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.
Objective
To retrospectively analyze the emergency complications of the patients after oocyte retrieval with assisted reproductive technology (ART), and analyze the corresponding strategies.
Methods
The clinical data of patients after oocyte retrieval with ART between January and December 2016 were retrospectively anayzed. The postoperative emergency complications were observed.
Results
A total of 5 013 patients were included in the study. The common emergency complications after oocyte retrieval included vaginal bleeding in 137 cases (2.73%) , ovarian hyperstimulation syndrome (OHSS) in 35 (0.69%), hematuria caused by bladder injury in 11 cases (0.21%), pelvic infection in 3 (0.06%), and vagal reflex in 2 (0.04%). OHSS was related to age, the number of basal follicles, the number of oviposaccharides and the estradiol level on the day of human chorionic gonadotropin injection, but not related to the body mass index and the number of days of gonadotropin use; which might be misdiagnosed most likely.
Conclusions
OHSS is one of the common and severe emergency complications after oocyte retrieval with ART, which should be concerned. Active treatment of complications is helpful to reduce the incidence of emergency complications after oocyte retrieval with ART.
【摘要】 目的 探討高血壓危象評估和處理原則及對高血壓危象急診處理的指導意義。 方法 依據高血壓危象評估和處理原則對2008年1月-2009年12月期間收治的160例高血壓危象患者進行診斷和治療。結果 160例高血壓危象患者中,高血壓急癥134例,高血壓亞急癥26例。高血壓急癥中,以心腦血管病變為主,包括腦卒中、急性冠脈綜合征和急性左側心力衰竭。依據高血壓危象評估和處理原則進行急診處理,能夠對高血壓危象進行準確評估和有效處理,減少診治失誤,降低死亡率并改善預后。結論 有關高血壓危象的評估和處理原則能夠指導高血壓危象的急診處理,取得良好的預后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
Internet of Things (IoT) technology plays an important role in smart healthcare. This paper discusses IoT solution for emergency medical devices in hospitals. Based on the cloud-edge-device architecture, different medical devices were connected; Streaming data were parsed, distributed, and computed at the edge nodes; Data were stored, analyzed and visualized in the cloud nodes. The IoT system has been working steadily for nearly 20 months since it run in the emergency department in January 2021. Through preliminary analysis with collected data, IoT performance testing and development of early warning model, the feasibility and reliability of the in-hospital emergency medical devices IoT was verified, which can collect data for a long time on a large scale and support the development and deployment of machine learning models. The paper ends with an outlook on medical device data exchange and wireless transmission in the IoT of emergency medical devices, the connection of emergency equipment inside and outside the hospital, and the next step of analyzing IoT data to develop emergency intelligent IoT applications.
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 study the earthquake emergency response capability and post-earthquake psychological state of students after the Wenchuan earthquake. And also, to investigate the level of earthquake-related knowledge so as to provide basic information for enhancing the emergency response capabilities among college students. Methods We selected 1% Sichuan University students by convenience sample method and conducted the survey in person with a self-designed questionnaire. Results were analyzed with Epidata 3.0 and SPSS13.0 software. Results We distributed 527 questionnaires and 517 (97.27%) valid questionnaires were retrieved. Most college students had a good grasp of earthquake knowledge: 65.4% to 97.7% of the responders gave the correct answers, but only 12.77% said they had ever received earthquake survival training. 15.2% suffered from fear after the earthquake, 59.4% became uneasy, and 25.4% remained calm. Gender, grade, or major were not the factors influencing the psychological state of college students after the earthquake (P= 0.246, 0.216, and 0.406, respectively). Also, earthquake survival training did not influence the psychological state of college students after the earthquake (P=0.090). Psychological intervention after the earthquake was identified as an important factor that affected the psychological state of students (P=0.002). Conclusion College students have a good grasp of the basic knowledge regarding earthquake, but relevant survival training is far from sufficient. Universities should strengthen earthquake survival training, enhance the post-earthquake emergency response capacity of students, and carry out post-disaster psychological intervention directly following an earthquake. There is no significant difference in the mental status among students of different genders, grades, or professional backgrounds.
ObjectiveTo explore the methods to improve the success rate of intubation and reduce the intubation time consuming in emergency orotracheal intubation by improving the method of holding laryngoscope.
MethodsA total of 146 patients needed orotracheal intubation were randomly divided into a traditional group who was intubated with traditional method of holding laryngoscope and an improved group who was intubated with improved method of holding laryngoscope. The success rate of intubation for the first time, success rate in difficult intubation, intubation time consuming, the incidence of complications by mechanical injury between two groups were compared.
ResultsSixty-nine petients received traditional method of holding laryngoscope and 77 petients received improvement method of holding laryngoscope. The success rate for the first time intubation [71(92.2%) vs. 56(81.2%)] and success rate in difficult intubation [13(72.2%) vs. 3(23.1%)] of the improved group were higher than those of the traditional group. The differences were statistically significant (all P < 0.05). The intubation time consuming [(28.3±3.5)s vs. (35.6±4.1)s] and the incidence of complications by mechanical injury [1(1.3%) vs. 6(8.7%)] of the improved group were lower than those of the traditional group with statistical significance (all P < 0.05).
ConclusionThe success rate of intubation for the first time and the difficult intubation can be improved effectively, and the intubation time consuming and the incidence of complications by mechanical injury can be reduced effectively by improving the method of holding laryngoscope.
Objective To analyze the injury and dysfunction as well as the rehabilitation status and demand of the 188 Lushan earthquake victims admitted in the hospitals in and around Ya’an city and the West China Hospital of Sichuan University, so as to provide guidance for the rehabilitation work in the following step. Methods By means of the onsite investigation, 122 victims admitted in 7 hospitals and 2 health centers in and around Ya’an city within 1-9 days after Lushan earthquake, and the other 66 victims treated in the West China Hospital of Sichuan University were analyzed. Results The injury categorization of 122 victims in and around Ya’an city was as follows: upper limb fracture (12.30%), lower limb fracture (42.62%), spine fracture (16.39%) (25.00% treated by surgery and 75.00% treated by non-surgery treatment), pelvis fracture (1.64%), rib fracture (4.10%), traumatic brain injury (10.66%), soft tissue contusion (8.20%), and others (4.09%). At the corresponding period, the injury categorization of 66 victims treated in the department of rehabilitation medicine of the West China Hospital of Sichuan University was as follows: fracture (77.27%), traumatic brain injury (3.03%), spinal cord injury (4.55%), and others, including soft tissue injury (15.15%). At the ninth day after earthquake, among the 122 victims in and around Ya’an city, 8 victims (6.56%) were recovered with self-care ability of daily living, and the other 144 (93.44%) still needed the strengthened rehabilitation treatment. At the corresponding period, among the 66 victims in the West China Hospital, one victim (1.52%) was recovered with self-care ability of daily living, and the other 65 (98.48%) still needed the strengthened rehabilitation treatment. Conclusion Early rehabilitation treatment such as active exercise, elevating injured limbs, physical therapy, turning over at regular time, and psychological intervention can help the earthquake victims to return to home and society early.
ObjectiveTo analyze the effect of noninvasive positive pressure ventilation (NPPV) on the treatment of severe acute pancreatitis (SAP) combined with lung injury [acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)] in emergency treatment.
MethodsFifty-six patients with SAP combined with ALI/ARDS treated between January 2013 and March 2015 were included in our study. Twenty-eight patients who underwent NPPV were designated as the treatment group, while the other 28 patients who did not undergo NPPV were regarded as the control group. Then, we observed patients' blood gas indexes before and three days after treatment. The hospital stay and mortality rate of the two groups were also compared.
ResultsBefore treatment, there were no significant differences between the two groups in terms of pH value and arterial partial pressure of oxygen (PaO2) (P>0.05). Three days after treatment, blood pH value of the treatment group and the control group was 7.41±0.07 and 7.34±0.04, respectively, with a significant difference (P＜0.05); the PaO2 value was respectively (60.60±5.11) and (48.40±3.57) mm Hg (1 mm Hg=0.133 kPa), also with a significant difference (P＜0.05). The hospital stay of the treatment group and the control group was (18.22±3.07) and (23.47±3.55) days with a significant difference (P＜0.05); and the six-month mortality was 17% and 32% in the two groups without any significant difference (P>0.05).
ConclusionIt is effective to treat patients with severe acute pancreatitis combined with acute lung injury in emergency by noninvasive positive pressure ventilation.
Objective To study the feasibility, indication, technique of emergency operation and the perioperative management on critical congenital heart disease in infants. Methods From May 1998 to May 2003, 67 emergency operations of critical congenital heart disease were performed in infants . The age was 14d-32 months (mean , 11.8±8.9 months), the weight was 2.6-14.8 kg( mean, 8.4±3.0 kg). The diagnosis included ventricular septal defect in 39, tetralogy of Fallot in 13, complete atrioventricular septal defect in 5, total anomalous pulmonary venous drainage in 4, atrial septal defect with pulmonary valve stenosis in 3, D-transposition of the great arteries in 2, and postoperative pulmonary valve vegetation in 1. Corrective operation in 64 and palliative operation in 3 were done. Results The preoperative managing time was 0-9 d(mean , 3.7±2.6 d), the lasting time of intubation was 1-14d( mean, 3.8±3.2 d), and ICU staying time was 2-18 d (mean, 5.7±2.8 d). The operative mortality was 7.5% (5/67), the postoperative complications in other infants include 14 low cardiac output syndrome, 14 atelectasis, 8 lung infection, 2 worsened pulmonary hypertension, 1 pneumothorax , and 1 phrenic nerve paralysis. Following up 2-60 months with 1 case late death, the cardiac function of the others were class Ⅰ-Ⅱ/Ⅵ, the operative result was satisfactory. Conclusions The emergency operation on critical congenital heart disease in infants is safe, and can save most of their lives, the good result can be obtained from surgical treatment. Accurate choice of indications, and perioperative good nutritional and cardiorespiratory function support are important.
