{"id":13606,"date":"2020-03-12T16:06:00","date_gmt":"2020-03-12T15:06:00","guid":{"rendered":"https:\/\/nlk.cz\/?p=13606"},"modified":"2020-06-24T10:11:03","modified_gmt":"2020-06-24T08:11:03","slug":"aktualni-samostatna-priloha-covid-19","status":"publish","type":"post","link":"https:\/\/nlk.cz\/en\/2020\/03\/aktualni-samostatna-priloha-covid-19\/","title":{"rendered":"Aktu\u00e1ln\u00ed samostatn\u00e1 p\u0159\u00edloha COVID-19 Refer\u00e1tov\u00e9ho v\u00fdb\u011bru z&nbsp;Anesteziologie, resuscitace a&nbsp;intenzivn\u00ed medic\u00edna"},"content":{"rendered":"<p>Informace pro anesteziology a&nbsp;intenzivn\u00ed p\u00e9\u010di v<span class=\"st\"> souvislosti s&nbsp;v\u00fdskytem epidemie <em>COVID<\/em>-19 <\/span><\/p>\n<p><!--more--><\/p>\n<p><em>Doc. MUDr. Jarmila Dr\u00e1bkov\u00e1, CSc.<\/em><\/p>\n<p><div class=\"panel-group\" id=\"collapse_4e03-6ee9\"><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_1723-ed4e\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_1723-ed4e\" data-parent=\"#collapse_4e03-6ee9\" href=\"#citem_1723-ed4e\">Covid-19 - specifity pro anesteziologii a pro intenzivn\u00ed p\u00e9\u010di <\/a>        <\/h4>    <\/div>    <div id=\"citem_1723-ed4e\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_1723-ed4e\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Covid.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p><strong>Specifick\u00e9 rysy, poznatky a&nbsp;doporu\u010den\u00ed<\/strong><\/p>\n<p style=\"text-align: justify;\">V\u00fdro\u010dn\u00ed kongres Society of Critical Care Medicine v&nbsp;Orlandu se v\u011bnoval <strong>sou\u010dasn\u00fdm priorit\u00e1m<\/strong> <strong>v\u00a0nemocnic\u00edch<\/strong> &#8211; detekci, prevenci infekci, bezpe\u010dnosti zdravotnick\u00e9ho person\u00e1lu a&nbsp;optim\u00e1ln\u00ed p\u00e9\u010di o&nbsp;pacienty v\u00a0sou\u010dasn\u00e9 dob\u011b konkr\u00e9tn\u00edho ohro\u017een\u00ed COVID-19.<\/p>\n<p style=\"text-align: justify;\">Dynamika se st\u00e1le stup\u0148uje; nebezpe\u010dn\u00e1 z\u00f3na roz\u0161\u00ed\u0159en\u00ed kap\u00e9nek, aerosolu je 2 m, perzistence v\u00a0such\u00fdch podm\u00ednk\u00e1ch je a\u017e 4 dny.<\/p>\n<p style=\"text-align: justify;\">Kontagiozita je 1,5 &#8211; 3; riziko ARDS pokleslo z\u00a03,5 na&nbsp;0,7 velmi rychle po zaveden\u00ed kategorick\u00fdch preventivn\u00edch opat\u0159en\u00ed zejm\u00e9na v\u00a0populaci.<\/p>\n<p style=\"text-align: justify;\">Do&nbsp;anamn\u00e9zy a&nbsp;do&nbsp;elektronick\u00fdch sd\u00edlen\u00fdch zdravotn\u00edch z\u00e1znam\u016f se za\u0159adily cestovatelsk\u00e9 \u00fadaje se <strong>\u201esitua\u010dn\u00ed bd\u011blost\u00ed\u201c,<\/strong> tj.&nbsp;obt\u00ed\u017ee, charakteristick\u00e9 t\u010d. pro COVID-19; ze zcela z\u00e1kladn\u00edch fyziologick\u00fdch \u00fadaj\u016f se za\u0159adila t\u011blesn\u00e1 teplota, srde\u010dn\u00ed frekvence, frekvence d\u00fdch\u00e1n\u00ed, krevn\u00ed tlak. Pom\u00e1haj\u00ed k\u00a0pohotov\u00e9 civiln\u00ed tri\u00e1\u017ei.<\/p>\n<p style=\"text-align: justify;\">Samostatn\u00e1 zpr\u00e1va <a href=\"#lit\">[2]<\/a> se speci\u00e1ln\u011b v\u011bnuje pacient\u016fm s&nbsp;<strong>nejt\u011b\u017e\u0161\u00edm pr\u016fb\u011bhem,<\/strong> kter\u00fd vy\u017eaduje <strong>sofistikovan\u00e9 postupy intenzivn\u00ed medic\u00edny a&nbsp;p\u00e9\u010de.<\/strong><\/p>\n<p style=\"text-align: justify;\">B\u011b\u017en\u00e1 letalita pacient\u016f na&nbsp;um\u011bl\u00e9 plicn\u00ed ventilaci p\u0159i sezonn\u00ed ch\u0159ipce byla a&nbsp;je 30 &#8211; 40&nbsp;% p\u0159i rozs\u00e1hl\u00e9 pneumonii a&nbsp;ARDS. \u010c\u00edsla z&nbsp;\u010d\u00ednsk\u00e9ho Wuhanu jsou srovnateln\u00fdch hodnot a&nbsp;p\u00e1sem.<\/p>\n<p style=\"text-align: justify;\">V&nbsp;Ji\u017en\u00ed Koreji i&nbsp;v\u00a0Severn\u00ed It\u00e1lii se u&nbsp;120 pacient\u016f s\u00a0onemocn\u011bn\u00edm COVID-19 vyvinula sekund\u00e1rn\u00ed bakteri\u00e1ln\u00ed pneumonie. Kauz\u00e1ln\u00ed terapie virov\u00e9ho posti\u017een\u00ed nen\u00ed dosud k\u00a0dispozici a&nbsp;z\u00e1sadou intenzivn\u00ed medic\u00edny je multiorg\u00e1nov\u011b a&nbsp;multisyst\u00e9mov\u011b podporovat pacienta antiinfek\u010dn\u011b, oxygenoterapi\u00ed i&nbsp;um\u011blou plicn\u00ed ventilac\u00ed do&nbsp;doby, ne\u017e jeho vlastn\u00ed obnoven\u00e1 imunita onemocn\u011bn\u00ed zvl\u00e1dne.<\/p>\n<p style=\"text-align: justify;\"><strong>Z\u00e1sadn\u00ed, vedouc\u00ed je posti\u017een\u00ed plic r\u00e1zu ARDS. P\u0159ibli\u017en\u011b 5&nbsp;% v\u0161ech onemocn\u011bl\u00fdch je indikov\u00e1no k\u00a0um\u011bl\u00e9 plicn\u00ed ventilaci, 15&nbsp;% pacient\u016f k\u00a0oxygenoterapii. <\/strong><\/p>\n<p style=\"text-align: justify;\">Rekondi\u010dn\u00ed obdob\u00ed vy\u017eaduje nejm\u00e9n\u011b 3 &#8211; 6 t\u00fddn\u016f.<\/p>\n<p>Vyzkou\u0161eny byly postupy:<\/p>\n<ul>\n<li>Pod\u00e1n\u00ed antibiotik k\u00a0profylaxi druhotn\u00fdch bakteri\u00e1ln\u00edch pneumoni\u00ed<\/li>\n<li>Pod\u00e1n\u00ed antivirotik v\u010d. dosud klinicky zkou\u0161en\u00fdch<\/li>\n<li>Hled\u00e1n\u00ed a&nbsp;pod\u00e1n\u00ed protil\u00e1tek<\/li>\n<li>Pod\u00e1n\u00ed kortikosteroid\u016f<\/li>\n<li>Dal\u0161\u00ed postupy, u\u017e\u00edvan\u00e9 p\u0159i z\u00e1va\u017en\u00fdch form\u00e1ch ARDS i&nbsp;z\u00a0jin\u00fdch p\u0159\u00ed\u010din.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Mortalita byla obecn\u011b vy\u0161\u0161\u00ed, u&nbsp;komorbidn\u00edch a&nbsp;polymorbidn\u00edch pacient\u016f star\u0161\u00edho v\u011bku; p\u0159\u00ed\u010dinou smrti byla progresivn\u011b postupuj\u00edc\u00ed hypoxemie a&nbsp;termin\u00e1ln\u00ed srde\u010dn\u00ed selh\u00e1n\u00ed.<\/p>\n<p style=\"text-align: justify;\">Od&nbsp;obdob\u00ed pandemie ch\u0159ipky H1N1 v&nbsp;roce 2009 se mo\u017enosti urgentn\u00ed a&nbsp;intenzivn\u00ed medic\u00edny v\u00fdznamn\u011b zdokonalily a&nbsp;roz\u0161\u00ed\u0159ily \u00a0<a href=\"#lit\">[10]<\/a>. Polohovateln\u00e1 nos\u00edtka lze p\u0159ekr\u00fdt &#8211; zaobalit nafukovac\u00ed bublinou s&nbsp;filtrac\u00ed vzduchu.<\/p>\n<p style=\"text-align: justify;\">Postup p\u0159i repatriaci pacient\u016f z\u00a0Diamond Princess nekompromisn\u011b vy\u017eadoval ochrann\u00e9 pom\u016fcky pro zdravotnick\u00fd person\u00e1l a&nbsp;n\u00e1le\u017eit\u00e9 bari\u00e9rov\u00e9 zaji\u0161t\u011bn\u00ed pro ka\u017ed\u00e9ho cestuj\u00edc\u00edho &#8211; v\u0161ichni byli p\u0159inejmen\u0161\u00edm suspektn\u00ed z\u00a0pozitivity COVID-19.<\/p>\n<p style=\"text-align: justify;\">Rezerva r\u016fzn\u00fdch typ\u016f ventil\u00e1tor\u016f je vhodn\u00e1; centrov\u00e1 intenzivn\u00ed p\u00e9\u010de je p\u0159ipravena i&nbsp;na&nbsp;p\u0159\u00edpadn\u00e9 u\u017eit\u00ed ECMO, na&nbsp;prona\u010dn\u00ed polohy, s&nbsp;um\u00edst\u011bn\u00edm do&nbsp;samostatn\u00fdch box\u016f s\u00a0line\u00e1rn\u00ed v\u00fdm\u011bnou atmosf\u00e9ry.<\/p>\n<p style=\"text-align: justify;\">\u00da\u010dinnou vakc\u00ednu lze o\u010dek\u00e1vat s\u00a0ov\u011b\u0159en\u00edm do&nbsp;n\u011bkolika m\u011bs\u00edc\u016f, z\u00a0dosavadn\u00edch antivirotik se pova\u017euje za nej\u00fa\u010dinn\u011bj\u0161\u00ed, pop\u0159.&nbsp;nejslibn\u011bj\u0161\u00ed\u00a0 remdesevir v\u00a0d\u00e1vce 10 mg \/ kg t.hm. ve&nbsp;30 minutov\u00fdch infuz\u00edch denn\u011b po dobu 10 dn\u016f.<\/p>\n<p style=\"text-align: justify;\">Sv\u011btov\u011b renomovan\u00fd \u010dasopis New England Journal of Medicine vydal kr\u00e1tk\u00e9 edukativn\u011b pojat\u00e9 sd\u011blen\u00ed na&nbsp;dan\u00e9 t\u00e9ma nov\u00e9ho koronaviru a&nbsp;\u010dasopis Lancet se v\u011bnuje <strong>prvn\u00ed \u0161ir\u0161\u00ed epidemiologick\u00e9 studii<\/strong> z\u00a0Wuhanu u&nbsp;dosp\u011bl\u00fdch pacient\u016f, kte\u0159\u00ed zem\u0159eli v\u00a0souvislosti s\u00a0infekc\u00ed COVID-19.<\/p>\n<p style=\"text-align: justify;\"><strong>Uv\u00e1d\u00ed charakteristick\u00e9 \u00fadaje a&nbsp;poznatky<\/strong>:<\/p>\n<ul style=\"text-align: justify;\">\n<li>Riziko interhum\u00e1nn\u00edho p\u0159enosu p\u0159etrv\u00e1v\u00e1 d\u00e9le ne\u017e se p\u016fvodn\u011b p\u0159edpokl\u00e1dalo.<\/li>\n<li>Rizikov\u00e9 faktory, sv\u011bd\u010d\u00edc\u00ed pro nep\u0159\u00edznivou progn\u00f3zu u&nbsp;star\u0161\u00edch pacient\u016f zahrnuj\u00ed: sn\u00ed\u017eenou imunitu, zv\u00fd\u0161en\u00e9, ji\u017e anamnestick\u00e9 z\u00e1n\u011btliv\u00e9 projevy, umo\u017e\u0148uj\u00edc\u00ed replikaci viru a&nbsp;prodlu\u017eov\u00e1n\u00ed z\u00e1n\u011btliv\u00fdch proces\u016f, d\u00e1le limitovan\u00e9 funkce myokardu a&nbsp;mozku v\u010d. rozvoje druhotn\u00fdch z\u00e1n\u011btliv\u00fdch bakteri\u00e1ln\u00edch komplikac\u00ed, MODS, sepse a&nbsp;MOSF. P\u0159it\u011b\u017euj\u00edc\u00ed momenty jsou hypertenze, diabetes, nutnost trval\u00e9 oxygenoterapie &#8211; DDOT, d\u00e1le NIV atd.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Do&nbsp;studie bylo za\u0159azeno 191 pacient\u016f s&nbsp;pozitivitou COVID-19, Z&nbsp;celkov\u00e9ho po\u010dtu bylo propu\u0161t\u011bno 137 pacient\u016f; 54 pacient\u016f zem\u0159elo v&nbsp;nemocnici za pln\u00e9 symptomatick\u00e9 p\u00e9\u010de &#8211; v\u0161ichni byli po celou dobu virologicky pozitivn\u00ed. Riziko p\u0159enosu bylo v&nbsp;pr\u016fm\u011bru 20 dn\u016f, ale u&nbsp;n\u011bkter\u00fdch pacient\u016f a\u017e 37 dn\u016f. Dv\u011b t\u0159etiny prokazovaly z\u00e1va\u017enou a\u017e kritickou intenzitu pr\u016fb\u011bhu.<\/p>\n<p style=\"text-align: justify;\">St\u0159edn\u00ed d\u00e9lka \u2013 medi\u00e1n trv\u00e1n\u00ed febrilit byla 12 dn\u016f u&nbsp;p\u0159e\u017eiv\u0161\u00edch i&nbsp;nep\u0159e\u017eiv\u0161\u00edch. Ka\u0161el tuto f\u00e1zi p\u0159etrv\u00e1val a\u017e u&nbsp;45&nbsp;% pacient\u016f, dokonce i&nbsp;po propu\u0161t\u011bn\u00ed. Du\u0161nost p\u0159e\u017eiv\u0161\u00ed pacienti poci\u0165ovali 13 dn\u016f, u&nbsp;nep\u0159e\u017eiv\u0161\u00edch se \u00fa\u010dastnila po celou dobu.<\/p>\n<p style=\"text-align: justify;\">Za\u0159azen\u00ed pacienti byli p\u0159edev\u0161\u00edm ze st\u0159edn\u00ed v\u011bkov\u00e9 skupiny s\u00a0medi\u00e1nem 56 let; v\u011bt\u0161inou se jednalo o&nbsp;mu\u017ee. P\u0159ibli\u017en\u011b polovina pacient\u016f trp\u011bla chronickou komorbiditou, p\u0159edev\u0161\u00edm hypertenz\u00ed a&nbsp;diabetes mellitus.<\/p>\n<p style=\"text-align: justify;\">Pr\u016fm\u011brn\u00e1 doba hospitalizace do&nbsp;propu\u0161t\u011bn\u00ed byla 22 dn\u016f, do&nbsp;\u00famrt\u00ed 18,5 dne.<\/p>\n<p style=\"text-align: justify;\">P\u0159i rozboru podsouboru nep\u0159e\u017eiv\u0161\u00edch se prok\u00e1zalo, \u017ee&nbsp;pacienti byli star\u0161\u00ed \u2013 v\u00a0pr\u016fm\u011bru 69 let v\u00a0porovn\u00e1n\u00ed s\u00a052 roky u&nbsp;p\u0159e\u017eiv\u0161\u00edch. Jejich SOFA sk\u00f3re bylo vy\u0161\u0161\u00ed, biomarkery sepse byly \u010dast\u011bj\u0161\u00ed, hodnoty D-dimeru a&nbsp;hemokoagulace byly patologick\u00e9. Po\u010det lymfocyt\u016f byl sn\u00ed\u017een, hodnota IL-6 zv\u00fd\u0161ena stejn\u011b jako hodnota HS-troponinu I.<\/p>\n<p style=\"text-align: justify;\">Klinicky se projevovalo u&nbsp;zem\u0159el\u00fdch postupuj\u00edc\u00ed srde\u010dn\u00ed selh\u00e1v\u00e1n\u00ed, selh\u00e1n\u00ed d\u00fdch\u00e1n\u00ed, sepse, pop\u0159.&nbsp;z\u00e1va\u017en\u00e1 sekund\u00e1rn\u00ed bakteri\u00e1ln\u00ed infekce <a href=\"#lit\">\u00a0[2, 4, 8]<\/a>.<\/p>\n<p style=\"text-align: justify;\"><strong>Speci\u00e1ln\u00ed po\u017eadavky v\u00a0anesteziologii<\/strong><\/p>\n<p style=\"text-align: justify;\">Velmi p\u0159ehledn\u00fd a&nbsp;speci\u00e1ln\u011b c\u00edlen\u00fd \u010dl\u00e1nek pro anesteziology <a href=\"#lit\">[9]<\/a> zahrnuje novodobou historii nebezpe\u010dn\u00fdch vir\u016f s\u00a0rychl\u00fdm \u0161\u00ed\u0159en\u00edm, vysokou kontagiozitou a&nbsp;bez mo\u017enosti kauz\u00e1ln\u00ed antivirov\u00e9 terapie. V\u00a0\u00favodu cituje \u0161irok\u00fd profil projev\u016f, kter\u00e9 jsou pro anesteziology \/ intenzivisty vedouc\u00ed. Maj\u00ed r\u016fzn\u00e9 zastoupen\u00ed a&nbsp;intenzitu:<\/p>\n<ul>\n<li>Lehk\u00e1 infekce velk\u00fdch d\u00fdchac\u00edch cest<\/li>\n<li>Hore\u010dka &#8211; 82&nbsp;%; ka\u0161el &#8211; 81&nbsp;%<\/li>\n<li>ARDS<\/li>\n<li>Sepse<\/li>\n<\/ul>\n<p>D\u011bti jsou posti\u017eeny v\u00fdjime\u010dn\u011b &#8211; p\u0159\u00ed\u010dina nen\u00ed zat\u00edm zn\u00e1m\u00e1. Nej\u010dast\u011bj\u0161\u00edmi pacienty jsou mu\u017ei ve&nbsp;v\u011bkov\u00e9m p\u00e1smu 49 &#8211; 56 let.<\/p>\n<p>Rozd\u011blen\u00ed podle intenzity:<\/p>\n<ul>\n<li>33&nbsp;% z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed;<\/li>\n<li>17&nbsp;% ARDS;<\/li>\n<li>4% nutnost um\u011bl\u00e9 plicn\u00ed ventilace;<\/li>\n<li>4&nbsp;% sepse.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Smrtnost je celkov\u011b 4&nbsp;% &#8211; mo\u017en\u00e1 i&nbsp;ni\u017e\u0161\u00ed. Vy\u0161\u0161\u00ed riziko je spojeno s\u00a0kardiovaskul\u00e1rn\u00ed komorbiditou a&nbsp;diabetes mellitus.<\/p>\n<p style=\"text-align: justify;\">V&nbsp;porovn\u00e1n\u00ed s&nbsp;p\u0159edchoz\u00edmi epidemiemi-pandemi\u00ed (SARS, MERS) je 70&nbsp;% geneticky homologn\u00edch. COVID-19 je nejsn\u00e1ze p\u0159enosn\u00fd (vy\u0161\u0161\u00ed R<sub>0<\/sub>), ale m\u00e9n\u011b fat\u00e1ln\u00ed.<\/p>\n<p style=\"text-align: justify;\"><strong>COVID-19 a&nbsp;nepodkro\u010diteln\u00e9 znalosti anesteziolog\u016f a&nbsp;intenzivist\u016f<\/strong><\/p>\n<p style=\"text-align: justify;\">V\u00a0dob\u011b SARS byli ve&nbsp;21&nbsp;% v\u0161ech naka\u017een\u00fdch zastoupeni o\u0161et\u0159uj\u00edc\u00ed zdravotn\u00edci; v\u00a0Kanad\u011b, p\u0159edev\u0161\u00edm v\u00a0Torontu bylo ze 251 SAR pacient\u016f 43&nbsp;% zdravotn\u00edk\u016f. D\u016fraz na&nbsp;jejich ochranu se z\u00e1sadn\u011b zv\u00fd\u0161il.<\/p>\n<p style=\"text-align: justify;\"><strong>Prevence se<\/strong> <strong>c\u00edl\u00ed specificky i&nbsp;na&nbsp;anesteziology, kte\u0159\u00ed jsou rizikov\u011b exponov\u00e1n\u00ed<\/strong> <strong>aerosolu z\u00a0d\u00fdchac\u00edch cest p\u0159i sv\u00fdch postupech<\/strong> &#8211; <strong>trache\u00e1ln\u00ed intubaci, neinvazivn\u00ed ventilaci, p\u0159i tracheostomii, ods\u00e1v\u00e1n\u00ed z\u00a0d\u00fdchac\u00edch cest, p\u0159i neodkladn\u00e9 resuscitaci, p\u0159i manu\u00e1ln\u00edm prod\u00fdch\u00e1v\u00e1n\u00ed p\u0159ed trache\u00e1ln\u00ed intubac\u00ed, p\u0159i bronchoskopii.<\/strong><\/p>\n<p style=\"text-align: justify;\">Vy\u017eaduje striktn\u00ed u\u017e\u00edv\u00e1n\u00ed obli\u010dejov\u00fdch \u00fastenek a&nbsp;masek, respir\u00e1tor\u016f, ochranu o\u010d\u00ed, oble\u010den\u00ed pl\u00e1\u0161t\u011b a&nbsp;rukavic. P\u0159i v\u00fdkonech, intervenc\u00edch m\u00e1 b\u00fdt u&nbsp;pacienta p\u0159\u00edtomno jen minimum skute\u010dn\u011b pot\u0159ebn\u00e9ho zdravotnick\u00e9ho person\u00e1lu, a&nbsp;to zejm\u00e9na v\u00a0situac\u00edch, kdy je zastoupena tvorba a&nbsp;expulze sputa a&nbsp;p\u0159i ods\u00e1v\u00e1n\u00ed aerosolizovan\u00e9ho sekretu z\u00a0d\u00fdchac\u00edch cest pacienta.<\/p>\n<p><strong>P\u0159\u00edprava pacienta a&nbsp;anesteziologick\u00e1 p\u0159\u00edprava<\/strong><\/p>\n<p><strong>\u00a0<\/strong>M\u00edstnost pro \u00favod do&nbsp;anestezie, prostor pro intervenci mus\u00ed m\u00edt n\u00e1le\u017eitou ventilaci.<\/p>\n<ul>\n<li>Intervence, produkuj\u00edc\u00ed aerosol v\u00a0d\u00fdchac\u00edch cest\u00e1ch se prov\u00e1d\u011bj\u00ed mimo opera\u010dn\u00ed s\u00e1ly<\/li>\n<li>Pacient m\u00e1 b\u011bhem transportu nasazenou ochrannou obli\u010dejovou masku<\/li>\n<li>Zdravotni\u010dt\u00ed pracovn\u00edci jsou vybaveni nasazen\u00fdmi ochrann\u00fdmi respir\u00e1tory<\/li>\n<li>Person\u00e1l si systematicky a&nbsp;spr\u00e1vn\u011b myje ruce p\u0159ed v\u00fdkonem a&nbsp;po n\u011bm, zejm\u00e9na p\u0159ed nasazov\u00e1n\u00edm masky\/respir\u00e1toru i&nbsp;po jej\u00edm sejmut\u00ed<\/li>\n<li>V\u00fdkonu se \u00fa\u010dastn\u00ed co nejmen\u0161\u00ed mno\u017estv\u00ed zdravotn\u00edk\u016f<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Ochrann\u00e9 pom\u016fcky a&nbsp;prost\u0159edky jsou p\u0159edeps\u00e1ny obecn\u011b a&nbsp;v\u00a0individu\u00e1ln\u00ed sm\u011brnici v\u00a0jednotliv\u00e9m konkr\u00e9tn\u00edm zdravotnick\u00e9m za\u0159\u00edzen\u00ed.<\/p>\n<p style=\"text-align: justify;\">Ochrana o\u010d\u00ed je speci\u00e1ln\u00edmi br\u00fdlemi nebo jednor\u00e1zov\u00fdm \u0161t\u00edtem. P\u0159ipojuj\u00ed se pl\u00e1\u0161\u0165, nepropou\u0161t\u011bj\u00edc\u00ed tekutiny, a&nbsp;rukavice.<\/p>\n<p style=\"text-align: justify;\">Je t\u0159eba db\u00e1t na&nbsp;postup navl\u00e9k\u00e1n\u00ed a&nbsp;sn\u00edm\u00e1n\u00ed &#8211; vznik\u00e1 tak nej\u010dast\u011bji autokontaminace.<\/p>\n<p style=\"text-align: justify;\">P\u0159ed dekontaminac\u00ed rukou se nesm\u00edme dot\u00fdkat vlas\u016f nebo obli\u010deje.<\/p>\n<p style=\"text-align: justify;\">U\u017eit\u00ed jednor\u00e1zov\u00e9 ochrann\u00e9 pom\u016fcky je nutno bezkontaktn\u011b odlo\u017eit do&nbsp;ur\u010den\u00fdch uzav\u00edrateln\u00fdch n\u00e1dob.<\/p>\n<p>\u00a0<strong>Minimalizace vzniku infek\u010dn\u00edho aerosolu<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<ul>\n<li>Zaji\u0161t\u011bn\u00ed d\u00fdchac\u00edch cest prov\u00e1d\u00ed nejzku\u0161en\u011bj\u0161\u00ed a&nbsp;nejobratn\u011bj\u0161\u00ed anesteziolog. Mezi obli\u010dejovou masku a&nbsp;d\u00fdchac\u00ed syst\u00e9m pacienta pop\u0159.&nbsp;samorozp\u00ednac\u00ed d\u00fdchac\u00ed vak (AMBU vak) se vlo\u017e\u00ed vysoce \u00fa\u010dinn\u00fd hydrofobn\u00ed filtr.<\/li>\n<li>P\u0159ed trache\u00e1ln\u00ed intubac\u00ed se pacient nep\u0159ipravuje preoxygenac\u00ed s&nbsp;manu\u00e1ln\u00ed ventilac\u00ed, kter\u00e1 m\u016f\u017ee podn\u00edtit aerosolizaci infek\u010dn\u00edho sekretu v\u00a0d\u00fdchac\u00edch cest\u00e1ch.<\/li>\n<li>Pokud m\u00e1 pacient vysoce nep\u0159\u00edzniv\u00fd alveoloarteri\u00e1ln\u00ed gradient kysl\u00edku s\u00a0rychlou desaturac\u00ed a&nbsp;netoleruje 30 sekund navozen\u00e9 apnoe nebo je u&nbsp;n\u011bho kontraindikov\u00e1no pod\u00e1n\u00ed suxamethonia, je t\u0159eba u\u017e\u00edt um\u011blou ventilaci s\u00a0minim\u00e1ln\u00edmi dechov\u00fdmi objemy a&nbsp;s&nbsp;vysokou FiO<sub>2<\/sub><\/li>\n<li>Fibroptick\u00e1 intubace p\u0159i v\u011bdom\u00ed je zcela nevhodn\u00e1, proto\u017ee atomizace m\u00edstn\u00edho anestetika s&nbsp;reaktivn\u00ed\u00a0epizodou ka\u0161le vedou k\u00a0expulzi sekretu s\u00a0virem. Je vhodn\u00e9 zv\u00e1\u017eit videolaryngoskopii.<\/li>\n<li>Trache\u00e1ln\u00ed intubaci se d\u00e1v\u00e1 p\u0159ednost p\u0159ed zaveden\u00edm supraglotick\u00e9 pom\u016fcky.<\/li>\n<li>P\u0159i dechov\u00e9 t\u00edsni p\u0159i koronavirov\u00e9 infekci mimo opera\u010dn\u00ed s\u00e1l a&nbsp;l\u016f\u017ekov\u00e9 odd\u011blen\u00ed intenzivn\u00ed p\u00e9\u010de je neinvazivn\u00ed ventilace nevhodn\u00e1.<\/li>\n<li>P\u0159i dechov\u011b se zhor\u0161uj\u00edc\u00edm stavu pacienta je indikov\u00e1na \u010dasn\u00e1 trache\u00e1ln\u00ed intubace a&nbsp;um\u011bl\u00e1 ventilace.<\/li>\n<li>P\u0159i kardiopulmon\u00e1ln\u00ed resuscitaci se mas\u00e1\u017en\u00ed komprese b\u011bhem trache\u00e1ln\u00ed intubace neprov\u00e1d\u011bj\u00ed, aby nebyl obli\u010dej intubuj\u00edc\u00edho l\u00e9ka\u0159e exponov\u00e1n aerosolu z\u00a0d\u00fdchac\u00edch cest resuscitovan\u00e9ho pacienta.<\/li>\n<li>P\u0159ed trache\u00e1ln\u00ed intubac\u00ed je vhodn\u00e9 zv\u00e1\u017eit preventivn\u00ed pod\u00e1n\u00ed svalov\u00e9ho relaxans, pokud nen\u00ed kontraindikov\u00e1no.<\/li>\n<li>Pro v\u0161echny p\u0159\u00edpady je m\u00edt pl\u00e1n postupu i&nbsp;z\u00e1lo\u017en\u00ed pl\u00e1n pro\u00a0p\u0159\u00edpad obt\u00ed\u017e\u00ed se zaji\u0161t\u011bn\u00edm probl\u00e9mov\u00fdch d\u00fdchac\u00edch cest a&nbsp;m\u00edt pro n\u011b p\u0159ipraveno funk\u010dn\u00ed vybaven\u00ed.<\/li>\n<\/ul>\n<p><strong>Sou\u010dasn\u00e9 poznatky a&nbsp;doporu\u010den\u00ed u&nbsp;t\u011bhotn\u00fdch \u017een<\/strong><\/p>\n<p>Mezin\u00e1rodn\u011b ji\u017e byla vypracov\u00e1na metodick\u00e1 doporu\u010den\u00ed o&nbsp;postupech \u2013 algoritmech p\u00e9\u010de o&nbsp;t\u011bhotn\u00e9 \u017eeny v\u00a0souvislosti s\u00a0pozitivitou test\u016f a&nbsp;infekc\u00ed COVID-19. Dal\u0161\u00ed doporu\u010den\u00ed budou ji\u017e prezentov\u00e1na ve&nbsp;z\u0159\u00edzen\u00e9m mezin\u00e1rodn\u00edm registru Covi-Preg (International COVID-19 and Pregnancy Registry, k\u00a0n\u011bmu\u017e je mo\u017en\u00e9 se p\u0159ipojit z\u00a0glob\u00e1ln\u00ed komunity <a href=\"#lit\">[6]<\/a>.<\/p>\n<p><strong>Sou\u010dasn\u00e9 poznatky<\/strong><\/p>\n<p>Zat\u00edm je k\u00a0dispozici m\u00e1lo \u00fadaj\u016f, ale t\u011bhotn\u00e9 jsou vysoce rizikov\u00e1 skupina s\u00a0pohledu velmi z\u00e1va\u017en\u00e9ho pr\u016fb\u011bhu a&nbsp;komplexn\u00edch opat\u0159en\u00ed \u2013 algoritmus je citov\u00e1n n\u00ed\u017ee, p\u0159i\u010dem\u017e t\u00fdm autor\u016f je p\u0159edev\u0161\u00edm ze \u0160v\u00fdcarska.<\/p>\n<p>Pro t\u011bhotn\u00e9, rodi\u010dky a&nbsp;ned\u011blky je p\u0159ijata sou\u010dasn\u00e1 obecn\u00e1 platnost v\u00a0n\u00e1sleduj\u00edc\u00edch stavech, situac\u00edch a&nbsp;bodech:<\/p>\n<ul>\n<li>T\u011bhotn\u00e1, kter\u00e1 cestovala v\u00a0problematick\u00e9 zemi v\u00a0p\u0159edchoz\u00edch 14 dnech nebo kter\u00e1 byla v\u00a0kontaktu s\u00a0k\u00fdmkoli s\u00a0pozitivn\u00edm testem na&nbsp;COVID-12, vy\u017eaduje otestov\u00e1n\u00ed, i&nbsp;kdy\u017e je asymptomatick\u00e1.<\/li>\n<li>Asymptomatick\u00e9 t\u011bhotn\u00e9 s\u00a0pozitivn\u00edm testem jsou indikov\u00e1ny na&nbsp;14 dn\u016f do&nbsp;dom\u00e1c\u00ed karant\u00e9ny s\u00a0osobn\u00edm pozorov\u00e1n\u00edm sv\u00e9ho stavu. Tyto \u017eeny, i&nbsp;kdy\u017e z\u016fstanou bez p\u0159\u00edznak\u016f nebo prod\u011blaj\u00ed pouze m\u00edrnou formu, se indikuj\u00ed k\u00a0dvoum\u011bs\u00ed\u010dn\u00edmu UZ sledov\u00e1n\u00ed r\u016fstu plodu a&nbsp;dopplerovsk\u00e9mu vy\u0161et\u0159en\u00ed.<\/li>\n<li>T\u011bhotn\u00e9 s\u00a0COVID-19 pneumoni\u00ed jsou hospitalizov\u00e1ny v\u00a0multidisciplin\u00e1rn\u00ed centrov\u00e9 p\u00e9\u010di s\u00a0mo\u017enost\u00ed komplexn\u00edho p\u0159\u00edstupu a&nbsp;\u0159e\u0161en\u00ed.<\/li>\n<li>U&nbsp;t\u011bhotn\u00fdch s\u00a0potvrzenou infekc\u00ed se timing porodu ur\u010d\u00ed striktn\u011b personalizovan\u011b podle postkoncep\u010dn\u00edho t\u00fddne gravidity a&nbsp;aktu\u00e1ln\u00edho stavu a&nbsp;klinick\u00e9 trajektorie u&nbsp;t\u011bhotn\u00e9 i&nbsp;plodu. P\u0159ednost se d\u00e1v\u00e1 indukci spont\u00e1nn\u011b veden\u00e9ho porodu, s\u00a0eventu\u00e1ln\u00edm instrument\u00e1ln\u00edm vy\u0159e\u0161en\u00edm druh\u00e9 doby porodn\u00ed.<\/li>\n<li>Novorozenci COVID-19 pozitivn\u00edch matek jsou izolov\u00e1ni nejm\u00e9n\u011b 14 dn\u016f, pop\u0159.&nbsp;do&nbsp;negativity jejich test\u016f; kojen\u00ed matkou se v\u00a0pr\u016fb\u011bhu uveden\u00e9 doby nedoporu\u010duje. Vertik\u00e1ln\u00ed p\u0159enos a&nbsp;vliv na&nbsp;plod v\u00a0pr\u016fb\u011bhu druh\u00e9ho a&nbsp;t\u0159et\u00edho trimestru t\u011bhotenstv\u00ed, nen\u00ed zat\u00edm p\u0159esn\u011b ur\u010den; p\u0159i porodu a&nbsp;po narozen\u00ed jsou v\u00a0ochrann\u00e9m re\u017eimu, maj\u00ed b\u00fdt kojen\u00ed zdravou kojnou, p\u0159i z\u00e1va\u017en\u00e9m pr\u016fb\u011bhu COVID-9 u&nbsp;t\u011bhotn\u00e9 jsou z\u0159ejm\u011b indikov\u00e1ni k\u00a0dlouhodob\u00e9mu sledov\u00e1n\u00ed.<\/li>\n<\/ul>\n<p><div id=\"attachment_13607\" class=\"wp-caption aligncenter\" style=\"width: 800px\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-13607 size-full\" src=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Obr.jpg\" alt=\"\" width=\"800\" height=\"1131\" srcset=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Obr.jpg 800w, https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Obr-212x300.jpg 212w, https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Obr-724x1024.jpg 724w, https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Obr-768x1086.jpg 768w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><p class=\"wp-caption-text\">Obr\u00e1zek &#8211; Algoritmus postupu p\u0159evzat bez p\u0159ekladu <a href=\"#lit\">[5]<\/a>.<\/p><\/div>&nbsp;<\/p>\n<p><a id=\"lit\"><\/a>Literatura:<\/p>\n<ol>\n<li style=\"text-align: justify;\">Ask About Travel History During Assessments. <em>Anesthesiology News<\/em> [online]. 2020, March 3 [cit. 2020-03-12]. Dostupn\u00e9 z: <a href=\"https:\/\/www.anesthesiologynews.com\/Online-First\/Article\/03-20\/Ask-About-Travel-History-During-Assessments\/57570\">https:\/\/www.anesthesiologynews.com\/Online-First\/Article\/03-20\/Ask-About-Travel-History-During-Assessments\/57570<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"2\">\n<li>BOOTH, William. How doctors treat the sickest coronavirus patients. <em>The Washington Post: Helth<\/em> [online]. 2020, March 7 [cit. 2020-03-12]. Dostupn\u00e9 z: <a href=\"https:\/\/www.washingtonpost.com\/health\/2020\/03\/07\/how-doctors-treat-sickest-coronavirus-patients\/\">https:\/\/www.washingtonpost.com\/health\/2020\/03\/07\/how-doctors-treat-sickest-coronavirus-patients\/<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"3\">\n<li>BOWSER, Andrew D. As Novel Coronavirus Outbreak Evolves, Critical Care Prep Crucial. <em>Medscape<\/em> [online]. 2020, February 18 [cit. 2020-03-12]. Dostupn\u00e9 z: <a href=\"https:\/\/www.medscape.com\/viewarticle\/925381\">https:\/\/www.medscape.com\/viewarticle\/925381<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"4\">\n<li>DUNLEAVY, Brian P.&nbsp;Older age, history of sepsis, heart trouble elevate COVID-19 death risk. <em>UPI: Health News<\/em> [online]. 2020, March 9 [cit. 2020-03-12]. Dostupn\u00e9 z: <a href=\"https:\/\/www.upi.com\/amp\/Health_News\/2020\/03\/09\/Older-age-history-of-sepsis-heart-trouble-elevate-COVID-19-death-risk\/3691583787186\/\">https:\/\/www.upi.com\/amp\/Health_News\/2020\/03\/09\/Older-age-history-of-sepsis-heart-trouble-elevate-COVID-19-death-risk\/3691583787186\/<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"5\">\n<li>LIPSHAW, James. Principles of Airway Management in Coronavirus COVID-19. <em>Center for Medical Simulation<\/em> [online]. 2020 [cit. 2020-03-12]. Dostupn\u00e9 z: <a href=\"https:\/\/harvardmedsim.org\/blog\/principles-of-airway-management-in-coronavirus-covid-19\/\">https:\/\/harvardmedsim.org\/blog\/principles-of-airway-management-in-coronavirus-covid-19\/<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"6\">\n<li>LARKIN, Marilynn. Managing SARS-CoV-2 Infection During Pregnancy: Proposed Algorithm. <em>Medscape<\/em> [online]. 2020 [cit. 2020-03-12]. Dostupn\u00e9 z: <a href=\"https:\/\/www.medscape.com\/viewarticle\/926462\">https:\/\/www.medscape.com\/viewarticle\/926462<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"7\">\n<li>FAVRE, Guillaume, L\u00e9o POMAR, Xiaolong QI, Karin NIELSEN-SAINES, Didier MUSSO a&nbsp;David BAUD. Guidelines for pregnant women with suspected SARS-CoV-2 infection. <em>The Lancet Infectious Diseases<\/em> [online]. 2020, March 3 [cit. 2020-03-12]. DOI: 10.1016\/S1473-3099(20)30157-2. ISSN 14733099. Dostupn\u00e9 z: <a href=\"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1473309920301572\">https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1473309920301572<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"8\">\n<li>ZHU, Na, Dingyu ZHANG, Wenling WANG, et al. A&nbsp;Novel Coronavirus from Patients with Pneumonia in China, 2019. <em>New England Journal of Medicine<\/em> [online]. 2020, <strong>382<\/strong>(8), 727-733 [cit. 2020-03-12]. DOI: 10.1056\/NEJMoa2001017. ISSN 0028-4793. Dostupn\u00e9 z: <a href=\"http:\/\/www.nejm.org\/doi\/10.1056\/NEJMoa2001017\">http:\/\/www.nejm.org\/doi\/10.1056\/NEJMoa2001017<\/a><\/li>\n<\/ol>\n<ol style=\"text-align: justify;\" start=\"10\">\n<li>PENG, Philip W.H., Pak-Leung HO a&nbsp;Susy S. HOTA. Outbreak of a&nbsp;new coronavirus: what anaesthetists should know. <em>British Journal of Anaesthesia<\/em> [online]. 2020 [cit. 2020-03-12]. DOI: 10.1016\/j.bja.2020.02.008. ISSN 00070912. Dostupn\u00e9 z: <a href=\"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0007091220300982\">https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0007091220300982<\/a><\/li>\n<li>WALKER, Molly. Improved ICU Care for Flu May Help Hospitals With COVID-19 Patients. <em>MedPage Today<\/em> [online]. 2020, March 2 [cit. 2020-03-12]. Dostupn\u00e9 z: <a href=\"https:\/\/www.medpagetoday.com\/infectiousdisease\/covid19\/85186\">https:\/\/www.medpagetoday.com\/infectiousdisease\/covid19\/85186<\/a><\/li>\n<\/ol>\n<p>        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_063f-621b\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_063f-621b\" data-parent=\"#collapse_4e03-6ee9\" href=\"#citem_063f-621b\">Prvn\u00ed instruktivn\u00ed COVID-19 kazuistika z vysp\u011bl\u00e9ho US zdravotnictv\u00ed<\/a>        <\/h4>    <\/div>    <div id=\"citem_063f-621b\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_063f-621b\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Prvni_instruktivni_COVID-19_kauzistika.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>Prvn\u00ed instruktivn\u00ed kazuistika &#8211; klinick\u00e1 trajektorie COVID \u2013 19 infekce ve&nbsp;vysp\u011bl\u00e9m zdravotnick\u00e9m syst\u00e9mu USA. Podrobn\u011b je pops\u00e1na a&nbsp;graficky dopln\u011bna rtg sn\u00edmky\na&nbsp;mikrobiologick\u00fdmi v\u00fdsledky i&nbsp;laboratorn\u00edmi biochemick\u00fdmi markery s\u00a020 citacemi z\u00a0nejnov\u011bj\u0161\u00ed literatury.<\/p>\n<p>Popis pr\u016fb\u011bhu u&nbsp;mu\u017ee st\u0159edn\u00edho v\u011bku se v\u011bnuje identifikaci, diagn\u00f3ze, klinick\u00e9mu pr\u016fb\u011bhu\ni&nbsp;l\u00e9\u010db\u011b, a&nbsp;to od&nbsp;\u00favodn\u00edch zcela m\u00edrn\u00fdch obt\u00ed\u017e\u00ed a\u017e po z\u00e1va\u017enou pneumonii dev\u00e1t\u00e9ho dne. Zd\u016fraz\u0148uje t\u011bsnou multidisciplin\u00e1rn\u00ed spolupr\u00e1ci, logistiku i&nbsp;spole\u010denskou prevenci\na&nbsp;organizaci.<\/p>\n<p><strong>Kazuistika i&nbsp;pou\u010den\u00ed<\/strong><\/p>\n<p style=\"padding-left: 40px;\"><strong>19.&nbsp;1.&nbsp;2020<\/strong> se na&nbsp;urgentn\u00ed p\u0159\u00edjem dostavil 35let\u00fd mu\u017e: neku\u0159\u00e1k, 4 dny ka\u0161el a&nbsp;hore\u010dka; v&nbsp;anamn\u00e9ze n\u00e1vrat z&nbsp;Wuhanu; v&nbsp;POCT pouze vy\u0161\u0161\u00ed TAG; SpO2&nbsp;96&nbsp;% &#8211; vzduch; pouze tachykardie 110 \/min; rtg sn\u00edmek plic bez n\u00e1lezu; virologick\u00e9 vy\u0161et\u0159en\u00ed neg. &#8211; odesl\u00e1n dom\u016f.<\/p>\n<p style=\"padding-left: 40px;\"><strong>20.&nbsp;1.<\/strong> pozit. n\u00e1lez Covid-19; p\u0159ijat do&nbsp;izolace se such\u00fdm ka\u0161lem a&nbsp;2 dny trvaj\u00edc\u00ed nauzeou\na&nbsp;zvracen\u00edm bez du\u0161nosti. Ordinov\u00e1na infuzn\u00ed terapie a&nbsp;ondansetron.<\/p>\n<p style=\"padding-left: 40px;\"><strong>22.&nbsp;1.<\/strong> \u00fanava, such\u00fd ka\u0161el; vzorky bronchi\u00e1ln\u00edho sekretu a&nbsp;stolice pozit., serum neg. Ord. Acetaminofen 650 mg po 4 h, ibuprofen 600 mg po 6 h, guaiafenezin 60 mg a&nbsp;6000 ml fyziologick\u00e9ho roztoku infuzn\u011b \/ 24&nbsp;h.<\/p>\n<p style=\"padding-left: 40px;\"><strong>7. &#8211; 9.&nbsp;den<\/strong> leukopenie, lehk\u00fd pokles trombocyt\u016f, vzestup CK, zm\u011bna ALP, ALT, AST, LDH; hemokultury neg.<\/p>\n<p style=\"padding-left: 40px;\"><strong>7.&nbsp;den<\/strong> rtg sn\u00edmek plic neg.<\/p>\n<p style=\"padding-left: 40px;\"><strong>9.&nbsp;den<\/strong> rtg sn\u00edmek plic: opacity v&nbsp;l. doln\u00edm plicn\u00edm poli, pokles SpO2 na&nbsp;90&nbsp;%; Ord: O2 = 2&nbsp;l \/min; Vankomycin \u00favodem 1750 mg a&nbsp;pot\u00e9 1 g po 8&nbsp;h + cefepim i.v. po 8&nbsp;h<\/p>\n<p style=\"padding-left: 40px;\"><strong>10.&nbsp;den<\/strong> rtg n\u00e1lez &#8211; atypick\u00e1 pneumonie s&nbsp;bilater\u00e1ln\u00edm poslechov\u00fdm n\u00e1lezem; prokalcitonin neg., MRSA neg.\nOrd. Remdesivir infuzn\u011b, vankomycin a&nbsp;cefepim postupn\u011b ex<\/p>\n<p style=\"padding-left: 40px;\"><strong>12.&nbsp;den<\/strong> zlep\u0161en\u00ed stavu, \u00faprava SpO2 na&nbsp;94 &#8211; 96&nbsp;% &#8211; vzduch, \u00fastup ka\u0161le a&nbsp;r\u00fdmy<\/p>\n<p style=\"padding-left: 40px;\"><strong>30.&nbsp;1.<\/strong> afebriln\u00ed, trv\u00e1 ustupuj\u00edc\u00ed ka\u0161el.<\/p>\n<p style=\"padding-left: 40px;\"><strong>Odb\u011br vzork\u016f<\/strong> nazofarynge\u00e1ln\u011b a&nbsp;orofarynge\u00e1ln\u011b podle sm\u011brnice CDC; dal\u0161\u00ed odb\u011bry mo\u010d, stolice, krevn\u00ed s\u00e9rum s&nbsp;podrobn\u00fdm mikrobiologick\u00fdm prov\u011b\u0159en\u00edm.<\/p>\n<p style=\"padding-left: 40px;\"><strong>7.&nbsp;den pozit. i&nbsp;vzorek stolice<\/strong>; serum neg., nazo- a&nbsp;orofarynge\u00e1ln\u00ed vzorky \u2013 pokles<\/p>\n<p style=\"padding-left: 40px;\"><strong>12.&nbsp;den neg<\/strong>.; p\u0159ipojeno genetick\u00e9 sledov\u00e1n\u00ed<\/p>\n<p><strong>P\u0159\u00edpad zapad\u00e1 do&nbsp;dosavadn\u00edch poznatk\u016f.\n<\/strong><strong>P\u0159ekvapily pozitivn\u00ed n\u00e1lezy ve&nbsp;stolici 7.&nbsp;den &#8211; jsou varovn\u00e9; s\u00e9rum opakovan\u011b neg.\n(na&nbsp;rozd\u00edl od&nbsp;\u010d\u00ednsk\u00fdch v\u00fdsledk\u016f).\n<\/strong><strong>Z\u00e1va\u017enost komplikac\u00ed se podce\u0148uje, zejm\u00e9na v\u00a0zim\u011b.\n<\/strong><strong>P\u0159ipojen\u00ed du\u0161nosti a&nbsp;poklesu SpO<sub>2<\/sub> je diagnosticky v\u00fdznamn\u00e9.\n<\/strong><strong>Antivirotikum remdesivir je indikov\u00e1no p\u0159i zhor\u0161uj\u00edc\u00edm se stavu s\u00a0informovan\u00fdm souhlasem pacienta.<\/strong><\/p>\n<p>Literatura:<\/p>\n<p>HOLSHUE, Michelle L., Chas DEBOLT, Scott LINDQUIST, et al. First Case of 2019 Novel Coronavirus in the United States.\u00a0<em>New England Journal of Medicine<\/em>\u00a0[online]. 2020,\u00a0<strong>382<\/strong>(10), 929-936 [cit. 2020-03-15]. DOI: 10.1056\/NEJMoa2001191. ISSN 0028-4793. Dostupn\u00e9 z: <a href=\"http:\/\/www.nejm.org\/doi\/10.1056\/NEJMoa2001191\">http:\/\/www.nejm.org\/doi\/10.1056\/NEJMoa2001191<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> COVID -19 v\u00a0USA kazuisticky\n<strong>Key words:<\/strong> COVID -19 in USA \u2013 medical record<\/p>\n<p>        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_71e4-b9fb\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_71e4-b9fb\" data-parent=\"#collapse_4e03-6ee9\" href=\"#citem_71e4-b9fb\">COVID-19 u d\u011bt\u00ed se pom\u011brn\u011b v\u00fdznamn\u011b li\u0161\u00ed od dosp\u011bl\u00fdch<\/a>        <\/h4>    <\/div>    <div id=\"citem_71e4-b9fb\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_71e4-b9fb\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/COVID-19_deti.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>P\u0159\u00edpady COVID -19 infekce jsou u&nbsp;d\u011bt\u00ed pom\u011brn\u011b m\u00edrn\u00e9, ale soub\u011b\u017en\u00e9 koinfekce nebo druhotn\u00e9 z\u00e1n\u011btliv\u00e9 komplikace jsou u&nbsp;nich v\u00a0porovn\u00e1n\u00ed s\u00a0dosp\u011bl\u00fdmi \u010dast\u011bj\u0161\u00ed, jak o&nbsp;tom vypov\u00eddaj\u00ed v\u00fdsledky dosud nepo\u010detn\u00fdch studi\u00ed z\u00a0Wuhanu. Jejich z\u00e1v\u011bry zd\u016fraz\u0148uj\u00ed v\u00a0diferenci\u00e1ln\u00ed diagnostice v&nbsp;t\u00e9to v\u011bkov\u00e9 kategorii indikaci CT hrudn\u00edku\/plic v\u00a0kombinaci s\u00a0ur\u010den\u00edm patogenu a&nbsp;laboratorn\u00edch marker\u016f.<\/p>\n<p><strong>Studie 1.<\/strong><\/p>\n<p>Soubor za\u010dlenil 13 hoch\u016f a&nbsp;7 d\u00edvek ve&nbsp;v\u011bku m\u00e9n\u011b ne\u017e 1 m\u011bs\u00edc do&nbsp;14 let a&nbsp;7 m\u011bs\u00edc\u016f (medi\u00e1n\n2 roky+-1,5 m\u011bs\u00edce). U&nbsp;13 z\u00a0nich byl zji\u0161t\u011bn p\u0159\u00edm\u00fd kontakt s\u00a0pozitivn\u00edm \u010dlenem rodiny v\u00a0izolaci.<\/p>\n<p>Soubor hodnotil uveden\u00fdch 20 d\u011bt\u00ed r\u016fzn\u00e9ho v\u011bkov\u00e9ho rozvrstven\u00ed, hospitalizovan\u00fdch v\u00a0\u010dasov\u00e9m rozmez\u00ed 23.&nbsp;ledna a\u017e 8.&nbsp;\u00fanora 2020 s\u00a0infekc\u00ed COVID &#8211; 19, potvrzenou z\u00a0farynge\u00e1ln\u00edch odb\u011br\u016f vzork\u016f. Hlavn\u00ed klinick\u00e9 zn\u00e1mky byly hore\u010dka v\u00a060&nbsp;% a&nbsp;ka\u0161el v\u00a065&nbsp;%. Koinfekce byla zastoupena u&nbsp;8 d\u011btsk\u00fdch pacient\u016f, tj.&nbsp;ve&nbsp;40&nbsp;%.<\/p>\n<p>Klinick\u00fd obraz byl podobn\u00fd jako u&nbsp;dosp\u011bl\u00fdch, pr\u016fb\u011bh byl m\u00edrn\u011bj\u0161\u00ed a&nbsp;celkov\u00e1 progn\u00f3za byla p\u0159\u00edzniv\u011bj\u0161\u00ed.<\/p>\n<p>U&nbsp;7 d\u011bt\u00ed (35&nbsp;%) byla ji\u017e anamnesticky p\u0159\u00edtomno kongenit\u00e1ln\u00ed nebo z\u00edskan\u00e9 onemocn\u011bn\u00ed, tak\u017ee dispozici i&nbsp;k\u00a0jejich projev\u016fm nebylo mo\u017eno vylou\u010dit.<\/p>\n<p>U&nbsp;80&nbsp;% d\u011bt\u00ed byla zji\u0161t\u011bna zv\u00fd\u0161en\u00e1 hodnota prokalcitoninu, co\u017e u&nbsp;dosp\u011bl\u00fdch nen\u00ed b\u011b\u017en\u00e9; nej\u010dast\u011bji byl varovn\u00fdm markerem bakteri\u00e1ln\u00ed komorbidity \u2013 na&nbsp;soub\u011bh je u&nbsp;d\u011bt\u00ed v\u017edy nutno pom\u00fd\u0161let.<\/p>\n<p>CT obrazy plic byly analogick\u00e9 dosp\u011bl\u00fdm \u2013 jednostrann\u00e1 nebo bilater\u00e1ln\u00ed opacity\na&nbsp;obl\u00e1\u010dkovit\u00e9 konzolidace s\u00a0lemuj\u00edc\u00edmi halo se manifestovaly p\u0159ibli\u017en\u011b u&nbsp;50&nbsp;% d\u011bt\u00ed a&nbsp;lze je pova\u017eovat za charakteristick\u00e9 pro d\u011btskou populaci.<\/p>\n<p>Celkem 18 d\u011bt\u00ed bylo po p\u0159\u00edzniv\u00e9m pr\u016fb\u011bhu propu\u0161t\u011bno po 13 dnech z\u00a0hospitalizace. Dva novorozenci byli d\u00e1le sledov\u00e1ni p\u0159i pozitivn\u00edm testu a&nbsp;p\u0159itom negativn\u00edm CT n\u00e1lezu; na&nbsp;jejich obrazu a&nbsp;pr\u016fb\u011bhu se mohl pod\u00edlet i&nbsp;pr\u016fb\u011bh porodu.<\/p>\n<p>Anamn\u00e9za mus\u00ed zahrnout epidemiologick\u00e9 i&nbsp;mo\u017en\u00e9 etiologick\u00e9 momenty.<\/p>\n<p>Diferenci\u00e1ln\u00ed diagnostika vy\u017eaduje vylou\u010dit jin\u00e9, aktu\u00e1ln\u00ed virov\u00e9 pneumonie \u2013 virus ch\u0159ipky, parainfluenzy, p\u0159\u00edtomnost respira\u010dn\u00edch synciti\u00e1ln\u00edch vir\u016f, adenovir. Odli\u0161it je t\u0159eba bakteri\u00e1ln\u00ed pneumonie, mykoplasmatick\u00fd p\u016fvod a&nbsp;chlamydie \u2013 u&nbsp;nich je n\u00e1lez na&nbsp;plic\u00edch vyzna\u010den podstatn\u011b z\u0159eteln\u011bji.<\/p>\n<p><strong>Studie 2.<\/strong><\/p>\n<p>Komplexn\u00ed diferenci\u00e1ln\u00ed diagnostika z\u00a0retrospektivn\u011b zpracovan\u00fdch zdravotnick\u00fdch z\u00e1znam\u016f prok\u00e1zala, \u017ee&nbsp;ve&nbsp;Wuhanu bylo hospitalizov\u00e1no v\u00a0lednu 2020 celkem 366 d\u011bt\u00ed mlad\u0161\u00edch ne\u017e\n16 let s\u00a0respira\u010dn\u00edmi infekcemi: ch\u0159ipka typu A: 6,3 %, typu B: 5,5&nbsp;%; COVID \u2013 19: 6&nbsp;%.<\/p>\n<p>St\u0159edn\u00ed v\u011bk byl u&nbsp;COVID -19 infekc\u00ed v\u00a0tomto souboru 3 roky (1-7 let) a&nbsp;d\u011bti byly v\u00a0p\u0159edchoz\u00edm obdob\u00ed zdrav\u00e9. Jejich z\u00e1kladn\u00ed klinick\u00e9 zn\u00e1mky byly vysok\u00e1 teplota, ka\u0161el a&nbsp;zvracen\u00ed; u&nbsp;p\u011bti z\u00a0nich byl charakteristick\u00fd CT n\u00e1lez, pop\u0159.&nbsp;rtg sn\u00edmek plic.<\/p>\n<p>Terapie zahrnovala antivirotika, antibiotika a&nbsp;podp\u016frnou l\u00e9\u010dbu. Zotaven\u00ed bylo v\u00a0pr\u016fm\u011bru po 7,5 dnech (medi\u00e1n) s\u00a0p\u00e1smem 5 \u2013 13 dn\u016f.<\/p>\n<p>Vznik a&nbsp;pr\u016fb\u011bh byly \u010dasov\u011b zastoupeny ji\u017e v\u00a0prvn\u00edch dnech epidemie. Diagn\u00f3zu COVID &#8211; 19 nebylo mo\u017eno apriorn\u011b vylou\u010dit ani p\u0159i norm\u00e1ln\u00ed t\u011blesn\u00e9 teplot\u011b, p\u0159i\u010dem\u017e se jedn\u00e1 o&nbsp;hlavn\u00ed rozd\u00edl oproti dosp\u011bl\u00fdm.<\/p>\n<p>V\u00fdskyt je mo\u017en\u00fd i&nbsp;u&nbsp;d\u011bt\u00ed mlad\u0161\u00edch ne\u017e jeden rok. V\u017edy je t\u0159eba zv\u00e1\u017eit v\u00a0diferenci\u00e1ln\u00ed diagnostice ch\u0159ipku A&nbsp;i&nbsp;B typu a&nbsp;syncyti\u00e1ln\u00ed virus jako vyvolavatele. Hodnota prokalcitoninu m\u016f\u017ee podpo\u0159it diagn\u00f3zu komorbidity \u2013 i&nbsp;na&nbsp;ni je t\u0159eba se diferenci\u00e1ln\u011b diagnosticky zam\u011b\u0159it.<\/p>\n<p>Literatura:<\/p>\n<p>XIA, Wei, Jianbo SHAO, Yu GUO, Xuehua PENG, Zhen LI a&nbsp;Daoyu HU. Clinical and CT features in pediatric patients with COVID\u201019 infection: Different points from adults.\u00a0<em>Pediatric Pulmonology<\/em>\u00a0[online]. 2020, , 1- 6 [cit. 2020-03-15]. DOI: 10.1002\/ppul.24718. ISSN 8755-6863. Dostupn\u00e9 z: <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/ppul.24718\">https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/ppul.24718<\/a><\/p>\n<p>LIU, Weiyong, Qi ZHANG, Junbo CHEN, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China.\u00a0<em>New England Journal of Medicine<\/em>. March 15, 2020. DOI: 10.1056\/NEJMc2003717. ISSN 0028-4793. Dostupn\u00e9 tak\u00e9 z: <a href=\"http:\/\/www.nejm.org\/doi\/10.1056\/NEJMc2003717\">http:\/\/www.nejm.org\/doi\/10.1056\/NEJMc2003717<\/a><\/p>\n<p>WORCESTER, Sharon. COVID-19 Characteristics Differ in Children vs Adults.\u00a0<em>Medscape<\/em>\u00a0[online]. March 13, 2020 [cit. 2020-03-15]. Dostupn\u00e9 z: <a href=\"https:\/\/www.medscape.com\/viewarticle\/926805\">https:\/\/www.medscape.com\/viewarticle\/926805<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> COVID &#8211; 19 v\u00a0pediatrii\n<strong>Key words:<\/strong> COVID &#8211; 19; Pediatric patiens<\/p>\n<p>        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_9c14-504c\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_9c14-504c\" data-parent=\"#collapse_8f7b-e51d\" href=\"#citem_9c14-504c\">COVID-19 a infekce GIT - dal\u0161\u00ed cesta p\u0159enosu?<\/a>        <\/h4>    <\/div>    <div id=\"citem_9c14-504c\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_9c14-504c\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/COVID-19_a_GIT_prenos.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>Sou\u010dasn\u00e9 v\u00fdsledky vy\u0161et\u0159ov\u00e1n\u00ed stolice COVID &#8211; 19 pozitivn\u00edch pacient\u016f sv\u011bd\u010d\u00ed o&nbsp;v\u00fdskytu viru\nve&nbsp;stolici u&nbsp;v\u00edce ne\u017e 50&nbsp;% z\u00a0nich. N\u011bkte\u0159\u00ed pacienti trp\u00ed nauzeou a&nbsp;pr\u016fjmem a&nbsp;sou\u010dasn\u011b maj\u00ed prokazateln\u00e9 pozitivn\u00ed n\u00e1lezy dan\u00e9ho viru ve&nbsp;stolici. P\u0159itom mohou sou\u010dasn\u011b m\u00edt sv\u00e9 nazo-\na&nbsp;orofarynge\u00e1ln\u00ed vzorky a&nbsp;jejich v\u00fdsledky ji\u017e negativn\u00ed.<\/p>\n<p>\u010c\u00edn\u0161t\u00ed auto\u0159i testovali PCR metodou 71 hospitalizovan\u00fdch pacient\u016f v\u00a0obdob\u00ed 1. &#8211; 14.&nbsp;\u00fanora 2020. Sou\u010dasn\u011b u&nbsp;nich vy\u0161et\u0159ovali bioptick\u00e9 vzorky ze st\u011bny\u00a0j\u00edcnu, \u017ealudku a&nbsp;duodena, pokud byla indikov\u00e1na a&nbsp;provedena endoskopie.<\/p>\n<p>A\u017e 53,4&nbsp;% vzork\u016f stolice bylo RNA pozitivn\u00edch, a\u010dkoli sou\u010dasn\u011b odebran\u00e9 vzorky z\u00a0horn\u00edch d\u00fdchac\u00edch cest &#8211; orofaryngu a&nbsp;nazofaryngu byly negativn\u00ed.<\/p>\n<p>Endoskopicky se nalezly infiltrace lymfocyty a&nbsp;interstici\u00e1ln\u00ed ed\u00e9m v\u00a0lamina propria \u017ealudku, duodena a&nbsp;rekta.<\/p>\n<p>Obdobn\u00fd n\u00e1lez byl zji\u0161t\u011bn z&nbsp;horn\u00edch d\u00fdchac\u00edch cest a&nbsp;GIT u&nbsp;prvn\u00edho hospitalizovan\u00e9ho pacienta s&nbsp;COVID &#8211; 19 pozitivitou v&nbsp;USA. K&nbsp;jeho subjektivn\u00edm obt\u00ed\u017e\u00edm pat\u0159ila n\u011bkolikadenn\u00ed nauzea a&nbsp;zvracen\u00ed a&nbsp;patologick\u00e1 st\u0159evn\u00ed peristaltika.<\/p>\n<p><strong>Nelze vylou\u010dit, \u017ee&nbsp;tento moment spolu s\u00a0uveden\u00fdmi n\u00e1lezy m\u016f\u017ee p\u0159isp\u00edvat k\u00a0interhum\u00e1nn\u00edmu p\u0159enosu &#8211; subjektivn\u00ed obt\u00ed\u017ee je dokonce ani nemus\u00ed doprov\u00e1zet.<\/strong><\/p>\n<p>Laboratorn\u00ed <strong>markery hepat\u00e1ln\u00edch funkc\u00ed <\/strong>jsou zm\u011bn\u011bny m\u00edrn\u011b se zastoupen\u00edm reprezentativn\u00edch \u00fadaj\u016f p\u0159edev\u0161\u00edm z\u00a0<strong>intrahepat\u00e1ln\u00edch \u017elu\u010dov\u00fdch cest.<\/strong><\/p>\n<p>Literatura:<\/p>\n<p>WILD, David. COVID-19 Infects GI Tract, a&nbsp;Possible Route of Viral Transmission.\n<em>Anesthesiology News<\/em>\u00a0[online]. 2020, March 14 [cit. 2020-03-16]. Dostupn\u00e9 z: <a href=\"https:\/\/www.anesthesiologynews.com\/Online-First\/Article\/03-20\/COVID-19-Infects-GI-Tract-a-Possible-Route-of-Viral-Transmission-\/57597\">https:\/\/www.anesthesiologynews.com\/Online-First\/Article\/03-20\/COVID-19-Infects-GI-Tract-a-Possible-Route-of-Viral-Transmission-\/57597<\/a><\/p>\n<p>GU, Jinyang, Bing HAN a&nbsp;Jian WANG. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission.\u00a0<em>Gastroenterology<\/em>\u00a0[online]. 2020 [cit. 2020-03-16]. DOI: 10.1053\/j.gastro.2020.02.054. ISSN 00165085. Dostupn\u00e9 z: <a href=\"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S001650852030281X\">https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S001650852030281X<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> COVID &#8211; 19, GIT infekce a&nbsp;p\u0159enos\n<strong>Key words: <\/strong>COVID \u2013 19 and GI Tract \u00a0transmission        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_593e-ea4f\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_593e-ea4f\" data-parent=\"#collapse_8f7b-e51d\" href=\"#citem_593e-ea4f\">Koronavirus ve stolici m\u016f\u017ee kontaminovat i hygienick\u00e9 prostory pro pacienty<\/a>        <\/h4>    <\/div>    <div id=\"citem_593e-ea4f\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_593e-ea4f\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Koronavirus_ve_stolici.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>Pozornost a&nbsp;diagnostiku je t\u0159eba zam\u011b\u0159it i&nbsp;na&nbsp;dal\u0161\u00ed cestu mo\u017en\u00e9 kontaminace, a&nbsp;to z\u00a0GIT cestou stolice pozitivn\u00edho COVID &#8211; 19 pacienta. Ve&nbsp;<strong>standardn\u00ed p\u00e9\u010di<\/strong> je mo\u017en\u00fd p\u0159enos i&nbsp;z&nbsp;ploch v\u00a0hygienick\u00fdch prostor\u00e1ch a&nbsp;WC, pop\u0159.&nbsp;ze sprchov\u00fdch box\u016f apod.<\/p>\n<p>V\u00a0<strong>intenzivn\u00ed p\u00e9\u010di<\/strong> byly ov\u011b\u0159ov\u00e1ny m\u00edstnosti &#8211; prostor i&nbsp;plochy ur\u010den\u00e9 k\u00a0o\u010dist\u011b le\u017e\u00edc\u00edch pacient\u016f na&nbsp;osprchovateln\u00fdch podlo\u017ek\u00e1ch v\u00a0boxov\u00fdch sprchov\u00fdch l\u00e1zn\u00edch pacient\u016f.<\/p>\n<p>Pro studie se v\u00a0Singapuru odebraly vzorky z\u00a026 povrch\u016f izola\u010dn\u00edho boxu, z\u00a0p\u0159eds\u00edn\u00ed\na&nbsp;z\u00a0boxov\u00e9 l\u00e1zn\u011b pacient\u016f a&nbsp;z\u00a0respir\u00e1tor\u016f PPE l\u00e9ka\u0159\u016f, kte\u0159\u00ed odch\u00e1zeli od&nbsp;pacienta a&nbsp;z\u00a0jeho prostoru.<\/p>\n<p><strong>Pacient 1.<\/strong> Po rutinn\u00ed o\u010dist\u011b prostoru a&nbsp;ploch byly v\u0161echny odebran\u00e9 vzorky negativn\u00ed v\u00a0pr\u016fb\u011bhu 4.&nbsp;a&nbsp;10.&nbsp;dne, a\u010dkoli m\u011bl pacient st\u00e1le manifestn\u00ed zn\u00e1mky choroby.<\/p>\n<p><strong>Pacient 2.<\/strong> Vzorky po rutinn\u00ed o\u010dist\u011b prostoru a&nbsp;ploch byly negativn\u00ed 2.&nbsp;den po o\u010dist\u011b.<\/p>\n<p><strong>Pacient 3.<\/strong> Vzorky byly odebr\u00e1ny p\u0159ed o\u010distou; ve&nbsp;13 p\u0159\u00edpadech z\u00a015 (87&nbsp;%) a&nbsp;byly pozitivn\u00ed v\u010detn\u011b v\u00fdstupu klimatizace. Stejn\u011b byly pozitivn\u00ed i&nbsp;v\u00fdsledky u&nbsp;t\u0159\u00ed z\u00a0p\u011bti toalet (60&nbsp;%). Negativn\u00ed byly p\u0159eds\u00ed\u0148, chodba a&nbsp;vzduch v\u00a0dan\u00e9m prostoru. Uveden\u00fd pacient m\u011bl pozitivn\u00ed COVID &#8211; 19 n\u00e1lez ve&nbsp;stolici, p\u0159i\u010dem\u017e nem\u011bl pr\u016fjem ani pneumonii.<\/p>\n<p>Kontaminace podr\u00e1\u017eek obuvi se neo\u010dek\u00e1v\u00e1, pravd\u011bpodobnost se pova\u017euje za minim\u00e1ln\u00ed.<\/p>\n<p><strong>\u0158\u00e1dn\u00e1 hygienick\u00e1 o\u010dista nejen pacienta, a&nbsp;to zejm\u00e9na s\u00a0pozitivn\u00edm n\u00e1lezem ve&nbsp;stolici, ale\ni&nbsp;ploch a&nbsp;prostor\u016f, ur\u010den\u00fdch k\u00a0hygien\u011b a&nbsp;po hygien\u011b dan\u00e9ho, a&nbsp;to i&nbsp;negativn\u00edho pacienta, je bezpodm\u00edne\u010dn\u011b nutn\u00e1.<\/strong><\/p>\n<p>Literatura:<\/p>\n<p>BOWSER, Andrew D. Coronavirus May Cause Environmental Contamination Through Fecal Shedding.\u00a0<em>Medscape<\/em>\u00a0[online]. 2020, March 6 [cit. 2020-03-16]. Dostupn\u00e9 z: <a href=\"https:\/\/www.medscape.com\/viewarticle\/926390\">https:\/\/www.medscape.com\/viewarticle\/926390<\/a><\/p>\n<p>ONG, Sean Wei Xiang, Yian Kim TAN, Po Ying CHIA, Tau Hong LEE, Oon Tek NG, Michelle Su Yen WONG a&nbsp;Kalisvar MARIMUTHU. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a&nbsp;Symptomatic Patient.\u00a0<em>JAMA<\/em>\u00a0[online]. 2020, March 4 [cit. 2020-03-16]. DOI: 10.1001\/jama.2020.3227. ISSN 0098-7484. Dostupn\u00e9 z: <a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2762692\">https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2762692<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> Covid \u2013 19 a\u00a0fek\u00e1ln\u00ed kontaminace\n<strong>Key words:<\/strong> Covid \u2013 19, fecal contamination\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_f39b-458d\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_f39b-458d\" data-parent=\"#collapse_8f7b-e51d\" href=\"#citem_f39b-458d\">Nov\u00e9 COVID-19 studie z Wuhanu<\/a>        <\/h4>    <\/div>    <div id=\"citem_f39b-458d\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_f39b-458d\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Nov_COVID-19_Wuhan.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>Mezi novinkami se ve&nbsp;sv\u011btov\u00e9m tisku ji\u017e objevuj\u00ed pom\u011brn\u011b standardn\u011b statisticky propracovan\u00e9 a&nbsp;vyhodnocen\u00e9 studie o&nbsp;posti\u017een\u00ed lidsk\u00e9ho organismu koronavirem\ns&nbsp;po\u010detn\u011bj\u0161\u00edmi soubory a&nbsp;v\u00fdsledky, zahrnuj\u00edc\u00edmi i&nbsp;rizikov\u00e9 faktor, z\u00e1va\u017enost, mo\u017enosti sou\u010dasn\u00e9 akutn\u011b pojat\u00e9 intenzivn\u00ed medic\u00edny i&nbsp;n\u00e1rok\u016f na&nbsp;paliativn\u00ed p\u00e9\u010di bez du\u0161nosti a&nbsp;pocitu utrpen\u00ed.<\/p>\n<p>Nej\u010dast\u011bji se op\u00edraj\u00ed o&nbsp;\u00fadaje z\u00a0Wuhanu, kde soubory ji\u017e dosahuj\u00ed zna\u010dn\u00e9 po\u010detnosti\na&nbsp;umo\u017e\u0148uj\u00ed statisticky pou\u010dn\u00e9 zpracov\u00e1n\u00ed. Podle citac\u00ed jsou pro z\u00e1jemce k\u00a0dispozici rozs\u00e1hl\u00e9 tabulky, v\u00fdpo\u010dty i&nbsp;vyhodnocen\u00ed.<\/p>\n<p>V\u00a0pom\u011brn\u011b zestru\u010dn\u011bl\u00fdch a&nbsp;obecn\u011b pochopiteln\u00fdch souhrnech maj\u00ed v\u00fdznam rizikov\u00e9 faktory\na&nbsp;\u010dasn\u00e9 a&nbsp;relevantn\u00ed prognostick\u00e9 momenty k\u00a0aktu\u00e1ln\u00edmu rozhodov\u00e1n\u00ed s\u00a0p\u0159ehledy\no&nbsp;klinick\u00fdch trajektori\u00edch u&nbsp;senior\u016f a&nbsp;septick\u00fdch pacient\u016f. Spojuj\u00ed je indikace, mo\u017enosti\ni&nbsp;meze sou\u010dasn\u00e9 intenzivn\u00ed medic\u00edny a&nbsp;p\u00e9\u010de p\u0159i pandemii s\u00a0postupuj\u00edc\u00edm glob\u00e1ln\u00edm rozsahem.<\/p>\n<p><strong>Klinick\u00e1 charakteristika vznikaj\u00edc\u00edho ARDS, komplikuj\u00edc\u00edch pneumoni\u00ed, vysoce nep\u0159\u00edzniv\u00e9 progn\u00f3zy<\/strong> [1]<\/p>\n<p>Retrospektivn\u00ed studie souboru 201 pacient\u016f s\u00a0COVID &#8211; 19 pneumoni\u00ed z\u00a0\u010dasov\u00e9ho obdob\u00ed 25.&nbsp;prosinec 2019 &#8211; 26.&nbsp;leden 2020.<\/p>\n<p>V\u00a0souboru bylo 201 pacient\u016f v\u00a0pr\u016fm\u011brn\u00e9m v\u011bku (medi\u00e1n) 51 let (43 &#8211; 60 let); po\u010det mu\u017e\u016f byl 128 (63,7&nbsp;%). U&nbsp;84 pacient\u016f (41,8&nbsp;%) se rozvinul ARDS. Z\u00a0tohoto po\u010dtu 44 pacient\u016f (52,4&nbsp;%) zem\u0159elo.<\/p>\n<p><strong>Rozd\u00edly <\/strong>mezi p\u0159e\u017eiv\u0161\u00edmi a&nbsp;podez\u0159el\u00fdmi byly charakteristick\u00e9.<\/p>\n<p><strong>Pacienti s\u00a0ARDS:<\/strong><\/p>\n<ul>\n<li>\u010cast\u011bj\u0161\u00ed du\u0161nost: 50 z\u00a084 = 59,5&nbsp;%<\/li>\n<li>\u010cast\u011bj\u0161\u00ed hypertenze: 23 z\u00a084 = 27,4&nbsp;%<\/li>\n<li>\u010cast\u011bj\u0161\u00ed diabetes mellitus: 16 z&nbsp;84 = 19&nbsp;%<\/li>\n<\/ul>\n<p><strong>V\u00fdvoj ARDS a\u017e po \u00famrt\u00ed &#8211; hlavn\u00ed faktory:<\/strong><\/p>\n<ul>\n<li>Star\u0161\u00ed v\u011bk<\/li>\n<li>Vysok\u00e1 neutrofilie<\/li>\n<li>Org\u00e1nov\u00e1 a&nbsp;hemokoagula\u010dn\u00ed dysfunkce<\/li>\n<li>Vy\u0161\u0161\u00ed a\u017e vysok\u00e9 hodnoty LDH, D-dimeru<\/li>\n<li>T\u011blesn\u00e1 teplota \u2265 39&nbsp;\u00b0C<\/li>\n<\/ul>\n<p><strong>Pod\u00e1n\u00ed vysok\u00e9 d\u00e1vky methylprednizolonu <\/strong>sn\u00ed\u017eilo riziko \u00famrt\u00ed: HR 0,38; 95&nbsp;% CI, 0,20 -0,72<\/p>\n<p><strong>Podrobn\u011bj\u0161\u00ed statistick\u00e9 zpracov\u00e1n\u00ed <\/strong>[2, 3]<\/p>\n<p>Uveden\u00e1 observa\u010dn\u00ed studie, oti\u0161t\u011bn\u00e1 v\u00a0\u010dasopise Lancet se zab\u00fdv\u00e1 obdobn\u011b zpracovan\u00fdm t\u00e9matem u&nbsp;kriticky nemocn\u00fdch dosp\u011bl\u00fdch pacient\u016f v\u00a0intenzivn\u00ed p\u00e9\u010di, hospitalizovan\u00fdch v\u00a0obdob\u00ed 29.&nbsp;prosinec 2019 &#8211; 31.&nbsp;leden 2020.<\/p>\n<p>Soubor zahrnul 191 pacient\u016f; 137 z\u00a0nich bylo propu\u0161t\u011bno po uzdraven\u00ed, 54 pacienti zem\u0159eli s\u00a0letalitou 28&nbsp;%.<\/p>\n<p><strong>Statistick\u00e9 zpracov\u00e1n\u00ed a&nbsp;zhodnocen\u00ed<\/strong><\/p>\n<ul>\n<li>Studie zpracov\u00e1v\u00e1 statisticky p\u0159esn\u011bji soubor, ji\u017e d\u0159\u00edve citovan\u00fd u&nbsp;pacient\u016f st\u0159edn\u00edho v\u011bku (medi\u00e1n 56 r.) se 62&nbsp;% mu\u017e\u016f; u&nbsp;zem\u0159el\u00fdch pacient\u016f byl pr\u016fm\u011brn\u00fdch v\u011bk 69 let, u&nbsp;p\u0159e\u017eiv\u0161\u00edch 52 let.<\/li>\n<li>SOFA sk\u00f3re &#8211; 5,65;95% CI; 2,61- 12,23; p &lt; 0,0001; p\u0159\u00ed\u010diny: prok\u00e1zan\u00e1 sepse.<\/li>\n<li>U&nbsp;91 pacient\u016f (48&nbsp;%) se jednalo o&nbsp;komorbidity: 58 pacient\u016f = 30&nbsp;% &#8211; hypertenze;\n26 pacient\u016f = 19&nbsp;% &#8211; diabetes mellitus; koron\u00e1rn\u00ed ischemick\u00e1 choroba srde\u010dn\u00ed:\n15 pacient\u016f = 8&nbsp;%.<\/li>\n<li>U&nbsp;50&nbsp;% pacient\u016f se rozvinula sepse.<\/li>\n<li>Jako hlavn\u00ed riziko byl vyhodnocen pokro\u010dil\u00fd a&nbsp;velmi pokro\u010dil\u00fd v\u011bk (OR 1,10; 95% CI; 1,03 &#8211; 1,17 za ka\u017ed\u00fd rok v\u011bku; p = 0,0043).<\/li>\n<li>Z\u00a0pr\u016fb\u011b\u017en\u00fdch nep\u0159\u00edzniv\u00fdch laboratorn\u00edch marker\u016f se jako dominantn\u00ed u&nbsp;zem\u0159el\u00fdch pacient\u016f projevilo zv\u00fd\u0161en\u00ed troponinu I&nbsp;ve&nbsp;v\u00edce ne\u017e 50&nbsp;%.<\/li>\n<li>Z\u00e1sadn\u00ed komplikace u&nbsp;zem\u0159el\u00fdch pacient\u016f byly: selh\u00e1n\u00ed d\u00fdch\u00e1n\u00ed &#8211; 98&nbsp;%; sepse &#8211; 100&nbsp;%; sekund\u00e1rn\u00ed infekce &#8211; 50&nbsp;%.<\/li>\n<\/ul>\n<p>V\u00fdsledky studie\/studi\u00ed nezcela odpov\u00eddaj\u00ed \u00fadaj\u016fm Sv\u011btov\u00e9 zdravotnick\u00e9 organizace, kter\u00e1 v\u00a0dan\u00e9 dob\u011b uv\u00e1d\u011bla smrtnost na&nbsp;COVID-19 pouze v\u00a0\u0159\u00e1du 3 &#8211; 4&nbsp;%. Na&nbsp;podstatn\u011b vy\u0161\u0161\u00ed mortalit\u011b a&nbsp;letalit\u011b se pod\u00edlely: nedostatek \u00fa\u010dinn\u00fdch antivirotik, nedostate\u010dn\u00e1 adherence pacient\u016f v\u00a0dodr\u017eov\u00e1n\u00ed podp\u016frn\u00e9 intenzivn\u00ed terapie a&nbsp;prevence; vysok\u00e9 d\u00e1vky del\u0161\u00edho pod\u00e1v\u00e1n\u00ed kortikosteroid\u016f, pozdn\u00ed p\u0159\u00edjmy do&nbsp;nemocnic centrov\u00e9 \u00farovn\u011b.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p>Literatura:<\/p>\n<ol>\n<li>WU, Chaomin, Xiaoyan CHEN, Yanping CAI, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China.\u00a0<em>JAMA Internal Medicine<\/em>[online]. 2020 [cit. 2020-03-16]. DOI: 10.1001\/jamainternmed.2020.0994. ISSN 2168-6106. Dostupn\u00e9 z: <a href=\"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2763184\">https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2763184<\/a><\/li>\n<li>ZHOU, Fei, Ting YU, Ronghui DU, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a&nbsp;retrospective cohort study.\u00a0<em>The Lancet<\/em>[online]. 2020, March 9 [cit. 2020-03-16]. DOI: 10.1016\/S0140-6736(20)30566-3. ISSN 01406736. Dostupn\u00e9 z: <a href=\"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0140673620305663\">https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0140673620305663<\/a><\/li>\n<li>VAN BEUSEKOM, Mary. Old age, sepsis tied to poor COVID-19 outcomes, death.\u00a0<em>CIDRAP<\/em>[online]. 2020, March 10 [cit. 2020-03-16]. Dostupn\u00e9 z: <a href=\"http:\/\/www.cidrap.umn.edu\/news-perspective\/2020\/03\/old-age-sepsis-tied-poor-covid-19-outcomes-death\">http:\/\/www.cidrap.umn.edu\/news-perspective\/2020\/03\/old-age-sepsis-tied-poor-covid-19-outcomes-death<\/a><\/li>\n<\/ol>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> COVID-2019; Progn\u00f3za; Letalita\n<strong>Key words:<\/strong> COVID-2019; Prognosis; Lethality<\/p>\n<p>        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_3232-c0a6\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_3232-c0a6\" data-parent=\"#collapse_6bd0-9274\" href=\"#citem_3232-c0a6\">COVID-19 a prognostika<\/a>        <\/h4>    <\/div>    <div id=\"citem_3232-c0a6\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_3232-c0a6\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/COVID-prediktory.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>Retrospektivn\u00ed, multicentrick\u00e1 studie souboru 150 COVID &#8211; 19 pozitivn\u00edch hospitalizovan\u00fdch dosp\u011bl\u00fdch kritick\u00fdch pacient\u016f se v\u011bnovala <strong>prognostick\u00fdm prediktor\u016fm jejich mortality\/<\/strong> <strong>p\u0159e\u017eit\u00ed.<\/strong><\/p>\n<p>Soubor byl ze dvou nemocnic akademick\u00e9 \u00farovn\u011b z&nbsp;Wuhanu sice nep\u0159\u00edli\u0161 po\u010detn\u00fd, ale poskytl inici\u00e1ln\u00ed poznatky a&nbsp;statisticky zhodnotiteln\u00e9 z\u00e1kladn\u00ed \u00fadaje a&nbsp;vztahy.<\/p>\n<p>Do&nbsp;souboru studie za\u0159adila 68 zem\u0159el\u00fdch (58 ze 150; 45&nbsp;%) a&nbsp;82 propu\u0161t\u011bn\u00fdch pacient\u016f (82 ze 150; 55&nbsp;%) s\u00a0prok\u00e1zanou COVID &#8211; 19 infekc\u00ed.<\/p>\n<p>Propu\u0161t\u011bn\u00ed pacienti museli splnit krit\u00e9ria: afebriln\u00ed pr\u016fb\u011bh minim\u00e1ln\u011b po dobu 3 dn\u016f, d\u00e1le v\u00fdznamn\u00e9 zlep\u0161en\u00e9 d\u00fdch\u00e1n\u00ed a&nbsp;negativn\u00ed v\u00fdstupn\u00ed testy na&nbsp;p\u0159\u00edtomnost koronaviru.<\/p>\n<p>Publikovan\u00fd text uv\u00e1d\u00ed demografii i&nbsp;klinick\u00e9 pr\u016fb\u011bhy s\u00a0prognosticky v\u00fdznamn\u00fdmi z\u00e1v\u011bry.<\/p>\n<p><strong>Klinick\u00fd pohled<\/strong><\/p>\n<p><strong>Mortalita \/ p\u0159e\u017eit\u00ed<\/strong><\/p>\n<ul>\n<li>Statisticky v\u00fdznamn\u00fd rozd\u00edl mortality v\u00a0<strong>neprosp\u011bch vy\u0161\u0161\u00edho v\u011bku<\/strong> s\u00a0p = &lt; 0,001<\/li>\n<li>\u017d\u00e1dn\u00fd genderov\u00fd rozd\u00edl s\u00a0p = 0,43<\/li>\n<li><strong>Komorbidita<\/strong> u&nbsp;p\u0159e\u017eiv\u0161\u00edch 41&nbsp;% pacient\u016f (34\/82) oproti zem\u0159el\u00fdm 63&nbsp;% pacient\u016fm (4,3 \/68) s\u00a0v\u00fdznamn\u00fdm statistick\u00fdm rozd\u00edlem (p= 0,0069).<\/li>\n<li>Diagn\u00f3za <strong>kardiokoron\u00e1rn\u00ed a&nbsp;kardiovaskul\u00e1rn\u00ed chronick\u00e9 morbidity<\/strong> m\u011bla vedouc\u00ed v\u00fdznam s\u00a0p &lt; 0,001<\/li>\n<li><strong>Druhotn\u00e9 infekce<\/strong> byly p\u0159\u00edtomny v\u00a016&nbsp;% (11 \/ 68) u&nbsp;zem\u0159el\u00fdch pacient\u016f a&nbsp;v\u00a01&nbsp;% (1\/82) u&nbsp;p\u0159e\u017eiv\u0161\u00edch pacient\u016f s&nbsp;p = 0,0018<\/li>\n<li>Statisticky signifikantn\u00ed rozd\u00edly byly mezi skupinou p\u0159e\u017eiv\u0161\u00edch a&nbsp;zem\u0159el\u00fdch v&nbsp;laboratorn\u00edch markerech: po\u010det leukocyt\u016f, lymfocyt\u016f, trombocyt\u016f, hodnota albuminu, celkov\u00e9ho bilirubinu, N urey, kreatininu; <strong>specificky v\u00fdznamn\u00fd byl zejm\u00e9na vzestup myoglobinu, troponinu, CRP a&nbsp;IL-6.<\/strong><\/li>\n<li>Doba do&nbsp;\u00famrt\u00ed pacient\u016f m\u011bla dva vrcholy: 14 dn\u016f: 22 x; 22 dn\u016f: &#8211; 17 x<\/li>\n<\/ul>\n<p><strong>Bezprost\u0159edn\u00ed p\u0159\u00ed\u010diny smrti v\u00a068 p\u0159\u00edpadech<\/strong><\/p>\n<ul>\n<li>36 pacient\u016f &#8211; 53&nbsp;% = selh\u00e1n\u00ed d\u00fdch\u00e1n\u00ed<\/li>\n<li>5 pacient\u016f &#8211; 7&nbsp;% = ob\u011bhov\u00e9 selh\u00e1n\u00ed z\u00a0kardi\u00e1ln\u00ed p\u0159\u00ed\u010diny s\u00a0fulminantn\u00edm pr\u016fb\u011bhem<\/li>\n<li>22 pacient\u016f &#8211; 33&nbsp;% = kombinace obou p\u0159\u00ed\u010din<\/li>\n<li>5 pacient\u016f &#8211; nejist\u00e1 p\u0159\u00ed\u010dina \u00famrt\u00ed<\/li>\n<\/ul>\n<p><strong>Predikce pr\u016fb\u011bhu a&nbsp;v\u00fdsledku &#8211; v\u00fdznamn\u00e9 prediktory<\/strong><\/p>\n<ul>\n<li>Vy\u0161\u0161\u00ed a&nbsp;vysok\u00fd v\u011bk, komorbidita, druhotn\u00e9 infekce, zv\u00fd\u0161en\u00ed z\u00e1n\u011btliv\u00fdch marker\u016f<\/li>\n<li>Cytokinov\u00e1 bou\u0159e<\/li>\n<li>Fulminantn\u00ed myokarditida<\/li>\n<\/ul>\n<p><strong>P\u0159edb\u011b\u017en\u00e9 zpracov\u00e1n\u00ed v\u010detn\u011b statistick\u00fdch vyhodnocen\u00ed jasn\u011b ur\u010duj\u00ed diagnostick\u00e9 sm\u011bry, klinick\u00e9 projevy a&nbsp;laboratorn\u00ed markery, s\u00a0nimi\u017e lze prognosticky pracovat. <\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p>Literarura:<\/p>\n<p>RUAN, Qiurong, Kun YANG, Wenxia WANG, Lingyu JIANG a&nbsp;Jianxin SONG. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China.\u00a0<em>Intensive Care Medicine<\/em>\u00a0[online]. 2020 [cit. 2020-03-17]. DOI: 10.1007\/s00134-020-05991-x. ISSN 0342-4642. Dostupn\u00e9 z: <a href=\"http:\/\/link.springer.com\/10.1007\/s00134-020-05991-x\">http:\/\/link.springer.com\/10.1007\/s00134-020-05991-x<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> COVID &#8211; 19 &#8211; progn\u00f3za; Prognostick\u00e9 markery\n<strong>Key words:<\/strong> COVID &#8211; 19 &#8211; prognosis; Prognostic markers        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_93ed-f091\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_93ed-f091\" data-parent=\"#collapse_6bd0-9274\" href=\"#citem_93ed-f091\">Jak dlouho vydr\u017e\u00ed koronavir v aerosolu nebo na povrchu r\u016fzn\u00fdch materi\u00e1l\u016f?<\/a>        <\/h4>    <\/div>    <div id=\"citem_93ed-f091\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_93ed-f091\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/COVID-19_vydrz.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>Stabilita COVID &#8211; 19 viru je podobn\u00e1 SARS-CoV-1, ale na&nbsp;rozd\u00edl od&nbsp;n\u011bho je jeho roz\u0161i\u0159ov\u00e1n\u00ed exponenci\u00e1ln\u011b potentn\u011bj\u0161\u00ed, a&nbsp;to interhum\u00e1nn\u00edm p\u0159enosem. Uveden\u00fd mechanismus ale nen\u00ed kvalitn\u011b zmapov\u00e1n, a&nbsp;to zejm\u00e9na u&nbsp;asymptomatick\u00fdch nebo presymptomatick\u00fdch jedinc\u016f.<\/p>\n<p>Prov\u011b\u0159ovala se stabilita a&nbsp;infek\u010dnost v\u00a0prost\u0159ed\u00ed, a&nbsp;to i&nbsp;v\u00a0simulovan\u00fdch situac\u00edch p\u0159i u\u017eit\u00ed aerosolu a&nbsp;p\u0159i ulp\u00edv\u00e1n\u00ed kap\u00e9nek na&nbsp;r\u016fzn\u00fdch ploch\u00e1ch a&nbsp;povr\u0161\u00edch.<\/p>\n<p>Sekrece z\u00a0d\u00fdchac\u00edch cest ve&nbsp;form\u011b aerosolu (&lt; 5 \u00b5m) nebo drobn\u00fdch kap\u00e9nek (&gt; 5 \u00b5m) je mo\u017en\u00e1. Je <strong>mo\u017en\u00e9 aerosol \u0161\u00ed\u0159it i&nbsp;z\u00a0nebuliz\u00e1tor\u016f;<\/strong> vydr\u017e\u00ed \u00fa\u010dinn\u00e9 a\u017e 180 minut s\u00a0postupn\u00fdm poklesem po 3 hodin\u00e1ch.<\/p>\n<p>SARS virus a&nbsp;COVID virus si jsou podobn\u00e9. Oba maj\u00ed t\u00bd (medi\u00e1n) stability v\u00a0aerosolu = 2,7&nbsp;h; \u010dasov\u00e9 rozmez\u00ed je pro SARS virus 1,65 a&nbsp;pro COVID virus 7,24&nbsp;h.<\/p>\n<p>Studie testovala i&nbsp;jejich <strong>rizikov\u00e9 ulp\u00edv\u00e1n\u00ed po dobu 7 dn\u016f na&nbsp;r\u016fzn\u00fdch povr\u0161\u00edch a&nbsp;ploch\u00e1ch.<\/strong> Napodobovalo se p\u0159itom dom\u00e1c\u00ed, <strong>nemocni\u010dn\u00ed, intenzivn\u00ed prost\u0159ed\u00ed<\/strong> po expozici objemu b\u011b\u017en\u00e9ho aerosolu z&nbsp;lidsk\u00fdch d\u00fdchac\u00edch cest, nap\u0159.&nbsp;50 \u00b5l roztoku s\u00a0obsahem viru.<\/p>\n<p><strong>Nov\u00fd \u2013 COVID &#8211; 19 koronavirus byl nejstabiln\u011bj\u0161\u00ed na&nbsp;plastick\u00fdch a&nbsp;nekovov\u00fdch ploch\u00e1ch\na\u017e po dobu 72 hodin.<\/strong> P\u0159itom jeho mno\u017estv\u00ed se sn\u00ed\u017eilo a\u017e o&nbsp;t\u0159i \u0159\u00e1dy s\u00a0exponenci\u00e1ln\u00edm poklesem.<\/p>\n<p>Medi\u00e1n t\u00bd je p\u0159ehledn\u011b uveden v\u00a0tabulce v\u00a0hodin\u00e1ch pro COVID-19 virus versus SARS virus.<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"205\"><strong>Plocha &#8211; materi\u00e1l<\/strong><\/td>\n<td width=\"205\"><strong>COVID \u2013 19 \u2013 virus &#8211; h<\/strong><\/td>\n<td width=\"205\"><strong>SARS \u2013 virus &#8211; h<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"205\"><strong>M\u011b\u010f<\/strong><\/td>\n<td width=\"205\">\u00a03,4<\/td>\n<td width=\"205\">\u00a0 3,76<\/td>\n<\/tr>\n<tr>\n<td width=\"205\"><strong>P\u0159ekli\u017eka, lepenka<\/strong><\/td>\n<td width=\"205\">\u00a0\u00a0 8,45<\/td>\n<td width=\"205\">\u00a0 1,74<\/td>\n<\/tr>\n<tr>\n<td width=\"205\"><strong>Kov\/ocel<\/strong><\/td>\n<td width=\"205\">13,1<\/td>\n<td width=\"205\">\u00a0 9,77<\/td>\n<\/tr>\n<tr>\n<td width=\"205\"><strong>Plast<\/strong><\/td>\n<td width=\"205\">15,9<\/td>\n<td width=\"205\">17,7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>Z\u00e1v\u011br a&nbsp;doporu\u010den\u00ed<\/strong><\/p>\n<p>Aerosol i&nbsp;dal\u0161\u00ed formy p\u0159ena\u0161e\u010d\u016f umo\u017e\u0148uj\u00ed p\u0159enos COVID -19 viru a&nbsp;jeho stabilitu po mnoho hodin na&nbsp;r\u016fzn\u00fdch ploch\u00e1ch a&nbsp;povr\u0161\u00edch a\u017e 10 dn\u016f.<\/p>\n<p>Prov\u011b\u0159ov\u00e1n\u00ed a&nbsp;snaha sn\u00ed\u017eit uveden\u00e9 riziko se d\u00e1le zam\u011b\u0159uje na&nbsp;plochy s\u00a0povrchy\nz&nbsp;lakovan\u00e9ho d\u0159eva a&nbsp;keramiky, kter\u00e9 jsou b\u011b\u017en\u00e9 v\u00a0koupeln\u00e1ch a&nbsp;v&nbsp;kuchyn\u00edch, ale vztahuj\u00ed\nse i&nbsp;na&nbsp;nebuliz\u00e1tory, \u010dist\u00edc\u00ed m\u00edstnosti a&nbsp;l\u00e1zn\u011b ohro\u017een\u00fdch pacient\u016f v\u00a0izolaci.<\/p>\n<p>Literatura:<\/p>\n<ol>\n<li>LEWIS, Ricki. Coronavirus Stays in Aerosols for Hours, on Surfaces for Days.\u00a0<em>Medscape<\/em>[online]. 2020, March 17 [cit. 2020-03-17]. Dostupn\u00e9 z: <a href=\"https:\/\/www.medscape.com\/viewarticle\/926929\">https:\/\/www.medscape.com\/viewarticle\/926929<\/a><\/li>\n<li>VAN DOREMALEN, Neeltje, Trenton BUSHMAKER, Dylan H. MORRIS, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1.\u00a0<em>New England Journal of Medicine<\/em>[online]. 2020, March 17 [cit. 2020-03-17]. DOI: 10.1056\/NEJMc2004973. ISSN 0028-4793. Dostupn\u00e9 z: <a href=\"http:\/\/www.nejm.org\/doi\/10.1056\/NEJMc2004973\">http:\/\/www.nejm.org\/doi\/10.1056\/NEJMc2004973<\/a><\/li>\n<\/ol>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> Koronavir- stabilita v\u00a0r\u016fzn\u00e9m prost\u0159ed\u00ed\n<strong>Key words:<\/strong> Coronavirus &#8211; stability\u00a0 in different environments<\/p>\n<p>        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_c206-d99d\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_c206-d99d\" data-parent=\"#collapse_cf48-0e80\" href=\"#citem_c206-d99d\">AHA - American Heart Association: d\u016frazn\u00e1 doporu\u010den\u00ed zachr\u00e1nc\u016fm Covid-19 suspektn\u00edch a pozitivn\u00edch pacient\u016f<\/a>        <\/h4>    <\/div>    <div id=\"citem_c206-d99d\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_c206-d99d\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/AHA-doporuceni-edit.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>American Heart Association (AHA) vydala jednoduch\u00e9, konkr\u00e9tn\u00ed a&nbsp;prakticky zam\u011b\u0159en\u00e9 pokyny pro neodkladnou resuscitaci a&nbsp;urgentn\u00ed kardiovaskul\u00e1rn\u00ed p\u00e9\u010di u&nbsp;pacient\u016f s\u00a0prok\u00e1zan\u00fdm nebo suspektn\u00edm koronavirem (COVID \u2013 19). C\u00edlem je p\u0159edev\u0161\u00edm zabr\u00e1nit p\u0159enosu viru, kter\u00fd vyvol\u00e1v\u00e1 onemocn\u011bn\u00ed SARS-CoV-2.<\/p>\n<p>Z\u00e1kladn\u00edm, naprosto prioritn\u00edm po\u017eadavkem je v\u00a0t\u00e9to n\u00e1ro\u010dn\u00e9 dob\u011b<strong> zjednodu\u0161it z\u00e1chrann\u00e9 postupy, aby neztratily \u00fa\u010dinnost a&nbsp;p\u0159itom maxim\u00e1ln\u011b uchr\u00e1nili zachr\u00e1nce.<\/strong><\/p>\n<p><strong>Postupy<\/strong> jsou zpracov\u00e1ny spole\u010dn\u011b se Sv\u011btovou zdravotnickou organizac\u00ed, CDC v\u00a0USA\na&nbsp;souhlasn\u011b\u00a0s po\u017eadavky AHA.<\/p>\n<p><strong>Zdravotnick\u00e1 za\u0159\u00edzen\u00ed \u2013 nemocnice stav\u00ed na<\/strong> <strong>nutnosti ochrann\u00fdch opat\u0159en\u00ed a&nbsp;ochrann\u00e9ho vybaven\u00ed.<\/strong><\/p>\n<ul>\n<li>Postupy, doprov\u00e1zen\u00e9 <strong>tvorbou aerosolu<\/strong>, jako je KPR a&nbsp;trache\u00e1ln\u00ed intubace, jsou pro zachr\u00e1nce velmi zv\u00fd\u0161en\u00fdmi rizikov\u00fdmi momenty. V\u00a0nemocnici je t\u0159eba je prov\u00e1d\u011bt v\u00a0izolovan\u00e9m, klimatizovan\u00e9m prostoru a&nbsp;zachra\u0148uj\u00edc\u00ed t\u00fdm mus\u00ed b\u00fdt vybaven ochrann\u00fdmi respira\u010dn\u00edmi prost\u0159edky.<\/li>\n<li><strong>Po\u010det \u010dlen\u016f<\/strong> zasahuj\u00edc\u00edho zdravotnick\u00e9ho t\u00fdmu mus\u00ed b\u00fdt omezen na&nbsp;naprosto <strong>nezbytn\u00e9 minimum<\/strong> Po v\u00fdkonech s\u00a0mo\u017enou tvorbou ulp\u00edvaj\u00edc\u00edho aerosolu\na&nbsp;infek\u010dn\u00ed tekutiny je t\u0159eba prostor vy\u010distit a&nbsp;vydezinfikovat.<\/li>\n<li>Pacienty v\u00a0riziku je t\u0159eba ji\u017e p\u0159edem um\u00edstit v\u00a0<strong>jednol\u016f\u017ekov\u00e9 izolaci<\/strong> &#8211; v&nbsp;pokoji se zav\u00edrateln\u00fdmi a&nbsp;zav\u0159en\u00fdmi dve\u0159mi a&nbsp;s\u00a0n\u00e1le\u017eitou klimatizac\u00ed.<\/li>\n<li><strong>Respir\u00e1tory s\u00a0vy\u0161\u0161\u00ed protektivn\u00ed schopnost\u00ed<\/strong> maj\u00ed b\u011bhem postup\u016f s\u00a0rizikem tvorby aerosolu z\u00e1sadn\u00ed p\u0159ednost p\u0159ed \u00fastenkami, p\u0159ed obli\u010dejov\u00fdmi rou\u0161kami\na&nbsp;b\u011b\u017en\u00fdmi obli\u010dejov\u00fdmi maskami.<\/li>\n<li>Z\u00e1chrann\u00fd zdravotnick\u00fd t\u00fdm si nasad\u00ed <strong>respir\u00e1tor<\/strong> (pokud nen\u00ed k\u00a0dispozici obli\u010dejovou masku, \u00fastenku, obli\u010dejovou rou\u0161ku) <strong>p\u0159ed vstupem<\/strong> do&nbsp;pokoje, boxu, prostoru pacienta.<\/li>\n<li>Zdravotnick\u00e9 za\u0159\u00edzen\u00ed zaji\u0161\u0165uje <strong>\u0159et\u011bzov\u00e9 dopl\u0148ov\u00e1n\u00ed<\/strong> ochrann\u00fdch pom\u016fcek\na&nbsp;prost\u0159edk\u016f s\u00a0um\u00edst\u011bn\u00edm p\u0159ed vstup do&nbsp;prostoru suspektn\u00edho nebo pozitivn\u00edho pacienta s\u00a0COVID &#8211; 19.<\/li>\n<li>Zdravotn\u00edci nos\u00ed <strong>ochrann\u00e9 respira\u010dn\u00ed pom\u016fcky, prost\u0159edky pro ochranu o\u010d\u00ed, rukavice a&nbsp;pl\u00e1\u0161t\u011b. <\/strong><\/li>\n<li>Pokud je ochrann\u00fdch pl\u00e1\u0161\u0165\u016f aktu\u00e1ln\u00ed nedostatek, soust\u0159ed\u00ed se jejich omezen\u00e1 z\u00e1soba naprosto p\u0159ednostn\u011b na&nbsp;prostory s\u00a0rizikem vzniku infek\u010dn\u00edho aerosolu, s\u00a0u\u017e\u00edv\u00e1n\u00edm sprej\u016f, se vznikem infek\u010dn\u00edho tekut\u00e9ho odpadu a&nbsp;k\u00a0pacient\u016fm, u&nbsp;nich\u017e je nutn\u00e1 p\u0159\u00edm\u00e1 kontaktn\u00ed o\u0161et\u0159ovatelsk\u00e1 p\u00e9\u010de, v&nbsp;n\u00ed\u017e vede riziko zne\u010dist\u011bn\u00ed rukou\na&nbsp;oble\u010den\u00ed.<\/li>\n<li>Je-li indikov\u00e1na <strong>trache\u00e1ln\u00ed intubace,<\/strong> provede se velmi pohotov\u011b a\u017e bleskov\u011b\nza pat\u0159i\u010dn\u00e9ho ochrann\u00e9ho vybaven\u00ed \u00fa\u010dastn\u00fdch zdravotn\u00edk\u016f.<\/li>\n<li>Je t\u0159eba se maxim\u00e1ln\u011b vyvarovat postup\u016f, kter\u00e9 vedou k&nbsp;tvorb\u011b aerosolu, jako je prod\u00fdch\u00e1v\u00e1n\u00ed samorozp\u00ednac\u00edm d\u00fdchac\u00edm vakem s\u00a0nasazenou obli\u010dejovou maskou; eliminuj\u00ed se nebuliz\u00e1tory a&nbsp;metody neinvazivn\u00ed um\u011bl\u00e9 ventilace p\u0159eru\u0161ovan\u00fdm p\u0159etlakem.<\/li>\n<li>P\u0159i vzniku akutn\u00ed dechov\u00e9 nedostate\u010dnosti, resp. ji\u017e p\u0159i varovn\u00fdch zn\u00e1mk\u00e1ch selh\u00e1v\u00e1n\u00ed d\u00fdch\u00e1n\u00ed je indikov\u00e1na \u010dasn\u00e1 trache\u00e1ln\u00ed intubace. Nen\u00ed vhodn\u00e9 p\u0159edem zkou\u0161et HFNO &#8211; naz\u00e1ln\u00ed oxygenaci s\u00a0vysok\u00fdm p\u0159\u00edkonem kysl\u00edku nebo syst\u00e9m CPAP s\u00a0endexspira\u010dn\u00edm p\u0159etlakem; oba toti\u017e ohro\u017euj\u00ed zv\u00fd\u0161enou tvorbou aerosolu.<\/li>\n<\/ul>\n<p><strong>Specifick\u00e1 doporu\u010den\u00ed pro Zdravotnickou z\u00e1chrannou slu\u017ebu<\/strong><\/p>\n<ul>\n<li>Osoby, volaj\u00edc\u00ed na&nbsp;t\u00eds\u0148ovou linku opera\u010dn\u00edho st\u0159ediska ZZS maj\u00ed oper\u00e1torovi \/rce na&nbsp;dotaz sd\u011blit, zda\u00a0 se jedn\u00e1 o&nbsp;pacienta se suspekc\u00ed nebo pr\u016fkazem COVID \u2013 19.<\/li>\n<li>Stejn\u00fd po\u017eadavek plat\u00ed, je-li pro pacienta po\u017eadov\u00e1n sekund\u00e1rn\u00ed transport.<\/li>\n<li>Pos\u00e1dky se \u0159\u00edd\u00ed aktualizovan\u00fdmi sm\u011brnicemi, rozhodnut\u00edm nad\u0159\u00edzen\u00e9 slo\u017eky, veden\u00ed ZZS a&nbsp;krizov\u00e9ho \u0161t\u00e1bu<strong>.<\/strong><\/li>\n<\/ul>\n<p>Literarura:<\/p>\n<p>BROOKS, Megan. AHA Guidance for CPR, Emergency CV Care Amid COVID-19.\u00a0<em>Medscape<\/em>\u00a0[online]. 2020, March 23 [cit. 2020-03-25]. Dostupn\u00e9 z: <a href=\"https:\/\/www.medscape.com\/viewarticle\/927389\">https:\/\/www.medscape.com\/viewarticle\/927389<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> Covid &#8211; 19; KPR, ECC &#8211; postupy\n<strong>Key words:<\/strong> Covid &#8211; 19; CPR; ECC &#8211; guidelines        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_c39c-7ebe\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_c39c-7ebe\" data-parent=\"#collapse_d30c-b67f\" href=\"#citem_c39c-7ebe\">COVID-19 a nejv\u00fdznamn\u011bj\u0161\u00ed etick\u00e9 aspekty podle BMA<\/a>        <\/h4>    <\/div>    <div id=\"citem_c39c-7ebe\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_c39c-7ebe\">        <div class=\"panel-body\"><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/BMA-_-COVID-19_edit.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a>\n<hr \/>\n<p>P\u0159ed jakou sou\u010dasnou realitou stoj\u00ed British Medical Association s\u00a0pandemick\u00fdch v\u00fdskytem COVID &#8211; 19 a&nbsp;jak\u00e9 etick\u00e9 z\u00e1sady mus\u00ed bezpodm\u00edne\u010dn\u011b prosazovat? Jak\u00e1 jsou ponau\u010den\u00ed\ni&nbsp;z\u00e1sady pro budoucnost?<\/p>\n<p>Za dan\u00e9 situace je nejv\u011bt\u0161\u00ed a&nbsp;nejv\u00edce stresuj\u00edc\u00ed n\u00e1tlak na&nbsp;zdravotn\u00edky a&nbsp;mezi nimi zejm\u00e9na\nna&nbsp;l\u00e9ka\u0159e. Pracuj\u00ed v\u00a0nov\u00fdch a&nbsp;v\u00a0nezvykl\u00fdch podm\u00ednk\u00e1ch a&nbsp;to i&nbsp;nad r\u00e1mec sv\u00fdch kompetenc\u00ed\na&nbsp;zku\u0161enost\u00ed; p\u0159ich\u00e1zej\u00ed l\u00e9ka\u0159i d\u016fchodci i&nbsp;studenti medic\u00edny za krizov\u00fdch a&nbsp;kritick\u00fdch podm\u00ednek.<\/p>\n<p>V\u00fdhledy jsou nejist\u00e9 v\u00fdvojem i&nbsp;\u010dasem. B\u011b\u017en\u00e9 standardy, sm\u011brnice, d\u0159\u00edve p\u0159ijat\u00e1 metodick\u00e1 doporu\u010den\u00ed jsou \u010dasto pouze teori\u00ed. N\u00e1roky \u2013 medic\u00ednsk\u00e9, medic\u00ednsko-pr\u00e1vn\u00ed, etick\u00e9 zdaleka vybo\u010duj\u00ed z\u00a0odborn\u00e9ho i&nbsp;spole\u010densk\u00e9ho r\u00e1mce. Do&nbsp;z\u00e1sadn\u00edho rozhodov\u00e1n\u00ed vstupuje prioritizace a&nbsp;civiln\u00ed tri\u00e1\u017e, bezpe\u010dnost zdravotnick\u00e9ho person\u00e1lu, etick\u00e9 z\u00e1sady ka\u017ed\u00e9ho l\u00e9ka\u0159e i&nbsp;zost\u0159en\u00fd d\u016fraz na&nbsp;bezpe\u010dnost vlastn\u00ed i&nbsp;na&nbsp;bezpe\u010dnost rodiny. Celkov\u00e1 atmosf\u00e9ra m\u016f\u017ee aktivovat ne\u017e\u00e1douc\u00ed vstupy a\u017e krimin\u00e1ln\u00edho r\u00e1zu.<\/p>\n<p>Z\u00e1kladem cel\u00e9ho racion\u00e1ln\u00edho textu, zformulovan\u00e9ho v\u00a0ned\u00e1vn\u00fdch dnech a&nbsp;vydan\u00e9ho British Medical Association k\u00a0dan\u00e9mu t\u00e9matu, je d\u00e1t l\u00e9ka\u0159\u016fm p\u0159ehled a&nbsp;v\u00fd\u010det o&nbsp;eticky a&nbsp;legislativn\u011b n\u00e1le\u017eit\u00fdch, opr\u00e1vn\u011bn\u00fdch a&nbsp;jednozna\u010dn\u011b zd\u016fvodniteln\u00fdch hodnocen\u00edch, rozhodnut\u00edch, postupech a&nbsp;opat\u0159en\u00edch z\u00a0pohledu medic\u00edny, pr\u00e1va a&nbsp;etiky k\u00a0p\u0159esn\u011b dan\u00e9 dob\u011b, ve&nbsp;vztahu k\u00a0jej\u00edm aktu\u00e1ln\u00edm mo\u017enostem, podm\u00ednk\u00e1m, omezen\u00edm i&nbsp;platn\u00e9 jurisdikci.<\/p>\n<p>Rozs\u00e1hl\u00fd text s\u00a0\u0159adou medic\u00ednsky ale i&nbsp;mimomedic\u00ednsky navazuj\u00edc\u00edch citac\u00ed m\u00e1 deset hust\u00fdch stran. Pln\u00e9 zn\u011bn\u00ed dokumentu m\u00e1 i&nbsp;pr\u00e1vn\u00ed doporu\u010den\u00ed. Nejen\u017ee upozor\u0148uje, ale uji\u0161\u0165uje l\u00e9ka\u0159e, \u017ee&nbsp;je vysoce nepravd\u011bpodobn\u00e9, \u017ee&nbsp;by mohli b\u00fdt kritizov\u00e1ni, pop\u0159.&nbsp;odborn\u011b dehonestov\u00e1ni za sv\u00e1 rozhodnut\u00ed a&nbsp;za p\u00e9\u010di v\u00a0dob\u011b pandemie a&nbsp;s\u00a0n\u00ed spojen\u00e9 krize v\u00a0syst\u00e9mu zdravotnictv\u00ed.<\/p>\n<p><strong>Rozhodnut\u00ed a&nbsp;p\u00e9\u010de<\/strong> mus\u00ed v\u00a0dan\u00e9 dob\u011b <strong>spl\u0148ovat po\u017eadavky<\/strong>:<\/p>\n<ul>\n<li>B\u00fdt za dan\u00fdch, aktu\u00e1ln\u00edch okolnost\u00ed racion\u00e1ln\u00ed<\/li>\n<li>B\u00fdt zalo\u017eeny na&nbsp;nejlep\u0161\u00edch, aktu\u00e1ln\u011b dosa\u017eiteln\u00fdch a&nbsp;v\u00a0dan\u00e9 dob\u011b prokazateln\u011b dostupn\u00fdch mo\u017enostech<\/li>\n<li>B\u00fdt u\u010din\u011bny v\u00a0souhlasu s\u00a0na\u0159\u00edzen\u00edm vl\u00e1dy, poskytovatel\u016f zdravotn\u00ed p\u00e9\u010de, podle sm\u011brnic zam\u011bstnavatel\u016f<\/li>\n<li>B\u00fdt pokud mo\u017eno konsenzu\u00e1ln\u00ed<\/li>\n<li>Poskytovat p\u00e9\u010di pacient\u016fm \u00fa\u010dinnou a&nbsp;bezpe\u010dnou, odpov\u00eddaj\u00edc\u00ed aktu\u00e1ln\u00edm okolnostem<\/li>\n<\/ul>\n<p>Pln\u011bn\u00ed po\u017eadavk\u016f bude i&nbsp;v\u00a0dal\u0161\u00ed dob\u011b v\u017edy posuzov\u00e1no a&nbsp;v\u00fdsledn\u011b zhodnoceno \u00fam\u011brn\u011b mo\u017enostem, dostupn\u00fdm v\u00a0dob\u011b, kdy byla jednotliv\u00e1 opat\u0159en\u00ed a&nbsp;rozhodnut\u00ed p\u0159ijata\na&nbsp;zrealizov\u00e1na.<\/p>\n<p>Text popisn\u011b uv\u00e1d\u00ed statistick\u00e9 \u00fadaje o&nbsp;v\u00fdskytu COVID -19 a&nbsp;o&nbsp;trajektori\u00edch pacient\u016f. Data se st\u00e1le obm\u011b\u0148uj\u00ed a&nbsp;pohotov\u011b je informov\u00e1na odborn\u00e1 l\u00e9ka\u0159sk\u00e1 ve\u0159ejnost a&nbsp;informov\u00e1ni jsou\ni&nbsp;ob\u010dan\u00e9.<\/p>\n<p><strong>Z\u00e1kladn\u00ed etick\u00e9 z\u00e1sady<\/strong><\/p>\n<p>Etick\u00e9 zar\u00e1mov\u00e1n\u00ed dan\u00e9 situace a&nbsp;jej\u00edho v\u00fdvoje m\u00e1 sv\u00e9 z\u00e1kladn\u00ed z\u00e1sady. Ty je nutno zn\u00e1t\na&nbsp;s\u00a0nimi \u2013 a&nbsp;to podle aktu\u00e1ln\u00edch mo\u017enost\u00ed \u2013 se vyrovnat i&nbsp;v\u00a0podm\u00ednk\u00e1ch vysoce nebezpe\u010dn\u00e9 pandemie. Pro l\u00e9ka\u0159e i&nbsp;dal\u0161\u00ed zdravotn\u00edky to za dan\u00fdch okolnost\u00ed znamen\u00e1 posun: u\u017e\u00edt utilit\u00e1rn\u011b objektivn\u00ed mo\u017enosti sou\u010dasn\u011b s\u00a0personalizovan\u00fdm respektem etick\u00e9 z\u00e1sady srovnateln\u00e9 pro v\u0161echny.<\/p>\n<ul>\n<li>Stejn\u00fd je respekt pro v\u0161echny nicm\u00e9n\u011b neznamen\u00e1, \u017ee&nbsp;ka\u017ed\u00fd m\u016f\u017ee b\u00fdt a&nbsp;bude l\u00e9\u010den stejn\u011b.<\/li>\n<li>Respekt znamen\u00e1 informovat pacienty podle mo\u017enost\u00ed, vysv\u011btlovat jim stav, mo\u017enosti, osobn\u00ed zdravotn\u00ed perspektivu, ponechat jim mo\u017enosti pro jejich vlastn\u00ed rozhodnut\u00ed o&nbsp;l\u00e9\u010db\u011b a&nbsp;p\u00e9\u010di.<\/li>\n<li>Z\u00e1kladn\u00ed po\u017eadavek je minimalizovat mo\u017enosti \u0161\u00ed\u0159en\u00ed patogenu \u2013 viru<\/li>\n<li>Spravedlnost a&nbsp;transparentnost v\u00a0zaji\u0161t\u011bn\u00ed t\u00e9ho\u017e p\u0159\u00edstupu a&nbsp;postupu k\u00a0p\u0159\u00ednosn\u00e9mu zdroji; nen\u00ed v\u0161ak nespr\u00e1vn\u00e9 vyzvat pacienta, aby vy\u010dkal, pokud t\u00fd\u017e p\u0159\u00edstup a&nbsp;p\u0159\u00ednos je realizovateln\u00fd pozd\u011bji.<\/li>\n<li>Konsenzus a&nbsp;spolupr\u00e1ce se vz\u00e1jemnou informovanost\u00ed a&nbsp;podporou je pro zdravotnick\u00fd t\u00fdm z\u00e1kladem.<\/li>\n<li>Reciprocita je vy\u017eadov\u00e1na pro ty, kte\u0159\u00ed p\u0159ij\u00edmaj\u00ed v\u011bt\u0161\u00ed z\u00e1t\u011b\u017e.<\/li>\n<li>Smysl pro proporcionalitu je nutn\u00fd: restrikce mus\u00ed b\u00fdt \u00fam\u011brn\u00e9 k\u00a0dosa\u017een\u00ed vyt\u010den\u00e9ho c\u00edle.<\/li>\n<li>Flexibilita v\u00a0pl\u00e1nech a&nbsp;pl\u00e1nov\u00e1n\u00ed je nezbytn\u00e1 \u2013 je nutno je upravit podle aktu\u00e1ln\u00ed situace a&nbsp;podle v\u00fdhled\u016f.<\/li>\n<li>Vy\u017eaduje se otev\u0159en\u00e9 a&nbsp;transparentn\u00ed rozhodov\u00e1n\u00ed, \u00fam\u011brn\u00e9 dan\u00fdm okolnostem\ni&nbsp;konkr\u00e9tn\u00ed situaci. Mus\u00ed b\u00fdt racion\u00e1ln\u00ed, zalo\u017een\u00e9 na&nbsp;opr\u00e1vn\u011bn\u00fdch \u00fadaj\u00edch\nza dan\u00fdch okolnost\u00ed a&nbsp;prakticky uskute\u010dniteln\u00e9.<\/li>\n<\/ul>\n<p><strong>Omezen\u00e9 mo\u017enosti a&nbsp;rozhodov\u00e1n\u00ed<\/strong><\/p>\n<p>V\u00a0nep\u0159edv\u00eddan\u00fdch krizov\u00fdch momentech je mo\u017eno se setkat se situacemi a&nbsp;probl\u00e9my \u2013 odborn\u00fdmi i&nbsp;zprost\u0159edkovan\u011b etick\u00fdmi a&nbsp;medic\u00ednsko-pr\u00e1vn\u00edmi.<\/p>\n<p><strong>Text doporu\u010den\u00ed z\u00a0etick\u00e9ho pohledu m\u00e1 z\u00e1kladn\u00ed body i&nbsp;doporu\u010den\u00ed k\u00a0jejich \u0159e\u0161en\u00ed<\/strong><\/p>\n<ul>\n<li>Racion\u00e1ln\u00ed a&nbsp;spravedliv\u00e1 alokace dostupn\u00fdch, ale nedostatkov\u00fdch zdroj\u016f<\/li>\n<li>Tri\u00e1\u017e pacient\u016f\n<ul>\n<li>Z\u00a0pohledu nezah\u00e1jen\u00ed nebo ukon\u010den\u00ed \u2013 odn\u011bt\u00ed terapie<\/li>\n<li>Z\u00a0pohledu optim\u00e1ln\u00ed \u00fa\u010delnosti<\/li>\n<li>Z\u00a0pohledu p\u0159\u00edm\u00e9, pop\u0159.&nbsp;nep\u0159\u00edm\u00e9 diskriminace<\/li>\n<li>Z\u00a0pohledu up\u0159ednost\u0148ov\u00e1n\u00ed \u2013 prioritizace rozhodnut\u00ed a&nbsp;opat\u0159en\u00ed<\/li>\n<\/ul>\n<\/li>\n<li>Udr\u017een\u00ed z\u00e1kladn\u00edch zdravotnick\u00fdch slu\u017eeb<\/li>\n<li>Mana\u017ement rizik, s\u00a0nimi\u017e jsou konfrontov\u00e1ni zdravotn\u00edci<\/li>\n<li>Omezen\u00ed obecn\u00e9ho a&nbsp;aktu\u00e1ln\u011b zbytn\u00e9ho zdravotnick\u00e9ho servisu<\/li>\n<li>Pracovn\u011b pr\u00e1vn\u00ed aspekty<\/li>\n<li>Reakce odborn\u00e9 i&nbsp;ob\u010dansk\u00e9 spole\u010dnosti<\/li>\n<\/ul>\n<p><strong>Alokace dostupn\u00fdch, ale aktu\u00e1ln\u011b nedostatkov\u00fdch zdroj\u016f<\/strong><\/p>\n<p><strong>\u00a0<\/strong>Je vedena snahou maximalizovat celkov\u00fd p\u0159\u00ednos, sn\u00ed\u017eit mortalitu a&nbsp;morbiditu a&nbsp;udr\u017eet hlavn\u00ed soci\u00e1ln\u00ed funkce posti\u017een\u00fdch pacient\u016f. Zahrnuje rozhodnut\u00ed nezah\u00e1jit nebo ukon\u010dit intenzivn\u00ed l\u00e9\u010dbu u&nbsp;pacient\u016f s\u00a0vysoce nep\u0159\u00edznivou progn\u00f3zou kvality budouc\u00edho \u017eivota (HRQoL- Health Related Quality of Life) a&nbsp;naopak alokovat dostupn\u00e9 mo\u017enosti v\u016f\u010di pacient\u016fm s\u00a0p\u0159\u00edzniv\u011bj\u0161\u00ed progn\u00f3zou p\u0159e\u017eit\u00ed. Tato rozhodnut\u00ed jsou pro l\u00e9ka\u0159e \u010dasto velmi obt\u00ed\u017en\u00e1 \u2013 vy\u017eaduj\u00ed p\u0159esn\u011b zd\u016fvodn\u011bnou prioritizaci \/ up\u0159ednost\u0148ov\u00e1n\u00ed, kter\u00e9 nez\u00e1vis\u00ed na&nbsp;rozhodov\u00e1n\u00ed rodiny, z\u00e1konn\u00fdch z\u00e1stupc\u016f nebo na&nbsp;specifick\u00e9 n\u00e1bo\u017eensk\u00e9 v\u00ed\u0159e. Rozhodnut\u00ed z\u00e1vis\u00ed na&nbsp;aktu\u00e1ln\u00edm stavu dostupn\u00fdch zdroj\u016f.<\/p>\n<p><strong>Z\u00e1sady <\/strong><\/p>\n<ul>\n<li>Rozhodnut\u00ed je za dan\u00fdch podm\u00ednek racion\u00e1ln\u00ed<\/li>\n<li>Je zalo\u017eeno na&nbsp;z\u00e1sadn\u00edch klinick\u00fdch \u00fadaj\u00edch a&nbsp;n\u00e1lezech, na&nbsp;odborn\u00fdch poznatc\u00edch\na&nbsp;n\u00e1zorech<\/li>\n<li>Je podlo\u017eeno koheretn\u00edmi etick\u00fdmi z\u00e1sadami a&nbsp;jejich zd\u016fvodn\u011bn\u00edm<\/li>\n<li>Pokud lze, odpov\u00edd\u00e1 p\u0159edem vysloven\u00fdm rozhodnut\u00edm pacienta, i&nbsp;kdy\u017e tato mohou b\u00fdt p\u0159i v\u00fdvoji klinick\u00e9ho stavu a&nbsp;situace zm\u011bn\u011bna<\/li>\n<li>Rozhodnut\u00ed je konzistentn\u00ed, vyj\u00e1d\u0159eno konsenzu\u00e1ln\u011b cel\u00fdm konzili\u00e1rn\u00edm t\u00fdmem<\/li>\n<li>Je vyj\u00e1d\u0159eno otev\u0159en\u011b a&nbsp;transparentn\u011b<\/li>\n<li>Je modifikovateln\u00e9 podle v\u00fdvoje a&nbsp;situace<\/li>\n<\/ul>\n<p>I&nbsp;p\u0159i rozhodnut\u00ed nezah\u00e1jit nebo ukon\u010dit dosud pod\u00e1vanou intenzivn\u00ed terapii a&nbsp;p\u00e9\u010di, pokra\u010duje empatick\u00e1 symptomaticky orientovan\u00e1 paliativn\u00ed p\u00e9\u010de. Je velmi vhodn\u00e9 k\u00a0t\u011bmto rozhodov\u00e1n\u00edm p\u0159ivz\u00edt \u010dleny etick\u00e9 komise dan\u00e9ho zdravotnick\u00e9ho za\u0159\u00edzen\u00ed a&nbsp;odborn\u00edky, schopn\u00e9 poskytnout psychologickou podporu pot\u0159ebn\u00fdm.<\/p>\n<p><strong>Tri\u00e1\u017e<\/strong><\/p>\n<p><strong>\u00a0<\/strong>P\u0159i tri\u00e1\u017ei \u2013 civiln\u00ed tri\u00e1\u017ei se jedn\u00e1 o&nbsp;okam\u017eit\u00e9 rozhodnut\u00ed o&nbsp;prioritizaci, a&nbsp;to v\u00a0situaci, kdy dostupn\u00e9 prost\u0159edky neposta\u010duj\u00ed k\u00a0realizaci optim\u00e1ln\u00ed terapie pro dan\u00e9 pacienty s\u00a0akutn\u00edm ohro\u017een\u00edm \u017eivota a&nbsp;za\u00a0aktu\u00e1ln\u00edho rizika v\u00fdznamn\u00e9ho zhor\u0161en\u00ed zdravotn\u00edho stavu. V\u0161em je nicm\u00e9n\u011b t\u0159eba poskytnout optim\u00e1ln\u00ed symptomatickou \u00falevu, komfortn\u00ed p\u00e9\u010di.<\/p>\n<p>Prioritn\u011b jsou k\u00a0n\u00e1le\u017eit\u00e9 i&nbsp;ke&nbsp;kauz\u00e1ln\u00ed terapii indikov\u00e1ni ti pacienti, jejich\u017e progn\u00f3za p\u0159\u00edzniv\u00e9ho p\u0159e\u017eit\u00ed je nejdel\u0161\u00ed. Celkov\u00fd p\u0159\u00ednos je v\u00a0p\u0159\u00edzniv\u00e9m ovlivn\u011bn\u00ed mortality a&nbsp;morbidity.<\/p>\n<p>V\u00a0p\u0159\u00edpad\u011b pandemick\u00e9 infekce COVID-19 je nejm\u00e9n\u011b p\u0159\u00edzniv\u00e1 progn\u00f3za p\u0159e\u017eit\u00ed v\u00a0kategorii nejstar\u0161\u00edch a&nbsp;polymorbidn\u00edch pacient\u016f. V\u00a0tri\u00e1\u017ei se nelze nicm\u00e9n\u011b vymezit pouze pokro\u010dil\u00fdm v\u011bkem ale ani infekce COVID &#8211; 19 nen\u00ed samostatnou prioritou pro plnou a&nbsp;n\u00e1le\u017eitou l\u00e9\u010dbu.<\/p>\n<p>Nejobt\u00ed\u017en\u011bj\u0161\u00ed je rozhodov\u00e1n\u00ed o&nbsp;v\u00fdkonech a&nbsp;terapii, kter\u00e9 mohou sn\u00ed\u017eit mortalitu jednotlivce, ale aktu\u00e1ln\u00ed nedostatek zdroj\u016f povede ke&nbsp;zhor\u0161en\u00ed v\u00fdsledk\u016f u&nbsp;v\u011bt\u0161\u00edho po\u010dtu posti\u017een\u00fdch pacient\u016f ve&nbsp;srovnateln\u00e9m stavu a&nbsp;se srovnatelnou progn\u00f3zou.<\/p>\n<p>V\u00a0tri\u00e1\u017ei v\u00fdznamn\u011b rozhoduj\u00ed:<\/p>\n<ul>\n<li>Nutnost neodkladn\u00e9 kardiopulmon\u00e1ln\u00ed resuscitace, nutnost pokra\u010duj\u00edc\u00ed intenzivn\u00ed p\u00e9\u010de vysok\u00e9 \u00farovn\u011b s\u00a0nejist\u00fdm v\u00fdsledkem<\/li>\n<li>Celkov\u00fd p\u0159edchoz\u00ed stav a&nbsp;snadno prolomiteln\u00e1 k\u0159ehkost pacienta, jeho nedostate\u010dn\u00e1 reakce na&nbsp;\u00favodn\u00ed z\u00e1chrann\u00fd postup a&nbsp;opat\u0159en\u00ed.<\/li>\n<\/ul>\n<p><strong>Nezah\u00e1jen\u00ed, ukon\u010den\u00ed intenzivn\u00ed terapie, p\u0159echod na&nbsp;paliativn\u00ed, komfortn\u00ed p\u00e9\u010di<\/strong><\/p>\n<p>Rozhodnut\u00ed z\u00e1vis\u00ed v\u00a0tomto sm\u011bru na&nbsp;v\u00fd\u0161e uveden\u00e9 \u00favodn\u00ed tri\u00e1\u017ei a&nbsp;na&nbsp;stupni p\u0159\u00edzniv\u00e9, pop\u0159.&nbsp;\u017e\u00e1dn\u00e9 pozitivn\u00ed reakci na&nbsp;\u00favodn\u00ed opat\u0159en\u00ed.<\/p>\n<p><strong>P\u0159\u00edm\u00e1 a&nbsp;nep\u0159\u00edm\u00e1 diskriminace p\u0159i rozhodnut\u00edch o&nbsp;prioritizaci<\/strong><\/p>\n<p>Volba pokra\u010duj\u00edc\u00ed intenzity zah\u00e1jen\u00e9 terapie se odv\u00edj\u00ed od&nbsp;\u00favodn\u00ed reakce pacienta na&nbsp;z\u00e1sadn\u00ed\na&nbsp;neodkladn\u00e1 opat\u0159en\u00ed. P\u0159\u00edm\u00e1 diskriminace je i&nbsp;legislativn\u011b hodnocena jako nep\u0159ijateln\u00e1, pokud se za\u0161ti\u0165uje pouze pokro\u010dil\u00fdm v\u011bkem nebo nesob\u011bsta\u010dnost\u00ed \u2013 disabilitou. Nep\u0159\u00edm\u00e1 diskriminace znamen\u00e1 p\u0159\u00edli\u0161 un\u00e1hlen\u00e9 negativn\u00ed rozhodnut\u00ed p\u0159ed dostate\u010dn\u00fdm zji\u0161t\u011bn\u00edm reakce pacienta.<\/p>\n<p><strong>Zaji\u0161t\u011bn\u00ed z\u00e1kladn\u00edch slu\u017eeb<\/strong><\/p>\n<p>M\u00e1 za c\u00edl:<\/p>\n<ul>\n<li>Nedovolit zhroucen\u00ed soci\u00e1ln\u00edho syst\u00e9mu<\/li>\n<li>Nedovolit zhroucen\u00ed syst\u00e9mu zdravotn\u00ed p\u00e9\u010de<\/li>\n<li>Udr\u017een\u00ed integrity soci\u00e1ln\u00ed infrastruktury<\/li>\n<li>Zabr\u00e1nit ekonomick\u00fdm ztr\u00e1t\u00e1m<\/li>\n<\/ul>\n<p>Tyto po\u017eadavky s\u00a0jejich konkr\u00e9tn\u00edm vyjmenov\u00e1n\u00edm a&nbsp;realizac\u00ed se nedot\u00fdkaj\u00ed p\u0159\u00edmo povinnost\u00ed l\u00e9ka\u0159\u016f a&nbsp;dal\u0161\u00edch zdravotn\u00edk\u016f.<\/p>\n<p><strong>Rizika pro zdravotn\u00edky \u2013 jejich prevence a&nbsp;zvl\u00e1dnut\u00ed<\/strong><\/p>\n<p>Zdravotn\u00edci jsou v\u00a0prvn\u00ed linii kontaktu a&nbsp;jsou tud\u00ed\u017e s\u00a0riziky p\u0159\u00edmo konfrontov\u00e1ni, jsou nejzraniteln\u011bj\u0161\u00ed. Z\u00e1kladn\u00ed z\u00e1sadou a&nbsp;etickou i&nbsp;pr\u00e1vn\u00ed povinnost\u00ed je jejich ochrana z\u00a0pohledu bezpe\u010dn\u00e9ho vybaven\u00ed, nasazen\u00ed, soci\u00e1ln\u00ed i&nbsp;psychologick\u00e9 podpory; to je p\u0159edev\u0161\u00edm povinnost\u00ed jejich zam\u011bstnavatel\u016f. V\u00a0\u010dasov\u011b neodkladn\u00fdch situac\u00edch je povinnost\u00ed zajistit alespo\u0148 jejich zcela z\u00e1kladn\u00ed bezpe\u010dnost a&nbsp;ochranu.<\/p>\n<p><strong>Omezen\u00ed ambulantn\u00edch slu\u017eeb<\/strong><\/p>\n<p>Zahrnuje podle situace:<\/p>\n<ul>\n<li>Omezen\u00ed nebo zru\u0161en\u00ed slu\u017eeb, aktu\u00e1ln\u011b nepodstatn\u00fdch<\/li>\n<li>Omezen\u00ed dom\u00e1c\u00edch n\u00e1v\u0161t\u011bv<\/li>\n<li>Zaveden\u00ed telefonick\u00e9 tri\u00e1\u017ee<\/li>\n<li>Zv\u00fd\u0161en\u011b vyu\u017e\u00edvat telefonick\u00e9 a&nbsp;video zdravotn\u00ed konzultace<\/li>\n<li>Zv\u00fd\u0161it e-mailov\u00fd kontakt a&nbsp;vyu\u017eit\u00ed app<\/li>\n<li>Zru\u0161it aktu\u00e1ln\u011b v\u0161echny neurgentn\u00ed v\u00fdkony \u2026 atd.<\/li>\n<\/ul>\n<p><strong>Z\u00e1sady spravedliv\u00e9ho a&nbsp;transparentn\u00edho chodu<\/strong><\/p>\n<p>Vy\u017eaduj\u00ed \u010dastou informovanost, zapojen\u00ed konzultant\u016f ke&nbsp;konsenzu\u00e1ln\u00edm rozhodov\u00e1n\u00edm\na&nbsp;k\u00a0formulaci rozhodnut\u00ed, zapojen\u00ed etick\u00fdch komis\u00ed a&nbsp;jejich \u010dlen\u016f do&nbsp;hodnot\u00edc\u00edch\na&nbsp;rozhodovac\u00edch proces\u016f.<\/p>\n<p><strong>Masm\u00e9dia <\/strong>maj\u00ed za \u00fakol vystupovat v\u00a0pozitivn\u00edch rol\u00edch, profesion\u00e1ln\u011b p\u0159edch\u00e1zet desinformac\u00edm, panick\u00fdm zpr\u00e1v\u00e1m, riziku vzniku chaosu a&nbsp;projev\u016fm ob\u010dansk\u00e9 neposlu\u0161nosti.<\/p>\n<p><strong>Medic\u00ednskopr\u00e1vn\u00ed aspekty<\/strong><\/p>\n<p><strong>\u00a0<\/strong>Zdravotnick\u00fd person\u00e1l je vystaven stresu, dlouh\u00fdm a&nbsp;n\u00e1ro\u010dn\u00fdm sm\u011bn\u00e1m, \u00fazkosti p\u0159i vn\u00edm\u00e1n\u00ed hrozby pro zdrav\u00ed vlastn\u00ed i&nbsp;sv\u00e9 rodiny; strachu p\u0159i prov\u00e1d\u011bn\u00ed postup\u016f, s\u00a0nimi\u017e nejsou uveden\u00ed zdravotn\u00edci, studenti medic\u00edny a&nbsp;o\u0161et\u0159ovatelstv\u00ed pravideln\u011b obezn\u00e1meni ani teoreticky ani prakticky. Vztahuje se to na&nbsp;l\u00e9ka\u0159e i&nbsp;na&nbsp;sestry &#8211; d\u016fchodce v\u00a0roli pom\u00e1haj\u00edc\u00edch dobrovoln\u00edk\u016f v\u00a0extr\u00e9mn\u011b slo\u017eit\u00fdch a&nbsp;omezen\u00fdch person\u00e1ln\u00edch podm\u00ednk\u00e1ch.<\/p>\n<p>Medic\u00ednskopr\u00e1vn\u011b se v\u017edy hodnot\u00ed specifick\u00e9 faktory dan\u00e9ho p\u0159\u00edpadu ve&nbsp;vztahu k\u00a0aktu\u00e1ln\u00ed situaci, v\u00a0n\u00ed\u017e se p\u0159\u00edpad realizoval &#8211; odehr\u00e1val.<\/p>\n<p>V\u00a0potaz se bere i&nbsp;vybaven\u00ed, stres, \u00fanava, zodpov\u011bdn\u00e9 individu\u00e1ln\u011b rozhodov\u00e1n\u00ed l\u00e9ka\u0159e v\u00a0dan\u00e9 kondi\u010dn\u011b, odborn\u011b i&nbsp;eticky exponovan\u00e9 dob\u011b a&nbsp;v\u00a0konkr\u00e9tn\u011b posuzovan\u00e9 z\u00e1le\u017eitosti.<\/p>\n<p>Literatura:\nCOVID-19 \u2013 ethical issues. A&nbsp;guidance note. In:\u00a0<em>BMA<\/em>\u00a0[online]. 2020, April 9 [cit. 2020-04-13]. Dostupn\u00e9 z: <a href=\"https:\/\/www.bma.org.uk\/media\/2226\/bma-covid-19-ethics-guidance.pdf\">https:\/\/www.bma.org.uk\/media\/2226\/bma-covid-19-ethics-guidance.pdf<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> Pandemie; COVID \u2013 19; Etick\u00e9 aspekty a&nbsp;z\u00e1sady\n<strong>Key words:<\/strong> Pandemic; COVID \u2013 19; Ethical tissues and principles<\/p>\n<p>        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_da4f-2363\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_da4f-2363\" data-parent=\"#collapse_d30c-b67f\" href=\"#citem_da4f-2363\">Volba optim\u00e1ln\u00ed nutrice u pacient\u016f se z\u00e1va\u017en\u00fdm pr\u016fb\u011bhem infekce COVID-19<\/a>        <\/h4>    <\/div>    <div id=\"citem_da4f-2363\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_da4f-2363\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/Nutrice_COVID-19.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<hr \/>\n<p>ASPEN 20 virtu\u00e1ln\u00ed konference pouk\u00e1zala na&nbsp;nov\u00e9 v\u00fdzvy v\u00a0nutrici u&nbsp;z\u00e1va\u017en\u00fdch COVID-19 pacient\u016f. Maj\u00ed za c\u00edl respektovat specificky volbu i&nbsp;zp\u016fsoby pod\u00e1n\u00ed um\u011bl\u00e9 v\u00fd\u017eivy u&nbsp;uveden\u00fdch pacient\u016f. Nutri\u010dn\u00ed specialist\u00e9 z\u00a0univerzity v\u00a0Oregonu &#8211; chirurg Prof. R.&nbsp;Martindale a&nbsp;PharmDr. J Boullata \u2013 klinick\u00fd farmakolog z\u00a0univerzity ve&nbsp;Philadelphii, odborn\u00e9 spole\u010dnosti ASPEN\na&nbsp;SCCM vydaj\u00ed ji\u017e v\u00a0povelikono\u010dn\u00edm t\u00fddnu spole\u010dn\u00e9 doporu\u010den\u00ed. Je zalo\u017eeno p\u0159edev\u0161\u00edm na&nbsp;zku\u0161enostech z\u00a0jin\u00fdch virov\u00fdch onemocn\u011bn\u00ed v\u010detn\u011b ch\u0159ipky, na&nbsp;2015 Cochrane Review, proto\u017ee v\u00a0sou\u010dasn\u00e9 krizov\u00e9 a&nbsp;\u010dasov\u011b velmi nal\u00e9hav\u00e9 dob\u011b nelze je\u0161t\u011b hodnotit teprve zahajovan\u00e9 klinick\u00e9 studie s\u00a0neobs\u00e1hl\u00fdmi soubory.<\/p>\n<p>Volba a&nbsp;zp\u016fsoby pod\u00e1n\u00ed zohled\u0148uj\u00ed nejen pot\u0159eby a&nbsp;optimum pro pacienta, ale sou\u010dasn\u011b velmi zd\u016fraz\u0148uj\u00ed i&nbsp;co nejjednodu\u0161\u0161\u00ed pod\u00e1v\u00e1n\u00ed s\u00a0minim\u00e1ln\u00edm rizikem pro o\u0161et\u0159uj\u00edc\u00ed zdravotn\u00edky.<\/p>\n<p>V\u00a0prvn\u00edm po\u0159ad\u00ed je enter\u00e1ln\u00ed nutrice gastrickou sondou. Tato z\u00e1sada je spole\u010dn\u00e1 i&nbsp;s\u00a0dal\u0161\u00edmi kategoriemi pacient\u016f. Pouze p\u0159i jej\u00ed intoleranci nebo p\u0159i indikaci podat speci\u00e1ln\u00ed dopl\u0148ky\nse up\u0159ednostn\u00ed nebo alespo\u0148 p\u0159ipoj\u00ed parenter\u00e1ln\u00ed \u2013 nitro\u017eiln\u00ed, infuzn\u00ed cesta.<\/p>\n<p>Uveden\u00fd zp\u016fsob je pro o\u0161et\u0159uj\u00edc\u00ed zdravotn\u00edky, a&nbsp;to \u010dasto pouze instruovan\u00e9, nejbezpe\u010dn\u011bj\u0161\u00ed, rychle a&nbsp;snadno provediteln\u00fd.<\/p>\n<p>Jako volba formule parenter\u00e1ln\u00ed nutrice infuzn\u00ed cestou se doporu\u010duje emulze lipid\u016f, kter\u00e9 obsahuj\u00ed jen velmi omezen\u011b proz\u00e1n\u011btliv\u011b \u00fa\u010dinn\u00fd sojov\u00fd olej. V\u011bt\u0161\u00ed je pod\u00edl ryb\u00edho a&nbsp;olivov\u00e9ho oleje a&nbsp;triacylglycerol\u016f st\u0159edn\u00edho \u0159et\u011bzce v\u00a0ryb\u00edm oleji.<\/p>\n<p>Ryb\u00ed oleje vytv\u00e1\u0159ej\u00ed speci\u00e1ln\u00ed modula\u010dn\u011b \u00fa\u010dinn\u00e9 metabolity SPMs (Specialized Pro &#8211; resolving Mediators) z\u00a0\u03c9-3 mastn\u00fdch kyselin, eikosapentanoidn\u00ed kyseliny a&nbsp;docosahexanoidn\u00ed kyseliny. Stimuluj\u00ed \u00fastup z\u00e1n\u011btliv\u00fdch proces\u016f, co\u017e prok\u00e1zaly ji\u017e v\u00a0minulosti studie p\u0159i ch\u0159ipce a&nbsp;p\u0159i dal\u0161\u00edch virov\u00fdch onemocn\u011bn\u00edch (<em>Baillie, Digard 2013<\/em>). Nen\u00ed vylou\u010deno, \u017ee&nbsp;by mohly podpo\u0159it\ni&nbsp;clearance vir\u016f COVID-19.<\/p>\n<p>P\u0159esto je t\u0159eba kontrolovat lipemie pacient\u016f a&nbsp;to zejm\u00e9na p\u0159i rychl\u00e9m eskaluj\u00edc\u00edm n\u00e1stupu kritick\u00e9 COVID-19 infekce do&nbsp;12-24 hodin. Hladiny lipid\u016f v\u00a0s\u00e9ru inklinuj\u00ed k\u00a0velmi rychl\u00e9mu\na&nbsp;podstatn\u00e9mu zv\u00fd\u0161en\u00ed.<\/p>\n<p>Zv\u00fd\u0161en\u00e1 opatrnost a\u017e kontraindikace se vztahuje i&nbsp;na&nbsp;infuzn\u00ed pod\u00e1v\u00e1n\u00ed propofolu \u2013 jeho emulze p\u016fsob\u00ed proz\u00e1n\u011btliv\u011b.<\/p>\n<p>Zna\u010dn\u00fd v\u00fdznam se p\u0159ipisuje i&nbsp;pod\u00e1v\u00e1n\u00ed probiotik, p\u0159\u00ednosn\u00fdch i&nbsp;u&nbsp;jin\u00fdch virov\u00fdch onemocn\u011bn\u00ed. \u00da\u010dinky prok\u00e1zala 2015 Cochrane Review (<em>Hao et al 2015<\/em>). O&nbsp;50&nbsp;% se sn\u00ed\u017eil v\u00fdskyt infekc\u00ed horn\u00edch d\u00fdchac\u00edch cest a&nbsp;jejich epizody se zkr\u00e1tily o&nbsp;dva dny.<\/p>\n<p>Zat\u00edm vych\u00e1zej\u00ed na\u0161e poznatky ale p\u0159edev\u0161\u00edm ze studi\u00ed s\u00a0jin\u00fdmi viry \u2013 obez\u0159etnost a&nbsp;sledov\u00e1n\u00ed jsou nutn\u00e9.<\/p>\n<p><em>\u00a0<\/em><\/p>\n<p>Literatura:<\/p>\n<p>PEEPLES, Lynne. Optimizing Nutrition for Critically Ill COVID-19 Patients.\u00a0<em>Anesthesiology News<\/em>\u00a0[online]. 2020, April 10 [cit. 2020-04-13]. Dostupn\u00e9 z: <a href=\"https:\/\/www.anesthesiologynews.com\/Online-First\/Article\/04-20\/Optimizing-Nutrition-for-Critically-Ill-COVID-19-Patients\/57850\">https:\/\/www.anesthesiologynews.com\/Online-First\/Article\/04-20\/Optimizing-Nutrition-for-Critically-Ill-COVID-19-Patients\/57850<\/a><\/p>\n<p><em>\u00a0<\/em><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> COVID -19; Nutrition\n<strong>Key words:<\/strong> COVID- 19; Nutrice<\/p>\n<p>        <\/p><\/div>    <\/div><\/div><div class=\"panel panel-default\">    <div class=\"panel-heading\" role=\"tab\" id=\"heading_citem_ab0d-3633\">        <h4 class=\"panel-title\"><a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\" aria-controls=\"heading_citem_ab0d-3633\" data-parent=\"#collapse_73ca-a90b\" href=\"#citem_ab0d-3633\">COVID-19 \u2013 Guidelines - metodick\u00e9 doporu\u010den\u00ed \u2013 NOV\u00c9<\/a>        <\/h4>    <\/div>    <div id=\"citem_ab0d-3633\" class=\"panel-collapse collapse\" role=\"tabpanel\" aria-labelledby=\"heading_citem_ab0d-3633\">        <div class=\"panel-body\">\n<p><a href=\"https:\/\/nlk.cz\/wp-content\/uploads\/2020\/03\/COVID-19-nove-quidelines-ERC.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span class=\"sr-only\">PDF<\/span>\r\n<span class=\"fa fa-file-pdf-o\" aria-hidden=\"true\"><\/span> Pln\u00fd text v&nbsp;PDF ke&nbsp;sta\u017een\u00ed<\/a><\/p>\n<p><!--more--><\/p>\n<p><strong>Sekce 1<\/strong><\/p>\n<p>WHO \u2013 SZO vyhl\u00e1sila infekci COVID \u2013 19 a&nbsp;jej\u00ed glob\u00e1ln\u00ed postup za pandemii s\u00a0vysokou kontagiozitou; v\u00a080&nbsp;% je pr\u016fb\u011bh m\u00edrn\u00fd, v\u00a015&nbsp;% st\u0159edn\u011b z\u00e1va\u017en\u00fd, v\u00a05&nbsp;% je pr\u016fb\u011bh kritick\u00fd\na&nbsp;vy\u017eaduje intenzivn\u00ed p\u00e9\u010di. Smrtnost je 3,1&nbsp;%; \u010d\u00ednsk\u00e9 prameny uv\u00e1d\u011bj\u00ed jako bezprost\u0159edn\u00ed p\u0159\u00ed\u010dinu srde\u010dn\u00ed z\u00e1stavu v\u00a087,5&nbsp;% p\u0159\u00edpad\u016f: asystolie \u2013 89,7 %, PEA 4,4&nbsp;%; VF\/pVT \u2013 5,9&nbsp;%. Dysrytmie jsou p\u0159\u00edtomny v\u00a016,7 %, akutn\u00ed kardi\u00e1ln\u00ed posti\u017een\u00ed popisov\u00e1no v\u00a07,2&nbsp;%.<\/p>\n<p>Mezi nezvykl\u00fdmi projevy \u2013 p\u0159\u00ed\u010dinami se cituje zhor\u0161uj\u00edc\u00ed se syndrom dlouh\u00e9ho QT,\na&nbsp;to po hydroxychinolonu, azithromycinu, z\u00a0postupuj\u00edc\u00ed ischemie.<\/p>\n<p><strong>Rizika pro zachr\u00e1nce, doprov\u00e1zej\u00edc\u00ed kardiopulmon\u00e1ln\u00ed resuscitaci<\/strong><\/p>\n<p><strong>P\u0159enos<\/strong> infek\u010dn\u00edho aerosolu \u2013 kap\u00e9nek z\u00a0d\u00fdchac\u00edch cest pacienta inhalac\u00ed zachr\u00e1ncem, p\u0159\u00edm\u00fd p\u0159enos z\u00a0kontaminovan\u00fdch povrch\u016f.<\/p>\n<p><strong>Ochrann\u00e9 vybaven\u00ed:<\/strong><\/p>\n<ul>\n<li>Ochrana p\u0159ed<strong> kap\u00e9nkami<\/strong>: rukavice, z\u00e1st\u011bry, chirurgick\u00e9 masky<\/li>\n<li>Ochrana p\u0159ed <strong>aerosolem<\/strong>: rukavice, pl\u00e1\u0161t\u011b s\u00a0dlouh\u00fdmi ruk\u00e1vy, speci\u00e1ln\u00ed br\u00fdle, \u0161t\u00edty FFP3, n\u00e1hradn\u011b N95<\/li>\n<\/ul>\n<p><strong>Informace ILCOR<\/strong> (International Liaison Committee on Resuscitation)<\/p>\n<p>Dosud je nedostatek exaktn\u00edch a&nbsp;robustn\u00edch studi\u00ed na&nbsp;t\u00e9ma konkr\u00e9tn\u00edch rizik.<\/p>\n<p>Pro KPR jsou na&nbsp;z\u00e1klad\u011b poznatk\u016f p\u0159ijata n\u00e1sleduj\u00edc\u00ed doporu\u010den\u00ed:<\/p>\n<ul>\n<li>Komprese vyvol\u00e1vaj\u00ed aerosol &#8211; zd\u016fvodn\u011bn\u00ed zat\u00edm slab\u00e9<\/li>\n<li>Laici \u2013 vyz\u00fdv\u00e1ni pouze ke&nbsp;kompres\u00edm a&nbsp;u\u017eit\u00ed AED \u2013 sni\u017euje riziko<\/li>\n<li>Laici p\u0159i KPR d\u011bt\u00ed: mo\u017eno p\u0159ipojit um\u011bl\u00e9 d\u00fdch\u00e1n\u00ed \u2013 riziko je klinicky mo\u017en\u00e9, ale z\u0159ejm\u011b n\u00edzk\u00e9<\/li>\n<li>Profesion\u00e1ln\u00ed zdravotn\u00edci: v\u017edy u\u017e\u00edt PPE p\u0159ed rizikem z\u00a0aerosolu<\/li>\n<li>AED u\u017e\u00edt, pokud je p\u0159\u00ednos vy\u0161\u0161\u00ed ne\u017e riziko \u2013 zd\u016fvodn\u011bn\u00ed je platn\u00e9<\/li>\n<\/ul>\n<p><strong>Sekce 2\n<\/strong><strong>Dosp\u011bl\u00ed \u2013 BLS<\/strong><\/p>\n<p>V\u00fdsledky infekc\u00ed COVID- 19 jsou nyn\u00ed v\u00a0Evrop\u011b r\u016fznorod\u00e9 a&nbsp;rozvrstveny i&nbsp;podle v\u011bkov\u00e9ho rozlo\u017een\u00ed, lok\u00e1ln\u00ed rizika jsou odstup\u0148ov\u00e1na; ERC jako spole\u010dn\u00e9 momenty v\u00a0dan\u00e9 dob\u011b uv\u00e1d\u00ed\na&nbsp;doporu\u010duje:<\/p>\n<p><strong>Lai\u010dt\u00ed sv\u011bdci a&nbsp;zachr\u00e1nci<\/strong><\/p>\n<ul>\n<li>Diagn\u00f3za srde\u010dn\u00ed z\u00e1stavy: jedinec je n\u00e1hle neosloviteln\u00fd, ned\u00fdch\u00e1 norm\u00e1ln\u011b<\/li>\n<li>Oslovitelnost se zji\u0161\u0165uje r\u00e1zn\u00fdm zat\u0159esen\u00edm a&nbsp;hlasit\u00fdm zavol\u00e1n\u00edm<\/li>\n<li>Pokud je d\u00fdch\u00e1n\u00ed na&nbsp;pohled zachov\u00e1no, neotv\u00edr\u00e1me pacientovi \u00fasta, nep\u0159ibli\u017eujeme se sv\u00fdm obli\u010dejem k\u00a0jeho tv\u00e1\u0159i<\/li>\n<li>Zavol\u00e1me pomoc mobilem, hlasit\u00fdm zavol\u00e1n\u00edm nejbli\u017e\u0161\u00edho sv\u011bdka &#8211; na&nbsp;t\u00eds\u0148ovou linku s\u00a0ohl\u00e1\u0161en\u00edm \u201eneosloviteln\u00fd, ned\u00fdch\u00e1 norm\u00e1ln\u011b\u201c<\/li>\n<li>TANR instrukt\u00e1\u017e v\u00a0mobilu d\u00e1me nahlas, odpov\u00edd\u00e1me pohotov\u011b na&nbsp;dotazy\na&nbsp;pracujeme podle instrukc\u00ed<\/li>\n<li>P\u0159ekryjeme pacientovi nos a&nbsp;\u00fasta textili\u00ed p\u0159ed zah\u00e1jen\u00edm kompres\u00ed a&nbsp;p\u0159ed AED defibrilac\u00ed<\/li>\n<li>Po ukon\u010den\u00ed KPR si laici pe\u010dliv\u011b omyj\u00ed ruce v\u00a0alkoholick\u00e9m, pop\u0159.&nbsp;m\u00fddlov\u00e9m roztoku a&nbsp;o\u0161et\u0159\u00ed si je podle mo\u017enost\u00ed dezinfek\u010dn\u00edm gelem \u2026 a&nbsp;ohl\u00e1s\u00ed sv\u016fj kontakt<\/li>\n<\/ul>\n<p><strong>TANR postup a&nbsp;rady u&nbsp;akutn\u00edch stav\u016f a&nbsp;srde\u010dn\u00ed z\u00e1stavy &#8211; u&nbsp;suspektn\u00edch nebo COVID-19 pozitivn\u00edch jedinc\u016f<\/strong><\/p>\n<ul>\n<li>Netr\u00e9novan\u00ed laici prov\u00e1d\u011bj\u00ed pouze nep\u0159\u00edmou srde\u010dn\u00ed mas\u00e1\u017e bez um\u011bl\u00e9ho d\u00fdch\u00e1n\u00ed<\/li>\n<li>Oper\u00e1tor uvede AED dostupn\u00fd z\u00a0nejbli\u017e\u0161\u00edho okol\u00ed, kter\u00fd je t\u0159eba \u2013 mo\u017eno pohotov\u011b don\u00e9st<\/li>\n<li>Pos\u00e1dka na&nbsp;v\u00fdjezdu je ji\u017e p\u0159i v\u00fdzv\u011b informov\u00e1na o&nbsp;podez\u0159en\u00ed, aby se mohla p\u0159ipravit\na&nbsp;n\u00e1le\u017eit\u011b chr\u00e1nit<\/li>\n<li>Netr\u00e9novan\u00ed laici i&nbsp;dal\u0161\u00ed zachr\u00e1nci bez pat\u0159i\u010dn\u00e9ho vybaven\u00ed pouze u\u017eij\u00ed AED bez nep\u0159\u00edm\u00e9 mas\u00e1\u017ee u&nbsp;suspektn\u00edch i&nbsp;pozitivn\u00edch resuscitovan\u00fdch<\/li>\n<\/ul>\n<p><strong>Postup zdravotn\u00edk\u016f p\u0159i podez\u0159en\u00ed a&nbsp;p\u0159i pozitivit\u011b COVID \u2013 19<\/strong><\/p>\n<ul>\n<li>Postupy jsou vyhrazeny jen instruovan\u00fdm t\u00fdm\u016fm a&nbsp;vybaven\u00fdm ochrann\u00fdmi prost\u0159edky<\/li>\n<li>P\u0159i AED u\u017eit\u00ed posta\u010duje pouze z\u00e1kladn\u00ed PPE \u2013 viz v\u00fd\u0161e<\/li>\n<li>srde\u010dn\u00ed z\u00e1stavy = nep\u0159\u00edtomnost zn\u00e1mek \u017eivota a&nbsp;norm\u00e1ln\u00edho d\u00fdch\u00e1n\u00ed<\/li>\n<li>V\u017edy se chr\u00e1nit u\u017eit\u00edm PPE p\u0159i kompres\u00edch, p\u0159i zaji\u0161\u0165ov\u00e1n\u00ed d\u00fdchac\u00edch cest i&nbsp;p\u0159i um\u011bl\u00e9 ventilaci<\/li>\n<li>\u010casov\u00fd harmonogram = 30&nbsp;:&nbsp;2 s\u00a0pauzou; b\u011bhem n\u00ed zku\u0161en\u00ed zachr\u00e1nci k\u00a0um\u011bl\u00e9mu d\u00fdch\u00e1n\u00ed pou\u017eij\u00ed obli\u010dejovou masku + d\u00fdchac\u00ed vak + p\u0159\u00edvod kysl\u00edku; nezku\u0161en\u00ed d\u00e1le pokra\u010duj\u00ed bez um\u011bl\u00e9ho d\u00fdch\u00e1n\u00ed, jen p\u0159ipoj\u00ed\u00a0p\u0159\u00edvod kysl\u00edku obli\u010dejovou maskou<\/li>\n<li>Obli\u010dejov\u00e1 maska se p\u0159idr\u017euje t\u011bsn\u011b ob\u011bma rukama, tak\u017ee nutno pracovat ve&nbsp;dvou \u2013 druh\u00e1 osoba stla\u010d\u00ed d\u00fdchac\u00ed vak v\u00a0pauze mezi dal\u0161\u00edmi 30 kompresemi<\/li>\n<li>V\u017edy se u\u017eije HEPA filtr<\/li>\n<li>Dal\u0161\u00ed postup podle doporu\u010den\u00ed AED<\/li>\n<\/ul>\n<p><strong>Sekce 3\n<\/strong><strong>Dosp\u011bl\u00ed \u2013 ALS<\/strong><\/p>\n<p><strong>Z\u00e1kladn\u00ed z\u00e1sada vy\u017eaduje n\u00e1sleduj\u00edc\u00ed po\u0159ad\u00ed ochrany a&nbsp;prevence: <\/strong><\/p>\n<ol>\n<li>j\u00e1; 2.&nbsp;kolegov\u00e9 + aktivn\u00ed sv\u011bdkov\u00e9 + zachr\u00e1nci, 3.&nbsp;pacient<\/li>\n<\/ol>\n<p><strong>IHCA<\/strong><\/p>\n<p><strong>V\u010das identifikace<\/strong> COVID-19, a&nbsp;to ji\u017e p\u0159i varovn\u00fdch zn\u00e1mk\u00e1ch, sv\u011bd\u010d\u00edc\u00edch o&nbsp;zhor\u0161ov\u00e1n\u00ed celkov\u00e9ho stavu + <strong>p\u0159\u00edprava<\/strong> preventivn\u00edch \u2013 ochrann\u00fdch opat\u0159en\u00ed pro p\u0159\u00edpad z\u00e1stavy srde\u010dn\u00ed v\u00a0nemocnici<\/p>\n<p>P\u0159i celkov\u00e9 beznad\u011bjn\u00e9 progn\u00f3ze <strong>v<\/strong><strong>\u010das rozhodnut\u00ed o&nbsp;postupu <\/strong>a&nbsp;informace t\u00fdmu, event. rodiny, v\u00a0p\u0159\u00edpad\u011b mo\u017enosti pacienta (?)<\/p>\n<p>P\u0159\u00edprava a&nbsp;v\u010dasn\u00e9 <strong>u\u017eit\u00ed PPE<\/strong> (Personal Protective Equipment) a&nbsp;to i&nbsp;v&nbsp;p\u0159\u00edpadech, kdy m\u016f\u017ee znamenat lehk\u00e9 \u010dasov\u00e9 zpo\u017ed\u011bn\u00ed v&nbsp;zah\u00e1jen\u00ed \u00fakon\u016f a&nbsp;v\u00fdkon\u016f<\/p>\n<p><strong>Nep\u0159\u00edm\u00e1 mas\u00e1\u017e<\/strong> \u2013 komprese = riziko aerosolu unikaj\u00edc\u00edho z\u00a0d\u00fdchac\u00edch cest; u\u017eit\u00ed optim\u00e1ln\u011b FFP3, N95; ochrana o\u010d\u00ed, rukavice, pl\u00e1\u0161\u0165; HEPA filtr na&nbsp;v\u00fddechov\u00e9 rameno p\u0159i um\u011bl\u00e9 ventilaci<\/p>\n<p><strong>Po\u0159ad\u00ed postupu:<\/strong><\/p>\n<ul>\n<li>zdravotn\u00edci: hmatnost tepu, nikoli poslech, u\u017eit\u00ed AED ++; s\u00a0PPE zah\u00e1jit nep\u0159\u00edmou mas\u00e1\u017e; 2 x opakovat defibrilaci<\/li>\n<li>minim\u00e1ln\u00ed po\u010det asistuj\u00edc\u00edch<\/li>\n<li>v\u017edy kysl\u00edk; FiO<sub>2<\/sub> = 1,0; pom\u011br 30:2; HEPA filtr<\/li>\n<li>um\u011bl\u00e1 ventilace ve&nbsp;dvou \u2013 t\u011bsn\u011b udr\u017eovat obli\u010dejovou masku<\/li>\n<li>\u010dasov\u011b prodlou\u017een\u00e1 KPR \u2013 u\u017e\u00edt mas\u00e1\u017en\u00ed p\u0159\u00edstroj<\/li>\n<li>p\u0159i um\u011bl\u00e9 ventilaci \u2013 nerozpojovat syst\u00e9m, frekvence = 10 \/min, FiO<sub>2<\/sub> = 1,0<\/li>\n<\/ul>\n<p><strong>Prona\u010dn\u00ed poloha \u2013 specifika:<\/strong><\/p>\n<ul>\n<li>pacient v\u011bt\u0161inou intubov\u00e1n \u2013 oto\u010dit \u2013 pokud lze &#8211; supinn\u011b<\/li>\n<li>nep\u0159\u00edmou mas\u00e1\u017e mo\u017eno prov\u00e1d\u011bt i&nbsp;v\u00a0prona\u010dn\u00ed poloze \u2013 komprese zad mezi lopatkami, hloubka 5 \u2013 6 cm, frekvence 2 komprese \/ s<\/li>\n<li>\u00fa\u010dinn\u00e1 nep\u0159\u00edm\u00e1 mas\u00e1\u017e vy\u017eaduje udr\u017eet diastolick\u00fd tlak &gt; 25 mm Hg<\/li>\n<li>defibrilace v\u00a0prona\u010dn\u00ed poloze anteroposteriorn\u011b nebo biaxil\u00e1rn\u011b<\/li>\n<\/ul>\n<p><strong>OHCA<\/strong><\/p>\n<p>Viz extra doporu\u010den\u00ed; informace od&nbsp;OS ihned s&nbsp;v\u00fdzvou; na&nbsp;m\u00edst\u011b postup podle TANR, v\u010das u\u017e\u00edt preventivn\u00ed ochrann\u00e9 vybaven\u00ed ji\u017e b\u011bhem v\u00fdjezdu do&nbsp;ter\u00e9nu a&nbsp;j\u00edzdy<\/p>\n<p><strong>Sekce 4\n<\/strong><strong>D\u011bti \u2013 BLS, ALS<\/strong><\/p>\n<p><strong>\u00a0<\/strong>D\u011bti pravd\u011bpodobn\u011b onemocn\u00ed pouze lehk\u00fdmi formami a&nbsp;t\u00e9m\u011b\u0159 v\u00fdjime\u010dn\u011b. Komorbidn\u00ed d\u011bti jsou co do&nbsp;z\u00e1va\u017en\u00e9ho a\u017e kritick\u00e9ho pr\u016fb\u011bhu ji\u017e rizikov\u011bj\u0161\u00ed &#8211; a\u017e v\u00a05,2&nbsp;% a&nbsp;v\u00a00,6&nbsp;% se cituj\u00ed\ni&nbsp;p\u0159\u00edpady d\u011bt\u00ed v\u00a0kritick\u00e9m stavu.<\/p>\n<p>Z\u00e1sadn\u011b pro n\u011b plat\u00ed obecn\u00e1 filozofie metodick\u00e9ho doporu\u010den\u00ed: postupovat podle rozsahu pandemie, po\u010dtu d\u011bt\u00ed, podle lok\u00e1ln\u00edch sm\u011brnic a&nbsp;dostupn\u00fdch zdroj\u016f. Zat\u00edm jsou doporu\u010den\u00e9 postupy zalo\u017eeny p\u0159edev\u0161\u00edm na&nbsp;expert\u00edz\u00e1ch odborn\u00edk\u016f pediatr\u016f a&nbsp;jsou informativn\u00ed. P\u0159ibli\u017en\u011b 70&nbsp;% d\u011bt\u00ed p\u0159i srde\u010dn\u00ed z\u00e1stav\u011b a&nbsp;z\u00e1stav\u011b d\u00fdch\u00e1n\u00ed v\u00a0ter\u00e9nu (OHCA) je resuscitov\u00e1no zprvu rodi\u010di, nej\u010dast\u011bji v\u00a0dom\u00e1cnosti nebo v&nbsp;nejbli\u017e\u0161\u00edm okol\u00ed.<\/p>\n<p>Zdravotnick\u00fd person\u00e1l, sv\u011bdkov\u00e9 mus\u00ed b\u00fdt n\u00e1le\u017eit\u011b vybaveni. PPE jsou nutn\u00e9 pro d\u011bti pozitivn\u00ed-infek\u010dn\u00ed a&nbsp;suspektn\u00ed. Nevybaven\u00ed laici u\u017eij\u00ed maxim\u00e1ln\u011b improvizovanou ochranu\na&nbsp;maj\u00ed b\u00fdt ve&nbsp;varovn\u00fdch p\u0159\u00edpadech ji\u017e p\u0159edem jasn\u011b pou\u010deni.<\/p>\n<p>Nutn\u00e1 je p\u0159edev\u0161\u00edm v\u010dasn\u00e1 diagnostika varovn\u00fdch zn\u00e1mek v\u010d. COVID &#8211; 19 zn\u00e1mek, charakteristick\u00fdch <strong>pro d\u011bti: zm\u011bny chov\u00e1n\u00ed, zm\u011bny d\u00fdch\u00e1n\u00ed, barva k\u016f\u017ee \u2013 Paediatric Assessment Triangle.<\/strong> Resuscita\u010dn\u00ed postupy n\u00e1sleduj\u00ed neprodlen\u011b bez \u010dek\u00e1n\u00ed na&nbsp;biochemick\u00e9 v\u00fdsledky apod., proto\u017ee riziko plicn\u00edho a&nbsp;kardi\u00e1ln\u00edho posti\u017een\u00ed je re\u00e1ln\u00e9.<\/p>\n<p><strong>Postup:<\/strong><\/p>\n<ul>\n<li>Uvolnit d\u00fdchac\u00ed cesty, u\u017e\u00edt p\u0159edev\u0161\u00edm samorozp\u00ednac\u00ed d\u00fdchac\u00ed vak s\u00a0p\u0159\u00edkonem kysl\u00edku \u2013 ale bez hyperoxie; u&nbsp;suspektn\u00edch d\u011bt\u00ed jim v\u017edy nasadit obli\u010dejovou masku<\/li>\n<li>V\u010das zv\u00e1\u017eit trache\u00e1ln\u00ed intubaci a&nbsp;sv\u011b\u0159it ji nejzku\u0161en\u011bj\u0161\u00edmu; vhodn\u011bj\u0161\u00ed je videolaryngoskopie ne\u017e p\u0159\u00edm\u00e1 laryngoskopie.<\/li>\n<li>U\u017eit\u00ed supraglotick\u00e9 larynge\u00e1ln\u00ed masky je vysoce v\u00fdb\u011brov\u00e9, obecn\u011b se nedoporu\u010duje; neinvazivn\u00ed ventilace se pova\u017euje za ne\u00fa\u010dinnou, rizikovou zejm. p\u0159i ARDS, p\u0159i srde\u010dn\u00ed z\u00e1stav\u011b; vyu\u017eij\u00ed se filtry na&nbsp;HME, filtry HEPA. Zachr\u00e1nci maj\u00ed ochrann\u00e9 vybaven\u00ed p\u0159ipraveno a&nbsp;navl\u00e9knuto ji\u017e p\u0159edem p\u0159i varovn\u00fdch zn\u00e1mk\u00e1ch<\/li>\n<li>Kontroluje se vizu\u00e1ln\u011b pohyb hrudn\u00edku, epigastrium; nep\u0159ibli\u017eujeme svou tv\u00e1\u0159 k\u00a0\u00fast\u016fm a&nbsp;nosu d\u00edt\u011bte<\/li>\n<li>P\u0159i n\u00e1hl\u00e9 z\u00e1stav\u011b srde\u010dn\u00ed se prov\u00e1d\u011bj\u00ed jen komprese, jinak je riziko infekce vysok\u00e9; AED defibrilace co nejd\u0159\u00edve<\/li>\n<li>Obstrukce d\u00fdchac\u00edch cest ciz\u00edm t\u011blesem p\u0159i aspiraci \u2013 v\u011bt\u0161inou vznik\u00e1 v\u00a0rodin\u011b \u2013 postup se oproti ji\u017e v\u00a0minulosti p\u0159ijat\u00e9mu nem\u011bn\u00ed<\/li>\n<li>Je indikov\u00e1n \u010dasn\u00fd zaji\u0161t\u011bn\u00fd transport do&nbsp;centrov\u00e9 p\u00e9\u010de<\/li>\n<li>Etick\u00e9 z\u00e1sady se neli\u0161\u00ed od&nbsp;dosp\u011bl\u00fdch \u2013 viz sekce 7<\/li>\n<\/ul>\n<p><strong>Sekce 5\n<\/strong><strong>Novorozenci \u2013\u00a0 NLS\u00a0 &#8211; podpora a&nbsp;KPR<\/strong><\/p>\n<p><strong>\u00a0<\/strong>V\u00a0sou\u010dasn\u00e9 dob\u011b se zat\u00edm jev\u00ed, \u017ee&nbsp;u&nbsp;novorozenc\u016f (a&nbsp;kojenc\u016f?) je minim\u00e1ln\u00ed riziko p\u0159enosu\ni&nbsp;u&nbsp;COVID-19 pozitivn\u00edch rodi\u010dek &#8211; matek. Lze o\u010dek\u00e1vat v\u00edce p\u0159ed\u010dasn\u00fdch porod\u016f a&nbsp;c\u00edsa\u0159sk\u00fdch \u0159ez\u016f. P\u0159ipravenost t\u00fdmu na&nbsp;resuscitaci novorozence je v\u017edy z\u00a0pohledu vlastn\u00ed ochrany\ni&nbsp;ochrany novorozence bezpodm\u00edne\u010dn\u011b nutn\u00e1. Resuscita\u010dn\u00ed postupy se nem\u011bn\u00ed, pouze se zvy\u0161uje n\u00e1rok \u2013 po\u017eadavek na&nbsp;ochranu \u2013 mus\u00ed b\u00fdt formulov\u00e1ny m\u00edstn\u00edmi sm\u011brnicemi: u\u017e\u00edt filtry, odhodit vlhk\u00e9 pr\u00e1dlo a&nbsp;rou\u0161ky bezpe\u010dn\u011b, chr\u00e1nit person\u00e1l; dal\u0161\u00ed postupy v\u010d. podvazu pupe\u010dn\u00edku atd.\u00a0 se nem\u011bn\u00ed. Z\u00e1kladn\u00ed podm\u00ednkou je zachov\u00e1vat p\u0159\u00edsnou hygienu, v\u010d. zaji\u0161t\u011bn\u00ed samostatn\u00e9ho prostoru. Spole\u010dn\u00fd pobyt matky a&nbsp;d\u00edt\u011bte a&nbsp;kojen\u00ed jsou mo\u017en\u00e9, rozhodnut\u00ed je podle konkr\u00e9tn\u00edho stavu a&nbsp;situace.<\/p>\n<p>Ji\u017e p\u0159edem jsou optim\u00e1ln\u00ed komunikace ad hoc \u2013 konkr\u00e9tn\u011b a&nbsp;v\u010detn\u011b jednozna\u010dn\u00fdch instrukc\u00ed.<\/p>\n<p>Um\u011bl\u00e9 d\u00fdch\u00e1n\u00ed se u&nbsp;novorozenc\u016f prov\u00e1d\u00ed \u2013 ochrana PPE.<\/p>\n<p><strong>Sekce 6\n<\/strong><strong>V\u00fduka<\/strong><\/p>\n<p>Organizace se \u0159\u00edd\u00ed podle r\u016fzn\u00fdch \u00farovn\u00ed pandemie v\u00a0dan\u00e9 sv\u011btov\u00e9 &#8211; \u00fazemn\u00ed oblasti, podle znalost\u00ed a&nbsp;organizace zdravotnictv\u00ed.<\/p>\n<p>Z\u00e1kladn\u00ed z\u00e1sada je <strong>p\u0159esun bezpe\u010dnosti od&nbsp;pacienta k\u00a0poskytovateli;<\/strong> z\u016fst\u00e1v\u00e1 n\u00e1rok na&nbsp;\u010dasn\u00e9 zah\u00e1jen\u00ed jako p\u0159edpoklad pro trval\u00fd \u00fasp\u011bch.<\/p>\n<p>V\u00fduka zahrnuje informace o&nbsp;COVID-19, o&nbsp;non-COVID-19 pacienty, pou\u010den\u00ed o&nbsp;PPE a&nbsp;jednotliv\u00e9 \u00faseky: BLS, ILS (Immediate Life Support), ALS, NLS.<\/p>\n<p>Organizace kurz\u016f mus\u00ed spl\u0148ovat po\u017eadavky, kladen\u00e9 na&nbsp;danou epidemiologickou situaci: \u00faprava prost\u0159ed\u00ed, neinfek\u010dnost instruktor\u016f, nov\u00e9 didaktick\u00e9 programy pro instruktory, m\u00edstn\u00ed vybaven\u00ed; za\u0159azuj\u00ed se telekurzy a&nbsp;n\u00e1cvik v\u00a0mal\u00fdch skupin\u00e1ch po \u0161esti pro \u201ehands-on\u201c. Z\u00e1sadn\u011b se nedoporu\u010duje \u201eface-to-face\u201c postup s\u00a0um\u011bl\u00fdm d\u00fdch\u00e1n\u00edm krom\u011b v\u00fdjimek \u2013 nap\u0159.&nbsp;u&nbsp;d\u011bt\u00ed, novorozenc\u016f v\u00a0rodin\u011b; neu\u017e\u00edvaj\u00ed se \u0161t\u00edty.<\/p>\n<p><strong>Sekce 7\n<\/strong><strong>Etika a&nbsp;EOL rozhodov\u00e1n\u00ed<\/strong><\/p>\n<p>Obdobn\u011b v\u0161em doporu\u010den\u00edm mus\u00ed b\u00fdt t\u00e9ma, informace a&nbsp;instrukce formulov\u00e1ny podle aktu\u00e1ln\u00ed situace a&nbsp;jej\u00edch zm\u011bn, podle mezin\u00e1rodn\u00edch rozd\u00edl\u016f pandemie.<\/p>\n<p>Z\u00e1kladn\u00ed z\u00e1sady KPR z\u016fst\u00e1vaj\u00ed beze zm\u011bny, neodkladn\u00e1 resuscitace je podm\u00edne\u010dn\u00e1 indikace. Podl\u00e9h\u00e1 princip\u016f \u201ewithholding\u201c a&nbsp;withdrawing\u201c \u2013 nezah\u00e1jen\u00ed a&nbsp;ukon\u010den\u00ed &#8211; a&nbsp;to v\u00a0lok\u00e1ln\u00edm kontextu \u2013 legislativn\u00edm, kulturn\u00edm, organiza\u010dn\u00edm.<\/p>\n<p>Pro ka\u017ed\u00e9ho pacienta je t\u0159eba pe\u010dliv\u011b zv\u00e1\u017eit progn\u00f3zu p\u0159e\u017eit\u00ed a&nbsp;dlouhodob\u00e9 kvality pokra\u010duj\u00edc\u00edho \u017eivota \u2013 HRQoL + n\u00e1kladnost. Rozhodov\u00e1n\u00ed nen\u00ed zalo\u017eeno pouze na&nbsp;v\u011bku pacienta, ale na&nbsp;jeho celkov\u00e9m posouzen\u00ed.<\/p>\n<p>Je nutno vyv\u00e1\u017een\u011b zohlednit progn\u00f3zu pro pacienta vs. rizika pro poskytuj\u00edc\u00edho \/ prov\u00e1d\u011bj\u00edc\u00edho zachr\u00e1nce v\u010d. sv\u011bdk\u016f, z\u00e1chran\u00e1\u0159\u016f. Podm\u00ednkou je b\u00fdt vybaven ochrann\u00fdmi prost\u0159edky pro v\u0161echny naka\u017een\u00e9 i&nbsp;pro suspektn\u00ed doty\u010dn\u00e9 pacienty. Protokoly se ad hoc konkretizuj\u00ed. Seznamuj\u00ed se s\u00a0nimi aktu\u00e1ln\u011b i&nbsp;oper\u00e1to\u0159i, kte\u0159\u00ed maj\u00ed za povinnost instruovat pos\u00e1dky i&nbsp;laick\u00e9 zachr\u00e1nce v\u00a0r\u00e1mci TANR.<\/p>\n<p>Literatura:\nJ.P. NOLAN et al. European Resuscitation Council COVID-19 Guidelines\u00a0[online]. <em>European Resuscitation Council,<\/em> 2020, April 24, 1-49 [cit. 2020-05-02]. Dostupn\u00e9 z: <a href=\"https:\/\/www.erc.edu\/sites\/5714e77d5e615861f00f7d18\/content_entry5ea884fa4c84867335e4d1ff\/5ea885f34c84867335e4d20e\/files\/ERC_covid19_pages.pdf?1588257310\">https:\/\/www.erc.edu\/sites\/5714e77d5e615861f00f7d18\/content_entry5ea884fa4c84867335e4d1ff\/5ea885f34c84867335e4d20e\/files\/ERC_covid19_pages.pdf?1588257310<\/a><\/p>\n<p><strong>Kl\u00ed\u010dov\u00e1 slova:<\/strong> ERC: 2020 \u2013 COVID-19 \u2013 metodick\u00e9 doporu\u010den\u00ed\n<strong>Key words:<\/strong> ERC: 2020- COVID-19 \u2013 guidelines<\/p>\n<p>        <\/p><\/div>    <\/div><\/div>\n<p><\/p><\/div><\/p>\n<p><i>Refer\u00e1tov\u00fd v\u00fdb\u011br z&nbsp;anesteziologie, resuscitace a&nbsp;intenzivn\u00ed medic\u00edny<\/i>. 2020,\u00a0<b>67<\/b>(Aktu\u00e1ln\u00ed samostatn\u00e1 p\u0159\u00edloha Covid-19). ISSN 1212-3048. Dostupn\u00e9 tak\u00e9 z: <a href=\"https:\/\/nlk.cz\/zdroje\/publikace-nlk\/anesteziologie-resuscitace-a-intenzivni-medicina\/\">https:\/\/nlk.cz\/zdroje\/publikace-nlk\/anesteziologie-resuscitace-a-intenzivni-medicina\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Informace pro anesteziology a&nbsp;intenzivn\u00ed p\u00e9\u010di v&nbsp;souvislosti s&nbsp;v\u00fdskytem epidemie COVID-19<\/p>\n","protected":false},"author":12,"featured_media":13612,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[63],"class_list":["post-13606","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-obecne","tag-covid-19"],"translation":{"provider":"WPGlobus","version":"3.0.6","language":"en","enabled_languages":["cs","en"],"languages":{"cs":{"title":true,"content":true,"excerpt":false},"en":{"title":false,"content":false,"excerpt":false}}},"_links":{"self":[{"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/posts\/13606","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/comments?post=13606"}],"version-history":[{"count":21,"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/posts\/13606\/revisions"}],"predecessor-version":[{"id":14116,"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/posts\/13606\/revisions\/14116"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/media\/13612"}],"wp:attachment":[{"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/media?parent=13606"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/categories?post=13606"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/nlk.cz\/en\/wp-json\/wp\/v2\/tags?post=13606"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}