Analysis of the Effect of Humanistic Care in the Process of Pre-Hospital Emergency Care

Objective:To explore the effectiveness of humanistic care in pre-hospital emergency care.Methods:From April 2020 to January 2021,80 pre-hospital emergency patients were studied.The patients were randomly divided into two groups:a control group(n=40),which received conventional care,and an experimental group(n=40),which received humanistic care.The effects of nursing care and psychological state were compared between the two groups.Results:The experimental group showed better nursing outcomes and a more positive psychological state compared to the control group(P<0.05).Conclusion:Humanistic care in pre-hospital emergency settings is more effective in reducing patients’anxiety and depression,enhancing the operational abilities and service attitudes of nursing staff,and increasing the emergency success rate.

Development of the trauma emergency care system based on the three links theory

The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.

Acute care needs in an Indian emergency department： A retrospective analysis

BACKGROUND: Emergencies such as road traffic accidents(RTAs), acute myocardial infarction(AMI) and cerebrovascular accident(CVA) are the most common causes of death and disability in India. Robust emergency medicine(EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department(ED) is needed.METHODS: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences(KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed.RESULTS: A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35%(n=662) were male and 44.7%(n=534) were female. The majority(67.14%, n=803) were adults, while only 3.85%(n=46) were infants. The most common chief complaints were fever(21.5%, n=257), renal colic(7.3%, n=87), and dyspnea(6.9%, n=82). The most common ED diagnoses were gastrointestinal(15.5%, n=185), pulmonary(12.3%, n=147), tropical(11.1%, n=133), infectious disease and sepsis(9.9%, n=118), and trauma(8.4%, n=101).CONCLUSION: The patient demographics, diagnoses, and distribution of resources identifi ed by this study can help guide and shape Indian EM training programs and faculty development to more accurately refl ect the burden of acute disease in India.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.

Survey of the current state of emergency care in Chennai, India

BACKGROUND：On July 21, 2009, the Medical Council of India officially recognized the specialty of emergency medicine in India. The city of Chennai with over six and a half million people is the fourth largest on the subcontinent and has already been a prominent city of interest in the specialty＇s development. However, there is no standardization of the resources found in the city＇s emergency departments. This study was to survey the equipment, training, and certification of Chennai area emergency departments and their staff. METHODS：We conducted a cross-sectional survey of emergency department staff from 38 Chennai area hospitals. The survey instrument contained 44 questions pertaining to hospital demographics, staff training and certification, and ED equipment and supplies. The items on the survey were specifically chosen to represent only the most basic and common resources necessary to practise emergency medicine. RESULTS： The survey found a majority of hospitals are privately operated but there is a wide range in terms of size and volume of patients. A minority of both doctors and nurses are certified in BLS, ACLS, PALS, and ATLS. While almost all departments surveyed had the basic code medications, a number of basic equipment items were lacking from a large percentage of the EDs surveyed. CONCLUSION：The newly established EP community in Chennai will have the responsibility to establish standards for both training and resources so that the specialty may grow and provide a higher standard of emergency care moving into the future.

Are Mentorship and Training the Key in Provision of Emergency Obstetric and New-Born Care (EmONC) Services? A Formative Evaluation of Pre and Post in Samburu County, Kenya

Background: In Kenya, the Maternal Mortality Ratio (MMR) is approximated to 362 maternal deaths per 100,000 live births while the stillbirth rate stands at 23 deaths per 100 live births which are far below the target of 147 maternal mortality per 100,000 live births and 12 stillbirths per 100 live births respectively. Progress in addressing preventable maternal and newborn deaths and stillbirths depend on the improvement of the quality of maternal, fetal and newborn care throughout the continuum of care. Objective: To determine the effect of mentorship and training in improving the provision of Basic Emergency Obstetric Newborn Care (BEmONC) and Comprehensive Emergency Obstetric Newborn Care (CeMONC) services among health workers in Samburu County. Methodology: A one-week training intervention was carried among health workers in level three, four and five health facilities by master trainers. Using two tools adopted from MEASURE Evaluation and a structured questionnaire, a total of 54 (before the intervention) and 64 (after the intervention) health workers from 29 health facilities were interviewed. Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of health workers, and through participatory observations at the time of on-site supervisory visits, mentorship and monthly meetings. An assessment was conducted to measure the level of confidence of the health workers in performing their duties. Results: Central Samburu had the majority of the health workers both at the pre-intervention (44.4%) and post-intervention (51.6%), North Samburu had an extra health worker at post-test while no change in numbers was recorded in East Samburu. A majority of the health workers across the three sub-counties were 31 - 40 years old, with only 2 (3.8%) aged 51 years and above. Following the interventions, improvements in the practice of BEmONC services were seen across the three sub-counties. There was an increase, at post analysis, in the use of the partograph to monitor labour (from 52% to 98.1%) and managing severe infection in the newborn (from 40.4% to 60.3%). Performing CS improved from 17.3% to 31% and the same was also recorded in carrying out blood transfusions. On post-survey, health workers reported the least confidence in performing manual vacuum. Other BEmONC services including active management of 3rd stage labor, use of partograph, manual removal of the placenta, managing maternal sepsis and identifying danger signs in the newborn had a high rate of confidence. Conclusions: This study finds that structured mentorship is an effective strategy to build the capacity of health workers. However, there is a need for further research to monitor and evaluate if such programmes improve clinical outcomes in the long run.

Community-Based Pregnant Women Initiative to Support Emergency Obstetric Care in Kimpese Health Zone, Province of Kogo Central, the Democratic Republic of the Congo

Background: Maternal mortality remains high in low- and middle-income countries. Many maternal deaths occur within hospitals often due to a lack of access to basic emergency obstetric care (Emoc). Aim: The study aimed to assess the effectiveness of a community-based pregnant women initiative to support emergency obstetric care in a Kimpese Health Zone (HZ). Setting: Kimpese Health Zone, Province of Central Kongo, in the South Western of the Democratic Republic of the Congo. Results: Four hundred and thirty-five women were received for Emoc between January 2008 and June 2011, 75% were aged between 18 - 34 years old. Mechanical dystocia was the first cause of emergencies (34%). The diagnosis concordance between the transfers and the reasons for the transfer was weak and not statistically significant (Kappa = 0.350, p = 0.405). After the évaluation of the newborns, a favorable outcome was noted after the 10th day of de follow-up (95.4%). In multivariate analysis, the lack of ANC visits, the waiting time > 1 hour before the visit at the referral hospital, and assisted birth were the factors associated with the unfavorable obstetric outcomes. Conclusion: Improvement in maternal health involves better preparation of the community and the healthcare system for Emergency Obstetric Care. Research is needed for innovative and effective interventions in resource constraints settings.

Risk Factors with Intimate Partner Violence among Women Seeking Emergency Care

Background: Identifying women at risk for violence caused by intimate partner violence is difficult in connection with visits at emergency department. Aims and objectives: The aim of this study was to explore and describe risk factors of IPV reported by women in connection with seeking emergency care, Design: This study is part of a larger study using an explorative and comparative design. Method: Based upon data from a questionnaire and some demographic data, 82 women who reported to have experienced intimate partner violence answered the Danger Assessment Scale. Results: The results showed that the violence escalated in frequency and severity when a weapon such as a knife or gun was used to harm the women. When the abuser used narcotics and threatened the woman with a weapon, the risk of being injured increased. The odds for being threatened to death when the abuser was reported to use narcotics and illegal drugs was about thirteen times higher compared to the case when the abuser was not using narcotics. Other life threatening factors were discovered such as the man’s capability of killing the woman. Conclusion: By using a questionnaire about the violence, healthcare personnel can identify women who are at risk of being severely injured or killed. By identifying these women, one can take action to provide for their safety. Relevance to Clinical Practice: Using the Danger Assessment instrument can facilitate health care personnel’s ability at emergency departments to identify women at risk for lethal violence.

Mediastinal emphysema in the context of perforated gastric ulcer

In the context of mediastinal emphysema/pneumomediastinum,the main aetiologies are associated with oesophageal perforation,lung pathology or post head and neck surgery related.The 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 imaging.The causes of pneumomediastinum should be differentiated between traumatic and non-traumatic.Oesophageal 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.

gpidemiology and characteristics of acute poisoning treated at an emergency center

BACKGROUND： Acute poisoning is frequently encountered at emergency department. This study was to investigate the epidemiology and characteristics of patients with acute poisoning who were treated at the Emergency Center, Fujian Provincial Hospital, China.METHODS： We retrospectively analyzed the gender, age, causes of poisoning, types of poisons, poisoning route, emergency diagnoses, outcomes, and prognoses of these patients.RESULTS： Altogether 2867 patients with acute poisoning were treated from January 2004 to December 2009. The ratio of male to female was 1：1.04, and their average age was 33.8 years. Of the 2867 patients, 76.39% were between 18 and 40 years old. The incidence of acute poisoning was as high as 11.33% in January each year. The incidence of poisoning was in a descending order： alcohol poisoning （54.55%）, medication poisoning （25.95%）, pesticide poisoning （5.65%）, and drug poisoning （4.88%）. Most （56.44%） of the patients with drug poisoning were under 25 years and their mean age was significantly lower than that of patients with medication poisoning or alcohol poisoning （P 〈 0.01）. Approximately 69.54% of the patients were followed up after emergency treatment, 30.39% were hospitalized, and four patients died.CONCLUSION： Acute poisoning is largely alcohol poisoning and medication poisoning in a city. The emergency green channel ＂pre-hospital emergency care-emergency department-hospital treatment＂ can significantly improve the survival rate of patients with acute poisoning.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Overview of the Shenzhen Emergency Medical Service Call Pattern

BACKGROUND：In Shenzhen, the Emergency Medical Service （EMS） system has been in service since 1997. This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.BACKGROUND：In this retrospective quantitative descriptive study, the data from the Shenzhen 120 EMS registry in 2011 were analyzed.RESULTS：Shenzhen 120 EMS center is a communication command center. When the number of 120 are dialed, it is forwarded to the closest appropriate hospital for ambulance dispatch. In 2011, the Shenzhen 120 EMS center received 153 160 ambulance calls, with an average of 420 calls per day. Calling emergency services was mainly due to traffic accidents. Trauma and other acute diseases constituted a majority of ambulance transports. The adult patients aged 15-60 years are the principal users of EMS. There are no recognized ＇paramedic＇ doctors and nurses. The pre-hospital emergency service is under the operation of emergency departments of hospitals. Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in posttrauma management. Moreover, specialized pre-hospital training, financial support, and public health education on proper use of EMS should be emphasized.CONCLUSION：The Shenzhen 120 EMS center has its own epidemiology characteristics. Traumatic injury and traffic accident are the main reasons for calling ambulance service. In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS.

Effectiveness of Musculoskeletal Emergency Physiotherapy Practitioners

Relevance and Method: The purpose of this project was to evaluate the effectiveness of the Emergency Physiotherapy Practitioner (EPP) service against quality care indicators identified as part of the “gold standard” for emergency care in England. The study was prospective and evaluated time to initial assessment, total time in the emergency department and un-planned re-attendance rate within a seven-day period for all patients seen by the EPP’s over a period of one year. Outcomes: One thousand and seven patients were seen by EPPs in the emergency department. The median wait time for treatment by an EPP was 34.5 minutes (95th percentile = 122). Regional median wait time was 45 minutes (95th percentile = 138). National median wait time was 55 minutes (95th percentile = 192). Median total time spent in ED for patients seen by EPPs was 99 minutes (95th percentile = 224). Regional median total time in ED was 223 (95th percentile = 239). Nationally median total time in ED was 136 minutes (95th percentile = 336). Three percent of patients seen by an EPP returned to the ED, compared to 6% regionally and 7.5% nationally. Conclusions: EPPs excelled in all three indicators and exceeded regional and national figures. The re-return rate met the current standard of being less than 5%. It could be justified that the addition of the EPPs to the emergency department was an efficient and effective service development.

Surgical first aid and nursing care of a parturient with massive hemorrhage in natural delivery

Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.

Triage for resource-limited emergency care:why it matters

Triage aims to identify and prioritize patients with time-sensitive health care needs.This process is particularly important when demand for emergency care exceeds the available resources.A small number of triage instruments have been purpose designed for low-and middle-income countries.Most recently,the World Health Organization,in collaboration with the International Committee of the Red Cross and Médecins Sans Frontières,has released the Interagency Integrated Triage Tool(IITT).Despite endorsement by leading global health agencies,little has been published regarding the IITT’s validity and reliability.Although triage is widely regarded as a critical tool for organizing emergency care services,many instruments have demonstrated suboptimal sensitivity for the detection of time-critical illness.There is a pressing need therefore to assess the performance of the IITT relative to other systems.Recent efforts to implement and evaluate the tool in the Western Pacific region will provide valuable insights into its validity,reliability and acceptability.

Effect of emergency nursing on the efficiency and quality of emergency care for patients with acute coronary syndrome

Background Acute coronary syndrome(ACS)is a common cardiovascular disease that typically occurs with a greater frequency in older adults,men and postmenopausal women.Methods A total of 62 patients with ACS admitted to our hospital from February 2021 to May 2023 were enrolled and divided into observation group and control group by the random number table method,with 31 cases in each group.The control group was given routine nursing,and the observation group was given additional emergency nursing on the basis of routine nursing.The emergency efficiency,emergency quality and quality of life were compared between the two groups.Results The emergency efficiency related indexes such as the time of triage,blood collection,referral time,and time spent on rescue after clinical reception was lower than that of control group(P<0.05).The emergency quality scores of emergency order,equipment preparation,nursing service,ward management and effective communication in the observation group were higher than those in the control group(P<0.05).The scores of 8 Quality of Life(QOL)dimensions in the observation group were higher than those in the control group(P<0.05).Conclusion Emergency nursing can improve the emergency efficiency and quality of ACS patients,and the quality of life of patients after emergency can be significantly improved as well,which is worthy of popularization and application.

Implementation of a Pediatric Emergency Triage System in Xiamen, China

Background：Pediatric emergency rooms （PERs） in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians.The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system （CPETS）,modeled after the Canadian Triage System and Acuity Scale.Methods：In this study,we compared CPETS outcomes in our PER relative to those of the prior two-level system.Patients who visited our PER before （January 2013-June 2013） and after （January 2014-June 2014） the CPETS was implemented served as the control and experimental group,respectively.Patient flow,triage rates,triage accuracy,wait times （overall and for severe patients）,and patient/family satisfaction were compared between the two groups.Results：Relative to the performance of the former system experienced by the control group,the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER （Cox-Stuart test,t =0,P 〈 0.05）,a higher triage rate （93.40% vs.90.75%;χ^2 =801.546,P 〈 0.001）,better triage accuracy （96.32% vs.85.09%;χ^2 =710.904,P 〈 0.001）,shorter overall wait times （37.30 ± 13.80 min vs.41.60 ± 15.40 min;t =11.27,P 〈 0.001）,markedly shorter wait times for severe patients （2.07 [0.65,4.11] min vs.3.23 [1.90,4.36] min;z =-2.057,P =0.040）,and higher family satisfaction rates （94.23% vs.92.21%;x2 =321.528,P 〈 0.001）.Conclusions：Implementing the CPETS improved nurses＇ abilities to triage severe patients and,thus,to deliver the urgent treatments more quickly.The system shunted nonurgent patients to outpatient care effectively,resulting in improved efficiency of PER health-care delivery.

Special features of SARS-CoV-2 in daily practice

The severe acute respiratory syndrome-coronavirus-2(commonly known as SARS-CoV-2)is a novel coronavirus(designated as 2019-nCoV),which was isolated for the first time after the Chinese health authorities reported a cluster of pneumonia cases in Wuhan,China in December 2019.Optimal management of the Coronavirus Disease-2019 disease is evolving quickly and treatment guidelines,based on scientific evidence and experts’opinions with clinical experience,are constantly being updated.On January 30,2020,the World Health Organization declared the SARS-CoV-2 outbreak as a"Public Health Emergency of International Concern".The total lack of immune protection brought about a severe spread of the contagion all over the world.For this reason,diagnostic tools,patient management and therapeutic approaches have been tested along the way,in the desperate race to break free from the widespread infection and its fatal respiratory complications.Current medical knowledge and research on severe and critical patients’management and experimental treatments are still evolving,but several protocols on minimizing risk of infection among the general population,patients and healthcare workers have been approved and diffused by International Health Authorities.

Analysis of Maternal Deaths in Suburban of Dakar, Senegal

Objective: Maternal mortality remains a major concern in developing countries. This survey aims to suggest strategic plans that would help decrease maternal and perinatal mortality in the suburbs. It is a descriptive study that shows the different causes of maternal deaths during pregnancy and puerperium period. Methods: It is a retrospective descriptive study done between January 1st 2016 and the 31st of December 2018. We have collected information on all deaths due to mortality issues in Five (5) maternity clinics around Dakar. The record shows that teach centre have an average of 4000 deliveries per year. The data collected from the hospital records were inputted using Sphinx software (version 5). These data were analysed using Epi Info software (version 3.5). After analysing these data, recommendations were made to minimize the different causes of maternal deaths. Results: We recorded 154 maternal deaths out of 32,420 live births. The direct causes of maternal deaths were a result of preeclampsia and its complications (31.2%), postpartum haemorrhage (24.7%), abruption placentae (20.8%) and obstructed labour (7.8%). The indirect causes were mainly sickle cell disease (1.3%), heart disease (1.3%) and gynaecological cancers (1.3%). Maternal deaths were also associated with fetal loss in 47.4% of 153 maternal deaths, need for blood transfusion 59% while none of the reference structures in the suburbs of Dakar has a blood bank;with a need for admission in intensive care unit was noted as 40%. Conclusion: Thus, preeclampsia and its complications are the leading cause of maternal deaths in suburban settings. Timely availability of resuscitation units and liable blood products could drastically reduce maternal deaths from direct obstetric complications.

Gastric laceration after cardiopulmonary resuscitation:A case report

The cardiopulmonary resuscitation (CPR) persists as the best practice to maintain cerebral and coronary perfusion after cardiac arrest. Due to the chest compressions and ventilation maneuvers during resuscitation, there are common complications reported. Abdominal organs injuries occur in approximately 30% of patients, although studies show that they are under diagnosticated. The aim of this article is to report a case of massive digestive hemorrhage by gastric laceration after cardiopulmonary resuscitation, due to the event severity and rare clinic diagnostic. A 75-year-old Caucasian man suffered a sudden malaise and cardiac arrest and transferred to an Emergency Unit (EU). The set of measures recommended by Advanced Cardiac Life Support (ACLS) was performed. Despite no resistance to the passage of nasogastric survey and spontaneous healing of fresh blood exteriorization, an endoscopy showed ulcers in gastric notch with clots adhered and active blood. There was no track record of liver or gastrointestinal diseases on this patient, identifying a gastric laceration after cardiopulmonary resuscitation. The mechanism by which the gastric laceration after CPR occurred is uncertain. Nevertheless, some precipitating factors are considered such as positioning of the patient during CPR, ideal point of compressions and ventilation pressure. In conclusion, this event is rare with a hard diagnostic however that could be avoided and minimized with preventive measures.