Приложение N 1. Карта интенсивной терапии (вкладыш в медицинскую карту стационарного больного, форма 003/У)

Приложение N 1
к приказу Комитета здравоохранения
Правительства Москвы
от 30 декабря 1998 г. N 688

Карта интенсивной терапии        /-----\ Группа крови_______ Rh__________

Лечебное учреждение _____________|Пала-|

Отделение ____ Дата заполнения___|та   |        Аллергические реакции

/-------------------------------\|     |

|Ф.И.О.больного ________________||Койка|

|Возраст _______________________||     |

|N и/б                          ||     |

\-------------------------------/\-----/

/-----------------------------------------------------------------------\

|Время          | 9 |10 |11 |12 |13 |14 |15 |16 |17 |18 |19 |20 |21 |22 |

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

| 35 | 40 |250  |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|----+----+-----++++++++++++++++++++++++++++++++++++++++++++++++++++++++|

| 30 | 39 |200  |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|----+----+-----++++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|ЧД25|Темр|АД   |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |38  |150  |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|----+----+-----++++++++++++++++++++++++++++++++++++++++++++++++++++++++|

| 20 |37  |ЧСС  |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |100  |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|----+----+-----++++++++++++++++++++++++++++++++++++++++++++++++++++++++|

| 15 |36  |50   |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|----+----+-----++++++++++++++++++++++++++++++++++++++++++++++++++++++++|

| 10 |35  | 0   |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|    |    |     |+++++++++++++++++++++++++++++++++++++++++++++++++++++++|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|/---\ ЦВД      |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

||Па-|----------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

||ра-| О2sat    |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

||ме-|----------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

||тры| СО2      |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

||ИВЛ|----------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|\---/ ДО       |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|     ----------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|      МОД      |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|     ----------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|      О2       |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|     ----------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|      РЕЕР     |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|     ----------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|               |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|Назначения     |---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|Желудочный     |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|зонд/per os    |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|Получасовой    |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|диурез         |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|Стул           |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

|Дренажи        |   |   |   |   |   |   |   |   |   |   |   |   |   |   |

|---------------+---+---+---+---+---+---+---+---+---+---+---+---+---+---|

\-----------------------------------------------------------------------/

ГАРАНТ:

Продолжение карты. См. начало

----------------------------------------\Диагноз ________________________

| 23|24 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |________________________________

+---+---+---+---+---+---+---+---+---+---|Операция _______________________

|+++++++++++++++++++++++++++++++++++++++|________________________________

|+++++++++++++++++++++++++++++++++++++++|Дата операции __________________

|+++++++++++++++++++++++++++++++++++++++|Сутки наблюдения _______________

++++++++++++++++++++++++++++++++++++++++|/------------------------------\

|+++++++++++++++++++++++++++++++++++++++||Аппарат ИВЛ:                  |

|+++++++++++++++++++++++++++++++++++++++||Вид ИВЛ:                      |

|+++++++++++++++++++++++++++++++++++++++||                              |

++++++++++++++++++++++++++++++++++++++++||Эндотрахеальная трубка:       |

|+++++++++++++++++++++++++++++++++++++++||Трахеостомическая трубка:     |

|+++++++++++++++++++++++++++++++++++++++|\------------------------------/

|+++++++++++++++++++++++++++++++++++++++|/------------------------------\

++++++++++++++++++++++++++++++++++++++++||Обследования:                 |

|+++++++++++++++++++++++++++++++++++++++||Глюкоза          Общий анализ |

|+++++++++++++++++++++++++++++++++++++++||Билирубин        крови        |

|+++++++++++++++++++++++++++++++++++++++||Холестерин       Общий анализ |

++++++++++++++++++++++++++++++++++++++++||Общий белок      мочи         |

|+++++++++++++++++++++++++++++++++++++++||Белковые         Анализ мочи  |

|+++++++++++++++++++++++++++++++++++++++||фракции          на сахар,    |

|+++++++++++++++++++++++++++++++++++++++||АСТ, АЛТ, ЛДГ,   ацетон       |

++++++++++++++++++++++++++++++++++++++++||ЩФ, КФК          Амилаза      |

|+++++++++++++++++++++++++++++++++++++++||Мочевина         Микробиоло-  |

|+++++++++++++++++++++++++++++++++++++++||Креатинин        гические     |

|+++++++++++++++++++++++++++++++++++++++||Ht, Hb           исследова-   |

+---+---+---+---+---+---+---+---+---+---||K, Na, Ca, Cl    ния с иден-  |

|   |   |   |   |   |   |   |   |   |   ||КЩС              тифицирова-  |

+---+---+---+---+---+---+---+---+---+---||Коагулограмма    нием возбу-  |

|   |   |   |   |   |   |   |   |   |   ||Осмолярность     дителя и     |

+---+---+---+---+---+---+---+---+---+---||                 определени-  |

|   |   |   |   |   |   |   |   |   |   ||Rg-исследо-      ем чувст-    |

+---+---+---+---+---+---+---+---+---+---||вания            вит. к ан-   |

|   |   |   |   |   |   |   |   |   |   ||УЗИ              тибиоти-     |

+---+---+---+---+---+---+---+---+---+---||ЭКГ              кам:         |

|   |   |   |   |   |   |   |   |   |   ||Консультации:    крови        |

+---+---+---+---+---+---+---+---+---+---||                 мочи         |

|   |   |   |   |   |   |   |   |   |   ||                 мокроты      |

+---+---+---+---+---+---+---+---+---+---||                 раневого     |

|   |   |   |   |   |   |   |   |   |   ||                 отделяе-     |

|---+---+---+---+---+---+---+---+---+---||                 мого         |

+---+---+---+---+---+---+---+---+---+---||                 Анализ       |

+---+---+---+---+---+---+---+---+---+---||                 ликвора      |

+---+---+---+---+---+---+---+---+---+---||                 Химико-то-   |

+---+---+---+---+---+---+---+---+---+---||                 ксиколо-     |

+---+---+---+---+---+---+---+---+---+---||                 гическое     |

+---+---+---+---+---+---+---+---+---+---||                 исследо-     |

+---+---+---+---+---+---+---+---+---+---||                 вание        |

+---+---+---+---+---+---+---+---+---+---||                 крови,       |

+---+---+---+---+---+---+---+---+---+---||                 мочи         |

+---+---+---+---+---+---+---+---+---+---|\------------------------------/

+---+---+---+---+---+---+---+---+---+---|/------------------------------\

+---+---+---+---+---+---+---+---+---+---||Лечебные мероприятия          |

+---+---+---+---+---+---+---+---+---+---||                              |

+---+---+---+---+---+---+---+---+---+---|\------------------------------/

+---+---+---+---+---+---+---+---+---+---|/------------------------------\

+---+---+---+---+---+---+---+---+---+---||Диета ________________________|

+---+---+---+---+---+---+---+---+---+---||Объем    Через    Per os      |

|   |   |   |   |   |   |   |   |   |   ||питания  зонд                 |

|   |   |   |   |   |   |   |   |   |   ||         _____    ______      |

+---+---+---+---+---+---+---+---+---+---||                              |

|   |   |   |   |   |   |   |   |   |   ||Каллораж                      |

|   |   |   |   |   |   |   |   |   |   ||питания  _____    ______      |

+---+---+---+---+---+---+---+---+---+---|\------------------------------/

|   |   |   |   |   |   |   |   |   |   |/------------------------------\

+---+---+---+---+---+---+---+---+---+---||          Итоги               |

|   |   |   |   |   |   |   |   |   |   ||Объем потребле-  Потери жид-  |

+---+---+---+---+---+---+---+---+---+---||ния жидкости:    кости:       |

|   |   |   |   |   |   |   |   |   |   ||                              |

+---+---+---+---+---+---+---+---+---+---||Гемотранс-       Кровопо-     |

|   |   |   |   |   |   |   |   |   |   ||фузия _________  теря _______ |

+---+---+---+---+---+---+---+---+---+---||В/венно________  Диурез______ |

|   |   |   |   |   |   |   |   |   |   ||Энтерально_____  Дренажи_____ |

+---+---+---+---+---+---+---+---+---+---||      _________     _________ |

|   |   |   |   |   |   |   |   |   |   ||                              |

+---+---+---+---+---+---+---+---+---+---||Баланс жидкости:              |

|   |   |   |   |   |   |   |   |   |   ||--______+______/сут           |

|   |   |   |   |   |   |   |   |   |   |\------------------------------/

|   |   |   |   |   |   |   |   |   |   |Врач ___________________________

----------------------------------------/Медсестра ______________________