Year of issue: 2007
Genre: Anesthesiology, resuscitation
Format: DjVu
Quality: Scanned pages
Description: Intensive care (reanimatology) is integral part a single specialty “Anesthesiology and Reanimatology”, which in turn is included in critical care medicine (MCC), which also includes emergency medicine (emergency and emergency care) and disaster medicine. The difference between anesthesiology and resuscitation consists only in the object of correction of vital functions: in anesthesiology, a critical condition is associated with surgical intervention or aggressive diagnostic and therapeutic procedure, and in resuscitation - occurs as a result of worsening pathology or injury that does not require surgical intervention. Resuscitation should be considered as intensive care, starting from the moment the heart and breathing stop.
In most textbooks on anesthesiology and resuscitation, these two sections of the ISS are dealt with sequentially. Traditionally, much more attention is paid to the problems of anesthesiology, which arose earlier and was more deeply developed. However, in everyday clinical practice For surgeons, therapists, pediatricians and other clinicians, problems of critical conditions related to the activities of intensive care physicians (as resuscitators are called in foreign countries) are, perhaps, more common than purely anesthesiological ones. Taking this into account, the authors made an attempt to present the main theoretical and practical issues in more detail than in other textbooks intensive care(including resuscitation) in accordance with the current curriculum.
Chapter 1. A Brief History of Intensive Care and Resuscitation Medicine
Chapter 2. Specifics, structure and organization of critical care medicine
2.1. The concept of "critical condition"
2.2. Structure and specificity of critical care medicine
2.3. Organization of critical care medicine
Chapter 3. Multiple organ dysfunction and failure as the basis of critical condition
3.1. Characteristics of multiple organ dysfunction and failure
3.2. Pathogenesis and tanatogenesis of multiple organ failure
3.3. Management of patients with multiple organ failure
Chapter 4. Principles and methods of intensive care
4.1. general characteristics intensive care methods
4.2. Critical condition monitoring
4.3. General and regional analgesia
Chapter 5. Respiratory failure and hypoxia
5.1. The concept of “respiratory failure”
5.2. Classification of respiratory failure
5.3. Inevitable respiratory damage in critical conditions
5.4. Clinical picture of acute respiratory failure
5.5. Diagnosis of acute respiratory failure
5.6. Intensive therapy of acute respiratory failure
Chapter 6. General principles long-term infusion therapy and blood transfusion
6.1. A Brief History of Infusion Therapy
6.2. Methods of administering infusion solutions
6.3. Types of infusion therapy
6.4. The most important solutions for infusion therapy
6.5. Water and electrolyte balance and water-salt metabolism
6.6. Construction of infusion programs
6.7. Blood transfusions
Chapter 7. Primary cardiopulmonary resuscitation
7.1. General characteristics of primary cardiopulmonary resuscitation
7.2. The main stages of primary cardiopulmonary resuscitation
Chapter 8. Critical conditions in diseases of the cardiovascular system
8.1. Sudden coronary death
8.2. Acute myocardial infarction myocardium
8.3. Pulmonary embolism
8.4. Hypertensive crisis
Chapter 9. Critical conditions with damage to the respiratory system
9.1. Acute pulmonary injury syndrome
9.2. Asthmatic status
9.3. Acute stenosing laryngotracheitis
9.4. Postoperative respiratory failure
Chapter 10. Acute blood loss and hemorrhagic shock
10.1. Clinical physiology of acute blood loss
10.2. Principles of intensive care for blood loss
Chapter 11. Acute failure liver and kidneys
11.1. Acute liver failure
11.2. Acute renal failure
11.3. Hepatorenal syndrome
Chapter 12. Acute deficiency of the immunoreactive system
12.1. Modern representations about the functions of the immunoreactive system
12.2. General reactive inflammation syndrome. Critical illness as disimmunity syndrome
12.3. The problem of apoptosis and autocorrection of the immunoreactive system
12.4. Immunoreactive system in critical conditions
12.5. Anaphylactic shock
Chapter 13. Sepsis and septic shock
Chapter 14. Comatose states
Chapter 15. Acute poisoning
15.1. General characteristics of poisoning
15.2. Therapy for poisoning
Chapter 16. Accidents
Chapter 17. Acute pathology pregnancy and childbirth
17.1. Preeclampsia and eclampsia
17.2. Amniotic embolism
17.3. Asphyxia of newborns
Chapter 18. Ethical and Legal Issues in Critical Care Medicine Settings
18.1. Ethical responsibility of a medical professional
18.2. Legal liability of medical workers
18.3. Iatrogenesis
18.4. Murder and euthanasia
Annex 1.Business games (situations for thinking)
Appendix 2. Solutions for infusion therapy
INTENSIVE THERAPY- a system of measures aimed at preventing or correcting violations of vital functions in the event of acute serious illnesses or strong influences on the body (major surgery, blood loss, trauma, cardiogenic shock etc.) when there is a threat to the patient’s life (see Terminal conditions). All I.T. activities are carried out in resuscitation and intensive care units, where patients with acute disorders hemodynamics of various etiologies(acute cardiovascular failure, traumatic shock, hypovolemic shock, cardiogenic shock, etc.), with acute respiratory disorders, other acute disorders of vital functions important organs and systems (central nervous system, parenchymal organs, etc.), acute disorders metabolic processes and others, patients in recovery period after agony and wedge, death, after surgical interventions resulting in dysfunction of vital organs or real threat their development, patients with severe poisoning (if hospitalization in the appropriate centers is impossible).
The main tasks of I. t. are intensive observation and treatment. Events.
Intensive monitoring methods primarily involve continuous monitoring of the patient's condition by medical staff. The best option intensive observation is monitor observation (see) with the help of installations that automatically record pulse, respiration, blood pressure, cardiac biocurrents, etc. When these indicators go beyond the established values, monitor installations give an alarm. Along with monitor observation, constant monitoring of biol, body environments is necessary: blood composition, acid-base balance, blood gases, concentrations of main cations (potassium, sodium), chlorine, as well as their daily excretion in urine, etc.
Intensive monitoring makes it possible to carry out adequate preventive and treatment measures in a timely manner. measures that can reduce mortality, for example in acute coronary insufficiency, by 5 - 10%.
Therapeutic measures are aimed at maintaining the proper level of hemodynamics, gas exchange, composition internal environment body and for the prevention of neurological disorders.
To prevent and eliminate hemodynamic changes, infusion therapy (see) and targeted pharmacotherapy are of paramount importance. Infusion therapy involves maintaining the proper balance of water in the body, the volume of circulating blood and its components, improving organ blood flow and microcirculation. Special attention pay attention to the issues of prevention and treatment of cardiac arrhythmias (see), which often directly cause the deterioration of the patients’ condition.
In ensuring proper gas exchange, a particularly important role is played by maintaining the patency of the upper respiratory tract through systematic cleansing of the oral cavity, nasopharynx, elimination of tongue retraction (see), the use of air ducts, tongue holders, and tracheal intubation in indicated cases. No less important have the prevention and elimination of tracheobronchial obstruction, for which appropriate therapy is carried out (vibration, effleurage chest, postural drainage, inhalation of drugs that help thin sputum and facilitate its evacuation from the bronchi).
In the most severe cases resort to cough stimulation (microtracheostomy, artificial cough apparatus). Only in exceptional situations is it permissible to use tracheostomy for this purpose (see). It is recommended, if indicated, inhalation of humidified oxygen through a catheter inserted into the nasopharynx, continuation of artificial ventilation after surgery or auxiliary artificial ventilation lungs through a mask or endotracheal tube (see Artificial respiration, artificial ventilation).
With correct and timely implementation of infusion therapy and maintaining proper gas exchange, as a rule, there are no major changes in the state of the internal environment of the body. If these changes occur, the task of infusion therapy also includes the correction of electrolyte and water balance body, acid-base state, coagulating properties of blood, etc. If proper nutrition is impossible through the gastrointestinal tract. tract, it is no less important to promptly start and properly administer parenteral nutrition, aimed at maintaining the body’s energy balance and preventing catabolism (see Artificial nutrition). In such cases, it is indicated first of all to provide the body with the necessary amount of energy (30-50 kcal/kg per day), nitrogen (0.14-0.3 g/kg per day) and water (20-40 ml/kg per day) . The ratio of amino acids, fats and carbohydrates in the diet should be 20, 30 and 50%, respectively. Parenteral nutrition combined with the use of vitamins, electrolytes and microelements.
Particular importance is attached to the prevention of possible psychoneurols, complications that arise in these conditions, most often due to hypoxic disorders. To prevent them, therapeutic measures aimed at saturating the blood with oxygen, improving microcirculation of the brain, reducing redox processes in it ( lytic mixtures, general and local hypothermia, corticosteroids, artificial respiration in mode of moderate hyperventilation) in early period and the use of drugs that improve metabolism (glutamic acid, encephabol, aminalon) in a later period. Tranquilizers and narcotics are also used.
Methods of And. t. also include local and general anesthesia (see). In some cases, for example, with trauma, myocardial ischemia, pain can be so acute that pain relief becomes of paramount importance. Here special place occupied by neuroleptanalgesia and anesthetics short acting, as well as therapeutic anesthesia. An effective remedy is GHB, which, while providing analgesic and hypnotic effect, does not reduce pulmonary ventilation and increases the tone of the heart muscle. In certain cases, hyperbarotherapy is useful (see Hyperbaric oxygen therapy).
Organization of intensive care activities. I. t. is carried out in specially equipped wards, which are part of the resuscitation and intensive care units. These branches are organized in cities with a population of 500 thousand people. and higher in large multidisciplinary hospitals with a number of beds of at least 800 (in children's hospitals - 400). The number of beds in the intensive care unit is no more than 20-25. The department must have special rooms for resuscitation (see), for intensive therapy, equipped with the necessary diagnostic and therapeutic equipment, including for artificial maintenance and control of basic body functions, an express laboratory providing round-the-clock laboratory research the most important vital functions of the body. The department can use laboratories, X-ray and other treatment-auxiliary and treatment-diagnostic rooms (departments) of the hospital. The department must be provided with medications and transfusion agents in quantities necessary for full resuscitation and intensive care. In the intensive care unit, the positions of an anesthesiologist-resuscitator (1 24-hour post for 6 beds) and a laboratory assistant (1 24-hour post per department) are provided.
IT plays a major role in the work of departments nursing staff, who is directly responsible for daily and continuous monitoring of the patients’ condition.
Bibliography Sudden death in acute coronary insufficiency, ed. I.K. Shkhvatsabaya and M.E. Raiskina, p. 31, M., 1968; Lube some Yu. M. and Rapoport Zh. Zh. Intensive therapy in pulmonology, L., 1977, bibliogr.; Luzhnikov E. A., D a g a-e in V. N. and F and r with about in N. N. Fundamentals of resuscitation in acute poisoning, M., 1977, bibliogr.; Mikhelson V. A. and Manevich A. 3. Fundamentals of intensive care and resuscitation in pediatrics, M., 1976; Fundamentals of resuscitation, ed. V. A. Negovsky, Tashkent, 1977; Reanimatology, ed. G. N. Tsy-bulyaka, M., 1976; Ruda M. Ya. Intensive observation wards for patients with acute coronary insufficiency, Cardiology, vol. 16, no. 4, p. 148, 1976; Ch a-call E.I. and Bogolyubov V.M. Heart rhythm disturbances, M., 1972; Lehr-buch der Anaesthesiologie, Reanimation und Intensivtherapie, hrsg. v. R. Frey u. a., B.u. a., 1972; Stephenson H. E. Cardiac arrest and resuscitation, St Louis, 1974, bibliogr.
V. A. Negovsky.
Reanimation and Intensive Care Unit
resuscitation and intensive care occupy an important place in any field of medicine. This is an independent department in which a set of measures is carried out to restore and maintain impaired vital functions of the body in people in critical condition.
The population of surgical patients in the ICU is very complex; these are the most critically ill patients in the surgical hospital.
Among them, there are three groups of patients requiring treatment and care in this department.
1. Patients after complex and traumatic operations who require intensive care.
2. Patients with postoperative complications that pose a threat to life, as well as patients with severe traumatic injuries in critical condition.
3. Patients requiring intensive preoperative preparation - replenishment of EBV, correction of metabolic disorders. The vast majority of these patients receive long-term infusions by catheterization of the subclavian veins; some require mechanical ventilation for several days. In addition, in some patients, drainage of the pleural or abdominal cavity and in the ICU, drainage care needs to be taken care of.
Ultimate Success resuscitation care ICU patients are determined by the quality of the diagnostic and treatment work of the medical team in combination with professional care and supervision of them by nursing staff.
Resuscitation measures consist of two parts: intensive monitoring of the patient and therapeutic and preventive measures.
Clinical hygiene of the patient's environment
Due to the high risk of developing a secondary infection in ICU patients, the decoration of the premises and the entire ICU regime are approaching the operating unit regime.
A regimen is a certain order established in a medical institution to create optimal conditions for the recovery of patients.
Compliance with the regimen is mandatory for both patients and staff.
The ICU regime consists of the following elements: epidemiological and sanitary regime, personal hygiene of the patient and staff, medical and protective regime.
Epidemiological regime of the ICU
The epidemiological regime of the ICU is aimed at preventing purulent (wound) infection.
Due to the severity of the condition, ICU patients become more susceptible to infection. Their defenses are so reduced that they cannot resist even the saprophytes that are constantly present in the human body.
At the same time, many patients themselves pose a danger to their roommates, since they continuously release a significant amount of microorganisms into the air. These include: - patients recovering from anesthesia;
Patients undergoing tracheobronchial sanitation; - patients with tracheostomies and intestinal fistulas; - patients with copious purulent, wound discharge; - burned patients (starting from 3-4 days, when the surface of the burn usually becomes infected), etc.
The most effective preventive measure in these conditions is the isolation of such patients in separate rooms.
Features of nosocomial infection (HAI) in the ICU
Sources of nosocomial infections in the ICU:
Patients with wound infections (bedsores, peritonitis, sepsis, meningitis) and viral infections (influenza, hepatitis, etc.);
Medical personnel (clothing, hands, gloves, bacteria carriers). Pathogens of nosocomial infections in the ICU:
√ Staphylococcus aureus,
√ Pseudomonas aeruginosa,
√ Friedlander's pneumobacterium,
√ streptococci (non-hemolytic, viridans),
√ Escherichia coli,
√ proteus,
√ enterococci.
Ways of transmission of nosocomial infections to the ICU. The infection is transmitted through:
Hands of medical staff;
Tools for invasive diagnostic and therapeutic measures;
Anesthesia and respiratory equipment, inhalers, humidifiers;
Dressing; tools; intubation, tracheostomy, drainage tubes; catheters;
Sinks, fans, vacuum suction, bedding, enemas, bedpans, etc.
Prevention of nosocomial infections in the ICU.
1) strict adherence by medical staff to the rules of asepsis and antiseptics;
2) restriction of access to the ICU (including for medical staff of other departments and relatives);
3) compliance with clinical hygiene by medical staff (overall clothing, shoes, masks, gloves);
4) compliance with the sanitary and hygienic regime in the department (wet cleaning with the use of disinfectants, ventilation of premises, use of air conditioners and bactericidal lamps);
5) monitoring compliance with asepsis by regular air sampling, culture of the skin of the hands, swabs of the nasal and pharyngeal mucosa from medical staff (to detect bacilli carriage);
6) use of disposable syringes and patient care items.
Sanitary and hygienic regime of the ICU
The sanitary operating regime of an ICU includes requirements for the location and design, interior decoration, furniture, lighting, heating, ventilation and cleaning of premises.
Requirements for the location and design of the ICU
It is advisable to locate the ICU close to the wards where there are patients with a potential threat of life-threatening disorders.
When planning ICU wards, it is necessary to provide for the possibility of: √ continuous monitoring of each patient from the nurse’s station; √ free access to each patient’s bed from three sides, taking into account the use of moving bedside devices; √ visual and sound isolation of patients from each other; √ implementation of all therapeutic and diagnostic measures; √ well-established communication between duty personnel and various departments.
There are two layout options
I. The centralized, or “open” system (Fig. 7.1) provides for the organization of one large room (the beds of patients are located radially and are separated from each other by screens or partitions that do not interfere with the visual control of the medical staff, whose post is located in the center).
Rice. 7.1. “Open” PIT device system.
Advantages of an “open” system:
♦ visual control of patients is significantly facilitated,
♦ the shortest route for the approach of the duty personnel is created,
♦ unnecessary movements are reduced to a minimum.
Disadvantages of this system:
♦ an environment of constant anxiety and tension;
♦ noise from operating devices and walking in the same room;
♦ increased risk of cross-infection.
II. The decentralized, or “closed” system (Fig. 7.2) provides for the organization of separate chambers of up to three people each. With such a system, there is less risk of infection, but it is more difficult to achieve monitoring of each patient from the medical staff station.
According to WHO, with an “open” ICU planning system, at least 14 m2 of space is allocated per bed, and with a “closed” system - 22 m2.
Requirements for interior decoration
√ for walls and floors it is advisable to use easily washable coverings made of special facing plastics and tiles;
√ correct painting of the floor, walls and ceiling is important; √ green, blue and cyan colors that give
skin and mucous membranes of observed cyanotic patients
ny shade;
√ It is better that light gray or orange tones predominate in the coloring of the premises.
ICU furnishing requirements:
√ furniture should be made of stainless steel and high-grade plastic materials (if possible, it can be built-in);
√ she must have smooth surface, be easy to clean.
Rice. 7.2. “Closed” PIT device system.
ICU lighting requirements:
√ the department must be provided with emergency lighting; √ have a sufficient number of power sources (at least three sockets per bed), a reliable grounding system;
√ when planning lighting, it is necessary to provide for the possibility of creating both diffused general light (natural lighting) and focused beams to enhance local lighting (bedside lamps);
√ in the resuscitation room and in the intensive care unit, if necessary, use mobile shadowless lamps.
ICU heating requirements:
√ temperature in the pit is 22 °C;
√ temperature in the intensive care room 25 °C;
√ heating radiators are built into the walls.
ICU ventilation requirements:
√ the ICU must have an artificial climate system with a perfect ventilation and air filtration system (air conditioners);
√ physical (radiation) disinfection of air is carried out with bactericidal UV radiation lamps.
Requirements for cleaning ICU premises:
√ ICU cleaning is carried out daily at least 3 times a day;
√ in the wards and resuscitation room, wet cleaning is performed by 4-
5 times a day using disinfectants in accordance with current regulations
instructions;
√ once a week they carry out general cleaning, after which they carry out mandatory bacteriological control of walls, equipment and air.
Sanitation of equipment and environmental items
All objects that come into contact with the patient’s skin and mucous membranes must be clean and disinfected. For this purpose, laryngoscopes, endotracheal tubes, catheters, mandrins, masks, and needles are sterilized.
Nozzles and other parts of anesthesia and breathing equipment are subjected to sterilization; they must be replaced for each patient. The devices themselves are sterilized in a special chamber at least every other day.
After each patient, the bed is subjected to special treatment and filled with bedding that has undergone chamber treatment. Bed linen is changed every day and as needed.
Therapeutic and protective regime of the ICU
Therapeutic and protective regime is a set of therapeutic and preventive measures aimed at ensuring maximum physical and mental rest for the patient in the ICU.
This includes:
Creating a cozy environment in the ICU (clean, quiet, warm);
Careful transportation of the patient on a gurney from the operating room, accompanied by an anesthesiologist, to the ICU;
Transfer of the patient to the resuscitator on duty and the ICU nurse on duty;
Transferring the patient to a functional bed in a lying position on his side or on his back without a pillow with his head turned to his side (after general anesthesia);
Ensuring constant monitoring of the patient until he fully awakens, restores spontaneous breathing and reflexes (there is a threat of tongue retraction);
Sufficient pain relief for the patient;
Attentive, caring attitude towards the patient on the part of the medical staff (during awakening, say a few kind words, cover with a blanket, talk quietly);
Timely delivery medical care the patient and care for him depending on the deficit of self-care;
Daily visits by the surgeon to the patient whom he operated on (maintaining his confidence in a favorable outcome of treatment);
A sympathetic attitude towards the patient’s relatives on the part of the ICU medical staff (to reassure them, to convince them that their loved one is provided with highly qualified help and care).
Features of clinical hygiene of medical staff
1. All ICU staff wear overalls of a certain color, preferably trouser suits (robe and cap are changed daily).
2. Medical staff should wear replaceable shoes (preferably leather or leatherette), which are disinfected after each shift.
3. Wearing medical caps and masks is mandatory (the mask is changed every 4-5 hours).
4. All manipulations are performed by medical staff wearing gloves.
5. When going to another department, ICU medical staff must change into different hospital clothes.
6. The doors to the ICU are constantly closed, and there is a sign on the doors: “RESUSCITATION! ENTRY IS PROHIBITED!
One of the most important requirements of the ICU regime is strict restriction of access to visitors, including medical personnel not directly related to resuscitation.
Relatives of ICU patients are admitted in exceptional cases (direct telephone and television connections are used to establish contact between patients and relatives).
Structure, facilities and equipment of the ICU, general principles of labor organization
Main structural divisions of the ICU:
1. Reanimation room.
2. ICU (intensive care wards).
3. Sister's post.
4. Insulator.
5. Express laboratory for biochemical research.
6. Hyperbaric oxygen chamber.
7. “Artificial kidney” device.
8. Room for extracorporeal detoxification (lymphosorption, hemosorption, plasmapheresis).
9. Gnotobiological chamber.
10. Utility rooms: - equipment room;
Manipulative;
Linen room;
Showers;
Toilets;
Nursing;
Residential;
Office of the head of the department; - the older sister's office.
Reanimation room
In the intensive care unit, the following activities are carried out for patients:
24/7 surveillance; - careful care; - revitalization activities; - long-term mechanical ventilation;
Catheterization of the great vessels;
Massive infusions into central veins; - tracheotomy (if necessary); - brain hypothermia; - forcing diuresis; - hemosorption sessions.
There can be from two to six patients in the room, isolated from each other by special lightweight hanging screens. Each bed must have free access from all sides.
The patient remains in the intensive care unit until the functions of organs and systems are stabilized, after which he can be transferred to the ICU.
Resuscitation room equipment
Control and diagnostic equipment:
The monitor with which the patient’s condition is continuously monitored - PS, ECG, blood pressure, central venous pressure, body temperature, respiratory volume, EEG (if necessary), BCC (systematically), acid-base balance and blood gas composition are determined;
Mobile X-ray machine. Medical equipment:
Ventilators (Fig. 7.3);
Anesthesia machines (Fig. 7.4);
Defibrillators (Fig. 7.5);
Electric pumps (Fig. 7.6);
Rice. 7.3. Ventilator "PHASE-11".
Rice. 7.4. Universal anesthesia apparatus "Julian".
Rice. 7.5. Hospital defibrillator.
Rice. 7.6. Surgical suction.
Rice. 7.7. Ultrasonic nebulizer.
Inhalers (Fig. 7.7);
Pacemakers;
Bronchoscopes;
Laryngoscopes;
Air ducts;
Endotracheal tubes;
Vascular catheters with guides;
Disposable syringes;
Sterile kits for venipuncture and venesection, tracheotomy, thoracotomy, epidural and spinal puncture;
On a sterile table: mouth dilators, tongue holders, urinary catheters, gastric tubes, drainage tubes, surgical instruments, sterile dressings;
Centralized or bottled supply of oxygen, nitrous oxide, compressed air (for working with respirators), vacuum;
Oxygen humidifier (maybe a Bobrov jar);
Systems for intravenous infusions;
Stands for drip infusions. Personal care items:
Urinals;
Kidney-shaped coxae;
Sippy cups;
Backing anti-decubitus circles;
Ice bubbles.
Intensive Care Ward (ICU)
ICU is intended for treatment and intensive monitoring of patients who are at risk of life-threatening disorders.
With an “open” planning system, the optimal number of beds in the ICU is 12-15.
With a decentralized planning system, the number of beds in the ICU is 1-3.
Chambers are allocated for:
1. purulent patients;
2. clean patients;
3. patients requiring isolation.
The wards should be clean, quiet, spacious, fresh, and warm.
The beds in the wards are placed so that the patient can be approached from three sides. Beds should be metal for ease of handling, easy to move (on wheels) and should allow the patient to change the position, and special anti-bedsore mattresses to avoid bedsores. Oxygen, nitrous oxide, compressed air, vacuum, and a sound and light signal for an individual call are centrally supplied to each bed.
To ensure continuous dynamic monitoring of patients in the ICU, there are special monitors (Fig. 7.8). They allow constant visual monitoring of:
Breathing;
Blood pressure;
Venous pressure;
Body temperature and other indicators.
Rice. 7.8. Monitor "ARGUS LCM".
Rice. 7.9. Bedside table.
On the bedside table there should be a kidney-shaped basin, a sippy cup and a device for breathing exercises (underwater exhalation) (Fig. 7.9).
Alarm equipment for calling medical personnel must be available and operational.
ICU nurse post
The ICU nurse's post is equipped in approximately the same way as the surgical department nurse's post (desk, chair, writing utensils, blank temperature sheets, medical history inserts, desk lamp, telephone, etc.).
In addition, there is a work table here, which is designed like an instrumental and material table in a dressing room.
A trolley (or “cito” bag) is placed next to the work table in the ICU for emergency care not only within the department, but also in other departments (on call).
The equipment of the emergency trolley includes:
Air ducts;
AMBU bag;
Laryngoscopes;
Endotracheal tubes;
Anesthesia equipment;
Sets for tracheotomy and thoracotomy;
Pacemaker;
Mechanical suction;
Gastric tubes;
Sets for central venous catheterization and venesection;
Disposable syringes;
Infusion systems;
Needle for intracardiac injections;
Sterile surgical instruments;
Sterile dressing material;
Infusion media;
A set of pharmacological preparations;
Electrocardiograph;
Defibrillator;
Extension cord with two sockets;
Cylinders with oxygen and nitrous oxide.
When starting work, the nurse on duty must check the availability and complete readiness of the trolley equipment for work.
The success of treating patients in the ICU is ensured by the staffing schedule, according to which there are 3 patients per nurse, and 6 patients per doctor.
Clinical hygiene of the patient’s body, linen, and secretions in the ICU
Responsibilities of an ICU nurse
The most important responsibility of the ICU nurse is intensive observation and monitoring of the condition of patients (Fig. 7.10).
Rice. 7.10. Monitoring of the patient.
The ICU nurse is required to have high professional skills, perfect mastery of the skills necessary to carry out resuscitation and intensive care, endurance, patience, determination, sensitivity and philanthropy.
With the help of monitor equipment, as well as conventional visual (visual) control methods, the nurse receives important information based on assessment:
1) patient complaints;
2) its appearance;
3) position in bed and behavior;
4) monitoring vital functions;
5) the state of its organs and systems (cardiovascular, respiratory, genitourinary and gastrointestinal tract).
In addition, the ICU nurse should:
I. Have a good understanding of the medical equipment used in the department (turn devices on and off, monitor their operation).
II. Promptly inform the doctor about the slightest changes in the patient’s condition or indicators of received tests, data from tracking devices, the volume of fluids released and administered and recording them on the observation sheet.
III. Carry out medical procedures prescribed by a doctor.
IV. Provide qualified assistance to the doctor in treating patients.
V. Provide care for seriously ill patients depending on their self-care deficit.
VI. Possess the skills of resuscitation techniques - mechanical ventilation and indirect massage hearts.
VII. Provide care for a patient with a subclavian catheter.
VIII. Provide care for patients on mechanical ventilation.
IX. Provide care for unconscious and dying patients.
General nursing care in the ICU
Kind, attentive, caring attitude of medical personnel towards the patient.
Compliance with the therapeutic and protective regime (it is necessary to protect the patient from anxiety, grief, fear and other difficult emotional experiences).
Monitoring the basic vital functions of the body (cardiovascular, central nervous system, liver, kidneys, etc.).
Hygienic care: - washing; - washing hands before eating; - wiping the body; - washing feet; - combing; - nose treatment; - eye treatment; - ear treatment; - treatment of the oral cavity; - washing; - change of bed linen; - change of underwear.
Therapeutic and preventive care: - carrying out adequate therapy;
Control of the dressing in the area of the postoperative wound and drainage;
Prevention of bedsores; - prevention of pulmonary complications;
Prevention of phlebitis (early motor activation of the patient, exercise therapy, elastic bandaging of the lower extremities);
Prevention of suppurative complications (strict adherence to
principles of asepsis by medical personnel); - prevention of thromboembolic complications; - prevention of paresis from the gastrointestinal tract and MPS. - Help with physiological needs: - feeding; - providing drinking water; - vessel delivery (Fig. 7.11);
Rice. 7.11. Delivery of a vessel to a seriously ill patient.
Supply of urine bag;
If there is difficulty urinating, catheterize the bladder or place a permanent catheter in the bladder; - if defecation is difficult, perform a cleansing enema. - Help with painful conditions: - fight against pain; - help with vomiting; - help with bleeding; - help with fever; - help with psychomotor agitation.
Remember! Care of patients in the ICU depends on the deficit of self-care and on the disease.
Caring for a patient with a subclavian catheter
Due to the fact that patients in the ICU receive long-term, massive infusions into the central vein (Fig. 7.12), the nurse must be able to handle the subclavian catheter: - after catheterization of the subclavian vein, seal the site where the catheter enters the skin with 2-3 drops of collodion or glue BF-6;
Rice. 7.12. Drip infusion into the subclavian vein.
The catheter is fixed to the skin with an adhesive tape;
The catheterization site is covered with a sterile napkin;
2-3 times a day, measure the length of the free part of the catheter and note it in the medical history;
Change the bandage in the catheterization area daily and treat the skin around the catheter with 70° ethyl alcohol;
Periodically check the reliability of fixation of the catheter and the tightness of its connection with the plug (when it is disconnected, there may be bleeding or embolism);
To carry out infusion through a subclavian catheter: ■ in the treatment room, put on gloves, fill the device for infusion of infusion solutions;
creations, place it on a tripod, bleed air from the system, check the patency of the needle and cover the needle with a protective cap; prepare a syringe with physiological sodium chloride solution (2 ml);
■ deliver the system and syringe to the patient, explain to him the essence of the manipulation and obtain consent to carry it out;
■ help the patient take a comfortable position (which depends on his condition);
■ the rubber stopper of the catheter is treated with 70° alcohol;
■ pierce the plug with a needle from the drip system (when inserting a needle through the catheter plug, it is necessary to move it carefully along the lumen of the catheter so as not to pierce the catheter wall) using a syringe with physiological sodium chloride solution, inject physiological solution into the catheter (checking the patency of the catheter). If, when you press the syringe plunger, the solution passes without effort, then the syringe is disconnected from the needle and the system is attached to it. Open the screw clamp and adjust the drop speed with the screw clamp (as prescribed by the doctor). If, when pressing the piston, the solution cannot be introduced into the catheter with normal force, then the procedure is stopped and the doctor is notified (the catheter must be replaced);
■ at the end of the infusion, the catheter lumen is filled with a heparin solution (prevention of catheter thrombosis);
■ the needle is removed from the plug, the outer end of the catheter with the plug is wrapped in a sterile napkin and secured with an adhesive plaster;
■ a device for infusion of infusion solutions and a syringe are delivered to treatment room;
■ remove gloves and wash hands;
If signs of inflammation appear at the catheterization site (redness, swelling, pain), immediately report them to the doctor.
Caring for a patient on mechanical ventilation
Artificial ventilation is the most effective and reliable means of treatment when the patient’s own breathing is not able to provide the volume of gases in the lungs.
The patient uses controlled breathing:
♦ in the absence of spontaneous breathing;
♦ if there is a violation of the frequency or rhythm of breathing;
♦ with progression of respiratory failure. Long-term mechanical ventilation is carried out with special breathing apparatus (respirators) through an endotracheal tube (Fig. 7.13) or a tracheotomy cannula.
The ICU nurse should know well:
√ arrangement of respirators used in the department; √ features of preparing the patient and equipment for mechanical ventilation;
Rice. 7.13. The patient is on mechanical breathing.
√ mechanical ventilation technique;
√ monitor the patient’s condition and the operation of devices during mechanical ventilation.
Before starting mechanical ventilation, it is necessary to check the respirator in operation. different modes. All hoses and connecting parts must be sterile and the humidifier filled with distilled water.
You should always have a functioning spare breathing apparatus in case of unexpected failure of the main respirator, as well as spare replacement hoses and connecting elements.
In addition to the respirator, the following must be prepared:
Tracheal and oral catheters (disposable);
Sterile saline sodium chloride solution for infusion into the trachea;
4% sodium bicarbonate solution (to thin the mucus in the trachea);
Lecture 7 (for paramedics)
Hyperthermia.
Overheating of the body is a condition that occurs under the influence of high ambient temperatures and factors that impede heat transfer.
Such situations arise as a result of prolonged stay in a room with a high temperature and at the same time performing heavy work, during long treks in hot climates in clothes that impede heat transfer. And also due to direct action solar radiation on the head or excessive sunbathing.
Hyperthermia caused by the last two factors is called sunstroke.
Heat stroke begins acutely, during the period of maximum heat, but the development of this condition is possible during exit from the overheating zone, as well as 6-8 hours after direct exposure to solar radiation.
The main links in the pathogenesis of hyperthermia are disorders of water and electrolyte metabolism, cardiovascular activity, which lead to collapse, as well as hyperemia and swelling of the membranes and tissues of the brain with severe neurological symptoms.
Depending on the severity of the flow, there are 3 forms of heat stroke:
Easy. It is characterized by the development of adynamia, lethargy, reluctance to work and move; headache, nausea, tachycardia and tachypnea are also noted. The skin is moist, body temperature is normal or subfebrile, the pupils are moderately dilated.
Moderate heatstroke. Complete immobility, apathy, severe headache with nausea and vomiting, and periodically a stuporous state are noted. The skin is moist, hyperemic, body temperature is elevated to 39-40 degrees, the pulse is weak, accelerated, and tachypnea is observed.
Severe heat stroke. It occurs suddenly and rapidly increases in neurological symptoms - coma, convulsions, psychomotor agitation, delirium, hallucinations. Frequent arrhythmic breathing of the Cheyne-Stokes type is observed, thready pulse(140 in 1 minute or more), the skin is dry, hot, pale cyanotic, covered with sticky sweat in closed areas, body temperature is 41 degrees.
Treatment. As quickly as possible, move the victim to a cool room, in the shade, remove clothing that makes sweating difficult, try to reduce body temperature with any physical method: wet your face cold water, cover the body with a cold damp towel, blow with a fan, to the locations of large neurovascular bundles (on the neck, groin areas) apply ice packs and cold compresses to the head.
At the same time, oxygen inhalation is established, because its consumption during hyperthermia increases sharply. If breathing is impaired, assisted ventilation or mechanical ventilation is performed. To compensate for the loss of water and electrolytes, an intravenous infusion of saline solution is performed. After regaining consciousness, the victim is given a drink cold water. Infusion therapy is supplemented with intravenous administration of cardiac stimulants (caffeine, corazol, cordiamine) and anticonvulsants (diazepam, sibazon, sodium hydroxybutyrate). If there are symptoms of increasing cerebral edema, a unloading spinal puncture is performed.
After a decrease in body temperature, elimination of convulsions, stabilization of cardiac activity and breathing, the victim is immediately hospitalized. They are transported to the intensive care unit on a stretcher, and oxygen is inhaled during transportation.
Hypothermia.
Freezing is observed due to prolonged exposure to an environment with a temperature below 14 degrees and a violation of thermoregulation ( alcohol intoxication, poisoning, coma, senile dementia, etc.). With prolonged cooling of the body normal temperature It is maintained longer in the centrally located parts of the body - the head and torso and quickly decreases in the periphery.
There are 4 degrees of general cooling:
– consciousness is a little confused. Lethargy, chills, " goose bumps", pain in the fingertips, bradycardia (60 beats per minute or less), sometimes euphoria, excitement. The temperature in the rectum is reduced to 34-35 degrees.
Apathy, depression of consciousness (stupor), and muscle rigidity are observed. The skin is cold, marble-cyanotic, reflexes are sharply weakened. Bradycardia (less than 50 per minute), bradypnea. The temperature in the rectum is 28-30 degrees.
There is no consciousness (coma). The pupils are dilated and the reaction to light is slow. The pulse is threadlike. Bradyarrhythmia, bradypnea. Spots appear on the skin that resemble corpses. Large local frostbite. Rectal temperature 25-27 degrees.
The pupils are dilated and do not react to light. The pulse is determined only in the carotid arteries. Breathing is agonal. The victim is in a terminal condition. Ventricular fibrillation is possible. The temperature in the rectum is below 27 degrees.
Treatment should begin with warming the patient by intravenous transfusion of a 5% glucose solution heated to 40-45 degrees, lavage of the stomach and intestines with warmed saline, since covering the patient with heating pads or immersing him in a bath will lead to a shift of relatively cold blood from the periphery to the center with further cooling and deepening of disorders in vital organs.
If spontaneous breathing is maintained, the victim is carefully placed on a stretcher, an infusion of 5% glucose solution heated to a temperature of 40-45 degrees is established, and transported to the hospital, while oxygen is inhaled. Patients with 3-4 degrees of cooling and respiratory failure undergo mechanical ventilation using the mask method, followed by tracheal intubation. When blood circulation stops, indirect cardiac massage is performed. If cardiac fibrillation occurs, defibrillation is performed. Calcium gluconate, diphenhydramine, prednisolone, and sodium bicarbonate are injected intravenously.
Patients with respiratory and circulatory disorders are hospitalized in the intensive care unit, without their impairment - in the therapeutic department.
Electrical injury.
Electrical injury is an unexpected pathological effect electric current on the body, which causes systemic functional disorders of the central nervous system, cardiovascular and respiratory system and leads to local damage. Mortality from electrical injury reaches 20%. Victims of electrical trauma are more likely than others to require resuscitation.
Severity functional disorders and damage depends on the conditions of the damage: the nature of the current, the strength of the current, the voltage, the duration of the current, the electrical conductivity of the skin, the state of the body at the time of injury, the path of the current in the body (current loops).
The most dangerous are the upper current loops: “hand - hand”, “hand - head” or “full loop”, i.e. "two arms - two legs."
Towards development terminal state in case of electrical injury, ventricular fibrillation leads first of all, then depression medulla oblongata and tetanic spasm of the respiratory muscles. Electric current through nervous system has a reflex effect on vital organs, leading to circulatory and respiratory disorders. Paralysis of the vital centers of the medulla oblongata may not occur immediately, but within the next 2-3 hours after the injury. Sometimes primary deep damage to the central nervous system leads to a sharp inhibition of the centers of regulation of breathing and blood circulation, up to the so-called electrical lethargy, requiring long-term treatment under the control of gas exchange in the lungs and ECG.
IN acute period After an electrical injury, widespread vascular spasm often occurs, manifested by sudden cold temperatures, cyanosis, and spotty skin. Subsequently, circulatory disorders may occur due to ruptures of the arterial wall, thrombosis with the development of ischemia, or edema of the limb exposed to the current. With prolonged exposure to electric current, ruptures of pulmonary vessels, focal necrosis of the liver and kidneys, perforation of hollow organs of the gastrointestinal tract, edema and necrosis of the pancreas are possible.
Primary gas exchange disorders in the lungs are usually the result of spasm of the respiratory muscles and vocal cords. Therefore, the victim cannot call for help. Less commonly, apnea is caused by damage to the medulla oblongata, when a current loop engulfs the respiratory center. In these cases, respiratory arrest persists even after cessation of contact with the current, which requires mechanical ventilation.
When an electric current passes through the body, depending on the general condition of the victims, disturbances of 4 degrees may occur:
– convulsive muscle contraction without loss of consciousness, the victim experiences fear. Skin pale. There are chills, convulsive cry
– convulsive contraction of muscles with loss of consciousness, but without disturbances in breathing or cardiac activity. Pronounced pallor of the skin. Consciousness is quickly restored. There is severe fear and cries for help. Independent release from the current is impossible
– convulsive muscle contraction with loss of consciousness, impaired breathing and cardiac activity and spasm of the vocal cords. The victim cannot scream even after regaining consciousness, breathing is difficult, and heart sounds are muffled. Bradycardia or fibrillation is noted.
– Clinical death. There is no cardiac activity or ventricular fibrillation is observed. After a convulsion, a sharp exhalation occurs, inhalation is impossible, apnea.
With mild (I-II) degree of damage, these phenomena stop within 1-2 weeks. With severe damage, persistent changes in the cardiovascular system are observed, up to myocardial infarction. Patients require long-term and intensive therapy.
Treatment. If the victim is not disconnected from the power source, immediately release him in compliance with safety rules, namely: turn off the power source, and if the switch is far away, cut the wire or throw it away, pull the victim out. To discard the wire, use a dry stick, board or other object that does not conduct current. The victim should be pulled away by the ends of his clothes, without touching the body, and if the clothes are wet, through a dry cloth rolled up in several layers.
To free the victim's hands if the fingers are convulsively clenched against the wire, it is only necessary to wear rubber or dry leather gloves, standing on a dry stand.
After releasing the victim from the action of the current, his condition is assessed. In the absence of breathing, pulsation on main arteries, consciousness – necessary immediate execution SLCR with an earlier transition to defibrillation. Before starting chest compressions, it is necessary to apply 2-3 short blows to the area of the lower third of the sternum.
Transportation of the victim is possible only on a stretcher, provided that cardiac activity is maintained or restored. The victim is hospitalized in the intensive care unit for intensive observation for 1-3 days (there may be repeated heart rhythm disturbances). The absolute rule should be constant readiness for repeated resuscitation. The main causes of delayed deaths after electrical trauma are shock, acute heart failure, and pulmonary edema.
Prolonged crushing of soft tissues.
Prolonged crushing of soft tissues is special kind trauma, which develops as a result of more or less prolonged crushing of soft tissues (usually limbs) by rock fragments in mines or stones in the mountains. Such damage can occur due to compression of the limbs by the weight of one’s own body, impaired blood circulation in these parts of the body during a prolonged forced position (this is facilitated by prolonged loss of consciousness due to intoxication carbon monoxide, alcohol, etc.)
Prolonged crushing of muscles (or compression of them in a forced position of the body) is accompanied by swelling of the injured limb due to extensive muscle loss and the development of shock in the first 1-2 days, the occurrence of acute renal failure from 3 days to 5 weeks after the injury, the development of stiffness in the joints, the appearance of wounds in the necrosis zone and impaired nerve conduction in the late period.
The main factor causing serious condition victims of prolonged compression, is the entry into the blood of breakdown products from destroyed muscles (myoglobin, potassium, etc.). Also important factor is a sharp and prolonged pain due to injury, which leads to spasm of the kidney vessels,
Leading to acute renal failure.
Blood loss and plasma loss are the third factor of damage (in compressed tissues, the permeability of the vessel walls for fluid sharply increases, so after the compression is removed, plasma rushes from the vessels into the muscles - on the one hand, swelling of the limb occurs, on the other, the amount of blood circulating in the vascular system decreases) .
Clinical signs of long-term compartment syndrome.
External signs of the syndrome are quite deceptive. Immediately after the compression is eliminated (removing the victim from the blockage, changing the body position after a long stay in a forced position), the victim’s condition may seem satisfactory. The patient is concerned about pain in the injured limb, limited mobility of the limb and swelling. The limb is pale, and there may be indentations and bruises in areas that have been crushed. You can usually feel a pulsation on the limb.
Soon after the compression is released, the limb increases in volume due to rapidly increasing swelling and acquires a woody density. Painful sensations are starting to increase. Swelling tends to quickly spread beyond the injured areas. Places of former dents are smoothed out. In areas of the skin that have been subjected to the greatest crushing, blisters with clear or bloody contents appear. The pulsation of the vessels of the extremities weakens. The limbs become cold, the victim cannot move them when trying to bend or straighten them injured limb arises sharp pain. The sensitivity of the skin on the injured limb is impaired - the patient
Does not feel touch or pin pricks.
General state the victim gets progressively worse. Pulse quickens and falls arterial pressure. Excited, euphoric, actively reacting to everything that happens, the victim becomes lethargic, apathetic, indifferent to his surroundings. Body temperature decreases. With a large area and prolonged exposure to crushing, symptoms of shock develop more quickly.
On the first day after the injury, the victim’s urine has a varnish-red color.
From the 2nd, more often the 3rd day after the injury, acute renal failure begins to increase. The amount of urine excreted by the victim decreases, up to its complete absence. Pain in the affected limb is reduced. In places of greatest crushing, the skin and subcutaneous fat often become dead and rejected. Damaged muscles bulge into the resulting wounds, looking like boiled meat. The body temperature rises and the patient begins to feel feverish. The pulse remains elevated. The general condition of the patient, at first glance, ceases to inspire concern. However, after 4-5 days, the patient develops breathing and cardiac problems (pain behind the sternum, a feeling of suffocation, shortness of breath - the number of breaths exceeds 30 per minute). By this moment, the victim in any situation must be in the hospital, otherwise there will be very little chance of a successful outcome.
In patients with crush injuries of both limbs lasting more than 8 hours, the chances are low. After being freed from the rubble, severe shock quickly develops, which is difficult to treat. All victims, as a rule, die within the first or second day. When one or two limbs are crushed within 4-6 hours, shock and impaired renal function develop. Mortality – from 50 to 70%.
If the duration of crushing does not exceed 4 hours, the mortality rate does not exceed 30%. When crushing only the lower leg or forearm for no more than 4 hours, all victims usually survive.
First of all, you need to free your head from under the rubble and top part body of the victim, to allow air access to clear the mouth and nose from foreign bodies, rinse your mouth. If breathing is impaired, it is necessary to perform artificial ventilation using the “mouth to mouth” or “mouth to nose” method. Inject 1-2 ml of promedol intramuscularly. Wounds and abrasions must be covered with aseptic dressings (sterile napkins). After being freed from crushing objects, the injured limb is tightly bandaged, starting with the hand or foot. Next, the limb is immobilized according to the rules for treating fractures. Packs with ice or snow are placed over the bandage (if they are not available, with cold water). His life literally depends on the speed of delivery of the victim to the hospital.
Victims released from compression during the first 2 hours most likely will not have ischemic toxicosis, despite the compression of large amounts of soft tissue, so they should be released from the blockage first. After 2 hours of compression, starting to release compression without first applying a tourniquet is necessary only for those who have a small mass of compressed tissue ( minor injury). In patients with severe compression injury, a tourniquet should be applied after 2 hours before removal to avoid ischemic toxicosis. In unfavorable conditions, it is necessary to expand the indications and carry out amputation “under pressure” without removing the tourniquet applied during the period of compression proximal to the compression in case of severe compression injury of the limb.
The initial task of IT is to restore the volume of interstitial space and correct metabolic acidosis. Drugs of choice for prehospital stage: crystalloid solutions, 5% glucose solution and 4% sodium bicarbonate solution. Ringer's solution and lactasol are undesirable due to the presence of potassium ions in their composition (4 mmol/l). A 5% glucose solution is injected into one vein, and a 4% sodium bicarbonate solution into the second. A glucose to sodium bicarbonate ratio of 1:3.5 provides an adequate ratio of sodium to water in the interstitial space.
With moderate and severe compression, blood pressure, heart rate, central venous pressure, and diuresis should be monitored during IT. To clarify renal dysfunction against the background of IT with a central venous pressure > 5 cm H2O. Art. carry out a test with Lasix: 80-120 mg of Lasix is administered intravenously and the effect is assessed. If there is diuresis, a 20% solution of mannitol 30 g is administered. In the absence of diuresis, Lasix or mannitol should not be re-prescribed, because Tubular necrosis has already developed in the kidneys. In case of acute renal failure, the volume of IT should be no more than 600 ml per day.
10% solution of calcium chloride or calcium gluconate to combat hyperkalemia,
Glucocorticoid hormones,
Protease inhibitors (contrical, trasylol),
For the prevention and treatment of acute renal failure - prostenon (prostaglandin E2),
Disaggregants (trental, chimes).
If the potassium level is more than 7 mmol/l, extracorporeal methods detoxification. With a massive influx of victims and the absence of devices for extracorporeal detoxification, the indications for limb amputation are expanding.
Intensive therapy is a set of methods for artificially replacing vital functions for a person. Therapy can be the basis for the intraoperative stage or be an independent process for the treatment of critically ill patients.
The principle of operation of the department
The basis for the procedure is to remove the patient from a critical condition incompatible with normal life. Its functions also include the elimination of hypoxia, convulsions, and the prevention of aspiration syndrome.
Home structural unit in medical institutions is the intensive care unit. Patients who require constant care are in an inpatient unit and are looked after by qualified staff. The anesthesiologist-resuscitator selects the type of anesthesia and the principle of operation during the preoperative state, monitors the condition of patients after the manipulations.
Methods of use and basics of intensive care
Infusion therapy is carried out for any serious illness and damage. This is one of the main methods of prevention and treatment of dysfunctions of vital organs and systems, providing the most controlled and controlled method of supplying the patient’s body with water, energy, proteins, electrolytes, vitamins, medicines. Intensive treatment refers to the practical branch of medicine, which is aimed at eliminating threats to the patient’s life.
In this regard, the basis of the industry is formed by other highly specialized principles:
- The infusion method of treatment corrects the main hemodynamic parameters. In this case, special colloidal and crystalloid infusion solutions are used. The following should be said about the infusion method. This method is by far the most important; it is designed to resolve wide range tasks. The intensity of the infusion procedure is determined by the volume of liquid used and its high-quality composition. There are venous and arterial administration of drugs.
- The infusion procedure maintains the acid-base composition of the blood plasma (pollion solutions are used).
- The performance of the heart muscle is corrected. Depending on the type of dysfunction, various cardiotropic drugs and the principle of their administration are prescribed.
- Blood oxygenation is maintained at the proper level, the procedure promotes vitality respiratory centers. In this regard, artificial ventilation of the lungs is used, and respiratory analeptics are used.
The effectiveness of all the procedures described above is determined by the quality of all tasks performed, the parameters of the volume of drugs used and the timeliness of all activities performed. The basis for stopping any actions regarding the patient is the stabilization of the functioning of his internal organs.
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