Emergency medicine is getting more & more in demand,particularly in trauma *** a major disaster, it is often not possible to bring the medical personnel to the victims *** if available, manpower will never be *** ...
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Emergency medicine is getting more & more in demand,particularly in trauma *** a major disaster, it is often not possible to bring the medical personnel to the victims *** if available, manpower will never be *** may not be *** of a strong and efficient first aid team can provide the manpower in a much bigger *** with interest,after a period of proper training,can fulfill the *** practice & competitions they are geared to perform under
The significance of transient ischemic attack(TIA) as a warning event and opportunity for stroke prevention varies with different ethnicity and with different risk *** are controversies in definition,time base verses ...
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The significance of transient ischemic attack(TIA) as a warning event and opportunity for stroke prevention varies with different ethnicity and with different risk *** are controversies in definition,time base verses image base,and management in recent *** on stroke risk after a transient ischemic attack(TIA) are predominantly in Western populations.A systematic review of 18 cohorts reported a risk of stroke of 3.1%and 5.2%on day 2 and day 7 after a TIA ***, there was substantial heterogeneity between studies,with risk ranging from 0%-12.8%at 7 days.A review
While attempts to provide emergency care have arguably existed since antiquity,it is only during the past five decades that the specialty of emergency medicine has emerged and flourished in the United States and *** t...
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While attempts to provide emergency care have arguably existed since antiquity,it is only during the past five decades that the specialty of emergency medicine has emerged and flourished in the United States and *** to the 1960s and 70s,hospital emergency departments were generally staffed by physicians on staff at the hospital on a rotating basis,among them general surgeons,internists,and psychiatrists,although in smaller hospitals this was sometimes done by residents,interns,students,and even nurses.
Hong Kong is a tiny city with more than 7 millions *** the 50 Km radius of the CBD is the Daya Bay Nuclear Power Station which is the first commercial nuclear station sited in the southern region of Guangdong *** Daya...
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Hong Kong is a tiny city with more than 7 millions *** the 50 Km radius of the CBD is the Daya Bay Nuclear Power Station which is the first commercial nuclear station sited in the southern region of Guangdong *** Daya Bay plant has two pressurized water reactors with a total electrical capacity of 1,*** its commissioning in 1994,the station has kept excellent safety and operational *** addition,China has also constructed further plants on adjacent regions under the
Medical knowledge advances rapidly,and good clinical practice requires that emergency physicians stay up to date with new medical *** residency is completed,it is up the individual physician to obtain continuing medic...
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Medical knowledge advances rapidly,and good clinical practice requires that emergency physicians stay up to date with new medical *** residency is completed,it is up the individual physician to obtain continuing medical *** the United States,graduating emergency medicine residents obtain certification of their qualifications through written and oral tests given by the American Board of Emergency Medicine(ABEM).This certification needs renewal every ten *** residents seek additional training after residency in supervised fellowships in subspecialty areas of emergency medicine.
Bleeding in severe pelvic fractures(causing high mortality) does not merely originate from the broken bone marrows,neighbouring venous & arterial vessels,but also the abdo-pelvic *** distant injuries can be the he...
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Bleeding in severe pelvic fractures(causing high mortality) does not merely originate from the broken bone marrows,neighbouring venous & arterial vessels,but also the abdo-pelvic *** distant injuries can be the hemorrhage *** significant intra-peritoneal bleeding is initially excluded by the FAST USG,the mainstay hemorrhage control is by the provisional NIPS(non-invasive pelvic stabilization) by a sling/splint to reduce the pelvic volume to create the tamponade effect to reduce venous bleeding
目的分析12例接受机械通气的重症新型甲型H1N1病毒性肺炎患者的临床资料,探讨高PEEP肺复张法的疗效及其影响因素。方法以2009年10月—2010年1月我院急诊监护室(EICU)救治的12例接受机械通气的重症新型甲型H1N1病毒性肺炎患者为研究对象,患者均经口气管插管采取压力控制通气模式进行机械通气,每4~6小时应用高PEEP法(设定PEEP为30cmHO持续40s)进行一次肺复张,肺复张前10min采用统一的吸痰操作标准为患者充分吸引气道分泌物并静脉注射安定10mg,记录每次肺复张前、复张时、复张后1min、3min、5min、10min、15min、20min、30min的呼吸机参数设置和患者平均动脉压、心率、脉搏血氧饱和度(SpO)的变化,记录复张后SpO最高值(maxSpO)、最低值(minSpO)及其出现时间,复张后15min内SpO升高≥5%为复张有效,分析高PEEP肺复张法的疗效及其影响因素。结果12例患者中存活4例,死亡8例,在EICU接受机械通气时间3.5~12d,中位数5.5d,共进行肺复张158例次,其中存活组71(71/158,44.9%)例次,死亡组87(87/158,55.1%)例次,复张有效76(76/158,48.1%)例次,存活组有效47例次(47/71,66.2%)与死亡组29例次(29/87,33.3%)比较差异有统计学意义(P=0.045)。复张前患者吸入气体氧浓度、吸气压力水平、SpO、氧合指数(PaO/FIO)以及平均动脉压和心率等指标在有效组和无效组间比较差异均无统计学意义(P均>0.05)。复张时患者心率较复张前增加(92.6±17.8 vs 73.0±18.6次/min,P=0.038),MAP较复张前降低(66.1±15.3vs73.9±21.4 mmHg,P=0.049),差异有统计学意义,复张后3min时心率和MAP与复张前比较差异无统计学意义(P=0.089)。134例次(134/156,85.9%)复张后SpO较复张前下降,minSpO出现时间平均在复张后(2.1±1.6 min),有效组复张后maxSpO较复张前平均增加(8.9±2.6%),maxSpO出现时间平均在复张后(12.7±5.6 min)。有效组复张后30min SpO较复张前增加(90.4±13.4 vs 86.7±19.6%,P=0.047),差异有统计学意义,无效组复张后30min SpO与复张前比较(88.2±17.3 vs 87.1±16.4%,P=0.082)差异无统计学意义。有效组复张前PEEP平均为(8.6±3.4 cmHO),与无效组(11.3±5.2 cmHO)比较(P=0.045),差异有统计学意义。有效组复张前平均机械通气时间为(6.6±4.1d),与无效组(8.3±3.5 d)比较(P=0.045),差异有统计学意义。结论重症甲型H1N1病毒性肺炎机械通气治疗时采取高PEEP肺复张法可引起短暂血流动力学改变,其效果可能与复张前PEEP水平和机械通气时间有关。
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