- MeSH
- klinické kompetence * MeSH
- lidé MeSH
- osobní ochranné prostředky * MeSH
- týmová péče o pacienty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- randomizované kontrolované studie MeSH
Kratom is a mixture of compounds that are present in the leaves of the tropical tree Mitragyna speciosa. It is used as a psychoactive agent with both opiate and stimulant-like effects. In this case series we describe the signs, symptoms, and the management of kratom overdose in the prehospital setting and in intensive care. We retrospectively searched for cases in the Czech Republic. Over 36 months we found 10 cases of kratom poisoning, which healthcare records were analyzed and reported as per CARE guidelines. The dominant symptoms in our series were neurological and included quantitative (n = 9) or qualitative (n = 4) disorder of consciousness. Signs and symptoms of vegetative instability [hypertension (n = 3) and tachycardia (n = 3) vs. bradycardia/cardiac arrest (n = 2), mydriasis (n = 2) vs. miosis (n = 3)] were noticed. Prompt response to naloxone in two cases and lack of response in one patient were observed. All patients survived and the effect of intoxication wore off within two days. Kratom overdose toxidrome is variable and, in keeping with its receptor physiology, consists of signs and symptoms of opioid-like overdose, sympathetic overactivation and serotonin-like syndrome. Naloxone can help to avoid intubation in some cases.
- MeSH
- lidé MeSH
- listy rostlin MeSH
- Mitragyna * MeSH
- naloxon MeSH
- opioidní analgetika MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Transcatheter aortic valve implantation (TAVI) has become a high-volume procedure with increasing demands on hospital resources. Local anaesthesia with sedation supervised by an anaesthesiology team is the current standard of care. We aimed to describe our experience with a simplified, nurse-led sedation (NLS) protocol. This study enrolled 128 consecutive patients who underwent transfemoral TAVI with self-expandable Evolut R prosthesis between November 2019 and April 2021. Operators selected 50% of patients for NLS based on the clinical expectation of lower risk of procedural difficulties. Nurse-led sedation protocol demanded only mild to moderate levels of sedation. The clinical outcomes were determined from the local TAVI registry and the national mortality database. Baseline patient characteristics were similar in the NLS (n = 64) and anaesthesiologist-led sedation (ALS) (n = 64) groups except higher prevalence of diabetes mellitus (48.4% vs. 31.3%, P = 0.035) and peripheral vascular disease (20.3% vs. 7.8%, P = 0.036) in the ALS group. There was a trend for the larger prostheses used in the ALS group (P = 0.058). The procedural results did not differ, and coronary care team backup was rarely needed in the NLS group (6% of patients). The in-hospital outcomes were identical from both clinical and echocardiography perspectives, and 30-day mortality was low in both groups (1.5%). For the NLS group, preparation in the catheterization laboratory was quicker by 6.4 min (P = 0.01), and intensive care unit stay was shorter (2.03 vs. 3.48 days, P = 0.001). In conclusion, the NLS for the selected transfemoral TAVI population seems safe.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
x
x
- Klíčová slova
- simulační centra, lektoři,
- MeSH
- anesteziologie * výchova MeSH
- komunikace MeSH
- lidé MeSH
- péče o pacienty v kritickém stavu * MeSH
- studium lékařství metody MeSH
- tréninková simulace * metody MeSH
- Check Tag
- lidé MeSH
Jak se mohou kliničtí lékaři dobře naučit léčbu komplikovaných zdravotních stavů pacientů, aniž by je vystavili nepřiměřenému riziku? Jak můžeme posoudit schopnosti lékařů i celých týmů, když každý pacient i lékař je jiný, stavů je mnoho a ještě více jejich kombinací? Podobné otázky vedly v posledních letech k rozvoji simulační medicíny. Inspirace pro vznik tohoto odvětví medicíny přišla z leteckého průmyslu, vojenství a kosmonautiky. Cílem simulací je rozvoj hlavně netechnických dovedností (např. komunikace) jednotlivců i celého týmu. Jedinečná možnost bezpečné (simulátor neumře) sebereflexe je příležitostí ke zlepšení dovedností každého z nás.
How can clinicians master the treatment of complicated medical conditions without exposing patients to risk? How can we assess the ability of physicians and teams when each patient and doctor is different, when there are many conditions and yet more combinations? These and similar issues have led to the development of medical simulation. The inspiration for the creation of this part of medicine has come from the airline, military and aerospace industry. The aim of simulation is the development of non-technical skills (e.g. communication) of individuals and the team. A unique opportunity for self-reflection (the simulator does not die) is an opportunity to improve the skills of each of us.
- Klíčová slova
- simulační medicína, simulační centra,
- MeSH
- anesteziologie výchova MeSH
- bezpečnost pacientů MeSH
- chybná zdravotní péče prevence a kontrola MeSH
- CRM management pro zdravotnictví * metody organizace a řízení využití MeSH
- komunikace MeSH
- kontinuální vzdělávání lékařů * MeSH
- krizová intervence MeSH
- lidé MeSH
- péče o pacienty v kritickém stavu MeSH
- řízení rizik MeSH
- rozhodování MeSH
- sebezhodnocení (psychologie) MeSH
- tréninková simulace * metody MeSH
- týmová péče o pacienty MeSH
- vyučovací postupy MeSH
- Check Tag
- lidé MeSH
1. vydání 54 stran : barevné ilustrace ; 30 cm
- Publikační typ
- abstrakt z konference MeSH
