Objective To explore the variations in category of internal diseases in order to plan out strategies to deal with during pre-hospital period in Chongqing urban area.Methods The category of internal diseases of pre-hospital emergency service in Chongqing urban area from January 2004 to December 2013 was studied and the data were analyzed retrospectively.Results Firstly,the number of patients in pre-hospital emergency service continued to mount up year by year,from 6031 patients in 2004 to 12 264 patients in 2013.The ration of male to femal was 1.24∶1 to 1.68∶ 1,and the cases of female increased year after year,from 2246 to 5486.Secondly,cardiovascular disease was the leading illness in the wide varieties of internal disease (15.35％-19.36％).The number of cerebrovascular accident (9.72％-13.11％),respiratory diseases (7.48％-10.20％) and digestive diseases (8.36％-10.58％) were escalating.However,the acute poisoning cases (2.36％-6.18％) showed a tendency of decline.The peak time of the pre-hospital emergency service was stable in past ten years.Thirdly,there were seasonal variation in incidence of cardiovascular,cerebrovascular and respiratory disease,more cases occurred in January and December than in other months.Alcoholism commonly peaked before Spring Festival.Fourthly,the peak time of internal disease occurred in the past 10 years was stable,peaked during 20:00-24:00,and the trough time was during 0:00-4:00,the ratio of trough to peak ranged from 30.7％ to 43.5％.Conclusion The variation of the internal disease category was associated more or less with seasonal rotation,the improved living standards,and stress of modern life,and the incidence of emergency illness were escalating year by year,thus the corresponding measures should be instituted to deal with those major changes.Improving pre-hospital emergency response capacity and efficacy of treatment is of great significance.Strengthening the prophylaxis and healthcare,and establishing a professional capability for triage classification of diseases during emergency service are great essential for promoting the swiftness of prehospital emergency response.

Objective To assay the early quality of life and posttraumatic stress disorder (PTSD) and relating influential factors in patients with severe blunt chest trauma (sBCT).Methods Demographic and clinical data of sBCT patients treated between January 2011 and December 2011 were collected.Early quality of life and PTSD symptom level at posttraumatic months 1,3,and 6 were analyzed by using short form 36 health survey (SF-36) and impact of event scale-revised (IES-R) respectively.Furthermore,logistic regression analysis was performed to identify the risk factors associated with quality of life of the patients.Results A total of 107 patients were included in the study.Ultimately,83 patients were available to the 6-month follow-up.A low score for SF-36 remained at posttraumatic 6 months and one-third of the 83 patients sustained mild or severe PTSD symptoms.Major influential factors to posttraumatic quality of life included age,ISS ≥ 20,combined craniocerebral injury,combined spinal and pelvic injuries,posttraumatic complications,and PTSD.Conclusions Early quality of life in sBCT patients is poor.Therefore,the early intervention with identification of specific risk factors is contributive to better quality of life.

Objective To sum up the experience on diagnosis and treatment of blunt bronchial injuries .Methods From January 2002 to December 2009 ,18 patients with blunt broncheal injuries were admitted .The definitive diagnosis was confirmed by fibro-bronchoscopy .Twelve patients suffered from main bronchial injuries and the remaining 6 patients from lobe bronchial injuries .All patients managed with surgical therapies .Emergent operation was performed in 15 patients and elective operation in 3 patients .End to end bronchial anastomosis was performed in 15 patients and primary repair in 3 patients .Results There was no death in this group .One patient after emergent primary repair developed ischic necrosis in the repair site on 3 the postoperative day and under-went resection of the necrotic tissue followed by end to end anastomsis .Thirteen patients had no complications and were able to take part in normal activities .Anastomotic stricture occurred in 5 patients and managed with granulation tissue resection and cryothera-py .Four patients were healed but one patient underwent lobectomy 6 months later as a result of recurrent stricture and severe dysp-nea .Conclusion Fibrobronchoscopy is able to define the blunt bronchial injuries immediately .Early surgery after trauma can im-prove the successful rate of treatment .

Objective To detemine the value of cardiac troponin in early diagnosis of severe myocardial contusion in the dog.Methods Twelve dogs weighing (11.4 ± 1.5) kg were subjected to severe myocardial contusion by impacting the chest area with BIM-Ⅱ biological impact machine.Electrocardiogram,cTnT and cTnI were measured before,immediately,and 2,4,6 and 8 hours after injury.Animals were then killed and the serum was separated for gross examination and triphenyl tetrazolium chloride (TTC) staining.Results Supraventricular tachycardia,ventricular tachycardia,ventricular premature beat,myocardial ischemia,atrial fibrillation,and ventricular fibrillation were seen on the electrocardiogram 2,4,6 and 8 hours after the injury,which suggested a high sensitivity but low specificity.cTnT and cTnI levels revealed no specific changes at postoperative 2 and 4 hours,but cTnT and cTnl were significantly increased to (0.130 ± 0.052) ng/ml and (1.615 ± 0.371) ng/ml at postoperative 8 hours,significantly higher than that immediately after operation (P ＜ 0.01).Sensitivity and specificity of cTnT and cTnI were both 100％,while the specificity of the TTC staining was (39.78 ± 9.07)％.Conclusion Cardiac troponin is of high sensitivity and specificity in early diagnosis of severe myocardial contusion and has good correlation with pathological changes,which exhibits great potential in clinical application.

OBJECTIVE: To improve the quality of management in biliary leakage following liver or bile tract injury. METHODS: All patients with liver and/or bile duct injuries from October 1987 to February 1998 inclusive were studied retrospectively in respects of their age, sex, type and mechanism of injury, the grade of liver trauma, treatment and subsequent complications. RESULTS: In 271 patients with hepatobiliary injuries, 14 (5.17%) developed a bile leak, which fell into 2 main types: Type I, injuries involving extrahepatic or first-order bile ducts (6 patients);Type II, injuries of more peripheral biliary radicles (8 patients). Most bile leakages in this series closed spontaneously in 7-14 days postoperatively. Intra-abdominal infection (28.57%) was a frequent complication which required active intervention. CONCLUSIONS: In the management of biliary leakage, it is important that (1) the leakage should be well localized; (2) adequate abdominal drainage plays a key role in controlling any type of biliary leakage; (3) decompression of the biliary tract favors the healing of injured biliary tree, especially in Type I leakage.

Objective To further improve level of severe chest trauma care in the elderly pa-tients. Methods A retrospective study was done on data of 148 elderly patients (≥65 years with se-vere chest trauma (AIS≥3 points) (elderly group) treated in Chongqing Emergency Medical Center from June 1995 to May 2005. A total of 1669 patients at age less than 65 years and with AIS≥3 points were set as control group in the same research period (control group). Results The main injury mechanism was blunt trauma, which aceouted for 83.8% (124/148) in elderly group, higher than 69.3% (1 157/ 1 669) in control group (P < 0. 01). The injury causes were mainly traffic accidents, slip and fall from a height. Traffic accidents and slip accounted for 66.2% (98/148) and 14.9% (22/148) respectively, which was significantly higher than 50.6% (845/1 669) and 3.1% (52/1 669) respectively in control group (P < 0. 01). There was no statistical difference upon ISS, RTS, GCS and prehospital time between both groups (all P value > 0.05). The fatality rate and indicence rate of complication in the elerly group were 15.5% (23/148) and 25.7% (38/148), which was significantly higher than 6.5% (108/1 669) and 10.4% (174/1 669) respectively in control group (P <0.01). The fatality rate in elderly group with complications was significantly higher than that in control group (51.7% vs 26.7%) (P < 0.01), while those without complications showed no statistical difference between two groups (6.7% :3.5%) (P >0. 05). Conclusions The patient' s age and complications are relative independent factors to es-timate the trauma care outcome. To raise risk awareness and strengthen the management of complications and supportive treatments for organ function are key to improve survival rate of the elderly patients with se-vere chest trauma.

Objective To explore the feasibility, safety and effectiveness of mobile intensive care and pre-hospital surgical service for patients with severe thoracic injuries so as to further improve success rate of treatment of severe thoracic trauma. Methods A retrospective study was done on the clinical data of 72 patients with severe thoracic injuries (AIS≥3) treated by surgeons from Chongqing Emergency Medical Center (CEMC) from April 1998 to August 2008. The patients were divided into pre-hospital group (n = 36) and in-hospital group (n = 36) according to the time that the definite surgery performed. Results (1) There was no significant statistical difference upon arrival time from scene to primary hospital between two groups (P > 0.05). For patients in pre-hospital group, the time to receive definite surgery was (3.9±4.1) hours, which was significant shorter than (9.6±8.2) hours in in-hospital group (P < 0.05). (2) There were no statistical significant differences upon blood loss volume and blood transfusion volume between two groups (P > 0.05). (3) There was no significant statistical difference upon ISS value between two groups (P > 0.05), but the RTS value of pre-hospital group was significantly lower than that of in-hospital group (P < 0.05). The incidence rate of shock in pre-hospital group was 86.1%, which was significantly higher than 41.7% in in-hospital group (P < 0.05). (4) The percentage of patients who received thoracic close drainage in pre-hospital group was 16.7%, which was significantly higher than 5.6% in in-hospital group. There was no significant statistical difference upon thoracic close drainage plus thoracotomy, thoracic close drainage plus laparotomy and thoracic close drainage plus other operations between two groups. However, the operative rate of thoracic close drainage plus thoracotomy for penetrating injury was 4.8 times higher than that for blunt injury in pre-hospital group, and 1.9 times higher than that for blunt injury in-hospitai group. The operative rate of thoracic close drainage plus laparotomy for blunt injury was 5 times higher than that for penetrating injury in prehospital group, and 4.5 times higher than that for penetrating injury in in-hospital group. The overall survival rate was 95.8% (69/72). Five of eight moribund patients were saved in pre-hospital group, the prevented death rate accounted for 13.9% (5/36) in this group. Conclusions It is flexible, safe and effective to implement mobile intensive care and definite lifesaving surgical interventions for patients with severe thoracic injuries in primary hospitals. After the condition of the patient is stabilized, a quick transportation of the patients to a higher level trauma centers (hospitals) for further treatment may reduce the pre-hospital death rate.

Objective To investigate the risk factors affecting the mortality in patients with severe chest trauma (SCT).Methods A total of 777 patients with SCT (AIS≥ 3) treated at Chongqing Emergency Medical Center from January 2006 to April 2009 were involved for retrospective study.Multivariate stepwise logistic regression analysis was used to analyze 15 possible risk factors affecting their mortality.Results The factors affecting mortality in patients with SCT included hemorrhagic shock (X6,B =1.710,OR =1.291,P＜0.01),multiple organ dysfunction syndrome (MODS) (X7,B=3.453,OR =1.028,P＜0.01 ),pulmonary infection ( X9,B =2.396,OR=10.941,P ＜ 0.01 ),abdominal organ injury (X11,B=1.542,OR=1.210,P＜0.01) and thoracic AIS ≥3 (X14,B =0.487,OR =1.622,P＜0.01 ).While the protective factors affecting mortality in patients with SCT contained age ≤60 years old (X1,B =-0.035,OR =0.962,P＜0.05) and GCS≥12 (X13,B=- 0.635,OR=0.530,P＜0.05).Conclusions The age,posttraumatic complications (hemorrhagic shock,MODS,pulmonary infection)and accurate diagnosis and evaluation of trauma severity are the related factors to predict the prognosis.Development of effective treatment measures based on these risk factors plays a key role in the survival rate of patients with SCT.

Objective To investigate the standards for management of traumatic intrapulmonary hematoma and hematocele.Methods A retrospective study was conducted on the data of 21 patients with traumatic pulmonary hematoma or hematocele (AIS≥4 points) treated at Chongqing Emergency Medical Center from August 1999 to August 2010.Results The overall mortality was 14％ (3/21)and death causes were respiratory passage hemorrhea and asphyxia.About 67％ of patients ( 14/21 ) were associated with hemoptysis,which lasted for 1-240 days (mean,15.8 days).The duration of hemoptysis due to traumatic intrapulmonary hematoma hematocele was about 3.4 times longer than that due to simple traumatic pneumatocele.The hematoma or cyst disappeared at average 61.6 days,with 3.4 times longer than the disappearance time of intrapulmonary hematoma or hematocele in comparison with that of simple pneumatocele.The size and position of traumatic pulmonary hematoma or pneumatocele influenced the treatment methods,outcomes and prognosis.Conclusions Standardized treatment for traumatic pulmonary hematoma or hematocele is key to improving the cure rate.Early emergency definitive surgery is required for patients with traumatic intrapulmonary hematoma or hematocele greater than 6.0 cm in diameter and for those with pneumatocele greater than 6.0 cm in diameter combined with incapability of keeping breathing due to severe air leakage.

Objective To investigate the role of ISS and new injury severity score (NISS) in evaluation of complications and treatment outcomes in the multiple trauma patients combined with severe chest trauma.Methods AIS-2005 was used to carry out retrospective analysis of the 1 377 multiple trauma patients combined with severe chest trauma (thoracic AIS≥3 points) treated at Chongqing Emergency Medical Center from January 2005 to January 2011.In the meantime,the related NISS and ISS were calculated and their relations with mortality were analyzed.Results The overall healing,mortality and complication rate were 93.2％,6.8％ and 28.5％ respectively.Both the ISSN and ISS had positive correlation with morbidity of complications ( r =0.569,P ＜0.01 ;r =0.442,P ＜0.01 ) and mortality (r =0.693,P ＜ 0.01 ; r =0.774,P ＜ 0.01 ),but a stronger relevance was demonstrated between NISS and morbidity of complications and between ISS and mortality rate.NISS showed a higher sensitivity but less specificity than ISS in prediction of morbidity of complications (P ＜ 0.01 ),and NISS was not superior to ISS in prediction of mortality ( P ＞ 0.05 ).Conclusions Both NISS and ISS work well in evaluating the complications and treatment outcomes in multiple trauma patients combined with severe chest trauma.Thus,NISS should be applied for prediction of complication occurrence and ISS for treatment outcomes to maximize the prediction accuracy.