Diagnostic Challenges in the Emergency Setting

Abstract

Healthcare professionals working in the prehospital emergency setting as well as in the Emergency Room (ER) face a multitude of challenges. They are required to set up a timely diagnose and initiate treatment encompassing a wide range of diseases involving critical thinking and be knowledgeable in various areas of the medical field. This thesis includes two important studies. Both demonstrate the difficulties inherent in Emergency Care. In periarrest situations and during resuscitation it is essential to rule out reversible causes, including hyperkalemia, which is a relatively common condition and may lead to fatal cardiac arrythmias. The ECG signs of hyperkalemia, such as peaked T waves, AV blocks, widening of the QRS and ventricular fibrillation have already been documented. The goal of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients. By investigating the frequency of ECG changes in both groups of patients we aimed to elucidate whether these ECG alterations may facilitate recognition of hyperkalemia in the prehospital setting. Case reports within medicine are important because they describe the special aspects and treatment options of certain medical conditions. Therefore, we found it important to describe the rare case of a snake envenoming by the Vipera berus bosniensis. In Europe there are three species of venomous snakes categorized as medically important, from which Vipera berus is the most widespread species. Envenomations mostly cause local symptoms, but have been associated with causing systemic symptoms, such as hypotension, gastrointestinal and coagulation disorders and neurotoxicity as well. The aim of our case presentation was to describe the course of the illness and its treatment and so to expand the knowledge about V. b. bosniensis envenomings.