Search

Diary of a Rescue Team Member in April 20th Lu-shan Earthquake

Lu-shan earthquake occurred at 8:02 am, on April 20th, 2013. The epicenter of earthquake was located in Lu-shan county, Ya’an city, Sichuan province, about 100 km from Chengdu along the Longmenshan fault zone in the same province heavily impacted by the 2008 Wenchuan earthquake. The earthquake has resulted in 196 people dead, 24 missing, at least 11,470 injured as of 14:30, April 24th, 2013. After Lu-shan earthquake, medical rescue teams were dispatched from the West China Hospital, Sichuan University to the stricken area. This article written by a member of the rescue team reported the difficult and dangerous rescue work and the performance of rescue members in the stricken area.

Consistency Analysis of JumpSTART Triage System and Injury Severity Score for Mass Casualties Including Children

目的　探讨适用于儿童的JumpSTART检伤分类程序在大型车祸所致的含儿童群体伤中，对患儿受伤严重程度评估的实践意义。 方法　回顾性分析2010年12月－2012年12月因大型车祸所致群体伤（3例以上伤员，至少含1例14岁以下儿童）就诊的20例患儿的病历资料。入急诊时对患儿行JumpSTART检伤分类程序，入院确诊后行国际公认的能较准确反映伤情严重程度的损伤严重度评分（ISS）。比较两种评估方法的一致性。 结果　JumpSTART检伤分类程序与ISS评分一致性较好（Kappa=0.474，P=0.003）。 结论　JumpSTART检伤分类程序可在含儿童的群体伤医疗急救时，初步评估患儿伤情严重度，从而进行检伤分类。

旧金山晕厥规则对急诊晕厥患者的评估价值

目的　探讨旧金山晕厥规则对国内以晕厥就诊的急诊患者发生严重不良后果及需要住院治疗有无评估价值。 方法　根据旧金山晕厥规则，将2009年1月1日－3月31日期间纳入的100例患者分为高危晕厥组（29例）和低危晕厥组（71例），比较两组患者入院情况，进而评估旧金山晕厥规则对晕厥患者是否需要入院和再入院情况有无预测价值。 结果　高危组和低危组住院的患者分别为25例和40例，分别占所在组总人数的86.2%和56.3%，两组间差异有统计学意义（P=0.004）。 结论　旧金山晕厥规则对急诊晕厥患者的快速评估和分流有一定的临床应用价值。

Clipless Laparoscopic Cholecystectomy for Patients with Calculous Cholecystitis in Acute Inflammation Stage

ObjectiveTo evaluate the feasibility of clipless laparoscopic cholecystectomy (LC) to patients with calculous cholecystitis in acute inflammation stage. Methods The clinical data of 169 patients with calculous cholecystitis in acute inflammation stage who underwent clipless LC from December 2008 to July 2010 were analyzed. ResultsAll patients were successfully operated by LC except one case who suffered from gallbladder perforation and a conversion to open surgery was performed. The operation time ranged from 25-70 min (mean 38 min). The blood loss ranged from 10-200 ml (mean 22 ml). Peritoneal drainage was done in 38 patients, and the drainage time ranged from 1-6 d (mean 1.8 d). The time to out-of-bed activity was at 2 h after operation and the hospitalization time was 3-7 d (mean 3.5 d). There was no complication such as bile duct injury, hemorrhage, billiary leakage, and intra-abdominal infection. ConclusionWith improvement of operator’s experiences and skills, the clipless LC becomes feasible and safe for patients with calculous cholecystitis in acute inflammation stage.

早期干预对缓解急诊危重患者心理危机

【摘要】　目的　通过对急诊重症监护室（emergency intensive care unit，EICU）患者心理干预对照试验，总结早期心理干预在急诊临床中的意义。　方法　将2009年10月－2010年10月入住急诊EICU的46例患者，根据就诊单双号顺序分为对照组和试验组，每组23例。对照组按整体护理常规进行，试验组在常规护理基础上加行心理干预，通过测量两组患者干预前后的焦虑评分值，判断心理干预的效果。　结果　患者入住EICU时试验组、对照组焦虑量表基线评分分别为（19.35±5.83）、（19.69±6.03）分，两组差异无统计学意义（t=0.066，P=0.948）；24 h后评分，试验组、对照组评分分别为（12.00±7.18）、（28.91±9.18）分，两组比较，差异有统计学意义（t=6.959，P=0.000）。试验组的焦虑评分较入EICU评分差异有统计学意义（Plt;0.001）；对照组焦虑评分较入EICU时升高，差异有统计学意义（Plt;0.001）。　结论　早期干预对缓解急诊危重患者心理危机有一定帮助。

Diagnostic Value of Procalcitoninfor Tuberculous Pleural Effusion: A Meta-Analysis

ObjectiveTo systematically review the diagnostic value of procalcitonin (PCT) for tuberculous pleural effusion. MethodsWe electronically searched CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library and EMbase from inception to April, 2013, to collect the literature about the diagnostic value of PCT for tuberculous pleural effusion compared with gold standard (positive outcomes of mycobacterium tuberculosis culture). Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. MetaDiSc 1.4 were used to conduct the meta-analysis. ResultsEight studies were finally included. The results of meta-analysis showed the pooled sensitivity and specificity were 0.63 (95%CI 0.58 to 0.68) and 0.76 (95%CI 0.70 to 0.81), respectively. The positive likelihood ratio and negative likelihood ratio were 2.72 (95%CI 1.48 to 5.02) and 0.49 (95%CI 0.29 to 0.82), respectively. The diagnostic odds ratio (DOR) was 5.77 (95%CI 1.89 to 17.58). And the SROC AUC was 0.79. Heterogeneity was mainly derived from the QUADAS score and Begg's test showed there was no presence of publication bias. ConclusionPCT is a potential marker in the diagnosis of benign and tuberculous pleural effusion, which can be used to determine diagnosis identification of tuberculous pleural effusion.

展望急诊医学的大数据时代

Value of Three Trauma Scaling Systems in Predicting Death for Patients in Mass Casualties

目的　探讨修正创伤评分（RTS）、CRAMS评分及院前伤情评分（PHI）对于群体伤患者死亡的评估作用。 方法　回顾性分析2011年8月－2012年8月就诊且记录完整的45例群体伤患者的病历资料，根据病历记录计算RTS、CRAMS及PHI评分，并记录患者是否死亡。绘制受试者工作特征曲线并计算出曲线下面积；根据约登指数筛选出各个评分适宜的截断值，据此计算3种创伤评分的灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值并进行比较。将患者按照性别、年龄分为亚组进行对比分析。 结果　RTS曲线下面积最大，且与参考线下面积对比差异有统计学意义（P=0.016），与另外两种评分比较其差异有统计学意义。 结论　RTS较CRAMS及PHI评分对于群体伤患者死亡预测具有更高的价值。

Clinical Study on the Value of Quick Sequential Organ Failure Assessment for Evaluating the Prognosis of Patients with Septic Shock

ObjectiveTo investigate the clinical value of quick sequential organ failure assessment (qSOFA) score in predicting the outcome of patients with septic shock. MethodsWe collected the clinical data of 170 patients with septic shock treated in the Emergency Intensive Care Unit between January 2013 and January 2014. According to the 28-day outcomes of the patients, they were recorded as survival group and non-survival group. We calculated the qSOFA score, acute physiology and chronic health evaluation (APACHE)Ⅱ score on patients' admission. Using receiver operating characteristic (ROC) curve, we analyzed the qSOFA score, the effect of APACHE Ⅱ score in predicting the 28-day prognosis for patients with septic shock. The correlation between qSOFA score and APACHEⅡ score was also assessed. ResultsThe qSOFA and APACHEⅡ scores in non-survivors were higher than those in the survivors. According to ROC curve analysis, the area under the curve for qSOFA score and APACHE Ⅱ score was 0.666 and 0.791, respectively. For qSOFA score with 2 cut-off points to evaluate the prognosis of septic shock, the sensitivity was 62.7%, specificity was 61.1%, positive predictive value was 56.0%, negative predictive value was 67.4%, positive likelihood ratio was 1.61, and negative likelihood ratio was 0.61. For the APACHEⅡ score with 24 cut-off points to evaluate the prognosis of septic shock, the sensitivity was 70.7%, specificity was 80%, positive predictive value was 73.6%, negative predictive value was 67.3%, positive likelihood ratio was 3.54, and negative likelihood ratio was 0.37. The correlation coefficient of qSOFA score and APACHE Ⅱ score was 0.499. ConclusionThe qSOFA score is useful to evaluate the prognosis of the patients with septic shock early in Emergency Department.

Function of Emotional Management in Alleviating Job Burnout for Health Care Providers

ObjectiveTo study whether emotional management can alleviate the occupational burnout of the health care providers. MethodsFrom May 1st 2015 to February 29th 2016, we sampled the medical workers of a class-3 grade-A hospital randomly, and performed the emotional management through self-emotion management and professionals-conducted emotion-management. The discrepancies before and after intervention were studied using Maslach Burnout Inventory General Survey (MBI-GS). ResultsIn total, 100 medical workers were enrolled in our study, of which there were 27 males and 73 females. There were 11 doctors and 89 nurses. The average age was (34.5±5.6) years. According to the MBI-GS survey, there were 69 medical workers suffering from occupational burnout. There were significant statistical differences before and after intervention in the MBI-GS scores in four aspects including emotion exhaustion, work status, sense of achievement and the total scores (P＜0.05). ConclusionThe medical workers can alleviate the occupational burnout under the self-management or professionals-conducted management of emotion.