Intensive care medicine in the context of "Pre-hospital emergency medicine"

Anesthesiology, anaesthesiology or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialized in anesthesiology is called an anesthesiologist, anaesthesiologist, or anaesthetist, depending on the country. In some countries, the terms are synonymous, while in other countries, they refer to different positions and anesthetist is only used for non-physicians, such as nurse anesthetists.

The core element of the specialty is the prevention and mitigation of pain and distress using various anesthetic agents, as well as the monitoring and maintenance of a patient's vital functions throughout the perioperative period. Since the 19th century, anesthesiology has developed from an experimental area with non-specialist practitioners using novel, untested drugs and techniques into what is now a highly refined, safe and effective field of medicine. In some countries anesthesiologists comprise the largest single cohort of doctors in hospitals, and their role can extend far beyond the traditional role of anesthesia care in the operating room, including fields such as providing pre-hospital emergency medicine, running intensive care units, transporting critically ill patients between facilities, management of hospice and palliative care units, and prehabilitation programs to optimize patients for surgery.

An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine.

An intensive care unit was defined by the task force of the World Federation of Societies of Intensive and Critical Care Medicine as "an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency."

Critical emergency medicine (CREM) refers to the acute medical care of patients who have medical emergencies that pose an immediate threat to life, irrespective of location. In particular, the term is used to describe the role of anaesthesiologists in providing such care.

The term was introduced in 2010 in a position paper by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, who defined it as "immediatelife support and resuscitation of critically ill and injured patients in the pre-hospital as well as hospital settings". It describes the roles and competencies of anaesthesiologists and intensive care physicians in caring for patients with life-threatening illness or injury who require resuscitation or support of their vital functions, particularly in Scandinavia and other parts of Europe. One reason the term was introduced was to distinguish these core activities from the broader internationally recognised medical specialty of emergency medicine; the latter deals with the acute care of a broad range of minor to major medical problems that present to an emergency department,.

Life support comprises the treatments and techniques performed in an emergency in order to support life after the failure of one or more vital organs. Healthcare providers and emergency medical technicians are generally certified to perform basic and advanced life-support procedures; however, basic life support is sometimes provided at the scene of an emergency by family members or bystanders before emergency services arrive. In the case of cardiac injuries, cardiopulmonary resuscitation is initiated by bystanders or family members 25% of the time. Basic life-support techniques, such as performing CPR on a victim of cardiac arrest, can double or even triple that patient's chance of survival. Other types of basic life support include relief from choking (which can be done by using the Heimlich maneuver), staunching of bleeding by direct compression and elevation above the heart (and if necessary, pressure on arterial pressure points and the use of a manufactured or improvised tourniquet), first aid, and the use of an automated external defibrillator.

The purpose of basic life support (abbreviated BLS) is to save lives in a variety of different situations that require immediate attention. These situations can include, but are not limited to, cardiac arrest, stroke, drowning, choking, accidental injuries, violence, severe allergic reactions, burns, hypothermia, birth complications, drug addiction, and alcohol intoxication. The most common emergency that requires BLS is cerebral hypoxia, a shortage of oxygen to the brain due to heart or respiratory failure. A victim of cerebral hypoxia may die within 8–10 minutes without basic life-support procedures. BLS is the lowest level of emergency care, followed by advanced life support and critical care.

Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an acutely ill patient. It is an important part of intensive care medicine, anesthesiology, trauma surgery and emergency medicine. Well-known examples are cardiopulmonary resuscitation and mouth-to-mouth resuscitation.

Adequate resuscitation and end-organ perfusion is best indicated by urine output of 0.5-1 mL/kg/h. For the average adult male weighing ~70 kg this would mean a urine output of 35 mL/h (70 x 0.5 = 35 mL/h). Heart rate, mental status, and capillary refill may be affected by underlying disease processes and are thus less reliable markers for adequate resuscitation.