STIGMATIZATION OF MENTALLY ILL PEOPLE BY PARAMEDICS – PILOT STUDY

Aim: Stigmatization is about making a division – people are grouped into better and worse, people with mental disorders are very often perceived as different, which is why they are largely stigmatized. Mental illnesses are a growing problem among the society of developed countries, therefore, the problem of stigmatization of these people has also become noticeable, which may adversely affect their mental condition and the convalescence process. The aim of the study is to assess the degree of stigmatization of mentally ill people by paramedics. Material and methods: An original questionnaire was used to collect the data, distributed from February 15, 2020 to April 7, 2020. among paramedics working in various medical rescue units and in units cooperating with the National Medical Rescue system. We collected 91 respondents replied. The research was a pilot study. Results: Paramedics are a professional group that does not show any particular signs of stigmatization in relation to the mentally ill, but single responses were obtained, which may indicate a given respondent’s lack of understanding for the mentally ill. Conclusions: In order to prevent stigmatization of the mentally ill, it is very important to educate not only paramedics, but also representatives of other medical professions who have contact with people suffering from mental disorders.

PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY IN THE DIAGNOSTICS OF COMMON BILE DUCT DISEASES COMPLICATED BY OBSTRUCTIVE JAUNDICE*

Aim: Evaluation of the effectiveness of percutaneous transhepatic cholangiography in the diagnostics of bile duct diseases complicated by obstructive jaundice. Material and methods: This article presents the experience of using percutaneous transhepatic cholangiography in 88 patients with benign and malignant common bile duct diseases complicated by obstructive jaundice. Results: Methods of direct contrasting of the biliary tract make it possible to visualize choledocholithiasis with 86.5% accuracy, with 84.1% common bile duct strictures, with 87.8% stricture of biliodigestive anastomosis and with 97.5% accuracy of cholangiocarcinomas. Conclusions: Direct antegrade bile duct enhancement should be used if ERCPG has low explanatory value. PTCG in case of “endoscopically complicated forms” of choledocholithiasis, CBD and BDA strictures and cholangiocarcinomas enhances all bile duct sections and helps assess the level and completeness of biliary blockade. Following PTCG, measures can be taken to achieve biliary decompression regardless of OJ genesis.

ASSESSMENT OF INTERVENTIONS COMPLETED BY THE VOIVODESHIP RESCUE SERVICE IN KATOWICE IN THE SILESIAN VOIVODESHIP IN 2018 DUE TO INJURIES

Aim: To assess the trips made by Emergency Medical Teams due to injuries (ICD-10 code: S) completed by Voivodeship Medical Rescue Teams in Katowice in 2018. Material and methods: Analysis of the characteristics of the trips was done based on information contained on “Emergency ambulance travel cards”. Statistical analysis was carried out using the t-Student, ANOVA variance as well as the Tukey post-hoc tests (p<0.05). Results: The whole number of trips made by the Emergency Medical Teams in the Silesian Voivodeship totalled 211,896, of which due to the reported injury, the total number of trips was 202,946 cases (183,827 calls were in town – 91%; 19,119 calls were out of town – 9%; p<0.05). The most common cause for calls were due to head injuries (S03 – dislocation, sprain and strain of joints and ligaments of the head as well as S04 – cranial nerve injuries). Statistically significant differences in the number of trips depending on cause identification (p<0.05) were determined, as well as in comparison to the number of cases identified as S03 and S04 between the in town and out of town territory (p<0.05). The median arrival time to an in town site was 7 minutes and 42 second, whereas in out of town sites it was 13 minutes and 19 seconds. Conclusion: The characteristics of the trips made by Emergency Medical Teams depends on the time, and what is affected by organizational changes in the emergency medical system.

METHOD OF ERYTHROCYTE PROTECTION IN URGENT CARDIAC SURGERY

Aim: The use of a simple, safe and convenient method of treatment extracorporeal circuit with «adaptation composition » (AdC) for the reduction of negative impact on the state of erythrocytes and tissue hypoxia. Material and methods: The research included 150 patients. They were divided into two groups. The first group included patients who underwent surgery with the treatment of an extracorporeal circuit by AdC, the second group was the control group. Сomplete blood count parameters, plasma free hemoglobin concentration, erythrocyte mechanical and osmotic resistance, erythrocyte membrane permeability and acid hemolysis were studied. Results: Use of AdC prevents adsorption the blood cells on the surface of the extracorporeal circuit and protects the erythrocytes during cardiopulmonary bypass in urgent cardiac surgery. Conclusions: The treatment of oxygenator with AdC reduces the negative influence СРВ on state of RBC. Membranes of erythrocytes were more resistant to traumatic factors in the group with AdC.

MANAGEMENT OF THE EMERGENCY DEPARTMENT PATIENT WITH TOXIC ALCOHOL POISONING

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.

LIFEGUARDS’ KNOWLEDGE RETENTION FOLLOWING AIRWAY MANAGEMENT, VENTILATION AND OXYGEN ADMINISTRATION TRAINING

Aim: To assess the retention of lifeguards’ knowledge after Qualified First Aid Course and its recertification in 3 essential categories: airway management, ventilation and oxygen administration. Material and methods: The study was performed from August 2020 to November 2020. The online survey addressed to lifeguards from 16 provinces of Poland was used as the evaluation method. Analysis of knowledge retention depending on the time that has passed since Qualified First Aid Course or its recertification was carried out on basis of 312 collected questionnaires. Results: Participants obtained the mean score of 7.9 ± 2.5 out of 15 points. Statistically significant difference was found between mean scores achieved by respondents who attended in the full course (n = 171) and those (n = 141) who have taken part in at least 1 recertification (respectively 7.6 ± 2.53 vs. 8.3 ± 2.7 points; p = 0.018). Although data analysis did not show a statistically significant downward trend depending on the time that has passed since Qualified First Aid Course, mean scores obtained by the study group in specific periods of time that has passed since recertification differ significantly (p = 0.026). The study identified 6 areas of knowledge least assimilated by lifeguards respectively: 2 in airway management, 3 in ventilation and 1 in oxygen administration category. Conclusions: Significant downtrend over time after Qualified First Aid Course recertification and detected areas of insufficient knowledge relating to key issues of life support indicates that the lifeguards’ training should be reanalyzed and redesigned carefully.

OUTCOMES OF PENETRATING CARDIAC INJURIES – A CARDIAC SURGEON APPROACH TO 22 CASES

Aim: Cardiac traumas are of great danger as they have life threatening potential. Although the patient may have normal vital signs at the time of admission the rate of mortality rate has been reported up to 69%. We believe that conducting the initial evaluation and early intervention by a cardiac surgeon may have an impact on decreased mortality. Material and methods: This study has been conducted with 22 patients that have been admitted with cardiac trauma history. The subjects who were operated after applying to emergency service have been enrolled in this retrospective analysis. İndividuals died due to cardiac arrest at admission have been excluded from the study. The subjects with penetrating cardiac injury who have undergone sternotomy or thoracotomy has been included in the analysis. Results: At the time of admission 4 patients has been presented with shock and 2 patients had been administered resuscitation due to cardiac arrest. The gun shot wound cases were 27% (n=6) and of these cases 3 of them were alive while the remaining 3 died. The stab wound cases were 73% (n=16) withh a higher survival rate of 75% (n=4/16). Thoracotomy has been conducted less than sternotomy as the rate was 13.6% (n=3) versus 86.4% (n=19). The overall rate of mortality has been found as 32% (n=7). Conclusıon: According to the results of this study one can say that conducting initial intervention to cardiac trauma patients by a cardiac surgeon reduced the rate of mortality and morbidity.

Long Term Outcome Prediction in Stemi/Nstemi Patients By Means of the Model Consisting of Simple Clinical Parameters

Aim: Our study aimed to identify the clinical variables associated with long-term mortality after MI and to construct a simple, easy to use clinical practice model for the prediction of 5 year mortality after MI. Material and Methods: This is a prospective 5-year observation study of MI patients admitted to the Department of Cardiology at the Copernicus Memorial Hospital in Lodz in 2010 and 2011. The data were collected during hospitalization and again after a period of 1 and 5 years. A multi-factor multi-level Cox regression model was constructed to investigate the impact of clinical factors on long-term survival.results: 92 patients (39 STEMI, 53 NSTEMI) were included in the study and their data were used to construct a Cox regression model with satisfactory fit (R 2 =0.7945). Factors associated with a decrease in 5-year risk are: age (1.06, 95%CI: 1.01-1.11), SYNTAX score (1.05, 95%CI: 1.02-1.08), WBC level (1.16, 95%CI: 1.08-1.26), and glycemia at enrollment (1.01, 95%CI: 1.01-1.01). Higher values of HDL at enrollment were associated with a decrease in 5-year risk (HR=0.97, 95%CI: 0.93-0.99).conclusion: The model we created is a valuable tool that is useful and easy to employ in everyday practice for assessing the 5-year prognosis of patients after MI. What is new: The study presents the new model for prediction of 5-year mortality after myocardial infarction. This model is based on simple clinical parameters and may by applied in everyday practice.

Difficult Decisions on the Cessation of Emergency Medical Treatment – The Lazarus Syndrome in the Practice of Paramedics

Cessation of emergency medical treatment on the basis of symptoms of clinical death and unclear indicators of death can result in numerous adverse phenomena. The currently available medical literature contains descriptions of cases of people with cardiac arrest in whom life function returned several minutes after emergency medical treatment was ceased. In the course of their work, paramedics must be aware of the existence of the auto-resuscitation phenomenon known as the Lazarus syndrome. Although the instance of the phenomenon remains exceptionally low, the possible consequences of an unrecognised case can be devastating. This can result in complaints of professional malpractice, negative reports in the media, as well as mental health issues among medical personnel and patients’ relatives. Medical response team procedures in the case of cessation of emergency medical treatment must contain elements that minimise the possibility of auto-resuscitation, also known as the Lazarus syndrome, from occurring.

ANALYSIS OF ORGANIZATIONAL COMPONENTS OF EMERGENCY MEDICAL CARE FOR PATIENTS WITH ACUTE CORONARY SYNDROME IN POLTAVA REGION OF UKRAINE

The aim of our research was to study the structure of patients with acute coronary syndrome and determine the organizational components of medical care for patients with suspected acute coronary syndrome in Poltava region. Material and methods: For our study was on the one hand statistical reports of health care institutions for 2016-2018, and on the other – a survey of doctors and paramedics of emergency medical care teams on tactics management of patients with AMI. The methodological apparatus used to achieve the set goals was based on the determination of relative values and analysis of time series. Results: The number of patients hospitalized with acute coronary syndrome is growing every year: from 82 people in 2012 to 489 in 2018. According to the monitoring conducted in Poltava region, emergency medical care for patients with acute coronary syndrome with ST segment elevation in 2018 in the cities was provided in the amount of 717, while in rural areas – 288. Conclusions: Data from the analysis of emergency medical care for patients with acute coronary syndrome showed that among patients with ST-segment elevation, urban residents predominate; in 90.6% of cases, the time to the patient’s hospitalization was less than 120 minutes.