Common critical values and processing flow 1. Critical values are sent to the nurse workstation, and the nurse on duty is responsible for receiving and printing.
Second, the printed report sheet shall be affixed to the critical value registration report book, and signed, and the signing time (specific to minutes).
Third, promptly notify the billing doctor or the doctor on duty, and the doctor will sign the registration book and sign the receipt time (specific to minutes).
Four, the doctor after analysis and disposal, the tracking disposal results will be registered in the critical value report registration book.
Five, every month, the quality controller will register the critical value report for this model review and sign it.
Six, the registration signature is clear and the content is complete.
Clinical common critical value treatment scheme 1. Platelets:
Platelet below 30? 109/L: If the platelet count is lower than this value, spontaneous bleeding may occur. If the bleeding time is equal to or longer than 15 minutes, and/or bleeding has occurred, the treatment of increasing platelets should be given immediately, and at the same time, the cause of thrombocytopenia should be found out and the treatment should be carried out according to the cause. 1000? Thrombosis often occurs when 109/L is higher than this value. If this thrombocytosis is not transient, antiplatelet drugs should be given and the primary disease leading to thrombocytosis should be treated.
2.PT extension:
Common causes: a) congenital deficiency of coagulation factors, such as prothrombin (factor Ⅱ), factor ⅴ, factor ⅶ, factor ⅹ and fibrinogen, b) acquired deficiency of coagulation factors, such as secondary/primary fibrinolysis, severe liver disease, etc. C) Using heparin, there are antibodies against prothrombin, factor V, factor VII, factor X and fibrinogen in the blood circulation, which can prolong the prothrombin time.
3.APTT time extension:
Congenital factor Ⅷ, Ⅷ and Ⅷ deficiency, such as hemophilia A, hemophilia B and factor Ⅷ deficiency; Acquired coagulation factor deficiency, such as liver disease, obstructive jaundice, neonatal hemorrhage, intestinal sterilization syndrome, malabsorption syndrome, use of aspirin, heparin and other drugs; Secondary, primary fibrinolysis, DIC; There are anticoagulant substances in blood circulation, such as anti-factor VIII antibody and lupus anticoagulant substances.
Prolonged treatment of PT and APTT: Symptomatic treatment should be carried out according to the etiology, the primary disease should be actively treated, and corresponding coagulation factors, frozen plasma, platelets, etc. can be transfused when necessary.
4. Blood sugar:
(1) blood sugar is less than 2.2mmol/L;
1, early hypoglycemia only has symptoms such as sweating, palpitation, fatigue, hunger, etc. When you are conscious, you can give patients sugar water or eat cookies or snacks with more sugar.
2. If the patient's consciousness has changed, 40-60ml of 50% glucose should be injected intravenously. In more serious cases, 10% glucose can be used for continuous intravenous drip.
3. Glucagon can be used by intramuscular injection of glucagon 1mg, but the price of glucagon is higher.
It should be noted that patients treated with Baitangping should be treated with glucose orally or intravenously if hypoglycemia occurs.
(2) Blood sugar greater than 22.2 mmol/L: fluid replacement? Salt before sugar, fast before slow.
1. Total amount: estimated by 10% of body weight (kg), it is generally 4 ~ 6L for adults. 2. Fluid replacement and insulin? Two venous passages:
A. Fluid replacement: the first 4 hours: input1/3 ~1/2 of the total water loss; Before 12h: 2/3 of the total input; The rest will be replenished within 24 ~ 28h. B insulin: NS 500ml+ insulin 20u is intravenously dropped at a speed of 4-6u/h, that is, 30-50 drops /min.
Check blood sugar and urine ketone body every hour,
If the rate of blood sugar decline is <: 1.2mmol/h, the dosage of insulin was doubled; If the rate of blood sugar decline >; 6. 1mmol /h, but insulin dosage decreased 1/3.
A. when the blood sugar drops to 13.9mmol/L, 5% GS 500ml+ insulin 12u is infused intravenously at a speed of 4-6u/h, that is, 50-80 drops /min; (calculated by 1ml water =20 drops) B. When the blood sugar drops to 1 1.2mmol/L, 5% GS 500ml+ insulin 8u is infused intravenously at the above speed;
C. when it drops to about 8.4mmol/L, 5% GS 500ml+ insulin 6u is infused intravenously at the above speed.
5. Blood potassium:
(1) blood potassium is less than 2.5mmol/L;
1. Actively deal with the causes of hypokalemia. 2. Take the method of supplementing potassium by stages and observing while treating. If the patient is in shock, crystalloid fluid and colloid fluid should be given first to restore his blood volume as soon as possible, and then potassium should be added intravenously when the urine volume returns to 40 ml/h.
(2) Blood potassium is higher than 6.2 mmol/L: Hyperkalemia may lead to cardiac arrest, so it has been diagnosed and should be actively treated. First stop using all drugs or solutions containing potassium. In order to reduce the blood potassium concentration, the following measures can be taken:
Transfer potassium ions into cells: 1. Infusion of sodium bicarbonate solution: intravenous injection of 5% sodium bicarbonate solution 60? 100ml, and then intravenous drip of sodium bicarbonate solution 100? 200ml; 2. Input glucose solution and insulin: 25% glucose solution 100? 200ml, add regular insulin 1U to every 5g of sugar, and drip intravenously; 3. For patients with renal insufficiency who can't be transfused too much, 10% calcium gluconate 100ml,1.2% sodium lactate solution 50ml, 25% glucose solution 400ml, and insulin 20U can be added for 24 hours.
Application of cation exchange resin: oral, each time 15g, 4g daily.
Dialysis therapy: there are two kinds of peritoneal dialysis and hemodialysis. When the blood potassium concentration cannot be reduced after the above treatment.
6. Blood calcium:
Blood calcium is less than 1.5mmol/L: First, the primary disease leading to hypocalcemia should be corrected; In order to relieve the symptoms, 10% calcium gluconate 10-20ml or 5% calcium chloride 10ml can be injected intravenously, and 8? /kloc-repeat the injection after 0/2 hours.
Blood calcium is greater than 3.5mmol/L: First of all, we should deal with the primary diseases that lead to hypercalcemia, such as hyperparathyroidism and bone metastasis cancer, and stop taking drugs immediately for hypercalcemia caused by excessive vitamin D intake. Measures to deal with hypercalcemia:
1. Volume expansion: Injection of physiological saline 1000~2000ml can increase urinary calcium excretion and temporarily decrease blood calcium; However, people with cardiovascular diseases should pay attention to excessive capacity load.
2. loop diuretic: furosemide 20~40mg, injected every 2~3 hours, can quickly block sodium reabsorption and lead to increased calcium excretion; However, water should be replenished in time, otherwise the blood volume will be insufficient, which will induce calcium to reabsorb in the proximal renal tubule.
3. Glucocorticoid: It can be taken orally with prednisone 10~30mg/d, which is especially effective for patients with granulomatous diseases and myeloma.
4. cytotoxic drugs, such as guangmycin: this drug can inhibit the synthesis of mRNA in bone cells, thus blocking bone resorption. Put 25mg/kg in 500ml of 5% glucose water and inject it intravenously for 3 hours. After injection, the blood calcium can drop within 12 hours, and then repeat every 3~7 days. Attention should be paid to the toxic reaction between liver and hematopoietic system during injection.
5. Calcitonin (salmon calcitonin or eel calcitonin): Generally, 4u/kg or 50U is injected subcutaneously or intramuscularly, every 1 2h1time, which has a good effect on those caused by tumor lesions, and a skin test should be made before injection.
6. Hemodialysis: When low-calcium dialysate is used for dialysis, the blood calcium level can be reduced 2-3 hours after dialysis, but then it may gradually return to the pre-dialysis level. This method is especially suitable for patients with renal insufficiency.
7. Calcium-sensitive receptor agonist (Sinacase): It is suitable for all kinds of hypercalcemia, primary and secondary hyperparathyroidism, which can not only reduce PTH, but also increase urinary calcium excretion and reduce blood calcium level.
8. Parathyroid resection: it is suitable for primary and secondary hyperparathyroidism that is difficult to control.
7. Blood sodium:
(1) Blood sodium is less than 1 10mmol/L: People with severe hyponatremia shock should first have insufficient blood volume to improve microcirculation and perfusion of tissues and organs, and crystal solution (compound sodium lactate solution and isotonic saline) and colloidal solution (hydroxyethyl starch, dextran and plasma) should be used. The amount of crystal liquid is 2-3 times larger than that of colloid liquid. Then 200-300ml hypertonic saline (usually 5% sodium chloride solution) can be intravenously instilled to correct hyponatremia as soon as possible. However, the dripping speed should be strictly controlled when infusing hypertonic saline, and should not exceed 100- 150ml per hour.
(2) Blood sodium is greater than 160mmol/L: First, it is important to treat the cause of hypernatremia. For patients who can't take it orally, 5% glucose solution or hypotonic 0.45% sodium chloride solution can be given intravenously to replenish the lost liquid. The required fluid replacement can first estimate the percentage of lost water to body weight according to clinical manifestations. Then, 400-500ml of fluid replacement is calculated according to 1% of body weight lost. Generally, the calculated fluid supplement is divided into two days. After one day of treatment, the whole body condition and blood sodium concentration should be tested, and the next day's supply can be adjusted as necessary.
8. Positive bacterial culture:
Sensitive antibiotics should be selected according to the results of culture and drug sensitivity test.
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