Analysis of qualified first aid procedures for injuries in the activities of the State Fire Service in Lublin in 2016–2018

INTRODUCTION: The State Fire Service (SFS) medical activities are conducted at the level of qualified first aid (QFA). This is a lower standard than emergency medical services (EMS) implemented by The Polish EMS, however, the number of QFA procedures available to firefighters allows them to conduct effective medical operations in both life-threatening and traumatic and non-traumatic life. The aim of the study is a comparative analysis of QFA procedures for injured trauma. MATERIAL AND METHODS: Medical activities of the SFS in Lublin were analysed, from which events and procedures regarding injuries to injured persons and rescuers themselves during activities over a three-year period (i.e. in the years 2016–2018) were separated. In order to analyse the collected results, medical procedures concerning only injuries were identified, which are the most numerous group of procedures. For the purposes of analysis, the procedure was divided into two groups: (1) injuries – burns; (2) injuries. RESULTS: In 2016, n = 133 trauma procedures were implemented among all medical activities. In 2017, n = 330 trauma procedures were implemented among all medical activities, while in 2018 n = 245 trauma procedures were implemented. In 2016, burns affected people with an average age of 56 ± 14 years, in 2017 — 51 ± 21 years, and in 2018 — 49 ± 19 years. The average for a total of three years of people with burns was 39 ± 19 years. CONCLUSIONS: 1. Traffic events (accidents, collisions, deductions) constitute the largest number of local threats. 2. QFA procedures well suited to current threats, officers of SFS Lublin in the examined period used 20 out of 22 QFA procedures, including most of the procedures regarding injuries

Non-invasive assessment of haemodynamic parameters in an Emergency Department

Introduction: Hospital Emergency Departments are places where fractions of a second decide about human life and every possibility of quickly and reliably obtaining additional information about the patient’s condition is extremely important. Therefore, an attempt was made to determine the usefulness of non-invasive assessment of haemodynamic parameters in patients in Emergency Departments.   Material and methods: The research was conducted in June and July 2019 in the Emergency Room of the Bielański Hospital, Jerzy Popiełuszko in Warsaw. Non-invasive measurement of haemodynamic parameters was performed with the ICON (Osypka Medical, GmbH) Heart Rate Monitor. The study was conducted among patients of the green part of the Emergency Department. P < 0.05 was adopted as the significance level.   Results: One-way non-parametric ANOVA confirmed the existence of statistically significant differences (all p for trend < 0.05) between BMI (p < 0.001), HR (p = 0.040), ICON (p = 0.048), and CO (p = 0.006) and for the four groups according to the reason for reporting to the Emergency Department (orthopaedic injuries, surgical intervention, internal medicine, other medical fields). One-way non parametric ANOVA confirmed the lack of statistically significant differences (all p for trend > 0.05) between age (p = 0.418), SV (p = 0.161), TFC (p = 0.142), and STR (p = 0.094) and for the four groups according to the reason for reporting to the Emergency Department. In simple linear regression analysis (Spearman), BMI was negatively correlated with CO, ICON, SV, and TFC (all p for trend < 0.05). Age was negatively correlated with CO, ICON, and SV.   Conclusions: Due to the diversity of patients and their conditions, non-invasive assessment of haemodynamic parameters can become an invaluable help during the diagnosis and subsequent treatment of Emergency Department patients

Extracorporeal membrane oxygenation as a method to manage acute cardiopulmonary failure after emergency coronary artery bypass grafting

Acute cardiopulmonary failure after emergency coronary artery bypass grafting (CABG) is a complex thera­peutic problem due to its high mortality rate. This paper reports the safety and effectiveness of extracorpor­eal membrane oxygenation (ECMO) in treating acute cardiopulmonary failure following emergency CABG. A 37-day period of mechanical circulation support and extracorporeal blood oxygenation with the ECMO method served as a bridge to recovery. At day 34 following the disconnection of ECMO, a patient with EF > 35% was transferred to a rehabilitation ward. The procedure can be successful only when the physi­cians, nurses and perfusionists of the intensive care team cooperate closely

Assessment of the exposure of nurses from Emergency Departments to aggressive behavior of patients

INTRODUCTION: A large number of patients and their families waiting for help in ED, deteriorating health, high levels of stress and a recent sudden event, such as an accident, assault, life or health threaten the patient’s anxiety, fear or fright that may result in irrational or violent behavior. These behaviors may be a threat to both the patient and the environment. This work aims to determine the exposure of nursing staff employed in ED for aggression on the part of patients.  METHODS: The research was carried out in the Masovian Province, in the Prague Hospital in Warsaw, in the Brodnowski Mazowieckie Hospital in Warsaw and in the Independent Public Health Care Team in Minsk Mazowiecki, from January to March 2018. The study was attended by 50 nurses working in ED.  RESULTS: According to the surveys carried out, nursing Staff in ED meets with the aggression of patients very often, ie at least once every few days — this is confirmed by as many as 60% of the respondents. For frequent contact with aggressive patients (ie on average once a week) indicates 28% of respondents, and the remaining 12% contact aggressive patients on average once a month. The most frequent type of aggres- sion manifested by ED patients is verbal aggression — 68% of respondents contact it. 22% indicate physical aggression directed to nursing staff, and 10% for physical aggression but directed to objects.  CONCLUSIONS: In conclusion, our data indicate that: (1) Aggression of patients in ED is a very frequent phenomenon, and the level of high personnel exposure — aggression is recorded at least once every few days. There is no clear relationship between the increase in the number of aggressive patients on certain days of the week or the time of day, although there is a tendency to note such cases on weekends and at night; (2) The most common type of aggression undertaken by ED patients is verbal aggression manifested in insults, insults, shouting, threats and intimidation; 

Teletransmission as a useful method in the conduct of Medical Rescue Teams

Introduction: Emergency medical services, during their activities, must diagnose conditions directly threatening the patient’s life and health, implement appropriate procedures, secure the patient, and transport them to a place where they can be given more appropriate assistance in the shortest possible time. Performing teletransmission significantly reduces the time to provide the patient with proper, life-saving assistance. In this study the authors undertook an analysis of teletransmissions carried out by the teams of EMS. These data are to be used to assess the MRT activities depending on the hospital to which the patient was transferred.   Material and methods: The information was obtained based on the analysis of MRT exit cards working in the area of the Sokołowski powiat and the city of Sokołów Podlaski. The author analysed 3804 travel cards of the MRT 04-51, 04-52, 04-54 teams in Sokołów Podlaski and Kosów Lacki in 2018, distinguished 147 cards during which the teams performed teletransmission to the Haemodynamics Centre in Siedlce. Then the exit cards were analysed according to the patient’s age, and then the time elapsed from departure to arrival at the place of call and from arrival to the moment of transferring the patient to the hospital, broken down by urgency code of departure: code 1 (C1) and code 2 (C2). P < 0.05 was adopted as the significance level.   Results: The average age of teletransmitted patients was 69.8 ± 17 years, and the average age without teletransmission was 65.8 ± 23.6 years (p = 0.042). The time elapsed from reaching the patient to the time of transfer in the hospital for patients who were teletransmitted was 49.1 ± 16.1 minutes, and for patients who were not it was 39 ± 22.2 minutes (p < 0.001). The average time to reach the patient in the code 1 was 10.9 ± 7.4 minutes, and in the code 2 it was 14.5 ± 17.9 min (p < 0.001). It was shown that the patient’s age did not affect the time of departure and arrival at the place of call (r = 0.075), nor the time of transferring the patient to the hospital (r = 0.027).   Conclusions: 1. The results obtained show the need to perform the teletransmission procedure as soon as possible and to apply appropriate treatment by MRT. This can significantly reduce the time to balloon a clogged vessel or attach a stent. 2. Performing teletransmission extends the time of patient transfer in hospital by nearly 10 minutes 3. Considering the place of patient transfer in ER or ED, both the age of the patients, times from the MRT departure to arrival at the call site, and the time from arrival at the place of call to transfer in hospital turned out to be statistically significant

Emergency care of the dialysis patients

End stage renal disease (ESRD) is one of the major health care burdens worldwide. Emergency staff are well aware of the frequent use of their services by dialysis patients. In this article we discuss the urgent and serious medical problems that bring the dialysis patient to the emergency department (ED), and the special considerations in the management of such patients in the acute care setting. The main medical problems in dialysis patients presenting to the emergency department are as follows: emergent acid-base and electrolyte disorders; fever; cardiovascular emergencies; dyspnea; angina/chest pain; anemia and emergencies related to access. In conclusion, hemodialysis (HD) and peritoneal dialysis (PD) patients frequently utilize ED services because of their proneness to a variety of emergency medical problems

COMPARISON OF FOUR LARYNGOSCOPES FOR OROTRACHEAL INTUBATION BY NURSES DURING RESUSCITATION WITH AND WITHOUT CHEST COMPRESSIONS: A RANDOMIZED CROSSOVER MANIKIN TRIAL

BACKGROUND: Currently, the gold standard for airway management in cardiopulmonary resuscitation is endotra- cheal intubation. This should be performed without interruptions in chest compressions, or with a short break only to introduce the tube. METHODS: A total of 47 nurses were recruited who performed endotracheal intubation on a manikin in 2 scenar- ios: A — normal airway, without chest compressions; B — normal airway, with continuous chest compressions performed with the Lifeline ARM system. They used 4 devices: a Macintosh blade laryngoscope (MAC), and a Tru- View EVO2 (EVO2), TruView EVO2 PCD (PCD), and an ETView SL (ETView) laryngoscope. The intubation time and effectiveness, the grade of larynx visibility, and the ease of intubation in adults were compared. RESULTS: The median time to rst ventilation in scenario A was: for the MAC, 30.5 (interquartile range [IQR], 27– –36.5); for the EVO2, 35.5 (IQR, 32–39.5): for the PCD, 26.5 (IQR, 25–28.5); and for the ETView, 23 (22–24.5)’]; in scenario B: for the MAC, 47.5 (IQR, 37.5–51); for the EVO2, 42.5 (IQR, 39–47.5): for the PCD, 29.5 (IQR, 28–33); and for the ETView, 26 (IQR, 23–30.5) seconds]. The rst inbunation attempt success rate in scrnario A was: for the MAC, 44.7%; for the EVO2, 68.8%; for the PCD, 82.9%; and for the ETView, 91.5%; in scenario B: for the MAC, 38.3%; for the EVO2, 61.7%; for the PCD, 70.2%; and for the ETView 89.4%. CONCLUSIONS: The ef cacy of endotracheal intubation by nurses turned out to be insuf cient. Ongoing chest compressions signi cantly reduced the intubation effectiveness with the MAC. After a short training session, nurses could perform intubation with videolaryngoscopes. ETView appeared to be the most effective method in both scenarios

BRAIN DEATH — A CURRENT PROBLEM OF OUR TIME

  The concept of brain death is a complex philosophical and medical construct which, despite the passage of time and strictly defined deadlines, is incomprehensible and unacceptable for a section of society. The diagnosis of brain death allows one not only to end the pursuit of persistent therapy, but also to collect organs for transplantation and thus help people who have been condemned to death so far. The purpose of this article is to show the public’s fears about stating the death of the brain, to realize that the death of the brain is equal to the death of an individual and a reminder of the criteria and rules for the recognition of death by doctors

THE LIMITS OF PERSISTENT THERAPY

  The growing average life expectancy of human beings is one of the greatest achievements of medicine. From the dawn of mankind, death has been associated with pain, suffering, loss and a series of many other negative emotions. Although it is an inseparable part of human existence, it is difficult to define it unequivocally, and the clarification of this phenomenon has been worked on, from antiquity, by medics, philosophers, clergy and psychologists, seeking to know man in the physiological, psychological, religious, social spheres [1]. The fact is that human life is the highest value, which is why there is a lot of controversy about making the decision to stop persistent therapy. The article is a review of the present problem, namely the cessation of persistent therapy, in an era of the development of medicine

COMPARISON OF ENDOTRACHEAL INTUBATION WITH THE AIRTRAQ AVANT® AND THE MACINTOSH LARYNGOSCOPE DURING INTERMITTENT OR CONTINUOUS CHEST COMPRESSION: A RANDOMIZED, CROSSOVER STUDY IN MANIKINS

BACKGROUND: Endotracheal intubation (ETI) currently is the gold standard of securing an airway during cardio- pulmonary resuscitation. PURPOSE: The aim of this study was to evaluate ETI with the Airtraq Avant (ATQ) compared to a conventional Macintosh laryngoscope when used by paramedics during resuscitation with and without chest compression (CC). METHODS: Forty-seven paramedics were recruited into a randomized crossover trial in which each performed ETI with ATQ and MAC in both scenarios. The primary endpoint was time to successful intubation, while secondary endpoints included intubation success, laryngoscopic view on the glottis, dental compression, and rating of the given device. RESULTS: In the manikin scenario without CC, nearly all participants performed ETI successfully both with ATQ and MAC, with a shorter intubation time using MAC 20.5 s [IQR, 17.5–22], compared to ATQ 24.5 s [IQR, 22–27.5] (p = 0.002). However, in the scenarios with continuous CC, the results with ATQ were signi cantly better than with MAC for all analyzed variables (success of rst attempt at ETI, time to intubation (TTI) [MAC 27 s [IQR, 25.5–34.5], compared to ATQ 25.7s [IQR, 21.5–28.5] (p=0.011), Cormack-Lehane grade and rating). The success rate in scenarios with CC was 82.9% vs. 91.5% for MAC Laryngoscope vs. ATQ, respectively (p=0.021). CONCLUSIONS: The ATQ provides bene ts in terms of ETI success rate, TTI, and glottic view when compared to MAC during ETI with continuous CC