The Early Warning Score is a simple physiological scoring system that can be calculated at the patient's bedside, using parameters which are mesured in the majority of unwell patients. Patients suffering in-hospital cardiac arrest often have abnormal clinical observations documented prior to the arrest. Study objestives:This study assesses wheather these patients have less favourable outcome following in-hospital cardiac arrest. Matherials and the methods:For the present study, the patients' hospital charts were reviewed to identify possible abnormal observations within 8 h prior to the arrest. Results: From the total of 100 patients who sufferd in-hospital cardiac arrest, 64 patients had documentation of vital signs and 9 patients had no documentation of vital signs. Of the patients with documented vital signs 27 (29,7%) had normal vital signs and 64 (70,3%) had abnormal observations. Among these 64 patients the distribution was as follows: 17 patients (13,1%) had respiatory rate below 8 or over 20 per min, 40 (30,8%) had puls rate below 40 or over 140 beats per min, 20 patients (15,4%) had systolic arterial blood pressure below 90 or over 200 mmHg, 5 (3,7%) had temperature (˚C) below 36,1 or over 37,9 ˚C, 20 (15,4%) had oxygen saturation below 90%, 14 (10,8%) had decrease in consciousness and 14 (10,8%) had urine output below 50 ml/2hours). Compared with patients whose EWS were 0-2 (ОR 1,2; 95% CI: 0,935-1,507) patients with EWS 3 or more were 6,5 times more likely to die in first 24 hours (OR: 7,8; 95% CI: 1,205-50,205). Conclusions:Patients with documented clinically abnormal observations prior to in-hospital cardiac arrest have a worse outcome than those without. The main implication of these is that these patients need to be identified in time thereby possibly avoiding arrest. This can also be used when assessing the prognosis of in-hospital patients after achieved ROSC.

Important facts about recombinant human factor VIIa have been mentioned, also about the renal cell carcinoma. Case report: Male, aged 69, with infiltrative renal cell carcinoma, underwent radical nephrectomy using Hasagawa`s approach. Extirpated tumor had 35 cm in diameter. During the surgery, patient suffered a cardiac arrest with 3500 ml blood loss. After operation, he lost 2100 ml more blood. Despite of active blood supstitutions with intensive surgical attempts in order of haemostasis, bleeding did not stop untill the application of rFVIIa (300 I. U.). Patient survives and recovers completelly. Conclusion: RFVIIa is very succesful in controling of massive surgical bleeding, possibly associated with paraneoplastic syndrome.