{"id":766,"date":"2016-11-16T10:55:46","date_gmt":"2016-11-16T08:55:46","guid":{"rendered":"http:\/\/urgentnimedicina.cz\/?p=766"},"modified":"2016-11-16T10:55:46","modified_gmt":"2016-11-16T08:55:46","slug":"obsah-32016","status":"publish","type":"post","link":"https:\/\/urgentnimedicina.cz\/?p=766","title":{"rendered":"Obsah 3\/2016"},"content":{"rendered":"
\u00a0 \u00a0 \u00a0\u00daVOD<\/span><\/h6>\n

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

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

Obsah<\/h4>\n
\u00a0 \u00a0 \u00a0T\u00c9MA ROKU: Z\u00c1VA\u017dN\u00dd \u00daRAZ<\/span><\/h6>\n

Tri\u00e1\u017e rizika \u00farazov\u00fdch pacient\u016f na m\u00edst\u011b \u00farazu a jejich sm\u011brov\u00e1n\u00ed do nemocni\u010dn\u00edch za\u0159\u00edzen\u00ed k poskytnut\u00ed definitivn\u00ed p\u00e9\u010de<\/h4>\n

V\u011bstn\u00edk Ministerstva zdravotnictv\u00ed \u010cR<\/em><\/p>\n

Z\u00e1va\u017en\u00fd \u00faraz \u2013 mechanismy adaptace, obecn\u00e9 priority l\u00e9\u010dby<\/h4>\n

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

Prednemocni\u010dn\u00fd mana\u017ement polytraumy v syst\u00e9me neodkladnej zdravotnej starostlivosti na Slovensku<\/h4>\n

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

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

Ka\u017edoro\u010dne zomr\u00fa celosvetovo pribli\u017ene 4 mili\u00f3ny \u013eud\u00ed n\u00e1sledkom \u00farazu a hoci ve\u013ek\u00e1 \u010das\u0165 pacientov s \u0165a\u017ek\u00fdm \u00farazom zomiera na mieste nehody a v prednemocni\u010dnej zdravotnej starostlivosti, r\u00f4zne zdroje uv\u00e1dzaj\u00fa, \u017ee 44 % \u00famrt\u00ed na traumu je po prijat\u00ed do nemocnice.
\nZ\u00e1va\u017en\u00e9 krv\u00e1canie je zodpovedn\u00e9 pribli\u017ene za tretinu \u00famrt\u00ed u pacientov hospitalizovan\u00fdch pre traumu (v\u010dasn\u00e9 \u00famrtia) a z\u00e1rove\u0148 v\u00fdznamne prispieva k ostatn\u00fdm pr\u00ed\u010din\u00e1m smrti (neskor\u00e9 \u00famrtia). V\u00fdznamnou pr\u00ed\u010dinou tzv. preventabilnej smrti n\u00e1sledkom \u0165a\u017ek\u00e9ho \u00farazu je zlyhanie v\u010dasn\u00e9ho a adekv\u00e1tneho mana\u017ementu pacienta s \u00farazom. R\u00fdchla a spr\u00e1vna identifik\u00e1cia pacientov s vysok\u00fdm rizikom smrti a n\u00e1sledne transport do spr\u00e1vnej nemocnice, m\u00f4\u017ee mortalitu \u0165a\u017ek\u00fdch \u00farazov zni\u017eova\u0165. Syst\u00e9m NZS by mal v ka\u017edej krajine fungova\u0165 ako celok a pri jeho tvorbe by mali by\u0165 zoh\u013ead\u0148ovan\u00e9 vedeck\u00e9 anal\u00fdzy a z\u00e1ujem o kvalitn\u00e9 pre\u017e\u00edvanie \u010do najv\u00e4\u010d\u0161ieho podielu pacientov.
\nEfekt\u00edvne vynakladanie zdrojov je tie\u017e ve\u013emi d\u00f4le\u017eit\u00e9, zva\u017eova\u0165 sa v\u0161ak mus\u00ed nielen okam\u017eit\u00fd finan\u010dn\u00fd efekt v u\u0161etren\u00fdch peniazoch za kilometre, pr\u00edpadne oblo\u017enos\u0165 oddelenia, \u010di vy\u0165a\u017eenos\u0165 person\u00e1lu. Do \u00favahy mus\u00edme bra\u0165 kvalitu pre\u017e\u00edvania zranen\u00fdch a ich schopnos\u0165 zaradi\u0165 sa do akt\u00edvneho, aj pracovn\u00e9ho \u017eivota dlhodobo.<\/p>\n

P\u00e9\u010de o pacienty se z\u00e1va\u017en\u00fdm \u00farazem a v\u00fdznam LZS v t\u00e9to p\u00e9\u010di<\/h4>\n

Roman Svit\u00e1k<\/em><\/p>\n

Srovn\u00e1n\u00ed vyu\u017eit\u00ed leteck\u00fdch v\u00fdjezdov\u00fdch skupin na jednotliv\u00fdch stanic\u00edch LZS v \u010cR z hlediska prim\u00e1rn\u00edch z\u00e1sah\u016f indikovan\u00fdch ZOS na z\u00e1klad\u011b vyhodnocen\u00ed t\u00eds\u0148ov\u00e9 v\u00fdzvy<\/h4>\n

Ond\u0159ej Fran\u011bk<\/em><\/p>\n

Maturace trauma syst\u00e9mu v regionu traumacentra I. typu<\/h4>\n

Jarom\u00edr Ko\u010d\u00ed, Jan Trlica, Petr Lochman, Tom\u00e1\u0161 D\u011bdek<\/em><\/p>\n

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

Kvalitn\u00ed a funguj\u00edc\u00ed trauma syst\u00e9m je z\u00e1kladem p\u00e9\u010de o poran\u011bn\u00e9 pacienty. Popis jeho tvorby, v\u00fdvoje a dopadu tohoto syst\u00e9mu na morbiditu a letalitu pacient\u016f je c\u00edlem \u010dl\u00e1nku.<\/p>\n

Polytrauma \u2013 stratifik\u00e1cia rizika a sk\u00f3rovacie syst\u00e9my<\/h4>\n

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

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

U pacientov s polytraumou a mnohopo\u010detn\u00fdmi poraneniami je s\u00fa\u010das\u0165ou mana\u017ementu okrem prvotn\u00e9ho o\u0161etrenia a stabiliz\u00e1cie vit\u00e1lnych funkci\u00ed aj spr\u00e1vne smerovanie. Nevyhnutnou podmienkou spr\u00e1vneho smerovania je zatriedenie do patri\u010dnej rizikovej skupiny (tzv. tri\u00e1\u017e) na z\u00e1klade predpokladu rizika smrti. Na Slovensku sa obvykle \u017eiaden prognostick\u00fd model prednemocni\u010dne nepou\u017e\u00edva a pritom vhodn\u00fd sk\u00f3rovac\u00ed syst\u00e9m, m\u00f4\u017ee by\u0165 pre spr\u00e1vne smerovanie do trauma centra, alebo \u0161pecializovanej nemocnice ve\u013emi u\u017eito\u010dn\u00fd. V na\u0161ej pr\u00e1ci sme sa zamerali na anal\u00fdzu, pou\u017eite\u013enos\u0165 a porovnanie presnosti sk\u00f3rovac\u00edch syst\u00e9mov pou\u017e\u00edvan\u00fdch v zahrani\u010d\u00ed. Potvrdili sme, \u017ee medzi hodnoten\u00edm z\u00e1va\u017enosti stavu anatomicky pod\u013ea ISS a klinicky pod\u013ea GAP je v\u00fdznamn\u00e1 korel\u00e1cia a vzh\u013eadom na obmedzen\u00fa mo\u017enos\u0165 pou\u017eitia ISS prednemocni\u010dne je pre odhad progn\u00f3zy vhodnej\u0161ie pou\u017ei\u0165 sk\u00f3re GAP. Liter\u00e1rne \u00fadaje sme porovnali s mortalitou pozorovanou v na\u0161om s\u00fabore a navrhujeme zaradenie syst\u00e9mu GAP do prednemocni\u010dn\u00e9ho mana\u017ementu pacientov s \u0165a\u017ek\u00fdm \u00farazom na Slovensku.<\/p>\n

P\u0159ednemocni\u010dn\u00ed p\u00e9\u010de o pacienta s v\u00e1\u017en\u00fdm \u00farazem v \u00dasteck\u00e9m kraji<\/h4>\n

Eva Smr\u017eov\u00e1<\/em><\/p>\n

Kvalita prednemocni\u010dnej zdravotnej starostlivosti vo Falck z\u00e1chrann\u00e1 a.s. \u2013 retrospekt\u00edvna \u0161t\u00fadia indik\u00e1torov kvality pri kraniocerebr\u00e1lnych poraneniach<\/h4>\n

Eva Havl\u00edkov\u00e1, Jozef Kara\u0161, Miroslav Humaj, Volodymyr Kizyma, \u0160tefan Trenkler<\/em><\/p>\n

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

\u00davod:<\/strong> Kraniocerebr\u00e1lne poranenie (KCP) je definovan\u00e9 ako po\u0161kodenie lebky a mozgu vplyvom vonkaj\u0161ej mechanickej sily, ktor\u00e9 m\u00e1 za n\u00e1sledok do\u010dasn\u00e9 alebo trval\u00e9 po\u0161kodenie funkci\u00ed centr\u00e1lneho nervov\u00e9ho syst\u00e9mu, spojen\u00fdch s r\u00f4znym stup\u0148om poruchy vedomia. Z\u00e1va\u017en\u00e9 kraniocerebr\u00e1lne poranenie je ved\u00facou pr\u00ed\u010dinou mortality a invalidiz\u00e1cie u det\u00ed a mlad\u00fdch dospel\u00fdch.
\nCie\u013eom pr\u00e1ce je anal\u00fdza kvality poskytovania prednemocni\u010dnej neodkladnej zdravotnej starostlivosti pri kraniocerebr\u00e1lnych poraneniach pos\u00e1dkami Falck Z\u00e1chrannej a.s.
\nMet\u00f3dy:<\/strong> Ide o retrospekt\u00edvnu \u0161t\u00fadiu z\u00e1sahov pos\u00e1dok Falck Z\u00e1chrann\u00e1 a.s. v roku 2015. Analyzovan\u00e9 boli indik\u00e1tory kvality \u010dinnosti pos\u00e1dok na sc\u00e9ne. Autori vych\u00e1dzali z usmernenia Slovenskej spolo\u010dnosti pre urgentn\u00fa medic\u00ednu a medic\u00ednu katastrof z r. 2015. Autori analyzovali aj \u010dasov\u00e9 indik\u00e1tory \u2013 dojazdov\u00fd \u010das a \u010das odovzdania pacienta v cie\u013eovom zdravotn\u00edckom zariaden\u00ed. Tieto \u010dasy boli stratifikovan\u00e9 do \u010dasov\u00fdch intervalov.
\nV\u00fdsledky:<\/strong> Pre stanovenie indik\u00e1torov kvality v\u00fdkonov na sc\u00e9ne bolo analyzovan\u00fdch 1579 z\u00e1sahov v roku 2015. Analyzovan\u00e9 boli indik\u00e1tory stanovenia presn\u00e9ho mechanizmu a okolnost\u00ed vzniku KCP, prevencia a korekcia hypoxie, prevencia a lie\u010dba syst\u00e9movej hypotenzie, monitoring vit\u00e1lnych funkci\u00ed, imobiliz\u00e1cia kr\u010dnej chrbtice a smerovanie pacienta.
\nAnal\u00fdza \u010dasov\u00fdch parametrov bola pre medi\u00e1n dojazdov\u00e9ho \u010dasu 8:20 min pre RLP pos\u00e1dky a 9:42 min pre RZP pos\u00e1dky. \u010cas od dosiahnutia pacienta po odovzdanie v zdravotn\u00edckom zariaden\u00ed bol v \u010dase \u201ezlatej hodiny\u201c dodr\u017ean\u00fd v 76,5% pacientov.
\nZ\u00e1ver:<\/strong> Z mno\u017estva v\u00fdsledkov, ktor\u00fdmi autori disponuj\u00fa, prezentuj\u00fa iba vybran\u00fa skupinu d\u00e1t. V\u00fdsledky uv\u00e1dzaj\u00fa ako vzor a potenci\u00e1lne v\u00fdchodisko pri zverej\u0148ovan\u00ed \u010fal\u0161\u00edch d\u00e1t v bud\u00facnosti.<\/p>\n

Vzdel\u00e1vanie pos\u00e1dok ZZS v oblasti nozologickej jednotky trauma<\/h4>\n

Martina Vitkov\u00e1, Jozef Kara\u0161, Eva Havl\u00edkov\u00e1, Ivo Hybrant, Miroslava Citriakov\u00e1, Volodymyr Kizyma<\/em><\/p>\n

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

Falck Z\u00e1chrann\u00e1 a.s. vytvorila vlastn\u00e9 Eduka\u010dn\u00e9 a tr\u00e9ningov\u00e9 centrum (ETC), ktor\u00e9 prvotne (pri zalo\u017een\u00ed v roku 2006) p\u00f4sobilo ako vstupn\u00e1 br\u00e1na pre nov\u00fdch zamestanancov. Nesk\u00f4r vznikla potreba realizova\u0165 aj kontinu\u00e1lne vzdel\u00e1vanie v\u0161etk\u00fdch zdravotn\u00edckych pracovn\u00edkov v spolo\u010dnosti. S prich\u00e1dzaj\u00facimi organiza\u010dn\u00fdmi zmenami sa ETC rozr\u00e1stlo na samostan\u00fa zlo\u017eku, ktorej hlavnou n\u00e1pl\u0148ou je predov\u0161etk\u00fdm pokr\u00fdva\u0165 intern\u00e9 potreby implement\u00e1cie ka\u017edej novej zavedenej pom\u00f4cky, pre\u0161kolenia zamestnancov v r\u00f4znych odborn\u00fdch t\u00e9mach, alebo zaraden\u00fdch odpor\u00fa\u010dan\u00fdch postupov, \u010di smern\u00edc. Pre tieto aktivity s\u00fa nevyhnutnou \u010das\u0165ou vzdel\u00e1vacieho procesu \u013eudia, ktor\u00ed vzdel\u00e1vanie realizuj\u00fa. Predov\u0161etk\u00fdm je to o preson\u00e1lnych zdrojoch, ktor\u00e9 akt\u00edvne vstupuj\u00fa do procesu. Pos\u00e1dky Falck Z\u00e1chr\u00e1nn\u00e1 a.s. ka\u017edoro\u010dne o\u0161etria cez 170.000 pacientov. Ide o pomerne ve\u013ek\u00e9 mno\u017estvo o\u0161etrovan\u00fdch pacientov, ktor\u00ed si vy\u017eaduj\u00fa kvalitn\u00fa starostlivos\u0165 zo strany pos\u00e1dok, jasn\u00e9 stanoven\u00e9 pravidl\u00e1 mana\u017ementu, lie\u010dby, organiz\u00e1cie udalost\u00ed pri poraneniach s v\u00e4\u010d\u0161\u00edm po\u010dtom pacientov. Pre nastavenie t\u00fdchto krit\u00e9rii je nutn\u00e9 ma\u0165 nastaven\u00fd syst\u00e9m, ktor\u00fdm sa bud\u00fa riadi\u0165 pos\u00e1dky na celom \u00fazem\u00ed spolo\u010dnosti. Toto je cie\u013eom eduka\u010dn\u00e9ho procesu a samotn\u00e9ho eduka\u010dn\u00e9ho centra.<\/p>\n

Maj\u00ed kurzy ATLS\u00ae m\u00edsto ve vzd\u011bl\u00e1v\u00e1n\u00ed l\u00e9ka\u0159\u016f v \u010cR?<\/h4>\n

Jana Kubalov\u00e1, Jakub D\u011bdek, Jarom\u00edr Ko\u010d\u00ed<\/em><\/p>\n

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

V prvn\u00ed \u010d\u00e1sti \u010dl\u00e1nku autorka p\u0159edstavuje kurz Advanced trauma life support (ATLS\u00ae) v \u010cesk\u00e9 republice \u2013 jeho zaveden\u00ed, z\u00e1kladn\u00ed c\u00edle, financov\u00e1n\u00ed a z\u00e1kladn\u00ed statistick\u00e1 data kurz\u016f dosud prob\u011bhl\u00fdch na \u00fazem\u00ed \u010cesk\u00e9 republiky. Ve druh\u00e9 \u010d\u00e1sti \u010dl\u00e1nku se soust\u0159ed\u00ed na validitu ATLS a jeho v\u00fdznam pro postgradu\u00e1ln\u00ed vzd\u011bl\u00e1v\u00e1n\u00ed l\u00e9ka\u0159\u016f a pro p\u0159e\u017eit\u00ed pacienta po z\u00e1va\u017en\u00e9m traumatu. Absolvov\u00e1n\u00ed ATLS signifikantn\u011b zlep\u0161uje znalosti a klinick\u00e9 dovednosti \u00fa\u010dastn\u00edk\u016f, jejich organiza\u010dn\u00ed schopnosti i p\u0159\u00edstup k priorit\u00e1m p\u0159i p\u00e9\u010di o t\u011b\u017ece zran\u011bn\u00e9ho pacienta. Uveden\u00e1 skute\u010dnost je jednozna\u010dn\u00fdm d\u016fvodem, pro\u010d je ATLS za\u0159azen do vzd\u011bl\u00e1vac\u00edho programu specializa\u010dn\u00ed zkou\u0161ky v urgentn\u00ed medic\u00edn\u011b.<\/p>\n

Vzd\u011bl\u00e1v\u00e1n\u00ed nel\u00e9ka\u0159sk\u00fdch zdravotnick\u00fdch pracovn\u00edk\u016f v problematice o\u0161et\u0159en\u00ed triage pozitivn\u00edho pacienta<\/h4>\n

Petr Karmaz\u00edn<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0 \u00a0 \u00a0\u00daVOD \u00davodn\u00ed slovo Jana \u0160eblov\u00e1 Obsah \u00a0 \u00a0 \u00a0T\u00c9MA ROKU: Z\u00c1VA\u017dN\u00dd \u00daRAZ Tri\u00e1\u017e rizika \u00farazov\u00fdch pacient\u016f na m\u00edst\u011b \u00farazu a jejich sm\u011brov\u00e1n\u00ed do nemocni\u010dn\u00edch za\u0159\u00edzen\u00ed k poskytnut\u00ed definitivn\u00ed p\u00e9\u010de V\u011bstn\u00edk Ministerstva zdravotnictv\u00ed \u010cR Z\u00e1va\u017en\u00fd \u00faraz \u2013 mechanismy adaptace,<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[29],"tags":[],"class_list":["post-766","post","type-post","status-publish","format-standard","hentry","category-rocnik-2016"],"_links":{"self":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/766","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=766"}],"version-history":[{"count":0,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/766\/revisions"}],"wp:attachment":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=766"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=766"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=766"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}