Chronic obstructive pulmonary disease (COPD) significantly reduces quality of life and is one of the main causes of chronic morbidity and mortality worldwide. Acute exacerbation of COPD (AECOPD) is a life-threatening condition that causes rapid deterioration of respiratory symptoms (worsening of dyspnea, cough and/or abundant sputum production) requiring urgent treatment. This review article examines the evidence underlying supplemental oxygen therapy and ventilator support during exacerbations of COPD. In the introduction, we discuss the epidemiology and pathophysiology of hypercapnic respiratory failure, and then we explain that the key to achieving appropriate levels of oxygenation is using controlled low-flow oxygen therapy. In patients with risk of hypercapnia a target oxygen saturation (SaO ) range of 88%–92% 2 is now generally accepted unless hypercapnia is disproved by gas analysis of arterial blood. However, if the partial pressure of carbon dioxide in arterial blood (PaCO ) is normal, oxygen therapy may target the usual saturation range of 94%–98%. 2 Many COPD patients may have a lower stable SaO , such that chasing this target (94%-98%) is not usually necessary unless 2 the patient is unwell. Further, we review current recommendations for ventilatory support in patients with AEHOBP. Noninvasive ventilation has assumed an important role in managing patients with acute respiratory failure. The use of invasive ventilation is the last remaining option, associated with a poor outcome.

The aim of this study was to perform a comparative analysis applied conventional (traditional) and protective mechanical lung ventilation in clinical conditions with regard to intraoperative parameters changes of oxygenation, ventilation and acid-base status. This was a prospective study that included 240 patients. All patients underwent the same elective surgery (classic cholecystectomy). Patients were divided into two groups of 120 patients, A and B. In group A during the operation had received conventional lung ventilation with tidal volume of 10-15 ml/kg body weight, respiratory rate 12/min. and a PEEP zero. In group B was applied protective lung ventilation with a tidal volume of 6-8 ml/kg body weight, respiratory rate 12/min. and a PEEP of 7 mbar. Monitoring of oxygenation included the monitoring SaO2 and PaO2. Monitoring of ventilation included the determination of the value of tidal volume and minute volume ventilation, peak inspiratory pressure (Ppeak), medium pressure in the airway (Paw.mean), PEEP, PaCO2 and EtCO2. Monitoring of acid-base status was performed via determination of the pH values of arterial blood. Monitoring was carried out in four intervals: T1 - 5-10 minutes after the establishment of the airway, T2 - after opening peritoneum, T3 - after removal of the gallbladder, T4 - after the closure of the abdominal wall. All monitoring results are presented as mean. The statistical significance of differences in mean values was tested by t - test mean values in the case of two independent samples. As a statistical significance test taken as standard values p <0.01 and p <0.001. Comparative analysis of the value of SaO2, PaO2, Ppeak did not reach statistical significance. Statistical significance there is in the analysis of values of tidal volume and Paw.mean (p <0.001). Analysis of PaCO2 and pH of arterial blood showed no statistical significance in the first interval measurements but did interval T2-T4 (p <0.001). Based on the results of this study, it can be concluded that the applied types of mechanical ventilation of lungs during the performance of surgical procedures of medium duration, have not led to significant changes in terms of maintaining the parameters of oxygenation, ventilation and acid-base status, and they stayed in normal, physiological range.

The most important characteristic of calcium channels is selective regulation of slow incoming stream of calcium into the cell tissue providing the slow increasement of action potential. Such tissues include smooth muscles of blood vessels, cardiocytes and heart noduses (AV and SA node). Different calcuim antagonists have different effects on previous tissues due to their different chemical formula. Verapamile, Nifedipin and Diltiazem are the most frequently used of all. Their commonest characteristic is blocking the calcium channels causing vasodilatation of blood vessels as well as negative inotropic and chronotropic influence. By blocking the incoming calcium through slow channels of myofibrils of smooth muscles, the antagonists of calcium decrease the quantity of available calcium for contraction which causes vasodilatation. The most famous and most frequently used calcium antagonist is Verapamile. In terms of electrophysiology, Verapamile inhibits action potentials of heart noduses, especially the AV node, where the slow incoming of calcium is the most important for depolarization. Prolongation of the efective refractory period of SA node causes the heart frequency decreasement while prolongation of the effective refractory period of AV node slows down the work of chambers in case of flater and fibrillation of atriums. The molecules of calcium-bonding protein called kalmodulin are located in synaptic endings. Each kalmodulin can bond four calcium ions providing transfer into active calcium-kalmodulin complex which activates the kinase protein. Activated kinase protein starts the exocytosis of neurotransmitters into synaptic gap. Apart from activating kinase protein, calciumkalmodulin complex also starts the activity of calcium pump presynaptic membrane which pumps calcium out of presynaptic ending stopping the further exocytosis of neurotransmitters into synaptic gap. Taking into consideration the fact that opening the calcium channels on membrane of presynaptic ending is necessary to free the neurotransmitter out of the vesicle, the aim of our work is to study whether Verapamile has effects on the membrane of presynaptic endings of sympathetic nervous system checking the level of catecholamine in serum. The experiment was conducted in 6 healthy dogs which were, after 10-minute- infusion (0.9% NaCl), treated with intravenous bolus veramapile injections in three occasions, in every 5 minutes, until the first signs of intoxication had appeared. This caused bradycardia, heart rhythm disorder and blood pressure drop. In order to determine the level of catecholamine, blood was taken sequentially, in every 5 minutes, before the new dose of verapamile was given. Verapamile (given intravenous) significantly decreases the concentration of adrenaline and noradrenaline in the serum of dogs.

Cilj ove studije je bio da definišemo faktore koji bi mogli da poboljšaju ishod reanimacije pacijenata koji su doživeli vanbolnički akutni zastoj srca poštujući "Utstein" model sakupljanja podataka. U dvogodišnjoj prospektivnoj studiji ispitano je 200 pacijenata koji su doživeli vanbolnički akutni zastoj srca i faktori koji su povezani sa preživljavanjem. 78% pacijenata je doživelo akutni zastoj srca kardijalne etiologije, 65% u kućnim uslovima, 3,7% je reanimirano od strane spasilaca, 36% je zatečeno u ventrikularnoj fibrilaciji (VF) ili ventrikularnoj tahikardiji (VT) bez pulsa, 64% u asistoliji/električnoj aktivnosti bez pulsa (PEA), 52% pacijenata je intubirano na mestu nastanka akutnog zastoja srca i preživljavanje do otpusta iz bolnice je bilo značajno veće u ovoj grupi pacijenata. Prosečno vreme stizanja do pacijenata bilo je 6,6 minuta. 66,7% pacijenata je defibrilirano nakon 4 i više minuta. 131 (65,5%) pacijent je proglašen mrtvim na terenu, 69 pacijenata je transportovano u bolnicu. 53 (76,8%) pacijenta iz grupe transportovanih je umrlo za vreme transporta ili na odeljenju reanimacije, 7 je umrlo nakon prijema u bolncu a 9 je preživelo do otpusta iz bolnice. Multivarijantnom logističkom regresijom je utvrđeno da su varijable značajno povezane sa preživljavanjem: starosno doba, endotrahealna intbacija na terenu i vreme stizanja do pacijenta. Uspeh reanimacije bio je značajno veći kod mlađih pacijenata, kod onih intubiranih na terenu i kod onih kod kojih je ekipa hitne medicinske pomoći stigla u kraćem vremenskom intervalu.

Copper is an essential element, a constituent of all living cells and an integral component of many enzymes. The increase in pollution of the environment, and various metabolic diseases, imbalances biological processes and homeostatic regulated content of bioelements in the body. For the purpose of determining changes in the contents of bioelements with increased intake of copper, the paper followed by interaction before and after ingestion of copper. The results showed that copper in excess causes disruption of physiological interactions of bioelements in tissues and significantly increases the content of iron and magnesium. The nature and relationships of these interactions are important, because in terms of exposure to metals, there are changes in their mutual relations, with some of these antagonistic relationships may be utilized for further study in order to protect them from toxicity.

Among all ALS procedures, effective airway management is vital in the treatment of critically ill patients. The aim of this study was to evaluate the impact of pre-hospital endotracheal intubation and early defibrillation on outcome of cardiac arrest (CA) patients. We examined 200 patients suffering from out-of-hospital cardiac arrest (OHCA) in a prospective cohort study in a two years period. We determined survival from CA to discharge from hospital and the factors associated with survival. We calculated the time intervals until shock decisions were made. Shock decisions were verified according to EKG downloads. 52% of patients were intubated in the field, survival to discharge from hospital was significantly higher among patients who were intubated in the field. Survival rates in patients with VF/VT was 9.7% compared to patients with asystole/PEA (1.6%). 66.7% of patients were given the shock after 4 minutes. Low survival to hospital discharge may be due to low number of CA patients who were intubated in the field and long "interval to shock delivery" (there are no AED). Existing literature shows that the first minutes are a critical time frame for successful resuscitation and this is an argument towards the introduction of AEDs used by bystanders.

Quick, proper and efficient transport is an integral part of all measures taken in treatment and effective care of polytraumatized patients. Before or during the transport, without regard to the transportation means, such patients often need their airways to be protected, connection to mechanical ventilation, applying of oxygen, infusion solution, painkillers or some other drugs. Continual monitoring of vital functions is required part of treatment during transport of critically ill or injured patients. Their transport, beside adequate equipment, demands theoretically and practically well trained stuff. In most European countries anesthesiologists have primary role especially in interhospital transport (for example in transport of neurosurgical patient from local to university hospital). Unfotunatelly, in our conditions transport is often carried out by unsufficiently skilled medical stuff without adequate equipment and experience what may have an effect on treatment success and surviva.

Scientific researches considering the effects of glucagon on cardiovascular system show that glucagon has a certain cardiostimulative potential. The fact that glucagon accomplishes its cardiostimulative effects by activating its own, highly specific glucagonic receptors is of most importance. That's the reason why we've wanted to give more details about the effects that glucagon has on cardiovascular system in terms of having more precise image of its effects on hemodynamics and changes which can be seen on electrocardiogram. The experiment included six dogs treated with intravenous glucagon injection. Electrocardiograph and hemodynamic parameters (middle arterial pressure, central venous pressure and heart st nd rd th th th th th frequency) have been recorded in 1 , 2 , 3 , 5 , 10 , 20 , 30 and 40 minute. Electrocardiograph and heart frequency have been recorded by continuous monitoring. Middle arterial pressure has been recorded through catheter placed into a. femoralis while central venous pressure has been recorded through central venous catheter placed into v. femoralis. Having received the intravenous injection, glucagon shows extremely positive chronotropic effect, followed by ephemeral increase of middle arterial pressure, while central venous pressure has a significant decrease. Having received intravenous injection, P-R, Q-Tand T-Pinterval have been significantly shorten.

Although there is generally world trend in decreasing of number of smokers, expecially in developed part of world, smoking cigarettes still have large importance in morbidity and mortality of modern human population. Taking anamnestics data about smoking habit instruct anaesthesiologist to apply special strategy in general anaesthesia for a reason of possible complications provoked bby a chronic influence of nicotin and other tobbaco ingredients on different organs. In this article we wanted to examine influence of chronic tobbaco smoke exposing on arterial oxygen saturation SaO2 during and short period after general anaesthesia. Research was evaluated on patients in Emergency Center of Clinical Center of Serbia. Patients were divided in two groups (ASAI and II): group I smokers (n=40) and group II nosmokers (n=40). Our investigation has shown no statistical significant difference on SaO2 during general anaesthesia between two experimental groups. Immediately after general anaesthesia and extubation in postoperative period SaO2 dicreases (p<0.001) during transport from operating room to recovery room in both groups of patients,but the level of hypoxemia was significantly higher in smokers group. In this study we demonstrated that tobbaco smoking corellate with postoperative decrease of SaO2 after general anaesthesia, proposing an additional oxygen therapy in early postoperative period.