ICU医生与院内急救

ICU医生与院内急救四川大学华西医院ICU金晓东CODE199!CODEBlue!一、前言医院需要ICU吗？医院需要成立院内急救小组吗？我院ICU现状2005年共收治2025例患者心肺复苏后转入者37例其中在转运途中心跳骤停者3例(２例痊愈)在普通病房未能成功复苏者医院现有状况普通病房心肺复苏操作流程不规范须请ＩＣＵ急会诊须请麻醉科急会诊我们的想法应有一个小组对全院患者实施监控由该小组判断患者该留治或转ＩＣＵ尽可能避免“突然的心跳骤停”该小组应由ＩＣＵ医师牵头组建ICU医生参与院内急救的同时，还需决定病人是否转运及时机。我们的想法先进、良好、待用的特殊急救设备（如便携式呼吸机、氧气瓶等）的及时到位。确保转运过程的安全性、快速性。从EMSS层面出发，尽量把ICU资源搬到院内急救，弥补院内急救相对薄弱的关键时机。ICU的功能集中严重心/肺/肾功能衰竭、创伤和其它各种严重有生命威胁的患者，便于严密观察病情变化和监护。应用先进的医学诊断技术和生命支持疗法，如：复苏除颤、体内心脏起搏、气管插管、机械通气、心导管、腹透、血透等。ICU的功能

ICU的医师和护士均受过特殊的训练，对严重疾病的紧急处理有特定的技术。ICU具有生命支持的环境，包括床旁监护、生命支持设备和机械通气机等，组成一个特异的生理功能单元

二、基础设施配置与合理使用良好齐全的急救设备:基本设备：中心气源、中心负压、多功能病床、多功能插座、微泵、多参数监护系统、气管插管设备、手动辅助换气囊、呼吸机、雾化系统，心电图机、电除颤器、临时起搏器、纤支镜、冰机、CRRT系统……特殊设备：IABP、B超、血透机……院内急救面临的问题目前院外急救已初具规模院内急救?没有相对固定的工作小组没有相对完善的工作流程没有全院各科室的积极配合没有复苏后的积极反馈院内急救效率下降！！！应成立专业院内急救小组！！！二、人员组成Primarycodeteammembers：ICUphysician(teamleader)residentphysiciansCriticalcarenurserespiratorytherapistsAdministrativesupervisorLabpersonnel.SupplementalTeamMembersOn-callanesthesiologistAspiritualcarepersonisoncallforcodes三、人员的素质要求高水平的鉴别诊断能力熟练掌握各类急救技术组织协调能力具有强健的体魄能适应紧张的工作有较高的业务素质较强的责任感和无私奉献的精神EducationandTrainingPhysicianshavereceivedup-to-datetraininginACLS protocols accordingtotheAmericanHeartAssociation.Basiclifesupport(BLS)trainingforthehealthcareproviderandHeartsaverPlus,withsatisfactorycompletion,arerequiredeveryotheryearandareprovidedaccordingtotheAHAstandards.EducationandTrainingEmployeesinvolvedindirectpatientcarearemandatedtoattendCPRprogramsandmustdemonstratecompetencyinCPR.OutpatientservicestaffmustconformtothesamestandardofCPReducation.Mouth-maskdevicesorresuscitationbagsareavailable.四、各级人员的职责ICUPhysician(teamleader)UltimatelyresponsibleforCodemanagement.Determineswhentodiscontinueeffortsorestablisheswhenpatientisstableenoughfortransport.Communicateswiththeattendingphysicianandfamily.improvementtoolResidentphysicianHelpwithCodemanagementHelpswithCPR,defibrillation,orpacing.CentrallineplacementDrawsbloodforABGsandotherlabs.DispensesthemedicationsfromtheemergencycarttotheRNandpreparesIVsolutionswithmedicationadditivesforRNadministration.Criticalcarenurse（1）Establishesthecardiacrhythmanddefibrillatesasquicklyaspossibleifindicated.Administersmedicationsasdirected.Maygiveepinephrine,atropine,and/orlidocaineasapprovedintheEmergencyMeasuresprotocol.UsesACLSguidelinesCriticalcarenurse（2）Helpswithallaspectsoftheresuscitativeeffort.Thecriticalcarenurseand/ortherespondingphysicianareresponsibleformanagingthecareofthepatient,includingascertainingthatproperchestcompressionsandventilationsarebeingperformed.BringsI-STATboxand“difficult-to-incubate”box.RespiratorytherapistManagestheairway,includingbag-valve-maskbreathing,intubation,andsuctioning.Helpsoverseeadequateoxygendelivery.HelpswithCPR.Replacestheemergencycart.Bringsanemergencycartanddefibrillatortothearrestsite,ifoneisnotstationedintheareaoftheemergency.RunsI-STAT.Administrativesupervisor（1）Rolevarieswithcircumstances.HelpswithCPRasneeded,especiallyinnon-clinicalareas.Validatescodeteammembersarepresentandthephysician/residentisgivingdirection.Assistswithtrafficcontrol.Administrativesu