Khoi dong nhanh — Danh sach kiem tra luong benh nhan
| # | Ai | Hanh dong |
|---|---|---|
| 1 | Dieu duong | Mo Nurse Station → Dang ky benh nhan → Gan muc phan loai |
| 2 | Bac si | Mo Doctor Station → Xem hang doi → Kham + ke don |
| 3 | Dieu duong | Ghi nhan dau hieu sinh ton (HA/mach/nhip tho/SpO2/nhiet do) |
| 4 | Duoc si | Mo Pharmacy → Xem don cho → Xac nhan cap phat |
| 5 | Dieu duong / Admin | Xac nhan dieu tri hoan tat → Ghi nhan xuat vien |
Nam buoc nay la luong benh nhan co ban. Phau thuat, truyen mau va tan thuong la cac quy trinh nang cao duoc de cap trong cac bai viet tiep theo cua loat bai nay.
Hanh trinh benh nhan: Buoi chieu cua ong Truong
2 gio chieu. Mot nguoi dan ong 45 tuoi duoc dua vao tram y te da chien. Mot ke sach do len chan phai cua anh ta trong tran dong dat. Anh ta khong the di lai binh thuong, va chan duoi phai sung ro rang.
Tram 1: Phan loai (Nurse Station)
Dieu duong Tran lay dien thoai va mo Nurse Station PWA.
Co an "Benh nhan moi" va nhap thong tin co ban: ten, tuoi, gioi tinh. He thong tu dong tao ma benh nhan.
Tiep theo la phan loai. Dieu duong Tran danh gia chan thuong:
- Tinh tao, duong tho thong
- Chan duoi phai sung, nghi gay xuong
- Dau hieu sinh ton on dinh
Co chon VANG (Tri hoan) — can dieu tri, nhung khong de doa tinh mang ngay lap tuc.
He thong tu dong lam hai viec: tao ho so benh nhan va dua benh nhan vao hang doi cua bac si.
Tram 2: Kham benh (Doctor Station)
Bac si Nguyen mo Doctor Station PWA. Ten ong Truong xuat hien trong hang doi, duoc gan nhan VANG.
Ong an vao ho so benh nhan va thay cac phat hien phan loai da duoc dieu duong ghi nhan. Ong tien hanh kham lam sang:
- Dau tai 1/3 giua xuong chay phai
- Sung dang ke, khong co vet thuong ho
- Mach ngoai vi con
Bac si Nguyen ghi chan doan: "Nghi gay xuong chay kin, chan phai" va ke don:
- Acetaminophen 500mg, moi 6 gio, 10 vien
- Bot bo chan ngan
Ngay khi don thuoc duoc gui, no xuat hien trong hang doi cho cua duoc pham.
Tram 3: Dau hieu sinh ton (Nurse Station)
Dieu duong Tran quay lai do dau hieu sinh ton cho ong Truong:
- Huyet ap: 128/82 mmHg
- Mach: 88 lan/phut
- Nhip tho: 18 lan/phut
- SpO2: 98%
- Nhiet do: 36,8°C
Co nhap cac gia tri vao Nurse Station PWA. Neu bat ky gia tri nao bat thuong (vi du, HA duoi 90/60), he thong tu dong to do.
Dau hieu sinh ton co the ghi nhieu lan. Moi lan nhap deu co danh dau thoi gian, giup de dang xem xu huong khi ban giao ca.
Tram 4: Cap phat thuoc (Pharmacy PWA)
Duoc si Le mo Pharmacy PWA va thay mot don thuoc dang cho: Acetaminophen cua ong Truong.
Ong xac minh chi tiet don thuoc, roi an "Cap phat." He thong tu dong tru 10 vien Acetaminophen khoi kho.
Neu ton kho khong du, he thong hien canh bao nhung khong chan cap phat — duoc si quyet dinh cap phat nhung gi co san.
Mot co che an toan quan trong: cung mot don thuoc khong the cap phat hai lan. Ngay ca neu duoc si vo tinh an xac nhan hai lan, kho chi bi tru mot lan.
Tram 5: Xuat vien
Ong Truong da duoc bo bot va cap thuoc giam dau. Tinh trang on dinh. Dieu duong ghi nhan xuat vien trong he thong, ghi lai thoi gian xuat vien va huong dan tai kham.
Neu ong Truong can chuyen den benh vien tuyen sau de danh gia them (vi du, chup X-quang xac nhan gay xuong), quy trinh chuyen sang tram EMT Transfer — duoc mo ta trong phan tiep theo.
Nang cao: Tiep nhan thuong binh tan thuong tu tuyen truoc
Doi khi benh nhan khong tu den. Trong kich ban quan su hoac tham hoa quy mo lon, thuong binh duoc tan thuong tu tuyen truoc qua he thong LSCO den tram y te.
Khi quan y tien tuyen an "Tan thuong den tram y te" trong he thong LSCO, day la nhung gi xay ra tai tram:
- Mot benh nhan moi xuat hien trong Nurse Station — duoc gan nhan DO hoac CAP CUU, uu tien cao nhat
- Du lieu benh nhan duoc dien san — the thuong TCCC va ho so cham soc PFC tu tuyen truoc duoc tu dong nhap
- Bac si co the xem ho so tuyen truoc truc tiep — khong can hoi lai lich su chan thuong
Tu day, quy trinh giong nhu bat ky benh nhan nao: kham bac si → ke don/phau thuat → duoc pham/ngan hang mau → xuat vien hoac tan thuong tiep.
Diem khac biet la benh nhan nay da co ho so dieu tri tuyen truoc day du. Bac si khong bat dau tu so khong — ho tiep noi tu noi quan y tien tuyen da dung lai.
Chi tiet ve phia tuyen truoc (cach dien the TCCC, ghi chep PFC, yeu cau MEDEVAC), xem Bai 4 trong loat bai nay.
Tan thuong benh nhan (EMT Transfer Station)
Khi benh nhan can chuyen den tram y te khac hoac benh vien tuyen sau, doi chuyen vien su dung EMT Transfer Station PWA.
Quy trinh chuyen vien theo dinh dang ISBAR:
| Muc | Ten day du | Noi dung |
|---|---|---|
| I | Identify | Ten benh nhan, ma, tuoi |
| S | Situation | Ly do chinh, tinh trang hien tai |
| B | Background | Tien su benh, di ung, thuoc dang dung |
| A | Assessment | Chan doan, dieu tri da thuc hien |
| R | Recommendation | Ly do chuyen vien, de xuat buoc tiep theo |
Sau khi dien xong, chon tram dich. He thong theo doi trang thai chuyen vien cho den khi tram tiep nhan xac nhan.
Cau hoi thuong gap
Don thuoc da gui nhung duoc pham khong thay? Dam bao dien thoai cua bac si va duoc si deu ket noi cung WiFi cua thiet bi. Neu mot nguoi dung mang ngoai hoac WiFi cua thiet bi khac, du lieu se khong dong bo.
Vo tinh tao benh nhan trung? Su dung chuc nang tim kiem de tim ho so benh nhan hien co thay vi tao moi. He thong ho tro tim theo ten va ma benh nhan. Neu da co trung lap, lien he vai tro Admin de xu ly.
Ton kho thuoc hien thi bang khong? Thuoc can duoc nhap kho truoc. Vao Supply Station PWA de thuc hien nhap kho, nhap ma thuoc va so luong. Xem Bai 5 trong loat bai nay de biet chi tiet.
Quen ghi dau hieu sinh ton? Ban co the bo sung bat cu luc nao. Nurse Station PWA ho tro nhap dau hieu sinh ton lien ngay. He thong ghi nhan ca thoi gian nhap thuc te va thoi gian lien ngay de phuc vu kiem tra.
Chon sai muc phan loai — co the doi duoc khong? Co. Vao lai ho so benh nhan va cap nhat muc phan loai. He thong luu giu ban ghi goc; muc moi ghi de len tren, dam bao tinh kha truy vet.
Dieu huong loat bai
Day la bai viet thu hai trong loat Huong dan van hanh tram y te xGrid. Toan bo loat bai:
- Ba phut khoi dong — Tu cap nguon den tram y te van hanh day du
- Hanh trinh benh nhan — Tu phan loai den xuat vien (bai nay)
- Phau thuat va truyen mau — Xu ly ca nang
- Y hoc chien truong LSCO — So tay van hanh cho quan y tien tuyen
- Van hanh hang ngay — Kho, ngan hang mau va ban giao ca
Bai nay bao gom luong benh nhan co ban. Neu benh nhan can phau thuat hoac truyen mau, tiep tuc den Bai 3.