- 期刊
Dead on Arrival with Ventricular Asystole: Impacts Just Arise
無心室收縮之到院死亡：衝擊才剛開始
摘要
到院死亡(DOA)對於在急診室工作的醫護人員而言，一直是件沈重的負擔。從接觸死亡開始，其急救、處理及善後均變化莫測，難以預料，尤其當病患家屬面臨親屬死亡之際，其認知與接受度方面，與醫護人員難免有差距，本文提出之目的即在於討論DOA對醫護人員所造成的困擾與衝擊。 本研究收集由一九九四年一月至十月共十例DOA病例，男性佔七位，年齡由八個月至七十九歲，平均年齡四十一歲。除三例外，其餘七例，均有其潛在之疾病或外傷。病患到院時，心電均呈心室無收縮狀態，無自發性呼吸，且均無反射或反應。經急救處理後，除二例一直是心室無收縮外，其餘八例曾出現短暫竇性心率(2人次)，心室顫動(6人次)，原發性心室心率(2人次)。ACLS急救時間，平均為53.6分鐘，其中有一例曾存活7小時。 DOA所造成的衝擊，常在於醫護人員、病患家屬及法律人士間存在某些觀念及認知上的差距。如果家屬之情緒反應，能得到妥善安撫，則宣告死亡事後之處理，較容易平穩。有些缺乏經驗之醫護人員或法律人士，常會有「既然已經死亡，何必急救？」之誤解。對於以上人員之教育與觀念的溝通，是非常重要的。至於病人之最終存活機會，則有賴於早期的急救處置，除施予心肺復甦術(CPR)及高級心臟救命術(ACLS)外；對於DOA觀念的溝通，更是不可或缺。因為病人到院死亡後，家屬情緒的衝擊及急診醫護人員所面對的挑戰才剛開始而已。
並列摘要
Ten cases of dead on arrival (DOA) were discussed recently at the Tainan Regional Emergency Medicine Conference. These cases had been admitted to our Emergency Department (ED) during the period from January to October, 1994. DOA patients account for 0.23% (10/4322) of all our ED visits. Eight of them were brought in by the 119 System, one by the family, and another one by a local physician. Seven of the DOA’s had underlying disease. The male/female ratio was 7:3. The mean age was 41 years. All patients presented with ventricular asystole on arrival. During CPR, sinus rhythm (2 patients), ventricular fibrillation (6 patients), and idioventricular rhythm (2 patients) were recorded transiently, while two patients remained in asystole. At the termination of CPR and after death was pronounced, great discrepancies existed between the family, the medical and the legal personnel. Therefore, more communications and counseling among the involved groups are required, and optional non-medical as well as medical management of DOA patients are extremely important.