{"id":1049,"date":"2020-04-08T08:17:06","date_gmt":"2020-04-08T06:17:06","guid":{"rendered":"http:\/\/urgentnimedicina.cz\/?p=1049"},"modified":"2020-07-10T09:24:41","modified_gmt":"2020-07-10T07:24:41","slug":"obsah-1-2020","status":"publish","type":"post","link":"https:\/\/urgentnimedicina.cz\/?p=1049","title":{"rendered":"Obsah 1\/2020"},"content":{"rendered":"<p><b>\u00daVOD<\/b><\/p>\n<ul>\n<li>Obsah<\/li>\n<li>\u00davodn\u00ed slovo \u2013 Jana \u0160eblov\u00e1<\/li>\n<\/ul>\n<p><b>URGENTN\u00cd P\u0158\u00cdJMY<\/b><\/p>\n<ul>\n<li>Status epilepticus jako komplikace tup\u00e9ho traumatu lebky u 41let\u00e9 pacientky: kazuistika \u2013 Robin \u0160\u00edn, Radek Tup\u00fd, Patrik Christian Cmorej, Luk\u00e1\u0161 Handl<\/li>\n<li>Paradoxn\u00ed embolie \u2013 vz\u00e1cn\u00e1 p\u0159\u00ed\u010dina kon\u010detinov\u00e9 isch\u00e9mie \u2013 kazuistika \u2013 Jana Berkov\u00e1, Tom\u00e1\u0161 Lutonsk\u00fd<\/li>\n<\/ul>\n<p><b>FYZIOLOGIE A URGENTN\u00cd MEDIC\u00cdNA<\/b><\/p>\n<ul>\n<li>Pulsus paradoxus a jeho v\u00fdznam v p\u0159ednemocni\u010dn\u00ed p\u00e9\u010di \u2013 David Astapenko, Vladim\u00edr \u010cern\u00fd<\/li>\n<\/ul>\n<p><b>VZD\u011aL\u00c1V\u00c1N\u00cd<\/b><\/p>\n<ul>\n<li>N\u00e1rodn\u00ed srovn\u00e1n\u00ed po\u010dt\u016f absolvent\u016f a person\u00e1ln\u00edch po\u017eadavk\u016f zdravotnick\u00fdch z\u00e1chrann\u00fdch slu\u017eeb po zru\u0161en\u00ed vy\u0161\u0161\u00edch odborn\u00fdch zdravotnick\u00fdch \u0161kol \u2013 David Pe\u0159an, Jaroslav Pekara, Radom\u00edr Vlk, Marek Slab\u00fd, Petr Kolouch<\/li>\n<li>Jak na atestaci z urgentn\u00ed medic\u00edny? \u2013 Katar\u00edna Vesel\u00e1, Jana Kubalov\u00e1, Jana \u0160eblov\u00e1<\/li>\n<\/ul>\n<p><b>DOPORU\u010cEN\u00c9 POSTUPY<\/b><\/p>\n<ul>\n<li>N\u00e1vrh jednotn\u00e9 metodiky pro p\u0159ednemocni\u010dn\u00ed neodkladnou p\u00e9\u010di b\u011bhem pandemie COVID 19 (SARSCoV- 2) \u2013 Eva Smr\u017eov\u00e1, Jana \u0160eblov\u00e1, Anatolij Truhl\u00e1\u0159, Roman G\u0159ego\u0159, Jana Kubalov\u00e1, Ond\u0159ej Fran\u011bk<\/li>\n<\/ul>\n<p><b>ETIKA, PSYCHOLOGIE, PR\u00c1VO<\/b><\/p>\n<ul>\n<li>Negativn\u00ed reverz: ob\u00e1van\u00e1 kompetence zdravotnick\u00e9ho z\u00e1chran\u00e1\u0159e \u2013 Nikola Brizgalov\u00e1, Roman S\u00fdkora, Milo\u0161 Kuka\u010dka<\/li>\n<\/ul>\n<p><b>DISKUZE, POLEMIKA, N\u00c1ZORY<\/b><\/p>\n<ul>\n<li>Urgentn\u00ed versus intenzivn\u00ed medic\u00edna \u2013 pr\u016fniky a odli\u0161nosti \u2013 Roman \u0160kulec<\/li>\n<li>Reakce na \u010dl\u00e1nek MF Dnes z 22. 11. 2019 \u201eZ\u00e1chranku u\u017e lid\u00e9 volaj\u00ed i kv\u016fli kl\u00ed\u0161t\u011bti\u201c \u2013 Ji\u0159\u00ed Knor<\/li>\n<\/ul>\n<p><b>INFORMA\u010cN\u00cd SERVIS<\/b><\/p>\n<ul>\n<li>Covid 19<\/li>\n<\/ul>\n<p><b>INTRODUCTION<\/b><\/p>\n<ul>\n<li>Contents<\/li>\n<li>Editorial \u2013 Jana \u0160eblov\u00e1<\/li>\n<\/ul>\n<p><b>EMERGENCY DEPARTMENTS<\/b><\/p>\n<ul>\n<li>Status epilepticus as a complication of blunt trauma in 41-year-old patient: a case report \u2013 Robin \u0160\u00edn, Radek Tup\u00fd, Patrik Christian Cmorej, Luk\u00e1\u0161 Handl<\/li>\n<li>Paradoxical embolism \u2013 a rare cause of acute limb ischaemia \u2013 a case report \u2013 Jana Berkov\u00e1, Tom\u00e1\u0161 Lutonsk\u00fd<\/li>\n<\/ul>\n<p><b>PHYSIOLOGY AND EMERGENCY MEDICINE<\/b><\/p>\n<ul>\n<li>Pulsus paradoxus and its significance in prehospital care \u2013 David Astapenko, Vladim\u00edr \u010cern\u00fd<\/li>\n<\/ul>\n<p><b>EDUCATION<\/b><\/p>\n<ul>\n<li>National analysis of the number of graduates and demands of employees of the Emergency Medical Services after abolition of higher professional medical schools \u2013 David Pe\u0159an, Jaroslav Pekara, Radom\u00edr Vlk, Marek Slab\u00fd, Petr Kolouch<\/li>\n<li>How to pass the specialisation exam in emergency medicine? \u2013 Katar\u00edna Vesel\u00e1, Jana Kubalov\u00e1, Jana \u0160eblov\u00e1<\/li>\n<\/ul>\n<p><b>GUIDELINES<\/b><\/p>\n<ul>\n<li>Guidelinea for prehospital emergency care during COVID 19 (SARS-CoV-2) pandemic \u2013 Eva Smr\u017eov\u00e1, Jana \u0160eblov\u00e1, Anatolij Truhl\u00e1\u0159, Roman G\u0159ego\u0159, Jana Kubalov\u00e1, Ond\u0159ej Fran\u011bk<\/li>\n<\/ul>\n<p><b>ETHICS, PSYCHOLOGY, LAW<\/b><\/p>\n<ul>\n<li>\u201eAgainst medical advice\u201c (AMA) form: a feared paramedic\u00b4s competence \u2013 Nikola Brizgalov\u00e1, Roman S\u00fdkora, Milo\u0161 Kuka\u010dka<\/li>\n<\/ul>\n<p><b>DISCUSSION, OPINION<\/b><\/p>\n<ul>\n<li>Emergency versus intensive medicine \u2013 intersections and differences \u2013 Roman \u0160kulec<\/li>\n<li>Response on MF Dnes article published on 22th November 2019: EMS is called even for a tick bite nowadays\u201c \u2013 Ji\u0159\u00ed Knor<\/li>\n<\/ul>\n<p><b>INFORMATION<\/b><\/p>\n<ul>\n<li>Covid 19<\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline;\"><strong>ABSTRAKTY<\/strong><\/span><\/p>\n<h6><b>STATUS EPILEPTICUS JAKO KOMPLIKACE TUP\u00c9HO TRAUMATU LEBKY U 41LET\u00c9 PACIENTKY: KAZUISTIKA<\/b><\/h6>\n<p><b>STATUS EPILEPTICUS AS A COMPLICATION OF BLUNT TRAUMA IN 41-YEAR-OLD PATIENT: A CASE REPORT<\/b><\/p>\n<p><b>Robin \u0160\u00edn, Radek Tup\u00fd, Patrik Christian Cmorej, Luk\u00e1\u0161 Handl<\/b><\/p>\n<p><b>Abstrakt <\/b><\/p>\n<p>Status epilepticus je definov\u00e1n jako p\u0159etrv\u00e1vaj\u00edc\u00ed nebo opakuj\u00edc\u00ed se epileptick\u00fd z\u00e1chvat v d\u016fsledku selh\u00e1n\u00ed mechanizm\u016f jeho ukon\u010den\u00ed. U tonicko-klonick\u00fdch z\u00e1chvat\u016f byl nov\u011b p\u0159ijat konsenzus, \u017ee ji\u017e po 5 minut\u00e1ch je hodnocen\u00fd jako epileptick\u00fd status a \u017ee dlouhodob\u00e9 n\u00e1sledky lze o\u010dek\u00e1vat, pokud aktivita trv\u00e1 d\u00e9le ne\u017e 30 minut. Rozvoj epileptick\u00e9ho z\u00e1chvatu lze o\u010dek\u00e1vat a\u017e u 3 % pacient\u016f s \u00farazem hlavy. Pokud dojde k rozvoji epileptick\u00e9ho statusu, je pozorov\u00e1na motralita a\u017e 25 %. Z\u00e1kladem l\u00e9\u010dby je zaji\u0161t\u011bn\u00ed pr\u016fchodnosti d\u00fdchac\u00edch cest, ventilace a stabilizace krevn\u00edho ob\u011bhu. L\u00e9kovou terapii zahajujeme aplikac\u00ed benzodiazepin\u016f, l\u00e9kem druh\u00e9 volby jsou fenytoin, kyselina valproov\u00e1 nebo levetiracetam. P\u0159i refraktern\u00edm epileptick\u00e9m statusu se z anestetik pou\u017e\u00edv\u00e1 propofol, n\u00e1sledn\u011b p\u0159i nedostate\u010dn\u00e9m efektu kontinu\u00e1ln\u011b fenobarbital. Nutn\u00e9 je v\u017edy c\u00edlen\u00e9 laboratorn\u00ed vy\u0161et\u0159en\u00ed, po \u00farazu tak\u00e9 CT mozku, vhodn\u00e1 je monitorace EEG. V kazuistice p\u0159edstavujeme pacientku s rozvojem status epilepticus na urgentn\u00edm p\u0159\u00edjmu s odstupem t\u0159\u00ed hodin od tup\u00e9ho traumatu lebky v dom\u00e1c\u00edm prost\u0159ed\u00ed bez prok\u00e1zan\u00e9 ztr\u00e1ty v\u011bdom\u00ed ihned po \u00farazu. Po pod\u00e1n\u00ed diazepamu a levetiracetamu do\u0161lo k \u00faprav\u011b stavu po 25 minut\u00e1ch epileptick\u00e9ho statusu a t\u00edm k zamezen\u00ed progresi do refraktern\u00edho status epilepticus.<\/p>\n<p><b>Kl\u00ed\u010dov\u00e1 slova: <\/b>status epilepticus \u2013 trauma hlavy \u2013 benzodiazepiny \u2013 levetiracetam \u2013 kyselina valproov\u00e1 \u2013 urgentn\u00ed p\u0159\u00edjem<\/p>\n<p><b>Abstract <\/b><\/p>\n<p>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\u00b4s condition was restored and thus the progression to refractory status epilepticus was prevented.<\/p>\n<p><b>Key words: <\/b>status epilepticus \u2013 head injury \u2013 benzodiazepines \u2013 levetiracetam \u2013 valproic acid \u2013 emergency department<\/p>\n<h6><b>PARADOXN\u00cd EMBOLIE \u2013 VZ\u00c1CN\u00c1 P\u0158\u00cd\u010cINA KON\u010cETINOV\u00c9 ISCH\u00c9MIE \u2013 KAZUISTIKA<\/b><\/h6>\n<p><b>PARADOXICAL EMBOLISM \u2013 A RARE CAUSE OF ACUTE LIMB ISCHAEMIA \u2013 A CASE REPORT<\/b><\/p>\n<p><b>Jana Berkov\u00e1, Tom\u00e1\u0161 Lutonsk\u00fd<\/b><\/p>\n<p><b>Abstrakt <\/b><\/p>\n<p>\u010cl\u00e1nek pojedn\u00e1v\u00e1 o vz\u00e1cn\u00e9 p\u0159\u00ed\u010din\u011b kon\u010detinov\u00e9 isch\u00e9mie, kterou je paradoxn\u00ed embolie. Paradoxn\u00ed emboli\u00ed je ozna\u010dov\u00e1n stav, kdy kv\u016fli p\u0159etrv\u00e1vaj\u00edc\u00edmu defektu v oblasti s\u00edn\u00ed (foramen ovale patens nebo defektu s\u00ed\u0148ov\u00e9ho septa) doch\u00e1z\u00ed k p\u0159estupu trombu ze \u017eiln\u00edho \u0159e\u010di\u0161t\u011b do tepenn\u00e9ho. Na dvou kazuistik\u00e1ch je demonstrov\u00e1n management pacienta s akutn\u00ed kon\u010detinovou isch\u00e9mi\u00ed a paradoxn\u00ed emboli\u00ed z pohledu zdravotnick\u00e9 z\u00e1chrann\u00e9 slu\u017eby a na urgentn\u00edm p\u0159\u00edjmu.<\/p>\n<p><b>Kl\u00ed\u010dov\u00e1 slova: <\/b>paradoxn\u00ed embolie \u2013 akutn\u00ed kon\u010detinov\u00e1 isch\u00e9mie \u2013 inici\u00e1ln\u00ed management<\/p>\n<p><b>Abstract <\/b><\/p>\n<p>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.<\/p>\n<p><b>Key words: <\/b>paradoxical embolism \u2013 acute limb ischemia \u2013 initial management<\/p>\n<h6><b>PULSUS PARADOXUS A JEHO V\u00ddZNAM V P\u0158EDNEMOCNI\u010cN\u00cd P\u00c9\u010cI<\/b><\/h6>\n<p><b>PULSUS PARADOXUS AND ITS SIGNIFICANCE IN PREHOSPITAL CARE<\/b><\/p>\n<p><b>David Astapenko, Vladim\u00edr \u010cern\u00fd<\/b><\/p>\n<p><b>Abstrakt <\/b><\/p>\n<p>Pulsus paradoxus (PP) p\u0159edstavuje pokles systolick\u00e9ho krevn\u00edho tlaku p\u0159i n\u00e1dechu o v\u00edce ne\u017e 10 mmHg. Vznik\u00e1 patologicky v d\u016fsledku alterace fyziologicky se vyskytuj\u00edc\u00edch kardiopulmon\u00e1ln\u00edch interakc\u00ed, kter\u00e9 vedou k p\u0159echodn\u00e9mu poklesu tepov\u00e9ho objemu a tlakov\u00e9 amplitudy (rozd\u00edlu mezi systolick\u00fdm a diastolick\u00fdm tlakem). PP je snadno zjistiteln\u00fd fenom\u00e9n, typick\u00fd pro \u0159adu patologick\u00fdch stav\u016f (nap\u0159. srde\u010dn\u00ed tampon\u00e1da, astmatick\u00fd z\u00e1chvat, masivn\u00ed plicn\u00ed embolie, hypovolemick\u00fd \u0161ok). Zm\u011bny PP lze orienta\u010dn\u011b vyu\u017e\u00edt i pro hodnocen\u00ed reakce ob\u011bhu na tekutiny. Mimo vlastn\u00ed palpaci pulzu lze PP objektivizovat na pletyzmografick\u00e9 k\u0159ivce pulzn\u00ed oxymetrie.<\/p>\n<p><b>Kl\u00ed\u010dov\u00e1 slova: <\/b>pulzus paradoxus \u2013 srde\u010dn\u00ed tampon\u00e1da \u2013 astma \u2013 hypovol\u00e9mie<\/p>\n<p><b>Abstract <\/b><\/p>\n<p>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 \u2013 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.<\/p>\n<p><b>Key words: <\/b>pulsus paradoxus \u2013 cardiac tamponade \u2013 asthma \u2013 hypovolemia<\/p>\n<h6><b>N\u00c1RODN\u00cd SROVN\u00c1N\u00cd PO\u010cT\u016e ABSOLVENT\u016e A PERSON\u00c1LN\u00cdCH PO\u017dADAVK\u016e ZDRAVOTNICK\u00ddCH Z\u00c1CHRANN\u00ddCH SLU\u017dEB PO ZRU\u0160EN\u00cd VY\u0160\u0160\u00cdCH ODBORN\u00ddCH ZDRAVOTNICK\u00ddCH \u0160KOL<\/b><\/h6>\n<p><b>NATIONAL ANALYSIS OF THE NUMBER OF GRADUATES AND DEMANDS OF EMPLOYEES OF THE EMERGENCY MEDICAL SERVICES AFTER ABOLITION OF HIGHER PROFESSIONAL MEDICAL SCHOOLS<\/b><\/p>\n<p><b>Pe\u0159an, Jaroslav Pekara, Radom\u00edr Vlk, Marek Slab\u00fd, Petr Kolouch<\/b><\/p>\n<p><b>Abstrakt <\/b><\/p>\n<p>\u00davod: Novela z\u00e1kona o nel\u00e9ka\u0159sk\u00fdch zdravotnick\u00fdch povol\u00e1n\u00edch p\u0159inesla v roce 2017 zm\u011bnu ve vzd\u011bl\u00e1v\u00e1n\u00ed zdravotnick\u00fdch z\u00e1chran\u00e1\u0159\u016f. V roce 2021, resp. lednu roku 2022, zanikne obor diplomovan\u00fd zdravotnick\u00fd z\u00e1chran\u00e1\u0159 vyu\u010dovan\u00fd na vy\u0161\u0161\u00edch odborn\u00fdch zdravotnick\u00fdch \u0161kol\u00e1ch.<br \/>\nMetoda: Anal\u00fdza po\u010dtu absolvent\u016f oboru zdravotnick\u00e9 z\u00e1chran\u00e1\u0159stv\u00ed na v\u0161ech vzd\u011bl\u00e1vac\u00edch instituc\u00edch a porovn\u00e1n\u00ed s p\u0159edpokl\u00e1dan\u00fdmi po\u017eadavky zdravotnick\u00fdch z\u00e1chrann\u00fdch slu\u017eeb na nov\u00e9 zam\u011bstnance.<br \/>\nV\u00fdsledky: Vy\u0161\u0161\u00ed odborn\u00e9 zdravotnick\u00e9 \u0161koly ro\u010dn\u011b absolvuje 280 student\u016f, vysok\u00e9 \u0161koly potom 196 student\u016f. Po\u017eadavky na pouhou genera\u010dn\u00ed obm\u011bnu zdravotnick\u00fdch z\u00e1chrann\u00fdch slu\u017eeb jsou 68 zam\u011bstnanc\u016f ro\u010dn\u011b.<br \/>\nZ\u00e1v\u011br: Zru\u0161en\u00edm vy\u0161\u0161\u00edch odborn\u00fdch zdravotnick\u00fdch \u0161kol dojde bez reakce na situaci k 59 % sn\u00ed\u017een\u00ed v po\u010dtu absolvent\u016f. Reagovat lze zv\u00fd\u0161en\u00edm po\u010dt\u016f p\u0159ij\u00edman\u00fdch student\u016f nebo otev\u0159en\u00edm obor\u016f na dal\u0161\u00edch instituc\u00edch.<\/p>\n<p><b>Kl\u00ed\u010dov\u00e1 slova: <\/b>zdravotnick\u00e9 z\u00e1chran\u00e1\u0159stv\u00ed \u2013 vysok\u00e1 \u0161kola \u2013 vy\u0161\u0161\u00ed odborn\u00e1 zdravotnick\u00e1 \u0161kola \u2013 zam\u011bstn\u00e1n\u00ed<\/p>\n<p><b>Abstract <\/b><\/p>\n<p>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.<br \/>\nMethod: 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.<br \/>\nResults: 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.<br \/>\nConclusion: 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.<\/p>\n<p><b>Key words: <\/b>paramedics \u2013 college \u2013 higher professional medical school \u2013 employment<\/p>\n<h6><b>NEGATIVN\u00cd REVERZ: OB\u00c1VAN\u00c1 KOMPETENCE ZDRAVOTNICK\u00c9HO Z\u00c1CHRAN\u00c1\u0158E<\/b><\/h6>\n<p><b>\u201eAGAINST MEDICAL ADVICE\u201c (AMA) FORM: A FEARED PARAMEDIC\u00b4S COMPETENCE<\/b><\/p>\n<p><b>Nikola Brizgalov\u00e1, Roman S\u00fdkora, Milo\u0161 Kuka\u010dka<\/b><\/p>\n<p><b>Abstrakt <\/b><\/p>\n<p>Nesouhlas pacienta s poskytnut\u00edm zdravotn\u00edch slu\u017eeb, negativn\u00ed reverz (NR), dle aktu\u00e1ln\u00edho v\u00fdkladu zdravotnick\u00e9 legislativy m\u016f\u017ee v r\u00e1mci poskytov\u00e1n\u00ed p\u0159ednemocni\u010dn\u00ed neodkladn\u00e9 p\u00e9\u010de (PNP) p\u0159ijmout na m\u00edst\u011b z\u00e1sahu zdravotnick\u00fd z\u00e1chran\u00e1\u0159 v\u00fdjezdov\u00e9 skupiny rychl\u00e9 zdravotnick\u00e9 pomoci (RZP) i bez \u00fa\u010dasti l\u00e9ka\u0159e a to do m\u00edry a rozsahu sv\u00fdch kompetenc\u00ed a poskytovan\u00e9 p\u00e9\u010de. Lze tedy p\u0159edpokl\u00e1dat, \u017ee v\u00fdjezdy indikovan\u00e9 pro RZP bez nutnosti eskalace p\u00e9\u010de (p\u0159ivol\u00e1n\u00ed \u010di konzultace l\u00e9ka\u0159e) jsou kompetenc\u00ed a tedy i adekv\u00e1tn\u00ed situac\u00ed k p\u0159ijet\u00ed NR. Mo\u017enost p\u0159ijmout NR zdravotnick\u00fdm z\u00e1chran\u00e1\u0159em je na Zdravotnick\u00e9 z\u00e1chrann\u00e9 slu\u017eb\u011b Karlovarsk\u00e9ho kraje upravena vnit\u0159n\u00edm p\u0159edpisem od roku 2018. B\u011bhem \u00fanora roku 2019 bylo provedeno dotazn\u00edkov\u00e9 \u0161et\u0159en\u00ed mezi zdravotnick\u00fdmi z\u00e1chran\u00e1\u0159i, proto\u017ee kompetence p\u0159ij\u00edmat NR v t\u00e9to pracovn\u00ed pozici vyvol\u00e1vala velkou diskuzi a obavy z odpov\u011bdnosti. V\u00fdsledky \u0161et\u0159en\u00ed dokladovaly obavy z\u00e1chran\u00e1\u0159\u016f zejm\u00e9na v hodnocen\u00ed zp\u016fsobilosti pacienta k odm\u00edtnut\u00ed poskytov\u00e1n\u00ed zdravotn\u00edch slu\u017eeb, p\u00edsemn\u00e9 formulace textu, rizik a p\u0159\u00edpadn\u00fdch n\u00e1sledk\u016f. Z tohoto d\u016fvodu bylo t\u00e9ma NR v PNP za\u0159azeno i do intern\u00edho \u0161kolen\u00ed z\u00e1chran\u00e1\u0159\u016f s c\u00edlem tyto obavy rozpt\u00fdlit, vyjasnit rizikov\u00e9 situace a n\u00e1sledn\u011b zhodnotit znalosti z\u00e1chran\u00e1\u0159\u016f v t\u00e9to kompetenci. Po pro\u0161kolen\u00ed z\u00e1chran\u00e1\u0159\u016f byl spr\u00e1vn\u00fd postup u pacienta a vypln\u011bn\u00ed NR proveden v souladu s vnit\u0159n\u00edm p\u0159edpisem v 73 %. V sou\u010dasnosti se lze domn\u00edvat, \u017ee tato kompetence je ji\u017e zdravotnick\u00fdmi z\u00e1chran\u00e1\u0159i p\u0159ij\u00edm\u00e1na, nicm\u00e9n\u011b p\u0159edkl\u00e1dan\u00e9 v\u00fdsledky poukazuj\u00ed na nutnost opakovan\u00e9ho a pravideln\u00e9ho pro\u0161kolen\u00ed v budoucnosti. Nutn\u00e9 bude nejen m\u011b\u0159en\u00ed konkr\u00e9tn\u00ed znalosti, ale i subjektivn\u00edch parametr\u016f a v\u0161eobecn\u00e9ho p\u0159ijet\u00ed t\u00e9to kompetence z\u00e1chran\u00e1\u0159i.<\/p>\n<p><b>Kl\u00ed\u010dov\u00e1 slova: <\/b>kompetence \u2013 nesouhlas s poskytnut\u00edm zdravotn\u00edch slu\u017eeb \u2013 negativn\u00ed reverz \u2013 zdravotnick\u00fd z\u00e1chran\u00e1\u0159<\/p>\n<p><b>Abstract <\/b><\/p>\n<p>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 \u201cagainst medical advice\u201d (AMA) form. Paramedics can do it without participation of medical doctor if the medical advice is within the range of paramedics\u2019 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\u2019 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\u2019 concerns especially about their ability to recognize patient\u2019s 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\u2019s decision of signing out AMA form. Because of these results the topic of \u201csigning out AMA form during paramedic calls\u201d 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.<\/p>\n<p><b>Key words: <\/b>competence \u2013 refusal of health care \u2013 against medical advice (AMA) \u2013 paramedic<\/p>\n<h6><b>URGENTN\u00cd VERSUS INTENZIVN\u00cd MEDIC\u00cdNA \u2013 PR\u016eNIKY A ODLI\u0160NOSTI<\/b><\/h6>\n<p><b>EMERGENCY VERSUS INTENSIVE MEDICINE \u2013 INTERSECTIONS AND DIFFERENCES<\/b><\/p>\n<p><b>Roman \u0160kulec<\/b><\/p>\n<p>Tento \u010dl\u00e1nek je vy\u017e\u00e1dan\u00fdm voln\u00fdm p\u0159episem p\u0159edn\u00e1\u0161ky na t\u00e9ma porovn\u00e1n\u00ed urgentn\u00ed a intenzivn\u00ed medic\u00edny, kterou autor p\u0159ednesl na vzd\u011bl\u00e1vac\u00edm kurzu \u010cesk\u00e9 l\u00e9ka\u0159sk\u00e9 komory \u201eUrgentn\u00ed medic\u00edna a pr\u016fniky s ostatn\u00edmi obory\u201c dne 7. 12. 2019 v Praze. Urgentn\u00ed a intenzivn\u00ed medic\u00edna jsou obory, kter\u00e9 se zab\u00fdvaj\u00ed p\u00e9\u010d\u00ed o nemocn\u00e9 v akutn\u00edm stavu. Na prvn\u00ed pohled jde o obory t\u00e9m\u011b\u0159 podobn\u00e9, nicm\u00e9n\u011b p\u0159i detailn\u011bj\u0161\u00edm pohledu je situace slo\u017eit\u011bj\u0161\u00ed. V dal\u0161\u00edm textu autor diskutuje o podobnostech a odli\u0161nostech urgentn\u00ed a intenzivn\u00ed medic\u00edny, p\u0159i\u010dem\u017e v\u00edce pozornosti v\u011bnuje odli\u0161nostem. Jedn\u00e1 se o subjektivn\u00ed pohled autora, kter\u00fd se nemus\u00ed shodovat s n\u00e1zorem v\u0161ech z\u00e1stupc\u016f obou odborn\u00fdch komunit.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u00daVOD Obsah \u00davodn\u00ed slovo \u2013 Jana \u0160eblov\u00e1 URGENTN\u00cd P\u0158\u00cdJMY Status epilepticus jako komplikace tup\u00e9ho traumatu lebky u 41let\u00e9 pacientky: kazuistika \u2013 Robin \u0160\u00edn, Radek Tup\u00fd, Patrik Christian Cmorej, Luk\u00e1\u0161 Handl Paradoxn\u00ed embolie \u2013 vz\u00e1cn\u00e1 p\u0159\u00ed\u010dina kon\u010detinov\u00e9 isch\u00e9mie \u2013 kazuistika \u2013<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[],"class_list":["post-1049","post","type-post","status-publish","format-standard","hentry","category-rocnik-2020"],"_links":{"self":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/1049","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1049"}],"version-history":[{"count":0,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=\/wp\/v2\/posts\/1049\/revisions"}],"wp:attachment":[{"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1049"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1049"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/urgentnimedicina.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1049"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}