In the age of advanced modern medicine, prolonging the lives of patients is becoming easier and easier. Science is even going so far that some authors are beginning to see the need to advocate for the patient's right to die. The authors of the recommended resuscitation procedures themselves state that prolonging the inevitable dying process should be considered a harm (dysthanasia). The issue of not initiating urgent resuscitation is part of not only clinical practice, but also the study of physicians and other health professionals. The various criteria, indications, and contraindications for this action are repeatedly discussed in the course of study and practice, but rarely does this discussion go into significant detail. The teaching is limited to their enumeration or description of some of the more clearly understood ones, which are, for example, certain signs of death and their presence. The terminal stage of an incurable chronic disease is only marginally mentioned as a contraindication to urgent resuscitation, perhaps due to its ethical and legal overlap. The article includes an analysis of the sources of regulation of this issue, focusing mainly on legal and professional sources and their relationship. It also describes the actual process of decision making about the initiation of palliative care, decision making about end-of-life care, including the issue of not initiating urgent resuscitation.

• Klíčová slova
• resuscitation, jurisprudence, death, palliative care, criminal behavior,
• MeSH
• lidé MeSH
• paliativní péče * zákonodárství a právo   etika   MeSH
• péče o umírající zákonodárství a právo   etika   MeSH
• resuscitační směrnice * zákonodárství a právo   etika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Advances in medicine have brought immense possibilities in therapy but at a price including tremendous financial costs and also protracted human suffering. Cardiopulmonary resuscitation (CPR) is an emergency procedure in patients with cardiopulmonary arrest. Out-come of the CPR depends upon the character and severity of the afflicting disease, upon the patient's condition before cardiopulmonary arrest and upon the response to therapy. CPR is instituted by emergency medical technicians automatically even in terminal condition of patients. Various models for prognostic prediction may confirm early decision about relevance of continuing treatment and writing a "DO-NOT-RESUSCITATE" order or withdrawing treatment. Numerous studies pointed out two exceptions, when CPR is not started and when the aggressive therapy is withdrawn-DNR order is written in the patient's medical record: 1. on the basis of autonomy the patient may not consent with CPR in advance or when he is incompetent, the family or surrogate decide to withdraw treatment: 2. physician is not obliged to provide diagnostic or therapeutical interventions (not even when requested by the family), when these acts are futile. The meaning of futility may be understood in a different way, but always the ethical principles must be considered: beneficence, maleficence, social justice and autonomy of the patient. In burn medicine, there are different factors encouraging the DNR orders, withheld and withdrawn treatment. This dilemma might be decided only by an interdisciplinary conference.

• MeSH
• chorobopisy MeSH
• dříve vyslovené přání MeSH
• etické komise MeSH
• kardiopulmonální resuscitace MeSH
• lékařská etika * MeSH
• lidé MeSH
• nemoc MeSH
• ochrana zájmů pacientů MeSH
• pacientova přání ohledně budoucí terapie MeSH
• péče o umírající MeSH
• popálení terapie   MeSH
• předpověď MeSH
• prognóza MeSH
• resuscitační směrnice * MeSH
• sociální spravedlnost MeSH
• výsledek terapie MeSH
• zbytečná diagnóza a terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Decisions related to the treatment of oncological diseases bring various ethical dilemmas to healthcare providers caring for cancer patients. Along with the development of medicine and new therapeutic methods, there are also increased demands on the appropriate selection of eligible patients for allocation to a particular treatment method, which causes a number of ethical connotations. The paper deals with ethical issues in the course of oncology treatment, with theoretical bases for ethical decision-making and with ethical aspects of communication with patients suffering from oncological diseases. The paper also contains results of studies that dealt with methods of ethical reasoning of health professionals in relation with the Do Not Resuscitate (DNR) decision in oncology, and with understanding of the concept of ethical competence of health professionals in order to make, or be involved in, DNR decisions, and how relevant skills can be developed. Among others, the results of the studies pointed out that in order to make ethically based DNR decisions in oncology, physicians and nurses need to improve their knowledge of ethical theories.

• Klíčová slova
• Medical ethics, ethical principles, ethical theories, ethics aspects, ethics dilemmas, ethics oncology, medical ethics,
• MeSH
• lékaři * MeSH
• lidé MeSH
• nádory * terapie   MeSH
• resuscitační směrnice MeSH
• rozhodování MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Advances in medical technology and practices have been associated with increasing medical specialization, but they have developed at a price. This price has included not only enormous financial costs, but the additional cost of dehumanized patient care, diminished confidence in the medical staff and, consequently, human suffering. Burn injuries are catastrophic in scope and require specialized, intensive and prolonged treatment from which ensure ethical and psychological problems often complicated by many individual factors. Some of them arising from the Code of Patients Rights not only in the Czech Republic and contribute to DNR decisions (do-not-resuscitate). Not only "Quantity" of life but also "Quality" of life should be considered, particularly in burns. Critical factor is age. In old patients more sophisticated medical knowledge and practice may actually contribute to suffering. At any age scarring represents a special type of disfigurement. The "burn image" is more likely to evoke public avoidance than sympathy. The non handicapped by their negative attitudes help create and perpetuate the handicap and the consequent burden of suffering in burn patients.

• MeSH
• dospělí MeSH
• kvalita života * MeSH
• lidé MeSH
• mladiství MeSH
• popálení patologie   chirurgie   MeSH
• předškolní dítě MeSH
• resuscitační směrnice MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zbytečná diagnóza a terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The prognosis of burn patients is dependent--apart from adequate treatment--upon health care system and health care professionals, regarding not only survival, but also life-long quality of life. The protection of patients' rights is spelled out in the European Countries' constitutions, charters or basic laws. The Code of Patients' Rights in the Czech Republic in 1992 entitles the patients to respectful and professional treatment, to be able to make decisions, ev. to refuse treatment, to the presence of their own families, to continuity of treatment after discharge, to withhold consent to students' participation in the curative process, to die with dignity. The increasing interest in economic justification of any treatment in the EU calls for considering the ethical aspects. There has been differentiated intuitive ethics, ethics based on principles of Hippocrates, ethics defined by duties, ethics defined by consequences, influencing the quality of life (Grant, 1998). The age of patients should not play any role in decision--making concerning diagnostic or curative procedures. However, in geriatric burn patients the "aggressive" therapy should not deteriorate their last days. From the ethical point of view there should be applied "palliative care". The age is a significant factor in the permanent sequels in children and youngsters, in whom scar deformities cause the loss of "body image" and severe psychological problems when the Patients Rights (comprehended in the Code of Czech Republic) are not respected.

• MeSH
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• kvalita života * MeSH
• lékařská etika * MeSH
• lidé MeSH
• ochrana zájmů pacientů * MeSH
• popálení rehabilitace   terapie   MeSH
• předškolní dítě MeSH
• představa o vlastním těle MeSH
• resuscitační směrnice MeSH
• rozhodování * MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé MeSH
• předškolní dítě MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Sepsis and/or acute blood loss can be encoutered as an emergency condition in gynaecology, especially in women with ectopic pregnancy/miscarriage, acute pelvic inflammatory disease (PID)/tuboovarian abscesses, post-puerperal sepsis/haemorrhage and even in postoperative scenarios. If underestimated or suboptimally treated, both can lead to an inadequate tissue perfusion (defined as shock) and the development of multi-organ failure. Morbidity and mortality after development of one of the shock syndromes (septic or haemorrhagic) correlates directly with the duration and severity of the malperfusion. The patient's prognosis depends on a prompt diagnosis of the presence of shock and immediate resuscitation to predefined physiological end-points, often before the cause of the shock has been identified. In septic shock, hypotension is primarily treated with fluid administration and eventually vasopressors, if required, in order to improve the circulation. Timely administration of antibiotics, control of infectious foci, appropriate use of corticoids and recombinant human activated protein C, tight glucose control, prophylaxis of deep vein thrombosis and stress ulcer prevention complete the therapy of septic shock. In haemorrhagic shock, the treatment primarily involves controlling haemorrhage, reversal of possible coagulopathy and administration of sufficient volumes of fluids and blood products to restore normal tissue perfusion.

• MeSH
• akutní nemoc MeSH
• antibakteriální látky terapeutické užití   MeSH
• antikoagulancia terapeutické užití   MeSH
• gynekologická onemocnění komplikace   terapie   MeSH
• hemoragický šok terapie   MeSH
• hypovolemie terapie   MeSH
• koagulancia terapeutické užití   MeSH
• krvácení terapie   MeSH
• lidé MeSH
• převod jednotlivých krevních složek metody   MeSH
• resuscitace metody   MeSH
• sepse terapie   MeSH
• septický šok terapie   MeSH
• tekutinová terapie metody   MeSH
• terapie náhlých příhod metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antibakteriální látky MeSH
• antikoagulancia MeSH
• koagulancia MeSH

Modern cardiopulmonary resuscitation and its introduction into wide practice has more than sixty years of history. Despite all efforts to improve the original procedures and improve the results of care for patients with cardiac arrest, the basic recommendations and rules of modern emergency resuscitation remain practically the same as at the time of its inception. In recent years, in order to increase the number of patients surviving cardiac arrest, urgent resuscitation has been used in combination with the method of extracorporeal cardiopulmonary oxygenation (ECPR). This procedure shows the potential and possibilities of contemporary medicine, but at the same time it brings a lot of question marks and cannot be recommended routinely.

• Klíčová slova
• sudden cardiac arrest, cardiac arrest, cardiopulmonary resuscitation, extracorporeal oxygenation,
• MeSH
• kardiopulmonální resuscitace metody   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * metody   MeSH
• srdeční zástava * terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. METHODS: A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. RESULTS: Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. CONCLUSIONS: Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a 'one-size fits all' FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research.

• Klíčová slova
• Cardiopulmonary resuscitation, ESCAPE-NET, Europe, First responders, Out-of-hospital cardiac arrest,
• MeSH
• databáze faktografické MeSH
• first responder * MeSH
• kardiopulmonální resuscitace MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• průzkumy a dotazníky MeSH
• senioři MeSH
• urgentní zdravotnické služby * statistika a číselné údaje   MeSH
• zástava srdce mimo nemocnici terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Intravenous fluid therapy is the most frequent therapeutic intervention in acutely hospitalized patients. They are administered in order to resuscitate the circulation in hypovolemia-associated shock states, to compensate for an impending or existing fluid extracellular deficit, or as a maintenance infusion if the patient is incapable of taking fluid by other means. Any fluid should be prescribed with the same caution as with any other drug. Errors in fluid therapy adversely affect patient - centered outcome. This may be the result of an incorrectly selected amount or inappropriate fluid composition for a given clinical situation. Prescribing intravenous fluids is a complex process involving a decision on the type, composition, dose, rate and possible toxicity of the particular solution. Balanced crystalloid solutions are the first choice for most acute conditions. The need for fluids dynamically changes over time in acutely ill patients. Uncontrolled cumulative positive balance is associated with substantial morbidity and mortality.

• Klíčová slova
• colloids, crystalloids, fluid resuscitation, fluid therapy,
• MeSH
• akutní nemoc MeSH
• intravenózní podání MeSH
• isotonické roztoky MeSH
• krystaloidní roztoky * MeSH
• lidé MeSH
• resuscitace MeSH
• tekutinová terapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• isotonické roztoky MeSH
• krystaloidní roztoky * MeSH

PURPOSE: Older patients were particularly vulnerable to severe COVID-19 disease resulting in high in-hospital mortality rates during the two first waves. The aims of this study were to better characterize the management of older people presenting with COVID-19 in European hospitals and to identify national guidelines on hospital admission and ICU admission for this population. METHODS: Online survey based on a vignette of a frail older patient with Covid-19 distributed by e-mail to all members of the European Geriatric Medicine Society. The survey contained questions regarding the treatment of the vignette patient as well as general questions regarding available services. Additionally, questions on national policies and differences between the first and second wave of the pandemic were asked. RESULTS: Survey of 282 respondents from 28 different countries was analyzed. Responses on treatment of the patient in the vignette were similar from respondents across the 28 countries. 247 respondents (87%) would admit the patient to the hospital, in most cases to a geriatric COVID-19 ward (78%). Cardiopulmonary resuscitation was found medically inappropriate by 85% of respondents, intubation and mechanical ventilation by 91% of respondents, admission to the ICU by 82%, and ExtraCorpular Membrane Oxygenation (ECMO) by 93%. Sixty percent of respondents indicated they would consult with a palliative care specialist, 56% would seek the help of a spiritual counsellor. National guidelines on admission criteria of geriatric patients to the hospital existed in 22 different European countries. CONCLUSION: This pandemic has fostered the collaboration between geriatricians and palliative care specialists to improve the care for older patients with a severe disease and often an uncertain prognosis.

• Klíčová slova
• Advance care planning, Collaboration, Covid-19, Older patients, Palliative care, Resuscitation order,
• MeSH
• COVID-19 * epidemiologie   terapie   MeSH
• lidé MeSH
• paliativní péče MeSH
• prognóza MeSH
• průzkumy a dotazníky MeSH
• rozhodování MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH