Khi Mot Mau Sac Tro Thanh Mot Cam Ket
Trong y hoc cap cuu, ai cung biet bon mau kiem thuong:
- RED — Ngay lap tuc (de doa tinh mang, co the cuu duoc)
- YELLOW — Khan (nghiem trong, co the cho mot khoang ngan)
- GREEN — Nhe (tu di duoc, co the doi)
- BLACK — Ky vong tu vong (kha nang song sot thap voi nguon luc hien co)
Hau het cac he thong coi day la nhan — mo ta lam sang ve muc do nghiem trong. Trong thuc te, khi ban chi dinh mot mau sac, ban da dua ra mot chuoi quyet dinh phan bo nguon luc:
RED co nghia benh nhan vao khu hoi suc, chiem mot trong 10 giuong, nhay len dau hang doi phau thuat, va duoc uu tien cap phat thuoc.
GREEN co nghia benh nhan vao khu thuong nhe, chiem mot trong 50 cho ngoi, va cho.
BLACK co nghia khong phan bo nguon luc dieu tri. Quyet dinh kho khan nhat trong y hoc.
Kiem thuong khong phai phan loai. No la dau vao dau tien cua he thong phan bo nguon luc.
Tu Chien Truong Den Tiep Nhan: Doi Chieu Tu Dong
xGrid tiep nhan benh nhan tu hai nguon: yeu cau hau song MEDEVAC va dang ky truc tiep.
MEDEVAC su dung he thong uu tien rieng (Khan Cap Phau Thuat, Khan Cap, Uu Tien, Thuong Quy, Tien Lo'i). Nhung muc nay duoc doi chieu sang mau kiem thuong va uu tien hang doi trong mot buoc thong nhat:
| Uu Tien MEDEVAC | Mau Kiem Thuong | Uu Tien Hang Doi |
|---|---|---|
| Khan Cap Phau Thuat | RED | TOI CAP |
| Khan Cap | RED | TOI CAP |
| Uu Tien | YELLOW | KHAN |
| Thuong Quy | GREEN | THUONG QUY |
| Tien Lo'i | GREEN | THUONG QUY |
Mot yeu cau MEDEVAC tu dong tao ho so benh nhan hoan chinh: thong tin ca nhan, dang ky, dau hieu sinh ton, tom tat lam sang (dinh dang MIST), va muc nhat ky su kien. Dieu duong tiep nhan thay mot benh nhan moi trong hang doi, da duoc kiem thuong, co dau hieu sinh ton va tom tat lam sang. Khong can hoi lai.
Tai Sao xGrid Khong Trien Khai START
START (Simple Triage and Rapid Treatment) la mot thuat toan cay quyet dinh: Benh nhan co di duoc khong? Co tho khong? Nhip tho? Mach quay? Co the lam theo lenh khong? Cac cau tra loi tu dong chi dinh RED, YELLOW, GREEN, hoac BLACK.
xGrid co y khong dua vao. Ba ly do:
START duoc thiet ke cho nguoi khong chuyen y te. No ton tai de linh cuu hoa va tinh nguyen vien co the kiem thuong nhanh trong vai giay. Dieu duong khong can cay quyet dinh — phan doan lam sang cua ho chinh xac hon bat ky thuat toan nao.
Thuat toan tao su chac chan gia. Mot nhan GREEN do thuat toan chi dinh khien nguoi phia sau gia dinh "benh nhan nay on." Nhung dieu duong co the nhan thay dieu thuat toan khong the — mau da, muc do lo lang, boi canh co che chan thuong.
Ma sat ghi de la nguy hiem. Neu thuat toan noi GREEN nhung dieu duong nghi la YELLOW, co ay can them mot buoc de ghi de. Duoi ap luc, them mot buoc la them mot ly do de chap nhan mac dinh. Con duong it khang cu nhat nen la phan doan cua dieu duong, khong phai goi y cua thuat toan.
xGrid cung cap cac cong cu thu thap dau hieu sinh ton toan dien — huyet ap, mach, nhip tho, SpO2, GCS (voi tung thanh phan Mat, Loi noi, Van dong), diem dau, kich thuoc va phan ung dong tu. Dieu duong ghi nhan du lieu khach quan, sau do chi dinh mau dua tren danh gia lam sang cua co. He thong tin tuong con nguoi; du lieu cung cap bang chung.
15 Giay Danh Gia Co Cau Truc
Giao dien dieu duong duoc toi uu cho toc do duoi ap luc:
Nut mau lon — Bon mau, than thien voi cam ung, khong can thao tac chinh xac. Trong khung hoang, khong che van dong giam sut. Muc tieu lon giam loi.
Tinh GCS thoi gian thuc — Ba thanh truot cho Mat (1-4), Loi noi (1-5), Van dong (1-6). Tong diem cap nhat truc tiep. Dieu duong khong can nham tinh.
Lua chon dinh dang — MIST cho tiep nhan chien truong, ISBAR cho ban giao noi vien. Mot cham de chuyen doi.
Bang dau hieu sinh ton day du — Huyet ap tam thu/tam truong, mach, nhip tho, SpO2, nhiet do, kich thuoc dong tu, phan ung dong tu, diem dau. Tat ca tuy chon — co the chi gui mau trong dot thuong vong hang loat, va bo sung dau hieu sinh ton khi co them 30 giay.
15 giay tu mo bieu mau den gui. Nhieu hon 10 giay so voi bao cao mieng. Nhung tu thoi diem do tro di, danh gia co the duoc truy van, kiem toan, va luu tru vinh vien.
Tai Kiem Thuong Khong Gioi Han
Tinh trang benh nhan thay doi. Mot benh nhan GREEN xau di o khu cho. Mot benh nhan RED on dinh sau dieu tri ban dau. Kiem thuong phai theo doi dieu nay.
xGrid cho phep tai danh gia khong gioi han. Doi mau, ghi nhan ai doi va khi nao. Nhat ky su kien ghi lai toan bo quy dao:
| Thoi gian | Mau | Ly do |
|---|---|---|
| 08:30 | GREEN | Tu dong doi chieu tu MEDEVAC Thuong Quy |
| 09:15 | YELLOW | Dieu duong: HA giam xuong 90/60 |
| 10:02 | RED | Dieu duong: thay doi y thuc, GCS 12 |
Khong co quy trinh "nang cap" hoac "ha cap" dac biet. Chi can doi mau. He thong tu dong theo doi thay doi.
Cong Suat Khu Vuc: Noi Kiem Thuong Gap Vat Ly
Kiem thuong quyet dinh benh nhan vao khu vuc nao. Cac khu vuc co gioi han cong suat vat ly:
| Khu Vuc | Cong Suat | Muc Dich |
|---|---|---|
| Khu Kiem Thuong | 20 | Diem danh gia ban dau |
| Hoi Suc Cap Cuu | 10 | RED — dieu tri ngay lap tuc |
| Cham Soc Khan | 30 | YELLOW — dieu tri uu tien |
| Cham Soc Nhe | 50 | GREEN — dieu tri hoan lai |
| Quan Sat | 20 | Theo doi va cach ly |
Khi ban chuyen benh nhan den mot khu vuc, he thong kiem tra cong suat. Neu khu hoi suc dang 10 tren 10, ban khong the them benh nhan nua — ban phai chuyen mot benh nhan RED da on dinh sang khu quan sat truoc, giai phong mot giuong.
Day la ly do kiem thuong la phan bo nguon luc, khong phai phan loai. Chi dinh RED khong chi co nghia "nguoi nay nguy kich." No co nghia "toi can mot trong muoi giuong hoi suc." Khi cac giuong day, ban khong doi mat voi van de phan loai. Ban doi mat voi van de nguon luc.
Thong Luong Thuong Vong Hang Loat
Khi dot thuong vong tran den, he thong giu nhip:
Kiem thuong hang loat: Toi da 100 benh nhan moi dot. Cho viec phan loai nhanh ban dau — chi dinh mau truoc, dau hieu sinh ton chi tiet sau.
Dam bao chat luong: Gioi han 50 truong hop moi phut moi tram dam bao nguoi van hanh khong vuot qua tinh toan ven du lieu. He thong co the nhanh hon — gioi han ton tai de bao ve chat luong du lieu, khong phai nang luc xu ly.
Hang Doi Cho
Hang doi kiem thuong sap xep theo uu tien, sau do theo thoi gian den:
Benh nhan RED (TOI CAP) xuat hien truoc, theo thu tu den. Benh nhan YELLOW (KHAN) xuat hien thu hai. Benh nhan GREEN (THUONG QUY) xuat hien cuoi cung.
Moi muc hien thi thoi gian cho bang phut. Con so nay phuc vu muc dich lam sang: mot benh nhan GREEN da cho 90 phut co the can tai kiem thuong. Thoi gian cho la chi bao lam sang, khong chi la chi so hang doi.
Phan Bo Kiem Thuong Nhu Tin Hieu Nguon Luc
Phan bo kiem thuong tong the la chi bao truc tiep nhat ve nhu cau nguon luc:
- Ty le RED cao — can them nang luc phau thuat va giuong hoi suc
- Ty le YELLOW cao — can them thiet bi giam sat va nhan luc dieu duong
- Ty le GREEN cao — can them khong gian cho va kha nang thu thuat nhe
- BLACK xuat hien — can nhom ho tro tam ly
xGrid cung cap phan bo kiem thuong thoi gian thuc, giup chi huy truong dua ra quyet dinh nguon luc chien luoc: tap trung nhan su o dau, yeu cau loai tang vien nao, mo rong khu vuc nao.
Moi quyet dinh do deu bat nguon tu mot dieu duong nhan nut mau tren man hinh dien thoai. Nut do khong chi la mot nhan. No la quan co domino dau tien trong thac phan bo nguon luc.
Bai lien quan: ISBAR Khong Chi La Mot Dinh Dang Ban Giao · Ngoai Tuyen Truoc Khong Phai Giai Phap Du Phong