Discussion on Homogenization of Emergency Clinical Decision

The objective of this work is to explore how to realize the homogenization of emergency clinical decision, and it means that patients receive the same effect of clinical decisions and the treatment in a different hospital. In order to achieve that, emergency doctors should first have the same clinical thinking and thinking mode which is the biggest challenge for homogenization of emergency clinical decision. The task of emergency medicine is to give priority to the treatment of critically ill patients, so step-down thinking of “excluding life-threatening symptoms first” is the basis, the preemptive thinking is the means, and Process thinking is the key of homogenization;The initial diagnosis and treatment mode of symptom-oriented is the starting point for emergency decision;establishing a unified “checklist” can not only broaden the lateral thinking of emergency doctors, but also unify the thinking of differential diagnosis of emergency;dynamic observation should run through the whole diagnosis and treatment process, which is necessary for the homogenization of emergency decision.

The Prediction Value of the Infection Probability Score (IPS) Combined with Serum Cholinesterase and D-Dimer Detection for Infection and Survival in Critically Ill Patients

Objective: To evaluate early prediction value of IPS combined with SchE and D-dimer detection for infection and survival in critically ill patients. Methods: 199 critically ill patients admitted to the emergency intensive care unit (EICU) of our hospital from December 2018 to December 2019 were retrospectively analyzed, including 110 infection patients (infection group) and 89 non-infection patients (non-infection group). According to the survival, the infection group was divided into death group (68 cases) and survival group (42 cases). The IPS, APACHE II, SOFA and SchE, D-dimer expression levels were detected and compared;Univariate and logistic regression analysis were used to evaluate the independent prognostic factors. Results: The IPS and APACHE II of patients in the infected group were higher than those in the non-infected group, the level of SchE was lower than that in the non-infected group, and the level of D-dimer was higher than that in the non-infected group (P < 0.001). IPS, SOFA, APACHE II, SchE, D-dimer, invasive mechanical ventilation, septic shock, and ICU length of stay had significant influence on the prognosis of critically ill patients (P < 0.001). Logistic regression analysis showed that IPS (OR = 2.821, 95% CI 1.501 - 5.227), SOFA (OR = 5.078, 95% CI 3.327 - 7.690), APACHE II (OR = 14.308, 95% CI 8.901 - 21.893), SchE (OR = 0.223, 95% CI 0.165 - 0.291), D-dimer (OR = 2.10, 95% CI 1.55 - 2.85), septic shock (OR = 9.948, 95% CI 7.012 - 17.012) were independent factors affecting the prognosis of critically ill patients with infection (P < 0.001). Conclusion: IPS and D-dimer expression level in infected patients were increased and SchE decreased significantly compared with those in non-infected patients, and they significantly correlated with disease severity of infected patients and could be early prediction for prognosis.