Małopłytkowość — najczęstsze zaburzenie hemostazy na OIT

Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units (ICUs). The mechanisms contributing to a decrease in the platelet count in critically ill patients are multifactorial, among which sepsis and trauma are the most frequent. A differential diagnosis of profound thrombocytopenia is crucial for effective treatment. A low platelet count is a strong independent predictor of morbidity and mortality because it is associated with life-threatening bleeding or thrombosis. This article aims to outline the definition and pathophysiology of thrombocytopenia and present a three-step algorithm of the clinical management of this haemostatic disorder

Małopłytkowość — najczęstsze zaburzenie hemostazy na OIT

Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units (ICUs). The mechanisms contributing to a decrease in the platelet count in critically ill patients are multifactorial, among which sepsis and trauma are the most frequent. A differential diagnosis of profound thrombocytopenia is crucial for effective treatment. A low platelet count is a strong independent predictor of morbidity and mortality because it is associated with life-threatening bleeding or thrombosis. This article aims to outline the definition and pathophysiology of thrombocytopenia and present a three-step algorithm of the clinical management of this haemostatic disorder.Thrombocytopenia is the most common haemostatic disorder in patients admitted to Intensive Care Units. The mechanisms contributing to decrease in platelet count in critically ill patients are multifactorial among which sepsis and trauma are the most frequent. Profound differential diagnosis of thrombocytopenia is crucial for effective treatment. Low platelet count is a strong independent predictor of morbidity and mortality because it is associated with life-threatening bleeding or thrombosis. This manuscript aims to outline the definition and pathophysiology of thrombocytopenia and present a three-step algorithm of clinical management of this haemostatic disorder

Multiple electrode aggregometry as a method for platelet function assessment according to the European guidelines

Platelets play an essential role in haemostasis. Assessment of their function is vital for anaesthesiologists evaluating haemostatic potential, especially during emergency operations. The monitoring of platelets function had been implemented into the European recommendations for management of perioperative and posttraumatic bleeding. One of the diagnostic methods described in the recommendations is multiple electrode aggregometry. As antiplatelet therapy becomes more widely used in modern medicine, this method, in contrast to standard laboratory tests, can significantly help to identify patients with drug-induced thrombocytopaty. The aggregometry enables prompt evaluation of the platelets aggregation which is very useful for everyday decision-making in goal-directed hemostatic therapy.Platelets play an essential role in haemostasis. Assessment of their function is vital for anaesthesiologists evaluating haemostatic potential, especially during emergency operations. The monitoring of platelets function had been implemented into the European recommendations for management of perioperative and posttraumatic bleeding. One of the diagnostic methods described in the recommendations is multiple electrode aggregometry. As antiplatelet therapy becomes more widely used in modern medicine, this method, in contrast to standard laboratory tests, can significantly help to identify patients with drug-induced thrombocytopaty. The aggregometry enables prompt evaluation of the platelets aggregation which is very useful for everyday decision-making in goal-directed hemostatic therapy

The assessment of platelet function using multiple electrode aggregometry in practical procedures in anaesthesia

Background: Platelets are responsible for primary haemostasis. Patients with suspected platelet dysfunction require prompt clinical assessment when qualifying for emergency surgical procedures. The purpose of this article is to present our experience in platelet function assessment using whole-blood multiple electrode aggregometry (MEA) in various clinical conditions. Case reports: Retrospective analysis of three patients with thrombocytopathy associated with normal platelet counts was performed using standard laboratory tests complemented by MEA. In two cases, platelet dysfunction was due to antiplatelet drugs, while in one other case it was caused by chronic kidney disease. Conclusions: Anaesthesiologists strive to make the perioperative period as safe as possible. Platelet function assessment should be considered in every patient in whom haemostatic disturbances are suspected. MEA provides support for clinical decision-making, especially in patients who undergo haemodialysis or require antiplatelet therapy, and are in need of emergency surgery.Background: Platelets are responsible for primary haemostasis. Patients with suspected platelet dysfunction requireprompt clinical assessment when qualifying for emergency surgical procedures. The purpose of this article is topresent our experience in platelet function assessment using whole-blood multiple electrode aggregometry (MEA)in various clinical conditions. Case reports: Retrospective analysis of three patients with thrombocytopathy associated with normal platelet countswas performed using standard laboratory tests complemented by MEA. In two cases, platelet dysfunction was dueto antiplatelet drugs, while in one other case it was caused by chronic kidney disease. Conclusions: Anaesthesiologists strive to make the perioperative period as safe as possible. Platelet function assessmentshould be considered in every patient in whom haemostatic disturbances are suspected. MEA provides supportfor clinical decision-making, especially in patients who undergo haemodialysis or require antiplatelet therapy, andare in need of emergency surgery

Non-invasive imaging tests in cardiology

Wprowadzenie. Nieinwazyjne badanie kardiologiczne to najbezpieczniejsza, a przy tym szybka i relatywnie tania możliwość oceny funkcjonowania układu sercowo-naczyniowego. Popularność oraz szczególna aprobata i uznanie dla wszystkich stosowanych technik, takich jak: echokardiografia, echokardiografia obciążeniowa, pozytonowa tomografia emisyjna, tomografia emisyjna pojedynczego fotonu, rezonans magnetyczny, związane są nie tylko z odpowiednim wysokiej jakości sprzętem, ale również z dużym doświadczeniem lekarza przeprowadzającego badanie. Cel pracy. Celem niniejszej pracy jest przedstawienie najczęściej stosowanych metod diagnostycznych w kardiologii nieinwazyjnej jakimi są: echokardiografia, echokardiografia obciążeniowa, pozytonowa tomografia emisyjna, tomografia emisyjna pojedynczego fotonu, rezonans magnetyczny. Opis stanu wiedzy. Wprowadzenie badania echokardiograficznego do diagnostyki kardiologicznej miało przełomowe znaczenie dla rozwoju tej dziedziny medycyny. Badanie echokardiograficzne obciążeniowe może być wykonywane zarówno metodą obciążenia wysiłkowego, stymulacją elektryczną, jak i metodą obciążenia farmakologicznego. Badanie PET przydatne jest w diagnostyce żywotności mięśnia sercowego – pozwala na pomiar aktywności fizjologicznej mięśnia sercowego. Badania scyntygraficzne najczęściej stosowane są w diagnostyce choroby niedokrwiennej serca oraz u osób, które są obciążone pośrednim ryzykiem wystąpienia choroby niedokrwiennej serca. Podsumowanie. Mimo iż od dawna mówi się o pandemii chorób sercowo-naczyniowych, to jednak pacjenci podstawowej opieki zdrowotnej nie korzystają z możliwości badań w kierunku ChUK. Wymaga to wprowadzania nowych rozwiązań, planów i programów zdrowotnych na skalę ogólnokrajową.Introduction. Non-invasive cardiac test is the safest, fast and relatively inexpensive opportunity to assess the functioning of the cardiovascular system. The popularity and the special appreciation for all the techniques used, such as: echocardiography, stress echocardiography, positron emission tomography, single photon emission computed tomography and magnetic resonance imaging, is associated not only with the appropriate high-quality equipment, but also with the extensive experience of the doctor who performs the examination. Objective. The aim of this study is to present the most commonly used methods of non-invasive diagnostic cardiology which are: echocardiography, stress echocardiography, positron emission tomography, single photon emission computed tomography and magnetic resonance imaging. Description of the state of the knowledge. The introduction of echocardiography into cardiac diagnostics was crucial for the development of this field of medicine. Stress echocardiography can be performed either by loading exercise, electrical stimulation and the pharmacological stress method. PET is useful in the diagnosis of myocardial viability – allows measurement of the physiological activity of the heart muscle. The body scan (scintigraphy) is most commonly used in the diagnosis of coronary artery disease, and in those who are subject to intermediate risk of coronary heart disease. Summary. Although for a long time it has been said about the pandemics of cardiovascular diseases, primary care patients still do not benefit from the possibility of screening for CVD. This requires the introduction of new solutions, health plans and programmes on a national scale

Effect of Intramuscular Tramadol on the Duration of Clinically Relevant Sciatic Nerve Blockade in Patients Undergoing Calcaneal Fracture Fixation: A Randomized Controlled Trial

Background: Calcaneal fracture fixation can generate severe postoperative pain and analgesia can be supported by a sciatic nerve block. However, following resolution of the sensory blockade, rebound pain may ensue. The aim of this study was to assess whether an incidental finding of two patients with an extension of the sciatic nerve block beyond 24 h following 100 mg of intramuscular tramadol administration could be confirmed. Methods: Thirty-seven patients scheduled for a calcaneal intramedullary fixation (Calcanail®) were randomly divided into two groups. The tramadol group (n = 19) received a sciatic nerve block with 20 mL of 0.25% bupivacaine and a concomitant dose of 100 mg of intramuscular tramadol, while the control group (n = 18) received an identical sciatic nerve block with concomitant injection of normal saline (placebo). All patients had a spinal anesthesia with light sedation for the procedure. The time to first analgesic request defined as appearance of any pain (NRS > 0) was assessed as the primary endpoint with a clinically relevant expected result of at least 50% elongation in sensory blockade. Results: The median time to first analgesic request from time of blockade in the tramadol group was 670 min compared with 578 min in the control group. The result was clinically not relevant and statistically not significant (p = 0.17). No statistical difference could be demonstrated in the time to first opioid request, although a trend for opioid sparing in the tramadol group could be seen. Total morphine consumption in the first 24 h was also statistically insignificant (the tramadol group 0.066 mg kg−1 compared with 0.125 mg kg−1 in the control group). In conclusion, intramuscular tramadol does not extend the duration of analgesia of a sciatic nerve block following a calcaneal fracture fixation beyond 2 h and an opioid sparing effect could not be demonstrated in this trial

What Do We Know about Early Management of Sepsis and Septic Shock in Polish Hospitals? A Questionnaire Study

Background: Sepsis and septic shock are medical emergencies with a high risk of poor prognosis. We investigate the correspondence between Surviving Sepsis Campaign (SSC) guidelines and clinical practice in Poland, with special attention given to differences between ICU and non-ICU environments as well as regional variations within the country. Methods: A web-based questionnaire study was performed on a random sample of 60 hospitals from the three most populated regions in Poland—Masovia, Silesia, and Greater Poland. A 19-item questionnaire was built based on the most recent edition of SSC guidelines. Results: Sepsis diagnosis was primarily based on clinical evaluation (ICUs: 94%, non-ICUs: 62%; p = 0.02). There were significant differences between ICUs and non-ICUs regarding taking blood cultures for pathogen identification (2-times more frequent in ICUs) and having hospital-based operating procedures to adjust antimicrobial treatment to a clinical scenario (a difference of 17%). Modification of empiric antimicrobial treatment was required post-ICU admission in 70% of cases. ICUs differed from non-ICUs with regard to the methods of fluid responsiveness assessment and the types of catecholamines and fluids used to treat septic shock. The mean fluid load applied before the implementation of catecholamines was 25.8 ± 10.6 mL/kg. Norepinephrine was the first-line agent used to treat shock, and balanced crystalloids were preferred in both ICUs and non-ICUs. Conclusion: Compliance with SCC guidelines in Polish hospitals is insufficient, especially outside ICUs. There is a need for education among healthcare professionals to reach at least an acceptable level of knowledge and attitude in this field

What Do We Know about Early Management of Sepsis and Septic Shock in Polish Hospitals? A Questionnaire Study

Background: Sepsis and septic shock are medical emergencies with a high risk of poor prognosis. We investigate the correspondence between Surviving Sepsis Campaign (SSC) guidelines and clinical practice in Poland, with special attention given to differences between ICU and non-ICU environments as well as regional variations within the country. Methods: A web-based questionnaire study was performed on a random sample of 60 hospitals from the three most populated regions in Poland—Masovia, Silesia, and Greater Poland. A 19-item questionnaire was built based on the most recent edition of SSC guidelines. Results: Sepsis diagnosis was primarily based on clinical evaluation (ICUs: 94%, non-ICUs: 62%; p = 0.02). There were significant differences between ICUs and non-ICUs regarding taking blood cultures for pathogen identification (2-times more frequent in ICUs) and having hospital-based operating procedures to adjust antimicrobial treatment to a clinical scenario (a difference of 17%). Modification of empiric antimicrobial treatment was required post-ICU admission in 70% of cases. ICUs differed from non-ICUs with regard to the methods of fluid responsiveness assessment and the types of catecholamines and fluids used to treat septic shock. The mean fluid load applied before the implementation of catecholamines was 25.8 ± 10.6 mL/kg. Norepinephrine was the first-line agent used to treat shock, and balanced crystalloids were preferred in both ICUs and non-ICUs. Conclusion: Compliance with SCC guidelines in Polish hospitals is insufficient, especially outside ICUs. There is a need for education among healthcare professionals to reach at least an acceptable level of knowledge and attitude in this field

Efficacy and Side Effect Profile of Intrathecal Morphine versus Distal Femoral Triangle Nerve Block for Analgesia following Total Knee Arthroplasty: A Randomized Trial

(1) Background: The management of postoperative pain after knee replacement is an important clinical problem. The best results in the treatment of postoperative pain are obtained using multimodal therapy principles. Intrathecal morphine (ITM) and single-shot femoral nerve block (SSFNB) are practiced in the treatment of postoperative pain after knee replacement, with the most optimal methods still under debate. The aim of this study was to compare the analgesic efficacy with special consideration of selected side effects of both methods. (2) Materials and methods: Fifty-two consecutive patients undergoing knee arthroplasty surgery at the Department of Orthopedics and Traumatology of the Medical University of Warsaw were included in the study. Patients were randomly allocated to one of two groups. In the ITM group, 100 micrograms of intrathecal morphine were used, and in the SSFNB group, a femoral nerve block in the distal femoral triangle was used as postoperative analgesia. The other elements of anesthesia and surgery did not differ between the groups. (3) Results: The total dose of morphine administered in the postoperative period and the effectiveness of pain management did not differ significantly between the groups (cumulative median morphine dose in 24 h in the ITM group 31 mg vs. SSFNB group 29 mg). The incidence of nausea and pruritus in the postoperative period differed significantly in favor of patients treated with a femoral nerve block. (4) Conclusions: Although intrathecal administration of morphine is similarly effective in the treatment of pain after knee replacement surgery as a single femoral triangle nerve block, it is associated with a higher incidence of cumbersome side effects, primarily nausea and pruritus

Fire Safety of Healthcare Units in Conditions of Oxygen Therapy in COVID-19: Empirical Establishing of Effects of Elevated Oxygen Concentrations

Large-scale usage of oxygen therapy (OT) may lead to increased oxygen concentrations (OC) in places where COVID-19 patients are treated. The aim of the study was to establish in an empirical way the OC in COVID-19 at the patient’s bedside and to assess the relationships and reactions that occur during OT in an uncontrolled oxygen-enriched environment. We analyzed and took into account the OC, the technical conditions of the buildings and the air exchange systems. Based on the results, we performed a Computational Fluid Dynamics analysis to assess evacuation conditions in the event of a fire outbreak in the COVID-19 zone. A total of 337 measurements of OC were carried out, and three safety thresholds were then defined and correlated with fire effects. The highest ascertained oxygen concentration was 25.2%. In the event of a fire outbreak at 25.2% oxygen in the atmosphere, the response time and evacuation of medical staff and patients is no longer than 2.5 min. Uncontrolled oxygen enrichment of the environment threatens the safety of medical staff and patients in COVID-19 hospitals