Chemical disasters

Nesreće uzrokovane kemijskim sojevima mogu biti uzrokom teških posljedica. Uzroci mogu biti (1) prirodni (vulkani, požari, deflacija, mineralni i termalni izvori, oceani, drugo), (2) prirodne opasnosti (potresi, poplave, munje, smrzavanja) mogu biti uzrokom događaja koji ugrožavaju sigurnost i rad kemijskih postrojenja i izazivaju nesreće (Natech) i (3) ljudske aktivnosti – industrijski objekti; promet. Kao primjeri teških nesreća često se navodi tvornica Bhopal u Indiji (otrovanje metilcijanatom) i nesreća u talijanskom gradu Saveso (dioksin). Posljedice kemijskih katastrofa su velike štete na opasnim postrojenjima, ispuštanje opasnih tvari u okoliš, požari i eksplozija što rezultira teškim posljedicama po zdravlje, zagađenje okoliša i ekonomskim gubicima.Accidents caused by chemical compounds can cause serious consequences. The causes can be (1) natural (volcanoes, fires, deflation, mineral and thermal springs, oceans, other), (2) natural hazards (earthquakes, floods, lightning, freezing) can be the cause of events that threaten the safety and operation of chemical plants and cause accidents (Natech) and (3) human activities (immovable – industrial facilities; moving traffic). The Bhopal Plant in India (methylcyanate poisoning) and the accident in the Italian city of Saveso (dioxin) are often cited as examples of serious accidents. The consequences of chemical catastrophes include huge damage to hazardous facilities, the release of dangerous substances into the environment, fires and explosions, which result in serious consequences for health, environmental pollution and economic losses

Reducing the incidence of adverse events in anesthesia practice

Background and purpose: adverse event during anesthesia is defined as an event that may result in the development of complications and is caused by human error, failure of the apparatus, the selected anesthetic techniques and individual reaction of the patient. Timely detection of adverse events prevents complications and their analysis through the register of the same to the adoption of preventive and remedial measures. Materials and methods:The Department of Anesthesiology in General Hospital Karlovac, in accordance with the accreditation standards of the Republic of Croatia monitors adverse events during anesthesia, the waking up period and the stay on the ward during the first 24 hours, and the type of anesthesia techniques applied. Results: During the 2012, a total of 4244 anesthesia with a 1.25% complications was done.We have been monitoring the number of anesthesia since 2011. when the percentage of complications was 5.4%. This is the basis to conclude that there is a tendency to reduce the number of complications. Anesthesia was classified as general and regional. The use of ultrasound contributes to safety of regional anesthesia, especially nerve conduction anesthesia of extremities and thus reducing the volume of local anesthetic administered and its toxicity. The incidence of complications of regional anesthesia among all regional anesthesias done during the 2012 was 0,31%. Conclusion: Keeping the register of complications during anesthesia has led to increased awareness of the need to record them and analyze the causes and consequences of complications at the department meetings. There is a trend of increased use of regional anesthesia techniques as indicated

MALIGNANT PAIN IN EMERGENCY MEDICINE

Bol je potrebno liječiti prema prihvaćenim smjernicama, a cilj je našeg istraživanja bio utvrđivanje učestalosti i osobitosti intervencija u izvanbolničkoj hitnoj medicini (HMP) zbog liječenja maligne boli. Učinili smo retrospektivnu analizu prospektivne baze podataka Nastavnog zavoda za hitnu medicinu Grada Zagreba u razdoblju od 1. siječnja do 31. prosinca 2014.godine. U ispitivanje su uključeni bolesnici oboljeli od maligne bolesti, a razlog intervencija tima hitne medicinske pomoći bila je maligna bol. Analizirani su: demografski podatci (dob, spol), struktura ispitanika prema vrsti maligne bolesti (Međunarodna klasifikacija bolesti), vrijeme intervencije (noć/dan), vrijeme intervencije prema danu u tjednu, vrsta primijenjenog analgetika (neopioid, opioid, adjuvantni analgetik) i načinu unosa analgetika u organizam. Podatci su prikazani u tablicama, kategorijske i nominalne vrijednosti prikazane su odgovarajućim frekvencijama i udjelima. U promatranom razdoblju HMP Zagreb imao je 70 155 intervencija, a zbog maligne boli ih je bilo 516 (0,74 %): 265 (51 %) bolesnica 251 (49 %) bolesnika. Povećan udio starije dobne skupine uzrok je sve većeg broja novootkrivenih bolesnika s malignim bolestima. Tako distribucija bolesnika prema dobnim skupinama pokazuje da je najveći broj bolesnika bio između 60. i 80. godine života (335 ili 64,91 %). Između 50. i 60. godine života pomoć je zatražio dvostruko manji broj bolesnika - 85 (16,47 %). Prema MBK klasifi kaciji bolesti najčešći uzrok bolova zbog kojih su bolesnici zatražili pomoć HMP-a bile su zloćudne novotvorine probavnih organa (138, 26,74%), respiratornih i intratorakalnih organa (10,5, 20,34 %). Tijekom dana ekipa HMP-a obavila je 288 (55,81 %) intervencija, tijekom noći 228 (44,19 %) .Tijekom vikenda obavljeno je 178 (34,36 %) intervencija, a radnim danom 340 (65,64 %). Ove intervencije posljedica su specifične organizacije rada izvanbolničkih zdravstvenih djelatnosti. Neopioidni su analgetici kao prva stepenica u liječenju maligne boli primijenjeni su puta 303 (58,72 %), slabi opioidi 205 puta (39,74 %), a jaki opioidi 8 puta (1,55 %). Glavna prepreka za optimalno liječenje boli je neadekvatna procjena boli. Najčešća je bila intramuskularna primjena analgetika (483, 93,24 %), a potom intravenska (21, 4,05 %) i supkutana (10, 1,93 %). Zaključujemo da je neophodno potrebno educirati timove HMP-a s naglaskom na procjenu jačine boli ljestvicama za bol uz propisivanje analgetske terapije sukladno preporukama.It is necessary to treat pain according to accepted guidelines and the goal of our research was to determine the frequency and characteristics of interventions in outpatient emergency medical services (EMS) for the treatment of malignant pain. We performed retrospective analysis of the prospective database of the Zagreb Municipal Teaching Institute of Emergency Medicine in the period from January 1 to December 31, 2014. The study included patients suffering from malignant diseases and malignant pain as the reason for the EMS team intervention. We analyzed demographic data (age, gender), structure of patients by type of malignant disease (International Classifi cation of Diseases, ICD), time of intervention (night/day), time of intervention according to day of the week, type of analgesics applied (non-opioid, opioid analgesic or adjuvant), and the route of painkiller administration. Data are presented in tables, categorical and nominal values are shown as appropriate frequencies and shares. Zagreb EMS had 70,155 interventions in the period observed, of which 516 (0.74%) patients with malignant pain, including 265 (51%) female and 251 (49%) male patients. The increased proportion of elderly population caused a growing number of newly diagnosed patients with malignant diseases. Therefore, distribution of patients according to age groups showed that the highest number of patients were in the 60-80 age group (n=335; 64.91%). Eighty-five (16.47%) patients aged 50-60 requested help from EMS. According to the ICD, the most common cause of pain for which patients sought help from EMS were malignant neoplasms of digestive organs (n=138; 26.4%), respiratory and intrathoracic organs (10.5% and 20.34%, respectively). The EMS team had 288 (55.81%) interventions during the day and 228 (44.19%) interventions during the night. They had 178 (34.36%) interventions over weekend and 340 (65.64%) interventions on work days. These interventions are the result of the specifi c work organization of outpatient hospital health services. Non-opioid analgesics as the fi rst step in the treatment of malignant pain were administered 303 (58.72%) times, weak opioids 205 (39.74) times, and strong opioids 8 (1.55%) times. The main obstacle to optimal pain management is inadequate assessment of pain. Intramuscular administration of analgesics (n=483; 93.24%) was most frequent, followed by intravenous (n=21; 4.05%) and subcutaneous (n=10; 1.93%) route. We conclude that it is necessary to educate EMS teams, especially focusing on the assessment of the degree of pain using scales for pain with prescription of analgesic therapy in accordance with recommendations

Prikladni alati za procjenu kronične boli u kliničkoj praksi

The aim of the study was to show the role of tools in the evaluation of chronic pain (CP) in general practitioner (GP) everyday clinical practice. The study was done by analyzing electronic database of the first visits of 1090 CP patients referred to the Pain Clinic of the Karlovac General Hospital, Karlovac, Croatia, by their GPs. All patient records were analyzed according to the cause of CP, strongest pain a week before the examination, quality of sleep, and the Patients’ Global Impression of Change scale. All statistical analyses were done using the IBM SPSS Statistics version 19.0.0.1 (www.spss.com). CP predominantly occurs in older age group. Patients with musculoskeletal pain accounted for the highest percentage (n=316; 29%), followed by those with neuropathic pain (n=253; 23.20%) and those with low back pain (n=225; 20.60%). The mean pain intensity rating scale score was 8.3±1.8 a week before the examination and the mean quality of sleep score was 6.8±1.9. Moderate and severe sleep quality disorder was significantly present in patients over 65 years of age (p=0.007), patients with musculoskeletal and neuropathic pain, back pain, and those having rated Patients’ Global Impression of Change scale as worsening (p=0.001). The severity of pain and poor quality of sleep are the leading causes of deterioration of the Patients’ Global Impression of Change scale in patients suffering from musculoskeletal and neuropathic pain. In order to treat CP comprehensively, it is important for GPs to evaluate the outcomes of clinical treatment using tools for CP assessment.Cilj istraživanja bio je pokazati ulogu alata za procjenu kronične boli u svakodnevnoj kliničkoj praksi obiteljskog liječnika. Istraživanje je provedeno analizom elektroničke baze podataka prvog pregleda 1090 bolesnika s kroničnom boli upućenih od obiteljskog liječnika u Ambulantu za bol Opće bolnice Karlovac, Karlovac, Hrvatska. Za sve bolesnike analizirani su uzrok kronične boli, najjača bol tjedan dana prije pregleda, kvaliteta sna i ljestvica općeg dojma bolesnika o promjeni. Statistička analiza je učinjena pomoću programa IBM SPSS Statistics ver. 19.0.0.1 (www.spss.com). Kronična bol se pretežito javlja u starijoj dobnoj skupini. Najzastupljeniji su bili bolesnici s mišićno-koštanom boli (n=316; 29%), potom oni s neuropatskom boli (n=253; 23,20%) i oni s bolnim leđima (n=225; 20,60%). Srednja najjača bol (Pain Intensity Rating Scale, PI-NRS) tjedan dana prije pregleda bila je 8,3±1,8, a kvaliteta sna 6,8±1,9. Srednje jaki i jaki poremećaj kvalitete sna značajnije je prisutan kod bolesnika iznad 65 godina starosti (p=0,007), bolesnika s mišićno-koštanom, neuropatskom boli i bolnim leđima te onih koji su prema ljestvici općeg dojma bolesnika o promjeni ocijenili kao pogoršanje (p=0,001). Jačina boli i loša kvaliteta sna bili su vodeći uzrok pogoršanja prema ljestvici općeg dojma bolesnika o promjeni za bolesnike koji boluju od mišićno-koštane i neuropatske boli. Radi sveobuhvatnog liječenja važno je da obiteljski liječnici procijene ishode kliničkog liječenja alatima za procjenu kronične boli