172 research outputs found
Comparison of Analgesic Effect between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy
Venska tromboembolija u hitnoj medicinskoj službi - iskustva jednog centra
Given the importance of early recognition of acute venous thromboembolism
(VTE ) and the nonspecificity of its symptoms and signs, it is essential to follow the guidelines for
diagnostic and therapeutic decisions. Ultrasound examination of the entire lower extremity is currently
the standard diagnostic method for symptomatic patients with a clinical probability of deep
vein thrombosis (DVT) according to the Wells scoring system. The aim of this study is to show the
demographic structure and analyze the number of patients in the emergency department with suspected
venous thrombosis. In the past 10 years, 2,022 patients with DVT and 686 with pulmonary
emboli have been diagnosed. Despite adherence to the diagnostic protocol, nearly two-thirds of patients
require early ultrasound diagnosis. One-fifth of patients had thrombosis of the superficial venous
system of the leg or arm. Thrombus was present in the veins of the lower leg in 37% of patients
with DVT. The presence of thrombi above the knee, involving the deep femoropopliteal venous system,
was found in as much as one-third of patients. These findings and current guidelines suggest that
there is a paradigm shift toward more frequent use of DO AC in patients with DVT. However, greater
educational efforts may be needed for many physicians to become comfortable with the use of
DO AC in the outpatient management of patient populations at low risk for pulmonary embolism.Venski tromboembolizam oznaÄava duboku vensku trombozu i pluÄnu emboliju, a uzevÅ”i u obzir važnost ranog prepoznavanja,
nespecifiÄnosti simptoma i znakova, neophodno je pridržavanja smjernicama prilikom donoÅ”enja dijagnostiÄkih i
terapijskih odluka. Ultrasonografija je trenutno standardna dijagnostiÄka metoda za simptomatske bolesnike s kliniÄkom
vjerojatnosti VTE prema Wellsovom bodovnom sustavu. Cilj rada je prikazati demografsku strukturu i analizirati broj bolesnika
u hitnoj službi sa sumnjom na vensku trombozu. Unazad 10 godina, dijagnosticirano je 2022 bolesnika s DVT i 686
pluÄnih embolija. UnatoÄ protokolu, u gotovo dvije treÄine bolesnika neophodna je rana ultrazvuÄna dijagnostika, sve viÅ”e
prihvaÄena od strane lijeÄnika, posebno u uvjetima hitne medicinske pomoÄi. U petine bolesnika, 21%, utvrÄena je tromboza
povrŔinskog venskog sustava noge ili ruke. U 37% bolesnika s DVT tromb je bio prisutan u venama potkoljenice. Prisutnost
tromba iznad razine koljena, uz zahvaÄenost femoropoplitealnog dubokog venskog sustava, dokazan je u 38% bolesnika.
Rezultati istraživanja i trenutne smjernice sugeriraju da je doŔlo do promjena u izboru antikoagulacijske terapije kod bolesnika
s DVT, u prilog DOAK-a. MeÄutim, možda Äe biti potrebni veÄi napori kako bi se lijeÄnici odluÄili za DOAK u vanbolniÄkim
uvjetima lijeÄenja bolesnika s pluÄnom embolijom
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
Ethical problems of doctors during a disaster
Katastrofe izazivaju Äitav niz etiÄkih izazova koji se znaÄajno razlikuju od standardne kliniÄke prakse. Katastrofe su viÅ”e povezane s javnozdravstvenom nego medicinskom etikom te zahtijevaju maksimalan trud i angažman cjelokupnog zdravstvenog sustava kako bi se postigla ravnoteža izmeÄu individualnih i kolektivnih prava. Ovaj rad ima za cilj dati pregled nekih etiÄkih dilema koje se javljaju u katastrofama i uglavnom se usmjerava
na zdravstvene usluge.Disasters lead to whole range of ethical challenges that differ significantly from standard clinical practice. Disasters are more related to public health than medical ethics and require maximum effort and engagement of the entire healthcare system to striking a balance between individual and collective rights. The aim of this paper is to provide an overview of some of the ethical dilemmas that appear in disasters and mainly focuses on health services
Definicija sepse: Å to je novo u smjernicama za lijeÄenje
Sepsis is a life-threatening organ dysfunction caused by an unregulated response
of a host. Septic shock is its most severe form. It is manifested by a drop in blood pressure, which
decreases tissue perfusion pressure, causing hypoxia that is characteristic of shock. Sepsis is still one of
the leading causes of mortality worldwide. Its incidence has increased since the first consensus definitions
were established in 1991. Raising sepsis awareness, its significance and the need for better treatment,
has led to an improvement in in defining sepsis and the development of guidelines for its treatment.
The first guidelines were published in 2004, the second 2008, the third 2013, the fourth 2016,
and the last revised guidelines appeared in 2021. This paper will describe the previous and new definitions
of sepsis and septic shock, the previous guidelines for the recognition and treatment, and the
latest recommendations for treatment. Timely diagnosis is crucial for the outcomes for patients with
sepsis and septic shock. The fact is that the sepsis care bundles have been modified to increasingly
shorter time determinants, which emphasizes the importance of emergency physicians, who frequently
first recognize and begin emergency treatment of septic patients.Sepsa je po život opasna disfunkcija organa uzrokovana nereguliranim odgovorom domaÄina na infekciju. SeptiÄki Å”ok je
najteži oblik sepse koji se oÄituje padom krvnog tlaka prilikom kojeg se smanjuje tlak perfuzije tkiva Å”to uzrokuje hipoksiju
tkiva koja je karakteristiÄna za Å”ok. Sepsa je joÅ” uvijek jedan od vodeÄih uzroka morbiditeta i mortaliteta u danaÅ”njem svijetu.
Incidencija je u porastu joÅ” od prvog konsenzusa definicije iz 1991. Podizanje razine svijesti o sepsi, njenom znaÄenju, prepoznavanju
i potrebi Å”to boljeg lijeÄenja dovelo je i do usavrÅ”avanja definicije sepse te razvoja smjernica za lijeÄenje. Prve smjernice
su objavljene 2004.god., druge 2008., treÄe 2013., Äetvrte 2016. a zadnje revidirane smjernice 2021. godine. U ovom radu
bit Äe opisana dosadaÅ”nja i nova definicija sepse i septiÄkog Å”oka, prikaz dosadaÅ”njih smjernica za prepoznavanje i lijeÄenje te
najnovije preporuke. Pravovremena dijagnoza kljuÄna je za ishod lijeÄenja u bolesnika sa sepsom i septiÄkim Å”okom. Äinjenica
da su se snopovi postupaka za zbrinjavanje septiÄnih bolesnika svakom izmjenom mijenjali do sve kraÄih vremenskih
odrednica, naglaÅ”ava ulogu I važnost lijeÄnika hitne medicine kao onih koji prvi prepoznaju i zapoÄinju hitno zbrinjavanje
septiÄnih bolesnika
Procjena standardnih antropometrijskih obilježja diÅ”noga puta u bolesnika sa sindromom opstrukcijske apneje pri spavanju za kirurgiju poremeÄaja disanja pri spavanju: retrospektivno istraživanje u jednom kliniÄkom centru
The aim of this study was to explore standard anthropometric airway characteristics
of patients with obstructive sleep apnea syndrome (OSAS) and determine the incidence and
risk factors for difficult airway management. Final analysis included 91 patients with polysomnography-
verified diagnosis of OSAS who underwent sleep breathing disorder surgery under general anesthesia
with direct laryngoscopy oroendotracheal intubation. The incidence of difficult manual mask
ventilation during anesthesia induction, difficult intubation and immediate postextubation respiratory
complications was 17.6%, 7.7% and 7.7%, respectively. Compared to patients without difficult manual
mask ventilation, the group of OSAS patients with difficult manual mask ventilation had a higher rate
of body mass index (BMI) ā„25 kgm-2 (p=0.010), Mallampati score ā„3 (p=0.024) and Cormack-Lehane
score ā„3 (p=0.002). The OSAS patients with difficult intubation had more Cormack-Lehane
score ā„3 (p=0.002) in comparison to those without difficult intubation. Our study demonstrated that
manual mask ventilation during anesthesia induction was the most troublesome airway management
task in OSAS patients during sleep breathing disorder surgery. Cormack-Lehane score was a relevant
determinator of difficult mask ventilation and difficult intubation, while Mallampati score and BMI
were relevant determinators only for difficult manual mask ventilation.Cilj ovoga istraživanja bio je odrediti standardna antropometrijska obilježja diŔnoga puta u bolesnika sa sindromom opstruktivne
apneje pri spavanju (OSAS), utvrditi incidenciju i riziÄne Äimbenike zbrinjavanja otežanoga diÅ”nog puta. ZavrÅ”na
analiza je ukljuÄivala 91 bolesnika s potvrÄenom dijagnozom OSAS polisomnografijom, koji su bili podvrgnuti kirurÅ”kom
zahvata poremeÄaja disanja kod spavanja u opÄoj anesteziji s oroendotrahealnom intubacijom. UÄestalost otežane manualne
ventilacije maskom tijekom uvoda u anesteziju, otežane intubacije i neposredne poslijeekstubacijeke komplikacije su bile slijedom
17,6%, 7,7% i 7,7%. U usporedbi s bolesnicima bez otežane manualne ventilacije maskom skupina bolesnika s OSAS i
otežanom manualnom ventilacijom na masku je ÄeÅ”Äe imala indeks tjelesne mase ( ITM) ā„25 kgm-2 (p=0,010), Mallampatijevu
ocjenu ā„3 (p=0,024) i Cormack- Lehaneovu ocjenu ā„3 (p=0,002). Bolesnici s OSAS i otežanom intubacijom su ÄeÅ”Äe
imali Cormack-Lehaneovu ocjenu ā„3 (p=0,002) u usporedbi s onima bez otežane intubacije. NaÅ”e istraživanje je pokazalo
da je najproblematiÄniji zadatak zbrinjavanja diÅ”noga puta u bolesnika podvrgnutih kirurgiji poremeÄaja disanja kod spavanja
manualna ventilacija na masku tijekom uvoda u anesteziju. Cormack-Lehaneova ocjena je relevantni riziÄni Äimbenik
za otežanu ventilaciju na masku i otežanu intubaciju, dok su Mallampatijeva ocjena i ITM bili relevantni riziÄni Äimbenici
samo za otežanu ventilaciju na masku
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