Anesthesia management for children with eye injuries

Eye injuries in childhood are very common and an important cause of ocular morbidity. They are a leading cause of non-congenital unilateral blindness in children.The anesthesia management of children with eye injuries requires particular skills and is a challange for all anesthesiologists. The anesthesia management must prove safety for the child, but also must not endanger eye injury any further. In the politraumatized child, trauma principlesmust allways be applied. Life-threatening problems should be managed before sight-threatening problems. General anesthesia is a choice for majority of child en with an eye injury.Maintenance of anesthesia will depend on patient factors, local facilities and surgeon preferences. Extubation is better to be performed in deep anesthesia, breathing spontaneously, lying on the side to avoid coughing and straining as this increase the risk of ocular hemorrhage. Multimodal approach and combination therapy (e.g. dexamethason and ondasteron) will minimize PONV in children. Satisfactory postoperative analgesia is important to have a non-crying and calm child to avoid rise in IOP and postoperative hemorrhage

Paravertebral block: review of the literature

Background: Paravertebral Block (PVB) is an established regional anesthetic technique. It is technically easy to perform and is being used increasingly for intra-operative and post-operative analgesia. This popularity is mainly due to the ease of the technique and fewer complications. Materials and Methods: This is quantitative systematic review of literature database with the aim to assess the efficacy and safety of Paravertebral block in thoracic, abdominal and breast surgery. Results: Six randomised control trials that included 386 patients were reviewed. Authors of reviewed articles reported 100% success in block effectivenes and low incidence of complications. Conclusion: Paravertebral block is effectiv anesthetic/analgetic technique with very few complications

Bol i palijativna medicina – tempus projekt u Hrvatskoj

Pain and Palliative Medicine Project (PPMP), funded by the TEMPUS programme of the European Union, has been established with a goal of sharing knowledge and experience from countries in which palliative care is already substantially developed to partner countries whose palliative care encountered more problems. Croatia as partner country, has tried to improve national palliative care systems through education of medical and non-medical personnel. Protocols of collaboration and training courses in pain management and palliative medicine at the Universities of Florence and Lyon, including options of collaboration with some university and clinical institutions in Croatia have been presented. After their two-year project, the Croatian team has noted significant progress in the fields of education, infrastructure and legislative support for development of palliative care. These results show the need for improving Croatian palliative care system as well as possible solutions for overcoming obstacles derived from nation’s traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenošenja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljšati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja. Prikazani su protokoli suradnje i tečajeva o boli i palijativnoj medicine na Sveučilištima u Firenci i Lyonu, kao i na nekim sveučilišnim i kliničkim institucijama u Hrvatskoj. Nakon dvogodišnjeg projekta hrvatski tim zabilježio je značajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljšavanjem hrvatske palijativne skrbi kao i moguća rješenja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda društva na skrb terminalno bolesnih

Dijagnostička vrijednost ultrazvuka srca u procjeni trajanja arterijske hipertenzije

The aim of the study was to assess the correlation between the degree and duration of arterial hypertension and the hypertrophy of the left ventricle and the ejection fraction of the heart, with cardiac ultrasound. Our prospective study included 50 patients with arterial hypertension as leading diagnosis. All 50 patients were consecutively examined in the Emergency Department and then referred to the Cardiac clinic of the Clinical Hospital “Sveti Duh” for further evaluation. The inclusion criteria were male and female aged 18 and older and arterial hypertension as leading diagnosis during Emergency Department visit. Exclusion criteria were pathological conditions that alter myocardial architecture and impair contractility. Measurement of the left ventricle thickness based on the thickness of the intraventricular septum and the posterior wall of the left ventricle, and the ejection fraction was ultrasonically determined. The highest proportion of subjects was with the first degree of arterial hypertension, followed by subjects with a third degree. The average duration of arterial hypertension was 6.14 years. Of the total number of subjects, 28% did not take any antihypertensive drugs. A statistically significant association was found between the degree and duration of arterial hypertension with the development of left ventricular hypertrophy. Significant association wasn’t found between the degree or duration of arterial hypertension and the heart ejection fraction. Our study have shown strong correlation between the degree and duration of arterial hypertension and the development of left ventricular hypertrophy and ultrasound could be a useful method in the evaluation of some patients with arterial hypertension in the emergency department.Cilj istraživanja je bio uz pomoć ultrazvuka srca procijeniti povezanosti između stupnja i duljine trajanja arterijske hipertenzije te razvoja hipertrofije lijeve klijetke i istisne frakcije srca. Provedeno je prospektivno istraživanje koje je uključivalo 50 bolesnika sa arterijskom hipertenzijom kao vodećom dijagnozom. Svih 50 bolesnika je uzastopno pregledano u Objedinjenom hitnom bolničkom prijamu, a nakon toga upućeno u kardiološku ambulantu Kliničke bolnice „Sveti Duh“ na daljnju obradu. U istraživanje su bili uključeni bolesnici stariji od 18 godina, oba spola, s vodećom dijagnozom arterijske hipertenzije postavljene u Objedinjenom hitnom bolničkom prijamu dok su iz istraživanja bili isključeni bolesnici s patološkim stanjima koja mijenjaju arhitekturu i narušavaju kontraktilnost srca. Ultrazvučno se određivala debljina stijenke lijeve klijetke sačinjena od debljine intraventrikularnog septuma i stražnje stijenke lijeve klijetke te istisna frakcija. Najveći udio ispitanika bio je s prvim stupnjem, a slijedili su ih ispitanici s trećim stupnjem arterijske hipertenzije. Prosječno trajanje arterijske hipertenzije iznosilo je 6.14 godina. Od ukupnog broja ispitanika, 28% nije uzimalo nikakve antihipertenzivne lijekove. Pronađena je statistički značajna povezanost između stupnja i duljine trajanja arterijske hipertenzije s razvojem hipertrofije lijeve klijetke. Nije pronađena značajna povezanost stupnja niti duljine trajanja arterijske hipertenzije s istisnom frakcijom srca. Naša studija pokazala je snažnu povezanost između stupnja i duljine trajanja arterijske hipertenzije i razvoja hipertrofije lijeve klijetke, a ultrazvuk bi mogao biti korisna metoda u procjeni nekih bolesnika s arterijskom hipertenzijom u hitnoj službi

Interkostalna hernacija pluća nakon tupe traume i odgođeni izvanpleuralni hematom

Blunt chest trauma is an important cause of morbidity and mortality in traumatized emergency patients. We report the case of a 74-year-old man who suffered a glenohumeral joint dislocation, trans trochanteric femur fracture, multiple rib fractures, diaphragmatic rupture with chest herniation of the spleen and stomach associated with herniation of the lung through an anterior chest wall defect after blunt trauma. Although immediate surgical repair was performed, he developed a delayed complication of multiple rib fracture in the form of large extrapleural hematoma that had to be surgically removed. Due to massive pulmonary contusion and prolonged pulmonary collapse, we used surfactant to facilitate alveolar opening after evacuation of the hematoma.Trauma prsnog koša uzrokovana udarcem tupim predmetom značajan je uzrok mortaliteta i morbiditeta bolesnika u hitnoj medicinskoj službi. Prikazujemo slučaj sedamdesetčetverogodišnjeg bolesnika koji je kao posljedicu udarca teškim predmetom doživio dislokaciju ramenog zgloba, transtrohanternu frakturu bedrene kosti, obostranu serijsku frakturu rebara, rupturu dijafragme s hernijacijom slezene i želuca u prsište uz pridruženu interkostalnu ventralnu hernijaciju pluća kroz ozlijeđeno prsište. Unatoč hitnom kirurškom zbrinjavanju, kao kasna posljedica serijskog prijeloma rebara razvio se veliki izvan pleuralni hematom koji je bilo potrebno kirurški evakuirati. Zbog velike kontuzije pluća i dugotrajnog kolapsa alveola, nakon odstranjena hematoma primijenili smo surfaktant kako bi potpomogli otvaranje i održavanje alveola otvorenima

EU project for training in ICU during the COVID pandemic (C19-SPACE)

Pandemija COVID-19 započela je u Wuhanu, Kina, u prosincu 2019. godine, brzo se šireći izvan Kine. U ožujku 2020. godine Svjetska zdravstvena organizacija (SZO) službeno je proglasila pandemiju. Pandemija je imala ozbiljne zdravstvene, socijalne i ekonomske posljedice, a zdravstveni sustav u Hrvatskoj, kao i u većini zemalja svijeta, suočavao se s brojnim izazovima i opterećenjima. Nedostatak bolničkih kreveta, posebno u jedinicama intenzivne medicine (JIM), te manjak medicinskog osoblja s kompetencijama potrebnim za skrb o najtežim bolesnicima predstavljali su ozbiljne izazove i stvarali značajne poteškoće u skrbi oboljelih od bolesti COVID-19. Europsko društvo za intenzivnu medicinu (engl. European Society of Intensive Care Medicine, ESICM) jedno je od prvih društava koje je naglasilo važnost dodatne edukacije liječnika i sestara/tehničara te organiziralo edukaciju za medicinsko osoblje kako bi im pružili osnovna znanja i vještine za rad s bolesnicima zaraženima bolešću COVID- 19. U razdoblju od 10. listopada 2020. do 9. svibnja 2021. provedena je izobrazba prvenstveno neintenzivnog medicinskog osoblja kako bi se povećao broj zdravstvenog osoblja koje bi se moglo rasporediti u vrijeme kada postoji potreba za brzim, privremenim i značajnim povećanjem kapaciteta u JIM-u te unaprijedila kvaliteta zbrinjavanja oboljelih od bolesti COVID-19.The COVID-19 pandemic began in Wuhan, China, in December 2019, quickly spreading out of China. In March 2020, the World Health Organization (WHO) declared the novel coronavirus outbreak a global pandemic. The pandemic had serious health, social, and economic consequences, and healthcare systems in Croatia and most countries worldwide faced numerous challenges and burdens. Shortages of hospital beds, especially in intensive care units (ICUs), and a lack of staff with skills or experience in the management of critically ill patients presented serious challenges.The European Society of Intensive Care Medicine (ESICM) was one of the first organizations to emphasize the importance of additional education for doctors, nurses, and technicians. They organized training for healthcare personnel to provide essential knowledge and skills for managing COVID-19 patients. From October 10, 2020, to May 9, 2021, education was primarily provided to nonintensive care medical personnel to increase the pool of healthcare workers available for rapid, temporary, and significant capacity expansion in ICUs and to enhance the quality of care for COVID-19 patients

DELIRIUM INCIDENCE IN PEDIATRIC INTENSIVE CARE UNIT

Delirij je ozbiljan neuropsihijatrijski poremećaj a delirij djece u jedinicama intenzivnog liječenja je kao klinički entitet neprepoznat. Rana dijagnoza delirija djece važna je zbog pravovremene terapije i raznih psihosocijalnih postupaka. Dijagnostika delirija u dječjoj populaciji je otežana jer postoji više ljestvica i testova ali niti jedan nije dovoljno specifičan i osjetljiv za procjenu mentalnog statusa djece u jedinicama intenzivnog liječenja. Algoritam za dijagnostiku i liječenje delirija djece u jedinicama intenzivnog liječenja ne postoji te je potrebno dodatnih kliničkih ispitivanja i radova radi poboljšanja dijagnostike i terapije tog ozbiljnog kliničkog entiteta.Delirium is a serious neuropsychiatric disorder and pediatric delirium (PD) is a similarly serious condition. PD is understudied and very often misdiagnosed, especially in pediatric intensive care units (PICU). It is important to early diagnose PD, so that early psychosocial interventions and therapy can be introduced. Valid diagnostic instruments are needed at PICU to assess PD. There are many scales and tests to diagnose delirium but none of them is specific enough to diagnose PD. Although PD is a serious complication at PICU, clinical guidelines for PD are still lacking, therefore additional investigations are needed to bring them out

Antibiotic-induced toxic epidermal necrolysis - a case report

Toxic epidermal necrolysis (TEN) is severe cutaneousToxic epidermal necrolysis (TEN) is severe cutaneous hypersensitivity reaction characterized by necrosis of the epidermis and detachment of the epidermis and dermis that usually occurs as an idiosyncratic reaction to certain drugs. We report the case of a patient admitted to our Intensive Care Unit after an above-the-knee amputation who developed toxic epidermal necrolysis, possibly resulting from antibiotics therapy. Therapy included a combination of intravenous immunoglobulin with gentle early debridement of necrotic skin areas followed by wound coverage with a synthetic cover (Aquacel Ag®). This case report suggests that intensive wound management together with intravenous immunoglobulin might be beneficial in the treatment of patients with TEN.</p

Bol i palijativna medicina – tempus projekt u Hrvatskoj

Pain and Palliative Medicine Project (PPMP), funded by the TEMPUS programme of the European Union, has been established with a goal of sharing knowledge and experience from countries in which palliative care is already substantially developed to partner countries whose palliative care encountered more problems. Croatia as partner country, has tried to improve national palliative care systems through education of medical and non-medical personnel. Protocols of collaboration and training courses in pain management and palliative medicine at the Universities of Florence and Lyon, including options of collaboration with some university and clinical institutions in Croatia have been presented. After their two-year project, the Croatian team has noted significant progress in the fields of education, infrastructure and legislative support for development of palliative care. These results show the need for improving Croatian palliative care system as well as possible solutions for overcoming obstacles derived from nation’s traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenošenja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljšati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja. Prikazani su protokoli suradnje i tečajeva o boli i palijativnoj medicine na Sveučilištima u Firenci i Lyonu, kao i na nekim sveučilišnim i kliničkim institucijama u Hrvatskoj. Nakon dvogodišnjeg projekta hrvatski tim zabilježio je značajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljšavanjem hrvatske palijativne skrbi kao i moguća rješenja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda društva na skrb terminalno bolesnih