Signa Vitae

Journal for Intensive Care and Emergency Medicine

Category: Articles (Page 1 of 51)

Emergency Medicine – A View From Another Angle

The process of reorganization of the emergency medicine system in the Republic of Croatia began in 2009, and included both out-of-hospital and hospital EMS. The reorganization was conducted by the Ministry of Health and the Croatian Institute of Emergency Medicine (CIEM) as an umbrella professional healthcare institution tasked with designing the emergency medicine doctrine in Croatia. For that purpose, in 2008, under the Development of the Emergency Medical Services and Investment Planning Project, the International Bank for Reconstruction and Development granted a loan to the Republic of Croatia.

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Approach To Septic Shock And Severe Sepsis In Prehospital Conditions

Sepsis is a systemic, deleterious host response to infection leading to severe sepsis (acute organ dysfunction) and septic shock (severe sepsis plus hypotension not reversed with fluid resuscitation). Severe sepsis and septic shock are major health care problems affecting millions of people each year, killing one in four and increasing in incidence. The Surviving Sepsis Campaign was initiated in 2002 as a joint collaboration committed to reduce mortality from severe sepsis and septic shock worldwide. Many emergency departments have implemented sepsis protocols, which include early identification of septic patients, rapid and appropriate fluid resuscitation, laboratory tests (serum lactate and blood cultures), early antibiotic administration and source control of infection. In ICU there are bundles to be completed within three and six hours. Targets for quantitative resuscitation are CVP of ≥8 mmHg, central venous oxygen saturation of ≥70 %, and normalization of lactate. Studies have consistently shown that, even in the case of hemodynamic stability, elevated lactate levels are associated with increased mortality. Therefore, there is need for early measurement of lactate levels in the emergency department as a reasonable biomarker alternative to invasive resuscitation monitoring.

Enteroviral Etiology Of Early And Late “Sepsis-Like” Syndrome In Three Neonates

Enteroviruses are common human viruses associated with various clinical syndromes, from minor febrile illness to severe, potentially fatal conditions (e.g., aseptic meningitis, paralysis, myocarditis, and neonatal enteroviral sepsis). Neonates are at higher risk for severe illness because of the immaturity of their immune system. Neonatal systemic enterovirus disease is characterized by multiorgan involvement. Typical clinical presentations include encephalomyocarditis (characteristic of group B coxsackieviruses) and haemorrhage-hepatitis syndrome (typical of echovirus 11). EV are important neonatal pathogens associated with a high risk of infection and death. Therefore, EV infections must be considered in the differential diagnosis of early and late neonatal sepsis. In the paper, the authors present three neonates with variable clinical courses, two with early “sepsis-like” syndrome and one with late „sepsis-like syndrome“ and aseptic meningitis. It is important to consider enteroviral infections in the differential diagnosis of neonatal sepsis, especially if, as in our cases, the poor clinical condition of the infants does not correspond to only a mild increase in acute phase reactants or if the LP findings suggest aseptic meningitis

Minimally Invasive Surfactant Therapy – A Single Center Experience

Surfactant replacement therapy is the mainstay treatment for preterm infants with respiratory distress syndrome. In recent years, the growing interest in non-invasive ventilation has led to a variety of novel approaches of surfactant administration (intra-amniotic instillation, pharyngeal instillation, administration via laryngeal mask airway, administration via thin endotracheal catheter without IPPV, aerosolized/nebulized surfactant administration in spontaneously breathing infants). In our Centre last year a number of preterm infants with RDS were treated using MIST technique, in which surfactant is administered using a thin feeding tube inserted below the vocal cords. In the paper we describe our experience with the novel technique and report short term outcomes.

Toxic Epidermal Necrolysis – Case Report Abstract

Aim. To report on rare serious side effects of medications and our successful treatment of these side effects.

Methods. We report a case of a 77-year-old female patient who developed toxic epidermal necrolysis (TEN). The patient was admitted to our intensive care unit (ICU) after thigh amputation, due to severe tissue infection and necrosis as a complication of diabetes mellitus type II. She was previously treated at the department of internal medicine, where she was receiving Vancomycin for 13 days and Piperacilin with Tazobactam for 15 days. After that period the antibiotics were excluded from the therapy. Preoperative anaesthesia assessment was made two days before surgery and four days after excluding the antibiotics.During the examination maculopapular efflorescence with crusts and some bubbles of pus were recognised on the whole body, predominantly on the chest and the back. There were no signs of skin peeling. The changes were present in the oral cavity as well and the otolaryngologist examined the patient on the same day. According to the otolaryngologist, changes resembled aphthous stomatitis. On the day of the anaesthesiologist’s visit Vancomycin was already re-introduced in the patient’s therapy, but this time in combination with Meropenem because the fever occurred again. Other medications that the patient received were Pantoprazol, Ramipril and LMWH. The surgical procedure was done 2 days later in general anaesthesia. After 3 days in ICU TEN was suspected. The bubbles started to pop and the skin started to peel, especially on the back.

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