Emergency & Critical Care

We can’t define that only a certain type of patients require critical care, because many seriously injured & polytrauma patients, patients with a serious infection and after major operation also patients require to be monitored in critical care for a better outcome. Above all mentioned patients have high chances of multi-organ dysfunction syndrome. The patient whose internal organs are failing requires critical care to minimize the failure of one organ affecting the other organ, because, in our body, the brain, heart, lungs, kidney, and digestive systems are interconnected with each other.

Some scenarios include

1. Brain stroke and heart attack
2. Bacterial & viral ( COVID/ H1N1 ) pneumonia with respiratory failure
3. Complicated malaria, dengue hemorrhagic fever, typhoid fever & leptospirosis
4. Patients with Meningitis( infection involving brain ) with convulsions
5. Sepsis or septic shock because of complicated urinary tract infection, meningitis, or other infective etiology
6. Patient with complicated diabetic foot infection with sepsis
7. Poisoning cases like snake bite, OP (Organophosphate compound) poisoning, acid-alkali poisoning, aluminium phosphide poisoning …etc.
8. Major road traffic accident, trauma & polytrauma patients with multi-organ involvement
9. POST-OPERATIVE case of major surgeries like bypass (CABG) surgery, intra-abdominal surgery, neurosurgery for a brain tumor, spine surgery, haemorrhage, thoracic surgery, etc.
10. Any post-cardiac arrest patient to be observed in ICU only
11. High-risk surgeries of high-risk medical patients who have multiple medical ailments
12. High-risk pregnancy & post pregnancy critically ill patients
13. To administer advanced medicine like chemotherapy

The role of critical care specialists in the decision-making of such patients only comes after admission of the patient, but selecting an appropriate hospital is the first & foremost step in saving the life of such patients.

So one has to choose a hospital that has multiple super-specialty services (like cardiac, neurology & neurosurgery, gastro medicine & gastro surgery, orthopedic, vascular & pulmonology, etc..) available under one roof and have advanced instruments & technology to handle any critical situation at any time for better outcome of patients.

Q – What is the difference between normal care and critical care?

The difference between normal care and critical care depends upon the condition of the patient.
Some of the differences are as mentioned below-

1. During normal care, the vital parameters of the patients are monitored every 4 to 8 hours, while in critical care, these parameters are checked every second (continuous monitoring) by using modern equipment and trained staff.
2. In critical care, treatment is going on for multiple organs and patients are quite critical or serious, while in normal care, simple measures are going on which are the patients which got stabilized after a serious illness.
3. In normal care, treatment strategy once decided, usually is not changed, while in critical care, treatment strategy may change as per the condition of the patients.

Apart from treating critically ill patients at a separate place (in a critical care unit), another reason to treat them at such a place is to isolate them from other patients. Critical care patients are susceptible to develop secondary infections. To prevent contamination of the atmosphere of ICU, certain types of filters are kept and floors, sidewalls, and equipment are cleaned with medicated solutions to keep them sterile.

Q – Who is a critical care specialist and what is their role?

Till the decade of 1960, all critical care services were not available in one single unit. So in an emergency situation, doctors had to rush to the patients in the wards. ICUs were started to overcome these shortcomings over a period of time. In the modern era, having an ICU is a must for all hospitals. There are special staff and doctors for ICUs. Specialists in critical care are called Critical Care Specialists or Intensivist.

Different subspecialties also have evolved in critical care. In super speciality hospitals, there are dedicated ICUs developed to cater to different specialities, like:

1. Intensive Coronary Care Unit(ICCU)
2. Medical Intensive Care Unit(MICU)
3. Neuro Intensive Care Unit(NICU)
4. Surgical Intensive Care Unit(SICU)
5. Intensive Transplant Care Unit(ITCU)
6. Paediatric Intensive Care Unit(PICU)
7. Neonatal Intensive Care Unit(NICU)

Today the role of critical care specialists is not limited to ICU, their role is expanded in all aspects of patient’s management. Nowadays a doctor’s duties are not limited to the patient’s treatment part only but they are also involved in social & administrative responsibilities. So what are the duties/roles of a critical care specialist? After knowing the answer your thinking towards critical care specialist doctors will change and it must, because people are not aware of critical care specialist doctors like other specialty doctors.

We think there are multiple roles of critical care specialists as follows

1. As a Doctor
2. As an Administrator
3. As an Organizer
4. As an Adviser
5. As a Teacher & Student
6. As an Assistant

What kind of training do critical care specialists have?

Before answering this question, we all know that doctors in ICU will handle various kinds of problems that require various kinds of treatments which remain unpredictable in an ICU. So, all the doctors have gained primary training in their respective fields and after finishing this training, they go for additional critical care training.

Critical care is a super-specialty branch. After completing M.B.B.S, doctors perceive basic post-graduation degrees, and later on, doctors take training for critical care as a super-specialty. A majority of critical care experts are from internal medicine, anesthesiologist, or pulmonologist as a primary specialty. Later on according to the interest of individuals they perceive a 2-3 year fellowship in critical care.

The basic aim of a critical care specialist is to save lives and gradually normalize the function of various internal organs, therefore critical care experts should be thorough with every small thing of various organs like heart, lung, brain, kidney, and intestine, etc. Therefore, critical care experts take intense training for diagnosis and treatment.

The critical care field is like an ocean of knowledge.
Critical care is a constantly developing field so all critical care experts have to update their knowledge & skills regularly. Because of rapid development in the field of Information and Technology in the modern era, as compared to previous eras, critical care experts can update their knowledge more rapidly and in an accurate manner.

Most of the critical care treatment is given on the basis of EVIDENCE-BASED MEDICINE, which means any treatment given is on the basis of previous studies. It is difficult to treat the patient based on personal experience, for e.g. from various studies it is being proved that transfusion of blood is more hazardous than beneficial. So transfuse blood only if needed.