1,959 research outputs found
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 settingās.PoremeÄaji koagulacije Äesti su u kritiÄnih bolesnika i u bolesnika s krvarenjem, te predstavljaju veliki izazov za sve lijeÄnike
koji su ukljuÄeni u rad hitne medicinske službe. LijeÄenje bolesnika s krvarenjem ukljuÄuje kontrolu krvarenja, nadoknadu
volumena krvi i korekciju koagulopatije. Tradicionalno, za korekciju koagulopatije i sprjeÄavanje krvarenja najÄeÅ”Äe se
koristi svježe smrznuta plazma (SSP), no danas se kao alternativa sve ÄeÅ”Äe koristi koncentrat protrombinskog kompleksa
(engl. prothrombin complex concentrates - PCC) zbog brojnih prednosti u odnosu na SSP, a koje ukljuÄuju primjenu manjeg
volumena, bržu korekciju IN R-a, bržu dostupnost, bolji sigurnosni profil, a takoÄer nije potrebna ni krvno grupna specifiÄnost.
Cilj ovog rada je pružiti kratki pregled o osnovnim indikacijama, sigurnosti i uÄinkovitosti primjene PCC u stanjima
krvarenja razliÄite etiologije
Zbrinjavanje hitnih stanja vezanih uz arterijsku hipertenziju u izvanbolniÄkoj 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 najÄeÅ”Äi uzrok kardiovaskularnih bolesti kao i smrtnosti. Znatno pridonosi uÄestalosti ostalih kroniÄnih bolesti, od kojih su najuÄestalije infarkt miokarda i moždani udar. Arterijska hipertenzija, bilo ona kroniÄna neregulirana, a posebno u sluÄaju hipertenzivne hitnoÄe ili emergencije, kompleksno je stanje koje je potrebno odgovarajuÄe procijeniti i zbrinuti. Hipertenzivne emergencije nisu uÄestale u populaciji, ali su ozbiljna hitna stanja koja u kratkom vremenu, ako se odgovarajuÄe ne zbrinu, uzrokuju ireverzibilno oÅ”teÄenje i gubitak funkcije ciljnih organa. Promptno i uÄinkovito postupanje u izvanbolniÄkoj 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 izvanbolniÄkog srÄanog zastoja - poboljÅ”anje uspjeÅ”nosti 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 izvanbolniÄki srÄani zastoj (ISZ) doživi oko 8000 osoba na godinu. Preživljenje od ISZ opÄenito
ostaje nisko unatoÄ 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 srÄanom arestu
Utstein. U analizama je primijenjen deskriptivni prikaz podataka. Podaci su izraženi kao apsolutne frekvencije i postoci te
mjere srediŔnje tendencije. Testiranje korelacija povratka spontane cirkulacije (return of spontaneous circulation, ROSC) provedeno
je logistiÄkom regresijom. Tijekom razdoblja promatranja ukupno su u izvanbolniÄkoj HMS na podruÄju 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 bolniÄku službu prijavljeni su u 126 (17%)
sluÄajeva. Ritam koji je za defibrilaciju u odnosu na ritmove srÄanog zastoja koji se ne defibriliraju (OR: 5,832, 95% CI:
3,621-9,392; p<0,001) i osvjedoÄeni srÄani zastoj od strane laika (OR: 8,213, 95% CI: 2,554-26,411, p<0,001) bili su znaÄajno
povezani s veÄom vjerojatnoÅ”Äu preživljavanja. Nije bilo znaÄajne razlike u korelaciji s dnevnom ili noÄnom smjenom i
etiologijom srÄanog zastoja. Stopa preživljenja bolesnika s ISZ u Republici Hrvatskoj kod kojih je provedena kardiopulmonalna
reanimacija do prijma u hitnu bolniÄku službu bila je 17%. VeÄa stopa preživljenja nakon ISZ bila je vjerojatnija meÄu
bolesnicima kod kojih je zapoÄeta kardiopulmonalna reanimacija od strane laika i koji su imali srÄani 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 ļ¬ 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 Ļ2-test was used to assess difference in the frequency of bleeding as the cause of emergency attendance (Ļ2=7.501; p<0.01). Conclusion: Study ļ¬ ndings suggested that patients using direct oral anticoagulants as anticoagulant therapy adjusted to renal function had signiļ¬ 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 viÅ”e, Äime uporaba antikoagulantne terapije u svijetu raste. BuduÄi da krvarenje nastaje kod uporabe varfarina kao i direktnih antikoagulansa, cilj ovoga istraživanja bio je pokazati postoji li razlika u uÄestalosti krvarenja kao glavnog uzroka hitnosti u ovih bolesnika ovisno o primijenjenom antikoagulansu. Metode: U istraživanje su bila ukljuÄena 83 bolesnika na antikoagulantnoj terapiji s kroniÄnom bubrežnom boleÅ”Äu stadija 2-4, pregledana u Hitnom prijmu KliniÄke bolnice Merkur u razdoblju od sedam mjeseci. Skupina A obuhvaÄala je 22 bolesnika (8 muÅ”karaca) na varfarinskoj terapiji, a skupina B 61 bolesnika (19 muÅ”karaca) na direktnoj oralnoj antikoagulantnoj terapiji. Srednja dob u skupini A bila je 80,77 godina, a u skupini B 80,95 godina. Nisu naÄene razlike u komorbiditetima meÄu skupinama. Doze antikoagulantnih lijekova bile su prilagoÄene bubrežnoj funkciji. Rezultati: U skupini A je glavni uzrok hitnosti bilo krvarenje u 15/22 (68,18%) bolesnika (veÄinom gastrointestinalnog podrijetla), dok je u skupini B krvarenje pronaÄeno u 21/61 (34,42%) bolesnika. Za provjeru statistiÄke znaÄajnosti razlike krvarenja kao glavne hitnosti meÄu dvjema skupinama bolesnika primijenjen je Ļ2-test (Ļ2=7,501; p<0,01). ZakljuÄak: Primjenom direktnih oralnih antikoagulantnih lijekova u dozi prilagoÄenoj bubrežnoj funkciji bilježi se statistiÄki znaÄajno manje krvarenja kao glavnog uzroka hitnosti u usporedbi s varfarinom
Dijagnostika pluÄne embolije u Objedinjenom hitnom bolniÄkom 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 kliniÄke slike, Wellsovog bodovnog sustava i vrijednosti D-dimera s MSCT pluÄnom
angiografijom. Provedena je studija istraživanja parova u Objedinjenom hitnom bolniÄkom prijamu KliniÄke bolnice āSveti
Duhā tijekom cijele 2019. godine. U istraživanje su bili ukljuÄeni bolesnici sa uputnom dijagnozom pluÄne embolije. Bolesnici
su podijeljeni u dvije skupine. U prvoj su skupini bili bolesnici kojima je dijagnoza pluÄne embolije potvrÄena MSCT
pluÄnom angiografijom ili post mortem, a drugu skupinu su Äinili bolesnici kod kojih je iskljuÄena pluÄna embolija. Za Wellsov
skor, D-dimere, troponin, frekvenciju disanja i perifernu zasiÄenost krvi kisikom naÄene su statistiÄki znaÄajne razlike izmeÄu
skupina bolesnika s potvrÄenom, odnosno iskljuÄenom pluÄnom embolijom (p<0,001). Za frekvenciju srca, bol u prsima,
sinkopu i hemoptizu nije naÄena statistiÄki znaÄajna razlika izmeÄu ove dvije skupine bolesnika. U >70% bolesnika s masivnom
pluÄnom embolijom ultrazvuÄno je naÄena duboka venska tromboza donjih ekstremiteta. Kod svih bolesnika kojima je
prema Wellsovom bodovnom skoru izraÄunat visok rizik potvrÄena je pluÄna embolija. ZakljuÄno, niski stupanj kliniÄke
vjerojatnosti (prema Wellsovom bodovnom skoru) zajedno s normalnom koncentracijom D-dimera sigurna su strategija u
iskljuÄenju pluÄne 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. Ā© 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
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