Cardiopulmonary Resuscitation in Special Circumstances

Cardiopulmonary resuscitation (CPR) in special circumstances includes the emergency intervention for special causes, special environments and special patients. Special causes cover the potential reversible causes of cardiac arrest that must be identified or excluded during any resuscitation, divided into two groups, 4Hs and 4Ts: hypoxia, hypo-/hyperkalaemia and other electrolyte disorders, hypo-/hyperthermia, hypervolemia, tension pneumothorax, tamponade (cardiac), thrombosis (coronary or pulmonary) and toxins. The special environments section includes recommendations for the treatment of cardiac arrest occurring in specific locations: cardiac surgery, catheterisation laboratory, dialysis unit, dental surgery, commercial airplanes or air ambulances, field of play, difficult environment (e.g. drowning, high altitude, avalanche and electrical injuries) or mass casualty incident. CPR for special patients gives guidance for the patients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease and obesity) and pregnancy women or elderly people

Prehospital Emergency Care in Acute Trauma Conditions

It is well known at this moment that a systems and systematic approach to trauma care cases is ideal. The prehospital controversies of in-the-field care in trauma cases, resuscitation, and transport, ground or air, are still debated. The most controversial is rapid transport to definitive care (“scoop and run”) versus field stabilization in trauma, which remains a topic of debate and resulted in great variability of prehospital policy. Emergency medical services, including ground and air transportation, significantly extend the reach of tertiary care facilities, leading to rapid transport of critically ill patients. Emergency medical services (EMS) providers are the first link to a trauma care system, and trauma triage made by EMS personnel is also a very important factor in a good outcome of trauma patients. The assessment of patient and the treatment delivered by the first medical crew could have a large impact over the clinical evolution and output of trauma patient; that way, it is necessary to apply a systematic approach in this pathology, guided by clear and simple-to-follow recommendations applied on the scene. Recent review of the literature on helicopter emergency medical services (HEMS) showed an overall benefit of 2.7 additional lives saved per 100 HEMS activations

AED: Optimal Use of Automated External Defribilators in BLS and ILS

The use of Automatic External Defibrillators (AED) present in public access defibrillation programs (PAD) in cardiopulmonary resuscitation (CPR) is a challenge in the effective treatment of cardiac arrest, especially for adult patients. It is already known that the majority of adult cases of out-of-hospital cardiac arrest arise from ventricular fibrillation (VF). The most important factor in determining survival from VF is the time from collapse to defibrillation. If laypersons are trained to perform Basic Life Support (BLS) and to attempt defibrillation using an automatic external defibrillator before the emergency medical services arrive, the survival rate of an out-of-hospital cardiac arrest can be increased. In many countries, the number of public access AEDs has increased but implementation of AED use and CPR performed by public bystanders has not been sufficiently frequent. In fact, only a minority of individuals demonstrate sufficient knowledge and willingness to operate an AED, suggesting that the public is not yet sufficiently prepared. It is also very important to support the permanent campaign of training as many laypersons, starting from school, to properly use such defibrillators in public places. Considering these facts, PAD is an effective way and may be a cost-effective way to improve outcomes in cardiac arrest

The Importance of Diet in Predicting the Remission of Urticaria—Determination of Allergen-Specific IgE

Background and Objectives: Different types of food introduced gradually in the diet will expose children to different food allergens, increasing the chance of developing allergic diseases. The aim of our study was to determine if allergen-specific IgE values can influence, depending on the diet, the prediction of remission of urticaria in children. Materials and Methods: This prospective study was conducted in 132 patients diagnosed over two years with urticaria, admitted to “Sf. Maria” Clinical Pediatric Hospital Iaşi. Total IgE assay was performed by ELISA, and determination of specific serum IgE by the CLA System Quanti Scan method (Innogenetics, Heiden, Germany). Data were gathered and statistical analysis was performed using statistical software SPSS, using descriptive and inferential statistics. Results: The determination of specific IgE to food allergens was performed on a total of 132 cases. The values of specific IgE were positive for one or more food allergens in 84 patients (63.64%). The most common allergens involved were: cow’s milk in 33.3% cases, egg white in 22.6% cases, and hazelnuts in 11.9% cases. The specific IgE values for the different types of food included in our study had a predictive value for disease remission. Conclusions: The determination of specific IgE confirms the presence of a particular food allergen and may have predictive value for the future development of an allergic manifestation

Impact of Cardiopulmonary Resuscitation on Emergency Medical Staff—Romanian Perspective (IRESUS-EMS)

Background: Unnecessary resuscitation is defined as putting in a disproportionate amount of effort compared to the patients’ prognosis and chance of survival. The primary objective of this study was to determine the number of resuscitations perceived as unnecessary by emergency medical personnel and to correlate it with the characteristics of resuscitation team members, patient particularities and organizational factors related to the professional environment. Methods: This was a prospective cross-sectional study carried out in the emergency department of a university hospital, exploring the perception of the uselessness of cardiopulmonary resuscitation (CPR) through the completion of a questionnaire. Results: In total, 70.37% of respondents are often involved in CPR attempts in which the efforts made are disproportionate compared to the patients’ expected prognosis, in terms of survival or quality of life. The presence of a non-shockable rhythm increased, by two times, the chances of medical staff finding it unnecessary to initiate CPR. Conclusions: The current study was the first in Romania to investigate the perception of unnecessary CPR, based on the recollection of the last resuscitation performed by the emergency medical staff. The objective criteria related to the patient were the most important predictors for assessing the adequacy of the decision to initiate CPR

Telemedicine System Applicability Using Drones in Pandemic Emergency Medical Situations

Drones have evolved significantly in recent years, acquiring greater autonomy and carrier capacity. Therefore, drones can play a substantial role in civil medicine, especially in emergency situations or for the detection and monitoring of disease spread, such as during the COVID-19 pandemic. The aim of this paper is to present the real possibilities of using drones in field rescue operations, as well as in nonsegregated airspace, in order to obtain solutions for monitoring activities and aerial work in support of the public health system in crisis situations. The particularity of our conceptual system is the use of a “swarm” of fast drones for aerial reconnaissance that operate in conjunction, thus optimizing both the search and identification time while also increasing the information area and the operability of the system. We also included a drone with an RF relay, which was connected to a hub drone. If needed, a carrier drone with medical supplies or portable devices can be integrated, which can also offer two-way audio and video communication capabilities. All of these are controlled from a mobile command center, in real time, connected also to the national dispatch center to shorten the travel time to the patient, provide support with basic but life-saving equipment, and offer the opportunity to access remote or difficult-to-reach places. In conclusion, the use of drones for medical purposes brings many advantages, such as quick help, shortened travel time to the patient, support with basic but life-saving equipment, and the opportunity to access remote or difficult-to-reach places

Pediatric Emergency Department Management in Acute Poisoning—A 2-Year Retrospective Study

(1) Background: Poisonings in children are common reasons for addressing ED and can potentially have serious complications. Our research aims to review risk factors leading to poisoning in children. (2) Methods: A retrospective review of all pediatric poisoning cases addressing the Children’s emergency department of St Mary Hospital over a two-year period was performed. (3) Results: We collected data on 797 children admitted for acute poisoning. The highest incidence identified was in the 12–18 and 1–3-year-old age groups. The distribution of voluntary versus unintentional poisonings was relatively balanced: 50.19% versus 47.43% (for some cases the type of intoxication remained unknown). Exposure to the toxic substance by ingestion was significant compared to the other routes, with an incidence of 87.1%. Acute poisoning happened at home in 70.4% of cases. A known risk factor before reaching the ED was present in 13.04%. (4) Conclusions: Our study showed a greater risk for acute poisoning in children between 1–3 years of age, and adolescents over 12 years. Identifying and documenting epidemiological aspects and other variables is important for establishing preventive measures and for therapeutic conduct. Adequate risk stratification and preventive measures involving closer supervision of minors or cognitive-behavioral programs can prevent voluntary intoxication

Argumente pentru continuarea finanţării Inventarului Forestier Naţional [Arguments for the further funding of the National Forest Inventory]

The paper summarizes the rationale and motives for having implemented and financed the National Forest Inventory in order to clarify a series of questions raised by the criteria taken into account when the sampling grid was design. Although the first cycle of measurements has produced some meaningful data about Romanian forests, some inconsistencies between the public opinion about the forest management and the outcome of the forest inventory have somehow undermined the confidence in the statistic background of the National Forest Inventory. The alternative, which is a simple accounting of the growing stock as estimated through the management plans is out of question, because only a tenth of the forest fund is being described by accurate data, while another tenth of the growing stock is completely outdated. Other important reasons shall be sought in the LULUCF reporting schemes, the requirements to appraise the carbon stock as well the important role played by the inventory grid in developing new evaluation methods based on remote sensing