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.
ObjectiveTo find out the possible factors that may affect the survival time of patients undergoing return of spontaneous circulation (ROSC) within seven days of cardio-pulmonary resuscitation.
MethodWe retrospectively collected 20 clinical indicators from 51 patients who underwent ROSC after cardio-pulmonary resuscitation in Emergency Department between August 2013 and February 2015. The indicators included gender, age, duration of cardio-pulmonary resuscitation, blood pressure acquired immediately after ROSC, heart rate, respiration, lactic acid, creatinine, prothrombin time, bilirubin, pH, arterial partial pressure of carbon dioxide, potassium, sodium, blood glucose, atrial natriuretic peptides, leukocyte, platelets, and hemoglobin. Then we analyzed the correlation of these indicators with survival time through Cox regression model.
ResultsThe results showed that duration of cardiopulmonary resuscitation[RR=1.053, 95% CI (1.020, 1.088), P=0.002] and systolic blood pressure acquired immediately after ROSC[RR=0.991, 95% CI (0.982, 0.999), P=0.038] significantly affected the survival time of patients after ROSC.
ConclusionsDuration of cardiopulmonary resuscitation and systolic blood pressure acquired immediately after ROSC may be useful in predicting the survival time of patients after ROSC.
ObjectiveTo explore how to select the suitable indications of ERCP for clinical diagnosis and treatment. MethodsThe data of patients treated by ERCP between January 2005 and December 2009 in our hospital were analyzed retrospectively. ResultsTotal 221 patients received ERCP, among whom 99 (45%) cases of common bile duct stones, 44 (20%) cases of malignant tumor, 9 (4%) cases of papilla narrow, 45 (20%) cases were negative, and 24 (11%) cases were failed. It had the trend that the number of the patients received ERCP reduced year by year. The postoperative complication rate was 11% (25 cases), including 15 cases of postoperative pancreatitis, 3 cases of bleeding, 5 cases of biliary duct infection, and 2 cases of basket stranded. ConclusionIn the modern medical condition, with the advancement of image and laparoscopy technology, we should select the diagnosis and treatment methods with the principles of no damage or less damage for patients, without unlimitedly broadening the clinical indications of ERCP.
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.
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.
ObjectiveTo evaluate the prognosis factors for early death (within 60 days) of acute myocardial infarction (AMI) patients for early identification and prevention of the disease.
MethodsWe analyzed the information of AML patients who were admitted to the emergency department between May 2009 and July 2010, and analyzed their clinical data, such as gender, age, prehospital time, myocardial enzyme, electrocardiogram, complications, whether the patients had thrombolysis therapy, time of thrombolysis, end point observation and time of death, ect. Cox multivariate survival analysis was performed with the use of SPSS 18.0 software.
ResultsSeventy-one cases were collected with one of them excluded for fragmented data. After analysing, we found that patients' age and isoenzymes of creatine kinase (CK-MB) level were prognosis factors for early death. Further analysis showed that the relative risk (RR) of age was 1.166 (P=0.023), and the RR of CK-MB was 1.001 (P=0.004).
ConclusionPatients' age has predictive value for early death of AML. More attention should be paid to AML patients with advanced age. Detecting myocardial enzymes levels, especially the CK-MB level, is significant for predicting early death. Other indicators need to be further explored due to the possible limitation of our study.
