10 research outputs found
MOTORCYCLE EMERGENCY MEDICAL SERVICE
Nastavni zavod za hitnu medicinu u suradnji s Gradom Zagrebom provodi probni projekt Hitna medicinska pomoÄ na motociklu od 2016. godine kada su nabavljena dva motocikla za pružanje medicinske pomoÄi. U 2019. godini projekt je proÅ”iren nabavom dvaju novih snažnijih motocikla. T3 timovi, medicinski tehniÄari na motociklima interveniraju od travnja do listopada kao tri tima rasporeÄena na tri lokacije: Centar, Jarun i Dubrava. Ciljevi projekta su skratiti vrijeme dolaska timova hitne medicinske pomoÄi na mjesto intervencije, smanjiti mortalitet kardiorespiratornog aresta, uÄinkovitije rasporediti raspoložive resurse (timovi na terenu) te podiÄi standard hitne medicinske pomoÄi u Gradu Zagrebu. Njihova prednost je Å”to brže i lakÅ”e stižu do unesreÄenih na gradskim prometnicama, osobito u vrijeme prometnih gužvi. Hitnoj pomoÄi na motociklu treba prosjeÄno 5,18 minuta za dolazak na mjesto intervencije, dok je za isto standardnom timu s kombijem potrebno oko 10,45 minuta. U 2019. godini ukupan broj intervencija HMP na motociklu iznosi 807, od toga 253 samostalne i 554 zajedno s vozilom HMP. ZapoÄeto je 11 reanimacija od medicinskog tehniÄara na motociklu, a vrijeme dolaska za prvi stupanj hitnosti iznosi 4,57 minuta. Medicinska oprema na motociklu sastoji se od AVD, kisika, opreme za zbrinjavanje diÅ”nog puta, glukometra, iv. kanile, infuzija, zavojnih materijala, ovratnika, udlaga i START trijaža seta. Neka od ograniÄenja hitne pomoÄi na motociklu su vremenski uvjeti, visoka riziÄnost rada, oprema ā prostor na motoru, ļ¬ nanciranje timova na motociklu i brojnost Älanova tima hitne medicinske službe. U buduÄnosti je cilj dodatno educirati medicinske tehniÄare i poveÄati broj postupaka na terenu, standardizirati kadar, poveÄati broj timova te obnoviti vozni park.Emergency Medicine Service, in cooperation with the City of Zagreb, has been implementing the pilot project Medical Emergency Motorcycle Assistance since 2016, with two motorcycles provided to enable emergency medical assistance. In 2019, the project was expanded with the acquisition of two new more powerful motorcycles. The T3 teams, motorcycle medical technicians, intervene from April to October as three teams deployed at three locations, i.e. Center, Jarun and Dubrava. The aim of the project is to shorten the time of emergency medical (EM) team arrival to the site of intervention, reduce the cardiac arrest mortality, provide more efļ¬ cient allocation of available resources (teams in the ļ¬ eld), and raise the standard of EM care in Zagreb. Their advantage is that they get to casualties on city roads as quickly and easily as possible, especially during trafļ¬ c jams. It takes the mean of 5.18 minutes for a motorcycle ambulance to arrive to the intervention site versus 10.45 minutes needed for the standard ambulance team to arrive. In 2019, the total number of motorcycle EM interventions was 807, of which 253 were standalone and 554 together with the EM team. Eleven resuscitations were started by a medical technician on the motorcycle and the mean arrival time for high-risk emergency was 4.57 minutes. Motorcycles are equipped with an automatic external deļ¬ brillator, oxygen, respiratory care equipment, glucometer, IV cannulas, infusions, bandages, collars, splints and START triage sets. Some of the limitations of a motorcycle ambulance are the weather, highrisk work, equipment (limited space on the motorcycle), ļ¬ nancing the motorcycle teams, and number of EM team members. The goal in the future is to further educate the teams and increase the number of interventions, standardize staff, increase the number of teams, and renew the existing equipment
EUROPEAN RESUSCITATION COUNCIL GUIDELINES FOR RESUSCITATION 2010
Osnovno održavanje života odraslih. ā Svi spaÅ”avatelji, bilo osposobljeni ili ne, kod žrtava kardijalnog aresta moraju primijeniti vanjsku masažu srca. Cilj je pritisnuti prsni koÅ” do dubine od najmanje 5 cm, frekvencijom od najmanje 100 kompresija u minuti, ali i dopustiti ponovo odizanje prsnog koÅ”a, te smanjiti prekide u kompresijama. Osposobljeni bi spaÅ”avatelji trebali primijeniti i ventilaciju s omjerom kompresija-ventilacija od 30:2. LijeÄenje strujom. ā Mnogo je veÄi naglasak na smanjivanju trajanja stanki prije ili poslije defibrilacije; preporuÄuje se nastavak vanjske masaže srca tijekom punjenja defibrilatora. PotiÄe se daljnji razvoj programa automatskih vanjskih defibrilatora (AED). Napredno održavanje života odraslih. ā NaglaÅ”ena je važnost visokokvalitetnih kompresija na prsni koÅ” tijekom provoÄenja ALS-a, koje se prekidaju samo kako bi se omoguÄili specifiÄni postupci. Uklanja se preporuka o potrebi reanimacije tijekom odreÄenog vremena prije defibrilacije nakon kardijalnog aresta izvan bolnice, kojemu nije svjedoÄilo osoblje hitne medicinske pomoÄi. Smanjena je uloga prekordijalnog udarca. Primjena lijekova putem endotrahealnog tubusa viÅ”e se ne preporuÄuje, veÄ se lijekovi moraju primijeniti intraosealnim (IO) pristupom. Atropin se viÅ”e ne preporuÄuje za rutinsku primjenu tijekom asistolije ili elektriÄne aktivnosti bez pulsa. Smanjen je naglasak na ranu endotrahealnu intubaciju ako ju ne provodi visokostruÄna osoba uz najmanji moguÄi prekid vanjske masaže srca. PoveÄan je naglasak na uporabu kapnografije. Prepoznat je moguÄ Å”tetan uÄinak hiperoksemije. Revidirana je preporuka za kontrolu glikemije. PreporuÄuje se primjena terapijske hipotermije kod komatoznih bolesnika nakon kardijalnog aresta povezanog s poÄetnim ritmovima koji se defibriliraju, kao i onima koji se ne defibriliraju, za ove druge sa smanjenom razinom dokaza. PoÄetno zbrinjavanje akutnih koronarnih sindroma. ā Uveden je pojam infarkt miokarda bez ST-elevacijeāakutni koronarni sindrom (NSTEMI-ACS) koji obuhvaÄa infarkt miokarda bez elevacije ST-spojnice i nestabilnu anginu pektoris. Primarna PCI (PPCI) najpoželjniji je reperfuzijski postupak, uz uvjet da ga obavi iskusan tim i u skladu s vremenskim okvirima. U lijeÄenju bi trebalo izbjegavati nesteroidne protuupalne lijekove, rutinsku intravensku primjenu beta-blokatora i kisik ā osim u sluÄaju hipoksemije, zaduhe ili zastoja na pluÄima. Održavanje života djece. ā Odluka o zapoÄinjanju reanimacije mora se donijeti u manje od 10 sekundi. Laike treba poduÄavati reanimaciji s omjerom 30 kompresija naprama 2 ventilacije, a spaÅ”avatelji koji imaju dužnost odgovoriti na poziv trebaju primjenjivati omjer kompresije-ventilacije od 15:2, meÄutim, ako su sami, mogu primijeniti omjer od 30:2. Ventilacija i dalje ostaje vrlo važna sastavnica reanimacije asfiksijskog aresta. Naglasak je na postizanju kvalitetnih kompresija frekvencije najmanje 100, ali ne viÅ”e od 120 u minuti, uz minimalne prekide. Automatski vanjski defibrilatori sigurni su i uspjeÅ”ni kada se primjenjuju kod djece starije od jedne godine. Za defibrilaciju kod djece preporuÄuje se jedna defibrilacija od 4 J/kg Äija se jaÄina ne poveÄava. Sa sigurnoÅ”Äu se mogu rabi endotrahealni tubusi s balonÄiÄem i kod dojenÄadi i kod mlaÄe djece. Monitoriranje izdahnutog ugljikova dioksida (CO2), najbolje kapnografijom, preporuÄuje se tijekom reanimacije. Reanimacija novoroÄenÄadi na porodu. ā Kod neugrožene novoroÄenÄadi sada se preporuÄuje odgaÄanje podvezivanja pupÄane vrpce od najmanje jedne minute nakon potpunog roÄenja djeteta. Za donoÅ”enu novoroÄenÄad, tijekom reanimacije pri porodu trebao bi se rabiti zrak. Za nedonoÅ”Äad mlaÄu od 32 tjedna gestacije treba razumno primijeniti mjeÅ”avinu kisika i zraka te primjena treba biti voÄena pulsnim oksimetrom. NedonoÅ”Äad mlaÄu od 28 tjedana gestacije trebalo bi neposredno nakon roÄenja potpuno do podruÄja vrata omotati plastiÄnom folijom, bez suÅ”enja. PreporuÄen omjer kompresija-ventilacija u reanimaciji novoroÄenÄadi ostaje 3:1. Ne preporuÄuje se pokuÅ”avati aspirirati mekonij iz nosa i usta joÅ” neroÄenog djeteta, dok mu je glava joÅ” na meÄici. Ako se daje adrenalin, preporuÄuje se intravenska primjena u dozi od 10 do 30 Āµg/kg. Kod terminske ili gotovo terminske novoroÄenÄadi s umjerenom do teÅ”kom hipoksiÄno-ishemijskom encefalopatijom preporuÄuje se terapijska hipotermija. NaÄela poduÄavanja reanimacije. ā Cilj je osigurati da polaznici steknu i zadrže vjeÅ”tine i znanje koje Äe im omoguÄiti ispravno djelovanje tijekom stvarnoga kardijalnog aresta te poboljÅ”ati ishod bolesnika. Kratki video/kompjutorski teÄajevi za samostalno uÄenje, s minimalnom ulogom instruktora ili bez njega, udruženi s praktiÄnom nastavom mogu se smatrati jednako uÄinkovitom alternativom teÄajevima osnovnog održavanja života (BLS i AED) koje vode instruktori. U najboljem sluÄaju, svi bi graÄani trebali biti osposobljeni za standardnu KPR koja ukljuÄuje vanjsku masažu srca i ventilaciju. Znanje i vjeÅ”tine osnovnog i naprednog održavanja života smanjuju se u samo tri do Å”est mjeseci. UreÄaji s glasovnim uputama tijekom reanimacije ili povratnim informacijama unaprjeÄuju stjecanje i zadržavanje vjeÅ”tina.Basic Life Support. ā All rescuers trained or not, should provide chest compressions to victims of cardiac arrest. The aim should be to push to a depth of at least 5 cm at a rate of at least 100 compressions per minute, to allow full chest recoil, and to minimise interruptions in chest compressions. Trained rescuers should also provide ventilations with a compression-ventilation ratio of 30:2. Electrical therapies. ā Much greater emphasis on minimising the duration of the pre-shock and post-shock pauses; the continuation of compressions during charging of the defibrillator is recommended. Further development of AED programmes is encouraged. Adult Advanced Life Support. ā Increased emphasis on high-quality chest compressions throughout any ALS intervention paused briefly only to enable specific interventions. Removal of the recommendation for a pre-specified period of cardiopulmonary resuscitation before out-of-hospital defibrillation following cardiac arrest unwitnessed by the EMS. The role of precordial thump is de-emphasized. Delivery of drugs via a tracheal tube is no longer recommended, drugs should be given by the intraosseous (IO) route. Atropine is no longer recommended for routine use in asystole or pulseless electrical activity. Reduced emphasis on early tracheal intubation unless achieved by highly skilled individuals with minimal interruptions in chest compressions. Increased emphasis on the use of capnography. Recognition of potential harm caused by hyperoxaemia. Revision of the recommendation of glucose control. Use of therapeutic hypothermia to include comatose survivors of cardiac arrest associated initially with shockable rhythms, as well as non-shockable rhythms, with a lower level of evidence acknowledged for the latter. Initial management of acute coronary syndromes. ā The term non-ST-elevation myocardial infarction-acute coronary syndrome (non-STEMI-ACS) has been introduced for both NSTEMI and unstable angina pectoris. Primary PCI (PPCI) is the preferred reperfusion strategy provided it is performed in a timely manner by an experienced team. Non-steroidal anti-inflammatory drugs should be avoided, as well as routine use of intravenous beta- blockers; oxygen is to be given only to those patients with hypoxaemia, breathlessness or pulmonary congestion. Paediatric Life Support. ā The decision to begin resuscitation must be taken in less than 10 seconds. Lay rescuers should be taught to use a ratio of 30 compressions to 2 ventilations, rescuers with a duty to respond should learn and use a 15:2 ratio; however, they can use the 30:2 compression-ventilation ratio if they are alone. Ventilation remains a very important component of resuscitation in asphyxial arrest. The emphasis is on achieving quality compressions with the rate of at least 100 but not greater than 120 per minute, with minimal interruptions. AEDs are safe and successful when used in children older than 1 year. A single shock strategy using a non-escalating dose of 4 J/kg is recommended for defibrillation in children. Cuffed tubes can be used safely in infants and young children. Monitoring exhaled carbon dioxide (CO2), ideally by capnography, is recommended during resuscitation. Resuscitation of babies at birth. ā For uncompromised babies, a delay in cord clamping of at least one minute from the complete delivery is now recommended. For term infants, air should be used fro resuscitation at birth. For preterm babies less than 32 weeks gestation blended oxygen and air should be given judiciously and its use guided by pulse oximetry. Preterm babies of less than 28 weeks gestation should be completely covered in a plastic wrap up to their necks, without drying, immediately after birth. The recommended compression: ventilation ratio remains at 3:1 for newborn resuscitation. Attempts to aspirate meconium from the nose and mouth of the unborn baby, while the head is still on the perineum, are not recommended. If adrenaline is given the n the intravenous route is recommended using a dose of 10ā30 Āµg /kg. Newly born infants born at term or near-term with moderate to severe hypoxic-ischaemic encephalopathy should be treated with therapeutic hypothermia. Principles of education in resuscitation. ā The aim is to ensure that learners acquire and retain skill and knowledge that will enable them to act correctly in actual cardiac arrest and improve patient outcome. Short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered as an effective alternative to instructor-led basic life support (BLS and AED) courses. Ideally all citizens should be trained in standard CPR that includes compressions and ventilations. Basic and advanced life support knowledge and skills deteriorate in as little as three to six months. CPR prompt or feedback devices improve CPR skill acquisition and retention
Smjernice za reanimaciju Europskog vijeÄa za reanimatologiju 2015. godine [European resuscitation council guidelines for resuscitation 2015]
Adult basic life support and automated external defibrillation ā Interactions between the emergency medical dispatcher, the bystander who provides CPR and the timely deployment of an AED is critical. All CPR providers should perform chest compressions, those who are trained and able should combine chest compressions and rescue breaths in the ratio 30:2. Defibrillation within 3ā5 min of collapse can produce survival rates as high as 50ā70%. Adult advanced life support ā Continued emphasis on minimally interrupted high-quality chest compressions, paused briefly only to enable specific interventions, including interruptions for less than 5 s to attempt defibrillation. Use of self-adhesive pads for defibrillation. Waveform capnography to confirm and continually monitor tracheal tube placement, quality of CPR and to provide an early indication of return of spontaneous circulation. Cardiac arrest in special circumstances ā Special causes: hypoxia; hypo-/hyperkalemia, and other electrolyte disorders; hypo-/hyperthermia; hypovolemia; tension pneumothorax; tamponade; thrombosis; toxins. Special environments are specialised healthcare facilities, commercial airplanes or air ambulances, field of play, outside environment or the scene of a mass casualty incident. Special patients are those with severe comorbidities and with specific physiological conditions. Post resuscitation care is new to the ERC Guidelines. Targeted temperature management remains, now aiming at 36Ā°C instead of the previously recommended 32 ā 34Ā°C. Pediatric life support ā For chest compressions, the lower sternum should be depressed by at least one third the anterior-posterior diameter of the chest (4 cm for the infant and 5 cm for the child). For cardioversion of a supraventricular tachycardia (SVT), the initial dose has been revised to 1 J kgā1. Resuscitation and support of transition of babies at birth ā For uncompromised babies, a delay in cord clamping of at least one minute from the complete delivery of the infant, is now recommended for term and preterm babies. Tracheal intubation should not be routine in the presence of meconium and should only be performed for suspected tracheal obstruction. Ventilatory support of term infants should start with air. Acute coronary syndrome (ACS) ā Pre-hospital recording of a 12-lead electrocardiogram (ECG) is recommended in patients with suspected ST segment elevation acute myocardial infarction (STEMI). Patients with acute chest pain with presumed ACS do not need supplemental oxygen unless they present with signs of hypoxia, dyspnea, or heart failure. In geographic regions where PCI facilities exist and are available, direct triage and transport for PCI is preferred to pre-hospital fibrinolysis for STEMI. First aid is included for the first time in the 2015 ERC Guidelines. Principles of education in resuscitation ā Directive CPR feedback devices are useful for improving compression rate, depth, release, and hand position. Whilst optimal intervals for retraining are not known, frequent ālow doseā retraining may be beneficial. Training in non-technical skills is an essential adjunct to technical skills. The ethics of resuscitation and end-of-life decisions ā Ethical principles in the context of patient-centered health care: autonomy, beneficence, non-maleficence; justice and equal access. The need for harmonisation in legislation, jurisdiction, terminology and practice still remains within Europe
STRESS AND STRAIN ANALYSIS OF AN AXIAL BELLOW
U radu je dana analiza aksijalnoga kompenzatora pri poviÅ”enoj temperaturi. Analiza se vrÅ”i primjenom metode konaÄnih elemenata pomoÄu osnosimetriÄnih elemenata. Iznosi se teorijska osnova modeliranja kontakta u metodi konaÄnih elemenata.This paper presents an analysis of an axial bellow expansion joint at elevated temperature. The analysis is performed with the finite element method, using axisymmetric elements. The theory of contact modeling in the finite element method is given
MOTORCYCLE EMERGENCY MEDICAL SERVICE
Nastavni zavod za hitnu medicinu u suradnji s Gradom Zagrebom provodi probni projekt Hitna medicinska pomoÄ na motociklu od 2016. godine kada su nabavljena dva motocikla za pružanje medicinske pomoÄi. U 2019. godini projekt je proÅ”iren nabavom dvaju novih snažnijih motocikla. T3 timovi, medicinski tehniÄari na motociklima interveniraju od travnja do listopada kao tri tima rasporeÄena na tri lokacije: Centar, Jarun i Dubrava. Ciljevi projekta su skratiti vrijeme dolaska timova hitne medicinske pomoÄi na mjesto intervencije, smanjiti mortalitet kardiorespiratornog aresta, uÄinkovitije rasporediti raspoložive resurse (timovi na terenu) te podiÄi standard hitne medicinske pomoÄi u Gradu Zagrebu. Njihova prednost je Å”to brže i lakÅ”e stižu do unesreÄenih na gradskim prometnicama, osobito u vrijeme prometnih gužvi. Hitnoj pomoÄi na motociklu treba prosjeÄno 5,18 minuta za dolazak na mjesto intervencije, dok je za isto standardnom timu s kombijem potrebno oko 10,45 minuta. U 2019. godini ukupan broj intervencija HMP na motociklu iznosi 807, od toga 253 samostalne i 554 zajedno s vozilom HMP. ZapoÄeto je 11 reanimacija od medicinskog tehniÄara na motociklu, a vrijeme dolaska za prvi stupanj hitnosti iznosi 4,57 minuta. Medicinska oprema na motociklu sastoji se od AVD, kisika, opreme za zbrinjavanje diÅ”nog puta, glukometra, iv. kanile, infuzija, zavojnih materijala, ovratnika, udlaga i START trijaža seta. Neka od ograniÄenja hitne pomoÄi na motociklu su vremenski uvjeti, visoka riziÄnost rada, oprema ā prostor na motoru, ļ¬ nanciranje timova na motociklu i brojnost Älanova tima hitne medicinske službe. U buduÄnosti je cilj dodatno educirati medicinske tehniÄare i poveÄati broj postupaka na terenu, standardizirati kadar, poveÄati broj timova te obnoviti vozni park.Emergency Medicine Service, in cooperation with the City of Zagreb, has been implementing the pilot project Medical Emergency Motorcycle Assistance since 2016, with two motorcycles provided to enable emergency medical assistance. In 2019, the project was expanded with the acquisition of two new more powerful motorcycles. The T3 teams, motorcycle medical technicians, intervene from April to October as three teams deployed at three locations, i.e. Center, Jarun and Dubrava. The aim of the project is to shorten the time of emergency medical (EM) team arrival to the site of intervention, reduce the cardiac arrest mortality, provide more efļ¬ cient allocation of available resources (teams in the ļ¬ eld), and raise the standard of EM care in Zagreb. Their advantage is that they get to casualties on city roads as quickly and easily as possible, especially during trafļ¬ c jams. It takes the mean of 5.18 minutes for a motorcycle ambulance to arrive to the intervention site versus 10.45 minutes needed for the standard ambulance team to arrive. In 2019, the total number of motorcycle EM interventions was 807, of which 253 were standalone and 554 together with the EM team. Eleven resuscitations were started by a medical technician on the motorcycle and the mean arrival time for high-risk emergency was 4.57 minutes. Motorcycles are equipped with an automatic external deļ¬ brillator, oxygen, respiratory care equipment, glucometer, IV cannulas, infusions, bandages, collars, splints and START triage sets. Some of the limitations of a motorcycle ambulance are the weather, highrisk work, equipment (limited space on the motorcycle), ļ¬ nancing the motorcycle teams, and number of EM team members. The goal in the future is to further educate the teams and increase the number of interventions, standardize staff, increase the number of teams, and renew the existing equipment
Application of gradient elasticity to armchair carbon nanotubes: Size effects and constitutive parameters assessment
The central focus of the paper is set on modelling of bending of armchair carbon nanotubes by means of the gradient elasticity theory. Influence of small-size effects on the Young's modulus is investigated. An attempt to determine small size (or nonlocal) parameter employed in the Bernoulli-Euler and Timoshenko gradient formulations is presented. To obtain such a goal, the paper provides an extensive set of molecular structural mechanics simulations of armchair nanotubes with different loading and kinematic boundary conditions. Dependence of the Young's modulus on small size effects is clearly noticed. Based on these results, small scale parameters for the gradient model are identified and limits of the method are pointed out. Results of the study indicate that the widely used theory should be modified to obtain a physically justified and reliable nanobeam model based on Bernoulli-Euler or Timoshenko kinematic assumptions
EUROPEAN RESUSCITATION COUNCIL GUIDELINES FOR RESUSCITATION 2010
Osnovno održavanje života odraslih. ā Svi spaÅ”avatelji, bilo osposobljeni ili ne, kod žrtava kardijalnog aresta moraju primijeniti vanjsku masažu srca. Cilj je pritisnuti prsni koÅ” do dubine od najmanje 5 cm, frekvencijom od najmanje 100 kompresija u minuti, ali i dopustiti ponovo odizanje prsnog koÅ”a, te smanjiti prekide u kompresijama. Osposobljeni bi spaÅ”avatelji trebali primijeniti i ventilaciju s omjerom kompresija-ventilacija od 30:2. LijeÄenje strujom. ā Mnogo je veÄi naglasak na smanjivanju trajanja stanki prije ili poslije defibrilacije; preporuÄuje se nastavak vanjske masaže srca tijekom punjenja defibrilatora. PotiÄe se daljnji razvoj programa automatskih vanjskih defibrilatora (AED). Napredno održavanje života odraslih. ā NaglaÅ”ena je važnost visokokvalitetnih kompresija na prsni koÅ” tijekom provoÄenja ALS-a, koje se prekidaju samo kako bi se omoguÄili specifiÄni postupci. Uklanja se preporuka o potrebi reanimacije tijekom odreÄenog vremena prije defibrilacije nakon kardijalnog aresta izvan bolnice, kojemu nije svjedoÄilo osoblje hitne medicinske pomoÄi. Smanjena je uloga prekordijalnog udarca. Primjena lijekova putem endotrahealnog tubusa viÅ”e se ne preporuÄuje, veÄ se lijekovi moraju primijeniti intraosealnim (IO) pristupom. Atropin se viÅ”e ne preporuÄuje za rutinsku primjenu tijekom asistolije ili elektriÄne aktivnosti bez pulsa. Smanjen je naglasak na ranu endotrahealnu intubaciju ako ju ne provodi visokostruÄna osoba uz najmanji moguÄi prekid vanjske masaže srca. PoveÄan je naglasak na uporabu kapnografije. Prepoznat je moguÄ Å”tetan uÄinak hiperoksemije. Revidirana je preporuka za kontrolu glikemije. PreporuÄuje se primjena terapijske hipotermije kod komatoznih bolesnika nakon kardijalnog aresta povezanog s poÄetnim ritmovima koji se defibriliraju, kao i onima koji se ne defibriliraju, za ove druge sa smanjenom razinom dokaza. PoÄetno zbrinjavanje akutnih koronarnih sindroma. ā Uveden je pojam infarkt miokarda bez ST-elevacijeāakutni koronarni sindrom (NSTEMI-ACS) koji obuhvaÄa infarkt miokarda bez elevacije ST-spojnice i nestabilnu anginu pektoris. Primarna PCI (PPCI) najpoželjniji je reperfuzijski postupak, uz uvjet da ga obavi iskusan tim i u skladu s vremenskim okvirima. U lijeÄenju bi trebalo izbjegavati nesteroidne protuupalne lijekove, rutinsku intravensku primjenu beta-blokatora i kisik ā osim u sluÄaju hipoksemije, zaduhe ili zastoja na pluÄima. Održavanje života djece. ā Odluka o zapoÄinjanju reanimacije mora se donijeti u manje od 10 sekundi. Laike treba poduÄavati reanimaciji s omjerom 30 kompresija naprama 2 ventilacije, a spaÅ”avatelji koji imaju dužnost odgovoriti na poziv trebaju primjenjivati omjer kompresije-ventilacije od 15:2, meÄutim, ako su sami, mogu primijeniti omjer od 30:2. Ventilacija i dalje ostaje vrlo važna sastavnica reanimacije asfiksijskog aresta. Naglasak je na postizanju kvalitetnih kompresija frekvencije najmanje 100, ali ne viÅ”e od 120 u minuti, uz minimalne prekide. Automatski vanjski defibrilatori sigurni su i uspjeÅ”ni kada se primjenjuju kod djece starije od jedne godine. Za defibrilaciju kod djece preporuÄuje se jedna defibrilacija od 4 J/kg Äija se jaÄina ne poveÄava. Sa sigurnoÅ”Äu se mogu rabi endotrahealni tubusi s balonÄiÄem i kod dojenÄadi i kod mlaÄe djece. Monitoriranje izdahnutog ugljikova dioksida (CO2), najbolje kapnografijom, preporuÄuje se tijekom reanimacije. Reanimacija novoroÄenÄadi na porodu. ā Kod neugrožene novoroÄenÄadi sada se preporuÄuje odgaÄanje podvezivanja pupÄane vrpce od najmanje jedne minute nakon potpunog roÄenja djeteta. Za donoÅ”enu novoroÄenÄad, tijekom reanimacije pri porodu trebao bi se rabiti zrak. Za nedonoÅ”Äad mlaÄu od 32 tjedna gestacije treba razumno primijeniti mjeÅ”avinu kisika i zraka te primjena treba biti voÄena pulsnim oksimetrom. NedonoÅ”Äad mlaÄu od 28 tjedana gestacije trebalo bi neposredno nakon roÄenja potpuno do podruÄja vrata omotati plastiÄnom folijom, bez suÅ”enja. PreporuÄen omjer kompresija-ventilacija u reanimaciji novoroÄenÄadi ostaje 3:1. Ne preporuÄuje se pokuÅ”avati aspirirati mekonij iz nosa i usta joÅ” neroÄenog djeteta, dok mu je glava joÅ” na meÄici. Ako se daje adrenalin, preporuÄuje se intravenska primjena u dozi od 10 do 30 Āµg/kg. Kod terminske ili gotovo terminske novoroÄenÄadi s umjerenom do teÅ”kom hipoksiÄno-ishemijskom encefalopatijom preporuÄuje se terapijska hipotermija. NaÄela poduÄavanja reanimacije. ā Cilj je osigurati da polaznici steknu i zadrže vjeÅ”tine i znanje koje Äe im omoguÄiti ispravno djelovanje tijekom stvarnoga kardijalnog aresta te poboljÅ”ati ishod bolesnika. Kratki video/kompjutorski teÄajevi za samostalno uÄenje, s minimalnom ulogom instruktora ili bez njega, udruženi s praktiÄnom nastavom mogu se smatrati jednako uÄinkovitom alternativom teÄajevima osnovnog održavanja života (BLS i AED) koje vode instruktori. U najboljem sluÄaju, svi bi graÄani trebali biti osposobljeni za standardnu KPR koja ukljuÄuje vanjsku masažu srca i ventilaciju. Znanje i vjeÅ”tine osnovnog i naprednog održavanja života smanjuju se u samo tri do Å”est mjeseci. UreÄaji s glasovnim uputama tijekom reanimacije ili povratnim informacijama unaprjeÄuju stjecanje i zadržavanje vjeÅ”tina.Basic Life Support. ā All rescuers trained or not, should provide chest compressions to victims of cardiac arrest. The aim should be to push to a depth of at least 5 cm at a rate of at least 100 compressions per minute, to allow full chest recoil, and to minimise interruptions in chest compressions. Trained rescuers should also provide ventilations with a compression-ventilation ratio of 30:2. Electrical therapies. ā Much greater emphasis on minimising the duration of the pre-shock and post-shock pauses; the continuation of compressions during charging of the defibrillator is recommended. Further development of AED programmes is encouraged. Adult Advanced Life Support. ā Increased emphasis on high-quality chest compressions throughout any ALS intervention paused briefly only to enable specific interventions. Removal of the recommendation for a pre-specified period of cardiopulmonary resuscitation before out-of-hospital defibrillation following cardiac arrest unwitnessed by the EMS. The role of precordial thump is de-emphasized. Delivery of drugs via a tracheal tube is no longer recommended, drugs should be given by the intraosseous (IO) route. Atropine is no longer recommended for routine use in asystole or pulseless electrical activity. Reduced emphasis on early tracheal intubation unless achieved by highly skilled individuals with minimal interruptions in chest compressions. Increased emphasis on the use of capnography. Recognition of potential harm caused by hyperoxaemia. Revision of the recommendation of glucose control. Use of therapeutic hypothermia to include comatose survivors of cardiac arrest associated initially with shockable rhythms, as well as non-shockable rhythms, with a lower level of evidence acknowledged for the latter. Initial management of acute coronary syndromes. ā The term non-ST-elevation myocardial infarction-acute coronary syndrome (non-STEMI-ACS) has been introduced for both NSTEMI and unstable angina pectoris. Primary PCI (PPCI) is the preferred reperfusion strategy provided it is performed in a timely manner by an experienced team. Non-steroidal anti-inflammatory drugs should be avoided, as well as routine use of intravenous beta- blockers; oxygen is to be given only to those patients with hypoxaemia, breathlessness or pulmonary congestion. Paediatric Life Support. ā The decision to begin resuscitation must be taken in less than 10 seconds. Lay rescuers should be taught to use a ratio of 30 compressions to 2 ventilations, rescuers with a duty to respond should learn and use a 15:2 ratio; however, they can use the 30:2 compression-ventilation ratio if they are alone. Ventilation remains a very important component of resuscitation in asphyxial arrest. The emphasis is on achieving quality compressions with the rate of at least 100 but not greater than 120 per minute, with minimal interruptions. AEDs are safe and successful when used in children older than 1 year. A single shock strategy using a non-escalating dose of 4 J/kg is recommended for defibrillation in children. Cuffed tubes can be used safely in infants and young children. Monitoring exhaled carbon dioxide (CO2), ideally by capnography, is recommended during resuscitation. Resuscitation of babies at birth. ā For uncompromised babies, a delay in cord clamping of at least one minute from the complete delivery is now recommended. For term infants, air should be used fro resuscitation at birth. For preterm babies less than 32 weeks gestation blended oxygen and air should be given judiciously and its use guided by pulse oximetry. Preterm babies of less than 28 weeks gestation should be completely covered in a plastic wrap up to their necks, without drying, immediately after birth. The recommended compression: ventilation ratio remains at 3:1 for newborn resuscitation. Attempts to aspirate meconium from the nose and mouth of the unborn baby, while the head is still on the perineum, are not recommended. If adrenaline is given the n the intravenous route is recommended using a dose of 10ā30 Āµg /kg. Newly born infants born at term or near-term with moderate to severe hypoxic-ischaemic encephalopathy should be treated with therapeutic hypothermia. Principles of education in resuscitation. ā The aim is to ensure that learners acquire and retain skill and knowledge that will enable them to act correctly in actual cardiac arrest and improve patient outcome. Short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered as an effective alternative to instructor-led basic life support (BLS and AED) courses. Ideally all citizens should be trained in standard CPR that includes compressions and ventilations. Basic and advanced life support knowledge and skills deteriorate in as little as three to six months. CPR prompt or feedback devices improve CPR skill acquisition and retention
European Resuscitation Council Guidelines for Resuscitation 2015.
Osnovno održavanje života odraslih i automatska vanjska defibrilacija ā KljuÄna je interakcija izmeÄu dispeÄera hitne medicinske pomoÄi (HMP), laika koji pruža kardiopulmonalnu reanimaciju (KPR) i pravodobne uporabe automatskoga vanjskog defibrilatora (AVD). Svi pružatelji KPR-a trebaju provoditi kompresije prsnog koÅ”a, oni koji su uvježbani i sposobni trebaju kombinirati kompresije prsnog koÅ”a s umjetnim disanjem, u omjeru 30 : 2. Defibrilacija u roku od 3 do 5 minuta od kolapsa može rezultirati visokim preživljavanjem od 50 do 70%. Napredno održavanje života odraslih ā Kontinuirani naglasak na minimalne prekide kompresija prsnog koÅ”a visoke kvalitete koje se prekidaju kratko samo da bi se omoguÄili specifiÄni postupci, Å”to ukljuÄuje i prekid na manje od 5 sekunda pri pokuÅ”aju defibrilacije. Uporaba samoljepljivih elektroda za defibrilaciju. Valna kapnografija kako bi se potvrdio i kontinuirano monitorirao položaj endotrahealnog tubusa, kvaliteta KPR-a i omoguÄio rani nagovjeÅ”taj povratka spontane cirkulacije. Kardijalni arest u posebnim okolno stima ā Posebni uzroci: hipoksija, hipo/hiperkaliemija i ostali elektrolitski poremeÄaji, hipo/hipertermija, hipovolemija, tenzijski pneumotoraks, kardijalna tamponada, tromboza, toksini. Posebno okružje jesu specijalizirani dijelovi bolnice, komercijalni avioni ili letjelice zraÄnoga medicinskog prijevoza, igraliÅ”ta, vanjsko okružje ili popriÅ”te masovne nesreÄe. Posebni su bolesnici oni s teÅ”kim komorbiditetom i posebnim fizioloÅ”kim stanjima. Postreanimacijska skrb novi je odjeljak u smjernicama ERC-a. I dalje se preporuÄuje ciljana kontrola temperature, sada nastojeÄi postiÄi 36Ā°C, za razliku od prethodno preporuÄena 32ā34Ā°C. Osnovno održavanje života djece ā Za kompresije prsnog koÅ”a donji dio prsne kosti trebalo bi potisnuti barem treÄinu antero-posteriornog promjera (4 cm u dojenÄeta i 5 cm u djeteta). Za kardioverziju supraventrikularne tahikardije (SVT) poÄetna je doza revidirana do 1 J/kg. Reanimacija i potpora prilagodbi novoroÄenÄeta nakon roÄenja ā Kod novoroÄenÄadi koja nije ugrožena odgoÄeno stezanje (klemanje) pupkovine barem jednu minutu od kompletnog poroÄaja djeteta sad se preporuÄuje kod terminske novoroÄenÄadi i nedonoÅ”Äadi. U sluÄaju mekonijske plodne vode ne treba raditi rutinsku trahealnu intubaciju, nego samo pri sumnji na opstrukciju diÅ”noga puta. Ventilacijsku potporu kod terminske novoroÄenÄadi treba zapoÄeti zrakom. Akutni koronarni sindromi (AKS) ā IzvanbolniÄko snimanje 12-kanalnog EKG-a preporuÄuje se kod pacijenata sa suspektnim infarktom miokarda sa ST-elevacijom (STEMI). Bolesnici s akutnom boli u prsiÅ”tu kod kojih se pretpostavlja da imaju AKS ne trebaju dodatni kisik osim ako ne pokazuju znakove hipoksije, dispneje ili kardijalne dekompenzacije. U geografskim regijama gdje postoje i dostupne su ustanove koje provode perkutanu koronarnu intervenciju (PCI) direktna trijaža i transport na PCI preferiraju se s obzirom na izvanbolniÄku fi brinolizu za STEMI. Prva pomoÄ ā po prvi put ukljuÄena u smjernice ERC-a 2015. godine. Principi edukacije u reanimatologiji ā UreÄaji s povratnom spregom o KPR-u korisni su za poboljÅ”anje brzine, dubine i otpuÅ”tanja kompresije te položaj ruku. Dok optimalni intervali ponovnog obuÄavanja nisu poznati, ÄeÅ”Äe obnavljanje u manjem opsegu moglo bi biti korisno. Trening netehniÄkih vjeÅ”tina esencijalni je dodatak tehniÄkim vjeÅ”tinama. Etika u reanimatologiji i odluke o kraju života ā EtiÄki principi u kontekstu zdravstvene zaÅ”tite usmjerene k bolesniku: autonomija, dobrobit i neÅ”kodljivost ; pravednost i jednaka dostupnost KPR-a. JoÅ” prisutna potreba za usklaÄivanjem u zakonodavstvu, ovlasti, terminologiji i praksi u Europi
EUROPEAN RESUSCITATION COUNCIL GUIDELINES FOR RESUSCITATION 2015
Osnovno održavanje života odraslih i automatska vanjska defibrilacija ā KljuÄna je interakcija izmeÄu dispeÄera hitne medicinske pomoÄi (HMP), laika koji pruža kardiopulmonalnu reanimaciju (KPR) i pravodobne uporabe automatĀskoga vanjskog defibrilatora (AVD). Svi pružatelji KPR-a trebaju provoditi kompresije prsnog koÅ”a, oni koji su uvježbani i sposobni trebaju kombinirati kompresije prsnog koÅ”a s umjetnim disanjem, u omjeru 30 : 2. Defibrilacija u roku od 3 do 5 minuta od kolapsa može rezultiĀrati visokim preživljavanjem od 50 do 70%. Napredno održavanje života odraslih ā Kontinuirani naglasak na minimalne prekide kompresija prsnog koÅ”a visoke kvalitete koje se prekidaju kratko samo da bi se omoguÄili specifiÄni postupci, Å”to ukljuÄuje i prekid na manje od 5 sekunda pri pokuÅ”aju defibrilacije. Uporaba Āsamoljepljivih elektroda za defibrilaciju. ĀValna kapnografija kako bi se potvrdio i kontinuirano monitorirao položaj endotrahealnog tubusa, kvaliteta KPR-a i omoguÄio rani nagovjeÅ”taj povratka spontane cirkulacije. Kardijalni arest u posebnim okolnoĀstima ā Posebni uzroci: hipoksija, hipo/hiperkaliemija i ostali elektrolitski poremeÄaji, hipo/hipertermija, hipovoĀlemija, tenzijski pneumotoraks, kardijalna tamponada, tromboza, toksini. Posebno okružje jesu specijalizirani dijelovi Ābolnice, komercijalni avioni ili letjelice zraÄnoga medicinskog prijevoza, igraliÅ”ta, vanjsko okružje ili popriÅ”te masovne nesreÄe. Posebni su bolesnici oni s teÅ”kim komorbiditetom i posebnim fizioloÅ”kim stanjima. Postreanimacijska skrb novi je odjeljak u smjernicama ERC-a. I dalje se preporuÄuje ciljana kontrola temperature, sada nastojeÄi postiÄi 36Ā°C, za razliku od Āprethodno preporuÄena 32ā34Ā°C. Osnovno održavanje života djece ā Za kompresije prsnog koÅ”a donji dio prsne kosti trebalo bi potisnuti barem treÄinu antero-posteriornog promjera (4 cm u dojenÄeta i 5 cm u djeteta). Za kardioverziju supraventrikularne tahikardije (SVT) poÄetna je doza revidirana do 1 J/kg. Reanimacija i potpora prilagodbi novoroÄenÄeta nakon roÄenja ā Kod novoroÄenÄadi koja nije ugrožena odgoÄeno stezanje (klemanje) pupkovine barem jednu minutu od kompletnog poroÄaja djeteta sad se preporuÄuje kod terminske novoroÄenÄadi i nedonoÅ”Äadi. U sluÄaju mekonijske plodne vode ne treba raditi rutinsku traĀhealnu intubaciju, nego samo pri sumnji na opstrukciju diÅ”noga puta. Ventilacijsku potporu kod terminske novoroÄenÄadi treba zapoÄeti zrakom. Akutni koronarni sindromi (AKS) ā IzvanbolniÄko snimanje 12-kaĀnalnog EKG-a preporuÄuje se kod pacijenata sa suspektnim infarktom miokarda sa ST-elevacijom (STEMI). Bolesnici s akutnom boli u prsiÅ”tu kod kojih se pretpostavlja da imaju AKS ne trebaju dodatni kisik osim ako ne pokazuju znakove hipoksije, dispneje ili kardijalne dekompenzacije. U geografskim regijama gdje postoje i dostupne su ustanove koje provode perkutanu koronarnu intervenciju (PCI) direktna trijaža i transport na PCI preferiraju se s obzirom na izvanbolniÄku Āfibrinolizu za STEMI. Prva pomoÄ ā po prvi put ukljuÄena u smjernice ERC-a 2015. godine. Principi edukacije u reanimatologiji ā UreÄaji s povratnom spregom o KPR-u korisni su za poboljÅ”anje brzine, dubine i otpuÅ”tanja kompresije te položaj ruku. Dok optimalni intervali ponovnog obuÄavanja nisu poznati, ÄeÅ”Äe obnavljanje u manjem opsegu moglo bi biti korisno. Trening netehniÄkih vjeÅ”tina esencijalni je dodatak tehniÄkim vjeÅ”tinama. Etika u reanimatologiji i odluke o kraju života ā EtiÄki principi u kontekstu zdravstvene zaÅ”tite usmjerene k bolesniku: autonomija, dobrobit i neÅ”kodljivost; pravednost i jednaka dostupnost KPR-a. JoÅ” prisutna potreba za usklaÄivanjem u zakonodavstvu, ovlasti, terminologiji i praksi u Europi.Adult basic life support and automated external defibrillation ā Interactions between the emergency medical dispatcher, the bystander who provides CPR and the timely deployment of an AED is critical. All CPR providers should perform chest compressions, those who are trained and able should combine chest compressions and rescue breaths in the ratio 30:2. Defibrillation within 3ā5 min of collapse can produce survival rates as high as 50ā70%. Adult advanced life support ā Continued emphasis on minimally interrupted high-quality chest compressions, paused briefly only to enable specific interventions, including interruptions for less than 5 s to attempt defibrillation. Use of self-adhesive pads for defibrillation. Waveform capnography to confirm and continually monitor tracheal tube placement, quality of CPR and to provide an early indication of return of spontaneous circulation. Cardiac arrest in special circumstances ā Special causes: hypoxia; hypo-/hyperkalemia, and other electrolyte disorders; hypo-/hyperthermia; hypovolemia; tension pneumothorax; tamponade; thrombosis; toxins. Special environments are specialised healthcare facilities, commercial airplanes or air ambulances, field of play, outside environment or the scene of a mass casualty incident. Special patients are those with severe comorbidities and with specific physiological conditions. Post resuscitation care is new to the ERC Guidelines. Targeted temperature management remains, now aiming at 36Ā°C instead of the previously recommended 32 ā 34Ā°C. Pediatric life support ā For chest compressions, the lower sternum should be depressed by at least one third the anterior-posterior diameter of the chest (4 cm for the infant and 5 cm for the child). For cardioversion of a supraventricular tachycardia (SVT), the initial dose has been revised to 1 J kgā1. Resuscitation and support of transition of babies at birth ā For uncompromised babies, a delay in cord clamping of at least one minute from the complete delivery of the infant, is now recommended for term and preterm babies. Tracheal intubation should not be routine in the presence of meconium and should only be performed for suspected tracheal obstruction. Ventilatory support of term infants should start with air. Acute coronary syndrome (ACS) ā Pre-hospital recording of a 12-lead electrocardiogram (ECG) is recommended in patients with suspected ST segment elevation acute myocardial infarction (STEMI). Patients with acute chest pain with presumed ACS do not need supplemental oxygen unless they present with signs of hypoxia, dyspnea, or heart failure. In geographic regions where PCI facilities exist and are available, direct triage and transport for PCI is preferred to pre-hospital fibrinolysis for STEMI. First aid is included for the first time in the 2015 ERC Guidelines. Principles of education in resuscitation ā Directive CPR feedback devices are useful for improving compression rate, depth, release, and hand position. Whilst optimal intervals for retraining are not known, frequent ālow doseā retraining may be beneficial. Training in non-technical skills is an essential adjunct to technical skills. The ethics of resuscitation and end-of-life decisions ā Ethical principles in the context of patient-centered health care: autonomy, beneficence, non-maleficence; justice and equal access. The need for harmonisation in legislation, jurisdiction, terminology and practice still remains within Europ