ObjectiveTo observe the effect of different preoxygenation methods for emergency intubation in severe patients in intensive care unit (ICU). MethodsProspective randomized study was performed in the intensive care unit between June 2013 and January 2014. Forty patients were randomly divided into 4 groups:group A (control group, n=10), group B (bag-valve-mask preoxygenation group, n=10), group C (noninvasive ventilator-mask preoxygenation group, n=10), and group D (invasive ventilator-mask preoxygenation group, n=10). Standardized rapid sequence intubation was performed without preoxygenation in group A; preoxygenation was performed by using a bag-valve-mask rose pulse oxygen saturation (SpO2) to 90% before a rapid sequence intubation in group B; preoxygenation was performed by using noninvasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group C; and preoxygenation was performed by using invasive ventilator through a face mask rose SpO2 to 90% before a rapid sequence intubation in group D. We recorded the time when SpO2 was more than or equal to 90% in group B, C, and D, and arterial blood gases and complications were observed. ResultsThere was no significant difference in the basic indexes before preoxygenation among the four groups (P>0.05). The time of the patients in group D and C was significantly lower than that of group B. The arterial oxygen saturation (SaO2) and arterial oxygen partial pressure (PaO2) in the group C and D were higher than those in group B after preoxygenation (P<0.05). After intubation, SpO2 in group B, C and D was significantly higher than that in group A (P<0.05). At the same time, SpO2 in group C and D was higher than that in group B (P<0.05); PaO2 and SaO2 in group C and D were higher than in those in group A and B (P<0.05); SaO2 in group D was higher than that in group B (P<0.05). The incidence of abdominal distension in group D was significantly lower than that of group B and C (P<0.05). ConclusionFor emergency tracheal intubation in critically ill patients in the ICU, preoxygenation is more effective than the rapid sequence intubation without preoxygenation in improving oxygenation indicators. Invasive ventilator-mask preoxygenation efficacy and safety are superior to other methods.
Objective To explore the effectiveness of situational experiential teaching mode in emergency internship teaching. Methods Interns from the Department of Emergency, Jiangyou Fifth People’s Hospital from July 2022 to May 2023 were selected as the research subjects. The interns were randomly divided into a trial group and a control group using a random number table method. The trial group adopted a situational experiential teaching mode, while the control group adopted a traditional teaching mode. Theoretical knowledge testing, clinical comprehensive ability assessment, and clinical information feedback were used to evaluate the effectiveness of different teaching methods. Results A total of 90 interns were included, with 45 people in each group, aged 18-23 years old. Both groups consist of 18 clinical medicine students and 27 clinical nursing students. There was no statistically significant difference in academic performance in school between the two groups of interns (P>0.05). The theoretical knowledge test score (92.98±2.71 vs. 85.29±6.24), clinical comprehensive ability assessment score (90.52±2.58 vs. 83.35±5.25) and clinical feedback (44 excellent and 1 fine in the trial group vs. 25 excellent, 5 fine, and 15 poor in the control group) of the trial group were better than those in the control group (P<0.05). Conclusions The situational experiential teaching mode can enhance interns’ learning interest, improve memory effectiveness, help students master theoretical knowledge, and enhance their comprehensive abilities in clinical evaluation and decision-making. It is worth promoting in clinical practice.
目的:探讨后路椎弓根螺钉固定在地震伤胸腰椎骨折中的应用及优点。方法:对19例胸腰椎骨折的地震伤患者行后路椎弓根螺钉内固定术。结果:本组病例的手术时间70～115分钟,平均出血量约280mL,两例病员术中出血超过400mL进行输血,复位椎体前缘高度由术前平均57.5%恢复到术后平均93.6%,后突角由术前平均21°矫正到术后平均3°,术后3～7天转往外地继续治疗,Frankel分级平均提高0.4。结论:后路椎弓根螺钉固定具有省时、节约医疗资源、提高救治效率、减轻患者痛苦的优点,尤其适用于大批伤病员的紧急救治。
ObjectiveTo investigate the epidemiological situation of pre-hospital emergency elderly and non-elderly patients in Chengdu and explore the characteristics of pre-hospital care in the city.MethodAll pre-hospital care records in the Chengdu 120 Emergency System Database in 2017 were retrospectively collected. According to the age of the patients, they were divided into the elderly group (≥60 years old) and the non-elderly group (<60 years old). The disease spectrum, the trends of the number of emergency help calls, the changes in different diseases over time, as well as the disease composition of the patients who died in the two groups were compared.ResultsA total of 179 387 pre-hospital emergency patients were enrolled, including 59 980 elderly patients and 119 407 non-elderly patients. Most of them were male patients in both groups. Patients in the elderly group were mainly between 60 to 89 years old, and the ones in the non-elderly group were mainly between 18 to 59 years old. The pre-hospital emergency patients in the elderly group presented with trauma, nervous system, symptoms and signs, and cardiovascular system diseases mainly, accounting for 29.19%, 14.64%, 13.82%, and 12.86%, respectively. In the non-elderly group, trauma, acute poisoning, and symptoms and signs were predominant, accounting for 50.89%, 10.98%, and 10.08%, respectively. Among the pre-hospital deaths, the number in the elderly group was the larger, accounting for 69.61% (7 043 cases); the mortality rate was 11.74%, with sudden death (28.70%), cardiovascular diseases (25.95%), and respiratory diseases (16.07%) being the major causes. The pre-hospital mortality rate of non-elderly patients was 2.58%, mainly including traumatic diseases (35.41%), sudden death (unknown cause of death) (25.33%), and cardiovascular diseases (17.56%). The number of emergency help calls in the elderly group began to increase gradually from September, reaching a peak in December and hitting the trough in February. While in the non-elderly group, the peak of the emergency help calls appeared in July, and it also fell to the lowest in February. The proportion of the number of emergency help calls in the elderly group was higher in January to February and October to December; while the peak in non-elderly group was in July. The number of emergency help calls in the elderly group were mainly concentrated in the daytime (08:00 to 20:00). In the non-elderly group, the changes in the number of emergency help calls were similar to that of the elderly, however, with another peak (20:00 to 24:00). The proportion of the number of emergency help calls in the elderly group was 06:00 to 09:59, and the peak time of the non-elderly group was in the early morning (00:00 to 04:59) and night (20:00 to 23:59).ConclusionsThe number of pre-hospital care for elderly and non-elderly patients has its own characteristics in terms of the time and the distribution of disease spectrum. Trauma and cardiovascular diseases are the most common causes of pre-hospital care and death in Chengdu. And the pre-hospital mortality in the elderly group is much larger than that in non-elderly group. Relevant departments can allocate emergency resources rationally, and focus on improving the on-site rescue capacity towards related diseases.
As a global accidental injury, drowning has a huge spiritual and economic impact on patients, families and society. In order to improve the quality of pre-hospital and in-hospital emergency treatment of drowning, improve the prognosis, improve survival rate, and reduce the burden of drowning, in 2016, the Wilderness Medical Society drafted practice guidelines related to drowning. The first update of this guide was released in June 2019. The updated guide covers the terms of drowning, rescue and resuscitation, emergency treatment, preventive measures and other aspects. This article interprets the updated guidelines in order to provide recommendations for the first aid of drowning.
目的:分析汶川大地震颅脑损伤的临床特点,探讨救治策略。方法:对2008年5月12日至6月2日汶川大地震中什邡市二医院收治的222例颅脑损伤伤员进行总结分析。结果:大批地震伤员中,颅脑损伤主要以轻、中型颅脑损伤为主,其中以头皮裂伤最多见,其次为脑挫伤、硬膜下血肿、硬膜外血肿、开放性脑损伤。大部分颅脑损伤伤员合并有其他部位损伤,以合并四肢骨折最多见。开展手术28例,死亡7例。结论:地震后伤员在短期内集中大量达到,颅脑损伤以头皮裂伤多见,医院有效的组织,快速评估病情,制定有效的治疗计划,注意合并伤的处理,强化院前急救以及三线医院转送,提高救治成功率。