《《急危重症的监护》ppt课件》由会员分享，可在线阅读，更多相关《《急危重症的监护》ppt课件（93页珍藏版）》请在金锄头文库上搜索。
1、急危重症的监护 Intensive Care/Critical Care,方向韶 中山大学附属第二医院 急诊科,1,急危重症监护,将危重患者、先进设备、掌握设备和技术的优秀医务人员同时集中于一体，充分发挥有经验和专业知识的医务人员的能力，也充分利用有限高级贵重设备，利用仪器、设备和技术方法，更加频繁进行快速有效的生命、器官检查或者连续监测，及必要的功能支持、加强的照料护理。目的是为迅速掌握患者病情及其变化情况，挽救患者生命和器官功能。,2,History of Critical Care,Critical care evolved from an historical recognition
2、that the needs of patients with acute, life-threatening illness or injury could be better treated if they were grouped into specific areas of the hospital. Nurses have long recognized that very sick patients receive more attention if they are located near the nursing station.,3,History of Critical C
3、are,Florence Nightingale wrote about the advantages of establishing a separate area of the hospital for patients recovering from surgery,4,In 1927, the first hospital premature-born infant care center was established at the Sarah Morris Hospital in Chicago During World War II, shock wards were estab
4、lished to resuscitate and care for soldiers injured in battle or undergoing surgery The nursing shortage, which followed World War II, forced the grouping of postoperative patients in recovery rooms to ensure attentive care,5,In 1947-1948, the polio (poliomyelitis) epidemic raged through Europe and
5、the United States, resulting in a breakthrough in the treatment of patients dying from respiratory paralysis. Patients with respiratory paralysis and/or suffering from acute circulatory failure required intensive nursing care Bjorn Aage Ibsen (1915-2007) became involved in the poliomyelitis outbreak
6、 in Denmark; Patients were managed in 3 special 35 bed areas; In this fashion, mortality declined from 90% to around 25%.,6,During the 1950s, the development of mechanical ventilation led to the organization of respiratory intensive care units (ICUs) in many European and American hospitals. Created
7、in 1958, Johns Hopkins Bayview Medical Center became the first multidisciplinary intensive care unit (ICU) in the United States.,7,By the late 1960s, most United States hospitals had at least one ICU. In 1970, an organization committed to meeting the needs of critical care patients: the Society of C
8、ritical Care Medicine (SCCM). Between 1990 and the present, critical care significantly reduced in-hospital time as well as costs incurred by patients with diseases such as cerebrovascular insufficiency and respiratory failure.,8,Landmark of History of Critical Care,1950 iron lungs (polio and brain
9、stem paralysis) 1958 Peter Safar: the first multidisciplinary first Intensive Care Unit at Baltimore City Hospital 1970 Swan Ganz catheter Transplantation,9,Landmark of History of Critical Care,World War II, shock wards,10,Landmark of History of Critical Care,1950 iron lungs (polio and brain stem pa
10、ralysis),11,Polio Survivors in Iron Lung,12,Landmark of History of Critical Care,1958 Peter Safar: the first multidisciplinary intensive care unit first Intensive Care Unit at Baltimore City Hospital Father of CPR: combined the A (Airway) and the B (Breathing) of CPR with the C (chest compressions),
11、13,Landmark of History of Critical Care,1970 Jeremy Swan and William Ganz: Swan-Ganz catheter (pulmonary artery catheterization ),14,ICU of the Second affiliated hospital,15,ICU of the Second affiliated hospital,16,急诊危重症监护地位的争议,17,Specialized types of ICUs include,Emergency Intensive Care Unit，EICU
12、Coronary Care Unit (CCU) for heart disease Medical Intensive Care Unit (MICU) Surgical Intensive Care Unit (SICU) Pediatric Intensive Care Unit (PICU) for children Neuroscience Critical Care Unit (NCCU) Shock/Trauma Intensive Care Unit (STICU) Neonatal Intensive Care Unit (NICU) for babies,18,急诊重症监护
13、室的定位和发展前景争议和困惑 与“危重医学”学科间的关系 ：“短期医疗行为” 还是“全程治疗 ” EICU也不同于急诊抢救室,19,EICU的位置和基本设置要求,EICU应该位于急诊的抢救区附近，与急诊抢救区直接相通连，要相对安静和独立。 EICU内部环境的设计和布局应该兼顾患者和工作人员的需要，常常将一个封闭的大房间划分为病床监护区、护士站、治疗室和工作室，留置一定空间放置备用的抢救、监护设备和设施。,20,EICU的主要设备,分为监测设备和治疗设备两种： 常用的监测设备有:各种监护仪、心电图机、心脏血液动力学监测设备以及血糖仪、快速血气和生化分析仪等。 常用治疗设备有：输液泵、注射泵、无创
14、和有创呼吸机、除颤器、抢救车、抢救药品和各种护理用具等。,21,multi-parameter monitors,22,Pulse oximeter,23,Blood gas analyzer,24,Medical Ventilator,25,Laryngoscope (Tracheal intubation ),26,27,Hemofiltration,28,Continuous veno-venous hemofiltration (CVVHF),29,Defibrillator,Manual external defibrillator,Automated external defibr
15、illator (AED),30,Intensive Care Monitoring,31,EICU的收治对象,通常主要收治急性中毒、急性危重病、严重慢性病急性发作、严重创伤以及未确诊但有高危因素的患者等几大类。 有时EICU还会接受部分不能马上入院的危重患者先进行抢救和部分专科治疗，当然也难以推辞临终患者和晚期肿瘤患者。,32,EICU的管理要求,封闭式病房 ：优点和缺点 EICU医师 工作制度：三级查房制度和值班制度 护理制度：对护士的技术和应变能力要求高 EICU治疗水准的标准化和规范化,33,四点关键,采用规范的治疗流程； 有一个具有相当权威的、可以处理各种政策和协调各个医务人员工作的
16、有能力领导者； 护士要有相当高的专业水平并掌握重症监护技术和熟练各种医疗设备的使用； 医生和护士有十分精强的协调关系。,34,合理使用监护和支持技术,认识和避免监护设备存在的负面问题 合理掌握监护的指征和使用设备,35,危重症的生命与器官功能监护策略,36,1. 心电参数监护,Detection of arrhythmias Permits monitoring of heart rate Evaluation of pacemaker function Detect myocardial ischemia Electrolyte abnormalities,37,Locations of the unipolar precordial leads on the body surface,38,Electrocardiography (ECG),39,40,Reminders,Consider potassium derangements in any arrhythmia in the ICU Focus on treating the underlying elec
