HEMORRHAGIC SHOCK DUE TO PSOAS MUSCLE RUPTURE IN A PATIENT ON ANTICOAGULATION THERAPY

Hipovolemijski urušaj zbog gubitka veće količine cirkulirajućeg volumena vitalna je ugroza za život bolesnika. Gubitak cirkulirajućeg volumena može biti potenciran brojnim čimbenicima, a jedan od čimbenika je i oralno antikoagulacijsko liječenje. U ovom radu dajemo prikaz slučaja 69-godišnjeg bolesnika koji je zaprimljen u hitnu medicinsku službu pod kliničkom slikom hipovolemijskog (hemoragijskog) urušaja nastalog kao posljedica rupture lijevog slabinskog mišića, a potencirano antikoagulacijskim liječenjem varfarinom. Konačna dijagnoza postavljena je višeslojnom kompjuteriziranom tomografi jom krvnih žila abdomena s kontrastom, a krvarenje je nakon početnog konzervativnog liječenja zbrinuto kirurški.Hypovolemic shock due to large circulating volume loss is a vital threat to patient life. Loss of circulating volume can be provoked by a number of factors, one of them being oral anticoagulation therapy. This paper presents a case report of a 69-year-old patient on warfarin anticoagulant therapy, who was admitted to the emergency department with clinical presentation of hypovolemic (hemorrhagic) shock due to left psoas muscle rupture. Defi nitive diagnosis was made by multi-slice computed tomography of abdominal blood vessels with contrast, and the bleeding was surgically treated after initial conservative 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

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

Psoriasis: female skin changes in various hormonal stages throughout life - puberty, pregnancy, and menopause

Psoriasis is one of the most prevalent immune mediated skin diseases worldwide. Despite the large prevalence in both men and women, the pathogenesis of this disease has not yet been fully clarified. Nowadays, it is believed that psoriasis is most likely a T helper Th1/Th17 induced inflammatory disease. Stressful life situations are known to cause flare-ups and psoriasis activity may be linked to stress from major life events. We know that stress greatly affects both the hormone and immune systems and that there are many different hormonal phases throughout a woman's lifetime. The severity of psoriasis may fluctuate or be influenced by each phase and this relationship can be seen as disease frequency seems to peak during puberty, postpartum, and menopause when hormone levels fall, while symptoms improve during pregnancy, a state when hormone levels are increased