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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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