In short, Sklifosovsky: how urgent medical care is provided in the capital
The word "cliff", which has long become a household name, is associated with the phrase "urgent life saving." Every day, hundreds of injured people and those in need of urgent medical care are brought to the Moscow hospital of the N.V. Sklifosovsky Research Institute of Joint Venture. Izvestia studied the work of Sklifa on the spot.
"There can be no leakage of patient data"
Hospitalization at Skliff has been taking place for two years in the flagship building, a state-of-the-art hospital with high-tech equipment and qualified staff. It has 90 beds, and anyone in need can be brought here — from a passerby with a heart attack to a victim of a serious accident or terrorist attack. According to official statistics, more than half of those admitted are patients of surgeons. 41% have various injuries, and 22% are in need of narrow—profile surgical procedures, which are performed in nine operating rooms, in two of them I can simultaneously perform various operations.
The center works around the clock, because people get injured and sick outside of schedule. In electronic form, medical staff receives information from colleagues from the ambulance on tablets and immediately figures out which team to prepare, whether urgent hospitalization is needed in the shock intensive care unit or only in the examination room, etc.
— Sometimes three patients are brought to us in three different cars at once, and we accept them because we have time to prepare. In general, everyone here is ready for anything," says Alexander Kondrashkin, Deputy Chief Physician for Internal Quality Control of Medical Care at the N.V. Sklifosovsky Research Institute of Joint Venture.
At the counter are a worried woman and a man whose elderly mother was brought here an hour ago in serious condition. She was found lying on the floor in the apartment, and there was a strong smell of medicine in the air. What caused the patient's loss of consciousness will become clear later. While the relatives are explaining that she is at the doctors, they will soon examine her and tell them what happened, and they must wait either here or at home. "But nothing has happened yet, right? They're not hiding anything from us, are they? I'll call at noon, then," the woman asks the nurse for the 10th time. She patiently answers the same question. Doctors really work very quickly, they don't write anything into a paper card with a pen — everything is entered into a computer program. They say that information about patients' illnesses is reliably protected.
— Indeed, it is necessary to go beyond the threshold of the "Cliff" with a tablet where the patient's data is entered, and it becomes impossible to enter this program — information about a person's illness is blocked, and there can be no leakage of patient data, — says Alexander Kondrashkin.
"They're cutting sausage, but we're operating"
The ultrasound operator looks closely at the monitor and moves the sensor over the abdomen of an elderly patient, Alexandra Sergeevna, who had a hernia at night. A smooth ball the thickness of a primary school student's fist stands out on his abdomen, which is dotted with mottled markings, and fluid accumulates in the abdominal tissues. Operative surgery is needed here. "What did you put up with so much, Alexandra Sergeevna?" — there is a slight reproach and suppressed concern in the doctor's voice. "Well, why bother anyone? I used to anoint her earlier, and she'd let go. And then I got sick, and at night, that's what to do? I had to call the doctor," the woman says, watching the new doctor, who has been studying the contents of her stomach for two minutes from the screen. "Yes, here is the umbilical hernia, here we see the accumulation of excess fluid in the abdominal cavity, here it is, and here is the weak umbilical ring, and the anterior abdominal wall. Yes... Everything is not very good," the doctor carefully examines the image of the insides on the screen. "What now? Will you cut it?" the woman asks. "Sausage is usually cut. And we will operate on you. By the way, the operation was needed yesterday," the doctor says and gestures to explain to the young sister how to prepare the patient.
Unlike Alexandra Sergeevna, 33-year-old Pavel, a slim, short guy in a black tracksuit and sneakers, has been waiting for a lung transplant operation for the last three years. At about nine in the morning, he was brought to the emergency room of the flagship center by ambulance, and doctors are currently treating him. "I waited in line, I waited, I hope they will do everything. I talked to everyone, it seemed to have calmed down," he tells us through a mask, which he holds to his face with his left hand. While he is being prepared for surgery, tests are being taken, and he is being taken for a CT scan, he is almost never alone, surrounded by young nurses and nurses.
The age of the junior medical staff is no more than 30 years, which is understandable. The work is stressful, associated with people, the psyche of a young employee recovers faster after a shift. Beautiful young people meet patients in the emergency room, escort them to the diagnostic room, do CT, MRI and other necessary manipulations, and take care of patients in shock intensive care units. Many of them, like Alexandra Nogotkova, a senior nurse at the diagnostic department of the N.V. Sklifosovsky Research Institute of Joint Venture Medicine, who has been working here since her studies at Medical School No. 8, began their career as students. Alexandra has a five-day working week, she spends the nights at home, but the girl at the counter works all day, she took over early in the morning. She says that the nights at the doctors are different. For example, the previous one was relatively calm, "only three people were hospitalized, and sometimes 10 are brought in."
In general, the influx of patients is an unpredictable business. It is believed that the peak falls in the evening hours, in the morning there is a relative lull, although there is no day to day. For example, before nine-thirty in the morning, only a woman with signs of stroke was brought in, but by the time we got to know technology for an hour, talked with patients and relatives, and returned to the diagnostic department again, half of the beds were already empty, five were occupied by patients: two women of retirement age and three men, one of whom was brought by helicopter from accident sites in case of collision with a truck.
"Patients are diagnosed fairly quickly thanks to modern technology," says Laila Khamidova, head of the Scientific Department of Radiation Diagnostics at the N.V. Sklifosovsky Research Institute of Joint Venture.
Head of the Department of Radiation Diagnostics, MD Laila Khamidova in the emergency department at the N. V. Sklifosovsky Research Institute of Emergency Medicine
Doctors have seen enough of broken, broken, suffocating, burned people and are no longer surprised by anything, they just treat what is happening without unnecessary negative emotions, and those who cannot cope with them are forced to change their occupation. But those who stayed know exactly how to save people without any instructions, and they are used to overloads. For example, during the pandemic, doctors were on duty around the clock outside of schedule, and when the terrorists attacked Crocus, no one left work.
— Moreover, I saw among my colleagues those whose shift had ended a long time ago. They heard about the incident on the radio, turned their cars around and returned to work. There were hundreds of patients, and all the surgeons were working. At such moments, you can see who came to the profession by vocation," says Alexander Kondrashkin, Deputy Chief Physician for Internal Quality Control of Medical Care at the N.V. Sklifosovsky Research Institute of Joint Venture.
"We have 12 beds, but there are usually 16 beds"
Alexander Shakotko is an anesthesiologist and intensive care physician. He looks like a kind giant with a shaggy red beard and the same head. He has been working here since 2003, started as a volunteer and an orderly, and in recent years has been the head of the General intensive care unit. In addition to managing staff, he has the skills to communicate in extreme situations with relatives of patients. Now there are 12 patients, as usual, lying on beds along the windows of a huge room with high ceilings.
Head of the Intensive Care Unit and Intensive Care Unit, Anesthesiologist-Intensive Care Unit Alexander Shakotko at the Intensive Care Unit and Intensive Care Unit at the N. V. Sklifosovsky Research Institute of Emergency Medicine
This intensive care unit in Sklifa is not the only one, there are more than a dozen of them. Among others, there is a shock intensive care unit, or, as it is called here, a shock room, where all primary patients with serious and very serious injuries enter. An initial reception is held in the shock room. Doctors diagnose a patient in half an hour, keep a protocol, and then decide whether to send him to the operating room or to the intensive care unit.
— We are conducting a step-by-step process for all those who have been decided to be brought to our floor. We do everything to stabilize them, treat them or prepare them for the next stage of surgery, fill in protein-analytical deficiencies, fight sepsis, etc. We joke that there are 12 beds in our intensive care unit, but there are always 16 patients. This is only partly a joke: we work with overload at any time of the year, and this is normal. We have all the beds occupied now, which may seem like a lot to you, but you haven't seen what we were involved in during Covid. We entered it, we survived it and acquired such immunity," Alexander Shakotko, head of the Intensive Care Unit at the N.V. Sklifosovsky Research Institute of Joint Venture, says in a calm voice, on one note and quite quickly. This person knows his subject very well. Without interrupting the conversation, he approaches the patients, jokes with some of them, covers them with a blanket.
Here is a bed on which a middle-aged man has been lying for the third month, in an accident he broke his spine and both legs. Here is his neighbor, a climber who was brought here from Elbrus, he fell unsuccessfully and hit the rocks, and now he is looking at the ceiling, both of his knees are "looking" at the same place. Both patients are conscious, responding to external stimuli, and doctors are talking about their speedy rehabilitation.
Their roommate with a stroke has only been here for a day, and her condition is unstable. Two young doctors call out her name and ask her to take their hand, but in vain. Here's a pretty young woman with smooth, polished skin and fashionably inflated lips. After cosmetic injections, her breathing and heartbeat stopped, and although she revived with the help of Sklifa doctors, she is unlikely to return to normal life, "she will remain in a vegetative state," says the head of the department.
Patients like her are rare here, and scooters and people knocked down by them, as well as cyclists, are much more likely to get here. But there are a lot fewer bikers. All these injuries are seasonal, and there are a lot of them from April to October. In the fall, according to Shakotko, it's usually time for other exacerbations, psychological ones. Then people who have made an unsuccessful suicide attempt appear in the department. Of course, they are also being rescued. Because saving people is the main and only purpose of the work here.
Переведено сервисом «Яндекс Переводчик»
