美国重症医学（FCCM）的基础教程—患者评估（英文）.pptVIP

Assessment of the Seriously Ill Patient Objectives Early identification of patients at risk for life-threatening illness Recognize early signs of critical illness Review the initial assessment of critically ill patients Why identify patients at risk? Easier management with simpler interventions Prevent further deterioration Provide time for investigation and treatment Challenging Patients Young, fit patients Immunosuppressed patients Debilitated patients Patients with abrupt deterioration Patients with limited reserve Risk Assessment Background health Severity of acute physiology Vital signs Other clinical monitoring Trends and rate of deterioration Goals Recognition that problem exists Maintain stability Risk Assessment Making a diagnosis Often secondary to treatment of physiological abnormalities Investigate while stabilizing Requires disciplined approach Assessment Primary survey What is main physiological problem? First minutes of initial contact Secondary survey What is underlying cause? Subsequent reviews Assessment of the Seriously Ill Patient History Physical examination Chart review and documentation Investigations Treatment Patient 54 year old diabetic with shortness of breath 3 days postoperative for laparoscopic cholecystectomy Initial Survey History Main symptoms Physiological abnormalities Co-existing illness Major surgery Severe hemorrhage/transfusion Lack of improvement Patient 54 year old diabetic with shortness of breath 3 days postoperative for laporoscopic cholecystectomy Secondary Survey History Past history, chronic diseases Psychosocial issues Medications/allergies Family history Ethical/legal issues Systems review Patient 54 year old diabetic with shortness of breath 3 days postoperative for laporoscopic cholecystectomy Initial Survey Examination Airway Breathing Circulation Level of consciousness Secondary Survey Examination Respiratory Cardiovascular Abdomen and genitourinary tract Central nervous system Musculoskeletal sy