Fluid management strategies for patients with severe blast injury / 中国实用护理杂志

Objective:To summarize the precision fluid management of patients with severe blast injury in the emergency intensive care unit, so as to help patients smoothly pass through the dangerous period and recover smoothly.Methods:Based on the experience of fluid management in 6 patients admitted to the Second Affiliated Hospital Zhejiang University School of Medicine in the tanker truck explosion on 14 June, 2020. The main measures included: fluid volume management and dynamic adjustment; assessment of intake, output and urine volume, and dynamic adjustment of infusion volume and speed; monitoring of pulmonary oxygenation and timely adjustment of fluid resuscitation strategies; monitoring indexes and providing nursing care strategies for fluid management.Results:Finally, among 6 patients with severe blast injury, 5 patients were discharged from the hospital with follow-up treatment after they suffered from the shock and infection phases and refined fluid management, 1 patient died due to severe injury and ineffective rescue.Conclusions:Adopting individualized, phased, and refined liquid management strategy has clinical significance for patients with severe blast injury to smoothly pass the risk period.

A primary study on construction of urban unmanned aerial vehicle emergency blood distribution system / 中华急诊医学杂志

Objective:To explore the feasibility and effectiveness of the construction of urban unmanned aerial vehicle (UAV) blood distribution system, and to provide a novel way for the distribution of emergency blood.Methods:The study was completed in Hangzhou from April 2019 to January 2021, and the main participants were from the Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province Blood Center and Hangzhou Fast Ant Network Technology Co., Ltd. Firstly, an unmanned aircraft delivery system was built for urban emergency blood and a special blood storage box for drones were developed. The drone was used to deliver blood products from Zhejiang Province Blood Center to Binjiang Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine, and the following indicators were obtained: (1) flight time of the drone blood delivery; (2) real-time temperature of blood products during transportation; (3) Baidu map software was used to measure the blood delivery time of road traffic, which was compared with the flight time of the drone.Results:The urban drone blood delivery system consists of intelligent logistics drones, cryogenic blood storage tanks, unmanned logistics hub stations, and cloud-based operation control platforms. The drone route distance from Zhejiang Provincial Blood Center to Binjiang Campus, the Second Affiliated Hospital of Zhejiang University School of Medicine was 2.36±0.06 km, and the ground distance was 5.8 km, with 27 flights from April 12, 2019 to January 29, 2021, and the drone flight time was, shorter than the road travel time for a round trip [(6.37±0.35) min vs. (17.00±1.94) min]. At different time points of the day, UAV blood delivery could save 15.98-4.28 min, with an average saving of 10.62±1.87 min. Conclusions:Urban UAV blood delivery systems have the advantages of being fast, unaffected by ground traffic conditions, and can ensure the safety of blood products during transportation, and are worthy of further exploration.

Reliability and validity of the four-level Chinese emergency triage scale in mainland China: A multicenter assessment.

BACKGROUND: An effective emergency triage system is lacking in mainland China. The Chinese Emergency Triage Scale (CETS) was developed based on vital complaints and vital parameters, according to Chinese data. OBJECTIVE: The aim of this study was to assess the reliability and validity of the CETS by emergency department (ED) nurses in eight EDs in mainland China. DESIGN: A cross-sectional multi-center study was conducted. SETTINGS: Eight EDs in the eastern, western, northern, and central areas of mainland China. PARTICIPANTS: A total of 51 ED nurses and 8000 active ED patients participated in the study between May and September 2018 in eight EDs. METHODS: Standardized triage scenarios and active patients were assigned to nurses who used the CETS for evaluative purposes. Accuracy was defined by concordance with the key for the scenarios and was calculated as percentages. Inter-rater reliability was measured by weighted κ to compare the triage nurse's rating with the research nurse's acuity level for each patient. The triage time and clinical outcome of 1000 active patients per site also were collected. The criterion-related validity of the CETS was evaluated; criteria included ED mortality, number of patients discharged, and admission to ICU or general ward. The relationship between the CETS acuity levels triaged by the research nurse and four possible outcomes was assessed with a cross-classification table, using a chi-square test. The ability of the CETS to predict ED mortality was assessed via the receiver-operating characteristic (ROC) area under the curve (AUC). RESULTS: Mean pooled accuracy from all sites was 89.4% (95% CI = 86.9%-91.8%), and the proportion of over-triage slightly exceeded under-triage (6.5% vs. 4.1%). There was no difference in accuracy between sites or according to nurse experience. Inter-rater reliability values for triage nurses and research nurses were 0.96 (95% CI = 0.95-0.97), based on the quadratic weight κ. Trauma cases were assigned to triage with greater accuracy than were nontrauma cases, both for the scenarios and for active patients. The average triage time of ED nurses in all sites was 151.5 ±â€¯26.3 s, using the computer-based triage instrument. The chi-square test showed that there was a significant difference in triage time between the CETS levels (p < 0.001). The AUC was 0.968 (95% CI = 0.958-0.979). CONCLUSIONS: The CETS is a reliable system for ED triage and can promote rapid and effective triage in mainland China.

Effects of heating intravenous fluid infusion and blood transfusion based on guidelines in sever trauma patients with hypothermia / 中华急诊医学杂志

Objective To explore the effects of heating intravenous fluid infusion and blood transfusion based on guidelines in severe trauma patients with hypothermia. Methods A total of 40 severe trauma patients with hypothermia admitted from July 2014 to December 2015 were enrolled as the control group treated with routine measures to maintain the body temperature at normothermia by such as electrical heating blanket; other 40 severe casualties with hypothermia admitted from January 2016 to July 2017 were recruited as the warming up group treated with heating intravenous fluid infusion and blood transfusion by hot water bath in addition to the routine measures for keeping body temperature at normothermia. The differences in core body temperature, prothrombin time, activated partial thromboplastin time, incidence of shivering and mortality rate were compared between the two groups. Results There was statistically signifi cant difference in core body temperature at 0.5 h, 1.0 h, 1.5 h, 3.0 h between the two groups (P<0.05). Though the prothrombin time and shivering were improved after warming up in both groups, and there were significant differences in prothrombin time at 3.0 h after warming up and the incidence of shivering between two groups(P<0.05).There was no signifi cant difference in mean arterial pressure at all seven intervals between two groups. Conclusion The heating intravenous fl uid infusion and blood transfusion had remarkable effects to prevent hypothermia, improves blood coagulation and reduced the incidence of shivering to provide more simple and convenient warming up intervention for clinical practice.