How to find out about the condition of the patient in intensive care. Determination of the general condition of the patient
Your loved one has serious health problems. This may be due to illness, injury, surgery, or other causes. His health problems require specialized medical care, the so-called "intensive care" (colloquially - "reanimation"). The ICU is often abbreviated as ICU in avian medical parlance.
Important! Getting into the ICU does not mean that your loved one will die.
After successful intensive care in the ICU, the patient is usually transferred to continue treatment in another department of the hospital, such as surgery or cardiology. The prognosis depends on the severity of the patient's condition, his age, concomitant diseases, the actions and qualifications of doctors, the equipment of the clinic, as well as numerous random factors, in other words, luck.
What should you do?
Calm down, concentrate and, first of all, take care of your own mental and physical condition. For example, one should not fall into despair, drown out fear and panic with alcohol, turn to fortune-tellers and psychics. If you act rationally, you can increase the chance of survival and speed up the recovery of your loved one. When you find out that your relative is in intensive care, notify the maximum number of loved ones, especially those related to medicine and healthcare, and also evaluate how much money you have and how much you can find additionally if necessary.
Can they not let you into intensive care?
Yes they can. Federal Law No. 323 “On the Fundamentals of Protecting the Health of Citizens in Russian Federation' is quite contradictory. It guarantees free visits to patients by their relatives and legal representatives, but at the same time categorically requires compliance with the requirements established by the internal regulations of the clinic. The reasons for a ban on the admission of a relative to the intensive care unit at the clinic can be quite understandable: the presence of an infection, inappropriate behavior, the employment of personnel during resuscitation.
If it seems to you that your right to communicate with a relative in the ICU is violated, it is usually useless and even harmful to conflict with security guards, nurses, nurses or doctors on duty. To resolve conflict situations, it is more expedient to contact the head of the department or the administration of the clinic. The good news is that staff in most intensive care units are more welcoming if they demonstrate willingness to cooperate and adequacy.
What is useful to ask doctors?
Ask these questions.
- Is there a need to purchase some drugs that are not available (for example, expensive antibiotics)?
- Do I need to buy additional care products? For example, a “duck” made of synthetic material, not metal, an anti-decubitus mattress, diapers.
Is it worth hiring a personal caregiver? If so, is it necessary to negotiate with the junior staff of the department or is it necessary to bring a person from outside (for example, from the patronage service)? Remember that with some diseases, the life of the patient directly depends on the care. Do not spare money for a nurse, if you need one.
- How is food organized and is there a need to buy special food for the seriously ill?
- Do you need outside expert advice? Suppose there is no full-time neurosurgeon in the clinic, and his consultation is advisable in case of illness of your loved one. Formally, doctors themselves are obliged to take care of this, in practice - this is often organized by relatives.
Finally, ask what else you can bring to a loved one. Some familiar things: toys for a child, personal medicines, hygiene and household items. Sometimes - a phone, a tablet and even a TV.
How to behave in intensive care?
Dress as you are told. As a rule, these are clothes made of synthetic fabrics (no wool), comfortable removable shoes, a disposable gown, a hat, a mask (you can buy it at a pharmacy). If you have long hair, put it in a bun. Carry hand sanitizer with you and sanitize your hands. Sometimes it even makes sense to get your own interchangeable surgical suit (you can buy it at a medical clothing store).
Moderate your emotions. You will find yourself in an extremely unusual environment, there will be seriously ill people around, there will be a lot of smells and sounds. Don't disturb the staff. For you, this is stress, for employees - everyday life. Your loved one may not speak, or speak the wrong way or the wrong thing, numerous tubes may stick out of him, there may be bandages, stickers on him. It may be a strange color, swollen, smell unusual.
Don't worry, it's not forever. He's just sick.
How can you help him?
No one knows how it works, but experienced practitioners can determine the likelihood of the patient's survival in case of complications even at the first conversation with the patient. Much depends on the psychological state of the patient. And this state is almost completely dependent on loved ones, that is, on you.
If possible, talk to the sick as if you were healthy. In no case do not sob, do not hysteria, do not look at him with despair and pain, even if you experience them, do not wring your hands, do not shout: “Oh, what is wrong with you ?!”. Do not discuss on your own the circumstances of the injury if it is an injury. Don't talk about the negative. Talk about the most practical things, both related to the disease, and purely domestic, family.
Remember: while your loved one is sick, but alive, he can and should participate in the life of his family.
And what to say if he is afraid of death?
I don't know, it's up to you. But anyway, listen. If a loved one asks to meet with a priest, arrange it. As a rule, those are allowed into intensive care even to terminal patients. If a loved one has a chronic impairment of consciousness (for example, is in a coma), devote a lot of time to verbal and non-verbal (touch, massage, things that are familiar to him in the accessible area) communication with him. Latest scientific work show that this has a positive effect on the rehabilitation process. Many patients who seem “coma” to the layman actually see and hear everything that happens around them.
If you have to nurse your loved one for long weeks, months or years, resuscitation becomes a significant part of life. You will need endurance and composure. Help the staff as soon as you feel that you have mastered the basic skills. I know of cases where relatives of resuscitation patients subsequently changed their life path and became nurses and doctors.
For the relatives of his patients wrotepracticing neurosurgeon Alexei Kashcheev.
PROCEDURE FOR PROVIDING INFORMATION
on the health status of patients on inpatient treatment in the Federal State Budgetary Institution "FTSSSH" of the Ministry of Health of Russia, Krasnoyarsk (hereinafter referred to as the Center) to relatives and friends of patients.
1. Providing information about the state of health of a patient undergoing inpatient treatment at the Center is carried out only to persons indicated by the patient in the authorization form for the transfer of information constituting a medical secret. This form is filled out by the patient during the registration of hospitalization in the emergency department and is placed in the medical history. Responsible for filling out the form and placing in the medical history is the nurse of the admission department.
2. Information about the patient's health status to persons to whom the patient has given consent to receive information may be provided by the attending physician, operating surgeon, head of the department, resuscitator or head of the intensive care unit when the patient is in the intensive care unit.
3. Information about the patient may be obtained in a personal conversation with a doctor or with the head of the department, or by telephone. If the patient indicates a specific person to receive information, the transfer method is only face-to-face - after the provision of documents confirming the identity and verification of their data with those specified by the patient in consent to the transfer of data.
4. On weekdays, information about the patient's health status is provided by the attending physician or operating surgeon at a personal meeting or by phone number of the internship from 14.00 to 16.00 (including information about patients in the anesthesiology and intensive care unit). Information about the condition of patients transferred to the intensive care unit after 16.00 is provided on that day by the doctor on duty resuscitator or on-duty pediatric resuscitator from 20.00 - 22.00 at the telephone number of the internship or medical post, or at a face-to-face meeting.
5. On weekends and holidays information about the health status of patients undergoing treatment in the department of anesthesiology and resuscitation is provided by the doctor on duty resuscitator or on-duty pediatric resuscitator from 10.00 to 12.00 and from 20.00 to 22.00 by the telephone number of the internship or medical post, or at a face-to-face meeting.
6. Information about the patient’s health status is received from the head of the department either directly by contacting the phone number of the office of the head of the department at work time or through the attending physician, who is obliged to inform the latter of the need to clarify the patient's state of health. The head of the department within 2 working days must ensure the provision of information over the phone or at a face-to-face meeting.
7. Other employees of the Center, except for the persons specified in paragraph 2 of this Procedure, are prohibited from providing any information about the patient's condition. Information about the request received, about the patient's condition must be transferred to the patient's attending physician or operating surgeon, while the patient is in the intensive care unit - to the resuscitator.
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 of the conduct 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 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 may complain of intense pain of various localization, severe weakness, shortness of breath with moderate physical activity, 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 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. 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 (decrease in 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.
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. 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, timely resuscitation measures can bring a person back to life.
With purulent-necrotic processes against the background of SDS, it is possible to provide two main types of assistance: conservative and operational. Conservative treatment includes help with the main endocrinological disease: glycemia, correction of concomitant pathologies, primarily of the cardiovascular system, and treatment of a specific surgical complication. These can be dressings, including them, such as vacuum drainage and ultrasonic cavitation. As an operative treatment can be used: hydrosurgical necrectomy, different kinds reconstructive surgeries and even various types of plastic surgeries to stop a purulent process, which are used to close a defect.
Where in the city can I get help for purulent surgery?
In St. Petersburg there is a department of purulent surgery in the hospital of St. George (Severny pr., 1).
Patients with what diseases can be admitted to the Limb Rescue Center?
The Center for Limb Rescue can get patients who have disorders of the peripheral circulation, most often - the circulation of the lower extremities against the background of either diabetes either - obliterating atherosclerosis vessels of the lower extremities, including in the presence of trophic changes and purulent-necrotic processes associated with circulatory disorders of various origins. You can find the list of tests for hospitalization at the Limb Rescue Center at.
Is it possible to get a remote consultation in your institution?
The possibility of providing remote consultation in each case is decided individually.
Tell me, do you take patients from other cities for operations?
On an emergency basis, treatment of patients with purulent surgical infection is carried out regardless of whether they have registration in St. Petersburg and other documents (passport, policy, etc.). If there is no threat to life, planned hospitalization is possible subject to the procedure for providing appropriate assistance, namely, if there is a referral and necessary studies in the order of priority for planned hospitalization. If the patient wishes, it is possible to provide planned medical care.
Can I get a paid consultation at the Hospital? Can this be done on a day off?
