Critical Illness ; Humans ; Tertiary Care Centers ; Transportation of Patients ; methods

It is a brief introduction of different transfer modes with focus on ranges,measures,quality control,systems,training and process of transfer system of children according to the situation in China even abroad.With analysis of main problems and causes of children' transfer system,the discussion contained management of pre-hospital transfer system,risk assessment of critical patients,establishment of transfer network of critically ill children,the relationship of first aid and pre-hospital transfer,an effective response to public health emergencies of children as well as developmental mode for emergency transfer of children.

High fidelity simulation training is the results of medical education and teaching method reform in recent years.This article focused on the discussion of simulation training significance,teaching model with simulation devices,establishment of simulation center,and the application and value of simulation training in emergency medical education.The training method which includes brief theory lectures of international simulation,separated technology practice,comprehensive simulation drill and video analysis is a development potential in the pediatric emergency medical education.

As a new branch of subject,pediatric emergency medicine developed rapidly but imbalanced.In this article,we reviewed the current situation of pediatric emergency medicine,analyzed the existed main problems and put forward some proposals about its development.Because we lacked professional and standardized medical team and systems,personnel configuration distributed unreasonably,pre-hospital transport developed relatively backward and scientific researches in this field do not have big progress,we are now still in lack of unified documents which are suitable for our national conditions as a guideline.So it is highly important to organize specialized talent training,introduce some new technologies and strengthen multidisciplinary cooperation for further constitute and promote guideline.

In March 2013,human cases of infection with the H7N9 avian influenza virus were reported in Shanghai and other places of China.This article highlights the background of human infection with the H7N9 avian influenza virus,the biological characteristics,epidemiology and pathogenesis,the clinical features,prevention and treatment of H7N9 avian influenza.In all,Pediatricians need to be aware of H7N9 avian influenza.

Objective To explore the effective urgent scheme and therapeutic strategy of the two cases of cured patients with human H5N1 avian influenza pneumonia.Methods A patient of 9 years old with human avian influenza pneumonia from Xiangtan in Hunan province was transported to the urgent care center in the children's hospital of Hunan province on Oct 18,2005.The patient got recovery with the treatment for 25 days and he was the first cured patient with the human avian influenza pneumonia in China.Another 6 years old patient with the same disease from Chenzhou Region was transported to the hospital on Jan 9,2006.The patient was cured with the treatment for 44 days and he was the youngest patient with the human avian influenza pneumonia in China.Results According to the characteristic of etiological agent and epidemiology,the clinical features of the human avian influenza pneumonia were analyzed.The effective therapeutic strategies were formulated,including the CPAP assistant ventilation,the protection of organ′s function,and the application of low-dosage glucocorticoid and microcrystalline heparin.The consummate emergency medical service system and scientific project of emergency had played important roles in the treatment of human avian influenza pneumonia.Conclusion The patients with human avian influenza pneumonia can be cured with the early detection of the disease and prompt integrative measure.

The incidence of invasive candida infection in critically ill patients is rising year by year. It's clinical manifestation lacks specificity which is easy to result in missed diagnosis or misdiagnosis.Tradi-tional diagnosis methods need very long time and have low positive rate,which are easy to delay treatment,so early diagnosis is particularly important.1 ,3-β-D-glucan,mannan and antibodies,anti-enolase antibodies,can-dida score and colonization index may be helpful to make early diagnosis.

Objective To investigate the causes and influencing factors of dead on arrival (DOA) in children.Methods The clinic data from 66 children with DOA admitted in the emergency department of Hunan Children's Hospital from Jan 2010 to Apr 2012 were analyzed retrospectively.Results All of the 66 cases had cardiac respiratory arrest when admission.Fourteen cases had arrest for 10 minutes,12 cases for 30 minutes to an hour,40 cases had no details.Forty-four (68.2％) cases were carried by parents,22(31.8％)cases were transferred by medical professionals.The main causes of DOA were severe pneumonia with respiratory failure and (or) heart failure,intracranial infection,neonatal diseases.All cases were taken to resuscitation room by triage immediately.Tracheal intubations were completed in 48 cases and intravenous access with injection of epinephrine and other resuscitative drugs were established in all cases,but all cases were dead due to breathing and heartbeat stopped for a long time.Conclusion DOA is one of the important reasons for pediatric high-risk.The key of reduction of DOA incidence and improvement of survival rate is to improve pediatric emergency medical service system,strengthen the health education for the parents,to carry out training and establish homogenization service in emergency ICU.

Sepsis is a major cause of secondra y pancreatic injury in critically ill children.A lagr e number of inflammatoyr m ediators werer elesa ed after acute ijn ury of the pancreas,which may aggravate the inflammatory reaction and the stress reaction.Nuclear factor E2-related factor 2(Nrf2),an important protec-tive transcription factor,could activate the expression of more than 500 genes.Most of the genes have the function of cytoprotection.Studise have dem onts rated that Nrf2 plays a certain role in cytoprotection,such as regulating the inflammatory response,anti-oxidative stress,improving mitochondrial functoi n and decreasing toxic protein aggregation.This review explored the protective mechanism of Nrf2 in pancreatic injury caused by sepis s.

The energy metabolism of septic patients is serious disorder.The major manifestation is protein degradation,the enhancement of glyconeogenesis and the adipose lipid mobilization.This may be link to abnormal ways of inflammatory media,the hormone secretion and ubiquitin-proteasome caused by sepsis.The discussion on high metabolic mechanism of sepsis,has great significance for guiding clinical practice,promoting targeted interventions and treatment measures and improving the prognosis of patients.This article summarized the progress on hyper metabolism in sepsis.