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To assist the Alarm clock
Heavy Equipment
To face all the Situations
A Complete Assessment
Why does one go in Reanimation?
The exemple of the aged Person
The exemple of the Cardiac one 

To assist the Alarm clock

  After the operation, according to his general state, the patient can go in recovery room, during a few hours, even a few days if it is necessary to ensure an assistance to compensate certain failing functions, in particular at the cardiac level.

  One cannot today dissociate the anaesthesia of the reanimation, which is apparently its opposite: the first consists in deadening, the second to be awaked.

  The reanimation puts in?uvre a whole of logical techniques making it possible to replace or assist certain organic functions. A patient in the coma, for example, needs to be nourished by intravenous way, and should be brought to him sometimes a cardiac and respiratory assistance.

Heavy Equipment

  The reanimation is ensured in specialized services, profiting from an especially trained personnel. But more than one question of equipment and structures, it is a way of considering medicine: if the reanimation is carried out using very sophisticated means, it also starts on the roadside, when one carries assistance to a victim, or on a beach, when one tries to reanimate one drowned (index, First aid).

  The reanimation thus represents the whole of the means which one uses to compensate for the defective functions. This medical discipline is often spectacular: it is put in?uvre tous.les.jours by teams specialized like those of Samu or the firemen. These specialists are able, when to make may be, to bring the good response to a situation of distress. It is often difficult, in these cases, to make the distinction between emergency reanimation and medicine.

  But, beyond this spectacular side, the reanimation is especially a logical step, reasoned: the doctor is led, on the one hand, to draw up a diagnosis, and, on the other hand, to give an adapted answer, the whole in record time.

To face all the Situations

  The doctor reanimator is of course brought to intervene in situations often extremely different. Most difficult is without any doubt that of the emergency doctor, called with the bedside of an unknown patient. It acts, for example, of a victim of the road, a person found without knowledge in a public place, or of a suffering patient of a well-known disease.

  The prime objectives of the doctor are to draw up a fast diagnosis, in order to include/understand the causes of the loss of consciousness, and to evaluate the risks to set up measurements of help.

  In the case of a road accident, for example, it is quite obvious that the principal risks are those of the haemorrhage and the problems arising from the osseous fractures, in particular on the level of the spinal column. The doctor must thus evaluate the whole of these dangers. But it should not neglect other aspects of the situation either: a road accident can be due, for example, with a myocardial infarction, the driver having lost the control of its vehicle at the time of the crisis.

A Complete Assessment

  At the hospital, the reanimator has more sophisticated means which enable him to know exactly the extent of the damage and the problems. In a few minutes, it obtains a blood and electrolytic assessment (index, biological Bilan) which authorizes it to avoid urgently, for example to carry out a blood transfusion in the event of too important haemorrhage.

  Very quickly, it can have also a radiological assessment and, possibly, a scanner (index, Imagerie) which enable him to discover the cause or the effects of the accident.

  It then puts in?uvre average the techniques necessary to correct the disorders observed, that they are cardiac, renal, endocrinological disorders (comas diabetics) or poisons (intoxications). - the cardiac reanimation calls upon increasingly sophisticated means, with regard to not only the drugs, but also the equipment. Is the traditional equipment of the cardiac reanimation the "defibrillator", an apparatus which is used to produce electric shocks? the assistance of a metal plate, one makes briefly circulate a fort electrical current through the chest, which makes it possible to make set out again a c?ur weakening or to stop a ventricular fibrillation (index, Troubles rate/rhythm).

  Today, the cardiologist has at his disposal of the tools much more modern, in order to correct some disturb rate/rhythm or to ensure a correct perfusion of the coronary arteries (index, Anatomie of the c?ur). - a renal dialysis can also be practised in the intensive care unit, in the event of acute renal insufficiency (index, Néphrologie) post-operative. - the artificial respirators make it possible to compensate for a defective breathing. - the urinary monitoring is carried out using probes, when a renal insufficiency is feared. The simple installation of a probe makes it possible to measure the urinary excretion permanently and to carry out examinations on the urines. - the blood biological parameters, finally, are controlled permanently. The patient being constantly under perfusion for his food by venous way, one carries out several times per day of the taking away to analyze the blood constants, and in particular the ionogramme. This monitoring makes it possible to unceasingly adapt the food (quantity of liquids and rock salt) to the state of dehydration of the patient.

Why does one go in Reanimation?

  These techniques of reanimation are employed, of course, following an operation when there are complications or when the patient is very fragile (insufficiency cardiac, respiratory or renal), but also in all the cases where a medical reanimation is necessary. Here the most frequent causes of stays in intensive care unit: - the coma : it is the principal cause, which requires a constant and high level monitoring; there are several types of comas, unquestionable reversible, the other final ones (index, Neurologie); - toxicological accidents : voluntary or involuntary catch of products toxic, at the origin of an obnubilation (benzodiazepines, psychotropic), or of a renal insufficiency; - serious infectious diseases (tetanus, AIDS at the last stage); - neurological accidents (cerebral vascular accident, méningée haemorrhage); - the polytraumatisms (road accidents); - diseases requiring a metabolic reanimation in order to restore great blood balances: coma diabetic, surrénalienne insufficiency, renal insufficiency.

The exemple of the aged Person

  The dehydration of the old person is a frequent cause of hospitalization in emergency service and it is explained by the accumulation of various disorders (and often also by an abuse certain drugs) which cause the appearance of one state in extreme cases of the coma.

  At an old person, the diseases are often added the ones with the others: dehydration causes a functional insufficiency of the c?ur and kidneys, which causes an aggravation of the hydrous disorders (index, Physiologie of the kidney). In addition, because of dehydration, the drugs tend to accumulate, and they have each one their own toxicity, in particular at the old people.

  Once the in-patient, the doctor carries out a clinical examination to evaluate the state of consciousness and that of the principal functions, in particular at the cardiorespiratory level. Dehydration is easily locatable with the "sign of the fold": when the skin is gripped, it remains folded a few moments before taking again its aspect of origin.

  The reanimator installs initially the principal ways in order to réhydrater his patient and to measure his losses: he sets up an intravenous catheter, on which he connects a perfusion, and he poses a urinary probe, in order to measure the quantity of urine excreted by the kidney. If necessary, it puts the patient under cardiac monitoring to supervise in real time the contractions of the c?ur and its possible anomalies.

  The first assessment, carried out on a blood test, immediately reveals the situation of the liquids of the organization: the most significant examination is the ionogramme, which makes it possible to know the exact concentrations in the liquids of the organization of the principal electrolytes, i.e. sodium (Na), potassium (K) and the bicarbonates.

  Let us recall indeed that the interior medium is a liquid, the serum, which is composed of water but also many élements mineral. In order to be reconstituted this liquid, should not only perfuser water, but add with this one with many elements, in particular with sugar, potassium, sodium salts, to give him a composition rather close to the physiological salt solution.

  According to the results of the ionogramme, the reanimator prescribes the number of liters of serum which will be needed perfuser in the course of the day (on average two to three liters, knowing that the patient does not drink and does not eat), as well as the quantities in grams of the various electrolytes which it will be necessary to add in the perfusions.

  In parallel, the other biological, like the blood numeration-formula, and complementary examinations, following the example radiographies (indices, Examinations complementary), will direct the doctors towards the cause of the disease. But it should be noted that the only rehydration often has spectacular results, restoring the hydrous balance of the organization and allowing the elimination of toxins.

The exemple of the Cardiac one 

  The myocardial infarction is also a cause frequent, and perfectly justified, of hospitalization in an intensive care unit. Indeed, an infarction requires an attentive monitoring in the first hours, because of the risk of collapse (falls fast, even mortal, of the blood pressure), and because there is an important risk of aggravation.

  In this case, and if possible, one does not wait to be the hospital to begin the intensive care. They often begin in the car from Samu, perfectly equipped as men and material to ensure this type of care.

  As in the preceding case, the first gestures of the doctor consist in bringing into service ways initially, i.e. to install a venous perfusion (in the event of collapse, it will be difficult and perhaps impossible to prick the patient). Once the patient perfusé and supervised using an electrocardiogram, the doctor tries to emerge his arteries blocked using a drug thrombolytic. It acts of a product, which, injected quickly in circulation, will dissolve the clot which stops the artery. It is preferable to carry out this gesture at the hospital, using a catheter installed in the aorta, and under x-ray inspection, in order to inject the product in the stopped artery well. It is important that this gesture is carried out in the hours which follow the beginning of the crisis (index, Myocardial infarction).

  Whatever the result of this intervention, the patient must in theory remain a few days in service of intensive care, because of the pain caused by the coronary attack, and, especially, because it is necessary to constantly control the evolution and the extent of the cardiac disease. Several times per day, one carries out biological examinations, precisely to supervise the evolution of the disease.

  When the infarction is stabilized, the patient can join a service of cardiology, where it begins his rehabilitation.



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