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Signa Vitae

Journal of Intensive Care and Emergency Medicine

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The significance of pre-existing knowledge of the latest guidelines for cardiopulmonary resuscitation in successful basic life support education of Belgrade sixth year medical students


Introduction. The latest Guidelines for cardiopulmonary resuscitation (CPR) were published in 2010. The aim of the implementation of basic life support (BLS) guidelines is the introduction of uniform criteria within the domain of cardiac arrest diagnostics and treatment both for lay rescuers and first line lifesavers without formal medical education as well as for medical personnel who happen to be in the role of the event witness but without medical equipment and outside of their working place.

Objective. The goal of this study was to investigate the significance of pre-existing knowledge of the latest 2010 Guidelines for CPR for achieving successful training in BLS among 6th year students of the Belgrade School of Medicine.

Methods. In a five-month prospective study of 6th year medical students doing a clinical internship at the Belgrade Emergency Medical Services (EMS) were in a peer training on the application of BLS. At the beginning and at the end of the training program, the students had to pass entrance (E) and final (F) tests composed of 25 identical questions. Using the E test, the students’ knowledge of the latest CPR Guidelines was tested; they were classified into groups with pre-existing knowledge (group I) and groups without pre-existing knowledge (group II). By comparing data from E and F tests we analyzed the influence of training on the improvement of pre-existing knowledge or gaining new knowledge in BLS and first aid.

Results. A total of 423 students were tested. The analysis of obtained data showed that in group I there was a statistically significant difference between correct and incorrect responses to eleven questions on the F and E tests. In group II there was a statistically significant difference between test responses in the E and F tests to 17 questions. In group II, knowledge additionally improved after training so that in the F test, a statistical significance in correct answers was achieved with regard to 8 questions in relation to the E test (p<0.05). There was a statistically significant difference between correct and inaccurate answers in tests F and E with regard to 10 questions. In the entire group of students, a total statistical significance (p<0.05) was achieved in answers to as much as 25 questions.

Conclusion. Among 6th year medical students without pre-existing knowledge of the latest 2010 CPR Guidelines, BLS training considerably improved their previously acquired knowledge. Also, students with good pre-existing knowledge, showed a considerably higher level of acquired knowledge after implemented training. A future study with a longer follow-up period to estimate the effect on long-term retention of learning outcomes is needed.

Key words: latest CPR Guidelines, knowledge, BLS, education, students

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Predictors of 30-day mortality in medical patients with severe sepsis or septic shock


Objectives. To evaluate independent predictors of 30-day mortality in patients with severe sepsis or septic shock.

Background. Severe sepsis and septic shock are associated with increased mortality. Admission APACHE II score is the gold standard for assessing prognosis in critically ill, but several other predictors of mortality have been evaluated.

Methods. We retrospectively evaluated clinical and laboratory data in adult patients with severe sepsis or septic shock as predictors of 30-day mortality.

Results. Thirty-day mortality was 62.7%. Nonsurvivors in comparison to survivors were significantly more likely to be treated with noradrenalin, renal replacement therapy, mechanically ventilated, to have suffered a fungal infection, had lower admission arterial pH, increased admission Acute Physiology, Age, Chronic Health Evaluation (APACHE) II score and a higher peak lactate level (5.6 ± 6.2 vs 3.1 ± 1.75, p=0.021). Binary logistic regression demonstrated that only peak in-hospital serum lactate level was a significant independent predictor of 30-day mortality (OR 1.367, 95% CI 1.041 to 1.795, p=0.025).

Conclusion. Only peak in-hospital lactate significantly and independently predicts 30-day mortality in severe sepsis or septic shock medical patients.

Key words: severe sepsis, septic shock, 30-day mortality, serum lactate

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Radiation exposure from computed tomography in blunt trauma patients


Introduction. Computed tomography (CT) has many diagnostic advantages, spurring growth in the number of CT examinations. As the use of CT increases, the potential for radiation-induced adverse effects has become an issue. The primary objective of this study was to assess the liberal use of CT induced radiation exposure in patients with multiple blunt traumas. The secondary objective was to investigate the factors affecting the estimated effective dose resulting from CTs unrelated to final diagnosis.

Methods. Using data from our hospital information system, we selected patients assigned a trauma code, according to the Korean Standard Classification of Diseases, and with three or more body lesions assessed by CT at the same time in the emergency department. Each CT conducted was categorized into ‘CT related to the final diagnosis’ or ‘CT unrelated to final diagnosis’. The characteristics and estimated effective dose of CTs unrelated to the final diagnosis were analyzed. The factors affecting the estimated effective dose of CTs unrelated to final diagnosis were investigated.

Results. More than half of all CT examinations were not associated with the final diagnosis. The additional estimated effective dose due to CTs being unrelated to the final diagnosis in each patient was a sufficient amount of radiation exposure to increase the possibility of fatal cancer.

Conclusion. A considerable number of CT scans were unrelated to the patient’s final diagnosis, which exposes the patient to additional radiation exposure.

Key words: radiation, trauma, computed tomography

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Stab wound leading to sub lingual haematoma


We report a case of a sublingual haematoma and proptosis of the right eye as a result of penetrative injury to the suprazygomatic supratemporal fossa. The case was seen in the accident and emergency department at the Royal London Hospital (RLH). The case was referred to the anaesthetic and oral and maxillofacial unit, following neurosurgery and ophthalmology assessments.

The case highlights the need for a multi disciplinary approach to dealing with penetrative wounds in the craniofacial region. It is essential that all healthcare professionals have excellent working knowledge of the anatomy of the orbit and its association with anatomical planes in the head and neck. (1) When diagnosing orbital compartment syndrome (also known as retrobulbar haemorrhage), radiographic findings should always be correlated to clinical signs and symptoms. Management of such a condition should be tailored to the individual. In this case medical management alone of 80mg of dexamethasone and 500mg of Mannitol was appropriate to enable a full recovery.

Key words: haematoma, airway obstruction, preoperative procedure, retrobulbar haemorrhage, floor of mouth

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Influenza A (H1N1)-induced ischemic stroke in a child: case report and review of the literature


Ischemic stroke is an important cause of death and long term morbidity in children. Viral respiratory infections are emerging as important risk factors responsible for ischemic stroke in this age group. The direct action of virus against cerebral vessels, autoimmune reactivity, and increased production of cytokines are advocated as the main factors for causing ischemic stroke. This study can be useful for clarifying some molecular aspects of H1N1 virus infection in children.
We report on the case of a H1N1-induced ischemic stroke in a Caucasian 2 year-old female. The cerebrospinal fluid samples showed the positivity of polymerase chain reaction for influenza A (H1N1) infection, confirmed also by pharyngeal swab culture. Increased levels of cerebrospinal fluid interleukin 6 and interleukin 1β were also detected.
H1N1 virus infection has been identified as an important cause of neurological involvement in children. The findings of increased levels of Interleukin 6 and interleukin 1β in the cerebrospinal fluid of this child with H1N1 induced-ischemic stroke seems to validate the role of pro-inflammatory cytokines as crucial mediators of cerebral thrombus formation.

Key words: children, H1N1 influenza virus, interleukins, ischemic stroke

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