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Differential diagnosis of dyspnoea in the prehospital emergency care
JENÍČEK, Petr
The bachelor work is devoted to the topic of differential diagnostics of dyspnoea in prehospital emergency care. The issue of dyspnoea is still very relevant because of number of diseases causing it. The theoretical part of this bachelor work contains basic information about terms of dyspnoea, differential diagnostics and examination methods with regard to the dyspnoea. The most often incidence of dyspnoea is generally associated with cardiac and pulmonic diseases. There are also described additional diseases caused by other reasons, i.e. the carbon monoxide intoxication, anemia or hyperventilation, which are often occurred in prehospital emergency care and therefore could be difficult to distinguish from the pulmonic dyspnoea. In particular for paramedics, distinguishing the cardiac or pulmonic dyspnoea from the dyspnoea caused by other reason could be difficult. The examination methods in prehospital emergency care currently available for paramedics are very limited, which can make the fieldwork diagnostic of dyspnoea more difficult. The research was realized by the standardized half-structured interviews with the paramedics working at Emergency service of South Bohemian region. The surveyed group was composed of 14 respondents from all regional centers of Emergency service of South Bohemian region. Selected respondents were at all age categories varying in the length of the praxis at the emergency service, educational background and also in the composition of ambulance crew. The respondents answered 20 prepared questions regarding the knowledge and experience with dyspnoea. The research was aimed to the knowledge of paramedics in the field of differential diagnostics of dyspnoea in prehospital care and also to the difficulty of determination of working diagnosis based on examination methods available for paramedics in prehospital emergency care. Results of the research were summed up into the tables and consequent results are included in the discussion. The first goal of the research was to monitor the knowledge of paramedical staff about differential diagnostics of dyspnoea in prehospital emergency care. The second goal is aimed to monitoring the difficulty of working diagnosis assessment of dyspnoea associated with possibilities of diagnostics in prehospital emergency care. Two experimental questions were elected for research. The first question is dealing with the enough knowledge of paramedics for correct differential diagnosis of dyspnoea in patients in prehospital emergency care. The second experimental question is addressed to the dyspnoea, diagnostics possibility in prehospital emergency care for paramedics and whether it is complicated symptom for working diagnosis assessment. Based on interviews results, the insufficient knowledge of paramedics in most cases of dyspnoea are evident. Paramedics with university degree are more educated in this field. The big lack of knowledge related to dyspnoea lies also in the education of paramedics in the Emergency service of South Bohemian region. Respondents also mentioned the absence of primarily focused course on dyspnoea. The theme is obviously discussed during the course of Emergency service of South Bohemian region only in connection with another theme. Therefore, the big lack of necessary information is obvious. Regarding the insufficient education of paramedics the problem of wrong dyspnoea diagnostics in prehospital emergency care could be closely related. Commonly, paramedics treat cardiac and pulmonic dyspnoea. However, research results emphasize the problems with working diagnosis assessment, necessary for subsequent treatment and targeting the patient. Concerning the gravity of some diseases causing dyspnoea, the incorrect diagnostics could be fatal for patient.
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Analysis EKG by paramedic in pre-hospital care
KOLLNEROVÁ, Kateřina
This Bachelor thesis deals with the issue of monitoring and evaluation of electrocardiography (ECG). The monitoring of ECG belongs to the basic diagnostic methods of heartbeat. It is also irreplaceble in prehospital emergency care (PEC). That is why a paramedic must be sure in manipulation with the ECG machine and he or she must faultlessly distinguish typical deviations in ECG curve, especially in case of life-threatening and frequent arrhythmia because a proper treatment in PEC usually has a decisive influence on a patient´s life. In the theoretical part of the thesis I dealt with basic knowledge about the anatomy and physiology of heart. Then I focused on electrocardigraphy as a basic diagnostic method, I mentioned various types of ECG and described ECG machine used in PEC. I also delineated electrodes and downspouts and their classification. I added a procedure of monitoring ECG by means of defibrillation electrodes and by means of downspouts. In the next chapter I dealt with physiological ECG curve, its description and assessment of cardiac rhythm. A considerable part of the theoretical part is devoted to heart rhythm disorders and classification of these disorders. In the last charter I mapped options of heart rhythm disorders treatment pharmacological as well as therapy without drug application. The research part of the thesis is based on qualitative and quantitative form of research. Data were gained by method of interview and by additional knowledge test designated for paramedics from the South Moravian Region. The interviews were carried out with paramedics from the Emergency Medical Service of the South Moravian Region. The additional test consists of 16 open as well as closed questions. Results of the research were processed and depicted by means of bar charts. These express numerical value of the research results. The main aim of the thesis was an analysis of paramedics´ procedure when evaluating ECG curve. The minor aim of the thesis was to map a paramedic´s knowedge in te field of ECG curve evaluation. The theoretical part of the thesis can be used as a study material for paramedic students and also for students of other medically-oriented branches who study the issue of ECG. On the basis of the thesis results a manual was made out which could simplify the evaluation of ECG curves.
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Contribution capnometrics in pre-hospital emergency care
BENEDIKT, Ladislav
In terms of prehospital emergency care (PEC), the rescuers get into contact with patients, who have breathing difficulties in connection with their health condition. As breathing, together with consciousness and bloodstream, is included in the observed vital signs, it is necessary to focus on the precise monitoring of its quality. Except evaluation by sight, we can also beneficially use device monitoring of breathing, more precisely the quality of blood gases exchange. During PEC we can monitor oxygen or carbon dioxide saturation in blood (pulse oximetry or capnometry, respectively). In this bachelor thesis we focused on capnometry. The principle of capnometry measurement is based on infrared light absorption. In comparison with pulse oximetry, the capnometry is useful in situations when we are not able to get objective results by using pulse oximetry. The greatest advantage of capnometry is the almost immediate reaction of a device to metabolic changes in respiratory system of a patient. Using this method is also beneficially during intubation, using combitube and laryngeal mask, because we can get precise overview about cannula position. Theoretical part of this bachelor thesis is focused on capnometry problematics. At the beginning is explained what capnometry and PEC are and they both are described. Also view on monitoring in general is present. The capnometry itself is divided into types according to way of use. Theoretical part is ended by chapter about capnography. The aims of practical part are monitoring of South Bohemian rescuers' knowledge about using of capnometry and using of capnometry during PEC. Data collection were realised quantitatively by using questionnaire focused on theoretical knowledge. Data were collected in March 2015. 100 pieces of anonymous questionnaires were given for filling across the South Bohemian Region (regional centre in České Budějovice and local centres in Český Krumlov, Písek, Prachatice, Strakonice and Tábor). 63 respondents answered the questionnaire (rate of return was 63 %). Questionnaire consisted of 24 questions targeted on knowledge of respondents about capnometry problematics. Results were analysed in statistical software SPSS into graphs and charts and hypotheses were statistically analysed by using of chi-square test method. Statistical analysis shows to us that South Bohemian rescuers have enough information about capnometry and that capnometry is not used for every patient with controlled air passages. The aim of this bachelor thesis is to get information about South Bohemian rescuers' knowledge about using of capnometry. Another aim is to monitor the using of capnometry in prehospital emergency care. Statistical analysis proves that knowledge about capnometry is sufficient among South Bohemian rescuers and they are able to use this method. Furthermore the guide for using of capnometr for rescuers was created on the basis of obtained information. This guide is included in this thesis as an appendix (app. 11).
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Prehospital emergency care of newborns from the perspective of medical personnel and parents
POLLAKOVÁ, Tereza
This Bachelor work is concerned with prehospital emergency care of newborns. This issue is viewed differently by the public, in particular by the enfant's parents, and the medical personnel. Nowadays a strong initiative arises of implementing public education campaigns in this field through all possible means to ensure at least a basic grasp with most of the population. Every 5 years, resuscitation reccomendations are updated on the basis of the European directives, which are adpoted, amended and communicated to the public in the Czech Republic. Concerning the medical personnel, procedures exist to inform them about the latest findings and sustain a high standard of knowledge in this field of their profession. This initiative was triggered by a suggestion from Pediatric Departments which stated that the compliance of these recommendations varies and generally appears low both with medical personnel and the public. The theoretical part presents the latest recommendations and materials regarding prehospital emergency care as well as the specific properties concerning newborn enfancy. The aim of this work is to assess the level of newborn prehospital emergency care knowledge of the parents and the medical personnel from non-pediatric departments. With the viewpoint of Midwife Programme I decided to choose as the target group the midwifes working at maternity ward in order to find out their knowledge in case of the necessity to povide prehospital emergency care outside the hospital. Equally, midwife is the most typical job on the border between pediatric and non-pediatric field. I also presumed this type of medical staff has experience with prehospital emergency care of newborn. The presumption of low knowledge of the parents also brings about a potential possibility of using the conclusions of this thesis for work of this medical personnel. The survey part of this work was carried out by qualitative investigation employing the data collection method of detailed interview with two groups of respondents mothers of newborn infants and midwives from the maternity wards of two hospitals. The concept of the interviews was intended to gain answers to three investigative questions: Do mothers have sufficient knowledge of prehospital care for newborn enfants? Do medical personnel have sufficient expertise of prehospital care for newborns? What form of education in this area do the medical personnel and parents consider as most efficient? The interviews gave answers not only to these questions but also pointed at the necessity to take into account the emotional side of the personality, especially in case of the parents, as it plays a significant role along with the actual knowledge in the ability of correct and immediate emergency response in stressful situations. This finding also corresponds with the fact that I deliberately chose mothers who had had experience with an newborn emergency.
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Monitoring of blood pressure and heart activity via ECG in prehospital urgent care
VRÁNOVÁ, Anna
The topic of this thesis is monitoring of blood pressure and heart activity via ECG in prehospital emergency care. So the thesis deals with a necessary part of a patient´s examination that precedes effective treatment. In the theoretical part the prehospital emergency care is defined and the emergency medical service, which provides this care, is characterized. Anatomy and physiology of heart is outlined there. Also blood pressure and its measurement is discussed there. Electrocardiography is described and information needed to basic orientation in ECG recording is introduced. The practical part was carried out using mixed methods research. The first method was a quantitative research in the form of a standardized anonymous questionnaire. Employees of the Emergency Medical Service of the South Bohemia Region who work as paramedics became the respondents of this questionnaire. The qualitative research strategy consisted in observation of paramedics when they were monitoring blood pressure and heart activity via ECG in the prehospital emergency care. The aims of the research part were these: mapping of states and situations that lead paramedics to monitor patient´s blood pressure and heart activity, description of different methods of blood pressure and heart activity monitoring and finding the paramedics´ experience with available apparatuses. The last aim was a detailed introduction to monitoring of blood pressure and heart activity via ECG. The results show the following information. Paramedics measure every or nearly every patient´s blood preasure. They begin to monitor heart activity via ECG when the patient suffers from chest pain, is unconcsious, when there is a risk of arrhythmias or when the patient is circulatory unstable. Auscultatory method mediated via aneroid sphygmomanometer is the most frequent way of blood pressure monitoring in prehospital emergency care. Paramedics are satisfied with apparatuses and tools used to blood pressure and heart activity monitoring. All the acquired knowledge serves to detailed introduction to the issue which a paramedic meets in his or her everyday work and must have full control of it.
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Injuries caused by an animal in the pre-hospital emergency care and subsequent outpatient care
VOTRUBOVÁ, Kateřina
The topic of this bachelor thesis is the various types of injuries from animals in prehosptial emergency care and their subsequent treatment in outpatient clinics. The theoretical section includes the summary of possible predicaments, which various animals cause. It discusses anaphylactic reaction to insect stings and furthermore the poisoning by snake venom, which in the Czech Republic primarily concerns the common viper (otherwise known as the common adder). The next chapter deals with the illnesses caused by cats, specifically cat scratch disease (lymphadenopathy) and toxoplasmosis with acute childbirth. The acute condition caused by dog bites and rabies belong to the next section of the thesis. In the conclusion a brief summary of injuries is mentioned, which are a threat during the handling of domestic animals, where the thesis focuses on the polytraumatized patient, fractures and cranio-cerebral injuries. The practical section was carried out on two qualitative levels in the Central Bohemian Region in connection with the Region of the Capital City, Prague and the Southern Bohemian Region. The first of these was the verification of knowledge of paramedics about injuries caused by animals through a knowledge test, comprising of ten questions. These questionnaires were always filled in my presence. In total 40 knowledge tests were distributed, of which 38 were returned completed. The return rate was thus 95%. The second section determined the differences in outpatient care in the individual regions. It was carried out through managed interviews with outpatient medical doctors from the surgical and internal medicine departments, a traumatologist, general practitioner and paediatrician. In total, eight medical doctors were approached. Furthermore an identical questionnaire was given to all these medical doctors. The research was carried out from November 2013 to April 2014. The aim of this thesis is to ascertain the knowledge about these injuries of paramedics in the Central Bohemian Region in connection with Region of the Capital City, Prague and the Southern Bohemian Region and compare them. Furthermore, it intends to find the difference in outpatient care of patients in the same territorial units injured in this way. Three research questions were asked, specifically to the mid-level health services personnel, whether paramedics have the correct knowledge about this issue and whether their knowledge varied in the regions. Regarding the second aim, the question asked was whether outpatient care of injured patients varied in the relevant regions.
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Prehospital emergency care for children with acute suffocation
VETÝŠKOVÁ, Petra
Bachelor thesis is prehospital emergency care for children with acute asphyxia. It discusses the treatment of children in prehospital care, whereby it becomes specific because care of children and adults is not always identical. Acute asphyxia is a very unpleasant condition, which requires expert intervention as fast as possible. Without help the patient's life can be threatened by loss of consciousness with shortness of breath. The theoretical section of the thesis deals initially with a concise outline of the anatomy and physiology of the respiratory system, specifics of treatment of patients between the ages 0 to 18 years, at which the childhood is defined, and the subsequently described principle of correct communication with children and methods in the treatment of a child. The theoretical section of the thesis chiefly delineates the causes of acute asphyxia in children. The individual illnesses and injuries, which can affect children up to the age of 18, are characterized as inhalation breathlessness or expiration breathlessness. Illnesses mentioned in this thesis are acute tracheitis, acute laryngotracheobronchitida, allergic swelling, acute laryngitis, acute epiglottitis, acute bronchitis, acute bronchiolitis and bronchial asthma. Injury is the inhalation of a foreign object. For individual illnesses, the causes, symptoms and prehospital emergency care, often diagnostics and first aid too, are described. The final chapter of the theoretical section concerns itself with emergency resuscitation of children. This bachelor thesis has three aims: to graph the frequency of occurrences of acute asphyxia in children in emergency service responses, to graph the causes of acute asphyxia in children in emergency service responses and to graph the awareness of paramedics of the correct provision of prehospital emergency care for children with acute asphyxia. The practical section of the thesis is divided into two sections. The data obtained in the first and second sections was evaluated and for improved transparency transcribed into tables and graphs, which were verbally described. Their evaluation corresponded to each research question. The frequency of occurrence of acute asphyxia in children in emergency medical service responses of the Southern Bohemian Emergency Services from 01/01/2011 to 31/12/2013 included is 598 responses. It was ascertained that the frequency of occurrences has grown every year. The most common causes of occurrences of acute asphyxia in children in the responses from Emergency Medical Service of South Bohemia are acute inflammation of the larynx (acute laryngitis) and breathlessness (dyspnea). Further causes dealt with by emergency responses were for example foreign objects in a respiratory organ or respiratory failure. The results of the survey by questionnaire were evaluated too. The questionnaire survey method was then graphed so that the paramedics had sufficient knowledge about the provision of prehosptial emergency care of children with acute asphyxia. The data obtained and processed in the research section of the bachelor thesis bears witness to the fact that acute asphyxia in children in the emergency responses of the Emergency Medical Service of South Bohemia occur and the number of these responses is growing. Therefore, it is important to have information on the causes of acute asphyxia in children, to know the nature and symptoms of individual illnesses and injuries and above all to have information on the provision of prehospital emergency care of underage patients with this problem. It is then on the spot that the paramedics from the Southern Bohemian Emergency Services would have the optimal awareness about the provision of prehospital emergency care of children with acute asphyxia.
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Options airway paramedics in terms of prehospital emergency care
KOZELKA, Pavel
This bachelor thesis deals with establishing an airway by a paramedic service in terms of pre-hospital emergency care. Considering unexpected accidents and life-threatening situations, securing the airway is one of the most important performances in pre-hospital care. Proper airway securing covers both effective ventilation and oxygenation. It is not always possible to secure using usual techniques. Therefore, alternative methods of airway management are introduced in this thesis as well. The theoretical part is concerned with the airway management. The first chapter aims at the historical background and describes the development of airway securing techniques. Following parts provide with a short introduction to the anatomy and physiology of the human respiratory tract. The thesis describes the concept of pre-hospital care and competencies of a paramedic. It focuses on airway management with or without medical devices and characterizes the main techniques, such as, the oral cavity examination, head-tilt method, the triple airway manoeuvre and Heimlich and Gordon manoeuvres. Regarding airway devices, the thesis mentions pharyngeal airway, combitube, laryngeal tube and laryngeal mask, I-gel, endotracheal intubation and alternative airway securing including coniotomy and laryngectomy. The last chapter of the theoretical part deals with the modes of artificial ventilation. The practical part compares the options of airway management and monitors the level of theoretical knowledge of airway establishing among emergency paramedics in South Bohemia, Central Bohemia and Pilsen Region.
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The use of sedative and analgesic in children's injuries in prehospital emergency care
TOMANOVÁ, Markéta
The theme of this work is the use of sedation during child injuries in pre-hospital emergency care. Children injuries are serious health, economic, and social problems in the Czech Republic, particularly infant, toddler and preschool age children due to their rapid development of physical skills, but this time the development of intellectual abilities does not allow the recognition of dangerous situations. Any sudden deterioration of health of the child is a burden not only for him but also for the parents and all others in its surrounding. Due to a smaller representation of pediatric patients compared with other broad spectrum of health services interventions, young children require more care and therefore paramedics need to be oriented in this field. This thesis focuses on mapping the knowledge of paramedics in connection with the administration of sedation for injuries of children in pre-hospital emergency care. Quantitative research is focused on paramedics working in emergency medical service in Ceske Budejovice and ARO department in the hospital in Ceske Budejovice. At the beginning of the theoretical part, I tried to describe pre-hospital emergency care and specifics of childhood. A large proportion of theoretical work I devoted to chapter about sedation, which is a look into the history of where they could be seen the beginnings of analgesia and pain management. I thought it was important to mention the principle of medication, application paths or drug usage. Therefore, attention is on the chapter of pain, its definition, types, children experiencing pain and elaboration of rating scales. As has been said, injuries are a hot topic, and therefore the next part of the theoretical part is dedicated to injuries. The practical part focuses on the mapping of knowledge concerning the administration of sedation for injuries of children in pre-hospital emergency care. Data were collected from January to March in 2014. Questionnaires were personally handed in the form of printed questionnaires, forms were also distributed electronically. A total of 70 questionnaires were handed in, that is 50 questionnaires to the "RZP" center in Ceske Budejovice and 20 questionnaires to "ARO" department in a hospital in Ceske Budejovice. The return was 82.8 %, which represents 58 returned questionnaires, which were included in the subsequent evaluation of the research. Interviewed paramedics were at the beginning informed with the nature of the research, with an emphasis on confidentiality. Individual questions were designed to obtain the information needed to answer the research question ("what is knowledge of paramedics administering sedation to children in pre-hospital emergency care"), and they fulfilled the objectives of this thesis. The questionnaire contained a total of 15 questions, the questions 1-3 were used for further mapping of the respondents. The following 12 questions were deliberately chosen to find out whether paramedics have the knowledge of sedation during children injuries. These data were then graphically represented and each question separately evaluated. Only questions number 4, 8, 9, 10, 11, 12, 13 and 14 were included in the survey to be able to answer the research question. Research questions were statistically using the chi- square test evaluated. The level of significance rejected the claims set ("sufficient knowledge will have 75 % of the respondents") and confirmed the results of research that paramedics knowledge is not sufficient. Finally, research shows that paramedics should be more interested in the area related to sedation, its administration, dosage and possible complications. A training for emergency workers at least once but preferably twice a year could be a solution.
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Ventilation support in prehospital care and during transport of the patient
PETROVIČ, Pavel
The topic of presented bachelor thesis is ventilation support in prehospital care and during transport of the patient. Consciousness, breathing and blood circulation belong among basic life functions. Thanks to ventilation support we are able to provide full or partial pulmonary ventilation. For this we use aids such as resuscitation masks meant for lay public or aids for trained paramedics like laryngeal masks, endotracheal tube and ventilator for artificial pulmonary ventilation. Prehospital care is not only about professional first aid, but about giving first aid by lay public as well. That is why aids for pulmonary ventilation are included in this thesis. This bachelor thesis had two aims; to map and compare knowledge of students attending the last year of high school in kiss of life and map experiences of paramedics with a laryngeal mask Supreme and capnometry. The research was implemented with mixed method research. Knowledge of students were found out by tests which were give in class "Z4" at Střední odborná škola veterinární, mechanizační a zahradnická a Jazyková škola s právem státní jazykové zkoušy and in class "4.B" Gymnázium Jírovcova. At Z4 class research took place on 14th March 2014. There were 25 students in this class, 4 men and 21 women. At class of 4.B students' knowledge was tested on 2nd April 2014 with presence of 26 students, 16 women and 10 men. At the beginning of test the anonymity of respondents was stressed, and then all respondents were acquainted with the character of my research and its aim. At the start of the test there were two statistic questions; if the respondent is either man or woman and whether the respondent has his/her driving license. There were 15 closed questions in the test and students were supposed to choose one right. After handing all the tests, the correct results were told to students. 51 tests altogether were given. Experiences of paramedic with the laryngeal mask and capnometry were found out in a form of five short dialogues in a week from 7th to 11th April 2014. The research group include paramedics of Zdravotnická záchranná služba Jihočeského kraje. Gained data from tests were evaluated, each question separately and then transformed in graphs which show the number of wrong and right answers. The aim of this thesis was to map and compare knowledge of students in the last year of their studies. Evaluated tests show us, that students of Z4 class have more knowledge about kiss of life or with cardiopulmonary resuscitation. In seven questions these students were more successful than their same-age colleagues from Gymnázium, who were better at three questions only. Experiences of paramedic with laryngeal masks Supreme are positive and if ensuring of air passages is needed, when a doctor is not present, they choose LMA Supreme. Paramedics agreed on that following ventilation via LMA Supreme is sufficient as long as we choose the right size. Paramedics ask for capnometer device in all cars EMS. Paramedics of the research group do not daily meet patients who would need or used at controlled ventilation. Students of the last year at high school have basic knowledge about kiss of life or about giving first aid. This knowledge is not 100% and teaching of giving first aid should be as a subject at high schools. Paramedics accept new aids and machines and use them during their practise. Thanks to this, first aid is becoming more beneficial for patients and for paramedics.
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