两针法股静脉穿刺置管抢救小儿失血性休克

目的为失血性休克患儿快速建立有效补液途径,提高抢救成功率。方法将100例外伤致失血性休克患儿随机分为观察组和对照组各50例。对照组采用传统股静脉穿刺方法;观察组以股动脉搏动内侧0.3～0.5cm或脐部引一直线垂直于腹股沟的垂直交叉点内侧约0.5cm定位为第1针穿刺点,第1针穿刺点垂直下方3.0～4.0cm处为第2针穿刺点留置股静脉置管。结果观察组留置成功率显著高于对照组,操作时间显著短于对照组(均P<0.01)。结论两针法股静脉穿刺置管能保证失血性休克患儿静脉通道及时建立。     

The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients

Background and objectiveThe National Emergency X-Radiography Utilization Study (NEXUS) criteria are used to assess the need for imaging to evaluate cervical spine integrity after injury. The aim of this study was to assess the sensitivity of the NEXUS criteria in older blunt trauma patients.MethodsPatients aged 65 years or older presenting between 1st July 2010 and 30th June 2014 and diagnosed with cervical spine fractures were identified from the institutional trauma registry. Clinical examination findings were extracted from electronic medical records. Data on the NEXUS criteria were collected and sensitivity of the rule to exclude a fracture was calculated.ResultsOver the study period 231,018 patients presented to The Alfred Emergency & Trauma Centre, of whom 14,340 met the institutional trauma registry inclusion criteria and 4035 were aged ≥65 years old. Among these, 468 patients were diagnosed with cervical spine fractures, of whom 21 were determined to be NEXUS negative. The NEXUS criteria performed with a sensitivity of 94.8% [95% CI: 92.1%–96.7%] on complete case analysis in older blunt trauma patients. One-way sensitivity analysis resulted in a maximum sensitivity limit of 95.5% [95% CI: 93.2%–97.2%].ConclusionCompared with the general adult blunt trauma population, the NEXUS criteria are less sensitive in excluding cervical spine fractures in older blunt trauma patients. We therefore suggest that liberal imaging be considered for older patients regardless of history or examination findings and that the addition of an age criterion to the NEXUS criteria be investigated in future studies.     

Ⅰ期前后路手术治疗下颈椎骨折脱位

目的 评价Ⅰ期前后路手术治疗下颈椎骨折脱位伴关节突绞锁的可行性和近期临床效果.方法 对27例下颈椎骨折脱位伴关节突绞锁的患者,Ⅰ期行后路复位和前路减压植骨内固定术,定期X线摄片观察损伤节段的稳定性和融合率,观察有无并发症发生,以ASIA分级判定脊髓功能的恢复情况.结果 随访6～32个月(平均21.5个月),27例患者均获得了完全复位,损伤节段稳定,颈椎高度和生理曲度维持良好,融合率为100%,内固定位置良好,无植骨块脱出或钢板、螺钉松动、断裂等并发症,脊髓功能平均提高1.4级,无一例患者出现神经症状加重.结论 Ⅰ期前后路手术治疗下颈椎骨折脱位伴关节突绞锁可获得满意的复位、彻底的减压和即刻稳定性的重建,有利于脊髓功能的恢复,近期临床疗效满意.     

Psychological well‐being and psychosocial work environment characteristics among emergency medical and nursing staff

The aim of this study was to determine if the effect of psychosocial work environment on psychological well‐being was different for doctors and nurses who work in emergency departments in Spain. A cross‐sectional survey was carried out among 945 emergency doctors and nurses staff from Spain. The outcome variable was the psychological well‐being measured by two dimensions of SF‐36 Health Survey (SF‐36) (mental health, vitality) and one dimension of Maslach's Burnout Inventory (emotional exhaustion). The explanatory variable was the psychosocial work environment evaluated according to Karasek and Johnson's demand‐control model that includes the dimensions of psychological demands, job control, supervisor social support and co‐workers' social support. The adjusted odds ratios and their 95 per cent confidence intervals were calculated by logistic regression. The prevalence of low vitality, bad mental health and high emotional exhaustion was higher among doctors than nurses. Exposure to high psychological demands increased the probability of low vitality, bad mental health and high emotional exhaustion among doctors and nurses. Low job control and low co‐workers' social support at work were associated with poor psychological well‐being only among doctors. Low job supervisors' social support increased the risk of bad mental health among doctors and of high emotional exhaustion among nurses. There is a different effect of psychosocial work environment on psychological well‐being between doctors and nurses. Copyright © 2007 John Wiley & Sons, Ltd.     

Percutaneous transtracheal emergency ventilation with a self-made device in an animal model

BACKGROUND: Special equipment for emergency percutaneous transtracheal ventilation is often not immediately available. We used a self-made device consisting of a three-way stopcock connected between a G-15 transtracheal airway catheter and an oxygen supply in a simulated 'cannot intubate, cannot ventilate' scenario and tested the hypothesis that the effectiveness of the device depends on the body weight of the experimental animals. METHODS: With approval of the local animal protection committee, two groups of six pigs each with a body weight of 21 +/- 2 and 36 +/- 6 kg, respectively, were tracheally intubated and mechanically ventilated after induction of anesthesia. Hemodynamic monitoring included cardiac output and arterial, central venous and pulmonary artery pressures. An emergency transtracheal airway catheter was inserted into the trachea and a situation of partial expiratory airway obstruction was created. Each animal was ventilated for 15 min via the transtracheal airway catheter with the self-made device (FiO(2) 1.0 at an oxygen flow of 15 l x min(-1); respiratory rate of 60 min(-1); I/E ratio approximately 1:1). RESULTS: Whereas satisfactory oxygenation was achieved in all animals, sufficient ventilation was obtained only in the lightweight animals. CONCLUSIONS: Adequate oxygenation could be provided by jet-like transtracheal ventilation with a simple self-made device using easily available materials. Sufficient ventilation depends on the body weight of the animals.     

颌面部急诊手术的特点与护理管理对策

目的:分析本院颌面部急诊手术的特点并提出对策,以便提高护理质量,提高患者满意度。方法:回顾分析西安交通大学口腔医院2011年1月～2012年8月急诊患者住院资料,统计急诊手术病种、分布时间,提出相应对策。结果:共诊疗169例急诊患者,颌面部急诊手术外伤最多见,占76.33%,外伤平均每月5.63例,间隙感染占急诊手术总数19.52%,平均每月1.5例;前3个月的统计量明显低于平均水平,而相应的4～8月则高出平均水平。结论:本院急诊以外伤与感染为主,主要为外伤;4～8月份外伤较多,主要与衣着较少有关。     

团队管理模式在儿科急诊护理管理中的应用

目的探讨团队管理模式在儿科急诊护理管理中的应用。方法选择2017年9月～2018年11月治疗并进行儿科急诊护理的患儿112例作为对象,采用随机数字表法分为对照组(n=56)和观察组(n=56)。对照组给予常规管理,观察组采用团队管理模式,管理1个月后对患者效果进行评估,比较两组患儿管理前后生活质量、相关指标、管理有效率。结果管理前两组生理方面、生活方面、心理方面评分差异均无统计学意义(P0.05)。经团队管理模式管理后,观察组患儿的生理方面、生活方面、心理方面的评分均高于对照组,差异有统计学意义(P0.05)。经团队管理模式管理后,观察组的VAS评分低于对照组,首次下床时间及术后住院时间均短于对照组,差异有统计学意义(P0.05)。观察组总有效率为78.57%,对照组总有效率为64.29%。观察组总有效率明显高于对照组,差异有统计学意义(P0.05)。结论将团队管理用于儿科急诊护理管理中能提高患儿的生活质量和管理有效率,减轻患儿的痛苦,缩短患儿首次下床时间和术后住院时间,值得临床推广应用。     

腹腔镜技术在胃肠外科急腹症中的应用

目的探讨腹腔镜技术在腹部外科急腹症诊断和治疗中的应用。方法回顾性分析2008年10月至2011年10月问解放军总医院普通外科收治的因诊断不明确而接受腹腔镜探查术44例急腹症患者的临床资料。并与同期行急诊剖腹探查术的65例患者资料进行比较分析。结果经腹腔镜探查的44例患者中,有42例患者（95．5％,42／44）在腹腔镜下明确诊断,其中34例（77．3％）患者在明确诊断的同时于腹腔镜下完成手术治疗,全腔镜下处理20例,小切口辅助14例。与传统剖腹探查术患者相比,腹腔镜探查术手术切口长度明显缩短[（6．7±2．2）cm比（15．8±3．4）cm]、术中出血明显减少[（51．4±303）ml比（117．9±49．5）m1]、术后胃肠功能恢复明显加快[术后进食时间（15．0±6．1）d比（30．5±8.4）d]和术后住院时间明显缩短[（5．6±4．2）d比（8．4±4．8）d],差异均具有统计学意义（均P〈O．05）,而且手术费用也并未见明显增加[（1．2±0．8）万元比（1．4±0．5）万元,P〉O．05]。结论腹腔镜探杏技术在腹部外科急腹症患者中的应用安全、有效．可在明确病因的同时实施治疗。     

1990年广州白云机场“10·2”空难的灾害医学分析

1990年10月2日上午，广州白云机场发生了因歹徒劫机而紧急着陆造成的大空难，现场死亡120人，受伤65人（8名伤员送医院后抢救无效死亡），生还102人。事发后，在机场当局、公安、武警、消防、医疗抢救组的密切配合下，40min内完成了现场的伤员抢救工作。这次空难的灾害医学应急反应是快速、高效的，体现了广州白云机场当局对机场重大空难的灾害应急计划和医学救援的能力，但也暴露了一些问题，如现场医学救援的统一指挥、伤员的分类、后送时机和医院的选择、以及身份识别等问题都有待进一步总结和改进。本次空难的伤亡情况分析揭示，这类灾害的救护重点是颅脑伤和烧伤，紧急情况下嘱乘客取弯腰、屈膝、双手抱头紧靠前座椅背的姿式，可减少伤亡。