ICU醫(yī)生與院內(nèi)急救課件

1、ICU醫(yī)生與院內(nèi)急救四川大學華西醫(yī)院ICU 金曉東CODE 199!CODE Blue!一、前言醫(yī)院需要ICU嗎？醫(yī)院需要成立院內(nèi)急救小組嗎？我院ICU現(xiàn)狀2005年共收治2025例患者心肺復蘇后轉(zhuǎn)入者37例 其中在轉(zhuǎn)運途中心跳驟停者3例(例痊愈)在普通病房未能成功復蘇者醫(yī)院現(xiàn)有狀況普通病房心肺復蘇操作流程不規(guī)范須請急會診須請麻醉科急會診我們的想法先進、良好、待用的特殊急救設備（如便攜式呼吸機、氧氣瓶等）的及時到位。確保轉(zhuǎn)運過程的安全性、快速性。從EMSS層面出發(fā)，盡量把ICU資源搬到院內(nèi)急救，彌補院內(nèi)急救相對薄弱的關鍵時機。ICU的功能集中嚴重心/肺/腎功能衰竭、創(chuàng)傷和其它各種嚴重有生命威脅

2、的患者，便于嚴密觀察病情變化和監(jiān)護。應用先進的醫(yī)學診斷技術和生命支持療法，如：復蘇除顫、體內(nèi)心臟起搏、氣管插管、機械通氣、心導管、腹透、血透等。二、基礎設施配置與合理使用良好齊全的急救設備:基本設備： 中心氣源、中心負壓、多功能病床、多功能插座、微泵、多參數(shù)監(jiān)護系統(tǒng)、氣管插管設備、手動輔助換氣囊、呼吸機、霧化系統(tǒng)，心電圖機、電除顫器、臨時起搏器、纖支鏡、冰機、CRRT系統(tǒng) 特殊設備 ： IABP、B超、血透機 院內(nèi)急救面臨的問題目前院外急救已初具規(guī)模院內(nèi)急救?沒有相對固定的工作小組沒有相對完善的工作流程沒有全院各科室的積極配合沒有復蘇后的積極反饋院內(nèi)急救效率下降！應成立專業(yè)院內(nèi)急救小組！Sup

3、plemental Team MembersOn-call anesthesiologistA spiritual care person is on call for codes三、人員的素質(zhì)要求高水平的鑒別診斷能力熟練掌握各類急救技術組織協(xié)調(diào)能力具有強健的體魄能適應緊張的工作有較高的業(yè)務素質(zhì)較強的責任感和無私奉獻的精神Education and TrainingPhysicians have received up-to-date training in ACLS protocols according to the American Heart Association.Basic lif

4、e support (BLS) training for the health care provider and Heartsaver Plus, with satisfactory completion, are required every other year and are provided according to the AHA standards.Education and TrainingEmployees involved in direct patient care are mandated to attend CPR programs and must demonstr

5、ate competency in CPR.Outpatient service staff must conform to the same standard of CPR education. Mouth-mask devices or resuscitation bags are available. 四、各級人員的職責 ICU Physician (team leader)Ultimately responsible for Code management.Determines when to discontinue efforts or establishes when patien

6、t is stable enough for transport.Communicates with the attending physician and family.improvement toolCritical care nurse （1）Establishes the cardiac rhythm and defibrillates as quickly as possible if indicated.Administers medications as directed. May give epinephrine, atropine, and/or lidocaine as a

7、pproved in the Emergency Measures protocol.Uses ACLS guidelinesCritical care nurse （2）Helps with all aspects of the resuscitative effort.The critical care nurse and/or the responding physician are responsible for managing the care of the patient, including ascertaining that proper chest compressions

8、 and ventilations are being performed.Brings I-STAT box and “difficult-to-incubate” box.Administrative supervisor （1）Role varies with circumstances.Helps with CPR as needed, especially in non-clinical areas.Validates code team members are present and the physician/resident is giving direction.Assist

9、s with traffic control.Administrative supervisor （2）Assists with physician notification and family support.Assists staff/code team as needed.Helps troubleshoot difficult situations.Makes arrangements for bed assignments.設備的規(guī)范化管理五定一隨時：搶救物資必須統(tǒng)一固定位置固定專人管理固定的物資管理模式一定的物資儲備量定期檢查隨時補充（平時禁止取用）合理使用疾病是個連續(xù)的病理過程

10、，應強調(diào)作連續(xù)和動態(tài)地監(jiān)測，孤立的、哪怕看來是“異?！钡臄?shù)據(jù)并不足以說明問題。使用各種儀器對病人進行生理功能監(jiān)測的結(jié)果是加強治療的決策依據(jù)。熟練地掌握使用方法。對檢測結(jié)果的解釋要全面合理，要充分考慮每項監(jiān)測的局限性和制約因素，注意研究同一系統(tǒng)不同指標間和不同系統(tǒng)間的聯(lián)系，防止片面性。發(fā)揮其先進性和優(yōu)越性，注意局限性和不足，揚長避短。 五、ICU醫(yī)生與?？漆t(yī)生的關系專業(yè)化的ICU是完全獨立的科室，ICU醫(yī)師將全權(quán)負責病人的醫(yī)療工作。ICU是高度開放的、與?？坡?lián)系最廣泛和密切的科室，因此?？漆t(yī)生應參與并協(xié)助ICU的治療，向ICU醫(yī)師提出要求和建議。ICU醫(yī)師也有義務將病情和治療計劃詳細向?qū)？漆t(yī)生溝通。關于?？漆t(yī)師?？漆t(yī)生對待急救小組切忌：缺乏信任，指手劃腳，事事干預；完全依賴，將病人棄之不管。擅作主張，不作評估直接將患者