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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

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Assessment of basic life support skills among medical doctors and technicians in Belgrade emergency medical services


Objective. Our aim was to assess BLS (basic life support) skills among medical doctors (MDs) and medical technicians (MTs) who work at Belgrade Emergency Medical Services (BEMS).

Methods. A prospective study was conducted between 28 September and 9 December, 2016. MDs (Group 1) and MTs (Group 2) attended an accredited course in BLS at BEMS. At the end of the course the participants were given a written test consisting of 20 questions (pass rate 65%). The results were analyzed for each group i.e. profession (Group 1 and Group 2) according to the number of accurate and inaccurate answers to each question. In the end, a number of participants from each group, who answered all 20 questions correctly, were identified. The results obtained, by test analysis, demonstrated the participants’ acquired BLS skills.

Results. The study involved 100 participants (50 in each group). All participants from Group 1 correctly answered questions number 1, 2, 3, 10, 13, 17 and 20. In Group 1 only two participants had three incorrect answers in the test. The largest number of incorrect answers was related to question number 16. Thirty-four participants in this group answered all questions correctly. All participants from Group 2 gave correct answers to questions number 2, 5, 9, 10 and 13. In Group 2, one participant had six incorrect answers and one participant had 5 incorrect answers. The largest number of incorrect answers was related to questions number 3 and 20. Nineteen participants from Group 2 answered all questions correctly. The rate of correct answers between Group 1 and Group 2 was 19.66 : 18.91 (0.75 difference).

Conclusion. The research showed a satisfactory level of knowledge in both groups. However, there is a statistically significant difference in the knowledge of MDs after the BLS course. The results obtained justify the ambitions that all healthcare professionals, regardless of their qualifications, should be trained in applying BLS, both at work and as eyewitnesses.

Key words: basic life support, knowledge/skills, doctors, medical technicians, emergency service

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Medical emergencies in dental offices in Slovenia and readiness of dentists to handle them


Introduction. Dentists, and all other dental healthcare workers, can expect to face a medical emergency directly or indirectly related to dental treatment. This study evaluates the incidence of medical emergencies in dental offices in Slovenia, the readiness of dentists and possession of specific medical equipment.

Methods. An anonymous online based questionnaire was sent through the Medical Chamber of Slovenia via email to all 1503 active dentists in Slovenia. The questionnaire was pilot-tested on 25 dentists and improved accordingly. Thirty closed-ended questions were answered by 289 (19.2 %) dentists.

Results. 93.4 % (n=267) of dentists reported a medical emergency in their dental office. The most prevalent diagnosis was syncope (1.88-2.44/dentist/year) followed by hypoglycaemia (0.20-0.25/dentist/year), hypertensive crisis (0.4/dentists/year) and anaphylaxis (0.3/dentists/year). There were no cardiac arrests reported in the dentists’ entire careers. 85.1 % (n=239) of dentists underwent postgraduate BLS training, 87.4 % (n=209) of them in the last 5 years. Responding dentists estimated that they are most capable of dealing with syncope and least proficient in dealing with stroke, cardiac arrest and a hypertensive crisis. They felt generally more prepared to manage than diagnose a medical emergency. Only 58.1 % (n=161) of dentists have access to a self-inflating bag with a reservoir, and 54.9 % (n=152) to an oxygen mask. Only 4.0 % (n=11) of them have a full set of equipment recommended by Medical Chamber of Slovenia.

Conclusions. Results support modification of the undergraduate and postgraduate curriculum for dental students to address specific medical emergencies and the usage of limited equipment. They support more rigorous regulations concerning postgraduate education and specific equipment for dealing with medical emergencies in dental offices in Slovenia.

Key words: emergencies, dental office, equipment, curriculum

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Focus on children murdered by parents in Italy: A sad reality


With a documented history of over a century, it is noted that child murders, perpetrated by their own parents, are an interesting and dramatic phenomenon in the Italian territory. There are three forms of child homicides: neonaticide, infanticide and filicide.

Thanks to several legal reports and studies, it is possible to draw the profile of the typical murderer: usually a young, Northern Italian woman, unemployed, in a conflicting relationship and suffering from psychiatric disorders. In most cases, the crime takes place at home. No particular method for committing the murder is preferred, but the death of the child can be due to different causes.

Precautionary measures should be taken: parents should never be left alone facing health or psychiatric problems, families should be helped and supported during difficult times, women should be well-informed and aware of their rights.

Key words: forensic science, neonaticide, infanticide, filicide, childhood, rights

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Do we need an individual approach to atrial fibrillation and adrenergic overload in the critically ill?


Despite catecholamines being lifesaving drugs, they can also be harmful. Adrenergic overload is one of the major promoters of supra- and ventricular arrhythmias, which induce hemodynamic instability in the critically ill. In this paper we will focus on the pathophysiology of atrial fibrillation (AF), the importance of adrenergic overload for triggering AF, the importance of the autonomic nervous system and finally, we will challenge the importance of decreasing adrenergic load with selective and non-selective β-blockers, which have different effects on the metabolism in the severely ill. We will also emphasize the importance of an individual approach due to pharmacogenetic differences in β-adrenergic signalling.

Key word: catecholamine, atrial fibrillation, beta-blocker, metabolism, resting energy expenditure

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Neuromuscular blockade in clinical practice in paediatric anaesthesia: retrospective cohort trial in a tertiary paediatric anaesthesia centre


Background. Neuromuscular blockade is associated with improved airway conditions for intubation and superior conditions for surgical interventions (predominantly important in laparoscopic surgery). Residual neuromuscular blockade in the postoperative period is, according to recently published data, associated with a negative impact on perioperative morbidity and mortality.

Aim. The aim of the study was to describe daily practice in clinical paediatric anaesthesia in a tertiary children’s hospital.

Methods. Data from anaesthesiology records during the period 1.1.2016 to 31.12.2016 were retrospectively screened. Primary outcomes included the rate of surgery cases with neuromuscular blockade, the incidence of cases with perioperative neuromuscular blockade monitoring and the incidence of neuromuscular pharmacologic block reversal. Secondary outcomes were myorelaxant usage according to the age of patients and duration of surgery.

Results. Overall 8046 paediatric patients underwent general anaesthesia in the study period. Muscle relaxants were administered in 1650 cases (20.5%). The most frequently administered muscle relaxant was mivacurium (48.2 %, n=795), followed by cis-atracurium (36.4 %, n=601), suxamethonium (10.3 %, n=170) and rocuronium (7.0 %, n=115). Neuromuscular blockade monitoring was used only in 2.5% (n=41) of cases. Active neuromuscular blockade reversal was administered in 5.8% (n=95) of cases.

Conclusion. Neuromuscular blockade in paediatric anaesthesia was less frequent compared to adults. The low rate of neuromuscular blockade monitoring in combination with the low rate of active block reversal can be considered dangerous due to the relatively high risk of potential residual postoperative blockade, that can negatively influence clinical outcome.

Key words: neuromuscular blocking agent, paediatric anaesthesia, residual blockade, neuromuscular blockade

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