在急诊室的同步评估研究 (SEEDS):对同步管理的多学科方法
Win K Shen1, Wyatt W Decker, Peter A Smars
1Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA. wshen@mayo.edu
Circulation
|November 13, 2004
概括
在急诊室设立一个专门的昏迷病房,大大改善了诊断,并减少了中等风险昏迷患者的住院治疗. 这种方法提高了患者的护理和资源利用率,而不会影响结果.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 临床研究 临床研究
背景情况:
- 昏迷在急诊室提出了诊断挑战.
- 中级风险患者需要仔细评估,以防止心血管不良后果.
- 优化诊断产量和资源利用对于昏迷管理至关重要.
研究的目的:
- 为了评估专门的昏迷装置的有效性.
- 为了确定昏迷单元是否与标准护理相比改善了诊断产量.
- 评估昏迷单位对中等风险昏迷患者住院率的影响.
主要方法:
- 未来的,随机的,单中心研究.
- 103名中等风险的患者随机分配到单位或标准护理.
- 使用奇平方和威尔科克森等级和总和测试对诊断产量,住院和住院时间进行比较.
主要成果:
- 综合症单元显著改善了假设诊断率 (67%对10%,P<0.001).
- 在昏迷单元组中,住院病例大幅减少 (43%对98%,P<0.001).
- 总体患者住院日数从140日减少到64天.
结论:
- 一个新的昏迷单元提高了急诊室的诊断准确度.
- 综合镜装置有效地减少了中等风险患者的住院和住院时间.
- 这种模式可以改善患者护理和医疗保健资源的利用,而不会影响安全结果.
相关概念视频
Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Coronary Syndrome V: Nursing Management
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
Dysrhythmias V: Evaluating Dysrhythmias
Dysrhythmias, also known as arrhythmias, are disturbances in the heart's rhythm that range from benign to life-threatening. A thorough evaluation is crucial for appropriate management and involves a comprehensive medical history, physical examination, and various diagnostic tests.Medical HistorySymptoms: Collect detailed information on palpitations, dizziness, syncope, chest pain, and fatigue. Note their onset, frequency, and triggers.Previous Cardiac Issues: Document any history of heart...
Dysrhythmias VII: Nursing Management of Dysrhythmias
Nursing management of dysrhythmias involves the following:AssessmentSubjective Assessment:The initial step involves gathering patient-reported symptoms such as dizziness, palpitations, and chest discomfort. It is crucial to collect a detailed history, including previous heart conditions, current medication use, and lifestyle factors like caffeine and alcohol consumption.Objective Assessment:This involves observing clinical signs such as jugular venous distention, cool and pale skin, and...
Cardiopulmonary Resuscitation IV: Pharmacological Management
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...


