BACKGROUND:There is limited evidence for emergency physicians and emergency trauma surgeons regarding the determinants of early and rapid assessment of older adult in-hospital mortality due to earthquakes.This study e...BACKGROUND:There is limited evidence for emergency physicians and emergency trauma surgeons regarding the determinants of early and rapid assessment of older adult in-hospital mortality due to earthquakes.This study explored factors related to the early and rapid assessment of the mortality among older adult earthquake trauma patients(OAETPs)and created a screening model.METHODS:Data on 7,308 OAETPs from the West China Earthquake Patients Database were analyzed retrospectively.The 35 variables that can be obtained rapidly on arrival at the hospital were collected.Least absolute shrinkage and selection operator(LASSO)regression analysis was performed.Then,the nomogram for assessing the mortality of OAETPs was constructed.RESULTS:We identified 10 independent mortality-related factors that contributed to the in-hospital mortality of OAETPs.The 10 factors included age(odds ratio[OR]=1.061,95%confidence interval[CI]:1.031-1.090),dementia(OR=5.146,95%CI:1.169-17.856),coronary heart disease(CHD;OR=23.441,95%CI:4.799-83.927),malignant tumor(OR=8.497,95%CI:3.583-17.967),deep vein thrombosis(DVT;OR=7.110,95%CI:1.369-27.168),chronic kidney disease(CKD;OR=11.783,95%CI:5.419-24.407),pulse rate(PR;OR=1.036,95%CI:1.022-1.048),mean artery pressure(MAP;OR=0.960,95%CI:0.945-0.975),Glasgow Coma Scale(GCS;OR=0.864,95%CI:0.760-0.972),and Triage Revised Trauma Score(T-RTS,OR=0.485,95%CI:0.351-0.696).CONCLUSION:The 10 mortality-related factors could be quickly obtained on hospital arrival and should be the focal point of future earthquake response strategies regarding hospitalized older adults with trauma.A nomogram was constructed based on the factors for screening OAETPs with a higher risk of in-hospital mortality.展开更多
BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tid...BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tidal carbon dioxide(ETCO2)waveform.CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma,resulting in pneumothorax.Tube placement was not confirmed during emergency airway management,and the patient was directly transferred to the emergency operation room.Assisted by ETCO2 and imaging examinations,the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.展开更多
基金This work was supported by the Strategic Priority Research Program of the Chinese Academy of Science(XDA23090502)Science and Technology Department of Sichuan Province(21KJPX0207).
文摘BACKGROUND:There is limited evidence for emergency physicians and emergency trauma surgeons regarding the determinants of early and rapid assessment of older adult in-hospital mortality due to earthquakes.This study explored factors related to the early and rapid assessment of the mortality among older adult earthquake trauma patients(OAETPs)and created a screening model.METHODS:Data on 7,308 OAETPs from the West China Earthquake Patients Database were analyzed retrospectively.The 35 variables that can be obtained rapidly on arrival at the hospital were collected.Least absolute shrinkage and selection operator(LASSO)regression analysis was performed.Then,the nomogram for assessing the mortality of OAETPs was constructed.RESULTS:We identified 10 independent mortality-related factors that contributed to the in-hospital mortality of OAETPs.The 10 factors included age(odds ratio[OR]=1.061,95%confidence interval[CI]:1.031-1.090),dementia(OR=5.146,95%CI:1.169-17.856),coronary heart disease(CHD;OR=23.441,95%CI:4.799-83.927),malignant tumor(OR=8.497,95%CI:3.583-17.967),deep vein thrombosis(DVT;OR=7.110,95%CI:1.369-27.168),chronic kidney disease(CKD;OR=11.783,95%CI:5.419-24.407),pulse rate(PR;OR=1.036,95%CI:1.022-1.048),mean artery pressure(MAP;OR=0.960,95%CI:0.945-0.975),Glasgow Coma Scale(GCS;OR=0.864,95%CI:0.760-0.972),and Triage Revised Trauma Score(T-RTS,OR=0.485,95%CI:0.351-0.696).CONCLUSION:The 10 mortality-related factors could be quickly obtained on hospital arrival and should be the focal point of future earthquake response strategies regarding hospitalized older adults with trauma.A nomogram was constructed based on the factors for screening OAETPs with a higher risk of in-hospital mortality.
文摘BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tidal carbon dioxide(ETCO2)waveform.CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma,resulting in pneumothorax.Tube placement was not confirmed during emergency airway management,and the patient was directly transferred to the emergency operation room.Assisted by ETCO2 and imaging examinations,the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.
