eDekontaminace
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Přehled článků

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Růže - Erysipel

Biopsie a cirhóza jater

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Cesty buprenorfinu k injekční aplikaci

Zhodnocení mezinárodního projektu IMPACT

Infekční centrum pro drogové závislé při FN Motol

Metodické materiály k testování na infekce

Vliv pervitinu na dutinu ústní

Infekční endokarditida

Těhotenství, děti a drogy

Test znalostí o hepatitidě C

Bolest a co s ní

Léčba závislosti na alkoholu

Delirium tremens

Porod v terénu?

Záchranná služba a uživatelé drog

Klíšťata a jak na ně?

Virus Hepatitidy C

Zdravotní péče pro Slováky

Stručný latinsko-český zdravotnický slovník

Hojivé masti

Mapování a metodika zvládání somatických komplikací injekčních uživatelů drog

Podávání léků v sociální službě: k další diskusi

Detoxikovat se sám nebo s pomocí?

HIV poradenství u vybraných rizikových skupin

Brouci pod kůží a v hlavě

Absces známý neznámý

Paraziti a jejich vnímání

Mýty o první pomoci

Neléčená žloutenka typu C

Omrzliny

Substituční programy v Praze

Doporučení k lékaři

Leták o hepatitidě typu C

Mastičky

Konference Imp.Ac.T.

Zuby a jedy

Srdeční endokarditida podrobně

Plísně & masti

Méně známé kousky - chlamydie a genitální opar

Už máš HIV (testy)?

AIDS - jak to všechno začalo

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Co víš o žloutence C? (anketa)

Kdo sbírá céčka? A co na obranu před žloutenkami?

Žloutenka C - přehledová tabulka aneb co vás čeká až jí dostanete

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Partneři

Infekční centrum pro drogové závislé při FN Motol

28.02.2013 | Sekce: Zdravotní

Přínášíme část rozhovoru s MUDr. Janem Dvořákem z ICDZ FN Motol. Ptáme se na toto specializované infekční oddělení, ale také např. na péči o bércové vředy, na infekčnost hepatitidy. Druhá část rozhovoru se týka infekčních endokarditid a vyjde v novém čísle Dekontaminace.

Do časopisu Dekontaminace připravujeme rozhovor na téma „Infekční endokarditidy s MUDr. Janem Dvořákem, lékařem z Infekčního centra pro drogově závislé (ICDZ  Motol), který rovněž pracuje v Kontaktním centru Stage 5 o.s. Progressive. Jako „vedlejší produkt" vznikl i tento malý rozhovor.

 

V nedávné době došlo u ICDZ ke změnám z hlediska organizačního začlenění. K jakým?

Od ledna 2012 je Infekční oddělení FN Motol spolu s ICDZ součástí interní kliniky.  Nedochází zatím k žádným změnám. Díky ročnímu grantu od MZD se můžeme soustředit na prevenci (očkování), léčbu chronických defektů dolních končetin nebo substituci suboxonem za hospitalizace.

 

Pracujete i ve Stage 5, co zde děláte?

Jedenkrát až dvakrát týdně jako lékařský konzultant, prohlédnu klienta a sdělím, co si myslím, že mu je...zhodnotím jeho stav, napíšu doporučení, poradím. Je to také jakýsi mezistupeň pro cestu klientů do FN Motol.

 

Kdo je indikovaný k ambulantnímu ošetření na ICDZ?

Indikovaní jsou lidé s infekční komplikací nebo podezřením na ni: infekce měkkých tkání, horečnaté stavy, sepse, žloutenky, infekce dýchacích cest, trombózy žil apod. Na ambulanci je vyšetřen a rozhoduje se o dalším postupu - ambulantní vyšetřování nebo hospitalizace. Nepojištěný cizinec za péči platí v hotovosti, na cizineckém oddělení FNM je mu vypsán formulář a platí zálohu. Ambulance ICDZ funguje ve všedních dnech od 8 do 15.00,

 

Kdo je indikovaný k hospitalizaci na ICDZ?

ICDZ funguje nonstop pro přijetí stavů, jako jsou akutní hepatitidy, horečky, infekce měkkých tkání (většinou přes přes urgentní příjem).  Indikovaní jsou pacienti především s horečnatými stavy, infekcí měkkých tkání, žloutenkami. Za rok 2012 bylo 9 endokarditid. Jsme menší oddělení, máme 24 lůžek, může se stát, že je plno.

 

Jaké jsou v ICDZ možnosti z hlediska péče o chronické rány (bércové vředy)?

Omezené, nicméně díky grantu máme  k dispozici sací velmi kvalitní krycí materiály. Kapacita je jeden, dva lidi denně.  Často nám hospitalizovaní s chronickými ranami zůstávají v ambulanci .

 

Jak se koukáte na bandážování u chronický ran?

Elastická bandáž (punčocháče pod tříslo) se doporučuje u žilní nedostatečnosti dolních končetin. Zlepší se návrat krve do srdce, krev nestagnuje v končetinách a zlepší se prokrvení tkání a tudíž se zlepší hojení. Důležitá je ale kvalitní bandáž, dávat si pozor například na nežádoucí přiškrcení končetiny pod kolenem. Bandáže lze docílit elastickým obinadlem nebo lépe speciálními elastickými gumovými punčochami, jsou na poukaz a výhodou je, že se vydávají na míru.

 

Řada uživatelů drog má oteklé ruce. Co jej jejich příčinou?.

Nejspíše kombinace faktorů - zničené žilní chlopně, žilní nedostatečnost - špatné prokrvování končetin - lymfatické otoky...

 

Na ICDZ také provádíte očkování. Kdo je indikován?

Indikován je jakýkoliv aktivní toxikoman. Očkujeme proti žloutenkám typu A a B. Očkování je pro klienta zdarma, je hrazeno z grantu MZd. Klient je nejprve vyšetřen na virové hepatitidy a pohlavní choroby (krevní testy) a následně podle potřeby očkován. Očkování vakcínou proti VHB a kombinovanou vakcínou proti VHA a VHB je celkem třemi dávkami v rozmezí jednoho a pak pěti měsíců. Proti VHA se provádí dvěma dávkami, v rozmezí 6-18 měsíců.

 

Jak je to s infekčností u člověka se žloutenkou? Je pravda, že když je člověk „žlutý", tak už není infekční?

Jakmile člověk „zežloutne", tak je to jistá známka akutního zánětu jater. Doba nakažlivosti je různá, záleží na typu žloutenky. Například u hepatitidy A je člověk zpravidla infekční 7-14 před začátkem onemocnění a minimálně týden po odeznění potíží (přesně to ale nelze říci). U chronických hepatitid B a C je pacient infekční i roky, dokud není vyléčen.

Často však virové hepatitidy, především žloutenka typu C, probíhají bez rozvoje ikteru, tedy zežloutnutí kůže a bělma. V těchto případech se hepatitida diagnostikuje pomocí krevních testů, vyšetřením protilátek a jaterních enzymů. Jakmile pacient „zežloutne"  je nutná hospitalizace a podrobné vyšetření příčiny jaterního zánětu. Délka hospitalizace záleží na vývoji zánětu jater, tedy na tom, jak rychle jaterní poškození ustupuje. Řádově se délka pobytu na lůžku pohybuje minimálně od jednoho týdne po několik týdnů (4-6). Léčba je režimová, podávají se podpůrné léky nebo se případně podávají infuze. Pokud hrozí selhání jater u VHB, podává se antivirotikum. U léčby akutní VHC taková možnost však není, ale selhání jater při akutní VHC je vzácné.

 

Pokud máte plno, kam přeposíláte?

V případě plné kapacity oslovíme u nutnosti řešení abscesů naši chirurgii, u žloutenky, horečnatých stavech apod. oslovujeme Infekční kliniku na Bulovce.

 

Díky velice

Aleš Herzog, TP Sananim

 

 

Komentáře

 

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