PROCEDURE FOR PROVIDING INFORMATION

on the state of health of patients undergoing inpatient treatment at the FGBU "FTSSKH" of the Ministry of Health of Russia, Krasnoyarsk (hereinafter referred to as the Center) to relatives and friends of patients.

1. Provision of information on the state of health of a patient who is inpatient treatment at the Center is carried out only to persons indicated by the patient in the form for permission to transfer information constituting medical secrets. This form is filled out by the patient when registering hospitalization in the admission department and is placed in the medical history. Responsible for completing the form and placing it in the medical history is the admissions nurse.

2. The attending physician, operating surgeon, head of the department, resuscitation doctor or head of the resuscitation department may provide information about the patient's health status to those to whom the patient has given consent to receive information, when the patient is in the intensive care unit.

3. It is possible to obtain information about the patient during a personal conversation with the doctor or with the head of the department, or by telephone. If the patient specifies a specific person to receive information, the transfer route is only face-to-face - after the submission of identity documents and verification of their data with the specified patient in consent to data transfer.

4. On weekdays, information about the patient's health status is provided by the attending physician or the operating surgeon in person or by the telephone number of the resident's office from 14.00 to 16.00 (including information about patients in the anesthesiology and intensive care unit). Information on the condition of patients transferred to the intensive care unit after 4 pm is provided on that day by the doctor on duty resuscitator or the duty child resuscitator from 20.00 - 22.00 by the telephone number of the resident's office or the medical post, or in person.

5. On weekends and holidays, information about the health status of patients undergoing treatment in the department of anesthesiology and resuscitation is provided by the doctor on duty resuscitator or the duty children's resuscitator from 10.00 to 12.00 and from 20.00 to 22.00 at the telephone number of the resident's or medical post, or during a face-to-face meeting.

6. Information about the patient's state of health is obtained from the head of the department either directly by contacting the phone number of the head of the department during working hours, or through the attending physician, who is obliged to inform the latter about the need to clarify the patient's health. The head of the department within 2 working days must ensure the provision of information by telephone or in person.

7. Other employees of the Center, except for the persons specified in clause 2 of this Procedure, are prohibited from providing any information about the patient's condition. Information about the received request, about the patient's condition must be transferred to the attending physician of the patient or the operating surgeon, when the patient is in the intensive care unit - to the resuscitation doctor.

The severity of the patient's general condition is determined depending on the presence and severity of decompensation of vital body functions. In accordance with this, the doctor decides on the urgency and the required amount of diagnostic and therapeutic measures, determines the indications for hospitalization, transportability and the probable outcome (prognosis) of the disease.

In clinical practice, there are several gradations of the general condition:

• satisfactory
• moderate
• heavy
• extremely severe (preagonal)
• terminal (atonal)
• the state of clinical death.

The doctor gets the first idea of \u200b\u200bthe general condition of the patient, getting acquainted with the complaints and data of general and local examination: appearance, state of consciousness, position, fatness, body temperature, color of the skin and mucous membranes, the presence of edema, etc. The final judgment on the severity of the patient's condition is made based on the results of a study of internal organs. At the same time, it is of particular importance to determine the functional state of the cardiovascular system and the system of organs of dykhaniya.

The description of the objective status in the medical history begins with a description of the general condition. In some cases, it is possible to really determine the severity of the general condition with a relatively satisfactory state of health of the patient and the absence of pronounced violations of the objective status is possible only after additional laboratory and instrumental studies, for example, on the basis of identifying signs of acute leukemia in a blood test, myocardial infarction on an electrocardiogram, bleeding gastric ulcer with gastroscopy, metastases of cancer in the liver with ultrasound.

The general condition of the patient is determined as satisfactoryif the functions of vital organs are relatively compensated. As a rule, the general condition of patients remains satisfactory in milder forms of the disease. At the same time, subjective and objective manifestations of the disease are not sharply expressed, the consciousness of the patients is usually clear, the position is active, the food is not disturbed, the body temperature is normal or subfebrile. The general condition of patients is also satisfactory during the period of convalescence after acute diseases and when exacerbations of chronic processes subside.

General condition of moderate severity they say if the disease leads to decompensation of the functions of vital organs, but does not pose an immediate danger to the patient's life. Such a general condition of patients is usually observed in diseases occurring with pronounced subjective and objective manifestations. Patients may complain of intense pains of various localization, severe weakness, shortness of breath with moderate physical exertion, dizziness. Consciousness is usually clear, but sometimes it is stunned. Motor activity is often limited: the position of patients is forced or active in bed, but they are able to serve themselves. Symptoms such as high fever with chills, widespread edema of the subcutaneous tissue, severe pallor, bright jaundice, mild cyanosis, or extensive hemorrhagic eruptions may occur. In the study of the cardiovascular system, an increase in the number of heartbeats at rest more than 100 per minute or, conversely, bradycardia with a number of heartbeats less than 40 per minute, arrhythmia, and increased blood pressure are revealed. The number of breaths at rest exceeds 20 per minute, there may be a violation of bronchial patency or the patency of the upper respiratory tract. On the part of the digestive system, signs of local peritonitis, repeated vomiting, severe diarrhea, the presence of moderate gastrointestinal bleeding are possible.

Patients whose general condition is regarded as moderate, usually require emergency medical care or hospitalization is indicated, since there is a possibility of rapid progression of the disease and the development of life-threatening complications. For example, in a hypertensive crisis, myocardial infarction, acute left ventricular failure, or stroke may occur.

The general condition of the patient is defined as severe in the event that the decompensation of the functions of vital organs developed as a result of the disease poses an immediate danger to the patient's life or can lead to profound disability. A severe general condition is observed with a complicated course of the disease with pronounced and rapidly progressing clinical manifestations. Patients complain of unbearable lingering persistent pain in the heart or abdomen, pronounced shortness of breath at rest, prolonged anuria, etc. Often the patient groans, asks for help, his facial features are sharpened. In other cases, consciousness is significantly depressed (stupor or stupor), delirium, severe meningeal symptoms are possible. The patient's position is passive or forced, he, as a rule, cannot serve himself, needs constant care. Significant psychomotor agitation or generalized convulsions may occur.

The growing cachexia, anasarca in combination with dropsy of cavities, signs of severe dehydration (decreased skin turgor, dry mucous membranes), "chalky" pallor of the skin or severe diffuse cyanosis at rest, hyperpyretic fever, or significant hypothermia testify to the severe general condition of the patient. In the study of the cardiovascular system, a threadlike pulse, a pronounced expansion of the boundaries of the heart, a sharp weakening of the I tone above the apex, significant arterial hypertension or, conversely, hypotension, impaired patency of large arterial or venous trunks are revealed. On the part of the respiratory system, tachypnea over 40 per minute, pronounced obstruction of the upper respiratory tract, a prolonged attack of bronchial asthma, or incipient pulmonary edema are noted. Indomitable vomiting, profuse diarrhea, signs of diffuse peritonitis, massive ongoing gastrointestinal (vomiting of "coffee grounds", melena), uterine or nosebleeds also testify to a serious general condition.

All patients, whose general condition is characterized as severe, require urgent hospitalization. Treatment is usually carried out in an intensive care unit.

Extremely severe (pre-gonal) general condition characterized by such a sharp violation of the basic vital functions of the body that without urgent and intensive therapeutic measures, the patient may die within the next hours or even minutes. Consciousness is usually sharply depressed, up to coma, although in some cases it remains clear. The position is most often passive, sometimes motor excitement, general convulsions with the involvement of the respiratory muscles are noted. The face is deathly pale, with pointed features, covered with drops of cold sweat. The pulse is felt only on the carotid arteries, blood pressure is not detected, heart sounds are barely heard. The number of breaths reaches 60 per minute. With total pulmonary edema, breathing becomes bubbling, frothy sputum of pink color is released from the mouth, and various-sized unsonic moist rales are heard over the entire surface of the lungs.

In patients with status asthmaticus, breathing sounds over the lungs are not heard. Respiratory disorders can be detected in the form of Kussmaul's "big breathing" or periodic breathing such as Cheyne-Stokes or Grokko. Treatment of patients in extremely serious general condition is carried out in the intensive care unit.

In the terminal (agonal) general state complete extinction of consciousness is observed, muscles are relaxed, reflexes, including blinking reflexes, disappear. The cornea becomes cloudy, and the lower jaw drops. The pulse is not felt even on the carotid arteries, blood pressure is not detected, heart sounds are not heard, however, the electrical activity of the myocardium is still recorded on the electrocardiogram. There are rare periodic respiratory movements like Biota breathing.

The agony can last for minutes or hours. The appearance of an isoelectric line or waves of fibrillation on the electrocardiogram and cessation of breathing indicate the onset of clinical death. Immediately before death, the patient may develop convulsions, involuntary urination and defecation. The duration of the state of clinical death is only a few minutes, however, resuscitation measures initiated in a timely manner can bring a person back to life.

APPENDIX 3

METHODOLOGICAL DEVELOPMENT FOR TEACHERS AND STUDENTS

To the topic "general examination of the patient"

General condition assessment criteria

2. Indications for urgent hospitalization, as well as the urgency and scope of treatment.

3. The nearest forecast.

4. Physical activity and the need for care.

The severity of the condition is determined by a complete examination of the patient

1. upon questioning and general examination (complaints, consciousness, position, skin color, edema ...);

2. when examining the systems (RR, HR, BP, ascites, bronchial breathing or the absence of respiratory noises above the lung area ...);

3. after additional methods (blasts in the blood test and thrombocytopenia, heart attack by ECG, bleeding gastric ulcer by FGDS ...).

Distinguish: a satisfactory condition, a condition of moderate severity, a serious condition and an extremely serious condition.

Satisfactory condition

The functions of the vital organs are compensated.

There is no need for urgent hospitalization.

There is no threat to life.

Does not need care (caring for a patient due to functional insufficiency of the musculoskeletal system is not a basis for determining the severity of the condition).

A satisfactory condition occurs in many chronic diseases with relative compensation of vital organs and systems (clear consciousness, active position, normal or subfebrile temperature, no hemodynamic disturbances ...), or with a stable loss of function from the CVS, respiratory system, liver, kidneys, ODA , nervous system but without progression, or with a tumor, but without significant dysfunction of organs and systems.

Wherein:

The functions of the vital organs are compensated,

There is no immediate unfavorable prognosis for life

There is no need for urgent medical measures (receives planned therapy),

The patient serves himself (although there may be a limitation due to the pathology of the ODA and diseases of the nervous system).

Moderate condition

2. There is a need for urgent hospitalization and treatment.

3. There is no immediate threat to life, but there is a possibility of progression and development of life-threatening complications.

4. Motor activity is often limited (active position in bed, forced), but they can serve themselves.

Examples of symptoms in a patient with a moderate condition:

Complaints: intense pain, severe weakness, shortness of breath, dizziness;

Objectively: consciousness is clear or deafened, high fever, severe edema, cyanosis, hemorrhagic rashes, bright jaundice, HR more than 100 or less than 40, HR more than 20, impaired bronchial patency, local peritonitis, repeated vomiting, severe diarrhea, moderate intestinal bleeding, ascites ;

Additionally: heart attack on ECG, high transaminases, blasts and thrombocytopenia less than 30 thousand / μl in an. blood (there may be a state of moderate severity, even without clinical manifestations).

Serious condition

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

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

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

From the point of view of a resuscitator, all patients are divided into three categories. The first - with diseases no worse than a cold, by resuscitation standards, of course. Well, for example, pneumonia, affecting 1-2 lobes out of 5 available. Or an allergy that breathes freely, does not require pressure support and in which the skin does not peel, well, at least not all. There is also bleeding, stopped by a surgeon, endoscopist, or stopped on its own after a couple of doses of plasma, when the patient is completely compensated for by saline solutions and does not require red blood cells and other transfusion wisdom.

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

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

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

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

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

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

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

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

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

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