- Editorial – Jana Šeblová
- Traumatic cardiac arrest – two case reports – Miroslav Durila, Klára Valchářová, Tomáš Kouba, Marcel Truelle, Barbora Začalová, Michal Fric, Jaroslav Pažout
PREHOSPITAL EMERGENCY CARE
- The role of chest tube in the prehospital care in trauma – Jana Berková
- Danis stent for management of bleeding from esophageal varices in critical situations – Daniel Tyč, Michal Vraný
- Paracetamol (acetaminofen) intoxications in the Czech Republic and current therapeutical guidelines – Jiří Hlušička, Viktorie Kolesnikova, Kateřina Kotíková, Daniela Pelclová
- Accidental dimetindene intoxications in children – Michal Čečrle, Daniela Pelclová
- Life-threatening vitamine B17 intoxication – Patrik Christian Cmorej, Petr Bureš, Ondřej Kounovský, Martin Kubát, Alena Kohlová
- How to pass the specialisation exam in emergency medicine? – Katarína Veselá, Jana Šeblová, Jana Kubalová
ETHICS, PSYCHOLOGY, LAW
- Historical development of emergency care provision – Robin Šín
- Policy statement on minimal standards for safe working conditions in Emergency Medicine – Roberta Petrino, Luis Garcia Castrillo, Basak Yilmaz, Christoph Dodt, Eeva Tuunainen, Abdo Khoury and the Emergency Medicine Day working group
- Position Statement on Over-crowded Emergency Departments – International Federation for Emergency Medicine (IFEM)
- In memoriam prof. William Gunn MD, MS, FRCSC, FRCSI (Hon), DSC (Hon), dr h c (10. 2. 1926 – 1. 11. 2022) – Leo Klein
- The Czech EMS Association and Kryštůfek foundation help paramedics in difficult life situations
TRAUMATIC CARDIAC ARREST – TWO CASE REPORTS
Miroslav Durila, Klára Valchářová, Tomáš Kouba, Marcel Truelle, Barbora Začalová, Michal Fric, Jaroslav Pažout
Traumatic cardiac arrest is an extremely unfavorable prognostic condition for the patient, but also a challenging situation for the medical personnel who care for the patient from the prehospital period to the postoperative period. We present two cases of therapy of a traumatic cardiac arrest, of which one arrest occurred in the prehospital period and in the other case cardiac arrest occurred both in the prehospital period and soon after admission at the emergency department. These rather typical but rare case reports are published not only for sharing experience, but also for motivational and educational reasons, especially for beginning health professionals in the field of emergency medicine.
Key words: trauma – cardiac arrest – bleeding
THE ROLE OF CHEST TUBE IN THE PREHOSPITAL CARE IN TRAUMA
The airway obstruction, tracheobronchial injury, tension pneumothorax and open pneumothorax are life-threatening chest injuries must be treated immediately in the prehospital care. The aim of this paper is an overview of the possible treatment for the tension and open pneumothorax in the context of current recommendations and the role of a chest tube insertion. The preferred method of treatment for tension pneumothorax is needle decompresion or thoracostomy, and for open pneumothorax vented chest seal. In general, the chest tube insertion in the prehospital care is not recommended because of the time comsumption, complications and training issues. The role of the chest tube is during the primary survey and management in the hospital.
Key words: chest injury – pneumothorax – chest tube – needle decompression – thoracostomy
DANIS STENT FOR MANAGEMENT OF BLEEDING FROM ESOPHAGEAL VARICES IN CRITICAL SITUATIONS
Daniel Tyč, Michal Vraný
Bleeding from esophageal varices is associated with high mortality in patients with portal hypertension. These patients often get access to health care through ambulances of the emergency service and emergency departments of hospitals. However, it often takes several hours to get the endoscopic treatment. In situations of pre-hospital and urgent hospital care, when a critically ill patient does not respond to pharmacological treatment, it is necessary to consider a temporary solution. For this purpose, a Sengstaken- Blakemore tube (and its variants) or an esophageal stent (Danis stent) are available today. The purpose of this review was to find and describe the information on the esophageal stent applicability in critical situations of urgent care (when pharmacological treatment failed, and acute endoscopic solution is temporarily unavailable). Publications since 2010 were included in the review. However, the current studies describing clinical data on Danis stent are focused on situations after failure of previous treatment. Thus, there is a lack of direct clinical data on the use of this method before endoscopic intervention. However, available clinical studies and guidelines in the field indicate that the Danis stent generally achieves a better benefit-risk ratio and also better cost-effectiveness compared to the Sengstaken–Blakemore tube. Future studies would be useful to provide clinical data on esophageal stenting as a primary treatment for life-threatening conditions without prior intervention.
Key words: chest injury – pneumothorax – chest tube – needle decompression esophageal varices, tamponade, Danis stent, emergency care
PARACETAMOL (ACETAMINOFEN) INTOXICATIONS IN THE CZECH REPUBLIC AND CURRENT THERAPEUTICAL GUIDELINES
Jiří Hlušička, Viktorie Kolesnikova, Kateřina Kotíková, Daniela Pelclová
Paracetamol (acetaminophen) has been one of the most popular analgesics and antipyretics since the 1980s, which can be used even by people who cannot tolerate other analgesics. It thus became one of the most widely used medicines ever. Every coin has two sides, the flip side of paracetamol is that an overdose leads to damage of the liver or kidneys. In the developed world, paracetamol intoxication is one of the most common causes of acute liver failure. Although the hepatotoxicity of paracetamol is becoming known to people, overdose cases in the Czech Republic are increasing according to inquiries to the Toxicology Information Center (TIC). In 2020–2022, TIC provided a total of 1,712 consultations for paracetamol overdose patients, which represented 6.5% of all drug inquiries. An amount greater than 200 mg/kg of body weight, or more than 10 g, is considered as a toxic dose. An effective, safe, and inexpensive treatment is the antidote N-acetylcysteine. Recommendations for its dosage vary. The indication is also determined by the level of paracetamol in the serum, collected no earlier than 4 hours after taking the tablets. The main message of this work is to describe the current recommended procedure for paracetamol intoxication. With early therapy, N-acetylcysteine is a highly effective antidote, and both hepatocellular and renal lesions are reversible.
Key words: Paracetamol – intoxication – N-acetylcystein – management
ACCIDENTAL DIMETINDENE INTOXICATIONS IN CHILDREN
Michal Čečrle, Daniela Pelclová
Dimetindene is a sedative antihistamine indicated for the symptomatic treatment of cough, common cold and urticaria in children. Toxicity data are very limited and there is no consensus on the dose at which children require hospitalization. According to inquiries to Toxicology Information Center (TIC) in the years 2010– 2022, the children were intoxicated in 95% of cases, adults in only a fraction of cases (5%). The number of consultations is increasing. In a study of 100 discharge reports from hospitalizations of children in 2020–2022, it was found that up to a dose of 0.25 mg/kg of body weight, children were asymptomatic, and up to a dose of 0.50 mg/kg, only mild symptoms occurred. In 98% of cases, the children were hospitalized for a maximum of 24 hours and their condition did not require treatment. According to these preliminary results, the prognosis of accidental dimetinden intoxications in children appears to be good. However, if a dose of 0.50 mg/kg is exceeded or in case of doubt, we recommend always consulting TIC.
Key words: dimetindene – sedative antihistamines – intoxication in paediatrics
LIFE-THREATENING VITAMINE B17 INTOXICATION
Patrik Christian Cmorej, Petr Bureš, Ondřej Kounovský, Martin Kubát, Alena Kohlová
Vitamin B17, well known as amygdalin, is originally a natural cyanogenic glycoside available as a dietary supplement used in the alternative treatment. Amygdalin hydroxylates to toxic cyanide in the body, which can cause life-threatening intoxication. The case report presents a life-threatening cyanide poisoning after ingesting a dietary supplement containing amygdalin identified in pre-hospital care, which was successfully treated with hydroxocobalamin. The case report also contains the management of pre-hospital care in a patient with acute intoxication.
Key words: amygdalin – hydroxocobalamin – intoxication – cyanide
HISTORICAL DEVELOPMENT OF EMERGENCY CARE PROVISION
Since prehistoric times, the ancestors of todays humans tried to treat wounds and solve acute health problems. From the belief in the influence of deities on the occurence of injuries and acute diseases and their treatment, emergency medicine has moved to today‘s therapy based on scientific evidence. Throughout human history, war conflicts have become a fundamental driving force in the development of emergency medicine. Mainly, the wars of 19th century were crucial. The large number of the injured brought the need for their classification and treatment according to priorities. The war conflicts of the 20th century produced a lot of treatmets that are also used in civilian medicine. Since the 1960s, in the Western world, we can talk about emergency medicine as an independent medical specialty. In our conditions, independent emergency medical services were established in the 1990s, and in the last fifteen years we have monitored the formation of a large amount of emergency departments.
Key words: history – emergency care – emergency medical service – emergency department – war medicine