Tomasz Kucmin

Distribution of injuries among patients of Department of Trauma and Emergency Medicine of Independent Public Teaching Hospital No. 1 in 2011

Abstract Introduction. Injuries are an extremely important public health problem, in both developed and developing countries. Various traumas contribute to some one third of deaths of the entire human population followed by cardiovascular diseases and cancer only. Understanding the epidemiology of trauma might improve hospitals’ ability to provide proper diagnoses and treatment. Aim. The aim of this study was to provide epidemiological characteristics of injuries in the analyzed group of patients. Material and methods. A retrospective analysis of patients admitted in state of emergency and hospitalized in the Department of Trauma Surgery and Emergency Medicine at the Medical University of Lublin due to injuries that occurred from January 1st 2011 till December 31st 2011 was conducted. Mechanism of injury, mortality rate, age and gender correlations were studied. Results. Some 485 patients were looked at in the study. The mortality rate reached 4.52% and was highest among males. Falling was the leading cause of injuries among patients Discussion. The results of this study correspond with the observations of other authors concerning the age distribution. Mortality rates noticed in this study were lower than in other studies. Conclusions. Trauma in elderly patients is a growing problem in trauma centers. Moreover, in the analyzed material incidence of blunt and non-transport related injuries increased.

History of trauma and posttraumatic disorders in literature

In 1980 a third edition of Diagnostic and Statistical Manual of Mental Disorders (DSM) brought diagnostic criteria for a new diagnosis - posttraumatic stress disorder (PTSD). This disorder is a result of highly intensive stressor and in many cases leads to sever psychiatric distress. Despite relatively recent introduction of PTSD as a new diagnosis, this disorder was excessively described in scientific papers as well as in fiction novels. Analysis of those descriptions across ages allows for the conclusion that character and type of stressors has changed, however, peoples reactions to highly intensive stressors are basically similar. First descriptions are found in notes of Egyptian physicians and then in papers of Homer, Herodotus and Plutarch. In consecutive parts of this paper, the authors present history of posttraumatic stress disorder describing contribution of Polish authors - Kepiński and Szymusik. Presented historical perspective of posttraumatic stress disorder allows for better understanding of reasons for introducing PTSD into classifications as well as controversies related to it.

Modern methods of treatment of post-traumatic bone defects in Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin

Abstract Motor organ injuries are one of the most common consequences of trauma, out of which comminuted fractures with a bone loss are the most challenging. Numerous methods are applied to treat these injuries; however, still in many cases we are unable to suggest successful medical treatment. Therefore, treating these injuries using elastic and surgically handleable bone replacement materials was started at Trauma Surgery and Emergency Medicine of Medical University of Lublin (provided for the experiments by Medical Inventi Lt). Preliminary assessment based on the results of treatment with bone replacement materials of two patients with comminuted fractures of femur was promising. Bone union was achieved without any adverse effects.

Rules, indications and documentation for applying physical coercion by emergency medical services

Abstract Helping people with mental disorders poses a challenge to the members of medical emergency services (EMS). Psychiatric patients are often unpredictable and applying physical coercion is necessary in some cases. The aim of this paper was to present and comment on legal foundations of application of different forms of physical coercion by EMS members and describe how to fill out medical records required every time physical coercion was used. According to the amendments of Polish Mental Health Act made in 2010, the EMS members were granted the right to apply physical coercion. Further amendments to the Mental Health Act and the introduction of appropriate Ministry of Health decree define forms of physical coercion, indications to apply physical coercion and include a sample of proper medical records which are required in all cases of application of physical coercion. Application of physical coercion should always be treated as last-line treatment option while helping patients suffering from mental disturbances. Obeying the law every time a decision regarding physical coercion is made protects patients’ right to receive dignified care and treatment as well as the rights of medical professionals

Life-threatening conditions in psychiatry – neuroleptic malignant syndrome (NMS)

The introduction of neuroleptics in the 1950’s was a turning point in psychiatric treatment. The new drugs brought hope to millions of patients and their doctors. However, there were also some side-effects, one of which is Neuroleptic malignant syndrome (NMS), a rare complication of antipsychotic treatment and untreated it may lead to mortality as high as 20%. The incidence of NMS, estimated to be 0.01–0.02%, has decreased significantly probably due to higher awareness of the diseases and shift to atypical antipsychotics. The aim of this study was to present the signs and symptoms of this rare condition and describe management possibilities since this condition is observed not only in psychiatric departments but also in emergency rooms. NMS is thought to be related to change caused by neuroleptics within the central nervous system due to dopamine D2 receptor antagonism, especially nigrostriatal pathways and the hypothalamus. There are three symptoms which are considered as major and indicate a high probability of NMS: muscle rigidity, hyperthermia (core body temperature above 38.5 °C), and elevated creatine phosphokinase concentration (above 1000 U/l). NMS is a diagnosis of exclusion and clinicians must be vigilant in detecting early signs of NMS. The basic management in NMS is antipsychotic discontinuation and proper supportive care of the patient (vital signs monitoring, hydration, correction of electrolyte and acid-base disturbances). In more severe cases, the introduction of bromocriptine or dantrolene, as well as benzodiazepines, may indicated. Further usage of neuroleptic in patients with a history of NMS should be with care, and low doses of low-potency neuroleptics or atypical neuroleptics seem to be the best treatment choice.