Reanimation thiab intensive kev saib xyuas

Intensive (thaum muaj xwm ceev) txoj kev kho - ib txoj kev kho cov kab mob, tuag taus. Pa tau rov - rov qab txheej txheem tseem ceeb heev (lub neej) zog poob los yog cov sim raws li ib tug tshwm sim ntawm tus kab mob. Cov kev kho mob ua rau nws tau mus nrhiav kom tau ib tug mus tas xyuas thiab rov qab zog los cuam tshuam nyob rau hauv tus txheej txheem nyob rau hauv cov ntaub ntawv ntawm ceev ceev teeb nyob rau hauv lub chaw ua hauj lwm ntawm tus kabmob thiab tshuab. Nyob rau hauv kev, resuscitation thiab intensive kev saib xyuas yog feem ntau zoo, thiab qhov kawg ntawm qhov tam sim no muaj nyob rau txoj kev tiv thaiv txoj kev tuag nyob rau hauv mob loj heev (txoj sia) cov kab mob thiab lawv cov teeb meem, kev raug mob.

tswv yim

Intensive txoj kev kho - ib txoj kev ntawm kev kho mob ib ncig ntawm lub moos, uas yuav tsum siv tso dej infusions los yog detoxification txoj kev nrog rau qhov kev tswj ntawm tseem ceeb heev tshwm sim. Lawv nrhiav tau tawm los ntawm cov ntshav thiab cov kua nruab nrog cev, uas yog feem ntau pheej rov qab ua rau cov fast-mus txog qhovtwg deterioration thiab txoj kev txhim kho ntawm Somatic zog ntawm tus neeg mob. Qhov thib ob txoj kev los tswj - nws yog xyuas, uas yog siv nyob rau hauv kev kho vajtse los ntawm siv cardiomonitors, roj analyzers, electroencephalograph thiab lwm yam ntawm cov khoom.

Pa tau rov txheej txheem uas hu lam daim ntaub ntawv thiab kev kho vajtse hom kev kawm lub cev rov mus rau lub neej nyob rau hauv thaum muaj xwm ceev tej yam kev mob tshwm sim. Yog hais tias tus neeg mob yog nyob rau hauv ib lub xeev, uas implies ib tug kev hem thawj rau lub neej, sawv los ntawm tus kab mob los yog nws teeb meem, rau nws cov stabilization intensive kev kho mob. Yog hais tias tus neeg mob yog nyob rau hauv ib lub xeev ntawm kev soj ntsuam txoj kev tuag thiab yuav tsis ua neej nyob tsis muaj ib tug ceev rov qab los ntawm poob zog, cov txheej txheem ntawm rov qab thiab raug mob no yog hu ua resuscitation.

Koom nyob rau hauv cov teeb meem nyob rau hauv resuscitation. Nws yog ib tug nqaim kws, ib qho chaw ua hauj lwm uas yog lub intensive kev saib xyuas unit. Feem ntau cov feem ntau, cov kws kho mob tsuas profession resuscitator tsis muaj nyob, vim hais tias cov tshwj xeeb yuav tau txais ib daim diploma ntawm tshuaj kom tsaug zog thiab resuscitation. Nyob rau hauv lub chaw ua hauj lwm, raws li cov tsev, nws yuav siv sij hawm peb hom posts: "Anesthetist", raws li zoo raws li ib tug nyias muaj nyias ib "resuscitation" los yog "anesthesiologist".

Tus kws kho mob nyob rau hauv intensive kev saib xyuas tsev

Tus kws kho mob ntawm intensive kev kho - nws anesthesiologist. Nws yog muaj kev txhawj xeeb nrog xaiv cov hom ntawm tshuaj loog preoperative cov neeg mob thiab saib xyuas lawv cov kev mob tom qab phais. Ib tug specialist ua hauj lwm nyob rau hauv tej diversified kho mob chaw zov me nyuam (feem ntau regional los yog cheeb tsam tsev kawm), thiab qhov kev sib cais no yog hu ua HITD. Tej zaum yuav muaj cov neeg mob uas tau compensated muaj nuj nqi, tiam sis nws yuav siv sij hawm tswj ntawm tseem ceeb heev tshwm sim. Nyob rau hauv tas li ntawd, HITD yog cov neeg mob uas txoj sia raug mob thiab cov kab mob, raws li tau zoo raws li lawv cov teeb meem. Postoperative cov neeg mob tej zaum yuav muaj kev zoo ib yam li HITD tus kws kho mob Anesthetist.

Tus kws kho mob nyob rau hauv resuscitation

Tus kws kho mob nyob rau hauv resuscitation tsuas hais txog nrog cov kho tshiab ntawm tseem ceeb heev functions, thiab feem ntau nws yog ib qho chaw ua hauj lwm yog ib tug chaw nres tsheb los yog substation tsheb thauj neeg mob. Muaj kev nkag tau rau cov khoom siv, uas equips lub tsheb loj thauj neeg resuscitation tsheb thauj neeg mob, nws yuav Cawm ib tug neeg mob ntawm txoj kev, uas yuav pab tau nyob rau hauv tag nrho cov xwm txheej muaj feem xyuam rau kev puas tsuaj tshuaj. Feem ntau cov feem ntau, tus kws kho mob-resuscitator yog tsis koom nyob rau hauv ib tug intensive kev kho nyob rau hauv HITD tab sis tsim tswj ntawm qhov tseem ceeb heev functions ntawm tus neeg mob nyob rau hauv lub tsheb thauj neeg mob. Uas yog koom nyob rau hauv kev kho mob kev kho mob thiab kev kho vajtse tswj kev khiav dej num ntawm tus neeg mob nrog cov kev hem thawj ntawm txoj kev tuag.

Anesthesiologist

Anesthetist - yog ib qho piv txwv ntawm ib tug kws nyob rau hauv ib tug nqaim profile kho mob chaw, piv txwv li, nyob rau hauv ib tug mob cancer tsev kho mob los yog nyob rau hauv lub perinatal chaw. Ntawm no, lub ntsiab hauj lwm ntawm tus kws khomob tshwjxeeb yog los npaj lub hom tshuaj loog rau cov neeg mob uas yuav hloov phais. Nyob rau hauv cov ntaub ntawv ntawm perinatal chaw anesthetist ua hauj lwm yog kev xaiv ntawm cov hom tshuaj loog rau cov neeg mob uas caesarean seem yog ua. Nws yog ib qho tseem ceeb uas muab siab kho nyob rau hauv cov me nyuam yog tseem nqa tawm nyob rau hauv no qhov chaw. Txawm li cas los, lub intensive kev saib xyuas unit rau cov neeg mob thiab cov me nyuam mos yog muaj cob qhia. Nyob rau hauv HITD rau cov me nyuam (cov me nyuam mos) yog ua hauj lwm neonatologists thiab cov laus tau txais kev pab los ntawm anesthesiologist.

HITD phais tsev kho mob

Intensive kev saib xyuas unit nyob rau hauv lub tsev kho mob, muaj kev phais kev tsis ncaj ncees, nws yog npaj nyob rau hauv lub xov tooj ntawm cov neeg mob uas yuav tsum tau kev pab, thiab cov heev ntawm lub lag luam. Thaum pab nyob rau hauv oncological dispensaries nruab nrab lub sij hawm ntawm nyob ntawm tus neeg mob nyob rau hauv HITD siab tshaj nyob rau hauv lub dav dav phais. Intensive kev saib xyuas no yuav siv sij hawm ntev, raws li nyob rau hauv lub chav kawm ntawm kev ua hauj lwm inevitably puas tseem ceeb heev anatomical lug.

Yog hais tias peb xav txog qhov mob cancer hlais tawm lawm, lub meej feem coob ntawm pab no mas puas thiab loj loj ntim ntawm resected lug. Nws yuav siv sij hawm ib tug ntev lub sij hawm rau tus neeg mob rov qab, raws li tom qab phais yog tseem txoj kev pheej hmoo ntawm deterioration ntawm kev noj qab nyob, thiab txawm tuag los ntawm ib tug xov tooj ntawm lwm yam. Muaj yog ib qho tseem ceeb tiv thaiv kev pab los yog tshuaj loog mob, livelihood kev pab txhawb thiab replenishment ntawm cov ntshav ntim, ib feem ntawm uas yog inevitably poob nyob rau hauv lub chav kawm ntawm cov kev pab. Cov kev pab raws qib tseem ceeb tshaj plaws thaum lub sij hawm tej post-operative kev ncaj ncees.

HITD cardiological tsev kho mob

Cardiology thiab kho lub tsev kho mob yog distinguished los ntawm qhov tseeb hais tias muaj yog ob yam tib si compensated cov neeg mob tsis muaj kev hem thawj rau lub neej thiab tsis ruaj tsis khov neeg mob. Lawv yuav tsum tau mus nrhiav kom tau thiab muaj kev tswj ntawm lawv tus mob. Nyob rau hauv cov ntaub ntawv ntawm cardiological kab mob feem ntau xim yuav tsum tau myocardial infarction nrog nws teeb meem nyob rau hauv daim ntawv ntawm cov cardiogenic poob siab los yog cia li mob tuag. Intensive txoj kev kho ntawm myocardial infarction thiaj li txoj kev pheej hmoo ntawm kev tuag nyob rau hauv lub approximate lub sij hawm, tsis txhob tus nqi ntawm cov kev raug mob los es ua lub patency ntawm lub infarct txog leeg, raws li zoo raws li kev txhim kho cov raug rau tus neeg mob.

Raws li cov Ministry of Health twg thiab thoob ntiaj teb cov tswv yim, nyob rau hauv mob coronary cov neeg mob yuav tsum tau kev tso kawm nyob rau hauv ib tug intensive saib xyuas tsev mus nqa tawm thaum muaj xwm ceev kev ntsuas. Assistance yog muab los ntawm tus neeg ua haujlwm ua ntej pab nyob rau theem ntawm tus me nyuam, ces koj xav tau los patency ntawm lub coronary hlab ntsha, uas yog occluded los ntawm ib tug thrombus. Ces tus neeg mob txoj kev kho mob mus rau stabilize koom resuscitator: intensive kev kho, tshuaj, kho vajtse thiab kuaj tswj ntawm lub xeev.

Nyob rau hauv HITD cardiological, qhov twg phais haujlwm yog nqa tawm nyob rau hauv cov hlab ntsha los yog lub plawv li qub, cov hauj lwm ntawm lub tuam tsev yog qhov thaum ntxov postoperative kev ncaj ncees thiab raws li txoj cai mus txog qhovtwg. Cov hauj lwm yog vysokotravmatichnyh siab yog nrog los ntawm ib tug ntev lub sij hawm ntawm rov qab thiab adaptation. Muaj yog ib txwm ib tug siab ntau yam ntawm thrombosis, vascular shunt los yog sawv implanted dag los yog tej yam ntuj tso valve.

HITD khoom

Reanimation thiab intensive kev saib xyuas - yog kev ua lag luam kev xyaum ntawm cov tshuaj, uas yog tswj hais ntshai heev txawm rau tus neeg mob lub neej. Cov kev ua ub no nqa tawm nyob rau hauv ib tug kws unit, uas zoo txawm peem rau. Nws yog suav hais tias yog feem ntau technologically tshaj, vim hais tias ntawm cov yam ntxwv ntawm tus neeg mob yeej xav kho vajtse thiab kuaj tswj. Ntxiv mus, muab txoj kev kho yuav lub tsev lag luam ntawm ib tug mus tas ntau zaus los tso dej thawj coj.

Principles ntawm kev kho mob nyob rau hauv HITD

Nyob rau hauv tsoos chaw ua hauj lwm, cov neeg mob yog tsis nyob rau hauv kev txaus ntshai ntawm txoj kev tuag los ntawm tus kab mob los yog nws teeb meem nyob rau hauv lub sij hawm luv luv Txoj kev lis ntshav nrog system yog siv rau lub hom phiaj no. Nyob rau hauv HITD feem ntau nws yog hloov los ntawm Txoj kev lis ntshav twj. Qhov no cov khoom tso cai rau kom tsis tu ncua kom paub ib tug tej yam koob tshuaj yeeb tshuaj, tsis muaj qhov yuav tsum tau rau hno ib leeg txhua txhua lub sij hawm yuav tsum tau muab cov tshuaj. Txoj kev lis ntshav twj tso kua mis kuj tso cai nkag teb chaws ntawm medicaments tsis tu ncua rau hnub los yog ntau tshaj.

Niaj hnub nimno hauv paus ntsiab lus ntawm intensive kev kho thiab ceev tus kab mob kas twb tsim thiab yog cov nram no:

• Tus thawj lub hom phiaj ntawm kev kho mob - stabilization ntawm tus neeg mob thiab sim ib tug ncauj lus kom ntxaws diagnostic nrhiav;
• txiav txim ntawm lub lwm tus kab mob, uas provokes degradation thiab yog reflected rau lub xeev kev kho mob, nqa tej zaum txoj kev tuag;
• kev kho mob ntawm cov kab mob lwm lub xeev stabilization los ntawm symptomatic txoj kev kho;
• tshem tawm ntawm lub neej-hem tej yam kev mob thiab cov tsos mob;
• kev siv ntawm laboratory thiab instrumental xyuas ntawm tus neeg mob tus mob;
• txhais lus rau tus neeg mob nyob rau hauv lub profile compartment tom qab stabilization thiab tshem tawm ntawm lub neej-hem yam.

Kuaj thiab instrumental tswj

Xyuas ib tug neeg mob tus mob raws li ib tug soj ntsuam ntawm peb cov ntaub ntawv qhov chaw. Tus thawj - tus neeg mob daim ntawv ntsuam xyuas, lub tsev lag luam ntawm kev tsis txaus siab, kev txheeb xyuas noj qab haus huv puab. Ob - kuaj cov kev tshawb fawb ua ntej mus thiab thaum lub sij hawm kev kho mob, kev sib piv ntawm cov kev tshwm sim ntawm analyses. Qhov thib peb qhov chaw - ntaub ntawv uas tau los ntawm lub instrumental xeem. Tsis tas li ntawd rau no hom ntawm qhov chaw ntawm cov ntaub ntawv hais txog cov kev kho mob raws li txoj cai ntawm tus neeg mob thiab cov system muaj xws li xyuas ntawm mem tes, ntshav oxygenation, zaus thiab atherosclerosis ntawm mob ua si, ntshav siab, lub hlwb kev ua si.

Ua kom loog thiab tshwj xeeb cov khoom

Tej ceg ntawm cov tswv yim tshuaj raws li tshuaj kom tsaug zog thiab intensive kev saib xyuas yog inextricably txuas. Cov tub txawg uas ua hauj lwm nyob rau hauv cov chaw no, muaj ib tug diploma nrog cov lus "tus kws kho mob anesthesiologist." Qhov no txhais tau tias tej teeb meem ntawm tshuaj kom tsaug zog, resuscitation thiab intensive kev saib xyuas tej zaum yuav koom nyob rau hauv ib tug thiab tib yam tshwj xeeb. Ntxiv mus, qhov no txhais tau tias kom tau raws li cov kev xav tau ntawm multidisciplinary tsev kho mob, xws li mus pw departments ntawm kev phais thiab kho kev tsis ncaj ncees, tsuas yog ib HITD. Nws yog txawm peem rau nrog cov khoom rau resuscitation, kev kho mob thiab tshuaj loog ua ntej phais.

Pa tau rov thiab intensive kev saib xyuas yuav tsum tau ib leeg-theem (los yog biphasic) defibrillator los yog cardioverter defibrillator, electrocardiograph, ib tug system ntawm cov neeg kho tshuab cua, cardiopulmonary bypass (yog tias yuav tsum los ntawm ib tug kev kho mob chaw ua hauj lwm), sensors thiab analizatorskih systems yuav tsum tau mus soj ntsuam ntsuas ntawm lub plawv thiab lub hlwb kev ua si . Nws tseem ceeb heev kom muaj Txoj kev lis ntshav twj uas yuav tsum tau rau kev haum ntawm lub ntawm qhov Txoj kev lis ntshav Txoj kev lis ntshav tshuaj.

Tshuaj kom tsaug zog yuav tsum tau cov khoom rau muab nqus tau pa tshuaj loog. Qhov no kaw los yog semi-qhib system, los ntawm kev uas ua kom loog sib tov me nyuam yog muab nyob rau hauv lub ntsws. Qhov no ua rau nws tau mus nrhiav kom tau endotracheal los yog endobronchial tshuaj loog. Nws yog ib qho tseem ceeb uas cov kev xav tau ntawm tshuaj loog yuav tsum tau laryngoscopes thiab endotracheal (los yog endobronchial) leeg, catheters rau lub zais zis catheters thiab tej ntawm lub hauv paus thiab peripheral hlab ntsha. Cov tib cov cuab yeej siv yog yuav tsum tau thiab rau intensive kev kho mob.

HITD perinatal chaw zov me nyuam

Perinatal chaw zov me nyuam - ib tug noj qab haus huv chaw uas yug muab qhov chaw, uas yuav muaj feem mus nrog teeb meem. Cov yuav tsum tau xa mus rau cov poj niam uas raug kev txom nyem ua kom nchuav menyuam los yog muaj extragenital pathology, uas tau ua phem rau nyob rau hauv zog noj qab haus huv. Tsis tas li ntawd, yuav tsum muaj ib tug poj niam uas cev xeeb tub pathologies tau thaum ntxov me nyuam thiab me nyuam mos zov. Intensive neonatal kho - yog ib tug ntawm cov kev pab raws qib ntawm cov chaw zov me nrog rau muab tshuaj loog mob rau cov neeg mob uas yuav ua kev phais.

Tool txij nkawm HITD perinatal chaw zov me nyuam

Ceg Perinatal Intensive Care Center yog txawm peem rau nyob ntawm seb lub tswv yim npaj cov xov tooj ntawm cov neeg mob. Qhov no yuav tsum tau tshuaj loog systems thiab intensive kev saib xyuas cov khoom, daim ntawv qhia saum toj no. Yog li HITD perinatal chaw zov me nyuam muaj thiab xyuas chaw. Lawv yuav tsum muaj kev tshwj xeeb cov khoom. Firstly, neeg laus dag ua pa thiab kev tsis haum me nyuam mos ntau thiab tsawg pab ntawm lub cev uas yog tsawg heev.

Niaj hnub no, xyuas cov chaw koom nyob rau hauv tsev laus cov me nyuam mos uas 500 grams, tau yug nyob 27 lub lis piam 'hnub. Nyob rau hauv tas li ntawd, koj xav tau ib tug tshwj xeeb kev tshuaj, vim hais tias cov me nyuam mos yug los zoo ua ntej lub hnub, yuav tsum tau lub sij hawm ntawm ib tug surfactant npaj. Qhov no kim tshuaj, yam uas yog yog tsis yooj yim sua mus rau tsev laus raws li ib tug me nyuam mos los txog rau txoj kev loj hlob ntawm lub teeb, tab sis tsis muaj lub surfactant. Qhov no cov ntaub ntawv uas tsis pub ntsws alveoli ntog down, uas underlies cov txheej txheem npaum lwm respiration.

Nta ntawm lub koom haum ua hauj lwm HITD

HITD ua hauj lwm puag ncig lub moos, thiab tus kws kho mob rau lub luag hauj xya hnub ib lub lim tiam. Qhov no yog vim lub cev tsis mus tua cov khoom thaum twg nws yog lub luag hauj lwm rau lub sustenance ntawm ib tug neeg mob. Nyob rau hauv lub xov tooj ntawm cov neeg mob thiab cov load rau hauv lub ceg, tus xov tooj ntawm txaj yog tsim. Txhua berth yuav tsum tau nruab nrog ib tug tshuab ua pa thiab saib. Kuaj pom ntawm tsawg tshaj li tus naj npawb ntawm cov txaj, tus nqi ntawm cov cua pab kiag li lawm, saib thiab sensors.

Lub department, uas yog tsim los rau 6 cov neeg mob, ua hauj lwm 2-3 resuscitator tus kws kho mob anesthesiologist. Lawv yuav tsum tau hloov rau lub thib ob hnub tom qab 24 teev ntawm hauj lwm. Qhov no tso cai rau koj kom khiav ntawm tus neeg mob nyob ib ncig ntawm lub moos thiab rau cov hnub so, thaum tus xyuas ntawm cov neeg mob txheem chaw ua hauj lwm tsuas yog lub luag hauj lwm tus kws kho mob. Anesthetist yuav tsum saib xyuas cov neeg mob uas muaj nyob rau hauv HITD. Tsis tas li ntawd, nws yog yuam ua hauj lwm mus koom nyob rau hauv kev saib xyuas lub rooj sib tham, thiab pab cov neeg mob Somatic ceg kom txog thaum pw tsev kho mob HITD.

Pab tus kws kho mob Nurse Anesthetist thiab intensive kev saib xyuas tus neeg tu mob. Lub xam ntawm tus xov tooj ntawm bets yog ua nyob rau hauv lub xov tooj ntawm cov neeg mob. 6 txaj yuav tsum tau muaj cov ib tug kws kho mob, neeg tu mob ob thiab ib tug kws tu neeg mob. Qhov no muaj pes tsawg tus neeg ua hauj lwm yuav tsum yog tam sim no nyob rau txhua lub luag hauj thaum lub sij hawm ib hnub. Neeg ua hauj lwm ces hloov los ntawm lwm hloov, thiab nws, nyob rau hauv lem, - rau peb.