INTRODUCTION
- Contents
- Editorial – Jana Šeblová
EMERGENCY DEPARTMENTS
- Status epilepticus as a complication of blunt trauma in 41-year-old patient: a case report – Robin Šín, Radek Tupý, Patrik Christian Cmorej, Lukáš Handl
- Paradoxical embolism – a rare cause of acute limb ischaemia – a case report – Jana Berková, Tomáš Lutonský
PHYSIOLOGY AND EMERGENCY MEDICINE
- Pulsus paradoxus and its significance in prehospital care – David Astapenko, Vladimír Černý
EDUCATION
- National analysis of the number of graduates and demands of employees of the Emergency Medical Services after abolition of higher professional medical schools – David Peřan, Jaroslav Pekara, Radomír Vlk, Marek Slabý, Petr Kolouch
- How to pass the specialisation exam in emergency medicine? – Katarína Veselá, Jana Kubalová, Jana Šeblová
GUIDELINES
- Guidelinea for prehospital emergency care during COVID 19 (SARS-CoV-2) pandemic – Eva Smržová, Jana Šeblová, Anatolij Truhlář, Roman Gřegoř, Jana Kubalová, Ondřej Franěk
ETHICS, PSYCHOLOGY, LAW
- „Against medical advice“ (AMA) form: a feared paramedic´s competence – Nikola Brizgalová, Roman Sýkora, Miloš Kukačka
DISCUSSION, OPINION
- Emergency versus intensive medicine – intersections and differences – Roman Škulec
- Response on MF Dnes article published on 22th November 2019: EMS is called even for a tick bite nowadays“ – Jiří Knor
INFORMATION
- Covid 19
ABSTRACTS
STATUS EPILEPTICUS AS A COMPLICATION OF BLUNT TRAUMA IN 41-YEAR-OLD PATIENT: A CASE REPORT
Robin Šín, Radek Tupý, Patrik Christian Cmorej, Lukáš Handl
Abstract
The status epilepticus is being defined as a persistent or recurrent epileptic seizures due to the failure of its terminating mechanisms. In a tonic-clonic seizures, a new consensus has been adopted, that already after 5 minutes it is assessed as the epileptic status and that we may expect long-term sequelae if the activity lasts longer than 30 minutes. Epileptic seizures can develop in up to 3% of patients with head trauma. If the epileptic status develops, the observed mortality reaches up to 25%. The basis of the treatment is the airway management, ventilation and stabilization of blood circulation. The medical therapy is initiated by administration of benzodiazepines, the second choice being phenytoin, valproic acid, or levetiracetam. In refractory epileptic status, propofol is used from anaesthetics. In case of its insufficient effect, it is followed by continuous administration of phenobarbital. It is always necessary to perform targeted laboratory tests, brain CT scan in case of head injury, too, while EEG monitoring is advisable. The case report presents a female patient who developed status epilepticus three hours after a blunt cranial trauma in the home environment without proven loss of consciousness immediately after the injury. Upon administration of diazepam and levetiracetam, after 25 minutes of the epileptic status, the patient´s condition was restored and thus the progression to refractory status epilepticus was prevented.
Key words: status epilepticus – head injury – benzodiazepines – levetiracetam – valproic acid – emergency department
PARADOXICAL EMBOLISM – A RARE CAUSE OF ACUTE LIMB ISCHAEMIA – A CASE REPORT
Jana Berková, Tomáš Lutonský
Abstract
This paper presents a rare cause of acute limb ischemia, paradoxical embolism. The pararadoxical embolism is defined as a passage of venous thrombus into arterial circulation caused by defect in the cardiac atrium region (patent oval foramen or atrial septal defect). Two case reports of patients with acute limb ischemia and paradoxical embolism are presented as a view of management by emergency medical servis and at the emergency department.
Key words: paradoxical embolism – acute limb ischemia – initial management
PULSUS PARADOXUS AND ITS SIGNIFICANCE IN PREHOSPITAL CARE
David Astapenko, Vladimír Černý
Abstract
Pulsus paradoxus (PP) represents a decrease in systolic blood pressure during inspiration of more than 10 mmHg. It is caused by pathologically altered cardiopulmonary interactions that lead to a transient decrease in stroke volume and pressure wave amplitude (systolic – diastolic pressure difference). PP can be easily examined. It is an important sign of a number of pathological conditions (e.g. cardiac tamponade, severe asthma, massive pulmonary embolism, hypovolemic shock). The dynamics of PP can also be used to monitor response to fluid treatment. In addition to the actual pulse palpation, PP can be objectified on the plethysmographic curve of pulse oximetry.
Key words: pulsus paradoxus – cardiac tamponade – asthma – hypovolemia
NATIONAL ANALYSIS OF THE NUMBER OF GRADUATES AND DEMANDS OF EMPLOYEES OF THE EMERGENCY MEDICAL SERVICES AFTER ABOLITION OF HIGHER PROFESSIONAL MEDICAL SCHOOLS
Peřan, Jaroslav Pekara, Radomír Vlk, Marek Slabý, Petr Kolouch
Abstract
Introduction: The amendment to the Act on Non-medical Health Professions brought a change in the education of paramedics in 2017. In 2021, respectively on January 2022, the branch of a qualified paramedic taught at higher professional medical schools ceases to exist.
Method: Analysis of the number of graduates of the paramedic study at all educational institutions and comparison with the presumptions of Emergency Medical Services for new employees was made.
Results: 280 students graduate from higher professional medical schools and 196 students graduate from college each year. The requirement for a mere generational replacement of emergency medical services is 68 employees each year.
Conclusion: The abolition of higher professional medical schools will result, without reaction to the situation, in a 59% reduction in the number of graduates. It is possible to respond by increasing the number of students admitted or by opening this field of study at other institutions.
Key words: paramedics – college – higher professional medical school – employment
„AGAINST MEDICAL ADVICE“ (AMA) FORM: A FEARED PARAMEDIC´S COMPETENCE
Nikola Brizgalová, Roman Sýkora, Miloš Kukačka
Abstract
According to current explanation of health care legislation it is possible for the paramedics taking care of the patient at the scene to let the patient sing out “against medical advice” (AMA) form. Paramedics can do it without participation of medical doctor if the medical advice is within the range of paramedics’ competencies. So it is possible to assume that calls indicated for the paramedic crews that can be completely taken care of by this type of crew without necessity of escalation of prehospital medical care (by calling the doctor to the scene or consulting the care with him/her) are within the paramedics’ competencies and therefore it is adequate to accept signed out AMA form filed in by paramedics. This paramedic competence has been in Karlovy Vary Emergency Medical Service set up by inner document since 2018. This decision brought out discussion and serious concerns within paramedics about their responsibility. Therefore during February 2019 there was released the questionnaire to find out the real extend of worries. The results confirmed paramedics’ concerns especially about their ability to recognize patient’s legal capacity to sign out AMA form, as well as ability to correctly formulate the medical information and describe the risks and possible consequences of patient’s decision of signing out AMA form. Because of these results the topic of “signing out AMA form during paramedic calls” was addressed on the next session of internal paramedic training. Its aim was to dispel the fears, clarify the questions and subsequently evaluate the competencies again. At the end of this session 73% of attendants filled in AMA form correctly and proved overall knowledge compliant with the inner document. In presence it is possible to assume that paramedics have accepted this new competence. Nevertheless the presented results show the need for repetitive educational sessions focused on this topic. The measurement of factual knowledge as well as subjective parameters together with awareness of overall acceptance of this competence in paramedic group of employees is going to be of the most importance.
Key words: competence – refusal of health care – against medical advice (AMA) – paramedic