Emergency ABCDE

The ABCDE approach

ABCDE流程化急诊处置步骤

Underlying principles

基本原则

The approach to all deteriorating or critically ill patients is the same. The underlying principles are:

适用于所有进行性恶化或危重患者。

Use the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach to assess and treat the patient.

Do a complete initial assessment and re-assess regularly.

按照气道，呼吸，循环，意识障碍，充分暴露患者，即ABCDE流程评估及治疗病人。予充分的初始评估及反复的再评估，，，，，反复反复再反复，发现问题，，，发现问题，，，解决问题，，，，

Treat life-threatening problems before moving to the next part of assessment.

在上述评估流程中，最优先处理危及生命的紧急状态，再进行下一步评估。

Assess the effects of treatment.

评估紧急处理后的治疗效果，有效，无效，无效的原因？

Recognise when you will need extra help. Call for appropriate help early.

充分认识到急诊状态下个人能力的局限性，你是一个团队，，团队，及时呼叫其它医师的帮助，呼叫，呼叫，越早越好。

Use all members of the team. This enables interventions (e.g. assessment, attaching monitors, intravenous access), to be undertaken simultaneously.

充分调动你的团队成员。如 接好心电监护仪，建议静脉通道，外周静脉，骨髓通路，各人员同时进行，同时进行。。。。

Communicate effectively - use the Situation, Background, Assessment, Recommendation (SBAR) or Reason, Story, Vital signs, Plan (RSVP) approach.

随时保持充分有效沟通。即团队智慧。

The aim of the initial treatment is to keep the patient alive, and achieve some clinical improvement. This will buy time for further treatment and making a diagnosis.

初始复苏目标是让病人活着，，活着，，，，，同时改善临床恶化状态。对下一步的病因的诊断及治疗可以暂缓。

Remember – it can take a few minutes for treatments to work, so wait a short while before reassessing the patient after an intervention.

初始用药或其它治疗起效需要数分钟，二次评估时需等待数分钟再评估。

First steps

第一步

Ensure personal safety. Wear apron and gloves as appropriate.

确保医护人员自身安全，带好手套及防护衣。

First look at the patient in general to see if the patient appears unwell.

对患者整体情况视诊，患者是否处于非常不适状态。

If the patient is awake, ask “How are you?”. If the patient appears unconscious or has collapsed, shake him and ask “Are you alright?” If he responds normally he has a patent airway, is breathing and has brain perfusion. If he speaks only in short sentences, he may have breathing problems. Failure of the patient to respond is a clear marker of critical illness.

如患者神志清楚，向患者询问，你哪里不舒服。如果患者意识丧失，摇晃他并大声呼喊 你怎么了，你怎么了。如果患者能清醒的回答，提示患者 气道OK，呼吸OK ,,脑灌注OK。如果患者只能说出简短的语句，可能提示 存在呼吸问题。患者对外界刺激无任何反应， 危险信号，，，，患者随时可能死亡。

This first rapid ‘Look, Listen and Feel” of the patient should take about 30 s and will often indicate a patient is critically ill and there is a need for urgent help. Ask a colleague to ensure appropriate help is coming.

看，，听，，对患者的第一印象评估通常需要30s,,,,,很短哦，如果患者处于危重状态，紧急呼叫同事给予帮助。

If the patient is unconscious, unresponsive, and is not breathing normally (occasional gasps are not normal) start CPR according to the resuscitation guidelines. If you are confident and trained to do so, feel for a pulse to determine if the patient has a respiratory arrest. If there are any doubts about the presence of a pulse start CPR.

如果患者无意识，对外界刺激无反应，呼吸不正常，频率、节律，深度，，，，，触摸患者脉搏，如无呼吸脉搏，立即进行心肺复苏。

Monitor the vital signs early. Attach a pulse oximeter, ECG monitor and a non-invasive blood pressure monitor to all critically ill patients, as soon as possible.

及早对生命体征进行监测，快速接好指末氧，心电监护，无创血压监测

Insert an intravenous cannula as soon as possible. Take bloods for investigation when inserting the intravenous cannula.

尽快建立静脉通路，同时抽取血标本进行相关检查。

Airway (A)

气道，，，气道，，，气道，，，气道，，，气道，，，气道，，，气道，，，气道，，，气道，，，气道就是生命

Airway obstruction is an emergency. Get expert help immediately. Untreated, airway obstruction causes hypoxia and risks damage to the brain, kidneys and heart, cardiac arrest, and death. 

气道阻塞非常紧急，，，非常紧急，，，，，，，需要专业的处理，如未及时处置，气道阻塞将致低氧血症，，，，继发脑损伤，肾、心脏损害，，心脏停止，，，死亡，，，

Look for the signs of airway obstruction:

发现气道阻塞的临床体征

Airway obstruction causes paradoxical chest and abdominal movements (‘see-saw’ respirations) and the use of the accessory muscles of respiration. Central cyanosis is a late sign of airway obstruction. In complete airway obstruction, there are no breath sounds at the mouth or nose. In partial obstruction, air entry is diminished and often noisy.

气道阻塞表现为胸腹矛盾运动，，，，，动用呼吸辅助肌肉，，，，全身紫绀为气道阻塞的较晚体征。气道完全梗阻嘴巴及鼻子没有呼吸音，，，，部分梗阻，，，呼吸音减弱并通常有明显的吸气性喘鸣。。。。。

In the critically ill patient, depressed consciousness often leads to airway obstruction.

危重患者，，，，，，意识障碍后 舌后坠及气道大量分泌物继发气道梗阻。。。

Treat airway obstruction as a medical emergency:

气道梗阻是一种非常紧急状态

In most cases, only simple methods of airway clearance are required (e.g. airway opening manoeuvres, airways suction, insertion of an oropharyngeal or nasopharyngeal airway). Tracheal intubation may be required when these fail.

大多数情况下，通过一些简单的手段即能重新开放气道，如压颌举颏缓解舌后坠，，吸除气道分泌物，建立口咽、或鼻咽人工气道，如口咽通气管，喉罩。上述措施失败后，气管插管是必须的。

Give oxygen at high concentration:

高浓度给氧

Provide high-concentration oxygen using a mask with oxygen reservoir. Ensure that the oxygen flow is sufficient (usually 15 L min-1) to prevent collapse of the reservoir during inspiration. If the patient’s trachea is intubated, give high concentration oxygen with a self-inflating bag.

带氧气储气囊的面罩高浓度给氧。氧流量15L/min，吸气时储气囊无塌陷

In acute respiratory failure, aim to maintain an oxygen saturation of 94–98%. In patients at risk of hypercapnic respiratory failure (see below) aim for an oxygen saturation of 88–92%.

急性呼衰，保持指末氧94–98%，II型呼衰，保持指末氧 88–92%.

Breathing (B)

呼吸，，，，呼吸

During the immediate assessment of breathing, it is vital to diagnose and treat immediately life-threatening conditions (e.g. acute severe asthma, pulmonary oedema, tension pneumo thorax, and massive haemothorax).

在评估患者呼吸状态下，诊断同时紧急处置危及生命的急症，如重症哮喘，肺水肿，张力性气胸，大量血气胸。

Look, listen and feel for the general signs of respiratory distress: sweating, central cyanosis, use of the accessory muscles of respiration, and abdominal breathing.

Count the respiratory rate. The normal rate is 12–20 breaths min-1. A high (> 25 min-1) or increasing respiratory rate is a marker of illness and a warning that the patient may deteriorate suddenly.

看、听，感应呼吸窘迫的体征，如 出汗，，中央性紫绀，动用呼吸辅助肌肉，腹式呼吸。

计数呼吸频率，正常为12-20次/分，大于25次，或呼吸频率越来越快提示患者病情随时恶化加重。

Assess the depth of each breath, the pattern (rhythm) of respiration and whether chest expansion is equal on both sides.

评估呼吸深度，呼吸节律，双侧呼吸是否对等。

Note any chest deformity (this may increase the risk of deterioration in the ability to breathe normally); look for a raised jugular venous pulse (JVP) (e.g. in acute severe asthma or a tension pneumothorax); note the presence and patency of any chest drains; remember that abdominal distension may limit diaphragmatic movement, thereby worsening respiratory distress.

评估胸廓完整性，，，颈外静脉是否充盈始终，如重症哮喘，张力性气胸。胸部是否有引流管，腹胀限制膈肌运动，加重呼吸窘迫。

Record the inspired oxygen concentration (%) and the SpO2reading of the pulse oximeter. The pulse oximeter does not detect hypercapnia. If the patient is receiving supplemental oxygen, the SpO2 may be normal in the presence of a very high PaCO2.

记录吸入氧浓度，指末氧读数，指末氧无法反应高碳酸血症，给氧后氧正常，但二氧化碳分压可以 非常高。

Listen to the patient’s breath sounds a short distance from his face: rattling airway noises indicate the presence of airway secretions, usually caused by the inability of the patient to cough sufficiently or to take a deep breath. Stridor or wheeze suggests partial, but significant, airway obstruction.

凑近患者脸部仔细听，，，，，气道卡嗒音提示  分泌物多，提示患者自主咳嗽能力差，无法进行深呼吸，喘鸣或喘息提示部分，，，，或完全气道梗阻。。。。

Percuss the chest: hyper-resonance may suggest a pneumothorax; dullness usually indicates consolidation or pleural fluid.

胸部叩诊，鼓音提示气胸，实音提示实变或胸水。

Auscultate the chest: bronchial breathing indicates lung consolidation with patent airways; absent or reduced sounds suggest a pneumothorax or pleural fluid or lung consolidation caused by complete obstruction.

胸部听诊，支气管呼吸音提示 肺实变但气道通畅，，，，呼吸音减弱或消失提示气胸或胸水，，或肺不张。

Check the position of the trachea in the suprasternal notch: deviation to one side indicates mediastinal shift (e.g. pneumothorax, lung fibrosis or pleural fluid).

Feel the chest wall to detect surgical emphysema or crepitus (suggesting a pneumothorax until proven otherwise).

胸骨上窝检查气道有无偏移，，，，，偏向一侧提示纵隔移位，如气胸，肺纤维化，胸水。触诊胸壁，，，如捻发音，提示气胸可能。

The specific treatment of respiratory disorders depends upon the cause. Nevertheless, all critically ill patients should be given oxygen. In a subgroup of patients with COPD, high concentrations of oxygen may depress breathing (i.e. they are at risk of hypercapnic respiratory failure - often referred to as type 2 respiratory failure). 

处理呼吸障碍取决于致病因素，所有呼吸危重患者应给氧。COPD II型呼衰患者避免高浓度给氧。

Nevertheless, these patients will also sustain end-organ damage or cardiac arrest if their blood oxygen tensions are allowed to decrease. In this group, aim for a lower than normal PaO2 and oxygen saturation. 

但II型呼衰患者允许的低氧血症过低也会致持续的脏器损伤或心搏停止，所以保持比正常动脉血氧分压及氧饱和度稍低目标值是合理的。

Give oxygen via a Venturi 28% mask (4 L min-1) or a 24% Venturi mask (4 L min-1) initially and reassess. Aim for target SpO2 range of 88–92% in most COPD patients, but evaluate the target for each patient based on the patient’s arterial blood gas measurements during previous exacerbations (if available). Some patients with chronic lung disease carry an oxygen alert card (that documents their target saturation) and their own appropriate Venturi mask.

II型呼衰初始可用文丘里给氧4L／分，吸氧浓度２８％，或２４％浓度，并不断重新评估。对大多数COPD患者保持目标氧饱和度88-92%，同时有既往住院资料时，可根据每个患者上次急性加重时的血气分析以指标给氧目标。一些慢性肺疾病患者携带有氧合警示卡，上面记录有患者的理想氧饱和度及适合的文丘里面罩。老外就是人性化。

我也没看过这种面罩，但这种面罩很好用的，可以保持稳定的氧浓度，不同颜色代表不同的氧浓度，分成人儿童型号。

If the patient’s depth or rate of breathing is judged to be inadequate, or absent, use bag-mask or pocket mask ventilation to improve oxygenation and ventilation, whilst calling immediately for expert help. In cooperative patients who do not have airway obstruction consider the use of non-invasive ventilation (NIV). In patients with an acute exacerbation of COPD, the use of NIV is often helpful and prevents the need for tracheal intubation and invasive ventilation.

如果患者的呼吸深度、频率异常，或消失，立即予球囊面罩给氧以改善氧合和通气，紧急呼叫专科帮助，如麻醉科、ICU医生。对于清醒可配合的患者，没有气道梗阻时可考虑使用无创通气。对于AECOPD患者，即慢阻肺急性发作，无创呼吸机通气往往有效并能避免气管插管和有创机械通气。

Circulation (C)

循环 循环 循环 循环 循环 循环 循环 循环 

In almost all medical and surgical emergencies, consider hypovolaemia to be the primary cause of shock, until proven otherwise.

对大多数表现为休克的内外科急诊，优先考虑低血容量为最常见病因，直到其它休克原因明确。

Unless there are obvious signs of a cardiac cause, give intravenous fluid to any patient with cool peripheries and a fast heart rate. In surgical patients, rapidly exclude haemorrhage (overt or hidden). Remember that breathing problems, such as a tension pneumothorax, can also compromise a patient’s circulatory state. This should have been treated earlier on in the assessment. 

除非存在明显的心源性休克表现，对于一个末梢冰凉、心率快的任何患者，立即予快速输入晶体液。对于外科休克的病人，迅速明确有无活动性或隐匿性出血。同时需排除是否存在呼吸系统问题，如张力性气胸，同样可致患者循环障碍，在评估循环之前，必须优先处理。

Look at the colour of the hands and digits: are they blue, pink, pale or mottled?

观察患者的手掌及足趾的颜色：紫绀、粉红色，苍白，或花斑样改变

Assess the limb temperature by feeling the patient’s hands: are they cool or warm?

触诊患者双手皮肤温度：冰凉还是温暖。

Measure the capillary refill time (CRT). Apply cutaneous pressure for 5 s on a fingertip held at heart level (or just above) with enough pressure to cause blanching. 

测定毛细血管充盈时间。在心脏或以上水平用力压迫患者的指尖5s钟使皮肤或指甲呈苍白色。

Time how long it takes for the skin to return to the colour of the surrounding skin after releasing the pressure. The normal value for CRT is usually < 2="" s.="" a="" prolonged="" crt="" suggests="" poor="" peripheral="" perfusion.="" other="" factors="" (e.g.="" cold="" surroundings,="" poor="" lighting,="" old="" age)="" can="" prolong="">

释放压力后观察按压部分皮肤恢复到非按压旁的皮肤颜色的时间，正常CRT时间为小于2s。CRT延长提示外周灌注不足。同时其它因素，如低温环境、室内光线太暗，老龄患者均可表现为CRT延长。

Assess the state of the veins: they may be underfilled or collapsed when hypovolaemia is present.

评估浅表静脉：低血容量时可以表现为充盈不足，塌陷，

Count the patient’s pulse rate (or preferably heart rate by listening to the heart with a stethoscope).

计数患者脉搏，或最好用听诊器听诊心率。

Palpate peripheral and central pulses, assessing for presence, rate, quality, regularity and equality. Barely palpable central pulses suggest a poor cardiac output, whilst a bounding pulse may indicate sepsis.

触诊外周或大动脉搏动，评估强弱、频率，节律。大动脉搏动微弱提示心输出血量显著减少，洪脉提示脓毒症可能。

Measure the patient’s blood pressure. Even in shock, the blood pressure may be normal, because compensatory mechanisms increase peripheral resistance in response to reduced cardiac output. A low diastolic blood pressure suggests arterial vasodilation (as in anaphylaxis or sepsis). A narrowed pulse pressure (difference between systolic and diastolic pressures; normally 35–45 mmHg) suggests arterial vasoconstriction (cardiogenic shock or hypovolaemia) and may occur with rapid tachyarrhythmia.

血压测量。即使处于休克状态，血压可能仍正常，因为机体代偿机制在心输出量下降时可以增加外周血管阻力以保持正常血压。低舒张压提示动脉扩张，如过敏性休克、或脓毒症，即液体向第三间隙丢失。脉压减小，正常为35–45 mmH 提示动脉收缩，存在于心源性休克或低血容量状态，或快速型心律失常

Auscultate the heart. Is there a murmur or pericardial rub? Are the heart sounds difficult to hear? Does the audible heart rate correspond to the pulse rate?

听诊。有无心脏杂音或心包摩擦音。心音强弱，心率与脉率一致么。

Look for other signs of a poor cardiac output, such as reduced conscious level and, if the patient has a urinary catheter, oliguria (urine volume < 0.5="" ml="">

观察低心输出量的其它体征，如意识水平下降，如患者有留置导管，每小时尿量小于0.5ml每公斤体重，如患者为60kg，即小于30ml尿量每小时。

Look thoroughly for external haemorrhage from wounds or drains or evidence of concealed haemorrhage (e.g. thoracic, intra-peritoneal, retroperitoneal or into gut). Intra-thoracic, intra-abdominal or pelvic blood loss may be significant, even if drains are empty.

全面评估外伤患者的外出血情况，或隐匿性出血，如胸腔、腹腔，后腹膜，消化道内出血。胸腔、腹腔或盆腔出血量可以很大，即使引流袋未引出血性液体。

The specific treatment of cardiovascular collapse depends on the cause, but should be directed at fluid replacement, haemorrhage control and restoration of tissue perfusion. Seek the signs of conditions that are immediately life threatening (e.g. cardiac tamponade, massive or continuing haemorrhage, septicaemic shock), and treat them urgently.

针对循环系统的极度不稳定，应采取针对性的治疗策略，通常采取液体复苏，出血控制及恢复组织的血液灌注。发现并紧急治疗那些随时可致死亡的危急状态，如心包堵塞，即梗阻性休克；大量或持续失血，失血性低血容量休克；感染性休克，即分布性休克。

Insert one or more large (14 or 16 G) intravenous cannulae. Use short, wide-bore cannulae, because they enable the highest flow.

建立一路或更多路的 14或16G 粗针头的静脉通路。输液管路尽可能短而粗，使能够以最快的输液速度输注入人体。

14号针头最粗。

Take blood from the cannula for routine haematological, biochemical, coagulation and microbiological investigations, and cross-matching, before infusing intravenous fluid.

在输入液体前从静脉穿刺针留取血标本 行常规血常规、生化，凝血，微生物学、及交叉配血等检查。

Give a bolus of 500 mL of warmed crystalloid solution (e.g. Hartmann's solution or 0.9% sodium chloride) over less than 15 min if the patient is hypotensive. Use smaller volumes (e.g. 250 mL) for patients with known cardiac failure or trauma and use closer monitoring (listen to the chest for crackles after each bolus).

如病人处于低血压，在15分钟内输入500ml预加温的晶体液，如乳酸林格液或0.9%氯化钠溶液。不明原因的心源性休克或创伤性休克15争钟内输入少于250ml的液体，同时密切评估输注后体征，如听诊双肺有无新发湿性啰音。

Reassess the heart rate and BP regularly (every 5 min), aiming for the patient’s normal BP or, if this is unknown, a target > 100 mmHg systolic.

每5分钟评估患者血压、心率，保持患者血压在平时的正常水平，如既往患者平均血压水平未知，应使收缩压大于100mmHg。

If the patient does not improve, repeat the fluid challenge. Seek expert help if there is a lack of response to repeated fluid boluses.

如患者循环状态无改善，可重复输注上述液体量，反复输注后患者无反应，应寻求专业帮助 ，如请ICU等医生会诊。

If symptoms and signs of cardiac failure (dyspnoea, increased heart rate, raised JVP, a third heart sound and pulmonary crackles on auscultation) occur, decrease the fluid infusion rate or stop the fluids altogether. Seek alternative means of improving tissue perfusion (e.g. inotropes or vasopressors).

如果存在心衰的症状体征，如呼吸困难、心率加快，静外静脉充盈或怒张，第三心音或肺部湿性啰音，减慢输液速度或停止输液。加用强心药 如多巴酚丁胺、或血压收缩剂 ，如去甲肾以改善组织灌注。

If the patient has primary chest pain and a suspected ACS, record a 12-lead ECG early.

如患者初始表现为胸痛，怀疑为急性冠脉综合征，及时行12导联心电图检查，必要时18导，以排除右室或后壁梗塞。

Immediate general treatment for ACS includes:

立即启动ACS治疗措施：可参考相关ACS的指南。

Aspirin 300 mg, orally, crushed or chewed, as soon as possible.

立即嚼服、或碾碎后口服300mg 阿司匹林，怀疑心梗，联合口服氯吡格雷 或替格瑞洛，可参考相关ACS的指南。

Nitroglycerine, as sublingual glyceryl trinitrate (tablet or spray).

舌下含服或喷雾吸入硝酸甘油。

Oxygen: only give oxygen if the patient’s SpO2 is less than 94% breathing air alone.

吸入空气条件下，指脉氧低于94%可给氧。

Morphine (or diamorphine) titrated intravenously to avoid sedation and respiratory depression.

吗啡镇痛，静脉缓慢注射，避免镇静过度及抑制呼吸。

Disability (D)

意识障碍

Common causes of unconsciousness include profound hypoxia, hypercapnia, cerebral hypoperfusion, or the recent administration of sedatives or analgesic drugs.

常见意识障碍病因包括：低氧血症，，，高碳酸血症，，，，，脑低灌注，，，，近期服用镇静、麻醉药品等。

Review and treat the ABCs: exclude or treat hypoxia and hypotension.

评估和处置治疗上述ABC存在的问题：排除或治疗低氧血症，低血压。

Check the patient’s drug chart for reversible drug-induced causes of depressed consciousness. Give an antagonist where appropriate (e.g. naloxone for opioid toxicity).

仔细查阅患者的用药史以找到可能为药物相关性的意识障碍，对于某些药物过量中毒，可以使用特效解毒药，如纳络酮拮抗阿片类药物中毒

Examine the pupils (size, equality and reaction to light).

检查瞳孔，，，大小，双侧是否等大等圆，及对光反射情况。

Make a rapid initial assessment of the patient’s conscious level using the AVPU method: Alert, responds to Vocal stimuli, responds to Painful stimuli or Unresponsive to all stimuli. Alternatively, use the Glasgow Coma Scale score. A painful stimuli can be given by applying supra-orbital pressure (at the supraorbital notch).

采用AVPU方法迅速评估患者意识水平：对外界的警觉状态，如缄默，淡漠，嗜睡，谵妄，躁狂，激惹；对语音的反应；对疼痛的刺激或对所有刺激均无反应。也可以采用GCS评分，格拉斯哥评分。疼痛刺激可采用压迫上眼眶的方式。

Measure the blood glucose to exclude hypoglycaemia using a rapid finger-prick bedside testing method. In a peri-arrest patient use a venous or arterial blood sample for glucose measurement as finger prick sample glucose measurements can be unreliable in sick patients. Follow local protocols for management of hypoglycaemia. 

检测末梢血糖，对于濒死患者应采用静脉或动脉血检测血糖水平，此类病人末梢血糖可能不准确。

For example, if the blood sugar is less than 4.0 mmol L-1 in an unconscious patient, give an initial dose of 50 mL of 10% glucose solution intravenously. If necessary, give further doses of intravenous 10% glucose every minute until the patient has fully regained consciousness, or a total of 250 mL of 10% glucose has been given. 

意识障碍的患者，如果血糖低于4mmol/L，初始可予50ml 10% GS 静脉推注，接着再持续推注10%GS，直到患者意识恢复，或总量达到250ml，不推高糖可能是因为在未建立中心静脉前外周高糖刺激性比较大，老外很讲人文关怀。

Repeat blood glucose measurements to monitor the effects of treatment. If there is no improvement consider further doses of 10% glucose. Specific national guidance exists for the management of hypoglycaemia in adults with diabetes mellitus.

反复监测血糖以评估治疗的反应。对于糖尿病人的低血糖可参考相关指南。

Nurse unconscious patients in the lateral position if their airway is not protected.

对于意识障碍病人有舌后坠或口腔分泌物多应使患者保持侧卧位以开放气道和使分泌物流出。

Exposure (E)

查体时的充分暴露

To examine the patient properly full exposure of the body may be necessary. Respect the patient’s dignity and minimise heat loss.

充分暴露患者进行全面的查体，同时尊重患者隐私及最小化皮肤热量的丢失

Additional information 

其它信息

Take a full clinical history from the patient, any relatives or friends, and other staff.

对病人进行充分的病史询问，以及陪同的亲属、朋友及其它人员。

Review the patient’s notes and charts:

查阅患者既往病史资料

Study both absolute and trended values of vital signs.

分析存在的明显异常症状体征或可能的症状体征。

Check that important routine medications are prescribed and being given.

查询患者重要的日常口服药或新开的相关药物。

Review the results of laboratory or radiological investigations.

分析实验室或影像学结果。

Consider which level of care is required by the patient (e.g. ward, HDU, ICU).

评估患者病情，需要住普通病房，加护病房，或重症监护室

Make complete entries in the patient’s notes of your findings, assessment and treatment. Where necessary, hand over the patient to your colleagues.

详细完整的记录病史体征，诊断及治疗情况，并交接给下一班医生或病房医生。

Record the patient’s response to therapy.

及时记录患者对治疗的反应，好转，无效，恶化。

Consider definitive treatment of the patient’s underlying condition.

针对患者的明确病因采取针对性治疗措施。

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