On the eve of world first aid day in 2015, carpenter hospital medical staff are mentoring patients' families on the outside heart-pressure skills exercise and first aid instruction. (oriental ic/chart)
(this paper was first published on 3 january 2018, the south weekend)
In this typical case of allergy to death, we mourn the dead, and we hope that the medical community and the public will clear up the controversy about the pipi test and truly establish a scientifically rigorous prevention and response programme for allergy, thus avoiding further tragedies。
Under the spirit of “self-preservation”, more and more hospitals are being held hostage to a sapilism test. “this is self-deception of lazyness.” yang fan is speaking out。
“a detailed inquiry into the history of allergies, close observation, constant vigilance and timely and correct rescue are truly meaningful measures.” sun is honest。
On new year's day 2019, ping chose to miss his husband zhang peak in the form of a photo sun. The first one is in the playground, where the husband holds a 4-year-old son, drawing a hand sign like "yes" ; the second one is in the infusion, wearing an earpiece and smiling... The last one was a 28-year-old husband lying in the emergency room with purple hair and never waking up again。
On the afternoon of 18 december 2018, zhang jianfeng was diagnosed by the same hospital attached to the shanghai university of transport medical school (hereinafter referred to as the same hospital) as an ear disease, which, after losing his head, was suspected of causing an allergic shock, resulting in an ineffective death of less than 90 minutes. In the medical dispute that followed, the name of a drug was repeatedly mentioned as “the sodium sodium twisted by injection”。
Head spores, which are probably the most familiar type of antibiotics in the public. It is used for lung, urinary, sepsis and meningitis. Like penicillin, which is commonly used in clinical practice, it is also an antibiotic of β-neamide. Such antibiotics are highly active, less toxic, adaptable, and clinically effective, but their shortcomings are equally evident - they can trigger allergic reactions。
The focus of the dispute between the sick party and the hospital is on whether the skin test is required before the head plaster is used (hereinafter referred to as the skin test)。
The family questioned the fact that the doctor had not examined the deceased. However, the staff of the hospital explained to the south's weekend journalists that “there is no harm in not having a skin test” - neither in the chinese pharmacy nor in the guidelines for clinical application of antibacterial medicines do not provide for a pictorial test of a pictorial drug with a sepsis. When asked about the medical history, the patient did not provide any history of allergy。
“whether or not to test the head”, which is a topic that yang has heard frequently in his work but he does not want to hear. He is the director of clinical applications at the institute of antibiotics of the university of joadan and the director of infection management section at mount hua hospital. In recognition of “the poor prediction of allergies in the cortex test”, the prevailing view from abroad has long been unrecommended, and he has been pushing for the elimination of cortex screening over the years。
This time, after too many unnecessary medical disputes and the cost of life, he once again called attention to this old and messy medical problem。
Something happened to the usual medicine
The bad news came in a little too soon。
On the afternoon of 18 december 2018, a friend, liu gaowei, informed yu ping that “your husband's ears are sick and he has to be treated in hospital”. Zhang zhang fengping was in good health, and he didn't do anything。
Once again, it was the sound of a nurse at the same hospital, "are you family? Your family is in the hospital
Yuhei's gone. On the way back to shanghai, she comforted herself repeatedly: an ear, a big hospital, will be fine。
According to information provided by liu gowey, the injection of sodium phosphate was started at around 1550 hours on zhang jian feng, and he was not given a skin test by the former doctor. After half an hour, he began to hang on to sodium cones for injection. In less than two minutes, zhang jian feng became ill and then pressed the emergency call button。
When looking back at the surveillance, liu gaowei found that zhang jian feng was shaking all over his body and his hands on his hands had begun to shake. Within two or three minutes of pressing the call button, the nurse starts first aid. However, at around 17:14, the hospital issued a notice of risk and shortly announced clinical death。
Following the incident, the family and the hospital requested mediation from the mayor of shanghai, ning district medical research board. “for the time being there is no result.” on 29 december, the staff of the hospital told journalists on weekends in the south。
He also confirmed that the commission had not issued a written conclusion. However, on 2 january 2019, she stated to the south's weekend reporter that after the preliminary investigation, the mrc had verbally indicated to the family that “the hospital was responsible for approximately 30 per cent of the patient's death in hospital”. However, the specific fault of the hospital was not specified by the board。
Two weeks later, the lack of a clear response from the hospital and the mrc has made her anxious. Following the husband's incident, she specifically sought instructions for the injection of sodium sulfur. “a report of an allergy to death”, she put a red circle on the instructions, “how can it not be decorated?”
"the emperor's new clothes"
Medical experts on infection are also following the dispute. They understood the tragedy of the ping family, but insisted that hospital responsibility should be investigated in terms of other aspects, such as the timeliness of treatment and the correctness of drug adaptation, “discussing whether or not a test has been done is completely misleading”. A hospital chief of infection told southern journalists about the weekend。
The reason for this is simple: a head-skin test does not accurately predict whether the patient is allergic。
"as the emperor's new coat." the sichuan university's wahsi hospital specialist clinic for ear, nose, throat and neck surgery is deeply concerned by the high rates of false positives and negatives of head-skin tests. It is popularly explained that pic-positive patients are sentenced to “head allergies”, which may in fact be normal; conversely, a normal pic-test may have fatal allergy。
When patients are allergic to one type of head, the other is often safely used. However, the fact is that, once the pico-positive test is completed, all the antibiotics of the hemogenesis are placed in a restricted area. “the patient’s treatment options will be significantly narrowed, and there is a risk that effective treatments will be lost.” the original pharmacist at the beijing pasifika hospital, yoon mei, explained。
Once positive, doctors tend to turn to more expensive, more widely effective and even less unsafe antibacterial drugs, which may indirectly facilitate the production of resistant strains. Yang sai said that the domestic use of antibacterial drugs for carbon cyanolene and fluorine (saltoids) was higher than in europe and the united states, “to a large extent it was a decorum problem”。
His hospital in mount hua did not undergo a pictorial screening before using a hemorrhage, but the mortality rate from allergy shock was lower than in some hospitals. He attributed this to the “false sense of security” created by the pitts test, which delayed treatment by being ignored by doctors when patients had symptoms of typical allergic reactions, “how did they feel the negative?”。
After the incident, the husband routinely went online to check for similar cases of allergic shock, and many were detected immediately. In the annual report on the national monitoring of the adverse effects of drugs of 2017, the number of reports of severe adverse effects of the haemorrhoids was ranked first in the number of anti-infective drugs, with the number of varieties and the number of cedars was second。
However, in the opinion of many doctors, this is not the reason why the head is in need of a skin test. The occurrence of an allergic reaction to drugs is related to the physico-chemical properties of drugs, individual differences in patients, etc. According to data from abroad, between 1 and 7 per cent of the patients reported that they were allergic to the aphrodisiac, but many of them were not really allergic。
Mengjun explained that many patients misperceived other adverse effects of the drug as allergic, such as gastrointestinal reaction after taking the drug, and that infection with the induced rash often caused the drug to become “pint”。
“who is responsible for what happened”
Since it is impossible to predict allergies accurately, why in some areas, do the heads or do the skin tests
The zhejiang zhejiang has been the first to test the skin of its head. In 1996, an allergy to death in a hospital in zhejiang province was followed by a communication from the former health department of zhejiang province, which led to the initiation of a primate test. Since then, hospitals have followed suit despite lack of evidence。
The peak was in 2003. In january of that year, the multinational pharmaceutical company, roth, introduced the decorative test requirement in the latest edition of the sodium cappuccino (trade name rosphine), warning that “sensitization tests would be required prior to delivery”。
The instructions approved by the national drug control agency have the force of law. As a result, it is inevitable that the medical instructions clearly indicate the need for a prude test。
It is estimated by a professional that the cost of the test is nearly $100 million a year for a single drug, and that it costs approximately 240,000 hours for a nurse, especially for patients and their families. At that time there was a doctor's reflection that “is it worthwhile to give medical care and patients extra human and financial resources for a completely unpredictable outcome?”
A lot of doctors started drumming with it. They lectured in hospitals and broadcast live on the internet, doing science between doctors and patients in an attempt to correct the notion that “head-to-head test is an effective means of protecting patients' safety”。
Yet those who speak and those who hear are disobedient. After hearing the lectures, the doctor found yang's sail, euphemismally saying, “i know you're right, but ...” and the strong eyes stare, “if you say no, who's responsible?”
For doctors, any slippage is enough to cause unnecessary trouble。
A doctor from jiangsutai state told southern journalists that more than 10 years ago, a patient in the hospital had not had a head-skin test and had died of an allergy after a drip. Since then, a leather test before the head was used has become a frame。
He lamented the fact that the greatest effect of the piping test was self-preservation, “no effort but no effort at all”. In a number of judicial decisions, doctors ' concerns quickly became a reality。
In 2011, an 85-year-old woman, who had been admitted to a hospital in the north because of asthma, had not had a leather test, had just lost about half a minute to rothphine, had suffocated, had purple lips and stopped breathing after seconds. Following the incident, the five children filed a lawsuit in court for compensation。
Beijing house ii considers that there is a high risk of allergies associated with sodium twilight, combined with the age of the patient, and that the possibility of a sensitization occurs before use, and that the taking of trace drugs for a leather test is a common method of preventing allergy in clinical medicine. The judgement states that “although the patient does not have an oral history of allergies, given the level of medical technology at the north great hospital, his attending physician should conduct a dermatological examination of the patient from the point of view of the high level of care required”
In the end, the court decided that the hospital would assume 30 per cent of the liability and compensate the patient's family for over 90,000。
There are no tests abroad
Under the concept of “self-preservation”, more and more units are being held hostage to a sapilism test. “this is self-deceptional laziness.” yang fan is speaking out。
In august 2018, the beijing children's hospital and the hunan children's hospital conducted a study on the status of β-neamide antibiotics in 55 hospitals in the country. As a result, as many as 93 per cent of hospitals have undergone a dermatology test even if the pharmacist and drug instructions do not provide for the need for a thioacin test, and some have also been extended to carbon pyroacne and monocyclic antibiotics。
But how the test is done, how the test is made, is generally done by the clinical section itself. There are different regulations in different regions and even in different hospitals in the same area。
In the above-mentioned study, 26 hospitals have established the requirements for a test and 28 have no regulations. In the same hospital, some of them have a skin test for all heads and others have been partially performed。
The paper produced by this study mentions that in europe and the united states, no tests were documented in the drug instructions, regardless of the type of antibiotics; the medical and food department of the ministry of health, labour and welfare of japan also recommended in september 2004 that the reference to a test prior to the use of antibiotics (including head bacterium) be eliminated。
“china may be a small number of countries in the world that need a head test.” mengjun said。
It is widely known that this is related to the quality of medicines in the country — an increase in impurities and an increase in allergies as a result of inadequate purification techniques。
Doctors had given the patient a skin test with a rash, typhus and other allergies, but had changed to imported medicine。
"the impurities do increase the likelihood of an allergic reaction." mengjun acknowledges. She spoke to foreign professors and said that all the crowds in china were going to do a pictorial test before they gave their heads
Mengjun replied that doctors in the country felt that the quality of medicines produced in the country was too high and impurities. Foreign experts asked, "what are the impurities? What are the mechanisms for allergies caused by impurities? What is the accuracy of the impurity allergy response?” none of these questions can be answered at this time. "peal tests to predict impurity are not scientifically sufficient." she said。
Prevention is key
Since there is no reliable way of predicting allergies, sun, an expert in the national monitoring system for reasonable medicines of the former ministry of health, is more concerned with the prevention of allergies。
“a detailed inquiry into allergies, close observation, constant vigilance and timely and correct rescue are truly meaningful precautions.” he said。
Before using a drug, the doctor must ask the patient in detail, including whether he has a history of allergies in the form of headgills, penicillin or other drugs; during the course of the drug, the medical staff must be closely observed, vigilant and, in the event of a sensitization, stop the drug immediately. “the sooner the intervention takes place, the better.” yang said that no one could be rescued until the allergies increased and the conditions were extremely dangerous; when serious reactions, such as allergies, were stopped, they were rescued, airways were opened and adrenaline was injected。
Yu ping told journalists in the south on weekends that zhang jianfeng's medical record says “no allergies”. According to the hospital, this was the first time a patient had gone to the same hospital and he did not raise it when the doctor asked about the allergies。
But more than 10 days after her husband left, the family was wondering how the hospital was saved. Is there an allergy process and plan? The court replied that it “operated in a normal process” and stated that surveillance videos in the rescue room were available only to the relevant departments. There is currently no official disclosure of the process。
However, for emergency relief, the level of some of the country's medical personnel is uneven. In july 2018, an article by a beijing doctor, “standing to a time of self-suspt”, screend the circle of friends. An emergency doctor in beijing told himself that he had been in a sensitive shock and had directed his colleagues to rescue him at the last moment of consciousness. After reading the article, yang sail cried and laughed, “the hair-disposal allergy response should be adrenaline, but the doctor used hormones”
The recognition of allergies by doctors also needs to be improved. Allergies are usually placed in the pervert reaction unit, but even specialists in this field are impressed by the fact that the pathological response discipline is weak and that most hospitals do not yet have such a section。
After years of driving, yang fan felt the change. In july 2015, rolfen removed the requirement for a pre-use test from the medical instructions; in july 2018, several academic organizations in zhejiang province issued a joint expert consensus that pointed to the lack of clear evidence-based basis for the prognosis of the prognosis and the non-recomposition of general pre-use screening. If a dermal examination is required, it must be ordered by a clinical practitioner。
Yang sail revealed that, with the support of the health administration, infection, perverted reactions, pharmacology, nursing, etc. Interdisciplinary experts are drafting guidelines for beta-neamide antibiotic pilot tests, which are aimed at correcting misconceptions and practices and promoting the elimination of routine pre-polymosis screenings for sepsis。
