Emergency medicine point of view on epidemiology of diabetes and diabetes-related complications

Despite centuries of research and clinical work, the diagnosis of diabetes was still treated as a quick death sentence at the beginning of the 20th century. Unfortunately, the number of patients with diabetes is increasing every year. Type 2 diabetes is increasingly common among young people: children and adolescents. The article discusses the type of diabetes and the importance of rapid diagnosis and management. Type 1 diabetes, type 2 diabetes, latent autoimmune diabetes in adults, monogenic diabetes, gestational diabetes was analyzed. Life threatening conditions resulting from complications of diabetes including diabetic ketoacidosis, hyperglycemic hyperosmolar state, hypoglycemia, lactic acidosis was discussed, and the first-line emergency treatment were analyzed. The life-threatening complications of diabetes and rescue procedures in these conditions were discussed in detail. Conclusion. Due to the frequency of life-threatening complications, diabetes is a heavy burden on the medical staff. Adequate diagnosis and implementation of appropriate treatment significantly improve the patient's condition

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

Targeted temperature management: State of the Art

One of the indicated elements of post-resuscitation care is therapeutic hypothermia or temperature treatment management. the survivability of out-of-hospital cardiac arrest (OHCA) till admission to hospital is only 23%. Efficient thermoregulatory mechanisms are the basis for maintaining optimal body temperature. Therapeutic hypothermia shows normalizing effect on metabolic processes disturbed in ischaemic conditions, including improving metabolism and maintaining glucose balance in the brain, lowering the concentration of lactates, limiting the secretion of free radicals in damaged neurons, lowering the production of pro-inflammatory cytokines, stabilizes the blood-brain barrier and reduces endothelial dysfunction preventing ischaemic damage to tissues and organs. Hypothermia has a wide multidirectional effect on the human body, which can be useful in patients. Most available scientific studies show the efficacy and benefits of hypothermia in patients with out-of-hospital sudden cardiac arrest, including especially with ventricular fibrillation. The delay in the initiation of therapeutic hypothermia and reaching target temperature significantly increased the odds of a poor neurological outcome. Current American Heart Association (AHA) and European Resuscitation Council (ERC) resuscitation guidelines recommend that targeted temperature management should be implemented in all adult coma patients with return of spontaneous circulation (ROCS) after sudden cardiac arrest. The target temperature should be between 32°C and 36°C and then maintained for at least 24 hours. In patients with coma after TTM, fever should be actively prevented. For patients with out-of-hospital cardiac arrest, it is not recommended to routinely cool patients in prehospital conditions with a rapid intravenous infusion of cold fluids after ROSC

Application of interventional ultrasound in emergency medicine conditions

ULTRASONOGRAPHY is a modern diagnostic tool both in intensive care and emergency medicine. Small, portable and simple ultrasound devices have been introduced due to technological advances. The image quality, size, and weight of portable ultrasound devices are improving. Prehospital point-of-care ultrasonog- raphy may have an impact on the decision making in prioritizing initial treatment. First aid at the scene of the accident and transporting the patient to the hospital is a key element, which in the case of appropriate diagnostics allows you to fight life-threatening injuries. The intention of using ultrasound protocols is to shorten and simplify the ultrasound examination allowing to eliminate or find complications of an injury as soon as possible. The protocols used include elements of ultrasonography and echocardiography of the lung tissue, abdominal cavity, pelvis, large vessels or the eyeball. The intention of the authors of the article was to present to the reader the basic ultrasound protocols applicable to patients in emergency situations.

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

Comparison of two infant chest compression techniques during simulated newborn cardiopulmonary resuscitation performed by a single rescuer: A randomized, crossover multicenter trial

Background: In newborns, ventilation is a key resuscitation element but optimal chest compression(CC) improves resuscitation quality. The study compared two infant CC techniques during simulatednewborn resuscitation performed by nurses.Methods: The randomized crossover manikin, multicenter trial involved 52 nurses. They underwenttraining with two CC techniques: standard two-finger technique (TFT) and novel two-thumb technique(NTTT; two thumbs at 90° to the chest, fingers in a fist). One week later, the participants performedresuscitation with the two techniques. A Tory® S2210 Tetherless and Wireless Full-term Neonatal Simulatorwas applied, with a 3:1 compression to ventilation ratio. CC quality in accordance with the 2015American Heart Association guidelines was assessed during the 2-min resuscitation.Results: Median CC depth was 30 mm for TFT and 37 mm for NTTT (p = 0.002). Correct handplacement reached 98% in both techniques; full chest relaxation was obtained in 97% vs. 94% for TFTand NTTT, respectively. CC fraction was slightly better for NTTT (74% vs. 70% for TFT; p = 0.044),the ventilation volume was comparable for both techniques. On a 100-degree scale (1 — no fatigue;100 — extreme fatigue), the participant tiredness achieved 72 points (IQR 61–77) for TFT vs. 47 points(IQR 40–63) for NTTT (p = 0.034). For real resuscitation, 86.5% would choose NTTT and13.5% TFT.Conclusions: The NTTT technique proved superior to TFT. Evidence suggests that NTTT offersbetter CC depth in various medical personnel groups. One-rescuer TFT quality is not consistent withresuscitation guidelines

Randomized trial of the chest compressions effectiveness comparing 3 feedback CPR devices and standard basic life support by nurses

Background: Out-of-hospital cardiac arrest is a leading cause of mortality and serious neurological morbidity inEurope.We aimto investigate the effect of 3 cardiopulmonary resuscitation (CPR) feedback devices on effectivenessof chest compression during CPR.Methods: Thiswas prospective, randomized, crossover, controlled trial. Following a brief didactic session, 140 volunteernurses inexperienced with feedback CPR devices attempted chest compression on amanikin using 3 CPRfeedback devices (TrueCPR, CPR-Ezy, and iCPR) and standard basic life support (BLS) without feedback.Results: Comparison of standard BLS, TrueCPR, CPR-Ezy, and iCPR showed differences in the effectiveness of chestcompression (compressions with correct pressure point, correct depth, and sufficient decompression),which are,respectively, 37.5%, 85.6%, 39.5%, and 33.4%; compression depth (44.6 vs 54.5 vs 45.6 vs 39.6mm); and compressionrate (129.4 vs 110.2 vs 101.5 vs 103.5 min-1).Conclusions: During the simulated resuscitation scenario, only TrueCPR significantly affected the increased effectivenesscompression compared with standard BLS, CPR-Ezy, and iCPR. Further studies are required to confirmthe results in clinical practice

Profile of practices and knowledge on stroke among Polish emergency medical service staff

BACKGROUND: Stroke is a leading cause of disability and death in both developed and developing countries. While hemorrhagic stroke often necessitates immediate neurosurgical intervention, ischemic stroke is treated with reperfusion therapies such as thrombolysis with intravenous recombinant tissue plasminogen activator (IV rtPA) and early endovascular thrombectomy for broad vessel occlusions.   OBJECTIVES: Early diagnoses, accurate emergency medical services (EMS) dispatch, rapid EMS transfer, and stroke team activation have helped reduce door-to-IV tPA time and continue to be critical in saving time for stroke patients’ treatment.   MATERIAL AND METHODS: One reason for prehospital delays may be incorrect qualification by emergency team members due to incomplete medical records and incorrect evaluation of symptoms by dispatchers or paramedics. The dispatcher’s precise identification of the report helps them decide on the patient’s priority disposal of the ambulance. In comparison, a correct initial diagnosis by paramedics allows the patient to be transported immediately to the destination hospital, i.e., the unit with a stroke unit. Extending the time it takes for the patient to enter the stroke facility due to the patient being moved through stages reduces the probability of successful treatment being introduced significantly.   RESULTS: We hypothesized that paramedics’ knowledge of prehospital stroke management protocols would be linked to their clinical experience as well as their stroke preparation.   CONCLUSION: A secondary goal of this study was to evaluate and compare the theoretical knowledge on stroke management among paramedics and identify factors associated with high knowledge. 468 EMS providers agreed to complete a questionnaire that included demographic questions, practical experience questions, and 14 theoretical information questions. Our research found that paramedics in Poland have significant awareness gaps in existing stroke treatment guidelines