急危重症患者转运20160524全解.ppt

模式与预后：现场救治与拉起来就跑，往往更多的患者需要现场抢救，稳定后再转运，而现场不具备相应能力 及时转运对患者生存至关重要，在条件最复杂最严酷的战争时期，美国的数据表明 尽早把患者转运至高水平医疗机构提高患者生存率，前提是转运的质量 * * 1、突发性强，往往是遭遇战，不可能所有人员设备准备好，随时等待转运，常常是没有充分准备，家属或领导眼皮下工作，一招错满盘皆输，导致纠纷，领导的不信任， 2、压力大：社会，家属或领导期望值极高， To describe the experience with a dedicated, intrahospital transport program, to report the rate of clinically significant adverse events, and to examine types of adverse events, interventions provided, and outcomes. Adverse events were defined as extubation, code team activation？, death, sustained arrhythmia, hypoxia exceeding 5 minutes, hypotension exceeding 20% of baseline systolic or diastolic blood pressure and requiring intervention, use of physical restraints, or acute change in mental status 美国呼吸治疗协会对院内机械通气病患的转运提出了一个临床实践指南（In-Hospital?Transport?of?the?Mechanically?Ventilated?Patient). Fanara 2010 Critical Care – Recommendations of intra-hospital transport of critically ill patients sources of extra discomfort , and generate additional physiological stress in critically ill patients -2 restrospective studies, 6 prospective studies -serious AE leading to therapeutic interventions= 4-8% 用全院图片说明院内转运的重要，提出面临的风险 Patient arrives at the hospital in two main ways: by emergency ambulance or independently In the Emergency Ambulance ususally first treatment is initialised The patient’s first contact in the hospital is the Emergency Department (ED) Usually emergency rooms are located at the ground floor, sometimes close to some functional departments, e.g the radiology department or department for different clinical examinations. In the emergency department, the status of the patient’s condition is determined. Sometimes further examinations and treatment initialisations are started (e.g. initialisation of ventilatory support), before he is transferred to a ward An ambulance is a vehicle designated for the transport of sick or injured people. Modern-day ambulances are typically large Automobiles on a van or light truck chassis. Under the laws of war, a