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A Guide to Intensive Care Unit (2) |
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ICU指南(2) |
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The Patients |
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ICU病人 |
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Patients are admitted to the intensive care unit either because they require high-intensity monitoring and life support by specially trained health care providers or because they require high-intensity nursing care that cannot be provided on a general medical or surgical ward. As noted previously, surgical patients are admitted to the surgical intensive care unit and medical patients to the medical or coronary intensive care units. |
病人進(jìn)入ICU，有的是因?yàn)樾枰山?jīng)過(guò)特殊訓(xùn)練的健康護(hù)理人員進(jìn)行高強(qiáng)度監(jiān)護(hù)和生命支持，有的是因?yàn)槠渌胀▋?nèi)科或外科病房無(wú)法提供病人所需要的高強(qiáng)度護(hù)理。如前所述，外科病人進(jìn)入外科ICU，內(nèi)科病人進(jìn)入內(nèi)科或冠心病ICU。 | |
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Many surgical patients are admitted with medical problems such as pneumonia or sepsis. |
許多外科病人都是因?yàn)橐恍﹥?nèi)科疾病，如肺炎、濃毒癥等，而住進(jìn)來(lái)的。 | |
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Patients come to the ICU from several areas |
ICU病人來(lái)自不同科室 | |
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Operating room (OR) or post-anesthesia care unit (PACU) -- Surgical patients who require invasive monitoring, mechanical ventilation, or resuscitation after surgery may be transported directly to the ICU from the OR or the PACU after a period of observation. Such direct transport is considered a transfer from one critical care area to another. Therefore, their ICU management is a continuation of care that they received from the anesthesiology team in the operating room or PACU. |
手術(shù)室(OR)或麻醉后監(jiān)護(hù)病房(RACU)—術(shù)后需要侵入性監(jiān)測(cè)、機(jī)械通氣或復(fù)蘇的病人，在經(jīng)過(guò)一段時(shí)間觀察后就可以直接從手術(shù)室或麻醉后監(jiān)護(hù)病房送到ICU。人們將這種直接運(yùn)送看作是危重病護(hù)理區(qū)之間的轉(zhuǎn)科，因此，其ICU處理也就是OR或PACU麻醉小組的護(hù)理繼續(xù)。 | |
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Emergent care center (ECC) or emergency room -- Medical, surgical, trauma, or burn patients can be admitted to the ICU from the ECC or emergency room. These patients typically undergo a series of diagnostic tests prior to their transfer, and the etiology of their illness may or may not be known by the time they come to the ICU. They are admitted to manage their acute illness. |
急診護(hù)理中心(ECC)或急診室—內(nèi)科、外科、創(chuàng)傷或灼傷病人可以從ECC或急診室住進(jìn)ICU。這些病人在轉(zhuǎn)來(lái)之前通常都做過(guò)一系列的診斷檢查，轉(zhuǎn)來(lái)ICU時(shí)，他們的病因可能已經(jīng)知道，也可能還不知道。他們是到ICU來(lái)處理急病的。 | |
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Medical or surgical ward -- Patients may be admitted to the ICU from a general medical or surgical ward. These are patients who were initially stable but who developed respiratory distress, low blood pressure, shock, cardiopulmonary arrest, or other physiologic instabilities on the ward. They require aggressive resuscitation, treatment, and invasive monitoring and are transferred to the ICU for closer observation, more frequent measurement of vital signs, invasive monitoring, or mechanical ventilation. |
內(nèi)科或外科病房—病人可以從普通內(nèi)科或外科病房收住ICU。這些病人開(kāi)始時(shí)的病情都很穩(wěn)定，但在病房治療時(shí)發(fā)生了呼吸窘迫、低血壓、休克、心肺停止或其他的生理不穩(wěn)定情況，需要超常規(guī)的復(fù)蘇、治療和侵入性監(jiān)護(hù)，因此被轉(zhuǎn)到ICU接受更密切的觀察、增加生命體征測(cè)量、采取侵入性監(jiān)護(hù)或進(jìn)行機(jī)械通氣。 | |
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Other facilities -- Patients may also be transferred from another facility that does not have the resources to provide the level or type of care they require. |
其他機(jī)構(gòu)—病人也可以是從另一個(gè)機(jī)構(gòu)轉(zhuǎn)到這里，因?yàn)樵摍C(jī)構(gòu)沒(méi)法提供所需的護(hù)理。 | |
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Common Reasons for Admission to the ICU |
ICU入院常見(jiàn)原因 | |
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Respiratory compromise--Patients with respiratory distress, manifested either as an inability to oxygenate or an inability to ventilate, are transferred to the ICU for supplemental oxygen and mechanical ventilation. Etiologies of respiratory distress are numerous and include pneumonia, acute respiratory distress syndrome, pulmonary embolism, and exacerbations of chronic obstructive lung disease. |
呼吸系統(tǒng)損傷—呼吸窘迫病人可表現(xiàn)為無(wú)法氧合或通氣不能，轉(zhuǎn)到ICU就是為了補(bǔ)充氧氣、機(jī)械通氣。呼吸窘迫病因很多，包括肺炎、急性呼吸窘迫綜合癥、肺栓塞和慢性阻塞性肺部疾病等。 | |
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Hemodynamic compromise--Patients with hemodynamic instability are admitted for management of arrhythmias, hypotension, or hypertension. Patients with hypotension are typically resuscitated with fluid or medications (e.g., vasopressors or inotropes) to increase vascular tone. If a predetermined minimal mean blood pressure cannot be maintained, or if the patient has signs of inadequate oxygen delivery to the tissues (i.e., altered mental status, decreased urine output, cool skin, and lactic acidosis), a pulmonary artery catheter (PAC) may be inserted to monitor cardiac output. Measurements obtained from the PAC aid the clinician in deciding, for example, whether to treat the patient with more fluids to improve preload—the filling pressure of the left ventricle--or to initiate inotropes to improve contractility. In these instances, an arterial catheter is often inserted to monitor systemic blood pressure continuously. Patients with severe hypertension are generally managed with titratable intravenous medications. |
血液動(dòng)力學(xué)功能損傷—血液動(dòng)力學(xué)功能不穩(wěn)病人收住ICU以處理心律失常、低血壓或高血壓。低血壓病人主要是通過(guò)液體或藥物進(jìn)行復(fù)蘇(如血管升壓類(lèi)藥物或收縮性藥物)，增加血管張力。如果無(wú)法保持預(yù)定的最低平均血壓，如果病人出現(xiàn)組織供氧不足癥狀(如精神狀態(tài)改變、排尿量減少、皮膚發(fā)冷和乳酸性酸中毒)，就可能需要施行肺動(dòng)脈插管(PAC)以監(jiān)測(cè)心排血量。PAC測(cè)量結(jié)果可以幫助臨床醫(yī)生做出決定，如是否需要增加輸液改善前負(fù)荷—即左室充盈壓—或使用收縮性藥物以提高收縮性。在上述情況中，常常要通過(guò)動(dòng)脈插管來(lái)連續(xù)監(jiān)測(cè)體循環(huán)血壓。有嚴(yán)重高血壓的病人通常采用可滴定靜脈給藥法進(jìn)行處理。 | |
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Myocardial ischemia or infarction -- Patients with inadequate oxygen delivery to their myocardium are admitted for the management of angina and myocardial infarction. They may require titration of nitroglycerin, beta blockers, and morphine. Each medication can result in further complications such as hypotension, decreased heart rate, bronchospasm, or decreased respiratory drive, respectively. These patients are often candidates for thrombolytic agents and cardiac catheterization. The goal of admission, to reverse ischemia and minimize myocardial injury, requires close monitoring and rapid intervention. 醫(yī)學(xué)全在線www.med126.com |
心肌缺血或梗死—心肌供氧不足病人入院處理心絞痛或心肌梗死。這些病人可能需要甘油滴定、β-阻止劑或嗎啡。每種藥物都可能導(dǎo)致進(jìn)一步的并發(fā)癥，如低血壓、心率減慢、支氣管痙攣或呼吸動(dòng)力減弱等。這些病人常常是血栓溶解劑和心導(dǎo)管插管的使用對(duì)象。收治目的是逆轉(zhuǎn)心肌缺血減少心肌損傷，這需要密切的監(jiān)護(hù)，并迅速采取措施。 | |
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Neurological compromise -- Patients with alterations in mental status are admitted to the ICU for frequent neurologic checks. If their condition deteriorates, they may need to have an endotracheal tube placed to protect their airway. |
神經(jīng)損傷—精神狀態(tài)變化病人住進(jìn)ICU進(jìn)行頻繁的神經(jīng)檢查。如果病情惡化，就可能需要放置氣管內(nèi)插管以保護(hù)氣道。 醫(yī)學(xué)全.在線提供 | |
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Gastrointestinal -- Patients with life-threatening gastrointestinal bleeding are admitted to treat hypotension with IV fluids, blood and blood products. Diagnostic tests such as endoscopy will likely be performed to locate and treat the source of bleeding in unstable patients in the ICU. |
胃腸—出現(xiàn)危及性命的胃腸出血病人住進(jìn)ICU，通過(guò)IV輸液、全血或血液制品治療低血壓。有可能在ICU通過(guò)內(nèi)窺鏡之類(lèi)的診斷檢查來(lái)定位和治療不穩(wěn)定病人的出血。 | |
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Renal and metabolic -- Patients may be admitted for treatment of the complications of renal failure, including acidosis, volume overload, and electrolyte abnormalities. More often, patients develop renal failure in the ICU secondary to hypotension and sepsis. Treatment with careful attention to acid-base balance, electrolytes, and volume status is provided in the ICU. Other metabolic crises, such as hypercalcemia, unrelated to renal failure, may result in a patient's admission to the ICU. |
腎和代謝問(wèn)題—病人入院也可能是為了治療腎衰引發(fā)的各種并發(fā)癥，包括酸中毒、容量過(guò)度負(fù)荷、電解質(zhì)異常等。更常見(jiàn)的情況是，病人在ICU時(shí)因低血壓和膿毒癥而繼發(fā)腎衰。ICU治療時(shí)應(yīng)密切注意酸堿平衡、電解質(zhì)和容積狀況。其他代謝性危象如高鈣血癥等，盡管與腎衰無(wú)關(guān)，但也可能導(dǎo)致病人收住 ICU。 | |
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Postoperative -- There are many reasons for admitting patients to the ICU. They may still be on a ventilator, or they may have other invasive monitoring. They may have a history of coronary artery disease and therefore be at risk for a perioperative MI. They may have had extensive bleeding and require frequent observation. They may have had an extensive surgical procedure, including open-heart surgery, organ transplantation, vascular surgery, or general abdominal surgery. Each surgical intervention has specific perioperative issues that require observation and treatment in the ICU. Patients with trauma, orthopedic injuries, and extensive thermal injuries are also admitted to ICUs. |
術(shù)后—很多原因可以使病人住進(jìn)ICU。他們可能仍在使用呼吸機(jī)，也可能是在接受其他入侵性監(jiān)測(cè)。他們可能有冠狀動(dòng)脈疾病史，因此有圍手術(shù)期心肌梗死危險(xiǎn)。病人也可能有大出血，需要密切觀察。病人可能接受過(guò)大型外科手術(shù)，如開(kāi)胸手術(shù)、器管移植、血管手術(shù)、或腹部手術(shù)。每次手術(shù)都有特定的圍手術(shù)期問(wèn)題需要在ICU進(jìn)行觀察和治療。創(chuàng)傷、骨傷和大面積熱損傷病人也會(huì)收住ICU。 | |
Transporting the Patient to the ICU： |
運(yùn)送病人到ICU | |
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Once it is clear that a patient requires management in the intensive care unit, the ICU personnel should be notified. An attending, fellow, or resident should call the ICU charge nurse and indicate the patient's name, illness, reason for transfer to the ICU, and immediate plans for treatment. Alerting the staff in the ICU prior to patient transport allows them to prepare for the patient's arrival. Advance communication with the ICU physician ensures that the appropriate support is available when the patient arrives. It is essential that the appropriate personnel, equipment, and monitors are available for all transfers to the ICU. |
一旦明確病人需要由ICU處理，就應(yīng)通知ICU醫(yī)護(hù)人員。由主治醫(yī)師、普通醫(yī)生或住院醫(yī)師呼叫ICU主管護(hù)師，弄清病人的姓名、疾病、轉(zhuǎn)科原因，立即制訂治療計(jì)劃。在病人送到前提醒ICU工作人員，使他們?yōu)椴∪说絹?lái)作好準(zhǔn)備。事先與ICU醫(yī)師溝通可確保病人到達(dá)時(shí)得到合適的支持。使轉(zhuǎn)到ICU的所有病人都有合適的人手、器械和監(jiān)護(hù)，這一點(diǎn)極為重要。 |
