Aim: The aim of the study was to determine the clinical characteristics and long term survival in patients with SARS-CoV-2 infection presenting with AMS. Material and methods: Retrospective analysis of the medical records was performed. The patients were divided into a group 1 with AMS and a group 2 without AMS. Demographics, the presence of concomitant diseases, systolic and diastolic blood pressure, heart rate and peripheral oxygen saturation (SpO2) were compared between the group that presented with AMS and the group that did not present with AMS. Survival analysis was performed with multiple regression models. The study was approved by Bioethical Commission. Results: The study group consisted of 174 patients aged 65±14 years. There were 88 (51%) women and 86 (49%) men. AMS at hospital admission was recognized in 14 (8%) patients. The patients with AMS were significantly older. Follow-up data were available for 163 patients. The median follow-up time was 467 (20-484) days. The 30 day mortality was 24% and the long term mortality was 30%. Conclusions: AMS occurs in about 8% of patients with COVID-19 admitted to the hospital. AMS is an independent from age, gender, and low oxygen saturation risk factor for long term mortality in patients with COVID-19 disease. Quarantine have the importance of early diagnosis of SARS-CoV-2 infection and patient monitoring in preventing deaths. The long term mortality in comparison to 30-day mortality doubled in patients with AMS and only slightly increased in patients without AMS.
The term ataxia includes impaired coordination and balance, and a lack of muscle control over intended movements. The most common signs and symptoms of cerebellar ataxia are ataxic gait (shaky, broad-based), movement disorders resulting from lack of proper muscular coordination, dysmetria, movement decomposition, intention tremor, and dysdiadachokinesia (disorder of alternating movements). Clinical symptoms vary depending on the damaged element: cerebellar hemisphere, cerebellar vermis, damage to the deep sensory pathways or damage to the cerebellar-frontal tracts and frontal centers. The most common causes of acute ataxia in children are drug overdoses, poisoning, and post-infectious cerebellitis. It is worth remembering that many causes of ataxia are metabolic and immunological. There are acute ataxias, intermittent and recurrent ataxias, chronic progressive and non-progressive ataxias. It should be remembered that each child with acute ataxia requires diagnosis and hospitalization. It is necessary to conduct a detailed interview regarding the time and circumstances of the onset of ataxia, accompanying symptoms, continuously and temporarily taken medications, possible previous episodes of these the symptoms themselves and the current state of health.
Aim: Paramedics carry out their work duties in a shift system. Shift work is related to a multitude of health complications, disrupting their biological habits and natural rhythm, impeding their private life and negatively affecting nutrition and the quality of sleep. The aim of the study was the evaluation of the effect of shift work on the nutrition habits of paramedics. Material and methods: The study was carried out in the period between in 2019 using diagnostic survey methodology among a group of 238 paramedics from mobile Emergency Response Teams of the Mazovian voivodeship. The mean age of the participants was 39.03±9.27 years for males and 31.93±7.76 years for females. In order to examine the differences between the groups, the χ2 test was used with an established statistical significance level of p <0.05. Results: Among the paramedics, the mean value of BMI was at a level of 24.99±3.36.56.30% (n = 134) of the participants indicated exhibiting improper nutrition habits. As the research found, the reasons for the improper nutrition habits in this occupational group are primarily shift work (151; 63.44%) and hurry (87; 36.54%). Conclusions: In order to minimize the possible health consequences related to the nutrition habits of paramedics, it seems essential to incorporate issues concerning the rules of proper nutrition in the health education process, as well as continuously monitoring their condition as part of occupational medicine practice.
Aim: The aim of this paper is an attempt to analyse the determinants of effective cardiopulmonary resuscitation (CPR) performed by medical personnel over a five-year span. Material and methods: An original research questionnaire was used to collect and process data for the purposes of this retrospective observational study. The research sample consisted of 167 patients aged between 16 and 102 who had in-hospital sudden cardiac arrest (SCA) and underwent cardiopulmonary resuscitation (CPR). Results: The most common causes of SCA in the study group of patients were cardiovascular diseases, and the mechanism of asystole was responsible for half of the recorded sudden cardiac arrests. While performing CPR, chest compressions were the most frequently applied procedure, whereas defibrillation or the Esmarch (jaw-thrust) maneuver were used less often. The effectiveness of resuscitation in almost a half of the cases was unsatisfactory, whereas the average time of performing resuscitation was 27,83 minutes. Pronouncement of death was made with regard to patients on whom resuscitation was performed for the longest time. On the other hand, among patients who were resuscitated for less than 20 minutes, breathing, blood circulation and con¬sciousness were restored, or only breathing and circulation were restored. Conclusions: The main cause of sudden cardiac arrest in the study period were non-shockable heart rhythms, whereas the restoration of spontaneous cir¬culation and breathing was achieved in the cases when resuscitation was performed for less than 20 minutes. The survival rate after successful resuscitation is comparable to the results obtained in other hospitals in Poland and Europe, as well as statistical data from scientific publications.
Aim: The COVID-19 pandemic is still a real threat to global public health. Medical personnel face new, previously unencountered challenges, and their feel¬ing of physical and psychological safety is under threat. The aim of the paper is to examine the differences in the feeling of safety among emergency medical personnel during the COVID-19 pandemic in selected European countries. Material and methods: The study group consisted of 1984 people working in the emergency medical services in seven countries. The research tool was a proprietary internet questionnaire, which prior to commencement of the research was validated using the Mc-Donald test, achieving a result of > 0.7, which underlines a satisfactory level of reliability. In the statistical analysis, a significance level of p = 0.05 was adopted. Analysis of the quantitative variables, presented by division into groups, was conducted using the non-parametric Mann-Whitney and Kruskal-Wallis tests. The choice of tests was conducted on the basis of the distribution of variables, verified by the Shapiro-Wilk test. Results: During the COVID-19 pandemic, the feeling of safety among employees of the emergency medical services and the feeling of danger to health and life as a result of infection with the SARS-CoV-2 virus was varied and depended on the job position. Principles for observing the sanitary regulations and the level of fear of infection are at a similar level and depend on place of work. Conclusions: Those most at risk from a lack of safety are emergency medical response teams.
Aim: To assess knowledge of the SARS-CoV-2 virus and attitudes toward the pandemic among patients in seven European countries in the opinion of medical personnel. Material and methods: The research was conducted across seven European countries. The questionnaire included questions relating to the Covid-19 pan¬demic regarding medical personnel’s opinions on the level of patient education, the sharing of incorrect information by patients, the following of quarantine procedures by patients, and the necessity of introducing tighter sanitary restrictions. Results: The research indicated significant differences between countries in the answers provided by medical personnel. Medical personnel encountered the sharing of incorrect information by patients most often in Poland, and most seldom in Norway. Staff in the United Kingdom and Poland had the lowest as¬sessment of patients following quarantine procedures, while personnel in Norway had the most positive assessment in this area. Education of the patients on the SARS-CoV-2 virus was most positively assessed by personnel in Finland, and the most poorly by staff from Poland. The necessity to impose tighter sanitary restrictions was indicated by the greatest number of personnel in Poland and the United Kingdom, and by the lowest number in Spain. Conclusions: The research indicated significant differences between countries in the provided answers. The study also demonstrated that as a rule the sanitary restrictions were supported.
Aim: To identify approaches to the practice of providing psychological assistance to law enforcement officers in extreme (crisis) situations. Material and methods: Research methods: bibliosemantic, forecasting, comparative, analysis, and generalization. Clarification of the etymology of extreme (crisis) situations allowed us to identify approaches and techniques of psychological assistance to law enforcement officers after their stay in extreme (crisis) situations and stressful conditions. Law enforcement officers often experience such emotions in extreme situations and stressful conditions as fear, anger, powerlessness, despair, and confusion. The use of psychological debriefing in work with law enforcement officers can help overcome the negative effects of stress after a crisis incident, as well as develop skills that may be needed in the event of a repeated encounter with similar events. Conclusions: The toolkit of professional psychological assistance to law enforcement officers should focus primarily on increasing their communicative open¬ness and social confidence. The psycho-correctional practice involves the best possible adaptation of law enforcement officers to the requirements of an extreme situation, enabling them to master it, weaken or mitigate these requirements, and try to avoid or get used to them.
Aim: Mass casualty incident is a challenge for the whole Emergency Medical System. The training had been prepared in order to optimize the readiness and to implement and practice the procedures issued by the ministry regarding mass casualty incidents. Material and method: The article analyzes the response capabilities of Emergency Medical System along with cooperating units, in case of mass casualty road traffic accident. Proper allocation of patients, following the procedure and the availability of forces and resources within the operational area were analyzed. Accident involved 30 casualties and was responded by numerous emergency units, such as Emergency Medical Teams, State Fire Service, Voluntary Fire Service, Police and City Guard. Emergency Medical System units implemented the procedures issued by the Ministry of Health regarding mass casualty incidents correctly. The leader of the first Emergency Medical Team to arrive served as the Action Medic in Charge. Further Emergency Medical Teams to arrive undertook proper cooperation with Medic in Charge. Allocation of patients to hospitals was correct. After the accident one casualty left the scene, which made the rescue action more complex. Conclusions: Simulating such incidents may prepare the medical personnel for real-life action. Regular training is the best form of gathering knowledge and increasing patients’ safety. Communication during incidents of this kind is problematic and requires high-priority improvement.
In the 21st century, we are experiencing the widespread use of new technologies that are designed to make work and daily life easier. The emergence of unmanned aerial vehicles (UAVs) has also opened up new opportunities for medical rescue support. This paper explores the various aspects of using medical drones to aid rescue operations. These devices can move at high speeds, traverse difficult terrain that ground vehicles cannot, and have many capabilities depending on their equipment. Currently, the use of UAVs is limited to rescue operations of an extreme nature, such as searching for missing individuals in dangerous or vast areas, or providing support during mass events.The paper describes the potential possibilities of using drones in rescue operations, such as delivering critical medicines, first aid equipment, or collecting information on hazards relevant to rescue planning. It is important to note that UAVs are still a relatively new technology that requires reliable safety systems, especially in the context of medical use. Possible threats, such as hacking attacks, collision risks in different environments, and the level of training of personnel involved in UAVs management, were also presented. Additionally, the paper addresses current legal and systemic issues in Poland and the European Union. Lastly, the results of public opinion polls on confi¬dentiality and consent to the use of medical drones were mentioned.
Aim: To assess the initial usefulness of an innovative, ecological manikin made of cardboard and coconut fiber, which is intended for resuscitation training. Material and methods: The study was conducted with the use of a mechanical chest compression device and assistance of human subjects. The first phase quantified the initial durability of the manikin. Phases two and three initially assessed manikins’ mechanical properties, its resistance to repetitive chest com¬pression training, and the quality of chest compressions performed on the tested manikin. Results: 268 and 49 participants took part in the first and the second phase of the study, respectively. The total number of chest compressions performed on the manikin was 30.736 and 4.928, respectively. The number of mechanical chest compressions reached 75.000 in phase three. The mean compression depth ranged between 47.1 ± 1.4 and 52.7 ± 0.6 mm, and the compression force ranged from 577 ± 10.0 to 686 ± 187 N. The rate of compressions ranged from 99.5 to 133/min, and the percentage of complete chest recoil ranged from 62.1 ± 20.3% to 100%. Conclusions: The tested ecological manikin invented for the purpose of resuscitation training provides the parameters necessary for students to master the ability to deliver high-quality chest compressions in terms of depth, rate, full recoil and force needed to perform chest compressions in a large adult. Durability tests showed that a manikin made of ecological materials can also be used multiple times, for many training groups.
Aim: Assessment of the risk of pulmonary embolism and myocardial dysfunction based on the measured levels of d-dimer and troponin-T in patients treated in the hospital for COVID-19. Material and methods: The study included a 3-year retrospective analysis of medical records of patients treated at the Independent Public Healthcare Institution. The authors compared the 12 months preceding the epidemic treating this group of patients (without COVID-19) as a control (comparative), and the 24 months of the epidemic in Poland (patients with COVID-19 infection). Results: Statistically significant differences in d-dimer concentrations before and during the pandemic were found (2.150 ± 3.892 vs. 4.990 ± 15.244 vs. 5.032 ± 13.426 μg/ml; P = 0.046). However, there were no statistically significant differences before and during the pandemic in troponin T concentrations (0.027 ± 0.049 vs. 0.032 ± 0.082 vs. 0.034 ± 0.121 ng/mL; P = 0.718). Comparing the periods of the pandemic and the time before the pandemic, the length of the hospitalization period was statistically significantly extended (8 ± 4 vs. 10 ± 7 vs. 12 ± 7 days; P<0.001). Conclusions: Diagnostics consisting in monitoring the level of d-dimer in patients with COVID-19 allows to reduce the risk of complications, including hospital death. Determining the level of d-dimer and troponin-T allows for the implementation of appropriate treatment in patients with COVID-19. Testing the level of d-dimer is important in making clinical decisions against the risk of flordembolism in adult COVID-19 patients.
Aim: Indication of appropriate treatment of the emergency medical team towards a patient with acute pericarditis being a life-threatening condition. Material and method: The retrospective study included two men to whom EMT (Emergency Medical Team) was called for chest pain and in the second case due to the correlation of chest pain, ECG changes and pathological results of ultrasensitive cardiac troponin and CRP. Both patients developed acute pericarditis as a result of the infection they were currently undergoing. In this paper, the case study method was used. The research material was obtained through the analysis of medical rescue cards, EMT departure order cards and hospital treatment information cards. Conclusions: Among cardiac patients with stenocardial pain, regardless of age and other factors, an examination should always be carried out and discriminatory diagnostics should be implemented, m.in. for suspected acute pericarditis. Medical interview, in particular epidemiological history, plays an important role.
Polytrauma patients with pelvic injuries have a high mortality rate, particularly in those who are haemodynamically unstable, reaching up to 42%. This case study involves a 66-year-old cyclist struck by a tram in Gdańsk, Poland in October 2022. Upon arrival at the Emergency Department of the Medical University of Gdańsk, the patient exhibited stability but later entered the initial shock phase. Comprehensive imaging unveiled flail chest, bilateral pneumothorax, spinal fractures, and an unstable pelvis. Despite a negative point-of-care ultrasound, the planned orthopaedic pelvic stabilization surgery transitioned to endovascular intervention due to deteriorating shock and suspected retroperitoneal bleeding. Despite a successful procedure, the patient succumbed to irreversible shock and multiple organ failure the next day in the intensive care unit. The significance of rapid identification of internal bleeding followed by timely endovascular intervention and retroperitoneal pelvic packing is underscored, as it has demonstrated decreased mortality in similar cases.
Aim: Improving emergency surgical care for patients with diabetic foot syndrome. Materials and methods: We conducted treatment of 268 patients with diabetic foot syndrome (DFS). The first group (136 patients) consisted of patients admitted to the hospital in 2012-2016, organ-preserving operations were performed according to the methods developed in the clinic (126 patients).The second group (132 patients) consisted of patients admitted in 2017-2021. Results: In the main group, surgical treatment was determined by the form of DFS. There were in the neuropathic form: stage I – surgical treatment of the focus, and stage II – plastic closure of the wound. There were in neuroischemic form (60 patients): stage I – correction of ischemia; stage II – surgical treat¬ment of the focus; stage III – plastic closure of the wound. In 10 (7.3%) patients of the main group amputations were performed at the level of the shin and the thigh. In the control group, in 19 (14.4%) patients, amputation was performed at the level of the thigh. Conclusions: Organ-preserving treatment of DFS should be carried out in accordance with the form of DFS with determination of tissue viability. Among the factors influencing the rate of healing, the shape of the wound, its size and localization are important.
Aim: The aim of this study was to analyze the confirmation of sudden cardiac arrest by team members during the tasks performed during the three editions of the “Polish Universities’ Championship in Emergency Medicine”. Material and methods: The study was based on an analysis of the evaluation sheets from the “Polish Universities’ Championship in Emergency Medicine” organized in 2015, 2017 and 2019 by the Faculty of Health Sciences of the University of Bielsko-Biala. The championships were attended by three-person teams of students, which could not include persons with medical training as well as those working in the Emergency Medical Service System. Results: The study showed that during task performance 87.20% of teams correctly confirmed SCA before starting CPR. Correct performance of this proce¬dure was not significantly influenced by the circumstances of SCA, the year of the task, the age of the patient, or the heart rhythm causing the SCA. Conclusions: The knowledge and skills of the participating in the championships team members, regarding confirmation of sudden cardiac arrest, appear to be at a satisfactory level. In order to minimize the risk that future medical personnel, will make while working with the patient mistakes that occur during the performance of tasks, more attention should be paid to the level of education in this important aspect.
Aim: To assess the level of knowledge about chest pain and the management procedure in patients with chest pain among nursing and midwifery students. Material and methods: The study was conducted in 276 nursing and midwifery students at the Medical University of Lodz, Poland. Results: First-year first-cycle program students constituted the largest group among the respondents (114 people), whereas the smallest group included third-year first-cycle program students. Classes attended in the course of university studies were the most common source of knowledge about chest pain in the surveyed group (62.7%, 173 subjects), whereas 6.9% of the respondents (19 individuals) reported having no knowledge about chest pain. Depending on their age, the surveyed students most often assessed their level of knowledge about prehospital management of a patient with chest pain as satisfac¬tory - 45.3% (125 respondents), and least frequently as very good - 4% (11 respondents). As regards the characteristic symptoms of myocardial infarction pain, the students most often indicated the correct answer, i.e. retrosternal pain (81.8%, 226 respondents), while 18.2% (50) of the students did not know the right answer. Conclusions: Cardiovascular diseases are the main cause of death in Poland, therefore, especially students of every medical field at the beginning of the education cycle should acquire knowledge and skills in the field of pre-hospital management of a patient with chest pain.
There are many studies which present advantages and disadvantages of the use of both minimally invasive and open method procedures in pediatric sur¬gery. This paper highlights the advantages of minimally invasive surgery and the resulting conclusions for use in clinical practice (e.g. the use of laparoscopy in children is associated with significantly less postoperative stress). The disadvantages of the described surgical techniques and other possible complica¬tions observed after the use of laparoscopic techniques and the open method are also presented. It was emphasized that surgical trauma, regardless of the surgical method used, causes not only a post-traumatic immune-inflammatory response of the body, but is often associated with the risk of developing infections (local or generalized) and the occurrence of recurrences. The study focuses on summarizing the current state of knowledge on minimally invasive pediatric surgery, in particular on the effectiveness of laparoscopic appendectomy, laparoscopic inguinal hernia repair and laparoscopic procedures used in pediatric oncology, taking into account postoperative immune response disorders. Moreover, progress was analyzed in the use of minimally invasive robotic surgery, which becomes an increasingly common method of treatment of many typical surgical diseases in children.
Poisoning is one of the reasons for which Emergency Medical Teams are called. They range from mild and asymptomatic incidents to those complicated by shock and Sudden Cardiac Arrest. The causes of poisoning may be related to accidental contact with a potentially poisonous substance, but also to deliberate use or exposure to poison for suicidal purposes. Some of these events are classified as situations subject to the assessment of forensic specialists. Rescue procedures in case of poisoning depend on the type of poison, the course of poisoning and the clinical signs presented by the patient. Medical Emergency Procedures should always be based on the pursuit of circulatory and respiratory stability of the patient. Pre-hospital management is aimed at limiting further absorption of the poison and, if possible, implementing causal treatment through the supply of antidotes. In the absence of a specific antagonist, the patient should be treated symptomatically.
Aim: To assess the impact of the pandemic on the number and mode of admissions and diagnoses in emergency patients transferred by emergency medical services. Material and methods: Data provided by the National Health Fund on the number and mode of hospital admissions and diagnoses according to Uniform Patient Group sections A C D E F G H J K L M Q S for patients admitted in an emergency after being transferred by emergency medical services between March 1 and December 31, 2020 were assessed. The data were analysed by month and compared with the report for the period of March 1 to December 31, 2019. Results: In the analysed period in 2020, the number of hospital admissions dropped by 79,867 cases (17.90%), including by 72,784 (21.14%) for conservative cases and by 7,083 (6.96%) for invasive cases. The highest number of hospital admissions was recorded in March (41,505, 11.33%), including conservative cases (32,005, 11.79%), and the highest number of surgical admissions was seen in July (10,799, 11.39%). In November, the largest decrease in the number of admissions (28,763, 7,85%), including conservative (21,140, 7.78%) and surgical (7,623, 8.04%) admissions, and the number of ICD-10 diagnoses in sections A, C, E, F, G, H , J, K, L, Q, and in sections D and S was recorded in April. Conclusions: The number of conservative and surgical hospital admissions decreased in the investigated period.
Aim: Analysis of priorities in the emergency treatment of patients with ectopic pregnancy who are in a life-threatening condition. Observation of differences in the course of treatment depending on belonging to the age group. Material and methods: The study included 68 patients of the Gynaecological and Obstetric Specialist Hospital. E. Szczeklik in Tarnów, Małopolskie Voivode¬ship, who were diagnosed with ectopic pregnancy. The patients were divided into two groups according to age, counting 34 people in both cases.The study was retrospective and concerned patients hospitalized in the period 27.01.2016–01.08.2022. Results: The length of hospital stay due to ectopic pregnancy is not significantly longer in patients under 30 years of age compared to patients over 30 years of age. No significant relationship was observed between the patient’s age and the stage of pregnancy in which health collapse occurs and the need for medical intervention in connection with ectopic pregnancy occurs. Ectopic pregnancies are most often localized in the right fallopian tube. No significant differences between age groups were shown in laboratory tests of hCG, WBC, RGB, HGB, HCT, PLT levels. The most common treatment in both groups was surgical resection of the ruptured fallopian tube. No statistically significant differences were found between age groups and treatment. Conclusions: Ectopic pregnancy is a dangerous clinical situation for pregnant women regardless of their age. The intensity of haemorrhage as a result of rupture at the site of implantation of the embryo, assessed on the basis of laboratory tests, is comparable in both patients before and after 30 years of age.
