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first aid strategy for severe traumatic patients in hospital

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Chinese Journal of Traumatology 2007年第6期10卷 357-359页

作者：李能平方伟敏顾永峰卢小兵丛建农惠小平林兆奋李文放杨兴易 emergency Surgery department Gongli Hospital of Shanghai Pudong New District first aid department Changzheng Hospital Shanghai Urgent Care Centre for Trauma

Objective:To study the emergency management principles of severe trauma in hospital(injury severity score≥16). Methods:We used'ATP principle'to manage severe traumatic patients.The ATP principle is composed of:1)attending surgeons offering initial management(A); 2)teamwork commencement immediately after patients admitted to hospital(T);3)parallel principle,ie, emergency resuscitation,evaluation and laboratory test performed simultaneously(P).Clinical effects before and after applying ATP principle were retrospectively analyzed and compared. Results:During January 1,2002 to December 31, 2003,338 patients were treated without applying ATP principle,in which ISS was 25.9±6.4,152 cases died with the mortality being 39.2%,and the time stayed in emergency department and the time to operation room after admission were(102.8±16.7)min,(140.3±20.6)min, respectively.During January 1,2004 to December 31, 2005,438 patients were treated based on ATP principle,in which ISS was 28.6±7.8,87 cases died with the mortality being 19.9%,and the time in emergency department and the time to operation room after admission were(69.5±11.5)min,(89.6±9.3)min,respectively.ISS showed no significant difference between the two groups(P>0.05), but the mortality,the time stayed in emergency department and the time to operation room after admission were greatly reduced and showed significant difference between the two groups(Pemergency treatment time in hospital and decrease mortality.

关键词：创伤紧急处理措施外伤治疗方法

Management of acute length-unstable Monteggia fractures in children:A case report

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World Journal of Orthopedics 2021年第11期12卷 954-960页

作者： Francesco Roberto Evola Giovanni Francesco Di Fede Santo Bonanno Giuseppe Evola Maria Elena Cucuzza department of Surgery Division of Orthopedics and Trauma Surgery“Cannizzaro”HospitalCatania 95100Italy Radiodiagnostics department Division of Radiology“S.Marta and S.Venera”HospitalAcireale 95024Italy emergency department Division of First Aid“Garibaldi”Hospitalcatania 95124CataniaItaly General and emergency Surgery department Division of Surgery“Garibaldi”HospitalCataniaItalyCatania 95124Italy Maternity-Childhood department Division of Paediatrics“Cannizzaro”HospitalCatania 95124Italy

BACKGROUND Monteggia fractures are uncommon injuries in paediatric age.Treatment algorithms assert that length-unstable fractures are treated with plate fixation.In this case report,intramedullary fixation of an acute length-unstable Monteggia fracture allowed a stable reduction to be achieved,along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture.The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture.CASE SUMMARY A four-year-old girl presented at the emergency department following an accidental fall off a chair onto the right forearm.The X-ray highlighted a lengthunstable acute Bado type 1 Monteggia fracture of the right forearm.On the same day,the patient underwent surgical treatment of the Monteggia fracture.The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation.The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and,subsequently,humeroradial joint reduction through manual manipulation.The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion,extension,pronation and supination of the forearm.Healing of the fracture occurred within six weeks after surgery,as indicated by the presence of calluses on at least three cortices on standard radiographs.Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination.CONCLUSION Intramedullary fixation of unstable Monteggia fractures results in excellent outcomes,provides reliable reduction and causes fewer complications.

关键词： Monteggia fractures Children Management Outcome Case report

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World Journal of emergency Medicine 2022年第1期13卷 65-66页

作者： Xi-quan Yan Ze-ya Shi Xiao-tong Han Fang Chen Hua Xiang Xiao-liang Liu Yi-min Zhu department of emergency Medicine Hunan Provincial Institute of Emergency MedicineHunan Provincial Key Laboratory of Emergency and Critical Care MetabonomicsHunan Provincial People's Hospital/the First Affi liated HospitalHunan Normal UniversityChangsha 410005China School of Life Sciences Hunan Normal UniversityChangsha 410081China Nursing department Hunan Provincial People's Hospital/the First Affi liated HospitalHunan Normal UniversityChangsha 410005China department of Interventional Radiology and Vascular Surgery Hunan Provincial People's Hospital/the First Affi liated HospitalHunan Normal UniversityChangsha 410005China

In China,there are 544,000 sudden deaths each year.Cardiac arrest is one of the most common causes of sudden death,and 70%of cardiac arrests occur outside the hospital.[1,2]However,fewer than 1%of bystanders at cardiac arrest deaths in China are well-trained and capable of administering first aid.[3]Therefore,it is urgent to popularize first-aid knowledge in the Chinese population.

关键词： cardiac death Popular

C-reactive Protein/Albumin Ratio as a Prognostic Indicator in Posttraumatic Shock and Outcome of Multiple Trauma Patients

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Current Medical Science 2023年第2期43卷 360-366页

作者： Xin LU Wei-chen LIU Yan QIN Du CHEN Peng YANG Xiong-hui CHEN Si-rong WU Feng XU emergency department the First Affiliated Hospital of Soochow UniversitySuzhou215000China

Objective C-reactive protein(CRP)/albumin ratio(CAR)is a new inflammation-based index for predicting the prognosis of various diseases.The CAR determined on admission may help to predict the prognostic value of multiple trauma patients.Methods A total of 264 adult patients with severe multiple trauma were included for the present retrospective study,together with the collection of relevant clinical and laboratory data.CAR,CRP,albumin,shock index and ISS were incorporated into the prognostic model,and the receiver operating characteristic(ROC)curve was drawn.Then,the shock index for patients with different levels of CAR was analyzed.Finally,univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for the 28-day mortality of multiple trauma patients.Results A total of 36 patients had poor survival outcomes,and the mortality rate reached 13.6%.Furthermore,after analyzing the shock index for patients with different levels of CAR,it was revealed that the shock index was significantly higher when CAR was≥4,when compared to CAR<2 and 2≤CAR<4,in multiple trauma patients.The multivariate logistic analysis helped to identify the independent association between the variables CAR(P=0.029)and shock index(P=0.019),and the 28-day mortality of multiple trauma patients.Conclusion CAR is higher in patients with severe multiple trauma.Furthermore,CAR serves as a risk factor for independently predicting the 28-day mortality of multiple trauma patients.The shock index was significantly higher when CAR was≥4 in multiple trauma patients.

关键词： C-reactive protein/albumin ratio multiple trauma C-reactive protein albumin prognosis

The expression of oxidative stress genes related to myocardial ischemia reperfusion injury in patients with ST-elevation myocardial infarction

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World Journal of emergency Medicine 2022年第2期13卷 106-113页

作者： Qian-lin Gu Peng Jiang Hui-fen Ruan Hao Tang Yang-bing Liang Zhong-fu Ma Hong Zhan emergency department the First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510000China Huangpu District emergency department the First Affiliated Hospital of Sun Yat-Sen UniversityGuangzhou 510000China

BACKGROUND:We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury(MIRI)in patients with acute ST-elevation myocardial infarction(STEMI)using stress and toxicity pathway gene chip technology and try to determine the underlying mechanism.METHODS:The mononuclear cells were separated by ficoll centrifugation,and plasma total antioxidant capacity(T-AOC)was determined by the ferric reducing ability of plasma(FRAP)assay.The expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction(qRT-PCR).Additionally,gene ontology(GO)enrichment analysis was performed on DAVID website to analyze the potential mechanism further.RESULTS:The total numbers of white blood cells(WBC)and neutrophils(N)in the peripheral blood of STEMI patients(the AMI group)were significantly higher than those in the control group(WBC:11.67±4.85×10^(9)/L vs.6.41±0.72×10^(9)/L,Pfirst day(Y=8.945+0.018X,P<0.05).In addition,the T-AOC was significantly lower in the AMI group comparing to the control group(12.80±1.79 U/mL vs.20.48±2.55 U/mL,P<0.05).According to the gene analysis,eight up-regulated differentially expressed genes(DEGs)included GADD45A,PRDX2,HSPD1,DNAJB1,DNAJB2,RAD50,TNFSF6,and TRADD.Four down-regulated DEGs contained CCNG1,CAT,CYP1A1,and ATM.TNFSF6 and CYP1A1 were detected by polymerase chain reaction(PCR)to verify the expression at different time points,and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total expression.GO and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response(UPR)and apoptosis.CONCLUSIONS:WBCs,especially neutrophils,were the critical cells that mediating reperfusion injury.MIRI was regulated by various genes,including o

关键词： Acute myocardial infarction Myocardial ischemia/reperfusion injury Oxidative stress TNFSF6 CYP1A1 Unfolded protein response

Spontaneous pneumomediastinum in diabetic ketoacidosis:A case series of 10 patients

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World Journal of emergency Medicine 2022年第2期13卷 141-143页

作者： Wan-ling Xu Li-chao Sun Xiu-xian Zang Hong Wang Wei Li department of emergency Medicine the First Hospital of Jilin UniversityChangchun 130021China

Dear editor,Spontaneous pneumomediastinum(SPM,also known as Hamman’s syndrome)is an uncommon finding.SPM is induced without any comorbidities and is secondary to underlying factors,such as smoke,asthma,esophageal rupture,or labor and delivery.[1,2]The frequency of idiopathic pneumomediastinum is 1 of 32,000 hospitalized persons.[3]Awareness of SPM and appropriate examination play a key role in the early diagnosis and intervention for SPM to avoid potentially serious complications.SPM in diabetic ketoacidosis(DKA)has been described in several case reports.[4-6]However,most data are described from isolated cases,and these cases have varying clinical symptoms.This study presents a case series of ten patients diagnosed with SPM complicating DKA to assess their characteristics,treatment,and prognosis.

关键词： patients diagnosis diabetic

The successful use of extracorporeal membrane oxygenation combined with continuous renal replacement therapy for a cardiac arrest patient with refractory hypokalemia and diabetic ketoacidosis

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World Journal of emergency Medicine 2022年第4期13卷 337-340页

作者： Yang Li Rui Xu Chun-Shui Cao Liang Huang department of emergency Medicine the First Affiliated Hospital of Nanchang UniversityNanchang 330006China

Dear editor,Diabetic ketoacidosis(DKA)is a common clinically severe disease,with an incidence of 24.9/1,000 among diabetes patients,and approximately 180,000 people in the United States suffer from DKA every year.[1]The reported mortality rate associated with DKA ranges from 0.65%to 3.30%,and is commonly caused by electrolyte imbalances,especially hypokalemia and hyperkalemia.[2]Reports indicated that hypokalemia was observed in 5.6%of patients with DKA before therapy,[3]and the overall prevalence of hypokalemia during treatment for DKA was 38%.[4]Several studies have shown that hypokalemia can lead to fatal dysrhythmia and even cardiac arrest,which are positively associated with increased mortality.

关键词： mortality cardiac ketoacidosis

A rare case of B-cell lymphoma characteristic of persistent lactic acidosis,hypoglycemia,and dyslipidemia in the emergency department

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World Journal of emergency Medicine 2022年第6期13卷 488-491页

作者： Shuo Zhang Bing-jie Wang Xiao-lan Chen Hui Xiong department of emergency Medicine Peking University First HospitalBeijing 100034China department of Hematology Peking University First HospitalBeijing 100034China

Dear editor,Lactic acidosis is a commonly encountered condition in the emergency department,and the most common causes of lactic acidosis are hypoperfusion and hypoxia induced by sepsis.A number of other diseases can also cause hyperlactatemia,such as hematological malignancies,which can sometimes be life-threatening.Treatment of hyperlactatemia is largely dependent on underlying conditions.Therefore,an accurate diagnosis is important,and prompt treatment could be lifesaving.Despite the advances in medical sciences,lactic acidosis and malignancy have been linked only in a small number of cases,[1]and hypoglycemia and dyslipidemia were rare findings.We report a case of an elderly woman who had persistent lactic acidosis and hypoglycemia with dyslipidemia and was finally diagnosed with B-cell lymphoma.The aim of this case is to highlight the importance of considering hematological malignancies when presented with persistent lactic acidosis and identify a diagnosis for appropriate and timely treatment.

关键词： diagnosis rare prompt

Sepsis caused by Eggerthelle lenta: a case report

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World Journal of emergency Medicine 2022年第5期13卷 415-417页

作者： Li-chao Sun Wan-ling Xu Jian-nan Chai Li Pang Xiu-xian Zang Wei Li Ji-hong Xing department of emergency Medicine the First Hospital of Jilin UniversityChangchun 130021China department of Clinical Laboratory the First Hospital of Jilin UniversityChangchun 130021China

Dear editor,Eggerthelle lenta(E.lenta)is a gram-positive non-spore-bearing anaerobic bacilli that was first isolated from human feces by Arnold Eggerth in 1935.[1]It is classified as an anaerobic eubacterium that cannot decompose glucose and tryptophan[2]but can synthesize diff erent kinds of steroid metabolism enzymes.[3]On the basis of the high content of guanine+cytosine detected by 16S ribosomal RNA gene sequencing,its original name Eubacterium lentum was changed to E.lenta and concurrently transferred to its own distinct genus Eggerthella.[4]E.lenta often exists in the gastrointestinal tract.[5]Previous reports on E.lenta-induced sepsis were rare.Herein,we present a case of E.lenta-induced sepsis with abdominal pain as the main symptom.

关键词： 16S editor metabolism