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Emergency Medicine does not represent a simple collection of various medical conditions, but rather an urgent approach to life threatening conditions. This urgent approach progresses as fast as the science in medicine does. Modern protocols for treatment of injured and ill patients are introduced, demanding more and more knowledge and skills as well as more modern equipment and wider spectrum of drugs. However, innovations are not followed by changes within the lists of medications set by National Health Insurance Fund of Serbia (NHIFS). Paper describes drugs necessary for adequate pre-hospital treatment that are not available to the physicians due to administrative barriers. On one hand, there are drugs from B list that are necessary for treatment, and are approved for use by NHIFS at hospital level only. The use of any of these drugs at pre-hospital level may lead to severe penalties to the physician in case of complications or adverse reactions in a patient following the treatment. On the other hand, there are drugs from D list which are also necessary for the urgent treatment of patients with life threatening conditions, according to latest recommendations. These drugs may be applied at pre-hospital level, but their procurement is complicated due to NHIFS regulations and that's why some of them may rarely be used (Propafenone and Magnesium sulfate). We particularly emphasize that one of the most effective drugs for the conversion of heart rhythm, Adenosine (6 mg/ml and 10mg/ml ampoule), is not registered in the Republic of Serbia and therefore cannot be used at pre-hospital level. Through these exclusive administrative barriers adequate treatment is rendered impossible while the system of urgent treatment of patients with life threatening conditions at pre-hospital level is degraded.

Introduction/Aim Carbon monoxide (CO) is a gas produced by incomplete combustion of carbon compounds and is a leading cause of poising throughout the world. The objective of this paper is to analyze 5 cases of acute carbon monoxide poisoning in petroleum industry workers, occupying a shared accommodation and to present diagnostic, therapeutic and preventive measures. Case report the workers had to be treated by the emergency medical service during the night for health problems arising from carbon monoxide inhalation from a faulty installation. Venous blood samples were collected to measure the concentration of carboxyhemoglobin (COHb) and gas analyses were done upon admission and 120 minutes later. They were treated with parenteral therapy and oxygen by mask, and they made a complete recovery. Conclusion Faulty installation of a gas-powered heating system caused acute carbon monoxide poisoning in 5 people occupying the space. After 120 minutes in a closed environment, the carbon monoxide concentration was high enough to cause a significant increase of COHb in the venous blood. Prompt diagnosis and adequate therapy are crucial to ensure a favorable treatment outcome. Preventive measures, such as educating workers and introducing health and safety measures into the work environment are extremely important in preventing accidents such as these.

Job burnout syndrome is a form of professional stress which occurs most frequently in human occupations. Three key aspects of job burnout that occur in response to chronic stress are: emotional exhaustion, depersonalization and personal achievement. The studies that have been conducted both in the highly industrialized and middle­income and developing countries have shown a high prevalence of occupational stress and job burnout syndrome in almost all branches of medicine. The direct consequences of job related stress on physicians physical and mental health indirectly lead to a decrease in the level of health services with all its consequences on the patients care. There is a need to detect stress factors and find the ways to prevent or at least mitigate them. The development of modalities in terms of training how to recognize and overcome the stressful factors of professional burnout and determining organizational reforms in health care system in order to reduce the presence of contributing factors for burnout are the priorities for the each country's society.

Sclerosing mesenteritis (SM) is a rare and poorly understood chronic benign inflammatory condition of the mesentery that sometimes can be manifested as acute abdominal emergency. In this paper sclerosing mesenteritis was discussed on the occasion of experience in the diagnosis and the treatment of patients in clinical practice, a 62-year-old man who was diagnosed SM on computed tomography (CT) which was confirmed histopathologically. SM manifests grossly as a diffuse, localized, or multinodular thickening of the mesentery. Microscopically, according to the pattern of the disease, SM can be divided into sclerosing panniculitis where necrosis and inflammation predominate and retractile mesenteritis in which fibrosis and retraction are hallmarks of the disease. Clinical presentation of patients suffering from SM is quite diverse - from asymptomatic, which is the most common, to abdominal pain, bloating, nausea, vomiting and febrile episodes. The 'fat ring sign' and peripheral pseudocapsule are virtually pathognomonic CT findings of SM. Management of SM is empirical with no guidelines yet established. SM should be listed in the differential diagnosis in every older patient with diverse abdominal complaints.

Various pesticides are applied in agriculture for crop protection. They could have toxic effects on nervous system, liver, kidneys and the other organs. The aim of the study was to investigate effects of occupational exposure to pesticides and consumption of alcoholic beverages on liver functions in agricultural workers. The study included sample of 117 male agricultural workers involved as tractor drivers in pesticide application at the workplace and the control group of 60 tractor drivers who do not applied pesticides. We collected data concerning age, use of alcohol and duration of exposure to pesticides. Parameters of liver functions in serum were determined in both groups of workers. In agricultural workers exposed to pesticides, activities of enzymes gamma-glutamyl transpeptidase, alanine and aspartate aminotransferases were higher comparing to the control group, but these differences were not statistically significant. Consumption of alcohol statistically significantly increased activity of gamma-glutamyl transpeptidase in both groups of workers. The most important measures concerning health protection of agricultural workers exposed to pesticides are continuous implementation of the safety measures at work, health promotion at workplace and regular health surveillance in occupational health services for the purpose of early detection of worker's health disorders.

Osteoporotic bone is a bone with decreased bone density and due to that predispose for fractures. Aim. To determine frequency of risk factors, type and localization of fractures in patients with decreased bone density. Material and method. Analysis included 763 patients of both sex. Osteodensitometry was performed and data on clinical risk factors for osteoporosis and osteoporotic fractures were collected. Results. Most of patient were female (96%) and average age was 63 years. The most frequent risk factors were early menopauses, previous fractures and fractures in relatives. Most of patients with osteoporotic fractures had T score of hip on osteopenia level and type was predominantly nonvertebral. Vertebral fractures were more frequent in patients with T score -2,5 SD. Conclusion. Besides osteodensitometry finding of decreased bone density, identifying of clinical risk factors for osteoporosis is essential for early making of diagnosis of osteoporosis and prevention of osteoporotic fractures.

Medicinske sestre svih nivoa obrazovanja, bez obzira na vrstu ustanove u kojoj rade, mogu da obavljaju istraživacku delatnost ukoliko ovladaju istraživackom metodologijom. Sestrinstvo se kao naucna disciplina razvija putem istraživanja. Istraživacka delatnost je od kljucne važnosti za uspostavljanje najbolje moguce prakse i protokola, kao i vodica zasnovanih na dokazima.

Indisputable is the value of pesticides for increased yield in agriculture. However, hazardous effects on man and environment are also evident. Pesticide skin absorption is probably of particular importance when pesticides are used in developing countries, because adequate protective measures are rarely applied. Aim. The aim of the study was to investigate frequency of the use of personal and hygienic work health measures in agricultural workers during pesticide application. Material and method. The study included 117 male agricultural workers involved as tractor drivers in pesticide application at the workplace. We collected data concerning age, working conditions, duration of exposure and the use of personal and hygienic work health measures. Results. Average exposure to various pesticides was 4-6 month per year and 4-7 hours per day. Concerning personal protective measures frequent use of gloves was found in 65%, and frequent use of working suit, mask and shoes in 46% interviewed workers. Gloves had never been used by 13% of workers, because they considered them uncomfortable. Hygienic measures of washing hands and taking shower after the work with pesticides were done by 65% workers. Conclusion. For the effective health protection of the exposed agricultural workers to pesticides, the essential is a comprehensive and continuous implementation of the safety measures at work (technical, personal, hygienic, legislative, medical etc.) for the purpose of reducing amount of pesticides which enter in the organism of workers and early detection of worker's health damage. .