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Background: Fluid resuscitation is a fundamental intervention in patients with hypovolemic shock resulting from trauma. Appropriate fluid resuscitation in trauma patients could reduce organ failure, until blood components are available, and hemorrhage is controlled. We conducted a systematic review and meta-analysis assessing the effect of hypertonic saline/dextran or hypertonic saline for fluid resuscitation on patient outcomes restricted to adults with hypovolemic shock. Methods: We conducted a search of electronic information sources, including PubMed, Embase, Web of Science, Cochrane library and bibliographic reference lists to identify all randomized controlled trials (RCTs) investigating outcomes of crystalloids versus colloids in patients with hypovolemic shock. We calculated the risk ratio (RR) or mean difference (MD) of groups using fixed or random-effect models. Results: Fifteen studies including 3264 patients met our inclusion criteria. Survival to hospital discharge rate between research groups varied and amounted to 71.2% in hypertonic saline/dextran group vs. 68.4% for isotonic/normotonic fluid (NS) solutions (odds ratio [OR] = 1.19; 95% confidence interval [CI] 0.97–1.45; I 2 = 48%; p = 0.09). 28- to 30-days survival rate for hypertonic fluid solutions was 72.8% survivable, while in the case of isotonic fluid (NS) — 71.4% (OR = 1.13; 95% CI 0.75–1.70; I 2 = 43%; p = 0.56). Conclusions: This systematic review and meta-analysis, which included only evidence from RCTs hypertonic saline/dextran or hypertonic saline compared with isotonic fluid did not result in superior 28- to 30-day survival as well as in survival to hospital discharge. However, patients with hypotension who received resuscitation with hypertonic saline/dextran had less overall mortality as patients who received conventional fluid.

INTRODUCTION: Additional mechanisms of neuromuscular blocking agents action create the haemodynamic condition during general anaesthesia. The aim was to investigate the effect of rocuronium on haemodynamic parameters during combined general anaesthesia. MATERIAL AND METHODS: The study was conducted in two groups: Group I underwent combined anaesthesia with rocuronium and Group II — combined anaesthesia without any muscle relaxants. Haemodynamic parameters: heart rate, systolic, diastolic and mean arterial blood pressure were recorded before anaesthesia, at the end of rocuronium infusion, and after recovery from anaesthesia. RESULTS: In both groups, the values of the median heart rate, systolic, diastolic and mean arterial blood pressure recorded before and after anaesthesia were similar and did not differ significantly. In Group I, significant reduction in heart rate in the end of rocuronium infusion [74 (61–103)], (p = 0.01) and after recovery from anesthesia [71 (53–100)], (p = 0.03), compared to the value before anesthesia [81 (56–104)], were demonstrated. Additionally, significant reduction in systolic [130 (96–169); 114 (92–144)], (p = 0.04), diastolic [80 (54–109); 73 (47–99)], (p = 0.01), and mean [95 (72–106); 85 (68–109)], (p = 0.02) arterial blood pressure in the end of rocuronium infusion were noticed. The values of systolic, diastolic and mean blood pressure after recovery from anaesthesia significantly increased in relation to the values observed in the end of the rocuronium infusion [129 (96–181)], (p = 0.01); [78 (47–107)], (p = 0.03); [93 (63–107)], (p = 0.03). CONCLUSIONS: The vagolytic effect was not observed during general anaesthesia with rocuronium. The changes in heart rate and blood pressure were associated with the rocuronium infusion and were normalized after recovery from anaesthesia.

Background: A 2017 update of the resuscitation guideline indicated the use of cardiopulmonary resuscitation (CPR) feedback devices as a resuscitation teaching method. The aim of the study was to compare the influence of two techniques of CPR teaching on the quality of resuscitation performed by medical students. Methods: The study was designed as a prospective, randomized, simulation study and involved 115 first year students of medicine. The participants underwent a basic life support (BLS) course based on the American Heart Association guidelines, with the first group (experimental group) performing chest compressions to observe, in real-time, chest compression parameters indicated by software included in the simulator, and the second group (control group) performing compressions without this possibility. After a 10-minute resuscitation, the participants had a 30-minute break and then a 2-minute cycle of CPR. One month after the training, study participants performed CPR, without the possibility of observing real-time measurements regarding quality of chest compression. Results: One month after the training, depth of chest compressions in the experimental and control group was 50 mm (IQR 46–54) vs. 39 mm (IQR 35–42; p = 0.001), compression rate 116 CPM (IQR 102–125) vs. 124 CPM (IQR 116–134; p = 0.034), chest relaxation 86% (IQR 68–89) vs. 74% (IQR 47–80; p = 0.031) respectively. Conclusions: Observing real-time chest compression quality parameters during BLS training may improve the quality of chest compression one month after the training including correct hand positioning, compressions depth and rate compliance.

Background: High-quality chest compression is one of the key elements of resuscitation to return of spontaneous circulation. In the COVID-19 era, medical personnel should wear personal protective equipment (PPE) against aerosol generating procedures (AGP) during resuscitation. However, the use of this personal protection equipment may reduce the effectiveness of medical procedures performed. Objective: We aimed to compare chest compression quality parameters between standard manual chest compression and chest compression with TrueCPR feedback device performed by medical students wearing full personal protractive equipment against aerosol generating procedure.Methods: The study was designed as a randomized, cross-over, single-blinded simulation study. Thirty-two medical students wearing PPE-AGP performed 2-min continuous chest compression on an adult simulator with and without TrueCPR feedback device.Results: Median chest compression depth with and without TrueCPR feedback device varied and amounted to 46 (IQR; 42-53) vs. 41 (IQR; 36-45) mm (MCC vs. TrueCPR, respectively). The manual chest compression rate was 117 (IQR; 112-125) compressions per minute (CPM) and was higher than with TrueCPR feedback device - 107 (IQR; 102-115; p = 0.017). Full chest relaxation in the manual's chest compression technique (without TrueCPR) was 33 (IQR; 26-42)% and was lower than with chest compression with TrueCPR feedback device - 58 (IQR; 40-75)% (p=0.002). Conclusions: We conclude that a TrueCPR feedback device improves chest compression quality during simulated COVID-19 resuscitation performed by medical students wearing PPE-AGP.

INTRODUCTION: Injury-related interventions currently place a heavy workload on emergency medical teams in both adults and paediatric patients. One of the most common types of injuries are limb injuries caused by physical activity, falls or traffic accidents. It is extremely important to provide adequate protection for the paediatric patient in case of injury, as homeostasis disorders can occur very quickly in this age group. The aim of the study was to obtain data on the type and frequency of limb injuries in the group of paediatric patients who received medical rescue services interventions. An attempt was also made to specify the most frequent causes of limb injuries. MATERIAL AND MeTHODS: The study was based on a retrospective analysis of medical records of emergency rescue teams in the period from November 2017 to October 2018. The study included an analysis of interventions to patients under 18 years of age to whom EMS teams intervened due to limb injury. The analysis included sociodemographic data such as age, gender, time and place of the injury, as well as the type of injury based on the ICD-10 classification. RESULTS: In the studied period, 289 interventions in paediatric patients with limb injuries were recorded, which constituted 9.8% of all interventions in paediatric patients. The main site of the injury was a school. Upper limb injuries were reported in 123 cases, which constituted 42.6% of the intervention to the studied group of patients. The upper limb injuries were predominantly caused by forearm fractures (n = 33; Tab. 3), while the lower limb — by knee joint injuries. CONCLUSIONS: Limb injuries account for nearly 10% of all EMS interventions in paediatric patients. The main site of the injury was a school and the most frequent were upper limb injuries including forearm fractures, while for the lower limb — knee joint injuries. Further action should be taken to reduce the number of limb injuries in children.

The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I2 = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I2 = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I2 = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I2 = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I2 = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL.

Introduction Laparoscopic sleeve gastrectomy (LSG) is recently a leading method in surgical treatment of morbid obesity. The metabolic outcome of intervention may be a result of many factors such as age, gender, preoperative weight loss and dietary restrictions. Aim To evaluate gender-related differences in the results of LSG in 6-month follow-up. Material and methods The study included 101 patients who underwent LSG at the University Clinical Hospital of Bialystok. Patients were divided and analyzed in 2 groups: males (n = 48) and females (n = 53). The primary analysis included the influence of gender on postoperative weight loss calculated using the percentage of excess weight loss (%EWL) and excess BMI loss (%EBMIL). For secondary outcomes the levels of glucose, insulin, glycated hemoglobin, aspartate transaminase, alanine transaminase, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides and C-reactive protein were analyzed. Results A significant influence of patients' gender was proved for both %EWL (p = 0.026) and %EBMIL (p = 0.001). Females had significantly higher %EWL in 6-month follow-up than males (p = 0.0034). The analysis also showed significantly higher %EBMIL for women at 3 and 6 months observation (p = 0.022 and p < 0.001 respectively). Conclusions Laparoscopic sleeve gastrectomy is an effective method of obesity treatment especially in terms of postoperative weight loss. Females seem to benefit more from the procedure when analyzing the parameters of body mass reduction. However, further research is needed to provide strong evidence of an association between gender and the results of LSG.

Introduction. Despite the undoubted success of modern medicine, peritonitis in children remains not only a surgical, but also a general pathological problem, the relevance of which does not decrease. The use of efferent therapy methods, in particular hemosorption, imitating the natural mechanisms of detoxification of the body, are promising in the complex therapy of children with peritonitis. Aim. The aim of the study was to establish the effectiveness of the antiproteinase hemosorbent „Hemo-proteazsorb” in the complex intensive care of children with generalized peritonitis. Material and methods. A prospective randomized study of 60 children with generalized peritonitis was conducted. In the main group, there were 30 patients who underwent hemosorption in complex intensive care, and the comparison group also included 30 patients who underwent traditional treatment. The examined groups were comparable in terms of the nature of the pathology and the severity of the condition. Results. During hemoperfusion, a significant increase in blood saturation was established from 95.1 (93.2; 97.1)% to 97.3 (95.5; 98.7)%, with an improvement in oxygen transport (ctO2, mmol/l) from 6.9 (6.4; 7.9) to 8.8 (1.5; 9.7) and a decrease in lactate level (mmol/l) from 1.7 (1.5;2.1) to 1.1 (0.9;1.3), which indicates normalization of blood oxygenation and improvement of microcirculation. After 24 hours, there was a significant decrease in the amount of points on the pSOFA scale, from 4.5 (3.0; 6.0) to 0.5 (0; 2.0), p < 0.001, normalization of body temperature, restoration of intestinal function was noted in 15 (50.0% CI: 32.1-67.9) children, which indicates a decrease in multiple organ dysfunction and improvement of the condition. When compared in the second group, the studied indicators changed much more slowly. Conclusions. The data obtained as a result of the study on the positive dynamics of clinical and laboratory parameters prove the high effectiveness of the use of the Belarusian hemosorbent ?Hemo-proteazsorb? in the complex of intensive care of generalized peritonitis.

The tympanic membrane retraction pocket is a phenomenon that is described as a deformation of the tympanic membrane (most often hollow) caused by long persistent negative pressure inside the tympanic cavity. There are many theories about the pathomechanism of the formation of retraction pockets, but the most probable seems to be the one that which talks about pockets as a natural attempt by the body to heal inflammation in the tympanic cavity. Most untreated retraction pockets can lead to the development of cholesteatoma, which is so important knowing the classification of pockets. Due to it, it is possible to properly assess pathology and apply an appropriate treatment. There is no standardized scheme to the treatment of retraction pockets. Everything depends on the severity of the disease as well as on the co-occurrence of the upper respiratory tract infections or ear effusion.

Health care system from the end of 2019 faced a huge challenge worldwide which was the emergence of a new species of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China. Within a short time, the pathogen revealed a pandemic nature. On January 30, 2019, the World Health Organization (WHO) announced the outbreak of the COVID-19 pandemic. The greatest threat to human health and life is the damage to the lungs that accompanies a virus infection and the development of Acute Respiratory Distress Syndrome (ARDS). As the epidemic proceeded, a significant amount of the hospital bed facilities was occupied by patients requiring passive oxygen therapy and, in large part, respiratory support using high flow oxygen therapy (HFNC) and continuous positive airway pressure (CPAP) devices. A variety of techniques for applying passive oxygen therapy allow the use of different oxygen flows, with a proportional increase in FiO2 in the breathing mixture.

INTRODUCTION: Sudden cardiac arrest treatment is challenging, And the effectiveness of resuscitation procedures — especially in pre-hospital conditions — is low. The purpose of this meta-analysis is to investigate the effects of magnesium sulfate (MgSO4) in cardiac arrest on the return of spontaneous circulation (ROSC) and survival to hospital discharge. MATERIAL AND METHODS: We searched in MEDLINE, EMBASE, Scopus, and ClinicalTrials.gov, Web of Science up to May 25, 2020, and we conducted a systematic review and meta-analysis. We synthesized results by using mean differences, and odds ratios. The overall incidence and outcome of cardiac arrest were assessed using a random-effects meta-analysis. RESULTS: A total of 5 eligible studies were included in this meta-analysis. Survival to discharge was higher in magnesium sulfate group compared to placebo group (9,5% vs. 8.2% respectively; OR = 1.17; 95% CI: 0.61, 2.23; p = 0.64). Higher survival rate to hospital admission was observed in the placebo group — 26.9% compared to the group where magnesium was administered — 25.7% (OR = 0.93; 95% CI: 0.59, 1.47; p = 0.77. CONCLUSIONS: In conclusion, this meta-analysis indicates no statistically significant benefit of resuscitation with magnesium sulfate compared to the placebo. Thus, due to the low number of studies we recommend future randomized controlled trials to identify which anti-arrhythmic drug we should use on shock-refractory cardiac arrest.

The aim of the study was to assess the usefulness of the Glasgow Coma Scale (GCS) score assessed by EMS team in predicting survival to hospital discharge in patients after out-of-hospital cardiac arrest (OHCA).Silesian Registry of OHCA (SIL-OHCA) is a prospective, population-based regional registry of OHCAs. All cases of OHCAs between the 1st of January 2018 and the 31st of December 2018 were included. Data were collected by EMS using a paper-based, Utstein-style form. OHCA patients aged ≥18 years, with CPR attempted or continued by EMS, who survived to hospital admission, were included in the current analysis. Patients who did not achieve return of spontaneous circulation (ROSC) in the field, with missing data on GCS after ROSC or survival status at discharge were excluded from the study.Two hundred eighteen patients with OHCA, who achieved ROSC, were included in the present analysis. ROC analysis revealed GCS = 4 as a cut-off value in predicting survival to discharge (AUC 0.735; 95%CI 0.655-0.816; p 0.001). Variables significantly associated with in-hospital survival were young age, short response time, witnessed event, previous myocardial infarction, chest pain before OHCA, initial shockable rhythm, coronary angiography, and GCS 4. On the other hand, epinephrine administration, intubation, the need for dispatching two ambulances, and/or a physician-staffed ambulance were associated with a worse prognosis. Multivariable logistic regression analysis revealed GCS 4 as an independent predictor of in-hospital survival after OHCA (OR of 6.4; 95% CI 2.0-20.3; p 0.0001). Other independent predictors of survival were the lack of epinephrine administration, previous myocardial infarction, coronary angiography, and the patient's age.The survival to hospital discharge after OHCA could be predicted by the GCS score on hospital admission.

INTRODUCTION: The aim of this study was to evaluate intubation performance by paramedics using Macintosh laryngoscope and VieScope® laryngoscope under simulated difficult airway conditions. METHODS: In a randomized, single-blinded, cross-over simulation trial, 42 paramedics performed endotracheal intubation using VieScope® and Macintosh (MAC) laryngoscopes in two difficult airway scenarios: (A) tongue edema, (B) manual cervical inline stabilization. The order of participants and intubation methods was random. Time to ventilation constituted the primary outcome, and the secondary outcomes were the success rate of first intubation attempt, overall intubation success rate, Cormack and Lehane grade, and ease of use. RESULTS: In scenario A, the median overall intubation time was 55s (46–109) in the MAC group and 30.5s (26–35) in the VieScope® group (p < 0.001). The efficacy of the first intubation attempt with MAC and Vie- Scope® varied and amounted to 64.3% vs. 95.2% (p < 0.001). During scenario B, VieScope® offered better intubation conditions than MAC (p < 0.001), including shorter intubation time, higher first attempt and overall intubation success rates, as well as better glottic view. CONCLUSIONS: In this simulation trial, we found that VieScope® could be successfully used for intubation in difficult airways by paramedics with little simulation experience with this device. VieScope® was associated with shorter time and higher success rates of intubation attempt compared with MAC. Nevertheless, we recommend that the performance of VieScope® and MAC should be further evaluated in the clinical setting to confirm our results.

Auditory processing disorders (APD) are characterized by a reduction in the efficiency of auditory processing, which results in a deficit in identifying and interpreting sounds by the brain. In 2017, auditory processing disorders were awarded an individual diagnostic code. Symptoms that indicate the presence of auditory processing disorders are numerous and non-specific. The primary symptom of impaired auditory processing is difficulty understanding speech in noise. This disorder affects about 5-7% of children. Most often, the result of at least two tests included in the set is considered to be the determinant which constitutes the basis for the diagnosis of disorders. In the diagnostic and therapeutic process of children with auditory processing disorders, the correct diagnosis is of key importance, thanks to which it will be possible to conduct an appropriate treatment. All therapeutic methods, tasks activating auditory perception and language skills should be selected reliably, individually for each participant of the therapy. The use of the so-called auditory training during corrective-compensatory and speech therapy classes in children with central auditory processing disorders should be the standard. It is the main method of treating children with central hearing impairment. Auditory training includes auditory education based on stimulating child’s auditory predispositions and on developing the ability to use them in order to gain better orientation in the environment. At present, therapists in Poland may use various types of therapeutic interactions that have a positive impact on the development of a child’s hearing skills. The aim of the work is to discuss auditory training and to present speech therapy exercises helpful in the therapeutic process of children with auditory processing disorders.

Hearing is one of the most important human senses. It is highly sensitive to any acoustic stimuli – some of them may be harmful. Hearing damage caused by noise is becoming more common these days. It affects not only adults, but also adolescents and children. It is often irreversible and may arise as a result of a single exposure to noise or during long-term occupational exposure. Noise has a strong impact on the hearing organ. It is a dangerous stimulus that damages external hair cells. Its effect may be caused by both long-term and short-term exposure. To prevent noise-induced hearing impairment, it is necessary to avoid loud acoustic stimuli. Noise is ubiquitous and sometimes we do not realize how harmful it is to our hearing. People of all ages are exposed to hearing loss caused by noise. In order to avoid or reduce the effects of noise, one should follow preventive recommendations. Noise has a huge impact on the quality of our hearing.

Background: Although the resuscitation of an adult trauma patient has been researched and written about for the past century, the ideal fluid strategy to infuse during the initial resuscitation period remains unresolved. This work was aimed at assessing the effect of hypotensive versus conventional resuscitation strategies in traumatic hemorrhagic shock patients on mortality, and the need for blood transfusions including adverse events. Methods: This systematic review and meta-analysis were performed following the PRISMA guidelines. Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of hypotension versus conventional fluid resuscitation for traumatic hemorrhagic shock patients. Two reviewers independently performed the screening, data extraction, and bias assessment. The data analysis was completed using the Cochrane Collaboration's software RevMan 5.4. Results: Data from 28 RCTs on 4503 patients were included in the final meta-analysis. Patients receiving hypotension fluid resuscitation compared with conventional fluid resuscitation experienced less mortality (12.5% vs. 21.4%; RR = 0.58; 95% CI: 0.51–0.66; p < 0.001), fewer adverse events (10.8% vs. 13.4%; RR = 0.70; 95% CI: 0.59–0.83; p < 0.001), including fever acute respiratory distress syndrome (7.8% vs. 16.8%) or multiple organ dysfunction syndrome (8.6% vs. 21.6%). Conclusions: This meta-analysis showed that hypotensive fluid resuscitation significantly reduced the mortality of hypovolemic shock patients. Findings are low in certainty and should be interpreted with caution. Therefore, there is an urgent need for larger, multicenter, randomized trials to confirm these findings.

Background: Pre-filled syringes are increasingly popular in medicine, especially in emergency medicine, where fast intervention is crucial. Additionally, as indicated by numerous studies, the use of drugs in prefilled syringes reduces the risk of medical errors associated with inadequate preparation of the drug and reduces the risk of contamination as a result of tissue injury due to rupture of a standard ampoule with the drug. The aim of the study was to compare the use of pre-filled syringes with adrenaline and standard adrenaline in ampoules during simulated CPR during simulated cardiopulmonary resuscitation in non-shockable rhythms performed by two-person teams. Methods: The study was a randomised cross-over study and was based on medical simulation. The study involved 40 paramedics assigned randomly to 20 two-person rescue teams. These teams were to perform 10-minute cardiopulmonary resuscitation in three research scenarios: Scenario A — During CPR, access to the median basilic vein and preparation and administration of adrenaline infusions from generally available ampoules at concentration 1:1000 were required (Adrenaline WZF 0.1%; Polfa, Warsaw, Poland) with a standard syringe; Scenario B — During resuscitation, the median basilic vein was accessed and adrenaline was to be administered from an adrenaline pre-filled syringe (Aguettant Sante, Lyon, France); Scenario C — During CPR, intraosseous tibial vascular access was obtained using a NIO Adult kit, and adrenaline was administered using a pre-filled syringe with adrenaline (Aguettant Sante, Lyon, France). Both the order of resuscitation and medication administration as well as the order of participants were random. Results : The time to obtain vascular access in the examined scenarios varied and was 240 sec [IQR; 220–265] for Scenario A, 236 sec [IQR; 210–270] for Scenario B, and 165 sec [IQR; 90–180] for Scenario C; A vs. C, (p < 0.001), B vs. C (p < 0.001). In scenarios A, B, and C, the duration of adrenaline administration varied and was 55 sec [IQR; 50–85] vs. 20 sec [IQR; 18–35] vs. 20 sec [IQR; 20–30] (A vs. B, and A vs. C, p < 0.001). Conclusion: A simulation study has shown that paramedics in two-person teams are unable to deliver adrenaline at the time recommended by CPR guidelines. The delay of CPM adrenaline supply compared to PFS adrenaline is statistically significant. In the opinion of paramedics participating in the study, adrenaline during resuscitation should be administered by means of pre-filled syringes, which eliminates the delays in rescue operations resulting from the time needed to prepare drugs as well as limited human resources in rescue teams.

Study objective: During a pandemic, medical personnel while in contact with patients with suspected/confirmed COVID-19 should wear full personal protective equipment (PPE) for aerosol-generating procedures to reduce the risk of infection. Most studies of intubation in level C PPE conditions have been relatively small. Our aim is to quantify the available data on success rates in order to provide an evidence-based benchmark to gauge performance in the published literature. Methods: A structured literature search was performed with PubMed, Scopus, Embase, Web of Science, and Cochrane databases. The electronic database search was supplemented by searching Google Scholar and by back-searching the reference lists of identified studies for suitable articles. Data were evaluated and extracted by two independent reviewers on the basis of qualitative and quantitative variables of interest. Q statistic and I2 statistics were used to assess the heterogeneity between the studies. Results : Fifteen randomized controlled trials were included. The use of PPE during intubation as compared with intubation without PPE reduced intubation efficacy (90.0% vs. 97.9%; RR = 0.94; 95%CI: 0.90–0.99; p < 0.001) and increased the procedure time (MD = 7.73; 95%CI: 4.98–10.47; p < 0.001). Direct laryngoscopy compared with video laryngoscopes offered similar intubation success rate (93.6% vs. 92.3%; RR = 0.99; 95%CI: 0.97–1.02; p = 0.66) and shorter intubation time (MD = 63; 95%CI: -0.77–12.03; p = 0.08). However, subgroup analysis showed that intubation with Macintosh blade video laryngoscopes was more effective than that with direct laryngoscopes (98.1% vs. 96.4%; RR = 1.00; 95%CI: 0.97–1.03; p = 0.90). Conclusions: Our meta-analysis suggests that PPE reduces the effectiveness of endotracheal intubation. The use of direct laryngoscopy for intubating patients with suspected/confirmed COVID-19 by an intubator wearing level C PPE is associated with overall intubation time reduction and an increase in intubation success rate compared with video laryngoscopes. However, the findings suggest that Macintosh blade video laryngoscopes during endotracheal intubation with PPE may be an alternative to direct laryngoscopes. Video laryngoscopy can be helpful for less experienced personnel.

Coronaviruses cause disease in animals and people around the world. Human coronaviruses (HCoV) are mainly known to cause infections of the upper and lower respiratory tract but the symptoms may also involve the nervous and digestive systems. Since the beginning of December 2019, there has been an epidemic of SARS-CoV-2, which was originally referred to as 2019-nCoV. The most common symptoms are fever and cough, fatigue, sputum production, dyspnea, myalgia, arthralgia or sore throat, headache, nausea, vomiting or diarrhea (30%). The best prevention is to avoid exposure. In addition, contact per-sons should be subjected to mandatory quarantine. COVID-19 patients should be treated in specialist centers. A significant number of patients with pneumonia require passive oxygen therapy. Non-invasive ventilation and high-flow nasal oxygen therapy can be applied in mild and moderate non-hypercapnia cases. A lung-saving ventilation strategy must be implemented in acute respiratory distress syndrome and mechanically ventilated patients. Extracorporeal membrane oxygenation is a highly specialized method, available only in selected centers and not applicable to a significant number of cases. Specific pharmacological treatment for COVID-19 is not currently available. Modern medicine is gearing up to fight the new coronavirus pandemic. The key is a holistic approach to the patient including, primar-ily, the use of personal protective equipment to reduce the risk of further virus transmission, as well as patient management, which consists in both quarantine and, in the absence of specific pharmacological therapy, symptomatic treatment.

Background: The aim of the study was to evaluate various methods of chest compressions in patients with suspected/confirmed SARS-CoV-2 infection conducted by medical students wearing full personal protective equipment (PPE) for aerosol generating procedures (AGP). Methods: This was prospective, randomized, multicenter, single-blinded, crossover simulation trial. Thirty-five medical students after an advanced cardiovascular life support course, which included performing 2-min continuous chest compression scenarios using three methods: (A) manual chest compression (CC), (B) compression with CPRMeter, (C) compression with LifeLine ARM device. During resuscitation they are wearing full personal protective equipment for aerosol generating procedures. Results: The median chest compression depth using manual CC, CPRMeter and LifeLine ARM varied and amounted to 40 (38–45) vs. 45 (40–50) vs. 51 (50–52) mm, respectively (p = 0.002). The median chest compression rate was 109 (IQR; 102–131) compressions per minute (CPM) for manual CC, 107 (105–127) CPM for CPRMeter, and 102 (101–102) CPM for LifeLine ARM (p = 0.027). The percentage of correct chest recoil was the highest for LifeLine ARM — 100% (95–100), 80% (60–90) in CPRMeter group, and the lowest for manual CC — 29% (26–48). Conclusions: According to the results of this simulation trial, automated chest compression devices (ACCD) should be used for chest compression of patients with suspected/confirmed COVID-19. In the absence of ACCD, it seems reasonable to change the cardiopulmonary resuscitation algorithm (in the context of patients with suspected/confirmed COVID-19) by reducing the duration of the cardiopulmonary resuscitation cycle from the current 2-min to 1-min cycles due to a statistically significant reduction in the quality of chest compressions among rescuers wearing PPE AGP.

The current pandemic has raised great global public health concern. The disease name was subsequently recommended as COVID-19 by the World Health Organisation (WHO) [1,2]. Meanwhile, 2019-nCoV was renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses. SARS CoV-2 is considered highly contagious. As of April 1, 2020, more than 883,255 confirmed cases, including more than 44,156 deaths, have been reported worldwide, affecting almost the whole world.

Voice is a work tool for many professional groups. For children, the ability to communicate plays a fundamental role in learning, developing and exploring the world. Taking appropriate therapeutic measures may give the patient a chance to achieve success in social communication, and thus in the school community or workplace. Voice efficiency and quality reflect human health problems both in the somatic and mental spheres, therefore it is very important to include psychological therapy in patients with psychogenic voice and speech disorders.

Introduction. Airway management plays an essential role in anaesthesia practice, during both elective and urgent surgery procedures and emergency medicine. Aim. The aim of the study was to compare Macintosh laryngoscope (MAC), McGrath, and TruView PCD in 5 separate airway management scenarios. Methods. This prospective cross-over simulation study involved 93 paramedics. All paramedics performed intubation using direct laryngoscope (MAC), McGrath, and TruView PCD video laryngoscopes. The study was performed in 5 different scenarios: (A) normal airway, (B) tongue oedema, (C) pharyngeal obstruction, (D) cervical collar stabilization with tongue oedema, and (E) cervical collar stabilization with pharyngeal obstruction. Results. In scenario A, the success rate was 99% with MAC, 100% with McGrath, and 94% with PCD. Intubation time was 17 s (IQR: 16–21) for MAC, 18 s (IQR: 16–21) for McGrath, and 27 s (IQR: 23–34) for PCD. In scenario B, the success rate was 61% with MAC, 97% with McGrath, and 97% with PCD (p<0.001). Intubation time was 44 s (IQR: 24–46) for MAC, 22 s (IQR: 20–27) for McGrath, and 39 s (IQR: 30–57) for PCD. In scenario C, the success rate with MAC was 74%, 97% with McGrath, and 72% with PCD (p<0.001). Intubation time was 21 s (IQR: 19–29) for MAC, 18 s (IQR: 18–24.5) for McGrath, and 30 s (IQR: 23–39) for PCD. In scenario D, the success rate with MAC was 32%, 69% with McGrath, and 58% with PCD (p<0.001). Intubation time was 26 s (IQR: 20–29) for MAC, 26 s (IQR: 20–29) for McGrath, and 45 s (IQR: 33–56) for PCD. In scenario E, the success rate with MAC was 32%, but 64% with McGrath and 62% with PCD (p<0.001). Intubation time was 28 s (IQR: 25–39) for MAC, 19 s (IQR: 18–26) for McGrath, and 34 s (IQR: 27–45) for PCD. Conclusions. The McGrath video laryngoscope proved better than Truview PCD and direct intubation with Macintosh laryngoscope in terms of success rate, duration of first intubation attempt, number of intubation attempts, Cormack-Lehane grade, percentage of glottis opening (POGO score), number of optimization manoeuvres, severity of dental compression, and ease of use.

Introduction. The SARS-CoV-2 infection pandemic has affected virtually the whole world. Since the outbreak in China, countries on all continents have been progressively infected, and COVID-19 represents a major challenge to healthcare systems even in highly developed countries. Children are a very special group, largely due to close family contacts, and may be susceptible to cross-infection. Children, generally, have low immunity and some exhibit a long incubation period after SARS-CoV-2 infection. Therefore, children should try to avoid contact with complex populations to avoid being infected by potential spreaders. Aim. The aim of the study was to identify the most frequently observed symptoms in pediatric patients with confirmed COVID-19. Material and methods. We performed a comprehensive systematic literature search of online databases, including PubMed, EMBASE, Web of Science, CENTRAL, from December 2019 to April 10, 2020 to identify all case studies. All the search results were evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The inclusion criterions for the articles were as follows: study population: pediatric patients with diagnosed COVID-19 (excluding newborn patient); study design: case studies; outcomes measure: at least one outcome reported among clinical symptoms. Results. The analysis of 10 papers reporting 466 pediatric patients with confirmed COVID-19 revealed that the most frequently observed symptoms are fever (56.0%), cough (49.8%), headache (22.9%), sore throat (22.7%) and fatigue/myalgia (20.3%). The remaining symptoms are much less frequent. In 13.6% of cases, the disease was asymptomatic, and in 40.8% it was mild in clinical classification and in 40.2% moderate type. Relatively rarely children with severe and critical presentation of COVID-19 are observed (3.0 and 1.0%, respectively). Conclusions. The five most frequent symptoms in pediatric patients with confirmed COVID-19 are: fever, cough, headache, sore throat and fatigue/myalgia. In the pediatric population, 81% of patients infected with SARS-CoV-2 have mild or moderate symptoms, and only 4% have severe and critical presentation.

Objective Survival after pre-hospital cardiac arrest (PHCA) remains low. Pre-hospital therapeutic hypothermia (PTH) is believed to improve patient's outcomes, but data on efficacy and safety remains scarce. Herein, we aimed to assess the influence of PTH on survival, neurological outcome, and adverse effects in patients with PHCA. Materials and methods A literature search of PubMed CENTRAL, EMBASE, and The Cochrane Central Register of Controlled Trials databases from inception to August 2019 was conducted and retrieved abstracts were independently assessed by two reviewers. The primary outcome was survival to hospital discharge with a favorable neurological outcome. Secondary outcomes were survival to hospital discharge and temperature upon hospital admission. The safety outcomes included pulmonary edema and recurrent arrest during transport to the hospital. We also considered a favorable neurological function to hospital discharge or longest post arrest follow-up. Results Eleven studies including 4891 patients were included into final analysis. The survival to hospital discharge did not differ between PTH and control group (RR 1.02; 95%CI 0.93 to 1.12). Among 4891 participants (2466 in PTH group and 2425 in control group), 1087 participants (564 vs. 523, respectively) had a favorable neurological outcome. Pulmonary edema occurred in 320 cases in PTH group and 273 in control group with significant heterogeneity (RR 0.90, 95%CI 0.59–1.38; I2 = 80%). The pooled results showed a significant difference in rearrests between the PTH and control group (RR 1.19; 95%CI 1.00 to 1.42). Conclusion Our analysis demonstrates that PTH does not improve survival at discharge or neurological outcome.

INTRODUCTION: Securing the stability of the cervical spine is one of the basic procedures performed by medical personnel in trauma patients. Unfortunately, standard cervical collars limit the effectiveness of some procedures, including endotracheal intubation, as well as affect the pain sensations of the injured person. The aim of the study was to compare the influence of two different types of cervical collars on the technical conditions of endotracheal intubation and the patient’s sense of comfort. METHOD: The study was designed as a randomised, cross-over research and included 32 healthy paramedics, who had a cervical collar installed for 20 minutes in a randomised way. During the examination, the patient’s comfort and pain resulting from the pressure on mastoid processes were evaluated. RESULTS: Prior to the study, the mouth opening in the examined group was 51 ± 12 mm. After the set-up of the Patriot collar, the mouth opening amounted to 37 ± 10 mm, while in the NECKLITE collar group amounted to 49 ± 13 mm (p < 0.001). The use of a cervical collar reduced the degree of mouth opening by 27% when using a standard cervical collar, and less than 4% when using a NECKLITE collar. The pressure on the mastoid processes assessed on a 10-point scale varied between the cervical collars and amounted to 7 ± 2 points for Patriot and 1 ± 1 points for NECKLITE collar (p < 0.001). The pain sensations associated with the cervical collar were also varied and amounted to 6 ± 3 points for Patriot collar vs. 1 ± 1 points for NECKLITE collar (p < 0.001). Ninety- -seven per cent of study participants declared, that they preferred the NECKLITE collar comparing to the Patriot cervical collar. CONCLUSIONS: A standard cervical collar causes an increase in pain due to the pressure on the mastoid processes and a sense of discomfort for the patient. The NECKLITE collar thanks to the possibility of better fit to the patient’s neck, does not cause any pain, and using this collar it is possible to perform endotracheal intubation without the need to unfasten it.

Background and aim: Recent American Heart Association guidelines from 2010 and 2015 stressed the importance of high-quality chest compression and defined standards for compression rate, depth, recoil, and maximal acceptable time for interruptions. High-quality cardiopulmonary resuscitation (CPR) is the “cornerstone” of a system of care that can optimise outcomes beyond the return of spontaneous circulation. Methods: One hundred medical students were enrolled to the study. Study participants, after attending a Basic Life Support Course according to American Heart Association 2015 guidelines, performed 2-min CPR on a Resusci Anne ® QCPR Mani­kin. The following data were collected: age, sex, and health status. The study made use of a Tanita MC-980 MA for body composition analysis. Results: Mean height of participants was 170.2 ± 8.3 cm, and mean weight was 65 ± 11.8 kg. Mean body mass index was 22.1 ± 2.7, and mean fat-free mass (FFM) was 50.1 ± 10.5 kg. The mean fat mass (FAT%) was 22.9 ± 7.6. Basal metabolic rate, FFM, trunk muscle mass, left arm muscle mass, and right arm muscle mass were positively correlated with compression depth (all p for trend < 0.05). Mean compression depth was 49.7 ± 8.4 (for female 48.7 ± 7.9 mm, for male 42.4 ± 9.5 mm; p = 0.144). Compression rate for males and females was the same, at 114 ×/min (p = 0.769). Conclusions: In our study, basal metabolic rate, FFM, trunk muscle mass, and left and right arm muscle mass were positively correlated with compression depth. Moreover, an arm muscle mass rise of 1 kg caused a rise of compression depth param­eter of 7.3 mm, while when chest compression was performed by females, a fall of compression depth of 3.3 mm was seen.

Sudden cardiac arrest (SCA) is a frequent cause of death in the developed world. Early defibrillation, preferably within the first minutes of the incident, significantly increases survival rates. Accessible automated external defibrillators (AED) in public areas have been promoted for many years, and several locations are equipped with these devices.The aim of the study was to assess the real-life availability of AEDs and assess possible sources of delay.The study took place in the academic towns of Poznan, Lodz, and Warsaw, Poland. The researchers who were not aware of the exact location of the AED in the selected public locations had to deliver AED therapy in simulated SCA scenarios. For the purpose of the trial, we assumed that the SCA takes place at the main entrance to the public areas equipped with an AED.From approximately 200 locations that have AEDs, 78 sites were analysed. In most places, the AED was located on the ground floor and the median distance from the site of SCA to the nearest AED point was 15 m (interquartile range [IQR] 7-24; range: 2-163 m). The total time required to deliver the device was 96 s (IQR 52-144 s). The average time for discussion with the person responsible for the AED (security officer, staff, etc.) was 16 s (IQR 0-49). The AED was located in open access cabinets for unrestricted collection in 29 locations; in 10 cases an AED was delivered by the personnel, and in 29 cases AED utilisation required continuous personnel assistance. The mode of accessing the AED device was related to the longer discussion time (p0.001); however, this did not cause any significant delay in therapy (p = 0.132). The AED was clearly visible in 34 (43.6%) sites. The visibility of AED did not influence the total time of simulated AED implementation.We conclude that the access to AED is relatively fast in public places. In the majority of assessed locations, it meets the recommended time to early defibrillation of under 3 min from the onset of the cardiac arrest; however, there are several causes for possible delays. The AED signs indicating the location of the device should be larger. AEDs should also be displayed in unrestricted areas for easy access rather than being kept under staff care or in cabinets.

Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.

INTRODUCTION: Ventricular tachycardia (VT) is a life-threatening event. The role of the medical rescue team is to diagnose this disorder on the basis of resuscitation guidelines and general recommendations concern­ing ECG diagnoses. Patients with ventricular tachycardia, as a result of cerebral hypoxia, may react with aggression. In such situations, taking one’s medical history, conducting a physical examination or attempting emergency rescue operations may become difficult, or even impossible. OBJECTIVE: The objective of the paper is to demonstrate the issue of unintentional aggression that may occur in patients with ventricular tachycardia (VT) with a high heart rate and a short episode of cardiac arrest (CA), and the impact of such a disorder on attempted medical rescue operations. MATERIAL AND METHODS: The analysis of the case study was performed on the basis of medical documen­tation, i.e. an emergency dispatch order and an emergency medical services form. CASE DESCRIPTION: A medical emergency unit stationed at one of the substations in Łodź Province, 27 km away from a multi-disciplinary hospital, received a call from a medical dispatcher. The person calling emer­gency services requested the urgent arrival of an ambulance for her husband, who had suddenly passed out and was now lying on the kitchen floor showing no signs of life. In the course of the ambulance’s arrival at the location, the patient’s wife urged the ambulance to arrive soon, on account of her husband’s aggres­sive behaviour. CONCLUSIONS: Cardiac dysrhythmia and particularly ventricular tachycardia (VT) may constitute a serious health issue for the patient. The clinical picture may also vary across patients. An analysis of the case study demonstrates that medical personnel must be prepared to handle unconventional scenarios. The article shows that the procedure of cardioversion may be the only right choice when handling a patient with an unstable tachycardia.

BACKGROUND: Endotracheal intubation in cardiopulmonary resuscitation conditions is the gold standard for the protection of airway patency, allowing for both ventilation with positive pressures and continuous moni­toring of carbon dioxide concentration in the exhaled air, as well as enabling continuous chest compressions. AIM: The aim of the study was to compare the effectiveness of endotracheal intubation performed with the usage of Macintosh laryngoscope in two positions: behind the patient’s head and in the face-to-face position. METHODS: We included 54 students during their final year of medicine in the study. All of participants declared the ability to perform endotracheal intubation based on direct laryngoscopy. Prior to the study, all participants took part in the training in laryngoscopy and cardiopulmonary resuscitation. During the study, the participants performed intubation in the simulated resuscitation environment in two scenarios: Scenario A — intubation from behind the patient;s head, Scenario B — face-to-face intubation. Participants had a maximum of three intubation attempts. The chest compressions were paused during the procedure. RESULTS: The effectiveness of the first intubation attempt in the case of scenario A was 44.4%, while in the case of scenario B — 24.1%. The overall success ratios of intubation for scenarios A and B were 88.9% vs. 53.7%, respectively. The median intubation time during scenario A was 43.5 [IQR; 34–53.5] seconds, and 54.5 [IQR; 38.5–59.5] seconds for scenario B. CONCLUSIONS: In the study, intubation performed by final-year medical students while taking a position behind the head of the victim was of a higher efficiency when compared to the face-to-face position.

Coronavirus disease 2019 (COVID-19) is rapidly spreading globally. As of October 3, 2020, the number of confirmed cases has been nearly 34 million with more than 1 million fatalities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is accountable for COVID-19. Newly diagnosed and worsening cardiovascular disease are common complications in COVID-19 patients, including acute cardiac injury, hypertension, arrhythmia, myocardial infarction, heart failure and sudden cardiac arrest. The mechanisms contributing to cardiac disease burden include hypoxemia, inflammatory factor storm, dysfunctional angiotensin converting enzyme 2 (ACE2), and drug-induced cardiac toxicity. Notably, the macrophages expressing ACE2 as direct host cells of SARS-CoV-2 secrete chemokine and inflammatory cytokines, as well as a decrease in cellular immune responses to SARS-CoV-2 infection due to elevated exhaustion levels and dysfunctional diversity of T cells, that may be accountable for the “hyperinflammation and cytokine storm syndrome” and subsequently acute cardiac injury and deteriorating cardiovascular disease in COVID-19 patients. However, no targeted medication or vaccines for COVID-19 are yet available. The management of cardiovascular disease in patients with COVID-19 include general supportive treatment, circulatory support, other symptomatic treatment, psychological assistance as well as online consultation. Further work should be concentrated on better understanding the pathogenesis of COVID-19 and accelerating the development of drugs and vaccines to reduce the cardiac disease burden and promote the management of COVID-19 patients, especially those with a severe disease course and cardiovascular complications.

This article deals with the question of the influence of preparations that contain pharmacological doses of iodine on the functional activity of the thyroid gland. In the practice of a cardiologist amiodarone and x-ray contrasting substances are often used that may induce thyroid disorders in many ways, followed by hypothyroidism and thyrotoxicosis development.

INTRODUCTION: The administration of fluids, drugs and blood products is frequently indicated in patients suffering from serious injury or illness in the out-of-hospital emergency setting. Placement of a peripheral venous catheter may be challenging and several insertion attempts may delay intravenous therapy. Intraosseous access serves as a valuable alternative. However, this technique is rarely performed and knowledge of its use may not remain satisfactory in out-of-hospital Emergency Medical Service (EMS) personnel. METHODS: A written invitation to participate in this questionnaire study was sent to all EMS providers in Poland. Participants were asked to answer an online questionnaire consisting of 10 questions about their knowledge, ex­perience, and training of intraosseous devices. All answers were collected and processed anonymously. RESULTS: 438 out of 550 Polish EMS providers with a median experience of 5 years completed the questionnaire. Although 88% confirmed that there is an intraosseous access device available in their ambulance, only 47% had previously performed the procedure. Moreover, 48% reported subjective psychological barriers to obtaining an intraosseous access and 37% reported that intraosseous access should not be performed on paediatric patients. DISCUSSION: Intraosseous devices are widely available in many ambulances. Experience and knowledge regarding intraosseous access remains unsatisfactory among Polish EMS providers. Critical review of training and education curricula is therefore indicated.

Introduction Pediatric cardiac arrest is an uncommon but critical life-threatening event requiring effective cardiopulmonary resuscitation. High-quality cardio-pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two-thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist-clenched. This technique might facilitate adequate chest-compression depth, chest-compression rate and rate of full chest-pressure relief. Methods 42 paramedics from the national Emergency Medical Service of Poland performed three single-rescuer CPR sessions for 10 minutes each. Each session was randomly assigned to the conventional two-thumb (TTHT), the conventional two-finger (TFT) or the nTTT. The manikin used for this study was connected with an arterial blood pressure measurement device and blood measurements were documented on a 10-seconds cycle. Results The nTTT provided significant higher systolic (82 vs. 30 vs. 41 mmHg). A statistically significant difference was noticed between nTTT and TFT (p Conclusions The new nTTT technique generated higher arterial blood pressures compared to established chest compression techniques using an infant manikin model, suggesting a more effective chest compression. Our results have important clinical implications as nTTT was simple to perform and could be widely taught to both healthcare professionals and bystanders. Whether this technique translates to improved outcomes over existing techniques needs further animal studies and subsequent human trials.