Halo 194 Scientific Journal of Emergency Medicine
The journal publish original articles, press releases, case reports, literature reviews, current topics, reports from congresses and professional meetings, expert news, book reviews, as well as comments and letters to the Editorial Board regarding published papers. The “Halo 194” Scientific Journal of Emergency Medicine publishes articles relating to the following fields of medicine: emergency medicine, general medicine, preventive medicine, biomedicine, internal medicine, cardiology, alergology, pulmology, endocrinology, gastroenterology, nephrology, reanimatology, anesthesiology, neurology, neurosurgery, surgery, traumatology, transfusiology, clinical pharmacology, pharmacotherapy, toxicology, forensics medicine, dentristy, medical law, medical history, clinical practice guides, in memoriam, etc. The articles must be written in either Serbian or English, with summaries in both Serbian and English. Articles are published free of charge.
Institute for Emergency Medicine of Belgrade
Autori koji objavljuju u ovom časopisu pristaju na sledeće uslove: Autori zadržavaju autorska prava i pružaju časopisu pravo prvog objavljivanja rada i licenciraju ga "Creative Commons Attribution licencom" koja omogućava drugima da dele rad, uz uslov navođenja autorstva i izvornog objavljivanja u ovom časopisu. Autori mogu izraditi zasebne, ugovorne aranžmane za neekskluzivnu distribuciju članka objavljenog u časopisu (npr. postavljanje u institucionalni repozitorijum ili objavljivanje u knjizi), uz navođenje da je članak izvorno objavljen u ovom časopisu. Autorima je dozvoljeno i podstiču se da postave objavljeni članak onlajn (npr. u institucionalni repozitorijum ili na svoju internet stranicu) pre ili tokom postupka prijave rukopisa, s obzirom da takav postupak može voditi produktivnoj razmeni ideja i ranijoj i većoj citiranosti objavljenog članka (Vidi Efekti otvorenog pristupa).
Modern optical approaches in the modulation of eye growth: a new era in the control of childhood myopia
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Accent 6"/> <w:LsdException Locked="false" Priority="67" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 1 Accent 6"/> <w:LsdException Locked="false" Priority="68" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 2 Accent 6"/> <w:LsdException Locked="false" Priority="69" SemiHidden="false" UnhideWhenUsed="false" Name="Medium Grid 3 Accent 6"/> <w:LsdException Locked="false" Priority="70" SemiHidden="false" UnhideWhenUsed="false" Name="Dark List Accent 6"/> <w:LsdException Locked="false" Priority="71" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/> <w:LsdException Locked="false" Priority="72" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful List Accent 6"/> <w:LsdException Locked="false" Priority="73" SemiHidden="false" UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/> <w:LsdException Locked="false" Priority="19" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/> <w:LsdException Locked="false" Priority="21" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" SemiHidden="false" UnhideWhenUsed="false" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Myopia among preschool and school-aged children represents a growing public health concern, closely linked to reduced exposure to natural light and excessive use of digital devices. Global projections indicate that by 2050, nearly half of the world’s population will be affected by myopia. Optical strategies based on the principle of peripheral myopic defocus, such as HAL, DIMS, MiYOSMART, Stellest, and DOT lenses, have proven to be the most effective non-invasive methods for slowing myopia progression in children. Clinical studies confirm that these lenses reduce axial eye elongation by 50–80% compared to standard single-vision lenses, while maintaining binocular balance and minimal adverse effects. HAL lenses achieve the most stable effect, whereas the DIMS design shows greater efficacy in children with slower myopic progression. Long-term studies demonstrate that these optical approaches do not induce a rebound effect after discontinuation and are safe for prolonged use.
Copyright (c) 2025 The Journal of Emergency Medicine – Halo 194
When myocardial infarction is not only inferior: the importance of prehospital recognition of right ventricular infarction
Introduction: Right ventricular myocardial infarction (RVI) occurs with complete occlusion of the right coronary artery proximal to the site of separation of the branches feeding the right ventricular wall. It rarely occurs independently, but it complicates about 50% of inferior infarctions. Clinically, it is recognized by the triad: hypotension, jugular venous distension and "clean" lungs. Vasodilators are contraindicated, while intravenous fluid replacement is the key of mennagement. Case report: A 50-year-old man complains of sudden shoulder pain, nausea and sweating. The ECG shows an infarction of inferior localization, with the greatest ST elevation in lead D3, combined with the clinical triad of RV infarction. ST elevation was also confirmed in V4R-V6R (Erhardt's sign). A rapid infusion of cristalloids was administrated, which led to an improvement in hemodynamics. Conclusion: Due to the worse prognosis of patients with right ventricular myocardial infarction and possible iatrogenic complications, early recognition and adequate treatment.
USE OF THE ALVARADO SCORE IN SUSPECTED ACUTE APPENDICITIS
INTRODUCTION/OBJECTIVE Appendicitis is an inflammation of the appendix,with the appearance of symptoms in the first 24 hours.Clinically,it presents with pain in the abdomen,most often in the lower right quadrant,increased temperature,loss of appetite,nausea and vomiting.Due to the non-specificity of symptoms,scoring systems have been developed to facilitate diagnostic of suspected appendicitis.Objective is the use of the Alvarado score at the prehospital level in case of suspected acute appendicitis.CASE REPORT The Department of Emergency Medicine in Belgrade was sent a call for intervention due to abdominal pain.The periumbilical pain started last night,she had fever and nausea.Alvarado score was 6, the patient was transported to the ER where the diagnosis of acute appendicitis was confirmed.CONCLUSION Prehospital diagnostics of acute appendicitis is based on history and physical examination,where use of the Alvarado score can be very important,with the aim of reducing the risk of complications,morbidity and mortality.KEY WORDS alvarado, scabies, appendicitis, ripasa
Health protection of detained or detained persons
The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) has visited closed institutions in Serbia several times in the last thirty years and made observations on the access to health care of persons detained by the police. The aim of the paper is to point out the legal framework relevant to the access to health care of detained persons, and that their health care should be equal to the protection of patients in the community. For this purpose, the authors have researched international and national regulations, as well as the CPT recommendations. Medical practice in the community and in closed institutions must be based on the same ethical principles, which imply ensuring the same preventive measures, as well as treatment measures, i.e. comprehensive health care for detained persons/detainees, as is available to citizens in the community. Unhindered access to health care implies that a detained person is provided with a medical examination. Impaired access to health care and an unsatisfactory level of it may indicate degrading or inhuman treatment. Health workers who provide health care in detention facilities must be familiar with the rules of personal and general safety. At the same time, police officers must be familiar with the basic rules of the medical profession and ethics.
SHORT BOWEL SYNDROME AND INTESTINAL FAILURE IN ADULTS: ANATOMY-DRIVEN PHENOTYPES, ADAPTATION BIOLOGY, AND CONTEMPORARY INTESTINAL REHABILITATION
Short bowel syndrome (SBS) is the leading cause of chronic intestinal failure in adults and most commonly follows extensive small-bowel resection. The resulting loss of absorptive surface and regulatory feedback leads to a spectrum of malabsorption syndromes, ranging from compensated intestinal insufficiency to intestinal failure requiring long-term parenteral support. Clinical outcomes are determined less by residual length alone than by postoperative anatomy, particularly the presence of colon in continuity and preservation of distal ileum and the ileocecal region. The pathophysiology of SBS integrates reduced absorptive capacity, accelerated transit, gastric hypersecretion, disordered bile acid handling, microbiome perturbation, and impaired enteroendocrine signaling. Intestinal adaptation, driven by luminal nutrients and trophic hormones such as GLP-2, can partially restore function over months to years, enabling stepwise reduction of parenteral support in selected patients. Modern care is centered on structured intestinal rehabilitation delivered by multidisciplinary teams, combining individualized fluid–electrolyte strategy, optimized oral/enteral nutrition, targeted pharmacotherapy to control secretion and motility, prevention and management of catheter-related complications, and selective reconstructive surgery. Disease-modifying therapy with GLP-2 analogues can reduce parenteral support requirements in SBS-associated intestinal failure, while transplantation remains reserved for refractory, life-threatening complications. This review summarizes current concepts and evidence-based principles for diagnosis, phenotype stratification, rehabilitation, and long-term surveillance in adult SBS. Keywords: short bowel syndrome; chronic intestinal failure; home parenteral nutrition; colon in continuity; intestinal adaptation; teduglutide; high-output stoma.
DIFFUSE B-LARGE CELL LYMPHOMA OF TERMINAL ILEUM - CASE REPORT
Diffuse large B-cell lymphoma (DLBCL) of the gastrointestinal tract represents the most common form of extranodal manifestation of this disease. Due to the abundance of lymphoid tissue, the terminal ileum is particularly prone to lymphoma development. The clinical presentation is often nonspecific, most commonly involving gastrointestinal hemorrhage or perforation, while obstruction is less frequent. This paper presents the case of an 80-year-old patient in whom obstruction was the initial manifestation of the disease. The diagnosis was established through endoscopy and histopathological analysis, and the patient was treated surgically and with chemoimmunotherapy. Despite treatment, complications occurred in the form of neutropenia, urinary infection, and ultimately a fatal outcome.
A CASE REPORT OF ADAMS-STOKES SYNDROME - COMPLETE ATRIOVENTRICULAR BLOCK MANIFESTED AS CARDIAC SYNCOPE
INTRODUCTION/OBJECTIVE Syncope is a sudden and transient loss of consciousness caused by brain hypoperfusion.Adams-Stokes syndrome is an arrhythmia manifested by cardiogenic syncope.It is diagnosed easily,by electrocardiographic recording,where a complete AV block is usually observed,often second-degree AV block with a slow ventricular response.The objective is to present a patient in whom syncope happened after physical therapy,while the cause of syncope as part of ASS,was complete AV block.CASE REPORT The patient,74 years old,states that,after getting off the bus,she felt weakness and fainting.She lost consciousness and fell and suffered a head injury.On examination,she was conscious,hypotensive,bradycardic.Electrocardiography registered complete AV block with ventricular response 24/min and complete RBBB.CONCLUSION Considering that unrecognized ASS can lead to serious complications and even sudden cardiac death,it is necessary to standardize the prehospital ECG recording in every patient who clinically presents with syncope or convulsions.
THE ROLE OF THE INSTITUTE FOR EMERGENCY MEDICINE BELGRADE IN THE SIMULATION EXERCISE OF THE EMERGENCY SERVICES ON THE OCCASION OF THE WORLD DAY OF REMEMBRANCE FOR ROAD TRAFFIC VICTIMS
On the occasion of World Day of Remembrance for Traffic Accident Victims, 11/17/2024. a joint exercise of all emergency services was held. Traffic accident simulation (SN) was organized by the Traffic Safety Agency and the Ministry of Internal Affairs, in cooperation with the Institute for Emergency Medicine (ZZUM) Belgrade and the Serbian Red Cross. In the designed scenario, a traffic accident occurred in which a pedestrian was injured while crossing the tracks outside the marked pedestrian crossing. At the same time, an accident involving three vehicles takes place at another intersection. ZZUM teams acted according to the protocol for taking care of a traffic accident with a large number of injured persons. The doctor of the first arriving triage team, according to the START triage algorithm, categorized the injured according to the urgency of treatment into three triage categories (RED; YELLOW; GREEN) and marked them with triage tapes. Out of a total of six injured: two were from the red, two from the yellow and two from the green category. In addition to the ZZUM teams, the police, the fire and rescue service and the helicopter unit also participated in the further treatment of the injured.
DE WINTER'S SIGN AS ELECTROCARDIOGRAPHIC EQUIVALENT OF STEMI INFARCTION
Introduction: We present the rarity early recognition and management of De Winter's ECG pattern at the prehospital level. Case report: A 68-year-old man felt chest pain with propagation in both arms and back, followed by nausea and vomiting. Conscious, pale, cold sweaty, agitated, normofrequency, normotensive. ECG: sinus rhythm 70/min, negative T in D3 and aVF. Reduced r in V2-V4, concomitant ST depression in V3-V5 with high, symmetrical T in V2-V5. A prehospital working diagnosis was De Winter T/ST pattern. After placement of 2 intravenous cannulas, prescribed drug therapy, with monitoring of vital functions and an announcement of arrival, he was transported directly to the catheterization room. The diagnosis was confirmed by an interventional cardiologist and a stent was implanted. Conclusion: Failure to recognize De Winter's sign as a STEMI equivalent can lead to a delay in activation of the STEMI network and sometimes be fatal to the patient.
APPLICATION OF KETOROLAK IN THE PREHOSPITAL TREATMENT OF RENAL COLIC - CASE REPORT AND LITERATURE REVIEW
Introduction:Renal colic (RC) is a sudden onset of severe pain in the costovertebral angle on the corresponding side.The clinical presentation is usually sudden,unilateral pain in the lumbar region,followed by nausea/vomiting and dysuric complaints.Objective:Presentation of a patient with sudden onset of RC.Case report:A 28-year-old patient stated that she felt a strong,sudden pain in the lumbar region on the left side,with propagation in the groin,nausea and sweating.The renal lobes are painfully sensitive to succussion,more intensely on the left.The patient was transported to the hospital.During transportation,ketorolac 30mg and hyoscine-butylbromide 20mg were administred intravenously.By the time she arrived at the hospital,the pain had stopped.Conclusion:Ketorolac is a very effective analgesic in the treatment of RCit has a stronger analgesic effect than opioids.In the prehospital treatment of RC,when choosing drugs and their dosage,the therapy should be adjusted individually for each patient.
Introduction: According to the Fourth Universal Definition of Myocardial Infarction (MI), the term ″reinfarction″ is clinically used for MI occurring within 28 days of an incident or recurrent MI. It is characterized by the recurrence of anginal pain, an increase in cardiospecific enzymes and changes in the electrocardiogram. Aim: To point out the importance of early recognition and prehospital diagnosis of myocardial reinfarction that occurred shortly after the first MI, with implications for a positive patient outcome. Case report: A 64-year-old female called 194 because of chest pain accompanied by vomiting. Discharged two days earlier after hospitalization for anterior wall MI. Changes in the ST segment are observed on the ECG recording, which indicate an MI anterolateral localization. Appropriate therapy, he was transported to the angio room for further diagnosis and treatment. Conclusion: Fast and timely diagnosis of reinfarction plays a key role in the further treatment of the patient.
In emergency medicine, there is no procedure that is more important than taking care of the airway. Numerous methods have been proposed in the literature that are used in the case of a compromised airway, and one of them is rapid sequence intubation (RSI). By definition, RSI is the coordinated, sequential process of preparing, sedating, and paralyzing a patient at high risk of aspiration of gastric contents to allow for emergency endotracheal intubation (ETI). Pharmacological sedation and paralysis are induced in rapid succession to provide optimal conditions for laryngoscopy and ETI. RSI is an advanced airway management technique used in critically ill and severely injured patients to protect the airways from regurgitation and aspiration of gastric contents. The application of the RSI technique, consisting of 15 steps, was first described by Stept and Safar in 1970. Today, it represents the gold standard for emergency management of the airway during rapid induction of general anesthesia. More recently, RSI is also applied at the prehospital level as an alternative method for managing the airways of patients with impaired consciousness, in whom it is assumed that they have a full stomach and there is a chance for their survival.
ASSESSMENT OF THE PERSONALITY STRUCTURE OF OPIAD ADDICTS AND PERSONS WITH INTERNET USE DISORDER
Internet use disorder is a psychophysical disorder that involves the appearance of tolerance, withdrawal symptoms, affective disturbances and disturbed social relationships. Neurobiological and pharmacological data suggest similarities in the pathopsychology of opiate addiction and pathological gambling. The aim of this research is to compare the sociodemographic characteristics of people with Internet use disorder, people who are addicted to opiates and a control group. As well as to compare psychological characteristics according to the Big Five model and psychopathological characteristics, and determine the degree of their expression in persons belonging to the mentioned groups. The research was conceived as a cross-sectional clinical study based on a methodological approach that includes the application of comparative methodology, with the use of assessment scales and psychological-psychiatric batteries for personality assessment. The total sample includes 300 subjects: 100 subjects with opiate addiction, 100 subjects showing symptoms of Internet use disorder, and 100 subjects of the control group. The results of this research indicate that personality characteristics such as empathy, extroversion, agreeableness, conscientiousness, openness and cooperation are expressed to a lesser extent in people with Internet use disorder and people addicted to opiates, compared to the control group. The obtained results contribute to the classification of Internet use disorders and suggest placing them in the diagnostic category of behavioral addictions.
RISK STRATIFICATION FOR ACUTE CEREBROVASCULAR ACCIDENT AFTER TRANSIENT ISCHEMIC ATTACK AND THE USE OF SCORING SYSTEMS IN PREHOSPITAL CARE
INTRODUCTION/PURPOSE-A transient ischemic attack (TIA) is a temporary disruption in cerebral circulation, presenting as a neurological deficit that typically resolves within 60 minutes. This contrasts with a cerebrovascular stroke, where the deficit is permanent. The ABCD2 and OTTAWA scores are used to predict the risk of a cerebrovascular accident following a TIA. This study aims to retrospectively apply these scores in a patient with a history of TIA.CASE PRESENTATION-A 68-year-old female, disoriented and dysphasic, with left hemiparesis and ataxia, is suspected of having a stroke. Symptoms persisted for over an hour, with a similar episode four days prior lasting 15 minutes. The patient refused hospital transport at that time, but was later admitted, where a cerebrovascular accident was confirmed. The ABCD2 score was 6, and the OTTAWA score was 10 points.CONCLUSION-Applying the ABCD2 and OTTAWA scores in emergency medical services can help predict and prevent strokes after a TIA.
SEPSIS - EMERGENCY AND DIAGNOSTIC CHALLENGE IN OUT-HOSPITAL CONDITIONS
Introduction/goal. Sepsis, by definition, is a life-threatening organ dysfunction caused by an inadequate response to infection. Earlier recognition and treatment improves outcome. The aim of the paper is to present a patient in whom the initial pre-hospital examination was suspected, and the diagnosis of sepsis was confirmed in hospital conditions, in order to draw attention to the symptomatology that patients can show in the case of sepsis. Case presentation. A patient suspected of having sepsis is shown. He was initially cared for in the field, with monitoring of vital parameters and adequate therapy, transported to an on-call health facility, where the diagnosis of sepsis was confirmed. Conclusion. Timely recognition and treatment is the key to the survival of patients suffering from sepsis. If the treatment is carried out in the first hour from the onset of symptoms, the survival rate is over 80%, after six hours - only 30%.
THE SILENT ENEMY FROM THE FIST - VIKING DISEASE
Dupuytren's contracture (DK) is a progressive idiopathic fibrosis of the superficial palmar fascia caused by changes in the palmar aponeurosis, resulting in flexion contracture of the fingers with inability to extend the fingers. The disease, also called Viking's disease, is present in 8% of the world's population, more common in men, and heredity, which shows variable expression, plays an important role in its etiology. The pathogenesis of DK is still unclear, and involves the formation of collagen nodules that progress into fibrous bands at the places of greatest pressure between the dermis and fascia. The diagnosis is established only by clinical examination, and the treatment can be conservative and surgical. Conservative treatment is reserved for patients with milder symptoms and no finger contracture, while surgical treatment is the gold standard in the therapy of people in whom the resulting contracture limits the function of the hand and/or flexion of the proximal interphalangeal joint by ≥15º and/or the metacarpophalangeal joint by ≥30º. The aim of this paper is to present the current findings related to DK. <pre id="tw-target-text" class="tw-data-text tw-text-large tw-ta" dir="ltr" style="font-size: 28px; line-height: 36px; background-color: #f8f9fa; border: none; padding: 2px 0.14em 2px 0px; position: relative; margin-top: -2px; margin-bottom: -2px; resize: none; font-family: inherit; overflow: hidden; width: 270px; text-wrap: wrap; overflow-wrap: break-word; color: #202124;" data-placeholder="Превод" data-ved="2ahUKEwjg8NHrsJKJAxWwKBAIHf4zPW4Q3ewLegQICxAU" aria-label="Преведени текст: Dipitren's contracture (DK) is a progressive idiopathic fibrosis of the superficial palmar fascia caused by changes in the palmar aponeurosis, resulting in flexion contracture of the fingers with inability to extend the fingers. The disease, known since the Viking Age, is present in 8% of the world's population, more common in men, and heredity, which shows variable expression, plays an important role in its etiology. The pathogenesis of DK is still unclear, and involves the formation of collagen nodules that progress into fibrous bands at the places of greatest pressure between the dermis and fascia. The diagnosis is established only by clinical examination, and the treatment can be conservative and surgical. Conservative treatment is reserved for patients with milder symptoms and no contracture of the fingers, while surgical treatment is the gold standard in the therapy of people in whom the resulting contracture limits the function of the hand and/or flexion of the proximal interphalangeal joint by ≥15º and/or the metacarpophalangeal joint by ≥30º. The aim of this paper is to present the current findings related to DK.">
Copyright (c) 2024 The Journal of Emergency Medicine – Halo 194
FROM IDEA TO ITS REALIZATION: NEW TRAINING CENTER IN THE INSTITUTE FOR EMERGENCY MEDICINE, BELGRADE
At the end of 2015, at an unofficial meating Goran Čolaković, MD, director of the Institute for emergency medicine in Belgrade (IEM), Slađana Anđelić, MD, Phd, coordinator of the IEM education center and Aleksandar Pavlović, MD, PhD, the initiator and founder of the Center for simulation of the Faculty of medicine of Priština, based in Kosovska Mitrovica, the idea of forming a new Training center IEM was born. The training center is imposed as a result of the need for a modern approach in education in the field of various urgent clinical conditions. This vision requires a new spatial and tehnical structure equipped with modern phantom mannequins (trainers) and medical devices and equipment. According to the project financed by the European Union and the European Bank for Reconstruction and Development (EBRD), in July 2021, the reconstruction of the ZUM building with a training center of over 2,000 m2 began. With the tendency to sublimate all the necessary skills and knowledge in taking care of urgent clinical conditions in real conditions, the Center would have two simulation centers, five training rooms, two hooded rooms and a large amphitheater with a library.
ELEVATED TROPONIN IN AN ATHLETE - MYOCARDIAL INFARCTION OR A PHYSIOLOGICAL OCCURRENCE?
INTRODUCTION Measurement of troponin values is a basic laboratory analysis in every patient with a chest pain. Increase of blood troponin is a highly specific indicator of AMI, but other diagnoses also can result in an increase of troponin,and it’s known that intense physical activities can lead to troponin release.The objective is to present a patient who, due to a collapse while running, was brought to the hospital, where further diagnostics revealed a huge increase of troponin and later an AMI was excluded. CASE REPORT A patient collapsed during a race and lost consciousness.In the laboratory analysis, increasing values of Troponin were found, but ACS was excluded. It was concluded that elevated troponin was probably a consequence of physical activity. CONCLUSION Any chest pain and simptoms that may indicate ACS requires special attention from an emergency physician and must be familiar with different pathologies and consequences of intense physical activity.
METHOD OF DETERMINING AIS/MAIS TRAUMA SCORE FROM ICD 10 DIAGNOSIS CODES
The group of high representatives of European Union (EU) member states for traffic safety published in 2013 a new definition of severe trauma (TT) caused by traffic accidents. According to this definition, TT in road traffic are non-fatal injuries with a Maximum Abbreviated Injury Scale (MAIS) of 3 and above. Since 2014, the Recommendation at the EU level has been in effect to use the Abbreviated Injury Scale (AIS) for the assessment of injuries in traffic accidents, and MAIS 3+ for serious injuries. The previous experiences of countries that record injuries based on the MAIS 3+ classification system have shown its high validity and reliability of the collected data, reducing the risk of making arbitrary conclusions and subjective assessment of the severity of the injury, as well as the risk of inadequate reporting. MAIS 3+ enables better and more complete collection of data on traffic accidents at the national and international level, enables international comparability of data and the creation of adequate preventive activities. The tendency is that in the coming period, all EU member states will collect data on serious bodily injuries according to this definition.
WORKLOAD AND RESPONSE İN PREHOSPİTAL EMERGENCY HEALTH SERVİCES
Background: In emergency situations, it is very important to prevent preventable losses, to get early information, reaching the scene in a short time as well as providing intervention by equipped and trained personnel.This study was conducted to investigate the cases in prehospital Emergency Health Services. Methods:In this retrospective study, 75.280 cases who applied to Kayseri 112 Emergency Health Services with the phone number of 112 were examined. The data include the demographic characteristics of the cases, the hospital where the cases are referred, the reason for the call, the diagnosis, the ambulance exit result, the arrival time of the case, the source of the call, etc. collected with a form containing the questions. In the data analysis, descriptive statistical methods were used. Results: It was determined that the emergency calls were mostly made between 10:00-16:00 and 57.3% of the transfers were mostly made to the Training and Research Hospital. Internal medicine problems were the top reason for the calls. According to the ambulance exit results, 66.7% of the cases resulted in transfer to the hospital. Conclusions:It is seen that the number of cases making an emergency call for emergency health services is increasing day by day. It was found that the highest number of application were made by the male gender and the demand was higher during the daytime. In the present study, more than half of the cases were not accepted as emergency according to the international emergency parameters determined by the World Health Organization (WHO).
IMPORTANCE OF PAIN ASSESSMENT: SPECIFICITY OF HEALTHCARE
Pain is defined as an unpleasant sensory and emotional experience, which we associate with existing or possible tissue damage or describe with words that correspond to that damage. The aim of this work was to point out the importance of pain assessment and show the ways of pain assessment in the general population with reference to the duty of the nurse in pain assessment and control. In their daily work, nurses use standardized scales to assess pain in a simple way, and today there are many different scales and questionnaires in use that differ in relation to the age of the patient, his psycho-physical condition and other characteristics. . The most commonly applied pain assessment scales can be: unidimensional, multidimensional and combined. By applying the process of health care, as the basic method of work, the nurse can adequately care for the patient with pain.
Epidermolysis bullosa (EB) is a hereditary multisystemic disease caused by genetic defects in the structural proteins of the skin. Depending on the type of disease, symptoms vary from localized fragility and bullae to a widespread generalized form, including extracutaneous disease. In the most severe forms, EB leads to death in the earliest period of life. The treatment of EB is complex and usually requires the involvement of several different specialists. In the absence of curative therapy, treatment is oriented towards supportive care, control of disease symptoms and prevention of mild to severe complications. A new hope for the treatment of wounds in patients with dystrophic form of EB, older than 6 months, is vector gene therapy Vyjuvek (beremagene geperpavec) based on herpes simplex virus type 1.
Utility of M-mode for assessment of grade 3 dyspneic patient
Respiratory distress is one of the leading diseases, and it can occur in those who are critically ill or who have significant injuries. It is often fatal, and the risk increases with age and severity of illness. So, early diagnosis of the causes of respiratory distress is an important process. But, the accurate diagnosis is challenging in this domain. So, to clinically achieve higher accuracy, in this diagnosis, the proposed study uses the Motion-mode echo parameters. This is a retrospective observational study.. The Mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), , and E-Point to Septal Separation (EPSS). parameters of those admitted patient measurements are obtained. For analysis, this study totally considered 75 patients, in that 75, 46 were male and 29 were female. For all patients, the mean values calculated for MAPSE, TAPSE, EPSS were 13.463mm, 15.132 mm, and 9.4685 mm. The M-Mode parameter along with emergency physician clinical gestalt(M-mode model) was compared with the final diagnosis at discharge or death of the patient. The sensitivity, specificity, accuracy of the M-mode model was analysed considering the final diagnosis as the control. Key words: M-mode echocardiography, Mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), E-Point to Septal Separation (EPSS).
Sudden hoarseness in severe heart failure - Ortner's syndrome
Introduction: All cardiological conditions that can lead to paralysis of the left or right half of the larynx fall under Ortner's syndrome. Case Presentation: A 57-year-old patient was urgently admitted to the Cardiology Department due to difficulty breathing and clinical suspicion of heart failure. Urgent otolaryngological consultation was sought for a sensation of choking and hoarseness. Fiberoptic nasopharyngolaryngoscopy revealed restricted mobility of his left hemilarynx. Changes indicative of chronic heart failure were observed on the ECG. Computed tomography of the neck and chest with intravenous contrast confirmed cardiomegaly with mediastinal structure displacement. Conclusion: Hoarseness can be an initial sign of a potentially lethal disease. Early recognition and treatment of the underlying cardiovascular condition are crucial for the patient's recovery. It is essential to emphasize that a dyspneic patient requires not only an otolaryngologist's examination but also a thorough cardiological assessment.
REACTION TIME AS ONE OF THE PREREQUISITES FOR THE SUCCESS OF CARDIOPULMONARY RESUSCITATION - CASE REPORT
Uvod/cilj: Ekipe hitne medicinske pomoći su na primerima iz prakse definisale reakciono vreme kao jedan od najznačajnijih preduslova uspeha reanimacije i prognoze preživljavanja. Reakciono vreme je vreme od trenutka predaje poziva ekipi do dolaska ekipe do pacijenta.Prikaz bolesnika: Dva pacijenta starosti 70-80 godina, sa srčanim zastojem nastalim u vanbolničkim uslovima gde je srčanom zastoju prethodio bol u grudima.Zaključak: U prikazanim slučajevima je intervenisala ista medicinska ekipa sa različitim reakcionim vremenom, pa posledično i različitom prognozom preživljavanja
FROM AN ALLERGIC REACTION TO A SUPERIOR VENA CAVA SYNDROME
Abstract Introduction: Superior vena cava syndrome ( SVCS) is a collection of clinical signs and symptoms resulting from partial or complete obstruction of blood flow through the SVC. Case report: An eighty-year-old patient with an allergy diagnosis was referred from the Community Health Centre to the Internal Medicine Clinic. The patient had previously been treated with antihistamines for days due to swelling and facial redness, which showed no signs of improvement. During the chest x-ray, a widened shadow of the upper side of the mediastinum on the right side was noticed. A CT chest scan showed an infiltrative change and a significantly compressed upper vena cava due to the mediastinal adenopathy. Conclusion: If primarily manifested by skin symptoms, the diagnosis of superior vena cava syndrome can be easily overlooked. In the presented case, this rare syndrome was the first symptom of intrathoracic malignancy.
APPLICATION OF KAMPALA TRAUMA SCORE FOR PREHOSPITAL ASSESSMENT OF SEVERITY OF INJURIES AND PREDICTION OF OUTCOME AFTER SEVERE TRAUMA
Injury severity scores are used to numerically characterize the nature and extent of the injury. They represent an important additional instrument that is used with the aim of faster triage, categorization severity injury, adequate care, treatment and transport patients with multiple injuries to the hospital. Objective is to point out the possibility of pre-hospital use of the Kampala Trauma Score (KTS) as an easily applicable and very suitable for monitoring the condition and predicting the outcome of a seriously injured person through patient reports. Pre-hospital, patients were assessed according to KTS with different injury severity, which were in accordance with the definitive outcome. We conclude that the KTS is an effective scoring system in the initial triage and categorization of severely injured, prediction mortality, necessity hospitalization and prediction of definitive outcome. Due to the limited number of patients, original research should be conducted on a larger sample.
Copyright (c) 2023 The Journal of Emergency Medicine – Halo 194
Occlusion in left coronary system - ecg dilemma in emergency medicine
Introduction/Objective: Chest pain is a main clinical symptome of acs. Posterior infarctus is usually an extension of inferior infarctus. The aim is to present a patient with mild symptomes whose ecg did not match the severity of his infarctus and retroactively we use algorithms for assessment of culpit lesion. Case report: An emergency team was dispatched to a man who was experiencing chest pain. Ecg: synus rythm, horizontal ST depression V1-V3 1 to 2mm, ST elevation V6 ≤ 1mm,ST elevation D3 and aVF <1mm, ST depression D1 and aVL <1mm, ST elevation V7-V9 1 to 2mm. Coronarography: System LCA dominant, RCA minor with 70-80% stenosis, occlusion in OM1. Using assessing algorythms for LCx/RCA occlusion ecg suggests occlusion in right dominant coronary system which doesn't corelate with coronarography. Conclusion: We recommend standardizational use of right/posterior leads in all inferior and suspicious posterior infarctus and including STEMI equivalents in STEMI network.
FATAL DYSPNEOA - CASE REPORT OF A FEMALE PATIENT WITH INOPERABLE THYROID CARCINOMA
Introduction Thyroid tumors, due to their location in the neck, can threaten the respiratory tract while growing. Thyroid malignancies, in addition to compression, can also cause infiltration of local tissues. Case report Here we will present a case from the practice of a patient with advanced thyroid cancer who required urgent airway management, but due to the spread of malignancy into the mediastinum and the resulting compression on the distal parts of the trachea and lung tissue, the hospital episode ended with a fatal outcome with all medical assistance provided. Conclusion Securing the airway by endotracheal intubation or tracheotomy in a certain number of cases is not enough to save the lives of our patients. Key words: advanced thyroid cancer, dyspnea, the airway management
MEDICAL EMERGENCY TEAM AS AN ACCIDENTAL WITNESS TO THE RITUAL OF EXORCISM PERFORMED ON A PREGNANT MUSLIM WOMAN
We present a religious ritual of exorcism performed by a Muslim priest of a pregnant woman of the Islamic faith in the third month of pregnancy with body twitches and abdominal pain, in which emergency medical services (EMS) team was an accidental witness.