氢氧化钙根管内封药预防根管治疗期间的急症

目的：探讨氢氧化钙（calcium hycroxide,CH)根管内封药对根管治疗期间急症（Endodontic interappointment emergencies,IAE)的预防效果。方法：对使用不同药物根管内封药IAE的发生率进行比较。结果：CMCP、PC、IPI、CH组IAE发生率分别是为22．0％、28．0％、26．0％和4．0％，有非常明显的差异，疼痛指数亦以CH组最优。结论：CH根管内封药，对IAE的发生有较好的预防作用。     

Simulation of medical emergencies in dental practice: development and evaluation of an undergraduate training programme

Background: The evidence available suggests that many dentists on graduation do not feel competent managing medical emergencies; a problem requiring improved undergraduate training. This study developed a comprehensive simulation based training programme for final year undergraduate dental students and assessed student attitudes towards training. Methods: Final year dental students (n = 52) from The University of Melbourne were required to complete simulation training incorporating an interactive tutorial and realistic, simulated emergency scenarios conducted in the students’ real clinical environment. A post‐participation questionnaire utilizing a 5‐point Likert scale (1 = strongly disagree, 5 = strongly agree) assessed student attitudes. Results: Student responses supported simulation training, evidenced by the following selected questionnaire responses: achieved greater confidence in managing emergencies 4.65 ± 0.48 (n = 52); prefer lecture to simulation 1.46 ± 0.74 (n = 52); simulation training is important in undergraduate teaching 4.86 ± 0.35 (n = 43). Conclusions: Realistic simulation training in management of medical emergencies for dental students is an effective adjunct to traditional lecture style teaching. Given the importance of this subject, this mode of training would benefit students if incorporated into undergraduate dental courses.     

Treatment of poisoning induced cardiac impairment using cardiopulmonary bypass: a review

Severe poisoning can cause potentially fatal cardiac depression. Cardiopulmonary bypass (CPB) can support the depressed myocardium, but there are no clear indications or guidelines available on its use in severe poisoning. A review was conducted of relevant papers in the available literature (seven single case reports of both deliberate and accidental ingestion of cardiotoxic drugs and two animal studies). Although CPB is rarely used in the management of poisoning, it may have potential benefits for haemodynamic instability not responding to conventional measures. At present there is insufficient evidence concerning the use of CPB as a treatment for severe cardiac impairment due to poisoning (grade C). This review suggests that in patients with severe and potentially prolonged reversible cardiotoxicity there is potential for full survival with CPB, provided that the patient has not already sustained hypoxic cerebral damage due to resistant hypotension prior to its use.     

导泻排毒液清除化道毒物治疗急性中毒的实验研究

目的：探讨导泻排毒液通过清除消化道残留毒物而治疗急性中毒的机制。方法：观察导泻排毒液对小白鼠胃排空的影响;对小鼠白鼠肠功能的;对家兔离体肠平滑肌的影响。对大白鼠口服苯巴比妥血药浓度的影响。结果：导泻降低小白鼠胃中甲基残留率,有促进胃排空作用,能提高小白鼠肠道炎末推进率,有增强肠道推进功能作用。能使家兔离体肠客收缩幅度增大,蠕皮明显加深,肠管肌张力明显增加,能降低大白鼠口服苯巴比妥血药浓度。与对照组     

Nicotinic acid treatment for Paralepistopsis acromelalga intoxication: assessment using magnetic resonance imaging

Context: Paralepistopsis acromelalga, formerly known as Clitocybe acromelalga, is a rare poisonous mushroom. The mycotoxins in this mushroom cause symptoms resembling those of erythromelalgia; however, its pathogenesis remains unclear. In this report, a patient who received nicotinic acid treatment for P. acromelalga poisoning and radiological evaluation for erythromelalgia has been presented.

Case detail: A 59-year-old woman was hospitalized for redness, swelling, and burning pain in her extremities that rendered difficulty in walking, and a diagnosis of P. acromelalga poisoning was made by detailed interview and mushroom identification. She was treated with intravenous nicotinic acid for 17 days followed by oral nicotinic acid amide for 2 months. She exhibited rapid symptomatic improvement and walked independently after 11 days of initial treatment. Initial MRI of her feet revealed toe-dominated subcutaneous thickening. After nicotinic acid treatment, those radiological findings improved dramatically.

Discussion: The subcutaneous thickening evident on MRI indicated P. acromelalga poisoning-induced erythromelalgia involved subcutaneous inflammatory edema. The typical duration of edema without treatment is more than a month. The improvement on MRI after nicotinic acid treatment indicated that the adequate vasodilation induced by nicotinic acid contributed to resolution of the symptoms. Nicotinic acid was associated with the improvement of the edematous changes caused by the P. acromelalga intoxication.     

Emergency Medical Care of Multiple Sclerosis Patients: Primary Data from the Mount Sinai Resource Utilization in Multiple Sclerosis Project

Background and Purpose

There has been no systematic analysis of emergency department (ED) utilization in the multiple sclerosis (MS) population. We investigated the acute-care needs of MS patients using ED as a route for entry into healthcare services.

Methods

ED visits made by MS patients were identified. Data extracted included demographics, medical/neurological history, and workup/management in the ED.

Results

The Mount Sinai ED received 569 visits from 224 MS patients during a 3-year period, of whom 33.5% were covered by Medicaid and 12.9% were uninsured. Patients with an Expanded Disability Status Scale score of ≥6 accounted for 54%, 50.5% of relapsing remitting MS patients were being treated with disease-modifying therapies, and 74.5% of the ED visits were non-neurological. Patients with mild-to-moderate MS were more likely to present to the ED for issues directly related to MS such as acute exacerbations, while those with severe MS presented more often due to medical issues indirectly related to MS, such as urinary tract infections (p<0.0001).

Conclusions

Most MS patients seeking ED care suffer from acute non-neurological problems. The MS patients presenting to the ED tended to be underinsured, had high levels of disability, and were undertreated with disease-modifying therapies. The acute-care needs of MS patients evolve over the disease course, as do the resources that must be utilized in providing emergency care across the spectrum of MS severity. Understanding the characteristics, problems, and needs of MS patients utilizing the ED is an important step in improving care in this population from both clinical and public health perspectives.     

Nurse triage, diagnosis and treatment of eye casualty patients: a study of quality and utility

INTRODUCTION: Patients presenting to the Accident and Emergency department of a district general hospital with an eye problem are referred directly to a dedicated eye casualty service. They are then triaged by a staff nurse from the eye department. This eye casualty sees around 8000 patients per annum. This study assesses whether the nurse triage of eye casualty patients forms an effective filter of problems which do not require the attention of the doctor on duty. The incidence of cases of misdiagnosis and inappropriate discharge of patients resulting in a delay in diagnosis and treatment was also assessed. METHODS: All patients presenting in a 3-month period managed solely by the triage nurse, were identified from the casualty register, and the hospital records retrieved and examined. RESULTS: Four hundred and forty of a total 1976 patients (22%) were seen exclusively by triage nurses; eight (2.5%) of these 440 patients returned unplanned to the eye department. In all cases it was considered that the return of the patient would not have been preventable by initial attention of the ophthalmologist on duty.DISCUSSION: With appropriate threshold for referral, nurses trained in slit lamp examination can offer a successful service to safely diagnose and treat common eye casualty presentations.     

The experience of the nurse at triage influences the timing of CPAP intervention

Increasing attention in the last decade has shown that intervention of continuous positive airway pressure therapy (CPAP) in cardiogenic pulmonary oedema (CPO) markedly improves the outcome of patients presenting with acute respiratory failure. This study used a non-experimental correlational design to research the relationship between the experience of the nurse, with the application of CPAP to patients presenting to a metropolitan emergency department with CPO and to establish what difference, if any, CPAP made to outcomes. A retrospective audit of records was used to extract data on all 54 patients that received CPAP over a 12-month period. The primary outcome measures were off CPAP within 2 h, transfer to intensive care unit (ICU) or cardiac care unit (CCU) and secondary outcome measures were length of hospital stay and death. There was a trend towards more experienced nurses attending patients who required immediate treatment or treatment within 10 min. These patients were more likely to be recognised at triage as requiring CPAP therapy. The early application of CPAP reduced hospital mortality, length of stay, and the need for intubation and ventilation. Attention needs to be given on how best to educate nurses so that more patients presenting with acute respiratory failure can benefit from nurses' decision-making regarding the commencement of CPAP.     

食物及药物中毒性急性肾功能衰竭血液透析治疗

目的 总结分析38例食物及药物中毒性急性肾功能衰竭患者经血液透析治疗后肾功能恢复正常的经验。方法 38例误食毒性物质或药物后发生急性肾功能衰竭患者(18例毒蕈中毒,14例鱼胆中毒,药物中毒6例)经临时血液透析通路进行血液透析。结果 38例患者经血液透析治疗后随访半年至一年尿量及肾功能均恢复正常。结论 血液透析是治疗急性食物或药物中毒导致急性肾功能衰竭的有效治疗方法之一。