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Sample records for pre-hospital stemi care

  1. Pre-hospital care--current concepts.

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    Boyington, T; Williams, D

    1995-01-01

    After a brief outline of past developments in the training of ambulance personnel, this paper traces the adoption in the UK of Pre-Hospital Trauma Life Support (PHTLS) courses from the US. The 1991 World Student Games in Sheffield, UK led to liaison between training staff from South Yorkshire Metropolitan Ambulance and Paramedic Service (SYMAPS) and from Western New York Medical Training Institute. As a result, the trauma care policy of SYMAPS was altered from aiming to stabilise the patient at the scene of the accident to emphasising rapid and thorough assessment, packaging and transport. This is a resume of the scope of the PHTLS provider course. The course concentrates on the principles of PHTLS for the multisystems trauma victim.

  2. Pre-hospital care in burn injury

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    Shrivastava Prabhat

    2010-10-01

    Full Text Available The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans

  3. Temporal trends of system of care for STEMI: insights from the Jakarta Cardiovascular Care Unit Network System.

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    Surya Dharma

    Full Text Available AIM: Guideline implementation programs are of paramount importance in optimizing acute ST-elevation myocardial infarction (STEMI care. Assessment of performance indicators from a local STEMI network will provide knowledge of how to improve the system of care. METHODS AND RESULTS: Between 2008-2011, 1505 STEMI patients were enrolled. We compared the performance indicators before (n = 869 and after implementation (n = 636 of a local STEMI network. In 2011 (after introduction of STEMI networking compared to 2008-2010, there were more inter-hospital referrals for STEMI patients (61% vs 56%, p12 hours after symptom onset were similar (53% vs 51%, NS. Moreover, the numbers of patients with door-to-balloon time ≤ 90 minutes were similar (49.1% vs 51.3%, NS, and in-hospital mortality rates were similar (8.3% vs 6.9%, NS in 2011 compared to 2008-2010. CONCLUSION: After a local network implementation for patients with STEMI, there were significantly more inter-hospital referral cases, primary PCI procedures, and patients with a door-to-needle time ≤ 30 minutes, compared to the period before implementation of this network. However, numbers of patients who presented very late, the targeted door-to-balloon time and in-hospital mortality rate were similar in both periods. To improve STEMI networking based on recent guidelines, existing pre-hospital and in-hospital protocols should be improved and managed more carefully, and should be accommodated whenever possible.

  4. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment.

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    Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O'Donnell, Cathal

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome.

  5. Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing infarction an subsequent quality care in Beijing

    Institute of Scientific and Technical Information of China (English)

    SONG Li; YAN Hong-bing; HU Da-yi; YANG Jin-gang; SUN Yi-hong

    2010-01-01

    Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P<0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.

  6. Refraining from pre-hospital advanced airway management: a prospective observational study of critical decision making in an anaesthesiologist-staffed pre-hospital critical care service.

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    Rognås, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else

    2013-10-25

    We report prospectively recorded observational data from consecutive cases in which the attending pre-hospital critical care anaesthesiologist considered performing pre-hospital advanced airway management but decided to withhold such interventions. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) registered data from February 1st 2011 to October 31st 2012. Included were patients of all ages for whom pre-hospital advanced airway management were considered but not performed. The main objectives were to investigate (1) the pre-hospital critical care anaesthesiologists' reasons for considering performing pre-hospital advanced airway management in this group of patients (2) the pre-hospital critical care anaesthesiologists' reasons for not performing pre-hospital advanced airway management (3) the methods used to treat these patients (4) the incidence of complications related to pre-hospital advanced airway management not being performed. We registered data from 1081 cases in which the pre-hospital critical care anaesthesiologists' considered performing pre-hospital advanced airway management. The anaesthesiologists decided to withhold pre-hospital advanced airway management in 32.1% of these cases (n = 347). In 75.1% of these cases (n = 257) pre-hospital advanced airway management were withheld because of the patient's condition and in 30.8% (n = 107) because of patient co-morbidity. The most frequently used alternative treatment was bag-mask ventilation, used in 82.7% of the cases (n = 287). Immediate complications related to the decision of not performing pre-hospital advanced airway management occurred in 0.6% of the cases (n = 2). We have illustrated the complexity of the critical decision-making associated with pre-hospital advanced airway management. This study is the first to identify the most common reasons why pre-hospital critical care

  7. Advanced communication infrastructure for pre-hospital EMS care.

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    Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, Marcie

    2008-11-06

    The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment.

  8. Trauma in elderly people: access to the health system through pre-hospital care

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    Hilderjane Carla da Silva

    2016-01-01

    Full Text Available Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25% and in the age range between 60 and 69 years (38.25%, average age 74.19 years (standard deviation±10.25. Among the mechanisms, falls (56.75% and traffic accidents (31.25% stood out, showing a significant relation with the pre-hospital care services (p<0.001. Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8% were the most used, with trauma referral hospitals as the main destination (56.7%. Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.

  9. Pre-hospital diagnosis and transfer of patients with acute myocardial infarction—a decade long experience from one of Europe's largest STEMI networks

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Schoos, Mikkel Malby; Lindholm, Matias Greve

    2013-01-01

    Early reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) is essential. Although primary percutaneous coronary intervention (pPCI) is the preferred revascularization technique, it often involves longer primary transportation or secondary inter-hospital transfers and thus...

  10. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

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    Grier Gareth

    2010-03-01

    Full Text Available Abstract Introduction We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. Methods A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic. Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians. Their role is to brief the training team and guide the scenario, results of patient assessment and the simulated responses to interventions and treatment. Pilots, fire-fighters and medical students are utilised in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed and introduced to the scene in a realistic manner. After completion of the scenario, the training team would usually be invited to prepare and deliver a hospital handover as they would in a real mission. A formal structured debrief then takes place. Results This training method technique has been used for the training of all London Helicopter Emergency Medical Service (London HEMS doctors and paramedics over the last 24 months. Informal participant feedback suggests that this is a very useful teaching method, both for improving motor skills, critical decision-making, scene management and team interaction. Although formal assessment of this technique has not yet taken place we describe how this type of training is conducted in a busy operational pre-hospital trauma service. Discussion The teaching and maintenance of pre-hospital care skills is essential to an effective pre-hospital trauma care system. Simple mannequin based scenario training is feasible on a day-to-day basis and has the advantages of low cost, rapid set up and turn around. The scope of scenarios is limited only by

  11. Trauma-informed care for children in the ambulance: international survey among pre-hospital providers.

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    Alisic, Eva; Tyler, Mark P; Giummarra, Melita J; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A; Kassam-Adams, Nancy

    2017-01-01

    Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one-off group

  12. Trauma-informed care for children in the ambulance: international survey among pre-hospital providers

    Science.gov (United States)

    Alisic, Eva; Tyler, Mark P.; Giummarra, Melita J.; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A.; Kassam-Adams, Nancy

    2017-01-01

    ABSTRACT Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers’ knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one

  13. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

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    Rodrigo Assis Neves Dantas

    2015-06-01

    Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

  14. Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

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    Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

    2015-01-01

    Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  15. Characterization of trauma patients treated in a pre-hospital care service

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    Amanda de Ornelas Carvalho

    2004-09-01

    Full Text Available Objectives: To identify the characteristics of trauma patientstreated in a pre-hospital care service, to characterize the factorsrelated to the trauma event and quantify the severity of trauma,according to the Revised Trauma Score. Methods: This is adescriptive, exploratory, retrospective study carried out at thePre-Hospital Care Service of the Military Police - Rescue in thecity of São Paulo. Data comprised a randomized sample of 60nursing charts, distributed among the four advanced life supportunits in the city. Results: Of the occurrences dealt with, 65% arerelated to public streets, 20% are medical cases, 65% are maleindividuals, predominantly young adults. The predominantmechanisms of trauma are crash and run-over. Casa Verde wasthe care unit which obtained the highest Revised Trauma Scoreweighted mean. Conclusions: The results presented here are inconformity with the national statistics on trauma: young adults, ofworking age, involved in road accidents are most frequentlyaffected. Identifying this population is of utmost importance forthe development of preventive and educational measures.

  16. Sex specific impact of prodromal chest pain on pre-hospital delay time during an acute myocardial infarction: Findings from the multicenter MEDEA Study with 619 STEMI patients.

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    von Eisenhart Rothe, A F; Albarqouni, L; Gärtner, C; Walz, L; Smenes, K; Ladwig, K-H

    2015-12-15

    Scarce evidence yields conflicting results regarding the effect of prodromal chest pain (PCP) on pre-hospital delay during an acute myocardial infarction (AMI). We aimed to assess the impact of PCP on delay. Data was collected on 619 ST-elevated MI patients from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Patients with any PCP (which was subdivided into undefined PCP, possible and definite angina) within a year before AMI were identified using the Rose questionnaire, administered in bedside interviews. The influence of PCP and its subdivisions (all compared to no PCP) was assessed using logistic regression (with cut-offs of 2 h, 6 h, and a 4-category ordinal outcome). Any type of PCP was reported by men (50.6%) more than women (34.6%) (OR=1.9; 95% CI: 1.3 to 2.8; p=.001). The median delay of patients with PCP was not significantly different to delay in patients with no PCP (p=.327). Prolonged delay times were observed in women with PCPs of lesser degree of cardiac confirmation, while the opposite was observed in men. In women, possible angina was more strongly associated with delay <2 h (OR=6.8; 95% CI=2 to 23.8) than any PCP (OR=2.6; 95% CI=1.2 to 5.7). For men, PCPs of increasing cardiac confirmation are associated with prolonged delay. For women, PCPs of lesser cardiac confirmation are more likely to lead to prolonged delay. Future studies should investigate mediating factors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Cost-benefit analysis of telehealth in pre-hospital care.

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    Langabeer, James R; Champagne-Langabeer, Tiffany; Alqusairi, Diaa; Kim, Junghyun; Jackson, Adria; Persse, David; Gonzalez, Michael

    2017-09-01

    Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. Methods Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention. The intervention consisted of telehealth-based consultation between the 911 patient and an EMS physician, to evaluate and triage the necessity for patient transport to a hospital emergency department (ED). Patients with non-urgent, primary care-related conditions were then scheduled and transported by alternative means to an affiliated primary care clinic. We measured CBA as both total cost savings and cost per ED visit averted, in US Dollars ($USD). Results In total, 5570 patients were treated over the first full 12 months with a telehealth-enabled care model. We found a 6.7% absolute reduction in potentially medically unnecessary ED visits, and a 44-minute reduction in total ambulance back-in-service times. The average cost for a telehealth patient was $167, which was a statistically significantly $103 less than the control group ( p cost savings from the societal perspective, or $2468 cost savings per ED visit averted (benefit). Conclusion Patient care enabled by telehealth in a pre-hospital environment, is a more cost effective alternative compared to the traditional EMS 'treat and transport to ED' model.

  18. Stent for Life Initiative: leading example in building STEMI systems of care in emerging countries.

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    Kaifoszova, Zuzana; Kala, Petr; Alexander, Thomas; Zhang, Yan; Huo, Yong; Snyders, Adriaan; Delport, Rhena; Alcocer-Gamba, Marco Antonio; Gavidia, Leslie Marisol Lugo

    2014-08-01

    This paper describes the opportunities and challenges in building ST-elevation acute myocardial infarction (STEMI) systems of care in Stent for Life affiliated and collaborating so-called emerging countries, namely India, China, South Africa and Mexico, where CAD mortality is increasing and becoming a significant healthcare problem. The Stent for Life model supports the implementation of ESC STEMI Guidelines in Europe and endeavours to impact on morbidity and mortality by improving services and developing regional STEMI systems of care, whereby STEMI patients' timely access to a primary percutaneous coronary intervention (PPCI) is assured. In India, the STEMI India model incorporates a dual approach of combining PPCI with a pharmacoinvasive strategy of reperfusion. The architecture of the system is based on a hub and spoke model with each unit called a STEMI cluster. The project is driven by a private non-profit organisation. In China, the STEMI PCI programme is led by the Chinese College of Cardiovascular Physicians and supported by the national government. Although primary PCI is performed nationwide, a thrombolytic treatment strategy is still the first option in many rural areas because of logistic considerations. Establishing local STEMI transfer networks and then implementing a pharmacoinvasive strategy of reperfusion are being considered and promoted currently. In South Africa, the pharmacoinvasive approach currently dominates as STEMI treatment option in many areas. A pilot study shows that low symptom awareness leads to long patient delays. The education of all role players, from patients to healthcare professionals and including institutions and governmental structures, is needed to achieve prompt diagnosis and treatment. In Mexico, improving the treatment of STEMI requires considering myocardial infarction to be an emergency that must be treated by an entire system and not just by a particular service. Patients need to receive quick treatment from

  19. Comparison between two mobile pre-hospital care services for trauma patients

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    Gonsaga Ricardo

    2012-08-01

    Full Text Available Abstract Objectives Pre-hospital care (PH in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Method Descriptive study evaluating all patients transported by both systems in Catanduva, SP, admitted to a single hospital. Results 850 patients were included, most of whom were men (67.5%; the mean age was 38.5 ± 18.5 years. Regarding the use of PH systems, most patients were transported by SAMU (62.1%. The trauma mechanisms involved motorcycle accidents in 32.7% of cases, transferred predominantly by SAMU, followed by falls (25.8%. Regarding the response time, CB showed the lowest rates. In relation to patient outcome, only 15.5% required hospitalization. The average score on the Glasgow Coma Scale was 14.7 ± 1.3; average RTS was 7.7 ± 0.7; ISS 3.8 ± 5.9; and average TRISS 97.6 ± 9.3. The data analysis showed no statistical differences in mortality between the groups studied (SAMU - 1.5%; CB - 2.5%. The trauma scores showed a higher severity of trauma among the fatal victims. Conclusion Trauma victims are predominantly young and male; the trauma mechanism that accounted for the majority of PH cases was motorcycle accidents; CB responded more quickly than SAMU; and there was no statistical difference between the services of SAMU and CB in terms of severity of the trauma and mortality rates.

  20. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

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    Lockey David

    2011-10-01

    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  1. Usage of documented pre-hospital observations in secondary care: a questionnaire study and retrospective comparison of records.

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    Knutsen, Geir O; Fredriksen, Knut

    2013-03-01

    The patient handover is important for the safe transition from the pre-hospital setting to secondary care. The loss of critical information about the pre-hospital phase may impact upon the clinical course of the patient. University Hospital Emergency Care registrars answered a questionnaire about how they perceive clinical documentation from the ambulance services. We also reviewed patient records retrospectively, to investigate to what extent eight selected parameters were transferred correctly to hospital records by clinicians. Only parameters outside the normal range were selected. The registrars preferred a verbal handover with hand-written pre-hospital reports as the combined source of clinical information. Scanned report forms were infrequently used. Information from other doctors was perceived as more important than the information from ambulance crews. Less than half of the selected parameters in pre-hospital notes were transferred to hospital records, even for parameters regarded as important by the registrars. Abnormal vital signs were not transferred as often as mechanism of injury, medication administered and immobilisation of trauma patients. Data on pre-hospital abnormal vital signs are frequently not transferred to the hospital admission notes. This information loss may lead to suboptimal care.

  2. Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians.

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    Mort, Alasdair J; Fitzpatrick, David; Wilson, Philip M J; Mellish, Chris; Schneider, Anne

    2016-02-01

    The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error.

  3. Pre-hospital emergency medicine.

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    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E

    2015-12-19

    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.

  4. Teams and working conditions in mobile pre-hospital care services: an integrative review

    OpenAIRE

    2015-01-01

    Study to identify, analyze and summarize the findings available in the literature on the composition of teams and working conditions in Mobile  Pre-Hospital Care Services  (PHC).  Integrative review to search the Base  de Dados  de  Enfermagem [Nursing Database] (BDEnf), the Cumulative  Index  to  Nursing  and  Allied  Health  Literature (CINAHL),  the Latin American and Caribbean Health Sciences Literature (LILACS), PubMed,  SCOPUS,  Web  of  Science and the portal of journals from the Scien...

  5. (Non-)utilization of pre-hospital emergency care by migrants and non-migrants in Germany.

    Science.gov (United States)

    Kietzmann, Diana; Knuth, Daniela; Schmidt, Silke

    2017-01-01

    This study was designed to explore the utilization and non-utilization of pre-hospital emergency care by migrants and non-migrants, and the factors that influence this behaviour. A cross-sectional representative German survey was conducted in a sample of 2.175 people, 295 of whom had a migration background. An additional sample of 50 people with Turkish migration background was conducted, partially in the Turkish language. Apart from socio-demographics, the utilization of emergency services and the reasons for non-utilization were assessed. Migrants had a higher utilization rate of pre-hospital emergency care (RR = 1.492) than non-migrants. Furthermore, migrants who were not born in Germany had a lower utilization rate (RR = 0.793) than migrants who were born in Germany. Regarding non-utilization, the most frequently stated reasons belonged to the categories initial misjudgment of the emergency situation and acting on one's own behalf, with the latter stated more frequently by migrants than by non-migrants. To prevent over-, under-, and lack of supply, it is necessary to transfer knowledge about the functioning of the medical emergency services, including first aid knowledge.

  6. Availability and utilisation of physician-based pre-hospital critical care support to the NHS ambulance service in England, Wales and Northern Ireland

    Science.gov (United States)

    Mackenzie, Rod; Ng, Gail; Reid, Cliff; Pearson, Gale

    2011-01-01

    Background Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care. Objective To identify the current availability and utilisation of physician-based pre-hospital critical care capability across England, Wales and Northern Ireland. Design A postal and telephone survey was undertaken between April and December 2009 of all 13 regional NHS ambulance services, 17 air ambulance charities, 34 organisations affiliated to the British Association for Immediate Care and 215 type 1 emergency departments in England, Wales and Northern Ireland. The survey focused on the availability and use of physician-based pre-hospital critical care support. Results The response rate was 100%. Although nine NHS ambulance services recorded physician attendance at 6155 incidents, few could quantify doctor availability and utilisation. All but one of the British Association for Immediate Care organisations deployed ‘only when available’ and only 45% of active doctors could provide critical care support. Eleven air ambulance services (65%) operated with a doctor but only 5 (29%) operated 7 days a week. Fifty-nine EDs (27%) had a pre-hospital team but only 5 (2%) had 24 h deployable critical care capability and none were used regularly. Conclusion There is wide geographical and diurnal variability in availability and utilisation of physician-based pre-hospital critical care support. Only London ambulance service has access to NHS-commissioned 24 h physician-based pre-hospital critical care support. Throughout the rest of the UK, extensive use is made of volunteer doctors and charity sector providers of varying availability and capability. PMID:21427108

  7. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Bigdeli Maryam

    2010-07-01

    Full Text Available Abstract Background Road traffic injuries (RTIs are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence - referred to as the "golden hour"- are vital for the saving of lives. The present study was designed to estimate the average of various time intervals occurring during the pre-hospital care process and to examine the differences between these time intervals as regards RTIs on urban and interurban roads. Method A retrospective cross-sectional study was designed and various time intervals in relation to pre-hospital care of RTIs identified in the ambulance dispatch centre in Urmia, Iran from 20 March 2005 to 20 March 2007. All cases which resulted in ambulance dispatches were reviewed and those that had complete data on time intervals were analyzed. Results In total, the cases of 2027 RTI victims were analysed. Of these, 61.5 % of the subjects were injured in city areas. The mean response time for city locations was 5.0 minutes, compared with 10.6 minutes for interurban road locations. The mean on-scene time on the interurban roads was longer than on city roads (9.2 vs. 6.1 minutes, p Conclusion The response, transport and total time intervals among EMS responding to RTI incidents were longer for interurban roads, compared to the city areas. More research should take place on needs-to and access-for EMS on city and interurban roads. The notification interval seems to be a hidden part of the post-crash events and indirectly affects the "golden hour" for victim management and it needs to be measured through the establishment of the surveillance systems.

  8. Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care

    Directory of Open Access Journals (Sweden)

    G.S. Youssef

    2017-09-01

    Conclusion: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

  9. ATTENTION TO THE EMERGENCY ROOM WITH EMPHASIS ON PRE-HOSPITAL CARE: INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    B. S. Santos

    2017-08-01

    Full Text Available The study aims to identify the factors, which influence positively and negatively the implementation of public policies geared to the needs in scope of mobile, found in the publications of brazilian researchers since the implementation of the National Policy of Attention to the Emergency room in Brazil. This is a study of Integrative Literature Review. Composing the basis of methodology, have been used official documents to guide the findings that comprised the conceptual bases of the study and to guide the Integrative Review were used publications that report on the issue in question respecting all steps of the protocol review. The results show the changes in the organizational structure of the Service Mobile Emergency, given the regionalization as something positive for the growth of this service modality and discuss prematurely early articulation between the sectors that make up the public health system in Brazil. In conclusion, the policies of attention to the urgencies, in particular within mobile, have favored beneficially all of the users who require this type of care, in the meantime, make the necessary reflections about this theme in the attempt of a better understanding of the regionalization process and coordination among the municipalities that will offer the mobile care so as to ensure continuity of care through the mechanisms of reference and counter-reference

  10. Pre-hospital treatment of snake envenomation in patients presented AT a tertiary care hospital in Northwestern India

    Directory of Open Access Journals (Sweden)

    S. Chauhan

    2005-09-01

    Full Text Available Snakebite is an important medical emergency. Anti-snake venom along with supportive care is the only specific treatment. However, many people put their faith in non-registered medical practitioners. Where medical aid is available, lack of trained health personnel jeopardizes the situation. This retrospective study, the first of its kind, was aimed at studying the pre-hospital treatment as well as the behavior of patients bitten by snakes and referred to the Postgraduate Institute of Medical Education and Research, Chandigarh, India. A total of 88 cases that occurred between January 1997 and December 2001 were studied. Seventy patients received treatment prior to admission (the majority was treated by non-registered medical practitioners, registered medical practitioners, and MBBS doctors. The various treatment modalities used were: anti-snake venom (ASV, tourniquet, incision and drainage (I&D, tetanus toxoid, injections, and tablets. Non-registered medical practitioners still preferred tourniquet and I&D. The patients who were referred within 24 hours stayed less time in the hospital and spent less money on the treatment compared to those who were referred after 24 hours. Non-registered medical practitioners and inadequately trained health staff are often the first contact of snakebite victims. Their traditional and unscientific methods of treatment lead to unnecessary morbidity and increased treatment cost. It is therefore necessary to train these people adequately so that proper treatment can be instituted at the earliest.

  11. The nurse-patient relationship in pre-hospital emergency care--from the perspective of Swedish specialist ambulance nursing students.

    Science.gov (United States)

    Berntsson, Tommy; Hildingh, Cathrine

    2013-10-01

    The development of the Swedish ambulance service has resulted in three different competence levels in Swedish ambulance teams: specialist ambulance nurses, registered nurses and emergency medical technicians. A nursing scientific model developed by Peplau (Peplau, H., 1991. Interpersonal Relations in Nursing. Springer Publishing Company, New York.) breaks down the nurse-patient relationship into a number of phases: an orientation, an identification, an exploitation and a resolution phase. This model has then been adapted to the pre-hospital emergency care by Suserud (Dahlberg, K., Segesten, K., Nyström, M., Suserud, B.-O., Fagerberg, I., 2003. Att förstå vårdvetenskap [To Understand Caring Science]. Studentlitteratur, Lund.). The purpose of this study was to explore, by direct content analysis, how the phases of the pre-hospital nurse-patient relationship described by Suserud (Dahlberg et al., 2003), emerge in 17 specialist ambulance nursing students descriptions of ambulance missions. The results show that the four phases of the pre-hospital nurse-patient relationship could be identified and each phase includes several different parts. Furthermore, the results show that the parts of each phase can vary depending on the patient's condition and the environmental circumstances of the ambulance mission. This improved understanding of the four phases of the pre-hospital nurse-patient relationship, and their parts, could be used by ambulance team members as a support during the pre-hospital caring process in ambulance missions. This new knowledge could also be used in education. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Variations in pre-hospital fibrinolysis process of care: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic 3 Plus international acute myocardial infarction pre-hospital care survey.

    NARCIS (Netherlands)

    Welsh, R.C.; Goldstein, P.; Adgey, J.; Verheugt, F.W.A.; Bestilny, S.A.; Wallentin, L.; Werf, F. van de; Armstrong, P.W.

    2004-01-01

    The Assessment of the Safety and Efficacy of a New Thrombolytic 3 (ASSENT 3 PLUS) Plus trial (n=1639) was an international trial of pre-hospital fibrinolysis with tenecteplase randomly assigned to enoxaparin or unfractionated heparin, involving 106 sites in 12 countries. Given the potential impact o

  13. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.

    Science.gov (United States)

    Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, A Niroshan

    2017-01-24

    Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research

  14. Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

    Directory of Open Access Journals (Sweden)

    Maxine Johnson

    2017-01-01

    Full Text Available Abstract Background Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. Methods The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16 and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events. Three staff focus groups (total n = 21 and three service user focus groups (total n = 23 explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. Results The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service

  15. Intraosseous infusion and its use in pre-hospital care%骨内输液及其在院前现场救治中的应用

    Institute of Scientific and Technical Information of China (English)

    赵云飞; 黄淦; 禹宝庆

    2014-01-01

    院前救治中,建立外周静脉通道对于外周静脉塌陷的患者及婴幼儿十分困难。作为替代途径,骨内输液技术由于建立所需时间短,安全可靠,容易掌握,在国外院前救治中的作用日益显著,已被广泛应用。相比之下,国内在这一领域的研究还十分有限,骨内输液技术在国内的应用还主要局限于儿科,因此有必要回顾近几十年来这一领域的研究、发展以及创新,以引起国内对骨内输液技术的关注,发现其应用于国内现场救治的价值。本综述从原理、安全性、部位及效率方面详细介绍了骨内输液技术,列举了国外主流的骨内输液设备,探讨了骨内输液技术应用于国内院前救治的可行性。%For infants and patients with collapsed veins ,it would become quite difficult to establish periph-eral venous access at pre-hospital care period .As an alternative access ,intraosseous infusion has been widely used during pre-hospital care in foreign countries .Since it is easy to master ,quick to establish ,safe and reliable ,intrao-sseous infusion has become more and more important during pre-hospital care.In contrast,the researches in this field in our country are still very limited ,and intraosseous infusion is predominantly used in pediatrics in our coun-try.So it is necessary to review the researches ,developments and innovations in this field to arouse interests in this field and to discover the potential value of this technique in domestic pre -hospital care .We provided a systematic review on the principle ,safety,infusion site and efficiency of intraosseous infusion ,listed the currently used IO infu-sion devices and discussed the possibility of applying intraosseous infusion technique in domestic pre -hospital care .

  16. Emergency percutaneous coronary intervention (PCI) for the care of patients with ST-elevation myocardial infarction (STEMI).

    Science.gov (United States)

    Morrison, D A; Berman, M; El-Amin, O; McLaughlin, R T; Bates, E R

    2007-10-01

    There is general consensus that emergency percutaneous coronary intervention (PCI) is the preferred treatment for patients with ST-elevation myocardial infarction (STEMI), so long as it can be delivered in a timely fashion, by an experienced' operator and cardiac catheterization laboratory (CCL) team. STEMI is both a functional and structural issue. Although it has been recognized since the work of pioneering cardiologists and surgeons in Spokane, Washington, that approximately 88% of patients presenting within 6 hours of onset of STEMI have an occluded coronary artery, it is the pathophysiology of myocardial necrosis, and the varied consequences of necrosis that characterize STEMI. Accordingly, experience' of both primary operator and cardiac catheterization laboratory (CCL) crew, in performing an emergency PCI for STEMI, are as much a function of experience with the treatment of complex MI patients, as experience with coronary intervention. Rapidly achieving normal coronary artery flow, at both the macro and micro vascular levels, is the recognized key to aborting the otherwise progressive wavefront' of myocardial necrosis. The time urgency of decisions (Time is muscle') make emergency PCI for patients with on-going necrosis, more like emergency room (ER) care, than like most in-hospital or outpatient care. In general, most patients with acute coronary syndromes (ACS) are currently thought to have plaque rupture and/or erosion with subsequent thrombosis and embolization. Consequences of thrombo-embolism, such as slow flow' or no-reflow' are in addition to, the structural (anatomic) considerations of PCI in stable patients (such as ostial location; bifurcation involvement; heavy calcification; tortuosity of lesion or access to it; length of disease; caliber of infarct-artery; etc.). Good quality studies have provided strong support for the specific added value of glycoprotein IIb/IIIa inhibitors (especially abciximab), dual antiplatelet therapy (the addition of

  17. Research Progress of Nursing Safety Management of Pre-hospital Care%院前急救中的护理安全管理研究进展

    Institute of Scientific and Technical Information of China (English)

    耿芙蓉; 沈玉君

    2013-01-01

    现代急救医学多分为院前急救和院内急救两部分,前者更是整个抢救体系中的重要部分。在抢救过程中,护理安全是决定急救质量的一项重要指标。其高低直接能造成最终患者的抢救结果。优秀的护理安全以及相应的细节管理目前越来越被医院以及医护人员所重视。本文通过对近年来国内医院护理安全和细节管理在院前急救中的实施情况进行了回顾,陈述当前护理安全细节管理在院前急救中的现状,以及其实际的应用前景。%Modern Emergency Medicine is normally divided as pre-hospital care and hospital care. The former one is a more important part in the whole emergency system. In the rescue process, nursing safety is an important indicator to decide rescue equality. Its level can directly influence the final rescue result. Now excellent nursing safety and relevant specific management are paid more and more attention by hospital and medical workers. This article reviewed the implementation of domestic hospital nursing safety and specific management in pre-hospital care in recent years, and stated current situation of nursing safety management in pre-hospital care and its practical application prospect.

  18. Delays in the treatment of patients with acute coronary syndrome: Focus on pre-hospital delays and non-ST-elevated myocardial infarction

    NARCIS (Netherlands)

    Mol, K. A.; Rahel, B. M.; Meeder, J. G.; van Casteren, B. C. A. M.; Doevendans, P. A.; Cramer, M. J. M.

    2016-01-01

    Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital

  19. Evaluation of the status of the pre-hospital trauma care in road trafifc accidents in Kancheepuram district of Tamil Nadu

    Institute of Scientific and Technical Information of China (English)

    Prateek Saurabh Shrivastava; Jegadeesh Ramasamy

    2015-01-01

    Objective:To evaluate the status of the pre-hospital trauma care in a road traffic accidents in a rural area of Kancheepuram district. Methods: A cross-sectional study of two months duration (June and July 2014) was conducted in the tertiary care hospital of a medical college, and its affiliated urban/rural health centers. Universal sampling was used and all road accident victims were enrolled as study participants. The required information was obtained with the help of a semi-structured questionnaire. Ethical clearance was obtained before the start of the study.SPSS version 18 was used for data entry and statistical analysis. Descriptive statistics were calculated for all the variables. Results:A total of 80 (77.7%) study subjects were from the productive age group (15–45 years). Most of the accidents were reported at night time [43 (41.7%)], on weekends [59 (56.5%)], and involved two-wheelers [81 (78.6%)]. In addition, 69 cases (67%) of the victims were not aware of the existence of emergency ambulance services, while only 6 (5.8%) of the victims were brought to the hospital in an emergency ambulance. Conclusions: The study findings clearly suggest that the quality of the pre-hospital trauma care for road traffic accidentvictims in a rural area of Kancheepuram district lacks on multiple dimensions and there is an immense need to improve and strengthen the range of services to save the lives of the victims.

  20. Evaluation of the status of the pre-hospital trauma care in road traffic accidents in Kancheepuram district of Tamil Nadu

    Directory of Open Access Journals (Sweden)

    Saurabh RamBihariLal Shrivastava

    2015-12-01

    Full Text Available Objective: To evaluate the status of the pre-hospital trauma care in a road traffic accidents in a rural area of Kancheepuram district. Methods: A cross-sectional study of two months duration (June and July 2014 was conducted in the tertiary care hospital of a medical college, and its affiliated urban/rural health centers. Universal sampling was used and all road accident victims were enrolled as study participants. The required information was obtained with the help of a semi-structured questionnaire. Ethical clearance was obtained before the start of the study. SPSS version 18 was used for data entry and statistical analysis. Descriptive statistics were calculated for all the variables. Results: A total of 80 (77.7% study subjects were from the productive age group (15–45 years. Most of the accidents were reported at night time [43 (41.7%], on weekends [59 (56.5%], and involved two-wheelers [81 (78.6%]. In addition, 69 cases (67% of the victims were not aware of the existence of emergency ambulance services, while only 6 (5.8% of the victims were brought to the hospital in an emergency ambulance. Conclusions: The study findings clearly suggest that the quality of the pre-hospital trauma care for road traffic accident victims in a rural area of Kancheepuram district lacks on multiple dimensions and there is an immense need to improve and strengthen the range of services to save the lives of the victims.

  1. Factors influencing pre-hospital delay among patients with acute myocardial infarction in Iran

    Institute of Scientific and Technical Information of China (English)

    Maryam Momeni; Arsalan Salari; Shora Shafighnia; Atefeh Ghanbari; Fardin Mirbolouk

    2012-01-01

    Background Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population.Pre-hospital delay is an important cause of increasing early and also late mortality in AMI.Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran.Methods Between August 2010 and May 2011,a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr.Heshmat Hospital,Rasht.All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic,clinical,situational and cognitive factors.Data were analyzed by descriptive and Logistic regression model at P < 0.05 using SPSS 16.Results Mean age was (60.11±12.29) years in all patients.Majority of patients (65.4%) were male.The median of pre-hospital delay was 2 hours,with a mean delay of 7.4 hours (±16.25 hours).Regression analysis showed that admission in weekend (P <0.04,OR=1.033,95% Cl=1.187-2.006) and misinterpretation of symptoms as cardiac origin (P <0.002,OR=1.986,95% Cl=1.254-3.155) and perceiving symptoms to not be so serious (P <0.003,OR=3.264,95%Cl=1.492-7.142) were factors influencing pre-hospital delay > 2 hours.Conclusions Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays.Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.

  2. The effect of paramedic training on pre-hospital trauma care (EPPTC-study): a study protocol for a prospective semi-qualitative observational trial

    Science.gov (United States)

    2014-01-01

    Background Accidents are the leading cause of death in adults prior to middle age. The care of severely injured patients is an interdisciplinary challenge. Limited evidence is available concerning pre-hospital trauma care training programs and the advantage of such programs for trauma patients. The effect on trauma care procedures or on the safety of emergency crews on the scene is limited; however, there is a high level of experience and expert opinion. Methods I – Video-recorded case studies are the basis of an assessment tool and checklist being developed to verify the results of programs to train participants in the care of seriously injured patients, also known as “objective structured clinical examination” (OSCE). The timing, completeness and quality of the individual measures are assessed using appropriate scales. The evaluation of team communication and interaction will be analyzed with qualitative methods and quantified and verified by existing instruments (e.g. the Clinical Team Scale). The developed assessment tool is validated by several experts in the fields of trauma care, trauma research and medical education. II a) In a German emergency medical service, the subjective assessment of paramedics of their pre-hospital care of trauma patients is evaluated at three time points, namely before, immediately after and one year after training. b) The effect of a standardized course concept on the quality of documentation in actual field operations is determined based on three items relevant to patient safety before and after the course. c) The assessment tool will be used to assess the effect of a standardized course concept on procedures and team communication in pre-hospital trauma care using scenario-based case studies. Discussion This study explores the effect of training on paramedics. After successful study completion, further multicenter studies are conceivable, which would evaluate emergency-physician staffed teams. The influence on the patients

  3. 216例患者的院前急救护理体会%Pre-hospital emergency care for 216 patients

    Institute of Scientific and Technical Information of China (English)

    李秀英

    2011-01-01

    目的 探讨院前急救的措施,提高急救效率和抢救成功率方法 将2003年9月至2010年9月“120”接收的270例患者,采用完全随机设计,按照2:1比例,随机分成两组,其中治疗组180例与对照组90例.试验结束后,其中治疗组脱落50例,纳入分析130例;对照组脱落4例,纳入分析86例.对照组病例给予常规急救护理,治疗组则根据我院分析的院前急救存在的安全隐患,给予相关的急救护理措施.结果 治疗组病例的抢救成功率高于对照组,两组病例抢救成功率有统计学意义(P< 0.05).结论 规范急救护理行为可以提高院前急救成功率.%Objective To explore the measures of pre-hospital emergency care,and to enhance the efficiency of first aid and the success rate of life-saving.Methods 270 patients who had been hospitalzed by 120 dispatch center during the period of September 2003 to September 2010 were randomly divided into study group( 180 patients )and control group( 90 patients )at a ratio of 2∶1.At the end of this stduy,50 patients withdrew from the study group and 4 from the control group.The data on 130 patients in the study group and 86 in the control group were analyzed.The control group received routine emergency care,while the study group received special emergency care based on the potential pre-hospital safety risks for first aid analyzed in our hospital.Results The success rate of life-saving was significantly higher in the study group than in the control group ( P < 0.05 ).Conclusions Standard emergency care can increase the success rate of pre-hospital life-saving.

  4. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M.; Vaal, de E.T.; Rood, Pleunie P.M.; Hoogerwerf, N.; Doggen, C.J.M.; Schoonhoven, L.

    2015-01-01

    Introduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was devel

  5. Pain management in trauma patients in (pre)hospital based emergency care: Current practice versus new guideline

    NARCIS (Netherlands)

    A.C. Scholten (Annemieke); S.A.A. Berben (Sivera); A.H. Westmaas (Alvin H); P.M. van Grunsven (Pierre); E.T. de Vaal; P.P.M. Rood (Pleunie); N. Hoogerwerf (N.); C.J.M. Doggen (Carine); R. van Schoonhoven (Renee)

    2015-01-01

    textabstractIntroduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideli

  6. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M. van; Vaal, E.T. de; Hoogerwerf, N.; Doggen, C.J.; Schoonhoven, L.

    2015-01-01

    INTRODUCTION: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was deve

  7. The impact of a pre-hospital medical response unit on patient care and emergency department attendances.

    LENUS (Irish Health Repository)

    Deasy, C

    2012-02-03

    A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.

  8. Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

    Science.gov (United States)

    Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

    2015-08-27

    Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care. © The European Society of Cardiology 2015.

  9. Impact of pre-hospital care on the outcome of children arriving with agonal breathing to a pediatric emergency service in South India

    Directory of Open Access Journals (Sweden)

    Debasis Das Adhikari

    2016-01-01

    Full Text Available Background: Data on the prehospital interventions received by critically ill children at arrival to Paediatric Emergency Services (PES is limited in developing countries. This study aims to describe the pre-hospital care scenario, transport and their impact on outcome in non-traumatic, acutely ill children presenting in PES with agonal breathing. Methods: Prospective observational study done on children aged below 15 years arriving in PES with agonal breathing due to non-trauma related causes. Results: Out of 75 children studied, 69% were infants. The duration of illness among 65% of them (75 was less than 3 days. Majority of them (81% had received treatment prior to arrival. Government sector physicians (72%, half of them (51% being pediatricians were the major treating doctors. 37% of the children had arrived to the Emergency in an ambulance. Cardiopulmonary Resuscitation (CPR was given to 27% on arrival in PES. Other interventions included fluid boluses to correct shock (92% and inotrope infusion (56%. Sepsis (24% and pneumonia (24% were the most common diagnoses. Out of 75, 57 (76% children who were stabilized and shifted to PICU and among them 27 (47% survived to discharge. Normal blood pressure (p=0.0410 and non-requirement of CPR (0.0047 and inotropic infusion (0.0459 in PES were associated with a higher chance of survival. Conclusion: 36% (27/75 of children who arrived to our PES with agonal breathing survived to hospital discharge. Survival was significantly better among those who did not need CPR.

  10. Saving Lives on the Battlefield: A Joint Trauma System Review of Pre-Hospital Trauma Care in Combined Joint Operating Area - Afghanistan (CJOA-A)

    Science.gov (United States)

    2013-01-30

    It was a point of emphasis by FORSCOM and TRADOC in the recent past. 14. Not one study has shown any survival benefit from pre-hospital resuscitation...initial entry general medical officer ( GMO ) flight surgeons with minimal clinical and practical experience. The PJ Medical Oversight and Advisory Board...companies vary on how skills are taught (e.g. “high and tight” tourniquets, improper location for needle decompression). Consider cost and benefit of

  11. Protection and disinfection of medical personnel in pre-hospital emergency care of human avian influenza%人禽流感院前急救中医护人员的防护与消毒

    Institute of Scientific and Technical Information of China (English)

    邓明瑞

    2014-01-01

    目的:探讨人禽流感院前急救中医护人员的防护与消毒。方法:2010年2月12-20日转运疑似人禽流感患者14例,在转运过程中遵守工作流程,严格执行防护、消毒隔离制度。结果:院前转运工作结束以后,参加转运工作的司机、医护人员没有发生疑似禽流感感染症状。结论:提高院前急救司机、医护人员的防护意识,加强防护、消毒隔离措施,能有效地避免人禽流感在院前转运中的感染传播。%Objective:To discuss the protection and disinfection of medical personnel in pre-hospital emergency care of human avian influenza.Methods:14 cases of suspected avian influenza were transfered from 12 February to 20 February 2010.In the process of transport,we should follow the work process,and strictly implement protection and disinfection isolation system.Results:After the end of pre-hospital transfer work,the drivers and medical personnel with the transport work had no occurrence of suspected avian influenza infection symptoms.Conclusion:Improving the protection awareness of the drivers and medical personnel in pre-hospital emergency,strengthening the protection,and disinfection isolation measures can effectively prevent the spread of infection of human avian influenza in pre-hospital transfer.

  12. Simplifying electrocardiographic assessment in STEMI reperfusion management: Pros and cons.

    Science.gov (United States)

    Wong, Cheuk-Kit

    2017-01-15

    Current guidelines on STEMI reperfusion management do not incorporate further electrocardiographic details over the presence of significant ST elevation. Fibrinolysis is considered an alternative therapy to primary PCI if there is a long PCI-related delay, but the 2 therapies should not be combined. Meanwhile, reperfusion for ischemic stroke has evolved on mechanistic understanding - reperfusion benefit being greatest in the patient with small "core" infarct and large ischemic "penumbra". Fibrinolysis is not regarded as an alternative to mechanical thrombectomy, and the 2 therapies can be combined. In this article describing how reperfusion regimes have evolved along different paths for STEMI and for ischemic stroke, a new concept is made that in STEMI infarct lead Q waves can be the counterpart of the "core" and ST elevation the "penumbra". Suggestions to modify STEMI treatment algorithms are made, exploring further the relative role of (pre-hospital) fibrinolysis versus PCI particularly in younger patients presenting at the onset of their STEMI (no Q waves). In contrast, some patients particularly the older ones with more evolved STEMI (large Q waves present) may be much more suited for PCI despite expecting a long delay. The article finishes by describing potential future alterations in the method of reperfusion. Despite primary PCI being the well-established therapy, there are rooms for further research to optimize STEMI outcomes.

  13. Acute myocardial infarction pre-hospital emergency care and emergency analysis%急性心肌梗死的院前急救和急诊急救护理分析

    Institute of Scientific and Technical Information of China (English)

    甘梅

    2015-01-01

    Objective:To analyze patients with acute myocardial infarction and emergency pre-hospital emergency care and first aid measures and effects.Methods:The clinical data of 52 cases admitted to hospital with acute myocardial infarction were retrospectively analyzed, All patients received pre-hospital care and emergency first aid and rescue effect observed in patients.Results:52 patients had 50 cases safely into wards or ICU, Patients with complications are under control, The survival rate was 96.15%.Conclusion:The effective pre-hospital care and emergency first aid care can improve the survival rate of patients with acute myocardial infarction,clinical worth promoting.%目的:分析急性心肌梗死患者的院前急救和急诊急救的护理措施和效果。方法:对本院收治的52例急性心肌梗死患者的临床资料进行回顾性分析,所有患者均接受院前急救和急诊急救护理,观察患者的抢救效果。结果:52例患者有50例安全送入专科病房或ICU,患者并发症均得到控制,抢救成功率为96.15%。结论:及时有效地院前急救和急诊急救护理可以提高急性心肌梗死患者的抢救成功率,值得临床大力推广。

  14. 新时期院外急救护理工作面临的问题和对策%The problem and strategy of the pre-hospital emergency care in the new period

    Institute of Scientific and Technical Information of China (English)

    刘玲

    2009-01-01

    Objective To explore the new demand and reform of the pre-hospital emergency care under the special medical environment in the new era.Methods The clinical data,including the construction of pre-hospital emergency care and the psychological requirement of patients and their dependents,was analyzed.Results In the market economy, the scope of pre-hospital emergency was widened,and the demands of the patients as well as their families were increased.The disadvantage of the open medical environment,including the participation of the families and the negative psychologic status would do harm to curative activity.Conclusion Raising the integrated ability to deal with the problems,shortening the waiting time of psycology, strengthening the legal education of the on-call doctors,and emphasizing the psychological nursing service of patients and their families could bring benefits to the pre-hospital care.%目的 探讨如何在新时期特殊医疗环境下使院外急救护理工作适应医疗改革发展的需求.方法 分析了院外急救患者的来源构成、院外急救患者和家属心理需求表现等资料.结果 市场经济条件下院外急救范畴拓宽;患者和家属需求增加;开放式急诊医疗环境弊多利少;家属参与存在不利因素;患者和家属负性心理状况影响院外急救.结论 培养护士处理问题的综合能力;缩短心理等候时间;加强对出诊人员的法制教育;重视院前急救患者及家属的心理护理均有助于医护人员应对这些问题.

  15. The Pre-hospital Care and Nursing Care of Critically Urgent Ill Patients in the Department of Obstetrics and Gynecology%妇产科急危重症患者的院前急救及护理

    Institute of Scientific and Technical Information of China (English)

    翟丹; 熊焱

    2013-01-01

    Objective To explore the pre-hospital care and nursing care of critically urgent ill patients in the department of obstetrics and gynecology and provide the clinical basis for future applications. Methods The clinical data of 128 cases of acute and critically ill patients admitted to the obstetrics and gynecology from March 2010 to February 2012 were chosen in the research. The ambulance process and the effect were taken for retrospective analysis. The pre-hospital emergency care and experience for intensive patients in the department of obstetrics and gynecology were summarized. Results 128 cases of acute obstetrics and gynecology in critically ill patients were selected, 126 cases were successful and 2 died, the survival rate was 98.4%. Conclusion The pre-hospital first aid and care for intensive patients in the department of obstetrics and gynecology should be done:fast visits, try to understand the patient's symptoms on the road, and develop effective and accurate treatment programs;try every possible complications to make process, make the ambulance and medical staff memorize it in heart;comprehensively improve the overall quality of health care workers, and thereby improve the success rate for the intensive maternal.%  目的探讨妇产科急危重症患者的院前急救及护理的方法,为今后应用提供临床依据.方法本次研究选择我院2010年3月至2012年2月收治的妇产科急危重症患者128例的临床资料,对其救护过程、效果进行分析进行回顾性分析,总结妇产科急危重症患者的院前急救及护理的方法和经验.结果选取128例妇产科急危重症患者抢救成功126例,死亡2例,抢救成功率98.4%.结论妇产科急危重症患者的院前急救及护理应做到:出诊速度快,在路途中尽量了解患者的症状,并制订有效、准确的治疗方案;对每一种可能出现的并发症制订相应的救护流程,并让医护人员熟

  16. Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study.

    Science.gov (United States)

    Tarpgaard, Mona; Hansen, Troels Martin; Rognås, Leif

    2015-08-27

    Pre-hospital advanced airway management has been named one of the top-five research priorities in physician-provided pre-hospital critical care. Few studies have been made on paediatric pre-hospital advanced airway management. The aim of this study was to investigate pre-hospital endotracheal intubation success rate in children, first-pass success rates and complications related to pre-hospital advanced airway management in patients younger than 16 years of age treated by pre-hospital critical care teams in the Central Denmark Region (1.3 million inhabitants). A prospective descriptive study based on data collected from eight anaesthetist-staffed pre-hospital critical care teams between February 1st 2011 and November 1st 2012. Primary endpoints were 1) pre-hospital endotracheal intubation success rate in children 2) pre-hospital endotracheal intubation first-pass success rate in children and 3) complications related to prehospital advanced airway management in children. The pre-hospital critical care anaesthetists attempted endotracheal intubation in 25 children, 13 of which were less than 2 years old. In one patient, a neonate (600 g birth weight), endotracheal intubation failed. The patient was managed by uneventful bag-mask ventilation. All other 24 children had their tracheas successfully intubated by the pre-hospital critical care anaesthetists resulting in a pre-hospital endotracheal intubation success rate of 96 %. Overall first pass success-rate was 75 %. In the group of patients younger than 2 years old, first pass success-rate was 54 %. The total rate of airway management related complications such as vomiting, aspiration, accidental intubation of the oesophagus or right main stem bronchus, hypoxia (oxygen saturation advanced airway management. Compared with the total population of patients receiving pre-hospital advanced airway management in our system, the overall success rate following pre-hospital endotracheal intubations in children is acceptable but

  17. 荆州市院前急救人员手卫生状况调查%Investigation of hand hygiene status among pre-hospital emergency care staff in Jingzhou City

    Institute of Scientific and Technical Information of China (English)

    刘克英; 李培玲; 张枭霄; 陈春霞

    2012-01-01

    目的 了解荆州市院前急救医护人员手卫生状况及其影响因素.方法 采用问卷调查方法,调查85名院前急救人员手卫生执行状况;采用手部菌落采样法调查试验组45人(加强六步洗手法教育和使用手消毒剂)、对照组40人的手部污染状况.并调查救护车上的洗手设备情况.结果 院前急救人员手卫生执行率低.两组院前急救人员出诊中、洗手后的平均菌落数与手合格率差异均有统计学意义(P<0.01).14辆救护车上有洗手设备的仅6辆,但均不能正常使用.结论 院前急救人员自我保护意识强于保护患者的意识.救护车上手卫生设施缺失严重,院前急救人员手部污染严重,出诊前按常规的六步洗手法洗手不现实,但在救护车上用快速手消毒剂擦手是切实可行的,是减少手部细菌污染的好办法.%[Objective] To understand the hand hygiene status and its influencing factors among pre-hospital emergency care staff in Jingzhou City. [ Methods] The practice status of hand hygiene was investigated in 85 pre-hospital emergency care workers by questionnaire survey. By using hand bacterial colonies sampling, the hand contamination status of the study group (45 people) which was given education of six-step hand-washing method and using hand disinfectant, and the control group (40 people) was investigated. The status of hand-washing equipment in the ambulances was investigated. [Results]The practice rate of hand hygiene among pre-hospital emergency care staff was low. There were significant differences in average colony counts during treatment and after hand-washing, and qualified rate of hand hygiene between two groups (P <0.01). Among 14 ambulances, only 6 had hand-washing equipment, but all of them cannot work normally. [Conclusion] The self-protection consciousness of pre-hospital emergency care staff is higher than the consciousness of protecting patients. The deficiency of hand-washing equipment is

  18. 加强120急救中心院前急救医疗服务体系的管理%Strengthening administration of pre-hospital care medical service system in 120 first-aid center

    Institute of Scientific and Technical Information of China (English)

    赵明锐

    2012-01-01

    OBJECTIVE To enhance emergency management and establish and further improve pre-hospital emergency medical service center management system,so as to provide better service to patients. METHODS This article summarized the common security risks of the work in 120 emergency centers, and targeted to explore the corresponding emergency medical service management solutions. RESULTS To improve 120 emergency operations and management, it was necessary to establish and improve pre-hospital emergency medical service system, improve the care management system, emergency aid mechanism and regulate treatment. CONCLUSION 120 emergency center pre-hospital emergency medical service system plays an important role in the rescue capabilities of hospitals.%目的 加强急救管理,建立并完善急救中心院前急救医疗服务体系,进一步为患者服务.方法 总结120急救中心园区急救工作中的常见安全隐患,并有针对性急救医疗服务管理对策.结果 主要安全隐患为急救人员急救意识不强、信息提取不清晰、操作技能不熟练等;针对上述问题,应建立并完善院前急救医疗服务体系,健全护理管理体系,加强教育与培训,完善紧急救援机制和规范救治工作.结论 做好120急救中心院前急救医疗服务体系的运行和管理,对提升突发事件医疗救援能力具有重要意义.

  19. Pre-Hospital ECG E-Transmission for Patients with Suspected Myocardial Infarction in the Highlands of Scotland

    Directory of Open Access Journals (Sweden)

    Gordon F. Rushworth

    2014-02-01

    Full Text Available Patients with ST elevation myocardial infarction (STEMI require prompt treatment, best done by primary percutaneous coronary intervention (PPCI. However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.

  20. Dyspnea is a dangerous symptom in the pre-hospital setting

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Kirkegaard, Hans; Christensen, Erika Frischknecht

    ABSTRACT: Background Electrocardiogram (ECG) based telemedicine is a cornerstone in pre-hospital triage of patients with suspected ST-elevation myocardial infarction (STEMI). An ECG transmitted from the ambulance is reviewed by a cardiologist on-call in case of ongoing or recent chest pain......, resuscitation from cardiac arrest, acute dyspnea of unknown origin and other suspicion of STEMI. We hypothesize that unresolved dyspnea is an independent predictor of mortality in this prehospital setting and that the mortality is higher in patients with acute dyspnea of unknown origin than in patients......,204 (70%) of the patients, acute dyspnea of unknown origin in 1,461 (8 %), resuscitated from cardiac arrest in 163 (1%) and other suspicion of STEMI in 3,533 (20%). When adjusting for age, sex, systolic blood pressure and Charlson Comorbidity Index (p

  1. Pre - hospital care of chest trauma in non - wartime at high altitude%高海拔地区非战时胸外伤的院前急救

    Institute of Scientific and Technical Information of China (English)

    石云; 张道全; 张利; 秦江丽; 罗国军; 赵青; 陈瑜; 陈小波; 潘兴华

    2012-01-01

    目的 探讨高海拔地区非战时胸外伤的一站式院前急救.方法 2006年6月~2011年4月,在海拔1800 ~2000 m的滇中地区,利用军警信息共享、军警共建急救绿色通道,采用“一站式”院前急救胸部外伤780例,抢救方式为A(气道通畅)、B(人工呼吸)、C(循环支持)、D(人工除颤)、E(心电监护),还要考虑到高海拔低氧分压的地域因素.结果 呼救后抵达现场时间低于国内文献的报道,780例住院伤者院内死亡33例,占总救治数的4.2%,低于近期国内报道.结论 高海拔地区非战时胸部外伤的军警联动绿色通道的方式,符合目前平时性胸部外伤,也可用于战时胸外伤的院前急救.%Objective To discuss the one - step mode of pre - hospital care of chest trauma in non - wartime at high altitude. Methods From June 2006 to April 2011, in the central area of Yunnan Province at the altitude of 1,800 m to 2,000 m, one - step mode of pre - hospital care was adopted in 780 cases of chest trauma using the military and police information sharing and the green fast -track. Rescue procedures were A (clear airway) , B (artificial breathing) , C (circulation support) , D (artificial defibrillation) , and E ( electrocardiographic monitoring). At the same time, the environment factor of high altitude low oxygen partial pressure should also be considered. Results The time of arrival at the scene after call for help was shorter than the time reported by domestic literatures. Thirty three cases died among the 780 hospitalized patients, which accounted for 4. 2% of the total treatment number. The mortality rate was lower than that showed in recent literature reports. Conclusion The military and police green channel of chest trauma in non - wartime at high - altitude is suitable for the rescue of chest trauma and also can be used in the pre - hospital care of chest trauma in wartime.

  2. Management of pain in pre-hospital settings.

    Science.gov (United States)

    Parker, Michael; Rodgers, Antony

    2015-06-01

    Assessment and management of pain in pre-hospital care settings are important aspects of paramedic and clinical team roles. As emergency department waiting times and delays in paramedic-to-nurse handover increase, it becomes more and more vital that patients receive adequate pre-hospital pain relief. However, administration of analgesia can be inadequate and can result in patients experiencing oligoanalgesia, or under-treated pain. This article examines these issues along with the aetiology of trauma and the related socioeconomic background of traumatic injury. It reviews validated pain-assessment tools, outlines physiological responses to traumatic pain and discusses some of the misconceptions about the provision of effective analgesia in pre-hospital settings.

  3. Development and Evaluation of Educational Materials for Pre-Hospital and Emergency Department Personnel on the Care of Patients with Autism Spectrum Disorder

    Science.gov (United States)

    McGonigle, John J.; Migyanka, Joann M.; Glor-Scheib, Susan J.; Cramer, Ryan; Fratangeli, Jeffrey J.; Hegde, Gajanan G.; Shang, Jennifer; Venkat, Arvind

    2014-01-01

    With the rising prevalence of patients with autism spectrum disorder (ASD), there has been an increase in the acute presentation of these individuals to the general health care system. Emergency medical services and emergency department personnel commonly address the health care needs of patients with ASD at times of crisis. Unfortunately, there…

  4. Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness.

    Science.gov (United States)

    Shaban, Ramon Z; Considine, Julie; Fry, Margaret; Curtis, Kate

    2017-02-01

    Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

  5. Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?

    DEFF Research Database (Denmark)

    Salam, Idrees; Hassager, Christian; Thomsen, Jakob Hartvig

    2016-01-01

    -hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). METHOD: ROSC-ECGs of 145 comatose survivors of out-of-hospital cardiac arrest, randomly assigned in the Target Temperature Management trial, were classified according to the current STEMI ECG criteria (third universal definition...... of myocardial infarction). RESULTS: STEs were present in the pre-hospital ROSC-ECG of 78 (54%) patients. A final diagnosis revealed that 69 (48%) patients had STEMI, 31 (21%) patients had non-STEMI and 45 (31%) patients had no myocardial infarction. STE in ROSC-ECGs had a sensitivity of 74% (95% confidence...... intervention was successful in 68% versus 36% (PECG is a suboptimal diagnostic tool to predict STEMI...

  6. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study.

    Science.gov (United States)

    Rognås, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else

    2013-07-25

    We report data from the first Utstein-style study of physician-provided pre-hospital advanced airway management. Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) prospectively registered data according to the template for reporting data from pre-hospital advanced airway management. Data collection took place from February 1st 2011 to October 31st 2012. Included were patients of all ages on whom pre-hospital advanced airway management was performed. The objective was to estimate the incidences of failed and difficult pre-hospital endotracheal intubation, and complications related to pre-hospital advanced airway management. The overall incidence of successful pre-hospital endotracheal intubation among 636 intubation attempts was 99.7%, even though 22.4% of pre-hospital endotracheal intubations required more than one intubation attempt. The overall incidence of complications related to pre-hospital advanced airway management was 7.9%. Following rapid sequence intubation, the incidence of first pass success was 85.8%, the overall incidence of complications was 22.0%, the incidence of hypotension 7.3% and that of hypoxia 5.3%. Multiple endotracheal intubation attempts were associated with an increased overall incidence of complications. No airway management related deaths occurred. The overall incidence of successful pre-hospital endotracheal intubations compares to those found in other physician-staffed pre-hospital systems. The incidence of pre-hospital endotracheal intubations requiring more than one attempt is higher than suspected. The incidence of hypotension or hypoxia after pre-hospital rapid sequence intubation compares to those found in UK emergency departments. Pre-hospital advanced airway management including pre-hospital endotracheal intubation performed by experienced anaesthesiologists is associated with high success rates and relatively low

  7. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims

    OpenAIRE

    Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei

    2016-01-01

    SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s...

  8. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims

    OpenAIRE

    Gholipour, Changiz; Vahdati, Samad Shams; NOTASH, Mehdi; MIRI, Seyed Hassan; Ghafouri, Rouzbeh Rajaei

    2016-01-01

    SUMMARY Objectives Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a s...

  9. 现代网络院前急救模式对重型颅脑损伤预后影响%Influence of modern network pre-hospital emergency care mode on the prognosis of severe brain trauma

    Institute of Scientific and Technical Information of China (English)

    张守祥; 王诚; 戴利强; 吴涛; 刘胜

    2012-01-01

    目的 探讨现代网络院前急救模式对重型颅脑损伤患者预后的影响.方法 将院前重型颅脑外伤患者分成两组;现代网络院前急救模式(A组,162例)由经过专业培训的急救队伍组成,能够进行基础、高级生命支持,配备先进急救设备和现代交通工具等,利用现代网络连接快捷的特点,在深圳市急救中心调度下开展院前现场急救工作;传统模式组(B组,124例)患者自行到达医院,无医务人员现场抢救及陪同.统计调度时间、到达时间、现场时间、返回时间、总时间,同时对受伤类型、颅内损伤程度、格拉斯哥预后分级( GOS)进行统计学分析.结果 A组和B组的受伤类型、颅内损伤程度差异无显著性(P>0.05).A组预后伤残程度评级:良好72.22%,中残19.14%,重残1.85%,植物状态0.62%,死亡6.17%;B组预后伤残程度评级:良好47.58%,中残24.19%,重残12.10%,植物状态2.23%,死亡14.51%;A组预后优于B组,差异有显著性(P<0.05).结论 现代网络院前急救模式能提升重型颅脑损伤急救速度,降低死亡率和改善预后.%Objective To explore the influence of modern network pre-hospital emergency care mode on the prognosis of the patients with severe brain trauma.Methods Divided the patients with severe brain trauma into 2 groups:modern network pre-hospital emergency care mode group( A group,162 cases ),which had a professional rescue team that equipped with advanced first-aid equipment and had modern transportation and modem fast network,carried pre-hospital emergency rescue work out under the management of the Shenzhen City Emergency Center; Patients in traditional mode group ( B group,124 cases ) went to hospital with no health care and no companionship of medical worker.Then recorded the scheduling time,running time,rescue time,returning time,and total time; statistically analyzed the traumatic type,traumatic degree,and Glasgow Outcome Scale( GOS ) in both

  10. Pre-hospital treatment of acute poisonings in Oslo

    Directory of Open Access Journals (Sweden)

    Nore Anne K

    2008-11-01

    Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

  11. Application of emergency nursing professional team in the pre-hospital care%院前急救护理专业小组在院前急救护理工作中的应用

    Institute of Scientific and Technical Information of China (English)

    洪小英; 李娜; 周玲; 王根群; 黄超莹

    2013-01-01

      目的探讨成立院前急救护理专业小组在院前急救护理工作中的作用。方法2011年10月~2012年3月收治的患者为成立院前急救护理专业小组前组(设为对照组),2012年4~9月收治的患者为成立院前急救护理专业小组后组(设为研究组),每组各200例。对照组在急救护理工作中按常规急救护理管理,研究组在急救护理工作中成立院前急救护理专业小组进行急救护理管理。比较两组患者满意度、出车时间及护理不良事件发生率。结果成立院前急救护理专业小组后,患者满意度较实施前明显升高,出车时间较实施前明显缩短、护理不良事件发生率较实施前明显减少,两组比较,均P<0.05,差异具有统计学意义。结论在急救护理工作中成立院前急救护理专业小组护理管理模式,能有效提高院前急救护理质量。%Objective To study the role of emergency nursing professional team in the pre-hospital care.Methods Two hundred patients from October 2011 to March 2012 were set as the control group and another 200 patients from April 2012 to September 2012 were selected as the experiment group.The control group was managed by routine emergency mode and the experiment group by the emergency nursing professional team.The two groups were compared in terms of satisfaction degree,the time for the team to start and the rate of adverse nursing events.Results After establishing the emergency nursing professional team,the satisfaction degree was significantly increased,the time for the team to start was significantly shortened and the rate of adverse nursing events was significantly decreased(all P<0.05).Conclusion The management mode of emergency nursing professional team in pre-hospital medical care can effectively improve the quality of nursing care.

  12. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

    DEFF Research Database (Denmark)

    Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

    2014-01-01

    Objective: European ST-segment elevation myocardial infarction (STEMI) guidelines recommend prehospital diagnosis to facilitate early reperfusion in patients with STEMI, and they provide recommendations regarding optimal system delay (time from first medical contact (FMC) to the primary...... percutaneous coronary intervention (PPCI)). There are limited data on achievable system delays in an optimal STEMI system of care using prehospital diagnosis to triage patients with STEMI directly to percutaneous coronary intervention (PCI) centres. We examined the proportion of tentative prehospital STEMI...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported

  13. 模拟场景下临床路径对提高院前创伤救治质量的研究%Effect of clinical pathway on promoting pre-hospital trauma care under clinical simulations condition

    Institute of Scientific and Technical Information of China (English)

    付卫林; 张军根; 袁轶俊; 唐春福; 张燕军; 张志伟

    2015-01-01

    Objective To explore the effect of clinical pathway on promoting pre-hospital trauma care under clinical simulations condition. Methods The traumatic mimic patients and pre-hospital clinical pathway were designed and the traditional traumaic treatment and clinical pathway treatment were used on simulated patients. Results After training, the percentage of locale assessment, life-threatening bleeding assessment, airway assessment, breathing assessment, circula-tion assessment, rapidly trauma assessment and communication with teammates and assistants were significantly increased (χ2=80.81, 88.17, 66.78, 55.54, 74.67, 84.41, 64.07, 74.67,P<0.05). The scores of control bleeding, dressing, cervi-cal spine immobilization, airway management were also significantly improved (t=-42.97,-35.37,-54.34,-88.75,-52.28, P<0.05). Moreover, the time of locale treatment, assessment, control bleeding and dressing, cervical spine immobiliza-tion, fracture fixation were significantly shortened than that of before training (t=4.88,12.81,6.63,3.92,4.58,P<0.05). Conclusion The clinical pathway under clinical simulations condition can improve the quality of trauma assessment, re-duce time of treatment, improve the efficiency and the quality of treatment.%目的:探讨在模拟场景下临床路径对提高院前创伤救治质量的有效程度。方法设计创伤的模拟病例场景和创伤的院前临床路径,以传统的创伤救治和临床路径的救治方式分别对模拟病例进行救治。结果培训后进行现场评估、显性大出血评估、气道评估、呼吸评估、循环评估、快速查体评估、救治沟通、协助救治的急救小组比例较培训前有明显提高(χ2分别=80.81、88.17、66.78、55.54、74.67、84.41、64.07、74.67,P均<0.05)。止血、包扎、长骨固定、颈椎固定、气道管理等各单项技能操作的成绩也较培训前明显提高(t分别=-42.97、-35.37、-54.34、-88.75、-52.28,P均<0.05

  14. Atendimento pré-hospitalar móvel em Fortaleza, Ceará: a visão dos profissionais envolvidos Mobile pre-hospital care in Fortaleza, Ceará: the vision of professionals involved

    Directory of Open Access Journals (Sweden)

    Juliana Guimarães e Silva

    2009-12-01

    Full Text Available Com o objetivo de descrever variáveis sociodemográficas, profissionais e operacionais das diferentes categorias envolvidas no Serviço de Atendimento Móvel de Urgência, bem como a percepção destas quanto à adequação do serviço oferecido às diretrizes da Política Nacional de Atenção às Urgências, foi realizado um estudo transversal, mediante um questionário autoaplicável, em 2007/2008. Os 89 pesquisados apontaram comprometimento da estrutura física (60,7%; escassez de materiais (82,0%; incipiência de recursos humanos (37,1%; mau estado de conservação e número insuficiente de ambulâncias (67,4%. 98,9% admitiram que há integração com outros serviços, com diferença estatística entre as categorias profissionais (p = 0,037. A terceirização predominou entre 71,4% dos médicos e 84,2% dos enfermeiros (p A cross-sectional study based on a self-administered questionnaire was performed in 2007/2008, with the objective of describing sociodemographic, professional, and operating variables of the various professional categories involved in the Mobile Emergency Care Service, and the perception of the compliance of the service offered with the guidelines of the National Emergency Care Policy. All 89 participants indicated deficient physical structure (60.7%; shortage of materials (82.0%; unskilled human resources (37.1%; poor conservation conditions and insufficient number of ambulances (67.4%; 98.9% admitted the existence of integration with other services, with some statistical differences among professional categories (p = 0.037. Outsourcing prevailed among 71.4% of physicians and 84.2% of nurses (p < 0.001. Specific capacity building was confirmed by 79.8%, and update by 88.8% of professionals. Total average response time was 29 minutes (SD ± 14.8, and 65.2% acknowledged knowing the policy. This study showed that pre-hospital care services have structural and planning problems, among which poor working conditions and fragile

  15. The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries : a retrospective observational study

    NARCIS (Netherlands)

    Oosterwold, J. T.; Sagel, D. C.; van Grunsven, P. M.; Holla, M.; de Man-van Ginkel, J.; Berben, S.

    Background Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital

  16. 衢州地区急性颅脑创伤患者院前及急诊救治现状分析%Analysis on pre-hospital care and emergency treatment of craniocerebral trauma patients in Quzhou district

    Institute of Scientific and Technical Information of China (English)

    黄强; 戴伟民; 揭园庆; 聂俊; 王小芳; 胡永亮; 余小明; 宋光太; 金涛

    2013-01-01

    Objective To study an epidemiological research and analysis on current status of craniocerebral trauma patients'pre-hospital care and emergency treatment.Methods In order to achieve the objective,factors,including age,sex,cause of injury,injury date and time,on-site emergency treatment,transport mode,time period from injury to specialist treatment,time period from injury to first-time head examine,emergency room treatment status,treatment outcomes,etc.,are analyzed based on statistics of craniocerebral trauma in-patients of Quzhou district in 2009.Results Young men are the high risk population of acute craniocerebral trauma.Traffic accident is the main cause of trauma,mines and factories are closely related places.The relative percentages of on-site professional emergency treatment and ambulance transportation are quite low.Township hospitals have the shortest time period from injury to hospital treatment,but also have the longest time period from injury to specialist treatment or first-time head CT examine.raniocerebral trauma are mainly closed injuries,while the most common emergency room treatments are debridement and suturing.Conclusion Craniocerebral trauma is a dangerous kind of traumatic diseases with high risk and incidence rate.The incidence rate of the trauma can be reduced by strengthening the enforcement of related laws and regulations as well as the popularization and education of related knowledge.The mortality rate and disability rate can be reduced by training the doctors and nurses as well as improving the medical equipment of hospitals,especially the primary hospitals.%目的 对颅脑创伤患者的院前急救和急诊室救治现状进行流行病学调查和研究.方法 以2009年衢州地区颅脑创伤住院病人为研究对象,对年龄、性别、致伤原因、致伤日期和时间、现场急救、伤员转运方式、受伤-急诊专科救治时间、受伤-首次头颅检查时间、急诊室急救现状和治疗结

  17. Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    James J McCarthy

    2011-05-01

    Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

  18. 加强120急救中心院前急救医疗服务体系的管理%Strengthening Administration of Pre-hospital Care Medical Service System in 120 First-aid Center

    Institute of Scientific and Technical Information of China (English)

    梁鹤峰

    2015-01-01

    目的:为完善120急救中心院前急救医疗服务体系,强化其管理,寻求最佳方式。方法分析当前120急救中心急救医疗服务体系管理中的不足,并提出相应的解决方案与措施。结果120急救中心院前急救医疗服务体系中存在着急救意识淡薄、信息获取模糊、救护人员医疗技术水平较低三个方面的不足,解决当前的现状则需要建立行之有效的急救医疗服务体系。结论加强120急救中西院前急救医疗服务体系的管理,对加强120应对临时事故的应对能力有着重要的现实意义。%Objective To improve the 120 emergency center of pre-hospital emergency medical services system, strengthen its management, seeking the best way. Methods Analyzing the 120 emergency center management of emergency medical services system is insufficient, and put forward corresponding solutions and measures. Results The 120 emergency center in the pre-hospital emergency medical services system there exists a weak consciousness of first aid, access to information fuzzy, rescuers have a relatively low level of medical technology, the shortage of the three aspects, the current situation requires to build a effective emergency medical service system. Conclusion To strengthen 120 ifrst aid of pre-hospital emergency medical service system of Chinese and western management, to strengthen the response capacity in coping with temporary accident have important practical signiifcance.

  19. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

    DEFF Research Database (Denmark)

    Kruger, Andreas J; Lockey, David; Kurola, Jouni

    2011-01-01

    by the experts. Subsequent rounds reduced the number of core variables to 45. These constituted the final core data set. Emphasis was placed on the standardisation of reporting time variables, chief complaints and diagnostic and therapeutic procedures. CONCLUSIONS: Using a modified nominal group technique, we...... a higher quality of care to pre-hospital patients. There is no current data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician......-staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...

  20. Framework for a National STEMI Program: consensus document developed by STEMI INDIA, Cardiological Society of India and Association Physicians of India.

    Science.gov (United States)

    Alexander, Thomas; Mullasari, Ajit S; Kaifoszova, Zuzana; Khot, Umesh N; Nallamothu, Brahmajee; Ramana, Rao G V; Sharma, Meenakshi; Subramaniam, Kala; Veerasekar, Ganesh; Victor, Suma M; Chand, Kiran; Deb, P K; Venugopal, K; Chopra, H K; Guha, Santanu; Banerjee, Amal Kumar; Armugam, A Muruganathan; Panja, Manotosh; Wander, Gurpreet Singh

    2015-01-01

    The health care burden of ST elevation myocardial infarction (STEMI) in India is enormous. Yet, many patients with STEMI can seldom avail timely and evidence based reperfusion treatments. This gap in care is a result of financial barriers, limited healthcare infrastructure, poor knowledge and accessibility of acute medical services for a majority of the population. Addressing some of these issues, STEMI India, a not-for-profit organization, Cardiological Society of India (CSI) and Association Physicians of India (API) have developed a protocol of "systems of care" for efficient management of STEMI, with integrated networks of facilities. Leveraging newly-developed ambulance and emergency medical services, incorporating recent state insurance schemes for vulnerable populations to broaden access, and combining innovative, "state-of-the-art" information technology platforms with existing hospital infrastructure, are the crucial aspects of this system. A pilot program was successfully employed in the state of Tamilnadu. The purpose of this article is to describe the framework and methods associated with this programme with an aim to improve delivery of reperfusion therapy for STEMI in India. This programme can serve as model STEMI systems of care for other low-and-middle income countries.

  1. False Positive STEMI Activations in a Regional Network: Comprehensive Analysis and Clinical Impact. Results From the Catalonian Codi Infart Network.

    Science.gov (United States)

    Regueiro, Ander; Fernández-Rodríguez, Diego; Freixa, Xavier; Bosch, Xavier; Martín-Yuste, Victoria; Brugaletta, Salvatore; Roqué, Mercè; Sabaté, Manel; Masotti, Mónica

    2017-07-12

    ST-segment elevation myocardial infarction (STEMI) network activation by a noncardiologist reduces delay times but may increase the rate of false-positive STEMI diagnoses. We aimed to determine the prevalence, predictors, and clinical impact of false-positive activations within the Catalonian STEMI network (Codi Infart). From January 2010 through December 2011, all consecutive patients treated within the Codi Infart network were included. Code activations were classified as appropriate if they satisfied both electrocardiogram and clinical STEMI criteria. Appropriate activations were classified as false positives using 2 nonexclusive definitions: a) "angiographic" if a culprit coronary artery was not identified, and b) "clinical" if the discharge diagnosis was other than STEMI. In total, 5701 activations were included. Appropriate activation was performed in 87.8% of the episodes. The rate of angiographic false positives was 14.6%, while the rate of clinical false positives was 11.6%. Irrespective of the definition, female sex, left bundle branch block, and previous myocardial infarction were independent predictors of false-positive STEMI diagnoses. Using the clinical definition, hospitals without percutaneous coronary intervention and patients with complications during the first medical contact also had a false-positive STEMI diagnoses rate higher than the mean. In-hospital and 30-day mortality rates were similar for false-positive and true-positive STEMI patients after adjustment for possible confounders. False-positive STEMI diagnoses were frequent. Outcomes were similar for patients with a true-positive or false-positive STEMI diagnosis treated within a STEMI network. The presence of any modifiable predictors of a false-positive STEMI diagnosis warrants careful assessment to optimize the use of STEMI networks. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  2. Telemedicine in pre-hospital care: a review of telemedicine applications in pre-hospital environment.

    OpenAIRE

    Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O'Donnell, Cathal

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality resear...

  3. APPROACHES TO INCREASE THE AVAILABILITY AND EFFECTIVENESS OF PRE-HOSPITAL THROMBOLYSIS IN REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    L. A. Ostroumova

    2012-01-01

    Full Text Available Aim. To identify the factors of the increasing the availability and effectiveness of pre-hospital thrombolytic therapy of patients with ST segment elevation acute coronary syndrome (STEACS. Material and methods. STEACS patients (n=70 were included in the study and stratified into two groups. Patients of the 1st group (n=30 received emergency medical assistance from the feldsher teams and patients of the 2nd group (n=40 — from the doctor teams. Expert estimation approach was used for the real practice assessment. Results. The hospital-matched diagnose rate was 97.5% in the doctor teams in comparison with 76.7% in feldsher teams (p<0.05. The efficiency of pre-hospital thrombolysis in 90 minutes after its beginning was 60.1% for the doctor teams versus 73.3% for the feldsher teams (p>0.05. The deviation from the standard operating procedure of the medical care for myocardial infarction patients was observed more often in the doctor teams in comparison with this in the feldsher teams. Time for the decision about pre-hospital thrombolysis start, the rate of unreasonable use or unreasonable refusal of thrombolysis did not differ significantly in feldsher and doctor teams. Conclusion. To increase the effectiveness of pre-hospital thrombolysis therapy it is necessary to follow strictly the standard of the medical care for patients with acute coronary syndrome. One of the main approaches to improve the availability of up to date medical care technologies in STEACS treatment is implementation of pre-hospital thrombolysis in practice of feldsher teams.

  4. Critically ill patients in the Pre-hospital Emergency First aid and Transit en Route Care Measures%院前急救中危重症患者现场急救和转运途中的护理措施

    Institute of Scientific and Technical Information of China (English)

    杨小内

    2013-01-01

      目的探讨院前急救中危重患者现场急救和转运途中的护理措施。方法针对我院2011年6月至2012年6月收治的400例院前急救的危重患者的临床资料进行分析,通过快速评估伤情,启动急救程序,有针对性地做好急救护理以及转运工作,实施一系列护理措施,使患者安全转运到医院继续治疗。结果本组患者经院前现场急救和转运的护理措施后,抢救成功371例,死亡29例。结论对于院前急救危重患者在现场实施急救措施与转运途中的护理措施是院前急救的关键,可以有效的提高患者的生存率,为到院内治疗创造了有利的条件,明显的降低患者的死亡率和致残率,提高患者的生活质量。%Objective To explore the nursing measures of pre-hospital care of critically ill patients with first aid and trans-portation. Methods the clinical data in our hospital from 2011 June to critically ill patients in emergency treatment of 400 cases from 2012 June were analyzed before,through the rapid evaluation of trauma,emergency procedures,to carry out emergency care and transport work,the implementation of a series of nursing measures,make the patient safety transport to the hospital to continue treatment. Results The nursing measures of first aid and transport in this group of patients before and after the house, 371 were successfully rescued,29 cases of death. Conclusion;for critically ill patients in the nursing measures on emergency measures and transport is the key of pre-hospital emergency pre-hospital care,can effectively improve the survival rate of pa-tients to the hospital treatment,in order to create favorable conditions,reduce the mortality and disability rate,improve the quality of life of patients. On-site emergency transport nursing measures of pre-hospital care

  5. STEMI院前溶栓的研究进展%Research Progress of Pre-hospital Thrombolyisi in STEMI

    Institute of Scientific and Technical Information of China (English)

    姜华

    2012-01-01

    溶栓治疗在STEMI的治疗非常广泛,院前溶栓的疗效得到广泛认可,但院前溶栓的开展受到多种因素的限制,需加强多方面的交流合作.随着对STEMI的公众宣教,急救医疗服务系统人员的培训,急救车辆设备和溶栓药物的配备,院前院内无缝连接绿色通道的建立,会让更多的STEMI患者得到溶栓获益.从而降低STEMI的死亡率,改善其预后.

  6. Atendimento pré-hospitalar: caracterização das ocorrências de acidente de trânsito Atención prehospitalaria: caracterización de las ocurrencias de accidentes de tránsito Pre-hospital care: characteristics of traffic accidents

    Directory of Open Access Journals (Sweden)

    Waleska Antunes da Porciúncula Pereira

    2006-09-01

    destacan el involucramiento del equipo de soporte básico en la atención prehospitalaria e indican la necesidad de prevención de esos daños y de calificación de los trabajadores para la estructuración del trabajo basado en la interdisciplinaridad.OBJECTIVES: to identify types of occurrence registered by a pre-hospital care unit and to characterize occurrences from traffic accidents. METHODS: a descriptive cross-sectional study was used to analyze 6,430 pre-hospital calls from July to September, 2003. RESULTS: the occurrences were classified as trauma (35.2 %, or traffic accidents (57.9%. Most occurrences took place in the afternoon and were common in all days of the week. The basic pre-hospital care team, consisting of a licensed practical nurse or associate degree nurse and an ambulance driver, was the team that answered most emergency calls (84.5%. A professional nurse participated in only 11.2% of the occurrences, and great part of these occurrences (4.27% was answered by the advanced pre-hospital care team. A physician participated in only 8.3% of occurrences. CONCLUSION: the basic pre-hospital care team was involved in the majority of emergency calls. This suggests a need of new strategies for preventing victim's complications and better ways to qualify pre-hospital care team members for a quality interdisciplinary-based work.

  7. [Pre-hospital observation as an alternative to emergency hospitalisation].

    Science.gov (United States)

    Jensvold, Morten; Seim, Arnfinn

    2014-09-30

    Pre-hospital observation beds in community care centres have for many years served as an alternative to hospitalisation in rural districts of Norway. The article presents the use of observation beds associated with the Fosen A&E centre. A retrospective review of records of patients who had contacted Fosen A&E centre during the period 21 August 2006-21 August 2009 was undertaken. Patient characteristics and clinical pathways were registered, including admissions to hospital or to an observation bed, as well as re-admissions. Ever since observation beds were first introduced, clear inclusion and exclusion criteria have been applied with regard to the allocation of patients to observation beds. Altogether 8027 patients had been in direct contact with an A&E doctor, and 2342 were admitted, of whom 77% to hospital and 23% to an observation bed. Of the 530 patients admitted to an observation bed, 55% were 70 years or older. Of these, 68% were discharged to their homes within 36 hours, 17% were transferred to hospital, and the remainder received further treatment in a local rehabilitation unit or nursing home. The rate of readmission to observation beds or hospital amounted to 4% among those who had been discharged after no more than three days, and 18% among those discharged after 3-28 days. A low number of readmissions may indicate that the use of observation beds is an alternative to hospitalisation.

  8. Algorithm for the automatic computation of the modified Anderson-Wilkins acuteness score of ischemia from the pre-hospital ECG in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Sejersten, Maria; Schoos, Mikkel Malby

    2017-01-01

    BACKGROUND: The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least...... the acuteness score. METHODS: We scored 50 pre-hospital ECGs from STEMI patients, manually and by the automated algorithm. We assessed the reliability test between the manual and automated algorithm by interclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS: The ICC was 0.84 (95% CI 0.......72-0.91), PECGs, all within the upper (1.46) and lower (-1.12) limits...

  9. Nursing Experience of Salvage at Scene and Transportation in Pre-hospital Care to Critically Ill Patients%危重症患者院前急救中现场抢救和转运途中的护理体会

    Institute of Scientific and Technical Information of China (English)

    袁玉媚

    2013-01-01

      目的:探讨危重症患者院前急救中现场抢救和转运途中的护理体会.方法:选择我院危重症患者200例,观察组和对照组各100例,观察组患者在院前实施现场抢救,以及在转运途中采取全过程的护理,而对照组则没有及时实施现场抢救和转运途中的护理.结果:经过统计学的对比,观察组患者的抢救成功率明显高于对照组(P<0.05),而且观察组患者的痛苦和伤残率也明显低于对照组(P<0.05).结论:对于危重症患者在院前急救中有效地实施现场抢救,以及转运途中的护理,不仅能有效地降低危重症患者的痛苦和伤残率,而且还能有效地为入院急救的成功率得到最大限度的提高.%Objective:To discuss the nursing experience of salvage at scene and transportation in pre-hospital care to critically ill patients. Methods:200 cases of critically ill patients in our hospital were chosen to divided into observation group and control group, which both included 100 cases. The patients in observation group received the salvage at scene and whole process care in transit, while the control group not. Results: By statistical comparison, the survival rate of observation group is significantly higher than control group (P<0.05), and the pain of the patients and rate of dis-ability are also significantly lower than control group (P<0.05). Conclusion:Effective implementa-tion of salvage at scene in pre-hospital care and care in transit to critically ill patients, not only can effectively reduce the rate of disability and pain of patients, but also effectively maximize the sur-vival rate of admission emergency.

  10. Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

    Directory of Open Access Journals (Sweden)

    Mamta Swaroop

    2013-01-01

    Full Text Available Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems . This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials and Methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003 . Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software. Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving . Patients with higher injury severity scores (ISS were transported more quickly. Injury severity scores (ISS ≥16 and emergency department (ED hypotension (systolic blood pressure, SBP <90 strongly predicted mortality (P < 0.05 for each . In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05. This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001. Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner . Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival . These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

  11. A validation of ground ambulance pre-hospital times modeled using geographic information systems

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    Patel Alka B

    2012-10-01

    Full Text Available Abstract Background Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS using geographic information systems (GIS. The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. Methods The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval. The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. Results There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7–8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. Conclusions The widespread use of generalized EMS pre-hospital

  12. A validation of ground ambulance pre-hospital times modeled using geographic information systems.

    Science.gov (United States)

    Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

    2012-10-03

    Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a

  13. Determining the composition and benefit of the pre-hospital medical response team in the conflict setting.

    Science.gov (United States)

    Davis, P R; Rickards, A C; Ollerton, J E

    2007-12-01

    To determine the optimal composition o f the pre-hospital medical response team (MERT) and the value of pre-hospital critical care interventions in a military setting, and specifically to determine both the benefit of including a doctor in the pre-hospital response team and the relevance of the time and distance to definitive care. A comprehensive review of the literature incorporating a range of electronic search engines and hand searches of key journals. There was no level 1 evidence on which to base conclusions. The 15 most relevant articles were analysed in detail. There was one randomized controlled trial (level 2 evidence) that supports the inclusion of a doctor on MERT. Several cohort studies were identified that analysed the benefits of specific critical care interventions in the pre-hospital setting. A doctor with critical care skills deployed on the MERT is associated with improved survival in victims of major trauma. Specific critical care interventions including emergency endotracheal intubation and ventilation, and intercostal drainage are associated with improved survival and functional recovery in certain patients. These benefits appear to be more easily demonstrated for the rural and remote setting than for the urban setting.

  14. The comprehension of nursing management for tuberculosis patients during pre-hospital care%结核病患者院前急救护理管理体会

    Institute of Scientific and Technical Information of China (English)

    罗翠波; 闫丽影; 王萌; 赵云霄

    2009-01-01

    探讨结核病患者院前急救中的护理风险管理.回顾性分析161例结核病患者院前转送过程中针对不同病情所给予的有效护理措施.除4例患者现场抢救无效死亡外,其余157例患者均安全转送至专科医院进一步救治.科学的分析患者转送风险,并在院前急救过程中给予有效的护理管理,可使患者成功得到救治与转送.%Objective To approach the nursing risk management for the tuberculosis patients during prehospital care.Methods Retrospective study the available nursing intervention to the variant conditions for 161 tuberculosis patients during prehospital transference.Results 157 cases were salty and successfully transferred to the specialized hospital except 5 cases dead on scene.Conclusions Analyzing the transference risk of the cases scientificlly and establishing a set of available nursing intervention before executing the duty can ensure the patients transferred safty and timely during prehospital care.

  15. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

    Directory of Open Access Journals (Sweden)

    Castrén Maaret

    2011-05-01

    Full Text Available Abstract Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

  16. 云平台和物联网技术在院前急救中的应用%The Application of Cloud Platform and Internet of Things Technology in Pre-hospital Emergency Medical Care

    Institute of Scientific and Technical Information of China (English)

    胡占生; 刘晓辉; 姚惠东; 蔡明珠; 覃森荣

    2014-01-01

    院前急救对时限性要求高,传统方式存在较大的局限性。运用云平台和物联网技术有效解决传统模式下存在的问题,包括远程专家支持、现场明确诊断、区域协同救治等,节省了医疗费用,同时提高了救治效果。介绍了广州军区总医院院前急救系统的软件平台和系统架构。运用院前急救平台使该地区的胸痛患者院前急救达到世界先进水平,取得了显著经济效益和社会效益。%The prehospital emergency medical care has high timing requirement. The traditional way has large limitation. With cloud platform and Internet of Things technology, the problems existing in the traditional mode can be effectively solved, including remote expert support, on-site definite diagnosis, regional coordination treatment, etc. It saves medical cost and improves the effect of the treatment. This paper introduces the composition and system architecture of software platform of prehospital emergency system of Guangzhou General Hospital of Guangzhou Military Command. With the prehospital emergency platform, the region's prehospital emergency level of chest pain patients has reached the world advanced level and significant economic and social benefits have been made.

  17. STEMI Associated with Overuse of Energy Drinks

    Directory of Open Access Journals (Sweden)

    Daniel Solomin

    2015-01-01

    Full Text Available Coronary artery disease (CAD and ST-elevation myocardial infarction (STEMI are predominantly diseases of middle-aged and older adults and when found in younger adults are usually associated with a strong family history. However, this report details the case of a nonobese 26-year-old Hispanic male who presented with an acute STEMI despite having no family history or other apparent risk factors for CAD or STEMI beyond a two pack-year smoking history and excessive energy drink consumption. The patient reported consuming between eight and ten 473 mL cans per day. Cardiac catheterization subsequently confirmed total occlusion of his left circumflex coronary artery.

  18. Effect of pre-hospital advanced airway management for out-of-hospital cardiac arrest caused by respiratory disease: a propensity score-matched study.

    Science.gov (United States)

    Ohashi-Fukuda, N; Fukuda, T; Yahagi, N

    2017-05-01

    Optimal pre-hospital care for out-of-hospital cardiac arrest (OHCA) caused by respiratory disease may differ from that for OHCA associated with other aetiologies, especially with respect to respiratory management. We aimed to investigate whether pre-hospital advanced airway management (AAM) was associated with favourable outcomes after OHCA caused by intrinsic respiratory disease. This nationwide, population-based, propensity score-matched study of adult patients in Japan with OHCA due to respiratory disease from 1 January 2005 to 31 December 2012 compared patients with and without pre-hospital AAM. The primary outcome was neurologically favourable survival at one month after the OHCA. Of 49,534 eligible patients, 20,458 received pre-hospital AAM and 29,076 did not. In a propensity score-matched cohort (18,483 versus 18,483 patients), the odds of neurologically favourable survival were significantly lower for patients receiving pre-hospital AAM (0.6% versus 1.5%; odds ratio [OR] 0.42 [95% confidence interval {CI} 0.34 to 0.52]). The results from multivariable logistic regression analysis also showed that pre-hospital AAM was significantly associated with a decreased chance of neurologically favourable survival (adjusted OR 0.43 [95% CI 0.35 to 0.52]). Similar findings were observed for one-month survival and pre-hospital return of spontaneous circulation. In subgroup analyses, pre-hospital AAM was associated with poor neurological outcomes, regardless of the type of airway device used (laryngeal mask airway, adjusted OR 0.35 [95% CI 0.19 to 0.57]; oesophageal obturator airway, adjusted OR 0.44 [95% CI 0.35 to 0.55]; and endotracheal tube, adjusted OR 0.47 [95% CI 0.30 to 0.69]). In conclusion, pre-hospital AAM was associated with poor neurological outcome among patients with OHCA caused by intrinsic respiratory disease.

  19. Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims.

    Science.gov (United States)

    Gholipour, Changiz; Vahdati, Samad Shams; Notash, Mehdi; Miri, Seyed Hassan; Ghafouri, Rouzbeh Rajaei

    2014-06-01

    Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a study on the success rate of PHEMS personnel in implementing PHTLS guidelines at the scene of trauma. Severe trauma patients who had been transferred to the emergency department were included in the study. Evaluations included transfer time, airway management, spinal immobilization, external bleeding management, intravenous (IV) line access, and fluid therapy. All evaluations were performed by an expert emergency physician in the emergency department. The mean response time was 17.87±9.1 minutes. The PHEMS personnel immobilized cervical spine in 60.4% of patients, out of whom 16.7% were not properly immobilized. Out of 99 (98%) cases of established IV line access by the PHEMS providers, 57% were satisfactory. Fluid therapy, which was carried out in 99 (98%) patients by the PHEMS personnel, was appropriate in 92% of the cases. PHEMS personnel need more education and supervising to provide services according to PHTLS guidelines.

  20. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2015-12-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  1. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2007-01-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  2. PRE-HOSPITAL CARE TO VICTIMS OF ACCIDENTS AUTOMOTIVE

    Directory of Open Access Journals (Sweden)

    Laísla Alves Moura

    2012-04-01

    Full Text Available Normal 0 21 false false false PT-BR X-NONE X-NONE MicrosoftInternetExplorer4 Objetivo: Analisar as ocorrências por trauma do Atendimento Pré-Hospitalar (APH do corpo de Bombeiros do município de Joinville/SC, entre os meses de janeiro e julho de 2008. Método: A coleta de dados foi realizada a partir da análise dos documentos arquivados do Corpo de Bombeiros no período de janeiro a julho de 2008. Resultados: O trauma por acidente automobilístico atinge principalmente jovens do sexo masculino e pode-se perceber que o corpo de bombeiros, apesar dos serviços do SAMU, ainda é considerado uma referência ao atendimento de urgências e emergências da população. Conclusões: Faz-se necessários campanhas educativas e de direção defensiva para esta população, visando minimizar os acidentes. E também capacitações para os serviços de atendimento pré-hospitalar a fim de atender de forma efetiva e eficaz as ocorrências.

  3. Pre-hospital treatment of convulsive status epilepticus in adults

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    Fei TIAN

    2015-11-01

    Full Text Available  Convulsive status epilepticus (CSE is the most serious seizure type in status epilepticus (SE, which may cause irreversible damage of brain and other vital organs without prompt and effective treatment, and result in a high mortality. Therefore, effective pre-hospital drug therapy can ensure the success of treatment for CSE. DOI: 10.3969/j.issn.1672-6731.2015.11.004

  4. Job Burnout Status among Pre-Hospital Emergency Technicians

    Directory of Open Access Journals (Sweden)

    Zohre Moradi

    2015-02-01

    Full Text Available Introduction: Since pre-hospital emergency staff, who play a vital role in saving peoples’ lives, work under a lot of pressure, determining the rate and dangers of their job burnout is very important. Therefore, this study was carried out to determine the job burnout rate of the pre-hospital emergency staff in Isfahan, Iran. Methods: In this cross-sectional study, all of the pre-hospital emergency staff in all emergency operation centers in Isfahan were included. Using the standard Maslach burnout inventory questionnaire, the job burnout rate of emergency technicians was measured. The studied aspects were frequency and intensity of emotional exhaustion, depersonalization and personal accomplishment feeling, which were then divided into 3 levels (low, average and high according to the intensity and frequency of these feelings. Results: In the end, 68 technicians were involved in this study (Mean age 26.97±7.7; 42.6% single. Regarding intensity, their mean emotional exhaustion score was 25.59±20.39, depersonalization score was 10.57±7.83 and personal accomplishment feeling was 34.6±8.46. Moreover, the mean emotional exhaustion frequency was 21.21±11.95 (low level, depersonalization frequency was 8.94±5.43 (low level and personal accomplishment feeling frequency was 26.82±5.72 (high level. Conclusion: The data obtained in this study shows that the pre-hospital emergency technicians in Isfahan show average levels of emotional exhaustion and depersonalization intensity and frequency and feel highly unaccomplished.

  5. Termination of pre-hospital resuscitation by anaesthesiologists - causes and consequences

    DEFF Research Database (Denmark)

    Mikkelsen, S; Lossius, H M; Binderup, L G

    2017-01-01

    extinct in situations where an emergency medical technician (EMT) would have been required to resuscitate. METHODS: All lifeless patients seen pre-hospitally by the anaesthesiologist-manned Mobile Emergency Care Unit in Odense, Denmark, from 2010 to 2014 were retrospectively studied. RESULTS: Of 17 035......, or do-not-resuscitate order. CONCLUSION: In one patient in 30, the MECU refrained from futile resuscitation in cases where legislation required an EMT to initiate resuscitation. This practice reduced unethical attempts of resuscitation, reduced unnecessary emergency ambulance transports, and reduced...

  6. Barriers of Pre-Hospital Services in Road Traffic Injuries in Tehran: The Viewpoint of Service Providers

    Directory of Open Access Journals (Sweden)

    Shahrokh Alinia

    2015-10-01

    Full Text Available Abstract Background: Iran is one of the countries with considerable road traffic injuries. Pre-hospital interventions have an important role in preventing mortalities and disabilities caused by traffic accidents.The present study aimed to explore the barriers of pre-hospital care in traffic injuries in Tehran, Iran. Methods: A qualitative content analysis approach was conducted based on 21 semi-structured interviews with 18 participants. A purposeful sampling method was applied until reaching data saturation. Interviews were transcribed verbatim, and then data condensing, labeling, coding and defining categories were performed by qualitative content analysis. Results: Four main barriers including 4 main categories and 13 subcategories emerged; they included Barriers related to people, Barriers related to metropolitan infrastructure,Barriers related to the profession and Barriers related to managerial issues. Conclusion: Based on the findings of this study, pre-hospital service barriers in traffic accidents have many dimensions including cultural, structural and managerial domains. Policy makers in health system can use these findings to promote the quality of pre-hospital services, especially in the field of traffic injuries.

  7. Repatriation to referral hospital after reperfusion of STEMI patients transferred for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Ting, Rudee; Tejpal, Ambika; Finken, Laura

    2016-01-01

    BACKGROUND: In regional systems of ST-segment elevation myocardial infarction (STEMI) care, patients presenting to hospitals without percutaneous coronary intervention (PCI) are transferred to PCI-capable hospitals for primary PCI. Repatriation, a practice whereby such patients are transferred ba...

  8. Does the Norwegian emergency medical dispatch classification as non-urgent predict no need for pre-hospital medical treatment? An observational study.

    Science.gov (United States)

    Grusd, Eystein; Kramer-Johansen, Jo

    2016-05-06

    The number of ambulance call-outs in Norway is increasing owing to societal changes and increased demand from the public. Together with improved but more expensive education of ambulance staff, this leads to increased costs and staffing shortages. We wanted to study whether the current dispatch triage tools could reliably identify patients who only required transport, and not pre-hospital medical care. This could allow selection of such patients for designated transport units, freeing up highly trained ambulance staff to attend patients in greater need. A cross-sectional observational study was used, drawing on all electronic and paper records in our ambulance service from four random days in 2012. The patients were classified into acuity groups, based on Emergency Medical Dispatch codes, and pre-hospital interventions were extracted from the Patient Report Forms. Of the 1489 ambulance call-outs included in this study, 82 PRFs (5 %) were missing. A highly significant association was found between acuity group and recorded pre-hospital intervention (p ≤ 0.001). We found no correlation between gender, distance to hospital, age and pre-hospital interventions. Ambulances staffed by paramedics performed more interventions (234/917, 26 %) than those with emergency medical technicians (42/282, 15 %). The strongest predictor for needing pre-hospital interventions was found to be the emergency medical dispatch acuity descriptor. This study has demonstrated that the Norwegian dispatch system is able to correctly identify patients who do not need pre-hospital interventions. Patients with a low acuity code had a very low level of pre-hospital interventions. Evaluation of adherence to protocol in the Emergency Medical Dispatch is not possible due to the inherent need for medical experience in the triage process. This study validates the Norwegian dispatch tool (Norwegian index) as a predictor of patients who do not need pre-hospital interventions.

  9. The epidemiological analysis of patients in pre-hospital medical care in large and medium-sized cities in China%我国八个大中城市院前急救流行病学调查分析

    Institute of Scientific and Technical Information of China (English)

    张在其; 李金年; 林才经; 刘向; 陆家韬; 孟庆华; 宁哗; 裴雅春; 孙文会; 熊悦安; 张斌; 骆福添; 赵兴吉; 欧阳文伟; 陈文标; 陈玮莹; 郭彦池; 杨正飞; 黄子通; 陈兵; 陈锋; 公保才旦; 黄力; 柯俊; 赖欣; 李继良

    2010-01-01

    、循环系统、呼吸系统类均以51岁(尤其是70岁)以上的中老年最多;其他、消化系统类均有两个高峰年龄段,其一是21~30岁青年阶段,其二是70岁以上的老年;中毒类以21~50岁青壮年最多,其中急性酒精中毒是最常见的病因.(4)在12 568例院前死亡病例中,循环系统、其他、呼吸系统、神经系统、消化系统类的死亡分别居第一、二、四、五、八位,均以51岁(尤其是70岁)以上的中老年最多,其中心脏性猝死又是循环系统类的死亡中最多的;创伤、中毒类的死亡分别居第三、六位,均以21~50岁青壮年最多.(5)男性患者院前急救的数量、总死亡量及院前心脏性猝死均明显高于女性.(6)院前死亡患者占院前急救的5.20%,院前心脏性猝死占院前急救的1.29%,院前心脏性猝死占院前死亡的24.87%,院前心脏性猝死占循环系统类死亡的67.33%.结论 (1)创伤与心脏性猝死已分别成为我国大中城市最常见的院前急救和致死原因.(2)加强心脑血管病和呼吸系统疾病防治,提高中老年患者的常见急危重症早期识别与院前急救水平对降低死亡率有重要意义.(3)加强安全生产、遵守交通法规、强化法制意识将是降低创伤,尤其是交通意外伤发生及其死亡的有力于段.%Objective To investigate the epidemiological information of patients in pre-hospital medical care for our large and medium-sized cities and probe the patients' characteristic. Method The data in 2008 were exported from the computer databases of 8 large and medium-sized cities' emergency medical centers in our country.The thorough records of data were conducted to statistical analysis. Results ( 1 ) The scheduling time, running time, rescue time, returning time, total time and service radius in the pre-hospital medical care group were 2.16± 1.10(min), 14.01 ±6.82(min), 12.12±5.96(min), 14.08± 6.85(min), 42.34± 20.21(min)and 8.50±4.18(km), and the

  10. Diagnostic Accuracy of Cincinnati Pre-Hospital Stroke Scale

    Directory of Open Access Journals (Sweden)

    Behzad Zohrevandi

    2015-07-01

    Full Text Available Introduction: Stroke is recognized as the third cause of mortality after cardiovascular and cancer diseases, so that lead to death of about 5 million people, annually. There are several scales to early prediction of at risk patients and decreasing the rate of mortality by transferring them to the stroke center. In the present study, the accuracy of Cincinnati pre-hospital stroke scale was assessed. Methods: This was a retrospective cross-sectional study done to assess accuracy of Cincinnati scale in prediction of stroke probability in patients referred to the emergency department of Poursina Hospital, Rasht, Iran, 2013 with neurologic symptoms. Three criteria of Cincinnati scale including facial droop, dysarthria, and upper extremity weakness as well as the final diagnosis of patients were gathered. Sensitivity, specificity, predictive values, and likelihood ratios of Cincinnati scale were calculated using SPSS version 20. Results: 448 patients were assessed. The agreement rate of Cincinnati scale and final diagnosis was 0.483 ± 0.055 (p<0.0001. The sensitivity of 93.19% (95% Cl: 90.11-95.54, specificity of 51.85% (95% Cl: 40.47-63.10, positive predictive value of 89.76% (95% Cl: 86.27-92.62, negative predictive value of 62.69% (95% Cl: 55.52-72.45, positive likelihood ratio of 1.94% (95% Cl: 1.54-2.43, and negative likelihood ratio of 0.13% (95% Cl: 0.09-0.20 were calculated. Conclusion: It seems that pre-hospital Cincinnati scale can be an appropriate screening tool in prediction of stroke in patients with acute neurologic syndromes.

  11. Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan.

    Science.gov (United States)

    Waseem, Hunniya; Naseer, Rizwan; Razzak, Junaid Abdul

    2011-06-01

    As in many other developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected in Pakistan. Consequently, patients are brought to the emergency departments by relatives or bystanders in private cars, taxis or any other readily available mode of transportation. Ambulances, where they exist, have barely a stretcher and arrangements for oxygen supply. Modern emergency services are considered too costly for many countries. A model of pre-hospital emergency services, called Rescue 1122 and established in Punjab province of Pakistan, is presented. The system is supported by government funding and provides a quality service. The article describes the process of establishment of the service, the organisational structure, the scope of services and the role it is currently playing in the healthcare of the region it serves.

  12. Fatores associados ao uso de serviço de atenção pré-hospitalar por vítimas de acidentes de trânsito Factors associated with pre-hospital care in victims of traffic accidents

    Directory of Open Access Journals (Sweden)

    Roberto Marini Ladeira

    2008-02-01

    Full Text Available Em um estudo de corte transversal foram avaliadas as características das vítimas de acidentes de trânsito ocorridos em Belo Horizonte, Minas Gerais, Brasil, com o objetivo de conhecer as características dos acidentes e das vítimas que usaram o serviço de atendimento pré-hospitalar, e investigar se o uso deste serviço está associado a um menor tempo até o atendimento hospitalar. Participaram do estudo todas as 1.564 vítimas de acidente de trânsito atendidas nos três maiores hospitais públicos de referência para emergência na cidade entre 10 de novembro e 14 de dezembro de 2003. As associações foram investigadas utilizando-se razões de prevalência obtidas por regressão de Poisson. Os resultados mostraram que 49,7% das vítimas usaram o serviço de atendimento pré-hospitalar, sendo a utilização menor entre ocupantes de bicicleta e pedestres. A gravidade (AIS = 2 e AIS ³ 3, idade (30-39 anos, 40-49, ³ 50 anos, relato de uso de álcool e tempo de admissão hospitalar This was a cross-sectional study of all victims of traffic accidents in Belo Horizonte, Minas Gerais State, Brazil, admitted to the three largest public hospitals in the city from November 10 to December 14, 2003, to identify characteristics associated with the use of pre-hospital emergency treatment and investigate whether the time between the accident and hospital admission was shorter among these victims. The association between pre-hospital treatment and target variables was assessed by prevalence ratios obtained from Poisson regression. Among 1,564 victims, 778 (49.7% were transported in vehicles with pre-hospital treatment. Pre-hospital treatment was less common for bicyclists and pedestrians. The prevalence ratio was higher among victims with more severe injuries (AIS = 2 and AIS ³ 3, older victims (30-39 years, 40-49 years, ³ 50 years, those who reported alcohol use, and when the time between accident and hospital admission was less than 60 minutes

  13. Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment

    OpenAIRE

    Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O’Donnell, Cathal

    2014-01-01

    The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality resear...

  14. Osteoprotegerin Levels Change During STEMI and Reflect Cardiac Function

    DEFF Research Database (Denmark)

    Lindberg, Søren; Jensen, Jan S; Hoffmann, Søren

    2014-01-01

    of OPG levels during STEMI treated with percutaneous coronary intervention (PCI) and additionally, the effect of OPG levels on cardiac function. METHODS: We prospectively included 42 patients with STEMI treated with primary PCI. Four consecutive blood samples were obtained before and after PCI treatment......BACKGROUND: High levels of circulating osteoprotegerin (OPG) predicts long-term outcome in patients with ST-elevation myocardial infarction (STEMI), possibly because of increased vascular inflammation resulting in myocardial damage. In the present study we aimed at elucidating the dynamic progress....... Plasma OPG levels were determined using an in-house immunoassay. Cardiac function was increased according to echocardiography, estimating left ventricular ejection fraction (LVEF) 1-3 days after STEMI. RESULTS: During STEMI, OPG levels peaked after PCI and then decreased; mean concentrations (95...

  15. Estresse da equipe de enfermagem do corpo de bombeiros no Atendimento Pré-Hospitalar Móvel El estrés del equipo de enfermería del cuerpo de bomberos en atención pre-hospitalaria móvil Stress at the nursing staff from the fire department in a mobile pre-hospital care

    Directory of Open Access Journals (Sweden)

    Richiére dos Santos Pereira Salvador

    2013-06-01

    profesionales.The research has as subject, the study of the stress at work on a nursing staff from the Fire Department in the pre - hospital care, and aims to identify what are the stressors in the work of professionals who are part of the nursing staff of APH Mobile from the Fire Department; analyze the impact of stress on the health of these professionals. The study characterized itself as qualitative descriptive - exploratory, involving 10 professionals. Data collection was conducted through interviews recorded electronically, using a semi-structured instrument. After transcription of the interviews, the similar aspects and differences found were grouped into analyze categories. It was confirmed that these professionals are subjected to constant stress, having modified their lifestyle habits, with health impact. It is suggested that the identified problems are studied in order to develop strategies in order to generate better working conditions for these professionals.

  16. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis.

    Science.gov (United States)

    Henriksen, Hanne H; Rahbar, Elaheh; Baer, Lisa A; Holcomb, John B; Cotton, Bryan A; Steinmetz, Jacob; Ostrowski, Sisse R; Stensballe, Jakob; Johansson, Pär I; Wade, Charles E

    2016-12-09

    The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. 75 patients received pre-hospital plasma and/or RBCs (PH group; nearly half received both RBCs and plasma) whereas 182 patients only received in-hospital blood products (RBCs, Plasma and Platelets) within 6 hours of admission (IH group). PH patients had lower Glasgow coma scale (GCS) scores, more penetrating injuries, lower systolic blood pressures, lower hemoglobin levels, lower platelet counts and greater acidosis upon ED admission than the IH group (all p plasma, more pre-hospital plasma transfusion was tendency towards improved rTEG variables. When adjusting for pre-hospital RBC, pre-hospital plasma was associated with significantly higher rTEG MA (p = 0.012) at hospital admission. After adjusting for pre-hospital RBCs, pre-hospital plasma transfusion was independently associated with increased rTEG MA, as well as arrival indices of shock and hemodynamic instability. Besides more severe injury and worse clinical presentation, the group that received pre-hospital transfusion had early and late mortality similar to patients not transfused pre-hospital. These data suggest that early administration of plasma can provide significant hemostatic and potential

  17. Factors Impacting Mortality in the Pre-Hospital Period After Road Traffic Accidents in Urban India.

    Science.gov (United States)

    Chandrasekharan, Ananthnarayan; Nanavati, Aditya J; Prabhakar, Sandhya; Prabhakar, Subramaniam

    2016-07-01

    personal safety, and driving vehicles under adverse conditions are some of the leading causes of road traffic accidents. There should be an emphasis on emergency trauma care in the pre-hospital setting.

  18. Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

    Directory of Open Access Journals (Sweden)

    Nakstad Anders R

    2010-04-01

    Full Text Available Abstract Introduction Endotracheal intubation (ETI has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement. Method We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS. The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it. Results In the risk assessment, we assigned a high probability (29% for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers. Conclusion Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.

  19. Scandinavian SSAI clinical practice guideline on pre-hospital airway management.

    Science.gov (United States)

    Rehn, M; Hyldmo, P K; Magnusson, V; Kurola, J; Kongstad, P; Rognås, L; Juvet, L K; Sandberg, M

    2016-08-01

    The Scandinavian society of anaesthesiology and intensive care medicine task force on pre-hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines. The literature was systematically reviewed and the grading of recommendations assessment, development and evaluation (GRADE) system was applied to move from evidence to recommendations. We recommend that all emergency medical service (EMS) providers consider to: apply basic airway manoeuvres and airway adjuncts (good practice recommendation); turn unconscious non-trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong recommendation, low quality of evidence (QoE)]. We suggest that intermediately trained providers use a supraglottic airway device (SAD) or basic airway manoeuvres on patients in cardiac arrest (weak recommendation, low QoE). We recommend that advanced trained providers consider using an SAD in selected indications or as a rescue device after failed endotracheal intubation (ETI) (good practice recommendation). We recommend that ETI should only be performed by advanced trained providers (strong recommendation, low QoE). We suggest that videolaryngoscopy is considered for ETI when direct laryngoscopy fails or is expected to be difficult (weak recommendation, low QoE). We suggest that advanced trained providers apply cricothyroidotomy in 'cannot intubate, cannot ventilate' situations (weak recommendation, low QoE). This guideline for pre-hospital airway management includes a combination of techniques applied in a stepwise fashion appropriate to patient clinical status and provider training. © 2016 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica

  20. pre-hospital management of febrile seizures in children seen at the ...

    African Journals Online (AJOL)

    appropriate health education to reduce the morbidity and mortality associated with ... parents/caregivers of children with febrile seizures and the maternal .... consequences of harmful traditional pre-hospital treatment of .... The natural history of.

  1. Pre-hospital management of mass casualty civilian shootings: a systematic literature review

    National Research Council Canada - National Science Library

    Turner, Conor D. A; Lockey, David J; Rehn, Marius

    2016-01-01

    .... This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice...

  2. The value of the pre-hospital learning environment as part of the emergency nursing programme

    Directory of Open Access Journals (Sweden)

    Sonett van Wyk

    2015-06-01

    Conclusion: The research findings support the value and continuation of utilising the pre-hospital clinical learning environment for placing post-basic emergency nursing students when enrolled in the emergency nursing programme.

  3. Fragmented QRS – A simple bedside non invasive predictor of early mortality and morbidity in STEMI

    Directory of Open Access Journals (Sweden)

    Abdul Mateen Athar

    2016-10-01

    Full Text Available Background and objectives: Fragmented QRS encompasses different RSR’ patterns showing various morphologies of the QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram. It has been shown possibly to cause adverse cardiac outcomes in patients with some heart diseases, including coronary artery disease. In view of the need for risk stratification of patients presenting with acute coronary syndrome in the most efficacious and cost-effective way, we conducted this study to clarify the value of fragmented QRS in patients presenting with STEMI in predicting complication during hospital stay. Methods: Fifty consecutive patients admitted to the coronary care unit with their first STEMI were enrolled in this prospective observational study. Demographic and electrocardiographic data on admission, in hospital complication and mortality were recorded. Results: 50 patients were divided into two groups, one consisting of patients who developed fQRS (fQRS +ve during hospital stay and the other group those who did not developed fQRS (fQRS –ve. Patients with fQRS on admission ECG had significantly higher incidence of arrhythmias (p=0.012, heart failure (p=0.008, hypotension (p=0.002 in comparison to patients with non fragmented QRS. In addition patients with more than one myocardial site involvement had higher incidence of fQRS (p=0.004. The mortality was significantly higher in fQRS positive (p= 0.029 group compared to fQRS negative group. Conclusion: This study strongly suggests that fragmented QRS on initial presentation with STEMI is predictive of subsequent events and provide very useful information in the risk stratification of acute STEMI patients.

  4. Exploration of key stakeholders' preferences for pre-hospital physiologic monitoring by emergency rescue services.

    Science.gov (United States)

    Mort, Alasdair J; Rushworth, Gordon F

    2013-12-01

    To gather preferences for novel pre-hospital physiologic monitoring technologies from emergency rescue services. Qualitative semi-structured interviews and focus groups were conducted with three groups from UK Search and Rescue (SAR); (1) Extractors (e.g. SAR teams), (2) Transporters (personnel primarily responsible for casualty transport), and (3) Treaters (e.g. Emergency Department doctors). Three themes were defined; SAR casualty management, novel physiologic monitor potential, and physiologic monitor physical properties. Some SAR groups already employed physiologic monitoring but there was no consensus on which monitor(s) to carry or what to monitor and how frequently. Existing monitors also tended to be bulky and heavy and could be unreliable in an unstable environment or if the casualty was cold. Those performing monitoring tended to have only basic first-aid training, and their workload was often high particularly if there was more than one casualty. The potential benefits of employing a novel monitor were strategic and clinical; an opportunity for transmitting data off-scene in order to facilitate monitoring or generate advice (i.e. telemedicine) was also voiced. A range of more intuitive, physical properties was also raised (e.g. small/compact, lightweight). SAR-specific technology should be simple to operate by those with less medical training, which means that clinical data interpretation and presentation should be carefully considered. It would be beneficial if novel monitors carried out a majority of the interpretation, allowing rescuers to proceed with their priority task of removing the casualty to safety.

  5. Reduction in STEMI transfer times utilizing a municipal "911" ambulance service.

    Science.gov (United States)

    Tennyson, Joseph C; Quale, Mark R

    2014-02-01

    The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality. It is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the "911" ALS ambulance. Quality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite. During the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P

  6. Interpretation of 2013 ACCF/AHA STEMI treatment guidelines%2013 ACCF及AHA急性ST段抬高性心肌梗死治疗指南更新解读

    Institute of Scientific and Technical Information of China (English)

    李宪凯; 徐亚伟

    2013-01-01

    基于近期大型临床试验,ACCF及AHA不断更新急性冠脉综合征的治疗指南,近期ACCF及AHA公布了2013年STEMI治疗指南,其中有很多亮点,如提出首次医疗接触(FMC)到再灌注的救治时间,使得心肌梗死的救治由“院内急救”提前到“院前急救”,强调普拉格雷和替格瑞洛的抗栓地位等等,为急性心肌梗死的救治提供了最新依据.%Based on the recent published large-scale clinical trials, ACCF/AHA constantly updated guide for the treatment of acute coronary syndrome. Recently,ACCF/AHA STEMI (acute ST-elevation myocardial infarction) guideline was published in Circulation in 2013,of which there were many bright spots, such as the new guideline proposed first medical contact ( FMC ) to reperfusion treatment time, shifting emergency treatment of STEMI to pre-hospital emergency from hospital treatment, it also stressed the status of P2Y12 inhibitor (prasugrel and ticagrelor) in STEMI patients. The latest guideline provides new evidences for the treatment of STEMI.

  7. Clinical update on the therapeutic use of clopidogrel: treatment of acute ST-segment elevation myocardial infarction (STEMI

    Directory of Open Access Journals (Sweden)

    Huyen Tran

    2006-12-01

    Full Text Available Huyen Tran1, Shamir R Mehta2, John W Eikelboom21Department of Clinical Haematology, Monash Medical Centre, Victoria, Australia; 2Department of Medicine, McMaster University, Hamilton, CanadaAbstract: The pathogenesis of ST-elevation myocardial infarction (STEMI involves plaque disruption, platelet aggregation and intracoronary artery thrombus formation. Aspirin is the cornerstone of antiplatelet therapy in patients with STEMI, reducing the risk of recurrent myocardial infarction or death during the acute phase and long term by about one-quarter. Recent large randomized trials have demonstrated that the addition of clopidogrel to aspirin reduces the risk of major ischemic events by up to a further one-third in patients with STEMI treated with fibrinolytic therapy and undergoing percutaneous coronary intervention, with no significant increase in bleeding. Thus, dual antiplatelet therapy with the combination of clopidogrel and aspirin is becoming the new standard of care for the management of patients with STEMI. Keywords: clopidogrel, antiplatelet drugs, acute coronary syndrome, myocardial infarction

  8. Myocardial Damage in Patients With Deferred Stenting After STEMI

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Ahtarovski, Kiril Aleksov

    2017-01-01

    BACKGROUND: Although some studies found improved coronary flow and myocardial salvage when stent implantation was deferred, the DANAMI-3-DEFER (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) did not show any improvement in clinical outcome...... in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and deferred stenting. OBJECTIVES: This study sought to evaluate the effect of deferred stent implantation on infarct size, myocardial salvage, and microvascular obstruction (MVO......) in patients with STEMI. METHODS: In the present DANAMI-3 substudy, a total of 510 patients with STEMI were randomized to PCI with deferred versus immediate stent implantation. The patients underwent a cardiac magnetic resonance examination before discharge after the index procedure and again 3 months later...

  9. Survey of WBSNs for Pre-Hospital Assistance: Trends to Maximize the Network Lifetime and Video Transmission Techniques

    Directory of Open Access Journals (Sweden)

    Enrique Gonzalez

    2015-05-01

    Full Text Available This survey aims to encourage the multidisciplinary communities to join forces for innovation in the mobile health monitoring area. Specifically, multidisciplinary innovations in medical emergency scenarios can have a significant impact on the effectiveness and quality of the procedures and practices in the delivery of medical care. Wireless body sensor networks (WBSNs are a promising technology capable of improving the existing practices in condition assessment and care delivery for a patient in a medical emergency. This technology can also facilitate the early interventions of a specialist physician during the pre-hospital period. WBSNs make possible these early interventions by establishing remote communication links with video/audio support and by providing medical information such as vital signs, electrocardiograms, etc. in real time. This survey focuses on relevant issues needed to understand how to setup a WBSN for medical emergencies. These issues are: monitoring vital signs and video transmission, energy efficient protocols, scheduling, optimization and energy consumption on a WBSN.

  10. PRE-HOSPITAL THROMBOLYSIS IN KRASNOYARSK: RESULTS OF A RETROSPECTIVE COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    S. A. Skripkin

    2011-01-01

    Full Text Available Aim. To compare the safety and efficacy of pre-hospital thrombolysis with tenecteplase and hospital thrombolysis with alteplase. Material and Methods. Pre-hospital thrombolytic therapy with tenecteplase (n=15 and hospital thrombolysis with alteplaza (n=60 in patients with acute coronary syndrome and acute ST-segment elevation myocardial infarction were analyzed in retrospective comparative study. Time characteristics of thrombolysis and its efficacy and safety were assessed. Results. The mean time from patients emergency medical service call to pre-hospital thrombolysis was 51.8±1.23 min, whereas to hospital thrombolysis 106.5±2.15 min (p<0.05. The effective hospital thrombolysis was observed in 68.3 and 83.3% of patients according to ECG (>50% resolution of ST-segment elevation and coronary angiography criteria, respectively. The effective pre-hospital thrombolysis was registered in 93.3% of patients as demonstrated with ECG and coronary angiography. Conclusion. Pre-hospital thrombolysis in patients with acute coronary syndrome was performed by 54.7 min earlier than hospital thrombolysis was. This can improve the patient prognosis.

  11. EMS Adherence to a Pre-hospital Cervical Spine Clearance Protocol

    Directory of Open Access Journals (Sweden)

    Johnson, David

    2001-10-01

    Full Text Available Purpose: To determine the degree of adherence to a cervical spine (c-spine clearance protocol by pre-hospital Emergency Medical Services (EMS personnel by both self-assessment and receiving hospital assessment, to describe deviations from the protocol, and to determine if the rate of compliance by paramedic self-assessment differed from receiving hospital assessment. Methods: A retrospective sample of pre-hospital (consecutive series and receiving hospital (convenience sample assessments of the compliance with and appropriateness of c-spine immobilization. The c-spine clearance protocol was implemented for Orange County EMS just prior to the April-November 1999 data collection period. Results: We collected 396 pre-hospital and 162 receiving hospital data forms. From the pre-hospital data sheet. the percentage deviation from the protocol was 4.096 (16/396. Only one out of 16 cases that did not comply with the protocol was due to over immobilization (0.2%. The remaining 15 cases were under immobilized, according to protocol. Nine of the under immobilized cases (66% that should have been placed in c-spine precautions met physical assessment criteria in the protocol, while the other five cases met mechanism of injury criteria. The rate of deviations from protocol did not differ over time. The receiving hospital identified 8.0% (13/162; 6/16 over immobilized, 7/16 under immobilized of patients with deviations from the protocol; none was determined to have actual c-spine injury. Conclusion: The implementation of a pre-hospital c-spine clearance protocol in Orange County was associated with a moderate overall adherence rate (96% from the pre-hospital perspective, and 92% from the hospital perspective, p=.08 for the two evaluation methods. Most patients who deviated from protocol were under immobilized, but no c-spine injuries were missed. The rate of over immobilization was better than previously reported, implying a saving of resources.

  12. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

    Directory of Open Access Journals (Sweden)

    Matute-Cruz Petra

    2009-04-01

    Full Text Available Abstract Background Mortality from invasive meningococcal disease (IMD has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848 diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72% of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93. Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

  13. The effectiveness of a military pre-hospital fluid infusion strategy.

    Science.gov (United States)

    O'Meara, M; Wood, P; Thurgood, A; Porter, K

    2007-09-01

    We performed a study to assess the effectiveness of a fluid infusion strategy currently used in the military pre-hospital environment using the patient's own body weight as an infusion device. Thirteen healthy volunteers were cannulated and 0.9% sodium chloride infused over a period of ten minutes. The volumes infused were measured and flow rates derived. A mean flow rate of 40 ml per minute was seen through an 18 g cannula. This strategy generates reasonable flow rates, but whether this is sufficient to the clinical aim of fluid resuscitation in pre-hospital settings is unknown.

  14. The trend of acute burns pre-hospital management

    Institute of Scientific and Technical Information of China (English)

    Abubakar Hamdiya; Agbenorku Pius; Aboah Ken; Paa Ekow Hoyte-Williams

    2015-01-01

    Objective: To study the trend and knowledge of first aid administration of any kind among the burns patients and also to create awareness to the general public who mostly act as first aid givers who seem ignorant about the appropriate immediate care to render to the burns victim. Methods: Pre-tested questionnaires were administered to the burns victims who had received or not some form of first aid at the scene of the burn injury. Results: The study showed varied first aid knowledge and administration outcomes as a result of different substances such as water or sand, muddy water, starch, corn dough, cow dung, egg white, calamine lotion, gentian violet, ointments, creams, lotions, tooth paste etc. applied as first aid. Conclusions: Burn injuries are common in our settings, a more reason for all to know the immediate intervention to give to victims of such accidents. The kind of first aid administered to burns victims possibly affects the burns management outcome. Thus, the earlier the right intervention implemented, the lesser the complications.

  15. Vessel healings after stenting with different polymers in STEMI patients

    Science.gov (United States)

    Jin, Qin-Hua; Chen, Yun-Dai; Tian, Feng; Guo, Jun; Jing, Jing; Sun, Zhi-Jun

    2016-01-01

    Background Different stents implantation in ST-segment elevation myocardial infarction (STEMI) patients may influence the long term prognosis by affecting vessel healings after stenting. The aim of this study was to evaluate the vessel healings after implantation of drug eluting stents (DES) with biodegradable or durable polymer or of bare-metal stents (BMS) in patients with acute STEMI. Methods This study included 50 patients, who underwent follow up angiogram and optical coherence tomography (OCT) assessment about one year after percutaneous coronary intervention (PCI) for STEMI. According to the initial stents types, these patients were classified to durable (n = 19) or biodegradable polymer sirolimus-eluting stents (n = 15), or BMS (n = 16) groups. The conditions of stent struts coverage and malapposition were analyzed with OCT technique. Results A total of 9003 struts were analyzed: 3299, 3202 and 2502 from durable or biodegradable polymer DES, or BMS, respectively. Strut coverage rate (89.0%, 94.9% and 99.3%, respectively), malapposition presence (1.7%, 0.03% and 0 of struts, respectively) and average intimal thickness over struts (76 ± 12 µm, 161 ± 30 µm and 292 ± 29 µm, respectively) were significantly different among different stent groups (all P < 0.001). Conclusions Vessel healing status in STEMI patients is superior after implantation of biodegradable polymer DES than durable polymer DES, while both are inferior to BMS. PMID:27403139

  16. Utilize on the tele-monitoring system in pre-hospital medical care in patients with acute coronary syndrome%远程生命监护传输系统在急性冠脉综合征院外急救中的应用

    Institute of Scientific and Technical Information of China (English)

    邱勇; 彭潇

    2014-01-01

    目的:探讨院外、院内一体化救治模式对急性冠脉综合征(ACS)患者救治效果。方法应用一体化救治模式703例ACS患者为研究组,非一体化救治模式508例ACS为对照组。结果研究组临床好转率为73.12%,死亡率为12.52%,溶栓627例(89.19%)、1 h内溶栓173例(27.59%)、1~3 h内溶栓297例(47.37%)、3~6h溶栓148例(23.6%),6 h以上溶栓9例(1.44%)、溶栓再通467例(74.48%,对照组临床好转率为62.6%。死亡率为19.49%,溶栓332例(65.35%)、1 h内溶栓28例(8.43%)、1~3 h内溶栓91例(27.41%)、3~6 h溶栓130例(39.16%),6 h以上的溶栓83例(25%)、溶栓再通206例(62.05%),两组参数间差异有统计学意义。结论一体化救治组的ACS患者治疗率较传统救治组提高、入院溶栓准备时间缩短,患者的临床好转率增高、死亡率下降。%Objective To investigate the effectiveness of the integrative treatment model for acute coronary syndrome (ACS) in pre-hospital and in-hospital phases. Methods The study group of 703 ACS patients was treated with integrative collaborative treatment model while the control group of 508 ACS patients was treated with conventional treatment model. Results For the study group, it reflected an improvement rate of 73.12%, a mortality of 12.52%; in 627 cases of the group which received thrombolytic therapy, it resulted in 1-hour thrombolysis rate of 27.59%(173/627), 1-3 hours thrombolysis rate of 47.37%(297/627), 3-6 hours thrombolysis rate of 23.6% (148/627), more than 6 hours thrombolysis rate of 1.44% (9/627), and the total recanalization of 74.48%(467/627). For the control group, it reflected an improvement rate of 62.6%, a mortality rate of 19.49%;in 332 cases of the group which received thrombolytic therapy, it reflected 1-hour thrombolysis rate of 8.43%(28/332), 1-3 hours thrombolysis rate of 27.41% (91/332), 3-6 hours thrombolysis rate of 39.16% (130/332), more than 6 hours thrombolysis rate of 25% (83/332), and the

  17. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis

    DEFF Research Database (Denmark)

    Henriksen, Hanne Herborg; Rahbar, Elaheh; Baer, Lisa A

    2016-01-01

    BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. W...

  18. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services.

    Science.gov (United States)

    Karlsen, Anders M; Thomassen, Oyvind; Vikenes, Bjarne H; Brattebø, Guttorm

    2013-08-12

    Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air ambulance service, and the national search and rescue service. The survey explored available insulation materials, active warming devices, and the presence of protocols describing wrapping methods, temperature monitoring, and the use of warm i.v. fluids. Throughout the services, hospital duvets, cotton blankets and plastic "bubble-wrap" were the most common insulation materials. Active warming devices were to a small degree available in vehicle ambulances (14%) and the fixed wing ambulance service (44%) but were more common in the helicopter services (58-70%). Suitable thermometers for diagnosing hypothermia were lacking in the vehicle ambulance services (12%). Protocols describing how to insulate patients were present for 73% of vehicle ambulances and 70% of Search and Rescue helicopters. The minority of Helicopter Emergency Medical Services (42%) and Fixed Wing (22%) units was reported to have such protocols. The most common equipment types to treat and prevent hypothermia in Norwegian pre-hospital services are duvets, plastic "bubble wrap", and cotton blankets. Active external heating devices and suitable thermometers are not available in most vehicle ambulance units.

  19. Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Ersbøll, Mads; Køber, Lars;

    2016-01-01

    OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF...... delays in these patients can therefore be of particular benefit in improving clinical outcome after STEMI....

  20. Practice of pre-hospital transportation in the rescue of premture infants%院前转运在早产儿救护中的应用

    Institute of Scientific and Technical Information of China (English)

    王月华

    2011-01-01

    探讨院前转运在早产儿救护中的重要性,降低早产儿病死率和致残率.通过院前转运系统将基层医院1116例早产儿转运至我院NICU,患儿全部安全转运,无一例在途中发生意外或死亡.认为NICU的专业人员转运是非常必要的;重视院前转运是成功的关键;院前转运在早产儿救护中发挥了积极的作用.%To discuss the importance of pre-hospital transportation in the rescue of premature infants,so as to reduce the mortality and disability of premature children. Totally 1116 premature infants in primary-level hospitals were transported to the newborn intensive care unit (NICU) through the pre-hospital transportation system. The premature infants were safely transported without any accident or death. Pre-hospital transportation is important for the successful rescue of premature infants.

  1. Positive Coping: A Unique Characteristic to Pre-Hospital Emergency Personnel

    Science.gov (United States)

    Ebadi, Abbas; Froutan, Razieh

    2017-01-01

    Introduction It is important to gain a thorough understanding of positive coping methods adopted by medical emergency personnel to manage stressful situations associated with accidents and emergencies. Thus, the purpose of this study was to gain a better understanding of positive coping strategies used by emergency medical service providers. Methods This study was conducted using a qualitative content analysis method. The study participants included 28 pre-hospital emergency personnel selected from emergency medical service providers in bases located in different regions of the city of Mashhad, Iran, from April to November 2016. The purposive sampling method also was used in this study, which was continued until data saturation was reached. To collect the data, semistructured open interviews, observations, and field notes were used. Results Four categories and 10 subcategories were extracted from the data on the experiences of pre-hospital emergency personnel related to positive coping strategies. The four categories included work engagement, smart capability, positive feedback, and crisis pioneering. All the obtained categories had their own subcategories, which were determined based on their distinctly integrated properties. Conclusion The results of this study show that positive coping consists of several concepts used by medical emergency personnel, management of stressful situations, and ultimately quality of pre-hospital clinical services. Given the fact that efficient methods such as positive coping can prevent debilitating stress in an individual, pre-hospital emergency authorities should seek to build and strengthen “positive coping” characteristics in pre-hospital medical emergency personnel to deal with accidents, emergencies, and injuries through adopting regular and dynamic policies. PMID:28243409

  2. The Countermeasures for the Problems Neglected of Pre-hospital Emergency Personal in our Country%我国院前急救人员被忽视的若干问题与对策

    Institute of Scientific and Technical Information of China (English)

    郑进

    2012-01-01

    Pre-hospital emergency care is an weak link of EMSS in China. This paper analyzed some problems which neglected in our country; (1)the nutrition of Prehospital emergency personnel;(2) the psychology of Pre-hospital emergency personnel; (3)the personal protection of Pre-hospital emergency personnel;(4) the occupation? established of emergency medical technician; (5)The success rate of rescue for Pre-hospital emergency care; (6)the time of emergency respond; (7) the international language of Pre-hospital emergency personnel; (8)the confusion of identifying marks on ambulance;(9) the constitution of male and female for Pre-hospital personnel; (10)the lack of philosophy idea of Pre-hospital emergency personnel, and propound the countermeasures for this problems also it may be beneficial to reformation and development for our Pre - hospital emergency care.%院前急救是我国急救医疗服务体系的薄弱环节,目前尚存在一些问题.本文分析了我国院前急救人员被忽视的若干问题:(1)院前急救人员的营养问题;(2)院前急救人员的心理问题;(3)院前急救人员的个人防护问题;(4)医疗救护员职业设置问题;(5)院前急救成功率问题;(6)急救反应时间问题;(7)院前急救人员的语言国际化问题;(8)急救车辆标识问题;(9)院前急救人员性别组成问题;(10)院前急救人员哲学理念缺失问题等,并提出了解决这些问题的相应对策.对我国院前急救事业的改革和发展或有促进作用.

  3. Plasma glucose and not hemoglobin or renal function predicts mortality in patients with STEMI complicated with cardiogenic shock

    NARCIS (Netherlands)

    M.M. Vis; A.E. Engström; K.D. Sjauw; F.V. Tjong; J.,Jr Baan; K.T. Koch; H.J. de Vries; J.G. Tijssen; R.J. de Winter; J.J. Piek; J.P. Henriques

    2010-01-01

    Objective To assess the predictive value of three biomarkers for mortality in ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock. Background STEMI complicated by cardiogenic shock accounts for the majority of STEMI related deaths. Patients with STEMI and hyperglycemia, anemia

  4. Regionalization of care for ST-segment elevation myocardial infarction: is it too soon?

    Science.gov (United States)

    Pottenger, Brent C; Diercks, Deborah B; Bhatt, Deepak L

    2008-12-01

    Interest in regionalization of the care of acute ST-segment elevation myocardial infarction (STEMI) has gained momentum recently. Optimal treatment of STEMI involves balancing time to treatment and reperfusion options. Primary percutaneous coronary intervention, when performed in a timely fashion, has been shown to be more effective than fibrinolysis. However, numerous practical barriers prevent many STEMI patients from receiving primary percutaneous coronary intervention. In an effort to increase beneficial primary percutaneous coronary intervention administration to STEMI patients, health care leaders have proposed regionalized STEMI care networks with advanced emergency medical services (EMS) involvement. Constructing regionalized STEMI networks presents a policy challenge because this shift in STEMI care would require changes in current EMS and emergency medicine practices. Therefore, we present various perspectives and issues that decisionmakers and system organizers must address properly before deciding whether to adopt this new model of care. Reorganizing STEMI care in a manner analogous to how trauma and stroke care are currently triaged and treated appeals intuitively; however, given the absence of evidence that STEMI regionalization actually improves patient outcomes and is cost-effective, more research is needed to determine whether STEMI regionalization is an efficient model for providing evidence-based care. The concept of STEMI regionalization represents an effort to inform policy according to evidence-based medicine, but real-world quality, geospatial, financial, cost, business, resource, and practice barriers present obstacles to implementing this concept efficiently and effectively.

  5. Factors Influencing Pre-hospital Patient Delay in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    La Xie; Su-Fang Huang∗; You-Zhen Hu

    2015-01-01

    Acute myocardial infarction ( AMI) is a dangerous disease with a high mortality rate. For AMI patients, the outcome of the patients depends on time to beginning of effective treatment in addition to other factors such as severity of disease and involved vessels etc. The key is whether reperfusion therapy is started early enough after the onset of symptoms, and the benefit of reperfu-sion therapy depends on the time, too. The delay of AMI treatment is divided into pre-hospital de-lay and in-hospital delay. In-hospital delay, Door-to-Balloon Time, has been well controlled. Pre-hospital delay, accounting for 75% of the total delay time, is the most important factor affect-ing AMI treatment. Patient delay ( PD) time for AMI patients is summarised in this study.

  6. Pre-hospital and initial management of head injury patients: An update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Most of the bad outcomes in patients with severe traumatic brain injury (TBI are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. Methods: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013, which specifically discussed about the topic, was conducted. Results: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. Conclusion: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

  7. Effect of educational television commercial on pre-hospital delay in patients with ischemic stroke.

    Science.gov (United States)

    Nishijima, Haruo; Kon, Tomoya; Ueno, Tatsuya; Haga, Rie; Yamazaki, Keishi; Yagihashi, Kei; Funamizu, Yukihisa; Arai, Akira; Suzuki, Chieko; Nunomura, Jin-ichi; Baba, Masayuki; Tomiyama, Masahiko

    2016-01-01

    Administering intravenous recombinant tissue plasminogen activator (r-tPA) within 4.5 h or endovascular procedures within 8 h of ischemic stroke onset may reduce the risk of disability. The effectiveness of media campaigns to raise stroke awareness and shorten pre-hospital delay is unclear. We studied 1144 consecutive ischemic stroke patients at Aomori Prefectural Central Hospital, Japan, between March 2010 and February 2014. From March 2012, the government sponsored an educational campaign based on a television commercial to improve knowledge of stroke symptoms and encourage ambulance calls for facial palsy, arm palsy, or speech disturbance. For the 544 and 600 patients admitted before and during the intervention, respectively, we recorded the National Institutes of Health Stroke Scale score, stroke type, the time when patients or bystanders recognized stroke symptoms, and hospital arrival time. Pre-hospital delay, as the time interval from awareness of stroke to hospital arrival, was categorized as 0-3, 3-6, and 6+ h. The mean pre-hospital delay was shorter (12.0 vs 13.5 h; P = 0.0067), the proportion of patients arriving within 3 h was larger (55.7 vs 46.5 %; P = 0.0021), and the proportion arriving after 6 h was smaller (32.7 vs 39.5 %; P = 0.0162) in the intervention group than in the pre-intervention group. There was no significant difference in the proportion of patients treated with r-tPA (6 and 7.5 % of the intervention and pre-intervention groups, respectively). A television-based public education campaign potentially reduced pre-hospital delay for ischemic stroke patients, but the r-tPA treatment rate was unchanged.

  8. Pre-Hospital and In-Hospital Thoracostomy: Indications and Complications

    Science.gov (United States)

    Aylwin, Christopher J; Brohi, Karim; Davies, Gareth D; Walsh, Michael S

    2008-01-01

    INTRODUCTION Pleural drainage with chest tube insertion for thoracic trauma is a common and often life-saving technique. Although considered a simple procedure, complication rates have been reported to be 2–25%. We conducted a prospective cohort observational study of emergency pleural drainage procedures to validate the indications for pre-hospital thoracostomy and to identify complications from both pre- and in-hospital thoracostomies. PATIENTS AND METHODS Data were collected over a 7-month period on all patients receiving either pre-hospital thoracostomy or emergency department tube thoracostomy. Outcome measures were appropriate indications, errors in tube placement and subsequent complications. RESULTS Ninety-one chest tubes were placed into 52 patients. Sixty-five thoracostomies were performed in the field without chest tube placement. Twenty-six procedures were performed following emergency department identification of thoracic injury. Of the 65 pre-hospital thoracostomies, 40 (61%) were for appropriate indications of suspected tension pneumothorax or a low output state. The overall complication rate was 14% of which 9% were classified as major and three patients required surgical intervention. Twenty-eight (31%) chest tubes were poorly positioned and 15 (17%) of these required repositioning. CONCLUSIONS Pleural drainage techniques may be complicated and have the potential to cause life-threatening injury. Pre-hospital thoracostomies have the same potential risks as in-hospital procedures and attention must be paid to insertion techniques under difficult scene conditions. In-hospital chest tube placement complication rates remain uncomfortably high, and attention must be placed on training and assessment of staff in this basic procedure. PMID:18201502

  9. Pre-hospital advanced airway management by anaesthesiologists: is there still room for improvement?

    Science.gov (United States)

    Sollid, Stephen J M; Heltne, Jon Kenneth; Søreide, Eldar; Lossius, Hans Morten

    2008-07-21

    Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  10. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2008-07-01

    Full Text Available Abstract Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88% felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  11. Development and validation of the Pre-hospital Stroke Symptoms Coping Test.

    Directory of Open Access Journals (Sweden)

    Qiuli Zhao

    Full Text Available BACKGROUND AND PURPOSE: Measures of specific knowledge of coping with pre-hospital stroke symptoms can help educate high-risk patients and family caregivers. This study aimed to develop and validate the Pre-hospital Stroke Symptoms Coping Test (PSSCT. MATERIALS AND METHODS: Reliability and validity were analyzed using multiple data sources. The Delphi expert consultation method was applied to assess the test's surface validity and content validity index. The final edition of the 19-item PSSCT contained 3 sections assessing coping with typical symptoms and symptoms associated with vomiting and twitching. Its psychometric properties were investigated in a community sample of 300 high-risk patients and family members. RESULTS: The PSSCT was readily accepted by participants. It demonstrated adequate surface validity and content validity, and good internal consistency (KR20 = 0.822 and test-retest reliability (0.769, with difficulty (P and degree of differentiation (D ranges of 0.28-0.83 and 0.15-0.66, respectively. It was also able to distinguish between individuals who had/had not experienced a stroke. Experienced individuals scored significantly higher overall and on coping with typical symptoms and twitching (P<0.01. CONCLUSIONS: The PSSCT can practically and directly assess critical knowledge regarding coping with pre-hospital stroke symptoms and has good reliability and validity.

  12. Postconditioning attenuates no-reflow in STEMI patients.

    Science.gov (United States)

    Mewton, Nathan; Thibault, Hélène; Roubille, François; Lairez, Olivier; Rioufol, Gilles; Sportouch, Catherine; Sanchez, Ingrid; Bergerot, Cyrille; Cung, Thien Tri; Finet, Gérard; Angoulvant, Denis; Revel, Didier; Bonnefoy-Cudraz, Eric; Elbaz, Meyer; Piot, Christophe; Sahraoui, Inesse; Croisille, Pierre; Ovize, Michel

    2013-11-01

    After acute myocardial infarction, the presence of no-reflow (or microvascular obstruction: MVO) has been associated with adverse left ventricular (LV) remodeling and worse clinical outcome. This study examined the effects of mechanical ischemic postconditioning on early and late MVO size in acute ST-elevation myocardial infarction (STEMI) patients. Fifty patients undergoing primary coronary angioplasty for a first STEMI with TIMI grade flow 0-1 and no collaterals were randomized to ischemic postconditioning (PC) (n = 25) or control (n = 25) groups. Ischemic PC consisted in the application of four consecutive cycles of a 1-min balloon occlusion, each followed by a 1-min deflation at the onset of reperfusion. Early (3 min post-contrast) and late (10 min post-contrast) MVO size were assessed by contrast-enhanced cardiac-MRI within 96 h after reperfusion. PC was associated with smaller early and late MVO size (3.9 ± 4.8 in PC versus 7.8 ± 6.6% of LV in controls for early MVO, P = 0.02; and 1.8 ± 3.1 in PC versus 4.1 ± 3.9% of LV in controls for late MVO; P = 0.01). This significant reduction was persistent after adjustment for thrombus aspiration, which neither had any significant effect on infarct size, nor on early or late MVO (P = NS for all). Attenuation of MVO was associated to infarct size reduction. Mechanical postconditioning significantly reduces MVO in patients with acute STEMI treated with primary angioplasty.

  13. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

    Directory of Open Access Journals (Sweden)

    Lori Giuliano

    2005-10-01

    Full Text Available Abstract Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT, the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT. 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline, or to arm 2 (no intervention, current practice. Arm 1 participants (152 physicians, 280 nurses, 50 drivers attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the

  14. Tuberculosis patients' pre-hospital delay and non-compliance with a longstanding DOT programme: a mixed methods study in urban Zambia.

    Science.gov (United States)

    Cremers, Anne Lia; Gerrets, René; Kapata, Nathan; Kabika, Austin; Birnie, Emma; Klipstein-Grobusch, Kerstin; Grobusch, Martin P

    2016-10-28

    Tuberculosis (TB) remains a major health problem in Zambia, despite considerable efforts to control and prevent it. With this study, we aim to understand how perceptions and cultural, social, economic, and organisational factors influence TB patients' pre-hospital delay and non-compliance with care provided by the National Tuberculosis Programme (NTP). A mixed methods study was conducted with 300 TB patients recruited at Kanyama clinic for structured interviews. Thirty were followed-up for multiple in-depth interviews. Six focus group discussions were organised and participant observation was conducted. Ten biomedical care providers, 10 traditional healers, and 10 faith healers were interviewed. Factors associated with non-compliance (disruption of treatment > one week) were assessed by applying logistic regression analyses; qualitative analysis was used to additionally assess factors influencing pre-hospital delay and for triangulation of study findings. TB treatment non-compliance was low (10 %), no association of outcome with cultural or socio-economic factors was found. Only patients' time constraints and long distance to the clinic indicated a possible association with a higher risk of non-compliance (OR 0.52; 95 % CI 0.25, 1.10, p = 0.086). Qualitative data showed that most TB patients combined understandings of biomedical and traditional TB knowledge, used herbal, traditional and/or faith healing, suffered from stigmatizing attitudes, experienced poverty and food shortages, and faced several organisational obstacles while being on treatment. This led in some cases to pre-hospital delay or treatment non-compliance. Mixed methods analysis demonstrated the importance of in-depth information ascertained by qualitative approaches to understand how cultural, socio-economic and organisational factors are influencing patients' pre-hospital delay and treatment compliance. To strengthen the Zambian NTP, combating stigma is of utmost priority coupled with

  15. The role of pre-hospital blood gas analysis in trauma resuscitation

    Directory of Open Access Journals (Sweden)

    Katila Ari

    2010-04-01

    Full Text Available Abstract Background To assess, whether arterial blood gas measurements during trauma patient's pre-hospital shock resuscitation yield useful information on haemodynamic response to fluid resuscitation by comparing haemodynamic and blood gas variables in patients undergoing two different fluid resuscitation regimens. Methods In a prospective randomised study of 37 trauma patients at risk for severe hypovolaemia, arterial blood gas values were analyzed at the accident site and on admission to hospital. Patients were randomised to receive either conventional fluid therapy or 300 ml of hypertonic saline. The groups were compared for demographic, injury severity, physiological and outcome variables. Results 37 patients were included. Mean (SD Revised Trauma Score (RTS was 7.3427 (0.98 and Injury Severity Score (ISS 15.1 (11.7. Seventeen (46% patients received hypertonic fluid resuscitation and 20 (54% received conventional fluid therapy, with no significant differences between the groups concerning demographic data or outcome. Base excess (BE values decreased significantly more within the hypertonic saline (HS group compared to the conventional fluid therapy group (mean BE difference -2.1 mmol/l vs. -0.5 mmol/l, p = 0.003. The pH values on admission were significantly lower within the HS group (mean 7.31 vs. 7.40, p = 0.000. Haemoglobin levels were in both groups lower on admission compared with accident site. Lactate levels on admission did not differ significantly between the groups. Conclusion Pre-hospital use of small-volume resuscitation led to significantly greater decrease of BE and pH values. A portable blood gas analyzer was found to be a useful tool in pre-hospital monitoring for trauma resuscitation.

  16. An application of the MEMbrain training module: Pre-hospital rescue operation

    DEFF Research Database (Denmark)

    Andersen, V.

    1998-01-01

    A system for training in pre-hospital emergency management is being developed and the first version of a prototype has been completed. The training system fulfils the demands from the domain of hospital emergency planning centres and medical attendants concerning increased efficiency of rescue...... efforts. This includes enhanced first aid on site and improved overall co-ordination amongst the organisations involved in coping with emergency situations. The training system is based on the Multi-User System for Training Emergency Response (MUSTER) concept which is used for the training module...... in the decision support system MEMbrain. (C) 1998 Elsevier Science Ltd. All rights reserved....

  17. [Scandinavian guidelines on the pre-hospital management of traumatic brain injury

    DEFF Research Database (Denmark)

    Juul, N.; Sollid, S.; Sundstrom, T.

    2008-01-01

    Head trauma causes the death of many young persons. The number of fatalities can be reduced through systematic management. Preventing secondary brain injury together with the fastest possible transport to a neurosurgical unit has been shown to be effective in reducing mortality and morbidity....... Evidence-based guidelines already exist that focus on all steps in the management. This article, which was written by members of the Scandinavian Neurotrauma Committee, presents recommendations on the pre-hospital management of traumatic brain injury adapted to the infrastructure of Scandinavia...

  18. Association diastolic function by echo and infarct size by magnetic resonance imaging after STEMI

    DEFF Research Database (Denmark)

    Soeholm, Helle; Lønborg, Jacob Thomsen; Andersen, Mads Jønsson

    2016-01-01

    by echocardiography and myocardial salvage assessed with cardiac magnetic resonance (CMR) imaging in patients with ST-segment elevation MI (STEMI). DESIGN:In a prospective study, echocardiography and CMR were performed in STEMI patients in the early post-MI phase assessing diastolic dysfunction according to E/A and E...

  19. Pre-hospital and early in-hospital management of severe injuries: changes and trends.

    Science.gov (United States)

    Hussmann, Bjoern; Lendemans, Sven

    2014-10-01

    The pre-hospital and early in-hospital management of most severely injured patients has dramatically changed over the last 20 years. In this context, the factor time has gained more and more attention, particularly in German-speaking countries. While the management in the early 1990s aimed at comprehensive and complete therapy at the accident site, the premise today is to stabilise trauma patients at the accident site and transfer them into the hospital rapidly. In addition, the introduction of training and education programmes such as Pre-hospital Trauma Life Support (PHTLS(®)), Advanced Trauma Life Support (ATLS(®)) concept or the TEAM(®) concept has increased the quality of treatment of most severely injured trauma patients both in the preclinical field and in the emergency trauma room. Today, all emergency surgical procedures in severely injured patients are generally performed in accordance with the Damage Control Orthopaedics (DCO) principle. The advancements described in this article provide examples for the improved quality of the management of severely injured patients in the preclinical field and during the initial in-hospital treatment phase. The implementation of trauma networks, the release of the S3 polytrauma guidelines, and the DGU "Weißbuch" have contributed to a more structured management of most severely injured patients.

  20. THE WEARING RELATED TO WORK IN THE PERSPECTIVE OF NURSES OF PRE-HOSPITAL CARE

    Directory of Open Access Journals (Sweden)

    Claudia Cristiane Filgueira Martins

    2011-06-01

    Full Text Available Objetivo: Identificar como enfermeiros do Serviço de Atendimento Móvel às Urgências (SAMU percebem o desgaste relacionado ao trabalho cotidiano. Metodologia: Estudo descritivo de abordagem qualitativa, realizado através de entrevistas com enfermeiros que atuam no SAMU e cujos dados foram analisados a luz da análise do discurso. Resultados: Dos discursos emergiram os núcleos de sentido: natureza do serviço; ausência de condições de trabalho; desgaste físico e emocional e risco para a vida profissional. O desgaste foi caracterizado como inerente à natureza do serviço, por lidar com situações de vida e morte, favorecendo estresse físico e emocional. Foi ainda associado aos múltiplos vínculos empregatícios, às condições e as jornadas de trabalho, situações que dificultam atuações resolutivas e potencializam riscos de acidentes para o trabalhador. Conclusões: O desgaste no trabalho, entendido de modo não reflexivo, é naturalizado como inerente a sua dinâmica, mesmo que gere redução do potencial de vida desses profissionais.

  1. Evaluation of Bacterial Contamination on Pre Hospital Ambulances in Qom University of Medical Sciences of Iran in 2015

    Directory of Open Access Journals (Sweden)

    Roohollah Farhadloo

    2016-07-01

    Full Text Available Abstract Background & Aims of the Study: When the issue of the quality of the patient's care is addressed, determination of infection degrees in reference to the quality of such cares has gained a high priority. Therefore, infections in ambulance equipment might play a significant role in reduction of the quality of the hospital cares. This study was conducted wishing to determine bacterial infection degrees in ambulances servicing in pre-hospital emergency medical services of Qom University of Medical Sciences, Iran. Materials and Methods: In this analytical cross-sectional study, 132 sampling of the equipments of 12 ambulances were done. Samples were stored on BHI broth as an amplifier for 24 hours. Then, they were introduced to blood agar and Eosin Methylene Blue (EMB agar culture environments. After 24 hours, negative staphylococcus coagulase and bacillus were specified by different environments, solutions, diagnostic discs, gram staining, catalase test, oxidase test and coagulase test. Then data were analyzed by SPSS16. Results: The results showed that the highest infection prevalence rate was observed in stretchers (12 samples, 100% and the lowest in oxygenation moisturizers (1 sample, 8.4%. From infected equipments, in addition, four instruments (37% were mobile and eight of them (63% were immobile. Conclusion: Results indicated that an infection degree of the utensils and instruments which were used in ambulances employed servicing in the Qom Province Medical Emergency Response Center of Iran is high, that might have their roots in non-application of disinfectants for disinfecting ambulance surfaces and equipment. This is a mandatory for healthcare agents to utilize the protective covers, especially medical gloves.

  2. Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI

    Directory of Open Access Journals (Sweden)

    Tödt Tim

    2012-02-01

    Full Text Available Abstract Background Studies on the impact of time to treatment on myocardial infarct size have yielded conflicting results. In this study of ST-Elevation Myocardial Infarction (STEMI treated with primary percutaneous coronary intervention (PCI, we set out to investigate the relationship between the time from First Medical Contact (FMC to the demonstration of an open infarct related artery (IRA and final scar size. Between February 2006 and September 2007, 89 STEMI patients treated with primary PCI were studied with contrast enhanced magnetic resonance imaging (ceMRI 4 to 8 weeks after the infarction. Spearman correlation was computed for health care delay time (defined as time from FMC to PCI and myocardial injury. Multiple linear regression was used to determine covariates independently associated with infarct size. Results An occluded artery (Thrombolysis In Myocardial Infarction, TIMI flow 0-1 at initial angiogram was seen in 56 patients (63%. The median FMC-to-patent artery was 89 minutes. There was a weak correlation between time from FMC-to-patent IRA and infarct size, r = 0.27, p = 0.01. In multiple regression analyses, LAD as the IRA, smoking and an occluded vessel at the first angiogram, but not delay time, correlated with infarct size. Conclusions In patients with STEMI treated with primary PCI we found a weak correlation between health care delay time and infarct size. Other factors like anterior infarction, a patent artery pre-PCI and effects of reperfusion injury may have had greater influence on infarct size than time-to-treatment per se.

  3. Routine diversion of patients with STEMI to high-volume PCI centres: modelling the financial impact on referral hospitals

    OpenAIRE

    Pathak, Elizabeth Barnett; Comins, Meg M; Forsyth, Colin J.; Strom, Joel A

    2015-01-01

    Objective To quantify possible revenue losses from proposed ST-elevation myocardial infarction (STEMI) patient diversion policies for small hospitals that lack high-volume percutaneous coronary intervention (PCI) capability status (ie, ‘STEMI referral hospitals’). Background Negative financial impacts on STEMI referral hospitals have been discussed as an important barrier to implementing regional STEMI bypass/transfer protocols. However, there is little empirical data available that directly ...

  4. Pre-hospital identification and post-recovery challenges of intoxication with synthetic cannabinoid containing legal high products such as 'Exodus Damnation'.

    Science.gov (United States)

    Fitzpatrick, David; O'Meara, Patrick; Cunningham, Andrew

    2016-11-01

    This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported. For those patients with the capacity to refuse on-going care, ambulance services may be in an opportune position to actively promote referral to support services for these vulnerable individuals.

  5. In-hospital complications after invasive strategy for the management of Non STEMI: women fare as well as men

    Science.gov (United States)

    2010-01-01

    Background To analyze the in-hospital complication rate in women suffering from non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI) compared to men. Methods The files of 479 consecutive patients (133 women and 346 men) suffering from a Non STEMI (Non ST-segment elevation myocardial infarction) between the January 1st 2006 and March 21st 2009 were retrospectively analyzed with special attention to every single complication occurring during hospital stay. Data were analyzed using nonparametric tests and are reported as median unless otherwise specified. A p value < .05 was considered significant. Results As compared to men, women were significantly older (75.8 vs. 65.2 years; p < .005). All cardiovascular risk factors but tobacco and hypertension were similar between the groups: men were noticeably more often smoker (p < .0001) and women more hypertensive (p < .005). No difference was noticed for pre-hospital cardiovascular drug treatment. However women were slightly more severe at entry (more Killip class IV; p = .0023; higher GRACE score for in-hospital death - p = .008 and CRUSADE score for bleeding - p < .0001). All the patients underwent PCI of the infarct-related artery after 24 or 48 hrs post admission without sex-related difference either for timing of PCI or primary success rate. During hospitalization, 130 complications were recorded. Though the event rate was slightly higher in women (30% vs. 26% - p = NS), no single event was significantly gender related. The logistic regression identified age and CRP concentration as the only predictive variables in the whole group. After splitting for genders, these parameters were still predictive of events in men. In women however, CRP was the only one with a borderline p value. Conclusions Our study does not support any gender difference for in-hospital adverse events in patients treated invasively for an acute coronary syndrome without ST-segment elevation and elevated

  6. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

    LENUS (Irish Health Repository)

    Feeney, A

    2016-04-01

    Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis

  7. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

    Directory of Open Access Journals (Sweden)

    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  8. [Cooperation between emergency and forensic medicine - retrospective evaluation of pre-hospital emergency measures].

    Science.gov (United States)

    Buschmann, Claas T; Kleber, Christian; Tsokos, Michael; Püschel, Klaus; Hess, Thorsten; Kerner, Thoralf; Stuhr, Markus

    2015-06-01

    Emergency medical research is subject to special conditions. Emergency patients e.g. are generally considered to be non-capable of giving consent. This results in sparse emergency medical data when compared to clinical observation studies under controlled conditions. After emergency medical treatment, deceased patients are not rarely subject to forensic investigation. The cooperation between emergency and forensic medicine has not only emergency medical training potential in individual cases, but also scientific innovation potential especially with respect to the retrospective evaluation of pre-hospital emergency measures. Such partnerships (like in Berlin at the Charité - Universitätsmedizin Berlin between the Institute of Legal Medicine and the Center for Musculoskeletal Surgery or in Hamburg between the Institute for Legal Medicine at the University Hospital and the Municipal Fire Brigade with the Emergency Medical Service) are yet exceptional in Germany. © Georg Thieme Verlag Stuttgart · New York.

  9. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene;

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during...... a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.MethodsWe performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch...... of the ambulance to arrival at the scene, on-scene time and transport time to the hospital¿in total, alarm-to-door time. In addition, we noted baseline characteristics.ResultsWe reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33¿52), of which 18 (12...

  10. A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway

    Directory of Open Access Journals (Sweden)

    Staff Trine

    2011-03-01

    Full Text Available Abstract Background Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs. Methods Records from police, Emergency Medical Communication Centers (EMCC, ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS, respiratory rate (RR, and systolic blood pressure (SBP was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend. Results 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: p Conclusion EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research.

  11. A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway.

    Science.gov (United States)

    Staff, Trine; Søvik, Signe

    2011-03-31

    Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS) documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs). Records from police, Emergency Medical Communication Centers (EMCC), ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS), respiratory rate (RR), and systolic blood pressure (SBP) was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend). 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: pground and 92% of cases by air ambulance. EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research. © 2011 Staff and S

  12. NSTE-ACS und STEMI: Zeitfenster zur Intervention?

    Directory of Open Access Journals (Sweden)

    Alber H

    2010-01-01

    Full Text Available Die neuesten Richtlinien zur Behandlung akuter Koronarsyndrome haben die Bedeutung der perkutanen Koronarintervention weiter gestärkt. Unverändert ist jedoch die Tatsache, dass ein richtig und individuell gewähltes Zeitfenster zur Intervention essenziell für den Benefit der mechanischen Revaskularisation ist. Angesichts vieler möglicher Zeitverzögerungen, vor allem im ländlichen Raum, kann im Einzelfall auch heute noch beim STEMI einer Fibrinolyse, häufig gefolgt von einer invasiven Abklärung innerhalb eines Tages, der Vorzug gegeben werden. Beim NSTE-ACS ist eine frühe Risikostratifizierung wichtig für die zeitliche Planung der Intervention. In allen Fällen bedarf es jedoch einer kontinuierlichen und konstruktiven Interaktion aller im Management von ACS-Patienten/innen beteiligten Berufsgruppen, um diesen sich stetig ändernden Empfehlungen mit dem Ziel der Prognoseverbesserung adäquat Rechnung tragen zu können.

  13. Impact of the timing of metoprolol administration during STEMI on infarct size and ventricular function

    OpenAIRE

    García Ruiz, José María; Fernández Jiménez, Rodrigo; García Álvarez, Ana; Pizarro, Gonzalo; Galán Arriola, Carlos; Fernández-Friera, Leticia; Mateos, Alonso; Nuño Ayala, Mario; Agüero, Jaume; Sánchez González, Javier; García Prieto, Jaime; López Melgar, Beatriz; Martínez Tenorio, Pedro; López Martín, Gonzalo J.; Macías, Ángel

    2016-01-01

    Pre-reperfusion administration of intravenous (IV) metoprolol reduces infarct size in ST-segment elevation myocardial infarction (STEMI). This study sought to determine how this cardioprotective effect is influenced by the timing of metoprolol therapy having either a long or short metoprolol bolus-to-reperfusion interval. We performed a post hoc analysis of the METOCARD-CNIC (effect of METOprolol of CARDioproteCtioN during an acute myocardial InfarCtion) trial, which randomized anterior STEMI...

  14. Prevention of contrast-induced nephropathy in STEMI patients undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Busch, Sarah Victoria Ekeløf; Jensen, Svend Eggert; Rosenberg, Jacob;

    2013-01-01

    Objective: To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac catheteri......Objective: To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac...

  15. Comparison of the Hospital Arrival Time and Differences in Pain Quality between Diabetic and Non-Diabetic STEMI Patients

    Directory of Open Access Journals (Sweden)

    Marina Gradišer

    2015-01-01

    Full Text Available The aim of our study was to determine whether diabetic ST segment elevation myocardial infarction (STEMI patients arrive in the emergency room (ER later than non-diabetics, compare the differences in pain quality and quantity between those groups, and measure differences in the outcome after an index hospitalization. A total of 266 patients with first presentation of STEMI were included in our study during a period of two years, 62 with diabetes and 204 without diabetes type 2. Pain intensity and quality at admission were measured using a McGill short form questionnaire. Diabetic patients did not arrive significantly later than non-diabetic (χ2; p = 0.105. Most diabetic patients described their pain as “slight” or “none” (χ2; p < 0.01, while most non-diabetic patients graded their pain as “moderate” or “severe” (χ2; p < 0.01. The quality of pain tended to be more distinct in non-diabetic patients, while diabetic patients reported mainly shortness of breath (χ2; p < 0.01. Diabetic patients were more likely to suffer a multi-vessel disease (χ2; p < 0.01, especially in the late arrival group. Therefore, cautious evaluation of diabetic patients and adequate education of target population could improve overall survival while well-organized care like a primary PCI Network program could significantly reduce CV mortality.

  16. Implementation of a pre-hospital decision rule in general practice. Triage of patients with suspected myocardial infarction

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); J.W. Deckers (Jaap); A.W. Hoes (Arno); H. Boersma (Eric); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten)

    1996-01-01

    textabstractOBJECTIVE: To improve pre-hospital triage of patients with suspected acute cardiac disease. DESIGN: Prospective study. SUBJECTS. Patients with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner, for whom acute admission into hospital was requested, an

  17. The Quality of Pre-hospital Circulatory Management in Patients With Multiple Trauma Referred to the Trauma Center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013

    Directory of Open Access Journals (Sweden)

    Maghaminejad

    2016-05-01

    Full Text Available Background Circulatory management is a critical issue in pre-hospital transportation phase of multiple trauma patients. However, the quality of this important care did not receive enough attention. Objectives The aim of this study was to investigate the quality of pre-hospital circulatory management in patients with multiple trauma. Patients and Methods This was a cross-sectional study conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services (EMS to the central trauma department in Kashan Shahid Beheshti medical center, Kashan, Iran. We recruited a convenience sample of 400 patients with multiple trauma. Data were collected using the circulatory assessment questionnaire and controlling hemorrhage (CAQCH that were designed by the researchers and were described by using frequency tabulations, central tendency measures, and variability indices. The chi-square test was used to analyze the data. Results The study sample consisted of 263 males (75.2%; 57.75% had lower levels of education and 28.75% were workers. The most common mechanism of trauma was traffic accident (85.4%. We found that the quality of circulatory management was unfavorable in 61% of the cases. A significant relationship was observed between the quality of circulatory management and type of trauma and staff’s employment status. Conclusions The quality of pre-hospital circulatory management provided to patients with multiple trauma was unfavorable. Therefore, establishment of in-service training programs on circulatory management is recommended.

  18. Technology for trauma: testing the validity of a smartphone app for pre-hospital clinicians.

    Science.gov (United States)

    Freshwater, Eleanor S; Crouch, Robert

    2015-01-01

    With the introduction of regional trauma networks in England, ambulance clinicians have been required to make triage decisions relating to severity of injury, and appropriate destination for the patient, which may require 'bypassing' the nearest Emergency Department. A 'Trauma Unit Bypass Tool' is utilised in this process. The Major Trauma Triage tool smartphone application (App) is a digital representation of a tool, available for clinicians to use on their smartphone. Prior to disseminating the application, validity and performance against the existing paper-based tool was explored. A case-based study using clinical scenarios was conducted. Scenarios, with appropriate triage decisions, were agreed by an expert panel. Ambulance clinicians were assigned to either the paper-based tool or smartphone app group and asked to make a triage decision using the available information. The positive predictive value (PPV) of each tool was calculated. The PPV of the paper tool was 0.76 and 0.86 for the smartphone app. User comments were mainly positive for both tools with no negative comments relating to the smartphone app. The smartphone app version of the Trauma Unit Bypass Tool performs at least as well as the paper version and can be utilised safely by pre-hospital clinicians in supporting triage decisions relating to potential major trauma. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Importance of Hospital Entry: Walk-in STEMI and Primary Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Eric Bansal

    2014-02-01

    Full Text Available Introduction: Patients with ST elevation myocardial infarction (STEMI require rapid identification and triage to initiate reperfusion therapy. Walk-in STEMI patients have longer treatment times compared to emergency medical service (EMS transported patients. While effective triage of large numbers of critically ill patients in the emergency department is often cited as the reason for treatment delays, additional factors have not been explored. The purpose of this study was to evaluate baseline demographic and clinical differences between walk-in and EMS-transported STEMI patients and identify factors associated with prolonged door to balloon (D2B time in walk-in STEMI patients. Methods: We performed a retrospective review of 136 STEMI patients presenting to an urban academic teaching center from January 2009 through December, 2010. Baseline demographics, mode of hospital entry (walk-in versus EMS transport, treatment times, angiographic findings, procedures performed and in-hospital clinical events were collected. We compared walk-in and EMS-transported STEMI patients and identified independent factors of prolonged D2B time for walk-in patients using stepwise logistic regression analysis. Results: Walk-in patients (n=51 were more likely to be Latino and presented with a higher heart rate, higher systolic blood pressure, prior history of diabetes mellitus and were more likely to have an elevated initial troponin value, compared to EMS-transported patients. EMS-transported patients (n=64 were more likely to be white and had a higher prevalence of left main coronary artery disease, compared to walk-in patients. Door to electrocardiogram (ECG, ECG to catheterization laboratory (CL activation and D2B times were significantly longer for walk-in patients. Walk-in patients were more likely to have D2B time > 90 minutes, compared to EMS- transported patients; odds ratio 3.53 (95% CI 1.03, 12.07, p = 0.04. Stepwise logistic regression identified hospital

  20. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management.

    Science.gov (United States)

    Sollid, Stephen J M; Lockey, David; Lossius, Hans Morten

    2009-11-20

    Advanced airway management is a critical intervention that can harm the patient if performed poorly. The available literature on this subject is rich, but it is difficult to interpret due to a huge variability and poor definitions. Several initiatives from large organisations concerned with airway management have recently propagated the need for guidelines and standards in pre-hospital airway management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus process with international experts to establish a set of core data points to be documented and reported in cases of advanced pre-hospital airway management. A four-step modified nominal group technique process was employed. The inclusion criterion for the template was defined as any patient for whom the insertion of an advanced airway device or ventilation was attempted. The data points were divided into three groups based on their relationship to the intervention, including system-, patient-, and post-intervention variables, and the expert group agreed on a total of 23 core data points. Additionally, the group defined 19 optional variables for which a consensus could not be achieved or the data were considered as valuable but not essential. We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core dataset for this template should be included in future studies on pre-hospital airway management to produce comparable data across systems and patient populations and will be implemented in systems that are influenced by the expert panel.

  1. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management

    Directory of Open Access Journals (Sweden)

    Lockey David

    2009-11-01

    Full Text Available Abstract Background Advanced airway management is a critical intervention that can harm the patient if performed poorly. The available literature on this subject is rich, but it is difficult to interpret due to a huge variability and poor definitions. Several initiatives from large organisations concerned with airway management have recently propagated the need for guidelines and standards in pre-hospital airway management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus process with international experts to establish a set of core data points to be documented and reported in cases of advanced pre-hospital airway management. Methods A four-step modified nominal group technique process was employed. Results The inclusion criterion for the template was defined as any patient for whom the insertion of an advanced airway device or ventilation was attempted. The data points were divided into three groups based on their relationship to the intervention, including system-, patient-, and post-intervention variables, and the expert group agreed on a total of 23 core data points. Additionally, the group defined 19 optional variables for which a consensus could not be achieved or the data were considered as valuable but not essential. Conclusion We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core dataset for this template should be included in future studies on pre-hospital airway management to produce comparable data across systems and patient populations and will be implemented in systems that are influenced by the expert panel.

  2. Between professional values and the social valuation of patients: the fluctuating economy of pre-hospital emergency work.

    Science.gov (United States)

    Nurok, Michael; Henckes, Nicolas

    2009-02-01

    A number of authors have shown how medical decisions are influenced by social values; others have minimized the putative influence of values and have argued that medical decisions are predominantly constrained by the organization of medical work. Based on fieldwork in France and the USA observing pre-hospital resuscitations, we seek to resolve these views by showing that while judgments about the social value of a patient do influence professional decisions, so do judgments about the work that must be accomplished to manage a case. Pre-hospital emergency work has many facets that are variably valued by different professionals at different moments of an emergency's trajectory. These values compete with each other in what we call a "fluctuating economy". This article analyses the role of social, technical, medical or surgical, heroic, and competence values in the course of pre-hospital emergency work. We show how these values may conflict or align with each other, forcing professionals to constantly establish priorities during an emergency trajectory.

  3. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine.

    Science.gov (United States)

    Mebazaa, Alexandre; Yilmaz, M Birhan; Levy, Phillip; Ponikowski, Piotr; Peacock, W Frank; Laribi, Said; Ristic, Arsen D; Lambrinou, Ekaterini; Masip, Josep; Riley, Jillian P; McDonagh, Theresa; Mueller, Christian; deFilippi, Christopher; Harjola, Veli-Pekka; Thiele, Holger; Piepoli, Massimo F; Metra, Marco; Maggioni, Aldo; McMurray, John; Dickstein, Kenneth; Damman, Kevin; Seferovic, Petar M; Ruschitzka, Frank; Leite-Moreira, Adelino F; Bellou, Abdelouahab; Anker, Stefan D; Filippatos, Gerasimos

    2015-06-01

    Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to practicing physicians and nurses to manage acute heart failure in the pre-hospital and hospital setting. Criteria of hospitalization and of discharge are described. Gaps in knowledge and perspectives in the management of acute heart failure are also detailed. This consensus paper on acute heart failure might help enable contiguous practice.

  4. Re-analysis of predictors of in-hospital mortality in Chinese STEMI patients

    Directory of Open Access Journals (Sweden)

    Ya-ling HAN

    2016-06-01

    Full Text Available Clinical predictors of ST-segment elevation myocardial infarction (STEMI patients may guide clinicians to select the type of treatment. Four articles published in present issue made an in-depth analysis of the data collected recent years from Cardiovascular Intervention Procedures Database of Chinese military hospitals, explored the effects of gender, preoperative severity of target-vessel stenosis, establishment of chest pain center and intra-aortic balloon pump on in-hospital mortality of STEMI patients, which may be helpful for clinicians to individualize treatment, further optimize reperfusion strategy, and improve the clinical efficacy and the prognosis of STEMI patients. DOI: 10.11855/j.issn.0577-7402.2016.06.01

  5. Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

    DEFF Research Database (Denmark)

    Pedersen, Frants; Butrymovich, Vitalij; Kelbæk, Henning

    2014-01-01

    ,804 consecutive patients with STEMI (age 63 ± 13 years, 72% males) treated with primary PCI. RESULTS: Patients were followed up for a median of 4.7 years. During a total of 13,447 patient-years, 717 patients died. Main causes of death within the first 30 days were cardiogenic shock and anoxic brain injury after......BACKGROUND: Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. OBJECTIVES: The goal of this study...... was to describe the association between time and cause of death in patients with STEMI undergoing primary PCI. METHODS: A centralized civil registration system, patient files, and public disease and death cause registries with an accurate record linkage were used to trace time and cause of death in 2...

  6. Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry

    Science.gov (United States)

    Dharma, Surya; Andriantoro, Hananto; Purnawan, Ismi; Dakota, Iwan; Basalamah, Faris; Hartono, Beny; Rasmin, Ronaly; Isnanijah, Herawati; Yamin, Muhammad; Wijaya, Ika Prasetya; Pratama, Vireza; Gunawan, Tjatur Bagus; Juwana, Yahya Berkahanto; Suling, Frits R W; Witjaksono, A M Onny; Lasanudin, Hengkie F; Iskandarsyah, Kurniawan; Priatna, Hardja; Tedjasukmana, Pradana; Wahyumandradi, Uki; Kosasih, Adrianus; Budhiarti, Imelda A; Pribadi, Wisnoe; Wirianta, Jeffrey; Lubiantoro, Utojo; Pramesti, Rini; Widowati, Diah Retno; Aminda, Sissy Kartini; Basalamah, M Abas; Rao, Sunil V

    2016-01-01

    Objective We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. Design Retrospective cohort study. Setting Emergency department of 56 health centres. Participants 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure Characteristics of reperfusion therapy. Results The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI

  7. Relationship between Neutrophil-To-Lymphocyte Ratio and Electrocardiographic Ischemia Grade in STEMI

    Directory of Open Access Journals (Sweden)

    Emre Yalcinkaya

    2015-02-01

    Full Text Available Background: Neutrophil-to-lymphocyte ratio (NLR has been found to be a good predictor of future adverse cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI. Changes in the QRS terminal portion have also been associated with adverse outcomes following STEMI. Objective: To investigate the relationship between ECG ischemia grade and NLR in patients presenting with STEMI, in order to determine additional conventional risk factors for early risk stratification. Methods: Patients with STEMI were investigated. The grade of ischemia was analyzed from the ECG performed on admission. White blood cells and subtypes were measured as part of the automated complete blood count (CBC analysis. Patients were classified into two groups according to the ischemia grade presented on the admission ECG, as grade 2 ischemia (G2I and grade 3 ischemia (G3I. Results: Patients with G3I had significantly lower mean left ventricular ejection fraction than those in G2I (44.58 ± 7.23 vs. 48.44 ± 7.61, p = 0.001. As expected, in-hospital mortality rate increased proportionally with the increase in ischemia grade (p = 0.036. There were significant differences in percentage of lymphocytes (p = 0.010 and percentage of neutrophils (p = 0.004, and therefore, NLR was significantly different between G2I and G3I patients (p < 0.001. Multivariate logistic regression analysis revealed that only NLR was the independent variable with a significant effect on ECG ischemia grade (odds ratio = 1.254, 95% confidence interval 1.120–1.403, p < 0.001. Conclusion: We found an association between G3I and elevated NLR in patients with STEMI. We believe that such an association might provide an additional prognostic value for risk stratification in patients with STEMI when combined with standardized risk scores.

  8. Pre-hospital and hospital emergency nursing of cohesion%院前与院内急救护理工作的衔接

    Institute of Scientific and Technical Information of China (English)

    沙丽华

    2015-01-01

    随着我国急诊医疗服务系统、急救网络的逐步形成,急诊急救工作飞速发展,急诊急救护理水平和质量也有了极大的提高,急救护理在急诊医疗服务系统中显现出举足轻重的地位和作用。急救护理是护理学科的一个分支,在其任务、功能和职责方面具有独立性、综合性与协作性,急救医疗服务(emergency medical service,EMS)包括院前急救、院内急救两部分,两者联系紧密、不可分割。%With the emergency medical service system in China, first aid network gradually formed and emergency first-aid work rapid development, emergency first aid levels and quality have greatly improved, emergency care in emergency medical services system shows the important position and role. Emergency care is a branch of nursing discipline, in terms of its task, function and responsibility independence, and the collaborative, comprehensive emergency medical services (emergency medical service, EMS) including pre-hospital first aid, hospital emergency two parts, both closely linked, inseparable.

  9. 急性ST段抬高型心肌梗死院前转运PCI治疗体会%Treatment of acute ST segment elevation myocardial infarction patients with pre-hospital transport PCI

    Institute of Scientific and Technical Information of China (English)

    李泊洁

    2016-01-01

    Objective To observe the better pre-hospital transfer of acute ST segment elevation myocardial infarction (STEMI) patients directly the effect of PCI.Methods Collected in May 2015, in May 2016 with acute ST segment elevation myocardial infarction (STEMI) via optimization of emergency transport admission line direct PCI treatment data of 33 patients to observe group (group A), collected in March 2014-May 2015 for STEMI data via the non-optimized emergency transport direct PCI treatment data 37 patients as control group (group B), the onset time within 12h.Compare two groups of patients with medical treatment for the first time contact to balloon dilation (FMC-to-B) time, the door to balloon dilation (D-to-B) time, into the international to balloon expansion time, the door to international time, length of hospital stay, hospital expenses and other indicators have difference.Results observation group FMC-to-B and D-to-B, into the international to balloon expansion time, the door to international time respectively (111.3± 35.7), (76.7± 35.0),(35.7± 8.5), (16.9± 5.1) minwere significantly lower than the control group , respectively (147.3± 36.7), (89.7± 39.6), (46.8± 9.7) (36.7± 8.3)min, (P<0.05).Team of hospital stay (9.0± 4.3) d than (9.8± 4.7) dand hospitalization expenses RMB (51253± 22108) yuan than (57156± 25619) yuan is lower than the control group (P<0.05).Conclusion pre-hospital transfer significantly shorten the FMC better-to-B and D-to-B of time, can improve the curative effect in patients with STEMI PCI, patients to reduce the economic burden.%目的:观察采用更优化的院前转运对急性ST段抬高型心肌梗死(STEMI)患者直接PCI疗效的影响。方法收集2015年5月-2016年5月因急性ST段抬高型心肌梗死(STEMI)经优化急救转运入院行直接PCI治疗33例患者资料为观察组(A组),收集2014年3月--2015年5月期间因STEMI经未优化急救转运直接PCI37例患者资料为对照组

  10. Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial

    NARCIS (Netherlands)

    Henriques, J.P.; Hoebers, L.P.; Ramunddal, T.; Laanmets, P.; Eriksen, E.; Bax, M.; Ioanes, D.; Suttorp, M.J.; Strauss, B.H.; Barbato, E.; Nijveldt, R.; Rossum, A.C. van; Marques, K.M.; Elias, J.; Dongen, I.M. van; Claessen, B.E.; Tijssen, J.G.; Schaaf, R.J. van der; Boer, M.J. de

    2016-01-01

    BACKGROUND: In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery is present and is associated with increased morbidity and mortality. OBJECTIVES: The EXPLORE (Evaluating Xience and Left Ve

  11. Effects of Implementing STEM-I Project-Based Learning Activities for Female High School Students

    Science.gov (United States)

    Lou, Shi-Jer; Tsai, Huei-Yin; Tseng, Kuo-Hung; Shih, Ru-Chu

    2014-01-01

    This study aims to explore the application of STEM-I (STEM-Imagination) project-based learning activities and its effects on the effectiveness, processes, and characteristics of STEM integrative knowledge learning and imagination development for female high school students. A total of 72 female high school students were divided into 18 teams.…

  12. Percepções de urgência para usuários e motivos de utilização do serviço de atendimento pré-hospitalar móvel Percepciones de urgencia para usuarios y motivos de utilización del servicio de atención prehospitalaria móvil Users' perceptions of urgency and reasons for using the mobile pre-hospital care service

    Directory of Open Access Journals (Sweden)

    Kelly Piacheski de Abreu

    2012-06-01

    transporte y locomoción. Los usuarios prefieren el servicio por la rapidez, gratuidad y para obtener transporte. Las percepciones de usuarios sobre urgencias son diversas, algunas veces concordantes con la perspectiva biomédica del profesional de salud; otras, propias del contexto social.The Mobile Emergency Care Services handle urgent situations of various types, and demand for this service occurs according to the perception of the user regarding what is urgent. The aim of the study was to analyze the perceptions of urgency by users who demand care from a Mobile Emergency Care Service in Porto Alegre and to identify the reasons for these requests. In this exploratory-descriptive study, with qualitative approach, data were collected through semi-structured interviews conducted by telephone, during the period from February to April 2009. Thematic analysis was used to analyze the information. Users consider urgent life-threatening conditions, which require a quick response, and visible situations, such as bleeding, chronic diseases, and difficulties in transportation. Users themselves feel motivated to call the service due to it being rapid and free, and for transportation. The perceptions of users regarding urgency were diverse, sometimes consistent with the biomedical perspective of health providers and sometimes with their own social context.

  13. [Analysis of the implementation of a mobile pre-hospital treatment system in five Brazilian state capitals].

    Science.gov (United States)

    Minayo, Maria Cecília de Souza; Deslandes, Suely Ferreira

    2008-08-01

    The article presents a description and analysis of the implementation of a pre-hospital treatment system (SAMU) as part of the research project Diagnostic Analysis of the Implementation of a National Policy for the Reduction of Violence and Accidents. Implementation and organization of the SAMU service, together with the related materials, human resources, and equipment, was studied in five Brazilian State capitals with high morbidity and mortality rates from external causes: Curitiba (Paraná), Recife (Pernambuco), Brasília (Federal District), Rio de Janeiro, and Manaus (Amazonas). The study involved four phases, each developing exploratory and analytical cycles, combined with fieldwork, triangulating quantitative and qualitative data. Implementation of the pre-hospital treatment system is now a key health sector asset. Further necessary steps include: comprehensive legislation covering vehicles, personnel, and equipment; closer networking between mobile units and healthcare facilities; focus on information generated in this sub-system, thus facilitating planning; and maintaining and upgrading high qualifications for SAMU crews. The service is officially establishing, standardizing, and regulating a sub-system that is crucial for saving lives.

  14. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene

    DEFF Research Database (Denmark)

    Højfeldt, S G; Sørensen, L P; Mikkelsen, Søren

    2014-01-01

    BACKGROUND: The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which...... with the Mobile Emergency Care Unit within 24 h. Of the 143 victims of traffic accidents, 19 (13%) required renewed contact with the emergency department and one required admission to hospital (0.7%). Of all 1609 patients, four died within 24 h of contact (0.2%). CONCLUSION: Patients treated and released...... investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS: ONE THOUSAND SIX HUNDRED NINE: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International...

  15. On the work of the pre-hospital emergency dispatchers%浅论院前急救中调度员的工作

    Institute of Scientific and Technical Information of China (English)

    吴蕙勤; 严莉

    2016-01-01

    Dispatching is a link between patients/witnesses and emergency workers and serves as a hub of pre-hospital care.It is the first and important part of the emergency medical system with attributes as an administrative behavior being both authoritative and public.The author describes norms in the centre's daily alarm dispatching, emergencies, routine duties as well as the specific requirements of the works.The paper takes into account the guidance and supervision to command station in emergency work and extends care and communication to frontlinestaff.Dispatching is a special job, requiring both the operational capacity of the individual and the teamwork spirit. In order to ensure the quality of the work,training and retraining are essential, in addition to the routine training in daily works,attention must be paid to cultivate dispatchers’personality and ability to handle a variety of alarming situation .%120调度员是患者或目击者与急救人员间的联系纽带,是院前急救的中枢,是急诊医学体系的第一环节和重要组成部分,其工作十分重要。该文阐述了120调度中心调度员的日常接警、突发事件应急调度等工作规范和具体要求。认为:调度是一个特殊的岗位,既需要个人的业务能力,又需要团队合作精神。为了保证调度员的工作质量,对其除加强工作常规培训外,更要注重其人格和灵活处理各警情能力的培养。

  16. Perceptions on the effectiveness of treatment and the timeline of Buruli ulcer influence pre-hospital delay reported by healthy individuals.

    Directory of Open Access Journals (Sweden)

    Marike Alferink

    Full Text Available BACKGROUND: Delay in seeking treatment at the hospital is a major challenge in current Buruli ulcer control; it is associated with severe sequelae and functional limitations. Choosing alternative treatment and psychological, social and practical factors appear to influence delay. Objectives were to determine potential predictors for pre-hospital delay with Leventhal's commonsense model of illness representations, and to explore whether the type of available dominant treatment modality influenced individuals' perceptions about BU, and therefore, influenced pre-hospital delay. METHODOLOGY: 130 healthy individuals aged >18 years, living in BU-endemic areas in Benin without any history of BU were included in this cross-sectional study. Sixty four participants from areas where surgery was the dominant treatment and sixty six participants from areas where antibiotic treatment was the dominant treatment modality were recruited. Using a semi-structured interview we measured illness perceptions (IPQ-R, knowledge about BU, background variables and estimated pre-hospital delay. PRINCIPAL FINDINGS: The individual characteristics 'effectiveness of treatment' and 'timeline acute-chronic' showed the strongest association with pre-hospital delay. No differences were found between regions where surgery was the dominant treatment and regions where antibiotics were the dominant treatment modality. CONCLUSIONS: Individual characteristics, not anticipated treatment modality appeared predictors of pre-hospital delay.

  17. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature.

    Science.gov (United States)

    Goodwin, Nicholas S; Spinks, Anneliese; Wasiak, Jason

    2016-08-01

    The aim of this systematic review was to determine the supporting evidence for the clinical use of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting. Two authors searched three databases (Ovid Medline, Ovid Embase and The Cochrane Library) for relevant English language articles published through September 2014. Reference lists, conference proceedings and non-indexed academic journals were manually searched. A separate search was conducted using the Internet search engine Google to source additional studies from burns advisory agencies, first aid bodies, military institutions, manufacturer and paramedic websites. Two authors independently assessed study eligibility and relevance of non-traditional data forms for inclusion. Studies were independently assessed and included if Hydrogel-based burn dressings (HBD) were examined in first aid practices in the pre-hospital setting. A total of 129 studies were considered for inclusion, of which no pre-hospital studies were identified. The review highlights that current use of HBD in the pre-hospital setting appears to be driven by sources of information that do not reflect the paramedic environment. We recommend researchers in the pre-hospital settings undertake clinical trials in this field. More so, the review supports the need for expert consensus to identify key demographic, clinical and injury outcomes for clinicians and researchers undertaking further research into the use of dressings as a first aid measure.

  18. Impact of the Timing of Metoprolol Administration During STEMI on Infarct Size and Ventricular Function.

    OpenAIRE

    Mateos Rodríguez, Alonso

    2016-01-01

    BACKGROUND Pre-reperfusion administration of intravenous (IV) metoprolol reduces infarct size in ST-segment elevation myocardial infarction (STEMI). OBJECTIVES This study sought to determine how this cardioprotective effect is influenced by the timing of metoprolol therapy having either a long or short metoprolol bolus-to-reperfusion interval. METHODS We performed a post hoc analysis of the METOCARD-CNIC (effect of METOprolol of CARDioproteCtioN during an acute myocardial Inf...

  19. Feasibility of Remote Ischemic Peri-conditioning during Air Medical Transport of STEMI Patients.

    Science.gov (United States)

    Martin-Gill, Christian; Wayne, Max; Guyette, Francis X; Olafiranye, Oladipupo; Toma, Catalin

    2016-01-01

    Remote ischemic peri-conditioning (RIPC) has gained interest as a means of reducing ischemic injury in patients with acute ST-elevation myocardial infarction (STEMI) who are undergoing emergent primary percutaneous coronary intervention (pPCI). We aimed to evaluate the feasibility, process, and patient-related factors related to the delivery of RIPC during air medical transport of STEMI patients to tertiary pPCI centers. We performed a retrospective review of procedural outcomes of a cohort of STEMI patients who received RIPC as part of a clinical protocol in a multi-state air medical service over 16 months (March 2013 to June 2014). Eligible patients were transported to two tertiary PCI centers and received up to four cycles of RIPC by inflating a blood pressure cuff on an upper arm to 200 mmHg for 5 minutes and subsequently deflating the cuff for 5 minutes. Data regarding feasibility, process variables, patient comfort, and occurrence of hypotension were obtained from prehospital records and prospectively completed quality improvement surveys. The primary outcome was whether at least 3 cycles of RIPC were completed by air medical transport crews prior to pPCI. Secondary outcomes included the number of cycles completed prior to pPCI, time spent with the patient prior to transport (bedside time), patient discomfort level, and incidence of hypotension (systolic blood pressure air medical transport for pPCI, without occurrence of prolonged bedside times. The incidence of excessive RIPC-related discomfort or hemodynamic instability is rare. STEMI patients requiring on average >30 minutes transport for pPCI may be the ideal group for RIPC utilization.

  20. Biomarkers of Hemodynamic Stress and Aortic Stiffness after STEMI: A Cross-Sectional Analysis

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    Sebastian Johannes Reinstadler

    2015-01-01

    Full Text Available Aim. Increased aortic stiffness might adversely affect cardiac structure, function, and perfusion. Release of biomarkers of hemodynamic stress is thought to be enhanced by these alterations. We aimed to evaluate the association between biomarkers of hemodynamic stress and aortic stiffness assessed at a chronic stage after ST-segment elevation myocardial infarction (STEMI. Methods. Fifty-four patients four months after STEMI were enrolled in this cross-sectional, single-center study. N-terminal pro–B-type natriuretic peptide (NT-proBNP, mid-regional pro–A-type natriuretic peptide (MR-proANP, and mid-regional proadrenomedullin (MR-proADM levels were measured by established assays. Aortic stiffness was assessed by the measurement of pulse wave velocity using phase-contrast cardiovascular magnetic resonance. Results. NT-proBNP, MR-proANP, and MR-proADM concentrations were all correlated with aortic stiffness in univariate analysis (r=0.378, r=0.425, and r=0.532; all P<0.005, resp.. In multiple linear regression analysis, NT-proBNP (β=0.316, P=0.005 and MR-proADM (β=0.284, P<0.020 levels were associated with increased aortic stiffness independently of age, blood pressure, and renal function. NT-proBNP was the strongest predictor for high aortic stiffness (area under the curve: 0.82, 95% CI 0.67–0.96. Conclusion. At a chronic stage after STEMI, concentrations of biomarkers for hemodynamic stress, especially NT-proBNP, are positively correlated with aortic stiffness. These biomarkers might also be useful as predictors of high aortic stiffness after STEMI.

  1. 德阳市院前急救现况调查与分析%Epidemiology Analysis of Pre-Hospital First Aid Patients of Deyang City

    Institute of Scientific and Technical Information of China (English)

    鄢涛; 王森; 谭鸿; 姜伟; 刘辉; 李远建; 胡壮俐

    2011-01-01

    (45.23 ± 17.46) years. The scheduling time, running time,rescue time,returning time were(1.89 ±0. 82)min, (14. 22 ±5. 23)min, (14. 33 ±4. 34)min, (13. 12 ±4. 35) min,respectively. The period with highest frequency of emergency call occurred in winter and summer( 62. 99% ,10 245/16 265 ) of the year and in 8:00 -24:00(86. 74% ,14 108/16 265)of the day. The top five causes of emergency call were trauma(38. 80% , 6311/16 265) .cerebrovascular diseases(18. 73% ,3047/1265) .cardiovascular diseases(17. 54% ,2852/16 265), respiratory diseases(9.67% , 1573/16 265) and poisonings(6.00% ,975/16 265). The radius of emergency care within five kilometer was 52.36% (8517/16 265). ②The scheduling time,running time,returning time had no significant difference between the death group and the non-death group( P >0.05),but rescue time in the death group were longer than those in the non-death group(P < 0.05) ,and the top three causes of the death cases were cerebrovascular diseases(28. 34% ,333/1175) .cardiovascular diseases (24.94% ,293/1175) and trauma(22.38% ,263/1175) .whose age grades was by far above 60. Conclusion It was significant to promote the pre-hospital first aid for human health and emergency medicines building. These results of epidemiology analysis of pre-hospital first aid patients could provide relative data for building emergency treatment system and promoting emergency management.

  2. 52. Early revascularization on veno-arterial ECMO for patients with cardiogenic shock post stemi

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    K. Alkhamees

    2016-07-01

    Full Text Available Refractory Cardiogenic shock (CS complicates 5–7% of cases of ST-elevation myocardial infarction (STEMI, and is a leading cause of hospital death after myocardial infarction. CS complicating acute myocardial infarction continues to have a high mortality of 60–80% despite early revascularization and adjunctive therapies. We studied the effectiveness of veno-arterial (VA – Extracorporeal Membrane Oxygenator (ECMO for the patients with CS post STEMI during coronary angiography at our institute. Between January 2014 to April 2015, 8 male patients who suffered from progressive severe refractory CS post STEMI underwent emergent peripheral VA-ECMO implantation while performing cardiopulmonary resuscitation during coronary angiography. 7 patients of underwent PCI, while 1 patient was not amenable to PCI or CABG. The mean duration of support was 8.5 ± 5.8 days. 6 patients were successfully weaned from ECMO. While on ECMO support, 2 patients died. Mean EF after ECMO explantation was 32.5% ± 10.5%. The 30-day survival was 50%. Early revascularization on ECMO allows supporting hemodynamic efficiently in cardiogenic shock patients.

  3. STEMI Outcomes in Guangzhou and Hong Kong: Two-Centre Retrospective Interregional Study.

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    Xiaohui Chen

    Full Text Available Healthcare systems are organized very differently in Hong Kong (HK and Guangzhou (GZ. This study compared managements of the emergency departments (ED and one-year mortalities of ST-segment elevation myocardial infarction (STEMI patients in two teaching hospitals in Guangzhou and Hong Kong.Retrospective observational study of STEMI mortalities and treatments in the Prince of Wales Hospital (PWH and the Second Affiliated Hospital of Guangzhou Medical University (AHGZMU, was conducted between January and December 2010. The primary outcome was one-year all cause mortality.Univariate analysis of 76 cases from PWH and 111 cases from AHGZMU showed similar clinical characteristics, except for lower proportions of males (74% vs 92%, P = 0.002, hyperlipidemia (5% vs 25%, P67 years and hyperglycemia (>10 mmol/L. Aged over 65 years, presence of anterior wall infarct, body weight ≤65 kg, SBP 10 mmol/L were the independent predictors of in-hospital MACE.There was no statistically significant difference between the standardized one-year all-cause mortalities of STEMI patients in the setting mainly using thrombolysis with shorter door-to-treatment time and the setting mainly using PCI with longer door-to-treatment time. Aged over 67 years and glucose level over 10 mmol/L were the independent predictors of one-year mortality. Older age, presence of anterior wall infarct, lower body weight, lower SBP at ED and hyperglycemia were the independent predictors of in-hospital MACE.

  4. Pre-hospital airway management by non-physicians in Northern Finland -- a cross-sectional survey.

    Science.gov (United States)

    Raatiniemi, L; Länkimäki, S; Martikainen, M

    2013-05-01

    Airway management is an important skill in pre-hospital emergency medicine. The most optimal method depends on the resources and experience of the emergency medical service (EMS) providers. We wanted to study the frequency of occurrence, equipment used, problems experienced and maintenance of skills in pre-hospital airway management by non-physicians. A structured questionnaire consisting of 30 questions was distributed to 383 EMS providers in three hospital districts (population 597,521 and area 147,467 km(2) ) in Northern Finland. The questionnaire was answered by 226 EMS providers and 58.5% (224/383) were included in the final analyses. In all, 82.6% (185/224) of the EMS providers were allowed to perform endotracheal intubation (ETI) and 44.2% (99/224) could perform ETI using sedative agents. The annual mean frequency of using a supraglottic airway device (SAD) was 1.0 (range 0-20, n = 224), for ETI it was 2.0 (range 0-16, n = 185) and for bag-valve-mask ventilation it was 4.3 (range 0-30, n = 223). The mean frequency of drug-assisted ETI was 1.1 (range 0-13, n = 99). Unsuccessful ETI had been experienced by 65.7% (119/181) of the EMS providers. Airway management had been practised in an operating room by 25.9% (56/216) and with a manikin by 81.3% (182/224) of the EMS providers during the past 12 months. Advanced airway management procedures are uncommon for most EMS providers in Northern Finland. Procedures, training in and maintenance of airway management skills should be re-evaluated. © 2013 The Acta Anaesthesiologica Scandinavica Foundation.

  5. Pre-Hospital and Hospital Management Practices and Circumstances behind Venomous Snakebite in Northwestern Part of Bangladesh

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    Ratindra Mondal

    2012-12-01

    Full Text Available Background: Snakebite is the most important cause of envenomation in South Asia particularly in Bangladesh, though there is lack of data from the rural part of the country. About 82 species of snakes (28 venomous exist in Bangladesh. In this study, demographic characteristics of the victim, circumstances behind the bite along with pre-hospital and hospital managements and outcomes were evaluated. Methods: It was a cross-sectional study during January 2010 to June 2012 at Rangpur Medical College Hospital. Only venomous snakebite cases were included and diagnosis was made on clinical syndrome. Descriptive statistics were presented using percentage and proportion. Results: Out of 28 patients (mean age: 31.7 years, 20 (71.4% were males with a significant male-female ratio (2.5:1. Majority were farmers (46.4% and most (50% of the bites happened during household activities. Lag period between bite and hospitalization was ≤5 hours in 50% patients; 6 to 10 hours in 39.2% and >10 hours in 10.7% cases. 82.1% patients received ligature as pre-hospital first aid. Total 21 patients received anti-snake venom (ASV in different dose regimens. 15 (53.5% patients recovered while 13 (46.4% died. Among 13 patients who died, 53.8% died within 2 hours, 15.3% within 3-24 hours and 30.7% after 24 hours post-bite. Conclusion: Snakebite has a significant impact on human health and economy through treatment-related expenditures and loss of productivity. Policy makers of Bangladesh should prioritize the issue to reduce future mortality and morbidity. Keywords: Poisoning, Snakebite, Bangladesh, Envenomation, Management        

  6. Modelling optimal location for pre-hospital helicopter emergency medical services.

    Science.gov (United States)

    Schuurman, Nadine; Bell, Nathaniel J; L'Heureux, Randy; Hameed, Syed M

    2009-05-09

    Increasing the range and scope of early activation/auto launch helicopter emergency medical services (HEMS) may alleviate unnecessary injury mortality that disproportionately affects rural populations. To date, attempts to develop a quantitative framework for the optimal location of HEMS facilities have been absent. Our analysis used five years of critical care data from tertiary health care facilities, spatial data on origin of transport and accurate road travel time catchments for tertiary centres. A location optimization model was developed to identify where the expansion of HEMS would cover the greatest population among those currently underserved. The protocol was developed using geographic information systems (GIS) to measure populations, distances and accessibility to services. Our model determined Royal Inland Hospital (RIH) was the optimal site for an expanded HEMS - based on denominator population, distance to services and historical usage patterns. GIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions - especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services.

  7. Modelling optimal location for pre-hospital helicopter emergency medical services

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    L'Heureux Randy

    2009-05-01

    Full Text Available Abstract Background Increasing the range and scope of early activation/auto launch helicopter emergency medical services (HEMS may alleviate unnecessary injury mortality that disproportionately affects rural populations. To date, attempts to develop a quantitative framework for the optimal location of HEMS facilities have been absent. Methods Our analysis used five years of critical care data from tertiary health care facilities, spatial data on origin of transport and accurate road travel time catchments for tertiary centres. A location optimization model was developed to identify where the expansion of HEMS would cover the greatest population among those currently underserved. The protocol was developed using geographic information systems (GIS to measure populations, distances and accessibility to services. Results Our model determined Royal Inland Hospital (RIH was the optimal site for an expanded HEMS – based on denominator population, distance to services and historical usage patterns. Conclusion GIS based protocols for location of emergency medical resources can provide supportive evidence for allocation decisions – especially when resources are limited. In this study, we were able to demonstrate conclusively that a logical choice exists for location of additional HEMS. This protocol could be extended to location analysis for other emergency and health services.

  8. [Pre-hospital management of adults with life-threatening emergencies].

    Science.gov (United States)

    Wattel, Francis; Dubois, François

    2012-01-01

    In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas

  9. Status of pre-hospital emergency medical service in China and abroad%国内外院前急救的现状

    Institute of Scientific and Technical Information of China (English)

    何美娟; 许玲玲; 马明丹; 帅先洁; 刘勇

    2016-01-01

    文章综述了国内外院前急救的模式、人员、物品管理、公众急救知识等方面的现状,分析了国外院前急救优势,为发展我国院前急救事业提供借鉴与参考。%The paper reviewed the status of domestic and overseas pre - hospital emergency medical service(EMS),including the models,staffing,item management,and general knowledge of the public. Then the paper analyzed the advantage of overseas pre - hospital emergency medical service,so as to provide suggestions and references for developing domestic pre - hospital emergency medical services.

  10. Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions; a Review Article

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    Saeed Safari

    2015-02-01

    Full Text Available Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.

  11. Pre-hospital endotracheal intubation and positive pressure ventilation is associated with hypotension and decreased survival in hypovolemic trauma patients: an analysis of the National Trauma Data Bank.

    Science.gov (United States)

    Shafi, Shahid; Gentilello, Larry

    2005-11-01

    Studies of pre-hospital endotracheal intubation (ETI) from single EMS systems have shown contradictory results, which may represent local differences in paramedic training and experience. An alternative hypothesis is that positive pressure ventilation increases mortality because positive pressure ventilation causes hypotension in severely injured hypovolemic patients. A national sample (National Trauma Data Bank, 1994-2002) was used to minimize effects of local paramedic training and experience. All patients with pre-hospital GCS 16 (most likely to be hypovolemic) were included. Patients intubated in the field (pre-hospital group, n = 871) and in the emergency department (ED group, n = 6581) were compared. To determine whether pre-hospital ETI was an independent predictor of hypotension and mortality, logistic regression was used to control for potential confounders, including age, ISS, body region injured, AIS scores, pre-hospital IV fluids, and other variables. Physiologic variables were not used, as they may be influenced by ETI and positive pressure ventilation, and were therefore considered outcomes, rather than predictors. Groups were comparable in age, gender, anatomic distribution of injuries, likelihood of at least one severe injury (AIS >3) and other variables, except for head injury (ED 83%, pre-hospital 71%, p intubated in the field were more likely to be hypotensive upon arrival in the ED (SBP predictor of hypotension upon arrival in ED (OR 1.7, 95% CI 1.46 -2.09, p endotracheal intubation in trauma patients is associated with hypotension and decreased survival. This may be mediated by the effect of positive pressure ventilation during hypovolemic states.

  12. Use of the GlideScope®-Ranger for pre-hospital intubations by anaesthesia trained emergency physicians – an observational study

    OpenAIRE

    Russo, Sebastian G.; Nickel, Eike A.; Leissner, Kay B; Schwerdtfeger, Katrin; Bauer, Martin; Roessler, Markus S.

    2016-01-01

    Background: Pre-hospital endotracheal intubation is more difficult than in the operating room (OR). Therefore, enhanced airway management devices such as video laryngoscopes may be helpful to improve the success rate of pre-hospital intubation. We describe the use of the Glidescope®-Ranger (GS-R) as an alternative airway tool used at the discretion of the emergency physician (EP) in charge. Methods: During a 3.5 year period, the GS-R was available to be used either as the primary or backup to...

  13. Using EMS Dispatch to Trigger STEMI Alerts Decreases Door-to-Balloon Times

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    Stowens, Justin C.

    2015-05-01

    Full Text Available Introduction: We sought to determine the potential reduction in door-to-balloon time (DTB by allowing paramedics to perform prehospital ST-Elevation Myocardial Infarction (STEMI notification using brief communications via emergency medical services (EMS 9-1-1 dispatchers as soon as they saw a STEMI on 12-lead electrocardiogram (EKG. Our hypothesis was that earlier cardiac catheterization lab (CCL activation would improve overall DTB and avoid delays arising from on-scene issues or the time required to deliver a full report. Methods: The study setting was a single suburban community teaching hospital, which is a regional percutaneous coronary intervention (PCI center with more than 120,000 Emergency Department (ED visits/year and is serviced by a single tiered-response, advanced life support (ALS paramedic-level agency. STEMI notifications from July 2009 to July 2012 occurred by either standard direct EMS-to-physician notification or by immediate 9-1-1 dispatch notification. In the 9-1-1 dispatcher-aided notification method, paramedics were asked to provide a brief one-sentence report using their lapel microphones upon immediate realization of a diagnostic EKG (usually within 1-2 minutes of patient contact. This report to the 9-1-1 dispatcher included the patient’s sex, age, and cardiologist (if known. The dispatcher then called the emergency department attending and informed them that a STEMI was being transported and that CCL activation was needed. We used retrospective chart review of a consecutive sample of patients from an existing STEMI registry to determine whether there was a statistically significant difference in DTB between the groups. Results: Eight hundred fifty-six total STEMI alert patients arrived by EMS during the study. We excluded 730 notifications due to events such as cardiac arrest, arrhythmia, death, resolution of EKG changes and/or symptoms, cardiologist decision not to perform PCI, arrival as a transfer after prior

  14. Pre-hospital delay in acute myocardial infarction: judgement of symptoms and resistance to pain

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    Fernanda Carneiro Mussi

    2014-02-01

    Full Text Available Objective To estimate the time of decision (TD to look for medical care and the time of arrival (TA at the health service for men (M and women (W suffering from acute myocardial infarction and to analyze the influence of the interpretation of pain and pain resistance behaviors during these times. Methods This is an exploratory research, performed at the university hospital in Salvador/Bahia. 43 W and 54 M were interviewed. To study the dependence among sociodemographic and gender variables, the Fisher Exact Test was used. To analyze times, a geometric mean (GM was used. In order to verify the association between the GM of TD and TA and the judgment of pain, and between the GM of TD and TA and the behavior of resistance to pain, as well as to test the time of interaction between the gender variable and other variables of interest, the robust regression model was used. The statistical significance adopted was 5%. Results The GM of the TD for M was 1.13 h; for W, 0.74 h. The GM of the TA was 1.74 h for M and 1.47 h for W. Those who did not recognize the symptoms of AMI and presented behavior of resistance to pain had higher TD and TA, being the associations significant. Gender did not change the associations of interest. Conclusion The findings demonstrate the importance of health education aiming at the benefits of early treatment.

  15. 27. The impact of introduction of code-stemi program on clinical outcomes of acute st-elevation myocardial infarction (stemi patients undergoing primary pci: Single center study in Saudi Arabia

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    A. ALYAHYA

    2016-07-01

    Full Text Available This study was conducted to evaluate the effect of direct Emergency Department activation of the Catheterization Lab on door to balloon (D2B time and outcomes of acute ST-elevation myocardial infarction (STEMI patients in King Khalid University Hospital (KKUH. Establishing dedicated comprehensive STEMI programs aiming at reducing door to balloon time will impact favourably the outcomes of patients presenting with acute STEMI. This was a retrospective cohort study that involved 100 patients in KKUH who presented with acute STEMI and underwent primary percutaneous intervention (PPCI, between June 2010 and January 2015. The cohort was divided into two groups, the first group consisted of 50 patients who were treated before establishing the Code-STEMI protocol, whereas the second group were 50 patients who were treated according to the protocol, which was implemented in June 2013. Code-STEMI program is a comprehensive program that includes direct activation of the cath lab team using a single call system, data monitoring and feedback, and standardized order forms. The mean age in both groups was 54 ± 12 years and 86% (43 and 94% (47 of the patients in the two groups were males, respectively. 90% (90 of patients in both groups had one or more comorbidities.Code-STEMI group had a significantly lower D2BT with 70% of patients treated within the recommended 90 minutes (median = 76.5 min, IQR: 63–90 min compared to only 26% of pre code-STEMI patients (median = 107 min, IQR: 74–149 min In-hospital complications were lower in the Code-STEMI group; however, the only statistically significant reduction was in non-fatal re-infarction, (8% vs. 0%, p = 0.043. In addition, the number of patients with more than one in-hospital complications was also reduced by 20%.Implementation of direct ER-Catheterization lab activation protocol was associated with a significant reduction in D2B time, and an overall improvement of in-hospital outcomes.

  16. Effect of Pre-Hospital Ticagrelor During the First 24 h After Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Montalescot, Gilles; van 't Hof, Arnoud W; Bolognese, Leonardo

    2016-01-01

    OBJECTIVES: The aim of this landmark exploratory analysis, ATLANTIC-H(24), was to evaluate the effects of pre-hospital ticagrelor during the first 24 h after primary percutaneous coronary intervention (PCI) in the ATLANTIC (Administration of Ticagrelor in the cath Lab or in the Ambulance for New ...

  17. Tuberculosis patients' pre-hospital delay and non-compliance with a longstanding DOT programme : a mixed methods study in urban Zambia

    NARCIS (Netherlands)

    Cremers, Anne Lia; Gerrets, René; Kapata, Nathan; Kabika, Austin; Birnie, Emma; Klipstein-Grobusch, Kerstin; Grobusch, Martin P

    2016-01-01

    BACKGROUND: Tuberculosis (TB) remains a major health problem in Zambia, despite considerable efforts to control and prevent it. With this study, we aim to understand how perceptions and cultural, social, economic, and organisational factors influence TB patients' pre-hospital delay and

  18. Tuberculosis patients' pre-hospital delay and non-compliance with a longstanding DOT programme: a mixed methods study in urban Zambia

    NARCIS (Netherlands)

    Cremers, A.L.; Gerrets, R.; Kapata, N.; Kabika, A.; Birnie, E.; Klipstein-Grobusch, K.; Grobusch, M.P.

    2016-01-01

    Background Tuberculosis (TB) remains a major health problem in Zambia, despite considerable efforts to control and prevent it. With this study, we aim to understand how perceptions and cultural, social, economic, and organisational factors influence TB patients’ pre-hospital delay and non-compliance

  19. Pre-hospital thrombolytic therapy with either alteplase or streptokinase. : Practical applications, complications and long-term results in 529 patients.

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); M.J.M. Bouten; J.W. Deckers (Jaap); A.W. Hoes (Arno); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten); T. Lenderink (Timo)

    1995-01-01

    markdownabstractOBJECTIVE: To assess the practical application, safety and long-term outcome of pre-hospital thrombolytic intervention with either alteplase or streptokinase in patients with extensive myocardial infarction. DESIGN: Prospective study. SUBJECTS: Patients with chest pain of more

  20. The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients

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    Ilker Gul

    2016-01-01

    Full Text Available Abstract Background: GRACE risk score (GS is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI. Objective: The present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT is more closely associated with high-risk non-STEMI patients according to the GS. Methods: We evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years. End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140, while other patients were categorized as the low-to-moderate risk group (LM-GS. Results: Systolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438. Conclusion: End-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS.

  1. The evaluation of time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah.

    Science.gov (United States)

    Mohammadi, Mohsen; Nasiripour, Amir Ashkan; Fakhri, Mahmood; Bakhtiari, Ahad; Azari, Samad; Akbarzadeh, Arash; Goli, Ali; Mahboubi, Mohammad

    2014-09-28

    This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients' cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents.

  2. Reasons that lead mothers looking for a pre-hospital unit as a first option for attendance - Sorocaba/SP

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    Thais Helena Campos

    2015-06-01

    Full Text Available Objective: to verify the reasons lead mothers to seek the Pre- hospital Unit of Sorocaba Western Zone (UPH-ZO as first option of attendance and quantify the inappropriate motives for this search. Method: it is an exploratory study with quantitative analyze performed at UPH-ZO through the emergence bulletin (BE and the mothers or guardians interview. Results: nine hundred mothers and guardians were interviewed. Four reasons prevailed as motivation for search the UPH-ZO by first option: better and quick resolution with technological resources provided; restrict period for attendance at the Basic Health Unit (UBS; delay for appointment in the UBS; lack of Pediatrician in this Unit. The prevalent diagnostic hypothesis in the sample was acute gastroenterocolitis and superior aerial way infections. Conclusions: for the 68.8% of the sample the looking for UPH-ZO was adequate; 31.2% referred reasons that could be solved at the UBS. This Unit must just be the entrance for the users of the Health Unique System (SUS.

  3. Dynamic changes in sRAGE levels and relationship with cardiac function in STEMI patients

    DEFF Research Database (Denmark)

    Jensen, Louise J N; Lindberg, Søren; Hoffmann, Søren;

    2015-01-01

    the dynamic changes in sRAGE levels during AMI and relationship with cardiac dysfunction. DESIGN AND METHODS: We prospectively included 80 patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). sRAGE concentrations were measured before p......OBJECTIVES: Soluble receptor of advanced glycation end-products (sRAGE) may be a predictive biomarker in coronary artery disease (CAD). Patients with acute myocardial infarction (AMI) have higher sRAGE levels compared to healthy subjects. Accordingly, the aim of this study was to investigate...

  4. Risk Factors of Reperfusion Failure following Primary Angioplasty for ST-Segment Elevation Myocardial Infarction (STEMI

    Directory of Open Access Journals (Sweden)

    HamidReza Sanati

    2015-10-01

    Full Text Available Background: Although  percutaneous  coronary  intervention  (PCI  improves  outcomes  compared  to  thrombolysis,  a substantial number of ST-elevation myocardial infarction (STEMI patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI.Methods: Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31- 85 years with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. Results: Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05. According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044 and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050 had reverse and male gender had direct significant associations with failed reperfusion (OR [95%CI]:0.34 [0.11 to 1.08]; p value = 0.068. More degrees of ST resolution occurred when the right coronary artery was the culpritvessel (p value = 0.001. The presence of more than three cardiac risk factors was associated with failed reperfusion (p value= 0.050.Conclusion: Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a

  5. Reduced Oxidative Stress in STEMI Patients Treated by Primary Percutaneous Coronary Intervention and with Antioxidant Therapy

    DEFF Research Database (Denmark)

    Ekeløf, Sarah; Jensen, Svend Eggert; Rosenberg, Jacob

    2014-01-01

    myocardial damage-a phenomenon known as ischemia-reperfusion injury (IRI). Oxidative stress is one of the major factors contributing to IRI. This systematic review focuses on the effect of antioxidant therapy on reperfusion triggered oxidative stress and myocardial IRI in patients with STEMI. METHODS: We....... Moreover, the included studies revealed a complex link between oxidative stress and cardiac function and/or cardiac adverse events and in order to further elucidate the detrimental role of oxidative stress in IRI in relation to primary PCI the assessment of oxidative stress and the clinical outcome...

  6. Atendimento pré-hospitalar ao idoso vítima de violência em cinco capitais brasileiras Pre-hospital attendance to elders victims of violence in five Brazilian capitals

    Directory of Open Access Journals (Sweden)

    Suely Ferreira Deslandes

    2010-09-01

    Full Text Available Este artigo analisa as características e a operacionalização no cotidiano da atenção pré-hospitalar aos idosos vítimas de violências e acidentes de cinco capitais (Manaus, Recife, Brasília, Rio de Janeiro e Curitiba, abordando ainda suas capacidades, seus obstáculos e potencialidades. Pautou-se na triangulação de métodos quantitativos e qualitativos. Analisaram-se dados de oitenta serviços da atenção pré-hospitalar móvel e fixa: 32 em Manaus; 18 em Recife; dez em Brasília; 12 no Rio de Janeiro e oito em Curitiba. Entre os achados estão as diferenças (de tamanho e diversidade de categorias profissionais e dificuldades das equipes para identificar, atender e notificar os casos por falta de capacitação; pouca atuação preventiva; quase nenhum envolvimento com a família e orientação a ela; praticamente nenhum atendimento ao autor da agressão; incipiente articulação e parcerias da rede, sobretudo dos serviços pré-hospitalares com os hospitalares.This article reviews the characteristics and operation in the daily routine of a pre-hospital care to the elderly victims of violence and accidents in five capitals (Manaus, Recife, Brasília, Rio de Janeiro and Curitiba. Besides that, it analyses their abilities, and potential obstacles. It was based on the triangulation of quantitative and qualitative methods analyzing data from 80 departments of mobile and fixed pre-hospitals: 32 in Manaus, 18 in Recife, 10 in Brasilia, 12 in Rio de Janeiro and eight in Curitiba. Among the findings are the differences in size and diversity of occupational categories and difficulties of the teams to identify, serve and report cases for lack of training, limited preventive action, almost no involvement and guidance to the family, practically no attention to the perpetrator; incipient articulation and partnership network, especially regarding on pre-hospital services and the hospital.

  7. Single Derivation Fragmented QRS Can Predict Poor Prognosis in Successfully Revascularized Acute STEMI Patients.

    Science.gov (United States)

    Tanriverdi, Zulkif; Dursun, Huseyin; Colluoglu, Tugce; Kaya, Dayimi

    2017-07-20

    QRS fragmentation (fQRS) is classically defined as the presence of slurred QRS morphology in at least two contiguous leads, and its prognostic importance has been shown in ST elevation myocardial infarction (STEMI). However, no study has investigated the significance of single lead fQRS (sl-fQRS) in surface electrocardiography (ECG). To evaluate whether sl-fQRS is as valuable as classical fQRS in patients with acute STEMI who had successful revascularization with primary percutaneous coronary intervention (pPCI). We included 330 patients with a first STEMI who had been successfully revascularized with pPCI. The patient's electrocardiography was obtained in the first 48 hours, and the patients were divided into three groups according to the absence of fQRS (no-fQRS); fQRS presence in a single lead (sl-fQRS); and ≥2 leads with fQRS (classical fQRS). In-hospital mortality was significantly higher both in patients with sl-fQRS and in patients with ≥ 2 leads with fQRS compared to patients with no-fQRS. In ROC curve analysis, ≥ 1 leads with fQRS yielded a sensitivity of 75% and specificity of 57.4% for the prediction of in-hospital mortality. Multivariate analysis showed that sl-fQRS is an independent predictor of in-hospital mortality (OR: 3.989, 95% CI: 1.237-12.869, p = 0.021). Although the concept of at least two derivations is mentioned for the classical definition of fQRS, our study showed that fQRS in only one lead is also associated with poor outcomes. Therefore, ≥1 leads with fQRS can be useful when describing the patients under high cardiac risk in acute STEMI. A fragmentação do QRS (fQRS) é classicamente definida como a presença de morfologia empastada do QRS em pelo menos duas derivações contíguas e sua importância prognóstica tem sido demonstrada no infarto do miocárdio com elevação do ST (STEMI). No entanto, nenhum estudo investigou a significância do fQRS de derivação única (sl-fQRS) no eletrocardiograma (ECG). Avaliar se o sl

  8. Revisiting the value of pre-hospital tracheal intubation: an all time systematic literature review extracting the Utstein airway core variables.

    Science.gov (United States)

    Lossius, Hans Morten; Sollid, Stephen J M; Rehn, Marius; Lockey, David J

    2011-01-01

    Although tracheal intubation (TI) in the pre-hospital setting is regularly carried out by emergency medical service (EMS) providers throughout the world, its value is widely debated. Heterogeneity in procedures, providers, patients, systems and stated outcomes, and inconsistency in data reporting make scientific reports difficult to interpret and compare, and the majority are of limited quality. To hunt down what is really known about the value of pre-hospital TI, we determined the rate of reported Utstein airway variables (28 core variables and 12 fixed-system variables) found in current scientific publications on pre-hospital TI. We performed an all time systematic search according to the PRISMA guidelines of Medline and EMBASE to identify original research pertaining to pre-hospital TI in adult patients. From 1,076 identified records, 73 original papers were selected. Information was extracted according to an Utstein template for data reporting from in-the-field advanced airway management. Fifty-nine studies were from North American EMS systems. Of these, 46 (78%) described services in which non-physicians conducted TI. In 12 of the 13 non-North American EMS systems, physicians performed the pre-hospital TI. Overall, two were randomised controlled trials (RCTs), and 65 were observational studies. None of the studies presented the complete set of recommended Utstein airway variables. The median number of core variables reported was 10 (max 21, min 2, IQR 8-12), and the median number of fixed system variables was 5 (max 11, min 0, IQR 4-8). Among the most frequently reported variables were "patient category" and "service mission type", reported in 86% and 71% of the studies, respectively. Among the least-reported variables were "co-morbidity" and "type of available ventilator", both reported in 2% and 1% of the studies, respectively. Core data required for proper interpretation of results were frequently not recorded and reported in studies investigating TI in

  9. 开展院前心肺复苏培训的必要性及措施%Carry Out Pre-hospital Cardiopulmonary Resuscitation Training Necessity and Measures

    Institute of Scientific and Technical Information of China (English)

    宗毅; 刘风; 洪波; 张翠荣; 张姣

    2013-01-01

    difference was statistically signiifcant. Emergency personnel involved in the investigation inquiries, of which 95%of the emergency personnel that scientiifc and comprehensive training in pre-hospital care skills for self-improvement and team collaboration capabilities play an important role. Conclusion The emergency personnel comprehensive, systematic pre-hospital training can improve individual skills and team better while other emergency personnel collaborate on emergency tasks, improve the efifciency of aid, thereby reducing mortality in order to receive further of treatment.

  10. 43. Predictors of delayed presentation among patients with STEMI (ST elevation myocardial infarction in King Abdul-Aziz Cardiac Center, Riyadh, KSA

    Directory of Open Access Journals (Sweden)

    Mohammed Abbas T. Albrahim

    2015-10-01

    Conclusion: Almost 30% of our patients with STEMI presented more than six hours after symptom onset, these patients have high prevalence of coronary risk factors. Programs should be designed to educate these patients at risk about the symptoms of STEMI and the necessary action to be taken if a heart attack is suspected.

  11. How the changes in the system affect trauma care provision: The assessment of and implications for Lithuanian trauma service performance in 2007–2012

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    Žilvinas Dambrauskas

    2017-01-01

    Conclusions: Changes in operational procedures in the Lithuanian pre-hospital care provision and management of trauma patients in emergency departments of trauma centers improved the efficiency of trauma care delivery over the 2007–2012 period.

  12. Protocol for a systematic review of the clinical effectiveness of pre-hospital blood components compared to other resuscitative fluids in patients with major traumatic haemorrhage.

    Science.gov (United States)

    Dretzke, Janine; Smith, Iain M; James, Robert H; Midwinter, Mark J

    2014-10-24

    There is growing interest in the use of blood components for pre-hospital resuscitation of patients with major traumatic haemorrhage. It has been speculated that early resuscitation with blood components may have benefits in terms of treating trauma-induced coagulopathy, which in turn may influence survival. The proposed systematic review will evaluate the evidence on the clinical effectiveness of pre-hospital blood components (red blood cells and/or plasma or whole blood), in both civilian and military settings, compared with other resuscitation strategies in patients with major traumatic haemorrhage. Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. General medical and specialist databases will be searched; the search strategy will combine terms for the population, intervention and setting. Studies will be selected for review if the population includes adult patients with major traumatic haemorrhage who receive blood components in a pre-hospital setting (civilian or military). Systematic reviews, randomised and non-randomised controlled trials and controlled observational studies will be included. Uncontrolled studies will be considered depending on the volume of controlled evidence. Quality assessment will be tailored to different study designs. Both patient related and surrogate outcomes will be considered. Synthesis is likely to be primarily narrative, but meta-analyses and subgroup analyses will be undertaken where clinical and methodological homogeneity exists. Given the increasing use by emergency services of blood components for pre-hospital resuscitation, this is a timely systematic review, which will attempt to clarify the evidence base for this practice. As far as the authors are aware, the proposed systematic review will be the first to address this topic. PROSPERO CRD42014013794.

  13. Pre-hospital midazolam for benzodiazepine-treated seizures before and after the Rapid Anticonvulsant Medication Prior to Arrival Trial: A national observational cohort study.

    Science.gov (United States)

    Shtull-Leber, Eytan; Silbergleit, Robert; Meurer, William J

    2017-01-01

    Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014. We compared the rates and odds of midazolam use as first-line treatment among all adult and pediatric benzodiazepine-treated seizures before and after RAMPART publication (February 2012). Secondary analyses were conducted for rates of airway interventions and rescue therapy, as proxies for safety and efficacy of seizure termination. 156,539 benzodiazepine-treated seizures were identified. Midazolam use increased from 26.1% in January 2010 to 61.7% in December 2014 (difference +35.6%, 95% CI, 32.7%-38.4%). The annual rate of midazolam adoption increased significantly from 5.9% per year to 8.9% per year after the publication of RAMPART (difference +3.0% per year; 95%CI, 1.6%-4.5% per year; adjusted OR 1.24; 95%CI, 1.17-1.32). Overall frequency of rescue therapy and airway interventions changed little after the publication of RAMPART. These data are consistent with effective, ongoing, but incomplete clinical translation of the RAMPART results. The effects of the trial, however, cannot be isolated. The study was limited by broad inclusion of all benzodiazepine-treated seizures as well as a lack of information on route of drug of administration. The safety and effectiveness of midazolam for benzodiazepine-treated seizures in prehospital clinical practice appear consistent with trial data, which should encourage

  14. Pre-hospital midazolam for benzodiazepine-treated seizures before and after the Rapid Anticonvulsant Medication Prior to Arrival Trial: A national observational cohort study

    Science.gov (United States)

    Silbergleit, Robert

    2017-01-01

    Background Implementation of evidence-based treatment for pre-hospital status epilepticus can improve outcomes. We hypothesized that publication of a pivotal pre-hospital clinical trial (RAMPART), demonstrating superiority of intramuscular midazolam over intravenous lorazepam, altered the national utilization rates of midazolam for pre-hospital benzodiazepine-treated seizures, while upholding its safety and efficacy outside the trial setting. Methods and findings This is a retrospective, observational cohort study of pre-hospital patient encounters throughout the United States in the National Emergency Medicine Services Information System database, from January 2010 through December 2014. We compared the rates and odds of midazolam use as first-line treatment among all adult and pediatric benzodiazepine-treated seizures before and after RAMPART publication (February 2012). Secondary analyses were conducted for rates of airway interventions and rescue therapy, as proxies for safety and efficacy of seizure termination. 156,539 benzodiazepine-treated seizures were identified. Midazolam use increased from 26.1% in January 2010 to 61.7% in December 2014 (difference +35.6%, 95% CI, 32.7%-38.4%). The annual rate of midazolam adoption increased significantly from 5.9% per year to 8.9% per year after the publication of RAMPART (difference +3.0% per year; 95%CI, 1.6%-4.5% per year; adjusted OR 1.24; 95%CI, 1.17–1.32). Overall frequency of rescue therapy and airway interventions changed little after the publication of RAMPART. Conclusions These data are consistent with effective, ongoing, but incomplete clinical translation of the RAMPART results. The effects of the trial, however, cannot be isolated. The study was limited by broad inclusion of all benzodiazepine-treated seizures as well as a lack of information on route of drug of administration. The safety and effectiveness of midazolam for benzodiazepine-treated seizures in prehospital clinical practice appear consistent

  15. Anticoagulation after subcutaneous enoxaparin is time sensitive in STEMI patients treated with tenecteplase.

    Science.gov (United States)

    Welsh, Robert C; Westerhout, Cynthia M; Buller, Christopher E; O'Neill, Blair; Gordon, Phillip; Armstrong, Paul W

    2012-07-01

    The adequacy of anticoagulation with enoxaparin as an adjuvant to fibrinolytic therapy for STEMI is unclear and has implications for both efficacy and safety; especially in patients undergoing a pharmacoinvasive reperfusion strategy. A subset of fibrinolytic-treated patients in the WEST study was enrolled in a systematic anti-Xa substudy. All received ASA and subcutaneous (SQ) enoxaparin 1 mg/kg followed by TNK-tPA. Incremental IV dosing of enoxaparin (0.3-0.5 mg/kg) was allowed prior to percutaneous coronary intervention (PCI). Anti-Xa blood samples were drawn prior and after angiography. Data are presented as percentages, medians and IQRs. Forty-five patients underwent angiography 2.8 h (2.5-14.6) after fibrinolytic. The pre-angiography median anti-Xa acquired 179 min (153-875) after SQ enoxaparin was 0.48 U/ml (0.42-0.65); a relationship between anti-Xa activity and time from administration was evident (r = 0.418, p < 0.007). Without supplemental IV enoxaparin the 2nd anti-Xa acquired 218 min (195-930) after SQ enoxaparin was 0.48 U/ml (0.41-0.80, n = 29). After supplemental IV enoxaparin, the 2nd anti-Xa was 0.92 U/ml (0.72-1.10, n = 16). An incremental IV enoxaparin dose and anti-Xa relationship was demonstrated (r = 0.59, p = 0.001) i.e. no IV 0.48 U/ml (0.41-0.80, n = 29), 0.3 mg/kg IV 0.81 U/ml (0.63-1.00, n = 12), and 0.5 mg/kg IV 1.34 U/ml (1.16-1.54, n = 4). Most fibrinolytic treated STEMI patients receiving weight-adjusted SQ enoxaparin (1 mg/kg) had subtherapeutic anti-Xa levels (<0.5 U/ml) after ~3 h. A strategy of supplemental 0.3 mg/kg IV enoxaparin at time of PCI reliably achieved anti-Xa ≥ 0.5 U/ml. Our findings provide a rational novel strategy for anti-thrombotic management in STEMI patients undergoing a pharmacoinvasive reperfusion strategy.

  16. PRIMARY PERCUTANEOUS CORONARY INTERVENTION AND CHANGING TRENDS IN ACUTE STEMI MORTALITY

    Directory of Open Access Journals (Sweden)

    Dilu VP

    2010-11-01

    Full Text Available Background: Thrombolysis and Primary Percutaneous Coronary Intervention (PPCI are the standard treatment options for coronary reperfusion in acute ST elevation myocardial infarction (STEMI. We conducted the study to assess the influence of PPCI on the short and intermediate term mortality in acute STEMI, and to identify the high risk subsets that may benefit from PPCI in our population. Methods: Consecutive acute ST elevation myocardial infarction patients admitted to Department of Cardiology, Medical College, Kottayam from November 2008 to March 2010 were allocated to thrombolysis or PPCI as per the standard indications and affordability. Primary endpoint analyzed was in-hospital mortality at 5 days. Secondary endpoints were mortality, angina, re-infarction and Left ventricular dysfunction at 1 month. Statistical analysis was done using chi-square analysis and student ttest. Results:962 consecutive cases of acute STEMI eligible for either PPCI or thrombolysis were included in the study. 135 patients (14% underwent PPCI and 827 (86% were subjected to thrombolysis. 6.7% of the females patients underwent PPCI compared to 15.9% of the males (p=0.001. Mortality in PPCI group was 5.2% compared to 11.2% in thrombolysed group (p=0.032. Inferior wall with Right Ventricular MI had higher mortality than Anterior Wall MI (AWMI (p=0.012. In the thrombolysed group those who presented within 6 hours of onset of pain had lower mortality (8% compared to those who presented >6 hours (14.42% (p=0.003. There was no difference in mortality in PPCI group in the above subsets (p=0.583. Mortality at 1 month was 1.4% in thrombolysed group while there was no mortality in PPCI group (p=0.163. Left ventricular dysfunction was present in 26.8% patients in thrombolysed group compared to 8.8% in PPCI group (p=<0.001. Conclusion: Mortality in acute ST elevation myocardial infarction is higher in thrombolysed group than PPCI group. PPCI significantly reduces mortality in all

  17. Some Thoughts of Pre-hospital Emergency Electronic Medical Record%构建院前急救电子病历的几点思考

    Institute of Scientific and Technical Information of China (English)

    陈志刚; 邹圣强; 赵伟

    2011-01-01

    构建院前急救电子病历应充分考虑院前急救"急、短、快"的工作特点,在其中纳入调度语音信息、急救视频信息、文字与图像信息等数字化信息,并采取有效的实现方式才能满足院前急救电子病历"客观、真实、准确、及时、完整、突出重点"的要求,达到提高急救质量,优化急救资源配置的最终目的.%Construction of pre-hospital emergency electronic medical record should take full account of pre-hospital emergency work characteristics that is urgent, short and fast, incorporating scheduling a voice message, first aid video information., text and image information, and other digital information. It should take effective way to meet the requirements of pre- hospital emergency electronic medical record which are objective, true, accurate,timely, complete, focused, for achieving aid quality improvement and aid resources optimization.

  18. Determinants of C-peptide levels and acute insulin resistance/sensitivity in nondiabetic STEMI role of Killip class

    Directory of Open Access Journals (Sweden)

    Chiara Lazzeri

    2014-03-01

    According to our data, the development of acute insulin resistance in the early phase of STEMI can be viewed as an adaptive mechanism to stress (represented by acute myocardial ischemia, similar to other acute critical conditions, related to the severity of stress (that is to the hemodynamic impairment.

  19. Prehospital electrocardiographic acuteness score of ischemia is inversely associated with neurohormonal activation in STEMI patients with severe ischemia

    DEFF Research Database (Denmark)

    Fakhri, Yama; Schoos, Mikkel Malby; Sejersten-Ripa, Maria;

    2017-01-01

    BACKGROUND: Elevated levels of N-terminal pro brain natriuretic peptide (NT-proBNP) are associated with adverse cardiovascular outcome after ST elevation myocardial infarction (STEMI). We hypothesized that decreasing acuteness-score (based on the electrocardiographic score by Anderson-Wilkins acu...

  20. Regionalization of ST-segment elevation acute coronary syndromes care: putting a national policy in proper perspective.

    Science.gov (United States)

    Rathore, Saif S; Epstein, Andrew J; Nallamothu, Brahmajee K; Krumholz, Harlan M

    2006-04-04

    A uniform policy for regionalization of ST-segment elevation myocardial infarction (STEMI) care raises several concerns. Transferring all STEMI patients to obtain primary percutaneous coronary intervention (PCI) may be less effective than transferring only high-risk STEMI patients. Delays in time to treatment >60 min associated with transferring patients for primary PCI may result in increased mortality for the average patient as compared with providing immediate fibrinolytic therapy at their initial hospital; yet more than 95% of patients transferred for primary PCI in the U.S. exceed this 60-min benchmark. Superior outcomes associated with treatment at higher-volume regional STEMI centers are inconsistent among centers, and there is no direct evidence that patients will benefit by a transfer to a high-volume hospital from a low-volume hospital. Published data suggest as many as 800 PCI patients would need to be transferred to a high-volume PCI hospital to avoid a single death at a low-volume PCI hospital. Although European randomized trial data suggest transferring patients with STEMI for primary PCI may be superior to immediate fibrinolytic therapy, these findings are unlikely to generalize to the U.S. health care system given size, geography, and organization. ST segment elevation myocardial infarction care regionalization would require a massive redistribution of health care resources, depriving several hospitals of advanced cardiac care facilities, expertise, and associated revenue. Clearer evidence of the benefits and discussion of potential harms are needed before adopting a national STEMI regionalization policy.

  1. A tailored antiplatelet strategy in STEMI patients based on CYP2C19 genotyping is feasible in daily practice-POPular Genetics study

    NARCIS (Netherlands)

    Bergmeijer, T.O.; Janssen, P.W.A.; Asselbergs, F.W.; Schipper, J.C.; Van 'T Hof, A.W.; Dewilde, W.J.M.; Postma, M.J.; De Boer, A.; Deneer, V.H.M.; Ten Berg, J.M.

    2014-01-01

    Rationale: Treatment with dual antiplatelet therapy (aspirin plus clopidogrel, pra- sugrel or ticagrelor) is essential to prevent atherothrombotic events in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Although ticagre

  2. Effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI

    Institute of Scientific and Technical Information of China (English)

    Xiao-Gang Zhu; Li-Yue Wang; Hao-Jin Ren; Jin-Hua Liu

    2016-01-01

    Objective:To analyze the effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI.Methods:A total of 78 patients with acute ST segment elevation myocardial infarction (STEMI) who received PCI therapy in our hospital were randomly divided into control group and observation group, control group accepted routine PCI treatment, observation group received intracoronary injection of tirofiban and anisodamine in PCI, and myocardial perfusion of two groups was compared.Results: QRS duration values of observation group the instant after PCI and 4h after PCI were less than those of control group (P<0.05);99mTc-MIBI and18F-FDG intake of observation group after PCI were more than those of control group (P<0.05); serum MCP-1, sFas, Copeptin, OPN and vWF levels of observation group 4 h after PCI were lower than those of control group (P<0.05).Conclusions:Intracoronary injection of tirofiban combined with anisodamine can optimize myocardial perfusion in patients with STEMI after PCI, and has positive clinical significance.

  3. Association of monocyte to HDL cholesterol level with contrast induced nephropathy in STEMI patients treated with primary PCI.

    Science.gov (United States)

    Sağ, Saim; Yıldız, Abdülmecit; Aydin Kaderli, Aysel; Gül, Bülent Cuma; Bedir, Ömer; Ceğilli, Ercan; Özdemir, Bülent; Can, Fatma Ezgi; Aydınlar, Ali

    2017-01-01

    Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN-) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration. A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (+) patients, monocytes were higher [1.02 (0.83-1.39) vs. 0.69 (0.53-0.90) 109/L, pMHR was significantly higher in the CIN (+) group [1.16 (0.89-2.16) vs. 0.72 (0.53-0.95) 109/mmol, pMHR, Mehran score, AGEF score and CV/eGFR were independently correlated with CIN. Higher MHR levels may predict CIN development after primary PCI in STEMI patients.

  4. Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients

    Directory of Open Access Journals (Sweden)

    Coyne, Christopher J.

    2014-12-01

    Full Text Available Introduction: The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG times for patients with ST-segment elevation myocardial infarction (STEMI. Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times. Methods: We conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based “cardiac triage” designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time. Results: We enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01, ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01, and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03. Conclusion: By creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time. [West J Emerg Med. 2015;16(1:184–189.

  5. 提高院前急救满意度的若干建议%Some suggestions to improve the satisfaction of pre hospital first aid

    Institute of Scientific and Technical Information of China (English)

    杜敏

    2013-01-01

    Objective To analyze the satisfaction of pre hospital first aid and to put forward some suggestions to improve the satisfaction . Methods Analyze based on the random sampling survey by using the 4884 patients’ data from information management database. Results In the questionnaire, the item of “vehicle stability” got the highest score of 7.98, whereas the item of “Charge rationality” got the lowest score of 6.81. The satisfaction scores were 7.76、7.51、7.52 and 7.50 from 2008 to 2011. Final average satisfaction score was 7.57. Conclusion Emergency Center should improve the satisfaction of pre hospital first aid from improving service fee transparency, shortening pre hospital average reaction time, regularly carrying out first aid training, and strengthening internal management etc.%目的:分析院前急救满意度情况并提出提高满意度的若干建议。方法通过随机抽样的调查方式,从120信息管理系统抽取4884份患者(家属)数据进行“满意度”调查,分析院前急救满意度情况。结果满意度调查结果为:车辆平稳性的满意度最高为7.98分,收费合理性的满意度最低为6.81分。2008年至2011年总体满意度分别为7.76分、7.51分、7.52分和7.50分,最终平均满意度为7.57分。结论建议从提高服务收费的透明度、缩短院前急救平均反应时间、定期开展急救能力培训、加强内部绩效管理等几方面来提高院前急救满意度。

  6. Pre-hospital and In-hospital Delays After Onset of Acute Ischemic Stroke—A Hospital-based Study in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Chun-Hung Chen

    2007-11-01

    Full Text Available The biggest hurdle for early hospital presentation is the narrow therapeutic window after stroke. The aims of our study were to investigate the time lags and the factors causing pre-hospital and emergency department (ED delay during acute ischemic stroke attack. Between June 2004 and October 2005, we prospectively studied 129 acute ischemic stroke patients who presented to the ED of the study hospital within 4 hours after symptom onset. Chi-square testing for trend, uni-variate and multiple logistic regression analyses was performed to evaluate the factors influencing delays in the ED presentation of acute ischemic stroke patients. The median time from symptom onset to ED arrival was 71 (mean ± SD, 82.7 ± 57.7 minutes. The median times from ED arrival to neurologic consultation, computed tomography scan, electrocardiogram, and laboratory data completion were 10 (11.3±9.9 minutes, 17 (9.6±11.3 minutes, 14 (23.3±55 minutes, and 39 (44.4±24.5 minutes, respectively. Univariate and multiple logistic regression models revealed that age < 65 years, illiteracy and awakening with symptoms were the most significant factors related to a delay in ED presentation. This study indicates that 2 hours of pre-hospital delay is the cutoff point for thrombolytic therapy. Organization of a stroke team and standardized stroke pathways may help to shorten in-hospital time consumption. Educational efforts should not only focus on the public, but also on the training of ED physicians and other medical personnel.

  7. 113例心脏骤停患者的院前急救分析%Analysis of the Impact of Pre-hospital Cardiopulmonary Resuscitation Success Factors

    Institute of Scientific and Technical Information of China (English)

    赵伟

    2016-01-01

    Objective:Analysis of the impact of pre-hospital cardiopulmonary resuscitation success factors.Methods:Clinical information of pre-hospital CPR from January 2008 to January 2013 was analyzed retrospectively, to explore the influencing factors related to the successful rate of CPR.Results:The success rate was 18.58%(21/113).The success rate of CPR was correlated with the age, history, time of initial CPR, Intubation, early defibrillation and adrenaline dose.Conclusion:Cardiovascular and Cerebrovascular disease are the main causes of car-diopulmonary arrest.Age is an important factor in re-suscitation.Complication of It cerebral vascular diseases and respiratory diseases are high risk factors of cardiopulmonary arrest.Early initiation of CPR and early defibrillation are key factors for successful CPR.%目的:分析院前影响心搏呼吸骤停患者心肺复苏( CPR)成功的因素。方法:回顾性分析2008年1月~2013年1月在院前发生的113例心脏骤停患者,探讨各因素对CPR成功的影响。结果:113例患者抢救成功21例(成功率18.58%),CPR的成功与年龄、既往器质性疾病、CPR开始时间、气管插管、早期除颤、肾上腺素用量有明显关系。结论:心、脑血管疾病是心脏骤停的主要原因,年龄是复苏成功的重要因素,CPR开始时间和早期除颤是复苏成功的关键。

  8. Discussion of Popularization Education on Pre-hospital Fi-rst Aid Ability of College Students%大学生院前急救能力普及教育对策探讨

    Institute of Scientific and Technical Information of China (English)

    赵璇; 郑丹; 丁钰; 刘冰冰; 禹良国

    2014-01-01

    This paper expounded the significance of populariza-tion education on pre-hospital first aid ability of college students. Combined with current situation of pre-hospital first aid knowl-edge and skills of college students, the main problems in first aid health education were analyzed, and the methods and counter-measures of strengthening pre-hospital first aid ability were dis-cussed.%阐述高校学生院前急救能力普及教育的意义,结合目前大学生对于院前急救知识与技能知晓情况,分析开展急救健康教育面临的主要问题,并探讨加强大学生院前急救能力的方法与对策。

  9. Improving trauma care in Trinidad and Tobago.

    Science.gov (United States)

    Adam, R; Stedman, M; Winn, J; Howard, M; Williams, J I; Ali, J

    1994-06-01

    Identification of trauma as a major cause of morbidity and mortality in Trinidad and Tobago prompted the establishment of a training programme aimed at improving trauma care in this developing country. An Advanced Trauma Life Support (ATLS) programme for physicians, funded through the Canadian International Development Agency resulted in a statistically significant improvement of in-hospital trauma patient outcome at the Port-of-Spain General Hospital (observed to expected mortality ratio of 3.16 pre-ATLS compared to 1.94 post-ATLS). A recent analysis of all motor vehicle injuries for a shorter period did not confirm this positive impact of the ATLS programme, primarily because a large number of these patients died in the pre-hospital period. Pre-hospital trauma care therefore required urgent attention to complement the positive in-hospital impact of the ATLS programme. A second training programme (the Pre-Hospital Trauma Life Support or PHTLS) for paramedical personnel was thus instituted in 1990. Over 250 physicians have been trained in the ATLS programme and to date over 100 paramedical personnel have been trained in the PHTLS programme. Attempts have also been made to equip the ambulances with more appropriate resuscitative devices in order to improve pre-hospital care. The combination of the PHTLS and the ATLS programme should result in further improvement in the care of patients sustaining major injuries in Trinidad and Tobago.

  10. Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention-Capable Hospitals.

    Science.gov (United States)

    Tran, Dat T; Welsh, Robert C; Ohinmaa, Arto; Thanh, Nguyen X; Kaul, Padma

    2017-04-01

    The aim of this study was to examine temporal trends and provincial variations in reperfusion strategies and in-hospital mortality among patients presenting with ST-segment elevation myocardial infarction (STEMI) at hospitals in Canada capable of performing percutaneous coronary intervention (PCI). We included patients aged ≥ 20 years who were hospitalized between fiscal years 2009 and 2013 in all provinces except Quebec. We categorized patients as receiving fibrinolysis (lysis), primary PCI (pPCI), or no reperfusion. Patients undergoing lysis were further categorized as (1) lysis + PCI ≤ 90 minutes, (2) lysis + PCI > 90 minutes, and (3) lysis only. Patients undergoing pPCI were further categorized as (1) pPCI ≤ 90 minutes and (2) pPCI > 90 minutes. We used logistic regression to examine the baseline-adjusted association between reperfusion strategy and in-hospital mortality. Among 44,650 STEMI episodes in 44,373 patients, 66.3% received pPCI (annual increase of 7.8%; P hospital mortality ranged from a high of 16.3% among patients receiving no reperfusion to a low of 1.9% among patients receiving lysis + PCI > 90 minutes (adjusted odds ratio of 0.42; 95% confidence interval, 0.32-0.55 compared with pPCI ≤ 90 minutes). The use of pPCI in STEMI has increased significantly in Canada; however, significant interprovincial variation remains. Changes in reperfusion strategies do not appear to have had an impact on in-hospital mortality rates. Patients who underwent lysis followed by PCI in a systematic fashion had the lowest mortality. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  11. M-Guard Stent in Stemi Patients with High Thrombus Burden Lesions: A Prospective, Single Arm Study

    Directory of Open Access Journals (Sweden)

    Mohammad Zade Shabestari M

    2014-04-01

    Full Text Available Introduction: Primary PCI is the preferred modality to restore blood perfusion in STEMI patients, but myocardial reperfusion is sometimes lower than optimal. Distal embolization seems to play the leading role. There is rare evidence suggestive of M-Guard stents; a recent innovation which protects against distal embolization may be beneficial in this circumstance. Materials and Methods:This was a prospective single arm study. Patients with acute STEMI admitted at the Cardiac Emergency Unit of Imam Reza Hospital from July 2011 to November  2012 who had a large bulk of thrombus in their angiogram, underwent M-Guard stenting and were followed up for six months for chest pain and secondary revascularization. Results: The 23 patients, aged between 34 and 84; 65.2%, were male and had undergone primary PCI, mechanical thrombus aspiration, and M-Guard stenting. Left Anterior Descending (LAD (63.9% and Right Coronary Artery (RCA (39.1% were most commonly involved. 78.2%, 13.1%, and 8.9% of patients had primary Thrombolysis in Myocardial Infarction (TIMI Thrombus grade five, four, and three. Among them, 86.9% achieved TIMI Flow grade three and 13.04% TIMI Flow grade two. The rate of transient "no-reflow" phenomenon was 21%. One patient died after stenting in the setting of cardiogenic shock. There was one case of in-stent restenosis five months after the procedure. Of the other 15 accessible patients, after six months, none experienced a second angioplasty or any ischemic symptoms. Conclusion: Using M-Guard stents in acute STEMI patients having undergone primary PCI with high thrombus burden is probably associated with lower rates of the "no-reflow" phenomenon and improved vessel reperfusion.  

  12. Problems and Countermeasures of Pre-hospital Emergency in the Overcrowded Emergency Room%医院急诊室过度拥挤状况下院前急救存在的问题和对策

    Institute of Scientific and Technical Information of China (English)

    王钱锋; 周海斌; 张军根; 陈淳

    2013-01-01

    目的:通过对医院急诊室过度拥挤状态下院前急救过程中存在的问题进行分析,提出有效的应对策略.方法:对院前急救工作进行回顾性分析,并结合杭州市急救中心实际问题提出对策.结果:院前急救与急诊室作为EMSS的重要组成部分,急诊室的过度拥挤状态下院前急救工作存在的问题包括救护车转向率提高、急救资源滞留及满意度下降等.结论:通过制定相应法律法规,解决急诊室拥挤情况,构建院前院内的资源信息联网平台等,可有效解决院前急救中存在的问题.%Objective:To put forward some effective countermeasures to the problems ledby emergency room overcrowding in the state of pre -hospital emergency process.Methods:To analyze the work of pre-hospital emergency retrospectively,and proposed the countermeasure considering the actual situation of emergency center of Hangzhou.Results:Pre-hospital emergency and emergency room werce importants component of EMSS,emergency room overcrowding problems in the state of pre-hospital emergency work.included ambulances turning rate increase,first aid resources retention and satisfaction levels decrease.Conclusion:probrems will be settled through formulating laws and regulations,ameliorating emergency room crowded situation,constructing network platform relate to the pre-hospital resources information,and effectively solve the problems existing in the pre-hospital emergency.

  13. Controversies in the treatment of patients with STEMI and multivessel disease: is it time for PCI of all lesions?

    Science.gov (United States)

    Ong, Peter; Sechtem, Udo

    2016-06-01

    Several randomized trials have suggested a benefit for multivessel PCI in patients with STEMI and multivessel disease. However, none of the studies compared multivessel PCI with a staged PCI-approach which is the current guideline recommended approach. The results of the trials may overestimate the beneficial effect of the multivessel PCI approach because the control group did not receive any ischaemia testing for evaluation of the significance of remaining lesions. Thus, unfavourable aspects of the multivessel PCI approach such as overestimation of non-culprit lesions at the time of acute coronary angiography, complications associated with PCI of the non-culprit lesion (i.e. dissection, no-reflow, acute stent thrombosis) or increased risk for contrast induced nephropathy may have gone unnoticed as the comparative management pathway was unusual and likely inferior to the guideline recommended approach. We believe that culprit lesion only PCI and staged evaluation of remaining areas of myocardial ischaemia with subsequent PCI is still preferable in patients with STEMI and multivessel disease but a randomized study comparing this approach with multivessel PCI is needed.

  14. Effect of remote ischemic post-conditioning on oxidative stress in blood of STEMI patients treated with primary angioplasty.

    Science.gov (United States)

    Lotfollahi, Hassanali; Mohammadi, Mustafa; Ghaffari, Samad; Badalzadeh, Reza; Sohrabi, Bahram; Aslanabadi, Naser; Separham, Ahmad; Golmohammadi, Ali; Abbasnejad, Ali; Roshani, Mehri

    2016-01-01

    Introduction: This study designed to use remote ischemic post conditioning (RIPC) as a protective strategy during percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI) to reduce myocardial cells damage due to reperfusion injury. Methods: Sixty-one patients were divided into test group (32 patients) receiving RIPC and control group (29 patients). Patients were included with first MI who had 20-80 years old. The RIPC protocol was applied on patients arm in three successive episodes during the opening of infarct-related artery (IRA). Whole blood sample were taken from patients after the first episode before IRA opening and after the third episode after IRA opening. The serums were extracted and stored in the freezer -70˚C to determine the levels of glutathione peroxidase (GPX), superoxide dismutase (SOD), total antioxidant capacity (TAC) and malondialdehyde (MDA). Results: The levels of GPX and SOD after the first episode of RIPC were significantly higher in test group than control group (P IRA opening (after third episode). In addition, the levels of TAC remained unchanged in control patients but it was significantly increased after the third episode of RIPC in test patients (P control group in comparison with test group, and administration of RIPC in test group prevented the enhancement of MDA levels significantly (P < 0.001). Conclusion: The results indicated that RIPC protocol has protective properties in patients with STEMI through enhancing the antioxidant potentials and decreasing lipid peroxidation.

  15. 严重烧伤院外和急诊处理策略%The Strategy Study of Pre-hospital Care and Emergency Management of Burn Victims

    Institute of Scientific and Technical Information of China (English)

    刘志国; 岳茂兴; 李轶; 徐冰心; 李建忠; 化楠

    2004-01-01

    目的探讨严重烧伤院外和急诊处理的简单而有重点的策略.方法参考国内外目前关于烧伤院外处理和急诊急救的方案,结合我们的急救经验,提出实用、简单的院外处理和急诊急救策略.结果总结出有序、系统的急救策略,简化了急救的程序.结论简化的程序重点突出,可以降低患者的伤残率和病死率.

  16. Discussion and Intervention on Safety Hidden Danger of Pre Hospital Emergency Care%院前急救调度安全隐患探讨及干预

    Institute of Scientific and Technical Information of China (English)

    林舒婷; 庄雅娟

    2016-01-01

    一个院前急救调度工作人员的优秀业务素质和强烈安全意识的水平,与急救人员是否能够准确、快速、高效地进行施救有着极为密切的关系。现将我急救中心调度工作中安全隐患的原因分析及干预措施报告如下。%Amergency personnel is able to accurately, quickly and efficiently carry out the rescue which has a very close relationship with excellent service quality and a strong safety awareness. Cause analysis and intervention study on the safety hazard of my first aid center scheduling work are as follows.

  17. Reduced pre-hospital and in-hospital survival rates after out-of-hospital cardiac arrest of patients with type-2 diabetes mellitus : An observational prospective community-based study

    NARCIS (Netherlands)

    Van Hoeijen, Daniel A.; Blom, Marieke T.; Bardai, Abdennasser; Souverein, Patrick C.|info:eu-repo/dai/nl/243074948; De Boer, Anthonius|info:eu-repo/dai/nl/075097346; Tan, Hanno L.

    2015-01-01

    Aims Out-of-hospital cardiac arrest (OHCA) remains a major cause of death. We aimed to determine whether type-2 diabetes mellitus (T2DM) is associated with reduced pre-hospital and in-hospital survival rates after OHCA. Methods and results An observational community-based cohort study was performed

  18. Long-term clinical outcome in STEMI patients treated with primary PCI and drug-eluting or bare-metal stents: insights from a high-volume single-center registry

    DEFF Research Database (Denmark)

    Pedersen, Sune; Galatius, Soren; Mogelvang, Rasmus

    2011-01-01

    Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial.......Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial....

  19. Blood oxygenation during hyperpressure intraperitoneal fluid administration in a rabbit model of severe liver injury: Evaluation of a novel concept for control of pre-hospital liver bleeding.

    Science.gov (United States)

    Ahmadi-Noorbakhsh, Siavash; Azizi, Saeed; Dalir-Naghadeh, Bahram; Maham, Masoud

    2012-01-01

    Oxygen is an essential part of the most important metabolic pathways in aerobic organisms. Oxygen delivery is merely dependent on blood, rendering blood loss a devastating event. Traumatic pre-hospital liver bleeding is a major cause of early trauma deaths in human and animals, with no established therapeutic method yet. Increasing intra-abdominal pressure (IAP) has been shown to reduce liver bleeding by half. Although reduction of blood loss could be in favor of blood oxygen delivery, however, the complex interaction between increased IAP and respiratory mechanics during severe hemorrhagic shock remained unclear. We used a novel model of liver trauma in 16 rabbits and randomly assigned them to either normotensive abdomen group or increased IAP by fluid infusion (HA) groups (n=8 each). Liver size and the amount of liver injury were evaluated. Various blood oxygenation parameters were recorded. Both groups were identical in terms of the liver size and injury. The HA group had significantly lower shock index. Arterial oxygen capacity and oxygen content were higher in the HA group. No significant statistical difference was seen between groups in terms of abdominal perfusion pressure; alveolar pressure of oxygen; dissolved oxygen in blood plasma; alveolar to arterial oxygen tension gradient; arterial to alveolar oxygen pressure ratio; the ratio between partial pressure of arterial oxygen and fraction of inspired oxygen; and respiratory index. In conclusion, the novel therapeutic method of increasing IAP by fluid infusion in a rabbit model of liver hemorrhage preserved blood oxygenation better than the classic therapeutic method.

  20. Blood oxygenation during hyperpressure intraperitoneal fluid administration in a rabbit model of severe liver injury: Evaluation of a novel concept for control of pre-hospital liver bleeding

    Directory of Open Access Journals (Sweden)

    Siavash Ahmadi-Noorbakhsh

    2012-06-01

    Full Text Available Oxygen is an essential part of the most important metabolic pathways in aerobic organisms. Oxygen delivery is merely dependent on blood, rendering blood loss a devastating event. Traumatic pre-hospital liver bleeding is a major cause of early trauma deaths in human and animals, with no established therapeutic method yet. Increasing intra-abdominal pressure (IAP has been shown to reduce liver bleeding by half. Although reduction of blood loss could be in favor of blood oxygen delivery, however, the complex interaction between increased IAP and respiratory mechanics during severe hemorrhagic shock remained unclear. We used a novel model of liver trauma in 16 rabbits and randomly assigned them to either normotensive abdomen group or increased IAP by fluid infusion (HA groups (n=8 each. Liver size and the amount of liver injury were evaluated. Various blood oxygenation parameters were recorded. Both groups were identical in terms of the liver size and injury. The HA group had significantly lower shock index. Arterial oxygen capacity and oxygen content were higher in the HA group. No significant statistical difference was seen between groups in terms of abdominal perfusion pressure; alveolar pressure of oxygen; dissolved oxygen in blood plasma; alveolar to arterial oxygen tension gradient; arterial to alveolar oxygen pressure ratio; the ratio between partial pressure of arterial oxygen and fraction of inspired oxygen; and respiratory index. In conclusion, the novel therapeutic method of increasing IAP by fluid infusion in a rabbit model of liver hemorrhage preserved blood oxygenation better than the classic therapeutic method.

  1. Optimization of care for ST-elevation myocardial infarction

    NARCIS (Netherlands)

    Velders, Matthijs Alexander

    2014-01-01

    978-94-6182-393-9 The first part of this thesis identified several high-risk sub-populations to improve the care and risk stratification of patients with ST-elevation myocardial infarction (STEMI). It was observed that common patient characteristics such as female gender, cancer and age have a stron

  2. Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES: Insights from the DESERT cooperation

    NARCIS (Netherlands)

    Luca, G. De; Dirksen, M.T.; Spaulding, C.; Kelbaek, H.; Schalij, M.; Thuesen, L.; Hoeven, B. van der; Vink, M.A.; Kaiser, C.; Musto, C.; Chechi, T.; Spaziani, G.; Diaz de la Llera, L.S.; Pasceri, V.; Lorenzo, E. Di; Violini, R.; Suryapranata, H.; Stone, G.W.

    2014-01-01

    BACKGROUND: Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data in patient

  3. Large discrepancy between prehospital visitation to mobile emergency care unit and discharge diagnosis

    DEFF Research Database (Denmark)

    Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann

    2012-01-01

    In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame...... to deliver optimal care in the form of percutaneous transluminal coronary angioplasty. In theory, all patients with chest pain could have STEMI. The aim of this study was to study which of the patients suspected of having acute cardiac disease based on the 112 calls and met by the MECU were given a cardiac...

  4. 院前急救护理路径在脑卒中患者院前急救中的应用%Application of pre-hospital emergency nursing pathway in the pre-hospital emergency of patients with cerebral stroke

    Institute of Scientific and Technical Information of China (English)

    刘艳

    2015-01-01

    Objective:To explore the application value of pre-hospital emergency nursing pathway in the pre-hospital emergency of patients with cerebral stroke.Methods:96 patients with emergency nursing were selected.They were randomly divided into the observation group and the control group with 48 cases in each group.The control group was given routine emergency nursing.The observation group was given pre-hospital nursing.Results:In the observation group,the arriving patient to implement rescue time was (30.5±9.2) minutes,the hospital stay was (11.2±2.6) days,23 cases were survival,the survival rate was 47.9%,the satisfaction of patients was 96.8%.In the control group,the arriving patient to implement rescue time was (41.3±13.2) minutes,the hospital stay was (18.9±4.5) days,18 cases were survival,the survival rate was 37.5%,the satisfaction of patients was 81.3%.The differ-ence was statistically significant between the two groups(P<0.05).Conclusion:The pre-hospital emergency nursing pathway can significantly reduce the emergency time,improve the survival rate and satisfaction of patients.%目的:探讨院前急救护理路径在脑卒中患者院前急救中的应用价值。方法:急诊护理患者96例,随机分成观察组和对照组各48例,对照组给予常规急救护理。观察组给予院前急救护理。结果:观察组抵达患者实施救护时间(30.5±9.2)min,住院时间(11.2±2.6)d,存活23例,存活率47.9%,患者满意度96.8%,对照组抵达患者实施救护时间(41.3±13.2)min,住院时间(18.9±4.5)d,存活18例,存活率37.5%,患者满意度81.3%,两组比较,差异具有统计学意义(P<0.05)。结论:院前急救护理路径可明显减少急救时间,提高患者的生存率和满意度。

  5. The 24-lead ECG display for enhanced recognition of STEMI-equivalent patterns in the 12-lead ECG.

    Science.gov (United States)

    Pahlm, Ulrika; Pahlm, Olle; Wagner, Galen S

    2014-01-01

    In a patient with chest pain and suspected acute coronary syndrome, the electrocardiogram (ECG) is the only readily available diagnostic tool. It is important to maximize its usefulness to detect acute myocardial ischemia that may evolve to myocardial infarction unless the patient is treated expediently with reperfusion therapy. Since diagnostic guidelines have usually included only ST-elevation myocardial infarction (STEMI) as the entity that should be diagnosed and treated urgently, a patient with coronary occlusion represented on ECG as ST depression is likely not to be considered a candidate for receiving immediate coronary angiography and coronary intervention. ECG criteria for STEMI detection require that ST elevation meet predetermined millivolt thresholds and appear in at least two spatially contiguous ECG leads. The typical ECG reader recognizes only three contiguous pairs: aVL and I; II and aVF; aVF and III. However, viewing the "orderly sequenced" 12-lead ECG display, two more contiguous pairs become obvious in the frontal plane: +I and -aVR; -aVR and +II. The 24-lead ECG is a display of the standard 12-lead ECG as both the classical positive leads and their negative (inverted) counterparts. Leads +V1, +V2, +V3, +V4, +V5, and +V6 and their inverted counterparts are used to generate a "clock-face display" for the transverse plane. Similarly, +aVL, +I, -aVR, +II, +aVF, +III in the frontal plane and their inverted counterparts are used to generate a clock-face display for the frontal plane. Optimum results, 78% sensitivity and 93% specificity, were obtained using the following 19 ECG leads: frontal plane: +aVR, -III, +aVL, +I, -aVR, +II, +aVF, +III, -aVL; transverse plane: +V1, +V2, +V3, +V4, +V5, +V6, -V1, -V2, -V3.

  6. Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Stone, Gregg W; Mehran, Roxana; Goldstein, Patrick;

    2015-01-01

    bleeding and mortality rates, but higher acute stent thrombosis rates compared with heparin + a glycoprotein IIb/IIIa inhibitor (GPI). Subsequent changes in primary PCI, including the use of potent P2Y12 inhibitors, frequent radial intervention, and pre-hospital medication administration, were incorporated...... into the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial, which assigned 2,218 patients to bivalirudin versus heparin ± GPI before primary PCI. OBJECTIVES: The goal of this study was to examine the outcomes of procedural anticoagulation with bivalirudin versus heparin ± GPI for primary PCI......, given the evolution in primary PCI. METHODS: Databases from HORIZONS-AMI and EUROMAX were pooled for patient-level analysis. The Breslow-Day test evaluated heterogeneity between trials. RESULTS: A total of 5,800 patients were randomized to bivalirudin (n = 2,889) or heparin ± GPI (n = 2,911). The radial...

  7. 不稳定型心绞痛院前急救临床观察%Clinical observation of unstable angina pre-hospital emergency intervention

    Institute of Scientific and Technical Information of China (English)

    郭华林

    2008-01-01

    目的 总结不稳定型心绞痛院前急救治疗的经验.方法 对院前胸痛患者,采集病史,体格检查,描记ECG并对其做出低中高危的评估,应用硝酸甘油、阿司匹林、使用β-受体阻滞剂、钙拮抗剂、转换酶抑制剂及肝素治疗,基础生命支持与监护.结果 留观期间:心绞痛症状缓解,有效98例(81.7%),加重21例(17.5%),收住院,其中因心绞痛发生顽固性心肌缺血4例,发展为严重心绞痛心律失常心房颤动6例,心源性休克4例,急性心力衰竭5例,非ST段抬高心肌梗死2例.院前猝死1例(0.8%).结论 不稳定型心绞痛患者院前急救措施的开展具有积极作用,早期识别、干预控制冠心病的危险因素,使心肌缺血症状改善,可减轻劳力性心绞痛的发作及改善患者的生活质量.%Objective To sum up unstable angina pre-hospital treatment interventions,clinical observation and assessment guide for emergency treatment.MethodsFor chest pain patients,collecting history,doing physical examination,checking ECG and making risk assessment,then,treating them with nitroglycerin,aspirin,beta-blocker,calcium antagonists,converting enzyme inhibitors,heparin therapy,and basic life support and monitor.Results During detention,there are 98 cases(81.7%)effective with angina symptoms subsided and discharged,21 cases (17.5%)aggravating and hospitalization,in which there are four cases get myocardial ischemia because of refractory angina,six cases of serious arrhythmia AF,four cases of cardiogenic shock,five cases of acute heart failure,and two cases of non.ST-segment elevation myocardial infarction.Also,there is one case(0.8%)of sudden death before prehospital treatment.Conclusion Pre-hospital treatment of unstable angina played a positive role in early identification,intervention and control of the risks of coronary artery disease,it also helps improving the symptoms of myocardial ischemia,reducing angina attack,and improving the life quality of the

  8. Does Pre-hospital Endotracheal Intubation Improve Survival in Adults with Non-traumatic Out-of-hospital Cardiac Arrest? A Systematic Review

    Directory of Open Access Journals (Sweden)

    Ling Tiah

    2014-11-01

    Full Text Available Introduction: Endotracheal intubation (ETI is currently considered superior to supraglottic airway devices (SGA for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA. We aimed to determine if the research supports this conclusion by conducting a systematic review. Methods: We searched the MEDLINE, Scopus and CINAHL databases for studies published between January 1, 1980, and 30 April 30, 2013, which compared pre-hospital use of ETI with SGA for outcomes of return of spontaneous circulation (ROSC; survival to hospital admission; survival to hospital discharge; and favorable neurological or functional status. We selected studies using pre-specified criteria. Included studies were independently screened for quality using the Newcastle-Ottawa scale. We did not pool results because of study variability. Study outcomes were extracted and results presented as summed odds ratios with 95% CI. Results: We identified five eligible studies: one quasi-randomized controlled trial and four cohort studies, involving 303,348 patients in total. Only three of the five studies reported a higher proportion of ROSC with ETI versus SGA with no difference reported in the remaining two. None found significant differences between ETI and SGA for survival to hospital admission or discharge. One study reported better functional status at discharge for ETI versus SGA. Two studies reported no significant difference for favorable neurological status between ETI and SGA. Conclusion: Current evidence does not conclusively support the superiority of ETI over SGA for multiple outcomes among adults with OHCA. [West J Emerg Med. 2014;15(7:-0.

  9. Definitive airway management of patients presenting with a pre-hospital inserted King LT(S)-D laryngeal tube airway: a historical cohort study.

    Science.gov (United States)

    Subramanian, Arun; Garcia-Marcinkiewicz, Annery G; Brown, Daniel R; Brown, Michael J; Diedrich, Daniel A

    2016-03-01

    The King LT(S)-D laryngeal tube (King LT) has gained popularity as a bridge airway for pre-hospital airway management. In this study, we retrospectively reviewed the use of the King LT and its associated airway outcomes at a single Level 1 trauma centre. The data on all adult patients presenting to the Mayo Clinic in Rochester, Minnesota with a King LT in situ from July 1, 2007 to October 10, 2012 were retrospectively evaluated. Data collected and descriptively analyzed included patient demographics, comorbidities, etiology of respiratory failure, airway complications, subsequent definitive airway management technique, duration of mechanical ventilation, and status at discharge. Forty-eight adult patients met inclusion criteria. The most common etiology for respiratory failure requiring an artificial airway was cardiac arrest [28 (58%) patients] or trauma [9 (19%) patients]. Four of the nine trauma patients had facial trauma. Surgical tracheostomy was the definitive airway management technique in 14 (29%) patients. An airway exchange catheter, direct laryngoscopy, and video laryngoscopy were used in 11 (23%), ten (21%), and ten (21%) cases, respectively. Seven (78%) of the trauma patients underwent surgical tracheostomy compared with seven (18%) of the medical patients. Adverse events associated with King LT use occurred in 13 (27%) patients, with upper airway edema (i.e., tongue engorgement and glottic edema) being most common (19%). In this study of patients presenting to a hospital with a King LT, the majority of airway exchanges required an advanced airway management technique beyond direct laryngoscopy. Upper airway edema was the most common adverse observation associated with King LT use.

  10. Barriers professional competence and its relationship with job satisfaction of nurses' moral distress and pre-hospital emergency city of Bam and Jiroft in 1393

    Directory of Open Access Journals (Sweden)

    Mohammadjavad Rahimzadeh

    2016-05-01

    Full Text Available In order to "protect the health of people" Several organizations have been founded and given its role in saving lives when seconds play, is formed Medical Center Emergency Management Whose duty is satisfactory service in the shortest possible time. Because one of the pre-hospital emergency center nurses work centers and first deal with critical diseases carried by nurses, so they are faced with numerous obstacles which could impact on their job satisfaction has less moral distress. In this study, efficient professional barriers and its relation to moral distress and job satisfaction are studied prehospital emergency nurses. This study is a descriptive - correlation of prehospital emergency personnel Bam on 82 Jiroft who were selected by census was conducted. Data gathering questionnaire, including demographic characteristics, barriers to efficient professional, moral distress, job satisfaction after obtaining the appropriate reliability and validity were used. Analysis of the data in this study using SPSS version 18, using measures of central tendency and dispersion, t-test, Pearson correlation coefficient, ANOVA and regression analysis were used. According to the non-normal distribution efficiency and moral distress two variables obstacles relationship between these two variables with Spearman nonparametric Kruskal-Wallis test other variables and for other variables that were normally distributed parametric tests and ANOVA were used Pearson correlation coefficient. A total of 82 patients with mean age (31.54± 5.66 participated in th e study showed. Results are73.4% married, work experience, most people (% 91.5 were under 15 years old. Most people (52% with traffic and pedestrians as factors impeding efficient professional, fully agreed, the average score of moral distress (o.48 ± 2.13, the level of moral distress was most mid-level and job satisfaction 52. 4% of them were average. The results showed that between moral distress and job

  11. Influence of thrombus aspiration combined tirofiban on patients with acute STEMI after primary PCI%血栓抽吸联合替罗非班对急性 STEMI 直接 PCI 术后的影响

    Institute of Scientific and Technical Information of China (English)

    邓长金; 金露萍; 成威; 魏国政; 徐晓东; 邵玲; 彭娜

    2015-01-01

    Objective:To study the influence of thrombus aspiration combined tirofiban on patients with acute ST seg-ment elevation myocardial infarction (STEMI)after primary percutaneous coronary intervention (PCI).Methods:A total of 98 patients,who received primary PCI because of STEMI in our hospital from Jan 2012 to Mar 2013,were selected.They were divided into thrombus aspiration group (n=48,received pure thrombus aspiration)and com-bined treatment group (n = 50,received thrombus aspiration combined intracoronary tirofiban injection during PCI).Coronary angiography (CAG)instantly after PCI and follow-up condition during hospitalization and six months after discharge were compared between two groups.Results:(1)Compared with thrombus aspiration group after PCI,there were significant rise in TIMI blood flow grade [(2.3±0.6)grades vs.(2.7±0.3)grades],per-centage of TIMI flow grade 3 (72.9% vs.90.0%)and ST segment regression >50% rate within 90min after PCI (52.1% vs.74.0%),P < 0.05 or < 0.01,and significant reduction in percentage of postoperative no-reflow (18.8% vs.4.0%,P =0.038)in combined treatment group in hospital;(2)After six-month follow-up,left ven-tricular ejection fraction (LVEF)of combined treatment group was significantly higher than that of thrombus aspi-ration group [(58±6.3)% vs.(51±5.6)%,P <0.05].Conclusion:Thrombus aspiration combined tirofiban can effectively reduce coronary thrombus burden and improve cardiac function in STEMI patients during primary PCI.%目的:研究血栓抽吸联合使用替罗非班对急性 ST 段抬高型心肌梗死(STEMI)直接冠脉介入治疗术(PCI)术后的影响。方法:选择荆门市第一人民医院2012年1月至2013年3月因 STEMI 行直接 PCI 治疗患者98例,其中单纯行血栓抽吸48例 (血栓抽吸组),术中应用血栓抽吸联合冠脉内注入替罗非班50例(联合治疗组),比较两组患者术后即刻冠状动脉造影以及住院期间和出院后6个

  12. 院前急救病历电子索引开发和应用探讨%Discussion on the Development and Application of Pre-hospital Emergency Medical Records Electronic Index

    Institute of Scientific and Technical Information of China (English)

    陈志刚; 陆素琴; 郭薇; 邹圣强

    2011-01-01

    As the paper pre-hospital emergency medical statistics in the information error-prone, and time-consuming, Zhenjiang City, this has not been achieved in the Emergency Center under the premise of electronic medical records, from starting to save money, to design, development and application of electronic medical records index. After application of the test, pre-hospital emergency epidemiological information to obtain significantly faster and more accurate: Moreover, the pre-hospital emergency medical quality has greatly improved.%由于纸质院前急救病历在信息统计方面容易出错,同时费时费力,为此镇江市急救中心在尚未实现电子病历的前提下,从节约资金出发,自行设计、开发和应用病历电子索引.经过应用测试,院前急救流行病学信息获取明显更加快捷、准确;不仅如此,院前急救病历质量也有了很大的提高.

  13. The Predictive Value of Total Neutrophil Count and Neutrophil/ Lymphocyte Ratio in Predicting In-hospital Mortality and Complications after STEMI

    Directory of Open Access Journals (Sweden)

    Samad Ghaffari

    2014-03-01

    Full Text Available Introduction: Leukocytosis, predominantly neutrophilia, has previously been described following ST elevation myocardial infarction (STEMI. The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to STEMI in the blood and its association with in-hospital mortality and/or adverse clinical events.Methods: In this cross-sectional study, 404 patients who were admitted with the diagnosis of acute STEMI at Madani Heart Hospital from March 2010 to March 2012 were studied. The complete blood cell count (CBC was obtained from all patientswithin12-24 hours of the onset of symptoms. Total leukocytes were counted and differential count was obtained for neutrophils, lymphocytes and neutrophil/lymphocyte ratio (NLR were evaluated. Association of cellular response with the incidence of post-MI mortality/complications was assessed by multiple logistic regression analyses.Results: In-hospital mortality and post-STEMI complication rate were 3.7% and 43.6%, respectively. Higher age (P=0.04, female gender (0.002, lower ejection fraction (P<0.001 and absolute neutrophil count (P=0.04 were predictors of mortality. Pump failure in the form of acute pulmonary edema or cardiogenic shock occurred in 35 (8.9% of patients. Higher leukocyte (P<0.03 and neutrophil counts (P<0.03 and higher NLR (P=0.01 were predictors of failure. The frequency of ventricular tachyarrhythmias (VT/VF at the first day was associated with higher neutrophil count (P<0.001 and higher NLR level (P<0.001. In multivariate analysis neutrophil count was an independent predictor of mortality (OR=2.94; 1.1-8.4, P=0.04, and neutrophil count [OR=1.1, CI (1.01-1.20, P=0.02], female gender [OR=2.34, CI (1.02-4.88, P=0.04] and diabetes [OR=2.52, CI (1.21-5.2, P=0.003] were independent predictors of heart failure.Conclusion: A single CBC analysis may help to identify STEMI patients at risk for mortality and heart failure, and total

  14. Nursing Procedure for Patients with Cerebral Vascular Accident Pre-hospital Emergency%浅谈脑血管意外患者院前急救的护理程序

    Institute of Scientific and Technical Information of China (English)

    潘帅平

    2015-01-01

    目的院前急救是抢救的重要环节,探讨运用规范的护理程序后院前急救脑血管意外患者生命支持的时效显著提高,在提高脑血管意外患者院前急救成功率中有重要作用。方法在院前急救中正确规范运用护理程序,迅速了解患者的生命体征,对病情做出及时评估,并进行必要的生命支持及安全转运。结果运用正确规范的护理程序后,院前急救脑血管意外患者生命支持的时效显著提高。结论在运用正确规范的护理程序后,院前急救脑血管意外患者生命支持的时效显著提高,在提高脑血管意外患者院前急救成功率中有重要作用。%Objective Pre-hospital first aid is an important part of the rescue,discussed using the normative nursing program backyard before emergency cerebrovascular accident patients life support aging significantly increased,in improving pre-hospital emergency cerebrovascular accident patients play an important role in the success rate.Methods In pre-hospital first aid cor ect specification using the nursing process,quickly understand the patient's vital signs,to condition assessment in time,and make the necessary life support and safe transport.Results Using the right after the normative nursing program,cerebrovascular accident patients with pre-hospital emergency life support aging significantly increased.Conclusion The ef ect of life support on the life support of patients with cerebral vascular accidents in the pre hospital emergency treatment is significantly improved, and it plays an important role in improving the success rate of cerebrovascular accident patients.

  15. In-hospital complications after invasive strategy for the management of Non STEMI: women fare as well as men

    Directory of Open Access Journals (Sweden)

    Roul Gerald

    2010-06-01

    Full Text Available Abstract Background To analyze the in-hospital complication rate in women suffering from non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI compared to men. Methods The files of 479 consecutive patients (133 women and 346 men suffering from a Non STEMI (Non ST-segment elevation myocardial infarction between the January 1st 2006 and March 21st 2009 were retrospectively analyzed with special attention to every single complication occurring during hospital stay. Data were analyzed using nonparametric tests and are reported as median unless otherwise specified. A p value Results As compared to men, women were significantly older (75.8 vs. 65.2 years; p vs. 26% - p = NS, no single event was significantly gender related. The logistic regression identified age and CRP concentration as the only predictive variables in the whole group. After splitting for genders, these parameters were still predictive of events in men. In women however, CRP was the only one with a borderline p value. Conclusions Our study does not support any gender difference for in-hospital adverse events in patients treated invasively for an acute coronary syndrome without ST-segment elevation and elevated troponin.

  16. Intraobserver reproducibility of parameters of standard and 2D speckle tracking echocardiography, dynamics of global longitudinal strain I in patients with acute primary anterior STEMI

    Science.gov (United States)

    Kercheva, M.; Ryabova, T.; Ryabov, V.; Karpov, R.

    2015-11-01

    The aim of this study was to assess the intraobserver reproducibility of parameters of standard and 2 dimensional speckle tracking echocardiography, dynamics of global longitudinal strain in patients with acute primary anterior STEMI. The study included 24 patients, mean age 58.46±10.2. Echocardiography with 2D speckle tracking imaging was performed on the 1st (T1), 7th (T2), 14th days (T3) after STEMI («Vivid E9»). Analysis of echocardiographic images was performed offline at the different periods by the two independent observers (EchoPac) - experienced and inexperienced. In order to assess the agreement between standard and 2D speckle tracking echocardiography, a correlation analysis (Pearson correlation, Spearman's rank correlation coefficient) and Bland-Altman analysis were undertaken. The 23 patients had urgent reperfusion therapy, 6 patients underwent primary PCI, 16 patients - PCI after successful fibrinolysis (68%). GLS and WMSI had the best intraobsever reproducibility. Dynamics of EDV LV, ESV LV, EF LV was without significant differences. Nevertheless, it was found positive dynamic of GLS: - 12.65±3.53 (T1), -13.61±3.81 (T2), -14.27±4.1 (T3), pspeckle-tracking and standard echocardiography was revealed in GLS and WMSI. The modern management of STEMI patients limits adverse postinfarction remodeling and preserves of global left ventricular contractility detected by the EF LV. However, GLS had the positive dynamics and improved to the 14th day.

  17. The size does not matter – The presence of microvascular obstruction but not its extent corresponds to larger infarct size in reperfused STEMI

    Energy Technology Data Exchange (ETDEWEB)

    Małek, Łukasz A., E-mail: lmalek@ikard.pl [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Śpiewak, Mateusz, E-mail: mspiewak@ikard.pl [Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology, Warsaw (Poland); Kłopotowski, Mariusz, E-mail: mklopotowski@hotmail.com [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland); Miśko, Jolanta, E-mail: jmisko@wp.pl [Magnetic Resonance Unit, Department of Radiology, Institute of Cardiology, Warsaw (Poland); Rużyłło, Witold, E-mail: wruzyllo@ikard.pl [Institute of Cardiology, Warsaw (Poland); Witkowski, Adam, E-mail: witkowski@hbz.pl [Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw (Poland)

    2012-10-15

    Background: Microvascular obstruction (MVO) is a cardiac magnetic resonance (CMR) marker of no-reflow in ST-segment elevation myocardial infarction (STEMI). It remains unresolved whether the infarct size corresponds only to the presence of MVO or also to its extent. Methods: The study included 53 patients with first STEMI (median age 61.5 years, 77% male) treated with percutaneous coronary intervention (PCI) who underwent CMR after median 5 days from PCI. Small MVO was defined as patchy, non-confluent spots of dark areas of absent contrast surrounded by late gadolinium enhancement (LGE). Large MVO was defined as confluent areas of MVO comprising a large amount of the infarct zone. Results: Microvascular obstruction was observed in 32 patients (60%) including 18 patients with small MVO (36%) and 14 patients with large MVO (24%). Patients with MVO were more likely to have TIMI 0/1 grade flow on initial angiogram, higher levels of necrotic markers, larger infarct size, larger left ventricular end-diastolic and end-systolic volume and lower ejection fraction in comparison to patients without MVO. These differences were not observed between patients with large and small MVO. Conclusions: The presence of MVO but not its extent corresponds to larger infarct size in STEMI.

  18. The relationship between admission monocyte HDL-C ratio with short-term and long-term mortality among STEMI patients treated with successful primary PCI.

    Science.gov (United States)

    Çiçek, Gökhan; Kundi, Harun; Bozbay, Mehmet; Yayla, Cagrı; Uyarel, Hüseyin

    2016-05-01

    Monocyte to HDL-C ratio (MHR) represents a simple assessment method for inflammatory status. The aim of the present study was to investigate whether MHR may be of short-term and long-term prognostic value in ST-elevation myocardial infarction (STEMI) patients who have undergone a primary percutaneous coronary intervention (PCI). A total of 682 consecutive STEMI patients who underwent successful primary PCI between March 2013 and September 2015 were included in this study. Patients were divided into groups according to their admission MHR values. Clinical follow-up data of participating patients were obtained through an outpatient examination 30 months after PCI. The study population included 172 patients with an MHR less than 1.16 (Q1), 169 patients with an MHR 1.16-1.59 (Q2), 161 patients with an MHR 1.60-2.21 (Q3), and 180 patients with an MHR greater than 2.21 (Q4). Rates of in-hospital mortality, major adverse cardiovascular events, cardiopulmonary resuscitation, dialysis, use of inotropic agents, shock, late mortality, target vessel revascularization, stroke, and reinfarct were higher in the Q4 group compared with the other MHR quartile groups. The results of this study have indicated that admission MHR is associated independently and significantly with short-term and long-term mortality in STEMI patients who undergo successful primary PCI.

  19. Large discrepancy between prehospital visitation to mobile emergency care unit and discharge diagnosis

    DEFF Research Database (Denmark)

    Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann;

    2012-01-01

    to deliver optimal care in the form of percutaneous transluminal coronary angioplasty. In theory, all patients with chest pain could have STEMI. The aim of this study was to study which of the patients suspected of having acute cardiac disease based on the 112 calls and met by the MECU were given a cardiac...

  20. 2013年北京市急救中心院前急救儿童患者流行病学研究%Epidemiological studies on children patients with pre-hospital emergency in Beijing Emergency ;Center in 2013

    Institute of Scientific and Technical Information of China (English)

    刘杉; 高丁

    2014-01-01

    Objective To summarize the age, gender, and the regularity of disease classification of children patients with pre-hospital emergency in Beijing Emergency Center in 2013, provide the basis for improving children's quality of pre-hospital first aid. Methods Based on the Beijing emergency center scheduling information database, of pre-hospital emergency first aid center in Beijing in 2013 children patients were retrospectively analyzed. Results 2013 emergency center of Beijing children pre-hospital emergency patients, male:female was 1.6∶1. In every age group, 4 to 7 years old preschool children, most patients with a total of 2 492 cases, accounting for 25.31%;Neonatal patients at least within 28 days, a total of 251 cases, accounting for 2.55%. Disease to constitute the top five of the respiratory system disease, trauma, respectively, digestive system disease, neuromuscular disease, airway foreign bodies. Respiratory system disease, trauma, in 4 to 7 years old preschool children group, most patients with digestive system disease, neuromuscular disease, patients with airway foreign bodies in 1 to 3 years old infants group most. Conclusion Pre-hospital emergency according to the emergency center of Beijing children patients with age, sex and characteristics of disease classification, targeted to carry out the related work, can make patients get better pre-hospital emergency services.%目的:总结2013年北京市急救中心院前急救儿童患者的年龄、性别及病种分类规律,为提高儿童的院前急救质量提供依据。方法以北京急救中心调度信息数据库为基础,对2013年北京市急救中心院前急救儿童患者进行回顾性分析。结果2013年北京市急救中心院前急救9845例儿童患者中,男∶女为1.6∶1。各年龄组中,4~7岁的学龄前儿童患者最多,共2492例,占25.31%;28 d以内的新生儿组患者最少,共251例,占2.55%。病种构成前五位分别为呼吸系统疾病、

  1. Pre-hospital emergency and nursing measures of acute carbon monoxide poisoning%急性一氧化碳中毒的院前急救及护理对策

    Institute of Scientific and Technical Information of China (English)

    黎秀英

    2015-01-01

    Objective:To explore the pre-hospital emergency and nursing measures of acute carbon monoxide poisoning.Methods:57 patients with acute carbon monoxide poisoning were given pre-hospital emergency and nursing measures,treatment and nursing measures at the poisoning scene,treatment and nursing measures in the transport process,treatment after admission. Results:In addition to 4 patients were died before the medical personnel arrived at the poisoning scene,other patients were significantly improved and discharged after the treatment,did not appear serious sequelae.Conclusion:Timely taking effective pre-hospital emergency and nursing measures can significantly reduce the disability and mortality of patients with acute carbon monoxide poisoning.%目的:探讨急性一氧化碳(CO)中毒的院前急救及护理对策。方法:对57例急性CO中毒患者采取院外急救及护理措施,中毒现场救治及护理措施,转运过程中救治及护理措施,入院后的治疗。结果:除4例患者在医务人员到达中毒现场前已死亡外,其余患者经治疗,均明显好转出院,未出现严重后遗症。结论:及时采取有效的院前急救及护理对策可明显降低急性CO中毒患者的伤残及死亡率。

  2. [Mistakes and complications in the diagnosis and medical services for persons with closed thoraco-abdominal injuries during pre-hospitalization stage].

    Science.gov (United States)

    Baramiia, N M; Antoniuk, M H; Zaruts'kyĭ, Ia L; Dorosh, V M; Sabov, V I

    2003-07-01

    Results of medical care, given to injured persons with closed thoracoabdominal trauma on the prehospital stage were analyzed. Lacks and complications in tactic of treatment and diagnosis were determined. Mistakes of the medical ambulance care physicians were noted in 51.3% of observations.

  3. Survey Research on Pre-hospital Emergency of Drug-induced Disulfiram-like Reaction%药源性双硫仑样反应院前急救情况分析

    Institute of Scientific and Technical Information of China (English)

    赵云霄; 牟丽

    2016-01-01

    Objective To survey and analyze the rationality and necessity of pre-hospital emergency of drug-induced disul-firam-like reaction. Methods 24 cases of patients with disulfiram-like reaction in the pre-hospital diagnosis in our hospital from January 2010 to May 2012 were selected as the survey objects, and the related data were retrospectively analyzed, and the physiological parameters, heart rate, mean arterial blood pressure and pulse saturation of arterial blood oxygen of pa-tients were counted and analyzed before and after the emergency disposal. Results The general state of patients was obvi-ously improved after the pre-hospital emergency, and various physiological indexes were obviously improved, and the differ-ence had statistical significance. Conclusion The pre-hospital emergency rational intervention can obviously improve the patients with disulfiram-like reaction in limited time, and the emergency physicians should pay great attention to the occur-rence of disulfiram-like reaction when handling the emergency events after drinking.%目的:调查分析药源性双硫仑样反应患者院前急救的合理性及必要性。方法选取2010年1月-2012年5月院前接诊的24例双硫仑反应患者的作为调查对象,对相关资料进行回顾性分析。统计分析病人急救处置前后生理参数情况,心率(HR)、平均动脉压(MABP)、脉搏氧饱和度(SpO2)。结果在经过院前救治后,患者的一般状态明显好转,各项生理指标较前有明显改善,差异有统计学意义。结论双硫仑样反应患者经过院前急救合理干预,能够在有限时间内得到显著明显的改善。急救医师在处理饮酒后发生的急救事件时应特别注意双硫仑样反应的发生。

  4. 院前急救时的检伤分类——定量分析方法及程序%Pre-hospital First Aid Triage: Quantitative Analysis Methods and Procedures

    Institute of Scientific and Technical Information of China (English)

    冯庚

    2012-01-01

    Objective This article introduces several common methods of triage assessments, including triage checklist, pre -hospital index, CRAMS score, trauma score and simple wound score, START triage method and improved CESIRA classification.%本文介绍了几种常用的检伤分类的评估方法的应用及程序,包括对照指标、院前指数、CRAMS评分法、创伤计分法及简易创伤计分法、START检伤分类法及改良CESIRA分类法.

  5. LAPSS对院外诊断卒中的信度与效度的研究%Reliability and Validity of Los Angeles Pre-hospital Stroke Screen (LAPSS)

    Institute of Scientific and Technical Information of China (English)

    马剡芳; 雷燕妮; 赵性泉; 王文治; 王拥军

    2012-01-01

    目的 探讨LAPSS对院外诊断卒中的可信度与效果.方法 本课题拟用LAPSS 量表在我国特定的中风人群中的诊断效能进行评价研究.采取院外急救人员评价与院内专家评价及最终诊断对比的方法判断量表的敏感度、特异性及准确性.结果 量表在对该研究人群不同时间、不同评定者测量下,结果稳定可靠同质性高.量表具有较高的灵敏度、特异度,具有较高的筛检效度.结论 在院外急救系统推广LAPSS量表有望缩短就诊时间,抓住机会,在时间窗内进行更积极的治疗.院外卒中量表的应用,使院外判断卒中更准确,更及时.%Objective The Los Angeles Pre-hospital Stroke Screen (LAPSS) is a 1-page instrument designed to allow pre-hospital personnel to rapidly identify acute stroke patients in the field. As a promising tool, the LAPSS enable paramedic recognition of stroke with a high degree of sensitivity and simplicity in a short period of time. Methods LAPSS was evaluated for its sensitivity, differentiation and accuracy by being used in a group of stroke patients in both of pre-hospital and in-hospital diagnosis. Results LAPSS is considered a promising tool enabling paramedic recognition of stroke with a high degree of sensitivity and simplicity in a short period of time. Conclusion LAPSS is considered as a reliable, valid in pre-hospital stroke screen and may be used in China . More studies may be required to evaluate in a lager scale.

  6. Issues and Solutions in Introducing Western Systems to the Prehospital Care System in Japan

    Directory of Open Access Journals (Sweden)

    Suzuki, Tetsuji

    2008-08-01

    Full Text Available Objective: This report aims to illustrate the history and current status of Japanese emergency medical services (EMS, including development of the specialty and characteristics adapted from the U.S. and European models. In addition, recommendations are made for improvement of the current systems.Methods: Government reports and academic papers were reviewed, along with the collective experiences of the authors. Literature searches were performed in PubMed (English and Ichushi (Japanese, using keywords such as emergency medicine and pre-hospital care. More recent and peer-reviewed articles were given priority in the selection process.Results: The pre-hospital care system in Japan has developed as a mixture of U.S. and European systems. Other countries undergoing economic and industrial development similar to Japan may benefit from emulating the Japanese EMS model.Discussion: Currently, the Japanese system is in transition, searching for the most suitable and efficient way of providing quality pre-hospital care.Conclusion: Japan has the potential to enhance its current pre-hospital care system, but this will require greater collaboration between physicians and paramedics, increased paramedic scope of medical practice, and greater Japanese societal recognition and support of paramedics.

  7. 102例院前猝死事件发生的特点与复苏的回顾性分析%Retrospective analysis of features and tactics of 102 cases of pre-hospital sudden death

    Institute of Scientific and Technical Information of China (English)

    罗惠玲; 赵静山

    2014-01-01

    Objective To retrospectively analyze the features of 102 cases of pre-hospital sudden death events(SDES) and its effective control measures. Methods Retrospectively analyzing the pathogenesis of the pre-hospital sudden death and its pre-ventive and curative of 102 cases of pre-hospital sudden death inpatients of the department of the ICU of First People’s Hospital of Urumqi during 2004 to 2006. Results The pre-hospital sudden death inpatients of 102 cases, about 59%of them subjected to cardiovascular diseases. With peak age incidence at more than 60 years (61.76%), occurred more in males, in winter. The ditect reasons of sudden death were ventricular tachycardia and ventricular fibrillation. 42 cases of on-site recovery be smaller or equal to 6 min, 10 cases for site recovery about 6~8 min, the rest of the cases ineffective recovery site greater than 8 min. Conclusion It’s emphasized that the patients who haue history of cardiovascular diseases,especially those haue old coronary arte-rial problems have higher possibility of sudden death. Its of great urgency to popularize the skill and consciousness of CPR for the first eyewitness as well as the use of automatic extracoporal defibrillator (AED) in public place. This discussion can supply the evidence to improve the pre-hospital emergency resustitation level.%目的:回顾性分析102例院前猝死事件发生的特点及有效防治措施。方法回顾性分析乌鲁木齐市第一人民医院2004~2006年ICU进行院前急诊救治的102例患者的猝死原因及防治措施。结果院前猝死病例102例,约59%有明确的心血管病史,高发年龄为60岁以上(61.76%),男性多于女性,冬季明显高于其他季节。引起猝死的直接原因:室颤,室速。在≤6 min内进行现场施救的复苏有效为42例,6~8 min内进行现场施救的复苏有效为10例,8 min以上进行复苏的均无效。结论对于已有心血管基础的患者应注意其发生猝死的高度危险性,加快

  8. Benefits of pharmacological facilitation with glycoprotein IIb-IIIa inhibitors in diabetic patients undergoing primary angioplasty for STEMI. A subanalysis of the EGYPT cooperation.

    Science.gov (United States)

    De Luca, Giuseppe; Michael Gibson, C; Bellandi, Francesco; Murphy, Sabina; Maioli, Mauro; Noc, Marko; Zeymer, Uwe; Dudek, Dariusz; Arntz, Hans-Richard; Zorman, Simona; Gabriel, H Mesquita; Emre, Ayse; Cutlip, Donald; Rakowski, Tomasz; Gyongyosi, Mariann; Huber, Kurt; Van't Hof, Arnoud W J

    2009-10-01

    The Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty (EGYPT) cooperation aimed at evaluating, by pooling individual patient's data of randomized trials, the benefits of pharmacological facilitation with Gp IIb-IIIa inhibitors among STEMI patients undergoing primary angioplasty. In the current study we analyze the benefits of early Gp IIb-IIIa inhibitors in diabetic patients. The literature was scanned by formal searches of electronic databases (MEDLINE, EMBASE) from January 1990 to October 2007. We examined all randomized trials on facilitation by early administration of Gp IIb-IIIa inhibitors in STEMI. No language restrictions were enforced. Individual patients' data were obtained from 11 out of 13 trials, including 1,662 patients. Diabetes was present in 281 (16.9%). Early Gp IIb-IIIa inhibitors were associated with improved preprocedural TIMI 3 flow (26.0% vs. 13.1%, P = 0.006), postprocedural TIMI 3 flow (90.1% vs. 75.0%, P = 0.18), MBG 3 (40.8% vs. 30.4%, P = 0.004), and less distal embolization (11.6% vs. 20.8%, P = 0.05). However, early Gp IIb-IIIa inhibitors did not significantly reduce mortality (8.3% vs. 9.5%, P = 0.64). This meta-analysis shows that pharmacological facilitation with early administration of Gp IIb-IIIa inhibitors in STEMI patients with diabetes undergoing primary angioplasty, is associated with significant benefits in terms of preprocedural and postprocedural TIMI flow, improved myocardial perfusion, without significant benefits in mortality.

  9. Can exercise capacity assessed by the 6 minute walk test predict the development of major adverse cardiac events in patients with STEMI after fibrinolysis?

    Directory of Open Access Journals (Sweden)

    Ayman K M Hassan

    Full Text Available BACKGROUND: To assess the added value of the 6 minute walk test distance (6MWTD in the risk-stratification methods for patients with ST -segment elevation myocardial infarction (STEMI treated with fibrinolysis. METHODOLOGY/PRINCIPAL FINDINGS: This is a prospective cohort study of one hundred consecutive patients with STEMI, who had received fibrinolysis, at Assuit University Hospital. All patients underwent 6MWT pre- discharge and were followed up for 3 months to monitor the incidence of major adverse cardiac events (MACE. Patients were divided into 3 groups according to the level of 6MWTD (level I>450 m, level II = 300-450 m and level III450 m, patients in level III (<300 m were more likely to have clinical risk factors as hypertension, diabetes and impaired renal function. The patient's mean TIMI score was 3.4±2.2, the mean GRACE score was 150.5±27.7. There was a significant negative correlation between the 6 MWTD and GRACE risk score (r = -0.80, p<0.001. At 3 months of follow-up, 51% had MACE including 16% were dead. Multivariate logistic regression analysis identified that the GRACE risk score and 6MWT distance levels were the best predictors of the MACE at 3 month of follow up. The incidence of MACE was 4 times higher in patients with high GRACE risk score who couldn't walk more than 300 meters (OR = 4.66, 95% CI = 1.1-14.5, p = 0.006. CONCLUSIONS/SIGNIFICANCE: In patients with STEMI treated with fibrinolysis, the addition of 6MWTD assessment pre-discharge to the traditional GRACE risk score improved the risk prediction of cardiovascular events at 3 month follow up.

  10. Place of pharmaco-invasive approach for revascularization in acute myocardial infarction: Experience of Kuzbass

    Directory of Open Access Journals (Sweden)

    Tavlueva E.V.

    2015-09-01

    Full Text Available The article describes methods for implementation of pharmaco-invasive approach the treatment of acute myocardial infarction with ST-segment elevation (STEMI in the Kemerovo region, Russian Federation. The result of improving cardiac care was 10-fold increase of pre-hospital thrombolytic therapy in STEMI patients. The number of STEMI patients transferred to the PCI-center in the first day increased by 3 times: 22.5% – 2014y, 66.6% – January-June 2015y (p=0.001. The number of STEMI patients transferred to the PCI-center in the first day after thrombolytic therapy increased 4.5%: 23.8% – 2014y, 28.3% – January-June 2015y (p=0.059.

  11. 静脉溶栓治疗对 STEMI 患者窦性心率震荡及 QT 离散度的影响%Effects of intravenous thrombolytic therapy on sinus heart rate turbulence and QT dispersion in patients with STEMI

    Institute of Scientific and Technical Information of China (English)

    廖通; 欧阳学逸; 李焕轮

    2015-01-01

    Objective To investigate the effects of intravenous thrombolytic therapy on sinus heart rate turbulence (HRT)and QT dispersion (QTd)in patients with acute ST-segment elevation myocardial infarc-tion (STEMI). Methods Seventy-eight patients firstly diagnosed with acute STEMI and treated by suc-cessful intravenous thrombolysis were selected as an observation group.Turbulence onset (TO),turbulence slope (TS)and QTd were detected before treatment and 2 weeks after treatment,and the results were com-pared.The incidence of malignant cardiac events within 2 weeks after treatment was recorded. Results Com-pared pre-treatment TO and QTd levels with post-treatment ,there were significant differences (P <0.05);compared to pre-treatment,post-treatment TS was improved(P <0.05).The incidence of malignant car-diac events was 14.10% within 2 weeks after successful thrombosis treatment. Conclusion Intravenous thrombolytic therapy can improve electrical stability of myocardium and cardiac nerve autonomic regulation ca-pacity in STEMI patients.%目的:探讨静脉溶栓治疗对急性 ST 段抬高型心肌梗死(STEMI)患者窦性心率震荡(HRT)及 QT 离散度(QTd)的影响。方法选择首次确诊为 STEMI 并成功实施静脉溶栓治疗的患者78例,于治疗前及治疗2周后,分别检测震荡初始(TO)、震荡斜率(TS)及 QTd,分析比较溶栓前后差异,并记录2周之内心脏恶性事件的发生率。结果TO及 QTd 水平治疗前后比较,差异有统计学意义(P <0.05);治疗后 TS 水平较治疗前明显改善(P <0.05)。成功溶栓治疗后的2周内,心脏恶性事件发生率14.10%。结论静脉溶栓可改善 STEMI 患者的心肌电稳定性和心脏自主神经调节能力。

  12. Association of circulating levels of RANTES and -403G/A promoter polymorphism to acute heart failure after STEMI and to cardiogenic shock.

    Science.gov (United States)

    Lipkova, Jolana; Parenica, Jiri; Duris, Kamil; Helanova, Katerina; Tomandl, Josef; Kubkova, Lenka; Vasku, Anna; Goldbergova Pavkova, Monika

    2015-08-01

    Chemokines, including RANTES, play a crucial role in the processes of inflammation during cardiovascular disorders, including myocardial infarction, disease progression and complications. This study aimed to evaluate the role of RANTES -403G/A polymorphism and levels in circulation in processes of development and progression of myocardial infarction and cardiogenic shock. A total of 609 patients with ST-segment elevation myocardial infarction, 43 patients with cardiogenic shock and 130 control subjects were enrolled in the study. RANTES -403G/A promoter polymorphism and baseline serum RANTES levels were analyzed. In the present study, we associated RANTES -403G/A promoter polymorphism with acute heart failure in patients with myocardial infarction (p = 0.006) and ejection fraction 3 months after MI onset (p = 0.02). Further, a difference in circulating RANTES levels among controls and STEMI subjects, and a relation of serum levels with acute heart failure was observed (p = 0.03, p = 0.003, respectively). We found a significant difference when comparing cardiogenic shock patients and controls (p shock and AHF subgroup of STEMI patients (p shock (cutoff level ≥80.4 ng/ml). Our results suggest the role of RANTES as a potential biomarker of cardiogenic shock and acute heart failure in the hospital phase after myocardial infarction.

  13. Assessment of myocardial injury markers and neurohumoral indicators in serum after STEMI patients received percutaneous coronary intervention combined with thrombus aspiration

    Institute of Scientific and Technical Information of China (English)

    Ling Gong

    2016-01-01

    Objective:To study the myocardial injury markers and neurohumoral indicators in serum after STEMI patients received percutaneous coronary intervention combined with thrombus aspiration.Methods:Patients with acute ST-segment elevation myocardial infarction who received percutaneous coronary intervention in our hospital from May 2010 to December 2015 were selected for study, 48 cases of patients who received PCI combined with thrombus aspiration and 50 cases of patients who received direct PCI were screened and included in experimental group and control group respectively. The degree of myocardial injury and neurohumoral indicators of two groups were compared.Results:Intraoperative TIMI grade of experimental group was significantly higher than that of control group, peak values of CK-MB, cTnT and cTnI 24 h after operation were significantly lower than those of control group, and ST-segment fallback ratio within 1h after operation was significantly higher than that of control group; 24h after operation, serum renin, angiotensin II, aldosterone, sodium and endothlin-1 content of experimental group were significantly lower than those of control group, potassium and nitric oxide content were significantly higher than those of control group, and the number of CD31+/CD42b- EMPs in peripheral blood was significantly lower than that of control group. Conclusion:Percutaneous coronary intervention combined with thrombus aspiration treatment of STEMI can improve coronary perfusion, reduce myocardial cell injury, inhibit RAS system activation and protect endothelial function.

  14. Effect analysis of emergency transradial intervention for STEMI%经桡动脉途径急诊介入治疗STEMI的效果分析

    Institute of Scientific and Technical Information of China (English)

    陈千生; 方勇; 李卫国; 陈开红

    2014-01-01

    目的:分析经桡动脉途径急诊介入治疗ST段抬高型心肌梗死(STEMI)的临床效果。方法:STEMI行急诊PCI患者120例,随机分为经桡动脉组60例,经股动脉组60例,分析两组患者介入治疗的成功率、治疗疗效、穿刺成功时间和术后并发症的情况。结果:经桡动脉组PCI成功率95.00%,经股动脉组PCI成功率96.67%,两组差异无统计学意义(P>0.05)。经桡动脉组并发症发生率3.33%,经股动脉组并发症发生率8.33%,两组比较差异有统计学意义(P<0.05)。另外,两组穿刺成功时间、住院时间及治疗费用比较差异有统计学意义(P<0.05)。结论:经桡动脉途径急诊介入治疗STEMI的成功率与经股动脉相似,而手术并发症发生率低、住院时间短、住院费用低,值得在急诊介入治疗STEMI中推广。%Objective:To analyze the clinical effect of emergency transradial intervention for ST segment elevation myocardial infarction(STEMI).Methods:120 STEMI patients with emergency PCI were randomly divided into the transradial artery group and the transfemoral intervention group with 60 cases in each.The interventional treatment success rate,curative effect,puncture success time and postoperative complications of patients in two groups were compared.Results:The PCI success rate of the transradial artery group was 95.00%;the PCI success rate of the transfemoral intervention group was 96.67%.The difference of two groups was statistically significant(P<0.05).The complication incidence rate of the transradial artery group was 3.33%;the complication incidence rate of the transfemoral intervention group was 8.33%.The difference of two groups was statistically significant(P<0.05).In addition,the differences between the puncture success times,hospitalization times and treatment costs of two groups were statistically significant(P<0.05).Conclusion:The success rate of emergency transradial intervention for STEMI is similar

  15. Analysis of pre-hospital airst aid in patients with paroxysmal supraventricular tachycardia%阵发性室上性心动过速的院前急救分析

    Institute of Scientific and Technical Information of China (English)

    朱洁; 余集才

    2015-01-01

    目的:探讨阵发性室上性心动过速的院前急救方法和疗效。方法以我市急救中心某分站2012年1~12月现场处置的16例Psvt患者为研究对象,对现场急救方法进行分析并总结。结果物理治疗方法(机械刺激迷走神经)转复成功2例,药物治疗方法(普罗帕酮、西地兰)转复成功13例,不成功1例。结论使用机械刺激迷走神经法和使用普罗帕酮或西地兰药物终止Psvt发作是院前急救中安全、可靠、易行的处置手段。%Objective To explore methods and curative effects of pre-hospital first aids in the patients with Paroxysmal supraventricular tachycardia. Methods16 patients with paroxysmal supraventricular tachycardia who were treated on the scene by some emergency center from January to December in 2012 were selected as research objects. The on-site first aid methods were analyzed and summarized.ResultsPhysical therapy(Mechanical stimulation on the vagus nerve) succeeded conversion for 2 patients, Drug treatment(propafenone or cedilanid) succeeded conversion for 13 patients, and failed for one patient.Conclusion Mechanical stimulation on the vagus nerve and drug treatment(propafenone or cedilanid) are both safe, reliable and easy to operate methods of Pre-hospital emergency treatment for PSVT.

  16. Current status of neck collar use in pre-hospital emergency in Hangzhou, Zhejiang Province%杭州地区院外急救颈托使用现状调查与分析

    Institute of Scientific and Technical Information of China (English)

    唐春福

    2013-01-01

    Objective To investigate the current status of neck collar use in pre-hospital emergency in Hangzhou. Methods The clinical data of 1855 prehospital high energy trauma patients in Hangzhou were analyzed so as to survey the neck collar use rate. Results Only 337 patients (19.1%) were given neck collar with a neck collar use rate of 19.1%. Conclusion Most of the high energy trauma patients failed to get neck collar, an effective tool to protect their cervical spinal cord during prehospital emergency treatment. Reasonable use of neck collar during pre-hospital emergency treatment should be promoted.%目的 调查分析杭州地区院外急救颈托使用的现状,为在院外急救中合理规范的使用颈托提供参考依据.方法 对符合标准的1752例高能量创伤患者进行调查,分析颈托不合理使用的现状、原因并提出合理使用的对策.结果 仅19.1%的患者使用了颈托,院外急救中颈托的不合理使用情况较严重.结论 应加强对急救医生创伤知识的培训,提高对高能量创伤的认识,积极推进颈托的合理使用.

  17. An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Forberg Jakob L

    2012-02-01

    Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

  18. Adesão às precauções padrão pela equipe do atendimento pré-hospitalar móvel de Belo Horizonte, Minas Gerais, Brasil Adherence to standard precautions by the public pre-hospital health team in Belo Horizonte, Minas Gerais State, Brazil

    Directory of Open Access Journals (Sweden)

    Aline Cristine Souza Lopes

    2008-06-01

    Full Text Available Estudo transversal com profissionais do Serviço de Atendimento Pré-hospitalar de Belo Horizonte, Minas Gerais, Brasil, com o objetivo de avaliar a adesão às precauções padrão. Instrumento constou de questões sobre conhecimento, atitude e fatores facilitadores à adesão das precauções. Para verificar a adesão considerou-se percentual de adequação: > 75% de respostas corretas. Condutores apresentaram menor e médicos maior grau de conhecimento. No relato das atitudes, profissionais não alcançaram adequação para uso de máscara facial, óculos e equipamento proteção individual (EPI, e, condutores relataram atitude inadequada para todos itens. Na análise univariada, categoria profissional, sexo e unidade de lotação foram associados à adoção das precauções. Já na multivariada, apenas categoria profissional (condutor e técnico/auxiliar enfermagem. Fatores facilitadores mais citados para melhorar adesão foram: treinamentos sobre infecções, riscos ocupacionais e uso de EPI; reuniões periódicas de equipe; e criação de central para limpeza, desinfecção e esterilização de material. Profissionais do Serviço de Atendimento Pré-hospitalar demonstraram atitudes compatíveis com conhecimento. No entanto, a profissão interferiu no conhecimento das medidas de precaução e no relato de atitudes adequadas.This was a cross-sectional study of workers in the pre-hospital care team in Belo Horizonte, Minas Gerais State, Brazil, aimed at evaluating adherence to precautions. The study instrument included questions on knowledge, attitudes, and facilitating factors for adherence to standard precautions. Adherence was verified by percentage of adequacy: > 75% correct answers. Drivers showed the lowest degree of knowledge and physicians the highest. In self-reported answers, none of the workers demonstrated adequate use of face masks, goggles, or personal protective equipment (PPE, and drivers reported inadequate attitudes on all

  19. 替格瑞洛联合比伐卢定对STEMI-PCI患者血小板抑制率、聚集率及预后的影响%Effect of ticagrelor combined with bivalirudin on platelet inhibition rate, aggregation rate, and prognosis in patients with STEMI-PCI

    Institute of Scientific and Technical Information of China (English)

    张晓霞

    2016-01-01

    目的 观察替格瑞洛联合比伐卢定对行冠状动脉介入治疗的ST段抬高心肌梗死(STEMI-PCI)患者血小板抑制率、聚集率及预后的影响.方法 以2014年2月至2015年1月本院心内科收治的80例STEMI-PCI患者为研究对象,随机数字表法均分为观察组和对照组.对照组给予替格瑞洛治疗,观察组替格瑞洛联合比伐卢定治疗,比较治疗后两组血小板抑制率、聚集率及预后.结果 治疗后,观察组血小板抑制率[(80.98±9.98)%]较对照组[(48.89±8.89)%]显著高(P<0.05);两组治疗后血小板聚集率均较治疗前显著降低,且观察组血小板聚集率[(35.69±5.01)%、(29.21±4.33)%、(24.2l±3.21)%]均较对照组显著降低(P< 0.05);观察组治疗后不良事件总发生率显著低于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05).结论 替格瑞洛联合比伐卢定对STEMI-PCI患者改善血小板抑制、聚集作用均显著,对患者预后效果佳.%Objective To observe the effect of ticagrelor combined with bivalirudin on the platelet inhibition,aggregation rate,and prognosis in patients with ST segment elevation myocardial infarction and undergoing percutaneous coronary intervention (STEMI-PCI).Methods Eighty patients with STEMI-PCI admitted into our hospital from February,2014 to January,2015 were randomized into an observation group and a control group.The control group was treated with ticagrelor and the observation group ticagrelor and bivalirudin.The effects on platelet inhibition rate,aggregation rate,and prognosis were compared between these two groups after treatment.Results After treatment,the platelet inhibition rate was significantly higher in the observation group than in the control group [(80.98±9.98)% vs.(48.89±8.89)%] (P < 0.05).The platelet aggregation rates were significantly lower after than before treatment in both groups.The platelet aggregation rates in the observation group [(35.69±5

  20. 2015年《中国急性ST段抬高型心肌梗死(STEMI)诊断治疗指南》要点解读%2015 Chinese Guideline for the Diagnosis and Treatment of Acute STEMI

    Institute of Scientific and Technical Information of China (English)

    范书英

    2015-01-01

    本文从急性ST段抬高型心肌梗死( STEMI)的急救转运流程、再灌注治疗和抗血栓治疗3个方面重点介绍了2015年中国急性STEMI的诊疗更新要点,指出完全再灌注治疗的急救转运流程在整个急性STEMI诊疗中非常重要,是缩短总体缺血时间,保证患者得到完全再灌注治疗的基础和保障。%The paper introduced the 2015 updated Chinese guideline for STEMI treatment from the aspects of first-aid procedure of acute STEMI,reperfusion therapy and antiplatelet therapy. It pointed out that the first-aid procedure of complete reperfusion therapy is very important in the entire treatment of acute STEMI and it reduces total ischemia time and ensures STEMI patients get complete reperfusion treatment.

  1. Outcome of everolimus eluting bioabsorbable vascular scaffold (BVS) compared to non BVS drug eluting stent in the management of ST-segment elevation myocardial infarction (STEMI) — A comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Chakraborty, Rabin; Patra, Soumya, E-mail: dr_soumyapatra@rediffmail.com; Banerjee, Suvro; Pande, Arindam; Khan, Aftab; Mandol, Prakash Chandra; Ghosh, Debashish; De, Swapan Kumar; Das, Sankha Subhro; Nag, Raja

    2016-04-15

    Background: The safety and efficacy of everolimus eluting bioabsorbable vascular scaffold (BVS) in the management of “ST” segment elevation myocardial infarction (STEMI) are yet to be established. Aims: To evaluate immediate and short term safety and efficacy of the everolimus-eluting ABSORB BVS compared with non BVS drug eluting stent (DES) in patients with STEMI. Methods: From December 2013 to December 2014, 220 patients with STEMI were included in this study. Among them, 35 patients treated with BVS were compared with a control group composed of 180 patients who underwent non BVS DES implantation in the same time period. The incidence of major adverse cardiac events (MACE: stent thrombosis: death, non-fatal myocardial infarction, or target vessel/lesion revascularization) before discharge and up to six months was evaluated. Results: 1 vessel disease was more frequent whereas, 2 and 3 vessel disease was less frequent in BVS group. Procedural characteristics were also similar between groups, except for the use of post dilation (p = 0.04). Procedural success, in-hospital, and up to six-month MACE rates were similar between both groups. Definite or probable stent thrombosis did not occur (according to the ARC criteria) in BVS patients, though two patients during the index admission and another two patients in the first month after DES implantation had stent thrombosis. Conclusion: The use of the ABSORB BVS for STEMI is feasible and associated with good procedural safety, and angiographic success rate.

  2. Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours

    DEFF Research Database (Denmark)

    Fakhri, Yama; Busk, Martin; Schoos, Mikkel Malby

    2016-01-01

    -presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters. METHODS: The AW-score (range 1......-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage...

  3. Inhibition of platelet function by abciximab or high-dose tirofiban in patients with STEMI undergoing primary PCI: a randomised trial

    Science.gov (United States)

    van Werkum, J.W.; Gerritsen, W.B.M.; Kelder, J.C.; Hackeng, C.M.; Ernst, S.M.; Deneer, V.H.M.; Suttorp, M.J.; Rensing, B.J.W.M.; Plokker, H.W.M.; ten Berg, J.M.

    2007-01-01

    Background In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI, few data exist on the magnitude of platelet activation, aggregation and dosing of glycoprotein (GP) IIb/IIIa receptor inhibitors. Methods Sixty STEMI patients were randomised to abciximab, to high-dose tirofiban or to no additional GP IIb/IIIa inhibitor treatment. Platelet activation (P-selectin expression) was measured using flow cytometry and the level of inhibition of platelet aggregation was assessed using the Plateletworks assay. Additionally, the PFA-100 with the collagen/adenosine-diphosphate cartridge (CADP) was used to compare the levels of platelet inhibition. All measurements were performed at baseline (T0), immediately after (T1), 30 minutes (T2), 60 minutes (T3) and 120 minutes (T4) after primary PCI. Results The level of platelet activation in both GP IIb/IIIa receptor inhibitor treated groups was significantly lower compared with the control group at all time points after primary PCI (p=0.04). Also the administration of the currently recommended dose of abciximab resulted in significantly lower levels of inhibition of aggregation compared with high-dose tirofiban (p<0.0001). In addition, the CADP closure times were significantly prolonged in both GP IIb/IIIa inhibitor treated groups compared with the control group at time points T1 (p=0.006) and T4 (p<0.0001). Conclusion The administration of high-dose tirofiban resulted in a significantly higher inhibition of platelet aggregation compared with the currently recommended dose of abciximab. Large clinical trials are needed to assess whether this laboratory superiority of high-dose tirofiban translates into higher clinical efficacy. (Neth Heart J 2007;15:375-81.18176639) PMID:18176639

  4. 德阳市19288例院外急救流行病学调查与分析%Epidemiology analysis on the pre-hospital patients in Deyang

    Institute of Scientific and Technical Information of China (English)

    鄢涛; 王森; 谭鸿; 姜伟; 刘辉; 李远建; 胡壮俐

    2012-01-01

    目的 调查了解德阳市院外急救患者流行病学特点,以提高院外急救质量和管理水平.方法 选用德阳市紧急救援指挥中心救护记录单为调查表,调查对象为2010年l月1日~12月31日德阳市急救中心所有院外急救患者,共19 288例,采用现况研究.结果 德阳市院外急救调度时间、到达时间、现场时间、返回时间分别为(1.88±0.91)min、(14.45±6.41)min、(14.17±5.26)min、(13.84±5.89)min.院外急救病种前5 位是创伤(37.59%,7 250/19 288)、脑血管病(19.09%,3 682/19 288)、心血管病(17.81%,3 436/19288)、呼吸系统疾病(10.47%,2 019/19 288)、中毒(5.93%,1 144/19 288).结论 德阳市院外急救有其自身的流行病学特点,本调查为德阳市院外急救的管理和建设提供了一定的参考依据.%Objective To investigate the epidemiological characteristics of the pre-hospital patients and distribution of disease, for provide reference to improve the Emergency medical treatment system in Deyang city. Method 19288 patients who called for pre-hospital first aid from 2009-01-01 to 2009-12-31 in Deyang city were analyzed. Results The dispatching time, ambulance running time, treatment time, returning time were (1.88±0.9l)min,(l4.45±6.4l)min,(l4.17±5.26)min,(l3.84±5.89)min respectively. The top five causes of emergency call were trauma(37.59% , 7 250/19 288), cerebrovascular diseases (19.09% , 3 682/19 288), cardiovascular diseases (17.81%, 3436/19288), respiratory diseases(10.47% , 2 019/19 288) and poisonings (5.93% , 1 144/19 288) respectively.Conclusion These results of epidemiology analysis on the pre-hospital patients could provide relative data for building emergency treatment system in Deyang city

  5. The application of the mobile telemedicine system in pre-hospital emergency treatment of severe traumatic brain injury%远程医疗系统在重型脑外伤院前救治中的应用

    Institute of Scientific and Technical Information of China (English)

    鲜华; 李捷; 刘斌; 谭杜勋; 欧阳晟

    2012-01-01

    目的 探讨远程医疗系统在重型脑外伤院前急救中应用的效果.方法 选取2010-10~2011-09运用远程医疗系统后我院"120"院前急救重型脑外伤患者37例(远程组),与2009-10~2010-09运用远程医疗系统前我院"120"院前急救重型脑外伤患者34例(传统组)进行对比.结果 两组患者受伤至到达急诊科时间比较差异无统计学意义(P>0.05).受伤至获确切治疗时间远程组较传统组显著缩短(P<0.05).死亡率远程组较传统组显著降低(P<0.05).结论 在重型脑外伤院前急救中应用远程医疗系统,可使院内治疗提前,缩短获得确切治疗的时间,使院内与院前急救无缝隙衔接成为可能,降低重型脑外伤的死亡率.%Objective To investigate the effect of the mobile telemedicine system applications in severe traumatic brain injury in pre - hospital emergency medical services. Methods Clinical data of 37 acute severe traumatic brain injury patients after using of the mobile telemedicine system in ambulances from October 2010 to September 2011 (mobile group) and 34 acute severe traumatic brain injury patients before using of wireless mobile IT in ambulance from October 2009 to September 2010 (traditional group) were collected. The data of these two groups were retrospectively analyzed and compared. Results There was no significant difference of the time from injury to arrive at the emergency department between two groups. The time from injury to be given the exact treatment of mobile group was significantly shorter than that of the traditional group ( P < 0. 05 ). Comparing to traditional group, the mortality of the mobile group was significantly reduced( P < 0. 05 ) . Conclusion For pre -hospital emergency treatment of severe traumatic brain injury, the mobile telemedicine system enables hospital treatment in advance and therefore shortens the waiting time to get the exact treatment, the mobile telemedicine system can be used to establish a continuous

  6. Pre-hospital emergency treatment and prognosis analysis of patients with severe brain injury accidents: a report of 1107 cases%交通事故性重型颅脑损伤院前急救与预后关联分析(附1107例报告)

    Institute of Scientific and Technical Information of China (English)

    胡明军; 杭军; 温大平; 徐如祥; 姜晓丹; 蔡颖谦; 罗成义; 宋国忠; 王学文; 王钢; 崔健

    2011-01-01

    Objective To analyze the importance of pre-hospital emergency treatment in patients with severe head injury in traffic accidents in terms of time and explore the general rule of severe head injury in traffic accidents to provide some evidence for relevant authority making the prevention and control measures of acute traumatic brain injury. Methods The patients were selected according to "statistical table of severe head injury in a traffic accident" established by our department; their correlated data were statistically analyzed. Based on the time intervals between receiving telephone time asking for first-aid and arriving to location of incidence, and time intervals between time of giving first-aid and injured time, the regularity of prognosis was analyzed.Results With the prolonged time intervals between time of giving first-aid and injured time, the mortality and disability rates gradually increased,followed by poor prognosis, which indicated that the prognosis was negatively correlated to the delayed time on the way and the on-site rescue time (rs=-0.10,P=0.002; rs=-0.06,P=0.034). Conclusion Prevention and control center for acute brain injury should be built and the roles for pre-hospital emergency treatment and transportation should be established to decrease the injured time (the delayed time on the way and the on-site rescue time) to improve the quality of care, and to reduce the death and disability in patients with severe head injury in traffic accidents.%目的 探讨院前急救在时间环节上对交通事故性重型颅脑损伤预后的重要性,为我国相关部门制定预防和控制措施提供参考依据.方法 根据珠江医院神经外科制定的严格筛选出合格病例,对其相关资料进行统计学分析,主要分析急救接报时间与到达现场时间差的不同时间段以及现场抢救中不同时间段与患者预后的相关性.结果 急救接报到到达现场时间段以及现场抢救时间段与患者预

  7. Health Care System Delay and Heart Failure in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Follow-up of Population-Based Medical Registry Data

    DEFF Research Database (Denmark)

    Terkelsen, Christian Juhl; Jensen, Lisette Okkels; Hansen, Hans-Henrik Tilsted;

    2011-01-01

    In patients with ST-segment elevation myocardial infarction (STEMI), delay between contact with the health care system and initiation of reperfusion therapy (system delay) is associated with mortality, but data on the associated risk for congestive heart failure (CHF) among survivors are limited....

  8. Large discrepancy between prehospital visitation to mobile emergency care unit and discharge diagnosis

    DEFF Research Database (Denmark)

    Holler, Christine Puck; Wichmann, Sine; Nielsen, Søren Loumann

    2012-01-01

    In Copenhagen, Denmark, patients in need of prehospital emergency assistance dial 112 and may then receive evaluation and treatment by physicians (from the Mobile Emergency Care Unit (MECU)). ST-elevation myocardial infarction (STEMI) is a severe condition leaving only a limited time frame to del...... diagnosis on the scene and, furthermore, to compare these on-scene diagnoses with the primary discharge diagnoses from hospital....

  9. Clinical observation of thrombolytic therapy combined with emergency PCI in treatment of STEMI%静脉溶栓联合急诊PCI治疗STEMI的临床观察

    Institute of Scientific and Technical Information of China (English)

    李素姣; 刘现义; 万迎杰; 宋书香; 王晓蕾; 张旭鸽; 王玉佳

    2015-01-01

    Objective To observe the efficacy and safety of early coronary angiography or PCI treatment when necessary after thrombolytic therapy in patients with STEMI.Methods Patients with STEMI who received diagnosis in department of cardiology in People' s hospital of Jiaxian were selected as the research objects.Eighty cases of STEMI as the control group were given the coronary angiography after 7-10 days of urokinase thrombolysis ; the other 80 cases of STEMI as the research group were given the coronary angiography binding urokinase thrombolysis within 24 h.Then the incidence of cardiovascular events and the length of hospitalization time of two groups were compared.Results The incidence of cardiovascular events and the length of hospitalization time in the research group were obviously lower than that in the control group there were significanct differences (P < 0.05).Conclusions For STEMI patients,early given the coronary angiography or made PCI treatment when necessary after thrombolytic therapy and have lower incidence of cardiovascular events,shorter length of stay in hospital and less risk of hemorrhage.%目的 观察急性ST段抬高型心肌梗死(STEMI)患者静脉溶栓后早期联合冠脉造影必要时行PCI治疗的有效性和安全性.方法 以郏县人民医院心内科住院诊断为STEMI患者为研究对象,收集进行尿激酶溶栓后7~10d行冠脉造影术的STEMI患者80例为对照组;收集诊断为STEMI尿激酶溶栓后24 h内联合冠脉造影患者80例为研究组,比较两组患者住院期间心血管事件发生率、住院时间等方面的差异.结果 研究组在住院期间住院时间及心血管事件发生率均显著低于对照组,差异有统计学意义(P<0.05).结论 溶栓后早期联合冠脉造影必要时行PCI治疗,可缩短患者住院时间,减少心血管事件的发生率,但不增加出血的风险.

  10. IVUS在STEMI患者急诊介入诊疗中的应用%The IVUS application research of the STEMI patients in the emergency diagnosis and treatment

    Institute of Scientific and Technical Information of China (English)

    宗振方; 董平栓; 王可; 尚喜艳; 李治国; 闫鹏; 李志娟; 翟秋翎; 孟雅丽

    2013-01-01

    Objective Explore intravascular ultrasound (IVUS) in patients with acute ST-segment elevation myocardial infarction (STEMI) in the application of emergency intervention. Methods Eighty patients within 12 h of a STEMI episode , who had ifxed stenosis (50%to 75%stenosis) of infraction related artery(IRA) by the coronary angiography (CAG) identiifed as the coronary intermediate lesion ,accompanying with a TIMI 3 lfow at the distal end of the coronary artery, were included. These patients were randomly divided into the IVUS (test group, n=38) and non-IVUS groups (control group, n=42). All the patients in the control group were implanted the stent, while the test group was further divided into the low-risk patients and high-risk patients according to the evaluation of IVUS, and then decided whether implanting the stent or not. We observed the incidence of the major cardiovascular events, the change of the left ventricular end diastolic diameter (LVEDD) and ejection fraction (EF), the number of stents implantation among the hospitalisation and 1, 3, 6 and 12 months after the surgery. Results There were no statistical signiifcant differences of incidence of adverse cardiac events, LVEDD and EF between the two groups among the hospitalisation and 1, 3, 6 and 12 months after the surgery (P>0.05). The number of stents implantation in the test group was signiifcantly less than the control group (P<0.05). Conclusion Under the guide of IVUS in emergency intervention, it was safe and feasible for the low-risk STEMI patients without stent implantation, reducing the stent implantation.%目的:探讨血管内超声(IVUS)在ST段抬高型心肌梗死(STEMI)患者急诊介入诊疗中的应用。方法选择冠状动脉造影(CAG)提示心肌梗死相关血管(IRA)固定狭窄为临界病变的STEMI患者80例,发病在12小时内,并且远端血流TIMIⅢ级;随机分为IVUS组(试验组)38例和未行IVUS组(对照组)42例;对照组全部置入

  11. The effects of different pre-hospital intervention of treatment modes on the prognosis of patients with severe multiple trauma%不同院前干预救治模式对重症多发创伤患者预后的影响

    Institute of Scientific and Technical Information of China (English)

    周开国; 李建忠; 贾慧林; 马炳辰; 曹秋梅

    2016-01-01

    Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma.Methods The general data of 396 patients with severe trauma [injurey severity scores (ISS) ≥25] in our hospital emergency for treatment from January 1,2008 to January 1,2012 was collected.The trauma patients were divided into study group and control group.In the study group,the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1,2010.In the control group,the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1,2010.The injury severity score,medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups.Results The emergency treatment time,length of hospital stays,ICU admission rate,prehospital mortality rate,long-term (6 months) disability rate,and complication rate in the study group were lower than those in the control group,presenting (78.23 ± 21.57) min vs.(96.45 ± 35.14) min,(23.55±12.46) dvs.(28.67±20.72) d,8.1% (18/222)vs.65.5% (114/174),13.3% (34/256) vs.21.6% (48/222),4.1% (9/222)vs.9.2% (16/174),8.1% (18/222)vs.18.4% (32/174),in which the differences were statistically significant (P < 0.05).Hospital mortality in the study group was also lower than that in the control group,showing 8.1% (18/222) vs.12.6% (22/174),but there was no statistically significant difference (P < 0.05).There was no significant difference in time from occurrence of injury to receiving treatment between the two groups.Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode.It is a good alternative emergency mode.%目的 探讨不同院前救治模式对重症创

  12. 院前病情评估表对急诊患者分诊的指导意义%Guiding Significance of Pre-hospital Condition Assessment for Emergency Triage

    Institute of Scientific and Technical Information of China (English)

    胡登科; 刘利生; 刘晓海; 朱勇

    2014-01-01

    Objective To discuss the values and guiding significance of pre-hospital condition assessment for emer-gency triage. Methods A total of 1 810 patients who visited Department of Emergency,the Fourth People's Hospital of Li-anyungang from August 2012 to January 2014 were enrolled in this study. The experienced nurses observed and scored the pa-tients' age,temperature,heart rate respiration frequency,blood pressure,blood oxygen saturation,state of consciousness, and divided the patients,according to score standards,into mild,moderate,severe,critical conditions,and followed physi-cians' disposals for the patients. Results The emergency physicians( doctor group) and triage nurses( nurse group) evalua-ted the 1 810 patients' condition. There was no significant difference in condition evaluation between 2 groups(P>0. 05). In 21 patients who were assessed as severe condition by nurse group,18 were assessed as severe,3 as moderate by doctor group;in 10 patients who were assessed as critical condition by nurse group,9 assessed as critical,1 as severe by doctor group. Conclu-sion Pre-hospital condition assessment which can score emergency patients' condition and help triage,is of a certain role in i-dentifying potential critical patients and has them treated first. It is an emergency triage method worthy of generalization.%目的:探讨院前病情评估表对急诊患者分诊的价值与指导意义。方法选取2012年8月—2014年1月于连云港市第四人民医院急诊科就诊的患者共1810例,由有经验的分诊护师按照院前病情评估表对患者进行年龄、体温、心率、呼吸、血压、血糖、血氧饱和度、意识状态的评估并评分,按评分标准将患者病情分为轻、中、重、危(护师组);同时追踪急诊医师对患者的评估结果(医师组)。结果医师组和护师组对急诊患者病情的评估比较,差异无统计学意义( P>0.05)。其中被护师组评估为重的21例中18

  13. Current Status of Applications of Scoring Tool in Pre-hospital Care and Its Prospect in China%我国院前急救中评分工具的应用现状与展望

    Institute of Scientific and Technical Information of China (English)

    唐维骏

    2011-01-01

    This paper reviews the application status and clinical evaluation of several scoring tools applying to prehospital first - aid and the difficulties and challenges we are currently facing in China. The future research direction is how to improve the sensitivity and specificity of scoring tools and how to use them to score disease severity and disability, etc. except death , thus to make the scoring system more perfect.%本文综述了适用于院前急救中的几种评分工具在国内的应用现状和临床评价,及目前面临的困境与挑战.认为今后的研究方向是如何提高评分工具的灵敏度和特异度,并对死亡之外的疾病严重程度和伤残等进行评分,使评分系统更加完善.

  14. Cause of pedo-burn and its statistical data analysis of pre-hospital care%小儿烧伤致伤因素及院前急救统计分析

    Institute of Scientific and Technical Information of China (English)

    李应贵

    2008-01-01

    目的:了解小儿烧伤的致伤因素和院前急救现状.方法:对十年来两家医院收治的小儿烧伤1403例按年龄、原因、场所以及院前急救进行回顾性分析.结果:小儿烧伤以0~3岁居多(占57.09%);热液烫伤比例大(占70.28%);家庭为烧伤主要场所(占78.12%);院前急救失误普遍存在,其中创面处理不当、未建立有效静脉通道和人为原因延误治疗比例较大.结论:小儿烧伤有一定规律,院前急救应加以重视.

  15. Effect analysis of applying cervical spine immobilization in pre-hospital care of patients with craniocerebral injury%颅脑损伤患者院前急救中应用颈托制动的效果分析

    Institute of Scientific and Technical Information of China (English)

    刘志明

    2014-01-01

    目的 探讨颅脑损伤患者院前急救中应用颈托制动的临床疗效.方法 选取2012年1月~2013年12月本院急诊中心接诊的颅脑损伤患者160例为研究对象,根据院前急救措施不同分为观察组和对照组各80例,对照组采用传统的治疗方式进行救治;观察组在对照组的基础上加用颈托制动的方式进行救治.比较两组院前急救的救治效果、院内死亡率.随访6~12个月,采用卡诺夫斯基健康状况量表(KPS)评估患者的生活质量.结果 观察组的总有效率为73.75%,死亡率为20.00%;对照组的总有效率为57.50%,死亡率为23.75%,两组的总有效率差异有统计学意义(P<0.05),死亡率差异无统计学意义(P>0.05).两组上急救车时及到医院时的呼吸、心率、收缩压、舒张压及血氧饱和度差异有统计学意义(P<0.05);两组到医院时的呼吸、心率、收缩压、舒张压及血氧饱和度均较治疗前改善(P<0.05),且观察组改善效果优于对照组(P<0.05).两组治疗后的KPS评分均较治疗前提高(P<0.05),且观察组明显高于对照组(P<0.05).结论 颅脑损伤患者院前急救中应用传统治疗结合颈托制动的方式进行救治的效果优于传统的治疗方式.

  16. An effectiveness study of vertigo treatment with balance acupuncture in pre-hospital emergency%平衡针在院前急救中对眩晕治疗效果的评价

    Institute of Scientific and Technical Information of China (English)

    杨时鸿; 龙亚秋; 郑珊珍; 覃小兰

    2012-01-01

    Objective To evaluate the efficacy of the balance acupuncture as a treatment in pre-hospital emergency. Methods This study is a randomized, placebo-controlled and the third-party blind method trial. A total of 67 eligible vertigo patients were randomly assigned to balance acupuncture treatment group (n = 34) and control group (n = 33). Meanwhile, all the patients received the routine therapeutic treatment. The vestibular symptom index (VSI) scores were assessed 15 minutes and 60 minutes after the treatments besides safety index. Results (1) There is significant difference between the balance acupuncture treatment group and control group when comparing the VSI scores, on dizziness, visual acuity, nausea, vomiting and headache scores, 15 minutes after the treatment (P 0.05). There is significant difference between the balance acupuncture treatment group and control group when comparing the VSI scores, on vertigo, dizziness, nausea, vomiting scores, 60 minutes after the treatment (P 0.05). (2) When comparing the curative effect 1 hour after the treatments, the balance acupuncture treatment group is superior to control group (P 0.05).两组治疗后60 min VSI评分比较,眩晕、头晕、恶心呕吐评分,差异有统计学意义(P0.05).(2)治疗后1 h疗效,试验组优于对照组(P<0.01).结论:在院前急救中平衡针治疗对眩晕疗效明显,有良好的安全性.

  17. 院前急救的护理风险及防范措施分析%Analysis of Nursing Risks and Preventive Measures of Pre-hospital Emergency

    Institute of Scientific and Technical Information of China (English)

    郭明清

    2013-01-01

    探讨院前急救中可能存在的护理风险,并对护理风险的防范措施进行分析和探讨。院前急救存在的主要护理风险有:风险不确定性强,对护理人员要求较高,各种原因导致容易发生护理差错,有的护理人员风险意识薄弱,人力资源和物资问题也是造成护理风险的一个重要方面。为减少护理风险,应加强护理管理,学习护理风险相关法律法规,注意定期检查急救物品,加强护理人员操作技能的培训。%To discuss the nursing risk that may exist in the prehospital emergency, and analyze and discuss the prevention measures of nursing risk. The main nursing risk of pre hospital first aid included:risk uncertainty, higher requirements for nursing staf , nursing errors of al causes, the weakness of some nurses' risk awareness, and human resource and material problems were also the important aspects that caused nursing risk. In order to reduce nursing risks, we should strengthen nursing management nursing risk, study relevant laws and regulations, pay at ention to regularly check first aid items, and strengthen the training of nursing skil .

  18. 谈院前急救及与院内治疗的无缝隙链接%Discussion on Pre-hospital First Aid before and Seamless Links

    Institute of Scientific and Technical Information of China (English)

    张参军; 王博; 张丽娟; 谈君; 武将; 李源文

    2011-01-01

    从院前急救的重要性、特点、任务、原则4方面探讨了院前急救与院内救治无缝隙链接的意义.提出畅通的"急救绿色通道"是无缝隙链接急救的基础,伤病员的现场施救、途中救护到院内抢救、手术住院治疗等连续性的无缝隙链接急救方式,可为抢救伤病员赢得时间,可大大缩短伤员获得确定性治疗的时间,可更好地保障突发事件意外情况下危重伤病员的生命安全.%This article probed the significance of seamless link between pfe-hospital first aid and hospital treament,fiom the 4 aspects of pre-hospital first aid:importance,features,tasks,principles. Proposed that the smooth "first aid green channel"was the basis of seamless link emergency,the seamless link emergency style,such as the on-site rescue of the sick and worunded,ambulance en route to the hospital emergency treatment,surgey and other hospital treatment,can win the prime time to rescue the wounded and sick,can greatly shorten the time of the wounded receiving certainty treatment and better protect the lives of sick and wounded incritical emergency accident cases.

  19. Characteristic analysis of pre-hospital treatment of 247 patients with cardiac arrest%院前救治247例心脏骤停患者特点分析

    Institute of Scientific and Technical Information of China (English)

    陈志刚; 吴敏; 邱晨; 何斌

    2015-01-01

    Objective:To explore the characteristics of cardiac arrest of Zhenjiang area. Methods:Datas of pre-hospital treat-ment of patients with cardiac arrest were retrospectively analysed from January 1,2013 to December 31,2013 of Zhenjiang Emer-gency Medical Center. Results:There were 247 cases , including 174 male and 73 female(male:female=2.38:1). The ages were from 1to 106 years , male age 63.14 ± 20.02,women age 69.82±17.63(P<0.05);median number(four points bit spacing)age [M (Qr)]=69(53,80). At home 175 cases, other areas 72 cases. Scene rescued and transported to hospital 180 cases, and no transport-ed 67 cases. Emergency reaction shortest time was 1 minutes,longest was 36 minutes,median(four points bit spacing)time [M (Qr)]=9(6,12)min, over 12 min was 60 cases (24.29%). Scene CPR was 16 cases(6.48%),including at home 6 cases, bystander 4 cases and medican 6 cases .And there were 3 cases achieved pre-hospital ROSC(1.21%). In December the cardiac arrest patients number was highest , 36 patients(14.57%);and the numbers in Feb、Mar、Nov were all beyond 10%. Patients with ages over 21 years had the highest arrest rates during 8AM to 4PM. 31 cases had no obvious medical history, while 166(67.21%)had, in which 113(45.75%)with a primary disease, 53 (21.46%) with two or more primary diseases. Conclusion:Sudden out-hospital cardiac ar-rest in Zhenjiang area occurred easily in winter, and most patients were older people with cardiac and brain vascular primary diseas-es. As well as doing well the prevention works , dual network should be strengthened in the construction of community first aid and pre-hospital rescue, and prolonged cardiopulmonary resuscitation.%目的:分析江苏镇江地区院外心脏骤停患者特点。方法:采用回顾性分析方法,对江苏镇江市急救中心2013年1月1日—12月31日院前救治心脏骤停患者的资料进行统计与分析。结果:247例心脏骤停患者,男性174例,女性73例(男:女=2.38:1

  20. The Tactical Combat Casualty Care Casualty Card TCCC Guidelines - Proposed Change 13-01

    Science.gov (United States)

    2013-04-30

    Summers Col Stacy A. Shackelford , USAF COL John B. Holcomb, USA (Ret.) Col Jeffrey A. Bailey, USAF DISCLAIMER: The recommendation contained herein is the...Brunstetter T. J., Diaz G. Y., Kirkpatrick J. W., Summers N. L., Shackelford S. A., Holcomb J. B., Bailey J. A., 5d. PROJECT NUMBER 5e. TASK...Butler FK, Edgar EP, Shackelford SA, Bennett DR, Bailey JA: Saving Lives on the Battlefield: A Joint Trauma System Review of Pre-Hospital Trauma Care in

  1. A inserção da enfermeria no atendimento pré-hospitalar: histórico e perspectivas atuais La inserción de la enfermera en la atención pre-hospitalaria: reseña historica y perspectivas actuales Nurse integration into pre-hospital medical services: historical outline and current perspectives

    Directory of Open Access Journals (Sweden)

    Viviane Oliveira Ramos

    2005-06-01

    Full Text Available Estudo bibliográfico de caráter histórico que tem por objetivos identificar marcos históricos da inserção da enfermeira no atendimento pré-hospitalar, identificar as transformações ocorridas em sua atuação e as conexões com os aspectos legais do exercício profissional. Foram analisados três teses e seis artigos de periódicos, encontrados na consulta às bases de dados LILACS, BEDENF E DEDALUS, mais seis documentos legais encontrados em sites de organizações governamentais e Associações de Classe. Os resultados encontrados permitiram apreciar os marcos históricos, a atuação da enfermeira nesta área e os aspectos legais que envolvem seu exercício.Estudio bibliográfico de carácter histórico que tuvo por objetivo identificar el marco que permitió la inserción de la enfermera en la atención pre-hospitalaria, las transformaciones que se dieron en su participación en este tipo de atención y las conexiones con los aspectos legales del ejercicio profesional. Fueron analizados seis artículos de periódicos y tres tesis, que se encontraron consultando las bases de datos LILAS, BEDENF y DEDALUS, y seis documentos legales, que se consiguieron en sitios de Internet de organizaciones governamentales y Asociaciones Profesionales. Los resultados encontrados permitieron apreciar el marco histórico, la participación de la enfermera en esta área y la conexión con los aspectos legales que regulan su ejercicio.This historical and bibliographic study aimed to identify the background that enabled the nurse integration into pre-hospital care, the transformations and the underwent involvement after his/her integration and the link to legal aspects of professional practice. The analysis considered six journal articles and three thesis found in LILAS, BEDENF and DEDALUS databases , and six legal documents downloaded from government organizations' official websites and professional associations. Results allowed in an understanding of the

  2. 建立院前急救数据库的4种数据录入软件的对照研究%Comparative study of four kinds of data entry software for establishing pre-hospital first aid database

    Institute of Scientific and Technical Information of China (English)

    徐平; 章成

    2011-01-01

    Objective To choose a software which can perform data entry simply and quickly to establish a pre-hospital first aid database.Methods 20 medical records of pre-hospital first aid in Zigong emergency medical center in 2009 were selected, and 20 participants entered the same 20 medical records into computers by means of SPSS13.0, Microsoft Access 2003, Microsoft Excel 2003 and pre-hospital first aid electronic medical record software of our own design in different time. Entry time,entry accuracy and degrees of customer satisfaction were recorded and compared.Results Comparison of average entry time using pre-hospital first aid electronic medical record software with that using SPSS13.0 showed no statistically difference(P>0.05) , but they were both less than that by means of Microsoft Access 2003 and Microsoft Excel 2003 (P<0.05) ; Comparison of average entry error rates using pre-hospital first aid electronic medical record software with that using Microsoft Access 2003 showed no significantly difference(P>0.05) , but they were both lower than that by means of SPSS13.O and Microsoft Excel 2003(P<0.05) ; Pre-hospital first aid electronic medical record software possessed the highest satisfaction score among the 4 kinds of software while Microsoft Excel 2003scores,the lowest.Conclusion The pre-hospital first aid electronic medical record software is a simple and practical tool for establishing pre-hospital first aid database with features of quick entry and high accuracy.%目的 选择简便、快捷的数据录入软件以构建院前急救数据库.方法 抽取2009年自贡市急救中心院前急救病历20份,20名数据录入人员在不同时间用SPSS13.0、Microsoft Access 2003、Microsoft Excel 2003及自行设计的院前急救电子病历软件录入相同的20份病历数据,记录并比较这4种软件的录入时间、录入准确率及用户满意度.结果 院前急救电子病历软件与SPSS13.0软件平均录入时间比

  3. The epidemiological analysis of patients in pre-hospital sudden cardiac death for our large and medium sized cities%我国大中城市院前心脏性猝死流行病学调查分析

    Institute of Scientific and Technical Information of China (English)

    张在其; 李金年; 林才经; 刘向; 陆家韬; 孟庆华; 宁哗; 裴雅春; 孙文会; 熊悦安; 张斌; 骆福添; 赵兴吉; 欧阳文伟; 陈文标; 陈玮莹; 郭彦池; 杨正飞; 黄子通; 陈兵; 陈锋; 公保才旦; 黄力; 柯俊; 赖欣; 李继良

    2010-01-01

    of female patients, and its age was less than that of female patients. ④The percentage of witness' CPR was 4.48%, and the success rates of medical care personnel' CPR was 2. 26%. Conclusion ①The sudden cardiac death is the overriding reason of death in our large and medium-sized cities. ②It is very important to cut the death rate of the middle-old age patients by strengthening prevention and cure of cardiovascular diseases, discerning the critical illness early,improving the level of pre-hospital medical care and popularizing CPR to public.

  4. 心电图参数和心肌酶峰与前壁 STEMI 患者短期心功能的相关性%Correlation among electrocardiogram indexes,myocardial enzyme peak and short term cardiac function in patients with anterior STEMI

    Institute of Scientific and Technical Information of China (English)

    董彬; 赵娜; 陈东芳

    2015-01-01

    目的:探讨心电图和心肌酶峰与急性前壁 ST 段抬高型心肌梗死(STEMI)患者短期心功能的相关性。方法:选择我院收治的150例急性前壁 STEMI 患者,根据3个月的左室射血分数(3m LVEF),分为心功能不良组(LVEF<50%,78例)和心功能正常组(LVEF≥50%,72例)。比较两组患者梗死相关导联心电图的 ST 段抬高幅度之和(ΣST)、R 波振幅之和(ΣR)、Q 波之和(ΣQ)、ST 段抬高最大值(STm)、Q 波最大值(Qm),以及CK 的峰值(CKm)、CK-MB 的峰值(CK-MBm)、cTnT 的峰值(cTnTm)等指标。结果:与心功能正常组比较,心功能不良组ΣST、ΣQ、STm、Qm、CKm、CK-MBm、cTnTm,左室舒张末期内径(LVEDd),3mLVEDd 均显著增大,ΣR、LVEF、3mLVEF 均显著减小(P <0.05或<0.01);Spearman 相关分析显示,ΣST、ΣQ、STm、Qm、CKm、CK-MBm、cTnTm 与3m LVEDd 均呈正相关(r =0.18~0.63,P <0.05或<0.01),与3m LVEF均呈负相关(r =-0.88~-0.42,P 均<0.01)。ΣR 与 LVEDd,3m LVEDd 呈负相关(r =-0.46、-0.51,P<0.01),与 LVEF,3m LVEF 呈正相关(r =0.81、0.71,P 均<0.01)。结论:前壁 STEMI 患者的 ST 段抬高越多,Q 波越大,R 波越小,心肌酶峰越高,患者短期的心功能越差。%Objective:To explore the correlation among ECG indexes,myocardial enzyme peak and short term cardi-ac function in patients with acute anterior ST elevation myocardial infarction (STEMI).Methods:A total of 150 pa-tients with acute anterior STEMI were selected from our hospital.According to left ventricular ejection fraction af-ter three months (3m LVEF),they were divided into cardiac dysfunction group (n=78,LVEF<50%)and normal cardiac function group (n= 72,LVEF≥ 50%).Following indexes were compared between two groups,including sum of ST elevation extent (ΣST),R wave (ΣR),Q wave (ΣQ),maximum value of ST elevation

  5. Curative Effects of Urokinase Thrombolysis for STEMI on the Onset within 2h%尿激酶溶栓治疗发病2h内急性ST段抬高型心肌梗死的疗效

    Institute of Scientific and Technical Information of China (English)

    盛祖桃; 吕云; 高彦

    2015-01-01

    目的:研究急性ST段抬高型心肌梗死( STEMI)患者在发病的2 h内采用尿激酶溶栓的疗效。方法选取72例2013年2月~2014年2月接收的STEMI患者,依据发病时间的不同分为对照组和研究组,溶栓后2 h内,研究组较对照组的临床再通率明显要高,复合终点事件的总发生率明显低于对照组( P<0.05),具有统计意义。结论发病在2 h内的STEMI患者采取尿激酶溶栓治疗,可明显提高患者的血管再通率,病死率较低,值得推广。%Objective To study the curative effects of urokinase thrombolysis for patients with STEMI on the onset within 2 h.Methods 72 patients with STEMI treated from February 2013 to February 2014 in our hospital were selected and divided into control group and research group according to the duration of disease .The recanalization rate of research group was significantly higher than that of control group;the total incidence of composite endpoint was significantly lower than that of control group (P<0.05).Conclusions The treatment of urokinase thrombolysis for patients with STEMI on the onset within 2 h can significantly improve the recanalization rate and reduce the fatality rate .It is worthy of clinical promotion.

  6. In-ambulance abciximab administration in STEMI patients prior to primary PCI is associated with smaller infarct size, improved LV function and lower incidence of heart failure: results from the Leiden MISSION! acute myocardial infarction treatment optimization program.

    Science.gov (United States)

    Hassan, Ayman K M; Liem, Su San; van der Kley, Frank; Bergheanu, Sandrin C; Wolterbeek, Ron; Bosch, Jan; Bootsma, Marianne; Zeppenfeld, Katja; van der Laarse, Arnoud; Atsma, Douwe E; Jukema, J Wouter; Schalij, Martin J

    2009-08-01

    Our aim was to evaluate the effects of early abciximab administration in the ambulance on immediate, short, and long term outcomes. Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is recommended in practice guidelines. However, optimal timing of administration remains indistinct. Within a fixed protocol for PPCI, December 2006 was the cut-off point for this prospective study. A total of 179 consecutive patients with STEMI were enrolled, 90 patients received abciximab bolus in the hospital (in-hospital group), and 89 patients received abciximab bolus in the ambulance (in-ambulance group). The two groups were comparable for baseline and angiographic characteristics. The in-ambulance group received abciximab within the golden period (median 63 min). The infarct related artery (IRA) patency at onset of the PCI was four times higher in the in-ambulance group compared to in-hospital group (odds ratio = 4.9, 95% CI 2.4-10.1). Enzymatic infarct size was smaller in the in-ambulance group (cumulative 48-h CK release 8011 vs. 11267 U/L, P = 0.004). This was associated with higher left ventricular ejection fraction (LVEF) at 90 days post-PPCI measured by myocardial scintigraphy (59% vs. 54%, P = 0.01), and lower incidence of heart failure through a median of 210 days of clinical follow-up (3% vs.11%, P = 0.04). Early abciximab administration in the ambulance significantly improves early reperfusion in STEMI patients treated with PPCI. Moreover this is associated with a smaller infarct size, improved LV function and a lower risk of heart failure on clinical follow-up. (c) 2009 Wiley-Liss, Inc.

  7. Effect of different patterns of pre - hospital emergency in patients with acute heart failure%不同院前急救模式对急性左心衰患者的疗效比较

    Institute of Scientific and Technical Information of China (English)

    严智勇

    2011-01-01

    目的 研究两种不同院前急救模式对急性左心衰竭患者的临床疗效及安全性的影响.方法 回顾性分析2007年1月-2010年12月南京市急救中心诊治的80例急性左心衰竭患者的临床资料,根据院前急救模式的不同分为治疗-转运组和转运-治疗组,各40例.治疗-转运组采取先治疗后转运的急救模式,转运-治疗组采用边转运边治疗的急救模式.比较两组临床疗效及安全性.结果 治疗-转运组总有效率(80.0%)显著高于转运-治疗组(55.0%),差异具有统计学意义(P<0.05).转运-治疗组在搬运过程中2例出现呼吸、心脏骤停,5例出现呼吸抑制,而治疗-转运组无1例出现安全问题.结论 急性左心衰竭明确诊断后,采取先治疗后转运的院前急救模式能显著降低患者意外事件的发生率,改善预后.%Objective To study the clinical efficacy and safety impact of different modes of pre -hospital emergency patients with acute left heart failure. Methods From Jan. 2007 to Dec. 2010, 40 patients with acute left heart failure underwent the mode of first aid treatment before the transfer (Observation group) and the other 40 patients with acute left heart failure underwent the mode of side of transport while the emergency treatment (control group). The clinical results and safety were compared between the two groups. Results The total effective (80. 0% ) in observation group was significantly higher than that(55. 0% ) in control group( P <0. 05). When handling process, there were 2 patients with respiratory, cardiac arrest and 5 patients with respiratory depression in the control group. However, there were no one with safety issues. Conclusions The modes of first aid treatment before the transfer for patients with acute left heart failure can significantly reduce the incidence of accidents and improve the prognosis.

  8. Capacitação de técnicos/auxiliares de enfermagem: repercussão nos registros de enfermagem relacionados ao atendimento pré-hospitalar móvel Capacitación de técnicos y auxiliares de enfermería en la atención pre-hospitalaria móvil: repercusiones en los registros de enfermería Training of nursing technicians/assistants in mobile pre-hospital healthcare: results from nursing records

    Directory of Open Access Journals (Sweden)

    Cibele de Lima Souza Silveira

    2009-10-01

    capacitation of associate degree nurses and licensed practical nurses in improving the documentation of respiratory care for children less than 5 years old in pre-hospital mobile units. METHODS: A quasi-experimental, prospective, and comparative one-group before and after design was used to conduct the study. The study was conducted in the Pre-Hospital Mobile Units of Recife. The sample consisted of 148 children's records in 2006 before the initiation of the program of capacitation and 113 children's records in 2007 and 2008 after the implementation of the program. RESULTS: There was a statistical significant change after the implementation of the program regarding to quality documentation and the frequency of respiratory system assessment, such as the use of the accessory respiratory muscle, nose flaring, agitation, xiphoid process retraction, and wheezes (p < .01. CONCLUSIONS: The implementation of the program of capacitation of associate degree nurses and licensed practical nurses improved communication, nursing care, documentation, and respiratory assessment of children in pre-hospital mobile units.

  9. Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study

    Institute of Scientific and Technical Information of China (English)

    QIU Jian-ping; ZHANG Qi; LU Ji-de; WANG Hai-rong; LIN Jie; GE Zhi-ru; ZHANG Rui-yan; SHEN Wei-feng

    2011-01-01

    Background Primary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.Methods The study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group).Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time,and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.Results Baseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P=0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54±18) minutes and (112±55) minutes, P <0.0001)and the percentage of patients with D2B <90 minutes was increased in the DIRECT group (96.9% and 27.0%, P<0.0001).The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P=0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P=0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis

  10. Intracoronary Compared to Intravenous Bolus Abciximab during Primary Percutaneous Coronary Intervention in ST-segment Elevation Myocardial Infarction (STEMI) Patients Reduces 30-day Mortality and Target Vessel Revascularization: A Randomized Trial

    DEFF Research Database (Denmark)

    Iversen, Allan; Abildgaard, Ulrik; Galloe, Anders;

    2011-01-01

    Background: Abciximab is beneficial in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). However, the optimal administration route of the initial bolus of abciximab, that is, intravenous (IV) versus intracoronary (IC), has...... patients who underwent pPCI and had indication for abciximab to either IV or IC bolus followed by a 12-hour IV infusion. Primary end-points at 30 days were target vessel revascularization (TVR), recurrent myocardial infarction (MI) or death, and the composite of the three. Secondary end-points were...

  11. Hypercalcaemia Mimicking STEMI on Electrocardiography

    Directory of Open Access Journals (Sweden)

    Joseph Donovan

    2010-01-01

    Full Text Available Acute coronary syndrome is a common cause of presentation to hospital. ST segment elevation on an electrocardiogram (ECG is likely to be cardiac in origin, but in low-risk patients other causes must be ruled out. We describe a case of a man with hypercalcaemia, no evidence of cardiac disease, and ECG changes mimicking acute myocardial infarction. These ECG changes resolved after treatment of the hypercalcaemia.

  12. Análise diagnóstica do atendimento pré-hospitalar para acidentes e violências contra idosos em Curitiba (PR, Brasil Situational analysis of the pre-hospital health services for attending accidents and violence against the elderly in Curitiba (PR, Brazil

    Directory of Open Access Journals (Sweden)

    Ana Lucia Schaefer Ferreira de Mello

    2010-09-01

    Full Text Available O estudo compõe uma análise situacional dos serviços de atenção a acidentes e violências, em Curitiba, focalizando as condições gerais de infraestrutura, planejamento e apoio no nível de atenção pré-hospitalar, considerando os serviços pré-hospitalares móveis e fixos, dirigidos ao atendimento do idoso vitimizado. Foram evidenciados pontos positivos, lacunas e necessidades de adequação para atender às diretrizes nacionais. A investigação integrou abordagens quantitativas e qualitativas e se pautou nos princípios da triangulação de métodos. Conclui-se que o tema dos acidentes e violência contra idosos comporta importantes melhorias nas ações desenvolvidas pelos serviços pesquisados: (1 ações preventivas não fazem parte da rotina dos serviços; (2 a maioria dos serviços não desenvolve atendimentos específicos, direcionados às demandas particulares dos idosos; (3 a experiência dos entrevistados revela dificuldades de obtenção de leitos hospitalares, para encaminhamento ou transferência de pacientes idosos. O enfrentamento das questões relativas aos acidentes e violências contra idosos em Curitiba impõe considerar a organização de dados, fluxos, capacitação dos profissionais e planejamento no desenvolvimento de programas de prevenção, assistência e reabilitação aos idosos vitimizados.This study is a situational analysis of the health care services for attending accidents and violence, in Curitiba, focusing the general conditions of infrastructure, planning and support at the pre-hospital assistance level, considering mobile and fixed emergency services dedicated to the victimized elderly. Positive points were evidenced as well as gaps and needs to meet the national guidelines. The investigation integrated quantitative and qualitative approaches and it was carried out on the grounds of the triangulation of methods. It is concluded that on the theme of accidents and violence against the elderly still

  13. System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.

    Directory of Open Access Journals (Sweden)

    Luciano de Andrade

    Full Text Available Mortality rates amongst ST segment elevation myocardial infarction (STEMI patients remain high, especially in developing countries. The aim of this study was to evaluate the factors related with delays in the treatment of STEMI patients to support a strategic plan toward structural and personnel modifications in a primary hospital aligning its process with international guidelines.The study was conducted in a primary hospital localized in Foz do Iguaçu, Brazil. We utilized a qualitative and quantitative integrated analysis including on-site observations, interviews, medical records analysis, Qualitative Comparative Analysis (QCA and System Dynamics Modeling (SD. Main cause of delays were categorized into three themes: a professional, b equipment and c transportation logistics. QCA analysis confirmed four main stages of delay to STEMI patient's care in relation to the 'Door-in-Door-out' time at the primary hospital. These stages and their average delays in minutes were: a First Medical Contact (From Door-In to the first contact with the nurse and/or physician: 7 minutes; b Electrocardiogram acquisition and review by a physician: 28 minutes; c ECG transmission and Percutaneous Coronary Intervention Center team feedback time: 76 minutes; and d Patient's Transfer Waiting Time: 78 minutes. SD baseline model confirmed the system's behavior with all occurring delays and the need of improvements. Moreover, after model validation and sensitivity analysis, results suggested that an overall improvement of 40% to 50% in each of these identified stages would reduce the delay.This evaluation suggests that investment in health personnel training, diminution of bureaucracy, and management of guidelines might lead to important improvements decreasing the delay of STEMI patients' care. In addition, this work provides evidence that SD modeling may highlight areas where health system managers can implement and evaluate the necessary changes in order to improve the

  14. Effects of early application of IABP on clinical prognosis of STEMI patients with elective PCI%择期PCI大面积STEMI患者术前应用IABP 临床预后观察

    Institute of Scientific and Technical Information of China (English)

    李志娟; 李春燕; 董平栓; 杨旭明; 刘威; 王可; 李治国; 赵玉伟; 靳国青; 李转珍

    2012-01-01

    Objective To evaluate the effect of early application of intra-aortic balloon pump counterpulsation (IABP) on patients with ST-segment elevation acute myocardial infarction (STEMI) for elective percutaneous coronary in-terventional (PCI). Methods One hundred STEMI patients were randomized into test group (n = 52) and control group (re =48). All the individuals onset of STEMI had been 12-72 hours. The patients in test group received IABP support treatment for 3-5 days. All the individuals were performed PCI after 10-14 days. Thrombolysis in acute myocardial infarction (TIMI) grade was studied before and after PCI. The major adverse cardiac events (MACE) and heart function at 4 weeks were studied. Result In test group, TIMI HI flow rate was significantly higher than that in control group after PCI ( P < 0. 05 ) , the occurance of MACE at 4 weeks was significantly lower than that in control group ( P < 0. 05 ) , and left ventricle ejection fraction ( LVEF) was significantly higher than that in control group ( P < 0. 05 ) . Conclusion Early application of IABP on patients with STEMI for elective PCI is safe and effective, which can reduce the occurance of MACE at 4 weeks, and improve LVEF.%目的 研究择期行经皮冠状动脉介入治疗(PCI)的大面积急性ST段抬高型心肌梗死(STEMI)患者早期应用主动脉内气囊反搏术(IABP)对临床预后的影响.方法 选取发病12~72 h的STEMI患者100例,随机分为两组,IABP组52例、对照组48例,对照组给予规范的药物治疗,IABP组在规范药物治疗的基础上床旁应用IABP 3~5 d.两组均于10~14 d后行冠脉造影及PCI术.评价梗死相关血管PCI术前及术后冠脉血流(TIMI)和术后4周心功能及主要不良心脏事件的发生情况.结果 IABP组PCI术前、术后TIMIⅢ级高于对照组,PCI术后4周主要不良心脏事件的发生率低于对照组,左心室射血分数高于对照组,P均<0.05.结论 对于大面积STEMI患者择期行PCI,早期应用IABP

  15. Optimal catchment area and primary PCI centre volume revisited

    DEFF Research Database (Denmark)

    Schoos, Mikkel Malby; Pedersen, Frants; Holmvang, Lene

    2015-01-01

    AIMS: The currently stated optimal catchment population for a pPCI centre is 300,000-1,100,000, resulting in 200-800 procedures/year. pPCI centres are increasing in number even within small geographic areas. We describe the organisation and quality of care after merging two high-volume centres....... The quality of a centre reflects governance, training, resources and pre-hospital triage, rather than catchment population and STEMI incidence, as long as a minimum volume is guaranteed. Resources can be utilised better by merging neighbouring centres, without negative effects on quality of care....

  16. Prevalence and Related Predictors for Hemorrhage of Upper Gastrointestinal Tract in Patients with STEMI During Hospitalization%急性心肌梗死患者院内上消化道出血的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    王永亮; 赵树梅; 付明玮; 陈佳纬; 吴永全

    2011-01-01

    目的 探讨急性ST段抬高心肌梗死(STEMI)患者住院期间上消化道出血的发生率及其预测因子.方法 回顾性分析2009年1 ~12月北京友谊医院心脏中心CCU住院治疗的233例STEMI患者的临床资料,观察上消化道出血的发生率,及与各种危险因素的相互关系.结果 17例(7.3%)STEMI患者在住院期间发生了上消化道出血,其临床危险因素包括既往消化性溃疡病史(P=0.01),和上消化道出血病史(P=0.004),肌酐>2mg/dl(P<0.001),心肺复苏术史(P<0.001),rt-PA溶栓(P=0.02),IABP置入(P<0.001),临时起搏器置入(P=0.02).结论 STEMI患者上消化道出血的发生率高达7.3%,rt-PA治疗,IABP置入,肾功能不全,既往上消化道出血病史等显著增加了上消化道出血的风险.%Objective To investigate the prevalence and predictorfactors for hemorrhage of upper gastrointestinal tract in patients with AMI during hospitalization. Methods Totally 233 patients with STEMI in CCU from Jan 2009 to Dec 2009 were analyzed retrospectively. The prevalence of upper gastrointestinal tract bleeding and the interrelation between bleeding and various risk factors were observed. Results 17 of these patients suffered from upper gastrointestinal tract hemorrhage during hospitalization(7. 3% ). Predictors of upper gastrointestinal tract hemorrhage included history of peptic ulcer( P =0. 04) and bleeding (P=0.04) , higher value of serum creati-nine( >2mg/dl,P <0. 001 ) , thrombolytic therapy with rt - PA(P =0. 02) , insertion of IABP( P< 0. 01) and temporary pacemaker( P = 0. 02) , and history of CPR ( cardiopulmonary resuscitation) . Conclusion There is a high prevalence of upper gastrointestinal tract hemorrhage in patients with STEMI. Treatment with rt -PA, insertion of IABP, renal dysfunction, and history of peptic ulcer and bleeding may be the proper predictors.

  17. 分析大剂量他汀类药物对STEMI的预后影响%Analysis of the effect of lar ge dose of statins on prognosis of STEMI

    Institute of Scientific and Technical Information of China (English)

    刘晓晨

    2015-01-01

    目的:探讨大剂量阿托伐他汀在伴白细胞增高及低钾急性ST段抬高性心肌梗塞(STEMI)治疗中的应用价值。方法将60例伴白细胞增高及低钾的STEMI患者随机分为两组,每组30例。以常规治疗时应用阿托伐他汀20 mg治疗者为A组,以常规治疗时应用阿托伐他汀90 mg治疗者为B组,对比两组预后情况。结果 B组治疗6个月后心绞痛月平均发作次数及平均每次发作时间均明显少于A组(P<0.05)。同时B组治疗12个月内心肌梗死再发率及心力衰竭发生率也低于A组(P<0.05)。结论大剂量阿托伐他汀可有效的改善伴白细胞增高及低钾STEMI患者的预后。%ObjectiveTo a large dose of atorvastatin in value associated with leukocyte and potassium acute ST-segment elevation myocardial infarction (STEMI) therapy.Methods60 cases with leukocytosis and hypokalemia STEMI patients were randomly divided into two groups, 30 cases in each group. To apply at the time of conventional treatment 20mg atorvastatin treatment group A, to apply at the time of conventional treatment 90mg atorvastatin treatment for group B, compared two groups of prognosis.ResultsGroup B after six months of treatment the mean number of episodes of angina each month and the average time of onset was significantly less than in group A (P<0.05). Meanwhile Group B within 12 months of treatment of recurrent myocardial infarction and heart failure incidence rate also lower than in group A (P<0.05).Conclusion The high-dose atorvastatin can effectively improve with increased white blood cells and prognosis in patients with hypokalemia STEMI.

  18. Analysis of 10 126 Cases of Pre-hosPital Emergency Care%10126例院前急救病例分析

    Institute of Scientific and Technical Information of China (English)

    付丽琼; 胡远扬; 林建功; 朱龙华

    2013-01-01

    目的:了解泉州市区院前急救疾病的病种及其特点。方法回顾性分析泉州市急救指挥中心2009年1月至2009年12月救治转送的10126例患者及180例死亡病例。结果院前急救病种排序前五位依次为各种创伤6035(59.58%)、脑血管病907(8.95%)、中毒与损伤621(6.13%)、心血管病446(4.6%)、消化系统423(4.2%)此前五位占全部患者的83.46%,创伤中交通伤占一半以上。结论院前急救在医务人员与设备配置方面应与急救疾病谱的变化相适应,要加强针对医务人员及社会公众进行急救创伤知识、心脑血管疾病等培训,提高急救抢救能力。%Objective To explore the disease entity and its clinical characteristics in the pre-hospital emergency cases. Method A retrospective study of 10 126 patients transferred by Quanzhou Emergency Center and 180 deaths among them between January 2009 and December 2009 was performed. Result The five common disease entities in pre-hospital emergency patients which account for 83.46%of the total amount are:6035 cases of trauma(59.58%),half of which are auto accidents,907 cases of cerebrovascular disease(8.95%),621 cases of poisoning (6.13%),446 cases of cardiovascular disease(4.6%),423 cases of gastrointestinal disease(4.2%). Conclusion It is recommended that the emergency resource such as pre-hospital rescuers and devices should be allocated in accordance with the disease spectrum for pre-hospital emergency care. It is essential to improve the quality of the training about the pre-hospital rescue of trauma and cardiac-cerebral vascular disease to ensure the high performance of pre-hospital emergency care.

  19. Recommendations on pre-hospital & early hospital management of acute heart failure : a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine

    NARCIS (Netherlands)

    Mebazaa, Alexandre; Yilmaz, M. Birhan; Levy, Phillip; Ponikowski, Piotr; Peacock, W. Frank; Laribi, Said; Ristic, Arsen D.; Lambrinou, Ekaterini; Masip, Josep; Riley, Jillian P.; McDonagh, Theresa; Mueller, Christian; deFilippi, Christopher; Harjola, Veli-Pekka; Thiele, Holger; Piepoli, Massimo F.; Metra, Marco; Maggioni, Aldo; McMurray, John; Dickstein, Kenneth; Damman, Kevin; Seferovic, Petar M.; Ruschitzka, Frank; Leite-Moreira, Adelino F.; Bellou, Abdelouahab; Anker, Stefan D.; Filippatos, Gerasimos

    2015-01-01

    Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to

  20. Impact of patients' symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    SONG Li; YAN Hong-bing; YANG Jin-gang; SUN Yi-hong; HU Da-yi

    2010-01-01

    Background Delay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI.Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review.Results The median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%),radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P <0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P <0.001) compared to those who interpreted their symptoms as cardiac in origin.Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS).

  1. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers

    Directory of Open Access Journals (Sweden)

    Marx Jean-Sebastian

    2009-01-01

    Full Text Available Abstract Background While ultrasound (US has continued to expedite diagnosis and therapy for critical care physicians inside the hospital system, the technology has been slow to diffuse into the pre-hospital system. Given the diagnostic benefits of thoracic ultrasound (TUS, we sought to evaluate image recognition skills for two important TUS applications; the identification of B-lines (used in the US diagnosis of pulmonary edema and the identification of lung sliding and comet tails (used in the US diagnosis of pneumothorax. In particular we evaluated the impact of a focused training module in a pre-hospital system that utilizes physicians as pre-hospital providers. Methods 27 Paris Service D'Aide Médicale Urgente (SAMU physicians at the Hôpital Necker with varying levels of US experience were given two twenty-five image recognition pre-tests; the first test had examples of both normal and pneumothorax lung US and the second had examples of both normal and pulmonary edema lung US. All 27 physicians then underwent the same didactic training modules. A post-test was administered upon completing the training module and results were recorded. Results Pre and post-test scores were compared for both the pneumothorax and the pulmonary edema modules. For the pneumothorax module, mean test scores increased from 10.3 +/- 4.1 before the training to 20.1 +/- 3.5 after (p Conclusion This brief training module resulted in significant improvement of image recognition skills for physicians both with and without previous ultrasound experience. Given that rapid diagnosis of these conditions in the pre-hospital system can change therapy, especially in systems where physicians can integrate this information into treatment decisions, the further diffusion of this technology would seem to be beneficial and deserves further study.

  2. Emergency care in South Asia: challenges and opportunities.

    Science.gov (United States)

    Joshipura, Manjul; Hyder, Adnan A; Rehmani, Riffat

    2004-12-01

    One of the striking deficiencies in the current health delivery structure is lack of focus on emergency care in primary health systems, which are ill-equipped to offer appropriate care in emergency situations resulting in a high burden of preventable deaths and disability. Emergency medical systems (EMS) encompass a much wider spectrum from recognition of the emergency, access to the system, provision of pre-hospital care, through definitive hospital care. The burden of death and disability resulting from lack of appropriate emergency care is very high in low- and middle-income countries. In South Asia, health services in general, and emergency care in particular, have failed to attract priority, investments and efforts for a variety of reasons. It has to be emphasized that integrating EMS with other health system components improves health care for the entire community, including children, the elderly, and other vulnerable groups with special needs. Out-of-facility care is an integral component of the health care system in South Asia. EMS focuses on out-of-facility care and also supports efforts to implement cost-effective community health care. There is a possibility of integration of other health services and programmes with an innovative, cost-effective EMS in the region.

  3. Epidemiological investigation on pre-hospital trauma first aid in Guangzhou%广州市中心城区院前创伤急救流行病学分析

    Institute of Scientific and Technical Information of China (English)

    梁子敬; 曾量波; 黄力; 李莲芬; 韩洁韵

    2005-01-01

    Objective Through epidemiological analysis of prehospital trauma care in Guangzhou during 1996~2004,to explore common characteristics and trends of it.Methods The data of the prehospital trauma patient were collected by Guangzhou First Aid Service Command Center from 1996 to 2004 and was prospectively analyzed. Results The number of prehospital care had been increased year by year(increased by 3.56 times in the nine years).The number of the trauma patients had been increased by 7.98 times.Head injury was in the first place(6.86%). Most of casualties fell into the age of 21~40 years old.The male patients were the two times that of female patients.Conclusion Trauma has become an serious problem. The improvement of prehospital emergency network, ability of on-the-spot emergency care and popularizing the knowledge of emergency are key to reduce the casualties.%目的分析广州市中心城区创伤院前急救的流行病学,探讨其特点及趋势. 方法采用描述性流行病学方法,收集1996年1月至2004年12月广州市中心城区"120"呼叫资料及院前创伤资料并进行分析.结果院前急救逐年增加的同时(9年间增加了3.56倍),创伤病例增加更明显(增加了7.88倍),构成比由最初的17.16%增至37.98%,创伤以颅脑创伤所占比例最大(6.86%).创伤患者年龄及死亡年龄主要集中在21~40岁,分别占57.20%和62.04%, 70岁以上年龄段创伤出现第2个小高峰,占8.09%.男性是女性患者的2倍以上.结论广州创伤伤亡人数逐年上升,创伤增加更明显,是院前急救的主要原因,其中以颅脑创伤占第一位,青壮年为主.需采取有效防治措施减少创伤事故的发生,同时,提高院前急救人员的抢救水平和快速反应能力.

  4. 乌鲁木齐市2011-2012年院前急救急性中毒流行病学分析%Analysis on the Epidemiology of Pre-hospital Emergency for Acute Poisoning in Urumqi from 2011 to 2012

    Institute of Scientific and Technical Information of China (English)

    杨建中; 李树林; 张亚楼; 帕尔哈提·拜合提; 王晓静; 马宏飞; 亚力坤·赛来; 肖开提·依布拉音; 贾志军

    2014-01-01

    目的:分析乌鲁木齐市2011—2012年院前急救急性中毒的流行病学特点。方法前瞻性调查2011—2012年乌鲁木齐市院前急救急性中毒患者的资料,登记患者年龄、性别、民族、中毒谱、中毒季节、中毒途径、中毒死亡病例并进行分析。结果2011—2012年9903例院前急救急性中毒患者年龄构成比较差异有统计学意义(χ2=7776,77,P <0,05),其中急性中毒患者以40~49岁最多见( P <0,05)。男7475例(75,48%),女2428例(24,52%),性别构成比较差异有统计学意义(χ2=1077,47,P <0,0001);男性酒精中毒发生率高于女性,气体中毒、药物中毒、农药中毒、毒品中毒发生率低于女性(P <0,05)。民族构成比较差异有统计学意义(χ2=586,63,P<0,0001),其中汉族最多(χ2=8,14,P =0,004)。中毒谱构成比较差异有统计学意义(χ2=26267,86,P <0,01),其中酒精中毒最多(χ2=1014,09,P <0,01)。季节构成比较差异有统计学意义(χ2=263,73,P <0,01),其中冬季最多(χ2=1401,15,P <0,01)。中毒途径构成比较差异有统计学意义(χ2=11,56,P =0,009),其中胃肠道中毒最多(χ2=3419,24,P <0,01)。死亡69例(0,70%),其中一氧化碳中毒45例(占65,22%)、毒品中毒11例(占15,79%)、酒精中毒9例(占13,20%)、农药中毒4例(占5,79%)。结论乌鲁木齐市院前急救急性中毒在年龄、性别、民族、中毒谱、季节、中毒途径和死亡原因方面尚有自身的特点和发病趋势,对本地区的医疗卫生工作有着重大的意义。%Objective To analyse the epidemiology of pre - hospital patients with acute poisoning in Urumqi from 2011 to 2012, Methods Using prospective study method,the data of pre - hospital patients with acute poisoning in Urumqi from 2011 to 2012,such as age,gender,nationality,cause of poisoning,poisoning seasons,poisoning routes,poisoning death cases

  5. ST-segment elevation myocardial infarction;reperfusion treatment;percutaneous coronary intervention%再灌注治疗的 ST段抬高型心肌梗死(STEMI)

    Institute of Scientific and Technical Information of China (English)

    乔果

    2012-01-01

    ST段抬高心肌梗死(STEMI)是一个主要的健康问题,甚至在目前急性心肌梗死的诊断和管理不断改善中也如此.STEMI在大约33%的患者中发生致命事件.STEMI是唯一的第二位最严重的急性冠脉综合征(ACS)的后心源性猝死的形式.约29%心肌梗死的患者 经历过STEMI(1),而47%的急性冠脉综合征(ACS)患者,表现出STEMI(2)症状.STEM是冠心病三要素之一,其他两个分别是不稳定型心绞痛和非ST段抬高心肌梗死(NSTEMI),三者构成已知冠心病要素.急性冠脉综合征的特点是急性缺血性胸痛(休息痛或劳累痛)与缺血性心电图变化(ST段抬高或压低或T反转)联系在一起.有无ST段抬高是STEMI区别于急性冠心病其他形式的特征.NSTEMI和不稳定型心绞痛以有无心肌损伤标记物的上升加以区别[3-6].纤溶和经皮冠状动脉介入治疗(PCI),最终在STEMI再灌注治疗.这些疗法已上一线,改善梗死动脉通畅性,减少梗死面积,降低死亡率.时间敏感性STEMI要求一个或这两个疗法的快速实施[4-7].调查表明,许多西方国家STEMI病人很难接触再灌注治疗法,而选择了临床使用成熟的药物疗法,至今仍是未处理疗法.高达三分之一的STEMI患者在症状出现12小时内仍没有接受再紧急灌注治疗,尽管保健在改善[7-8],但最近的一项研究显示,80.9%,在北京的STEMI患者接受再灌注治疗(81%为初始PCI;19%,溶栓).同时,研究表明初始PCI是北京病人的主要再灌注疗法[9].本文旨在给出两个明确的STEMI再灌注疗法的重要细节.

  6. 品管圈活动改善卒中患者院前急救气道护理的效果观察%Value of Quality Control Circle Activity Improving the Nursing Effect of Pre-hospital Emergency Airway Nursing of Patients with Stroke

    Institute of Scientific and Technical Information of China (English)

    王丽; 张富强

    2015-01-01

    目的:探讨品管圈活动改善卒中患者院前急救气道护理的效果。方法2014年2月由我院急救中心10名工作人员组成品管圈,确定活动主题为“改善卒中患者院前急救气道护理效果”。根据PDCA操作程序进行卒中患者院前急救气道护理现状和护理效果不佳的原因分析,制定活动目标并根据5 W2 H原则制定对策,实施对策并以改善前后患者预后和并发症发生情况、患者对护理的综合满意度及圈员素质改善情况评价本次品管圈活动效果。结果改善后患者死亡、呼吸衰竭、昏迷、肺不张、呼吸道梗阻等的发生率分别低于改善前的情况,差异有统计学意义( P<0.05)。与改善前比较,改善后患者对护理操作技术、生活护理、健康教育、服务态度、整体印象等方面的满意度均提高,差异有统计学意义( P<0.05)。改善后全体圈员在品管圈手法应用、护理品质意识、自信心、责任感、团队凝聚力等方面的素质均较改善前提高,差异有统计学意义( P<0.05)。结论品管圈管理应用于卒中患者院前急救气道护理可有效改善患者的预后情况,提高患者对护理的综合满意度和圈员素质,提高卒中患者院前急救气道护理效果,值得临床推广应用。%Objective To investigate the value of quality control circle ( QCC) activity improving the nursing effect of pre-hospital e-mergencyairwaynursingofpatientswithstroke.Methods 10ICUstaffformedQCCinFebruary,2014.Activitythemedeterminedas“improving the nursing effect of pre-hospital emergency airway nursing in patients with stroke”.Status and causes of nursing effect of pre-hospital emergency airway nursing in patients with stroke were analyzed based on PDCA operating procedures.QCC goals and improve-ment countermeasures were designed according to the 5W2H principle.Countermeasure was implemented and QCC effect was measured by

  7. Soluble TNF-related apoptosis induced ligand (sTRAIL) is augmented by Post-Conditioning and correlates to infarct size and left ventricle dysfunction in STEMI patients: a substudy from a randomized clinical trial.

    Science.gov (United States)

    Luz, André; Santos, Mário; Magalhães, Rui; Oliveira, José Carlos; Pacheco, Ana; Silveira, João; Cabral, Sofia; Torres, Severo; Leite-Moreira, Adelino F; Carvalho, Henrique

    2017-02-01

    Low levels of Soluble TNF-related apoptosis induced ligand (sTRAIL) seem to be related to worse prognosis after an acute coronary syndrome. PostConditioning (PostCond) may protect the heart from reperfusion injury. We sought to evaluate the impact of PostCond on sTRAIL in relationship to infarct size (area under the curve of Troponin T, AUCTnT) and left ventricle ejection fraction (LVEF) in a series of patients undergoing primary coronary intervention for ST-segment elevation myocardial infarction (STEMI). In a substudy of a randomized trial that tested the effects of PostCond in STEMI-patients, sTRAIL was measured 24 h after reperfusion (PostCond n = 39, Control n = 39). Correlations between sTRAIL and both AUCTnT and LVEF were studied for each study arm. At 24 h, sTRAIL was higher for PostCond vs Controls (46.4 ± 30.6 vs 32.9 ± 23.4, p = 0.031), was negatively related to AUCTnT [B = -0.09, 95 % CI (-0.15 to -0.30), p = 0.005] and was positively related to both in-hospital [B = 0.10, 95 % CI (0.02-0.17), p = 0.018], and follow-up LVEF [B = 0.21, 95 % (0.10-0.32), p = 0.001]. No significant relationship was found for Controls. On multivariate analysis, PostCond was an independent predictor for sTRAIL [B = 12.13 95 % CI (0.40-23.87), p = 0.043]. In conclusion, PostCond positively influenced sTRAIL, which was related to reduced infarct size and better LVEF. Further studies are needed to understand potential mechanisms elicited by PostCond in infarct size reduction.

  8. EVALUATION ON THE EFFECT OF PRE-HOSPITALIZED VENOUS THROMBOLYTIC THERAPY FOR LARGE AREA MYOCARDIAL INFARCTION EARLY LEFT VENTRICULAR REMODELING WITH ECHOCARDIOGRAPHY%超声评价院前静脉溶栓对大面积心肌梗死早期左室重构的影响

    Institute of Scientific and Technical Information of China (English)

    刘佳; 汪克非; 贾黎丹; 王翠丽; 赵晓兰

    2001-01-01

    目的:评价患者入院前静脉溶栓治疗对大面积心肌梗死(心梗)早期左室重构的影响,探讨超声新技术评价左室重构的价值。方法:对院前静脉溶栓治疗有效(32例)及未溶栓治疗(30例)两组大面积急性心梗病例应用超声多项技术进行同期(心梗后1周、6周)左室结构及功能的观察、分析及对比研究。结果:未溶栓治疗组左室重构在1周时已发生,左室趋向球形变化、容积增大、整体及局部收缩功能下降、舒张功能减低。溶栓治疗有效组左室结构及功能无明显变化。结论:有效的院前静脉溶栓治疗可阻止大面积心梗早期左室重构的发生及心功能的恶化,应用超声心动图声学定量技术、彩色室壁动力技术评价急性心梗后左室重构方法简便、省时,结果客观、准确。%Objective:Evaluate the effect of pre-hospitalized venousthrombolytic therapy for large area myocardial infarction early left ventricular remodeling,and discuss the value of evaluation of left ventricular remodeling with new ultrasonic technology.Methods:Observe,analysis and research by contrast the left ventricular structure and its function of the same stage (one week and 6 weeks after myocardial infarction) of two groups of large area myocardial infarction cases in which one is efficient(32 cases) for pre-hospitalized venous thrombolytic therapy and the other hasn't undergoing venous thrombolytic therapy (30 cases) with several method of echocardiography.Results:In the group which no thrombolytic therapy has been taken,the left ventricular remodeling can be seen after the one week myocardial infarction,with left ventricular leading to ball-shape and bigger cubage and whole and local contraction and diastolic function decreased.And in efficinent group,there are no distinct changes.Conclusion:The efficient pre-hospitalization venous thrombolygtic therapy can prevent the happening of large area myocardial

  9. 品管圈在颅脑外伤院前急救质量管理中的运用效果分析%The application effect of quality control circles applied in the quality management of pre-hospital first aid for craniocerebral trauma

    Institute of Scientific and Technical Information of China (English)

    赵扬; 陈朝霞; 彭婉琳; 颜源均; 程丹

    2016-01-01

    Objective To explore the application effect of quality control circle applied in the quality manage-ment of pre-hospital first aid for craniocerebral trauma. Methods A total of 40 patients with craniocerebral who received trauma emergency treatment in our hospital from January 2013 to December 2013 were selected as the observation group and another 40 patients with craniocerebral who received trauma emergency treatment in our hospital from January 2014 to December 2014 were selected as the control group. All the patients of the two groups and 9 emergency medical per-sonnel were selected as the research objects. The control group received the conventional pre-hospital first aid treatment, while the patients of the observation group received quality control circle for the pre-hospital first aid. Results The mor-tality rate, disability rate, plant survival rate and cure rate of the patients before intervention were 17. 50%, 32. 50%, 10. 00% and 40. 00% respectively. After the intervention, the mortality rate, disability rate, plant survival rate and cure rate of the patients were 2. 50%, 22. 50%, 0. 00% and 75. 00% respectively. After the intervention, the out-come of the patients was significantly better than that before intervention ( P<0. 05 ) . Before intervention, time from call for help to receive professional treatment was ( 23. 46 ± 10. 54 ) minutes, the reaction time of the hospital was (18. 25 ±8. 13) minute. While after the intervention, they were (14. 06 ±10. 00) minute and (5. 82±3. 14) minute respectively. The time from call for help to receive professional treatment and the reaction time of the hospital after in-tervention were obviously shorter than that before intervention ( P<0. 05 ) . Conclusion The quality control circle can effectively improve the quality of pre-hospital emergency for craniocerebral trauma, reduce mortality and morbidity, shorten the time from call for help to receive professional treatment and hospital reaction time, and help

  10. Analysis of gender differences of clinical characteristics,inflammaory response and prognosis in patients with acute STEMI%急性ST段抬高心肌梗死患者临床特点和炎性反应及预后的性别差异分析

    Institute of Scientific and Technical Information of China (English)

    范振兴; 华琦; 李银平; 谭静; 李静

    2012-01-01

    目的 研究不同性别急性ST段抬高心肌梗死(STEMI)患者临床特点和炎性反应以及预后差异.方法 连续入选初发STEMI患者263例,男203例,女60例.收集患者住院时和2年随访时的临床资料,检测发病早期白细胞介素6(IL-6)、可溶性细胞间黏附分子1(sICAM 1)和可溶性P选择素水平,并进行比较分析.结果 女性年龄、高血压、Killip分级≥Ⅱ级比例明显高于男性,吸烟明显低于男性(P<0.01).男性血清可溶性P选择素水平明显高于女性(P<0.01),男性与女性IL6和sICAM-1水平无显著差异.不同性别患者再灌注治疗比例和溶栓再通率以及急诊PCI后血流恢复率、冠状动脉病变分布总体无显著差异.女性住院及随访2年时心血管病病死率更高,性别与住院期间及随访2年心血管死亡无独立相关.结论 STEMI患者男性多于女性,女性发病年龄晚、且病情重;STEMI急性期炎性反应水平无性别差异;STEMI预后与性别无关.%Objective To investigate the influence of gender on clinical characteristics,inflammatory response and mortality in patients with STEMI. Methods 263 consecutive patients (77. 2% males) within 6 h of symptoms onset with the diagnosis of first STEMI were selected. Clinical data were recorded,and the early serum levels of IL-6 ,sICAM-l and sP-selectin were measured. The patients were then followed up for the occurrence of cardiovascular mortality for 2 years. Results The age,hypertension ratio,and Killip class≥H in women were all significantly higher,while the smoking rate in women was much lower than in men. sP-selectin level was higher in men. Percentages of patients received reperfusion therapy ,recanalization of thrombolytic treatment and the restoration rate of blood flow after PCI were similar among different gender groups. Coronary lesion distribution in women, as measured by angiography, was similar to that in men. Women showed significantly higher rates of

  11. ST-segment elevation myocardial infarction, systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality.

    Science.gov (United States)

    Malik, Ali Osama; Abela, Oliver; Allenback, Gayle; Devabhaktuni, Subodh; Lui, Calvin; Singh, Aditi; Diep, Jimmy; Yamashita, Takashi; Yoo, Ji Won; Malhotra, Sanjay; Ahsan, Chowdhury

    2017-08-01

    Regional trends for ST-segment elevation myocardial infarction (STEMI) treatment is not known in the state of Nevada. Great disparity exists for treatment for STEMI in different geographical areas of Nevada. There is a great potential to improve treatment and outcomes of STEMI patients in the State of Nevada. Admissions to non-federal hospitals in the state of Nevada, using 2011 to 2013 discharge data from the Nevada State Inpatient Data Base (acquired from Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), were analyzed. Outpatient-onset STEMI patients were identified. The state of Nevada was divided into three divisions based on population densities, defined as population per square mile. Division A included counties with population density of 200 per square mile. Trends in use of STEMI-related therapies and the impact on in-hospital mortality rates were compared. Almost 20% of the patients with outpatient-onset STEMI do not get any STEMI-related therapy and have significantly higher mortality rate. Patients from Division A do not have direct access to percutaneous coronary intervention (PCI) centers. These patients receive less STEMI-related therapies. Low-volume PCI centers had equivalent mortality rates for STEMI patients who got PCI, compared to high-volume PCI centers. Policies must be created and processes streamlined so all STEMI patients in Nevada receive appropriate treatment. Copyright © 2017. Published by Elsevier B.V.

  12. The trend of acute burns pre-hospital management

    Directory of Open Access Journals (Sweden)

    Abubakar Hamdiya

    2015-08-01

    Conclusions: Burn injuries are common in our settings, a more reason for all to know the immediate intervention to give to victims of such accidents. The kind of first aid administered to burns victims possibly affects the burns management outcome. Thus, the earlier the right intervention implemented, the lesser the complications.

  13. Pre-hospital Obstacles in Thrombolytic Therapy and Suggested Solutions

    Directory of Open Access Journals (Sweden)

    Betül Tekin Güveli

    2015-12-01

    Full Text Available INTRODUCTION: Acute ischemic stroke is frequently encountered in emergency neurology clinics. Especially when administered within 3 hours of symptom onset, thrombolytic therapy is important in reducing ischemic injury and neurological disability. In this study, we aimed to investigate the demographic and clinical characteristics according to application time, to identify situations which pose an obstacle to thrombolytic therapy and to review the thrombolytic therapy results in patients diagnosed with acute ischemic stroke. METHODS: The patients diagnosed with acute ischemic stroke were evaluated and their age, gender, complaints, risk factors, previous history of stroke, with whom they live, how they arrived at the hospital and their application time information were recorded. Those who were admitted within 3 hours of symptom onset were assessed as early, those admitted after 3 hours were assessed as late admission. Then the rate of thrombolytic therapy, final results and the clinical status in early admission patients and the reasons for delay in late admission patients were discussed. RESULTS: Among 361 acute ischemic stroke patients, the mean age was 66±14,1. 111 patients were admitted within 3 hours of symptom onset, 246 patients were admitted after three hours. Patients arriving to emergency room with 112 Ambulance Service were admitted earlier than those brought in by family, and this difference was statistically significant. The most common causes of time loss in late admissions were the patients being referred from other centers and the unawareness of family about the importance of the disease. There were 13 patients treated with thrombolytic therapy, and complications occurred in one patient. DISCUSSION AND CONCLUSION: Thrombolytic therapy is important in acute ischemic stroke for suitable patients.Our study suggested that the most important factors in spreading of performing the thrombolytic therapy are informing the public about stroke and taking on the more active role in transporting patients of 112 ambulance services.

  14. Strategies for pre-hospital thrombolysis: an overview

    NARCIS (Netherlands)

    M.J.M. Bouten; M.L. Simoons (Maarten)

    1991-01-01

    textabstractImprovement in survival as a result of thrombolytic therapy in patients with myocardial infarction is determined by the delay between coronary occlusion and reperfusion. Treatment at home can reduce this delay, provided that appropriate patients can be identified. Different strategies fo

  15. Delayed educational reminders for long-term medication adherence in ST-elevation myocardial infarction (DERLA-STEMI: Protocol for a pragmatic, cluster-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Ivers Noah M

    2012-06-01

    Full Text Available Abstract Background Despite evidence-based recommendations supporting long-term use of cardiac medications in patients post ST-elevation myocardial infarction, adherence is known to decline over time. Discontinuation of cardiac medications in such patients is associated with increased mortality. Methods/design This is a pragmatic, cluster-randomized controlled trial with blinded outcome assessment and embedded qualitative process evaluation. Patients from one health region in Ontario, Canada who undergo a coronary angiogram during their admission for ST-elevation myocardial infarction and who survive their initial hospitalization will be included. Allocation of eligible patients to intervention or usual care will take place within one week after the angiogram using a computer-generated random sequence. To avoid treatment contamination, patients treated by the same family physician will be allocated to the same study arm. The intervention consists of recurrent, personalized, paper-based educational messages and reminders sent via post on behalf of the interventional cardiologist to the patient, family physician, and pharmacist urging long-term adherence to secondary prevention medications. The primary outcome is the proportion of patients who report in a phone interview taking all relevant classes of cardiac medications at twelve months. Secondary outcomes to be measured at three and twelve months include proportions of patients who report: actively taking each cardiac medication class of interest (item-by-item; stopping medications due to side effects; taking one or two or three medication classes concurrently; a perfect Morisky Medication Adherence Score for cardiac medication compliance; and having a discussion with their family physician about long-term adherence to cardiac medications. Self-reported measures of adherence will be validated using administrative data for prescriptions filled. Discussion This intervention is designed to be

  16. Nursing experiences of trauma patients with prehospital care and transport in Mount Huangshan%黄山山岳型景区外伤患者院前急救与转运的护理体会

    Institute of Scientific and Technical Information of China (English)

    程利萍; 王莉; 汪秀桃; 方婷婷; 潘海波

    2012-01-01

    目的 分析黄山景区院前急救中外伤患者的院前急救与转运特点,探讨山岳型景区外伤患者院前急救护理经验,提高山岳型景区医疗急救人员院前急救和转运外伤患者的能力.方法 对2005年1月1日~2010年12月31日黄山风景区院前急救中的483例外伤患者的病情、急救应急反应、急诊诊断、转运情况、院前护理、死亡等情况进行统计、分析.结果 院前急救外伤患者483例患者,其中头面部外伤216例,死亡5例;四肢伤155例;全身多处伤112例,死亡4例.按病情:一般362例,较重85例,危重27例,死亡9例;转运途中(共转运259例):平稳234例,加重23例,死亡2例.结论 山岳型景区发生的外伤患者需要得到现场及时的急救和规范的院前急救护理,以及转运途中的良好护理,从而提高院前急救的整体水平和急救效果.%Objective To analyse the characteristics in trauma patients with pre-hospital emergency and transport in Mount Huangshan, and discuss the flrst-aid nursing experiences in trauma patients of pre-hospital emergency, to improve the emergency medical technicians ' ability of pre-hospital care and transport of trauma patients in mountain type scenic spot. Methods Statistics and analysis were made of the emergency response, emergency diagnosis, transfer case, pre-hospital care, death on 483 cases of trauma patients with pre-hospital care in the Mount Huangshan scenic area from January 1, 2005 to December 31, 2010. Results The 483 cases of pre-hospital trauma patients, included 216 cases of head and face injuries, S deaths; limb injuries 155 cases; systemic multiple injuries 112 cases, 4 deaths. As for the disease; general 362 cases, severe 85 cases, 27 cases critical, 9 dead; In the course of transport;smooth 234 cases, worsen 23 cases, 2 deaths. Conclusion Trauma patients need to receive timely and standard pre-hospital emergency care, and good transit care, to improve the overall level of first aid

  17. Protective effect of ischemic postconditioning on myocardium during emergency PCI in STEMI pa-tients%STEMI急诊介入治疗中缺血后处理对心肌的保护作用

    Institute of Scientific and Technical Information of China (English)

    彭荣琳; 涂荣会; 郑国军

    2015-01-01

    目的:探讨ST段抬高型心肌梗死(STEMI)急诊介入治疗中缺血后处理对心肌的保护作用。方法:选择广西医科大学附属医院2011年1月~2012年12月心内科住院,且在12h内行冠状动脉介入治疗(PCI )的82例STEMI患者,根据处理方法不同分为缺血后处理组(42例)和单纯再灌注组(40例),评价两组心功能情况等。结果:与单纯再灌注组比较,缺血后处理组ST段完全回落率(55.0%比81.0%)、左室射血分数[(0.5±0.1)比(0.7±0.1)]明显提高,心律失常率(60.0%比21.4%),室壁运动计分[WMSI ,(2.0±0.7)分比(1.3±0.6)分]、心肌梗死面积[MIS ,(15.1±7.1)%比(9.9±5.3)%]、核素心肌灌注缺损范围分数[ES ,(0.4±0.1)%比(0.2±0.1)%]和核素心肌灌注缺损严重程度积分[SS ,(2.3±1.1)%比(1.8±1.2)%]均显著减少(P<0.05~<0.01)。结论:缺血后处理可显著改善ST段抬高型心肌梗死患者心肌缺血再灌注损伤程度,保护心肌组织。%Objective:To explore the protective effect of ischemic postconditioning on myocardium during emergency percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI) . Methods:According to different treatment method ,a total of 82 STEMI patients ,who hospitalized in the depart-ment of Cardiology of Affiliated Hospital of Guangxi Medical University from Jan 2011 to Dec 2012 and received PCI within 12h ,were divided into ischemic postconditioning group (n= 42) and pure reperfusion group (n= 40) . Heart function etc .were evaluated in both groups .Results:Compared with pure reperfusion group ,there were sig-nificant rise in complete ST segment resolution rate (55.0% vs .81.0% ) and left ventricular ejection fraction [ (0.5 ± 0.1) vs .(0.7 ± 0.1)] ,significant reductions in arrhythmia rate (60.0% vs .21.4% ) ,wall motion score index [WMSI ,(2.0 ± 0

  18. Clinical Study of ST Segment Fell Back and Cardiac Function in Patients with STEMI After Emergency PCI%STEMI患者急诊PCI术后ST段回落与心功能的临床研究

    Institute of Scientific and Technical Information of China (English)

    沈杨

    2016-01-01

    目的:探讨STEMI患者急诊PCI术后ST段回落与心功能的临床关系。方法选取该院2013年10月―2015年5月收治的STEMI患者84例,根据心电图检查ST段回落情况分为回落组(56例)和未回落组(28例),比较两组术后不良心血管事件发生率及心功能变化。结果急诊PCI术后ST段回落者的不良心血管事件发生率7.14%,低于未回落者46.43%,差异有统计学意义(P<0.05);急诊PCI术后1个月,回落组LVEF、LVD和Em/Am心功能参数指标均高于未回落组(51.32±3.87)vs (47.68±4.51)、(51.26±3.42)vs (54.12±2.98)、(1.08±0.32)vs (0.76±0.15)(P<0.05);术后6个月,两组心功能各项指标均升高,且回落组各项指标均高于未回落组(54.72±5.12)vs (48.36±6.87)、(52.36±3.17)vs(56.12±2.84)、(1.27±0.42)vs(0.84±0.21)(P<0.05)。结论行急诊PCI术治疗后出现ST段的回落STEMI患者,其心功能恢复效果较好,且不良心血管事件发生率低。%Objective To study the STEMI emergency PCI in patients with ST segment fell back and postoperative car-diac function relations of clinical. Methods 84 STEMI patients of our hospital from Octomber 2013 to May 2015 based on electrocardiogram (ecg) monitor ST segment fell back into back group (56)and not ease group (28),compared two groups of postoperative incidence of adverse cardiovascular events and changes in cardiac function. Results After the emergency PCI postoperative, the incidence of adverse cardiovascular events of the ST segment fallen back is 7.14%, which is lower than that of 46.43% in the not ease group (P<0.05).One month after the operation,the cardiac function parameters index,such as LVEF,LVD and Em/Am were all higher in the back group than that in the other group(51.32± 3.87)vs(47.68±4.51),(51.26±3.42)vs(54.12±2.98)and(1.08±0.32)vs(0.76±0.15)(P<0.05).Six months later,the index in the two groups were both improved,which was higher in the back group than that in the other

  19. Análise da implantação do sistema de atendimento pré-hospitalar móvel em cinco capitais brasileiras Analysis of the implementation of a mobile pre-hospital treatment system in five Brazilian state capitals

    Directory of Open Access Journals (Sweden)

    Maria Cecília de Souza Minayo

    2008-08-01

    Full Text Available Apresentamos descrição e análise da implantação do sistema de atendimento pré-hospitalar móvel (Serviço de Atendimento Móvel de Urgência - SAMU. O texto é parte de uma pesquisa denominada Análise Diagnóstica de Implantação da Política Nacional de Redução de Acidentes e Violências. Estudamos a história recente da implantação, organização, recursos humanos, materiais e equipamentos do SAMU em cinco capitais (Curitiba - Paraná; Recife - Pernambuco; Brasília - Distrito Federal; Manaus - Amazonas; Rio de Janeiro que apresentam elevadas taxas de morbimortalidade por causas externas. Trabalhamos em quatro fases, cada qual agregando ciclos exploratórios, de trabalho de campo e de análise, triangulando dados quantitativos e qualitativos. Os resultados mostram que a implantação do SAMU constitui, hoje, um avanço do setor saúde e da sociedade. É preciso ainda completar a implantação de várias portarias quanto a veículos, pessoal e equipamentos; intensificar a articulação do pré-hospitalar móvel com as unidades de saúde; enfatizar informações geradas nesse subsistema visando ao melhor planejamento das ações; manter e promover a alta qualificação dos profissionais do SAMU. Este serviço veio oficializar, padronizar e regular um subsistema fundamental para salvar vidas.The article presents a description and analysis of the implementation of a pre-hospital treatment system (SAMU as part of the research project Diagnostic Analysis of the Implementation of a National Policy for the Reduction of Violence and Accidents. Implementation and organization of the SAMU service, together with the related materials, human resources, and equipment, was studied in five Brazilian State capitals with high morbidity and mortality rates from external causes: Curitiba (Paraná, Recife (Pernambuco, Brasília (Federal District, Rio de Janeiro, and Manaus (Amazonas. The study involved four phases, each developing exploratory and

  20. Analysis of the Influence of Traumatic Incidents on Mental Health of Pre-hospital Practitioners, Hangzhou%创伤事件对杭州市某急救中心急救人员心理健康的影响分析

    Institute of Scientific and Technical Information of China (English)

    王祺; 周海斌; 张军根; 余灵芝; 孙毓文; 汪永光

    2013-01-01

    Objective: To investigate the impact of traumatic incidents on mental health of pre -hospital practitioners. Methods: Psychological consequences and well-being were evaluated with the Impact of Event Scale-Revised (IES-R) and General-Weil-Being Scale (GWB) among 97 pre-hospital practitioners, respectively. Traumatic incidents were evaluated with Self-report Traumatic incidents questionnaire. Results: IES -R total scores and GWB total scores was significantly associated with frequencies of subjective reaction to traumatic incidents, but not frequencies of experience of traumatic incidents.In the objective injure issues, the results between genders show that the percentage for men to take a risk is significant higher than that for women. There were no significant differences between genders in IES-R, PTSS positive items and GWB. It has been shown in table 1 that in 27 different injure issues, the rate of "seeing the bodies or touching the bodies" is the highest which is 77.32%, while "happening to see the procedure of sexual abusing on children" is the lowest which is 14.43%. In the injure issues, the results between genders show that the percentage for men to take a risk is significant higher than that for women. Conclusion: Our results highlight the importance of applying the psychological crisis intervention after traumatic events in psychological service for the individuals having subjective reaction to traumatic incidents.%目的:探讨创伤事件对院前急救人员心理健康的影响.方法:采用事件影响量表修订版(IES-R)和总体幸福感量表(GWB)对97名院前急救人员进行了心理健康评估,同时采用创伤事件评定问卷分析创伤事件的客观经历与主观评价.结果:主观经历创伤事件的类型总数是院前急救人员心理健康的危险因素,院前急救人员的心理健康状况与客观经历创伤事件类型总数无相关性:在客观经历创伤事件中,男性组在多种创伤事件中的发生比例

  1. Integrated regional network construction for ST-segment elevation myocardial infarction care%区域协同ST段抬高型心肌梗死救治网络建设探讨

    Institute of Scientific and Technical Information of China (English)

    王斌; 王焱; 叶涛; 肖国胜; 常贺; 温红梅; 陈媛; 林吉怡; 杨鹭琳

    2014-01-01

    (STEMI) care in China and evaluate the implementation effect of this network.Methods Based on real-time electrocardiogram transmission technology,we established an integrated regional network for STEMI care (IRN-STEMI) with Xiamen Heart Center as the core center,120Emergency Systems,PCI-capable hospitals and other community health units as core elements of this network.Reperfusion treatment data of Xiamen Heart Center including the number of patients receiving primary percutaneous coronary intervention (PCI),the mean first medical contact to balloon (FMC-to-B)time,the mean door to balloon (D-to-B) time,the mean length of hospital stay,the mean medical cost and in-hospital mortality were compared before (n =165) and at 1 year after the built-up of IRN-STEMI (n =343).Results Compared to pre-IRN-STEMI era,primary PCI ratio (84.5% (290/343) vs.75.5%(185/245)) were significantly increased post establishment of IRN-STEMI within the network(P =0.06).STEMI patients admitted in Xiamen Heart Center was significantly increased from 165 to 256,the annual mean FMC-to-B time ((110.3 ± 34.0) min vs.(137.9 ± 58.5) min,P < 0.01) and D-to-B ((76.5 ±33.0) min vs.(107.3 ± 38.0) min,P < 0.01),as well as the mean medical cost were significantly decreased ((51 398±22 100)RMB vs.(56 970 ± 24 593)RMB,P < 0.05),while the mean length of hospital stay ((9.0 ± 4.3) d vs.(9.7 ± 4.8) d,P > 0.05) and in-hospital mortality (3.1% (8/256) vs.3.0% (5/165),P > 0.05) remained unchanged before and after the setting of IRN-STEMI in Xiamen Heart Center.Conclusion Establishment of an integrated regional network system for STEMI patients in China is feasible.With collaboration of qualified heart center,EMS and PCI-capable and non-PCI capable local hospitals,establishment of IRN-STEMI effectively increased the ratio of primary PCI for STEMI patients,it also significantly shortened the FMC-to-B and D-to-B time,decreased mean medical cost,thus,the regional IRN-STEMI network might be an

  2. Suboptimal medical care of patients with ST-Elevation Myocardial Infarction and Renal Insufficiency: results from the Korea acute Myocardial Infarction Registry

    Directory of Open Access Journals (Sweden)

    Choi Joon

    2012-09-01

    Full Text Available Abstract Background The clinical outcomes of ST-segment elevation myocardial infarction (STEMI are poor in patients with renal insufficiency. This study investigated changes in the likelihood that patients received optimal medical care throughout the entire process of myocardial infarction management, on the basis of their glomerular filtration rate (GFR. Methods This study analyzed 7,679 patients (age, 63 ± 13 years; men 73.6% who had STEMI and were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR from November 2005 to August 2008. The study subjects were divided into 5 groups corresponding to strata used to define chronic kidney disease stages. Results Patients with lower GFR were less likely to present with typical chest pain. The average symptom-to-door time, door-to-balloon time, and symptom-to-balloon time were longer with lower GFR than higher GFR. Primary reperfusion therapy was performed less frequently and the results of reperfusion therapy were poorer in patients with renal insufficiency; these patients were less likely to receive adjunctive medical treatment, such as treatment with aspirin, clopidogrel, β-blocker, angiotensin-converting enzyme (ACE inhibitor/angiotensin-receptor blocker (ARB, or statin, during hospitalization and at discharge. Patients who received less intense medical therapy had worse clinical outcomes than those who received more intense medical therapy. Conclusions Patients with STEMI and renal insufficiency had less chance of receiving optimal medical care throughout the entire process of MI management, which may contribute to worse outcomes in these patients.

  3. Fibrinolytic Therapy Versus Primary Percutaneous Coronary Interventions for ST-Segment Elevation Myocardial Infarction in Kentucky: Time to Establish Systems of Care?

    Science.gov (United States)

    Wallace, Eric L.; Kotter, John R.; Charnigo, Richard; Kuvlieva, Liliana B.; Smyth, Susan S.; Ziada, Khaled M.; Campbell, Charles L.

    2013-01-01

    Background Fibrinolytic therapy is recommended for ST-segment myocardial infarctions (STEMI) when primary percutaneous coronary intervention (PPCI) is not available or cannot be performed in a timely manner. Despite this recommendation, patients often are transferred to PPCI centers with prolonged transfer times, leading to delayed reperfusion. Regional approaches have been developed with success and we sought to increase guideline compliance in Kentucky. Methods A total of 191 consecutive STEMI patients presented to the University of Kentucky (UK) Chandler Medical Center between July 1, 2009 and June 30, 2011. The primary outcome was in-hospital mortality and the secondary outcomes were major adverse cardiovascular events, extent of myocardial injury, bleeding, and 4) length of stay. Patients were analyzed by presenting facility—the UK hospital versus an outside hospital (OSH)—and treatment strategy (PPCI vs fibrinolytic therapy). Further analyses assessed primary and secondary outcomes by treatment strategy within transfer distance and compliance with American Heart Association guidelines. Results Patients presenting directly to the UK hospital had significantly shorter door-to-balloon times than those presenting to an OSH (83 vs 170 minutes; P P = 0.45). Overall, only 20% of OSH patients received timely reperfusion, 13% PPCI, and 42% fibrinolytics. In a multivariable model, delayed reperfusion significantly predicted major adverse cardiovascular events (odds ratio 3.87, 95% confidence interval 1.15–13.0; P = 0.02), whereas the presenting institution did not. Conclusions In contemporary treatment of STEMI in Kentucky, ongoing delays to reperfusion therapy remain regardless of treatment strategy. For further improvement in care, acceptance of transfer delays is necessary and institutions should adopt standardized protocols in association with a regional system of care. PMID:23820318

  4. Epidemiological investigation and analysis on pre-hospital emergency of traumatic patients in the east of Yichang City%宜昌市城区东部院前急救创伤患者的流行病学调查与分析

    Institute of Scientific and Technical Information of China (English)

    李意; 李新志; 阙祥勇; 谢德平; 朱蕾

    2015-01-01

    目的:分析和探讨宜昌市城区东部创伤发生的规律和临床特点。方法采用回顾性调查研究2008年1月至2012年1月期间通过我院急诊科出动“120”接诊的3531例创伤患者,记录包括年龄、职业、性别、致伤原因、创伤部位、院前时间等指标并进行统计学分析。结果我院“120”接诊的院前急救创伤患者人数呈逐年递增趋势,其人数占院前急救患者总人数的比例却不呈逐年递增趋势;院前急救创伤患者男女比值约为2.5:1;创伤高发人群为中青年人(平均年龄为36.25岁),高发年龄段分别为21~30岁(18.86%)、31~40岁(23.65%)、41~50岁(24.16%);我院接诊的3531例创伤患者的创伤发生时间分布规律为:每年好发月份为9月、11月、12月,整体上来说下半年创伤发生率明显高于上半年,每周分布中以周一及周日创伤发生率高,每天好发创伤的时间段为14:00~16:00、18:00~22:00,尤以20:00~22:00为多;致伤原因位居前三位的分别为交通伤、摔伤、暴力伤,其在不同年龄段的分布有所不同,而男、女性在致伤原因中所占构成比也不同;创伤部位中前三位的分别为头颅和脑、下肢、胸部。结论以创伤好发时间、年龄等相关指标的流行病学规律为依据,组织医护人员进行专项培训,合理的分配急救资源,使创伤患者得到及时确切的救治,做好院前与院内救治的无缝连接,可大大减少创伤患者的致死率和致残率。%Objective To investigate and analyze the epidemiological characteristics of the patients with trau-ma in the east of Yichang City. Methods The clinical data of 3 531 traumatic patients who were rescued by“120”of our hospital region from January 2008 to January 2012 were retrospectively analyzed, including age, occupation, gender, causes, wound areas and pre-hospital time. Results During this four-year period, the number of

  5. [Perspective technologies of surgical care to the wounded].

    Science.gov (United States)

    Samokhvalov, I M; Badalov, V I; Reva, V A; Golovko, K P; Petrov, A N; Kaznacheev, M V; Rozov, A I

    2013-06-01

    A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.

  6. Analysis of factors influencing admission to intensive care following convulsive status epilepticus in children.

    LENUS (Irish Health Repository)

    Tirupathi, Sandya

    2012-02-01

    OBJECTIVES: To identify clinical features and therapeutic decisions that influence admission to the Intensive Care unit (ICU) in children presenting with convulsive status epilepticus (CSE). METHODS: We evaluated 47 admissions with status epilepticus to a tertiary paediatric hospital A&E over a three year period (2003-2006). Following initial management 23 episodes required admission to ICU and 24 were managed on a paediatric ward. We compared clinical, demographic data and compliance with our CSE protocol between the ICU and ward groups. RESULTS: Median age at presentation in the ICU group was 17 months (range 3 months-11 years) compared to 46 months in the ward group (range 3 months-10 years). Fifty per cent of patients in both groups had a previous history of seizures. Median duration of pre-hospital seizure activity was 30 min in both groups. More than two doses of benzodiazepines were given as first line medication in 62% of the ICU group and 33% of the ward group. Among children admitted to ICU with CSE, 26% had been managed according to the CSE protocol, compared to 66% of children who were admitted to a hospital ward. Febrile seizures were the most common aetiology in both groups. CONCLUSION: Younger age at presentation, administration of more than two doses of benzodiazepines and deviation from the CSE protocol appear to be factors which influence admission of children to ICU. Recognition of pre-hospital administration of benzodiazepines and adherence to therapeutic guidelines may reduce the need for ventilatory support in this group.

  7. Did the Olympics need more drugs? a doctor's reflection on providing medical care during Op OLYMPICS.

    Science.gov (United States)

    Monteiro de Barros, James; Ross, D A

    2014-09-01

    This paper examines some of the medical problems arising from the successful deployment of Defence Medical Services personnel to Op OLYMPICS (mid-June 2012-September 2012). It does not aim to be all encompassing in its scope, but focuses on the most pressing issues affecting a junior military doctor's ability to work effectively under field conditions. This will entail a discussion about whether in a deployment such as Op OLYMPICS medical care should be based upon offering solely primary healthcare in medical centres or using Role 1 medical treatment facilities, which include primary healthcare and pre-hospital emergency care. The main recommendations arising from the deployment are: clinicians should deploy with a minimum of basic emergency drugs and equipment; a medical facility treating a large population at risk for a prolonged period should have a broad stock of medications available on site; and medical risk assessments must be performed on all Reservists during mobilisation.

  8. The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care.

    Science.gov (United States)

    Goldstein, Judah; McVey, Jennifer; Ackroyd-Stolarz, Stacy

    2016-01-01

    Caring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

  9. The state of emergency care in Democratic Republic of Congo

    Directory of Open Access Journals (Sweden)

    Luc Malemo Kalisya

    2015-12-01

    Full Text Available The Democratic Republic of Congo (DRC is the second largest country on the African continent with a population of over 70 million. It is also a major crossroad through Africa as it borders nine countries. Unfortunately, the DRC has experienced recurrent political and social instability throughout its history and active fighting is still prevalent today. At least two decades of conflict have devastated the civilian population and collapsed healthcare infrastructure. Life expectancy is low and government expenditure on health per capita remains one of the lowest in the world. Emergency Medicine has not been established as a specialty in the DRC. While the vast majority of hospitals have emergency rooms or salle des urgences, this designation has no agreed upon format and is rarely staffed by doctors or nurses trained in emergency care. Presenting complaints include general and obstetric surgical emergencies as well as respiratory and diarrhoeal illnesses. Most patients present late, in advanced stages of disease or with extreme morbidity, so mortality is high. Epidemics include HIV, cholera, measles, meningitis and other diarrhoeal and respiratory illnesses. Lack of training, lack of equipment and fee-for-service are cited as barriers to care. Pre-hospital care is also not an established specialty. New initiatives to improve emergency care include training Congolese physicians in emergency medicine residencies and medic ranger training within national parks.

  10. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers

    Science.gov (United States)

    Noble, Vicki E; Lamhaut, Lionel; Capp, Roberta; Bosson, Nichole; Liteplo, Andrew; Marx, Jean-Sebastian; Carli, Pierre

    2009-01-01

    Background While ultrasound (US) has continued to expedite diagnosis and therapy for critical care physicians inside the hospital system, the technology has been slow to diffuse into the pre-hospital system. Given the diagnostic benefits of thoracic ultrasound (TUS), we sought to evaluate image recognition skills for two important TUS applications; the identification of B-lines (used in the US diagnosis of pulmonary edema) and the identification of lung sliding and comet tails (used in the US diagnosis of pneumothorax). In particular we evaluated the impact of a focused training module in a pre-hospital system that utilizes physicians as pre-hospital providers. Methods 27 Paris Service D'Aide Médicale Urgente (SAMU) physicians at the Hôpital Necker with varying levels of US experience were given two twenty-five image recognition pre-tests; the first test had examples of both normal and pneumothorax lung US and the second had examples of both normal and pulmonary edema lung US. All 27 physicians then underwent the same didactic training modules. A post-test was administered upon completing the training module and results were recorded. Results Pre and post-test scores were compared for both the pneumothorax and the pulmonary edema modules. For the pneumothorax module, mean test scores increased from 10.3 +/- 4.1 before the training to 20.1 +/- 3.5 after (p < 0.0001), out of 25 possible points. The standard deviation decreased as well, indicating a collective improvement. For the pulmonary edema module, mean test scores increased from 14.1 +/- 5.2 before the training to 20.9 +/- 2.4 after (p < 0.0001), out of 25 possible points. The standard deviation decreased again by more than half, indicating a collective improvement. Conclusion This brief training module resulted in significant improvement of image recognition skills for physicians both with and without previous ultrasound experience. Given that rapid diagnosis of these conditions in the pre-hospital system

  11. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

    2017-02-01

    Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

  12. Tracheostomy care

    Science.gov (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  13. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications ... a team of specially-trained health care providers. Critical care usually takes place in an intensive care ...

  14. Patient and System-Related Delays of Emergency Medical Services Use in Acute ST-Elevation Myocardial Infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps)

    Science.gov (United States)

    AlHabib, Khalid F.; Sulaiman, Kadhim; Al Suwaidi, Jassim; Almahmeed, Wael; Alsheikh-Ali, Alawi A.; Amin, Haitham; Al Jarallah, Mohammed; Alfaleh, Hussam F.; Panduranga, Prashanth; Hersi, Ahmad; Kashour, Tarek; Al Aseri, Zohair; Ullah, Anhar; Altaradi, Hani B.; Nur Asfina, Kazi; Welsh, Robert C.; Yusuf, Salim

    2016-01-01

    Background Little is known about Emergency Medical Services (EMS) use and pre-hospital triage of patients with acute ST-elevation myocardial infarction (STEMI) in Arabian Gulf countries. Methods Clinical arrival and acute care within 24 h of STEMI symptom onset were compared between patients transferred by EMS (Red Crescent and Inter-Hospital) and those transferred by non-EMS means. Data were retrieved from a prospective registry of 36 hospitals in 6 Arabian Gulf countries, from January 2014 to January 2015. Results We enrolled 2,928 patients; mean age, 52.7 (SD ±11.8) years; 90% men; and 61.7% non-Arabian Gulf citizens. Only 753 patients (25.7%) used EMS; which was mostly via Inter-Hospital EMS (22%) rather than direct transfer from the scene to the hospital by the Red Crescent (3.7%). Compared to the non-EMS group, the EMS group was more likely to arrive initially at a primary or secondary health care facility; thus, they had longer median symptom-onset-to-emergency department arrival times (218 vs. 158 min; p˂.001); they were more likely to receive primary percutaneous coronary interventions (62% vs. 40.5%, p = 0.02); they had shorter door-to-needle times (38 vs. 42 min; p = .04); and shorter door-to-balloon times (47 vs. 83 min; p˂.001). High EMS use was independently predicted mostly by primary/secondary school educational levels and low or moderate socioeconomic status. Low EMS use was predicted by a history of angina and history of percutaneous coronary intervention. The groups had similar in-hospital deaths and outcomes. Conclusion Most acute STEMI patients in the Arabian Gulf region did not use EMS services. Improving Red Crescent infrastructure, establishing integrated STEMI networks, and launching educational public campaigns are top health care system priorities. PMID:26807577

  15. Socioeconomic Inequalities in Quality of Care and Outcomes Among Patients With Acute Coronary Syndrome in the Modern Era of Drug Eluting Stents

    Science.gov (United States)

    Yong, Celina M.; Abnousi, Freddy; Asch, Steven M.; Heidenreich, Paul A.

    2014-01-01

    Background The rapidly changing landscape of percutaneous coronary intervention provides a unique model for examining disparities over time. Previous studies have not examined socioeconomic inequalities in the current era of drug eluting stents (DES). Methods and Results We analyzed 835 070 hospitalizations for acute coronary syndrome (ACS) from the Healthcare Cost and Utilization Project across all insurance types from 2008 to 2011, examining whether quality of care and outcomes for patients with ACS differed by income (based on zip code of residence) with adjustment for patient characteristics and clustering by hospital. We found that lower‐income patients were less likely to receive an angiogram within 24 hours of a ST elevation myocardial infarction (STEMI) (69.5% for IQ1 versus 73.7% for IQ4, P<0.0001, OR 0.79 [0.68 to 0.91]) or within 48 hours of a Non‐STEMI (47.6% for IQ1 versus 51.8% for IQ4, P<0.0001, OR 0.86 [0.75 to 0.99]). Lower income was associated with less use of a DES (64.7% for IQ1 versus 71.2% for IQ4, P<0.0001, OR 0.83 [0.74 to 0.93]). However, no differences were found for coronary artery bypass surgery. Among STEMI patients, lower‐income patients also had slightly increased adjusted mortality rates (10.8% for IQ1 versus 9.4% for IQ4, P<0.0001, OR 1.17 [1.11 to 1.25]). After further adjusting for time to reperfusion among STEMI patients, mortality differences across income groups decreased. Conclusions For the most well accepted procedural treatments for ACS, income inequalities have faded. However, such inequalities have persisted for DES use, a relatively expensive and until recently, controversial revascularization procedure. Differences in mortality are significantly associated with differences in time to primary PCI, suggesting an important target for understanding why these inequalities persist. PMID:25398888

  16. Pre-hospital attitudes adopted by patients faced with the symptoms of acute myocardial infarction Actitudes prehospitalarias adoptadas por pacientes frente a los síntomas de infarto agudo del miocardio Atitudes pré-hospitalares adotadas por pacientes frente aos sintomas de infarto agudo do miocárdio

    Directory of Open Access Journals (Sweden)

    Viviane de Araújo Gouveia

    2011-10-01

    Full Text Available This case series aimed to evaluate the behavior adopted by patients during the pre-hospital phase of acute myocardial infarction (AMI. A total of 115 AMI sufferers with ST-segment elevation were evaluated. The chi-square and Fisher's exact tests were applied. The individuals that did not associate the symptoms with cardiovascular disease most often attributed them to the following sources: gastrointestinal (38%, musculoskeletal (29.7%, food and/or medication poisoning (8.5% and arising from the respiratory apparatus (6.3%. The proportion of major outcomes and of patients that arrived in the emergency department after 12 hours was higher among women, individuals with monthly income of up to one minimum wage, those who used analgesics and did not associate the symptoms with cardiovascular disease. It was found that individuals in unfavorable socioeconomic conditions, who interpreted the symptoms incorrectly, arrived later at the emergency department and had worse intra-hospital outcomes.Esta serie de casos tuvo el objetivo de evaluar las conductas adoptadas por los pacientes durante la fase prehospitalaria del infarto agudo del miocardio (IAM. Se evaluaron 115 individuos portadores de IAM con el segmento ST supradesnivelado. Fue aplicada la prueba Chi-cuadrado y la prueba exacta de Fisher. Los individuos que no asociaron los síntomas a la enfermedad cardiovascular la atribuyeron más frecuentemente a los siguientes orígenes: gastrointestinal (38%, osteomuscular (29,7%, intoxicación alimentar y/o medicamentosa (8,5% y provenientes del aparato respiratorio (6,3%. La proporción de resultados más graves y de pacientes que llegaron a la emergencia después de 12 horas fue más elevada entre mujeres, individuos con renta mensual de hasta un salario mínimo, que usaron analgésicos y no asociaron los síntomas a la enfermedad cardiovascular. Se constató que individuos en condiciones socioeconómicas desfavorables, que interpretaron los síntomas de

  17. 缺血性卒中高危者院前延迟行为意向测评量表的编制与验证%Development and Psychometric Validation of Pre-hospital Delay Behavior Intention Scale in Patients at High Risk of Ischemic Stroke

    Institute of Scientific and Technical Information of China (English)

    赵秋利; 吴燕妮

    2012-01-01

    目的 编制缺血性卒中高危者院前延迟行为意向测评量表,用于测评高危者发生院前延迟行为的可能性.方法 采用文献回顾法、半结构访谈法和反头脑风暴法构建量表概念框架和初期条目.采用专家评议、小范围测试及预测试,形成暂定版量表;对哈尔滨市高危者进行大样本测试,有效问卷420例形成正式版量表,并进行信度与效度检验.结果 形成24条目,5因子的缺血性卒中高危者院前延迟行为意向测评量表,累积方差贡献率为64.597%,量表项目间平均相关系数、Cronbach′s系数分别为0.265和0.896;验证因子分析显示拟合指数χ2、df、χ2/df、RMSEA、CFI、GFI、AGFI、NFI、IFI、TLI分别为412.007、234、1.761、0.050、0.948、0.897、0.868、0.888、0.948和0.938.结论 量表具有较好的信度和效度,可用于测评缺血性卒中高危者的院前延迟行为意向水平,为有针对性地进行健康教育干预提供依据.%Objective To develop a pie - hospital delay behavior intention scale for patients at high risk of ischemic stroke. Methods The conceptual framework and initial items were complied using literature review, semi - structured interviews, and anti - brainstorming method. The expert evaluation method, small simple test method, and pre -tested method were used to form the preliminary version of scale. Then, 425 at high risk of ischemic stroke were tested to finalize the scale. Results The final version of the scale was composed of 24 items and 5 factors. The cumulative variance contribution rate was 64. 597% . The mean inter - item correlations and Cronbach's alpha coefficient were 0. 265 and 0. 896. Confirmatory factor analysis showed that the fit index χ2, df, χ2/df, HMSEA, CFI, GFI, AMI, NFI, IFI, and TLI were 412. 007, 234, 1.761, 0.050, 0.948, 0.897, 0.868, 0.888, 0.948, and 0.938, respectively. Conclusion The scale has good reliability and validity and can be used to evaluate the level of pre

  18. An Intelligent Ecosystem for Providing Support in Prehospital Trauma Care in Cuenca, Ecuador.

    Science.gov (United States)

    Timbi-Sisalima, Cristian; Rodas, Edgar B; Salamea, Juan C; Sacoto, Hernán; Monje-Ortega, Diana; Robles-Bykbaev, Vladimir

    2015-01-01

    According to facts given by the World Health Organization, one in ten deaths worldwide is due to an external cause of injury. In the field of pre-hospital trauma care, adequate and timely treatment in the golden period can impact the survival of a patient. The aim of this paper is to show the design of a complete ecosystem proposed to support the evaluation and treatment of trauma victims, using standard tools and vocabulary such as OpenEHR, as well as mobile systems and expert systems to support decision-making. Preliminary results of the developed applications are presented, as well as trauma-related data from the city of Cuenca, Ecuador.

  19. STEMI急诊PCI治疗联用替格瑞洛与11b/111a受体拮抗剂不明显增加出血风险的分析%Observation on Effect of PCI Treatment Combined with Ticagrelor and 11b/111a Receptor Antagonist on Hemorrhage Risks of Patients with STEMI E-mergency

    Institute of Scientific and Technical Information of China (English)

    崔文章; 刘和平

    2016-01-01

    Objective To discuss the effect of PCI treatment combined with Ticagrelor and 11b/111a receptor antagonist on hemorrhage risks of patients with STEMI emergency. Methods 184 cases of STEMI patients admitted and treated in our hospital from January 2010 to May 2015 were selected and randomly divided into two groups with 92 cases in each, the ob-servation group were treated with PCI combined with Ticagrelor and 11b/111a receptor antagonist, the control group were treated with PCI combined with clopidogrel and 11b/111a receptor antagonist, and the hemorrhage risks were compared be-tween the two groups. Results The hemorrhage risk was 3.3% in the control group and 4.4% in the observation group, P>0.05. Conclusion PCI treatment combined with Ticagrelor and 11b/111a receptor antagonist cannot obviously increase the hemorrhage risk of STEMI patients.%目的:探讨STEMI急诊PCI治疗联用替格瑞洛与11b/111a受体拮抗剂对出血风险的影响。方法整群选取2010年1月—2015年5月该医院收治的STEMI患者184例,随机分成观察组(PCI治疗联用替格瑞洛与11b/111a受体拮抗剂)和对照组(PCI治疗联用氯吡格雷与11b/111a受体拮抗剂)各92例,比较两组患者的出血风险。结果对照组出血风险为3.3%,观察组出血风险为4.4%(P>0.05)。结论急诊PCI治疗联用替格瑞洛与11b/111a受体拮抗剂不明显增加STEMI患者的出血风险。

  20. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  1. Hospice Care

    Science.gov (United States)

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  2. 葛根素对急性ST段抬高型心肌梗死溶栓再通后心肌保护作用的临床观察%Clinical observation of the myocardial protection effect of puerarin on STEMI after thrombolytic recanalization

    Institute of Scientific and Technical Information of China (English)

    张雅婷

    2014-01-01

    目的:探讨葛根素注射液对急性ST段抬高型心肌梗死(STEMI)溶栓再通后心肌的保护作用。方法选择2009年6月12日至2013年12月12日收治的198例STEMI 患者中溶栓靶血管再通176例作为治疗组,另选择2006年5月25日至2009年5月27日住院的207例STEMI患者中溶栓再通129例作为对照组。对照组患者采用常规溶栓治疗;治疗组患者在常规溶栓治疗的同时应用葛根素注射液治疗,分别监测两组患者溶栓后心肌酶变化(每隔2 h),用动态心电图监测两组患者8h内心律失常的发生情况。结果治疗组患者心肌酶到达峰值的时间较对照组提前,且心律失常发生率较对照组明显低,差异均有统计学意义(P<0.05)。结论葛根素注射液可明显减低各种心肌酶的释放,降低严重心律失常发生率,促进心功能恢复,从而有效减轻STEMI患者心肌缺血后再灌注损伤。%Objective To explore the protective effect of puerarin injection on acute ST-segment elevation myocardial infarction(STEMI) after thrombolytic therapy. Methods A total of 176 patients with thrombolytic recanalization from 198 STEMI patients,who were received from June 12,2009 to December 12,2013,were taken as treatment group;while other 129 pa-tients from 207 STEMI patients,who were hospitalized from May 25,2006 to May 27,2009,were selected as control group. The control group adopted routine thrombolytic therapy ,while the treatment group was added with puerarin injection on the basis of routine thrombolytic therapy. The changes of myocardial enzyme (every other 2 h) were monitored,and the incidence of arrhythmia within 8 h was detected by dynamic electrocardiogram. Results The time of myocardial enzyme to peak in the treatment group was shorter than that in the control group ,and the levels of myocardial enzyme and the incidence rate of arrhythmia reduced more obviously than those of the control group,and the differences

  3. ST段抬高型心肌梗死患者择期PCI术后左心功能及血尿酸水平的研究%Investigation of left heart function and level of serum uric acid in patients with STEMI after PCI treatment

    Institute of Scientific and Technical Information of China (English)

    贺红; 王利青; 王彩霞; 刘健荣; 杨铃; 李雪松; 刘志跃

    2011-01-01

    目的 通过左室射血分数及血尿酸水平的检测评价ST段抬高型心肌梗死(STEMI)患者择期PCI的临床价值.方法 对93例STEMI患者常规行择期PCI术,然后与同期静脉溶栓成功后药物治疗的80例患者对照,观察住院期间和随访3年的心脏不良事件、超声心动图及血尿酸水平的对比变化.结果 对于STEMI患者静脉溶栓后7~30 d,经择期PCI治疗手术成功率高,围手术期未见死亡,住院期间及随访期间PCI治疗组与药物治疗组相比再次心肌梗死的发生率下降(P﹤0.05),住院期间心血管病死率下降有统计学差异(P﹤0.05).随访3年心血管病死率、左心功能和血尿酸水平未见显著差异(P﹥0.05).结论 STEMI患者择期PCI可防止再梗死的发生以及住院期间的病死率,但随访3年的病死率、左心功能和血尿酸水平与药物治疗无显著差异.%Objective To evaluate the clinical value of PCI treatment in patients with STEMI by evaluating left ventricular ejection fraction and level of serum uric acid.Methods 93 patients with ST segment elevation myocardial infarction underwent selective PCI, and 80 patients with drug treatment after the success of intravenous thrombolytic treatment over the same period during hospitalization were enrolled as control group.The adverse cardiac events, echocardiography, and blood uric acid levels were observed and followed up 3 year.Results For patients with STEMI, from 7 to 30 days after intravenous thrombolytic treatment, selective PCI surgery had highly successful rate, the peri-operative death in the patients was not found.Compared with the drug treatment group, the incidence of reoccur of nyocardial infarction was lower in PCI treatment group during hospitalization and follow up( P < 0.05 ), cardiovascular mortality in patients with different treatment methods had significant differences during hospital( P < 0.05 ).In the three years follow up there was no significant difference in

  4. Influence of non-infarction-related artery stenosis on transmural dispersion of repolarization in STEMI patients after PCI%非梗死相关动脉狭窄对急诊介入术后ST段抬高心肌梗死患者心室跨壁复极离散度的影响

    Institute of Scientific and Technical Information of China (English)

    姚青海; 吴尚勤; 孙姗; 杨琦; 程爱娟; 丁军; 陈炳伟; 李鹏; 杨培根

    2011-01-01

    Objective To study the influence of different stenoses of non-infarction-related artery on transmural dispersion of repolarization(TDR) in ST elevated myocardial infarction (STEMI)patients after primary PCI. Methods 341 STEMI patients were divided into revascularized group (n = 212) and unrevascularized group (n = 129) according to whether successful reperfusion was accomplished after PCI. The patients in revascularized group were further divided into single-vessel group(104 cases) and multiple-vessel group(102 cases). Other 6 patients with moderate lesions(50%) were excluded. Thirty-six healthy persons without coronary heart disease were selected to serve as control group. Tp-e (in present study Tp-e was corrected and Tp-e/RR1/2 ,Tp-e/c were adopted) was used as quantitation index of TDR. Decrease and decrease percentage of Tp-e/c were measured at different time points after operation and were compared between single vessel group and multiple-vessel group. Results Tp-e/c of patients in unrevascularized group was much higher in comparison with control group on admission (P < 0.01). Tp-e/c of both single-vessel group and multiple-vessel group after operation was significantly reduced as compared with the values measured before operation (P< 0. 01). In single-vessel group, Tp-e/c was decreased on third day in comparison with the value measured on the second day (P < 0.05).Conclusion Primary PCI can effectively reduce TDR in STEMI patients no matter how serious the stenosis is in non-infarction related artery.%目的 探讨非梗死相关动脉(IRA)的不同程度病变对急诊PCI术后急性ST段抬高心肌梗死(STEMI)患者心室跨璧复极离散度(TDR)的影响.方法 选择STEMI患者341例,经急诊PCI再通者212例(再通组),未能实现IRA再通者129例(非再通组).再通组患者又根据IRA狭窄程度分为单支病变组(104例)和多支病变组(102例),除外6例狭窄等于50%患者.另选健康体检者36例(对照组).以校正的T

  5. 转院方式对ST段抬高心肌梗死患者直接PCI及其预后的影响%The impact of inter-hospital transfer methods on the prognosis of patients with STEMI and primary PCI treatment

    Institute of Scientific and Technical Information of China (English)

    梅健; 何凌宇; 王岩; 王磊; 项军; 刘成

    2014-01-01

    Objective To compare the impact of inter -hospital transfer methods in the rural area on the prognosis of patients with ST -elevation myocardial infarction ( STEMI ) and primary percutaneous coronary intervention ( PCI ) treatment.Method A retrospective survey was made of 155 consecutive STEMI patients , who with the onset of STEMI within 6 h had completed the first medical contacts , been admitted to rural area hospitals and then referred to our hospi-tal.Based on inter-hospital transfer method , the patients were divided into two groups:direct referral first class hospital group and first taken to a secondary class hospital and later transferred to first class hospital group .This study was to compare two groups of early reperfusion time and in -hospital mortality rate .Results Sixty-four cases of STEMI were in direct referral group , 91 cases in indirect referral group .Compared with that in indirect referral group , the rate of the patients received primary PCI within 12 h of onset time was higher in direct referral group (64.1% vs.30.8%, P<0.001).Primary PCI vs.non-primary PCI OR was 4.025 (95%CI, 1.934-8.377;P=0.000).The total ischemic time from the onset of myocardial infarction to reperfusion was shorter [(6.92 ±1.89) h vs.(9.37 ±1.66) h, P<0.001].There was no significant difference in in -hospital mortality between the two groups (1.6% vs.6.6%; P=0.241).All of the patients who died did not undergo PCI .Conclusion The patients with STEMI who are transferred di-rectly to a first class hospital capable of PCI treatment after the first medical contact have a higher rate of primary PCI treatment.The referral of such cases to a non -PCI capable hospital leads to delay arrival of 12 h after the onset of STE-MI to a first class hospital capable of PCI treatment .%目的:比较农村地区院间不同转院方式对ST段抬高心肌梗死( STEMI)患者再灌注及其预后的影响。方法回顾性调查2011年1月至2013年7月间

  6. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2011-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  7. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

    Directory of Open Access Journals (Sweden)

    V. V. Omel'yanovskiy

    2016-01-01

    Full Text Available Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI, including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI, prehospital thrombolysis, hospital thrombolysis.  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

  8. Hospice care

    Science.gov (United States)

    ... family a break (called respite care). Doctor services. Nursing care. Home health aide and homemaker services. Counseling. Medical ... may be given in other locations, including: A nursing home A ... in charge of care is called the primary care giver. This may ...

  9. Palliative Care

    Science.gov (United States)

    ... you are a partner with the palliative care team as you all work toward the same goal — providing the best quality of life for your child for as ... Care for Children With Terminal Illness Managing Home Health Care Taking Care of You: Support ...

  10. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

    Directory of Open Access Journals (Sweden)

    P. Brian Savino

    2015-12-01

    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  11. Analysis of occupational accidents with biological material among professionals in pre-hospital services Análisis de los accidentes ocupacionales con material biológico entre profesionales en servicios de atención prehospitalaria Análise dos acidentes ocupacionais com material biológico entre profissionais em serviços de atendimento pré-hospitalar

    Directory of Open Access Journals (Sweden)

    Adriana Cristina de Oliveira

    2013-02-01

    Full Text Available OBJECTIVE: To estimate the prevalence of accidents due to biological material exposure, the characteristics and post-accident conduct among professionals of pre-hospital services of the four municipalities of Minas Gerais, Brazil. METHOD: A cross-sectional study, using a structured questionnaire that was developed to enable the calculation of prevalence, descriptive analysis and analytical analysis using logistic regression. The study included 228 professionals; the prevalence of accidents due to biological material exposure was 29.4%, with 49.2% percutaneous, 10.4% mucousal, 6.0% non-intact skin, and 34.4% intact skin. RESULTS: Among the professionals injured, those that stood out were nursing technicians (41.9% and drivers (28.3%. CONCLUSION: Notification of the occurrence of the accident occurred in 29.8% of the cases. Percutaneous exposure was associated with time of work in the organization (OR=2.51, 95% CI: 1.18 to 5.35, pOBJETIVO: estimar la prevalencia de los accidentes por exposión a material biológico, sus características y conductas después del accidente entre los profesionales de la Atención Prehospitalaria de cuatro municipios de Minas Gerais, en Brasil. MÉTODO: estudio transversal, donde se utilizó cuestionario estructurado, se realizó cálculo de prevalencias, análisis descriptivo y analítico por medio de regresión logística. Participaron del estudio 228 profesionales, la prevalencia de accidentes por exposición a material biológico fue de 29,4%, siendo 49,2% percutáneo; 10,4% mucosas; 6,0% piel no íntegra; y, 34,4% piel íntegra. RESULTADOS: entre los profesionales accidentados se destacaron técnicos de enfermería (41,9% y conductores (28,3%. CONCLUSIÓN: la notificación del accidente ocurrió en 29,8% de los casos. Estuvo asociada a la exposición por vía percutánea el tempo de actuación en la institución (OR = 2,51; IC 95%: 1,18 - 5,35; pOBJETIVO: estimar a prevalência dos acidentes por exposição a

  12. 眼镜蛇咬伤的临床特点与院前急救策略分析%The clinical features and pre-hospital first aid strategies of patients with cobra bites:a retrospec-tive analysis of 115 cases

    Institute of Scientific and Technical Information of China (English)

    宾文凯; 贺华; 刘斌; 李威; 吴小林

    2016-01-01

    目的:分析眼镜蛇咬伤中毒临床特点,探讨不同的院前急救措施对眼镜蛇咬伤患者预后的影响。方法收集我院蛇伤中毒科2014-01~2016-01眼镜蛇咬伤患者115例临床数据资料进行回顾性分析。按就诊时间分为两组:A组(0 h≤就诊时间<8 h)、B组(8 h≤就诊时间<24 h),按是否行捆扎分为捆扎组50例与非捆扎组65例,按是否切开分为切开组52例与非切开组63例。患者入院后进行血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及溃疡评分、肿胀评分、病情评分。并对结果进行统计学分析。结果①115例患者平均就诊时间10.1 h,最早l h,最晚24 h;植皮56例,未植皮59例,A组的重危型发生率低于B组;②捆扎组血清CK、溃疡评分、肿胀评分明显高于非捆扎组,两组比较差异有统计学意义(P<0.01);③切开组的血清CK、CK-MB、溃疡评分、肿胀评分、病情评分低于非切开组,两组比较差异有统计学意义(P<0.05)。结论眼镜蛇咬伤短时间容易引起局部皮肤软组织坏死,早期切开排毒是最佳的预防措施。捆扎不当及就诊时间延长是加重局部组织坏死的危险因素。%Objective To summarize the characteristics of patients with cobra bite, and analyze the different pre-hospital emergency treatments effect on the prognosis of patients with cabra bite. Meth-ods A retrospective study was conducted in Affiliated Nanhua Hospital, Universty of South China from Jan 2014 to Jan 2016. A total of 115 patients bitten by cabra which admitted into Snake Bite and Toxico⁃sis Unit were included in the study based on inclusion criteria. There were two groups, A group(visit time<8 h)and B group(visit time ≥ 8 h), based on visit time. Data of the patients were collected and analyzed. They were divided into binding group and non-binding group according to pretreatment, and divided into incision group and non

  13. Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.

    Science.gov (United States)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique; Kombe, Yeri; Nyandieka, Lillian; Byskov, Jens

    2014-01-01

    Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.

  14. Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care.

    Science.gov (United States)

    Norouzpour, Amir; Khoshdel, Ali Reza; Modaghegh, Mohammad-Hadi; Kazemzadeh, Gholam-Hossein

    2013-09-01

    Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.

  15. [Prehospital management of very elderly patients with ST segment elevation in Paris by mobile intensive care units (Samu)].

    Science.gov (United States)

    Leroy, J E; Bensouda, C; Durand, E; Greffet, A; Scemama, A; Carli, P; Danchin, N; Sauval, P

    2005-03-01

    More and more elderly people are hospitalised with myocardial infarction. Little is known on their pre-hospital management. In 2001 and 2002, 105 patients aged 80 years or more with suspected ST elevation infarction were managed by the mobile intensive care unit system of the SAMU de Paris-Necker. Diagnosis of infarction was confirmed in 92 (88%). Over 60% of the patients were women. Median time delay from symptom onset to call to the emergency service was 127 minutes, longer in nonagenarians (175 vs 101 minutes). Prehospital use of aspirin was 81% and 39% received an intravenous bolus of heparin. A reperfusion strategy was decided in only 30% (primary PCI: 23/26). One-month mortality was 21% and was related to older age, time when the call to the Samu was made, and absence of current smoking. Overall, the prehospital management of very elderly patients with suspected ST elevation infarction appears far from optimal.

  16. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....... of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... the performance of specific home care services by means of video conversations rather than physical visits in the citizens’ homes. As scholars within the STS tradition maintain, technologies do not simply replace a human function; they rather transform care work, redistributing tasks between citizens, technology...

  17. Pin care

    Science.gov (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. www.aast.org/discharge-instructions-for-wound-cares . Accessed May 13, 2016.

  18. An educational training program for the care at the site of injury of trauma to the central nervous system.

    Science.gov (United States)

    Rimel, R W; Jane, J A; Edlich, R F

    1981-03-01

    The treatment of head and spinal cord injuries must be directed towards prevention of secondary insults which will increase the extent of permanent disability. Improved extrication techniques at the scene of the accident, earlier recognition and treatment of complications and improved transfer management have all reduced the acute morbidity and mortality of injuries to the central nervous system. At the University of Virginia we have implemented a comprehensive training program in the acute care of the head and spinal cord injured patient for Emergency Medical Technicians (EMT), nurse, community referring physicians, and house staff within the medical center. A booklet, prepared for care at the site of injury, outlines the assessment, care and intervention with the head and spinal injury patient for the EMT. Another booklet provides guidelines for care of the patient in the emergency department. Included here are instructions in respiratory care, adequate circulation and spinal splinting. The greatest emphasis is placed on the history and physical examinations, which documentation of the extent of neurologic deficit, including the Glasgow coma scale. Data on 900 pre-hospital calls by volunteer EMTs demonstrate a 90% compliance in basic life support skills outlined in the educational program. A similar compliance has been achieved with referring physicians and house staff in the medical center, in the acute management of the CNS injured patient, due primarily to this educational program and increase in the optimal care of these patients has resulted.

  19. Prehospital care for multiple trauma patients in Germany.

    Science.gov (United States)

    Maegele, Marc

    2015-01-01

    For the German speaking countries, Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid. The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care. The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system. The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept. The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first"). If no immediate treatment is necessary, a "Secondary Sur- vey" follows with careful and structured body examination and detailed assessment of the trauma mechanism. Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme. Critical trauma patients should be referred without any delay ("work and go")toTR-DGU® certified trauma centers of the local trauma networks. Due to the difficult pre- hospital environment the number of quality studies in the field is low and, as consequence, the level of evidence for most recommendations is also low. Much information has been obtained from different care systems and the interchangeability of results is limited. The present article provides a synopsis of rec- ommendations for early prehospital care for the severely injured based upon the 2011 updated multi- disciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung", the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

  20. Comparing Care

    NARCIS (Netherlands)

    Evert Pommer; Isolde Woittiez; John Stevens

    2007-01-01

    Home care is one of the most important means of compensating for disabilities and ensuring continuity in people's daily functioning. Home care services in the Netherlands have recently been transferred from a national social security provision for long-term care to a local social service. In most ot

  1. Preconception Care and Prenatal Care

    Science.gov (United States)

    ... at risk for complications? How does stress affect pregnancy? NICHD Research Information Clinical Trials Resources and Publications Preconception Care and Prenatal Care: Condition Information Skip sharing on social media links Share this: Page Content What is preconception ...

  2. Evaluation of hospital diagnosis and treatment quality based on the quality-evaluation model of STEMI%基于ST段抬高型心肌梗死质量评价模型的医院诊疗质量评估

    Institute of Scientific and Technical Information of China (English)

    杨柳; 陈晖; 闻思源; 马晓伟; 孟月莉; 饶克勤

    2015-01-01

    Objective To evaluate and compare the diagnosis and treatment quality of 15 tertiary hospitals in Beijing with the quality-evaluation model of STEMI.Methods The quality-evaluation model has been formatted with the document analysis method and expert consultation method,with the indicators weighted by analytic hierarchy process.By collecting the data of 15 hospitals,we can get the values of indicators,then synthetically evaluate and compare the diagnosis and treatment quality at these 15 hospitals with the method of WRSR.Results In the diagnosing and treating the cases of STEMI at the hospitals,gaps are found between the clinical guidelines and the tests,patient evaluation,reperfusion treatment and drug therapy,with some indicators falling even below 22%.Also,there are significant differences in the diagnosis and treatment quality among hospitals.All hospitals are consistent on the five dimensions-tests,patient evaluation,reperfusion treatment,drug therapy and prognosis.Conclusion The quality-evaluation model of STEMI can comprehensively reflect the diagnosis and treatment quality of cardiovascular medicine,and partly reflect hospital's overall management level,so as to provide operating methods in improving hospital diagnosis and treatment quality.%目的 利用ST段抬高型心肌梗死(ST EMI)质量评价模型对北京市15家三级医院进行诊疗质量的评价比较.方法 应用文献分析法和专家咨询法构建STEMI质量评价指标体系,运用层次分析法确定各指标的权重系数,在15家医院(H1~H15)进行数据采集,对其指标值进行评价,最终用加权秩和比法对医院的STEMI病例诊疗质量进行综合评价.结果 H1~H15家医院在STEMI病例的诊疗中,其检查检验、患者评估、再灌注治疗、药物治疗水平和临床指南的要求尚有一定差距,甚至某些指标的达标率低于22%;医院间诊疗水平差异度较大;各医院在检查检验、患者评估、再灌注治

  3. Study on Effect and Safety about Intravenous Thrombolytic Therapy and Direct PCI in Acute ST Elevation Myocardial In-farction Onset in 3 Hours%发病3h 内急性 STEMI 静脉溶栓及直接 PCI治疗的效果及安全性研究

    Institute of Scientific and Technical Information of China (English)

    牛锋

    2016-01-01

    目的:探讨发病3h内急性ST段抬高型心肌梗死(STEMI)的静脉溶栓及直接经皮冠状动脉介入治疗术(PCI)治疗的效果及安全性。方法:将我院发病3h内急性STEMI患者95例分为PCI组和静脉溶栓组,静脉溶栓组给予尿激酶治疗,PCI组给予直接PCI术,观察两组临床效果及并发症发生率。结果:PCI组梗死相关动脉再通率明显高于静脉溶栓组(P<0.05)。PCI组再次血运重建或补救性 PCI、心绞痛再发作率明显低于静脉溶栓组(P<0.05)。PCI组再发非致死性心肌梗死率及死亡率与静脉溶栓组比较,差异无统计学意义(P>0.05)。治疗7d后PCI组LVESD、LVEDD及LVEDD与静脉溶栓组比较,差异无统计学意义(P>0.05)。治疗14d后 PCI组 LVESD、LVEDD 及LVEDD明显优于静脉溶栓组(P<0.05)。PCI组患者出血率明显低于静脉溶栓组(P<0.05)。结论:PCI治疗发病3h内急性STEMI其梗死相关动脉的开通率更高,更有利于保护左室功能。%Objective :To investigate the effect and safety about intravenous thrombolytic therapy and direct PCI in the acute ST elevation myocardial infarction (STEMI) onset within 3 hours . Methods:In our hospital ,the STEMI cases on‐set within 3 hours were divided into the PCI group and the intravenous thrombolytic therapy group .The intravenous thrombolytic therapy group was given the urokinase treatment ,and the direct PCI group was given the direct PCI ,and the effect and incidence of complications were evaluated .Results:The recanalization of infarction related artery in the di‐rect PCI group was significantly higher than that of intravenous thrombolysis group (P0 .05) .The LVESD ,LVEDD and LVEDD after 7d treatment of the direct PCI group were same to those of the thrombolytic therapy group (P>0 .05) .The LVESD , LVEDD and LVEDD after 14d treatment of the direct PCI group was superior to those of the intravenous thrombolysis

  4. Who Cares for Care Leavers?

    Science.gov (United States)

    Askew, Julie; Rodgers, Paul; West, Andrew

    2016-01-01

    This chapter describes a programme of learning and development at the University of Sheffield, United Kingdom, to support looked-after children and care leavers (youth previously provided care outside or beyond family) throughout the student lifecycle. In this context, looked-after children are those cared for by a town/city authority where…

  5. Advance care directives

    Science.gov (United States)

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  6. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

    Directory of Open Access Journals (Sweden)

    Woodhams Victoria

    2012-06-01

    Full Text Available Abstract Background Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. Method We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN. We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. Results We identified three types of intervention: pre-hospital; within the emergency department (ED; and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Conclusions Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change.

  7. Regionalized care for time-critical conditions: lessons learned from existing networks.

    Science.gov (United States)

    Carr, Brendan G; Matthew Edwards, J; Martinez, Ricardo

    2010-12-01

    The 2010 Academic Emergency Medicine (AEM) consensus conference "Beyond Regionalization" aimed to place the design of a 21st century emergency care delivery system at the center of emergency medicine's (EM's) health policy research agenda. To examine the lessons learned from existing regional systems, consensus conference organizers convened a panel discussion made up of experts from the fields of acute care surgery, interventional cardiology, acute ischemic stroke, cardiac arrest, critical care medicine, pediatric EM, and medical toxicology. The organizers asked that each member provide insight into the barriers that slowed network creation and the solutions that allowed them to overcome barriers. For ST-segment elevation myocardial infarction (STEMI) management, the American Heart Association's (AHA's) Mission: Lifeline aims to increase compliance with existing guidelines through improvements in the chain of survival, including emergency medical services (EMS) protocols. Increasing use of therapeutic hypothermia post-cardiac arrest through a network of hospitals in Virginia has led to dramatic improvements in outcome. A regionalized network of acute stroke management in Cincinnati was discussed, in addition to the effect of pediatric referral centers on pediatric capabilities of surrounding facilities. The growing importance of telemedicine to a variety of emergencies, including trauma and critical care, was presented. Finally, the importance of establishing a robust reimbursement mechanism was illustrated by the threatened closure of poison control centers nationwide. The panel discussion added valuable insight into the possibilities of maximizing patient outcomes through regionalized systems of emergency care. A primary challenge remaining is for EM to help to integrate the existing and developing disease-based systems of care into a more comprehensive emergency care system.

  8. [Implementation of a regional system for the emergency care of acute ischemic stroke: Initial results].

    Science.gov (United States)

    Soares-Oliveira, Miguel; Araújo, Fernando

    2014-06-01

    Implementing integrated systems for emergency care of patients with acute ischemic stroke helps reduce morbidity and mortality. We describe the process of organizing and implementing a regional system to cover around 3.7 million people and its main initial results. We performed a descriptive analysis of the implementation process and a retrospective analysis of the following parameters: number of patients prenotified by the pre-hospital system; number of times thrombolysis was performed; door-to-needle time; and functional assessment three months after stroke. The implementation process started in November 2005 and ended in December 2009, and included 11 health centers. There were 3574 prenotifications from the prehospital system. Thrombolysis was performed in 1142 patients. The percentage of patients receiving thrombolysis rose during the study period, with a maximum of 16%. Median door-to-needle time was 62 min in 2009. Functional recovery three months after stroke was total or near total in 50% of patients. The regional system implemented for emergency care of patients with acute ischemic stroke has led to health gains, with progressive improvements in patients' access to thrombolysis, and to greater equity in the health care system, thus helping to reduce mortality from cerebrovascular disease in Portugal. Our results, which are comparable with those of international studies, support the strategy adopted for implementation of this system. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. MULTInational non-interventional study of patients with ST-segment elevation myocardial infarction treated with PRimary Angioplasty and Concomitant use of upstream antiplatelet therapy with prasugrel or clopidogrel - the European MULTIPRAC Registry

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Grieco, Niccolò; Ince, Hüseyin

    2015-01-01

    registry enrolling 2053 ST-segment elevation myocardial infarction (STEMI) patients. Patients were grouped according to adherence to the initially prescribed thienopyridine. Pre-hospital use of prasugrel increased from 12.5% to 67.1% at study end. Prasugrel compared to clopidogrel-initiated patients more...

  10. Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes

    DEFF Research Database (Denmark)

    Bueno, Héctor; Sinnaeve, Peter; Annemans, Lieven

    2016-01-01

    .4%); 1705 (16.1%) had triple anti-platelet therapy, and 849 (8%) single anti-platelet therapy. STEMI patients more often received pre-hospital anti-thrombotics, and prasugrel, GP IIb/IIIa inhibitors and UFH in-hospital (all p

  11. Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia

    Directory of Open Access Journals (Sweden)

    VanRooyen Michael J

    2005-02-01

    Full Text Available Abstract Background Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment – combining quantitative and qualitative methodologies – may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. Methods Integrated quantitative and qualitative methodologies – system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis – were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. Results Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. Conclusions By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings.

  12. Psychometric evaluation of the Perceived Barriers to Health Care-seeking Decision in Chinese patients with acute coronary syndromes.

    Science.gov (United States)

    Li, Polly W C; Lee, Diana T F; Yu, Doris S F

    2014-01-01

    This study aimed to develop the Chinese version of the Perceived Barriers to Health Care-seeking Decision (PBHSD-C) and evaluate its psychometric properties in Chinese patients with acute coronary syndromes (ACS). The assessment of the level of perceived barriers in the care-seeking trajectory of ACS patients is important for the understanding of its impact on pre-hospital delay in seeking care. The psychometric properties of PBHSD-C were evaluated among 114 ACS patients in the cardiac unit of two major hospitals in Hong Kong. The Content Validity Indexes were ranged from .88 to 1. The Cronbach's alpha of the PBHSD-C was .74. The intraclass correlation coefficients of all items were above .80. The convergent validity of the PBHSD-C was also supported. The PBHSD-C is reliable and valid to be used to assess the level of perceived barriers in the care-seeking of Chinese patients with ACS. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública ST-Elevation myocardial infarction network: systematization in 205 cases reduced clinical events in the public health care system

    Directory of Open Access Journals (Sweden)

    Ana Christina Vellozo Caluza

    2012-11-01

    % due to difficulties inherent in large metropoles. OBJECTIVE:To describe in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network. METHODS: Health care teams of four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé and Saboya of the periphery of the city of São Paulo and advanced ambulances of the Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis or in 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis. RESULTS: From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients, most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding. CONCLUSION: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.

  14. Palliative Care

    Science.gov (United States)

    ... symptoms can cause fear and anxiety, the palliative care team usually includes: a physician or nurse who is an expert in prescribing medications or other symptom -relieving measures, behavioral health providers who can help answer your ...

  15. Hospice Care

    Science.gov (United States)

    ... terminally ill individuals live their remaining days with dignity. These programs can assist the family (or other ... to prepare herself and her family for her death. She realized that she wanted to be cared ...

  16. CARES Foundation

    Science.gov (United States)

    ... today and CARES will receive 5% of your purchase! THEIR HISTORY: In 2001, Lauren’s Hope introduced the ... Go to the staff directory Find Us on Facebook Recent Tweets In case you missed it! http:// ...

  17. Dysarthria - care

    Science.gov (United States)

    Speech and language disorder - dysarthria care; Slurred speech - dysarthria; Articulation disorder - dysarthria ... Dysarthria is a condition that occurs when there are problems with the muscles that help you talk. ...

  18. Residential Care

    Science.gov (United States)

    ... Last name: Email: * Zip: * *required We will not sell or share your name. Residential Care Tweet Bookmark ... for the future. Use Alzheimer's Navigator ™ - our free online tool - to guide you as you map out ...

  19. Caring Encounters

    Science.gov (United States)

    Gunn, Alyson

    2012-01-01

    Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

  20. Early reperfusion strategy for acute myocardial infarction:a need for clinical implementation

    Institute of Scientific and Technical Information of China (English)

    Yan ZHANG; Yong HUO

    2011-01-01

    Reperfusion is the key strategy in acute ST-segment elevation myocardial infarction (STEMI) care,and it is time-dependent.Shortening the time from symptom to reperfusion and choosing the optimal reperfusion strategy for STEMI patients are great challenges in practice.We need to improve upon the problems of low reperfusion rate,non-standardized treatment,and economic burden in STEMI care.This article briefly reviews the current status of reperfusion strategy in STEMI care,and also introduces what we will do to bridge the gap between the guidelines and implementation in the clinical setting through the upcoming China STEMI early reperfusion program.

  1. Integrating Palliative Care into Primary Care.

    Science.gov (United States)

    Gorman, Rosemary D

    2016-09-01

    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  2. Care for patients with cerebrovascular disease in a general hospital. 2 years experience

    Directory of Open Access Journals (Sweden)

    Joan Omar Rojas Fuentes

    2010-08-01

    Full Text Available Background: The care of patients with cerebrovascular disease requires an organized system from pre-hospital care until discharge of the patient, to ensure the continuity of rehabilitation. In order to provide differentiated services to patients with this condition was created in the General Hospital Universitario "Dr. Gustavo Lima Aldereguía "a specialized room for attention to these diseases and the rehabilitation of patients. Objective: To determine the benefits obtained with differentiated services to patients with cerebrovascular disease in a general hospital. Methods: Descriptive case series that included 1038 patients admitted to the specialized chamber for cerebrovascular disease. We analyzed the following variables: stay, type of cerebrovascular disease, clinical classification, the Barthel index and discharge status. Results: 972 patients suffered from cerebrovascular disease, hospital stay was reduced by two days, the attention of specialized equipment increased from 51.75% to 79.2% patients were discharged with a mild degree of functional dependence. Conclusions: The differentiated services to cerebrovascular disease in general hospitals shows benefits for patients.

  3. Improving bariatric patient transport and care with simulation.

    Science.gov (United States)

    Gable, Brad D; Gardner, Aimee K; Celik, Dan H; Bhalla, Mary Colleen; Ahmed, Rami A

    2014-03-01

    Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics' knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions and 95% confidence

  4. Improving Bariatric Patient Transport and Care with Simulation

    Directory of Open Access Journals (Sweden)

    Brad D. Gable

    2014-03-01

    Full Text Available Introduction: Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Methods: Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree to 5 (strongly agree on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p

  5. Careful science?

    DEFF Research Database (Denmark)

    Jespersen, Astrid P; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2014-01-01

    the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives....... Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for public...

  6. 中青年与老年急性 ST 段抬高心肌梗死冠状动脉内自发性再通患者的临床特点比较%Comparison of the clinical characteristics between middle aged and elderly patients who suffered from STEMI with spontaneous reperfusion

    Institute of Scientific and Technical Information of China (English)

    肖平喜; 柳剑; 高应东; 田乃亮

    2015-01-01

    Objective To explore the clinical features of the patients with acute ST segment elevation myocardial infarction who got a spontaneous reperfusion between middle age and the elderly patients. Methods Sixty -eight acute ST segment elevation myocardial infarction ( STEMI ) patients with spontaneously recanalization in the coronary artery were consecutively enrolled.The patients were divided into two groups based on age, middle age group and elderly age group.The demographic data, clinical baseline data, coronary angiographic findings and hospital survival rate were documented in the two groups.Results Between the two groups, gender composition ratio, chest pain lasting time,“with or without chest pain symptoms”, myocardial infarction site, nitroglycerin containing history, smoking history, aspirin taking history, hyperlipidemia history, hypertension history, statin-taking history, PCI history, whether involving the trunk, in -hospital survival rate, heart failure rate, pre -infarction angina, myocardial infarction complication, cardiogenic shock, coronary occlusion site, “whether to need to vasoactive drugs” were counted and analyzed with no significant difference ( P >0.05 ). However, the middle group had a higher rate of initial coronary heart disease(P There is no significant difference between middle and elderly patients with STEMI in the demographic data, baseline clinical data, coronary angiography results and hospital survival rate.The middle age group has a higher rate of initial coronary heart disease, which suggests that first time-STEMI in middle age people is prone to spontaneous reperfusion.%目的:研究中青年与老年患者急性ST段抬高心肌梗死( STEMI)冠状动脉内自发性再通的临床特点。方法连续入选2013-01~2015-07南京市第一医院108例急性STEMI冠状动脉内自发性再通的患者,记录患者的人口学资料、临床基线数据、冠状动脉造影结果及院内生存率。根据年龄

  7. Influences of thrombus aspiration combining intra-coronary IRA injection of tirofiban on no-reflow phenomenon and heart function in patients with STEMI%血栓抽吸联合冠状动脉内注射替罗非班对ST段抬高型患者无复流和心功能的影响

    Institute of Scientific and Technical Information of China (English)

    张学志; 杜青; 王其新; 周长勇

    2012-01-01

    Objective To investigate the influences of thrombus aspiration combining intra-coronary infarction-related artery ( IRA ) injection of tirofiban on no-reflow phenomenon and heart function in patients with ST-elevation myocardial infarction ( STEMI) during percutaneous coronary intervention ( PCI) . Methods The patients ( n=86) with STEMI ( TIMI≤ 1 ) were collected from Feb. 2008 to Apr. 2012 and randomly divided into experimental group and control group ( each n=43 ) . Control group was given tirofiban before PCI and experimental group was given additionally thrombus aspiration. The changes of TIMI flow grades after PCI, level of plasma N-terminal pro-brain natriuretic peptide ( Nt-proBNP) before PCI and one week and 6 months after PCI, and left ventricular end-diastolic volume ( LVEDV ) , left ventricular end-systolic volume ( LVESV ) , left ventricular ejection fraction ( LVEF ) and left ventricular end-diastolic volume index ( LVEDVI) immediately after PCI and one week and 6 months after PCI were compared between two groups. The heart function was reviewed and incidence rate of major adverse cardiovascular events ( MACE ) was observed in the patients within 6 months after PCI. Results ①The patients with TIMI flow grade 3 were more in experimental group than those in control group after PCI ( 39 vs. 28, P<0.05 ) . ②The level of Nt-proBNP decreased significantly ( P<0.01) , LVEF increased significantly (P<0.05 ) , and LVESV, LVEDV and LVEDVI decreased significantly (P <0.05 ) in experimental group compared with control group one week and 6 months after PCI. ③The incidence rate of MACE including angina and heart failure decreased significantly ( P<0.05 ) in experimental group within 6 months after PCI. Conclusion Thrombus aspiration combining intra-coronary IRA injection of tirofiban can reduce the incidence of no—reflow phenomenon during emergency PCI, relieve flow reperfusion in infarction area, improve left ventricular function, decrease ventricular

  8. Wound Care.

    Science.gov (United States)

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.

  9. Continuing Care

    Science.gov (United States)

    ... a Mutation That Protects Against the Development of Alzheimer’s Disease to the Effect of Gleevec Newly Inducted Into the Basketball Hall ... a serious, progressive illness. A vast network of social, medical and ... person with Alzheimer’s – and their caregiver(s) – get the best care and ...

  10. Pregnancy care

    Science.gov (United States)

    ... Avoid all alcohol and drug use and limit caffeine. Quit smoking, if you smoke. Go for prenatal visits and tests: You will see your provider many times during your pregnancy for prenatal care. The number of visits and types of exams you receive will change, depending on where you ...

  11. Just caring.

    Science.gov (United States)

    Hussey, Trevor

    2012-01-01

    Social justice is concerned with fair distribution of the benefits and burdens of living together in society. Regarding nursing care, social justice is concerned with who should receive its benefits, how much they should receive, and who should take up the burden of providing and paying for it. A specific thesis is offered: 'Health care, including nursing care, should be distributed on the basis of need, free at the point of use, the cost being born by the community involved.' This thesis is shown to be incompatible with consequentialist (utilitarian) and libertarian approaches to social justice, but reasons are given for rejecting these theories. It is shown that it may be compatible with Rawl's liberal theory of justice and definitely compatible with a version of the teleological (Aristotelian) theory. The thesis is then defended against criticisms concerned with desert and responsibility: that the provident ought not to pay for the improvident, and that those who are responsible for their health do not deserve free care. There are answered by an epistemological argument concerning what we need to know before we can decide what people deserve, and an argument about social cohesion. The conclusion is that the thesis can be offered as a moral principle for a fair society. © 2011 Blackwell Publishing Ltd.

  12. Prenatal Care.

    Science.gov (United States)

    Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Office for Maternal and Child Health Services.

    This booklet is the first in a series of publications designed to provide parents with useful information about childrearing. Contents are organized into three parts. Part I focuses on the pregnancy, prenatal care, development of the baby, pregnant lifestyles, nutrition, common discomforts, and problems of pregnancy. Part II provides information…

  13. Respite Care

    Science.gov (United States)

    ... provided in a home, an adult day-care program or over a weekend in a nursing home or an assisted living facility. For more information on the NFCSP visit the Administration on Aging website at http://www.aoa.gov/ ...

  14. Prevalencia de procesos y patologías atendidos por los servicios de emergencia médica extrahospitalaria en España Prevalence of processes and pathologies dealt with by the pre-hospital emergency medical services in Spain

    Directory of Open Access Journals (Sweden)

    A. Pacheco

    2010-01-01

    operational forces: intensive care units (mobile-ICUs: 329, rapid intervention vehicles (RIV 20, health ambulances 39 and medical helicopters 39 (5 of them 24 hour: Canary and Balearic Islands and Castille-La Mancha and 3 airplanes. Interventions: mobile-ICUs: 94.3%, medical helicopters: 1.4% and health ambulances: 4.3%. Number of AandE doctors/day: 388, nursing personnel 427. Pathologies dealt with, grouped according to ICE-9-MC: V-psychiatry group: 3.7%, VI-neurological group: 2.7%, VII-cardiovascular group: 9.3%, VIII-respiratory group: 3.2%, XVII-lesions poisonings group: 23.1%, IX-digestive group: 1.3%, X-XI-genital-urinary and gynaecology-obstetrics groups: 1.4%, XVI-group of other ill-defined pathologies: 40.1%. Specifically studied groups (from the MESs that provided them were: thoracic pain- dyspnea: 3.7%, ictus/acute cerebrovascular accident: 0.9%, alteration in consciousness: 7.7%, syncope-blackout: 2.5%, self-inflicted lesions: 2,654 (0.4%. Total of pathological and syndrome groups: 59.9% and total of other ill-defined pathologies: 40.1%. Of the pathologies considered to be of greater relevance in AandE: acute coronary syndrome: 3.1%, arrhythmias: 3.2%, cardiac arrest: 1.7%, respiratory stoppage: 0.16%, total traumatisms: 34.9%, traumatisms: 1.16%, cranioencephalic traumatism: 1.77%, intoxications: 5.1%, aggressions: 6.9%, burns: 0.26%.

  15. FastStats: Hospice Care

    Science.gov (United States)

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  16. Design and methods of European Ambulance Acute Coronary Syndrome Angiography Trial (EUROMAX): an international randomized open-label ambulance trial of bivalirudin versus standard-of-care anticoagulation in patients with acute ST-segment-elevation myocardial infarction transferred for primary percutaneous coronary intervention.

    Science.gov (United States)

    Steg, Philippe Gabriel; van 't Hof, Arnoud; Clemmensen, Peter; Lapostolle, Frédéric; Dudek, Dariusz; Hamon, Martial; Cavallini, Claudio; Gordini, Giovanni; Huber, Kurt; Coste, Pierre; Thicoipe, Michel; Nibbe, Lutz; Steinmetz, Jacob; Ten Berg, Jurrien; Eggink, Gerrit Jan; Zeymer, Uwe; Campo dell' Orto, Marco; Kanic, Vojko; Deliargyris, Efthymios N; Day, Jonathan; Schuette, Diana; Hamm, Christian W; Goldstein, Patrick

    2013-12-01

    In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard-of-care anticoagulation. In addition, it has not been tested in conjunction with the newer P2Y12 inhibitors prasugrel or ticagrelor. EUROMAX is a randomized, international, prospective, open-label ambulance trial comparing bivalirudin with standard-of-care anticoagulation with or without glycoprotein IIb/IIIa inhibitors in 2200 patients with STEMI and intended for primary percutaneous coronary intervention (PCI), presenting either via ambulance or to centers where PCI is not performed. Patients will receive either bivalirudin given as a 0.75 mg/kg bolus followed immediately by a 1.75-mg/kg per hour infusion for ≥30 minutes prior to primary PCI and continued for ≥4 hours after the end of the procedure at the reduced dose of 0.25 mg/kg per hour, or heparins at guideline-recommended doses, with or without routine or bailout glycoprotein IIb/IIIa inhibitor treatment according to local practice. The primary end point is the composite incidence of death or non-coronary-artery-bypass-graft related protocol major bleeding at 30 days by intention to treat. The EUROMAX trial will test whether bivalirudin started in the ambulance and continued for 4 hours after primary PCI improves clinical outcomes compared with guideline-recommended standard-of-care heparin-based regimens, and will also provide information on the combination of bivalirudin with prasugrel or ticagrelor. © 2013 Mosby, Inc. All rights reserved.

  17. [Postacute care].

    Science.gov (United States)

    Admetlla Falgueras, Margarita; Fusté Sugrañes, Josep

    2014-07-07

    The aging of the population and changes in family and social structures have led to increasing care needs for elderly persons following an acute disease or accident, with consequent concerns regarding costs and sustainability within the public health system. The main objective of postacute care (PAC) is to restore the functional capabilities of the patient after an acute event and contribute to determine the patient's outcome and future healthcare requirements. With this background, we carried out a systematic review of the published literature from 1990 to 2011 focused on the following aspects of PAC: a) objectives; b) estimations of the need and the indicators for access to it, and c) transfer strategies from acute care to PAC. The results of this review indicate that PAC is an efficient approach to improve patients' quality of life and to sustain the public healthcare system. The choice of candidates for PAC should be based on both health and social indicators, and the overall process viewed in a cross-sectional manner in order to avoid increases in total cost. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  18. Multimedia Education Increases Elder Knowledge of Emergency Department Care

    Directory of Open Access Journals (Sweden)

    Thomas E. Terndrup

    2013-03-01

    Full Text Available Introduction: Elders who utilize the emergency department (ED may have little prospectiveknowledge of appropriate expectations during an ED encounter. Improving elder orientation toED expectations is important for satisfaction and health education. The purpose of this study wasto evaluate a multi-media education intervention as a method for informing independently livingelders about ED care. The program delivered messages categorically as, the number of tests,providers, decisions and disposition decision making.Methods: Interventional trial of representative elders over 59 years of age comparing pre andpost multimedia program exposure. A brief (0.3 hour video that chronicled the key events after ahypothetical 911 call for chest pain was shown. The video used a clinical narrator, 15 ED healthcare providers, and 2 professional actors for the patient and spouse. Pre- and post-video testsresults were obtained with audience response technology (ART assessed learning using a 4point Likert scale.Results: Valid data from 142 participants were analyzed pre to post rankings (Wilcoxon signedranktests. The following four learning objectives showed significant improvements: number oftests expected [median differences on a 4-point Likert scale with 95% confidence intervals: 0.50(0.00, 1.00]; number of providers expected 1.0 (1.00, 1.50; communications 1.0 (1.00, 1.50;and pre-hospital medical treatment 0.50 (0.00, 1.00. Elders (96% judged the intervention asimproving their ability to cope with an ED encounter.Conclusion: A short video with graphic side-bar information is an effective educational strategy toimprove elder understanding of expectations during a hypothetical ED encounter following calling911.

  19. New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system.

    Science.gov (United States)

    Szentes, Tamás; Kovács, László; Óváry, Csaba

    2016-01-01

    The determination of the necessary capacity and number of neurology wards of level III progressivity that can be defined in the system of criteria detailed in this article and which possess optimal operating conditions in Hungarian terms. We used the National Health Insurance Company's database to calculate case numbers and capacity for different levels of neurological and stroke care. We also revised the allocation of advanced diagnostic and therapeutic technologies, and proposed changes, based on health insurance data. We also discussed these propositions with clinical experts to test their viability. We determined the adequate number of organisational units capable of providing special neurological healthcare services on the basis of the basic data of the Hungarian healthcare system, specifying this number as 6 instead of the current 11. In our study, we have identified significant bias in the nationwide level of neurological and stroke care organisation, which needs revised allocation of healthcare resources. Naturally, this can only be carried out through the restructuring of the emergency care system and the expansion of pre-hospital care.

  20. The relationship between MMP-9 and the recent incidence of ISR of the acute STEMI patients who received PCI treatment%MMP-9与急性STEMI患者介入治疗近期ISR的关联性研究

    Institute of Scientific and Technical Information of China (English)

    陈小节; 严金川; 丁澍; 李璇; 孙涛

    2016-01-01

    目的 观察基质金属蛋白酶-9(MMP-9)与急性ST段抬高心肌梗死(STEMI)接受经皮冠状动脉介入(PCI)治疗并置入药物涂层支架的患者近期支架内再狭窄(ISR)的关系.方法 选择2010年3月至2013年3月在该院接受介入治疗的STE-MI患者210例为观察对象,按照是否发生ISR,分为ISR组33例与.无ISR组177例,测量并比较两组外弹力膜横截面面积、斑决面积、最小管腔面积及内膜增生面积;术前及随访时均检测MMP-9水平.结果 ISR组患者MMP-9水平在随访节点明显高于非ISR组,ROC曲线分析发现,以MMP-9≥2.425 ng/mL为诊断分界值预测ISR的发生,其曲线下面积(AUC)为0.834(95%CI:0.745~0.923),敏感度0.697,特异性0.915,约登指数0.612,具有较好的诊断价值.MMP-9升高的患者外弹力膜横截面积、内膜增生面积及斑块面积大于不升高患者,而最小管腔面积低于不升高患者,差异有统计学意义(P<0.05).结论 PCI术后ISR患者MMP-9水平较术前升高,监测MMP-9水平对PCI术后ISR有一定的预测作用.

  1. An unusual cause of ST elevation myocardial infarction (STEMI).

    Science.gov (United States)

    Monem, Mohammed; Rampat, Rajiv

    2014-09-22

    A 67-year-old Caucasian woman presented to clinic with a 2-month history of worsening shortness of breath on exertion and a single episode of chest pain 1 week before. Her ECG in clinic showed ST elevation inferiorly and she was admitted from clinic for further investigations as inpatient. She was initiated on the acute coronary syndrome protocol and underwent emergency left heart catheterisation on the day of admission. The coronary angiogram revealed large aneurysmal dilations in the right coronary artery and left main stem. A ventriculogram showed poor left ventricular (LV) systolic function in line with subsequent transthoracic echocardiogram, which revealed her to have an left ventricular ejection-fraction (LVEF) of approximately 20%. It was agreed with the cardiothoracic surgeons to treat the aneurysms non-operatively and start low-molecular weight heparin. Furthermore the underlying biventricular impairment was treated with ACE-inhibitors, β-blockers and diuretic therapy (loop and potassium-sparing). The strategy was to prevent further thrombus formation with the aneurysmal vessels and to achieve this the patient was initiated on lifelong warfarin. Other medical risk factors were optimised and patient started on statin medication. The aneurysm was monitored with serial CTs with a view to reconsider surgical intervention if any evidence of dilation. This case highlights an unusual cause of ST elevation myocardial infarction.

  2. Did Cannabis Precipitate an STEMI in a Young Woman?

    Science.gov (United States)

    Jehangir, Waqas; Stanton, Michael; Khan, Rafay; Sahgal, Puneet; Yousif, Abdalla

    2015-01-01

    Cannabis is a substance that contains compounds that bind cannabinoid receptors, CB1 and CB2. Cannabis also contains substances that do not bind these receptors. Delta-9-tetrahydrocannabinol (THC) is the compound in cannabis responsible for its psychoactive effects and binding to cannabinoid receptors. Despite increasing popularity of the medical and recreational uses of cannabis, little attention has been paid to the adverse effects of the use of the substance. Evidence demonstrating an association between cannabis use and acute coronary syndromes has emerged with case reports and in vitro studies. This case report highlights an ST-segment myocardial infarction in a 27-year-old female with little cardiovascular risk factors, but a significant history of frequent cannabis use. PMID:28197241

  3. Intraoperative Care of Direct Percutaneous Coronary Intervention Treatment on Patients with Acute ST-segment Elevation Myocardial Infarction%急性 ST 段抬高型心肌梗死直接冠状动脉介入术中护理

    Institute of Scientific and Technical Information of China (English)

    苏宏; 常丽; 孙艳华

    2014-01-01

    Objective To investigate the important role of intraoperative care during direct percutaneous coronary intervention (PCT) treatment on patients with acute ST-segment elevation myocardial infarction (STEMI). Methods By retrospectively analy-zing 70 patients receiving direct coronary artery interventional therapy of acute ST-segment elevation myocardial Infarction in terms of the clinical data, treatment procedures, nursing intervention to explore the significance of intraoperative care on enhancing the success rate of PCI. Results 69 cases were successful; the success rate was 98. 57% . 1 case of elderly patient died who was with acute ex-tensive anterior myocardial infarction and heart failure; the mortality rate was 1. 43% . Conclusion Accurate judgment and the rapid implementation of intervention led to successful operation; close observation and intraoperative cooperation are the guarantee of success-ful intervention. The highly qualified nursing plays a significant role in the success rates of PCI.%目的:探讨急性 ST 段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PCI)术中护理配合的重要性。方法回顾性分析70例急性 STEMI 患者急诊入导管室直接 PCI 治疗的病例资料、救治过程、护理措施,分析护理配合对提升 PCI 成功率的意义。结果手术成功69例,成功率为98.57%;1例急性广泛前壁心肌梗合并心衰的高龄患者抢救无效死亡,死亡率为1.43%。结论准确判断、迅速实施介入治疗是手术成功的关键;密切观察、术中配合默契是手术成功的保障。高质量的护理配合对提升 PCI 成功率起到很大支持作用。

  4. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  5. What is palliative care?

    Science.gov (United States)

    Comfort care; End of life - palliative care; Hospice - palliative care ... The goal of palliative care is to help people with serious illnesses feel better. It prevents or treats symptoms and side effects of disease and ...

  6. Medical Care during Pregnancy

    Science.gov (United States)

    ... 1- to 2-Year-Old Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During Pregnancy Print ... both moms and their babies. Prenatal Care Before Pregnancy Prenatal care should start before you get pregnant. ...

  7. Medical Care during Pregnancy

    Science.gov (United States)

    ... 1- to 2-Year-Old Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During Pregnancy A ... both moms and their babies. Prenatal Care Before Pregnancy Prenatal care should start before you get pregnant. ...

  8. Pre-Hospital Resuscitation of Traumatic Hemorrhagic Shock with Hypertonic Solutions Worsen Hypocoagulation and Hyperfibrinolysis

    Science.gov (United States)

    2015-07-01

    advantages over isotonic crystalloids (7), and stud- ies in animals and humans show substantial physiologic benefits for treatment of hemorrhagic...Coagulation and Hyper-Fibrinolysis. 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Delano M. J., Rizoli S. B., Rhind S. G...damage, inflammation, and coagulation system requires further investigation. FIG. 1. Plasma concentrations of TF (A), TFPI (B), TM (C), TAFI (D) were

  9. Pre-hospital treatment of bee and wasp induced anaphylactic reactions

    DEFF Research Database (Denmark)

    Ruiz Oropeza, Athamaica; Mikkelsen, Søren; Bindslev-Jensen, Carsten;

    2017-01-01

    was assessed according to Sampson's severity score and Mueller's severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine. RESULTS: We identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009-2014 n = 259) of bee and wasp induced...... could not be graded according to Mueller's severity score. Adrenaline was administrated in 54% (96/177) of cases with moderate to severe anaphylaxis according to Sampson's severity score, compared to 88% receiving intravenous glucocorticoids (p antihistamines (p...

  10. Pre-hospital treatment of bee and wasp induced anaphylactic reactions

    DEFF Research Database (Denmark)

    Ruiz Oropeza, Athamaica; Mikkelsen, Søren; Bindslev-Jensen, Carsten

    2017-01-01

    was assessed according to Sampson's severity score and Mueller's severity score. Treatment was evaluated in relation to administration of adrenaline, glucocorticoids and antihistamine. RESULTS: We identified 273 cases (Odense 2008 n = 14 and Region of Southern Denmark 2009-2014 n = 259) of bee and wasp induced...... could not be graded according to Mueller's severity score. Adrenaline was administrated in 54% (96/177) of cases with moderate to severe anaphylaxis according to Sampson's severity score, compared to 88% receiving intravenous glucocorticoids (p ... adrenaline was administered in only 80% of the cases. CONCLUSION: Treatment with adrenaline is not administered in accordance with international guidelines. However, making an assessment of the severity of the anaphylactic reaction is difficult...

  11. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit

    LENUS (Irish Health Repository)

    McGovern, M

    2017-02-01

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128\\/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114\\/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child’s illness but on educating and empowering the parent.

  12. Determination of the Pre-Hospital Practices Performed for Children with Burn Injuries

    Directory of Open Access Journals (Sweden)

    Mehtap Kavurmaci

    2016-04-01

    Full Text Available Aim: The objective of this study was to determine the first aid practices performed and, effecting factors in burn injuries in before hospital admission. Material and Method: The study was conducted in burn centers of two hospitals in the Erzurum, between December 2013 and August 2014. The population was consisted of inpatient children aged 0-12 years who were treated in burn centers of related hospitals and their mothers at the date of the study. The study was carried out with a total of 121 children and their mothers who met the research inclusion criteria. Questionnaire data was used to collect data. In data analysis, percentage distributions, means and chi-square test were used. Results: It was found that, children%u2019 mothers applicate the cold water first when the burns ocur (57.9%, secondly only applying cold water (27.3%, then the mothers took off their children to hospital not to any application (75.2%, burn wound on the olive oil riding (10.7%, burn wound yogurt riding (8.3%. Discussion: As a result, it was determined that children%u2019 mothers don%u2019t have an adequate level of first-aid knowledge, and younger mothers with low levels of education living in rural areas perform incorrect first aid practices.

  13. CHARACTERIZATION OF VICTIMS ATTENDED BY MOTORCYCLE ACCIDENT SERVICE PRE-HOSPITAL

    Directory of Open Access Journals (Sweden)

    Nalu Rodrigues Felix

    2013-12-01

    Full Text Available This isa descriptive studywith a quantitative approach, aiming to characterize the profileof victims ofmotorcycle accidents attended by the Fire Departmentat Sinop-MT. Thepopulation consisted of473vítimas. Data analysiswas performed usingdescriptive statistics.The survey resultsrevealed thatmost victimsofmotorcycle accidentswere male(61.3% aged15 to 35 years, beingthe maindriver of themotorcyclevictimattendedby professionals from thefire departmentandbody regioninjuries weremost affectedbytheupper and lower limbsrepresenting78.4%. Given our resultshas beenthe expectationthat thisstudy willdraw attention tothe high rates ofvictimsof traffic accidentsinvolving motorcyclesat Sinop-MT, which are having theirlives cut shortorimpairedtheir quality.

  14. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit.

    Science.gov (United States)

    McGovern, M; Kernan, R; O'Neill, M B

    2017-02-10

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child's illness but on educating and empowering the parent.

  15. Social differentiation and embodied dispositions: a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia

    Directory of Open Access Journals (Sweden)

    Liljestrand Jerker

    2009-07-01

    Full Text Available Abstract Background Use of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia. Methods Thematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours. Results The self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system. Conclusion The findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.

  16. Palliative wound care: principles of care.

    Science.gov (United States)

    Dale, Barbara; Emmons, Kevin R

    2014-01-01

    Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among these individuals requires that home care nurses have a certain level of knowledge to provide excellent care. Many times, individuals with wounds do not have the capacity to heal or are burdened with numerous symptoms affecting quality of life. In these cases, the home care nurse must understand concepts of palliative wound care to alleviate symptoms with the goal of improving quality of life.

  17. Who cares?

    DEFF Research Database (Denmark)

    Petersen, Morten Krogh

    and solve problems. Design thinking tends to be depicted as a wonder cure resulting in not only commercial success, but also democratic inclusion and, possibly, environmentally sustainable solutions. While the many promises are certainly problematic (e.g. Kimbell 2011; 2012), this paper suggests that STS...... practices. If that is the case, the great challenge is to “come up with ingenious solutions to the problem of how to become interesting enough for practices to care about” (ibid: 72). Through ethnographic fieldwork encounters with Radicand Design Collaboratory, a collaborative product development...... consultancy located in Silicon Valley’s Redwood City, the paper suggests that design thinking as it unfolds at Radicand has a lot to offer STS in overcoming this challenge. Notably, through an absolute and irrefutable commitment to rapid prototyping, Radicand cultivates an attitude towards the configuration...

  18. Intensive care management of head injury patients without routine intracranial pressure monitoring

    Directory of Open Access Journals (Sweden)

    Santhanam R

    2007-01-01

    Full Text Available Background: Head injury contributes significantly to mortality and morbidity in India. Evaluation of the available trauma care facilities may help improve outcome. Aim: To evaluate the factors influencing the mortality of patients with head injury who had intensive care management and evolve strategies to improve outcome. Setting and Design: Retrospective study in a tertiary hospital where intracranial pressure monitoring (ICPM is not routinely practiced. Materials and Methods: All patients with head injury managed in the intensive care unit in a two-year period were included. The factors evaluated were age, vital signs, Glasgow Coma scale score (GCS at admission, pupillary light reflex (PR, oculocephalic reflex (OCR, hemodynamic stability, computerized tomography (CT findings, diabetes mellitus, anemia, infections and abnormalities of serum sodium. Results: We analyzed 208 patients (202 without ICPM. In-hospital mortality was 64 (31%. Only 24 (11.5% patients were admitted within one hour of injury, while one-third arrived after six hours. The clinical factors (at admission that influenced mortality included age, GCS, PR, OCR and diastolic blood pressure (DBP. Effacement of the basal cisterns in the initial and repeat CT scans, hyperglycemia, hemodynamic instability and serum sodium imbalances were associated with higher mortality. The independent predictors of mortality by logistic regression were initial GCS, DBP, hemodynamic instability and effacement of cisterns on repeat CT. Conclusions: Mortality following head injury is high. Pre-hospital emergency medical services are disorganized. The key to reducing mortality within the limitations of our current trauma system is maintenance of DBP>70 mmHg and SBP> 90 mmHg from the time of first contact.

  19. Cost-effectiveness and benefit of alternatives to improve training for prehospital trauma care in Mexico.

    Science.gov (United States)

    Arreola-Risa, Carlos; Mock, Charles; Herrera-Escamilla, Alejandro J; Contreras, Ismael; Vargas, Jorge

    2004-01-01

    In Latin America, there is a preponderance of prehospital trauma deaths. However, scarce resources mandate that any improvements in prehospital medical care must be cost-effective. This study sought to evaluate the cost-effectiveness of several approaches to improving training for personnel in three ambulance services in Mexico. In Monterrey, training was augmented with PreHospital Trauma Life Support (PHTLS) at a cost of [US] dollar 150 per medic trained. In San Pedro, training was augmented with Basic Trauma Life Support (BTLS), Advanced Cardiac Life Support (ACLS), and a locally designed airway management course, at a cost of dollar 400 per medic. Process and outcome of trauma care were assessed before and after the training of these medics and at a control site. The training was effective for both intervention services, with increases in basic airway maneuvers for patients in respiratory distress in Monterrey (16% before versus 39% after) and San Pedro (14% versus 64%). The role of endotrachal intubation for patients with respiratory distress increased only in San Pedro (5% versus 46%), in which the most intensive Advanced Life Support (ALS) training had been provided. However, mortality decreased only in Monterrey, where it had been the highest (8.2% before versus 4.7% after) and where the simplest and lowest cost interventions were implemented. There was no change in process or outcome in the control site. This study highlights the importance of assuring uniform, basic training for all prehospital providers. This is a more cost-effective approach than is higher-cost ALS training for improving prehospital trauma care in environments such as Latin America.

  20. [Standardisation of the Initial Treatment of Severely Burned Patients: The Necessary Transfer of Concepts from Trauma Care].

    Science.gov (United States)

    Münzberg, M; Harbers, T; Kneser, U; Grützner, P A; Reichert, B; Kremer, T; Wölfl, C G; Horter, J; Hirche, C

    2016-12-01

    The initial treatment of severely burned patients remains a huge challenge for first responders in emergency services as well as emergency doctors who do not work in a centre for severe burn injuries. The reason for this is the low number of cases in developed countries and a lack of training concepts for the specific aspects of the initial treatment of severe burn injuries. Because of guidelines with limited evidence (S1, S2k) and a lack of structured treatment approaches, uncertainties with respect to initial treatment are still visible. Even within the professional societies and on international comparison, controversial aspects remain. In contrast, optimised and standardised procedures are available for the treatment of severely injured (trauma) patients, based on PHTLS® (Pre Hospital Trauma Life Support) for preclinical and ATLS® (Advanced Trauma Life Support) for in-hospital first aid. This article takes stock of the current structure of care and the relevant evidence for the initial treatment of severe burns. Also it discusses a possible transfer and further development of concepts for primary trauma care by all disciplines involved. Nine essential steps in the primary care of burned patients are identified and evaluated. The need for the introduction of a uniform treatment algorithm is illustrated. The treatment algorithm presented in this article addresses all first responders who are faced with initial treatment in the first 24 hours outside of burn centres. As an essential, new aspect, it offers a transfer and adaptation of concepts from trauma care to standardise the care of severely burned patients.

  1. Perioperative Care of Prisoners: Providing Safe Care.

    Science.gov (United States)

    Smith, Francis Duval

    2016-03-01

    Correctional nurses are trained to care for prisoners in a controlled security environment; however, when a convict is transferred to a noncorrectional health care facility, the nurses there are often unfamiliar with custody requirements or how to safely care for these patients. The care of prisoners outside of prison has not been adequately investigated, and a gap exists between research and nursing education and practice. Nurses rarely have to consider how providing care for a prisoner in custody affects their practice, the potential dissonance between routine nursing care and the requirements to maintain security, or that care of prisoners in unsecured clinical areas places the nurse and other personnel at risk for physical assault or prisoner escape. Educating perioperative nurses in the care of prisoners in a public hospital environment is important for the provision of safe care and prevention of physical and emotional repercussions to personnel.

  2. Acne - self-care

    Science.gov (United States)

    Acne vulgaris - self-care; Cystic acne - self-care; Pimples - self-care; Zits - self-care ... If daily skin care does not clear up blemishes, try over-the-counter acne medicines that you apply to your skin. These products ...

  3. Understanding palliative care.

    Science.gov (United States)

    Martin, Caren McHenry

    2006-09-01

    While most pharmacists and other health care practitioners are familiar with the programs and philosophy of hospice, they may lack a clear understanding of palliative care. Because myths and misconceptions about palliative care abound, a review of the definitions and components of palliative care can enhance the practice of all practitioners who care for patients with chronic diseases.

  4. Your cancer care team

    Science.gov (United States)

    ... gov/ency/patientinstructions/000929.htm Your cancer care team To use the sharing features on this page, ... help your body heal. Working with Your Care Team Each member of your care team plays an ...

  5. Office of Child Care

    Science.gov (United States)

    ... for Children & Families Office of Child Care By Office Administration for Native Americans (ANA) Administration on Children, ... Care Partnerships. Review the profiles. > What is the Office of Child Care (OCC)? The Office of Child ...

  6. Adult Day Care

    Science.gov (United States)

    ... Evening care Exercise Health screening Meals Medical care Physical therapy Recreation Respite care Socialization Supervision Transportation Medication management Back to top Center Operations Centers are usually open during normal business ...

  7. Adoption & Foster Care

    Science.gov (United States)

    ... Family Life > Family Dynamics > Adoption & Foster Care Adoption & Foster Care Article Body ​Each year, many children join families through adoption and foster care. These families may face unique challenges. The acceptance ...

  8. Emergency care toolkits.

    Science.gov (United States)

    Black, Steven

    2004-06-01

    Emergency care services are the focus of a series of toolkits developed by the NHS National electronic Library for Health to provide resources for emergency care leads and others involved in modernising emergency care, writes Steven Black.

  9. Developing the Care in Pharmaceutical Care.

    Science.gov (United States)

    Fjortoft, Nancy F.; Zgarrick, David P.

    The purpose of this study was to assess the level of caring ability of a sample of pharmacy students and assess the relationship between selected predictor variables and pharmacy students' caring ability. Caring was viewed as the ability to assume responsibility for the protection and welfare of another without being perfunctory or begrudging.…

  10. Developing interprofessional care plans in chronic care

    NARCIS (Netherlands)

    Jerôme Jean Jacques van Dongen; Marloes Amantia van Bokhoven; Trudy van der Weijden; Anna Beurskens; Wencke Emonts; Ramon Daniëls

    2016-01-01

    Background: The number of people suffering from one or more chronic conditions is rising, resulting in an increase in patients with complex health care demands. Interprofessional collaboration and the use of shared care plans support the management of complex health care demands of patients with

  11. Medicaid Managed Care Structures and Care Coordination.

    Science.gov (United States)

    Gilchrist-Scott, Douglas H; Feinstein, James A; Agrawal, Rishi

    2017-09-01

    Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, P = .034) and receipt of care coordination (adjusted odds ratio: 1.37, P = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, P = .05) and receipt of care coordination (adjusted odds ratio: 0.71, P coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs. Copyright © 2017 by the American Academy of Pediatrics.

  12. Putting the 'care' back into aged care.

    Science.gov (United States)

    Beadnell, Cathy

    2006-04-01

    Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.

  13. Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study

    Directory of Open Access Journals (Sweden)

    Jahangir Rashid Beig

    2017-01-01

    Conclusion: The standard of STEMI management in our state is far from ideal, and calls for a lot of improvement. Major efforts to reduce prehospital and in-hospital treatment delays are urgently needed.

  14. [The Day Service as a tool to reduce inappropriateness of care: the experience of a research hospital in Rome (Italy)].

    Science.gov (United States)

    Cadeddu, Chiara; Specchia, Maria Lucia; Principi, Francesca; Marchini, Raffaele; Cerimele, Marina; Ricciardi, Walter; Cavuto, Costanza

    2015-01-01

    The Day Service was established in Italy to promote appropriateness of care and consists in the delivery of packages of complex outpatient services. A Working Group for the continuous improvement of pre-hospitalization activities of the Regina Elena Scientific Institute in Rome, Italy, established that the outpatient management of surgical patients in the hospital would occur in a Day Service, through a package of services identified at the regional level or appropriate diagnostic and therapeutic pathways. This article describes the experience of the hospital's Day Service and compares results from the last four months of 2013 with those of the first four months of 2014. The introduction of a Day Service has led to a reduction in the number of inappropriate pre-admission tests (mainly computerized tomography, magnetic resonance and Positron emission scans and scintigraphy) and this has had a positive impact not only in terms of organization, reduction of hospital stay and overall hospitalization-related activities, but also from an economic standpoint. The implementation of a Day Service has also improved the overall patient experience, from an organizational point of view, and this is an important aspect, considering that patients at the Regina Elena Scientific Institute are oncological patients, they are often elderly and most reside in other Italian regions.

  15. Convergence of Health Level Seven Version 2 Messages to Semantic Web Technologies for Software-Intensive Systems in Telemedicine Trauma Care.

    Science.gov (United States)

    Menezes, Pedro Monteiro; Cook, Timothy Wayne; Cavalini, Luciana Tricai

    2016-01-01

    To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on th