救護車實習 practice of ambulance care
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救護車實習 Practice of Ambulance Care. 台大醫院 急診醫學部 江文莒 醫師. EMS ? 由誰執行 ? 如何運作 ?. Fire-based EMS 示意圖 Two Tiered BLS / ALS. Fire ALS. Hospital ALS. 119. Fire BLS. Fire ALS. Fire BLS. EMS 系統架構. 初級救護 傷患評估 心肺復甦 給氧 止血 包紮 固定 電擊. 高級救護 電擊 氣管插管 靜脈給藥. (89 年 2 月 ). - PowerPoint PPT PresentationTRANSCRIPT
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救護車實習救護車實習Practice of Ambulance CarePractice of Ambulance Care
台大醫院 急診醫學部江文莒 醫師
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EMS ?EMS ?由誰執行由誰執行 ??如何運作如何運作 ??
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119
Fire ALS
Fire ALS
Fire BLS
Fire BLS
Fire-based EMS 示意圖Two Tiered BLS / ALS
Hospital
ALS
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EMS 系統架構初級救護傷患評估心肺復甦給氧止血包紮固定電擊
•高級救護• 電擊• 氣管插管• 靜脈給藥
(89 年 2月 )
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急診醫師在 EMS 的角色醫療指導 Medical Direction
•協助規畫•教育訓練•醫療背書•品質監控
救護派遣
現場與到院前救護 急診重症醫療
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EMS 的兩種運作模式非創傷非創傷 : : STAY and PLAYSTAY and PLAY
‘就地醫療’先穩定再運送「生命之鏈」四個環節都可以在現場進行如果現場高級救護無法恢復循環,即使送到醫院幫忙也有限
創傷模式 創傷模式 LOAD and GLOAD and GOO
‘打帶跑’儘速送醫在現場僅從事呼吸道與頸椎固定等最必要措施黃金時間內到最近創傷中心接收最適切治療
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重大創傷指標 ( 台北市版本 )意識不清 (GCS<14 or P / AVPU)呼吸大於 29 下或小於 10 下收縮壓小於 90mmHg 或摸不到橈動脈多於兩處近端長骨骨折肢體癱瘓手脕或足踝以上截肢性外傷頭 頸 軀幹的穿透傷二度燒燙傷大於 15%高處墜落高能量撞擊證據病患本身因素
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Medical & Non-medical Problems on Scene
119 EMT
Base HospitalEMS Communication Center
• 線上醫療指導 與 協勤護理師
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何時需要線上醫療指導
重症病患主訴不明或不易判斷 現場宣佈死亡病患拒絕醫療醫療法律問題後送單位選擇 大量傷患分配 (Now: EOC)
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線上醫療指導的人員基地醫院
急診醫學專科醫師資深住院醫師專科護理人員
119 救護派遣中心專科護理師
雙軌救護制的現場醫師
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Case Discussion-1Case Discussion-1
35 歲男性騎機車遭酒醉汽車駕駛從後追撞,汽車駕駛為閃躲而撞上路旁柵欄。開車者被壓在駕駛座上,意識半昏迷。機車騎士則跌倒在地不動、不時發出呻吟聲;路人趕緊報案…你們是首先到現場的兩位 EMT ,有什麼要作的 ? 處置時要注意什麼事 ?
EMT 該如何向醫院回報 ? 接受通報的醫師還想問什麼事 ?
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Case Discussion-2Case Discussion-2
現場人潮眾多,突然有一名自稱為醫生的人大聲表示『不要再浪費時間了 !!』,並向旁觀民眾嗆聲說『這些人在現場處理只會延誤就醫 !! 直接上車送去最近的醫院就好了…』
EMT 同仁請求線上醫療指導。請問你 ( 妳 ) 該如何處理 ?
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線上醫療指導無線電固定台 ( 台大急診重症區 )
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Case Discussion-3Case Discussion-3
你們是兩位急診室的值班 R ,該不該把 VS 叫醒 ?
五分鐘後… 病人現在已經送到急診門口,卻發現意識不清、血壓很低。你們要如何評估病人 ?
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Trauma: Primary Survey
For immediately lethal injuries to treat
Airway (Obstruction and unsteady C-spine!)
Breathing (Artificial Airway and Tension PNEX)
Circulation and (Hemorrhage control and Cardiac tamponade)
Disability (GCS and Pupil)
Exposure and Environmental control
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Trauma: Secondary Survey
For all injuries to set further prioritiesTrauma series X-ray: C-spine, CXR, Pelvis.Head-to-toe examinationNG / OG / Foley /Pregnancy testLogroll to exam the backTetanus prophylaxis and Other medicationFAST or DPL ……What does it mean?
Decision of further exams: eg. Brain CT.Decision of intervention priorities
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