Acute Disease ; Cytokines ; metabolism ; Lung Injury ; chemically induced ; Paraquat ; toxicity

ObjectiveTo investigate the feasibility of using pulse oximetry plethysmographic waveform (POP) to identify the restoration of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR).Methods An observational research was conducted. A porcine model of ventricular fibrillation (VF) arrest was reproduced. After 3 minutes of untreated VF, animals received CPR according to the latest CPR guidelines, providing chest compressions to a depth of 5 cm with a rate of 105 compressions per minute and instantaneous mechanical ventilation. After 2 minutes of CPR, animals were defibrillated with 100 J biphasic, followed by continuous chest compressions. Data of hemodynamic parameters, partial pressure of end-tidal carbon dioxide (PETCO2) and POP were collected. The change in POP was observed, and the characteristics of changes of the waves were recorded during the peri-CPR period using the time and frequency domain methods.Results VF was successfully induced in 6 pigs, except 1 death in anesthesia induction period.① After VF, invasive blood pressure waveform and POP of the animals disappeared. PETCO2 was (18.83±2.71) mmHg (1 mmHg=0.133 kPa), and diastolic arterial pressure was (23.83±5.49) mmHg in compression stage. Animals attained ROSC within 1 minute after defibrillation, with PETCO2 [(51.83±9.35) mmHg] and diastolic arterial pressure [(100.67±10.97) mmHg] elevated significantly compared with that of compression stage (t1 = 8.737,t2 = 25.860, bothP = 0.000), with appearance of arterial blood pressure waveform.② Characteristic changes in POP were found in all experimental animals. During the stages of induced VF, compression, ROSC, and compression termination, POP showed characteristic waveform changes. POP showed disappearance of waveform, regular compression wave, fluctuation hybrid and stable pulse wave in time domain method; while in the frequency domain method waveform disappearance, single peak of compression, double or fusion peak and single peak of pulse were observed.Conclusion Analysis of POP using time and frequency domain methods could not only quickly detect cardiac arrest, but also show a role as a feasible, non-invasive marker of ROSC during CPR.

Objective: To investigate the coping styles and subjective well-being of nurses in the emergency treatment room of grade A tertiary hospitals in a province of China, and to explore the relationship between coping styles and subjective well-being. Methods: In January 2016, 189 nurses in the emergency treatment room were selected from 9 grade A tertiary hospitals in a province of China by random sampling. The general data, coping styles, and subjective well-being of these nurses were analyzed using the general questionnaire, coping style questionnaire, and Campbell index of well-being scale, respectively. Results: The total score of subjective well-being of nurses in the emergency treatment room was 7.54, and the subjective well-being was significantly different between the nurses with different professional titles and between those with different education levels (F=3.46 and 3.47, both P<0.05). The score of illusion coping style differed significantly across the nurses of different ages (F=5.17, P<0.05) , the scores of self-reproach, illusion, and withdrawal coping styles differed significantly across the nurses with different nursing years (F=3.99, 5.30, and 4.97, all P<0.05) , and the score of illusion coping style differed significantly across the nurses with different education levels (F=5.09, P<0.05). Most (71.9%) of the nurses in the emergency treatment room adopted the mature coping style. Subjective well-being was positively correlated with problem-solving, help-seeking, and rationalization (r=0.232, 0.018, and 0.167, all P<0.05) and negatively correlated with withdrawal (r=-0.146, P<0.05) . Conclusion Most nurses in the emergency treatment room adopt the mature coping style. Their subjective well-being and coping style vary with different ages, nursing years, professional titles, and education levels, and the subjective well-being is relatively low.

Objective: To establish the Wistar rat model of acute diquat poisoning and observe the pathological damage of main target organs. Methods: Thirty-six Wistar rats were randomly divided into six groups (n=6) , including one normal saline control group and five treatment groups which were separately given single-dose of intragastric administration at the doses of 46.2 mg/kg, 77.0 mg/kg, 115.5 mg/kg, 231.0 mg/kg and 346.5 mg/kg. The pathological changes of lung, liver and kidney were observed by hematoxylin and eosin (HE) and Masson staining. The optimal dose was determined according to the general situation and pathological changes. Thirty-six Wistar rats were randomly divided into five treatment groups and one normal saline control group. Treatment groups were given single-dose of intragastric administration according to the optimal dose. The rats were sacrificed at 1st, 3rd, 7th, 11th and 14th day after exposed, respectively. The activity of serum glutamic-pyruvic transaminase (ALT) and glutamic-oxalacetic transaminase (AST) were measured by chemical colorimetry. The pathological changes of lung, liver and kidney were observed by HE and Masson staining. Results: According to 14 d survival rate, the toxic symptoms and pathological changes, 115.50 mg/kg was determined the best dose. Given single-dose of intragastric administration at the doses of 115.50 mg/kg, it was found that the serum AST and ALT activity of rats on the first and third day of exposure was significant higher than those in control group. The results of pathological examination exhibited that in 115.50 mg/kg group, the pathological changes of lung, liver and kidney began to appear on the first day of exposure, the pathological changes were the most serious on the third day, and then gradually alleviated. On the 14th day, the alveolar septum was slightly widened, with inflammatory cell infiltration, local alveolar cavity became narrow, atrophy, peripheral alveolar compensation, bronchi and alveolar septum collagen fiber proliferation; The local renal tubular epithelial cells were enlarged and necrotic; the central vein surrounding hepatic cells showed vacuolar degeneration with punctate necrosis. Conclusion The rat model of acute diquat poisoning can be successfully induced by single-dose of intragastric administration. The condition of wistar rats and the pathological damage of the main target organs could be observed during the whole course of 115.50 mg/kg administration.

Objective To observe the nutritional biochemical indicators of paraquat poisoning patients, analyze and compare the nutritional status of patients and understand the changing trend of each indicator. Methods A total of 104 patients with acute paraquat poisoning who were admitted to the emergency department of the Second Hospital of Hebei Medical University from December 2015 to December 2017 were enrolled, and divided into the cure group (patients who survived >30 days) and the death group. Nutritional biochemical indicators including serum protein (ALB, PA, TP) and serum lipids (TCh, TG, LDL) were selected for dynamic observation. The observation time points were set as follows: immediate treatment of poisoned patients (day 1 on admission), on day 4, 7, 10, 13 and 16 after admission, and on day 30 after follow-up. The nutritional biochemical indicators of the two groups on day 1 and 4 were statistically analyzed and compared by t test. The nutritional status of the patients in the cure group was analyzed, and the Repeated Measures Anova was performed to understand the trend of each indicator over time. Results In the cure group, the TP level decreased from (73.34±5.75)g/L on day 1 to (51.95±6.05)g/L on day 4, t=20.34, P<0.01; and the TCh level decreased from (4.37±0.98) mmol/L on day 1 to (3.03±1.01)mmol/L on day 4, t=7.56, P<0.01. In the death group, the TP level decreased from (72.25±8.80)g/L on day 1 to (49.07±5.48)g/L on day 4, t=12.38, P<0.01, and the TCh level decreased from (4.38±0.88)mmol/L on day 1 to (2.51±1.07) mmol/L on day 4, t=7.94, P<0.01. Compared with the cure group, serum levels of ALB, TP and TCh in the death group decreased greater from day 1 to day 4 (all P<0.05). In addition, dynamic observation of the indicators in the cure group within 16 days after admission showed that, after treatment, the levels of ALB and TP recovered slowly and were still lower than normal . While the levels of PA and lipid rose rapidly after 10 days of admission. Conclusions Paraquat poisoning seriously affects the nutritional status of patients, and the serum protein levels decline significantly and can not be recovered easily. Therefore, sufficient attention should be paid to the treatment, and timely and appropriate nutritional support should be provided.

With the progress of science and technology and the development of society, more and more chemical substances have been discovered and countless chemicals have been artificially synthesized, and the risk of exposure to some toxic chemicals by human beings has been greatly increased, resulting in the increasing incidence of acute poisoning, which has seriously endangered the public's physical health and life safety. As the poisoned patients are unconscious or refuse treatment when they are admitted to the hospital, it is difficult to understand the drug exposure history by asking the medical history, so the toxicity detection has become the key to the clinical diagnosis and treatment, and this paper briefly introduces some common toxicity detection methods in the clinic in the hope that it will bring help to the clinical doctors.

With the progress of science and technology and the development of society, more and more chemical substances have been discovered and countless chemicals have been artificially synthesized, and the risk of exposure to some toxic chemicals by human beings has been greatly increased, resulting in the increasing incidence of acute poisoning, which has seriously endangered the public's physical health and life safety. As the poisoned patients are unconscious or refuse treatment when they are admitted to the hospital, it is difficult to understand the drug exposure history by asking the medical history, so the toxicity detection has become the key to the clinical diagnosis and treatment, and this paper briefly introduces some common toxicity detection methods in the clinic in the hope that it will bring help to the clinical doctors.

Objective:To investigate the in-hospital diagnosis and treatment time for patients with acute ischemic stroke in Hebei Province.Methods:The data of in-hospital diagnosis and treatment of acute ischemic stroke in Hebei Province were collected and analyzed, and then compared with the NINDS recommended time. Methods The data of in-hospital diagnosis and treatment of acute ischemic stroke in Hebei Province were collected and analyzed, and then compared with the NINDS recommended time.Results:The median time in hospital diagnosis and treatment was significantly longer than the NINDS recommended time (104 min vs. 60 min, P<0.001). The median time from completing the cranial CT scan to getting the CT report differed significantly to the NINDS recommended time (30 min vs. 20 min, P<0.001). The median time from getting the CT report to obtaining treatment was 43 min, which was significantly longer than the NINDS recommended 15 min ( P<0.001). The median time of in-hospital diagnosis and treatment for emergency service system (EMS) patients was 101 min, which was shorter than that for non-EMS patients (104 min, P=0.01). The median time of in-hospital diagnosis and treatment in Tertiary Hospital was 105 min, which was significantly longer than that in Secondary Hospital 99 min, ( P<0.05). Conclusions:The in-hospital emergency treatment delay in Hebei Province was relatively serious for patients with acute ischemic stroke. The time between obtaining the head CT report to beginning thrombolytic therapy is the most important factor in hospital delay. EMS can shorten in-hospital delay for acute ischemic stroke. Compared with the tertiary hospital, the secondary hospital has shorter in-hospital delay time.

Objective To investigate the current practice of ventilation during cardiopulmonary resuscitation (CPR) in Chinese emergency physicians. Methods Self-designed questionnaires were used to survey mainly the present situation of CPR ventilation practice performed by 800 physicians who participated in the Peking Union International Summit for Emergency Medicine from April 17th to 19th, 2015. Results A total of 800 questionnaires were distributed and 638 (79.75%) valid questionnaires were taken back; the responders joining the survey came from 29 provinces and regions, including Beijing, Hebei, Shandong, Guangdong, Liaoning, etc. There were 331 males and 307 females; 91.54% (584 responders) were emergency physicians and 77.90% (497 responders) came from tertiary hospitals, 17.55% (112 responders) came from the secondary hospitals. Regarding ventilation during CPR, 86.4% (551 responders) declared the patients was routinely given endo-tracheal intubation; after intubation, 25.8% (142 responders) adopted bag-mask ventilation, and 74.2% (409 responders) applied mechanical ventilation. When a ventilator was used, 301 (73.6%) responders used the volume controlled ventilation mode, 334 (81.7%) responders set the respiratory rate (RR) lower than 15 bpm, while 89.2% (365 responders) used the tidal volume set at a range of 400-500 mL. When adopted the flow triggering sensitivity, 79.7% (326 responders) set the sensitivity at 1-6 L/min, while 16.4% (67 responders) selected the default parameter, not adjusting the flow triggering parameter; when adopted the pressure triggering sensitivity, 75.1% (307 responders) set the sensitivity between -1 to -6 cmH2O (1 cmH2O = 0.098 kPa) and 20.3% (83 responders) selected the default value, not adjusting the pressure triggering parameter. When the mechanical ventilation (MV) was adopted, 84.8% (347 responders) declared often experiencing problems with MV, such as airway high peak pressure alarms [39.6% (162/409)], lower ventilation volume per minute alarms [24.9% (102/409)], higher respiratory frequency alarms [21.3% (87/409)], but only 67.2% (275 responders) would again adjust the ventilation mode related parameters and only 59.2% (242 responders) would observe the actual respiratory frequency. Conclusions With regards to artificial ventilation during CPR, the majority of emergency physicians tend to adopt endotracheal intubation and commonly use the volume controlled mode of mechanical ventilation; among the ventilator parameter setting, the RR is not strictly in accordance with the CPR guidelines, and most of the inspiration triggering sensitivity setting was too low, very easily to induce hyperventilation; simultaneously, the emergency physicians often neglect the practical RR; although there are many problems with ventilation such as frequent alarms, only 67.2% of the emergency physicians would again adjust the ventilation parameters.

Objective:To investigate the current situation of emergency medical service (EMS) system and its effect on treatment of the acute stage and short- and long-term prognosis in patients with acute myocardial infarction in Hebei province.Methods:Totally 2 961 patients with acute myocardial infarction who were admitted to major tertiary and some representative secondary hospitals in Hebei province from January 2016 to December 2016 were collected. According to the pattern of arriving hospital, all the patients were divided into the EMS group and self-transport group. The general conditions, time from onset to treatment, treatment methods, in-hospital mortality rate and 3-year mortality rate were compared between the two groups.Results:Of the included 2 961 patients, 33.13% of them were transported through EMS and 66.87% of them by private transport. Patients with a history of hypertension and ST-segment elevation myocardial infarction were more likely to choose EMS, and the difference was statistically significant ( P<0.05). Moreover, patients in the EMS group were more likely to go to tertiary hospitals for treatment (88.58% vs 85.76%, P=0.033). The time from onset to treatment of the EMS group was significantly shorter than that of the self-transport group (160 min vs 185 min, P<0.01), and the proportion of patients in the EMS group from onset-to-door time in <3 h and 3-6 h was higher than that of the self-transport group (55.76% vs 49.14%, 21.41% vs 19.09%, P<0.01). Compared with the self-transport group, the EMS group has a higher rate of reperfusion therapy (67.48% vs 61.67%, P=0.002). Patients in the EMS group had a higher in-hospital mortality rate in the acute stage (7.03% vs 4.44%, P=0.003), but its 3-year mortality rate was lower than that of the self-transport group (17.31% vs 20.77%, P<0.05). Conclusions:EMS can shorten symptom-onset-to-arrival time, increase the rate of reperfusion therapy and improve long-term prognosis of patients with acute myocardial infarction.