Resuscitation and intensive care

Intensive (emergency) therapy is a method of treating life-threatening diseases. Resuscitation is the process of restoring vital (vital) functions, partially lost or blocked as a result of the disease. These types of treatment can establish a permanent control of the restoration of functions and interfere with the process in the event of rapid disruption in the work of organs and systems. In general, resuscitation and intensive care are the most effective and last of the methods available to date to prevent the development of death in severe (life-threatening) diseases, their complications, injuries.

Basic concepts

Intensive therapy is a method of round-the-clock treatment, requiring the use of infusion injections or methods of detoxification with constant monitoring of vital signs. They are clarified through blood tests and biological fluids, which are often repeated to quickly track the deterioration and improvement of the body's somatic functions. The second method of monitoring is monitoring, which is implemented by hardware using the use of cardiac monitors, gas analyzers, electroencephalograph and other typical equipment.

Resuscitation is the process of applying medication and hardware techniques to return the body to life in the event of emergence of emergency conditions. If the patient is in a condition that implies a life threat arising from the disease or its complications, intensive therapy is used to stabilize it. If the patient is in a state of clinical death and will not live without the rapid restoration of lost functions, then the process of their compensation and return is called resuscitation.

The doctor-resuscitator is engaged in these questions. This is a narrow specialist, whose place of work is the department of resuscitation and intensive care. Most often, doctors with a single profession resuscitator does not exist, since the specialist receives a diploma of an anesthesiologist and resuscitator. In the place of work, depending on the profile of the institution, he can occupy three types of positions: "anesthesiologist-resuscitator", as well as separately "resuscitator" or "anesthesiologist."

Doctor in the intensive care unit

The intensive care doctor is an anesthesiologist-resuscitator. He deals with the choice of the type of anesthesia in pre-operative patients and the monitoring of their condition after surgical operations. Such a specialist works in any multidisciplinary medical center (often regional or district), and the department carries the names of the DIT. There may be patients who have compensated functions, but require monitoring of vital signs. In addition, patients with life-threatening traumas and diseases, as well as their complications, are at the DIC. Postoperative patients can similarly be observed in the DIC by an anesthesiologist-resuscitator.

The doctor-resuscitator

The resuscitation physician deals only with the restoration of vital functions, and often his place of work is a station or an emergency substation. Having access to the equipment with which the intensive care ambulance is equipped, he can reanimate the patient on departure, which is useful in all situations related to disaster medicine. Most often, the resuscitator does not engage in intensive care in the DIC, but establishes control over the vital functions of the patient in the ambulance. That is, it is engaged in drug treatment and hardware control of the patient's functions with the threat of death.

Anesthesiologist

An anesthesiologist is an example of a specialist position in a narrowly specialized medical center, for example, in an oncological dispensary or in the perinatal center. Here, the main job of a specialist is to plan the type of anesthesia for patients who have to undergo surgical interventions. In the case of the perinatal center, the task of the anesthetist is to select the type of anesthesia for patients who will have a cesarean section. It is important that intensive therapy in children is also conducted in this center. However, intensive care units for patients and for newborns are structurally separated. Neonatologists work for the children's (neonatal) children, and an anesthesiologist-resuscitator serves adults.

Hospital of Surgical Profile

Department of resuscitation and intensive care in hospitals with surgical bias is planned depending on the number of patients who need intervention and the severity of operations. At interventions in oncological dispensaries the average time of the patient's stay in the ICD is higher than in the general surgical ones. Intensive therapy here takes more time, because in the course of the operation, important anatomical formations are inevitably damaged.

If we consider oncology, the absolute majority of interventions are highly traumatic and have a large volume of resected structures. This takes a long time to restore the patient, since after the operation there is still a risk of deterioration of well-being and even death from a number of factors. It is important to prevent complications of anesthesia or intervention, support life and blood volume, part of which is inevitably lost during the intervention. These tasks are most important in any post-operative rehabilitation.

Cardiac Hospital Hospitals

Cardiological and therapeutic hospitals are distinguished by the fact that here there are both compensated patients without threats to life, and unstable patients. They are required to establish control and maintain their condition. In the case of diseases of the cardiological profile, myocardial infarction with its complications in the form of cardiogenic shock or sudden cardiac death requires the most careful attention. Intensive therapy of myocardial infarction allows to reduce the risks of death in the approximate perspective, to limit the extent of the lesion by restoring the patency of the infarction-related artery, and to improve the prognosis for the patient.

According to the protocols of the Ministry of Health and international recommendations, in case of acute coronary pathology, the patient must be placed in the intensive care unit for urgent activities. The assistance is provided by the ambulance staff at the delivery stage, after which the restoration of patency in the coronary arteries, which are occluded by the thrombus, is required. Then, the patient is treated with a resuscitator before stabilization: intensive therapy, medical treatment, hardware and laboratory monitoring of the condition are carried out.

In the cardiologic ICD, where surgical operations are performed on the vessels or valves of the heart, the task of separation is early postoperative rehabilitation and monitoring of the condition. These operations are classified as highly traumatic, which are accompanied by a long period of recovery and adaptation. In this case, there is always a high probability of thrombosis of the vascular shunt or stand, implanted artificial or natural valve.

Equipment DITR

Resuscitation and intensive care are the branches of practical medicine that are aimed at eliminating the threats to the patient's life. These events are held in a specialized department, which is well equipped. It is considered the most technological, because the functions of the patient's body always require hardware and laboratory control. Moreover, intensive therapy implies the establishment of permanent or frequent intravenous administration.

Principles of treatment in the DIC

In traditional departments, patients who are not threatened by death from the disease or its complications in the short term, an infusion drip system is used for these purposes. In OITR more often it is replaced by infusomats. This equipment allows you to constantly enter a certain dose of the substance, without resorting to the need to puncture the vein every time the drug is required. Also infusomat allows you to enter medicines constantly for a day or more.

Modern principles of intensive therapy of diseases and urgent conditions have already developed and are the following:

• The first goal of the treatment is stabilization of the patient and an attempt at a detailed diagnostic search;
• The definition of the underlying disease, which provokes impairment and reflects on the state of health, approximating the likely fatal outcome;
• Treatment of the underlying disease, stabilization of the condition through symptomatic therapy;
• Elimination of life-threatening conditions and symptoms;
• Implementation of laboratory and instrumental monitoring of the patient's condition;
• Transfer of the patient to the profile department after stabilization of the state and elimination of life-threatening factors.

Laboratory and instrumental control

The monitoring of the patient's condition is based on the evaluation of three information sources. The first - a questioning of the patient, the establishment of complaints, clarification of the dynamics of well-being. The second - the data of laboratory studies performed before and during treatment, comparison of the results of the analyzes. The third source is information obtained through instrumental research. Also to this type of source of information about the state of health and the patient's condition are the systems of pulse monitoring, oxygenation of blood, frequency and rhythm of cardiac activity, blood pressure index, brain activity.

Anesthetics and special equipment

Such branches of practical medicine as anesthesiology and intensive care are inextricably linked. Specialists who work in these areas have diplomas with the phrase "anesthesiologist-resuscitator". This means that the same specialist can deal with questions of anesthesiology, resuscitation and intensive care. Moreover, this means that one DSM is sufficient to meet the needs of multi-disciplinary health facilities, including stationary departments of surgical and therapeutic bias. It is equipped with equipment for resuscitation, treatment and anesthesia before surgical intervention.

Resuscitation and intensive care require the presence of a monophasic (or biphasic) defibrillator or cardioverter defibrillator, an electrocardiograph, an artificial lung ventilation system, an artificial circulation device (if required by a healthcare institution), sensors and analyzer systems necessary to monitor cardiac and brain activity . It is also important to have infusomats necessary for adjusting the systems of permanent infusion infusions of medicines.

Anesthesiology requires the availability of equipment for the supply of inhalation anesthesia. These are closed or semi-open systems, through which the narcotic mixture is delivered to the lungs. This allows us to establish endotracheal or endobronchial anesthesia. It is important that for the needs of anesthesiology, laryngoscopes and endotracheal (or endobronchial) tubes, catheters for the bladder and catheters for puncture of the central and peripheral veins are required. The same equipment is required for intensive care.

OITR of perinatal centers

Perinatal centers are health facilities where births take place, which can potentially go through with complications. Women who suffer from miscarriages or have extragenital pathologies that are potentially capable of damaging health in childbirth should be referred to this place. Also here should be women with pathologies of pregnancy, requiring early delivery and nursing a newborn. Intensive neonatal therapy is one of the tasks of such centers, along with providing anesthesia for patients who will undergo surgical operations.

Instrumental support for OITR perinatal centers

The intensive care unit of the perinatal center is equipped according to the planned number of patients. Here anesthesia systems and resuscitation equipment are required, the list of which is indicated above. In this case, the NITR of perinatal centers also have neonatological departments. They must have special equipment. First, adult devices for artificial respiration and circulation are not suitable for newborns whose body size is minimal.

Today neonatology departments are engaged in nursing newborns weighing 500 grams, which were born at the 27th week of pregnancy. In addition, special medical supplies are needed , since babies born much earlier than the prescribed period require the administration of surfactant preparations. These are expensive medicinal substances, without which nursing is impossible, since the newborn appears with developed lungs, but without surfactant. This substance does not allow the alveoli of the lungs to subside, which underlies the process of effective external respiration.

Peculiarities of organization of work

OITR works round the clock, and the doctor is on duty without days off. This is due to the impossibility of switching off the equipment in the case when it is responsible for the life-support of a particular patient. Depending on the number of patients and the burden on the department, a bed fund is formed. Each bunk should also be equipped with ventilators and monitors. The number of ventilators, monitors and sensors that are smaller than the number of beds is allowed.

In the department, which is designed for 6 patients, there are 2-3 doctors of an anesthesiologist. They need to change on the second day after 24 hours of watch. This allows you to monitor the patient around the clock and on the weekends, when only the doctor on duty supervises the patients of standard departments. An anesthesiologist-resuscitator must monitor patients who are in the DIC. Also, he is obliged to participate in consultations and to provide assistance to patients of general medical departments up to hospitalization in the hospital.

Assist an anesthesiologist and intensive care specialist in the work of an intensive care nurse and a nurse. Calculation of the number of bets is conducted depending on the number of patients. 6 beds require the presence of one doctor, two nurses and one orderlies. Such a number of employees should be present on each watch during the day. Then the staff is replaced by another shift, and it, in turn, is the third.