Intensive care patients are patients with serious illnesses and injuries after complex surgical procedures and anesthesia. And if most of us know what happens in hospital rooms, then intensive care and intensive care are usually always closed to prying eyes. Visits to the intensive care unit are usually prohibited. However, any of us is sure that when a person is in critical condition, it is very important to have a loved one nearby.
The head of the Intensive care Unit (ICU) tells about visiting patients with relatives and friends EMC Elena Aleshchenko:
Why visit ICU patients?
In fact, a patient in the ICU rarely needs the presence of relatives. But for many people, it is very important to make sure that everything is okay with a loved one, to be with them for at least a minute, and we understand this perfectly well. After anesthesia and surgery, the patient does not need additional care from relatives: he is fully provided by the medical staff of the department. Moreover, most people cannot always adequately perceive the appearance of a loved one who is connected via wires and "tubes" to devices and monitors, and nurses are constantly scurrying around him.
It should be understood that a person who wants to visit a patient in the ICU must be prepared. Before allowing a visit, we talk in detail with relatives so that they correctly perceive everything that is happening with their loved one - of course, they have questions. Admittedly, we manage to find a common language with most of the visitors. Then, being in the ICU, they do not interfere with the treatment process. But in fact, the best time to see your loved ones is when the patient is close to recovery and ready to be transferred to a hospital.
However, relatives should keep in mind that the most important thing for us is the patient's opinion about visits to both the ICU and the hospital. We also follow the patient's wishes about who can be provided with information about his health status, which are recorded in the inpatient's medical record.
How should visits to the NICU be organized?
Intensive care is a department where there is a special sanitary and epidemiological regime dictated primarily by the interests of patients. We do not allow you to enter the department in outerwear and outdoor shoes. We will ask you to change into disposable shoe covers and a bathrobe.
When is the best time to go to the ICU?
Of course, all visits to the ICU must be coordinated with the doctors and the head of the department, and, of course, the main thing is the patient's desire. Intensive therapy is also a treatment, but it is many times more active, in simple terms, and it is aimed at restoring vital functions (respiration, blood circulation, metabolism) disrupted as a result of surgery, anesthesia, trauma, or serious illness. There is a lot of sophisticated equipment that monitors the condition of individual organs and systems and supports the vital functions of the body. In addition, we have a lot of invasive procedures, so the doctor will tell you the most convenient time to visit the patient. We are always in touch with the relatives and friends of our patients.
How much time can a visitor spend in the ICU?
If you visit someone in the ICU, you need to understand that not only your relative is here, but also other patients. Everything that happens here with the patient takes place in the presence of many people - the medical staff and the patients themselves, so you need to be prepared for the fact that you will witness not only medical events, but also meals, hygiene procedures, and toilets. In our department, it is possible to mark the area around the patient's bed with a screen, which allows you to create some personal space. However, this restricts free access to the patient and may prevent medical staff from providing the necessary care, so we set the number of visitors in advance and ask you not to stay too long in the department.
How long can a patient stay in the ICU?
The more severe the patient's condition, the longer he stays in the ICU. We need a certain period of observation, monitoring of vital signs, round-the-clock medical and nursing posts.
For simple surgical procedures, we monitor the patient from one to several hours, for large operations - a day or more, and transfer him to the hospital only after complete stabilization of the function of organs and systems. If the patient's condition requires intensive therapy and replacement of vital functions, he remains in the ICU until full recovery. It can be a lengthy process. But we explain to the patient (as much as possible) and his relatives that there is no need to force events, there is no need to rush back to the hospital, because intensive care is carried out in the ICU. We need to make sure that nothing threatens our lives.
The ideal situation
There is no "Do not enter" or "No trespassing" sign on the doors of our department and there never will be. The doors of all branches in the EMC are open to visitors (except for the operating unit, which is sterile). However, we ask you to adhere to the time of visits or coordinate your visits with the doctors of our department. After all, we have one goal – to help sick people in a critical situation. It's not easy, let's try to combine and coordinate our efforts.
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Questions and answers
Lump in my breast
I have noted the lump in my breast periodically appeared following breastfeeding my first child (as a result of plugged duct). I did an ultrasound, but it revealed nothing, as if everything was normal. I knead my breast periodically and feel pain at those moments. Now I am pregnant, due date is on 20th. What should I
do?? When to examine my breasts, is it possible to perform the examination during pregnancy and lactation?
...more The "lump" in the breast cannot occur after feeding, even if it was the plugged duct. You should not "knead" the breasts. If there is a problem or even if you think it is – the breast should be examined. Pregnancy and breastfeeding are not contraindications for this. Under normal conditions for pregnant women we
recommend a breast examination during 1 and 3 trimester (before childbirth). There are no contraindications for breast examination in your case. You are welcome at any convenient time for examination and advice on breastfeeding.
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Benign disease
I have a benign lump in one breast size of 12.0*9.9 mm. Puncture or a biopsy will be done next week. I was told by mammologist that surgery is needed. As far as I know, concerning the surgery, axillary lymph nodes are to be removed together with the tumor. I also know that in Europe lymph nodes are testes for
specific markers and only affected ones should be removed; if lymph nodes are no affected, they are not to be dissected and the surgery is minimally invasive. So what is your approach? Does it make sense to do it or you have the same methods and the same equipment?
...more If histological examination of the sample reveals fibroadenoma of basic type or tissue hyperplasia without atypia, or nodular type fibrocystic condition of the breast tissue, the question of surgical treatment should not arise. If biopsy reveals giant fibroadenoma sectoral resection is indicated, i.e. mass excision
within the healthy tissues and lymph nodes will be removed. In case of non- benign histological result, i.e. carcinoma is detected, subsequent immunohistochemical examination is required as well as a clinical oncologist and surgeon consultation; and the decision on complex treatment will be taken by case management team. With regard to the diagnosis and treatment methods in our center, each case is addressed individually. Sometimes we remove a benign area (for example, the area of hyperplasia with atypia) using the vacuum-needle technique through 3-4 mm incision. As for the surgical procedure protocols for benign breast tumors, benign simple fibroadenoma is not removed in America, Europe, Israel, etc. I would like to discuss your case with you in more details and perform some additional tests if needed, so I would be glad to see you at EMC’s Breast center.
...more
Melanoma
My mom had a mole (suspected for melanoma) removed in November 2015. Histology revealed lentigo melanoma in situ. We checked the slides back in the Netherlands, and the diagnosis was a superficial spreading melanoma of Clark 3 Т1а Beslow 0,8 stage; re-excision with capture of 1 cm of healthy skin is recommended. Is
it possible to make re-excision and subsequent histology in your hospital? If so, how soon?
...more We absolutely agree with the opinion of the European colleagues: re-excision with a wider offset is required; according to the Russian Protocol it is necessary to move 2 cm from the peripheral edge. This is for counter insurance, as lentigo-melanoma is a favorable type, and previous surgery is likely to put an end to
this story and the forecast is favorable. All the necessary manipulations for the study are possible in our Clinic; we have our own well-equipped laboratory with the possibility to ask the advice concerning the sample in Germany and Israel.
You should make an appointment with the surgeon-oncologist (Marina Bissessar) in the nearest time to conduct the diagnostic re-excision. Hope to help!
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A spot on the back and chest
I have a spot on the back and chest, what could it be?
A spot on the skin is one of the most common symptoms of various skin diseases. Infectious (viral, bacterial or fungal) as well as noninfectious skin including serious diseases and nevi (moles or birthmarks) can manifest as spots on the skin. You should go to the dermatologist for accurate diagnosis. The doctor will
examine you and, if necessary, a special instrument (Dermatoscope, wood lamp) will be used. A skin scraping can also be done in the lesion for microscopy, cytology or culture. A treatment will be prescribed after diagnosis.
...more 
Batkaeva Nadezhda
07 September 2016
Uterine cancer
My mom was diagnosed with the uterine cancer. She is 68 years of age and has an obesity of 4th grade (the growth of 166 cm, weight 135 kg) and hypertension. Admission to the radiology department was recommended. What should we do? As far as I know the surgery is the only method for cancer of the uterus to be removed.
Is it really so that this surgery is only possible for young and relatively healthy persons?
...more It is not quite so. We can operate on any patient, but the issue is which complications can lead to patient’s death and which of them can just delay the recovery. From the anesthesiologist’s point of view, it is a major challenge to intubate patients with 4th degree obesity; the abdominal section is also possible,
but there is a 100% risk of suture line disruption and inflammation, let alone the postoperative pneumonia, venous thrombosis, etc. There is another option such as vaginal hysterectomy which is more acceptable and relatively safe in obese patients. It is not a «treatment standard», however, as it allows not obtaining pelvic washings, but still there is a possibility of complete cure. Anesthesia remains a problem - both general and spinal. Radiation therapy without surgery is another acceptable treatment option besides vaginal hysterectomy. A chance of complete cure is still exists, but the survival rate is on average lower than in surgical treatment
...more 
Vladimir Nosov
07 September 2016
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