Kada učenje matematike u razredu postane monotono i po utvrđenom redoslijedu, učitelj može obogatiti nastavu raznim didaktičkim igrama, koje može izraditi sam ili s učenicima. Učenici vole didaktičke ...igre jer se uz njih opuštaju i na njih djeluju vrlo motivirajuće. Didaktičke igre učitelj može koristiti i u razredu produženog boravka, jer tako učenici utvrđuju gradivo.
This prospective study assessed the efficacy of the predicting power for mortality of two different prehospital scoring systems in trauma with ISS > 14. We present an improved Mainz Emergency ...Evaluation Scoring system (MEES) in combination with capnometry (MEESc). MEESc is a new scoring system.
In a prehospital setting, the values of MEES and capnometry (initial and final) were collected from each patient. We added final values of partial pressure of end-tidal CO2 (petCO2) to the MEES scoring system and ranked them from 0 to 2 so that the final maximum sum of this scoring system would be 30 without any change in the minimal score being 10. This study was performed over 4 years (from January 2000 to December 2004) and included 114 consecutive patients hospitalized for major trauma with ISS >14, requiring intubation at the roadside and in whom prehospital petCO2 had been recorded. Patients younger than 16 years and those with severe hypothermia (core temperature less than 30 degrees C) were excluded from the study. There were 81 males and 34 females, age range 16 to 82, mean 41.8 +/- 16.4 years. For every scoring system, the sensitivity, specificity, correct outcome prediction and area under the ROC curve were determined. Results were compared with McNemar's test in Z score. A significant difference was p < 0.05.
For prediction of mortality, the best cutoff points were 20 for MEES and 23 for MEESc. The area under the ROC curve was 0.63 for MEES and 0.81 for MEESc (p < 0.05).
There were significant differences between MEES and MEESc. MEESc improved the results of MEES in predicting trauma outcome with ISS > 14. The prehospital use of the improved MEESc system could be an efficient communication protocol between the prehospital and hospital settings.
Introduction. Some studies have shown that the presence of bradycardia in hemorrhage-caused-hypotension is associated with a better prognosis. The aim of this retrospective study was to compare ...bradycardic and tachycardic responses to hemorrhaging in a pre-hospital setting and to evaluate the outcome.
Patients and methods. All patiens were adults (>18 years) with tachycardia and bradycardia hypotension (hemorrhaging) in a pre-hospital setting. We compared a tachycardic group with a bradycardic group using the following criteria: age, gender, APACHE II on admission, trauma vs. non-trauma patients, outcome (survival) and the use of vasopressors.
Results. Over a two year period, 107 patients were screened. The tachycardic group was younger in age than the bradycardic group. Tachycardia was significantly more common in males. The bradycardic group had better APACHE II on admission and also better outcome (survival). Mortality was lower in bradycardic patients than in tachycardic patients.
Conclusion. Bradycardia is a real phenomenon in hemorrhaging patients in a prehospital setting. It might be associated with both better APACHE II on admission and better outcome.
PDF
