Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Objective: To investigate the occurrence of PTSD in pre-hospital emergency nurses and its related factors, and to compare the differences of neurotransmitter and immune-related factors between pre-hospital emergency nurses who experienced traumatic events and those who did not develop PTSD and healthy people. How: Post-traumatic Stress Disorder Self-Rating Scale (PCL-C) tests were performed on pre-hospital emergency nurses in PTSD group, non-PTSD group and healthy control group, and the plasma monoamine neurotransmitters and serum cytokines were determined by double-antibody sandwich ABC-ELISA assay using enzyme-linked adsorption kit provided by Shanghai Xitang Biotechnology Co., Ltd. Results: 1) There were statistically significant differences in PCL-C scores between PTSD group, non-PTSD group and healthy group (p α between PTSD group, non-PTSD group and healthy group (p Conclusion: Pre-hospital emergency nurses should have early psychological intervention and guidance to reduce the occurrence of PTSD in emergency and emergency nurses.

Parental Knowledge of Pre-Hospital Management of Avulsed Permanent Tooth in Children at Kath

BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered as the treatment of choice. OBJECTIVE: The study was undertaken to assess the knowledge of parents who accompany their children to the pediatric dental clinic, KATH on the pre-hospital management of avulsed permanent tooth in children. METHODS: A researcher administered structured questionnaire was used to collect data on the knowledge of pre-hospital management of avulsed permanent tooth from 83 parents who accompanied their wards to the pediatric dental clinic at KATH. RESULTS: A total of 83 parents were involved in the study. 30 (36%) were males while 53 (64%) were females. The majority of the parents (57%) were either university trained or had attended college of education. Only 32 parents (39%) were aware of the possibility of replantation. Majority of the parents chose non-physiologic media as the transport media of choice and only 10% would attempt self-replantation before seeking professional help. 76 parents (92%) had no previous education on pre-hospital management of avulsed tooth. CONCLUSION: The results obtained from this study indicate that parental knowledge on pre-hospital management of avulsed permanent tooth is low hence the need for massive public educational campaigns.

Current pre-hospital traumatic brain injury management in China

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 early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, prehospital service can signifi cantly reduce case-fatality rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of 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 National Knowledge Infrastructure(CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment 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 literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied 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.

Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9305687 from 2007 to 2016 in Zhengzhou, of which 418882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups:emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

French pre-hospital trauma triage criteria:Does the “prehospital resuscitation” criterion provide additional benefit in triage?

AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.

Clinical Research of Pre-Hospital Emergency Care, Nursing, Infection Prevention and Control for Senile Osteoporotic Vertebral Compression Fracture during Epidemic Period

Background: Novel coronavirus pneumonia (NCP) and osteoporotic vertebral compression fractures (OVCF) are the high incidences of diseases in the elderly. During the epidemic period, if not treated in time, the complications are high and the mortality is high. If we do not pay attention to infection prevention and control in pre-hospital emergency care, it will lead to the first time infection of medical staff and in-hospital cross infection in emergency outpatient receiving area. The correct consideration of both and the establishment of perfect pre-hospital emergency treatment and infection prevention and control synchronous strategy is an important premise to ensure the stable, orderly and safe medical treatment. Objective: To explore the effect of synchronous implementation of pre-hospital emergency care, nursing and infection pre-vention and control for senile OVCF during the epidemic. In order to improve the efficiency of pre-hospital emergency care and prevent the spread of infection. Method: A total of 92 elderly patients with OVCF who received pre-hospital treatment in 18 hospitals in Zhangjiakou City during the epidemic prevention and control period from January 2020 to November 2022 and met the inclusion criteria were selected as research objects, including 24 males and 68 females, aged 65 - 82 (74.2 ± 2.2) years. All patients were associated with concomitant injuries and underlying diseases. All patients in this group underwent predictive pre-hospital rescue and infection prevention and control procedures. Results: All the 92 elderly patients with OVCF received timely pre-hospital treatment during the epidemic period, and no aggravation occurred of the 92 patients, 35 were in the high risk area, 10 were in the medium risk area, and 47 were in the low risk area. Exclude OVCF for NCP Patients were treated according to the conventional diagnosis and treatment principles. Suspected and confirmed cases are transferred to designated surgical hospitals for treatment. All patients were followed up 3 months, 6 months and 12 months after treatment. There was no death rate, high satisfaction of pre-hospital first aid, high diagnostic accuracy, and good curative effect. None of the rescue personnel had any infection rate, and no hospital infection transmission and nosocomial cross infection occurred. Conclusion: It is the first step to safely treat patients and prevent cross infection to establish a perfect synchronous strategy of pre-hospital first aid and infection prevention and control.

基于降阶梯思维的一站式急救模式对高血压脑出血患者救治情况及肢体功能、神经功能的影响

目的研究降阶梯思维的一站式急救模式对高血压脑出血患者救治情况及肢体功能、神经功能的影响。方法选取2019年1月—2021年12月于四川省人民医院进行诊断并治疗的高血压脑出血患者120例作为研究对象,按照随机数字表法分为观察组和对照组,每组60例。对照组采取常规急救模式,观察组采取基于降阶梯思维的一站式急救模式。比较两组急救效率、功能恢复情况、脑血肿出血量、急救能力评分和护理满意度。结果观察组抢救成功率高于对照组,急诊停留时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。治疗前,两组NIHSS评分、BI评分、脑血肿出血量比较,差异无统计学意义(P>0.05);治疗后,两组NIHSS评分低于治疗前,BI评分高于治疗前,脑血肿出血量少于治疗前,且观察组NIHSS评分低于对照组,BI评分高于对照组,脑血肿出血量少于对照组,差异有统计学意义(P<0.05)。观察组对护理人员专业知识、快速反应能力、医护配合评分均高于对照组,差异有统计学意义(P<0.05)。观察组护理总满意度高于对照组,差异有统计学意义(P<0.05)。结论基于降阶梯思维的一站式急救模式对高血压脑出血患者的急救成功率较高,患者的肢体功能、神经功能显著改善。

急诊急救模式在急性脑梗死患者中的应用效果

目的探讨急性脑梗死患者治疗中急诊急救模式的应用效果。方法回顾性选取急性脑梗死患者100例,依据治疗方法分为急诊急救模式组和常规急诊治疗组,每组各50例。结果急诊急救模式组患者的急诊急救成功率高于常规急诊治疗组,从入院到急救医师接诊,时间短于常规急诊治疗组;从入院到开具CT报告,时间短于常规急诊治疗组;从入院到静脉溶栓,时间短于常规急诊治疗组;从入院到动脉成功置鞘,时间短于常规急诊治疗组;从置鞘到血管再通,时间短于常规急诊治疗组。美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、改良爱丁堡-斯堪的纳维亚评分(Improved Edinburgh Scandinavian Score,CSS)评分均低于常规急诊治疗组,简易精神状态检查量表(Mini Mental Status Examination,MMSE)评分、改良Barthel指数量表(Modified Barthel Index,MBI)评分均高于常规急诊治疗组,差异均具有统计学意义(P<0.05)。急诊急救模式组患者的力气、手功能、交流、记忆与思维、参与、情绪、移动能力、日常生活能力评分均高于常规急诊治疗组(P<0.05),并发症发生率低于常规急诊治疗组(P<0.05)。结论急性脑梗死患者在救护中,急诊急救模式的应用效果优于常规急诊救护。

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.

院前急救待援期公众参与救援的生态圈建设及效果分析

本文基于WSR方法论,通过“六步骤一要素”有效组织管理和步骤落实,探讨构建院前急救待援期公众参与生态圈,有效提升了院前急救待援期公众现场自救互救能力以及抢救成功率,为提升我国院前急救待援期公众参与的研究和实践提供参考。

紧急医疗服务环境用呼吸机标准ISO 80601-2-84:2020解析

详细梳理了新版国际标准ISO 80601-2-84:2020 Medical electrical equipment—Part 2-84:Particular requi-rements for basic safety and essential performance of ventilators for the emergency medical services environment,比较了ISO 80601-2-84:2020与ISO 10651-3:1997 Lung ventilators for medical use—Part 3:Particular requirements for emergency and transport ventilators的差异,分析了新版国际标准对工作数据准确性、危险输出的防护、呼吸机系统、使用环境等几方面的要求,可为生产企业和检验技术人员正确理解标准条款的要求和内涵提供参考。

急性胸痛患者一体化急救诊治及效果分析

目的探究急性胸痛患者应用一体化急救护理模式的效果及对患者预后的影响。方法选取2021年1月一2022年12月我院收治的符合排纳标准的急性胸痛患者260例作为研究对象,根据患者的入院时间先后顺序对其进行分组。其中将2021年1月-2021年12月收治的130例患者设为对照组,将2022年1月-2022年12月收治的130例患者设为研究组。对照组采用常规的急救护理模式,研究组则采用一体化急救护理新模式,对比两组患者的救治时间以及救治情况,并调查患者的满意度。结果研究组患者的病情评估用时、检查用时、入院至首次球囊扩张时长、门球时长、有效救治时长和住院时长上要明显短于对照组(p<0.05);研究组患者救治的成功率为90.00%明显高于对照组的73.08%(p<0.05);研究组在通过一体化急救护理后的总满意度为96.92%,较对照组77.69%的满意度更高(p<0.05)。结论一体化急救护理新模式可以有效提高急性胸痛患者的救治和护理效果,能够为患者争取更佳的救治时间,显著降低了该病的致死率,进一步的改善了患者的预后情况,提升了患者对护理的满意率,值得临床广泛应用和推广。

新型便携式救护包

介绍1种战时后送途中的新型便携式救护包,可供医生、卫生员、护理人员使用。救护包集中止血、包扎、固定、辅助呼吸及抗休克等急救功能。内部结构合理,包裹设计便于快速展收和后勤保障补给,优化配备急救药品和急救物品,实现了野战卫生装备模块化、高效化的需求。

创伤现场救护教育游戏的开发与应用

目的探讨创伤现场救护教育游戏的开发与应用效果。方法利用Unity3D虚拟平台开发教育游戏,并应用于本科护生创伤现场救护实验教学。将426名护生按随机数字表分为三组各142名,对照组采用"理论+实践操作"教学方式,实验A组采用"理论+3D创伤现场救护教育游戏"教学方式,实验B组采用"理论+3D创伤现场救护教育游戏+实践操作"教学方式。结果实验教学后,三组护生的理论与操作考核成绩比较,差异有统计学意义(均P<0.01)。结论创伤现场救护教育游戏的开发与应用,有利于促进护生对创伤现场救护理论知识的掌握和运用,为其临床实践奠定基础。

急救吸引器设计研究

目的:设计一种手持式急救吸引装置,以满足临床医疗和野战与现场急救的需要。方法:将手持式急救吸引装置分解为手柄、握柄、L型拉杆、活塞、气缸、储液罐及罐盖、过渡接头等部分并对这些部分进行优化设计。结果:通过对手持式急救吸引装置的优化设计,提高其便携性、易用性和可靠性。结论:实践证明,设计的手持式急救吸引装置具有体积小、质量小、操作简单、易于携带等优点,不但能有效减轻医护人员的劳动强度,利于医护人员的心身健康,而且完全能满足临床抢救及治疗的需要。

经皮扩张气管切开术在急诊急救中的应用研究

目的 探讨经皮扩张气管切开术在急诊急救临床的应用价值。方法 对 4 2例不同类型的急诊急救患者实施了PDT ,同时观察手术过程中患者心率、血氧饱和度的变化 ,及手术时间和并发症。结果 手术成功率 10 0 % ,最短手术时间 3.5min ,平均 6 .4min。术中并发症主要有缺氧、低血压、导管误放等 ;术后近期并发症主要有出血和皮下气肿等 ;术后远期并发症主要有术口感染、导管堵塞等。结论 PDT操作简单、方便、快速、高效 ,既适应于院内急救、也适应于院外急救的建立人工气道较安全的方法。

基于区域信息化平台的危重新生儿协同急救系统设计

目的:设计一套基于区域信息化平台的危重新生儿协同急救系统,以提高区域内危重新生儿救治效率。方法:采用前后端完全分离的架构,设计包括危重新生儿协同救治平台和危重新生儿数据库2个子系统的基于区域信息化平台的危重新生儿协同急救系统。其中,前端采用移动端+PC的设计方案,只处理UI层逻辑;后端包括应用服务、缓存服务和文件服务,只处理业务相关逻辑。结果:该系统实现了危重新生儿区域内协同急救业务和全流程救治管理,以及在救治各个环节信息与数据的互联互通,有效减轻了数据收集、统计和管理专案的工作量,提高了危重新生儿的抢救及时性和救治效率。结论:基于区域信息化平台的危重新生儿协同急救系统为危重新生儿中心提供了良好的质量管理手段,为临床急救决策、监督、反馈及质量管理提供了数据支撑,为持续性危重新生儿急救的质量管理提供了有力的手段。

在野战综合手术救治方舱中行经皮椎弓根螺钉内固定术的实践

目的探讨在战争或灾难救治现场利用新型野战综合手术救治方舱对无神经功能损伤的胸腰椎骨折行经皮椎弓根螺钉内固定术的近期临床疗效。方法回顾性分析我院在综合手术救治方舱中救治的29例无神经损伤的胸腰椎骨折患者临床资料,其中男18例、女11例,平均(31.54±2.86)岁。29例患者均行经皮椎弓根螺钉内固定术。观察患者手术时间、术中失血量、术后下床锻炼时间及术后相关并发症,同时对比观察患者术前、术后的腰痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评分以及患者手术前后伤椎的椎体前缘高度及后凸Cobb’s角。结果 29例患者均于野战综合手术救治方舱中顺利完成手术,术后一般状况良好,手术时间为(86.55±16.15)min,术中失血量为(42.35±6.55)mL,术后患者下地时间为(1.20±0.61)d,无并发症出现,术后胸腰部疼痛均得到明显改善,VAS评分、ODI评分及患者术后伤椎椎体前缘高度及脊柱后凸Cobb’s角均得到明显改善,与术前比较差异具有统计学意义(P<0.05)。结论在野战综合手术救治方舱中行经皮椎弓根螺钉内固定术对无神经功能损伤的胸腰椎骨折早期治疗有效安全,可应用于战争或灾难现场紧急救治。

家庭急救监护网络系统的研究与设计

目的:分析了远程监护的发展与研究现状,提出构建家庭急救监护网络系统的研究。方法:该系统由家庭部分、救护车部分、社区部分和医院中心站4部分组成,并以深圳宝安人民医院和其所辖的10个社康站作为研究基地,对患者的重要生理参数实行远程监护。结果:构成了功能强大的家庭急救监护网络系统,将急救监护功能延伸到社区和家庭。结论:能够促进疾病的早诊早治,减少院前猝死率,提高急救水平,降低死亡率,加强医疗服务体系间的联系、合作,缓解了医疗卫生资源的缺乏和分布不均。