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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.

Theme of bachelor thesis is a hypothermia from a look of the Emergency Medical Service, (paramedic). The theoretical part of this thesis focuses on the main causes of hypothermia, physiological and anatomic knowledge about a skin, diagnostic hypothermia, procedure in the pre-hospital emergency care, cardiopulmonary resuscitation in a patient with hypothermia and the subsequent intensive care. In the practical part of the thesis, we set one goal and three research questions too.This bachelor thesis maps the awareness of paramedics about the issue of hypothermia. The first research question is aimed at ensuring that the members of Emergency Medical Service (or paramedics) have a sufficient theoretical knowledge of hypothermia.The second research question is focused on the general knowledge of the Emergency Medical Service on specific cardiopulmonary resuscitation in a patient with hypothermia.The third research question examines the paramedics´ expertise in the subsequent intensive care of a patient with hypothermia. The practical part of the thesis consists of a semi-structured interview with twelve paramedics from the South Bohemian Region.The interview included 23 questions. For better orientation, were results seperated to 12 categories.The goal of the bachelor thesis was accomplished thanks to answering all questions related to the research. Paramedics Responders have some knowledge about the topic of hypothermia but it is important to provide more information about the specifics of pharmacotherapy during cardiopulmonary resuscitation on a patient with hypothermia.I rate the research questions about intensive care very positively. This bachelor thesis could be used as a basis for educating students of non-medical pharmaceutical specializations in the future.

Title: Rescue people on the frozen water surface Aim: The aim of this thesis is to give a comprehensive overview of the rescue people on the frozen water surface. Methods: This bachelor thesis is based on a literature review, and does not contain experimental suggestions. It is a qualitative research that has been tested and completed by the author. The conclusions were made without any quantitative experiments or statistical analysis. Key words: Integrated Rescue System, rescue, first aid, hypothermia

Damage control surgery (DCS) is an integral part of management in critically injured patients. These usually involve patients with profound hemorrhagic shock with the development of acidosis, hypothermia and coagulopathy. Three stages of DCS are widely accepted: 1) Limited operation to control bleeding and contamination. 2) Continued resuscitation in intensive care unit. 3) Reoperation. Besides DCS in intraabdominal trauma, DCS techniques are currently employed also in thoracic injuries. DCS techniques in heart, lung, internal thoracic vessel and esophagus injuries are presented.Key words: damage control surgery thoracic trauma.

It was shown almost 50 years ago that hypothermic incubation of chicken embryos results in a reduction in the size of embryos and an increase in the heart weight, presumably by hypertrophy (increase in cell volume). The chicken embryos were incubated in normothermia (37.5 ř C) and hypothermia (33.5 ř C) from the eleventh embryonic day. On the 17th day, the embryos were weighed and then their hearts were weighed. In agreement with the previous results, hypothermic embryos were 29% smaller and their hearts 18% heavier. The heart-to-body weight ratio was 67% higher in the hypothermic group. The measured cell size was very similar in the target areas and it was also between the two groups. The left ventricle width was twofold that the right one and the difference was not significantly higher in the hypothermia model. Purkinje fibers, the terminal part of the conduction system, were smaller than the working cardiomyocytes. Purkinje fibers were slightly enlarged after hypothermic incubation. The proliferation rate was measured by immunohistochemical labeling of anti-phospho histone H3. The experimental group showed much higher proliferation rate; it reached statistical significance in the right ventricle. Thus, hypothermic incubation resulted in increased growth of embryonic heart based on hyperplasia...

The thesis deals with risks of travelling to high mountains and rescue in high mountains before provision of professional rescue. It summarizes major risks and most common injuries in high mountains and researches preparedness and equipment of laymen to provide first aid. It also proposes procedures to increase the chance of surviving in high mountains through education of people, going to high mountains, which can contribute on potentional increase of successfull rescue operations, initiated by laymen. Object of the thesis is to research risks of travelling to high mountains and rescue operations before professional rescue, which can last longer than in valley due to either arduous terrain or bad weather conditions and it is necessary to provide first aid in order to rescue the patient. This target was reached by qualitative research, dealing with six respondents. Scientific contribution of the tesis are the rescue cards, usable to educate laymen those cards were made according to conclusion, that lamen have got lack of skills in rescue techniques, required for travelling to high mountains.

Background Hyperthermic isolated limb perfusion is used to treat irresectable extremity malignancies. It is based on the following principle - the perfusion of the extremity is isolated from systemic circulation and connected to an extra-corporal circuit via which a very high concentration of a chemotherapeutic agent is administered into the blood compartment of the extremity. In some cases, treatment efficiency can be improved using tasonermin (a TNF-α agent). By itself, tasonermin can cause severe health complications in patients if leakage into systemic circulation results in a level that exceeds the maximally tolerated dose. Therefore, it is important to monitor for leakage during the whole operation. Method Leakage monitoring was performed by a nuclear medicine method based on the measurement of activity of a gamma-emitting radiotracer detected by a scintillation probe located over the heart. An amount of radiotracer that resulted in a basal level of measured signal was first administered into the systemic circuit followed by the administration of a second, one order of magnitude higher amount of radiotracer into the perfusion circuit. Leakage, when it occurred, increased the count rate detected over the heart, and the mathematical relation between leakage level and count rate increase was derived. Results In our department, the method was tested and optimized during isolated limb perfusion without using a TNF-α agent. Then, accreditation for the use of TNF-α was granted. Since then, the method has been used to monitor leakage in all cases of isolated limb perfusion with TNF-α. All isolated limb perfusion operations with TNF-α passed without complications. The radiation burden was almost negligible for both the patient and medical staff. Conclusion The method described in this report represents a reliable method for perfusion leakage monitoring when using TNF-α in our department.Key words: perfusion - isolated limb - TNF-α - leakage - monitoring - nuclear medicine - radiopharmaceuticalsThe authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 16. 6. 2016Accepted: 21. 6. 2016.

Perioperative hypothermia, defined as a core body temperature lower than 36řC, is associated with increased perioperative complications and prolonged hospitalization. The aim of this thesis is to analyze measures that are taken to prevent perioperative hypothermia at the Orthopedic Clinic of one Czech hospital and compare them with the current recommendations of the American Society of PeriAnesthesia Nurses, Association of Operating Room Nurses and the National Institute for Health and Care Excellence. The study included 223 patients who underwent a planned orthopedic surgery and who were more than 18 years old. As a method of data collection I chose studying the medical documentation. The obtained data were processed quantitatively. The recommended body temperature range 36.5-37.5řC before leaving an operating room had total of 60.55% of cases. Neither one patient has been no action in terms of prevention of hypothermia. Body temperature was taken in 22.4% of cases at the beginning of and during the surgery. Except for a cotton sheet, which was used in 100% of patients, no additional measures were taken in 18,4% of patients. Thermal insulation was used in 41,7% of patients, in-line warming system of infusion fluids in 65% of patients, forced air warming system in 17.9% of patients, and disposable...

This thesis deals with the topic of hypothermia in a rescuer's practice. Hypothermia is one of the reasons, why rescuers intervene. The problem of hypothermia is known for many years and the stress is laid on in it during the first aid. Hypothermia is a very serious condition which is needed to be solved without any suspension. Rescuers who work at Water rescue service deals with hypothermia the most. Their first task is to find a hypothermic person, move him to a safe place and give him a professional aid. Then they provide a transport to the hospital by Emergency medical services. In the theoretical part of my thesis is explained what is hypothermia, other related terms, description of manifests and a treatment of hypothermia is also mentioned. The next chapter mentions groups of people who are threatened the most. The last chapter deals with Emergency service. The research part of the thesis consists of qualitative method using questionnaires. It contains both polar and non-polar questions. At the beginning of the questionnaire there are three personal questions which are aimed at sex, education and how long do you do for Water rescue service. Other questions are aimed at rescuer's techniques and means. Rescuers working at Water rescue services were addressed. They were from South Bohemia, Central Bohemia and Vysocina Region. The purpose of this thesis was to evaluate methodical techniques, certain activities and following care provided by the rescuers at Water rescue services while they are saving a hypothermic person. The theoretical part of my thesis could be used as a study material for everyone who studies to be a rescuer. On the bases of the research part's results a description of methods for rescuers will be compiled. This will be useful for rescuers who work at Water rescue services.

Název: Hyperkapnie a difuse plynů ve sněhové lavině - (Změny funkčních parametrů jedinců v krizové situaci) Cíle práce: Cílem studie bylo kontinuální sledování kompenzačních mechanismů, zejména změn ventilačně-respiračních ukazatelů, v simulované sněhové lavině. Metoda: K získání dat byl použit experiment a nestandardizovaný dotazník. Výběr souboru byl vzhledem ke sledované problematice přísně selektivní. Výzkumu se účastnilo 22 probandů, ale po analýze dat bylo pro nesplnění požadovaných kritérií 11 osob vyřazeno. Soubor tedy tvořilo 11 zdravých mužů průměrného věku 25,3 let. Před vlastním experimentem byla pomocí osobního spirometru testována senzitivita na hyperkapnii a hypoxii (výdrž v apnoi) a dechová zdatnost (vitální kapacita plic s usilovným výdechem). Experimentální situaci představovalo jak dýchání do uzavřeného objemu (8 l), tak do vytvořené vzduchové kapsy ve sněhu (400 ml). Kontinuální záznamy oběhových funkcí (srdeční frekvence, krevní tlak) a ventilačně-respiračních parametrů (dechová frekvence, dechový objem, minutová ventilace, obsah O2 a CO2 ve vdechovaném a vydechovaném vzduchu, odpor při výdechu a saturace krve kyslíkem) byly snímány pacientským monitorem DATEX Ohmeda. Vzhledem k charakteru dat byla využita analýza rozptylu při opakovaném měření se dvěma faktory (dvoucestná...

Hypothermia is condition, when the temperature of the body drops below 35 °C. This specific shock caused by unfavourable surrounding circumstances can lead into a seriously threatening life condition of the patient. It is necessary to recognize the hypothermia and give the patient adequate care. The aim of my work is to map the knowledge to recognize the area of Hyperthermia for the medical rescue staff of the Medical rescue services in South Bohemia. Hypothesis was given one, H 1: Medical rescue workers know how to review the problems of hypothermia as a whole complex. In the practical part was used quantitative research. All the data were gathered via questionnaires which were distributed in regional centres for Medical Rescue services in South Bohemia. Record were evaluated and processed into the Pie and column graphs. The representation of respondents was almost equal according to gender of the participants with the various length of practice in this service. Only four out of twenty trivia questions related to problems of hypothermia reached the set limits of 75 % correctness. The results of this research show that the medical rescue worker do not have sufficient knowledge about the hypothermia. This could be caused by lack of information about this subject in Czech literature. Problems of hypothermia should be more taught at Medical schools for future medical rescue workers. And for those who are already employed by the Medical rescue service should be provided training courses or seminar on this subject. Medical rescue workers in South Bohemia region do not have sufficient knowledge about the problems of hypothermia which means that the hypothesis H 1 was not proved.

My thesis deals with therapeutic hypothermia and associated methods of cooling. Focus is given to technical and time demands of the methods in terms of reaching the target body temperature and nursing care complexity. The first theoretical part gives a brief introduction to history of hypothermia and the first existent records of the technique. Another chapter is focused on the current use of induced hypothermia, medical fields in which induced hypothermia is used both in the local or overall controlled hypothermia. Physiology and pathophysiology of thermoregulation in humans is described. More details are given on classification of hypothermia and hyperthermia. Changes in the organism during shifts in body temperature and their causes, positive and negative effects of temperature changes on the organism are discussed. Another chapter covers the issue of controlled hypothermia, its definition, positive treatment effects, negative effects on the organism and methods of cooling. External and internal methods as well as nursing procedure while the methods are applied are described in detail. The final chapter of the theoretical part of my thesis summarizes comprehensive nursing care for patients with controlled hypothermia. The objective of my thesis was to evaluate the utilization of therapeutic hypothermia in intensive care units, assessment of technical and time demands of cooling methods for comprehensive nursing care from the view of a nurse, and to find the optimal combination of cooling methods to achieve the desired core body temperature as soon as possible and to maintain the temperature. The first assumption was that therapeutic hypothermia utilization would be influenced by the patients structure on the wards. The second hypothesis was that utilization of physical cooling methods and more technically and time demanding methods such as coolgard and extracorporeal circulation would be more time consuming for nurses. The method of quantitative research, the questionnaire method, was chosen to comply with objectives of the thesis. The questionnaire contained open questions with the possibility of more responses, closed questions and one semi-closed question. The following nursing staff members were addressed: diploma nurses, registered nurses, specialized nurses working in intensive care units and resuscitation departments of four different hospitals. The research was conducted in 2009. In the concluding part of my thesis results of my work are shown in the graphic form. Discussions with literary sources on the use and application of therapeutic hypothermia are brought in. A large proportion is devoted to practical experience with cooling methods, which are compared with the results of the questionnaire. The results of my theses may be used to make the comprehensive nursing care for patients with therapeutic hypothermia more effective, with increased comfort for patients in intensive care units and resuscitation departments .

Burns is a type of injury which is lawfully regarded as one of the heaviest injuries in the area of human traumatology. This kind of thermic injury has already damaged many human lives and left many psychical and physical consequences. Injuries of this kind require the most complicated, longest and thus the most expensive treatment. Some burned clients are deformed by scars for life and gradually start to realize their social limitation. Crucial part in these cases is played by good family background and simultaneously sensitive attitude of society, which has a significant influence on the patient life quality. As a consequence of this injury most people tend to insulate from society and simultaneously change his or her value system and life style. From the psychic point of view the most serious are the cases where on the basis of thermic effect affection and deformity of face occurred. . The people affected like this are frustrated by views of strange people who are determined to have two types of feelings-antipathy or sympathy. The aim of my thesis was to map the level of burned people knowledge of prevention measures and laic first aid during thermic injuries. Research group was created by the clients of The Burn Medicine Clinic at Královské Vinohrady, who were hospitalized or treated as outpatients in consequence of thermic injury from 1 August to 31 October 2007. The collection of data was carried out by means of anonymous questionnaire. With the view of this I asked the personnel of the clinic for cooperation; the personnel took willingly charge of the mediator and continued to distribute the questionnaires to clients older than eighteen years, who were affected by thermic injury. The clients filled in 95 questionnaires of the total number of 150 (63.34%); filled in questionnaires were used for the processing of experimental part of my thesis. The final part of this thesis will be the processing of an information leaflet proposal concerning the primary prevention and administration of laic first aid at thermic injuries; this leaflet may be applied in terms of certain prevention programmes or in the area of further research.

In the following study, possible protective effect of hypothermia (of various degree) on brain cortex metabolic activity in very young animals and adult rats was examined.Experimental study.Institute of Physiology, 1st Med. Faculty, Charles University, Prague, Czech Republic.Homogenates of brain cortex of 14-day-old and adult rats and simultaneously blood serum were examined for lactate-dehydrogenase activity (LDH), [E.C. 1.1.1.27]. Three variously tempered incubation media (38 degrees C = control values, 30 degrees C = mild hypothermia, 22 degrees C = strong hypothermia) were checked. Also the adult rats (90-120 days) were examined (in the same arrangement).The LDH activity in the blood serum of 14-day-old rats under hypothermic condition was unchanged as compared with control values. In their brain cortex the hypothermia evokes a significant changes in LDH activity (mukat/l). In adult rats the results are different: no significant changes in LDH activity in the brain cortex under hypothermic condition were found, but significant drop in mentioned enzyme activity in the blood serum was established. Finally: in young animals the starting LDH activity in the blood serum as well as in the brain cortex was always significantly higher as compared with values found in adult animals.The starting higher LDH activity in the blood serum as well as in the brain cortex in young rats (as compared with adults) and the different feature of LDH changes under hypothermic conditions are considered and discussed especially with the possibility of protective action of hypothermia in hypoxic and asphyxic newborns.

The case-history describes successful resuscitation of a young man who was found after 15 hours following attempted suicide (intoxication with carbamazepine) in deep hypothermia (19 degrees C) with cardiac arrest. For rewarming the patient extracorporeal circulation was used. The patient was successfully disconnected from the extracorporeal circulation, relieved of the shock incl. severe rhabdomyolysis and intoxication with carbamazepine and discharged to domiciliary treatment without suffering from a neurological deficiency.

Perioperative hypothermia is associated with the development of haemocoagulation, cardiovascular and metabolic disorders leading to an increased morbidity and mortality. The objective of the investigation was to assess the extent of hypothermia and its clinical and laboratory consequences. A group of 30 patients subjected to elective radical laparotomy on account of colorectal carcinoma was divided into to equivalent groups. To the first group heated infusions were administered, to the second group not heated ones. In all patients the central and peripheral temperature, rate of postoperative normalization of the temperature, postoperative thermal comfort, consumption of analgesics and biochemical and haematological parameters were monitored.In patients with non-heated infusions more marked and longer perioperative hypothermia was recorded with a significant alteration of the number of leucocytes and thrombocytes. In the other investigated indicators there was no significant difference between the two groups. Hypothermia did not cause serious complications in any of the patients.Although no serious clinical complications induced by hypothermia were recorded, the authors recommend an active approach and provisions for the perioperative maintenance of body temperature as a standard of contemporary perioperative care.