Content 2/2019

INTRODUCTION

  • Editorial – Jana Šeblová
  • Contents
  • International Editorial Board of „Urgentní medicína“ journal

EMERGENCY DEPARTMENTS

  • Nonadherence to antihypertensive therapy in emergency medicine – Marcel Nesvadba, Petr Bureš, Alena Kohlová, Patrik Christian Cmorej
  • Patient with abdominal pain at emergency department – Jana Berková

PAEDIATRICS IN EMERGENCY MEDICINE

  • Non-traumatic abdominal pain in children – Pavel Heinige

MEDICAL DEVICES

  • Telemedicine in pre-hospital emergency care: 2019 update – Roman Sýkora, Metoděj Renza

PHYSIOLOGY AND EMERGENCY MEDICINE

  • Relief position in dyspnea – what does patient tell us? – David Astapenko, Vladimír Černý

EDUCATION

  • Education at Prague Emergency Medical Services – David Peřan, Radomír Vlk, Petr Pavlíček, Jarmila Paukertová, Dagmar Vysočanská, Viktor Bažant, Jaroslav Pekara, Robert Tomka, Vladimír Nedvěd, Radana Krtilová, Petr Kolouch

INFORMATION

  • Emergency Medicine Day 27th May – Jana Šeblová
  • Review of the book by Jan Smetana et al.: „Highly infectious diseases“ – Patrik Christian Cmorej

 

ABSTRACTS

 

NONADHERENCE TO ANTIHYPERTENSIVE TREATMENT IN EMERGENCY MEDICINE

Marcel Nesvadba, Petr Bureš, Alena Kohlová, Patrik Christian Cmorej

Abstract

Nonadherence to antihypertensive treatment is a common cause of pseudo-resistant hypertension. Nonadeherence is responsible for a higher incidence of hypertensive crisis. Patient nonadherence to antihypertensive treatment causes false diagnosis of resistant hypertension in emergency departments. This article explores factors that have an impact on patient antihypertensive medication nonadherence.

Key words: hypertension – nonadherence – resistant hypertension – emergency medicine

 

PATIENT WITH ABDOMINAL PAIN AT EMERGENCY DEPARTMENT

Jana Berková

Abstract

Abdominal pain is one of the most common reasons of emergency department´s visit. Accurate medical history and clinical examination forms the basis of the diagnostic-therapeutic approach. Recognition of severely ill patient is a crucial part of this management, as the abdominal pain could be lifethreatening in this case. A timely surgical examination and the earliest indication of surgical treatment are important parts of symptom´s management, too.

Key words: acute abdominal pain – emergency department – differential diagnosis

 

NON-TRAUMATIC ABDOMINAL PAIN IN CHILDREN

Pavel Heinige

Abstract

Acute abdominal pain is in childhood one of the most frequent reasons to seek a medical help. Pain of abdomen is a symptom, that can be presented in large volume of diseases. Some of those may be urgent and potentially life threatening. The most important task for the medical staff is to identify a manifestation of a acute abdomen.

Key words: Acute abdominal pain – child – acute abdomen

 

TELEMEDICINE IN PRE-HOSPITAL EMERGENCY CARE: 2019 UPDATE

Roman Sýkora, Metoděj Renza

Abstract

Introduction: The current level of information and communication technologies leads to extensive development and research in the use of telemedicine (TM) methods in pre-hospital emergency care (PEC). Objective: To present a summary of news, possibilities, including own experience from the Emergency Medical Service of the Karlovy Vary Region (EMS KV) and possible future directions for the use of TM.
Methods: The recently published papers on this topic were actively searched for in the Pubmed database. However, with regard to their inhomogeneity and fundamental methodological differences, these researched publications were further evaluated without a specific systematic methodology, but only according to the criterion of topicality, relevance or interest for presentation in this summary. As a part of this review, there are commented the outcomes of technical feasibility implemented at the EMS KV in the years 2016–2019, which aimed to utilize existing, commonly used technologies in the PEC for audiovisual consultations of distant physicians with the paramedics at scene.
Results: In some sub-specialisations of the PEC, TM is well used in the world and Czech Republic. Nowadays, it is possible to rely on a number of data showing better outcomes in patients especially with acute coronary syndrome or stroke. Partial results are available for trauma care. Audiovisual TM assistance was provided to the paramedics, where the goal was to perform a supervised procedure or action (pericardiacentesis, thoracostomy, intubation, burns, ultrasound examination). However, described promising results have been achieved mainly in simulations and expectations were less fulfilled under normal clinical conditions. More complicated is the general use of TM in the PEC. An example is the Houston research programme, which is probably the largest so far. It is based on application of the audiovisual consultations to events with low clinical severity or urgency. In those local conditions, there was a significant reduction in crews “back in service time”, mainly due to the physician´s consultation and the recommendation of alternative patient transport to an emergency department. During verifying the technical feasibility of TM in the EMS KV with use of available and currently used technologies (computer and mobile phone), it is suggestive that the dominant direction of the development of TM assistance will be in lower urgency or diagnostic uncertainties.
Conclusion: Despite all technical limitations, TM can be considered a sub-discipline that, thanks to its dynamic development, will increasingly penetrate into the work of the PEC, either individually or systematically. Truly relevant data on patient´s outcomes from prospective and randomized studies are currently available, particularly in urgent cardiology and neurology. The general and wide interdisciplinary use of audiovisual consultations or TM assistances is technically easy to implement, but it is still a very unsystematic subject in which research questions, methodology and data collection need to be set for future direction.

Key words: telemedicine – telehealth – pre-hospital emergency care – telemedicine assistance

 

RELIEF POSITION IN DYSPNEA – WHAT DOES PATIENT TELL US?

David Astapenko, Vladimír Černý

Abstract

Dyspnoea is a subjectively unpleasant feeling of breathing deficiency that can arise from a variety of pathological conditions. In the differential diagnosis, the so-called relief position, which the patient takes spontaneously, and which is related to pathogenesis can help. In the relief position the patient can optimally utilize the accessory respiratory muscles, the distribution of ventilation and perfusion in the lungs or increase venous return and right heart filling pressures. Orthopnoea links the decompensation of many chronic diseases. In contrast, platypnoe is a relatively rare condition that can guide us quite accurately in diagnosis.

Key words: dyspnoea – relief position – orthopnoea – platypnoea

 

EDUCATION AT PRAGUE EMERGENCY MEDICAL SERVICES

David Peřan, Radomír Vlk, Petr Pavlíček, Jarmila Paukertová, Dagmar Vysočanská, Viktor Bažant, Jaroslav Pekara, Robert Tomka, Vladimír Nedvěd, Radana Krtilová, Petr Kolouch

Abstract

Education and Training Centre (ETC) of the Prague Emergency Medical Services is with the Personal department responsible for the education of all employees of the organisation. ETC takes care of employees from their selection through the adaptation process to continuous lifelong learning, which is divided into compulsory, developmental and voluntary education.
ETC builds an education system based on the blended learning model – a combined method of learning, combining a class room education and distance learning with a special virtual learning environment.
The article describes different parts of education and presents data from the years 2016–2018.

Key words: Education – blended learning – emergency medical services – Education and Training Centre (ETC)

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