{"id":11385563,"date":"2009-07-15T00:00:00","date_gmt":"2009-07-14T22:00:00","guid":{"rendered":"https:\/\/alertdiver.eu\/uncategorized-cs_cz\/diferencialni-diagnoza\/"},"modified":"2009-07-15T00:00:00","modified_gmt":"2009-07-14T22:00:00","slug":"diferencialni-diagnoza","status":"publish","type":"post","link":"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/diferencialni-diagnoza\/","title":{"rendered":"Diferenci\u00e1ln\u00ed diagn\u00f3za"},"content":{"rendered":"<p style=\"text-align: justify;\"><strong>Pot\u00e1p\u011b\u010d<\/strong><br \/> Jedn\u00e1 se o jednapades\u00e1tiletou zdravou \u017eenu. V p\u0159edchoz\u00edm roce j\u00ed byly operov\u00e1ny dva kr\u010dn\u00ed obratle (5. a 6.), co\u017e je chirurgick\u00fd z\u00e1krok zn\u00e1m\u00fd jako laminektomie (opera\u010dn\u00ed snesen\u00ed trnu a oblouku obratle umo\u017e\u0148uj\u00edc\u00ed p\u0159\u00edstup do p\u00e1te\u0159n\u00edho kan\u00e1lu &ndash; pozn. p\u0159.). Ob\u010das m\u00edv\u00e1 migr\u00e9nu a ned\u00e1vno byla posti\u017eena naz\u00e1ln\u00ed kongesc\u00ed (ucp\u00e1n\u00edm nosn\u00edch dutin), na co\u017e pou\u017e\u00edvala voln\u011b prodejn\u00fd l\u00e9k pro uvoln\u011bn\u00ed dutin; jinak nem\u00e1 \u017e\u00e1dn\u00e9 fyzick\u00e9 \u010di zdravotn\u00ed pot\u00ed\u017ee. Nepot\u00e1p\u00ed se nijak pravideln\u011b, ale t\u00e9m\u011b\u0159 ka\u017ed\u00fd rok si vyraz\u00ed na &ldquo;pot\u00e1p\u011b\u010dskou&rdquo; dovolenou.<\/p>\n<p style=\"text-align: justify;\"><strong>Pot\u00e1p\u011bn\u00ed<\/strong><br \/> P\u00e1t\u00fd den sv\u00e9 dovolen\u00e9 se dvakr\u00e1t potopila; den p\u0159edt\u00edm si \u0159\u00e1dn\u011b odpo\u010dala a v\u011bnovala se jen nen\u00e1ro\u010dn\u00e9 prohl\u00eddce m\u00edstn\u00edch pam\u011btihodnost\u00ed. Zm\u00edn\u011bn\u00fd den zah\u00e1jila tato pot\u00e1p\u011b\u010dka n\u011bkolika\u00farov\u0148ov\u00fdm profilem do hloubky 70 stop mo\u0159sk\u00e9 vody (t.j. 21 metr\u016f mo\u0159sk\u00e9 vody) na dobu 1 hodiny 15 minut, po kter\u00e9 n\u00e1sledovala hodinov\u00e1 p\u0159est\u00e1vka na hladin\u011b. Pot\u00e9 n\u00e1sledoval druh\u00fd n\u011bkolika\u00farov\u0148ov\u00fd sestup op\u011bt do hlouby 70 stop mo\u0159sk\u00e9 vody asi na jednu hodinu. Sou\u010d\u00e1st\u00ed tohoto druh\u00e9ho (a v ten den posledn\u00edho) pono\u017een\u00ed byla p\u011btiminutov\u00e1 bezpe\u010dnostn\u00ed zast\u00e1vka v hloubce 15 stop mo\u0159sk\u00e9 vody (4,5 metr\u016f). B\u011bhem obou ponor\u016f nedo\u0161lo k \u017e\u00e1dn\u00fdm incident\u016fm, ale zm\u00ednila se o tom, \u017ee v z\u00e1v\u011bru ka\u017ed\u00e9ho pono\u0159en\u00ed poci\u0165ovala dosti velk\u00fd chlad. V\u00edce ne\u017e polovinu ka\u017ed\u00e9ho pono\u0159en\u00ed str\u00e1vila v hloubk\u00e1ch men\u0161\u00edch ne\u017e 70 stop mo\u0159sk\u00e9 vody.<\/p>\n<p style=\"text-align: justify;\"><strong>Komplikace<\/strong><br \/> Pot\u00e1pe\u010dka ukon\u010dila sv\u00e9 pot\u00e1p\u011bn\u00ed v 1 hodinu odpoledne. Kr\u00e1tce nato za\u010dala poci\u0165ovat postupn\u00fd n\u00e1r\u016fst \u00fanavy, co\u017e ji p\u0159ipadalo nep\u0159im\u011b\u0159en\u00e9 a podivn\u00e9, nebo\u0165 \u017e\u00e1dn\u00e9 z obou ob\u011b pono\u0159en\u00ed nebylo nijak n\u00e1ro\u010dn\u00e9. Rovn\u011b\u017e ji za\u010dala bolet hlava (podle jej\u00edch slov na obou stran\u00e1ch, tedy jinak ne\u017e p\u0159i migr\u00e9n\u00e1ch, kter\u00e9 ob\u010das za\u017e\u00edv\u00e1). Vr\u00e1tila se do hotelu, kter\u00fd se nach\u00e1z\u00ed ve v\u00fd\u0161ce 762 metr\u016f nad mo\u0159em, lehla si a asi hodinu a p\u016fl spala. Krom\u011b st\u00e1l\u00e9 \u00fanavy se po\u0159\u00e1d c\u00edtila n\u011bjak &ldquo;nesv\u00e1&rdquo;. Ve\u010der \u0161la sp\u00e1t v 8 hodin a spala bez p\u0159eru\u0161en\u00ed celou noc, co\u017e je podle jejich vlastn\u00edch slov dost neobvykl\u00e9.<br \/> R\u00e1no se probudila se stejnou \u00fanavou i ment\u00e1ln\u00ed mal\u00e1tnost\u00ed.<br \/> B\u011bhem dne ji za\u010dalo ob\u010das pobol\u00edvat koleno; v\u017edy to chv\u00edli bolelo a pot\u00e9 bolest zcela ustoupila. I kdy\u017e se jej\u00ed bolesti hlavy po prospan\u00e9 noci pon\u011bkud zm\u00edrnily, ve\u010der zna\u010dn\u011b zes\u00edlily. P\u0159ipadalo j\u00ed to, jako by dost\u00e1vala r\u00fdmu nebo ch\u0159ipku. Vzhledem k neobvykl\u00fdm a pokra\u010duj\u00edc\u00edm p\u0159\u00edznak\u016fm zavolal ve\u010der jej\u00ed pot\u00e1p\u011b\u010dsk\u00fd partner DAN. V tu dobu pot\u00e1p\u011b\u010dka nepoci\u0165ovala \u017e\u00e1dn\u00e9 bolesti kloub\u016f ani jin\u00e9 bolesti, \u017e\u00e1dn\u00e9 sn\u00ed\u017een\u00ed citlivosti \u010di brn\u011bn\u00ed, ani v\u0161eobecnou slabost.<\/p>\n<p style=\"text-align: justify;\"><strong>L\u00e9\u010dba<\/strong><br \/> DAN odk\u00e1zala pot\u00e1p\u011b\u010dku na m\u00edstn\u00ed nemocnici z t\u011bchto dvou hlavn\u00edch d\u016fvod\u016f:<\/p>\n<ul>\n<li style=\"text-align: justify;\">takov\u00e9 p\u0159\u00edznaky lze jen t\u011b\u017eko vyhodnotit prost\u0159ednictv\u00edm telefonu; a<\/li>\n<li style=\"text-align: justify;\">takto sm\u00ed\u0161en\u00e9 a v\u00e1gn\u00ed p\u0159\u00edznaky po pot\u00e1p\u011bn\u00ed by m\u011bl vyhodnodit l\u00e9ka\u0159 profesion\u00e1l.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Po vy\u0161et\u0159en\u00ed stanovil m\u00edstn\u00ed l\u00e9ka\u0159 jako diagn\u00f3zu virov\u00e9 onemocn\u011bn\u00ed (ch\u0159ipku) a dal j\u00ed p\u0159\u00edpravek proti naz\u00e1ln\u00ed kongesci a proti bolestem hlavy.<\/p>\n<p style=\"text-align: justify;\"><strong>V\u00fdsledek<\/strong><br \/> Vy\u0161et\u0159en\u00ed uk\u00e1zalo, \u017ee naz\u00e1ln\u00ed kongesce, s kterou sv\u00e9 pot\u00e1p\u011bn\u00ed za\u010dala, se ani nezhor\u0161ila, ani nezmizela. B\u011bhem zm\u00edn\u011bn\u00fdch pot\u00ed\u017e\u00ed po pot\u00e1p\u011bn\u00ed nem\u011bla v \u017e\u00e1dn\u00e9m okam\u017eiku hore\u010dku a ony nep\u0159\u00edjemn\u00e9 p\u0159\u00edznaky postupn\u011b (b\u011bhem t\u0159\u00ed a\u017e \u010dty\u0159 dn\u016f) zmizely. P\u0159\u00edznaky t\u00e9to pot\u00e1p\u011b\u010dky p\u0159ipom\u00ednaly dekompresn\u00ed onemocn\u011bn\u00ed (DCI), ale tak\u00e9 byly podobn\u00e9 virov\u00e9mu onemocn\u011bn\u00ed. Podle slov pot\u00e1p\u011b\u010dky, vy\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159 nepova\u017eoval ned\u00e1vn\u00e9 dva ponory za sou\u010d\u00e1st diagn\u00f3zy.<\/p>\n<p style=\"text-align: justify;\"><strong>Diskuse<\/strong><br \/> Kolik pot\u00e1p\u011b\u010d\u016f by pova\u017eovalo takov\u00e9 p\u0159\u00edznaky za mo\u017en\u00fd n\u00e1sledek dekompresn\u00edho onemocn\u011bn\u00ed? Do\u0161li by k n\u00e1zoru, \u017ee tyto pot\u00ed\u017ee nejsou nic jin\u00e9ho ne\u017e n\u00e1sledek dlouh\u00e9ho a pom\u011brn\u011b ru\u0161n\u00e9ho t\u00fddne dovolen\u00e9, kter\u00fd za\u010dal po p\u0159edchoz\u00ed naz\u00e1ln\u00ed kongesci? S nejv\u011bt\u0161\u00ed pravd\u011bpodobnost\u00ed by t\u00e9m\u011b\u0159 v\u0161ichni pot\u00e1p\u011b\u010di postupovali stejn\u011b: Na chv\u00edli by si lehli, pot\u00e9 se nave\u010de\u0159eli, \u0161li by brzy sp\u00e1t a sna\u017eili se &ldquo;z toho vyspat&rdquo; a kdyby se jejich stav nelep\u0161il, zavolali by DAN. Jedn\u00e1 se diagnostick\u00fd probl\u00e9m pro mnoho l\u00e9ka\u0159\u016f. <\/p>\n<p style=\"text-align: justify;\">Oboustrann\u00e9 ob\u010dasn\u00e9 bolesti hlavy, p\u0159eru\u0161ovan\u00e1 bolest kolena, nadm\u011brn\u00e1 \u00fanava a pocit &ldquo;neb\u00fdt ve sv\u00e9 k\u016f\u017ei&rdquo; sice pat\u0159\u00ed k p\u0159\u00edznak\u016fm dekompresn\u00edho onemocn\u011bn\u00ed, ale nejsou jej\u00edm d\u016fkazem. Dilema pro l\u00e9ka\u0159e je rozpoznat, zdali m\u00e1 tyto nejednozna\u010dn\u00e9 p\u0159\u00edznaky spojovat s pot\u00e1p\u011bn\u00edm a tud\u00ed\u017e s dekompresn\u00edm onemocn\u011bn\u00edm, nebo je m\u00e1 p\u0159i\u010d\u00edst n\u011bjak\u00e9mu jin\u00e9mu zdravotn\u00edmu probl\u00e9mu.<br \/> Bolest je nej\u010dast\u011bj\u0161\u00edm \u00favodn\u00edm p\u0159\u00edznakem dekompresn\u00edho onemocn\u011bn\u00ed a proto se mus\u00ed d\u016fkladn\u011b vy\u0161et\u0159it. P\u0159eru\u0161ovan\u00e1 bolest kloub\u016f je norm\u00e1ln\u00ed u ka\u017ed\u00e9 fyzick\u00e9 n\u00e1mahy (v\u010detn\u011b p\u0159\u00edstrojov\u00e9ho pot\u00e1p\u011bn\u00ed), kdy\u017e n\u011bkdo pou\u017e\u00edv\u00e1 svaly jinak, ne\u017e je tomu u n\u011bj b\u011b\u017en\u00e9. V\u0161eobecn\u011b lze \u0159\u00edci, \u017ee bublinky p\u0159i dekompresn\u00edm onemocn\u011bn\u00ed vytv\u00e1\u0159ej\u00ed konstantn\u00ed tlak, tak\u017ee poru\u0161en\u00ed tk\u00e1n\u011b a bolesti v p\u0159\u00edpad\u011b dekompresn\u00edho onemocn\u011bn\u00ed zpravidla nejsou jen ob\u010dasn\u00e9 a p\u0159eru\u0161ovan\u00e9. <\/p>\n<p style=\"text-align: justify;\">Bolesti zp\u016fsoben\u00e9 dekompresn\u00edm onemocn\u011bn\u00edm se zpravidla nem\u011bn\u00ed p\u0159i zm\u011bn\u011b polohy \u010di p\u0159i jin\u00e9 manipulaci a \u010dasto je lid\u00e9 ozna\u010duj\u00ed jako &ldquo;divn\u00e9&rdquo; nebo &ldquo;neobvykl\u00e9&rdquo;. V\u011bt\u0161ina lid\u00ed za\u017eila ch\u0159ipku a proto jsou jim pot\u00ed\u017ee a bolesti spojen\u00e9 s virov\u00fdm onemocn\u011bn\u00edm jim pom\u011brn\u011b dob\u0159e zn\u00e1m\u00e9. Ale i bolesti kloub\u016f spojen\u00e9 s virov\u00fdm onemocn\u011bn\u00edm a dal\u0161\u00ed pot\u00ed\u017ee mohou b\u00fdt konstantn\u00ed a zvy\u0161ovat se s n\u011bjakou prov\u00e1d\u011bnou \u010dinnost\u00ed. Proto je nutno p\u0159ipustit, \u017ee jasn\u00e9 rozli\u0161en\u00ed t\u011bchto p\u0159\u00edznak\u016f a stanoven\u00ed jednozna\u010dn\u00e9 diagn\u00f3zy m\u016f\u017ee b\u00fdt obt\u00ed\u017en\u00e9.<br \/> &nbsp;<\/p>\n<p style=\"text-align: justify;\">Oboustrann\u00e1 bolest hlavy se d\u00e1 snadno p\u0159ipsat naz\u00e1ln\u00edmu barotraumatu zp\u016fsoben\u00e9mu pot\u00e1p\u011bn\u00edm s p\u0159edchoz\u00ed naz\u00e1ln\u00ed kongesc\u00ed. V tomto p\u0159\u00edpad\u011b pot\u00e1p\u011b\u010dka popisovala svou bolest hlavy jako odli\u0161nou ve srovn\u00e1n\u00ed s jak\u00fdmikoliv jin\u00fdmi bolestmi hlavy, kter\u00e9 kdy za\u017eila, co\u017e nazna\u010dovalo i na mo\u017en\u00e9 (ale rozhodn\u011b ne jist\u00e9) onemocn\u011bn\u00ed z dekomprese. V datab\u00e1zi DAN se bolest hlavy jako p\u0159\u00edznak dekompresn\u00edho onemocn\u011bn\u00ed vyskytuje asi v 10 a\u017e 20 procentech p\u0159\u00edpad\u016f.<br \/> Zm\u011bny v ment\u00e1ln\u00edm rozpolo\u017een\u00ed se definuj\u00ed nesnadno, pokud se nejedn\u00e1 o tak v\u00fdrazn\u00e9 p\u0159\u00edznaky, jak\u00fdmi jsou ztr\u00e1ta v\u011bdom\u00ed, z\u00e1chvat nebo neschopnost komunikovat se sv\u00fdm okol\u00edm. Tyto siln\u00e9 symptomy by m\u011bli v\u0161ichni pot\u00e1p\u011b\u010di snadno rozeznat jako p\u0159\u00edznaky ment\u00e1ln\u00ed poruchy, kter\u00e1 m\u016f\u017ee souviset s dekompresn\u00edm onemocn\u011bn\u00edm. &ldquo;Nec\u00edtit se ve sv\u00e9 k\u016f\u017ei&rdquo; je subjektivn\u00ed p\u0159\u00edznak, jeho\u017e s\u00edla se t\u011b\u017eko kvantifikuje. <\/p>\n<p style=\"text-align: justify;\">V\u0161eobecn\u011b plat\u00ed, \u017ee v\u011bt\u0161ina p\u0159\u00edznak\u016f dekompresn\u00edho onemocn\u011bn\u00ed (60 procent) nastane do dvou hodin po pot\u00e1p\u011bn\u00ed. V tomto p\u0159\u00edpad\u011b vy\u0161et\u0159uj\u00edc\u00ed l\u00e9ka\u0159 usoudil, \u017ee existuj\u00edc\u00ed p\u0159\u00edznaky jsou d\u016fsledkem vir\u00f3zn\u00ed infekce: Pot\u00e1p\u011b\u010dka se po t\u0159i n\u00e1sleduj\u00edc\u00ed dny c\u00edtila ka\u017ed\u00fdm dnem l\u00e9pe a p\u0159\u00edznaky se j\u00ed nevracely. Takto nejednozna\u010dn\u00e9 p\u0159\u00edpady jsou hl\u00e1\u0161eny DAN t\u00e9m\u011b\u0159 ka\u017ed\u00fd t\u00fdden a my se sna\u017e\u00edme pomoci l\u00e9ka\u0159\u016fm co nejv\u00edce, aby dok\u00e1zali vyskytnuv\u0161\u00ed se p\u0159\u00edznaky spojit s pot\u00e1p\u011bn\u00edm, nebo je od n\u011bj odd\u011blit. <\/p>\n<p style=\"text-align: justify;\">Pot\u00e1p\u011b\u010di mus\u00ed pe\u010dliv\u011b sledovat ka\u017ed\u00fd p\u0159\u00edznak, kter\u00fd se objev\u00ed po proveden\u00e9m ponoru. I b\u011bhem pot\u00e1p\u011bn\u00ed berte v \u00favahu v\u0161e zvl\u00e1\u0161tn\u00ed, co se p\u0159ihod\u00ed a samoz\u0159ejm\u011b si v\u0161\u00edmejte i ka\u017ed\u00e9ho neobvykl\u00e9ho p\u0159\u00edznaku, kter\u00fd zpozorujete b\u011bhem pono\u0159en\u00ed nebo po n\u011bm. Upozorn\u011bte na to sv\u00e9ho partnera a kdy\u017e jste naho\u0159e, vyslechn\u011bte si jeho n\u00e1zor. A pamatujte si, \u017ee objeven\u00ed se n\u011bkter\u00fdch p\u0159\u00edznak\u016f m\u016f\u017ee trvat a\u017e 24 hodin. Nic dlouho neodkl\u00e1dejte, zavolejte DAN okam\u017eit\u011b, jakmile v\u00e1m n\u011bco p\u0159ipad\u00e1 podez\u0159el\u00e9. A kone\u010dn\u011b &ndash; p\u0159i pot\u00e1p\u011bn\u00ed m\u011bjte neust\u00e1le na mysli: Jestli\u017ee chcete sv\u016fj z\u00e1sobn\u00edk vzduchu vyu\u017e\u00edt a\u017e na maximum, kompenzujte to pos\u00edlen\u00edm ostatn\u00edch bezpe\u010dnostn\u00edch faktor\u016f. Nejjednodu\u0161\u0161\u00ed a nej\u00fa\u010dinn\u011bj\u0161\u00ed strategi\u00ed je sni\u017eovat hloubku a prodlu\u017eovat p\u0159est\u00e1vky na hladin\u011b.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Pot\u00e1p\u011b\u010d Jedn\u00e1 se o jednapades\u00e1tiletou zdravou \u017eenu. V p\u0159edchoz\u00edm roce j\u00ed byly operov\u00e1ny dva kr\u010dn\u00ed obratle (5. a 6.), co\u017e je chirurgick\u00fd z\u00e1krok zn\u00e1m\u00fd jako&#8230;<\/p>\n","protected":false},"author":1,"featured_media":11374192,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[384],"tags":[],"authors":[1193],"class_list":["post-11385563","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clanky","authors-joel-dovenbarger-cs_cz"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.2 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Diferenci\u00e1ln\u00ed diagn\u00f3za - Alert Diver<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/diferencialni-diagnoza\/\" \/>\n<meta property=\"og:locale\" content=\"cs_CZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diferenci\u00e1ln\u00ed diagn\u00f3za - Alert Diver\" \/>\n<meta property=\"og:description\" content=\"Pot\u00e1p\u011b\u010d Jedn\u00e1 se o jednapades\u00e1tiletou zdravou \u017eenu. 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