Risk factors for postoperative sepsis in patients with gastrointestinal perforation

BACKGROUND Sepsis is fatal in patients with gastrointestinal perforation(GIP).However,few studies have focused on this issue.AIM To investigate the risk factors for postoperative sepsis in patients with GIP.METHODS This was a retrospective study performed at the Department of General Surgery in our treatment center.From January 2016 to December 2018,the medical records of patients with GIP who underwent emergency surgery were reviewed.Patients younger than 17 years or who did not undergo surgical treatment were excluded.The patients were divided into the postoperative sepsis group and the non-postoperative sepsis group.Clinical data for both groups were collected and compared,and the risk factors for postoperative sepsis were investigated.The institutional ethical committee of our hospital approved the study.RESULTS Two hundred twenty-six patients were admitted to our department with GIP.Fourteen patients were excluded:Four were under 17 years old,and 10 did not undergo emergency surgery due to high surgical risk and/or disagreement with the patients and their family members.Two hundred twelve patients were finally enrolled in the study;161 were men,and 51 were women.The average age was 62.98±15.65 years.Postoperative sepsis occurred in 48 cases.The prevalence of postoperative sepsis was 22.6%[95%confidence interval(CI):17.0%-28.3%].Twenty-eight patients(13.21%)died after emergency surgery.Multiple logistic regression analysis confirmed that the time interval from abdominal pain to emergency surgery[odds ratio(OR)=1.021,95%CI:1.005-1.038,P=0.006],colonic perforation(OR=2.761,CI:1.821–14.776,P=0.007),perforation diameter(OR=1.062,95%CI:1.007-1.121,P=0.027),and incidence of malignant tumorrelated perforation(OR=5.384,95%CI:1.762-32.844,P=0.021)were associated with postoperative sepsis.CONCLUSION The time interval from abdominal pain to surgery,colonic perforation,diameter of perforation,and the incidence of malignant tumor-related perforation were risk factors for postoperative sepsis in patients with GIP.     

Relationship between intubation rate and continuous positive airway pressure therapy in the prehospital setting

BACKGROUND: To determine whether the prehospital use of continuous positive airway pressure(CPAP) therapy is associated with a reduced rate of endotracheal intubation in patients with an acute respiratory disorder brought to the emergency department(ED).METHODS: We reviewed medical records of patients with acute respiratory distress who had been treated with CPAP in the Mobile Intensive Care Unit(MICU) from January 2010 to December 2011. These records were compared with those of patients who received standardized care without CPAP in the MICU from January 2004 to December 2004. Categorical variables were summarized as frequencies and compared between groups using Fisher's exact test or the Chi-square test. Continuous variables were summarized as medians(interquartile range), and comparison between the groups was made using Wilcoxon's rank-sum test. The relationship between CPAP and intubation rate was determined using multivariable logistic regression analysis of propensity scores. The results were presented as odds ratio(OR), 95% confidence interval(CI), and P value for test effect. The adequacy of the model was calibrated using Hosmer and Lemeshow's goodness-of-fit test. P0.05 was considered statistically significant.RESULTS: The records of 785 patients were reviewed. Of the 215 patients treated with CPAP in the MICU, 13% were intubated after admission. In contrast, of the 570 patients who did not receive CPAP, 28% were intubated after ED admission. Unadjusted logistic regression analysis showed that patients who had been treated with CPAP were less likely to be intubated than those without CPAP treatment(OR=0.37, 95% CI, 0.24–0.57, P0.0001). With propensity scores adjusted, multivariate logistic regression analysis showed that CPAP treatment was associated with a 62% reduction of intubation(OR=0.384, 95%CI, 0.25–0.60, P≤0.0001).CONCLUSIONS: In patients with acute respiratory disorder, there was a relationship between CPAP therapy and the decreased intubation rate. CPAP therapy was feasible in prehospital management of patients with respiratory distress.     

雾化吸入灭活草分枝杆菌治疗中度支气管哮喘的临床研究

Objective To introduce inhaled inactivated-mycobacterium phlei on prevention and treatment of moderate bronchial asthma to observe the clinical effect. Method This study was a prospective and controlled study. The patients diagnosed with asthma in our out-patient from March 2009 to December 2010 were collected, who met the following conditions were included in the study: age≥ 14 years; met the criteria of moderate chronic persistent bronchial asthma in Global Initiative for Asthma (GINA) in 2008; suspended receiving systemic corticosteroids, Montelukast, ketotifen and other anti-inflammatory and anti-allergic drugs in one month; no significant respiratory tract infections; and other serious illnesses or abnormalities known.A total of 100 patients with asthma were selected, including 37 males and 63 females, age (32.11 ± 12.95 )years. The patients were randomly(random number) divided into two groups: A group(treatment group; 16males and 34 females, age 33.56 ± 14.23 years) and B group (control group; 21 males and 29 females,age 30.66 ± 11.50 years); 50 in each group. No significant difference was noted between the two groups on age and gender composition. The patients in A group were treated with inhaled inactivated-mycobacterium phlei F. U. 36 Injection 1.72 μg/mL × 2 that adding 3 mL normal saline, once a day for 5 days. The patients in B group were treated with salmeterol xinafoate and fluticasone propionate powder for inhalation (50/100 μg), twice daily for sustainable use. The patients in the two groups were observed for one month. During this course, the patients in the two groups could inhale the salbutamol sulphate aerosol as need to relieve symptoms. And the number of using was recorded. Pulmonary function test and asthma provocative test were carried out on the Day O, 6 and 31. ACT scores were measured before and after the treatment. Results On Day 6 and 31 after treatment, the negative conversion rates of asthma provocative test of the patients in A group were 82% and 78% respectively, B group were 84% and 90% respectively. Provocative test of the patients in the two groups were negative conversion significantly before and after treatment. There was no significant difference between the two groups by chi-square test (P ＞ 0. 05 ). Completely random designed data was analyzed by analysis of variance. The analysis showed that the accumulated doses of methacholine of the patients in the two group increased significantly ( P ＜ 0. 05 ), but no difference between the two groups.There was a improvement trend on forced expiratory volume in one second( FEV1 )of the patients in A group after treatment, but no difference. FEV1 of the patients in B group increased significantly higher ( P ＜0.05), which was significantly higher than A group on the 31th day (P ＜0. 05); Peak expiratory flow (PEF) of the patients in the two group increased significantly on Day 6 and 31 after treatment (P ＜0.05 ).On Day 31, B group was significantly higher than A group ( P ＜ 0. 05 ); Scores of asthma control test (ACT)of the patients in the two group were significantly increased, and the number of using of salbutamol sulfate aerosol was significantly reduced (P ＜0.01 ). B group was obvious than group A (P ＜0.05 ). During treatment, there were only two adverse reaction cases of transient low fever; most obvious was on the third day.Conclusions Inhaled inactivated-mycobacterium phlei would inhibit the airway hyperresponsiveness of the patients with moderate bronchial asthma in short time, improve the symptoms, reduce the acute exacerbation, and reduce the use of rescue medication, which has the roles of prevention and treatment of moderate asthma in a certain period of time.     

α1-receptor blockers combined with acupuncture treatment efficacy analysis of elderly patients with acute urinary retention

Objective To explore acupuncture and al-receptor blocker treatment efficacy of elderly patients with acute urinary retention. Methods Use of forward-looking monitoring and retrospective survey methodology, Choose January 1,2006 to January 1,2009 of acute urinary retention in 82 cases of elderly inpatients,Chronological order according to treatment group,39 cases were divided into control group,43 cases; Transurethral catheterization in both groups, stay catheter. The control group was treated with α1-receptor blocker hytrin (terazosin) and the application of antibiotics; the treatment group based on the above plus acupuncture therapy. Results The treatment group was 94.87% in the control group response rate was 76.74%, the two groups,P<0.05, the difference was significant. Conclusion al-receptor blockers combined with acupuncture treatment of elderly patients with acute urinary retention al-receptor blocker than simply good effects, synergistic effect, shortening the indwelling catheter time, avoid repeated urinary catheterization and reduce hospital infection, worthy to be popularized.     

α1-receptor blockers combined with acupuncture treatment efficacy analysis of elderly patients with acute urinary retention

Objective To explore acupuncture and al-receptor blocker treatment efficacy of elderly patients with acute urinary retention. Methods Use of forward-looking monitoring and retrospective survey methodology, Choose January 1,2006 to January 1,2009 of acute urinary retention in 82 cases of elderly inpatients,Chronological order according to treatment group,39 cases were divided into control group,43 cases; Transurethral catheterization in both groups, stay catheter. The control group was treated with α1-receptor blocker hytrin (terazosin) and the application of antibiotics; the treatment group based on the above plus acupuncture therapy. Results The treatment group was 94.87% in the control group response rate was 76.74%, the two groups,P<0.05, the difference was significant. Conclusion al-receptor blockers combined with acupuncture treatment of elderly patients with acute urinary retention al-receptor blocker than simply good effects, synergistic effect, shortening the indwelling catheter time, avoid repeated urinary catheterization and reduce hospital infection, worthy to be popularized.     

Risk factors of contrast-induced nephropathy in patients with acute myocardial infarction treated with emergent percutaneous coronary intervention北大核心CSCD

Objective To explore the risk factors of contrast-induced nephropathy (CIN) in patients with acute ST-segment elevation myocardial infarction(STEMI)treated with emergent percutaneous coronary intervention(PCI). Methods The clinical data of patients with STEMI treated by emergent PCI from January 2014 to February 2017 in Peking University People's Hospital was reviewed. Exclusion criteria included contrast agent allergy, previous renal diseases, chronic renal failure, heart failure, tumor, acute infection, only one renal function test available during hospitalization and lacking essential medical records. Data of demographics, past medical history, general conditions at admission, laboratory findings, etc, were collected. Patients were divided into CIN group and non-CIN group. The univariate comparison analysis and Logistic regression analysis were performed to obtain the risk factors of CIN. Results A total of 236 patients were enrolled. The incidence of CIN was 10.2% (24/236). Univariable analysis demonstrated that the risk factors of CIN were age, diabetes mellitus, Killip grade ≥ 3 stage, serum uric acid (SUA) level at admission, blood glucose level at admission. Binary logistic regression analysis showed that SUA ≥ 350 μ.mol/L at admission, blood glucos ≥ 11 mmol/L at admission, age 5= 75 years were independent risk factors for CIN. Conclusion SUA ≥ 350 μ mol/L at admission, blood sugar 5= 11 mmol/L at admission, age ≥ 75 years were independent risk factors of CIN in patients with STEMI treated with emergent PCI. © 2018 Chinese Medical Association. All rights reserved.     

Multiple organ dysfunction and rhabdomyolysis associated with moonwort poisoning: Report of four cases

BACKGROUND Moonwort is a widely used Chinese herbal medicine. It has various pharmacological effects, such as relieving cough and preventing asthma. To date,multiple organ dysfunction and rhabdomyolysis caused by moonwort poisoning have not been reported.CASE SUMMARY Here we report four cases of moonwort poisoning that presented with multiple organ dysfunction and rhabdomyolysis accompanied by vomiting, fatigue, and muscle aches. One patient was an adult male, two were adult females, and one was a boy, with an age range of 7–64 years. The adults were treated with hemoperfusion and symptomatic therapies, while the child was treated with plasma exchange and symptomatic therapies. All four patients recovered.CONCLUSION Blood purification combined with symptomatic treatment may be an effective method for managing multiple organ dysfunction and rhabdomyolysis caused by acute moonwort poisoning.     

Follow-up study of factors influencing prognosis of cardiac arrest patients after acute myocardial infarction北大核心CSCD

Objective To assess the factors associated with the restoration of spontaneous circulation (ROSC) and 2-year survival prognosis in patients with cardiac arrest (CA) after acute myocardial infarction (AMI), and after ROSC, the effects of various factors on midian survival time and on 2-year survival. Methods In a registry study from January 2005 to January 2015, all consecutive AMI-induced CA patients treated with cardiopulmonary resuscitation (CPR) admitted to our hospital were enrolled. The survivors were followed-up for 2 years. Univariate analysis was applied to evaluate factors associated with rate of ROSC and 2-year survival. Multivariate logistic regression analysis was applied to evaluate statistically significant factors in the univariate analysis. Medians with inter-quartile ranges were used to describe 2-year survival time affected by various factors after ROSC. Kaplan-Meier survival curve analysis was used to evaluate the effect of factors on 2-year survival. Results A total of 254 cases with CA after AMI were enrolled, including 129 cases of ROSC and 71 cases of 2-year survival. Univariate analysis showed age ≥ 70 years, CA occurred during 22:00-8:00, the duration time of CPR > 15 min and adrenaline dosage > 5 mg were unfavorable predictors of ROSC; while, left ventricular ejection fraction (LVEF) > 40% before CA, shockable rhythm and percutaneous coronary intervention (PCI) therapy were favorable predictors. Besides, age ≥ 70 years, intubation during CPR, adrenaline dosage > 5 mg and cardiogenic shock were unfavorable predictors of 2-year survival; While, male, normal daily activity before CA and PCI treatment were favorable predictors. Multivariable analysis showed age, the duration of CPR, adrenaline dosage, LVEF before CA, the rhythm during CPR and PCI therapy were independent predictors of ROSC. Age and PCI therapy were independent predictors of 2-year survival. Among patients, the survival time was affected by various factors after ROSC, and the factors with minimum 25% and small median value were associated with cardiac rupture, cancer, adrenaline dosage > 5 mg and cardiogenic shock. The factor with maximum 25% value was PCI treatment (216 days). Kaplan-Meier survival analysis suggested that age ≥ 70 years was an unfavorable factor of 2-years survival (Log-rank test, P=0.007); while, PCI treatment was a favorable factor (Log-rank test, P<0.01). PCI-related prognosis analysis showed that the effectiveness of PCI was related to the timing of PCI, the number of infarct-related artery and the difference in culprit lesion. Conclusions The age ≥ 70 years was disadvantageous to both ROSC and 2-year survival. PCI treatment was favorable to both ROSC and 2-year survival. © 2018 Chinese Medical Association. All rights reserved.     

急诊科护士急救知识技能掌握情况的调查研究

目的　了解急诊科护士急救知识、技能的获得途径和现阶段的掌握情况 ,探讨影响其业务素质的因素。方法　采用问卷调查法对上海市 9所医院 2 82名急诊科护士进行调查 ,统计处理用Excel和SAS软件包进行。计量资料用t检验和方差分析 ,计数数据以百分比表示 ,知识得分影响因素的分析运用多元逐步回归的方法。结果　急诊科护士的平均知识得分为 71.95± 10 .75 ;知识得分 =62 .3 67+0 .5 2 5护龄 +2 .15 6职务。护龄、职务对护士知识得分的影响差异显著 ,不同级别医院知识得分差别不显著。结论　急诊科护士急救知识技能的全面素质需进一步提高 ,低护龄护士毕业后教育工作应引起高度重视 ,充分发挥高年资护士的业务专长。对急救业务影响因素的分析研究和怎样进一步提高护士急救水平的研究尚需继续深入。     

Emergency operation indications in emergency medicine clinic (model of emergency medicine in Turkey)

Although patients who present for emergency medical care have a broad spectrum of symptoms, such events can generally be categorized as internal medicine, surgical, and pediatric emergency cases. Indications for emergency surgery are estimated to be infrequent compared with the overall number of patients admitted for emergency care. This study investigated the indications for emergency surgery in patients (612 of 8422 patients who sought emergency care) admitted to the surgical division of the emergency department at Konya City Hospital between January and July of 2002. This retrospective study, which investigated reasons for surgical procedures and relevant branch distribution, comprised 405 men (65%) and 207 women (35%). Ages of enrolled patients ranged from 6 months to 70 years. Most of the patients (n=280, 46%) who underwent surgery at the emergency clinic were treated for acute abdomen. Emergency indications for neurosurgery (n=71, 12%) were the second most common reason for emergency procedures. Epidural hematoma and depressed fracture were the most apparent indications for neurosurgery. Surgery of the thorax was the third most common emergency surgery performed (n=44, 7%). Patients who had emergency surgery indications and who underwent surgery account for approximately 7% of the total number of patients who presented for emergency care. Acute abdomen and trauma were the most frequently reported precipitating events. This study was presented orally at the 4th International Trauma and Emergency Surgery Congress, held in 2002 in Istanbul, Turkey.     

Evaluation of prehospital emergency care in the field and during the ambulance drive to the hospital

This study was conducted to evaluate the appropriateness of ambulance procedures and interventions in the management of patients dispatched to 2 emergency departments (EDs) of urban hospitals in Izmir. Use of trauma boards and cervical collars, airway patency, breathing, and circulation problems were recorded in both EDs. Eighty-one patients with a mean age of 47.54±2.36 years (range, 4–89) brought into the ED via ambulances were enrolled in the study. Airway maneuvers were performed in patients with airway and breathing problems. There was no significant relationship between administration of IV fluids and the presence of circulatory impairment (P=.053). A trauma board was used in 9 of 30 trauma cases (30%) and a cervical collar in 6 of 30 (20%). It was concluded that basic procedures used in the management of patients brought into the ED via ambulances were inadequate.     

急诊科护士专业水平及培训现状调查分析

目的　了解急诊科护士对急救知识、技能的获取途径、掌握现状及学习需求 ,探讨对急诊科护士开展专业培训的意义和实施方法。方法　采用问卷调查法对上海市 9所医院 2 82名急诊科护士进行调查 ,统计处理用Excel和SAS软件包进行。结果　急诊护士的专业知识平均得分为 71 .95± 1 0 .75分 ,但作为急诊中坚力量的年轻护士平均得分不尽人意。结论　有必要开展急诊科护士专业培训 ,培训内容和形式应结合我国实际、针对薄弱环节开展     

The Impact of Two Freestanding Emergency Departments on a Tertiary Care Center

Background

Freestanding emergency departments (FEDs) have become increasingly popular as the need for emergency care continues to grow.

Objective

To analyze the impact of two FEDs on a local tertiary care center’s patient volume and admission rates.

Methods

A retrospective analysis examined monthly volume and admission rates for the main ED and two FEDs located 9.6 and 12 miles away. Main ED census records were divided into three distinct time frames: period A (control) was January 2007 through June 2007. Period B was July 2007 through July 2009 when one FED was open. Period C was August 2009 through June 2010 when both FEDs were open. A two-factor analysis of variance was used to analyze admission rates while adjusting for monthly variation.

Results

The mean monthly patient volume for the main ED was 4709 for period A, but dropped significantly (p < 0.01) to 4447 for period B, and again dropped significantly (p < 0.01) to 4242 during period C. The volume for all facilities increased throughout the study period. A combined monthly volume increase to 5642 occurred in Period B, and increased to 6808 in Period C. The adjusted mean admission rate at the main ED for period A was 0.221, which dropped somewhat, though not significantly (p = 0.3505) to 0.213 for period B, and then significantly (p < 0.01) to 0.189 for period C.

Conclusion

Opening two FEDs decreased the volume and admission rates for the main ED and increased the overall ED volume for the health care system.     

Changes in Academic Attributes Associated with Establishment of Departments of Emergency Medicine

Abstract. Objective: To test the hypothesis that establishment of academic departments of emergency medicine (EM) is associated with improvements in attributes valued by traditional academic medicine.
Methods: Cross-sectional, observational analysis of academic departments of EM at all accredited allopathic medical schools, as of July 1, 1996. Nonre-spondents were mailed questionnaires three times, followed by phone contact. All variables were examined as before-after comparisons associated with department formation. Findings were reported as absolute differences, bounded by 99% confidence intervals (99% CIs), adjusted for multiple comparisons.
Results: Of 50 departments, 49 responded. Department formation was associated with a 25% (99% CI 5% to 46%) increase in accredited EM residencies, a 33% (99% CI 9% to 56%) increase in extramural grant funding, and 46% (99% CI 23% to 69%) and 34% (99% CI 8% to 58%) increases in departmental representation on medical school curriculum and promotions committees, respectively. The mean increase in academic faculty full-time equivalents (FTEs) was 6.7 (99% CI 3.3 to 10.1). There were average increments of 2.1 FTEs (99% CI 1.4 to 2.7) and 0.8 FTEs (99% CI 0.4 to 1.1) attaining senior ranks of associate professor and professor, respectively. With a top possible Likert scale score of 3, departmental status was associated with essentially identical improvements in the quality of faculty [2.6 (99% CI 2.4 to 2.8)], EM residents [2.6 (99% CI 2.4 to 2.8)], student teaching [2.7 (99% CI 2.5 to 2.9)], and overall academic productivity [2.8 (99% CI 2.7 to 3.0)].
Conclusion: Establishment of academic departments of EM at medical schools is associated with quantitatively and statistically significant improvements in many academic attributes that are mutually beneficial for both the institution and the specialty.     

Current status of Japanese emergency medicine based on a cross-sectional survey of one prefecture

Objective: To ascertain the current status of emergency medicine at certified emergency hospitals in Fukuoka, a Japanese prefecture. Fukuoka prefecture has the 9th largest population volume of the 46 prefectures throughout Japan. Methods: Written questionnaire sent to 146 certified emergency hospitals. Results: A total of 132 of 146 (90.4%) emergency hospitals replied. Data were complete from 131. Nineteen of 131 hospitals (14.5%) were qualified by the Japanese Association for Acute Medicine, whereas 85 of 131 (64.9%) were certified by other medical associations. In 32 of 131 hospitals (24.4%), there was an emergency medicine specialist or acute care physician, whereas 117 hospitals (89.3%) had a specialist doctor qualified by another medical association. In 33 of 131 hospitals (25%), there were doctors who undertook training in emergency medicine of surgery‐related courses, and 66 (50%) undertook internal medicine‐related courses. Conclusion: The current status of emergency medicine practice in the Fukuoka prefecture is poor. Medical associations relevant to emergency medicine should collaborate with each other to share information, as well as provide help to solve problems associated with emergency medicine manpower. This collaboration should occur as a national effort within the Japanese Association for Acute Medicine.     

急诊科单个病例的非技术性急救管理问题探讨

急救是急诊科最重要的工作内容,急救具有突发性、严重性及复杂性等特点。急救管理,是指在急救发生时对急救过程的一系列组织管理,使急救规范、有序进行,以提高急救成功率及减少风险。急救中的非技术性问题是指病情判断、用药、手术方法或策略等技术性问题之外的其他问题,