系统性红斑狼疮患者急诊就诊的主诉症状

目的总结急诊就诊的系统性红斑狼疮(systemic lupus erythematosus,SLE)患者的主诉症状及特点。方法采用回顾性分析的方法对本院急诊科2009年9月至2013年1月留观的200例SLE患者主诉症状数目、常见症状分布、初治患者主诉症状分布、发热的病因等方面情况进行统计分析。结果 SLE患者急诊就诊时主诉症状以两种症状为多见(47.5%,95/200),发热是最常见症状(58%,116/200);中枢神经系统(38.5%,20/52)、呼吸系统(23.1%,12/52)和消化系统(19.2%,10/52)受累易伴发热;初治SLE患者发热病因多为狼疮活动(78.8%,26/33),非初治SLE患者发热病因多为继发感染(69.9%,58/83);感染性发热患者最常见的感染部位为肺部(81.5%,53/65)。结论急诊就诊的SLE患者主诉症状有一定的特点,了解其规律可最大程度避免误诊和漏诊。

Role of penehyclidine in acute organophosphorus pesticide poisoning

BACKGROUND:Penehyclidine is a newly developed anticholinergic agent.We aimed to investigate the role of penehyclidine in acute organophosphorus pesticide poisoning(OP)patients.METHODS:We searched the Pubmed,Cochrane library,EMBASE,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical literature(CBM)and Wanfang databases.Randomized controlled trials(RCTs)recruiting acute OP patients were identifi ed for meta-analysis.Main outcomes included cure rate,mortality rate,time to atropinization,time to 60%normal acetylcholinesterase(AchE)level,rate of intermediate syndrome(IMS)and rate of adverse drug reactions(ADR).RESULTS:Sixteen RCTs involving 1,334 patients were identifi ed.Compared with the atropineor penehyclidine-alone groups,atropine combined with penehyclidine significantly increased the cure rate(penehyclidine+atropine vs.atropine,0.97 vs.0.86,RR 1.13,95%CI[1.07–1.19];penehyclidine+atropine vs.penehyclidine,0.93 vs.0.80,RR 1.08,95%CI[1.01–1.15])and reduced the mortality rate(penehyclidine+atropine vs.atropine,0.015 vs.0.11,RR 0.17,95%CI[0.06–0.49];penehyclidine+atropine vs.penehyclidine,0.13 vs.0.08,RR 0.23,95%CI[0.04–1.28]).Atropine combined with penehyclidine in OP patients also helped reduce the time to atropinization and AchE recovery,the rate of IMS and the rate of ADR.Compared with a single dose of atropine,a single dose of penehyclidine also signifi cantly elevated the cure rate,reduced times to atropinization,AchE recovery,and rate of IMS.CONCLUSION:Atropine combined with penehyclidine benefi ts OP patients by enhancing the cure rate,mortality rate,time to atropinization,AchE recovery,IMS rate,total ADR and duration of hospitalization.Penehyclidine combined with atropine is likely a better initial therapy for OP patients than atropine alone.

Venous thromboembolism in the emergency department:A survey of current best practice awareness in physicians and nurses in China

BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.CONCLUSION: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).

A survey of ventilation strategies during cardiopulmonary resuscitation

BACKGROUND:Many controversies still exist regarding ventilator parameters during cardiopulmonary resuscitation(CPR).This study aimed to investigate the CPR ventilation strategies currently being used among physicians in Chinese tertiary hospitals.METHODS:A survey was conducted among the cardiac arrest team physicians of 500 tertiary hospitals in China in August,2018.Surveyed data included physician and hospital information,and preferred ventilation strategy during CPR.RESULTS:A total of 438(88%)hospitals completed the survey,including hospitals from all 31 Chinese mainland provinces.About 41.1%of respondents chose delayed or no ventilation during CPR,with delayed ventilations all starting within 12 minutes.Of all the respondents who provided ventilation,83.0%chose to strictly follow the 30:2 strategy,while 17.0%chose ventilations concurrently with uninterrupted compressions.Only 38.3%respondents chose to intubate after initiating CPR,while 61.7%chose to intubate immediately when resuscitation began.During bagvalve-mask ventilation,only 51.4%of respondents delivered a frequency of 10 breaths per minute.In terms of ventilator settings,the majority of respondents chose volume control(VC)mode(75.2%),tidal volume of 6–7 mL/kg(72.1%),PEEP of 0–5 cmH2O(69.9%),and an FiO2 of 100%(66.9%).However,62.0%of respondents had mistriggers after setting the ventilator,and 51.8%had high pressure alarms.CONCLUSION:There is a great amount of variability in CPR ventilation strategies among cardiac arrest team physicians in Chinese tertiary hospitals.Guidelines are needed with specific recommendations on ventilation during CPR.

Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.

Tension hydropneumothorax in a Boerhaave syndrome patient:A case report

Dear editor,Boerhaave syndrome,firstly described by Hermann Boerhaave in 1724,is a rare and life-threatening condition characterized by spontaneous transmural tear of the oesophagus.[1]The early diagnosis of Boerhaave syndrome is extremely important since a delay in the diagnosis can increase the mortality rate.[2]Here,we reported a Boerhaave syndrome patient combined with tension hydropneumothorax.

My mother is looking blue

Dear editor,A 76-year-old Chinese female presented by ambulance to the Emergency Department complaining of dizziness,headache and fatigue.Her son claimed that the patient“turned blue”three hours prior to onset of the patient’s symptoms.Paramedics noted the patient’s SpO2 was 83%on room air with no improvement with a nonrebreather mask.Past medical history was signifi cant for diabetes and hypertension.Family,social and medication history were non-contributory.

糖皮质激素在埃博拉病毒病治疗中可能的作用及应用前景

埃博拉病毒病（Ebola virus disease，EVD），过去称为埃博拉出血热，是一种由埃博拉病毒（Ebola virus，EBOV）引起的严重的、高病死率的流行性出血热．1976年，EVD第一次出现在中部非洲的扎依尔（现为刚果民主共和国）和南苏丹．此后的40多年里，非洲发生不同规模的埃博拉疫情共24次，导致1590人死亡，总体病死率高达66．61％．