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THYROID STORM AS A LIFE-THREATENING CONDITION IN THE PRACTICE OF EMERGENCY MEDICAL SERVICE TEAMS 甲状腺风暴作为一种危及生命的疾病在医疗急救队伍中的实践
Pub Date : 1900-01-01 DOI: 10.36740/emems202104109
Agnieszka Ciastkowska-Berlikowska
Thyroid storm is a medical emergency. It comprises disorders of several organs and body systems, including disturbances of consciousness (also coma), heart failure, symptoms of shock, and high body temperature. The diagnosis of thyroid storm is challenging because it is based primarily on medical history and physical examination. Additional laboratory tests only perform an auxiliary function, and the initiation of therapy should not be delayed until the determination of thyroid hormones in the blood. Moreover, clinical symptoms often do not correlate with thyroid hormones concentration in the blood. Diarrhea, vomiting, and fever may lead to the diagnosis of thyroid storm. These are not typical symptoms of uncomplicated hyperthyroidism. The remaining symptoms of thyroid storm are symptoms of decompensation of individual organs and systems. When diagnosing thyroid storm, one uses the Burch and Wartofsky criteria. Accurate and quick diagnosis and implementation of initial treatment is the aim of pre-hospital management. These are fluid therapy, oxygen therapy, and antipyretic drugs. For this reason, it is essential not to delay the patient’s transport to the nearest hospital emergency department. One may also consider calling a specialist ambulance with a doctor who can give the right medication on the spot. Rapid treatment initiation can improve the status of most patients within 12-24 hours. Treatment delay worsens, and intensive treatment improves the prognosis in patients with thyroid storm. The mortality rate of thyroid storm has decreased and is now 20-30%.
甲状腺风暴是一种医疗紧急情况。它包括几个器官和身体系统的紊乱,包括意识障碍(也包括昏迷)、心力衰竭、休克症状和高体温。甲状腺风暴的诊断是具有挑战性的,因为它主要基于病史和体格检查。额外的实验室检查仅起辅助作用,治疗的开始不应延迟至血液中甲状腺激素的测定。此外,临床症状往往与血液中甲状腺激素浓度无关。腹泻、呕吐和发烧可导致甲状腺风暴的诊断。这些都不是单纯甲亢的典型症状。甲状腺风暴的其余症状是个别器官和系统失代偿的症状。当诊断甲状腺风暴时,人们使用Burch和Wartofsky标准。准确、快速的诊断和实施初期治疗是院前管理的目标。这些是液体疗法、氧气疗法和退烧药。出于这个原因,不延误病人到最近的医院急诊科是至关重要的。你也可以考虑叫一辆有医生的专科救护车,医生可以在现场给你正确的药物。快速开始治疗可在12-24小时内改善大多数患者的状况。治疗延误加重,强化治疗可改善甲状腺风暴患者的预后。甲状腺风暴的死亡率已经下降,目前为20-30%。
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引用次数: 0
COMPREHENSIVE TREATMENT OF COMPLICATED COURSE OF LIVER CIRRHOSIS IN CASE OF BLEEDING FROM THE VARICOS VEINS OF ESOPHAGUS, ENCEPHALOPATHY AND ASCITES 肝硬化并发食管静脉曲张出血、脑病、腹水的综合治疗
Pub Date : 1900-01-01 DOI: 10.36740/emems202203104
V. Rusyn, Konstantin E. Rumiantsev, Andriy A. Rusyn, O. Balazh
Aim: To develop a complex treatment for patients with decompensated cirrhosis in case of bleeding from the varicose veins of the esophagus. Material and methods: With bleeding from varicose veins of the esophagus for the period 2015–2020. in the clinic of the Transcarpathian Regional Clinical Hospital. A. Novak examined and treated 64 patients with C-class liver cirrhosis according to the Child-Turcotte-Pugh criteria. Results: In 17 patients they used extracorporeal ultrafiltration of ascitic fluid with it’s subsequent intravenous reinfusion. In the subgroup of 39 patients with effective sclerotherapy the mortality rate was 23.1%. In the subgroup of 25 patients where the ES was ineffective and the Blackmore tube was applied, the mortality rate was 32%. Among the 20 patients after laparocentesis with ascitic fluid evacuation 8 (40%) died. In the 17 patients after extracorporeal ultrafiltration of ascitic fluid with its subsequent intravenous reinfusion 2 (11.8%). In the subgroup where albumin peritoneal dialysis was applied 7 patients died (25.9%). Conclusions: The prognostic factors for the lethal outcome of bleeding from varicose veins of the esophagus in patients with decompensated liver cirrhosis are: the ineffectiveness of endoscopic sclerotherapy as a means of primary hemostasis, bleeding recurrence in the first 5 days. The use of staged treatment using extracorporeal methods can significantly improve the results of treatment, reduce mortality.
目的:探讨食道静脉曲张出血伴失代偿性肝硬化的综合治疗方法。材料与方法:2015-2020年食管静脉曲张出血患者。在喀尔巴阡地区临床医院的诊所A. Novak根据child - turcote - pugh标准检查并治疗了64例c级肝硬化患者。结果:17例患者采用体外超滤腹水后静脉再输注腹水。在39例接受有效硬化治疗的患者亚组中,死亡率为23.1%。在25例ES无效且使用Blackmore管的患者亚组中,死亡率为32%。腹腔镜穿刺术并发腹水排出患者20例,死亡8例(40%)。体外超滤腹水后静脉再输注2例(11.8%)。在应用白蛋白腹膜透析的亚组中,有7例患者死亡(25.9%)。结论:失代偿期肝硬化患者食道静脉曲张出血致死性结局的预后因素为:内镜下硬化治疗作为原发性止血手段无效,前5天出血复发。采用分阶段体外治疗方法可显著提高治疗效果,降低死亡率。
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引用次数: 0
Emergency and immediate medicine in Ukraine: organizational, legal, clinical aspects 乌克兰的紧急和即时医疗:组织、法律和临床方面
Pub Date : 1900-01-01 DOI: 10.36740/emems202201110
February 25, 2022, Poltava State Medical University, Poltava, UkraineABSTRACTS WERE PUBLISHED IN THE ALPHABETICAL ORDER OF AUTHORS’ LAST NAMES
2022年2月25日,波尔塔瓦国立医科大学,波尔塔瓦,乌克兰,摘要按作者姓氏的字母顺序发表
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引用次数: 0
MEDICAL DISPENSARY AS A BASIC LINK OF THE STATE EMERGENCYMEDICAL SYSTEM - HISTORICAL ANALYSIS AND THE CURRENT MODEL 药房作为国家应急医疗体系的基本环节——历史分析与现状模式
Pub Date : 1900-01-01 DOI: 10.36740/emems201902105
P. Spiess, Robert Gałązkowski, Mateusz Komza
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引用次数: 0
EVALUATION OF THE USEFULNESS OF MEASURING THE WIDTHOF THE OPTIC NERVES TO GETHER WITH THE OPTIC NERVE SHEATHUSING ULTRASONOGRAPHY TO PREDICT THE OCCURRENCEOF INCREASED INTRACRANIAL PRESSURE – PRELIMINARY REPORT 评价视神经宽度与视神经鞘超声检查预测颅内压增高的有效性——初步报告
Pub Date : 1900-01-01 DOI: 10.36740/emems201903103
D. Gałuszka, K. Nadolny, J. Ładny
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引用次数: 0
WHY DO NOT POMERANIAN VOIVODSHIP (POLAND) CITIZENS WANT TO USE AED DEVICES? 为什么波美拉尼亚省(波兰)的公民不想使用aed设备?
Pub Date : 1900-01-01 DOI: 10.36740/emems202202104
D. Ślęzak, M. Robakowska, Katarzyna Pogorzelczyk, Joanna Synoweć, A. Tyrańska-Fobke, Przemysław Żuratyński, Sylwia Jałtuszewska
Aim: To analyze the level of knowledge and awareness among the inhabitants of the Pomeranian Voivodeship about the AED apparatus and its use in a life and health threatening situation. Material and methods: The survey was conducted on a group of 20,971 inhabit-ants of the Pomeranian Voivodeship (northern Poland). Results: The responses of people with primary education indicated that they did not know what AED was used for. People from cities with district status with incomplete or higher education most often answered that they knew what AED was for. The analysis showed a relationship between the level of education and the willingness to start training. People with primary and vocational education usually did not want to undertake such activities. Women with lower than incomplete higher and higher education would not provide the greatest aid with the use of AED. Conclusions: There is a need to install more devices, as well as educational and preventive measures in the areas defined as ruralurban and rural communes. Educational activities targeted at the youngest should be implemented. The implementation of educational activities with the youngest recipients will result in positive results in the future.
目的:分析波美拉尼亚省居民对AED设备及其在危及生命和健康的情况下使用的知识和意识水平。材料和方法:对波美拉尼亚省(波兰北部)的20,971名居民进行了调查。结果:初等文化程度人群的反应表明他们不知道AED的用途。来自城市的受过高等教育或教育程度不高的人通常回答说他们知道AED是用来做什么的。分析显示了教育水平和开始培训的意愿之间的关系。受过初等教育和职业教育的人通常不愿从事这种活动。低于未完成高等教育和高等教育的妇女在使用AED时不会提供最大的帮助。结论:在农村城市和农村社区需要安装更多的装置,并采取教育和预防措施。应该实施针对最年轻的教育活动。与最年轻的受助人一起开展教育活动将在未来产生积极的结果。
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引用次数: 0
Analysis of Aggressive Behavior Towards Healthcare Workers Before and During the Sars-Cov-2 Epidemic in Poland. Part 1 波兰Sars-Cov-2流行前和期间对医护人员的攻击行为分析第1部分
Pub Date : 1900-01-01 DOI: 10.36740/emems202103103
Aleksandra Kuć, Daria Kubik, Klaudia Kościelecka, Wojciech Szymanek, T. Męcik-Kronenberg, Dariusz Ceglarz
Aim: To analyze aggressive behavior towards healthcare workers before and during the SARS-CoV-2 epidemic in Poland and confront the obtained results with reports on this phenomenon from the scientific world.Material and methods: The study included 999 respondents constituting healthcare workers from all over Poland. The proprietary questionnaire consisting of three parts was the research tool.Results: 86% of healthcare personnel encountered violence in the workplace before announcing the epidemic state, and 81% – during the epidemic state. Respondents indicated that the frequency of this phenomenon increased significantly after that date. Patients were the most frequent offenders.Conclusions: Aggression being a relatively constant and unchanging problem in healthcare, according to the authors, requires the development of new, more effective solutions to improve the situation of victims. Encouraging staff to report aggressive behaviors and actively supporting them in these actions could lead to more frequent legal consequences for aggressors, increasing the chance for more respectful treatment of medical staff and disrupting the false sense of impunity in perpetrators.
目的:分析波兰SARS-CoV-2流行前和期间对医护人员的攻击行为,并将所得结果与科学界对这一现象的报道进行比较。材料和方法:该研究包括来自波兰各地的999名卫生保健工作者。研究工具是由三部分组成的专有问卷。结果:86%的医护人员在宣布疫情前遭遇过职场暴力,81%的医护人员在疫情期间遭遇过职场暴力。答复者指出,在该日期之后,这种现象的频率显著增加。病人是最常见的罪犯。结论:根据提交人的说法,攻击是医疗保健中一个相对恒定和不变的问题,需要制定新的、更有效的解决办法来改善受害者的状况。鼓励工作人员报告攻击行为并积极支持他们采取这些行动,可使攻击者更频繁地承担法律后果,增加医务人员获得更尊重的机会,并打破犯罪者有罪不罚的错误感觉。
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引用次数: 0
Participation of Polish paramedics in missions abroad - selected issues 波兰护理人员在国外任务中的参与-选定的问题
Pub Date : 1900-01-01 DOI: 10.36740/emems202201109
Maksymilian Kilian, Krystyna Frydrysiak, Łukasz Kikowski
Aim: Assesment of the preparedness of paramedics for mission trips. Evaluation of the mission as a place for professional development of paramedics. Assesment of the usefulness of the experience gained by paramedics on missions in working conditions in Poland. Analysing the attendance of paramedics on missions. Learning about personal opinions and experi¬ences of selected participants of missions. Material and Methods: The study was conducted between 01.2020 and 08.2020. The research group consisted of 20 paramedics of different ages. Data were collected using an electronic survey consisting of 22 questions and extended tel¬ephone interviews consisting of 33 questions. Statistical data obtained from the Redemptoris Missio Foundation were used to analyse attendance. Results: The majority of survey participants rated their preparation for their first mission at a score of 3 (f=0.45) or 4 (f=0.35) on a 5-point scale. The most frequently used skill was foreign language, with 9 (f=0.45) respondents using it all the time and 9 (f=0.45) using it frequently. The paramedics experienced the greatest development in the area of non-medical skills (f=0.6) and in foreign language use (f=0.5). Most of the respondents rated the usefulness of the experience gained as 5 (f=0.35) or 4 (f=0.25) on a 5-point scale. Analysis of the obtained statistical data showed very low attendance of paramedics on missions compared to other medical professions. The interviews provided an in-depth look into the feelings and opinions of selected paramedics regarding missions, which were mostly consistent or similar. Conclusions: The paramedics believe that they are sufficiently prepared to go on missions. Thanks to missions: they gain new experience, consolidate their knowledge and skills, exchange experience with medical personnel from all over the world. However, missions do not allow one to fully utilize their expertise in emer¬gency medicine. Experience gained abroad is proved to be useful for paramedics in working conditions of Polish health care system. Attendance of paramedics on missions is very low, but there are a lot of potential areas where their knowledge and skills could be used.
目的:评估护理人员为特派团旅行做好的准备。评价特派团作为护理人员专业发展的场所。评估在波兰工作条件下特派团护理人员获得的经验的有用性。分析特派团护理人员出勤情况。了解选定的特派团参与者的个人意见和经验。材料和方法:研究于2020年1月1日至2020年8月8日进行。研究小组由20名不同年龄的护理人员组成。数据是通过包含22个问题的电子调查和包含33个问题的扩展电话访谈来收集的。从救赎主使命基金会获得的统计数据被用于分析出席率。结果:大多数调查参与者对他们第一次任务的准备工作的评分为3分(f=0.45)或4分(f=0.35),满分为5分。最常使用的技能是外语,9名(f=0.45)受访者一直使用外语,9名(f=0.45)受访者经常使用外语。辅助医务人员在非医疗技能(f=0.6)和外语使用(f=0.5)方面的发展最大。大多数受访者将获得的经验的有用性评为5 (f=0.35)或4 (f=0.25),满分为5分。对获得的统计数据进行的分析表明,与其他医疗专业相比,特派团护理人员的出勤率非常低。访谈深入了解了选定的护理人员对特派团的感受和意见,这些感受和意见大多一致或相似。结论:护理人员认为他们为执行任务做好了充分的准备。由于任务:他们获得新的经验,巩固他们的知识和技能,与来自世界各地的医务人员交流经验。然而,特派团不允许人们充分利用其在急诊医学方面的专门知识。在国外获得的经验被证明是有用的护理人员在波兰卫生保健系统的工作条件。执行任务的护理人员的出勤率非常低,但他们的知识和技能可以在许多潜在领域得到利用。
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引用次数: 0
The assessment of the Polish lifeguards’ knowledge of the principles of cardiopulmonary resuscitation in victims of drowning depending on work experience, type of workplace and experience in resuscitation 根据工作经验、工作场所类型和复苏经验,评估波兰救生员对溺水受害者心肺复苏原理的知识
Pub Date : 1900-01-01 DOI: 10.36740/emems202201106
K. Starosta, Filip Jaśkiewicz, Krystyna Frydrysiak, Dawid Kowalewski, Krzysztof Guzenda, D. Timler
Aim: The main aim of the study was to assess the lifeguards’ knowledge of qualified first aid depending on: work experi¬ence, type of workplace, experience in providing CPR (cardiopulmonary resuscitation). Material and methods: The study included 433 lifeguards. Males 60.05% (n=260). The mean age was 24.7±7.5. Management of a person after an episode of drowning, CPR, AED (automatic external defibrillation), oxygen therapy, methods of opening the airway were assessed using a questionnaire. Statistical analysis was carried out using PQStat set ver. 1.8.0.338. The correct answers in the group was compared by one-way analysis of variance and post-hoc test by Tukey and estimating the Fisher’s linear method. Test probability at p < 0.05 was considered as significant. Results: The mean of the results in the group was 74.65% ± 17.22. The correct answers in the study group differs significantly depending on work experience. The results in the group with the longest work experience are significantly higher than in the other groups. The correct answers in the surveyed group also differs significantly depending on the type of workplace. The results obtained in the group of sea lifeguards are significantly higher than in the other groups. The comparison of the groups indicates a significant trend proportional to the size of the waterbody. The correct answers differed significantly depending on the experience in providing CPR. Conclusions: Work experience, type of workplace and experience in providing resuscitation have an impact on the lifeguards’ knowledge of selected elements of qualified first aid. Attention should be paid to the education of the group with the shortest work experience.
目的:本研究的主要目的是评估救生员的合格急救知识取决于:工作经验,工作场所类型,提供CPR(心肺复苏)的经验。材料与方法:研究对象为433名救生员。男性60.05% (n=260)。平均年龄24.7±7.5岁。对溺水患者的处理、心肺复苏术、体外自动除颤(AED)、氧疗、气道开放方法进行问卷调查。采用PQStat set ver进行统计分析。1.8.0.338. 组内正确答案的比较采用单向方差分析、Tukey事后检验和估计Fisher线性方法。检验概率p < 0.05为显著性。结果:两组结果的平均值为74.65%±17.22。学习小组的正确答案因工作经验的不同而有很大差异。工作经验最长的一组的结果明显高于其他组。根据工作场所的类型,被调查者的正确答案也有很大差异。海上救生员组的结果明显高于其他组。各组的比较显示出与水体大小成正比的显著趋势。根据提供心肺复苏术的经验不同,正确答案有显著差异。结论:工作经验、工作场所类型和提供复苏的经验对救生员对合格急救要素的选择知识有影响。要注意对工作经验最短的群体进行教育。
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引用次数: 0
MANAGEMENT OF THE EMERGENCY DEPARTMENT PATIENT WITH TOXIC ALCOHOL POISONING 急诊中毒性酒精中毒病人的处理
Pub Date : 1900-01-01 DOI: 10.36740/emems202104108
Barbara Porębska, M. Kaczmarek-Fojtar
The aim of the study is to present the process of diagnosis and treatment of the patients poisoned with toxic alcohols. Furthermore, the suicide risk assessment was presented. The role of supportive cure and the importance of the treatment with alcohol dehydrogenase blockade with fomepizole or ethanol hemodialysis for severe intoxicated patients were presented. The differences in the treatment of poisoning with particular toxic alcohols were presented. Moreover, the important psychological factors in the management of this group of patients were also discussed. The paper was illustrated with typical case studies of patients suffering from methanol and ethylene glycol intoxication. Conclusions: 1. The recognition of toxic alcohol poisoning remains a challenge for the clinician, because nonspecific symptoms are similar in many other conditions. 2. Proper management of the poisoned patients requires thorough analysis of many aspects: circumstances of the event, laboratory findings, response to the treatment, and the patient’s psychological problems.
本研究的目的是介绍中毒性酒精中毒患者的诊断和治疗过程。此外,还提出了自杀风险评估。本文介绍了支持治疗的作用,以及甲氧美唑或乙醇血液透析对重度中毒患者进行酒精脱氢酶阻断治疗的重要性。介绍了特定毒性酒精中毒的不同治疗方法。此外,本文还讨论了影响这类患者治疗的重要心理因素。本文介绍了甲醇和乙二醇中毒患者的典型病例研究。结论:1。对于临床医生来说,识别中毒性酒精中毒仍然是一个挑战,因为非特异性症状在许多其他情况下是相似的。2. 对中毒患者的适当管理需要对许多方面进行彻底的分析:事件的情况、实验室检查结果、对治疗的反应以及患者的心理问题。
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引用次数: 0
期刊
Emergency Medical Service
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