批量伤接诊预案的制定与实施

通过对6年内77批435例批量伤员急救的组织与管理,分析批量伤救治与演练经验,建立并不断完善预案,预案内容包括制定应急响应级别、建立健全组织机构、采取分区救治模式、明确各级各类人员职责、采用便捷有效的通讯方式等。经多次实践,形成了较完善的批量伤接诊预案,预案应具备较强操作性,同时做好抢救前准备工作、定期培训与演练也是确保预案实施的重要条件。对于批量伤员救治,建立和实施预案是非常必要的,可以提高对批量伤员的抢救成功率。     

四川省紧急医学救援人员现场初级创伤救治能力调查

目的调查紧急医学救援人员在救援现场进行初级创伤救治(PTC)的能力,为应急培训演练提供循证医学证据。方法模拟突发公共性事件批量危重伤员救治现场,对四川省市(卅)、县级救援人员进行横断面调查,对其初级创伤救治表现进行测评分析。结果①287名救援演练人员纳入调查。②初级创伤救治能力总体得分中位数57.14(53.57,82.14);各维度得分:初级评估42.86(42.86,85.71),组织协同58.33(50,75),循环管理70.59(64.71,76.47),呼吸管理36.36(27.27,81.82),次级评估77.78(66.67,88.89)。各职业分层:临床医生83.93(82.14,87.50),护士87.50(82.14,89.29),医技53.57(50,57.59),公卫医生53.57(50,57.14),卫生管理55.36(50,57.14)。各职称分层:初级63.39(53.57,83.93),中级58.93(53.57,83.93),高级55.36(50,58.93)。③各维度间测评得分比较,初级评估与分配任务、循环管理、次级评估比较,组织协同与循环管理、呼吸管理、次级评估比较,循环管理与呼吸管理、次级评估比较,呼吸管理与次级评估比较;临床医生、护士与医技、公卫医生、卫生管理比较,初级、中级与高级比较,场P<0.05,差异有统计学意义。结论模拟灾害批量危重伤员的救援场景,对救援人员的PTC技能行为进行数据化考评,为灾难救援演练提供一种数据考评模式。救援人员现场PTC总体能力一般;初级评估和呼吸管理维度能力较差,应重点提升;组织协同维度能力一般,应进行强化训练;高级职称人员,医技、公卫医生及卫生管理人员是重点培训人群。     

航空母舰突发事故批量伤员救治的研究

发达国家拥有航空母舰已近百年,在使用过程中不断有突发事件发生.航空母舰突发事故中,能否及时有效处理大量伤员,对提高伤员治愈率,维护战斗力都有着至关重要的作用.随着我军航母的列装,如何对航母突发事件批量伤亡实施救治是急需解决的问题,本文分析了外军航母突发事故的特点,总结了其批量伤病员救援的组织实施经验主要是：制定批量伤员救治预案,根据救护需求在不同位置预置物资储备以及组建医疗应急小组.借鉴外军经验,我军航母突发事故批量伤员的救治应当完善预案、预置物资、规范流程和反复预演.     

紧急医疗救援应急能力建设再思考

紧急医疗救援机制是社会危机处理机制的重要组成部分,紧急医疗救援应建立在短期内出现大量伤患者时,多部门参与的、以降低伤患者致残率和死亡率为目的的社会应急医疗救治体系、应具备与之相适应的急救网络、急救通讯、急救装备,急救队伍,还应建立相关法律体系以提高应急能力。应在紧急医疗救援的各个环节及有效衔接上提高应急能力,并通过培训与演练予以强化、提高。急救组织和应急人员在紧急医疗救援的各个环节及有效衔接上应急能力是急救网络应急系统医疗救援能力发挥更大作用的基础。     

应急医学救援疲劳及其积极性恢复方法

医学救援,是指运用现代医学等手段使受困对象脱离灾难或危险,得到医学救护的活动.它是救援中不可缺少的一部分[1].＂应急医学救援＂界定为：对突发公共事件引发的批量伤病员,按时效救治理论、原则,组织并实施医疗救治的活动.现在人常常把＂医学救援＂和＂应急＂这两个概念紧密的联系在一起[2].应急医学救援疲劳是发生在医学救援过程中的疲劳现象,与平时训练或重体力劳动时所发生的疲劳是不完全相同的,即应急救援时人员高度的精神紧张对疲劳的影响是平时所没有的.     

国内外直升机应急医学救援的回顾与展望

应急医学救援是指由灾害或突发公共事件引发的批量伤病员,按时效救治理论、原则,组织并实施医疗救治的活动。直升机应急医学救援,主要任务是在医院外环境中发生意外灾害、各种危重急症或突发事件,地面应急医学救援力量无法到达或途中耗时较长时,用直升机将救援力量、药品器材等快速运送至现场,对个体或群体实施及时有效地救援,或在医疗监护条件下,将伤病员运至后方医院,接受进一步全面的救治。     

化学性事故医学应急救援探讨

本文结合作者十多年来,组织实施处理日遗化武医学保障工作实践,以化学性事故医学应急救援勤务管理为牵引,勤务与技术相结合,立足于组织实施现场救援的实际需要,对化学性事故现场医学应急救援的对象任务、应遵循的主要原则,以及分区救援、分级救治,伤病员洗消、急救等重要问题进行了深入讨论,以期与同道们共同探讨,不断提高我国化学事故医学应急救援能力和技术水平。     

乌鲁木齐“7·5”事件院内救治伤员216例组织与管理工作分析

乌鲁木齐“7·5”事件,大批伤员短时间内被送入新疆医科大学附属中医医院急救中心。我院随即按预案组织开展院内救治工作。调集医院医疗、护理等重点职能部门负责人及相关专家、科主任来医院集结待命。应急腾空近200张病床用于收治伤员。选调医院普外科、骨伤科、神经外科等知名外科专家成立了院内急救专家组,参与救治危重伤病员。在接诊伤员时,按伤情和受伤部位进行检伤分类、伤情评估、腕带标识和院内分类、分科（组）救治。在救治程序上,医院迅速开通了急救检查、治疗、手术及住院绿色通道,并针对在门诊就诊的受伤群众,医院从简、从快,开展免费紧急医疗救助。对重伤危重患者各科室协作,尽快紧急手术;对于遇难不幸死亡的伤员,医院给予尸体处理后,并由党办工作人员拍照留像后交由保卫科负责妥善集中保管;轻伤患者在急诊外科、内科进行及时处理后紧急收治和疏散。参与救治的护理人员与医师之比为1．6：1,充分发挥应急护理的独特作用,积极开展心理干预。我院累计接诊216例,248人次（其中门诊104人次,入院144人次）,门诊死亡8例,病情好转或痊愈出院99人次。暴力事件伤员医疗救治的组织与管理有其独特的特点,要增强危机意识和应急观念;及时制定相应的反恐应急医疗预案,常备不懈,适时演练,按规范分级负责,以增强应急医疗救援能力。     

可乐定急性中毒80例院外急救和急诊科教治效果分析

目的总结急性集体药物中毒事件院外急救和急诊科救治及组织经验,以进一步提高急性集体药物中毒事件的救治效果。方法回顾性总结北京市怀柔区某餐厅“4．23”可乐定中毒事件80例患者院外急救和急诊科内救治及组织的相关资料。结果经院外及时救治,院外与院内高效绿色通道开通,急诊科正确救治,本组80例中毒患者,留观35例,转往三级甲等医院45例,经治疗全部康复。结论对于急性集体药物中毒事件,全区应急系统密切配合协调,院内院外应急绿色通道畅通高效,可以提高抢救成功率。     

核和辐射事故卫生应急能力信息平台构建及应用

目的为实现对核和辐射突发事件卫生应急工作的有效管理和应急能力评估,动态掌握我国省级及部分涉核地区的卫生应急准备与响应能力相关信息及数据。方法结合核和辐射突发事件的特点,设计开发了以卫生行政部门、核和辐射损伤救治基地、指定医疗机构、相关疾控及职防机构等为主要用户（填报对象）的综合网络信息报告平台。结果本文介绍了平台的设计思路、特点、构架及实现方式。结论希望通过这一平台系统的推广应用来评估和提高核和辐射突发事件卫生应急准备与响应能力,为今后核和辐射突发事件的处置提供决策信息支持。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.