THE WHAT DO YOU NEED TO KNOW ABOUT EMERGENCY MEDICAL SERVICE PUBLIC EDUCATION PROJECT IN THE VARAŽDIN COUNTY

Primarna uloga županijskih zavoda za hitnu medicinu (ZHM) je prehospitalna skrb za bolesnike kojima je ugrožen život ili im je teško narušeno zdravlje do njihovog konačnog liječenja u bolnici. Svaki mjesec prate se indikatori rada, između ostalog broj terenskih intervencija te broj bolesnika koji su sami došli u prostorije Zavoda i koliko je tih dolazaka bilo zbog hitnih, a koliko zbog nehitnih stanja. Primijećeno je da je više od 90 % dolazaka bilo zbog nehitnih stanja, što utječe na organizaciju i funkcionalnost hitne medicinske službe (HMS). Sa ciljem smanjenja tog broja dolazaka, ali i edukacije stanovništva iz područja hitne medicine, 2013. godine pokrenut je u Varaždinskoj županiji projekt „Što trebate znati o HMS“. Ključni dio projekta sastoji se od interaktivnog predavanja koje provode zdravstveni radnici ZHM Varaždinske županije, a kojima je do sada obuhvaćeno gotovo 3.000 stanovnika. Rezultat projekta je smanjenje broja dolazaka nehitnih bolesnika s 24 484 u 2014. na 13 486 u 2016. godini (45 %). Projekt „Što trebate znati o HMS“ u Varaždinskoj županiji pokazao je da se edukacijom stanovništva i bez primjene represivnih mjera može bitno smanjiti opterećenje službe nehitnim bolesnicima te tako povećati funkcionalnost rada Zavoda za hitnu medicinu sa ciljem što boljeg zbrinjavanja hitnih bolesnika.The objective of this paper is to present the What Do You Need to Know about Emergency Medicine Service project which was conducted in the Varaždin County (VC). The Institutes of Emergency Medicine (IEM) treat all emergency patients prior to their fi nal hospital treatment, either upon their arrival to the IEM on their own or if an Emergency Medical Services (EMS) team was dispatched to the patient’s location. Analysis of the number of fi eld interventions and the number of patient visits to the VC IEM revealed that a high proportion (more than 90%) of patients visited VC IEM for non-emergency medical conditions. In order to reduce this number, the project of general population education in emergency medicine was developed and conducted in the VC. Partners in the project were VC IEM, Varaždin marketing and promotor agency d.o.o, and VC Health Department. The project documentation was previously approved by the Croatian Institute of Emergency Medicine. In phase one, the project was presented through local media, television and newspapers, and posters with information on EMS were placed on more than 60 locations in the VC. Interactive lectures held by healthcare professionals working in the VC IEM had the key role in the project. In these lectures, people learned not only about EMS, but also how to help an unconscious person or in case of cardiac arrest by providing basic life support until EMS team arrival. The lectures were taking place in small groups with no more than 30 participants. To date, nearly 3000 VC inhabitants attended the lectures. In 2014, there were 9025 fi eld interventions and a total of 26,580 patient visits to VC IEM. The share of emergency patients in all these visits was only 2096 (7.9%), whereas 24,484 (92.1%) patients were without emergency medical condition. In 2016, there were 10,460 fi eld interventions and a total of 14,203 patient visits. The share of emergency patients in these this visits was 717 (5%), while 13,486 (95%) patients did not have emergency medical condition. The number of patient visits without emergency medical condition was dramatically reduced, i.e. by 45%. This might also be achieved with repressive actions such as charging patients for unnecessary use of EMS but it could also lead to the people deciding to avoid EMS even in emergency situations. The What Do You Need to Know about Emergency Medical Service project in the Varaždin County has shown that public education is of great importance in reducing patient visits to the IEM due to non-emergency health problems. It would lead to more effective EMS in providing care for emergency patients in order to provide the best possible, timely and effi cient patient care

Zbrinjavanje hitnih stanja vezanih uz arterijsku hipertenziju u izvanbolničkoj hitnoj medicinskoj službi

SUMMARY Arterial hypertension is the most common cause of cardiovascular diseases and mortality. It significantly contributes to the incidence of other chronic diseases, the most frequent being myocardial infarction and stroke. Arterial hypertension, whether chronically uncontrolled or especially in case of hypertensive emergency, represents a complex state that must be adequately assessed and managed. Hypertensive emergencies are not common in the general population, but represent a serious health emergency that can rapidly lead to irreversible damage and loss of function of target organs if not treated adequately. Prompt and effective treatment in prehospital emergency care significantly contributes to the overall quality of the healthcare system.SAŽETAK Arterijska je hipertenzija najčešći uzrok kardiovaskularnih bolesti kao i smrtnosti. Znatno pridonosi učestalosti ostalih kroničnih bolesti, od kojih su najučestalije infarkt miokarda i moždani udar. Arterijska hipertenzija, bilo ona kronična neregulirana, a posebno u slučaju hipertenzivne hitnoće ili emergencije, kompleksno je stanje koje je potrebno odgovarajuće procijeniti i zbrinuti. Hipertenzivne emergencije nisu učestale u populaciji, ali su ozbiljna hitna stanja koja u kratkom vremenu, ako se odgovarajuće ne zbrinu, uzrokuju ireverzibilno oštećenje i gubitak funkcije ciljnih organa. Promptno i učinkovito postupanje u izvanbolničkoj hitnoj medicinskoj službi znatno doprinosi kvaliteti cjelokupnoga zdravstvenog sustava

Dijagnostika plućne embolije u Objedinjenom hitnom bolničkom prijamu

The aim of this study was to determine the association of clinical presentation, the Wells scoring system and D-dimer values with MSCT pulmonary angiography. A case control study was conducted in the Emergency Department of the Clinical Hospital Sveti Duh throughout 2019. Patients with a referral diagnosis of a pulmonary embolism were included in the study. Patients were divided into two groups. The first group consisted of patients diagnosed with pulmonary embolism by MSCT pulmonary angiography or postmortem, and the second group consisted of patients excluded from pulmonary embolisms. For the Wells score, D-dimers, troponin, respiratory rate and peripheral blood oxygen saturation, statistically significant differences were found between groups of patients with confirmed or excluded pulmonary embolism (p <0.001). For heart rate, chest pain, syncope, and hemoptysis, no statistically significant differences were found between these two groups of patients. Deep venous thrombosis of the lower extremities was found by ultrasound in > 70% of patients with massive a pulmonary embolism. Pulmonary embolism was confirmed in all patients for whom a high risk was calculated according to the Wells score. In conclusion, a low degree of clinical probability (according to the Wells score), along with a normal concentration of D-dimer, are a sure strategy in excluding pulmonary embolism.Cilj rada je bio utvrditi povezanost kliničke slike, Wellsovog bodovnog sustava i vrijednosti D-dimera s MSCT plućnom angiografijom. Provedena je studija istraživanja parova u Objedinjenom hitnom bolničkom prijamu Kliničke bolnice „Sveti Duh“ tijekom cijele 2019. godine. U istraživanje su bili uključeni bolesnici sa uputnom dijagnozom plućne embolije. Bolesnici su podijeljeni u dvije skupine. U prvoj su skupini bili bolesnici kojima je dijagnoza plućne embolije potvrđena MSCT plućnom angiografijom ili post mortem, a drugu skupinu su činili bolesnici kod kojih je isključena plućna embolija. Za Wellsov skor, D-dimere, troponin, frekvenciju disanja i perifernu zasićenost krvi kisikom nađene su statistički značajne razlike između skupina bolesnika s potvrđenom, odnosno isključenom plućnom embolijom (p<0,001). Za frekvenciju srca, bol u prsima, sinkopu i hemoptizu nije nađena statistički značajna razlika između ove dvije skupine bolesnika. U >70% bolesnika s masivnom plućnom embolijom ultrazvučno je nađena duboka venska tromboza donjih ekstremiteta. Kod svih bolesnika kojima je prema Wellsovom bodovnom skoru izračunat visok rizik potvrđena je plućna embolija. Zaključno, niski stupanj kliničke vjerojatnosti (prema Wellsovom bodovnom skoru) zajedno s normalnom koncentracijom D-dimera sigurna su strategija u isključenju plućne embolije

ACUTE DIABETIC COMPLICATIONS ATTENDED AT HOSPITAL EMERGENCY DEPARTMENT FROM 2010 TO 2018

Cilj rada: Šećerna bolest je veliki zdravstveni i socioekonomski problem u Republici Hrvatskoj. Prema podatcima Hrvatskog zavoda za javno zdravstvo registrirano je preko 300.000 bolesnika sa šećernom bolesti, uz daljnji rast broja oboljelih. U 2017. godini šećerna bolest nalazila se na petom mjestu vodećih uzroka smrti sa 3,7 % udjela u ukupnoj smrtnosti. Dijabetička ketoacidoza, hiperglikemijsko hiperosmolarno stanje i hipoglikemija su ozbiljne komplikacije šećerne bolesti tip 1 i tip 2, koje su ujedno i najčešća hitna stanja u endokrinologiji. Iako se dijabetička ketoacidoza najčešće javlja u osoba s tipom 1 šećerne bolesti, a hiperosmolarno stanje s tipom 2 sve je veća pojavnost dijabetičke ketoacidoze i u dijabetičara s tipom 2 šećerne bolesti. Glavni cilj istraživanja je analizirati hipoglikemijske i hiperglikemijske krize bolesnika u hitnoj medicinskoj službi u razdoblju od 2010. do 2018. godine u Kliničkoj bolnici Sveti Duh. Metode: Ispitivana populacija obuhvaćala je ukupno 175.446 odrasle osobe pregledane u hitnoj medicinskoj službi u razdoblju od 1. 1. 2010. do 31. 12. 2018., uz vrijednost glukoze u plazmi većoj od 13,9 mmol/L ili manjoj od 3,9 mmol/L. Ovisno o nalazu acidobaznog statusa, ketonuriji i osmolarnosti plazme bolesnici su podijeljeni u jednu od četiri skupine: neketotična hiperglikemija, hipoglikemija u šećernoj bolesti, dijabetička ketoacidoza ili hiperosmolarno hiperglikemijsko stanje. Bolesnici su također podijeljeni prema dobi i tipu šećerne bolesti. Rezultati: U 3.773 posjeta bila je zadovoljena defi nicija hiperglikemijske ili hipoglikemijske krize, od čega 180 epizoda dijabetičke ketoacidoze, 29 hiperosmolarna hiperglikemijska stanja, 359 hipoglikemijska stanja te 567 slučajeva novootkrivene šećerne bolesti. Broj epizoda hiperglikemijskih kriza bio je tijekom godina bez većih odstupanja. Samo 17,72 % slučajeva dijabetičke ketoacidoze zabilježeno je u bolesnika sa šećernom bolesti tip 1, dok su preostali bolesnici imali dijagnozu tip 2. Zabilježeno je da su infekcije bile najčešći čimbenik rizika dijabetičke ketoacidoze s 35,4 %, propuštanjem terapije inzulina kao drugim najčešćim uzrokom s 29,3 %. U 15 % bolesnika s akutnim komplikacijama šećerne bolesti zabilježen je ponovni prijam u razdoblju od 30 dana. Rasprava: Učestalost posjeta hitnom prijmu bolesnika sa šećernom bolesti bila je veća od očekivane s obzirom na učestalost dijagnoze u općoj populaciji. Zabilježeno je godišnje povećanje broja slučajeva dijabetičke ketoacidoze i hipoglikemija u bolesnika sa šećernom bolesti starijih od 60 godina. S obzirom na smjernice kliničke prakse, vrijeme započinjanja i volumen primjene kristaloidnih otopina bili su u preko dvije trećine slučajeva zadovoljavajući. Međutim, usporedbom sa smjernicama kliničke prakse o primjeni inzulina unutar prvih 60 minuta, u više od dvije trećine slučajeva dijabetičke ketoacidoze vrijeme prve primjene bilo je nakon 100 minuta. Mogući razlozi su nespecifi čnost kliničkih znakova i vrijeme potrebno do dostupnosti rezultata krvnih nalaza. Zaključak: Učestalost šećerne bolesti u bolesnika koji su zaprimljeni u hitnu medicinsku službu veća je od očekivane u općoj populaciji uz porast broja bolesnika sa šećernom bolesti tip 1 i tip 2. Većina bolesnika s dijabetičkom ketoacidozom imala su šećernu bolest tip 2, iako su se bolesnici s tipom 1 u hitnoj službi češće prezentirali s dijabetičkom ketoacidozom. Najčešći prepoznati čimbenici rizika za dijabetičku ketoacidozu bile su infekcije i neodgovarajuća terapija inzulina. Zabilježen je porast korištenja metformina i DPP-4 inhibitora u terapiji šećerne bolesti.Objective: Diabetes is one of the major health and socioeconomic problems in Croatia. According to data from the Croatian Institute of Public Health, over 300,000 patients with diabetes have been registered, with further increase in the number of patients. In 2017, diabetes was recognized as the fi fth leading cause of death, accounting for 3.7% of total mortality. Diabetic ketoacidosis, hyperglycemic hyperosmolar condition, and hypoglycemia are serious complications of type 1 and type 2 diabetes, which also are the most common emergency conditions in endocrinology. Although diabetic ketoacidosis most commonly occurs in people with type 1 diabetes and hyperosmolar condition in those with type 2 diabetes, there is an increasing incidence of diabetic ketoacidosis in subjects with type 2 diabetes. The main aim of the research was to analyze the hypoglycemic and hyperglycemic crisis patients at Department of Emergency Medicine, Sveti Duh University Hospital, during the 2010-2018 period. Methods: The study population included a total of 175,446 adults examined at Emergency Department from January 1, 2010 until December 31, 2018, with plasma glucose values greater than 13.9 mmol/L or less than 3.9 mmol/L. Depending on the acid-base status, ketonuria and plasma osmolarity, patients were divided into four groups as follows: non-ketotic hyperglycemia, hypoglycemia in diabetes, diabetic ketoacidosis, and hyperosmolar hyperglycemic state. Patients were also divided according to age and type of diabetes. Results: At 3,773 visits, defi nitions of hyperglycemic or hypoglycemic crisis were met, of which 180 episodes of diabetic ketoacidosis, 29 hyperosmolar hyperglycemic conditions, 359 hypoglycemic conditions, and 567 cases of newly diagnosed diabetes. The number of episodes of hyperglycemic crisis was been without major fl uctuations over years. Only 17.72% of diabetic ketoacidosis cases were reported in patients with type 1 diabetes, whereas the remaining patients were diagnosed with type 2 diabetes. Infections were reported as the most common risk factor for diabetic ketoacidosis (35.4%), followed by missed insulin therapy as the second most common cause (29.3%). Repeated admission within 30 days was recorded in 15% of patients with acute complications of diabetes. Discussion: The frequency of visits of diabetic patients was higher than expected due to the frequency of diagnoses in the general population. There was an annual increase in the incidence of diabetic ketoacidosis and hypoglycemia in patients older than 60 years. Considering the guidelines for clinical practice, the starting time and volume of crystalloid solutions administered were satisfactory in more than two-thirds of cases. However, compared to clinical practice guidelines for insulin administration within the fi rst 60 minutes, the time of fi rst administration was after 100 minutes in more than two-thirds of diabetic ketoacidosis cases. The possible reasons were non-specifi city of the clinical signs and the time it took for blood test result reporting. Conclusion: The incidence of diabetes in patients admitted to the emergency department was higher than expected in the general population, with an increase in type 1 and type 2 diabetes patients. Most patients with diabetic ketoacidosis had already been diagnosed with type 2 diabetes, although patients with type 1 diabetes more often presented with diabetic ketoacidosis to the emergency department. The most commonly recognized risk factors for diabetic ketoacidosis were infection and inadequate insulin therapy. There was an increase in the use of metformin and DPP-4 inhibitors in diabetes therapy

ACUTE DIABETIC COMPLICATIONS ATTENDED AT HOSPITAL EMERGENCY DEPARTMENT FROM 2010 TO 2018

Cilj rada: Šećerna bolest je veliki zdravstveni i socioekonomski problem u Republici Hrvatskoj. Prema podatcima Hrvatskog zavoda za javno zdravstvo registrirano je preko 300.000 bolesnika sa šećernom bolesti, uz daljnji rast broja oboljelih. U 2017. godini šećerna bolest nalazila se na petom mjestu vodećih uzroka smrti sa 3,7 % udjela u ukupnoj smrtnosti. Dijabetička ketoacidoza, hiperglikemijsko hiperosmolarno stanje i hipoglikemija su ozbiljne komplikacije šećerne bolesti tip 1 i tip 2, koje su ujedno i najčešća hitna stanja u endokrinologiji. Iako se dijabetička ketoacidoza najčešće javlja u osoba s tipom 1 šećerne bolesti, a hiperosmolarno stanje s tipom 2 sve je veća pojavnost dijabetičke ketoacidoze i u dijabetičara s tipom 2 šećerne bolesti. Glavni cilj istraživanja je analizirati hipoglikemijske i hiperglikemijske krize bolesnika u hitnoj medicinskoj službi u razdoblju od 2010. do 2018. godine u Kliničkoj bolnici Sveti Duh. Metode: Ispitivana populacija obuhvaćala je ukupno 175.446 odrasle osobe pregledane u hitnoj medicinskoj službi u razdoblju od 1. 1. 2010. do 31. 12. 2018., uz vrijednost glukoze u plazmi većoj od 13,9 mmol/L ili manjoj od 3,9 mmol/L. Ovisno o nalazu acidobaznog statusa, ketonuriji i osmolarnosti plazme bolesnici su podijeljeni u jednu od četiri skupine: neketotična hiperglikemija, hipoglikemija u šećernoj bolesti, dijabetička ketoacidoza ili hiperosmolarno hiperglikemijsko stanje. Bolesnici su također podijeljeni prema dobi i tipu šećerne bolesti. Rezultati: U 3.773 posjeta bila je zadovoljena defi nicija hiperglikemijske ili hipoglikemijske krize, od čega 180 epizoda dijabetičke ketoacidoze, 29 hiperosmolarna hiperglikemijska stanja, 359 hipoglikemijska stanja te 567 slučajeva novootkrivene šećerne bolesti. Broj epizoda hiperglikemijskih kriza bio je tijekom godina bez većih odstupanja. Samo 17,72 % slučajeva dijabetičke ketoacidoze zabilježeno je u bolesnika sa šećernom bolesti tip 1, dok su preostali bolesnici imali dijagnozu tip 2. Zabilježeno je da su infekcije bile najčešći čimbenik rizika dijabetičke ketoacidoze s 35,4 %, propuštanjem terapije inzulina kao drugim najčešćim uzrokom s 29,3 %. U 15 % bolesnika s akutnim komplikacijama šećerne bolesti zabilježen je ponovni prijam u razdoblju od 30 dana. Rasprava: Učestalost posjeta hitnom prijmu bolesnika sa šećernom bolesti bila je veća od očekivane s obzirom na učestalost dijagnoze u općoj populaciji. Zabilježeno je godišnje povećanje broja slučajeva dijabetičke ketoacidoze i hipoglikemija u bolesnika sa šećernom bolesti starijih od 60 godina. S obzirom na smjernice kliničke prakse, vrijeme započinjanja i volumen primjene kristaloidnih otopina bili su u preko dvije trećine slučajeva zadovoljavajući. Međutim, usporedbom sa smjernicama kliničke prakse o primjeni inzulina unutar prvih 60 minuta, u više od dvije trećine slučajeva dijabetičke ketoacidoze vrijeme prve primjene bilo je nakon 100 minuta. Mogući razlozi su nespecifi čnost kliničkih znakova i vrijeme potrebno do dostupnosti rezultata krvnih nalaza. Zaključak: Učestalost šećerne bolesti u bolesnika koji su zaprimljeni u hitnu medicinsku službu veća je od očekivane u općoj populaciji uz porast broja bolesnika sa šećernom bolesti tip 1 i tip 2. Većina bolesnika s dijabetičkom ketoacidozom imala su šećernu bolest tip 2, iako su se bolesnici s tipom 1 u hitnoj službi češće prezentirali s dijabetičkom ketoacidozom. Najčešći prepoznati čimbenici rizika za dijabetičku ketoacidozu bile su infekcije i neodgovarajuća terapija inzulina. Zabilježen je porast korištenja metformina i DPP-4 inhibitora u terapiji šećerne bolesti.Objective: Diabetes is one of the major health and socioeconomic problems in Croatia. According to data from the Croatian Institute of Public Health, over 300,000 patients with diabetes have been registered, with further increase in the number of patients. In 2017, diabetes was recognized as the fi fth leading cause of death, accounting for 3.7% of total mortality. Diabetic ketoacidosis, hyperglycemic hyperosmolar condition, and hypoglycemia are serious complications of type 1 and type 2 diabetes, which also are the most common emergency conditions in endocrinology. Although diabetic ketoacidosis most commonly occurs in people with type 1 diabetes and hyperosmolar condition in those with type 2 diabetes, there is an increasing incidence of diabetic ketoacidosis in subjects with type 2 diabetes. The main aim of the research was to analyze the hypoglycemic and hyperglycemic crisis patients at Department of Emergency Medicine, Sveti Duh University Hospital, during the 2010-2018 period. Methods: The study population included a total of 175,446 adults examined at Emergency Department from January 1, 2010 until December 31, 2018, with plasma glucose values greater than 13.9 mmol/L or less than 3.9 mmol/L. Depending on the acid-base status, ketonuria and plasma osmolarity, patients were divided into four groups as follows: non-ketotic hyperglycemia, hypoglycemia in diabetes, diabetic ketoacidosis, and hyperosmolar hyperglycemic state. Patients were also divided according to age and type of diabetes. Results: At 3,773 visits, defi nitions of hyperglycemic or hypoglycemic crisis were met, of which 180 episodes of diabetic ketoacidosis, 29 hyperosmolar hyperglycemic conditions, 359 hypoglycemic conditions, and 567 cases of newly diagnosed diabetes. The number of episodes of hyperglycemic crisis was been without major fl uctuations over years. Only 17.72% of diabetic ketoacidosis cases were reported in patients with type 1 diabetes, whereas the remaining patients were diagnosed with type 2 diabetes. Infections were reported as the most common risk factor for diabetic ketoacidosis (35.4%), followed by missed insulin therapy as the second most common cause (29.3%). Repeated admission within 30 days was recorded in 15% of patients with acute complications of diabetes. Discussion: The frequency of visits of diabetic patients was higher than expected due to the frequency of diagnoses in the general population. There was an annual increase in the incidence of diabetic ketoacidosis and hypoglycemia in patients older than 60 years. Considering the guidelines for clinical practice, the starting time and volume of crystalloid solutions administered were satisfactory in more than two-thirds of cases. However, compared to clinical practice guidelines for insulin administration within the fi rst 60 minutes, the time of fi rst administration was after 100 minutes in more than two-thirds of diabetic ketoacidosis cases. The possible reasons were non-specifi city of the clinical signs and the time it took for blood test result reporting. Conclusion: The incidence of diabetes in patients admitted to the emergency department was higher than expected in the general population, with an increase in type 1 and type 2 diabetes patients. Most patients with diabetic ketoacidosis had already been diagnosed with type 2 diabetes, although patients with type 1 diabetes more often presented with diabetic ketoacidosis to the emergency department. The most commonly recognized risk factors for diabetic ketoacidosis were infection and inadequate insulin therapy. There was an increase in the use of metformin and DPP-4 inhibitors in diabetes therapy

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

USE OF TRANSPORT VENTILATOR AT THE INSTITUTE OF EMERGENCY MEDICINE OF VARAŽDIN COUNTY

Svaki liječnički tim izvanbolničkih zavoda za hitnu medicinu - Tim 1 opremljen je transportnim ventilatorom. Cilj rada bio je utvrditi razinu edukacije i osposobljenost zdravstvenih radnika Tima 1 Zavoda za hitnu medicinu Varaždinske županije (ZHM VŽ) iz područja mehaničke ventilacije te koliko se transportni ventilator upotrebljava u svakodnevnom radu. Ispitanici su dobili zadatak da na transportnom ventilatoru namjeste postavke za dva načina ventilacije: invazivni, tijekom reanimacije (Volume Controlled Continuous Mandatory Ventilation) i neinvazivni (Spontaneous Continuous Positive Airway Pressure). Od ukupno 21 ispitanika 7 (33 %) ih je uspješno namjestilo postavke transportnog ventilatora za oba zadana scenarija, 6 (29 %) samo u scenariju reanimacije, a 8 (38 %) ispitanika nije uspjelo ni u jednom scenariju. Bolje rezultate postigli su ispitanici koji su završili tečaj „Održavanje dišnog puta i mehanička ventilacija u hitnoj medicini“ te koji su neku od edukacija završili prošle ili ove go dine. Čak 19 (90 %) ispitanika izrazilo je potrebu za dodatnom edukacijom. Broj radnih sati transportnih ventilatora u posljednje dvije godine iznosio je prosječno 2 sata i 10 minuta po uređaju, što je nedovoljno. Međutim, s obzirom na velik udio zdravstvenih radnika koji su naveli potrebu za dodatnom edukacijom, postoji velik prostor za poboljšanje upotrebe transportnog ventilatora u ZHM VŽ s ciljem što bolje skrbi za hitne bolesnike.The objective of this study conducted at the Institute of Emergency Medicine of Varaždin County (IEM VC) was to investigate the emergency medicine service (EMS) healthcare workers’ education and capability regarding mechanical ventilation and to explore the use of transport ventilator in daily practice. To quantify EMS healthcare workers’ capability for use of transport ventilator, we developed two clinical scenarios with emphasis on emergency management of ventilated patients, i.e. one during resuscitation (VC CMV mode) and the other for noninvasive mechanical ventilation (SpnCPAP mode). The following data were collected: profession, years of work in the EMS, and year and type of education in the fi eld of mechanical ventilation. Years of work in the EMS were 1-21 years in both scenarios solved, 2 months to 25 years in the fi rst scenario solved, and 1-27 years in neither scenario solved. The number of operating hours of each transport mechanical ventilator was obtained from the memory of the device at regular service, which is carried out every two years. Out of 21 respondents, 7 (33%) had successfully adjusted the transport mechanical ventilator settings in both scenarios, 6 (29%) only in the scenario of resuscitation, and 8 (38%) failed in both scenarios. Distribution by profession was as follows: 3 out of 8 doctors and 4 out of 13 nurses/technicians successfully solved both scenarios, 3 doctors and 3 nurses/technicians successfully solved first scenario, and 2 doctors and 6 medical nurses/technicians failed to solve both scenarios. Better results were achieved by respondents who had completed the Respiratory and Mechanical Ventilation in Emergency Medicine course or other education in the last two years. Even 19 (90%) respondents expressed the need for additional education. The number of operating hours of transport mechanical ventilator in the last two years was 2 hours and 10 minutes per device. The medical teams of IEM VC often take care of patients who could benefit from the use of transport ventilator because of their condition. The results suggest that the knowledge about the use of transport mechanical ventilator is not dependent on the years in work in the EMS, being a physician or a nurse/technician. However, this knowledge was found to greatly depend on the type and time of education. Literature data show that even though mechanical ventilation is considered a standard in emergency medicine, the exact time of training required for its use has not been established, and the number of studies investigating the use of mechanical ventilator in the fi ld of emergency medicine is limited. The limitations of this study were a relatively small number of respondents and the fact that each subject was individually tested about working with transport ventilator, whereas teamwork is used in daily work, so that a physician and nurse/ technician together with educated driver provide care of emergency patients. In conclusion, transport ventilator is not used enough in daily care of patients in IEM VC. Much better ability to work with transport ventilator was demonstrated by physicians and nurses/technicians with a higher level of education in mechanical ventilation, regardless of years of work in the EMS. Considering the large proportion of healthcare workers who have identifi ed the need for additional education, there is a great opportunity to improve the use of mechanical ventilator, with the aim of providing better care for emergency patients

MOTORCYCLE EMERGENCY MEDICAL SERVICE

Nastavni zavod za hitnu medicinu u suradnji s Gradom Zagrebom provodi probni projekt Hitna medicinska pomoć na motociklu od 2016. godine kada su nabavljena dva motocikla za pružanje medicinske pomoći. U 2019. godini projekt je proširen nabavom dvaju novih snažnijih motocikla. T3 timovi, medicinski tehničari na motociklima interveniraju od travnja do listopada kao tri tima raspoređena na tri lokacije: Centar, Jarun i Dubrava. Ciljevi projekta su skratiti vrijeme dolaska timova hitne medicinske pomoći na mjesto intervencije, smanjiti mortalitet kardiorespiratornog aresta, učinkovitije rasporediti raspoložive resurse (timovi na terenu) te podići standard hitne medicinske pomoći u Gradu Zagrebu. Njihova prednost je što brže i lakše stižu do unesrećenih na gradskim prometnicama, osobito u vrijeme prometnih gužvi. Hitnoj pomoći na motociklu treba prosječno 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. Započeto je 11 reanimacija od medicinskog tehničara 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 dišnog puta, glukometra, iv. kanile, infuzija, zavojnih materijala, ovratnika, udlaga i START trijaža seta. Neka od ograničenja hitne pomoći na motociklu su vremenski uvjeti, visoka rizičnost rada, oprema – prostor na motoru, fi nanciranje timova na motociklu i brojnost članova tima hitne medicinske službe. U budućnosti je cilj dodatno educirati medicinske tehničare i povećati broj postupaka na terenu, standardizirati kadar, povećati 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 effi cient allocation of available resources (teams in the fi 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 traffi 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 defi 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), fi 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

Blokovi perifernih živaca u bolesnika s prijelomom kuka

Hip fractures represent a major public health issue with increasing incidence as a population ages. The aim of this review is to describe peripheral nerve block techniques (the fascia iliaca compartment block and the pericapsular nerve group block) as pain management for hip fractures in emergency medicine, and to emphasize their benefits. Hip fractures are extremely painful injuries. The pain itself is unpleasant for patients and if left untreated it can lead to multiple complications during preoperative, operative and postoperative patient management. Pain management for elderly hip fracture patients is often challenging. Non-steroidal anti-inflammatory drugs are not recommended due to their side effects, the increased risk of gastrointestinal bleeding, renal function impairment and platelet aggregation inhibition. Paracetamol alone is often insufficient, and opioids have many potentially harmful side effects, such as delirium development. Peripheral nerve blocks for hip fractures are safe and effective, also in emergency medicine settings. The benefits for patients are greater pain relief, especially during movement, less opioid requirements and decreased incidence of delirium. Regional analgesia should be routinely used in hip fracture pain management.Prijelom kuka predstavlja značajan javno zdravstveni problem čija će incidencija rasti sa starenjem populacije. Cilj ovog preglednog članka je opisati blokove perifernih živaca u liječenju boli kod bolesnika s prijelomom kuka, (bloka ilijakalne fascije i bloka perikapsularnih živaca), te naglasiti prednosti njihove primjene. Prijelom kuka je izrazito bolna ozljeda. Bol sama po sebi je neugodna za bolesnika, a ukoliko je neodgovarajuće liječena može dovesti do višestrukih komplikacija tijekom prijeoperacijskog, operacijskog i poslijeoperacijskog zbrinjavanja bolesnika. Unatoč postojanju brojnih analgetika, liječenje boli u starijih bolesnika s prijelomom kuka često je zahtjevno. Nesteroidni protuupalni lijekovi se ne preporučuju radi svojih neželjenih učinaka, paracetamol je često nedovoljan, a opioidi također mogu imati brojne neželjene učinke, uključujući razvoj akutnog smetenog stanja. Primjena blokova perifernih živaca je sigurna i učinkovita, također u uvjetima hitne medicine. Koristi za bolesnike su bolje ublažavanje boli, osobito prilikom pomicanja, smanjena potreba za primjenom opioida i smanjena incidencija akutnog smetenog stanja. Primjena blokova perifenih živaca u liječenju boli kod bolesnika s prijelomom kuka trebala bi postati svakodnevnica u kliničkoj praksi