急诊病人严重程度定义.docx

1、急诊病人严重程度定义附录 急诊医学临床实践指南急诊医学临床实践指南由美国急诊医学委员会(ABEM)、美国急诊医师学会(ACEP)、急诊医师训练指导委员会(CORD)、急诊医学住院医师协会(EMRA)、急诊医学住院医师评价委员会(RRC-EM)和急诊医学学院协会(SAEM)等6个学术组织联合编写，它以急诊医学临床实践为基础，经过多次修订而成。目前的版本是2001年修订稿。本指南详细列出了急诊患者常见的临床表现，并对各症状和体征等临床表现进行了严重程度分级，以使急诊医护人员在初次接触患者后就可以迅速作出正确的评估，并对随后进行的急救工作具有指导意义。文中用“”表示疾病严重性分属不同级别。急诊病人严

2、重程度定义Critical危急Emergent紧急Lower Acuity普通急诊红色标志严重威胁生命的疾病或者创伤，如果不及时进行干预，随时都有死亡可能。黄色标志病人有严重疾病或者创伤，如果不及时处理，随疾病的发展或者出现并发症可能有较高的死亡率。绿色标志疾病或者创伤向严重方面发展或者出现并发症的可能性较小。1.0 SIGNS, SYMPTOMS AND PRESENTATIONS体征、症状和表现Critical危急Emergent紧急Lower Acuity普通急诊1.1 General 一般症状Altered mental status精神状态改变Anxiety焦虑Apnea呼吸暂停,窒

3、息Ataxia共济失调Back pain背部疼痛Bleeding出血Coma昏迷Confusion精神错乱Crying/Fussiness 哭泣、易激怒Cyanosis发绀Decreased level of consciousness意识水平降低Dehydration脱水Dizziness眩晕;头晕Edema水肿Failure to thrive呼吸衰竭Fatigue疲乏, 疲劳Feeding problems喂养问题Fever发热Hypotension低血压Jaundice黄疸Joint pain/Swelling关节痛、肿胀Limp跛行Lymphadenopathy淋巴结病Malaise

4、不适, 抑郁Multiple trauma 多发伤Needle stick 针刺伤Pain 疼痛Paralysis麻痹Paresthesia/Dysthesia感觉异常、感觉障碍Poisoning中毒Pruritus瘙痒Rash皮疹Shock休克SIDS (See 3.1)Sleeping problems睡眠问题Syncope晕厥;昏厥Tremor震颤Weakness;虚弱;无力Weight loss体重减轻1.2 Abdominal 腹部Abnormal vaginal bleeding异常阴道出血Anuria无尿Ascites腹水Colic绞痛Constipation便秘Cramps痛性

5、痉挛Diarrhea腹泻Dysmenorrhea痛经Dysuria排尿困难Hematemesis呕血Hematochezia便血Hematuria血尿Nausea/Vomiting恶心;呕吐Pain疼痛Pelvic pain骨盆痛Peritonitis腹膜炎Rectal bleeding直肠出血Rectal pain直肠痛Urinary incontinence尿失禁Urinary retention尿潴留1.3 Chest 胸廓Chest pain胸痛Cough咳嗽Dyspnea呼吸困难Hemoptysis咯血Hiccough呃逆Palpitations心悸Shortness of brea

6、th呼吸急促Tachycardia心动过速Wheezing哮喘1.4 Head and Neck 头颈部Congestion充血;淤血Diplopia 复视Dysphagia吞咽困难Eye pain眼痛Headache (See 12.3)头痛Loss of hearing脱发Loss of vision视力丧失Rhinorrhea;鼻溢液Sore throat咽喉痛Stridor喘鸣Tinnitus耳鸣Vertigo眩晕2.0 ABDOMINAL AND GASTROINTESTINAL DISORDERS腹部与胃肠道疾病CriticalEmergentLower Acuity2.1 Abd

7、ominal Wall腹壁Hernias疝2.2 Esophagus食道Infectious disorders感染性疾病Candida (See 4.4, 7.5) 念珠菌属Inflammatory disorders炎性疾病炎症疾病Esophagitis食管炎Gastroesophageal reflu (GERD)胃食管反流Toxic effects of caustic (See 17.1) 毒性腐蚀Acid酸Alkali碱Motor abnormalities运动肌异常Spasms痉挛Structural disorders结构异常 Boerhaaves syndrome Boerh

8、aave综合征Diverticula 憩室Foreign body 异物Hernias疝Mallory-Weiss syndrome贲门粘膜裂伤综合征Stricture and stenosis 狭窄Tracheoesophageal fistula 气管食管瘘Varices静脉曲张Tumors肿瘤2.3 Liver肝脏Cirrhosis肝硬化Alcoholic酒精性Biliary obstructive胆道梗阻性Drug-induced 药物性Hepato-renal failure 肝肾衰竭Infectious disorders感染性疾病Abscess 脓肿Hepatitis 肝炎Acu

9、te急性Chronic慢性Tumors肿瘤2.4 Gall Bladder and Biliary Tract胆囊和胆道Cholangitis胆管炎Cholecystitis胆囊炎Cholelithiasis/Choledocholithiasis胆石症Tumors肿瘤2.5 Pancreas胰腺Pancreatitis胰腺炎Tumors肿瘤2.6 Peritoneum腹膜Spontaneous bacterial peritonitis自发性细菌性腹膜炎2.7 Stomach胃Infectious disorders感染性疾病Inflammatory disorders炎性疾病Gastrit

10、is胃炎Peptic ulcer disease消化性溃疡Hemorrhage出血Perforation穿孔Structural disorders结构异常Congenital hypertrophic pyloricStenosis先天性幽门肥大症Foreign body异物Tumors肿瘤2.8 Small Bowel小肠Infectious disorders感染性疾病Inflammatory disorders炎性疾病Regional enteritis/Crohns disease克隆氏病Motor abnormalities肌运动异常Obstruction梗阻Paralytic i

11、leus麻痹性肠梗阻Structural disorders结构异常结构异常Aortoenteric fistula主动脉肠瘘Congenital anomalies先天性畸形Intestinal malabsorption小肠吸收不良Meckels diverticulum麦克尔憩室Tumors肿瘤Vascular insufficiency血管功能不全2.9 Large Bowel大肠Infectious disorders感染性疾病Antibiotic associated抗生素相关性Bacterial细菌Parasitic寄生虫Viral病毒Inflammatory disorders

12、炎性疾病Acute appendicitis急性阑尾炎Necrotizing enterocolitis (NEC)坏死性肠炎Radiation colitis放射性结肠炎Ulcerative colitis溃疡性结肠炎Motor abnormalities肌运动异常Hirschsprungs disease Hirschsprung病Irritable bowel 肠易激惹症Obstruction梗阻Structural disorders结构异常Congenital anomalies先天性异常Diverticula憩室Intussusception肠套叠Volvulus肠扭转Tumors

13、肿瘤2.10 Rectum and AnusInfectious disorders感染性疾病Perianal/Anal abscess肛周脓肿Perirectal abscess直肠周脓肿Pilonidal cyst and abscess毛囊肿和脓肿Inflammatory disorders炎性疾病Proctitis直肠炎Structural disorders结构异常Anal fissure肛裂Anal fistula肛门瘘Congenital anomalies先天性畸形Foreign body异物Hemorrhoids痔Rectal prolapse直肠脱垂Tumors肿瘤3.0

14、CARDIOVASCULAR DISORDERS心血管疾病CriticalEmergentLower Acuity3.1 Cardiopulmonary Arrest心脏呼吸停止SIDS (See 1.1)3.2 Congenital Abnormalities of the Cardiovascular SystemDisorders due to anatomic anomalies解剖学异常Genetically transmitted disorders 普通转运异常3.3 Disorders of Circulation循环异常Arterial动脉Aneurysm动脉瘤Aortic

15、dissection主动脉夹层动脉瘤Thromboembolism血栓性Venous静脉Thromboembolism (See 16.6)静脉血栓形成3.4 Disturbances of Cardiac RhythmCardiac dysrhythmias心律失常Ventricular心室Supraventricular室上Conduction disorders传导障碍3.5 Diseases of the Myocardium, Acquired心肌疾病Cardiac failure心力衰竭Cor pulmonale肺源性心脏病High output高输出量Low output低输出量

16、Cardiomyopathy心肌病Hypertrophic肥大性Congestive heart failure先天性心脏病Coronary syndromes冠脉综合症Ischemic heart disease缺血性Myocardial infarction;心肌梗塞Myocarditis心肌炎Ventricular aneurysm心室壁瘤3.6 Diseases of the Pericardium心包疾病Pericardial tamponade (See 18.1) 心包填塞Pericarditis心包炎3.7 Endocarditis心内膜炎3.8 Hypertensive Em

17、ergencies高血压危相3.9 Tumors肿瘤3.10 Valvular Disorders 心脏瓣膜疾病4.0 CUTANEOUS DISORDERS 皮肤疾病CriticalEmergentLower Acuity4.1 Cancers of the Skin皮肤癌Basal cell基底细胞癌Kaposis sarcoma肉瘤Melanoma黑色素瘤Squamous cell鳞状细胞4.2 Decubitus Ulcer褥疮4.3 Dermatitis皮炎Atopic特发的Contact接触性Eczema湿疹Psoriasis银屑病、牛皮癣Sebaceous cyst皮脂腺囊肿Se

18、borrhea溢脂皮炎4.4 Infections感染Bacterial细菌性Abscess脓肿Cellulitis蜂窝织炎Erysipelas丹毒Impetigo脓疱病Necrotizing infection坏死感染Fungal真菌的Candida (See 2.2, 7.5) 念珠菌属Tinea癣Parasitic寄生虫性Pediculosis infestation虱病侵染Scabies疥疮Viral病毒Aphthous ulcers口疮性溃疡Erythema infectiosum传染性红斑Herpes simple (See 10.6, 13.1) 单纯疱疹Herpes zoste

19、r (See 10.6) 带状疱疹Human papillomavirus (HPV) (See 13.1) 人乳头状瘤病毒Molluscum contagiosum触染性软疣Warts疣4.5 Maculopapular Lesions斑丘疹的Erythema multiforme多形红斑Erythema nodosum结节性红斑Henoch-Schnlein purpura (HSP) 紫癜Pityriasis rosea玫瑰糠疹Purpura紫癜Urticaria荨麻疹4.6 Papular/Nodular Lesions丘疹、结节损害Hemangioma/Lymphangioma血管瘤

20、、巴管瘤Lipoma脂肪瘤4.7 Vesicular/Bullous LesionsPemphigus天疱疮Staphylococcal scalded skin syndrome葡萄球菌性鳞屑性皮肤综合征Stevens Johnson syndrome史蒂约翰生综合症Toxic epidermal necrolysis中毒性表皮融解坏死5.0 ENDOCRINE, METABOLIC, AND NUTRITIONAL DISORDERS内分泌、代谢和营养性疾病CriticalEmergentLower Acuity5.1 AcidBase Disturbances酸-碱紊乱Metabolic

21、 or respiratory代谢性/呼吸性Acidosis酸中毒Alkalosis碱中毒Mixed acid-base balance disorder混合型酸碱平衡紊乱5.2 Adrenal Disease肾上腺疾病Corticoadrenal insufficiency肾上腺皮质功能不全Cushings syndrome库欣综合征5.3 Fluid and Electrolyte Disturbances水电介质紊乱Calcium metabolism钙代谢Fluid overload/Volume depletion水过多与脱水Hyperkalemia/Hypokalemia高钾血症/低钠血症Hypernatremia/Hyponatremia高钠血症/低钠血症Magnesium metabolism镁代谢Phosphorus metabolism磷代谢5.4 Glucose Metabolism糖代谢Dia