在线诊疗——未来急诊医学新趋势

任梅梅

Emergency medicineAn online medic
急诊医学——在线诊疗
Field medicine, for soldiers and civilians alike, gets smarter

就地诊疗方便士兵亦惠及平民，且日益智能化

Jun 8th 2010

2010年6月8日

HALF WAY through a flight from Mumbai to London, a male passenger complains of a swollen right hand and an inability to bend his fingers. The flight attendants are uncertain about what to do and hook the passenger up to a small device which takes and transmits vital signs, including his pulse, blood pressure and a picture of his hand to a ground-based medical team. As the passenger’s condition worsens, the device is also used to transmit an electrocardiographic (ECG) trace, which rules out heart problems. The passenger is stabilised and monitored with the assistance of a doctor on the flight and the decision is made to continue the journey rather than divert to the nearest airport.
孟买飞往伦敦的航班飞行途中，一名男性乘客称自己右手肿胀无法弯曲手指。机组人员不确定如何是好，于是为该乘客连通了一个小型医疗装置，他的脉搏、血压等生命体征以及其手部图像随即通过这个装置被传往地面医疗队。随着这名乘客状况益发糟糕，该装置还被用于传输心电图（ECG）曲线以甄别心脏问题。最终在航班上一名医生的协助下，患病乘客状况得以稳定并处于监控中，机组决定继续航程而不用转移到就近机场。

                               
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Medical emergencies like this often occur on aircraft, and there are not always doctors on board. But in this incident the doctor says she would have asked for the flight to be diverted if it had not been for the ability of the portable vital-signs monitor being carried on the aircraft to rule out a heart attack. Now these remote health monitors are becoming even more sophisticated and capable of being used in the most extreme conditions.
类似于此的急诊病情在飞机上时有发生，而且机舱内不一定总有医生。在此例中，那名医生说：假设飞机上没有配备那台便携式生命体征监测仪从而排除了患者心脏病的可能性，那么她就不得不要求飞机就近降落。而如今，这类远程健康监测仪已经益发功能复杂化，并能在最极端情形下使用。
RDT, a British company based near Basingstoke, makes the Tempus system of telemedicine monitors—the type used on the Mumbai flight. Besides aircraft, it also supplies them for ships and for use at remote locations like oil wells. The Tempus is similar to a high-end portable monitor used by some ambulance crews, except that it is small, extremely rugged and capable of simultaneously transmitting the data for vital signs, including ECG, blood-sugar and blood-oxygen levels, along with voice and video pictures. It can do this in multiple ways, with built in Wi-Fi, mobile, satellite and Bluetooth communication links. It is also designed to be simple to operate using a touch-screen and pictorial instructions, so the need for training is minimal.
RDT是座落于贝辛斯托克附近的一家英国公司，正是它制造了Tempus远程医用监测仪系统——也就是孟买航班上用到的那款机型。除了飞机之外，该公司还为轮船以及诸如油田之类的远程地点提供监测系统。Tempus类似于一些急救人员所用的高端便携监测仪，仅有的区别在于它体积很小、异常坚固、并能伴随声音和视频图像一道，同步传输包括心电图、血糖值、血氧量在内的生命体征。它实现以上功能有多种途径：可利用无线保真（Wi-Fi）、手机、卫星、蓝牙建立通讯连接。另外，它还被设计为触摸屏以及图形指南的简单操作方式，因此使用者所需培训也十分有限。

Now RDT has come up with an even tougher version, which has just gone into trials with America’s special forces. It is waterproof, soundproof (so as not to give a unit’s position away) and will operate over military radios as well. As it will be used by trained combat medics, new features are being added. These include a small ultrasound probe that can be used to scan for internal injuries such as fluid in the abdomen or internal bleeding, and a video laryngoscope, which can be used to view and open a patient’s airway by inserting a tube—a tricky and potentially dangerous procedure. A miniature video camera on the tip of the laryngoscope relays a picture to the screen on the monitor to help its correct insertion. The monitor could also be preprogrammed with medical details of individual members of a unit, or automatically obtain them from “smart” dog tags, which are being considered by some armies.

如今RDT公司已经开发出一款甚为强大的新版装置，刚投入美国特种部队的测试使用中。新款防水、隔音（因此不会泄漏编制单位的所在地），还可以借助军事无线电波运行。因其为训练有素的随军医护人员所用，所以额外添加了一些新功能。包括一个可以用来扫描腹部液体或内出血的超声波小探头，还有一个可视喉镜，借助它可以边看边插入呼吸管从而打开患者的呼吸通道，插管本身是一个棘手并存在潜在风险的过程。喉镜顶端的小型摄像机将图像传输到监测仪屏幕上从而保证管子的正确插入。监测仪还能根据编制单位中个体成员的医疗详细信息进行预编程，或者从“智能“身份识别牌（一些部队正在考虑应用）中自动获取信息。
Just as the crew of an aircraft or ship can use such monitors to connect to remote medical centres, in order to help make diagnosis, obtain treatment advice and determine whether to divert for help or not, a commander in the field would be better informed about the need to evacuate a casualty—which might mean calling off an operation. And if the trials with the special forces go well, Graham Murphy, RDT’s chief executive, believes versions could be provided for civilian paramedic use.
正如飞机或轮船工作人员能使用类似监测仪连接到远程医疗中心一样，为了帮助作出诊断、获得治疗建议、并决定是否就近转移寻求帮助，地面指挥官最好被告知疏散伤员的必要性，这可能意味着取消一次行动。如果特种部队测试使用进展顺利，RDT首席执行官格雷厄姆·墨菲认为该版本就可以供给民间医疗之用。
Future capabilities, Mr Murphy hopes, might include a digital stethoscope to analyse breathing sounds and a haematoma scanner to look for a brain haemorrhage. In both civilian and military use, the vital signs recorded by the monitor would provide doctors attending a casualty arriving at a hospital with a history of the patient’s condition and any treatment administered—something which is not always readily available. It could be sent remotely, or carried with the patient downloaded onto a USB stick. Medical emergency-room dramas will never be the same again.
墨菲先生希望，未来该装置的功能还包括：一个数字听诊器来分析呼吸声，一个血肿扫描仪以寻找脑部出血点。无论民用还是军用，监测仪记录下的生命体征能提供伤患人员的全部发病过程和任何处置手段——并不总是常备可用的一些内容，当伤患人员抵达医院时呈交给诊断医生。呈交方式可以是远程发送，也可以下载到U盘由患者随身携带。如此这般，急诊室的剧幕必将不复从前。

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