降阶梯思维.ppt

降阶梯思维在急诊的临床应用
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10/10/2018
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急危重症患者抢救中心
疑难病人会诊中心
慢性病人康复中心
临终病人关怀中心
待住院患者侯床中心
醉酒患者的暴力发泄中心
三无人员的收留中心
各种检查的必查中心
What is Emergency Medicine?
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10/10/2018
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What is Emergency Medicine?
急诊医学(非院前、突发公共卫生事件、灾害救援等)是研究和处理各类疾病急性发病阶段的病因、病理和抢救治疗的专业。在临床实践中往往要求急诊医生能够在最短的时间内,用最快的速度、判断明确病人的病情,稳定患者的生命体征,为后续专科治疗赢得宝贵时间。
急诊患者特点:病情急、脾气急、病情重、资料少、时间紧、风险大
A specialty devoted to initial evaluation, resuscitation & stabilization of patients presenting to the emergency department (ED)
EP’s render life saving treatment in an exciting, fast-paced environment
EP’s evaluate patients of all ages with a wide range of medical & surgical conditions – variety!
EP’s have the privilege of caring for patients of diverse socioeconomic, racial, and ethnic backgrounds – variety!
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This is Emergency Medicine!!
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内科
外科
妇科
儿科
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0时刻
急诊
0时刻=?
发病、急性加重、被发现的时刻
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Duties of the EP
The EP's primary duties:
Resuscitate & stabilize emergent patients
Ensure that all life-threatening causes of a patient's condition are considered. 
Admit pts to hospital for further evaluation if all life-threatening causes cannot be adequately ruled-out in the ED  
Arrange appropriate follow up for those d/c home
EP must be able to:
Quickly recognize the sick patient
Stabilize pts with limited or no information
Evaluate pts efficiently and expeditiously to reach a tentative diagnosis. 
“Must Haves”
Quick thinking
Decisive nature
Well rounded knowledge
Interest in the breadth of medicine
Excellent physical diagnostic skills, good manual dexterity
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降阶梯思维
“降阶梯式”思维是指在急诊临床作症状鉴别诊断时,从严重疾病到一般疾病,从迅速致命疾病到进展较慢疾病依次鉴别的思维方式。
“降阶梯”思维的目的是:第一,确保患者的生命安全。生命是第一位的,在接诊患者时,要抓住威胁患者生命的主要矛盾,分清轻重缓急。第二, “降阶梯”思维是一种科学的急诊思维方法,是提高医疗质量,减少误诊漏诊的重要基础。
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