群体创伤患者规范化处理及护理(1)
【摘要】 目的探讨如何在急诊科对群体创伤患者进行及时、有序、高效的救治及护理,提高抢救成功率,降低致残率。方法 通过对2006年7月至2009年6月本院急诊科收治的42起群体创伤共176例患者的救治及护理进行回顾性总结及分析。结果 176例创伤患者在急诊均得到妥善处理,入院行紧急手术治疗有19例,占10.80%;在急诊手术室行清创、缝合、固定等处理后在急诊观察病区进一步观察有76例,占43.18%;在急诊处理后可离院有81例,占46.02%;无一例患者死亡。结论 制定“群体事故处理流程”,及时开通急救绿色通道,严格执行请示报告制度,尽快对群体创伤患者进行检伤分类及分区救护,优先对危重创伤患者进行抢救,同时在日常工作中重视对急诊医护人员进行创伤救护技能的培训,提高医护人员的快速反应能力及医护配合水平,保证了创伤患者救护的时效性,提高了群体创伤患者的救治成功率。
【关键词】群体伤员;创伤;急救护理
Normalized treatment and nursing for the groups’ traumatic patients
, http://www.100md.com
CAI Ying-jie,XIE Pei-ling,GUANG Kui-fen.
The emergency department of the Second Affiliated Hospital of Guangzhou Medical College,Guangdong 510260,China
【Abstract】 Objective To explore how to give the patients in the groups of trauma with timely, orderly and efficient treatment and care in the emergency department, improve success rate of rescue and reduce disability.Methods To retrospectively review and analyze the treatment and nursing for 176 patients of a total of 42 groups of trauma which attended to our emergency department from July 2006 to June 2009.Results 176 cases of trauma patients received properly treatment in the emergency department;19 cases (10.80%)were hospitalized for emergency operation ; 76 cases(43.18%) received debridement, suture, fix and other treatment in the emergency operating room,and then arranged tothe emergency observation ward for further observation ; 81 cases(46.02%)could be discharged after emergency treatment; None of the patients died.Conclusion To establish "groups of incident handling process", get into the first-aid fast tract rapidly, strictly enforce the reporting system, quick triage to give priority to critically ill trauma patients for emergency treatment, and at the same time attach importance to emergency medical staffs for trauma rescue skills in their daily work, improve staffs’ rapid response capabilities and their coordination, guarantee the timeliness of trauma rescue, increase success rate of rescue.
, 百拇医药
【Key words】 Group patients;Trauma;Emergency care
随着城市经济的发展、外来人口及城市车辆的迅速增加,各种群体创伤事件逐年上升,创伤已成为城市院前急救的首要病因[1]。本院是广州市一家综合性三级甲等医院,承担了本市重要的各类抢救工作,对多起群体创伤患者进行了救护,现报告如下。
1 临床资料
自2006年7月至2009年6月本院急诊科救治了42起突发群体创伤患者,共176例,男性135例,占76.70%,女性41例,23.30%;其中车祸外伤18起,患者76例,占43.18%;打架、斗殴20起,患者86例,占48.86%;生产事故4起,患者14例,占7.96%。年龄分布以21岁到40岁青壮年为主,占91.54%。伤情分布:根据损伤严重程度(ISS评分),9分以下(轻伤)104例,占59.09%;10分-16分(中度伤)53例,占30.11%;17分以上者(重伤)19例,占10.80%。
, 百拇医药
2 临床救治及护理
2.1 尽早开通急救绿色通道,严格执行请示报告制度 接收到群体创伤患者时,按医院制定的“群体事故处理流程”,立即报告科室主任、护士长以及医院相关领导,根据群体创伤患者的多少及伤情调配增援人员,同时通知相关部门如检验科、放射科、药房、运送中心等做好准备工作。对群体创伤患者,一律采取先检查、治疗,后补办手续、交费的原则进行处理,危重伤员优先进行治疗及检查。
2.2 做好检伤分类工作,分流患者 迅速对群体创伤患者进行伤情评估,按病情轻重分三类:Ⅰ轻度:神志清醒,对检查能配合并反应灵敏的伤员;Ⅱ中度:对检查有反应但不灵敏,有轻度意识障碍的伤员;Ⅲ重度:对检查完全无反应、意识丧失、休克等随时有生命危险的伤员[2],并给患者挂上检伤牌:红色-重度,黄色-中度,蓝色-轻度,黑色-死亡。同时根据伤情马上分流伤员,重度伤员放置在急诊重症监护室或抢救室立刻进行抢救,中度伤员放置在急诊外科观察病区,轻度伤员在急诊外科诊室外等侯检查及治疗,根据患者的需要提供车床或轮椅。
2.3 分工协作,避免混乱 为了避免混乱,对群体创伤患者的救护必须分工协作进行:①抢救组:负责马上对危重患者进行抢救,包括保持气道通畅、止血、包扎、给氧、建立静脉通道、心电监测、气管插管配合、送患者检查等,采用“人盯人”战术[3],严密观察病情及做好护理记录。②治疗护理组:负责对一般患者的治疗及护理,巡视病情,及时发现患者的需要。③登记及报告组:负责对所有群体创伤患者的资料、病情、治疗等的登记,避免重复就诊,并将登记资料汇总,及时上报。, 百拇医药(蔡映杰 谢佩玲 管癸芬)
【关键词】群体伤员;创伤;急救护理
Normalized treatment and nursing for the groups’ traumatic patients
, http://www.100md.com
CAI Ying-jie,XIE Pei-ling,GUANG Kui-fen.
The emergency department of the Second Affiliated Hospital of Guangzhou Medical College,Guangdong 510260,China
【Abstract】 Objective To explore how to give the patients in the groups of trauma with timely, orderly and efficient treatment and care in the emergency department, improve success rate of rescue and reduce disability.Methods To retrospectively review and analyze the treatment and nursing for 176 patients of a total of 42 groups of trauma which attended to our emergency department from July 2006 to June 2009.Results 176 cases of trauma patients received properly treatment in the emergency department;19 cases (10.80%)were hospitalized for emergency operation ; 76 cases(43.18%) received debridement, suture, fix and other treatment in the emergency operating room,and then arranged tothe emergency observation ward for further observation ; 81 cases(46.02%)could be discharged after emergency treatment; None of the patients died.Conclusion To establish "groups of incident handling process", get into the first-aid fast tract rapidly, strictly enforce the reporting system, quick triage to give priority to critically ill trauma patients for emergency treatment, and at the same time attach importance to emergency medical staffs for trauma rescue skills in their daily work, improve staffs’ rapid response capabilities and their coordination, guarantee the timeliness of trauma rescue, increase success rate of rescue.
, 百拇医药
【Key words】 Group patients;Trauma;Emergency care
随着城市经济的发展、外来人口及城市车辆的迅速增加,各种群体创伤事件逐年上升,创伤已成为城市院前急救的首要病因[1]。本院是广州市一家综合性三级甲等医院,承担了本市重要的各类抢救工作,对多起群体创伤患者进行了救护,现报告如下。
1 临床资料
自2006年7月至2009年6月本院急诊科救治了42起突发群体创伤患者,共176例,男性135例,占76.70%,女性41例,23.30%;其中车祸外伤18起,患者76例,占43.18%;打架、斗殴20起,患者86例,占48.86%;生产事故4起,患者14例,占7.96%。年龄分布以21岁到40岁青壮年为主,占91.54%。伤情分布:根据损伤严重程度(ISS评分),9分以下(轻伤)104例,占59.09%;10分-16分(中度伤)53例,占30.11%;17分以上者(重伤)19例,占10.80%。
, 百拇医药
2 临床救治及护理
2.1 尽早开通急救绿色通道,严格执行请示报告制度 接收到群体创伤患者时,按医院制定的“群体事故处理流程”,立即报告科室主任、护士长以及医院相关领导,根据群体创伤患者的多少及伤情调配增援人员,同时通知相关部门如检验科、放射科、药房、运送中心等做好准备工作。对群体创伤患者,一律采取先检查、治疗,后补办手续、交费的原则进行处理,危重伤员优先进行治疗及检查。
2.2 做好检伤分类工作,分流患者 迅速对群体创伤患者进行伤情评估,按病情轻重分三类:Ⅰ轻度:神志清醒,对检查能配合并反应灵敏的伤员;Ⅱ中度:对检查有反应但不灵敏,有轻度意识障碍的伤员;Ⅲ重度:对检查完全无反应、意识丧失、休克等随时有生命危险的伤员[2],并给患者挂上检伤牌:红色-重度,黄色-中度,蓝色-轻度,黑色-死亡。同时根据伤情马上分流伤员,重度伤员放置在急诊重症监护室或抢救室立刻进行抢救,中度伤员放置在急诊外科观察病区,轻度伤员在急诊外科诊室外等侯检查及治疗,根据患者的需要提供车床或轮椅。
2.3 分工协作,避免混乱 为了避免混乱,对群体创伤患者的救护必须分工协作进行:①抢救组:负责马上对危重患者进行抢救,包括保持气道通畅、止血、包扎、给氧、建立静脉通道、心电监测、气管插管配合、送患者检查等,采用“人盯人”战术[3],严密观察病情及做好护理记录。②治疗护理组:负责对一般患者的治疗及护理,巡视病情,及时发现患者的需要。③登记及报告组:负责对所有群体创伤患者的资料、病情、治疗等的登记,避免重复就诊,并将登记资料汇总,及时上报。, 百拇医药(蔡映杰 谢佩玲 管癸芬)