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Portable ultrasonography in mass casualty incidents:The CAVEAT examination

World Journal of Orthopedics 2010年第1期1卷 10-19页

作者： Stanislaw Peter Stawicki James M Howard John P Pryor David P Bahner Melissa L Whitmill Anthony J Dean department of Surgery Division of Critical CareTraumaand BurnThe Ohio State University Medical CenterColumbusOH 43210United States department of Surgery Division of Traumatology and Surgical Critical CareUniversity of Pennsylvania School of MedicinePhiladelphiaPA 19104United States department of emergency Medicine The Ohio State University Medical CenterColumbusOH 43210United States department of emergency Medicine University of Pennsylvania School of MedicinePhiladelphiaPA 19104United States

Ultrasonography used by practicing clinicians has been shown to be of utility in the evaluation of time-sensitive and critical illnesses in a range of environments,including pre-hospital triage,emergency department,and critical care *** increasing availability of lightweight,robust,user-friendly,and low-cost portable ultrasound equipment is particularly suited for use in the physically and temporally challenging environment of a multiple casualty incident(MCI).Currently established ultrasound applications used to identify potentially lethal thoracic or abdominal conditions offer a base upon which rapid,focused protocols using hand-carried emergency ultrasonography could be *** a detailed review of the current use of portable ultrasonography in military and civilian MCI settings,we propose a protocol for sonographic evaluation of the chest,abdomen,vena cava,and extremities for acute *** protocol is two-tiered,based on the urgency and technical difficulty of the sonographic *** addition to utilization of well-established bedside abdominal and thoracic sonography applications,this protocol incorporates extremity assessment for long-bone *** of the proposed protocol will need to be conducted to determine its utility in simulated and actual MCI settings.

关键词： Focused Assessment with Sonography in Trauma chest,abdomen,vena cava,and extremities for acute triage Ultrasonography Disaster Field triage Pre-hospital care Mass casualty incident

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Specific Patterns of Spinal Metabolite Ratio Underlying a-Me-5-HTevoked Pruritus Compared with Compound 48/80 Based on Proton Nuclear Magnetic Resonance Spectroscopy

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Current Medical Science 2020年第4期40卷 761-766页

作者： Ying-le CHEN Zhi-gang HE Qian WANG Hong-bing XIANG Li FAN Jun XIONG department of Anesthesiology the First Affiliated Quanzhou Hospital of Fujian Medical UniversityQuanzhou 362000China emergency Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China department of Anesthesiology and pain Medicine Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China department of Orthopedics Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Hepatobiliary Surgery center Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China

Summary:Mechanisms of pruritus are implicated in the dysregulation of the metabolites in the spinal *** investigated pruritus behavioral testing in three groups of young adult male C57B1/6 mice,including one group treated with normal saline,while the other groups intradermally injected with a-Me-5-HT(histamine-independent pruritogen),compound 48/80(histaminedependent pruritogen)at the nape skin of the neck,*** nuclear magnetic resonance spectroscopy(MRS)was used to compare spinal metabolites from the vertebral cervical among three groups,and to study the association of spinal metabolite ratio and pruritus *** MRS-measured N-acetylaspartate-to-myoinositol ratio(NAA/Ins)was significantly correlated with the number of scratches between normal saline group and 48/80 group or a-Me-5-HT group(both P<0.0001),indicating that NAA/Ins may be a robust surrogate marker of histamine-independent/dependent *** was significant difference in Glu/Ins between normal saline group and 48/80 group(P=0.017),indicating that Glu/Ins may be a surrogate marker of histamine-dependent pruritogen,while GABA/Ins was highly significantly different between normal saline group and a-Me-5-HT group(P=0.008),suggesting that GABA/Ins may be a surrogate marker of histamineindependent *** may reflect the extent of pruritus intensity elicited by a-Me-5-HT and compound 48/80 with sensitivity similar to the number of scratches,and above potential markers need to be further validated in pre-clinical and clinical treatment trials.

关键词： itch pruritus intensity spinal cord metabolomics proton nuclear magnetic resonance

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Does the Nature of Chief Complaint, Gender, or Age Affect Time to Be Seen in the emergency Room

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Open Journal of emergency Medicine 2014年第2期2卷 36-41页

作者： Ayesha Sattar Kenneth Sable Antonios Likourezos Christian Fromm John Marshall department of emergency Medicine Maimonides Medical Center Brooklyn USA department of emergency Medicine Saint Peter’s Healthcare System New Brunswick USA department of emergency Medicine Stanford Hospital and Clinics Stanford USA

Objectives: EM physicians may be biased in seeing patients presenting with nonspecific complaints or requiring more extensive work-ups. The goal of our study was to ascertain if chief complaint affected time to be seen (TTBS) in the ED. Methods: A retrospective report was generated from the EMR for all moderate acuity patients who visited the ED from January 2005 to December 2010 at a large urban teaching hospital. Abdominal pain, alcohol intoxication, back pain, chest pain, cough, dyspnea, dizziness, fall, fever, flank pain, headache, infection, pain (nonspecific), psychiatric evaluation, “sent by MD”, vaginal bleeding, vomiting, and weakness were the most common complaints. Non-Parametric Independent Sample Tests assessed median TTBS between complaints, gender, and age. Chisquare testing assessed for differences in the distribution of arrival times. Results: We obtained data from 116,194 patients. Patients presenting with weakness and dizziness waited the longest time of 35 minutes and patients with flank pain waited the shortest with 24 minutes. Males waited 30 minutes and females waited 32 minutes. Younger females between the ages of 18 - 50 waited significantly longer when presenting with a chief complaint of abdominal pain, chest pain, or flank pain. There was no difference in the distribution of arrival times for these complaints. Conclusion: There is a significant bias toward seeing young male patients more quickly than women or older males. Patients might benefit from efforts to educate EM physicians on the delays and potential quality issues associated with this bias in an attempt to move toward more egalitarian patient selection.

关键词： Waiting Time Chief Complaint emergency department Gender Disparity

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Predicting value of serum soluble ST2 and interleukin-33 for risk stratification and prognosis in patients with acute myocardial infarction

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Chinese Medical Journal 2013年第19期126卷 3628-3631页

作者： ZHANG Kun ZHANG Xin-chao MI Yu-hong LIU Juan department of emergency Beijing Hospital Ministry of HealthBeijing 100730 China department of emergency Beijing Anzhen Hospital Capital MedicalUniversity Beijing 100029 China department of Physiology and Pathophysiology Peking UniversityHealth Science Center Beijing 100191 China

Background Acute myocardial infarction （AMI） is a common cardiac emergency with high *** soluble ST2 （sST2） is a new emerging biomarker of cardiac *** present study is to investigate the predictive value of sST2 and interleukin-33 （IL-33） for risk stratification and prognosis in patients with *** Fifty-nine patients with AMI,whose chief complaint was chest pain or dyspnea,were selected for our *** examination,chest radiograph,electrocardiograph （ECG）,biomarkers of myocardial infarction,NT-proBNP,echocardiography and other relevant examinations were performed to confirm the diagnosis of ***-six healthy people were chosen as the control *** samples from these subjects （patients within 24 hours after acute attack） were collected and the levels of sST2 and IL-33 were assayed by enzyme-linked immuno-sorbent assay （ELISA） *** follow-up was performed on the 7th day,28th day,3rd month and 6th month after acute *** to the follow-up results we defined the end of observation as recurrence of AMI or any causes of *** Median sST2 level of the control group was 9.38ng/ml and that of AMI patients was 29.06ng/*** with the control group,sST2 expression in the AMI group was significantly different （P〈0.001）.In contrast,the IL-33 level showed no significant difference between the two *** sST2 was a predictive factor independent of other variables and may provide complementary information to NT-proBNP or GRACE risk ***-33 had no relationship to recurrence of *** sST2 and the IL-33/sST2 ratio were correlated with the 6-month prognosis; areas under the ROC curve were 0.938 and 0.920 *** Early in the course （〈24 hours） of AMI,sST2 usually increases *** increase of sST2 has an independent predictive value for the prognosis in AMI patients and provides complementary information to NT-proBNP or GRACE risk *** IL-33/sST2 ratio correlates with the 6-m

关键词： serum soluble ST2 interleukin-3 3 acute myocardial infarction risk stratification prognosis

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A patient presenting painful chest wall swelling: Tietze syndrome

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World Journal of emergency Medicine 2019年第2期10卷 122-124页

作者： Kohei Sawada Hiromi Ihoriya Taihei Yamada Tetsuya Yumoto Kohei Tsukahara Takaaki Osako Hiromichi Naito Atsunori Nakao department of emergency Critical Care and Disaster Medicine Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences

Dear editor,Patients frequently visit the emergency room with acute chest *** some potentially life-threatening disorders may cause the pain,in approximately 80%of cases,the chest pain source is benign,and musculoskeletal chest pain accounts for nearly 20%– 50%of those cases.^[1–6]Thus,pain caused by benign and pathological conditions of the chest wall encountered in the emergency department is sometimes incorrectly attributed to angina pectoris or pleuritic and other serious cardiopulmonary diseases.

关键词： Patients frequently emergency room life-threatening

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Polytrauma with thoracic and/or abdominal injuries: experience in 1 540 cases

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Chinese Journal of Traumatology 2006年第2期9卷 108-114页

作者：高劲谋高云瀚曾剑波王建柏何平韦功滨项震 department of Traumatology Chongqing emergency Medical center Chongqing 400014China

Objective ：To investigate the early diagnosis and treatment of polytrauma patients with thoracic and/or abdominal injuries. Methods： The data of all polytrauma patients with thoracic and/or abdominal injuries during the past 10 years were studied retrospectively. Results： In the present study, there were 1 540 polytrauma patients, accounting for 65.0% of all 2 368 trauma patients. Of these patients, 62.4% were in shock state on admission. The operative rates were 15.0% （181/1 206） and 79.9% （ 612/766 ） in patients with thoracic and abdominal injury （ P 〈 0.01 ）, 5.2 % （39/758） and 31.7% （142/448） in patients with blunt and penetrating chest trauma （P〈0.01）, and 72.4% （359/496） and 93.7 % （253/270） in patients with blunt and penetrating abdominal injuries （P〈0.01）, respectively. To deal with abdominal injury, angioembolization was performed in 43 cases, with 42 cured. The overall mortality rate was 6.2%. And in the blunt and penetrating subgroups, the mortalities were 7.9 % （75/950） and 3.6 % （21/590）, respectively （P〈0.01）. Most patients died from exsanguination. Conclusions： The first ＂golden hour＂ after trauma should be grasped, since the treatment in this hour can determine greatly whether the critically-injured victim could survive. Prompt diagnosis and proper treatment contribute more greatly to the survival of the victim than the severity of injury.

关键词： Wounds and injuries Multiple trauma Thoracic injuries Abdominal injuries Hemostasis, surgical

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Mediastinal emphysema in the context of perforated gastric ulcer

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World Journal of Clinical Cases 2024年第15期12卷 2479-2481页

作者： Debkumar Chowdhury department of emergency Medicine Wythenshawe HospitalManchester M239LTUnited Kingdom

In the context of mediastinal emphysema/pneumomediastinum,the main aetiologies are associated with oesophageal perforation,lung pathology or post head and neck surgery *** main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase *** causes of pneumomediastinum should be differentiated between traumatic and *** perforation(Boerhaave syndrome)is associated with Mackler’s triad in upto 50%of patients(severe retrosternal chest pain,pneumomediastinum,mediastinitis).Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.

关键词： Pneumomediastinum Duodenal ulcer Computed tomography Visceral perforation Diagnostic imaging emergency care

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A Case Study in the Use of Capsaicin in the Treatment of Neuropathic chest Wall pain and Post-thoracotomy Intercostal Neuralgia

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Open Journal of Anesthesiology 2012年第4期2卷 99-101页

作者： Charles Roberts Leonard Morgan Kanisha Hall Prashant Kumar Stacy J.Smith department of Anesthesiology and Interventional pain LSU Health Science Center School of MedicineShreveportUSA

Off label use of Quetenza? (capsaicin 8%) patch in relieving post-thoracotomy neuropathic pain proved temporarily effective, but to a degree indicating limited usefulness in a clinical setting.A 57 year-old male with chronic post-thoracotomy pain was treated with 8% capsaicin topically. Pre-procedure pain was rated as 8 on a 10 point scale, the 30 minute post procedure pain was reported as 2 - 3 on a 10 point scale. Neuralgia was completely resolved for the initial 48 hours post-procedure, then returned gradually over the next 5 days. Because pain transmission pathways are the same in post herpetic and post traumatic neuralgias, the use of 8% capsaicin merits additional study.

关键词： Post-thoracotomy Neuralgia Capsaicin Qutenza^(█)

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Analysis on care outcome of patients with polytrauma and coma

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Chinese Journal of Traumatology 2007年第1期10卷 53-58页

作者：赵兴吉孔令文都定元苏泓洁 department of Cardiothoracic Surgery Chongqing Emergency Medical Center Chongqing Institute of Accident ＆ Emergency Medicine Chongqing 400014 China

Objective ： To make further improvement of outcome of patients with polytrauma and coma. Methods： The data of 3 361 patients （2 378 males and 983 females, aged from 5-95 years, 38. 2 years on average） with severe polytrauma and coma admitted to Chongqing emergency Medical center （Level I Trauma center ）, Chongqing, China, from November 1978 to December 2004 were analyzed retrospectively in this study. Results： The overall survival rate and mortality were 93.2%（3 133/3 361 ）and 6.8%（228/3 361 ）, respectively. The mortalities in patients with coma duration 〈 1 hour and combined with neural dysfunction and in patients with coma duration ≥ 1 hour and combined with or without neural dysfunction were signifieantly higher than that of those with coma duration 〈 1 hour but without neural dysfunction [39.5%（136/344）vs 3.0%（92/3 017）, P 〈0.01]. There existed significant differences in GCS, ISS, and revised trauma score （RTS） between the death group and the survival group （P 〈 0. 01 ）. RTS was in good correspondence with patient＇ s pathophysiological status and outcome in patients with multiple trauma and coma for different groups of systolic blood pressure （SBP）. The mortality in patients with SBP 〈90 nun Hg was significantiy higher than that of those with SBP ≥ 90 mm Hg [ 33. 3 % （68/204） vs5.1%（160/3 157）, P 〈0.01]. The mortality in polytranma patients combined with serious head injury （AIS≥3） was8.2%, among which, 76.5% died from lung complications. The morbidity rate of lung complications and mortality rate increased in patients with head injury complicated with chest or abdomen injury （23.9%, 61.1% vs 27.3 %, 50.0 % ）. The mortality reached up to 61.9 % in patients complicated with severe head, chest and abdomen injuries simultaneously. Conclusions： It plays a key role to establish a fast and effective trauma care system and prompt and definite surgical procedures and to strengthen the management of complications for improving the survival rate of patients with severe

关键词： Multiple trauma Coma Injury severity score

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COVID-19 and Liver Dysfunction:Current Insights and Emergent Therapeutic Strategies

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Journal of Clinical and Translational Hepatology 2020年第1期8卷 18-24页

作者： Gong Feng Kenneth I.Zheng Qin-Qin Yan Rafael S.Rios Giovanni Targher Christopher D.Byrne Sven Van Poucke Wen-Yue Liu Ming-Hua Zheng Xi’an Medical University Xi’anChina NAFLD Research center Department of Hepatologythe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina Section of Endocrinology Diabetes and MetabolismDepartment of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly Southampton National Institute for Health Research Biomedical Research center University Hospital SouthamptonSouthampton General HospitalSouthamptonUK Ziekenhuis Oost-Limburg Department of AnesthesiologyCritical CareEmergency Medicine and Pain TherapyGenkBelgium department of Endocrinology the First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina Institute of Hepatology Wenzhou Medical UniversityWenzhouChina Key Laboratory of Diagnosis and Treatment for The Development of Chronic Liver Disease in Zhejiang Province WenzhouChina

The outbreak of coronavirus disease 2019(COVID-19),caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has attracted increasing worldwide *** of liver damage or dysfunction(mainly characterized by moderately elevated serum aspartate aminotransferase lev-els)have been reported among patients with ***,it is currently uncertain whether the COVID-19-related liver damage/dysfunction is due mainly to the viral infection per se or other coexisting conditions,such as the use of potentially hepatotoxic drugs and the coexistence of sys-temic inflammatory response,respiratory distress syndrome-induced hypoxia,and multiple organ *** on the current evidence from case reports and case series,this review article focuses on the demographic and clinical characteristics,potential mechanisms,and treatment options for COVID-19-related liver *** review also describes the geo-graphical and demographic distribution of COVID-19-related liver dysfunction,as well as possible underlying mechanisms linking COVID-19 to liver dysfunction,in order to facilitate future drug development,prevention,and control measures for COVID-19.

关键词： COVID-19 Liver dysfunction SARS-CoV-2

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