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Emergency care of burned patients on the trauma scene and during transport - a prospective study
Benáková, Lada ; Bakalář, Bohumil (advisor) ; Sýkora, Roman (referee)
The aim of this thesis was to compare real prehospital care provided to adult burn patients to recommended procedures published in "Prehospital care for thermal injury" by the Czech Medical Society J. E. Purkyně, Society of Burn Medicine ČLS JEP, Society of Emergency Medicine and Disaster Medicine ČLS JEP in 2017. This thesis is divided into a theoretical part, which analyses the issue and defines the concepts, and a research survey, which was conducted at the Department of Burn Medicine, Královské Vinohrady University Hospital, Prague. The research took the form of data acquisition from the paramedic records and other admission documentation, and divided them into categories for subsequent comparison with the recommended procedures. The results of the research point to differences in the provision of urgent pre-hospital care in comparison to recommended procedures. The largest differences were noted in the estimation of the burn area and the amount of infusion administered. In contrast, the greatest agreement between the care provided and recommended has been demonstrated in the areas of determining the mechanism of injury and ensuring venous access. This thesis thus offers suggestions for a possible further extensive investigation in this medical field and for improvement of the existing care....
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Children CPR, the most common causes and prognosis
Koubová, Magdaléna ; Knor, Jiří (advisor) ; Sýkora, Roman (referee)
Aims: The aim of this work was to map the differences in the primary causes of cardiac arrest in children and compare them with adults. It was also important to compare the diversity of forecasts, or CPR results, for certain causes of circulatory arrest. Last but not least, certain socio-demographic parameters were compared here. Specifically, they were gender and age. Methods: The research part of this work was processed retrospectively. The data were provided from the emergency services of the Central Bohemian Region for the years 2019 and 2020. These were trips to the reported circulations. The hypotheses were processed using the chi square test and the independence test, with a significance level of 5%. Results: Of the total number of 1,190 patients with OHCA, 21 were children and 1,169 were adult patients. It was found that 15 children had a respiratory cause of circulatory arrest (68.75%). In contrast, in adults, only 102 (8.73%) had a respiratory cause. CPR resulted in 8 ROSC for children (38.1%) and for 286 adults (24.47%). There were 5 children (71.43%) who had a primary cause of OHCA drowning and a positive result (ROSC). Only 3 children (21.43%) had a different cause of circulatory arrest and ROSC as a result of CPR. Adults with OHCA are mostly men (72.63%). Conversely, in children,...
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Analysis of methods of analgesia in pre-hospital emergency care and creation of a proposal to increase the competencies of non-medical medical staff in the administration of analgesia
Hricová, Kristina ; Sýkora, Roman (advisor) ; Uchytilová, Eva (referee)
Introduction: A paramedic in pre-hospital emergency care cannot indicate the administration of analgesics alone at the site of the intervention, without consulting a doctor. For this reason, there may be time delays that prolong the patient's suffering and pain and acute trauma. Aims: The first aim is to evaluate the paramedics subjective perception of the pain treatment and to determine their willingness to accept the competence to administer sufentanil without consultation. The second goal is to create and implement an educational program to gain this competence. The third goal is to evaluate the incidence of complications of sufentanil administered without doctor cosultation. Methodology: The first goal is realized in the form of a questionnaire survey among the paramedics (n = 118) at the Emergency Medical Service of the Karlovy Vary Region. The second goal is achieved by creating and implementing an educational program for paramedics to acquire competence to administer sufentanil in patients with acute trauma. The third objective is to evaluate the incidence of complications of sufentanil administration over a 6month period by comparing two groups of intravenous administration of sufentanil in adult patients with acute trauma: 1) competence (n = 70) based on established competence; 2)...
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Hemo elimination method in the treatment of sepsis and early multi-organ dysfunction
Sýkora, Roman ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Maňák, Jan (referee) ; Šrámek, Vladimír (referee)
The most common cause of death in patients with sepsis/septic shock is deterioration of the function of multiple organs, termed multiple organ dysfunction syndrome. Although our understanding of mechanisms involved in the pathophysiology of sepsis-induced tissue damage has improved substantially, therapy of these syndromes still remains largely supportive. The hallmark of sepsis is an overwhelming systemic production of both pro- and anti-inflammatory mediators leading to generalized endothelial and epithelial damage, microcirculatory-mitochondrial distress, altered endocrine and coagulation homeostasis and cellular immune hyporesponsiveness. Therefore, the hypothesis that modulation of this excessive immunological and biological response to infection might improve patient outcome appears reasonable. Hemoelimination techniques represent biologically plausible way to provide non-specific removal of soluble pro- and anti-inflammatory mediators, although the concept of blood purification in sepsis remains a matter of considerable debate. The aim of this thesis was to elucidate effects of 1) high volume hemofiltration (HVHF) and 2) coupled plasma filtration adsorption (CPFA) in a long-term, hyperdynamic porcine septic shock model, which fulfils the criteria for human sepsis. We hypothesized that both HVHF and...
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Hemo elimination method in the treatment of sepsis and early multi-organ dysfunction
Sýkora, Roman ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Maňák, Jan (referee) ; Šrámek, Vladimír (referee)
The most common cause of death in patients with sepsis/septic shock is deterioration of the function of multiple organs, termed multiple organ dysfunction syndrome. Although our understanding of mechanisms involved in the pathophysiology of sepsis-induced tissue damage has improved substantially, therapy of these syndromes still remains largely supportive. The hallmark of sepsis is an overwhelming systemic production of both pro- and anti-inflammatory mediators leading to generalized endothelial and epithelial damage, microcirculatory-mitochondrial distress, altered endocrine and coagulation homeostasis and cellular immune hyporesponsiveness. Therefore, the hypothesis that modulation of this excessive immunological and biological response to infection might improve patient outcome appears reasonable. Hemoelimination techniques represent biologically plausible way to provide non-specific removal of soluble pro- and anti-inflammatory mediators, although the concept of blood purification in sepsis remains a matter of considerable debate. The aim of this thesis was to elucidate effects of 1) high volume hemofiltration (HVHF) and 2) coupled plasma filtration adsorption (CPFA) in a long-term, hyperdynamic porcine septic shock model, which fulfils the criteria for human sepsis. We hypothesized that both HVHF and...
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