Reanimatologist anesthetist

The department in which the anesthesiologist-resuscitator works, can be called differently: the resuscitation-anesthesiology department (RAO), the department of resuscitation and intensive care (ICU), the intensive care unit (BIT). Despite the variety of names, due largely to historical reasons, the essence of the work does not change. In order to maintain qualifications, rotation is organized: the doctor alternates between work in resuscitation posts and in the operating unit. In addition, anesthetic changes help to temporarily reduce mental stress after working in intensive care, since only relatively stable (non-dying) patients with a favorable prognosis are usually allowed to perform planned surgery.

In large medical institutions, specialization of departments or posts is possible: "general resuscitation", toxicological, cardiological, etc. Departments of anesthesiology can also be divided according to the profile of the operations performed (general, cardiac surgery, transplantation).

The work of the resuscitator

As a resuscitator, the doctor works at the ICU posts along with medical anesthetists and support staff (nursing nurses, nurses, etc.). The post is a spacious bright room with the necessary tracking equipment and the distribution of medical gases. For every 2-3 resuscitation beds, a round-the-clock post of anesthetic nurse is created. For every 6 beds (i.e., two nursing posts), a post of an anesthetist-resuscitator is allocated. Basically, the work of an on-site resuscitator is as follows:

• Assessment of vital functions of patients in the intensive care unit, as well as counseling for doctors from other departments
• Airway management ( intubation , mechanical ventilation )
• Continuous monitoring of hemodynamics and cardiac activity:
  • Management of blood pressure and vascular tone ( antihypertensive therapy or vice versa - the introduction of vasopressors )
  • Heart rate monitoring, ECG monitoring. Conducting electrical pulse therapy : defibrillation , cardioversion temporary pacemaker
• Prescribing drugs and infusion media , calculating doses, providing access for their administration
• Monitoring the functioning of the body's excretory systems ( diuresis , defecation ), as well as replacing the lost kidney and liver function by methods of efferent therapy (for example, hemofiltration and hemosorption )
• Performing extended cardiopulmonary resuscitation ( ACLS ) according to indications

Due to the severity of the patient’s condition, the ICU monitors the volume and nature of all substances entering the patient and excreted by him, including gas exchange ( CO ₂ and O ₂ ) and the color of feces, urine. In children's and neonatal wards, control is more stringent. Nursing staff ( anesthetist nurse ) installs peripheral venous catheters , urinary catheters , performs the appointment of a resuscitator and, together with the junior medical staff ( nurse ), provides patient care. An ICU doctor organizes difficult access for administering drugs, and establishes the work of bedside monitoring and life support systems. The main medical manipulations:

• Catheterization of the central vein (right atrium) for convenient administration of drugs and parenteral nutrition
• Artery catheterization for blood gas analysis ( KShchS ) and carrying out invasive monitoring of hemodynamics
• Tracheal intubation , respiratory equipment tuning
• Installation of an epidural catheter for long-term pain relief
• Performing a lumbar puncture at the request of neurologists
• Cavity drainage with surgical staff

Resuscitation departments are often not specialized and accept patients with any pathology. Since the A&R doctor cannot replace all other narrow specialists, treatment is agreed with consultants - as a rule, with the head of the specialized department to which the patient will be transferred with a favorable course of treatment (patients from ICU are not discharged). Since patients hospitalized in the ICU are more likely to die, the management tactics are consistent and arranged in the form of a consultation, with the participation of the administration of the medical institution.

The work of an anesthetist

Unlike the resuscitator, the anesthesiologist spends a significant part of his working time outside his own department. In the morning, the anesthesiologist works in the operating room together with an anesthetist nurse, where he provides anesthetic benefits, monitors the patient and the progress of the operation. After the end of the day, the doctor goes to the surgical department to examine the planned patients for tomorrow.

The workplace of the anesthetist is organized at the head of the operating table. The necessary equipment is concentrated there: a table for record keeping, a chair and an apparatus for inhalation anesthesia . This zone is usually non-sterile. The main work of the anesthetist is as follows:

• While the surgeon determines the indications for the operation, the anesthesiologist determines the contraindications to it, thereby allowing the patient to undergo surgery
• On the eve of the operation: examination of the patient, examination of the medical record and examination data, correction of drug prescriptions, prescribing
• Choosing the safest method of anesthesia ( Eng. Anesthesia # Techniques ), taking into account the age, health status of the patient, as well as the intended operation and composition of the operating team (operating surgeon)
• Ensuring the vital activity of the patient during the operation (actually the work of the resuscitator)
• Postoperative follow-up of the patient, if required (return of the patient to the surgical department or transfer to the wake-up room or ICU )

Contrary to a common misconception, the patient’s vitality during surgery is not the responsibility of the operating surgeon. From the moment of peripheral vein catheterization to the complete awakening of the patient, with the technically correctly performed surgical intervention, the responsibility for the patient’s life lies with the anesthetist.

Who the Reanimatologist is not An

• An A&R doctor doesn’t “inject a vein to fall asleep” - he does not perform routine nursing procedures
• Does not establish a diagnosis - this is done by the attending physician
• Does not provide psychological counseling to patients and their relatives
• The work of an A&R doctor can be performed by a person of any gender and age, provided that the necessary manual skills and theoretical training are available

• Intensive Care Unit
• Anesthesiology (science)
• Resuscitation (science)

• Who is who in medicine. Resuscitation anesthetist / Newslab, 01/10/2010
• Who is he - an anesthetist-resuscitator? - Radio Liberty, 2005
• Fundamentals of Anesthesiology and Intensive Care - GBOU SPO SK "Kislovodsk Medical College"