The patient's condition is moderate. Determination of the general condition of the patient. Support for patients in intensive care

Treatment in intensive care

Patients’ lack of understanding of the peculiarities of the treatment regime in the intensive care unit often becomes the cause of serious complications, which sometimes pose a great danger to their lives. In addition, treatment in intensive care is a great psychological stress for patients. Reducing the level of anxiety and restlessness, as well as preventing the development of severe complications associated with patients’ violation of the intensive care regimen are the main goals of this educational article. This article will be especially useful for patients after whom further treatment is expected in the intensive care unit.

The intensive care unit is a highly specialized department of the hospital. The main contingent of intensive care patients are patients in critical conditions, with serious illnesses and injuries, as well as seriously ill patients after complex surgical interventions, etc.

The severity of the condition of patients in the intensive care unit necessitates round-the-clock monitoring (surveillance) of the work of vital organs and systems of the body - blood pressure level, heart rate, respiratory rate, blood oxygen saturation level, etc. For these purposes, a large amount of special equipment is used in intensive care, directly connected to the patient. In addition, intensive care patients are continuously administered 24 hours a day with medications through vascular access, which uses the veins of the arm, neck, or subclavian chest area. It is also quite common for patients to have special drainage tubes temporarily left in the area of ​​the surgical intervention, which are necessary to monitor the healing process of the postoperative wound.

The extremely serious condition of patients in intensive care is the reason for attaching a large number of monitoring equipment to them, as well as other medical devices that are mandatory components of intensive care carried out in intensive care (drips, urinary catheter, oxygen mask, etc.). All this sharply limits the amount of physical activity of intensive care patients and makes it impossible for them to get out of bed. On the other hand, excessive physical activity of the patient can cause a critical condition and disaster (for example, “disconnection of an IV” causing bleeding or “displacement” of a pacemaker leading to cardiac arrest).

Considering all the reasons listed above, patients in intensive care must observe strict bed rest. Maintaining strict bed rest is one of the most important conditions for a safe stay in the intensive care unit.

In intensive care, it is possible to cope with a physiological need (need) only within the confines of the bed. If the patient cannot relieve himself “little by little”, then to facilitate urination, a thin tube - a urinary catheter - is installed in the bladder. If there is difficulty in coping with the need “to a large extent,” then laxative medications or an enema are used. In fact, these seemingly intimate moments of a person’s life are routine everyday procedures in the work of the intensive care unit, as natural as, for example, a nurse installing a “drip”, so in no case should they be a reason for Your anxiety and excitement.

Critical care medical personnel must have immediate access to the patient's entire body at all times in the event of cardiac or respiratory arrest. Resuscitators must be able to quickly and easily initiate cardiopulmonary resuscitation. This is one of the reasons why intensive care patients are without underwear. On the other hand, the presence of clothing on the patient significantly complicates the hygienic treatment of the skin, thereby increasing the risk of developing infectious complications.

Taking into account certain features of the organization of the treatment process, one of the specifics of placing patients in intensive care is the presence of joint wards, that is, both men and women are located in the same room. This fact should also not be a cause for concern, since in case of any need (for example, to relieve oneself), you can always ask the medical staff to place a dividing screen between the beds.

All of the above features of the intensive care treatment regimen are of course not psychologically and physically comfortable, but they all pursue one noble goal - achieving a speedy recovery for our patients.

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 (pregonal)
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...

A person’s critical condition is determined by a set of symptoms that are determined by a separate branch of medicine. The risk group often includes patients with chronic diseases. Patients are less common after emergencies. Systematization of diseases that lead to dangerous outcomes helps reduce the number of severe cases.

Areas of rehabilitation medicine

The purpose of studying patients is:

• improving the quality of life of incurable patients;
• help to prolong life;
• exclusion of such advanced cases in healthy people.

Timely rehabilitation of patients in extremely difficult conditions helps to fully study the problem of incurable diseases. Each new successful experiment suggests that such incidents can be completely prevented. But at the moment, classical approaches are not able to save people from a pre-mortem diagnosis.

By moving in the direction of emergency care for patients, it is possible to achieve significant improvements in the condition of the patient’s body. From the above it follows: medicine that excludes a critical condition gives people with severe forms of illness a chance to return to normal life in the future. Science is constantly moving forward, and perhaps there will be a solution to problems that are currently not yet available to doctors.

The problem of saving patients

The basics of resuscitation of each patient should be known to all doctors in any field. The direction of returning a person to life lies on the shoulders of even an ordinary therapist in order to recognize critical conditions of the body in time. However, the most experienced specialists in this field are:

• ambulance workers;
• resuscitators;
• anesthesiologists;
• intensivists.

Resuscitation is aimed at the area in which pathological changes have occurred in humans. Well-established techniques allow patients to be brought back to life even at home, on their own. Replenishment of experience describing a critical condition is carried out daily. Each positive outcome is studied in detail, new techniques are introduced to eliminate deaths.

Classification of the field of resuscitation

Critical differs according to the type of chronic disease:

• Central nervous system - polio, Creutzfeldt-Jakob disease.
• Internal organs: liver - cirrhosis, hepatitis, cancerous lesions; kidneys - subacute glomerulonephritis, renal failure, amyloidosis.
• Circulatory system - leukemia, hypertension, thrombosis.
• Respiratory system - cancer, obstructive disease, emphysema.
• Cerebral cortex - cerebrovascular disease, tumor, vascular sclerosis.

Each area differs in the specifics of the rehabilitation approach and has its own characteristics of the recovery period. Mixed types of diseases are also taken into account.

The statistics include infections:

Mixed types pose the greatest danger to humans. They can provoke severe conditions and clinical forms of inflammation. Critical conditions in children are associated with mixed infections, especially in newborns.

What has already been achieved in the field of resuscitation?

Treatment of critical illnesses has already helped reduce the number of the following patients:

• The first benefit of rehabilitation measures is saving the lives of patients on the brink.
• Reducing disability in the population.
• Incurable diseases can be operated on.
• The treatment period is significantly reduced.
• Recurrence of chronic inflammation is excluded.

Restoring the body of incurable patients is the main task of the field of medicine. There are practical examples of helping people who have previously been diagnosed with a near-death condition. The essential value of the resuscitation approach lies in the economic return on such investments.

In the future, not only the patient's current chronic diseases should be assessed, but also the possible critical condition. Substances for resuscitation are selected in advance so that when health deteriorates, they can be used immediately.

What are the prospects for the development of resuscitation?

The main directions of medical movement in the field of studying conditions bordering on death are the search for fundamentally new approaches to resuscitation of the patient. Classical methods of therapy no longer meet modern requirements.

In case of clinical death, cardiac massage and effects on the chest can be replaced with technological methods of pumping blood and supplying oxygen to a suddenly deceased person. Computer intelligence can be used to perform such a function. Such devices have already been successfully used in isolated cases.

When a patient's critical condition requires emergency care, the goals of resuscitation medicine include returning the person to a normal state. Classical methods only postpone the hour of death. There is a constant search for ways that at first glance seem absurd and incredible.

What complications can there be after the pre-death periods?

If the patient was able to be brought out of such a phase as a critical health condition, the human body remains still under the threat of repeated attacks. To prevent the development of complications, long-term rehabilitation treatment will be required.

When a person is in a critical condition, psychological changes occur in his consciousness. Deviations are observed during the period:

• the patient discovers that he cannot, as before, lead a full life;
• difficulties arise when performing mental work (mathematical calculations, the ability to make logical conclusions);
• partial memory loss occurs;
• the patient notices that he is unable to make responsible decisions.

Post-traumatic syndrome is accompanied by a decrease in the number of brain cells, which is reflected in all areas of life. Recent studies have shown: a patient who has survived the line between life and death needs not only to return to its former physical state, but also to undergo treatment in the direction of returning the psychological component.

Method of restoring the body

New methods allow patients to recover fully, subject to the following rules for caring for a sick person:

• the patient needs to avoid nervous situations, even the slightest worries about any reason;
• observe sleeping conditions, silence and absence of light are recommended here;
• the patient requires constant support from loved ones;
• the patient’s emotional state is affected by the noise of operating devices and loud conversation of clinic staff;
• it is necessary to reduce the supply of drugs after visible improvements in the patient’s condition;
• To restore physical capabilities, constant exercises are carried out with the patient.

To completely cure a person, a long period of treatment will be required with several specialists from different fields of medicine. Attempts to return to the social world with the help of relatives or independently may not be successful. An integrated approach and systematic implementation of tasks will help reduce the duration of therapy.

Distinctive features of resuscitation actions

There is a significant difference between the treatment of a normal patient and a patient experiencing a critical illness:

• The treatment method of a classical specialist is aimed at maintaining the vitality of the patient’s body. He needs periods of examination of a person’s health to make corrective changes to therapy. In intensive care conditions there is absolutely no time to carry out this kind of action.
• The first step is to make efforts to restore the patient’s vitality, and only then carry out the necessary clarifications about the state of health. An ordinary doctor has a different approach: first you need to establish the cause of the ailment, then act according to the instructions for treating a specific disease.
• The classical doctor follows the path of analyzing the diagnosis. In intensive care, there is an approach to identifying noticeable syndromes.
• Lack of time affects the choice of drug that eliminates a critical condition. Sometimes doctors can confuse substances due to the lack of a patient’s medical history, but if a person still survives, it is thanks to the efforts of the body. An ordinary specialist has a chance to study the full picture of what is happening.

How is the dire situation of patients determined?

To prevent death, doctors rely on the main syndromes that indicate critical conditions. Such prerequisites may be:

• loss of breath;
• periodic;
• the tongue sinks, the person suffocates due to spasms of the larynx;
• complete immobilization of the patient, loss of consciousness;
• bleeding, dehydration;
• change in the shape of the limbs, head, body due to internal hemorrhage;
• analysis of symptoms in case of stroke, heart attack, the condition of the pupils, heartbeat, and breathing rate are assessed.

Which patients are at risk?

To analyze pre-resuscitation events, the concept of “critical developmental state” is used. It is based on collecting the following information about the patient that influences the development of syndromes:

• congenital predisposition of the body;
• chronic diseases;
• pain and abnormalities in the functioning of organs;
• collection of general tests or necessary x-rays;
• assessment of injuries due to mechanical damage to the body.

What are the typical complications requiring resuscitation?

Among the huge list of critical conditions, we highlight a few:

• Shock conditions: infectious nature, toxic, hemorrhagic, anaphylactic.
• Embolism: renal arteries, pulmonary, vascular.
• Peritonitis: general, local. The peritoneal area is affected.
• Sepsis: latent and with manifestations of acute symptoms.

All of the listed conditions have their own syndromes, which resuscitators are guided by when providing emergency care. Restorative treatment and the choice of drugs depend on the type of development of the critical condition.

The degree of condition of a sick person is calculated taking into account the present indicators of decompensation of important body functions for life. Therapeutic measures prescribed to a patient in a very serious condition are carried out exclusively in the intensive care unit.

All patients whose health condition is assessed as severe or much worse, extremely serious, must be immediately hospitalized at the nearest medical facility. Due to the serious condition of the patients, patients in the intensive care unit are constantly monitored by specially trained medical personnel.

Staying in intensive care is a rather difficult situation for people, since in such departments there are no separate rooms for women or men. Often, patients lie in beds completely naked, with open wounds and injuries of any nature. In addition, correction of the need must be carried out right in the bed.

To continuously monitor body parameters, many sensors and special medical electronics are attached to the patient. All people staying in the intensive care unit after surgery are left with drainage tubes for a while.

A stable, serious condition in intensive care requires monitoring using special sensors that record every important indicator for life. Due to these devices, the patient is limited in mobility, so he must comply with strict and unquestionable bed rest and all medical prescriptions. Some activity may cause the loss of important components of the equipment.

Serious condition

Taking into account all the obtained indicators, the doctor can make adjustments regarding the need for additional diagnostic procedures or changes in the direction of the treatment plan.

“What does it mean to have a stable serious condition in intensive care?” As resuscitation specialists say, this expression means a specific situation of the patient, due to which processes of decompensation of vital organs and systems appear, without obvious improvement or deterioration. Problems of this kind are a great threat to human life, and also often lead to disability.

Often, a serious condition in a patient develops in the event of a complication of the existing pathology, which is characterized by a bright course and rapid development. But the greatest threat is posed by an extremely serious condition that requires urgent medical attention.

Patient's stay in intensive care

If a patient is transferred to the intensive care unit, then his health or even his life are at great risk. A stable, serious condition can last from days to weeks. In contrast to a severe condition, a stable condition means that the patient does not experience any dynamics or changes. In such a case, various kinds of violations of the vital functions of the body are observed.

Every person who is preparing for a major surgical procedure, after which a stay in the intensive care unit may be required, should be aware of such features.

Each hospital should have a specific unit with a narrow specialty - an intensive care unit or resuscitation unit. It has strict rules and restrictions, one of which is limiting the patient’s physical activity.

Medical personnel who serve the intensive care unit must have unimpeded access to the human body, especially if an emergency such as cardiac arrest or lack of breathing develops.

Sensors that are connected to the patient’s body are of great importance. They must capture the functioning of the cardiovascular system and respiratory rate. For each patient, a personal medical history is created, which records the dynamics of changes in condition, prescribed and carried out diagnostic and treatment procedures.

Possible degrees of deterioration

Often, the general condition of the patient can remain quite good, provided the pathology is mild. Subjective and objective symptoms of pathologies, in this case, are not very pronounced, the person’s consciousness is clear, he behaves actively, eats and defecates normally, body temperature remains within normal limits or is subfebrile.

The general condition of a person, which is assessed as moderate severity, has manifestations of decompensation of the functioning of vital organs, but without a direct threat to life.

Stably serious condition in intensive care, much more serious than those described above, but in this phrase the only pleasant word is stable. The patient has all the indicators of a severe stage of decompensation of organs and systems. Patients are usually unconscious or, much worse, in a coma, so they require constant monitoring by specialists.

Sometimes, patients experience pronounced psychomotor agitation and seizures. Similar conditions are sometimes observed after severe operations, severe injuries after a fall or fight, car accidents, etc.

The consequences of a stroke are varied. Disruption of blood flow in the vessels of the brain can result in minor damage to neurons with subsequent recovery. But a tragic outcome is also possible in severe stroke, when the focus of necrosis is extensive, vital centers are affected, or a pronounced displacement of brain structures occurs. The early stages of stroke (acute and acute) have the greatest number of life-threatening complications. The specified period is the period of time from the onset of the disease to 3 weeks (the most acute period is the first 24 hours). The more severe the patient's condition, the greater the threat to life at the onset of the disease.

Stroke can vary in severity

That is why basic treatment measures should be carried out as early as possible. Correct provision of assistance in the initial stages of stroke reduces the likelihood of death and increases the chances of recovery. The survival of patients with severe stroke directly depends on the location of the vascular accident and the quality of treatment.

Briefly about classification

According to the severity of acute strokes, they are divided into three groups:

• A mild stroke is characterized by focal symptoms without pronounced cerebral symptoms. There is no depression of consciousness. After 3 weeks from the onset of the disease, complete restoration of impaired functions is possible.
• ACVA of moderate severity is also characterized by predominantly persistent focal symptoms. There are no signs of swelling or dislocation of the brain, or irritation of the meninges.
• A severe stroke implies the occurrence of serious complications that jeopardize the possibility of full rehabilitation, and sometimes even survival. This condition is always associated with depression of consciousness. Coma is a common manifestation of a severe form of stroke. Neurological symptoms are varied and progress rapidly. Swelling of the brain, as well as displacement of its structures, aggravate the patient’s condition, threatening life.

Drawings for the NIHSS scale for describing patients during the examination and assessing the naming of objects

For an objective assessment of stroke severity, the NIHSS scale is most convenient. It includes assessing the level of consciousness; movement and sensitivity disorders; impairments of vision, speech and coordination. For each item, points are awarded, the sum of which indicates the severity of the patient’s condition. Normally, it is equal to 0. Severe neurological disorders can be considered when the number of points is more than 13.

A severe form of stroke poses a serious danger to the patient. An extensive vascular accident never results in complete recovery. The likelihood of death with a stroke of this severity is high, and if you survive, many functions are lost forever.

Risk factors for severe vascular accident

Factors predisposing to stroke

Is it possible to predict how serious neuronal damage will be in stroke? There are a number of factors that significantly increase the likelihood of a severe stroke:

• Concomitant pathology of the cardiovascular system aggravates the scale of the lesion and the severity of symptoms. Hypertension, diabetes mellitus, and atherosclerosis lead to changes in the structure of the walls of blood vessels, creating favorable conditions for the occurrence of an extensive focus of ischemia.
• Smoking and excessive alcohol consumption. These bad habits have a detrimental effect on blood vessels, and therefore can increase the risk of severe stroke.
• Previous episodes of cerebrovascular accident. These include not only mild and moderate strokes, but also transient ischemic attacks.

All these factors aggravate the patient’s condition in the event of stroke and contribute to the progression of the disease in a severe form.

Pre-hospital assistance

The described form of stroke is often accompanied by disturbances in vital functions and poses a threat to life. Resuscitation may be required, because with severe stroke, clinical death is not so rare. Even if the patient is conscious, it should be remembered that his condition can quickly deteriorate to critical condition, so monitoring of pulse and breathing is mandatory.

The task of emergency doctors is to transport the patient to a specialized hospital as quickly as possible, maintain vital functions, and, if possible, stabilize the condition.

Transporting and transporting a stroke patient to the place of treatment

Thus, the action plan at the prehospital stage is as follows:

• Normalization of respiratory function: ensuring airway patency and adequate oxygenation. If necessary - mechanical ventilation.
• Control and stabilization of blood pressure: use of vasopressors for low blood pressure or antihypertensive drugs for blood pressure rises above 200/120 mmHg. Art.
• Resuscitation in case of cessation of vital activity.
• Symptomatic therapy.
• Immediate transportation of the patient to the hospital.

A severe form of stroke is a life-threatening condition. It is possible to effectively help a patient only at the stage of inpatient treatment. However, even before arriving at the hospital, complications may develop that can lead to death. Any delay in providing assistance contributes to the tragedy.

Principles of inpatient treatment

Patients diagnosed with a severe form of stroke are hospitalized in the intensive care unit. Very often they arrive in a state of coma, often with breathing problems, which requires them to be connected to a ventilator. Hemodynamics in such patients is also seriously affected. Control and stabilization of blood pressure and myocardial contractility must be carried out (vasopressors, antihypertensive therapy, cardiac glycosides, antiarrhythmic drugs, depending on the situation).

In the treatment of cerebral edema, drugs from the group of diuretics (mannitol, furosemide) are of great importance, ensuring the removal of excess fluid from the body. At the same time, it is important to restore normal blood circulation in the vessels of the brain and improve cellular metabolism. Antiplatelet agents and neuroprotectors are used for these purposes.

Antihypertensive therapy is of great importance in the treatment of hemorrhagic stroke, as it helps reduce the intensity of bleeding. However, it must be performed under blood pressure control, since severe hypotension will aggravate neuronal hypoxia. At the same time, hemostatic drugs (dicinone) are prescribed.

Hemostatic drug

With a hemorrhagic stroke, dislocation of the brain often occurs, that is, displacement of its elements by an increasing hematoma. This is an extremely dangerous condition because it can lead to compression of vital parts of the brain. In this case, there is a need for surgical intervention. However, it should be remembered that coma, uncompensated concomitant pathology and the unstable serious condition of the patient are contraindications to surgery.

Prognosis for severe stroke

Serious complications that accompany this form of stroke can lead to death in the early stages of the disease. Mortality is high. Old age and concomitant pathology only aggravate the situation. Effective resuscitation in the event of clinical death does not mean that re-cessation of life will not occur in the future.

It is almost impossible to completely restore lost functions due to the large scale of the vascular disaster. The prognosis for rehabilitation is unfavorable. Most survivors of severe stroke remain disabled.