Green Robert S, McIntyre J
Department of Emergency Medicine, Division of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia.
J Emerg Trauma Shock. 2011 Oct;4(4):488-93. doi: 10.4103/0974-2700.86638.
Critically ill patients are common in emergency medicine, and require expert care to maximize patient outcomes. However, little data is available on the provision of critical care in the ED. The goal of this study is to describe the management of critically ill patients in the ED via a survey of Canadian emergency physicians.
A survey of attending physician members of CAEP was conducted by email. The survey was developed by the authors and internal validity was established prior to survey deployment. Data on physician demographics, hospital resources, use of invasive procedures, vasopressor/inotropic medications, length of stay in the ED and patient responsibility were assessed.
The survey response rate was 22.9%, with the majority of respondents possessing speciality training in EM (73.5%). Respondents indicated that critically ill patients were commonly managed in the ED, with 68.5% reporting >6 critically ill patients per month, and 12.4% indicating > 20 patients per month. Respondents indicated that the majority of critically ill patients remained in the ED for 1-4 hours (70%) after resuscitation, yet 18% remained in the ED for >5 hours. Patients with a "respiratory" etiology were the most common critically ill patient population reported, followed by "cardiovascular", "infectious" and "traumatic illness". Direct laryngoscopy was frequently performed (66.9%> 11 in the year prior to the survey) in the year prior to the survey, while other invasive procedures and vasopressor/inotropic medications were utilized less often. EM physicians were responsible for the management of critically ill patients in the ED, even after consultation to an inpatient service, and were often required to provided acute care to critically ill patients admitted to an ICU, yet remaining in the ED prior to transfer (20% reported > 50% of the time).
Our survey demonstrates that critically ill patients are common in Canadian ED's, and that EMP's are often responsible to provide care for prolonged period of time. In addition, the use of invasive procedures other then direct laryngoscopy was variable. Further research is warranted to determine the impact of delayed transfer and ED physician management of critically ill patients in the ED.
危重症患者在急诊医学中很常见，需要专业护理以实现最佳治疗效果。然而，关于急诊科提供重症护理的数据却很少。本研究的目的是通过对加拿大急诊医生的调查来描述急诊科危重症患者的管理情况。
通过电子邮件对加拿大急诊医师协会的主治医师成员进行了一项调查。该调查由作者制定，并在调查开展前确定了内部效度。评估了有关医生人口统计学、医院资源、侵入性操作的使用、血管活性药物/正性肌力药物、在急诊科的停留时间以及患者责任等数据。
调查回复率为22.9%，大多数受访者拥有急诊医学专业培训（73.5%）。受访者表示，危重症患者通常在急诊科接受治疗，68.5%的受访者报告每月有超过6名危重症患者，12.4%的受访者表示每月超过20名患者。受访者指出，大多数危重症患者在复苏后在急诊科停留1 - 4小时（70%），但18%的患者在急诊科停留超过5小时。病因是“呼吸系统”的患者是报告中最常见的危重症患者群体，其次是“心血管系统”、“感染性”和“创伤性疾病”。在调查前一年，直接喉镜检查经常进行（66.9%在调查前一年进行超过11次），而其他侵入性操作和血管活性药物/正性肌力药物的使用频率较低。即使在咨询住院服务后，急诊医生仍负责急诊科危重症患者的管理，并且经常需要为入住重症监护病房但在转科前仍留在急诊科的危重症患者提供急性护理（20%的受访者报告这种情况的时间超过50%）。
我们的调查表明，危重症患者在加拿大急诊科很常见，并且急诊医生通常要负责长时间的护理。此外，除直接喉镜检查外，其他侵入性操作的使用情况各不相同。有必要进行进一步研究以确定延迟转科和急诊医生对急诊科危重症患者管理的影响。
