How to lie resuscitation patient. Never talk to a resuscitator. Stable serious condition

A person in intensive care seems to fall out of our world. You can't come to him, you can't talk to him, his phone, clothes and personal belongings are taken away from him. The most that loved ones can count on is a note sent through the nurse. What if a man? And if it's a child? All that remains is to wait for a call from a doctor and hope for the best.

Why are hospitals such draconian rules and how not to go crazy with the unknown? We answer the most common questions about resuscitation.

1. Will he die?

Don't screw yourself up or panic. Yes, your loved one has a health problem. Yes, this is serious. And yet, if someone is in intensive care, this does not mean that he is by a hair's breadth from death. A person can be put there even for a couple of hours - for example, after. As soon as the doctors are convinced that nothing threatens his life, the patient will be transferred to the hospital.

The prognosis depends on the severity of the patient's condition, on the age and concomitant diseases, on doctors, on the clinic and many, many more factors. And, of course, luck.

2. What's going on there?

Doctors need access to equipment, and nurses need to be able to wash a patient - which is why they usually lie in the ward without clothes. Many find this inconvenient and humiliating.

Maria Borisova told the story of her elderly mother on Facebook: “They immediately said:“ Take off your clothes, take off everything, socks and panties, inclusive ”. Mother lay in a large corridor, where a huge number of people walked, talked loudly, laughed. A little detail: in order to relieve a small need, you have to get up naked from your bed in front of a large number of people who walk back and forth, sit on the ship on a stool that stands next to the bed, and relieve your need in public. "

Lying under one sheet is not only embarrassing, but also cold. And it is dangerous for already weakened health. There are diapers and disposable linens, but these are additional costs. And there is always not enough money in public hospitals. Therefore, it is easier to keep the patients naked. If the person is able to walk, they may be given a shirt.

Bedridden patients are daily treated with liquid to prevent pressure ulcers, and once every two hours, they are turned over. The body is also kept clean. Hair and nails are cut. If the patient is conscious, he can do it himself.

Life support systems and tracking devices are connected to the patient in the intensive care unit. He can also be tied to a bed so that in delirium he does not pull out all the sensors and harm himself.

3. Why am I not allowed to see him?

By law, doctors cannot refuse to let you into intensive care without a serious reason. If a child under 15 got there, the parents have the right to go to the hospital with him. But this is in official papers, but in practice everything is different. The hospital staff has a "classic" set of reasons not to let relatives in: special sanitary conditions, infections, lack of space, inappropriate behavior.

Whether this is correct or not is a difficult question. On the one hand, in the West, you can come to a patient almost immediately after the operation. So it is calmer for both the relatives and the patient. On the other hand, in the West, the conditions are suitable for this: air purification systems, bacterial filters, spacious rooms. And who can guarantee that he does not collapse into a swoon when he sees a loved one unconscious and all hung with equipment? Or will he not rush to pull out the droppers and tubes? This is also not uncommon.

In general, it is up to you to insist on visiting or not. If the staff flatly refuses to let you in, refer to Federal Law No. 323 and contact the clinic's management.

Follow all the rules of visiting: put on a robe, mask and shoe covers. Collect your hair and bring along a hand sanitizer.

4. How can I help?

You can buy missing medicines, care products ("duck", for example), or special food. You can hire a nurse or pay for an outside consultation. Ask your doctor if this is necessary.

And ask the patient himself if he needs anything. Children often ask to bring their favorite toys, adults - a tablet or books, the elderly - even a TV.

5. How to behave in intensive care?

As calm as possible. Do not disturb the staff. Your loved one may be lying unconscious or acting strangely. It may look or smell unusual. Tubes and wires can stick out of it, and wounded, seriously ill people can lie in the same room with it. Get ready for anything.

The patient largely depends on his mood, and the mood depends on you - loved ones. Do not cry, do not wear out, do not wring your hands and do not curse fate. Talk to him as if he were healthy. Do not discuss the illness until he brings it up himself. It is better to discuss the most ordinary, everyday things: how are you at home, what news your friends have, what is happening in the world.

If a person is in a coma, you also need to communicate with him. Many patients actually hear and understand everything that is happening, so they also need to be supported, stroked on the arm and told the latest news. Research shows that it speeds up recovery.

If the patient asks for a meeting with the priest, doctors are obliged to let him into the ward. This right is ensured by Article 19 of the draft law “On the Fundamentals of Health Protection of Citizens in the Russian Federation”.

It is impossible to answer it unequivocally and equally for everyone. It all depends on the disease and the general condition of the body. Resuscitation is an emergency return to life, and treatment in a general or separate ward. If there is deterioration again, then they are returned to intensive care until they come to their senses. The time spent in intensive care is not limited by anything other than the state of health.

The reason to leave the intensive care unit is the restoration and stability of the basic functions of human life: the presence of consciousness, restoration and stability of spontaneous breathing, hemodynamic parameters (blood pressure, pulse), restoration of independent urination, bowel function (presence of peristalsis, spontaneous passage of gases). With various diseases and severe injuries, each person has an individual journey time to these bases.

How many are kept in intensive care?

It all depends on the complexity of the patient's condition. They can be in intensive care for various reasons, sometimes even if there is no threat to life. If a person has heart problems, then after giving birth, I send such a mother to intensive care, where she is under special control. Although in fact there is no threat to life. If a person is in serious condition, he will stay there until remission. If in a coma, then at least until he comes to his senses, if the coma has dragged on and the person lives on the apparatus. That depends on the hospital load. They can be transported home in a month, or even after 2.

It's a strange question. This is determined solely by medical indications for each individual. It is not clear from your question what the question is specifically asked about. It is impossible to answer it unequivocally and equally for everyone. It all depends on the disease and the general condition of the body. Resuscitation is an emergency return to life, and treatment in a general or separate ward. If there is deterioration again, then they are returned to intensive care until they come to their senses. The time spent in intensive care is not limited by anything other than the state of health.

The reason to leave the intensive care unit is the restoration and stability of the basic functions of human life: the presence of consciousness, restoration and stability of spontaneous breathing, hemodynamic parameters (blood pressure, pulse), restoration of independent urination, bowel function (presence of peristalsis, spontaneous passage of gases). For various diseases and severe injuries, each person has an individual journey time to these bases.

It all depends on the person's condition, how difficult it is. My daughter was in intensive care for 2 months in a coma.

Average duration of stroke treatment in a hospital

Currently, the prevalence of stroke is 3-4 cases per 1000 people in Russia, while the majority are patients with ischemic stroke - about 80% of cases, the remaining 20% are patients with hemorrhagic type of the disease. For relatives and friends of the victim, an attack of acute cerebrovascular accident is often a surprise, and an important issue that worries them is the question of how long they are in intensive care after a stroke and how long the treatment in the hospital takes in general.

Stroke treatment consists of several stages

All treatment of acute cerebrovascular accident consists of several stages:

Prehospital stage.
Treatment in the intensive care unit.
Treatment in the general ward.

The issue of the number of days of hospitalization for stroke is regulated by the treatment standards developed by the Ministry of Health. The duration of the stay of patients in hospital is 21 days in patients without disruption of vital functions and 30 days in patients with serious disabilities. In the event that this period is not enough, a medical and social examination is carried out, where the issue of further treatment according to an individual rehabilitation program is considered.

As a rule, patients stay in the intensive care unit for no more than three weeks after a stroke. During these periods, specialists try to prevent serious complications, which for the most part arise due to the defective work of the brain, therefore, strict monitoring of the patient's vital indicators is carried out.

All patients who have signs of cerebral ischemia or hemorrhagic stroke are subject to hospitalization. The period during which the patient is kept in the intensive care unit is always individual and depends on many factors:

Localization of the lesion and its size - with extensive stroke, the period of stay in intensive care is always longer.
The severity of the clinical symptoms of the disease.
The level of depression of the patient's consciousness - if the patient is in a coma, transfer to the general ward is impossible, he will be in the intensive care unit until the state changes in a positive direction.
Suppression of the basic vital functions of the body.
The need for constant monitoring of the pressure level due to the threat of recurrent stroke.
The presence of serious concomitant diseases.

Treatment after a stroke in the intensive care unit of the hospital is aimed at eliminating violations of vital functions of the body and consists of undifferentiated, or basic, and differentiated, depending on the type of disorder.

Stroke therapy should be early and comprehensive.

Basic therapy includes:

Correction of breathing disorders.
Maintaining hemodynamics at an optimal level.
Fight against cerebral edema, hyperthermia, vomiting and psychomotor agitation.
Patient nutrition and care arrangements.

Differentiated therapy differs depending on the nature of the stroke:

After a hemorrhagic stroke, the main task of specialists is to eliminate cerebral edema, as well as to correct the level of intracranial and blood pressure. The possibility of surgical treatment is being investigated - the operation is performed for 1-2 days in the intensive care unit.
Treatment after ischemic stroke is aimed at improving blood circulation in the brain, increasing tissue resistance to hypoxia and accelerating metabolic processes. Timely and correct treatment significantly reduces the length of stay in the intensive care unit.

It is rather difficult to predict how long the patient will stay in the intensive care unit after a stroke - the timing is always individual and depends on the extent of the brain damage and the compensatory abilities of the body. As a rule, young people recover faster than older patients.

There are certain criteria for transferring a patient from intensive care to a general ward:

Stable level of blood pressure, heart rate over an hour of observation.
The ability to breathe spontaneously without the support of apparatus.
Recovery of consciousness at an acceptable level, the ability to establish contact with the patient.
The ability to call for help when needed.
Elimination of complications in the form of possible bleeding.

Only after making sure that the patient's condition has stabilized, the specialists decide to transfer to the general ward of the neurological department of the hospital. In a hospital setting, the prescribed therapeutic measures continue and the first exercises to restore the lost function begin.

Terms of sick leave after a stroke

The doctor fills out a certificate of incapacity for work

All patients admitted to the neurological department of the hospital with a diagnosis of "Acute cerebrovascular accident" temporarily lose their ability to work. The terms of the sick leave are always individual, and depend on the volume and nature of the damage, the rate of recovery of lost skills, the presence of concomitant diseases and the effectiveness of the treatment.

In the case of subarachnoid bleeding, as well as with a minor stroke of mild severity without extensive violations of the basic functions, the treatment period is on average 3 months, while inpatient treatment takes about 21 days, the rest of the treatment measures are carried out on an outpatient basis. A stroke of moderate severity requires a longer treatment - about 3-4 months, while the patient is kept in the neurological department of the hospital for about 30 days. In the case of a severe stroke, with a slow recovery, the standard length of hospital stay is often not enough, therefore, to extend the sick leave and confirm disability after 3-4 months of treatment, the patient is sent to undergo a Medical and Social Expertise to assign a disability group and develop an individual rehabilitation program.

After a stroke resulting from a ruptured cerebral aneurysm, the average period of treatment for an unoperated patient in a hospital is 2 months, while a sick leave is issued for 3.5-4 months. In case of a relapse of the disease, the treatment period is extended by an average of 2.5 months by the decision of the medical commission. In the case of a positive prognosis and maintaining the ability to work, the sick leave can be extended up to 7-8 months without a referral to the Medical and Social Expertise.

The length of time spent on sick leave depends on many factors.

Patients who underwent surgery for a ruptured aneurysm are disabled for at least 4 months after surgery, taking into account the rate of recovery.

The terms of treatment in the intensive care and neurological department of the hospital are always individual and depend on the general condition of the patient - patients with severe disorders, with a loss of the ability to independently maintain vital functions, are in the department much longer.

Tatyana on Prognosis after a stroke: how long will life be?
Musaev on Duration of treatment for meningitis
Yakov Solomonovich on Consequences of CVA for life and health

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Life is unconscious. How long can a coma last?

The girl came to after 7 years of coma. Is there a chance for such patients to return to full life?

In 2009, 17-year-old Daniela Kovacevic from Serbia developed blood poisoning during childbirth. She fell into a coma, and doctors do not call her coming out of a coma after 7 years otherwise than a miracle. After active therapy, the girl can move (for now with the help of strangers), hold a pen in her hands. And those who are on duty near the bedside of patients in a coma, there is a hope that the same miracle can happen to their loved ones.

General is not with us yet

More than 3 years ago, Maria Konchalovskaya, the daughter of director Andron Konchalovsky, was in a coma. In October 2013, in France, the Konchalovsky family had a serious accident. The director and his wife Yulia Vysotskaya, thanks to the deployed airbags, escaped with minor bruises. And the girl, who was not wearing a seatbelt, received a severe head injury. Doctors saved the child's life, but warned that the recovery would be long. Alas, their prediction came true. The girl's rehabilitation continues.

The rehabilitation of Colonel-General Anatoly Romanov, the commander of the united group of federal forces in Chechnya, has been going on for 21 years. On October 6, 1995, his car was blown up in a tunnel in Grozny. Romanov was collected literally in parts. Thanks to the efforts of doctors, after 18 days, the general opened his eyes and began to respond to light, movement and touch. But the patient is still not aware of what is happening around him. What methods were not used by doctors to "break through" into his consciousness. The general has been undergoing treatment at the Burdenko hospital for 14 years. Then he was transferred to the hospital of the internal troops near Moscow. But so far this strong and courageous person, as doctors say, is in a state of minimal consciousness.

Life with a clean slate

Until now, only one case is known when a patient after a long coma managed to return to a full life. On June 12, 1984, Terry Walless from Arkansas, after drinking heavily, went for a drive with a friend. The car fell off a cliff. The friend died, Walless fell into a coma. After a month, he passed into a vegetative state, in which he stayed for almost 20 years. In 2003, he suddenly uttered two words: "Pepsi-Cola" and "mom". After conducting a study on MRI, scientists discovered that something incredible happened: the brain repaired itself, growing new structures to replace the affected ones. For 20 years of immobility, Wallace atrophied all muscles and he lost the simplest skills of self-care. Also, he did not remember anything either about the accident or about the events of the past years. In fact, he had to start life from scratch. However, the example of this man still inspires hope in those who continue to struggle to return their loved ones to normal life.

Mikhail Piradov, Academician of the Russian Academy of Sciences, Director of the Scientific Center of Neurology:

From the point of view of pathophysiology, any coma ends no later than 4 weeks after its onset (if the patient does not die). There are options for getting out of a coma: transition to consciousness, a vegetative state (the patient opens his eyes, breathes on his own, the cycle "sleep - wakefulness" is restored, there is no consciousness), a state of minimal consciousness. A vegetative state is considered permanent if it lasts (according to various criteria) from 3-6 months to a year. During my long practice, I have not seen a single patient who would come out of a vegetative state without loss. The prognosis for each individual patient depends on many factors, the main of which is the nature and nature of the injuries received. The most favorable prognosis is usually in patients with metabolic (eg, diabetic) coma. If the resuscitation care was provided competently and in a timely manner, such patients come out of the coma quickly enough and often without any losses. However, there have always been, are and will be patients with severe brain damage, whom it is very difficult to help even with the highest level of intensive care and rehabilitation. The worst prognosis is for coma due to vascular genesis (after a stroke).

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How many days are kept on an artificial respiration apparatus

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Question: Good afternoon. Dad underwent surgery on the heart (stenting, 2 bypass grafts, valve suturing) and on the carotid artery (bypass grafting). The operation lasted more than 9 hours and was performed on a beating heart. 13 days after the operation, my dad is in intensive care on an artificial respiration apparatus. On the 11th day, they stopped introducing sedatives. Revealed cerebral edema. Three days after the sedatives were turned off, he has not yet regained consciousness. The doctors say this is normal. Tell me, how long does it take to regain consciousness? Can you breathe on its own only when you are conscious? How can such a long stay under the influence of sedative drugs and on an artificial respiration apparatus affect?

Answer: Hello. The time of awakening from sedatives depends on the type of drugs used (which determines the duration of the drug's action), as well as the duration of their administration (some drugs, with prolonged administration, accumulate in the body, that is, they accumulate and are excreted for a long time). 11 days is a rather long sedation time, in which case awakening can take from a day (when using propofol) to 3-7 days (when using sodium thiopental). The ability to effectively breathe independently depends on two factors - the level of consciousness (there is no breathing in a coma, in a clear consciousness there is) and lung function (with pneumonia or pulmonary edema, it is severely impaired). In itself, long-term administration of sedatives (also artificial ventilation of the lungs) is not so harmful, at least it is not a determining factor in the final prognosis of the disease. Much more important is what is happening to the body right now - how the heart, lungs, kidneys, and liver work. How does the brain work? Why was sedation carried out for such a long time? What were the problems during the operation, what was wrong? The fact is that usually after the described operation, patients are on artificial ventilation for no more than a day, while the indication for prolonged sedation and ventilation is the presence of any problems - impaired brain function (posthypoxic encephalopathy or stroke) or heart (cardiogenic shock or pulmonary edema) ). Therefore, you need to ask the attending doctor in more detail what is still happening, why the postoperative treatment did not go according to the usual scenario (when the patient is transferred from the intensive care unit the next day). I sincerely wish your father a speedy recovery!

Question: Hello! I had an operation to straighten the nasal septum two weeks ago, and now I need to be tested for drug use, I'm afraid that there are such substances in anesthesia and the results will show this. The composition of anesthesia is removed from the human body for a long time and does it generally contain similar components?

Answer: Hello. Yes, narcotic drugs are used in most cases for anesthesia. The clinical effect (pain relief) of these drugs is not long lasting (from several tens of minutes to 4-6 hours), while the time for complete elimination from the body is 72 hours. Considering that two weeks have already passed since the anesthesia, you can safely pass the proposed analysis, it will not show anything bad. All the best!

Question: Hello doctor. In 2001, I underwent a resection of the ovaries (laparoscopy), during the operation I felt severe pain, it is beyond words. After the operation, I told the anesthesiologist about it, he just brushed it off, said that it couldn't be. I have a question: on April 2, I will have an operation to remove the bile. And I am very afraid of repetition. What was it? And how can you avoid repetition? Many thanks.

Answer: Good evening. Sensation of pain or sudden awakening during surgery is one of the most unpleasant complications of anesthesia. According to various studies, this condition occurs not so rarely - in about 1 out of 600 general anesthesia. There are a large number of causes of intranarcotic awakening, and the individual characteristics of the organism in this list occupy the very last place. That is, what happened to you in 2001 was most likely due to some specific situational factors (possibly an anesthesiologist's mistake). This means that the likelihood of a repeat of the events of the past with the forthcoming anesthesia is extremely small. You can virtually completely eliminate the risk of intranarcotic awakening if you inform your anesthesiologist about the features of the previous anesthesia. In this case, the anesthesiologist will be extremely vigilant for the slightest signs of inadequate anesthesia (awakening or sensation of pain), that is, he will do everything possible to prevent the recurrence of the early complication that happened. You can read more about intranarcotic awakening at the link. All the best!

Question: Hello! On the 27th I had an operation to remove the cyst from the ovary. Spinal anesthesia was used. After the operation, I was in intensive care for a day, I went well. From lunchtime on the 28th I felt good, and on March 29th, in the evening, my head ached unbearably, and at the same time my back, especially in the place where the injection was given. Today, on the 30th, too, a terrible headache all day. When I’m lying, it’s still bearable, but if I get up, it’s a hell of a pain. So it is with the back. The anesthesiologist came and said that for headaches you can drink regular citramone, tea, coffee, plenty of fluids and bed rest. And when asked why my back hurts, he replied that I have a slight scoliosis and it was difficult to find the exact place for the injection. Said it will pass. But how long can these unbearable back and head pains last? Can't they stay forever?

Answer: Hello. The complaints that bother you are due to the development of post-dural puncture syndrome, which is a frequent consequence of spinal anesthesia. Despite its excruciating nature, headaches (including back pain) have a fairly favorable prognosis - in the vast majority of cases, they completely disappear within a few days or weeks and never make themselves felt in the future. So don't worry, everything should be back to normal soon. The prescribed treatment is sufficient. You can read more detailed information on an exciting issue in the article "Headache after spinal anesthesia". I wish you a speedy recovery!

Question: My grandfather (now deceased) is a Jew, because was a communist, in the passport they wrote down nationality - "Russian" (Slavin Simon Abramovich). I am an ultrasound doctor. I am 36 years old, will I be able to find a job when moving to Israel for permanent residence?

Answer: Hello. If you have any grandfather's documents, then the chance for repatriation is very high, but the final decision in any case will be made after the interview at the embassy. In Israel, there is no separate specialty of ultrasound diagnostics, this research method is routinely used by most doctors in their work. However, this does not mean at all that you cannot become a doctor. After confirming the diploma of a doctor, many of our compatriots radically changed their profession, finding for themselves something more interesting, promising or highly paid. All the best!

Question: Hello. My baby is 1.6 years old, had an MRI scan under general anesthesia (30 min), four days later, an operation to remove the tumor is needed. Please tell me, is it possible to do anesthesia with such a short interval and how harmful is it? Thanks for the answer.

Answer: Good evening. If the first anesthesia passed without complications, then, if necessary, the next anesthesia can be carried out almost immediately after the first. That is, there is no time frame that limits the possibility of performing the next anesthesia. Modern drugs for general anesthesia are very quickly processed by the liver, excreted by the kidneys or exhaled by the lungs, so having several anesthesia in a short period of time is not a problem. In your specific situation, the most important will be the quality of the operation performed (that is, the work of the surgeon's hands), as well as postoperative treatment in the intensive care unit (that is, the painstaking and hard work of resuscitators), so you need to try to ensure that the surgeon and the attending resuscitator are good doctors. I wish your baby a successful operation and health!

Question: After the operation, the mother, 79 years old, did not come out of anesthesia, the doctors say that she is in a coma, she has sugar (fluctuations), arrhythmia, and pulmonary edema. Is there a chance of getting better? This state lasts 18 hours.

Answer: Hello. There is, of course, always a chance of getting better, but whether it is big and quite real or very small and hardly achievable is another matter. In order to more or less accurately answer your question, you need to know additional information: what kind of operation was performed, what was the initial state of health, what was the immediate cause of the coma (anesthesia does not lead to coma and "did not come out of anesthesia" this is not a diagnosis, this is not it happens, that is, the reason is something else - a stroke, a consequence of acute blood loss, serious heart failure, etc.), what other problems are there (except for high sugar, arrhythmias and pulmonary edema), etc. It is clear that all this information is fully owned only by the attending resuscitation doctor or the head of the resuscitation department, therefore it is these doctors that you need to contact for detailed explanations. I sincerely wish your mother a speedy recovery!

Question: Hello. My child is now 6 years old. We were offered strabismus surgery. The operation time is about 30 minutes. Before that, they were treated and dragged out for 4 years. There is a choice of medical facilities. One clinic is paid and there they do anesthesia intravenously while maintaining spontaneous breathing, they are monitored for 2 hours after the operation, and if everything is sent home normally until the next day (dressing), the stitches dissolve on their own. There is an opportunity to stay for a day. Another option is a public hospital, inhalation anesthesia with connection to a breathing apparatus, followed by inpatient observation for 7 days and removal of stitches. Which anesthesia is less harmful? What is less dangerous for a child?

Answer: Hello. If we take the ideal conditions (a professional anesthesiologist, plus he has all the necessary equipment and medications at his disposal), then it is best to conduct anesthesia with airway control - that is, anesthesia with a laryngeal mask (or in the absence of experience with the latter, an endotracheal tube) , requiring connection to an anesthesia-respiratory apparatus, while the child may retain spontaneous (spontaneous) breathing or the apparatus breathes for him. That is, of the options presented, the operation is best performed in a public hospital. At the same time, I would like to draw your attention to the fact that the well-being of anesthesia is largely determined by the professionalism of the anesthesiologist: if a mediocre anesthesiologist works in a public hospital, and a highly qualified specialist works in a private hospital, then anesthesia performed in a paid clinic will be "less harmful". So what should you do then? My opinion is to operate in a public hospital, while finding the best surgeon and anesthesiologist there. Why in the state? Because sometimes anesthesia (regardless of which specialist conducts it or where it is carried out) leads to complications, in the success of the treatment of which the presence / absence of an intensive care unit (intensive care unit) plays an important role. Usually, such departments are available only in public hospitals and very rarely in paid private clinics.

I wish you a successful operation and anesthesia!

On May 15, my mother had a seizure (severe headache, speech cut off, vomiting, convulsions, head turned blue). It lasted about 4-5 minutes, consciousness was switched off, breathing after the seizure was choppy, hoarse, no consciousness. Within 40 minutes. (while the ambulance was traveling) she remained in this state. When the doctors arrived and gave an injection (I don’t know which one) she began to move, did not react to the treatment, there was no question, but in response to the injection she tried to move her hand away, the color of the head became normal. The onset was preceded by headaches. within a week and higher pressure until, the ambulance was taken to the hospital and in the emergency room she had a second attack, 1 hour 40 m after the first (everything was the same as with the first, but a clear liquid flowed from her nose). After that she fell into a coma, was When she was connected to mechanical ventilation, severe cerebral edema began. Today, 6 days, she is in a coma of 3-4 degrees, she does not breathe reflexes, there are no reflexes from the first day, pressure sores begin from the first day. Hemorrhagic stroke was diagnosed only based on the experience of doctors. MRI, EEG is not possible due to its lack of portability, puncture can also not be done (there are no neurosurgeons in our hospital.) Doctors say nothing, I hear only one answer (no improvement, no chances) Uva Dear doctors, please explain what is happening, what to expect and how long can this condition last? I will add that my mother is hypertensive. Regarding the current treatment, I can’t write anything, the doctors answer my questions with one thing - GETS ALL THE NECESSARY TREATMENT. I will add that 3-4 degree of coma developed within 3.5-4 hours after the first attack!

Forum of doctors: how many sick people can be in intensive care - Forum of doctors

how much a sick person can be in intensive care Assessment:

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# 9 acero

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acero (23.1.2011, 22:30) wrote:

While on mechanical ventilation - he will be in intensive care. Further - according to the state.

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General situation: My grandmother was admitted to the hospital on the night of December 31 (I was far away at that moment). She drank, or rather even drank constantly, an encoding was required. She fell down in the toilet, had a stroke, and hit her head. They called an ambulance, the ambulance said strong alcoholic intoxication. At the hospital, the doctor looked and said nothing. She was given a drip.

From the 31st to the 3rd, they tried to call her, then no one picked up the phone, then some patients picked up the phone and said that the grandmother was bad, she did not move with everything and all that. Doctors called on January 1 and they say grandmother is normal. As a result, on the 3rd of December, relatives-doctors came there, they saw such an outrage. Lies in the corridor, not covered, all crumpled, she was not fed for 3 days, the card was not brought to her. As a result, there relatives shouted for a very long time.

On the 4th - apparently they hesitated, they took her to the regional hospital - they took a picture of the head, it turned out that there was a hemotoma on the left side of the occiput, 12 cm.

Underwent an operation, he is in a coma from the 4th to the present day. During this time, she underwent 2 more operations - they say the hemotoma was formed again. Literally 2 days ago, she was disconnected from artificial lung ventilation, she breathes on her own, but the condition is still the same.

For 3 weeks, the fact that she was in intensive care, I bought a lot of everything (doctors and nurses said) - diapers, diapers, dry food, water, etc., etc.

Now she is being transferred to a regular ward, they called and said come, take care of, feed. But in my position I cannot pull it, I have to work and live myself. And I just don't make that much. I will bring myself to the grave faster than I can pull her out of the coma.

How to be? what to do? I can’t even find her insurance policy - only the old one, they don’t give her trust because she’s in a coma! How to be in such a situation ?! thank you in advance.

# 12 acero

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Our expert is an anesthesiologist of branch No. 6 of the Central Military Clinical Hospital No. 3 named after A. A. Vishnevsky Russian Ministry of Defense, member of the American Association of Anesthesiologists (ASA) Alexander Rabukhin.

It's not just infection

Unfortunately, people are often faced with a situation when doctors do not allow visiting their loved ones in the intensive care unit. It seems to us that when a person is between life and death, it is very important for him to be with his family. And the relatives want to see him, help him, cheer him up, at least somehow alleviate his condition. It is also no secret that the care of relatives can be much better than the care of medical personnel. It is believed that the reason for this ban is the fear of doctors that relatives may bring some kind of infection with them. Although it is difficult to imagine that people with an infection will rush to the intensive care unit to see their relatives! It would seem, why doesn't the current Ministry of Health revise the instructions?

Doctors understand the emotions of people whose relatives are so seriously ill. But they insist that in such a serious matter as the question of life and death, one should be guided not only by emotions. Objectively speaking, close relatives are often allowed to the intensive care unit. True, not for long and not in all cases. Once you are denied, doctors usually have good reasons for this. Which?

First, it really protects the patient from infection. Despite the fact that relatives look healthy and bring on themselves quite common microflora, even it can be dangerous for a weakened, recently operated person or for a patient with a defect in immunity. And even if not for himself, then for his neighbors in the intensive care unit.

The second reason, as paradoxical as it sounds, is the protection of visitors. After all, the patient himself can be a source of infection, and sometimes very dangerous. There are often severe viral pneumonia and purulent infections. And the most important factor is the psychological protection of relatives. After all, most people have a poor idea of \ u200b \ u200b. What we see in a movie is significantly different from a real hospital, in much the same way that movies about war differ from real military actions.

... maybe I live

Resuscitation patients often lie in the common room, without distinction of sex and without clothes. And this is not for "mockery" and not out of the devil-may-care attitude of the staff, this is a necessity. In the state in which patients most often end up in intensive care, they do not care about "decency", there is a struggle for life. But the psyche of an ordinary average visitor is not always ready to perceive this kind of loved one - with, say, six drains sticking out of the abdomen, plus a stomach tube, plus a catheter in the bladder, and even an endotracheal tube in the throat.

Let me give you a real case from my own practice: the husband begged for a long time to let him go to his wife, and when he saw her in such a state, he shouted "Why, this thing prevents her from breathing!" tried to pull the tube out of the trachea. Understand that ICU staff have a lot to do other than keeping an eye on visitors — no matter how they start the equipment or faint from the stress.

What kind of dates are there ...

It should be borne in mind that the relatives of other patients will be very unpleasant if their loved ones appear in this form in front of strangers.

In addition, believe me, in the overwhelming majority of cases there is no time for communication with relatives, not for the "last words", and indeed there is nothing at all. Intensive care was not created for dating, here they treat (or, at least, should treat) to the last, as long as there is at least some hope. And no one should distract either doctors or patients from this difficult struggle, who need to mobilize all their strength in order to get out.

It seems to relatives that the patient in intensive care only dreams of meeting them, telling them something, asking for something. In the vast majority of cases, this is not the case. If a person needs to be kept in the intensive care unit, then he is most likely either unconscious (in a coma), or is on artificial ventilation or connected to other equipment. He cannot and does not want to talk to anyone - due to the severity of his condition or under the influence of potent drugs.

As soon as the patient gets better, he will be conscious and able to communicate with his family - he will certainly be transferred to the general ward, where relatives will have a great opportunity to say hello to him instead of “goodbye”. If there is no hope of "pulling out" the patient, if he dies from a serious chronic disease - for example, from oncology with numerous metastases or from chronic renal failure, then such patients are not sent to intensive care, they are given the opportunity to calmly and with dignity leave in a regular ward, or at home, surrounded by loved ones. Remember: if your relative is in intensive care, and your presence can not always help him, but can often interfere with the doctors.

Of course, there are exceptions in such situations, both from a medical and social point of view. And, if the doctors deem it possible, they will let their relatives into the "reserved" intensive care unit. If not, show understanding and hope for the best.

Today I will step back from my principles and repost the article. sovenok101 ... It clearly and practically on the fingers explains why you should not talk with resuscitators, why you should not rush to the intensive care unit to visit relatives and why you will not hear the truth from the doctors.

It happens that acquaintances ask: how to talk to the resuscitator, so that he would tell the whole truth, let him into the block, realize that this particular patient must be rescued with all his might, did not conceal the information about the lack of drugs and said what to buy. So that's it. It is impossible to achieve these goals. Why, let's figure it out.

Let's start with the first point - when the resuscitator speaks the truth.

From the point of view of a resuscitator, all patients are divided into three categories. The first - with diseases not worse than a cold, by resuscitation standards, of course. Well, for example, pneumonia, affecting 1-2 lobes out of 5 available. Or an allergy that breathes freely, does not require pressure support and in which the skin does not peel, well, at least not all. There is also bleeding, stopped by a surgeon, endoscopist, or stopped on its own after a couple of doses of plasma, when the patient is completely compensated for with saline solutions and does not require erythrocytes and other transfusion wisdom.

Second category- these are really reanimation patients who have a chance of surviving well, for example, 1: 2 or even less. For example, pneumonia 3-5 lobes, ARDS, blood loss with internal combustion engine. Sepsis with multiple organ. Pancreatic necrosis with infectious toxic shock. They tinker with such patients, shamans over them, they are dragged and dragged out, they stand by their side for days on end, leaving the entire first category to sisters and other surgeons.

Well, the third category- patients who have no chance of survival from the word at all. This is often terminal oncology. Mesenteric thrombosis with necrosis of the whole intestine. But you never know what else. These patients are relieved of their condition, and after death they say: he was cured, which means "tortured". No irony, resuscitation specialists wish themselves a quick and easy death, preferably in a dream, maybe with medication.

So. Consider the simplest situation when you yourself are a patient. And for some reason you can speak. In any case, you will be told that everything is in order. Now we will undergo treatment and everything will be fine. All the rantings about the patient's right to information work somewhere out there, in the outside world. Resuscitators know all too well how a patient's attitude influences the outcome of the disease. The saddest situation is when you are here beating like a fish on ice, and he just doesn't want to live. I want to kill this! So everything is in order, but you are in front of you. And only to the already really saved patient, at the door, can they tactfully explain that, in fact, he has almost visited a better world. And they sincerely wish not to come back here again.

The situation is more difficult when you are a worried relative.
Well, your brother belongs, for example, to the first category. You can assume that everything is not so bad if the resuscitator comes out to you, frantically leafing through the medical history. This means that he does not remember the patient. That is, he accepted him, gave appointments, and then the sisters followed the patient. Well, an ulcer blew. Well, they coagulated. Everything is fine, we will watch until morning, tomorrow we will go to the department. Do you think the resuscitator will tell you this straight? Aha! And if it still gets bloods during the night? And the probe will shift and no one will notice anything in time. And in the laboratory, the device glitches and the decrease in hemoglobin will not show. And when everything is cleared up, it will cover two liters, they will take it to the table, but there will be no plasma and ermass, and while they are brought in, there will already be an internal combustion engine, and nothing will grow together, the seams will disperse, and then we will treat peritonitis for a long time and painfully ... And who will be to blame? The same resuscitator who assured the relatives that everything would be fine. So while the patient is in intensive care, he is dying. And the point. And we'll talk about everything well on the way to the department. And we sincerely wish this patient not to come back. And then anything can happen.

Or even more trenchant, patient from the second category. The resuscitator will most likely come to the relatives of such a patient without a history of the disease in his hands, because he already remembers all its contents by heart. And he will say that everything is bad and there are almost no chances. We treat, we fight, but we are not omnipotent. A good sign if he says "no deterioration", "slight positive dynamics", "tendency towards stabilization". You can't get more out of him, even if you put a knife to your throat.

And only about the patient third category you will be told the pure truth: "The patient is incurable, symptomatic therapy is being carried out." Which means: the patient dies, and we alleviate his suffering.

Perhaps you will be allowed to see a patient of the third category, to say goodbye. It depends on the situation in the block and the workload of the doctor and usually contradicts the internal orders of the hospital. But doctors are people too, and they respect death. You can be led to a patient of the second category only if, from the point of view of the resuscitator, this can push the "hung between heaven and earth" in the right direction. You will never be admitted to a patient of the first category. Chat tomorrow or the day after tomorrow at the department.

It is impossible to stimulate the resuscitator to "save" your patient better. That is, he can take money, but he will treat him the way it is customary to treat such patients in this hospital. It is the same with medicines. Not so long ago, during the period of another drug hunger, one surgeon asked a relative of a freshly operated patient to buy a penny analgin at the pharmacy. A relative reported this to the administration and the surgeon was immediately fired. All the rest drew conclusions. We treat with what is, if there is nothing, we treat with affection. But relatives will never know about it. As a standard, they will be offered to bring hygiene products, water in a convenient bottle, perhaps, a homemade treat like broth in a thermos, if the sick person's health will allow it to eat. Exceptions are for very own people. Yes, write a note, it will be handed over, if anything, they will even read it aloud to the patient. And the patient in a coma too. If the patient is healthy enough, he will be given the opportunity to write an answer. But this answer is sure to be read by a doctor or nurse. A note like "I'm being taken apart for the organs here" will not be handed over. The mobile phone will not be transferred under any circumstances. And not at all because it interferes with the operation of instruments. Doesn't interfere. It's just that the more helpless the patient is, the calmer the staff. You never know where he can call and who to call ...

So, in any case, they will tell you that everything is bad, they do not make predictions here, they save with all their might, all the medicines are there. Your phone will be recorded, but they will only use it in case of a sad outcome. They won't give you your own, and even if you somehow get it, they will only say over the phone that the patient is alive and in the ward.

So never talk to a resuscitator. And best of all, never date him. Not as a patient, not as a relative!

Yes they can. Moreover, we are talking not only about children, but in general about relatives who are in the intensive care unit and intensive care. This right is separately stipulated in the information and methodological letter of the Ministry of Health of the Russian Federation of May 30, 2016 N 15-1 / 10 / 1-2853 "On the rules for visiting patients by relatives in intensive care units (intensive care units)." We recommend that you print it out before visiting a medical facility and have it with you.

The letter specifies the conditions that must be met by visitors:

Relatives should not have signs of acute infectious diseases (fever, manifestations of a respiratory infection, diarrhea). In this case, medical certificates about the absence of diseases are not required.

Before visiting the medical staff, it is necessary to conduct a short conversation with relatives to clarify the need to inform the doctor about the presence of any infectious diseases, psychologically prepare for what the visitor will see in the department.

Before visiting the department, the visitor must take off his outer clothing, put on shoe covers, a dressing gown, a mask, a hat, and wash his hands thoroughly. Mobile phone and other electronic devices must be turned off.

Visitors in a state of alcoholic or drug intoxication are not allowed into the department.

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.

Children under the age of 14 are not allowed to visit patients.

No more than two visitors are allowed to be in the room at the same time.

Visits to relatives are not allowed during invasive manipulations in the ward (tracheal intubation, vascular catheterization, dressings, etc.), cardiopulmonary resuscitation.

Relatives can assist medical staff in caring for the patient and keeping the ward clean only at their own request and after detailed instructions.

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 security regime, provision of timely assistance).

Resuscitation workers do not have the right to make any other requirements for visitors, for example, ask for certificates of absence of diseases or other documents. But always remember that you can only claim your rights if you follow the rules yourself.

Can parents be with the child in the intensive care unit?

According to clause 3 of Article 51 of the Federal Law of November 21, 2011 No. 323 "On the Basics of Health Protection of Citizens in the Russian Federation", family members can be near the child during his treatment in the hospital:

One of the parents, another family member or other legal representative is given the right to a free joint stay with the child in a medical organization when providing him with medical assistance in a hospital during the entire period of treatment, regardless of the child's age. If you are jointly in a medical organization in stationary conditions with a child until he reaches the age of four years, and with a child older than this age, if there are medical indications, a fee for creating conditions for staying in stationary conditions, including for the provision of a bed and food, from the indicated persons are not charged.

Remember that the phrase “if medically indicated” refers to payment for a stay, and not to parent's right to be present at all. The point is that the parents of a child over 4 years old may be charged for the provision of bedding and food. However, only if the doctor decides that there is no medical indication for the parent's stay with the child.

Joint stay applies to all departments of the hospital, including the department of anesthesiology and intensive care, the Ministry of Health of the Russian Federation explained in Letter of the Ministry of Health of the Russian Federation of 09.07.2014 N 15-1 / 2603-07:

In connection with the increased frequency of appeals to the Ministry of Health of the Russian Federation related to the refusal of the administration of medical organizations to visit children in the departments of anesthesiology and intensive care, the Department of Medical Care for Children and the Obstetrics Service recalls.

In accordance with clause 3 of Article 51 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation", one of the parents, another family member or other legal representative is given the right to a free joint stay with medical organization when providing him with medical care in stationary conditions during the entire period of treatment, regardless of the age of the child.

Considering the above, we ask you to take the necessary measures to organize visits by relatives of children undergoing treatment in medical organizations, including in the departments of anesthesiology and intensive care.

Parents and other legal representatives of a child under 18 have the right to decide for themselves whether to stay with the child in the hospital permanently or choose a visiting regime.

Please note that a doctor cannot refuse a relative to stay with a child under 15 years old in the intensive care unit, citing the lack of appropriate conditions.

Can other family members, relatives, acquaintances visit the sick child?

Yes they can. Other family members, including grandfathers, grandmothers, aunts, etc., do not need a power of attorney to be with the child. Parental consent is sufficient.

However, visitors who are not direct relatives of the patient are admitted to the intensive care unit only accompanied by a close relative - father, mother, child.

Remember that no more than two visitors are allowed to be in the ICU at the same time. Also, children under the age of 14 are not allowed to visit patients.

What if you are not allowed to enter the intensive care unit?

We go to the attending physician

We demand to provide a justified written (!) Refusal with an indication of the normative document, on the basis of which they refuse to let the child in, we mention the determination to contact the head physician and send a complaint to the prosecutor's office and Roszdravnadzor

From the attending physician we go to the head physician (deputy, if the main physician is absent or does not accept) with a printed application in duplicate asking for admission to the child

In case of refusal, we demand to provide a justified written (!) Refusal and indicate the normative document on the basis of which they refuse to admit to the child

We again mention the determination to file a complaint with the Prosecutor's Office and Roszdravnadzor, we warn you that we will come again and already with a written complaint

If the head physician is not present, or he does not accept you, we turn to the secretary with a request to accept the application and register it officially (you give one copy, on the other you must put down the incoming number, the date of acceptance and the signature of the person who received you - leave this copy with you) )

If the situation has not changed, we draw up a complaint addressed to the head physician, we again talk with the head physician (deputy) with two copies of the complaint, if they refused again, we also file it officially with registration with the secretary

If a copy of the complaint was not registered, then we warn the head physician that we will send it by mail - we go to the post office and send the complaint by registered mail with a list of attachments