Critical value refers to the abnormal results of a certain examination or a certain type of examination. When such abnormal results appear, it indicates that the patient may be on the verge of life-threatening. Clinicians need to get the test information in time and give patients effective intervention measures or treatment quickly, so as to save patients' lives, otherwise serious consequences may occur and the best rescue opportunity may be lost. I have compiled some information for you, I hope you like it!

Firstly, the critical value is transmitted to the nurse workstation, and the nurse on duty is responsible for receiving and printing.

Second, the printed report should be pasted on the critical value registration report and signed, and the signing time is * * * to * * minutes.

Third, notify the billing doctor or the doctor on duty in time, and the doctor will sign the register, and the time for receipt will be * * * to the minute * * *.

Four, the doctor after analysis and disposal, the tracking disposal results registered in the critical value report register.

5. Every month, the quality inspector will register and sign the critical value report of this model review.

Sixth, the registration signature is clear and the content is complete.

Clinical common critical value treatment scheme 1. Platelets:

Platelets below 30× 109/L: Platelet count below this value can cause spontaneous bleeding. If the bleeding time is equal to or longer than 15 minutes, and bleeding has occurred in * * * or * * *, platelet-raising treatment should be given immediately, and the cause of thrombocytopenia should be found out and treated according to the cause. When the value of 1000× 109/L is higher than this value, thrombosis often occurs. If this thrombocytosis is not temporary, antiplatelet drugs should be given and the primary disease leading to thrombocytosis should be treated.

2.PT extension:

Common causes: a*** congenital coagulation factor deficiency, such as prothrombin * * * factor II * * *, factor V, factor VII, factor VIII and fibrinogen deficiency, and b*** acquired coagulation factor deficiency, such as secondary/primary fibrinolysis and severe liver disease. C*** Using heparin and circulating antibodies against prothrombin, factor V, factor VII, factor X and fibrinogen can prolong 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 aspirin, heparin and other drugs; There are anticoagulant substances in the blood circulation of secondary and primary fibrinolysis and DIC, such as anticoagulant factor VIII antibody and lupus anticoagulant substances.

Delayed treatment of PT and APTT: Symptomatic treatment should be carried out according to the etiology, the primary disease should be actively treated, and the corresponding coagulation factors, frozen plasma and platelets should be given. Blood transfusion can be given if necessary.

4. Blood sugar:

*** 1*** Blood sugar is lower than 2.2mmol/L:

1, early hypoglycemia only has symptoms such as sweating, palpitation, fatigue and hunger. When awake, patients can drink sugar water or eat cookies or snacks with more sugar.

2. If the patient's consciousness changes, 40-60ml of 50% glucose should be injected intravenously. In severe cases, continuous intravenous drip of 10% glucose can be used.

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 Baicaiping should take glucose orally or intravenously if hypoglycemia occurs.

***2*** Blood sugar greater than 22.2 mmol/L: fluid replacement-salt before sugar, fast first and then slow.

1. Total amount: estimated by10% * * kg * * of body weight, it is generally 4 ~ 6L for adults. 2. Fluid replacement and insulin-two intravenous channels:

A. Fluid replacement: the first 4 hours: enter1/3 ~1/2 of the total water loss; Before 12h: 2/3 of the total investment; The rest will be replenished within 24 ~ 28 hours. B insulin: NS 500ml+ insulin 20u is infused intravenously at a speed of 4-6u/h, that is, 30-50 drops /min.

Check blood sugar and urine ketone body every hour,

If the speed of blood sugar decline is; 6. 1mmol /h, insulin dosage decreased 1/3.

A. when the blood sugar drops to 13.9mmol/L, 5% GS 500ml+ insulin12u 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 8 u 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 2.5 mmol/L;

1. Actively deal with the etiology of hypokalemia. 2. Take the method of supplementing potassium by stages and observing while treating. If the patient is in a state of 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 60-100-200 ml of 5% sodium bicarbonate solution, followed by intravenous drip of100-200ml of sodium bicarbonate solution; 2. Infusion of glucose solution and insulin: 25% glucose solution 100-200ml, every 5g sugar 1U routine insulin intravenous drip; 3. Patients with renal insufficiency who can't receive excessive blood transfusion can be given 10% calcium gluconate 100ml,1.2% sodium lactate solution 50ml, 25% glucose solution 400ml and insulin 20 u for 24 hours.

Application of cation exchange resin: oral administration, 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; To relieve symptoms, intravenous injection of 10% calcium gluconate 10-20ml or 5% calcium chloride 10ml can be used, and repeated injection can be made after 8- 12 hours if necessary.

Blood calcium is greater than 3.5mmol/L: First, 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 reduce 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, resulting in increased calcium excretion; However, water should be replenished in time, otherwise insufficient blood volume will induce calcium reabsorption in proximal renal tubules.

3. Glucocorticoid: oral prednisone 10~30mg/d is especially effective for patients with granulomatous diseases and myeloma.

4. cytotoxic drugs, such as phototmycin: this drug can inhibit the synthesis of mRNA in bone cells, thus blocking bone absorption. 25mg/kg was put into 500 ml of 5% glucose water and injected intravenously for 3 hours. After injection, blood calcium can decrease within 12 hour, and then repeat every 3~7 days. Attention should be paid to the toxic reaction of liver and hematopoietic system during injection.

5. Calcitonin * * * salmon calcitonin or eel calcitonin * * *: Generally, subcutaneous or intramuscular injection of 4u/kg or 50U, every 12 hours 1 time, has a good effect on those who cause tumor lesions, and a skin test should be done 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 * * * Sinakarce * *: It is suitable for all kinds of hypercalcemia and 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: For severe hyponatremia shock, firstly, blood volume is insufficient, microcirculation and perfusion of tissues and organs are improved, crystal solution * * * compound sodium lactate solution, isotonic saline * * and colloidal solution * * * hydroxyethyl starch. The amount of crystallization liquid is 2-3 times that of colloidal liquid. Then ***200-300ml hypertonic saline (usually 5% sodium chloride solution) can be injected intravenously to correct hyponatremia as soon as possible. However, the dripping speed should be strictly controlled when infusing hypertonic saline, and it should not exceed 100- 150ml per hour.

***2*** Blood sodium is greater than 160mmol/L: It is very important to treat the cause of hypernatremia first. For patients who can't take orally, 5% glucose solution or hypotonic 0.45% sodium chloride solution can be injected intravenously to supplement the lost liquid. The required rehydration can first estimate the percentage of water loss to body weight according to clinical manifestations. Then calculate 400-500ml of fluid replacement according to weight loss 1%. Generally, the calculated rehydration is divided into two days. After one day of treatment, the general condition and blood sodium concentration should be detected, and the supply for the next day can be adjusted if necessary.

8. Positive bacteria culture:

Sensitive antibiotics should be selected according to the results of culture and drug sensitivity test.

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