Nursing in critical

Resuscitation is the branch of medicine that deals with the patient in critical condition and the care and restoration of vital functions compromised by the onset of a disease or an acute traumatic event. With intensive care indicates the highest available level of continuous treatment of the patient. In addition, nursing care, observation and continuous monitoring of the patient, this usually means an active treatment, ie the intensive care unit. In intensive care patients are hospitalized with very serious diseases. Sometimes, after surgery and for particularly complex subjects in critical health, we resort to hospitalization in intensive care in order to adequately assist the patient. This is to give way completely to the patient to resume breathing and muscle. The work includes intensive care specialist multidisciplinary skills typical of internal medicine and perioperative applied to critically ill patients. The special feature is the intensive support of the patient as a whole, which includes the control of respiratory function, cardiovascular, neurological, nephrological and control of infections and metabolic homeostasis. His practice is highly dependent on the concept of intensive monitoring of vital signs and effects of continuous infusion of drugs and aids and invasive extracorporeal therapy that are active (not passive, as is often thought) to restore physiological functions of the spontaneous patient.

In addition to those multi-purpose, there Resuscitation specialized in specific areas, such as post-surgery, neurosurgery, cardiac surgery.

The doctors who run intensive care units are specialists in anesthesia and resuscitation.

Critical Care
The intensive care department is the hospital where they are guaranteed to the patient's critical care intensive that are necessitated by the particular state of health of the patient, such as the life support (mechanical ventilation, drugs, inotropes , etc..), after recent surgery greater need for continuous monitoring and immediate action. The intensive care unit bed for each normally has an automatic respirator, multiparameter monitor, a manual defibrillator , infusion pumps, suction system , the department is guaranteed nursing specializing in a number not less than one unit every two beds and a medical normally anesthetist - resuscitator .

It is classically composed of a single area of ​​treatment in order to ensure at all times by all employees, the easy control of what happens in the department and the guarantee of immediate intervention in cases of necessity. There are specialized intensive care in cardiac surgery , cardiology , neurosurgery , traumatology , transplantation . In all medical cultures European and North American equivalent to the term intensive care to intensive care. In Italy there is still a widespread misunderstanding of terminology that considers the patient to intensive care "less critical than that of the intensive care unit.

Tracheotomy
The tracheotomy is an operation surgical incision surgery is that the trachea to open an airway to the natural alternative. This surgery is performed routinely in patients requiring endotracheal intubation for periods generally longer than one week (eg state of coma longer), or the beginning of surgery to the head and neck that make it impossible intubation .

The percutaneous tracheostomy is a modern variant of the classical technique is practiced in intensive care and directly at the bedside and has gradually replaced, in the ICU, the technique of surgery . Use a dilatation and minimally invasive approach to create the stoma (opening). It is reversible and is used in those patients requiring prolonged artificial respiratory assistance. The different systems used to vary the type of instrument used to dilate, the main methods are Ciaglia Blue Dolphin (using a balloon dilator) Blue Rhino (use a cone), PercuTwist (use a screw), Griggs and Fantoni. By definition, the airway created by the tracheotomy is intended to be temporary. This is the difference between tracheotomy and tracheostomy . The latter, while not an irreversible surgical procedure, is intended to be permanent and therefore provides the suture of the margins of the stoma to the skin of the neck.

The other conditions are for elective tracheotomy for acute syndromes: large tumors of the head and neck, congenital tumors, branchial cysts , inflammation of acute head and neck, or severe maxillofacial trauma. In some cases, instead of the classic is better to perform a tracheotomy cricothyroidotomy or mini-tracheotomy.

Percutaneous tracheostomy
The intervention is a percutaneous tracheotomy surgical incision surgery which consists of the trachea to open an airway to the natural alternative. It is a modern variant of the classical technique, practiced in intensive care, directly at the bedside and has gradually replaced, in the ICU, the surgical technique. Use a dilatation and minimally invasive approach to create the stoma (opening). This procedure is reversible and is used in patients requiring prolonged artificial respiratory assistance. Different techniques of percutaneous tracheostomy have been proposed over the years and many of these are based on the original Ciaglia.

The different systems used to vary the type of instrument used to dilate the trachea and create the stoma (opening). The main methods are Ciaglia Blue Dolphin (using a balloon dilator) Blue Rhino (use a curved cone), PercuTwist (use a screw), Griggs and Fantoni. The newly created airway with a tracheotomy is intended to be temporary. PercuTwist frequent complication of the method is the fracture of tracheal rings, while the desaturation (decreased oxygen in the blood) can occur in the course of the method of Fantoni, due to its operational complexity. The indication for percutaneous tracheotomy is essentially the need to extend the artificial respiration in patients admitted to intensive care.