BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly ...BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS： This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months （June 2009 to June 2011）. Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively.RESULTS： In 1934 patients with AMS recruited, accounting for 0.93% of all emergency department （ED） patients, 1 026 （53.1%） were male, and 908 （46.9%） female. Their average age was 51.95±15.71 years. Etiologic factors were neurological （n=641; 35.0%）, pharmacological and toxicological （n=421; 23.0%）, systemic and organic （n=266; 14.5%）, infectious （n=167; 9.1%）, endocrine/metabolic （n=145; 7.9%）, psychiatric （n=71; 3.9%）, traumatic （n=38; 2.1%）, and gynecologic and obstetric （n=35; 1.9%）. Total mortality rate was 8.1% （n=156）. The death rate was higher in elderly patients （≥60） than in younger patients （10.8% vs. 6.9%, P=-0.003）.CONCLUSION： Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.展开更多
BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This stud...BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.CONCLUSION: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).展开更多
BACKGROUND:Septic cardiomyopathy(SCM)occurs in the early stage of sepsis and septic shock,which has implications for treatment strategies and prognosis.Additionally,myocardial involvement in the early stages of sepsis...BACKGROUND:Septic cardiomyopathy(SCM)occurs in the early stage of sepsis and septic shock,which has implications for treatment strategies and prognosis.Additionally,myocardial involvement in the early stages of sepsis is difficult to identify.Here,we assess subclinical myocardial function using laboratory tests and speckle-tracking echocardiography(STE).METHODS:Emergency department patients diagnosed with sepsis or septic shock were included for analysis.Those with other causes of acute or pre-existing cardiac dysfunction were excluded.Transthoracic echocardiography(TTE),including conventional echocardiography and STE,were performed for all patients three hours after initial resuscitation.Samples for laboratory tests were taken around the time of TTE.RESULTS:Left ventricular functions of 60 patients were analyzed,including 21 septic shock patients and 39 sepsis patients.There was no significant difference in global longitudinal strain(GLS),global circumferential strain(GCS),or global radical strain(GRS)between patients with sepsis and septic shock(all with P>0.05).However,GLS and GCS were significantly less negative in patients with abnormal troponin levels or in patients with abnormal left ventricular ejection fraction(LVEF)values(all with P<0.05).There were also moderate correlations between GLS and levels of cTnI(r=0.40,P=0.002)or N-terminal pro-B-type natriuretic peptide(NT-proBNP)(r=0.44,P=0.001)in sepsis and septic shock patients.CONCLUSION:Myocardial dysfunction,e.g.,lower LVEF or less negative GLS in patients with sepsis or septic shock,is more affected by myocardial injury.GLS could be incorporated into mainstream clinical practice as a supplementary LVEF parameter,especially for those with elevated troponin levels.展开更多
BACKGROUND: The use of corticosteroids in septic shock has been studied for many decades but yielded conflicting results. We conducted a systematic review to evaluate the efficacy and the safety of corticosteroids in ...BACKGROUND: The use of corticosteroids in septic shock has been studied for many decades but yielded conflicting results. We conducted a systematic review to evaluate the efficacy and the safety of corticosteroids in immunocompetent patients with septic shock.METHODS: Medline via Pub Med, Cochrane Central Register of Controlled Trials(CENTRAL) in the Cochrane Library, and EMBASE were searched from inception to March 2020. Two reviewers independently identified randomized controlled trials(RCTs) comparing corticosteroids with a control group for immunocompetent patients with septic shock. Data were abstracted and reported following the Cochrane Handbook for Systematic Review of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) statement. The efficacy outcome included mortality and shock reversal. The safety outcomes were infection, gastrointestinal bleeding, and hyperglycemia.RESULTS: Nine RCTs with a total of 1,298 patients were included. Compared with the control group, corticosteroid group did not lower the short-term(28 or 30 days) mortality(risk ratio [RR] 0.95, 95% confidence interval(CI) 0.85 to 1.06, inconsistency [I2]=0%, trial sequential analysis [TSA]-adjusted CI 0.83 to 1.09, moderate-certainty evidence). Corticosteroids significantly shortened the time to shock reversal compared with the control group(mean difference [MD] –21.56 hours;95% CI –32.95 to –10.16, I2=0%;TSA-adjusted CI –33.33 to –9.78, moderate-certainty evidence). The corticosteroid treatment was associated with an increased risk of hyperglycemia but not the infection or gastrointestinal bleeding.CONCLUSIONS: The corticosteroid treatment is not associated with lower short-or longterm mortality compared with placebo in immunocompetent patients with septic shock. However, corticosteroids significantly shorten the time to shock reversal without increasing the risk of infection. The patient's immune status should also be considered during clinical treatment and clinical trials in future.展开更多
BACKGROUND:This study aimed to determine whether modified shock index(MSI)is associated with mortality that is superior to heart rate,blood pressure,or the shock index(SI).in emergency patients.METHODS:A retrospective...BACKGROUND:This study aimed to determine whether modified shock index(MSI)is associated with mortality that is superior to heart rate,blood pressure,or the shock index(SI).in emergency patients.METHODS:A retrospective database review was performed on 22 161 patients who presented to Peking Union Medical College Hospital Emergency Department and received intravenous fluids from January 1 to December 31,2009.We gathered data of the patients on age,gender,vital signs,levels of consciousness,presenting complaints,and SI and MSI were calculated for all patients.RESULTS:Multivariate regression analysis was performed to determine the correlation between risk factors and outcome.There is a significant correlation between emergency patient mortality rate and patient's vital signs obtained at the triage desk(HR>120 beats/min,systolic BP<90 mmHg,diastolic BP<60 mmHg).MSI is a stronger predictor of emergency patient mortality compared to heart rate and blood pressure alone,whereas SI does not have a significant correlation with emergency patient mortality rate.CONCLUSION:MSI is a clinically significant predictor of mortality in emergency patients.It may be better than using heart rate and blood pressure alone.SI is not significantly correlated with the mortality rate of the emergency patient.展开更多
BACKGROUND:Many controversies still exist regarding ventilator parameters during cardiopulmonary resuscitation(CPR).This study aimed to investigate the CPR ventilation strategies currently being used among physicians ...BACKGROUND:Many controversies still exist regarding ventilator parameters during cardiopulmonary resuscitation(CPR).This study aimed to investigate the CPR ventilation strategies currently being used among physicians in Chinese tertiary hospitals.METHODS:A survey was conducted among the cardiac arrest team physicians of 500 tertiary hospitals in China in August,2018.Surveyed data included physician and hospital information,and preferred ventilation strategy during CPR.RESULTS:A total of 438(88%)hospitals completed the survey,including hospitals from all 31 Chinese mainland provinces.About 41.1%of respondents chose delayed or no ventilation during CPR,with delayed ventilations all starting within 12 minutes.Of all the respondents who provided ventilation,83.0%chose to strictly follow the 30:2 strategy,while 17.0%chose ventilations concurrently with uninterrupted compressions.Only 38.3%respondents chose to intubate after initiating CPR,while 61.7%chose to intubate immediately when resuscitation began.During bagvalve-mask ventilation,only 51.4%of respondents delivered a frequency of 10 breaths per minute.In terms of ventilator settings,the majority of respondents chose volume control(VC)mode(75.2%),tidal volume of 6–7 mL/kg(72.1%),PEEP of 0–5 cmH2O(69.9%),and an FiO2 of 100%(66.9%).However,62.0%of respondents had mistriggers after setting the ventilator,and 51.8%had high pressure alarms.CONCLUSION:There is a great amount of variability in CPR ventilation strategies among cardiac arrest team physicians in Chinese tertiary hospitals.Guidelines are needed with specific recommendations on ventilation during CPR.展开更多
BACKGROUND:Sepsis is a common cause of death in emergency departments and sepsis-associated encephalopathy(SAE)is a major complication.Rosuvastatin may play a neuroprotective role due to its protective effects on the ...BACKGROUND:Sepsis is a common cause of death in emergency departments and sepsis-associated encephalopathy(SAE)is a major complication.Rosuvastatin may play a neuroprotective role due to its protective effects on the vascular endothelium and its anti-inflammatory functions.Our study aimed to explore the potential protective function of rosuvastatin against SAE.METHODS:Sepsis patients without any neurological dysfunction on admission were prospectively enrolled in the“Rosuvastatin for Sepsis-Associated Acute Respiratory Distress Syndrome”study(SAILS trial,ClinicalTrials.gov number:NCT00979121).Patients were divided into rosuvastatin and placebo groups.This is a secondary analysis of the SAILS dataset.Baseline characteristics,therapy outcomes,and adverse drug events were compared between groups.RESULTS:A total of 86 patients were eligible for our study.Of these patients,51 were treated with rosuvastatin.There were significantly fewer cases of SAE in the rosuvastatin group than in the placebo group(32.1%vs.57.1%,P=0.028).However,creatine kinase levels were significantly higher in the rosuvastatin group than in the placebo group(233[22-689]U/L vs.79[12-206]U/L,P=0.034).CONCLUSION:Rosuvastatin appears to have a protective role against SAE but may result in a higher incidence of adverse events.展开更多
BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patie...BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.展开更多
BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulatin...BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.展开更多
Dear editor,Boerhaave syndrome,firstly described by Hermann Boerhaave in 1724,is a rare and life-threatening condition characterized by spontaneous transmural tear of the oesophagus.[1]The early diagnosis of Boerhaave...Dear editor,Boerhaave syndrome,firstly described by Hermann Boerhaave in 1724,is a rare and life-threatening condition characterized by spontaneous transmural tear of the oesophagus.[1]The early diagnosis of Boerhaave syndrome is extremely important since a delay in the diagnosis can increase the mortality rate.[2]Here,we reported a Boerhaave syndrome patient combined with tension hydropneumothorax.展开更多
Seasonal infl uenza,which is transmitted by droplets and direct contact,is a global public health issue that causes an average of 2.5 excess infl uenza-like illness(ILI)consultations per 1,000 person-years in China.[1...Seasonal infl uenza,which is transmitted by droplets and direct contact,is a global public health issue that causes an average of 2.5 excess infl uenza-like illness(ILI)consultations per 1,000 person-years in China.[1]Nonpharmaceutical interventions(NPIs)against droplet and direct contact transmission,including social distancing measures and personal protective measures,are recommended to reduce the spread of disease.Social distancing measures comprised isolating ill persons,quarantining exposed persons,school and workplace closures,and avoiding crowds.Personal protective measures included hygiene,respiratory etiquette,and face masks.[2]In December 2019,coronavirus disease 2019(COVID-19)started to spread,and China introduced NPIs to address the pandemic in January 2020.These NPIs could also help reduce the spread of other respiratory diseases,such as seasonal influenza.[3]In the second half of 2020,the COVID-19 pandemic was gradually brought under control.Production,transport,and schools were returning to normal,while citizens were still required to wear masks in public.Cases of influenza also reappeared.This study compared the ILI percentage(ILI%),laboratory(LAB)-positive rate,incidence rate,and effective reproductive number(Rt)of infl uenzas from 2019 to 2022 to clarify the change in seasonal infl uenza spread after the COVID-19 outbreak.展开更多
Hyperkalemic emergency(HE)refers to life-threatening hyperkalemia consisting of a high serum potassium level with severe complications(e.g.,dysrhythmias,cardiac arrest,or myopathy).^([1])Hyperkalemic emergencies(HEs)a...Hyperkalemic emergency(HE)refers to life-threatening hyperkalemia consisting of a high serum potassium level with severe complications(e.g.,dysrhythmias,cardiac arrest,or myopathy).^([1])Hyperkalemic emergencies(HEs)are commonly encountered(2%–3%)in the emergency department(ED).^([2,3])展开更多
文摘BACKGROUND： Altered mental status （AMS） is a very common emergency case, but the exact etiology of many AMS patients is unknown. Patients often manifest vague symptoms, thus, AMS diagnosis and treatment are highly challenging for emergency physicians. The aim of this study is to provide a framework for the assessment of AMS patients. This assessment should allow providers to better understand the etiology of mental status changes and therefore improve diagnostic skills and management.METHODS： This is a prospective cohort observational study. We recruited all adult patients with undifferentiated AMS at a single center tertiary care academic emergency department over 24 months （June 2009 to June 2011）. Demographic characteristics, clinical manifestations, assessment approaches, causative factors, emergency treatments and outcomes were collected prospectively.RESULTS： In 1934 patients with AMS recruited, accounting for 0.93% of all emergency department （ED） patients, 1 026 （53.1%） were male, and 908 （46.9%） female. Their average age was 51.95±15.71 years. Etiologic factors were neurological （n=641; 35.0%）, pharmacological and toxicological （n=421; 23.0%）, systemic and organic （n=266; 14.5%）, infectious （n=167; 9.1%）, endocrine/metabolic （n=145; 7.9%）, psychiatric （n=71; 3.9%）, traumatic （n=38; 2.1%）, and gynecologic and obstetric （n=35; 1.9%）. Total mortality rate was 8.1% （n=156）. The death rate was higher in elderly patients （≥60） than in younger patients （10.8% vs. 6.9%, P=-0.003）.CONCLUSION： Patients with AMS pose a challenge for ED physicians. The most frequently encountered diagnostic categories causing AMS were primary CNS disorders, intoxication, organ system dysfunction, and endocrine/metabolic diseases. AMS has a high fatality rate in the ED. AMS is an important warning signal for ED patients because of its potentially fatal and reversible effects. Prompt evaluation and treatment are essential to decreasing morbidity and mortality associated with AMS.
文摘BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.CONCLUSION: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).
文摘BACKGROUND:Septic cardiomyopathy(SCM)occurs in the early stage of sepsis and septic shock,which has implications for treatment strategies and prognosis.Additionally,myocardial involvement in the early stages of sepsis is difficult to identify.Here,we assess subclinical myocardial function using laboratory tests and speckle-tracking echocardiography(STE).METHODS:Emergency department patients diagnosed with sepsis or septic shock were included for analysis.Those with other causes of acute or pre-existing cardiac dysfunction were excluded.Transthoracic echocardiography(TTE),including conventional echocardiography and STE,were performed for all patients three hours after initial resuscitation.Samples for laboratory tests were taken around the time of TTE.RESULTS:Left ventricular functions of 60 patients were analyzed,including 21 septic shock patients and 39 sepsis patients.There was no significant difference in global longitudinal strain(GLS),global circumferential strain(GCS),or global radical strain(GRS)between patients with sepsis and septic shock(all with P>0.05).However,GLS and GCS were significantly less negative in patients with abnormal troponin levels or in patients with abnormal left ventricular ejection fraction(LVEF)values(all with P<0.05).There were also moderate correlations between GLS and levels of cTnI(r=0.40,P=0.002)or N-terminal pro-B-type natriuretic peptide(NT-proBNP)(r=0.44,P=0.001)in sepsis and septic shock patients.CONCLUSION:Myocardial dysfunction,e.g.,lower LVEF or less negative GLS in patients with sepsis or septic shock,is more affected by myocardial injury.GLS could be incorporated into mainstream clinical practice as a supplementary LVEF parameter,especially for those with elevated troponin levels.
基金supported by the CAMS Innovation Fund for Medical Sciences(CIFMS)(2020-I2M-C&T-B-014)CAMS Teaching Reform Research Fund(2018zlgc0101)CAMS Online Open Course Construction Fund(J2009022861)。
文摘BACKGROUND: The use of corticosteroids in septic shock has been studied for many decades but yielded conflicting results. We conducted a systematic review to evaluate the efficacy and the safety of corticosteroids in immunocompetent patients with septic shock.METHODS: Medline via Pub Med, Cochrane Central Register of Controlled Trials(CENTRAL) in the Cochrane Library, and EMBASE were searched from inception to March 2020. Two reviewers independently identified randomized controlled trials(RCTs) comparing corticosteroids with a control group for immunocompetent patients with septic shock. Data were abstracted and reported following the Cochrane Handbook for Systematic Review of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) statement. The efficacy outcome included mortality and shock reversal. The safety outcomes were infection, gastrointestinal bleeding, and hyperglycemia.RESULTS: Nine RCTs with a total of 1,298 patients were included. Compared with the control group, corticosteroid group did not lower the short-term(28 or 30 days) mortality(risk ratio [RR] 0.95, 95% confidence interval(CI) 0.85 to 1.06, inconsistency [I2]=0%, trial sequential analysis [TSA]-adjusted CI 0.83 to 1.09, moderate-certainty evidence). Corticosteroids significantly shortened the time to shock reversal compared with the control group(mean difference [MD] –21.56 hours;95% CI –32.95 to –10.16, I2=0%;TSA-adjusted CI –33.33 to –9.78, moderate-certainty evidence). The corticosteroid treatment was associated with an increased risk of hyperglycemia but not the infection or gastrointestinal bleeding.CONCLUSIONS: The corticosteroid treatment is not associated with lower short-or longterm mortality compared with placebo in immunocompetent patients with septic shock. However, corticosteroids significantly shorten the time to shock reversal without increasing the risk of infection. The patient's immune status should also be considered during clinical treatment and clinical trials in future.
文摘BACKGROUND:This study aimed to determine whether modified shock index(MSI)is associated with mortality that is superior to heart rate,blood pressure,or the shock index(SI).in emergency patients.METHODS:A retrospective database review was performed on 22 161 patients who presented to Peking Union Medical College Hospital Emergency Department and received intravenous fluids from January 1 to December 31,2009.We gathered data of the patients on age,gender,vital signs,levels of consciousness,presenting complaints,and SI and MSI were calculated for all patients.RESULTS:Multivariate regression analysis was performed to determine the correlation between risk factors and outcome.There is a significant correlation between emergency patient mortality rate and patient's vital signs obtained at the triage desk(HR>120 beats/min,systolic BP<90 mmHg,diastolic BP<60 mmHg).MSI is a stronger predictor of emergency patient mortality compared to heart rate and blood pressure alone,whereas SI does not have a significant correlation with emergency patient mortality rate.CONCLUSION:MSI is a clinically significant predictor of mortality in emergency patients.It may be better than using heart rate and blood pressure alone.SI is not significantly correlated with the mortality rate of the emergency patient.
基金supported by the Fundamental Research Funds for the Central Universities(No:3332018018)
文摘BACKGROUND:Many controversies still exist regarding ventilator parameters during cardiopulmonary resuscitation(CPR).This study aimed to investigate the CPR ventilation strategies currently being used among physicians in Chinese tertiary hospitals.METHODS:A survey was conducted among the cardiac arrest team physicians of 500 tertiary hospitals in China in August,2018.Surveyed data included physician and hospital information,and preferred ventilation strategy during CPR.RESULTS:A total of 438(88%)hospitals completed the survey,including hospitals from all 31 Chinese mainland provinces.About 41.1%of respondents chose delayed or no ventilation during CPR,with delayed ventilations all starting within 12 minutes.Of all the respondents who provided ventilation,83.0%chose to strictly follow the 30:2 strategy,while 17.0%chose ventilations concurrently with uninterrupted compressions.Only 38.3%respondents chose to intubate after initiating CPR,while 61.7%chose to intubate immediately when resuscitation began.During bagvalve-mask ventilation,only 51.4%of respondents delivered a frequency of 10 breaths per minute.In terms of ventilator settings,the majority of respondents chose volume control(VC)mode(75.2%),tidal volume of 6–7 mL/kg(72.1%),PEEP of 0–5 cmH2O(69.9%),and an FiO2 of 100%(66.9%).However,62.0%of respondents had mistriggers after setting the ventilator,and 51.8%had high pressure alarms.CONCLUSION:There is a great amount of variability in CPR ventilation strategies among cardiac arrest team physicians in Chinese tertiary hospitals.Guidelines are needed with specific recommendations on ventilation during CPR.
基金This research received funding from the CAMS Innovation Fund for Medical Sciences(CIFMS)(2020-I2M-C&T-B-014,2021-I2M-1-020).
文摘BACKGROUND:Sepsis is a common cause of death in emergency departments and sepsis-associated encephalopathy(SAE)is a major complication.Rosuvastatin may play a neuroprotective role due to its protective effects on the vascular endothelium and its anti-inflammatory functions.Our study aimed to explore the potential protective function of rosuvastatin against SAE.METHODS:Sepsis patients without any neurological dysfunction on admission were prospectively enrolled in the“Rosuvastatin for Sepsis-Associated Acute Respiratory Distress Syndrome”study(SAILS trial,ClinicalTrials.gov number:NCT00979121).Patients were divided into rosuvastatin and placebo groups.This is a secondary analysis of the SAILS dataset.Baseline characteristics,therapy outcomes,and adverse drug events were compared between groups.RESULTS:A total of 86 patients were eligible for our study.Of these patients,51 were treated with rosuvastatin.There were significantly fewer cases of SAE in the rosuvastatin group than in the placebo group(32.1%vs.57.1%,P=0.028).However,creatine kinase levels were significantly higher in the rosuvastatin group than in the placebo group(233[22-689]U/L vs.79[12-206]U/L,P=0.034).CONCLUSION:Rosuvastatin appears to have a protective role against SAE but may result in a higher incidence of adverse events.
基金the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2016-12M-1-003)。
文摘BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.
基金supported by grants from Chinese Academy of Medical Science Teaching Reform Research Fund(2018zlgc0101)Chinese Academy of Medical Science Online Open Course Construction Fund(J2009022861)+1 种基金CAMS Innovation Fund for Medical Sciences(CIFMS)(serial number 2021-1-I2M-020)CAMS Innovation Fund for Medical Sciences(CIFMS)(serial number 2020-I2M-C&T-B-014).
文摘BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.
文摘Dear editor,Boerhaave syndrome,firstly described by Hermann Boerhaave in 1724,is a rare and life-threatening condition characterized by spontaneous transmural tear of the oesophagus.[1]The early diagnosis of Boerhaave syndrome is extremely important since a delay in the diagnosis can increase the mortality rate.[2]Here,we reported a Boerhaave syndrome patient combined with tension hydropneumothorax.
基金supported by National High Level Hospital Clinical Research Funding(2022-PUMCH-D-005)National High Level Hospital Clinical Research Funding(2022-PUMCH-B-109)。
文摘Seasonal infl uenza,which is transmitted by droplets and direct contact,is a global public health issue that causes an average of 2.5 excess infl uenza-like illness(ILI)consultations per 1,000 person-years in China.[1]Nonpharmaceutical interventions(NPIs)against droplet and direct contact transmission,including social distancing measures and personal protective measures,are recommended to reduce the spread of disease.Social distancing measures comprised isolating ill persons,quarantining exposed persons,school and workplace closures,and avoiding crowds.Personal protective measures included hygiene,respiratory etiquette,and face masks.[2]In December 2019,coronavirus disease 2019(COVID-19)started to spread,and China introduced NPIs to address the pandemic in January 2020.These NPIs could also help reduce the spread of other respiratory diseases,such as seasonal influenza.[3]In the second half of 2020,the COVID-19 pandemic was gradually brought under control.Production,transport,and schools were returning to normal,while citizens were still required to wear masks in public.Cases of influenza also reappeared.This study compared the ILI percentage(ILI%),laboratory(LAB)-positive rate,incidence rate,and effective reproductive number(Rt)of infl uenzas from 2019 to 2022 to clarify the change in seasonal infl uenza spread after the COVID-19 outbreak.
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文摘Hyperkalemic emergency(HE)refers to life-threatening hyperkalemia consisting of a high serum potassium level with severe complications(e.g.,dysrhythmias,cardiac arrest,or myopathy).^([1])Hyperkalemic emergencies(HEs)are commonly encountered(2%–3%)in the emergency department(ED).^([2,3])
