The current issue
- Religions of the world and transplants Part 2. The views of the unchristian world’s religions on issues associated with the transplantation of organs and tissues
Michał Mandecki
Since the transplants have become the recognized way of saving human life, the transplantation has been developing at an impressive pace. The medical aspect is not the solely one that strongly influences the transplantation and transplants. For the transplantation, the social and religious aspects, which shape the attitude towards transplantation and transplants presented by the particular communities, are of extreme importance. The more multicultural and multiethnic the society is, the more difficult and complicated the discussion becomes, thus requiring the implementation of greater number of factors and views into the analysis, especially when it relates to unchristian religions, in which the multiplicity of their fractions is often much greater than in the case of the Christian religions. The following work provides a synthetic review of the opinions of the unchristian churches on the issues associated with the transplantation of organs and tissues.
- Ultrasound examination of the optic nerve sheath width in practice of the emergency department – preliminary report
Zenon Truszewski, Łukasz Szarpak
Background. Ultrasound measurement of the optic nerve sheath width is a good diagnostic method which facilitates the diagnosis of increased intracranial pressure. However, it is rarely performed to assess the condition of patients hospitalized in Emergency hospital departments (ED). Objective. The study aimed to assess the usefulness of ultrasound examination of the optic nerve sheath width in the diagnosis of Emergency Department patients with head injuries, loss of consciousness and with consciousness disturbances. Material and methods. Ultrasound examination of optic nerve sheath width was performed in 22 patients. The results were compared with the respective head computed tomography (CT) scans. It was assessed whether the abnormal results of the ultrasound were confirmed by the respective CT scans. Results. Normal ultrasound results were reported in 13 (59.1%) out of 22 patients. Borderline normal results were found in 5 (22.7%), and results above the norm – in 4 (18.2%) patients. 15 patients had normal CT scan results. In 7 patients the CT showed abnormalities, but only 3 of those patients had an indication for hospitalization due to the severity of the condition. Conclusions. Ultrasound examination (USG) of optic nerve sheath width may be useful in the preliminary diagnosis of Emergency Department patients with head injuries, loss of consciousness and with consciousness disturbances. Anestezjologia i Ratownictwo 2016; 10: 145-149.
- Adverse drug interactions in patients treated in the intensive care unit – a transient problem or a serious threat?
Jarosław Woroń, Elżbieta Dobrowolska, Wojciech Serednicki, Katarzyna Liber-Stuwczyńska, Jerzy Wordliczek
Background. Drug treatment conducted in the Intensive Care Unit (ICU), in most cases, based on the use of polytherapy, or associate drugs that due to synergism of their actions allow you to extend the therapeutic effect without also significantly potentiate the risk of adverse events. In turn polypragmasy identified with the simultaneous use of drugs that not only complement and enhance its therapeutic effect, but significantly increase the risk of developing drug-induced side effects. Aim of study. The aim of this study was to evaluate the prevalence of adverse drug interaction in the course of pharmacotherapy in patients hospitalized in the ICU, as well as assessment of the possibility of correlation of side effects that occur in hospitalized patients in the ICU with the applied polytherapy. Material and methods. The study analyzes the merits of 200 randomly selected card orders medical patients hospitalized in the ICU during the period from 1 October 2015 to 31 March 2016. Analysis of the merits was tasked with assessing drug interactions that occur between single stages used drugs. Evaluated pharmacodynamic interactions, pharmacokinetics and interactions related to a single stage summing side effects of drugs. Results. The analysis shows that as many as 68% of a single stage is associated drugs, which included amongst themselves in adverse interactions in patients hospitalized in the ICU, up 74% on the 136 cases confirmed interactions, patients experienced an adverse reaction with the clinical picture consistent with the profile found drug interactions. Anestezjologia i Ratownictwo 2016; 10: 150-162.
- Tracheal intubation by novice medical doctors using SALT, Air-Q, i-gel, Cobra PLA, LMA Curve and LMA Classic
Przemysław Kluj, Tomasz Gaszyński
Background. Endotracheal intubation (ETI) in direct laryngoscopy (DL) is a difficult technique to master with a low success rate among novices. The advantage of supraglottic airway devices (SGDs) is their ease of use by beginners and occasional operators. The aim of this study was to assess the time and the effectiveness of blind tracheal intubation using six SGDs: Supraglottic Airway Laryngopharyngeal Tube (SALT), Air-Q, i-gel, Cobra PLA, LMA Curve (The Aura-i) and laryngeal mask airway (LMA Classic). Material and methods. The study was carried out in a group of 30 novice medical doctors which performed manikin airway management with six SGDs. In the case of an effective device placement participants were given one attempt of blind intubation using every device. We evaluated time to complete airway management and efficiency of first intubation attempt. Proper placement of the device and successful intubation ended the test successfully. Timeout (1 min) or esophageal intubation were counted as failed attempts. The parameters collected were subjected to a statistical analysis using analysis of variance. Results. The study evaluated 180 intubations. The effectiveness of the first intubation attempt was 26/30, 20/30, 9/30, 9/30, 7/30 and 6/30 while the average intubation time was 33,84; 35,95; 35,44; 35,11; 31,14 and 23,83 successively for the SALT, i-gel, Cobra PLA, LMA Classic, Air-Q and LMA Curve. Conclusion. The effectiveness of intubation by novice medical doctors using SALT and i-gel was higher than the other devices. Intubation time for the i-gel was longer than LMA Curve; there were no statistically significant differences between other devices. Anestezjologia i Ratownictwo 2016; 10: 163-171.
- The analysis of medical interventions during the 2012 European Football Championships at the Wrocław City Stadium
Jacek Kleszczyński, Jakub Koch, Bartosz Szafran, Tomasz Sikora, Jakub Szyller
Background. In 2012, three football matches were held at the newly constructed city stadium in Wrocław, as part of the EURO 2012 Championships. Each of these events was attended by 40,000 fans. Medical supervision of the stadium was provided by standard and specialist ambulances as well as foot patrols and health checkpoints. During these events, medical attention was given altogether to 190 people. The aim of this paper was to determine the most prevalent health hazards and classify patients, as well as to determine whether or not the medical supervision provided was adequate to an event of such magnitude. Material and methods. The material used in this research consisted of medical documentation containing information about the age, sex and nationality of the patient, as well as data concerning the preliminary diagnosis and all medical procedures employed, including transport to hospital. Results. The majority of patients did not present with life-threatening symptoms, and medical attention was provided on the spot. The safety measures employed during the events proved sufficient, although they exceeded the statutory minimum. Anestezjologia i Ratownictwo 2016; 10: 172-180.
- Point-of-care ultrasound use in patient with shock – case report
Magdalena Kozak, Wojciech Wierzejski, Krzysztof Karwan
Background. Case report of 21-years old patient after cardiac arrest illustrates the efficacy of point-of-care ultrasound application in diagnosis process in the Emergency Department. Case report. Young female was brought by ambulance to the ER of the Military Institute of Medicine after cardiac arrest in myocardial fibrillation mechanism, suffered on the street. Admitted in severe status, no anamnesis, unconscious, GCS 3, wide fixed pupils, intubated, ventilated mechanically. Based on the results of the point-of-care ultrasound findings the diagnosis was channelled in the appropriate direction and the patient was quickly referred to Cardiosurgery Department, with the diagnosis of the acute cardiac failure after myocarditis. The care reported illustrates how point-of-care ultrasound may accelerate the appropriate diagnostic and treatment actions significantly influencing the final therapy effect.Anestezjologia i Ratownictwo 2016; 10: 181-183.
- The use of simulation-based assessments of technical skills of medical and paramedic students: an up-to-date review of studies
Mariusz Panczyk, Robert Gałązkowski, Joanna Gotlib
Background. Simulation is being increasingly used not only as a teaching tool but also as a method of evaluating practical clinical skills of both healthcare students and employees. Objective. To present available evidence that would confirm that simulation is a reliable and valid method of assessing technical skills of medical and paramedic students. Material and methods. The review of studies includes English language scientific literature published between 2000 and 2015. Resources of two bibliographic databases were searched through: Medline (Medical Literature Analysis and Retrieval System Online) and Web of Science. Key words used referred to reliability and validity of the simulation method in student assessment. The publications included in the review were critically analyzed in accordance with the guidelines of McMasters Critical Review Form for Quantitative Studies. Results. A total of 2,199 publications that met the search criteria were identified. Thirty-six full texts were qualified for a detailed analysis, of which eight were ultimately subject to critical analysis. The results indicate that simulation is a better tool to assess students’ technical skills than traditional assessment methods. In addition, very good results were obtained when simulations were used in combination with other methods and when several different examination scenarios were used. The key drawback of available evidence was the small size of subject groups, low methodological quality and inclusion in the studies of mainly medical students. Conclusions. Simulation techniques can be successfully used to assess technical skills of medical and paramedic students. Further research is required with larger and more diversified groups of students, taking into account rigid methodological rules that will enable better assessment of the usefulness of simulation in assessing students’ selected skills in the future. Anestezjologia i Ratownictwo 2016; 10: 184-193.
- Patient after craniocerebral injury – a suggested algorithm for prehospital emergency care
Cezary Pakulski, Marcin Podgórski, Maciej Denisiuk, Robert Gałązkowski, Monika Bułak, Beata Wudarska
In this study, we propose an algorithm for emergency medical care provided at accident sites and during transportation to hospital for patients who have sustained severe traumatic brain injury (sTBI), either as an isolated injury or as one of multiple injuries to the body. In describing these principles, we take into account the limitations resulting from Polish legal regulations. It is emphasized that all inadequacies in the medical management of patients with sTBI leading to secondary cerebral damage enhance the dynamics of brain damage and worsen the prognosis for survival and recovery. Anestezjologia i Ratownictwo 2016; 10: 194-202.
- Central blockade in children (is it worth it!/?)
Małgorzata Domagalska, Grzegorz Kowalski
Central blockades in children were described a little bit later than in adults but for many years they could not become a standard procedure. The anaesthesia of the child, still growing immature organism makes necessity to preserve particular caution and attentiveness for using the most safe drugs and technics. The central blockades are one of the elements that provide that rule. They of course require to remember about the anatomical and physiological differences, to assure absolutely safe requirements for the procedure and assure the possibility for monitoring before, during and after operation. They are used in many procedures affecting lower extremities, abdomen, chest, analgesia in acute pain and in chronic conditions. The contraindications are the same like in adults, the primary one is the lack of parental permission. Possible complications are not frequent and do not eliminate this technic from use. The central blockades allow safe put through the operation and after operation period, they speed up implement of prospective rehabilitation, and shorten the duration of treatment and child mind wellness. Anestezjologia i Ratownictwo 2016; 10: 203-218.
- Ultrasound assisted internal jugular vein and femoral vein cannulation
Jacek Wadełek
Utilizing portable two-dimensional ultrasonography to guide the insertion of CVCs (internal jugular, subclavian or femoral) improves patients’ safety. The procedure can take one of two forms– the “static” approach, whereby a mark is placed on the skin to indicate where to insert the needle, or the “real time” approach, where the needle insertion is visualized during the procedure. The alternative to using US guidance is the “landmark” approach, whereby anatomic landmarks are used to determine, to the extent possible, where the underlying vein is located. It may be carried out as a two-person procedure with the probe controlled by a second person, or by a single operator controlling the probe with one hand, while the introducer needle is inserted with the other. It is probably ideal to carry out line insertions under the real-time guidance with a single operator controlling the probe and the introducer needle. A high frequency linear probe (8-15 MHz)
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is best suited for ultrasound guided insertion of lines. Catheterization procedure sterility must be ensured. Anestezjologia i Ratownictwo 2016; 10: 219-226
- Sequential therapy in the prevention of pain; why is optimal for the patient with the acute and post-operative pain?
Jarosław Woroń, Jerzy Wordliczek
Sequential therapy in practice means replacing the drug administered parenteral to oral route of administration. This method of therapy is important in patients in the pharmacotherapy of acute pain and post-operative when we want to start as soon as possible the patient but equally important in this period is to ensure an effective and stable analgesia. While in the case of intravenous analgesics we can modify the route of administration using eg. A continuous infusion of analgesic, whereas this method greatly complicates the normal activity of the patient. At present, the standards of treatment of acute postoperative pain and recommend the use of oral analgesics controlled release formulation. Anestezjologia i Ratownictwo 2016; 10: 227-230.