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Emergency Medicine does not represent a simple collection of various medical conditions, but rather an urgent approach to life threatening conditions. This urgent approach progresses as fast as the science in medicine does. Modern protocols for treatment of injured and ill patients are introduced, demanding more and more knowledge and skills as well as more modern equipment and wider spectrum of drugs. However, innovations are not followed by changes within the lists of medications set by National Health Insurance Fund of Serbia (NHIFS). Paper describes drugs necessary for adequate pre-hospital treatment that are not available to the physicians due to administrative barriers. On one hand, there are drugs from B list that are necessary for treatment, and are approved for use by NHIFS at hospital level only. The use of any of these drugs at pre-hospital level may lead to severe penalties to the physician in case of complications or adverse reactions in a patient following the treatment. On the other hand, there are drugs from D list which are also necessary for the urgent treatment of patients with life threatening conditions, according to latest recommendations. These drugs may be applied at pre-hospital level, but their procurement is complicated due to NHIFS regulations and that's why some of them may rarely be used (Propafenone and Magnesium sulfate). We particularly emphasize that one of the most effective drugs for the conversion of heart rhythm, Adenosine (6 mg/ml and 10mg/ml ampoule), is not registered in the Republic of Serbia and therefore cannot be used at pre-hospital level. Through these exclusive administrative barriers adequate treatment is rendered impossible while the system of urgent treatment of patients with life threatening conditions at pre-hospital level is degraded.

Rotator cuff disease, external and internal impingement syndromes, low shoulder stability, various types of trauma, and overuse injuries are all related to sports activities. In order to check symptoms in patients with disability and shoulder pain, clinicians use different methods and diagnostic imaging assessment. The research is aimed at evaluating whether there is a difference between provocation function tests (PFT) and ultrasonographic (US) testing of muscles within the rotator cuff in elite collegiate athletes. Patients ( n = 184 ) were recruited from university team sports selections and tested with a standardized US examination of the shoulder and five PFTs (Speed’s test, Neer’s test, Hawkins test, lift-off test, Yergason’s test). Based on the VAS pain assessment scale, 60 subjects had some pain, which was taken for further processing in the work (124 subjects did not have the presence of pain and were excluded from further processing). The US examination was conducted using Voluson 730 apparatus, by a linear probe, with the frequency in the range of 6-12 MHz. The chi-square test showed significant differences between PFT and the occurrence of shoulder muscle tendinitis for the following variables: Speed’s test and subscapularis tendinitis ( p = 0.02 ) and Speed’s test and infraspinatus tendinitis ( p = 0.01 ); Neer test and biceps brachii caput longum tendinitis ( p = 0.01 ), Neer test and supraspinatus tendinitis ( p = 0.02 ) and Neer test and infraspinatus tendinitis ( p = 0.01 ); lift-off test and subscapularis tendinitis ( p = 0.05 ); and Yergason’s test and biceps brachii caput longum tendinitis ( p = 0.03 ) and Yergason’s test and subscapitis tendinitis ( p = 0.01 ). The greatest effect of differences was observed in Neer’s test and biceps brachii caput longum tendinitis ( φ = 0.60 ), while the other effects can be described as medium and small in most cases. It can be concluded that functional tests are good predictors of soft tissue changes in the muscles of the rotator cuff of the shoulder. Further monitoring and analysis are needed on a larger number of athletes.

Background/Aim: Cardiac arrest (CA) is a leading cause of mortality in the last forty years worldwide. Immediately initiated cardiopulmonary resuscitation (CPR) improves chances for survival. Aim of this study was to determine the efficiency of the Emergency medical service (EMS) dispatch centre in the absence of the uniform emergency medical dispatch assessment protocols in the management of cardiac arrest. Methods: The retrospective and observational study was conducted in Institute for Emergency Medical Service Novi Sad (IEMS Novi Sad) Serbia during a one-year follow-up. The study included patients with out-of-hospital cardiac arrests who underwent CPR. Results: EMS teams of the IEMS Novi Sad had 198 CPRs in the follow-up period. In 142 (71.72 %) calls, the EMS dispatcher got information that the patient was unconscious. The reported reaction time I by the dispatchers for the unconscious patients was 1.37 ± 1.27 minutes, actual duration of the conversation between the dispatcher and a caller - was longer: 138.21 ± 103.02 seconds (p < 0.001). The average conversation time with a caller was 61.37 ± 31.13 seconds. In 6 (4.22 %) cases, the EMS team was dispatched to a patient before the phone call was terminated. At the moment of arrival, all patients were unconscious, 194 (94.37 %) were pulseless, while the remaining 8 (5.63 %) experienced cardiac arrest during the examination. The cardiac arrest was witnessed by a layman in 120 (84.51 %) cases and CPR was initiated by bystanders, before the arrival of the EMS team, only in 13 (10.83 %) patients. Twenty-seven (19.01 %) patients arrived in a hospital with vital signs. Conclusion: The absence of the uniform EMS dispatch assessment protocols for the triage of incoming calls and phone assisted CPR for lay rescuers decreases the survival rate of patients with cardiac arrest.

Introduction. Cardiac arrest (CA) is defined as a sudden cessation of normal circulation of blood due to failure of the heart to contract effectively during systole. Objective. The aim of this study was to determine the difference in outcome among patients, depending on the location of out-of-hospital CA; to determine the influence of observed determinants on the survival rate. Methods. Observational and retrospective study was conducted in the Institute for Emergency Medical Service Novi Sad (IEMS NS). It included patients who underwent cardiopulmonary resuscitation (CPR) by medical ambulance squads. Patients were divided into three groups, based on the location of CA: private place, public place, and medical institution. Results. CA occurred in private places in 151 cases (76.26%). The shortest duration of a phone call with the dispatcher and Reaction Time I was in the group of patients with CA in a public place (59.1 ± 36.4 seconds and 137.1 ± 89.8 seconds, respectively). CA was recognized in more than 80% of cases, but CPR was initiated in only 9.09% of patients in private places and in 19.35% of patients in public places. Though they initially presented with shockable rhythm in 57.14% of cases in public places, this group has the worst immediate outcome (11.43%), in contrast to the patients with CA in medical institutions (58.33%). Factors determining the survival of patients with CA were CPR attempted immediately after collapse, initial rhythm and eyewitnesses of CA. Conclusion. In order to improve survival of patients with out-of-hospital CA, both education of laymen and introduction of standard questioning protocol in the IEMS Call Centre are necessary. [Projekat Ministarstva nauke Republike Srbije, br. 175007]

Aim: to present basic demographic characteristics for accidentally intoxicated patients in the municipality of Becej and the possibility of their treatment at the Emergency Department, Health Care Centre, Becej (EDHCCB), depending on the substances eaten in the cases of intoxications. Material and methods: A retrospective, observational study was used in the research conducted at the Emergency Department Health Care Centre Becej (ED Becej). The target group included intoxicated patients treated from 1 January 2010 till 31 December 2010. The data were collected from the ambulance protocol and field teams protocols and were analysed by means of statistical packages - Statistica 7 and SPSS 11. Results: During the respective period, 29,670 patients were examined at the EDHCCB. Poisoning was diagnosed in 195 (0.66%) patients of which 126 (64.62%) were male and 69 (35.38%) female. The mean age of the poisoned patients was 36.79±17.36. Disturbance of consciousness was found in 47(24.10%) intoxicated patients. Most intoxications had been caused by alcohol (100patients -51.28%), by drugs (62 patients - 31.79%) or by a combination of alcohol and drugs (8 patients - 4.10%). Opiates, household cleansers, petroleum based products, herbicides, carbon monoxide or insulin were identified as toxins in other cases. After initial treatment and a period of observation 122 (62.56%) intoxicated patients returned home without the need for further treatment. Patients' referral of to secondary and tertiary health institutions depended on oxygen saturation in peripheral blood, states of consciousness, type of toxin and previous psychiatric illness. Of 73 (37.44%) patients referred to secondary and tertiary institutions, 6 patients did not survive, meaning that the mortality rate in the observed sample was 3,08%. Conclusion: Numerous cases of intoxicated patients are registered each year. The most commonly used substances for intoxication are from their immediate surroundings which are generally non-toxic in small doses, so that primary care physicians can perform detoxification of patients with mild cases of poisoning. So in cases when secondary and tertiary medical institutions are far to reach, primary care physicians can perform triage and refer only heavily intoxicated patients to hospital.

Introduction: Cardiac rhythm disturbances in children are rare and do not have to be associated with structural damage to the heart muscle. The most common are paroxysmal atrial tachycardia with an incidence of 1:500. These tachyarrhythmias in children are characterised by the number of strokes ranging 160- 360. Aim: The aim of this paper is to present the quality of life in children with paroxysmal supraventricular tachycardia (PSVT), and the role of Emergency Department (ED) in the treatment of attacks of tachycardia. Case report: A girl aging 7 was taken by her mother to the Emergency Department of Health Care Centre (HCC) Becej on 1st November 2008 at 17:09 for palpitations. The attack occurred in the child for the first time, in an effort, half hour earlier. Clinical examinations revealed that the patient was hypotensive (TA 85/50 mmHg), tachycardia (300 beats/min) with oxygen saturation in the peripheral blood of 100%. On electrocardiogram (ECG) recorded the reading in sinus rhythm 300/min in frequency, levogram, the displacement of the ST segment in all leads of 3-5mm. Accompanied by a nurse, the patient was transported and diagnosed with Tachycardia Parohysmalis ( I 47.) without any pre-hospital therapy applied. She was hospitalized for ten days at the Cardiology Department of the Institute for Health Care of Children and Youth, Novi Sad (Novi Sad IZZZDiO). She was discharged with the diagnosis of Tachycardia Paroxysmalis Supraventrikularis (I 47.1) and Propranolol therapy was recommended. In spite of the treatment, attacks of PSVT were still being recorded in the patient. The therapy was replaced by the cardiologist. The applied therapy included Presolol, then Amiodarone, and then combinations Amiodarone and Presolol and since Avgusta 2011 she started using Propafen tablets. Until 10th February 2013 the patient had 27 attacks of tachycardia in total. The patient was treated at the Children's Medical Centre Becej for five times, four times the ED HCC were invited to take her from the CMC and for18 times she was brought directly to the ED. In most cases, when the patient was cared for at ED HCC, PSVT was converted to sinus rhythm by Presolol or a combination of Presolol and Amiodaron. In two cases PSVT was converted by Valsalva maneuver. In two thirds of the visits, the patient was sent back home after the therapy and converting PSVT to a sinus rhythm. Nine times she was sent to IZZZDiO in Novi Sad, where he was hospitalized. Conclusion: If the PSVT attacks in children older than one, with a severe clinical course and frequent, continual medical therapy is applied. The highest efficiency is demonstrated by Amiodarone preventing the attacks in even 85% cases. However, in our patient the attacks continued despite of continuous drug therapy. They are frequent, with severe clinical course, limiting the child's daily activities. ED HCC physicians manage to convert most of the attacks to the sinus rhythm, so she does not have to be sent each time to a tertiary health institution and hospitalised.