ObjectiveTo investigate the status quo of emergency resources in all township hospitals in a county of Aba Autonomous Region. MethodWe set up a uniform electronic version questionnaire between April 15th and 18th, 2015. The leaders of township hospitals filled in their information and uploaded the data including emergency medical services, human resources, medical device and technology application situation. Then, the data were statistically analyzed. ResultsFor these township hospitals, the service population was 2 206.05±846.95, the service radius was (25.5±14.3) km. The number of registered doctors per 1 000 people of resident population was 1.52, the number of registered nurses per 1 000 people of resident population was 0.47, and the number of hospital beds per 1 000 people of resident population was 1.69. The staff in all township hospitals included 74 doctors and 23 nurses. The constitution of positional titles and academic qualifications of doctors and nurses in these township hospitals was not significantly different (P>0.05). All township hospitals had a total of six ambulances, one of which was ambulance for rescue and monitoring, and the others were ordinary ambulances. The devices equipped in the ambulances and hospitals were not sufficient, and most doctors and nurses could only perform surrounding vein puncture, and debridement and suture surgery. They could not recue critically ill patients alone. ConclusionsFor these township hospitals, the service radius is too long, the number of doctors and nurses is too small, and the ability of service is insufficient. In order to meet the demand of emergency resources in ethnic areas as far as possible, we should increase investment and promote medical devices, increase the number of doctors and nurses, improve the personnel structure, and strengthen professional training.
ObjectiveTo investigate the effects of medical simulation (MST) combined with case-based learning (CBL) in training of trainee doctors in emergency department. MethodA total of 120 trainee doctors practicing in the emergency department between March 2008 and December 2014 were randomly divided into two groups:MST combined with CBL group and CBL group, who accepted MST combined with CBL training and merely CBL training, respectively. The training effects were evaluated in terms of theoretical knowledge, practical operation, comprehensive abilities of case analysis and questionnaire survey. The results were compared and analyzed with the t test. The P value less than 0.05 was a significant difference. ResultsTrainee doctors in MST combined with CBL group acquired higher scores in all of the indicators (P<0.05). ConclusionsMST combined with CBL is a feasible method and has a better effect in training of trainee doctors in Emergency Department.
ObjectiveTo investigate the correlation between rapid emergency medicine score (REMS) and therapeutic intervention scoring system (TISS-28) score and analyze the feasibility of assessing the nursing workload by REMS score for critically wounded earthquake victims, in order to provide reference for rapid and effective resource allocation for earthquake victims. MethodsA retrospective analysis was carried out on 39 Lushan earthquake victims with their acute plysiology and chronic health evaluationⅡ scores higher than 25, who were directly transferred from the earthquake site to the Emergency Department of West China Hospital between April 20 and 27, 2013. Among them, there were 24 males and 15 females aged between 5 and 90 years old averaging (57.1±19.8) years. REMS score and TISS-28 score were calculated for each victim. The relationship between REMS score and TISS-28 score was analyzed by correlation analysis and curve estimation including linear model, quadratic model, composite model, growth model, logarithm model, cubic model and exponential model. Then, we tried to find out the most suitable description for the relationship between REMS score and TISS-28 score. ResultsThe Spearman correlation coefficient between the two score systems was 0.710 and the most suitable description for the relationship between REMS score and TISS-28 score was logarithmic curve model. The formula was TISS=-5.946+4.467lnREMS. ConclusionREMS score can be applied as a nursing workload predicting tool for critically wounded victims in Lushan earthquake and it provides a guidance for rational allocation of health resources.
摘要:目的:探讨急诊医疗过程中意外死亡的原因,以引起广大同道的重视。方法:对急诊就诊过程中24 h内死亡且符合入选标准的68例患者进行死亡原因分析,分析意外死亡常见的病因并探讨死亡原因与就诊之初临床特征的关系。结果:68例意外死亡患者占同期死亡人数的4.39％,其中主动脉夹层31例,占同期死亡2％,占意外死亡的45.6％;心脏性猝死(急性心肌梗塞9例,心肌炎4例,)13例占同期死亡病人的0.84％,占意外死亡总数的191％;急性脑血管病(小脑出血5例,小脑梗塞8例)13例,占同期死亡人数的0.84％,占意外死亡总数的19.1％;重症哮喘3例;不明原因死亡5例。临床特征多为胸痛、胸背痛、头痛、上腹痛、眩晕等为首发症状。结论:急诊就诊过程意外死亡发生取决于多种因素,由于这些病例症状多不典型,病情复杂多样,临床医师极易忽视,临床极易漏诊、误诊,一旦发生,都将引起较大的医疗纠纷,耗费大量的人力物力。因此对急诊就诊过程中的不典型特征高度重视及时考虑主动脉夹层、心脏性猝死、急性脑血管病,早期治疗,避免意外死亡的发生。Abstract: Objective: To explore the character of accidental death during treatment in emergency department, and get more attention of other emergent doctors to avoid death in emergent treatment.Methods: To analysis death causes of 68 qualified patients, who died within 24 hours after they went to hospital; To analysis familiar accidental death causes and the relationship between them and initial clinical signs. Results:These 68 accidental dead patients occupied 4.39% in all dead patients during the same period, including 31 cases of aortic dissecting hematoma(2% in all dead patients vs 45.6% in accidental dead patients); 13 cases of sudden cardiac death(0.84% in all dead patients vs 19.1% in accidental dead patients), which included 9 cases of acute myocardial infaction, 4 cases of myocarditis; 13 cases of acute cerebravascular diseases(0.84% in all dead patients vs 19.1% in accidental dead patients),which included 5 cases of cerebella hemorrhage and 8 cases of cerebella infarction; 3 severe asthma and other 5 cases without exact reasons. Clinical initial showed frequently the pain of breast, breast and back, head and upper belly, and dizzling. Conclusion: The happening of accidental death during treatment in emergent department was decided by many complicated factors. Because being nontypical and complicated, these factors always were ignored by clinical doctors, resulting wrong diagnosis or leaked diagnosis, which brought many clinical dissensions. Clinical dissensions cost much money and energy. So to know and pay more attention to these nontypical signs is very important to diagnosis aortic dissecting hematoma, sudden cardiac death and acute cerebravascular diseases, and is helpful to treat in time, and consequently the death was avoided.
Improving the quality of infection management in outpatient and emergency departments is crucial for ensuring medical safety and advancing infection control practices. To enhance the level of infection management in outpatient and emergency departments, Tengzhou Central People’s Hospital developed a two round risk assessment system for outpatient and emergency departments hospital infection management using risk matrix and failure mode and effects analysis methods, including hospital-outpatient and emergency departments, very high risk outpatient and emergency departments-high risk point. Based on the enterprise risk management integration framework, the risk management system has been optimized to provide decision support for the prevention and control of outpatient and emergency departments hospital infection. This article will introduce the practical exploration experience of optimizing management in outpatient and emergency departments hospital infection based on risk assessment.
ObjectiveTo identify the risk factors for hospital mortality in patients with acute myocardial infarction (AMI) after emergency coronary artery bypass grafting (CABG).MethodsWe retrospectively analyzed the clinical data of 145 AMI patients undergoing emergency CABG surgery in Qingdao Municipal Hospital from 2009 to 2019. There were 108 (74.5%) males and 37 (25.5%) females with a mean age of 67.7±11.5 years. According to whether there was in-hospital death after surgery, the patients were divided into a survival group (132 patients) and a death group (13 patients). Preoperative and operative data were analyzed by univariate analysis, followed by multivariate logistic regression analysis, to identify the risk factors for hospital mortality.ResultsOver all, 13 patients died in the hospital after operation, with a mortality rate of 9.0%. In univariate analysis, significant risk factors for hospital mortality were age≥70 years, recent myocardial infarction, left ventricular ejection fraction (LVEF)<30%, left main stenosis/dissection, operation time and simultaneous surgeries (P<0.05). Multivariate logistic regression analysis showed that LVEF<30% (OR=2.235, 95%CI 1.024-9.411, P=0.014), recent myocardial infarction (OR=4.027, 95%CI 1.934-14.268, P=0.032), operation time (OR=1.039, 95%CI 1.014-1.064, P=0.002) were independent risk factors for hospital mortality after emergency CABG.ConclusionEmergency CABG in patients with AMI has good benefits, but patients with LVEF<30% and recent myocardial infarction have high in-hospital mortality, so the operation time should be shortened as much as possible.
Objective To summarize the clinical therapeutic efficacy of emergent laparoscopic cholecystectomy （LC） and emergent open cholecystectomy （OC）. Methods One hundred and thirty-three patients with acute cholecystitis from March 2011 to June 2012 in this hospital were randomly divided into emergent LC （ELC） group and emergent OC （EOC） group. The examination and treatment before and after operation were the same. The clinical data before and during operation， postoperative complications， and recovery conditions were observed and compared. Results There was no obvious difference of the clinical data before operation between the ELC group and EOC group （P＞0.05）. Also， there were no significant differences of the operation time， biliary duct injury rate， postoperative bleeding rate， and reoperation rate in two groups （P＞0.05）. The time of postoperative anal exsufflation， time of out-of-bed activity， and postoperative hospital stay in the ELC group were significantly shorter than those in the EOC group （P＜0.05）， the poor incision healing rate in the ELC group was significantly lower than that in the EOC group （P＜0.05）， and the intraoperative blood loss in the ELC group was significantly less than that in the EOC group （P＜0.05）. Conclusions ELC as compared with EOC， are less intraoperative blood loss， less postoperative complications， more rapid recovery， and do not increase operation time. In a hospital with skilled LC technique， ELC is safe and feasible， has obvious advantages of minimal invasion.