Preparing for Consults and Investigations

Administrative Reception

Patient reception takes place at the Reception-Scheduling Desk located at the ground floor of the Hospital, during the following hours:

  • Monday to Friday, between 08:00 a.m. – 08:00 p.m.
  • Saturday, between 08:00 a.m. – 02:00 p.m.
  • Sundays, between 08:00 a.m. – 12:00 a.m.

Medical Reception

Medical reception is carried out by the physician in whose department the patient is admitted, who will fill in the medical chart for the patient’s hospitalization. This document attests the actual taking in charge of the patient under medical care.

Preparing for Outpatient Investigations

Upper Digestive Endoscopy

Endoscopy is a direct exploration (at sight) of the first part of the digestive tract: the esophagus, the stomach, the pylorus, the duodenum I and II. To visualize them, an endoscope is inserted through the oral cavity, which is a flexible tube-like device made of optical fiber and endowed with light and a minuscule video camera.

Endoscopy is a procedure used both for diagnosis and therapy. It offers the possibility to perform a lot of therapeutic procedures such as biopsies, polyp extraction, excision of small tumors, electrocoagulation, injection of bleeding vessels and dilation of esophageal stenosis.

Indications

The patient must not eat at least 6 hours before the exploration.
Any patient that is going to undergo an endoscopic investigation must have a general physical examination and an indication for such exploration, signed by the attending physician.
Since some patients find it difficult to tolerate with such investigation, sometimes analgesics, sedatives, and hypnotics such as Midazolam or Propofol are used (only after consulting with the patient).

Complications
Upper digestive endoscopy is an investigation with a high degree of safety for the patient, as it was described in medical treaties and guidelines in the modern world. Nevertheless, it is an invasive investigation and there is a possibility for complications to occur, such as respiratory dysfunctions, lipotimic states, pulmonary aspiration, pneumonia or infection of some cardiac prosthesis. Very rarely, there can occur digestive perforations, bleeding, and hematoma.
The risks of endoscopy manifest themselves especially in the elderly patients, those suffering from lung diseases, heart conditions, and those hemodynamically unstable.
For these reasons, the patient must be informed a well on the risks deriving from the investigation itself, therefore, any exploration requires the written consent signed by the patient. Also, the patient assumes in his/her turn the risks related to the severity of his/her disease, as well as to other chronic ailments.

Colonoscopy

FORTRANS – 03:00 p.m.
The day before the exploration, the patient may eat normally just until 04:00 p.m. After such time, only ingestion of clear fluids is allowed, sweetened tea, mineral water, light coffee, and mint candies. On the days prior to the exploration (1-2 days) it is not recommendable for the patient to eat raw vegetables and fruit (especially grapes, kiwi, or figs), vegetables, tomatoes, medical coal, laxative oils, or iron products.

As from 04:00 p.m. in the day before the exploration, the patient must drink, for a duration of 4-6 hours, 3 liters of FORTRANS (one sachet of FORTRANS dissolved into one liter of water), in a rhythm as constant as possible. The slow, constant rhythm prevents the abdominal bloatedness, nausea, and vomiting — the latter is not desirable, since it may cause loss of active ingredient. The next morning, starting from 07:00, the patient will drink another liter of FORTRANS in 6-8 hours.

In the end, the objective is to eliminate an almost clear, aqueous stool. In rare cases, if the stool is not aqueous, the exploration is difficult to carry out and the laboratory staff or the nurse/physician of the room must be contacted by phone before the patient comes in for the exploration. There is also the possibility for the patient to drink another liter of substance until the stool becomes completely liquid.

The exploration is performed the next day after 03:00 p.m.

The patient must come for the examination accompanied and s/he must have a large towel with him/her.

It is important for the patient to know the following:

  • the patient will sign a written consent in which s/he agrees with the exploration;
  • the exploration lasts for approximately 30 minutes;
  • if the taste of the preparing solution is hard to tolerate, lemon juice, sugar, refined grapefruit or orange juice can be added to it;
  • analgesic and/or sedative medication will be administered, and in such case the patient is not allowed to drive a car for 4-6 hours after the investigation.

Prescription for the pharmacy:

  • Prescription
  • Fortrans 1 box with 4 sachets
  • 1 sachet + 1 liter of water

Transesophageal Echocardiography

Ecocardiografia transesofagiană înseamnă examinarea cu ultrasunete a inimii dinspre esofag. Ca procedură se Transesophageal echocardiography represents the ultrasound examination of the heart from the esophagus. This procedure resembles the upper digestive endoscopy. To prepare for it, the patient must swallow a probe with the diameter of 8-10 mm. Before inserting the probe, the pharynx is anesthetized with a Xyline spray — in the case of patients who are not allergic — or some gel can be applied onto the probe to facilitate its gliding. The investigation lasts for approximately 20 minutes.

The examination is made by aid of a GE Vivid E9 device, provided with multiplane transesophageal echocardiography probe. The images are stored both in the EchoPac, and in the hospital database. At the end of the examination, the patient received a written report and a CD with the images recorded.

By aid of this device, the heart cavities and valves, as well as the great vessels can be analyzed better, due to the proximity of the probe to these structures (there are structures which can be visualized only by aid of this examination, such as the left auricle). To confirm or exclude a thrombosis in the atriums or in the left auricle, this examination is the only one that can give an exact answer.

Indication

Before the analysis

On the day of the examination, the patient must not eat or drink anything 6 hours before the investigation.
A catheter will be inserted in the patient’s right forearm.
Mobile dental prostheses must be taken out before the investigation.

During the investigation

The patient naked from the waist up lies on his left side, with his/her left hand under his/her head and with the chin lowered toward the chest. Three EKG electrodes are applied on the patient’s skin to monitor the heart rate. The patient must not swallow his/her saliva, but let it flow on a cloth held under the mouth. In order to avoid biting and deteriorate the probe, the patient will hold between his/her teeth a plastic mouthpiece through which the probe will be inserted. All instruments used are sterilized in a special disinfectant solution which kills all bacteria and viruses known, so that there is no possibility to infect the patient.
After the pharynx has been anesthetized, the patient is requested to swallow the probe. Even if s/he cannot feel his/her tongue and pharynx, the patient must do as if s/he were swallowing, and the physicians will help him/her by pushing the probe down the pharynx.

Through the catheter inserted in his/her forearm, the patient may receive, if needed, a mild intravenous sedative (midazolam) for a short-duration moderate sedation.
During the investigation, the patient must remain with his/her chin directed toward the chest, so that the saliva flows on the cloth, as swallowing the saliva triggers the movement of the esophagus and disturbs the image acquired by the probe and prolongs the examination. The patient must also keep as calm as possible and breathe through his/her nose or mouth — as any movement of the head can disturb the image acquired by the probe. During the investigation, the physician examines bidimensionally and by color Doppler the heart cavities at approximately 30 cm from the dental arch in all plans possible and, in the end, he visualizes the thoracic aorta and the aortic cross.

After the echography, the patient may not eat or drink anything for another two hours, due to the pharynx anesthesia which presents a danger of aspiration. Also, in the case of outpatient investigation and under sedation with midazolam, the patient may not drive a car.

Complications

During the examination, nausea or vomiting may occur while swallowing the probe. Other reactions seldom observed are the following: cardiac rhythm disorders, bronchospasm, raucousness, mild lesions of the pharynx caused by the passage of the probe, and hypertensive episode.
Incidents that may occur extremely seldom are perforation of the esophagus, rupture of an aortic aneurysm or of preexisting esophageal varices, and aspiration pneumonia.

Preparing for imaging investigations

CT Angio coronarography

The patient must come in with the results of the following tests: creatinine and urea. If the case is an emergency, creatinine will suffice.

6-8 hours before the investigation, the patient must not eat solid food. It is recommendable that s/he does not drink even tea, coffee, chocolate, cola, or other energizing foods and beverages on the examination day.

Note for the Referring Physician

For the CT cardiography and CT coronarography, the heart rate must be under 60 bpm, because the patients will receive preventive beta blockers. If the administration of beta blockers is contraindicated, an anxiolytic should be administered in the morning of the examination day.

The treatment for diabetes or other cardiological problems will be discontinued only if recommended by the attending physician.

On the examination day, the patient must present all the medical documents related to the cardiological disease.

Prețuri intervenții