CENTRAL VENOUS-TO-ARTERIAL CARBON DIOXIDE PARTIAL PRESSURE DIFFERENCE AS A GUIDING PARAMETER FOR CARDIOTONIC DRUG ADMINISTRATION IN PATIENTS WITH EARLY-STAGE SEPTIC SHOCK.

ABSTRACT: Objective: This study aimed to investigate the effect of the central venous-to-arterial carbon dioxide partial pressure difference (Pcv-aCO2) on the administration of cardiotonic drugs in patients with early-stage septic shock. Methods: A retrospective study was conducted on 120 patients suffering from septic shock. At admission, the left ventricular ejection fraction (LVEF) and Pcv-aCO2 of the patients were obtained. On the premise of mean arterial pressure ≥ 65 mm Hg, the patients were divided into two groups according to the treatment approaches adopted by different doctors-control group: LVEF ≤50% and observation group: Pcv-aCO2 ≥ 6. Both groups received cardiotonic therapy. Results: The two groups of patients had similar general conditions and preresuscitation conditions ( P > 0.05). Compared with the control group, the observation group had a higher mean arterial pressure, lactic acid clearance rate, and urine output after 6 h of resuscitation ( P < 0.05), but a lower absolute value of lactic acid, total fluid intake in 24 h, and a lower number of patients receiving renal replacement therapy during hospitalization ( P < 0.05). After 6 hours of resuscitation, the percentages of patients meeting central venous oxygen saturation and central venous pressure targets were not significantly different between the control and observation groups ( P > 0.05). There was no difference in the 28-day mortality rate between the two groups ( P > 0.05). Conclusion: Pcv-aCO2 is more effective than LVEF in guiding the administration of cardiotonic drugs in the treatment of patients with septic shock.

Effect of a Template Case Report Based on Cognitive Task Analysis on Emergency Thinking Ability of Resident Doctors in Standardized Training.

OBJECTIVE: To explore the effect of a template case report based on cognitive task analysis on the emergency thinking ability of resident doctors in standardized training. METHODS: The doctors were split into two groups, according to the date they joined the emergency department (n = 40, each group): the observation and control groups. In the observation group, the resident doctors' teachers in standardized training adopted the cognitive task analysis method to determine the primary links of emergency thinking, made case templates, and carried out training based on the case template report. In the control group, traditional teaching methods were used by the teachers. RESULTS: In the observation and control groups, the scores at departure were 88.10 ± 3.88 and 75.23 ± 7.19, respectively (P < 0.05), and the student's ability improvement rates were 92.5% and 75.0% (P < 0.01). In addition, the awareness rate of "know how to study" and "know how to work in emergency" in the observation group was 90% and 90%, respectively. The rate of doctors that considered "missed diagnosis and misdiagnosis can be reduced" was 85%, and the rate of doctors that considered "help to learn in other departments in the future" was 80%. CONCLUSION: Template case reports based on the cognitive task analysis for emergency thinking training can help resident doctors in standardized training improve their emergency thinking ability.

[Effect of acute stress stimulation on the seizure induction in epileptic model rats].

This study was undertaken to observe the effect of acute stress on seizure occurrence in chronic period of epileptic model rats. Lithium-pilocarpine (LiCl-PILO)-induced epileptic rat model was constructed. At the spontaneous recurrent seizure period, acute stress stimulations such as cat's urine and foot electrical shock were applied to observe the behavioral changes and seizure occurrence. The results showed that after the cat's urine stimulation, the self-directed behaviors of the epileptic model rats decreased significantly, while the risk assessment behaviors increased significantly. The seizure occurrence, however, was not observed during the 45 min after the stimulation. Applying electrical foot shocks also did not evoke seizures in epileptic model rats. On the contrast, intra-peritoneal injection of low dose of pentylenetetrazole (PTZ, 30 mg/kg) evoked seizure more efficiently, and the duration of seizure activity was extensively prolonged in epileptic model rats than that of control rats. Taken together, these results indicate that although applying stress stimulations such as cat's urine and electrical foot shock cause several behavioral changes, they are not severe enough to evoke seizure in epileptic model rats.