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危重醫(yī)學(xué)與加強(qiáng)醫(yī)療病房 Critical Care Medicine and Intensive Care Unit,危重病醫(yī)學(xué) Critical Care Medicine 研究危重病發(fā)生、發(fā)展及其預(yù)防與治療的臨床學(xué)科。 為危及生命的危急重癥患者提供高技術(shù)、高質(zhì)量的生命器官支持手段的醫(yī)療服務(wù)。,何為ICU?,Money?------Buy TimeMedicine?Hospital among Hospital,加強(qiáng)醫(yī)療科 Intensive Care Unit一種集現(xiàn)代醫(yī)療、護(hù)理技術(shù)為一體的醫(yī)療組織管理形式。 把危重病人集中起來，對各種危重病人實施連續(xù)的監(jiān)測、治療和護(hù)理， 為原發(fā)病的治療創(chuàng)造良好的基礎(chǔ)、贏得寶貴的時間，提高危重病救治的成功率。,19世紀(jì)50年代克里米亞戰(zhàn)爭時期Nightingale提出“分級護(hù)理”觀念 1863年第一個術(shù)后恢復(fù)室（Recovery Room)建立 二次大戰(zhàn)中，歐洲各地集中救治創(chuàng)傷及休克病員，形成早期外科ICU（SICU） 1948-1953年間，洛杉磯、丹麥、瑞典等地脊灰大規(guī)模流行，促成呼吸治療單位（Respiratory Care Unit ，RCU)建立，是文獻(xiàn)報道的第一個ICU。 60年代，歐美等國家相繼成立冠心 病治療病房（Coronary Care Unit)CCU, 美國Baltimore City Hospital 建立了具有現(xiàn)代規(guī)范的綜合 ICU 1970年，美國危重病醫(yī)學(xué)會成立。,80年代初僅數(shù)家大型教學(xué)醫(yī)院設(shè)立ICU 1989年北京召開第一次“加強(qiáng)醫(yī)療危重醫(yī)學(xué)座談會” 1991年11月召開“全國首屆ICU專題討論會”，54所醫(yī)院共設(shè)ICU59個（綜合21個，?？?8個） 1996年12月16日北京成立了“中國病理生理學(xué)會危重病醫(yī)學(xué)專委會籌委會 1997年9月在北京正式成立中國病理生理學(xué)會危重病專委會，產(chǎn)生了第一屆全國專委會委員 2005年5月，中華醫(yī)學(xué)會重癥醫(yī)學(xué)分會在北京成立,四個主體部分 重癥病員。 一支訓(xùn)練有素的醫(yī)護(hù)技術(shù)人員。 完備的生理監(jiān)測設(shè)備及先進(jìn)的搶救治療措施。能動態(tài)、定量觀察及捕捉瞬息變化，反饋治療效果；能作較長時間生命支持，為治療原發(fā)病爭取時間。 嚴(yán)格、科學(xué)的管理。,Physician (Intensivist) Physician Assistant* Nurse Practitioner* Registered nurse Nurse Respiratory Therapist Clinical Pharmacist Nutritionist Technician,人員結(jié)構(gòu),Physician, Intensivist,Nutritionist,Nurse Practitioner,Clinical Pharmacist,Resident,Registered Nurse,Fellow,,,,,,,,,,The ICU Model in Europe and in the United States,----An Interview With Jean-Louis Vincent and Timothy G. Buchman Posted 06/30/2005,Timothy G. Buchman, PhD, MD, past president of the Society of Critical Care Medicine and Professor of Surgery at Washington University School of Medicine in St. Louis, Missouri.,Jean-Louis Vincent, MD, PhD, past president of the European Society of Intensive Care Medicine and the European Shock Society,Open versus Closed ICUs,it is very important to place critically ill patients in the hands of a properly trained, experienced doctor who is part of a team available 24 hours a day.,The key feature is an integrated team of dedicated experts that brings multiprofessional perspective to bear on the needs of each patient. Intensivists are trained and ideally suited to provide this sort of leadership, which is why I personally practice and support the intensivist-led model.,High-Intensity vs. Low Intensity ICU Physician Staffing,,Pronovost PJ et al, JAMA, 288:2151 (2002),Financial solution to the rising ICU requirements,The future of “minimally reasonable“ healthcare will be tough, as the cost of medicine continues to increase dramatically and the population will continue to age. In the future we may face a need to limit the expenses for those at the end of their lives.,make our care as effective and as efficient as possible. But the greater imperative is to identify those patients for whom care with curative intent will not return them to a satisfactory quality of life. This will require a great deal of education both in the professional community as well as in the general public, which includes all of our patients and their families.,The separate ICU specialty curriculum, training and…,This would be the Spanish model: a mixture of internal medicine, anesthesiology, surgery, and emergency medicine.,critical care benefits from the multiple perspectives that intensivists with diverse backgrounds bring to the bedside. I believe that our discipline would become more attractive to medical students if we offered a pathway that did not require prior training in another discipline.,About Nursing shortage…,with a number of ingredients, including a fantastic head nurse, improvement in communication, and the “team approach,“ we now have enough ICU nurses!,We certainly need more nurses in the USA, especially those who have achieved advanced competencies and certifications in the care of the critically ill patient. We also especially need strategies that will preserve and use the years of accumulated wisdom that are contained in the aging bodies of our most experienced nurses.,The nursing curriculum and education…,Most nursing schools in Europe now have a separate specialty in intensive care and emergency medicine, such a specialty has increased nurses' interest in our discipline.,Nurses are professionals who value the same things as physicians: We need to ensure that the ICU remains an environment in which professionalism is maintained, where ideas are valued, and where caregivers feel as safe and as cared for as the patients they treat. we should build a profession that people flock to because it is exciting and rewarding.,the physician assistant and nurse practitioner…,For the lack of ICU physicians in the future, I very much believe in the applications of telemedicine. I think it is much better to have an ICU physician controlling the ICU at a distance,This is not a matter of physician shortage so much as it is a strategy to use their training and wisdom most effectively. Advanced practice nurses who partner with intensive care physicians can provide outstanding care to critically ill patients.,Relationship between the ED and the ICU,In our institution, we manage a so-called “shock lab“ with the emergency doctors. This means that we are called immediately when a critically ill patient is admitted to the ED.,Acute care medicine spans many areas of the modern medical center, Innovative training programs that lead to well-trained, hospital-based medical specialists who practice safely and effectively across this continuum have great potential to improve professional satisfaction and patient care.,An ICU crisis is approaching in the near future…,Critical care medicine is the most interesting specialty: I am sure it will continue to raise a lot of interest. The importance of the specialty will also increase in the future -- we should all be proud to be a part of it.,The most important step is to engage thought leaders, policymakers, and the public in an open and frank discussion about available resources… We must become diligent about measuring, reporting and improving our performance within presently available resources. Personal insights are of inestimable value when critical care professionals, families, and patients must make difficult decisions on the goals of intensive care.,謝謝！,