home Audience 3 Stable grave condition in intensive care. What does the term "serious patient condition" mean? The patient's condition of moderate severity

Stable grave condition in intensive care. What does the term "serious patient condition" mean? The patient's condition of moderate severity

What does STABLE SEVERE IN ICU mean?

The patient's condition is assessed at the first examination and then recorded at each observation. The general condition of the patient is an important parameter for making a prognosis of the course of the disease. Correct assessment of the severity of the patient’s condition allows us to exclude the most negative scenarios for the development of pathology. With timely hospitalization and medical care, the patient restores his health in the shortest possible time. On the contrary, if the patient’s condition is assessed incorrectly and the risks to life are underestimated, then death may occur.

This material describes the main indicators of the patient’s condition and the definition scale, which can be used to conduct a comparative analysis and identify hidden pathologies. The described types of patient's condition are unified and are used by doctors around the world to classify signs of disease development.

The severity of the patient's condition

The severity of the patient’s condition is determined depending on the presence and severity of existing or threatening to develop in the near future disorders of the vital functions of the body (breathing, blood circulation, etc.), which can negatively affect the patient’s life. The main degrees of severity of the patient’s condition: satisfactory, moderate, severe, extremely severe, critical and thermal.

The degree of the patient's condition is assessed based on two criteria - physical examination and results of laboratory and instrumental diagnostics. Of particular importance is the determination of the functional state of the cardiovascular system and respiratory system.

In some cases, laboratory and instrumental diagnostics will help determine the severity of the condition when the patient is feeling relatively well and there are no significant impairments in objective status. For example, criteria are used to assess the severity of a patient’s condition based on identifying signs of acute leukemia in a blood test, myocardial infarction (MI) on an electrocardiogram (ECG), a bleeding gastric ulcer during gastroscopy, and cancer metastases in the liver during ultrasound examination (ultrasound).

Satisfactory condition of the patient

The patient's condition is defined as satisfactory if the functions of vital organs are relatively compensated. As a rule, the general satisfactory condition of the patient remains the same in mild forms of the disease. Subjective and objective manifestations of the disease in such patients are often mild, their consciousness is usually clear, their position is active, nutrition is not impaired, body temperature is normal or subfebrile, pulse 60-90 beats/min, blood pressure (BP) 110-140/60- 90 mmHg Art., respiratory rate (RR) is within normal values (16-20 beats/min).

According to the classification of the patient’s condition, it is also satisfactory during the period of convalescence after acute illnesses and when exacerbations of chronic processes subside.

Physical objective condition of the patient is of moderate severity

The patient's condition is said to be of moderate severity when it is subcompensated - the disease does not pose an immediate danger to the patient's life. This physical condition of patients is usually observed in diseases that occur with pronounced subjective and objective manifestations. Patients may complain of intense pain of various locations, severe weakness, shortness of breath with moderate physical activity, and dizziness.

The patient's consciousness is usually clear, but sometimes it is stunned. Motor activity is often limited: the position of patients in bed is forced or active, but at the same time they can take care of themselves. In some cases, high fever with chills, widespread swelling of the subcutaneous tissue, severe pallor or icteric discoloration of the skin and sclera, moderate cyanosis or extensive hemorrhagic rashes are noted. When examining the cardiovascular system, tachycardia (heart rate - heart rate at rest > 100 beats/min) or bradycardia is noted (< 40 уд./мин), аритмию, повышение (>140/90 mm Hg. Art.) or decrease (< 110/60 мм рт.ст.) АД.

In case of moderate objective condition of the patient, the respiratory rate at rest exceeds 20 beats/min, and obstruction of the bronchial or upper respiratory tract (URA) may be observed. Repeated vomiting, severe diarrhea, and moderate gastrointestinal bleeding are also possible. When examining the patient, signs of local diffuse peritonitis may be detected. Such patients require emergency medical care and emergency hospitalization due to the possible rapid progression of the disease and the development of life-threatening complications.

Serious condition of the patient

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

Patients complain of unbearable long-term pain in the heart or abdomen, severe shortness of breath at rest (> 40 beats/min), prolonged anuria, etc. Often the patient groans, asks for help, and his facial features are sharpened. In other cases, consciousness is significantly depressed (stupor or stupor), delirium and severe meningeal symptoms are possible. The patient's position is passive or forced; he, as a rule, cannot care for himself and needs constant care.

Significant psychomotor agitation or a convulsive state may occur. The severe general condition of the patient is indicated by increasing cachexia, anasarca (in combination with hydrocele), signs of severe dehydration (decreased skin turgor, dry mucous membranes), severe pallor of the skin or diffuse cyanosis at rest, hyperpyretic fever or significant hypothermia. When examining the cardiovascular system in such patients, a thread-like pulse, a pronounced expansion of the borders of the heart, a sharp weakening of the first sound above the apex, significant arterial hypertension (AH) or hypotension, and impaired patency of large arterial or venous trunks are revealed.

In patients in serious condition, tachypnea > 40 beats/min, severe obstruction of the upper respiratory tract, a prolonged attack of bronchial asthma (BA) or incipient pulmonary edema are noted. A serious condition is also indicated by uncontrollable vomiting, profuse diarrhea, signs of widespread peritonitis, massive ongoing gastrointestinal (coffee-ground vomiting, melena), uterine or nasal bleeding. Such patients require emergency hospitalization; their treatment is carried out, as a rule, in the intensive care unit.

Extremely serious condition of the patient

The extremely serious condition of the patient is characterized by such a sharp disruption of the basic vital functions of the body that without emergency and intensive treatment measures the patient may die within the next hours or even minutes. In such patients, consciousness is usually sharply depressed, even to the point of coma, although in some cases it remains clear. The position is often passive, sometimes there is motor agitation and general convulsions involving the respiratory muscles.

The face is deathly pale, with pointed features, covered with drops of cold sweat (“Hippocrates mask”), the pulse is determined only in the carotid arteries; Blood pressure is not determined, heart sounds are barely audible. Heart rate reaches 60 bpm. With total pulmonary edema, breathing becomes bubbling, foamy pink sputum is released from the mouth, and various silent moist rales are heard over the entire surface of the lungs. In patients with status asthmaticus, respiratory sounds over the lungs are not heard.

Critical terminal (near-death) condition of the patient

In the terminal state of the patient, a complete loss of consciousness is observed, the muscles are relaxed, reflexes (including the corneal one) disappear. The cornea becomes cloudy, the lower jaw droops. In a critical condition, the patient’s pulse cannot be felt even in the carotid arteries, blood pressure cannot be determined, heart sounds cannot be heard, although the electrical activity of the myocardium is still recorded on the ECG. They have rare periodic respiratory movements according to the Biota breathing type.

The patient's dying state can last several minutes or an hour. The appearance of an isoelectric line or fibrillation waves on the ECG 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.

Assessment of the patient’s general state of consciousness

The ability to adequately assess the patient’s state of consciousness, his ability to make contact, level of intelligence, and character of speech. Thus, the patient’s consciousness can be clear and darkened. The patient may be excited, indifferent, euphoric (high spirits). When assessing the general condition of the patient, darkened consciousness is characterized by the patient’s detachment (impossibility of correctly perceiving the surrounding world), impaired orientation in space and time, as well as in one’s own personality, incoherent thinking, and complete or partial amnesia.

Stupor (from Latin numbness; synonym: stuporous state), characterized by insufficient orientation of the patient and his delayed reaction, can, like stupor, be accompanied by delusions and hallucinations.

Deep depression of consciousness - stupor (from the Latin sopor - unconsciousness; synonym: suporous state, subcoma) is characterized by the fact that the possibility of mental activity remains, although to a very small extent - patients lie motionless or make automatic reflex movements without showing signs consciousness, without showing any initiative and without reacting to the environment; however, with a sharp impact (shock, noise, bright light), they can be brought out of this state for a short time with the appearance of one or another reaction (opening the eyes and directing them to an irritating object, one or another movement, a short answer to a question), after which returns to its previous state. Even in moments of such relative clarity, mental activity is characterized by extreme vagueness and automaticity: often the entire reaction consists of a short-term awakening of attention without returning the ability to understand what is happening. With stupor, reflexes are preserved, swallowing is not impaired, and the patient turns over in bed independently. In other words, stupor is a deep stage of stunning, in which there is no reaction to verbal treatment and only reactions to painful stimulation are preserved.

Unconscious state of the patient

Coma (from the Greek cat - deep sleep, drowsiness; synonym: comatose state) is characterized by an unconscious state with impaired reflex activity and a disorder of vital functions (blood circulation, breathing, metabolic processes) as a result of deep inhibition of the cerebral cortex spreading to the subcortex and underlying parts of the central nervous system (CNS).

The patient appears to be in deep sleep. According to another definition, coma is an unconscious state of a patient in the form of deep depression of the central nervous system function, characterized by complete loss of consciousness, loss of response to external stimuli and a disorder in the regulation of vital body functions.

Scale of functional assessment of the severity of the patient’s condition according to his position

During the examination, the patient's position is assessed: active, passive, forced (gentle for shortness of breath, forced for injury). The scale for assessing the severity of the patient’s condition based on the forced position he has adopted is mainly correlated with other physical parameters. To objectively assess the patient’s functional state, it is necessary to compare the data of laboratory examinations, consciousness and mental stability, and clinical symptoms of the disease.

Answer from Neurosis[expert]
Extremely severe, this means at the last stage, but can still be saved

Answer from contribute[guru]
God forbid you find out about your loved ones. At one o'clock in the morning they told me about my mother. that the condition was serious, and at 9 she died

Answer from Pavel Golovnyak[guru]
He's in intensive care

Answer from Dark Guard[active]
a condition close to death or a period of rehabilitation of clinical death, the pulse is unstable, intermittent breathing, visits are prohibited...

Answer from Edward Usachew[guru]
In clinical practice, there are several gradations of the general condition:
satisfactory
moderate severity
heavy
extremely severe (preagonal)
terminal (atonal)
state of clinical death.
An extremely severe (preagonal) general condition is characterized by such a sharp disruption 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 slowed down only by medicine.

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

Table of contents of the topic "Fainting. Collapse. Coma. Acute vascular insufficiency.":
1. Fainting. Collapse. Coma. Acute vascular insufficiency. Definition. Terminology. Definition of coma, collapse, fainting.
2. Classification of oppression of consciousness (A. I. Konovalova). Assessment of the state of consciousness. Degrees of depression of consciousness. Glasgow scale.
3. General condition of the patient. Assessment of the patient's general condition. The severity of the patient’s general condition.
4. Coma states. Causes (etiology) of coma. Classification of comatose states.
5. Loss of consciousness. Types of loss of consciousness. Systematization of types of loss of consciousness. General recommendations for emergency care. Eyewitness Interview Scheme.
6. Sudden and short-term loss of consciousness. Causes of sudden and short-term loss of consciousness. Simple fainting (postural syncope). Causes (etiology) of simple fainting.
7. Pathogenesis of simple fainting. Clinic for simple fainting. Differential diagnosis of simple fainting (postural syncope).
8. Sudden and short-term loss of consciousness due to narrowing or occlusion of the arteries supplying the brain. Pathogenesis.
9. Sudden and prolonged loss of consciousness. Scheme of examination of a patient in a comatose state.
10. Prolonged loss of consciousness with a gradual onset. Causes (etiology) and diagnostic signs of comatose states with gradual onset and prolonged loss of consciousness. General condition of the patient. Assessment of the patient's general condition. The severity of the patient’s general condition.

In addition to assessing the impairment of consciousness and determining the etiological factor, it is important to evaluate general condition of the patient.

The clinic differentiates 5 degrees of severity of the patient’s general condition: satisfactory, moderate, severe, extremely severe and terminal.

Satisfactory condition- consciousness is clear. Vital functions are not impaired.

Moderate condition- consciousness is clear or there is moderate stupor. Vital functions are slightly impaired.

Serious condition- consciousness is impaired to the point of deep stupor or stupor. There are severe disorders of the respiratory or cardiovascular systems.

The condition is extremely serious- moderate or deep coma, severe symptoms of damage to the respiratory and/or cardiovascular systems.

Terminal state- extreme coma with gross signs of damage to the trunk and disturbances of vital functions.

Contents of the article: classList.toggle()">toggle

The system for assessing the severity of the patient’s condition predetermines, in the short term, potentially possible actions to carry out complex therapy or resuscitation of the person. What are the assessment criteria? How accurate are modern domestic prognostic methods? What are the features of the intensive care unit? You will read about this and much more in our article.

The severity of the patient's condition

The general condition of the patient and its types includes definitions of 5 stages:

Satisfactory condition. The vital functions of the human body are not impaired;
The condition is of moderate severity. There are mild disturbances of vital functions with the obligatory presence of clear symptoms, indicating the linear course of the disease, pathological process, syndrome;
Serious condition. Moderate impairment of vital functions according to several basic indicators;
Extremely serious condition. Serious impairment of vital functions according to a number of basic indicators;
Terminal state. Critical impairment of vital functions, in the vast majority of cases leading to death.

In modern medical practice, there is no single mechanism for classifying the severity of a patient.

Thus, within the framework of nursing practice, the need to hospitalize a patient is assessed without a short-term forecast of the dynamics of the process. Resuscitation includes in the gradation a lot of specific parameters, including laboratory and instrumental research methods diagnosed by express methods.

Satisfactory

The patient's satisfactory condition means that the functions of important organs are relatively compensated and is usually observed in the presence of mild forms of the disease.

Clear consciousness and active position;
Blood pressure – 110-140/60-90 millimeters of mercury;
Respiratory rate – From 16 to 20 DD for 1 minute;
Normal or low-grade fever, only symptoms of the underlying disease are observed;
The epidermis and subcutaneous tissue are within normal limits;
Heart rate – 60-90 per minute;
The functions of vital organs are compensated;
The nature of the disease is stable with a mild or moderate course of the disease and the presence of general indications for hospitalization.

Moderate condition

A condition of moderate severity means that the condition does not pose an immediate danger to the patient’s life. The main criteria are as follows:

The work of the nervous system. The patient is conscious, but may be partially disoriented in space/time. There is inhibition, adynamicity and some difficulty in speech contact;
Functionality. Forced or active position in bed while maintaining the ability to perform independent care;
Skin. There is swelling, severe pallor or moderate cyanosis;
Temperature indicator. Body temperature – low or high, fever is observed;
Cardiovascular parameters. They are in the stage of compensated failure. There are moderate signs of microcirculation disorders and pastosity of the lower extremities. There is bradycardia or tachycardia, low or high blood pressure within 10-15% of normal;

Stable heavy

A stable serious condition in intensive care, as a rule, means that there is no improvement, but also no deterioration, i.e. no dynamics, no changes. In this condition, the patient in the intensive care unit is constantly monitored by doctors and nurses, both visually and with the help of diagnostic equipment.

In most cases, the prognosis for a patient in this condition with timely emergency treatment is favorable. A stable serious condition can be understood by next main criteria:

The work of the nervous system. Deficiency or depression of consciousness, complete apathy and drowsiness. Low mobility with partial preservation of basic coordinated defense reactions;
Functionality. Psychomotor agitation with a passive or forced position. Lack of self-service and the need for constant third-party care;
Skin. Severe pallor of the epidermis and pronounced cyanosis in a state of complete rest;
Temperature indicators. Severe hypothermia or hyperthermia;

There is a significant increase or decrease in pressure (Ps less than 40 or more than 120, systolic blood pressure - 79-60), the patient requires cardiotropic support against the background of acute circulatory failure and pronounced signs of impaired microcirculation of the systemic blood flow;
Functions of breathing. There are prerequisites for transferring a person to artificial ventilation. There is tachypnea more than 35 DD/minute or bradypnea less than 8 DD/minute;
Explicit decompensation disrupts the functioning of vital functions and in the medium term can lead to profound disability;
Secondary symptoms. Severe complications, often associated with uncontrollable vomiting, profuse diarrhea, peritonitis, massive bleeding in the gastrointestinal tract against the background of the main signs of the disease.

Extremely serious condition

In an extremely serious condition, resuscitation is performed immediately, since violations of the basic vital functions of the body without emergency and intensive measures can lead to death of the patient. The prognosis for a critically ill patient in intensive care depends on how long the condition lasts. The main criteria are as follows:

The work of the nervous system. Absence of signs of mental activity against the background of blackout. Deep antecoma or coma;
Functionality. Most often passive or absent. In some cases, convulsions and general motor uncoordinated excitation are observed;
Skin. Chalky pallor of the skin, deep cyanosis, deathly pale face with pointed features, covered with cold sweat;
Parameters of the cardiovascular system. Blood pressure is not determined, the pulse is detected exclusively in the carotid arteries. With active cardiotropic and vasopressor support, Ps values are observed less than 40 or more than 120, systolic blood pressure is less than 60;
Breathing functions. Intermittent, rare, does not stabilize with the use of mechanical ventilation. Tachypnea reaches 60 DD/minute. Bradypnea – 5 or less DD/minute;

General condition of internal organs. Severe violations of the basic vital functions of the body, leading to disability in the short term;
Secondary symptoms. Severe dyspeptic disorders with systemic intense bleeding, total pulmonary edema, other manifestations against the background of partial failure of internal organs;
Medical tactics. Immediate treatment in the intensive care unit.

Terminal degree

The main criteria are as follows:

Central nervous system. Areflexia, partial or complete brain death is observed;
The cardiovascular system. There are no signs of cardiac activity, independent recovery is impossible - resuscitation and assisted circulation are necessary;
Breath. There is no spontaneous breathing. Ventilation with pure oxygen in the maximum functional mode of the device does not stabilize the parameters - PaO2 becomes less than 70 millimeters of mercury, and PaCO2 more than 55 millimeters of mercury;
General condition and medical tactics. The terminal degree causes critical impairment of vital functions with the highest risk of rapid death. Medical tactics consist of trying to stabilize vital signs.

Unconscious state

In an intensive care unit, the term unconsciousness of a patient means the transition of a person into a coma. It has 3 main stages:

Stage 1. Cardiac and respiratory activity is present with stable indicators. The photoreaction of the pupils, cough, gag and corneal reflexes were preserved. The general prognosis is conditionally favorable;
Stage 2. Hyperthermia and hyporeflexia are observed with preservation of some functions without bilateral mydriasis. Bradypnea or tachypnea, bradycardia or tachycardia develops in the background. The general prognosis is conditionally unfavorable;
Stage 3. Areflexia, critical impairment of vital functions and parameters, bilateral mydriasis. The prognosis is unfavorable, with a high risk of death.

Features of the intensive care unit

The intensive care unit at large hospitals is a separate structure designed to provide emergency medical care. Departments of this type can be specialized or general.

In the ICU, one resuscitator cares for several (2 to 4) patients. Specific differences from regular branches:

Round-the-clock work of specialized specialists;
The maximum possible technical and drug equipment;
An established care system with operational channels for transporting and servicing patients.

A person is not in intensive care for a long time - the task of specialized specialists is to stabilize the patient’s condition to an average or moderate stage, followed by transfer of the person to specialized general departments.