Je li tablica ETDRS bolja od Snellenove tablice u procjeni vidne oštrine kod operacije katarakte?

This study was designed to explore practical differences between visual acuity (VA) scores measured on Snellen chart versus ETDRS chart, to grade cataracts using LOCS III system, and to compare VA on both charts depending on cataract grade and type. Prospective evaluation of uncorrected and best-corrected visual acuity was carried out on the eye scheduled for cataract surgery preoperatively and postoperatively on the Snellen and ETDRS charts. The study was carried out at Department of Eye Diseases, Clinical Center of Serbia, during a two-year period. Inclusion criteria were met by 540 patients who underwent testing, surgery, data collection and analysis. The mean VA score was better on ETDRS than on Snellen chart. The mean difference was 6.05 letters or 1.21 lines. VA results correlated with all types of cataract regardless of the chart used, with the highest statistical significance (p<0.0001) for subcapsular cataract. The ETDRS chart was found to be more discriminative and precise than Snellen chart, especially for poor VA.Cilj studije bio je procijeniti razlike vidne oštrine mjerene Snellenovom tablicom nasuprot tablici ETDRS, odrediti stupanj katarakte primjenom sustava LOCS III i usporediti vidnu oštrinu dobivenu pomoću oba optotipa ovisno o tipu i stupnju katarakte. Provedena je prospektivna procjena nekorigirane i najbolje korigirane vidne oštrine primjenom tablica Snellen i ETDRS prije i nakon operacije katarakte. Ova dvogodišnja studija izvedena je na Klinici za očne bolesti Kliničkog centra Srbije. Kriterije za uključivanje u studiju ispunilo je 540 bolesnika koji su podvrgnuti testiranju, operaciji, prikupljanju i analizi podataka. Srednja vrijednost zbroja vidne oštrine procijenjena tablicom ETDRS bila je bolja u usporedbi sa Snellenovom tablicom. Srednja vrijednost bila je 6,05 slova ili 1,21 linija. Rezultati vidne oštrine korelirali su sa svim tipovima katarakte bez obzira na tablicu koja se primijenila, s najvećom statističkom značajnošću (p<0,0001) za subkapsularnu kataraktu. Grafikon ETDRS pokazao se više diskriminativnim i preciznijim nego Snellenov, osobito za slabu vidnu oštrinu

Sudden cardiac arrest in Belgrade emergency medical technician occurring at workplace – a brand new case

Sudden cardiac arrest (SCA) is always an important topic, which catches physicians and health professionals’ attention. According to the Occupational Safety and Health Organization, 15% of workplace fatalities are due to SCA. While the incidence of SCA among employees in other Emergency services, i.e. firefighters (1) and police (2) has been described in the literature, there are no recorded data or published studies about SCA among medical staff employees in Emergency Medical Services (EMS). We describe the rare case SCA in emergency medical technicians (EMT) while in workplace

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

Bigeminy: A result of digoxin and St John’s wort interaction

A case of an by digoxin under unusual circumstances is reported. An 80-year-old man, previously on long-term digoxin treatment, started consuming St John’s wort herbal tea (2 000 ml/daily) because of frequent episodes of depression. After the cessation of consuming herbal tea containing Hypericum perforatum, digoxin poisoning developed in our patient. Electrocardiography revealed nodal bradicardia 36/min and bigeminy. Manifested symptoms were the consequence of interaction between digoxin and Hypericum perforatum which were consumed simultaneously, and the cessation of consuming St John’s wort herbal tea afterwards. Therapy was the same as in the standard digitalis poisoning. Consumers of St John’s wort combined with medical products are advised not to discontinue tea consumption on their own, without consulting their physician

THE FREQUENCY OF HEART RHYTHM DISORDERS IN PREHOSPITAL PHASE OF ACUTE CORONARY SYNDROME

Prehospital management of patients with acute coronary syndrome (ACS) is the essential element which influences the survival of patients and the outcome of the disease. Most lethal outcomes occur within the first hour after the onset of acute myocardial infarction (AMI), and the usual cause is some of heart rhythm and conduction disorder.Aim. To assess the frequency of each form of ACS, and the incidence of the development of rhythm and conduction disorders during the first 12 hrs in relation to the localization of ACS and disease outcome.Material and methods. We analyzed prospectively 107 patients transported under continual ECG monitoring to the Coronary Unit after ACS diagnosed prehospitally by the team of the Belgrade Emergency Medical Services. AMI localization was detected and the development of rhythm (supraventricular and ventricular), and conduction disorders were followed by prehospital ECG monitoring. Patients’ outcome was under follow-up until discharge from hospital.Results. Acute ST-elevation myocardial infarction (STEMI), both anterior and diaphragmatic, is most frequent in men aged 50–59 years. There were no statistically significant differences in the occurrence of heart rhythm and conduction disorders both in the STEMI and non-STEMI (NSTEMI) groups. The most frequent rhythm disorders during the first 4 hrs after STEMI onset were sinus bradycardia, sinus tachycardia and ventricular tachycardia, while atrial fibrillation and single ventricular extrasystole were most frequent after 5–12 hrs. In STEMI, AV blocks occurred exclusively during the first 4 hrs, while bundle branch blocks occurred statistically more significantly during the first 4 hrs. Sinus bradycardia and atrioventricular blocks were statistically significantly associated with diaphragmatic STEMI. In this localization there were no bundle branch blocks. The most frequent rhythm disorder associated with anterior STEMI was sinus tachycardia that occurred exclusively during the first 4 hrs. The occurrence of ventricular tachycardia and ventricular fibrillation in any of STEMI locations was statistically more significant in the first 4 hrs after complaints onset. In the studied group of patients with ACS mortality rate was 12,1%, while in the group of STEMI patients it was 11%, with a significant frequency of infarction with anterior localization and bundle branch block in men.Conclusion. Future studies should be directed toward identifying methods, as precise as possible, for early screening of heart rhythm and conduction disorders in ACS so as to enable a timely, preventive and therapeutic management

Is there a doctor on the plane? The distinctive conditions of cardiopulmonary resuscitation on commercial flights

Even today, when over 3.5 billion passengers travel on commercial flights each year, there is confusion about the duties and role of doctors and other licensed medical professionals volunteering to provide assistance to a passenger whose life is in jeopardy, especially when it comes to measures of cardiopulmonary resuscitation in the distinctive conditions of an airborne commercial aircraft. There are still no international, standardized guidelines, rulebooks, or instructions applying to all airlines when it comes to training and organizing the cabin crew, equipping emergency medical kits and covering the role of medical professionals volunteering their services in medical emergency situations. The aim of this work was to attempt to solve a common quandary among medical professionals when it comes to airplane travel. Based on the available literature, national and regional guidelines and rulebooks of airlines, in accordance with the ethical and legal principles binding medical professionals, we have attempted to answer the major questions related to cardiopulmonary resuscitation on commercial flights. All aspects are covered – from a doctor volunteering to provide emergency medical care, through the marshalling of the cabin attendants, the availability of equipment, interaction with the flight captain and the captain’s decision whether to perform an emergency landing, to the possibility of obtaining additional information from medical call centers on the ground and calling medical crews to the nearest airport

Application of ultrasound diagnostics in cardiopulmonary resuscitation

Ultrasound is becoming increasingly available and incorporated into emergency medicine. Focused echocardiographic evaluation in resuscitation (FEER) is a training program available to emergency doctors in order to ensure adequate application of echocardiography in the cardiac arrest setting. The FEER protocol provides an algorithm, whereby a “quick view” can be provided in 10 seconds during minimal interruptions in chest compressions. Performing ultrasound in the cardiac arrest setting is challenging for emergency doctors. The International Liaison Committee on Resuscitation recommend the ‘quick look’ echocardiography view can be obtained during the 10-second pulse check, minimizing the disruption to cardiopulmonary resuscitation

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