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Management of pre-hospital care in patients with refractory ventricular fibrillation.
ZEMAN, Denis
Ventricular fibrillation is a life-threatening arrhythmia that manifests as rapid and irregular contraction of the heart chambers. If not treated immediately, it can lead to circulatory arrest and death of the patient. Treatment of ventricular fibrillation consists of immediate cardiopulmonary resuscitation and defibrillation, which restores normal heart rhythm with an electrical shock. However, some patients may be refractory, that is, resistant to repeated defibrillation bursts. The first aim of my bachelor's thesis was to find out what awareness paramedics have of the options for managing refractory ventricular fibrillation. The second aim was to find out what methods paramedics use for refractory ventricular fibrillation in practice. The research investigation was carried out by means of semi-structured interviews with paramedics working at the South Bohemia Region ambulance service. The results show that paramedics are sufficiently familiar with the treatment options for refractory ventricular fibrillation. A negative finding was that not every rescuer was able to mention all the options for changing electrode positions and the correct pharmacological management. Another negative finding was that rescuers could not agree on the number of times that ventricular fibrillation is refractory. On the contrary, the investigated method of double sequential external defibrillation was found to be very successful and thus more beneficial than conventional methods in the treatment of refractory ventricular fibrillation. The results of the bachelor thesis may offer a way for paramedics to approach refractory ventricular fibrillation. This bachelor thesis may improve the management of refractory ventricular fibrillation, which should be approached differently than classical ventricular fibrillation.
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Anaphylactick shock and the possibilities of dealing with it by a paramedic.
ZÁBRANSKÝ, Stanislav
The aim of the thesis was to map knowledge that paramedics of South Bohemian Emergency Medical Service have during a medical treatment of Anaphylactic shock in out-of-hospital emergency care. This topic included the knowledge of terms Anaphylactic shock, describing its symptoms, the way of its medical treatment, recommended procedures and its style of training. Six employees of South Bohemian Emergency Medical Service take part in this research. Respondents received 15 questions related to this issue. The qualitative research was used to achieve results. All the interviews were semi-structured. As emerged from the research, the training concerning Anaphylactic shock is insufficient. Most of paramedical staff have not been present during any Anaphylactic shock. They have been more present during some Allergic reaction. Therefore, their motivation to gain more knowledge of this issue is not satisfactory. Also, paramedics do not have enough knowledge of a term Anaphylactic shock. They are aware of this term, however, they are not able to describe it. The biggest problem is dosage medications. The paramedics are not sure how to dose medications without consultation with a doctor. Concerning medication of adults, the knowledge is better. However, in the case of children, the paramedics confess that they do not remember the procedure. Paramedics follow the rule which takes into consideration kilograms of a patient. However, for the reason of the faster intervention, it is better to give the amount of medication with regard to the age of a child. Another problematic question is a position of a patient when transporting to a hospital. To have better orientation and knowledge of procedures during Anaphylactic shock, paramedics should have more extensive training. Except for the mandatory training from an employer, the paramedics should have an occasional initiative of gaining the knowledge by their own.
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