Intensive (emergency) therapy is a way to treat life-threatening diseases. Resuscitation is the process of restoring vital (vital) functions, partially lost or blocked as a result of an illness. These types of treatment allow you to establish constant monitoring of the restoration of functions and intervene in the process in case of rapid violations in the functioning of organs and systems. In general, resuscitation and intensive care are the most effective and the latest available methods to prevent the development of a fatal outcome in severe (life-threatening) diseases, their complications, and injuries.
Basic concepts
Intensive therapy is a round-the-clock treatment method that requires the use of infusion infusions or detoxification methods with constant monitoring of vital signs. They are ascertained through blood and body fluids, which are often repeated to quickly track the deterioration and improvement of the patient's somatic functions. The second control method is monitoring, which is implemented in hardware by using cardiomonitors, gas analyzers, an electroencephalograph, and other typical equipment.
Resuscitation is the process of applying medical and hardware techniques to restore the body to life in the event of an emergency. If the patient is in a condition 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 the lost functions, then the process of their compensation and return is called resuscitation.
Resuscitator deals with these issues. This is a narrow specialist, whose place of work is the intensive care unit and intensive care unit. Most often, doctors with the only profession of resuscitator do not exist, since the specialist receives a diploma of an anesthesiologist and resuscitator. At the place of work, depending on the profile of the institution, he can occupy three types of positions: “anesthesiologist-resuscitator”, as well as separately “resuscitator” or “anesthesiologist”.
Intensive care unit doctor
An intensive care doctor is an anesthetist-resuscitator. He deals with the selection of the type of anesthesia in preoperative patients and monitoring their condition after surgery. Such a specialist works in any multidisciplinary medical center (usually regional or district), and the department is called OITD. Patients may be located here whose functions are compensated, but vital signs monitoring 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 ICU with an anesthetist-resuscitator.
Resuscitator
A resuscitator only deals with the restoration of vital functions, and often his place of work is an emergency station or substation. Having access to the equipment that equips the intensive care ambulance, he can reanimate the patient on the move, which is useful in all situations related to disaster medicine. Most often, the resuscitator does not engage in intensive care in the ICU, but establishes control of the vital functions of the patient in the ambulance. That is, he is engaged in medical treatment and hardware control of patient functions with the threat of death.
Anesthetist
An anesthetist is an example of a specialist position in a narrow-profile medical center, for example, in an oncology clinic or in a perinatal center. Here, the specialist’s main job is to plan the type of anesthesia for patients who have to undergo surgery. In the case of the perinatal center, the task of the anesthesiologist is to select the type of anesthesia for patients who will undergo a cesarean section. It is important that intensive care in children is also carried out in this center. However, the resuscitation and intensive care units for patients and for newborns are structurally separated. Neonatologists work in OITR for children (newborns), and an anesthetist-resuscitator serves adults.
OITR surgical hospitals
The intensive care unit in hospitals with a surgical bias is planned depending on the number of patients who require intervention and the severity of the operations. With interventions in oncology clinics, the average patient’s stay in the ICU is higher than in general surgical ones. Intensive therapy here takes more time, since important anatomical formations are inevitably damaged during operations.
If we consider oncological surgery, then the vast majority of interventions are highly traumatic and a large volume of resected structures. This requires a long time to recover the patient, since after the operation there is still a risk of deterioration of well-being and even death from a number of factors. It is important to prevent complications of anesthesia or intervention, support vital functions and replenish blood volume, part of which is inevitably lost during the intervention. These tasks are most important during any postoperative rehabilitation.
OITR of hospitals of a cardiological profile
Cardiological and therapeutic hospitals are distinguished by the fact that there are both compensated patients without life threatening and unstable patients. They need to establish control and maintain their condition. In the case of diseases of a cardiological profile, myocardial infarction with its complications in the form of cardiogenic shock or sudden cardiac death requires the closest attention. Intensive therapy of myocardial infarction can reduce the risks of death in the near term, limit the amount of damage by restoring patency of the infarcted artery, and improve the prognosis for the patient.
According to the protocols of the Ministry of Health and international recommendations, in case of acute coronary pathology, it is necessary to place the patient in the intensive care unit to perform emergency measures. Assistance is provided by an ambulance officer at the delivery stage, after which restoration of patency through the coronary arteries that are occluded by a blood clot is required. Then, the resuscitator is engaged in treating the patient until stabilization: intensive therapy, drug treatment, hardware and laboratory monitoring of the condition are carried out.
In the cardiological ICU, where surgical operations are performed on the vessels or valves of the heart, the task of the department is the early postoperative rehabilitation and monitoring of the condition. These operations are highly traumatic, which are accompanied by a long recovery and adaptation period. In this case, there is always a high probability of thrombosis of a vascular shunt or stand implanted with an artificial or natural valve.
Equipment OITR
Resuscitation and intensive care are branches 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 technological, 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 ICTR
In traditional departments, patients who are not threatened with death from a disease or its complications in the short term, an infusion drip system is used for these purposes. In OITD, it is often replaced by infusomats. This equipment allows you to constantly enter a certain dose of a substance, without resorting to the need to puncture a vein every time a drug is needed. Also, the infusomat allows you to enter drugs continuously for a day or more.
The modern principles of intensive care for diseases and emergency conditions have already developed 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, approximating the likely fatal outcome;
- treatment of the underlying disease, stabilization of the condition through symptomatic therapy;
- elimination of life-threatening conditions and symptoms;
- laboratory and instrumental monitoring of the patient;
- transfer of the patient to the specialized department after stabilization and elimination of life-threatening factors.
Laboratory and instrumental control
Monitoring the patient's condition is based on an assessment of three information sources. The first is to interview the patient, establish complaints, clarify the dynamics of well-being. The second - data from laboratory studies performed before admission and during treatment, a comparison of test results. The third source is information obtained through instrumental research. Also, this type of source of information about the patient’s well-being and condition includes systems for monitoring heart rate, blood oxygenation, heart rate and rhythm, blood pressure index, and brain activity.
Anesthetic and special equipment
Practical medicine sectors such as anesthesiology and intensive care are inextricably linked. Specialists who work in these areas have diplomas with the phrase "anesthetist-resuscitator." This means that the same specialist can deal with issues of anesthesiology, resuscitation and intensive care. Moreover, this means that to meet the needs of multidisciplinary health care institutions, including inpatient departments of the surgical and therapeutic bias, one MIT is enough. It is equipped with equipment for resuscitation, treatment and anesthesia before surgery.
Resuscitation and intensive care require a monophasic (or biphasic) defibrillator or cardioverter-defibrillator, electrocardiograph, mechanical ventilation system , cardiopulmonary bypass (if required by a particular healthcare institution), sensors and analysis systems necessary to monitor cardiac and brain activity . Also important is the availability of infusomats necessary for setting up systems of continuous infusion infusions of drugs.
Anesthesiology requires equipment for inhalation anesthesia. These are closed or semi-open systems, through which the flow of anesthetic mixture into the lungs is ensured. This allows you to establish endotracheal or endobronchial anesthesia. It is important that for the needs of anesthesiology laryngoscopes and endotracheal (or endobronchial) tubes, catheters for the bladder and catheters for puncture of the central and peripheral veins are required. The same equipment is required for intensive care.
OITD of perinatal centers
Perinatal centers are healthcare facilities where deliveries occur that can potentially go away with complications. Women who suffer from miscarriage or have extragenital pathologies that are potentially capable of harming health during childbirth should be sent here. Also here 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 anesthetic care to patients who will undergo surgical operations.
Instrumental support of OITD of perinatal centers
The intensive care unit of the perinatal center is equipped depending on the planned number of patients. It requires anesthetic systems and resuscitation equipment, the list of which is indicated above. At the same time, neonatological departments have perinatal centers. They must have special equipment. Firstly, adult artificial respiration and blood circulation devices 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 support is needed , because infants born much earlier than the due date require the use 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 work OITR
OITD 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 when it is responsible for the life support of a particular patient. Depending on the number of patients and the load on the ward, a bed fund is formed. Each bed should also be equipped with ventilators and monitors. Less than the number of beds, the number of ventilators, monitors and sensors is allowed.
The department, which is designed for 6 patients, employs 2-3 resuscitation anesthetists. 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 only the doctor on duty is monitoring the patients in the standard departments. An anesthetist-resuscitator should monitor patients who are in the ICU. He is also obliged to take part in consultations and provide assistance to patients of somatic departments until hospitalization in the ICU.
An intensive care nurse and a nurse assist the physician in the work of an anesthesiologist-resuscitator. The calculation of the number of rates is carried out depending on the number of patients. For 6 beds, one doctor, two nurses and one orderlies are required. Such a number of employees must be present on each duty during the day. Then the staff is replaced by another shift, and it, in turn, is the third.