Sepsis is a critical condition. The key factor affecting the survival of patient is whether standard treatment can be obtained timely. Because of the complexity of its pathogenesis and high heterogeneity, there is no special diagnosis method currently. Early identification is difficult. Delayed diagnosis and treatment is closely related to the mortality of patients. With the continuous updating of the guidelines, sepsis has been included in the “time window” disease, putting forward a great challenge to the early screening and evaluation of sepsis. This article aims to review the application of Sepsis-Related Organ Failure Assessment, sepsis biomarkers and artificial intelligence algorithms in early screening and evaluation of sepsis, so as to provide guidance tools for timely starting standardized treatment of sepsis.
The American Heart Association (AHA) released the 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality (2017 AHA guidelines update) in November 2017. The 2017 AHA guidelines update was updated according to the rules named " the update of the guideline is no longer released every five years, but whenever new evidence is available” in the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The updated content in this guideline included five parts: dispatch-assisted cardiopulmonary resuscitation (CPR), bystander CPR, emergency medical services - delivered CRP, CRP for cardiac arrest, and chest compression - to - ventilation ratio. This review will interpret the 2017 AHA guidelines update in detail.
目的 探讨修正创伤评分（RTS）、CRAMS评分及院前伤情评分（PHI）对于群体伤患者死亡的评估作用。 方法 回顾性分析2011年8月－2012年8月就诊且记录完整的45例群体伤患者的病历资料，根据病历记录计算RTS、CRAMS及PHI评分，并记录患者是否死亡。绘制受试者工作特征曲线并计算出曲线下面积；根据约登指数筛选出各个评分适宜的截断值，据此计算3种创伤评分的灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值并进行比较。将患者按照性别、年龄分为亚组进行对比分析。 结果 RTS曲线下面积最大，且与参考线下面积对比差异有统计学意义（P=0.016），与另外两种评分比较其差异有统计学意义。 结论 RTS较CRAMS及PHI评分对于群体伤患者死亡预测具有更高的价值。
ObjectiveTo investigate the correlation between rapid emergency medicine score (REMS) and therapeutic intervention scoring system (TISS-28) score and analyze the feasibility of assessing the nursing workload by REMS score for critically wounded earthquake victims, in order to provide reference for rapid and effective resource allocation for earthquake victims. MethodsA retrospective analysis was carried out on 39 Lushan earthquake victims with their acute plysiology and chronic health evaluationⅡ scores higher than 25, who were directly transferred from the earthquake site to the Emergency Department of West China Hospital between April 20 and 27, 2013. Among them, there were 24 males and 15 females aged between 5 and 90 years old averaging (57.1±19.8) years. REMS score and TISS-28 score were calculated for each victim. The relationship between REMS score and TISS-28 score was analyzed by correlation analysis and curve estimation including linear model, quadratic model, composite model, growth model, logarithm model, cubic model and exponential model. Then, we tried to find out the most suitable description for the relationship between REMS score and TISS-28 score. ResultsThe Spearman correlation coefficient between the two score systems was 0.710 and the most suitable description for the relationship between REMS score and TISS-28 score was logarithmic curve model. The formula was TISS=-5.946+4.467lnREMS. ConclusionREMS score can be applied as a nursing workload predicting tool for critically wounded victims in Lushan earthquake and it provides a guidance for rational allocation of health resources.
ObjectiveTo investigate the effect of noninvasive positive-pressure ventilation for elderly patients with chronic obstructive pulmonary disease (COPD) combined with left heart failure. MethodsA total of 152 patients (70-85 years old) diagnosed with COPD combined with left heart failure and treated in our hospital between June 2011 and January 2015 were randomly divided into trial group (noninvasive positive-pressure ventilation with routine treatment, n=76) and control group (routine treatment, n=76). Respiratory rate, heart rate, blood pressure, pH, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2) and left ventricular ejection fraction (LVEF) were analyzed and compared between the two groups after treatment. We did t-test to analyze the difference of these indexes between the two groups statistically. ResultsRespiratory rate, heart rate and PaCO2 in both of the two groups after the treatment were significantly lower than those before the treatment (P<0.001), while PaO2 and LVEF in both of the two groups after the treatment were significantly higher than those before the treatment (P<0.001). The systolic pressure and diastolic pressure in both of the two groups after the treatment didn't differ much from those before the treatment (P>0.05). The pH value after the treatment increased only in the trial group compared with that before the treatment (P<0.05). The respiratory rate, heart rate, pH value, PaO2, PaCO2 and LVEF after the treatment in trial group were meliorated compared with those in the control group (P<0.05). ConclusionTreatment with noninvasive positive-pressure ventilation for elderly patients with COPD combined with left heart failure is more efficient than the routine treatment.