INTRODUCTION
- Contents
- Editorial – Jana Šeblová
EMERGENCY DEPARTMENTS
- Admission of a patient with severe trauma to traumacenter – Jana Berková
- Comparison of SIRS and qSOFA diagnostic criteria in early detection of sepsis – a prospective observational study 4S – Jana Šeblová, Dominika Šeblová, Štěpánka Burešová, Jiří Knor, Viktor Rybáček
- A case report: Mild organophosphorus compound intoxication – Lucie Junová, Ondřej Rennét
PHYSIOLOGY AND EMERGENCY MEDICINE
- The principles of proper oxygen therapy in critically ill patients – Marcela Bílská, Roman Škulec, Barbora Stadlerová, Tomáš Pařízek, Michal Kalina, Vladimír Černý, David Astapenko
GUIDELINES
- Geriatrics and emergency medicine – do we really need age-specific standards? – Jana Šeblová, Eva Topinková
- Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine – Jacinta Lucke et al., translation: Vojtěch Mezera
- Guidelines: High priority emergency calls – Ondřej Franěk
- Criteria for identification of a person with vital functions´ failure or imminent endangering of vital functions during emergency call – Society for Emergency and Disaster Medicine CzMA JEP – Ondřej Franěk
EDUCATION
- How to pass the specialisation exam in emergency medicine? – Katarína Veselá, Jana Šeblová, Jana Kubalová
INFORMATION
- Memorandum between Ministry of Health and Ministry of Transport on co-operation in the field of HEMS safety and development
- Communiqué of the expert group for HEMS safety and development
- Contens – 2021
- The Heart – a ballet on transplantations and critical life events in the National Theatre in Prague – Jana Šeblová
ABSTRACTS
ADMISSION OF A PATIENT WITH SEVERE TRAUMA TO TRAUMACENTER
Jana Berková
Abstract
According to current recommendations, a severely injured patient is transported to the closest trauma center Level I. The activated and prepared trauma team is waiting for him or her; the team is composed of various specialists and has cleary defined tasks and aims to prevent preventable deaths. The aim of this paper is to describe the optimal composition of trauma team, possibilities of his activation and the tasks during initial assessment of severely injured patient.
Key words: severe injury – trauma center – trauma team
COMPARISON OF SIRS AND QSOFA DIAGNOSTIC CRITERIA IN EARLY DETECTION OF SEPSIS – A PROSPECTIVE OBSERVATIONAL STUDY 4S
Jana Šeblová, Dominika Šeblová, Štěpánka Burešová, Jiří Knor, Viktor Rybáček
Abstract
Introduction: Sepsis remains a global health problem with increasing incidence every year and with high mortality rates, especially hospitalization mortality rates. Diagnostics in primary and emergency care is still a huge challenge. In 2016, new sepsis definition (Sepsis-3) brought simplified screenig criteria qSOFA for identification of septic patients outside the intensive care environment. We decided to examine the usability of qSOFA in prehospital emergency care (PHC) and at emergency department (ED).
Methods: 4S study was monocentric prospective observational pragmatic study; standard therapy was provided to enrolled patients. The primary goal was to compare the qSOFA and SIRS criteria, their sensitivity and specificity in prehospital care and at the ED. Secondary goals included examinng the diagnostic accuracy of prehospital professionals and hospitalization mortality in the three study groups (patients with 1) sepsis and septic shock; 2) infection without organ failure; 3) no-infectious disease).
Results: 203 patients were enrolled from 1st February 2018 till 29th February 2020 and 104 had final diagnosis of sepsis or septic shock, 90 had infection and 9 had non-infectious disease diagnosis. SIRS criteria had higher sensitivity (71,2% at PHC and 87,5% at ED) compared to qSOFA (39,4% vs. 43,3%). Specificity was higher when using qSOFA (84,9% PHC and 83,8% at ED). Infection was identified as the cause for EMS activation in 96% of cases by the EMS personnel, and 51% of these patients were septic. Hospitalization mortality was the highest (36.5%) in the group of septic patients and the lowest in patients with infection without any organ failure (2,2%).
Discussion: Even if this study was monocentric, our results corroborate other studies in discovering that qSOFA score is not an appropriate screening tool for early identification of sepsis. However, it can be a suitable predictor of general severity of the patient´s condition. The main limitation of the 4S study is failure to enroll all septic patients by the EMS personnel. Hospitalization mortality was high and those patients who died were nearly 7,5 years older than those who survived.
Conclusion: There is no single, simple and reliable screening tool for early identification and risk stratification of septic patients. A combination of health professionals´ education and gudeliness for management of the care of septic patients in primary and emergency care may lead to improvement in this field.
Key words: sepsis – scoring systems – diagnostics – emergency medicine
A CASE REPORT: MILD ORGANOPHOSPHORUS COMPOUND INTOXICATION
Lucie Junová, Ondřej Rennét
Abstract
A case report of mild organophosphorus compound intoxication is presented in this paper. Such intoxication is very rare in the Czech Republic and therefore authors describe organophosphorus compounds, mechanisms of their action, diagnosis and treatment in more detail based on the case report.
Key words: poisoning – nerve agent – organophosphate – soman – miosis
THE PRINCIPLES OF PROPER OXYGEN THERAPY IN CRITICALLY ILL PATIENTS
Marcela Bílská, Roman Škulec, Barbora Stadlerová, Tomáš Pařízek, Michal Kalina, Vladimír Černý, David Astapenko
Abstract
Oxygen is one of the most widely used drugs in emergency medicine. Therefore, it is necessary to know the indications and contraindications for its use, as well as the risks resulting from its incorrect administration. In the following article, we summarize the principles of proper oxygen therapy with a focus on critically ill patients. We particularly target the group of patients with chronic obstructive pulmonary disease, in which myths about proper oxygen therapy still prevail.
Key words: oxygen – carbon dioxide – oxygen face mask – chronic obstructive pulmonary disease
PROVIDING CARE FOR OLDER ADULTS IN THE EMERGENCY DEPARTMENT: EXPERT CLINICAL RECOMMENDATIONS FROM THE EUROPEAN TASK FORCE ON GERIATRIC EMERGENCY MEDICINE
Jacinta Lucke et al., autor překladu: Vojtěch Mezera
Abstract
Background: Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group.
Objective: The aim was to develop pragmatic clinical Geriatric Emergency Medicine guidelines based on expert consensus, to be disseminated across Europe.
Design: Using a modified Delphi procedure a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters.
Setting and participants: A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe.
Outcome: The expert group identified the following eight subject areas to develop targeted guidelines on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, family involvement, ED environment, silver trauma, end of life care in the acute setting.
Main results: Eight posters with guidelines on the most important topics in Geriatric Emergency Medicine are now available through https:// posters.geriemeurope.eu/
Conclusion: Pragmatic guidelines for Geriatric Emergency Medicine in Europe were created and are ready for dissemination across Europe.
Key words: Guidelines – Emergency Medicine – Geriatrics – Frailty – Acute care – Geriatric Emergency Medicine