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 setting’s.Poremećaji koagulacije česti su u kritičnih bolesnika i u bolesnika s krvarenjem, te predstavljaju veliki izazov za sve liječnike koji su uključeni u rad hitne medicinske službe. Liječenje bolesnika s krvarenjem uključuje kontrolu krvarenja, nadoknadu volumena krvi i korekciju koagulopatije. Tradicionalno, za korekciju koagulopatije i sprječavanje krvarenja najčešće se koristi svježe smrznuta plazma (SSP), no danas se kao alternativa sve češće koristi koncentrat protrombinskog kompleksa (engl. prothrombin complex concentrates - PCC) zbog brojnih prednosti u odnosu na SSP, a koje uključuju primjenu manjeg volumena, bržu korekciju IN R-a, bržu dostupnost, bolji sigurnosni profil, a također nije potrebna ni krvno grupna specifičnost. Cilj ovog rada je pružiti kratki pregled o osnovnim indikacijama, sigurnosti i učinkovitosti primjene PCC u stanjima krvarenja različite etiologije

Public access to the “Restart a Heart – Save a Life” early defibrillation programme in Croatia

In collaboration with the Croatian Institute of Emergency Medicine and the Croatian Institute of Public Health, the Ministry of Health launched the National Public Access to Early Defibrillation Programme entitled “Restart a Heart – Save a Life” in 2013. The main implementing activities are public health education about early defibrillation in the case of sudden cardiac arrest, enlarging the accessibility of the automated external defibrillator (AED) and training laymen to perform cardiopulmonary resuscitation and defibrillation by use of AED. Forty-one training courses were organised and 422 lay people trained in 2013. In addition, 197 AEDs were obtained and fitted in settings where people are expected to assemble permanently or occasionally. The “Restart a Heart – Save a Life” programme ensures a broad platform for joint action of public administration authorities, governmental and nongovernmental agencies, and all organisations and individuals interested in reaching the goal of increasing the rate of survival of people suffering from a sudden cardiac arrest

Promjene učestalosti trovanja psihoaktivnim lijekovima u Hrvatskoj

The aim of this study was to analyse the frequency of poisoning with psychoactive drugs (benzodiazepines, antidepressants and neuroleptics) over the last 15 years in Croatia. The analysis was based on poisoning incidents reported over the phone (hot line) to the Zagreb Poison Control Center and included two periods: 1985–1991 (period I) and 1992–1999 (period II). The data were analysed separately for children and adults. Each phone call was counted as one poisoning incident. Child poisoning with neuroleptics was significantly higher in period II than in period I and so was the adult poisoning with antidepressants, amytriptyline, and combined psychoactive drugs. The frequency of total psychoactive drug poisoning was significantly higher in adults than in children in both periods. From 1992, the frequency of adult poisoning with antidepressants considerably increased as one of the many consequences of war-related stress. The results indicate a need for careful psychiatric evaluation and more critical use of antidepressants in affected individuals.Retrospektivno su analizirani telefonski pozivi vezani uz ingestije lijekova primljeni u nacionalnom Centru za kontrolu otrovanja u Zagrebu u posljednjih 15 godina. Tri skupine psihoaktivnih lijekova (benzodiazepini, neuroleptici, antidepresivi) bile su od posebnog značenja u ovom radu. Svi slučajevi ingestije lijekova analizirani su u dva vremenska intervala: period I (1985.–1991.) i period II (1992.–1999.) te u dvije skupine s obzirom na dob otrovanih: djeca (<16 godina) i odrasli (316 godina). Svaki telefonski poziv brojen je kao jedan slučaj trovanja, uključujući i višestruke ingestije lijekova (ingestije više od jedne vrste lijeka u isto vrijeme) koje su uključivale barem jedan psihoaktivni lijek. Kod djece, učestalost akutnih otrovanja neurolepticima bila je značajno veća u periodu II nego u periodu I (7.4%:4.4%; P<0.05). Učestalost otrovanja benzodiazepinima, antidepresivima i amitriptilinom kod djece nije se značajno razlikovala u periodu I i II (benzodiazepini – 13.5%:9.9%; antidepresivi – 1.8%:1.8%; amitriptilin – 0.3%:0.6%), kao ni učestalost višestrukih ingestija lijekova (19.4%:20.5%). Kod odraslih, učestalost otrovanja antidepresivima i amitriptilinom bila je značajno veća u periodu II nego u periodu I (antidepresivi – 13.0%:5.9%; P<0.01; amitriptilin – 7.3%:2.9%; P<0.05), kao i učestalost višestrukih ingestija lijekova (45.3%: 29.1%; P<0.01). Učestalost otrovanja benzodiazepinima i neurolepticima kod odraslih nije se značajno razlikovala u periodu I i II (benzodiazepini – 27.5%: 28.4%; neuroleptici – 20.6%: 19.7%). U oba perioda učestalost otrovanja psihoaktivnim lijekovima bila je značajno veća u odraslih nego u djece (period I – 53.9%: 19.4%; P<0.01; period II – 61.3%:19.1%; P<0.01). Od 1992. u Hrvatskoj se bilježi značajan porast broja akutnih otrovanja antidepresivima, osobito tricikličkim, u odraslih osoba, što je vezano vjerojatno uz učestalije propisivanje tih lijekova. Ovaj fenomen nije zabilježen u djece. Povećanje učestalosti akutnih otrovanja psihoaktivnim lijekovima, kao jedna od mnogih posljedica rata i posttraumatskoga stresnog poremećaja, upućuje na potrebu pažljive psihijatrijske procjene oboljelih, osobito pažljiviju uporabu antidepresiva. Rezultati ovog rada govore u prilog potrebe daljnjeg istraživanja učestalosti propisivanja psihoaktivnih lijekova u Hrvatskoj

Public access to the “Restart a Heart – Save a Life” early defibrillation programme in Croatia

In collaboration with the Croatian Institute of Emergency Medicine and the Croatian Institute of Public Health, the Ministry of Health launched the National Public Access to Early Defibrillation Programme entitled “Restart a Heart – Save a Life” in 2013. The main implementing activities are public health education about early defibrillation in the case of sudden cardiac arrest, enlarging the accessibility of the automated external defibrillator (AED) and training laymen to perform cardiopulmonary resuscitation and defibrillation by use of AED. Forty-one training courses were organised and 422 lay people trained in 2013. In addition, 197 AEDs were obtained and fitted in settings where people are expected to assemble permanently or occasionally. The “Restart a Heart – Save a Life” programme ensures a broad platform for joint action of public administration authorities, governmental and nongovernmental agencies, and all organisations and individuals interested in reaching the goal of increasing the rate of survival of people suffering from a sudden cardiac arrest

Correlation of Psychosis and Suicide Attempts with Meteorological Factors

ln this study the authors have tried to find out if there is any correlation between weather caracteristics and acute psychoses and suicidal attempts (APSA). This research was based on SHMP data about the number of interventions in cases of APSA over a period of one year (VI/1988 - V/1989) in Zagreb and on the meteorological data registered at the Observatory Zagreb-Maksimir in the same period as well as on weather charts prepared daily or collected in the Hydrometeorological lnstitute of Croatia in Zagreb. A possible correlation with weather types and passages of cold fronts and especially with meteorological elements as: cloudiness, barometric pressure, air temperature and relative humidity, was studied. Linear correlation coefficients were calculated for daily values and for moving three-, five- and seven-day periods. The results revealed that the number of psychoses and suicidal attempts increased from month to month during the period considered, especially in females of the 15-20, 21-30 and 31-40 age groups. The acute psychosis and suicidal attempt number does not significantly differ with respect to weather type. The daily frequency of these pathological reactions increases in all seasons typically a day or two before and after a cold font passage, but differences are not significant. A significant correlation was obtained only with the duration of a high daily cloudiness amount. Suicidal attempts and psychoses increase significantly if the cloudy period lasts at least three days, but their significance is higher if the cloudy weather period is longer

RECOGNITION AND TIMELY TREATMENT OF CARBON MONOXIDE POISONING

Ugljikov monoksid (CO) je visokotoksični bezbojni plin, bez okusa i mirisa koji je posvuda prisutan u suvremenom industrijskom društvu. Dijagnoza otrovanja ovisi o detaljnim anamnestičkim podatcima koji ukazuju na povezanost simptoma i znakova otrovanja i izloženosti iz okoliša. Za potvrdu dijagnoze potrebno je određivanje razine karboksihemoglobina u venskoj ili arterijskoj krvi, koje je rijetko dostupno u izvanbolničkim uvjetima. Novi pulsni CO-oksimetri mjere apsorpciju svjetlosti na 8 valnih duljina pa osim uobičajene razine zasićenja hemoglobina kisikom pokazuju postotak karboksihemoglobina u krvi. Osnova liječenja je brza primjena normobaričnog kisika s visokim protokom putem maske sa spremnikom. Međutim, još uvijek nema općeprihvaćenih kriterija za liječenje hiperbaričnim kisikom kao ni dobrih pokazatelja kod kojih bolesnika takvo liječenje osigurava bolji ishod i manju vjerojatnost nastanka kasnih neuroloških posljedica.Carbon monoxide (CO) is a colorless, odorless, tasteless, and extremely toxic gas, which is ubiquitous in our industrial society. Diagnosing CO poisoning relies on taking thorough history exploring the relationship of symptoms and signs of poisoning to environmental CO exposure. Venous or arterial blood gas analysis measurement of carboxyhemoglobin is required for defi nitive diagnosis, and this is rarely available outside the hospital environment. New eight-wavelength pulse oximeters are designed to measure carboxyhemoglobin, in addition to the usual measurements of hemoglobin oxygen saturation. Essential treatment for CO poisoning is immediate delivery of high fl ow normobaric oxygen through a non-rebreather mask with reservoir bag. However, still no consensus exists on hyperbaric oxygen therapy, and reliable indicators for identifying patients who will benefi t from such therapy with better outcomes and lower risk of delayed neurological sequels are also lacking

Mucoepidermoid Carcinoma Misdiagnosed as Palatal Odontogenic Infection: An Overview on the Differential Diagnosis of Palatal Lesions

Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authors’ knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MEC’s differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list

Mucoepidermoid carcinoma misdiagnosed as palatal odontogenic infection: an overview on the differential diagnosis of palatal lesions [Mukoepidermoidni karcinom pogrešno dijagnosticiran kao odontogena upala: pregled diferencijalne dijagnoze nepčanih lezija]

Mucoepidermoid carcinoma (MEC) accounts for approximately 30% of malignant salivary gland tumors and approximately 30% occur in minor salivary glands. The palate is the most frequent localization for those arising in minor glands. A 33-year-old male patient with MEC of the hard palate was treated as an acute odontogenic infection, which was not cured after tooth endodontic treatments, repeated incisions and antibiotics. On the hard palate ovoid, a hard painless mass, which had not extended over the middle palatal line, was observed. Partial maxillectomy was performed. A review of the literature was performed in order to provide a coherent overview on the differential diagnosis of palatal lesions. To the best of authors’ knowledge, this is the first report in English literature describing palatal MEC misdiagnosed and treated as odontogenic infection. Considering the extensive list of MEC’s differential diagnoses on the hard palate, acute odontogenic infection can now be added to that list