This introductory guide to the critical care environment describes the ICU and the caregivers who staff it; the patients and how they are admitted, monitored, and treated; and some of the common life-support equipment. It includes a strategy for presenting your patient to your team and prepares you for the ethical issues that might confront you in the ICU. The guide also describes some of the career paths that culminate in leadership positions in critical care medicine.

危重病护理环境指南介 绍重症监护室及室内护理人员，病人与病人入院、监护和治疗方式，及一些常用的生命支持设备等内容。指南还包括如何向ICU小组介绍病人和如何在心理上作好 应对ICU可能遇到的职业道德问题的准备。指南还对危重病护理医学中领导职位职业提升途径进行了描述。

The hospital you are in today is different from the hospital your attending physician claimed as his or her environment. Lengths of stay are down, patient acuity is rising, and critical care units are proliferating. Although the health care system is changing, hospitals will always need an area to care for their sickest patients--a critical care center. The need for these units is growing as patients at all extremes of life—the most premature infants, adults with cardiovascular disease, the severely injured—are growing, both in absolute numbers and in proportion to the general population. Citizens of developed nations around the world are living--and staying active--into the ninth and tenth decades of life. When they become ill, they often require aggressive intervention to stabilize their delicate physiologic balance so they can heal.医学 全在.线提供www.med126.com

你今天所在的医院与你主治医生以前 所说的那种环境已大不相同。病人住院时间缩短、病人要求提高、危重护理病房不断增多。虽然健康护理系统在不断变化，但医院将始终需要有一个护理最严重的病 人的区域 – 一个危重病护理中心。由于处于生命极端状态的病人的增多，如早产儿、成人心血管疾病患者和重伤病人等，无论是按绝对数字还是按总人口比率计算，对这些病房 的需求都在增长。发达国家的人口正在迈向90岁、100岁。这些人生病时常常需要采取入侵性措施，稳定其脆弱的生理平衡，使他们得以治愈。

The interventions required to manage life-threatening illnesses generally include both core supports--intensive nursing care and cardiopulmonary monitoring--as well as supports focused on the patient's particular illness. While nearly all ICUs are capable of providing a spectrum of care, many have developed a focused area of excellence: care of critically ill and injured children in the pediatric ICU (PICU); adult cardiac diseases in the coronary care unit (CCU); perioperative care, trauma care, and care of multiple organ dysfunction in the surgical ICU (SICU); care of neurological and neurosurgical patients in the neuroscience ICU; and so on. Many teaching hospitals also have graded critical care centers such as intermediate care units and telemetry units where patients who require more than ward care can benefit from specific monitoring and intervention.

威胁生命的疾病的处理措施包括核心 支持—重症护理和心肺监护—及以病人特定疾病为重点的支持措施。尽管几乎所有的ICU都能够提供整套的护理，但很多ICU都有自己的强项：儿科 ICU(PICU)危重病及受伤儿童的护理；冠心病监护室的成人心脏病护理；外科ICU(SICU)的围手术期护理、外伤护理和多种器官功能障碍的护理 等；神经科ICU的神经和神经外科病人护理；等等。很多教学医院也有不同等级的危重病护理中心，如过渡监护治疗病房和远程治疗病房等。需要病房外护理的病 人可以从远程治疗的特殊监护和介入中受益。医学全.在线提供

The more things get busy, the more you will appreciate that each team member in the ICU has a specific role.

你越忙就越有体会：每个ICU成员都有他特殊的作用。

The team leader is a physician. Students typically are assigned to train in intensive care units where the team leader is an intensivist physician who has received advanced training in the art and science of critical care medicine. In North America, added qualifications in critical care medicine are obtained after board certification in a primary specialty such as pediatrics, internal medicine, surgery, or anesthesiology. Many countries have established critical care medicine as an independent specialty.

ICU小组长由医生担任。学生被指 定到重症监护室实习。通常，ICU组长是一个重症专科医生，他在危重病护理医学方面受过高级培训。在北美地区，专科医生在拥有基本专业证书---如儿科、 内科、外科或麻醉科等---后就可以去获得另的危重病护理医学资格证书。很多国家已将危重病护理医学设为一个独立的专业。

Irrespective of the training pathway, your team leader embraces the philosophy of critical care medicine, namely that a physician-led, multidisciplinary team can provide optimal care to the critically ill patient.

不管接受何种培训，组长都会掌握危重病护理医学的基本原理，也就是说，一个由医生领导的多学科小组能够为危重病人提供最佳的护理。

The term "multidisciplinary" refers not only to other physicians who may participate as consultants or coattendings in the ICU, but also to the other health care professionals who work side by side, around the clock in the ICU. The most numerous of these are the critical care nurses, many of whom also have advanced training and certification in critical care and are recognized as CCRNs. Some have achieved even greater recognition and responsibility. They are the acute care nurse practitioners and clinical nurse specialists who complement the physician staff in establishing plans, writing orders, and directing management. Physician assistants also provide care in the ICU.

“多学科”一词并不仅仅是指以会诊 医师或合作主治医师身份加入ICU的其他医生，它同时也指在ICU内并肩昼夜工作的其他卫生保健专业人员，其中以重症监护护士人数最多。他们当中有很多人 在重症护理方面受过高级培训，获得过相应的证书，是公认的“重症监护注册护士”。有些护士所受到的重视更大，被赋予的职任也更大。他们是急症开业护士和临 床护理专家，他们是医生的补充，参与制定计划、写医嘱和指导治疗。医生助理也提供ICU护理。

Respiratory therapists are experts in many forms of pulmonary diagnosis and intervention. In addition to operating the mechanical ventilator, therapists often obtain and analyze arterial blood for blood gases and test patients' breathing strength by obtaining forced vital capacity, negative inspiratory pressure, and other parameters. In some hospitals, respiratory therapists perform endotracheal intubation in addition to supporting ventilation with "bag-and-mask" devices. The ICU team typically includes a pharmacist who helps you review medication profiles and determine if your patient is predisposed to side effects or drug interactions.

呼吸治疗师是多种肺病诊断和治疗的 专家，除了使用机械呼吸机外，这些治疗师常常获取并分析动脉血气，通过用力肺活量、负压吸气及其他参数测试病人的呼吸力。在一些医院，呼吸治疗师除了用“ 袋-面罩”装置支持通气外也施行气管内插管。一个典型的ICU小组都有一个药剂师，他帮助护士评估药物性质，确定病人是否会诱发副作用或药物相互作用。

The pharmacist will help you calculate clearance rates from measured drug levels and plan dosing schedules for many of the medications used in the ICU.

药剂师根据测得的药物浓度帮助计算药物清除率，为ICU使用的多种药物计划给药方案。

The team also typically includes someone who is an expert in nutrition support such as a dietitian who has advanced training in enteral (gut) and parenteral (intravenous) nutritional support strategies and pitfalls. Other important members of the ICU team are the medical social worker, who provides ongoing psychosocial assessments and support; representatives of the chaplaincy staff, who are available on call to offer spiritual support to patients, families, and ICU staff members; and a unit secretary, who manages administrative tasks such as reception, telecommunications, and chart maintenance. In addition, the ICU staff generally includes many other trainees who are there to learn with you such as fellows, residents, nursing students, and dietetics students.

典型的ICU小组里还有一位营养支 持方面的专家，如一位在肠道和非肠道(静脉内)营养支持方法及缺陷方面受过高级培训的营养师等。ICU小组其他重要成员有社会医疗工作者，他为病人提供连 续的心理社会评估和支持；牧师代表，可以随时招他为病人、家属和ICU成员提供精神帮助；以及一位病房秘书，处理一些行政性工作，如接待、联系及病案保管 等。此外，ICU成员通常包括其他很多在此学习的受训实习人员，如会员、高级专科住院实习医生、护生及营养学学生等。