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医生在抢救病人时造成病人胸部骨折,这是谁的责任? 第1页

  

user avatar   hao-hao-zuo-ren-ba 网友的相关建议: 
      

问这个问题的多半是不了解心肺复苏,先说说按压的时候怎么做吧

找准患者两乳头连线的中点部位(胸骨中下段),右手(或左手)掌根紧贴患者胸部中点,双手交叉重叠,右手(或左手)五指翘起,双臂伸直;利用上身力量,用力按压30次,速度至少保证100-120次/分,按压深度至少5-6厘米。

按压过程中,掌根部不可离开胸壁,以免引起按压位置波动,而发生肋骨骨折。(我们老师也特别强调了的,不能离开胸壁)但是人终有别,不是每一个人骨头都那么韧性的,5-6cm的深度确实可能让很多人的胸骨发生骨折

但是你最应该感谢的也是那个将你胸骨压骨折的人

大多数心跳停止的患者,其心脏会在某个时间点,出现心室纤维颤动。心肺复苏术不管是在电击前或电击后,都扮演着很重要的角色。当心室纤维颤动造成的急性心跳停止发生,若心肺复苏术能在第一时间施行,则患者的生存机会将提高二至三倍,所以,每个给你按压的医生都会一直持续不留余力的给你按压,一直持续到自动体外去颤器或手动去颤器的到来。

对于上图这种医生跟随推车一直按压的情况真的很常见,而且多半是男医生,因为胸外按压真的很累,一般女生坚持不下来的

所以,当医生在全力救治你的生命时,能让你还能活跃在这大千世界,已经是最好的结果了呀……


user avatar   nryannehi 网友的相关建议: 
      

《中华人民共和国医疗事故处理条例》

第三十三条 有下列情形之一的,不属于医疗事故:

(一)在紧急情况下为抢救垂危患者生命而采取紧急医学措施造成不良后果的;

(二)在医疗活动中由于患者病情异常或者患者体质特殊而发生医疗意外的;

(三)在现有医学科学技术条件下,发生无法预料或者不能防范的不良后果的;

(四)无过错输血感染造成不良后果的;

(五)因患方原因延误诊疗导致不良后果的;

(六)因不可抗力造成不良后果的。

【奉狗依法】


user avatar   dylan-xuan 网友的相关建议: 
      

我一直觉得逻辑、辩论和博弈这类教育的缺失是中国教育的一大遗憾。不是说没有,而是基本只停留在名词解释。

回到题目,单就事实,这确实就是医生的责任,不管后果是否严重。然后呢?

你是要想医生负责么,能问出这个问题的人其心可诛。

如果要医生负责的话,那么以后对于医生的最优解,就是想尽一切办法(比如签各种同意书)去规避责任然后急救,或者不去救。

所以能问出这种问题的不是蠢就是坏。但这年头的坏人其实我觉着智商都不错,不会这样明着来找骂,所以我觉着是蠢。


user avatar   wang-hao-54-71 网友的相关建议: 
      

CPR时,胸部骨折不增加死亡率。(后附检索文献过程)

这是写在指南里的。

差不多每五年更新一版心肺复苏指南,前面有一版写了要按压深度大于5厘米,因为按压不够深的话效果差,就是死的多。

有人说那也不能无限制的增加深度吧?改版后写成5-6厘米,同时加了一句,更深增加骨折发生率,但骨折不增加死亡率。

绝大多数这种骨折,即使发生了,也都不用特殊处理,自己慢慢长就行。

骨折原因如果是手掌按压的,则形状钝圆,一般都按成中心塌陷,多根多处对称性骨折。尸检能摸到骨折,但都不能突破壁层胸膜,更谈不上损伤。

以下为12-16号补充,非医学专业可以不看:

上述回答,是用手机,基于印象,写的简略答案,对非医学人士应该是够了。如果想要查询相关资料,可以看我的操作流程。

1,看什么指南?毫无疑问,美国心脏病学会(AHA)心肺复苏指南,其他国家的指南基本都是以此为蓝本小修小改,小改还不如不修不改,所以看AHA的就可以了。链接如下:

2,对于本问题,看哪一部分?

第5篇,BLS基础生命支持和CPR心肺复苏质量,下面第8章胸外按压技术,下面第3节胸外按压深度。

如图,可见这一部分最后是2015年更新,点击2015跳接到全文。Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality

找到相关部分,原文如下:

Even with this heterogeneity, there is consistent evidence that achieving compression depth of approximately 5 cm is associated with greater likelihood of favorable outcomes compared with shallower compressions.5765In the largest study to date (n=9136), the optimal compression depth with regard to survival occurred within the range of 41 to 55 mm (4.1 to 5.5 cm, or 1.61 to 2.2 inches).60Less evidence is available about whether there is an upper threshold beyond which compressions may be too deep. During manual CPR, injuries are more common when compression depth is greater than 6 cm (2.4 inches) than when it is between 5 and 6 cm (2 and 2.4 inches).66

最后一句话“在人工心肺复苏过程中,当按压深度大于6厘米(2.4英寸)时,损伤比在5到6厘米(2到2.4英寸)之间时更为常见”

3,看原始研究。如上所见,资料来源于第66篇参考文献,如下:

66.Hellevuo H, Sainio M, Nevalainen R, Huhtala H, Olkkola KT, Tenhunen J, Hoppu S.Deeper chest compression - more complications for cardiac arrest patients?Resuscitation.2013;84:760–765. doi: 10.1016/j.resuscitation.2013.02.015.

找到原文resuscitationjournal.com

对摘要进行粗略翻译如下:

“研究目的:胸骨和肋骨骨折是心肺复苏(CPR)时胸部按压引起的常见并发症。本研究旨在探讨心肺复苏相关胸腹部损伤与加速计测量压缩深度的潜在关联。方法:我们分析了2009-2011年间坦佩雷大学医院170名患有院内心脏骤停的成人患者的尸检记录、CT扫描或胸片,以探讨胸外按压与医源性损伤的可能关联。心肺复苏过程中手动按压的质量记录在飞利浦HeartStart MRx Q-CPR™除颤器上。结果:男性110例,女性60例。36%的男性和23%的女性患者受伤。在男性患者中,心肺复苏相关损伤与较深的平均压缩深度和峰值压缩深度相关(p<0.05)。在妇女中没有观察到这种联系。平均压缩深度<5、5-6和>6 cm的损伤发生率分别为28%、27%和49%(p = 0.06)。所有患者中27%的肋骨骨折,11%的胸骨骨折和8例心肌血肿/破裂。此外,我们还观察到一例无出血的胃裂伤,一例脾脏破裂,一例纵隔出血和两例气胸。结论:男性患者的医源性损伤与心肺复苏期间的胸外按压有关,随着测量的按压深度超过6 cm,胸外按压次数增加。虽然深部压迫会增加并发症的风险,但重要的是要认识到这些损伤基本上不是致命的。

4,寻找相关文献。


通过搜索,可以找到引用此文献的研究,如我亲爱的Giuseppe Ristagno兄弟新写的:

The priority after cardiac arrest is to perform high quality chest compression (CC) to generate and maintain coronary and cerebral perfusions likely to restore spontaneous circulation (ROSC) and mitigate brain injury. Accordingly, hemodynamics produced during cardiopulmonary resuscitation (CPR) is directly related to the depth of CC.1Thus, achieving adequate CC depth, i.e. at least 5 cm, should be prioritized during CPR, even if potential harm from excessive depth has been reported.2

还有最新的尸检研究:BMC Emerg Med. 2019二月

粗略翻译如下“背景:心肺复苏(CPR)可以显著提高存活率,即使是由旁观者进行。然而,旁观者可能会因为害怕最终的医疗事故诉讼而避免进行心肺复苏。目前缺乏指导方针来明确某一特定的心肺复苏相关并发症是否不可避免。为了填补这一空白,需要在最相关的主要学术文献中发表大量研究。本文旨在为应对这一挑战作出贡献。方法:一项基于法医尸检材料的回顾性观察研究,旨在记录因应用心肺复苏术而造成的损伤。对损伤的严重程度进行法医学评估。结果:88例尸检中,肋骨骨折仅占26.7%(仅20%位于6根下肋骨),胸骨骨折占17.4%(85.7%位于胸骨体,14.3%位于手部)。胸骨骨折与肋骨骨折的比率与文献报道的其他研究(2∶3,约)的比例相似。骨折7.86处(右侧4.11处,左侧4.75处)。轻度16%,中度48%,重度35%。当有医生在场时,发现有更严重并发症的趋势(没有统计学意义)。结论:研究结果与文献中提到的经典体外心肺复苏术的其他类似研究一致。这项研究提出了一项建议,旨在帮助制定指导方针,明确特定的心肺复苏相关并发症是否完全可能不可避免。”

至此,问题的答案已经比较清楚了。


user avatar   zhaogang1217 网友的相关建议: 
      

如果你自认算不上社科学者、作家,或者陈道明那样的艺术家,不用多想,看书没用。

书是人类进步的阶梯,我认同这句话。但说到底,真正能让人类得到进步的,只是其中一小部分个体。

我大学毕业后才渐渐养成了阅读的习惯,每年看的实体书,没仔细数,摞起来大概是身高两倍吧。

网文也看,比实体书少一些。

一开始喜欢读《1984》、《动物农场》、《美丽新世界》和《菊与刀》这些,很幼稚地认为,看这些书会让自己卓尔不群,“独立思考”。

包括王小波的书,黑格尔的大部头,史铁生的散文。

后来,小说占比越来越高,人文社科只占大约一成。最后发现自己钟爱的还是侦探小说,阿加莎的书只剩下《帷幕》,一直不忍心读。

统统没用。

借用阿婆书里一句话,这人就没什么品味,你看看他读的都是什么书,西部拓荒故事和侦探小说!

不可否认,看书增长了我的知识量,有效提高了我的写作文笔,让我体会了不一样的人生百态,聚会时更有谈资,思考了一些问题,得到一丢丢答案。

但我要告诉你,所谓的提高就这些,你接受吗?

我估计不会接受。

大部分人追求的提高,是那种看得见的生活质量提升,是社会地位带来的自信,是升职加薪,是生活美满。

这没什么不好意思说出来。每个人都有欲望,每个人都有压力,每个人都要生活。

这个题目下的大部分回答,开头阐述究竟什么样的书才算是好书,只要读了这些“好书”,就能实现自我升华。

这其实是个很难征明的论题。

就比如说,我确实认识一些家庭事业都很成功的大叔,客厅里、书房里一整面墙都是书,他们的成功得益于阅读吗?其实未必。

他们喜欢读书,是因为双亲都是有良好阅读习惯的高级知识分子;他们成功,是因为高智商、勤奋、精力旺盛,加之父母督促,考上了名牌大学。

既然能较为轻松地在事业方面做出成绩,早早实现财务自由,从小被爸妈培养出阅读习惯的他们,选择在闲暇时间读许多许多的杂书。

所以,你看,爱读书说是成功的因,不如说是成功的果。

或者换种思路,我们反证这个问题。

假设读书真的能有效提高一个人。

我们生活在一个高度商品化的社会,如果通过读书提升自我的方法真的被开发出来了,而且被证明切实有效,那么,它就一定可以转化为一种商机,一项可盈利的教育产业。

换句话说,市面上会出现大量的“成人读书班”。

多么大量呢?今天你能看到多少考研班、考证班、职业技能培训班,就该有多少“成人读书班”。

有吗?并没有。

倒是”5分钟带你读XXX“这种短视频火了。瞧瞧吧,就算是想读书的人,仰慕书中思想的人,最终的追求也是”不读书“。

30分钟带你读完《战争与和平》!

乖乖,配上苏联版电影的剪辑,质量真的高,好看。

其实30分钟视频对现代人来说也太长了,所以视频分上中下三部,一部10分钟。

哪怕是给美少女和精神小伙网上刷礼物这种社交需求,都被开发成了一年不知多少亿的直播产业。

再打个比方,有创业的打算,就该脚踏实地地考察项目,结识合伙人,筹集启动资金。闲下来了,看看名人传记,打打鸡血,只是个可有可无的放松项目。

还有那种,认为读书可以提高自身谈吐和综合素质,进而遇到伯乐的观点。

我只能说,我们活在现实世界里,要适当减少一些幻想,放低一点要求。

也许你真的会在一场晚宴中,跟同样喜欢读书的老板、上级所聊甚欢,伯牙子期。但现实中的绝大多数情况是,这顿饭过去,领导就把你忘了,该干啥干啥。

还有一种情况,就是领导寻思这小伙子既然有时间看这么多闲书,怎么工作上就不能多加把劲?可见他事业上没太大野心。

而同事们的看法则刚好相反,觉得你这是削尖脑袋往上爬,是在花样拍马屁。

什么人都有,什么事都可能发生。

现实世界里,我不秀阅读量,也不提自己喜欢看书。

作为一种爱好,绘画和摄影可以拿来给人看,唱歌和乐器可以请人听,舞蹈更是赏心悦目。

阅读呢?大多数情况下,只会让身边的人认为,你自命不凡,且喜好炫耀这点。

包括很多答案里的用词和腔调,恕我直言,从大众的视角看,不是特别让人舒服。

摄影需要购买昂贵的器材,绘画需要天赋,至于读书,大部分人看来,谁都可以读,谁读都一样。

他们也许没有阅读习惯,也许不能坚持阅读,但不妨碍就这么认为。

在这些人看来,之所以不读书,是因为必须忙活事业和学业,得照顾老人和小孩,要张罗无穷无尽的琐事。

而你,有时间看闲书,必然是牺牲了其中不止一项的时间,逃避了家庭和社会的部分责任。

这样的人,也好意思跑我跟前炫耀吗?

这不是对不对、该不该的问题,也不是社会风气的问题,更不是价值观扭曲、礼崩乐坏的前兆。

人性使然,人都倾向于认为,自己的价值观最正确,手头上的事最紧要。

我父母那辈,平时还是有时间和精力看书的。他们对喜欢读书、坚持读书的人也是发自心底地佩服、敬重。

但世界已经变了。

出于这个原因,现实中,我也极少看到有人抱团交流读书体验。

唯一一次意外,是个漂亮姑娘,她喜欢小说,身边自然而然地围拢了一群男生,争相对情节、人物和文笔发表看法。


user avatar   cao-ling-er-36 网友的相关建议: 
      

全面地,从宏观介绍差异的一篇文章:

12 Differences Between Chinese Education and American Education

Posted on June 1, 2007

This analysis is being prepared for a presentation I am going to make at the International Conference on Intercultural Education in Harbin, China on June 22-24. I would be interested in receiving your observations, comments, questions about the differences between Chinese and American educational practices.

  1. Class Size is the first noticeable difference at the middle school and high school level. Teachers typically teach two classes (in an 8 period day) with from 55 to 65 students. American secondary teachers typically teach five or six classes with class sizes ranging from 25 to 30. The Chinese teachers use their non-teaching time to grade papers and to prepare for their classes, except for the head teachers (banzhuren) which will be explained later.
  2. While Americans think the "cohort" concept is innovative, China has been using it for decades. Throughout China, students beginning in a school are put into classes and they stay in those classes with one another for the entire time they are in that school unless higher test scores permit them to move to a more advanced grouping. Understood in the Chinese system is that this group of students will learn each of their subjects together. In America, students are not grouped into such classes. Instead, the 30 students who are together for English class will be randomly split up into any of the other subjects for the next period and the period after that, and so on. The next year, the students are totally mixed up again into different classes. Occasionally, the same class of students will take two courses together, such as English and history, but that is rare. The Chinese carry the cohort concept into the university level as well. My four classes of students stay together for all of their required courses the whole time they are at university.
  3. Chinese students stay in the same classroom for their main classes and their teachers come to them while American students change rooms every period and the room belongs to the teacher. Thus, Chinese students don’t have hallway lockers. Students sit in the same seats for each subject and keep their materials in a shelf under their desk top. Many students have cloth covers for their desk and other means of making it "homey".
  4. Chinese education is built on what Americans call "looping". The teachers of the students in the entering class will also follow their same students to the next grade level and the next. In America, it is very unusual for teachers to move with their students from one grade level to the next at the middle school or high school level let alone to loop for the entire period of time the student is in that school. At the primary school level, students begin in grade one with a teacher and stay with that teacher every year they are in primary school. My university students reflect on that teacher as being so very important to them that they really didn’t want to leave them when it was time to go to middle school. American teachers, on the other hand, tend to specialize in the curriculum and content for a particular grade level and then stay at that level. Sometimes, teachers who want to teach older students will ask to move to a higher grade, but then that teacher would typically stay at that level until retirement. That practice means that in America, subject matter and teacher preference might be valued more highly than student needs or student learning.
  5. Another significant structural difference between American and Chinese schools is the concept of head teacher or "banzhuren". The banzhuren takes additional responsibility in delivering instruction, supervising their specific class of students, and in knowing their students and the families of the students and in communicating with those families. For less than 200 yuan per month more, the banzhuren will arrive at school prior to 7:00 a.m. to prepare for the day and to work with early arriving students. The student day at the middle school ends at 4:55 and the teachers leave shortly after that. The banzhuren will not only teach her specific class that she is in charge of but will also sit in on many other subjects throughout the day so she can monitor the progress of her students with other teachers, counsel her students, and contact the parents of those students if necessary. The banzhuren will monitor her class during lunch and nap with them after lunch. One banzhuren told me that she is like a mother to those students who don’t have the parental support they need. In addition, at Liaoning Normal University Junior Middle School (LNUJMS) thebanzhurens are expected to visit the homes and families of half their students sometime during the first term and the other half during the second term. These visitations would take place on Saturdays or Sundays or on holidays. The banzhurenwill, after three years, receive a bonus based on the academic improvement of her class. In America, the individual teacher is expected to make parent contact when a student misbehaves or is not performing at a satisfactory level. In American secondary schools there is also a person called a guidance counsellor who will assist with parent contact. However, the guidance counsellor will have a case load of 350 to 500 students and she often must resort to group counselling sessions.
  6. The Chinese believe in merit pay and in using student test scores for teacher evaluation. For example, when the 9th graders leave middle school they are tested to see which high school they are qualified to attend. Since the same teachers have had those students for three years, they compare their entry score to their exit score. The classes that showed the most academic gain resulted in that banzhurenreceiving a bonus that might range from 3000 yuan to 6000 yuan (one month or two months pay). The same is true at the high school level. On the other hand, a teacher whose students did not show growth will be evaluated accordingly. At LNUJMS, the math team won first place in the District math contest. As a reward, the four math teachers split a 2000 yuan bonus. The teachers I have talked with like the bonus system. So for years the Chinese have been doing what the American conservatives have been advocating and our teacher unions have been fighting.
  7. Discipline in Chinese schools easier than in American schools. For example, at LNUJMS, I was surprised to find minimal student supervision during lunch and between classes. One administrator and one teacher were in the hallway and no teachers were in their classrooms. The other teachers had gone to their offices to meet with students for academic or disciplinary reasons or for a rest between classes. In America, the time between classes is as short as possible, three, four, or perhaps five, minutes. Students are expected to move from their classroom, go to their lockers to get materials for their next class, and then move to that class. The American teachers are expected to be in the hallways during passing periods because that is when fighting and other misbehaviors occur. It is nearly impossible to even imagine a 10 minute passing period in an American school.
  8. Chinese students are very respectful. When Chinese students recite, they stand; when students hand in a paper, they use both hands as if they were making a presentation of the paper to the teacher; when students refer to their teacher in writing, they often use terminology such as , “Our dear teacher.” In interviewing thebanzhurens, they commented that is their duty to teach students how to do well in life and how to be a man. University students, when asked to recall their middle school and high school years often speak of their teachers in very exalted ways telling how much their teachers meant to them.
  9. Chinese students play active and important roles (zhirisheng) in sweeping the classrooms, scrubbing the steps, serving meals, being class monitors, and helping teachers. Student monitors can be seen wearing special armbands in the hallway, watching to make certain students are doing their twice-daily eye exercises properly, providing leadership on the marching field, watering plants, empty bins, cleaning windows, helping to distribute the daily lunch, and so on. Students always seemed to be carrying out their tasks very seriously and in good humor. The student monitor system is utilized at the university level as well with these appointed students helping the teacher in making copies, distributing and collecting papers, contacting classmates and so on. Like the concept of banzhuren, the concept of zhirishengcannot find its English equivalent due to the different Sino-American educational systems. Most Chinese schools are operated on the zhirisheng system for the purpose of maintaining clean classrooms and schools.
  10. Chinese students buy their textbooks each year and the textbooks are soft cover and relatively thin. The textbooks I looked at had a 2006 copyright and I understand that they all have recently undergone revision. The cost is about $1 for a textbook and $2 for a workbook that accompanies the textbook. Students make heavy use of highlighters and annotations in their books. In addition, the textbooks often have moral lessons built into them. For instance, when a particular scientist is highlighted, aspects of his/her life that are exemplary are extolled, such as hard work, protecting the environment, overcoming obstacles, etc. On the other hand, American textbooks are hard cover, updated every six years (at least in Indiana), and are rented to students. Students are not allowed to mark in their textbooks in America.
  11. It almost goes without saying that the curriculum in China is standard nation-wide and that students have few elective choices. National goals, national curriculum, national expectations, national exercises, and even a national class schedule are all built around the Chinese Education Schema that is based on centuries of tradition. In America, education is primarily the responsibility of the state governments. Counting Washington D.C., there are 51 separate governments that give direction to public schools. Further, except for Hawaii, states are divided into school districts that also have certain autonomies. Indiana, for example, has 292 school districts, 292 different teacher contracts, salary schedules, and sets of working conditions.
  12. Deeply embedded in the Chinese culture is the examination system. Since the Song Dynasty (960 AD), the Chinese have relied on the examination process to identify their governmental leaders. Now the examination system is used to determine which university students are able to attend. These national exams were given on June 7 and 8. Local middle schools were used as test sites and those middle school students had a two day holliday. The test is of such great significance that parents rent hotel rooms nearby so their student can have a quiet lunch and take a nap. I saw one hotel with a big banner wishing students luck on the exam. Students will take either the liberal arts test or the science test. For liberal arts students, the first test, Chinese, was from 9:00-11:30. Students were dismissed and came back for the math test from 3:00-5:00. On Friday, the schedule was the same, with the morning session being geography, politics, and history and the afternoon session being English. The parents filled the street in front of the school and anxiously awaited students coming from the test sites and wanted to know how their child did. Taxi cabs even offer free service to these students to help them get home or to the testing site. My friend Kevin’s uncle took time off work to drive Kevin to the test site, pick him up at noon to take him home, then bring him back. It is huge deal!
    (原文:slkchina.wordpress.com/

user avatar   ci-ren-yi-bei-feng-hao 网友的相关建议: 
      

当年红十字会急救培训时,强调过,心肺复苏很容易造成胸骨骨折,尤其是我们这种业余选手。

但是,不进行心肺复苏,5分钟基本上就没救了。心肺复苏就算骨折了,也有可能能救回来。

必死和有伤二选一。

我选必死,因为死的是题主,不是我。

自我保护也是红十字会培训的重点内容之一。




  

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