The general condition of the patient. What does a stable, severe condition mean in intensive care? Signs of a state of depression in a patient

It is important to understand that severity of traumatic brain injury and the severity of the patient's condition- different concepts. The severity of the patient's condition certainly reflects the severity of the injury, but it may or may not correspond to the true morphological lesions of the brain, which depends on many reasons. On the other hand, within each clinical form of brain injury, depending on the period of traumatic brain injury (TBI) and the direction of its course, conditions of varying severity can be observed.

Assessment of the severity of the condition of a patient who has suffered a brain injury, including the prognosis for his life and recovery, can be complete only when using at least three terms of the state, namely: consciousness, vital functions and focal neurological functions. The following five gradations of severity of the condition of patients with traumatic brain injury are distinguished: satisfactory, moderate, severe, extremely severe, terminal.

Gradation of the severity of the condition of patients with TBI

Satisfactory condition characterized by the following criteria:
clear consciousness;
there are no violations of vital functions, and there is also no secondary (dislocation) neurological symptoms;
primary hemispheric and craniobasal signs are absent or mild (for example, motor disturbances do not reach the degree of paresis).

When qualifying the condition as satisfactory, along with objective indicators, it is permissible to take into account the complaints of the victim. With adequate treatment, there is no threat to life, the prognosis for recovery is usually good.

Moderate condition characterized by the following criteria: the state of consciousness is clear or there is a moderate stunning;
vital functions are not impaired (only bradycardia is possible);
focal symptoms - hemispheric and craniobasal signs may be observed, which are more often selective: monoparesis or hemiparesis of the extremities, paresis of individual cranial nerves, blindness or a sharp decrease in vision in one eye, motor or sensory aphasia, etc .; single stem symptoms are possible (spontaneous nystagmus, etc.).

In order to state a state of moderate severity, the presence of these violations in at least one of the parameters is sufficient. For example, the detection of moderate stunning (or hemiparesis of the extremities, sensory or motor aphasia with clear consciousness) is sufficient to assess the patient's condition as moderate. With adequate treatment, the threat to the life of the patient is insignificant, the prognosis for recovery is often favorable.

serious condition diagnosed in the following cases:
consciousness is disturbed - there is a deep stupor or stupor;
there is a disorder of vital functions, usually moderate in 1-2 indicators;
focal symptoms: stem symptoms are moderately expressed (anisocoria, decreased pupillary reactions, upward gaze restriction, homolateral pyramidal insufficiency, dissociation of meningeal symptoms along the axis of the body, etc.); hemispheric and craniobasal signs are clearly expressed, both in the form of symptoms of irritation (epileptic seizures) and prolapse (motor disorders can reach the degree of plegia).

To ascertain the severe condition of the patient, the presence of these violations in at least one of the parameters is necessary. For example, the detection of stupor even in the absence or mild severity of disturbances in vital and focal parameters, or the detection of hemiplegia (blindness in both eyes, total aphasia, etc.) even with moderate stunning is sufficient to assess the condition as serious. The threat to the life of the patient is significant, the prognosis for life largely depends on the duration of the serious condition. The prognosis for the restoration of working capacity is sometimes unfavorable.

Extremely serious condition diagnosed if:
the patient is in a state of moderate or deep coma;
vital functions are characterized by gross violations simultaneously in several parameters;
focal symptoms: grossly expressed signs of damage to the brain stem (reflex paresis or plegia of upward gaze, tonic spontaneous nystagmus, severe anisocoria, a sharp weakening of pupillary reactions to light, divergence of the eyes along the vertical or horizontal axis, decerebrate rigidity, bilateral pathological signs, etc.) ; hemispheric and craniobasal symptoms are pronounced, up to bilateral and multiple paresis.

The threat to the life of the patient is maximum, the prognosis for life largely depends on the duration of the extremely difficult condition. The prognosis for the restoration of working capacity is often unfavorable.

Terminal state characterized by the following criteria: consciousness is lost, there is a terminal (beyond) coma;
there are critical violations of vital functions;
focal symptoms: stem signs - bilateral fixed mydriasis, absence of pupillary and corneal reflexes; hemispheric and craniobasal symptoms are covered by cerebral and stem disorders.
Survival is usually impossible.

For a general assessment of the patient's condition, the nurse should determine the following indicators.

The general condition of the patient.

The position of the patient.

The patient's state of mind.

anthropometric data.

DETERMINATION OF THE GENERAL CONDITION OF THE PATIENT

The severity of the general condition of the patient is determined depending on the presence and severity of decompensation of vital body functions. In accordance with this, the doctor decides on the urgency and the necessary 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 (pre-agonal)

terminal (atonal)

state of clinical death.

The first idea about the general condition of the patient, the medical worker receives, getting acquainted with the complaints and data of 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 taken out on the basis of the results of the study of internal organs.

The general condition of the patient is determined as satisfactory. if the functions of the 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 pronounced, the consciousness of patients is usually clear, the position is active, nutrition is not disturbed, the body temperature is normal or subfebrile. The general condition of patients is also satisfactory in the period of convalescence after acute diseases and when exacerbations of chronic processes subside.

About the general state of moderate severity they say if the disease leads to decompensation of the functions of vital organs, but does not pose an immediate danger to the life of the patient. Such a general condition of patients is usually observed in diseases that occur with severe subjective and objective manifestations.

Patients whose general condition is regarded as moderate, usually require emergency medical care or hospitalization because there is a possibility of rapid progression of the disease and the development of life-threatening complications.

The general condition of the patient is defined as severe in the event that the decompensation of the functions of vital organs that has developed as a result of the disease poses an immediate danger to the life of the patient or can lead to profound disability. A severe general condition is observed with a complicated course of the disease with pronounced and rapidly progressing clinical manifestations.

Extremely severe (predagonal) general condition It is characterized by such a sharp violation 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, up to coma, although in some cases it remains clear. The position is most often passive, motor excitation, general convulsions with the involvement of the respiratory muscles are sometimes noted. The face is deathly pale, with pointed features, covered with drops of cold sweat. The pulse is palpable only on the carotid arteries, blood pressure is not determined, heart sounds are barely heard. The number of breaths reaches 60 per minute

In the terminal (agonal) general state there is a complete extinction of consciousness, the muscles are relaxed, reflexes, including blinking, disappear. The cornea becomes cloudy, the lower jaw droops. The pulse is not palpable even on the carotid arteries, blood pressure is not detected, heart sounds are not heard, however, the electrical activity of the myocardium is still recorded on the electrocardiogram. The agony can last for minutes or hours.

Answer from Neurosis[expert]
Extremely severe, which means at the last stage, but you can still save

Answer from promote[guru]
God forbid you find out about your loved ones. They told me about my mother at one in the morning. that the condition is serious, and at 9 she died

Answer from Pavel Golovnyak[guru]
In intensive care

Answer from Dark Guard[active]
a state close to death or a period of rehabilitation of clinical death, the pulse is not stable, breathing intermittent visits are prohibited ...

Answer from Edward Usachew[guru]
In clinical practice, there are several gradations of the general condition:
satisfactory
moderate
heavy
extremely severe (pre-agonal)
terminal (atonal)
state of clinical death.
An extremely severe (pre-agonal) general condition is characterized by such a sharp violation 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.
In practice, a person is already dying and this process is hampered only by medicine.

Answer from Dorofei Kolinichev[guru]
He is in intensive care.
The machine breathes for him.
Life is supported by drugs.
Almost no chance of survival...

What does STABLE SEVERE IN ICU mean?

1. stable means not getting better or worse than it already is.. . means in serious condition
2. Stably heavy - this is without improvement and without deterioration !!!))))
3. There are some problems, but stable means not to die - when they say hard, it is dangerous, and stable means that although it is hard for him, your friend, he will survive! Bless him and get well soon!
4. It doesn't get worse, but it doesn't get better either!
5. stable means there is no threat to life at the moment .... and severe is a normal condition after surgery .... in moderate severity they are not in intensive care
6. you need to order a magpie in the church about his health, believe me, he should get better
7. I really sympathize with you! Your friend is now between two worlds - life and death, but when there is such a worried PERSON nearby, I am sure that everything will be fine - your friend will recover. You will still experience many joyful, happy moments in life together. If you have the opportunity - be sure to tell him how much you need him, he will hear and this will help him return to you. Think only about the good, believe in luck, because thought is material, because that is why people say that hope dies last. I sincerely wish you joy, and your friend recovery.
8. well, as I understand it, it means ... that everything is without changes and the condition is serious
9. It seems to me that after such an operation, one should lie at least a day in intensive care ...
   After all, it is required to move away from anesthesia, and gradually transfer the patient from the apparatus of artificial life to normal life ...
   In this case, the device is turned off for a while and the doctors look at the patient’s condition, if they don’t like it, they reconnect it ... This can happen many times...
   Sun recount = numerical - my own opinion ...
10. with such an operation (appendicular peritonitis apparently developed), the patient is under constant observation in intensive care, usually for about 3 days. the severity of the condition is due to the scale of the operation performed and the severity of the postoperative period. Stability in this case indicates that there are no complications of the operation and the course of the disease is normal, in a word, everything is under control!
11. CONSISTENTLY HEAVY - in a word, it sucks. in short, this means that a person cannot independently maintain vital functions (such as breathing and cardiovascular activity), so they are kept on machines, and dopamine, I suppose, is being dripped. It differs from just a serious condition in that there is no dynamics (changes). That is, if off. it’s a device .... and it’s not getting better yet ((The whole catch is that practically nothing can be said with certainty about the forecast (of course, there are statistics, but not all cases are the same). In this case, the term stable means that it will be possible to stabilize on devices (it happens, after all, people die on devices)
12. It means it doesn’t get worse, but it’s also getting better, but this is a good sign, it means it will be Better soon, Pray, Believe and Good luck!!!
13. oh, Russian darkness... Have us so same colleague endured pain. It turned out - stomach cancer, the doctors could no longer do anything ...
    And stably heavy - means does not worsen and does not become better. After such a serious operation, it could not be otherwise. We must wait and hope for the best

In accordance with this, the doctor decides on the urgency and the necessary 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
• heavy
• extremely severe (pre-agonal)
• terminal (atonal)
• state of clinical death.

The doctor gets the first idea about the general condition of the patient, 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 the study of internal organs. In this case, the determination of the functional state of the cardiovascular system and the respiratory system is of particular importance.

The description of the objective status in the case history begins with a description of the general condition. In some cases, it is possible to really determine the severity of the general condition with 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 the detection of signs of acute leukemia in a blood test, myocardial infarction on an electrocardiogram, a bleeding stomach ulcer in gastroscopy, cancer metastases in the liver by ultrasound.

The general condition of the patient is defined as satisfactory if the functions of the 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 pronounced, the consciousness of patients is usually clear, the position is active, nutrition is not disturbed, the body temperature is normal or subfebrile. The general condition of patients is also satisfactory in the period of convalescence after acute diseases and when exacerbations of chronic processes subside.

A general state of moderate severity is said if the disease leads to decompensation of the functions of vital organs, but does not pose an immediate danger to the life of the patient. Such a general condition of patients is usually observed in diseases that occur with severe subjective and objective manifestations. Patients may complain of intense pain of various localization, severe weakness, shortness of breath with moderate exertion, dizziness. Consciousness is usually clear, but sometimes it is deafened. Motor activity is often limited: the position of patients is forced or active in bed, but they are able to serve themselves. There may be symptoms such as high fever with chills, widespread swelling of the subcutaneous tissue, severe pallor, bright jaundice, moderate cyanosis, or extensive hemorrhagic rashes. In the study of the cardiovascular system, an increase in the number of heartbeats at rest is more than 100 per minute, or, conversely, bradycardia with a heart rate of less than 40 per minute, arrhythmia, and increased blood pressure. The number of breaths at rest exceeds 20 per minute, there may be a violation of bronchial patency or patency of the upper respiratory tract. On the part of the digestive system, signs of local peritonitis, repeated vomiting, severe diarrhea, and moderate gastrointestinal bleeding are possible.

Patients whose general condition is regarded as moderate usually require emergency medical care or hospitalization, since there is a possibility of rapid progression of the disease and the development of life-threatening complications. For example, in a hypertensive crisis, myocardial infarction, acute left ventricular failure, or stroke can 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 life of the patient or can lead to profound disability. A severe general condition is observed with 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, his facial features are pointed. In other cases, consciousness is significantly depressed (stupor or stupor), delirium, severe meningeal symptoms are possible. The position of the patient is passive or forced, he, as a rule, cannot serve himself, needs constant care. There may be significant psychomotor agitation or general convulsions.

Growing cachexia, anasarca in combination with dropsy of the cavities, signs of severe dehydration of the body (decreased skin turgor, dry mucous membranes), "chalky" pallor of the skin or pronounced diffuse cyanosis at rest, hyperpyretic fever or significant hypothermia testify to the severe general condition of the patient. In the study of the cardiovascular system, a threadlike pulse, a pronounced expansion of the boundaries of the heart, a sharp weakening of the first tone above the apex, significant arterial hypertension or, conversely, hypotension, impaired patency of large arterial or venous trunks are revealed. On the part of the respiratory system, tachypnea over 40 per minute, severe obstruction of the upper respiratory tract, a protracted attack of bronchial asthma, or beginning pulmonary edema are noted. The severe general condition is also indicated by indomitable vomiting, profuse diarrhea, signs of diffuse peritonitis, massive ongoing gastrointestinal (vomiting "coffee grounds", melena), uterine or epistaxis.

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

An extremely severe (pre-agonal) general condition is characterized by such a sharp violation 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, up to coma, although in some cases it remains clear. The position is most often passive, motor excitation, general convulsions with the involvement of the respiratory muscles are sometimes noted. The face is deathly pale, with pointed features, covered with drops of cold sweat. The pulse is palpable only on the carotid arteries, blood pressure is not determined, heart sounds are barely heard. The number of breaths reaches 60 per minute. With total pulmonary edema, breathing becomes bubbling, pink frothy sputum is released from the mouth, different-sized, inaudible moist rales are heard over the entire surface of the lungs.

In patients with status asthmaticus, breath sounds over the lungs are not heard. Respiratory disturbances in the form of "big breath" Kussmaul or periodic breathing such as Cheyne-Stokes or Grokko can be detected. Treatment of patients in extremely serious general condition is carried out in the intensive care unit.

In the terminal (agonal) general state, there is a complete extinction of consciousness, the muscles are relaxed, reflexes, including blinking, disappear. The cornea becomes cloudy, the lower jaw droops. The pulse is not palpable even on the carotid arteries, blood pressure is not detected, heart sounds are not heard, however, the electrical activity of the myocardium is still recorded on the electrocardiogram. Rare periodic respiratory movements are noted according to the type of Biot's breathing.

The agony can last for minutes or hours. The appearance on the electrocardiogram of an isoelectric line or fibrillation waves 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, promptly initiated resuscitation can bring a person back to life.

Consequences of critical conditions

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

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 ends up in the intensive care unit (ICU). According to a US study, about 2% of the population is treated in the ICU each year.

Saving the life of a critically ill patient requires a huge investment of effort on the part of doctors and nurses, modern equipment and expensive medicines. Fortunately, often the efforts expended pay off: the patient's condition is stabilized, consciousness returns to him, the ability to breathe on his own and dispenses with the constant administration of drugs. The patient is transferred from the intensive care unit to the usual one, and after a while they are 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 the victory.

However, in recent decades, researchers have asked the question: what happens to patients who have survived a critical condition after discharge from the hospital? It turned out that very few of them manage to return to a full life. The data of numerous studies indicate that the majority of people who have undergone a critical condition later experience significant difficulties at work and in daily activities. The reason for their social maladjustment is associated primarily with mental disorders.

Patients who have undergone a critical condition are characterized by both a decrease in cognitive abilities (difficulties in learning new material, memory impairment, difficulty in making decisions, etc.) and deep emotional disorders, up to severe depression. Patients are unable to enjoy the life saved with such difficulty. Mental disorders arising from a critical condition suffered are described within the framework of post-traumatic stress syndrome.

According to computed tomography (the work of a group of researchers led by R.O. Hopkins), in patients who have undergone a critical condition, there are signs of brain atrophy - a decrease in its volume, accompanied by a loss of functions. The brain of a young person who has had a critical illness may look like the brain of a patient suffering from severe dementia.

The causes of mental disorders that occur after critical illness are currently being investigated. It is assumed that both physical and mental factors are important. The former include insufficient oxygen supply to the brain due to severe respiratory and circulatory 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” with its deficiency), as well as complex biochemical changes that occur during sepsis. Mental factors include pain, emotional isolation, the inability to talk due to the presence of breathing tubes, artificial lung ventilation, to which not all patients easily adapt, always-on lights (patients lose their sense of day and night and counting time), noise - every few minutes, equipment alarms, sleep disturbances are heard.

To prevent the cognitive and emotional consequences of a critical condition, it is necessary, first of all, to change the target settings of medical personnel working with patients in the ICU. It is necessary to understand that saving the life of the patient is not enough, it is necessary, if possible, to save his psyche. Factors provoking post-resuscitation cognitive and emotional impairment, including non-physical factors, should be avoided. For example, at night, if there is no active work, you can turn off the light. It can be useful to hang a wall clock in the ward. To prevent emotional isolation, visits by relatives should not be unnecessarily limited*. The alarm limits of the equipment must be adjusted so that they are activated only when there is a real threat. The number of invasive devices should be minimized. For example, remove the urethral catheter as soon as the patient recovers spontaneous urination.

Relatives of patients play a huge role in the prevention of the mental consequences of a critical condition. When visiting a patient, one should actively communicate with him, not only with the help of conversation, but also with sign language: you can shake his hand, stroke him, etc. Even people with depression of consciousness can perceive environmental signals: if the patient does not respond, this does not mean that it is not necessary to communicate with him. To support the patient, one must demonstrate not grief and pity, but love, the joy of 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. Good newspapers with news: they not only entertain the sick, but also allow them not to feel cut off from the rest of the world. In most ICUs, 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 have been developed in the course of correcting other neuropsychiatric disorders. In order to improve cognitive functions, drugs from the nootropic group can be used, as well as classes with a neuropsychologist. To correct the emotional state, antidepressants, anxiolytics (drugs that relieve fear) and other drugs are used, depending on what kind of disorders prevail, and psychotherapy is also carried out (specialists will find information on psychopharmacotherapy in patients who have come out of a coma in the book by O.S. Zaitsev and S.V. Tsarenko "Neuroresuscitation. Coma recovery"). The social adaptation of the patient is important: if he cannot return to his previous work and hobbies, you need to find an alternative for him.

In order for patients who have undergone a critical condition to return to a full life, a long and patient work of a whole team of specialists is necessary. Abroad, they are currently creating entire centers specializing in rehabilitation after a critical condition. There are no such centers in Russia, and care for a patient who has undergone a critical condition falls on the shoulders of his relatives.

* In some ICUs, relatives are not allowed, motivating refusal by 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, which in the course of natural selection have developed resistance to most known antibiotics, get to patients not "from the street", but from the hands of medical personnel.

What is a stable serious condition in intensive care

Treatment in intensive care is a very stressful situation for the patient. Indeed, in many intensive care centers there are no separate wards for men and women. Often patients lie naked, with open wounds. Yes, and you have to cope with the need without getting out of bed. The intensive care unit is represented by a highly specialized unit of the hospital. Patients are referred to the intensive care unit:

• 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 condition of patients in the intensive care unit, round-the-clock monitoring is carried out. Specialists monitor the functioning of all vital organs and systems. The following indicators are monitored:

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

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

Patients who are in the intensive care unit after the operation have temporary drainage tubes. They are needed to monitor the wound healing process after surgery.

The extremely serious condition of patients means the need to attach to the patient a large amount of special equipment necessary to monitor vital signs. Various medical devices are also used (urinary catheter, dropper, oxygen mask).

All these devices significantly limit the patient's motor activity, he is unable to get out of bed. Excessive activity may cause critical equipment to become disconnected. So, as a result of removing the dropper, bleeding may open, and the disconnection of the pacemaker will cause cardiac arrest.

Determination of 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 the indications for hospitalization, determines the transportability, the probable outcome of the disease.

The general condition of the patient has the following classification:

1. Satisfactory.
2. Medium severity.
3. Severe condition.
4. Extremely heavy.
5. Terminal.
6. clinical death.

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

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

When examining a patient, a specialist gets acquainted with the existing symptoms of diseases, injuries: the appearance of the patient, fatness, his state of consciousness, body temperature, the presence of edema, foci of inflammation, the color of the epithelium, mucosa. Especially important are indicators of the functioning of the cardiovascular system, respiratory organs.

In some cases, an accurate determination of the patient's condition is possible only after obtaining the results of additional laboratory, instrumental studies: the presence of a bleeding ulcer after gastroscopy, the detection of signs of acute leukemia in blood tests, the visualization of cancerous liver metastases 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 deep disability.

Usually, a serious condition is observed in case of a complication of the current disease, which is characterized by pronounced, rapidly progressive clinical manifestations. Patients in this condition are characterized by the following complaints:

• for frequent pain in the heart;
• manifestation of shortness of breath at rest;
• the presence of prolonged anuria.

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

Usually, the following symptoms indicate a serious condition of the patient:

• increase in cachexia;
• anasarca;
• dropsy of cavities;
• rapid dehydration of the body, in which there is dryness of the mucous membranes, a decrease in epidermal turgor;
• the skin becomes pale;
• hyperpyretic fever.

When diagnosing the cardiovascular system, the following are found:

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

When diagnosing the organs of 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, gastric bleeding.

All patients with a very serious condition are subject to mandatory hospitalization. And this means that their treatment is carried out in the intensive care unit.

Stable serious condition

This term is often used by emergency room physicians. Many relatives of patients are interested in the question: Stably 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 the constant supervision of specialists. Doctors, 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 stably serious condition can last from several days to weeks. It differs from the usual serious condition in the absence of dynamics, any changes. Most often, this condition occurs after major operations. The vital processes of the body are supported by special equipment. After turning off the equipment, the patient will be under the close supervision of medical staff.

Extremely serious condition

In this condition, there is a sharp violation of all vital functions of the body. Without prompt treatment, the patient may die. This state is noted:

• sharp oppression of the patient;
• general convulsions;
• face pale, pointed;
• heart sounds are weakly audible;
• respiratory failure;
• wheezing is heard in the lungs;
• blood pressure cannot be determined.

What does a stable condition in intensive care mean?

The intensive care unit is a medical unit that provides assistance to patients with recorded critical violations of the functions of vital organs. Doctors, conducting a course of intensive therapy, conduct round-the-clock monitoring of the patient's well-being, diagnosing the severity of disorders and ways to eliminate them.

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

The specifics of the intensive care unit

People with impaired functioning of vital systems and organs are admitted to the intensive care unit. Critically ill patients with the following pathologies are referred to a specialized intensive care unit:

• Progression of life-threatening ailments;
• Severe injuries;
• Progression of diseases in the presence of severe injuries;
• After using anesthesia;
• After a complex surgical intervention;
• Stroke injury;
• 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.

Taking into account the criticality of the general well-being of the patient, round-the-clock monitoring is carried out in the intensive care unit, the purpose of which is to evaluate the work 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, sensors of medical equipment are connected to the patient's body. In order to stabilize the general condition of the patient, in parallel with diagnostic studies, the necessary drugs are administered intravenously to him. They do this with the help of droppers so that the medicines 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 the wound healing process in the postoperative period. In dangerous situations, when a person is in an extremely serious condition, additional medical devices are connected to him: a catheter for urine output, a mask for oxygen supply.

Patients in this state are in an immobilized position. The patient must lie down with little or no movement, otherwise the mandatory set of connected equipment may be damaged or disrupted. In this case, he is in serious danger in the form of bleeding or cardiac arrest.

Severity of critical violations

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

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

• Satisfactory;
• Having an average severity;
• Severe 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;
• The color of the skin and mucous membranes.

Sometimes such studies are not enough, and then the doctor prescribes laboratory and hardware diagnostics. After all, only in this way it is possible 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 has all the 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 result of a dangerous pathology, which begins to progress rapidly, manifesting itself in vivid symptoms. Patients who are conscious, present such complaints:

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

The patient has confusion, delirium and agitation. He screams for help, groans. Facial features look pointed. With confusion, a convulsive syndrome may appear.

In this state, 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 is quickly dehydrated, the skin becomes pale, almost gray, cold to the touch. There are extreme changes in the lung tissue, which manifests itself in pulmonary edema or asthma attacks.

From the gastrointestinal tract, the reaction of the body is manifested as follows:

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

Extremely serious violations

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

Symptoms of extremely severe disorders are as follows:

• A sharp deterioration in general well-being;
• Extensive convulsions throughout the body;
• The face becomes earthy gray, its features sharpened;
• Heart sounds are barely audible;
• Breathing is disturbed;
• 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 the resuscitation ambulance team.

Stable serious condition

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

A stable condition means a violation of the functioning of life-support systems of moderate severity, which, thanks to the efforts of doctors, does not turn into an extremely severe one. That is, there are no dynamic changes in the life support process of the patient: neither positive nor negative.

For such patients, round-the-clock monitoring with the help of medical devices is provided. They record the slightest changes in the indicators that the medical staff monitors. Violations of stably severe require the same therapy as in other cases: round-the-clock administration of medications to maintain the vital activity of the body.

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

After the stable serious condition of the patient has taken positive dynamics with the help of intensive therapy, he is disconnected from the equipment that artificially supported life support. Nevertheless, the patient and his condition continue to be closely monitored to adjust further drug treatment tactics.

Then diagnostic examinations are 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 the general condition

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

3. Nearest forecast.

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

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

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

3. after additional methods (blasts in the blood test and thrombocytopenia, heart attack on the ECG, bleeding stomach ulcer on FGDS ...).

There are: a satisfactory condition, a moderate condition, a serious condition and an extremely serious condition.

Functions of vital organs are compensated.

No need for emergency hospitalization.

There is no threat to life.

Does not need care (care for a patient due to functional insufficiency of the musculoskeletal system is not the 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 adverse prognosis for life,

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

The patient serves himself (although there may be a limitation due to the pathology of the musculoskeletal system and diseases of the nervous system).

Moderate condition

2. There is a need for urgent hospitalization and medical measures.

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 serve 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, HR over 100 or under 40, RR over 20, impaired bronchial patency, local peritonitis, repeated vomiting, severe diarrhea, moderate intestinal bleeding, ascites ;

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

2. There is a need for emergency hospitalization and therapeutic measures (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 take care of themselves, they need care.

Examples of symptoms seen in a severely ill patient:

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, thready pulse, severe arterial hypertension or hypotension, shortness of breath over 40, prolonged attack of bronchial asthma, incipient pulmonary edema, indomitable 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 therapeutic measures (in intensive care)

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 seen in a critically ill patient:

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

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

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

4. Motor activity and the need for care.

Bilateral coxarthrosis III–IVst. FN 3.

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

Bronchial asthma, attacks 4-5 times a day, stops on its own, dry rales 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 disturbed, hemodynamics is satisfactory.

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

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

Condition of moderate severity (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 a violation of the rhythm.

Moderate condition (2, 3)

Pneumonia, volume - segment, good health, subfebrile temperature, weakness, cough. There is no shortness of breath at rest.

Condition of moderate severity (2, 3).

Pneumonia, volume-lobe, fever, dyspnea at rest. The patient prefers to lie down.

Condition of moderate severity (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. Feeling good. Enlargement of the liver, spleen. No ascites or slight ascites on ultrasound.

Cirrhosis of the liver. Hepatic encephalopathy, ascites, hypersplenism. The patient walks, serves himself.

Moderate condition (1.3)

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

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

Wegener's granulomatosis. Fever, lung infiltrates, shortness of breath, weakness, progressive decline in kidney function. Arterial hypertension is medically controlled. Prefers to be in bed but can walk and take care of himself.

Condition of moderate severity (1,2,3,4).

Wegener's granulomatosis. Deviations in blood tests persist, CRF IIst.

Determination of medical age, significance for diagnosis.

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

On the hands of up to 55 years, the skin, taken in a fold, quickly and well straightens out, at 60 years old it straightens out slowly, and at 65 it no longer straightens out on its own. Teeth with age are erased on the cutting surface, darken, fall out.

By the age of 60, the cornea of ​​the eyes begins to lose transparency, whitishness / arcussenilis / appears along 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. There are eternally young subjects, on the other hand - prematurely aged. Patients with increased thyroid function look younger than their years - usually thin, slender, with delicate pink skin, sparkle in the eyes, mobile, emotional. Premature aging is caused by mexedema, malignant tumors and some long-term severe diseases.

Determination of age is also important because certain diseases are characteristic of each age. 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 and more/.

Age groups /Guide to gerontology, 1978/:

Children's age - flight.

Teenage - flight flight.

Youthful - years of flight.

Young - departure up to 29 years.

Mature - from 33 years to 44 years.

Medium - from 45 years 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, least prone 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 the prognosis /outcomes/: at a young age, the disease mostly proceeds rapidly, their prognosis is good; in senile - the reaction of the body is sluggish, and those diseases that end in recovery at a young age, for example, pneumonia, in old people are often the cause of death.

Finally, in certain age periods, there are sharp shifts in both the somatic and neuropsychic spheres:

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

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

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

The doctor determines the correspondence of gender and age to passport data already when questioning the patient, records deviations in the medical history if they are detected, for example: “the patient looks older than his years” or “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 that detailed information is not given over the phone, this is incorrect. Usually relatives come at the set hours, they are personally informed about the patient's condition. When they call the hospital reference, they are usually given minimal information - the severity of the patient's condition and temperature. Everyone is guided by temperature. People are usually scared by the phrases “heavy” or “extremely difficult”. It is clear that every relative, close one is worried about his 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 amount of injury, the amount of decompensation of the disease. Extremely severe - these are most often patients on artificial lung ventilation. It may also be due to unstable heart function, as doctors say: “With unstable hemodynamics”, when drugs are added that stimulate the work of the heart and blood vessels. I would not want someone close or relative to end up in the intensive care unit.

If the patient moves from the status of "severe" to moderate, moderate, he goes to an ordinary ward, where he usually progresses through treatment.

resuscitation

Resuscitation: definition, implementation 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 response to light. Also called intensive care unit, which treats the most severe patients on the verge between life and death and specialized emergency teams that treat such patients. Pediatric resuscitation is a very complex and responsible branch in medicine, which helps to save the smallest patients from death.

Resuscitation in adults

The algorithm for cardiopulmonary resuscitation in men and women is not fundamentally different. The main task is to achieve the restoration of airway patency, spontaneous breathing and maximum chest excursion (the amplitude of the movement of the ribs 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 independent 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 body is arranged in a special way, therefore, in order to provide emergency care for clinical death in babies, you need to know certain rules. After all, sometimes out of ignorance, the wrong technique of resuscitation of children leads to death in cases where this could have been avoided.

Children's resuscitation

Very often, the cause of respiratory and cardiac arrest in children is the aspiration of foreign bodies, vomit or food. Therefore, before starting them, it is necessary to check for foreign objects in the mouth, for this you need to slightly open it and examine the visible part of the pharynx. If you have them, 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 amount of air.

The heart rate in children is more frequent 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 pressure with one hand with an amplitude of chest fluctuations of no more than 3-4 cm.

Children's resuscitation is an extremely responsible event, however, while waiting for an ambulance, you should at least try to help your baby, because it can cost him his life.

Newborn resuscitation

Resuscitation of newborns is not a rare procedure that doctors perform in the delivery room immediately after the birth of the baby. Unfortunately, the birth does not always go smoothly, sometimes severe injuries, prematurity, medical manipulations, 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 lack of certain manipulations in the framework of resuscitation of newborns leads to the fact that he may die.

Fortunately, neonatologists and pediatric nurses practice all actions to automaticity, and in the vast majority of cases they manage to restore blood circulation in a child, 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 have health problems in the future, caused by a not very successful start to their life.

What is human resuscitation

The word "resuscitation" in translation from Latin literally means "re-giving life." Thus, resuscitation of a person is a set of certain actions that are carried out by medical workers or ordinary people who are nearby, under favorable circumstances, allowing a person to be brought out of a state of clinical death. After that, in the hospital, if there are indications, a number of therapeutic measures are carried out aimed at restoring the vital functions of the body (the work 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, however, it is used in a broader sense with other meanings.

Very often, this term is used to refer to the department, which has the official name "reanimation and intensive care unit". However, it is long and not only ordinary people, but medical professionals themselves reduce it to one word. Another resuscitation is often called a specialized emergency medical team, which leaves for calls to people who are in extremely serious condition (sometimes clinically dead). They are equipped with everything necessary for carrying out various activities that may be needed in the process of resuscitation of a victim in severe traffic, industrial or criminal accidents, or those who suddenly have a sharp deterioration in health, which has led 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 among all other medical professions: these doctors have a very big load, since their work is related to helping patients who are on the verge of life and death. Every day they face the most severe patients, and they are required to make immediate decisions that directly affect their lives. Resuscitation patients require attention, constant monitoring and thoughtful attitude, because any mistake can lead to their death. A particularly heavy burden falls on doctors who are engaged in anesthesiology and resuscitation of the smallest patients.

What should an anesthesiologist resuscitator be able to do

A doctor specializing in anesthesiology and resuscitation has two main and main tasks: the treatment of seriously ill patients in the intensive care unit and the assistance during surgical interventions associated with the choice and implementation of anesthesia (anesthesiology). The work of this specialist is prescribed in the job descriptions, so the doctor must carry out his activities in accordance with the main points of this document. Here is some of them:

• Evaluates the patient's condition before surgery and prescribes additional diagnostic measures in cases where there are doubts about the possibility of surgical treatment under anesthesia.
• Organizes the workplace in the operating room, monitors the serviceability of all devices, in particular the ventilator, monitors for monitoring heart rate, 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 deteriorates sharply, informs the surgeons who directly perform it, and takes all necessary measures to correct this condition.
• After the end of the operation, the patient is taken out of the state of anesthesia or other type of anesthesia.
• In the postoperative period, he monitors the patient's condition, in case of unforeseen situations, takes all the necessary measures for its correction.
• In the resuscitation and intensive care unit, he treats seriously ill patients using all the necessary techniques, manipulations and pharmacotherapy.
• A doctor specializing in anesthesiology and resuscitation should be proficient in various types of vascular catheterization, the technique of tracheal intubation and artificial lung ventilation, and perform various types of anesthesia.
• In addition, he must be fluent in such an important skill as cerebral and cardiopulmonary resuscitation, know how to treat all major urgent life-threatening conditions, such as various types of shocks, burn disease, polytrauma, various types of poisoning, heart rhythm and conduction disorders, tactics for especially dangerous infections, etc.

The list of what an anesthesiologist 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 for sure.

In addition to the knowledge and skills that relate to his professional activities, a doctor of 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 will be able to 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 "General Medicine" or "Paediatrics", and then complete a 1-year internship, 2-year residency or professional retraining courses (4 months ) with a degree in anesthesiology and resuscitation. Residency is the most preferable, since such a complex profession cannot be mastered qualitatively in a shorter period of time.

Further, a doctor of this specialty can begin independent work, however, in order to feel more or less calm in this role, he needs another 3-5 years. Every 5 years, a doctor must take 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 no action is taken, then it will inevitably be replaced by true death, that is, biological, when a person can no longer be helped.

In general, everyone should know the basics of cardiopulmonary resuscitation, because anyone has a chance to be next to such a person, and his life will depend on his determination. Therefore, before the arrival of the ambulance, you need to try to help the person, since in this state every minute is precious, and the car will not be able to 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 attenuation 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 the 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 snow blockage) it can be minutes, while in the heat the period when resuscitation of a person can be successful, reduced to 2-3 minutes.

Carrying out resuscitation during this period of time gives a chance to restore the work of the heart and the breathing process, and prevent the complete death of nerve cells. However, it is far from always successful, because the result depends on the experience and correctness of this difficult procedure. Doctors who, by 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 the entire responsibility for its implementation lies with ordinary people.

If resuscitation was started 10 minutes after the onset of clinical death, even if the work of the heart and breathing was restored, irreparable death of some neurons had already occurred in the brain, and such a person, most likely, would 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 neurons have died, and, nevertheless, when the work of the heart is restored, the life of such a person can be continued by special devices (the patient himself will be in the so-called "vegetative state").

Biological death is recorded 40 minutes after the establishment of clinical death and / or at least half an hour of unsuccessful resuscitation. 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. Not making sure that the person is not in it, you should not torment him with your attempts to resuscitate. However, true clinical death - a condition in which resuscitation is the only treatment - no drugs can artificially resume the work of the heart and the breathing process. It has absolute and relative signs that allow you to suspect it quickly enough, even without a special medical education.

Absolute signs of a condition requiring resuscitation include:

The patient does not show signs of life, does not answer questions.

In order to determine whether the heart is working or not, it is not enough to attach the ear to the cardiac region: in very obese people or at low pressure, it can simply not be heard, mistaking this condition for clinical death. Pulsation on the radial artery is also sometimes very weak, moreover, its presence depends on the anatomical location of this 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 is breathing in a critical condition is also sometimes difficult to determine (with shallow breathing, chest fluctuations are practically invisible to the naked eye). To find out exactly whether a person is breathing or not and start intensive resuscitation, you need to attach a sheet of thin paper, cloth or a blade of grass to your nose. The air exhaled by the patient will cause these objects to vibrate. Sometimes it is enough just to put your ear to the nose of a sick person.

• Pupillary response to light stimulus.

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

Relative signs of clinical death:

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

They are not in themselves an indication for resuscitation, however, 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 a critical condition, in which resuscitation does not make sense. Of course, doctors are trying to save anyone's life, but if the patient suffers from an end-stage cancer, a systemic or cardiovascular disease that has led to decompensation of all organs and systems, then an attempt to restore his life will only prolong his suffering. Such conditions are a contraindication for intensive resuscitation.

In addition, cardiopulmonary resuscitation is not performed in the presence of signs of biological death. These include:

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

A severe injury incompatible with life (for example, a detachment of the head or a 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 urgent event, but medical workers, especially emergency services, are fluent in it. Cardiopulmonary resuscitation, the algorithm of 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 elementary 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 happened to be near the 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 (responds or not to questions) and reaction to stimuli (press the phalanx of the patient's finger with a fingernail or a sharp object and see if there is a reflex contraction of the hand).

Check for breathing. First, assess if there is movement of the chest or abdominal wall, then lift the patient and again monitor if there is breathing. Bring an ear to his nose for auscultation of respiratory noise or a thin cloth, thread or leaf.

Assess the reaction of 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 narrowed, and this symptom is not informative.

Check for a heartbeat. Pulse control for at least 15 seconds on the carotid artery.

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

If you find out that the patient is clinically dead, you need to call for help everyone who happened to be close to you - the more people help you, the more chances to save the person.

One of the people helping you should immediately call for emergency assistance, be sure to give all the details of the incident and listen carefully to all instructions from the service dispatcher.

While one calls an ambulance, the other should immediately begin to conduct cardiopulmonary resuscitation. The algorithm of this procedure involves a number of manipulations and certain 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 by giving the patient a position on his side, with his hand wrapped in a thin cloth.

After that, in order to avoid overlapping the respiratory tract with the tongue, it is necessary to put the patient on his back, open his mouth slightly and push the jaw forward. In this case, you need to put one hand under the patient’s neck, throw back his head, and manipulate with the other. A sign of the correct position of the jaw is a parted mouth and the position of the lower teeth directly on the same level with the upper ones. Sometimes spontaneous breathing is fully restored after this procedure. If this does not happen, then the following steps must be followed.

Next, you need to start artificial ventilation of the lungs. Its essence is as follows: a man or woman who resuscitates a person is located on the side of him, put one hand under his neck, put the other on his forehead and pinch his nose. Then they take a deep breath and exhale tightly into the mouth of a clinically dead person. After that, an excursion (movement of the chest) 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 the obstruction of the airways, which must be tried to be eliminated.

The third point of the cardiopulmonary resuscitation algorithm is a closed heart massage. To do this, the caregiver must position himself on either side of the patient, put his hands one on one on the lower part of the sternum (they should not be bent with the elbow joint), after which he needs to make intense pressure on the corresponding area of ​​\u200b\u200bthe chest. The depth of these pressings should ensure the movement of the ribs to a depth of at least 5 cm, lasting about 1 second. Such movements need to be done 30, and then repeat two breaths. The number of pressings during artificial indirect heart massage should coincide with its physiological contraction - that is, it should be 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 moment when the emergency team arrives and continues all these activities. Therefore, it is optimal that several people take turns conducting it, 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 - artificial ventilation of the lungs, and then change places.

The provision of emergency care in cases of clinical death in young patients has its own characteristics, so resuscitation of children or newborns differs from that in adults. First, it must be taken into account that they have a much smaller lung capacity, so trying to breathe too much into them can lead to injury or rupture of the airways. Their heart rate is much higher than in adults, therefore, resuscitation of children under the age of 10 years involves at least 100 chest compressions and an excursion of no more than 3-4 cm. Resuscitation of newborns should be even more accurate and gentle: artificial ventilation of the lungs is carried out not in the mouth, but in the nose, and the volume of air blown in should be very small (about 30 ml), but the number of clicks 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 mechanical ventilation and closed heart massage (2:30) should replace each other before the arrival of emergency doctors. If you stop carrying out these manipulations, then a state of clinical death may again occur.

Criteria for the effectiveness of resuscitation

Resuscitation of the victim, and indeed of any person who was in clinical death, should be accompanied by constant monitoring of his condition. The success of cardiopulmonary resuscitation, its effectiveness can be assessed by the following parameters:

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

The patient may be unconscious, the main thing is the restoration of the heart and free breathing. If a pulsation appears, but breathing does not, then it is worth continuing only artificial ventilation of the lungs until the emergency team arrives.

Unfortunately, not always the resuscitation of the victim leads to a successful result. The main mistakes during its implementation:

• The patient is on a soft surface, the force applied by the resuscitator when pressing on the chest is extinguished due to body vibrations.
• Insufficient pressure intensity that results in chest excursion of less than 5 cm in adults.
• The cause of the airway obstruction has not been eliminated.
• Incorrect position of the hands during ventilation and heart massage.
• Delayed start of cardiopulmonary resuscitation.
• Pediatric resuscitation may not be successful due to the insufficient frequency of chest compressions, which should be much more frequent than in adults.

During resuscitation, injuries such as a fracture of the sternum or ribs may develop. However, in themselves, these conditions are not as dangerous as clinical death, so the main task of the caregiver is to return the patient to life at any cost. If successful, the 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 the most severe patients are treated here, requiring round-the-clock close monitoring by medical workers.

Who is an intensive care patient

Resuscitation patients are the following categories of people:

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

Resuscitation patients are usually transferred to specialized departments (therapy, neurology, surgery or gynecology) after stabilization of their condition: restoration of spontaneous breathing and the ability to eat, recovery from a coma, maintaining normal pulse and pressure values.

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 controlled by various monitors, a number of them are artificially ventilated, drugs are constantly administered through various infusomats (devices that allow you to inject 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 (in each of them there are 1-6 patients),
• Doctors' (staff's), nurses' (nursing), head of department and senior nurse's offices.
• Auxiliary zone, where everything necessary to control the cleanliness in the department is stored, junior medical personnel often rest there.
• Some intensive care units are equipped with their own laboratory, where emergency tests are carried out, there is a doctor or laboratory assistant.

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 artificial lung ventilation devices, an oxygen therapy device, a pacemaker, various infusion pumps, drip stands. Depending on the indications, other special equipment may be delivered to the patient. The intensive care unit can perform an emergency hemodialysis procedure. In each ward there is a table where the resuscitator works with papers or the nurse draws up an observation card.

Beds for intensive care patients differ from those in conventional departments: there is an opportunity for giving the patient an advantageous position (with a raised head end or legs), fixing the limbs if necessary.

A large number of medical personnel work in the intensive care unit, which ensures the smooth and continuous work of the entire department:

• head of the resuscitation and intensive care unit, senior nurse, housewife,
• anesthesiologists-resuscitators,
• nurses,
• junior medical staff,
• resuscitation laboratory staff (if any),
• support services (which monitor the health of all devices).

City intensive care

City resuscitation - these are all intensive care units of the city, which are ready at any moment to accept severe patients brought to them by ambulance teams. Usually, in each major city, there is one leading clinic that specializes in emergency care and is on duty all the time. This is what can be called urban resuscitation. 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 accepted and receive all the necessary assistance.

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

Regional resuscitation

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

Regional resuscitation is engaged in the treatment of patients who unsuccessfully tried to remove 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 is the resuscitation of the victim

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

How to resuscitate an injured person in an emergency

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 beginning of the onset of clinical death, because after 30 minutes it is already considered ineffective.

Artificial ventilation of the lungs by doctors is carried out with a breathing bag (Ambu), since prolonged breathing "mouth to mouth" or "mouth to nose" reliably leads to infectious complications. In addition, it is not so hard physically and allows you to transport the victim to the hospital without stopping this procedure. There is no artificial replacement for indirect heart massage, so the doctor conducts it according to general canons.

In case of a successful result, when the patient's pulse resumes, they catheterize and inject substances that stimulate the work of the heart (adrenaline, prednisone), control the work of the heart by monitoring the electrocardiogram. When spontaneous breathing is restored, an oxygen mask is used. In this condition, the patient after resuscitation is taken to the nearest hospital.

How the ambulance works

If a call arrives at the ambulance dispatcher, which reports that the patient has signs of clinical death, then a specialized team is immediately sent to him. However, not every ambulance is equipped with everything necessary for emergencies, but only an ambulance. This is a modern car, specially equipped for cardiopulmonary resuscitation, equipped with a defibrillator, monitors, 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, sometimes it has a bright yellow color, which allows other drivers to quickly notice it and let it pass ahead.

An ambulance with the words "newborn resuscitation" is also usually painted yellow and equipped with everything necessary for emergency care of the smallest patients who are in trouble.

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 quite different. For some, this is just an unpleasant memory and nothing more. And others after resuscitation cannot fully recover. It all depends on the speed of the start of revitalization activities, their quality, effectiveness, and how quickly specialized medical assistance arrived.

Features of patients who have undergone 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 a result, then the brain cells did not have time to die. Such a patient can return to a full life, but certain problems with memory, the level of intelligence, and the ability to exact sciences are not ruled out. If breathing and heartbeat against the background of all activities did not recover within 10 minutes, 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 possibility of independent movement.

If more than 15 minutes have passed since the onset of clinical death, through active cardiopulmonary resuscitation, the work of breathing and the heart can be supported artificially by various devices. But the patient's brain cells have already died, and then he will be in the so-called "vegetative state", that is, there are no prospects to return his life without life support devices.

The main directions of rehabilitation after resuscitation

The volume of measures within the framework of rehabilitation after resuscitation directly depends on how long the person was previously in a state of clinical death. The extent to which the nerve cells of the brain have been damaged can be assessed by a neurologist, who will also prescribe all the necessary treatment as part of the recovery. It may include various physiotherapy, 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.