Intensive care unit
An intensive care unit (less often intensive care unit , even less often intensive therapy unit and intensive care unit ) is a ward in the hospital where patients with severe to life-threatening illnesses or injuries are treated in intensive care. Common abbreviations are IS from intensive care unit , IPS from intensive care unit , ITS from intensive therapy unit , IB from intensive care unit , ICU from English. intensive care unit and ITV from Intensiv .
Many hospitals in Germany have meanwhile divided their patients according to the severity of their illness and set up wards with staff and technical equipment between intensive care and normal wards. Such stations are often called IMC or IC of intermediate care referred.
In many, especially smaller, hospitals, there is only one interdisciplinary intensive care unit that is available to all medical areas. These intensive care units are usually run by anesthetists who are responsible for intensive medical therapy, while specialists in the primary specialist area treat the underlying disease. In hospitals with maximum care there are often two (operative and non-operative) or more intensive care units, each assigned to a specialty (anesthesiology, surgery, cardiac surgery, cardiology, neurosurgery, neurology, pediatrics, neonatology, internal medicine with nephrology, gastroenterology, pulmonology etc.).
history
In 1954 Björn Ibsen headed an independent anesthesia department in the municipal hospital in Copenhagen and set up an all-day recovery room , which enabled intensive care for patients independent of diagnosis and illness, and trained specialist staff exclusively for intensive care, thus establishing the world's first intensive care unit. As a result of the poliomyelitis epidemic, Ibsen was confronted with many patients who had to be ventilated for a long period of time.
Principles
The intensive care unit differs from other units in the hospital in that it uses a wide range of technical devices (including for performing anesthesia and long-term ventilation therapies) as well as the use of more staff. In intensive care units, each nurse only cares for one to three patients at the same time, while in normal wards up to twenty patients receive care from one nurse. More doctors are also employed so that a doctor is always on hand or available in the shortest possible time.
For nursing work in intensive care units, special knowledge of the operation and function of devices, of assisting and, in some cases, of taking over medical activities and specialist knowledge of special clinical pictures are required. Nurses can acquire an additional qualification for intensive care and anesthesia .
Indication for an intensive stay
Basically, sick people of all ages are treated in intensive care units if their illness or condition requires particularly intensive monitoring or treatment . The main advantage of ITS is the possibility of constant monitoring of the patient's vital parameters .
Heart attack or severe cardiac arrhythmias , ARDS , pulmonary embolism , severe asthma attacks , pancreatitis , gastrointestinal bleeding and sepsis are incomplete lists of clinical pictures that require such monitoring . Close monitoring and drug control of urine output in the event of kidney failure also indicate an intensive stay. Serious injuries such as multiple trauma or surveillance after operations require intensive care, as do patients with severe pulmonary edema and severe pneumonia . Patients who are delirious also often have to be cared for there because of the necessary personal monitoring. Rapid transport to a stroke unit has now become the standard for patients with neurological deficits, especially if a stroke is suspected . In many clinics, certain therapies (such as cardioversion , lysis therapy ) are only carried out in the intensive care unit for the safety of the patients; This can also be the reason for relocating other stations.
All patients who require artificial respiration due to their symptoms , such as people after cardiopulmonary resuscitation , are cared for in an intensive care unit, since ventilation can only be carried out here.
Equipping intensive care units
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Both the spatial design and the equipment of an intensive care unit usually differ considerably from conventional hospital wards in order to meet the special requirements for the care of the predominantly seriously ill people.
Access to an intensive care unit usually takes place through a so-called sluice in order to keep the import of pathogenic germs as low as possible. For the complex monitoring and treatment procedures, for example, 20-25 m² of floor space, 16-20 sockets and at least two oxygen connections are considered necessary for each patient . For the continuous control of EKG , blood pressure , body temperature and often many more vital parameters , monitors are attached to each treatment station , the signals of which are usually also sent to a monitoring center and can also be observed and evaluated from there. Many of the drugs used in intensive care medicine have to be administered directly intravenously via electronically controlled drug pumps ( syringe pumps ) , so that often four to ten such devices are set up next to the patient's bed. In addition, many people are mechanically ventilated, so often respirators ready. Some patients also need dialysis or apheresis ; all equipment must be able to be set up in the immediate vicinity of the patient.
Web links
- IntensivCareUnit.de Specialist portal for intensive care workers
- zwai: Journal - Portal - Forum - Further training for anesthesia and intensive care.
Individual evidence
- ↑ Intensive care unit in Duden online
- ↑ Swiss Society for Intensive Care Medicine
- ↑ fachpflegewissen.de: What is an intensive care unit?
- ↑ B. Ibsen: From anesthesia to anesthesiology. Personal experiences in Copenhagen during the past 25 years. In: Acta Anesthesiologica Scandinavica. Supplementum 1975; 61: 1-69, p. 29.
- ↑ Stephen Pincock: Bjørn Aage Ibsen. In The Lancet . Volume 370, H. 9598, November 3, 2007, p. 1538, doi: 10.1016 / S0140-6736 (07) 61650-X
- ↑ Martin Lindig: Pain, Sedation and Anesthesia. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 581–618, here: pp. 593–595 ( anesthesia in the intensive care unit ).
- ↑ Christof Kessler , Alexander V. Khaw, Darius G. Nabavi, Jörg Glahn, Martin Grond, Otto Busse: Standardized procedure in the prehospital phase of the stroke. (PDF; 394 KB) In: Deutsches Ärzteblatt . 2011, accessed on December 7, 2018 (print edition: Heft 36/2011, p. 585 ff.).