Success Rate Of Rescue Research Articles

Application value of bedside noninvasive hemodynamic monitoring in the diagnosis and treatment of neonatal septic shock

Objective To evaluate the application value of bedside noninvasive hemodynamic monitoring in the diagnosis and treatment of neonatal septic shock. Methods The purchase time and use of Ultrasound Cardiac Output Monitor (USCOM) to monitor hemodynamic status were taken as the grouping condition, and the infants admitted to Department of Neonatology in Shanghai Children′s Hospital from March 2014 to December 2016 were divided into 3 groups, 16 of USCOM′s pre-purchased septic shock infants were taken as non-USCOM monitoring group, 20 patients with septic shock received USCOM monitoring as USCOM monitoring group, the other 20 non-septic shock neonates were assigned as a control group, whose primary diseases were premature, neonatal jaundice or neonatal pneumonia.Systolic volume (SV), cardiac output (CO), heart rate (HR), cardiac index (CI) and systemic vascular resistance index (SVRI) in USCOM monitoring group and control group were recorded.The doses of dopamine, dobutamine, epinephrine or norepinephrine and the time of vasoactive drug administration were compared between the USCOM monitoring group and non-USCOM monitoring group.The data of 3 groups were analyzed statistically. Results Compared with the control group, the hemodynamic parameters of the USCOM monitoring group before treatment such as CO [(0.68±0.44) L/min vs.(0.44±0.17) L/min, t=3.306, P=0.004], CI [(4.40±1.88) L/(min·m2) vs.(3.00±0.40)L/(min·m2), t=3.328, P=0.004], SV [(3.90±2.39) cm3vs.(3.08±0.31) cm3, t=2.227, P=0.038] and HR [(166.09±26.20) times/min vs.(145.35±16.16) times/min, t=2.750, P=0.013] were increased, while the SVRI showed an obvious decline [(795.88±450.19) d·s/(cm5·m2) vs.(1 160.61±49.59) d·s/(cm5·m2), t=-2.898, P=0.009], and the differences were statistically significant.While in the USCOM monitoring group after treatment, the CO [(0.56±0.28) L/min vs.(0.68±0.44) L/min, t=2.456, P=0.024] and CI [(3.65±1.10) L/(min·m2) vs.(4.40±1.88) L/(min·m2), t=2.614, P=0.017] were decreased significantly compared with those in USCOM monitoring group before treatment.Compared with non-USCOM monitoring group, the doses of dopamine [(45.72±28.80) mg/kg vs.(85.83±69.33) mg/kg, t=2.352, P=0.005], dobutamine [(12.81±26.18) mg/kg vs.(85.83±69.33) mg/kg, t=4.351, P=0.002], epinephrine [(0.11±0.33) mg/kg vs.(0.90±1.75) mg/kg, t=1.986, P=0.014], and the time of vasoactive drug use [(68.10±34.37) h vs.(167.75±117.14) h, t=3.626, P=0.001] were decreased significantly in USCOM monitoring group.The doses of norepinephrine [(1.91±3.79) mg/kg vs.(0.47±0.90)mg/kg, t=-1.481, P=0.046]were increased significantly in USCOM monitoring group. Conclusion The noninvasive hemodynamic monitoring plays an important role in the diagnosis and treatment of septic shock in neonates by clarifying the hemodynamic status of shock and guiding the rational use of vasoactive drugs so as to improve the successful rescue rate. Key words: Bedside noninvasive hemodynamics monitoring; Ultrasound cardiac output monitor; Infant, newborn; Septic shock

Application of emergency nursing program in traumatic shock patients

Objective To explore the effects of emergency nursing program in traumatic shock patients. Methods A retrospective analysis was performed to emergency nursing programs for 43 traumatic shock patients in the Affiliated Hospital of Hangzhou Normal University from June 2016 to June 2017 along with summarizing nursing experience. Nursing main points included evaluating condition, monitoring patients' condition closely, position, keeping warm, establishing venous access immediately, controlling pain, controlling hemorrhage and mental intervention. Results The average rescue time was (38.49±5.62) min. A total of four patients died after rescue due to severe wounds, and 39 patients had successful rescue with 90.70% for the success rate of rescue. Family members' satisfaction was 95.35% at discharge. Conclusions Emergency nursing has significant clinical effects in traumatic shock patients. It is worth to be referred in clinic. Key words: Shock, traumatic; First aid; Effect

Clinical application of case teaching method combined with clinical pathway in pediatrics teaching

Objective To explore the clinical application of case teaching method combined with clinical pathway in pediatrics teaching. Methods 103 students in pediatric practice from September 2016 to September 2017 were enrolled as the study object, who were divided randomly into observation group (52 cases) and control group (51 cases). Routine teaching method was adopted in the control group, while case teaching method combined with clinical pathway was adopted in the observation group. In addition, 100 cases of children in need of rescue were selected for each group and the students were divided into two or three in a group to participate in the rescue. If the student could complete the rescue with the assistance of supervisor, he will be considered as playing a leading role in rescue process. Otherwise, another supervisor would join to lead the rescue, and the student would assist by the side, who will be considered as playing an auxiliary role in rescue process. The results of examination, classroom participation, homework, the rescue performance and the satisfaction of teaching were compared between two groups. Results The scores of theoretical course, case analysis and skill operation in the observation group was significantly higher than that of the control group (P<0.05). The scores of classroom attendance, classroom activity and homework quality in the observation group was significantly higher than that of the control group (P<0.05). Success rate of rescue conducted by students in the observation group was significantly higher than that in the control group(P<0.05). The teaching satisfaction of the observation group was also significantly higher than that of the control group (P<0.05). Conclusion The application of case teaching method combined with clinical pathway teaching model in pediatrics teaching is effective and worthy of popularizing, which can obviously improve teaching quality, arouse students' interest in teaching process, and improve students' professional quality. Key words: Case teaching method; Clinical pathway; Pediatric teaching; Clinical application

Effect of pre-hospital care on prognosis of hypertensive intracerebral hemorrhage

Objective To investigate the effect of pre-hospital emergency on prognosis of patients with hypertensive cerebral hemorrhage. Methods From January 2016 to March 2017, 66 patients of hypertensive cerebral hemorrhage in Yuncheng Emergency Center were randomly divided into control group(routine treatment, 33 cases) and observation group(pre-hospital emergency, 33 cases)according to the digital table.The first aid efficiency, incidence of complications, quality of life and rescue result of the two groups were compared. Results The onset to the emergency department time, emergency department preliminary processing time, the relevant departments to do special inspection time, specialist diagnosis and treatment time, total emergency time in the observation group were (19.36±2.05)min, (15.13±2.41)min, (12.26±3.42)min, (8.20±1.21)min, (51.52±5.41)min, respectively, which were shorter than those in the control group[(35.26±2.52)min, (26.36±2.73)min, (17.25±4.12)min, (12.23±2.23)min, (84.26±4.56)min], there were statistically significant differences between the two groups(t=28.12, 17.72, 5.35, 9.12, 26.58, all P<0.05). The incidence rates of gastrointestinal bleeding, reduced blood oxygen saturation, central high fever, hypostatic pneumonia in the observation group were 0.00%, 3.03%, 3.03%, 6.06%, respectively, which were lower than those in the control group (12.12%, 21.21%, 18.18%, 24.24%)(χ2=4.26, 5.12, 4.00, 4.24, all P<0.05). After the condition was stable, the mental health score, emotional function score, physiological body function score, pain score, physiological function score, social function score of the observation group were (82.36±1.52), (84.36±2.43), (81.56±2.10), (83.64±2.54), (85.21±3.46), (84.59±3.26), respectively, which were higher than those of the control group[(68.53±2.57), (70.26±3.25), (69.64±3.56), (68.52±2.49), (69.12±3.23), (70.31±2.26)], there were statistically significant differences between the two groups(t=26.61, 19.96, 16.57, 24.42, 19.53, 20.68, all P<0.05). The rescue success rate of the observation group was 100.00%, which was higher than 78.79% of the control group, there was statistically significant difference between the two groups(χ2=7.83, P<0.05). Conclusion Pre-hospital care can effectively improve the prognosis of hypertensive intracerebral hemorrhage. Key words: Intracranial hemorrhage, hypertensive; Emergency medical services; Prognosis

Research progress on anti-infection therapy for sepsis in children

Abstract Sepsis is a systemic inflammatory response caused by infection and a critical illness in pediatrics. This disease is the leading cause of death in infants and children worldwide. An early, appropriate, and adequate anti-infective treatment can effectively prevent disease progression and improve the survival rate of children. However, antimicrobial drug abuse, increased drug-resistant bacteria, and lack of epidemiological data have hampered the effective and rational anti-infective treatment of patients with sepsis and enhancement of the success rate of rescue, especially for children. This article briefly reviews the recent advances in anti-infective treatment for sepsis in children at home and abroad based on sepsis definition, pathogen distribution and drug resistance, infection source control, and rational anti-infection. The results provide a foundation for clinical treatment of sepsis.

Research progress of factors influencing chest compression and nursing intervention during cardiopulmonary resuscitation

This paper summarizes the current situation of the implementation of cardiopulmonary resuscitation (CPR) technology for nursing staff, and summarizes the related factors and intervention strategies for high quality chest compressions, in order to improve the technical ability of the chest compressions, reduce the ineffective pressure and the meaningless interruption, so as to provide the basis for the maximum improvement of the rescue success rate of the patients with cardiac arrest. Key words: Review; Cardiopulmonary resuscitation; Chest compression; Influencing factors

Experimental research on individual-specific rapid potassium supplementation strategy for fatal severe hypokalemia

To explore the effectiveness and safety of the individual-specific rapid potassium supplementation strategy, and to provide experimental basis for treating fatal severe hypokalemia. An acute fatal severe hypokalemia model was reproduced in 20 healthy adult Japanese big ear white rabbits with half lethal dose (LD50) of barium chloride (BaCl2) solution 168 mg×5 mL-1×kg-1. The rabbits were divided into conventional potassium supplementation group and individual-specific rapid potassium supplementation group according to random number table method with 10 rabbits in each group. All the animals were injected with 3% KCl through the auricular marginal veins by a micro-injection pump, and the target plasma potassium concentration was 4 mmol/L. The rabbits in conventional potassium supplementation group were administered continuously potassium infusion at the standard infusion rate of 0.4 mmol×kg-1×h-1. And those in the individual-specific rapid potassium supplementation group were treated in two steps: first, a loading dose of potassium was rapidly injected within 5 minutes, and this step was repeated until the plasma potassium concentration increased to 3.5 mmol/L; second, a sustaining dose of potassium infusion was continued at the rate of 0.4 mmol×kg-1×h-1 after the increase in plasma potassium concentration. The changes in electrocardiogram, blood pressure, respiratory rate (RR), plasma potassium concentration, urine potassium concentration, urine volume, potassium content in extracellular fluid (ECF) and other parameters were monitored. The potassium supplementation, potassium excretion and potassium cross cell status were recorded. Adverse reactions and 7-day death were observed. Since the BaCl2 administration, the plasma potassium concentration of all experimental rabbits were significantly lower than baseline at 0.5 hour, which was decreased below 2.5 mmol/L at 2.0 hours when the ventricular arrhythmias appeared, indicating the reproduction of fatal severe hypokalemia model was successful. There was no significant difference in gender, weight, baseline heart rate (HR), RR, mean arterial pressure (MAP), blood gas analysis or K+, Na+, Cl- levels between the two groups. Compared with baseline levels, MAP was significantly decreased and RR was significantly increased before potassium supplementation in both groups, but the parameters were improved significantly and restored to the baseline after potassium supplementation. There was no significant difference in MAP or RR during potassium supplementation between the two groups. The amount of potassium supplementation in two groups showed no significant differences. However, compared with the conventional potassium supplementation group, in the individual-specific rapid potassium supplementation group, the increase in plasma potassium concentration, urine potassium concentration, and the increase in potassium content in ECF were significantly increased [the increase in plasma potassium concentration (mmol/L): 2.40±0.33 vs. 1.51±0.75, urine potassium concentration (mmol/L): 164.94±18.07 vs. 108.35±19.67, the increase in potassium content in ECF (mmol): 1.17±0.16 vs. 0.73±0.35], the duration of potassium infusion was shortened (hours: 2.1±0.7 vs. 4.7±1.4), the total urine volume, renal excretion of potassium, and the amount of transcellular potassium shift were significantly decreased [total urine volume (mL): 6.40±1.78 vs. 13.60±4.69, renal excretion of potassium (mmol): 1.04±0.26 vs. 1.46±0.51, amount of transcellular potassium shift (mmol): 1.39±0.21 vs. 1.84±0.62], the duration of arrhythmia was shortened (minutes: 19.60±8.92 vs. 71.80±9.84), with statistically significant differences (all P < 0.05). Hyperkalemia did not occur in both groups. The rabbits of the individual-specific rapid potassium supplementation group were all alive, while 4 died in the conventional potassium supplementation group, and statistically significant difference was found between the two groups (P < 0.01). These data demonstrate that the individual-specific rapid potassium supplementation strategy can shorten the time for correcting hypokalemia, which is a better option to reverse life-threatening arrhythmia caused by severe hypokalemia, with a high rescue success rate. The process of potassium supplement is safe and effective.

Improved in vitro Vitis vinifera L. embryo development of F1 progeny of ‘Delight’ × ‘Ruby seedless’ using putrescine and marker-assisted selection

Production of seedless V. vinifera L. cultivars is one of the major goals of table grape breeding. Traditional methods result in only a low percentage of seedless progeny. Modern techniques, such as embryo rescue, are used to improve production efficiency of seedless cultivars. In this study, the effects of various putrescine concentrations (0, 1, 2, 3, 4, and 5 mmol L−1) and different stages of embryo development (globular-, heart-, torpedo-, and cotyledon-shaped embryo) on the success rate of embryo rescue were assessed in three lines of the F1 Vitis vinifera L., cross ‘Delight’ × ‘Ruby Seedless,’ ‘DR2,’ ‘DR3,’ and ‘DR6’ (with small seed traces). The plant development rates of ‘DR2,’ ‘DR3,’ and ‘DR6’, which contain small seed traces, as female parents, were significantly higher than those of seedless varieties. The rates of embryo development on woody plant medium (WPM) of ‘DR2’ × ‘Thompson Seedless,’ ‘DR3’ × ‘Thompson Seedless,’ and ‘DR6’ × ‘Monukka’ were highest with 2, 2, and 4 mmol L−1 putrescine, respectively. The germination rates of torpedo- and cotyledon-shaped embryos were significantly higher than those of globular- and heart-shaped embryos. Characteristics of the embryo germination progress of ‘DR2’ × ‘Thompson Seedless’ at different developmental stages were recorded. The Grape Seedless gene Probe 1 (GSLP1) marker was used to help identify the seedless descendants; 14 plantlets showed a corresponding electrophoresis band at 569 bp and were preliminarily defined as seedless.

The curative effect of synthetic treatment for refractory acute myocardial infarction.

This study aims to investigate the curative effect of synthetic treatment for refractory acute myocardial infarction (AMI). A total of 76 patients with coronary AMI accompanied by shock, who were treated with combined therapy from August 1999 to April 2017, were included into this study. Sixty patients received emergency percutaneous coronary intervention (PCI). Among these patients, 39 patients received intra-aortic balloon counterpulsation (IABP), eight patients had failed PCI underwent emergency off-pump coronary artery bypass (E-OPCAB), and eight patients were treated by hybrid cardiac surgery. All patients were successfully rescued. However, two patients died afterward due to postoperative complications. For AMI patients complicated with shock, especially when emergency PCI fails or is difficult to perform, PCI + IABP, emergency E-OPCAB and hybrid cardiac surgery should be carried out, in order to achieve a good outcome and improve the success rate of rescue for this group of patients. Acute myocardial infarction (AMI); emergency percutaneous coronary intervention (PCI); intra-aortic balloon counterpulsation (IABP); emergency off-pump coronary artery bypass (E-OPCAB); hybrid cardiac surgery.

Blood purification therapy in children with acute poisoning

Acute poisoning is one of the commonly acute disease and critical illness in PICU.However, along with the application of blood purification therapy, we′ve made remarkable progress in treating the poisoned children.Learning about common patterns and mechanism of blood purification in acute poisoning, being familiar with the indications and contraindications of blood purification, selecting appropriate treatment model combined with the features of toxicants and different patterns of blood purification, mastering the procedures, which all above can help us reduce the complications and upgrade the successful rescue rate of acute poisoning in children. Key words: Blood purification; Poisoning; Children

Distribution and epidemiological characteristics of disease spectrum in patients with pre-hospital care in Hohhot in 2016: a case analysis in 28 325 patients

To analyze the distribution and epidemiological characteristics of patients in pre-hospital emergency in Hohhot. The data of 28 325 pre-hospital emergency patients in 7 first-aid stations in Hohhot from January 1st to December 31st in 2016 were analyzed retrospectively. The gender, age, call time, disease spectrum of patients served as investigation elements, the data were collected into Excel 2010 form, and statistical analysis was carried out. Among 28 325 pre-hospital emergency patients, there were 15 973 male (56.39%) and 12 352 female (43.61%), with the ratio of male to female of 1.29:1. The age of patients were 1 day-108 years, with the majority of patients aged 51-60 years, which accounting for 16.08% (4 554/28 325). The top 6 of diseases were trauma [33.10% (9 376/28 325)], neurological system diseases [16.81% (4 762/28 325)], circulatory system diseases [12.31% (3 486/28 325)], respiratory system diseases [7.62% (2 159/28 325)], digestive system diseases [5.68% (1 609/28 325)], acute poisoning [5.02% (1 422/28 325)]. The peak period of call for help was 09:00-11:00 (12.55%, 3 554/28 325), and 1 small peak occurred at 15:00-17:00 (11.22%, 3 179/28 325). The highest number of patients with pre-hospital care happened in summer (26.22%, 7 428/28 325), followed by autumn (24.94%, 7 065/28 325) and winter (24.83, 7 032/28 325), and the lowest in spring (24.01%, 6 800/28 325). The peak incidence of traumatic patients was in November (11.13%, 1 044/9 376), the most patients with nervous system diseases were found in October (9.97%, 475/4 762), and the most patients with circulatory system diseases were found in July (11.16%, 389/3 486). The first aid patients in Hohhot were mainly suffered from diseases of trauma, nervous system and circulatory system, more men than women, most in 51-60 years old patients, and the summer was the peak season. Therefore, the establishment of trauma center in emergency department, strengthening the health education of high-risk groups and the primary prevention of patients with cardiovascular and cerebrovascular diseases, scientific and effective use of medical resources can improve the success rate of pre-hospital rescue.

The effect of predictable aid support in tracheal intubation with severe acute organophosphorus pesticide poisoning patients

Objective To explore the effect of predictable aid support in tracheal intubation with severe acute organophosphorus pesticide poisoning(SAOPP)patients. Methods A total of 109 patients were randomly divided into treatment group(n=55) and control group(n=54). All the patients were treated with the gastric lavage and catharsis, and accepted atropine, pralidoxime chloride and ventilatory support as prescribed.More predictability ambulance measures were applied to the treatment group such as: reinforcement tracheal intubation, endotracheal intubation tube off alarm device and joint of thermostatic wetting with oxygen driving atomization.The therapy efficacy were compared between the two groups. Results There was no statistically significant difference between the two groups of patients before treatment, such as respiration, heart rate and blood oxygen saturation(P>0.05). The observation group was compared with the control group of 72 hours after treatment, and the difference was statistically significant(P<0.01). The mechanical ventilation time, endotracheal intubation time, monitoring time and length of hospital stay of the observation group were(25.63±3.24) hours, (32.17±3.50) hours, (5.65±1.63) days and (8.52±2.13) days respectively, while the control group were (37.82±3.75) hours, (43.64±3.83) hours, (9.78±1.85) days and(13.79±2.17) days.The differences between the two groups were statistically significant(P<0.01). The incidence of UE and complications of the observation group was significantly lower than those in the control group, while the success rate of rescue was significantly higher than that in the control group, and the difference was statistically significant(P<0.05). Conclusions Foresight rescue support plan in endotracheal intubation can increase the success rate, enhance the efficacy, reduce complications and improve prognosis of SAOPP patients. Key words: Organophosphorus pesticide poisoning; Tracheal intubation; Medical support; Prognosis

Protective effects of scopolamine and penehyclidine hydrochloride on acute cerebral ischemia-reperfusion injury after cardiopulmonary resuscitation and effects on cytokines

The objective of this study was to investigate the protective effects of scopolamine and penehyclidine hydrochloride on acute cerebral ischemia-reperfusion injury after cardiopulmonary resuscitation, and the effect on cytokine levels. Eighty patients with cardiac arrest admitted to our hospital from June 2011 to December 2015 were recruited and randomly divided into two groups (n=40 each). Following cardiopulmonary resuscitation, scopolamine was administered in the control group, whereas penehyclidine hydrochloride was administered in the observation group. After intervention, the following medical indicators were compared between the groups: Intracranial pressure, cerebral oxygen partial pressure, cerebral perfusion pressure, assessment of the balance of cerebral oxygen supply and demand, levels of neuron-specific enolase (NSE) and blood lactic acid, levels of oxidative stress markers, and levels of inflammatory-related factors. Additionally, the areas of brain tissue edema and National Institutes of Health Stroke Scale (NIHSS) scores before and after intervention were compared. Rescue success rates of the groups were recorded. After intervention, the following indicators were lower in the observation group than in the control group: Intracranial pressure (p<0.05), levels of NSE (p<0.05), levels of blood lactic acid (p<0.05), levels of malondialdehyde (p<0.05), and levels of interleukin 6 (IL-6), tumor necrosis factor-α, IL-1, and hs-CRP (p<0.05). However, the following indicators were higher in the observation group than in the control group: Cerebral oxygen partial pressure, cerebral perfusion pressure (p<0.05), levels of CaO2, CjvO2, and CERO2 (p>0.05), and levels of superoxide dismutase and glutathione peroxidase (p<0.05). Additionally, the areas of brain tissue edema after intervention were smaller in the observation group than those before intervention and those after intervention in the control group (p<0.05). Similarly, the NIHSS scores after intervention in the observation group were lower than those before intervention and those after intervention in the control group (p<0.05). Rescue success rate was significantly higher in observation group than in control group (p<0.05). In conclusion, administration of penehyclidine following cardiopulmonary resuscitation can effectively improve cerebral perfusion pressure, lower intracranial pressure, reduce brain tissue edema and inflammation, and improve neurological function.

Study on safety management and risk response measures of prehospital emergency care in patients with cerebral hemorrhage

Objective To study the safety management and risk response of preoperative emergency in patients with cerebral hemorrhage. Methods 92 patients with intracerebral hemorrhage were divided into two groups.The conventional group was treated with routine care in prehospital first aid.The prehospital intervention group used transport safety management and risk comprehensive response measures.The incidence of first aid consciousness, rapid response score, safe transshipment score, medical care score and the success rate of rescue and the incidence of medical disputes were compared between the two groups.The satisfaction of the family members of the patients with first aid treatment was analyzed. Results The score of first aid consciousness, rapid response score, safe transfer score, medical care score of the prehospital intervention group were (96.24±3.91)points, (93.98±2.72)points, (95.26±3.57)points and (95.72±3.02)points, respectively, which were significantly better than those of the conventional group [(83.12±3.15)points, (82.02±1.53)pointss, (83.52±2.92)points, (83.14±2.15)points, t=8.629, 8.826, 8.042, 8.514, all P<0.05]. The success rate of hospitalization of the prehospital intervention group was 95.65%, which was higher than 78.26% of the conventional group(χ2=6.133, P<0.05). The incidence rate of medical disputes in the prehospital intervention group was significantly lower than that in the conventional group(χ2=5.145, P<0.05). Among them, there were 9 cases of medical disputes in the conventional group, the incidence rate was 19.57%.In the prehospital intervention group, there was 1 case of medical disputes, the incidence rate was 2.17%.The satisfaction rate of prehospital emergency treatment in the prehospital intervention group was 95.65%, which was significantly higher than 78.26% in the conventional group (χ2=6.133, P<0.05). Conclusion The safety management and risk response measures of preoperative emergency in patients with intracerebral hemorrhage are effective, which can effectively improve the success rate of cerebral hemorrhage rescue, improve nursing staff first aid consciousness and rapid response ability, improve medical care and transport safety, it is worthy of promotion. Key words: Cerebral hemorrhage; Emergency medical services; Safety management

Consensus on the establishment of urban trauma rescue system in China

With the rapid economic development in China, the incidence of all sorts of accidental injury, such as traffic injuries and fall-induced injuries, increased significantly. Trauma, particularly severe trauma, often involves multiple organs and multiple system damage, and needs a scientific, standardized comprehensive multidisciplinary approach for treatment. Due to meticulous sub-division of clinical department sand lack of professional trauma treatment team in general hospitals in China's major cities, the overall level of trauma rescue in China is much lower than the developed countries. So the urgent need is to establish and form an efficient and standardized urban trauma treatment system. In order to further guarantee the establishment of urban trauma rescue system, and to further improve the success rate of trauma rescue in China, nationally well-known trauma experts of China developed the "Expert consensus document on the establishment of urban trauma rescue system in China" based on its previous research results, foreign countries' successful experience and China's national conditions. This document would be an important reference for our local governments at all levels to create urban trauma rescue system.

Effect of thrombelastography on the assessment of sepsis severity and septic shock with disseminated intravascular coagulation condition in children

Objective To explore the effect of thrombelastography in sepsis and septic shock with disseminated intravascular coagulation (DIC) condition in children. Methods Ninety-one cases of children admitted to the Pediatric Intensive Care Unit, Zhengzhou Children′s Hospital between January 2013 and December 2016 were enrolled in this study.Fifty-eight cases of sepsis, 17 cases of severe sepsis and 16 cases of septic shock (including 7 cases DIC and 9 cases non-DIC) were included in 91 cases of children.After admission, they were given conventional treatment according to their condition of illness, such as expansion of rehydration, applying vascular active drugs, anti-infection, mechanical ventilation, maintaining internal environment, nutrition support, etc.Thrombelastography of all the patients were detected for 6 hours after admission.The test indexes included blood coagulation reaction time (R), blood clot formation time (K) and blood clot formation rate (alpha), maximum width (MA), coagulation index (CI), etc.And pe-diatric critical illness scores(PCIS) were also evaluated for 6 hours after admission. Results With the progression of sepsis severity, R value, K value increased dramatically(F=3.629, 4.237, all P 0.05). Conclusions TEG has a great significance in evaluating severity of children with sepsis.It can also guide clinical assessment in children with septic shock DIC so as to give accurate effective intervention and improve the rescue success rate and the prognosis. Key words: Thrombelastography; Child; Sepsis; Pediatric critical illness score; Disseminated intravascular coagulation

Applicatioin of integrated model of emergency care in patients with diabetic ketoacidosis

Objective To investigate the application effects of integrated model of emergency care in patients with diabetic ketoacidosis. Methods A number of 30 patients with diabetic ketoacidosis from June 2014 to May 2015 were selected as the control group. Another 30 patients with diabetic ketoacidosis from June 2015 to May 2016 were selected as the experimental group. Patients in the control group were given conventional first aid, while patients in the experimental group received additional integrated emergency nursing. The rescue success rate, urine ketone bodies clearance time, incidence of hypoglycemia, professional skills of nurses before and after the integration of emergency nursing were analyzed and compared between the two groups. Results The rescue success rate of the experimental group (100.00%) was higher than that of the control group (76.67%) , with a statistically significant difference (χ2=5.82, P<0.05) . The urine ketone bodies clearance time were (1.68±0.87) d in the experimental group and (2.19±0.95) d in the control group, and the difference was statistically significant (t=2.16, P<0.05) . The incidence of hypoglycemia of the experimental group (3.33%) was significantly lower than that of the control group (26.67%) , and the difference was statistically significant (χ2=4.71, P<0.05) . The pass rate of professional skills test of nurses after the integration of emergency care was statistically significant higher than before the implementation (P<0.05) . Conclusions Integrated model of emergency care can improve the emergency treatment in patients with diabetic ketoacidosis and increase the professional skills in emergency nursing of nurses. Key words: Emergency medical services; First aid; Diabetic ketoacidosis; Intergrated model of emergency care

Study of central venous oxygen saturation monitoring applicated in fluid resuscitation of patients with severe sepsis and septic shock

Objective To guide the fluid resuscitation in patients with severe sepsis and septic shock by monitoring the central venous oxygen saturation(ScvO2), and to improve the rescue success rate and prognosis of patients with sepsis. Methods Based on the standard of ScvO2 of 6h, 45 patients with severe sepsis and septic shock were divided into two groups: observation group(n=28) and control group(n=17). The ScvO2, mean arterial pressure(MAP) and central venous pressure(CVP) levels were measured in the two groups after fluid resuscitation, and then the mortality, MAP compliance rate and CVP compliance rate were compared between the two groups. Results Compared with mortality in the control group(52.94%), the mortality in the observation group(14.29%) was significantly lower, the difference was significant (χ2=5.927, P=0.015), but after 6h's fluid resuscitation, the MAP and CVP standard number in the two groups did not exist significant difference(χ2=1.182, P>0.05). Conclusion ScvO2 with or without reaching the standard level(more than 65%) was positively correlated with the severity of the disease after fluid resuscitation in patients with severe sepsis and septic shock.Therefore, the monitoring of ScvO2 plays an important role in guiding the treatment of fluid resuscitation and judging the prognosis. Key words: Sepsis; Shock, Septic; Resuscitation

Comparison of clinical efficacy of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus pesticide poisoning

Objective To compare the clinical effect of penehyclidine hydrochloride and atropine in the treatment of acute organophosphorus pesticide poisoning. Methods 86 patients with organophosphorus pesticide poisoning were selected and randomly assigned to the observation group and the control group according to the digital table, 43 cases in each group. The two groups were given conventional treatment, while the control group was treated with atropine, the observation group was given penehyclidine hydrochloride.The disappearance time of main symptoms, rescue success rate and adverse reactions of the two groups were observed. Results After salvage treatment, the rescue success rate of the observation group was 97.8%, which of the control group was 88.4%, the difference was statistically significant (χ2=1.433, P<0.05). The disappear time of M like symptoms, N like symptoms and central nervous system symptoms in the observation group was significantly shorter compared with the control group (all P<0.05). The number of drugs, dosage, cholinesterase recovery time and hospitalization time between the two groups had statistically significant differences (P<0.05). The incidence rates of blurred vision, restlessness, heart rate and urinary retention in the control group were significantly higher than those in the observation group (all P<0.05). Conclusion Penehyclidine hydrochloride for acute organophosphorus pesticide poisoning can significantly reduce the incidence of symptoms, shorten the disappearance time of symptoms, reduce hospitalization time, improve the efficacy of rescue, reduce the incidence of adverse reactions, it is safe, effective and has great clinical significance. Key words: Organophosphorus pesticide poisoning; Penehyclidine hydrochloride; Atropine

Analysis of clinical features and risk factors of death in children with trauma

Objective To analyze the clinical features and risk factors of death in pediatric trauma, in order to provide preventing strategies and reduce mortality. Methods A retrospective study of 7 936 traumatic children admitted to the emergency department of our hospital from April 2014 to March 2016 was conducted.We retrospectively summarized the clinical features and Logistic regression analysis was used to analyze the risk factors of death in children with trauma. Results Compared to females, male patients contributed higher percentages(1.73∶1). There were more migrant children(5 535 cases) than local ones(2 401 cases)(χ2=14.314, P<0.05). Children in infancy stage(2 024 cases)and toddler period(3 097 cases) were more than in the other periods.Limb[41.9%(3 324/7 936)] and skin injuries[38.5%(3 058 324/7 936)] were the most common.Children trauma causes varied with age, fall, tumble and traffic accidents were common causes of children trauma.Pediatric trauma score of surviving group(n=1933), death group(n=5), general ward group(n=1852) and ICU group(n=86) were 8.53± 2.17, 3.17± 1.29, 9.72± 1.25, 5.23± 1.84, respectively.Shock decompensation, mechanical ventilation, Glasgow coma scale ≤7 and pediatric trauma score<8 were the risk factors which caused the death of trauma. Conclusion Parents should improve the security sense, strengthen the care of children and obey the traffic rules to reduce the rate of children trauma.Clinicians should pay attention to shock decompensation, mechanical ventilation, Glasgow coma scale and pediatric trauma score in order to identify critically ill patients in early stage and improve the success rate of rescue. Key words: Children; Trauma; Risk factor,