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Management of Pediatric Emergencies on the General Hospital

Journal of Health Science 2018年第4期6卷 316-323页

作者： Nurse Nicole Chinellato Rosanna Varutti aas 5 "friuli occidentale" department of emergency A&E Territorial Emergency Service Pordenone 33170 Italy aas 5 "friuli occidentale" department of emergency ICU Pordenone 33170 Italy

Due to the lack of casuistry, the management of the pediatric patient remains a source of stress and high risk of errors for the personnel working in the Territorial emergency Service, General First Aid and Multipurpose ICU （intensive care unit）, In order to facilitate the management of emergent or urgent pediatric casuistry, a specific training course, which involves all medical and paramedical staff; has begun in the reality of Pordenone Hospital. The new work strategy consists of an organized equipment according to the Broselow method, adapting the American model to our reality. A dedicated course was created to become confidential with the new operative strategy, to reduce mistakes and stress from the staff. After, a questionnaire was given to nurses working on ICU Dept. to assess the level of confidence with the new method introduced. It showed an improved confidence with the method, easier management of the pediatric emergency, fewer stress and better communication between health workers. Subsequently an updating course was created dedicated to the medical and nursing staff working on the emergency department of the entire province to start the integration between the hospitals in the area. The fmal project includes the drafting of a provincial protocol for the use of both intra and extra hospital pediatric material. The goal is to ensure that they do not create unevenness, errors or lack of care and communication between the professionals involved in the management of the pediatric emergency, from taking charge on the territory to hospitalization or transfer to the center Hub.

关键词： Broselow tape pediatric emergency Broselow color coding critically ill children.

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Neonatal acute scrotum:do not forget Amyand hernia

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World Journal of Pediatric Surgery 2020年第2期3卷 34-35页

作者： Edoardo Guida Irene Del Rizzo Francesca Galdo Flora Maria Murru Jurgen Schleef Francesco Maria Risso Egidio Barbi Ingrid Rabach department of Pediatric Surgery IRCCS Materno Infantile Burlo GarofoloTriesteFriuli-Venezia GiuliaItaly Clinical department of Medical Surgical and Health Sciences University of TriesteTriesteFriuli-Venezia GiuliaItaly department of Neonatology and Neonatal Intensive Care Unit IRCCS Materno Infantile Burlo GarofoloTriesteFriuli-Venezia GiuliaItaly department of Pediatric Radiology IRCCS Materno Infantile Burlo GarofoloTriesteFriuli-Venezia GiuliaItaly Pediatric department IRCCS Materno Infantile Burlo GarofoloTriesteFriuli-Venezia GiuliaItaly

A 15-day old full-term newborn was admitted to the emergency department for right scrotal swelling,irritability and poor feeding that started 12 hours earlier,without fever or *** reported that his last defecation occurred 3 days before *** examination was remarkable for a swollen,erythematous and tender right hemiscrotum(figure 1).

关键词： admitted vomiting hernia

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急性主动脉综合征风险分层评分的构建

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中国医药导报 2024年第6期21卷 15-20页

作者：孟凡亮付凤霞徐鑫王新艳李勇师猛肖子亚济宁医学院附属医院急诊科山东济宁272029

目的构建对急性主动脉综合征(aas)诊断具有较高预测价值的aas风险分层评分(aas-RSS)。方法回顾性收集2019年8月至2022年7月在济宁医学院附属医院急诊科就诊怀疑aas患者共630例,根据aas诊断标准将患者分为aas组和非aas组,其中aas组346... 详细信息

目的构建对急性主动脉综合征(aas)诊断具有较高预测价值的aas风险分层评分(aas-RSS)。方法回顾性收集2019年8月至2022年7月在济宁医学院附属医院急诊科就诊怀疑aas患者共630例,根据aas诊断标准将患者分为aas组和非aas组,其中aas组346例,非aas组284例。采用二分类logistic回归分析法分析aas的独立危险因素,构建aas-RSS,绘制ROC曲线对aas-RSS进行评价。结果 aas组男性、高血压病、突发胸背部痛、撕裂样或刀割样疼痛、疼痛评分≥5分、持续无缓解、大汗、呼吸困难、呕吐、动脉搏动消失或无脉、四肢血压差异明显、新发主动脉瓣杂音、低血压或休克、D-二聚体、C反应蛋白,合并心包填塞、肠功能障碍、急性肾损伤发生率高于非aas组,差异有统计学意义(P5)。aas组深吸气或咳嗽诱发、针刺样疼痛、心悸、合并急性心肌梗死发生率低于非aas组,差异有统计学意义(P5)。logistic回归分析结果显示,男性、突发胸背部痛、撕裂样或刀割样疼痛、心悸、动脉搏动消失或无脉、D-二聚体、C反应蛋白、合并急性心肌梗死是aas发生的影响因素(P5)。根据logistic回归分析β值大小及结合ADD-RS(主动脉夹层检测风险评分),共有23个变量被有效整合成aas-RSS。aas-RSS分值高低与aas的发生呈正相关(r=0.72,P5)。aas-RSS、ADD-RS预测发生aas的曲线下面积分别为0.919(0.898~0.941)、0.734(0.694~0.773)。aas-RSS约登指数最大值为0.699,截断值为8.5分,aas-RSS评分9分为区分高危aas和低危aas的界值。aas-RSS识别高危aas的灵敏度、特异度分别为89.3%、80.6%;ADD-RS识别高危aas的灵敏度、特异度分别为85.0%、52.5%。结论 aas-RSS对aas风险分层具有较高预测价值。

关键词：急性主动脉综合征急性主动脉夹层风险分层诊断

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急性主动脉综合征22例误诊分析

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临床误诊误治 2024年第12期37卷 1-7页

作者：李雪纯张传峰朱德才蚌埠医科大学研究生院安徽蚌埠233000 蚌埠医科大学实践教学基地亳州市人民医院急诊科安徽亳州236800

目的探讨急性主动脉综合征(aas)临床特点、误诊原因及防范策略。方法回顾性分析2018年1月至2023年12月收治的曾误诊为其他疾病的aas 22例。结果22例主要临床表现:心前区撕裂样、压榨性、紧缩性疼痛10例;伴后背痛2例;胸闷、气促5例;单独... 详细信息

目的探讨急性主动脉综合征(aas)临床特点、误诊原因及防范策略。方法回顾性分析2018年1月至2023年12月收治的曾误诊为其他疾病的aas 22例。结果22例主要临床表现:心前区撕裂样、压榨性、紧缩性疼痛10例;伴后背痛2例;胸闷、气促5例;单独表现为头晕2例;晕厥发作伴腹部隐痛1例;食欲减退伴乏力1例;头痛、呕吐伴发热1例。误诊为急性冠状动脉综合征11例,其中2例心电图提示ST段特异性改变,同时肌钙蛋白升高,初步诊断为急性心肌梗死;误诊为脑梗死1例;头晕2例误诊为短暂性脑缺血发作;误诊为慢性心功能不全2例,糖尿病酮症酸中毒、慢性阻塞性肺疾病急性加重、痛风、急性左侧心力衰竭、先天性心脏病各1例。误诊时间2 h~6 d。22例均按照误诊疾病予以相应治疗症状未见明显缓解,19例行CT血管造影检查确诊为主动脉疾病,2例经数字减影血管造影确诊,1例经开胸探查确诊。确诊后行相应治疗后19例预后良好,3例死亡。结论aas病情进展快,早期识别和诊断至关重要。加深临床工作者对此类疾病的认识,提高对该病快速诊断率,及早有效治疗,改善患者预后。

关键词：主动脉疾病动脉瘤,夹层穿透性主动脉溃疡壁内血肿误诊急性冠状动脉综合征脑梗死 CT血管造影

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Identifying Lifetime and Occurrence of Intimate Partner Violence among Women in Sweden Seeking emergency Care

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Open Journal of Nursing 2015年第6期5卷 548-557页

作者： Darcia Pratt-Eriksson Elisabeth Dahlborg-Lyckhage Caroline Lind Katarina Sundberg Ingegerd Bergbom Institute of Health and Care Sciences Sahlgrenska Akademy University of Gothenburg Gothenburg Sweden Neurological department Huddinge Karolinska University Hospital Stockholm Sweden University West Trollh&aumlttan Sweden emergency Care Emergency Department Kung&aumllv Hospital Kung&aumllv Sweden Psychiatric Care Psychiatric Outpatient Clinic Community Hospital Lilla Edet Sweden

Background: Sweden is known for its strong views on equality between men and women. Nevertheless, if one scratches the surface, one will realize that intimate partner violence (IPV) is a problem meriting much closer attention. emergency nurses have an important role in identifying women who have IPV experiences. Objective: To identify and investigate the occurrence of reported experienced IPV during their lifetime among women seeking emergency care. Design: An explorative and comparative design was used based on answers on the Abuse Assessment Screen questionnaire and some demographic data. The data was described and analyzed using the Statistical Package for the Social Sciences version 21. Results: Of the 300 invited women visiting an emergency department in a small town, 234 completed the questionnaire. Of these 234, 82 (35%) reported having experienced emotional;physical or sexual violence and 31 (13%) reported to being afraid of their partner. Of the women 181 had one child or more and 58 (32%) of these reported having been abused. Of all women, with four or more children, 75% (15) reported to have been abused, while only 25% (5) reported no abuse. Of the 82 women who reported having been abused 12 (15%) reported being abused in the course of the year prior to pregnancy and 9 (11%) during pregnancy, often several times. The main abuser was the woman’s husband, boyfriend, cohabitating partner, ex-partner, or someone else who was seen as a relative, e.g., a parent. Conclusion: Using the questionnaire aas may contribute to identifying victims of intimate partner violence and increasing health care practitioners’ attentiveness concerning the type of injury, frequency of care seeking and actions that may indicate such violence lead to changes of the woman’s situation.

关键词： Intimate Partner Violence Pregnancy Abuse Women Abuse Assessment Screen

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新型冠状病毒肺炎疫情期间79例心脏大血管外科急诊手术的围术期管理

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中国心血管病研究 2020年第6期18卷 507-511页

作者：肖红艳祁明宋来春许铭陶凉武汉科技大学附属武汉亚洲心脏病医院心脏大血管外科武汉市心肌病临床医学研究中心湖北省武汉市430022

目的总结突发重大传染病时心脏大血管外科急诊手术的围术期管理经验.方法对我院2020年1月23日至3月31日新型冠状病毒肺炎(COVID-19)疫情期间,79例心脏大血管急诊外科患者进行回顾分析,其中男性63例,女性16例,年龄8个月至77岁,平均(49.91... 详细信息

目的总结突发重大传染病时心脏大血管外科急诊手术的围术期管理经验.方法对我院2020年1月23日至3月31日新型冠状病毒肺炎(COVID-19)疫情期间,79例心脏大血管急诊外科患者进行回顾分析,其中男性63例,女性16例,年龄8个月至77岁,平均(49.91±7.21)岁;武汉市内患者26例,市外53例;急性主动脉综合征(aas)55例,急性冠状动脉综合征(ACS)合并机械并发症8例,心脏瓣膜病合并心内膜炎8例、难治性心力衰竭5例,左心房黏液瘤2例,婴幼儿高度房室传导阻滞1例.所有患者由120转运,市内患者在急诊科明确诊断,市外患者转运前均通过网络会诊明确诊断和确定急诊手术指征后再转运,在急诊完善肺部CT平扫初步排除COVID-19后收治隔离病区,紧急核酸检测和完善术前检查后行急诊手术,术后转运至监护室单间隔离直至排除COVID-19,住院期间出现发热时即行核酸检测和复查肺部CT.所有参与手术和围术期管理的医护人员均采取三级防护和医学观察.结果行急诊手术大血管外科手术29例,主动脉腔内隔绝手术24例,大血管杂交手术2例,单纯冠状动脉旁路移植3例,冠状动脉旁路移植联合瓣膜手术3例,急性心肌梗死室间隔穿孔封堵2例,瓣膜置换11例,瓣膜修复2例,左心房黏液瘤摘除2例,心外膜永久起搏器置入1例,同期心房颤动射频消融术3例.术前首次核酸检测均为阴性,肺部CT有COVID-19影像学表现12例,4例确诊为COVID-19,疑似病例5例.全组患者中因COVID-19危重型死亡1例,因合并肾功能不全和重症感染放弃出院1例,其余患者均康复出院.所有参与手术和围术期管理的医护人员无人感染COVID-19.结论急诊手术是救治心脏大血管急危重症的有效手段,在重大传染病期间,规范心脏急危重症患者收治流程,应加强院内感染的控制,做好防护,医护人员的个人安全是有保证的.

关键词：新型冠状病毒肺炎心脏急危重症急诊外科手术

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Nurse Documentation in Deteriorating Patients Prior to In-hospital Cardiac Arrest--A Pilot Study in A Swedish University Hospital

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Journal of Health Science 2014年第7期2卷 330-337页

作者： Lars aas Maria Ouchterlony Therese Djarv department of emergency Medicine Karolinska University Hospital Solna Stockholm SE-171 76Sweden department of Medicine in Solna Karolinska Institutet Stockholm Sweden

Presence of abnormal vital signs prior to IHCA and consequently higher mortality has been found in numerous studies. It is unknown whether abnormal vital signs are acted upon or not and how this affects the outcome of the IHCA. Aim： Compare differences in journal notes regarding abnormal vital signs or worry by nurses up until 24 h between survivors and non-survivors after an in-hospital cardiac arrest （IHCA）. Design： Pragmatic retrospective case-control study in a Swedish university hospital. Methods： All IHCA during 2007-2011 was reviewed （n = 720）. Out of them, 20 （3%） fulfilled the inclusion criteria; survived 30 d, had their IHCA at a general ward, were aged 〉 18 years and had documented abnormal vital signs or nurse worries. Out of the non-survivors, two controls were after matching for age, sex and number of diseases randomly drawn for each case. Pearson＇s chi test was used to assess significance on the level of 0.05 in differences between survivors and non-survivors. Results： Of 20 survivors with preceding abnormal vital signs prior to IHCA, 15 patients （75%） had documented worries or action taken by a nurse compared to 23 patients （58%） among non-survivors （p-value： 0.258）. Conclusion： The journal documentation 24 h prior to a 1HCA was fairly equal in numbers between patients surviving at least 30 d afterwards compared to those not surviving, but the content of the journal notes had a slightly higher, but not statistical significant, frequency of worry or action taken by attending nurses in survivors.

关键词： In-hospital cardiac arrest abnormal vital signs nurse management survival rate.

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急性主动脉综合征391例临床分析

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中华急诊医学杂志 2018年第10期27卷 1101-1106页

作者：窦丽稳高伟波吴春波曹宝平朱继红北京大学人民医院急诊科北京100044

目的探讨急性主动脉综合征（acute aortic syndrome，aas）患者的临床特征及预后相关因素。方法收集北京大学人民医院2000年1月至2015年12月急诊及住院的aas患者的临床资料，分析其临床特征、辅助检查及预后相关因素。结果391例aas患者... 详细信息

目的探讨急性主动脉综合征（acute aortic syndrome，aas）患者的临床特征及预后相关因素。方法收集北京大学人民医院2000年1月至2015年12月急诊及住院的aas患者的临床资料，分析其临床特征、辅助检查及预后相关因素。结果391例aas患者的年龄为（52．7±13．3）岁，男女比例4．3：1。其中73．4％的aas患者存在高血压，约半数未规律口服降压药物或者血压控制不佳；疼痛为aas患者最常见临床表现，占90．0％以上，疼痛性质以转移性或扩展性疼痛多见，疼痛范围扩大提示夹层进展。91．1％的aas患者D-二聚体水平升高，且A型aas患者显著高于B型。超声／超声心动检查诊断aas的敏感度为88．4％，在A型aas患者中的敏感度可达99．1％；A型aas患者的病死率显著高于B型患者（34.3％vs．0．9％，P〈0．01），经手术／支架治疗的aas患者住院期间的病死率明显下降（11．7％vs．28．0％，P〈0．01）。aas患者死亡组较存活组白细胞计数、中性粒细胞／淋巴细胞（neutrophil to lymphocyte ratio，NLR）、纤维蛋白原降解产物（fibrinogen degradation product，FDP）及D．二聚体均升高（P均〈0．01），血小板计数（P〈0．05）及纤维蛋白原（fibrinogen，FIB）均降低（P〈0．01）。结论疼痛是aas的特征性临床表现，多为突发，剧烈或撕裂样，呈转移性或扩展性；D-二聚体及超声检查方便宜行，对aas诊断价值高；aas死亡组患者较存活者白细胞计数、NLR、FDP及D-二聚体升高，血小板计数及FIB降低。A型aas患者病死率显著高于B型，手术、支架治疗可显著降低aas患者住院期间病死率。

关键词：急性主动脉综合征临床特点中性粒细胞/淋巴细胞预后

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Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes

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World Journal of Radiology 2014年第6期6卷 355-365页

作者： James Thomas Patrick Decourcy Hallinan Gopinathan Anil department of Diagnostic Imaging National University Health System Singapore 119074 Singapore

Acute aortic syndrome(aas) is a spectrum of conditions, which may ultimately progress to potentially life-threatening aortic rupture. This syndrome encompasses aortic dissection(AD), intramural haematoma, penetrating atherosclerotic ulcer and unstable thoracic aortic aneurysms. Multi-detector CT(MDCT) is crucial for the diagnosis of aas, especially in the emergency setting due to its speed, accuracy and ready availability. This review attends to the value of appropriate imaging protocols in obtaining good quality images that can permit a confident diagnosis of aas. AD is the most commonly encountered aas and also the one with maximum potential to cause catastrophic outcome if not diagnosed and managed promptly. Hence, this review briefly addresses certain relevant clinical perspectives on this condition. Differentiating the false from the true lumen in AD is often essential; a spectrum of CT findings, e.g., "beak sign", aortic "cobwebs" that allows such differentiation have been described with explicit illustrations. The value of non enhanced CT scans, especially useful in the diagnosis of an intramural hematoma has also been illustrated. Overlap in the clinical and imaging features of the various conditions presenting as aas is not unusual. However, on most instances MDCT enables the rightdiagnosis. On select occasions MRI or trans-esophageal echocardiography may be required as a problem solving tool.

关键词： Acute aortic syndrome Computed tomography scan Aortic dissection Intramural haematoma Penetrating aortic ulcer Aortic aneurysm

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Significance of an additional unenhanced scan in computed tomography angiography of patients with suspected acute aortic syndrome

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World Journal of Radiology 2018年第11期10卷 150-161页

作者： Nikolaos Panagiotopoulos Felix Drüschler Martin Simon Florian M Vogt Sebastian Wolfrum Steffen Desch Doreen Richardt Jorg Barkhausen Peter Hunold Clinic for Radiology and Nuclear Medicine University Hospital Schleswig-HolsteinCampus LübeckLübeck 23538Germany department of Nephrology University HospitalHeidelberg 69120Germany Radiologische Allianz Hamburg 20259Germany Radiologie München München 80331Germany Interdisciplinary emergency department University Hospital Schleswig-HolsteinCampus LübeckLübeck 23538Germany department of Cardiology Leipzig UniversityHeart Centre LeipzigLeipzig 04289Germany department of Cardiac and Thoracic Vascular Surgery University Hospital Schleswig-HolsteinCampus LübeckLübeck 23538Germany

AIM To assess potential benefits of an additional unenhanced acquisition in computed tomography angiography(CTA) in patients with suspected acute aortic syndrome(aas).METHODS A total of 103 aortic CTA(non-electrocardiography-gated, 128 slices) performed due to suspected aas were retrospectively evaluated for acute aortic dissection(AAD), intramural hematoma(IMH), or penetrating aortic ulcer(PAU). Spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If aas was detected, a venous phase(delay, 90 s) was added. Images were evaluated for the presence and extent of AAD, IMH, PAU, and related complications. The diagnostic benefit of the unenhanced acquisition was evaluated concerning detection of *** Fifty-six(30% women; mean age, 67 years; median, 68 years) of the screened individuals had AAD or IMH. A triphasic CT scan was conducted in 76.8%(n =43). 56% of the detected AAD were classified as Stanford type A, 44% as Stanford type B. 53.8% of the detected IMH were classified as Stanford type A, 46.2% as Stanford type B. There was no significant difference in the involvement of the ascending aorta between AAD and IMH(P = 1.0) or in the average age between AAD and IMH(P = 0.548), between Stanford type A and Stanford type B in general(P = 0.650) and between Stanford type A and Stanford type B within the entities of AAD and IMH(AAD: P = 0.785; IMH: P = 0.146). Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH(P = 0.035). Subadventitial hematoma involving the pulmonary trunk was present in 5 patients(16%) with Stanford A AAD. The difference between the median radiation exposure of a triphasic(2737 mGy*cm) compared to a biphasic CT scan(2135 mGy*cm) was not significant(P = 0.135).CONCLUSION IMH is a common and difficult to detect entity of aas. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.

关键词： Aortic dissection Acute aortic syndrome Intramural hematoma Pulmonary trunk subadventitial hematoma Computed tomography angiography

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