Koncentrat protrombinskog kompleksa u hitnoj medicinskoj službi

Coagulation abnormalities are common in bleeding or critically ill patient and hemostatic management remains a major challenge for the emergency physician. Management of bleeding patients consists of bleeding control, restoration of blood volume, and correction of any associated coagulopathy. Traditionally, the fresh frozen plasma (FFP) is used for correction of coagulopathy to manage and prevent bleeding, but today Prothrombin complex concentrates (PCCs) offer an attractive alternative because they offers a number of advantages over FFP, including lower infusion volume, rapid IN R normalization, faster availability, lack of blood group specificity, and better safety profile. The aim of the present review is to provide an short overview about using PCC, their indication, efficacy and safety in different bleeding setting’s.Poremećaji koagulacije česti su u kritičnih bolesnika i u bolesnika s krvarenjem, te predstavljaju veliki izazov za sve liječnike koji su uključeni u rad hitne medicinske službe. Liječenje bolesnika s krvarenjem uključuje kontrolu krvarenja, nadoknadu volumena krvi i korekciju koagulopatije. Tradicionalno, za korekciju koagulopatije i sprječavanje krvarenja najčešće se koristi svježe smrznuta plazma (SSP), no danas se kao alternativa sve češće koristi koncentrat protrombinskog kompleksa (engl. prothrombin complex concentrates - PCC) zbog brojnih prednosti u odnosu na SSP, a koje uključuju primjenu manjeg volumena, bržu korekciju IN R-a, bržu dostupnost, bolji sigurnosni profil, a također nije potrebna ni krvno grupna specifičnost. Cilj ovog rada je pružiti kratki pregled o osnovnim indikacijama, sigurnosti i učinkovitosti primjene PCC u stanjima krvarenja različite etiologije

Zbrinjavanje hitnih stanja vezanih uz arterijsku hipertenziju u izvanbolničkoj hitnoj medicinskoj službi

SUMMARY Arterial hypertension is the most common cause of cardiovascular diseases and mortality. It significantly contributes to the incidence of other chronic diseases, the most frequent being myocardial infarction and stroke. Arterial hypertension, whether chronically uncontrolled or especially in case of hypertensive emergency, represents a complex state that must be adequately assessed and managed. Hypertensive emergencies are not common in the general population, but represent a serious health emergency that can rapidly lead to irreversible damage and loss of function of target organs if not treated adequately. Prompt and effective treatment in prehospital emergency care significantly contributes to the overall quality of the healthcare system.SAŽETAK Arterijska je hipertenzija najčešći uzrok kardiovaskularnih bolesti kao i smrtnosti. Znatno pridonosi učestalosti ostalih kroničnih bolesti, od kojih su najučestalije infarkt miokarda i moždani udar. Arterijska hipertenzija, bilo ona kronična neregulirana, a posebno u slučaju hipertenzivne hitnoće ili emergencije, kompleksno je stanje koje je potrebno odgovarajuće procijeniti i zbrinuti. Hipertenzivne emergencije nisu učestale u populaciji, ali su ozbiljna hitna stanja koja u kratkom vremenu, ako se odgovarajuće ne zbrinu, uzrokuju ireverzibilno oštećenje i gubitak funkcije ciljnih organa. Promptno i učinkovito postupanje u izvanbolničkoj hitnoj medicinskoj službi znatno doprinosi kvaliteti cjelokupnoga zdravstvenog sustava

Building Environmentally Sustainable Communities: A Framework for Inclusivity

Reviews literature on past inequitable and unsustainable urban development and visions for linking sustainability, opportunity, and inclusion. Analyzes possible metrics for measuring sustainability and access as well as next steps for policy

Ishodi izvanbolničkog srčanog zastoja - poboljšanje uspješnosti kardiopulmonalne reanimacije od strane laika

Approximately 8000 people suffer from an out-of-hospital cardiac arrest (OHCA) in the Republic of Croatia every year. OHCA survival rates generally remain low despite major advances in resuscitation. Its incidence and survival rate are well known in many European countries, but reliable data on OHCA in Croatia are lacking. The aim of the study was to determine survival rate of patients with OHCA in the Republic of Croatia and the importance of the community bystander cardiopulmonary resuscitation (CPR) rates in the survival chain. This prospective observational study performed between October 1, 2017 and December 31, 2017 included all adult patients with OHCA in Croatia who were treated by Emergency Medical Services (EMS). OHCA data were collected from the Croatian Institute of Emergency Medicine database and Utstein cardiac arrest data collection form. Descriptive data presentation was used in the analyses. Data were expressed as absolute frequencies and percentages and central tendency measures. Testing of correlations in return of spontaneous circulation (ROSC) was performed by logistic regression. During the observation period, a total of 1763 adult patients without signs of circulation were assessed by EMS in Croatia and 760 (43%) adult patients were resuscitated by EMS personnel. Outcomes measured in ROSC until emergency department admission were reported in 126 (17%) cases. Shockable rhythm vs. non-shockable rhythm (OR: 5.832, 95% CI: 3.621-9.392; p<0.001) and bystander witnessed cardiac arrest (OR: 8.213, 95% CI: 2.554-26.411, p<0.001) were significantly associated with a higher probability of survival. There was no significant difference in correlation with day or night shift, etiology of cardiac arrest and bystander CPR variables. Survival rate of OHCA patients who received CPR until emergency department admission in Croatia was 17%. A higher survival rate post-OHCA was more likely among patients who received bystander CPR and had shockable rhythm.U Republici Hrvatskoj izvanbolnički srčani zastoj (ISZ) doživi oko 8000 osoba na godinu. Preživljenje od ISZ općenito ostaje nisko unatoč velikom napretku u reanimaciji. Njegova incidencija i stopa preživljenja dobro su poznati u mnogim europskim zemljama, ali pouzdani podaci o ISZ u Hrvatskoj nedostaju. Cilj istraživanja bio je utvrditi stopu preživljenja bolesnika s ISZ u Republici Hrvatskoj i važnost kardiopulmonalne reanimacije (KPR) provedenu od strane laika u cjelokupnom lancu preživljenja. Ova prospektivna opservacijska studija provedena od 1. listopada 2017. do 31. prosinca 2017. obuhvatila je sve odrasle bolesnike s ISZ u Hrvatskoj koji su bili zbrinjavani od djelatnika hitne medicinske službe (HMS). Podaci o ISZ prikupljeni su iz baze podataka Hrvatskoga zavoda za hitnu medicinu i obrasca za prikupljanje podataka o srčanom arestu Utstein. U analizama je primijenjen deskriptivni prikaz podataka. Podaci su izraženi kao apsolutne frekvencije i postoci te mjere središnje tendencije. Testiranje korelacija povratka spontane cirkulacije (return of spontaneous circulation, ROSC) provedeno je logističkom regresijom. Tijekom razdoblja promatranja ukupno su u izvanbolničkoj HMS na području Republike Hrvatske bile 1763 odrasle osobe bez znakova cirkulacije, a 760 (43%) odraslih bolesnika reanimirano je od strane osoblja HMS. Ishodi mjereni po povratku spontane cirkulacije (ROSC) do prijma u hitnu bolničku službu prijavljeni su u 126 (17%) slučajeva. Ritam koji je za defibrilaciju u odnosu na ritmove srčanog zastoja koji se ne defibriliraju (OR: 5,832, 95% CI: 3,621-9,392; p<0,001) i osvjedočeni srčani zastoj od strane laika (OR: 8,213, 95% CI: 2,554-26,411, p<0,001) bili su značajno povezani s većom vjerojatnošću preživljavanja. Nije bilo značajne razlike u korelaciji s dnevnom ili noćnom smjenom i etiologijom srčanog zastoja. Stopa preživljenja bolesnika s ISZ u Republici Hrvatskoj kod kojih je provedena kardiopulmonalna reanimacija do prijma u hitnu bolničku službu bila je 17%. Veća stopa preživljenja nakon ISZ bila je vjerojatnija među bolesnicima kod kojih je započeta kardiopulmonalna reanimacija od strane laika i koji su imali srčani ritam za defibrilaciju

KRVARENJE KAO GLAVNI UZROK HITNOSTI U BOLESNIKA NA ANTIKOAGULANTNOJ TERAPIJI

Background: Anticoagulant therapy is increasingly used in the world because the population is getting older and conditions that require anticoagulant treatment are more frequent. Since bleeding occurs in patients taking warfarin, as well as in patients taking direct oral anticoagulants, the goal of this study was to determine whether there was a difference in the frequency of bleeding as a major cause of emergency attendance between these two groups. Methods: The study included 83 patients examined in Emergency Unit, Merkur University Hospital from December 1, 2018 until June 1, 2019, who were taking anticoagulant therapy and had chronic kidney disease (stage 2-4). Group A included 22 patients (8 male) using warfarin and group B included 61 patients (19 male) taking direct oral anticoagulants. The median age was 80.77 years in group A and 80.95 years in group B. There were no differences in comorbidities. Doses of anticoagulants were adjusted to the glomerular fi ltration rate. Results: In group A, the main cause of emergency attendance was bleeding (mostly gastrointestinal) in 15 (68.18%) group A patients, whereas in group B bleeding was the main cause in 21 (34.42%) patients. The χ2-test was used to assess difference in the frequency of bleeding as the cause of emergency attendance (χ2=7.501; p<0.01). Conclusion: Study fi ndings suggested that patients using direct oral anticoagulants as anticoagulant therapy adjusted to renal function had signifi cantly less bleeding as the cause of attendance at Emergency Unit as compared to patients taking warfarin.Starenjem populacije stanja koja zahtijevaju antikoagulantnu terapiju ima sve više, čime uporaba antikoagulantne terapije u svijetu raste. Budući da krvarenje nastaje kod uporabe varfarina kao i direktnih antikoagulansa, cilj ovoga istraživanja bio je pokazati postoji li razlika u učestalosti krvarenja kao glavnog uzroka hitnosti u ovih bolesnika ovisno o primijenjenom antikoagulansu. Metode: U istraživanje su bila uključena 83 bolesnika na antikoagulantnoj terapiji s kroničnom bubrežnom bolešću stadija 2-4, pregledana u Hitnom prijmu Kliničke bolnice Merkur u razdoblju od sedam mjeseci. Skupina A obuhvaćala je 22 bolesnika (8 muškaraca) na varfarinskoj terapiji, a skupina B 61 bolesnika (19 muškaraca) na direktnoj oralnoj antikoagulantnoj terapiji. Srednja dob u skupini A bila je 80,77 godina, a u skupini B 80,95 godina. Nisu nađene razlike u komorbiditetima među skupinama. Doze antikoagulantnih lijekova bile su prilagođene bubrežnoj funkciji. Rezultati: U skupini A je glavni uzrok hitnosti bilo krvarenje u 15/22 (68,18%) bolesnika (većinom gastrointestinalnog podrijetla), dok je u skupini B krvarenje pronađeno u 21/61 (34,42%) bolesnika. Za provjeru statističke značajnosti razlike krvarenja kao glavne hitnosti među dvjema skupinama bolesnika primijenjen je χ2-test (χ2=7,501; p<0,01). Zaključak: Primjenom direktnih oralnih antikoagulantnih lijekova u dozi prilagođenoj bubrežnoj funkciji bilježi se statistički značajno manje krvarenja kao glavnog uzroka hitnosti u usporedbi s varfarinom

Dijagnostika plućne embolije u Objedinjenom hitnom bolničkom prijamu

The aim of this study was to determine the association of clinical presentation, the Wells scoring system and D-dimer values with MSCT pulmonary angiography. A case control study was conducted in the Emergency Department of the Clinical Hospital Sveti Duh throughout 2019. Patients with a referral diagnosis of a pulmonary embolism were included in the study. Patients were divided into two groups. The first group consisted of patients diagnosed with pulmonary embolism by MSCT pulmonary angiography or postmortem, and the second group consisted of patients excluded from pulmonary embolisms. For the Wells score, D-dimers, troponin, respiratory rate and peripheral blood oxygen saturation, statistically significant differences were found between groups of patients with confirmed or excluded pulmonary embolism (p <0.001). For heart rate, chest pain, syncope, and hemoptysis, no statistically significant differences were found between these two groups of patients. Deep venous thrombosis of the lower extremities was found by ultrasound in > 70% of patients with massive a pulmonary embolism. Pulmonary embolism was confirmed in all patients for whom a high risk was calculated according to the Wells score. In conclusion, a low degree of clinical probability (according to the Wells score), along with a normal concentration of D-dimer, are a sure strategy in excluding pulmonary embolism.Cilj rada je bio utvrditi povezanost kliničke slike, Wellsovog bodovnog sustava i vrijednosti D-dimera s MSCT plućnom angiografijom. Provedena je studija istraživanja parova u Objedinjenom hitnom bolničkom prijamu Kliničke bolnice „Sveti Duh“ tijekom cijele 2019. godine. U istraživanje su bili uključeni bolesnici sa uputnom dijagnozom plućne embolije. Bolesnici su podijeljeni u dvije skupine. U prvoj su skupini bili bolesnici kojima je dijagnoza plućne embolije potvrđena MSCT plućnom angiografijom ili post mortem, a drugu skupinu su činili bolesnici kod kojih je isključena plućna embolija. Za Wellsov skor, D-dimere, troponin, frekvenciju disanja i perifernu zasićenost krvi kisikom nađene su statistički značajne razlike između skupina bolesnika s potvrđenom, odnosno isključenom plućnom embolijom (p<0,001). Za frekvenciju srca, bol u prsima, sinkopu i hemoptizu nije nađena statistički značajna razlika između ove dvije skupine bolesnika. U >70% bolesnika s masivnom plućnom embolijom ultrazvučno je nađena duboka venska tromboza donjih ekstremiteta. Kod svih bolesnika kojima je prema Wellsovom bodovnom skoru izračunat visok rizik potvrđena je plućna embolija. Zaključno, niski stupanj kliničke vjerojatnosti (prema Wellsovom bodovnom skoru) zajedno s normalnom koncentracijom D-dimera sigurna su strategija u isključenju plućne embolije

Understanding young people's transitions in university halls through space and time

This article contributes to the theoretical discussion about young people's transitions through space and time. Space and time are complex overarching concepts that have creative potential in deepening understanding of transition. The focus of this research is young people's experiences of communal living in university halls. It is argued that particular space-time concepts draw attention to different facets of experience and in combination deepen the understanding of young people's individual and collective transitions. The focus of the article is the uses of the space-time concepts 'routine', 'representation', 'rhythm' and 'ritual' to research young people's experiences. The article draws on research findings from two studies in the North of England. © 2010 SAGE Publications

Seasonality of bivalve larvae within a high Arctic fjord

Paid Open Acces

Overview of the practices of on-farm emergency slaughter of cattle in the Nordic countries

On farm mortality is an increasing problem in cattle production systems in the Nordic countries. It represents an economic loss to the farmer and raises questions of sustainability, food waste and animal welfare. On-farm emergency slaughter (OFES) represents, in some situations, an opportunity for a farmer to salvage some of the economic value from an animal that cannot be transported to a slaughterhouse. The basis of the regulation of OFES in the Nordic countries originates largely from legislation from the European Union. However, this review has found that the availability and practice of OFES in the Nordic countries differs considerably. For example, in Norway 4.2% of all cattle slaughter is OFES, whilst in Iceland OFES has never been recorded. National food safety authorities have issued differing regulations and guidelines regarding the suitability of sick and injured animals for OFES. This review shows there is a paucity of data regarding the incidence and reasons for the use of OFES of cattle in the Nordic countries and points out the need for more investigation into this area to improve veterinary education, consumer protection and animal welfare