Simon H K, Sullivan F
Department of Pediatrics, Egleston Children's Hospital, Emory University School of Medicine, Atlanta, GA 30322, USA.
Pediatr Emerg Care. 1996 Oct;12(5):336-9. doi: 10.1097/00006565-199610000-00003.
To survey a cohort of physicians who work in general community emergency departments (ED) in order to assess their comfort levels in performing urgent and emergent medical procedures on children.
One hundred seventeen emergency physicians were surveyed at 23 institutions within the referral base of Hasbro Children's Hospital, a tertiary care pediatric ED. Physicians rated their comfort levels (4-point scale: 1 = comfortable, 2 = moderately comfortable, 3 = uncomfortable but would perform in an emergency, 4 = uncomfortable and would never perform) for all procedures in which the American Academy of Pediatrics recommends competence for pediatric emergency physicians.
Sixty (51%) physicians completed the survey. Residency training included internal medicine, family practice, surgery, general practice, pediatrics, and emergency medicine, while only 32 (53%) were Board certified in emergency medicine. All respondents treated pediatric patients. Over 25% were uncomfortable (level 3 or 4) with performing certain potentially life-saving pediatric procedures. These included cardioversion, defibrillation, external pacing, nasal intubation, needle cricothyrotomy, rapid sequence intubation, laryngoscopy, tracheostomy replacement, chest tube placement, vascular cutdowns, emergency childbirth, pericardiocentesis, intraosseous line placement, infant subdural and ventriculoperitoneal (V-P) shunt taps, and upper airway foreign body removal. Over 25% of respondents were also uncomfortable with non-life-saving procedures such as temperomandibular joint (TMJ) reductions, tooth reinsertions, rape evaluations, suprapubic taps, tympanocentesis, retrograde urethrograms, thoracentesis, paraphimosis reduction, ear foreign body removal, and pain management.
While emergency physicians within the catchment area of a tertiary care children's hospital feel comfortable with most pediatric procedures, they express a significant degree of discomfort with many potentially life-saving skills. Because of the infrequent need for many of these interventions in children, the high levels of discomfort are not surprising. These procedures may most comfortably be performed at pediatric centers but can be accomplished well at all EDs if personnel are adequately trained. A strong working relationship with pediatric emergency centers and an enhanced teaching of these procedures may increase comfort levels with these potentially life-saving measures.
对一批在普通社区急诊科工作的医生进行调查，以评估他们在为儿童实施紧急和急诊医疗程序时的舒适度。
在一家三级护理儿科急诊科——哈斯波罗儿童医院转诊范围内的23家机构，对117名急诊医生进行了调查。医生们对美国儿科学会建议儿科急诊医生应具备能力的所有程序，评定自己的舒适度（4级量表：1 = 舒适，2 = 中度舒适，3 = 不舒服但在紧急情况下会实施，4 = 不舒服且永远不会实施）。
60名（51%）医生完成了调查。住院医师培训包括内科、家庭医学、外科、全科医学、儿科学和急诊医学，而只有32名（53%）获得了急诊医学委员会认证。所有受访者都诊治儿科患者。超过25%的受访者在实施某些可能挽救生命的儿科程序时感到不舒服（3级或4级）。这些程序包括心脏复律、除颤、体外起搏、鼻腔插管、环甲膜穿刺、快速顺序诱导插管、喉镜检查、气管造口更换、胸腔闭式引流管置入、血管切开、急诊分娩、心包穿刺、骨髓腔内输液、婴儿硬膜下及脑室腹腔（V-P）分流穿刺，以及上呼吸道异物取出。超过25%的受访者对一些非挽救生命的程序也感到不舒服，如颞下颌关节（TMJ）复位、牙齿再植入、强奸评估、耻骨上穿刺、鼓膜穿刺、逆行尿道造影、胸腔穿刺、包皮嵌顿复位、耳部异物取出和疼痛管理。
虽然三级护理儿童医院服务区域内的急诊医生对大多数儿科程序感到舒适，但他们对许多可能挽救生命的技能表示出相当程度的不舒服。由于儿童对其中许多干预措施的需求很少，这种高度的不舒服并不奇怪。这些程序在儿科中心实施可能最舒适，但如果人员经过充分培训，在所有急诊科也能很好地完成。与儿科急诊中心建立牢固的工作关系以及加强这些程序的教学，可能会提高对这些可能挽救生命措施的舒适度。
