Access for relatives to the intensive care unit: what to do if you are not allowed to see your child? Average treatment time for a stroke in a hospital. List of things a patient needs in intensive care.

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:

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. 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.

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:

1. Satisfactory.
2. Medium severity.
3. Extremely difficult.
4. Terminal.
5. 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.

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.

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.

The word “reanimation”, which frightens and alarms the average person, is translated as “revival”. This is where the real struggle for human life takes place. In this department, the day is not divided into day and night: medical workers attend to patients every minute. The intensive care unit is a closed area of ​​the hospital. This is a forced measure that is necessary so that no one and nothing distracts doctors from saving human life. After all, some of the patients will never be able to leave the cold walls of the intensive care unit.

Relatives of such patients are worried because they do not know how long they have been in intensive care. How resuscitation treatment is carried out, what factors are associated with the length of a patient’s stay in the “rescue” department, you will learn from our article.

Specifics of the resuscitation state

– a department of the hospital where emergency actions are carried out to eliminate violations of the vital functions of the body. No one can answer how many days the patient will spend between life and death. Recovery time is always individual and depends on the type, condition of the patient and the presence of concomitant complications that appeared after the injury.

For example, after the operation, blood flow and spontaneous breathing were restored. However, at this stage a complication is diagnosed: cerebral edema or damage. Therefore, monitoring the patient’s condition in the intensive care unit will continue until all complications are eliminated. After this, the patient will be transferred to a regular ward.

It is important to understand that relatives, acquaintances and friends cannot visit the patient in the intensive care unit. This rule applies to all visitors with rare exceptions. Let's tell you why.

All visitors bring a lot of bacteria and viruses on their clothes, bodies and hands. They are absolutely safe for a healthy person. But for patients in Russia they will cause a complex infection. Moreover, patients themselves can infect visitors.

There are several patients in the general intensive care unit. Their location does not depend on gender: patients are undressed and connected to numerous equipment. Not everyone will be able to calmly react to such an appearance of people close to them. Therefore, people who are worried about the condition of their relatives need to wait until the patients are transferred to therapy. There it will be possible to communicate normally, regularly visiting friends and relatives.

Let us consider the features of resuscitation treatment in patients whose critical health condition is associated with the most common pathologies: stroke and heart attack.

Stroke

– a dangerous change in the blood circulation of the brain. He spares neither women nor men at any age. Moreover, 80% of stroke cases are characterized by ischemic pathology and only 20% by the hemorrhagic type. It is impossible to predict when the cerebral hemorrhage itself will occur: the course of the pathology is unique for each patient. Therefore, each patient spends a different time in intensive care after a stroke.

How long a stroke will keep a person in the hospital depends on several factors:

• Localization and size of brain tissue damage;
• Severity of symptoms;
• Presence or absence of coma;
• Functioning of systems and organs: breathing, heartbeat, swallowing and others;
• Possibility of relapse;
• Presence of concomitant diseases.

As you can see, the patient will stay in the intensive care unit as long as his condition requires. Patients in the department are carefully examined every day, making a verdict on their further stay in the hospital.

It should be noted that in case of pathological changes in the brain, the patient is required to stay in intensive care for 3 weeks. This time is needed for the doctor so that he can track possible relapses and prevent them.

General standardization of stroke treatment involves a month. This period is approved by the Ministry of Health for the complete recovery of the patient. However, on an individual basis, the period of therapy is extended if it is determined that the patient needs further treatment and rehabilitation.

Stroke therapy includes 3 stages.

The first therapeutic course consists of basic treatment measures:

• Improve the functioning of the respiratory system;
• Adjust hemodynamics;
• Eliminate body and psychomotor disorders;
• Fight cerebral edema;
• Provide proper nutrition and care to the patient.

After restoration of the primary functions of the body, differentiated treatment follows. It depends on the type of stroke and the patient's condition.

Hemorrhagic stroke:

• Eliminate cerebral edema;
• Adjust intracranial and blood pressure indicators;
• Assess the need for surgical intervention.

Ischemic stroke:

• Restore good blood circulation in brain tissue;
• Improve metabolism;
• Eliminate manifestations of hypoxia.

The larger the affected area in the brain tissue, the more time the patient will need to recover.

Also, relatives should know what happens to the patient when he falls into. This dangerous complication occurs only in 10% of cases. occurs due to instantaneous stratification of brain vessels. No one knows how long it will last. Therefore, in this situation, it is important to quickly provide qualified emergency care and ensure regular monitoring of the patient’s condition.

Diagnostic and corrective therapy for comatose state consists of the following actions:

• Using constant hardware monitoring, the functioning of vital human organs and systems is monitored;
• Measures against pressure ulcers are used;
• The patient is fed through a feeding tube;
• The food is ground and heated.

Note!

If the patient is in an extremely serious condition, he may be placed in an induced coma. This is necessary to perform emergency brain surgery.

After the patient comes to his senses, therapy is aimed at combating the consequences of the attack: restoring speech and motor activity.

The reason for transfer to a general ward is the following improvements in the patient’s well-being:

• Stable pulse and blood pressure readings within an hour of diagnosis;
• Having the ability to breathe independently;
• Full awareness of the speech addressed to him, the opportunity to contact the attending physician;
• Complete exclusion of relapse.

Treatment is carried out in the neurological department. Therapy consists of taking medications and rehabilitation exercises aimed at developing motor activity.

Heart attack

The most dangerous consequence is... Severe pathology requires constant medical supervision, the timing of which depends on the severity and criticality of the condition.

As a rule, a heart attack and all other heart ailments require rehabilitation measures within 3 days from the onset of the attack. Then rehabilitation therapy begins in the general ward.

Treatment of heart problems occurs in 2 stages.

Note!

7 days after an attack is the most critical and dangerous time for the patient’s life. Therefore, it is extremely important for him to stay in the hospital for several weeks in order to completely eliminate the possible negative consequences of the attack.

An acute attack of a heart attack requires resuscitation. They are aimed at providing the myocardium with oxygen to maintain its viability. The patient is prescribed the following treatment:

• Complete rest;
• Analgesics;
• Hypnotic;
• Medicines that reduce heart rate.

The first day of resuscitation is important for further treatment. On this day, the need to use the following types of surgical intervention is decided:

• Installation of a catheter in the heart;
• Expansion or narrowing of an injured vessel;
• Coronary artery bypass grafting (helps restore blood flow).

The administration of drugs that stop the formation of blood clots is necessarily indicated.

After restoration of the necessary functioning of the heart muscle, the patient is transferred to the cardiology department for further therapy. Then the attending physician will provide a plan of rehabilitation actions, with the help of which cardiac activity will resume in a natural manner.

The duration of the recovery period depends on the following factors:

• Timeliness of emergency assistance during an attack;
• Age category (persons over 70 years of age suffer a more severe heart attack);
• The presence or absence of complications;
• Possibility of complications.

The patient is discharged from the hospital only if the patient’s condition meets the following indicators:

• Complete restoration of heart rhythm;
• No complications were identified.

The recovery period after rehabilitation treatment continues even after discharge from the hospital. The patient must change his lifestyle, correctly alternating periods of rest and physical activity. It is important to completely reconsider nutrition issues and give up bad habits. It is better to continue the rehabilitation period in a sanatorium-resort treatment setting.

It is better to never get into some situations in life, and it is better to never try to find an answer to some questions. But if it so happens that you have to wonder whether the wife has the right to go to intensive care, it is necessary to obtain extremely objective information. This will help you be fully prepared in the event of a conflict situation.

How do you get to intensive care?

To the intensive care unit:

• Patients are transferred in case of a sharp deterioration in their general condition or a real threat to life.
• You can go straight from the emergency room if your condition is unsatisfactory and you need qualified emergency care.
• Representatives of all races and nationalities, regardless of gender, age and religion, enroll. They have one thing in common - the severity of the condition.
• They try not to let any outsider in.

In this case, everyone except patients and medical personnel are considered outsiders. After all, no outsider is needed to work effectively and provide assistance, or not? Are there any changes for the better after visiting your family? The dynamics, as a rule, only get worse and there is an explanation for this.

How can a visit to intensive care result?

Patient in intensive care:

1. He lies in a common room with many others.
2. “Stuffed” with tubes that help him breathe or drain fluid from the peritoneum and lungs.
3. Often he lives only due to the devices connected to him.
4. It is a sad sight.
5. Has reduced immunity.

Now imagine, “compassionate relatives” came:

1. The infection was brought in from outside.
2. We hit some equipment.
3. In a fit of hysteria, the probe or catheter was pulled out.
4. They were horrified by the patient’s appearance and decided that the end was near.
5. They interfered with the work of the resuscitation team, which, due to the crowds, did not have time to provide assistance to the patient in the next bed.

Of course, these are just doctors’ fears and in some places they are seriously exaggerated. But phobias don’t form out of nowhere, everything listed has already happened somewhere and once, and no one wants a repetition.

Why might they not be allowed into intensive care?

It is not entirely reasonable to be guided only by the letter of the law in such a matter. Purely from the point of view of the law, a wife has the right to visit her husband in intensive care. But if doctors prevent this, for some reason, calling the police is not an option. Law enforcement officers will not scatter resuscitation doctors and accompany the wife to the intensive care unit, this is already clear.

As a rule, admission issues are managed by the head physician. It is this person who must be contacted to obtain permission to visit her husband.

Doctors can quite reasonably prohibit the visit, the reason for this may be:

• The patient's condition is extremely serious.
• Exceeding the epidemiological threshold in the region for any infection.
• Changing sanitary conditions in the department.

As a rule, doctors are guided by their own considerations regarding the patient’s condition and further prognosis. All arguments, in this case, are nothing more than a formality. Therefore, sometimes a “heart-to-heart conversation” is useful, rather than further bickering.

Scandals will not help if medical workers follow the principle and decide not to let people into the intensive care unit; they will not be able to break through such a “barrier” on their own. But yes, from the point of view of the law, a wife has the right to visit her legal husband. If there are no medical contraindications for this.

Rights of a common-law wife

The institution of civil marriage in our country is practically undeveloped. Purely theoretically, the marriage that is registered after going to the registry office should be called civil, as opposed to a church wedding. In our country, a similar concept is called banal cohabitation.

If young people live together for a long time, this does not give the common-law wife any additional rights. Of course, in the event of division of property or any other conflict, if you can prove the fact of joint farming, you can claim your share. But this is only through the court, on the basis of its decisions, and not by any other right.

A common-law wife may not be allowed into intensive care or even a regular hospital department; she will not be provided with the personal information of her common-law spouse. But in any field you can issue a power of attorney, include a person in the list of trusted persons or perform other manipulation that will seriously expand the capabilities of a loved one, the relationship with whom is not legalized.

Can a legal wife visit her husband in intensive care?

Presence of a stamp in the passport gives the wife the legal right to visit her husband in intensive care. But the decision on admission will still be made by the head physician, who has the right to refuse:

• Due to the severity of the patient's condition.
• To protect the patient from exposure to infection.
• Due to a possible violation of sanitary conditions in the department.
• For patient safety reasons.
• To maintain positive dynamics.

Visitors may calm down a little when they see that a loved one is still alive and fighting for life. But for the patient this is guaranteed to be stress, which will complicate an already very difficult struggle.

Information about whether a wife has the right to go to intensive care is not always applicable. As a rule, the matter lasts for days or even hours, and seeking a court order or intimidating the police chief is completely pointless. It is better to listen to the recommendations and go to peace.

Video about the work of the intensive care unit

In this video report, Alexander Nikonov will tell you how the intensive care unit works in Voronezh and whether they have the right to admit the wives of patients:

Important! Just being admitted to the ICU does not mean that your loved one will die.

After successful intensive care in the ICU, the patient is usually transferred to continue treatment in another department of the hospital, for example, to surgery or cardiology. The prognosis depends on the severity of the patient’s condition, his age, concomitant diseases, the actions and qualifications of doctors, the equipment of the clinic, as well as numerous random factors, in other words, luck.

2 What should you do?
Calm down, concentrate and first of all take care of your own mental and physical state. For example, you should not fall into despair, drown out fear and panic with alcohol, or turn to fortune tellers and psychics. If you act rationally, you can increase the chance of survival and speed up your loved one's recovery. Having learned that your relative is in intensive care, notify as many relatives as possible, especially those related to medicine and healthcare, and also evaluate how much money you have and how much additional money you can find if necessary.

3 Can you not be allowed into intensive care?
Yes they can. Federal Law No. 323 “On the fundamentals of protecting the health of citizens in the Russian Federation” is quite contradictory. He guarantees free visits to patients by their relatives and legal representatives, but at the same time categorically demands compliance with the requirements established by the internal regulations of the clinic. The reasons for a clinic’s ban on admitting a relative to the intensive care unit may be quite understandable: the presence of an infection, inappropriate behavior, or staff being busy during resuscitation measures.

If you feel that your right to communicate with a relative in the ICU is being violated, conflicting about this with security guards, nurses, orderlies or doctors on duty is, as a rule, useless and even harmful. To resolve conflict situations, it is more advisable to contact the head of the department or the clinic administration. The good news is that the staff of most intensive care units are more friendly if you demonstrate a desire to cooperate and adequacy.

4 What is useful to ask doctors?
Ask these questions.

Is there a need to purchase any drugs that are not available (for example, expensive antibiotics)?

Do I need to buy additional care products? For example, a “duck” made of synthetic material, not metal, an anti-bedsore mattress, diapers.

Is it worth hiring a personal caregiver? If so, is it necessary to negotiate with the junior staff of the department or do you need to bring in a person from the outside (for example, from the patronage service)? Remember that for some diseases the patient’s life directly depends on care. Don't spare money on a nurse if you need one.

How is food organized and is there a need to purchase special food for seriously ill patients?

Do you need outside expert advice? Let’s assume that the clinic does not have a full-time neurosurgeon, and his consultation in case of your loved one’s illness is advisable. Formally, doctors themselves are obliged to take care of this, but in practice, this is often organized by relatives.

Finally, ask what else you can bring for your loved one. Some familiar things: toys for the child, personal medicines, hygiene and household items. Sometimes - a phone, a tablet and even a TV.

5 How to behave in intensive care?
Dress as you are told. As a rule, these are clothes made of synthetic fabrics (no wool), comfortable replaceable shoes, a disposable robe, a cap, a mask (can be bought at a pharmacy). If you have long hair, put it in a bun. Carry antiseptic liquid with you and sanitize your hands. Sometimes it even makes sense to have your own replacement surgical suit (you can buy it at a medical clothing store).

Moderate your emotions. You will find yourself in an extremely unusual environment, there will be seriously ill people around, there will be a lot of smells and sounds. Don't disturb the staff. For you this is stress, for your employees it is everyday life. Your loved one may not speak, or may say the wrong thing, there may be numerous tubes sticking out of him, there may be bandages or stickers on him. It may be a strange color, swollen, or smell unusual.

Don't worry, this won't last forever. He's just sick.

6 How can you help him?
No one knows how it works, but experienced medical practitioners can determine the patient’s likelihood of surviving complications even during the first conversation with a patient. A lot depends on the psychological state of the patient. And this state almost entirely depends on your loved ones, that is, on you.

If possible, talk to the sick person as if you were healthy. Do not cry under any circumstances, do not become hysterical, do not look at him with despair and pain, even if you experience them, do not wring your hands, do not shout: “Oh, what’s wrong with you?!” Do not discuss the circumstances of the injury on your own initiative if it is an injury. Don't discuss the negative. Talk about the most practical things, both related to the disease and purely everyday, family ones.

Remember: while your loved one is sick but alive, he can and should participate in the life of his family.

7 What to say if he is afraid of death?
I don't know, it's up to you to decide. But, in any case, listen. If a loved one asks for a meeting with a priest, arrange it. As a rule, they are allowed into intensive care even with terminal patients. If a loved one has a chronic disorder of consciousness (for example, is in a coma), devote a lot of time to verbal and non-verbal (touch, massage, things familiar to him in the area of ​​​​accessibility) communication with him. Recent scientific work shows that this has a positive effect on the rehabilitation process. Many patients who appear “comatose” to a non-specialist actually see and hear everything that is happening around them.

If you have to nurse your loved one for long weeks, months or years, intensive care becomes a significant part of life. You will need endurance and composure. Help staff as soon as you feel you have mastered the basic skills. I know of cases where relatives of intensive care patients subsequently changed their path in life and became nurses and doctors.