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Practical approach to a patient with accidental hypothermia and possible solutions in the conditions of ZZS JčK
MASAŘ, Jakub
The topic of this bachelor thesis is Practical approach to the patient with accidental hypothermia and the possibilities of its management in conditions of the South Bohemian Health Service. The theoretical part of this thesis deals with manifestations and mechanisms of hypothermia, division and classification systems of hypothermia and risk groups with predisposition to hypothermia. The main part of the thesis is the management of prehospital care in accidental hypothermia. The thesis concludes with possible interventions for the hypothermic patient after a transportation to a medical facility. Two objectives and two research questions were set in the practical part. The first aim was to map an issue of accidental hypothermia and the experience of paramedics with calls to cases of accidental hypothermia in the South Bohemian Health Service. The second aim was to map the current options of dealing with accidental hypothermia and the best possible practical approach to it within the resources of the South Bohemian Health Service. Later on, another two research questions were set, namely, what are the most common cases of accidental hypothermia encountered by paramedics of the South Bohemian Health Service, and what is the best possible care we can provide to a patient with accidental hypothermia within the resources of the South Bohemian Health Service. The practical part was carried out by means of semi-structured interviews with six paramedics from the regions of South Bohemia. The interview included 25 questions and the results of these interviews were divided into 12 categories. The objectives of the bachelor's thesis were fulfilled by answering both research questions. Paramedics understand the basics of the topic of accidental hypothermia. There is a need to update the awareness and information of paramedics regarding the specifics of pharmacotherapy, cardiopulmonary resuscitation, and the options for transporting a patient affected by hypothermia. This could be achieved by increasing the number of trainings of paramedics. This bachelor thesis could be used as a teaching material for these trainings and for setting up the methodology in accidental hypothermia in the future.
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Key competences of a nurse in extracorporeal membrane oxygenation
HOLKUPOVÁ, Klára
The aim of this thesis is to map the specifics of work in intensive care of a critically ill patient on extracorporeal membrane oxygenation and to find out what knowledge and skills an intensive care nurse caring for a critically ill patient connected to extracorporeal membrane oxygenation must have. Three research questions were established to meet the objectives: What are the key competencies of a critical care nurse in caring for a critically ill patient on extracorporeal membrane oxygenation? What activities does a critical care nurse perform in intensive care when caring for a critically ill patient on extracorporeal membrane oxygenation? What is a critical care nurse's role in a multidisciplinary team when caring for a critically ill patient on extracorporeal membrane oxygenation? The theoretical part of the thesis focuses on the ECMO device itself, its history and components. It also describes the risks and complications that may occur as a result of this method. Last but not least, the necessary education and competence of nurses who can provide care for a critically ill patient on ECMO is described. A part of the thesis is also dedicated to the nursing management of care for such a patient. Qualitative research was used to achieve the objectives. The empirical part of the thesis was drawn up on the basis of semi-structured interviews with nine informants providing highly specialised nursing care for patients on extracorporeal membrane oxygenation working throughout the Czech Republic. The open coding method was used to analyse the data. Analysis of the data gave us a comprehensive view of care for patients on extracorporeal membrane oxygenation. Intensive care nurses provide comprehensive highly specialised nursing care, and it is essential that they have sufficient knowledge of the matter and the ability to work collaboratively in a team. The output of the thesis is a manual with basic information for nurses who encounter extracorporeal membrane oxygenation for the first time.
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The needs of the ICU patient after myocardial infarction requiring V-A ECMO support
Procházková, Tereza ; Konopásková, Marie (advisor) ; Pražáková, Zuzana (referee)
Introduction: The coronary heart disease is still an actual topic. The mortality has been in recent years declining, but prevalence in the population stagnates, so involve a large group of patients. The incidence of acute myocardial infarction is still high. One of the methods of reperfusion therapy is the cardiac surgery by coronary artery bypass graft, which may be postoperatively complicated by the development of low cardiac output syndrome with the need of the extracorporeal membrane oxygenation. These patients require very specialized not only during the critical phase, but also during the long-term convalescence including rehabilitation, weaning from the artificial lung ventilation, self-sufficiency training and help with return to normal life. Literature search: The theoretical part is based on the research of National Medical Library (NLK) and Study and Scientific Library of the Pilsen Region (SVKPL). The PubMed, Scopus, Web of science and Science direct databases were used to search articles in professional publications, including the latest cohort studies. The periodicals Cor et Vasa, the European Heart Journal, Critical Care and the European Journal of Cardiovascular Nursing were used. An important source of information is the guidelines of the Czech Society of Cardiology (ČKS), European...
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Replacement and Support of Vital Organs in Sepsis Pathophysiology and New Aspects of Treatments
Martínková, Vendula ; Matějovič, Martin (advisor) ; Chytra, Ivan (referee) ; Charvát, Jiří (referee)
Infectious diseases are the worldwide leading cause of morbidity and mortality. Sepsis is the major cause of death in infectious diseases. It is one of the most serious and also one of the most difficult treatable conditions of contemporary medicine. Sepsis is the main cause of death in intensive care units. Causal therapy of sepsis does not yet exist. With a far better understanding of patho/physiological mechanism of sepsis, it is possible to model new preclinical experiments to verify the efficiency and security of new therapeutic procedures. Large animal experiments in progressive sepsis, with the use of domestic porcine, play a vital role. Long-standing experience with this model and similarity to human facilitate the realization of more complex experiments with potential for the relevant translation of results into the subsequent clinical studies on human subjects. The objective of this doctoral dissertation was to assess on the clinically relevant model: 1) the efficiency and security of extracorporeal membrane oxygenation in the event of vasoplegic septic shock; and 2) the benefit of two innovative therapeutic approaches to treatment of sepsis: a) the intravenous administration of mesenchymal stem cells; and b) the activation of the neuro-inflammatory reflex through the vagus nerve stimulation.
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Using extracorporeal membrane oxygenation - demanding methods to bridge the critical phase of cardiopulmonary failure
VAŠURA, Ondřej
Extracorporeal membrane oxygenation (ECMO) is a demanding method, which is used in critically ill patients and whose use raises a number of controversies, such as: How far can we go in intensive care? Is it right to torment the patient? When to disconnect an infaust patient? and many others. But this bachelor thesis doesn't address these issues,it's just something to think about. The theoretical part of this thesis deals with what ECMO is, how it can be divided, how it works and what the indications and contraindications are. It also discusses the history associated with ECMO, the ECMO circuit, nursing care and everything related to it, including nursing competences, monitoring and anticoagulation. It also focuses on complications that occur in connection with ECMO and also with the patient, the way weaning works and the disconnection of the patient from ECMO occurs. The research part was made using a qualitative method in the form of semi-structured interviews, which I then divided into 8 categories. The research sample consisted of 7 respondents, 3 from the General University Hospital in Prague and 4 from the Hospital in České Budějovice. I set the following goal - To find out the quality of life after using ECMO in a critically ill patient. On the basis of this objective, I set myself two research questions. The first research question is: "How often is ECMO used in critically ill patients?". The second research question is: "What is the success rate of returning patients to families?" Research has shown that the exact quality of life cannot be ascertained in this way. In general, the patient's quality of life after disconnection from ECMO is dependent on the recovery rate of the damaged organs (heart and/or lung). The higher the rate of recovery of damaged organs, the higher the patient's quality of life will also be. However,it depends on many factors, which are further mentioned in this thesis.
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The needs of the ICU patient after myocardial infarction requiring V-A ECMO support
Procházková, Tereza ; Konopásková, Marie (advisor) ; Pražáková, Zuzana (referee)
Introduction: The coronary heart disease is still an actual topic. The mortality has been in recent years declining, but prevalence in the population stagnates, so involve a large group of patients. The incidence of acute myocardial infarction is still high. One of the methods of reperfusion therapy is the cardiac surgery by coronary artery bypass graft, which may be postoperatively complicated by the development of low cardiac output syndrome with the need of the extracorporeal membrane oxygenation. These patients require very specialized not only during the critical phase, but also during the long-term convalescence including rehabilitation, weaning from the artificial lung ventilation, self-sufficiency training and help with return to normal life. Literature search: The theoretical part is based on the research of National Medical Library (NLK) and Study and Scientific Library of the Pilsen Region (SVKPL). The PubMed, Scopus, Web of science and Science direct databases were used to search articles in professional publications, including the latest cohort studies. The periodicals Cor et Vasa, the European Heart Journal, Critical Care and the European Journal of Cardiovascular Nursing were used. An important source of information is the guidelines of the Czech Society of Cardiology (ČKS), European...
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Tissue microcirculation in cardiac arrest setting - impact of various methods of circulatory support
Krupičková, Petra ; Bělohlávek, Jan (advisor) ; Widimský, Jiří (referee) ; Rokyta, Richard (referee)
Introduction: This dissertation thesis aims to describe microcirculatory changes in cardiac arrest setting and to assess the impact of circulatory supports (i.e. mechanical chest compressions and extracorporeal membrane oxygenation (ECMO)) on tissue microcirculation. Methods and results: Two separate studies were designed. Microcirculation was monitored sublingually by a recent Sidestream Dark Field (SDF) technique and its parameters were evaluated offline, separately for small (of diameter ≤ 20µm) and other vessels. In order to monitor microcirculation during cardiac arrest (CA) and resuscitation (CPR) an experimental pig model was used; eighteen pigs were commenced to 3 minutes of untreated CA and subsequent 5 minutes of mechanical CPR. During CA the microcirculatory parameters deteriorated, in CPR they improved and reached 59 - 85 % of the prearrest values. The microcirculatory variables correlated neither to parameters of systemic circulation (mean arterial blood pressure and carotid blood flow) nor to lactate. In the second, clinical, study the sublingual microcirculation was monitored 29 (± 17) hours after the CA onset in 15 patients, who were after unsuccessful conventional CPR rescued by ECMO. In comparison to healthy (sex and age matched) volunteers, the patients showed mild but...
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Complex nursing care for patient after lung transplant at Anesthesiology resuscitation department.
Ivánková, Vendula ; Hocková, Jana (advisor) ; Maffei Svobodová, Ludmila (referee)
Lungs transplantation is a solution for the end stage of pulmonary disease after other therapeutic possibilities that the modern medicine has to offer have been exhausted. The main objective of this thesis is to show postoperative patient care after lung transplantation in the department anesthesiology and resuscitation. A highly specialized complex care and cooperation of various fields is needed. Nurses who take care of these patients must be experienced and skillful. They also need to manage well the nursing care for patients in sedation as well as fully conscious patents. It is also needed that the nurses are acquainted with specialized methods of hemodynamics measurements, administration of nitrous oxide and operation of extracorporeal membrane oxygenation machine. They need to know well the drugs that are being administered. The thesis summarizes anatomy and physiology of respiratory system, it deals with lung disease and their symptoms which most often lead to lung transplantation. Finally, the thesis describes the development of lung transplantation from its beginning to the present including the number of cases of lung transplantation per year. The last chapter of the theoretical part also shows indication, contraindication and the main principles of patient care that is given prior to and...
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