To get an idea of what is happening in the intensive care unit, let's try to answer a few questions.
Who is being treated in intensive care?
The majority of patients in the intensive care unit in our clinic are patients after surgery. With simple surgical procedures, monitoring is carried out from half an hour to several hours, and only after making sure that the patient is fully awake after anesthesia, such important indicators as blood pressure, pulse, breathing are stable, and pain is not bothering him, the issue of transfer to a hospital ward is resolved.
After more complex operations, for example, hip replacement or major surgery on the stomach or intestines, the patient is observed and treated in intensive care for about a day or longer, until the condition is fully stabilized and vital functions are restored.
The most severe category is patients with combined injuries, multiple fractures, or serious health problems requiring temporary replacement of the function of various organs and systems. For example, patients with extremely severe pneumonia undergo mechanical ventilation, and patients with impaired renal function require renal replacement therapy, hemodialysis, or other methods of extrarenal blood purification. Patients with extensive heart attacks are given medications that support heart function in very precise dosages using special infusion pumps.
What do they do in the intensive care unit?
Looking at the equipment of the intensive care unit, the question involuntarily arises: is all this equipment really used? For example, let's look at the situation with a patient after a serious car accident. Chest contusion, rib fracture, lung injury – artificial ventilation is required until the chest regains its former frame and the hematomas and hemorrhages disappear in the lungs after impact. Modern devices allow for very precise selection of ventilation modes in order to maintain the patient's independent breathing, rather than completely replacing it. This provides comfort to the patient and facilitates the transition to independent breathing.
To monitor the work of the heart, a heart monitor is used – a device that records a cardiogram in a preset mode, measures blood pressure, pulse, and saturation (the oxygen content in the blood is measured using a beam of light through a nail). If necessary, the depth of the patient's sleep can be measured when the so–called drug sedation is used - artificial sleep. The technique of measuring the depth of sleep is widely used in the operating rooms of the European Medical Center, which makes it possible to tell the patient with confidence that the fear of "waking up during surgery" is unfounded.
Sometimes patients experience chills after surgery. In these situations, a fan heater is used, which blows warm air over the patient, and the tremor quickly disappears.
Some patients cannot eat for several days after a complex operation on the intestines or stomach. In these cases, the first days of nutrition are carried out intravenously with amino acid solutions, which are administered at a certain precisely calculated rate. As soon as the meal is allowed, feeding begins through the probe, or the patient drinks special nutritional mixtures for postoperative feeding on his own. We can monitor the adequacy of nutrition based on a number of tests performed by our laboratory at any time of the day or night.
In case of severe kidney diseases, we perform hemodialysis or various types of filtration with an artificial kidney device. Temporary replacement of a function makes it possible for a diseased organ to restore it after a certain period. In the photo you can see a hemodialysis session in a patient with renal insufficiency.
In some operations, to relieve pain in the postoperative period, we perform epidural anesthesia, when an anesthetic is constantly injected through a thin catheter connected to the nerve roots in the spine. This allows the patient to move freely and comfortably endure the first difficult days after surgery.Thus, the capabilities of our intensive care unit make it possible to successfully treat patients with various serious illnesses, qualified anesthesiologists, intensive care specialists and nurses do everything necessary for a speedy recovery of the patient.
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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.
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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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