Successful management of severe exertional heat stroke complicated by ventricular fibrillation in 19 years old male

Heatstroke is a heat-related disease that is highly fatal. However, it is significant that if symptoms are quickly recognized, the outcome remains satisfactory. In this paper, the authors present the case of a 19-year-old physical worker in whom heatstroke was complicated by cardiac arrest. The proper action and full diagnosis of the underlying cause of cardiac arrest allowed for a full recovery. Attention was also drawn to the lack of appropriate equipment for active cooling and potential use of automatic chest compressions devices

Paramedic students need more training in left ventricular assist device — a pilot simulation study

INTRODUCTION: Mechanical Circulation Systems are a promising therapy for patients with end-stage of heart failure. Left ventricular assist device (LVAD) enforces using of concomitant anticoagulant therapy. This may lead to severe complications. LVAD patients are more and more frequent users of the emergency department. There are several differences in cardiovascular function in these patients, as well as on examination. Its interpretation may be challenging and result in potentially fatal conclusions. The aim of this research was to assess the skills of paramedic students in assessing patients with LVAD MATERIAL AND METHODS: The study was designed as a simulation study. The aim of this scenario was to provide a full primary survey of an unconscious, spontaneously breathing person with an LVAD pump implanted. Ten groups of paramedic students from Polish medical universities took part in this study. RESULTS: Four teams started chest compressions unnecessarily. Of them, only one had contacted LVAD local coordinator and discontinued after short instructions. Four teams completed the driveline and device check and six checked only the line without moving the controller. No major errors were noted in the field of airway assessment and management as well as assessment of consciousness, breathing, and circulation. CONCLUSIONS: More attention should be paid to educating paramedic students in LVAD therapy. Educators should focus mainly on differences in cardiovascular function and pay attention to complete perfusion assessment. Medical simulation seems to be a good tool for assessing difficult clinical cases rarely encountered in practice

Are we well prepared to examine patients with left ventricular assist device in emergency conditions? — a simulation-based pilot study

Introduction: Left ventricular assist device (LVAD) therapy is becoming more and more important. There is now increasing number of patients on LVAD therapy. This means that they will also be more frequent patients in emergency departments. There are several differences in cardiovascular function in these patients. An examination performed according to the well-known ABCDE algorithm, can be difficult to interpret and result in incorrect decisions. The aim of this pilot study was to preliminarily assess the ability of medical university students to examine a patient with LVAD. Material and methods: The authors designed a simulation study. The aim of the scenario was to assess the unconscious, spontaneously breathing patient with LVAD and provide assistance appropriate to the patient’s condition. Ten groups of students from different polish medical universities participated in the study. Results: All teams implemented the ABCDE examination protocol. Seven teams started chest compressions due to absence of pulse despite spontaneous breathing. Out of seven teams that started compressions, two terminated after discussion within the team. Half of the teams completed the driveline and LVAD device check. Four teams contacted the LVAD coordinator. Three teams in the study did not perform perfusion assessment. Conclusions: An examination according to the ABCDE algorithm can be performed in a patient with LVAD. However, there is a need to modify the standard algorithm to adjust for the characteristics of an LVAD patient. Consideration should be given to inadequate skills in interpreting the results ABCDE examination. Simulation-based learning should be an important part of pre- and postgraduate education

Carbon dioxide as a potential danger to medical rescue teams at work – A case study

Medical rescue teams might be exposed to the risk of accidental poisoning while performing rescue procedures. Exposure to the risk of lethal carbon dioxide (CO2) concentrations is a rare situation. This case study describes rescuing a patient who suffered from sudden cardiac arrest due to accidental CO2 poisoning. The victim was finally evacuated and resuscitated, but the circumstances of the rescue operation point to the need to equip ambulances with carbon dioxide detectors and hermetic oxygen masks. Med Pr 2017;68(1):135–13

Critical considerations in management of patients with left ventricular assist device in an Emergency Department practice

In recent years, mechanical circulatory support has become an increasingly used treatment strategy for end-stage heart failure. Due to technological progress and higher availability of this therapy, the number of patients receiving left ventricular assist devices (LVAD) is increasing. A natural consequence of this is occurrence of complications related to this therapy. A patient presenting to an emergency department (ED) expects the highest level of care. Emergency department staff should have basic knowledge and skills to provide initial diagnostic and therapeutic interventions for patients with LVAD in life-threatening conditions. The most common reasons for patients with LVADs presenting to the ED are bleeding, heart rhythm disorders, stroke, or infections. This article aims to present the basic information that may be useful during the first medical contact in an emergency department. The authors have discussed the issue of diagnosis, and differences in laboratory findings and indicate where to best seek help. The article is dedicated to physicians, nurses, and paramedics working in emergency departments

Examination of a patient with left ventricular assist device in an emergency condition — proposal for adaptation of the ABCDE examination algorithm

Heart failure is becoming a medical issue that concerns more and more patients. The most effective treatment method is heart transplantation, however, more people are waiting for the procedure than there are available donors. The improvement of left ventricular assist device (LVAD) method was possible because of the joining forces of technological and medical advances. In recent years more patients have undergone the LVAD treatment. It has been a considerable challenge for medics in prehospital conditions. Device malfunction, bleeding, chest pain, or collapse pose a threat to life for those patients. The aim of this paper was to adjust the ABCDE examination algorithm to be applied for patients with LVAD. Additionally, the author has described the method in detail. The article itself and the modification of the algorithm are based on the analyses of available source literature. The biggest challenge for medics who examine patients with LVAD is a lack of pulse and inability to measure the pressure in a classical method. The most visible differences in the examination scheme have been observed in points C and E. The authors have identified the need for simulation-based trainings dedicated to medical staff working in prehospital conditions. Additionally, a special system informing emergency services about LVAD patients living in their area should be implemented

Dynamics of the Third Wave of COVID-19 from the Perspective of the Emergency Department in a Large Regional Hospital—Single Center Observational Study

Background: The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic has caused many significant social and economic changes. The consecutive waves of the epidemic in various countries have had dissimilar courses depending on the methods used to combat it. The aim of this study was to determine the dynamics of the third wave of COVID-19 from the perspective of emergency departments (ED). Methods: This was a retrospective review of medical records from ED. The authors have identified the most frequent symptoms. Prognostic factors have been chosen—prognostic scales, length of stay (LOS)—and a number of resources required have been calculated. Results: As the time passed, there were fewer patients and they presented mild symptoms. A statistically significant difference was observed in the median of blood oxygenation measurement (p = 0.00009), CRP level (p = 0.0016), and admission rate. Patients admitted to the hospital required more resources at ED. LOS was shorter in patients discharged home (p < 0.0001). Conclusions: The blood oxygen saturation (SPO2) and CPR levels can be helpful in decision-making regarding medical treatment. The fast-track for patients in good clinical condition may shorten the duration of stay in ED, and reduce the number of required resources

Patient Safety during ECMO Transportation: Single Center Experience and Literature Review

Background. Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams. Aim. The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature. Methods. A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019. Results. Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2–63 years) were transferred to our ECMO center. In 92% (n = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5–200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%). Conclusions. Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety