How many days do they stay in the intensive care unit after a stroke? What are the conditions in intensive care? If a person is unconscious in intensive care
Patients are hospitalized in the intensive care unit:
1) with acute hemodynamic disorders (cardiovascular system) of various etiologies (such as acute cardiovascular failure (CHF), traumatic shock, hypovolemic shock - shock with large loss of body fluid, cardiogenic shock, etc.);
2) with acute respiratory disorders (respiratory failure);
3) with other disorders of the functions of vital organs and systems (central nervous system, internal organs, etc.);
4) with acute disorders of metabolic processes in the body, etc.;
5) with severe poisoning;
6) in the recovery period after clinical death, after surgical interventions that resulted in dysfunction of vital organs, or with a real threat of their development.
The main methods of treatment in the intensive care unit will be outlined below using the example of treatment of acute respiratory failure.
The most common causes of acute respiratory failure are:
1) trauma to the chest and respiratory organs, which is accompanied by fractured ribs, pneumo- or hemothorax (entry of air or blood into the pleural cavity, respectively) and disruption of the position and mobility of the diaphragm;
2) a disorder of the central (at the level of the brain) regulation of breathing, which occurs during traumatic injury and diseases of the brain (for example, encephalitis);
3) obstruction of the airway (for example, due to foreign bodies);
4) a decrease in the working pulmonary surface, which may be caused by either atelectasis (collapse) of the lung;
5) impaired blood circulation in the lung area (due to the development of the so-called shock lung, a blood clot entering the pulmonary arteries, pulmonary edema).
To determine the causes of acute respiratory failure, a chest x-ray is performed. To determine the degree of oxygen starvation and accumulation of carbon dioxide in the blood, a special apparatus - a gas analyzer - examines the gas composition of the blood. Until the cause of respiratory failure is identified, the patient is strictly prohibited from giving sleeping pills or narcotic drugs.
If the patient is diagnosed, then to treat respiratory failure, drainage of the pleural cavity is performed, which consists of inserting a rubber or silicone tube into the pleural cavity in the area of the second intercostal space, which is connected to suction. When a large amount of fluid accumulates in the pleural cavity (with hemo- or hydrothorax, pleural empyema), it is removed using pleural puncture through a needle (see description above).
If the patency of the upper respiratory tract is impaired, an urgent examination of the oral cavity and larynx is performed using a laryngoscope and freed them from vomit and foreign bodies. If the obstruction is located below the glottis, bronchoscopy is performed to eliminate it using a special device - a fiber-optic bronchoscope. Using this device, foreign bodies or pathological fluids (blood, pus, food masses) are removed. Then the bronchi are washed (lavage). It is used when it is impossible to simply suck out the contents of the bronchi due to the presence of dense mucopurulent masses in their lumen (for example, in severe asthmatic conditions).
Clearing the airways of mucus and pus is also carried out by suctioning them with a sterile catheter, which is inserted in turn into the right and left bronchus through an endotracheal tube through the mouth or nose. If it is impossible to apply the listed methods, then a tracheostomy is performed to restore the patency of the airways and cleanse the bronchi.
Treatment of acute respiratory failure due to intestinal paresis or paralysis, when the position and mobility of the diaphragm is impaired as a result, consists of inserting a probe into the stomach to remove its contents, while the patient is placed in an elevated position.
Of course, in addition to what is described above, the patient is given drug therapy. To achieve a quick effect, medications are injected into the subclavian vein, for which it is catheterized (see above). In addition to drug treatment, the patient must undergo oxygen therapy, which creates constant increased pressure and increased resistance at the end of expiration in the respiratory tract. For this purpose, various devices for an oxygen inhaler or anesthesia-respiratory apparatus are used.
When acute respiratory failure is caused or aggravated by severe pain during breathing (for example, with a chest injury or with acute surgical diseases of the abdominal organs), painkillers are used only after the cause of the pathology has been determined. For analgesic purposes, a block of intercostal nerves is performed. If there is a rib fracture, then a novocaine blockade is performed at the fracture site or near the spine.
When breathing stops or in very severe forms of respiratory failure, the patient is given mechanical ventilation.
The most effective way to carry out mechanical ventilation is with the help of special devices, which can be either imported or domestically produced.
To transfer to mechanical breathing, as well as to maintain airway patency during mechanical ventilation, tracheal intubation is used. For this purpose, special devices are used - a laryngoscope with a lighting device, a set of plastic tubes for intubation with inflatable cuffs and a special adapter (connector) for connecting the endotracheal tube to the ventilator.
During tracheal intubation, the patient is placed on his back, then, placing the laryngoscope blade into the mouth and lifting the epiglottis with it, an endotracheal tube is inserted into the glottis. After making sure that the tube is positioned correctly, it is attached with an adhesive plaster to the skin of the cheek, after which the tube is connected to the ventilator through a connector.
In the absence of ventilators, the procedure is carried out using an Ambu bag or the mouth-to-tube method.
- Take off your clothes. We are transferring you to intensive care.When I first heard this phrase, the ground literally went out from under my feet. To say that I was scared is to say nothing!!! I was TERRIFIED! Reanimation then seemed to me like a place where people die... It turned out to be quite the opposite. Lives are saved there.
Good morning my name is Evgenia enia . This year I spent more than 3 months in the hospital, more than 2 weeks of which were in intensive care.
So... Reanimation. Or in other words “intensive care unit”. Those who actually need “intensive care”, which is not available in a regular department, are transferred there.
There are completely different medications, equipment and unlimited access to the laboratory (for tests) and personnel.
There's a completely different world there. Everything is much cleaner, stricter, tougher... and more serious. They don’t lie there with simple diagnoses or for examination because “something stabbed in the side.” If you are in intensive care, it means there is a threat to life and everything is very serious.
But first things first.
They bring you to the intensive care unit naked. At all. The wedding ring and cross will also need to be removed. You cannot take anything with you... Phones, books or any other entertainment - all this remains in the department. The sister will carefully collect your things in a large bag and put special valuables in the safe. But this is already without you. If they told you that they are transferring to intensive care, then they will take you without delay... with a breeze. The maximum you can do is undress.
Upon entering the intensive care unit, you will immediately be surrounded by wires. The kit includes the installation of a subclavian catheter (for conventional droppers), often with a tee, so that several jars can drip at once, spinal anesthesia (infusion into the spine) for pain relief and more, sensors on the chest to determine the heart rate (I don’t remember how they are called), a cuff on the arm (for measuring pressure) and a urinary catheter (too many... because, of course, there is no question of getting up and going to the toilet in such a set of wires). And this is just the “basic package”. In the case of more serious or simply specific problems, there are another two dozen different devices that can be connected to you.
Devices are a quiet horror of intensive care!!! They squeak all the time! Quietly, but confidently, constantly. In different tones and modes. With different tempo-rhythm and volume. Someone reports someone's heart rate, someone signals their blood pressure, someone simply sings some song unknown to me without shutting up... And so 24 hours a day! And if one beeper is turned off, it means another one will be connected soon! This constant soundtrack literally drives you crazy.
The rooms in our department were for four people. Men and women, old, young, heavy and not so heavy - all together.
- There is no room for embarrassment here.- they told me for the first time. And I remembered it.
There is a nurse in each ward. She is indoors almost constantly. And she is always busy with something. She doesn't sit still for a minute. He either changes someone’s IVs, or takes some tests, or fills out some documents, or straightens the beds, or turns around the attendants so that they don’t develop bedsores. Every morning, all patients must be washed with special hygiene products and the bed changed.
The staff in the intensive care unit is specific... These people, both doctors and nurses, seem tough and even almost heartless. They talk in official numbers and diagnoses, and the dialogue is conducted in the style of “twice two makes four.” At first, such a lack of humanity was depressing, but then I realized that it was just a mask... Once I burst into tears, even the manager came to calm me down. Department. Just humanly... All their callousness is nothing more than a defensive reaction, so as not to go crazy in this horror.
The worst thing in intensive care is the patients! Someone is moaning, someone is screaming, someone is delirious, someone is vomiting, someone is wheezing, someone is getting an enema, and someone is just quietly dying on the next bed. You fall asleep to the quiet moans of your neighbor's grandmother, and when you open your eyes, she is already being taken away, covered with a sheet... and this happens all the time, around you, in close proximity. And this is very scary...
Every new patient causes a big commotion. Doctors flock to him from all over the department, entangle him with IV wires, and perform various procedures. For some, a capillary in the nose, for others, gastric lavage, and for others, intubation. All this is nearby, here, with you... All this is in a hurry, because minutes are counting, because another patient was brought in next and he also needs to be saved, now, at this minute... and there is no way to press pause! And all this at any time of the day or night... With bright lighting and musical accompaniment from a dozen instruments beeping in different ways...
And visitors are not allowed into the intensive care unit. And you lie in a complete information vacuum, entangled in wires, with a wild headache (despite all the painkillers) from beeping devices, surrounded by moaning and delirious people, and counting the minutes until you will be released from this hell...
But when you see how the person on the bed opposite, who just yesterday was unable to breathe on his own, has the tube removed from his throat, and the next day he is transferred to a regular ward, you understand what all this is for...
They really do everything to save lives... Although without unnecessary curtsies.
This year I was in intensive care 6 times! But even 1 time is too much!!!
Never go there.
If you have questions, please ask them in the comments!
Sooner or later, people are faced with a situation when one of their relatives or friends is in the intensive care unit. At the same time, everyone, without exception, wants to go to the intensive care unit, but often doctors do not let in relatives of patients there. Meanwhile, relatives want to cheer them up, look after them, or just see their loved ones person. They are sincerely perplexed Why You can’t stay in intensive care, and in case of imminent death, you can’t say goodbye to him. Under no circumstances should we assume that doctors are soulless people; they, of course, understand all the lamentations relatives, but in this matter it is better to rely on common sense rather than emotions . The concept of resuscitation This is a rather serious topic, because it is in the intensive care unit that all the vital functions of the body are restored.
Why not
In terms of sterility, the intensive care unit is equal to operating rooms; there is no place for strangers here. Doctors constantly have to provide assistance to patients - they resuscitate, intubate, and then visitors get in the way, and sometimes they even give “advice”. Also, any visitor can bring in microflora that is harmful to him or her, which, unfortunately, can be deadly for person who was here with open wounds after surgery. Only extremely critical patients are in intensive care, and any virus or bacteria brought from outside can only aggravate the patient’s already serious condition. Another reason for observing the regime in this department, and the answer, Why it is impossible, it may be that it happens that the patient himself turns out to be a carrier of a severe infection, and then his visit for relatives is fraught with unpleasant consequences.
The reaction of relatives when visiting is unpredictable
Many doctors also note that loved ones person was in serious condition after transferred operations when visiting, they cannot cope with the surging emotions and, as a rule, do not behave quite adequately. There was a case when person, who suffered the most difficult surgery after car accident, requiring tracheal intubation. A tube was inserted into him larynx, for artificial ventilation of the lungs. When the doctors allowed the visitor into the room, it seemed to him that tube A ventilator located in larynx, prevents his dear and close person from breathing, and he tried to “ease” the latter’s suffering by pulling him out of larynx tubes artificial ventilation. It’s even scary to imagine how a relative’s “help” could end; fortunately, the professionalism of the doctors working in the intensive care unit cannot be overestimated.
In rare cases, resuscitators make exceptions and allow one of the patient’s close relatives to visit. But, seeing my loved one Human and everything hung t felling, yes with mechanical ventilation larynx, Often, unable to bear such a spectacle, they faint. Visitors after What you see, you have to hastily pump it out to the same doctors, and in other cases even put it on the next bed. And believe me, they don’t have time for this; every nurse in the intensive care unit is overworked.
Just to survive
In the intensive care unit, patients lie in the same room, without distinction by gender. Their clothes are usually removed, this is due to the fact that doctors, in the fight for the patient’s life, have not yet had to struggle with locks and buttons on clothes, but many of the visitors take this for mockery or neglect. Most often, patients end up in the intensive care unit in an unsightly state, and believe me, no one here cares, the main thing here is to survive. But for the psyche of the average visitor, it becomes horror, relatives They’re just not ready to accept what they see. After carrying out operations, When Human is in serious condition, he may have a drain installed, the tubes of which protrude terribly from his stomach. And add to this a catheter in the bladder, a gastric tube, an endotracheal tube in larynx, often open postoperative wounds.
No goodbye
Asking an intensive care doctor for a date with your loved one person, you should think not only about yourself, but also about those people who share this room with your relative. After all, neither he nor his loved ones will like the fact that complete strangers will see him in such an unsightly form. Besides, you should trust the doctors and understand that the intensive care unit is not a place for dating. Here they fight for the life of the patient as long as there is at least the slightest hope of survival. And it will be better if visitors do not distract either the medical staff or the patient after any complications from this difficult and important struggle for life with their endless questions.
Why then it seems to those close to us that the person after operations, or for some other reason, someone who is admitted to the intensive care unit urgently needs to talk or ask for something from their relatives. Yes, he doesn’t want anything, due to his serious condition. After all, if a patient is taken to the intensive care unit, then he is most likely in a coma, or connected to specialized equipment, and because of the tube in larynx he can't talk.
As soon as the patient's condition improves, he will be transferred from the intensive care unit to a regular ward. Then the time will come for dates, and it will be possible to thank the doctors for winning this fight.
Unfortunately, there are cases when it is no longer possible to help a patient; he only has a few minutes left to live, for example, when person cancer or kidney failure. In such cases, patients are not kept in intensive care units; they try to Human He left this life calmly, within the walls of his home.
It is best to adhere to the opinion that if a person is placed in an intensive care unit, then he urgently and urgently needs highly qualified help, without which he may simply not survive. Here the doctors will fight for his life to the end, and the presence of relatives may not always help the patient, but on the contrary, only harm him.
Possibility of visiting stable patients
The word resuscitation itself means “revival of the body,” rebirth. At a time when a person is in serious condition after operations or after accident, visitors will not be allowed to see it. This does not mean when, some patients afteroperations are sent to the intensive care unit to recover from anesthesia. Does it make sense to visit here? It seems not, because in a few hours these patients will be transferred to the general ward for further treatment.
Small patients whose vital body functions have been restored, but are still on a ventilator, are also not allowed any visitors. Often, mothers or other relatives simply do not understand the importance of what is included in larynx child's ventilator tube, some of them even try to pull it out completely for fear of damaging it larynx, or because it seems to them that the child wants to say something, without consulting with resuscitators.
However, if a small child in intensive care has nevertheless reached a stable state and is conscious, in order to improve the child’s overall emotional background, a short visit from the mother is allowed.
In any case, no matter the age group and severity of the patient, you should not be willful in his room, since often relatives themselves, out of ignorance, cause significant harm to their loved one.
Chief freelance specialist in anesthesiology and resuscitation, chief physician of the City Clinical Hospital named after S.S. Yudina DZM"
After the question about relatives visiting intensive care units was asked during a direct line with the President of the Russian Federation, its discussion continued in the media and on social networks. As always, the debaters were divided into two opposing camps, slightly forgetting that they were discussing a very complex and delicate issue.
Relatives of patients often believe that they should have access to intensive care rooms around the clock and can dictate their terms or interfere with the work of medical staff. This causes quite fair rejection among doctors. To understand how to come to a decision that would suit everyone, it is worth remembering how the intensive care unit generally works.
The most balanced intensive care unit consists of 12 beds - usually two rooms of six people each.
Why is this so? This correlates with the recommended staffing table approved by Order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 919 “On approval of the procedure for providing medical care to the adult population in the field of anesthesiology and resuscitation.” According to it, one round-the-clock doctor post should be organized for six intensive care patients. And this practice is typical not only for Russia, it is used in many countries around the world.
Seriously ill patients are accumulated in one place so that doctors have the opportunity to constantly monitor them and begin providing emergency care as soon as possible.
After all, if each patient is placed in a separate room, even the presence of high-tech medical equipment, video cameras and other devices will not replace the personal presence of a doctor. And it certainly won’t speed up the ability to perform emergency procedures.
The second feature of the intensive care unit, and especially the surgical department, is the lack of separation of patients by gender and age. Both men and women, young and old can be in the same room. Of course, we try to create a certain comfort zone for conscious patients - for example, we fence off the beds with screens. But here a very serious question arises: even if one patient wants to see his relatives, how will his roommates react to this? Is everyone, being in such a serious condition, ready for a visit from strangers?
In addition, we should not forget that the work of an anesthesiologist-resuscitator does not consist of the most aesthetic moments. The patient is in a state in which he does not control himself; for example, he may experience involuntary urination. Are all the relatives of patients ready to watch this around the clock? I don't think so.
As a rule, it is enough for relatives to see their loved one who is connected to life support systems. He is washed, shaved, smells normal, next to him are professional doctors and modern equipment. For the peace of mind of relatives, first of all, confidence is needed that the person is not abandoned, that they are caring for him - for this, 5-7 minutes are enough, and sometimes even one glance.
Of course, there are different situations. But if doctors manage to build normal human relationships with patients’ relatives, everything can be solved.
For example, a situation may arise in which a visitor is asked to leave the emergency room immediately. Later, you can go out and explain that the patient was ill and needed resuscitation measures - and this is the serious reason why the relative was asked to leave. If a person is not intoxicated by alcohol or drugs, if you can communicate normally with him, then he understands everything and begins to feel the situation in the intensive care unit.
There is another very serious question: even if the patient is conscious, does he want to see his relatives?
This is also a very delicate moment. There are serious injuries that can disfigure a person, and he will simply be afraid to appear to those close to him. How comfortable will this be for him psychologically?
Therefore, the wishes of the patient are taken into account first. If the patient says “no,” we politely apologize to the relatives and discuss further visitation issues. But even in this case, relatives want to know as much as possible. And a very important skill that intensive care unit staff need to learn is the ability to talk about a patient’s condition in a way that an ordinary person can understand. That is, as accessible as possible, avoiding complex medical terms.
For example, you might tell a woman that her husband has bilateral hydrothorax. Sounds scary, doesn't it? And he won’t tell her anything at all. Or you can say it completely differently: “Due to a serious illness, your husband has accumulated fluid in his lungs. We installed two tubes and pumped out this fluid to make it easier for him to breathe.” It's much clearer and sounds more calming. This is an opportunity to engage a relative in a dialogue and establish good contact with him.
Communication with patients and their relatives and even telling them bad news is a separate issue, because, unfortunately, patients die in intensive care. They have parents, spouses, children - and the sad news must be conveyed to loved ones in a way that does not cause additional pain.
Our resuscitation specialists must not only embrace the concept of preserving life, but also become more gentle, compassionate and empathetic. The ability to find a common language with people, to empathize with the grief of others - this is often much more important in intensive care units than unlimited visiting time.
I want to tell you about a victory that is important for all of us, which was made possible thanks to a petition on Change.org and 360 thousand caring people who took part in the campaign and signed the petition.
In March of this year, I created a petition on Change.org, demanding that the Ministry of Health oblige hospitals not to prevent relatives from being admitted to intensive care. Once upon a time, I myself came every day to the doors of the intensive care unit. For eight days my nine-year-old child was conscious and lay in the intensive care unit alone, tied to the bed….
15 years have passed since then, and nothing has changed in our country. In March of this year, I decided to raise this pressing issue. And we did it!
The Ministry of Health’s document on admission to intensive care, approved on June 29, 2016, has been in effect for 2 months now, the situation is changing for the better, it has received wide publicity, the doors of intensive care are starting to open!
And all this, believe me, would not have been possible without this campaign and the active participation of all of you - Change.org users. I am proud of each of you and very grateful to each of you! This is our merit! We did a very great job!
I wish everyone well! I am sure that many more great things await us - together we are strong!
Thank you!
Olga Rybkovskaya,
Omsk, author of the petition
RULES FOR VISITING THE ICU
Information and methodological letter dated May 30, 2016
On the rules for visiting relatives of patients in intensive care units
Visits by relatives of patients in intensive care units are allowed if the following conditions are met:
1. Relatives should not have signs of acute infectious diseases (fever, manifestations of respiratory infection, diarrhea). Medical certificates of absence of diseases are not required.
2. Before visiting, medical personnel need to have a brief conversation with relatives to explain the need to inform the doctor about the presence of any infectious diseases, and to psychologically prepare for what the visitor will see in the department.
3. Before visiting the department, the visitor must take off his outer clothing, put on shoe covers, a robe, a mask, a cap, and wash his hands thoroughly. Mobile phones and other electronic devices must be turned off.
4. Visitors under the influence of alcohol (drugs) are not allowed into the department.
5. The visitor undertakes to maintain silence, not to impede the provision of medical care to other patients, to follow the instructions of medical personnel, and not to touch medical devices.
6. Children under the age of 14 are not allowed to visit patients.
7. No more than two visitors are allowed to be in the room at the same time.
8. Visits to relatives are not permitted during invasive procedures (tracheal intubation, vascular catheterization, dressings, etc.) or cardiopulmonary resuscitation in the ward.
9. Relatives can assist medical staff in caring for the patient and maintaining cleanliness in the ward only at their own request and after detailed instructions.
10. In accordance with Federal Law N 323-FZ, medical personnel should ensure the protection of the rights of all patients in the intensive care unit (protection of personal information, compliance with the protective regime, provision of timely assistance).
Dear visitor!
Your relative is in our department in serious condition, we are providing him with all the necessary assistance. Before visiting a relative, we ask you to carefully read this leaflet. All the requirements that we place on visitors to our department are dictated solely by concern for the safety and comfort of the patients in the department.
1. Your relative is sick, his body is now especially susceptible to infection. Therefore, if you have any signs of contagious diseases (runny nose, cough, sore throat, malaise, fever, rash, intestinal disorders), do not enter the department - this is extremely dangerous for your relative and other patients in the department. Tell the medical staff if you have any medical conditions so they can decide whether they pose a threat to your relative.
2. Before visiting the ICU, you must take off your outer clothing, put on shoe covers, a gown, a mask, a cap, and wash your hands thoroughly.
3. Visitors under the influence of alcohol (drugs) are not allowed into the ICU.
4. No more than 2 relatives can be in the ICU ward at the same time; children under 14 years old are not allowed to visit the ICU.
5. You should maintain silence in the department, do not take mobile and electronic devices with you (or turn them off), do not touch devices and medical equipment, communicate with your relative quietly, do not violate the protective regime of the department, do not approach or talk to other patients ICU, strictly follow the instructions of medical personnel, do not impede the provision of medical care to other patients.
6. You should leave the ICU if invasive procedures need to be performed in the ward. Medical professionals will ask you about this.
7. Visitors who are not direct relatives of the patient are allowed into the ICU only if accompanied by a close relative (father, mother, wife, husband, adult children).
I have read the memo. I undertake to comply with the
requirements.
Full name __________________________ Signature ___________________________
Degree of relationship with the patient (underline) father mother son daughter husband
wife other _________
Date ________
Download pdf file>>>
