Emergency Care Sick Palliative and Problems Oncology in Emergency Department during the COVID-19 Pandemic

Emergency medical care in palliative patients during the COVID-19 pandemic, it is important to provide a consistent treatment for stable patients that should be consistent with the goals and benefits, the perspective of these patients, but avoiding palliative patients with a poor prognosis that is unlikely to survive. Cancer is the second leading cause of death in the world around 8.8 million deaths a year. Worldwide, about 7 million to 10 million patients are diagnosed with cancer each year, recently there has been a significant increase in the number of cases diagnosed with cancer. About 70% of cancer deaths are in lowand middle-income countries. The goals of emergency medical care based on the criteria of BLS and ACLS, that is should be done “Do not do resuscitation, do not intubate but continue medical treatment excluding end tracheal intubation without prospects for the patient, but offering BLS only treatment concentrated symptomatic. ED is often the only place that can provide the necessary medical interventions (e.g., intravenous fluids or pain management medications). Medications as well as immediate access to advanced diagnostic tests when needed such as CT, RM and other diagnostic and treatment procedures.


Introduction
Emergency medical care for palliative patients during the COVID-19 pandemic, it is important that in ED to provide a consistent treatment for stable patients that should be consistent with the goals and bene its, the patient's perspective and avoid patients palliative with a poor prognosis that is unlikely to survive. Palliative care includes for people suffering from life-threatening diseases, aiming to improve the quality of life by often attempting to positively progress the disease. Palliative care addresses not only the issue of physical suffering from the disease, but also issues related to in all aspects: physiological, social, psychological and spiritual. Palliative care is essentially full ongoing active care in patients with life-threatening illnesses. Palliative care should provide relief of signs and symptoms by improving the best possible quality of life. The ive types of cancer that cause the highest number of deaths at the system level are carcinomas: Pulmonary 1.69 million deaths, hepatic 788,000 deaths, colorectal 774,000 deaths, gastric 754,000 deaths, thoracic cortex 571,000 deaths [1].
In most countries there may be changes to a country's health care system, but they can be well-organized units with home medical teams, primary and secondary care, hospital consultants and health care providers in emergency department. ED is often the only place that can provide life expectancy for possible and necessary medical interventions (eg, intravenous luids or painkillers. Medications as well as immediate access to advanced diagnostic tests (e.g. computed tomography or magnetic resonance imaging) as well as other diagnostic and treatment procedures, and ACLS, how to proceed "Do not resuscitate, do not intubate but continue medical treatment, knowing the meningitis in the population? Excluding benign bene it intratracheal intubation, but offering BLS only concentrated symptomatic treatment. Palliative addresses not only the issue of physical suffering from the disease, but also issues related to in all aspects: physiological, social, psychological of spiritual [2]. EMS must to provide complete, continuous, active emergency medical care to patients with life-threatening illnesses and by providing relief from signs and symptoms by improving the best possible quality of life.

Purpose of the work
The purpose is to show the number of malignant patients seeking ED, the reason for coming for emergency medical care and aiming to improve the quality of life and the course of the disease Occupying pain, monitoring and treatment of side effects of cytostatics, radiotherapy and patients affected by COVID-19 in the Emergency Clinic.

Material and methods
The study is of retrospective observational type which included 105 patients with oncological problems, palliative as well as concomitant diseases for the period March -August 2020 during the pandemic COVID-19. The data were taken from the documentation of patients in the ED archive as anamnesthetic data (gender, age, place of residence, status of life parameters, results of objective examination, results of laboratory diagnostic research, radiological data. The data are presented in tables and graphs [3]. Working methodology. These patients were treated by emergency physicians and consulting services with the emergency medical care team for assistance with any need related to palliative care and we reviewed the clinical characteristics and outcomes of patients who received medical interventions that did not match the expected prognosis. Palliative care intervention focused on observation, diagnostics, specialist consulting, moderate or advanced treatment, and systematization [4,5]. Data were collected from the medical register. For the period March -August 2020 during the time of the COVID-19 pandemic, such as age, gender, location, evaluation of vital signs, monitoring, complications and hospitalization.

Results
The study is of retrospective type realized for the period Masrs-August 2020 treated 105 patients with oncological and palliative problems, with concomitant diseases and identi ied with the PR-CPR COVID-19 test at the Emergency Clinic of UCCK in Prishtina. (Tables 1-12). Patients by age < 65 years were 8 cases or 7.6%, 65-74 years were 16 cases or 15.2%, 75-84 years were 45 cases or 42.8%, 85-94 years were 29 cases or 27.6% and 95-104 years were 7 cases or 6.6% [6].
According to the place of residence in the city there were 66 cases or 62.8%, while in the village there were 49 cases or 37.2%. According to the vital signs stable were 28 cases or 26.4%, while unstable 77 cases or 73.6%. According to the support provision BLishin 79 cases or 75.2%, while with ACLS         Patients with moderate complications were 48 cases or 47.5% and those with severe complications were 57 cases or 52.5%. Oncology patients after the presentation of signs and symptoms with pain were 57 cases or 54.2%, with vomiting were 9 cases or 8.5, with anemia 7 cases or 6.6%, with cardiac dissection were 9 cases or 8.5%, with dyspnea were 10 cases or 9.52%, conscious 4 cases or 3.8% and unconscious were 9 cases or 8.5%.
It is a necessity of the time that in ED there is a palliative care space, but it is necessary that emergency physicians should receive of icial training on how to manage palliative patients, this will contribute and help reduce ED overcrowding. Patients with oncological and palliative problems in ED, after receiving, monitoring, observation, laboratory diagnosis, radiology and medical consultations, with decision-making were systematized according to the diagnosis and treatment unit for further treatment according to the pathology of the disease [7,8]. After the palliative care intervention the criteria of BLS were determined, ACLS "Do not do resuscitation alone" (follow all the principles of palliative care except CPR), do not intubate, continue the symptomatic medical treatment "(follow all the steps of palliative care) excluding intubation and CPR); and taking care directed only at relieving pain and psychological and social problems [9].

Discussion
It is very important that the emergency physician should make an early identi ication of signs and symptoms, based on primary criteria (life-threatening patients, frequent hospitalizations due to worsening vital signs, complex care requirements) and secondary (Indicators), speci ic needs, long-term care hospitalization, advanced age, pathological fractures, metastases, necessary oxygen therapy, outpatient cardiac arrest and limited social support (eg, family stress, chronic mental illness) to be admitted Emergency Department (ED).

Conclusion
Implemented medical interventions of patients with malignant diseases are a small part of the total number of interventions and treatment. The most common medical care was emergency medical care, pain management, monitoring and treatment of side effects of cytostatics and radiotherapy. Based on the research, it is clear that we have an increase in medical visits with oncological problems, the emergency doctor, very quickly manages to identify the obstacles and showing the optimal care in ED, as well as the use of valuable resources of health care.
But a very important thing for these patients with oncological problems diagnosed with COVID-19 their transport to the respective clinics, was noticed the creation of medical teams for transport by ambulance ACLS with emergency doctor because other clinics which dealt with the treatment of patients with oncological problems veri ied or suspected of having COVID-19 did not know how to transport them. The establishment of medical teams with emergency transport physicians will enable a correct professional transport and in this way can avoid possible complications during transport. ED special spaces should be created, human resources educated and trained for palliative care treatment.
A comprehensive national program should be established for a speci ic integrated program in emergency palliative care training, guidelines and protocols designed for emergency medical service providers at three levels of health care.   Pain management is diffi cult 9 (8.5) Relatives of the patient with anyone seeking hospitalization 9 (8.5) They hardly agree with reality 10 (9.5)