Advanced journal of emergency medicine最新文献

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Application Effect of Limited Fluid Resuscitation in Emergency Patients with Multiple Trauma Complicated with Shock 有限液体复苏在多发创伤合并休克急诊患者中的应用效果

Advanced journal of emergency medicine

Pub Date : 2021-04-30 DOI: 10.18686/AEM.V10I1.183

Biao Wang, Jian-qing Qiu, Wenhao Lin, Wei Han

This article explores the methods and effects of limited fluid resuscitation in the treatment of hemorrhagic shock caused by multiple trauma, which is common in clinic. 80 patients with multiple trauma complicated with shock were randomly selected from the emergency department of our hospital and divided into the observation group and the control group, with 40 members in each group. Patients in the observation group were treated with limited fluid resuscitation, while those in the control group were treated with aggressive fluid resuscitation. By comparing the therapeutic effects of the two groups, it is concluded that the therapeutic effect of the observation group is significantly better than that of the control group. Therefore, adopting limited fluid resuscitation in the clinical treatment of patients with multiple trauma complicated with shock can realize faster recovery, as well as protect patients’ coagulation function, effectively reducing complications and mortality. Moreover, it can also reduce the injury of trauma perfusion to the body, ensuring the recovery of patients.

本文探讨有限液体复苏治疗临床常见的多发外伤失血性休克的方法及效果。选取我院急诊科多发创伤合并休克患者80例，随机分为观察组和对照组，每组40人。观察组采用有限液体复苏治疗，对照组采用积极液体复苏治疗。通过比较两组的治疗效果，得出观察组的治疗效果明显优于对照组。因此，在临床治疗多发创伤合并休克患者时，采用有限液体复苏可以实现更快的恢复，保护患者凝血功能，有效降低并发症和死亡率。而且还可以减少创伤灌注对机体的损伤，保证患者的康复。

引用次数: 0

Discussion on the Effect of Introducing Clinical Pharmacists to Guide Clinical Medication in ICU 引入临床药师指导ICU临床用药效果探讨

Advanced journal of emergency medicine

Pub Date : 2021-04-30 DOI: 10.18686/AEM.V10I1.186

Dalai Wuyun

Objective: to investigate the effect of clinical pharmacists in ICU. Methods: 108 ICU patients from January 2018 to March 2020 were divided into the control group and the observation group, with 54 cases in each group. The control group used the previous medication route, while the observation group introduced clinical pharmacists to guide clinical medication. The infection rate and adverse reaction rate of the two groups were compared. Results: the infection rate of the observation group was 3.70%, and that of the control group was 14.81%, which was significantly lower than that of the control group (P<0.05). The adverse reaction rate of the observation group was 5.56%, and that of the control group was 18.52%, which was significantly lower than that of the control group (P<0.05). Conclusion: the introduction of clinical pharmacists to guide clinical medication in ICU can effectively control the infection, and reduce various adverse reactions during drug use, so as to realize the scientific and standardized use of drugs, and improve the efficiency and safety of drug use.

目的:探讨临床药师在ICU工作中的作用。方法:将2018年1月~ 2020年3月收治的ICU患者108例分为对照组和观察组，每组54例。对照组沿用原用药路线，观察组引入临床药师指导临床用药。比较两组患者的感染率和不良反应发生率。结果:观察组感染率为3.70%，对照组感染率为14.81%，显著低于对照组(P<0.05)。观察组不良反应发生率为5.56%，对照组为18.52%，两组不良反应发生率均显著低于对照组(P<0.05)。结论:ICU引入临床药师指导临床用药，可有效控制感染，减少用药过程中的各种不良反应，实现药物使用的科学化、规范化，提高用药效率和安全性。

引用次数: 0

Relationship between Ambulatory Pulse Pressure, Pulse Pressure Index and Coronary Artery Disease in Patients with Hypertension 高血压患者动态脉压、脉压指数与冠状动脉病变的关系

Advanced journal of emergency medicine

Pub Date : 2021-04-30 DOI: 10.18686/AEM.V10I1.187

Jiajuan Chen, Yunjie Wei, Zhen Gao, Haijun Xu, Hezhong Zhu

Objective: To analyze the relationship between ambulatory pulse pressure, pulse pressure index, and coronary artery disease in patients with hypertension. Methods: From February 2018 to February 2019, a group of 100 patients with hypertension (control group) and a group of 100 patients with hypertension and coronary artery disease (experimental group) were selected to monitor and analyze dynamic pulse pressure and pulse pressure indicators. Results: In terms of clinical indicators, values of NPPI, 24hPP and 24hPPI in the experimental group were significantly higher than those in the control group. P < 0.05 indicates that there is statistical value in the data difference. Conclusion: In the clinical diagnosis of hypertension patients, ambulatory pulse pressure, pulse pressure index are highly correlated with the risk of coronary artery disease. Therefore, researchers should actively pay attention to the relevant indicators of patients to lay a solid foundation for the effective protection of patients’ health.

目的:分析高血压患者动态脉压、脉压指数与冠状动脉病变的关系。方法:2018年2月至2019年2月，选取100例高血压患者(对照组)和100例高血压合并冠状动脉疾病患者(实验组)监测并分析动态脉压和脉压指标。结果:在临床指标方面，实验组NPPI、24hPP、24hPPI均显著高于对照组。P < 0.05表示数据差异有统计学意义。结论:在高血压患者的临床诊断中，动态脉压、脉压指数与冠心病发生风险高度相关。因此，研究者应积极关注患者的相关指标，为有效保障患者的健康打下坚实的基础。

引用次数: 0

Application of Microscrew Implant Anchorage in Orthodontics 微螺钉种植体支抗在正畸中的应用

Advanced journal of emergency medicine

Pub Date : 2021-04-30 DOI: 10.18686/AEM.V10I1.188

H. Wong

Objective: To study the value of microscrew implant anchorage in orthodontic treatment. Methods: A total of 80 cases received orthodontic treatment in recent two years were selected and divided into experimental group and control group based on their received orthodontic measures, each group contains 40 cases. The control group was treated with general orthodontic treatment plan, while the study group received microscrew implant anchorage for the treatment. The clinical conditions of the two groups were counted and observed. Results: After different treatments, the effect of the study group was significantly better than that of the control group. All the indicators (including the improvement of molar displacement, incisor inclination angle and incisor convex distance) were available. In addition, there are obvious differences between the two groups in the occurrence of adverse reactions including inflammatory reaction, soft tissue edema and discomfort. Conclusion: In oral clinic, microscrew implant anchorage can achieve ideal curative effect for those who need orthodontics. Besides, its safety is relatively high, which is worth popularizing widely.

目的:探讨微螺钉种植体支抗在正畸治疗中的应用价值。方法:选取近两年接受正畸治疗的患者80例，根据其所采取的正畸措施分为实验组和对照组，每组40例。对照组采用普通正畸治疗方案，研究组采用微螺钉种植支抗治疗。统计观察两组患者的临床情况。结果:经不同治疗后，研究组治疗效果明显优于对照组。所有指标(磨牙位移、切牙倾角、切牙凸距的改善)均可获得。此外，两组在炎症反应、软组织水肿、不适感等不良反应的发生上也有明显差异。结论:在口腔临床中，应用微螺钉种植体支抗可以达到理想的治疗效果。此外，其安全性较高，值得广泛推广。

引用次数: 0

The Impact of Deep Brain Stimulation on the Cognitive Ability of Patients with Parkinson Disease 脑深部电刺激对帕金森病患者认知能力的影响

Advanced journal of emergency medicine

Pub Date : 2020-10-13 DOI: 10.18686/aem.v9i3.172

Kuo Liu

Deep Brain Stimulation, especially STN-DBS, is one of the most prevalent treatments for the Parkinson’s Disease. Previous researches already showed its positive effects on the general conditions of the patients but lack evaluation of its influence on the cognitive ability of the patients. A comparison in the effect of DBS and surgical lesioning procedures can determine DBS’s influence on the quality of life and confirm whether it is the most optimal treatment. This proposal reviewed previous researches about the influence of STN-DBS and proposed a study on its influence of patients’ cognitive ability.

脑深部电刺激，尤其是STN-DBS，是帕金森病最流行的治疗方法之一。以往的研究已经显示了它对患者一般情况的积极作用，但缺乏对患者认知能力影响的评估。比较DBS和外科病变程序的效果，可以确定DBS对生活质量的影响，并确认它是否是最优的治疗方法。本提案回顾了以往关于STN-DBS影响的研究，提出了其对患者认知能力影响的研究。

引用次数: 0

Sample Size Calculation Guide - Part 5: How to calculate the sample size for a superiority clinical trial 样本量计算指南-第5部分:如何计算优势临床试验的样本量

Advanced journal of emergency medicine

Pub Date : 2019-08-29 DOI: 10.22114/ajem.v0i0.255

In the previous educational articles, we explained how to calculate the sample size for a rate or a single proportion, for an independent cohort study, for an independent case-control study, and for a diagnostic test accuracy study. In this article, we explain how to calculate the sample size for a superiority clinical trial.

在之前的教育文章中，我们解释了如何计算一个比率或单一比例、独立队列研究、独立病例对照研究和诊断测试准确性研究的样本量。在本文中，我们解释了如何计算一个优势临床试验的样本量。

引用次数: 3

Auto-amputation of an Entire Foot with Ankle in a Diabetic Patient 糖尿病患者全足踝关节自动截肢术

Advanced journal of emergency medicine

Pub Date : 2019-08-17 DOI: 10.22114/ajem.v0i0.245

Utsav Anand Mani, Danish Ansari, F. Bhot, Elizabeth Sada, Rajesh Ursekar

A 62-year-old male came to emergency department (ED) with a complaint of “separation of foot” during sleep at night. He noticed he lost his foot while getting up from bed to go to toilet at midnight. Upon arrival in ED, his blood pressure was 218/96 mmHg and random blood sugar 556mg/dl. The patient had large ketone bodies in urine. He was a known case of diabetes and hypertension for many years. He was on homeopathic medications for his diabetes, hypertension and diabetic foot. He refused any form of invasive treatment and hospitalization. The patient was adamant on not getting admitted and wanted to continue his homeopathic medications as before. He only wanted his leg stump covered with a dressing after which he was discharged.

一名62岁男性患者因夜间睡眠时出现“足部分离”症状来到急诊科。午夜起床上厕所时，他发现自己失去了一只脚。到达急诊科时，血压218/96 mmHg，随机血糖556mg/dl。病人尿中有大量酮体。多年来，他一直是一个众所周知的糖尿病和高血压患者。他服用顺势疗法药物治疗糖尿病、高血压和糖尿病足。他拒绝接受任何形式的侵入性治疗和住院治疗。病人坚持不住院，并希望像以前一样继续他的顺势疗法药物治疗。他只需要给他的残肢包扎一下，然后就出院了。

引用次数: 0

ED Assembly: Introducing a Simple Method of Bringing Emergency Department Staff Together to Facilitate Improvement; A Report of a Real Experience 急诊科会议:介绍一种简单的方法，把急诊科的员工聚集在一起，以促进改进;真实经历的报告

Advanced journal of emergency medicine

Pub Date : 2019-07-28 DOI: 10.22114/ajem.v0i0.212

Introduction: The emergency department (ED) at Ashford and St Peter’s Hospitals NHS Foundation Trust (ASPH) is a medium size department which sees around 260–300 patients per day. As a result of sustained demand, we continue to struggle to meet the four hour waiting target and face similar challenges of those of ED’s nationally. Working in a busy ED is challenging and demanding. specific challenges around communication and risks arise directly from the unique contextual demands of the ED environment. Objective: Aim being to improve the productivity of the ED team and find a mechanism to create a more supportive and enjoyable working environment within the department. Method: Our clinical leadership started looking for answer to improve communication among team members and to create a platform where there was no hierarchy and all team members could be directly involved in problem solving. With the support of the quality improvement (QI) team, ED assembly was born. The assembly is a simple method of regularly bringing together staff to facilitate improvement and better team working. It is a platform for effective communication and innovation, in which there is no hierarchy and everyone is encouraged to contribute. Results: The assembly runs to a routine; every other Wednesday at 11am, the team come together for just half an hour. The agenda is set by the team in advance and everyone is encouraged to contribute their ideas and items they wish to contribute to others. Here are some examples of the quality improvement initiatives that have been born out of ED assembly: ED board rounds, coding information, overdose proforma, timely completion of standard investigations, access to fracture clinic appointments, nil-by-mouth communication, safety huddles, patient safety and sepsis, inclusive improvement, adoption of the ED assembly model by other teams and etc. Conclusion: ED assembly has supported many small but effective QI initiatives and regular communications support timely feedback on progress and update on plan-do-study-act (PDSA) cycles, resulting in changes in the everyday practice and improved pathways of patient care.

简介:阿什福德和圣彼得医院NHS基金会信托(ASPH)的急诊科(ED)是一个中等规模的部门，每天接待约260-300名患者。由于持续的需求，我们继续努力满足四小时的候诊目标，并面临着与全国急诊室类似的挑战。在一个繁忙的急诊室工作是充满挑战和要求的。围绕沟通和风险的具体挑战直接来自ED环境的独特上下文需求。目的:旨在提高急诊科团队的生产力，并找到一种机制，在部门内创造一个更支持性和愉快的工作环境。方法:我们的临床领导开始寻找解决方案，以改善团队成员之间的沟通，并创建一个没有等级制度的平台，所有团队成员都可以直接参与解决问题。在质量改进(QI)团队的支持下，ED组装诞生了。大会是一种简单的方法，定期将员工聚集在一起，以促进改进和更好的团队合作。这是一个有效沟通和创新的平台，没有等级制度，每个人都被鼓励做出贡献。结果:程序集运行到一个例程;每隔一周的周三上午11点，团队就聚在一起半个小时。议程是由团队事先设定的，每个人都被鼓励贡献自己的想法和项目，他们希望贡献给其他人。以下是一些因急诊科装配而产生的质量改进举措的例子:急诊科董事会查房、编码信息、过量形式、及时完成标准调查、获得骨折门诊预约、口头沟通、安全会议、患者安全和败血症、包容性改进、其他团队采用急诊科装配模式等。结论:ED大会支持了许多小型但有效的QI倡议，定期沟通支持及时反馈进展和更新计划-执行-研究-行动(PDSA)周期，从而改变了日常实践和改善了患者护理途径。

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引用次数: 1

A 34-year-old Pregnant Woman with Chickenpox Re-infection 34岁孕妇再次感染水痘

Advanced journal of emergency medicine

Pub Date : 2019-05-25 DOI: 10.22114/ajem.v0i0.163

Somayeh Karimi, Sepideh Babaniamansour, Ehsan Aliniagerdroudbari

A 34-year-old pregnant woman was referred to our emergency ward, complaining of intensification of skin lesions which had started six days earlier. Initially, vesicular lesions had started from head and face accompanied by fever which turn to generalized pustular lesions expanded to the whole body within four days (figure 1). By investigating the patient's personal contact history, we found that same symptoms were detected in her 9-year-old child 19 days prior to admission which was diagnosed as chickenpox. The patient also had mentioned previous history of chicken pox infection at her age of seven. She was ill but not toxic and was conscious with a blood pressure of 98/59 mmHg, respiratory rate of 18 breaths per minute, heart rate of 100 beats per minute and oral temperature of 37.2 °C in physical examination. She didn't have respiratory distress, dyspnea, meningism symptoms (Kernig Sign, Brudzinksi, and Nuchal Rigidity), ataxia or sensory defect and her all other physical examinations were normal. Upon diagnosis of chickenpox, intravenous (IV) acyclovir 750 mg three times a day and also IV clindamycin 900 mg TDS in combination with IV fluid were administered and finally the patient was admitted in Infectious diseases ward.

一名34岁孕妇被转介到我们的急诊科，她抱怨6天前开始的皮肤病变加剧。最初，水疱性病变始于头部和面部，并伴有发热，在4天内转变为全身范围的脓疱性病变(图1)。通过调查患者的个人接触史，我们发现在入院前19天，她9岁的孩子也出现了同样的症状，诊断为水痘。患者在7岁时也曾有过水痘感染史。患者患病但无毒，意识清醒，血压98/59 mmHg，呼吸频率18次/分钟，心率100次/分钟，体检口腔体温37.2℃。患者无呼吸窘迫、呼吸困难、脑膜症状(Kernig征、Brudzinksi征和颈部强直)、共济失调或感觉缺陷，其他体格检查均正常。确诊为水痘后，静脉注射阿昔洛韦750 mg，每日3次，同时静脉注射克林霉素900 mg TDS，并联合静脉输液，最终患者住进传染病病房。

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引用次数: 0

The Role of Ultrasonography in Patients Referring to the Emergency Department with Acute Abdominal Pain. 超声检查在急诊科急性腹痛患者中的作用。

Advanced journal of emergency medicine

Pub Date : 2019-05-16 eCollection Date: 2019-01-01 DOI: 10.22114/ajem.v0i0.152

Ali Abdolrazaghnejad, Ali Rajabpour-Sanati, Hojjat Rastegari-Najafabadi, Maryam Ziaei, Abdolghader Pakniyat

Context: Acute abdominal pain is a common clinical problem in emergency and non-emergency cases accounting for 5 to 10% of all referrals to the emergency department. Studies have indicated that these widely differentiated diagnoses are common to these complaints. Considering the high prevalence of this complaint in the patients and the wide range of its differential diagnosis, this review study was designed and evaluated aiming at investigating the causes of acute abdominal pain with a focus on assessing the position of ultrasound as a diagnostic tool in the emergency department.

Evidence acquisition: This article was conducted as a narrative review of selected articles from 2005 through 2019. By comparing them, a comprehensive review of ultrasound role was conducted in patients with acute abdominal pain referring to the emergency department.

Results: In this review study, we attempted to use the articles of the clinical approach, the required laboratory tests, the disadvantages and advantages of each imaging technique, the differential diagnosis for acute abdominal pain according to the location of the pain, and the position of ultrasound as a diagnostic aid tool. Eventually, the proposed protrusion will be considered in dealing with a patient with acute abdominal pain.

Conclusion: Regarding the wide range of causes providing multiple differential diagnosis, as well as the limited time of the health team in the emergency department for diagnostic and therapeutic measures, particularly in time-sensitive clinical conditions, ultrasound offered by emergency medicine specialists as a diagnostic aid is considered to improve the overall diagnosis and treatment of patients, thereby reducing complications.

背景：急性腹痛是急诊和非急诊病例中常见的临床问题，占急诊科所有转诊病例的5%至10%。研究表明，这些差异很大的诊断在这些投诉中很常见。考虑到这种主诉在患者中的高患病率及其鉴别诊断的广泛性，本综述研究旨在调查急性腹痛的原因，重点评估超声作为诊断工具在急诊科的地位。证据获取：本文对2005年至2019年的精选文章进行了叙述性综述。通过比较它们，对超声在急诊科急性腹痛患者中的作用进行了全面的回顾。结果：在这项综述研究中，我们试图使用临床方法、所需的实验室测试、每种成像技术的缺点和优点、根据疼痛位置对急性腹痛的鉴别诊断以及超声作为诊断辅助工具的位置的文章。最终，在治疗急性腹痛患者时，将考虑使用拟议的突出物。结论：关于提供多种鉴别诊断的广泛原因，以及急诊科卫生团队采取诊断和治疗措施的时间有限，特别是在时间敏感的临床条件下，急诊医学专家提供的超声波作为诊断辅助手段，被认为可以改善患者的整体诊断和治疗，从而减少并发症。

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