危重病的早期预警.pptxVIP

危重病的早期预警;ICU=重症医学？ —危重病的早期预警;内容; 什么叫重症医学?;早期发现并积极处理危重症----提高抢救成功率的关键;病情的突然变化-----病情变化被突然发现;从不同部门入ICU患者死亡率的差别; Hillman KM等前瞻性研究了551例从不同科室入ICU患者情况：90例来自普通病房，239例来自OR，222例来自ED。普通病房入ICU患者APACHE II 评分21，OR 15，ED 19；死亡率分别为47.6%、 OR 19.3%、 ED 31.5%；入ICU前经历的不良事件：普通病房72%、 OR 64.4%、 ED 61.8%。入ICU前8小时常见的不良事件： hypotension (n=199), tachycardia n=73), tachypnoea (n=64), and sudden change in level of consciousness (n=42). ;危重病的早期预警;Recommendation Multiple-parameter or aggregate weighted scoring systems used for track and trigger systems should measure: ? heart rate ? respiratory rate ? systolic blood pressure ? level of consciousness ? oxygen saturation ? temperature.;Recommendation In specific clinical circumstances, additional monitoring should be considered; for example: ? hourly urine output ? biochemical analysis, such as lactate, blood glucose, base deficit, arterial pH ? pain assessment.;危重病的早期预警;改良早期危险评分（MEWS);Journal of Critical Care (2012) 27, 424.e7–424.e13;第15页/共27页;Content of measurements. The combination (in white) of all measurements taken (N = 2688) is shown compared with the measurements with a positive MEWS (≥3 points) in black (n = 988). All possible combinations were analyzed, and those with a prevalence of 4% or more were included. BP indicates systolic blood pressure; Resp, respiratory rate; Temp, temperature; Sat, peripheral saturation with supplementary oxygen therapy;第17页/共27页;第18页/共27页; Early Warning Score scoring system EWS 3 2 1 0 1 2 3 Pulse rate 51-100 101-110 111-130 130 BP (systolic) 70 70-80 81-100 101-200 200 Respiratory rate 9 9-14 15-20 21-30 30 Temperature 35.1 35.1-36.5 36.6-37.5 37.5 Consciousness A V P