Akutní stavy v interní medicíně

Martin Matějovič

Vnitr Lek 2019, 65(3):163 | DOI: 10.36290/vnl.2019.031  

An unstable patient in first contact with a doctor in hospital: how to recognize the risk?

Vladimír Šrámek

Vnitr Lek 2019, 65(3):166-169 | DOI: 10.36290/vnl.2019.032  

The primary triage of patients on first contact with a physician is crucial for its further direction and it essentially influences the prognosis. In addition to the physician's experience and given the proper stratification, an important role is played by medical history, basic clinical examinations and laboratory tests. The level of established risk affects the indication for hospital admission or possibly admission to a monitored bed. For each new patient, it is advisable to monitor the development of the overall condition and response to the initiated therapy within the first hours of hospitalization. Team cooperation often helps to get a complete...

Diagnosing hypovolemia and hypervolemia: from clinical examination to modern methods

Jan Beneš

Vnitr Lek 2019, 65(3):170-176 | DOI: 10.36290/vnl.2019.033  

In acutely ill patients, disturbances of circulating blood volume and water homeostasis are frequently encountered. In order to choose adequate treatment strategy a well based diagnostics of these disturbance sis necessary, because fluid therapy possess the potential not only to help but also to worsen patient's state. Currently we have at hand several possibilities to diagnose hypovolemia or hypervolemia: besides standard clinical assessment novel approaches as dedicated laboratory markers or sonography. Tests of fluid responsiveness are other mean how to ensure that the acutely ill patient will receive just the right amount of fluids. In this review...

Importance of ultrasound examination in diagnosing acute conditions

Martin Balík

Vnitr Lek 2019, 65(3):177-186 | DOI: 10.36290/vnl.2019.034  

Availability of an ultrasound device at the critical care setting significantly enhances possible diagnostic ways and makes the management of critically ill patients more effective. Growing amount of papers confirms that qualified intensivists with background in medicine and anaesthesiology may provide accurate, safe and extensive diagnosis of the haemodynamic system with the aid of echocardiography. Examination of lungs, pleural space, quantification of pleural fluid and eventual exclusion of ventral pneumothorax should be an integral part of transtoracic echocardiographic examination. Interrogation of abdomen in sepsis of unknown origin, acute abdominal...

Intravenous fluid therapy in acutely ill patients for non-intensivists

Martin Matějovič, Jan Horák, Martin Harazim, Thomas Karvunidis, Jaroslav Raděj, Ivan Novák

Vnitr Lek 2019, 65(3):187-192 | DOI: 10.36290/vnl.2019.035  

Intravenous fluid therapy is the most frequent therapeutic intervention in acutely hospitalized patients. They are administered in order to resuscitate the circulation in hypovolemia-associated shock states, to compensate for an impending or existing fluid extracellular deficit, or as a maintenance infusion if the patient is incapable of taking fluid by other means. Any fluid should be prescribed with the same caution as with any other drug. Errors in fluid therapy adversely affect patient - centered outcome. This may be the result of an incorrectly selected amount or inappropriate fluid composition for a given clinical situation. Prescribing intravenous...

Acute respiratory distress syndrome

Vlasta Dostálová, Pavel Dostál

Vnitr Lek 2019, 65(3):193-203 | DOI: 10.36290/vnl.2019.036  

Acute respiratory distress syndrome (ARDS) is a type of acute diffuse lung injury associated with a predisposing risk factor, characterized by inflammation leading to increased pulmonary vascular permeability and loss of aerated lung tissue. The hallmarks of the clinical syndrome are hypoxemia and bilateral radiographic opacities, associated with several physiological derangements including: increased pulmonary venous admixture, increased physiological dead space, and decreased respiratory system compliance. No pharmacologic treatments aimed at the underlying pathology have been shown to be effective, and the management remains supportive. Lung-protective...

Initial antibiotic treatment of serious bacterial infections

Jiří Beneš

Vnitr Lek 2019, 65(3):204-209 | DOI: 10.36290/vnl.2019.037  

The article summarizes the known facts regarding the selection of antibiotics for the treatment of sepsis and similar serious infections, their mechanism of action, dosage and mode of administration. Particular attention is paid to early antibiotic therapy: a delay of several hours in the onset of antibiotic therapy can be tolerated if it helps to clarify the aethiology and to refine the treatment. However, in case of the very acute infections it is necessary to start antibiotic treatment immediately; diagnostic procedures are mentioned that can be used for the selection of the appropriate drug.

Hemorrhagic shock and treatment of severe bleeding

Dagmar Seidlová, Alena Buliková

Vnitr Lek 2019, 65(3):211-218 | DOI: 10.36290/vnl.2019.038  

Hemorrhagic shock is a severe complication of conditions that are accompanied by massive bleeding and is associated with high mortality and morbidity. The authors summarize the recent knowledge in the pathophysiology of coagulopathy in the course of its development and some options in treatment strategy

Nutrition in the acute phase of illness

František Novák

Vnitr Lek 2019, 65(3):219-226 | DOI: 10.36290/vnl.2019.039  

Recent research of nutrition in the acute phase has brought up important findings regarding high protein and energy administration in critical illness with suggested adverse outcomes in catabolic patients. On the other hand, refeeding hypophosphatemia and refeeding syndrome may also be common during acute illness especially in chronically malnourished patients. Moreover, enteral nutrition is no longer superior to parenteral nutrition in recent studies as signals of harm using the enteral route in shock have been suggested. A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale has been proposed. Nutrition screening,...