Intensive (emergency) therapy is a way to treat life-threatening diseases. Resuscitation is the process of restoring vital (life) functions, partially lost or blocked as a result of an illness. These types of treatment allow you to establish constant control over the restoration of functions and intervene in the process in case of rapid disturbances in the functioning of organs and systems. In general, resuscitation and intensive care are the most effective and last of the currently available methods for preventing the development of a fatal outcome in severe (life-threatening) diseases, their complications, and injuries.
Basic concepts
Intensive care is a 24/7 treatment that requires infusions or detoxification methods with constant monitoring of vital signs. They are determined through blood and body fluid tests, which are repeated frequently to quickly track deterioration and improvement in somatic conditions.functions of the patient's body. The second method of control is monitoring, which is implemented in hardware by using heart monitors, gas analyzers, an electroencephalograph and other standard equipment.
Resuscitation is the process of using medical and hardware methods to bring the body back to life in the event of an emergency. If the patient is in a state that implies a threat to life arising from the disease or its complications, then intensive therapy is carried out to stabilize it. If the patient is in a state of clinical death and will not live without an early restoration of lost functions, then the process of their compensation and return is called resuscitation.
Dealing with these issues is a resuscitator. This is a narrow specialist, whose place of work is the intensive care unit and intensive care unit. Most often, there are no doctors with the only profession of an resuscitator, since a specialist receives a diploma in an anesthesiologist and resuscitator. At the place of work, depending on the profile of the institution, he can hold three types of positions: "anaesthesiologist-resuscitator", as well as separately "resuscitator" or "anaesthesiologist".
Doctor in intensive care unit
An intensive care physician is an anesthesiologist-resuscitator. He deals with the choice of the type of anesthesia in preoperative patients and monitoring their condition after surgery. Such a specialist works in any multidisciplinary medicalcenter (often regional or district), and the department is called OITR. There may be patients whose functions are compensated, but monitoring of vital signs is required. In addition, patients with life-threatening injuries and diseases, as well as their complications, are in the ICU. Postoperative patients can similarly be observed in the intensive care unit by an anesthesiologist-resuscitator.
Resuscitator
A resuscitator deals only with the restoration of vital functions, and often his place of work is an ambulance station or substation. Having access to the equipment that comes with an ambulance, he can resuscitate a patient on the road, which is useful in all situations related to disaster medicine. Most often, the resuscitator does not deal with intensive care in the intensive care unit, but establishes control of the patient's vital functions in the ambulance. That is, he is engaged in drug treatment and hardware control of the functions of a patient with a threat of death.
Anesthesiologist
An anesthesiologist is an example of a specialist position in a narrow-profile medical center, for example, in an oncology dispensary or in a perinatal center. Here, the main work of a specialist is planning the type of anesthesia for patients who are to undergo surgery. In the case of a perinatal center, the task of the anesthesiologist is to select the type of anesthesia for patients who will undergo a caesarean section. It is important that intensive care in children is also carried outin this center. However, the intensive care and intensive care units for patients and for newborns are structurally separated. Neonatologists work in the intensive care unit for children (newborns), and an anesthesiologist-resuscitator serves adults.
MID of surgical hospitals
Resuscitation and intensive care unit in hospitals with a surgical bias is planned depending on the number of patients who require intervention and the severity of operations. During interventions in oncological dispensaries, the average time spent by a patient in the ICU is higher than in general surgical ones. Intensive care here takes more time, as important anatomical structures are inevitably damaged during operations.
If we consider oncosurgery, then the vast majority of interventions are characterized by high trauma and a large volume of resected structures. This requires a long time for the recovery of the patient, since after the operation there is still a risk of deterioration in he alth and even death from a number of factors. Here, prevention of complications of anesthesia or intervention, life support and replenishment of blood volume, part of which is inevitably lost during the intervention, are important. These tasks are most important during any postoperative rehabilitation.
ICT of cardiological hospitals
Cardiology and therapeutic hospitals differ in that they are located here as compensatedpatients without life threats, and unstable patients. They need to be monitored and maintained. 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 closest attention. Intensive care for myocardial infarction can reduce the risk of death in the short term, limit the extent of the lesion by restoring the patency of the infarct-related artery, and improve the patient's prognosis.
According to the protocols of the Ministry of He alth and international recommendations, in case of acute coronary pathology, it is required to place the patient in the intensive care unit for urgent measures. Assistance is provided by an ambulance officer at the stage of delivery, after which restoration of patency in the coronary arteries, which are occluded by a thrombus, is required. Then the resuscitator is engaged in the treatment of the patient until stabilization: intensive therapy, drug treatment, hardware and laboratory monitoring of the condition.
In the cardiac intensive care unit, where surgical operations are performed on the vessels or heart valves, the task of the department is early postoperative rehabilitation and monitoring of the condition. These operations are highly traumatic, which are accompanied by a long period of recovery and adaptation. At the same time, there is always a high probability of thrombosis of a vascular bypass or stand, an implanted artificial or natural valve.
Instrumentation equipment
Resuscitation and intensive care isbranches of practical medicine that are aimed at eliminating threats to the patient's life. These events are held in a specialized department, which is well equipped. It is considered the most technologically advanced, because the functions of the patient's body always need hardware and laboratory control. Moreover, intensive care involves the establishment of constant or frequent intravenous administration.
Principles of treatment in the NICU
In traditional departments, where patients are not threatened with death from the disease or its complications in the short term, an infusion drip system is used for this purpose. In RITR, it is often replaced by infusion pumps. This equipment allows a constant dose of a substance to be administered without the need to puncture a vein each time a drug is required. Also, the infusion pump allows you to administer drugs continuously for a day or more.
Modern principles of intensive care of diseases and emergency conditions have already been established and represent the following provisions:
- The first goal of treatment is to stabilize the patient and attempt a detailed diagnostic search;
- determination of the underlying disease, which provokes deterioration and affects well-being, bringing closer a 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 andinstrumental monitoring of the patient's condition;
- transfer of a patient to a specialized department after stabilization of the condition and elimination of life-threatening factors.
Laboratory and instrumental control
Control of the patient's condition is based on the evaluation of three information sources. The first is a patient survey, the establishment of complaints, the clarification of the dynamics of well-being. The second is the data of laboratory studies performed before admission and during treatment, comparison of test results. The third source is information obtained through instrumental research. Also, this type of source of information about the well-being and condition of the patient includes systems for monitoring the pulse, blood oxygenation, heart rate and rhythm, blood pressure, brain activity.
Anesthesia 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 wording "anesthesiologist-resuscitator". This means that the same specialist can deal with anesthesiology, resuscitation and intensive care. Moreover, this means that to meet the needs of multidisciplinary he althcare institutions, including inpatient surgical and therapeutic departments, one CITR is enough. It is equipped with equipment for resuscitation, treatment and anesthesia before surgery.
Resuscitation and intensive care requirethe presence of a monophasic (or biphasic) defibrillator or cardioverter-defibrillator, an electrocardiograph, an artificial lung ventilation system, a heart-lung machine (if required by a particular he althcare institution), sensors and analyzer systems necessary to monitor cardiac and brain activity. It is also important to have infusion pumps necessary for setting up systems for continuous infusion of medicines.
Anesthesiology requires equipment for the delivery of inhalation anesthesia. These are closed or semi-open systems, through which the anesthetic mixture is delivered to the lungs. This allows you to establish endotracheal or endobronchial anesthesia. Importantly, for the needs of anesthesiology, laryngoscopes and endotracheal (or endobronchial) tubes, bladder catheters and catheters for puncture of central and peripheral veins are required. The same equipment is required for intensive care.
OITR perinatal centers
Perinatal centers are he alth care facilities where births take place that can potentially lead to complications. Women who suffer from miscarriage or have extragenital pathologies that can potentially harm their he alth during childbirth should be sent here. Also, there should be women with pathologies of pregnancy, requiring early delivery and nursing of the newborn. Intensive care of newborns is one of the tasks of such centers, along with providing anesthesia care to patients,who will undergo surgery.
Instrumentation of CITR perinatal centers
The intensive care unit of the perinatal center is equipped depending on the planned number of patients. This requires anesthesia systems and resuscitation equipment, the list of which is indicated above. At the same time, the RITR of perinatal centers also have neonatological departments. They must have special equipment. First, adult ventilators and circulators are not suitable for newborns, whose body sizes are minimal.
Today, neonatology departments are nursing newborns weighing 500 grams, born at 27 weeks of gestation. In addition, special drug provision is needed, because babies born much earlier than the due date require the appointment 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.
Features of the organization of the work of the RITR
ITR works around the clock, and the doctor is on duty seven days a week. This is due to the impossibility of turning 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 load on the department, a bed is formedfund. Each bed must also be equipped with ventilators and monitors. Fewer than the number of beds, ventilators, monitors and sensors are allowed.
In the department, which is designed for 6 patients, 2-3 resuscitator-anaesthesiologists work. They need to change on the second day after 24 hours of duty. This allows you to monitor the patient around the clock and on weekends, when the observation of patients in standard departments is carried out only by the doctor on duty. An anesthesiologist-resuscitator should monitor patients who are in the ICU. He is also obliged to take part in consultations and provide assistance to patients in general somatic departments up to hospitalization in the ICU.
The anesthesiologist-resuscitator is assisted in the work by an intensive care nurse and an orderly. The number of rates is calculated depending on the number of patients. For 6 beds, one doctor, two nurses and one orderly are required. This number of employees must be present at each duty during the day. Then the staff is replaced by another shift, and it, in turn, by the third one.
