汶川地震大批伤员分类的组织及方法

通过对3103例地震伤员的现场分类，认为迅速启动应急机制、建立分类组织、明确分类人员职责、选择合理分类场所和佩带分类标志是使大批伤员能得到及时、合理救治的前提。现场将伤员分为3类：一类是紧急救治组，二类是延期治疗组，三类是期待治疗组。采取收容分类、救治分类和后送分类3种基本形式，可避免伤员多所致工作忙乱、救治效率低的问题，为地震灾害中大批伤员分类急救提供一种程序、规范、高效的分类方法。     

突发事件成批伤员现场急救程序的研究

通过对71批次1389例突发事件伤员的院前急救，认为迅速启动应急机制、明确有序的急救护理程序是提高救治质量的重要保证。现场抢救采用分组管理，包括指挥组、文书组、救治组、后送组，可避免工作忙乱、救治效率低的问题，为现代战争中成批伤员的急救提供一种程序、规范、高效的急救途径。     

重大灾害后伤员转运管理中心的组建与运行模式的探讨

重大灾害爆发后由于现场急救、医疗条件有限，根据紧急援助的原则需要在现场紧急处理后快速转运至适当医院而确保其得到更有效的专科治疗和护理，批量伤员的后送转运工作的快速、高效对伤员救治成功意义重大。批量伤员的转运救护工作既是对专业救援人员，更是对医护人员综合能力、急救组织管理能力的严峻考验。结合国内外多次重大灾害伤员后送转运实例，     

"5·12"汶川地震震中区映秀镇首批伤员检伤救治与后送

目的 分析第三军区大学西南医院医疗队在"5·12"汶川地震震中区映秀镇大批量伤员的检伤救治与后送转运工作,探讨地震灾害现场大批量伤员的医疗救援模式.方法 结合映秀镇救援现场实际,根据CRASHPLAN原则将救治区分为检伤分类区、轻伤区、重伤区和后送区.医疗队工作分组分区实施,检伤、治疗和后送在统一协调下展开.结果 到达后的3 d时间内,医疗队共计分类救治批量伤员415例,其中危重伤员251例,行清创手术153例次,紧急骨筋膜室切开减压术12例次,直升机空运后送伤员317例.救治工作有序高效,所有伤员在救治过程和后送途中无一例死亡.结论 根据现场救治能力和医疗资源情况科学地把握检伤分类后送原则和分级救治原则,对地震灾害大批量伤员的医疗救援具有特别重要的意义.     

灾难事故的紧急医疗救援

目的:报告河南省5次重大突发事件和紧急救援的组织管理.方法:重大灾害事件发生后,迅速报告上级主管部门和紧急救援中心,公安、消防和医疗急救人员共同参加现场急救,保持通讯和道路通畅,维持现场秩序,保证现场急救和顺利转运伤员到医院.应急医疗救治专家迅速赶赴现场和救治伤员的医院,指导急诊手术和重症监护治疗.结果:5次重大突发事件现场共死亡259人,181例伤员送入院治疗,其中危重伤员26例.仅2例死于多器官衰竭,其余179例康复出院.结论:重大突发事件紧急救援需要公安、消防、医疗急救等多系统的协调合作,急诊医学专家指导大批伤员的分类急救和重症监护治疗,可提高救治成功率.     

重大灾害后伤员转运管理中心的组建与运行模式的探讨

重大灾害爆发后由于现场急救、医疗条件有限,根据紧急援助的原则需要在现场紧急处理后快速转运至适当医院而确保其得到更有效的专科治疗和护理[1],批量伤员的后送转运工作的快速、高效对伤员救治成功意义重大.批量伤员的转运救护工作既是对专业救援人员,更是对医护人员综合能力、急救组织管理能力的严峻考验.结合国内外多次重大灾害伤员后送转运实例,尤其是2008年5月12日的汶川大地震中大批伤员转运的具体转运情况,我们认为应在重大灾情爆发地设立伤员转运管理中心,专职对伤员的后送转运工作进行全面管理,以提高批量伤员转运效率.     

汶川地震突发成批量伤员的救治与护理

探讨汶川地震中大批量伤员救治与护理的有效做法.根据地震伤的创伤特点,通过对大批量伤员救治区域划分,即:伤员分类救治场、紧急手术区、缓冲医疗区和应急治疗区.使伤员能快速通过有效分类及时得到救治.依据地震伤的急救护理特点,采用迅速、果断、准确、有效的急救护理措施对伤员施救.及时建立的"一场三区"救治区域和快速而准确的急救护理流程为成功抢救伤员生命赢得了时间.快速的分类区域划分、准确的分类救治、有效的急救护理流程是抢救批量伤员的重要保证.     

汶川地震中颅脑损伤的院前急救

目的探讨5·12汶川大地震中颅脑损伤伤员的伤情特点和现场急救经验教训,为地震中颅脑损伤伤员的现场救治提供临床经验。方法回顾2008年5月12日2008年5月18日收治的817例颅脑损伤伤员资料,对伤情、致伤原因、伤情特点、救治方法、地震后医疗救治措施等进行分析。结果 817例伤员中多数为头皮裂伤、挫伤,均予以清创缝合处理,预后良好。其余伤员急诊处理后转入后方医院治疗。结论正确判断处理伤员颅脑损伤并使其得到积极救治是提高伤员生存率的关键;正确分类转运和协调现场指挥是重型颅脑损伤得到二次救治的重要前提。建立灾害救治功能完善的野战医院迫在眉捷。     

联合国维和行动中群体伤亡事件的处置

目的 通过参加联合国维和行动,掌握了联合国对群体伤亡事件的处置,对建立和完善我国灾难医学救援体系有重要启迪.方法回顾性分析联合国卫勤保障中群体伤亡事件的处置程序,如事件报告伤员分类及现场处理和伤员后送等.结果协同有效的急救体系和分类分级的伤员救治,最大限度地挽救了伤员的生命.结论重视灾难医疗求援教育,提高求援质量.     

地震后24h内紧急救治与转运伤员的体会

报告了在汶川地震后24 h内对地震伤员进行紧急救治与转运的情况,以及对伤员进行清创处理的体会.根据救援现场条件差、伤员多的特点,因地制宜地将场地划分为收容、急救、后送等3个区域,并根据伤员的伤情轻重给予相应处理.认为现场救援必须有紧迫感,现场救护必须有科学的管理方法,才能为进一步治疗奠定基础.     

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.     

分级预警模式在急危重患者院前与院内急救衔接中的应用

目的探讨分级预警模式在急危重患者院前与院内急救衔接中的应用效果。方法方便抽样法抽取某依托型急救中心2017年1-6月出诊的院前患者2728例为对照组,实施常规急救模式进行急危重患者院前与院内急救交接;2017年7-12月的2802例为观察组,实施分级预警模式衔接急危重患者院前与院内急救。比较两组患者院内急救反应时间、病情分级一致率及意外事件发生率。结果观察组院内急救反应时间及意外事件发生率低于对照组(P<0.05),病情分级一致率高于对照组(P<0.05),差异均有统计学意义。结论分级预警模式可量化院前急救患者病情分级,启动相应级别的院内急救调配预案,引入信息化技术衔接急救过程,从而缩短院前急危重患者院内急救反应时间,保障院前与院内急救交接期间的医疗安全,实现院前与院内无缝隙急救衔接。     

2013年北京市急救中心院前急救儿童患者流行病学研究

目的总结2013年北京市急救中心院前急救儿童患者的年龄、性别及病种分类规律,为提高儿童的院前急救质量提供依据。方法以北京急救中心调度信息数据库为基础,对2013年北京市急救中心院前急救儿童患者进行回顾性分析。结果 2013年北京市急救中心院前急救9 845例儿童患者中,男∶女为1.6∶1。各年龄组中,4⁷岁的学龄前儿童患者最多,共2 492例,占25.31%;28 d以内的新生儿组患者最少,共251例,占2.55%。病种构成前五位分别为呼吸系统疾病、创伤、消化系统疾病、神经肌肉系统疾病、气道异物。呼吸系统疾病、创伤在47岁的学龄前儿童患者最多,共2 492例,占25.31%;28 d以内的新生儿组患者最少,共251例,占2.55%。病种构成前五位分别为呼吸系统疾病、创伤、消化系统疾病、神经肌肉系统疾病、气道异物。呼吸系统疾病、创伤在4⁷岁的学龄前儿童患者组最多,消化系统疾病、神经肌肉系统疾病、气道异物在17岁的学龄前儿童患者组最多,消化系统疾病、神经肌肉系统疾病、气道异物在1³岁的幼儿患者组最多。结论根据北京市急救中心院前急救儿童患者具有年龄、性别及病种分类特点,针对性地开展相关工作,才能使患者得到更好的院前急救服务。     

The consistency of emergency physicians' and cardiologists' ECG interpretation and likelihood classification of chest pain patients

Patients presenting to the emergency department with chest pain are evaluated by emergency physicians in hospitals without cardiology cover 24 h a day. The purpose of this study is to determine the consistency of electrocardiography (ECG) interpretation and chest pain likelihood classification between emergency physicians and cardiologists. This randomised prospective cross-sectional study was performed in a tertiary care university hospital emergency department. The study form included ECG interpretation and chest pain likelihood classification according to American College of Cardiology (ACC)/American Heart Association (AHA) guideline which were recorded by emergency physicians and cardiologists separately in a blinded fashion. All chest pain patients who consulted with a cardiologist were enrolled into the study during the study period. The consistency between the two groups and the kappa value were calculated. Recorded study forms of 133 patients with cardiology consultations were evaluated. The consistency in the interpretation of ECG between the emergency physicians and cardiologists was found to be 94.6% (kappa = 0.85) for ST segment elevation, 78.6% (kappa = 0.57) for ischaemic ECG findings and 79.3% (kappa = 0.36) for dynamic ECG changes. The consistency for the likelihood classification between two groups for predicting the pain as angina or non-cardiac was 90.8% (kappa = 0.30), for classifying as acute coronary syndrome or stable angina pectoris (SAP) was 95.6% (kappa = 0.26) and for classifying patients as low likelihood or intermediate-high likelihood was 86.3% (kappa = 0.61). A strong consistency was shown between the emergency physicians' and cardiologists' ECG interpretation especially in determining the ST segment elevation. And also, there is a strong concordance in the likelihood classification of chest pain patients.     

Emergency department patient classification systems: A systematic review

BACKGROUND: The emergency department is a dynamic environment with a high throughput of patients. The clinical stability of patients varies considerably. In order to provide optimal care for patients a responsive staffing pattern is required. There is a need for a valid and reliable, prospective, emergency department patient classification system to set adequate nurse staffing levels in the UK. AIMS AND OBJECTIVES: To conduct a systematic review of the literature and determine the validity, reliability, strengths and weaknesses of emergency department patient classification systems. METHODS: The following electronic databases were searched for years 1985-2004: MEDLINE; CINAHL; COCHRANE Library databases DARE, CDSR, CCTR, BioMedNet Reviews, National Research Register (NRR). Manual searches were also conducted and relevant references retrieved from those listed in key papers, reports, theses and dissertations. Studies were also retrieved by contacting researchers in the field. RESULTS: Twelve patient classification systems met all the inclusion criteria. Only three systems reported evidence of good validity and reliability: the ED Patient Needs Matrix developed in the US, the Conner's Tool (a modified version of the ED Patient Needs Matrix) developed in Australia and the Jones Dependency Tool developed in the UK. CONCLUSION: There are very few patient classification systems developed for use in the ED setting that have demonstrated good validity and reliability. The Jones Dependency Tool is a simple, easy to use prospective, patient classification system that has demonstrated good validity and reliability in the UK.     

急诊绿色通道中护理工作环节的重要作用

阐述了急诊绿色通道中护理工作环节的作用,提出绿色通道运行中护理工作的3个关键环节,即:迅速评估,准确分类;密切观察,按需处置;及时联系,安全转运。急诊绿色通道的开通提高了急危重症病人的救治水平,方便了病人,护理管理者应注重环节管理,以确保通道的正常运行。     

氨基末端B型钠尿肽原在急诊呼吸困难患者诊治中的应用

目的研究氨基末端B型钠尿肽原(NT-proBNP)水平检测在急诊室呼吸困难患者诊治及充血性心力衰竭(CHF)患者心功能分级中的应用价值,并探讨CHF患者的NT-proBNP最佳诊断阀值。方法利用胶体金法对急诊的405例呼吸困难患者进行NT-proBNP检测,比较心源性呼吸困难[主要指CHF患者,166例(41%)]和非心源性呼吸困难患者[239例(59%)]之间血浆NT-proBNP水平。结果166例由CHF引起的呼吸困难患者血浆NT-proBNP的中位数(四分位数)为4 245(1 535~11 158)ng/L,明显高于239例由非CHF引起的呼吸困难患者[中位数(四分位数)为175(35~489)ng/L](P<0.001)。NYHA分级Ⅱ、Ⅲ、Ⅳ级的CHF患者的NT-proBNP水平[中位数(四分位数)分别为1 358(1 098~2 966)、3 252(1 322~9 089)、5 980(2 674~12 143)ng/L],两两比较差异均有统计学意义(P(0.05)。血浆NT-proBNP诊断CHF的最佳阈值为900 ng/L,其敏感性为90%、特异性为85%,受试者工作特征(ROC)曲线下面...     

Lack of agreement in classification of the severity of acute asthma between emergency physician assessment and classification using the National Asthma Council Australia guidelines (1998)

Aims: To determine the level of agreement in classification of the severity of acute asthma at presentation to the emergency department, between emergency physician global assessment and severity classification according to the National Asthma Council Guidelines, Australia 1998 (NACG). Methods: Prospective observational study in emergency departments throughout Australia, participating in the Asthma Snapshot 2000 project. Patients between the ages of one and 60 years presenting to participating emergency departments with acute asthma between 21 August and 3 September 2000 were included. Data collected were emergency physician global assessment of asthma severity and severity classification according to the National Asthma Council Guidelines and disposition. Results: Five hundred and five subjects had completed data for emergency physician assessment of severity and for calculation of severity classification according to the National Asthma Council Guidelines. Weighted kappa for agreement in classification was 0.48 (95% confidence interval: 0.40, 0.56). Emergency physicians assess asthma as less severe compared to the National Asthma Council Guidelines assessment. Conclusions: Agreement between physician assessment of severity of acute asthma and severity classification according to National Asthma Council Guidelines is only moderate. This may have implications in treatment and disposition. This also suggests that emergency physicians may be using other methods to classify acute asthma than the National Asthma Council Guidelines classification.     

脑钠肽水平测定在急诊呼吸困难病因鉴别中的价值

[目的]探讨血浆脑钠肽水平测定在急诊呼吸困难鉴别诊断及病情评估中的价值.[方法]测定138例急诊呼吸困难患者的血浆BNP浓度,其中88例行超声心动图仪检查测定左室射血分数(LVEF).依据病史和相关检查分为心源性呼吸困难组及非心源性呼吸困难组,比较BNP水平,同时依心脏彩超结果分为EF＞50%、EF 30%～50%、E...     

Efficacy of the Manchester Triage System: a systematic review

IntroductionThe growing number of patients in emergency departments can lead to overcrowding, often adding to organisational problems. Triage aims to predict the severity of disease, with the aim of organising patient flow. The aim of this study was to analyse the efficacy of the Manchester Triage System (MTS) for risk classification of patients.MethodsA systematic review of the literature in Ebscohost, Pubmed and Scielo (2002–2013) was undertaken. Articles were selected independently by two researchers using selection criteria. Twenty-two articles were selected for inclusion in this review.ResultsThe results support the applicability of the MTS, which has proven validity for use in children, adults, patients with coronary syndrome and patients with acute pulmonary embolism. The MTS was found to be inclusive, and to predict emergency department admission and death in the short term.ConclusionThe majority of studies found that the MTS was useful in triage of patients in emergency departments, but sub-triage and super-triage (i.e. under and over classification of severity, respectively) still occur.