What Does a Critical Care Paramedic Do?
Intensive care refers to the use of various advanced medical technologies, modern monitoring and rescue equipment to implement centralized and intensive treatment and care of various types of critically ill patients treated. To maximize the patient's survival and subsequent quality of life.
- Chinese name
- ICU
- Foreign name
- intensive care
- Use of technology
- Various advanced medical technologies
- Function
- Ensure patient survival and subsequent quality of life
- Intensive care refers to the use of various advanced medical technologies, modern monitoring and rescue equipment to implement centralized and intensive treatment and care of various types of critically ill patients treated. To maximize the patient's survival and subsequent quality of life.
Intensive care unit
- The intensive care unit is a unit that treats critical illness and gives careful monitoring and precise treatment. Critical Care Medicine (CCM) takes critical illness as the main research object, based on the combination of basic medicine and clinical medicine, and uses modern monitoring and interventional techniques as a method to conduct a more comprehensive review of critical illness. A medical discipline that understands and ultimately improves the survival rate of critically ill patients through effective treatment measures for critically ill patients. That is, the critical care medicine is the theoretical basis of the work of the intensive care unit, and the intensive care unit is the clinical practice base of the critical care unit.
- The comprehensive intensive care unit is generally located in a more central location in the hospital, and is close to the anesthesia department and various operating departments. The specialized intensive care unit is located in each specialized ward. Generally tend to the large ward, large flat transparent glass is usually used to separate semi-closed units. The ward is spacious, with clean and non-clean areas, and various medicines, medical instruments and other medical supplies. There is also a central monitoring station, which can observe all monitored patients. The requirements for the interior architecture and facilities of the ICU are higher than those of the ordinary ward, in order to maximize the convenience of timely monitoring and rescue of critical patients. In order to ensure continuous power, multiple power systems are available. In addition to the necessary equipment in the general ward, diagnostic equipment is often equipped with an electrocardiogram recording monitor, a cardiac output tester, a defibrillator, a meal counterpulsation, a multifunctional ventilator, a blood gas analyzer, a pulmonary function tester, Oxygen saturation monitor, renal function monitoring treatment instrument, small hemodialysis machine, peritoneal dialysis equipment, urine hydrometer, intracranial pressure monitor, electroencephalograph, cerebral blood flow meter, transcranial Doppler, etc., And commonly used in intensive care units
- In principle, the intensive care unit's subjects are all kinds of critical acute reversible diseases. Such as those who need monitoring after major surgery, anesthesia accidents, severe combined trauma, acute circulatory failure, acute respiratory failure, cardiac arrest and resuscitation, electric shock, drowning, resuscitation, various poisoning patients, various shock patients, sepsis, Amniotic fluid embolism, severe pregnancy toxemia, etc. Each specialty intensive care unit treats critically ill patients in each specialty, such as myocardial infarction and coronary heart disease intensive care unit; burn intensive care unit treats large area burn patients; neurological intensive care unit treats various cerebrovascular accidents, and so on. In principle, those who have been definitely cut off and died but still have a heartbeat, advanced cancer that has failed, and various serious infections are not included in the integrated intensive care unit. The critically ill patients undergo rescue treatment in the intensive care unit, and the patients who have passed through the intensive care unit undergo rescue treatment in the intensive care unit. After passing through the critical stage, the patient is generally transferred out of the intensive care unit to enter the general ward to continue treatment.
Intensive care
- The staffing of guardians depends on the size, nature, human and financial situation of the hospital, and the active status of teaching and scientific research activities. The following is an overview of the medium-sized teaching hospital monitoring center (ICU):
- Physician: The ratio of the number of physicians to the number of beds at all levels is usually 1: 1. Generally there are 3 to 5 attending physicians, of which two are responsible for the work of the chief and deputy directors. There are 4 to 6 resident doctors, who rotate regularly. 3 to 6 specialist researchers. The attending physician of ICU is an emergency care specialist who has been specially trained after 2 to 3 years of completion of the residency training. During the ICU training stage, he must also receive training in anesthesiology, cardiology, pulmonary, and ENT.
- Nurses: The ratio of the total number of nurses to the number of beds should be 2.5 to 3: 1 or even 4.25: 1. One head nurse and one assistant head nurse for each class. The head nurse and assistant head nurse must have more than 2 years of ICU work experience. The nurses who graduated from the formal nursing school are qualified as ICU nurses after more than 2 years of general clinical nursing work and operating room work. First-time nurses in the ICU must go through six months of internship and theoretical study to work independently. A critically ill patient should be nursed by at least one nurse; two patients with more stable conditions can be nursed by one nurse; once the condition is improved and stable, one nurse can care for 3 patients. In the ICU, a nurse usually cares for 3 to 4 patients.
- Respiratory therapy room: Respiratory therapy is one of the most important treatment measures for critically ill patients in the ICU, and it is the most critical part of rescuing patients. Therefore, ICU is best equipped with 2 to 3 specially trained respiratory therapists who are responsible for oxygen therapy, artificial ventilation, repair and maintenance of ventilator, chest physiotherapy, aspiration of respiratory secretions and aerosolized medication.
- Technician: There should be skilled technicians to maintain and repair the complex monitors and therapeutic instruments in the ICU at any time. Others: Set up assistants such as secretary, a certain number of assistants, hygienists, and cleaners as needed.
ICU Intensive care ICU monitoring
- ICU treats all kinds of critically ill patients. Different patients often need different emphasis on monitoring and treatment, so it is impossible to formulate a unified ICU monitoring program suitable for each patient. However, ICU patients have a common feature, that is, they are critically ill. In addition to special monitoring, they need at least basic daily monitoring, that is, general monitoring.
Intensive care
- Monitor heart rate, ECG and breathing with a monitor; record respiratory rate and blood pressure at least once every hour; measure and record body temperature every 2 hours; strictly record the amount of input and output; measure urine specific gravity, urine routine and ketone body every 8 hours, Check the fecal occult blood once; accurately measure the weight once a day, and accurately record the heat snap-in amount once.
Intensive care
- Varies according to the condition: Intravascular intubation patient monitoring: change the catheter irrigation solution, intravenous infusion solution, infusion tube and dressing daily. When changing dressings, check the catheter site for signs of infection. If the catheter is placed for a long time, take a sample from the catheter for bacterial culture at least every 3 days. In patients with catheters placed in the central vein, artery, or pulmonary artery, fever above 38.5 ° C should be used for peripheral blood culture, and blood should be taken from each catheter for culture. If the patient has symptoms of sepsis or a positive blood culture, remove the infected catheter. If the catheter is still needed, the catheter needs to be replaced and re-intubated. When the catheter in the artery, central vein or pulmonary artery is removed, the tip of the catheter should be sampled and cultured. Catheters inserted into arteries, central veins, and pulmonary arteries, and screw-locked joints should be used at each connection of the pipeline to prevent accidental shedding and bleeding and air embolism. Surveillance of tracheal intubation and tracheotomy patients: proper methods to fix mouth tracheal intubation, nasal tracheal intubation and tracheotomy cannula, and limb restraint and fixation. Clear the secretions in the intubation or cannula in time, sucking sputum at least every two hours. Check the tracheal aspirate at least weekly for Gram-stained bacteria and sensitivity tests twice. Monitoring of peritoneal dialysis patients: To prevent infection, catheter placement should be performed in the operating room. Use a closed sterile drainage device. Drainage devices should be replaced once a day, gloves and masks should be worn when changing, and strict attention should be paid to aseptic operation techniques. When replacing the drainage tube, the drainage fluid should be counted, classified, Gram stained, and cultured to observe the occurrence of peritonitis. When hypertonic glucose is used for the dialysate, blood glucose is measured every two hours. When using potassium-free dialysate to reduce blood potassium, the blood potassium should be measured every 4 hours until the blood potassium is normal. When the potassium level is changed to a potassium-containing dialysate, the number of potassium levels can be reduced. If the amount of dialysate is too large, it can cause excessive abdominal distension, increase blood pressure and respiratory insufficiency, and should be observed carefully. Surveillance of comatose patients: closely monitor the neuropsychiatric state (see coma).
Intensive care isolation technology
- There are two types of patients to be isolated: one is an infectious disease patient and is contagious to others; the other is not itself an infectious disease, but is susceptible to infection due to the disease. The isolation techniques and treatment of patients with severe infectious diseases are the same as those in general infectious diseases. As for critically ill patients who have no infectious disease and need protective isolation, this is a special problem in the ICU. Patients with severe burns (area> 15%, second- or third-degree burns), and immunocompromised patients (especially those undergoing bone marrow transplantation) need protective isolation. It is best to separate protective isolation from infectious disease isolation. If only the same isolation area can be used due to conditions, the same nurse cannot take care of two patients who need isolation. [1]
Scope of intensive care
- The monitoring scope of the intensive care unit is very wide, and can be divided into several major systems such as breathing, circulation, liver, brain, kidney, gastrointestinal, blood and coagulation mechanisms, endocrine, water electrolytes and oxygen supply. There are more than 20 commonly used monitoring items such as electrocardiogram, cardiac function, blood pressure, breathing frequency and rhythm and pattern, body temperature, urine volume, arterial blood gas analysis, EEG, etc., and the monitoring scope is divided into 3 levels according to the severity of the disease. Special monitoring patients use primary monitoring, and patients who may be at risk of death after surgery are monitored by secondary monitoring, and those who have stabilized their conditions are monitored by tertiary monitoring.
- The intensive care unit's treatment of critical illness has created opportunities and possibilities for the treatment of the primary disease, so that some of the original poor or incurable diseases can be effectively controlled and satisfactorily treated; at the same time, other professional departments The treatment of disease is the basis for fundamental improvement of critical illness. The organic combination of critical care medicine and other specialties is one of the keys to the development of intensive care units in general hospitals.