- Editorial – Jana Šeblová
EMERGENCY DEPARTMENTS – TOPIC: INTOXICATIONS
- Lethal MDMA intoxication: a case report – Tomáš Veleta, Martina Čermáková
- Daphne mezereum poisoning: a case report – Martina Čermáková, Tomáš Veleta
SYSTEMS´ ORGANIZATION AND MANAGEMENT
- Non-conveyance of patients following prehospital emergency care: Karlovy Vary region – Michaela Adamcová, Nikola Brizgalová, David Peřan, Miloš Kukačka, Jiří Smetana, Jaroslav Pekara, Roman Sýkora
- The use of video transmissions via mobile applications to call for help to medical dispatch centers in the Czech Republic – Gabriela Divišková, Jan Mužík
PAEDIATRICS IN EMERGENCY MEDICINE
- Paediatric diabetic ketoacidosis, prehospital care, differential diagnosis and an early hospital care – Pavel Heinige
- Warning of the working group of the Section of intensive medicine of the Czech paediatric society CzMA JEP about repeated occurence of very severe invasive infections caused by Streptococcus pyogenes – Pavel Heinige, Martin Prchlík, Tomáš Zaoral, Petr Pavlíček, Tomáš Habanec, Petr Dominik, Miroslav Jiránek, Marie Váchová, Marie Kopecká, Pavel Leden, Pavel Vojtovič, Alena Kokešová, Vratislav Smolka, Marie Rohanová, Martin Žáček, Lumír Šašek, Jiří Fremuth, René Hrdlička, Jana Kozáková, Sandra Vohrnová
- Methods for recieving emergency SMS messages (and similar emergency communication) on 155 national emergency line – Ondřej Franěk
- How to pass the specialisation exam in emergency medicine? – Jana Šeblová, Jana Kubalová, Katarína Veselá
LETHAL MDMA INTOXICATION: A CASE REPORT
Tomáš Veleta, Martina Čermáková
Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is among the three most commonly used drugs in Europe. It is used for its stimulating and hallucinogenic effects. MDMA is most often used as tablets or capsules. Serious intoxications are rare. Their symptoms are determined by an increase in the level of serotonin, dopamine and noradrenaline. These severe symptoms are serotonin syndrome with severe hyperthermia, rhabdomyolysis and renal failure, as well as circulatory symptoms (hypertension, tachycardia, heart failure, dysrhythmias). The case report describes a case of severe intoxication of a young man in whom the symptoms progressed to multiorgan failure refractory to all used therapeutic methods.
Key words: MDMA – intoxication – hyperthermia – serotonin syndrome
DAPHNE MEZEREUM POISONING: A CASE REPORT
Martina Čermáková, Tomáš Veleta
In the Czech Republic, plant intoxication is a frequent reason for consultation with the Toxicology Information Center. Some poisonings can have a serious progress of the disease. This presented case report deals with the accidental use of a poison ivy. The toxins daphnetoxin and mezerein are dangerous due to their nephro- and hepatotoxicity. Among the basic treatment of intoxication with this plant, we primarily include elimination methods – gastric lavage or intestinal lavage.
Key words: Intoxication – poisoning – plant intoxication – ABCDE approach – gastric lavage – GIT decontamination
NON-CONVEYANCE OF PATIENTS FOLLOWING PREHOSPITAL EMERGENCY CARE: KARLOVY VARY REGION
Michaela Adamcová, Nikola Brizgalová, David Peřan, Miloš Kukačka, Jiří Smetana, Jaroslav Pekara, Roman Sýkora
Introduction: Non-conveyance of patients following prehospital emergency care is a current issue. There are no available national comparative data on non-conveyance of the patient from scene or evaluation of the safety of the procedure.
Aim: To evaluate the frequency of non-conveyance of the patient by the decision of healthcare workers and describe the characteristics of these cases. To find out the rate of repeated visits to patients left at the scene of intervention.
Methods: The data was collected from the database of the Emergency medical services of Karlovy Vary region from 1st to 31st January 2023. A total of 335 patients were left on the place based on the decision of the ambulance crew (out of 3005 patients).
Results: The non-conveyance rate of patients from primary calls was 11.1% (335/3005). The decision of paramedics, who consult the patient‘s condition over the phone with physician (90% of cases) dominates over leaving the patient on site by the ambulance crew with physician. The most common reasons for non-transport of the patient are non-specific health conditions, alcohol intoxication and psychiatric conditions. Repeated visits occurred to these patients in 11.0% (n = 37). Most of the repeated calls took place within 24 hours (51% (n = 19)) or within 72 hours (87% (n = 32)). A higher frequency of repeated visits to these patients was more common in older patients. No death of the patient left on the scene was recorded.
Conclusion: In the Karlovy Vary region, over eleven percent of patients from primary visits during January 2023 were left on place. Non-conveyance of the patient can be considered safe part of providing prehospital emergency care. However, there is a lack of a national recommendations or guidelines that would consider the risks stratification for non-transport of the patient.
Key words: emergency medical services – pre-hospital emergency care – paramedic – non-conveyance of the patient
THE USE OF VIDEO TRANSMISSIONS VIA MOBILE APPLICATIONS TO CALL FOR HELP TO MEDICAL DISPATCH CENTERS IN THE CZECH REPUBLIC
Gabriela Divišková, Jan Mužík
Video calls are a relatively new function that enables dispatchers of medical dispatch centers to obtain new information through the transmission of images from the scene. We examined the level of use and potential barriers to the increased use of video calls using structured interviews with dispatchers. All 14 centers in the Czech Republic and several foreign ones were contacted. A total of 7 interviews were obtained from the Czech Republic and 4 from abroad. In the Czech Republic, the function is implemented in most of the dispatch centers, but the frequency of its use is very low. It is less than 10 activated video calls in the whole year within each center. Compared to foreign centres, this is quite insufficient. For example, Norway reports up to 10 % of the total number of emergency calls which are converted to video calls. Technological innovation is also often viewed negatively by dispatchers due to the lack of expectation of new information obtained through video and the overall increase of time for a given call. Video calls are certainly beneficial, but in specific cases. The overall benefit, the technical capabilities of the caller, their ability to collaborate and to control the technology, the time commitment and other risk factors need to be considered before the actual activation.
Key words: video call – medical dispatch center – telephone-assisted cardiopulmonary resuscitation
PAEDIATRIC DIABETIC KETOACIDOSIS, PREHOSPITAL CARE, DIFFERENTIAL DIAGNOSIS AND AN EARLY HOSPITAL CARE
Diabetic ketoacidosis is a life threatening event, associated with diabetes mellitus. Diabetic ketoacidosis is the main reason of mortality in pediatric diabetic population. It is usually associated with the first type of diabetes mellitus, however, it can rarely appear in patient with diabetes type two, too. Dehydration, metabolic acidosis with Kussmaul breathing, hyperglykaemia and ketonuria are the leading symptoms. In severe cases peritonism, vomiting and severe consciousness disorder or even coma can occur. The most frequent reason of death is brain edema. The value of pH lower than 7,1 and sodium bicarbonate concentration lower than 5 mmol/l are considered severe ketoacidosis.
Diabetic ketoacidosis is a frequent primary presentation of diabetes mellitus in childhood with negative case history. Unrecognized and untreated ketoacidosis may lead to death. Missdiagnosis of diabetic ketoacidosis or inadequate therapy may also lead to severe complications.
Key words: Diabetes mellitus – ketoacidosis – pediatric age