icu英文版課件

1、Intensive care unit,www.themegallery.com,,What is ICU?,An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit(CCU)

2、,is a special department of a hospital or health care facility that provides intensive care medicine.An intensive care unit (ICU) is a specially staffed and equipped hospital ward dedicated to the management of pat

3、ients with life-threatening illnesses,injuries or complications.,www.themegallery.com,History,1852年，F(xiàn)lorence Nightingale在克里米亞戰(zhàn)爭期間，就把可望救活的重傷員安置在最靠近護士站的地方，以加強巡視和及時救治，并主張把術(shù)后的患者安置在近手術(shù)室的小房間內(nèi)，度過恢復期后再送回病房。    &#

4、160;1863年護理學先驅(qū)南丁格爾撰文：“在小的鄉(xiāng)村醫(yī)院里，把病人安置在一間由手術(shù)室通出的小房間內(nèi)，直至病人恢復或至少從手術(shù)的即時影響中解脫的情況已不鮮見”。這種專門為術(shù)后病人開辟的“小房間”即被認定為ICU的雛形。     1923年，Dandy在美國為腦外科病人開辟術(shù)后恢復室。1930年Kirschner在德國創(chuàng)建手術(shù)恢復室與ICU混合型病房。    第二次

5、世界大戰(zhàn)期間，在歐洲以及軍隊中逐步建立起創(chuàng)傷單位。1943年建立休克病房。1942年開辟燒傷病房(BurnsUnit)。1945年建立產(chǎn)后恢復室。    1952年丹麥哥本哈根發(fā)生脊髓灰質(zhì)炎大流行，并發(fā)呼吸衰竭的患者大量死亡，人工氣道持續(xù)的手法通氣及后期Engstrom呼吸器的應用，使病死率由87%下降至40%以下，隨后多家醫(yī)院相繼開設(shè)了ICU，并激發(fā)了危重病醫(yī)學的崛起，這是醫(yī)學發(fā)展史上的一個里程碑。,w

6、ww.themegallery.com,History of ICU,In 1854, Florence Nightingale left for a Crimean War, where triage used to separate seriously wounded soldiers from the less-seriously wounded, was observed. Un

7、til recently,it was reported that Nightingale reduced mortality from 40% to 2% on the battlefield. Florence Nightingale在克里米亞戰(zhàn)爭期間，就把可望救活的重傷員安置在最靠近護士站的地方，以加強巡視和及時救治，并主張把術(shù)后的患者安置在近手術(shù)室的小房間內(nèi)，度過恢復期后再送回病房。,www.themegallery.com,

8、,Although this was not the case, her experiences during the war formed the foundation for her later discovery of the importance of sanitary conditions in hospitals, a critical component of intensive care.,www.themegaller

9、y.com,,,www.themegallery.com,,,www.themegallery.com,,In 1950, anesthesiologist Peter Safarestablished the concept of "Advanced Support of Life", keeping patients sedated and ventilated in an

10、 intensive care environment. Safar is considered to be the first practitioner of intensive care medicine as a speciality. In response to a polio epidemic (where many patients required constant ventilation

11、and surveillance),,www.themegallery.com,,Bjørn Aage Ibsen established the first intensive care unit in Copenhagen in 1953.[3][4][5] The first application of this idea in the United States was in

12、1955 by Dr. William Mosenthal, a surgeon at theDartmouth-Hitchcock Medical Center.[6] In the 1960s, the importance of cardiac arrhythmias as a source ofmorbidity and mortality in myocar

13、dial infarctions (heart attacks) was recognized. This led to the routine use of cardiac monitoring in ICUs, especially after heart attacks.[7],www.themegallery.com,Category of ICU,Neonatal intensive care unit (

14、NICU)Pediatric intensive care unit (PICU) Psychiatric intensive care unit (PICU)Coronary care unit (CCU) Medical intensive care unit (MICU) Neurological intensive care unit (Neuro ICU) Trau

15、ma intensive care unit (Trauma ICU) Post-anesthesia care unit (PACU) High dependency unit (HDU) Surgical Intensive Care Unit (SICU),www.themegallery.com,,綜合性ICU (general ICU)、?？艻CU SICU 外科ICU(surgery ICU)

16、CICU，冠心病ICU(coronary intensive care unit, CCU) RICU，呼吸系統(tǒng)疾病ICU(respiratory intensive care unit, RCU) EICU，急診ICU(emergency care unit) NICU，新生兒ICU(neonatalICU) 心肺重癥監(jiān)護治療病房(CPICU)心臟外科重癥監(jiān)護治療病房(CSICU)神經(jīng)外科重癥監(jiān)護治療病房(NSICU)危

17、重腎病重癥監(jiān)護治療病房(UICU),www.themegallery.com,Type of ICU patients,Intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support. P

18、atients requiring intensive care usually require support for hemodynamic instability (hypertension/hypotension) airway or respiratory compromise (such as ventilator support) acute renal failurepotentially lethal card

19、iac dysrhythmias, frequently the cumulative effects of multiple organ system failure,www.themegallery.com,,Terminal illness or irreversibleTerminal cancerPermanent brain damage,×,www.themegallery.com,Gerneral ICU

20、 ward,www.themegallery.com,Equipment and systems,,www.themegallery.com,,,www.themegallery.com,Equipment and systems,Common equipment in an ICU includes mechanical ventilators to assist breathing through an 

21、;endotracheal tube or a tracheostomy tube; cardiac monitors including those with telemetry; external pacemakers;defibrillators; dialysis equipment for renal problems; equipment for

22、 the constant monitoring of bodily functions; a web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and a wide array of drugs to treat the

23、primary condition(s) of hospitalization. Medically induced comas, analgesics, and induced sedation are common ICU tools needed and used to reduce pain and preventsecondary infections.,www.th

24、emegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,What do we do in ICU?,monitoringECG heart rate, rhythm, ischemiaBlood pressure non-invasive invasive

25、 arterial,central venous, pulmonary arteryHemodynamic measurement cardiac outputPulse oxymetry and capnographyIntracranial,intraabdominal pressureMany others electrolyte, CNS,www.themegallery.com,What do we

26、do in ICU?--Treatment,Hemodynamic support -inotrope and vasoactive medicationMechanical ventilationOrgan support (eg.dialysis) Sedation and analgesiaTreatment of underlying illnessesEnteral/parenteral nutrition,www

27、.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,Quality of care,The available data suggests a relation between ICU volume and quality of care for mechanically ventilated patients.[10] After adjustmen

28、t for severity of illnesses, demographic variables, and characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was significantly associated with lower ICU and hospital 

29、mortality rates. A ratio of 2 patients to 1 nurse is recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical floors. This varies from country to country, though; e.g., in Austr

30、alia and the United Kingdom most ICUs are staffed on a 2:1 basis (for high-dependency patients who require closer monitoring or more intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requ

31、iring very intensive support and monitoring; for example, a patient on a mechanical ventilator with associated anaesthetics or sedation such as propofol, midazolam and use of strong analgesics such as 

32、;morphine, fentanyl and/or remifentanil.,www.themegallery.com,Gerneral ICU ward,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,www.themegallery.com,,,,,www.themegallery.com,www.theme