Application of toxicant and drug detection in 895 patients with clinical poisoning diseases / 中华急诊医学杂志

Objective:To explore the diagnostic value of the toxicant and drug detection in clinical poisoning diseases and analyze the clinical characteristics of patients with positive poison test.Methods:This study was a multicenter retrospective cohort study. Sampling and clinical information data were collected between October 1, 2020 and September 30, 2022 from 41 tertiary hospitals in and around Jiangsu province. The clinical characteristics of patients with positive toxicology tests were analyzed, and the correlation between the drug sampling situation and the test results was analyzed..Results:A total of 895 patients with clinical diagnosis or suspected poisoning were enrolled in this study. Among them, 652 patients had positive results, accounting for 72.85%. Among all positive patients, 506 patients were exposed to a single poison and 147 patients were exposed to multiple poisons. The top three poisons were pesticide herbicides (202 cases, 30.98%), sedative and psychotropic drugs (151 cases, 23.16%), and pesticide insecticides (97 cases, 14.88%). Among 541 patients with clear exposure history, the positive rate was 78.19%, and among 354 patients with unclear exposure history, the positive rate was 64.69%. The top three poisons (drugs) of patients with unclear exposure history were sedative and psychotropic (82, 12.58%), herbicide (26, 3.99%), and rodenticide (22, 3.37%). Patients who admitted to hospital for unexplained consciousness disorder, abnormal blood coagulation function and multiple organ dysfunction were more likely to obtain positive poison test results.Conclusions:There is uncertainty in the exposure history of poisoning diseases, so it is necessary to improve the detection of toxic substances as soon as possible. Toxicant testing should be considered when patients have impaired consciousness, abnormal coagulation function and multiple organ dysfunction.

A qualitative study on the cognition and management of the head nurse of orthopedics department on the risk assessment and management of patients with deep vein thrombosis / 中国实用护理杂志

Objective:To understand the current situation of the head nurses of orthopedics department on bleeding risk assessment and management in the prevention of DVT, to provide a reference for future clinical practice of bleeding risk assessment.Methods:Using phenomenological research methods, five head nurses of orthopedics department were interviewed one-on-one and analyzed by Colaizzi ′s phenomenological analysis. Results:Four themes were refined for the awareness and management of bleeding risk assessment in DVT prevention, mainly focusing on risk assessment, choice of assessment timing, multiple risk assessment methods, and unclear grading attitudes.Conclusions:The bleeding risk assessment work needs to be further explored. It is necessary to further scientifically clarify the timing and methods of bleeding risk assessment, effectively guide clinical practice, strengthen nurses ′ awareness of bleeding risk classification, and promote clinical nursing practice, so as to better conduct bleeding assessment and Care.

Application of extracorporeal cardiopulmonary resuscitation in adult patients with cardiac arrest / 中华急诊医学杂志

Objective:To identify the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on neurological outcome and survival in adults with cardiac arrest (CA).Methods:Totally 31 adult patients with ECPR were enrolled from March 2015 to June 2019 in Emergency Department of the First Affiliated Hospital of Nangjing Medical University (Jiangsu People Hospital). Patients were divided to the survival group ( n=12) and death group ( n=19). Duration of conventional cardiopulmonary resuscitation (CCPR) and extracorporeal membrane oxygenation (ECMO) and other mechanical support were compared between groups. Cerebral performance category (CPC) and hospital survival were also evaluated according to the duration of CCPR before ECPR. Results:The duration of CCPR before ECPR was significantly shorter in the survival group than that in the death group ( P=0.002). Duration of ECMO had no significant difference between the two groups ( P=0.478). The location of CA occurrence had no impact on the hospital survival rate ( P=0.716). ECPR in combination with intra-aortic balloon pump (IABP) also had no impact on the hospital survival rate ( P=0.174), and patients received continuous renal replacement therapy (CRRT) had higher hospital survival than patients without CRRT ( P = 0.032). Patients with CCPR duration ≤ 60 min had higher rates of ROSC and hospital survival ( P <0.001). CPC evaluation showed no difference between the two groups. Conclusions:ECMO can provide effective life support to CA patients, and improve their survival rates. It is recommended to initiation of ECMO implantation within 60 min after CCPR.

Application of different turnover intervals in preventing stress injury to patients in rescue room / 中国实用护理杂志

Objective@#To investigate the effect of different turnover intervals in preventing stress injury to patients in emergency room.@*Methods@#The 200 eligible patients from July 2016 to July 2017 were divided into 4 groups by random number table method, 50 patients per group, named as the conventional group, test group 1, test group 2 and test group 3. Turning frequency was used for 2.0 h in the conventional group, and 2.5 h, 3.0 h and 3.5 h in the first, second and third groups, respectively. The average body pressure of the shoulder blade, left and right lateral ankle and sacral tail between the four groups at different turning time, the incidence of stress injuries, the comprehensive satisfaction of patients with turn-over nursing were compared.@*Results@#There was no statistically significant difference in the body pressure value of the main compression site between the four groups (P>0.05), and the incidence of stress injury was 2.0% (1/50), 2.0% (1/50), 2.0% (1/50), and 4.0% (2/50), respectively (P>0.05). The comprehensive satisfaction degree of the patients in the four groups was 71.0%(71/100), 75.0%(81/108), 79.8% (83/104), and 86.6% (97/112), respectively, with statistically significant differences (χ2=8.517, P< 0.05). For each of the two groups, only the general group and the experimental group showed statistically significant differences in the comprehensive satisfaction degree of the patients in the three groups (χ2=7.824, P< 0.01).@*Conclusions@#It shows that the 3.5 h turning-over interval can effectively prevent stress injuries, improve patient satisfaction, and reduce the workload of nursing staff without affecting patient treatment, nursing, and stress injury prevention.

Practice and effect evaluation of establishment of first aid green channel for acute ischemic stroke based on medical team resource management model / 中国实用护理杂志

Objective To explore the application effectiveness of medical team resource management model in the first aid green channel of acute ischemic stroke (AIS). Methods A total of 215 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2015 to October 2017 as an observation group.The observation group adopted AIS first aid green channel based on medical team resource management mode.A total of 61 patients with acute ischemic stroke who underwent intravenous thrombolysis were enrolled from November 2013 to October 2015 as a control group.The control group adopted three districts and four treatment procedures.The time course of intravenous thrombolysis was compared between the two groups and to compare the satisfaction of the two groups with different AIS procedures. Results Application of medical team resource management model to establish a dedicated first aid green channel, the key links were significantly shortened,Door-to-Needle Time (DNT) decreased from (114.84 ± 8.05) minutes prior to establishment to (57.63 ± 6.30) minutes, the difference was statistically significant (t=51.263, P<0.05), the satisfaction degree of the medical staff was improved,the overall satisfaction increased from (2.86 ± 0.20) before establishment to (4.27 ± 0.20) points, the difference was statistically significant (t=-34.368,P<0.05).Conclusions The medical team resource management model applied to the treatment of AIS patients, the establishment of multidisciplinary integration of first aid green channel, to strengthen the team to effectively improve the timeliness of the key aspects of intravenous thrombolysis, shorten DNT, improve the quality of treatment of patients.

Effect of hemihepatectomy on the level of serum thyroxin and insulin / 中国普通外科杂志

Objective To study the mechanism of serum thyroxin and insulin change after hemihepatectomy. Methods The hemihepatectomy was performed in rabbits, the fasting peripheral blood samples were drawn on the day prior to surgery, and 24 hour, 48 hour, the first week, one month after operation respectively for monitoring the serum thyroxin and insulin.Results The level of TT 3 was (1.93?0.47) nmol/L, TT 4 (53.56?8.4) nmol/L preoperatively. The levels of TT 3 and TT 4 significantly decreased at 24 hour postoperatively, and gradually rose at 48 hour and up to normal levels in the first month postoperatively. The level of insulin rapidly rose immediately after operation, and began to decrease in the first week, and returned to the preoperative level in one month after operation. Conclusions The syndrome of normal thyroid disease and the syndrome of non thyroid disease can occur after hemihepatectomy; and hyperinsulinemia also can occur after hemihepatectomy.