外科OHCA救活的機率 - EMT
By Iris
at 2008-10-12T16:21
at 2008-10-12T16:21
Table of Contents
在第787篇,由skyphenix99發表的"[情境]先救哪個??"一文中,出現了底下推文。
→ greatfish :COMA.......外科OHCA機率真的太低122.120.7.114 10/12 00:12
推 miaooooooooo:樓上說出我掙扎許久但沒說出的話~210.203.61.241 10/12 01:21
推 cad2001306 :先救coma,必須先救還活的要不然到61.60.127.28 10/12 02:42
→ cad2001306 :面變成兩個都ohca,必須捨其一61.60.127.28 10/12 02:43
→ xoorz :這時候需要任意門...59.115.117.237 10/12 02:48
推 kl9 :昨天遇到創傷OHCA 請問大家會用AED嗎118.170.124.31 10/12 11:47
推 idanny :用,因為不知是否心臟原因導致車禍 61.56.148.99 10/12 12:39
推 miaooooooooo:用吧 除非小baby,沒脈搏有AED有保庇140.112.25.101 10/12 12:55
→ OoSteve :我記得上課好像有提過創傷ohca(非心 116.59.31.76 10/12 13:11
→ OoSteve :因性)救活率不高。116.59.31.76 10/12 13:12
→ OoSteve :有錯請指正。 116.59.31.76 10/12 13:12
恩~
我也記得過去在EMT1&2的訓練過程中,有聽到說創傷OHCA的救活率比較低。
不過我剛查到一篇文章,跟我們所學到的內容似乎有點矛盾。以下是部分節果,但請各位
謹記,這個結果是在雙軌制非常健全的法國得到的,當地的ACLS部分是由醫師在現場執
行。
根據一項在法國進行的研究,全部268位創傷OHCA病人與2,642位內科OHCA病人相較後發現
,外科與內科的OHCA病人在恢復自發循環的比率上,是創傷病人較高 (外:內
34.0%,30.2%),而病人活著進醫院的比率則是29.9%,23.5%。
但病人活著出院的比率(2.2%,2.8%)以及一年存活率(1.9%,2.5),因差距較小,在統計
學上沒有顯著的差異。也就是說,就長期生還率來看,創傷與非創傷病人的存
活率是接近的。
在來是貼AED的問題,根據同一份研究,第一個被記錄的心律如下:
Trauma Non-Trauma
Asystole 85.8% 74.2%
Vf 3.4% 17.3%
PEA 10.4% 8.4%
也就是說,對於外科病人來說,電擊的機會相對較少。但是省略為創傷病人貼上AED這個
初步判定"可電擊與否"的步驟,而盡速"load and go"是否對病人有益,則有待研究。
該paper的部分節錄如下
Conclusions: The survival and neurologic outcome of out-ofhospital
cardiac arrest were not different between trauma and
medical patients. This result suggests that, under the supervision
of senior physicians, active resuscitation after out-of-hospital
cardiac arrest is as important in trauma as in medical patients
REFERENCE:
1.David, Jean-Stephane MD, PhD; Gueugniaud, Pierre-Yves MD, PhD; Riou, Bruno
MD, PhD; Pham, Emmanuel PhD; Dubien, Pierre-Yves MD; Goldstein, Patrick MD;
Freysz, Marc MD, PhD; Petit, Paul MD. (2007) Does the prognosis of cardiac
arrest differ in trauma patients? Critical Care Medicine Volume 35(10), October
2007, pp 2251-2255
==
我把這篇paper的全文下載收好了
想看的人可以跟我要
但關於AED的這件事,我個人應該會不分內外,沒脈搏我就貼了再說。
不知大家看法如何?
※ 編輯: miaooooooooo 來自: 140.112.25.101 (10/12 16:22)
※ 編輯: miaooooooooo 來自: 140.112.25.101 (10/12 16:24)
※ 編輯: miaooooooooo 來自: 140.112.25.101 (10/12 16:48)
※ 編輯: miaooooooooo 來自: 140.112.25.101 (10/12 16:50)
推 Mink0417 :不知道上課時提到外科OHCA不易救活的 140.135.30.117 10/12 18:52
→ Mink0417 :結論是從哪裡得到的? 140.135.30.117 10/12 18:52
推 agiko :以前有學過檢傷分類 不過都忘了 61.57.145.133 10/12 19:01
推 Mink0417 :我想看論文全文 >"< 140.135.30.117 10/12 19:25
→ miaooooooooo:記站內信給我~ 留e-mail~ 210.203.61.241 10/12 19:43
推 carlyu :如果你很行...可以不用XD 123.194.28.186 10/12 21:30
→ chooser :我不知道這個問題在各位是有爭議的!? 123.110.6.235 10/12 23:18
→ chooser :因為我聽過某T2教官教課是說還是要貼 123.110.6.235 10/12 23:18
→ chooser :而且貼也比較合理 123.110.6.235 10/12 23:19
推 xoorz :外科不可逆ˊˋ 59.115.117.237 10/12 23:45
→ miaooooooooo:^^^^^^^^^^ 所以這研究結果才神奇~ 210.203.61.241 10/13 01:12
→ greatfish :我們醫院的內科跟外科OHCA相比 122.120.7.7 10/13 02:59
→ greatfish :實在是有明顯的感受到差別 122.120.7.7 10/13 02:59
→ greatfish :外科的機率真的低於內科很多 122.120.7.7 10/13 02:59
→ miaooooooooo:其實..我與樓上同感~ 台灣的可能要再 210.203.61.241 10/13 03:00
→ miaooooooooo:另外做.. 210.203.61.241 10/13 03:00
推 chooser :論文中有提到這間醫院會派醫師跟車, 59.126.29.59 10/13 11:46
→ chooser :所以能夠執行的醫療行為會更多,可能 59.126.29.59 10/13 11:46
→ chooser :是這原因讓外科患者存活率增加 59.126.29.59 10/13 11:47
→ chooser :因此可再討論一個問題是台灣需不需要 59.126.29.59 10/13 11:47
→ chooser :跟車醫師? 59.126.29.59 10/13 11:48
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