- Editorial – Jana Šeblová
- Emergency resuscitative thoracothomy in multiple trauma. A case report and literature review – Miroslav Durila, Tomáš Brož, Martin Šnajdauf, Pavla Baťková, Zuzana Přikrylová
PREHOSPITAL EMERGENCY CARE
- A rare case of cardiac arrest – a case report – Martin Novák, Jan Staněk, Petr Handlos, Klára Handlosová, Paula Dzurňáková, Roman Gřegoř
- Use of the points of interest in locating a caller on the emergency number 155 – national survey – David Peřan, Ondřej Franěk, Jaroslav Pekara, Radomír Vlk
PHYSIOLOGY AND EMERGENCY MEDICINE
- Palpitations – pathophysiology and clinical significance – David Astapenko, Roman Škulec
- Introduction – Ondřej Franěk
- Quality indicators in Emergency Medical Systems performance – Ondřej Franěk, Jaroslav Kratochvíl, Anatolij Truhlář
- Indication criteria and medical dispatching in Helicopter Emergency Medical Service (HEMS) – Anatolij Truhlář, Ondřej Franěk, Eva Smržová, Jaroslav Kratochvíl, Roman Gřegoř
- Interhospital transport of patients with severe and critical course of COVID-19 – Roman Škulec, Jan Bilík, Eva Smržová, Vladimír Černý
- How to pass the specialisation exam in emergency medicine? – Jana Šeblová, Katarína Veselá, Jana Kubalová
ETHICS, PSYCHOLOGY, LAW
- Children with life-limiting and life-shortening conditions – the aspects of palliative and intensive care – Jana Djakow, Mahulena Exnerová
EMERGENCY RESUSCITATIVE THORACOTHOMY IN MULTIPLE TRAUMA. A CASE REPORT AND LITERATURE REVIEW
Miroslav Durila, Tomáš Brož, Martin Šnajdauf, Pavla Baťková, Zuzana Přikrylová
In this case report, we present a case of a patient who suffered a traumatic circulatory arrest that was reversed only after performing a resuscitation thoracotomy with clamping of the descendent aorta. Despite 77 minutes long CPR, he survived without a neurological deficit.
Since the goal of primary CPR in polytrauma is „saving the brain and heart,“ this procedure should not be neglected in these patients. In the case of such serious types of injuries, the cooperation of paramedics, emergency doctors, anesthesiologists/intensivists and surgeons is critically important, beginning with pre-hospital care to definitive treatment in the operating room.
Key words: CPR – trauma – thoracotomy – circulatory arrest
A RARE CASE OF CARDIAC ARREST – A CASE REPORT
Martin Novák, Jan Staněk, Petr Handlos, Klára Handlosová, Paula Dzurňáková, Roman Gřegoř
Neuroleptic malignant syndrome (NMS) is a life-threatening clinical syndrome, which occurs in patients using antipsychotic medication, and is characterized with a tetrad of symptoms: qualitative or quantitative disturbance of consciousness, muscle rigidity, hyperpyrexia, and disorders of the autonomous nervous system. The incidence reported in literature ranges between 0.02 and 3% of all patients using antipsychotics. The presence of NMS is most frequently reported in first-generation antipsychotics – haloperidolum (Haloperidol), chlorpromazine (Plegomazin), methotrimeprazine (Tisercin) but also in other types of antipsychotic medication, such as e.g. Clozapine, Risperidone, Olanzapine. Other medications responsible for the occurrence of NMS include antiemetics, antiparkinsonics, lithium, and others. The diagnostics is very difficult. Laboratory results are characterized with metabolic acidosis and elevation of creatine kinase (CK), due to rhabdomyolysis and leucocytosis. Rhabdomyolysis may result in renal failure requiring haemodialysis. CT examination of the brain is usually negative. The therapy is symptomatic, individual, and depends on the actual manifestation of NMS. In the first place, the therapy with antipsychotics, or possibly other medication, which may be suspected as being responsible for the onset of NMS, should be discontinued. Several medicines have been experimentally tested for decreasing the morbidity and mortality of patients with NMS. At present, Bromocriptine and Dantrolene are being used, either individually or in combination.
The authors present a case report of a young patient, in whom the presence of neuroleptic malignant syndrome was masked with symptoms of multiple trauma with subsequent cardiac arrest. Despite successful cardiopulmonary resuscitation, the patient died with manifestations of hepatorenal failure and refractory shock. The definitive cause of death was established only after autopsy.
Key words: Malignant neuroleptic syndrome – immediate resuscitation – antipsychotic drugs
USE OF THE POINTS OF INTEREST IN LOCATING A CALLER ON THE EMERGENCY NUMBER 155 – NATIONAL SURVEY
David Peřan, Ondřej Franěk, Jaroslav Pekara, Radomír Vlk
Introduction: Localization is the most important step in the receiving of an emergency call, which technologies and their implementation in dispatching systems can greatly facilitate. The use of points of interest varies across regions. This survey aims to map the development of the use of points of interest in the Czech Republic (CR) and individual regions.
Method: A questionnaire survey was conducted at all emergency medical services (EMS) of the CR in the years 2014 and 2019 – complete data collection using structured questions with quantitative evaluation.
Results: In 2014, EMS in the CR used a total of 84 points of interest, while in 2019 it was already 162 (p = 0.04). Public lighting poles (SVO) had 7 emergency medical dispatching (EMD) introduced in the map data in 2014, while in 2019 it was already 10 EMD.
Conclusion: The emergency medical services in the CR is still involved in improving the databases of points of interest.
Key words: emergency medical dispatching – points of interest – integrated rescue system
PALPITATIONS – PATHOPHYSIOLOGY AND CLINICAL SIGNIFICANCE
David Astapenko, Roman Škulec
Palpitations are a subjective unpleasant perception of heart activity. Palpitations are the result of the complex sensation of the cardiac chambers, large vessels and mediastinum. They are associated with a wide range of diagnoses from completely benign (increased perception of physiological heart activity in anxiety or excessive physical activity) to severe conditions with uncertain prognosis (congenital heart defects, structural heart disease, valve pathology, chronic drug abuse, systemic diseases, etc.). For clinical practice, palpitations are an important impulse for initiating a broader diagnosis of the cardiovascular system.
Key words: palpitations – arrythmia – anxiety disorder – structural heart disease
CHILDREN WITH LIFE-LIMITING AND LIFE-SHORTENING CONDITIONS – THE ASPECTS OF PALLIATIVE AND INTENSIVE CARE
Jana Djakow, Mahulena Exnerová
There is increasing number of children with life-limiting and lifeshortening conditions (LLC). Although these conditions are usually rare, the contact with such patients might be more and more frequent also in the field of prehospital and emergency care. This text aims to clarify aspects of intensive and palliative care. We explain the main differences between paediatric and adult palliative care as well as the most frequent myths associated with the paediatric palliative care. We also try to outline frequent challenges perceived by prehospital and emergency care staff together with possible solutions of these difficult situations. Lastly, we mention the communication as the most important non-technical skill while taking care of these children and their families.
Key words: paediatric palliative care – life-limiting and life-shortening conditions – ethics – communication – prehospital and emergency care