Vode li smjernice liječnike beogradske hitne pomoći u zbrinjavanju akutnog infarkta miokarda sa ST elevacijom?

The aim of the study was to assess whether current guidelines for diagnosis and treatment of acute ST-elevation myocardial infarction (STEMI) in daily clinical practice are adequately applied in the Belgrade Emergency Medical Service (EMS). A retrospective research included 2,982 STEMI patients who were cared for by EMS teams. Therapy consisting of morphine, oxygen, nitroglycerin and aspirin (MONA) was applied. Dual antiaggregation therapy (aspirin 325 mg + ticagrelor 180 mg or clopidogrel 600 mg) was administered to patients with primary percutaneous coronary intervention (PCI) indicated. With electrocardiographic monitoring included, the patients were transported directly to PCI unit with announcement of the arrival. Response times I-V were measured. There was an increasing trend in the number of STEMI patients. A rapid increase in the use of dual antiaggregation therapy (MONA and clopidogrel or MONA and ticagrelor) was reported from year to year, as well as a dramatic increase in the use of ticagrelor compared to clopidogrel. The time from receiving the call to the arrival on the scene was 13.72 minutes, and the time from receiving the call to hospital arrival was 52.83 minutes. Our physicians care for STEMI patients in accordance with the current international and local recommendations.Cilj ovoga rada bio je procijeniti primjenjuju li se aktualne smjernice za dijagnostiku i liječenje akutnog infarkta miokarda sa ST elevacijom (STEMI) primjereno u svakodnevnoj kliničkoj praksi u beogradskoj hitnoj medicinskoj pomoći (HMP). Retrospektivnim istraživanjem obuhvaćeno je 2.982 bolesnika sa STEMI kod kojih su intervenirali timovi HMP. Ordinirana je terapija MONA (morfin, kisik, nitroglicerin, aspirin). Dualna antiagregacijska terapija (aspirin 325 mg + tikagrelor 180 mg ili klopidogrel 600 mg) davana je bolesnicima kojima je indicirana primarna perkutana koronarna intervencija (PCI). Bolesnici su uz elektrokardiografsko praćenje transportirani izravno u jedinicu PCI uz prethodnu najavu. Mjerena su vremena reakcije I-V. Bolesnika sa STEMI je bilo 2982, više muškaraca nego žena (63,5% prema 36,5%), sa statistički značajnom razlikom (p<0,001) u dobi između žena (69,30±13,08) i muškaraca (62,67±13,02). Uočen je rastući trend bolesnika sa STEMI. Zabilježen je brz porast primjene dvojne antiagregacijske terapije (MONA i klopidogrel ili MONA i tikagrelor) iz godine u godinu, kao i drastičan porast primjene tikagrelora u odnosu na klopidogrel. Vrijeme od primitka poziva do stizanja ekipe na mjesto intervencije je iznosilo 13,72 min, a vrijeme od primitka poziva do predaje bolesnika u bolnicu 52,83 min. Naši liječnici liječe bolesnike sa STEMI u skladu s aktualnim svjetskim i domaćim preporukama

Assessment of basic life support skills among medical doctors and technicians in Belgrade emergency medical services

Objective. Our aim was to assess BLS (basic life support) skills among medical doctors (MDs) and medical technicians (MTs) who work at Belgrade Emergency Medical Services (BEMS). Methods. A prospective study was conducted between 28 September and 9 December, 2016. MDs (Group 1) and MTs (Group 2) attended an accredited course in BLS at BEMS. At the end of the course the participants were given a written test consisting of 20 questions (pass rate 65%). Te results were analyzed for each group i.e. profession (Group 1 and Group 2) according to the number of accurate and inaccurate answers to each question. In the end, a number of participants from each group, who answered all 20 questions correctly, were identifed. Te results obtained, by test analysis, demonstrated the participants’ acquired BLS skills. Results. Te study involved 100 participants (50 in each group). All participants from Group 1 correctly answered questions number 1, 2, 3, 10, 13, 17 and 20. In Group 1 only two participants had three incorrect answers in the test. Te largest number of incorrect answers was related to question number 16. Tirty-four participants in this group answered all questions correctly. All participants from Group 2 gave correct answers to questions number 2, 5, 9, 10 and 13. In Group 2, one participant had six incorrect answers and one participant had 5 incorrect answers. Te largest number of incorrect answers was related to questions number 3 and 20. Nineteen participants from Group 2 answered all questions correctly. Te rate of correct answers between Group 1 and Group 2 was 19.66 : 18.91 (0.75 diference). Conclusion. Te research showed a satisfactory level of knowledge in both groups. However, there is a statistically signifcant diference in the knowledge of MDs afer the BLS course. Te results obtained justify the ambitions that all healthcare professionals, regardless of their qualifcations, should be trained in applying BLS, both at work and as eyewitnesses

The application of the Kampala trauma Score for prehospital assessment of severity of injuries and prediction of outcome after severe trauma

Severe trauma is the main cause of mortality and disability in modern society. Emergency medical doctors are usually the first to establish contact with the injured person, and the extent of definitive care largely depends on their correct assessment of the severity of the injury, using an adequate pre-hospital trauma score. Injury severity scores are used to numerically categorize the type and extent of the injury. They represent an important additional instrument, which is used to enable faster triage, the categorization of injury severity, adequate care, treatment, and transport of patients with multiple injuries to the appropriate hospital. They are also important in research. This paper aims to suggest, using several case reports, the possibility of pre-hospital use of the Kampala Trauma Score (KTS) as an easily applicable and very suitable system for monitoring the condition and predicting the outcome of seriously injured patients. The patients were primarily assessed at the pre-hospital level and assigned a certain injury severity score according to the KTS, which later proved to reflect their definitive outcome. It can be concluded that the KTS is an effective scoring system that can be used during initial triage of the seriously injured for categorization of the severity of the injury, prediction of mortality and necessity of hospitalization. The possibility of its potential application during emergency care of the seriously injured, both for differentiating the severity of injuries and for predicting the definitive outcome, is indicated. However, due to the limited number of patients, original research should be conducted on a larger sample

Do the Guidelines Guide the Belgrade Emergency Medical Service Physicians through the Management of Acute St-Elevation Myocardial Infarction?

The aim of the study was to assess whether current guidelines for diagnosis and treatment of acute ST-elevation myocardial infarction (STEMI) in daily clinical practice are adequately applied in the Belgrade Emergency Medical Service (EMS). A retrospective research included 2,982 STEMI patients who were cared for by EMS teams. Therapy consisting of morphine, oxygen, nitroglycerin and aspirin (MONA) was applied. Dual antiaggregation therapy (aspirin 325 mg + ticagrelor 180 mg or clopidogrel 600 mg) was administered to patients with primary percutaneous coronary intervention (PCI) indicated. With electrocardiographic monitoring included, the patients were transported directly to PCI unit with announcement of the arrival. Response times I-V were measured. There was an increasing trend in the number of STEMI patients. A rapid increase in the use of dual antiaggregation therapy (MONA and clopidogrel or MONA and ticagrelor) was reported from year to year, as well as a dramatic increase in the use of ticagrelor compared to clopidogrel. The time from receiving the call to the arrival on the scene was 13.72 minutes, and the time from receiving the call to hospital arrival was 52.83 minutes. Our physicians care for STEMI patients in accordance with the current international and local recommendations

Case report the sudden cardiac death of a food delivery service worker due to unrecognized myocarditis

Introduction/Objective The COVID-19 pandemic enabled an increase in the use of food delivery apps and provided more work for delivery services, especially while the lockdown measures were in place. Many scientific papers have been written about epidemiological measures and the safety of delivered food in the prevention of COVID-19, but there is little research dedicated to the pressures suffered by delivery service workers and the health consequences that may have arisen due to their unregulated work status. We present the rare combination of difficult work conditions and myocarditis, which led to the sudden cardiac death of a food delivery worker. Case report The Emergency Medical Team (EMT) was dispatched to help a person lying in a corridor of a building showing no signs of life. Upon arrival at the scene, they found an approximately 30-40-year-old man lying on the ground near the entrance of the building next to his bicycle with a delivery bag still on his back. He was unconscious, with no breathing or pulse, and with no visible signs of injury. Information was obtained from bystanders about a delivery to the fifth floor of the building with no elevator, but there was no reliable information about the time of cardiac arrest. The initial rhythm was asystole, so the non-shockable rhythm cardiopulmonary resuscitation (CPR) protocol was immediately initiated. During CPR, two IV lines were opened, seven adrenaline injections were administered intravenously (IV), a 0.9% NaCl solution was initiated, and the airway was secured by placing an endotracheal tube. Despite all the efforts, the resuscitation measures were unsuccessful, and the patient was pronounced dead. Because the patient had died in a public place of an unknown cause, the police was notified, and the body was transferred to forensic pathology. The autopsy revealed no macroscopic changes in the myocardium, but pathohistology did reveal myocarditis. Since all this occurred during the COVID-19 pandemic, a PCR test was performed, which was negative. Toxicology findings revealed the presence of amphetamine and THC in traces, which were not thought to have affected the fatal outcome. Conclusion Myocarditis is an important but underrecognized cause of sudden death in young people, including delivery workers. Future research should be focused on adopting more precise criteria for myocarditis detection in such high-risk occupations

Relationship between mentalizing and teacher burnout: A cross sectional study.

BackgroundTeaching is considered a high-risk profession due to the high impact of occupational risk factors which can endanger educators' mental health and lead to burnout syndrome. This study aimed to examine whether the capacity for mentalizing in teachers explains the degree of their burnout syndrome. The expectation was that a low capacity for mentalizing increases the degree of burnout.MethodsA cross-sectional study was conducted on a sample of 823 teachers. The Maslach Burnout Inventory-Educators Survey was used to examine the burnout syndrome. The capacity for mentalizing was examined using hypomentalizing and hypermentalizing scales from the Reflective Functioning Questionnaire.ResultsThe expectation that a low capacity for mentalizing increases teachers' burnout confirms the finding that hypomentalizing is a positive predictor of their emotional exhaustion as a dimension of burnout (ß = 0.09; p ConclusionsCapacity for mentalizing and burnout syndrome in teachers are interrelated phenomena. With a good capacity for mentalizing, emotional exhaustion and burnout in teachers are reduced. Knowledge and skills that enable a good capacity for mentalizing should be included in educational and teacher training programs