Intensive Care of Emergency Conditions - V. M. Zaporozhan 2006

Introduction

Emergencies pose a genuine threat to a patient's life. Because they are closely linked to the potential development of critical or even terminal states requiring intensive care and resuscitation techniques inherent to anesthesiology, it is essential to become familiar with this terminology.

A critical condition is one in which an existing Impairment of the body's vital physiological Functions cannot be spontaneously corrected through self-regulation and requires partial or complete correction or substitution.

Intensive care is The process of treating critically ill patients, a comprehensive therapy administered in severe and life-threatening conditions. Based on the definition of a critical condition given above, the cornerstone of intensive care must be the correction or substitution of the body's vital functions. In this context, the primary Diagnosis often takes a back seat, while the syndromes associated with the condition come to the fore. It is precisely this syndromic approach that generally forms The basis of intensive care for emergency conditions.

In foreign countries, the term "intensive care" is used to define the branch of clinical medicine that studies the Pathogenesis of processes and phenomena occurring in the body during terminal states and the recovery period following clinical death. In recent years in Ukraine, the term "intensive care" has been used in place of "reanimatology".

Terminal states (preagony, agony, clinical death) represent the threshold (terminus) between life and death, characterized by the progressive fading of vital functions up to their complete cessation.

Resuscitation (from the Latin re — again, animatio — animation, animo — to breathe life into) is the process of treating terminal states, reviving the Organism, and a complex of therapeutic measures aimed at restoring fading or just-extinguished vital Functions of the body.

Reanimatology (resuscitation + Greek logos — science) is the science of organism revival. In the USSR, for many years this term applied not only to The Study of dying and resuscitation processes, but also to the normalization of acutely disturbed functions of a living organism, which in English-speaking foreign countries, and nowadays in Ukraine as well, is defined as "intensive care".

Intensive observation is the monitoring of patients with a potential risk of developing a critical condition. It is identical to the term "monitoring". Based on the axiom that it is better not to wait for vital functions to be damaged only to restore them later, intensive observation prevents The Development of critical states. Similarly, intensive care to some extent prevents the development of terminal states, and resuscitation prevents the onset of biological death. Monitoring is conducted using Invasive Methods (involving entry into the Circulatory system, for example) and non-invasive methods utilizing special technical devices, as well as non-instrumental methods with continuous or intermittent recording of parameters.

When performing intensive care and resuscitation, methods applied in anesthesiology are utilized.

The term "anesthesiology" (from an — absence, esthesia — sensation, logos — science) was initially interpreted as the science of pain relief during surgical operations. Although surgery is always aimed at Treatment, according to René Leriche, "surgery saves the patient by means that can kill him." The primary task of anesthesiology is to protect the organism from surgical trauma. Over time, the semantics of the word "anesthesiology" expanded significantly. It acquired the meaning of the science of managing vital functions not only in connection with surgery, but also in critical conditions of any origin. Therefore, an anesthesiologist must master not only pain management methods, but also resuscitation and intensive care. Consequently, they are directly involved in the intensive care of emergencies.

Structure/19.html">The Importance of anesthesiology is evidenced by the very history of this science. For many centuries, humanity was driven by the idea of eliminating pain and restoring life to the dying.

The first period in the Development of the science of pain relief and resuscitation is the empirical period (3rd–5th millennia BC to the discovery of ether anesthesia in 1846). Since ancient times, mandrake, opium, Indian hemp, ethyl alcohol, and scopolamine (the "potion of the damned" in the Middle Ages) were used for pain relief. In 1200, Lullius isolated, and in 1540, Cordus synthesized, diethyl ether from alcohol and sulfuric acid. In the same year, Paracelsus established the anesthetic properties of ether, and in 1794, attempts were made to study ether's effect in reducing pain. Avicenna mentioned the cooling of extremities for pain relief, a technique also used by Larrey, the chief surgeon of Napoleon's army. Ambroise Paré used a tourniquet for pain relief during limb operations.

Attempts at resuscitation by blowing air into the Lungs of victims using the Mouth-to-mouth method were used 3–5 thousand years ago. Paracelsus proposed special bellows for blowing air into the lungs of victims. In 1767, a society for the resuscitation of the drowning was established in the USA. At the beginning of the 19th century, attempts to resuscitate the drowning were made by the English physician Buchan and the Russian medical practitioner Nikitin.

The second period in the development of Anesthesiology and Intensive Care spans from the discovery of ether anesthesia to the establishment of "major surgery".

The chemist Humphry Davy studied The properties of nitrous oxide and called it "laughing gas". It began to be used for entertainment sessions. Davy suggested the possibility of using it for pain relief as well. Henry Hillman (1800–1830) studied methods of pain relief and resuscitation (artificial Respiration using special bellows, restoration of heart activity with an electric current). Horace Wells tested The Effect of nitrous oxide on himself in 1844 during a tooth extraction, and then performed 15 anesthesias on patients before suffering a setback at a public demonstration. Long used ether anesthesia in 1842 for the removal of a HEAD tumor, but reported it only 10 years later. Thomas Morton in Boston on October 16, 1846, performed ether anesthesia (operated by Warren), and this day is considered worldwide as "the day of the discovery of anesthesia".

News of this discovery spread rapidly and found followers in England, France, and Russia (February 7, 1847, Moscow, F. I. Inozemtsev). N. I. Pirogov (1810–1881) was one of the first in Russia to use ether and chloroform anesthesia, and the first in the world to apply anesthesia in military field surgery, publishing the world's first monograph on anesthesia. S. P. Fedorov and M. P. Kravkov in 1904 proposed intravenous anesthesia with hedonal (the "Russian method").

Local anesthesia was proposed by V. K. Anrep (1880); Koller (1884); Eichhorn (1905); Bier (1897). O. V. Vishnevsky detailed the methods of local anesthesia, including the "creeping infiltrate" method. Local anesthesia with novocaine was widely used by Soviet surgeons during the Great Patriotic War.

The third period in the development of anesthesiology and intensive care continues to the present day. It began when "major surgery" demanded the creation of new methods of pain relief coupled with the management of the vital functions of the patient undergoing surgery. Griffith in 1942 proposed using curare-like substances for the relaxation of striated Muscles — Muscle relaxation. S. S. Bryukhonenko and S. I. Chechulin in 1924 proposed The Heart-lung machine and thereby pioneered the method of artificial Circulation.

Attempts at cardiac massage to restore Cardiac Activity were made as early as the last century (Schiff in an experiment in 1874, Niehaus in a human in 1899), but were successfully performed in a clinic for the first time in 1901 (Igelsrud), though the method gained widespread recognition only in the third period of the development of anesthesiology and reanimatology.

Myocardial defibrillation using electric current was performed experimentally by Battelli and Prevost in 1899, chemically in 1929–1948, and with alternating current in 1947–1955. However, it only came into widespread clinical practice after M. L. Gurvich and G. S. Yunyev (1939, 1946–1955) developed a technique using a capacitor discharge. Peter Safar in 1958 detailed the mouth-to-mouth artificial respiration method and proved in practice the advantages of the insufflation method of artificial respiration over the previously used methods of Sylvester, Schäfer, Laborde, and others.

Methods of Blood transfusion and transfusion of blood substitute solutions developed slowly (Harvey, 1628; Bordet's Blood Circulation scheme — heteroagglutination, 1895; Landsteiner, 1901, and Jansky, 1907 — isoagglutination; Landsteiner and Wiener — rhesus factor, 1940). In 1936, Gamble made a major step forward in solving The problem of studying Water-salt METABOLISM in the Body ("chemical anatomy, physiology, and Pathology of the extracellular space"). Further development of this problem led to the creation of the hemodialysis method (Abel, Rowntree, and Turner, 1914 — the "artificial Kidney" in experiment; Kolff, 1943 — in clinic). Of great importance in the development of modern resuscitation methods were scientific studies that established The Physiological Role of Adrenal Cortex Hormones (1934–1948), aldosterone (1954), the potassium-sodium pump (1950s), the discovery of The Significance of the Autonomic Nervous system in the body's reaction to stress (H. M. Laborit, H. Selye, 1933–1951), and the development of neuroplegia and artificial hibernation methods to protect the organism during Shock (HUGENARD, Laborit, Laborit, Huguenard).

The development of anesthesiology and intensive care is actively continuing today. THE CONCEPT OF shock is being revised, and metabolic pathways and methods of Metabolic control are being refined. New intensive care methods have been proposed — Hyperbaric Oxygenation (Boerema, 1960) and hemisorption (Yatzidis, 1964).

The Use of modern combined anesthesia in the countries of the former USSR became possible thanks to the scientific works and organizational measures of domestic surgeons A. V. Vishnevsky, Y. S. Zhorov, B. V. Petrovsky, and others in the 1960s.

In a short span of about two decades, anesthesiology and resuscitation services were established in all former republics. In terms of the number of physicians, anesthesiologists ranked fifth among other medical specialties in 1989 (the year of the IV All-Union Congress of Anesthesiologists in Odesa). A decisive role in the birth and ESTABLISHMENT OF THE new discipline was played by the active efforts of a true champion of new beneficial undertakings, especially in surgical specialties, B. V. Petrovsky, who contributed to the rapid and planned development of anesthesiology and intensive care. However, it must be admitted that innovations were not always and not by everyone accepted immediately and irrevocably. As A. A. Bunyatyan aptly put it in an article in Anesteziologiya i Reanimatologiya (1977, No. 5, p. 13): "Fortunately for domestic anesthesiology, a group of prominent surgeons (N. M. Amosov, A. N. Bakulev, A. A. Vishnevsky, I. S. Zhorov, P. A. Kupriyanov, G. P. Zaitsev, T. P. Makarenko, E. N. Meshalkin, B. V. Petrovsky, and others) managed by the force of their authority, example, and immense personal labor to create all the necessary conditions for the new medical discipline to rapidly pass through the dangerous 'neonatal' period."

A significant contribution to the development of anesthesiology and intensive care in Ukraine was made by the first chief specialist of the Ministry of Health of Ukraine, A. I. Treshchinsky, and professors L. P. Chepky, V. A. Arkatov, L. V. Usenko, R. I. Novikova, and others.

There is no doubt that the establishment of any medical field is primarily driven by qualified personnel. This exact approach made it possible to rapidly establish independent departments of anesthesiology and intensive care in all advanced training institutes for physicians (in Kyiv, Ukraine, and Zaporizhzhia) as well as in the majority of medical institutes and universities. Notably, the Department of Odesa State Medical University was the first among them.

The activities of the anesthesiology service in Ukraine are regulated by Order No. 303 of the Ministry of Health of Ukraine dated October 8, 1997. Specifically, it provides for the following structural units:

1. In healthcare facilities where staffing standards provide for no more than 3 anesthesiologists along with the appropriate number of nurse anesthetists, an anesthesiology group is organized.

2. If more than 4 anesthesiologists are provided for, an anesthesiology department without intensive care beds is organized.

3. In healthcare facilities with high surgical activity and a significant number of patients requiring intensive care, anesthesiology departments with intensive care beds are organized.

4. When A large number of such casualties are concentrated in a hospital, general intensive care units are established.

5. If, based on the feasibility of improving the quality of care and for economic reasons, a hospital concentrates patients with a specific pathology requiring intensive care, specialized intensive care units may be established (toxicology, Sepsis, cardiology, etc.).

6. Within The structure of anesthesiology departments with intensive care wards, general intensive care units, and specialized units, express laboratories are established that operate independently from the hospitals' clinical diagnostic laboratories.

It should also be noted that the anesthesiology group reports directly to the chief physician and the deputy chief physician for clinical affairs, rather than being part of the surgical department, since its work extends across the entire hospital rather than being limited to surgery alone.

Therefore, the most appropriate methods for providing intensive care in emergency conditions are those utilized in anesthesiology. After all, they achieve a unified goal: restoring vital bodily functions that have been lost (in terminal states) or normalizing those that are acutely impaired (in critical states).

Familiarity with the terminology, Basic Concepts, and History of the formation and development of anesthesiology and intensive care as an independent discipline, as well as its current organizational status in Ukraine, should serve as a foundation for students striving for professional excellence.

References

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