With the change of COVID-19, the prevention and control of COVID-19 infection epidemic entered a new stage in December 2022. How to quickly complete the emergency treatment of a large number of patients in a short period of time, and ensure that patients in emergency department can get rapid and effective medical treatment has always been an urgent problem that emergency department need to solve. The Department of Emergency Medicine of West China Hospital of Sichuan University has adopted patient-oriented management measures based on the core idea of the new public management theory, and has achieved remarkable results. Therefore, this article summarizes the workflow and nursing management strategies of the emergency department rescue area of West China Hospital of Sichuan University in dealing with the batch treatment of COVID-19 infected patients, including optimizing and correcting the environment layout of the ward, implementing the “secondary triage” mode in the rescue area, adding an inter-hospital referral platform for critical patients with COVID-19 emergency, building a conventional COVID-19 reserve material repository in the emergency department, setting up a field office for multi-department joint emergency admission service, optimizing emergency transport services for patients with COVID-19, scientific scheduling and reasonable human resource management, and providing humanistic care for employees, in order to provide reference for the management practice of the emergency department.
Through reviewing the regulations on the right of emergency treatment of hospitals, we analyzed reasons of emergency treatment of hospitals, including uninformed patients and informed patients without consent in emergency situations, as well as the risk of emergency rescue of hospitals. We put forward how to consider the judgment of emergency situations, justification of emergency treatment of hospitals, and risk attribution. We suggested improving the related legislation and regulations, developing compulsory medical insurance and a medical rescue system on emergency treatment.
ObjectiveTo compare the short- and long-term effects of emergency surgery (ES) and self-expanding metal stent (SEMS) in treatment of malignant left-sided colonic obstruction.MethodsThe patients with malignant left-sided colonic obstruction who met the inclusion and exclusion criteria in the Third Affiliated Hospital of Soochow University from October 2010 to October 2020 were retrospectively collected and divided into ES group (n=43) and SEMS group (n=22). The baseline data, surgical data, postoperative data, and prognosis (overall survival and relapse free survival) were compared, and the risk factors of tumor recurrence after surgery were further analyzed by Cox proportional hazards regression model. ResultsIn this study, 65 cases of malignant left-sided colonic obstruction were included, including 43 cases in the ES group and 22 cases in the SEMS group. There were no statistical differences in the baseline data of the two groups (P>0.05). There were no significant differences in the incidence of postoperative complications [13.6% (3/22) vs. 23.3% (10/43), P=0.555], recurrence rate [40.9% (9/22) vs. 37.2% (16/43), P=0.772], and rate of receiving postoperative chemotherapy [68.2% (15/22) vs. 48.8% (21/43), P=0.138] between the SEMS group and ES group. Compared with the ES group, although the median hospitalization time was longer (20 d vs. 12 d, P=0.001), and the median hospitalization cost was higher (65 033 yuan vs. 40 045 yuan, P=0.001), the stoma rate of the SEMS group was lower [36.4% (8/22) vs. 88.4% (38/43), P=0.001], and the minimally invasive (laparoscopic) rate was higher [36.4% (8/22) vs. 7.0% (3/43), P=0.008]. There were no significant differences in the 4-year cumulative overall survival (46.9% vs. 48.4%, P=0.333) and 4-year cumulative relapse free survival (36.2% vs. 44.8%, P=0.724) between the SEMS group and ES group, but the overall survival of the SEMS group was better than that of the ES group for the patients with stage Ⅲ–Ⅳ (χ2=4.644, P=0.047). Multivariate analysis of Cox proportional hazards regression model showed that increased TNM stage increased the risk of postoperative tumor recurrence of patients with malignant left-sided colonic obstruction [HR=2.092, 95%CI (1.261, 3.469), P=0.004]. ConclusionsShort- and long-term effects of ES and SEMS in treatment of malignant left-sided colonic obstruction are equivalent. Although SEMS mode has a longer hospital stay and higher hospitalization costs, stoma rate is lower and laparoscopic surgery rate is higher. Overall survival of SEMS mode in treatment malignant left-sided colonic obstruction patients with stage Ⅲ–Ⅳ is better.
ObjectiveTo provide recommendations for the management of intensive care unit patients without novel coronavirus disease 2019 (COVID-19).MethodsWe set up a focus group urgently and identified five key clinical issues through discussion. Total 23 databases or websites including PubMed, National Guideline Clearing-House, Chinese Center for Disease Control and Prevention and so on were searched from construction of the library until February 28, 2020. After group discussion and collecting information, we used GRADE system to classify the evidence and give recommendations. Then we apply the recommendations to manage pediatric intensive care unit in the department of critical care medicine in our hospital. ResultsWe searched 13 321 articles and finally identified 21 liteteratures. We discussed twice, and five recommendations were proposed: (1) Patients should wear medical surgical masks; (2) Family members are not allowed to visit the ward and video visitation are used; (3) It doesn’t need to increase the frequency of environmental disinfection; (4) We should provide proper health education about the disease to non-medical staff (workers, cleaners); (5) Medical staff do not need wear protective clothing. We used these recommendations in intensive care unit management for 35 days and there was no novel coronavirus infection in patients, medical staff or non-medical staff. ConclusionThe use of evidence-based medicine for emergency recommendation is helpful for the scientific and efficient management of wards, and is also suitable for the management of general intensive care units in emergent public health events.
Emergency medical rescue system is an important part of public health and urban security system. Based on the emergency medical rescue practice of" 6·24”sudden high mountain collapse disaster in Diexi town of Mao county, this article mainly analyzes, summarizes and puts forward the countermeasures and suggestions for the emergency medical rescue system, which has been sharpened, explored and established in numerous disasters in Sichuan province.
After 5?12 When Chuan earthquake,The third hospital of Mianyang which is the nearest hospital of severely afflicted area recived 1 804 wounded persons.We aimed to summarize the achievement and limitation in management of medical rescue, medical treatment of the wounded and logistical support. Hospital shouled set up a special medical rescue system to relieve the sufferings of victims of unexpected natural calamities which include staff training, reserve supplies,psychological intervention of the wounded and safeguard of the rescuers.
Objective To systematically and thoughtfully summarize the experience and lessons of emergency medical rescue during the Wenchuan earthquake in order toprovide relevant evidence to inform decision making for future emergency medical situations. Methods The relevant data was collected and analyzed through brainstorming and questionnaire. Result ① The Sichuan province Headquarters for Earthquake Disaster Relief was organized at the first time after the earthquake, and a coordination mechanism was established between the national ministry and Sichuan, as well as different departments and the army, to ensure the powerful, ordered, and effective action for the medical rescue. ② Thirty-five thousand eight-hundred medical rescue workers were organized within 72 hours of the earthquake and were sent to all the worst-hit counties via land, water, and air. Some effective measures such as “Four concentration”and“Transfer of wounded patients” were used to reduce the mortality and disability of the wounded patients. ③ The anti-epidemic measures were performed across all the villages and settlements of the people affected by the earthquake to ensure no recurrence of public health events during the first two weeks after the quake. ④ Medical resources were organized scientifically and transparently to meet the demand of medical rescue. ⑤ The recovery and re-establishment of medical services were promoted by two phases. Conclusion The emergency medical rescue of those affected by the earthquake in the Sichuan Province is succesful. In the future, we should establish an effective emergency medical rescue system, supply the reserve of medical resources, improve the equipment of medical rescue teams, strengthen the establishment of discipline of disaster medicine, and improve the emergency pre-plan.
This paper expounds the experiences and thinking of enclosed emergency management under emergency coronavirus disease 2019 (COVID-19) epidemic in a Grade A tertiary hospital in Shanghai. The main emergency prevention and control measures included accurately controlling information of all people in the hospital, implementing strict hospitality prevention and control programs, providing strongly logistics support services, ensuring the safety of medical services, stabilizing mood of all people in the hospital, and guiding the correct public opinion. During the enclosed management period, the hospital worked smoothly and orderly, and no infection or transmission ocurred. Practice shows that the use of enclosed emergency management model is an effective way to respond to emergency COVID-19 epidemic, which can provide scientific reference for the hospital facing public health emergencies.
ObjectiveTo analyze the earthquake emergency plans in 31 provinces (including autonomous regions, municipalities directly under the Central Government) of China, in order to summarize the relevant characteristics and discuss the existing problems to provide references for the revision and improvement of the earthquake emergency plan for the government and relevant departments. MethodsComprehensive literature search was conducted in the following websites:The Central People's Government of the People's Republic of China, China Earthquake Information Network, China Earthquake Administration, Government Websites and Earthquake Information Networks in 31 provinces (including autonomous regions, municipalities directly under the Central Government) of China. The literature which met the inclusion criteria was collected for descriptive analysis. ResultsEarthquake emergency plans in 31 provinces (including autonomous regions, municipalities directly under the Central Government) played a guiding role in the earthquake emergency and rescue work. However, some existing problems needed to be solved, which included:poor manoeuvrability of earthquake emergency plan, inadequate mechanisms of early warning and prevention, lower security on command platform and emergency shelter, and unclearly defined updating and revising time. ConclusionDifferent provinces (including autonomous regions, municipalities directly under the Central Government) of China should establish sound laws and regulations, improve the mechanisms of early warning and prevention, strengthen security measures of command platform and emergency shelter, and update and revise plans timely combined with its own characteristics, so that earthquake emergency plans could play a greater role in earthquake emergency in the future.
To evaluate the ultrasound imaging characteristics and diagnostic criteria for acute abdominal Meckel's diverticulum disease (MD), we retrospectively analyzed the ultrasonic characteristics, clinical data of 58 cases of pathologically proved MD from January 2009 to May 2012. We found that among all the 58 patients, 21 patients were diagnosed with the preoperative clinical diagnosis of MD. Fourteen cases of MD inflammation with acute appendicitis were evaluated by pathological examinations after the surgery. We also found 4 cases of MD with perforation, 15 cases of MD with intussusceptions, 14 cases MD with intestinal obstruction, 5 cases of MD secondary to intestinal obstructionor intestinal necrosis, and 5 cases of MD without any obvious complications. Emergency ultrasound examinations revealed 8 cases of simple MD, 1 case of MD with intussusceptions, 9 cases of MD with acute appendicitis, 12 cases of MD with intestinal obstruction, 2 cases of MD with intussusceptions and intestinal obstruction, 1 case of MD with omphalocele and 1 case of MD with abdominal abscess. The emergency sonographic findings suggested that MD was relatively fixed bowel or thick-walled cystic mass, with one end connected to small intestine, and the other end connected to the blind side, at the periumbilicus region or at the lower right abdomen. A conclusion could be drawn that MD is difficult to be detected by ultrasound (detection rate was about 15.5%), and MD with complications such as intussusceptions, intestinal obstruction, acute appendicitis can usually be more easily detected (detection rates were 24.1%, 24.1% and 15.5%, respectively). Sonography is a simple, effective way to make diagnosis and differential diagnosis of MD with different acute abdomen symptoms from other disease.