Glossary
A
Adrenalin / Noradrenalin
A drug that is administered by continuous flow infusion and whose function is to improve the work of the heart or increase blood pressure.
Enteral feeding / parenteral feeding
When patients can no longer eat by mouth (sedation, coma, swallowing problems, etc.) they can be fed through a tube placed in the stomach: the gastric tube (enteral feeding). Another possibility, if the digestive tract is not functional, is to pass food directly through the veins into the infusions (parenteral feeding). The food is administered in liquid form and covers all the patient’s needs.
Amnesia
Patients often do not remember all or part of their ICU stay. There are many causes of amnesia: amnesia-inducing drugs, severe infection, sleep disorders, confusion, etc. Allowing patients to understand what happened during the phases they forgot allows for a better psychological recovery.
Cardiac arrest
The heart circulates the blood in the body and allows the supply of oxygen to the cells of the different organs. When the heart stops, the oxygen supply is interrupted and the cells are rapidly destroyed. In a few minutes, the consequences can be irreversible. Thus, the speed of care (cardiac massage, ventilation) is essential to minimize the possible after-effects.
B
-
BMR : Multi-resistant bacteria
Bacteria that have developed a defense against several antibiotics. It is therefore more difficult to fight and it is extremely important to avoid its dissemination within the hospital: this is why it may be asked to respect certain precautions at the entrance of the patients’ rooms: the “isolation measures”.
C
Health care framework
The care managers are nurses with additional training. They manage the service in terms of logistics and personnel.
Catheter
Catheters are flexible, hollow tubes that are inserted into the patient’s veins or arteries. Catheters allow the administration of medication or the monitoring of pressures in the vessels. They are often necessary for the treatment of resuscitation patients. The insertion is performed sterile, under local anesthesia. Their maintenance requires sterile care.
Head of Clinic
Heads of clinics and hospital practitioners are doctors of medicine. They supervise the work of interns as well as the training of externs (or medical students).
Shock
Sudden and profound drop in blood pressure. Several types of shock can be distinguished: septic shock, linked to a serious infection; hemorrhagic shock, linked to a significant loss of blood; cardiogenic shock, linked to a malfunctioning heart; and finally anaphylactic shock, linked to a serious allergy.
Extracorporeal circulation, CEC or ECMO (ExtraCorporeal Membran Oxygenation)
There are two types of extracorporeal circulation: the first type aims to compensate for the major failure of the lungs alone: two large catheters (called cannulas) are placed in large venous trunks of the patient (often in the groin), the blood is sucked with a pump and passes through a membrane of oxygenation and decarboxylation (carbon dioxide is purified there) The second type of extracorporeal circulation aims to supplement the heart function via the pump, and if necessary, the lungs as well. The cannulas are then positioned, one in arterial and the other in venous.
Coma
Coma is an altered state of consciousness. It can be induced voluntarily by sedative drugs to allow the resting of certain organs and the management of pain: it is a form of general anesthesia. It can also be caused by certain pathologies or during an accident with head trauma. Coma impairs the patient’s ability to protect the crossroads between the airway (to the lungs) and the digestive tract (to the stomach), which is why it is necessary to intubate and place comatose patients on artificial respiration. A patient in a coma requires increased monitoring. It is not known what a coma patient hears, but it seems that the presence and voices of loved ones can in some cases be recognized, even if they have little or no memory of it later. The caregivers explain their actions to the patient and warn him/her before any physical contact. Verbal presence is beneficial to the patient and one should not hesitate to talk to the patient.
Confusion
It is also common for patients awake in the ICU to be a little confused and lost. This may be due to stress, infection, medication or fatigue. Age is also an important risk factor. It is advisable to regularly place them in space and time by reminding them where they are, the day and the time. News media (radio, TV) are often used to keep them aware of the passage of time in a closed environment where every day is the same.
D
Dialysis or Extra Renal Replacement Therapy (ERT)
A technique that consists of using a catheter, a filter (artificial kidney) and a pump to clean the blood of toxic waste that accumulates when the kidneys malfunction or in certain critical situations.
Dietitian
Dietitians are called upon to ensure that patients receive the nutritional intake they need.
Advance directives
Advance directives are a way to write down your wishes in advance in case you are unable to give your opinion. They can be written on plain paper, or use a pre-constructed form.
Organ donation
Organ donation is possible in France in certain circumstances, in particular after the diagnosis of brain death or after a decision to limit or stop treatment (the so-called Maastricht III legal framework).
Drain
A tube placed in the body to allow the removal of blood, air or secretions that could interfere with proper healing or organ function.
E
Ultrasound
Ultrasound is an external examination that explores the anatomy and functions of certain organs. The doctor applies a probe against the skin at the level of the organ he wishes to explore, this probe emits ultrasounds which pass through the tissues and are returned to him in the form of an echo. It is a quick and painless examination.
Escarre
Skin lesion due to bed rest. The bed rest and immobilization necessary for the safety of the resuscitation patient can have consequences related to the pressures that the skin undergoes at the level of the points of support and the rubbings. To prevent pressure sores, nurses and orderlies regularly massage the pressure points (back of the head, back, sacrum, elbows and heels) of patients and ensure that patients receive adequate nutritional intake. You can participate in the fight against pressure sores by giving light massages to your loved ones.
F
Fibroscopy
The principle of this examination is to explore the interior of the body with an endoscope introduced through a natural orifice. The endoscope or fiberscope is composed of a flexible tube a few millimeters in diameter into which an optical fiber is inserted. It has a light source at one end. Some use a mini-camera and are connected to a video screen. They can be equipped with tweezers to take samples for laboratory analysis. A control system allows you to direct yourself once inside the body.
Muscle depletion
Forced immobility leads to muscle wasting which can be impressive when hospitalization in the intensive care unit is prolonged. The recovery of autonomy will be all the longer, which is why physiotherapists and nurses intervene early to stop this phenomenon by mobilizing patients as soon as they are able to bear it.
G
Guard
At night, weekends and holidays, care continues in the intensive care unit: these time slots are called “on-call”. While there are generally as many nurses and orderlies during the day and night, during the week and on holidays, to ensure continuous care and monitoring, there are fewer doctors on call. The most serious patients and emergency situations are therefore given priority during these periods, and doctors are less available for interviews or the management of routine matters, which are more easily handled during the day.
H
Hypothermia
For certain pathologies, it is possible to place patients in hypothermia, that is to say to cool their body below 36 degrees, sometimes down to 34 degrees. This therapy is useful to protect brain cells.
I
Iatrogenic
Disorders caused by medical treatment or medication.
Nosocomial infections
These are infections contracted within the hospital. In intensive care, and despite the constant attention paid to hygiene, they affect on average 1 patient out of 5 because of their great fragility and invasive techniques.
Internal
Interns are young physicians who have passed the internship competition (at the end of the 6th year of study). They are authorized to prescribe under the responsibility of the head of the clinic. They are very present in the units and will be your first contacts.
Intubation
Medical procedure consisting of placing a tube, through the mouth or nose, in the trachea of an anesthetized patient in order to ventilate him or her (supply of oxygen to help the patient breathe). Extubation: removal of this probe.
Isolation
Among the many hygienic measures taken in the hospital, isolation may be decided. It is either the protection of the most fragile patients against the germs naturally present in each of us, or the protection of visitors and other patients against multi-resistant bacteria (MRB). Specific actions to be taken are usually indicated on the door of the room.
K
Physiotherapist
Physiotherapists have a major role in resuscitation. They spend time with patients on a daily basis to maintain joint flexibility and work the muscles. Their role is also very important in the weaning of artificial respiration and the rehabilitation of all muscles.
L
Limiting and stopping treatment
When a patient will not benefit from certain treatments, or no longer benefits from the treatments that have been put in place, and in order to minimize the discomfort, pain and anguish they cause, these treatments may not be started or may be discontinued. Since 2004, and more recently in 2016, the Léonetti and Claeys-Leonetti laws have framed what are called “treatment limitation and cessation” (TLC) decisions. These decisions are made in consultation with the entire health care team and an outside consultant, taking into account the patient’s expressed wishes and informing the patient’s family and friends. These decisions are re-evaluated every day according to the evolution of the patient’s condition. Discontinuing certain life-sustaining treatments can accelerate the dying process. If necessary, the health care teams set up palliative care and, since 2016, French law has authorized “deep and continuous sedation until death”, thus allowing the end of life to be as comfortable as possible for the patients concerned.
Oxygen goggles
Hose that allows to bring additional oxygen to the nostrils in case the oxygen present in the air is not enough for the patient. When these are not sufficient, a mask, a mask with reservoir or more intensive therapies such as NIV (non-invasive ventilation) or artificial ventilation via an intubation tube can be used.
M
Monitor or Scope
A monitor (or “scope”) continuously records the heart and breathing rate, blood pressure and oxygen saturation in the blood. These data are collected using sensors and electrodes connected to the scope by cables. The monitors are configured to alert caregivers if the patient’s condition is unstable. These monitors are also connected to central monitoring stations so that the patient’s condition remains monitored at all times, even when the caregiver is out of the room.
Brain death or encephalic death
Brain death is not coma. It is an irreversible condition where a crucial part of the brain is destroyed without the possibility of recovery. In resuscitation, patients may go into brain death while still hooked up to machines that maintain the appearance of life: a ventilator that raises the chest, extracorporeal circulation that circulates blood, adrenaline or norepinephrine that maintains heart activity and blood pressure. The diagnosis of encephalic death is based on precise and specific criteria. Once this diagnosis is made, the death certificate is signed by the physician. Even if machines can maintain the appearance of life in the body for some time, the functions of a body whose brain is destroyed become very unstable very quickly and it is not possible to maintain things for very long. Brain death may allow for organ donation.
O
Unreasonable Obstinacy (or Therapeutic Overkill)
During the stay in the intensive care unit, the evolution of the patient’s state of health may lead to questions about the appropriateness of the treatments in progress. The absence of expected benefit despite heavy and sometimes aggressive care for the patient may lead to limiting the use of certain treatments or interrupting others, or even to limiting treatment to ensure comfort. Indeed, in France, unreasonable obstinacy is prohibited by law. Since 2004, and more recently in 2016, the Léonetti and Claeys-Leonetti laws have framed what are called “treatment limitation and cessation” (TLC) decisions. These decisions are made in consultation with the entire health care team and an outside consultant, taking into account the patient’s expressed wishes and informing the patient’s family and friends. These decisions are re-evaluated every day according to the evolution of the patient’s condition.
Oedema
To administer the medications, they are diluted in water-based solutions so as not to irritate the veins. Thus, every day, patients receive large amounts of fluids, and despite treatments to promote elimination, it is extremely common for resuscitation patients to experience edema. The limbs swell, especially the hands. In some cases, these swellings are generalized to the whole body, including the face, and then disappear. Patients are weighed regularly and when necessary, this can be accelerated.
P
Palliative care
Palliative care is the care that is implemented to relieve certain symptoms in order to allow the patient to live as comfortably as possible. Often opposed to curative care in the media discourse, it is in fact useful care to be carried out from the acute phase in parallel with curative care (i.e. care aimed directly at healing). At the end of life, or in the absence of a curative project, all care will focus on this care in order to offer the patient the most comfortable last moments possible. As the saying goes, it’s “all that’s left to do when there’s nothing left to do”.
Person of trust
This is a person of legal age, designated by the patient in advance (family member, friend, neighbor, attending physician, etc.) to receive medical information and report the patient’s wishes if he or she is unable to express his or her wishes. It is important that this person be able to have in-depth discussions with the patient in order to best carry out the patient’s wishes, since he or she will be speaking on behalf of the patient and not in a personal capacity. This designation is forensic and must be made in writing, on plain paper or on the form provided by the service. The designation document must include the contact information for the support person and the signature of both the patient and the designated support person. The trusted support person may have a copy of the advance directive to use when appropriate. The designation of the trusted support person can be reviewed and revoked at any time.
Infusion pump or syringe pump
An infusion pump (or syringe pump) is a device that injects medications and fluids into veins, often through a catheter inserted into a large vein.
Prescription
Prescriptions are constantly updated by the doctors in charge of the patient, in the morning after having read the latest test results and throughout the day, according to the evolution of vital parameters (pulse, blood pressure, oxygen saturation) and the evolution of the patient’s condition.
R
Search
In order to advance scientific knowledge and improve care techniques, intensive care units are very active in scientific research. The data collected during the patient’s hospitalization may be used secondarily in an anonymous manner for evaluation and research purposes. In addition, the consent of the patient himself or herself or of the relatives may be requested to conduct comparative studies between different types of treatment or care. For this, a consent form will be communicated to the patient if he/she is able to read and understand it, or to his/her relatives, and must be signed. This form details the terms of the study proposed to the patient or his or her family. Of course, the patient or his or her relatives are free to refuse and this will not change the care or the relationship with the health care team.
Resuscitation
A care service for the most seriously ill patients in the hospital or those at risk of worsening. Resuscitation also refers to the technical and medical care given to these critically ill patients in order to replace organs that have become ineffective due to the acute illness while the body “passes the point” of the acute phase. Resuscitation cannot be continued for very long because the equilibrium it maintains is very unstable and fragile.
S
Scanner
A CT scan, also called a CAT scan, is an X-ray examination. The principle consists in making images in thin sections of a part of the body. The X-ray tube rotates around the patient’s body and images are obtained by computer. It is then necessary to ‘read’ them to allow a diagnosis. Frequently, an iodine-based contrast medium is used to improve their quality, it is usually injected by infusion.
Sedation (Artificial coma or general anesthesia)
Administration of drugs to “put the patient to sleep”, to put him into an artificial coma. This is done in several indications: to put one or more organs at rest, to avoid pain during an invasive procedure (unpleasant gesture, or surgical operation), to allow patients to better tolerate the respirator.
Intubation probe
The breathing and therefore the life of your loved one depends on it. It goes through the mouth and is usually attached with a cord that surrounds the patient’s head. This often hollows out the cheeks and slightly alters the face. This can be a bit overwhelming.
Gastric tube
A gastric tube (or feeding tube) helps to feed the patient during his or her stay in the ICU. The patient receives a balanced diet through this tube, with adapted quantities of carbohydrates, proteins, lipids, vitamins and minerals. A stomach tube can be inserted into the esophagus and stomach through the nose or mouth. Sometimes a gastrostomy tube can be inserted directly into the small intestine through a small surgical procedure.
Urinary catheter
This is a plastic tube that drains urine from the bladder. These probes are essential when patients are unconscious. The urinary catheter makes it easier for caregivers to monitor kidney function.
T
Tracheotomy
A small procedure that consists of placing a breathing tube in the trachea through an incision at the base of the neck. It is performed to facilitate and accelerate the recovery of respiratory autonomy when the process is too long and/or uncomfortable for the patient. In most cases, this tracheostomy is then removed and the orifice heals spontaneously.
Transport
Moving a patient to another department of the hospital for an examination or surgery. During this transport, the continuity of care and monitoring continues. It is a delicate act requiring special logistics and medical support.
V
Ventilator or Respirator
The respirator is a machine that allows the administration of a gas mixture adapted to the patient’s needs by controlling the volume and frequency. This maintains a stable and sufficient oxygen content in the patients’ blood and removes carbon dioxide. The ventilator assists respiratory function in the event of lung and/or heart failure, but it is also used when the patient is in a coma to protect the patient’s lungs from infection. For this, the patient will be connected to the ventilator through the intubation tube placed in his trachea. The placement of this probe is always done under anesthesia.
Non-invasive ventilation (NIV)
Non-invasive ventilation is an alternative method to intubation in some specific cases. It is performed with a respirator that blows air in the same way as with a probe but through a mask placed tightly over the face.
