{"id":4193,"date":"2023-02-15T10:42:20","date_gmt":"2023-02-15T10:42:20","guid":{"rendered":"https:\/\/www.karotidnahirurgija.com\/?page_id=4193"},"modified":"2023-02-24T09:18:34","modified_gmt":"2023-02-24T09:18:34","slug":"17-povrede-arterija-koje-ishranjuju-mozak","status":"publish","type":"page","link":"https:\/\/www.karotidnahirurgija.com\/?page_id=4193","title":{"rendered":"17. POVREDE ARTERIJA KOJE ISHRANJUJU MOZAK"},"content":{"rendered":"

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\n\"\"<\/a><\/p>\n

<\/p>\n

POVREDE ARTERIJA KOJE ISHRANJUJU MOZAK<\/h1>\n

<\/a><\/h1>\n

\n

Surgery is poetry of precission. When something goes amiss the surgeon should not pause to determine who is responsible, or who is to blame. The surgeon should direct his effort toward correcting the problem. Placement of blame can wait until the storm abates.<\/p>\n

J. Vollmar<\/em><\/p>\n<\/div>\n

\n

Epidemija saobra\u0107ajnih nesre\u0107a i nasilja ukazuje da Bog rata (Mars) ne miruje, a to zna\u010di puno povreda arterija.<\/p>\n

Povreda arterije<\/strong> je lezija arterijskog zida nastala delovanjem spolja\u0161nje sile sa posledi\u010dnim krvarenjem ili perifernom ishemijom. Povrede arterija koje dovode krv do mozga specifi\u010dne su jer izazivaju mo\u017edanu ishemiju.<\/p>\n

Prema mehanizmu povre\u0111ivanja razlikuju se povrede arterija nastale:<\/p>\n

    \n
  • Direktnim dejstvom sile i<\/li>\n
  • Indirektnim dejstvom sile.<\/li>\n<\/ul>\n

    Direktno<\/b><\/span> <\/b><\/span>dejstvo<\/b><\/span> <\/b><\/span>sile<\/b><\/span> <\/b><\/span>je <\/span>naj\u010de\u0161\u0107i<\/span> <\/span>mehanizam<\/span> <\/span>povre\u0111ivanja<\/span> <\/span>arterija<\/span> <\/span>(oko<\/span> <\/span>90%<\/span> <\/span>slu\u010dajeva).<\/span> <\/span>Direktno<\/span> <\/span>dejstvo<\/span> <\/span>sile<\/span> <\/span>mo\u017ee<\/span> <\/span>izazvati:<\/span><\/p>\n

      \n
    • dejstvo o\u0161tre sile (otvorena povreda arterije) ili<\/li>\n
    • tupa trauma (zatvorena povreda arterije).<\/li>\n<\/ul>\n

      Lezija arterije dejstvom o\u0161tre sile<\/strong> mo\u017ee biti izazvana: (1) sekotinom, ubodom, projektilom iz vatrenog oru\u017eja ili gelerom ili (2) jatrogeno: intraarterijska injekcija, arteriografija. O\u0161tra sila, zavisno od intenziteta dejstva mo\u017ee izazvati:<\/p>\n

      Leziju<\/span> <\/span>adventicije<\/strong><\/span> <\/span>i<\/span> <\/span>medije,<\/span> <\/span>bez<\/span> <\/span>otvaranja<\/span> <\/span>lumena<\/span> <\/span>arterije<\/span>,<\/span> <\/span>bez<\/span> <\/span>znakova<\/span> <\/span>krvarenja<\/span> <\/span>i<\/span> <\/span>ishemije.<\/span> <\/span>Postoji<\/span> <\/span>opasnost<\/span> <\/span>od<\/span> <\/span>kasnije<\/span> <\/span>rupture<\/span> <\/span>i<\/span> <\/span>stvaranja<\/span> <\/span>pseudo-<\/span> <\/span>aneurizme.<\/span><\/strong><\/p>\n

      Leziju<\/span> <\/span>sva<\/span> <\/span>tri<\/span> <\/span> <\/span>sloja<\/span> <\/span> <\/span>arterijskog<\/span> <\/span> <\/span>zida.<\/span> <\/span>Punktiformno<\/span> <\/span><\/strong> <\/b><\/span>ili<\/b><\/span> <\/b><\/span> <\/b><\/span>tangencijalno<\/b><\/span> <\/b><\/span>je<\/b><\/span> <\/b><\/span>otvorena<\/b><\/span> <\/b><\/span>arterija<\/b><\/span>,<\/span> <\/span>ali<\/span> <\/span>njen<\/span> <\/span>kontinuitet<\/span> <\/span>nije<\/span> <\/span>prekinut.<\/span> <\/span>Arterija<\/span> <\/span>reaguje<\/span> <\/span>spazmom<\/span> <\/span>i<\/span> <\/span>formiranjem<\/span> <\/span>lokalnog<\/span> <\/span>tromba,<\/span> <\/span>a<\/span> <\/span>u<\/span> <\/span>okolini<\/span> <\/span>se<\/span> <\/span>razvija<\/span> <\/span>hematom<\/span> <\/span>\u0161to<\/span> <\/span>mo\u017ee<\/span> <\/span>spre\u010diti ve\u0107e<\/span> <\/span>krvarenje. Postoje znaci<\/span> <\/span>razli\u010ditog stepena unutra\u0161njeg<\/span> <\/span>ili<\/span> <\/span>spolja\u0161njeg<\/span> <\/span>krvarenja.<\/span> <\/span>Mo\u017ee<\/span> <\/span>se<\/span> <\/span>(ali<\/span> <\/span>ne<\/span> <\/span>mora)<\/span> <\/span>javiti<\/span> <\/span>periferna<\/span> <\/span>ishemija.<\/span><\/p>\n

      Kompletnu<\/b><\/span> <\/b><\/span>transekciju<\/b><\/span> <\/b><\/span>arterije<\/b><\/span>.<\/span> <\/span>Arterije<\/span> <\/span>muskularnog<\/span> <\/span>tipa<\/span> <\/span>mogu<\/span> <\/span>spazmom<\/span> <\/span>i<\/span> <\/span>retrakcijom<\/span> <\/span>zaustaviti<\/span> <\/span>krvarenje<\/span> <\/span>(zaklju\u010dno<\/span> <\/span>sa<\/span> <\/span>femoralnom<\/span> <\/span>i<\/span> <\/span>brahijalnom<\/span> <\/span>arterijom).<\/span> <\/span>Arterije<\/span> <\/span>elasti\u010dnog<\/span> <\/span>tipa<\/span> <\/span>(pre\u010dnik<\/span> <\/span>ve\u0107i<\/span> <\/span>od<\/span> <\/span>6<\/span> <\/span>mm)<\/span> <\/span>nemaju<\/span> <\/span>ovu<\/span> <\/span>sposobnost,<\/span> <\/span>pa<\/span> <\/span>bolesnik<\/span> <\/span>mo\u017ee<\/span> <\/span>iskrvariti<\/span> <\/span>za<\/span> <\/span>nekoliko<\/span> <\/span>minuta.<\/span> <\/span>Osim<\/span> <\/span>jasnih<\/span> <\/span>znakova<\/span> <\/span>krvarenja<\/span> <\/span>postoji<\/span> <\/span>te\u0161ka<\/span> <\/span>periferna<\/span> <\/span>ishemija.<\/span><\/p>\n

        \n
      • Arterijske lezije<\/strong> izazvane o\u0161trom traumom imaju slede\u0107e zajedni\u010dke osobine:<\/li>\n<\/ul>\n
          \n
        1. Prisustvo otvorene rane u predelu arterije,<\/li>\n
        2. Spolja\u0161nje krvarenje. Dijagnoza se lako postavlja. Pri dejstvu o\u0161tre sile defekat arterijskog kontinuiteta nije velik i lako se rekonstrui\u0161e suturom ili interpozicijom grafta.<\/li>\n<\/ol>\n<\/div>\n

          \"\"
          \n\"\"<\/p>\n

          \n

          Pseudoaneurizma zajedni\u010dke karotidne arterije, posttraumatska sa komununikacijom sa jugularnom venom (arterio-venska fistula).<\/em><\/p>\n<\/div>\n

          \"\"<\/p>\n

          \n

          Tupa<\/b> <\/b>trauma<\/b> <\/b>arterije<\/b> <\/b>Delovanje tupe traume (kontuzija, kompresija) se najpre ispoljava na najosetljivijem (unutra\u0161njem) sloju arterije. Prvo strada intima, za razliku od o\u0161tre traume gde prvo strada adventicija. U zavisnosti od intenziteta tupe traumatiziraju\u0107e sile i otpornosti tkiva razlikuju se tri stadijuma:<\/p>\n

            \n
          • Lezija<\/b> <\/b>intime<\/b>. Krvarenja nema, a obi\u010dno nije prisutna ni periferna ishemija. Destrukcija intime mo\u017ee zahvatati duga\u010dak segment. Intima mo\u017ee biti zacepljena celom cirkumferencijom, sa flotiraju\u0107im listi\u0107ima, dovode\u0107i do tromboze (ili disekcije) sa perifernom ishemijom.<\/li>\n
          • Lezija<\/b> <\/b>intime<\/b> i<\/b> <\/b>medije<\/b> <\/b>delovanjem tupe sile. Nema znakova krvarenja. Verovatno\u0107a da \u0107e se razviti sekundarna tromboza (\u010dak i u ve\u0107im arterijama) je velika. Mo\u017ee se razviti posttraumatska aneurizma.<\/li>\n
          • Lezija<\/b> <\/b>intime,<\/b> <\/b>medije<\/b> <\/b>i<\/b> <\/b>adventicije<\/b>, sa kompletnim prekidom kontinuiteta arterije. Proksimalni i distalni segment kontuzovane arterije se retrahuje. Razvija se akutna ishemija. Ako je u pitanju arterija ve\u0107eg kalibra spazam nije dovoljan da zaustavi krvarenje iz proksimalnog segmenta.<\/li>\n<\/ul>\n

            Dijagnoza arterijske lezije<\/strong> nastale delovanjem tupe sile je ote\u017eana zbog odsustva spolja\u0161nje rane u predelu arterije i politraume, pogotovo ako postoje frakture ili avulzije mekih tkiva. Delovanje tupe sile izaziva povrede du\u017eih arterijskih segmenata.<\/p>\n

            Zbog toga nikad ne treba insistirati na direktnoj suturi naizgled zdravih arterijskih segmenata. Uvek je lediran du\u017ei segment no \u0161to se to makroskopski zapa\u017ea. Zato je \u010desto neophodna interpozicija grafta da bi se uspostavila korektna revaskularizacija.<\/p>\n

            Indirektno<\/b> <\/b>dejstvo<\/b> <\/b>sile:<\/b> <\/b>Arterijske povrede koje nastaju kao posledica dejstva sile usmerene na drugi region tela smatraju se indirektnim. Indirektne arterijske lezije su:<\/p>\n

              \n
            • Deceleracione povrede arterija, i<\/li>\n
            • Traumatski arterijski spazam.<\/li>\n<\/ul>\n

              Deceleracione<\/b> <\/b>povrede<\/b> <\/b>arterija:<\/b> <\/b>Saobra\u0107ajni traumatizam dovodi do iznenadnih udara ubrzanja ili usporenja velike kineti\u010dke energije. Pri sudaru \u010desto dolazi do udara u prednji zid grudnog ko\u0161a; sa abruptnim masivnim pomeranjem intratorakalnih organa.<\/p>\n

              Obzirom da se radi o organima razli\u010dite specifi\u010dne te\u017eine i razli\u010dite otpornosti na sile istezanja i cepanja deceleracija izaziva povrede unutra\u0161njih organa.<\/p>\n

              Descendentna aorta pri\u010dvr\u0161\u0107ena je za ki\u010dmeni stub bo\u010dnim granama (interkostalne arterije). Nasuprot tome sam aortni luk nije \u010dvrsto fiksiran za ko\u0161tane strukture. Njegov jedini oslonac su grane luka aorte. Zbog toga se izdvajaju tri slabe ta\u010dke koje su izlo\u017eene dejstvu udara pri deceleraciji:<\/p>\n

                \n
              • Po\u010detni deo ascendentne aorte,<\/li>\n
              • Orificijum brahiocefali\u010dnog trunkusa i<\/li>\n
              • Predeo aortnog istmusa neposredno ispod odvajanja leve subklavijalne arterije.<\/li>\n<\/ul>\n

                Vertikalna<\/b> <\/b>deceleracija<\/b> <\/b>(prilikom pada sa visine) naj\u010de\u0161\u0107e dovodi do lezija luka aorte. Pri padu sa visine sr\u010dana masa ima ve\u0107e ubrzanje od okolnih organa, izazivaju\u0107i ekstremnu fleksiju aortnog luka, koji se zbog svoje fiksiranosti cepa. Vertikalna deceleracija izaziva popre\u010dni rascep po\u010detnog dela ascendentne aorte ili konveksiteta aortnog luka.<\/p>\n

                Horizontalna<\/b> <\/b>deceleracija<\/b> <\/b>se naj\u010de\u0161\u0107e de\u0161ava pri sudaru u velikoj brzini. Pri naglom ko\u010denju sr\u010dana masa udara u sternum. Hidrauli\u010dni udar dovodi do torzije i angulacije aortnog luka. Me\u0111utim, aortni luk je u predelu svog istmusa (lig.<\/i> <\/i>arteriosum<\/i>) fiksiran. Okolni nefiksirani delovi torakalne aorte (proksimalno i distalno) najlak\u0161e \u0107e rupturirati. Obi\u010dno nastaje popre\u010dni rascep neposredno ispod ostijuma subklavijalne arterije.<\/p>\n

                Deceleraciona<\/span> <\/span>trauma<\/span> <\/span>aortnog<\/span> <\/span>luka<\/span> <\/span>i<\/span> <\/span>velikih<\/span> <\/span>supraaortalnih<\/span> <\/span>stabala<\/span> <\/span>zapo\u010dinje<\/span> <\/span>cepanjem<\/span> <\/span>intime.<\/span> <\/span>Ako<\/span> <\/span>se<\/span> <\/span>delimi\u010dno<\/span> <\/span>sa\u010duva<\/span> <\/span>medija<\/span> <\/span>i<\/span> <\/span>adventicija<\/span> <\/span>ne\u0107e<\/span> <\/span>do\u0107i<\/span> <\/span>do<\/span> <\/span>rupture<\/span> <\/span>aorte.<\/span> <\/span>U<\/span> <\/span>takvih<\/span> <\/span>pacijenata<\/span> <\/span>se<\/span> <\/span>posle<\/span> <\/span>izvesnog<\/span> <\/span>vremena<\/span> <\/span>razvija<\/span> <\/span>pulsiraju\u0107i<\/span> <\/span>hematom,<\/span> <\/span>a<\/span> <\/span>kasnije<\/span> <\/span>pseudoaneurizma.<\/span> <\/span>Predilekciona<\/span> <\/span>mesta<\/span> <\/span>su:<\/span> <\/span>zavr\u0161ni<\/span> <\/span>deo<\/span> <\/span>aortnog<\/span> <\/span>luka<\/span> <\/span>(istmus)<\/span> <\/span>i<\/span> <\/span>aorta<\/span> <\/span>descendens.<\/span><\/p>\n

                Traumatski<\/b><\/span> <\/b><\/span>arterijski<\/b><\/span> <\/b><\/span>spazam:<\/b><\/span> <\/b><\/span>Trauma<\/span> <\/span>mo\u017ee<\/span> <\/span>dovesti<\/span> <\/span>do<\/span> <\/span>spazma<\/span> <\/span>muskularnog<\/span> <\/span>sloja<\/span> <\/span>arterije<\/span> <\/span>koja<\/span> <\/span>nije<\/span> <\/span>ledirana.<\/span> <\/span>Klini\u010dki<\/span> <\/span>znaci<\/span> <\/span>blage<\/span> <\/span>ishemije<\/span> <\/span>se<\/span> <\/span>brzo<\/span> <\/span>povla\u010de.<\/span> <\/span>Izvestan<\/span> <\/span>stepen<\/span> <\/span>arterijskog<\/span> <\/span>spazma<\/span> <\/span>se<\/span> <\/span>javlja<\/span> <\/span>kao<\/span> <\/span>deo<\/span> <\/span>posttraumatskog<\/span> <\/span>\u0161oka<\/span> <\/span>i<\/span> <\/span>centralizacije<\/span> <\/span>krvotoka.<\/span> <\/span>Dijagnoza<\/span> <\/span>traumatskog<\/span> <\/span>arterijskog<\/span> <\/span>spazma<\/span> <\/span>je<\/span> <\/span>vrlo<\/span> <\/span>opasna,<\/span> <\/span>jer<\/span> <\/span>mo\u017ee<\/span> <\/span>da<\/span> <\/span>dovede<\/span> <\/span>do<\/span> <\/span>gubitka<\/span> <\/span>vremena<\/span> <\/span>u<\/span> <\/span>urgentnoj<\/span> <\/span>situaciji.<\/span> <\/span>Pravi<\/span> <\/span>arterijski<\/span> <\/span>spazam<\/span> <\/span>je<\/span> <\/span>raritet.<\/span> <\/span>Spazam<\/span> <\/span>mo\u017ee<\/span> <\/span>biti<\/span> <\/span>posledica:<\/span> <\/span>(1)<\/span> <\/span>kompresije<\/span> <\/span>hematomom<\/span> <\/span>ili<\/span> <\/span>ko\u0161tanim<\/span> <\/span>fragmentima,<\/span> <\/span>(2)<\/span> <\/span>posttraumatske<\/span> <\/span>intramuralne<\/span> <\/span>hemoragije.<\/span><\/p>\n

                Dijagnoza<\/span> <\/span>traumatskog<\/span> <\/span>arterijskog<\/span> <\/span>spazma<\/span> <\/span>se<\/span> <\/span>sme<\/span> <\/span>postaviti<\/span> <\/span>\u201c<\/span>per<\/i><\/span> <\/i><\/span>exclusionem<\/i><\/span>\u201d,<\/span> <\/span>ako<\/span> <\/span>isklju\u010dimo<\/span> <\/span>sve<\/span> <\/span>organske<\/span> <\/span>lezije.<\/span> <\/span>Tek<\/span> <\/span>tada<\/span> <\/span>je<\/span> <\/span>mo\u017eemo<\/span> <\/span>le\u010diti:<\/span> <\/span>(1)<\/span> <\/span>intraarterijskim<\/span> <\/span>infundiranjem<\/span> <\/span>2-5%<\/span> <\/span>Papaverina,<\/span> <\/span>(2)<\/span> <\/span>Perkutanom<\/span> <\/span>transluminalnom<\/span> <\/span>dilatacijom.<\/span><\/p>\n

                Lezije<\/b><\/span> <\/b><\/span>karotidnih<\/b><\/span> <\/b><\/span>arterija<\/b><\/span> <\/b><\/span>su<\/span> <\/span>uzrok<\/span> <\/span>mo\u017edane<\/span> <\/span>ishemije.<\/span> <\/span>Me\u0111utim,<\/span> <\/span>ishemija<\/span> <\/span>mozga,<\/span> <\/span>\u010dak<\/span> <\/span>i<\/span> <\/span>u<\/span> <\/span>slu\u010daju<\/span> <\/span>kompletne<\/span> <\/span>akutne<\/span> <\/span>okluzije,<\/span> <\/span>ne<\/span> <\/span>mora<\/span> <\/span>da<\/span> <\/span>dovede<\/span> <\/span>do<\/span> <\/span>ishemi\u010dkog<\/span> <\/span>insulta.<\/span> <\/span>Asimptomatski<\/span> <\/span>tok<\/span> <\/span>postoji<\/span> <\/span>u<\/span> <\/span>oko<\/span> <\/span>30%<\/span> <\/span>pacijenata,<\/span> <\/span>Reverzibilna<\/span> <\/span>mo\u017edana<\/span> <\/span>ishemija<\/span> <\/span>javlja<\/span> <\/span>se<\/span> <\/span>u<\/span> <\/span>oko<\/span> <\/span>30%<\/span> <\/span>pacijenata,<\/span> <\/span>a<\/span> <\/span>ostali<\/span> <\/span>\u0107e<\/span> <\/span>razviti<\/span> <\/span>ishemi\u010dki<\/span> <\/span>infarkt<\/span> <\/span>mozga.<\/span><\/p>\n

                Kod<\/span> <\/span>tupih<\/span> <\/span>povreda<\/span> <\/span>karotidnih<\/span> <\/span>arterija<\/span> <\/span>neurolo\u0161ke<\/span> <\/span>manifestacije<\/span> <\/span>javljaju<\/span> <\/span>se<\/span> <\/span>obi\u010dno<\/span> <\/span>posle<\/span> <\/span>vi\u0161e<\/span> <\/span>sati,<\/span> <\/span>pa<\/span> <\/span>i<\/span> <\/span>nekoliko<\/span> <\/span>dana.<\/span> <\/span>Prilikom<\/span> <\/span>opservacije,<\/span> <\/span>u<\/span> <\/span>neposrednom<\/span> <\/span>posttraumatskom<\/span> <\/span>periodu,<\/span> <\/span>pa\u017enju<\/span> <\/span>treba<\/span> <\/span>posvetiti<\/span> <\/span>ranom<\/span> <\/span>otkrivanja<\/span> <\/span>promena<\/span> <\/span>mentalnog<\/span> <\/span>stanja<\/span> <\/span>i<\/span> <\/span>pojavi<\/span> <\/span>\u017eari\u0161nih<\/span> <\/span>slabosti,<\/span> <\/span>glavobolja,<\/span> <\/span>disfazije,<\/span> <\/span>vrtoglavice<\/span> <\/span>itd.<\/span> <\/span>Na<\/span> <\/span>tupe<\/span> <\/span>povrede karotidnih<\/span> <\/span>arterija, <\/span>sa<\/span> <\/span>disekcijom zida,<\/span> <\/span>treba pomisliti<\/span> <\/span>u<\/span> <\/span>slu\u010daju<\/span> <\/span>hiperekstenzivnih<\/span> <\/span>povreda<\/span> <\/span>vrata,<\/span> <\/span>posebno<\/span> <\/span>ako<\/span> <\/span>su<\/span> <\/span>pra\u0107ene<\/span> <\/span>prelomom<\/span> <\/span>pr\u0161ljenova<\/span> <\/span>i<\/span> <\/span>kada<\/span> <\/span>aktuelni<\/span> <\/span>neurolo\u0161ki<\/span> <\/span>de<\/span>fi<\/span>cit<\/span> <\/span>ne<\/span> <\/span>mo\u017ee<\/span> <\/span>da<\/span> <\/span>se<\/span> <\/span>objasni<\/span> <\/span>povredom<\/span> <\/span>glave.<\/span><\/p>\n

                Penentrantne lezije karotidnih arterija izazvane vatrenim oru\u017ejem su te\u0161ke pov- rede sa visokom smrtno\u0161\u0107u zbog neurolo\u0161kih o\u0161te\u0107enja i \u0161oka. Izuzetak je retka mogu\u0107nost nastanka pseudoaeurizme i fistule izme\u0111u zajedni\u010dke karotidne arterije<\/p>\n

                Lezije<\/b> <\/b>potklju\u010dnih<\/b> <\/b>arterija<\/b> <\/b>podrazumevaju veliki neposredni morbiditet. U objektivnom nalazu dominira gubitak radijalnog pulsa, ishemija ruke i znaci lezije brahijalnog spleta. Disekcija potklju\u010dne arterije se manifestuje: bolovima u grudnom ko\u0161u i vratu i slabim radijalnim pulsom. Kod okluzije proksimalnog segmenta potklju\u010dne arterije, pre odstupa vertebralne arterije, razvija se steal<\/i> <\/i>syndrom<\/i>.<\/b> <\/b>Obi\u010dno se javlja kod tupe povrede grudnog ko\u0161a, preloma klavikule i povreda ramenog pojasa.<\/p>\n

                \"\"<\/p>\n

                Traumatska disekcija po\u010detnog dela unutra\u0161nje karotidne arterije, zbog rascepa intime, sa trombozom la\u017enog lumena.<\/em><\/p>\n

                Posttraumatska pseudoaneurizma, posle preloma klavikule, razvija se vi\u0161e meseci nakon povrede. Znaci su bol i klaudikacije u ruci zbog embolizacije. Pridru\u017eeno o\u0161te\u0107enje brahijalnog pleksusa sre\u0107e se u oko 30 % osoba sa povredom potklju\u010dne arterije. Povrede brahijalnog spleta su \u010de\u0161\u0107e i te\u017ee posle tupih povreda.<\/p>\n<\/p>\n<\/div>\n


                \n<\/p>\n","protected":false},"excerpt":{"rendered":"

                POVREDE ARTERIJA KOJE ISHRANJUJU MOZAK Surgery is poetry of precission. When something goes amiss the surgeon should not pause to determine who is responsible, or who is to blame. The surgeon should direct his effort toward correcting the problem. Placement of blame can wait until the storm abates. J. Vollmar Epidemija saobra\u0107ajnih nesre\u0107a i nasilja […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-4193","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n17. 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