教学医院急诊科在医学生心肺复苏培训中的重要作用

目的了解急诊科培训前后医学生对心肺复苏理论和技能的掌握情况及存在的问题,探讨教学医院急诊科在加强医学生心肺复苏教学中的作用。方法对115名医学本科临床实习学生行心肺复苏基本理论测试并利用模拟教具行单项操作测试,然后给予4学时的综合模拟培训。再次进行理论和操作测试,并就培训方式作问卷调查,将培训前后的测试结果进行对比。结果培训前理论考核平均成绩(57.1±22.1)分;操作总及格率仅7.8%。培训后理论考核成绩达到96.8分,操作考核及格率达到100%,均远远高于培训前。全部单项操作正确率在66.1%～97.3%,较培训前有大幅度提高。反馈意见收回115份,认为医学生在急诊实习中有必要加强心肺复苏培训者占82.3%,认为最佳培训方式是增加实际操作模拟培训者占96.6%。结论虽然经过系统学习,医学生的心肺复苏理论和操作技能仍明显不足,教学医院急诊科对医学生在急诊实习中,特别是应用模拟教学手段在心肺复苏实际操作培训方面能够发挥重要的作用。     

边看视频边练习教学法在实习护生2015版心肺复苏指南培训中的应用

目的：介绍边看视频边练习方法在实习护生心肺复苏培训中的做法与体会,为以后实习护生的心肺复苏教学提供参考。方法抽取2015年6─12月在某三级甲等医院的实习护生218名,其中专科103名,本科97名,研究生18名,以《2015美国心脏协会心肺复苏及心血管急救指南》为依据,运用美国心脏协会的医务人员基础生命支持课程,采用边看视频边练习方法进行培训,以美国心脏协会的考核标准测试培训效果。结果不同学历实习护生理论成绩明显高于培训前（均 P<0.05）,按压速率、按压深度、胸廓回弹、吹气长度及吹气量的合格率提高明显（均P<0.05）。结论边看视频边练习教学法能有效提高实习护生心肺复苏理论与技能考核成绩。     

改良版DOPS在急诊科护理实习生心肺复苏操作培训考核中的应用

目的 探讨改良版临床操作技能评估(DOPS)在急诊科护理实习生心肺复苏操作培训考核中的应用效果。方法 选取2020年10-12月该院采取传统操作考核方式期间于急诊科实习的护理实习生60名作为对照组;另选取2021年1-3月该院采取改良版DOPS考核方式期间于急诊科实习的护理实习生60名作为观察组。比较两组考核成绩、临床学习环境、质量考核情况及对临床带教老师教学工作的满意度。结果 观察组操作技能及理论知识考核成绩,临床学习环境量表评分,DOPS质量考核评价量表中考核质量、学习过程、考核满意度评分及教学满意度评分均明显高于对照组,差异有统计学意义(P<0.05)。结论 改良版DOPS可提高急诊科护理实习生心肺复苏操作考核质量,有助于提升护理实习生理论知识和操作技能水平,为其创造更好的临床学习环境,进而提升护理实习生满意度。     

运用品管圈 提高急诊科心肺复苏医护配合抢救效率

目的:探讨品管圈(QCC)活动在急诊科心肺复苏抢救医护配合中的应用效果。方法:成立品管圈小组,制定急诊科医护配合的培训及考核制度,制作心肺复苏、除颤操作的教学视频,制定心肺复苏抢救中医护配合流程及定位图,加强抢救流程中医护配合的培训及考核。结果:实施QCC活动后,急诊医护对于心肺复苏理论及操作考核成绩均高于活动前,结果有统计学意义(P0.05)。品管圈活动目标达标率为182.48%,进步率为97.83%,最终形成心肺复苏医护配合站位图及标准作业流程,形成了心肺复苏抢救中医护配合的教学视频。活动后,圈员的工作积极性、个人责任心、自信心、沟通协调及解决问题的能力、团队凝聚力及默契度均有提高。结论:运用品管圈,明确及规范了心肺复苏抢救中医护站位及分工,增强了医护在抢救过程中配合的协调性及默契度,提高了抢救效率。     

多元化心肺复苏培训模式在急诊心肺复苏技能培训中的应用

目的:探讨多元化心肺复苏培训模式在急诊心肺复苏技能培训中的作用和效果。方法:将我院接受心肺复苏技能培训的124名学员随机等分为对照组和研究组,两组均接受模拟人心肺复苏训练1次,然后对照组继续应用模拟人培训;研究组则实施多元化心肺复苏培训模式。比较两组学员考核成绩。结果:研究组各单项技能以及综合演练考核的合格率均高于对照组(P0.05)。结论:应用多元化心肺复苏培训模式,可以有效提高学员操作技能的掌握程度及急诊心肺复苏技能培训中的合格率。     

PBL结合情景模拟教学法在八年制医学生2010版心肺复苏指南教学中的运用

目的:探讨以问题为基础的教学法(PBL)结合情景模拟教学法在八年制医学生2010版心肺复苏指南教学中的运用效果.方法:将八年制医学生40名分为研究组和对照组各20例,研究组采用PBL和情景模拟教学相结合进行CPR培训,对照组采用常规方法培训,比较两组教学效果.结果:研究组学员的理论和实践考核成绩均明显优于对照组,P <0.05.结论:PBL结合情景模拟教学法有助于学员掌握心肺脑复苏的基本理论和CPR操作技能,建议推广应用.     

ICU专科护士临床培训及考核方法的效果分析

[目的]探讨ICU专科护士有效的临床培训考核方法.[方法]对49名ICU护士专科培训前后采用理论考核、专科技能考核与综合能力考核相结合的考核模式进行综合评价,对培训前后进行综合分析评价,并与未培训的ICU专科护士进行综合技能比较.考核成绩按百分制计算,理论考核成绩占35%、专科技能考核成绩占35%、综合能力考核成绩占30%(包括工作能力、教学能力、专业经验).[结果]ICU专科护士培训前后理论考核、专科技能考核与综合能力考核成绩比较,有统计学意义(P<0.001);ICU专科护士培训考核后与未培训的ICU专科护士综合技能比较,有统计学意义(P<0.001).[结论]ICU专科护士临床培训前后实施综合技能考核,使临床培养ICU专科护士有目标、有计划、有目的、有步骤地进行临床教学,提高了临床指导老师的责任心和教学能力,提高了护士的整体素质及综合技术水平,提高了同行对ICU专科护士的认同度.     

合作学习理论在护士心肺复苏技能培训中的应用

目的:探讨合作学习理论在护士心肺复苏(CPR)技术操作培训中应用的可行性及实际效果。方法:采用随机数字表法将8个护理单元分为实验组和对照组。实验组:每个合作学习小组的人数3～4人,形成组内异质、组间同质的格局,按"示教—小组练习"的半开放培训方式进行;对照组:按传统的"示教—练习—纠正错误—再练习"培训方式进行。培训结束采用统一的评分标准进行实践技能和相关理论知识考核,发放问卷调查自评,对护理核心能力进行综合评价。结果:实验组采取合作学习方式培训后,护士的护理技术操作、理论考核成绩与对照组差异有统计学意义(P<0.05),护士核心能力高于对照组(P<0.01)。结论:合作学习理论应用于护士心肺复苏操作培训中能提高护士心肺复苏的实际操作水平和护士的核心能力。     

从机动卫勤人员的基础心肺复苏考核看再培训

目的通过对机动卫勤分队成员基础心肺复苏考核结果的分析,提出机动卫勤分队成员存在的问题及改进措施。方法依据战伤救治规则和军队医院机动卫勤分队训练教材,结合平时训练要求,制定基础心肺复苏再培训方法及考核评分标准,对114名参考人员采用抽签排序以确定考核顺序和考台。结果培训前,机动卫勤分队成员基础心肺复苏操作考核优良率和及格率分别为29.4%和56.9%,再培训后分别为87.9%和100%,经检验,有统计学意义(P<0.01);军医培训前后得分分别为(31.6±13.2)分和(49.9±7.2)分,护士为(39.1±10.6)分和(53.0±5.4)分,其他非临床人员为(26.8±10.6)分和(50.3±4.3)分,各类人员的考核成绩在培训前后均有统计学意义(P<0.01)。结论机动卫勤分队人员定期再培训、再考核是提高机动卫勤分队战伤救治水平的必要手段。     

翻转课堂教学模式在实习学生心肺复苏培训中的应用

[目的]探讨翻转课堂教学模式在实习学生心肺复苏培训中的应用效果。[方法]选取我院实习学生257人,随机分为两组,观察组(n=128)采用翻转课堂教学模式,对照组(n=129)采用传统教学模式,比较两组心肺复苏操作考核成绩。[结果]观察组学生心肺复苏理论成绩、操作成绩及两者的优秀率均高于对照组(P0.05),观察组学生自主学习能力高于对照组(P0.05)。[结论]翻转课堂教学模式能有效提高实习学生心肺复苏培训效果,拓展学生的自主学习能力,提升教学质量。     

Abscess incision and drainage in the emergency department--Part I

Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases. Incision is generally performed using local anesthesia, with intraoperative and postoperative systemic analgesia. Care must be taken to make a surgically appropriate incision that allows adequate drainage without injuring important structures. Postoperative care includes warm soaks, drains or wicks, analgesia, and close follow-up. Antibiotics are usually unnecessary. Complications of incision and drainage include damage to adjacent structures, bacteremic complications, misdiagnosis of such entities as mycotic aneurysms, and spread of infection owing to inadequate drainage. The infectious agents responsible for abscess formation are numerous and depend largely on the anatomic location of the abscess. Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses. Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.     

Risk stratification of severe sepsis patients in the emergency department

Objective

To determine the efficacy of the Mortality in Emergency Department Sepsis (MEDS) score in the stratification of patients who presented to the emergency department (ED) with severe sepsis.

Methods

Adults who presented to the ED with severe sepsis were retrospectively recruited and divided into group A (MEDS score <12) and group B (MEDS score ⩾12). Their outcomes were evaluated with 28 day hospital mortality rate, length of hospital stay, Kaplan‐Meier survival analysis, and receiver operating characteristic (ROC) analysis. Discriminatory power of the MEDS score in mortality prediction was further compared with the Acute Physiology and Chronic Health Evaluation (APACHE) II model.

Results

In total, 276 patients (44.6% men and 55.4% women) were analysed, with 143 patients placed in group A and 133 patients in group B. Patients with MEDS score ⩾12 had a significantly higher mortality rate (48.9% v 17.5%, p<0.01) and higher median APACHE II score (25 v 20 points, p<0.01). Significant difference in mortality risk was also demonstrated with Kaplan‐Meier survival analysis (log rank test, p<0.01). No difference in the length of hospital stay was found between the groups. ROC analysis indicated a better performance in mortality prediction by the MEDS score compared with the APACHE II score (ROC 0.75 v 0.62, p<0.01).

Conclusion

Our results showed that mortality risk stratification of severe sepsis patients in the ED with MEDS score is effective. The MEDS score also discriminated better than the APACHE II model in mortality prediction.     

急诊护士对急诊急救专科护士培训的认知与需求

目的 了解急诊护士对急诊急救专科护士培训的认知与需求情况.方法 便利抽取南京市三级甲等医院在职急诊护士96名,采用自行设计的调查表进行调查.结果 急诊护士认为有必要接受和愿意接受急诊急救专科护士培训的比例分别为100％和92.7％,培训对护士的急诊急救知识和技能影响最大,最受认可的培训方式是示范练习,培训压力居第一位的是害怕考试和论文答辩.结论 急诊急救专科护士培训已被广大护士所接受,在临床有较高的需求,而培训方式应更贴近临床实际和学员需求,医院应在专科护士的使用和福利待遇等方面有所调整,以体现其价值.     

急诊留观患者的特点与护理人力资源的管理

目的 了解急诊留观患者的疾病谱和时间分布规律,提高急诊留观护理管理质量.方法 对2010年9361例急诊留观患者资料进行回顾性调查,分析患者的一般资料、留观月份和各时间段内留观人数分布、疾病种类分布,并进行统计分析.结果 急诊留观患者以上呼吸道感染、头晕、腹痛查因的人数最多,位居前3位,女性多于男性,平均留观时间中位数为3.0h,3、8月留观人数最多,患者留观时间集中于8:00～22:00,8:00～12:00为全天高峰.结论 应根据患者留观的疾病谱和时间规律,科学合理地分配护理人力资源和加强业务培训,以提高急诊留观室的护理质量.     

急诊手术室护士疲劳症状调查及干预措施分析

目的：研究急诊手术室护士的职业压力状况,寻求缓解或排除其压力的方法。方法：采用量表法来客观表达急诊手术室护士身心受压的情况。结果：经过适当干预,急诊手术室护士抑郁自评量表、焦虑自评量表、护士职业压力源量表和护士疲劳综合征量表评分明显降低,有统计学差异。结论：护理管理中应充分重视应对手术室护士的职业压力,采取合理的干预措施,营造一个融洽、和谐的工作环境,促其身心健康发展。     

Shortened preprocedural fasting in the pediatric emergency department

Background

There is no evidence of an association between fasting time and the incidence of adverse events during procedural sedation and analgesia. Pediatric and adult emergency medicine guidelines support avoiding delaying procedures based on fasting time. General pediatric guidelines outside emergent care settings continue to be vague and do not support a set fasting period for urgent and emergent procedures.

Association between ambient PM2.5 and emergency department visits for psychiatric emergency diseases

BackgroundWhether or not short-term exposure to particulate matter <2.5 μm in diameter (PM_2.5) increases the risk of psychiatric emergency diseases is unclear.MethodsThe study was performed in a metropolis from January 2015 to December 2016. The exposure was PM_2.5, and the confounders were weather (temperature and humidity) and other pollutants (PM₁₀, SO₂, CO, O₃, and NO₂). The outcomes were emergency department (ED) visits with psychiatric disease codes (F00-F99 in ICD10 codes). General additive models were used for the statistical analysis to calculate the adjusted relative risks (ARRs) and 95% confidence intervals (95% CIs) for the daily number of ED visits with a lag of 1 to 3 days following a 10 μg/m³ increase in PM_2.5.ResultsDuring the study period, a total of 67,561 ED visits for psychiatric diseases were identified and tested for association with PM_2.5. Daily ED visits for all psychiatric diseases were not associated with PM_2.5 in the model that was not adjusted for other pollutants. The ARR (95% CI) in the model adjusted for SO₂ was 1.011 (1.002–1.021) by 10 μg/m³ of PM_2.5 on Lag 1 for all psychiatric diseases (F00-F99). The ARR (95% CI) in the model adjusted for O₃ was 1.015 (1.003–1.029) by 10 μg/m³ of PM_2.5 on Lag 1 for F40-F49 (Neurotic, stress-related and somatoform disorders).ConclusionAn increase in PM_2.5 showed a significant association with an increase in ED visits for all psychiatric diseases (F00-F99) and for neurotic, stress-related and somatoform disorders (F40-F49) on lag day 1.     

彩色多普勒超声在小儿阴囊急症的应用

目的 总结儿童阴囊急症的声像图特征及血流表现。方法 采用彩色高频超声观察60例阴囊急症患儿阴囊及其内容物的形态学表现及血流状况。结果 超声提示附睾炎25例,附睾丸炎12例,睾丸附件扭转15例,嵌顿疝5例,睾丸挫裂伤1例,急性阴囊感染2例。结论 彩色多普勒超声可以作为早期监督诊断儿童阴囊急症的首选方法。