trauma

OBJECTIVE: To examine survival rates for paediatric trauma patients requiring cardiopulmonary resuscitation (CPR) in the pre-hospital setting, and to identify characteristics that may be associated with survival. DESIGN: Ten-year retrospective trauma database review. SETTING: An urban physician-led pre-hospital trauma service serving a population of approximately 7.5 million, in the United Kingdom. PATIENTS: Eighty paediatric trauma patients (15 years or less) who received pre-hospital resuscitation following cardiorespiratory arrest between July 1994 and June 2004. INTERVENTION: Pre-hospital cardiopulmonary resuscitation. MAIN OUTCOME MEASURE: Survival to hospital discharge. RESULTS: Eighty children met inclusion criteria for the study. Nineteen (23.8%) were discharged alive from the emergency department and seven children (8.75%) survived to hospital discharge. Of the seven survivors, one had spinal cord injury. Two suffered asphyxial injury associated with blunt trauma and three sustained hypoxic insults following drowning or burns/smoke inhalation. In one patient with known congenital cardiac disease the cause of cardiac arrest was likely to have been medical. CONCLUSION: This study confirms the poor outcome for children requiring pre-hospital CPR following trauma. However, the results are better in this physician-attended group than in other studies where physicians were not present. They also suggest that cardiac arrest associated with trauma in children has a better outcome than in adults. In common with adults treated in this system, those patients with hypovolaemic cardiac arrest did not survive (Ann Emerg Med 2006;48:240-4). A large proportion of the survivors suffered hypoxic or asphyxial injuries. Targeted aggressive out-of-hospital resuscitation in certain patient groups can produce good outcomes.     

36例突发致命性胸痛病人院前急救和转运效果分析

目的探讨突发致命性胸痛病人院前急救及转运效果。方法回顾性分析深圳市急救中心院前急救科2006年1月至2009年1月接收的突发致命性胸痛病人36例的临床资料,并比较同期自行人院的21例同类病人病死率。结果院前急救组病人经专业现场急救处理后,其处理前后呼吸、心率、血压、胸痛程度差异均有统计学意义,院前急救组病死率低于自行入院组。结论突发致命性胸痛病人临床表现复杂,专业的院前急救能及时抢救监护,合理用药,保证安全、快速、有效转送,病情控制较好,有效降低病死率。     

东莞市镇区创伤院前死亡病例分析

目的:探讨严重创伤院前死亡病例的临床特点和高危因素。方法:回顾性分析本院2000～2005年创伤院前死亡患者285例的临床资料。结果:本组创伤院前主要致死原因是交通伤(73.3%),其次是坠落伤(12.6%);现场或送医院已经死亡214例(75.1%),途中死亡13例(4.6%),急诊科死亡58例(20.4%);91.2%的患者是多发伤;急救反应时间为15.3min。结论:尽快健全急救医疗服务体系(EMSS),努力提高急救人员对严重创伤的救治水平,普及全民的急救意识,可最大限度地降低创伤院前死亡率。     

上海市2007年院前急救患者流行病学调查

目的 探讨上海市2007年院前急救患者的流行病学特征.方法 以上海市急救中心2007年院前急救患者数据库和同期全市人口数据为基础,对其中记录完整者进行统计分析.构成比之间比较采用y2检验和确切概率法,对时间、日期和月份使用圆形分布的统计方法 .结果 2007年本市中心城区实施的院前急救患者中,有完整数据记录者86 815人,男女比为3.89:1,老年人占84.95%.其主要疾病依次分别为创伤.脑血管病、心脏病、昏迷、高热、肿瘤急症、急腹症、妇产科急症和上消化道出血.一天中,院前急救的高峰时点为12:15,高峰时段为05:43至17:45,不同疾病的院前急救均有其高峰时点和时段;一年中,院前急救无明显高峰期,但高热、急腹症和上消化道出血的院前急救均有其高峰期.结论 上海市中心城区院前急救患者有其自身的流行病学特点,因此不断完善院前急救系统建设,加强从业人员的业务培训,以适应新形势下的院前急救需求,是提高危急重患者院前急救成功率的根本保证.     

Utilizing Geographic Information Systems to Identify Clusters of Severe Sepsis Patients Presenting in the Out-of-Hospital Environment

Understanding the geographic distribution of critical illness within a community may provide public health stakeholders with information that can be used to expedite access to specialized care. We hypothesized that severe sepsis patients transported by emergency medical services (EMS) exhibit geospatial clustering and that prehospital providers would recognize sepsis more frequently in patients transported from sepsis clusters. Retrospective review of a prospective, observational study of patients with severe sepsis transported to the emergency department (ED) by EMS and treated with early goal-directed therapy (EGDT). Inclusion criteria: suspected infection, 2 or more criteria for systemic inflammation, and either systolic blood pressure <90 mmHg after a fluid bolus or lactate >4 mmol/liter. Exclusion criteria: age <18 or need for immediate surgery. Patient location at the time of EMS activation was recorded. Analysis of the addresses identified clusters, defined as a location in which EMS transported more than one patient experiencing the above associated signs and symptoms of septic shock. Other data collected included self-reported patient location as private residence or chronic care facility. One hundred sixty severe sepsis patients transported by EMS were eligible for analysis, presenting from 125 locations. Ninety-one patients (57%) presented from a private residence and 69 (37%) from a chronic care facility. Fifty (31%) patients were transported from 15 locations, with 25 of those transported from just 4 locations. Cluster patients tended to be older, come from medical facilities, and were more likely to have sepsis recognized by prehospital providers. Results from this study demonstrate low pre-hospital recognition of sepsis, as well as geospatially clustered presentations, most notably from skilled nursing facilities. Community education, public health initiatives, and EMS interventions could be targeted in such clusters of cases in order to both improve sepsis recognition and potentially expedite time-sensitive interventions.     

严重创伤患者107例的院前急救护理

目的探讨和完善严重创伤患者的院前急救护理措施。方法回顾性分析解放军第202医院急诊科2008年1月至2011年12月间107例严重创伤患者的院前急救状况和护理措施。结果经过及时有效的包扎、止血、固定、维持呼吸等院前急救处理,本组患者院前抢救成功率达到98.13%。结论强化的急救护理专业队伍建设、采取正确的急救护理措施、合理配置院前急救资源,能有效提高严重创伤患者院前急救的成功率。     

院前急救与急诊介入一体化治疗急性脑梗死的临床研究

目的:观察院前急救与急诊脑动脉内溶栓一体化治疗急性脑梗死的临床疗效,探讨急性脑梗死临床治疗的新模式.方法:采用院前急救与急诊脑动脉内溶栓一体化的治疗模式治疗57例急性脑梗死患者,观察脑血管再通率和患者生存率,采取欧洲卒中量表(ESS)及,Barthel指数(BI),评价患者神经功能的恢复情况.结果:在超早期时间窗内接受溶栓治疗率达91.2%,在3 h、6 h、12 h内接受溶栓治疗的再通率分别为:96.7%、85.7%、60.0%;病死率分别是:0%、4.76%、20.00%;致残率及接近治愈-完全恢复率:0%、9.5%、20.0%;近完全恢复率为:96.8%、85.7%、60.0%.结论:院前急救与急诊脑动脉内溶栓一体化的治疗模式显著缩短了治疗流程,提高了脑血管再通率和神经功能恢复率,值得在临床推广应用.     

Measurement of end-tidal carbon dioxide in spontaneously breathing patients in the pre-hospital setting. A prospective evaluation of 350 patients

OBJECTIVE: Monitoring of end-tidal carbon dioxide (EtCO(2)) is good clinical practice in the patient who is intubated and ventilated. This study investigated the EtCO(2) values in spontaneously breathing patients treated in a physician-staffed mobile intensive care unit (MICU). This article also discusses whether EtCO(2) monitoring may have an influence on therapeutic decisions by emergency physicians by providing additional information. METHODS: Over a period of 6 months, 350 spontaneously breathing patients (162 males, 137 females) were treated and transported in our MICU and monitored using a LifePak 12 monitor (EtCO(2), respiratory rate, pO(2), blood pressure, heart rate). Only 299 were enrolled in the study. RESULTS: Pathological EtCO(2) values were detected in 19 patients (6.3%). EtCO(2) levels of >55 mmHg (7.3 kPa) were found in nine of 12 (75%) patients with asthma, in one of 23 patients with hypoglycaemia (4.3%), and in all patients with subarachnoid hemorrhage, acute seizures and drug intoxications. With the exception of the asthma patients, all patients had an initial Glasgow Coma Score <8. EtCO(2) levels <20 mmHg (2.7 kPa) were found in all patients with hyperventilation or shock due to volume deficiency. Errors in EtCO(2) measurement occurred in 5% of cases. CONCLUSION: Although EtCO(2) monitoring may be a useful additional variable in spontaneously breathing patients. Consideration of the respective disease and the cost to benefit ratio suggests that this method should only be used for selected indications.     

广州市97 823例院前急救患者流行病学分析

目的 调查广州市院前急救患者流行病学情况,探讨院前急救病例特点.方法 从广州市急救医疗指挥中心系统数据库中导出2008年度全部数据进行统计分析.结果 ①在969 410次呼叫量中,日时间分布以16:00-18:00为最高(114 224次、占11.78%),以04:00-06:00为最低(23 237次、占2.40%).②在109 682次出车中,白云区出车量最多(29 364次、占26.77%),其次是海珠区(20 069次、占18.30%)、天河区(19 962次、占18.20%).③在97 823例院前急救患者中,男性的比例与死亡率均明显高于女性[比例:57.65%(56 394)比38.48%(37 641),死亡率:59.17%(3 269)比33.95%(1 876)].④在97 823例院前急救患者中,创伤类是院前急救中最多的,占34.57%(33 820),尤其是交通意外,占11.56%(11 307);且以21～50岁青壮年者最多;其次分别是神经系统、循环系统、呼吸系统、消化系统急症,且均以51岁(尤其是70岁)以上的中老年者最多.⑤在97 823例院前急救患者中,共死亡5 525例,占5.65%.循环系统急症死亡(尤其是猝死)居首位(1 827例、占33.07%),其次分别为其他系统急症死亡(1 646例、占29.79%)、创伤类死亡(866例、占15.67%)、呼吸系统急症死亡(413例、占7.48%)、神经系统急症死亡(329例、占5.95%);其中循环系统、呼吸系统、神经系统急症死亡均以51岁(尤其是70岁)以上的中老年者最多,其他系统急症死亡以61岁以上的老年者最多,创伤类死亡以21～40岁中青年者最多.结论 ①加强心脑血管疾病和呼吸系统疾病防治,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对降低死亡有重要意义.②加强安全生产、遵守交通法规、强化法制意识是降低创伤,尤其是交通意外发生及其死亡的有力手段.

Abstract：

Objective To investigate the epidemiological information of patients in pre-hospital medical care in Guangzhou city, and to explore the characteristics of the patients. Methods The data in the year of 2008 were retrieved from the computer database of Guangzhou Emergency Medical Rescue Command Center. Results ①In a total of 969 410 calls received, the time of distribution was found to be mainly between 16:00 and 18:00 [11.78% (114 224)], and least frequently between 04:00 and 06:00 [2.40% (23 237)]. ②Among 109 682 dispatches of ambulances, Baiyun district received the most [26.77% (29 364)], and followed by Haizhu district [18.30% (20 069)], Tianhe district [18.20% (19 962)], respectively. ③Among 97 823 cases of pre-hospital medical care, death rate of the male patients was higher than the female [amount: 57.65% (56 394) vs. 38.48% (37 641), mortality: 59.17% (3 269) vs. 33.95% (1 876)]. ④In 9 7823 cases of pre-hospital medical care, trauma constituted the highest rate [34.57% (33 820)], especially traffic accidents [11.56% (11 307)], and the age of most of the patients ranged between 21 and 50. Disease of the nervous system ranged the second, followed by diseases of circulatory system, respiratory system and digestive system, and most of them were over 51 years old, and most frequently above 70. ⑤In 97 823 cases of pre-hospital medical care, there were 5 525 deaths (5.65%), in whom the circulatory system diseases ranged first (especially sudden death) [33.07% (1 827)], followed by unclassified diseases [29.79% (1 646)], trauma [15.67% (866)], respiratory diseases [7.48% (413)], and neurological emergency illnesses [5.95% (329)]. The age of deceased was far older than 51, particularly 70. The age of most of the deceased was above 61, and age of traumatic death was 2140. Conclusion ①It is very important to reduce the death rate of the middle-old aged patients by strengthening prevention and timely treatment of cardiovascular and cerebrovascular diseases, and improve the medical strategies in emergency care, in order to lower the death rate during emergency. ②It is very important to emphasize safely in production lines and to strengthen traffic regulations in order to reduce the incidence of trauma, thus it is especially traffic accident, expect that the death rate of trauma could be lowered.     

院前急救指挥调度信息分析

目的：分析宜宾市院前急救指挥调度信息，旨在提高院前急救水平和指挥调度质量。方法：对2006年7月．2007年6月间宜宾市“120”指挥调度的群众呼救病种构成．日呼救高峰时段等资料进行分析。结果：全年受理的15917次群众呼救中，呼救病种的构成前四大类依次是：交通伤（32．76％）、除交通伤外的其它创伤（23．57％）、一般内科疾病（17．56％）、心脑血管病（9．75％）。日呼救高峰时段主要集中在18：00-24：00（31．36％）。全年呼救高峰期在1、2、5、8、10月。结论：宜宾市院前急救的主要病种是创伤（56．33％），应重视创伤的急救，提高院前急救水平。在呼救的高峰时期，要作好人员、物资准备，加强质量控制，提高指挥调度质量。     

The prehospital SIGARC score to assess septic shock in-hospital, 30-day and 90-day mortality

BackgroundIn the pre-hospital setting the early identification of septic shock (SS) patients presenting with a high risk of poor outcome remains a daily challenge. The development of a simple score to quickly identify these patients is essential to optimize triage towards the appropriate unit: emergency department (ED) or intensive care unit (ICU).We report the association between the new SIGARC score and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU).MethodsSS patients cared for by a MICU between 2017, April 15th, and 2019, December 1st were included in this retrospective study. The SIGARC score consists of the addition of 5 following items (1 point for each one): shock index≥1, Glasgow coma scale<13, age > 65, respiratory rate > 22 and comorbidity defined by the presence of at least 2 underlying conditions among: hypertension, coronaropathy, chronic cardiac failure, chronic renal failure, chronic obstructive pulmonary disease, diabetes mellitus, history of cancer and human immunodeficiency virus infection. A threshold of SIGARC score ≥ 2 was arbitrarily chosen to define severity for its usefulness in clinical practice.ResultsData from 406 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 71 ± 15 years and 268 of the patients (66%) were male. The presumed origin of SS was pulmonary (42%), digestive (25%) or urinary (17%) infection. Overall in-hospital mortality was 31% with, 30 and 90-day mortality was respectively 28% and 33%. A prehospital SIGARC score ≥ 2 is associated with an increase in 30 and 90-day mortality with HR = 1.57 [1.02–2.42] and 1.82 [1.21–2.72], respectively.ConclusionA SIGARC score ≥ 2 is associated with an increase in in-hospital, 30 and 90-day mortality of SS patients cared for by a MICU in the prehospital setting. These observational results need to be confirmed by prospective studies.     

2017—2019年妇产科重症监护病房院内感染的特征分析

目的 分析2017—2019年妇产科重症监护病房(MICU)院内感染的特征,为产科管理服务新模式下院内感染的预防及控制工作提供参考。方法 选取2017年1月1日至2019年12月31日西北妇女儿童医院MICU院内感染患者作为研究对象,对其特征进行分析。结果 4 681例患者中,发生院内感染61例,其中3例发生2次院内感染,共发生院内感染64次。2017—2019年院内感染发生率分别为1.02%、1.32%、1.51%,2017—2019年院内感染发生率比较,差异无统计学意义(P>0.05)。感染部位以生殖道为主,占40.62%,其次为血液系统,占26.56%;2017—2019年,生殖道、血液、尿管相关部位、盆腹腔、呼吸道、导管血流、皮肤感染例次占比比较,差异无统计学意义(P>0.05)。送检标本中导管阳性检出率最高,占61.11%,血阳性检出率最低,占30.91%;2017—2019年,血、生殖道分泌物、尿、引流液等体液、导管阳性检出率比较,差异无统计学意义(P>0.05)。病原菌以G⁺菌为主,占56.67%,其中肠球菌占G⁺     

院前急救4109例ICD-10疾病谱分析

目的：通过分析地市级急救中心院前急救资料,探讨ICD-10疾病分类方法在院前急救中的实用性。方法：回顾性分析2007年1～12月份自贡市急救中心出诊的全部有效急救患者的急诊诊断以及随访诊断,使用ICD-10编码进行归类,比较疾病性别构成比。结果：全年院前急救4109例,排5位的疾病分别为损伤、中毒和外因的某些其他后果（48.4%）、循环系统疾病（17.0%）、消化系统疾病（8.1%）、呼吸系统疾病（6.4%）、精神和行为障碍（5.2%）,损伤、中毒和外因的某些其他后果、循环系统疾病以及消化系统疾病出诊量男性多于女性（P〈0.05）,耳和乳突疾病以及妊娠、分娩和产褥期疾病出诊量女性多于男性（P〈0.05）。结论：采用ICD-10标准对院前急救病谱分类有进一步探讨的价值。