For example, a change in the patient's condition over time. Stable serious condition in intensive care: what does it mean? Conditions requiring resuscitation

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The severity of the condition of the victims (TSP), unified criteria. It is necessary to distinguish between "severity of TBI" and "severity of the victim's condition". The concept of the severity of the condition of the victims, although it is largely derived from the concept of "injury severity", is nevertheless much more dynamic than the latter. Within each clinical form of TBI, depending on the period and direction of its course, conditions of varying severity can be observed.

The assessment of the severity of the injury and the assessment of the severity of the condition of the victims coincide in most cases upon admission of the patient. But situations are often possible when these estimates diverge. For example, with subacute development of a shell hematoma against a background of a slight bruise of the brain; with moderate or even severe brain contusions, with depressed fractures, when the “silent” zones of the hemispheres selectively suffer, etc.

The severity of the condition of the victims is a reflection of the severity of the injury at the moment; it may or may not correspond to the morphological substrate of the brain injury. At the same time, an objective assessment of the severity of the condition of victims upon admission is the first and most important stage in diagnosing a specific clinical form of TBI, which significantly affects the correct sorting of victims, treatment tactics and prognosis (not only in terms of survival, but also recovery). The role of the evaluation of the TSP is similar in the further observation of the victim.

Assessment of the severity of the condition of victims in the acute period of TBI, including the prognosis for both life and recovery, can be complete only when using at least three terms, namely the condition:

1. consciousness,
2. vital functions,
3. focal neurological functions.

The following 5 gradations of the state of patients with TBI are distinguished:

1. satisfactory,
2. moderate,
3. heavy
4. extremely heavy
5. terminal.

Satisfactory condition.

Criteria:

1. clear consciousness;
2. lack of violations of vital functions;
3. absence of secondary (dislocation) neurological symptoms; absence or mild severity of primary hemispheric and craniobasal symptoms (for example, motor disorders do not reach the degree of paresis).

When qualifying the condition as satisfactory, it is permissible to take into account, along with objective indicators, the complaints of the victim. There is no threat to life (with adequate treatment); the prognosis for recovery is usually good.

Moderate condition.

1. state of consciousness - clear or moderate stunning;
2. vital functions are not impaired (only bradycardia is possible),
3. focal symptoms - certain hemispheric and craniobasal symptoms can be expressed, which are more often selective: mono- or hemiparesis of the extremities; insufficiency from individual cranial nerves; decreased vision in one eye, sensory or motor aphasia, etc.). There may be single stem symptoms (spontaneous nystagmus, etc.).

To state a state of moderate severity, it is sufficient to have the indicated violations in at least one of the parameters. For example, the detection of moderate stunning in the absence of severe focal symptoms is sufficient to determine the patient's condition as moderate. When qualifying the patient's condition as moderate, along with the objective, it is permissible to take into account the severity of subjective signs (primarily headache).

The threat to life (with adequate treatment) is insignificant: the prognosis for recovery is often favorable.

Severe condition.

Criteria (limits of violations for each parameter are given):

1. state of consciousness - deep stupor or stupor;
2. vital functions - violated, mostly moderately in 1-2 indicators;
3. focal symptoms:

• stem - moderately expressed (anisocoria, decreased pupillary reactions, upward gaze restriction, homolateral pyramidal insufficiency, dissociation of meningeal symptoms along the axis of the body, etc.);
• hemispheric and craniobasal - are clearly expressed both in the form of symptoms of irritation (epileptic seizures) and prolapse (motor disorders can reach the degree of plegia).

To ascertain the serious condition of the patient, it is permissible to have these violations in at least one of the parameters. Identification of violations of vital functions by 2 or more indicators, regardless of the severity of depression of consciousness and focal symptoms, is sufficient to qualify the condition as severe.

The threat to life is significant, largely depends on the duration of the serious condition. The prognosis for recovery of working capacity is sometimes unfavorable.

Extremely serious condition.

Criteria (limits of violations for each parameter are given):

1. state of consciousness - moderate or deep coma;
2. vital functions - gross violations simultaneously in several parameters;
3. focal symptoms:

• stem - are expressed roughly (reflex paresis or plegia of upward gaze, gross anisocoria, divergence of the eyes along the vertical or horizontal axis, tonic spontaneous nystagmus, a sharp weakening of pupillary reactions to light, bilateral pathological signs, hormetonia, etc.);
• hemispheric and craniobasal - pronounced sharply (up to bilateral and multiple paresis). Threat to life - maximum; largely depends on the duration of the extremely serious condition. The prognosis for recovery is often poor.

terminal state.

Criteria:

1. state of consciousness - terminal coma;
2. vital functions - critical disorders;
3. focal symptoms:

• stem - bilateral fixed mydriasis, absence of pupillary and corneal reflexes;
• hemispheric and craniobasal - blocked by cerebral and stem disorders.

Prediction: Survival is usually impossible.

When using the scale for assessing the severity of the condition of the victims for diagnostic and especially prognostic judgments, one should take into account the time factor - the duration of the patient's stay in a particular state. A serious condition within 15-60 minutes after the injury can also be observed in victims with concussion and mild contusion of the brain, but it has little effect on a favorable prognosis of life and recovery. If the patient stays in a serious and extremely serious condition for more than 6-12 hours, then this usually excludes the leading role of many concomitant factors, such as alcohol intoxication, and indicates a severe TBI.

It should be borne in mind that along with the brain component, the leading causes of a protracted severe and extremely severe condition may be extracranial factors (traumatic shock, internal bleeding, fat embolism, intoxication, etc.).

In addition to assessing impaired consciousness and elucidating the etiological factor, it is important to assess general condition of the patient.

The clinic distinguishes 5 degrees of severity of the general condition of the patient: satisfactory, moderate, severe, extremely severe and terminal.

Satisfactory condition- clear consciousness. Vital functions are not impaired.

Moderate condition- consciousness is clear or there is moderate stunning. Vital functions are slightly impaired.

serious condition- Consciousness is impaired to a deep stupor or stupor. There are severe disorders of the respiratory or cardiovascular systems.

Extremely serious condition- moderate or deep coma, fubo pronounced symptoms of damage to the respiratory and / or cardiovascular systems.

Terminal state- exorbitant coma with gross signs of damage to the trunk and violations of vital functions.

APPENDIX 3

METHODOLOGICAL DEVELOPMENT FOR TEACHERS AND STUDENTS

TO THE TOPIC "GENERAL EXAMINATION OF THE PATIENT"

Criteria for assessing the general condition

2. Indications for emergency hospitalization, as well as the urgency and scope of therapeutic measures.

3. Nearest forecast.

The severity of the condition is determined by a complete examination of the patient.

1. during questioning and general examination (complaints, consciousness, position, skin color, swelling ...);

2. when examining systems (respiratory rate, heart rate, blood pressure, ascites, bronchial breathing or the absence of breath sounds over the lung area ...);

3. after additional methods (blasts in the blood test and thrombocytopenia, heart attack on the ECG, bleeding stomach ulcer on FGDS ...).

There are: a satisfactory condition, a moderate condition, a serious condition and an extremely serious condition.

Satisfactory condition

Functions of vital organs are compensated.

No need for emergency hospitalization.

There is no threat to life.

Does not need care (care for a patient due to functional insufficiency of the musculoskeletal system is not the basis for determining the severity of the condition).

A satisfactory condition occurs in many chronic diseases with relative compensation of vital organs and systems (clear consciousness, active position, normal or subfebrile temperature, no hemodynamic disturbances ...), or with a stable loss of function from the cardiovascular system, respiratory system, liver, kidneys, musculoskeletal system , nervous system but without progression, or with a tumor, but without significant dysfunction of organs and systems.

Wherein:

The functions of vital organs are compensated,

There is no immediate adverse prognosis for life,

There is no need for urgent therapeutic measures (receives planned therapy),

The patient serves himself (although there may be a limitation due to the pathology of the musculoskeletal system and diseases of the nervous system).

Moderate condition

2. There is a need for urgent hospitalization and medical measures.

3. There is no immediate threat to life, but there is a possibility of progression and development of life-threatening complications.

4. Motor activity is often limited (active position in bed, forced), but they can serve themselves.

Examples of symptoms detected in a patient with a moderate condition:

Complaints: intense pain, severe weakness, shortness of breath, dizziness;

Objectively: consciousness is clear or stunned, high fever, pronounced edema, cyanosis, hemorrhagic rashes, bright jaundice, HR over 100 or under 40, RR over 20, impaired bronchial patency, local peritonitis, repeated vomiting, severe diarrhea, moderate intestinal bleeding, ascites ;

Additionally: heart attack on the ECG, high transaminases, blasts and thrombocytopenia less than 30 thousand / µl in an. blood (may be a state of moderate severity even without clinical manifestations).

serious condition

2. There is a need for emergency hospitalization and therapeutic measures (treatment in an intensive care unit).

3. There is an immediate threat to life.

4. Motor activity is often limited (active position in bed, forced, passive), they cannot take care of themselves, they need care.

Examples of symptoms seen in a severely ill patient:

Complaints: unbearable prolonged pain in the heart or abdomen, severe shortness of breath, severe weakness;

Objectively: consciousness may be impaired (depression, agitation), anasarca, severe pallor or diffuse cyanosis, high fever or hypothermia, thready pulse, severe arterial hypertension or hypotension, shortness of breath over 40, prolonged attack of bronchial asthma, incipient pulmonary edema, indomitable vomiting, diffuse peritonitis, massive bleeding.

Extremely serious condition

1. Severe decompensation of the functions of vital organs and systems

2. There is a need for urgent and intensive therapeutic measures (in intensive care)

3. There is an immediate threat to life in the next minutes or hours

4. Motor activity is significantly limited (the position is often passive)

Examples of symptoms seen in a critically ill patient:

- Objectively: the face is deathly pale, with pointed features, cold sweat, pulse and blood pressure are barely detectable, heart sounds are barely audible, respiratory rate up to 60, alveolar pulmonary edema, "silent lung", pathological Kussmaul or Cheyne-Stokes breathing ...

State examples

It is based on 4 criteria (in the rationale for the examples are indicated by numbers):

2. Indications for emergency hospitalization, as well as the urgency and volume of treatment

events.

3. Forecast.

4. Motor activity and the need for care.

Bilateral coxarthrosis III–IVst. FN 3.

Satisfactory condition (care of the patient due to functional insufficiency of the musculoskeletal system is not the basis for determining the severity of the condition).

Bronchial asthma, attacks 4-5 times a day, stops on its own, dry rales in the lungs.

Satisfactory condition.

Iron deficiency anemia, Hb100g/l.

Satisfactory condition.

IHD: stable angina. Extrasystole. NK II.

Satisfactory condition.

Diabetes mellitus with angiopathy and neuropathy, sugar 13 mmol/L, consciousness is not disturbed, hemodynamics is satisfactory.

Satisfactory condition.

Hypertonic disease. BP 200/100 mmHg But not a crisis. BP decreases with outpatient treatment.

Satisfactory condition.

Acute myocardial infarction without hemodynamic disturbances, according to ECT: ST above the isoline.

Condition of moderate severity (2.3).

Myocardial infarction, without hemodynamic disturbances, subacute period, according to ECG: ST on the isoline.

Satisfactory condition.

Myocardial infarction, subacute period, according to ECG: ST on the isoline, with normal blood pressure, but with a violation of the rhythm.

Moderate condition (2, 3)

Pneumonia, volume - segment, good health, subfebrile temperature, weakness, cough. There is no shortness of breath at rest.

Condition of moderate severity (2, 3).

Pneumonia, volume-lobe, fever, dyspnea at rest. The patient prefers to lie down.

Condition of moderate severity (1,2,4).

Pneumonia, volume - a fraction or more, fever, tachypnea 36 per minute, decreased blood pressure, tachycardia.

The condition is severe (1,2,3,4).

Cirrhosis of the liver. Feeling good. Enlargement of the liver, spleen. No ascites or slight ascites on ultrasound.

Satisfactory condition.

Cirrhosis of the liver. Hepatic encephalopathy, ascites, hypersplenism. The patient walks, serves himself.

Moderate condition (1.3)

Cirrhosis of the liver. Ascites, impaired consciousness and / or hemodynamics. In need of care.

The condition is severe (1,2,3,4).

Wegener's granulomatosis. Fever, lung infiltrates, shortness of breath, weakness, progressive decline in kidney function. Arterial hypertension is medically controlled. Prefers to be in bed but can walk and take care of himself.

Condition of moderate severity (1,2,3,4).

Wegener's granulomatosis. Deviations in blood tests persist, CRF IIst.

Satisfactory condition.

APPENDIX 4

Determination of medical age, significance for diagnosis .

1) Determination of medical age is of no small importance, for example, to forensic practice. A doctor may be asked to determine the age due to the loss of documents. This takes into account that the skin loses elasticity with age, becomes dry, rough, wrinkled, pigmentation, keratinization appear. At the age of about 20 years, frontal and nasolabial wrinkles already appear, about 25 years old - at the outer corner of the eyelids, by 30 years old - under the eyes, at 35 years old - on the neck, about 55 - in the area of ​​the cheeks, chin, around the lips.

On the hands of up to 55 years, the skin, taken in a fold, quickly and well straightens out, at 60 years old it straightens out slowly, and at 65 it no longer straightens out on its own. Teeth with age are erased on the cutting surface, darken, fall out.

By the age of 60, the cornea of ​​the eyes begins to lose transparency, whitishness / arcussenilis / appears along the edges, and by the age of 70 the senile arc is already clearly expressed.

It should be remembered that medical age does not always correspond to metric. There are eternally young subjects, on the other hand - prematurely aged. Patients with increased thyroid function look younger than their years - usually thin, slender, with delicate pink skin, sparkle in the eyes, mobile, emotional. Premature aging is caused by mexedema, malignant tumors and some long-term severe diseases.

Determination of age is also important because certain diseases are characteristic of each age. There is a group of childhood diseases that are studied in the course of pediatrics; on the other hand, gerontology is the science of diseases of the elderly and senile age /75 years and more/.

Age groups /Guide to gerontology, 1978/:

Children's age - up to 11 - 12 years.

Teenage - from 12 - 13 years to 15 - 16 years.

Youth - 16 - 17 years old to 20 - 21 years old.

Young - from 21 - 22 years old to 29 years old.

Mature - from 33 years to 44 years.

Medium - from 45 years to 59 years.

Elderly - from 60 years to 74 years.

Old - from 75 years to 89 years.

Long-livers - from 90 and more.

At a young age, they often suffer from rheumatism, acute nephritis, and pulmonary tuberculosis. In adulthood, the body is most stable, least prone to disease.

The patient's age must also be taken into account due to the fact that it has a significant impact on the course of the disease and the prognosis /outcomes/: at a young age, the disease mostly proceeds rapidly, their prognosis is good; in senile - the reaction of the body is sluggish, and those diseases that end in recovery at a young age, for example, pneumonia, in old people are often the cause of death.

Finally, in certain age periods, there are sharp shifts in both the somatic and neuropsychic spheres:

a) puberty /pubertal period/ - from 14 - 15 years to 18 - 20 years - characterized by increased morbidity, but relatively low mortality;

b) the period of sexual withering / menopause / - from 40 - 45 years to 50 years is marked by a tendency to cardiovascular, metabolic and mental diseases / there are functional disorders of the vasomotor, endocrine-nervous and mental nature /.

c) The period of aging - from 65 years to 70 years - during this period it is difficult to separate the purely age-related phenomena of wear and tear from the symptoms of a particular disease, in particular atherosclerosis.

The doctor determines the correspondence of gender and age to passport data already when questioning the patient, records deviations in the medical history if they are detected, for example: “the patient looks older than his years” or “medical age corresponds to the metric age”.

Patient's condition (general condition of the patient).

The patient's condition is determined depending on the presence and severity of dysfunction of vital organs and systems. Determining the severity of the patient's condition is of great clinical importance, because. orients the doctor to a certain tactic of patient management and allows:

determine the indications for hospitalization and transportability of the patient;

resolve the issue of the urgency and the required volume of diagnostic and therapeutic measures;

predict the likely outcome of the disease.

There are several gradations of the general state:

I. satisfactory;

II. moderate;

III. heavy;

IV. extremely severe (pre-agonal);

V. terminal (agonal);

VI. state of clinical death.

The doctor's assessment of the general condition of the patient is carried out in two stages:

First stage- preliminary, which is based on a general impression of the patient and general examination data with an assessment of the patient's appearance, level of consciousness, degree of activity, position in space, body temperature, color of the skin and mucous membranes, the presence and severity of shortness of breath, edema, etc. .

Second phase- the most reliable, allows you to form a final idea of ​​the severity of the patient's condition. It is based on data from in-depth clinical, laboratory and instrumental studies.

Of particular importance is the determination of the functional state of vital organs and systems - cardiovascular, respiratory system, liver, kidneys, etc.

In some cases, it is possible to really determine the severity of the general condition with a relatively satisfactory state of health of the patient and without pronounced disturbances in the objective status only after additional laboratory and instrumental studies. So the serious condition of a patient with acute leukemia is substantiated by the data of a general blood test, with acute myocardial infarction - by electrocardiogram data, with a bleeding stomach ulcer - FGDS, in the presence of cancer metastases in the liver - ultrasound, etc.

Clinical signs of the patient's condition.

I. Satisfactory condition is typical for mild or relatively mild acute and exacerbated chronic diseases with minimal deviations in the function of various organs and systems:

pain and other subjective symptoms may be absent or present, but not severe;

consciousness is preserved, the patient is freely oriented in space and time, adequately assesses his condition and reacts to others;

active position, nutrition is not disturbed, body temperature is normal or subfebrile;

the frequency, depth and rhythm of breathing are not disturbed, shortness of breath can occur only during physical exertion (DN 0 - I degree);

the function of the cardiovascular system (pulse, blood pressure) without deviations, or with minimal deviations, which is detected only during physical exertion (NK 0 - I degree);

function of the liver, kidneys, endocrine system without pronounced deviations from the norm;

indicators of laboratory and instrumental studies with minimal deviations.

II. The state of moderate severity is detected in a disease that leads to decompensation of the functions of vital organs, but does not pose an immediate danger to the life of the patient. This condition is observed in diseases that occur with severe subjective and objective manifestations.

Patients usually complain about:

Intense pain of various localization, severe weakness, shortness of breath with moderate physical exertion, dizziness;

On examination:

Consciousness is usually clear, sometimes it can be somewhat inhibited,

The position of patients is often forced or active within the bed;

In some diseases, there may be high fever with chills or hypothermia,

Changes in skin color characteristic of the disease are revealed: severe pallor or cyanosis, yellowness of the skin and mucous membranes,

In the study of the cardiovascular system, cardiac arrhythmias (tachycardia or bradycardia, arrhythmia, increase or decrease in blood pressure) are detected;

With left ventricular and respiratory failure, shortness of breath (tachypnea) appears with an increase in the respiratory rate at rest up to 20 per minute and above;

In congestive heart failure, peripheral edema with distal cyanosis (“colored” edema), ascites,

In acute pathology of the digestive system, symptoms of an "acute" abdomen, intestinal paresis, with indomitable or repeated vomiting, diarrhea - symptoms of dehydration (exicosis), with moderate gastrointestinal bleeding - moderate hypotension, tachycardia, with massive blood loss - a sharp decrease in blood pressure, severe tachycardia, melena, coffee grounds vomiting, pallor of the skin and mucous membranes, etc.

Patients whose general condition is regarded as moderate require hospitalization and emergency medical care, since there is a possibility of rapid progression of the disease and the development of life-threatening complications.

III. The severe condition of the patient develops with severe decompensation of the functions of vital organs, represents an immediate danger to the life of the patient. It is observed in the complicated course of the disease with pronounced and rapidly progressive clinical manifestations. Patients complain of unbearable lingering persistent pain of various localization, which depends on the nature of the underlying disease (for example, pain behind the sternum in acute myocardial infarction, in the upper half of the abdomen of a girdle character in acute pankteratitis, etc.), severe weakness, shortness of breath at rest etc.

Severe disturbances of consciousness are revealed up to the stage of stupor or stupor, delirium and hallucinations are possible.

The position of the patient is passive or forced.

The severe general condition of the patient is evidenced by severe symptoms of general intoxication, cardiovascular, respiratory, hepatic or renal failure, increasing cachexia, anasarca, signs of severe dehydration, severe diffuse cyanosis or “chalky” skin pallor.

In the study of the cardiovascular system, a pronounced tachycardia at rest, a thready pulse, a sharp weakening of the first tone above the apex, a gallop rhythm, and significant arterial hypertension are revealed.

From the respiratory system:

Tachypnea over 40 per minute;

Choking (status asthma), pulmonary edema (cardiac asthma).

The severe general condition is also indicated by:

indomitable vomiting, profuse diarrhea;

signs of diffuse peritonitis (dense, "board-like" abdominal wall, lack of intestinal peristalsis);

signs of massive gastrointestinal bleeding (vomiting the color of “coffee grounds”, milena).

All patients with a severe general condition require urgent hospitalization and treatment in an intensive care unit.

IV. An extremely severe (pre-agonal) general condition is characterized by a sharp violation of the basic vital functions of the body, which, without urgent and intensive therapeutic measures, the patient may die within the next hours or even minutes.

The patient's consciousness is disturbed to the level of coma, there are deep respiratory disorders such as Cheyne-Stokes, Biot, Kussmaul.

The position is passive, motor excitation, general convulsions with the involvement of the respiratory muscles are sometimes noted. The face is deathly pale, with pointed features, covered with drops of cold sweat (the face of Hippocrates).

The pulse is palpable only on the carotid arteries, blood pressure is not detected, heart sounds are barely heard, the number of breaths reaches 60 per minute. With alveolar edema of the lungs, breathing becomes bubbling, pink frothy sputum is released from the mouth, various unsound wet rales are heard over the entire surface of the lungs. In patients with asthmatic status II - III degree, respiratory sounds over the lungs are not heard (silent lung).

Treatment of patients in extremely serious condition is carried out in the intensive care unit.

V. The terminal (agonal) state is characterized by complete extinction of consciousness, reflexes disappear, muscles are relaxed.

The cornea becomes cloudy, the lower jaw droops.

The pulse is not palpable even on the carotid arteries, blood pressure is not determined, heart sounds are not heard.

Rare periodic respiratory movements according to the type of Biot's breathing are noted, the bioelectric activity of the myocardium is still recorded on the ECG in the form of rare deformed complexes of the idioventricular rhythm or in the form of rare waves of residual ventricular activity.

The agony can last for minutes or hours.

The appearance on the ECG of an isoelectric line (asystole) or fibrillation waves (ventricular fibrillation) and cessation of breathing (apnea) indicates the onset of clinical death.

The duration of clinical death is only a few minutes, however, timely resuscitation measures can bring the patient back to life.

24.12.2009, 14:21

The husband was taken to the hospital by ambulance. The operation was performed at night, and he is now in intensive care. It makes no sense for me and the children from the suburbs to go in such weather, they said they would not let me in. In the help desk they say "he is in intensive care, his condition is serious, the pace is 36.7" and they hang up.
Please explain what "a serious condition" means?, ... and I can’t find out how he recovered from anesthesia ... For the first time I encounter this in such a way that it concerns me personally .....

24.12.2009, 14:25

well, after the operation, the condition is always serious,
You can’t just call it light .... or moderate)
and the fact that the temperature is normal is already GOOD!
don't worry, everything will be fine.
Peace to you, and a speedy recovery to your husband: 091:

24.12.2009, 15:42

In intensive care, there are always 2 statuses of the condition: extremely severe and severe. When it is stable, they will transfer to the department.

24.12.2009, 15:48

The husband was taken to the hospital by ambulance. The operation was performed at night, and he is now in intensive care. It makes no sense for me to go with children from the suburbs in such weather.
Hmmm ... It's even difficult to comment ....

24.12.2009, 15:48

24.12.2009, 15:49

I agree with nezabvennaya. Don't worry, everything will be fine. Go to the doctor and talk.

24.12.2009, 15:52

Children - acquaintances, most - in b-tsu. Why are you still here?!
Talk to a doctor. Necessarily!

24.12.2009, 16:04

Hmmm ... It's even difficult to comment ....
Let's put it this way: a ban on entering the intensive care unit does not mean a ban on meeting with the attending physician and receiving all the information about the husband's health.
Only he can answer your questions clearly and unambiguously.

The father-in-law communicates with the attending physician. Today he forbade me to go, the children were ill for more than a month, and to go on my own, tomorrow morning I will go. The words of the father-in-law "I control, communicate with the doctor, there is nothing for everyone to go there and bother"

24.12.2009, 16:34

The father-in-law communicates with the attending physician. Today he forbade me to go, the children were ill for more than a month, and to go on my own, tomorrow morning I will go. The words of the father-in-law "I control, communicate with the doctor, there is nothing for everyone to go there and bother"
Don't be offended by me - I'm old and apparently angry - but then I don't understand the meaning of the post. If the father-in-law communicates with the doctor, then why ask what a "serious condition" is on the forum, if you can ask the father-in-law like a husband.

If the father-in-law does not moo and does not calve, send him to .... mother-in-law and go yourself. You are a wife and you have every right to communicate directly with the doctor.
If the question is not to find a common language with the father-in-law, then this is clearly not the question of this section.
Sorry again :(

24.12.2009, 16:45

Go, if possible, to your spouse. And may you be all right. @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@ @@@@@@@@@@@@@@@@@@@@@@@@@@@@@

24.12.2009, 17:03

24.12.2009, 17:10

As if everything is so simple. On the day of the operation, they did not let me go to the hospital to see my husband. And no one called the doctor to talk to me. They said: "The patient is in intensive care, they will be transferred to the department, you will receive a permanent pass, and now go home, madam, do not interfere with people's work." Author, do not worry, everything will be fine. Health husband.
You know, everything is much more complicated and easier at the same time. That's the way our Russia is, unfortunately. And you need to get to the doctor, regardless of whether they let you in or not. Unfortunately, I have a very decent experience of communicating with hospitals (children, mother, husband, friends) - try to stop. Another question is at what cost to get there.
But this has nothing to do with the topic of the author - the father-in-law is already talking there.