At the time of the COVID-19 pandemic, the Emergency Center of the University Clinical Center of Serbia (EC-UCCS), although a non-covid hospital, had to adapt to taking care of a large number of critically ill and, at the same time, potentially contagious patients. In this paper, we present the ways that the EC-UCCS has adjusted to the conditions of the pandemic, where no precise protocols had previously been established for acting in these types of situations. In March 2019, the Admissions Triage Facility of Emergency Medicine (ATFEM) was established. The main task of this facility was to separate patients with epidemiological risk (ER) from patients without risk and to carry out their further isolated care. ER assessment involves completing an epidemiological questionnaire, a targeted brief history, body temperature measurement, and assessment of the patient's respiratory status. The complete triage process, initial diagnosis, and treatment of patients with ER is the task and responsibility of emergency medicine specialists. Between March 15, 2020 and March 15, 2021, about 155,000 patients were examined in triage, of whom 9,519 had ER and were taken care of in the ATFEM. This triage method minimizes the spread of infection while taking care of all critically ill patients, regardless of ER. However, both patients with low and high risk of COVID-19, were all admitted to the same facility, due to the shortage of available space. Also, triage relates only to "covid triage" and not to triage according to the degree of urgency of the patients, which is the primary task of every modern emergency center.
Autor za korespondenciju: Olga Petrović, Klinika za kardiologiju Klinički centar Srbije,
uPOtRebA mObilnOg telefOnA u VOŽnJi? Sažetak: Upotreba mobilnog telefona u toku vožnje postaje sve rasprostranjenija. U anonimnim anketama čak 47,2% vozača prijavljuje da nekada tokom vožnje upotrebljava mobilni telefon, a u nekim studijama ovaj broj prelazi 50%. Rezultati publikovanih studija su pokazali značajno povećanu stopu saobraćajnih udesa kod vozača prilikom upotrebe mobilnih telefona zbog nepažnje, nesigurne brzine, vožnje na pogrešnoj strani puta, udara u nepokretni predmet, prevrtanja vozila, prevrtanja pre nesreće i povređivanja pešaka. Ovi vozači imali su povećane izglede za letalni ishod. Muškarci upotrebljavaju mobilne telefone u toku vožnje znatno češće od žena i tom prilikom izazivaju teže saobraćajne udese. Stope nesreća i smrtnih slučajeva povećavaju se s povećanjem starosne dobi, osim vozača u dobi od 20 do 24 godine. Osnovno pravilo, koje postoji u gotovo svim zakonodavstvima i preporukama, treba da bude zaustavljanje vozila zbog razmene informacija i upotrebe mobilnog telefona. Ovo pravilo se, međutim, masovno krši. Radnjom najvećeg rizika smatra se slanje SMS poruka. U eksperimentu izvedenom 2013. god. otkriveno je da su ljudi koji su se bavili mobilnim telefonom u toku simulirane vožnje propustili duplo više simuliranih saobraćajnih signala u odnosu na simulaciju bez upotrebe mobilnih. Ispitivana je i povezanost saobraćajnih udesa i razgovora mobilnim telefonima sa i bez upotrebe ruku (hands-free). Preliminarna istraživanja govore da je na incidencu udesa povezanih sa upotrebom mobilnih telefona više uticao broj i dužina razgovora nego prisustvo ili odsustvo hands-free sistema. Kako se ispostavilo da hands-free sistemi ne doprinose poboljšanju sigurnosti upotrebe mobilnih telefona u toku vožnje, njihovo dalje usavršavanje verovatno vodi povećanju rizika od saobraćajnih udesa.
Biological agents, including TNF-alpha antagonists, have been used in treatment of autoimmune diseases for over 20 years. Due to impaired T-cell immunity and blocked effects of TNF-alpha mediator, patients receiving this therapy have increased risk of developing tuberculosis or other non-tuberculous mycobacterial infections. Both tuberculosis and other mycobacterial infections may occur anytime in patients who have ever used these medicines, even after the first injection. Most often we see activation of latent tuberculosis confirmed by screening tests. IGRA tests (QuantiFERON and T-SPOT.TB) are significantly more sensitive and specific for testing population of immunosuppressed patients, in comparison to tuberculosis skin test. There are contemporary recommendations for diagnosing, monitoring, chemoprophylaxis and treatment of latent and active tuberculosis in adults and children in case of planning administration of TNF-alpha antagonists or in cases when these drugs have already been used. Prevention of active tuberculosis via diagnosing LTBI and use of chemoprophylaxis is the crucial component of the strategy of World Health Organization for elimination of TB (End TB Strategy).
Wide complex tachycardia (WCT) presents on an ECG with a rate higher than 100 beats per minute and the QRS complex width of over 120ms. The usual classification of wide complex tachycardia includes ventricular tachycardia and supraventricular tachycardia with aberration, but they can also be the result of the effects of metabolic and/or toxic agents. A xenobiotic is a chemical substance that is present in an organism but is not produced within the organism or expected to be there. That also includes substances that are present within the organism in much higher concentrations than usual. For people, various drugs are also considered to be xenobiotics. One type of irregularity caused by xenobiotic poisoning is based on cardiomyocyte sodium channel blockade, responsible for the phase 0 rapid depolarization of action potentials. Certain groups of drugs can cause the WCT as a result of a repolarization disorder and prolonging of the QTc interval. Treating WCT as a result of xenobiotic poisoning depends primarily on the type of tachycardia and the disorder that caused it. Early recognition and adequate treatment are of the utmost importance for a favourable outcome.
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