An action research investigation into the feasibility of experienced registered sick children's nurses (RSCNs) becoming children's emergency nurse practitioners (ENPs)

• ? Emergency nurse practitioners (ENPs) formally developed in accident and emergency (A & E) departments as a direct response to waiting times for the walking wounded, the need to reduce junior doctors hours and changes in nursing practice.
• ? ENPs existed informally for many years in minor injuries units and specialist ophthalmic departments.
• ? This study aimed to examine whether or not the role of ENP could be applied to the specialist service of a paediatric casualty department.
• ? The results showed that 3% of patients could be seen and treated to conclusion by a children's ENP, and some patients could have their care accelerated by a children's ENP.
• ? The introduction of children's ENPs would have an impact on waiting times, junior doctors work-load and the quality of patient care.

     

Anaesthetic management of acute blunt thoracic trauma

Sunnybrook Health Science Centre is an adult regional trauma unit serving metropolitan Toronto and environs. We undertook a nvo-year retrospective review of patients admitted to our institution with blunt thoracic trauma. Three hundred and thirty-three patients with blunt trauma and an injury severity score (ISS) greater than 17 required emergency surgery. Of these, 208 had blunt thoracic injuries while 125 did not have chest injuries. Both groups were similar with respect to age but patients with thoracic trauma had a greater ISS. (P < 0.05) and greater intraoperative mortality (P < 0.01). The aetiology of the intraoperative deaths with one exception was exsanguination. Emergency thoracotomy or sternotomy indicated a poor prognosis with a mortality rate of 80%. The most common intraoperative problem was an elevated airway pressure. Awake intubation was undertaken in 77.5% of patients requiring anaesthesia and surgery because of the potentially compromised airways and difficult intubations due to the nature of the associated injuries. Finally, 74% of patients undergoing urgent surgery required mechanical postoperative ventilation. The presence of blunt chest trauma should be considered a marker of the severity of injury sustained by the patient.     

通腑泄热豁痰法治疗急性脑出血42例疗效观察

目的:观察通腑泄热豁痰法治疗急性脑出血的临床疗效。方法:将80例患者随机分为2组。治疗组42例根据病情对症采用西医常规处理,并口服或鼻饲通腑泄热豁痰方药;对照组38例以常规西药治疗。2组均以4周为1疗程,观察2组疗效及意识状态、运动功能的变化。结果:治疗组显效32例,有效3例,无效2例,死亡5例,总有效率83.3％;对照组显效19例,有效4例,无效6例,死亡9例,总有效率60.5％。2组总有效率比较,差异有显著性意义(P<0.05)。治疗组治疗后意识状态及运动功能评分均显著提高(P<0.001)。结论:通腑泄热豁痰方药对急性脑出血效果显著优于常规西药治疗。     

福州120院前急救系统2341例患者呼救原因、时间与年龄的对应分析

目的 研究福州市120院前急救系统的呼救原因、时间与患者年龄3个指标间的关系，为制订处理措施提供依据。方法 收集福州市120院前急救调度室1997年至2000年的呼救信息资料，以15％的比例从约1．5万例数据中，单纯随机抽样2341例，以SPSS8．0 for Windows建立数据库，以其中的对应分析(ANACOR)命令进行统计分析与绘图。结果 上午为心脑血管疾病，上夜为交通事故肇事及挫裂挤压伤的多发时间。14～29岁青年人交通事故肇事及挫裂挤压伤多见，30～59岁壮年人急性胃肠炎多见，60岁以上老年人心脑血管疾病多见。其它几项指标间未见明显的对应关系。结论 对应分析表明120院前急救系统呼救原因、时间和患者年龄间有一定的对应关系，这对于制订相应措施、提高警惕、妥善处理有参考价值。     

Cranial CT interpretation by senior emergency department staff

The aims of the present study were to determine the rate of misinterpretation of non‐contrast cranial CT scans by emergency specialists and trainees compared with specialist radiologists, and the proportion of misinterpretations that is consequential. A 12‐month prospective blinded cohort study was performed. One‐hundred and ninety of 1282 scans (14.8%) were misinterpreted, and 78 of these (41.1%) were of potential or actual consequence. We conclude that the performance of senior emergency department staff in non‐contrast cranial CT interpretation is no better than moderately good, and a large proportion of misinterpretations are of potential or actual clinical consequence.     

The use of intravenous nitroglycerin for cervico-uterine relaxation: a review of the literature

The safety, predictability, and ease of intravenous administration of nitroglycerin (NTG) have been firmly documented. In recent years, intravenous NTG has come to the attention of the obstetrician as a potent uterine relaxant. Intravenous nitroglycerin has been used to relax the uterus during manual extraction of retained placenta and to permit replacement of a contracted, completely prolapsed, inverted uterus. The use of this agent as a tocolytic has previously been reported in cesarean delivery of twins, in cases of intra partum external cephalic version, and for internal intrapartum podalic version of the second twin. This new procedure was also used for fetal head entrapment after vaginal breech delivery. The authors report a review of the literature about this subject. Received: February 1997 / Accepted: 20 June 1997     

恶性上腔静脉综合征的坐位急诊放射治疗

目的回顾性分析不能常规卧位放疗的恶性上腔静脉综合征坐位急诊放疗的疗效。方法12例患者先坐位急诊放疗6MV—X DF300CGY／次／天；总剂量DT3000CGY／10次／2周。待症状明显缓解已基本能平卧后再改用常规卧位放疗补量DT3000—4000CGY／15—20次／3—4周。结果2周内总缓解率92％(11／12)，整个放疗计划完成后总有效率100％(12／12)。结论病情较重、病期较晚无法耐受化疗和常规卧位放疗的患者先坐位急诊放疗待症状部分缓解后再改常规卧位放疗能迅速改善症状，提高生活质量，为下一步治疗创造有利条件。     

黑龙江省医疗机构突发事件监测能力的影响因素分析

采用定性与定量相结合的方法对黑龙江省部分医疗机构突发公共卫生事件监测情况调查研究.结果显示:现阶段影响医院应急预警信息收集与上报能力的主要因素为:人员、资金、政策支持、培训演练;其中影响人员信息收集与上报能力的因素为:预案知晓情况、传染病的知晓情况、传染病报告时限的了解情况、医院类别.     

综合医院应对危机和突发公共卫生事件的探讨

各种各样的灾难对人类造成的危害与日俱增,综合医院如何应对危机和突发公共卫生事件是一个新的课题.就危机和突发公共卫生事件发生医院可能遇到的问题,如何增强危机意识,构建现代危机和突发公共卫生事件管理体系,努力培养医学救治队伍等问题进行了探讨.     

院前系统救治对重度急性有机磷农药中毒预后的影响

目的探讨口服重度急性有机磷农药中毒(SAOPP)患者服毒至救治时间(无治疗期)的长短与患者预后的关系。方法选择经过院前系统救治后接回医院的174例SAOPP患者作为治疗组,自行前往医院或拒绝院前洗胃者160例为对照组。两组治疗方法为洗胃、应用氯磷定、阿托品及对症治疗等综合措施。统计患者无治疗期的长短与死亡、严重并发症的发生情况;观察症状消失时间、全血乙酰胆碱酯酶(AChE)活力恢复至正常时间、阿托品化时间、阿托品用量、氯磷定用量、纳洛酮用量与住院天数等指标。结果治疗组无治疗期时间为(1.2±0.3)h,而对照组为(2.8±0.5)h,差异有统计学意义(P<0.01);治疗组死亡11例(死亡率6.32%),对照组死亡36例(死亡率22.50%),差异有统计学意义(P<0.01);治疗组呼吸衰竭、心脏损害、脑损害、阿托品中毒、中间综合征、肝损害发生率分别为12.64%、5.75%、8.62%、1.72%、4.60%、5.17%,与对照组(25.63%、13.75%、17.50%、6.25%、7.50%、9.38%)的差异有统计学意义(P<0.05或P<0.01);治疗组的中毒症状消失时间、阿托品化时间、AChE恢复至正常时间、阿托品用量、氯磷定用量、纳络酮用量、住院天数各指标均明显优于对照组,差异有统计学意义(P<0.05或P<0.01)。结论院前系统救治可改善SAOPP患者的预后,值得推广应用。