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A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

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World Journal of emergency Medicine 2024年第1期15卷 16-22页

作者： Jing Yang Hanqi Tang Shihuan Shao Feng Xu Yangyang Fu Shengyong Xu Chen Li Yan Li Yang Liu Joseph Harold Walline Huadong Zhu Yuguo Chen Xuezhong Yu Jun Xu emergency department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China emergency department Peking University People’s HospitalBeijing 100044China department of emergency and chest pain center Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceQilu Hospital of Shandong UniversityJinan 250012China emergency department Beijing Jishuitan HospitalBeijing 100035China emergency department Tianjin Medical University General HospitalTianjin 300052China department of emergency Medicine Penn State Health Milton S.Hershey Medical Center and Penn State College of MedicineHershey 17033USA

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest *** study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ***:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to ***’general information,ETCO_(2),and POP parameters were collected and statistically ***:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC *** 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),***:Patients with unsustained ROSC have a poor *** combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

关键词： Return of spontaneous circulation Pulse oximetry photoplethysmogram End-tidal carbon dioxide Cardiac arrest Cardiopulmonary resuscitation

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Comparative effects of rosuvastatin and atorvastatin on the risk of new-onset diabetes mellitus in patients with acute coronary syndrome receiving percutaneous coronary intervention:a retrospective cohort study

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emergency and Critical Care Medicine 2022年第4期2卷 209-213页

作者： Cunhui Jia Rui Tian Mengzhi Zong Fangyun Luan Wenjun Wang Chuanbao Li department of emergency Medicine and chest pain center Qilu Hospital of Shandong UniversityJinanShandongChina Key Laboratory of emergency and Critical Care Medicine of Shandong Province Qilu Hospital of Shandong UniversityJinanShandongChina.

Background:Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol ***,the use of statins leads to an increased incidence of new-onset type 2 diabetes mellitus(NODM).Our study aims to compare the effect of rosuvastatin versus atorvastatin on NODM in patients with acute coronary syndrome(ACS)who underwent percutaneous coronary intervention(PCI)within 18 months of ***:A retrospective cohort study was conducted on patients with ACS who underwent PCI and were treated with rosuvastatin or atorvastatin between June 2012 and June *** survival functions between the 2 groups were estimated using the Kaplan-Meier method and compared using the log-rank test with NODM as the *** proportional hazards models were used to calculate hazard ratios(HRs)and 95%confidence intervals(CIs)for the risk factors of ***:In total,220 patients received rosuvastatin and 168 *** cumulative incidence of NODM in the rosuvastatin group was lower but did not reach statistical significance,compared with that in the atorvastatin group(7.27%vs.12.50%,respectively;log-rank P=0.08).Using Cox proportional hazards models,baseline fasting blood glucose level was associated with a statistically significant increase in the risk of NODM(HR:4.56;95%CI:2.83–7.36;P<0.01).Conclusion:Long-term use of moderate rosuvastatin had a similar incidence of NODM compared with atorvastatin in patients with ACS receiving PCI.

关键词： Acute coronary syndrome Atorvastatin New-onset diabetes mellitus Percutaneous coronary intervention Rosuvastatin

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Trends in point-of-care ultrasound protocols in the emergency department and intensive care unit:a review

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emergency and Critical Care Medicine 2023年第2期3卷 64-69页

作者： Xinhui Fan Yuan Bian Guoying Wang Weikang Liu Luyao Gao Yuhui Pan Shengchuan Cao Qiuhuan Yuan Shujian Wei Feng Xu Yuguo Chen department of emergency and chest pain center Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineInstitute of Emergency and Critical Care Medicine of Shandong UniversityKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceKey Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceQilu Hospital of Shandong UniversityJinanChina.

Together with the development of the focused assessment with sonography for trauma protocol for ultrasound in trauma patients,point-of-care ultrasound is widely used in the field of emergency and critical care *** have established several classic operating protocols for different diseases,such as acute respiratory failure,shock,and cardiac arrest,in the emergency department and intensive care *** further development in the portability and popularity of ultrasonic equipment,it is expected to be used as a new type of technology for physical examination,including inspection,palpation,percussion,auscultation,and insonation,which will improve the clinical medicine practice in the future.

关键词： Auscultation and insonation Inspection Palpation Percussion Point-of-care ultrasound Protocol Seven-point and nineplane protocol

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Sub-dissociative dose ketamine administration for managing pain in the emergency department

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World Journal of emergency Medicine 2018年第4期9卷 249-255页

作者： Sergey Motov Jefferson Drapkin Antonios Likourezos Joshua Doros Ralph Monfort John Marshall department of emergency Medicine Maimonides Medical Center

BACKGROUND： We describe our experience of utilizing sub-dissociative dose ketamine （SDK） in managing a variety of acute and chronic painful conditions in the emergency department （ED）. METHODS： A descriptive study was conducted in our ED over a period of seven years （2010-2016） by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration （intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]）, dosing, rates of analgesic utilization before and after SDK administration, and adverse effects. RESULTS： Three hundred sixty-two patients were enrolled in the study. Mean ketamine doses given by IVP, St and CI were 26.3 rag, 23.4 rag, and 11.3 rag. The mean duration of CI was 135.87 minutes. The percentage of patients not requiring post-SDK analgesia increased by 16%, 18%, and 37% in IVP, SI and CI groups. Adverse effects were recorded for 13% of patients. CONCLUSION： SDK administered by IVP, SI, and CI in the ED for a variety of painful conditions is a feasible analgesic modality in the ED that is associated with a decrease in overall requirements of post-ketamine analgesia and opioid sparing.

关键词： Ketamine Analgesia emergency department Sub-dissociative Infusion

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Expert consensus on the emergency diagnosis and therapy of acute chest pain(English version)

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emergency and Critical Care Medicine 2021年第2期1卷 53-63页

作者： Yuguo Chen department of emergency Medicine and chest pain center Clinical Research Center for Emergency and Critical Care Medicine of Shandong ProvinceInstitute of Emergency and Critical Care Medicine of Shandong UniversityKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceKey Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceQilu HospitalCheeloo College of MedicineShandong UniversityJinanShandongChina

In recent years,with the accelerated aging of the population in China,the incidence of acute cardiovascular diseases has increased,and the number of patients seeking treatment for acute chest pain has also increased *** chest pain has different clinical manifestations,rapid changes in the patient's condition,wide disparity in risk,incomplete correlation between prognosis and degree of pain,and strong time dependence of treatment.

关键词： pain acute diagnosis

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Trends in oxycodone and oxycodone-containing analgesics administration for back pain in emergency departments in the USA(2007–2018)

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World Journal of emergency Medicine 2024年第3期15卷 169-174页

作者： Jonathan Chabon Jemer Garrido Deanna Schreiber-Gregory Jefferson Drapkin Sergey Motov department of emergency Medicine Maimonides Medical CenterBrooklyn 11219USA

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs) in the USA from 2007 to ***:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS) from 2007 to *** study population included individuals of all ages presenting to USA *** NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back *** main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time ***:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3% from 2007(244,000 visits) to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8% to 57.6%),female patients(from 54.5% to 62.0%),black patients(from 22.5% to 30.4%),and Hispanic/Latino patients(from 9.4% to 19.6%).Oxycodone/acetaminophen was most prescribed and accounted for 90.2% of all oxycodone-containing analgesics in 2007,with a decrease to 68.5% in *** oxycodone was the second most prescribed medication,accounting for 6.1% in 2007 and 31.5% in ***:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to ***,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to *** total amount of pure oxycodone increased significantly from 2007 to 2008.

关键词： Oxycodone Back pain emergency department

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EFFECT OF ASPIRIN PLUS CLOPIDOGREL ON INFLAMMATORY MARKERS IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME

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Chinese Medical Journal 2006年第1期119卷 32-36页

作者： CHEN Yu-guo XU Feng ZHANG Yun JI Qiu-shang SUN Yi LUE Rui-juan LI Rui-jian department of emergency and center of chest pain Qilu Hospital of Shandong University Ji＇nan 250012 China department of Cardiology Qilu Hospital of Shandong University Ji＇nan 250012 China

Background Aspirin can inhibit inflammatory reactions and platelet aggregation, but little is known about the effects of the combination of aspirin plus clopidogrel, a new antiplatelet agent, on inflammation. The purpose of this study was to determine whether aspirin plus clopidogrel can further suppress inflammation in patients with non-ST-segment elevation acute coronary syndrome （NSTEACS）. Methods One hundred and fifteen patients with NSTEACS were randomized into two groups： group A （aspirin alone, n=58） and group B （aspirin plus clopidogrel, n=57）. Patients in group A received a loading dose of 300 mg aspirin, then 100 mg per day. The patients in group B received a loading dose of 300 mg aspirin and 300 mg clopidogrel, then 100 mg aspirin and 75 mg clopidogrel per day. Serum high sensitivity C-reactive protein （hs-CRP） and tumor necrosis factor-α （TNF-α ） were measured in all patients at baseline prior to any drug treatment after admission, and at 7 and 30 days after beginning drug treatment. Thirty healthy volunteers on no medications were enrolled as controls （group C）. Results Baseline levels of hs-CRP and TNF-α in group A and group B were significantly higher than those in group C. Seven days after administration, the levels of hs-CRP in both group A and group B decreased significantly [Group A：（6.15 ± 1.39） mg/L vs （9.18 ± 1.62） rag/L, P 〈0.01; Group B：（4.99 ± 1.62） mg/L vs （10.29 ± 1.47） rag/L, P〈0.01]. Similarly, levels of TNF-α in both groups decreased at 7 days compared to baseline [Group A：（90.99 ± 28.91） pg/ml vs （117.20 ± 37.13） pg/ml, P 〈0.01; Group B：（74.32± 21.83） pg/ml vs （115.27 ± 32.11） pg/ml, P 〈0.01]. Thirty days after administration, the levels of hs-CRP in both group A and group B decreased further to （3.49 ± 1.53） rag/L, and （2.40 ± 1.17） mg/L respectively （P 〈0.01 for both comparisons）. Levels of TNF-α in groups A and B also decreased significantly between 7 and 30 days, to 63.28 ± 29.01 pg/ml （group A） and （43.95 ± 17.10） pg/ml （g

关键词： acute coronary syndrome clopidogrel inflammation high sensitivity C-reactive protein tumor necrosis factor- alpha

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Hydrocarbon pneumonitis following fuel siphonage: A case report and literature review

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World Journal of emergency Medicine 2019年第2期10卷 69-74页

作者： Yi-jung Chen Chien-chin Hsu Kuo-tai Chen emergency department Chi-Mei Medical Center department of Biotechnology Southern Tainan University of Technology department of emergency Medicine School of Medicine College of Medicine Taipei Medical University

BACKGROUND: People sometimes siphon fuel to fill their tanks. However, this is a potentially dangerous procedure and may cause hydrocarbon pneumonitis. We present the case of a patient with severe hydrocarbon pneumonitis after siphoning fuel. The patient underwent artifi cial ventilation and was admitted to hospital for 97 days. METHODS: We review the relevant literature for a better understanding of clinical features and management strategies for hydrocarbon pneumonitis following fuel ***: We reviewed 15 articles, which included 3 original articles and 12 case reports that reported the clinical features of fuel siphonage. In addition, we added our presented case for data analysis. A total of 40 cases were included in this review. The literature review found that hydrocarbon pneumonitis caused by fuel siphonage occurs worldwide and that most patients(80%) became symptomatic within 1 day of aspiration. Cough(70%), chest pain(62.5%), dyspnoea(55%), and fever(52.5%) presented in more than half of all patients. The right middle lobe(80%) was the predominantly involved lung fi eld; more than one-third of patients(36.7%) showed the involvement of two ***: Patient history, computed tomographic scans of the chest, and bronchoalveolar lavage are the commonly used diagnostic tools. Supportive care remains the foundation of treatment, whereas antibiotics, steroids, and bronchoalveolar lavage are practical therapies. Patients' clinical improvement precedes the resolution of lesions on chest X-ray. Most complications arise from pulmonary lesions. The prognosis of patients suffering from hydrocarbon pneumonitis following fuel siphonage might be improved by accurate diagnosis and appropriate care.

关键词： Siphonage Diesel Fuel Aspiration Hydrocarbon pneumonitis

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Expert Consensus by Qilu Hospital of Shandong University on the diagnosis,management,and treatment of suspected COVID-19 cases(English version)

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emergency and Critical Care Medicine 2021年第1期1卷 6-11页

作者： Yuguo Chen Expert Consensus Group of Qilu Hospital of Shandong University on Diagnosis and Treatment for COVID-19 department of emergency and chest pain center Clinical Research Center for Emergency and Critical Care Medicine of Shandong ProvinceInstitute of Emergency and Critical Care Medicine of Shandong UniversityKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceKey Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceQilu HospitalCheeloo College of MedicineShandong UniversityJinanShandongChina

We devised a protocol to establish a standardized method of screening,diagnosing,and managing suspected cases of coronavirus disease(COVID-19)and to enhance the management of COVID-19 suspected *** protocol that included diagnostic criteria,preventive measures,and control measures against COVID-19 was developed based on new evidence regarding the epidemiological and clinical characteristics of COVID-19.A consensus document was subsequently *** consensus focused on the clinical management of patients with suspected fever and reviewed the procedure for undergoing severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)nucleic acid *** consensus will contribute to the ongoing efforts worldwide for the prevention and control of COVID-19.

关键词： COVID-19 Nucleic acid testing Suspected cases

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Comparison of sedative effectiveness of thiopental versus midazolam in reduction of shoulder dislocation

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World Journal of emergency Medicine 2018年第2期9卷 125-129页

作者： Elnaz Vahidi Rezvan Hemati Mehdi Momeni Amirhossein Jahanshir Morteza Saeedi emergency Medicine Research center Shariati Hospital Emergency Medicine Department Tehran University of Medical Sciences

BACKGROUND: Various sedative drugs have been proposed to control anxiety and agitation in shoulder dislocation, but none of them has been diagnosed as the best sedative and relaxant agent. The study aimed to compare the sedative effectiveness of thiopental versus midazolam in reduction of shoulder ***: A randomized double-blind controlled trail was performed in 80 patients with shoulder dislocation recruited from the emergency department. Ten patients were excluded and 70 patients were enrolled in the study. Case group received intravenous thiopental 2 mg/kg+2 μg/kg fentanyl while control group received intravenous midazolam 0.1 mg/kg+2 μg/kg fentanyl. Number of times, patients and physician's satisfaction, difficulty of procedure, degree of muscle relaxation, time of sedation and complete recovery, number of patients with apnea episode, O2 saturation, patient's pain score and adverse events were all ***: Muscular tone had significant difference between the two groups(P-value=0.014) and thiopental was more muscle relaxant than midazolam. Replacement of shoulder dislocation in thiopental group was easier than midazolam group(P-value=0.043). There was no need to use multiple methods of reduction in either group. Before drug infusion the mean±SD VAS scores were 8.37±2.21 in the midazolam group(A) and 8.94±1.78 in the thiopental group(B); mean difference 0.57, 95% CI= –0.38 to 1.52. After completion of the procedure, the mean±SD VAS scores in group(A) and(B) were 3.20±1.30 vs. 3.65±1.30; mean difference –0.45, 95% CI= –1.07 to ***: Thiopental might be more effective and relaxant than midazolam for reduction of shoulder dislocation.

关键词： Thiopental Shoulder dislocation Midazolam emergency medicine

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