In this study, examinations of 6 patiens of the ICU of the University Hospital in Hradec Kralove were included. The aim of this study was to describe case reports of individual patients and to look for statistically significant correlations between nutritional support, oxidation of nutrients and other parameteres. Anthropometric measuring and indirect calorimetry were used for the examination of patients. The case reports show the individuality that occurs in patients. Spearman's correlation analysis was used to evaluate measured data. Statistically significant correlations were proven, among them relations between enterally given nutrition and the creation/loss of muscle tissue (carbohydrates: P = 0,000189, lipids: P = 0,001284, proteins: P = 0,000255), between carbohydrate oxidation, resp. protein oxidation and the number of hours spent on ventilation (carbohydrates: P = 0,041278, proteins: P = 0,02185), between respiratory quotients and the duration of the trauma (respiratory quotient: P = 0,014695, nonprotein respiratory quotient: P = 0,027904), between carbohydrate oxidation related to ideal body weight and lipid intake (P = 0,014085) and between protein oxidation and carbohydrate intake (P = 0,012703). Key words: polytrauma, indirect calorimetry, nutritional support, malnutrition

No description available.

Background: Whole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relatively high radiation exposure that might result in an increased life time cancer risk. The aim of this study was to investigate the frequency and type of non trauma associated incidental medical findings in relation to patient age and potential clinical relevance. Methods: Between January 1st 2011 and December 15th 2012, a total of 704 trauma patients were referred to our hospital’s emergency room that triggered trauma room alarm according to our trauma mechanism criteria. Of these 534 (75.8%) received a whole-body CT according to our dedicated multiple trauma protocol. Incidental Findings (IF) were assigned in three groups according to their clinical relevance. Category 1: IF with high medical relevance (urgent life threatening conditions, unless treated) needing early investigations and intervention prior to or shortly after hospital discharge. Category 2: IF with intermediate or low medical relevance, warranting further investigations. Category 3: IF without clinical relevance. Results: Overall 231 IFs (43.3%) were identified, 36 (6.7%) patients had IFs with a high clinical relevance, 48 (9.0%) with a moderate or minor clinical relevance and 147 (27.5%) with no clinical relevance. The distribution of incidental findings with high or moderate relevance according to age showed an incidence of 2.6%, 6.6% and 8.8% for patients younger than 40 years, 40 to 60 years and older than 60 years, respectively. Conclusion: Whole-body CT scans of trauma patients demonstrate a high rate of incidental findings. Potentially life-threatening, medical findings were found in approximately every 15th patient, predominantly aged over 40 years and presenting with minor to moderate injuries and an Injury Severity Score (ISS) of 10 or less.

Diese Arbeit beschreibt verzögert detektierten Fußfrakturen bei 47 Polytraumapatienten, die im Zeitraum zwischen 01.01.2000 und 31.12.2004 aufgrund eines Polytraumas in der Klinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie der Universität Leipzig behandelt wurden. 30 Patienten wurden mittels Fragebogen, davon 19 klinisch und radiologisch nachuntersucht. Für die Ermittlung des Outcome der Patienten wurden der AOFAS- Mittel- und -Rückfuß, HSS-, HS-, und der SF - 36 Fragebogen verwand. Zusätzlich erfolgten native Röntgenaufnahmen der Füße in 3 Ebenen und bei Calcaneusfrakturen nach Broden. Die Gründe für eine verzögerte Diagnose von Fußverletzungen wurden eruiert und die klinischen und im Outcome relevanten Läsionen extrahiert. Probleme welche im prioritätsorientierten Behandlungsablauf auftraten und Folgen für die Lebensqualität der Patienten hatten wurden ermittelt. Die Resultate der Scores wurden mittels T- Test und linearer Regression auf Allgemeingültigkeit und hinsichtlich den singulären Einfluss der verzögerten Detektion der Fraktur nachuntersucht. Die Ergebnisse dieser Arbeit zeigen, dass polytraumatisierte Patienten einem hohen Risiko unterliegen, dass eine Fraktur eines Fußknochens verzögert detektiert wird. Diese Verzögerung führt in 14,4 % der Fälle zu einer Änderung der Therapie. Eine erhöhte Rate an Komplikation während der Behandlung oder einen signifikant negativen Einfluss auf das Outcome der Patienten konnte nicht festgestellt werden. Die Zeitdauer bis diese erkannt wird hat einen negativen Einfluss auf das Outcome der Patienten. Abweichungen im Outcome sowie Komplikationen und Probleme in der Therapie traten in 4,8 % der Fälle auf.

Background: Whole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relatively high radiation exposure that might result in an increased life time cancer risk. The aim of this study was to investigate the frequency and type of non trauma associated incidental medical findings in relation to patient age and potential clinical relevance. Methods: Between January 1st 2011 and December 15th 2012, a total of 704 trauma patients were referred to our hospital’s emergency room that triggered trauma room alarm according to our trauma mechanism criteria. Of these 534 (75.8%) received a whole-body CT according to our dedicated multiple trauma protocol. Incidental Findings (IF) were assigned in three groups according to their clinical relevance. Category 1: IF with high medical relevance (urgent life threatening conditions, unless treated) needing early investigations and intervention prior to or shortly after hospital discharge. Category 2: IF with intermediate or low medical relevance, warranting further investigations. Category 3: IF without clinical relevance. Results: Overall 231 IFs (43.3%) were identified, 36 (6.7%) patients had IFs with a high clinical relevance, 48 (9.0%) with a moderate or minor clinical relevance and 147 (27.5%) with no clinical relevance. The distribution of incidental findings with high or moderate relevance according to age showed an incidence of 2.6%, 6.6% and 8.8% for patients younger than 40 years, 40 to 60 years and older than 60 years, respectively. Conclusion: Whole-body CT scans of trauma patients demonstrate a high rate of incidental findings. Potentially life-threatening, medical findings were found in approximately every 15th patient, predominantly aged over 40 years and presenting with minor to moderate injuries and an Injury Severity Score (ISS) of 10 or less.

No description available.

No description available.

The Polytrauma/TBI Rehabilitation Center (PRC) of the Veterans Affairs Hospital (VAH) treats patients with Traumatic Brain Injury (TBI). These patients have major motor and cognitive disabilities. Most of the patients stay in the hospital for many months without major improvements. This suggests that patients, family and the VAH could benefit if healthcare provider had a way to better assess or "predict" patients' progression. The individual progress of patients over time is assessed using a pre-defined multi-component performance measure Functional Independence Measures (FIM) at admission and discharge, and a semi-quantitative documentation parameter Clinical Pathway (CP) at weekly intervals. This work uses already de-identified and transformed data to explore developing a clinical outcome predictive model for patients with TBI, as early as possible. The clinical outcome is measured as percentage of recovery using CP scores. The results of this research will allow healthcare providers to improve the current resource management (e.g. staff, equipment, space) through setting goals for each patient, as well as to provide the family more accurate and timely information about the status and needs of the patient.

In the first part of my thesis I focus on mapping problems associated with antibiotic therapy and subsequent development of antibiotic resistance. Tracking resistance is based primarily on data collection and evaluation of the results set sensitivity from around the world. Antibiotic resistance is a natural phenomenon that can be observed in the evolution of microbes as one of the mechanisms of adaptation to new conditions in the environment. For this work I have chosen the following research questions. Do the incidence of ESBL strains in the České Budějovice Hospital a.s. increase over time? Are these values comparable to those achieved in another region, namely in Moravian hospitals the University Hospital of Olomouc, Ostrava University Hospital and Regional University Hospital of T. Bata in Zlin? The data collection I made in collaboration with the laboratory technicians and doctors at Hospital?s Bacteriology Laboratory in České Budějovice. Bacteries tested for the detection of ESBL production originated from biological materials, witch came from patients of hospital in České Budějovice. The first objective was to compare the results achieved in the České Budějovice Hospital in the period of 2007 to 2012. If we look at the total number of ESBL strains that have been isolated since 2007, values have upward trend. While in 2007 there were only 64 strains a year later, the number more than doubled. In 2010, the value soared to 281 tribes and in the year 2012, the number was 321 tribes. The incidence of ESBL strains in 2007 increased about five times. In the long term we can say the numbers have increasing tendency and the range of each species in the production of ESBL has significantly changed. In 2007, it was K. pneumoniae strains that dominated the statistics, but over time the strains of E. coli came forefront. Values of 2012 suggest that the presence of ESBL strains of K. pneumoniae is again almost equal to the number of E. coli strains. The second objective was to compare the results of the 2012 with study of the Prevalence of ESBL-positive Enterobacteriaceae in large Moravian hospitals. In the general overview of ESBL producers values in Hospital České Budějovice (5.23%) are comparable to those in Ostrava (4.9%) and in Zlín (4.3%). Number of strains in the Hospital in Olomouc (11.8%) is about twice as high as the numbers in České Budějovice. In this comparison the České Budějovice Hospital is one of the hospitals with a lower incidence of ESBL producers. The České Budějovice Hospital is below the national average, which originate from an elaborate system of care for patients with colonization or infection with ESBL strains, and from therapy control system using antibiotic center. These results may serve to the Hospital in České Budějovice for statistical purposes, and also for proposals for improving patient care. In the discussion, I pointed out the danger of the spread of resistant strains of bacteria in the community and also the associated risks that mentioned bacteria mean for patients injured in mass accidents or disasters. In these cases, number of infections including ESBL producers can penetrate through open wounds into the affected body. Unlike conventional sensitive bacteria those strains are resistant to commonly used antibiotics and thereby endanger the lives of people affected by the accident.

Multiple trauma is characterized by a simultaneous injury to multiple body systems, at least one from them directly affects by weakening injured patient or faillure of basic life functions - ventilation, bloodstream and consciousness. Accidents are, despite all prevention measures, one of the important cause of death. Multiple traumas are leading cause of death in the age group up to 45 years in the developed countries. The multiple trauma therapy is continues long and complete process which needs individual approach. The therapy starts at the place of accident and then during the transport and continue in the trauma center. The trauma center is able to provide complete therapy including treatment conditions, which require multidisciplinary coordinated cooperation. The diploma thesis deals with the issue of admission of patient with polytraumate into the traumatic center. The aim of the thesis is to approach the readers the multiple trauma, the possible causes of multiple trauma, which are the treatments of algorithms, how is the role and specification of trauma team during incoming of patient. Practical part of the thesis is about cause study of patient with the multiple trauma which complicated fat embolism. This part describes all processes from incoming patient with multiple trauma, including...