危重病的早期预警培训课件-豆柴文库

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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HillmanKM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APACHEII评分21，OR15，ED19；死亡率分别为47.6%、OR19.3%、ED31.5%；入ICU前经历的不良事件：普通病房72%、OR64.4%、ED61.8%。入ICU前8小时常见的不良事件：hypotension(n=199),tachycardian=73),tachypnoea(n=64),andsuddenchangeinlevelofconsciousness(n=42).危重病的早期预警Recommendation1.2.2.6
Inspecificclinicalcircumstances,additionalmonitoringshouldbeconsidered;
forexample:
•hourlyurineoutput
•biochemicalanalysis,suchaslactate,bloodglucose,basedeficit,arterialpH
•painassessment.危重病的早期预警改良早期危险评分（MEWS)JournalofCriticalCare(2012)27,424.e7–424.e1314Contentofmeasurements.Thecombination(inwhite)ofallmeasurementstaken(N=2688)isshowncomparedwiththemeasurementswithapositiveMEWS(≥3points)inblack(n=988).Allpossiblecombinationswereanalyzed,andthosewithaprevalenceof4%ormorewereincluded.BPindicatessystolicbloodpressure;Resp,respiratoryrate;Temp,temperature;Sat,peripheralsaturationwithsupplementaryoxygentherapy1617EarlyWarningScorescoringsystem

EWS3210123

Pulserate51-100101-110111-130>130
BP(systolic)<7070-8081-100101-200>200
Respiratoryrate<99-1415-2021-30>30
Temperature<35.135.1-36.536.6-37.5>37.5
ConsciousnessAVPU

EWS=EarlyWarningScore;BP=bloodpressure;A=alert;V=responsivetovoice;P=responsivetopain;U=unresponsive.Worriedaboutpatient’s
condition:1point;Urineproductionbelow75mlduringprevious4hours:1point;Saturationbelow90%despiteadequateoxygentherapy:3points.13months(May2010-May2011),71,911EWSvaluesintheMedicalCentreAlkmaar.56%(40,183)onsurgicalwards,44%(31,728)onmedicalwards20Mortalityrateasapercentageofadmissionseachyear.Averagevaluespre-andpost-MEWSareshownalongwithPvalues22ThedistributionofNEWSvaluesandtherelationshipwitheachofthefouroutcomesstudied.24小结26