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Objective:To explore the automated external defibrillator (AED) configuration optimization strategy in line with the characteristics of the rapidly developing cities by analyzing the actual coverage of AED in Bao'an District based on the real world data of out-of-hospital cardiac arrest (OHCA) in Bao'an District, Shenzhen City.Methods:The data of cardiac arrest database registered in Bao'an District of Shenzhen City from March 1, 2019 to February 29, 2020 were included in a retrospective observational study. The AED coverage of public and non-public areas was analyzed by calculating the minimum distance between the occurrence place of each OHCA event and the nearest AED. The minimum distance ≤100 m was set as AED coverage, and the minimum distance > 100 m was set as non-AED coverage. It was assumed that one AED was configured for each OHCA hotspot area, then the AED coverage changes were analyzed. Based on the actual situation that the AED in schools, governments, sports venues, subways, tourist attractions and parks of public areas in Bao'an District could not be obtained at any time within 24 hours, it was assumed that all AED in the public areas could be obtained at any time within 24 hours, the impact of AED available at any time on AED coverage was analyzed.Results:A total of 525 cases of OHCA were enrolled. The highest incidence of OHCA was found in residential and industrial areas [54.5% (286/525) and 14.3% (75/525), respectively]. There were 252 AED in Bao'an District, Shenzhen, and 115 OHCA events occurred within the coverage area of AED. Even if all AED met the ideal state that could be obtained at any time within 24 hours, the coverage rate was only 21.9% (115/525). The AED coverage rate of the public areas and non-public areas was 31.6% (37/117) and 19.1% (78/408) respectively, with uneven distribution, and the AED coverage rate of non-public areas was low. Assuming that the residential community and industrial zone with more than 2 OHCA cases were respectively equipped with one AED, the coverage rate of AED in the non-public areas increased from 19.1% (78/408) to 28.2% (115/408), basically meeting the requirement that AED could be obtained at any time when OHCA events occurred. Some AED in the public areas of Bao'an District were not available at any time within 24 hours. If the ideal state that all AED in the public area could be obtained at any time within 24 hours could be achieved, the AED coverage rate of all regions increased from 16.8% (88/525) to 21.9% (115/525), the AED coverage rate of the public areas increased from 29.1% (34/117) to 31.6% (37/117), the AED coverage rate of the non-public areas increased from 13.2% (54/408) to 19.1% (78/408).Conclusions:AED configuration in Bao'an District was unevenly distributed, and the coverage rate of AED in non-public areas was low. The allocation strategy for AED in fast-growing cities like Shenzhen should be as follows: on the premise of ensuring AED availability for 24 hours, priority should be given to covering the number of AED in the non-public areas including residential communities and industrial zones; AED is available in the public areas for 24 hours.
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Objective:To share the implementation experience of hierarchical first aid training scheme for elementary and middle school students in Baoan District of Shenzhen City and evaluate its effect of training. Methods:During August 2018 and August 2019, elementary and middle schools students who participated in the first aid training held by emergency rescue training center of Baoan District were enrolled. Baseline information including the number of students, the number of attending tutors, the number of cardiopulmonary resuscitation (CPR) training models, automated external defibrillator (AED) models were recorded. According to hierarchical levels of three age, students received different courses with content from simple to hard: the course of elementary school students was consisting of dialing 120, smart animation on how to identify accidental damage, demonstration of AED and Hemlick techniques, CPR practise (40 minutes). The course of junior high school students was consisted of how to dial 120, how to identify accidental damage and simple disposal, application of CPR and AED, practice CPR and AED and Hemlick techniques (90 minutes). The course of high school students was consisted of how to dial 120, identify accidental damage and right disposal, identification of out-of-hospital cardiac arrest, the key-point of CPR and AED, practice CPR and AED, Hemlick techniques and hemostatic bandage (120 minutes). At the end of course, elementary school students were voluntary for skill assessment; junior high school students only were compulsory for skill assessment in small classes but not required in large classes, just for demonstration; additionally, the whole high school students were compulsory for skill assessment. The characteristics of first aid training students at different levels were collected in order to compare the differences on the usage of CPR training model and AED training model, the distribution of emergency resource, the ratio for passing examination.Results:A total of 12 896 students and 2 086 training instructors took parted in 200 lists of first aid training courses, 8 557 CPR models and 8 493 AED models were used. On average, there are 65.27±5.61 students in each session, and 10.52±10.43 training instructors. There are 43.09±19.06 CPR training models and 42.77±18.61 AED training models. The mean ratio of student to tutor was 6.07±1.47, student to CPR model was 1.54±1.02, and student to AED model was 1.54±1.03. In the end of course, 10 494 students participated in the examination with the participation rate of 81.37%; 10 114 students passed the examination with the passing rate of 96.38%. Hierarchical analysis showed: compare to elementary school students, the average number of junior high school students in every training session significantly increased (cases: 69.94±8.77 vs. 58.69±6.12, P < 0.05), but the average number of high school students in every training session significantly decreased (cases: 57.35±5.79 vs. 58.69±6.12, P < 0.05). The proportion of instructors in junior high school students' training significantly reduced (5.94±1.39 vs. 6.48±2.02, P < 0.05). The examination ratio of junior high school students and high school students was increased significantly [81.07% (6 667/8 224), 100% (2 313/2 313) vs. 64.18% (1 514/2 359), both P < 0.05], but the ratio of passing the examination was significantly reduced [95.47% (6 365/6 667), 96.88% (2 241/2 313) vs. 99.60%(1 508/1 514), both P < 0.01]. This might be related to the low difficulty of elementary school students' assessment and the low proportion of compulsory examination. Conclusions:Hierarchical scheme is feasible for first aid training in elementary and middle school students, the content of course should be desighed from easy to hard. Synchronously, sufficient training instructors and training models should be equipped to ensure the quality.
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Objective:To investigate the effect of early enteral nutrition (EN) standardized treatment process management on the ventilation treatment effect and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) on invasive mechanical ventilation.Methods:Forty-three patients with AECOPD on invasive mechanical ventilation admitted to Shenzhen Baoan District People's Hospital from January 2017 to December 2018 were enrolled. According to the start time of the continuous quality improvement project of nutritional support treatment for critically ill patients in the hospital, 20 patients from January 1st to December 31st in 2017 were enrolled in the routine EN group, and 23 patients from January 1st to December 31st in 2018 were enrolled in the early EN group. In the early EN group, when the patient was hemodynamically stable within 24 hours after intensive care unit (ICU) admission and there was no contraindication for EN, early trans nasal intestinal EN was started, and the infusion rate was adjusted or parenteral nutrition was added according to the EN tolerance score. The target feeding amount was 104.6-125.5 kJ·kg -1·d -1, and achieve complete EN. The conventional EN group started EN after patients had experienced the early stress stage, the vital signs were stable, and 48 hours after ICU admission. The management process was the same as the early EN group. The ventilation indicators including rapid shallow breathing index (RSBI), arterial blood pH value, arterial oxygen partial pressure (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), and base excess (BE) at weaning, PaCO 2, CO 2 retention rate at 2 hours after weaning, as well as critical management indicators including the incidence of ventilator-associated pneumonia (VAP), duration of invasive mechanical ventilation, length of ICU stay, total hospitalization cost and re-intubation rate between the two groups were compared. Results:After the early EN standardized treatment process management, the RSBI at weaning of the patients in the early EN group was significantly lower than that in the conventional EN group (times·min -1·L -1: 36.68±16.12 vs. 52.63±14.81, P < 0.05), but no significant difference in pH value, PaO 2, PaCO 2 or BE was found as compared with the conventional EN group. The PaCO 2 and CO 2 retention rate at 2 hours after weaning in the early EN group were significantly lower than those in the conventional EN group [PaCO 2 (mmHg, 1 mmHg = 0.133 kPa): 52.48±7.62 vs. 58.32±8.43, CO 2 retention rate: (10.25±2.86)% vs. (18.46±3.21)%, both P < 0.05]. Compared with the conventional EN group, the incidence of VAP [8.7% (2/23) vs. 15.0% (3/20)], duration of invasive mechanical ventilation (hours: 52.64±14.81 vs. 53.78±12.75), length of ICU stay (days: 4.92±1.26 vs. 5.24±1.84), total hospitalization costs (thousand Yuan: 20.9±4.8 vs. 21.0±6.9) and re-intubation rate [13.0% (3/23) vs. 20.0% (4/20)] were slightly decreased in the early EN group without statistically significance (all P > 0.05). Conclusion:The management of early EN standardized treatment process for patients with AECOPD on invasive mechanical ventilation may alleviate the respiratory muscle fatigue status, and does not increase the complications.
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Objective:To analyze the component ratio of the social emergency training instructors in Baoan District, Shenzhen;Methods:During January 2018 to January 2019,participants, candidate to be social emergency training instructors in Baoan district, Shenzhen, were enrolled in our analysis. they needed orderly pass primary selection and intensive selection to be formal social emergency training instructors. Personal data from candidates including hospital, serving department, degree and professional types were collected. According to serving departments, candidates from pre-hospital emergency, emergency ward and critical care unite is belong to the emergency group and other s who is not from above departments belong to the non-emergency group.Results:Total of 1 270 candidates took part in 7 primary classes and 27 intensive selection until 1131 of them received the formal certifications. 440(38.90%) instructors from emergency group and 691(61.10%) instructors belong to non-emergency group. At category level of hospital, 213 (18.83%) is from three grade, 525 (46.42%) is from two grade, 254 (22.46%) is from specialized hospitals, and 139 (12.29%) is from community health centers. In non-emergency group, ratio of serving departments are consists of: 15.77% from internal medicine, 10.14% from chirurgery, 8.11% from pediatrics, 7.96% from obstetrics and gynecology, 2.62% cases from otorhinolaryngology, 24.29% from medical assistants, 20.11% from community health center and 11.00% from administrative officer. Nurses (64.13%) is the majority professional types of social emergency training instructors. In terms of degree, bachelor mainly occupied at 71.02%. Primary (53.18%) and attending (30.47%) account for majority of position ranks.Conclusions:Our team of social emergency training instructors,mainly from local medical staffers, has a great educational background and competitive team; Among them, emergency team is crucial to provoke other medical staffs from different departments to participate in career at social emergency training.
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Objective To This article mainly takes the Shenzhen Baoan people's Hospital pre-hospital department as the observation object,analyses the spacial site data distribution of pre-hospital,to realize optimum allocation for pre-hospital resource.Methods By means of the intelligentized ambulance,the site data of the pre-hospital is obtainecd,so is the pre-hospital hot map.With the hot map,the special pre-hospital characteristics is researched.Results The three spatial data characteristics of pre-hospital medical are proposed,i.e.,non-uniform,relative stability,individual difference.Conclusions These three characteristics provide us with a new method and a new basis for decision making.In this paper,based on the pre-hospital characteristic,a modeling method of non-uniform relative stability model is proposed,and the optimized distribution of hospital site is discussed by applying planning mathematics.
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Objective To observe the clinical effects and safety of Angongniuhuang Pill (a traditional Chinese medical preparation)adjuvant to haloperidol for the treatment of Intensive Care Unit (ICU)patients in postoperative delirium.Methods A prospective study of 243 postoperative patients with delirium adimitted in Intensive Care Unit of Xinjiang Medical University First Affiliated Hospital (January 2013-December 2014),by using confusion assessment method of Intensive Care Unit (CAMICU).All of 243 patients with delirium were randomly divided into two groups by computer randomization software (SAS 9.1):group A in which patients were treated with Angongniuhuang Pill adjuvant to haloperidol and group Fin which patiets were treated with haloperidol alone.The end of two intervention methods was determined by two consecutive CAMICU showing negative or the treatment were ended up at seven days treatment.The data of general information,and the results of treatment were recorded and analized by statistical software SPSS 19.0.The measurement data was expressed as mean ±standard deviation;the comparision between two groups was tested by t test;and repeated measurement was analised by variance.Count data was described as number and constitution ratio;and intergroup comparision was tested by Chi-square test. Results There was no significant difference in general information between two groups.The delirium duration and ICU treatment time in group A were shorter than those in group F [(3.0 ±0.9)d vs.(3.8 ±1.0) d,P =0.010; (6.2 ± 1.4) d vs.(6.7 ± 1.5) d,P = 0.008].When delirium was diagnosed (T0),all patients had EEG abnormalities.As treatment went on,EEG abnormal rate gradually declined.At day one (T1),there was no statistically significant difference in EEG findings between group A and group F (95.7% vs.97.5%,P = 0.045 ).At day two (T2 )and day three (T3 ),there was statistically significant difference in EEG findings between group A and group F (65.5% vs.77.7%,P =0.038;42.2% vs.56.2%,P = 0.032).The levels of S100βprotein,interleukin-6 (IL-6),tumor necrosis factor α(TNF-α)in two groups at T0 were all elevated without noticeable difference.These markers were all deceased at T1,T2,T3,but the speed of descend in group A was relatively faster than that in group F.The differences were statistically significant (S100β:time effect P <0.01,inter-group effectp =0.002,interaction effectp =0.686;IL-6:time effect P <0.01,inter-group effectp =0.034,interaction effectp =0.01;TNF-α:time effect P <0.01,inter-group effectp =0.003,interaction effectp =0.516). The discharge rate in group A after improvement of general condition was higher than that in group F (89.7% vs.79.3%,P =0.029).The incidence of postoperative complications and mortality 28 days after operation in group A were lower than those in group F (45.7% vs.58.7%P =0.045;12.9% vs. 24.0%,P =0.028).Conclusion During the treatment of delirium,Angongniuhuang pill adjuvant to haloperidol was a better method compared with using haloperidol alone in respect of effectiveness and safety perspectives.It may be a novel approach to the treatment for delirium by the combination of Chinese and Western medicine.
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Objective To discuss the influence of two recombinant hemoglobin (rHb1.1 and rHb2.0) and human serum albumin (HSA) on oxygen supply and demand balance in rat with coronary heart disease (CHD). Methods Male Wistar rats were randomly divided into normal control group, CHD model group, HSA treatment group, rHb1.1 treatment group and rHb2.0 treatment group, 20 rats in each group. Rat model of CHD was established by high fat diet combined with pituitrin injection. The mean arterial pressure (MAP) decreased to 40 mmHg (1 mmHg = 0.133 kPa) after femoral arterial blood was drawn from the femoral arteries, and the rats were resuscitated with 13.4% HSA, rHb1.1 and rHb2.0, respectively, at the rate of 60 mL·kg-1·h-1 (20 mL/kg). The changes of electrocardiogram (ECG) ST-segment were calculated before model reproduction and at 12 hours after the last time injection of pituitrin. MAP, heart rate (HR), superior mesenteric artery blood flow (QSMA) and arterial blood gas analysis were recorded at 0, 30, 60, 90 and 120 minutes after the administration. The blood was collected after 12-hour fasting, and serum total cholesterol (TC) and triglyceride (TG) were determined by enzymatic method. The pathological changes in cardiac tissue were observed with light microscope. Results Compared with the normal control group, the changes of ECG ST-segment and TC, TG of model group were significantly increased. Compared with the model group, rHb can significantly reduce the value of ST segment changes, and HSA has no such effect; rHb short-term infusion has no significant effect on blood lipids, but can reduce myocardial pathological changes. Compared with the normal control group, the MAP of the model group decreased significantly, the HR was increased, the QSMA was slowed down, the pH value, the residual alkali (BE), the arterial carbon dioxide partial pressure (PaCO2) and HCO3- were decreased significantly. MAP in rHb1.1 group and rHb2.0 group were significantly higher than those in HSA group. Values of MAP were significantly higher in rHb2.0 group than those in rHb1.1 group at 90 minutes and 120 minutes (mmHg: 80.9±3.3 vs. 69.4±4.9, 79.2±4.0 vs. 69.1±3.7, both P < 0.05). The HR of HSA, rHb1.1 and rHb2.0 decreased to normal in 30 minutes after administration, significantly lower than those in the model group (bpm: 534±46, 518±28, 526±37 vs. 609±52, all P < 0.05). In the rHb2.0 group, the QSMA increased significantly at 60, 90 and 120 minutes compared with the model group (qv·mL-1·min-1: 5.6±0.4 vs. 3.9±0.6, 6.2±0.6 vs. 4.1±0.4, 6.9±0.7 vs. 4.0±0.3, all P < 0.05), but there was no significant difference between the HSA group and the rHb1.1 group. The pH, BE, PaCO2 did not return to the normal level after administration of HSA; pH, PaCO2 and HCO3- in the rHb1.1 group returned to normal level at 60 minutes after administration, and BE returned to normal level at 90 minutes after administration. Each index in rHb2.0 group can restore to normal levels 30 minutes ahead of. Conclusion Recombinant hemoglobin can significantly improve the oxygen supply and demand balance of rats with CHD model, can quickly and effectively correct the hypoxic state of blood metabolic acidosis, and rHb2.0 has better effect than rHb1.1.
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Objective To collect the data of present basic constructive situation of intensive care units (ICUs) in second and tertiary grade hospitals in Xinjiang Uygur Autonomous Region and to provide a data base beneficial to the construction of ICUs in the whole region.Methods The information including basic situation of ICUs in a total of 49 second and tertiary grade hospitals as samples in Xinjiang Uygur Autonomous Region were investigated by questionnaire survey from December 2012 to April 2013. The contents of questionnaire chiefly included the basic situations of hospitals, ICU constructions, ICU human resources and allocation of equipments.Results Forty-nine questionnaires were sent out, and all of them gave answers, the recovery rate being 100%. In the whole region of Xinjiang, there were 49 second and tertiary grade hospitals with establishment of 66 various types of ICUs. ① Medical unit basic situation: the second grade A hospitals accounted for 59.2%, and the tertiary grade A hospitals, 34.7%. There was a larger proportion of local hospitals (67.3%); most of the hospitals had beds over 500 (57.14%), the designed hospital bed number was 41 403, and 35 442 beds were open up for service (85.60%). ② The ICU basic construction situation: the construction of ICUs concentrated mainly after the year 2000, from 2000 to 2010, a total of 37 units, and from 2010 to 2012, 12 units were constructed; when they opened to the public, the beds were relatively few, and the ICUs containing less than 10 beds occupied 79.00%. In the 66 ICUs surveyed, there were 43 general ICUs, accounting the largest proportion, followed by 7 emergency ICUs, and the least were 1 neurosurgery and 1 cardiac surgery ICU. In the 66 ICUs, all together 765 beds were prepared, but actually 808 beds were opening up to public; most of ICUs had 5 - 20 beds, accounting for 71% in all the ICUs. At present, in the whole Xinjiang region, the rate of beds in ICUs in various grades of hospitals opening to the outside for use accounted for more than 80% of which 56% ICUs were almost turning round fully. ③ ICU human resources situation: totally, there were 484 doctors in ICUs in the whole region, the ratio of full-time doctor to nurses was 1:3.50, the ratio for bed to physician 1:0.55 and the ratio for bed to nurse 1:0.92. The title of doctor was primarily resident, and the various title gradient levels were good. Most doctors graduated from a regular medical college, and the doctors having obtained a master degree were few. The physician professional backgrounds were mainly critical disease medicine, emergency medicine and respiratory medicine, the professional relevance being good; the chief way of ICU physicians to engage in advanced study of their professional training was in China, and generally they joined professional continuing education programs poorly, mostly joining once a year or non at all. The physicians who obtained the identification of Chinese critical care medicine specialist accounted only for 23.56%. ④ ICU equipment allocation situation: according to the requirements of ICU construction guidelines, the equipments must be allocated including bedside monitors (703 units), ventilators (516 units) and infusion pumps (702 units), occupying the highest proportion. In the optional equipments, there were enteral nutritional pump (89 stations), blood glucose monitoring device (57 units) and anti-decubitus mattresses (54 units), the proportion being the largest, bispectral index monitor (2 units), extracorporeal membrane oxygenation (ECMO, 1 table) and gastric mucosal carbon dioxide tension pHi meter (0 unit), the proportion being the least or non at all.Conclusions In the whole Xinjiang region, the construction of ICUs is still at the developing stage, and needs to further strengthen the standardized construction. The human resources, equipments, etc. are not distributed in balance, and it is necessary to move forward the adjustment to benefit the development of ICUs in the whole region.