According to current European Resuscitation Council guidelines, priorities in advanced life support in adult are chest compression with minimal interruption and early defibrillation. Endotracheal ...intubation is still considered the gold standard in airway management, but guidelines suggest that securing the airway be incremental, ranging from basic techniques to more complex ones. Doctors who work in pre-hospital emergency medicine teams (EMT) in Croatia usually lack sufficient education and expertise. The aim of this study was to determine whether there was a significant difference in recovery of spontaneous circulation during cardiopulmonary resuscitation (CPR) in out-of-hospital setting depending on the EMT airway management technique of choice. This retrospective analysis included data collected during a 10-year period at the Krapina-Zagorje County Emergency Medicine Institute on all patients with CPR performed by EMTs 20 minutes from initial emergency call. The airway management groups included oropharyngeal tube, i-gel supraglottic device, and endotracheal tube. There were 968 patients, mean age 70. In 74.61% of patients, the cause of arrest was of cardiac etiology. Our study did not find a statistically significant in difference of CPR success among the three groups analyzed according to the airway management technique of choice (p=0.74, χ2-test).
Antiplatelet therapy is an integral part of optimal medicamentous therapy in patients with coronary artery disease. The strategy of antiplatelet/anticoagulant therapy is adjusted (combination of ...drugs, dosing and duration of therapy) depending on the stage of the disease (acute coronary syndrome with percutaneous coronary intervention, chronic coronary syndrome, or coronary surgical revascularization) and comorbidity of each patient (e.g., atrial fibrillation, left ventricular thrombus, etc.). Guidelines and clinical practice in particular are not uniform and specific regarding dual antiplatelet therapy in patients undergoing coronary artery bypass grafting, especially in the setting of chronic coronary syndrome.
According to current European Resuscitation Council guidelines, priorities in advanced life support in adult are chest compression with minimal interruption and early defibrillation. Endotracheal ...intubation is still considered the gold standard in airway management, but guidelines suggest that securing the airway be incremental, ranging from basic techniques to more complex ones. Doctors who work in pre-hospital emergency medicine teams (EMT) in Croatia usually lack sufficient education and expertise. The aim of this study was to determine whether there was a significant difference in recovery of spontaneous circulation during cardiopulmonary resuscitation (CPR) in out-of-hospital setting depending on the EMT airway management technique of choice. This retrospective analysis included data collected during a 10-year period at the Krapina-Zagorje County Emergency Medicine Institute on all patients with CPR performed by EMTs 20 minutes from initial emergency call. The airway management groups included oropharyngeal tube, i-gel supraglottic device, and endotracheal tube. There were 968 patients, mean age 70. In 74.61% of patients, the cause of arrest was of cardiac etiology. Our study did not find a statistically significant in difference of CPR success among the three groups analyzed according to the airway management technique of choice (p=0.74, chi square-test). Key words: Arrest; Cardiopulmonary resuscitation; Endotracheal intubation Prema aktualnim smjernicama Europskog reanimacijskog vijeca prioriteti u naprednim mjerama odrzavanja zivota u odraslih su kompresija prsnoga kosa s minimalnim prekidima i rana defibrilacija. Iako je endotrahealna intubacija zlatni standard zbrinjavanja disnoga puta, smjernice upucuju na zbrinjavanje disnoga puta postupno, od bazicnih tehnika zbrinjavanja disnoga puta prema slozenijim, sukladno iskustvu lijecnika i ucinkovitosti ventilacije. U Hrvatskoj timovi izvanbolnicke hitne medicine (IBHM) najcesce ukljucuju mlade lijecnike bez dovoljno izobrazbe i iskustva u naprednim tehnikama zbrinjavanja disnoga puta. Cilj istrazivanja bio je utvrditi postoji li razlika u oporavku spontane cirkulacije pri kardiopulmonalnoj reanimaciji (KPR) u uvjetima IBHM ovisno o izboru tehnike zbrinjavanja disnoga puta. Retrospektivno smo analizirali podatke iz programa e-Hitna kroz desetogodisnje razdoblje u Zavodu za hitnu medicinu Krapinsko-zagorske zupanije. U analizu su ukljuceni svi bolesnici kod kojih su KPR proveli timovi IBHM unutar 20 minuta od poziva. Tehnike zbrinjavanja disnoga puta koje su se analizirale bile su: orofaringealni tubus, i-gel maska, endotrahealni tubus. Istrazivanjem je obuhvaceno 968 ispitanika srednje dobi od 70 godina. U 74,61% ispitanika uzrok aresta bio je kardijalne etiologije. U provedenom istrazivanju nije pronadena statisticki znacajna razlika u uspjesnosti ozivljavanja izmedu tri skupine ovisno o tehnici zbrinjavanja disnoga puta (p=0,74, chi square-test). Kljucne rijeci: Arest; Kardiopulmonalno ozivljavanje; Endotrahealna intubacija
Antiplatelet therapy is an integral part of optimal medicamentous therapy in patients with coronary artery disease. The strategy of antiplatelet/anticoagulant therapy is adjusted (combination of ...drugs, dosing and duration of therapy) depending on the stage of the disease (acute coronary syndrome with percutaneous coronary intervention, chronic coronary syndrome, or coronary surgical revascularization) and comorbidity of each patient (e.g., atrial fibrillation, left ventricular thrombus, etc.). Guidelines and clinical practice in particular are not uniform and specific regarding dual antiplatelet therapy in patients undergoing coronary artery bypass grafting, especially in the setting of chronic coronary syndrome. Key words: Antiplatelet therapy; Coronary artery disease; Coronary artery bypass grafting Sastavni dio optimalne medikamentne terapije u bolesnika s koronarnom bolescu je antitrombocitna terapija. Terapija antitrombocitnim te antikoagulantnim lijekovima (kombinacija lijekova, doziranje i trajanje terapije) prilagodava se ovisno o stadiju bolesti (akutni koronarni sindrom s perkutanom koronarnom intervencijom, kronicni koronarni sindrom ili kirurska revaskularizacija) i komorbiditetu pojedinog bolesnika (npr. atrijska fibrilacija, tromb lijeve klijetke itd.). Smjernice, a oso bito klinicka praksa, nisu jedinstvene u pogledu dvojne antitrombocitne terapije u bolesnika koji su podvrgnuti operaciji aortokoronarnog premostenja, narocito u postavkama kronicnog koronarnog sindroma. Kljucne rijeci: Antitrombocitna terapija; Koronarna bolest; Aortokoronarno premostenje
Prinzmetal’s angina, also known as Prinzmetal’s variant or Prinzmetal’s vasospastic angina is characterized by angina attacks caused by spasm of the great epicardial coronary arteries. Coronary ...artery endothelial dysfunction plays a crucial role in the development of this vasospastic angina. The attacks of vasospastic angina can be prevented with calcium antagonists and nitrates, whereas in refractory variant angina, coronary angioplasty with stenting may help prevent further coronary spasm. In this case report, we present a 52-year-old male patient with a transient electrocardiographic recording of acute myocardial ischemia with ST-segment elevation of the diaphragmal location accompanied by a total atrioventricular block immediately after exercise testing and as a first manifestation of Prinzmetal’s angina. After regression of the symptoms and electrocardiographic changes, significant pathomorphologic changes of coronary arteries were excluded by coronary angiography. Following discharge, the patient was treated with calcium antagonists and did not show symptoms during a 4-year follow-up period.
Osim somatskih posljedica akutnoga koronarnog sindroma u obliku različitoga stupnja intolerancije
napora, radne nesposobnosti, simptoma kroničnog srčanog zatajivanja, angine pektoris,
pojave ...različitih aritmija i sl., moguć je već u ranoj subakutnoj te u kroničnoj fazi u oboljelih osoba
razvoj niza psihosomatskih i psihičkih poremećaja, koji, ako se ne prepoznaju navrijeme i aktivno
ne liječe, mogu pridonijeti nepovoljnom ishodu i povećanoj smrtnosti takve skupine bolesnika. Osim
povezanosti akutnoga koronarnog sindroma i kroničnog stresa, anksioznosti i depresije, on može biti
„okidač“ za razvoj kasnijega posttraumatskoga stresnog poremećaja (PTSP) sa stopom prevalencije od
prosječno 15-ak posto među oboljelim osobama. Više je istraživanja pokazalo da bolesnici sa simptomima
PTSP-a povezanog s prethodnim akutnim koronarnim sindromom, napose oni neliječeni, imaju
povećanu smrtnost i veću stopu reinfarkta miokarda. Budući da PTSP povezan s akutnim koronarnim
sindromom ili kardiokirurškom operacijom zna biti zanemaren i podcijenjen, svrha je ovog rada podizanje
svijesti o ovom problemu u svakodnevnoj kliničkoj praksi.
Sastavni dio optimalne medikamentne terapije u bolesnika s koronarnom bolešću je antitrombocitna terapija. Terapija
antitrombocitnim te antikoagulantnim lijekovima (kombinacija lijekova, doziranje i ...trajanje terapije) prilagođava se ovisno o
stadiju bolesti (akutni koronarni sindrom s perkutanom koronarnom intervencijom, kronični koronarni sindrom ili kirurška
revaskularizacija) i komorbiditetu pojedinog bolesnika (npr. atrijska fibrilacija, tromb lijeve klijetke itd.). Smjernice, a osobito
klinička praksa, nisu jedinstvene u pogledu dvojne antitrombocitne terapije u bolesnika koji su podvrgnuti operaciji aortokoronarnog
premoštenja, naročito u postavkama kroničnog koronarnog sindroma.
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