复旦大学附属中山医院：《内科学》课程教学资源（PPT讲稿）黄培志 - 危重医学 Critical Care Medicine

Critical Care Medicine Dr Huang Peizhi Zhongshan Hospital of Fudan universit

Critical Care Medicine Dr. Huang Peizhi Zhongshan Hospital of Fudan Universit

What is critical care medicine? Multidisciplinary healthcare specialty cares for patients with acute, life threatening illness or injury which including continuum of life support from the scene through discharge Coordinated care systems, analysis of treatment options, protocols, guidelines for the care of individual patients Monitoring and therapy a Intensive care medicine in Europe

What is critical care medicine？ ◼ Multidisciplinary healthcare specialty cares for patients with acute, life￾threatening illness or injury which including continuum of life support from the scene through discharge ◼ Coordinated care systems, analysis of treatment options, protocols, guidelines for the care of individual patients ◼ Monitoring and therapy ◼ Intensive care medicine in Europe

What is critical illness A condition where ife cannot be sustained without invasive therapeutic interventions Characterized by acute loss of physiologic reserve Cardiac arrest, shock, sepsis, severe trauma, coma Dysfunction of one or more organ systems hemodynamic insufficiency, respiratory failure, abnormalities of fluid and electrolytes

What is critical illness ? ◼ A condition where life cannot be sustained without invasive therapeutic interventions ◼ Characterized by acute loss of physiologic reserve ◼ Cardiac arrest, shock, sepsis, severe trauma, coma ◼ Dysfunction of one or more organ systems : hemodynamic insufficiency, respiratory failure , abnormalities of fluid and electrolytes

Characters of CCM(1) life support from site of accident to injury during transportation and management in emergency department (ED) and to surgical intervation in operating room or in intensive care unit (IcU) a Require emergency medicine and Intensive care medicine

Characters of CCM (1) ◼ life support from site of accident to injury during transportation and management in emergency department (ED) and to surgical intervation in operating room or in intensive care unit (ICU) ◼ Require emergency medicine and Intensive care medicine

Characters of CCM(2) Team action by physicians with various specialty backgrounds a Added expertise in resuscitation a No focus of interest to a single body system, but wide variety of ilness Intensivist- ability to provide effective critical care is in all cases

Characters of CCM (2) ◼ Team action by physicians with various specialty backgrounds ◼ Added expertise in resuscitation ◼ No focus of interest to a single body system, but wide variety of illness ◼ Intensivist - ability to provide effective critical care is in all cases

Emergency and critical care medicine(ECCM) system Pre-hospital care(self-help, help from bystanders, ambulance personnel via transport) life support in Emergency department, operation room and Icu EM physician is based in the ED, intensivist remained in ICU

Emergency and critical care medicine (ECCM) system ◼ Pre-hospital care (self-help, help from bystanders, ambulance personnel via transport) ◼ life support in Emergency department , operation room and ICU ◼ EM physician is based in the ED, intensivist remained in ICU

History of CCM In 1940s: physician sitting at the bedside through the long night 1st ICU opened in Europe in 1950's In 1970: set up society of CCM in USA Since 1991: teaching of CCM in China In 2001: set up committee of CCM in Shanghai

History of CCM ◼ In 1940’s: physician sitting at the bedside through the long night ◼ 1st ICU opened in Europe in 1950’s ◼ In 1970： set up society of CCM in USA ◼ Since 1991: teaching of CCM in China ◼ In 2001: set up committee of CCM in Shanghai

Intensive Care Unit (CU)

Intensive Care Unit (ICU)

What is cu Multidisciplinary multi-professional medical/nursing field A very high nurse to patient ratio 3-4: 1) The availability of invasive monitoring The use of mechanical and pharmacological life sustaining therapies (mechanical ventilation vasopressors, continuous dialysis, defibrillation pacemaker)

What is ICU ? ◼ Multidisciplinary multi-professional medical/nursing field ◼ A very high nurse to patient ratio (3-4:1) ◼ The availability of invasive monitoring ◼ The use of mechanical and pharmacological life sustaining therapies (mechanical ventilation, vasopressors, continuous dialysis, defibrillation, pacemaker)

Service in CU a Elementary service Bedside monitor system ■ Treatment equipment Experiment instrument

Service in ICU ◼ Elementary service ◼ Bedside monitor system ◼ Treatment equipment ◼ Experiment instrument