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.
危重病護理環境指南介紹重症監護室及室內護理人員，病人與病人入院、監護和治療方式，及一些常用的生命支持設備等內容。指南還包括如何向ICU小組介紹病人和如何在心理上作好應對ICU可能遇到的職業道德問題的準備。指南還對危重病護理醫學中領導職位職業提升途徑進行了描述。
ICU TYPES ICU種類
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.
你今天所在的醫院與你主治醫生以前所說的那種環境已大不相同。病人住院時間縮短、病人要求提高、危重護理病房不斷增多。雖然健康護理系統在不斷變化，但醫院將始終需要有一個護理最嚴重的病人的區域―― 一個危重病護理中心。由於處於生命極端狀態的病人的增多，如早產兒、成人心血管疾病患者和重傷病人等，無論是按絕對數字還是按總人口比率計算，對這些病房的需求都在增長。發達國家的人口正在邁向90歲、100歲。這些人生病時常常需要採取入侵性措施，穩定其脆弱的生理平衡，使他們得以治癒。
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.
威脅生命的疾病的處理措施包括核心支持―重症護理和心肺監護―及以病人特定疾病爲重點的支持措施。儘管幾乎所有的ICU都能夠提供整套的護理，但很多ICU都有自己的強項：兒科 ICU(PICU)危重病及受傷兒童的護理；冠心病監護室的成人心臟病護理；外科ICU(SICU)的圍手術期護理、外傷護理和多種器官功能障礙的護理等；神經科ICU的神經和神經外科病人護理等等。很多教學醫院也有不同等級的危重病護理中心，如過渡監護治療病房和遠程治療病房等。需要病房外護理的病人可以從遠程治療的特殊監護和介入中受益。
The ICU Team ICU小組
The more things get busy, the more you will appreciate that each team member in the ICU has a specific role.
你越忙就越有體會：每個ICU成員都有他特殊的作用。
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小組長由醫生擔任。學生被指定到重症監護室實習。通常，ICU組長是一個重症專科醫生，他在危重病護理醫學方面受過高級培訓。在北美地區，專科醫生在擁有基本專業證書，如兒科、內科、外科或麻醉科等就可以去獲得另的危重病護理醫學資格證書。很多國家已將危重病護理醫學設爲一個獨立的專業。
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.
不管接受何種培訓，組長都會掌握危重病護理醫學的基本原理，也就是說，一個由醫生領導的多學科小組能夠爲危重病人提供最佳的護理。
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.
“多學科”一詞並不僅僅是指以會診 醫師或合作主治醫師身份加入ICU的其他醫生，它同時也指在ICU內並肩晝夜工作的其他衛生保健專業人員，其中以重症監護護士人數最多。他們當中有很多人在重症護理方面受過高級培訓，獲得過相應的證書，是公認的“重症監護註冊護士”。有些護士所受到的重視更大，被賦予的職任也更大。他們是急症開業護士和臨牀護理專家，他們是醫生的補充，參與制定計劃、寫醫囑和指導治療。醫生助理也提供ICU護理。
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.
呼吸治療師是多種肺病診斷和治療的 專家，除了使用機械呼吸機外，這些治療師常常獲取並分析動脈血氣，通過用力肺活量、負壓吸氣及其他參數測試病人的呼吸力。在一些醫院，呼吸治療師除了用“ 袋-面罩”裝置支持通氣外也施行氣管內插管。一個典型的ICU小組都有一個藥劑師，他幫助護士評估藥物性質，確定病人是否會誘發副作用或藥物相互作用。
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.
藥劑師根據測得的藥物濃度幫助計算藥物清除率，爲ICU使用的多種藥物計劃給藥方案。
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小組裏還有一位營養支持方面的專家，如一位在腸道和非腸道(靜脈內)營養支持方法及缺陷方面受過高級培訓的營養師等。ICU小組其他重要成員有社會醫療工作者，他爲病人提供連續的心理社會評估和支持；牧師代表，可以隨時招他爲病人、家屬和ICU成員提供精神幫助；以及一位病房祕書，處理一些行政性工作，如接待、聯繫及病案保管 等。此外，ICU成員通常包括其他很多在此學習的受訓實習人員，如會員、高級專科住院實習醫生、護生及營養學學生等。