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 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.

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 investigate the effect and significance of AIS-ISS in assessing injury severity and prognosis of aged trauma patients.Methods A retrospective study was done on data of 2 599 patients hospitalized over 24 hours from October 2009 to September 2012.There were 597 patients aged 60 years or over (aged group) and 2 002 patients aged below 60 years (non-aged group).Injury causes,ISS,complication incidence,emergency operation rate,and ICU treatment were compared between the two groups.Results Similar in causes of injury,the two groups were mainly injured from traffic accidents and falls on the ground or from height.ISS was (10.7 ± 7.8) points in aged group and (10.4 ± 8.3) points in non-aged group,with no significant difference (t =0.653,P ＞ 0.05).Incidence of major complications was higher in aged group than in non-aged group (P ＜ 0.01).Top three complications were pulmonary infection or atelectasis (4.36％),shock (4.19％),and urinary infection (3.52％).Lower emergency operation rate (21.44％ vs 30.57％,P ＜ 0.01),higher ICU treatment (75.71％ vs 36.26％,P ＜ 0.05),and higher mortality (3.85 ％ vs 2.25％,P ＜ 0.05) were observed in aged group when compared to non-aged group.Conclusions AIS-ISS should be carefully selected to evaluate injury severity and prognosis of the aged trauma patients.Early total care should be performed for the aged trauma patients even if AIS-ISS is relatively low.

Objective To summarize the medical rescue of Chinese Government Medical Team (Chongqing) in Nepal earthquake region in order to explore the work pattern of transnational medical rescue,and improve the rescue efficiency.Methods From the experience about the post-earthquake medical rescue of Chinese Government Medical Team (Chongqing) in Nepal in 2015,several aspects were worthy to summarize such as the establishment of medical team,the layout of camp site,the work algorithm and process,with the analysis of injury feature and outcome of treatment.Results Under the setting of efficient organization and rational assignment of professional work,special working rules,the mutual transfer treatment and multi-disciplinary treatment were employed for 737 emergency patients.Of them,128 patients were hospitalized (including 63 patients completely recovered,56 patients were of clinical improvement,and 9 patients were critically ill transferred to other hospital for advanced treatment),and post-traumatic complication occurred in 48 cases without death.In addition,148 operations were carried out successfully.Conclusions The earthquake disaster has specific feature such as suddenness,a host of casualties and poor rescue conditions,and overseas rescue is with the presence of the language barrier,the difference in living habit,and the lack of coordination with local rescue system,therefore,rationally assigning personnel and resources and establishing work pattern with flexibility,orderly and good communication are the key to promote the efficiency of transnational medical rescue for the injured patients in earthquake region.

Objective To investigate clinical effect of damage control surgery (DCS) in treatment of patients with flail chest combined with severe multiple injuries.Methods A total of 187 cases of flail chest combined with severe multiple injuries treated by fixation of floating chest wall were enrolled and divided into three groups on the basis of different treatments:DCS group (66 cases) underwent early suspension traction of ribs and delayed internal fixation of the ribs ; Group A (70 cases) underwent rib suspension traction alone; Group B (51 cases) underwent initial internal fixation of rib.Complications,mortality,and main parameters before and after operation in each group were analyzed and compared.Results Complications including pulmonary infection (32 cases),atelectasis (38 cases),and acute lung injury (ALI)/ARDS (39 cases) were found.Twenty-two cases died,including 13 deaths from ARDS,two from tension pneumothorax,one from massive hemoptysis,three from cardiac shock,two from craniocerebral injury,and one from liver trauma and thus the overall death rate occupied 11.8％.Oxygenation index (OI) had significant rise postoperatively both in the DCS group and Group A (P ＜ 0.01),but the change of OI was inappreciable in Group B.Mortality,complication rate,cases treated with mechanical ventilation,tracheotomy or fiberoptic bronchoscopy,and average length of ICU and hospital stay were the lowest in the DCS Group,followed by a relatively higher result in Group B and a much higher result in Group A (P ＜ 0.01).Conclusion DCS decreases mortality and complications dramatically when appolied to treat flail chest combined with severe multiple trauma.