{"id":778,"date":"2017-02-27T16:20:56","date_gmt":"2017-02-27T14:20:56","guid":{"rendered":"http:\/\/urgentnimedicina.cz\/?p=778"},"modified":"2017-12-11T08:56:10","modified_gmt":"2017-12-11T06:56:10","slug":"obsah-42017","status":"publish","type":"post","link":"https:\/\/urgentnimedicina.cz\/?p=778","title":{"rendered":"Obsah 4\/2016"},"content":{"rendered":"<h6><span style=\"color: #ff6600;\">\u00a0 \u00a0 \u00a0\u00daVOD<\/span><\/h6>\n<h4>\u00davodn\u00ed slovo<\/h4>\n<p><em>Jana \u0160eblov\u00e1<\/em><\/p>\n<h4>Obsah<\/h4>\n<h6><span style=\"color: #ff6600;\">\u00a0 \u00a0 \u00a0KONCEPCE, \u0158\u00cdZEN\u00cd, ORGANIZACE<\/span><\/h6>\n<h4>Mimonemocni\u010dn\u00ed z\u00e1stava ob\u011bhu: dopad zm\u011bn syst\u00e9mu poskytov\u00e1n\u00ed p\u0159ednemocni\u010dn\u00ed neodkladn\u00e9 p\u00e9\u010de v obdob\u00ed 2012\u20132016 v Karlovarsk\u00e9m kraji<\/h4>\n<p><em>Vojt\u011bch M\u00edra, Metod\u011bj Renza, Aneta Fridrichovsk\u00e1, Roman S\u00fdkora<\/em><\/p>\n<p><strong style=\"line-height: 1.5em;\">Abstrakt<\/strong><\/p>\n<p><strong>\u00davod:<\/strong> Pokrok v p\u00e9\u010di o pacienty s mimonemocni\u010dn\u00ed n\u00e1hlou z\u00e1stavu ob\u011bhu (NZO) je z\u00e1kladem a hlavn\u00edm parametrem hodnocen\u00ed kvality p\u0159ednemocni\u010dn\u00ed neodkladn\u00e9 p\u00e9\u010de (PNP). V Karlovarsk\u00e9m kraji (KVK) byly od roku 2012 implementov\u00e1ny zm\u011bny v organi\u00aczaci, vzd\u011bl\u00e1v\u00e1n\u00ed a vyu\u017e\u00edvan\u00e9m technick\u00e9m zabezpe\u010den\u00ed.<br \/>\n<strong>C\u00edl:<\/strong> Zhodnotit retrospektivn\u011b \u00fa\u010dinek zm\u011bn v organizaci, edukaci a technick\u00e9m zabezpe\u010den\u00ed v p\u00e9\u010di o pacienty s NZO.<br \/>\n<strong>Metodika:<\/strong> Zm\u011bny v poskytov\u00e1n\u00ed PNP v KVK v obdob\u00ed od b\u0159ezna 2012 do listopadu 2015 byly n\u00e1sleduj\u00edc\u00ed: p\u0159echod na setk\u00e1vac\u00ed syst\u00e9m (RV); zm\u011bna distribuce a sn\u00ed\u017een\u00ed po\u010dtu v\u00fdjezdov\u00fdch skupin (VS) s l\u00e9ka\u0159em; celkov\u00e9 zv\u00fd\u0161en\u00ed po\u010dtu VS a z\u00e1kladen; edukace VS a oper\u00e1tor\u016f v doporu\u010den\u00edch, aplikace vnit\u0159n\u00edch standard\u016f pro l\u00e9\u010dbu NZO; ov\u011b\u0159ov\u00e1n\u00ed znalost\u00ed VS; vybaven\u00ed p\u0159\u00edstrojem pro au-tomatick\u00e9 stla\u010dov\u00e1n\u00ed hrudn\u00edku (LUCAS II); doporu\u010den\u00ed o sm\u011b\u0159ov\u00e1n\u00ed pacient\u016f po resuscitaci (KPR) do centra pro srde\u010dn\u00ed z\u00e1stavu (CARC). Byla porovn\u00e1na obdob\u00ed p\u0159ed uveden\u00fdmi zm\u011bnami (skupina CONTROL) a po aplikaci a\u017e v\u0161ech zm\u011bn (skupina CHANGE), byly vyhled\u00e1ny z\u00e1znamy pacient\u016f s NZO s indikovanou KPR mimo l\u016f\u017ekov\u00e1 zdravotnick\u00e1 za\u0159\u00edzen\u00ed (ZZ). Sledovan\u00e9 parametry: dojezdov\u00e9 \u010dasy; typy VS zahajuj\u00edc\u00ed KPR; pr\u016fb\u011bh KPR: adherence k doporu\u010den\u00edm, vyu\u017eit\u00ed kompetenc\u00ed VS bez l\u00e9ka\u0159e a technick\u00e9ho vybaven\u00ed a sm\u011b\u0159ov\u00e1n\u00ed do CARC.<br \/>\n<strong>V\u00fdsledky:<\/strong> Ve sledovan\u00e9m t\u0159\u00edm\u011bs\u00ed\u010dn\u00edm obdob\u00ed byla skupina CONTROL (n=55) vyhled\u00e1na z 6033 o\u0161et\u0159en\u00fdch pacient\u016f a skupina CHANGE (n=52) z 8658 pacient\u016f PNP. Rozd\u00edl v dojezdov\u00fdch \u010dasech prvn\u00ed VS na m\u00edsto NZO nebyl pozorov\u00e1n, ve skupin\u011b CHANGE byla v\u011bt\u0161\u00ed ochota sv\u011bdk\u016f poskytovat KPR p\u0159ed p\u0159\u00edjezdem VS, prvn\u00ed na m\u00edst\u011b byly v\u00fdznamn\u011b \u010dast\u011bji VS bez l\u00e9ka\u0159e a zahajovaly KPR. Ve skupin\u011b CHANGE byla v\u00fdznamn\u011b vy\u0161\u0161\u00ed adherence k u\u017eit\u00ed EtCO2, nebyl rozd\u00edl v respektov\u00e1n\u00ed doporu\u010den\u00e9 farmakoterapie. V \u010dase se v\u00fdznamn\u011b roz\u0161\u00ed\u0159ilo u\u017e\u00edv\u00e1n\u00ed intraose\u00e1ln\u00edho vstupu, zaveden\u00ed laryng\u00e1ln\u00ed masky a za\u010dal b\u00fdt pou\u017e\u00edv\u00e1n p\u0159\u00edstroj LUCAS II. Rozd\u00edl v po\u010dtu pacient\u016f sm\u011brovan\u00fdch do CARC nebyl prok\u00e1z\u00e1n. D\u00e9lka ne\u00fasp\u011b\u0161n\u00e9 KPR se mezi skupinami v\u00fdznamn\u011b neli\u0161ila.<br \/>\n<strong>Z\u00e1v\u011br:<\/strong> Vy\u0161\u0161\u00ed m\u00edra vyu\u017eit\u00ed kompetenc\u00ed zdravotnick\u00fdch z\u00e1chran\u00e1\u0159\u016f, zahajov\u00e1n\u00ed resuscitace samotn\u00fdmi z\u00e1chran\u00e1\u0159i prvn\u00edmi na m\u00eds\u00act\u011b spole\u010dn\u011b s vy\u0161\u0161\u00ed ochotou sv\u011bdk\u016f zahajovat KPR u NZO nem\u00e1 negativn\u00ed vliv na kr\u00e1tkodob\u00fd klinick\u00fd v\u00fdsledek. V\u00fdsledky tohoto pozorov\u00e1n\u00ed podporuj\u00ed d\u016fle\u017eitost standardizovan\u00e9 p\u00e9\u010de o NZO.<\/p>\n<h6><span style=\"color: #ff6600;\">\u00a0 \u00a0 \u00a0VZD\u011aL\u00c1V\u00c1N\u00cd, ZKU\u0160ENOSTI<\/span><\/h6>\n<h4>Ako resuscitujeme III<\/h4>\n<p><em>T\u00e1\u0148a Bul\u00edkov\u00e1, Martina V\u00edtkov\u00e1, Gabriel Tomko, Franti\u0161ek Majersk\u00fd, Marek \u017dif\u010d\u00e1k, J\u00e1n Zori\u010d\u00e1k<\/em><\/p>\n<p><strong style=\"line-height: 1.5em;\">Abstrakt<\/strong><\/p>\n<p>S\u00fa\u0165a\u017e z\u00e1chran\u00e1rov RESCUE LESNICA m\u00e1 dlhoro\u010dn\u00fa trad\u00edciu, je ob\u013e\u00faben\u00e1 a nav\u0161tevovan\u00e1 medzi z\u00e1chran\u00e1rmi. Autor pr\u00edspevku pon\u00faka \u010ditate\u013eom anal\u00fdzu z III. ro\u010dn\u00edka Majstrovstiev Slovenska v kardiopulmon\u00e1lnej resuscit\u00e1cii. Ide o s\u00fa\u0165a\u017e dvoj\u00edc v zlo\u017een\u00ed \u0161tu\u00acdent, vodi\u010d \u2013 z\u00e1chran\u00e1r, z\u00e1chran\u00e1r, oper\u00e1tor, lek\u00e1r. Hodnoten\u00e1 je 10 min\u00fatov\u00e1 KPR s umelou p\u013e\u00facnou ventil\u00e1ciou pomocou ambuvaku. Cie\u013eom je overi\u0165 optim\u00e1lnos\u0165 KPR vykon\u00e1vanej zdravotn\u00edckym person\u00e1lom pracuj\u00facim v prednemocni\u010dnej urgent\u00acnej zdravotnej starostlivosti. Jednotliv\u00e9 hodnoten\u00e9 kroky s\u00fa spracovan\u00e9 v tabu\u013ek\u00e1ch a grafoch, ktor\u00e9 s\u00fa v druhej \u010dasti porovn\u00e1\u00acvan\u00e9 s uplynul\u00fdmi ro\u010dn\u00edkmi majstrovstiev.<\/p>\n<h4>Z\u00e1chrana 2016 v Humennom. In medias res. Anal\u00fdza s\u00fa\u0165a\u017en\u00fdch \u00faloh<\/h4>\n<p><em>t\u00e1\u0148a Bul\u00edkov\u00e1, Viktor Korba<\/em><\/p>\n<p><strong style=\"line-height: 1.5em;\">Abstrakt<\/strong><\/p>\n<p>\u010cl\u00e1nok sa zaober\u00e1 anal\u00fdzou celoslovenskej s\u00fa\u0165a\u017ee pos\u00e1dok z\u00e1chrann\u00fdch zdravotn\u00fdch slu\u017eieb \u2013 Z\u00e1chranou 2016 (XXV.ro\u010dn\u00edk), ktor\u00e1 sa konala na jese\u0148 v Humennom. S\u00fa\u0165a\u017e organizoval Falck Z\u00e1chrann\u00e1 a.s. spolu s Asoci\u00e1ciou ZZS pod z\u00e1\u0161titou Minister\u00acstva zdravotn\u00edctva SR v spolupr\u00e1ci s Opera\u010dn\u00fdm strediskom ZZS a Slovenskou spolo\u010dnos\u0165ou urgentnej medic\u00edny a medic\u00edny katastrof.<br \/>\nAutor predklad\u00e1 jednotliv\u00e9 odborn\u00e9 \u00falohy s\u00fa\u0165a\u017ee a ich optim\u00e1lne rie\u0161enie. Uv\u00e1dza nedostatky pri plnen\u00ed jednotliv\u00fdch \u00faloh a po\u00acrovn\u00e1va v\u00fdsledky u pos\u00e1dok s lek\u00e1rom (RLP) a bez lek\u00e1ra (RZP). Dosiahnut\u00e9 priemern\u00e9 bodov\u00e9 zisky pos\u00e1dok s\u00fa spracovan\u00e9 graficky u ka\u017edej \u00falohy.<\/p>\n<h6><span style=\"color: #ff6600;\">\u00a0 \u00a0 \u00a0ODBORN\u00c9 T\u00c9MA L\u00c9KA\u0158SK\u00c9<\/span><\/h6>\n<h4>P\u0159ednemocni\u010dn\u00ed p\u00e9\u010de o pacienty s akutn\u00ed c\u00e9vn\u00ed p\u0159\u00edhodou \u2013 Aktualizace doporu\u010den\u00e9ho postupu SUMMK \u010cLS JEP<\/h4>\n<p><em>Jana \u0160eblov\u00e1, Ale\u0161 Tomek, Milan Tich\u00e1\u010dek, Roman G\u0159ego\u0159, Ji\u0159\u00ed Knor, Anatolij Truhl\u00e1\u0159, Marek Slab\u00fd, Ilja Deyl, Ond\u0159ej Fran\u011bk, Pavel Urb\u00e1nek, Petr Hub\u00e1\u010dek, Jarom\u00edr Ko\u010d\u00ed, Roman \u0160kulec, Ond\u0159ej \u0160koda, Michal Bar, Roman Herzig, Robert Mikul\u00edk, Ji\u0159\u00ed Neumann, Daniel \u0160a\u0148\u00e1k, David \u0160koloud\u00edk, Daniel V\u00e1clav\u00edk<\/em><\/p>\n<h4>Hranice \u017eivot smrt \u2013 a nad\u011bje na p\u0159e\u017eit\u00ed<\/h4>\n<p><em>Jarmila Dr\u00e1bkov\u00e1<\/em><\/p>\n<p><strong>Abstrakt<\/strong><\/p>\n<p>Tonut\u00ed je specifick\u00e9 trauma spojen\u00e9 s rekrea\u010dn\u00edmi a sportovn\u00edmi aktivitami. Jeho symptomatologie a klinick\u00fd pr\u016fb\u011bh jsou kom\u00acplexn\u00ed \u2013 v \u00favodu vede t\u011b\u017ek\u00e9 hypoxick\u00e9 posti\u017een\u00ed p\u0159edev\u0161\u00edm mozku a jeho funkc\u00ed. Jeho z\u00e1va\u017enost je z\u00e1visl\u00e1 na trv\u00e1n\u00ed hypoxemie a hypoxie, na teplot\u011b vody i t\u011bla, na n\u00e1maze. Je d\u00e1le propojeno s dyshomeost\u00e1zou metabolismu, s rozvojem ARDS a MODS. Vysoce rizikov\u00fdmi komplikacemi jsou mechanick\u00e1 poran\u011bn\u00ed, dlouhotrvaj\u00edc\u00ed um\u011bl\u00e1 plicn\u00ed ventilace, plicn\u00ed infekce a dlouhodob\u00e9 neuropsychick\u00e9 n\u00e1sledky. Akutn\u00ed postupy jsou p\u0159edev\u0161\u00edm org\u00e1nov\u011b c\u00edlen\u00e9 a symptomatick\u00e9; u p\u0159e\u017eiv\u0161\u00edch rozhoduje o kvalit\u011b \u017eivota prioritn\u011b regenerace kognitivn\u00edch funkc\u00ed.<\/p>\n<h4>Bolest v prav\u00e9m pod\u017eeb\u0159\u00ed \u2013 v\u017edy \u201echirurgick\u00e1\u201c diagn\u00f3za? Kazuistika<\/h4>\n<p><em>Jana Berkov\u00e1<\/em><\/p>\n<p><strong>Abstrakt<\/strong><\/p>\n<p>Kazuistika p\u0159edstavuje p\u0159\u00edpad pacientky s bolestmi v prav\u00e9m pod\u017eeb\u0159\u00ed a n\u00e1sledn\u00fd diagnostick\u00fd proces na Odd\u011blen\u00ed urgentn\u00ed medic\u00edny. P\u0159\u00ed\u010dinou obt\u00ed\u017e\u00ed pacientky byl izolovan\u00fd infarkt prav\u00e9 komory. Diskuze rozeb\u00edr\u00e1 diferenci\u00e1ln\u00ed diagnostiku mo\u017en\u00fdch p\u0159\u00ed\u010din bolest\u00ed v prav\u00e9m pod\u017eeb\u0159\u00ed a mo\u017enosti diagnostiky izolovan\u00e9ho infarktu prav\u00e9 komory.<\/p>\n<h6><span style=\"color: #ff6600;\">\u00a0 \u00a0 \u00a0ETIKA, PSYCHOLOGIE, PR\u00c1VO<\/span><\/h6>\n<h4>Zku\u0161enosti s n\u00e1sil\u00edm ve vztahu zdravotn\u00edk a pacient na Zdravotnick\u00e9 z\u00e1chrann\u00e9 slu\u017eb\u011b hl. m. Prahy v letech 2004\u20132014<\/h4>\n<p><em>Jaroslav Pekara, Petr Kolouch<\/em><\/p>\n<p><strong>Abstrakt<\/strong><\/p>\n<p>C\u00edlem p\u0159\u00edsp\u011bvku je sezn\u00e1mit s v\u00fdvojem n\u00e1siln\u00fdch ud\u00e1lost\u00ed u VS ZZS HMP p\u0159i kontaktu s n\u00e1siln\u00fdmi pacienty v letech 2004 a\u017e 2014. Problematika n\u00e1sil\u00ed v prost\u0159ed\u00ed ZZS nen\u00ed prioritou v\u0161ech ZZS v \u010cR. ZZS HMP je v tomto ohledu v\u00fdjimkou. Na z\u00e1klad\u011b uveden\u00fdch informac\u00ed lze souhrnn\u011b konstatovat, \u017ee ZZ a \u0159idi\u010di vozidel ZZS HMP jsou vystaveni p\u0159i re\u00e1ln\u00e9m provozu nej\u010dast\u011bji n\u00e1sil\u00ed verb\u00e1ln\u00ed\u00acmu (p\u0159es 80 % zam\u011bstnanc\u016f 1x\/m\u011bs\u00edc). S fyzick\u00fdm n\u00e1sil\u00edm p\u0159ijde do kontaktu cca 80 % pracovn\u00edk\u016f 1x za rok. Uk\u00e1zalo se, \u017ee mo\u00acnitoring n\u00e1sil\u00ed p\u0159in\u00e1\u0161\u00ed nejen vhled do problematiky, ale m\u00e1 vliv na prevenci, zejm\u00e9na v\u00fdstupy z hloubkov\u00fdch rozhovor\u016f. V\u00fdsledn\u00e1 minimalizace konflikt\u016f a n\u00e1sil\u00ed v re\u00e1ln\u00e9m provozu je p\u0159\u00edkladem dobr\u00e9 praxe pro v\u0161echna ostatn\u00ed pracovi\u0161t\u011b, kter\u00e1 maj\u00ed probl\u00e9my s n\u00e1sil\u00edm p\u0159i vz\u00e1jemn\u00e9m kontaktu zam\u011bstnanc\u016f a jejich pacient\u016f.<\/p>\n<h4>Stres ve v\u00fdkonu profese zdravotnick\u00e9ho z\u00e1chran\u00e1\u0159e<\/h4>\n<p><em>Petra Svobodov\u00e1, Tibor A. Bre\u010dka<\/em><\/p>\n<p><strong>Abstrakt<\/strong><\/p>\n<p>\u010cl\u00e1nek se zab\u00fdv\u00e1 problematikou stresu ve v\u00fdkonu profese zdravotnick\u00e9ho z\u00e1chran\u00e1\u0159e. P\u0159in\u00e1\u0161\u00ed data z v\u00fdzkumu t\u00e9to problemati\u00acky, kter\u00fd byl realizov\u00e1n na Zdravotnick\u00e9 z\u00e1chrann\u00e9 slu\u017eb\u011b Pardubick\u00e9ho kraje. Hlavn\u00edm c\u00edlem bylo zjistit, jak\u00e9 z\u00e1t\u011b\u017eov\u00e9 situace nejv\u00edce ovliv\u0148uj\u00ed jejich psychiku, jak se vyrovn\u00e1vaj\u00ed se stresem a jak\u00e9 maj\u00ed mo\u017enosti krizov\u00e9 intervence.<\/p>\n<h6><span style=\"color: #ff6600;\">\u00a0 \u00a0 \u00a0INFORMA\u010cN\u00cd SERVIS<\/span><\/h6>\n<h4>Konference Integrovan\u00e9ho z\u00e1chrann\u00e9ho syst\u00e9mu v Karlov\u00fdch Varech dne 11. 11. 2016<\/h4>\n<p><em>Old\u0159ich Volf, Roman S\u00fdkora<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u00a0 \u00a0 \u00a0\u00daVOD \u00davodn\u00ed slovo Jana \u0160eblov\u00e1 Obsah \u00a0 \u00a0 \u00a0KONCEPCE, \u0158\u00cdZEN\u00cd, ORGANIZACE Mimonemocni\u010dn\u00ed z\u00e1stava ob\u011bhu: dopad zm\u011bn syst\u00e9mu poskytov\u00e1n\u00ed p\u0159ednemocni\u010dn\u00ed neodkladn\u00e9 p\u00e9\u010de v obdob\u00ed 2012\u20132016 v Karlovarsk\u00e9m kraji Vojt\u011bch M\u00edra, Metod\u011bj Renza, Aneta Fridrichovsk\u00e1, Roman S\u00fdkora Abstrakt \u00davod: Pokrok<\/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-778","post","type-post","status-publish","format-standard","hentry","category-rocnik-2016"],"_links":{"self":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/778","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=778"}],"version-history":[{"count":0,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/778\/revisions"}],"wp:attachment":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=778"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=778"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=778"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}