seejournal.rs sazetaka_2015_1.pdfSoutheast European Journal of Emergency and Disaster Medicine Open...

Southeast European Journalof Emergency and Disaster MedicineOpen Access Journal of Serbian Society of Emergency Physicians

Supplement No. 1

Društvo lekara urgentne medicine Srbije/Serbian Society of Emergency Physicians

Web: www.dlums.rsE-mail: [email protected]

DRUŠTVO LEKARA URGENTNE MEDICINE SRBIJESERBIAN SOCIETY OF EMERGENCY PHYSICIANSISBN 978-86-919339-0-6

Serbian Society of Emergency Physicians1st International Congress2015, november 05-07. Niš, SerbiaAbstract Book

Southeast European Journalof Emergency and Disaster MedicineOpen Access Journal of Serbian Society of Emergency Physicians

Supplement No. 1

Društvo lekara urgentne medicine Srbije/Serbian Society of Emergency Physicians

Web: www.dlums.rsE-mail: [email protected]

DRUŠTVO LEKARA URGENTNE MEDICINE SRBIJESERBIAN SOCIETY OF EMERGENCY PHYSICIANSISBN 978-86-919339-0-6

Društva lekara urgentne medicine SrbijeNiš, 05-07. 11. 2015.Zbornik sažetaka

Southeast European Journal P a g e | 3of Emergency and Disaster Medicinevol. I, godina 2015, br. 1

www.dlums.rs [email protected]

Southeast European Journal of Emergency and Disaster MedicineOpen Access Journal of Serbian Society of Emergency Physicians

UredništvoGlavni i odgovorni urednik

dr Dušan GostovićPomoćnik glavnog i odgovornog urednika

Acc. spec. prim. dr Tatjana Rajković

Tehnički urednikdr Miljan Jović

Sekretar Uredništvadr Ana Stojiljković

Uređivački odbordr Saša Ignjatijevićdr Tatjana Mićić

dr Dušica Jankovićdr Biljana Radisavljević

dr Snežana Mitrovićdr Goran Živković

dr Milan Đorđevićdr Milan Elenkov

dr Ivana Ilićdr Jelena Moskovljevićdr Dusan Milenković

NAUČNI ODBORPredsednik: prof. dr Milan Pavlović

Članoviprof. dr Aleksandar Pavlović

prof. dr Branko Beleslinprof. dr Miloje Tomašević

prof. dr Saša Živićprof. dr Predrag Minić

prof. dr Radmilo Jankovićprof. dr Milan Rančić

doc. dr Snežana Manojlovićprim. dr. sci. Vladimir Mitov

ass. dr Milan DobrićAcc. spec. prim. dr Tatjana Rajković

dr Branislav Ničićdr Dimitar Sotirov

Međunarodni Naučni odborprof. dr Viktor Švigelj (Slovenia)

prof. dr Zoka Milan, (United Kingdom)prof. dr Aristomenis Exadaktylos (Sweden)

prof. dr Tyson Welzel (South Africa)prof. dr Costas Bachtis (Greece)

prof. dr Heinz Kuderna (Austria)prof. dr Roberta Petrino, (Italy)

prof. dr Masimiliano Sorbello (Italy)prof. dr Vasna Paver Eržen (Slovenia)

Katrin Hruska, MD (Sweden)

LEKTORILektor za srpski jezik

prof. Zorica IgnjatijevićLektor za engleski jezik

prof. Suzana Popovic Ickovski

Vlasnik i izdavačDruštvo lekara urgentne medicine Srbije

Bulevar Nemanjića 19/33,18000 Niš

Časopis izlazi dva puta godišnje u OpenAccesselektronskom izdanju na adresi www.dlums.rs

Adresa Uredništva:[email protected]

www.dlums.rs

Volumen I, ISSN 2466-2992 (Online) , broj 1/2015

P a g e | 4 Southeast European Journalof Emergency and Disaster Medicine

vol. I, year 2015, No. 1

[email protected] www.dlums.rs

Southeast European Journal of Emergency and Disaster MedicineOpenAccess Journal of Serbian Society of Emergency Physicians

EditorialEditor-in-chief

Dušan Gostović, MDAssociate Editor

Acc. spec. prim. dr Tatjana Rajković, MD

Tehnical EditorMiljan Jović, MD

Editorial SecretaryAna Stojiljković, MD

Editorial Board

dr Saša Ignjatijevićdr Tatjana Mićić

dr Dušica Jankovićdr Biljana Radisavljević

dr Snežana Mitrovićdr Goran Živković

dr Milan Đorđevićdr Milan Elenkov

dr Ivana Ilićdr Jelena Moskovljevićdr Dusan Milenković

Scientific BoardPresident: prof. dr Milan Pavlović

Membersprof. dr Aleksandar Pavlović

prof. dr Branko Beleslinprof. dr Miloje Tomašević

prof. dr Saša Živićprof. dr Predrag Minić

prof. dr Radmilo Janković

doc. dr Snežana Manojlovićprim. dr. sci. Vladimir Mitov

ass. dr Milan DobrićAcc. spec. prim. dr Tatjana Rajković

dr Branislav Ničićdr Dimitar Sotirov

International Scientific Boardprof. dr Viktor Švigelj (Slovenia)

prof. dr Zoka Milan, (United Kingdom)prof. dr Aristomenis Exadaktylos (Sweden)

prof. dr Tyson Welzel (South Africa)prof. dr Costas Bachtis (Greece)

prof. dr Heinz Kuderna (Austria)prof. dr Roberta Petrino, (Italy)

prof. dr Masimiliano Sorbello (Italy)prof. dr Vasna Paver Eržen (Slovenia)

Katrin Hruska (Sweden)

ProofreadersSerbian language

prof. Zorica IgnjatijevićEnglish language

prof. Suzana Popovic Ickovski

Owner and PublisherSerbian Society of Emergency Physicians

Bulevar Nemanjića 19/33,18000 Niš

The journal is published two times a yearas an Open Acess Journal on

www.dlums.rs

Editorial [email protected]

www.dlums.rs

Volume I, ISSN 2466-2992 (Online), No 1/2015

Southeast European Journal P a g e | 5of Emergency and Disaster Medicinevol. I, godina 2015, br. 1 Supplement 1


Serbian Society of Emergency Physicians1st International Congress 2015

Abstract Book


vol. I, year 2015, No. 1, Supplement 1


Legend: doctorsnurses

Abstract number: 001Abstract type: poster

The basic principles of the oxygen utilizationin emergency conditionesS.Trpković,1A.Pavlović,1,N.Videnović,1R.Zdravković,1O.Marinković,2A.Sekulić2

1School of Medicine, Pristina, Kosovska Mitrovica, Serbia2KBC "Bežanijska kosa, Belgrade, SerbiaPresenting author e-mail address: [email protected]

Oxygen is the most widely used drug in life-threatened patients. Oxygen is used by doctors andnurses/technicians of almost all specialties. Thepurpose of this article is to familiarize theparticipants with the current guidelines for the useof oxygen therapy, which was published by theBritish Thoracic Association (BTS) in October,2008. For the application of oxygen therapy it isnecessary to provide: a source of oxygen (mostoften oxygen bottles), a system for deliveringoxygen (nasal catheter, or different types of masks),rotameter (flow-meter) and moisturizer. Systemsfor the application of oxygen therapy, depending onthe concentration of oxygen, can be divided intodelivery systems for low, medium and highconcentrations of oxygen. Systems for deliveringlow concentrations of oxygen are: nasal catheter(flow of 1-6 L/min; the delivery of 24% - 45%oxygen) and simple (standard) mask (minimumflow>5 L/min, delivered 35-40% oxygen). Systemsfor delivering medium oxygen concentration are:Venturi mask (the flow of 2-15 L/min; delivery 24-50%oxygen) and mask with reservoir without non-return valves (flow of 6-10 L/min, delivered 35-60%oxygen). For the delivery of highconcentrations of oxygen (95%) we use a mask withreservoir and no-return valves (mask withoutrebreathing), oxygen tent, "jet" ventilation etc. Inlife-threatened patients (cardiac arrest, trauma,anaphylaxis, massive bleeding in the lungs, sepsis,shock, convulsions, hypothermia) we need to applyhigh concentrations of oxygen to normalize vital

signs and then reduce the supply of oxygen so thatthe target value of SaO2 is 94 -98%. If the patient iswithout breathing we need to ventilate the patientwith Ambu balloon, if breathing is present oxygenshould be administered using masks withoutrebreathing with a flow rate of 15 L/min. In patientswith severe disease who are hypoxic (acutehypoxemia or central cyanosis of unknown cause,deterioration of pulmonary fibrosis or otherinterstitial lung diseases, acute exacerbation ofbronchial asthma, acute heart failure, pneumonia,lung cancer, postoperative dyspnea, pulmonaryembolism, pleural effusion, pneumothorax, severeanemia etc.), in which the SaO2 is <85% highconcentrations of oxygen should be applied untilnormalization of vital signs and then reduce thesupply of oxygen so that the target value of SaO2 is94-98%. Oxygen therapy should be applied by usingmasks without rebrithing whith a flow rate of 10-15L/min and when we achieve value of SaO2> 85-93%,we can replace the mask without rebrithing, nasalcannula with a flow of 2-6 L/min or simple facemask at a flow rate of 5 -10 L/min. In patients withChronic Obstructive Pulmonary Disease (COPD)oxygen should be applied in low concentration withtarget values of SaO2 88-92%. Delivery of oxygen iscarried out using 28% Venturi mask with a flow rateof 4 L/min or simple face mask with a flow of 5-10L/min. In not hypoxic patients the continuousmonitoring is essential (myocardial infarction oracute coronary syndrome, stroke, cardiacarrhythmia, non-traumatic chest pain, pregnancyand emergency conditions related to pregnancy,abdominal pain, headache, hyperventilationsyndrome or dysfunctional breathing, poisoningand drug overdose, metabolic or renal disorders,acute and sub-acute neurological conditions,conditions after seizures, gastrointestinal bleeding,heatstroke, etc.) and oxygen therapy should not beused. If these patients become hypoxic (SaO2

<85%), oxygen should be administered by thepreviously mentioned principles. Health workers ofalmost all specialties apply oxygen therapy. If thesepatients become hypoxic (SaO2 <85%) oxygen



should be administered by the previouslymentioned principles. Even though thehealth/medical workers of almost all specialtiesapply oxygen therapy, their theoretical and practicalknowledge is quite low in terms of handling theequipment and knowledge of the guidelines of thedelivery of oxygen.Key words: oxygen, hypoxia, oxygen therapy


The multimodal approach to the therapy ofacute postoperative pain in older patientsafter knee joint prosthesis placementO.Marinkovic,1A.Sekulic,1V.Milenkovic,1J.Zlatic,.1V.Kostic,1 S.Trpkovic2

1KBC "Bezanijska kosa, Belgrade, Serbia2School of Medicine, Pristina, Kosovska Mitrovica, SerbiaPresenting author e-mail address: [email protected]

Background: According to the classification of theEuropean Society of Regional Anaesthesia (ESRA)in 2010, the pain of knee replacement surgery is thepain of high intensity. Good postoperative analgesiais very important in the elderly because it isassociated with a slow recovery, altered immuneresponse, the possibility of occurrence of changes inthe peripheral and central nervous system withprogression to chronic pain syndrome, alteredresponse to stress and unfavorable outcome. In thetreatment of pain in elderly patients, the mostimportant is the concept of individual analgesiawith regular measurement of postoperative pain asthe fifth vital parameter and the application of theprinciple of "start low, go slow". The multimodalapproach is a combination of several analgesictechniques to achieve optimal analgesia effect andminimal side effects.Material and methods: The study included 63patients older than 70 years of age, with ASAclassification II and III, who had undergone kneereplacement surgery. Patients were divided into twogroups. The first group of patients (PI) with thegeneral endotracheal anesthesia underwentintraoperative periarticular infiltration cocktail ofdrugs: a local anesthetic-Chirokain 100mg +NSAIDs (ketorolac-30mg-100mg or ketonal) +Adrenaline 0.1mg. Specifically frozen solution is

applied for postoperatively cooling. The secondgroup of patients (BI) has received only generalanesthesia. Postoperatively the occurrence of thepain and the need for the addition of analgesicNSAIDs (ketorolac) and tramadol was monitored.Assessment of pain intensity was carried out on thebasis of a visual analog scale (VAS from 1 to 10) orverbal pain scale VPS (no pain to worst possiblepain), depending on the cognitive function ofpatients. The values of this scale were thenrecalculations for VAS scale. Measurements weretaken every two hours during the first 24hpostoperatively in the ICU.Results: In the first group (PI) there were 35patients. The maximum dose analgesic NSAIDs(ketorolac-90mg) and 400mg of tramadol weregiven to 5 patients. The minimum dose of theanalgesic ketorolac 60mg and 100mg of tramadolhave been received by 19 patients. In the secondgroup (BI) maximum doses of the analgesicketorolac 90mg and 400mg of tramadol wererequired by 18 patients. Minimum doses ofanalgesic ketorolac 90mg and 100mg tramadol weregiven to 2 patients. In 5 patients in the PI group forthe assessment of pain intensity VSB scale was used.Moderate pain had 3 patients, medium pain had 1patient and intese pain had 1 patient. In the groupBI Verbal pain scale (VSB) was used in 4 patients.Two patients described the pain as a medium and 2as intense pain. VAS score of the first group (PI)was 4.2 ± 0.7 in a group of (BI), 6.32 ± 0.52. Thedifference between the doses of analgesics for painand cropping value VAS scale was statisticallysignificant between the groups.Conclusion: With this multimodal approach weused advantage of combining different drugs andtechniques to obtain the maximum analgesic effectin elderly patients after knee replacement. The firstdoses of analgesics should be administered at fixedintervals and then the dose is adjusted dependingon the needs of patients.Key words: Acute pain, knee prostheses,multimodal approach





Atelecttrauma - histopathological,radiological and pathophysiological aspectN.Videnović,1J.Mladenović,1A.Pavlović,1S.Tripković,1S.Nikolić,1 R.Zdravković,1 V.Videnović2

1School of Medicine, Pristina, Kosovska Mitrovica, Serbia2General hospital Leskovac, SerbiaPresenting author e-mail address: [email protected]

Introduction: Several potential disadvantages andcomplications of mechanical ventilation of thelungs stand opposite its beneficial effects.Ventilation, which is characterized by small end-expiratory lung volumes, allowing repetitivealveolar opening and closing (collapse) may exertundesirable effects in the form of originatelekttrauma.Objective: To determine the effect of low tidalvolume ventilation on histopathological andradiological findings in the lungs of experimentalanimals and pathophysiological changes thataccompany low tidal volume ventilation.Materials and Methods: This study was conductedas a prospective experimental study, which included20 experimental animals (pigs). Experimentalanimals were divided into two groups. CPPV withlow tidal volumes (6-8 ml/kg) and PEEP (cmH2O7) was used in the control group. IPPV with a tidalvolume of 6 to 8 cm H2O, and without a PEEP wasused in the study group. Duration of mechanicalventilation of the lungs is limited to 240 min.Monitoring included Vt, Ppeak, Paw.mean, SaO2,O2, Pa CO2, pH and Pa O2 / O2 Fi ratio.Monitoring parameters were measured at intervalsof 60 minutes. X-ray of the lungs was performed atbaseline, after 90 and 240-minute duration ofmechanical ventilation. The second phase entailedtaking samples of lung tissue of experimentalanimals (pigs) on completion of a four-hourduration of mechanical ventilation, and send themto histopathological examination. Wilcoxon ranksum test evaluated statistically significant difference(p <.05), rank sum parameter data observationcharacteristics of two independent samples.Statistically significant difference (p <0.01) in themean values was tested by t-test in case of a sample.

Results: The results of the study revealed significantchanges in the histopathologic findings ofventilated lungs of experimental animals studiedgroups (moderate perivascular, interstitial andalveolar edema, collapse of the alveoli and smallairways, with prominent micro ateletasis fields)compared to the control group (p <0.05). Changesare more pronounced in the dorsal (lower) lungregions. Radiological findings pointed to theexistence of interstitial edema mind peribronchialand perivascular muff both groups present nosignificant differences (p>0.05). Statisticallysignificant differences was found when comparedwith each other monitoring parameters ofventilation, oxygenation and acid-base status,control and test groups (p <.001).Discussion and Conclusion: The use of IPPV smalltidal volume without PEEP, causing significantstructural changes in the lungs of experimentalanimals. The resulting histopathological changes(longer-lasting inadequate strategy of mechanicalventilation) cover all major lung regions reflectingnegatively in terms of the ability to maintainhomeostasis pulmonary gas exchange (ventilation,oxygenation and perfusion) and acid-base status.Periodic radiological control of ventilated lungindirectly may indicate the emergence of new orworsening of pre-existing pathological changes inthe lung. All this completes the picture ofatelectraume as a form of lung damage caused byusing an inadequate strategy of mechanicalventilation.Keywords: atelecttrauma, mechanical ventilation, asmall tidal volume, histopathological, radiologicaland pathophysiological changes


Case report of the patient with a systemicreaction to an insect stingA.Stankov, T.Rajkovic

Emergency Medical Service Nis, SerbiaPresenting author e-mail address:[email protected]

Introduction: Systemic reaction to animal bites andstings poses a significant medical risk of vascular or



respiratory reactions that vary according to thepatient’s response. Emergency Physiciansfrequently see patients who complain of an allergicreaction to an animal bite or sting.Objective: To present the patient with systemicreaction to insect stings.Materials and methods: Descriptive data display.Data source: the book of calls, the protocol of theInstitute for Emergency Medical Nis, medicalreport and discharge letter from the Clinical Centerof NisCase report: EMS team was called to the publichealth center where a patient after wasp bites hadarrived. The patient had received the followingtherapy: amp. Synopen No I i.m, amp.Dexason NoII i.v and amp.Ranisan No I i.v. The patient said hehad been stung by four wasps. Vital parameters: TA80/60mmHg, SF~90/min, RF16/min, SaO293%,glycemia 5,3mmol/L, TT 36,5C. During theexamination he had dizziness, nausea, dyspnea,urticarial sweating. The physical examination:Heart-action rhythmical, clear tones without heartmurmurs. ECG-b.o. Over lungs: normal respiratorysound. Slightly swollen uvula. Neurologicalexamination – b.o. The abdomen below the level ofthe chest, the superficial palpation painfullyinsensitive. The liver and spleen is not palpable. Thepulses of a.femoralis are equal. The patient wasdiagnosed with systemic allergic reaction to aninsect sting. The cannula IV was applied, the patientwas connected to the oxygen and monitor and hewas treated with Sol.NaCl 0,9%500ml, amp.LemodSolu 40mg i.v, amp.Adrenalin ( 1:10000) 0,5ml i.v.After the treatment, the vital parameters were TA120/70, SF~100min, RF 14/min; SaO2 97%, a patientsubjectively felt better. The patient was transportedto the hematology clinic for the further observation.Discussion: There are three types of reaction oninsect stings. The first is a normal local reactionwhich results in pain, swelling and redness on thesting site, the second is a large local reaction whichresults in swelling well beyond the sting site and thethird is a systemic allergic reaction with generalizedrash, urticaria, angioedema, the patient may haveanxiety, weakness, gastrointestinal disturbances(cramping, nausea, vomiting), dizziness, syncope,hypotension, stridor, dyspnea, or cough. As thereaction progresses, a patient may experiencerespiratory failure and cardiovascular collapse.

Conclusion: Systemic allergic reaction to insectsting requires immediate medical response. Overall,15-25% of a population exposed to insect stingsshows serological and/or skin test evidencesensitization. Only 1-5% of population will give ahistory of immediate systemic allergic reaction tothe prevalent stinging insects, and only half of thesewill experience life threatening reactions.Key words: Systemic reaction, insect sting


Pulmonary edema of cardiac origin,prehospital treatment – Sabac EMSexperience in 2015M.Popović1, Ž.Nikolić1, B.Vujković2, N.Beljić2

1Emergency Medical Service Sabac, Serbia2General Hospital, Šabac, SerbiaPresenting author e-mail adress: [email protected]

Introduction: Pulmonary edema is a pathologicalcondition which is characterized by an increasedamount of extravascular lung fluid. Quantity oftransudate is greater than that which could beremoved by lympha. Lung edema develops in threestages. There are two ways of entering fluid in thealveoli a) indirect b) direct. The pulmonary edemais divided to: cardiogenic (when PKP> 8 mmHg)and non-cardiac a) damage to capillaries andincreased permeability (in pneumonia, toxic effectsof snake venom etc.) b) decrease in colloid osmoticpressure in diseases of liver and kidney c)disorders of lymph drenage from the lungs inlymphangitis, carcinomatosis or d) after anesthesia,stroke, eclampsia, opiate overdoses.Most often is pulmonary edema of cardiogenicorigin. The clinical picture begins with the firststage in which it appears as dyspnea andhyperventilation with the occurrence of wet rustleat bases of the lungs. The second stage is continuedas increased dyspnea, development of mass wetrustle from the base to the top of lungs. The thirdstage is intensified cough, sputum is frothy withtraces of blood, the findings of the wet lungs, with"wheezing", tachycardia and tachyarrhythmia anddisturbance of mental state of the patient.Treatment and medicines used depending on the




findings include: 1.sitting position, 2.airway andoxygen through a mask, 3.Morfium S divided todoses up to max 20-30mg iv, 4.diuretics(Furosemide, Bumetanide II-III amp.iv bolus for 2minutes), 5. NTG in the form of a bolus iv or 1mgper infusion of 10-15mg in 250ml of 5% glucosae,6.venipuncture up to 500ml., 7.Aminophylin I-IIamp.a 250mg iv slowly iv 8.Digitalis I-II ampDilacor if there is AF with a rapid ventricularresponse, 9. Infusion of Inotropic drugs (dopamine,dobutrex).Materials and Methods: Observational studies ofthe book of protocols and medical reports EMSSabac.Results: 23 patients with pulmonary edema wereexamined in EMS Sabac from 01.01. to 31.08.2015ambulatory (tabulation-distribution by gender andage) and 29 patients (tabular representation bygender and age) in the field. The average value TA=186.3/114 mmHg, SpO2: 94.5%, SF about 116/min. The most common therapy was: Furosemideamp (32 amp x I, II x 16 amp, 4 x III and more ampiv) amp Aminophylline x 35 and amp; amp Dilacor5 x I amp; NTG ling.a 0.5 mg 6 x 1 sl; Oxygen 52 xat a dose of 4-12 L /min. An objective improvementwere at 37 cases (21 on the field and 16 ambulatory;in other cases the situation unchanged, there is nodeterioration, no deaths until discharge fromGeneral hospital)Key words: acute heart failure, diagnosis, treatment


Emergency Medical Service of Montenegro atThe Sea Dance festival 2015R.Furtula1, S.Stefanović1, M.Šaponjić1, B. Stojanović2,V.Đurašković2

1Emergency Medical Service of Monte Negro, MonteNegro2Special hospital CODRA - Podgorica, Monte NegroPresenting author e-mail adress:[email protected]

Introduction: The Sea Dance Festival 2015 was heldin Montenegro from 15th-18th of July on the Jazbeach. During four days of this event there werearound 110 000 visitors (up to 35,000 per day).Institute for Emergency Medicine of Montenegro

secured the event through the organization andwork of field hospitals and five remote points withreanimobiles and complete medical teams, as wellas additional vehicles for further transportation ofpatients.Materials and methods: Descriptive data display.Data source: the protocol of the fild hospital withand statistically analyzed in SPSS.Results: A total number of 330 patients from 28countries worldwide were examined. The largestnumber from Balkan: 270 (81.8%) and WesternEurope: 35 (10.6%). Most examined were fromSerbia 116 (35.2%), Montenegro 91 (27.6%),Macedonia 20 (6.1%) and the United Kingdom 18(5.5%). Among examined there were 210 men(63.6%) and 120 women (36.4%). The average ageof patients was 26 years, (19-33 years), the mostcommon 20-25 years. The largest number ofpatients were examined between 21-04h (60.7%),with a peak between 02-03h (13.9%). The mostfrequent examinations were the first day from 01-03h. The minimum number was between 07-08h(0.3%). Among the examined patients there were128 injuries (38.8%) and 202 nontraumatic diseases(61.2%). The most common diagnoses were injuriesof ankle and foot (19.4%), use of psychoactivesubstances (7.6%), general symptoms and signs ofdisease (7.3%), respiratory infections (6.1%),injuries of the knee and lower leg (5.5%). Threeinjuries were the result of violence. 6 patients weretranspoted to the Public Health Centar (acutepsychosis, the use of psychoactive substances, headinjuries, knee and ankle injuries). There were nolethal outcomes.Conclusion: All examined patients are adequatelytreaeted and medical interventiones were efficientand timely.Key words: emergency medical system,Montenegro, Sea dance festival 2015




Abdominal pain as differential diagnosticproblem-newly discovered aortic aneurysmD.Milanović, N.T.Kostić

Public Health Center Gračanica, SerbiaPresenting author e-mail address:[email protected]

Objective: to present a case of patient withabdominal pain, abdominal aortic aneurysms wasfound.Materials and methods: present a patient with apain in the abdomen, where ultrasoundexamination revealed the existence of abdominalaortic aneurysms, which until then had beenunknown.Case: Patient 69 years comes to the emergencyroom because of the pain in the abdomen in thearea of epigastrium. The pain appeared 90 minutesbefore the arrival to the doctor. Pain developed aftertaking larger amounts of fatty and caloric foods. Onpalpation abdomen remains painless. Lab analysis:WBC 9.8, glycemia 8.9mmol/L, ECG was normal,renal succussion was negative. Given that theavailable results were in the normal range, weimmediately began abdominal ultrasound. The liverwas hyperechoic but homogeneous, gall bladderwas empty, but the impression was that there iscalculus. Both kidney and pancreas were normal. Itwas observed that there is abdominal aorticaneurysm, which was a diameter of 4.9 cm, a lengthof 9 cm. There was a wall thrombus. Because of allthat, we immediately suspected that the aneurysm iscausing pain. But the there were no intimal flapandseparation of the wall thrombus. The ultrasonicsigns of aortic rupture were absent. According tothe available findings it was obvious that the newlydiscovered aortic aneurysm did not cause problems.Its suspected that the couse of pain is cholelithiasis.Re-ultrasound examination in different positionsfound calculosis of gallbladder. Problems were soonstopped after an appropriate treatment. The nextday ultrasound, carried out with adequatepreparation, is clearly showed the existence ofmultiple calculosis of gallbladder.Conclusion: Although the typical clinical findingsimmediately pointed to calculosis of gallbladder,

observed aortic aneurysm give us suspicion thatpain may be coused by aortic dissection. Thanks tothe existence of good diagnostic equipment in theEMS, diagnosis was made immediately, and appliedtherapy resulted in withdrawal of symptoms.Key words: abdominal pain, nausea


AV block caused by alcohol as a probablecause of unconsciousness - case reportN.T.Kostić, D.Milanović

Public Health Center Gračanica, SerbiaPresenting author e-mail address: [email protected]

Objective: To present the case where the alcoholintoxication is likely cause of a higher degree AVblock, followed by loss of consciousness.Materials and methods: case studies presents a caseof a patient who has repeatedly lost consciousnessseveral hours after consuming large quantities ofalcoholic drinks and always after waking up.Results: The patient of 37 years, after the familycelebrations returned to home and fell asleep.About 2 hours in the morning he woke up and wentto the toilet. Before he reached the bathroom door,he suddenly loses consciousness and falls. The fallwas heard by the wife who comes to him and findhim unconscious. She colled the EMS immediatly.Until the arrival of the team, he wakes up. Onexamination: the patient was conscious, oriented,TA 120/80mm Hg, SF 55/min, auscultatory findingof the heart and lungs were normal, SpO2 98% andGly 5.9 mmol/L. ECG: sinus rhythm without STchanges, but with the presence of AV block of firstdegree. The patient and his wife say that it'sprobably 8-10 time in the last 5 years, the patientloses consciousness, and always at night, alwaysafter getting out of bed and going to the toilet, inthe interval between midnight and 5 o'clock in themorning.The patient was subsequently completedultrasound, x-ray of the heart and lungs, completelaboratory analysis, and all findings were in normalrange. EKG holter showed a constant presence offirst degree AV block. Neurologist found noneurological etiological factor as the cause of loss ofconsciousness.




The patient says that almost every night waking andgoing to the toilet to urinate and he never lostconsciousness, except in cases where the drinkgreater amounts of alcohol. The rule is thatwhenever he drank large amounts of alcohol (morethan 6-8 bottles of beer and / or 10 stong alcoholicdrink), he has a few hours later (not immediately),loss of consciousness. When he drank 1-2 beersand/or a glass strong alcoholic drink, he never lostconsciousness.Conclusion: Based on these data, it is obvious thatthe only permanent thing is presence of first degreeAV block. The assumption is that the patient due tothe large amounts of alcohol develops transientsecond degree AV block type II-Mobic, (or thirddegree AV block), which, probably, lead to loss ofconsciousness.Key words: AV block, alcohol, syncope


Spontaneous pneumothorax - PrehospitaldiagnosisD.Husović, A.Husović, F.Pašović, A.Tuzinac Hanuša

Public Health Center Novi Pazar - EMS, SerbiaPresenting author e-mail address:[email protected]

Introduction. Pneumothorax is presented asaccumulation of air in the intrapleural space due todiscontinuity of the visceral or parietal pleura,equaling atmospheric and intrapleural pressure andcollapsed lung.Objective: To show the importance of prehospitaldoubt on the development of pneumothorax inpatients with chronic obstructive pulmonarydisease (COPD).Method. We present case of a man aged 58 years.and the development of spontaneouspneumothorax, as well as undertaken prehospitaltreatment.Case report: EMS team was called for a patient whohas shortness of breath, chest pain, and that thelung disease. EMS was dispached immediately andon site we found the patient lying down, pale, withcold sweating, with shortness of breath, bloodpressure was 95/60 mmHg, the pulse was about 115/ min. He complained of stabbing pain on the left

side of the chest which occurred after physicalexertion, shortness of breath and fatigue. We get theinformation that the patient has chronic bronchitis,uses a "puffer" for a few days he feel increasedfatigue and shortness of breath. That morning herepeatedly used a pump and planned to go togeneral practitioners but because of the severe painhe decided to call an ambulance. On examination,the patient was cyanotic, his chest is barrel-shaped,he uses the accesory respiratory muscles. Onauscultation of the lungs we faund weakenedrespiratory sound, on the left inaudible breathingnoise. Percutory, hipersonoran sound was found onthe left. Patient was seeted in half-sitting position,Analgesia was administered IV, oxygen through amask 5l/min and with the suspicion of spontaneouspneumothorax transported to the surgery wardwhere X-rays confirmed the diagnosis of a patientand he was treated performing thoracic drainage.Conclusion. Patients with COPD are common inthe work of doctors at emergency medical servicesprimarily in the outpatient clinic, rarely on the field,but in this particular case, the pneumothorax wassuspected already at a phone call. Workingdiagnosis is set thanks to the history and clinicalexamination, which was significant for rapid patienttransport to surgery.Key words: dyspnea, COPD, spontaneouspneumothorax




The importance of cooperation between thegendarmerie health service and mobilemedical units in providing care in emergencysituationsD. Veljković1, K.Bulajić Živojinović1, D.Tijanić1, J.Zlatić1,V.Stojanović2

1Healthcare team , the Fifth unit of the Gendarmerie,Kraljevo, Serbia2Gerontology Center, Krusevac, Serbia3Healthcare team, the Fifth unit of the Gendarmerie,Kraljevo, Serbia4 Department of Anatomy, Faculty of Medicine,University of Nis, SerbiaPresenting author e-mail address:[email protected]

Introduction: A good deal of time and energy goesinto thinking about the future: what we want toachieve, what our goals are, where we would like totravel, live, with whom and how we would like tospend time. Accidents occur suddenly,unexpectedly, quickly and most often it is verydifficult to predict them. Natural disasters such asfloods, landslides, volcanic eruptions, earthquakes,snow storms, fires, hurricanes, tornadoes, affect theentire community, or most of it. Such naturalcataclysms cause great emotional suffering, humanand material losses, medical and social problems,extensive devastation and destruction.Rehabilitation of the consequences requires theengagement of the whole society, in material andpsychological sense.Objective: Our goal is to point out the necessity andimportance of coordinated cooperation of themedical service of the Gendarmerie and the medicalteam on the ground in emergency situations.Case study: In May 2014 the Republic of Serbiafaced catastrophic floods caused by heavy rain. Astate of emergency was declared initially in fivecities and fourteen municipalities, and from May 15to May 23 was in force throughout the territory ofour country. Rapid rise in water level caused riversto overflow their banks, leading to devastatingconsequences in Kolubara, Macva, Morava,Pomoravlje and Belgrade municipality ofObrenovac. Firemen-rescuers, the police(Gendarmerie, the SAJ, PTJ, the Helicopter unit),

Serbian Armed Forces, the Red Cross, MountainRescue Service evacuated and saved over 31thousand people, and from the most vulnerablemunicipality of Obrenovac more than 25 thousandpeople have been evacuated (it was reported byMUP). On 15th of May, 2014 at 6:00 the firstmedical teams and police officers of theGendarmerie, who were sent to Obrenovac,belonged to the Command and the Second andThird Squad. In its work, the medical teams ofspecial police units, both here and abroad, asopposed to emergency medical services, respond toemergencies in the so-called red zone - imminentdanger area.Conclusion: The floods that took away many livesand inflicted enormous material damage, havehighlighted the necessity of training the staff forproviding medical aid in situations of naturaldisasters. Connecting all the services and adheringto medical emergency response plan, gives adequateresults.Key words: emergency situation, calling, medicalcare.


Options to improve the diagnosis of acuteappendicitis in children, in ambulatorysettingsA.Kostić, Z.Marjanović, M.Krstić, Z.Jovanović,G.Janković, I.Đorđević, N.Vacić

Clinic for Pediatric Surgery and Orthopedics,Clinical Center Nis, SerbiaPresenting author e-mail address:[email protected]

Introduction: Acute appendicitis (AA) is the mostcommon cause of acute abdominal pain in childrenand the reason for even one-third ofhospitalizations. Although the classic presentationof AA is well known, accurate and timely diagnosisof AA in children is not yet possible in everypatient. Clinical presentation of AA in childrendepends on the age of the little patient and can veryfrom minimally symptomatic child, to severeclinical presentation (with a picture of acuteabdomen and signs of endotoxemic shock). The




rate of negative appendectomies is still around 10%,while the form of perforate (despite the use ofmodern radiological techniques) is still too much -up to 35%.A particular problem is the diagnosis of AA in anambulatory setting, with a very limited possibilityfor further tests. Diagnostic accuracy of AA inchildren can be increased only by integratingclinical findings and the results of laboratoryfindings- primarily of blood count (BC) and thevalues of C-reactive protein (CRP).Objective: To evaluate the importance of examiningclinical signs of AA (12 in total), as well as elementsof BC (total leukocyte count, count of neutrophils,the ratio of neutrophils / leukocytes and CRPvalues, to improve the diagnostic accuracy of AAinambulatory setting).Materials and Methods: A months-long prospectivestudy enrolled a total of 200 patients which wererandomized into two groups. The first group (100patients) included the patients who underwentappendix surgery, second (100 patients) childrenwith acute abdominal pain of non surgical genesis.All 12 clinical signs of AA were examined in allpatients (Mc Barney sign, Bloomberg sign,Grassmano's sign, Rovsigno's sign, psoas sign,obturator sign, Lanz-Horn's sign, Rosensteino'ssign, Markleo's sign, Giordano's sign, Owingo'ssign, Ben Ashero's sign ), as well as the results of theBC and CRP. Quantitative statistical analysis wascarried out on the computer.Comparison of the mean values of numericalcharacteristics between the two groups wasperformed by Student's t test or Mann-Whitney Utest (Mann-Whitney U test). Comparison of thefrequency of attribute characteristics betweengroups was performed Mantel-Hencelovim Hikvatrat test (Mantel-Haenszel chi square test). Forthe assessment correlation factor of interest and AAwas used logistic regression analysis (univariate andmultivariate).Results: In the first group were significantly higher(P <.001) were all tested positive physical signs.Also in the first group were significantly increasedvalues of all examined laboratory parameters.Multivariate logistic regression analysis as the mostimportant characteristics associated with asignificant increase in the probability of theexistence of AA confirmed: Grassmano's sign,Markle total leukocyte count greater than 12, 70

and the neutrophils / leukocytes ratio greater than4, and CRP greater than the 16.Conclusion: Diagnosis AA ambulatory practiceremains a challenge, primarily because of the oftennonspecific presentation of this disease in children.Relying often only on limited diagnosticcapabilities, the clinician can have benefits formexamination of the physical characters, but also theintegrated analysis of several available laboratoryparameters.Key words: appendicitis, children, ambulatorysettings


Hyperkalaemia-case reportG.Simić

Public Health Center Krusevac, EMS- Kruševac, SerbiaPresenting author e-mail address: [email protected]

Introduction: The normal physiological cells workand human organism as a whole is conditioned bythe permanence of the internal environment with astrict limits of concentration of the electrolyte. Anydisturbance of the water balance by pathologicaldisorders may be one of the causes of lethaloutcome if they are not timely identified andadequately treated.Potassium - the main intracelulalrni cation isresponsible for transmembrane action potential,intracellular glucose transport, electroneutrality andosmotic balance. Hyperkalemia (more than 5.5mmol/l) is rare disorder but extremely dangerousbecause of the direct effect on muscles andconductive system of the heart. Symptomatology,such as palpitations, fatigue, cramping andabdominal pain indicates a broader spectrum ofdifferential diagnosis which further complicates thework of EMS doctors. In the shortest possible time,guided by intuition, experience and knowledge thaymust justify the doubt about the possiblehyperkalemia. ECG findings will guide thediagnosis in the prehospital settings and lab resultswill be just subsequent confirmation.



The aim is to highlight the importance of earlyrecognition of hyperkalemia based on changes inthe ECG as it was in the case of our patient.Case report: A call is received for 30 years oldpatient already well-known for EMS team(Occasional seizures, abdominal pain type of renalcolic and frequent urinary infections as aconsequence of SAH at the age 26.) Now, he wascomplaining of pain for the entire abdomen andpersistent vomiting. He was in a wheelchair visiblyanxious, febrille, hypotensive and ECG recordedpathognomonic tented T waves. He was transportedand hospitalized at the internal department wherelaboratory had been done and confirmedhyperkalemia (K=7.4 mmol/l). ECG is theframework of the general views and the onlypossible complementary diagnostic procedure inprehospital setting.Conclusion: ECG procedures must be an integralpart of the examinationof each patient andespecially for patients with non-specific symptoms,because in certain situations, as in the case of ourpatient is very important, reliable, and only certainextra prehospital diagnosis.Keywords: hyperkalemia, ECG recording, therapy


Statistical overview of patients with febrileconvulsions and epilepsy up to 18 yearsD.Ševo1, T.Rajković,1 A.Dimić2

1Emergency Medical Service Nis, Serbia2Clinical Center Nis, SerbiaPresenting author e-mail address:[email protected]

Introduction: Febrlilne seizures are usually definedas seizures that occur during fever in children aged6 months to 5 years, where during diagnostictreatment infection of the central nervous system orthe presence of acute or chronic neurologicaldiseases must be ruled out.Objective: Statistical overview of patients up to 18years in 2014 with febrile seizures and epilepsy.Materials and Methods: The descriptive datadisplay. Source: The book of medical interventionof the Emergency Medical Service Nis.

Results: In 2014 in EMS Nis examined 7,406patients up to 18 years, 6,072 ambulatory, 1334 inthe field. Diagnosis "febrile seizures" are givenambulatory in 83,35% and 48% in the field. Inambulatory 25 people were examined born between2010-2014y.Eight (2005-2009y) two (2000-2004y),eight (1996-1999y). (Up to 2012y,-ten). Of the totalnumber 8 were the first attack. All were marked asthird line of emergency. For further treatment 34patients were referred.The therapy was given to 20 patients (7 supp. 2mgdiazepam, 7 diazepam rectal gel 5mg, 10 supp.Efferalgan 150mg and 9-O2). On the field there were43 patients born between 2010-2014y, 4 (2005-2009y), 1(1996-1999y) (maximum 2012 year-18).With the first attack four children. Of the 47patients in the field, 15 were rated as a first line ofemergency, 20 second and 13 third line ofemergency. 16 patients received following therapy:2pt supp. Diazepam 2mg, 5mg diazepam rectal gel5pt, 5pt supp. efferalgan 150mg, 10pt-O2. Diagnosisof "epilepsy" has appeared at 45 children, 37 in thefield, 8 ambulatory. In the field, there were 5 (2010-2014y.), 14(2005- 2009y.), 7 (2000- 2004y),10(1996-1999y.) Of the total number of 5 hasappeared for the first time. Of all calls 4 were eratedas a first line of emergency, 21 second and 12 thirdline of emergency.For further treatment 21 patients were sent.Therapy was given 12, (6 tabl. Valium 5mg, 6-O2, 4iv cannula). Ambulatory total number of 8 patientswas examined: 2 (2010-2014y.), 2 (2005-2009y.), 1(2000-2004y.), 3 (1996-1999y.) All were rated as athird line of emergency and refered for furtherevaluation. Therapy: 1 supp.efferalgana 150mg, 1diazepam rectal gel 5mg and 1 iv cannulaplacement.Discussion: The biological basis of febrile seizures isstill unknown and is ascribed to a number offactors. It occures with sudden body temperatureraise to more than 38,5ºC, and often represent thefirst symptom of the disease. The most commoncause of body temperature rise are viral upperrespiratory tract infections, bacterial infections ofthe gastro intestinal tract, the urinary tract etc. Theclinical picture is dramatic and frustrating for anyparent. In these attacks the child turne and fixeyeballs to one side, lose consciousness and begin toshake. Longer pauses in breathing create greatepanic and fear in parents. They differ in the typical




and atypical febrile convulsions. Typical generalizedseizures are seen in children aged 1 to 5 years, lastless than 15 minutes and are not recurring within24 hours. Atypical seizures are seizures that lastmore than 15 minutes and occur several times a dayand often are focal or hemi generalized. After theattack transient or permanent neurological deficitcan be observed (Todd's paresis).Conclusion: Febrile seizures are the most commonseizures which are usually benign. In -almost 50%of children thay may recurre. Rarely areaccompanied by subsequent development ofepilepsy. Although the pathogenesis is unknown,research suggests genetic predisposition.Key words: statistics, febrile convulsions, epilepsy


The deadly duo: mixing alcohol and Xanaxcan lead to bad habits or unexpected deathLJ.Milošević1, K.Jovanović2, M.Donić3

¹,³Clinical Hospital Center Zemun-Belgrade, Serbia²High medical school Cuprija, SerbiaPresenting author e-mail address:[email protected]

Introduction: Xanax (alprazolam) is abenzodiazepine indicated for short-term relief ofanxiety disorders as well as treatment of panicattacks. The efficiency for the treatment of anxietycan be explained by their pharmacological action inthe brain at specific receptors. Receptors are specificlocations on the membrane of nerve cells, whichreceive a signal from neurochemicalneurotransmitters. Once locked neurotransmitterreceptor changes to electric or other chemical signaland travels along the neuron. Receptors (location)where benzodiazepines cause their effect are locatedin different regions of the brain. The reaction of thebenzodiazepine receptors facilitates the inhibitoryaction of the neurotransmitter γ-aminobutyric acid(GABA) in the brain region. It seems that the actionof benzodiazepines on GABA receptors produces itsanxiolytic, sedative, and anticonvulsant action andis effective as a hypnotic. The usual starting dose ofXanax in the treatment of depression and anxietydisorders is 0.25-0.5 mg three times a day. The dose

may be increased to 4 mg per day and in thetreatment of panic attacks may be increased up to6-8mg per day. Side-effects of sedation aresomnolence, decreased concentration and memoryas well as the reduced movement coordination.The aim is to show that patients who take Xanaxshould not take other CNS depressants such asalcohol, narcotics, hypnotics, barbiturates and evenantihistamines, which can lead to increasedsedation, disorders of breathing and respiratorydepression and death.Case: Patient age 26 years was admitted to theemergency internal department of KBC Zvezdara-Belgrade. He was confused, somnolent, haddiscordant movements (ataxia), weakened reflexes,impaired breathing movement, bradycardia,cyanosis, hypotension, and already during theexamination of the initial signs indicative of loosingconsciousness and respiratory arrest. From relativeswe obtained the information that the patient is ontherapy with xanx and that he was at a party wherehe consumed alcohol. He was intubated (from themouth the smell of alcohol can be felt) and admitedat the surgical intensive care unit of KBC Zvezdara-Belgrade. He was in need for respiratory support,(invasive mechanical ventilation).Arterial blood gasanalysis showed high values of PaCO2>48 mmHg,hypercapnia. The patient was on invasivemechanical ventilation (MV-IV) form BIPAP, theset PEEP = 5cmH2O, and ventilatory support withlung protective ventilation. Blood biochemistryvalues were within normal limits and the furthermeasures were taken on the principles of therapyfor poisoned patient: 1.Maintenance of vitalfunctions (heart and lungs) 2.The prevention ofabsorption of toxins 3.The elimination of poison 4.Symptomatic treatment 5.Antidote. The content ofthe nasogastric tube and blood were sent to thetoxicological center of VMA. After 24 hours ofmechanical ventilation of the lungs patient reachedrecovery and was referred to the psychiatricdepartment of KBC Zemun. The report of thepoison center VMA Belgrade confirmed thepresence of Xanax and blood alcohol in gastriccontents.Results and discussion: The primary and mostimportant in intoxicated patients is to improveventilation and oxygenation as in our patient.



During mechanical ventilation, adjustable fan isbased on the "ideal body weight" and gas analysis ofthe arterial blood. The patient was successfullyremoved of respiratory support after 24 hours ofhospitalization in the surgical intensive care unitand was sent to psyhiatric department.Conclusion: Overdose with the oral administrationof only benzodiazepine is generally not fatal. In theworld literature most letal outcomes are describedas a result of consumption of benzodiazepines alongwith other CNS depressants such as alcohol,narcotics or barbiturates.Keywords: Xanax, alcohol overdose, respiratoryfailure, mechanical ventilation


Emergency treatment of near-fatal acuteasthma – case reportLJ.Milošević1, K.Jovanović2

¹Clinical Hospital Center Zemun-Belgrade, Serbia²High medical school Cuprija, SerbiaPresenting author e-mail address:[email protected]

Background: Asthma is defined as a chronicinflammation of the airways, which causes theirincreased sensitivity to external agents. They causeconstriction of the airways, which couses feeling ofdifficult breathing, cough, feeling of oppression andwheezing. Problems are usually occure at night and/or early in the morning, but can also appear duringthe day. Number of patients with asthma over thelast two decades of steadily increasing, especially inchildren, teenagers, and in high-income countries(particularly allergic asthma) and has been definedas a disease of modern societies and the epidemic ofthe 21st century. It is estimated that about 350million people worldwide have the disease, and thatanother 150 million fall ill for the next 10 years. Ourcountry is among the others with an average rate ofasthma illnes.The aim is to point that the patients in the acutephase of severe asthma who do not respond tointensive bronchodilator therapy could have letaloutcome if they are not placed on mechanicalventilation(MV): noninvasive mechanical

ventilation (NIV) or invasive mechanicalventilation (IV).Case report: The patient aged 30 years was admittedto the emergency department of KBC Zvezdara-Belgrade conscious but agitated, unable to lie down,with signs of respiratory ditress and the use ofauxiliary respiratory muscles. He was not able tospeak, only single words. Auscultation of lungsbilaterally found depressed respiration with severediffuse and bilateral wheezing. There was no otherincidental physical findings of the examination.Vital signs showed: blood pressure 145/80 mmHg,heart rate 140/min, SpO2 70% on room air, BT36,8ºC, respiratory rate 40/min. The patient wasimmediately transfered to surgical intensive careKBC Zvezdara-Belgrade because there was a needfor respiratory support, ie. mechanical ventilation(MV) of the lungs. Arterial blood gas analysisshowed pH7.14, elevated PaCO2 77mmHg, PO2

44,2mmHg, HCO3 28,4mEq/l, lactate 2.8mg/dl.Patient was treated with inhalation, salbutamol (β2-adrenergic receptor agonist), ivmethylprednisolone, aminophilline iv, imepinephrine, iv magnesium sulfate.Due to severe respiratory distress and severe acuterespiratory acidosis we began noninvasivemechanical ventilation (NIV) by face mask with theparameters 5cm H20 PEEP, FiO2 100%. The patientwell tolerated NIV. Chest X-ray showed enhancedbronchovascular drawing without pulmonaryhemorrhage, cardiovascular profile was normal.After 30min. NIV blood gas analysis was: pH 7.22,PaCO2 66mmHg, PaO2 110 mmHg, SpO2 99%, vitalparameters were stabil. NIV is continued withreduced FiO2 50% and after 3 hours arterial bloodgas analysis were pH 7.37, PaCO2 45 mmHg, PO2

87, HCO3 25.4. The patient was transferred to thedepartment of pulmonology, where he was on nasalcannula with O2 4L/min and continued therapy(bronchodilators and steroids). The patient wasdischarged from hospital in good general conditionafter 6 days.Discussion: The primary and principal in asthmaticpatients is to improve ventilation and oxygenationas like it was achived in our patient. Patientparameters are monitored during (MV-NIV) andwhen gas analyzes of arterial blood showedimprovement there was no need for invasivemechanical vetilation (MV-IV).




Conclusion: Mortality in the severe asthmaticattack, is coused by asphyxia in exacerbation ofrespiratory distress-a. It is caused by "air trapping"in the alveoli and reduced ventilation which isaccompanied by hypoxia and acidosis. Often knowntriggers are psychological stress, lifestyle, smoking,obesity, allergens etc.Keywords: asthma, respiratory failure, mechanicalventilation


Non-operative treatment of blunt kidneyinjury in children-a case reportZ.Jovanović, A.Slavković, M.Bojanović

Clinic for Pediatric Surgery and Orthopedics, ClinicalCenter Nis, SerbiaPresenting author e-mail address:[email protected]

Introduction: Genitourinary injuries in 50% includekidney, and in 90% of the cases the cause is bluntabdominal trauma. The main goal of treatment ofthese injuries is to preserve functional renalparenchyma and reduce the rate of morbidity.Parallel with progress in diagnosis andhemodynamic monitoring, scoring systems aredeveloped and they contribute to more successfullmethods of non-operative treatment of renalpreservation. Non-operative treatment, reducesrepeated hemorrhage and hemodynamic instability.These treatment modalities are ureteral stentingand percutaneous drainageObjective: To present patients with renal injury whois treated by uretheric retrograde stenting.Case report: A 13-year-old girl was injured byfalling down the stairs. She was sent from anotherhospital, due to persistent hematuria and vomiting,more than 20 times. Status on admission: consciousand actively mobile. Abdomen soft, tenderness inthe left lumbar region. Laboratory diagnosis: CBC:(Ht 36). In urine: mass of fresh red blood cells. Allbiochemical parameters were normal. Ultrasound atthe admission: subcapsular hematoma of the leftkidney. CT findings: softness and rupture of thelower pole of the left kidney, subcapsular,intraparenchymal and perirenal hematoma.

Treatment: cystoscopic, in general anesthesiaretrograde approach to left ureteral orifice JJ stentwas placed. Position the proximal end of the stentin the renal pelvis of the left kidney was confirmedby radiography and ultrasound. FurtherConservative treatment includes antibiotic andantifungal therapy, rehydration, correction ofelectrolyte disbalance, analgesia, implementation ofthe SAA and washed red blood cells, to correct lowhematocrit values. ECHO findings after seven days:Regression of subcapsular and perirenal hematoma,regression of ascites intraperitoneally. 3 weeks afterthe injury: Left kidney voluminous, hematoma inalmost complete resorption. Scintigraphy (DMSA),after two weeks of injury absent intracorticallyaccumulation of the drug in the distal third of theleft kidney, which corresponds with a scar change.Distribution: 59% right, left 41%-DTPA, 3 weeks ofinjury: Left kidney reduced craniocaudal diameter,preserved contours. In the lower third moderatephoton deficient zone. Radiorenogramm shows thatit is slightly lower than the right, shows the normalflow of radiopharmaceuticals, rapid transit andparenchymatous swift and proper elimination. Bothkidneys appear symmetrical and good intensity invascular and parenchymal phase. There is nosignificant delay in the elimination stage. Theindividual participation in the global kidneyfunction is left 44%, right 56%. After 27 days the girlwas discharged from hospital withoutmicrohematuria without pain. Regular clinical andultrasound controls were made.Discussion: Kidney injuries in children have theirown peculiarities considering the anatomicalcharacteristics: larger kidneys relative to body size,less developed perinephric adipose tissue andcapsule, poorly ossified chest, greater mobility. Theusual V degrees injury staging determines theprocedure: From I to III conservative, V is mainlysurgical and IV is the subject of controversy.Retrospective studies have shown that conservativetreatment in children can be safe for degrees IV andV. In our patient hemodynamic stability was ofcrucial importance. The positive sides of internaldrainage: the child does not wear a catheter, urinebag, and has less risk of infection, and is sociallymore acceptable. Possible complications:



obstruction, infection and hypertension are rare.For the extraction of a stent requires an additionalgeneral anestesia.Conclusion: endoscopic tretaman of blunt kidneyinjury (IV level) in children can be successful andsafe, and lead to a significant resolution andpreservation of renal function.Key words: trauma, kidney, non-operativetreatment.


Syncope in children and adolescents - amedical emergency or not?Lj.Šulović, J.Živković, D. Odalović, Z.Živković,S.Filipović-Danić

Medical School of Pristina, Kosovska Mitrovica, SerbiaPresenting author e-mail address: [email protected]

Introduction: Syncope is a sudden loss ofconsciousness associated with loss of muscle tone.Of all hospitalized patients 6-7% with syncope,namely 3-6% is emergency admission. Potentiallylethal, syncope creates great fear in parents, patientsand doctors, and children are often exposed tounnecessary often prolonged clinical examinations.Objective: to show the importance of anamnesticdata and monitoring guidelines to identify the causeof syncope and risk stratification and distinction ofpotentially deadly from harmless cases.Materials and Methods: retrospective analysis ofchildren aged 6 months to 18 years, in a period(from June 2010y. to June 2015y) which werehospitalized due to a short-term loss ofconsciousness at the Children's Hospital ClinicalHospital at Gracanica. The diagnosis was madeaccording to well-taken history data and a detaileddescription of the quality of the attack, thoroughphysical examination and routine laboratoryanalysis (CBC, glucose, standard ECG). Additionaltests were selectively done: Holter ECG / a stresstest, tilt table test, echocardiogram, NMR, EEG.Results: In the five-year period, we received 116children or 6.4% of total hospitalized withsymptoms of short loss of consciousness. Theaverage age of children was 12.2 years (usuallybetween the ages of 15-18 years). There was

statistically significant occurrence of syncope inrelation to sex, girls 61.8%, boys 38.8% (p <0.01).Syncope has been divided into 3 groups accordingto etiologic causes, within which we madesubgroups (Table 1). The cause of syncope wasidentified in 88/116 or 75.8% of patients. Cardiaccause of syncope was significantly rarest, p <.001.Autonomous cause 70.4%; the non-cardiac 27.2%;cardiac 2.3%; vasovagal 52%; neurological 42.4%;cardiomyopathy 50%; orthostatic syncope 25%;mental 38.4%; arrhythmias, 50%; situationalsyncope 13%; Affective repetitive crisis 7.7%;Enhanced vagal tone, 10%; Metabolic 11.5%. Mostchildren had only one attack. The largest number ofattacks was 5 at two children.Conclusions: The largest number of syncope inchildren are benign. Cardiac syncope is rare butpotentially dangerous. Diagnostic protocols forsyncope is the fastest way to diagnosis, riskstratification, reduced fear and rationalize costs.Key words: syncope, children, causes, risk


Infectiones at region of Nuchae in patientswith comorbiditiesM.Mrvaljević1, S.Pajić2, T.Boljević3, M.Božić4, Z.Pešić5,I.Bogdanović2, J.Arsov2

1KCS Clinic for Urgent surgery, Belgrade, Serbia2KCS Clinic for Neurosurgery and neurotraumatologyEmergency Center in Belgrade, Serbia3KC Podgorica, Department of Maxillofacial Surgery,Monte Negro4Medical School of Nis, Serbia5Department of Maxillofacial Surgery, Medical SchoolUniversity of Nis, SerbiaPresenting author e-mail address:[email protected]

Introduction: Anatomic region of nuchaerepresents a zone that provides solid foundation forthe development of furunculosis and carbunculosis,especially in patients burdened with contributingcomorbidities. Their treatment almost uniformlyconsists of simple or cross excisions, drainage andappropriate antibiotic therapy. This type oftreatment yields often more than satisfactory resultsin patients with regular immune status. However,




recommended therapy as such, rarely providesadequate results in patients with weaken immunestatus, i.e. diabetics, when even banal infectioncould result in occurrence of phlegmona.Objective: To present our solutions andconsiderations of this issue in order to determine anoptimalsurgical solutions for patients who haveturned to us for help .Method: In the period of 7 years (2008 /2015), 13patients with diabetes who developed carbuncle atregion of nuchae with progressive phlegmona weretreated in our ward. Most of the patients (9) wereaware of their chronic disease but wereadministered insufficient therapy and had poor dietregime until admission at our ward. Others,however, are diagnosed for the first time atadmission and than introduced to the adequatetherapy from that point on. Due to the extent andintensity of the inflammatory process in themajority of cases 10 patients underwent extensiveskin excision , fascia and muscle tissue of affectedregion, with multiple divisions of muscle tissue forthe purpose of drainage.Results: Postoperatively, we applied multiple dailydressing of the wound with antiseptic topical agentsalong with maximum dose of antibiotics by theantibiogram, vigorous adjuvant therapy. Moreover,within the third day of hospitalization patients havebeen exposed to active O2 – (hyperbaric chamber)therapy, along with optimal corrections andbalanced antidiabetic therapy. After the regressionof the inflammatory process, and once healthygranulation was established, scarred surface wasreconstructed with Thiersch skin grafts.Conclusion: By applying aforementioned therapyprocedure curable effects were achieved in 12patients (93%). In one case, local curing wasachieved, but the patient suffered lethal outcome 9months after the beginning of treatment due todeveloped pulmonary miliary abscess as a result ofsepsis, which had occured on the 12th day ofhospitalization. Average treatment time wasapproximately 19 days.Key words: anatomic region of nuchae,furunculosis, carbunculosis, infection.


Location and importance of tracheotomy inpatients with craniofacial injuriesS.Pajić1, J.Arsov,1 I.Bogdanović1, B.Olujić2, D.Jovanović2,T.Boljević3, M.Mrvaljević2, M.Božić4, Z.Pešić5, I.Nikolić6,M.Jokić6

1KCS Clinic for Neurosurgery and neurotraumatologyEmergency Center in Belgrade, Serbia2KCS Clinic for Urgent surgery, Belgrade, Serbia3KC Podgorica, Department of Maxillofacial Surgery,Monte Negro4Medical School of Nis, Serbia5Department of Maxillofacial Surgery, Medical SchoolUniversity of Nis, Serbia6KCS Center for radiology and magnetic resonanceimaging, Belgrade, SerbiaPresenting author e-mail address:[email protected]

Introduction: The size of traumatic force that isreceived by polytraumatized patient is frightening,which greatly exceeds the minimum force requiredto fracture each part of the facial skeleton andendocranium. This extensive traumatic force crashbones. This happens together with destructivechanges in the skin layer and soft structures, withvery often impressive abundant hemorrhages,hematomas, and everywhere present edema in thefirst 48 hours.Objective: To describe early and late indicationsthat guide the decision for tracheotomy and topresent our experience.Method: In all extensive fractures in midface airwayis compromised due to dislocation of fracturedsegments and edema of soft tissues. Patient materialof treated patients in intensive care units ofemergency surgery and NeurotraumatologyEmergency Center in Belgrade for the periodJanuary 01, 2014 to January 01, 2015, there were250 patients with craniofacial injuries withinpolytraumatism. We did early and delayedtracheotomy according to general condition of thepatient and their Glasgow Coma Score.Results: In some patients rubber nasopharyngeal airway can be placed, while in others intubation isindicated or more often urgent tracheotomy.Sometimes the cause of airway obstruction was:



broken teeth, aspirated blood, dentures, parts of thebone... In the observed period the number ofpatients with craniofacial injuries in the EmergencyCenter was 250, and of that number, in 100(40%) atracheotomy was indicated, emergencytracheotomy in 29(29%), and in comatose patientsand long beded done 48 (48%) of theseinterventions, while 23(23%) patients were done fortherapeutic purposes. Of this number ofpolytrauma patients cured and discharged was223(89.2%), with the need for further treatment atone of the rehabilitation centers 14(5.6%) and 13died (5.2%).Conclusion: Maintaining of airways is the mostimportant primary measure for patients who havesuffered high-energy injuries to the face andendocranium. Patients with associated headinjuries, especially when they are unconscious, haveto be intubated within the initial care. At extensivemidfacial injury there is a significant disorder ofanatomy so intubation can be extremely difficult ina patient who is actively bleeding, in emergencysituations and with compromised airway. Ifintubation fails, tracheotomy must be performedwithout delay. At high-energy injuries that causedthe complex injuries of the craniofacial region, themiddle third of the face or multifrgament fracturesof the lower jaw, early tracheotomy is indicated, asdramatic face edema during the first 48 hours isexpected, and significantly simplifies the definitivesurgical care.Key words: tracheotomy, emergency tracheotomy,craniofacial injuries, high-energy injuries,polytrauma


Pleomorphic adenoma in the sub mandibularsalivary gland

S.Pajić1, J.Arsov 1, I.Bogdanović1, B.Olujić2, D.Jovanović2,T.Boljević3, M.Mrvaljević2, M.Božić4, Z.Pešić5, I.Nikolić6,M.Jokić6

1KCS Clinic for Neurosurgery and neurotraumatologyEmergency Center in Belgrade, Serbia2KCS Clinic for Urgent surgery, Belgrade, Serbia3KC Podgorica, Department of Maxillofacial Surgery,Monte Negro4Medical School of Nis, Serbia5Department of Maxillofacial Surgery, Medical SchoolUniversity of Nis, Serbia6KCS Center for radiology and magnetic resonanceimaging, Belgrade, SerbiaPresenting author e-mail address:[email protected]

Introduction: In the submandibular gland tumor(pleomorphic adenoma) is a rare tumor (5%). It ismuch more common in other salivary glands. Alsoit is the most common benign tumor of the salivarygland (45-74%). It is most common in the 4th and5th decade, more often in women. This tumor hasthe ability of malignant alteration in 3-15% after 10-15 years. Treatment is surgical.The objective of this paper is to present the clinical-pathological characteristics of the submandibulargland tumors.Methods: We analyzed the history of 8 patients withtumors of the submandibular gland treated in theperiod from 01 January 2005 to 31 December 2014.in the Department of Otolaryngology andMaxillofacial Surgery Clinical Center ofMontenegro.Results. There were 5 female patients (62.5%) and 3males (37.5). Patients were aged from 37 to 57years, and the average age was 47. These patientswere treated surgically, tumor was extirpatedtogether with the submandibular gland, which wasnecessary because the tumor in some places, thecapsule may be incomplete, eg because ofrecurrence, and the possibilities of malignantalteration.Conclusion: Pleomorphic adenoma is a rare tumorin the submandibular gland, more common in




women in the fifth decade of life. What is needed isa better understanding of the clinical andpathological characteristics of these tumors, and togain access to adequate treatment and improve thehealth of these patients.Key words: pleomorphic adenoma of the submandibular gland


Optimum usability of skin grafts - ThierschtypeT.Boljević1, S.Pajić2, J.Arsov2, I.Bogdanović2, B.Olujić2,D.Jovanović2, M.Mrvaljević2, M.Božić3, Z.Pešić4,I.Nikolić6, M.Jokić6

1KC Podgorica, Department of Maxillofacial Surgery,Monte Negro2KCS Clinic for Neurosurgery and neurotraumatologyEmergency Center in Belgrade, Serbia3KCS Clinic for Urgent surgery, Belgrade, Serbia4Medical School of Nis, Serbia5Department of Maxillofacial Surgery, Medical SchoolUniversity of Nis, Serbia6KCS Center for radiology and magnetic resonanceimaging, Belgrade, SerbiaPresenting author e-mailaddress:[email protected]

Introduction: The most popular and most oftenused for short-term storage of grafts is conservationin a standard refrigerator at + 4C. The need for suchpreserved grafts ranges from one day up to onemonth of taking transplant. According to theliterature the usability of grafts ranges from 10 daysto 21 days.Objective: to more precisely determine the time towhich the applicability of this preserved grafts issafe, we performed a study with 50 samplesThiersch Type grafts.Methods: The study was done at the ICU of of theEmergency Center. Five patients agreed to giveparts of their skin size 3x5cm. Parts of the skin weretaken during the operation, preserved in the usualway and in a certain period tested clinically andhistologically.Starting from 11th day, 5 preparationwas divided into two parts, of which one wasapplied to a suitable surface for accepting thetransplant, while the other was placed in formalin

and sent to HP analysis.Then we made a series offive preparations in within which every subsequentprolonged period of conservation by 1 day longer,and continued until 20 day.Results and Conclusion: The results of the clinicaland histological examination were consistent. Arerepresented by tables. Usability above 50% of thegraft is conserved up to 17 days of the preservation,and then falling. From that perspective it is possiblethat a transplant is used 30 days from theconservation, but as an exception, not the usualstate.Key words: skin grafts, Thiersch


Reconstructive options in closing decubitusulcers of sacrococcygeal regionM.Mrvaljević1, S.Pajić2, T.Boljević3, M.Božić4, Z.Pešić5,I.Bogdanović2, J.Arsov2

1KCS Clinic for Urgent surgery, Belgrade,2KCS Serbia Clinic for Neurosurgery andneurotraumatology Emergency Center in Belgrade, Serbia3KC Podgorica, Department of Maxillofacial Surgery,Monte Negro4Medical School of Nis, Serbia5Department of Maxillofacial Surgery, Medical SchoolUniversity of Nis, SerbiaPresenting author e-mail address:[email protected]

Introduction: Sacrococcygeal decubital ulcers areusually the first decubital wounds that develops inpatients related to the long-term immobile lying inbed. Hence their frequency and extensiveness. Theyare found in patients with plegia and in severesurgical and chronically ill patients. The basis oftheir surgical treatment is excision of necrotic anddevitalized scarring altered soft tissue ulcerationand periostitis and osteitis affected parts of thebones on the bottom of ulceration. The closure ofthe defect is achieved by using high-quality softtissue cover.Objective: find an optimal solution for the realproblem of patients who are immobile for a long



time with the presence of decubital ulcerations ofdifferent degree and extent.Metod: The study was done at the Surgical ICU ofof the Emergency Center. There were 46 patientspatients who are in a state of coma, plegia orquadriplegics who were observed for the periodfrom January 01, 2013 to January 01, 2015. Therewere 21 female and 25 male patients, aged in therange of from 29-83y, and 11 patients who require amore extensive treatment. Classic treatmentaproach of these defects with rotary lobe, carries arisk of complications - partial necrosis of peakslobes, and not healing lobes to the substrate becauseof formation of large subcutaneous pockets filledwith hematoma, seroma or infected content.Results and Conclusion: The use of myocutaneousgluteus maximus flap is undoubted progress inclosing these wounds. Horizontal sliding, an islandlike, myocutaneous gluteus maximus flap isaccepted in our practice because of its numerousqualities.This flap is relatively easy to plan,mobilizes and lifted separating the muscles along itsmedial insertion of sacral and coccygeal bone andalong its upper edge, which allows it to germinateover the midline. The secondary defect ismaintained in V-Y procedure. The flap is vital in allits parts. By mobilizing two lobes can closeextensively large defects. Defects are closed in threelayers, a region exposed to chronic pressure iscovered by muscle and full thickness skin. Thesewell vascularised tissues have positiv influences onlocal infection. We used These lobes in mobile -notplegic patients without disrupting the function,since there is intact innervation, vascularization andfunctional integrity of the muscles.Key words: decubital ulcers, reconstructive surgery,sacrococcygeal regia


Our experience in the treatment of fracturesof the zygomatico-maxillary complex,zygomatic bone and of the orbit floorT.Boljević1, S.Pajić2, J.Arsov2, I.Bogdanović2, B.Olujić2,D.Jovanović2, M.Mrvaljević2, M.Božić3, Z.Pešić4,I.Nikolić6, M.Jokić6

1KCPodgorica, Department of Otorhinolaryngology andMaxillofacial Surgery, Monte Negro2KCSClinic for Neurosurgery and neurotraumatologyEmergency Center in Belgrade, Serbia2KCS Clinic for Urgent surgery, Belgrade, Serbia3KC 4Medical School of Nis, Srbia5Department of Maxillofacial Surgery, Medical SchoolUniversity of Nis, Serbia6KCS Center for radiology and magnetic resonanceimaging, Belgrade, SerbiaPresenting author e-mail address:[email protected]

Introduction: The zygomatic bone is laterally themost prominent bone of the face. Because of thatthis fractures are the second most common (8-20%), immediately after fractures of the nose. Themost common causes of fractures are in fights, falls,traffic accidents and sports injuries.Objective: The primary objective was to assess theincidence of fractures of zygomatico-maxillarycomplex, zygomatic bone and the the orbit floor,analysing frequency by sex and age, as well as theetiological factors and treatment choices, all inorder to make improvement of care for thesepatients.Method: In the period of 3 years, 126 patients werestudied with fracture of zygomatico-maxillarycomplex, zygomatic bone and the of the orbit floorwho were treated at the Clinic. Information ondemographic, etiologic and clinical data andradiological tests, surgical therapy andpostoperative complications data were statisticallyanalysed.Results: Injuries were more frequent among men, inthe third and fourth decade. The most commonetiology was violence, followed by traffic accidents,accidents in the home and sports. The clinicalpicture that dominated were: deformities of theface, paresthesia in the inervation zone of N.Infraorbitalis, double vision and inability to open




the mouth. The average duration of injuries tohospital admission was 2 days and of injury to theoperative treatment 4 days. The most commonsurgical approach was sub ciliary section.Zaključak: Fractures of the zygomatico-maxillarycomplex, zygomatic bone and of the orbit floor aremore common in men, occurring most often as aresult of violence. Surgical treatment is necessary inmost cases. Inadequate injuries assessment leads toinadequate treatment, which results in poorcosmetic outcome or vision problem.Key words: zygomatico-maxillary complexfractures, zygomatic bone


Cervico-mediastinal hematoma -Compression as life threatening conditionfor patientB.Olujić1, Z.Lončar1, S.Pajić1, P.Savić1, D.Jovanović1,G.Kaljević1, T.Boljević2, M.Mrvaljević1, M.Đorđević3,M.Božinović3, Z.Pešić4, I.Nikolić5, M.Jokić5

1KCS Clinic for Urgent surgery, Belgrade, Serbia2KCPodgorica, Department of Otorhinolaryngology andMaxillofacial Surgery, Monte Negro3KC Medical School of Nis, Serbia4Department of Maxillofacial Surgery, Medical SchoolUniversity of Nis, Serbia5KCS Center for radiology and magnetic resonanceimaging, Belgrade, SerbiaPresenting author e-mail address: [email protected]

Introduction: Spontaneous hematoma in the neck(cervico-mediastinal hematoma) caused by ruptureof extracapsular parathyroid gland occurs veryrarely. There is no standard approach and methodof treatment but it is the uniqueness of eachindividual case.Objective: We wanted to present this rare case ofspontaneous cervical-mediastinal hematoma, wherebleeding has occurred from a parathyroid adenoma,which is detected in absolutely healthy patientsMethod: There were 5 patients, younger age, 29-38y, two women and 3 men. All were hospitalizedwithin 2 hours after manifestation of the disease,complaining of neck pain and numbness of one sideof the neck. Indirect laryngoscopy: there is paresison one side of the vocal cords. Biochemical analysis

of blood showed an increased level of parathyroidhormone compared to normal is 12-15 timeshigher, while the value of ionized calcium increasedslightly. Symptoms of acute compression of neckorgans were seen between 5 and 7 hours afterhospitalization.Results: All patients were operated with theevacuation of hematoma where active arterialbleeding was found. Histological examinationdiscovered fragments of parathyroid adenoma inhematoma. The positive dynamics of recovery wasobserved within 12 hours from administration ofanti-inflammatory therapies and interventions.Analysis showed that the level of ionized calcium inthe blood was normal 24-hour post-surgery. Thepatient is regularly controlled and re-examined 6months after surgery and there was no disphagia,quality of voice was intact, and breathing waswithout restrictions. The level of parathyroidhormone in the blood ranged within normal levels.Conclusion: The rarity of this pathology and thevariability of treatment do not allow choosing asingle uniform medical and diagnostic protocol.Our cases show that radical correction of primaryhyperparathyroidism, the evacuation of hematomaand fibrous capsule while preserving the thyroidgland is possible in conditions of strained cervical-mediastinal hematoma with inflammation in thearea where there is a manifest bleeding.Keywords: Hyperparathyroid gland diseases;Acuteneck diseases, extracapsular parathyroidbleeding; hypercalcemia; Tumors of the parathyroidglands; paresis of the larynx




Reasons for visiting Emergency Center in thepostoperative period of patients whounderwent thyroid and parathyroid glandssurgeryB.Olujić1, Z.Lončar1, S.Pajić1, P.Savić1, D.Jovanović1,G.Kaljević1, T.Boljević2, M.Mrvaljević1, M.Đorđević3,M.Božinović3, Z.Pešić4, I.Nikolić5, M.Jokić5

1KCS Urgentna hirurgija, Beograd, Srbija2KC Podgorica,Klinika za otorinolaringologije imaksilofacijalne hirurgije, Crna Gora3KCMedicinski fakultet u Nišu, Srbija4Medicinski fakultet u Nišu,Klinika za maksilofacijalnuhirurgiju, Srbija5KCS Centar za radiologiju i magnetnu rezonancu,Beograd, SrbijaPresenting author e-mail address: [email protected]

Introduction: A review of the literature data doesnot have adequate evaluation of postoperativecomplications of patients treated within 30 daysafter surgery of the thyroid and parathyroid glands.Description of post-operative condition thatrequires evaluation of patients who have undergonethis type of surgery is missing in the literature.These questions are important because they affectthe total cost and efficiency of patient care. We willshow the number of patients who have hadproblems due to the need to contact EmergencyCenter during the first 30 postoperative days.Reasons for the evaluation at the Emergency Centervaried, but a significant number related toelectrolyte disturbances. With the exception ofpatients who underwent lobectomy, all patientsbegan with supplementation of calcium deficitpostoperatively, but the quantity, type, as well as thecompliance rate varied, and therefore this factorwas not evaluated. Magnesium levels wereperiodically tested and rarely there was a need forits supplementation because hypomagnesaemia wasnot found. However, it was quite a large number ofpatients who contacted Emergency Center forparesthesia and had normal levels of ionizedcalcium, with hypomagnesia and without detectableabnormalities in their serum calcium andmagnesium levels. Patients taking proton pumpinhibitors (PPI) in the postoperative period werestatistically more frequent visitors of Emergency

Center in comparison to those who did not take thismedicine.Objective: To describe patients who need evaluationthrough the Emergency Center within 30 days afterthyroidectomy or parathyroidectomy and theirassociated risk factors.Material and Methods: Study design, setting tasksfor the evaluation and classification of the patientpresented as retrospective study of theexaminations carried out in a tertiary institution ofadult patients aged 42-79y. Patients underwentthyroidectomy or parathyroidectomy in the periodfrom 01 January 2010 until 01. January2015. Thedocumentation is taken from the database ofmedical history of diseases of the Emergency Centerwhere KCS conducted an institutional exam. Theseare patients in the postoperative period who visitedthe clinic Emergency Surgery Emergency Center,Clinical Center of Serbia in the first 30 days aftersurgery and for this paper the data was selected andcompared with a control group of patients who hadthe same surgery and did not have the need foremergency visit. Demographic data included age,gender, body mass index (BMI). Clinical featuresare the type of operation, the use of proton pumpinhibitors (PPI) and medical comorbidities, such asdiabetes mellitus, hypertension, kidney disease andgastroesophageal reflux. We were monitoring thetime of arrival at the Emergency Center in relationto the date of the operation. Laboratory values forpotassium, ionized Ca, phosphorus, magnesium. Allanalyzes were performed using SPSS software,version 21.0.Results: The main results and measures of statisticalanalysis, were evaluated through the association ofdemographic and clinical characteristics betweenpatients who require evaluation in EmergencyCenter and those who did not. Clinicalcharacteristics were evaluated through the type ofsurgery, medical comorbidities, and use of protonpump inhibitors (PPI). We identified 263 patients,72 patients had the need to contact EmergencyCenter, including paresthesias (n = 19), earlycomplications (n = 7) and weakness (n = 5). Therewere fifteen hospitalizations for treatment ofvarious postoperative complications. A significantassociation was found between the presence ofdiabetes (P = 0.03), gastroesophageal reflux disease(P = 0.04), and current use of proton pumpinhibitors (PPI) (P = 0.03). During controls of




diabetes and gastroesophageal reflux disease as adisease, we found that patients taking proton pumpinhibitors (PPI) had 1.81 times greater opportunityto visit the Emergency Center than patients whowere not taking a PPI (P = 0.04). This correspondsto a rate of 11% reporting to Emergency Center forevaluation within the first 30 days after surgery ofthyroid or parathyroid glands and if there weremore visits we have not taken it into account.Conclusion: The causes of patients emergency visitsto emergency surgery of the Emergency Center wasthe fact that patients taking PPIs had 1.81 timeshigher chance to seek help.This paper describes therisk factors that increase the likelihood of urgentexamination within 30 days of postoperativethyroidectomy and parathyroidectomy in tertiaryinstitutions, and gave the reasons for their re-entryat the hospital and some of the medical findings onthis group of patients. This problem is more incorelation to the outcome of the applied treatments,which reduces the unexpected need for health carein the postoperative period, which is essential. Thispaper describes the reasons for the emergency re-entry to the emergency center, evaluation anddisplay of rate of occurrence of these patients in thehospital, and significant risk factors for remission inthe postoperative period.Key words: emergency admission, postoperativeperiod, tiroidectomia, parathyroidectomia, a protonpump inhibitor


Acute acalculous cholecystitisS.Mitrović, G.Živković, B.Radisavljević, R.Krstić


Introduction: Acute acalculous cholecystitisrepresents about 5-10% of all cases of acutecholecystitis. It occurs more often in hospitalizedpatients, and rarely is in ambulatory conditions.The aim is to highlight the importance of repetingfast, non-invasive diagnostic procedures in patientswith acute abdominal pain.

Methods and Materials: Observational protocol ofpatients from the Emergency medical Service Nis,discharge papers of Clinic for Surgery.Case Report: A man, 45 years old, came for acheckup in abulance emergency room on 12December 2014 due to the pain in the upperabdomen followed by nausea and vomiting. Thepatient says that he had an operation of inguinalhernia on the right side and an appendectomy onemonth ago. Problems began while on business tripon 11th December 2014, when he was admitted tothe nearest hospital Surgery Department. Afteradmission physicians started with examination,repeated laboratory tests, radiological examinations,abdominal ultrasound, and all of this were normal.He was treated with intravenous solutions,antibiotics, antispasmodics and opioid analgesics.The pain is coupled and the acute surgical diseasewas excluded. He was discharged in a good generalcondition.In our survey the abdomen on palpation is painfuland sensitive in the epigastric region, right upperquadrant and the lower right quadrant.Hematologic analysis and abdominal ultrasoundwas repeated.Hematological analyzes showed moderateleukocytosis with granulocytosis.Echo of abdomen showed distended gallbladder,slightly thickened wall. Intraluminal echogeniccontent is inhomogeneous with no signs ofcalculosis (suspected empyema). Circularly aroundthe entire gallbladder the greater amount of fluid ispresent (periholecystitis). Positive Murphy sign.The bladder is full without the urge to urinate(urinary retentio).Patient was sent to the surgery department ofclinical center Nis with Dg: Abdomen acutumwhere he was operated (Dg: Abdomen acutum.Cholecystitis acuta gangrenosa perforativa.Peryholecistitis. Peritonitis diffusa. Appendicitisacuta consecutiva.)Discussion and conclusion: Postponement ofdiagnosis in very rare acalculous cholecystitisincreases mortality rate, because it is often notrecognizing at an early stage because of the absenceof gallstones. To make diagnose of this diseasewhich has a high mortality rate, ultrasound is themethod of choice. The sensitivity for acutecholecystitis is 75%, and can be frequently repeated



because of which has a special significance in thesepatients.Keywords: acalculous cholecystitis, high mortality,non-invasive diagnostics


Case report of patient with nonspecificclinical presentation in acute myocardialinfarction (AMI)V.Lučković Mitić


Introduction: In most cases, AIM as a leadingsymptom has a severe chest pain with differentpropagation and with other symptoms attached.However, the literature says that up to 10% ofpatients at first presentation to the physician havenonspecific problems. In emergency medicine, thecontact with the patient is with limited time and ifyou do not pay attention, you can overlook the firstmajor symptoms.Case report: Patient K.N. 58y. calls EMS because ofnausea, dizziness and cold sweats. The call wasreceived as a first line of emergency and medicalteam arrives within 7 minutes after the call. Thepatient is in bed, sitting up and conscious, oriented,pale and cold sweating. He complains of dizziness,unsteadiness and nausea. On the target question:"whether he has chest pain?" - Answers "as it has ...but is not sure." We insist on answer and heconfirmes that there is pain, which is a lowerintensity. On examination we find the followingvital parameters: TA 90/60 mmHg; SF 75/min; SpO2

98%; glycemia 5,6mmol/L; TT norm. Breathing isbilateral and vesicular breathing. Above the heart,heart beating rhythmical, heart sounds are of lowerintensity, murmors are not heard. ECG is done. Onthe ECG: sinus rhythm with normal heart axis, 5-6mm ST elevation in D2, D3 and AVF; ST elevation3mm in V3-V5; ST depression in D1, aVL, V1 andV2, 2-3mm, negative T in V6. In right leads in V4there is ST elevation of 1.5 mm. The diagnosis isinfarctus Myocardii parietes infero posterioris cumVentriculi Dextri. IV line was placed, ECG

monitoring and therapy administered was Tbl. ASA300mg, 300mg Plavix Tbl, amp Clexane 0.3 IV, ampFentanyl 2 mg, Sol NaCl 0.9%. The patient wastransported seeted in ambulance chair to theDepartment of Cardiology. During transport thepatient was hemodynamically stable, withoutdeterioration.Conclusion: In this study a patient who had a clearclinical picture, but the monitoring protocol for thetreatment of patients with chest pain, rapiddiagnosis, given adequate therapy and the patientwas transferred to the Department of Cardiologywhere they performed pPCI in the first hour.Keywords: AIM, nonspecific clinical presentation.


Polytrauma-case reportV.Jančković, I.Jovanovski, D.Miletić, D.Anasonović,J.Stojiljković, M.Lilić

Department of Anesthesia, Reanimation and IntensiveCare Surgical Department of the Military Hospital in Nis,SerbiaPresenting author e-mail address:[email protected]

Introduction: Polytrauma takes 3-8% of totalnumber of injuries, but it is the leading cause ofmortality and has a significant impact on morbidity(mortality in the place of incident is from 50 to80%). The overall polytrauma patient hospitalmortality goes up to 25%. The mortality within thefirst 6 hours is 50%, in a further 24 hours 30%, and20% due to secondary damage and complications.Aim: Case raport of polytraumatized patient.Case report: Patient A.V. 30y, was admitted tomilitary medical corps. We got the information thatafter the jump from a plane regular parachuteopened but that during the next paratrooper jump(carried by a windblow) there was a collision in theair injuring both paratroopers. Patient A.V. landedwith open fracture of the right femur and medicalteam on call at the airport did primary examination.Right leg was imobilized with Kramer's splint, IVline 20G was placed, no analgesic were added, norhas volume replacement begun. At the SurgicalDepartment after 50 minutes from the event at10:50, we were announced the arrival and two




anesthetic teams awaited him in the receiving clinic.On admission the patient was conscious, orientedin time, place and persona. The skin and visiblemucous membranes were visibly pale, sweated,occasionally shouting, visibly psychomotorly upset.He gives data himfelfe, but he could not reconstructthe actual event. Head and neck were with novisible injuries, the pupils were equal, cervical collarwas placed and O2 7L/min. Thorax is with novisible injuries, respiratory sound is present. Cor:normal heart sounds, no noise. Abdomen ispainless to superficial and deep palpation. Vitalparameters-TA: immeasurable, SF 110/min; RF:20/min. Right thigh was bigger in volume. After aquick orientation, two large IV lines were placed,samples taken for complete laboratory andintensive volume replacement of crystalloid andcolloids was started. Patient was given fentanyl forpain and further diagnostics were started. MSCT ofthe whole body, color Doppler of blood vessels ofthe legs, ECG, echo of heart were done. After thediagnostic tests following dg could be set:Polytrauma, Contusio pulmonis, Contusio cordis,Contusio capitis, fracture femoris dex, Shockhaemorrhagicus. With intensive therapyhemodynamic recovery is achieved 2 hours afteradmission when the patient is brought to operatingroom so that stabilization of the fracture can bedone by placing an external fixator. 24 hours afterthe injury patient was transferred to a tertiarymedical facility - VMA, for final treatment.Conclusion: Fast and accurate assessment oftraumatized patients, rapid diagnosis, adequatefinal treatment is the key to treatingpolytraumatized patient. Chain of treatment mustnot be interrupted.Key words: polytrauma, chain care


Cardiac injury-frequently neglecteddiagnosisB.Radisavljević, D.Gostović, S.Mitrović

Emergency Medical Service Nis, SerbiaPresenting author e-mailaddress:[email protected]

Introduction: Chest injuries are of particularsignificance for their potential to compromiserespiratory and/or circulatory function. Thoracictrauma can result from blunt and penetratingmechanisms. Rescuers in the field usually payattention to the traumas of the chest wall and thelung tissue, and rarely think about cardiac injury.Aim.To point out to the importance of cardiacinjury in chest trauma.Data sources and data extraction. A retrospectiveanalysis of the literature with keywords: trauma,chest, and cardiac injury. The search is performedthrough: PubMed, Medline and electronic journalsavailable through KoBSON as well as publicationsavailable in the Faculty of Medicine in Nis Library.(PHTLS Chapter 11 Thoracic trauma).Results of data synthesis. Blunt cardiac injury oftenresults from cardiac compression due to applicationof force to the anterior chest causing the followingentities:• Cardiac contusion. Often causes abnormal heartrhythms e.g. sinus tachycardia, prematureventricular contractions, ventricular tachycardia,ventricular fibrillation and intraventricularconduction abnormalities. The contractility of theheart may be impaired, and cardiac output falls,resulting in cardiogenic shock.• Valvular rupture. Rupture of the supportingstructures of the heart valves or the valvesthemselves causes a reduction in their functionswith symptoms and signs of congestive heartfailure.• Blunt cardiac rupture. Occurs in less than 1% ofpatients with blunt chest trauma. Most of thesepatients will die at the scene from exsanguination orfatal cardiac tamponade. The surviving patients willpresent with cardiac tamponade. The increase ofpressure in the pericardium prevents the return ofvenous blood to the heart and leads to a reduction



in cardiac output. With each cardiac contractionthis condition deepens and leads to the heart'selectrical activity without a pulse. Most frequently,cardiac tamponade occurs due to stab wounds tothe heart penetrating to the cardiac chambers ormyocardial laceration. Rupture of the chamber dueto blunt chest injuries frequently causes massivebleeding. The level of suspicion of cardiactamponade should be raised to "present untilproven otherwise" when the injury occurs is withina rectangle (the cardiac box) formed by drawing ahorizontal line along the clavicles, vertical linesfrom the nipples to the costal margins, and a secondhorizontal line connecting the points of intersectionbetween the vertical lines and the costal margin.Physical signs of threatening cardiac tamponade(Beck's triad) are: remote, dull, muffled heartsounds, jugular venous distension, low bloodpressure.Assessment. Assessment of the patient with thepotential for blunt cardiac injury reveals amechanism of injury and physical signs.Management. The key management strategy iscorrect assessment that cardiac injury may haveoccurred and transmission of those data to thereceiving facillity. A high concentration of oxygen isto be administered, and IV access established alongwith fluid replacement. The patient should beconnected to the ECG monitor. If arrhythmia ispresent, standard antiarrhythmic therapy should beadministered. In pericardial tamponade, removal ofsmaller amounts of fluid from the pericardium bypericardiocentesis is an effective temporarymeasure.Conclusion. Cardiac injuries may cause seriouscomplications with fatal outcome, requires correctassessment of the mechanism of injury, urgenttreatment and rapid, monitored transport to afacility that can perform immediate surgical repairas soon as it is recognized. After a primary survey,the patient should be managed on the way tohospital. Even when there are no outer signs ofchest trauma, special care should be taken in thearea of the cardiac box because these injuries maycause fatal complications and lethal outcome.Keywords: trauma, chest, injury


Foreign body in the airway as the cause ofcardiac arrest-case reportM.Knežević1, A.Dimić2

1Emergency Medical Service Nis, Serbia2Center for anesthesia and reanimatian of Clilnical CenterNis, SerbiaPresenting author e-mail address:[email protected]

Introduction: The most common cause of cardiacarrest is previous heart diseases. Other causes ofcardiac arrest are of noncardiac etiology. Newetiological clasification is based as 5H (hypoxia,hypovolemia, hypothermia, hydrogen ion-acidosis,hyper/hypokalemia) and 5T (thrombosis-coronary,thrombosis-pulmonary, tension pneumothorax,cardiac tamponade, poisoning) causes of cardiacarrest. These causes of cardiac arrest should alwaysbe thought of and if necessary to apply the specificprocedures during cardiopulmonary resuscitationin order to correct them.Objective: Presenting the case report to emphasisethe importance of early CPR, as well as theimportance of timely eliminating causes of cardiacarrest in the prehospital level.Materials and Methods: We analyzed the medicalintervention protocols of Emergency Medicalinstitute and medical history and discharge letterfrom the Clinic for Cardiovascular diseases.Case report: Call was made from GerontologyCenter and is classified as first line of emergency,because we received the information that thepatient is unconscious. Medical team is dispachedin the first minute after the call was received, andwas on the scene in 3 minutes. We find the patientin bed unconscious, not breathing and withoutpulse ower carotid artery. The pupils are dilated,non-reactive. The skin and visible mucousmembranes are cyanotic. Heteroanamnestic datataken from ward nurse say that the patient suffersfrom heart disease and diabetes and regularly takesits medication. We also got the data that the patientcoughed during the meal, turned bluish andstopped breathing, which indicated the possiblecause of cardiac arrest. We immediately begancardiopulmonary resuscitation with chestcompressions and placed the venous line. On the




monitor of defibrillator we register asystole, andresuscitation continued according to the protocolfor asystole. While direct laryngoscopy of the oralcavity, oropharynx and hypopharynx we couldvisualize the foreign body, which was removedMagill forceps, before placing the endotrachealtube. After endotracheal intubation withendotracheal tube 8mm, we continued controlledventilation with ambu balloon. Six individual dosesof adrenaline 1 mg with intervals of five minuteswere given intravenous, followed by chestcompressions and controlled ventilation. After sixampoules of adrenaline, we got the pulse of thecarotid artery, and the monitor registered sinusrhythm. The patient has seldom spontaneousrespirations. Medical team transferd patient withthe continuous monitoring of vital functions to theClinic for Cardiovascular Diseases in Nis. Duringtransport the patient was on oxygen therapy with aflow of 10 L/minute, with assisted ventilationcontinued. During the hospital stay, thestabilization of vital parameters of the patient wasachieved. After 15 days of hospital treatment thepatient was discharged in good general condition,without neurological deficit.Conclusion: Although commonly in practice weencounter primary cardiac arrest, we should alwaysthink about the other possible causes of cardiacarrest, as in our case was the obstruction of theairway with foreign body. Accessing the patientwith acute heart failure and all diagnostic andtherapeutic procedures that we perform at thatmoment are crucial for the success of resuscitation.Keywords: cardiac arrest, cardiopulmonaryresuscitation, foreign body in the airway


Acute pulmonary edema-case reportN.Milenković, E.Miletić, D.Milijić, M.Lazarević

HC Emergency Medical Service Knjaževac, SerbiaPresenting author e-mail address: [email protected]

Introduction: Acute pulmonary edema (lat.Oedema pulmonis acuta) is a lung disease which islifethreatening and therefore presents the first lineof emergency Emergency Medical Service (EMS)

system. It is characterized by the accumulation ofextravascular fluid in the lung alveoli due toelevated pulmonary capillary wedge pressure orimpaired permeability of the alveolar-capillarymembrane of the lungs. Timely management isessential for patient with acute pulmonary edema,as well as the right choice of therapy in a given time.Case report: On 14.07.2015. (protocol No. 9592)after receiving a call at 14: 35h by an unidentifiedpersons Emergency Department medical team wasdispached to a patient M.Z. 1936y. With the firstvisual contact with the patient, I have noticed thatthe patient is sitting in a chair, is covered in sweatand has breathing difficulties. His lips were blueand he had very pronounced veins on his neck.After inspection I noted that the patient has a intensshortness of breath, coughing and expectoration ofmucous sparkling sputum, rapid shallow breathing,anxiety, central cyanosis, impaired respiratorysound to the mass inspirium diffuse cracklesaudible on both sides of the lungs to over half of thelung fields. TA 180/100. Immediately after theexamination we started with therapeuticprocedures. The patient is in a sitting positionduring transport, IV line is placed and administeredtherapy was Amp. Furosemide 20mg i.v. and Tbl.Captopril 25mg SL. ECG (sinus rhythm, left axis,HR 100/ min -T D1, aVL, without significantchanges in the ST segment), SpO2 70%, BP 170/95.Therapy continued as oxygen support using masks4 l/min., Spray glyceryl trinitrate 2 doses of 0.4 mgsl. on 5 min. intervals, ½ Amp. Morphine 20 mg i.v.Amp. Furosemide 2X20 mg. i.v. After 15-20 min.there was improvement of the patients conditionand SpO2 was 80%, BP 155/90, after which he wastransported in a sitting position to the internalmedicine ward for further observation andtreatment.Conclusion: After timely and adequate therapeuticprocedures by medical team of emergencydepartment, there has been an improvement in thehealth condition of a person with acute pulmonaryedema, after which she was hospitalized in internaldepartment for further treatment and observation.Key words: edema, prehospital treatment




Prolonged hypoglycemia-attention!R.Krstić, B.Radisavljević, S. Mitrović


Introduction: The hypoglycemic coma is the mostcommon complication of diabetes mellitus, withwhich phusicians of EMS medical team encounterdurig interventions. In most cases there is no focalneurological signs and meningeal irritation.Complete recovery of consciousness is usualy seenafter adequate therapy. Inadequate response totherapy should always arouse suspicion of otherreasons for impairment of consciousness.Aim: Case report that highlightes the importance ofa carefull approach to patients with impairedconsciousness with the prolonged hypoglycemiaand in which compensation with hypertonicglucose does not bring desired effect.Materials and methods: We analyzed the protocolof medical team interventions of EmergenczMedical Institute and history chart and dischargeletter from the Clinic for Neurosurgery.Case report: Call to EMS was made for old patient61y, due to impared level of counsciousness. Thecall is classified as a call of the second line ofurgency and the medical team was dispached in thefirst minute after call is received, and was on thescene after 10 minutes. We find the patient (largeosteomuscular structure) in bed unconscious, withspontaneous breathing and present pulse over thecarotid artery that is well filed. Pupils are mediumdilated, slowly reactive. The colour of the skin isnormal but cold and damp. Heteroanamnestic, hiswife, we got data that the patient is diabetic on oralanti-diabetics, poorly regulated, who took hismedication irregularly. We got the information thatthe patient prior to losing consciousness sweated,had nausea and that they tried to solve the problemsby sugar intake per os. They measure Gly 2 mmol/L.Vital parameters: BP 170/90mmHg; HR: 75 / min;RF 16/min; SpO2 99%; Gly 6.0 mmHg, TT 36,8C.ECG: sinus rhythm without signs of ischemia.Given that the patient long history of diabetes(poorly regulated) and that before the eventsentered by increasing the amount of sugar, the idea

was that the protracted hypoglycemia led to theslow response to the intake of sugar and providingaccess Sol. Glycosae 50% 20 + 20 + 20 ml. Aftergiven therapy partial recovery was obtained. II Gly11,0mmol/L. The patient wakes up, answerquestions, but is slow and confused. After the reply,immediately falls asleep. He denies the complaintsand refused further help. Neurological examinationwas normal. The patient was accompanied bymedical teams, and with the continuous monitoringof vital functions, transfered to the Department ofEndocrinology. During transport of the patientoxygen therapy with 4 L/minute was administered.After examination by an endocrinologist and withdeterioration of level conciousnessdisorder patientwas referred to the Department of Neurology,where CT was performed which confirmed thesuspicion of SAH.Conclusion: In the prehospital treatment, withlimited diagnostic posibilities, impairment ofconsciousness should always be considered inseveral directions, although the circumstancesclearly point to the underlying disease. Troughcareful examination we should always sought forsigns of other diseases.Key words: hypoglycemia, impaired consciousness,SAH


Differential diagnosis of chest painM.Bogdanović1, S.Radojičić2

1Emergency Medical Service of Montenegro, Montenegro2General Hospital, Cetinje, Montenegroe-mail adresa autora: [email protected]

Background: Chest pain is one of the biggestdifferential diagnostic dilemma in medicine. Inpractice, the pre-hospital settings, we often writeworking diagnosis "stenocardia, dolor praecordialis"on the basis of history. What we have as the biggestissue is precisely whether the chest pain is directlyassociated with myocardial infarction, one of theleading causes of death worldwide.Objective: To examine the incidence of stenocardiain patients with chest pain in the general populationfrom 30 to 70 years.




Methods: Descriptive data display. Data source:Dispatcher protocol, protocol of EmergencyMedical Service Podgorica, Cetinje department,medical reports.Results: During the period of 10 months we haveexamined 121 patients in EMS Cetinje, of which 28patients had AIM, 35 patients had myalgia, 58patients was with a diagnose of depression. Theincidence of AMI in the given period was 23.1%,while with myalgia there were 28.9% and withdepressive disorders 47.9%.Conclusion: We conclude that not every chest painis of cardiac origin, but considering that the AIM isone of the biggest causes of death in the world, wemust pay special attention to every patient withchest pain because of the likelihood that it is AMI.Key words: Acute myocardial infarction,stenocardia, chest pain.


Arrhythmia absolute in hypertensive crisisM.Bogdanović1, S.Radojičić2

1Emergency Medical Service Podgorica, Montenego2General hospital Cetinje, MontenegroPresenting author e-mail address:[email protected]

Background: Objective: To check the frequency ofoccurrence of the first episode of arrhythmiaabsolute in hypertensive crisis.Results: In a period of 10 months in EMS in Cetinjeand OB in Cetinje of 100 patients (48 men and 52women) with hypertensive reaction of BP> 180/120mmHg there were de novo absolute arrhythmia in80 patients (36 men and 44 women).Conclusion: Arrhythmia absolute occurs in a highpercentage as a manifestation of hypertensive crisisand can be explained by the high percentage ofuntreated hypertension in our population.Key words: arterial hypertension, arrhythmiaabsolute, hypertensive crisis.


Early defibrillation key to a successful CPR –A case reportJ.Arnautović, A.Stankov


Introduction: The most common cause of acutecardiac arrest, according to statistics up to 80% isthe fibrillation that occurs with acute coronaryevent. DC shock is an integral part ofcardiopulmonary resuscitation (CPR) and outcomeof CPR depends on of timely and adequateimplementation of defibrillation. Earlydefibrillation is critical to the survival of suddencardiac death, and the probability of successfuldefibrillation decreases rapidly with time.Objective: Case report will highlight the importanceof early CPR, which is the first measure of earlydefibrillation.Materials and Methods: We analyzed the medicalteam intervention protocols of Emergency MedicalService and medical charts and discharge lettersfrom the Cardiovascular Clinic.Case report: The patient calls EMS because of chestpain that lasts about 30 minutes. The pain wasnoticed after a quarrel with his son. The patient inthe course of the conversation shows thenervousness and agitation. Call was received assecond line of emergency and medical team wasdispatched in the first minute of a call was receivedand come to the patient after 5 minutes. Police teamis present at the patient's home because of previousconflict in which there was no physical contact. Thepatient M.P. 74 y, was found in bed, conscious,oriented, huffy and irritable, newly diagnosed assuffering from hypertension. Wife, who is presentat the scene, is convinced that he simulatesproblems. The patient was pale and sweating andhas never had such pain earlier. Vital parameters:BP 150/100 mmHg; HR 100/min; RR 16/min; SpO298%, Gly 5,8mmol/l, TT normal. On the ECG: sinusrhythm, bigeminy, downward depression D2, D3and aVF, ST elevation V1-V4 of 1-2mm. IV linewas placed, monitoring and Therapy: AmpFentanyl 2 ml IV; Amp Clexane 30 mg IV; Aspirin



Tablets 300mg PO; Plavix 300mg tablets; PO; AmpRanitidine IV; O2 - 4 L/min. During thetransportation on the monitor frequentpolymorphic VES (bigeminy) are still present.Rhythm disorder with VF occurs approximately 30minutes from the first contact with the patient. DCThe first shock was given with the 200J, after whichwe started chest compressions, as VF continued, wedelivered and second DC shock 300J after which thepatient starts to breathe spontaneously and openshis eyes. It is slightly confused in answers. Wecontinued monitoring of vital signs and transferredpatient to the Clinic for Cardiovascular Diseases inNis. In receiving outpatient Clinic for Cardiologypatient again had FV and was defibrillated bycardiologists 2X200 J. The patient undergone pPCI,with stent placed in the LAD that in the next fewhours acutely occludes. The patient is givenBrilique. He is discharged home after 6 days ofhospitalization in a good general condition.Conclusion: Early defibrillation will only take effectwhen and if timely and adequately performed. Itmust be an integral part of the chain of survival.EMS or measures of ALS (advance life support) arepart of the chain which in this case proved to be agood and solid link.Key words: cardiac arrest, cardiopulmonaryresuscitation, early defibrillation.


Geriatric traumaT.Mićić,T.Rajković, I.Ilić

Emergency Medical Service Nis, SerbiaPresenting author e-mail address: [email protected]

Introduction: Advances in medicine during the lastseveral decades have resulted in a significantincrease in the percentage of the population over 65years of age. The changes that occur during agingare reflected in a different response in trauma.Data source: We considered more than 1250Medline Geriatric Trauma publications andguidelines and Prehospital Trauma Life Supportrecommandations published between Jan 2008-Sep2015. References were selected following the level ofevidence.

Synthesis of reviews: During ageing, normalphysiologic changes occur and people may havedifferent medical problems. The most importantchanges in respiratory system are lower efficiencycaused by anatomy changes of thorax and spine andreduction in alveolar surface area. The results ofage-related changes in cardiovascular system areatherosclerosis, hypertension, myocardialhypertrophy, dysrhythmias etc. Cardiac outputdecreases and cannot meet the demands ofincreased myocardial oxygen consumption intrauma. Also, elderly patients usually takemedications which may change their response intrauma. Biologic aging of the brain leads to poorcerebral function. Also, vision and hearingdifficulties may play independent role in injuringand also cause difficulties in communication andaccess to an elderly trauma patient. Because ofpresence of some conditions or illnesses, such asdiabetes, or chronic pain syndroms elderly personsmay have increased or decreased tolerance to pain.Musculoskeletal system changes includeosteoporosis, coupled with reduced muscle strengthand it can result in multiple fractures with onlymild or moderate force. Elderly patients are moreprone to hypothermia and infection than theyounger ones. All this age-determined changescause a need to modify the access and managementof elderly trauma patients.Conclusion: Assessment and management of theelderly trauma patients have some specificities.Numerous medical conditions may predisposeindividuals to traumatic events and also changetheir response to trauma. Vital signs are a poorindicator in the elderly patients’s state. Early controlof airway, ventilation and hemorrhage, adequateimmobilization and rapid transport are the essentialtasks in geriatric trauma management.Key words: geriatric, trauma, erderly.





The activation patterns of emergencymedical services during out-of-hodpitalcardiac arrestand decision to resuscitate -EURECA ONE study 2014D.Milenković, T.Rajković, S.Ignjatijević, S.Mitrović,V.Anđelković, M. Stojanović


The A activation patterns of emergency medicicalservices during out of hospital cardiac arrest anddecision to resuscitate - EURECA ONE study 2014Introduction: Cardiac arrest represents one finalcascade of adverse events during manyemergencies, often in the prehospital settings.Institute for Emergency Medical Care Niš enroledinternational EuReCa ONE study with the aim tofollow up and investigate the problem of out-of-hospital cardiac arrest (OHCA). AIM: The aim ofthis study was to evaluate the activation patterns ofemergency medical service from dispatch call todecision to resuscitate.Method: The occurrence and treatment of OHCAduring the period 01. October 2014. - 31. October2014. in the city of Niš using the expanded studyprotocol based on Utstein style reporting.RESULTS: The average trigger time for all calls was3 minutes 5 seconds, 13 seconds for 1st, 1 minute 56seconds for 2nd, 12 minutes 14 seconds for 3rd and10 minutes 50 seconds for 4th priority of emergencycalls (p<0.05). When receiving calls, a level ofconsciousness was possible to specify in 88.9% ofcases, while the presence/absence of respirationswas determined in 28.6% of cases (p<0.001). Usingmultivariate analysis of parameters which mayaffect the use of CPR measures in OHCA, priorityorder of emergency calls (p<0.001), information ontime of respiration cessation (p<0.001), the initialrhythm on the defibrillator monitor (p<0.05),information about serious illness (p<0.05) and thetime from departure to arrival at the scene (p <0.001) were identified as important factors.Concusion: The trigger time for 1st order ofemergency calls is impressive. Emergency callstriage targeted level of consciousness as the main

benchmark during the brief interview, withinsufficient data about the quality of breathing.CPR measures were not initiated in all cases withconfirmed OHCA. Cases that are triaged to thehighest priority of urgency calls, with informationabout the short time of the breathing cessation, withthe initial schockable rhythm, with no bystanderinformation about serious illness and with shortertime from departure to arrival of the EMS team atthe scene, had a significantly greater chance of CPRmeasures to be initiated.


A Case report of the trauma patienttreatmentM.Janković, S.Gopić, T.Masoničić, Lj. Cvetković

Emergency Medical Service Niš, SerbiaPresenting author e-mail address:[email protected]

Background: Trauma is the leading cause of deathamong people aged 1- 44 y. and over 70% of alldeaths are people between 15 and 24 years old. Thetrauma is on the high eight place as a cause of deathamong elderly. Successful treatment of traumatizedperson, not only saves the patient's life, but alsoreduces the high level of disability. The quality ofthe pre-hospital care depends on the: trained team,good cooperation with other rescue services, qualitytreatment and adequate transport of the patient tocontinue to definitive care in the hospital setting.Objective: To present a patient who was treatedtimely and efficiently by emergency medicalservices and fire services. He was medicaly treatedon the field and transported to the emergencyroom.Material and Methods: Descriptive representationof the patient from the available documentation:medical protocol, protocol book, discharge letterfrom the hospital.Case report: EMS was called for a patient who,according to eyewitness, fell into the riverbed. Thedoctor at the dispatch center tried to get moreinformation but the people who called wereaggressive and appeared to be intoxicated byalcohol. The emergency crew was sent to the sceneas a first line of emergency. Fire department also



immediately responded after the call. The crewarrived on the scene after 12 min (15km distancefrom the city). At the scene of an EMS team foundthe patient who was located in the riverbed, lyingon his back, between two rocks, conscious butconfused, with visible head wound that wasbleeding profusely. The patient accidentally fellfrom a height of about 3m. There is no data on thefall. Due to the inaccessible terrain to the patientmedical nurse first arrives and starts primarytrauma examination by the system ABCDE. Injuryof the head is in the middle of the forehead, star-shaped with a diameter of about 5cm, and wasbleeding profusely. Swelling of the both lids of theleft eye is present. Bleeding was stopped by digitalcompression, airway was intact, breathingbilaterally. Abdomen, pelvis and femur are painless.The cervical collar was placed, venous access wasobtained and NaCl 0,9% administered. Patient wasplaced on board but as there were no safety straps,stability was maintained with improvisation.Extraction of the injured was performed using 4firefighter and EMS driver. The patient was all thetime held by the nurses due to the influence ofalcohol and inadequately responding to thesituation. Because of difficult field extraction of thepatient lasted 1h 05min. During transportsecondary trauma examination was performed by adoctor of EMS. During transport to NeurosurgeryClinic patient was hemodynamically stable, withoutdeterioration.Conclusion: Teamwork in the care of traumatizedpersons is one of the basic elements for the successand effectiveness of the EMS team. The educationand organization of each team member is ofparticular importance. The nurse, when highlyeducated and well prepared for this kind of activity,can in large part take responsibility in dealing withthe traumatized person. Cooperation with otheragencies involved in the care of injured patients isessential and requires joint trainings.Key words: trauma, the role of medical nurses.


Polytrauma – A case reportD.Stefanović, D.Janković, T.Rajković

Emergency Medical Service Niš, SerbiaPresenting author e-mail address: [email protected]

Introduction: Topic is case report of the patientwho is treated pre-hospitaly and who had beeninjured in unusual circumstances.Objective: To describe a patient case where themechanism of injury and the clinical presentationindicates a potentially life-threatening condition.Point out the necessity of a proper pre-hospitaltreatment of the patient as well as the need foradditional diagnostic procedures.Material and Methods: An insight into the medicaldocumentation of the Emergency Medical ServiceNis, protocol book for medical intervention and themedical reports from the field. Insight into themedical documentation from the EmergencyCenter, Clinic of Neurosurgery and Institute ofRadiology, Clinical Center Nis and the Clinic formaxillofacial surgery.Case report: 28.06.2014. at 21:35h the call was madeto 194 by patients neighbor. He described that theolder man is stuck in an elevator, which is locatedbetween floors. He suspected that he wasunconscious and knew that he suffers fromdiabetes. The call was marked as second level ofurgency. Dispatch of Institute for Institute forEmergency Medicine sent a medical team to thescene at 21: 37h. Patient Đ.D. 77 y, was caught in asmall elevator that has stopped between floors. Thepatient was not available for review because he wasblocked by shelf which he tried to put in theelevator. Hairy part of the head could be visualizedand right arm, which had some movements. Thepatient was suspended from the floor of elevator atabout 20 cm and hanged in the air. He did notanswer to calls. With the help of firefighters andmaintenance services for elevators, patient wasextracted with maintaining manual stabilization ofthe cervical spine and placed on the stretcher. Thepatient was unconscious and after his placing in ahorizontal position regains consciousness andbegan to vomit. Breathing is adequate on both sides.Vital parameters were within normal limits BP:




120/80 mmHg, HR 80/min, RR: 10-14/min, Gly:13.9 mmol /L. General examination of body showsno tenderness of the abdomen, pelvis andextremities. Due to the mechanism of injury andthe clinical presentation, patient was assessed ascritical and transported to the Emergency Center,Clinical Center Nis. During transport treatment ofthe patient was continued, IV line was placed andsolution of NaCl 0.9%, 500ml was administered, 02

12l / min with maintaining manual stabilization ofthe cervical spine. Referral diagnosis posed doubtson possible contusion injuries of the neck, chest andabdomen. Upon arrival at the emergency centerfurther diagnostics were ordered and consultativeexaminations of specialist at clinic for neurosurgeryand maxillofacial surgery. MSCT of endocranium,cervical spine, chest and abdomen showed notraumatic lesions. After the consultativeexaminations, the patient was given advice foranalgesic therapy and AT protection, after which hewas sent to home treatment.Conclusion: Trough medical records of the patientit is possible to follow sequence of events fromcitizens calls on the phone 194, medical teamactivation of the Institute for Emergency MedicineNis, the course of the interventions and patientmanagement in the field who has been assessed ascritical, and treated under that principles, and afterarrival of the patient to hospital setting to haveinsight into the performed diagnostic tests andtherapeutic recommendations.Keywords: trauma, mechanism of injury, diagnosis


Moral and ethical issues regarding CPRA.Nikolić, D.Janković


Introduction: In the entire medical practice there isno more exciting and more dramatic situation thanwhen a medical professional finds itself with apatient who has a sudden deterioration of vitalfunctions.

Objective: This paper presents moral and ethicalproblems that we encounter prior, during and aftercardiopulmonary resuscitation.Data source: Search materials from web browserCobson, PubMed; written literature of domesticand foreign professional publications.Data choice: trough key words and relevanceData synthesis and discussion: In past times, littlecould be done to extend human life. The power oftoday's medicine to postpone death has generateddifficult moral and ethical questions. The decisionof when to start, when to stop or abandon startedcardiopulmonal resuscitation is an importantproblem of medical professionals, patients, familymembers and lawyers. In contemporary society,marked by pluralism of supervision operations,where it is not always clear what is good and what isnot, it is not easy to be a nurse/technician and be atthe service of health and life. The autonomy ofconscience and the decision of the patient arerightly emphasized.Conclusion: It is important to note that the goal ofCPR is not to prolong life when there is no hope forhealing and good quality of life. Recovery is a goalwith restoring dignified life and not just vegetating.Key words: ethics, morality, cardiopulmonalresuscitation


Ulcus cruris - treatment of open wounds witha fibrin membraneD.Trajković


Introduction: Ulcus cruris venosum is an openwound caused by poor circulation in the veins,localized in the lower legs. There is an increasingnumber of patients with this problem in Serbia andworldwide. The main problem in the past treatmentof lower leg ulcers was reflected in the way oftreatment and especially in the period of recoverythat is required from the patient as well as hugeengagement by family members.



Objective: To show the benefits of treatment openwounds of lower leg ulcers with fibrin membranecompared to the previous, conventional methods.Materials and Methods: Retrospective analysis ofthe literature with key words: ulcus cruris, fibrinmembranes, treatment.Data source and selection of materials: Searching isdone through: PubMed, Medline and electronicjournals available via Kobson as well as literatureavailable in the Library of the Faculty of MedicineNis .The results of the synthesis: In Serbia this problemexists, according to some statistics, in around 2.5-3% of the population. Women suffer more oftenthan men. The most common age is between 40-45y, and in the working age population. Over 30% ofpatients with chronic venous ulcers are treated formore than 20 years and about 10% for more than 30years. Venous ulcers of the lower leg makes upbetween 57% and 80% of all chronic ulcerations inSerbia. Dermatologists and vascular surgeonsrecommend medicament treatment or surgicaltreatment of ulcerations, where they insist on thereconstruction of veins and valves, valvuloplastic(Guidelines for the treatment of chronic venousinsufficiency). The common approach to heal thewounds of lower leg ulcers (conventional approach)included treatment with powder boric acid, with thebasic aim to create the acidic environment with thegoal of healing of wounds. This method is painfuland uncomfortable for the patient and it has longrecovery period, with a regular toilet wounds,bandaging with a smaller percentage of success inthe final healing. The use of fibrin membranes inthe treatment of wounds is much more comfortablefor the patient with a significantly higherpercentage of success in fully healing of openwounds. Fibrin membrane is prepared from theblood of the patient, who has problems with ulcers.Blood samples that are taken are treated troughspecial procedure by which the end product isobtained as a fibrin membranes enriched withplatelets and growth factors and a smaller numberof stem cells. Formed fibrin membrane is placed onthe cleaned wound, which is not under aninflammatory process. The membrane remains onthe wound for 5-10 days, after which it continueswith wound bandaging, without antibiotics,povidone-iodine or rivanol in the next few days.The recovery period and healing begins on the fifth

day of application of the membrane. In the next twomonths the treatment can be repeated if necessary.Complete healing, depends on the size of woundsand it is expected in the next two months. The totalperiod of wound healing should not take longerthan the 4 months. This method of treatment ofopen wounds is more comfortable for the patient ascompared to the conventional.Conclusion: Treating of open wounds can be verytroublesome and complicated and so far it is mostlydifficult and took a long time and was usuallyunsuccessfully. Treating ulcers with fibrinmembrane may represent a new more successfuland less expensive way in the treatment of thesechronic wounds.Key words: ulcer cruris, fibrin membranes,treatment


Acute abdomen-prehospital careM. Nikolić


Introduction: Abdominal pain is one of the mostcommon reasons why a medical emergency teamsare called, both in the field and at the outpatientclinic, or in observational room. According to ourstatistics, the percentage varies from 20-45%depending on the period of the year.Objective: To show the importance of knowing thedefinition, etiology, the basic characteristics of acuteabdomen, recognition, approach and the role of thenurses in the care of patients with abdominal painand suspected acute abdomen.Materials and Methods: Retrospective analysis ofthe literature with the key words: chest pain, acuteabdomen, pre-hospital treatment, the role of thenurses/technician.Data source and selection of materials: Search isdone through: PubMed, Medline and electronicjournals available via Kobson as well as literatureavailable in the Library of the Faculty of Medicinein Nis.Results synthesis: The term acute abdomen consistsof various clinical entities. It includes all those




pathological conditions in the abdominal cavitywhich, due to their clinical presentation, severity ofa pathological substrate and progressive evolution,require immediate hospitalization, appropriateprocedures for resuscitation and intensive therapy.It must be noted that the set diagnosis of acuteabdomen is the result of present and temporarydiagnostic insufficiency. While there are a numberof definitions that determine the term acuteabdomen, we could accept one definition by whichthis term covers three main syndromes: syndromeperitonitis, intestinal obstruction syndrome,syndrome of intra-abdominal bleeding. The patientwith developed clinical picture of acute abdomen ishard movable or completely motionless, exhausted,without appetite, bent at the waist, and with one orboth hands holding his stomach. When lying down,the patient holds the legs bent at the knees and hips(takes antalgic position). He is pale, frightened, witha coated tongue, rapid and filiform pulse, rapidbreathing, sub-febrile or febrile, with pronouncedabdominal face (facies abdominalis Hypoccrati).Only in biliary peritonitis, and due to the inhibitoryeffect of resorbed bile salts on myocardialconduction system, bradycardia can be seen. Palesclera may indicate intra-abdominal bleeding, whilesub-icterus of the sclera may be a sign of biliaryperitonitis. Livid spots on the trunk may indicate amesenteric thrombosis, acute hemorrhagic-necroticpancreatitis, but can be found in the terminal(irreversible) states of peripheral circulatorycollapse. Visible abdominal bloating in the supineposition usually indicates intestinal occlusion(ileus), but can also be a sign of acute intra-abdominal hemorrhage or the presence of otherfree fluid in the abdomen (ascites). Leading(dominant) local character in acute abdomen is -abdominal pain. The clinical picture of acuteabdomen should always distinguish two maingroups according to symptoms and clinical signs:general signs and symptoms, local symptoms andsigns. Adequate diagnose can be set based on thegood judgment of the clinical condition andvulnerability of the patient, patients history andclinical examination. The available diagnosticmethods in observation EMS Nis are: EHOabdomen; LAB analysis: (blood tests, Le formula,HCT). The therapeutic method (compensation ofcirculatory volume) and symptomatic therapy

without coupling of PAIN! and emergencytransport to the Clinic for Surgery.Conclusion: Adequate an initial approach to thepatient with acute abdominal pain increases thepercentage of positive outcomes afterhospitalization and surgical treatment. Since theacute abdomen develops diversely, depends uponthe cause, medical nurse/technician should be wellfamiliar with the basic symptoms, which wouldcontribute to the proper approach to the pre-hospital care.Keywords: pain, acute abdomen, prehospitalapproach


Development of the emergency medicaldispatch center in the worldT.Masoničić, S.Gopić, M.Janković


Introduction: Dispatching emergency medicalcenter is a professional Telecommunicator, with thetask of collecting information related to emergencymedical care, assistance and voice instructionbefore the arrival of emergency medical services,sending and supporting EMS teams. To perform thework of dispatchers in the majority of countriesrequires having a certain certificate, level ofeducation and professional designation, which isacquired through education at the nationaldispatching academies and other education.Objective: To show the development of theemergency medical dispatch center in the world.Materials and Methods: Retrospective analysis ofthe literature with key wards: the development ofdispatching, emergency medical services.A new era of development dispatch center beganthe 1950's when the use of radio communicationstarted to be used all over the USA and Canada. Inthe beginning, the dispatch center was formeddepending on the institutions that were involved inproviding assistance. It used to be the city, firedepartment or hospital. In a number of cases withindependent emergency medical service dispatcher



would be a family member of the owner and hisqualifications did not require additional educationbesides knowing the street and the local geographicsituation. Unique number was introduced inCanada in 1959 and in 1967 in the United States,but the coverage of the entire territory lasted until2008. Currently a unique number does not cover4% of the territory of the United States. By calling asingle number, call is made to the fire departmentand the police and it became known as the Public-safety answering point (PSAP). The technology isstill developing and at one point introduced 'closedlock' the phone line, which prevents accidentallyinterrupting the emergency call, as well asAutomatic Number Identification / AutomaticLocation Identification (ANI / ALI), which allowsthe dispatcher to check the number of (preventingfalse call), and identifies the location from whichcall is made. Principle - to send the closest medicalteam to a patient who has a life threateningcondition. This process has caused the need fordevelopment of protocols for triage of patients. Thefirst such triage protocol appeared in 1975, theFenix. Since then, they have developed a MedicalPriority Dispatch System (MPDS), APCO (EMD)and PowerPhone's Total Response Computer AidedCall Handling (CACH) system. The first systemswere initially quite simple. Development of a systemin which information to the medical team comesprior to arriving at the scene and continues further,and other medical teams called for the first line ofemergency can arrive in the best of cases within thefirst 8 minutes of the call. Well educated dispatcherunlike team can provide guidance in the firstseconds of the call. It was developed Dispatch LifeSupport.Conclusion: The development of dispatchingsystems largely depends on the development ofelectronic devices. The need to more adequatelyrespond to the needs of patients has influenced thedevelopment of dispatching centers. Knowledge ofhow dispatcher systems function in the world willaffect the decisions in which direction to go in thedevelopment of dispatching centers in our country.Keywords: dispatching center, development


Febrile convulsions – a case reportLj. Cvetković, I. Ilić, S. Gopić, M. Janković, T. Masoničić


Introduction: Seizures are most often tonic-cloniccontraction of skeletal muscles, but can also occuras loss of muscle tone, as well as sensory outbursts(paresthesia, pain), vegetative (vomiting, sweating,salivation) or in the form of of the absences. Theymost commonly occur with higher bodytemperatures but may occur in drop oftemperature. There is often a family history in thesepatients. It occurs in children age 6 months to 6years and more among the boys. Repeated seizuresappear in 20% to 30%.Objective: To present a child with generalizedfebrile seizures, which then changed to partialseizures while maintaining consciousness of thechild and the role of nurse.Materials and methods: Descriptive representationof the patient from the available documentation:medical protocol, protocol book, discharge letterfrom the hospital.Case report: In the late afternoon, father andgrandmother brought boy aged 4.5 years. At firstcontact we saw that the child is unconscious withthe presence of tonic clonic spasms of the wholebody. Its appearance is appropriate and looksnormally fed. Gaze fixed to the left. Skin wasslightly cyanotic, there was no foam at the mouth.We obtained the data that the same thing happenedearlier in the boy's third year, and that too was withhigh fever. Now they have not noticed that he has afever, all they saw that he fell. In such a state he wasfor more than ten minutes. We begin with a quickoverview: we registered elevated TT, respiratoryinfection, and started therapy: Supp Eferalgan150mg, Supp Diazepam 2mg, secured IV line (22Gcannula). Oxygen-therapy 6L/min. During the nextten minutes, generalized seizures stopped butpartial seizures on the left side of the body remainedand the child was conscious and responding toquestions. The child was then transported to thehospital accompanied with the medical team.




Discussion: Febrile seizures represent a medicalemergency that parents find extremely frightening.They can also upset an uneducated andinexperienced medical staff and lead to a superficialand inadequate response. The nurse must know aseries of procedures and their role is of the greatestimportance. Procedures that are expected of nurseto perform are: measurement of body temperature(rectal - in most cases), to prepare the child forexamination, to assist in the examination, to placethe IV line, administer oxygen-therapy, airwaymanagement, application of the drug, and infusiontherapy.Conclusion: The role of nurses in the care of a childwith seizures is of the most significant importance.Their reactions have to be quick, quiet andadequate. Their behavior sends a message toparents that in an unprecedented fear that theirchild will be all right. Teamwork as well as othermanagement of severe condition has the advantage.Key words: febrile seizures, the role of nurses


Telephone assisted cardiopulmonaryresuscitationM. Mitrović


Background: Out of hospital cardiac arrest is amajor health problem in most developed countries.Despite national and international guidelines forcardiopulmonary resuscitation (CPR) overallsurvival of patients with primary out of hospitalcardiac arrest (OHCA) is 7.6% and is unchanged inthe last thirty years. Most AHCA happens in thepresence of witnesses, and only one of the fiveeyewitnesses began resuscitation. Telephoneassisted CPR (TA-CPR) has proven to be aneffective measure to increase survival rates in casesof OHCA. In the United States in 200000 of 300000cases OHCA eyewitness do not start CPR.Implementation of A-CPR has the potential to savethousands of lives each year.Objective: Review and analysis of phone guidedCPR methods.

Methods and Materials: Database BioMed Central,PubMed, Kobson.Results and discussion: TA-CPR is defined as a setof instructions that the emergency dispatcherprovides trough phone call in order to increase thepossibility that an eyewitness starts CPR. EMSDispatcher should be trained to recognize cardiacarrest and give concrete and clear guidelines fromthe basic life support. The preferred strategy forprimary cardiac arrest resuscitation is chestcompressions only. The recommendations alsoinclude cases of foreign body airway obstruction.There are two types of protocols: for adults andchildren. The basic preconditions for makingrecommendations are: Short messages containingkeywords; Easily understood and spoken in plainlanguage; Feasible actions by the lay person indifficult conditions; Poster presentation containingthe steps that are easy to follow, with emphasis onkey activities.Conclusion: The first problem that contributes tothe low survival rate in OHCA is the unwillingnessof eyewitnesses to start resuscitation. Telephonesupport to eyewitness of cardiac arrest bydispatchers increases the possibility of the survivalof these patients. The development of a singleprotocol for the TA-CPR at the level of allemergency services, is the first step towardsachieving greater survival in OHCA, and includesthe process of preparing a document withrecommendations and instructions for TA-CPR aswell as their presentation in the form of posters,banners and billboards, as well as with good mediacoverage.Key words: telephone assisted CPR, dispatcher,protocols




Dispather education in emergency medicalservices in the world and in our countryS. Gopić


Background: In the system of emergency medicalservices (EMS) in our country, depending on theorganization, there are mainly physicians (inEmergency Medical Services), and nurses /technicians in services that cover a smaller areas. Inour country there is no formal education for thisjob position. It is often a case that this job is doneby workers who have extensive experience in thefield, knowledge of chronic patients andgeographical area. Often these workers, because ofchronic illness are unable to be part of the medicalteam in ambulance, and their work as dispatcher istraditionally considered a good solution. However,the rapid development of technology, changes inthe mode of communication, the need for theintroduction of the protocol as well as higherexpectations of the population, point to the need forestablishing a clear standings on the education ofthis profile in health care.Objective: To show the need to introduce formaleducation for work dispatcher working position inEMS.Materials and Methods: Retrospective analysis ofthe literature with settings: dispatcher training.Data source and selection of materials. Search isdone through: PubMed, Medline and electronicjournals available via KoBSON.Results synthesis: Official training for dispatchers inthe world exists through certain courses thatcontribute to the safe and efficient performance ofdispatchers in the Emergency Medical System(EMS). Guidelines for basic content of these coursesin the USA, are standardized trough theorganization of the American Society for Testingand Materials (ASTM). These guidelines providetargets for further training and certification ofdispatchers education. In the context of this broadgoal, ASTM training is generally at least 24 hoursi.e. total (three times, 8 hours a day). A typical

course consists of a display of dispatching objectivesand mastering the basic techniques as well asdirecting training to known problem areas. The roleof the dispatcher is defined, and concepts ofmedical action are discussed in detail. The protocolfor sending medical teams to the scene is usuallyintroduced by owner EMS agencies. For dispatchercandidates is insisted on testing their abilities tocomply with protocol, as well as their ability toprovide guidance to the caller until the team arrives.The course analyzes the common health problems,with an emphasis on examining the specifics foreach type of problem. It is insisted on accepting theimportance of providing adequate instructions tocallers in emergency situations until the arrival ofthe team. During the training, it is important thatthe student identifies the presence or absence ofsymptoms (such as "chest pain"). Suspicion of sucha diagnosis without these questions does not makeany sense. The medical significance of the differentlevels of urgency for each leading complain give thestudent the ability to quickly determine the priorityof different types of emergencies faced by thedispatching service. Often, courses use simulationtasks so that the dispatcher could have a real senseof the protocol characteristics. The training endswith formal examination and practical exam ofunderstanding and assimilation of the curriculum.This allows for a formal certification.Conclusion: It is recommended that training shouldbe conducted for all medical dispatchers, that thebasic content of the curriculum should not change,and should be formed at the national level. Theservices must be selected by the medical director ofthe agency.Keywords: dispatcher, education, receiving calls.


Acute poisoning in childrenV .Cvetanović


Background: The incidence of poisoning in childrenis 450/100.000, most common in children younger




than 6y, slightly more girls and 11% of childrenwith poisoning requires medical treatment.Fortunately deaths from poisoning is small -0,005%. Acute poisoning occurs as a brief, instantand often one-time intake of large amounts oftoxins in the body trough - eating, drinking andinhalation or through the skin. They represent amedical emergency even when the first symptomsare mild require observation and careful approach.Objective: To show the importance of thedispatcher as the first link in the moment ofreceiving a call in cases of poisoning in children.Data source and selection of materials. Search isdone through: PubMed, Medline and electronicmagazines available via KoBSON.Results synthesis: The largest number of poisoningsoccurs in the home or environment in which thechild is most often present. This actually shows thatthe main cause for these events are parents andcaregivers, or people who guard them and oftenthey are grandparents. This fact explains theavailability of a wide range of different drugs,primarily for cardiovascular disease to children.The role of the doctor or nurse/technician at the callreceiving position is to ask targeted questionsrelated to the appearance and behavior of the child,to detect a potential source of poisoning, to give thesolution for the given situation (to lay person andall other categories of health workers), to sendimmediately a trained medical team and if it ispossible with pediatrician. A doctor receiving callmust instruct the caller to three basic things: if thechild is unconscious not to give anything by mouth,to try to determine whether there is a suspicioussubstance (which they should preserve and bring

with them), and if the contact of toxic substanceswas through the skin, to rinse with plenty of wateruntil the arrival of the team. The calm voice andclear instructions to caller is recommended for allcalls and especially for this situation. During theintervention of EMS medical team and if toxicsubstance is known, dispatcher can save time bycalling the institution dealing with poisoning (inSerbia, it is the National Center for poisoningVMA), in order to get closer directions on thecause, symptoms and initial treatment and transferthat information through radio communication. Indispatcher receives information on the cessation ofbreathing, he can start instructing the caller tobegin cardiopulmonary resuscitation procedures.Conclusion: The dispatcher is the first link indealing with emergencies. Acute poisoning inchildren are potentially life-threatening condition,parents and other persons presenting their fearfurther burden our work. Dispatcher, as a first link,with adequate initial response enables qualitymanagement of a poisoned child.Key words: children, poisoning, call receiving.



Prvi međunarodni kongresDruštva lekara urgentne medicine Srbije

Zbornik sažetaka




Legenda: doktor

medicinska sestra/zdravstveni tehničar

Broj apstrakta: 001Tip apstrakta: poster

Osnovni principi primene kiseonika u hitnimstanjimaS.Trpković1, A.Pavlović1, N.Videnović1, R.Zdravković1,O.Marinković2, A.Sekulić2

1Medicinski fakultet Priština, Kosovska Mitrovica, Srbija2KBC "Bežanijska kosa, Beograd, Srbijae-mail adresa autora: [email protected]

Kiseonik je najčešće primenjivan lek u hitnimstanjima kod životno-ugroženih bolesnika i koristega lekari i medicinske sestre/tehničari gotovo svihspecijalnosti. Svrha ovog članka je da upoznamedicinsko osoblje sa aktuelnim smernicama zaprimenu oksigenoterapije koje je objavilo BritanskoTorakalno Udruženje (BTS) u oktobru 2008. Zaprimenu oksigenoterapije neohodno je obezbeditiizvor kiseonika (to su najčešće boce sa kiseonikom),sistem za isporuku kiseonika (nazalni kateter ilirazličite vrste maski), rotametar (flow-metar) iovlaživač. Sistemi za primenu oksigenoterapije, uzavisnosti od koncentracije kiseonika koju aplikuju,mogu se podeliti na sisteme za isporuku niske,srednje i visoke koncentracije kiseonika. Sistemi zaisporuku niske koncentracije kiseonika su: nazalnikateter (protok 1-6 L/min; isporuka 24%-45%kiseonika) i jednostavna (standardna) maska za lice(minimalni protok >5 L/min, isporuka 35-40%kiseonika). Sistemi za isporuku srednjekoncentracije kiseonika su: Venturi maska (protok2-15 L/min; isporuka 24-50% kiseonika) i maska sarezervoarom bez nepovratnih ventila (protok 6-10L/min, isporuka 35-60% kiseonika). Za isporukuvisoke koncentracije kiseonika (do 95%) koristimomasku sa rezervoarom i nepovratnim ventilima(maska bez rebritinga), kiseonički šator, „jet“ventilaciju itd. Kod životno-ugroženih bolesnika(akutni zastoj srca, trauma, anafilaksa, masivnakrvarenja u plućima, sepsa, šok, konvulzije,hipotermija) treba primeniti visoke koncentracije

kiseonika do normalizacije vitalnih znakova a zatimsmanjiti isporuku kiseonika tako da ciljna vrednostSaO2 bude 94-98%. Ukoliko bolesnik ne diše trebaga ventilirati samoširećim Ambu balonom a ako jedisanje prisutno kiseonik treba primeniti pomoćumaske bez rebritinga sa protokom od 15 L/min.Kod bolesnika sa težim oboljenjima koji suhipoksični (akutna hipoksemija ili centralnacijanoza nepoznatog uzroka, pogoršanje plućnefibroze ili drugih intersticijalnih bolesti pluća,akutno pogoršanje bronhijalne astme, akutnasrčana slabost, pneumonija, karcinom pluća,postoperativna dispneja, plućna embolija, pleuralniizliv, pneumotoraks, teška anemija itd.), kod kojihje SaO2<85%, treba primeniti visoke koncentracijekiseonika do normalizacije vitalnih znakova a zatimsmanjiti isporuku kiseonika tako da ciljna vrednostSaO2 bude 94-98%. Oksigenoterapiju trebaprimeniti pomoću maske bez rebritinga i protokomod 10-15 L/min a kada postignemo vrednostSaO2>85-93%, možemo zameniti masku bezrebritinga nazalnom kanilom sa protokom 2-6L/min ili jednostavnom maskom za lice saprotokom 5-10 L/min. Kod bolesnika sa hroničnomopstruktivnom bolesti pluća (HOBP) trebaprimeniti niske koncentracije kiseonika sa ciljnimvrednostima SaO2 88-92%. Isporuka kiseonika seizvodi pomoću 28% Venturi maske sa protokom od4 L/min ili jednostavne maske za lice sa protokomod 5-10 L/min.Kod nehipoksičnih bolesnika kod kojih jeneophodan kontinuirani monitoring (infarktmiokarda i akutni koronarni sindrom, moždaniudar, poremećaj srčanog ritma, ne-traumatski bol ugrudima, trudnoća i hitna stanja vezana zatrudnoću, abdominalni bol, glavobolja,hiperventilacioni sindrom ili disfunkcionalnodisanje, trovanja i predoziranja lekovima,metabolički i bubrežni poremećaji, akutna isubakutna neurološka stanja, stanja posle



konvulzija, gastrointestinalna krvarenja, toplotniudar itd.) ne treba primeniti oksigenoterapiju.Ukoliko ovi bolesnici postanu hipoksični(SaO2<85%) kiseonik se ordinira po prethodnonavedenim principima. Iako zdravstveni radnicigotovo svih specijalnosti primenjujuoksigenoterapiju, njihova teorijska i praktičnaznanja su prilično skromna kako u pogledurukovanja naizgled jednostavnom opremom tako iupogledu poznavanja aktuelnih smernica zaisporuku kiseonika.Ključne reči: kiseonik, hipoksija, oksigenoterapija


Multimodalni pristup terapiji akutnogpostoperativnog bola kod starih pacijenatanakon ugradnje proteze kolenaO.Marinković1, A.Sekulić1, V.Milenković1, J.Zlatić1,T.Kostić1, S.Trpković2

1KBC "Bežanijska kosa2Medicinski fakultet Priština, Kosovska Mitrovica, Srbijae-mail adresa autora: [email protected]

Uvod: Po klasifikaciji Evropskog udruženja zaregionalnu anesteziju (ESRA) iz 2010. godine bolkod operacije ugradnje proteze kolena predstavljabol jakog intenziteta. Dobra postoperativnaanalgezija je jako bitna kod starih pacijenata jer jepovezana sa usporenim oporavkom, promenjenimimunološkim odgovorom, mogućnošću nastankapromena u perifernom i centralnom nervnomsistemu sa progresijom u hroničan bolni sindrom,promenjenim odgovorom na stres i nepovoljnimishodom lečenja. U terapiji bola kod starijihpacijenata najvažniji je koncept individualneanalgezije uz redovno merenje postoperativnog bolakao petog vitalnog parametra i primena principa“start low, go slow”. Multimodalni pristuppredstavlja kombinaciju više tehnika analgezije radipostizanja optimalnog analgetskog efekta iminimalnih neželjenih efekata.Materijal i metode: Ispitivanjem su obuhvaćena 63pacijenta starija od 70 godina ASA klasifikacije II iIII kod kojih je urađena operacija ugradnje protezekolena. Pacijenti su podeljeni u dve grupe. Prvojgrupi pacijenata (PI) je uz opštu endotrahealnu

anesteziju urađena intraoperativno periartikularnainfiltracija koktelom lekova: lokalni anestetik-Chirokain 100mg + NSAIL (ketrolak-30mg iliketonal-100mg) + Adrenalin 0,1mg. Postoperativnoje primenjeno hlađenje specijalno zaleđenimrastvorom. Druga grupa pacijenata (BI) je dobilasamo opštu anesteziju. Postoperativno je praćenapojava i intenzitet bola i potreba za dodavanjemanalgetika NSAIL (ketrolak) i tramadola. Procenaintenziteta bola vršena je na osnovu Vizuelnoanalogne skale VAS (od 1 do 10) ili Verbalne skalebola VSB (bez bola do najgoreg mogućeg bola), uzavisnosti od kognitivnih funkcija pacijenata.Vrednosti ove skale su zatim preračunavane u VASskalu. Merenja su vršena na svaka dva sata u prvih24 h postoperativno u JIL.Rezultati: U prvoj grupi (PI) je bilo 35 pacijenata.Maksimalne doze analgetika NSAIL (ketrolak-90mg) i tramadola 400mg dobilo je 5 pacijenta.Minimalnu dozu analgetika ketrolak 60mg itramadola 100 mg dobila su 19 pacijenta. U drugojgrupi (BI) maksimalne doze analgetika ketrolaka90mg i tramadola 400mg zahtevalo je 18 pacijenata.Minimalne doze analgetika ketrolak 90mg itramadol 100mg dobila su 2 pacijenta. Kod 5pacijenata u PI grupi za procenu intenziteta bolakorišćena je VSB skala. Umereni bol su imala 3pacijenta, srednje jak 1 pacijent i jak 1 pacijent. Ugrupi BI Verbalna skala bola (VSB) je korišćena kod4 pacijenta. Dva pacijenta su bol opisala kao srednjejak i 2 kao jak. VAS skor u prvoj grupi (PI) je bio4,2±0,7, u grupi (BI) 6,32±0,52. Razlika u primenidoze analgetika za kupiranje bola i vrednost VASskale je statistički značajna.Zaključak: Multimodalnim pristupom iskoristilismo prednosti kombinovanja različitih lekova itehnika za postizanje maksimalnog analgetskogefekta kod starijih pacijenata nakon ugradnjeproteze kolena. Prve doze analgetika moraju biti ufiksnim intervalima a kasnije doze se prilagođavajuu zavisnosti od potreba pacijenata.Ključne reči: Akutni bol, proteza kolena,multimodalni pristup





Atelektrauma – histopatološki, radiološki ipatofiziološki aspektN.Videnović1, J.Mladenović1, A.Pavlović1, S.Tripković1,S.Nikolić1, R.Zdravković1, V.Videnović2

1Medicinski fakultet u Kosovskoj Mitrovici, Srbija2Opšta bolnica Leskovac, Srbijae-mail adresa autora: [email protected]

Nekoliko potencijalnih mana i komplikacijamehaničke ventilacije pluća nalaze se nasuprotnjenim korisnim efektima. Ventilacija koja sekarakteriše malim krajnjim ekspiratornim plućnimvolumenom, koji dozvoljava ponavljano alveolarnootvaranje i zatvaranje (kolaps) može ispoljitineželjene efekte u vidu nastanka atelektraume.Cilj rada: Utvrditi efekat ventilacije malim disajnimvolumenom na histopatološki i radiološki nalaz uplućima eksperimentalnih životinja i patofiziološkepromene koje prate ventilaciju malim disajnimvolumenom.Materijal i metode: Istraživanje je obavljeno kaoprospektivna eksperimentalna studija koja jeobuhvatila 20 eksperimentalnih životinja (prasad).Eksperimentalne životinje podeljene su u dve grupe.U kontrolnoj grupi je primenjena CPPV sa malimdisajnim volumenom (6-8 ml/kg) i PEEP (7cmH2O). U ispitivanoj grupi sprovedena je IPPV sadisajnim volumenom od 6 do 8 cmH2O i bez PEEP.Trajanje mehaničke ventilacije pluća ograničeno jena 240 min. Monitoring je obuhvatio Vt, Ppeak,Paw.mean, Sa O2, PaO2, PaCO2, pH i odnos PaO2/Fi O2. Parametri monitoringa određivani su uvremenskim intervalima od 60 min. Rendgenskosnimanje pluća je obavljeno na početku, nakon 90 i240-minutnog trajanja mehaničke ventilacije.Druga faza, podrazumevala je uzimanje uzorakaplućnog tkiva eksperimentalne životinje (prasadi)po završetku četvoro-časovnog trajanja mehaničkeventilacije i njihovo slanje na patohistološkipregled. Wilcoxonovim testom sume rangova,procenjena je značajnost razlike (p<,05) sumerangova izmešanasti parametarskih podatakaobeležja posmatranja dva nezavisna uzorka.statistička značajnost razlika (p<0,01) srednjihvrednosti testirana je primenom poznatog t–testa uslučaju uzorka.

Rezultati: Rezultati istraživanja ukazali su naznačajne promene u histopatološkom nalazuventiliranih pluća eksperimentalnih životinjaispitivane grupe (umereni perivaskularni,intersticijalni i alveolarni edem, kolaps alveola imalih disajnih puteva sa naglašenim mikroatelektatičnim poljima) u odnosu na kontrolnugrupu (p<,05). Promene su izraženije u dorzalnim(donjim) plućnim regijama. Radiološki nalaz jeukazao na postojanje intersticijalnog edema viduperibronhijalnog i perivaskularnog mufa obe grupebez prisutne signifikantne razlike (p>0,05).Statistički značajna razlika postoji kada semeđusobno uporede parametri monitoringaventilacije, oksigenacije i acido-baznog statusa,kontrolne i ispitivane grupe (p<,001).Diskusija i zaključak: Primena IPPV malimdisajnim volumenom, bez upotrebe PEEP izazivaznačajne strukturalne promene u plućimaeksperimentalnih životinja. Nastale histopatološkepromene (sa dužim trajanjem neadekvatnestrategije mehaničke ventilacije) zahvataju sve većeplućne regije odražavajući se negativno u pogledusposobnosti pluća da održe homeostazu gasnerazmene (ventilacije, oksigenacije i perfuzije) iacido-baznog statusa. Povremena radiološkakontrola ventiliranih pluća indirektno može daukaže na pojavu novih ili pogoršanje već postojećihpatoloških promena u plućima. Sve ovoupotpunjuje sliku atelektraume kao vida oštećenjapluća izazvanog primenom neadekvatne strategijemehaničke ventilacije.Ključne reči: atelektrauma, mehanička ventilacija,mali disajni volumen, histopatološke, radiološke ipatofiziološke promene


Sistemska reakcija na ubod insekataA.Stankov, T. Rajković

Zavod za hitnu medicinsku pomoć Niš, Srbijae-mail adresa autora: [email protected]

Uvod: Sistemska reakcija na ubod ili ujed insekatapredstavlja značajan medicinski rizik odvaskularnih i respiratornih reakcija koje variraju uzavisnosti od pacijentovog odgovora na ubod.



Lekari urgentne medicine se često sreću sapacijentima koji se žale na alergijske reakcije naujed ili ubod insekata.Cilj: Prikaz pacijenta sa sistemskom reakcijom naubod insekata.Materijal i metod rada: Deskriptivni prikazpodataka. Izvor podataka: knjiga poziva, protokolZavoda za hitnu medicinsku pomoć Niš, lekarskiizveštaj i otpusna lista Klinike za hematologiju KCNišPrikaz slučaja: Ekipa je pozvana u ambulantu DomaZdravlja gde je došao pacijent nakon uboda višeosa. Pacijent je u ambulanti Doma Zdravlja primioterapiju amp.Synopen N I i.m, amp.Dexason N IIi.v i amp.Ranisan N I i.v. Vitalni parametri: TA80/60mmHg, SF~/90min, RF 16; SaO293%, ŠUK5,3mmol/L; TT36,5C. U toku pregleda osećavrtoglavicu, mučninu, gušenje, profuzno jepreznojen i po koži ima crvenilo po tipu urtikarije.U fizikalnom nalazu: Srčana akcija ritmična, tonovijasni, šumova nema. EKG-b.o. Nad plućimanormalan disajni šum. Neurološki nalaz uredan.Abdomen u ispod ravni grudnog koša, palpatornomek, bolno neosetljiv na površnu i dubokupalpaciju. Jetra i slezina se ne palpiraju. Peristaltikačujna. Pulsevi nad a.femoralis su jednaki.Postavljena radna dijagnoza Sistemska alergijskareakcija na ubod insekata. Postavljena IV linija,priključen na kiseonik i monitor, dat Sol.NaCl0,9%500ml, amp.Lemod solu 40mg i.v,amp.Adrenalin (1:10000) 0,5 ml i.v. Nakon terapijevitalni parametri: TA 120/70 mmHg, SF~ 100/min,RF14; SaO295%, pacijent se subjektivno oseća bolje,tegobe se povlače. Pacijent transportovan doKlinike za Hematologiju KC Niš, radi daljeopservacije.Diskusija: Postoje tri tipa reakcije na ubod insekata.Prvi je normalna lokalna reakcija koja se karakterišebolom, otokom i crvenilom na mestu uboda. Drugitip veća lokalna reakcija koju karakteriše širenjeotoka i crvenila. Treći tip je sistemska alergijskareakcija sa generalizovanim crvenilom, urtikarijom,angioedemom, pacijent može da oseća malaksalost,strah, gastrointestinalne tegobe (grčevi, mučninapovraćanje), vrtoglavica, sinkopa, hipotenzija,stridor, gušenje ili kašalj. Ukoliko reakcijaprogredira može nastati respiratorna insuficijencijai kardiovaskularni kolaps.Zaključak: Sistemska alergijska reakcija zahtevabrzo i trenutno delovanje. Oko 15-25% populacije

izložene ujedu insekata pokazuje serološku i/ ilipreosetljivost dokazanu kožnim probama. Samo 1-5% populacije daje podatak o trenutnoj sistemskojalergijskoj reakciji na ubod insekata a polovina odnjih je bila životno ugrožena.Ključne reči: Sistemska alergijska reakcija, ubodinsekata


Edem pluća srčanog porekla, prehospitalnitretman - iskustva SHMP Šabac u 2015 gM.Popović1, Ž.Nikolić1, B.Vujković2, N.Beljić2

1SHMP, DZ Šabac, Srbija2OB Šabac, Srbijae-mail adresa autora: [email protected]

Uvod: Edem pluća je patološko stanje koje seodlikuje povećanom količinom ekstravaskularnetečnosti u plućima. Količina transudirane tečnosti jeveća od one koja se može odstraniti limfom. Edempluća se razvija u tri faze, a postoje dva načinaulaska tečnosti u alveole –a) indirektan i b)direktan. Etiološki se edem pluća deli na:KARDIOGENI (kad je PKP >8 mmHg) iNEKARDIOGENI a) oštećenje kapilara i povećanapropustljivost (kod pneumonija, toksičnog dejstvazmijskog otrova, DIK-a, šoknih pluća itd.), b)smanjenje koloidnoosmotskog pritiska u bolestimajetre i bubrega c) poremećaji oticanja limfe iz plućakod limfangitisa ili karcinomatoze d) posleanestezije, CVI, eklampsija, predoziranjeopijatima...U praksi se najčešče sreće plućni edemkardiogenog porekla. Klinička slika počinje prvimstadijumom u kome se javlja dispnea ihiperventilacija uz pojavu vlažnih šušnjeva pribazama. Drugi stadijum se nastavlja pojačanomdispneom, razvojne mase vlažnih šušnjeva od bazeka vrhu. U trećem staduijumu se pojačava kašalj,ispljuvak je penast sa primesama krvi, obilat nalazvlažnih nad plućima, uz „wheezing“, tahikardiju itahiaritmiju, te poremećaj mentalnog stanjabolesnika. Tretman i lekovi koji se koriste zavisnood nalaza su: 1.sedeći položaj 2.toaleta disajnogputa i kiseonik preko maske 3.Morfijum i.v.upodeljenim dozama do max-20-30 mg 4.diureticii.v. (Furosemid, Bumetanid II-III amp.iv bolus u




trajanju 2 minuta) 5. NTG u vidu iv bolusa a 1mg iliper infusionem 10-15 mg u 250 ml 5% glucosae6.venepunkcija do 500 ml. 7.Aminofilin I-II amp.a250 mg iv polako 8.Digitalis iv I-II amp Dilacor akopostoji AF sa brzim komorskim odgovorom9.Inotropni lekovi (Dopamin, Dobutrex ) ivinfuzija.Materijal i metode: Opservaciona studija uvidom uknjigu protokola i lekarske izveštaje SHMP ŠaabacRezultati: U SHMP Šabac od 01.01. do 31.08. 2015zbrinuto je ambulantno 23 pacijenata sa DG J81(tabelarni prikaz-distribucija po polu i starosti) iterenski 29 pacijenata (tabelarni prikaz distribucijapo polu i starosti). Prosečna vrednostTA=186,3/114mmHg, SpO2:94,5%, SF oko 116/min.Najčešće data TH: Furosemid amp (32 x I amp,16 xII amp,4 x III i više amp iv), Aminofilin amp 35 x Iamp; Dilacor amp 5 x Iamp; NTG ling.a 0,5 mg 6 x1sl; kiseonik 52 x u dozi od 4-12 lit/min. Objektivnopoboljšanje u 37 slučajeva (21 terenski i 16ambulatorno; u ostalim slučajevima stanjenepromenjeno, pogoršanja nema, ni smrtnih ishodado primopredaje na IO OB Šabac).Zaključak: rano prepoznavanje kao i pravovremenodata terapija u dozvoljenim dozama povećavanjuprocenat preživljavanja, smanjuju broj bolničkihdana i doprinose bržem oporavku pacijenata.Ključne reči: akutno popuštanje srca, dijagnoza,lečenje


Hitna medicinska pomoć na Sea Dancefestivalu 2015R.Furtula1, S.Stefanović1, M.Šaponjić1, B.Stojanović2,V.Đurašković2

1Zavod za hitnu medicinsku pomoć, Crna Gora2Specijalna bolnica CODRA - Podgorica, Crna Gorae-mail adresa autora:[email protected]

Uvod: Sea Dance Festival 2015 održan je u CrnojGori od 15-18. jula na plaži Jaz u Budvi. Tokomčetiri dana, ovaj događaj imao je oko 110 000posjetilaca (do 35000 dnevno). Zavod za hitnumedicinsku pomoć Crne Gore obezbjeđivao jemanifestaciju kroz organizaciju i rad poljske bolnicei pet isturenih punktova sa reanimobilima i

kompletnim medicinskim timovima, kao idodatnim vozilima za dalji transport pacijenata.Metod rada: Podaci o ukazanoj hitnoj medicinskojpomoći dobijeni su putem protokola poljskebolnice u koji su pregledi upisivani, a statističkianalizirani u SPSS-u.Rezultati: Pregledano je ukupno 330 pacijenata iz 28zemalja svijeta. Najveći broj sa Balkana: 270 (81,8%)i iz Zapadne Evrope: 35 (10.6%). Najvišepregledanih je iz Srbije 116 (35.2%), Crne Gore 91(27.6%), Makedonije 20 (6.1%) i UjedinjenogKraljevstva 18 (5.5%). Među pregledanima bilo je210 muškaraca (63.6%) i 120 žena (36.4%).Prosječna starost pacijenata bila je 26 godina,pretježna 19-33 godine, najučestalija 20-25 godina.Najveći broj pacijenata pregledan je između 21-04h(60.7%), sa pikom između 02-03h (13.9%).Najučestaliji pregledi bili su prvog dana od 01-03h.Minimalan broj pregleda bio je između 07-08h(0.3%). Među pregledanim pacijentima bilo je 128povreda (38.8%) i 202 netraumatska oboljenja(61.2%). Najčešće dijagnoze bile su povredeskočnog zgloba i stopala (19.4%), upotrebapsihoaktivnih supstanci (7.6%), opšti simptomi iznaci bolesti (7.3%), respiratorne infekcije (6.1%),povrede koljena i potkoljenice (5.5%). Tri povredebile su posledica nasilja. U zdravstvene centretransportovano je 6 pacijenata (akutna psihoza,upotreba psihoaktivnih supstanci, povrede glave,koljena i skočnog zgloba). Nije bilo letalnih ishoda.Zaključak: Svi pregledani adekvatno su zbrinuti, asprovedena medicinska pomoć bila je efikasna ipravovremena.Ključne reči: hitna medicinska pomoć, Crna Gora,Sea dance festival 2015


Novo otkrivena aneurizma aorte kaodiferencijalno dijagnostički problem kodabdominalnog bolaD.Milanović, N.T.Kostić

Dom zdravlja Gračanica, Srbijae-mail adresa autora:[email protected]

Cilj rada: Cilj rada je prikaz slučaja gdje je pacijentus bolom u abdomenu, pronađeno postojanjeaneurizme abdominalne aorte.



Materijal i metode: Metodom prikaza slučaja jepredstavljen slučaj pacijenta koji se u ambulantujavio zbog bolova u abdomenu, a pri tom jeultrazvučnim pregledom ustanovljeno postojanjeaneurizme abdominalne aorte, za koje se do tadanije znalo.Rezultati: Pacijent star 69 godina, se javio uambulantu Službe hitne medicinske pomoći zbogbola u abdomenu u predelu epigastrijuma. Bol sejavio 90 minuta prije dolaska kod lekara. Bol jenastao nakon uzimanja veće količine masnije ikaloričnije hrane. Palpacijom je ustanovljena bolnaneosjetljivost, leukociti su iznosili 9,8, glikemija jebila 8,9 mmol/l, EKG je bio normalan, renalnasukusija je bila negativna. Obzirom da su dostupnepretrage bile u normalnom rasponu, odmah jezapočet ultrazvučni pregled abdomena. Jetra je bilahiperehogena ali homogena, žučna kesa je bilaprazna, ali se sticao utisak da postoji kalkuloza. Obabubrega i pankreas su bili uredni. Primećeno jepostojanje aneurizme abdominalne aorte, koja jebila promjera 4,9 cm, a duljine 9 cm. Postojao je izidni tromb. Zbog svega toga je odmah postavljenasumnja da je aneurizma uzrok bola. Nije uočenopostojanje intimalnog flapa, niti je postavljenasumnja na moguće odvajanje zidnog tromba. Nijebilo ni ultrazvučnih znakova rupture. Premadostupnom nalazu je bilo očito da novootkrivenaaneurizma nije uzrok tegoba, već se vjerojatnoradilo o holelitijazi. Ponovnim ultrazvučnimpregledom u više različitih pozicija je utvrđeno daipak postoji kalkuloza žučne kese. Primjenomodgovarajuće terapije tegobe su uskoro prestale. Nasutrašnjem ultrazvuku, rađenom uz odgovarajućupripremu, je jasno uočeno postojanje višestrukekalkuloze žučne kese.Zaključak: Iako je tipična klinička slika odmahukazivala na kalkulozu žučne kese, uočenaaneurizma je postavila sumnju da se možda radi onjenoj disekciji. Zahvaljujući postojanju dobredijagnostičke opreme u Službi za hitnu medicinskupomoć, dijagnoza je postavljena odmah, aprimijenjena terapija dovela do povlačenja tegoba.Ključne reči: bol u trbuhu, mučnina


AVblok uzrokovan alkoholom kao verovatniuzrok gubitka svesti- prikaz slučajaN.T.Kostić, D.Milanović

Dom zdravlja Gračanica, Srbijae-mail adresa autora: [email protected]

Cilj rada: Cilj rada je prikaz slučaja, gde jeintoksikacija alkoholom verovatni uzrok AV blokavišeg stepena, a potom i gubitka svesti.Materijal i metode: Metodom prikaza slučaja jepredstavljen slučaj pacijenta koji je u više navratagubio svest, uvek nekoliko sati nakon konzumiranjavecih količina alkoholnih pica i uvek nakonbuđenja.Rezultati: Pacijent star 37 godina, se nakonporodičnog veselja vratio kuci i zaspao. Oko 2 časaujutro se probudio i otišao do toaleta. Pre nego štoje stigao do vrata kupatila, on iznenada gubi svest ipada. Pad čuje supruga koja dolazi do njega,pronalazi ga bez svesti i poziva Službu za hitnupomoc. Do dolaska ekipe, on se budi i nakonpregleda se nalazi sledeci nalaz: pacijent je svestan,orijentisan, pritisak je 120-80 mmHg, puls je 55 uminuti, auskultatorni nalaz na srcu i plucima jeuredan, a saturacija kiseonika 98%, a šecer u krvi5,9. Na EKG-u se beleži sinusni ritam, bez STpromena, ali uz postojanje AV bloka I stepena.Pacijent i supruga navode da to verovatno 8-10 putu poslednjih 5 godina, da pacijent gubi svest, i touvek nocu, uvek nakon ustajanja iz kreveta iodlaska u toalet, u intervalu između ponoci i 5časova ujutro. Pacijent je naknadno obavioultrazvuk srca, rendgen srca i pluca, kompletnelaboratorijske analize, i svi ti nalazi su bili unormalnom opsegu. EKG holter koji je pokazaokonstantno postojanje AV bloka I stepena.Konsultovan je i neurolog koji je nije pronašaoneurološki etiološki faktor kao uzročnika gubitkasvesti. Pacijent navodi da skoro svako veče se budiiz sna i ide u toalet da mokri i da nikada nije gubiosvest, osim u slučajevima kada popije vecu količinualkoholnih pica. Pravilo je da uvek kada popije vecekoličine alkohola (više od 6-8 flaša piva i / ili 10čašica žestokog alkoholnog pica), on uvek nakonnekoliko sati (ne odmah), gubi svest. Kada popije 1-




2 piva i/ili čašicu žestokog alkoholnog pica, nikadanije gubio svest.Zaključak: Na osnovu dobijenih podataka,očigledno je jedino stalno postojanje AV bloka Istepena. Pretpostavka je da pacijent zbog velikekoličine alkoholnih pica upada u prolazni AV blokII stepena tipa mobicom II (ili AV blok III stepena),što uzrokuje duge pauze, koje verovatno, dovode dogubitka svesti.Ključne reči: AV blok, alkohol, sinkopa


Spontani pneumotoraks - PrehospitalnadijagnozaD.Husović, A.Husović, F.Pašović, A.Tuzinac Hanuša

Dom Zdravlja Novi Pazar - Služba za Hitnu pomoć,Srbijae-mail adresa autora: [email protected]

Uvod. Pneumotoraks podrazumeva nakupljanjevazduha u intrapleuralnom prostoru usled prekidakontinuiteta visceralne ili parijetalne pleure,izjednačavanje atmosferskog i intrapleuralnogpritiska te kolaps pluća.Cilj rada. Prikazati značaj prehospitalno postavljenesumnje na razvoj pneumotoraksa kod pacijenta sahroničnom opstruktivnom bolešću pluća (HOBP).Metod. Prikazaćemo slučaj muškarca starosti58god. kod koga je došlo do razvoja spontanogpneumotoraksa, kao i mere preduzeteprehospitalno.Prikaz slučaja. Iz telefonskog poziva saznajemo daje pacijentu pozlilo, da ima gušenje, bol u grudima, ida je plućni bolesnik. Odmah se upućujemo nateren, na licu mesta smo zatekli pacijenta u ležećempoložaju, bledog, hladno preznojenog, dispnoičnog,TA 95/60mmHg, SF oko 115/min. Žali se naprobadajući bol sa leve strane grudnog koša nastaonakon fizičkog napora, gušenje i malaksalost.Anamenestički dobijamo podatak da pacijent imahronični bronhitis, koristi „pumpice“, već nekolikodana oseća pojačano zamaranje i gušenje, da je togjutra više puta koristio “pumpice” i da je planirao dase javi izabranom lekaru ali je zbog jakog bolaodlučio da pozove hitnu pomoć. Inspekcijom,pacijent cijanotičan, bačvastog grudnog koša,

koristi pomoćnu disajnu muskulaturu.Auskultatorno nad plućima oslabljen disajni šum,sa leve strane nečujan. Perkutorno, levohipersonoran zvuk. Pacijent postavljen u polusedećipoložaj, dat analgetik i.v, apliciran kiseonik prekomaske 5l/min i pod sumnjom na spontanipneumotoraks transportovan na odeljenje hirurgijegde je rentgenskim snimkom potvrđena dijagnoza apacijent zbrinut torakalnom drenažom.Zaključak. Pacijenti sa HOBP su česti u radu lekarahitne službe pre svega u ambulanti, ređe na terenu,ali se u konkretnom slučaju na pneumotoraksposumnjalo već pri prijemu telefonskog poziva, aradna dijagnoza postavljena zahvaljujući anamnezi ikliničkom pregledu, što je bilo značajno za brztransport pacijenta na hirurgiju.Ključne reči: Gušenje, HOBP, spontanipneumotoraks


Značaj saradnje zdravstvene službežandarmerije i medicinskih ekipa na terenu upružanju pomoći u vanrednim situacijamaD. Veljković1, K.Bulajić Živojinović1, D.Tijanić1,J.Zlatić1, V.Stojanović2

1Grupa za zdravstvenu zaštitu, Peti odred Žandarmerije,Kraljevo, Srbija2Gerontološki Centar, Kruševac, Srbija3Grupa za zdravstvenu zaštitu, Peti odred Žandarmerije,Kraljevo, Srbija4Katedra za anatomiju, Medicinski fakultet, Univerzitet uNišu, Srbijae-mail adresa autora: [email protected]

Uvod: Dobar deo vremena i energije ulažemo urazmišljanje o budućnosti: šta želimo dapostignemo, koji su nam ciljevi, gde bismo voleli daputujemo, živimo, s kim da provodimo vreme, nakoji način. Nesreće se dešavaju iznenada,neočekivano, naglo i najčešće ih je veoma teškopredvideti. Prirodne katastrofe kao što su poplave,klizišta, erupcije vulkana, zemljotresi, snežne oluje,vatra, uragani, tornado, pogađaju celokupnuzajednicu ili njen veći deo. Ovakve kataklizmeizazivaju veliku emocionalnu patnju, ljudske imaterijalne gubitke, medicinske i socijalneprobleme, velika razaranja i uništavanja. Saniranje



posledica zahteva angažovanje čitavog društva, umaterijalnom i psihološkom smislu.Cilj: rada je da ukažemo na neophodnost saradnje iznačaj koordinisanog delovanja zdravstvene službežandarmerije i medicinskih ekipa na terenu uvanrednim situacijama.Prikaz slučaja: Republika Srbija suočila se u maju2014. godine sa katastrofalnim poplavama,uzrokovanih obilnim padavinama. Vanrednasituacija proglašena je u početku u pet gradova ičetrnaest opština, a od 15. maja do 23. maja bila jena snazi na celoj teritoriji naše zemlje. Usled naglogporasta nivoa vode, reke su se izlile što je dovelo toteških posledica u Kolubarskom, Mačvanskom,Moravičkom, Pomoravskom okrugu i beogradskojopštini Obrenovac. Vatrogasci - spasioci, policija(žandarmerija, SAJ, PTJ, Helikopterska jedinica),Vojska Srbije, Crveni krst i Gorska službaspasavanja evakuisali su i spasli preko 31 hiljaduljudi a iz najugroženije opštine Obrenovac više od25 hiljada ljudi je evakuisano (saopštenje MUP-a).Dana 15.05.2014.godine od 06:00 časova prvesanitetske ekipe i policijski službenici žandarmerijekoje su upućene u Obrenovac bile su iz sastavaKomande i Drugog i Treceg odreda. U svom radumedicinske ekipe specijalnih i posebnih policijskihjedinica, kako kod nas tako i u svetu, za razliku odslužbe hitne medicinske pomoći, reaguju utakozvanoj crvenoj zoni - zoni neposredne opsnostiZaključak: Poplave koje su sa sobom odnele i veilkibroj ljudskih života, nanele ogromnu materijalnuštetu ukazale su na neophodnost obuke kadra zapružanje medicinske pomoći u situacijamaelementarnih nepogoda. Povezivanje svih službi naterenu i pridžavanje plana zbrinjavanja uvanrednim situacijama omogućava adekvatnerezultate.Ključne reči: vanredna situacija, pozivanje,zbrinjavanje.


Mogućnosti poboljšanja dijagnostikeakutnog apendicitisa kod dece uambulantnim uslovimaA.Kostić, Z.Marjanović, M.Krstić, Z.Jovanović,G.Janković, I.Đorđević, N.Vacić

Klinika za dečiju hirurgiju i ortopediju KC Niš, Srbijae-mail adresa autora:[email protected]

Uvod: Akutni apendicitis je najčešći uzrok akutnogabdominalnog bola kod dece i razlog za čak trećinuhospitalizacija. Iako je klasična prezentacija AAdobro poznata, tačna i pravovremena dijagnoza AAu dečjem uzrastu još uvek nije moguća kod svakogpacijenta. Klinička slika AA kod dece zavisi oduzrasta malog pacijenta i može jako varirati-odminimalno simptomatskog deteta, do krajnje teškekliničke prezentacije (sa slikom akutnog abdomenai znacima endotoksemijskog šoka). Stopanegativnih apendektomija se i dalje kreće oko 10%,dok je perforativnih oblika (uprkos primenisavremenih radioloških tehnika) i dalje mnogo-čak35%. Poseban problem predstavlja dijagnostika AAu ambulantnim uslovima, sa vrlo ograničenommogućnošću za dodatna ispitivanja. Dijagnostičkatačnost AA u dečjem uzrastu može se povećatisamo integracijom kliničkog nalaza, kao irezultatima laboratorijskih ispitivanja-u prvomredu nalazom krvne slike (KS) i vrednostima Creaktivnog proteina (CRP).Cilj rada: Evaluirati značaj ispitivanja kliničkihznakova za AA (ukupno 12), kao i elemenata KS(ukupan broj leukocita-TL, broj neutrofila-NEU,odnos neutrofili/leukociti- N/L) i vrednostimaCRPa, radi poboljšanja dijagnostičke tačnosti AA uambulatnim uslovima.Materijal i metode: Višemesečna prospektivnastudija obuhvatila je ukupno 200 pacijenata,podeljenih u dve grupe. Prvi grupu (100 bolesnika)činili su apendektomirani, drugu (100 bolesnika)deca sa akutnim abdominalnim bolom nehirurškegeneze. Kod svih pacijenata ispitivano je 12kliničkih znakova za AA ( Mc Barney znak,Blumbergov znak, Grassmanov znak, Rovsignovznak, psoas znak, obturator znak, Lanz-Hornovznak, Rosensteinov znak, Markleov znak,Giordanov znak, Owingov znak, Ben Asherov




znak), kao i rezultati KS ( TL, NEU, N/L) i CRP.Kvantitativna statistička analiza je sprovedena naračunaru. Poređenje srednjih vrednosti numeričkihobeležja između dve grupe ispitanika vršeno jeStudentovim t testom ili Man-Vitni U testom(Mann-Whitney U test). Poređenje učestalostiatributivnih obeležja između grupa vršeno jeMantel-Hencelovim Hi kvatrat testom (Mantel-Haenszel Chi square test). Za procenu povezanostifaktora od interesa i AA korišćena je logističkaregresiona analiza (univarijantna i multivarijantna).Rezultati: U prvoj grupi su statistički značajno vise(p<001) bili pozitivni svi ispitivani fizikalni znaci.takođe, kod bolesnika prve grupe su značajno bilepovećane vrednosti svih ispitivanih laboratorijskihparametara. Multivarijantna logistička regresionaanaliza je kao najvažnija obeležja povezana saznačajnim porastom verovatnoće za postojanje AApotvrdila: grasmanov znak, markle ukupan brojleukocita veći od 12, neutrofila 70 i n />L odnos većiod 4, kao i CRP veći od 16.Zaključak: Dijagnostika AA u ambulantnimuslovima ostaje pravi izazov, pre svega zbog čestonespecifične prezentacije ovog oboljenja u dečjemuzrastu. Oslanjajući se neretko samo na limitiranedijagnostičke mogućnosti, kliničaru od pomoćimogu biti ispitivanje fizikalnih znakova, ali iintegrisana analiza nekoliko dostupnihlaboratorijskih parametara ( TL, NEU, N/L, CRP).Ključne reči: akutni apendicitis, deca, ambulanta


Hiperkalijemija-prikaz slučajaG.Simić

SHMP-DZ Kruševac, Srbijae-mail adresa autora:[email protected]

Uvod: Normalan fiziološki rad kako ćelija tako iorganizma u celini uslovljen je stalnošću unutrašnjesredine strogo odredjene uskim granicamakoncentracija elektrolita. Svaka narušavanjaravnoteže vode patološkim poremećajima kojiukoliko se pravovremeno ne prepoznaju iadekvatno ne leče mogu biti jedan odmnogobrojnih uzroka letalnog ishoda.

Kalijum - glavni intracelulalrni katjon odgovoran jeza transmembranski i akcioni potencijal,intraćelijski transport glukoze, elektroneutralnost iosmotsku ravnotežu. Hiperkalijemija (više od 5,5mmola/l) je ređi poremećaj ali izuzetno opasanzbog direktnog dejstva na radnu muskulaturu isprovodni sistem srca. Simptomatologija poputpalpitacija, malaksalosti, grčeva i bolova u trbuhuupućuje na širi spektar diferencijalne dijagnostikešto dodatno opterećuje lekara hitne pomoći koji unajkraćem mogućem vremenu vođen intuicijom,iskustvom i znanjem treba da svoje opravdanesumnje o eventualnoj hiperkalijemiji i dokaže. Kaopristupačniji, u prehospitalnim uslovima, EKGnalaz biće vodič u postavljanju dijagnoze alabaratorijski rezultati samo sledstvena potvrda.Cilj rada je da ukaže na značaj ranog prepoznavanjahiperkalijemije na osnovu promena u EKG kao naprimeru našeg pacijenta.Prikaz slučaja: Primljen je poziv za već dobropoznatog pacijent starog samo 30 god.( povremeniEpi napadi, bolovi u trbuhu tipa renalne kolike ičeste urinarnih infekcija kao posledica SAH u 26-ojgod.) zbog bolova u celom trbuhu i upornogpovraćanja. Zatečen je u invalidskim kolicima vidnouznemiren, febrilan, hipotenzivan a u EKG zapisupatognomoničan šatorasti T talas. Prevežen ihospitalizovan na interno odelenje naše opštebolnice gde je dobijena i labaratorijska potvrda K=7,4 mmola/L. EKG nalaz je rađen u okviru opštegpregleda i jedina je moguća dopunska dijagnostičkaprocedura u prehospitalnim uslovima. EKGprocedura mora biti sastavni deo pregleda svakogpacijenta a posebno za pacijente sa nespecifičnomsimptomatologijom jer u pojedinim situacijama kaona primeru našeg pacijenta je vrlo važna, pouzdanai jedina sigurna pomoćna dijagnostika uprehospitalnim uslovima.Zaključak: EKG procedura mora biti sastavni deopregleda svakog pacijenta a posebno za pacijente sanespecifičnom simptomatologijom jer u pojedinimsituacijama kao na primeru našeg pacijenta je vrlovažna, pouzdana i jedina sigurna pomoćnadijagnostika u prehospitalnim uslovima.Ključne reči: hiperkalijemija, EKG zapis, terapija




Statistički prikaz pacijenata sa febrilnimkonvulzijama i epilepsijom do 18 godinaD.Ševo, T.Rajković A.Dimić


Uvod: Febrlilne konvulzije se najčešće definišu kaokonvulzivni napadi koji se javljaju u toku povišenetemperature kod dece od 6 meseci do 5 godina, pričemu se u dijagnostičkom tretmanu mora jasnoisključiti infekcija centralnog nervnog sistema ilipostojanje akutnog ili hroničnog neurološkogoboljenja.Cilj: Statistički prikaz pacijenata do 18 godine u2014.god sa febrilnim konvulzijama i epilepsijomMaterijali i metod rada: Retrospektivna analizapodataka. Izvor podataka: Knjiga poziva, knjigaprotokola Zavoda za hitnu medicinsku pomoć Niš.Rezultati: U 2014. godini u ZHMP Niš jepregledano 7.406 pacijenata do 18 godine, 6.072 uambulanti i 1.334 na terenu. Dijagnozu „febrilnekonvulzije“dobilo je 83 (35 u ambulanti i 48 naterenu). U ambulanti se javilo 25 osoba rođenihizmeđu 2010-2014g, 8 (2005-2009), 2 (2000-2004g),8 (1996-1999g).(najviše 2012g,-10). Od ukupnogbroja 8 je prvi napad. Svi su procenjeni kao treći redhitnosti. Na dalje lečenje je upućeno 34pacijenta.Terapiju je dobilo 20, (7 supp. diazepama2mg, 7 klizmi diazepama 5mg, 10 supp. efferalgana150mg i 9-O2). Na terenu je bilo 43 pacijentarođenih između 2010-2014g, 4 (2005-2009g), 1(1996-1999g), (najviše 2012 godište-18). Sa prvimnapadom 4.dece. Od 47 terena 15 je procenjeno kaoprvi red hitnosti, 20 drugi i 13 treći red hitnosti.Terapiju je dobilo 16 pacijenata: 2 supp. diazepama2mg, 5 klizmi diazepama 5mg, 5 supp. efferalgana150mg, 10-O2. Sa dijagnozom „epilepsija“ se javilo45 dece, 37 na terenu, 8 u ambulanti. Na terenu jebilo 5 (2010- 2014g.), 14 (2005- 2009g), 7 (2000-2004g), 10 (1996-1999g.) Od ukupnog broja 5 sejavilo prvi put. Od svih poziva 4 je procenjeno kaoprvi red hitnosti, 21 drugi i 12 treći red hitnosti. Nadalje lečenje je upućen 21 pacijent. Terapiju jedobilo 12 (6 tabl. Bensedina 5mg, 6-O2 , 4 ivkanile). U ambulanti se javilo ukupno 8 pacijenta: 2od 2010-2014g., 2 (2005-2009g.), 1 (2000-2004g), 3

(1996-1999g). Svi su procenjeni kao treći redhitnosti i upućeni dalje. Terapija:1 supp.efferalgana150mg, 1 klizma diazepama 5mg i postavljena je 1iv kanila.Diskusija: Biološka osnova febrilnih konvulzija jošuvek je nepoznata i prepisuje se brojnim činiocima.Ispoljavaju se pri naglom skoku temperature većojod 38,5ºC, i često predstavljaju prvi simptombolesti. Najčešći uzrok skoka temperature su:virusne infekcije gornjih respiratorinih puteva,bakterijske infekcije gastro intestinalnog trakta,urinarnog trakta itd. Klinička slika je dramatična ifrustrirajuća za svakog roditelja. U ovim napadimadete okrene i fiksira očne jabučice u jednu stranu,izgubi svest i počne da se trese. Duže pauze disanjastvaraju povećanu paniku i uplašenost roditelja.Razlikuju se tipične i atipičke febrilne konvulzije.Tipične su generalizovani napadi kod dece uzrastaod 1 do 5godina, kraće od 15 minuta, i neponavljaju se unutar 24h. Atipične konvulzije sunapadi koji traju duže od 15 minuta i javljaju se višeputa u toku dana, često fokalni ilihemigeneralizovani. Posle napada zapažaju seprolazni ili trajni neurološni ispadi (Todovapareza).Zaključak: Febrilne konvulzije su najčešćiepileptički napadi uglavnom benignog toka. Kodgotovo 50% dece mogu recidivirati. Retko supraćene kasnijom pojavom epilepsije. Iakopatogenetski mehanizam nije poznat, istraživanjaupućuju na naslednu sklonost.Ključne reči: statistika, febrilne konvulzije,epilepsija


Smrtonosni duo: mešanje alkohola i xanaxamože dovesti do loše navike ili neočikivanesmrtiLJ.Milošević1, K.Jovanović2, M.Donić3

¹,³Kliničko bolnički centar Zvezdara-Beograd, Srbija²Visoka medicinska škola Ćuprija, Srbijae-mail adresa autora:[email protected]

Uvod: Xanax (alprazolam) je benzodiazepinindikovan za kratkotrajno olakšanje anksioznihporemećaja kao i lečenje napada panike. Efikasnostza tretiranje anksioznosti može se objasniti




njegovom farmakološkom akcijom u mozgu naspecifičnim receptorima. Receptori su specifičnelokacije na membrani nervnih ćelija koje primajusignal od neurohemijskog neurotransmitera.Jednom zaključan neurotransmiter na receptorumenja se u električni ili drugi hemijski signal iputuje duž neurona. Receptor (lokacija) na kojojbenzodiazepini izazivaju njihovo delovanje senalaze u različitim regionima mozga. Reakcijabenzodiazepina za receptore olakšava inhibitornodejstvo neurotransmitera γ-aminobuterne kiseline(GABA) u tom regionu mozga. Izgleda da akcijabenzodiazepine na GABA receptore prozvodi svojuanksiolitičku, sedativnu i antikonvulzivnu akciju aefektivan je i kao hipnotik. Uobičajena početnadoza za xanax u lečenju anksiolitičkih poremećaja je0,25-0,5 mg.tri puta dnevno. Doza može bitipovećana do 4 mg na dan a kod lečenja napadapanike može se povećati i do 6-8mg.na dan.Sporedni efekti su sedacija i dremljivost, smanjenakoncentracija i pamćenje kao i smanjenakordinacija pokreta.Cilj rada je da ukaže na to da pacijenti koji uzimajuxanax ne smeju da uzimaju druge depresore CNS-akao što su alkohol, narkotici, hipnotici, barbituratipa čak i antihistaminici koji mogu dovesti dopovećanja sedacije, poremećaja mehanike disanja,respiratorne depresije i smrtnog ishoda.Materijal i metode: Pacijent starosti 26 godinaprimljen je na hitnom internističkom prijemu uKBC Zvezdara-Beograd konfuzan, somnolentan,neskladnih pokreta (ataxia), oslabljenih refleksa,poremećene mehanike disanja, bradikardije,cijanoze, hipotenzije, a već tokom pregleda sapočetnim znacima gubitka svesti i prestankadisanja. Od rodbine se dobija podatak da je pacijentna terapiji xanx-om i da je sa društvom bio na žurcigde je konzumirao alkohol. Intubiran je (iz ustiju seoseća zadah alkohola) na hitnom internističkomprijemu i smešten u hiruršku intenzivnu negu KBCZvezdara-Beograd jer je postojala potreba zarespiratornom potporom, tj.invazivnommehaničkom ventilacijom (IV) pluća. Urađenegasne analize arterijske krvi pokazale su povišenevrednosti PaCO2 > 48 mmHg tj. hiperkapniju.Pacijent je na invazivnoj mehaničkoj ventilaciji(MV-IV) oblik BIPAP, sa podešenim PEEP=5cmH2O, a ventilatorna podrška je po tipuprotektivne plućne ventilacije. Hitno su urađenebiohemijske analize krvi čije su vrednosti u

fiziološkim granicama i preduzete mere tj.opštiprincipi terapije trovanja: 1. Održavanje vitalnihfunkcija (rad srca i pluća). 2. Prevencija resorpcijeotrova. 3. Eliminacija otrova. 4. Simptomatskaterapija. 5. Primena antidota. Sadržaji iznazogastrične sonde i krv u cilju toksikološkeanalize poslati su u toksikološki centar VMABeograd. Nakon 24 sata mehaničke ventilacije plućadolazi do oporavka pacijenta koji je dalje upućen naneuropsihijatrijsko odeljenje KBC Zvezdara.Izveštaj toksikološkog centra VMA Beogradpotvrdio je prisustvo xanax-a u gastričnom sadržajui alkohola u krvi.Rezultati i diskusija: Primarno i glavno kodintoksiciranih pacijenata je poboljšanje ventilacije ioksigenacije što je kod našeg bolesnika postignuto.Za vreme mehaničke ventilacije podešavanjeventilatora bazirano je na “ideal body weight”ipraćeno gasnim analizama iz arterijske krvi.Pacijent je uspešno odviknut od respiratornepodrške nakon 24 sati hospitalizacije u hirurškojintenzivnoj nezi i upućen na neuropsihijatrijskoodeljenje.Zaključak: Overdose kod oralnog uzimanja samobenzodiazepina nije generalno fatalan. U svetskojliteraturi većina fatalnih ishoda je kodkonzumiranja benzodiazepina zajedno sa drugimCNS depresorima kao što su alkohol, narkotici ilibarbiturati.Ključne reči: Xanax, alkohol, overdose,respiratorna slabost, mehanicka ventilacija


Hitno lečenje blizu-fatalne akutne ashme-prikaz slučajaLj. Milošević1, K.Jovanović 2

¹Kliničko bolnički centar Zvezdara-Beograd, Srbija²Visoka medicinska škola Ćuprija, Srbijae-mail adresa autora:[email protected]

Uvod: Asthma se definiše kao hronićna upaladisajnih puteva koja izaziva njihovu povećanupreosetljivost na razne spoljašnje uticaje. Oniuzrokuju suženje disajnih puteva, zbog čega sejavljaju tegobe u vidu osećaja otežanog disanja,kašlja, osećaja tištanja i zviždanja u grudima.



Tegobe su najččešće noću i/ili u ranim jutarnjimsatima, ali mogu biti i tokom dana. Broj obolelih odasthme tokom poslednje dve decenije stalno raste,naročito kod dece, tinejdžera i u visoko razvijenimzemljama (posebno od alergijske asthme) te se onadefiniše kao bolest savremenog društva i epidemija21.veka. Procenjuje se da oko 350 miliona ljudi usvetu ima pomenutu bolest, kao i da će još 150miliona oboleti za sledećih 10 godina. Naša zemljaubraja se u one sa srednjom stopom oboljevanja odasthme.Cilj rada je da ukaže na to da kod pacijenata uakutnoj fazi teške asthme koji ne reaguju naintenzivnu bronhodilatatornu terapiju može doći ido smrtnog ishoda ukoliko se ne preduzmu meremehaničke ventilacije (MV) bilo da se radi oneinvazivnoj mehaničkoj ventilaciji (NIV) iliinvazivnoj mehaničkoj ventilaciji (IV).Prikaz slučaja: Pacijent starosti 30 godina primljenje na hitnom intrnističkom prijemu u KBCZvezdara-Beograd svestan ali uznemiren, nemoćanda legne, sa znacima respiratornog distress-a iupotrebom pomoćne disajne muskulature. Nije biou mogućnosti da govori, samo pojedinačne reči.Auskultatorno obostrano na plućima oslabljenodisanje sa teškim difuznim i bilateralnim wheezing-om. Nije bilo drugog uzgrednog fizikalnog nalazapri pregledu. Vitalni znaci su pokazivali: krvnipritisak 145/80 mmHg, srčana frekvenca 140/min,SpO2 70% na sobnom vazduhu, TTemp. 36,8ºC,respiratorna frekvenca 40/min. Pacijent je hitnopreveden u hiruršku intenzivnu negu KBCZvezdara-Beograd jer je postojala potreba zarespiratornom potporom, tj. mehaničkomventilacijom (MV) pluća. Urađene gasne analizearterijske krvi pokazale su pH 7,14, povišenevrednosti PaCO2 77mmHg, PaO2 44,2mmHg,HCO3 28,4mEq/l, laktati 2,8 mg/dl. Pacijentu jeordiniran inhalatorno salbutamol (β2-adrenergičkireceptor agonist), iv metilprednizolon, ivaminophilline, im epinefrin, iv magnezijum sulfat.Zbog teškog respiratornog distress-a i teške akutnerespiratorne acidize započeta je neinvazivnamehanička ventilacija (NIV) preko maske na licu saparametrima PEEP 5cm H20, FiO2 100%. Pacijent jedobro tolerisao NIV. Rentgen pluća pokazivao jepojačan bronhovaskularni crtež, bez plućnih izliva,kardiovaskularni profil normalan. Posle 30min.NIV-a gasne analize krvi: pH 7,22, PaCO2

66mmHg, PaO2 110mmHg, SpO2 99%, vitalni

parametri stabilni. Nastavljena je NIV sasmanjenim FiO2 50% i posle 3 sata gasne analizearterijske krvi su pH 7,37, PaCO2 45mmHg, PaO2

87, HCO3 25,4. Pcijent je prebačen na odeljenjepulmologije gde mu je postavljen nazalna kanila saO2 4L/min i nastavljena terapija bronhodilatatorimai steroidima. Pacijent je 6 dana nakon prijemaotpušten iz bolnice u dobrom opštem stanju.Rezultati: Primarno i glavno kod asmatičnihpacijenata je poboljšanje ventilacije i oksigenaciješto je kod našeg bolesnika postignuto. Za vreme(MV-NIV) kod pacijenta su praćeni parametri ugasnim analizama iz arterijske krvi, koji su pokazalipoboljšanje te nije bilo potrebe za invazivnommehaničkom vetilacijom (MV-IV).Zaključak: U teškom asmatičnom napadu, smrtnostje praćena asfiksijom za vreme pogoršanjarespiratornog distress-a. To je uzrokovano “airtrapping-zarobljenim vazduhom” u alveolama ismanjenom ventilacijom koja je praćenahipoksijom i acidozom. Često poznati okidači supsihički stres, način života, pušenje, gojaznost,alergeni itd.Ključne reči: asthma, respiratorna slabost,mehanička ventilacija (MV-NIV)


Neoperativni tretman tupe povrede bubregakod dece-prikaz slučajaZ.Jovanović, A.Slavković, M.Bojanović

Klinika za dečiju hirurgiju i ortopediju KC Niš, Srbijae-mail adresa autora:[email protected]

Uvod: Genitourinarne povrede u 50% uključujububreg, a u 90% slučajeva uzrok je tupaabdominalna trauma. Osnovni cilj lečenja ovihpovreda je da se maksimalno očuva funkcionalniparenhim bubrega i smanji stopa morbiditeta.Paralelno sa napretkom radiološke dijagnostike ihemodinamskog monitoringa, razvijaju se skoringsistemi koji doprinose da se sve uspešnijeprimenjuju metode neoperativnog lečenja radirenalne prezervacije. Neoperativni tretman, takođeštedi pacijenta od ponovljene hemoragije ihemodinamske nestabilnosti. Modaliteti lečenja suureteralni stenting i perkutana drenaža.




Cilj: prikaz renalne povrede lečene retrogradnimureteralnim stentingom.Prikaz slučaja: 13-togodišnja devojčica povređenapadom niz stepenište, upućena iz drugog ZC, zbogperzistentne hematurije i povraćanja, preko 20 puta.Status na prijemu: svesna i aktivno pokretna, trbuhmek, bolna osetljivost u levoj lumbalnoj regiji.Laboratorijska dijagnostika: KKS: nalaz uredan (Ht36). U urinu: masa svežih eritrocita. Svi biohemijskiparametri uredni. Ultrazvuk na prijemu:subkapsularni hematom levog bubrega. CT nalaz:Konkvasacija i ruptura donjeg pola levog bubrega,subkapsularni, intraparenhimski i perirenalnihematom. Terapija: cistoskopski, u opštoj anestezijiretrogradnim pristupom u levi orificijum ureteraplasiran JJ stent, a pozicija njegovog proksimalnogdela u pijelonu levog bubrega potvrđenaradiografski i ultrazvučno. Dalji konzervativnitretman podrazumeva antibiotsku i antimikotskuTh, rehidrataciju, korekciju elektrolitnogdisbalansa, analgeziju, primenu SSP I opraniheritrocita, radi korekcije niskih vrednostihematokrita. EHO nalaz nakon sedam dana:Regresija subkapsularnog i perirenalnog hematoma,regresija slobodne tečnosti intraperitonealno. Trinedelje nakon povređivanja: Levi bubregvoluminozniji, hematom u skoro potpunojresorpciji. Statička scintigrafija (DMSA), nakon dvenedelje od povređivanja odsutno intrakortikalnonakupljanje radiofarmaka u distalnoj trećini levogbubrega, što odgovara ožiljnoj promeni.Distribucija: desno 59%, levo 41%. DTPA. Trinedelje od povređivanja: Levi bubreg smanjenogkraniokaudalnog dijametra, očuvanih kontura. Udonjoj trećini manja foton deficijentna zona. Pratećiradiorenogram je na nešto nižem nivou od desnog,pokazuje uredan dotok radiofarmaka, brzparenhimski tranzit i brzu i pravilnu eliminaciju.Oba bubrega se prikazuju simetrično i dobrimintenzitetom u vaskularnoj i parenhimskoj fazi. Ufazi eliminacije nema značajne retencije.Pojedinačno učešće bubrega u globalnoj funkciji jelevog 44%, desnog 56%. Nakon 27 dana devojčica jeotpuštena na kućno lečenje, bez mikrohematurije,bez bolova. Sprovode se redovne kliničke iultrazvučne kontrole. Povrede bubrega kod deceimaju svoje specifičnosti obzirom na anatomskekarakteristike: veći bubrezi u odnosu na veličinutela, slabije razvijeno perirenalno masno tkivo ikapsula, slabo okoštali grudni koš, veća mobilnost.

Uobičajeni staging na V stepena povreda određujepostupak: Od I do III- konzervativni, V uglavnomhirurški a IV je predmet kontroverzi.Retrospektivne studije pokazuju da kod decekonzervativni tretman može biti bezbedan i zastepene IV i V. Kod naše pacijentkinje od presudnevažnosti je bila hemodinamska stabilnost. Dobrestrane interne drenaže: dete ne nosi kateter, urinkesu, manji je rizik od infekcije, i socijalnoprihvatljivija. Moguće komplikacije: opstrukcija,infekcija i hiprertenzija su retke. Za ekstrakcijustenta potrebna je još jedna opšta anestezija.Zaključak: endoskopski tretaman tupe povredebubrega kod dece IV stepena može biti uspešan ibezbedan i dovesti do značajne rezolucije i očuvanjabubrežne funkcije.Ključne reči: trauma, bubreg, neoperativni tretman


Sinkopa kod dece i adolescenata - urgentnostanje ili ne?LJ.Šulović, J. Živković, D.Odalović, Z.Živković,S.Filipović-Danić

Medicinski fakultet Priština u Kosovskoj Mitrovici, Srbijae-mail adresa autora:[email protected]

Uvod: Sinkopa je iznenadni kratkotrajni gubitaksvesti udružen sa gubitkom mišićnogtonusa.Pacijenti sa sinkopom čine 6-7% svihhospitalizovanih bolesnika, odnosno 3-6%urgentnih prijema. Potencijalno smrtonosana,sinkopa stvara veliki strah kod roditelja, pacijenata ilekara, pa se deca često izlažu nepotrebnom i čestodugotrajnom kliničkom ispitivanju.Cilj rada je: da se prikaže značaj anamnestičihpodataka i praćenja smernica za indetifikacijuuzroka sinkope i stratifikaciju rizika, odnosnorazlikovanje potencijalno smrtonosnih odbezazlenih.Materijal i metodologija: U radu suretrospektivnom analizom obuhvaćana deca uzrastaod 6 meseci do 18 god, koja su u petogodišnjemperiodu (od juna 2010g. do juna 2015g) zbogkratkotrajnog gubitka svesti pregledana ihospitalizovana u Dečjoj bolnici KBC Priština u



Gračanici. Dijagnoza bolesti postavljana je naosnovu dobro uzetih anamnestičkih podataka idetaljnog opisa kvaliteta napada, detaljnogfizikalnog pregleda i rutinskih laboratorijskihanaliza: (KKS, glikemija, standardni EKG).Dopunska ispitivanja su selektivno rađena: HolterEKG/a, Test opterećenja, Tilt table test,Ehokardiogram, NMR, EEG.Rezultati rada: U petogodišnjem periodu sasimptomima kratkotrajnog gubitka svesti primljenoje 116-toro dece ili 6,4% od ukupnohospitalizovanih. Prosečni uzrast dece iznosio je12,2 godine (najčešće uzrasta od 15-18 godina).Postoji statistička značajnost javljanja sinkope uodnosu na pol, devojčice 61.8%, dečaci 38,8 % (p<0.01). Etiološki sinkopa je podeljena u 3 grupe, uokviru kojih je napravljeno više podgrupa. Uzroksinkope je identifikovan kod 88/116 ili 75,8%pacijenata. Kardijalni uzrok sinkope je statističkiznačajno najređi, p<.001. Autonomni uzrok 70,4%;Nekardijalni 27,2%; Kardijalni 2,3%; Vazovagalna52%; Neurološka 42,4%; Kardiomipatija 50%;Ortostatska sinkopa 25%; Psihička 38,4%;Poremećaji ritma 50%; Situaciona sinkopa 13%;Afektivne repetitivne krize 7,7%; Pojačan vagusnitonus 10%; Metaboličke 11,5%. Najveći broj deceimao je samo jedan napad. Najveći broj napada je 5i javio se kod dvoje dece.Zaključak: Najveći broj sinkopa u dece je benigneprirode. Kardijalna sinkopa je retka ali potencijalnonajopasnija. Praćenje dijagnostičkih protokola zaispitivanje sinkope je najbrži put do dijagnoze,stratifikacije rizika, smanjenja straha iracionalizacije troškova.Ključne reči: sinkopa, deca, uzroci, rizik


Infekcije nuhealne regije pacijenata sakomorbitetomM.Mrvaljević1, S.Pajić2, T.Boljević3, M.Božić4, Z.Pešić5,I.Bogdanović2, J.Arsov2

1.KCS Urgentna hirurgija,Beograd, Srbija2.KCS Klinika za neurohirurgiju i neurotraumatološkicentar Urgentnog centra, Beograd, Srbija3.KC Podgorica,Klinika za maksilofacijalnu hirurgiju,Crna Gora4.Medicinski fakultet u Nišu, Srbija5.Medicinski fakultet u Nišu,Klinika za maksilofacijalnuhirurgiju, Srbijae-mail adresa autora: [email protected]

Uvod: Nuhealna regija prestavlja zonu koja jeodlična osnova za nastanak furunkuloze ikarbunkuloze, a naročito znaju da budu ispoljenekod pacijenata opterećenih komorbitetom različitemanifestacije. Gotovo unoiformno, tretiraju sejednostavnim ili krstastim incizijama, drenažom iodgovarajućom antibiotskom terapijom. Kodpacijenata sa održanim imunobiološkim statusomto je najčešće i dovoljno. Međutim, preporučenahirurško-medikamentozna terapija najčešće nezadovoljava u slučajevima oslabljenogimunobiološkog statusa, tipično kod dijabetičara,kada se banalna infekcija komplikuje flegmonom.Cilj: Prikazati načine našeg sagledavanja oveproblematike u svetlu iznalaženja optimalnoghirurškog rešenja za ovu vrstu pacijenata koji sunam se obratili za pomoć.Metod: U periodu od 7 godina (2008/2015.) lečenihu Urgentnom centru bilo je 13 bolesnika-dijabetičara sa karbunkulozom nuhealne regijekomplikovanom flegmonom. Veći deo bolesnika,njih 9, znao je za svoj dijabet i bio najčešće podinsuficijentnom dijabetičkom terapijom idijetetskim režimom. Kod ostalih dijabet jeregistrovana pri prijemu na bolničko lečenje i tektada se započelo sa terapijom. Zbog opsega iinteziteta inflamatornog procesa, u najvećem brojuslučajeva 10 bolesnika je tretirano opsežnimekcizijama kože, fascija i dela muskulatornog tkivanuhealne regije, uz višestruko raslojavanje mišićnogtkiva u cilju drenaže.Rezultati: Postoperativno je primenjivanavišekratna dnevna toaleta rane sa više antiseptika u




istoj seansi, maksimalne doze antibiotika poantibiogramu, energična roborantna terapija, odtrećeg dana hospitalizacije pacijenti su bili izloženiaktivnom O2–u u barokomori, korekcija ibalansiranje antidijabetičke terapije. Po regresijiinflamatornog procesa i dobijanju zdravihgranulacija, ranjava površina tretirana je Tiršovimtransplantatom.Zaključak: Postignutim postupcima postignuto jeizlečenje kod 12 bolesnika (93%). U jednom slučajupostignuto je lokalno izlečenje, ali je bolesnikegzitirao 9 meseci od početka lečenja zbogmilijarnih pulmonalnih apscesa kao posledica sepsekoja se javlja 12.dan po hospitalizaciji. Prosečnovreme lečenja iznosilo je 19.dana.Ključne reči: nuhealna regija, furunkuloze,karbunkuloze, infekcije


Mesto i značaj traheotomije kod pacijenata sakraniofacijalnim povredamaS.Pajić1, J.Arsov1, I.Bogdanović1, B.Olujić2, D.Jovanović2,T.Boljević3, M.Mrvaljević2, M.Božić4, Z.Pešić5, I.Nikolić6,M.Jokić6

1KCS Klnika za neurohirurgiju i neurotraumatološkicentar Urgentnog centra,Beograd, Srbija2KCS Urgentna hirurgija,Beograd, Srbija3KC Podgorica,Klinika za maksilofacijalnu hirurgiju,Crna Gora4Medicinski fakultet u Nišu, Srbija5Medicinski fakultet u Nišu,Klinika za maksilofacijalnuhirurgiju, Srbija6KCS Centar za radiologiju i magnetnu rezonancu,Beograd, Srbijae-mail adresa autora:[email protected]

Uvod: Veličina traumatske sile koju primapolitraumatizovani pacijent je zastrašujuća, kojauveliko prelazi minimalnu silu potrebnu za prelomesvakog pojedinog dela facijalnog skeleta iendokranijuma. Ove ekstenzivne traumatske silesmrskavaju kosti. Udruženo dolazi do destruktivnihpromena na kožnom omotaču i mekimstrukturama, sa vrlo često impresivnim obilnimhemoragijama, hematomima i svud prisutnimedemima u prvih 48 sati.

Cilj: Prikazati rane i kasne indikacije kojima serukovodimo u odluci za traheotomiju, prikazatinaša iskustva.Metod: Kod svih obimnih fraktura srednjeg masivalica kompromitovan je vazdušni put usleddislokacije frakturisanih segmenata i edema mekihtkiva. Na bolesničkom materijalu lečenih pacijenatau Intezivnim negama Urgentne hirurgije ineurotraumatologije Urgentnog centra u Beograduza period 01.januar 2014 do 01.januara 2015.godinebilo je 250 pacijenata sa kraniofacijalnimpovredama u okviru politraumatizma. Sprovodilismo rane i odložene traheotomije, kako je nalagalotrenutno opšte stanje pacijenta i njegova GlasgowComa Skala.Rezultati: Kod takvih pacijenata nekada može seplasirati nazofaringealni gumeni air way, dok koddrugih indikovana je intubacija ili još češćeurgentna traheotomija. Ponekad razlogopstrukcijama disajnih puteva bio je: polomljenizubi, aspirirana krv, protetska nadoknada, delovikosti. Za posmatrani period broj pacijenata sakraniofacijalnim povredama u Urgentnom centrubilo je 250 bolesnika, a od tog broja kod njih100(40%) indikovana je traheotomija, urgentnihtraheotomija bilo je 29(29%), a kod komatoznih idugoležećih pacijenata urađeno je 48(48%) ovihintervencija, dok je kod 23(23%) bolesnika urađenou terapijsku svrhu. Od ovog brojapolitraumatizovanih izlečeno je i otpušteno kući223(89,2%), sa potrebom za dalje lečenje u neki odrehabilitacionih centara poslato 14(5,6%) i umrlo13(5,2%).Zaključak: Zbrinjavanje vazdušnih puteva jenajbitnija primarna mera kod pacijenata koji supretrpeli visokoenergetske povrede lica iendokranijuma. Pacijenti sa udruženim povredamaglave, naročito kada su bez svesti, treba da suintubirani u sklopu inicijalnog zbrinjavanja. Kodžestokih midfacijalnih povreda dolazi doznačajnijih poremećaja anatomije, tako daintubacija može da bude izuzetno teška kodpacijenta koji aktivno krvari, u urgentnimsituacijama, kada su ugroženi vazdušni putevi, aintubacija ne uspeva, bez odlaganja se izvoditraheotomija. Kod visokoenergetskih povreda kojesu uslovile kompleksne povrede kraniofacijalnogspoja, srednje trećine lica ili multifrgamentarneprelome donje vilice indikovana je ranatraheotomija, gde se očekuje dramatičan edem lica



tokom prvih 48 sati,a istovremeno značajnopojednostavljuje definitivno hirurško zbrinjavanje.Ključne reči: traheotomija, urgentna traheotomija,kraniofacijalne povrede, visokoenergetske povrede,politrauma


Miksni tumor u submandibularnojpljuvačnoj žlijezdiS.Pajić1, J.Arsov1, I.Bogdanović1, B.Olujić2, D.Jovanović2,T.Boljević3, M.Mrvaljević2, M.Božić4, Z.Pešić5, I.Nikolić6,M.Jokić6

1KCS Klnika za neurohirurgiju i neurotraumatološkicentar Urgentnog centra, Beograd, Srbija2KCS Urgentna hirurgija, Beograd, Srbija3KC Podgorica,Klinika za maksilofacijalnu hirurgiju,Crna Gora4Medicinski fakultet u Nišu, Srbija5Medicinski fakultet u Nišu,Klinika za maksilofacijalnuhirurgiju, Srbija6KCS Centar za radiologiju i magnetnu rezonancu,Beograd, Srbijae-mail adresa autora:[email protected]

U submandibularnoj žlezdi Miksni tumor(adenoma pleomorphe) je redak tumor (5%).Znatno češći je u drugim pljuvačnim žlezdama, anajčešći je benigni tumor pljuvačnih žlezda (45-74%). Najčešće se javlja u 4.i 5.deceniji, češće kodžena. Ovaj tumor ima sposobnost maligne alteracijeu 3-15% nakon 10-15 godina. Lečenje je hirurško.Cilj ovog rada je prikazati kliničko-patološkekarakteristike Miksnog tumora submandibularnihžlezde.Metod: Analizirali smo istorije bolesti 8 pacijenta saMiksnim tumorom submandibularne žlezde lečenihu periodu od 01. januara 2005. god do 31. decembra2014.god. u Klinici za Otorinolaringologiju iMaksilofacijalnu hirurgiju Kliničkog centra CrneGore.Rezultati: Miksni tumor je bio jedini benigni tumorsubmandibularne žlezde u navedenom periodu.Bilo je 5 pacijenata ženskog pola (62,5%), a 3muškog (37,5). Pacijenti su bili starosti od 37 do 57godina, a prosečna starost je bila 47. Ovi pacijenti sulečeni hirurški, tako što je tumor ekstirpiranzajedno sa submandibularnom žlezdom, što jeneophodno, jer tumoru u pojedinim mestima, iako

je benigan može kapsula da bude inkopletna, zbogrecidiva, a i mogućnosti maligne alteracije.Zaključak: Miksni tumor je redak tumor usubmandibularnoj žlezdi, češći kod žena i u petojdeceniji života. Potrebno je što bolje poznavanjekliničko-patoloških karakteristika ovih tumora,kako bi se pristupilo adekvatnom lečenju iunapredilo zdravlje ovih pacijenata.Ključne reči: Miksni tumor, submandibularnažlijezda, liječenje


Optimum upotrebljivosti kožnih graftovatipa ThierschT.Boljević1, S.Pajić2, J.Arsov2, I.Bogdanović2, B.Olujić2,D.Jovanović2, M.Mrvaljević2, M.Božić3, Z.Pešić4,I.Nikolić6, M.Jokić6

1KCS Klnika za otorinolaringologiju i maksilofacijalnuhirurgiju KC Podgorica, Crna Gora2KCS Klnika za neurohirurgiju i neurotraumatološkicentar Urgentnog centra, Beograd, Srbija3KCS Urgentna hirurgija, Beograd, Srbija4Medicinski fakultet u Nišu, Srbija5Medicinski fakultet u Nišu,Klinika za maksilofacijalnuhirurgiju, Srbija6KCS Cenar za radiologiju i magnetnu rezonancu,Beograd, Srbijae-mail adresa autora:[email protected]

Uvod: Najpopularniji i najčešće korišćeni zakratkotrajno čuvanje graftova je kozerviranje istih ustandardnom hladnjaku na temperaturi od +4C.Potrebe za tako čuvanim graftovima se kreće odjednog dana, pa do i posle mesec dana od uzimanjatransplantata. Prema literaturi upotrebljivost istihkreće se od 10 dana do 21 dan.Cilj u želji da preciznije odredimo vreme do kog jeupotrebljivost ovako konzerviranih graftovasigurna, izvršili smo ispitivanje sa 50 uzoraka naovaj način konzervisanih transplantata tipaThiersch.Metod: na bolesničkom materijalu Urgentnogcentra intezivne nege njih 5 uz njihov pristanakuzeti su delovi kože veličine 3x5cm, i to su uzimaniprilikom operativnih zahvata, konzervisani su nauobičajeni način i po određenom periodu testiraniklinički i histološki. Počev od 11.tog dana, po 5




preparata je bilo deljeno na dva dela, od kojih jejedan aplikovan na pogodnu površinu zaprihvatanje transplantata, dok je drugi plasiran uformalin i poslat na HP analizu. Potom je pravljenaserija od po pet preparata u okviru koje je svakojsledećoj produžavan period konzervacije za po 1dan duže, zaključno sa 20tim danom.Retultati i Zaključak: Rezultati kliničkog ihistološkog ispitivanja su saglasni i predstavljenitabelarno. Upotrebljivost iznad 50% konzerviranihtransplantata se nalazi do 17 dana kodkonzerviranja, a potom pada. Tako gledano mogućeje da neki transplantat bude upotrebljen i 30 danaod konzerviranja, ali je to izuzetak, a ne uobičajenostanje.Ključne reči: transplantat kože,Thiersch


Rekonstruktivne mogućnosti u zatvaranjusakrokcigealnih dekubitalnih ulceracijaM.Mrvaljević1, S.Pajić2, T.Boljević3, M.Božić4, Z.Pešić5,I.Bogdanović2, J.Arsov2

1KCS Urgentna hirurgija, Beograd, Srbija2KCS Klinika za neurohirurgiju i neurotraumatološkicentar Urgentnog centra, Beograd, Srbija3KC Podgorica, Klinika za maksilofacijalnu hirurgiju,Crna Gora4Medicinski fakultet u Nišu, Srbija5Medicinski fakultet u Nišu, Klinika za maksilofacijalnuhirurgiju, Srbijae-mail adresa autora: [email protected]

Uvod: Sakrokokcigealne dekubitalne ulceracije suobično prve dekubitalne rane koje se stvaraju ubolesnika vezanih za dugotrajno nepomično ležanjeu postelji. Odatle njihova učestalost i ekstenzivnost.Nalaze se kako kod plegičnih bolesnika tako i kodteških hirurških i hroničnih bolesnika. Osnovunjihovog hirurškog lečenja čini ekcizijadevitalizovanih nekrotičnih i ožiljno izmenjenihmekih tkiva ulceracije i periostitisom i osteitisomzahvaćenih delova kosti sa dna ulceracije izatvaranje defekta kvalitetnim mekotkivnimpokrivačem.Cilj: naći optimalno rešenje za vrlo aktuelanproblem dugoležećih pacijenata sa ispoljenim

dekubitalnim ulceracijama različitog stepena iobima.Metod: Na Kliničkom materijalu pacijenata koji senalaze u Hirurškim intezivnim negama Urgentnogcentra sa stanjima kome, plegije ili kvadriplegijekoji su opservirani za period od 01.januar 2013 do01.januar 2015. bilo je 46 pacijenata od toga 21ženskog pola i 25 muškog, starosne dobi u rasponuod 29-83.god. Pacijenti koji su zahtevali opsežnijitretman bilo ih je 11. Klasično rešavanje ovihdefekata rotacionim režnjem nosi rizikkomplikacija delimične nekroze vrhova režnjeva,kao i nesrastanja režnjeva za podlogu zbog stvaranjavelikih potkožnih džepova ispunjenih hematomom,seromom ili inficiranim sadržajem.Rezultati i zaključak: Miokutani gluteus maksimusrežnjevi predstavljaju nesumnjiv napredak uzatvaranju ovih rana. Horizontalni klizajućiostrvasti miokutani gluteus maksimus režanjprihvaćen je u našoj praksi zbog svojih brojnihkvaliteta. Ovaj režanj se relativno jednostavnoplanira, odiže i mobiliše odvajanjem mišića dužnjegove medijalne insercije za sakralnu ikokcigealnu kost i duž njegove gornje ivice, štoomogućava njegovo klijanje preko srednje linije.Sekundarni defekt zbrinjava se V-Y postupkom.Režanj je vitalan u svim svojim delovima.Mobilizacijom dva režnja mogu se zatvoritiekstenzivno veliki defekti. Defekti se zatvaraju u trisloja, a regija izložena hroničnom pritisku pokrivamišićem i kožom pune debljine. Dovođenjem ovihdobro prokrvljenih tkiva pozitivno utiče i nasaniranje lokalne infekcije. Ove režnjeve smoupotrebljavali i kod pokretnih–neplegičnihbolesnika bez remećenja funkcije, budući da ostajeočuvana inervacija, vaskularizacija i funkcionalniintegritet mišića.Ključne reči: dekubitalne ulceracije,rekonstruktivni zahvati, Sakrokokcigealni predeo




Naša iskustva u liječenju prelomazigomatiko-maksilarnog kompleksa,zigomatične kosti i poda orbiteT.Boljević1, S.Pajić2, J.Arsov2, I.Bogdanović2, B.Olujić2,D.Jovanović2, M.Mrvaljević2, M.Božić3, Z.Pešić4,I.Nikolić6, M.Jokić6

1KCS Klnika za otorinolaringologiju i maksilofacijalnuhirurgiju KC Podgorica, Crna Gora2KCS Klnika za neurohirurgiju i neurotraumatološkicentar Urgentnog centra, Beograd, Srbija3KCS Urgentna hirurgija, Beograd, Srbija4Medicinski fakultet u Nišu, Srbija5Medicinski fakultet u Nišu, Klinika za maksilofacijalnuhirurgiju, Srbija6KCS Cenar za radiologiju i magnetnu rezonancu,Beograd, Srbijae-mail adresa autora: [email protected]

Uvod: Zigomatična kost je bočno najisturenija kostlica i zato su prelomi drugi po učestalosti (8-20%),odmah nakon preloma nosa. Najčešći uzrocipreloma su tuče, padovi, saobraćajni udesi, kao isportske povrede.Cilj: osnovni cilj je bio procjena učestalosti prelomazigomatikomaksilarnog kompleksa, zigomatičnekosti i poda orbite, praćenje učestalosti po polu iuzrastu, kao i etioloških faktora i izbora liječenja, asve u cilju što boljeg zbrinjavanja ovih pacijenata.Metod: U periodu od 3 godine, ispitivano je 126pacijenata sa prelomom zigomatko-maksilarnogkompleksa, zigomatične kosti i poda orbite liječenihu Klinici za ORL i MFH KCCG. Praćeni sudemografski, etiološki i klinički podaci kao iradiološka ispitivanja, hirurška terapija ipostoperativne komplikacije uz statistički obradupodataka.Rezultati: Povrede su bile češće kod muškaraca, utrećoj i četvrtoj deceniji. Najčešći etiološki faktorbio je nasilje, potom saobraćajni udes, zades i sport.U kliničkoj slici su dominirali: deformiteti lica,parestezija u inervacionoj zoni n.Infraorbitalisa,diplopije i ograničeno otvaranje usta. Prosečanperiod od povređivanja do prijema u bolnicu bio je2 dana a od povredjivanja do operativnog lečenja 4dana. Najčešći hirurški pristup bio je subcilijarnimrezom.

Zaključak: Prelomi zigomatiko-maksilarnogkompleksa, zigomatične kosti i poda orbite su češćikod muškaraca, najčešće nastaju u nasilju. Hirurškoliječenje je u većini slučajeva neophodno.Neadekvatna procjena povrede vodi neadekvatnomliječenju, što ima za posljedicu loš kozmetskirezultat ili problem sa vidom.Ključne reči: zigomatiko-maksilarni kompleks,prelomi, zigomatična kost


Cerviko-medistijalni hematom kompresijaopasna po život pacijentaB.Olujić1, Z.Lončar1, S.Pajić1, P.Savić1, D.Jovanović1,G.Kaljević1, T.Boljević2, M.Mrvaljević1, M.Đorđević3,M.Božinović3, Z.Pešić4, I.Nikolić5, M.Jokić5

1KCS Urgentna hirurgija, Beograd, Srbija2KC Podgorica, Klinika za otorinolaringologije imaksilofacijalne hirurgije, Crna Gora3KCMedicinski fakultet u Nišu, Srbija4Medicinski fakultet u Nišu, Klinika za maksilofacijalnuhirurgiju, Srbija5KCS Centar za radiologiju i magnetnu rezonancu,Beograd, Srbijae-mail adresa autora:[email protected]

Uvod: Spontano nastali hematom na vratu(cervikalno-medijastinalni hematom) uzrokovanrupturom ekstrakapsularno paratiroidnih žlezdajavlja se vrlo retko. Ne postoje standardni pristup ipostupak tretmana već je to posebnost svakogpojedinačnog slučaja.Cilj: Želeli smo da ukažemo na ovaj retke slučajevespontanog cervikalno-medijastinalnog hematomagde je došlo do krvarenja iz paratiroidnog adenoma,koji je otkriven kod do tada apsolutno zdravihpacijenata.Metod: Radi se o 5 bolesnika, mlađeg životnog doba29-38.godina, od toga 2 žene i 3 muškarca. Svi suhospitalizovani u 2 sata nakon manifestacije bolesti,žaleći se na bol u vratu i utrnulost jedne stranevrata. Indirektnom laringoskopijom: postojala jepareza na jednoj od strana glasnica. Biohemijskaanaliza krvi ukazala na povećani nivoparatitiroidnih hormona u odnosu na normalnevrednosti 12-15 puta više, dok je vrednostjonizovanog kalcijuma neznatno uvećana.




Simptomi kompresije organa vrata akutno su seispoljili između 5 i 7og sata po hospitalizaciji.Rezultati: Svi pacijenti su operisani sa evakuacijomhematoma gde se uočilo aktivno arterijskokrvarenje. Histološkim pregledom otkrili su sefragmenti paratireoidnog adenoma u hematomu.Pozitivna dinamika oporavka uočena je tokom 12sati od sprovedene protiv zapaljenske terapije iizvršene intervencije. Analizom se pokazalo da jenivo jonizovanog kalcijuma u krvi bio normalan i to24 sata nakon operacije. Pacijenti su redovnokontrolisani, 6 meseci nakon operacije nisu imalidisphagiju, kvalitet glasa je bio netaknut, a disanjebez ograničenja. Nivo paratiroidnih hormona u krvikretao se u granicama referentnih vrednosti.ZAKLJUČAK: Retkost ove patologije i varijabilnostlečenja ne dozvoljavaju da se izabere jedinstveniuniformni medicinski i dijagnostički protokol. Našislučajevi pokazuju da radikalna korekcijaprimarnog hiperparatireoidizma, evakuacijahematoma i vlaknaste kapsule uz očuvanje štitnežlezde je moguće u uslovima napetosti zbogcervikalno-medijastinalnog hematoma sa upalnimprocesom u području gde je ispoljeno krvarenje.Ključne riječi: Parathiroidna žlezda, akutne bolestivrata, ekstrakapsularno paratiroidno krvarenje,hiperkalcijemija.


Razlozi poseta Urgentnom centru pacijenatau postooperativnom periodu onih koji suoperisali štitnu i paraštitne žlezdeB.Olujić1, Z.Lončar1, S.Pajić1, P.Savić1, D.Jovanović1,G.Kaljević1, T.Boljević2, M.Mrvaljević1, M.Đorđević3,M.Božinović3, Z.Pešić4, I.Nikolić5, M.Jokić5

1KCS Urgentna hirurgija, Beograd, Srbija2KC Podgorica, Klinika za otorinolaringologije imaksilofacijalne hirurgije, Crna Gora3KCMedicinski fakultet u Nišu, Srbija4Medicinski fakultet u Nišu, Klinika za maksilofacijalnuhirurgiju, Srbija5KCS Centar za radiologiju i magnetnu rezonancu,Beograd, Srbijae-mail adresa autora:[email protected]

Uvod: Pregledom literaturnih podataka nemaadekvatne evaluacije pitanja postoperativnihkomplikacija lečenih unutar 30 dana nakon

operacija tireoidne i paratireoidnih žlezda opisanihkroz komplikacije. Nedostaje među literaturom opispostoperativnog stanja koja zahtevaju evaluacije uokviru urgentne hirurgije pacijenata koji su prošlioperaciju ovog entiteta. Ova pitanja su važna jerutiču na ukupne troškove i efikasnost brige opacijentu. U ovom radu biće prikazan brojbolesnika koji su zbog tegoba imali za potrebu da sejave Urgentnom centru tokom postoperativnihprvih 30 dana. Razlozi za evaluaciju su biliraznovrsni, ali značajan broj odnosio se naporemećaje elektrolita. Uz izuzetak pacijenata kojisu podvrgnuti lobektomiji, svi pacijenti su počeli sanadoknadom deficita kalcijuma postoperativno, alikoličina, vrsta, kao i stopa usklađenosti je varirala, atime i ovaj faktor nije ocenjen. Nivo magnezijumasmo povremeno testirali i retko je postojala potrebaza njegovom dopunom jer nismo dijagnostikovalinjegov manjak. Velik broj pacijenata koji su sejavljali zbog parestezija, a imali su normalni nivojonizovanog kalcijuma sa hipomagnezemijumom ilibez detektibilne abnormalnosti njihovih seruma sasadržajem kalcijuma i magnezijuma. Pacijenti kojisu uzimali inhibitore protonske pumpe (PPI) upostoperativnom periodu bili su statistički češćejavljali od onih koji ne uzimaju ovaj lek.Ciljevi rada: opisati pacijente kojima je potrebnaevaluacija kroz Urgentni centar u roku od 30 danaod dana tiroidektomije ili paratroidektomije injihovih povezanih faktora rizika.Materijal i metode: Retrospektivna studijapacijenata starosti od 42.-79.godina koji su bilipodvrgnuti tiroidektomiji ili paratiroidektomiji uperiodu od 01.01. 2010.god do 01.01. 2015.god.uzetih iz baze medicinskih istorija bolestiUrgentnog centra KCS. To su pacijenti izpostoperativnog perioda koji su javili u prvih 30dana nakon operacije, za rad su odabrani ikomparirani podacima sa kontrolnom grupompacijenta koji su imali identične operacije a nisuimali za potrebu i hitnost javljanja. Demografskipodaci prikupljeni uključuju starost, pol, indekstelesne mase (BMI). Kliničke karakteristike cenilismo kroz vrstu operacije, korišćenje inhibitoraprotonske pumpe (PPI) kao i izraženih medicinskihkomorbiditeta, kao što su dijabetes mellitus,hipertenzija, bubrežne bolesti i gastroezofagealnirefluks. Pratili smo vreme javljanja Urgentnomcentru u odnosu na datum operacije. Laboratorijskevrednosti za kalijum, jonizovani kalcijum, fosfor,



magnezijum. Sve analize provedene su pomoćuSPSS softvera, verzija 21.0.Rezultati: Glavni rezultati i mere statističke analizeocenili smo kroz udruženost demografskih ikliničkih karakteristika između pacijenata kojizahtevaju evaluaciju u Urgentnom centru i onihkoji nisu. Kliničke karakteristike ocenjene su krozvrstu operacije, medicinske komorbiditete ikorišćenje inhibitora protonske pumpe (PPI).Takvih je bilo 263 identifikovanih bolesnika, 72pacijenta imali su potrebu da se jave Urgentnomcentru, uključujući parestezije (n = 19), ranekomplikacije (n = 7) i slabost (n = 5). Bilo jepetnaest hospitalizacija radi lečenja raznihpostoperativnih komplikacija. Značajna povezanostnađena je između prisustva dijabetesa (P = 0,03),gastroezofagealnog refluksa kao oboljenje (P =0,04), a trenutna upotreba inhibitora protonskepumpe (IPP) (P=0,03). Kod kontrola za dijabetes igastroezofagealni refluks kao oboljenja, otkrili smoda je kod pacijenata koji su uzimali inhibitoreprotonske pumpe (PPI) 1,81 puta postojala većašansa za javljanje nego kod pacijenata koji nisuuzimali IPP (P=0,04). To odgovara stopi od 11%javljanja radi evaluacije unutar prvih 30 dana nakonoperacije štitne žlezde ili paratireoidne operacije,ako je bilo veći broj poseta nismo uzimali to u obzir.Zaključak: Kod uzimanja IPP 1,81 je puta većašansa da zatraže pomoć. Ovaj rad opisuje faktorerizika koji povećavaju verovatnost za javljanje uroku od 30 dana nakon postoperativnetiroidektomije i paratiroidektomije, a iznosimoneke njihove razloge za javljanje i neke od nalaza oovoj grupi pacijenata. Ovaj problem je sve viševezan za ishod primenjenih mera, čime se smanjujeneočekivana potreba za zdravstvenom zaštitom upostoperativnom periodu koja je od suštinskogznačaja. Takođe, rad opisuje razloge za hitnajavljanja Urgentnom centru i vrednovanje i prikazstope javljanja ovih pacijenata u bolnicu, a značajnifaktori rizika za remisiju u postoperativnomperiodu.Ključne reči: hitnost javljanja, postooperativniperiod, tiroidectomia, parathyroidectomia,inhibitor protonske pumpe


Akutni akalkulozni holecistitisS.Mitrović, G.Živković, B.Radisavljević, R.Krstić


Uvod: Akutni akalkulozni holecistitis predstavljaoko 5-10% svih slučajeva akutnog holecistitisa.Češće se javlja kod hospitalizovanih bolesnika, aređe se sreće u ambulantnim uslovima.Cilj rada je da ukaže na značaj ponavljanja brzih,neinvazivnih dijagnostičkih procedura kod akutnogbola u abdomenu.Metode i material: Opservacioni protokol bolesnikaZavoda za hitnu medicinsku pomoć, otpusne listehiruških klinika.Prikaz bolesnika: Muškarac, star 45 godina, dolazina pregled u ambulantu hitne pomoći 12. decembra2014 godine zbog bola u gornjim partijama trbuha,praćen mučninom i povraćanje. U ličnoj anamnezinavodi operaciju desnostrane ingvinalne kile islepog creva. Tegobe su počele na službenom putu11.decembra 2014 godine, zbog kojih je primljen naodeljenje hirurgije najbliže bolnice. Uvidom umedicinsku dokumentaciju, saznajemo da su naprijemu i ponavljane laboratorijske analize,rendgengrafija i ultrazvuk abdomena bili urednognalaza. Tretiran infuzionim rastvorima,antibioticima, spazmoliticima i opoidnimanalgeticima. Bolovi su kupirani i isključeno jeakutno hiruško oboljenje. Otpušta se u dobromopštem stanju. Pri našem pregledu abdomenpalapatorno bolno osetljiv u epigastrijumu, poddesnim rebarnim lukom i donjem desnomkvadrantu. Ponavljamo hematološke analize iultrzvuk abdomena. Hematološke analize pokazujuumerenu leukocitozu sa granulocitozom.Eho abdomena: Žučna kesa disteditana, blagozadebljanog zida. Intraluminalno je nehomogeniehogeni sadržaj bez znakova za kalkulozu(suspektan empijem). Cirkularno, oko cele žučnekese prisutna je veća količina periholecističnetečnosti (periholecystitis). Pozitivan Murphy-evznak. Mokraćna bešika puna bez nagona namokrenje (retentio urinae).Upućen pod dg. Abdomen acutum u Urgentnicentar hirurgije Kliničkog centra Niš gde je istog




dana operisan (Dg: Abdomen acutum. Cholecystitisacuta gangrenosa perforativa. Peryholecistitis.Peritonitis diffusa, Appendicitis acuta consecutiva.)Diskusija i zaključak: Odlaganje dijagnoze u vrloretkom akalkuloznom holecistitisu povećava stopusmrtnosti, jer se često ne prepoznaje u početnoj fazizbog odsustva žučnih kamenaca. Za dijagnozu ovebolesti sa visokim mortalitetom, ultrazvuk jemetoda izbora. Senzitivnost za akutni holecistitis je75% i može se često ponavljati zbog čega imaposeban značaj kod ovih bolesnika.Ključne reči: akalkulozni holecistitis, visokmortalitet, neinvazivna dijagnostika


Prikaz slučaja pacijenta sa nespecifičnomkliničkom slikom u akutnom infarktumiokarda (AIM)V.Lučković Mitić

Zavod za hitnu medicinsku pomoć Niš, Srbijae-mail adresa autora:[email protected]

Uvod: U najvećem broju slučajeva AIM kao vodećisimptom ima jak bol u grudima sa različitompropagacijom i uz druge pridodate simptome.Međutim u literaturi se navodi da do 10 % pacijentase pri prvoj prezentaciji doktoru javi sanaspecifičnim tegobama. U urgentnoj medicini,kontakt sa pacijentom je vremenski limitaran iukoliko se ne posveti pažnja, mogu se prevideti prvivažni simptomi.Prikaz slučaja: Pacijent K.N. star 58 god., pozivaHMP zbog mučnine, nesvestice i hladnogpreznojavanja. Poziv je primljen kao prvi redhitnosti i lekarska ekipa stiže u roku od 7 min odpoziva. Pacijent zatečen na krevetu, u sedećempoložaju, svestan, orjentisan, bled i hladnopreznojen. Žali se na vrtoglavicu, nestabilnost, namučninu. Na ciljano pitanje: „da li ima bol ugrudima“?- odgovara „kao da ima...ali nije siguran“.Na insistiranje potvrđuje da ima bol koji je slabijegintenziteta. Pri pregledu nalazimo sledeće vitalneparametre: TA 90/60mmHg; SF 75/min; SpO2 98%;glikemija 5,6mmol/L; norm TT. Disanje obostanovezikularno, bez propratnih šušnjeva. Nad srcem,akcija srca ritmična, nešto tiši srčani tonovi, šumove

ne čujem. Radi se ECG. Na ECG-u: sin ritamnormalna srčana osovina, ST elevacija 5-6mm u D2,D3 i avF; ST elevacija 3mm u V3-V5; ST depresija uD1, avL, V1 i V2, 2-3mm, Neg T u V6. Rade se desniodvodi gde se u V4 nalazi ST elevacija od 1,5 mm.Postavlja se dijagnoza Infarctus Myocardii parietesinferoposterioris cum Ventriculi Dextri. PostavljenaIV linija, postavljen ecg monitoring, započetaterapija: Tbl: ASA 300mg, Tbl Plavix 300mg, ampClexane 0,3 IV, amp Fentanil 2 mg, Sol NaCl 0,9%.Pacijent transportovan do Klinike za kardiologiju.U toku transporta pacijent hemodinamski stabilan,bez pogoršanja.Zaključak: u ovom radu prikazan je pacijent kojinije imao jasnu kliničku sliku, ali je praćenjemprotokola za tretman pacijenta sa bolom u grudima,brzo postavljena dijagnoza, data adekvatna terapija ipacijent transportovan do Klinike za kardiologijugde je u prvom satu urađena pPCI .Ključne reći: AIM, nespecifična klinička slika.


Politrauma-prikaz slučajaV.Jančković, I.Jovanovski, D.Miletić, D.Anasonović,J.Stojiljković, M.Lilić

Odsek za Anesteziju, reanimaciju i intenzivnu terapijuhirurškog odeljenja Vojne bolnice Niš, Srbijae-mail adresa autora:[email protected]

Uvod: udeo politraume u ukupnom traumatizmuiznosi 3-8%, ali je vodeći uzrok mortaliteta iznačajno utiče na morbiditet (mortalitet na licumesta je od 50 do 80%). Ukupni hospitalnimortalitet politraumatiziranih pacijenata i do je25%. Mortalitet u prvih 6 sati iznosi 50%, usledećih 24 sata 30%, dok je 20% posledicasekundarnih oštećenja i komplikacijaCilj: Prikaz zbrinjavanja politraumatizovanogbolesnikaPrikaz slučaja: pacijent A.V. star 30 god, doveženvojnim sanitetom. Dobijamo podatak da se posleskoka iz aviona padobran regularno otvorio ali da jeprilikom skoka sledećeg padobranca (koji je nošenvetrom) došlo do sudara u vazduhu i povređivanjaobojice. Pacijent A.V se prizemljuje sa otvorenimprelomom desne butne kosti i dežurna lekarska



ekipa na aerodromu ga primarno zbrinjava.Imobilisana desna noga Kramerovom šinom,postavljena IV Linija 20G, nije dodat analgetik, nitije započeta nadoknada volumena. Na Hirurškoodeljenje stiže nakon 50 min od događaja u 10:50,najavljen je dolazak i dve anesteziološke ekipe gačekaju u prijemnoj ambulanti. Na prijemu pacijentsvestan, orjentisan u vremenu, prostoru i premaličnostima. Koža i vidljive sluzokože vidljivo blede,orošen znojem, povremeno viče, vidnopsihomotorno uznemiren. Podatke daje sam adogađaj ne rekonstruiše. Glava i vrat-bez vidljivihpovreda, zenice jednake, postavljena Šancovakragna, dat O2 7L/min. Grudni koš bez vidljivihpovreda, disajni šum obostrano prisutan. Cor: neštotiši srčani tonovi, šumova nema. Abdomen napovršnu i duboku palpaciju bezbolan. Vitalniparametri-TA: nemerljiva, SF: 110/min; RF: 20/min.Desna butina veća u obimu. Nakon brze orjentacije,postavljene dve veće IV kanile, uzeti uzorci zakompletnu laboratoriju i započeta intenzivnanadoknada volumena kristaloidima i koloidima.Pacijent obezboljen fentanilom i započetadijagnostika. Urađen MSCT celog tela, kolor doplerkrvnih sudova nogu, ecg, eho srca. Nakondijagnostičkih pretraga postavljene su sledeće dg:Polytrauma, Contusio pulmonis, Contusio cordis,Contusio capitis, Fractura femoris lat dex, Shockhaemorrhagicus. Intenzivnom terapijom se postižehemodinamski oporavak 2h posle prijema kada sepacijent uvodi u salu da bi se pristupilo stabilizacijipreloma postavljanjem spoljašnjeg fiksatora.Pacijent je 24h posle povređivanja prebačen utercijalnu zdravstvenu – VMA, radi konačnogzbrinjavanja.Zaključak: brza i tačna procena traumatizovanogpacijenta, brza dijagnostika, adekvatno konačnozbrinjavanje je ključ za lečenje i tretmanpolitraumatizovanog pacijenta. Lanac zbrinjavanjane sme biti prekinut.Ključne reči: politrauma, lanac zbrinjavanja


Povrede srca-često zapostavljena dijagnozaB.Radisavljević, D.Gostović, S.Mitrović


Uvod: povrede grudnog koša su posebno značajnezbog potencijala da kompromituju respiratornu i/ilicirkulatornu funkciju. Mogu biti tupe i penetrantne.Spasioci na terenu najčešće obraćaju pažnju napovredu zida grudnog koša i plućnog tkiva a mnogoređe razmišljaju o povredi srca.Cilj: ukazati na značaj povreda srca u traumigrudnog koša.Izvor podataka i izbor materijala: retrospektivnaanaliza literature sa odrednicama: trauma, grudnikoš, povrede srca. Pretraživanje je vršeno kroz:PubMed, Medline i elektronske časopise dostupnepreko KoBSON-a kao i litratura raspoloživa uBiblioteci Medicinskog fakulteta u Nišu (PHTLSChapter 11 Thoracic trauma).Rezultati sinteze: tupa povreda srca je najčešćerezultat kompresije srca zbog delovanja sile naprednji zid grudnog koša i daje sledeće entitete:• Kontuzija srca. Često izaziva poremećaje srčanogritma npr. sinusnu tahikardiju, ventrikularneekstrasistole, ventrikularnu tahikardiju,ventrikularnu fibrilaciju i smetnje sprovođenja.Kontraktilnost srca može biti promenjena sasmanjenjem kardijalnog output-a, rezultujućikardiogenim šokom.• Ruptura valvula. Ruptura potpornih strukturavalvula ili samih valvula uzrokuje smanjenje njihovefunkcije sa simptomima i znacima kongestivnesrčane insuficijencije.• Tupa ruptura srca. Dešava se u manje od 1%pacijenata sa tupom traumom grudnog koša.Najveći broj ovih pacijenata će umreti na licu mestazbog iskrvavljenja ili fatalne srčane tamponade.Preživeli će se prezentovati kliničkom slikomtamponade srca. Povećanje pritiska u perikardusprečava povratak venske krvi u srce i dovodi dosmanjenja kardijalnog output-a. Sa svakomsrčanom kontrakcijom ovo stanje se produbljuje idovodi do električne aktivnosti srca bez pulsa.Najčešće, tamponada srca nastaje zbog ubodnihrana u srce sa penetracijom u srčane komore ili




laceracijom miokarda. Ruptura komora zbog tupepovrede grudnog koša češće uzrokuje jakoiskrvarenje. Nivo sumnje na tamponadu srca trebapodići na "prisutna dok se ne dokaže drugačije"kada je povreda u pravougaoniku (srčana kutija)koji formiraju horizontalne linije duž klavikula,vertikalne linije od klavikula preko bradavica doivica rebara, i donja horizontalna linija koja spajavertikalne linije na mestu spoja sa ivicom rebara.Fizički znaci preteće tamponade srca (Beck-ovatrijada) su: udaljeni, mukli, prigušeni srčani tonovi,jugularna venska distenzija, nizak krvni pritisak.Procena: procena pacijenta sa potencijalom za tupupovredu srca uključuje mehanizam povređivanja ifizikalne znake.Pristup lečenju: ključ u strategiji je dobra procenada je trauma grudnog koša izazvala povredu srca iprenošenje tih podatka pri prijemu pacijenta ubolnicu. Daje se visoka koncentracija kiseonika,uspostavlja se IV linija uz nadoknadu tečnosti.Pacijenta treba monitorirati – EKG. Kod pojavearitmije daje se standardna antiaritmijska terapija.Kod tamponade perikarda ispuštanje manjekoličine tečnosti iz perikarda perikardiocentezom ječesto efikasna privremena mera.Zaključak: povrede srca daju ozbiljne komplikacijesa fatalnim ishodom zahtevaju dobru procenumehanizma povrede, urgentno lečenje i brztransport. Posle kratkog primarnog pregledapacijenta treba zbrinjavati na putu za bolnicu. Ovepovrede treba zbrinjavati u ustanovama zadefinitivno hirurško zbrinjavanje. Čak i kad nemaspoljnih znakova povrede grudnog koša, posebno upredelu srčane kutije treba uvek ozbiljno shvatitizbog potencijala da izazovu fatalne komplikacije ismrtni ishod.Ključne reči: trauma, grudni koš, povrede srca


Strano telo u disajnom putu kao uzrokakutnog zastoja srca-prikaz slučajaM.Knežević1, A.Dimić2

1Zavod za hitnu medicinsku pomoć Niš, Srbija2Centar za anesteziju i reanimaciju, Klinički centar Niš,Srbijae-mail adresa autora: [email protected]

Uvod: najčešći uzrok akutnog zastoja srca suprethodna oboljenja srca. Ostali razlozi srčanogzastoja su nesrčane etiologije. Nova etiološka podelajeste podela na 5H (hipoksija, hipovolemija,hipotermija, hidrogen jon-acidoza,hiper/hipokalijemija) i 5T (tromboza-koronarna,tromboza-plućna, tenzioni pneumotoraks,tamponada srca, trovanja) uzroke akutnog zastojasrca. Na ove uzroke akutnog zastoja srca treba uvekmisliti i u slučaju potrebe primeniti specifičnepostupke tokom kardiopulmonalne reanimacije, a ucilju njihovog otklanjanja.Cilj rada. Prikazom slučaja ukazati na značaj ranekardiopulmonalne reanimacije, kao i na značajranog otklanjanja uzroka akutnog zastoja srca naprehospitalnom nivou.Materijali i metode: analiziran je protokol terenskihintervencija Zavoda za hitnu medicinsku pomoć iistorija bolesti i otpusna lista Klinike zakardiovaskularne bolesti.Prikaz slučaja: poziv hitnoj pomoći je upućen izGerontološkog centra i klasifikovan kao pozivprvog reda hitnosti, jer je dobijen podatak da jepacijentkinja bez svesti. Ekipa hitne pomoći kreće uprvoj minuti od prijema poziva i dolazi na licemesta nakon 3 minuta. Pacijentkinju zatičemo ukrevetu bez svesti, disanja i pulsa nad karotidnomarterijom. Zenice su srednje dilatirane, nereaktivne.Koža i vidljive sluzokože su cijanotične.Heteroanamnestički, od dežurne medicinske sestre,dobijamo podatak da je pacijentkinja srčanibolesnik i dijabetičar i da redovno uzima svojuterapiju. Takođe dobijamo i podatak da sepacijentkinja zakašljala u toku obroka, pomodrela iprestala da diše, što nas upućuje na mogući uzrokakutnog zastoja srca. Odmah je započetakardiopulmonalna reanimacija, masažom srca iistovremenim otvaranjem venske linije. Na



monitoru defibrilatora se registruje asistolija, pa sereanimacija nastavlja po protokolu za asistoliju.Prilikom direktne laringoskopije u usnoj duplji,orofarinksu i hipofarinksu se vizuelizuje strano telo,koje je odstranjeno Magilovim hvataljkama, preplasiranja endotrahealnog tubusa. Nakonendotrahealne intubacije tubusom 8mm, nastavljase kontrolisanom ventilacijom. Intravenski je datošest pojedinačnih doza adrenalina od 1 mg sarazmacima od pet minuta, praćenih masažom srca ikontrolisanom ventilacijom. Nakon šeste ampuleadrenalina, dobijamo puls nad arterijom carotis, ana monitoru se registruje sinusni ritam.Pacijentkinja ima i retke spontane respiracije.Pacijentkinja je u pratnji ekipe hitne pomoći, a uzkontinuirani monitoring vitalnih funkcija,transportovana na Kliniku za kardiovaskularnebolesti. Tokom transporta pacijentkinja je naoksigenoterapiji sa protokom 10 L/minuti, nastavljase sa asistiranom ventilacijom.Tokom hospitalizacije dolazi do stabilizacijevitalnih parametara pacijentkinje. Nakon 15 danahospitalnog lečenja pacijentkinja se otpušta kući udobrom opštem stanju, bez neuroloških posledica.Zaključak: iako se najčešće u praksi srećemo saprimarnim cardiac arrestom, uvek treba misliti i nadruge moguće uzroke srčanog zastoja, kao što je unašem slučaju bila opstrukcija disajnog putastranim telom. Pristup pacijentu sa akutnimzastojem srca i svi dijagnostički i terapijski postupcikoje ćemo izvesti u tom momentu su presudni zauspeh reanimacije.Ključne reči: akutni zastoj srca, kardiopulmonalnareanimacija, strano telo u disajnom putu


Akutni edem pluća-prikaz slučajaN.Milenković, E.Miletić, D.Milijić , M.Lazarević

ZC Knjaževac, Služba hitne medicinske pomoćie-mail adresa autora: [email protected]

Uvod: Akutni edem pluća (lat. Oedema pulmonisacuta) predstavlja plućno oboljenje opasno po životpacijenta te stoga spada u prvi red hitnostizbrinjavanja Službe hitne medicinske pomoći(SHMP). Karakteriše ga ekstravaskularno

nakupljanje tečnosti u plućnim alveolama zbogpovišenog plućnog kapilarnog pritiska iliporemećene propustljivosti kapilarno-alveolarnemembrane pluća. Od ključnog je značaja brzinazbrinjavanja pacijenata sa akutnim edemom plućakao i pravi izbor terapije u određenom trenutku.Prikaz slučaja: Dana 14.07.2015. (br. protokola9592) nakon dobijenog poziva u 14:35h od straneNN lica ekipa SHMP izlazi na teren gde se nalazioM.Z. 1936 god. Pri prvim vizuelnim kontaktom sapacijentom primetio sam da pacijent sedi na stolici,obliven znojem i otežano diše. Usne su mu bilemodre i imao je jako izražene vene na vratu. Nakonobavljenog pregleda konstatovao sam da pacijentima gušenje jakog intenziteta, kašalj saiskašljavanjem sluzavog penušavog ispljuvka,ubrzano plitko disanje, anksioznost, cijanozucentralnog tipa, oslabljen disajni šum sa masominspirijumskih pukota difuzno obostrano čujnimnad plućnim krilima do iznad polovine plućnihpolja. TA 180/100mmHg. Odmah nakon pregledazapočeo sam sa terapijskim procedurama. Pacijentuje plasirana braunila i prilikom transporta usedećem položaju data terapija amp.Furosemid20mg i.v. i tbl. Kaptoprila 25mg s.l. Uradjen je EKG(sinusni ritam, leva osovina, SF 100/min, -T u D1,aVL, bez bitnijih promena u ST segmentu), SpO2

70%, TA 170/95mmHg. Nastavljenja je terapija uvidu oksigene potpore pomoću maske 4 l/min.,sprej Gliceril trinitrat 2 doze po 0,4 mg s.l. na po 5min., ½ Amp. Morfina od 20 mg i.v. Amp.Furosemid 2 od po 20 mg. i.v. Nakon 15-20min.dolazi do poboljšanja zdravstvenog stanja pacijentaSpO2 80%, TA 155/90mmHg, nakon čega je ontransportovan u sedećem položaju na odeljenjeinterne medicine radi dalje opservacije i terapije.Zaključak: Nakon brzo primenjenih adekvatnihterapijskih postupaka u SHMP, došlo je dopoboljšanja zdravstvenog stanja osobe sa akutnimedemom pluća, nakon čega je ona hospitalizovanana internom odeljenju radi dalje terapije iopservacije.Ključne reči: edem, prehospitalno lečenje





Produžena hipoglikemija-oprez!R.Krstić, B.Radisavljević, S. Mitrović


Uvod. Hipoglikemijska koma je najčešćakomplikacija DM, s kojom se lekar HMP sreće naterenu. U najvećem broju bez fokalnih neurološkihznakova i meningealnog nadražaja. Nakonadekvatne terapije uobičajno dolazi do potpunogoporavka svesti. Neadekvatna reakcija na terapijuuvek mora da pobudi sumnju na druge razlogeporemećaja stanja svesti.Cilj rada: Prikazom slučaja ukazati na značajobazrivog pristupa pacijentima koji imajuporemećaj svesti uz protrahovanu hipoglikemiju ikod kojih nadoknadom hipertone glukoze ne dolazido željenog efekta.Materijali i metode: Analiziran je protokol terenskeintervencije Zavoda za hitnu medicinsku pomoć iistorija bolesti i otpusna lista Klinike zaNeurohirurgiju.Prikaz slučaja: Poziv hitnoj pomoći je upućen zbogpacijenta starog 61 god, zbog poremećaja nivoasvesti. Poziv je klasifikovan kao poziv drugog redahitnosti, a ekipa hitne pomoći kreće u prvoj minutiod prijema poziva i dolazi na lice mesta nakon 10minuta. Pacijenta (krupne osteomuskularne građe)zatičemo u krevetu bez svesti, spontanog disanja iprisutnog pulsa nad karotidnom arterijom koji jedobro punjen. Zenice su srednje dilatirane, spororeaktivne. Koža, je normalne prebojenosti ali hladnai vlažna. Heteroanamnestički, od supruge, dobijamopodatak da je pacijent dijabetičar na oralnimantidijabeticima, loše regulisan, da neredovnouzima svoju terapiju. Dobijamo i podatak da jepacijent neposredno pre gubitka svesti, imaopreznojavanje, mučninu, i da su tegobe pokušali dareše unosom šećera per os. Oni su izmerili Šuk2mmol/L. Vitalni parametri: TA 170 /90mmHg; SF:75/min; RF 16/min; SpO2 99%; Šuk 6,0 mmHg, TT36,8C. ECG: sin ritam, bez znakova za ishemiju. Sobzirom da je pacijent dugogodišnji dijabetičar(loše regulisan) i da je pre događaja unosio većukoličinu šećera, ideja je bila da je protrahovanahipoglikemija dovela do sporog odgovora na unos

šećera te se pristupilo davanju Sol.Glycosae 50%20+20+20ml. Nakon date terapije dolazi dodelimičnog oporavka. II Šuk 11,0mmol/L. Pacijentse budi, odgovara na pitanja, ali je usporen ikofuzan. Posle datog odgovora, odmah tone u san.Negira tegobe i odbija dalju pomoć. Neurološkinalaz je uredan. Pacijent je u pratnji ekipe hitnepomoći, a uz kontinuirani monitoring vitalnihfunkcija, transportovan na Kliniku zaendokrinologiju. Tokom transporta pacijent je naoksigenoterapiji sa protokom 4 L/minuti. Nakonpregleda od strane endokrinologa i uzprodubjivanje poremećaja svesti pacijent upućen naKliniku za neurologiju gde je urađen CT koji jepotvrdio sumnju na SAH.Zaključak: U prehospitalnom tretmanu, gde susužene dijagnostičke mere, poremećaj stanja svestitreba uvek razmatrati u više pravaca, iako okolnostijasno navode na osnovnu bolest. Pažljivimpregledom uvek treba tražiti i znake drugihoboljenja.Ključne reči: hipoglikemija, poremećaj svesti, SAH


Diferencijalna dijagnoza bola u grudimaM.Bogdanović1, S.Radojičić2

1Zavod za hitnu medicinsku pomoć Podgorica, CrnaGora2Opšta bolnica Cetinje, Crna Gorae-mail adresa autora: [email protected]

Uvod: Bol u grudima predstavlja jednu od najvećihdiferencijalno dijagnostičkih dilema u medicini. Upraksi, na prehospitalnom nivou, često pišemoradnu dijagnozu "stenocardia, dolor praecordialis"na osnovu uzete anamneze. Ono što nampredstavlja najveći problem jeste upravo da li je bolu grudima direktno povezan sa infarktommiokarda, jednim od vodećih smrti u svijetu.Cilj rada: Ispitati učestalost stenokardije upacijenata sa bolom u grudima u opštoj populacijiod 30 do 70 godina.Metod: Deskriptivni prikaz podataka. Izvorpodataka: knjiga poziva, protokol Zavoda za hitnumedicinsku pomoć Podgorica, odsek Cetinje,lekarski izveštaji.



Rezultati: U periodu od 10 mjeseci ispitan je 121pacijent u hmp na Cetinju od kojih je AIM imalo 28pacijenata, 35 pacijenata sa mijalgijom 58 pacijentasa dijagnozom depresije. Učestalost AIM u zadatomperiodu iznosila je 23,1% dok je sa mijalgijom bilo28,9% depresivaca 47,9 %.Zaključak: Možemo zaključiti da nije svaki bol ugrudima kardijalnog porijekla ali s obzirom da jeAIM jedan od najvećih uzroka smrti u svijetu,svakom bolu u grudima moramo posvetiti posebnupažnju upravo zbog vjerovatnoće da se radi o AIM.Ključne reči: Akutni infarkt miokarda, stenocardia,bol u grudima


Aritmija absoluta u hipertenzivnoj kriziM.Bogdanović1, S.Radojičić2

1Zavod za hitnu medicinsku pomoć Podgorica, CrnaGora2Opšta bolnica Cetinje, Crna Gorae-mail adresa autora: [email protected]

Cilj rada: je bio da proverimo učestalost javljanjaprve epizode aritmije absolute u hipertenzivnojkrizi.Rezultati: U periodu od 10 meseci u hitnojmedicinskoj pomoći na Cetinju i Opšte bolnice naCetinju kod 100 pacijenata (48 muškaraca i 52 žene)sa hipertenzivnom reakcijom KP>180/120 mmHgbilo je de novo aritmije absolute kod 80 pacijenata(36 muškaraca i 44 žene).Zaključak: Aritmija absoluta se javlja u visokomprocentu kao manifestacija hipertenzivne krize štose može objasniti visokim procentom nelečenearterijske hipertenzije u našoj populaciji.Ključne reči: arterijska hipertenzija, a. absoluta,hipertenzivna kriza

Broj apstrakta: 035

Tip apstrakta: poster

Rana defibrilacija ključ uspešne CPR -prikazslučajaJ.Arnautović, A.Stankov


Uvod: Najčešći uzrok akutnog srčanog zastoja, postatističkim podacima i do 80 %, je fibrilacija koja sejavlja sa akutnim koronarnim događajem. DC šok jesastavni deo kardiopulmonalne reanimacije (CPR).I od pravovremene i adekvatne primene DC šoka,zavisi i ishod CPR. Rana defibrilacija je od ključnogznačaja u preživljavanju iznenadne srčane smrti, averovatnoća uspešne defibrilacije naglo opada savremenom.Cilj rada: Prikazom slučaja ćemo ukazati na značajrane kardiopulmonalne reanimacije, u kojoj je prvamera rana defibrilacija.Materijali i metode: Analiziran je protokolterenskih intervencija Zavoda za hitnu medicinskupomoć i istorija bolesti i otpusna lista Klinike zakardiovaskularne bolesti.Prikaz slučaja: Pacijent lično poziva ekipu hitnepomoći zbog bola u grudima koji traje oko 30 min.Bol se javio posle svađe sa sinom. Pacijent u tokurazgovora pokazuje nervozu i uznemirenost. Pozivprimljen kao drugi red hitnosti a ekipa hitnepomoći kreće u prvoj minuti od prijema poziva idolazi do pacijenta nakon 5min. U kući pacijentaprisutna i ekipa MUP-a zbog prethodnog sukoba ukome nije bilo fizičkog kontakta. Pacijent M.P., star74 god, zatičemo u krevetu, svestan, orjentisan,uznemiran i razdražljiv, novodi da boluje od HTA.Prisutna je supruga, koja je ubeđena da on simulirategobe. Pacijent je bled i preznojen i do sada nijeimao ovakve bolove. Vitalni parametri: TA150/100mmHg; SF 100/min; RF 16/min; SpO298%,Šuk 5,8mmol/l, TT norm. Na ECG-u: sin ritam,bigeminia, nishodna depresija D2, D3 i aVF,STelevacija V1-V4 od 1-2mm. Postavljena IV linija,monitoring i započeta Th: Amp Fentanil 2ml IV;Amp Clexane 30mg IV; tbl Aspirin 300mg PO; TblPlavix 300mg PO; Amp Ranitidin IV; O2- 4 L/min.U toku transporta na monitoru su i dalje prisutnečeste polimorfne VES po tipu bigeminije.Poremećaj ritma po tipu VF nastaje otprilike 30




min od prvog kontakta sa pacijentom. Prvi DC Šokisporučen sa jačinom 200J, posle čeka započetamasaža grudnog koša, kako je i dalje na monitoruVF, isporučen i drugi DC šok 300J nako čegapacijent počinje spontano da diše i otvara oči. Lakoje konfuzan u odgovorima. Nastavljen kontinuiranimonitoring vitalnih funkcija, transportovan naKliniku za kardiovaskularne bolesti. U prijemnojambulanti Klinike za kardiologiju pacijent ponovofibrilira, i biva defibriliran od strane kardiologa2X200 J. Pacijentu se radi pPCI, postavlja se stentna LAD koji u sledećih nekoliko sati akutnotrombozira. Pacijent preveden na Brilique. Otpuštase kući posle 6 dana hospitalizacije u dobromopštem stanju.Zaključak: rana defibrilacija će imati efekta samokada je pravovremena i adekvatno izvedena. Onamora da bude sastavni deo lanca preživljavanja.HMP odnosno mere ALS ( advance life support) sudeo lanca koji se u ovom slučaju pokazao kao dobrai čvrsta karika.Ključne reči: akutni zastoj srca, kardiopulmonalnareanimacija, rana defibrilacija


Trauma kod starihT.Mićić, T.Rajković, I.Ilić


Uvod: Tokom poslednjih nekoliko decenijanapredak u medicini doveo je do značajnogpovećanja procenta stanovništva starijeg od 65godina. Glavne promene koje se događaju tokomstarenja mogu dovesti do različitog odgovora natraumu.Izvor podataka: Razmatrali smo više od 1250PubMed publikacija o gerijatrijskoj trauma ismernice za prehospitalno zbrinjavanje povređenihobjavljene između Jan 2008-Sep 2015. Pri izborureeferenci rukovodili smo se nivoom dokaza.Sinteza pregleda: Tokom starenja se javljajunormalne fiziološke promene i ljudi mogu imatirazličite zdravstvene probleme. Najvažnijapromena u respiratornom sistemu je smanjenaefikasnost izazvana izmenama u anatomskojstrukturi grudnog koša i kičmenog stuba i

smanjenjem alveolarne površine. Promene ukardiovaskularnoom sistemu povezane sa starenjemsu: ateroskleroza, hipertenzija, hipertrofijamiokarda, aritmije itd. Kardijalni output je smanjeni ne može da zadovolji povećane potrebe miokardaza kiseonikom u traumi. Takođe, stariji pacijentiobično koriste lekove koji mogu izmeniti njihovodgovor na traumu. Biološko starenje mozgadovodi do cerebralne insuficijencije. Takođe,oslabljen vid i sluh mogu da imaju ulogu upovređivanju i da otežaju komunikaciju izbrinjavanje starijeg pacijenta. Zbog prisustva nekihstanja ili bolesti, kao što su dijabetes ili hroničnibolni sindromi, starije osobe mogu da imajupovećanu ili smanjenu toleranciju na bol. Promeneu koštano-zglobnom sistemu uključujuosteoporozu, koja zajedno sa smanjenom snagommišića može dovesti do multiplih preloma usleddejstva slabe ili umerene sile. Stariji pacijenti sutakođe, podložniji hipotermiji i infekciji negomlađi. Sve ove, starenjem izazvane promene,dovode do potrebe da se prilagodi pristup i tretmanu zbrinjavanju starijih povređenih pacijenata.Zaključak: Procena i zbrinjavanje starijih,povređenih pacijenta ima određene specifičnosti.Brojni medicinski činioci mogu predisponiratistarije osobe za traumatska dešavanja i moguizmeniti njihov odgovor na traumu. Vitalni znaci sunedovoljni indikator stanja kod starijih pacijenta.Rana kontrola disajnog puta, ventilacije i krvarenja,adekvatna imobilizacija i brz transport su najvažnijizadaci u zbrinjavanju starijih povređenih osoba.Ključne reči: gerijatrijski, trauma, stari.


Parametri aktivacije sistema hitnemedicinske pomoći u vanbolničkom srčanomzastoju i odluka o primeni mera CPR-studijaEURECA ONE 2014D.Milenković, T.Rajković, S. Ignjatijević, S. Mitrović,V.Anđelković, M.Stojanović


Uvod: Srčani zastoj predstavlјa konačan nepovolјanishod kaskade događaja kod mnogih urgentnihmedicinskih stanja, često u vanbolničkim uslovima.



Zavod za hitnu medicinsku pomoć Niš se uključio upraćenje problema vanbolničkog srčanog zastojaputem učešća u internacionalnom trajalu EuReCaONE. Cilj: Cilj ovog istraživanja predstavljapraćenje aktivacije sistema hitne pomoći odtrenutka poziva hitnoj službi do utvrđivanja faktorakoji utiču na odluku o započinjanju KPR mera usrčanom zastoju. METOD: Praćena je pojava,tretman i ishod vanbolničkog srčanog zastoja uperiodu 01. oktobar 2014. – 31. oktobar 2014.godine na teritoriji grada Niša putem proširenogprotokola studije baziranog na Utstein matriciizveštavanja. REZULTATI: Prosečno aktivacionovreme za sve pozive iznosilo je 3 minuta 5 sekundi,od toga 13 sekundi za I red, 1 minut 56 sekundi zaII red, 12 minuta 14 sekundi za III red i 10 minuta50 sekundi za IV red hitnosti (p<0.05). Prilikomprijema poziva, stanje svesti bilo je moguće odreditiu 88.9% slučajeva, dok je prisustvo/odsustvo disanjabilo moguće odrediti u 46.0% slučajeva (p<0.001).Multivarijantnom analizom parametara koji moguuticati na primenu KPR mera u srčanom zastojuizdvojili su se red hitnosti (p<0.001), podatak ovremenu prestanka disanja (p<0.001), inicijalniritam na monitoru defibrilatora (p<0.05),heteroanamnestički podatak o teškoj bolesti(p<0.05) i vreme od polaska do dolaska ekipe na licemesta (p<0.001).Zaključak: Aktivaciono vreme za I red hitnosti jeimpresivno. Trijažiranje poziva uzimalo je kaoglavnu odrednicu stanje svesti dobijeno tokomkratkog intervjua, sa nedovoljnim podacima okvalitetu disanja. Mere KPR nisu započete kod svihpacijenata kojima je konstatovan srčani zastoj naterenu. Slučajevi koji su trijažirani u najviši redhitnosti, sa podatkom o kraćem proteklom vremenuod prestanka disanja, inicijalnim ritmom namonitoru defibrilatora koji je šokabilan, bezheteroanamnestičkih podataka o teškoj bolesti ikraćim vremenom od polaska do dolaska ekipe nalice mesta imali su značajno veću šansu da KPRmere budu primenjene.Ključne reči: parametri aktivacije, hmp, cpr


Prikaz slučaja zbrinjavanjatraumatizovanog pacijentaM.Janković, S.Gopić,T.Masoničić, LJ.Cvetković


Uvod: Trauma je vodeći uzrok smrti kod osoba od1- 44 god., preko 70% svih smrti su osobe između15 i 24 god. Trauma je kod starih osoba zadržalavisoko 8 mesto kao uzrok smrti. Uspešan tretmantraumatizovane osobe ne samo da spašava životpacijenta nego i smanjuje u velikom stepenuinvaliditet. Preduslov za kvalitetano prehospitalnozbinjavanje je uigranost tima, kvalitetna saradnja saostalim spasilačkim službama, kvalitetan tretman iadekvatan transport pacijenta na dalje definitivnozbrinjavanje u hospitalnim uslovima.Cilj: Prikaz pacijenta koji je pravovremnom iefikasnom reakcijom hitne medicinske pomoći ivatrogasne službe bio zbrinut i transportovan uurgentni centar.Materijal i Metode: Prikaz slučaja pacijenta izdostupne dokumentacije: lekarski poziv, knjigaprotokola, otpusna lista iz urgentnog centra.Prikaz slučaja: HMP je pozvana da interveniše zbogpacijenta koji je po rečima očevidaca pao u koritopotoka. Lekar na prijemu poziva je pokušao dadobije više podataka ali su osobe koje pozivaju bileagresivne i činilo se da su alkoholisane. Ekipa HMPje upućena na mesto događaja kao prvi red hitnostia pozvana je i vatrogasna služba koja je krenulaodmah po pozovu. Na mesto događaja ekipa stiženakon 12 min. (udaljenost od grada je 15km). Namestu događaja ekipa HMP zatiče pacijenta koji senalazi u rečnom koritu, leži na leđima, između dvestene, svestan, ali konfuzan, sa vidljivomlacerokontuznom ranom koja obilno krvari.Heteroanamnestički dobijamo podatak da jepacijent upao slučajno, pavši sa visine od oko 3m.Nema drugih podatka o padu. Zbog nepristupčnogterena do pacijenta prvo stiže med. sestra izapočinje primarni trauma-pregled po sistemuABCDE. Povreda na glavi je na sredini čela,zvezdastog oblika, prečnika oko 5 cm, i obilnokrvari. Prisutan otok oba kapka levog oka.Krvarenje je zaustavljeno digitalnom kompresijom,




disajni put prohodan, disanje obostrano očuvano.Trbuh, karlica i butne kosti su bezbolne. PostavljenaŠancova kragna, otvoren venski put i ukljućen NaCl09%. Pripadnici vatrogasne službe su po dolaskupristupili izvlačenju povređenog. Pacijent jepostavljen na ferno nosila, međutim kako neposedujemo sigurnosne kaiševe, pacijent dodatnoimobilisan priručnim sredstvima. Izvlačenjepovređenog je izvršeno uz pomoć 4 vatrogasca ivozača hmp. Pacijent sve vreme pridržavan odstrane medicinske sestre obzirom da je alkoholisan ineadekvatno reaguje na situaciju. Zbog otežanihuslova terena izvlačenje pacijenta je trajalo 1h05min. U toku transporta sekundarni traumapregled od strane lekara HMP. Do Klinike zaneurohirurgiju pacijent hemodinamski stabilan, bezpogoršanja.Zaključak: Timski rad u zbrinjavanjutraumatizovane osobe je jedan od osnovnihelemenata za uspešnost i efikasnost ekipe HMP.Edukovanost i uigranost svakog člana tima je odposebne važnosti. Medicinska sestra, kada je visokoedukovana i dobro pripremljena za ovu vrstuaktivnosti, može u velikom delu da preuzmeodgovornost u postupanju sa traumatizovanomosobom. Saradnja sa drugim službama kojeučestvuju u zbrinjavanju traumatizovanihpacijenata je neophodna i iziskuje zajedničketreninge.Ključne reči: trauma, uloga medicinske sestre


Politrauma - prikaz slučajaD.Stefanović, D. Janković, T.Rajković


Uvod: Tema rada je prikaz slučaja pacijenta koji jezbrinjavan na terenu u neobičnim okolnostimapovređivanja.Cilj: Prikazati slučaj pacijenta gde mehanizampovređivanja i klinička slika ukazuju napotencijalno životno ugrožavajuće stanje. Ukazatina neophodnost pravilnog prehospitalnogzbrinjavanja pacijenta kao i potrebu za dodatnimdijagnostičkim procedurama.

Materijal i metode: Uvid u medicinskudokumentaciju Zavoda za hitnu medicinsku pomoćNiš, poziv za lekarsku intervenciju i lekarskogizveštaja sa terena. Uvid u medicinskudokumentaciju pacijenta iz Urgentnog centra,Neurohirurške klinike i Instituta za radiologijuKliničkog centra Niš kao i Klinike zamaksilofacijalnu hirurgiju.Prikaz slučaja: 28.06.2014.god u 21:35h je upućenpoziv na 194 od strane komšije pacijenta. Dat jeopis da je stariji čovek zaglavljen u liftu koji senalazi između spratova. Postavljena je sumnja da jebez svesti a zna da boluje od šećerne bolesti. Poziv jeobeležen kao drugi red hitnosti. Dispečer Zavoda zahitnu medicinsku pomoć u 21:37h upućuje terenskuekipu ka mestu događaja.Pacijent Đ.D. 77 godina, je zatečen u malom liftuzgrade koji je zaustavljen između spratova. Pacijentnije dostupan za pregled jer se nalazi priklještenpolicom koju je pokušao da unese u lift. Uočava sekosmati deo glave, vidljiva je i desna ruka koja imadiskretne pokrete. Pacijent je od poda lifta odvojenoko 20 cm i visi u vazduhu. Ne odgovara na pozive.Uz pomoć vatrogasaca i službe za održavanjeliftova, pacijent izvađen uz manuelnu stabilizacijuvratnog dela kičme, postavljen na ferno nosila.Pacijent je bez svesti a nakon postavljanja u ležećipoložaj vraća svest i počinje da povraća. Disanje jeočuvano obostrano. Vitalni parametri su ugranicama normale TA:120/80mmHg, SF: 80/min,RF: 10-14/min, ŠUK: 13,9 mmol/L. Opštimpregledom tela nema palpatorno bolne osetljivostitrbuha, karlice i ekstremiteta. Zbog mehanizmapovređivanja i kliničke slike pacijent je procenjenkao kritičan i započet je transport do Urgentnogcentra Kliničkog centra. Tokom transporta jenastavljeno sa zbrinjavanjem pacijenta, postavljenaIV linija i dat rastvor NaCl 0,9% 500ml, 02 12 l/mini održavana manuelna stabilizacija vratne kičme.Uputne dijagnoze su postavljale sumnju nakontuzione povrede predela vrata, grudnog koša iabdomena. Po dolasku u urgentni centarsprovedena dalja dijagnostika i zatraženikonsultativni pregledi specijalista klinike zaneurohirurgiju i maksilofacijalnu hirurgiju.Načinjen je MSCT endokranijuma, vratne kičme,toraksa i abdomena na kojem nije utvrđenopostojanje traumatskih lezija. Nakon konsultativnihpregleda, pacijentu je data preporuka za analgetsku



terapiju i AT zaštitu, nakon čega je upućen nakućno lečenje.Zaključak: Uvidom u medicinsku dokumentacijupacijenta, moguće je propratiti sled događaja odpoziva građana na telefon 194, aktivacije ekipeZavoda za hitnu medicinsku pomoć Niš, sam tokintervencije i zbrinjavanje pacijenta na terenu kojije procenjen kao kritičan i po tim principima izbrinjavan a nakon prijema pacijenta ima se uvid uizvedena dijagnostička ispitivanja i terapijskepreporuke.Ključne reči: trauma, mehanizam povređivanja,dijagnostika


Moralna i etička pitanja vezana zakardiopulmonalnu reanimacijuA.Nikolić, D.Janković

Zavod za hitnu medicinsku pomoć Niš , Srbijae-mail adresa autora: [email protected]

Uvod: U čitavoj medicinskoj praksi nemauzbudljivije i dramatičnije situacije od one kada sezdravstveni radnik nađe uz pacijenta kod kojeg jedošlo do naglog poremećaja njegovih vitalnihfunkcija.Cilj rada: je prikazati moralne i etičke probleme sakojima se susrećemo pre, tokom ili poslekardiopulmonalnoj reanimaciji.Izvor podataka: Pretraga materijala internetpretraživača Cobson, PubMed, pisana literaturedomaćih i inostranih stručnih publikacija.Izbor podataka: po ključnim rečima i relevantnostiSinteza podataka sa diskusijom: u prošlimvremenima se malo toga moglo učiniti zaproduženje ljudskog života. Moć današnje medicineda odloži smrt, stvorila je teška moralna i etičkapitanja. Odluka kada započeti, kada prestati iliodustati od započete kardiopulmonalne reanimacijevažan je problem medicinskih stručnjaka,bolesnika, članova porodice i pravnika. Usuvremenom društvu, obeleženom pluralizmomnadzora i delovanja, gde nije uvek jasno što je dobroa šta loše, nije jednostavno biti medicinska sestratehničar i biti u službi zdravlja i života. Sa pravomse ističe autonomija savesti i odluke pacijenta.

Zaključak: Važno je imati na umu da ciljkardiopulmonalne reanimacije nije produžavanježivota onda kada ne postoji nikakva nada zaozdravljenjem, i vraćanjem kvaliteta života.Ozdravljenje je cilj kome se teži uz vraćanjedostojanstvenom životu pacijenta a ne samo pukovegetiranje.Ključne reči: etika, moral, kardiopulmonalnareanimacija


Ulcus cruris – tretiranje otvorene ranefibrinskom membranomD.Trajković

Zavod za hitnu medicinsku pomoć Niš , Srbijae-mail adresa autora: [email protected]

Uvod: Ulcus cruris venosum je otvorena rananastala zbog loše cirkulacije u venskom sistemu,najčešće lokalizovana na potkolenicama. U Srbijikao i u svetu, sve je veći broj pacijenata sa ovimproblemom. Osnovni problem u dosadašnjemtretmanu ulcus crurisa ogledao se u načinu obrade anaročito u period oporavka koji je zahtevao odsamog pacijenta ali i članova porodice velikuangažovanost.Cilj: Ukazati na prednosti obrade otvorene raneulcus crurisa fibrinskom membranom u odnosu nadosadašnje, konvencionalne metodeMaterijal i metodologija: Retrospektivna analizaliterature sa odrednicama: ulkus cruris, fibrinskamembrane, lečenje.Izvor podataka i izbor materijala: Pretraživanje jevršeno kroz: PubMed, Medline i elektronskečasopise dostupne preko KoBSON-a kao i litraturaraspoloživa u biblioteci Medicinskog fakulteta uNišuRezultati sinteze. U Srbiji sa ovim problemompostoji, prema nekim statističkim podacima, oko2,5-3% stanovništva. Žene boluju češće odmuškaraca. Najčešća starosna granica je imeđu 40-45 god, odnosno u populaciji radno sposobnogstanovništva. Preko 30% pacijenata sa hroničnimvenskim čirom se leči duže od 20 godina a oko 10%duže od 30 godina. Venski čir potkolenice činiizmeđu 57% i 80% svih hroničnih ulceracija u Srbiji.




Preporuka dermatologa i vaskularnih hirurga ulečenju ulceracija je medikamentozna ili hirurška,gde se insistira na rekonstrukciji vena i zalistaka,valvulopltka i sl. (Vodič za lečenje hronične venskeisuficijencije Prim. Dr.Javorka Delić,spec.dermatologije). Dosadašnji pristup lečenjurana ulcus crurisa (konvencionalni pristup)podrazumevao je tretman prahom acidi-borici saosnovnim ciljem stvaranja kisele sredine a sve ucilju zarastanja rane. Ova metoda je bila bolna ineprijatna za samog pacijenta i podrazumevala jedug period oporavka uz redovnu toaletu rane,previjanje uz procentualno manju uspešnost ukonačno izlečenje. Korišćenje fibrinske membraneu obradi rane je znatno konforniji za pacijenta saznatno većim procentom uspešnosti u potpunozarastanje otvorenih rana. Fibrinska membrane sedobija iz krvi pacijenta, koji ima problem saulcusom. Uzeti uzorak krvi se tretira posebnomprocedurom kojom se kao krajnji proizvod dobijafirbinska membrane obogaćena trombocitima ifaktorima rasta i manjim brojem matičnih ćelija.Formirana fibrinska membrane postavlja se naočišćenu ranu, koja nije pod upalnim procesom.Membrana ostaje na rani 5-10 dana nakon čega senastavlja sa previjanjem, bez primene antibiotika,povidon-joda ili rivanola sledećih nekoliko dana.Period oporavka i zarastanja kreće petog dana odpostavljanja membrane i nastavlja se ubrzano usledeća dva meseca kada je neophodno ponovititretman. Potpuno zarastanje, zavisno od veličinerane, očekuje se u sledeća dva meseca. Ukupanperiod zarastanja rane ne bi trebalo da traje duže od4 meseca. Ovakav način tretmana otvorenih rana jekonforniji za samog pacijenta u odnosu nakonvencionalni.Zaključak: Otvorene rane ulcus crurisa mogu bitivrlo problematične i komplikovane i do sada su seuglavnom teško i dugo lečile i najčešće neuspešno.Tretiranje ulcusa fibrinskom membranom možeprestavljati novi uspešniji ali i jeftiniji način ulečenju ovih hroničnih rana.Ključne reči: ulkus cruris, fibrinske membrane,lečenje


Akutni abdomen-prehospitalno zbrinjavanjeM. Nikolić


Uvod: Bol u abdomenu je jedan od najčešćihrazloga zbog čega timovi hitne medicinske pomoćiintervenišu, kako na terenu tako i ambulanti,odnosno opsevaciji hitne medicinske pomoći.Prema našoj statistici, taj procenat varira od 20-45%u zavisnosti od perioda u godini.Cilj: Ukazati na značaj poznavanja definicije,etiologije, osnovnih karakteristika akutnogabdomena, prepoznavanje, pristup i ulogumedicinske sestre u zbrinjavanju pacijenata sabolom u trbuhu i sumnjom na akutni abdomen.Materijal i metodologija: Retrospektivna analizaliterature sa odrednicama: bol u grudima, akutniabdomen prehospitalni tretman, uloga medicinsekesestre/tehničara.Izvor podataka i izbor materijala.Pretraživanje je vršeno kroz: PubMed, Medline ielektronske časopise dostupne preko KoBSON-akao i litratura raspoloživa u Biblioteci Medicinskogfakulteta u NišuRezultati sinteze: Pojam akutnog abdomenapodrazumeva skup raznorodnih kliničkih entiteta.On obuhvata sva ona patološka stanja u trbušnojduplji koja, zbog svoje kliničke slike, ozbiljnostipatološkog supstrata i progresivne evolucije,zahtevaju neodložnu hospitalizaciju, preduzimanjeodgovarajućih mera reanimacije i intenzivneterapije. Ipak treba naglasiti da je postavljenadijagnoza akutnog abdomena izraz trenutne iprivremene dijagnostičke insuficijentnosti. Iakopostoji veliki broj definicija koje determinišu pojamakutnog abdomena, sažeto posmatrano, mogla bi seprihvatiti ona definicija po kojoj ovaj pojamobuhvata tri osnovna sindroma: Sindromperitonitisa, Sindrom ileusa, Sindromintraabdominalnog krvarenja. Bolesnik sarazvijenom kliničkom slikom akutnog abdomena jeteško pokretan ili potpuno nepokretan, adinamičan,malaksao, bez apetita, povijen je u struku i jednomili obema rukama drži se zatrbuh. Kada se postavi uležećipoložaj, noge drži povijene u kolenima i



kukovima (zauzima antalgični položaj). Bled je,uplašen, obloženog jezika, ubrzanog i filiformnogpulsa, ubrzanog disanja, subfebrilan ili febrilan, i saizraženim abdominalnim facijesom (faciesabdominalis s. Hypoccrati). Jedino se kod bilijarnogperitonitisa, a usled inhibitornog efektaresorbovanih žučnih soli na sprovodni systemmiokarda, javlja bradikardija). Blede beonjače moguukazivati na intraabdominalno krvarenje, doksubikterus sclera može biti znak bilijarnogperitonitisa. Lividne mrlje po trupu mogu ukazivatina mezenterijalnu trombozu, na akutnihemoragično-nekrotični pankreatitis, ali se mogusresti i u terminalnim (ireverzibilnim) stanjimaperifernog cirkulatornog kolapsa. Vidljiva nadutosttrbuha u ležećem položaju najčešće ukazuje nacrevnu okluziju (ileus), ali može biti i znak akutnogintraabdominalnog krvarenja ili prisustva drugeslobodne tečnosti u trbuhu (ascites). Vodeći(dominantan) lokalni znak kod akutnog abdomenajeste - bol u trbuhu. U kliničkoj slici akutnogabdomena treba uvek razlikovati dve osnovne grupesimptoma i kliničkih znakova: opšti simptomi iznaci, lokalni simptomi i znaci. Dijagnoza sepostavlja na osnovu dobre procene težine stanja iugroženosti pacijenta, a na osnovu anamneze ikliničkog pregleda. Dostupne dijagnostičke metodeu opservaciji ZHMP Niš su: EHO abdomena;LAB.analize: (krvna slika, LE formula, HCT):Terapijski postupak (nadoknada cirkulatornogvolumena) i simptomatska terapija bezKUPIRANJA BOLA!, a zatim hitan transport nahirušku kliniku.Zaključak: Adekvatan inicijalan pristup pacijentu saakutnim abdomenom, povećava procenatpozitivnog ishoda nakon hospitalizacije i hiruškoglečenja istog. Posto se akutni abdomen različitorazvija i zavisi od samog uzroka, od stranemedicinskog tehničara potrebno je dobropoznavanje osnovnih simptoma, što bi doprineloadekvatnom pristupu i prehospitalnomzbrinjavanju istog.Ključne reči: bol, abdomen, prehospitalni pristup


Razvoj dispečerskog centra u svetuT.Masoničić, S.Gopić, M.Janković


Uvod: Dispečerski centar Hitne medicinske pomoćije profesionalni telekomunikator, sa zadatkomprikupljanja informacija vezanih za hitnumedicinsku pomoć, pružanje pomoći i uputstvoglasom pre dolaska hitne medicinske pomoći, slanjei podrška ekipama HMP. Za obavljanje poslovadispečera u najvećem broju zemalja potreban je iodređeni certifikat, nivo edukacije i profesionalnaoznaka koja se stiče kroz edukaciju u Nacionalnimdispečerskim akademijama i drugim vidovimaobrazovanja.Cilj: Prikazati razvoj dispečerskog centra u svetu.Materijal i metodologija: Retrospektivna analizaliterature sa odrednicama: razvoj, dispečerskicentar, hitna medicinska pomoć.Izvor podataka i izbor materijala. Pretraživanje jevršeno kroz: PubMed, Medline i elektronskečasopise dostupne preko KoBSON-a kao i ostaleraspoložive literature.Rezultati sinteze: Dispečerski centar je oduvek biokarakteristika HMP. Prepoznavanje problema,obrada informacija i lociranje pacijenta su osnovnizadaci dispečerskog centra. Na samom početkupozivaoc bi javljao problem, ekipa odlazila na pozivi po završetku se vraćala u stanicu da čeka sledećipoziv. Pedesetih godina dvadesetog veka bilo jeretkih pokušaja da se koristi radio veza ukomunikaciji. Nova era razvoja počinje 1950godkada upotreba radio veze počinje da bivakorišćena širom USA i Kanade. U samom početkudispečerski centar je formiran zavisno od ustanovakoje su se bavile pružanjem pomoći. Nekada je tobio grad, vatrogasna služba ili bolnica. U jednombroju slučajeva kod nezavisnih hitnih pomoćidispečer bi bio član porodice vlasnika te hitnepomoći i njegove kvalifikacije nisu zahtevaledodatno obrazovanje osim poznavanja ulica ilokalne geografske situacije. Jedinstveni broj uvedenje u Kanadi 1959 a 1967 u SAD, ali je pokrivanjecelokupne teritorije trajalo do 2008. Trenutno,jedinstvenim brojem nije pokriveno 4 % teritorije




SAD. Pozivanjem jedinstvenog broja, poziva se ivatrogasna služba i policija I to je postalo poznatokao Public-safety answering point (PSAP).Tehnologija se dalje razvijala i u jednom trenutkuuvedene su 'zatvorene-locked' telefonske linije, kojaonemogućavaju slučajno prekidanje hitnog poziva,kao i automatska identifikacija brojeva AutomaticNumber Identification / Automatic LocationIdentification (ANI/ALI), koji omogućavadispečeru da proveri broj (sprečavanje lažnihpoziva), i identifikuje lokaciju sa kog stiže poziv.Princip - poslati najbližu ekipu koja će intervenisatikod pacijenta koji je životno ugrožen. Ovaj procesje uslovio potrebu za razvojem protokola za trijažupacijenata. Prvi takav trijažni protokol pojavio se1975, u Fenixu. Od tada su se razvili MedicalPriority Dispatch System (MPDS), APCO (EMD) iPowerPhone's Total Response Computer aided callhandling system (CACH). Prvi sistemi su u početkubili prilično jednostavni. Razvoj sistema u kojimainformacije ekipi stižu pre stizanja na mestodogadjaja i dalje ekipe mogu na prvi red da stignu unajboljim slučajevima u okviru prvih 8 min odpoziva. Edukovan dispečar za razliku od tima možeda pruži uputstva u prvim sekundama od poziva.Tako je razvijen Dispatch Life Support.Zaključak: Razvoj Dispečerskog centra u mnogomezavisi od razvoja elektromske opreme. Potreba da sešto adekvatnije odgovori potrebama pacijenatauslovilo je razvoj sistema za prijem poziva. Saznanjekako sistemi funkcionišu u svetu uticaće nadonošenje odluka u kom pravcu će se dispečerskisistem i razvijati u našoj zemlji.Ključne reči: dispečerski centar, razvoj


Febrilne konvulzije - prikaz slučajaLJ. Cvetković, I.Ilić, S.Gopić, M.Janković, T.Masoničić


Uvod: Konvulzije predstavljaju najčešće toničko-kloničke kontrakcije skeletne muskulature ali moguda se jave i obliku gubitka tonusa muskulature, kaosenzorni ispadi (parestezije, bol), vegetativni(povraćanje, znojenje, salivacija) ili u obliku

apsansa. Najčešće nastaju kod porasta temperatureali mogu i kod pada temperature. Često postojiporodično opterećenje ovih bolesnika. Javljaju se uuzrastu od 6 meseci do 6 godina i više kod dečaka.Ponavljene konvulzije se sreću u 20% do 30%.Cilj: Prikaz slučaja deteta sa generalizovanimfebrilnim konvulzijma, koji zatim prelaze uparcijane epi napade uz očuvanu svest deteta i ulogamedicinske sestre u lečenju.Materijal i metode: Uvid u medicinskudokumentaciju Zavoda za hitnu medicinsku pomoćNiš, poziv za lekarsku intervenciju i lekarskogizveštaja iz ambulante. Uvid u medicinskudokumentaciju pacijenta sa Dečije Interne Klinike.Prikaz slučaja: U kasnim popodnevnim satima otaci baka donose u ambulantu ZHMP muško detestaro 4,5 god. Pri prvom kontaktu uočavamo dadete odgovara uzrastu, normalno je uhranjno i bezsvesti je sa prisutnim klonično toničnim grčevimacelog tela. Pogled je fiksiran u levu stranu. Lako jecijanotično bez pene na ustima. Dobijamo podatakda se slična stvar desila jos jednom u dečakovojtrećoj godini i da je i tada imao visku temperaturu.Sada nisu primetili da ima povišenu temperaturu,samo su videli da je pao. U ovakvom je stanju višeod deset minuta. Započet brz pregled, gde seregistruje povišena TT, respiratorna infekcija,ordinira se terapija: Supp Eferalgan 150mg, SuppDiazepam 2mg, osiguran IV put IV braunilom 22G.Oxigenoterapije 6L/min. U toku sledećih desetakminuta, generalizovani napadi prestaju ali ostajuparcijalni napadi na levoj strani tela pri čemu jedete svesno i odgovara na pitanja. Dete se zatim upratnji ekipe transportuje do DIK.Diskusija: Febrilne konvulzije predstavljajuurgentno stanje koje roditelje izuzetno uplaše aneedukovano i neiskusno medicinsko osoblje moguda uznemire i dovedu do površnog i neadekvatnogodgovora. Medicinska sestra, kod ovih pacijenta,mora da zna niz postupaka i njena uloga je odneprocenjive vrednosti. Postupci koji se očekuju odsestre: merenje telesne temperature (u najvećembroju slučajeva rektalno), priprema deteta zapregled, asistiranje pri pregledu, postavljanje IVlinije, oxigenoterapija, obezbeđenje disajnog puta,aplikacija leka, uključivanje infuzione terapije.Zaključak: Uloga medicinske setre u zbrinjavanjudeteta sa konvulzijama je od neprocenljive važnosti.Njene reakcije moraju biti brze, mirne i adekvatne.Svojim ponašanjem šalje poruku i roditeljima, koji



u neviđenom strahu, da će sa njihovim detetom bitisve u redu. Timski rad kao i u drugimzbrinjavanjima teških stanja ima prednost.Ključne reči: febrilne konvulzije, uloga medicinskesestre


Kardiopulmonalna reanimacija vođenatelefonomM. Mitrović

Zavod za hitnu medicinsku pomoć Niše-mail adresa autora: [email protected]

Uvod: Vanbolnički srčani zastoj je značajanzdravstveni problem u većini razvijenih zemalja.Uprkos nacionalnim i internacionalnim vodičimaza kardiopulmonalnu reanimaciju (KPR) ukupnopreživljavanje pacijenata sa primarnim vanbolničkim srčanim zastojem (VBSZ ) je 7,6% inepromenjeno je u poslednjih trideset godina.Većina VBSZ se dešava u prisustvu svedoka, a samojedan od pet očevidaca započinje reanimaciju.Telefonski vođena KPR (T-KPR) se pokazala kaoefikasna mera za povećanje stope preživljavanja uslučajevima VBSZ. U Sjedinjenim AmeričkimDržavama u 200000 od 300000 slučajeva VBSZočevidac ne započinje KPR. Primena T-KPR imapotencijal da sačuva hiljade života svake godine.Cilj rada: Prikaz i analiza metode telefonski vođeneKPR .Metode i material: Baza podataka BioMed Central,Pubmed, Kobson.Rezultati i diskusija: T-KPR se definiše kao nizinstrukcija koje dispečer hitne pomoći pružatelefonom kako bi se povećala mogućnost daočevidac pokrene KPR. Dispečer hitne pomoćitreba da prođe obuku u prepoznavanju srčanogzastoja i davanju konkretnih i jasnih upustava izosnovne životne potpore. Preporučena strategija zaprimarni srčani zastoj je reanimacija samo sakompresijama grudnog koša. U preporukama suuključeni i slučajevi sa opstrukcijom disajnog putastranim telom. Izrađene su dve vrste protokola: zaodrasle i decu. Osnovni preduslovi za izradupreporuka su: Kratke poruke koje sadrže ključnereči; Lako razumljive i izgovorene prostim jezikom;

Izvodljive radnje od strane laika u teskim uslovima;Prezentacija u vidu postera koji sadrži korake kojise lako prate, uz stavljanje akcenta na ključneaktivnosti.Zaključak: Prvi problem koji doprinosi niskoj stopipreživljavanja VBSZ je nespremnost očevidaca daotpočnu reanimaciju. Telefonska podrška očevicusrčanog zastoja od strane dispečera hitne pomoćipovećava mogućnost preživljavanje ovih bolesnika.Razvoj jedinstvenog protokola za T-KPR na nivousvih hitnih službi, je prvi korak ka postizanju većestope preživljavanja VBSZ, a obuhvata procespripreme dokumenta sa preporukama i uputstvimaza T-KPR kao i njihovu prezentacija u vidu postera,plakata i bilborda kao i uz dobru medijsku


Edukacija dispečera u službama hitnemedicinske pomoći u svetu i kod nasS.Gopić, M.Janković, T.Masoničić, Lj.Cvetković


Uvod: U Službama Hitne Medicinske Pomoći(SHMP) u našoj zemlji, zavisno od organizacijeslužbe, rade uglavnom lekari (u Zavodima za hitnumedicnsku pomoć), a medicinske sestre/tehničari uslužbama koji pokrivaju manji proctor. U našojzemlji ne postoji zvanična edukacija za ovo radnomesto. Uobičajeno je da se na ova radna mestopostavljaju radnici imaju veliko radno iskustvo naterenu, poznaju hronične pacijente i geografskiprostor. Često su ovi radnici, zbog hroničnih bolestiu nemogućnosti da budu sastavni deo terenskeekipe, te se njihov rad na dispečerskom mestusmatra tradicionalno dobrim rešenjem. Međutim,ubrzan razvoj tehnologije, izmena u načinukomunikacije, potreba za uvođenjem protokola kaoi veća očekivanja od strane stanovništva sve viseukazuju na potrebu za formiranjem jasnih stavova oedukaciji ovog profila u zdravstvu.Cilj: Ukazati na potrebu uvođenja zvaničneedukacije za posao dispečera u HMP.Materijal i metodologija: Retrospektivna analizaliterature sa odrednicama: dispečer, edukacija.




Izvor podataka i izbor materijala. Pretraživanje jevršeno kroz: PubMed, Medline i elektronskečasopise dostupne preko KoBSON-a.Rezultati sinteze:Zvanična edukacija za dispečera u svetu postojikroz određene kurseve koji imaju za cilj dadoprinesu bezbednom i efikasnom obavljanju posladispečera u Emergency Medical System (EMS).Smernice za osnovni sadržaj ovih kurseva u USA,standardizuju se kroz organizaciju AmericanSociety for Testing and Materials (ASTM). Ovesmernice obezbeđuju ciljeve za dalju obuku isertifikaciju edukacije dispecera. U kontekstu ovogširokog cilja, ASTM trening je generalno najmanje24h ukupno tj (tri puta po 8h dnevno). Tipičan kursse sastoji od prikaza dispečerskih ciljeva isavladavanja osnovnih tehnika, usmeravajući obukuka poznatim problematičnim oblastima. Ulogadispečera je definisana, a koncepti medicinskogdelovanja se raspravljaju u detalje. Protokol zaslanje ekipa na teren obično je uveden od stranevlasnika EMS agencije. Kod kandidata za dispčerainsistira se na ispitivanju njegove sposobnostipoštovanja tog protokola, kao i na sposobnostpružanje uputstva pozivaocu dok ne stigne ekipa.Na kursu se analiziraju uobičajeni zdravstveniproblemi, sa naglaskom na ispitivanju specifičnostiza svaku vrstu problema. Potencira se usvajanjestave o važnosti pružanja adekvatnih uputstavapozivaocu u urgentnim stanjima do stizanja ekipe.Tokom obuke, značajno je da polaznik kursaidentifikuje prisustvo ili odsustvo simptoma (kaošto su "bol u grudima"). Postavljanje sumnje natakvu dijagnozu bez ovih pitanja nema nikakvogsmisla.Medicinski značaj različitih nivoa hitnosti za svakuvodeću tegobu daju učeniku mogucnost da odredibrzo prioritet različitih vrsta incidenata sa kojima sesuočava dispečerska služba. Često, kursevi koristesimulacione zadatke da bi dispečer imao realniosecaj o karakteristikama protokola. Formalnimispitivanjem i praktičnim delo razumevanja iasimilacija nastavnog plana i programa završava seobuka. Ovo omogucava formalnu sertifikaciju.Zaključak: Preporučuje se da obuka budesprovedena za sve medicinske dispečere, da seosnovni sadržaj nastavnog plana i programa nemenja i da bude formiran na nacionalnom nivou. Uslužbama mora biti odabran od stranemedicinskogdirektora agencije.

Ključne reči: dispečer, edukacija, prijem poziva.


Akutna trovanja kod deceV.Cvetanović


Uvod: incidenca trovanja kod dece je 450 ∕ 100.000,najčešća kod dece mlađih od 6g, nešto visedevojčica a 11% dece zbog trovanja zahtevamedicinski tretman, Na sreću smrtnost usledtrovanja je mala– 0,005%. Akutna tovanja nastaju utoku kratkog, često trenutnog jednokratnogunošenja velike količine otrova u organizam –jelom, pićem, udisanjem, dodirom preko kože.Predstavljaju urgentno stanje čak kada su prvisimtomi blagi zahevaju opservaciju i pažljiv pristup.Cilj: Ukazati na važnost dispečera kao prve karike utrenutku prijema poziva u slučajevima trovanjadece.Izvor podataka i izbor materijala. Pretraživanje jevršeno kroz: PubMed, Medline i elektronskečasopise dostupne preko KoBSON-a.Rezultati sinteze: Najveći broj trovanja se dese ukući ili sredini u kojoj dete najčešće i boravi. Ovoustvari i ukazuje da su glavni krivci za ovakvedogađaje roditelji i staraoci, odnosno osobe koje ihčuvaju a često su to bake i deke. Ta činjenca iobjašnjava dostupnost dece širokoj lepezinajrazličitijih lekova, pre svega za kardiovaskularnebolesti. Uloga lekara ili medicinske sestre naprijemu poziva je da postavi ciljana pitanja vezanaza izgled i ponašanje deteta, detektuje potencijalniizvor trovanja, da da rešenje za datu situaciju(laicima i svim ostalim kategorijama zdravstvenihradnika), pošalje odmah edukovanu ekipu, ukolikopostoji mogućnost sa pedijatrom. Lekar na prijemumora da uputi pozivaoca na tri osnovne stvari: daukoliko je bez svesti ne daju detetu ništa na usta, dapokušaju da utvrde da li ima sumnjive supstance(koju treba da sačuvaju i ponesu sa sobom), i ako jekontakt otrovne supstance preko kože, obilnomkoličinom vode speru s deteta do dolaska ekipe.Smiren glas i jasna uputstva pozivaocu supreporuka za sve pozive a pogotovu za ovu



situaciju. U toku intervenisanja ekipe HMP iukoliko je poznata otrovna supstanca dispečer možeda uštedi vreme i pozove instituciju koja se bavitrovanjem (u Srbiji, to je Nacionalni centarzatrovanje VMA) kako bi dobio bliža uputstva ouzročniku, simptomima i načinu primarnogtretmana i da radio vezom prosledi informacije. Uslučaju da dobije podatke o prestanku disanja,dispečar može da počne sa upućivanjem pozivaocada započne postupke kardiopulmonalnereanimacije.

Zaključak: Dispečer je prva karika u zbrinjavanjasvih urgentnih stanja. Akutna trovanja dece sustanja koja predstavljaju potencijalno stanje opasnopo život, roditelji i druge prisutne osobe svojimstrahom dodatno opterete naš rad. Dispečer kaoprva karika svojim adekvatnim reagovanjemomogućava započinjanje kvalitetnog zbrinjavanjaotrovanog deteta.Ključne reči: deca, trovanja, prijem poziva




CONTENTS / SADRŽAJ

ENGLISH

Abstract number: 001................................................................6The basic principles of the oxygen utilization inemergency conditionesS.Trpković,A.Pavlović,,N.Videnović,R.Zdravković, O. Marinković,A.Sekulić

Abstract number: 002................................................................7The multimodal approach to the therapy of acutepostoperative pain in older patients after knee jointprosthesis placementO.Marinkovic,A.Sekulic,V.Milenkovic, J.Zlatic,. V.Kostic, S.Trpkovic

Abstract number: 003............................................................... 8Atelecttrauma - histopathological, radiological andpathophysiological aspectN.Videnović, J.Mladenović, A.Pavlović, S.Tripković, S.Nikolić,R.Zdravković, V.Videnović

Abstract number: 004................................................................8Case report of the patient with a systemic reaction to aninsect stingA.Stankov, T.Rajkovic

Abstract number: 005................................................................9Pulmonary edema of cardiac origin, prehospital treatment– Sabac EMS experience in 2015M.Popović, Ž.Nikolić, B.Vujković, N.Beljić

Abstract number: 006..............................................................10Emergency Medical Service of Montenegro at The SeaDance festival 2015R.Furtula, S.Stefanović, M.Šaponjić, B. Stojanović, V.Đurašković

Abstract number: 007..............................................................11Abdominal pain as differential diagnostic problem-newlydiscovered aortic aneurysmD.Milanović, N.T.Kostić

Abstract number: 008..............................................................12AV block caused by alcohol as a probable cause ofunconsciousness - case reportN.T.Kostić, D.Milanović

Abstract number: 009..............................................................12Spontaneous pneumothorax - Prehospital diagnosisD.Husović, A.Husović, F.Pašović, A.Tuzinac Hanuša

Abstract number: 010..............................................................13The importance of cooperation between the gendarmeriehealth service and mobile medical units in providing carein emergency situationsD. Veljković, K.Bulajić Živojinović, D.Tijanić, J.Zlatić, V.Stojanović

SRPSKI

Broj apstrakta: 001...................................................................44Osnovni principi primene kiseonika u hitnim stanjimaS.Trpković, A.Pavlović, N.Videnović, R.Zdravković, O.Marinković,A.Sekulić

Broj apstrakta: 002...................................................................45Multimodalni pristup terapiji akutnog postoperativnogbola kod starih pacijenata nakon ugradnje proteze kolenaO.Marinković, A.Sekulić, V.Milenković, J.Zlatić, V.Kostić, S.Trpković

Broj apstrakta: 003...................................................................46Atelektrauma – histopatološki, radiološki i patofiziološkiaspektN.Videnović, J.Mladenović, A.Pavlović, S.Tripković, S.Nikolić,R.Zdravković, V.Videnović

Broj apstrakta: 004...................................................................46Sistemska reakcija na ubod insekataA.Stankov, T. Rajković

Broj apstrakta: 005...................................................................47Edem pluća srčanog porekla, prehospitalni tretman -iskustva SHMP Šabac u 2015 gM.Popović, Ž.Nikolić, B.Vujković, N.Beljić

Broj apstrakta: 006...................................................................48Hitna medicinska pomoć na Sea Dance festivalu 2015R.Furtula, S.Stefanović, M.Šaponjić, B.Stojanović, V.Đurašković

Broj apstrakta: 007...................................................................48Novo otkrivena aneurizma aorte kao diferencijalnodijagnostički problem kod abdominalnog bolaD.Milanović, N.T.Kostić

Broj apstrakta: 008...................................................................49AVblok uzrokovan alkoholom kao verovatni uzrokgubitka svesti- prikaz slučajaN.T.Kostić, D.Milanović

Broj apstrakta: 009...................................................................50Spontani pneumotoraks - Prehospitalna dijagnozaD.Husović, A.Husović, F.Pašović, A.Tuzinac Hanuša

Broj apstrakta: 010...................................................................50Značaj saradnje zdravstvene službe žandarmerije imedicinskih ekipa na terenu u pružanju pomoći uvanrednim situacijamaD. Veljković, K.Bulajić Živojinović, D.Tijanić, J.Zlatić, V.Stojanović



Abstract number: 011..............................................................13Options to improve the diagnosis of acute appendicitis inchildren, in ambulatory settingsA.Kostić, Z.Marjanović, M.Krstić, Z.Jovanović, G.Janković,I.Đorđević, N.Vacić

Abstract number: 012..............................................................14Hyperkalaemia-case reportG.Simić

Abstract number: 013.............................................................15Statistical overview of patients with febrile convulsionsand epilepsy up to 18 yearsD.Ševo, T.Rajković, A.Dimić

Abstract number: 014..............................................................16The deadly duo: mixing alcohol and Xanax can lead to badhabits or unexpected deathLj.Milošević, K.Jovanović, M.Donić

Abstract number: 015..............................................................17Emergency treatment of near-fatal acute asthma – casereportLj.Milošević, K.Jovanović

Abstract number: 016..............................................................18Non-operative treatment of blunt kidney injury inchildren-a case reportZ.Jovanović, A.Slavković, M.Bojanović

Abstract number: 017..............................................................19Syncope in children and adolescents - a medicalemergency or not?Lj.Šulović, J.Živković, D. Odalović, Z.Živković, S.Filipović-Danić

Abstract number: 018..............................................................19Infectiones at region of Nuchae in patients withcomorbiditiesM.Mrvaljević, S.Pajić, T.Boljević, M.Božić, Z.Pešić, I.Bogdanović,J.Arsov

Abstract number: 019..............................................................20Location and importance of tracheotomy in patients withcraniofacial injuriesS.Pajić, J.Arsov, I.Bogdanović, B.Olujić, D.Jovanović, T.Boljević,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić

Abstract number: 020..............................................................21Pleomorphic adenoma in the sub mandibular salivaryglandS.Pajić, J.Arsov , I.Bogdanović, B.Olujić, D.Jovanović, T.Boljević,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić

Abstract number: 021..............................................................22Optimum usability of skin grafts - Thiersch typeT.Boljević, S.Pajić, J.Arsov, I.Bogdanović, B.Olujić, D.Jovanović,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić

Broj apstrakta: 011...................................................................51Mogućnosti poboljšanja dijagnostike akutnog apendicitisakod dece u ambulantnim uslovimaA.Kostić, Z.Marjanović, M.Krstić, Z.Jovanović, G.Janković,I.Đorđević, N.Vacić

Broj apstrakta: 012...................................................................52Hiperkalijemija-prikaz slučajaG.Simić

Broj apstrakta: 013...................................................................53Statistički prikaz pacijenata sa febrilnim konvulzijama iepilepsijom do 18 godinaD.Ševo, T.Rajković, A.Dimić

Broj apstrakta: 014...................................................................53Smrtonosni duo: mešanje alkohola i xanaxa može dovestido loše navike ili neočikivane smrtiLj.Milošević, K.Jovanović, M.Donić

Broj apstrakta: 015...................................................................54Hitno lečenje blizu-fatalne akutne ashme-prikaz slučajaLj. Milošević, K.Jovanović

Broj apstrakta: 016...................................................................55Neoperativni tretman tupe povrede bubrega kod dece-prikaz slučajaZ.Jovanović, A.Slavković, M.Bojanović

Broj apstrakta: 017...................................................................56Sinkopa kod dece i adolescenata - urgentno stanje ili ne?Lj.Šulović, J. Živković, D.Odalović, Z.Živković, S.Filipović-Danić

Broj apstrakta: 018...................................................................57Infekcije nuhealne regije pacijenata sa komorbitetomM.Mrvaljević, S.Pajić, T.Boljević, M.Božić, Z.Pešić, I.Bogdanović,J.Arsov

Broj apstrakta: 019...................................................................58Mesto i značaj traheotomije kod pacijenata sakraniofacijalnim povredamaS.Pajić, J.Arsov, I.Bogdanović, B.Olujić, D.Jovanović, T.Boljević,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić

Broj apstrakta: 020...................................................................59Miksni tumor u submandibularnoj pljuvačnoj žlijezdiS.Pajić, J.Arsov, I.Bogdanović, B.Olujić, D.Jovanović, T.Boljević,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić

Broj apstrakta: 021...................................................................59Optimum upotrebljivosti kožnih graftova tipa ThierschT.Boljević, S.Pajić, J.Arsov, I.Bogdanović, B.Olujić, D.Jovanović,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić




Abstract number: 022..............................................................22Reconstructive options in closing decubitus ulcers ofsacrococcygeal regionM.Mrvaljević, S.Pajić, T.Boljević, M.Božić, Z.Pešić, I.Bogdanović, J.Arsov

Abstract number: 023..............................................................23Our experience in the treatment of fractures of the zygomatico-maxillary complex, zygomatic bone and of the orbit floorT.Boljević, S.Pajić, J.Arsov, I.Bogdanović, B.Olujić, D.Jovanović,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić

Abstract number: 024..............................................................24Cervico-mediastinal hematoma - Compression as lifethreatening condition for patientB.Olujić, Z.Lončar, S.Pajić, P.Savić, D.Jovanović, G.Kaljević,T. Boljević, M.Mrvaljević, M.Đorđević, M.Božinović, Z.Pešić,I.Nikolić, M.Jokić

Abstract number: 025..............................................................25Reasons for visiting Emergency Center in thepostoperative period of patients who underwent thyroidand parathyroid glands surgeryB.Olujić, Z.Lončar, S.Pajić, P.Savić, D.Jovanović, G.Kaljević, T.Boljević, M.Mrvaljević, M.Đorđević, M.Božinović, Z.Pešić, I.Nikolić,M. Jokić

Abstract number: 026..............................................................26Acute acalculous cholecystitisS.Mitrović, G.Živković, B.Radisavljević, R.Krstić

Abstract number: 027..............................................................27Case report of patient with nonspecific clinicalpresentation in acute myocardial infarction (AMI)V.Lučković Mitić

Abstract number: 028..............................................................27Polytrauma-case reportV.Janačković, I.Jovanovski, D.Miletić, D.Anasonović, J.Stojiljković,M.Lilić

Abstract number: 029..............................................................28Cardiac injury-frequently neglected diagnosisB.Radisavljević, D.Gostović, S.Mitrović

Abstract number: 030..............................................................29Foreign body in the airway as the cause of cardiac arrest-case reportM.Knežević, A.Dimić

Abstract number: 031..............................................................30Acute pulmonary edema-case reportN.Milenković, E.Miletić, D.Milijić, M.Lazarević

Abstract number: 032..............................................................31Prolonged hypoglycemia-attention!R.Krstić, B.Radisavljević, S. Mitrović

Broj apstrakta: 022...................................................................60Rekonstruktivne mogućnosti u zatvaranjusakrokcigealnih dekubitalnih ulceracijaM.Mrvaljević, S.Pajić, T.Boljević, M.Božić, Z.Pešić, I.Bogdanović,J.Arsov

Broj apstrakta: 023...................................................................61Naša iskustva u liječenju preloma zigomatiko-maksilarnog kompleksa, zigomatične kosti i poda orbiteT.Boljević, S.Pajić, J.Arsov, I.Bogdanović, B.Olujić, D.Jovanović,M.Mrvaljević, M.Božić, Z.Pešić, I.Nikolić, M.Jokić

Broj apstrakta: 024...................................................................61Cerviko-medistijalni hematom kompresija opasna poživot pacijentaB.Olujić, Z.Lončar, S.Pajić, P.Savić, D.Jovanović, G.Kaljević,T. Boljević, M.Mrvaljević, M.Đorđević, M.Božinović, Z.Pešić,I.Nikolić, M.Jokić

Broj apstrakta: 025...................................................................62Razlozi poseta Urgentnom centru pacijenata upostooperativnom periodu onih koji su operisali štitnu iparaštitne žlezdeB.Olujić, Z.Lončar, S.Pajić, P.Savić, D.Jovanović, G.Kaljević,T.Boljević, M.Mrvaljević, M.Đorđević, M.Božinović, Z.Pešić,I.Nikolić, M.Jokić

Broj apstrakta: 026...................................................................63Akutni akalkulozni holecistitisS.Mitrović, G.Živković, B.Radisavljević, R.Krstić

Broj apstrakta: 027...................................................................64Prikaz slučaja pacijenta sa nespecifičnom kliničkomslikom u akutnom infarktu miokarda (AIM)V.Lučković Mitić

Broj apstrakta: 028...................................................................64Politrauma-prikaz slučajaV.Janačković, I.Jovanovski, D.Miletić, D.Anasonović, J.Stojiljković,M.Lilić

Broj apstrakta: 029...................................................................65Povrede srca-često zapostavljena dijagnozaB.Radisavljević, D.Gostović, S.Mitrović

Broj apstrakta: 030...................................................................66Strano telo u disajnom putu kao uzrok akutnog zastojasrca-prikaz slučajaM.Knežević, A.Dimić

Broj apstrakta: 031...................................................................67Akutni edem pluća-prikaz slučajaN.Milenković, E.Miletić, D.Milijić , M.Lazarević

Broj apstrakta: 032...................................................................68Produžena hipoglikemija-oprez!R.Krstić, B.Radisavljević, S. Mitrović



Abstract number: 033..............................................................31Differential diagnosis of chest painM.Bogdanović, S.Radojičić

Abstract number: 034..............................................................32Arrhythmia absolute in hypertensive crisisM.Bogdanović, S.Radojičić

Abstract number: 035..............................................................32Early defibrillation key to a successful CPR – A case reportJ.Arnautović, A.Stankov

Abstract number: 036..............................................................33Geriatric traumaT.Mićić,T.Rajković, I.Ilić

Abstract number: 037..............................................................34The activation patterns of emergency medical servicesduring out-of-hodpital cardiac arrestand decision toresuscitate - EURECA ONE study 2014D.Milenković, T.Rajković, S.Ignjatijević, S.Mitrović, V.Anđelković,M. Stojanović

Abstract number: 038..............................................................34A Case report of the trauma patient treatmentM.Janković, S.Gopić, T.Masoničić, Lj. Cvetković

Abstract number: 039..............................................................35Polytrauma – A case reportD.Stefanović, D.Janković, T.Rajković

Abstract number: 040..............................................................36Moral and ethical issues regarding CPRA.Nikolić, D.Janković

Abstract number: 041..............................................................36Ulcus cruris - treatment of open wounds with a fibrinmembraneD.Trajković

Abstract number: 042..............................................................37Acute abdomen-prehospital careM. Nikolić

Abstract number: 043..............................................................38Development of the emergency medical dispatch center inthe worldT.Masoničić, S.Gopić, M.Janković

Abstract number: 044..............................................................39Febrile convulsions – a case reportLj. Cvetković, I. Ilić, S. Gopić, M. Janković, T. Masoničić

Abstract number: 045..............................................................40Telephone assisted cardiopulmonary resuscitationM. Mitrović

Broj apstrakta: 033...................................................................68Diferencijalna dijagnoza bola u grudimaM.Bogdanović, S.Radojičić

Broj apstrakta: 034...................................................................69Aritmija absoluta u hipertenzivnoj kriziM.Bogdanović, S.Radojičić

Broj apstrakta: 035...................................................................69Rana defibrilacija ključ uspešne CPR -prikaz slučajaJ.Arnautović, A.Stankov

Broj apstrakta: 036...................................................................70Trauma kod starihT.Mićić, T.Rajković, I.Ilić

Broj apstrakta: 037...................................................................70Parametri aktivacije sistema hitne medicinske pomoći uvanbolničkom srčanom zastoju i odluka o primeni meraCPR-studija EURECA ONE 2014D.Milenković, T.Rajković, S. Ignjatijević, S. Mitrović, V.Anđelković,M.Stojanović

Broj apstrakta: 038...................................................................71Prikaz slučaja zbrinjavanja traumatizovanog pacijentaM.Janković, S.Gopić,T.Masoničić, LJ.Cvetković

Broj apstrakta: 039...................................................................72Politrauma - prikaz slučajaD.Stefanović, D. Janković, T.Rajković

Broj apstrakta: 040...................................................................73Moralna i etička pitanja vezana za KPRA.Nikolić, D.Janković

Broj apstrakta: 041...................................................................73Ulcus cruris – tretiranje otvorene rane fibrinskommembranomD.Trajković

Broj apstrakta: 042...................................................................74Akutni abdomen-prehospitalno zbrinjavanjeM. Nikolić

Broj apstrakta: 043...................................................................75Razvoj dispečerskog centra u svetuT.Masoničić, S.Gopić, M.Janković

Broj apstrakta: 044...................................................................76Febrilne konvulzije - prikaz slučajaLJ. Cvetković, I.Ilić, S.Gopić, M.Janković, T.Masoničić

Broj apstrakta: 045...................................................................77Kardiopulmonalna reanimacija vođena telefonomM. Mitrović




Abstract number: 046..............................................................41Dispather education in emergency medical services in theworld and in our countryS.Gopić, M.Janković, T.Masoničić, Lj.Cvetković

Abstract number: 047..............................................................41Acute poisoning in childrenV .Cvetanović

Broj apstrakta: 046...................................................................77Edukacija dispečera u službama hitne medicinske pomoćiu svetu i kod nasS.Gopić, M.Janković, T.Masoničić, Lj.Cvetković

Broj apstrakta: 047...................................................................78Akutna trovanja kod deceV.Cvetanović

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