ICU的介绍

　　重症医学监护是随着医疗护理专业发展、新型医疗设备诞生和医院管理体制改进而出现的一种集现代化医疗护理技术为一体的医疗组织管理形式。接下来小编为大家整理了ICU的介绍，希望对你有帮助哦!

　　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.

　　危重病护理环境指南介绍了重症监护室及室内护理人员，病人与病人入院、监护和治疗方式，及一些常用的生命支持设备等内容。指南还包括如何向ICU小组介绍病人和如何作好应对ICU可能遇到的职业道德问题的心理准备，并对危重病人护理医学中提升领导职位的职业发展途径进行了描述。

　　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种类

　　你今天所在的医院与你主治医生所说的那种环境已大不相同。病人住院时间缩短、病人要求提高、危重护理病房不断增多。虽然健康护理系统正在不断发生变化，但医院将始终需要有一个护理最病重的病人的区域 – 一个危重病护理中心。由于处于生命极端状态病人的增多，如早产儿、成人心血管疾病患者和重伤病人等，无论是按绝对数字还是按总人口比率计算，对这些病房的需求也在增长。发达国家人口正进入到人生的90和100岁。一旦生病，他们就常常需要采取入侵性措施使他们那脆弱的生理平衡得以稳定，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.

　　威胁生命的疾病的处理措施包括核心支持—重症护理和心肺监护—及以病人特定疾病为重点的支持措施。尽管几乎所有的ICU都能够提供整套的护理，但很多ICU都有自己 重点关注的强项：儿科ICU(PICU)危重病及受伤儿童的护理;冠心病监护室的成人心脏病护理;外科ICU(SICU)的围手术期护理、外伤护理和多种器官功能障碍的护理等;神经科ICU的神经和神经外科病人护理;等等。很多教学医院也有不同等级的危重病护理中心，如过渡监护治疗病房和远程治疗病房等。需要病房外护理的病人可以从远程治疗特殊的监护和介入中受益。

　　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小组

　　事情越忙，你就越能体会每个ICU成员所起的特殊作用。

　　ICU小组长是一位医生。在指定的医学生实习重症监护室里，ICU组长通常是一个重症专科医生，他在危重病人护理医学方面受过高级培训。在北美地区，额外的危重病护理医学资格是在其有了基本的专科证书---如儿科、内科、外科或麻醉科等专科资格证书---后获得的。很多国家已将危重病护理医学设为一个独立的专业科室。

　　不管组长接受的是何种途径的培训，他都会掌握危重病护理医学的基本原理，也就是说，一个由医生领导的多学科小组能够向危重病人提供最佳的护理。

　　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.

　　“多学科”一词并不仅仅是指以会诊医师或合作主治医师身份加入ICU的其他医生，它同时也指在ICU内并肩工作24小时的其他卫生保健专业人员，人数最多的是重症监护护士。这些护士多数在重症护理方面受过高级培训，并获得相应的证书，是公认的“重症监护注册护士”。有些护士所获得的认可不尽于此，他们的职责也更重大。他们是急症护理医生和临床护理专家，也可以制定计划、写医嘱和指导治疗，是医生的补充。医生助理也提供ICU护理。

　　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.

　　呼吸治疗师是多种肺病诊断和治疗的专家，除了使用机械呼吸机外，这些治疗师常常获取并分析动脉血气，通过用力肺活量、负压吸气及其他参数测试病人的呼吸力。在一些医院，呼吸治疗师除了用“袋-面罩”装置支持通气外也施行气管内插管。一个典型的ICU小组都有一个药剂师，他帮助护士评估药物性质，确定病人是否会诱发副作用或药物相互作用。

　　药剂师根据测得的药物浓度帮助你计算药物清除率，为ICU使用的多种药物计划给药方案。

　　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小组还会包括一位营养专家，如在肠道和非肠道(静脉内)营养支持方法及缺陷方面受过高级培训的营养师等。ICU小组其他重要成员有医务社会工作者，他为病人提供不断的心理社会评估和支持;牧师代表，可以随时招他为病人、家属和ICU成员提供精神上的帮助;以及一位病房秘书，处理一些行政性工作，如接待、联系及图表保管。此外，ICU成员通常包括其他很多在此学习的实习人员，如同行、居民、护生及营养学学生等。