Intensive Care Service. What’s an ICU?
How do you define the specialty?
Intensive Care Medicine:
Recognized since 1978 in Spain, is a multidisciplinary and multi-specialty, which aims to practice comprehensive care of the patient whose life life is the risk of fatal outcome by presenting a serious process of retrieving and potentially pathophysiological, and whose proper treatment requires attention in the areas of specialized care. Develop knowledge of the physiological bases of the ways of death and the way how to avoid combat.
Means comprehensive care and coordinated action continued at the same time unit that includes the detection process until the end of the critical situation and discharge.
The specialty was born and developed for the care of critically ill’s patient, in all its aspects. There may be many diseases, but the pathophysiological events leading to death usually quite homogeneous and require similar diagnostic and therapeutic.
Intensive Care Services are highly developed in terms of technology and its location in the Hospital is well defined and centrally.
Scientific and technological determinants that define the specialty.
The practice of Intensive Care Medicine required to have a certain field of knowledge, mastering a set of skills and attitudes have psycho-physical and human resources. As a starting point, the practice of medicine required to have an intensive grounding in internal medicine, is to master the critical phase of Internal Medicine, with a clear pathophysiologic projections, our ultimate goal is to understand the mechanisms by which all diseases can lead to a situation in which life is threatened, ie the final common pathways (Fynn 1974): failure of respiration, circulation systems or maintenance of the internal environment, which requires the management of functional diagnostics dependent on life support. Likewise, the intensivist needs to have some knowledge of bioengineering, and one to manage mechanical and electronic devices that will form a unit with the patient and this requires knowing the physical foundations of mechanical ventilators, the transducers and microprocessor technology, management gases and so on.
A Service of Intensive Care Medicine, may have one or more types of ICUs. The most common are polyvalent ICUs, others are Coronary ICUs (CCU calls or Coronary Care Unit). Others are post-operative ICUs, such as Heart Surgery! Depending on the level of hospital may be one or more ICUs. There are hospitals with specific areas such as intermediate care units, which are units where the level of care is lower and output serve as critically ill patients to hospital wards.
In America it is called ICU (Intensive Care Units) and specialty (Critical Care Medicine) is usually a subspecialty of others as Internal Medicine, Pulmonology, Anesthesiology, and so on. that access to it only requires training for a while in Critical Care Medicine.
In Spain since 1978 (and for some years in Switzerland, Australia, New Zealand and Aguna American Universities) is primary and specialty required 5 years of education and training. This training is multidisciplinary, meaning that faces the knowledge of different fields for 2 years (Internal Medicine, Nephrology, Pulmonology, Cardiology, Anesthesiology, etc …) and during the last 3 years in training at any time in the ICU. At the end of 5 years, the specialist is entitled and can develop their specialty.
Spain is calling on the world stage as one of the most decisive examples of excellence in Intensive Care Medicine, for their high efficiency. The quality is very high even by adopting rules in other parts of Europe and America seen as potentially acceptable. Several U.S. insurance companies, given the high efficiency of our ICUs are trying to begin staffing services and ranked solely on intensive care physicians.
As in the section on the specialty, Critical Care Medicine is a specialty unknown to the public, unlike what occurs with other specialties, it is confused with other specialties by being a multidisciplinary specialty, but …
Its social importance is indisputable for three reasons:
• Value added generated: About 80-85% survival.
• High opportunity cost
• High monetary cost: From 15-18% of the budget of a hospital and from .25 to .30% of Gross Domestic Product (GDP) in Spain (1.1% in the U.S.)
How would define the ICU?
“The concentration of knowledge and resources needed to meet all of a coordinated and continuing the patient in a stage of serious disease characterized by actual or potential life threatening” (SEMICYUC, 1986)
Although initially the Intensive Care was started from a hospital setting to a Central demarcated in an area known as Intensive Care Unit, the specialty has been able to be accommodating to the needs of the target population, which must meet the EC wherever are.
The environment extends to the Specialty Care Specialized Areas, corresponding to the field hospital in what is calling the Progressive Acute Hospital, supporting the EC in any part of it (Intensive Care Units, Coronary Care Units, Care Units Intermediate semi-critical, emergency departments, outpatient, recovery rooms, plant rooms, Indoor Activity) and the extra field hospital (Emergency Services and Transport Extra interhospital hospital).
The ICU is the space related to the nurse and where are critically ill patients.
Behind these doors usually closed to all non-medical staff, there is another world within the hospital. A different way of working than the rest of the hospital, visiting hours and other continuity of care for 24 hours, with patients being discharged depending on the situation that the ICU is at any time of day and night. Patients are usually transferred to other general hospital wards when they are high. This can happen at any time 24 hours a day, 365 days a year.
The nursing assistants and orderlies working in rounds (3, morning, noon and night) of work and doctors (morning and those who are on call 24 hours). On a day in our General Hospital (Cabueñes) there are about 56 people working for up to 14 patients. It means that there are 4 people working for every patient and day continuously. In peak times it may even be several nurses and doctors with a patient only when conditions require it.
Intensive Care Services, as staff who care for patients, clinical material sophistication of life support and are working this system is recognized as extremely effective, not only by staff caring for the patient, but because has required a high capacity training for patient management and life support connected to them.
In the following days we will be discussing what makes up an ICU, departments, nursing, dirty and clean units.
What is a box of hospitalization and making up!
What are the boxes of isolation, how, etc …
Santiago Herrero. What’s an ICU?. Journal of Pearls in Intensive Care Medicine. 2011. Vol 1. Nº 7
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