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Sira Verzija Vodica Za Prehospitalno Zbrinjavanje Hitnih Stanja
Sira Verzija Vodica Za Prehospitalno Zbrinjavanje Hitnih Stanja
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10
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BLS
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PDEI
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FAST
CPAP
CPSS
WPW
Advance life support
Basic Life Support ( )
ST
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Continous positive airway pressure
Cincinnati Prehospital Stroke Scale ( )
Wolf Parkinson White
11
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CHA2DS2VASc
HAS-BLED
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INR
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MAX. SKOR
MAKS. SKOR
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(4, 5, 49-53).
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- /
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QRS , QRS , R-R .
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QRS , , R-R .
: ,
.
38
20 AV () QRS
()
.
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30 , . VTNS (QRS R-R ) ( /
QRS ).
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41
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23
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25 25
, , (, , ) ( I III , ).
26 Torsade de pointes Q
Torsade de pointes QRS 3600
5 20 QRS ( 26). Torsade de pointes Q ,
, ,
, III (), ,
.
45
TORSADE DE POINTES K
QT
QT
Q
:
- : (,
, )
(, )
- ,
,
-, ,
long QT
27
().
, ( ), /, ,
.
12- ( ) , . ,
, g.
1)
MgSO4 .. 2 ( 4 / g 2 /)
: 150 .. 10 , ,
360 6 , 24
540 , 24 h 1000 .
: 1-1,5 / .. , 0,5 0,75 3 ( 3 /
), 2 4 /h, 24 h
overdrive
2)
360 200 .
/ .
, (4, 5,
55-61).
46
28 (4)
(49, 50)
1.
60/.
.
, (. ). ,
(
40/.).
() V I II
Wenckebach, .
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:
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;
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. ,
;
47
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, ,
.
: P QRS , PQ
(120-200 ); 60/. ( 29)
29
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2. /
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48
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( ). ( 31).
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AV ,
.
( , , ).
/ ,
3 .
31 -
12- , , , .
:
- .
49
4. AV I
AV / ,
(P ) .
V I :
AV I
, (. ).
AV I , V II Wenckebach. .
AV I ():
- ( , C , ),
- ( ),
- , ,
- (, , ),
- ,
- ,
- ,
- .
12- , , , .
32 AV I
: PQ >200 , P QRS ( 32).
- QRS (<120 ), AV blok je po pravilu na nivou AV vora.
- Ako je QRS kompleks (>120 , ), V
AV () - ().
V .
.
V I
V
/ V
.
V (. , ) .
50
5. AV II
AV II - P
.
5) AV II MOBITZ 1 (WENCKEBACH- ):
AV II Mobitz 1 (Wenckebach) PQ
P . R-R . QRS (120 ) AV ,
AV V ( 33).
V I :
. Wenckebach- .
. , AV
I . Wenckebach- ,
.
34 AV II Mobitz 2
V II e Mobitz 2 -
P PQ . QRS
(>120 , ) AV ,
- ( 34).
51
: AV II Mobitz 2
:
- (
),
- ( ),
- ( , , , , ),
- , ,
- ,
- ,
- ,
- .
V III ( ).
6. V III ( V ):
V III P .
- ( ).
V III AV . QRS
. 40/.
V III - V . QRS
, , . 40/. ( 35) .
/ ( , / , ,
), .
35 V III QRS
V III :
- V III : ( Lyme ), , ( ), , ,
( , C , ).
- : ( ), ( ),
(, , ), , , .
- V III ( , )
. . V QRS
40/. ,
.
52
12- , , , .
: AV P QRS .
QRS () (), . 40/.
V II MOBITZ 2 V III
36 (5)
0,5 .. 6 .
,
, . :
AV II 2:1
V III QRS-
<40/.
Polimorfne //Torsades de pointes
Pauze >3
53
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134
Deakin CD, Morrison LJ, Morley PT, et al. 2010 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations.
Part 8: Advanced Life Support. Resuscitation 2010;81:e93-e169.
Hazinski MF, Nolan JP, Billi JE, et al. Part 1: Executive Summary: 2010 International Consensus
on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment
Recommendations. Circulation 2010;122:S250-275
Field JM, Hazinski MF, Sayre M, et al. Part 1: Executive Summary of 2010 AHA Guidelines for
CPR and ECC. Circulation. 2010;122:S640-S656
Nolan JP, Hazinski MF, Billi JE, et al. Part 1: Executive Summary: 2010 International Consensus
on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment
Recommendations. Resuscitation 2010; 81S:e1e25.
European Resuscitation Council guidelines for resuscitation 2010 Section 1. Executive summary
Jerry Nolan, Jasmeet Soar, David Zideman, Domininique biarent, Leo Bossaert, Charles Deakin,
Rdolf Koster, on behalf of the ERC guidelines Writing Group
Lee. T, Goldman L. Evaluation of the patient with acute chest pain. New Engl J med 2000,342;11871195.
Davies, M.J. and A.C. Thomas, Plaque fissuring--the cause of acute myocardial infarction, sudden
ischaemic death, and crescendo angina. Br Heart J, 1985. 53(4): p. 363-73.
Ostoji M, Terzi B, Janev M, Rajkovi T, Nii B, Nedeljkovi I. Protokol za prehospitalnu
dijagnostiku i terapiju akutnog koronarnog sindroma. Dostupno na sajtu: https://www.google.rs/
url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CCkQFjAA&url=http%3A%2
F%2Fwww.sld.org.rs%2Fdownloads%2F2010-5-25%2FACS_protocol_
Steg G, James SK, Atar D et al: ESC Guidelines for the management of acute myocardial
infarction in patients presenting with ST-segment elevation. The Task Force on the management of
ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC).
European Heart Journal 2012;33,25692619
Kalla, K., et al., Implementation of guidelines improves the standard of care: the Viennese
registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry).
Circulation, 2006. 113;20:2398-405.
Hamm CW, Bassand JP Agewall S et al. ESC Guidelines for the management of acute coronary
syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the
management of acute coronary syndromes (ACS) in patients presenting without persistent STsegment elevation of the European Society of Cardiology (ESC). European Heart Journal 2011;32:
29993054
Guidelines Committee 2003 European Society of HypertensionEuropean Societyof Cardiology
guidelines for the management of arterial hypertension. J Hypertens2003; 21:10111053
Mancia G et al. 2013 ESH/ESC Guidelines for themanagement of arterial hypertension The Task
Force for the management of arterial hypertension of the European Society of Hypertension (ESH)
and of the European Society of Cardiology (ESC).
Dodson PM. Epidemiology and pathogenesis of hypertension in diabetes.In Hypertension and
Diabetes. 3rd Ed.Barnett AH, Dodson PM(Eds). Science Press. London, 2000. 1-9.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones JW,Materson
JB, Oparil S, Wright JT, Roccella EJ, and the National High BloodPressure Education Program
Coordinating Committee Sevent Report of the JointNational Commite on Prevention, Detection,
Evaluation and Treatment of HighBlood Pressure. Hypertension 2003;42:12061252
Kaplan N. Systemic Hypertension: Mechanisms and Diagnosis. In Braunwalds Heart Disease, A
Textbook of Cardiovascular Medicine.7th Ed. Zipes DP, Libby P,Bonow RO, Braunwald E(Eds).
959-987. Elsevier Saunders, Phyladelphia.Phyladelphia, 2005.
Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS. British Hypertenion
Society Guidelines. Guidelines for management of hypertension: report of the fourth working
party of the British HypertensionSociety 2004-BHS IV. J Human Hypertens 2004; 18:139-185.
39. Benko D, Tretjak M, Rainer S. Cardiac tamponade resulting from acute aortic dissection type
A case report and diagnostic approach. In: Bruan A, Griar M, Klanar S, Fink A, editors.
Emergency medicine: selected topics 6. Ljubljana: Slovenian Society for Emergency Medicine;
2000. p. 441-6.
40. Ayrik C, Cece H, Aslan O, Karcioglu O, Yilmaz E. Seeing the invisible: painless aortic dissection
in the emergency setting. Emerg Med J 2006;23(3):24.
41. Nadour W, Goldwasser B, Biederman RW, Taffe K. Silent aortic dissection presenting as transient
locked-in syndrome. Tex Heart Inst J 2008; 35(3):359-61.
42. Auer J, Berent R, Eber B. Aortic dissection: incidence, natural history and impact of surgery. J Clin
Basic Cardiol 2000;3:151-4.
43. Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA. 2002;287:226272.
44. Yagdi T, Atay Y, Engin C, et al. Impact of organ malperfusion on mortality and morbidity in acute
type A aortic dissections. J Card Surg.2006;21:3639.
45. Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic
dissection: long-term echocardiographicassessment and clinical outcome. Ann Thorac Surg.
1993;55:15137.
46. Spittell PC, Spittell JA, Jr, Joyce JW, Tajik AJ, Edwards WD, Schaff HV, et al. Clinical features and
differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990)Mayo
Clin Proc.1993;68:64251.
47. Hirata K, Kyushima M, Asato H. Electrocardiographic abnormalities in patients with acute aortic
dissection.Am J Cardiol.1995;76:120712.
48. McMurray JJV, Adamopoulos S, Anker SD et al: ESC Guidelines for the diagnosis and treatment
of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute
and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration
with the Heart Failure Association (HFA) of the ESC. European Heart Journal 2012;33,17871847
49. Olgin J.E. Zipes D.P Specific cardiac arrhythmias. In Zipes D.P, Libby P, Bonow R.O Braunwald
E (eds): Braunwalds heart disease. A textbook of cardiovascular medicine. 7th ed. Phyladelphia
Elsevier Saunders, 2005: 803-863.
50. Bashian GG, Wazni O. Bradyarrhythmias, atrioventricular block, asystole, and pulsless electrical
activity. In: ed. Griffin BP, Topol EJ, Nair D, Ashley K. Mannual of cardiovascular medicine.
Third eddition. Lippincot, Williams&Wilkins 2009:319-336.
51. Camm JA, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar
N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De
Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey J-Y,
Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation. European Heart
Journal.2010;31:3692429.
52. Blomstrm-Lundqvist C, Scheinman MM, et al. ACC/AHA/ESC Guidelines for the Management
of Patients With Supraventricular Arrhythmias. A Report of the American College of Cardiology/
American Heart Association Task Force and the European Society of Cardiology Committee for
Practice Guidelines. European Heart J 2003;24:1857-1897
53. Fox D.J, Tischenko A, Krahn A.D et al. Supraventricular tachycardia: diagnosis and management.
Mayo Clin Proc. 2008;83:1400-1411.
54. Zipes D, Camm A.J, Borggrefe M. et al.ACC/AHA/ESC 2006 Guidelines on management of
patients with ventricular arrhythmias and the prevention of sudden cardiac death. Europace 2006;
8: 746-837.
55. Buxton A.E, Kirk M.M, Michaud G.F et al. Nonsustained Ventricular Tachycardia Update:
Epidemiology, Pathophysiology, Immediate Evaluation & Management, Long-term Management,
Experimental & Theoretical Developments. Car Electrophysiology Rev. 2001;5:323327.
56. Callans D.J. Sustained Monomorphic Ventricular Tachycardia: Immediate Evaluation and
Management, Long-Term Management. Card Electrophysiology Rev. 1997;1/2:105109
57. Cuoco F.A, Singh S.N. Nonsustatined ventricular tachycardia in dilated cardiomyiopathy. Cur
Card Rep 2005; 7:368-375.
58. Doavl HC, Nur DR, Grancelli H.O et al. Nonsustatined ventricular tachycardia in severe heart
136
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
failure: independent marker of increased mortality due to sudden death. Circulation 1996;94:
3198-3203.
Nogami A. Idiopathic left ventricular tachycardia: assessment and treatment. Card Electrophysiol
Rev 2002;6:448457
Mazur A, Kuseniec J, Strasberg B. Bundle branch reentrant tachycardia. Ind pacing electrophysiol
J 2005; 5:85-96.
Srivathsan K, Lester S.J. Appleton C.P. et al. Ventricular Tachycardia in the Absence of Structural
Heart Disease. Ind pacing electrophysiol J 2005; 5: 106-1217.
Soar J, Perkins GD, Abbas G, et al. European Resuscitation Council Guidelines for Resuscitation
2010. Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning,
drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma,
pregnancy, electrocution. Resuscitation 2010; 81: 1400 33.
Warner DS, Bierens JJ, Beerman SB et al. Drowning: a cry for help. Anesthesiology 2009;110:1211
3.
Layon AJ, Modell JH. Drowning: update 2009. Anesthesiology 2009; 110: 1390 401.
Zafren K, Durrer B, Herry JP, Brugger H. Lightning injuries: prevention and on-site treatment in
mountains and remote areas. Official guidelines of the International Commission for Mountain
Emergency Medicine and the Medical Commission of the International Mountaineering and
Climbing Federation (ICAR and UIAA MEDCOM). Resuscitation 2005; 65: 369 72.
Fahmy FS, Brinsden MD, Smith J, Frame JD. Lightning: the multisystem group injuries. J Trauma
1999; 46: 937 40.
Walther A, Bttiger BW: Lungenembolie. Notfallmedizin up date 2007; 2: 5770.
Goldhaber SZ: Pulmonary embolism. Lancet 2004; 363:1295305.
Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F,Grosser KD, Rauber K, Iversen
S, Redecker M, Kienast J. Management strategies and determinants of outcome in acute major
pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997;30:11651171
Tapson VF: Acute pulmonary embolism. N. Engl. J. Med 2008,358:1037-52.
Konstantinides SV: Acute pulmonary embolism revisited: thromboembolic venous disease. Heart
2008; 94: 795802.
Susec O, Boudrow D, Kline JA: The clinical features of acute pulmonary embolism in ambulatory
patients. Acad Emerg Med 997, 4:891-7.Anderson FA Jr., Spencer FA: Risk factors for venous
thrombo -embolism. Circulation 2003; 107: 916.
Le Gal G, Testuz A, Righini M, Bounameaux H, Perrier A: Reproduction of chest pain by palpation:
diagnostic accuracyin suspected pulmonary embolism. BMJ 2005, 330:452-3.222
Chan TC, Vilke GM, et al. Electrocardiographic manifestations: pulmonary embolism. J Emerg
Med. 2003; 21(3):263-70.
Miodrag Ostoji,i saradnici: Kardiologija; Zavod za udbenike, 2011, poglavlje 7: Pluna embolija
550- 568
GINAGlobal Strategy for Asthma Menagment and Prevention. Dostupno na http://ginasthma.org/
Hale KE, Gavin C, ODriscoll BR. Audit of oxygen use in emergency ambulances and in a hospital
emergency department. Emerg Med J 2008; 25: 773776.
ODriscoll BR, Howard LS, Bucknall C, et al. British Thoracic Society emergency oxygen audits.
Thorax
2011; 66: 734735.
ODriscoll BR. Short burst oxygen therapy in patients with COPD. Monaldi Arch Chest Dis 2008;
69: 7074
Muraro A, Roberts G,Clark A, Eigenman P.A, Halken S, Lack G, Moneret-Vautrin A, Niggemann
B, Rance F. The management of anaphylaxis in childhood:position paper of the European academy
of allergology and clinical immunology. Allergy 2007:62:857-871.
Levy JH, Yegin A. Anaphylaxis. What is monitored to make a diagnosis? How is therapy monitored?
Anesthesiol Clin North America. 2001;19 (4):705-15.
Brown SG, Mullins RJ, Gold MS. Anaphylaxis: diagnosis and management. Med J Aust 2006; 185
(5): 283-289.
137
84. Brown SG. The pathophysiology of shock in anaphylaxis. Immunol Allergy Clin North Am
2007;27:16575.
85. Dnser MW, Torgersen C, Wenzel V. Treatment of Anaphylactic Shock: Where Is the Evidence?
Anesth Analg August 2008; 107:359-361.
86. Simon G A Brown, Raymond J Mullins and Michael S Gold. Anaphylaxis: diagnosis and
management. Med J Aust 2006; 185 (5): 283-289.
87. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA . 10-Year follow-up of intensive glucose
control in type 2 diabetes. N Engl J Med 2008;359:1577-1589
88. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group Intensive diabetes treatment and cardiovascular
disease in patients with type 1 diabetes. N Engl J Med 2005; 353:2643-2653
89. Cryer PE The barrier of hypoglycemia in diabetes. Diabetes 2008;57:3169-3176
90. Cryer PE Hypoglycemia in Diabetes: Pathophysiology, Prevalence and Prevention. American
Diabetes Association, Alexandria, VA, 2009
91. Kitabchi AE, Murphy MB, Spencer J, Matteri R, and Karas J . Is a prig dose of insulin necessary
in a low-dose insulin protocol for the treatment of diabeTIC ketoacidosis? Diabetes care 2008; 31:
2081-2085.
92. Kitabchi AE, Umpierrez GE, Fisher JN, Murphy MB, and Stentz FB . Thirty years of personal
experience in hyperglycemic crises: diabeTIC ketoacidosis and hyperglycemic hyperosmolar
state. The Journal of clinical endocrinology and metabolism 2008;93: 1541-1552.
93. Kitabchi AE, Umpierrez GE, Miles JM, and Fisher JN . Hyperglycemic crises in adult patients
with diabetes. Diabetes care 2009;32: 1335-1343.
94. English P, Williams G. Hyperglycaemic crisis and lactic acidosis in diabetes mellitus.Postgrad
Med 2004;80:25361.
95. Ennis ED, Kreisberg RA. DiabeTIC ketoacidosis and the hyperglycemic hyperosmolar syndrome.
In: LeRoith D, Taylor SI, Olefsky JM, editors. Diabetes mellitus: a fundamental and clinical text.
2nd edition. Philadelphia: Lippincott Williams and Wilkins; 2000. p. 32647.
96. Trence DL, Hirsch IB. Hyperglycemic crises in diabetes mellitus type 2. Endocrinol Metab Clin
North Am 2001;30(4):81731.
97. Chiasson J, Aris-Jilwan N, Belanger R, et al. Diagnosis and treatment of diabeTIC ketoacidosis
and the hyperglycemic hyperosmolar state. Can Med Assoc J 2003;168(7):85966.
98. Graffeo CS. Hyperosmolar hyperglycemic state. In: Tintanelli JE, editor. Emergency medicine: a
comprehensive study guide. New York: Mc Graw Hill; 2004. p. 130711.
99. Londer M, Hammer D, Kelen GD. Fluid and electrolyte problems. In: Tintanelli JE, editor.
Emergency medicine: a comprehensive study guide. New York: McGraw Hill; 2004. p. 16779.
100. Liamis G, Gianoutsos C, Elisaf MS. Hyperosmolar nonketotic syndrome with hypernatremia: how
can we monitor treatment? Diabetes Metab 2000;26:4035.
101. Aron DC, Findling JW, Tyrrell JB. Glucocorticoids and adrenal androgens. In: Greenspans Basic
and Clinical Endocrinology. Gardner DG, Shoback D (eds). Mc Graw Hill 2007; pp 367-378
102. Lvs K, Gjesdal CG, Christensen M, Wolff AB, Alms B, Svartberg J, Fougner KJ, Syversen U,
Bollerslev J, Falch JA, Hunt PJ, Chatterjee VK, Husebye ES. Glucocorticoid replacement therapy and
pharmacogenetics in Addisons disease: effects on bone. Eur J Endocrinol . 2009; 160(6): 993-1002.
103. Bleicken B, Hahner S, Loeffler M, Ventz M, Decker O, Allolio B, Quinkler M. Influence of
hydrocortisone dosage scheme on health-related quality of life in patients with adrenal insufficiency.
Clin Endocrinol (Oxf) . 2010; 72(3): 297-304.
104. Bleicken B, Hahner S, Loeffler M, Ventz M, Allolio B, Quinkler M. Impaired subjective health
status in chronic adrenal insufficiency: impact of different glucocorticoid replacement regimens.
Eur J Endocrinol . 2008; 159(6): 811-7.
105. Ting JYS. Hyperosmolar diabetic nonketotic coma, hyperkalaemia and an unusual near death
experience. Eur J Emerg Med 2001;8:5763
106. Dayan CM. Interpretation of thyroid function tests. Lancet 2001;357:61924.
107. Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid
dysfunction. Arch Intern Med 2000;160:15735.
138
111. Lin EP, Bhatt S,Rubens DJ, et al. Testicular torsion: twists and turns. Semin Ultrasound CT MR.
2007; 28 (4): 317-28
112. Lynch TH, Martinez-Pineiro L, Plas E, et al. EAU guidelines on urological trauma. Eur Urol 2005;
47(1): 115
113. Micali S, Grande M, Sighinolfi MC, et al. Medical therapy of urolithiasis. J Endourol 2006; 20
(11): 841-7
114. Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory
drugs and opioids in the treatment of acute renal colic. BMJ 2004; 328 (7453): 1401.
115. Katedra infektivnih bolesti, Infektivne bolest, udbenik za studente medicine, CIBF, Beograd,
2004.
116. Mandell, Douglas and Bennett`s Principles and practice of infectious diseases, 7th ed. Churchill
Livingstone, 2010.
117. Auerbach P. Wilderness medicine, 6th ed. Mosby title, 2012.
118. American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical
Toxicologists. Position Paper: Gastric Lavage. J Toxicol Clin Toxicol 2004; 42: 933-43.
119. American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical
Toxicologists. Position Paper: Single-Dose Activated Charcoal. Clin Toxicol 2005; 43: 61-87.
120. Flomenbaum NE, Goldfrank LR, Hoffman RS, Howland MA, LewinNA, Nelson LS. Initial
evaluatin of the patient: vital signs and toxic syndromes. In: Goldfranks toxicologic emergencies.
8th edition, McGraw-Hill, 2011; p. 37-41.
121. Clarke S, Dargan P, Jones A. Naloxone in opioid poisoning: walking the tightrope. Emerg Med
J.2005;22(9): 612616.
122. Eddleston M,Buckley NA,Eyer P,Dawson AH. Management of acute organophosphorus pesticide
poisoning. Lancet2008; 371(9612): 597-607.
123. Jovi-Stoi J. Trovanja korozivnim tenostima dijagnostike i terapijske nedoumice. Vojnosanit
Pregl 2006; 63(6): 593-9.
124. Common antidotes. Dostupno na: http://www.emergency-medicine-tutorials.org/ Home/
toxicology/common-antidotes.
125. Flanagan R, Jones A, Robert L Maynard RL. Antidotes: Principles and Clinical Applications.
Taylor & Francis, 2001.
126. Ayildiz GSS, Turgav: Pharmacological Management of agitation in emergency setting, Emerg
Med J 2003;20:339-348
127. Newton VM, Elbogen EB, Brown CL, Snyder J, Barrick AL. : Clinical Decision-making About
Inpatient Violence Risk at Admission to a Public-Sector Acute Psychiatric Hospital. J Am Acad
Psychiatry Law. 2012;40:206-14.
128. Jovanovi A, Jaovi Gai M, Lei Toevski D. Medikolegalni aspekti bolnikog zbrinjavanja
osoba sa duevnim poremeajem koje ispoljavaju nasilno ponaanje. Srpski arhiv za celokupno
lekarstvo 2009;137: 293-8.
129. Ronquillo L, Minassian A, Vilke GM, Wilson MP.Literature-based recommendations for suicide
assessment in the emergency department: a review. J Emerg Med. 2012;43:836-42.
130. Barron EA, Holmes J. Delirium within the emergency care setting, occurrence and detection: a
systematic review. Emerg Med J. 2013;30:263-8.
139