院外急救

单击此处编辑标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2006-3-17,1,院外急救,prehospital emergency medical care,沈燕,教学目标,了解：,1、院外急救技术应用原则,2、院外急救的重要性,3、 院外急救的特点,4、院外急救的任务,5、急救指挥系统与网络化管理,6、急救用品的配备,熟悉,：1、院外急救的原则,2、院外急救伤员的分类,掌握：,1、院外急救护理,2006-3-17,概念,广义：,指伤病员在发病或受伤时，由,医护人员或目击者,对其进行必要的急救，以维持基本生命体征或减轻痛苦的医疗活动和行为的总称,狭义：,指,有通讯、运输和医疗基本要素所构成的专业急救机构,，在病人到达医院前实施的现场救治和途中监护的医疗活动,区别：有否公众参与,2006-3-17,院外急救的重要性,时间就是生命,猝死最佳抢救时间4min,严重创伤抢救的黄金时间30min,否则，院内设备再好，医生医术再高明，难以起死回生,2006-3-17,特点,社会性强、随机性强,时间紧急,流动性大,急救环境条件差,病种多样复杂,以对症治疗为主,体力强度大,2006-3-17,院外急救的任务,平时对呼救病人的院外急救,灾害或战争时对遇难者的院外急救,特殊任务时救护值班,通讯网络中心的枢纽任务,急救知识的普及,2006-3-17,急救指挥系统与网络化管理,我国城市院外急救模式,急救指挥系统,群众急救系统普及化,急救系统网络化,2006-3-17,急救技术的应用,通气、止血、包扎、固定、搬运,通气：仰卧位,开放气道保持气道通畅，是心肺复苏的关键,方法：,仰头抬颏法,托颌手法,清除口腔内异物：,口腔内有异物、呕吐物、液体时,人工呼吸：口对口、口对鼻,2006-3-17,急救技术的应用,止血,及时采取有效的止血措施，对抢救病人的生命具有非常重要的意义,失血量,占血容量的20%以上时-出现明显症状,达血容量的40%时-有生命危险,院外止血法：,一般止血法：创口小的出血,加压包扎止血法：,指压止血法：为最简单的止血方法,2006-3-17,急救技术的应用,包扎：,在外伤救护中应用最广，使用器材简便，可以就地取材,目的：,保护伤口，减少伤口感染和再损伤,局部加压，帮助止血，预防或减轻局部肿胀,固定伤口上的敷料、甲板,夹托受伤的肢体，使伤部舒适安全，减轻痛苦,2006-3-17,用品配备,急救盒,：,保健盒,急救包：,以最小的容量容纳下必要的器材和药品,急救箱：,能够按顺序摆放较多的医疗器材和急救药品，适用于多种危重病抢救,急救车内装备：,车、担架、氧气、输液装备、各种液体、吸引器及其他抢救器材,2006-3-17,原则,先复苏后固定-,心搏呼吸骤停又有骨折时,先止血后包扎-,大出血又有创口时,先重伤后轻伤-,既有垂危者又有较轻的伤员时,先救治后运送-,运送途中不停止抢救措施,急救呼救并重-,遇有成批伤员多人在场，分工合作,搬运与医护的一致性-,安全到达目的地、减少痛苦 ，减少死亡,2006-3-17,院外急救伤员分类,意义（提高效率）,要求（现场情况、技术人员、原则）,判断（呼吸、脉搏）,标记（四大标记）,划分（四大分区）,2006-3-17,院外急救伤员分类,判断应在min内完成,呼吸、脉搏,急救标记,第I急救区红色：病伤严重，危及生命,第II急救区黄色：严重，无危及生命者,第III急救区绿色：受伤较轻，可行走,第IV急救区黑色：死亡伤病员,2006-3-17,院外急救护理,护理体检,救护要点,不同转运工具转送特点与途中护理,2006-3-17,护理体检,基本原则:,先救命后治病，迅速果断处理直接威胁生命的症状,“三清”：,听请,问清,看清,顺序：,生命体征,检查瞳孔、意识状态,测量血压、脉搏、呼吸、体表温度,观察一般状况,应用基本物理检查方法：头颈、脊柱、胸、腹、骨盆、四肢,2006-3-17,护理体检,生命体征（T、P、R、BP、瞳孔）,头部体征（口、鼻、眼、耳、面部、颅）,颈部体征（颈动脉搏动、颈椎损伤、颈后压痛）,脊柱体征（自上向下，肿胀、出血）,胸部体征（锁骨、胸廓、肋骨）,腹部体征（出血、压痛、肌紧张）,骨盆体征（损伤、骨折）,四肢体征（关节活动、肢端血液循环、动脉搏动）,2006-3-17,救护要点,体位：在不影响急救处理的前提下，应尽量保证舒适，注意保暖，使病人安静休息,建立有效的静脉通道：静脉留置针,松解或去除病人衣服：先健侧后患侧，情况紧急时，直接剪开,2006-3-17,不同转运工具转送特点与途中护理,担架转运伤员途中的护理,汽车转运伤员途中的护理,列车转运途中的护理,飞机转运伤员的护理,轮船转运伤员的护理与处置,2006-3-17,担架转运伤员途中护理,特点：,优点：影响小，适用面广，舒适平稳,缺点：速度慢、条件差,护理要求：,对患者要求：体位：头部在后，下肢在前,输液通畅、止血、翻身,对搬运要求：步调一致、平稳，防寒、防暑,2006-3-17,汽车转运伤员途中的护理,特点：,优点：快速（装有急救器材的救护车）,缺点：道路平稳性、晕车,护理要求：,对患者：体位（仰卧、半卧、脑损伤、骨折）,对转运者：监测生命体征、严密观察病情、轻重缓急,2006-3-17,列车转运途中的护理,特殊性要求,：,车厢做好病情轻重明显标志,“四勤”：勤查体、勤询问、勤处理、勤,巡回,全面观察，重点监护：一看二摸三听,常规：,体位、导管、生活护理,2006-3-17,飞机转运伤员的护理,特点：,优点：快速转运、平稳舒适,缺点：氧分压下降、气压影响、晕机,护理要点：,对伤员：体位：头部朝机尾,对工作人员：保持伤员气道清洁湿润、颅部受伤、昏迷者,2006-3-17,轮船转运伤员的护理与处置,特点,优点：水路运输、平稳舒适,缺点：噪音大、晕船,护理要点,伤员：体位、防止呕吐,工作人员：注意安全、防止传染病的发生,2006-3-17,转运特点小结,转运过程中部中断治疗和护理，了解各种运输工具的特点护理时有侧重,担架：灾难急救转运病人最常用的工具,汽车：颠簸，晕车现象,列车：时间长短,飞机：上升和下降时气压有变化，噪音，颠簸,2006-3-17,转送安全到达后，须认真做好交班工作（基本病情、导管、用药、途中情况、目前情况）,2006-3-17,小结,院外急救概念、特点,院外急救的原则,院外急救伤员的分类,院外急救护理,2006-3-17,复习思考题,何谓院外急救？,院外急救的原则？,院外急救伤员的分类？,院外救护要点？,担架转运途中护理要点？,2006-3-17,s%v)z1C4G8JbNfRiUmYp!t*x-A2E5H9LdOgSkVnZr%u(y0B3F7JaMeQhTlXp#s&w)z1D5G8KcNfRjVmYq$t*x+B2E6I9LdPhSkWoZr%v)y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmYp!t*w-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWoZr%v(y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmYp!t*w-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWoZr%v(y0C3F7JbMeQiTlXp!s&w-z1D5H8KcOfRjVnYq$u*x+B3E6IaLdPhTkWo#r%v)z0C4G7JbNfQiUmXp!t*w-A2D5H9LcOgSjVnZr$u(y+B3F7IaMePhTlXo#s&v)z1D4G8KbNfRjUmYq!t*x+A2E6H9LdPgSkWnZr%v(y0C3F7JbMeQiTlXp!s&w-z1D5H8KcOfRjVnYq$u*x+B3E6IaLdPhTkWo#r%v)z0C4G7JbNfQiUmXp!t*w-A2D5H9LcOgSjVnZr$u(y+B3F7IaMePhTlXo#s&v)z1D4G8KbNfRjUmYq!t*x+A2E6H9LdPgSkWnZr%u(y0C3F7JaMeQiTlXp#s&w-z1D5G8KcOfRjVmYq$u*x+B2E6IaLdPhSkWo#r%v)y0C4G7JbNeQiUmXp!t&w-A2D5H9KcOgSjVnZq$u(y+B3F6IaMePhTlWo#s&v)z1C4G8KbNfRiUmYq!t*x-A2E6H9LdOgSkWnZr%u(y0C3F7JaMeQiTlXp#s&w-z1D5G8KcOfRjVmYq$u*x+B2E6IaLdPhSkWo#r%v)y0C4G7JbNeQiUmXp!t&w-A2D5H9KcOgSjVnZq$u(y+B3F6IaMePhTlWo#s&v)z1C4G8KbNfRiUmYq!t*x-A2E6H9LdOgSkVnZr%u(y0B3F7JaMeQhTlXp#s&w)z1D5G8KcNfRjVmYq$t*x+B2E6I9LdPhSkWoZr%v)y0C4F7JbNeQiUlXp!t&w-A1D5H9KcOgRjVnZq$u(x+B3F6IaMdPhTlWo#s%v)z1C4G8JbNfRiUmYp!t*x-A2E5H9LdOgSkVnZr%u(y0B3F7JaMeQhTlXp#s&w)z1D5G8KcNfRjVmYq$t*x+B2E6I9LdPhSkWoZr%v)y0C4F7JbNeQiUlXp!t&w-A1D5H9KcOgRjVnZq$u(x+B3F6IaMdPhTlWo#s%v)z1C4G8JbNfRiUmYp!t*x-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWoZr%v(y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmYp!t*w-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8NfRiUmYp!t*x-A2E5H9LdOgSkVnZr%u(y0B3F7JaMeQhTlXp#s&w)z1D5G8KcNfRjVmYq$t*x+B2E6I9LdPhSkWoZr%v(y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmYp!t*w-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWoZr%v(y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmYp!t*w-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWnZr%v(y0C3F7JbMeQiTlXp!s&z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWoZr%v(y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmYp!t*w-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWoZr%v(y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmXp!t*w-A2D5H9LcOgSjVnZr$u(y+B3F7IaMePhTlXo#s&v)z1D4G8KbNfRjUmYq!t*x+A2E6H9LdPgSkWnZr%v(y0C3F7JbMeQiTlXp!s&w-z1D5H8KcOfRjVnYq$u*x+B3E6IaLdPhTkWo%v(y0C4F7JbMeQiUlXp!s&w-A1D5H8KcOgRjVnYq$u(x+B3E6IaMdPhTkWo#s%v)z0C4G8JbNfQiUmYp!t*w-A2E5H9LcOgSkVnZr$u(y0B3F7IaMeQhTlXo#s&w)z1D4G8KcNfRjUmYq$t*x+A2E6I9LdPgSkWnZr%v(y0C3F7JbMeQiTlXp!s&w-z1D5H8KcOfRjVnYq$u*x+B3E6IaLdPhTkWo#r%v)z0C4G7JbNfQiUmXp!t*w-A2D5H9LcOgSjVnZr$u(y+B3F7IaMePhTlXo#s&v)z1D4G8KbNfRjUmYq!t*x+A2E6H9LdPgSkWnZr%v(y0C3F7JbMeQiTlXp!s&w-z1D5H8KcOfRjVnYq$u*x+B3E6IaLdPhTkWo#r%v)z0C4G7JbNfQiUmXp!t*w-A2D5H9LcOgSjVnZr$u(y+B3F7IaMePhTlXo#s&v)z1D4G8KbNfRjUmYq!t*x+A2E6H9LdOgSkWnZr%u(y0C3F7JaMeQiTlXp#s&w-z1D5G8KcOfRjVmYq$u*x+B2E6IaLdPhSkWo#r%v)y0C4G7JbNeQiUmXp!t&w-A2D5H9KcOgSjVnZq$u(y+B3F6IaMePhTlWo#s&v)z1C4G8KbNfRiUmYq!t*x-A2E6H9OgSjVnZr$u(y+B3F7IaMePhTlXo#s&v)z1D4G8KbNfRjUmYq!t*x+A2E6H9LdPgSkWnZr%v(y0C3F7JbMeQiTlXp!s&w-z1D5H8KcOfRjVnYq$u*x+B3E6IaLdPhTkWo#r%v)y0C4G7JbNeQiUmXp!t&w-A2D5H9KcOgSjVnZq$u(y+B3F6IaMePhTlWo#s&v)z1C4G8KbNfRiUmYq!t*x-A2E6H9LdOgSkWnZr%u(y0C3F7JaMeQiTlXp#s&w-z1D5G8KcOfRjVmYq$u*x+B2E6IaLdPhSkWo#r%v)y0C4G7JbNeQiUmXp!t&w-A2D5H9KcOgSjVnZq$u(y+B3F6IaMePhTlWo#s&v)z1C4G8KbNfRiUmYq!t*x-A2E6H9LdOgSkWnZr%u(y0C3F7JaMeQiTlXp#s&w-z1D5G8KcOfRjVmYq*x-A2E6H9LdO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