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世界急诊医学杂志(英文版)

世界急诊医学杂志(英文版)

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《世界急诊医学杂志（英文）》，是由浙江大学、浙江大学医学院附属第二医院主办的国内急诊医学唯一全英文期刊。 期刊邀请来自美国、英国、法国、德国、荷兰、瑞士、希腊、澳大利亚等国家的专家，中国台湾、香港地区的专家，以及中国大陆北京大学、浙江大学、首都医科大学等的教授组成专业水平一流并具有广泛代表性的编委会，由来自中国的王建安教授、美国Steven M. Dubinett教授联合担任主编。WJEM在全球范围邀请相关专业方向的学者对作者投递的稿件进行双盲法审稿，充分尊重审稿专家的审评结论，以保证期刊的学术价值。 自创刊以来，期刊一直处于快速、健康的发展状态，进步显著，其成绩得到广泛认同。目前已经被Emerging Sources Citation Index (ESCI), PubMed, Pubmed Central, Google Scholar, Chemical Abstracts, VINITI database, EMBASE and EMCare, EBSCO, Ulrich＇s Peridicals Directory, J-Gate, CNKI (China National Knowledge Infrastructure)等国际知名检索系统收录。
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  • 发文量：604
  • 被引量：99
  • H指数：0
  • 开始收录时间：2010,1(1)
  • CNKI综合因子：0.0
  • 维普期刊影响因子： 1.01
  • 万方期刊影响因子：0.89
  • 创刊时间：2010
  • 国内刊号/CN：33-1408/R
    国际刊号/ISSN：1920-8642
  • 发行周期：季刊
    邮发代号：-
  • 主管单位：教育部
    主办单位：浙江大学;浙江大学医学院附属第二医院
世界急诊医学杂志(英文版)-联系信息
  • 主编：王建安
  • 电话：0571-87783951
  • 邮箱：em_nancy@zju.edu.cn
  • 地址：浙江省杭州市解放路88号
  • 邮编：310009
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世界急诊医学杂志(英文版) >2023年第6期

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  • 摘要：BACKGROUND： Cardiac arrest （CA） is a common and serious event in emergency medicine.Despite recent improvements in resuscitation techniques, the survival rate of patients with CA isunchanged. The present study was undertaken to observe the effect of mild hypothermia （MH） on thereactive oxygen species （ROS） and the effect of neurological function and related mechanisms.METHODS： Sixty-five healthy male Sprague Dawley （SD） adult rats were randomly （randomnumber） divided into 2 groups： blank control group （n=5） and CPR group （n=60）. CA was induced byasphyxia. The surviving rats were randomly （random number） divided into two groups： normothermiaCPR group （NT） and hypothermia CPR group （HT）. Normothermia of 37 °C was maintained in theNT group after return of spontaneous circulation （ROSC）, hypothermal intervention of 32 °C wascarried out in the HT group for 4 hours immediately after ROSC. Both the NT and HT groups werethen randomly divided into 2 subgroups 12 hours and 24 hours after ROSC （NT-12, NT-24, HT-12,HT-24 subgroups）. During observation, the neurological defi cit scores （NDSs） was recorded, then thebilateral hippocampi were obtained from rats＇ head, and monoplast suspension of fresh hippocampustissue was made immediately to determine the level of intracellular ROS by flow cytometry.Transmission electron microscope was used to observe the ultramicro changes of cellular nucleus andmitochondria. Reverse transcription-polymerase chain reaction （RT-PCR） was used to determine theexpression of caspase-3 mRNA, and western-blotting （WB） was used to determine the level of LC3in frozen hippocampus tissue. Measured data were analyzed with paired sample t test and One-WayANOVA.
  • 摘要：BACKGROUND： We commonly encounter fractures secondary to trauma on and off in our dailypractice. While it is not uncommon to see fractures due to underlying pathology, we need to be on thealert when patients present atypically because the treatment for pathological fractures is far differentfrom that for simple fractures.METHODS： We presented a case of left clavicle fracture secondary to minor trauma, in which theinitial X-ray shows suspicious lesion around the fracture site and further investigation reveals multiplemyeloma. The patient received treatment at the clinical oncology department upon diagnosis. Sincehe was relatively young and fi t, he was started on the induction therapy of VTD, which was followed byhigh dose melphalan and autologous stem cell transplant.RESULTS： He is currently free from symptoms and on maintenance thalidomide.CONCLUSIONS： Though multiple myeloma is not commonly encountered in emergencypractice, earlier identification of relatively subtle symptoms can allow early treatment. Missing thisdiagnosis will delay treatment and produce severe outcome to the patient. We should be on the alertfor such important condition.
  • 摘要：BACKGROUND： In approximately 20% of patients, necrotizing pancreatitis is complicatedwith severe acute pancreatitis, with high morbidity and mortality rates. Minimally invasive step-upapproach is both safe and effective, but sometimes requires multiple access sites.METHODS： A 62-year-old woman was admitted with diabetic ketoacidosis, and initial computedtomography （CT） revealed no evidence of acute pancreatitis. She was clinically improved with insulintherapy, fl uid administration, and electrolyte replacement. However, on the 14th day of admission, shedeveloped a high-grade fever, and CT demonstrated evidence of acute necrotizing pancreatitis with alarge collection of peripancreatic fl uid. Percutaneous transgastric drainage was performed and a 14French gauge （Fr） pigtail catheter was placed 1 week later, which drained copious pus. Because ofpersistent high-grade fever and poor clinical improvement, multiple 8 and 10 Fr pigtail catheters wereplaced via the initial drainage route, allowing the safe and effective drainage of the extensive necrotictissue that was occupying the bilateral anterior pararenal space.RESULTS： After drainage, the patient recovered well and the last catheter was removed on day123 of admission.CONCLUSIONS： Multiple percutaneous drainage requires both careful judgment and specialistskills. The perforation of the colon and small bowel as well as the injury of the kidney and majorvessels can occur. The current technique appears to be safe and minimally invasive compared withother drainage methods in patients with extended, infected necrotic pancreatic pseudocysts.
  • 摘要：BACKGROUND： Thoracostomy tube insertion is one of the common bedside proceduresin emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from theconnection tube of chest drainage system is an important problem with potential complications suchas contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction.It is a common practice to tape the connection of the system. This study aimed to evaluate thematerials and methods of connection of chest drain system to minimize drainage dislodgement.METHODS： We conducted an experimental study to assess the tightness of the connection withvarious taping materials and methods. We selected three commonly used adhesive materials （3M？Transpore？ Medical tape, 3M？ Micropore？ Medical tape, 3M？ Soft Cloth Tape on Liner） and threedifferent methods （cross method, straight method, nylon band） to secure the junction between thethoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was theweight causing visible loosening of the junction between thoracotomy tube and the adaptor.RESULTS： For each taping material and taping method, 10 trials were performed. The medianweight required to disconnect the junction is 26.22 lb for Transpore？, 31.29 lb for Micropore？ and32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore？ isused （P〈0.001）. There was no statistical signifi cant difference between Micropore？ and Soft ClothTape on Liner （P=0.98）. The median disconnecting force is 32.44 lb for straight taping method, 40.55lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the moresecure method （P〈0.0001 when compared with plastic band） （P=0.033 when compared with straightmethod）.CONCLUSION： Cross-taping is the most secure method among the tested varieties inconnecting the thoracostomy tube to the chest drainage system. Transpore？ is not a recommendedmaterial for thoracostomy tube taping.
  • 摘要：BACKGROUND： Pulmonary embolism （PE） is one of the most frequent diseases that could bemissed in overcrowded emergency departments as in Turkey. Early and accurate diagnosis coulddecrease the mortality rate and this standard algorithm should be defi ned. This study is to fi nd theaccurate, fast, non-invasive, cost-effective, easy-to-access diagnostic tests, clinical scoring systemsand the patients who should be tested for clinical diagnosis of PE in emergency department.METHODS： One hundred and forty patients admitted to the emergency department with thefi nal diagnosis of PE regarding to anamnesis, physical examination and risk factors, were included inthis prospective, cross-sectional study. The patients with a diagnosis of pulmonary embolism, acutecoronary syndrome or infection and chronic obstructive pulmonary disease （COPD） were excludedfrom the study. The demographics, risk factors, radiological fi ndings, vital signs, symptoms, physicallaboratoryfi ndings, diagnostic tests and clinical scoring systems of patients （Wells and Geneva） werenoted. The diagnostic criteria for pulmonary emboli were： fi lling defect in the pulmonary artery lumenon spiral computed tomographic angiography and perfusion defect on perfusion scintigraphy.RESULTS： Totally, 90 （64%） of the patients had PE. Age, hypotension, having deep veinthrombosis were the risk factors, and oxygen saturation, shock index, BNP, troponin and fi brinogenlevels as for the biochemical parameters were signifi cantly different between the PE （＋） and PE （-）groups （P〈0.05）.The Wells scoring system was more successful than the other scoring systems.CONCLUSION： Biochemical parameters, clinical findings, and scoring systems, when usedaltogether, can contribute to the diagnosis of PE
  • 摘要：BACKGROUND： Although non-thyroidal illness syndrome （NTIS） is considered a negativeprognostic factor, the alterations in free triiodothyronine （fT3） levels in trauma patients requiringmassive transfusion have not been reported.METHODS： A prospective observational study comparing 2 groups of trauma patients wasconducted. Group M comprised trauma patients requiring massive transfusions （〉10 units of packedred blood cells） within 24 hours of emergency admission. Group C comprised patients with an injuryseverity score 〉9 but not requiring massive transfusions. Levels of fT3, free thyroxine （fT4）, and thyroidstimulatinghormone （TSH） were evaluated on admission and on days 1, 2, and 7 after admission. Theclinical backgrounds and variables measured including total transfusion amounts were compared andthe inter-group prognosis was evaluated. Results are presented as mean±standard deviation.RESULTS： Nineteen patients were enrolled in each group. In both groups, 32 were men, andthe mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3levels in group M （1.95±0.37 pg/mL） were signifi cantly lower than those in group C （2.49±0.72 pg/mL;P〈0.01） and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels werenot significantly different. TSH levels at 1 week （1.99±1.64 μIU/mL） were higher than at admission（1.48±0.5 μIU/mL） in group C （P〈0.05）.CONCLUSION： Typical NTIS was observed in trauma patients requiring massive transfusions. Wheninitial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.
  • 摘要：BACKGROUND： Mild to moderate musculoskeletal trauma is a common cause for anemergency room visit, and frequent pain is one of the cardinal symptoms of consultation. Theobjective of this study is to assess the perception of a single subcutaneous dose of 50 mg tramadolfor pain management in patients with mild to moderate musculoskeletal trauma, likewise to appraisethe perception of pain by subcutaneous injection.METHODS： A total of 77 patients, who met inclusion criteria, received a single subcutaneousdose of tramadol. Pain control was evaluated based on the verbal numerical pain scale （0-10） atbaseline, 20 and 60 minutes; similarly, pain perception was evaluated secondary to subcutaneousinjection of the analgesic.RESULTS： On admission, the average pain perceived by patients was 8; twenty minutes later,89% of the patients reported fi ve or less, and after sixty minutes, 94% had three or less on the verbalnumerical pain scale. Of the patients, 88% reported pain perception by verbal numeric scale of 3 orless by injection of the drug, and 6.5% required a second analgesic for pain control. Two events withdrug administration （soft tissue infection and mild abdominal rectus injection） were reported.CONCLUSION： We conclude that a single subcutaneous dose of tramadol is a safe andeffective option for the management of patients with mild to moderate pain and musculoskeletaldisease in the emergency department.
  • 摘要：BACKGROUND： Traumatic brain injury （TBI） is associated with most trauma-related deaths.Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By earlyprevention and slowing of the initial pathophysiological mechanism of secondary brain injury, prehospitalservice can signifi cantly reduce case-fatality rates of TBI. In China, the incidence of TBI isincreasing and the proportion of severe TBI is much higher than that in other countries. The objectiveof this paper is to review the pre-hospital management of TBI in China.DATA SOURCES： A literature search was conducted in January 2014 using the China NationalKnowledge Infrastructure （CNKI）. Articles on the assessment and treatment of TBI in pre-hospitalsettings practiced by Chinese doctors were identified. The information on the assessment andtreatment of hypoxemia, hypotension, and brain herniation was extracted from the identifi ed articles.RESULTS： Of the 471 articles identified, 65 met the selection criteria. The existing literatureindicated that current practices of pre-hospital TBI management in China were sub-optimal andvaried considerably across different regions.CONCLUSION： Since pre-hospital care is the weakest part of Chinese emergency care,appropriate training programs on pre-hospital TBI management are urgently needed in China.
  • 摘要：BACKGROUND： Ultrasound diagnosis of pediatric intussusception is feasible with limitedoperator training. The authors report the test characteristics of bedside ultrasound （BUS） for thediagnosis of pediatric intussusception at a single institution.METHODS： Inclusion criteria were： 1） patients of 0-18 years old were seen in the pediatricemergency department （ED） with a clinical presentation suspicious for intussusception; 2） BUS wasperformed to identify intussusception and bedside impression documented in the medical record; 3） a＂formal＂ diagnostic study （such as computed tomography, ultrasound, or barium enema） was performedby the radiology department after BUS was completed. Electronic medical record and ED BUS archivewere screened for potentially eligible ED visits between January 1st 2009 to October 3rd 2012. Theserecords were then reviewed to identify patients for inclusion in the study. All emergency physicians whoperformed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnosepediatric intussusception.RESULTS： A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Fiveof those were later excluded for incomplete documentation or lack of saved BUS images. Theprevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was100% sensitive （95%CI 66%-100%） and 94% specifi c （95%CI 79%-99%） for detection of pediatricintussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5（95%CI 4.30%-63.21%） and 0 （95%CI 0-0） respectively.CONCLUSIONS： BUS is an accurate means of diagnosing acute intussusception in pediatricpatients. Further study might be indicated to confi rm such benefi ts.
  • 摘要：BACKGROUND： Rapid sequence induction and intubation （RSII） is an emergency airwaymanagement technique for patients with a risk of pulmonary aspiration. It involves preoxygenation,administration of predetermined doses of induction and paralytic drugs, avoidance of maskventilation, and laryngoscopy followed by tracheal intubation and keeping cricoid pressure applied tillendotracheal tube cuff be inflated. Oxygen desaturation has been seen during RSII. We assessedthe incidence of oxygen desaturation during RSII.METHODS： An institution-based observational study was conducted from March 3 to May 4,2014 in our hospital. All patients who were operated upon under general anesthesia with RSII duringthe study period were included. A checklist was prepared for data collection.RESULTS： A total of 153 patients were included in this study with a response rate of 91.6%.Appropriate drugs for RSII, equipments for RSII, equipments for diffi cult intubation, suction machinewith a catheter, a monitor and an oxygen backup such as ambu bag were not prepared for 41（26.8%）, 50 （32.7%）, 51 （33.3%）, 38 （24.8%） and 25 （16.3%） patients respectively. Cricoid pressurewas not applied at all for 17 （11.1%） patients and 53 （34.6%） patients were ventilated after inductionof anesthesia but before intubation and endotracheal cuff inflation. A total of 55 （35.9%） patientsdesaturated during RSII （SPO2〈95%）. The minimum, maximum and mean oxygen desaturationswere 26%, 94% and 70.9% respectively. The oxygen desaturation was in the range of 〈50%, 50%-64%, 65%-74%, 75%-84%, 85%-89 % and 90%-94% for 6 （3.9%）, 7 （4.6%）, 5 （3.3%）, 10 （6.5%）,13 （8.5%） and 14 （9.2%） patients respectively.CONCLUSION： The incidence of oxygen desaturation during RSII was high in our hospital.Preoperative patient optimization and training about the techniques of RSII should be emphasized.
  • 摘要：BACKGROUND： This study aimed to investigate the epidemiological and clinical characteristics ofpatients with heat-related illness, and guide the prevention, diagnosis and treatment of heat-related illness.METHODS： From June 2013 to August 2013, seventy patients with heat-related illness weretreated at Jinshan Hospital of Fudan University, and their epidemiological characteristics, laboratoryresults, treatment and prognosis were retrospectively analyzed.RESULTS： In the 70 patients, 18 patients suffered from heat stroke and 52 patients from nonheatstroke. When the environmnent temperature was above 35 °C, the body temperature of thepatients began to increase markedly. The patients with heat stroke were significantly older thanthose with non-heat stroke （P〈0.05）. The body temperature, heart rate, blood glucose, blood lactatedehydrogenase and blood creatine kinase in the patients with heat stroke were higher than those inthe patients with non-heat stroke （P〈0.05）. Blood lactate dehydrogenase and blood creatine kinasewere positively correlated with body temperature （r=0.801）.CONCLUSION： When the environmental temperature goes above 35 °C, heat-related illnessshould be prevented, especially in the elderly. The body temperature, heart rate, blood glucose, bloodlactate dehydrogenase and blood creatine kinase in patients with heat stroke are higher than those inpatients with non-heat stroke. Blood lactate dehydrogenase and blood creatine kinase are positivelycorrelated with body temperature, but their relationship with heat-related illness awaits further study.
  • 摘要：BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.
  • 摘要：BACKGROUND: Harmless acute pancreatitis score(HAPS), neutrophile/lymphocyte ratio and red blood cell distribution width(RDW) are used to determine the early prognosis of patients diagnosed with nontraumatic acute pancreatitis in the emergency department(ED).METHODS: Patients diagnosed with acute pancreatitis(K 85.9) in the ED according to the ICD10 coding during one year were included in the study. Patients with chronic pancreatitis and those who had missing data in their files were excluded from the study. Patients who did not have computed tomography(CT) in the ED were not included in the study.RESULTS: Ultimately, 322 patients were included in the study. The median age of the patients was 53.1(IQR=36–64). Of the patients, 68.1%(n=226) had etiological causes of the biliary tract. The mortality rate of these patients within the first 48 hours was 4.3%(n=14). In the logistic regression analysis performed by using Balthazar classification, HAPS score, RDW, neutrophile/lymphocyte ratio, age, diabetes mellitus and systolic blood pressure, the only independent variable in determining mortality was assigned as Balthazar classification(OR: 15; 95% CI: 3.5 to 64.4).CONCLUSIONS: HAPS, neutrophile/lymphocyte ratio and RDW were not effective in determining the mortality of nontraumatic acute pancreatitis cases within the first 48 hours. The only independent variable for determining the mortality was Balthazar classifi cation.
  • 摘要：BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insuffi ciency(CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit(ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group(n=32) and a control group(n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone(150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers ofinfl ammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically signifi cant.RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4%. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI(23.8% vs. 8.7%, P<0.01). KaplanMeier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group(P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group(18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers ofinfection and inflammation(P<0.01), such as C-reactive protein(13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α(26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin(3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group(P<0.01).CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers ofinfection and infl ammation.
  • 摘要：BACKGROUND: Sepsis is a common complication ofinfections, burns, traumas, surgeries, poisonings, and post-cardiopulmonary resuscitation. The present study aimed to investigate prognostic value of CD4+CD25+ regulatory T cells(Treg) in peripheral blood of patients with sepsis.METHODS: Periphery blood from 28 patients diagnosed with sepsis was collected on day 1 and 7 after hospitalization in the ICU of Shanghai Changzheng Hospital between December 2013 to April 2014. The blood was used for analyses of Treg ratio using flow cytometry and for analyses of blood routine test, C-reactive protein(CRP), bilirubin, procalcitonin(PCT), and coagulation. APACHE II and sequential organ failure assessment(SOFA) scores were also investigated. The results were compared between two outcome groups of survival or death to evaluate prognostic value for sepsis.RESULTS: The patients had an average age of 60.36±15.03 years, APACHE II score 16.68±7.00, and SOFA score 7.18±3.78. Among the 28 patients, 12 had severe trauma(42.9%), 10 had septic shock(35.7%), and 9(32.2%) died. The median ratio of Tregs was 2.10%(0.80%, 3.10%) in the survival group vs. 1.80%(1.15%, 3.65%) in the death group(Z=–0.148, P=0.883) on day 1; however it was signifi cantly changed to 0.90%(0.30%, 2.80%) vs. 5.70%(2.60%, 8.30%)(Z=–2.905, P=0.004).CONCLUSION: With better prospects for clinical application, dynamic monitoring of Tregs ratio in peripheral blood has potential value in predicting prognosis of sepsis.
  • 摘要：BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not.METHODS: The study was performed at two urban hospitals enrolling 125 emergency department(ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit(10–14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1–10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals(CI).RESULTS: In the 125 patients with SHL [median age: 28(18, 43); range: 1–102 years old; 36% female], 44(35%, 95% CI: 27%–44%) were given antibiotics in the ED. Wound infection was reported in 6 patients(4.8%, 95% CI: 2%–10%). Age, gender, history of diabetes and wound closure were not associated with wound infection(P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7%(3/44), 95% CI: 2%–10% vs. 4%(3/81), 95% CI: 1%–11%, P=0.66]. Patient's satisfaction with appearance ofinfected and non-infected wounds were significantly different [7.5(6, 8) vs. 9(8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk ofinfection.
  • 摘要：BACKGROUND: Modern civilization and the sharp rise in living standards have led to dramatic changes in trauma pattern in Saudi Arabia. This study aimed to describe the different patterns of injuries of patients attending the Emergency Department of Jazan General Hospital(JGH) in the southwest corner of Saudi Arabia.METHODS: A total number of 1 050 patients were enrolled in the study. A pre-organized data sheet was prepared for each patient attended the Emergency Department of JGH from February 2012 to January 2013. It contains data about socio-demographics, trauma data, clinical evaluation results, investigations as well as treatment strategies.RESULTS: The mean age of the patients was 25.3±16.8 years. Most(45.1%) of the patients were at age of 18–30 years. Males(64.3%) were affected by trauma more common than females. More than half(60.6%) of the patients were from urban areas. The commonest kind of injury was minor injury(60%), followed by blunt trauma(30.9%) and then penetrating trauma(9.1%). The mean time from the incident to arrival at hospital was 41.3±79.8 minutes. The majority(48.2%) of the patients were discharged after management of trivial trauma, whereas 2.3% were admitted to ICU, 7.7% transferred to inpatient wards, and 17.7% observed and subsequently discharged. The mortality rate of the patients was 2.6%.CONCLUSION: Trauma is a major health problem, especially in the young population in Saudi Arabia. Blunt trauma is more frequent than penetrating trauma, with road traffic accidents accounting for the majority.
  • 摘要：BACKGROUND: This study aimed to describe the clinical and socio-demographic aspects of acute poisoning in 2010 in Duzce City, Northwest Anatolian Region of Turkey.METHODS: Acute poisoning was due to the intentional ingestion of drugs in young and adult people(≥16), who were treated at the Emergency Service of Duzce University Medical Hospital, Turkey from January 1, 2010 to December 31, 2010. In this retrospective and descriptive study, 95 patients were diagnosed with intoxications and 30 of them intentionally ingested drugs to commit suicide. Records of the patients diagnosed with intoxication were obtained from the Clinical Archive of the hospital. Their diagnoses were established according to the International Statistical Classification of Diseases and Related Health Problems. Codes X60-X84 of this classification were used to classify self-infringed drug injuries and drug poisoning.RESULTS: In this series, 35(36.8%) patients were male and 60 patients(63.2%) female. The male/female ratio was 1.0/1.7. The mean age of the patients was 33.1±14.2 years; 17(17.9%) patients were below 20 years old and 9(9.5%) were older than 50 years. Of these patients, 29(30.5%) were single, 7(7.4%) divorced or separated, and 59(62.1%) married. Their mean time for admission to the emergency service after the incident was 208±180(15–660) minutes. The mean time for admission to the emergency service for patients with food intoxication after the incident was 142±160 minutes, for those with drug intoxication 173±161 minutes, for those with carbon monoxide(CO) intoxication 315±209 minutes, and for those with undefined intoxication 289±166 minutes(P=0.005). Most of the intoxication cases occurred in winter(41.1%, 39 of 95 patients). Admissions to the emergency service were most common in December and April(21 and 16 of 95 patients, respectively). Sixty-five(68.4%) cases were involved in non-deliberate poisoning, whereas 30(31.6%) were involved in deliberate poisoning. Twenty-six of the 95 patients with acute poisonings had mortality risk at admission, however only one died from CO intoxication in the emergency service(1.1%). Suicide attempts were more common in females than in males(21 of 30 patients, 70%, P<0.05). CONCLUSION: In Duzce City of Turkey, most intoxication cases occurred in winter, especially in December. They had non-deliberate poisoning, but deliberate poisoning in suicide attempts was more common in females than in males.
  • 摘要：BACKGROUND: To determine whether the prehospital use of continuous positive airway pressure(CPAP) therapy is associated with a reduced rate of endotracheal intubation in patients with an acute respiratory disorder brought to the emergency department(ED).METHODS: We reviewed medical records of patients with acute respiratory distress who had been treated with CPAP in the Mobile Intensive Care Unit(MICU) from January 2010 to December 2011. These records were compared with those of patients who received standardized care without CPAP in the MICU from January 2004 to December 2004. Categorical variables were summarized as frequencies and compared between groups using Fisher's exact test or the Chi-square test. Continuous variables were summarized as medians(interquartile range), and comparison between the groups was made using Wilcoxon's rank-sum test. The relationship between CPAP and intubation rate was determined using multivariable logistic regression analysis of propensity scores. The results were presented as odds ratio(OR), 95% confidence interval(CI), and P value for test effect. The adequacy of the model was calibrated using Hosmer and Lemeshow's goodness-of-fit test. P<0.05 was considered statistically significant.RESULTS: The records of 785 patients were reviewed. Of the 215 patients treated with CPAP in the MICU, 13% were intubated after admission. In contrast, of the 570 patients who did not receive CPAP, 28% were intubated after ED admission. Unadjusted logistic regression analysis showed that patients who had been treated with CPAP were less likely to be intubated than those without CPAP treatment(OR=0.37, 95% CI, 0.24–0.57, P<0.0001). With propensity scores adjusted, multivariate logistic regression analysis showed that CPAP treatment was associated with a 62% reduction of intubation(OR=0.384, 95%CI, 0.25–0.60, P≤0.0001).CONCLUSIONS: In patients with acute respiratory disorder, there was a relationship between CPAP therapy and the decreased intubation rate. CPAP therapy was feasible in prehospital management of patients with respiratory distress.
  • 摘要：BACKGROUND: The present study was undertaken to examine the regulatory effect of hydrogen sulfide(H2S) on endoplasmic reticulum stress in alveolar epithelial cells of rats with acute lung injury(ALI) induced by oleic acid(OA).METHODS: Seventy-two male Sprague Dawley(SD) rats were divided into control group, oleic acid-induced ALI group(OA group), oleic acid-induced ALI with sodium hydrosulfide(Na HS) pretreatment group(OA+Na HS group), and sodium hydrosulfide treatment group(Na HS group). Rats of each group were further subdivided into 3 subgroups. Index of quantitative assessment of histological lung injury(IQA), wet/dry weight ratio(W/D) and H2 S level of lung tissues were measured. The expressions of endoplasmic reticulum stress markers including glucose-regulated protein 78(GRP78) and α-subunit of eukaryotic translation initiation factor-2(el F2α) in lung tissues were measured by immunohistochemical staining and Western blotting.RESULTS: The IQA score and W/D ratio of lung tissues at the three time points significantly increased in rats injected with OA, but significantly decreased in other rats injected with OA and Na HS. The level of H2 S in lung tissue at the three time points significantly decreased in rats injected with OA, but significantly increased in other rats injected with both OA and Na HS. GRP78 and el F2α decreased in rats injected with OA, but increased in other rats injected with both OA and Na HS, especially at 4-hour and 6-hour time points.CONCLUSION: The results suggested that H2 S could promote alveolar epithelial cell endoplasmic reticulum stress in rats with ALI.
  • 摘要：BACKGROUND: In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke.METHODS: A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue.RESULTS: His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later.CONCLUSIONS: Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.
  • 摘要：BACKGROUND: The survival rate of patients after cardiac arrest(CA) remains lower since 2010 International Consensus on Cardiopulmonary Resuscitation(CPR) and Emergency Cardiovascular Care(ECC) was published. In clinical trials, the methods and techniques for CPR have been overly described. This article gives an overview of the progress in methods and techniques for CPR in the past years.DATA SOURCES: Original articles about cardiac arrest and CPR from MEDLINE(PubM ed) and relevant journals were searched, and most of them were clinical randomized controlled trials(RCTs).RESULTS: Forty-two articles on methods and techniques of CPR were reviewed, including chest compression and conventional CPR, chest compression depth and speed, defibrillation strategies and priority, mechanical and manual chest compression, advanced airway management, impedance threshold device(ITD) and active compression-decompression(ACD) CPR, epinephrine use, and therapeutic hypothermia. The results of studies and related issues described in the international guidelines had been testifi ed.CONCLUSIONS: Although large multicenter studies on CPR are still difficult to carry out, progress has been made in the past 4 years in the methods and techniques of CPR. The results of this review provide evidences for updating the 2015 international guidelines.
  • 摘要：BACKGROUND: Although the Australasian Triage Scale(ATS) has been developed two decades ago, its reliability has not been def ined; therefore, we present a meta-analyis of the reliability of the ATS in order to reveal to what extent the ATS is reliable.DATA SOURCES: Electronic databases were searched to March 2014. The included studies were those that reported samples size, reliability coefficients, and adequate description of the ATS reliability assessment. The guidelines for reporting reliability and agreement studies(GRRAS) were used. Two reviewers independently examined abstracts and extracted data. The effect size was obtained by the z-transformation of reliability coefficients. Data were pooled with random-effects models, and meta-regression was done based on the method of moment's estimator.RESULTS: Six studies were included in this study at last. Pooled coefficient for the ATS was substantial 0.428(95%CI 0.340–0.509). The rate of mis-triage was less than fifty percent. The agreement upon the adult version is higher than the pediatric version.CONCLUSION: The ATS has shown an acceptable level of overall reliability in the emergency department, but it needs more development to reach an almost perfect agreement.
  • 摘要：BACKGROUND: Venous thromboembolism(VTE), including both deep vein thrombosis(DVT) and pulmonary embolism(PE), is a common, lethal disorder that affects hospitalized and nonhospitalized patients. This study aimed to review the progress in the research into VTE.DATA SOURCES: We reviewed the studies about VTE and verified different genetic polymoriphisms of VTE.RESULTS: The pathogenesis of VTE involves hereditary and acquired factors. Many studies indicated that the disorder of coagulation and fibirnolytic system is of utmost importance to this disease. Genetic polymoriphism-related VTE demonstrated significant differences among geographies and ethnicities.CONCLUSION: VTE has many risk factors, but genetic factors play an important role.
  • 摘要：BACKGROUND: Near-infrared spectroscopy(NIRS) non-invasively monitors muscle tissue oxygen saturation(St O2). It may provide a continuous noninvasive measurement to identify occult hypoperfusion, guide resuscitation, and predict the development of multiple organ dysfunction(MOD) after severe trauma. We evaluated the correlation between initial St O2 and the development of MOD in multi-trauma patients.METHODS: Patients presenting to our urban, academic, Level I Trauma Center/Emergency Department and meeting standardized trauma-team activation criteria were enrolled in this prospective trial. NIRS monitoring was initiated immediately on arrival with collection of St O2 at the thenar eminence and continued up to 24 hours for those admitted to the Trauma Intensive Care Unit(TICU). Standardized resuscitation laboratory measures and clinical evaluation tools were collected. The primary outcome was the association between initial St O2 and the development of MOD within the f irst 24 hours based on a MOD score of 6 or greater. Descriptive statistical analyses were performed; numeric means, multivariate regression and rank sum comparisons were utilized. Clinicians were blinded from the StO 2 values.RESULTS: Over a 14 month period, 78 patients were enrolled. Mean age was 40.9 years(SD 18.2), 84.4% were male, 76.9% had a blunt trauma mechanism and mean injury severity score(ISS) was 18.5(SD 12.9). Of the 78 patients, 26(33.3%) developed MOD within the first 24 hours. The MOD patients had mean initial St O2 values of 53.3(SD 10.3), signifi cantly lower than those of nonMOD patients 61.1(SD 10.0); P=0.002. The mean ISS among MOD patients was 29.9(SD 11.5), significantly higher than that of non-MODS patients, 12.1(SD 9.1)(P<0.0001). The mean shock index(SI) among MOD patients was 0.92(SD 0.28), also signifi cantly higher than that of non-MODS patients, 0.73(SD 0.19)(P=0.0007). Lactate values were not signifi cantly different between groups.CONCLUSION: Non-invasive, continuous St O2 near-infrared spectroscopy values during initial trauma resuscitation correlate with the later development of multiple organ dysfunction in this patient population.
  • 摘要：BACKGROUND: A poor communication with immigrants can lead to inappropriate use of healthcare services, greater risk of misdiagnosis, and lower compliance with treatment. As precise information about communication between emergency physicians(EPs) and immigrants is lacking, we analyzed difficulties in communicating with immigrants in the emergency department(ED) and their possible associations with demographic data, geographical origin and clinical characteristics.METHODS: In an ED with approximately 85 000 visits per year, a multiple-choice questionnaire was given to the EPs 4 months after discharge of each immigrant in 2011.RESULTS: Linguistic comprehension was optimal or partial in the majority of patients. Signifi cant barriers were noted in nearly one fourth of patients, for only half of them compatriots who were able to translate. Linguistic barriers were mainly found in older and sicker patients; they were also frequently seen in patients coming from western Africa and southern Europe. Non-linguistic barriers were perceived by EPs in a minority of patients, more frequently in the elderly and frequent attenders. Factors independently associated with a poor f inal comprehension led to linguistic barriers, non-linguistic obstacles, the absence of intermediaries, and the presence of patient's fear and hostility. The latter probably is a consequence, not the cause, of a poor comprehension.CONCLUSION: Linguistic and non-linguistic barriers, although quite infrequent, are the main factors that compromise communication with immigrants in the ED, with negative effects especially on elderly and more seriously ill patients as well as on physician satisfaction and appropriateness in using services.
  • 摘要：BACKGROUND: Life-threatening emergencies can occur at anytime, at anywhere and in anyone. Effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal complications. Therefore, health professionals including dentists must be well prepared to deal with medical emergencies. This study was undertaken to assess the knowledge about and attitude towards basic life support(BLS) among dental interns and postgraduate students in Bangalore city, India.METHODS: A cross sectional survey was conducted among dental interns and postgraduate students from May 2014 to June 2014 since few studies have been conducted in Bangalore city. A questionnaire with 17 questions regarding the knowledge about and attitude towards BLS was distributed to 202 study participants.RESULTS: The data analyzed using the Chi-square test showed that dental interns and postgraduate students had average knowledge about BLS. In the 201 participants, 121(59.9%) had a positive attitude and 81(40.1%) had a negative attitude towards BLS.CONCLUSIONS: Cardiopulmonary resuscitation should be considered as part of the dental curriculum. Workshops on a regular basis should be focused on skills of cardiopulmonary resuscitation for dental students.
  • 摘要：BACKGROUND: Triggering receptor expressed on myeloid cells-1(TREM-1) is a cell surface receptor expressed on neutrophils and monocytes. TREM-1 acts to amplify infl ammation and serves as a critical mediator of infl ammatory response in the context of sepsis. To date, the predisposition of TREM-1 gene polymorphisms to septic shock has not been reported. This study was designed to investigate whether TREM-1 genomic variations are associated with the development of septic shock.METHODS: We genotyped two TREM-1 single nucleotide polymorphisms(SNPs, rs2234237 and rs2234246) and evaluated the relationships between these SNPs and septic shock on susceptibility and prognosis.RESULTS: TREM-1 rs2234246 A allele in the promoter region was signifi cantly associated with the susceptibility of septic shock in recessive model(AA, OR=3.10, 95%CI 1.15 to 8.32, P=0.02), and in codominant model(AG, OR=0.72, 95%CI 0.43–1.19, P=0.02; AA, OR=2.71, 95%CI 1.00–7.42; P=0.03). However, in three inherited models(dominant model, recessive model, and codominant model), none of the assayed loci was signif icantly associated with the prognosis of septic shock. The nonsurvivor group demonstrated higher plasma IL-6 levels(99.7±34.7 pg/mL vs. 61.2±26.5 pg/mL, P<0.01) than the survivor group. Plasma concentrations of IL-6 among the three genotypes of rs2234246 were AA 99.4±48.9 pg/m L, AG 85.4±43 pg/m L, and GG 65.3±30.7 pg/m L(P<0.01). The plasma concentrations of IL-6 in patients with AA genotypes were signifi cantly higher than those in patients with GG genotypes(P<0.01).CONCLUSION: TREM-1 genetic polymorphisms rs2234246 may be significantly correlated only with susceptibility to septic shock in the Chinese Han population.
  • 摘要：BACKGROUND: Although pneumonia severity index(PSI) is widely used to evaluate the severity of community-acquired pneumonia(CAP), the calculation of PSI is very complicated. The present study aimed to evaluate the role of B-type natriuretic peptide(BNP) in predicting the severity of CAP.METHODS: For 202 patients with CAP admitted to the emergency department, BNP levels, cardiac load indexes, inf lammatory indexes including C-reactive protein(CRP), white blood cell count(WBC), and PSI were detected. The correlation between the indexes and PSI was investigated. BNP levels for survivor and non-survivor groups were compared, and a receiver operating characteristic(ROC) curve analysis was performed on the BNP levels versus PSI.RESULTS: The BNP levels increased with CAP severity(r=0.782, P<0.001). The BNP levels of the high-risk group(PSI classes IV and V) were signifi cantly higher than those of the low-risk group(PSI classes I–III)(P<0.001). The BNP levels were signifi cantly higher in the non-survivor group than in the survivor group(P<0.001). In addition, there were positive correlations between BNP levels and PSI scores(r=0.782, P<0.001). The BNP level was highly accurate in predicting the severity of CAP(AUC=0.952). The optimal cut-off point of BNP level for distinguishing high-risk patients from low-risk ones was 125.0 pg/m L, with a sensitivity of 0.891 and a specifi city of 0.946. Moreover, BNP level was accurate in predicting mortality(AUC=0.823). Its optimal cut-off point for predicting death was 299.0 pg/m L, with a sensitivity of 0.675 and a specifi city of 0.816. Its negative predictive cut-off value was 0.926, and the positive predictive cut-off value was 0.426.CONCLUSION: BNP level is positively correlated with the severity of CAP, and may be used as a biomarker for evaluating the severity of CAP.
  • 摘要：BACKGROUND: Noninvasive monitoring of intra-abdominal pressure(IAP) by measuring abdominal wall tension(AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit(ICU).METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure(UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index(BMI) on baseline AWT(IAP<12 mm Hg) were assessed using one-way analysis of variance.RESULTS: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP(R=0.986, P<0.01); the regression equation was Y=–1.369+9.57X(P<0.01). There were signif icant differences among the different respiratory phases and body positions(P<0.01). However, gender and BMI had no signif icant effects on baseline AWT(P=0.457 and 0.313, respectively).CONCLUSIONS: There was a signif icant linear correlation between AWT and UBP and respiratory phase, whereas body position had signif icant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

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    • 创刊时间：2010
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