《ICU学科建设》PPT课件

危重医学与加强医疗病房CriticalCareMedicineandIntensiveCareUnit,危重病医学CriticalCareMedicine研究危重病发生、发展及其预防与治疗的临床学科。为危及生命的危急重症患者提供高技术、高质量的生命器官支持手段的医疗服务。,何为ICU?,Money?-BuyTimeMedicine?HospitalamongHospital,加强医疗科IntensiveCareUnit一种集现代医疗、护理技术为一体的医疗组织管理形式。把危重病人集中起来，对各种危重病人实施连续的监测、治疗和护理，为原发病的治疗创造良好的基础、赢得宝贵的时间，提高危重病救治的成功率。,19世纪50年代克里米亚战争时期Nightingale提出“分级护理”观念1863年第一个术后恢复室（RecoveryRoom)建立二次大战中，欧洲各地集中救治创伤及休克病员，形成早期外科ICU（SICU）1948-1953年间，洛杉矶、丹麦、瑞典等地脊灰大规模流行，促成呼吸治疗单位（RespiratoryCareUnit，RCU)建立，是文献报道的第一个ICU。60年代，欧美等国家相继成立冠心病治疗病房（CoronaryCareUnit)CCU,美国BaltimoreCityHospital建立了具有现代规范的综合ICU1970年，美国危重病医学会成立。,80年代初仅数家大型教学医院设立ICU1989年北京召开第一次“加强医疗危重医学座谈会”1991年11月召开“全国首届ICU专题讨论会”，54所医院共设ICU59个（综合21个，专科38个）1996年12月16日北京成立了“中国病理生理学会危重病医学专委会筹委会1997年9月在北京正式成立中国病理生理学会危重病专委会，产生了第一届全国专委会委员2005年5月，中华医学会重症医学分会在北京成立,四个主体部分重症病员。一支训练有素的医护技术人员。完备的生理监测设备及先进的抢救治疗措施。能动态、定量观察及捕捉瞬息变化，反馈治疗效果；能作较长时间生命支持，为治疗原发病争取时间。严格、科学的管理。,Physician(Intensivist)PhysicianAssistant*NursePractitioner*RegisterednurseNurseRespiratoryTherapistClinicalPharmacistNutritionistTechnician,人员结构,Physician,Intensivist,Nutritionist,NursePractitioner,ClinicalPharmacist,Resident,RegisteredNurse,Fellow,TheICUModelinEuropeandintheUnitedStates,-AnInterviewWithJean-LouisVincentandTimothyG.BuchmanPosted06/30/2005,TimothyG.Buchman,PhD,MD,pastpresidentoftheSocietyofCriticalCareMedicineandProfessorofSurgeryatWashingtonUniversitySchoolofMedicineinSt.Louis,Missouri.,Jean-LouisVincent,MD,PhD,pastpresidentoftheEuropeanSocietyofIntensiveCareMedicineandtheEuropeanShockSociety,OpenversusClosedICUs,itisveryimportanttoplacecriticallyillpatientsinthehandsofaproperlytrained,experienceddoctorwhoispartofateamavailable24hoursaday.,Thekeyfeatureisanintegratedteamofdedicatedexpertsthatbringsmultiprofessionalperspectivetobearontheneedsofeachpatient.Intensivistsaretrainedandideallysuitedtoprovidethissortofleadership,whichiswhyIpersonallypracticeandsupporttheintensivist-ledmodel.,High-Intensityvs.LowIntensityICUPhysicianStaffing,PronovostPJetal,JAMA,288:2151(2002),FinancialsolutiontotherisingICUrequirements,Thefutureofminimallyreasonablehealthcarewillbetough,asthecostofmedicinecontinuestoincreasedramaticallyandthepopulationwillcontinuetoage.Inthefuturewemayfaceaneedtolimittheexpensesforthoseattheendoftheirlives.,makeourcareaseffectiveandasefficientaspossible.Butthegreaterimperativeistoidentifythosepatientsforwhomcarewithcurativeintentwillnotreturnthemtoasatisfactoryqualityoflife.Thiswillrequireagreatdealofeducationbothintheprofessionalcommunityaswellasinthegeneralpublic,whichincludesallofourpatientsandtheirfamilies.,TheseparateICUspecialtycurriculum,trainingand,ThiswouldbetheSpanishmodel:amixtureofinternalmedicine,anesthesiology,surgery,andemergencymedicine.,criticalcarebenefitsfromthemultipleperspectivesthatintensivistswithdiversebackgroundsbringtothebedside.Ibelievethatourdisciplinewouldbecomemoreattractivetomedicalstudentsifweofferedapathwaythatdidnotrequirepriortraininginanotherdiscipline.,AboutNursingshortage,withanumberofingredients,includingafantasticheadnurse,improvementincommunication,andtheteamapproach,wenowhaveenoughICUnurses!,WecertainlyneedmorenursesintheUSA,especiallythosewhohaveachievedadvancedcompetenciesandcertificationsinthecareofthecriticallyillpatient.Wealsoespeciallyneedstrategiesthatwillpreserveandusetheyearsofaccumulatedwisdomthatarecontainedintheagingbodiesofourmostexperiencednurses.,Thenursingcurriculumandeducation,MostnursingschoolsinEuropenowhaveaseparatespecialtyinintensivecareandemergencymedicine,suchaspecialtyhasincreasednursesinterestinourdiscipline.,Nursesareprofessionalswhovaluethesamethingsasphysicians:WeneedtoensurethattheICUremainsanenvironmentinwhichprofessionalismismaintained,whereideasarevalued,andwherecaregiversfeelassafeandascaredforasthepatientstheytreat.weshouldbuildaprofessionthatpeopleflocktobecauseitisexcitingandrewarding.,thephysicianassistantandnursepractitioner,ForthelackofICUphysiciansinthefuture,Iverymuchbelieveintheapplicationsoftelemedicine.IthinkitismuchbettertohaveanICUphysiciancontrollingtheICUatadistance,Thisisnotamatterofphysicianshortagesomuchasitisastrategytousetheirtrainingandwisdommosteffectively.Advancedpracticenurseswhopartnerwithintensivecarephysicianscanprovideoutstandingcaretocriticallyillpatients.,RelationshipbetweentheEDandtheICU,Inourinstitution,wemanageaso-calledshocklabwiththeemergencydoctors.ThismeansthatwearecalledimmediatelywhenacriticallyillpatientisadmittedtotheED.,Acutecaremedicinespansmanyareasofthemodernmedicalcenter,Innovativetrainingprogramsthatleadtowell-trained,hospital-basedmedicalspecialistswhopracticesafelyandeffectivelyacrossthiscontinuumhavegreatpotentialtoimproveprofessionalsatisfactionandpatientcare.,AnICUcrisisisapproachinginthenearfuture,Criticalcaremedicineisthemostinterestingspecialty:Iamsureitwillcontinuetoraisealotofinterest.Theimportanceofthespecialtywillalsoincreaseinthefuture-weshouldallbeproudtobeapartofit.,Themostimportantstepistoengagethoughtleaders,policymakers,andthepublicinanopenandfrankdiscussionaboutavai