应急预案+流程图.docx

应急预案+流程图.docx

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应急预案+流程图

应急预案流程图第三军医大学新桥医院

血液净化中心应急预案

1.低血压...............................................................................................................................................22.肌肉痉挛............................................................................................................................................

33.恶心呕吐............................................................................................................................................

44.头痛...................................................................................................................................................55.失衡综合症........................................................................................................................................66.空气栓塞............................................................................................................................................

透析器反7.

应........................................................................................................................................87

8.透析器破膜........................................................................................................................................99.体外循环凝血....................................................................................................................................1010.火灾..............................................................................................................................................1111.意外停水.........................................................................................................................................12

12.意外停电.........................................................................................................................................13

13.地震................................................................................................................................................14

forcomputersoftwareengineeringGB/T50314-2000ofelectrical

installationscodeforconstructionandacceptanceofGBJ232-92

intelligentbuildingweakdesignconstructionfiguresetGJBT-4712.

systemdescriptionthistimesengineeringweakdesignincluding:

hoursa

Kokinformationfacilitiessystemintegratedwiringsystem（containing

roomnetwork,communicationspart）wiredTVsysteminformationguideand

thereleasedsystemhoursIIKokpublicsecuritysystemfire

automaticallyalarmsystem（containingpublicbroadcastpart）security

technologypreventionsystemsecuritymonitoringsystemoutentrance

controlsystemcarlibrarymanagementsystemhoursthreeKokbuilding

equipmentmonitoringsystemhoursfourKokinformationapplication

systemqueuedstationICUvisitationsystemoperationthesystem

monitoringandtrainingsystemcallintercomsystemhours,fivehours

KokKokintelligentintegratedsystemofinformationsystem

（1）cabling

systems（includingcomputerroomnetwork,communicationcomponent）

computernetworksystemsandvoicecommunicationssystemsCenterof

informationonmedicalfloorcomputerroomlocatedintheengineroom.

Voicecommunicationsystemusingalocaltelecommunicationsoperator

providingvoiceservice,configuration-independentintegratedservices

digitalprogram-controlledswitchboards.Operatorsproviding

communications...Ifanycompatibilityrequirements,bywayof

increasedaccesstotheCommunicationsBoardwithinthechassistomeet

1.低血压

透析中低血压

采取头低脚高位立即采取措施

停止超滤减慢血流速度

补充生理盐水100ml报告医生

查看病人，分析原因，对症处理．

好转无好转

密切观察血压，逐

步恢复超滤

继续补充生理盐准确记录病情水扩容，根据情况

使用升压药

必要时停止透析

下次转换透析模

式:

序贯超滤，CRRT等

透析中常见低血压原因分析:

（1）容量相关性因素:

包括超滤速度过快（0.35ml?

Kg-1?

min-1）、设定的干体重过低、透

析机超滤故障或透析液钠浓度偏低等。

（2）血管收缩功能障碍:

包括透析液温度较高、透前应用降压药物、透析中进食、中重度贫

血、自主神经功能障碍（如糖尿病神经病变患者）及采用醋酸盐透析者。

（3）心脏因素:

如心脏舒张功能障碍、心律失常（如房颤）、心脏缺血、心包填塞、心肌梗

死等。

（4）其它少见原因:

如出血、溶血、空气栓塞、透析器反应、脓毒血症等。

forcomputersoftwareengineeringGB/T50314-2000ofelectrical

installationscodeforconstructionandacceptanceofGBJ232-92

intelligentbuildingweakdesignconstructionfiguresetGJBT-4712.

systemdescriptionthistimesengineeringweakdesignincluding:

hoursa

Kokinformationfacilitiessystemintegratedwiringsystem（containing

roomnetwork,communicationspart）wiredTVsysteminformationguideand

thereleasedsystemhoursIIKokpublicsecuritysystemfire

automaticallyalarmsystem（containingpublicbroadcastpart）security

technologypreventionsystemsecuritymonitoringsystemoutentrance

controlsystemcarlibrarymanagementsystemhoursthreeKokbuilding

equipmentmonitoringsystemhoursfourKokinformationapplication

systemqueuedstationICUvisitationsystemoperationthesystem

monitoringandtrainingsystemcallintercomsystemhours,fivehours

KokKokintelligentintegratedsystemofinformationsystem

（1）cabling

systems（includingcomputerroomnetwork,communicationcomponent）

computernetworksystemsandvoicecommunicationssystemsCenterof

informationonmedicalfloorcomputerroomlocatedintheengineroom.

Voicecommunicationsystemusingalocaltelecommunicationsoperator

providingvoiceservice,configuration-independentintegratedservices

digitalprogram-controlledswitchboards.Operatorsproviding

communications...Ifanycompatibilityrequirements,bywayof

increasedaccesstotheCommunicationsBoardwithinthechassistomeet

2.肌肉痉挛

透析器反应报告上级医师准确记录病情

肌肉痉挛

A型透析器反应B型透析器反应

透析开始后5分钟内发生透析开始后20,60min出现

监测血压发生

立即采取措施

外力挤压痉挛肌肉立即停止血泵，夹闭血路报告医生吸氧，心电监护报告医生

管，丢弃管路和透析器中

血液，予吸氧，心电监护查看病人，分析原因，对症处理报告医生予抗组胺、激素或肾上腺素药物治疗必要时心肺支持治疗

超滤过多过快低钙血症

补充10%葡萄糖酸钙快速输注生理盐水，采用高钠透析，或设置超滤曲线

准确记录病情

采取预防措施:

病人体重增长不超过干体重的5,

透析中肌肉痉挛原因分析透析中低血压、低血容量、超滤速度过快及应用低钠透析液治疗等导致肌肉血流灌注降低是引起透析中肌肉痉挛最常见的原因;血电解质紊乱和酸碱失衡也可引起肌肉痉挛，如低镁血症、低钙血症、低钾血症等。

3forcomputersoftwareengineeringGB/T50314-2000ofelectrical

installationscodeforconstructionandacceptanceofGBJ232-92

intelligentbuildingweakdesignconstructionfiguresetGJBT-4712.

systemdescriptionthistimesengineeringweakdesignincluding:

hoursa

Kokinformationfacilitiessystemintegratedwiringsystem（containing

roomnetwork,communicationspart）wiredTVsysteminformationguideand

thereleasedsystemhoursIIKokpublicsecuritysystemfire

automaticallyalarmsystem（containingpublicbroadcastpart）security

technologypreventionsystemsecuritymonitoringsystemoutentrance

controlsystemcarlibrarymanagementsystemhoursthreeKokbuilding

equipmentmonitoringsystemhoursfourKokinformationapplication

systemqueuedstationICUvisitationsystemoperationthesystem

monitoringandtrainingsystemcallintercomsystemhours,fivehours

KokKokintelligentintegratedsystemofinformationsystem

（1）cabling

systems（includingcomputerroomnetwork,communicationcomponent）

computernetworksystemsandvoicecommunicationssystemsCenterof

informationonmedicalfloorcomputerroomlocatedintheengineroom.

Voicecommunicationsystemusingalocaltelecommunicationsoperator

providingvoiceservice,configuration-independentintegratedservices

digitalprogram-controlledswitchboards.Operatorsproviding

communications...Ifanycompatibilityrequirements,bywayof

increasedaccesstotheCommunicationsBoardwithinthechassistomeet

3.恶心呕吐

恶心呕吐

头偏向一侧防误吸

保护穿刺侧肢体，防止针滑脱，A-V管受压

清除口腔分泌物，床旁备吸引器及相关物品立即采取措施

监测血压

查看病人，分析原因，对症处理报告医生

失衡综合征按失衡低血压者按低血高血压脑病或脑综合征处理压处理血管意外结束透

析治疗抢救

准确记录病情

透析中恶心呕吐原因分析:

常见原因有透析低血压、透析失衡综合征、透析器反应、糖尿病导致的胃轻瘫、透析液受污染或电解质成份异常（如高钠、高钙）、高血压导致高血压脑病或脑血管意外等。

．

forcomputersoftwareengineeringGB/T50314-2000ofelectrical

installationscodeforconstructionandacceptanceofGBJ232-92

intelligentbuildingweakdesignconstructionfiguresetGJBT-4712.

systemdescriptionthistimesengineeringweakdesignincluding:

hoursa

Kokinformationfacilitiessystemintegratedwiringsystem（containing

roomnetwork,communicationspart）wiredTVsysteminformationguideand

thereleasedsystemhoursIIKokpublicsecuritysystemfire

automaticallyalarmsystem（containingpublicbroadcastpart）security

technologypreventionsystemsecuritymonitoringsystemoutentrance

controlsystemcarlibrarymanagementsystemhoursthreeKokbuilding

equipmentmonitoringsystemhoursfourKokinformationapplication

systemqueuedstationICUvisitationsystemoperationthesystem

monitoringandtrainingsystemcallintercomsystemhours,fivehours

KokKokintelligentintegratedsystemofinformationsystem

（1）cabling

systems（includingcomputerroomnetwork,communicationcomponent）

computernetworksystemsandvoicecommunicationssystemsCenterof

informationonmedicalfloorcomputerroomlocatedintheengineroom.

Voicecommunicationsystemusingalocaltelecommunicationsoperator

providingvoiceservice,configuration-independentintegratedservices

digitalprogram-controlledswitchboards.Operatorsproviding

communications...Ifanycompatibilityrequirements,bywayof

increasedaccesstotheCommunicationsBoardwithinthechassistomeet

4.头痛

透析中头痛

监测血压

立即采取措施

降低血流量

查看病人，分析原因，对症处理报告医生

失衡综合征按失衡高血压者按高血

综合征处理压处理

准确记录病情

透析中常见原因

透析失衡综合征、严重高血压和脑血管意外等。

对于长期饮用咖啡者，

由于透析中咖啡血浓度降低，也可出现头痛表现。

5forcomputersoftwareengineeringGB/T50314-2000ofelectrical

installationscodeforconstructionandacceptanceofGBJ232-92

intelligentbuildingweakdesignconstructionfiguresetGJBT-4712.

systemdescriptionthistimesengineeringweakdesignincluding:

hoursa

Kokinformationfacilitiessystemintegratedwiringsystem（containing

roomnetwork,communicationspart）wiredTVsysteminformationguideand

thereleasedsystemhoursIIKokpublicsecuritysystemfire

automaticallyalarmsystem（