Objective To analyze the clinical characteristics, diagnosis, therapy and prognosis of acute pulmonary embolism (APE) following surgery so as to advise clinicians to pay more attention to and prevent postoperative APE. Method Thirty-one APE patients following surgery treated in the recent 8 years were analyzed retrospectively. The clinical features, diagnosis, therapy and prognosis of patients were analyzed. Results (1) Post-operative APE patients accounted for 21.9% of all APR patients during that period. The mortality of patients after surgical operation was 3.2%. (2) APE following surgery often occurred in patients after operations of spine, abdomen, gynecological surgery and point replacement as well as in patients with malignant tumor. The APE following surgery often occurred in the first week after surgery. The APE after surgery for malignant tumor occurred sooner. (3) Among many clinical manifestations, dyspnea (90.3%) was the commonest one. Other manifestations included chest pain, palpitation and syncope. The typical triad of dyspnea, hemoptysis and cheat pain was rarely seen. (4) The venous thrombolysis was a absolute contra-indication for massive PE after surgery. Catheter embolectomy and fragmentation, and surgical embolectomy were the alternative treatment. Conclusions Surgery is the essential risk factor of APE. When patients present dyspnea, chest pain or syncope, clinicians should pay attention to APE. Anticoagulation and embolectomy can improve the prognosais of the patients.

Emergency practice is an important part of clinical study.At present,the emergency teaching content of general practice is so wide that the teaching time is not enough,We do not pay enough attention to the cultivation of clinical thinking,pre-hospital care,two-way referral,and first aid skills training and so on.In this paper,the development of community emergency oriented teaching content,cultivation of de-escalation clinical thinking,and the pre-hospital emergency training and other aspects are studied for the students' teaching in emergency practice in order to improve the clinical practice teaching level of general medicine sttdents.

Objective To investigate the correlation between serum procalcitonin (PCT) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and prognosis in acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods A total of 88 patients with AECOPD admitted to emergency department of Peking university third hospital were prospectively studied,and were divided into three groups,namely high score group,median score group and low score group according to APACHE Ⅱ score.Serum PCT,hypersensitive C-reactive protein (hs-CRP),WBC and lactate were assayed within the first 24 hours after admission,the differences in those indicators between three groups were analyzed; and the correlation between PCT and APACHE Ⅱscore,hs-CRP,WBC,lactate were investigated.The patients were divided into survival group and death group according to prognosis,and the differences in those indicators between the two groups were analyzed.Results The serum levels of PCT was higher in high score group (0.60±0.32) ng/ml than that in median score group (0.36 ±0.23) ng/ml and that in low score group (0.24 ±0.19) ng/ml,differences between groups were statistically significant (P ＜0.01).The hs-CRP was higher in high score group M (P25,P75) 36.88 (10.14,47.16) mg/L than that in median score group 15.00 (3.64,30.33) mg/L and that in low score group 14.77 (4.35,15.80) mg/L (P =0.046).The PCT significantly correlated with APACHE Ⅱ and hs-CRP (P ＜0.01).The serum levels of PCT,APACHE Ⅱ score,hs-CRP and lactate were significantly higher in death group than those in survival group (P ＜ 0.05).Conclusions There is a good correlation between PCT and APACHE Ⅱ score in patients of AECOPD,suggesting PCT to be a sensitive predictor of prognosis.

Objective To investigate the clinical characteristic and treatment of dieulafoy lesion in order to improve the early diagnosis and treatment.Methods A retrospective review of clinical records of 15 cases of dieulafoy lesion admitted to our emergency department from October 2005 to August 2012 was carried out.Results The male patients were more vulnerable to this disease than female patients,thereby the ratio of male to female patients was 6.5∶ 1,and the mean age was 48.3 years.The precipitating factors were often obscure,and some possible factors were related with certain amount of wine (1/15),using nonsteroidal anti-inflammatory drugs (2/15),and eating irritant food (2/15),and a few patients had a past history of hypertension (3/15) or diabetes mellitus (5/15) and no patient had past history of peptic lesion and cirrhosis of liver.The Dieulafoy' s lesion occurred suddenly without premonitory symptoms such as pain or upset of stomach,presented with the episodes of hematemesis or hemafecia,and the patients were in a stage of shock and moderate to severe anemia because of massive blood loss.The majority of lesions located at the posterior wall of the stomach (9/15) or adjacent to the lesser curvature (10/15).Endoscopy was of prime importance for confirming the diagnosis of Dieulafoy's lesions.Endoscopic treatments included hemostasis with clipping combined with epinephrine submucosa injection and successfully excising the lesion in 14 patients (14./15).Surgical treatment was done in 1 patient after failure of endoscopic treatments.Conclusions Dieulafoy lesion is characterized by sudden massive hemorrhage of the alimentary tract,it most commonly locates in the pars posterior of stomach adjacent to the lesser curvature in the middle-aged and the elderly males.Endoscopy is the most simple and essential method to confirm the diagnosis,and emergency endoscopic hemostasis with clipping for treating Dieulafoy lesion is an effective therapeutic strategy.

Objective To evaluate the early diagnostic value of human heart-type fatty acid- binding protein (H-FABP) of acute coronary syndrome (ACS) and compare the diagnostic accuracy of different combination regimens of cardiac markers. Methods A total of 103 consecutive patients with chest pain (within 6 h after admission to Peking University Third Hospital,emergency department) suggestive of ACS were recruited for the analysis from April,2010 to June,2011.The blood levels of H-FABP,cardiac troponin-T (cTnT) and creatine kinase-myocardial band (CK-MB) were obtained at admission. The sensitivity,specificity,positive predictive value and negative predictive value together with the sensitivity and specificity in different phases of illness at admission were analyzed and compared among H-FABP,cTnT,CK-MB and different combinations by using SPSS version 17.0 software.Results Within 6 h of onset of symptom,the overall sensitivities of H-FABP,cTnT and CK-MB were 62.5％,30.6％ and 33.3％ respectively for patients with ACS.The sensitivity of H-FABP was significantly higher than that of cTnT and CK-MB (P ＜0.01 ).There were no differences in specificity and positive predictive value.The combination of H-FABP with cTnT had the greatest negative predictive value (53.8％ ).The sensitivity of H-FABP was higher during 3 - 6 h (77.8％ ) than during 0 - 3 h (53.3 ％ ) after chest pain onset (P =0.038).Within 0 - 3 h of onset of AMI,the overall sensitivities of the combination of H-FABP with cTnT and H-FABP with CK-MB (55.6％) were significantly higher than the combinaton of cTnT with CK-MB ( 24.4％ ) ( P =0.003 ).The sensitivity of the combination of H-FABP with cTnT was higher than that of single H-FABP during 0- 3 h and 3 -6 h after onset of AMI with increment in 3.3％ and 7.4％ respectively.The combination of H-FABP with cTnT had the greatest sensitivity ( 85.2％ ) during 3 - 6 h after onset.Conclusions H-FABP is the most sensitive cardiac marker in diagnosing of ACS in the early phase within 6 h,especially during 3 -6 h after onset.The sensitivity of the combination of H-FABP with cTnT is higher than that of H-FABP alone.The combination of H-FABP with cTnT has the best diagnostic value during 3 -6 h after onset of ACS.

Objective To investigate the regularity of variation in number of emergency patients visiting doctors within each 24 h during holidays and festival days,so as to provide a scientific basis for hospital administration and the rational allocation of human resources.Methods Based on the hospital's statistical data of emergency patients visiting doctors during winters from December 2010 to February 2014,a retrospective analysis was carried out for the number and the visiting time of emergency patients on holidays (weekends,the minor long holiday of 3 days for New Year and the major long holiday of 7 days for spring festival) and on general working days (Monday to Friday),respectively.The variation in number of patients and peak time of visiting doctors were analyzed by using circular distribution method,and compared the differences in the number of emergency patients visiting doctors and peak time period between holidays and working days.Results Most of emergency patient visitors were 50-79 years old males; the number of emergency patients on holidays was significantly higher than that on general working days,especially during the seven-day spring festival (P ＜ 0.01),while the number on New Year' s day was similar to that on weekends; peak time for emergency patients' visiting doctors was from 13:05 to 0:28 during general working days.On the contrary,the peak time occurred earlier at 10:05 until 21:05 during the holidays if the hospital offers half-day outpatient service,and in the absence of outpatient service,the peak time emerged further earlier at 9:16 until 21:26 during holidays.Conclusions The ages,number and the peak time of emergency patients visiting doctors on holidays are different from those on the general working days,so medical staff on duty should be arranged reasonably to follow this regularity.

Objective To evaluate the status of implementation of the chain of survival and the gap between the guideline's recommendations and clinical practice as well as to analyze the factors influencing the prognosis of cardiac arrest (CA) patients.Methods A retrospective analysis of CA in adult patients admitted to Emergency Department of Peking University Third Hospital from January 2012 to December 2013 was carried out.The epidemiology,clinical features,implementations of the chain of survival and outcome were compared between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients,with regard to the analysis of the predictors for survival and neurological outcome.Results A total of 414 patients with 69.8％ male and average age of (61.7 ± 18.0) years were divided into two groups,OHCA group (n =190) and IHCA group (n =224).Cardiogenic cause was found in 30％ of CA patients.There were 27.5％ patients with restoration of spontaneous circulation (ROSC),8.2％ patients discharged in survival and 3.1％ patients with good neurologic outcome (CPC =1 and 2).There were higher proportion of medical responders arriving to CA patients within 5 minutes after onset (99.1％ vs.10.5％,P ＜0.01),bystander carrying out cardiopulmonary resuscitation (100％ vs.15.3％,P ＜0.01),CPR initiated in 5 minutes (98.7％ vs.11.1％,P ＜ 0.01),defibrillation performed in 5 minutes (87.5％ vs.12.5％,P ＜ 0.01) in IHCA group compared with OHCA.There were no statistical differences in epinephrine administration and epinephrine dose,and targeted temperature management between two groups.There were higher proportion of ROSC (37.1％ vs.16.3％,P ＜ 0.05),higher percentage of survivals discharged (31.0％ vs.22.6％,P =0.002) and good neurologic outcome with CPC =1 or 2 (48.1％ vs.0.0％,P =0.029) in IHCA group compared with OHCA.Location of CA occurred and initial arrhythmia rectifiable with defibrillation treatment after ROSC were the favorable predictors for assessing the percentages of ROSC and survivals discharged.In contrast,male and age over 65 years were the unfavorable predictors of ROSC.Conclusions Improvement in outcome of victims with CA is required in every link of the chain of survival,especially in prehospital rescue act,bystander carrying out CPR,defibrillation,and therapeutic hypothermia in unconscious patients after resuscitation.The effective implementation of chain of survival concept can improve the prognosis of CA patients.

Organic phosphorus pesticide poisoning is a common disease in emergency.Compared with other clinical disease teaching,the basic concepts and theories of this unit are relatively less and more fixed,which is conducive to the case-based learning(CBL).The CBL teaching curriculum of organic phosphorus pesticide poisoning includes three aspects:pre-class teaching design,classroom teaching,after-class teaching evaluation and feedback.Pre-class teaching requires teachers to carefully read the syllabus,choose the teaching content,and design typical cases and problems.Classroom teaching emphasizes a lively and relaxed atmosphere,Teachers should guide students to think about questions and find answers themselves,and cultivated the correct clinic ideation through the combination of their theoretical knowledge and clinical practice in a classroom environment.Teaching evaluation and feedback help teachers to summarize what they are teaching and promote the teaching,which benefits both the teachers and students.

OBJECTIVE To study the characteristic of pathogenic bacteria isolated from patients in the emergency department and to investigate the relativity of experience and targeted antibiotic treatment.METHODS The pathogenic bacteria and drug sensitivity results of all samples in 2005 were analyzed and the relativity of experience and targeted antibiotic treatment was summarized.RESULTS Totally 1061 specimens were acquired from 463 patients including sputum,venous blood,middle urine,purulent fluid on wound surface and 312 strains pathogenic bacteria were isolated.52.09% of them were Gram-positive bacteria,28.29% were Gram-negative bacteria and 19.16% were fungi.Of all pathogenic bacteria,there were 44 strains of drug-resistant bacteria.The relativity of experience and targeted antibiotic treatment was 89.67%.CONCLUSIONS The patients admitted to the emergency department are in severe and complicated conditions,with multiple system diseases.The pathogenic bacteria of emergency department are different from the bacteria of other units.Antibiotic treatment by experience should combined with bacteria monitoring and drug sensitivity.Infection caused by fungi should be paid great attention.

Objective To explore the impact of atrial fibrillation (AF) recognized at primary diagnosis on clinical features and outcomes of patients with AF in emergency service.Methods Data were collected from consecutive patients admitted in resuscitation room in the Department of Emergency (ED) of a major comprehensive teaching hospital,from January 1,2011 through December 31,2015.Patients were checked by electrocardiogram examination and / or monitored in resuscitation room after admission,and were divided into patients with AF recognized at a primary diagnosis and those with AF judged by alternative primary diagnoses in ED.The main criteria of prognosis were the length of resuscitation room stay,number of repeated ED visits,and outcome scale (such as death,transferred to intensive units,transferred to general wards,or direct discharge).Non-paired student t test,x2,and circular distribution analysis were performed using SPSS 10.0 and EXCEL 2007 software.Results A total of 929 patients with mean age of (70.3 ± 12.7) years,and 502 (54.0％) female were enrolled.There were 122 cases with AF not recognized at primary diagnosis but by an alternative primary diagnosis (non-primary group,NPG),and 807 cases with AF recognized at primary diagnosis (primary group,PG).Compared with the PG,the patients were older [(76.9 ±9.3) vs.(68.7 ± 14.4),P ＜0.01],had more comorbidities [(1.75 ± 1.26) vs.(0.08±0.39),P＜0.01],higher APACHE Ⅱ scores [(17.89±8.19) vs.(8.64±4.15),P＜ 0.01],longer resuscitation room stay (P ＜ 0.01),higher mortality (11.5％ vs.0.2％,OR =52.176,95％ CI:11.698-232.710,x2 =78.928,P ＜ 0.01) and a higher percentage of transferring to intensive careunit (14.8％ vs.5.1％,OR=3.234,95％CI:1.791-5.838,x2 =16.674,P＜0.01) in NPG.There were no significant difference in number of repeated-visits in ED between the PG and the NPG.Conclusion Patients with AF in the ED judged by alternative primary diagnosis are older and have more comorbidities,higher mortality and higher probability to be transferred to intensive care unit than patients with AF directly recognized by a primary diagnosis.This cohort of patients with special characteristics should be meticulously cared for and be distinguished from the patients with AF crystal clear at a primary diagnosis.Future studies are needed to examine the specific impact of AF on outcomes in the setting of primarydiagnoses in ED.