Lijec̆nic̆ki vjesnik
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Good organization and coordination of emergency services are one of the most crucial factors, which influences the number of survivors and severity of incident overall health and structural long-term damages. Different studies showed that poor leadership is the main cause for poor intervention results at mass casualty incidents. This article briefly presents French, American, and English incident command systems at mass casualty incident and other crisis. If the incident command want to achieve the best intervention results then they, independently from command level and formal system, should establish a proper level of flexibility, controllable span of command, use of common terminology, effective use and accountability of resources, integrated and available telecommunications with profound exchange of information and intelligence.
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Mass casualty incident is event with several injured or acutely ill persons, which is impossible to manage with available resources bit it can be managed after activation of special plan and spare resources. Every day at least one mass casualty incident happens in the world and that varies from Ljubljana Ambulance Service coverage area where 11 such incidents happened in the last 40 years. Success of intervention at mass casualty incident depends on quality of preparation for such event. ⋯ In general one person can manage only one key element or in the case of smaller mass casualty incident one person can manage few key elements. But in the case of large scale mass casualty event more than one person is needed to successfully manage certain key element. It is very important that all potential providers at mass casualty incident are well informed of functioning and establishing of all possible key elements and that they play all kind of key roles in advance at mass casualty drills.
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Lijec̆nic̆ki vjesnik · Sep 2006
Review[Anaphylactic reaction as a side-effect of administration of general anesthetics and neuromuscular blocking agents].
The incidence of anaphylactic reactions during anesthesia is between 1:5000 and 1:25000 anesthetics. During the IgE-mediated anaphylactic reaction mast cells release proteases such as tryptase, histamine and vasoactive mediators. The release of mediators from the mast cells and basophils is responsible for the immediate clinical manifestations of anaphylaxis. ⋯ Airway maintenance, 100% oxygen administration, intravascular volume expansion and epinephrine are essential to treat the hypotension and hypoxia that result from vasodilatation, increased capillary permeability and bronchospasm. As soon as the diagnosis has been made the adrenalin should be given intravenously 1 to 3 ml of 1:10000 aqueous solution (0.1 mg/ml) over 10 minutes. Prevention is possible with methylprednisolone 125 mg i.v. 1 hour before administering of anesthetics and neuromuscular blocking agents with or without antihistaminic chlorpiramine-chloride 1 amp i.v. few minutes before anesthesia.
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Lijec̆nic̆ki vjesnik · Sep 2006
Review[Use of magnetic resonance imaging in the diagnosis and prognosis of multiple sclerosis].
Multiple sclerosis is an autoimmune disease characterized by demyelination and axonal loss. Conventional magnetic resonance imaging allows the demonstration of spatial and temporal dissemination of multiple sclerosis lesions earlier than is possible from clinical assessments. A variety of conventional magnetic resonance imaging protocols, in conjunction with clinical assessment, are now routinely used to increase the accuracy of diagnosis and long-term prognosis of multiple sclerosis. ⋯ Several studies have used brain atrophy, T1-hypointense lesion volume, magnetization transfer imaging, diffusion-weighted imaging and magnetic resonance spectroscopy to test whether the extent and severity of tissue loss in lesions and in normal appearing gray and white matter at the time of clinically isolated syndrome may have diagnostic and prognostic value. These magnetic resonance imaging techniques represent a powerful tool to non-invasively study different pathological substrates of lesions and microscopic tissue changes. Additional short- and long-term prospective studies are requested to establish their value in the diagnosis and prognosis of multiple sclerosis.