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3079 results in Jagiellonian University Press

Page 50 of 154

  • 8 - ECG in Hypothermia

  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 75-80

  • Summary

    Hypothermia is defined as a drop of core temperature (usually measured in oesophagus or rectum) below 35°C. Impact of hypothermia onto electrical conduction system of heart was first described in 1892. The first observations concerning changes in ECG of a patient in accidental hypothermia date back to 1938. Hypothermia is associated with presence of characteristic changes in ECG, depending on hypothermia stage.

    Motion artefacts related to shivering and tremors are characteristic of mild hypothermia (Figure 1) together with sinus bradycardia resulting from compensatory stimulation of sympathetic nervous system.

    Prolonged exposure to low temperature significantly impairs both electric as well as mechanic activity of the heart. As a result of catecholamines release, advanced stages of hypothermia are distinguished by decreased peripheral vascular resistance and noticeable drop in cardiac output. Prolonging of action potential duration and decrease in conduction velocity in conduction system of the heart are related to delay in activation/inactivation of cellular ionic (sodium, potassium and calcium) currents. Hypothermia causes prolonging of both depolarisation duration as well as repolarisation of sinus node cells. Decrease of body temperature below 32°C causes substantial reduction of conduction velocity. In such situation, serious sinus bradycardia develops, with PR and QT/QTc intervals prolongation as well as prolongations of P wave, QRS and T wave durations (Figure 2). There is a non-linear relationship between reduced heart rate and decrease in core temperature. Prolongation of QT/QTc interval is caused both by delayed ventricular repolarisation and well as presence of so-called Osborn wave (J wave). In some patients, reduction of conduction velocity in atrio-ventricular node leads to development of conduction blocks.

    Osborn wave (J wave) is certainly the most evident anomaly in ECG of hypothermic patients. Occurrence of the wave in hypothermic patients was first recorded in 1938 (Tomasjewski), but the full description of of the phenomenon was published in 1951 by J. Osborn (hence eponym). Osborn wave is a positive deflection appearing at junction between QRS complex and ST segment, resembling “camel hump” (Figure 3).

  • 4 - Measurement of Patient's Body Temperature

    • By Jacek Majkowski, “Heat for Life” Foundation, Cracow, Poland, Tomasz Sanak, Department of Battlefield Medicine, Military Institute of Medicine, Warsaw, Poland
  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 43-52

  • Summary

    A bit of history

    The first medical thermometer, based on Gallileo's concept, was crafted by Sanctorius of Padua. The relevant information was published in 1612. Yet the person who popularised the use of temperature measurement of patients was a German physician, Carl Wunderlich. After having performed more than a million of measurements on 25,000 patients, he calculated the average temperature of a healthy person to be 37°C, and defined “fever” as body temperature exceeding 38°C.

    Temperature scales

    In Poland, as in many countries, Celsius scale is used in medical measurements. The other legally approved temperature scale in Poland is Kelvin. As Kelvin scale is base unit of SI system, the term “degree” does not apply to it. So, in order to express relationship between the two scales we can say: “Temperature 0 degrees Celsius is 273.15 Kelvin.” The difference stems from the fact that in Celsius scale 0 was set as a point of freezing of water, whilst in Kelvin scale 0 is absolute zero – theoretically lowest possible temperature.

    There are only five countries in the world where Fahrenheit scale is used instead of Celsius: The Bahamas, Belize, Cayman Islands, Palau and… United States of America. It is rumoured that German scientist Fahrenheit accepted as 0 in his scale the lowest temperature of winter season 1708/1709 in his hometown Gdańsk (–17.8°C). Similar scale to Fahrenheit, with 0 at absolute zero, is Rankine scale. Romer, Delisle, Newton and Réaumur scales are nowadays almost extinct. Yet, in 1841 there were at least 18 temperature scales!

    Temperature measurements

    Temperature cannot be measured directly like length or weight. A sensor which changes its physical properties must be used, for instance:

  • • change of volume of liquid (classic glass thermometers, e.g. containing mercury);

  • • change in resistance (thermistor and resistance temperature detector – RTD);

  • • generation of electric voltage in place of contact of two metals (thermocouple);

  • • change of colour (liquid crystal thermometer);

  • • deformation of bimetals (thermostat);

  • • emission of heat radiation (pyrometer, infrared sensor – IR);

  • • change of parameters of semiconductor contactors (integrated circuit – IC).

  • Conclusion

  • from PART THREE - THE QUESTION OF GENRE
  • Katarzyna Bazarnik
  • Book:
    Liberature: A Book-bound Genre
    Published by:
    Jagiellonian University Press
    Published online:
    22 December 2017
    Print publication:
    01 December 2016, pp 165-170

  • Summary

    Liberature: what's in the name?

    What's in a name? That which we call a rose

    By any other name would smell as sweet.

    Shakespeare, Romeo and Juliet (act II, scene ii, 1–2)

    “Almost always a form appears earlier than the critical name for it,” claims Fowler based on the evidence of his decades-long study of empirical genres. He adds that “[t]he absence of a genre label is of course no argument against the genre's existence; after all architectural orders themselves went unnamed for more than 1500 years” (2003: 187). As I have described, first came book-bound works, then came the name liberature, “cepted” from a critical reflection on writing and reading. The idea, originating in a fusion of LITERATURE and BOOK, was tentatively framed in terms of genre. My argument has been that it is both conceivable and helpful to think about it in this way since genre is one of the fundamental means by which we organise knowledge about literature. Carolyn Miller notes that “our ‘stock of knowledge’ is based upon types” and explains that a new category may emerge and be accepted as,

    …useful only in so far as it can be brought to bear upon new experience: the new is made familiar through the recognition of relevant similarities; those similarities become constituted as a type. A new type is formed from typifications already on hand when they are not adequate to determine a new situation. If a new typification proves continually useful for mastering states of affairs, it enters the stock of knowledge and its application becomes routine. (Miller 1994: 25)

    For the pragmatic scholar, the ultimate test of genre viability is its use. This generates a web-like structure of associations that simultaneously delineates the semantic field of the concept. As regards liberature, even those who are skeptical about its generic dimension admit that it is a handy term, and use it. They apply it in analyses of actual works, acknowledging that it does tell us something theoretically important about literary discourse. First of all, they agree that it highlights the multimodality and multimediality of literature. Secondly, they acknowledge that it foregounds the book as a spatial means of organising literary discourse – a semantically charged, non-transparent interface. Of course, these features have always been present in literature.

  • 21 - Accidental Hypothermia: the Need for the International Hypothermia Registry

    • By Beat H. Walpoth, Division of Cardiovascular Surgery, University Hospitals of Geneva, Switzerland, Marie Meyer, Dept. of Anesthesia, University Hospital, Lausanne, Switzerland, Christophe Gaudet-Blavignac, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland, Philippe Baumann, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland, Pierre Gilquin, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland, Christian Lovis, Division of Medical Information Sciences, University Hospitals of Geneva, Switzerland
  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 179-182

  • Summary

    Accidental hypothermia can be of multiple aetiologies and is often related to an accident in a cold environment and contrasts with urban hypothermia. People living in the cold such as workers, fishermen and military personnel are at risk. More recently there is an increase in unprepared lay people practicing leisure activities such as winter sports, thus exposing themselves to hypothermia in case of an accident. Most of the cases concern mild hypothermia which does not need hospitalization or medical assistance. In contrast, deep hypothermia, with or without cardiac arrest, is rare and carries a high mortality in healthy adults and children [1, 2, 3].

    Induced hypothermia which has been used for cardiac surgery as well as therapeutic hypothermia used for brain ischaemia, are medically indicated and highly monitored and therefore cannot be compared to accidental hypothermia. Patients with induced hypothermia may reach the same degree (< 28°C) but are in controlled narcosis and are normally cooled down and rewarmed by Cardiopulmonary Bypass (CPB) [4]. Therapeutic hypothermia cools the patient to mild hypothermia (32–34°C) to enhance a better and faster functional brain recovery [5].

    The concept of applying the technique of CPB rewarming, as used in induced deep hypothermic cardiac arrest, to victims of accidental hypothermia with temperatures below 28°C and cardio-respiratory arrest was initiated successfully by Prof. Ueli Althaus at the University Hospital Insel in Bern, Switzerland over 30 years ago [6]. Since that time our team and other Swiss universities started to use this method and we published a multi-centre study showing a long-term sequelae-free survival rate of 47% after rewarming of 32 deep accidental hypothermic patients in cardiac arrest using cardiopulmonary bypass (CPB) [7]. Due to the fact that many patients died from post-rewarming complications, we and others have shown the beneficial effect of using extra-corporeal life support (ECLS) such as prolonged ECMO use after rewarming for cardiovascular and pulmonary dysfunctions [8, 9].

  • 9 - Hypothermia as a Reversible Cause of Cardiac Arrest

    • By Piotr Mazur, Institute of Cardiology, Jagiellonian University Collegium Medicum; John Paul II Hospital, Cracow, Poland, Sylweriusz Kosiński, Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland, Tomasz Darocha, “Heat for Life” Foundation, Cracow, Poland
  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 81-86

  • Summary

    Hypothermia, defined as unintended drop in core temperature < 35°C, is one of cardiac arrest causes which have been proven to be reversible. Hypothermia is one of “Hs” in universally accepted “4Hs + 4Ts” algorithm. Hypothermia however has one major advantage over the remaining “Hs” and all “Ts.” Not only when early diagnosed and appropriately treated it may change the outcome of resuscitation, but it additionally increases chances of both survival as well as avoidance of ischaemic encephalopathy. Each 1°C of drop of body temperature below norm causes decrease of brain metabolism by 6–10% [1]. Hypothermia affects almost all cell damage mechanisms caused by hypoxia, by preventing their activation or interrupting them on early stage of apoptosis [2]. Intended, induced and controlled hypothermia is increasingly more often used in all these situations in which neuroprotective effect is desired. In emergency care the rule “No one is dead until warm and dead” exists. This phrase, however, proves right under a condition: hypothermia may show its protective action only if it occurs before cardiac arrest. Secondary hypothermia, which develops e.g. during resuscitation in cold environment, not only does not provide neuroprotection, but may be an obstacle in attempts to restore circulation. If however cardiac arrest occurs during cooling of the body or is a direct effect of it, the neurological prognosis is good – provided of course that circulation is restored. The longest reported resuscitation of hypothermic patient resulting in return of spontaneous circulation, restoring of consciousness and full neurological capabilities, endured for over 6.5 hours [3]. This and other reported cases prove that hypothermia may the most optimistic of “4Hs and 4Ts.”

    Unfortunately, it happens in practice that all hopes related to hypothermia become ruined. The usual reason for this is lack of diagnostic sensitivity. Hypothermia is one of the least frequent reversible causes of cardiac arrest listed in “4Hs and 4Ts.” What is partially understandable, more attention is given to hypoxia, hypovolaemia or thromboembolisms, while hypothermia is considered a mostly theoretical issue. It also happens that overcome with first impression we consider a hypothermic patient to be dead, after only a superficial, imprecise examination and no resuscitation attempt is made.

  • Conceptual metaphors in liberature

  • from PART TWO - LIBERATURE AND RELATED CONCEPTS
  • Katarzyna Bazarnik
  • Book:
    Liberature: A Book-bound Genre
    Published by:
    Jagiellonian University Press
    Published online:
    22 December 2017
    Print publication:
    01 December 2016, pp 57-76

  • Summary

    B.S. Johnson: breaking through the walls of fiction

    The book as an architectural structure, and the book as a human body, are two pervasive conceptual metaphors underlying liberatic works. The material rhetoric of these conceptual metaphors goes hand in hand with ways of structuring discourse, and this sometimes involves the visualisation, or literalisation, of spatial conceptualisations of linguistic forms. The relation “between the spatialized form of the language and the conceptual system, especially the metaphorical aspects of the conceptual system” (Lakoff and Johnson 2003: 138) is translated into, or reflected in, the physical shape of the text. This is because these two conceptual metaphors structure the way we speak about texts in general. Literary works seen as material embodiments of ideas must be close to architecture, the most material of arts, and the one, moreover, which requires the audience to actively move in and around the architectural object. Since many writers who have resorted to the rhetoric of materiality draw explicit parallels between them, let me mention two of them who are particularly relevant to my subject. One is B.S. Johnson, a British novelist well known for his unconventional exploitation of the technological space of the book. The other is William H. Gass, an American philosopher, essayist and writer who is deeply preoccupied with “habitations of the word.”

    In the “Introduction” to a collection of short texts, Aren't You Rather Young to Be Writing Your Memoirs?, B.S. Johnson points out that writers can learn much from architects insofar as in writing, just as in designing buildings, artists should consider their goals and available means. As Johnson explains, the “architecture of the book” needs to be connected with its subject matter. Repeating the dictum of Louis Sullivan, “the father of modernist architecture” he declares that “form follows function” (B.S. Johnson 1973: 16). Johnson insists that his “formal innovations” in typography, and the structure of his books, are the result of the search for adequate expression. He claims that he uses the means available to him as a writer (not a book designer or visual artist), but he also admits that sometimes the novelist must “borrow, steal or cobble” from other media in order to invent “forms which will more or less satisfactorily contain an ever-changing reality” (16–17).

  • Liberature and multimodality

  • from PART TWO - LIBERATURE AND RELATED CONCEPTS
  • Katarzyna Bazarnik
  • Book:
    Liberature: A Book-bound Genre
    Published by:
    Jagiellonian University Press
    Published online:
    22 December 2017
    Print publication:
    01 December 2016, pp 87-106

  • Summary

    The Intermedia

    As suggested above, affinities with theatre, performance, and the visual arts, including sculpture, imply that liberature could be described as a kind of discourse in which the author intentionally blends the linguistic and non-linguistic codes, and uses different materials as the space of inscription. This resort to mixed verbal, visual, and spatial resources inspired Wojciech Kalaga to describe liberature as “a hybrid transgenre” (2010a: 8; see also 2010b: 76–77). The Polish semiotician focuses on the ontological hybridity of works in which the physical shape of the text, or to use the Ingardenian term – its material foundation – is combined with the work's intentionality thereby creating a hybrid carrier of multiple senses. As he explains, the “materiality of text does not do away with its function as the intentional object, but it calls for concretising it along with its entire extraverbal, semiotic load,” hence “a hybrid text is one that integrates senses emerging out of a collaboration of the semantics of language and the structure of the matter” (2010b: 76, 78, translation mine). Consequently, non-linguistic aspects of materialised language contribute to the architecture of the book, which is no longer seen as a transparent container for words, but a legitimate constituent of the literary text. As we have seen, Fajfer envisaged the organic, unified fusion of the semantic and material dimensions of literary texts in generic terms, although such ontic hybrids have also been described as the intermedia, or as multimodal literature.

    This invites a comparison of liberature with Dick Higgins’ concept of the intermedia. This seems necessary given that some works mentioned as proto-liberatic in “A Brief History of Liberature” combine texts with drawings, or photographs (Bazarnik and Fajfer 2005a: 17–21), and hence fulfill Higgins’ criteria for defining them in this way. In the mid 1960s, the American scholar-painter revived Coleridge's coinage in order to describe pieces that are conceptually and materially situated between different types of art. In his view, such works “fall between media”; they should therefore be understood as new art forms emerging when different media are conceptually fused in one piece (Higgins 2001: 49). The con-fusion is vividly demonstrated in a chart added to the revised version of his essay, in which different arts, media, and even genres are represented by overlapping circles.

  • 3 - Facts and Myths about Hypothermia and its Treatment

  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 33-42

  • Summary

    Human organism is able to adapt to extreme external conditions. Among other reasons, this characteristic has enabled humans to flourish on Earth. We are generally able to fight cold, but in some conditions this defence proves inefficient. And even though our knowledge of hypothermia is constantly becoming more comprehensive, many doubts, myths and understatements pertaining to this phenomenon persist. We would like to make an attempt here to clarify some of them.

    Hypothermia and “freezing with cold” are not the same thing

    Common “freezing with cold” means exposure to cold, but it does not necessarily mean lowering of core body temperature. We speak of hypothermia when temperature of internal organs of the body drops below 35°C (Table 1). If a cause of drop in temperature is a simple disproportion between heat generation and loss, we speak about “accidental hypothermia.” If hypothermia is caused by body trauma, we speak about “post-traumatic hypothermia.” It is worth noting that post-traumatic hypothermia varies in many ways from accidental hypothermia, and different temperature thresholds are assigned to both types of the disorder (Table 1) [1, 2].

    Cold “creeps in” however it can

    From a physical point of view, warmth may equally stand for both quantity as well as a form of internal energy transmission in a system [3]. If we say that an object is warm, it means it has a higher internal energy than the environment. So is the other way round: an object described as cold has lower internal energy. The process of heat transferral occurs between systems (bodies) of different temperatures – from the warmer system (of higher energy) to colder one (of lower energy). Hence, it is not the cold that “creeps in” but the warmth that “escapes.”

    Human beings lose most of their heat by radiating it outside

    Human body dissipates heat by four processes: radiation, convection, conduction, and evaporation. In a closed room, with minimal air movement, and in standard room temperature (21°C), an undressed human indeed loses most of his/her heat (about 55%) as infrared radiation [4, 5].

  • Hybridity

  • from PART ONE - INBETWEENNESS
  • Katarzyna Bazarnik
  • Book:
    Liberature: A Book-bound Genre
    Published by:
    Jagiellonian University Press
    Published online:
    22 December 2017
    Print publication:
    01 December 2016, pp 25-30

  • Summary

    Admittedly, to begin with hybridity is a perplexing prospect, not least because it connotes an impure mixture, infertility, monstrosity, that which is an eye-sore. On the other hand, in the light of several of the responses that Oka-leczenie (the first work that came to be know by the name of liberature) provoked, there seems to be no better option. Some critics, asked to review the book, admitted to mixed feelings and doubted if such an amalgam of language, typography, images, and unconventional binding could make any coherent sense at all. One reviewer explicitly described it as “neither fish nor fowl nor good red herring [or to use the literal, word for word translation: “neither dog, nor otter”],” declaring helplessness in the face of such a (monstrous) hybrid (Cuber 2003). The colloquial metaphor is suggestive of the reading since the etymology of “hybrid” can be traced back to a mongrel, something that apparently comes from the ancient Greek, and means “an insult or outrage, with special reference to lust” (Warren 1884: 501). Investigating the numerous semantic fields of the original Greek word, Josef Kuře adds to the definition a frighteningly impressive list of vices: “vainglory, pride, superciliousness, arrogance, profanation, maltreatment, high-handedness, degrade, abuse; […] debauchery, revelry, offence, malefaction, crime, injustice,” and concludes that “[t]here are not many Greek words that have such a broad palette of negative meanings as hybris” (2009: 12). Mythological hybrids represent a whole spectrum of monsters: from Minotaur, Chimera, Harpies, to seductive mermaids, centaurs, fauns, and the devil. And even in the case of angels and amiable divinities, such as Ganesha, there is still something uncanny about them. (Some liberatic books combine different arts, media, and materials, appearing strangely non-bookish.) In biology, the term denotes the (usually infertile) offspring of parents of different species, genera or, rarely, families. (Indeed, the generic status of liberature has sometimes been described as an abortive idea.) Perhaps hybrid cars have more positive connotations due to their environment-friendly nature? But they still fall behind petrol-fuelled vehicles when it comes to acceleration, maximum speed, and the price, too. (Liberatic works cannot be easily scanned and speed-read, for sure. Fortunately, though a little more expensive that “ordinary” books, the price of trade editions is not prohibitive.)

  • 6 - Thermal Insulation

    • By Sylweriusz Kosiński, Department of Anesthesiology and Intensive Care, Pulmonary Hospital, Zakopane, Poland, Tomasz Sanak, Department of Battlefi eld Medicine, Military Institute of Medicine, Warsaw, Poland
  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 61-68

  • Summary

    Maintaining homeothermy (stable body temperature) requires equilibrium between heat generated by the organism and dissipated to the environment [1]. Each living cell of the body produces heat as a side-effect of metabolic processes. Apart from this “basic” production, heat is generated also during physical effort, and its amount is proportional to the intensity of the activity. It is worth noting that certain amount of thermic energy may be “absorbed” from the outside via the same pathways it is lost. On a sunny winter day, when ambient temperature is 0–5°C, we may do without warm clothing as we absorb significant amount of solar radiation. In a cold room we stand close to a hot radiator, and desiring to get warmer faster, we put our back close to it. In moments of danger we have one more heat generation method at our disposal – shivering (see: Chapter 1).

    Intensity of metabolic processes, including heat generation, depends on many factors: weight, sex, age, physical activity, ambient temperature, type of cover/clothing. In emergency care, the disorders reducing metabolic rate may be of additional importance, in particular: severe injuries, exhaustion – understood as deficit of energy substrates, and influence of medications.

    Mechanisms of heat loss (conduction, convection, radiation and evaporation) have been described in Chapters 1 and 3. As human being loses about 90% of heat through skin, the prevention of thermic imbalance should focus on body surface insulation. Are we able to stop the processes of heat transferral to the surroundings entirely? Unfortunately not. Yet we can minimise them to such an extent so as to compensate even a severely limited production. Of course, in extreme cases the balance may be “tipped” by heat delivery, but this chapter aims to concentrate on means to prevent heat loss, i.e. thermal insulation.

    First of all, let us use an example to illustrate the pathways of heat loss and counteraction measure. Let us compare streams of heat leaving the organism in two places: vicinity of Supraśl (Poland) and area of Spitsbergen (Norway) [2, 3] – Table 1.

  • 10 - The Role and Tasks of Polish Medical Air Rescue

  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 87-88

  • Summary

    Continuing advancement of medical science and advent of new technologies have enabled efficient treatment of patients in severe hypothermia. The efficacy of therapeutic process of these patients is possible thanks to organisation of hypothermia treatment system, which encompasses both prehospital as well in-hospital care phases. Emergency medical system, which beside land ambulances includes also air rescue teams, provides medical life-saving capability as well as translocation with intensive care capacity to centres that ensure focused, specialised therapy.

    Polish Medical Air Rescue, as a part of National Emergency Medical System, so as to aid successfully developing program of treatment of severe hypothermia has undertaken organisational and educational actions aiming at active participation of medical air rescue teams in saving hypothermic patients.

    Medical air rescue teams possess equipment enabling direct invasive blood pressure and core temperature measurements what enables exact monitoring of hypothermic patients. Specialised thermometers for core temperature measurement in oesophagus constitute part of equipment of all rescue helicopters.

    As a part of educational project, National Dispatch staff along with all members of medical personnel of Polish Medical Air Rescue received educational materials concerning hypothermia and extracorporeal treatment. Keeping in mind the possibility of further development of hypothermia treatment program into other areas of Poland, Medical Air Rescue plans to introduce training for medical personnel of all HEMS/EMS centres in Poland on this subject based upon currently introduced e-learning platform.

    National Dispatch Office of Polish Medical Air Rescue actively participates in coordination of transportation of patients in severe hypothermia, both from place of incident as well as between medical institutions. Joint experience of Severe Hypothermia Treatment Centre in Kraków and Polish Medical Air Rescue shows that air transport may be the preferable method of translocation of patients in severe hypothermia. Speed, stability and capacity to monitor various aspects of patient's condition are among various advantages of medical helicopter. It is worth noting that despite the slowing of metabolism and prolonged tolerance to hypoxia among hypothermic patients, time of arrival at destination treatment centre remains critical condition for patient's survival chances, like in all other life threatening disorders.

  • 11 - Trauma and Hypothermia

    • By Peter Paal, Head of the Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brother Hospital, Salzburg, Austria, Bernd Wallner, Resident, Department of Anesthesiology and Critical Care Medicine, Innsbruck University Hospital, Austria, Hermann Brugger, Head of the Institute of Mountain Emergency Medicine, EURAC Research
  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 89-96

  • Summary

    In multiple trauma patients accidental hypothermia (i.e. core temperature < 35°C) is more frequent in winter but must be expected at all seasons of the year, even in regions with moderate climate [1]. The incidence of multiple trauma patients admitted with accidental hypothermia is underestimated, but may exceed 30% [1]. The low reporting rate of accidental hypothermia is partly owed to the lack of reliable thermometers for cold environment. The low awareness for accidental hypothermia leads to insufficient insulation and rewarming measures in the pre- and in-hospital setting.

    Accidental hypothermia in multiple trauma is an independent risk factor for increased mortality. In a state-wide trauma registry in Pennsylvania (n = 38,520) mortality of multiple trauma patients increased exponentially with the degree of accidental hypothermia at hospital admission. With a core temperature < 32°C at hospital admission mortality approached 50% (Figure 1) [2]. Multiple trauma patients are prone to accidental hypothermia because central and peripheral thermoregulation are inhibited. This may be due to haemorrhage (i.e. underperfusion of thermoregulation centres in the hypothalamus) and reduced or abolished shivering. Vasodilation as a result of peripheral hypoxia with concomitant metabolic acidosis or analgosedation (possibly less pronounced with ketamine) [3, 4].

    Keeping the traumatized patient normothermic is of utmost importance. Patients should be thoroughly and timely insulated, cold and excessive infusions avoided, considerate analgesia and sedation provided with the understanding that they may accelerate cooling. In a cold environment changing clothes is not required as long as patients are insulated water-vapour-tight to avoid heat loss through evaporation [5, 6]. Implementation of the available knowledge and equipment is recommended [7]. Rewarming should be commenced as soon and as aggressively as possible. Even though in regular ambulances and transport times of < 1 hour prehospital rewarming may not be feasible, further cooling of the warm body core by the cold body shell can be limited. In prolonged transports with the availability of forced warm air or heating body pads rewarming (1–2°C/h) may be achieved [8].

Liberature: A Book-bound Genre
  • Katarzyna Bazarnik
  • Published by:
    Jagiellonian University Press
    Published online:
    22 December 2017
    Print publication:
    01 December 2016
  • Liberature: A Book-bound Genre discusses the concept, proposed by the Polish poet Zenon Fajfer in 1999, which refers to the kind of writing fusing text with its material form into a conceptual whole in the space of the book. In her monograph, described by the author as 'the fruit of miscegenation between a scholar and a creative writer', Katarzyna Bazarnik explains how liberature is indebted to modernist explorations of the materiality of writing pointed out by Jerome McGann, as well as practices of 'presentification' described by Hans Ulrich Gumbrecht. She flags affinities between liberature and related concepts: N. Katherine Hayles’s 'technotexts', Jessica Pressman’s 'bookishness', Lori Emerson’s 'readingwriting interfaces', and Alison Gibbons’ analyses of multimodal literature. Finally, reading liberature through contemporary genre theory, she proposes to see it as a multimodal, literary genre bound to the architecture of the material book.

  • 12 - Prehospital Management of Avalanche Victims

    • By Hermann Brugger, Head of the Institute of Mountain Emergency Medicine, EURAC Research, Giacomo Strapazzon, EURAC Institute of Mountain Emergency Medicine, Bozen, Italy, Peter Paal, Head of the Department of Anaesthesiology and Intensive Care Medicine, Hospitallers Brother Hospital, Salzburg, Austria
  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 97-114

  • Summary

    This chapter is based on following publications:

  • • Brugger H., Durrer B., Elsensohn F., Paal P., Strapazzon G., Winterberger E., Zafren K., Boyd J. Resuscitation of avalanche victims: Evidence- -based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM): intended for physicians and other advanced life support personnel. Resuscitation 2013; 84: 539–546.

  • • Brugger H., Paal P., Boyd J. Prehospital resuscitation of the buried avalanche vict im. High Altitude Medicine & Biology 2011; 12: 199–205.

  • • Truhlář A., Deakin C.D., Soar J., Khalifa G.E., Alfonzo A., Bierens J.J., Brattebo G., Brugger H., Dunning J., Hunyadi-Anticevic S., Koster R.W., Lockey D.J., Lott C., Paal P., Perkins G.D., Sandroni C., Thies K.C., Zideman D.A., Nolan J.P. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95: 148–201.

    • Summary

    In North America and Europe, approximately 165 people die of avalanches per year. Four factors are decisive for survival: grade and duration of burial, presence of a free airway, and severity of trauma. The overall mortality rate is 23%, but 52.4% in completely buried (i.e. head below the snow) victims in contrast to 4.2% in partially buried (i.e. head free) victims. Survival in completely buried victims drops to 30% within the first 35 minutes due to trauma and asphyxia. Thereafter survival decreases more gradually and victims slowly succumb to a trias of hypoxia, hypercapnia and hypothermia if they are able to breath. In the absence of fatal injuries, rescue strategies depend primarily on trauma, duration of burial, the victim's core temperature and the patency of the airway. In 2015, the European Resuscitation Council proposed an algorithm for the management of avalanche victims. With a burial time < 60 minutes (or core temperature ≥ 30°C) rapid extrication and prevention of asphyxia is essential, with adequate airway management and cardiopulmonary resuscitation. With a burial time > 60 minutes or core temperature < 30°C tackling severe hypothermia should be expected. Gentle extrication and continuous core temperature and cardiac monitoring are recommended. Pulseless victims with a patent airway, duration of burial > 60 minutes or a core temperature < 30°C should receive continuous or intermittent cardiopulmonary resuscitation and be transported to a hospital with extracorporeal rewarming facilities.

  • 5 - Prehospital Management of Hypothermia

    • By Paweł Podsiadło, Polish Medical Air Rescue, Kielce branch, Polish Society of Mountain Medicine and Rescue
  • Edited by Sylweriusz Kosiński, Tomasz Darocha, Jerzy Sadowski, Rafał Drwiła
  • Book:
    Hypothermia: Clinical Aspects Of Body Cooling
    Published by:
    Jagiellonian University Press
    Published online:
    03 January 2018
    Print publication:
    01 December 2016, pp 53-60

  • Summary

    Patient assessment

    A patient suspected of hypothermia requires special treatment. Evaluation of hypothermia severity and prevention of iatrogenic cardiac arrest are crucial. The gold standard measurement for core temperature is measurement in lower 1/3 of oesophagus, what can be problematic in conscious patients retaining vomiting reflex [1]. Methods of temperature measurement have been described in Chapter 4 of this book.

    If a prehospital rescue team possess no appropriate thermometer an approximate assessment should be performed with Swiss Staging System devised for this purpose [2] – Table 1.

    The original Swiss classification published in 2003 has been updated [2].

    Searching for presence of breath and pulse should take at least 1 minute [3]. Difficulties in diagnosis result from breath becoming significantly slow and shallow, and from bradycardia with low systemic blood pressure. Wrong diagnosis of cardiac arrest and erroneous commencement of CPR may lead to ventricular fibrillation (VF) [4]. ECG displayed on monitor may be helpful – VF or asystole require instant commencement of resuscitation. Presence of organised rhythm necessitates verification of spontaneous circulation. In absence of palpable pulse, capnography (distinctive “wavy” capnogram suggests presence of circulation) or ultrasonography may be used [1].

    Freezing of body tissues makes chest compressions impossible, evident fatal injuries such as decapitation, major crush injuries of the trunk etc. and unequivocal asphyxiation preceding hypothermia (burial, drowning in warm water) are situations where no indications for resuscitation exist. In all other patients in whom hypothermia occurred with patent airways, regardless of body temperature, the rule “nobody is dead until warm and dead” should be applied [1, 3].

    Management of basic body functions

    Circulatory system

    In the natural course of cooling of the heart, cardiac arrest occurs in asystole [4]. Hypothermic heart, however, is very prone to VF as a result of various, even very slight stimuli: mechanical (rough transportation, ambulation, resuscitation), changes in pH (excessively aggressive ventilation), changes of temperature (afterdrop). It is most likely a result of non-uniform prolongation of action potential in various areas of myocardium (refraction dispersion) and forming of looped impulse circuit (reentry) [4, 5].

  • Literature in the form of the book

  • from PART TWO - LIBERATURE AND RELATED CONCEPTS
  • Katarzyna Bazarnik
  • Book:
    Liberature: A Book-bound Genre
    Published by:
    Jagiellonian University Press
    Published online:
    22 December 2017
    Print publication:
    01 December 2016, pp 41-56

  • Summary

    Liberature and the artist's book

    Fajfer's claim that liberature ought to be understood as a distinct literary genre is perhaps more understandable when one realises that that was intended to counteract an identification of his material poetics with the kind of material rhetoric that features prominently in artists’ books. This fuzzy, highly heterogeneous, and inclusive field of creative practice can, like liberature, trace its roots to innovative modernist publications, William Blake's artistic individualism embodied in the book, and a long tradition of visual and figurative poetry. Present in many languages, the term has culturally-specific, and often mutually exclusive, referents and connotations. In Poland, the artist's book is strongly associated with the visual arts (Rypson 2000; Dawidek Gryglicka 2012). Simply put, the term refers to a self-contained, autonomous artistic work expressed through or inspired by the form of the book, which is historically grounded in the rich tradition of the Polish literary avant-garde, and the strict control of printing technologies in communist Poland. Importantly, the artist's book may include text (in the conservative sense of a verbal message), but this needn't be so. This qualification is more relevant to the American or Polish traditions of book art, and contestable in the context of the French livre d'artiste, which refers to a joint composition by a poet and a painter, often inspired and coordinated by an editor and typographer. So in it text is an important component, the feature livre d'artiste shares with liberature. In the artist's book, moreover, there is no need for the text to be authored by the person who designs, illustrates, and makes the work. The work can be a typographically innovative presentation or artistic adaptation of someone else's text, a found text, or a textual collage. Furthermore, the semantic and literary dimensions of the text may be of little or no importance to the meaning of the work, as in Zbigniew Sałaj's Miękka książka (Soft Book), which is in fact closer to a book-based sculpture or installation.

    But generally speaking, regardless of local differences, artists’ books are considered to be hybrid forms that are situated between literature, the visual arts, sculpture, installation, and even the happening.

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