- Preface
Leon Drobnik
- Preoperative ondansetron does not reduce the incidence of maternal hypotension during elective caesarean delivery under spinal anaesthesia, but mitigate its severity: a double blind, randomized, placebo controlled trial
José Ramón Ortiz-Gómez, Francisco Javier Palacio-Abizanda, Francisco Morillas-Ramirez, Inocencia Fornet-Ruiz, Ana Lorenzo-Jiménez, Maria Lourdes Bermejo-Albares
Background. The prophylactic administration of ondansetron has been reported to provide a protective effect against hypotension in spinal anaesthesia (SA). Material and methods. This prospective double-blind, randomised, placebo-controlled study included 130 healthy pregnant women scheduled for elective caesarean delivery under SA randomly allocated to receive placebo (n = 65) or ondansetron 8 mg (n = 65) intravenously before SA. Demographic, obstetric, intraoperative timing and anaesthetic variables were assessed at 16 different time points, including blood pressure, heart rate, oxygen saturation, nausea, vomiting, electrocardiographic changes, skin flushing, discomfort or pruritus and vasopressor equirements. Results. There were no differences in the number of patients with hypotension: 33 (placebo) vs. 29 (ondansetron). However, as a single patient could had more than one hypotensive episode, we analysed the number of hypotensive events per patient (placebo 2.9 ± 4.0 vs. ondansetron 1.4 ± 2.2) (P = 0.011) and the percentage of time points with systolic hypotension (placebo 17.4% vs. ondansetron 8.7%) (P = 0.012). We also found differences at min 9 in diastolic blood pressure (DBP) (P = 0.014), mean arterial pressure (MAP) (P = 0.049), the variations from baseline of systolic blood pressure at min 5 to 13 and 20 (Figure 3), DBP at min 7 to 11, and MAP at 7 to 13 min between groups (P < 0.05) and the number of patients requiring ephedrine (P = 0.042). There were no differences in the number of patients with adverse effects excepting pruritus (P = 0.042). Conclusions. prophylactic administration of ondansetron 8 mg has a certain protective effect in the prevention of maternal hypotension in healthy women scheduled for elective caesarean delivery under spinal anaesthesia.
- Application of ultrasound protocols in immediate postoperative care
Anna Róziewska, Ewa Puchalska, Elżbieta Nowacka, Lidia Jureczko, Tomasz Łazowski
Background. Clinical application of point-of-care ultrasound in immediate postoperative period is still to be evaluated. The aim of this report is to present the possible application of the critical care ultrasound protocols for early detection of the most common postoperative complications. Material and methods. 73 women between 27 and 74 years of age, ASA (American Society of Anesthesiologists) grade 1-3, up to 6 hours after gynecological procedures or cesarean sections were evaluated. Examination consisted of lung ultrasound and fluid status assessment. Results. In 5 laparotomy cases interstitial pulmonary oedema was noted, which was associated with mildly decreased oxygen saturation readings of 92-95%. In only one of these cases fluid status indices were suggestive of hypervolemia, while the remaining four have shown the sonographic signs of hypovolemia. Subpleural consolidations were detected in one patient. In 2 cases pleural effusion and atelectasis were found. One case of postoperative hemorrhage was shown. In 23% of patients fluid status indices were suggestive of hypovolemia, while in 6% hypovolemia was shown to be severe. Conclusion. It appears that ultrasound imaging may help to improve the quality of postoperative care in terms of early detection of possible complications and fluid status assessment.
- The role of the Polish Medical Air Rescue in optimization of transport time of patients with burns
Arkadiusz Wejnarski, Marcin Podgórski, Artur Kamecki, Stanisław Paweł Świeżewski
Background. Every year 400 000 people fall victim to thermal burns in Poland. Burns pose a great challenge to the public health care system. Due to the current number of burn treatment centers and the availability of places for patients, using air transport makes it possible to speed up implementing specialist treatment. Material and methods. A retrospective analysis of air and medical records documenting 31837 missions performed by Polish Medical Air Rescue (PMAR) transport in the years 2011-2014. Results. In the years 2011–2014 PMAR aircraft carried out 806 HEMS (Helicopter Emergency Medical Services) missions, as well as undertook inter-hospital transport of patients with burns 541 times, which accounted for 4.2% of all the flights within the reference period. 831 victims were transported to burn centers. Children under the age of 5 constituted the largest group of these patients, i.e. 255, the second largest one being grown-ups between the ages of 50 and 60, i.e. 206 people. The greatest number of flights were made by HEMS Warszawa, i.e. 143, while the smallest number of flights was carried out by HEMS Koszalin. i.e 23. The predominant diagnosis in the International Statistical Classification (ICD) – 10 system was T29 – burns and corrosions of multiple body regions. The largest number of grown-up patients went to the West Pomeranian Center for Severe Burns and Plastic Surgery (WPCfSBPS) in Gryfice – 31.4% of the total number, while the least to Poznań – 2%. Children were most frequently treated in the Szczecin hospital, accounting for 64.2% of all the cases, and least frequently in Ostrów Wielkopolski where 1.1% of the patients went. Conclusions. Using Air Rescue Service (ARS) helicopters and airplanes is the appropriate way of transporting patients with severe
burns. Most of those transported are small children and grown-ups over the age of 60. There is a predominance of transport directly from the scene of the accident to the treatment center. The agreement between the Polish Society for Burn Treatment (PSfBT) and PMAR improved cooperation in choosing the burn center.
- Aggression of patients and their relatives against Emergency Department Staff
Krystyna Frydrysiak, Justyna Ejdukiewicz, Małgorzata Grześkowiak
Background. The medical community is the second leading professional group especially vulnerable to acts of aggressive behavior at work. Emergency Departments (ED) are a place where the largest number of patients is staying during the day in the hospital. Patients are generally accompanied with one to three relatives. Aggression is becoming an increasingly common form of discharge of negative emotions. Objectives. The main objective of the study was to assess the incidence of verbal and physical abuse of ED staff by patients and accompanying people. Material and methods. The study included 50 employees of ED in Zgierz. The diagnostic survey was used as the basis for the study, a research tool was a questionnaire consisting of 26 questions relating to verbal and physical violence performed against the ED staff. Results. The results indicated that ED employees are particularly vulnerable to aggression from patients and people staying with them. Ways of dealing with aggression stems mainly from the experience of working in a hospital, so there is an urgent need to develop procedures to combat aggression and ED staff training in this area.
- Analysis of stress factors in the work of the staff of the Medical Emergency Teams
Krystyna Frydrysiak, Damian Góraj, Wiesława Trendak, Małgorzata Grześkowiak
Background. People who doing professions related to saving human life from many years are enjoying the trust and respect of citizens. Daily routine for members of the Emergency Medical Teams is to help people be able to emergency danger to health or life. Their part in rescue operations is often associated with confrontation with human suffering, and death. The continuous demands and pressures from ambient are additionally contributed to the fight against another insidious and harmful effects, which is stress. Aim of the study. Aim of this work is to show appearing stress among members of the Medical Rescue Teams in Lodz and to identify determinants of the occurrence of this phenomenon. Material and methods. research tool was author’s questionnaire containing 27 questions. Study surrendered 70 employees the Provincial Emergency Medicine in Lodz-doctors, nurses , emergency workers in the period from middle of April until the end of May 2014 Results: The vast majority of respondents believe that the stress in their work is a very significant problem. The vast majority of respondents believe that the stress in their work is a very significant problem and every second person knows that during the execution of their duties Almost half of the respondents stated that beep / light causes to them distress. Aggression of patients against medical personnel is a major element witch causing their stress Increased irritability, trouble with concentration, sleep problems, headaches and stomach are the consequences of stress at work. Conclusions. The high demands and expectations placed on members of the Medical Rescue Teams, situations requiring rapid and difficult decisions, observation of the patient in danger of life or death are the elements that cause stress. It may have effects both positive
and negative. During the analyze elements of stress you can look at the medical profession, paramedic, nurse working in the ambulance service, from a broader perspective and see how important it is to continuously develop competencies and skills to cope with the eternal enemy of what is stress.
- Beta-blockers poisoning – case report
Marek Wojtaszek, Elżbieta Mach-Lichota, Dorota Ozga, Beata Horeczy, Dawid Filip
Background. Beta-blockers are a common type of drugs used in treating diseases of the circulatory system. By halting the activity of the sympathetic nervous system beta-blockers influence the entire organism. It is one of the most important and the most widely used group of medicaments in cardiology, especially in case of myocardial ischemia. Poisoning with beta-adrenolytics administered in combination with other circulatory ones (especially, the calcium channel blockers) is one of the most serious types of poisonings as they may require introducing extracorporeal circulation. Despite significant advancement in medicine, circulatory drugs poisoning are still fraught with high mortality. Such poisonings constitute the most common cases at Toxicology and Intensive Care Units. Case study. The paper presents the case of an 18-year-old male hospitalized at the Toxicology, Intensive Care and Cardiac Surgical Units. In the evening of the previous day the man took approximately 40 pills of Propranolol a 40 mg in an apparent suicide attempt. Prior to the event the patient was healthy. At the moment of admittance to the hospital the patient condition was critical, with extreme bradycardia (15/min), shock. He was conscious with logical contact sustained. In an emergency mode there was an endocavitary electrode implemented but its effectiveness turned out to be only temporary as the cardiac arrest occurred. After the spontaneous circulation was restored the patient was transferred to the Cardiac Surgical Ward for further treatment (ECMO). The intraaortic balloon contrapulsation or the renal replacement therapy (CVVHDF) was introduced. After the patient’s general condition improved he was transferred to the Toxicology Ward. The man was released home after 6 days of hospitalization and a psychiatric consult. Further psychiatric treatment was recommended in an Outpatient Clinic.
- Recommendations of perioperative care and general anaesthesia (including low and free opioid anaesthesia) for the obese patient
Tomasz Gaszyński, Marcin Możański
Anaesthesia and perioperative care of the obese patient should be well planned for the best safety of the patient. Presented recommendations are based on key-points of European Society for Perioperative Care of the Obese Patient (www.espcop.org). Presented recommendations are not only valid for bariatric surgery but also in any case of general anaesthesia in obese patient. In recommendations the methods of conducting low opioid or opioid free anaesthesia in obese patient.
- Some issues in the treatment of chronic pain in the elderly
Anna Rupniewska-Ładyko, Małgorzata Malec-Milewska
Population aging is one of the most important demographic processes of the modern world and a serious social problem. Pain is one of the most common feelings in the elderly, occurs in approx. 60% of people aged over 65 years. Opioids are not recommended as first choice in non-malignant pain of origin in this group of patients, but should be considered when the current treatment is ineffective, poorly tolerated or unavailable. Strong opioids are recommended most often for pain, constant, chronic (lasting longer than 3 months) and high intensity (more than 5 in 11-point numerical rating scale) as well as in situations where the current medication does not bring result and there are no other treatment options or when the pain significantly negative impact on the patient’s life. Oxycodone, hydromorphone and buprenorphine next, is recommended as one of the safety of opioids for the treatment of pain in the elderly.
- Early stages of rehabilitation in the intensive care unit using the method of Proprioceptive Neuromuscular Facilitation (PNF)
Katarzyna Kwiecień-Jaguś, Tomasz Zwoliński, Jolanta Szamotulska, Rita Hansdorfer-Korzon
Intensive care units are highly specialized hospital departments, which main task is to maintain vital functions and treat patients with life – threatening conditions. Most of the patients hospitalized in an intensive care unit require prolonged artificial ventilation by means of a respirator and infusions of vasoactive medications, antibiotics or diuretics. Intensive care patients are often unconscious or befuddled. Contact with them can be difficult, they are not always able to change their position, they cannot respond to commands. Moreover, a situation in which they are connected to a ventilator creates an additional difficulty and a barrier to startup whole rehabilitation process. Early rehabilitation of the patient in the intensive care unit is important in the context of the prevention of physical impairments associated with prolonged immobilization in bed and shortening the ICU length of stay. The action to improve finds its justification in the general statistical data on prolonging life expectancy of patients and increases demand for care in departments such as intensive care.
- Prehospital thrombolysis in STEMO-Ambulance
Jacek Kleszczyński, Jakub Koch
The only proven treatment in cerebrovascular accident is thrombolysis. Treatment timing is crucial, the best case scenario is starting the thrombolytic therapy within 1 hour since the accident, during the so called “golden hour”. This can only be achieved when thrombolytic therapy has been started before arriving to the hospital. In such situation highly professional and well trained team is required. Thrombolytic therapy before hospitalization is administered in Berlin, Germany, within the scope of a PHANTOM-S research programme. To any patients, who might be suspected of suffering a stroke a specially equipped ambulance (STEMO) is dispatched. The ambulance is equipped with a CT with telemedicine and a critical parameter analyser and manned with a neurologist, who is also an emergency physician. After the medical indications are confirmed and all contraindications are eliminated the patient is administered rtPA on his way to the hospital.
- Selected health-threatening and life-threatening conditions related to high altitude exposure
Tomasz Janus, Jacek Piechocki
Human body is evolutionarily adapted to life in a fairly narrow range of physicochemical parameters of the environment. Any substantial change in ambient pressure, as well as partial pressure of air components has an impact on of physiological or pathophysiological processes. The aim of the article is to present selected health-threatening and life-threatening conditions related to high altitude exposure.