|
|
Use of thrombolytics in prehospital emergency care
OHNESORG, Adam
The topic of this bachelor thesis is the use of thrombolytics in pre-hospital care.The theoretical part is focused on the anatomy and physiology of the cardiovascular system. The work presents recent information on anticoagulants, antiaggregants and indications for thrombolysis in pre-hospital care.The practical part of the bachelor's thesis was processed through a qualitative investigation, where semi-structured interviews were used. 13 paramedics from the Karlovy Vary region were involved in the research. The aim of the research was to find out the level of awareness of the paramedics about the issue of thrombolysis in pre-hospital care and to detect practical and theoretical obstacles to its use. The research investigation took place in March 2023. Each informant underwent the interview voluntarily. The resulting data from the interviews were analyzed and coded in the thesis. Subsequently, the data was divided into categories and subcategories. Two research questions were set in the research investigation. The first question focused on the awareness of paramedics about the possibilities of using thrombolytics in pre-hospital care. The second research question addressed barriers to use from a paramedic perspective. Among the obstacles, paramedics also included the small number of cases that require the use of thrombolytics and the resulting limited experience of doctors and paramedics. The main indication for the administration of thrombolytics in pre-hospital care is sudden the use of thrombolysis in acute myocardial infarction is not practically used. Paramedics demonstrated a not good awareness of the indications for thrombolysis and the risks associated with its administration. Due to the very rare administration of thrombolysis in pre-hospital care, it is certainly appropriate to carry out regular training on this issue for both paramedics and EMS doctors.
|
|
|
The role of paramedic in curing pacient with acute pulmonary embolism in pre-hospital care
FRANZ, Milan
The bachelor's thesis deals with the issue of pulmonary embolism, especially the role of the paramedic in this issue in pre-hospital care. The theoretical part briefly describes the anatomy and physiology of circulatory and respiratory system. Furthermore, tromboembolic disease, specifically deep vein thrombosis, and especially pulmonary embolism are characterized. The etiology, a clinical picture, diagnosis and subsequent treatment are mentioned in this thesis. Then the pre-hospital care and the definition of the field of paramedics are defined, including the professional procedure in pre-hospital care and paramedic's competences. The research part was performer on the basis of semi-structured and anonymously processed interviews with paramedic from the South Bohemian Region and the Vysočina Region. The data obtained while asking the medical rescuers were analyzed from the point of view of information on a given problem, including work procedures in the occupational crew and from the point of view of the patient's re-directing and/or admitting to other departments. Results of the obtained data led to the finding that paramedies have good awareness about pumonary embolism in terms of it's definition and treatment steps. As the most problematic matter seems to be the question of the right diagnosis. The right diagnosis and transport of the patient is an important step that allows early and correct initiation of treatment. The brochure which was created as part of this bachelor's thesis could be helpful in raising awareness in this regard.
|
|
|
Nursing care of the patient with pulmonary embolism after the hormonal therapy
Tučková, Kateřina ; Hakenová, Renata (advisor) ; Hocková, Jana (referee)
This bachelor thesis is focused on nursing care of a patient with pulmonary embolism after a hormonal therapy. The theoretical part deals with the issue of pulmonary embolism from the point of view of etiopathogenesis, diagnosis, treatment, risk factors including hormonal therapy, where it the procoagulant effect of hormonal preparations and the increased risk of thromboembolic disease for young women is pointed out. The bachelor thesis was sourced from the National Medical Library through the PubMed database, Embase (Ovid), Medvik, CINHAL and the keyword search engine. For the practical part a qualitative research method in form of a case study was selected. The case for the study was a patient with pulmonary embolism after the hormonal preparation within the first cycle of assisted reproduction of the IVF. For the purpose of the case study the documentation, method of an interview, observation and cooperation with the care staff was used. Ethical aspects of research were respected during writing of this thesis. The objective of this bachelor thesis is to elaborate a case report including the creation of a nursing care plan for the patient in question and to increase the availability of information on possible risks of hormonal treatment to the general public. The contribution of this bachelor...
|
|
|
Relation between the reperfusion of pulmonary arteries after an acute pulmonary embolism to the development of chronic thromboembolic pulmonary hypertension.
Mrózek, Jan ; Jansa, Pavel (advisor) ; Maxová, Hana (referee) ; Hutyra, Martin (referee)
Relation between the reperfusion of pulmonary arteries after acute pulmonary embolism to the development of chronic thromboembolic pulmonary hypertension Incomplete resolution of thromboemboli following acute pulmonary embolism (PE) is a key factor in development of chronic thromboembolic pulmonary hypertension (CTEPH). In our study, we evaluated the incidence, risk factors and clinical impact of incomplete reperfusion after acute PE. Study population and methods: 85 patients after the first acute PE were assessed clinically and by pulmonary scintigraphy and echocardiography at month 6, 12 and 24 after an acute PE. Results: Incomplete reperfusion was detected in 23.5 % of patients after 6 months, in 24.9 % of patients after 12 months and in 18.6 % of patients after 24 months. At month 6, patients with incomplete reperfusion were more obese when compared with patients with normal reperfusion BMI 30.8 vs 28.3 kg/m2 ; p=0.012) and their initial hemoglobin levels were higher (143.0 vs 136.0 g/l; p=0.012). Similar results were observed at month 12 - patients with residual perfusion defects were more obese (BMI 31.1 vs 28.5; p=0.016) with higher initial hemoglobin levels (144.0 vs 136.0; p=0.007). Patients with incomplete reperfusion at month 24 were significantly older (67.7 vs 55.0 years; p=0.02), their...
|
|
|
THE ROLE OF RADIOLOGICAL ASSISTANT IN DIAGNOSTIC OF PULMONARY EMBOLISM
DVOŘÁK, Daniel
The topic of the bachelor thesis is the role of a radiological assistant in the diagnosis of pulmonary embolism. I briefly and easily explained in my thesis the role of radiological assistant in radiodiagnostic and radionuclide diagnosis of pulmonary embolism. The thesis is divided into several chapters from which each chapter goes to other detailed parts, which includes introduction, anatomy of the respiratory system, physiology and lung pathology, description of individual radiodiagnostic and radionuclide lung examinations, radiation protection, practical part and conclusion. Used methods in this part of medicine are being increasingly modernized (upgraded). They started with simply X-ray snapshot, which is often one of the first examinations that a patient with a history of dyspnoea and similar symptoms undergo. Pulmonary embolism may occur on X-ray as atelectasis, elevation of the diaphragm on the affected side, enlarged hilus or pulmonary prominence. During acute pulmonary embolism is most often possible to find reduced vascular pattern in a certain lung area. Diagnostic benefit increases with other signs such are cardiomegaly or pulmonary prominence. Standard X-ray snapshot does not exclude the diagnosis of pulmonary embolism, its benefit is more in combination with other methods, mainly with ventilatory perfusion scan or angiography of the pulmonary arteries; where is defect finding a mark confirming the diagnosis of embolization. I used these diagnostic methods - CT angiography and lung scintigraphy In practical part. I describe individual methods from radiological assistant's point of view. This part is based on own practical experience together with photos from the entire course of the examination. The statistical survey is focused on the number of patients with CT angiography or lung scintigraphy. The data was obtained at the Hospital Havlíčkův Brod. The last part is the conclusion of the thesis. It contains an overall evaluation of given topic, aim of the bachelor thesis and the role of the radiological assistant in the diagnosis of pulmonary embolism.
|
|
|
Nursing care of the patient with pulmonary embolism after the hormonal therapy
Tučková, Kateřina ; Hakenová, Renata (advisor) ; Hocková, Jana (referee)
This bachelor thesis is focused on nursing care of a patient with pulmonary embolism after a hormonal therapy. The theoretical part deals with the issue of pulmonary embolism from the point of view of etiopathogenesis, diagnosis, treatment, risk factors including hormonal therapy, where it the procoagulant effect of hormonal preparations and the increased risk of thromboembolic disease for young women is pointed out. The bachelor thesis was sourced from the National Medical Library through the PubMed database, Embase (Ovid), Medvik, CINHAL and the keyword search engine. For the practical part a qualitative research method in form of a case study was selected. The case for the study was a patient with pulmonary embolism after the hormonal preparation within the first cycle of assisted reproduction of the IVF. For the purpose of the case study the documentation, method of an interview, observation and cooperation with the care staff was used. Ethical aspects of research were respected during writing of this thesis. The objective of this bachelor thesis is to elaborate a case report including the creation of a nursing care plan for the patient in question and to increase the availability of information on possible risks of hormonal treatment to the general public. The contribution of this bachelor...
|
|
| |
|
|
Pulmonary embolism in the practice of paramedic
KAHOUNOVÁ, Šárka
The bachelor thesis discusses the issue of states of dyspnoea, specifically pulmonary embolism from the perspective of a paramedic working in the area of pre-hospital emergency care. In the theoretical part, a brief characteristic of pre-hospital emergency care is given, the paramedic branch is briefly defined and further on, the basic anatomy and the physiology of the circulatory and respiratory systems is given. Dyspnoea is defined from a general perspective, its causes, diagnosis and risk factors are mentioned. Diagnostically and therapeutically, the thesis is focused on specific characteristics of dyspnoea within pulmonary embolism, including the main causes of their origin. The research part of the thesis was implemented based on semi-structured, anonymously processed interviews. The research file was made of randomly chosen paramedics of the Ambulance in South Bohemia and Central Bohemia. The analysis of the obtained data was focused on the awareness of the paramedics themselves concerning the given issue of dyspnoea, including the presentation of their perspective on the implementation of professional preparation in the dyspnoea issue from their employer´s side. Further on, the procedures of differential diagnosis and pulmonary embolism treatment in pre-hospital emergency care were evaluated. The implemented research has found out that the paramedics from South Bohemia are not sufficiently educated in the issue of dyspnoea, including pulmonary embolism. The paramedics from Central Bohemia are, compared to that, educated by the relevant educational and training centre, educated enough concerning states of dyspnoea. Based on the findings, the thesis results might be presented to the educational and training centre of the South-Bohemian and Central-Bohemian Ambulances to perhaps consider the future aiming of educational and training programmes concerning dyspnoea issues, including the specific aiming at the awareness about pulmonary embolism diagnosis and therapy.
|
|
|
Importance of trombophilic mutations in clinical genetic.
Vavrušková, Klára ; Kuklík, Miloslav (advisor) ; Černá, Marie (referee)
Trombophilia means an increased disposition to creation of trombs. Health complication incurred as a consequence of hypercoagulation can be very serious. When a trombophilic mutation is found at a patient, it brings necassity of thrombosis - control in risk situations (e.g. pregnancy, operation) for the rest of the patient's life. There were filed 300 people (206 women and 94 men) with trombophilic mutations into my study of clinical signification of trombophilic mutations. These people were examinated in years 2008 - 2010. Most of positive medical findings - 266 people, were recorded in the area of MTHFR (C677T i A1298C) mutations. There were less findings in the field of FV Leiden and FII prothrombin mutations. Multipath trombophilic mutations were found at 99 patients. I accordance with foreign literature, our results advert to clinical consequences of trombophilic mutations like: repeated spontanious aborts, cerebrovascular akcident (CA), ischaemic heart disease (IHD), thrombosis, flebothrombosis, pulmonary embolism, varicose veins, aseptic necrosis of hip bone, arterial sclerosis and aortic stenosis. Mutations MTHFR C677T and MTHFR A1298C we found mainly at patients with CA, IM and IHD. Leiden mutation was most often found at patients with thrombosis, flebothrombosis and pulmonary embolism. We...
|
|
|
Diagnostics of Hypercoagulation Status by D-dimer Concentration Measurement
STIEBLEROVÁ, Romana
In common thrombofilia is the state of the vessel system in arterial, venous or microcirculation part when the probability of thrombs-creation is increased, but thrombs are not present yet. It is the pre-state of thrombotization. Thrombofilia is denoted as hypercoagulation status. Thrombofilia also is a common term for hereditary and acquired prothrombotic states in arterial, venous and microcirculation system. Progress in thrombotic and anticoagulation treatment and high-powered clinical research in pathogenesis together enable the radical progress in modern conception of pathophysiology in clinical diagnostic and introduce usage of very efficient treatments. Results of big multi-central studies show clearly how the precise fibrinolytic and coagulation tests and treatments can help in long-term surviving of patients with thrombosis. The search part of this study shows a summary of last information in pathophysiology and last potentialities in laboratory tests and interpretations focused on clinical exposure and diagnostic of PE and DVT. Inspiration for this study are results published in JOURNAL OF THROMBOSIS AND HAEMOSTASIS 10 (7): Penaloza, A., Roy, P. -M., Kline, J., Verschuren, F., Le Gal, G., Quentin-Georget, S. , Delvau, N. , Thys, F. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. 1291-1296, 2012. doi:10.1111/j.1538-7836.2012.04769.x and HAEMATOLOGICA-THE HEMATOLOGY JOURNAL 97(10) Douma, Renee A.; Tan, Melanie; Schutgens, Roger E. G.; et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded. 1507-1513, 201, doi:10.3324/haematol.2011.060657. In this part also the need of Good Laboratory Praxis for pre-analytics extraction and transportation of whole blood samples for coagulation and fibrinolytic tests is highlighted. The practical part of this study covers either the laboratory results aimed to confirm the diagnosis or the results of D-dimer concentration done for preventive reasons and selected in specific files. D dimer is the specific fissile product of fibrin and the presence of D-dimer in plasma testifies the activation of coagulation and fibrinolysis. D-dimer tests were done on the automatic coagulation analyzer ACT Elite Pro. D-dimer test has been done by immunological method based on reaction between antigen and antibody. Analyzer ACL Elite PRO uses nephelometry for detection of blood clogs and reads the intensity of scattered 90° angle light in the sample. Results of sonography are from data stored in hospital information system FONS Akord STAPRO Hospital Jindřichův Hradec a.s. All data were collected in several data-files. This study verificates the hypothesis of predicted difference of D-dimers in patients from preventive file and patients in file with thrombofilia diagnosis. The hypothesis of D-dimer test positivity in venous thrombosis was confirmed as well, D-dimer as a marker of thrombofilia shows an actual activation in-vivo system and increased D-dimer concentration confirmed venous thrombosis DVT together with a positive sonography. The most interesting and the most important result of this study is the confirmation of the hypothesis of using an age-dependent D-dimer cut-off in patients over 50 of age with suspect DVT or/and PE diagnosis. The importance of using an age-dependent D-dimer cut-off was published in articles in JOURNAL OF THROMBOSIS AND HAEMOSTASIS 10 (7): Penaloza, A., Roy, P. -M., Kline, J., Verschuren, F., Le Gal, G., Quentin-Georget, S. , Delvau, N. , Thys, F. Performance of age-adjusted D-dimer cut-off to rule out pulmonary embolism. 1291-1296, 2012. doi:10.1111/j.1538-7836.2012.04769.x and HAEMATOLOGICA-THE HEMATOLOGY JOURNAL 97(10) Douma, Renee A.; Tan, Melanie; Schutgens, Roger E. G.; et al. Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded.
|
guest ::
