唯物辩证法在院前心肺复苏实践中的指导作用

在院前心肺复苏实践中,我们会遇到很多矛盾的问题。本文从唯物辩证法的角度出发,分析了院前心肺复苏中一些比较棘手的问题,并为解决这些问题提出建议,对从事院前急救的医学专业人士以及非医学专业人士均具有一定的启发意义。     

唯物辩证法在院前心肺复苏实践中的指导作用

在院前心肺复苏实践中,我们会遇到很多矛盾的问题.本文从唯物辩证法的角度出发,分析了院前心肺复苏中一些比较棘手的问题,并为解决这些问题提出建议,对从事院前急救的医学专业人士以及非医学专业人士均具有一定的启发意义.     

2005国际心肺复苏和心血管病急救指南的若干问题

2005年国际心肺复苏和心血管病急救指南制订中有5个最有争议的问题以及一些重要的新改变。这5个问题分别是:(1)室颤时,按压与电击何者优先;(2)按压—通气比;(3)一次电击与三次电击除颤的争议;(4)电击剂量;(5)复苏后处理。有利于在心肺复苏和心血管病急救工作中施行。     

2005国际心肺复苏和心血管病急救指南的若干问题

2005年国际心肺复苏和心血管病急救指南制订中有5个最有争议的问题以及一些重要的新改变.这5个问题分别是:(1)室颤时,按压与电击何者优先;(2)按压-通气比;(3)一次电击与三次电击除颤的争议;(4)电击剂量;(5)复苏后处理.有利于在心肺复苏和心血管病急救工作中施行.     

科学思维为心肺复苏注入活力

笔者结合近30年临床心肺复苏的实践,系统总结了善用科学思维模式,破解心肺复苏过程中的诸多疑难问题的心得体会,充分阐述了科学思维在获得学术发明成果方面所发挥的巨大作用。     

心肺复苏新观点在临床技能培训中的应用

心肺复苏是急救医学的重要组成部分,也是医学生临床技能培训的重点内容.因此,该技术培训的先进性尤为重要. 2005年由美国心脏学会(american heart association,AHA)和国际急救与复苏联合会(international liaison committee on resuscitation,ILCOR)举办的"2005年心肺复苏和心血管病急诊科学治疗建议国际会议"(以下简称"2005国际会议")在美国达拉斯举行[1].会议完成了心肺复苏(cardiopulmonary resuscitation,CPR)和心血管病急诊领域国际学术界所期待的5年一度的指南修订.此后,复苏学的研究热点集中于新指南的相关变动[2].为使学生掌握最新的操作流程与方法,我们将以往制定的心肺复苏操作培训流程(初级复苏)进行了及时的修改与完善.     

不复苏医嘱的伦理准则

不复苏医嘱的伦理准则［英］ＬｅｎＤｏｙａｌ，ＤａｎｉｅｌＷｉｌｓｈｅｒ娄长春，马世忠译１．下不复苏医嘱的程序１．１不复苏状态意味着，如果患者遭遇心脏停止，则将不呼叫救生队，既不给予基础心肺复苏又不给予晚期心肺复苏。但不含有有关患者治疗的任何其它临床决...     

科学思维为心肺复苏注入活力

笔者结合近30年临床心肺复苏的实践,系统总结了善用科学思维模式,破解心肺复苏过程中的诸多疑难问题的心得体会,充分阐述了科学思维在获得学术发明成果方面所发挥的巨大作用.     

心肺复苏时肾上腺素剂量变迁的思考

肾上腺素是临床上心肺复苏的一线药物,但在最近二十几年以来,其剂量应用方案几经变迁,从20世纪80年代的小剂量,到90年代大剂量方案的兴起,又经历了个体化方案阶段,近几年又重新回归到小剂量给药方案。从唯物辩证法的基本思想出发,阐述心肺复苏时肾上腺素剂量变迁的哲学基础,并运用辩证唯物主义原理来探讨肾上腺素剂量研究的发展方向,这将有助于心肺复苏研究的理论与实践。     

心肺复苏时肾上腺素剂量变迁的思考

肾上腺素是临床上心肺复苏的一线药物,但在最近二十几年以来,其剂量应用方案几经变迁,从20世纪80年代的小剂量,到90年代大剂量方案的兴起,又经历了个体化方案阶段,近几年又重新回归到小剂量给药方案.从唯物辩证法的基本思想出发,阐述心肺复苏时肾上腺素剂量变迁的哲学基础,并运用辩证唯物主义原理来探讨肾上腺素剂量研究的发展方向,这将有助于心肺复苏研究的理论与实践.     

意识和无意识的关系--实证的视角

意识和无意识的相互关系曾经是纯粹的哲学问题,科学心理学的诞生促进了对这一问题的实证视角考察。实证取向认为,意识和无意识同属人类心理的机能,并能够在外在的任务操作中表现出来。现代认知心理学发现了对应意识机能的外显过程和对应无意识机能的内隐过程,两者相对独立又共生共存。任何认知过程都是意识和无意识共同作用的产物,两者之间存在复杂的相互作用,并表现出权衡的特点。神经生理学的研究揭示了意识和无意识在发生学意义上可能的先后关系。无意识在心理过程中起的作用是普遍的、抽象的、抗干扰的,而意识则建筑在无意识的基础之上,有着更大的变异性。     

Emergencies: what are they and do they influence bystanders to intervene?

Social psychological research on helping has, in part, been concerned with the intervention of bystanders into emergencies. Pertinent empirical literature does not seem to be available on what factors bystanders use to define an emergency nor the effect of such a decision on the rate of helping. A series of four studies was conducted to answer these questions. We found that (a) Emergencies are a subclass of problem situation that usually result from accidents; (b) there is a high degree of agreement concerning what problem situations are definitely an emergency; (c) emergency situations are differentiated from other problem situations by threat of harm or actual harm worsening with time, unavailability of an easy solution to the problem, and necessity of obtaining outside help to solve the problem; (d) disagreement on whether a problem situation is an emergency or not results from differing perceptions of the degree to which threat of harm or actual harm worsens with time; (e) bystanders are more likely to help in emergency than in nonemergency problem situations. The results were interpreted as indicating that the need of the victim is a salient feature used by bystanders in determining whether or not to help.     

抢救一例Rh阴性稀有血型危重孕妇的体会与思考

Rh阴性稀有血型危重患者的临床救治相当棘手。本文通过回顾对一名Rh阴性血型危重孕妇的临床救治经过,探讨了应急情况下Rh阴性血型危重患者的临床救治策略和采供血应急措施,建议我国尽快建立稀有血型血库和制定相关法律法规,为应急情况下抢救Rh阴性血型患者提供依据和保障。     

Integration and authority: rescuing the ‘one thought too many’ problem

Four decades ago, Bernard Williams accused Kantian moral theory of providing agents with ‘one thought too many’. The general consensus among contemporary Kantians is that this objection has been decisively answered. In this paper, I reconstruct the problem, showing that Williams was not principally concerned with how agents are to think in emergency situations, but rather with how moral theories are to be integrated into recognizably human lives. I show that various Kantian responses to Williams provide inadequate materials for solving this ‘integration problem’, and that they are correspondingly ill-positioned to account for the authority of morality, as Williams suspected all along.     

Risk Factors for Suicide and Suicidal Behavior Relevant to Emergency Health Care Settings: A Systematic Review of Post‐2007 Reviews

Suicide is a global public health problem, and with recent economic and societal changes, there may be emerging risk factors unrecognized by health care professionals. The aim of this systematic review was to update existing suicide risk factor literature applicable to emergency health care settings. A total of 35 articles identified from PsycINFO, CINAHL, and Medline met the inclusion criteria. Results supported the significance of existing suicide risk factors and identified emerging risk factors. The review provides a high‐quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.     

对2010AHACPR-ECC指南及相关问题的思考

心肺复苏是院前急救人员的必备技能,是挽救猝死等危急重症患者生命的首要方法。2010美国心脏协会心肺复苏及心血管急救（AHA CPR-ECC）指南发表至今3年有余,广大院前急救人员仍然存在诸多问题和困惑,猝死的复苏成功率也无明显提高,针对这些问题和困惑,笔者提出了相应的看法和建议,包括（1）该不该删去“听、看、感”;（2）判断循环是否应该结合具体情况;（3）施救者位置与体位是否应该标准化;（4）打开气道时施救者手型与位置是否应该标准化;（5）心脏按压频率如何把握;（6）是否应该掐压人中穴;（7）如何提高复苏成功率;（8）心脏按压板的应用问题;（9）医学院校教科书应当与时俱进。研究并解决好以上问题,对我国院前急救实践或有裨益。     

儿童惊厥性癫痫持续状态——难题与决策

癫痫持续状态是儿科神经系统最常见的一种急重症,其中惊厥性癫痫持续状态可能严重至危及生命,因而尤其需要准确紧急处理。准确的早期诊断、正确处理是抢救成功的关键。近年来对于癫痫持续状态的定义、分类以及程序化治疗都有很多新的认识和研究进展。本文拟从定义、分类、流行病学、临床诊治以及对发育中脑的影响方面对惊厥性癫痫持续状态进行综述,希望能帮助儿科医生在日常工作中能准确认识惊厥性癫痫持续状态,及早做出合理的临床决策,从而最终改善此症的预后。     

Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care

Panic disorder (PD) is associated with the rapid onset of fear-related symptomatology, often somatic in nature. As a result, individuals with the disorder often fear that they are experiencing a life-threatening emergency and present in hospital emergency departments (EDs). As the operating heuristics of EDs are geared toward identifying organic causes and allow only brief physician–patient contact, the diagnosis of PD is more often than not overlooked. Those with the disorder go on to incur enormous costs as they seek out an explanation for their symptoms. Efforts to alleviate this problem, including increased physician education and the development of screening instruments, have been largely unsuccessful. The continued misidentification and mismanagement of this disorder argues for greater incorporation of mental health professionals into the ED, allowing collaborative efforts that recognize the relationship between physiological and psychological aspects of panic.     

La contraception d’urgence chez les mineures. Une offre illimitée en manque d’évaluation

Avoiding the use of abortion by minors is the aim that has been pursued since 2000 through the facilitated access of young girls to emergency contraception : breaking numerous rules relative to health security and to Social Security, the dispensation is done anonymously and free of charge. However, the analysis shows that the three postulates from which this policy was built – satisfactory benefit/risk ratio of emergency contraception, safety of repeated medication and real efficiency to reduce numbers of unwanted pregnancies and abortion – are not validated. In addition, there are some indications that this policy is not devoid of adverse effects.