简介：AbstractPurpose:Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.Methods:All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.Results:Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.Conclusion:The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

简介：

简介：无

简介：AbstractPurpose:Overcrowding in emergency department (ED) is a concerning global problem and has been identified as a national crisis in some countries. Several emergency sorting systems designed successfully in the world. Launched in 2004, a group of branches in South African triage scale (SATS) developed. The effectiveness of the case sorting system of SATS was evaluated to reduce the patient's length of stay (LOS) and mortality rate within the ED at Suez Canal University Hospital.Methods:The study was designed as an intervention study that included a systematic random sample of patients who presented to the ED in Suez Canal University Hospital. This study was implemented in three phases: pre-intervention phase, 115 patients were assessed by the traditional protocols; intervention phase, a structured training program was provided to the ED staff, including a workshop and lectures; and post-intervention phase, 230 patients were assessed by SATS. All the patients were retriaged 2 h later, calculating the LOS per patient and the mortality. Data was collected and entered using Microsoft Excel software. Collected data from the triage sheet were analyzed using the SPSS software program version 22.0.Results:The LOS in the ED was about 183.78 min before the intervention; while after the training program and the application of SATS, it was reduced to 51.39 min. About 15.7% of the patients died before the intervention; however, after the intervention the ratio decreased to 10.7% deaths.Conclusion:SATS is better at assessing patients without missing important data. Additionally, it resulted in a decrease in the LOS and reduction in the mortality rate compared to the traditional protocol.

简介：AbstractPurpose:To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department (TED) of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.Methods:A retrospective study was conducted in the TED in the affected zone. Data of all victims affected by the cyclone Fani on May 3, 2019 were obtained from disaster records and medical case sheets. All patients except death on admission were included. Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score (RTS) and injury severity score (ISS). Trauma injury severity score (TRISS) was also calculated.Results:Of 75 patients, 74 were included and the other one was brought dead and thus excluded. The age, median ± interquartile range (IQ), was 41.0 (27.7-53.0) years. The male to female ratio was 2:1. Most of the wounded were transported by the police control room vans on day 1: first 10 h, 50.0%; 10-24 h, 20.3%. The median ± IQ range of RTS, ISS and TRISS were 20 (14-28), 7.84 (7.841-7.841), and 97.4 (91.6-98.9), respectively. Simple external injury was the dominant injury type. Polytrauma (ISS >15) was seen in 67% cases and spine injury in 14% cases (7% cervical and 7% thoracolumbar). Injury causes included sharp flying objects (broken pieces of glasses and asbestos) in 31% cases, followed by fall of trees in 20.3%. Twenty-four patients were discharged after primary treatment, 30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center. There was no in-house mortality. Challenges were related to electricity failure, mobile network breakdown, infrastructure collapse, and delay in expertise repair from outside due to airport/railway closure.Conclusion:In cyclonic storm like Fani, sharp flying objects, fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions. Polytrauma was seen in the majority of patients though external injury was the commonest. The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.

简介：AbstractPurpose:The human-wildlife conflicts (HWCs) causing nuisances and injuries are becoming a growing public health concern over recent years worldwide. We aimed to study the demographic profile, mode of injury, pattern of injury, and outcome of wild animal attack victims presented to the emergency department.Methods:This retrospective cross-sectional study was conducted in the emergency department of a tertiary-care hospital in Eastern India. Data were retrieved from the medical records from May 2017 to May 2021. Patients of all ages and genders attacked by wild animals and secondary injuries were included in this study. Patients with incomplete data, injuries due to the attack of stray and domestic animals and trauma due to other causes were excluded. Demographic profile, mode of injury, the pattern of injury, injury severity score (ISS), radiological pattern, and outcome were recorded. Statistical analysis with R (version 3.6.1.) was conducted.Results:A total of 411 wild animal attack victims were studied, of which 374 (90.9%) were snakebite injuries and 37 (9.1%) were wild mammalian (WM) attack injuries. The mean age of WM attack victims was 46 years, and the male-to-female ratio was 4:1. Elephant attack injury (40.5%) was the most common WM attack injury reported. Most WM attacks (43.2%) occurred between 4:00 a.m. to 8:00 a.m. The median ISS was 18.5 (13-28), where 54.2% of patients had polytrauma (ISS>15). Elephant attack was associated with a higher ISS, but the difference was not significant compared to other animal types (p= 0.2). Blunt trauma was common pattern of injury in the elephant attack injury cases. Lacerations and soft tissue injuries were common patterns in other animal attacks. Among snakebites, neurotoxic was the most common type (55.4%), and lower extremity was the most common site involved.Conclusion:The young male population is the major victim of HWCs; and elephant is the most common animal involved. There is a need to design scientifically sound preventive strategies for HWCs and to strengthen the preparedness in health establishments to manage victims effectively.

简介：AbstractPurpose:The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients.Methods:The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients’ outcome.Results:The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8-12 and the third group was patients at high risk with score of 12-24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p < 0.001). Cronbach's alpha was 0.76 showing the reliability of this questionnaire to predict the future of patients.Conclusions:The study tool has a sensitivity to predict the BAT patients’ outcome, and has a proper specificity that can be used to reduce the use of harmful modalities such as computed tomography scan.

简介：【摘要】目的：探索封闭式应急管理模式在急诊新型冠状病毒肺炎疫情爆发期间的应用，为此后更好地应对突发公共卫生事件提供科学决策依据。方法：选择2019年11月-12月在急诊按常规工作模式就诊的4221例患者作为对照组，将2020年2月-3月新冠疫情期间前往急诊就诊的患者3252例作为试验组，开展封闭式应急管理模式，其主要措施包括组建急诊抗新冠肺炎疫情应急管理队伍、工作流程及规章制度的修订、隔离诊治传染源、完善疫情信息监测，加快疑似病例诊断、加强医护人员个人防护管理和院内感染防控和对高危人群开展追踪随访等，探究封闭式应急管理模式在急诊的运用效果。结果：疫情期间急诊开展封闭式应急管理模式取得了较好的成果，与对照组相比，前来就诊患者的预检时间、急诊停留时间、转诊时间、补液量都较过去减少；急诊患者满意度量表各维度接待和咨询、答疑解惑、服务态度、护士技术、保护隐私、环境及次序、等候时间、护士巡视和用药指导得分均显著高于对照组，差异具有统计学意义（P＜0.05）。结论：创立高效、有序的封闭式应急管理模式为急诊应对突发公共卫生事件的医疗、护理和防护事宜提供了保障，同时也提高了急诊管理者的组织协调和应急处理能力。

简介：ADepartmentStoreisaspecialtypeofstore,itdoesn'tselljustonetypeofproductratheritsellsmanydifferentproductscoveringallhumanneeds,inalargedepartmentstoreacustomercanbuybothcheapandexpensivewhereonecanbuyawiderangeoffooditems(项目)。

简介：

简介：

简介：

简介：

简介：Shuigou(GV26)isalsocalledRenzhong,locatinginthephiltrum,thejunctionofthesuperior1/3andthemiddle1/3.Itisoftenappliedtotreattheacutediseasesandsymptoms.Withregardtoacutelumbarsprainandacuterigidneck,Shuigou(GV26)functionstorelaxthemusclesandtendonsandbenefitthespinalcolumn.ItissaidinOdeoftheEssentialsofUnerstanding(TongXuanZhiYaoFu):'Shuigou(GV26)relievesthestiffnessandpainofthespinalcolumnanderectormuscleofspine.'ItissaidinSongsoftheJadeDragon(YuLongFu):'Forstiffnessandpainofspineandback,

简介：

简介：I.OutlineInordertocopewithvariouscrises,morethan80countriesintheworldhavedeclaredemergencystatesince1985.Sotospeak,'emergencystatesarea

简介：

简介：客观巨大的出血在武装冲突期间是威胁生活的。止血带是过去常减少在损伤的严重流血的重要医药设备。这研究的目的是以经验为主地评估在中国使用的当前的止血带并且在选择适当止血带提供信息给紧急情况护士。方法五条止血带由20个健康参加者是自我适用的。对止血带地点远侧的血流动用脉管的Doppler超声被估计。应用程序时间，疼痛，麻木，和另外的参数被评估。结果膀胱止血带和吊起止血带有效地堵塞了有成功的动脉的血流动在两个比75%高评价上面、更低的极限。货物带最快适用，拿(7.22

简介：Withthedevelopmentofmetropolitanregionsandtheappearanceofurbanagglomerations,citieshavebeenmorecloselyrelated.Fortherestrictedemergencyrescueresourceinasinglecity,ithasbecomemoreandmoreimminentforthedemandoftheintercitycollaborativeresistancetomajoraccident,soastoimprovetheprotectioncapacityofurbansecurity.Inordertofindaneffectiveintercityemergencyrescuecollaborativesystem,thispaperintroducestheconceptandanalysismethodofecosystemtheoryintointercityemergencyrescue.Basedontheanalysisoftheformation-processofemergencyrescueindividual,populationandcommunity,athree-levelintercityemergencyrescuecollaborativesystemisconstructedaccordingtothecharacteristicsofdynamicsandstructureofintercityemergencyrescueecosystem,thenthecollaborationmechanismofinformation,resourceandprocessintheintercityemergencyrescueecosystemisalsostudiedinthispaper,soastoofferavailablestrategyandmethodfortheecosystemtheoryappliedtointercityemergencyrescue.Throughthestudiesofintercityemergencyrescueeco-system,itilluminatesthattheproposedemergencysystemcannotonlycopewiththemajoraccidentmoretimelyandeffectively,butalsointegratetheintercityinformationresourcesandemergencyrescueresourceandprocessoptimization.

简介：Inordertoformanemergencycontrolpolicytablequickly,thispaperproposesafastalgorithmofemergencycontrolnamed'micro-stepdiscretemethod',whichisbasedonthephysicalmeaningofthegradientandthediscretecharacteristicsofemergencycontrol.Thenitisimprovedthroughthestabilitycriterion,integralstep,andmicro-stepfactor.Thispapertakesgenerator-sheddingastheemergencycontrolmeasures.Astheoptimalgenerator-sheddingcontrolisessentiallyanoptimalcontrolproblemandthegenerator-sheddingvariablesarealwaysconstant,itisconvenienttousethecontrolparameteralgorithmtosolvetheproblem,whichcancalculatethegradientofthetransientstabilityfunctiontocontrolvariables.