Name: setting up a stroke team algorithm and conducting simulation-based training in the emergency department - a practical guide
Uploaded: 2017-01-15T14:00:00
Description: Watch this Scientific Journal Video about Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide at JoVE.com

The Stroke Team training was supported by a research grant of Boehringer Ingelheim to WP.

1. ED的预先通知<ol><li>急诊护士听到警报后，去电脑屏幕上立即生效。 </li><li>检查通过在线平台（ 如电子健康IVENA）7输入患者上述信息。发现系统宣布，一名66岁的男性患者，中风的时间窗口（中风&lt;6小时），与预计到达的时间内初步诊断。 </li><li>通过电话预先通知SU的居民。 </li><li>由于SU居民听到移动电话铃声，有苏居民采取电话。有SU居民进入ED的预计到达时间。 </li></ol><p c...

<ol>
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Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.</a> Lancet. 384 (9958), 1929-1935 (1929).</li><li>Goyal, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=HERMES+collaborators.+Endovascular+thrombectomy+after+large-vessel+ischaemic+stroke:+a+meta-analysis+of+individual+patient+data+from+five+randomised+trials.">HERMES collaborators. 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A结合卒中小组算法和基于常规模拟冲程队训练可导致的门到针时间长期减排为主要基准处理时间为急性卒中治疗。一组改善的急性中风的工作流程的措施，这也激发我们的算法的很好的例子，已经由赫尔辛基组14,15说明。另一种非常新颖的方法来缩短从症状出现到溶栓的时间间隔是移动卒中单元，如创业STEMO在德国柏林16,17或者从俄亥俄州克利夫兰美国18 PHAST项目。相比之...

用重组组织纤溶酶原激活物（rt-PA），用于急性缺血性中风溶栓的效力是高度依赖于时间的，甚至在4.5小时1的治疗时间窗随时间减少。同样已经显示出血管内治疗中风2。溶栓后的额外的机械再通已被证明是在改善的重症患者中风的结果高效由于大血管闭塞（LVO）3。由于血管内治疗需要neurointerventionalist，一名麻醉师或neurointensivist，在许多情况下甚至急性以后病人的专门中心的转诊这种新疗法增加了复杂性和急性卒中治疗的交叉学科。 因此，需要的概念，以尽量减少治疗时间不把病人安全处于危险之中。由于急性中风护理是跨学科的团队提供，标准化ALGORithm以及技术和非技术技能的基于模拟的训练似乎是一个简单的方法。在这种情况下，不仅是“时间就是大脑”，还要“球队大脑”，因为珍贵分钟和安全相关的信息可以通过低效率的沟通团队成员会丢失。在非医疗高保真情况下，如航空，一个称为机组资源管理（CRM）的概念已被证明是4高度有效的。 有很大一部分致命错误是不是由于缺乏知识或技能，而是在沟通，交流和决策赤字。 CRM强调的“非技术技能”的重要性，并将其定义为补充的技术技能的认知，社会和个人资源。六大重点领域包括明确的沟通，团队合作，态势感知，决策，领导和应激5的管理。 这个概念有alreaDY被专业心血管生命支持6顺利实施。一个绑定的算法，在CRM基础教育为所有卒中小组成员和定期基于模拟的培训为高保真中风病研究小组提供的方法来改善急性卒中治疗的所有新成员。 成立谁是集体通过电话快速拨号通知，并有精确的任务定义行程算法于7人员专用中风病研究小组的治疗时间窗内治疗病人。这些是召集到每个笔画报警7强制性团队成员： 1居民从卒中单元神经病（SU） 1驻留在从急诊神经科（ED） 从ED 1名护士 1实验室技术员 1驻地专业神经放射学 1放射技师 1专科神经内科（卒中单元的资深神经科医师） 星期四S，一个基于仿真的行程队训练的构想，这是每隔一个月对所有新的Stroke团队成员，并作为长期工作人员复习进行。基于模拟训练传输CRM的价值，并强调了非技术技能的跨学科团队multiprofessional的重要性。监测这一由急诊室（ER）算法和定期培训，送货针次，溶栓相关的并发症，员工的满意度和安全感的中风病研究小组干预的影响连续记录。

<table border="0" cellpadding="0" cellspacing="0" width="1228">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:209px;">Drug</td>
			<td style="width:363px;"></td>
			<td style="width:135px;"></td>
			<td style="width:523px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Alteplase (rtPA)</td>
			<td>Boehringer Ingelheim, Ingelheim am Rhein, Germany</td>
			<td></td>
			<td>Licensed drug, which has proven effectiveness for acute ischemic stroke</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Urapidil 50 mg/10 ml</td>
			<td>Takeda Pharma, Berlin, Germany</td>
			<td></td>
			<td>Licensed drug, antihypertensive</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Granisetron 3 mg/3 ml</td>
			<td>Hameln Pharma, Hameln, Germany</td>
			<td></td>
			<td>Licensed drug, antiemetic</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Lorazepam 2 mg/1 ml</td>
			<td>Pfizer, Berlin, Germany</td>
			<td></td>
			<td>Licensed drug, sedative</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Iopromid 300 mg/ml</td>
			<td>Bayer Vital GmbH, Leverkusen, Germany</td>
			<td></td>
			<td>Licensed drug, non-ionic contrast agent for computed tomography</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Name</td>
			<td>Company</td>
			<td>Catalog Number</td>
			<td>Comments</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Device</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">S-Monovette citrate 3 ml</td>
			<td>Sarstedt, N&#252;rnbrecht, Germany</td>
			<td></td>
			<td>to collect blood for coagulation assays</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">S-Monovette EDTA 1.6 ml</td>
			<td>Sarstedt, N&#252;rnbrecht, Germany</td>
			<td></td>
			<td>to collect blood for hematology assays</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">S-Monovette lithium heparinate 7.5 ml</td>
			<td>Sarstedt, N&#252;rnbrecht, Germany</td>
			<td></td>
			<td>to collect blood for clinical chemistry assays</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">ACL Top 500&#160;</td>
			<td>Instrumentation Laboratory, Kirchheim, Germany</td>
			<td></td>
			<td>Automated hemostasis analyzer</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Sysmex XE 2100</td>
			<td>Sysmex Corporation, Norderstedt, Germany</td>
			<td></td>
			<td>Automated hematology analyzser</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Cobas 6000</td>
			<td>Roche Diagnostics, Mannheim, Germany</td>
			<td></td>
			<td>Automated clinical chemistry analyzser</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Resusci Anne Skillreporter</td>
			<td>Laerdal, Stavanger, Norway</td>
			<td></td>
			<td>remote-controlled manikin</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Ingenuity 128</td>
			<td>Philips, Hamburg, Germany</td>
			<td></td>
			<td>CT-scanner</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">MEDRAD Stellant</td>
			<td>Bayer Radiology, Leverkusen Germany</td>
			<td></td>
			<td>Contrast agent delivery system</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Universal 320 R</td>
			<td>Hettich, Tuttlingen, Germany</td>
			<td></td>
			<td>Centrifuge</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Perfusor fm</td>
			<td>Braun, Melsungen, Germany</td>
			<td></td>
			<td>Infusion pump</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Infinity Gamma</td>
			<td>Dr&#228;ger, Hamburg, Germany</td>
			<td></td>
			<td>Monitor</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Ivena ehealth</td>
			<td>mainis IT-Service GmbH, Offenbach, Germany</td>
			<td></td>
			<td>online prenotification platform</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Braun ThermoScan PRO 4000</td>
			<td>Welch Allyn, Hechingen, Germany</td>
			<td></td>
			<td>ear thermometer</td>
		</tr>
	</tbody>
</table>

setting up a stroke team algorithm and conducting simulation-based training in the emergency department - a practical guide

时间就是生命关怀急性中风病人时。最终的目标是要血流恢复到缺血性脑。这可以通过重组组织型纤溶酶原激活物（rt-PA），对当前的第一时间出现症状的无禁忌之内谁中风患者的标准治疗或者溶栓来实现，或者通过血管内的办法，如果近端脑血管阻塞检测。由于两种治疗的功效随时间下降，每分钟沿途会改善患者的结果保存。 这种严峻的形势，需要深入细致的工作，并与病人，家庭和同事们从不同的行业来获取所有相关信息，达到正确的决策，同时仔细地监控病人精确沟通。这是一个高保真的局面。在非医疗高保真环境S使得航空，机组资源管理（CRM），用于提高安全性和团队效率。 本指南说明了如何一台S troke牛逼 EAM算法，这是转移到其他医院设置，建立和如何进行常规基于仿真的培训。这需要决心和耐力，以保持超过时间的推移定期这些耗时模拟培训。然而，由此产生的团队合作精神和卓越的送货时间针改善将有利于患者，并在任何一家医院的工作环境。 谁是集体通过电话快速拨号通知24/7并运行一个具有约束力的算法，大约需要20分钟，7人的专门团队行程，正式成立。对参与这个大家算法，为所有新款S troke牛逼 EAM成员基于仿真的团队训练的设想，并每隔一个月进行。这导致了一个相关的和持续减少的平均门到针时间25分钟，特别是加强在初中的医生和护士准备中风的感觉。

门到针次，溶栓率的影响伴随着常规的基于仿真笔划团队训练在2012年中风队算法的执行导致与门到针时间低于30分钟和60分钟，并增加了我们的溶栓速率治疗的患者相关的增加。 <img alt="图1" src="/files/ftp_upload/55138/55138fig1.jpg" /> 图1：法兰克福大学医院的中风病研究小组算法。所有的工作人员，以卒中小组结合的任命?...

Watch this Scientific Journal Video about Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide at JoVE.com

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

每分钟在急性中风护理计数。本指南介绍了如何建立一个中风病研究小组算法并加强其与普通模拟训练的表现。 机组资源管理（CRM）的原则，有利于直的工作流程，减少送货针时间，提高员工的满意度。

建立中风病研究小组算法并进行急诊科基于仿真的培训 - 实用指南

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Research

Education

JoVE Core

JoVE Journal

Nursing

Medicine

Unit 1

Introduction to Nursing

SCIENTISTS IN ACTION

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

过期的CO 2测量气管插管或自主呼吸的病人从急诊科

Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth ...

科研

医学

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

驾驶模拟诊所：测试视觉与视野缺损的患者在日常活动中的探索行为

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily ...

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

Excitotoxic Stimulation of Brain Microslices as an In vitro Model of Stroke

脑Microslices的兴奋性刺激作为<em&gt;在体外</em&gt;中风模型

Examining molecular mechanisms involved in neuropathological conditions, such as ischemic stroke, can be difficult when using whole animal systems. As ...

Isolation and Excision of Murine Aorta; A Versatile Technique in the Study of Cardiovascular Disease

隔离和小鼠主动脉切除;心血管疾病研究的一个多功能的技术

Cardiovascular disease is a broad term describing disease of the heart and/or blood vessels. The main blood vessel supplying the body with oxygenated ...

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

应急方案和设置药物和液体管理的新方法

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

机器人手术中的紧急脱位: 一个模拟课程

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Setup and Execution Of the Blindfolded Code Training Exercise

盲民代码训练练习的设置和执行

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

介入诊断程序：冠状动脉血管功能评估实用指南

Approximately 40% of patients undergoing invasive coronary angiography for investigation of angina are found to have no obstructive coronary artery ...

Conducting Respiratory Oscillometry in an Outpatient Setting

在门诊环境中进行呼吸示波法

Respiratory oscillometry is a different modality of pulmonary function testing that is increasingly used in a clinical and research setting to provide ...

A Real-World High-Intensity Interval Training Protocol for Cardiorespiratory Fitness Improvement

一种用于改善心肺健康的真实世界高强度间歇训练方案

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, ...