{"id":683,"date":"2015-02-02T15:47:16","date_gmt":"2015-02-02T13:47:16","guid":{"rendered":"http:\/\/urgentnimedicina.cz\/?p=683"},"modified":"2015-02-02T15:59:45","modified_gmt":"2015-02-02T13:59:45","slug":"obsah-42014","status":"publish","type":"post","link":"https:\/\/urgentnimedicina.cz\/?p=683","title":{"rendered":"Obsah 4\/2014"},"content":{"rendered":"
\u00a0 \u00a0 \u00a0\u00daVOD<\/span><\/h6>\n

\u00davodn\u00ed slovo<\/h4>\n

Jana \u0160eblov\u00e1<\/em><\/p>\n

Obsah<\/em><\/p>\n

\u00a0 \u00a0 \u00a0KONCEPCE, \u0158\u00cdZEN\u00cd, ORGANIZACE<\/span><\/h6>\n

Krizov\u00e1 p\u0159ipravenost a p\u0159\u00edprava zdravotnick\u00fdch z\u00e1chrann\u00fdch slu\u017eeb a zdravotnick\u00fdch za\u0159\u00edzen\u00ed<\/h4>\n

Pavel Urb\u00e1nek, Jan Urb\u00e1nek<\/em><\/p>\n

Abstrakt<\/strong><\/p>\n

Krizov\u00e1 p\u0159ipravenost zdravotnictv\u00ed je vn\u00edm\u00e1na jako schopnost poskytovatel\u016f zdravotnick\u00fdch slu\u017eeb a zdravotnick\u00fdch za\u0159\u00edzen\u00ed poskytovat nezbytnou zdravotn\u00ed p\u00e9\u010di obyvatelstvu za krizov\u00fdch stav\u016f a za mimo\u0159\u00e1dn\u00fdch ud\u00e1lost\u00ed a to v odpov\u00eddaj\u00edc\u00ed kvalit\u011b p\u0159ipraven\u00fdmi a odborn\u011b zp\u016fsobil\u00fdmi pracovn\u00edky. Maj\u00ed-li b\u00fdt pracovn\u00edci p\u0159ipraveni a zp\u016fsobil\u00ed, mus\u00ed se na z\u00e1klad\u011b odborn\u011b zpra\u00adcovan\u00fdch pl\u00e1n\u016f\/sc\u00e9n\u00e1\u0159\u016f kvalitn\u011b vzd\u011bl\u00e1vat a jejich schopnosti mus\u00ed b\u00fdt ov\u011b\u0159ov\u00e1ny.<\/p>\n

Auto\u0159i se pokusili zmapovat, jak\u00fdm zp\u016fsobem prob\u00edhala v posledn\u00edch letech p\u0159\u00edprava zdravotnick\u00fdch z\u00e1chrann\u00fdch slu\u017eeb (ZZS) a n\u011bkter\u00fdch zdravotnick\u00fdch za\u0159\u00edzen\u00ed (ZZ) na \u0159e\u0161en\u00ed mimo\u0159\u00e1dn\u00fdch ud\u00e1lost\u00ed a krizov\u00fdch situac\u00ed. Proto\u017ee vn\u00edm\u00e1me-li zdravotnick\u00fd z\u00e1chrann\u00fd \u0159et\u011bzec, kter\u00fd je definov\u00e1n jako funk\u010dn\u00ed propojen\u00ed poskytovatel\u016f neodkladn\u00e9\/urgentn\u00ed p\u00e9\u010de, jako\u017eto z\u00e1kladn\u00ed n\u00e1stroj krizov\u00e9 p\u0159ipravenosti zdravotnictv\u00ed, pak p\u0159edev\u0161\u00edm p\u0159\u00edprava a p\u0159ipravenost t\u011bchto subjekt\u016f vypov\u00edd\u00e1 o jeho funk\u010dnosti.<\/p>\n

Doporu\u010den\u00fd postup pro zdravotnick\u00e9 zaji\u0161t\u011bn\u00ed kulturn\u00edch a sportovn\u00edch akc\u00ed<\/h4>\n

Ji\u0159\u00ed Knor<\/em><\/p>\n

\u00a0 \u00a0 \u00a0VZD\u011aL\u00c1V\u00c1N\u00cd, ZKU\u0160ENOSTI<\/span><\/h6>\n

P\u016fsoben\u00ed \u010cesk\u00e9ho \u010derven\u00e9ho k\u0159\u00ed\u017ee p\u0159i povodn\u00edch v roce 2013 na M\u011blnicku<\/h4>\n

Lucie Balarinov\u00e1, Kate\u0159ina Ivanov\u00e1<\/em><\/p>\n

Abstrakt<\/strong><\/p>\n

\u010cesk\u00e1 republika pat\u0159\u00ed mezi \u00fazem\u00ed su\u017eovan\u00e9 mimo\u0159\u00e1dn\u00fdmi ud\u00e1lostmi jak men\u0161\u00edho rozsahu (dopravn\u00ed a jin\u00e9 nehody, po\u017e\u00e1ry, tor\u00adn\u00e1da, nehody v hor\u00e1ch \u010di ve vod\u011b atd.), tak i v\u011bt\u0161\u00ed mimo\u0159\u00e1dn\u00e9 ud\u00e1losti, mezi kter\u00e9 pat\u0159\u00ed i povodn\u011b. Ud\u00e1losti doprov\u00e1z\u00ed poskyto\u00adv\u00e1n\u00ed pomoci zasa\u017een\u00fdm osob\u00e1m, na kter\u00e9m se pod\u00edl\u00ed profesion\u00e1lov\u00e9 z \u0159ad slo\u017eek integrovan\u00e9ho z\u00e1chrann\u00e9ho syst\u00e9mu ale i dob\u00adrovoln\u00edci r\u016fzn\u00fdch nest\u00e1tn\u00edch neziskov\u00fdch organizac\u00ed. V p\u0159\u00edpadov\u00e9 studii se zab\u00fdv\u00e1me konkr\u00e9tn\u00ed ud\u00e1lost\u00ed (povodn\u011b v roce 2013) se zam\u011b\u0159en\u00edm na jednu organizaci (\u010cesk\u00fd \u010derven\u00fd k\u0159\u00ed\u017e) a lokalitu (M\u011blnicko). V\u00fdzkumn\u00e1 ot\u00e1zka zn\u00ed: \u201eJak\u00e1 byla krizov\u00e1 p\u0159ipravenost \u010c\u010cK p\u0159i povodn\u00edch v roce 2013 na M\u011blnicku?\u201c V\u00fdsledkem je p\u0159\u00edpadov\u00e1 studie obsahuj\u00edc\u00ed t\u0159i celky: (1) fakta o vzniku a v\u00fdvoji po\u00advodn\u00ed na M\u011blnicku v roce 2013, (2) zapojen\u00ed \u010c\u010cK do poskytov\u00e1n\u00ed pomoci p\u0159i povodn\u00edch na M\u011blnicku, (3) reflexe \u010c\u010cK v obdob\u00ed po povodni. Studie m\u016f\u017ee b\u00fdt z\u00e1kladem pro vytvo\u0159en\u00ed dal\u0161\u00edch p\u0159\u00edpadov\u00fdch studi\u00ed nap\u0159. poskytov\u00e1n\u00ed pomoci \u010c\u010cK p\u0159i povodn\u00edch v roce 2010, 2009 a n\u00e1slednou vz\u00e1jemnou komparaci v\u0161ech studi\u00ed. Katastrof p\u0159ib\u00fdv\u00e1 a auto\u0159i citovan\u00e9 literatury se shoduj\u00ed v tom, \u017ee kl\u00ed\u010dov\u00e1 je kvalitn\u00ed krizov\u00e1 p\u0159ipravenost na v\u0161ech \u00farovn\u00edch tzn. jednotlivc\u016f, organizac\u00ed, st\u00e1tu.<\/p>\n

\u010cinnost zdravotnick\u00e9 slo\u017eky p\u0159i z\u00e1sahu integrovan\u00e9ho z\u00e1chrann\u00e9ho syst\u00e9mu u po\u017e\u00e1ru v\u00fd\u0161kov\u00e9 budovy<\/h4>\n

Robin \u0160\u00edn, David Steindl, Pavel B\u00f6hm<\/em><\/p>\n

Abstrakt<\/strong><\/p>\n

\u010cl\u00e1nek p\u0159edstavuje \u010dinnost zdravotnick\u00e9 slo\u017eky p\u0159i z\u00e1sahu integrovan\u00e9ho z\u00e1chrann\u00e9ho syst\u00e9mu u po\u017e\u00e1ru v\u00fd\u0161kov\u00e9 budovy. Po\u00adps\u00e1na jsou specifika z\u00e1sahu spojen\u00e1 s charakterem mimo\u0159\u00e1dn\u00e9 ud\u00e1losti a \u010dl\u00e1nek se tak\u00e9 zam\u011b\u0159uje na zp\u016fsoby zapojen\u00ed sil a pro\u00adst\u0159edk\u016f zdravotnick\u00e9 z\u00e1chrann\u00e9 slu\u017eby, kter\u00e1 standardn\u011b tvo\u0159\u00ed z\u00e1klad zdravotnick\u00e9 slo\u017eky z\u00e1sahu. Praktick\u00fd postup je p\u0159edsta\u00adven na kazuistice z\u00e1sahu u ho\u0159\u00edc\u00ed v\u00fd\u0161kov\u00e9 budovy v Chodov\u011b v okresu Sokolov.<\/p>\n

\u00a0 \u00a0 \u00a0ODBORN\u00c9 T\u00c9MA L\u00c9KA\u0158SK\u00c9<\/span><\/h6>\n

Sepse v urgentn\u00ed medic\u00edn\u011b: obt\u00ed\u017en\u00e1 diagnostika, n\u00edzk\u00e1 priorita, vysok\u00e1 mortalita<\/h4>\n

Jana \u0160eblov\u00e1, \u0160t\u011bp\u00e1nka Bure\u0161ov\u00e1<\/p>\n

Abstrakt<\/strong><\/p>\n

Diagnostika sepse v p\u0159ednemocni\u010dn\u00ed p\u00e9\u010di je n\u00edzk\u00e1, op\u00edr\u00e1 s o anamn\u00e9zu, m\u011b\u0159en\u00ed z\u00e1kladn\u00edch parametr\u016f vit\u00e1ln\u00edch funkc\u00ed (t\u011blesn\u00e1 teplota, tepov\u00e1 frekvence, po\u010det dech\u016f\/min., krevn\u00ed tlak) a o klinick\u00e9 vy\u0161et\u0159en\u00ed (p\u0159\u00edtomnost org\u00e1nov\u00e9ho posti\u017een\u00ed, oligurie\/anu\u00adrie). Mezi z\u00e1kladn\u00ed terapeutick\u00e1 opat\u0159en\u00ed pat\u0159\u00ed zaji\u0161t\u011bn\u00ed p\u0159\u00edstupu do krevn\u00edho ob\u011bhu a volumoterapie, co\u017e je dosa\u017eiteln\u00e9 i v ter\u00e9nu.<\/p>\n

C\u00edlem pilotn\u00ed retrospektivn\u00ed studie bylo jednak zjistit, jak\u00fd je v\u00fdskyt pacient\u016f se seps\u00ed v urgentn\u00ed p\u00e9\u010di a pod jak\u00fdmi symptomy se septick\u00e9 stavy manifestuj\u00ed. D\u00e1le jsme cht\u011bli zjistit, jak\u00e9 jsou hodnoty parametr\u016f vit\u00e1ln\u00edch funkc\u00ed, a zda se n\u011bjak li\u0161\u00ed pacienti p\u0159ive\u00adzen\u00ed zdravotnickou z\u00e1chrannou slu\u017ebou od ostatn\u00edch infek\u010dn\u00edch pacient\u016f.<\/p>\n

Z 1036 pacient\u016f UP Kladno v obdob\u00ed od 1. ledna 2014 do 28. \u00fanora 2014 m\u011blo diagn\u00f3zu z\u00e1va\u017en\u00e9 infekce 68 pacient\u016f (7 %), 42 (= 62 %) z nich bylo p\u0159ivezeno ZZS. Hospitaliza\u010dn\u00ed mortalita v\u0161ech pacient\u016f byla 26 %, u pacient\u016f transportovan\u00fdch ZZS tak\u00e9 26 % a u skupiny, kter\u00e1 se dostala na UP jin\u00fdm zp\u016fsobem, byla mortalita 27 % . Pacienti transportovan\u00ed ZZS byli v 75 % za\u0159azeni do n\u00edzk\u00e9 priority a transportov\u00e1ni pos\u00e1dkou bez l\u00e9ka\u0159e. Diagn\u00f3za infekce byla uvedena pouze u 10 % pacient\u016f, u dal\u0161\u00edch 28 % byla stanovena symptomatick\u00e1 diagn\u00f3za febriln\u00edho stavu.<\/p>\n

Sepse a infekce jsou pom\u011brn\u011b \u010dastou a z\u00e1va\u017enou diagn\u00f3zou s vysokou mortalitou. Septi\u010dt\u00ed pacienti se v p\u0159ednemocni\u010dn\u00ed f\u00e1zi manifestuj\u00ed bu\u010f du\u0161nost\u00ed (v p\u0159\u00edpad\u011b respira\u010dn\u00ed etiologie infekce) nebo celkov\u00fdmi necharakteristick\u00fdmi p\u0159\u00edznaky (v p\u0159\u00edpad\u011b jin\u00e9 ne\u017e respira\u010dn\u00ed etiologie). Identifikace septick\u00fdch pacient\u016f je v ter\u00e9nu velmi obt\u00ed\u017en\u00e1 a zhor\u0161uje ji i nedostate\u010dn\u00e9 vy\u0161et\u0159en\u00ed pacienta. Rutinn\u00ed m\u011b\u0159en\u00ed teploty, respira\u010dn\u00ed frekvence, tepov\u00e9 frekvence a tlaku by mohlo zlep\u0161it diagnostiku.<\/p>\n

\u00a0 \u00a0 \u00a0 ETIKA, PSYCHOLOGIE, PR\u00c1VO<\/span><\/h6>\n

Bystander efekt p\u0159i penetruj\u00edc\u00edm poran\u011bn\u00ed hypogastria<\/h4>\n

Tibor A. Bre\u010dka, Veronika K. Netu\u0161ilov\u00e1<\/em><\/p>\n

Abstrakt<\/strong><\/p>\n

Auto\u0159i na z\u00e1klad\u011b kasuistiky v\u00fdjezdu ZZS k pacientovi s penetruj\u00edc\u00edm poran\u011bn\u00edm hypogastria teoreticky popisuj\u00ed fenom\u00e9n tzv.
\n\u201ebystander efektu\u201c a faktory, kter\u00e9 se pod\u00edlej\u00ed na jeho vzniku a pr\u016fb\u011bhu. N\u00e1sledn\u011b pak tyto teoretick\u00e9 poznatky p\u0159ibli\u017euj\u00ed na \u00favodn\u00edm\u00a0p\u0159\u00edkladu kasuistiky. V z\u00e1v\u011bru auto\u0159i p\u0159in\u00e1\u0161ej\u00ed mo\u017en\u00e1 doporu\u010den\u00e1 do praxe, zejm\u00e9na v oblasti prevence a edukace civiln\u00edho
\nobyvatelstva.<\/p>\n

Z\u00e1chran\u00e1rske s\u00fa\u0165a\u017ee a ich miesto v hist\u00f3rii z\u00e1chraniek na Slovensku<\/h4>\n

Andrea Smolkov\u00e1<\/em><\/p>\n

Abstrakt<\/strong><\/p>\n

Korene z\u00e1chrannej slu\u017eby na Slovensku siahaj\u00fa do roku 1872, ke\u010f vznikol hasi\u010dsk\u00fd spolok v Ko\u0161iciach a bol vytvoren\u00fd priestor pre vzdel\u00e1vanie prv\u00fdch samarit\u00e1nov. Prv\u00e1 stanica z\u00e1chrannej zdravotnej slu\u017eby na \u00fazem\u00ed Bratislavy bola zalo\u017een\u00e1 v roku 1907, kde nesk\u00f4r vznikol aj dispe\u010ding s telef\u00f3nom. Vo v\u00e1\u017enych pr\u00edpadoch vyr\u00e1\u017eal za pacientom aj lek\u00e1r. V roku 1966 bol prijat\u00fd z\u00e1\u00adkon o zdravotnej starostlivosti, ktor\u00fd rie\u0161il aj prednemocni\u010dn\u00fa starostlivos\u0165 a okrem transportu u\u017e popisuje aj prvotn\u00e9 vy\u0161etrenie a zabezpe\u010denie vit\u00e1lnych funkci\u00ed. Za\u010dal sa kl\u00e1s\u0165 d\u00f4raz na adekv\u00e1tne zabezpe\u010denie pacienta pred transportom so siln\u00fdm dopa\u00addom na v\u00fdsledok. V 70-tych rokoch minul\u00e9ho storo\u010dia sa pod vplyvom rozvoja dopravy a priemyslu zv\u00fd\u0161ila incidencia \u00farazov a v tomto \u010dase sa zrodila my\u0161lienka z\u00e1chran\u00e1rskych s\u00fa\u0165a\u017e\u00ed ako n\u00e1stroj vzdel\u00e1vania a rozvoja z\u00e1chran\u00e1rskych kompetenci\u00ed. Slo\u00advensk\u00e1 s\u00fa\u0165a\u017e pos\u00e1dok z\u00e1chrann\u00fdch zdravotn\u00fdch slu\u017eieb je najstar\u0161ia z\u00e1chran\u00e1rska s\u00fa\u0165a\u017e na svete. Hist\u00f3riu za\u010dala p\u00edsa\u0165 v roku 1979 a bola jedin\u00fdm metodick\u00fdm, v\u00fdcvikov\u00fdm a praktick\u00fdm zamestnan\u00edm v slovenskom zdravotn\u00edctve, kde sa praktick\u00e1 v\u00fdu\u010dba nepraktikovala na pacientoch. V s\u00fa\u0165a\u017ei sa dodnes stret\u00e1vaj\u00fa pos\u00e1dky RLP (r\u00fdchlej lek\u00e1rskej pomoci \u2013 s lek\u00e1rom) a RZP (r\u00fdchlej zdravotn\u00edckej pomoci \u2013 bez lek\u00e1ra) z celej krajiny a s\u00fa\u0165a\u017eia v rie\u0161en\u00ed \u00faloh, ktor\u00e9 s\u00fa simul\u00e1ciou nozologick\u00fdch jednotiek a pr\u00edpadov z ka\u017edodennej z\u00e1chran\u00e1rskej praxe. Prv\u00e1 s\u00fa\u0165a\u017e sa konala v roku 1979 a bola to s\u00fa\u0165a\u017e dvoj\u010dlenn\u00fdch pos\u00e1dok (vodi\u010d a z\u00e1chran\u00e1r), kde pos\u00e1dky s\u00fa\u0165a\u017eili v jazde zru\u010dnosti, vedomostnom teste a v teste fyzickej v\u00fdkonnosti. V roku 1984 pribudla resuscit\u00e1cia na figur\u00edne. Na s\u00fa\u0165a\u017ei vl\u00e1dne typick\u00e1 atmosf\u00e9ra a \u00fa\u010das\u0165 je skvel\u00fdm z\u00e1\u017eitkom a sk\u00fasenos\u0165ou nielen pre s\u00fa\u0165a\u017eiacich a rozhodcov, ale aj pre figurantov. Mnoho plodn\u00fdch, inov\u00e1torsk\u00fdch my\u0161lienok bolo prediskutovan\u00fdch pr\u00e1ve na f\u00f3rach s\u00fa\u0165a\u017e\u00ed a stali sa impulzom pre zmeny v odbore \u2013 praktick\u00e9 aj legislat\u00edvne.<\/p>\n

\u00a0 \u00a0 \u00a0INFORMA\u010cN\u00cd SERVIS<\/span><\/h6>\n

Zpr\u00e1va o \u010dinnosti v\u00fdboru SUMMK \u010cLS JEP 2011 \u2013 2014<\/h4>\n

Jana \u0160eblov\u00e1<\/em><\/p>\n

Mezin\u00e1rodn\u00ed konference v roce 2014<\/h4>\n

Jana \u0160eblov\u00e1<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0 \u00a0 \u00a0\u00daVOD \u00davodn\u00ed slovo Jana \u0160eblov\u00e1 Obsah \u00a0 \u00a0 \u00a0KONCEPCE, \u0158\u00cdZEN\u00cd, ORGANIZACE Krizov\u00e1 p\u0159ipravenost a p\u0159\u00edprava zdravotnick\u00fdch z\u00e1chrann\u00fdch slu\u017eeb a zdravotnick\u00fdch za\u0159\u00edzen\u00ed Pavel Urb\u00e1nek, Jan Urb\u00e1nek Abstrakt Krizov\u00e1 p\u0159ipravenost zdravotnictv\u00ed je vn\u00edm\u00e1na jako schopnost poskytovatel\u016f zdravotnick\u00fdch slu\u017eeb a zdravotnick\u00fdch<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"class_list":["post-683","post","type-post","status-publish","format-standard","hentry","category-rocnik-2014"],"_links":{"self":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/683","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=683"}],"version-history":[{"count":0,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/683\/revisions"}],"wp:attachment":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=683"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=683"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=683"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}