9 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
Public access to the āRestart a Heart ā Save a Lifeā early defibrillation programme in Croatia
In collaboration with the Croatian Institute of Emergency Medicine and the Croatian Institute of Public Health, the Ministry
of Health launched the National Public Access to Early Defibrillation Programme entitled āRestart a Heart ā Save a Lifeā in
2013. The main implementing activities are public health education about early defibrillation in the case of sudden cardiac
arrest, enlarging the accessibility of the automated external defibrillator (AED) and training laymen to perform cardiopulmonary
resuscitation and defibrillation by use of AED. Forty-one training courses were organised and 422 lay people trained
in 2013. In addition, 197 AEDs were obtained and fitted in settings where people are expected to assemble permanently or
occasionally. The āRestart a Heart ā Save a Lifeā programme ensures a broad platform for joint action of public administration
authorities, governmental and nongovernmental agencies, and all organisations and individuals interested in reaching the
goal of increasing the rate of survival of people suffering from a sudden cardiac arrest
Promjene uÄestalosti trovanja psihoaktivnim lijekovima u Hrvatskoj
The aim of this study was to analyse the frequency of poisoning with psychoactive drugs (benzodiazepines, antidepressants and neuroleptics) over the last 15 years in Croatia. The analysis was based on poisoning incidents reported over the phone (hot line) to the Zagreb Poison Control Center and included two periods: 1985ā1991 (period I) and 1992ā1999 (period II). The data were analysed separately for children and adults. Each phone call was counted as one poisoning incident. Child poisoning with neuroleptics was significantly higher in period II than in period I and so was the adult poisoning with antidepressants, amytriptyline, and combined psychoactive drugs. The frequency of total psychoactive drug poisoning was significantly higher in adults than in children in both periods. From 1992, the frequency of adult poisoning with antidepressants considerably increased as one of the many consequences of war-related stress. The results indicate a need for careful psychiatric evaluation and more critical use of antidepressants in affected individuals.Retrospektivno su analizirani telefonski pozivi vezani uz ingestije lijekova primljeni u nacionalnom Centru za kontrolu otrovanja u Zagrebu u posljednjih 15 godina. Tri skupine psihoaktivnih lijekova (benzodiazepini, neuroleptici, antidepresivi) bile su od posebnog znaÄenja u ovom radu. Svi sluÄajevi ingestije lijekova analizirani su u dva vremenska intervala: period I (1985.ā1991.) i period II (1992.ā1999.) te u dvije skupine s obzirom na dob otrovanih: djeca (<16 godina) i odrasli (316 godina). Svaki telefonski poziv brojen je kao jedan sluÄaj trovanja, ukljuÄujuÄi i viÅ”estruke ingestije lijekova (ingestije viÅ”e od jedne vrste lijeka u isto vrijeme) koje su ukljuÄivale barem jedan psihoaktivni lijek. Kod djece, uÄestalost akutnih otrovanja neurolepticima bila je znaÄajno veÄa u periodu II nego u periodu I (7.4%:4.4%; P<0.05). UÄestalost otrovanja benzodiazepinima, antidepresivima i amitriptilinom kod djece nije se znaÄajno razlikovala u periodu I i II (benzodiazepini ā 13.5%:9.9%; antidepresivi ā 1.8%:1.8%; amitriptilin ā 0.3%:0.6%), kao ni uÄestalost viÅ”estrukih ingestija lijekova (19.4%:20.5%). Kod odraslih, uÄestalost otrovanja antidepresivima i amitriptilinom bila je znaÄajno veÄa u periodu II nego u periodu I (antidepresivi ā 13.0%:5.9%; P<0.01; amitriptilin ā 7.3%:2.9%; P<0.05), kao i uÄestalost viÅ”estrukih ingestija lijekova (45.3%: 29.1%; P<0.01). UÄestalost otrovanja benzodiazepinima i neurolepticima kod odraslih nije se znaÄajno razlikovala u periodu I i II (benzodiazepini ā 27.5%: 28.4%; neuroleptici ā 20.6%: 19.7%). U oba perioda uÄestalost otrovanja psihoaktivnim lijekovima bila je znaÄajno veÄa u odraslih nego u djece (period I ā 53.9%: 19.4%; P<0.01; period II ā 61.3%:19.1%; P<0.01). Od 1992. u Hrvatskoj se bilježi znaÄajan porast broja akutnih otrovanja antidepresivima, osobito tricikliÄkim, u odraslih osoba, Å”to je vezano vjerojatno uz uÄestalije propisivanje tih lijekova. Ovaj fenomen nije zabilježen u djece. PoveÄanje uÄestalosti akutnih otrovanja psihoaktivnim lijekovima, kao jedna od mnogih posljedica rata i posttraumatskoga stresnog poremeÄaja, upuÄuje na potrebu pažljive psihijatrijske procjene oboljelih, osobito pažljiviju uporabu antidepresiva. Rezultati ovog rada govore u prilog potrebe daljnjeg istraživanja uÄestalosti propisivanja psihoaktivnih lijekova u Hrvatskoj
Public access to the āRestart a Heart ā Save a Lifeā early defibrillation programme in Croatia
In collaboration with the Croatian Institute of Emergency Medicine and the Croatian Institute of Public Health, the Ministry
of Health launched the National Public Access to Early Defibrillation Programme entitled āRestart a Heart ā Save a Lifeā in
2013. The main implementing activities are public health education about early defibrillation in the case of sudden cardiac
arrest, enlarging the accessibility of the automated external defibrillator (AED) and training laymen to perform cardiopulmonary
resuscitation and defibrillation by use of AED. Forty-one training courses were organised and 422 lay people trained
in 2013. In addition, 197 AEDs were obtained and fitted in settings where people are expected to assemble permanently or
occasionally. The āRestart a Heart ā Save a Lifeā programme ensures a broad platform for joint action of public administration
authorities, governmental and nongovernmental agencies, and all organisations and individuals interested in reaching the
goal of increasing the rate of survival of people suffering from a sudden cardiac arrest
Correlation of Psychosis and Suicide Attempts with Meteorological Factors
ln this study the authors have tried to find out if there is any correlation between weather caracteristics and acute psychoses and suicidal attempts (APSA). This research was based on SHMP data about the number of interventions in cases of APSA over a period of one year (VI/1988 - V/1989) in Zagreb and on the meteorological data registered at the Observatory Zagreb-Maksimir in the same
period as well as on weather charts prepared daily or collected in the
Hydrometeorological lnstitute of Croatia in Zagreb. A possible correlation with weather types and passages of cold fronts and especially with meteorological elements as: cloudiness, barometric pressure, air temperature and relative humidity, was studied. Linear correlation coefficients were calculated for daily values and for moving three-, five- and seven-day periods.
The results revealed that the number of psychoses and suicidal attempts increased from month to month during the period considered, especially in females of the 15-20, 21-30 and 31-40 age groups. The acute psychosis and suicidal attempt number does not significantly differ with respect to weather type. The daily frequency of these pathological reactions increases in all seasons typically a
day or two before and after a cold font passage, but differences are not significant. A significant correlation was obtained only with the duration of a high daily cloudiness amount. Suicidal attempts and psychoses increase significantly if the cloudy period lasts at least three days, but their significance is higher if the cloudy weather period is longer
RECOGNITION AND TIMELY TREATMENT OF CARBON MONOXIDE POISONING
Ugljikov monoksid (CO) je visokotoksiÄni bezbojni plin, bez okusa i mirisa koji je posvuda prisutan u suvremenom industrijskom druÅ”tvu. Dijagnoza otrovanja ovisi o detaljnim anamnestiÄkim podatcima koji ukazuju na povezanost simptoma i znakova otrovanja i izloženosti iz okoliÅ”a. Za potvrdu dijagnoze potrebno je odreÄivanje razine karboksihemoglobina u venskoj ili arterijskoj krvi, koje je rijetko dostupno u izvanbolniÄkim uvjetima. Novi pulsni CO-oksimetri mjere apsorpciju svjetlosti na 8 valnih duljina pa osim uobiÄajene razine zasiÄenja hemoglobina kisikom pokazuju postotak karboksihemoglobina u krvi. Osnova lijeÄenja je brza primjena normobariÄnog kisika s visokim protokom putem maske sa spremnikom. MeÄutim, joÅ” uvijek nema opÄeprihvaÄenih kriterija za lijeÄenje hiperbariÄnim kisikom kao ni dobrih pokazatelja kod kojih bolesnika takvo lijeÄenje osigurava bolji ishod i manju vjerojatnost nastanka kasnih neuroloÅ”kih posljedica.Carbon monoxide (CO) is a colorless, odorless, tasteless, and extremely toxic gas, which is ubiquitous in our industrial society. Diagnosing CO poisoning relies on taking thorough history exploring the relationship of symptoms and signs of poisoning to environmental CO exposure. Venous or arterial blood gas analysis measurement of carboxyhemoglobin is required for deļ¬ nitive diagnosis, and this is rarely available outside the hospital environment. New eight-wavelength pulse oximeters are designed to measure carboxyhemoglobin, in addition to the usual measurements of hemoglobin oxygen saturation. Essential treatment for CO poisoning is immediate delivery of high ļ¬ ow normobaric oxygen through a non-rebreather mask with reservoir bag. However, still no consensus exists on hyperbaric oxygen therapy, and reliable indicators for identifying patients who will beneļ¬ t from such therapy with better outcomes and lower risk of delayed neurological sequels are also lacking
Mucoepidermoid Carcinoma Misdiagnosed as Palatal Odontogenic Infection: An Overview on the Differential Diagnosis of Palatal Lesions
Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authorsā knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MECās differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list
Mucoepidermoid carcinoma misdiagnosed as palatal odontogenic infection: an overview on the differential diagnosis of palatal lesions [Mukoepidermoidni karcinom pogreÅ”no dijagnosticiran kao odontogena upala: pregled diferencijalne dijagnoze nepÄanih lezija]
Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authorsā knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MECās differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list
Mukoepidermoidni karcinom pogreÅ”no dijagnosticiran kao odontogena upala: pregled diferencijalne dijagnoze nepÄanih lezija
Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authorsā knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MECās differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list.Mucoepidermoidni carcinom (MEC) Äini oko 30% malignih tumora žlijezda slinovnica i otprilike isto toliko ih nastaje u malim žlijezdama slinovnicama. Nepce je najÄeÅ”Äa lokalizacija onih koji nastaju u malim žlijezdama slinovnicama. Bolesnik star 33 godine s nepÄanim MEC-om neuspjeÅ”no je lijeÄen kao akutna odontogena upala, koja nije reagirala na endodontsko lijeÄenje zuba, viÅ”ekratne incizije i antibiotike. Na tvrdom nepcu postojala je polukuglasta, tvrda, bezbolna tvorba koja nije prelazila srediÅ”nju liniju. UÄinjena je djelomiÄna maksilektomija. Temeljem pregleda literature prikazujemo diferencijalnu dijagnozu nepÄanih lezija. Koliko je autorima poznato ovo je prvi prikaz nepÄanoga MEC-a pogreÅ”no dijagnosticiranoga i lijeÄenoga kao odontogena upala. S obzirom da diferencijalno dijagnostiÄki postoje brojne promjene na nepcu, sada u diferencijalnu dijagnozu MEC-a možemo pribrojiti i akutnu odontogenu upalu