How to understand a satisfactory state. What does stable serious condition mean in intensive care? Method of restoring the body

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Severity of the condition of the victims (SSP), unified criteria. It is necessary to distinguish between “severity of TBI” and “severity of the victim’s condition.” The concept of the severity of the condition of the victims, although in many ways derived from the concept of “severity of injury,” is nevertheless much more dynamic than the latter. Within each clinical form of TBI, depending on the period and direction of its course, conditions of varying severity can be observed.

The assessment of the severity of the injury and the assessment of the severity of the condition of the victims in most cases upon admission of the patient coincide. But situations are often possible when these estimates diverge. For example, with the subacute development of meningeal hematoma against the background of a mild brain contusion; with moderate or even severe contusions of the brain, with depressed fractures, when “silent” zones of the hemispheres are selectively affected, etc.

The severity of the condition of the victims is a reflection of the severity of the injury at the moment; it may or may not correspond to the morphological substrate of the brain injury. At the same time, an objective assessment of the severity of the condition of victims upon admission is the first and most important stage in the diagnosis of a specific clinical form of TBI, which significantly influences the correct triage of victims, treatment tactics and prognosis (not only in relation to survival, but also restoration of working capacity). The role of the TSP assessment is similar during further observation of the victim.

An assessment of the severity of the condition of victims in the acute period of TBI, including the prognosis for both life and restoration of working capacity, can be complete only when using at least three terms, namely the condition:

consciousness,
vital functions,
focal neurological functions.

The following 5 gradations of the condition of patients with TBI are distinguished:

satisfactory,
moderate severity,
heavy,
extremely difficult
terminal.

Satisfactory condition.

Criteria:

clear consciousness;
absence of violations of vital functions;
absence of secondary (dislocation) neurological symptoms; absence or mild severity of primary hemispheric and craniobasal symptoms (for example, motor disorders do not reach the degree of paresis).

When qualifying a condition as satisfactory, it is permissible to take into account, along with objective indicators, the victim’s complaints. There is no threat to life (with adequate treatment); the prognosis for recovery is usually good.

Moderate condition.

state of consciousness - clear or moderate stupor;
vital functions are not impaired (only bradycardia is possible),
focal symptoms - one or another hemispheric and craniobasal symptoms may be expressed, often appearing selectively: mono- or hemiparesis of the limbs; insufficiency of individual cranial nerves; decreased vision in one eye, sensory or motor aphasia, etc.). Single brainstem symptoms (spontaneous nystagmus, etc.) may be observed.

To establish a condition of moderate severity, it is enough to have the indicated violations in at least one of the parameters. For example, the detection of moderate stunning in the absence of pronounced focal symptoms is sufficient to determine the patient’s condition as moderate. When qualifying a patient's condition as moderately severe, along with objective ones, it is permissible to take into account the severity of subjective symptoms (primarily headache).

The threat to life (with adequate treatment) is insignificant: the prognosis for restoration of working capacity is often favorable.

Serious condition.

Criteria (limits of violations for each parameter are given):

state of consciousness - deep stupor or stupor;
vital functions are impaired, mostly moderately according to 1-2 indicators;
focal symptoms:

stem - moderately expressed (anisocoria, decreased pupillary reactions, limitation of upward gaze, homolateral pyramidal insufficiency, dissociation of meningeal symptoms along the body axis, etc.);
hemispheric and craniobasal - clearly expressed both in the form of symptoms of irritation (epileptic seizures) and loss (motor disorders can reach the degree of plegia).

To establish the serious condition of the patient, it is permissible to have the indicated violations in at least one of the parameters. Detection of violations of vital functions by 2 or more indicators, regardless of the severity of depression of consciousness and focal symptoms, is sufficient to qualify the condition as severe.

The threat to life is significant and largely depends on the duration of the serious condition. The prognosis for restoration of working capacity is sometimes unfavorable.

Extremely serious condition.

Criteria (limits of violations for each parameter are given):

state of consciousness - moderate or deep coma;
vital functions - gross violations simultaneously in several parameters;
focal symptoms:

stem - expressed roughly (reflex paresis or plegia of upward gaze, gross anisocoria, divergence of the eyes along the vertical or horizontal axis, tonic spontaneous nystagmus, sharp weakening of pupil reactions to light, bilateral pathological signs, hormetonia, etc.);
hemispheric and craniobasal - pronounced sharply (up to bilateral and multiple paresis). The threat to life is maximum; largely depends on the duration of the extremely serious condition. The prognosis for restoration of working capacity is often unfavorable.

Terminal state.

Criteria:

state of consciousness - terminal coma;
vital functions - critical impairment;
focal symptoms:

stem - bilateral fixed mydriasis, absence of pupillary and corneal reflexes;
hemispheric and craniobasal - blocked by cerebral and brainstem disorders.

Prognosis: Survival is usually not possible.

When using the scale used to assess the severity of the condition of victims for diagnostic and especially prognostic judgments, one should take into account the time factor - the duration of the patient’s stay in a particular condition. A serious condition within 15-60 minutes after the injury can also be observed in victims with a concussion and mild contusion, but has little effect on the favorable prognosis of life and restoration of working capacity. If a patient’s stay in a serious and extremely serious condition lasts more than 6-12 hours, then this usually excludes the leading role of many contributing factors, such as alcohol intoxication, and indicates a severe TBI.

It should be taken into account that, along with the cerebral component, the leading causes of a protracted severe and extremely severe condition may be extracranial factors (traumatic shock, internal bleeding, fat embolism, intoxication, etc.).

Treatment in intensive care is a very stressful situation for the patient. After all, many intensive care centers do not have separate rooms for men and women. Often patients lie naked, with open wounds. And you have to relieve yourself without getting out of bed. The intensive care unit is a highly specialized department of the hospital. Patients are referred to intensive care:

In critical condition; with serious illnesses; in the presence of severe injuries; after anesthesia; after a complex operation.

Intensive care unit, its features

Due to the severity of the patients' condition, 24-hour monitoring is carried out in the intensive care unit. Specialists monitor the functioning of all vital organs and systems. The following indicators are under observation:

Blood pressure level; blood oxygen saturation; breathing rate; heart rate.

To determine all of these indicators, a lot of special equipment is connected to the patient. For...

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Resuscitation is a set of measures aimed at restoring vital functions of the body that are impaired or lost due to any factors.

Functions, the violation of which leads to the patient being placed in intensive care (one item may be present or all at once):

Failures in cardiac activity; problems with independent breathing; disruption of brain activity; failure in the body’s metabolic system; some others.

Important: if a person is admitted to intensive care, his condition is already very serious; in this department, doctors are fighting to save the patient’s life. However, it happens that a period of remission gives way to an exacerbation, then a person from a regular ward ends up in intensive care.

Diagnostics: classification of conditions

Satisfactory. Such patients are not placed in intensive care, since their vital functions are not impaired. Moderate severity. Functions may be partially impaired if a patient in this condition is placed in...

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The severity of the patient’s general condition is determined depending on the presence and severity of decompensation of the vital functions of the body. Treatment of patients in extremely severe general condition is carried out in an intensive care unit.

To determine all of these indicators, a lot of special equipment is connected to the patient. Patients in the intensive care unit after surgery are temporarily left with drainage tubes. The extremely serious condition of patients means the need to attach to the patient a large amount of special equipment necessary to monitor vital...

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Girls, on one site today there were heated discussions about “What I will never do during the next renovation.” The topic turned out to be so relevant and interesting that I decided to raise it here. Let's share our mistakes and successes in repairing and decorating our nests. I'll start with myself.

Perhaps such posts have already been written, and I missed it, but I’ll write again, forearmed means forewarned. Yesterday I was at home in Moscow and missed my granddaughter and daughter, the granddaughter was sick, everything was as always, the granddaughter is on the mend, the daughter was doing household chores, and we were playing and laughing with the granddaughter, everyone was having a great time. Nothing foreshadowed a storm and spoiled mood until I received this SMS

Many photographs touch to the core. Below I present those that touched the strings of my soul. You can attach those photos that touched you in some way.

My grandmother is 90 years old and has 5 children. My grandfather has been gone for more than 40 years. He cheated, there were even children on the next street. What am I talking about? Besides...

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APPENDIX 3

METHODOLOGICAL DEVELOPMENT FOR TEACHERS AND STUDENTS

TO THE TOPIC “GENERAL EXAMINATION OF THE PATIENT”

Criteria for assessing general condition

2. Indications for emergency hospitalization, as well as the urgency and scope of treatment measures.

3. Nearest forecast.

4. Motor activity and need for care.

The severity of the condition is determined by a complete examination of the patient

1. upon questioning and general examination (complaints, consciousness, position, skin color, swelling...);

2. when examining systems (respiratory rate, heart rate, blood pressure, ascites, bronchial breathing or absence of breath sounds over the lung area...);

3. after additional methods (blasts in the blood test and thrombocytopenia, infarction according to ECG, bleeding gastric ulcer according to FGDS...).

There are: satisfactory condition, moderate condition, severe condition and extremely severe condition....

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Resuscitation - psychological and physical discomfort for the patient?

Treatment in intensive care

Patients’ lack of understanding of the peculiarities of the treatment regime in the intensive care unit often becomes the cause of serious complications, which sometimes pose a great danger to their lives. In addition, treatment in intensive care is a great psychological stress for patients. Reducing the level of anxiety and restlessness, as well as preventing the development of severe complications associated with patients’ violation of the intensive care regimen are the main goals of this educational article. This article will be especially useful for patients preparing for major operations, after which further treatment is expected in the intensive care unit.

The intensive care unit is a highly specialized department of the hospital. The main contingent of intensive care patients are patients in critical conditions, with serious illnesses and injuries, as well as severe...

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Father (86 years old) is in intensive care with a stroke

Rinat 10.30.2007 - 19:03

Hello, Doctor.

My father (86 years old) is in intensive care with a stroke. It started when he felt unwell on Sunday evening, an hour later I returned home and took his blood pressure. the upper level was 200+ and severe arrhythmia. after which an ambulance was called. The doctors gave injections. but the pressure remained high, the cardiogram could not be taken, so they decided to take him to the hospital. There they took a cardiogram and placed me in cardiology (the upper pressure at that time was 220).

By the way, my father got into the car himself with a little help, but he could no longer get out, his speech became slurred, his movements were like that of a very drunk man.

The department installed an IV. then they gave an injection. After some time, he felt better, his speech and coordination of movements were completely restored, he even walked around the ward a little.

The morning began with the fact that at 04.00 he slid out of bed onto the floor; it was difficult to lift him back, his arms and legs were...

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Currently, the prevalence of stroke is 3-4 cases per 1000 people in Russia, with the majority being patients with ischemic stroke - about 80% of cases, the remaining 20% are patients with the hemorrhagic type of the disease. For relatives and friends of the victim, an attack of acute cerebrovascular accident is often a surprise, and an important question that worries them is the question of how long they stay in intensive care after a stroke and how long the treatment in the hospital lasts in general.

Treatment of stroke consists of several stages

All treatment of acute cerebrovascular accident consists of several stages:

Pre-hospital stage. Treatment in the intensive care unit. Treatment in a general ward.

The question of the number of days of hospital stay for a stroke is regulated by treatment standards developed by the Ministry of Health. The duration of stay of patients in hospital conditions is 21...

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Terra_Nova, stop tormenting yourself.. If there was something bad, you would have already been invited to a conversation.
While they say that the condition is stable, relax your buns and calm down. Soon she will be transferred to the ward, apparently they are waiting for a chair.
If you're really worried, send your dad and let him go look for a surgeon.
Just thoughts like yours and such torment - why? If it’s really just recovery after surgery, maybe not as fast as for young people.

I don’t know, no one has ever refused me. Yes, I waited for doctors under the operating room, anesthesiologists, waited for several hours. But I always received information. Ignorance is worse.

Again, resuscitators come out to talk about the condition of the patients. Put 500 rubles in your pocket, they'll tell you everything...

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View full version: The condition is serious. What does it mean?

The husband was taken to the hospital by ambulance. He underwent surgery at night and is now in intensive care. It makes no sense for me and my children from the suburbs to go in this weather, they said they wouldn’t let me in. The information desk says “he is in intensive care, his condition is serious, the rate is 36.7” and they hang up.
Please explain what “serious condition” means?, ...and I can’t find out how he recovered from anesthesia... This is the first time I’ve encountered this in a way that concerns me personally.....

24.12.2009, 14:25

well, after surgery the condition is always serious,
You just can’t call it light...or moderate)
and the fact that the temperature is normal is already GOOD!
don't worry, everything will be fine.
Peace of mind to you, and a speedy recovery to your husband:091:

24.12.2009, 15:42

In intensive care there are always 2 statuses of the condition: extremely severe and severe. When he is stable, he will be transferred to the department.

Husband in the ambulance...

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Svetlana asks:

Hello. My grandmother is 86 years old, she is in the hospital for a routine examination, she always goes to bed in the winter. Yesterday I left the room and when I came back and went to my bed I felt bad, she fell and hit her face on the bedside table... The doctors came running and said it was an ischemic stroke. Eyes open but unresponsive. The right side was paralyzed. From the hospital where she was lying, she was transferred to neurosurgery, and then she became ill and began to vomit black. Doctors transferred her to intensive care, now she is in a coma. They say his condition is stable and serious. My question is, what should we prepare for? How long can a coma last? Will speech be restored if the outcome is favorable?

Unfortunately, in this situation the prognosis is extremely unfavorable. The area of brain damage is probably very large, so the risk of death is high. But even if your grandmother comes out of a coma, most likely she will still have...

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The severity of the patient’s general condition is determined depending on the presence and severity of decompensation of the vital functions of the body. In accordance with this, the doctor decides on the urgency and required volume of diagnostic and therapeutic measures, determines the indications for hospitalization, transportability and the likely outcome (prognosis) of the disease.

In clinical practice, there are several gradations of the general condition:

Satisfactory moderate severe extremely severe (preagonal) terminal (atonal) state of clinical death.

The doctor gets the first idea about the general condition of the patient by getting acquainted with the complaints and data of the general and local examination: appearance, state of consciousness, position, fatness, body temperature, color of the skin and mucous membranes, the presence of edema, etc. The final judgment on the severity of the patient’s condition is made based on the results of a study of internal organs. In this case, the definition...

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This has always been a stumbling block - determining the severity of the patient. The therapist sees that “Aunt Glasha” is severe, while the resuscitator sees that it is fully compensated. Even between colleagues there are often conflicting judgments. I’ve been thinking for a long time, perhaps I’ve “reinvented the wheel” in a new way, I’m starting from this stratification: (can be adjusted)

Gradation of degrees of severity of the general condition
Satisfactory condition: no disturbances in the vital functions of the body,
Moderate severity: there are no disturbances in the vital functions of the body, in the presence of symptoms characteristic of this disease,
Severe condition: moderate disturbances of vital functions according to 1-2 indicators,
Extremely serious condition: gross violations of vital functions simultaneously in several parameters,
Terminal condition: critical impairment of vital functions.

central nervous system
Satisfactory condition: 15 points according to GSC: clear consciousness, active wakefulness, complete correct...

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In accordance with this, the doctor decides on the urgency and required volume of diagnostic and therapeutic measures, determines the indications for hospitalization, transportability and the likely outcome (prognosis) of the disease.

In clinical practice, there are several gradations of the general condition:

satisfactory
moderate severity
heavy
extremely severe (preagonal)
terminal (atonal)
state of clinical death.

The description of the objective status in the medical history begins with a description of the general condition. In some cases, it is possible to really determine the severity of the general condition in a relatively satisfactory state of health of the patient and the absence of pronounced violations of the objective status only after additional laboratory and instrumental studies, for example, based on identifying signs of acute leukemia in a blood test, myocardial infarction on an electrocardiogram, bleeding stomach ulcers with gastroscopy, cancer metastases in the liver with ultrasound examination.

The general condition of the patient is defined as satisfactory if the functions of vital organs are relatively compensated. As a rule, the general condition of patients remains satisfactory in mild forms of the disease. Subjective and objective manifestations of the disease are not clearly expressed, the consciousness of patients is usually clear, the position is active, nutrition is not impaired, body temperature is normal or subfebrile. The general condition of patients is also satisfactory during the period of convalescence after acute illnesses and when exacerbations of chronic processes subside.

A general condition of moderate severity is said to exist if the disease leads to decompensation of the functions of vital organs, but does not pose an immediate danger to the patient’s life. This general condition of patients is usually observed in diseases that occur with pronounced subjective and objective manifestations. Patients may complain of intense pain of various locations, severe weakness, shortness of breath with moderate physical activity, and dizziness. Consciousness is usually clear, but sometimes it is stunned. Motor activity is often limited: patients are forced or active in bed, but they are able to care for themselves. Symptoms may include high fever with chills, widespread swelling of the subcutaneous tissue, severe pallor, bright jaundice, moderate cyanosis, or extensive hemorrhagic rashes. A study of the cardiovascular system reveals an increase in the number of heartbeats at rest, more than 100 per minute, or, conversely, bradycardia with a number of heartbeats less than 40 per minute, arrhythmia, and increased blood pressure. The number of respirations at rest exceeds 20 per minute, and there may be a violation of bronchial obstruction or patency of the upper respiratory tract. From the digestive system, signs of local peritonitis, repeated vomiting, severe diarrhea, and moderate gastrointestinal bleeding are possible.

Patients whose general condition is assessed as moderate usually require emergency medical care or hospitalization is indicated, since there is a possibility of rapid progression of the disease and the development of life-threatening complications. For example, during a hypertensive crisis, myocardial infarction, acute left ventricular failure or stroke may occur.

The general condition of the patient is defined as severe if the decompensation of the functions of vital organs that has developed as a result of the disease poses an immediate danger to the patient’s life or can lead to profound disability. A severe general condition is observed in a complicated course of the disease with pronounced and rapidly progressing clinical manifestations. Patients complain of unbearable, prolonged persistent pain in the heart or abdomen, severe shortness of breath at rest, prolonged anuria, etc. Often the patient groans, asks for help, and his facial features are sharpened. In other cases, consciousness is significantly depressed (stupor or stupor), delirium and severe meningeal symptoms are possible. The patient's position is passive or forced; he, as a rule, cannot care for himself and needs constant care. Significant psychomotor agitation or generalized convulsions may occur.

The severe general condition of the patient is indicated by increasing cachexia, anasarca in combination with hydrocele, signs of severe dehydration (decreased skin turgor, dry mucous membranes), “chalky” pallor of the skin or pronounced diffuse cyanosis at rest, hyperpyretic fever or significant hypothermia. When examining the cardiovascular system, a thread-like pulse, a pronounced expansion of the borders of the heart, a sharp weakening of the first tone above the apex, significant arterial hypertension or, conversely, hypotension, and impaired patency of large arterial or venous trunks are revealed. From the respiratory system, tachypnea over 40 per minute, severe obstruction of the upper respiratory tract, a prolonged attack of bronchial asthma or incipient pulmonary edema are noted. A severe general condition is also indicated by uncontrollable vomiting, profuse diarrhea, signs of diffuse peritonitis, massive ongoing gastrointestinal (vomiting "coffee grounds", melena), uterine or nasal bleeding.

All patients whose general condition is characterized as serious require urgent hospitalization. Treatment is usually carried out in an intensive care ward.

An extremely severe (preagonal) general condition is characterized by such a sharp disruption of the basic vital functions of the body that without urgent and intensive therapeutic measures, the patient may die within the next hours or even minutes. Consciousness is usually sharply depressed, even to the point of coma, although in some cases it remains clear. The position is most often passive, sometimes there is motor agitation and general convulsions involving the respiratory muscles. The face is deathly pale, with pointed features, covered with drops of cold sweat. The pulse is palpable only in the carotid arteries, blood pressure is not determined, and heart sounds are barely audible. The number of respirations reaches 60 per minute. With total pulmonary edema, breathing becomes bubbling, foamy pink sputum is released from the mouth, and various silent moist rales are heard over the entire surface of the lungs.

In patients with status asthmaticus, respiratory sounds over the lungs are not heard. Breathing disturbances may be detected in the form of Kussmaul's "big breathing" or periodic breathing of the Cheyne-Stokes or Grocco type. Treatment of patients in extremely severe general condition is carried out in an intensive care unit.

In a terminal (agonal) general state, there is a complete loss of consciousness, the muscles are relaxed, and reflexes, including blinking, disappear. The cornea becomes cloudy, the lower jaw droops. The pulse is not palpable even in the carotid arteries, blood pressure is not determined, heart sounds are not heard, but the electrical activity of the myocardium is still recorded on the electrocardiogram. There are rare periodic respiratory movements of the Biota breathing type.

The agony can last for several minutes or hours. The appearance of an isoelectric line or fibrillation waves on the electrocardiogram and the cessation of breathing indicate the onset of clinical death. Immediately before death, the patient may develop convulsions, involuntary urination and defecation. The duration of the state of clinical death is only a few minutes, however, timely resuscitation measures can bring a person back to life.

Consequences of critical conditions

The material was prepared by anesthesiologist-resuscitator Olga Rolandovna Dobrushina.

Often, diseases and injuries lead to the so-called critical condition - severe impairment of vital functions, which with a high probability can lead to death. In such cases, the patient is admitted to the intensive care unit (ICU). According to a study conducted in the USA, about 2% of the population are treated in the ICU each year.

Saving the life of a patient in critical condition requires a huge investment of effort from doctors and nurses, modern equipment and expensive medications. Fortunately, the effort often pays off: the patient’s condition can be stabilized, consciousness and the ability to breathe on his own return, and he can do without the constant administration of drugs. The patient is transferred from the intensive care unit to a regular one, and after some time is discharged home. For a long time, doctors believed that this was the end of their work: they managed to bring the patient back to life - it would seem that they could celebrate their victory.

However, in recent decades, researchers have asked the question: what happens to critically ill patients after discharge from the hospital? It turned out that very few of them manage to return to a full life. Data from numerous studies indicate that most people who have suffered a critical illness subsequently experience significant difficulties at work and in daily activities. The reason for their social maladaptation is primarily related to mental disorders.

Patients who have suffered a critical illness are characterized by both a decrease in cognitive abilities (difficulties in learning new material, memory impairment, difficulty making decisions, etc.) and deep emotional disorders, including severe depression. Patients find themselves unable to enjoy the life they have saved with such difficulty. Mental disorders that arise as a result of a critical illness are described within the framework of post-traumatic stress syndrome.

According to computed tomography data (the work of a group of researchers led by R.O. Hopkins), patients who have suffered a critical illness show signs of brain atrophy - a decrease in its volume, accompanied by loss of function. The brain of a young person who has had a critical illness may look like the brain of someone with severe dementia.

The causes of mental disorders that occur after critical illness are currently being investigated. Both physical and mental factors are hypothesized to be important. The first include insufficient oxygen supply to the brain due to severe respiratory and blood supply disorders, episodes of hypoglycemia - a decrease in the concentration of glucose in the blood (the brain is able to feed exclusively on glucose and therefore “starves” when there is a lack of it), as well as complex biochemical changes that occur during sepsis. Among the mental factors, one should note pain, emotional isolation, inability to talk due to the presence of breathing tubes, artificial ventilation, to which not all patients easily adapt, constantly switched on lights (patients lose the sense of day and night and track time), noise - every few minutes, equipment alarms sound and sleep disturbances occur.

To prevent the cognitive and emotional consequences of a critical illness, it is necessary, first of all, to change the goals of medical personnel working with patients in the ICU. It is necessary to understand that saving the life of a patient is not enough; if possible, it is also necessary to preserve his psyche. Factors that provoke post-resuscitation cognitive and emotional disturbances, including non-physical factors, should be avoided. For example, at night, if there is no active work, you can turn off the lights. It can be useful to hang a wall clock in the room. To prevent emotional isolation, visits to relatives should not be unnecessarily limited*. Equipment alarm limits should be adjusted so that they are activated only when a real threat is present. The number of invasive devices should be minimized. For example, remove the urethral catheter as soon as the patient regains independent urination.

Relatives of patients play a huge role in preventing the mental consequences of a critical condition. When visiting a patient, you should actively communicate with him, not only through conversation, but also through sign language: you can shake his hand, stroke him, etc. Even people with depressed consciousness can perceive signals from the environment: if the patient does not respond, this does not mean that there is no need to communicate with him. To support the patient, you need to demonstrate not grief and pity, but love, joy from meeting and faith in recovery. It is worth bringing the patient objects that are significant to him: photographs of loved ones, drawings of children, for believers - religious symbols. So that the patient does not get bored when visitors leave him, you can leave him an audio player or a book. Newspapers with news are good: they not only entertain patients, but also allow them not to feel cut off from the rest of the world. In most NICUs, staff will not mind if a relative brings a small amount of items, but this should be asked in advance.

There is no specific treatment for the consequences of critical conditions, so doctors are guided by the principles that were developed during the correction of other psychoneurological disorders. To improve cognitive functions, medications from the group of nootropics, as well as classes with a neuropsychologist, can be used. To correct the emotional state, antidepressants, anxiolytics (drugs that relieve fear) and other medications are used, depending on what type of disorder prevails, and they also conduct psychotherapy (specialists will find information on psychopharmacotherapy for patients who have recovered from a coma in the book by O.S. Zaitsev and S.V. Tsarenko "Neuroreanimatology. Coming out of coma"). The social adaptation of the patient is important: if he cannot return to his previous work and hobbies, an alternative must be found for him.

In order for patients who have suffered a critical condition to return to a full life, long-term and patient work of a whole team of specialists is necessary. Abroad, entire centers are currently being created that specialize in rehabilitation after a critical illness. There are no such centers in Russia, and care for a patient who has suffered a critical condition falls on the shoulders of his relatives.

* Some ICUs do not allow relatives to enter, citing the risk of infection. However, the practice of our colleagues from the USA and Europe shows that people who come “from the street” are not dangerous in terms of infection: they can only bring so-called community-acquired strains of bacteria that do not pose a real threat. The most dangerous bacteria, nosocomial ones, which through natural selection have developed resistance to most known antibiotics, reach patients not “from the street”, but from the hands of medical personnel.

What is a stable serious condition in intensive care?

in critical condition;
with serious illnesses;
in the presence of severe injuries;
after anesthesia;
after a complex operation.

Intensive care unit, its features

blood pressure level;
blood oxygen saturation;
breathing rate;
heart rate.

To determine all of these indicators, a lot of special equipment is connected to the patient. To stabilize the patients' condition, medications are administered around the clock (24 hours). The drugs are administered through vascular access (veins of the arms, neck, subclavian region of the chest).

Patients in the intensive care unit after surgery are temporarily left with drainage tubes. They are needed to monitor the healing process of wounds after surgery.

The extremely serious condition of patients means that a large amount of special equipment must be attached to the patient to monitor vital signs. Various medical devices are also used (urinary catheter, IV, oxygen mask).

All these devices significantly limit the patient’s motor activity; he is unable to get out of bed. Excessive activity may cause important equipment to become disconnected. So, as a result of removing the IV, bleeding may occur, and disconnecting the pacemaker will cause cardiac arrest.

Determining the patient's condition

Experts determine the severity of the patient’s condition depending on the decompensation of vital functions in the body, their presence, and severity. Depending on these indicators, the doctor prescribes diagnostic and therapeutic measures. The specialist establishes indications for hospitalization, determines transportability and the likely outcome of the disease.

The general condition of the patient is classified as follows:

Satisfactory.
Medium severity.
Serious condition.
Extremely difficult.
Terminal.
Clinical death.

One of these conditions in intensive care is determined by the doctor depending on the following factors:

examination of the patient (general, local);
familiarization with his complaints;
conducting examination of internal organs.

When examining a patient, the specialist gets acquainted with the existing symptoms of diseases and injuries: the patient’s appearance, fatness, state of consciousness, body temperature, the presence of edema, foci of inflammation, color of the epithelium, mucous membrane. Indicators of the functioning of the cardiovascular system and respiratory organs are considered especially important.

In some cases, an accurate determination of the patient’s condition is possible only after obtaining the results of additional laboratory and instrumental studies: the presence of a bleeding ulcer after gastroscopy, detection of signs of acute leukemia in blood tests, visualization of cancer metastases in the liver through ultrasound diagnostics.

Serious condition

A serious condition means a situation in which the patient develops decompensation of the activity of vital systems and organs. The development of this decompensation poses a danger to the patient’s life and can also lead to his profound disability.

Typically, a serious condition is observed in the case of a complication of the current illness, which is characterized by pronounced, rapidly progressing clinical manifestations. The following complaints are typical for patients in this condition:

for frequent pain in the heart;
manifestation of shortness of breath in a calm state;
the presence of prolonged anuria.

The patient may be delirious, ask for help, moan, his facial features become sharpened, and the patient’s consciousness is depressed. In some cases, states of psychomotor agitation and general convulsions are present.

Typically, the patient’s serious condition is indicated by the following symptoms:

increase in cachexia;
anasarca;
dropsy of cavities;
rapid dehydration of the body, in which dry mucous membranes and decreased turgor of the epidermis are noted;
the skin becomes pale;
hyperpyretic fever.

When diagnosing the cardiovascular system, the following is detected:

thready pulse;
arterial hypo-, hypertension;
weakening of tone above the apex;
expansion of cardiac boundaries;
deterioration of patency inside large vascular trunks (arterial, venous).

When diagnosing the respiratory system, experts note:

tachypnea more than 40 per minute;
the presence of obstruction of the upper respiratory tract;
pulmonary edema;
attacks of bronchial asthma.

All these indicators indicate a very serious condition of the patient. In addition to the listed symptoms, the patient has vomiting, symptoms of diffuse peritonitis, profuse diarrhea, nasal, uterine, and gastric bleeding.

All patients with very serious conditions are subject to mandatory hospitalization. This means that their treatment is carried out in the intensive care unit.

Stable serious condition

Emergency room doctors use this term quite often. Many relatives of patients are interested in the question: Stable serious condition in intensive care, what does this mean?

Everyone knows what a very serious condition means; we examined it in the previous paragraph. But the expression “stable heavy” often scares people.

Patients in this condition are under constant supervision of specialists. Doctors and nurses monitor all vital signs of the body. What is most pleasing about this expression is the stability of the state. Despite the lack of improvement in the patient, there is still no deterioration in the patient’s condition.

A persistently severe condition can last from several days to weeks. It differs from the usual serious condition in the absence of dynamics or any changes. Most often, this condition occurs after major operations. Vital processes of the body are supported through special equipment. After turning off the equipment, the patient will be under close supervision of medical personnel.

Extremely serious condition

In this condition, there is a sharp disruption of all vital functions of the body. Without urgent treatment measures, the patient's death may occur. In this condition it is noted:

severe depression of the patient;
general cramps;
face pale, pointed;
heart sounds are faintly audible;
breathing problems;
wheezing is heard in the lungs;
blood pressure cannot be determined.

What does stable serious condition mean in intensive care?

The intensive care unit is a medical unit that provides care to patients with documented critical dysfunction of vital organs. Doctors, conducting a course of intensive therapy, monitor the patient’s well-being around the clock, diagnosing the severity of disorders and ways to eliminate them.

What does a stable serious condition in intensive care mean and why is it dangerous, we will tell you in our article.

Specifics of the intensive care unit

People with impaired functioning of vital systems and organs are admitted to the intensive care unit. Patients in critical condition with the following pathologies are referred to a specialized intensive care unit:

Progression of life-threatening illnesses;
Severe injuries;
Progression of diseases in the presence of severe injuries;
After using anesthesia;
After complex surgery;
Stroke damage;
Extensive burn lesions;
Respiratory and heart failure;
After traumatic brain injury accompanied by brain damage;
Venous thrombosis caused by pathologies of the nervous system;
TELA;
Pathological changes in the brain and central circulatory system.

Considering the criticality of the patient’s general well-being, round-the-clock monitoring is carried out in the intensive care unit, the purpose of which is to evaluate the functioning of all organs and systems. Experts determine the functionality of such indicators:

Arterial pressure;
The degree of saturation of the bloodstream with oxygen;
Heartbeat;
Breathing rate.

To monitor the dynamics of important systems and organs every minute, medical equipment sensors are connected to the patient’s body. In order to stabilize the patient’s general condition, in parallel with diagnostic studies, the necessary medications are administered intravenously. This is done with the help of droppers so that the medications enter the body continuously.

After a complex operation, patients are admitted to the intensive care unit with drainage tubes. With their help, doctors monitor the speed and quality of wound healing in the postoperative period. In dangerous situations, when a person is in extremely serious condition, additional medical devices are connected to him: a catheter for urine output, a mask for oxygen supply.

Patients in this condition are in an immobilized position. The patient must lie down, practically motionless, otherwise the required set of connected equipment may be damaged or torn off. In this case, he faces serious danger in the form of bleeding or cardiac arrest.

Severity of critical violations

To determine the level of severity of indicators of a critical condition, the doctor prescribes diagnostic tests. Their goal is to identify the degree of disturbance of the vital functions of the body, their manifestations and the possibility of recovery. Based on the diagnostic data obtained, intensive therapy is prescribed.

The criticality of the functioning of the patient's body is classified as follows:

Satisfactory;
Having moderate severity;
Serious condition;
Extremely heavy;
Terminal (with increasing hypoxia);
Clinical death.

After conducting a visual examination, interviewing relatives or studying the patient’s outpatient card (to determine the presence of chronic diseases), the doctor evaluates the following indicators:

Body weight;
Presence and clarity of consciousness;
Indicators of blood pressure and body temperature;
Heart rate to determine possible disorders of the cardiovascular system;
The presence of edema and signs of inflammation;
Color of skin and mucous membranes.

Sometimes such studies are not enough, and then the doctor prescribes laboratory and hardware diagnostics. After all, this is the only way to identify dangerous pathologies in the form of an open ulcer, acute leukemia or cancerous tumors.

Let's consider how the most dangerous resuscitation conditions caused by impaired functioning of the body manifest themselves.

Severe violations

The patient develops all signs of decompensation of systemic organs, which without appropriate therapy will lead to disability or death.

Most often, severe development of disorders occurs as a consequence of a dangerous pathology, which begins to rapidly progress, manifesting itself in vivid symptoms. Conscious patients present the following complaints:

Severe and frequent pain in the heart area;
Shortness of breath in a static position;
Prolonged anuria.

The patient experiences confusion, delirium, and agitation. He screams, asking for help, moans. Facial features look pointed. With confusion, a convulsive syndrome may occur.

In this condition, pathological changes in the cardiovascular system are observed:

Weak pulse;
Hypotension or hypertension;
Heart boundaries are violated;
The permeability of large vessels is difficult.

The body quickly becomes dehydrated, the skin becomes pale, almost gray, and cold to the touch. Extreme changes in the lung tissue are observed, which manifests itself in pulmonary edema or attacks of bronchial asthma.

From the gastrointestinal tract, the body’s reaction manifests itself as follows:

Treatment of such patients is carried out in the intensive care unit under continuous medical supervision.

Extremely severe violations

The patient’s health is rapidly deteriorating: life support systems are in a depressed state. Without timely medical intervention, death will occur.

Symptomatic manifestations of extremely severe disorders are as follows:

A sharp deterioration in general health;
Extensive cramps throughout the body;
The face becomes earthy gray in color, its features become sharper;
Heart sounds are barely audible;
Breathing is impaired;
When listening to the lungs, wheezing is clearly audible;
It is not possible to determine blood pressure indicators.

It is impossible to help a person with such violations on his own. The sooner medical help arrives, the greater the chance of saving the patient’s life. In this case, the only help that can be provided to the patient is to immediately call a resuscitation ambulance team.

Stable serious condition

Relatives of patients who were admitted to intensive care units hear from doctors the conclusion that their condition is stable and serious. Should I be afraid of such a diagnosis and what does it mean?

A stable condition means a disruption of the functioning of life-support systems of moderate severity, which, thanks to the efforts of doctors, does not become extremely severe. That is, no dynamic changes occur in the patient’s life support process: neither positive nor negative.

For such patients, 24-hour monitoring is provided using medical devices. They record the slightest changes in indicators that are monitored by medical staff. Violations that are consistently severe require the same therapy as in other cases: round-the-clock administration of medications to maintain the vital functions of the body.

The duration of absence of dynamic changes depends on the nature of the pathology and its severity. Thus, a stable, serious condition is often observed after surgery, when the patient is taken to the intensive care unit at the moment of recovery from anesthesia. Its duration ranges from 2 days to 3 weeks.

After the patient’s stable and serious condition has improved with the help of intensive therapy, he is disconnected from the equipment that artificially maintained life support. However, the patient and his condition continue to be closely monitored to adjust further drug treatment tactics.

Diagnostic examinations are then carried out, after which further treatment is expected.

/ assessment of the severity of the condition

METHODOLOGICAL DEVELOPMENT FOR TEACHERS AND STUDENTS

TO THE TOPIC “GENERAL EXAMINATION OF THE PATIENT”

Criteria for assessing general condition

2. Indications for emergency hospitalization, as well as the urgency and scope of treatment measures.

3. Nearest forecast.

The severity of the condition is determined by a complete examination of the patient

1. upon questioning and general examination (complaints, consciousness, position, skin color, swelling...);

2. when examining systems (respiratory rate, heart rate, blood pressure, ascites, bronchial breathing or absence of breath sounds over the lung area...);

3. after additional methods (blasts in the blood test and thrombocytopenia, infarction according to ECG, bleeding gastric ulcer according to FGDS...).

There are: satisfactory condition, moderate condition, severe condition and extremely severe condition.

The functions of vital organs are compensated.

There is no need for emergency hospitalization.

There is no threat to life.

Does not require care (care for a patient due to functional insufficiency of the musculoskeletal system is not a basis for determining the severity of the condition).

A satisfactory condition occurs in many chronic diseases with relative compensation of vital organs and systems (clear consciousness, active position, normal or subfebrile temperature, no hemodynamic disturbances...), or with a stable loss of function from the cardiovascular system, respiratory system, liver, kidneys, musculoskeletal system , nervous system but without progression, or with a tumor, but without significant dysfunction of organs and systems.

The functions of vital organs are compensated,

There is no immediate unfavorable prognosis for life,

There is no need for urgent treatment measures (receives planned therapy),

The patient takes care of himself (although there may be restrictions due to the pathology of the musculoskeletal system and diseases of the nervous system).

Moderate condition

2. There is a need for emergency hospitalization and treatment.

3. There is no immediate threat to life, but there is a possibility of progression and development of life-threatening complications.

4. Motor activity is often limited (active position in bed, forced), but they can take care of themselves.

Examples of symptoms detected in a patient with a moderate condition:

Complaints: intense pain, severe weakness, shortness of breath, dizziness;

Objectively: consciousness is clear or stunned, high fever, severe edema, cyanosis, hemorrhagic rashes, bright jaundice, heart rate more than 100 or less than 40, respiratory rate more than 20, bronchial obstruction, local peritonitis, repeated vomiting, severe diarrhea, moderate intestinal bleeding, ascites ;

Additionally: infarction on the ECG, high transaminases, blasts and thrombocytopenia less than 30 thousand / μl in an. blood (there may be a condition of moderate severity even without clinical manifestations).

2. There is a need for emergency hospitalization and treatment (treatment in an intensive care unit).

3. There is an immediate threat to life.

4. Motor activity is often limited (active position in bed, forced, passive), they cannot care for themselves, they need care.

Examples of symptoms detected in a patient with a serious condition:

Complaints: unbearable prolonged pain in the heart or abdomen, severe shortness of breath, severe weakness;

Objectively: consciousness may be impaired (depression, agitation), anasarca, severe pallor or diffuse cyanosis, high fever or hypothermia, threadlike pulse, severe arterial hypertension or hypotension, shortness of breath over 40, prolonged attack of bronchial asthma, incipient pulmonary edema, uncontrollable vomiting, diffuse peritonitis, massive bleeding.

Extremely serious condition

1. Severe decompensation of the functions of vital organs and systems

2. There is a need for urgent and intensive treatment measures (in intensive care conditions)

3. There is an immediate threat to life in the next minutes or hours

4. Motor activity is significantly limited (the position is often passive)

Examples of symptoms detected in a patient in extremely serious condition:

Objectively: the face is deathly pale, with pointed features, cold sweat, pulse and blood pressure are barely detectable, heart sounds are barely audible, RR up to 60, alveolar pulmonary edema, “silent lung”, pathological Kussmaul or Cheyne-Stokes breathing...

It is based on 4 criteria (indicated by numbers in the justification for the examples):

2. Indications for emergency hospitalization, as well as the urgency and volume of treatment

4. Motor activity and need for care.

Bilateral coxarthrosis III–IVst. FN 3.

Satisfactory condition (caring for a patient due to functional insufficiency of the musculoskeletal system is not a basis for determining the severity of the condition).

Bronchial asthma, attacks 4-5 times a day, self-limiting, dry wheezing in the lungs.

Iron deficiency anemia, Hb100g/l.

IHD: stable angina. Extrasystole. NK II.

Diabetes mellitus with angiopathy and neuropathy, sugar 13 mmol/l, consciousness is not impaired, hemodynamics are satisfactory.

Hypertonic disease. Blood pressure 200/100 mmHg. But not a crisis. Blood pressure decreases with outpatient treatment.

Acute myocardial infarction without hemodynamic disturbances, according to ECT: STabove the isoline.

Moderate condition (2.3).

Myocardial infarction, without hemodynamic disturbances, subacute period, according to ECG: ST on the isoline.

Myocardial infarction, subacute period, according to ECG: ST on the isoline, with normal blood pressure, but with an emerging rhythm disturbance.

Moderate condition (2, 3)

Pneumonia, volume – segment, not feeling well, low-grade fever, weakness, cough. There is no shortness of breath at rest.

Moderate condition (2, 3).

Pneumonia, volume – lobe, fever, shortness of breath at rest. The patient prefers to lie down.

Moderate condition (1,2,4).

Pneumonia, volume - a fraction or more, fever, tachypnea 36 per minute, decreased blood pressure, tachycardia.

The condition is severe (1,2,3,4).

Cirrhosis of the liver. I feel good. Enlarged liver, spleen. There is no ascites or slight ascites according to ultrasound.

Cirrhosis of the liver. Hepatic encephalopathy, ascites, hypersplenism. The patient walks and takes care of himself.

Moderate condition (1.3)

Cirrhosis of the liver. Ascites, impaired consciousness and/or hemodynamics. Needs care.

The condition is severe (1,2,3,4).

Wegener's granulomatosis. Fever, pulmonary infiltrates, shortness of breath, weakness, progressive decline in renal function. Arterial hypertension is controlled with medication. Prefers to be in bed, but can walk and care for himself.

Moderate condition (1,2,3,4).

Wegener's granulomatosis. Abnormalities in blood tests remain, stage II chronic renal failure.

Determination of medical age, significance for diagnosis.

1) Determining medical age is of no small importance, for example, in forensic medical practice. The doctor may be asked to determine the age due to the loss of documents. It is taken into account that with age the skin loses elasticity, becomes dry, rough, wrinkled, pigmentation and keratinization appear. At the age of about 20 years, frontal and nasolabial wrinkles already appear, at about 25 years - at the outer corner of the eyelids, by 30 years - under the eyes, at 35 years - on the neck, about 55 - in the area of the cheeks, chin, and around the lips.

On the hands, up to 55 years of age, the skin, folded, quickly and well straightens out; at 60 years old, it straightens out slowly, and at 65, it no longer straightens out on its own. With age, teeth wear away on the cutting surface, darken, and fall out.

By the age of 60, the cornea of the eyes begins to lose transparency, whitishness (arcussenilis) appears at the edges, and by the age of 70, the senile arc is already clearly expressed.

It should be remembered that medical age does not always correspond to metric age. There are eternally young subjects, on the other hand – prematurely aged ones. Patients with increased thyroid function look younger than their age - usually thin, slender, with delicate pink skin, sparkle in the eyes, active, emotional. Premature aging is caused by mexedema, malignant tumors and some long-term severe diseases.

Determining age is also important because each age is characterized by certain diseases. There is a group of childhood diseases that are studied in the course of pediatrics; on the other hand, gerontology is the science of diseases of the elderly and senile age /75 years or more/.

Age groups /Guide to Gerontology, 1978/:

Children's age - reaching age.

Teenage - fly away.

Youthful years have come.

Young – departure to 29 years of age.

Mature – from 33 years to 44 years.

Average – from 45 to 59 years.

Elderly – from 60 years to 74 years.

Old – from 75 years to 89 years.

Long-livers – from 90 and more.

At a young age they often suffer from rheumatism, acute nephritis, and pulmonary tuberculosis. In adulthood, the body is most stable and least susceptible to disease.

The patient’s age must also be taken into account due to the fact that it has a significant impact on the course of the disease and prognosis /outcomes/: at a young age, diseases mostly progress rapidly, their prognosis is good; in the elderly, the body’s reaction is sluggish, and those diseases that end in recovery at a young age, for example, pneumonia, are often the cause of death in old people.

Finally, during certain age periods, sharp changes occur in both the somatic and neuropsychic spheres:

a) period of puberty / puberty / - from 14 - 15 years to 18 - 20 years - characterized by increased morbidity, but relatively low mortality;

b) the period of sexual decline /menopause/ - from 40 – 45 years to 50 years is marked by a tendency to cardiovascular, metabolic and mental diseases /functional disorders of a vasomotor, endocrine-nervous and mental nature appear/.

c) The period of aging - from 65 years to 70 years - during this period it is difficult to separate purely age-related wear and tear from the symptoms of a specific disease, in particular atherosclerosis.

The doctor determines whether the gender and age correspond to the passport data when questioning the patient, and records deviations in the medical history if they are identified, for example: “the patient looks older than his age” or “the medical age corresponds to the metric age.”

What does the term “serious patient condition” mean?

First of all, it is necessary for relatives to understand: detailed information is not given over the phone, this is incorrect. Usually relatives come at set hours and are personally informed about the patient’s condition. When they call the hospital information line, they are usually read out minimal information - the severity of the patient's condition and temperature. Everyone is guided by temperature. People are usually scared by the phrases “severe” or “extremely difficult.” It is clear that every relative and loved one is worried about their person who is in intensive care.

There are only two types of patients in the intensive care unit: severe and extremely severe. There are no others. Extremely severe patients are hospitalized due to severe disorders - in terms of the volume of injury, the volume of decompensation of the disease. Extremely severe cases are most often patients on mechanical ventilation. It may also be due to unstable heart function, as doctors say: “With unstable hemodynamics,” when drugs are used that stimulate the work of the heart and blood vessels. I wouldn’t want someone’s loved one or relative to end up in the intensive care unit.

If a patient moves from the status of “severe” to moderate, moderate, he goes to a regular ward, where he usually progresses in treatment.

Reanimation

Resuscitation: definition, algorithm, features of the intensive care unit

Resuscitation is a set of activities that can be carried out by both medical professionals and ordinary people, aimed at reviving a person who is in a state of clinical death. Its main signs are the absence of consciousness, spontaneous breathing, pulse and pupillary reaction to light. Intensive care is also the name given to the department in which the most critically ill patients are treated, those on the brink of life and death, and the specialized emergency teams that treat such patients. Pediatric resuscitation is a very complex and responsible branch of medicine, which helps save the youngest patients from death.

Resuscitation in adults

The algorithm for performing cardiopulmonary resuscitation in men and women is not fundamentally different. The main task is to achieve restoration of airway patency, spontaneous breathing and maximum chest excursion (amplitude of rib movement during the procedure). However, the anatomical features of obese people of both sexes make it somewhat difficult to carry out resuscitation measures (especially if the resuscitator does not have a large physique and sufficient muscle strength). For both sexes, the ratio of respiratory movements to chest compressions should be 2:30, the frequency of chest compressions should be about 80 per minute (as happens with spontaneous contraction of the heart).

Resuscitation of children

Pediatric resuscitation is a separate science, and it is most competently carried out by doctors with a specialization in pediatrics or neonatology. Children are not small adults; their bodies are designed in a special way, so in order to provide emergency assistance in case of clinical death in children, you need to know certain rules. Indeed, sometimes, out of ignorance, incorrect techniques for resuscitating children lead to death in cases where this could have been avoided.

Pediatric intensive care

Very often, the cause of respiratory and cardiac arrest in children is aspiration of foreign bodies, vomiting or food. Therefore, before you start, you need to check for foreign objects in your mouth; to do this, you need to open it slightly and examine the visible part of the pharynx. If present, try to remove them yourself by placing the baby on his stomach with his head down.

The lung capacity of children is smaller than that of adults, so when performing artificial respiration it is better to resort to the mouth-to-nose method and inhale a small volume of air.

The heart rate in children is higher than in adults, so resuscitation of children should be accompanied by more frequent pressure on the sternum during chest compressions. For children under 10 years old - 100 per minute, by applying pressure with one hand with an amplitude of chest oscillation of no more than 3-4 cm.

Pediatric resuscitation is an extremely important undertaking, but while waiting for an ambulance you should at least try to help your baby, because this could cost him his life.

Neonatal resuscitation

Neonatal resuscitation is not a rare procedure that is performed by doctors in the delivery room immediately after the birth of a baby. Unfortunately, birth does not always go smoothly; sometimes severe injuries, prematurity, medical procedures, intrauterine infections and the use of general anesthesia for caesarean section lead to the fact that the child is born in a state of clinical death. The absence of certain manipulations within the framework of neonatal resuscitation leads to the fact that the child may die.

Fortunately, neonatologists and pediatric nurses practice all actions until they become automatic, and in the vast majority of cases they manage to restore the child’s blood circulation, although sometimes he spends some time on a ventilator. Considering the fact that newborn children have a great ability to recover, most of them do not subsequently have health problems caused by a not very successful start to their lives.

What is human resuscitation

The word “reanimation” translated from Latin literally means “re-giving life.” Thus, human resuscitation is a set of certain actions that are carried out by medical workers or ordinary people who happen to be nearby, under favorable circumstances, which make it possible to bring a person out of a state of clinical death. After this, in the hospital, if indicated, a number of therapeutic measures are carried out aimed at restoring the vital functions of the body (the functioning of the heart and blood vessels, the respiratory and nervous systems), which are also part of the resuscitation. This is the only correct definition of the word, but it is widely used in other meanings.

Very often this term is used to refer to a department that has the official name “resuscitation and intensive care unit.” However, it is long and not only ordinary people, but also medical professionals themselves shorten it to one word. Reanimation is also often referred to as a specialized emergency medical care team that responds to calls for people in extremely serious condition (sometimes clinically dead). They are equipped with everything necessary to carry out various types of measures that may be needed in the process of resuscitation of a victim in severe road transport, industrial or criminal accidents, or those who suddenly experienced a sharp deterioration in health, leading to a threat to life (various shocks, asphyxia, cardiac diseases, etc.).

Specialty: anesthesiology and resuscitation

The work of any doctor is hard work, as doctors have to take great responsibility for the life and health of their patients. However, the specialty “anesthesiology and resuscitation” stands out especially among all other medical professions: these doctors bear a very heavy burden, since their work is related to providing assistance to patients who are on the verge of life and death. Every day they encounter the most critically ill patients and are required to make immediate decisions that directly affect their lives. Intensive care patients require attention, constant monitoring and a thoughtful attitude, because any mistake can lead to their death. A particularly heavy burden falls on doctors who deal with anesthesiology and resuscitation of the youngest patients.

What should an anesthesiologist and resuscitator be able to do?

A doctor specializing in anesthesiology and resuscitation has two main and main tasks: treating seriously ill patients in the intensive care unit and assisting with surgical interventions related to the selection and implementation of pain relief (anesthesiology). The work of this specialist is prescribed in job descriptions, so the doctor must carry out his activities in accordance with the main points of this document. Here are some of them:

Assess the patient's condition before surgery and prescribe additional diagnostic measures in cases where there are doubts regarding the possibility of surgical treatment under anesthesia.
Organizes a workplace in the operating room, monitors the serviceability of all devices, in particular the ventilator, monitors for tracking pulse, pressure and other indicators. Prepares all necessary tools and materials.
Directly carries out all activities within the framework of a pre-selected type of anesthesia (general, intravenous, inhalation, epidural, regional, etc.).
Monitors the patient's condition during the operation, if it sharply worsens, reports this to the surgeons who directly perform it, and takes all necessary measures to correct this condition.
After the operation is completed, the patient is brought out of the state of anesthesia or other type of anesthesia.
During the postoperative period, he monitors the patient’s condition and, in case of unforeseen situations, takes all necessary measures to correct it.
In the intensive care unit, he treats seriously ill patients using all the necessary techniques, manipulations and pharmacotherapy.
A doctor specializing in anesthesiology and resuscitation must be proficient in various types of vascular catheterization, methods of tracheal intubation and artificial ventilation, and perform various types of anesthesia.
In addition, he must be fluent in such an important skill as cerebral and cardiopulmonary resuscitation, know the methods of treating all major emergency life-threatening conditions, such as various types of shocks, burn disease, polytrauma, various types of poisoning, cardiac arrhythmias and conduction disorders, tactics for especially dangerous infections, etc.

The list of what an anesthesiologist and resuscitator should know is endless, because there are a great many serious conditions that he may encounter on his shift, and in any situation he must act quickly, confidently and surely.

In addition to the knowledge and skills that relate to his professional activity, a doctor in this specialty must improve his qualifications every 5 years, attend conferences, and improve his skills.

How to study in the specialty “anesthesiology and resuscitation”

In general, any doctor studies throughout his life, because this is the only way he can provide quality care at any time according to all modern standards. In order to get a job as a doctor in the intensive care unit, a person must study for 6 years in the specialty “medicine” or “pediatrics”, and then undergo a 1-year internship, 2-year residency or professional retraining courses (4 months ) with a specialty in anesthesiology and resuscitation. Residency is the most preferable, since such a complex profession cannot be mastered well in a shorter period of time.

Next, a doctor in this specialty can begin to work independently, but in order to feel more or less comfortable in this role, he needs another 3-5 years. Every 5 years, a doctor must undergo 2-month advanced training courses at one of the departments at the institute, where he learns about all the innovations, medicinal innovations and modern methods of diagnosis and treatment.

Cardiopulmonary resuscitation: basic concepts

Despite the achievements of modern medical science, cardiopulmonary resuscitation is still the only way to bring a person out of clinical death. If you do not take any action, then it will inevitably be replaced by true death, that is, biological, when the person can no longer be helped.

In general, everyone should know the basics of cardiopulmonary resuscitation, because anyone has a chance to be close to such a person and his life will depend on his determination. Therefore, before the ambulance arrives, you need to try to help the person, since in this state every minute counts, and the car cannot arrive instantly.

What is clinical and biological death

Before touching on the main aspects of such an important procedure as cardiopulmonary resuscitation, it is worth mentioning the two main stages of the process of extinction of life: clinical and biological (true) death.

In general, clinical death is a reversible condition, although it lacks the most obvious signs of life (pulse, spontaneous breathing, constriction of the pupils under the influence of a light stimulus, basic reflexes and consciousness), but the cells of the central nervous system have not yet died. It usually lasts no more than 5-6 minutes, after which neurons, which are extremely vulnerable to oxygen starvation, begin to die and true biological death occurs. However, you need to know the fact that this time interval is very dependent on the ambient temperature: at low temperatures (for example, after removing a patient from under a snowbank) it can be minutes, while in the heat the period when resuscitation of a person can be successful, is reduced to 2-3 minutes.

Carrying out resuscitation during this period of time gives a chance to restore the functioning of the heart and the breathing process, and prevent the complete death of nerve cells. However, it is not always successful, because the result depends on the experience and correctness of this difficult procedure. Doctors, who, due to the nature of their work, often encounter situations requiring intensive resuscitation, are fluent in it. However, clinical death often occurs in places remote from the hospital and all responsibility for its implementation falls on ordinary people.

If resuscitation was started 10 minutes after the onset of clinical death, even if the heart and breathing were restored, irreparable death of some neurons has already occurred in the brain and such a person will most likely not be able to return to a full life. Minutes after the onset of clinical death, resuscitation of a person does not make sense, since all the neurons have died, and, nevertheless, when the heart function is restored, special devices can continue the life of such a person (the patient himself will be in the so-called “vegetative state”).

Biological death is recorded 40 minutes after clinical death is established and/or at least half an hour of unsuccessful resuscitation measures. However, its true signs appear much later - 2-3 hours after the cessation of blood circulation through the vessels and spontaneous breathing.

Conditions requiring resuscitation

The only indication for cardiopulmonary resuscitation is clinical death. Without making sure that the person is not in it, you should not torment him with your attempts to resuscitate him. However, true clinical death is a condition in which resuscitation is the only treatment method - no medications can artificially resume the work of the heart and the breathing process. It has absolute and relative signs that make it possible to suspect it quickly enough, even without special medical education.

Absolute signs of a condition requiring resuscitation include:

The patient shows no signs of life and does not answer questions.

In order to determine whether the heart is working or not, it is not enough to put your ear to the cardiac area: in very obese people or with low blood pressure, you may simply not hear it, mistaking this condition for clinical death. The pulsation on the radial artery is also sometimes very weak, and its presence depends on the anatomical location of the vessel. The most effective method for determining the presence of a pulse is to check it on the carotid artery on the side of the neck for at least 15 seconds.

Whether or not a patient in critical condition is breathing is also sometimes difficult to determine (with shallow breathing, vibrations of the chest are practically invisible to the naked eye). To accurately determine whether a person is breathing or not and begin intensive resuscitation, you need to apply a sheet of thin paper, cloth or a blade of grass to the nose. The air exhaled by the patient will cause these objects to vibrate. Sometimes it is enough to simply put your ear to the nose of a sick person.

The reaction of the pupils to a light stimulus.

This symptom is quite simple to check: you need to open the eyelid and shine a flashlight, lamp or turned on mobile phone on it. The absence of reflex constriction of the pupil, together with the first two symptoms, serves as an indication that intensive resuscitation should be started as soon as possible.

Relative signs of clinical death:

Pale or livid skin color
Lack of muscle tone (raised arm falls limply to the ground or bed),
Lack of reflexes (an attempt to prick a patient with a sharp object does not lead to a reflex contraction of the limb).

They in themselves are not an indication for resuscitation, but in combination with absolute signs they are symptoms of clinical death.

Contraindications for intensive resuscitation

Unfortunately, sometimes a person suffers from such serious illnesses and is in critical condition, in which resuscitation does not make sense. Of course, doctors are trying to save the life of anyone, but if the patient suffers from a terminal stage of cancer, systemic or cardiovascular disease, which has led to decompensation of all organs and systems, then trying to restore his life will only prolong his suffering. Such conditions are a contraindication for intensive resuscitation.

In addition, cardiopulmonary resuscitation is not performed if there are signs of biological death. These include:

Presence of cadaveric spots.
Clouding of the cornea, change in the color of the iris and the cat's eye symptom (when the eyeball is compressed from the sides, the pupil takes on a characteristic shape).
Presence of rigor mortis.

Severe injury incompatible with life (for example, avulsion of the head or large part of the body with massive bleeding) is a situation in which intensive resuscitation is not carried out due to its futility.

Cardiopulmonary resuscitation: algorithm of action

Everyone should know the basics of this emergency procedure, but medical workers, especially emergency services staff, are fluent in it. Cardiopulmonary resuscitation, the algorithm for which is very clear and specific, can be carried out by anyone, since this does not require special equipment and devices. Ignorance or incorrect implementation of basic rules leads to the fact that when the emergency team arrives at the victim, he no longer needs resuscitation, since there are initial signs of biological death and time has already been lost.

The main principles by which cardiopulmonary resuscitation is carried out, the algorithm of actions for a person who accidentally finds himself next to a patient:

Move the person to a place convenient for resuscitation (if there are no visual signs of a fracture or massive bleeding).

Assess the presence of consciousness (answers questions or not) and reaction to stimuli (use a nail or a sharp object to press on the phalanx of the patient’s finger and see if there is a reflex contraction of the hand).

Check for breathing. First, assess whether there is movement of the chest or abdominal wall, then lift the patient and again monitor whether there is breathing. Bring your ear to his nose to auscultate breathing sounds or a thin cloth, thread or leaf.

Assess the reaction of the pupils to light by pointing a burning flashlight, lamp or mobile phone at them. In case of poisoning with narcotic substances, the pupils may be constricted, and this symptom is not informative.

Check for heartbeat. Monitor the pulse for at least 15 seconds on the carotid artery.

If all 4 signs are positive (no consciousness, pulse, breathing and reaction of the pupil to light), then clinical death can be stated, which is a condition requiring resuscitation. It is necessary to remember the exact time when it occurred, if this is of course possible.

If you find out that a patient is clinically dead, you need to call for help from everyone who is near you - the more people who help you, the greater the chance of saving the person.

One of the people who is helping you should immediately call emergency services, be sure to provide all the details of the incident, and carefully listen to all instructions from the service dispatcher.

While one calls an ambulance, the other must immediately begin cardiopulmonary resuscitation. The algorithm for this procedure involves a number of manipulations and specific techniques.

Resuscitation technique

First, it is necessary to clean the contents of the oral cavity from vomit, mucus, sand or foreign bodies. This should be done with the patient in a position on his side, with his hand wrapped in a thin cloth.

After this, in order to avoid blocking the respiratory tract with the tongue, it is necessary to place the patient on his back, open his mouth slightly and move his jaw forward. In this case, you need to place one hand under the patient’s neck, tilt his head back, and perform the manipulation with the other. A sign of correct jaw position is a slightly open mouth and the position of the lower teeth directly at the same level as the upper teeth. Sometimes spontaneous breathing is completely restored after this procedure. If this does not happen, then the following points must be followed.

Next you need to start artificial ventilation. Its essence is as follows: a man or woman who resuscitates a person is positioned on his side, one hand is placed under the neck, the other is placed on the forehead and the nose is pinched. Next, they take a deep breath and exhale tightly into the mouth of the person who is in clinical death. After which excursion (chest movement) should be visible. If, instead, a protrusion of the epigastric region is visible, it means that air has entered the stomach, the reason for this is most likely related to obstruction of the respiratory tract, which must be tried to eliminate.

The third point of the cardiopulmonary resuscitation algorithm is to perform closed cardiac massage. To do this, the person providing assistance must position himself on either side of the patient, place his hands one on top of the lower part of the sternum (they should not be bent at the elbow joint), after which he must apply intense pressure to the corresponding area of the chest. The depth of these presses should ensure movement of the ribs to a depth of at least 5 cm, lasting about 1 second. You need to make 30 such movements, then repeat two breaths. The number of compressions during artificial chest compressions should coincide with its physiological contraction - that is, carried out at a frequency of about 80 per minute for an adult.

Carrying out cardiopulmonary resuscitation is hard physical work, because pressing must be carried out with sufficient force and continuously until the emergency team arrives and continues all these activities. Therefore, it is optimal for several people to carry it out in turn, because at the same time they have the opportunity to relax. If there are two people next to the patient, one can perform one cycle of pressing, the other can perform artificial ventilation, and then change places.

Providing emergency care in cases of clinical death in young patients has its own characteristics, so resuscitation of children or newborns differs from that of adults. The first thing to consider is that they have a much smaller lung capacity, so trying to breathe too much into them can result in injury or rupture of the airway. Their heart rate is much higher than that of adults, so resuscitation of children under 10 years of age involves performing at least 100 compressions on the chest and extruding it no more than 3-4 cm. Resuscitation of newborns should be even more careful and gentle: artificial ventilation of the lungs is carried out not into the mouth, but into the nose, and the volume of air blown in should be very small (about 30 ml), but the number of presses is at least 120 per minute, and they are carried out not with the palm, but simultaneously with the index and middle fingers.

Cycles of artificial ventilation of the lungs and closed cardiac massage (2:30) should replace each other until emergency doctors arrive. If you stop performing these manipulations, a state of clinical death may occur again.

Criteria for the effectiveness of resuscitation measures

Resuscitation of a victim, and indeed any person who has been clinically dead, must be accompanied by constant monitoring of his condition. The success of cardiopulmonary resuscitation, its effectiveness can be assessed by the following parameters:

Improved skin color (more pink), reduction or complete disappearance of cyanosis of the lips, nasolabial triangle, and nails.
Constriction of the pupils and restoration of their reaction to light.
The appearance of breathing movements.
The pulse appears first in the carotid artery, and then in the radial artery; the heartbeat can be heard through the chest.

The patient may be unconscious, the main thing is to restore the heart and free breathing. If pulsation appears, but breathing does not, then you should continue only artificial ventilation until the emergency team arrives.

Unfortunately, resuscitation of the victim does not always lead to a successful result. The main mistakes when carrying it out:

The patient is on a soft surface, the force that the resuscitator applies when pressing on the chest is dampened by body vibration.
Insufficient pressure intensity, which leads to chest excursion of less than 5 cm in adults.
The cause of airway obstruction has not been eliminated.
Incorrect hand position during ventilation and cardiac massage.
Delayed initiation of cardiopulmonary resuscitation.
Pediatric resuscitation may be unsuccessful due to insufficient frequency of chest compressions, which should be much more frequent than in adults.

During resuscitation, injuries such as a fractured sternum or ribs may develop. However, these conditions themselves are not as dangerous as clinical death, so the main task of the person providing assistance is to return the patient to life at any cost. If successful, treatment of these fractures is not difficult.

Resuscitation and intensive care: how the department works

Resuscitation and intensive care is a department that should be present in any hospital, as it treats the most severe patients who require close monitoring by medical professionals around the clock

Who is an intensive care patient?

Intensive care patients are the following categories of people:

patients who are admitted to the hospital in extremely serious condition, on the verge between life and death (comas of varying degrees, severe poisoning, shocks of various origins, massive bleeding and injuries, after myocardial infarction and stroke, etc.).
patients who experienced clinical death at the prehospital stage,
patients who were previously in a specialized department, but their condition sharply worsened,
patients on the first day or several after surgery.

Intensive care patients are usually transferred to specialized departments (therapy, neurology, surgery or gynecology) after stabilizing their condition: restoring spontaneous breathing and the ability to eat, emerging from a coma, maintaining normal pulse and blood pressure.

Equipment in the intensive care unit

The intensive care unit is the most technically equipped, because the condition of such seriously ill patients is completely monitored by various monitors, a number of them are given artificial ventilation, medications are constantly administered through various infusion pumps (devices that allow the administration of substances at a certain speed and maintain their concentration in the blood at the same level) .

There are several zones in the intensive care unit:

The treatment area where the wards are located (each of them has 1-6 patients),
Offices of doctors (residency), nurses (nursing), head of department and head nurse.
An auxiliary area where everything necessary to monitor the cleanliness of the department is stored; junior medical staff often rest there.
Some intensive care units are equipped with their own laboratory, where emergency tests are carried out, and there is a doctor or paramedic laboratory assistant there.

Near each bed there is its own monitor, on which you can track the main parameters of the patient’s condition: pulse, pressure, oxygen saturation, etc. Nearby there are machines for artificial lung ventilation, an oxygen therapy device, a pacemaker, various infusion pumps, and IV stands. Depending on the indications, other special equipment may be delivered to the patient. The intensive care unit can perform emergency hemodialysis. In each ward there is a table where a resuscitator works with papers or a nurse draws up an observation card.

Beds for intensive care patients differ from those in regular departments: there is an opportunity to give the patient an advantageous position (with the head or legs raised), and to fix the limbs if necessary.

The intensive care unit employs a large number of medical personnel who ensure the coordinated continuous operation of the entire department:

head of the resuscitation and intensive care unit, senior nurse, hostess nurse,
anesthesiologists-resuscitators,
nurses,
junior medical staff,
staff of the resuscitation laboratory (if there is one),
support services (which monitor the serviceability of all devices).

City intensive care

City intensive care unit is all the intensive care units of the city, which are ready at any moment to receive seriously ill patients brought to them by ambulance teams. Typically, in every major city there is one leading clinic that specializes in providing emergency care and is on duty constantly. This is exactly what can be called urban intensive care. And, nevertheless, if a seriously ill patient was brought to the emergency department of any clinic, even one that does not provide assistance on that day, he will certainly be admitted and receive all the necessary help.

The city intensive care unit accepts not only those who are delivered by emergency teams, but also those who are independently brought by relatives or friends in personal transport. However, in this case, time will be lost, because the treatment process continues at the pre-hospital stage, so it is better to trust the specialists.

Regional resuscitation

Regional intensive care unit is the intensive care unit at the largest regional hospital. Unlike the city intensive care unit, the most critically ill patients are brought here from all over the region. Some regions of our country have very large territories, and delivery of patients by car or ambulance is not possible. Therefore, sometimes patients are delivered to the regional intensive care unit by air ambulance (helicopters specially equipped to provide emergency care), which a specialized vehicle is waiting for at the airport when they land.

The regional intensive care unit treats patients who were unsuccessfully tried to recover from their serious condition in city hospitals and interregional centers. It employs many highly specialized doctors involved in a specific profile (hemostasiologist, combustiologist, toxicologist, etc.). However, the regional intensive care unit, like any other hospital, accepts patients who are delivered by a regular ambulance.

How to resuscitate a victim

First aid to a victim who is in a state of clinical death should be provided by those nearby. The technique is described in section 5.4-5.5. At the same time, it is necessary to call emergency assistance and perform cardiopulmonary resuscitation either until spontaneous breathing and heartbeat are restored, or until it arrives. After this, the patient is transferred to specialists, and then they continue the resuscitation work.

How to resuscitate a victim in emergency conditions

Upon arrival, doctors assess the condition of the victim, whether or not there was an effect from the cardiopulmonary resuscitation performed at the pre-medical stage. They must definitely clarify the exact onset of clinical death, because after 30 minutes it is considered ineffective.

Doctors perform artificial ventilation of the lungs with a breathing bag (Ambu), since prolonged mouth-to-mouth or mouth-to-nose breathing reliably leads to infectious complications. In addition, it is not so physically difficult and allows you to transport the victim to a hospital without stopping this procedure. There is no artificial substitute for indirect cardiac massage, so the doctor carries it out according to the general canons.

If the result is successful, when the pulse resumes, the patient is catheterized and substances that stimulate the heart (adrenaline, prednisolone) are administered, and heart function is monitored by monitoring the electrocardiogram. To restore spontaneous breathing, an oxygen mask is used. In this condition, the patient is taken to the nearest hospital after resuscitation.

How does a reanimobile work?

If the ambulance control room receives a call reporting that a patient has signs of clinical death, a specialized team is immediately sent to him. However, not every ambulance is equipped with everything necessary for emergencies, but only a reanimobile. This is a modern car, specially equipped for cardiopulmonary resuscitation, equipped with a defibrillator, monitors, and infusion pumps. It is convenient and comfortable for the doctor to provide all types of emergency care. The shape of this car makes it easier to maneuver in the traffic of others, and sometimes it has a bright yellow color, which allows other drivers to quickly notice it and let it pass ahead.

An ambulance labeled “neonatal intensive care” is also usually painted yellow and is equipped to provide emergency care to the smallest patients in distress.

Rehabilitation after resuscitation

A person who has experienced clinical death divides his life into “before” and “after”. However, the consequences of this condition can be completely different. For some, this is just an unpleasant memory and nothing more. And others cannot fully recover after resuscitation. It all depends on the speed at which resuscitation measures are initiated, their quality, effectiveness and how quickly specialized medical assistance arrives.

Features of patients who experienced clinical death

If resuscitation measures were started in a timely manner (within the first 5-6 minutes from the onset of clinical death) and quickly led to results, then the brain cells did not have time to die. Such a patient can return to a full life, but certain problems with memory, level of intelligence, and ability in exact sciences cannot be ruled out. If breathing and heartbeat were not restored within 10 minutes against the background of all measures, then, most likely, such a patient after resuscitation, even according to the most optimistic forecasts, will suffer from serious disturbances in the functioning of the central nervous system, in some cases, various skills and abilities are irreversibly lost, memory, sometimes the ability to move independently.

If more than 15 minutes have passed since the onset of clinical death, the work of breathing and the heart can be supported artificially by means of active cardiopulmonary resuscitation using various devices. But the patient’s brain cells have already died and he will continue to be in a so-called “vegetative state,” that is, there are no prospects of returning him to life without life support devices.

Main directions of rehabilitation after resuscitation

The scope of rehabilitation activities after resuscitation directly depends on how long the person was previously in a state of clinical death. A neurologist will be able to assess the extent to which the nerve cells of the brain have been damaged, and he will also outline all the necessary treatment as part of the recovery. It may include various physical procedures, physical therapy and gymnastics, taking nootropic, vascular drugs, B vitamins. However, with timely resuscitation measures, clinical death may not affect the fate of the person who suffered it.

A person’s critical condition is determined by a set of symptoms that are determined by a separate branch of medicine. The risk group often includes patients with chronic diseases. Patients are less common after emergencies. Systematization of diseases that lead to dangerous outcomes helps reduce the number of severe cases.

Areas of rehabilitation medicine

The purpose of studying patients is:

improving the quality of life of incurable patients;
help to prolong life;
exclusion of such advanced cases in healthy people.

Timely rehabilitation of patients in extremely difficult conditions helps to fully study the problem of incurable diseases. Each new successful experiment suggests that such incidents can be completely prevented. But at the moment, classical approaches are not able to save people from a pre-mortem diagnosis.

By moving in the direction of emergency care for patients, it is possible to achieve significant improvements in the condition of the patient’s body. From the above it follows: medicine that excludes a critical condition gives people with severe forms of illness a chance to return to normal life in the future. Science is constantly moving forward, and perhaps there will be a solution to problems that are currently not yet available to doctors.

The problem of saving patients

The basics of resuscitation of each patient should be known to all doctors in any field. The direction of returning a person to life lies on the shoulders of even an ordinary therapist in order to recognize critical conditions of the body in time. However, the most experienced specialists in this field are:

ambulance workers;
resuscitators;
anesthesiologists;
intensivists.

Resuscitation is aimed at the area in which pathological changes have occurred in humans. Well-established techniques allow patients to be brought back to life even at home, on their own. Replenishment of experience describing a critical condition is carried out daily. Each positive outcome is studied in detail, new techniques are introduced to eliminate deaths.

Classification of the field of resuscitation

Critical differs according to the type of chronic disease:

Central nervous system - polio, Creutzfeldt-Jakob disease.
Internal organs: liver - cirrhosis, hepatitis, cancerous lesions; kidneys - subacute glomerulonephritis, renal failure, amyloidosis.
Circulatory system - leukemia, hypertension, thrombosis.
Respiratory system - cancer, obstructive disease, emphysema.
Cerebral cortex - cerebrovascular disease, tumor, vascular sclerosis.

Each area differs in the specifics of the rehabilitation approach and has its own characteristics of the recovery period. Mixed types of diseases are also taken into account.

The statistics include infections:

Mixed types pose the greatest danger to humans. They can provoke severe conditions and clinical forms of inflammation. Critical conditions in children are associated with mixed infections, especially in newborns.

What has already been achieved in the field of resuscitation?

Treatment of critical illnesses has already helped reduce the number of the following patients:

The first benefit of rehabilitation measures is saving the lives of patients on the brink.
Reducing disability in the population.
Incurable diseases can be operated on.
The treatment period is significantly reduced.
Recurrence of chronic inflammation is excluded.

Restoring the body of incurable patients is the main task of the field of medicine. There are practical examples of helping people who have previously been diagnosed with a near-death condition. The essential value of the resuscitation approach lies in the economic return on such investments.

In the future, not only the patient's current chronic diseases should be assessed, but also the possible critical condition. Substances for resuscitation are selected in advance so that when health deteriorates, they can be used immediately.

What are the prospects for the development of resuscitation?

The main directions of medical movement in the field of studying conditions bordering on death are the search for fundamentally new approaches to resuscitation of the patient. Classical methods of therapy no longer meet modern requirements.

In case of clinical death, cardiac massage and effects on the chest can be replaced with technological methods of pumping blood and supplying oxygen to a suddenly deceased person. Computer intelligence can be used to perform such a function. Such devices have already been successfully used in isolated cases.

When a patient's critical condition requires emergency care, the goals of resuscitation medicine include returning the person to a normal state. Classical methods only postpone the hour of death. There is a constant search for ways that at first glance seem absurd and incredible.

What complications can there be after the pre-death periods?

If the patient was able to be brought out of such a phase as a critical health condition, the human body remains still under the threat of repeated attacks. To prevent the development of complications, long-term rehabilitation treatment will be required.

When a person is in a critical condition, psychological changes occur in his consciousness. Deviations are observed during the period:

the patient discovers that he cannot, as before, lead a full life;
difficulties arise when performing mental work (mathematical calculations, the ability to make logical conclusions);
partial memory loss occurs;
the patient notices that he is unable to make responsible decisions.

Post-traumatic syndrome is accompanied by a decrease in the number of brain cells, which is reflected in all areas of life. Recent studies have shown: a patient who has survived the line between life and death needs not only to return to its former physical state, but also to undergo treatment in the direction of returning the psychological component.

Method of restoring the body

New methods allow patients to recover fully, subject to the following rules for caring for a sick person:

the patient needs to avoid nervous situations, even the slightest worries about any reason;
observe sleeping conditions, silence and absence of light are recommended here;
the patient requires constant support from loved ones;
the patient’s emotional state is affected by the noise of operating devices and loud conversation of clinic staff;
it is necessary to reduce the supply of drugs after visible improvements in the patient’s condition;
To restore physical capabilities, constant exercises are carried out with the patient.

To completely cure a person, a long period of treatment will be required with several specialists from different fields of medicine. Attempts to return to the social world with the help of relatives or independently may not be successful. An integrated approach and systematic implementation of tasks will help reduce the duration of therapy.

Distinctive features of resuscitation actions

There is a significant difference between the treatment of a normal patient and a patient experiencing a critical illness:

The treatment method of a classical specialist is aimed at maintaining the vitality of the patient’s body. He needs periods of examination of a person’s health to make corrective changes to therapy. In intensive care conditions there is absolutely no time to carry out this kind of action.
The first step is to make efforts to restore the patient’s vitality, and only then carry out the necessary clarifications about the state of health. An ordinary doctor has a different approach: first you need to establish the cause of the ailment, then act according to the instructions for treating a specific disease.
The classical doctor follows the path of analyzing the diagnosis. In intensive care, there is an approach to identifying noticeable syndromes.
Lack of time affects the choice of drug that eliminates a critical condition. Sometimes doctors can confuse substances due to the lack of a patient’s medical history, but if a person still survives, it is thanks to the efforts of the body. An ordinary specialist has a chance to study the full picture of what is happening.

How is the dire situation of patients determined?

To prevent death, doctors rely on the main syndromes that indicate critical conditions. Such prerequisites may be:

loss of breath;
periodic;
the tongue sinks, the person suffocates due to spasms of the larynx;
complete immobilization of the patient, loss of consciousness;
bleeding, dehydration;
change in the shape of the limbs, head, body due to internal hemorrhage;
analysis of symptoms in case of stroke, heart attack, the condition of the pupils, heartbeat, and breathing rate are assessed.

Which patients are at risk?

To analyze pre-resuscitation events, the concept of “critical developmental state” is used. It is based on collecting the following information about the patient that influences the development of syndromes:

congenital predisposition of the body;
chronic diseases;
pain and abnormalities in the functioning of organs;
collection of general tests or necessary x-rays;
assessment of injuries due to mechanical damage to the body.

What are the typical complications requiring resuscitation?

Among the huge list of critical conditions, we highlight a few:

Shock conditions: infectious nature, toxic, hemorrhagic, anaphylactic.
Embolism: renal arteries, pulmonary, vascular.
Peritonitis: general, local. The peritoneal area is affected.
Sepsis: latent and with manifestations of acute symptoms.

All of the listed conditions have their own syndromes, which resuscitators are guided by when providing emergency care. Restorative treatment and the choice of drugs depend on the type of development of the critical condition.

The severity of the patient's condition is assessed using the following algorithm:

1. Assessment of the state of consciousness.

2. Assessment of position in bed.

3. Evaluation of facial expression.

4. Assessment of the severity of symptoms of the disease.

There are:

satisfactory condition

moderate condition

serious condition

Satisfactory condition:

1. Consciousness is clear.

2. Can take care of himself, actively talks with medical staff.

3. Facial expression without features.

4. Many symptoms of the disease may be detected, but their presence does not prevent the patient from being active.

Moderate condition:

1. The patient's consciousness is usually clear.

2. The patient prefers to stay in bed most of the time, since active actions increase general weakness and painful symptoms, and often takes a forced position.

3. Facial expression is painful.

4. When directly examining the patient, the severity of pathological changes in internal organs and systems.

Severe condition:

1. Consciousness may be absent or confused, but often remains clear.

2. The patient is almost constantly in bed and has difficulty performing active actions.

3. The facial expression is pained.

4. Complaints and symptoms of the disease are significantly expressed.

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Caring for febrile patients

Human body temperature is an indicator of the body's thermal state. In a healthy person, body temperature normally fluctuates within a very small range during the day and does not exceed 37 0 C. Maintaining a constant body temperature is ensured by thermoregulation processes: heat production and heat transfer.

Fever (febris) is an increase in body temperature above 37 0 C, which occurs as an active protective-adaptive reaction of the body in response to a variety of external and internal stimuli. Most often these are the so-called pyrogenic substances (in Greek pyr - fire, heat genes - generating, producing). These can be microbes and their toxins, serums, vaccines, decay products of the body’s own tissues due to injury, internal hemorrhages, necrosis, burns, etc.

There are three periods in the development of fever.

I period- This is a period of rising temperature. During this period, heat production prevails over heat transfer, which sharply decreases due to the narrowing of skin blood vessels.

1. Headache.

2. Body aches.

Objectively: - the skin is pale, cold to the touch, has the appearance of “goose bumps”, consciousness is not altered.

Care:

1. Bed rest and rest.

2. Cover up warmer, you can additionally put a heating pad on your feet.

3. Drink hot tea.

4. Monitoring body temperature, pulse, respiratory rate, blood pressure.

II period is a period of relative constant temperature. During this period, the blood vessels of the skin expand, so heat transfer increases and equals heat production. The temperature stops further increasing and it stabilizes. This period can last from several hours to several days.

The patient's complaints during this period:

1. Headache.

2. Feeling hot.

3. Dry mouth.

5. Heartbeat.

Objectively:- the skin is hot, the face is hyperemic, the pulse is rapid, there are crusts and cracks on the lips.

Complication:- delirium, hallucinations.

Care:

1. Bed rest and rest.

2. A warm blanket can be replaced with a light one or a sheet.

3. Fortified cool drink (as often as possible!) – fruit drink, rosehip infusion, juice, mineral water without gases, approximately 3 liters per day.

4. Monitor your oral cavity (periodically treat it with a weak solution of soda, and lubricate your lips with Vaseline or other fat).

5. In case of severe headache, to prevent disturbance of consciousness, place an ice pack or a cold compress on the patient’s forehead (can be moistened with a solution of vinegar at the rate of 2 tablespoons per 0.5 liters of water).

6. At very high temperatures - an individual nurse’s station.

7. Monitor your pulse, respiratory rate, and blood pressure.

8. Feed the patient 5-6 times a day with high-calorie and easily digestible food in liquid and semi-liquid form. Diet No. 13.

9. Limit table salt in the diet, which will lead to increased diuresis and, together with plenty of fortified drinks, will help remove toxic substances from the body that are absorbed into the blood during fever.

10. Carry out skin care and take measures to prevent bedsores.

11. Monitor stool and diuresis.

12. A patient with severe fever should carry out all physiological functions in bed. If stool is retained for more than 2 days - a cleansing enema.

III period– period of temperature decrease. During this period, heat production decreases compared to heat transfer. Temperature reduction can occur in different ways. In most cases, the temperature drops lytically - gradually, which is accompanied by the appearance of slight perspiration on the skin and weakness.

Care:

1. Rest and bed rest.

2. Change of underwear and bed linen

3. Fortified drink.

With a critical decrease, the temperature quickly drops from high to low numbers (for example, from 40 0 to 36 0 C), within several hours, complications may develop - collapse.

The patient's complaints during this period:

1. Weakness.

2. Dizziness.

3. Darkening in the eyes.

4. Nausea.

Objectively: consciousness is confused! The skin is pale, cold to the touch, sticky sweat, cyanosis of the lips, rapid, thread-like pulse, more than 100 beats per minute, blood pressure 80/50 mm. rt. Art.

Help and care:

1. Call a doctor

2. Raise the foot end of the bed and remove the pillows from under your head.

4. Warm the patient with heating pads.

5. Prepare a kit for emergency care for acute vascular insufficiency when the doctor arrives.

6. Monitor body temperature, pulse, respiratory rate, blood pressure.

7. Organize an individual nurse post.

9. If the patient’s condition improves, dry the skin, change underwear and bed linen.

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MEASURING BODY TEMPERATURE

Body temperature can be measured according to indications:

in the inguinal fold;

in the oral cavity;

in the rectum

in the vagina.

It should be taken into account that the temperature in the cavities is 0.5-1 0 C higher than in the skin folds.

Indications: mandatory 2 times daily manipulation

Workplace equipment:1) disinfected thermometer; 2) towel; 3) containers with disinfectant.

Preparatory stage of performing the manipulation.

1. Shake the thermometer below 35 o C.

2. Lay down or make the patient sit (depending on the condition).

3. Examine the armpit and dry it with a towel.

The main stage of the manipulation.

4. Place the thermometer in the patient’s armpit so that the mercury reservoir is in contact with the body on all sides.

5. Press the thermometer with your hand.

6. Take measurement readings after 10 minutes.

7. Record the measurement result in a journal and on a temperature sheet.

The final stage of the manipulation.

8. After use, immerse the thermometer in a disinfectant solution for a while, according to the instructions for its use.

9. After the exposure time has expired, rinse the thermometer with clean running water until the smell of the disinfectant disappears, wipe dry and store in a clean, marked container with a layer of cotton wool on the bottom.

Application

to the Instructions for the technique

therapeutic and diagnostic procedures and manipulations in disciplines

"Nursing in Therapy"

"Therapy" by specialty

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