Content 1/2019

INTRODUCTION

  • Editorial – Jana Šeblová
  • Contents
  • New editorial team of „Urgentní medicína“ journal

EMERGENCY DEPARTMENTS

  • Diagnostics and Treatment of Influenza on Emergency Department – Robin Šín, Dalibor Sedláček

PREHOSPITAL EMERGENCY CARE

  • Bystander CPR and succesful primary percutaneous coronary intervention of culprit lesion within two hours – case
    report – Táňa Bulíková, Patrik Christian Cmorej
  • Analysis of patients´ entrappment in traffic crashes associated with trauma severity – Radek Přecechtěl, Tomáš Vaňatka
  • Crisis Resource Management in the prehospital emergency care – Katarína Veselá

TECHNICAL EQUIPMENT AND DEVICES

  • The patient with subcutaneous implantable cardioverter defibrilator in the prehospital emergency care – Jaroslav Halamka, Lukáš Vais, Martin Kubát, Radomír Vlk

PHYSIOLOGY AND EMERGENCY MEDICINE

  • Intraosseous administration of medications – how does it “work”? – David Astapenko, Vladimír Černý

DISCUSSION, OPINION

  • Misuse of Emergency Medical Services? – Marek Slabý
  • We and our patients are in the same boat – it’s name is emergency medicine – Jana Šeblová, Ondřej Franěk
  • Who is endangered by overuse of Emergency Medical Services? – Roman Gřegoř

INFORMATION

  • A report on 10th Central European Congress of Disaster and Emergency Medicine in Vyhne – Táňa Bulíková, Štefan Trenkler

 

ABSTRACTS

 

DIAGNOSTICS AND TREATMENT OF INFLUENZA ON EMERGENCY DEPARTMENT

Robin Šín, Dalibor Sedláček

Abstract

Influenza is an infectious disease caused by influenza viruses A, B and exceptionally C that belong to the family of orthomyxoviruses. Pandemics and epidemics of the influenza have been historically well documented and have been accompanying the whole mankind for a long time. Typical flu symptoms include sudden onset of fever with chills, fatigue and weakness. The patient has headache, muscle and joint pain. There may also occur a gastrointestinal symptoms such as nausea, vomiting and diarrhea. Non-productive cough can also be observed. Influenza can be accompanied by serious complications such as bacterial pneumonia, heart failure, myocarditis, pericarditis, encephalopathy or encephalitis. The diagnosis can be made by rapid influenza diagnostic test, RT-PCR, possibly virus culture. Oral oseltamivir is also used in therapy and chemoprophylaxis, which can also be given to pregnant women and children. Zanamivir is intended for inhalation and is suitable even when oseltamivir chemoprophylaxis has failed. Using appropriate available diagnostic methods and correctly interpreting hospital entry results, it is possible to precisely identify influenza patients, early use of antiviral therapy, reduce unnecessary laboratory testing and reduce the use of antibiotics.

Key words: influenza – diagnostics – treatment – oseltamivir – emergency department

 

BYSTANDER CPR AND SUCCESFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION OF CULPRIT LESION WITHIN TWO HOURS – CASE REPORT

Táňa Bulíková, Patrik Christian Cmorej

Abstract

The authors are presenting a commented case report of outof- hospital cardiac arrest with initial defibrillated rhythm as a deterioration of acute myocardial infarction. Early detection of STEMI and initialisation of rapid transport to PCI depends on several factors as early start of lay CPR provided by bystanders, early defibrillation and achieving of ROSC by the EMS crew and 12leads ECG provided soon after ROSC. The outcome is higher if the time between call to Emergency Medical Dispatching and handover in the hospital is less than 90 minutes.

Key words: out-of-hospital cardiac arrest, first aid, early defibrillation, STEMI, primary percutaneous coronary intervention

 

ANALYSIS OF PATIENTS´ ENTRAPPMENT IN TRAFFIC CRASHES ASSOCIATED WITH TRAUMA SEVERITY

Radek Přecechtěl, Tomáš Vaňatka

Abstract

A trapped patient is one of the aspects of mechanism of injury in motor vehicle collisions. This aspect remains unknown to the EMS (emergency medical services). While the patient may be in a critical condition, it may also turn out that the person is simply unable to get out of the crashed vehicle.
The primary objective is to analyse and evaluate the relevance of being trapped to the extent of the injury. In other words, the work attempts to establish possible predictive aspects relevant to the extent of the injury, thereby enabling easier triage at the scene of the accident.
A retrospective data analysis is carried out in the region of Vysočina from the period of 2016–17 by means of applied research. 638 triage positive patients are selected out of a total of 84,336. The whole process of reanimation is observed until the patient has reached a trauma centre (University Hospital Brno and Military University Hospital Prague). Complete data is available for 81. The following points are analysed: body position, mechanism of injury, use of seatbelts, length of reanimation period, amount of lactate and haemoglobin in two groups ISS ≤ 15 a ISS ≥ 16.
The results show that the highest amount of ISS is linked with the frontal impact and the ‘UP’ position (20.67 ISS) whereas the lowest amount of ISS comes with the position ‘DOWN’ (19.70 ISS). The most significant predictor is the amount of lactate (1,770;3,503 mmol/l), lenght of reanimation period (81;100,2 min.) and the amount of haemoglobin (140,6;122,7 g/l). The results also reveal the prediction of the use of seatbelts RISS = 2.65.
The applied research shows over-triage of 57% of patients who, due to the absence of predictive aspects of being trapped, were transported to trauma centres. We propose the acceptance of criteria of the factor of being trapped, especially the ‘extrication length’ factor and the ‘intrusion occupant site’ factor. Finding out the amount of lactate by the EMS is of great significance, too.

Key words: triage positivity – being trapped – mechanism of injury – lactate – haemoglobin – reanimation period

 

CRISIS RESOURCE MANAGEMENT IN THE PREHOSPITAL EMERGENCY CARE

Katarína Veselá

Abstract

Crisis resource management (CRM) means to coordinate, use and apply all available resources to protect and help the patient as best as possible. The term resources includes all personnel involved, along with all their skills, abilities and attitude. Machines, devices, and information sources, including cognitive aids, are also critical resources. It is very closely related to the non-technical skills needed for effective teamwork in an emergency situation.

Key words: CRM – crisis – soft skills – nontechnical skills

 

THE PATIENT WITH SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILATOR IN THE PREHOSPITAL EMERGENCY CARE

Jaroslav Halamka, Lukáš Vais, Martin Kubát, Radomír Vlk

Abstract

A subcutaneous implantable cardioverter defibrillator is a relatively new technology in the treatment of life-threatening arrhythmias. Its advantage is subcutaneous electrode placement, which eliminates the complications associated with intravenous electrode insertion used with conventional implantable cardioverter defibrillator. Increasing the number of implantations of this device brings new problems also in pre-hospital emergency care. The authors present basic information about this type of device, including selected complications in the context of pre-hospital emergency care.

Key words: prehospital emergency care – subcutaneous implantable cardioverter defibrillator – inappropriate shocks

 

INTRAOSSEOUS ADMINISTRATION OF MEDICATIONS – WHY DOES IT “WORK”?

David Astapenko, Vladimír Černý

Abstract

Intraosseous administration of drugs is legitimate method used mainly in emergency medicine. It is well known from the practice that the pharmacokinetics of the drug delivery through this way corresponds to the intravenous administration. The anatomical substrate of this connection has been elusive until recently. Trans–cortical junctions are responsible for linking anatomical and functional bone circulation.

Key words: intraosseous access – bone microcirculation

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