![急诊临床路径](https://wfqqreader-1252317822.image.myqcloud.com/cover/11/36535011/b_36535011.jpg)
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第一章 概 述
1. 危重症患者的评估与稳定
概 述
在急诊的临床实践中,使急诊科医师最感困难的是如何在众多急诊患者中识别潜在危及生命的因素,以减少漏诊和误诊,避免医疗纠纷的发生。在临床工作中,医师对不能确诊的患者,首要的是区分症状的严重程度和危险因素,而不是急于确诊。因为一旦有威胁生命的因素存在,不管原因如何,即要以优先原则进入“绿色通道”。以下是危重症患者的评估和具体的临床路径。
表1.1 使用早期预警评分识别潜在的危重症患者
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.1_59928.jpg?sign=1734449381-fO46ddhAaiM7OoxYl0dAIaU4uvUovn4K-0-6c9d3e8fb3d028c694f993c41aba0738)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.1_1_59929.jpg?sign=1734449381-fCF1CAwAe4747nZ6e1lleDPmnrfKnBCi-0-d04eeabc9e53e124c3143e3f5ec70e1a)
注:评分≥3分预示存在潜在的危重疾病,需要立即进行评估。此评分仅作为指导,还没有得到循证医学的证实
表1.2 怀疑重症疾病时9项关键观察指标
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.2_59930.jpg?sign=1734449381-QyIMgNn3IW7noEkdndy1hiyxzr6fbU4L-0-b9e0065200ef5bc540999ef59bfbdbaa)
表1.3 评估气道
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.3_59931.jpg?sign=1734449381-hGIcKwpHjW1ddjEwLqQbrBCl2f0en82X-0-f896458c48da60fd8c32903c659c5b62)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.3_1_59932.jpg?sign=1734449381-VRWwn5sFNus8AExF69VvbFe0eGVA6bGp-0-4793d68259088eed0cc54849a7f36ec3)
注:*呼吸窘迫表现为呼吸费力、心率快、只能说简短的句子或单个的字、躁动、大汗、肺呼吸音低或无
表1.4 评估呼吸
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.4_59602.jpg?sign=1734449381-U0Y9TUcaioLO9ygt5vevT8y0pfJZVVnc-0-783d437f617fd6d9f4ee530bc399043a)
提示:脉搏血氧饱和度仪可能会给出不准确的动脉血氧饱和度,特别是有指甲油或皮肤角化时,如果怀疑通常要检查动脉血气
表1.5 呼吸衰竭的处理[氧合和(或)通气受损]
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.5_2386.jpg?sign=1734449381-zT4MX88Rp0xPEOc1zq3K9HVdftvR71YN-0-3d88bd5d20e6440c5f5d0ee67e96ae75)
注:*COPD,慢性阻塞性肺疾病
表1.6 评估循环
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.6_2394.jpg?sign=1734449381-pzTEhthmbcylGrdbY9GF9mlihf8zRNhU-0-5b2231b77c38b3b4defce7adb049380a)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.6_1_2442.jpg?sign=1734449381-bDL6esF1yYb7ENZGOTK8QbSZDzdAugmr-0-d032b5b2adcac729c23f21eeb4da4336)
表1.7 循环衰竭的处理:一般原则
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.7_2449.jpg?sign=1734449381-S1FgrgSLMeJRxZsDMMi9Pyq0doKeRNV0-0-34b202ad0e89674da2fe3aad9fe58a31)
表1.8 低血糖的处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.8_2456.jpg?sign=1734449381-27GxfvphGMx1WXRveoIpvxf90ZJLyuli-0-4a8657e54e9d65568e1fe12ce9a6e52d)
表1.9 危重症患者全身体格检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.9_59933.jpg?sign=1734449381-yZWHI76iu8xKTcJlwfrFfxgIsEkCyUkw-0-ac55564d8e91a76fc74e82a113ed8f4b)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.9_1_59934.jpg?sign=1734449381-QDkFJ43krXQ64XdanNLHwuZnQEdNxjDp-0-1d69b9aaa9fa5867a471f78c70d55d8a)
注:ICD,植入型心律转复除颤器
表1.10 危重症患者的检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.10_2550.jpg?sign=1734449381-XMT0U75j5zqWCbXQIKQQC7zvfjZuBIp0-0-0850976f04dd5c965ae87a616903e889)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.10_1_2598.jpg?sign=1734449381-KKhedA3bmWIzfMR6gBIrdX0zLybbXsPR-0-f422de03ca4f8784d3866231b99db1ee)
表1.11 神经系统的处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.11_2605.jpg?sign=1734449381-qiKyBGmFM0eVpTru4crGx5MT9XM9kpK1-0-7f0a35a95984f5262db681981bc7d846)
表1.12 内分泌系统的处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.12_2612.jpg?sign=1734449381-zHwox6eQq3HCiIpkZGrW7sZuqlLboMnA-0-10116cf0520773d4917fb8495876c164)
表1.13 肾脏的处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.13_2619.jpg?sign=1734449381-4tFftVLJaJS9PW0Jl86RdNULczrKfz4H-0-e4a8a43400b5e05a015f1723d1a3cbd9)
表1.14 胃肠道和肝脏的处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.14_2626.jpg?sign=1734449381-a2M7GMDV2fnmeP3ZRvkW8WZIqYrV6K3l-0-c9ffe0aac19cbc633f02ffc5faba045a)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.14_1_2670.jpg?sign=1734449381-80DFgc3jw95sG4LlUwlvPdn2Fa82phf7-0-e51dcdb08100d32039e8ce1a9ccba8c4)
表1.15 血液系统的处理
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.15_2677.jpg?sign=1734449381-B9kVHSmPHm1FFVcovY3gTofGkHmYK1Cp-0-52b1b14b57237eb8bdb32cf1f0e15bd2)
表1.16 抗生素的应用
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T1.16_2684.jpg?sign=1734449381-pwOuEjHTedmDoN1NGpriN9aXgyy7jgTs-0-d292cece58708466375448f5d36d65fa)