Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Sep 2010
Review[Glycaemia control in critically ill patients is justified and effective].
Hyperglycemia and insulin resistance develop in the majority of severe acute illness and/or injury. One of the main causes of hyperglycemia in critically ill patients is the release of counterregulatory stress hormones and proinflammatory cytokines, in addition to increased production of glucose along with its decreased utilization. Hyperglycemia plays an important role not only in influencing the cascade of inflammatory cytokines, but it also increases oxidative stress. ⋯ Procedures seeking optimal intensive control in critically ill patients are accepted in intensive care units. However, it is undoubtedly necessary to improve monitoring techniques and the quality of biosensors in order to ensure the safety and effectiveness of interventions aimed at reducing blood glucose levels while using advanced protocols. Automatic closed systems are a promise for the future.
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Vnitr̆ní lékar̆ství · Aug 2010
Review[Care for patients on mechanical ventilation from the perspective of an internal medicine physician].
At times of respiratory insufficiency, mechanical ventilation (MV) provides support for or a substitution ofcertain components of the respiratory system. The aim of ventilation therapy is to achieve appropriate ventilation and oxygenation parameters and to minimize adverse events of MV. ⋯ To perform invasive mechanical ventilation, it is necessary to secure the airways with intubation or tracheotomy. We aim for the shortest possible duration of mechanical ventilation and intubation; their duration is a risk factor in development of ventilator-associated pneumonia.
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Vnitr̆ní lékar̆ství · Jun 2010
Review[Sepsis and the septic shock in oncological or other immunocompromised patients--diagnosis, therapy].
Sepsis and the septic shock and the up to date knowledge about them represent a marked drifting for diagnostics and the treatment of this complications. Their application in patients with the oncological disease or the other immunocompromised patients represents further extension in the specific group of patients with several unique properties. ⋯ They have to master the basal image about the specialties of this patient group. In our article we analyze this group of patients with focus on antibiotics in febrilie neutropenia and sepsis and on the other supportive care in the immunocopromised patients.
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Vnitr̆ní lékar̆ství · May 2010
[ILCOR recommendation on signage of automated external defibrillators (AEDs)].
Early defibrillation is a determinant of survival in both out-of-hospital and in-hospital cardiac arrests from ventricular fibrillation and pulseless ventricular tachycardia. The review summarizes importance of early defibrillation with automated external defibrillators (AED) and presents the International Liaison Committee on Resuscitation (ILCOR) recommendation for universal AED sign. The aim of the recommendation is to unify the AED signs worldwide and to spread the knowledge of this. The public in general, but healthcare professionals particularly, should be able to recognize AED location and use the device immediately in case of cardiac arrest.
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Incidence of myocardial dysfunction in studies with severe sepsis patients is up to two thirds of patients. On the other side, patients with normal echocardiography have some type of myocardial injury, which can be detected by elevated serum levels of troponins and natriuretic peptides. Strong prognostic value of these markers regarding morbidity and mortality of septic patients indicates an important role of this "occult" myocardial injury. ⋯ Nowadays, because of detrimental effects of classical inotropes, new strategies are under investigation. Namely levosimendan is promising alternative, not only related to its inotropic effects. Early diagnostics, assessment of prognosis and therapeutic strategy in patients with SMD are challenging for continuing research and for clinicians of different specialities.