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A Guide to Intensive Care Unit (3) |
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ICU指南(3) |
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The Equipment |
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設 備 |
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The vast array of technology present in an average patient's room can be overwhelming. Even the beds have become incredibly complex, costing tens of thousands of dollars and requiring detailed operating instructions. It is stressful enough just to be in the room of a patient who is critically ill, let alone to cope with the anxiety that the equipment might alarm or malfunction and require an intervention. In reality, the machines in the ICU have many fail-safe backup systems so that mechanical failure is rare. Furthermore, devices that require more supervision are usually accompanied by an individual with expertise, such as a cardiac technician for an intra-aortic balloon pump or a hemodialysis technician for a hemodialysis machine. Respiratory therapists are in close proximity to patients' rooms and intervene quickly if a mechanical ventilator alarms or malfunctions. The best way to resolve anxiety is to become familiar with all of the different devices. |
普通病人病房里的技術(shù)多得使人暈頭轉(zhuǎn)向，連床鋪也復雜得令人難以置信，不但要花數(shù)萬美元，還要有詳細的操作說明。危重病人病房護理已夠緊張的了，更不用說還要應付器械告警或故障需要處理這樣令人焦慮的事。在現(xiàn)實中，ICU機 器都有很多故障保險備份系統(tǒng)，因此，出現(xiàn)機械故障的可能性很小。而且，需要監(jiān)督的裝置通常都由專業(yè)人員看著，如由心臟科技師負責主動脈內(nèi)氣囊泵或血透技師 負責血液透析機等。呼吸治療師離病人房間很近，一旦機械呼吸機告警或故障，他可以很快進行處理。減輕焦慮的最佳方法是熟悉各種裝置。 | |
Bedside monitors |
床邊監(jiān)測儀 | |
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All patients are connected to a bedside monitor whose screen displays several parameters. Channels I and II typically display two EKG leads providing continuous monitoring of the patient's heart rhythm. The patient's blood pressure is displayed either continuously from a catheter in the patient's arterial system or intermittently from an automatically inflating blood pressure cuff on channel III. The arterial line allows beat-to-beat measurement of blood pressure. An A-line is also inserted in patients who require numerous arterial blood gases in order to avoid repeated punctures. |
所有病人都接有一個床邊監(jiān)測儀，它可以顯示多種參數(shù)。其中通道I、II 主要顯示兩臺EKG 導聯(lián)儀，對病人心律進行連續(xù)監(jiān)測。病人血壓監(jiān)測有連續(xù)和間斷兩種，前者通過病人動脈系統(tǒng)插管監(jiān)測，后者通過通道III自動充氣血壓袖帶監(jiān)測。動脈插管可以測量每一搏動的血壓情況，它可以用于需要大量動脈血氣的病人，避免重復穿刺。 | |
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Patients may have a central venous catheter placed in the superior vena cava through the internal jugular or subclavian vein. A central venous catheter allows measurement of central venous pressure (CVP). The CVP serves as an estimate of the patient's volume status. Central lines are also used to rapidly infuse fluid and to administer substances that cannot be infused into a peripheral vein such as hypertonic parenteral fluids and medications such as vasopressors. |
病人也可以經(jīng)由頸內(nèi)靜脈或鎖骨下靜脈放置上腔靜脈中心靜脈插管，測定中心靜脈壓(CVP)，由此估計病人的容積狀態(tài)。中心靜脈插管也可用于快速輸液和給藥。一些周圍靜脈難以輸入的藥物或液體，如高滲非腸道液體、血管升壓類藥物等，都可以通過該插管輸入。 | |
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When more data about a patient's hemodynamic physiology is required, a pulmonary artery catheter can be inserted and advanced through the right ventricle into the pulmonary artery. The PAC allows continuous display of pulmonary artery pressure, and variables such as cardiac output and pulmonary artery occlusion pressure, or wedge pressure, can be intermittently obtained. The "wedge pressure" is a measurement that reflects the patient's preload. The catheter is used to diagnose and manage hemodynamic instability. 醫(yī)學全在線www.med126.com |
如需要更多的病人血液動力生理學資料，就可以施行肺動脈插管(PAC)，經(jīng)由右室插入肺動脈。PAC可以連續(xù)顯示肺動脈壓及其他多種變量，如心排血量，也可以間斷性顯示肺動脈閉塞壓或楔壓。楔壓反映了病人的前負荷情況，插管用于診斷和處理血液動力學的不穩(wěn)定性。 | |
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The respiratory rate and the pulse oximeter reading, which indicates the patient's oxygen saturation, are also displayed on the monitor. The pulse oximeter is a noninvasive monitor attached to the patient's finger or earlobe to measure oxygen saturation continuously. Bedside monitors can be set to alarm for bradycardia or tachycardia, hypotension or hypertension, tachypnea, and/or oxygen desaturation. |
監(jiān)測儀還可顯示呼吸頻率和脈氧值。脈氧儀顯示病人氧飽和度，這是一種非侵入式監(jiān)測儀，套在病人指頭或耳垂上連續(xù)監(jiān)測氧飽和度。經(jīng)過設置，床邊監(jiān)測儀可以警示下列情況：心動過緩或過速，低或高血壓、呼吸急促和/或氧減飽和。 | |
Mechanical ventilators |
機械呼吸機 | |
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Patients are mechanically ventilated for several reasons. If they are unable to protect their airway due to encephalopathy or massive stroke, they may be intubated (have an endotracheal tube placed through their mouth or nose into the trachea) to minimize the possibility of aspiration. If they have refractory hypoxemia (low oxygen saturation that does not respond to oxygen delivered by face mask), the ventilator will allow higher concentrations of FIO2 to be delivered to the alveoli, and pressure can be delivered through the ventilator to open alveoli that have collapsed. If they have respiratory failure and are unable to take adequate tidal volume, the ventilator can deliver a preselected tidal volume and respiratory rate. Patients remain on the ventilator until the underlying disease is resolved. When this occurs, the doctors and respiratory therapists begin the process of decreasing, or "weaning," ventilator support until the endotracheal tube can be removed, a process known as extubation. |
病人因多種原因需要進行機械通氣。如果病人因腦病或大面積中風無法保護氣道，這時就需要插管(即經(jīng)口或鼻施行氣管內(nèi)插管)，最大限度地減少抽吸可能性。如果病人有難治性低氧血癥(低氧飽和度，面罩供氧無效)，呼吸機就可以將高濃度的吸入氧輸送到肺泡，并通過呼吸機輸送的壓力張開塌陷的肺泡。如果病人呼吸衰竭潮氣量不足，呼吸機就可以按預先設置的潮氣量和呼吸率進行輸送。在疾病消失前，病人都要使用呼吸機。如要除去呼吸機，醫(yī)生和呼吸治療師通常要先逐漸減少或“斷奶”呼吸機支持，最后才撥掉氣管內(nèi)插管，即撥管。 | |
Other common devices |
其他 | |
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Intravenous medication pumps allow the nursing staff to titrate medications; Foley catheters and urine collection bags aid in monitoring urine output; sequential compression devices squeeze the lower extremities and reduce the incidence of deep venous thrombosis; transvenous pacemakers stimulate the patient's heart to beat; dialysis machines remove fluid and correct electrolyte and acid-base disturbances; intraaortic balloon pumps assist the heart's contractility; and neurologic monitoring systems measure intracranial pressure. |
靜脈內(nèi)給藥泵由普通護士用于滴定藥物；弗利氏導管和集尿袋幫助監(jiān)測排尿量；連續(xù)壓迫裝置擠壓下肢，減少深部靜脈血栓形成；經(jīng)靜脈起搏器刺激病人心臟跳動；透析儀除去液體，糾正電解質(zhì)和酸堿紊亂；主動脈內(nèi)氣囊泵支持心臟收縮；神經(jīng)病學監(jiān)測系統(tǒng)測定顱內(nèi)壓。 |
