Impact of Various Atrial Fibrillation Treatment Strategies on Length of Stay in the Emergency Department and Early Complications-3 Years of a Single-Center Experience.

Atrial fibrillation (AF) is the most common arrhythmia presenting in emergency departments (EDs), vastly increasing mainly due to society's lifestyles leading to numerous comorbidities. Its management depends on many factors and is still not unified. Aims: The aim of this study was to compare different AF management strategies in the ED and to evaluate their influence on the length of stay (LOS) in the ED and their safety. We analyzed medical records over 3 years of data collection, including age, primary AF diagnosis, an attempt to restore sinus rhythm, complications, and length of stay. Patients were divided into three groups according to the treatment method received: only pharmacological cardioversion (MED), only electrical cardioversion (EC), and patients who received medications followed by electrical cardioversion (COMB). We included 599 individuals in the analysis with a median age of 71. The restoration of sinus rhythm and LOS were as follows: MED: 64.95%, 173 min; COMB: 87.91%, 295 min; SH: 92.40%, 180 min. The difference between the MED and EC strategies, as well as MED and COMB, was statistically significant (p < 0.001 in both). The total number of complications was 16, with a rate of 32.67%. The majority of them followed a drug administration, and the most common complication was bradycardia. Electrical cardioversion is a safe and effective treatment strategy in stable patients with AF in the ED. It is associated with a shortened LOS. Medication administration preceded the majority of complications.

Patient Safety during ECMO Transportation: Single Center Experience and Literature Review.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams. AIM: The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature. METHODS: A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019. RESULTS: Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2-63 years) were transferred to our ECMO center. In 92% (n = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5-200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%). CONCLUSIONS: Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety.

Dynamics of the Third Wave of COVID-19 from the Perspective of the Emergency Department in a Large Regional Hospital-Single Center Observational Study.

BACKGROUND: The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic has caused many significant social and economic changes. The consecutive waves of the epidemic in various countries have had dissimilar courses depending on the methods used to combat it. The aim of this study was to determine the dynamics of the third wave of COVID-19 from the perspective of emergency departments (ED). METHODS: This was a retrospective review of medical records from ED. The authors have identified the most frequent symptoms. Prognostic factors have been chosen-prognostic scales, length of stay (LOS)-and a number of resources required have been calculated. RESULTS: As the time passed, there were fewer patients and they presented mild symptoms. A statistically significant difference was observed in the median of blood oxygenation measurement (p = 0.00009), CRP level (p = 0.0016), and admission rate. Patients admitted to the hospital required more resources at ED. LOS was shorter in patients discharged home (p < 0.0001). CONCLUSIONS: The blood oxygen saturation (SPO2) and CPR levels can be helpful in decision-making regarding medical treatment. The fast-track for patients in good clinical condition may shorten the duration of stay in ED, and reduce the number of required resources.

A Successfully Treated STEMI Due to Simultaneous Thrombotic Occlusion of Left Anterior Descending Artery and Left Circumflex Artery: A Case Report and Review of the Literature.

ST-segment elevation myocardial infarction (STEMI) due to simultaneous double vessel thrombotic occlusion of two major coronary arteries is an extremely rare clinical entity. Available studies indicate that most frequently it affects two coronary arteries originating from different sides of a coronary tree (i.e. right coronary artery (RCA) and left anterior descending artery (LAD) or RCA and left circumflex artery (LCx)) and usually has a fatal clinical course. However, it must be pointed out that the data have been derived from studies before the era of a widely-used pre-hospital electrocardiogram (ECG) teletransmission. Herein, we present a case report of successfully-treated STEMI due to simultaneous occlusion of LAD and LCx. Furhtermore, the case report highlights a crucial role of ECG teletransmission for immediate treatment and survival of patients with the so-called "the deadly double infarct syndrome".

Carbon dioxide as a potential danger to medical rescue teams at work - A case study.

Medical rescue teams might be exposed to the risk of accidental poisoning while performing rescue procedures. Exposure to the risk of lethal carbon dioxide (CO2) concentrations is a rare situation. This case study describes rescuing a patient who suffered from sudden cardiac arrest due to accidental CO2 poisoning. The victim was finally evacuated and resuscitated, but the circumstances of the rescue operation point to the need to equip ambulances with carbon dioxide detectors and hermetic oxygen masks. Med Pr 2017;68(1):135-138.

Evaluation of the Trail Making Test and interval timing as measures of cognition in healthy adults: comparisons by age, education, and gender.

BACKGROUND: Human cognitive functioning can be assessed using different methods of testing. Age, level of education, and gender may influence the results of cognitive tests. MATERIAL AND METHODS: The well-known Trail Making Test (TMT), which is often used to measure the frontal lobe function, and the experimental test of Interval Timing (IT) were compared. The methods used in IT included reproduction of auditory and visual stimuli, with the subsequent production of the time intervals of 1-, 2-, 5-, and 7-seconds durations with no pattern. Subjects included 64 healthy adult volunteers aged 18-63 (33 women, 31 men). Comparisons were made based on age, education, and gender. RESULTS: TMT was performed quickly and was influenced by age, education, and gender. All reproduced visual and produced intervals were shortened and the reproduction of auditory stimuli was more complex. Age, education, and gender have more pronounced impact on the cognitive test than on the interval timing test. The reproduction of the short auditory stimuli was more accurate in comparison to other modalities used in the IT test. CONCLUSIONS: The interval timing, when compared to the TMT, offers an interesting possibility of testing. Further studies are necessary to confirm the initial observation.

The quality of defibrillation performance among students of the University of Medical Sciences.

The major objective was to assess the time period from a witnessed ventricular fibrillation (VF) to the first defibrillation (DEF) in a simulated manikin scenario, while the minor objective was to analyze the most common errors that occurred during DEF and the maintenance of 2-min intervals during resuscitation. We examined 210 students (medical faculty students, MF; and paramedic faculty students, PF) who had to treat a patient with VF. In the study we used the Laerdal(®) Training Manikin and the Zoll M Series(®) defibrillator. The mean time period from the witnessed VF to the first DEF was 50.1 s (SD 32.5 s) in the MF group and 62.9 s (SD 36.9 s) in the PF group (no statistically significant difference). The delay resulted from the lack of constant ECG monitoring and charging in the option "Monitor" instead of the option "Defibrillation." The PF group shortened the 2-min cycles between defibrillations. The problems observed during the study were technical and educational. We concluded that the option "Monitor" should be removed from the equipment because it seems to be redundant. The teaching problems were a lack of constant ECG monitoring, incorrect handling of the defibrillator, and not keeping to 2-min loops of CPR.

The first attempt at initiating problem-based learning as a method of teaching-learning at the University of Medical Sciences in Poznan, Poland.

The main objective of problem-based learning (PBL) is to provoke students to solve a new problem by themselves. The aim of this study was to investigate whether PBL was a better method of teaching basic and advanced life support to medical students compared with the classical method. The research was undertaken in 2002 in accordance with the European Guidelines 2000 and involved 36 medical students in year 4. The students were divided into two groups: experimental PBL group (17 students) and the control-classical method group (19 students). After the advanced life support course, the students wrote two tests to assess their knowledge on how to open the airway and how to perform basic and advanced resuscitation. The questions contained true or false answers. The students' skills of basic and advanced methods of opening the airway and advanced resuscitation were checked by practical tests. The Mann-Whitney test was used for statistical analysis. The experimental PBL group received significantly better results: 30-45 points (mean, 38.29 points) and 30-47 points (mean, 40.94 points) for the written and practical tests, respectively, compared with the control-classical group (22-34 points [mean, 29.36 points] and 22-35 points [mean, 28.63 points], respectively). Therefore, PBL offers a better method for teaching basic and advanced life support to medical students compared with the classical method.