Neurointensive care of patients with subarachnoid haemorrhage is based on the theory that clinical outcome is the consequence of the primary haemorrhage and a number of secondary insults in the acute post haemorrhage period. Several neuromonitoring techniques have been introduced or accomplished into clinical practice in the last decade with the purpose of monitoring different but related aspects of brain physiology, such as cerebral blood flow (CBF), pressure within the cranial cavity, metabolism, and oxygenation. The aim of these techniques is to obtain information that can improve knowledge on brain pathophysiology, and especially to detect secondary insults which may cause permanent neurological damage if undetected and untreated in "real time", at the time when they can still be managed. These techniques include intracranial pressure (ICP) measurements, jugular venous oxygen saturation, near-infrared spectroscopy, brain tissue monitoring, and transcranial Doppler. The available devices are limited because they measure a part of complex process indirectly. Expense, technical difficulties, invasiveness, limited spatial or temporal resolution and the lack of sensitivity add to the limitation of any individual monitor. These problems have been partially addressed by the combination of several monitors known as multimodality monitoring. In this review, we describe the most common neuromonitoring methods in patients with subarachnoidal hemorrhage that can assess nervous system function, cerebral haemodynamics and cerebral oxygenation.
There is a significant difference between the results of gas analysis of arteries and the internal jugular vein, in patients with infarctions of the left and right hemisphere of the brain.
Despite advances in neurosurgical and neuroanesthesiological practice, postoperative pain continues to be undertreated. There are many modalities that may provide safe and effective postoperative analgesia. We discuss mainly systemic (e.g. opioids, nonsteroidal antiinflammatory agents) analgesic options. They still remain the most widely used method for providing pain relief in acute surgical situations. The exact choice or combination of analgesics utilized for a particular patient will depend on the risk benefit profile and patient preferences. Especially is crucial to promptly involve the analgesics when an opioid tolerant patient requires aggressive pain treatment. But, opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Combinations of drugs acting on different mechanisms of nociceptive modulation will decrease the incidence of adverse effects and offer additive and/or sinergistic effects. Analgesic concentrations of ketamine infusions remain a valuable addition to opioid administration. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and improve postoperative distress. Neuromuscular blocking agents (NMB) in the intensive care unit (ICU) patient facilitate intubation and ventilatory support, decrease oxygen consumption, facilitate bedside procedures and diagnostics, and potentially decrease intracranial pressure. Ideally, analgesics, sedatives and/or muscle relaxants should be combined into a multimodal approach to facilitate patient recovery after surgery. Although a great deal is known about specific drugs and dosage requirements, further research is needed that clearly examines optimal scheduling regimens if we are to maximize patient care. The most important rule of pain management is that pain is what the patient says it is.
Osnovna tema ovog rada je sagledavanje na koji način, kako i koliki uticaj može imatiupravljanje ljudskim resursima sistema bezbjednosti na realizaciju zadataka u procesupreventivnog djelovanja i otklanjanja posljedica kriminaliteta, sa ciljem unaprjeđenjapostojećeg stanja u oblasti upravljanja ljudskim resursima sistema bezbjednosti RepublikeSrpske, i poboljšanje efekata u procesu prevencije kriminaliteta.Istraživanja su pokazala, da je kriminalitet u Republici Srpskoj veoma ozbiljan problem,i da specifičnosti upravljanja ljudskim resursima u procesu prevencije kriminaliteta zavise odbrojnih činilaca, a najznačajniji su: poznavanje uzroka kriminaliteta, uslova kojiomogućavaju izvršenje krivičnog djela i povoda koji podstiču izvršenje krivičnog djela,pravovremeno informisanje, predviđanje kriminaliteta, identifikacija, regrutovanje, selekcija ipravilna raspodjela ljudskih resursa; usavršavanje, vrednovanje i stimulisanje kadrova, iodržavanje intelektualne sposobnosti, fizičkog zdravlja i psihološke stabilnosti svih subjekatasistema bezbjednosti Republike Srpske. U vezi s tim postavljeno je i osnovno pitanje kojeglasi: „Na koji način, kako i koliki uticaj može imati upravljanje ljudskim resursima sistemabezbjednosti na realizaciju zadataka u procesu preventivnog djelovanja i otklanjanjaposljedica kriminaliteta“?
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