ICU的介紹

　　重癥醫(yī)學(xué)監(jiān)護(hù)是隨著醫(yī)療護(hù)理專業(yè)發(fā)展、新型醫(yī)療設(shè)備誕生和醫(yī)院管理體制改進(jìn)而出現(xiàn)的一種集現(xiàn)代化醫(yī)療護(hù)理技術(shù)為一體的醫(yī)療組織管理形式。接下來小編為大家整理了ICU的介紹，希望對你有幫助哦!

　　This introductory guide to the critical care environment describes the ICU and the caregivers who staff it; the patients and how they are admitted, monitored, and treated; and some of the common life-support equipment. It includes a strategy for presenting your patient to your team and prepares you for the ethical issues that might confront you in the ICU. The guide also describes some of the career paths that culminate in leadership positions in critical care medicine.

　　危重病護(hù)理環(huán)境指南介紹了重癥監(jiān)護(hù)室及室內(nèi)護(hù)理人員，病人與病人入院、監(jiān)護(hù)和治療方式，及一些常用的生命支持設(shè)備等內(nèi)容。指南還包括如何向ICU小組介紹病人和如何作好應(yīng)對ICU可能遇到的職業(yè)道德問題的心理準(zhǔn)備，并對危重病人護(hù)理醫(yī)學(xué)中提升領(lǐng)導(dǎo)職位的職業(yè)發(fā)展途徑進(jìn)行了描述。

　　ICU TYPES

　　The hospital you are in today is different from the hospital your attending physician claimed as his or her environment. Lengths of stay are down, patient acuity is rising, and critical care units are proliferating. Although the health care system is changing, hospitals will always need an area to care for their sickest patients--a critical care center. The need for these units is growing as patients at all extremes of life—the most premature infants, adults with cardiovascular disease, the severely injured—are growing, both in absolute numbers and in proportion to the general population. Citizens of developed nations around the world are living--and staying active--into the ninth and tenth decades of life. When they become ill, they often require aggressive intervention to stabilize their delicate physiologic balance so they can heal.

　　ICU種類

　　你今天所在的醫(yī)院與你主治醫(yī)生所說的那種環(huán)境已大不相同。病人住院時間縮短、病人要求提高、危重護(hù)理病房不斷增多。雖然健康護(hù)理系統(tǒng)正在不斷發(fā)生變化，但醫(yī)院將始終需要有一個護(hù)理最病重的病人的區(qū)域 – 一個危重病護(hù)理中心。由于處于生命極端狀態(tài)病人的增多，如早產(chǎn)兒、成人心血管疾病患者和重傷病人等，無論是按絕對數(shù)字還是按總?cè)丝诒嚷视?jì)算，對這些病房的需求也在增長。發(fā)達(dá)國家人口正進(jìn)入到人生的90和100歲。一旦生病，他們就常常需要采取入侵性措施使他們那脆弱的生理平衡得以穩(wěn)定，使疾病得以治愈。

　　The interventions required to manage life-threatening illnesses generally include both core supports--intensive nursing care and cardiopulmonary monitoring--as well as supports focused on the patient's particular illness. While nearly all ICUs are capable of providing a spectrum of care, many have developed a focused area of excellence: care of critically ill and injured children in the pediatric ICU (PICU); adult cardiac diseases in the coronary care unit (CCU); perioperative care, trauma care, and care of multiple organ dysfunction in the surgical ICU (SICU); care of neurological and neurosurgical patients in the neuroscience ICU; and so on. Many teaching hospitals also have graded critical care centers such as intermediate care units and telemetry units where patients who require more than ward care can benefit from specific monitoring and intervention.

　　威脅生命的疾病的處理措施包括核心支持—重癥護(hù)理和心肺監(jiān)護(hù)—及以病人特定疾病為重點(diǎn)的支持措施。盡管幾乎所有的ICU都能夠提供整套的護(hù)理，但很多ICU都有自己 重點(diǎn)關(guān)注的強(qiáng)項(xiàng)：兒科ICU(PICU)危重病及受傷兒童的護(hù)理;冠心病監(jiān)護(hù)室的成人心臟病護(hù)理;外科ICU(SICU)的圍手術(shù)期護(hù)理、外傷護(hù)理和多種器官功能障礙的護(hù)理等;神經(jīng)科ICU的神經(jīng)和神經(jīng)外科病人護(hù)理;等等。很多教學(xué)醫(yī)院也有不同等級的危重病護(hù)理中心，如過渡監(jiān)護(hù)治療病房和遠(yuǎn)程治療病房等。需要病房外護(hù)理的病人可以從遠(yuǎn)程治療特殊的監(jiān)護(hù)和介入中受益。

　　The ICU Team

　　The more things get busy, the more you will appreciate that each team member in the ICU has a specific role.

　　The team leader is a physician. Students typically are assigned to train in intensive care units where the team leader is an intensivist physician who has received advanced training in the art and science of critical care medicine. In North America, added qualifications in critical care medicine are obtained after board certification in a primary specialty such as pediatrics, internal medicine, surgery, or anesthesiology. Many countries have established critical care medicine as an independent specialty.

　　Irrespective of the training pathway, your team leader embraces the philosophy of critical care medicine, namely that a physician-led, multidisciplinary team can provide optimal care to the critically ill patient.

　　ICU小組

　　事情越忙，你就越能體會每個ICU成員所起的特殊作用。

　　ICU小組長是一位醫(yī)生。在指定的醫(yī)學(xué)生實(shí)習(xí)重癥監(jiān)護(hù)室里，ICU組長通常是一個重癥?？漆t(yī)生，他在危重病人護(hù)理醫(yī)學(xué)方面受過高級培訓(xùn)。在北美地區(qū)，額外的危重病護(hù)理醫(yī)學(xué)資格是在其有了基本的專科證書---如兒科、內(nèi)科、外科或麻醉科等?？瀑Y格證書---后獲得的。很多國家已將危重病護(hù)理醫(yī)學(xué)設(shè)為一個獨(dú)立的專業(yè)科室。

　　不管組長接受的是何種途徑的培訓(xùn)，他都會掌握危重病護(hù)理醫(yī)學(xué)的基本原理，也就是說，一個由醫(yī)生領(lǐng)導(dǎo)的多學(xué)科小組能夠向危重病人提供最佳的護(hù)理。

　　The term "multidisciplinary" refers not only to other physicians who may participate as consultants or coattendings in the ICU, but also to the other health care professionals who work side by side, around the clock in the ICU. The most numerous of these are the critical care nurses, many of whom also have advanced training and certification in critical care and are recognized as CCRNs. Some have achieved even greater recognition and responsibility. They are the acute care nurse practitioners and clinical nurse specialists who complement the physician staff in establishing plans, writing orders, and directing management. Physician assistants also provide care in the ICU.

　　“多學(xué)科”一詞并不僅僅是指以會診醫(yī)師或合作主治醫(yī)師身份加入ICU的其他醫(yī)生，它同時也指在ICU內(nèi)并肩工作24小時的其他衛(wèi)生保健專業(yè)人員，人數(shù)最多的是重癥監(jiān)護(hù)護(hù)士。這些護(hù)士多數(shù)在重癥護(hù)理方面受過高級培訓(xùn)，并獲得相應(yīng)的證書，是公認(rèn)的“重癥監(jiān)護(hù)注冊護(hù)士”。有些護(hù)士所獲得的認(rèn)可不盡于此，他們的職責(zé)也更重大。他們是急癥護(hù)理醫(yī)生和臨床護(hù)理專家，也可以制定計(jì)劃、寫醫(yī)囑和指導(dǎo)治療，是醫(yī)生的補(bǔ)充。醫(yī)生助理也提供ICU護(hù)理。

　　Respiratory therapists are experts in many forms of pulmonary diagnosis and intervention. In addition to operating the mechanical ventilator, therapists often obtain and analyze arterial blood for blood gases and test patients' breathing strength by obtaining forced vital capacity, negative inspiratory pressure, and other parameters. In some hospitals, respiratory therapists perform endotracheal intubation in addition to supporting ventilation with "bag-and-mask" devices. The ICU team typically includes a pharmacist who helps you review medication profiles and determine if your patient is predisposed to side effects or drug interactions.

　　The pharmacist will help you calculate clearance rates from measured drug levels and plan dosing schedules for many of the medications used in the ICU.

　　呼吸治療師是多種肺病診斷和治療的專家，除了使用機(jī)械呼吸機(jī)外，這些治療師常常獲取并分析動脈血?dú)?，通過用力肺活量、負(fù)壓吸氣及其他參數(shù)測試病人的呼吸力。在一些醫(yī)院，呼吸治療師除了用“袋-面罩”裝置支持通氣外也施行氣管內(nèi)插管。一個典型的ICU小組都有一個藥劑師，他幫助護(hù)士評估藥物性質(zhì)，確定病人是否會誘發(fā)副作用或藥物相互作用。

　　藥劑師根據(jù)測得的藥物濃度幫助你計(jì)算藥物清除率，為ICU使用的多種藥物計(jì)劃給藥方案。

　　he team also typically includes someone who is an expert in nutrition support such as a dietitian who has advanced training in enteral (gut) and parenteral (intravenous) nutritional support strategies and pitfalls. Other important members of the ICU team are the medical social worker, who provides ongoing psychosocial assessments and support; representatives of the chaplaincy staff, who are available on call to offer spiritual support to patients, families, and ICU staff members; and a unit secretary, who manages administrative tasks such as reception, telecommunications, and chart maintenance. In addition, the ICU staff generally includes many other trainees who are there to learn with you such as fellows, residents, nursing students, and dietetics students.

　　典型的ICU小組還會包括一位營養(yǎng)專家，如在腸道和非腸道(靜脈內(nèi))營養(yǎng)支持方法及缺陷方面受過高級培訓(xùn)的營養(yǎng)師等。ICU小組其他重要成員有醫(yī)務(wù)社會工作者，他為病人提供不斷的心理社會評估和支持;牧師代表，可以隨時招他為病人、家屬和ICU成員提供精神上的幫助;以及一位病房秘書，處理一些行政性工作，如接待、聯(lián)系及圖表保管。此外，ICU成員通常包括其他很多在此學(xué)習(xí)的實(shí)習(xí)人員，如同行、居民、護(hù)生及營養(yǎng)學(xué)學(xué)生等。