BACKGROUND: COVID-19 is a viral disease notorious for frequent worldwide outbreaks. It is difficult to control, thereby resulting in overload of the healthcare system. A possible solution to prevent overcrowding is rapid triage of patients, which makes it possible to focus care on the high-risk patients and minimize the impact of crowding on patient prognosis. METHODS: The triage algorithm assessed self-sufficiency, oximetry, systolic blood pressure, and the Glasgow coma scale. Compliance with the triage protocol was defined as fulfillment of all protocol steps, including assignment of the correct level of care. Triage was considered successful if there was no change in the scope of care (e.g., unscheduled hospital admission, transfer to different level of care) or if there was unexpected death within 48 hours. RESULTS: A total of 929 patients were enrolled in the study. Triage criteria were fulfilled in 825 (88.8%) patients. Within 48 hours, unscheduled hospital admission, transfer to different level of care, or unexpected death occurred in 56 (6.0%), 6 (0.6%), and 5 (0.5%) patients, respectively. The risk of unscheduled hospital admission or transfer to different level of care was significantly increased if triage criteria were not fulfilled [13.1% vs. 76.1%, RR 5.8 (3.8-8.3), p < 0.001; 0.5% vs. 5.2%, RR 11.4 (2.3-57.7), p = 0.036, respectively]. CONCLUSION: The proposed algorithm for triage of patients with proven COVID-19 is a simple, fast, and reliable tool for rapid sorting for outpatient treatment, hospitalization on a standard ward, or assignment to an intensive care unit.
- MeSH
- COVID-19 * epidemiologie MeSH
- hospitalizace MeSH
- jednotky intenzivní péče MeSH
- lidé MeSH
- třídění pacientů metody MeSH
- urgentní služby nemocnice MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY This study aims to analyse a subpopulation of patients with severe haemorrhagic shock and a concurrent unstable pelvic ring fracture. MATERIAL AND METHODS This manuscript is a retrospective study of prospectively collected data on trauma patients over a period of 10 years, namely between 2010 and 2019. These patients, primarily (after injury) referred to the trauma centre of the University Hospital Hradec Králové, were diagnosed with an unstable pelvic ring fracture as a part of multiple injuries. RESULTS The total number of patients with a pelvic ring fracture and concurrent acute phase of decompensated haemorrhagic shock in the period from 2010 to 2019 was 112. After excluding 25 patients with AIS 4 and 5 (Abbreviated Injury Scale) severe head trauma and another two patients who died of late-stage SIRS (systemic infl ammatory response syndrome) complications, the group consisted of 85 patients. Subsequently, the subpopulation of patients "in extremis" evaluated by the study included a total of 22 patients with the baseline systolic pressure below 70 mm Hg and/or baseline haemoglobin level below 80 g/l. CONCLUSIONS Prior to the evaluation of this study population, our department had no single algorithm developed to treat such patients. Slow blood circulation stabilisation or death were usually associated with inadequate haemostatic algorithm. The patients leaving the operating room and being handed over to the ICU presented the signs of a decompensated shock. Oftentimes, the pelvis was merely stabilised, with no further intervention to stop the bleeding. The extraperitoneal pelvic packing was performed in very few cases only. The extravasation of contrast media during the initial CT scan does not necessarily have to be detected due to vasospasm or hypotension with reduced blood fl ow. In such cases, only the size of haematoma is a sign of arterial bleeding. It is also risky to rely solely on vasography when stopping the bleeding which will certainly fail to stop venous bleeding. However, venous bleeding always accompanies arterial bleeding. Stabilisation of both segments of the pelvis is essential to stop bleeding in haemodynamically unstable patients with a pelvic ring injury. It is followed by extraperitoneal pelvic packing and in the case of continuing haemodynamic instability also vasography, namely even if there is a negative fi nding of the initial CT scan or if no initial CT scan was performed. This procedure has become the core of our single haemostatic algorithm. Key words: pelvic ring injury, patients in extremis, haemostatic algorithm.
Management pacienta se závažným traumatickým krvácením zahrnuje postupy damage control resuscitation, jejichž součástí je kromě chirurgického řešení krvácení aplikace masivního transfuzního protokolu. Cílem tohoto sdělení je představit masivní transfuzní protokol a vybrané skórovací systémy pro včasnou detekci závažně krvácejících pacientů. Využití standardizovaného protokolu aktivace masivního transfuzního protokolu vede ke snížení letality na vykrvácení a spotřeby transfuzních přípravků v traumacentrech.
The management of severe traumatic bleeding includes damage control resuscitation procedures including, in addition to surgical bleeding control, the application of the massive transfusion protocol. The aim of this paper is to present the massive transfusion protocol and selected scoring systems for an early detection of patients with severe post-traumatic bleeding. The use of a standardized protocol to activate the massive transfusion protocol reduces lethality due to severe traumatic bleeding and the consumption of blood products in trauma centers.
- Klíčová slova
- masivní transfuzní protokol,
- MeSH
- krevní transfuze * metody MeSH
- krvácení etiologie terapie MeSH
- lidé MeSH
- resuscitace metody MeSH
- traumatologická centra MeSH
- Check Tag
- lidé MeSH
Úvod: Chirurgická léčba je spojena s nežádoucí reakcí organismu na tzv. chirurgické trauma, která je označována jako chirurgický stres. Jednou z jeho základních příčin je ischemicko-reperfuzní poškození tkání, které zahrnuje funkční a strukturální změny v tkáních. Ty vznikají po obnovení průtoku krve po epizodě ischemie. Dochází k nekróze ireverzibilně změněných buněk či otoku tkání vznikajícímu na podkladě endoteliální a mitochondriální dysfunkce. Metody: Fyziologie, patofyziologie endoteliálního glykokalyxu: Endoteliální glykokalyx je 0,2 až 5 mikrometrů vysoká heteropolysacharidová vrstva pokrývající endotel na jeho intraluminální straně. Páteřními molekulami glykokalyxu jsou proteoglykany, na které se vážou glykoproteiny a glykosaminoglykany. Poškození endoteliálního glykokalyxu bylo dokumentováno u traumatu, u pacientů se septickým šokem, při ischemicko-reperfuzním poškození či při rozsáhlých chirurgických výkonech. Postupy prevence poškození endoteliálního glykokalyxu: Jako prevence ischemicko-reperfuzního poškození tkání byla zkoumána metoda vzdálené prekondice ischemie. Provedené metaanalýzy přínos tohoto postupu v chirurgii ale nepotvrdily. Farmakologicky může být bráněno poškození glykokalyxu látkami, jako jsou antitrombin III, doxycyklin, hydrokortizon, etanercept či dárci oxidu dusnatého. Protektivně na glykokalyx působí také albumin a inhalace vodíku. Protektivní a reparační účinek na glykokalyx vykazuje také sulodexid. Jedná se o proteoglykan působící antitromboticky, fibrinolyticky, hypofibrinogenemicky a lipolyticky. Současná indikace sulodexidu je v léčbě žilních onemocnění, ischemické choroby srdeční a ischemické choroby dolních končetin. Byl prokázán pozitivní efekt sulodexidu na renální poškození při modelování ischemie a reperfuze a na reparaci endotelu po jeho mechanickém poškození. Závěr: Prostor pro další zkoumání se otevírá směrem k prokázání účinku endotelprotektiv prostřednictvím reparace endoteliálního glykokalyxu při ischemicko-reperfuzním poškození na modelu velkého laboratorního zvířete a také při klinické studii u pacientů podstupujících cévně rekonstrukční výkon.
Introduction: Surgical treatment is associated with an unwanted response of the organism to the so-called surgical trauma. This response is called surgical stress. Ischaemia-reperfusion injury is one of essential causes of tissue damage. It comprises functional and structural changes in tissue that occur after the restoration of circulation, after an episode of ischaemia. Necrosis of irreversibly changed cells and endothelial and mitochondrial-induced tissue swelling occur. Methods: Physiology, pathophysiology of endothelial glycocalyx: Endothelial glycocalyx is a 0.2 to 5 micrometres thin heteropolysaccharide layer that covers the endothelium on its intraluminal side. Backbone molecules of the glycocalyx include proteoglycans, glycoproteins, and glycosaminoglycans. Damage of the endothelial glycocalyx was described in trauma patients, in patients with septic shock, in ischemia and reperfusion injury, and during extensive surgical procedures. Approaches to prevent endothelial glycocalyx damage: Remote ischemic preconditioning was tested as a method of ischemia and reperfusion injury prevention during and after surgery. Nevertheless, the expected effect was not confirmed in performed meta-analyses. Endothelial glycocalyx damage can be prevented pharmacologically with a broad spectrum of substances, such as antithrombin III, doxycycline, hydrocortisone, etanercept, or nitric oxide donors. Hydrogen inhalation or albumin affects glycocalyx positively. Sulodexide provides a positive effect on the protection and reparation of endothelial glycocalyx. This proteoglycan with antithrombotic, fibrinolytic, hypofibrinogenemic, and lipolytic function is used for the treatment of venous diseases, ischaemic heart disease, and peripheral arterial disease. A positive effect of sulodexide on renal dysfunction was documented in a model of ischaemia and reperfusion injury. Equally, a positive effect of sulodexide was described on endothelium repair after its mechanical damage. Conclusion: Further research needs to be performed to evaluate the effect of endothelium-protectives on glycocalyx damage prevention and repair in ischaemia and reperfusion models involving large laboratory animals or in clinical trials in patients undergoing surgical revascularisation procedures.
- MeSH
- chirurgie operační škodlivé účinky MeSH
- glykokalyx * fyziologie patologie MeSH
- hematologické látky farmakologie klasifikace terapeutické užití MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- pooperační komplikace farmakoterapie prevence a kontrola MeSH
- reperfuzní poškození etiologie prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Pre-hospital blood transfusion (PHBT) is a safe and gradually expanding procedure applied to trauma patients. A proper decision to activate PHBT with the presently limited diagnostic options at the site of an incident poses a challenge for pre-hospital crews. The purpose of this study was to compare the selected scoring systems and to determine whether they can be used as valid tools in identifying patients with PHBT requirements. METHODS: A retrospective single-center study was conducted between June 2018 and December 2020. Overall, 385 patients (aged [median; IQR]: 44; 24-60; 73% males) were included in this study. The values of five selected scoring systems were calculated in all patients. To determine the accuracy of each score for the prediction of PHBT, the Receiver Operating Characteristic (ROC) analysis was used and to measure the association, the odds ratio with 95% confidence intervals was counted (Fig. 1). RESULTS: Regarding the proper indication of PHBT, shock index (SI) and pulse pressure (PP) revealed the highest value of AUC and sensitivity/specificity ratio (SI: AUC 0.88; 95% CI 0.82-0.93; PP: AUC 0.85 with 95% CI 0.79-0.91). CONCLUSION: Shock index and pulse pressure are suitable tools for predicting PHBT in trauma patients.
Background: Drug-related hospital admissions (DRAs) represent a significant problem affecting all countries worldwide. This study aimed to determine the prevalence and preventability of DRAs, identify the most common medications involved in DRAs, the most common clinical manifestations of DRAs and describe the preventability aspects of DRAs. Methods: This cross-sectional study examined unplanned hospital admissions to the University Hospital Hradec Králové via the department of emergency medicine in August-November 2018. Data were obtained from electronic medical records. The methodology of DRA identification was adapted from the OPERAM DRA adjudication guide. Results: Out of 1252 hospital admissions, 195 DRAs have been identified (145 related to treatment safety, 50 related to treatment effectiveness). The prevalence of DRAs was 15.6% (95% CI 13.6-17.6). The most common medication classes involved in DRAs related to treatment safety were Antithrombotic agents, Antineoplastic agents, Diuretics, Corticosteroids for systemic use, and Beta blocking agents. The most common medication classes involved in DRAs related to treatment effectiveness included Diuretics, Antithrombotic agents, Drugs used in diabetes, Agents acting on the renin-angiotensin system, and Lipid modifying agents. Gastrointestinal disorders were the leading causes of DRAs related to treatment safety, while Cardiac disorders were the leading causes of DRAs related to treatment effectiveness. The potential preventability of DRAs was 51%. The highest share of potential preventability in medication classes repeatedly involved in DRAs related to treatment safety was observed for Anti-inflammatory and antirheumatic products, Psycholeptics, and Drugs used in diabetes. Potentially preventable DRAs related to treatment safety were most commonly associated with inappropriate drug selection, inappropriate monitoring, inappropriate dose selection, and inappropriate lifestyle measures. On the contrary, DRAs related to treatment effectiveness were more commonly associated with medication nonadherence. Conclusion: It should be emphasized that in most DRAs, medications were only a contributory reason of hospital admissions and that benefits and risks have to be carefully balanced. It is highlighted by the finding that the same medication classes (Antithrombotic agents and Diuretics) were among the most common medication classes involved in DRAs related to treatment safety and simultaneously in DRAs related to treatment effectiveness. The study highlighted that apart from problems related to prescribing, problems related to monitoring and patient-related problems represent significant preventability aspects.
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: To recommend appropriate immobilization after the initial reduction of acetabular displaced fractures in order to minimize the risk of heterotopic ossification formation. DESIGN: Retrospective study of patients treated in our surgical department during the years 2005-2018. MATERIALS AND METHODS: There were 94 patients included in statistical analysis. The factors of injury severity, course of surgery and hospitalization and incidence of complications were recorded. The functional and X-ray results were evaluated at least one year after surgery. RESULTS: The patients were divided into the two groups according to the type of fixation after closed reduction, the external fixation (EF) and the skeletal traction (ST) group. According to the type of fracture there were 33 patients with central displacement and 61 patients with posterior displacement. Ossification grade III. And IV. Occur in 20% of our sample. There was greater incidence of Brooker grade III. And IV. Ossification in the ST group, but statistically insignificant, p = 0.57. There was no statistically significant difference in the occurrence of ossifications regarding the severity of the head injury, p = 0.11, or to the severity of the injury p = 0.54. The combination of posterior displacement and ST results in higher risk for ossifications, specifically in our group at 11.48% compared to the combination of posterior displacement and EF where it is 8.2%. CONCLUSION: Skeletal traction for posterior displaced acetabular fracture appears to be a more risky procedure for the development of ossifications than external fixation.
- MeSH
- acetabulum zranění chirurgie MeSH
- externí fixátory * škodlivé účinky MeSH
- fixace fraktur škodlivé účinky MeSH
- heterotopická osifikace * epidemiologie etiologie prevence a kontrola MeSH
- lidé MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The paper aims to evaluate the effect of COVID-19 pandemic on a change in the number of major trauma cases, their mechanism and length of hospital stay as seen by a Level I Trauma Centre. MATERIAL AND METHODS The retrospective study included a total of 755 major trauma patients (ISS ≥ 16) treated at our Level I Trauma Centre in the period 2018-2019 ("pre-COVID-19 time") and 2020-2021 ("COVID-19 time"). The effect of COVID-19 infection on the change in the number and nature of major trauma, mechanism of injury, length of treatment during prehospital care, length of hospital stay, and mortality. RESULTS Of the total number of 755 patients with major trauma, in the "pre-COVID-19 time" 399 patients were treated, while in the "COVID-19 time" it was 356 patients (p = 0.10). The mechanism of major trauma did not change, road traffic accidents prevailed (61% vs. 56%, p = 0.25), the proportion of injuries due to falls from height increased (25% vs. 32.5%, p = 0.08), a significant decrease was observed in the category of severe skiing injuries (7 vs. 2, p = 0.003). The severity of injuries evaluated by Injury Severity Score remained unchanged (25 vs. 25, p = 0.08), but an increased number of patients with traumatic brain injury (TBI) marked by the Abbreviate Injury Score (AIS) ≥ 4 was observed (38 vs. 56, p = 0.03). The total length of a hospital stay shortened (18 vs. 15 days, p = 0.04), but the mortality rate spiked (52 vs. 73 patients, p = 0.08). DISCUSSION In the "COVID-19 time", the total number of major trauma cases dropped just like in the other European countries. Despite restrictive measures imposing mobility restrictions, no change was reported in the mechanism of injury, with traffic accidents still prevalent, except for skiing injuries. Unlike the US, we did not see an increase in penetrating injuries due to interpersonal violence or suicidal behaviour. However, there was an increase in the percentage of patients with an isolated TBI as a result of a fall from height. An increase in mortality was reported due to an increase in severe TBI. The length of hospital stay was reduced as a result of efforts to maintain hospital bed availability. CONCLUSIONS During the COVID-19 pandemic, compared to the two years immediately preceding, no significant decrease in the number of major trauma cases was reported, despite the introduction of restrictive measures. The proportion of road traffic injuries remained the same, whereas the number of falls from height slightly increased, which consequently led to an increase in the number of severe TBI. The number of penetrating injuries due to acts of violence did not increase, but due to the lockdown there was a significant decrease in severe skiing-related injuries. The anti-epidemic measures in place did not prolong the pre-hospital care for severely injured patients. Key words: major trauma, Injury Severity Score, COVID-19, mechanism of injury.
1. vydání 10 stran : ilustrace ; 21 cm
Příručka, která se zaměřuje na diagnostiku akutní závrati. Určeno odborníkům v praxi.
- MeSH
- akutní nemoc MeSH
- fyzikální vyšetření MeSH
- závrať diagnóza MeSH
- Publikační typ
- příručky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- neurologie
- otorinolaryngologie
- NLK Publikační typ
- brožury
