THE ROLE OF MALE NURSE AND HIS ROLE IN THE MANAGMENT OF PATIENTS WITH ACUTE CORONARY SYNDROM IN PREHOSPITAL EMERGENCY MEDICAL UNIT

V diplomskem delu smo predstavili začetke in organiziranost nujne medicinske pomoči (NMP) v Sloveniji, organiziranost NMP na Koroškem, ker je posebnost v slovenskem prostoru, ter samo sestavo prehospitalne (PHE) enote. Na kratko smo predstavili tudi zgradbo in delovanje krvnih obtočil. Opisali smo akutni koronarni sindrom (AKS), klinično sliko ter verigo preživetja ob AKS-ju. Opredelili smo delitev AKS-ja glede na 12-kanalni elektrokardiogram in možne zaplete ob AKS-ju. Omenili smo tudi obravnavo bolnika z AKS-jem s strani PHE enote NMP ter vlogo diplomiranega zdravstvenika in aktivnost zdravstvene nege pri oskrbi bolnikov z AKS-jem v PHE enoti. V raziskavi, ki smo jo izvedli na Zdravstveno reševalnem centru Koroške, smo predstavili podatke, koliko bolnikov z AKS-jem iz terena prepeljemo v nadaljnjo oskrbo in zdravljenje v Splošno bolnišnico Slovenj Gradec in koliko v Univerzitetni klinični center Maribor. Ugotovili smo, da so bolniki z AKS-jem starejši ter da prevladuje moški spol, čas in pot sta bila krajša do SB Slovenj Gradec. Večino bolnikov smo prepeljali v SB Slovenj Gradec, vsi bolniki so bili dispnoični ali z bolečino v prsih, v samo enem primeru je prišlo do zapletov med prevozom — reanimacija.In this diploma paper we presented the beginnings and the organization of the emergency medical aid in Slovenia. The structure of the NMP in Koroška, as the specificity of the Slovenian territory, as well as the structure of the pre-hospital unit. We also presented the structure and functioning of the blood circulatory system. We described an acute coronary syndrome (ACS), the clinical picture and the chain of survival at ACS as well as defined the division of an acute coronary syndrome according to the twelve-channel electrocardiogram and possible complications with ACS. We also mentioned the treatment of patients with an acute coronary syndrome by the pre-hospital emergency medical unit, the role of a male nurse as well as nursing activities in caring for patients with ACS in pre-hospital unit. In the survey, which was carried out at Zdravstveno reševalni center Koroška, we presented the data showing the number of patients with an acute coronary syndrome transported for further care and treatment to the General Hospital Slovenj Gradec and to the University Medical Centre Maribor. We found out that, patients with ACS are older, and that the male gender is dominant, time and route was shorter to SB Slovenj Gradec. Most patients were transported in SB Slovenj Gradec, all patients have diffculty breathing or having chest pain, only in one case there was a complication during transport/ resuscitation

THE COMPETENCIES OF HEALTH RESCUERS WHILE TREATING ACUTE CORONARY SYNDROME IN THE EMERGENCY MEDICAL SERVICE ON THE FIELD

Uvod: Akutni koronarni sindrom (AKS) predstavlja enega najpomembnejših in pogostih zdravstvenih problemov v svetu ter glavni vzrok umiranja bolnikov s koronarno boleznijo. Namen magistrskega dela je ugotoviti, če znanja in spretnosti zdravstvenih reševalcev zadostujejo za celostno začetno obravnavo bolnikov z AKS. Metode: Uporabljena je bila kvantitativna metodologija. Kot instrument zbiranja podatkov je bil uporabljen strukturiran anketni vprašalnik. Pridobljene podatke smo obdelali z uporabo deskriptivne in inferenčne statistike. Za obdelavo podatkov smo uporabili statistični program IBM SPSS 21. Rezultati: V raziskavi je bila nizka odzivnost anketirancev, morda zaradi zahtevne ankete. Podatki kažejo, da zdravstveni reševalci ne dosegajo željeni/potrebni nivo znanja za samostojno začetno obravnavo bolnikov z AKS, kar je pokazalo preverjanja znanja v anketi. Rezultati tudi kažejo (p = 0,16), da ni statistične povezanosti med dolžino delovne dobe v NMP in znanjem reševalcev. Interpretacija in zaključek: V raziskavi je bila nizka odzivnost anketirancev. Podatki kažejo, da zdravstveni reševalci ne dosegajo nivo željenega/potrebnega znanja za samostojno začetno obravnavo bolnikov z AKS. Rezultati raziskave kažejo, da je potrebno na področju začetne obravnave bolnikov z AKS izvajati dodatna izobraževanja zdravstvenih reševalcev. Znanje, spretnosti ter poznavanje protokolov bi lahko uporabili skupaj z informacijsko komunikacijsko tehnologijo zlasti v odsotnosti zdravnika, s čimer bi močno prispevali k boljšim končnim rezultatom zdravljenja AKS.Introduction: Acute coronary syndrome (ACS) is one of the most significant and common health problems in the world and also a major cause of death for patients with coronary disease. The purpose of the master’s thesis is to find out whether the knowledge and skills of the health rescuers are sufficient for a holistic initial treatment of patients with ACS. Methods: A quantitative methodology was used. A structured questionnaire was used as an instrument for collecting data. The acquired data was analysed by using a descriptive and inferential statistics. For processing the data we used the statistics programme IBM SPSS 21st. Results: Low responsiveness of the respondents in the survey was perhaps due to the complex of the survey. Data show that health rescuers do not reach the level of knowledge for the independent initial treatment of patients with ACS, which was also evident from the questionnaire. The results also show (p = 0.16) that there is no statistical relationship between the length of service in EMT (emergency medical treatment) and the knowledge of the rescuers. Interpretation and conclusion: There was a low response of the respondents in the survey. Data show that the health rescuers do not reach the level of knowledge for the independent initial treatment of patients with ACS. The results of the research indicate that some additional trainings are needed for the health rescuers in this field. Knowledge, skills and the knowledge of the protocols could be used together with the information and communication technology, particularly in the absence of a doctor, which would greatly contribute to better final results of the treatment of ACS

To ventilate or not to ventilate during bystander CPR — A EuReCa TWO analysis

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both

To ventilate or not to ventilate during bystander CPR : a EuReCa TWO analysis

Background: Survival after out-of-hospital cardiac arrest (OHCA) is still low. For every minute without resuscitation the likelihood of survival decreases. One critical step is initiation of immediate, high quality cardiopulmonary resuscitation (CPR). The aim of this subgroup analysis of data collected for the European Registry of Cardiac Arrest Study number 2 (EuReCa TWO) was to investigate the association between OHCA survival and two types of bystander CPR namely: chest compression only CPR (CConly) and CPR with chest compressions and ventilations (FullCPR). Method: In this subgroup analysis of EuReCa TWO, all patients who received bystander CPR were included. Outcomes were return of spontaneous circulation and survival to 30-days or hospital discharge. A multilevel binary logistic regression analysis with survival as the dependent variable was performed. Results: A total of 5884 patients were included in the analysis, varying between countries from 21 to 1444. Survival was 320 (8%) in the CConly group and 174 (13%) in the FullCPR group. After adjustment for age, sex, location, rhythm, cause, time to scene, witnessed collapse and country, patients who received FullCPR had a significantly higher survival rate when compared to those who received CConly (adjusted odds ration 1.46, 95% confidence interval 1.17–1.83). Conclusion: In this analysis, FullCPR was associated with higher survival compared to CConly. Guidelines should continue to emphasise the importance of compressions and ventilations during resuscitation for patients who suffer OHCA and CPR courses should continue to teach both