Emergency Medical Care Of Patients Research Articles

Necessity of Emergency Medical Care for Patients with Epilepsy Presenting with Typical Seizures (P5.050)

Necessity of Emergency Medical Care for Patients with Epilepsy Presenting with Typical Seizures (P5.050)

O112 How much does a non-physician healthcare worker based model of care for cardiovascular disease management cost?

Introduction: In patients with non-ST-elevation acute coronary syndrome (ACS), early risk stratification is of critical importance. Among others, the Thrombolysis in Myocardial Infarction (TIMI) risk score is the most validated and the most extensively used in patients with non-ST-elevation ACS. However, this score does not utilize results of evaluation of early markers of myocardial necrosis such as heart-type fatty acidbinding protein (hFABP). Objectives: The aim of this study was to estimate the effectiveness of new cardiac marker hFABP in the protocol of early risk stratification during rendering emergency medical care for patients with suspected non-ST-elevation acute coronary syndromes (NSTEACS). Methods: The study included two groups of patients. The first group included 442 patients (67 13 years) with suspected NSTEACS who underwent early risk stratification and the second (control group) consist of 491 patients (59 16 years) with suspected NSTEACS but without pre-operative risk stratification. We stratificated patient from first group accordind Modified TIMI risk score which was constructed with included results of hFABP evaluation. This evaluation was provided by a novel, sensitive assay that is based on the immunochromatographic test-strip technique has been recently developed for rapid qualitative detection of hFABP in whole blood (BioTest Co., Novosibirsk, Russia). The procedure requires approximately 100 microliters of whole blood and can be completed within 20 min in any in-patient or out-patient settings without any special equipment. The analytical sensitivity of this test is 15 ng/ml. Results: A preliminary diagnosis of myocardial infarction (MI) was adjudged in 52 (11.8%) patients from the first group and 64 (13.0%) from the second, and a preliminary diagnosis of unstable angina was adjudged in 390 (88.2%) and 427 (87.0%) patients, respectively. The accuracy of diagnosis of myocardial infarction in the first group was higher in the first group than the second (86,5% and 60,9% respectively, p1⁄40,003). The sensitivity of the hFABP assay within the first 12 hours was 84% for the detection of MI and the corresponding specificity was 93%. Conclusion: Using of new cardiac marker hFABP is effective in early risk stratification for patients with suspected non-ST-elevation acute coronary syndromes during rendering emergency medical care. Disclosure of Interest: None Declared

Особенности клиники и оказания экстренной медицинской помощи больным с острым инфарктом миокарда пожилого возраста

.

Abstract WP396: Effects of the Accessibility to Emergency Medical Systems on Stroke Mortality: A Nationwide Survey (J-ASPECT study)

Objective: Rapid emergency medical care for patients with acute stroke is necessary for better prognoses. To decrease the time to medical care, emergency medical systems (EMSs) and stroke centers are distributed extensively in Japan, with universal coverage of medical insurance. We examined the influence of the accessibility to EMSs on stroke mortality in Japan. Methods: We approached 1381 certified training institutions of the Japan Neurosurgical Society and/or the Japan Stroke Society with a question survey regarding acute stroke care capacity. In institutions that responded, the data of the stroke patients hospitalized were obtained from Japanese Diagnosis Procedure Combination database of 2011. The transfer time was measured by an electronic mapping system as the time taken from the postal address of the patient to the transferred hospital. Geographical location by urban employment area (UMA) was classified into 5 categories: metropolitan employment areas (MEA) - central, MEA - outlying, micropolitan employment areas (McEA) - central, McEA - outlying, and unclassified. We examined the effects of UMA and transfer time as measures of accessibility by using a hierarchical linear regression model adjusted by age, gender, and characteristics of institutions. Results: The data of 256 institutions and 53,170 emergency hospitalized patients were analyzed. Mortalities were as follows: 7.8% in cerebral infarction (n = 32,671); 16.8% in intracerebral hemorrhage (n = 15,699); and 28.1% in subarachnoid hemorrhage (n = 4,934). The mortality was lower in MEA - central and higher in unclassified areas for mortality in cerebral infarction (MEA - central, 7.3%; unclassified, 12.0%; OR = 1.55, 95%CI = 1.01-2.39) and subarachnoid hemorrhage (MEA - central, 26.7%; unclassified, 42.9%; OR = 1.95, 95%CI = 1.03-3.70). In areas in cerebral infarction, longer transfer time affected mortality (P = 0.027, MEA - central; P = 0.038, unclassified). Conclusion: Stroke mortality increased according to the inaccessibility to EMS combined with UMA and transfer time. These factors should be taken into account to resolve inappropriate EMS disparities.

Prehospital Atrial Fibrillation: Clinical and Economic Aspects

Objective: to retrospectively study the results of emergency medical care for patients with uncomplicated attacks of atrial fibrillation and to provide a clinical and economic assessment of their prehospital management tactics. Material and methods. A comparative retrospective study was conducted to examine the results of emergency medical care rendered to 1200 patients with uncomplicated atrial fibrillation attacks lasting as long as 24 hours. Ambulance call and outpatient cards and inpatient case reports were used. A clinical and economic assessment of the prehospital management tactics for the patients was made. Results. The prehospital therapy of atrial fibrillation was found to be ineffective in the first hour of observation. In more than 90% of cases, an atrial fibrillation attack was eliminated by the end of the first 24 hours regardless of which antiarrhythmic agent had been used. Conclusion. The proposed prehos-pital management tactics for patients with uncomplicated atrial fibrillation attacks lasting as long as 24 hours make it possible to decrease the length of stay of a called ambulance team and to enhance its efficiency, without reducing the clinical effect of performed antiarrhythmic therapy. Key words: atrial fibrillation, emergency medical care, prehospi-tal stage, clinical and economic analysis.

Critical Pathway Improves Arrival-In-Cath-Lab Interval for Patients With Acute Myocardial Infarction in the Emergency Department.

A newly developed critical pathway has been applied to emergency medical care of patients with acute myocardial infarction (AMI) in the emergency department. The arrival-in-cath-lab interval (ACI) was selected as a clinical indicator of quality assurance, according to American Heart Association and American College of Cardiology guidelines. This report describes the first experience of applying the critical pathway to patients with AMI in an emergency department in Japan. The ACI of 35 AMI patients who underwent primary percutaneous transluminal coronary angioplasty during a 24-month period following application of the pathway were compared with those of 50 AMI patients during the 48 months before application of the pathway. The median ACI value was significantly reduced from 65.5 min to 50.0 min. Also, the proportion of patients with acceptably short ACI (<60 min) significantly improved from 42.0% to 68.6%.

Prise en charge préhospitalière du traumatisé crânien grave

Advanced prehospital emergency care of patients with severe head injuries. Advanced prehospital emergency medical care of patients with a severe head injury must essentially focus on the impact of secondary cerebral insults of systemic origin on the outcome. The first objective of prehospital care is to prevent hypoxaemia and hypercapnia. Therefore, all patients with a Glasgow Coma Scale score equal to or lower than 8 must be treated with endotracheal intubation and controlled ventilation under continuous monitoring of SpO 2 and PETCO 2. Treatment is similar in head-injured patients with significant deterioration of consciousness level, seizures, respiratory distress, or severe facial and thoracoabdominal injuries. The endotracheal tube is inserted by the orotracheal route under direct laryngoscopy, after a rapid induction sequence of anaesthesia and immobilization of the cervical spine in neutral position. For the induction of anaesthesia in these high-risk patients (full stomach, unknown medical history, deteriorated haemodynamic status), etomidate and suxamethonium are the preferred agents. Sedation is maintained with an hypnotic-opioid association (fentanyl). Simultaneously, the main goal is the maintenance of an optimal cerebral perfusion pressure, as arterial hypotension severely worsens cerebral ischaemia. Volume loading is accomplished with 0.9% saline and hydroxyethyl starch.

A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction: Pressley JC, Severance HW, Raney MP,et al. J Am Coll Cardiol. 1988:12:1555–1561

A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction: Pressley JC, Severance HW, Raney MP,et al. J Am Coll Cardiol. 1988:12:1555–1561

A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction

This prospective study compares the outcome of patients with acute myocardial infarction managed by mobile intensive care (paramedic phase) with that of similar patients managed by basic emergency medical care (control phase) in the same community before the introduction of paramedics. All paramedic-transported patients were managed according to a standard chest pain protocol with use of prophylactic lidocaine and, as needed, treatment for sinus bradycardia, hypotension and life-threatening ventricular arrhythmia. There were no specific interventions for supraventricular tachyarrhythmia or hypertension. All patients were treated under similar in-hospital protocols. Percent mortality in patients with hypotension, the highest risk subgroup in the control phase, was significantly lowered with paramedic-level care (69 versus 10%, p = 0.01). Patients with hypertension, a relatively low risk subgroup during the control phase (16% mortality), were also at lower risk during the paramedic phase (10% mortality). In fact, there was no mortality in either study phase for patients with an initial systolic blood pressure greater than 180 mm Hg. During the combined study phases, patients with normotension and tachycardia demonstrated a tendency toward higher percent mortality (33%) than either patients with normotension without tachycardia (10%) or those with hypertension and tachycardia (6%). Although the overall percent mortality was reduced by 24% (from 21 to 16%), this decrease was largely due to the improvement of patients with hypotension. Investigation into the feasibility of prehospital interventions for the high risk patient with acute myocardial infarction normotension and tachycardia appears warranted.

Basic emergency medical care of patients with acute myocardial infarction: Initial prehospital characteristics and in-hospital complications

This prospective study documents the natural history of the prehospital phase of 110 patients with acute myocardial infarction transported by a basic emergency medical system during a 22 month period. Ambulances in a mixed urban-rural county were staffed by basic emergency medical technicians certified in basic life support and the administration of intravenous fluids. Systolic blood pressure, pulse rate and cardiac rhythm were noted for all patients at the time of ambulance arrival and intermittently during transport. Analyses of patient data were performed to determine the relation between the occurrence of subsequent in-hospital urgent complications and death and 1) patient delay time, 2) initial pulse rate, 3) initial systolic blood pressure, and 4) initial cardiac rhythm. Twenty-three (21%) of the 110 patients died and 66 (60%) experienced at least one in-hospital urgent complication. When initial rhythm, pulse rate and blood pressure were considered, patients with hypotension had a higher mortality rate than did those who were either normotensive or hypertensive. The 10 patients with initial sinus bradycardia but no hypotension constituted a subgroup with zero mortality. These results identify high and low risk patient subgroups that may benefit from either providing or withholding interventions directed toward hemodynamic stabilization during the prehospital phase of acute myocardial infarction.

Effect of the cardiac arrhythmias on the coronary circulation.

Excerpt This study will consider the hemodynamic disturbances of the coronary flow which occur during cardiac arrhythmias. It has been shown that fast cardiac arrhythmias can precipitate severe dis...