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1.
Prim Care ; 48(4): 627-643, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752274

RESUMO

In an era where cardiovascular disease continues to increase in prevalence, chest pain is a commonly encountered complaint in the outpatient setting. Clinicians are often tasked with the challenge of selecting the most appropriate screening tool in the evaluation of a patient with suspected coronary artery disease. With proper consideration of indications and contraindications, exercise electrocardiogram (ECG) stress testing is an accessible, cost-conscious, and validated outpatient diagnostic modality for predicting coronary artery disease.


Assuntos
Doença da Artéria Coronariana , Teste de Esforço , Dor no Peito/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Eletrocardiografia , Humanos
2.
Am J Cardiol ; 160: 31-39, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34740394

RESUMO

Chest pain (CP) has been reported in 20% to 40% of patients 1 year after percutaneous coronary intervention (PCI), though rates of post-PCI health-care utilization (HCU) for CP in nonclinical trial populations are unknown. Furthermore, the contribution of noncardiac factors - such as pulmonary, gastrointestinal, and psychological - to post-PCI CP HCU is unclear. Accordingly, the objectives of this study were to describe long-term trajectories and identify predictors of post-PCI CP-related HCU in real-world patients undergoing PCI for any indication. This retrospective cohort study included patients receiving PCI for any indication from 2003 to 2017 through a single integrated health-care system. Post-PCI CP-related HCU tracked through electronic medical records included (1) office visits, (2) emergency department (ED) visits, and (3) hospital admissions with CP or angina as the primary diagnosis. The strongest predictors of CP-related HCU were identified from >100 candidate variables. Among 6386 patients followed an average of 6.7 years after PCI, 73% received PCI for acute coronary syndrome (ACS), 19% for stable angina, and 8% for other indications. Post-PCI CP-related HCU was common with 26%, 16%, and 5% of patients having ≥1 office visits, ED visits, and hospital admissions for CP within 2 years of PCI. The following factors were significant predictors of all 3 CP outcomes: ACS presentation, documented CP >7 days prior to the index PCI, anxiety, depression, and syncope. In conclusion, CP-related HCU following PCI was common, especially within the first 2 years. The strongest predictors of CP-related HCU included coronary disease attributes and psychological factors.


Assuntos
Dor no Peito/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Intervenção Coronária Percutânea , Síndrome Coronariana Aguda/cirurgia , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris , Angina Estável/cirurgia , Angina Instável/cirurgia , Ansiedade/epidemiologia , Estudos de Coortes , Depressão/epidemiologia , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , AVC Isquêmico/epidemiologia , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio sem Supradesnível do Segmento ST/cirurgia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Fatores Sexuais
3.
BMJ Case Rep ; 14(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753720

RESUMO

A 24-year-old fit and well Caucasian man was referred to acute hospital via his General Practitioner with chest pain, palpitations, shortness of breath and an antecedent sore throat. Investigations revealed pericardial and pleural effusions, pericardial thickening on MRI, mild mitral regurgitation on echocardiogram and a raised Antistreptolysin O (ASO) titre.He was treated as acute rheumatic fever (ARF) with a prolonged course of penicillin, supportive therapy with bisoprolol and colchicine with lansoprazole cover. The patient made a full recovery and subsequent cardiac MRI showed resolution of all changes.


Assuntos
Derrame Pleural , Febre Reumática , Adulto , Dor no Peito , Ecocardiografia , Humanos , Masculino , Penicilinas/uso terapêutico , Febre Reumática/complicações , Febre Reumática/diagnóstico , Febre Reumática/tratamento farmacológico , Adulto Jovem
4.
Pneumologie ; 75(11): 901-909, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34788891

RESUMO

Acute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.


Assuntos
Dor no Peito , Eletrocardiografia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/terapia , Diagnóstico Diferencial , Humanos
5.
Ann Card Anaesth ; 24(4): 470-472, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747756

RESUMO

Hydatid infection of the heart is rare and there is always the lethal hazard of cyst perforation. We present an 18-year-old male from Kashmir valley who was admitted to the emergency department of our hospital with fever and chest pain for the last 4 days. Using echocardiography and cardiac tomography (CT), cardiac Echinococcosis was diagnosed. The results of surgical treatment of cardiac Echinococcosis were better than the conservative strategy. Surgical excision was performed. The patient had an uneventful recovery.


Assuntos
Equinococose , Cardiopatias , Adolescente , Dor no Peito , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Ecocardiografia , Coração , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Masculino
6.
Cir Cir ; 89(S1): 97-101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762639

RESUMO

INTRODUCTION: Boerhaave syndrome consists of a spontaneous perforation of the esophagus, with high mortality. OBJECTIVE: To describe a case with Boerhaave syndrome with double esophageal perforation. CASE REPORT: 33-year-old female who came to the hospital for emetic symptoms, followed by retrosternal chest pain; chest drainage is performed. Esophageal perforation was diagnosed late and he was transferred to a tertiary level institution. Successive treatments were performed: videothoracoscopy and pleural decortication; alimentary jejunostomy; esophageal stent placement, diagnosis of new perforation, pyloric exclusion, new stent placement, and esophageal exclusion. CONCLUSIONS: The delay in diagnosis contributed to the fatal outcome of the patient.


Assuntos
Perfuração Esofágica , Doenças do Mediastino , Adulto , Dor no Peito , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Feminino , Humanos , Masculino , Doenças do Mediastino/complicações , Doenças do Mediastino/cirurgia , Ruptura Espontânea
7.
West J Emerg Med ; 22(6): 1291-1294, 2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34787553

RESUMO

INTRODUCTION: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. METHODS: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995-September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. RESULTS: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. CONCLUSION: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST , Troponina , Biomarcadores , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Creatina Quinase , Eletrocardiografia , Humanos , Troponina T
8.
J Cardiothorac Surg ; 16(1): 339, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34802423

RESUMO

BACKGROUND: Although not common, coronary artery aneurysms (CAAs) can develop to over 8 mm in diameter to become giant CAAs. In the context of systemic lupus erythematosus (SLE), autoantibody- and immune complex-mediated atherosclerosis is believed to be the most prevalent cause of aneurysm. CASE PRESENTATION: We report the case of a 53-year-old female SLE patient who presented to our hospital with radiating chest pain. Coronary angiography revealed a giant aneurysm in the middle segment of the left anterior descending artery (LAD) and distal subtotal occlusion in the left circumflex artery (LCX). Laboratory testing also identified risk factors such as an abnormal pulmonary enzyme profile, dyslipidemia, and nephritis parameters.To prevent thromboembolism, anticoagulation and antiplatelet therapy were administered. In addition, one stent was implanted at the distal end of the LCX and repeated coronary angiography verified restoration of TIMI grade III flow.The patient was discharged with resolved chest pain. During 6 months of follow-up, the patient is in good health. CONCLUSIONS: Our case study, together with 16 recent comparable reports, emphasizes the need for coronary aneurysm screening in SLE patients. It is necessary that thromboembolism, anticoagulation and antiplatelet therapy were administered for CAA.


Assuntos
Aneurisma Coronário , Lúpus Eritematoso Sistêmico , Dor no Peito/etiologia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Pessoa de Meia-Idade
9.
BMC Surg ; 21(1): 364, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641847

RESUMO

BACKGROUND: Symptomatic Bochdalek hernias are found mainly in infants in respiratory distress and occur rarely in adults. CASE PRESENTATION: We report a rare case of Bochdalek hernia associated with developmental abnormalities in an adult who exhibited acute chest pain and dyspnea on exertion. CONCLUSIONS: This case highlights the importance of the differential diagnosis of acute left-sided chest pain and antenatal examination.


Assuntos
Hérnias Diafragmáticas Congênitas , Adulto , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Gravidez
10.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598963

RESUMO

This case describes the first documented clinical presentation of Sweet's syndrome with unilateral swelling of the neck, severe pain and fever. The clinical and radiological manifestation resembled necrotising fasciitis and the patient underwent acute neck dissection. The patient was ultimately diagnosed with a new subtype of Sweet's syndrome called necrotising Sweet's syndrome, and quickly recovered after treatment with intravenous administration of prednisolone.


Assuntos
Síndrome de Sweet , Dor no Peito , Edema/etiologia , Feminino , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/tratamento farmacológico
11.
Aerosp Med Hum Perform ; 92(10): 815-824, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34642002

RESUMO

BACKGROUND: Neck pain (NP) is common among high performance aircrew, yet evidence remains insufficient to guide examination, treatment, and prevention. The purpose of this randomized pilot study was to collect baseline data for neck function for F-15E aircrew and determine efficacy and feasibility of two separate exercise protocols in measuring short-term outcomes of subjective and objective neck function in order to inform future study design. METHODS: Randomized to either progressive (PRO) or general (GEN) exercise groups were 41 F-15E aircrew. Data collection occurred at baseline, 3 wk, and 3 mo. RESULTS: At baseline, 39% of the subjects reported current NP, 79.5% reported a history of NP attributed to flying, 12.8% reported being removed from flying duties due to NP, and 10% reported receiving medical care for NP. PRO and GEN group randomization showed similar baseline assessment data. Blinding was successful and exercise logs showed 31.6% compliance with prescribed exercise regimens. There were small but statistically significant increases in neck range of motion in both groups over the course of the study. Aircrew with current NP had significantly higher F-15E flight hours. DISCUSSION: This study supports the high prevalence of NP in aircrew, yet low frequency of seeking care for NP. Future studies to assess NP prevention and treatment in aircrew require an integrated approach that includes operational exercise policy and long-term data collection in flying units with dedicated resources for assessment and analysis. Lee MS, Briggs R, Scheirer V, Kearby G, Young BA. Exercise effects on neck function among F-15E aircrew. Aerosp Med Hum Perform. 2021; 92(10):815824.


Assuntos
Exercício Físico , Cervicalgia , Dor no Peito , Humanos , Cervicalgia/epidemiologia , Cervicalgia/prevenção & controle , Projetos Piloto , Amplitude de Movimento Articular
12.
Adv Emerg Nurs J ; 43(4): 303-308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34699420

RESUMO

This column discusses what appears to be a lead reversal in a 12-lead electrocardiogram (ECG) of a routine low-risk chest pain evaluation in a 36-year-old man. A 12-lead ECG was completed and identified ST changes suggestive of ischemia in the inferior leads. Findings in the ECG suggested arm lead reversal that created an ST-segment elevation myocardial infarction (STEMI) mimic. Repeating the ECG and correcting the arm lead mistake identified a correction of these changes and identified an ECG more suggestive of benign early repolarization or J-point elevation. This case discusses the importance of identifying ECG findings that may suggest arm lead reversal and how sometimes misplaced leads could create the appearance of an STEMI. This is a review of the case, key points to interpreting ECGs for possible lead reversal and identifying the REVERSE mnemonic.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Adulto , Dor no Peito/diagnóstico , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
13.
Medicina UPB ; 40(2): 60-66, 13 oct. 2021.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1342230

RESUMO

El síndrome coronario agudo (SCA) es la principal causa de muerte, por esta razón, es fundamental reconocer sus características clínicas. Tradicionalmente ha sido descrito un cuadro denominado típico, consistente en dolor torácico retroesternal o en la región izquierda del tórax, explicado como una sensación de presión o pesadez, de duración superior a 20 minutos, que se puede irradiar a la extremidad superior izquierda o derecha, cuello o mandíbula, asociado a diaforesis y náuseas. Diversos grupos de pacientes como mujeres, diabéticos, ancianos y con antecedentes de falla cardiaca o accidente cerebrovascular presentan cuadros llamados atípicos, que en gran proporción no manifiestan dolor torácico. Varios estudios plantean que no hay síntomas suficientemente sensibles y específicos para ser considerados típicos en el contexto del SCA, por lo que el diagnóstico debe incluir además de la evaluación clínica, el electrocardiograma, los factores de riesgo y los biomarcadores. El uso de puntajes de riesgo como el HEART ha demostrado ser útil en este escenario.


Acute coronary syndrome (ACS) is the main cause of mortality around the world; the-refore, it is essential to recognize the clinical characteristics that increase its diagnostic suspicion. Traditionally, it has been defined as a so-called typical condition, consisting of retrosternal chest pain or pain in the left region of the thorax. It is described as a feeling of pressure or heaviness, lasting more than 20 minutes, which can radiate to the left or right upper limb, neck or jaw, and can be associated with diaphoresis and nau-sea. Various groups of patients such as women, diabetics, the elderly, and those with a history of heart failure or cerebrovascular accident, have so-called atypical clinical sets of symptoms, which in a large proportion may not present chest pain. Various studies suggest that there are not sufficiently sensitive and specific symptoms to be considered typical in the context of ACS, thus, the approach must include the electrocardiogram, risk factors and biomarkers in addition to the clinical evaluation. The use of risk scores such as the HEART has proven very useful in this scenario.


A síndrome coronariana aguda (SCA) é a principal causa de morte, por isso é fundamen-tal o reconhecimento de suas características clínicas. Tradicionalmente, é descrita uma condição dita típica, que consiste em dor torácica retroesternal ou na região esquerda do tórax, explicada como uma sensação de pressão ou peso, com duração superior a 20 minutos, que pode irradiar para a esquerda ou direita membro superior, pescoço ou mandíbula, associado a sudorese e náusea. Vários grupos de pacientes como mulheres, diabéticos, idosos e com história de insuficiência cardíaca ou acidente vascular cerebral apresentam condições atípicas, que em grande parte não manifestam dor no peito. Vários estudos sugerem que não existem sintomas suficientemente sensíveis e específicos para serem considerados típicos no contexto da SCA, de modo que o diagnóstico deve incluir, além da avaliação clínica, o eletrocardiograma, fatores de risco e biomarcadores. O uso de escores de risco, como o CORAÇÃO, tem se mostrado útil nesse cenário.


Assuntos
Humanos , Síndrome Coronariana Aguda , Dor no Peito , Coração , Insuficiência Cardíaca
14.
Medicina UPB ; 40(2): 84-87, 13 oct. 2021. Ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1342239

RESUMO

Se describe el caso de un paciente de 70 años que consultó por cefalea súbita, tipo trueno, sin alteración del estado de consciencia, acompañada de dolor torácico de una hora de evolución y de baja intensidad. A su ingreso fue enfocado como cefalea en trueno, que es clasificada, en cuanto a la atención, como bandera roja. La medición de troponina fue negativa y una tomografía de cráneo fue leída como normal. Desde el ingreso presentaba signos vitales normales, cuando iba a ser dado de alta se torna hipotenso (completamente asintomático) y por su síntoma cardinal (cefalea), que se asoció a dolor torácico leve y no anginoso, se solicitó angiotomografía toracoabdominal, con la que se demostró aneurisma disecante de la aorta. Con la presentación de este caso, se busca resaltar la importancia en el servicio de urgencias de la asociación de la cefalea tipo trueno, con condiciones vasculares como la disección aórtica.


We describe the case of a 70-year-old patient, who seeks medical advice due to sudden, thunder headache, without alteration of the state of consciousness, accompanied by chest pain of 1 hour of evolution and of low intensity. Upon his admission, the patient was treated as a thunderclap headache, which is considered a red flag. His troponin was negative, and his head tomography was interpreted as normal. From admission he had normal vital signs, but when he was going to be discharged, he became hypotensive (completely asymptomatic) and due to his cardinal symptom (headache) that was asso-ciated with mild non-anginal chest pain, a thoracoabdominal angioCT was requested, with which dissecting aneurysm of the aorta was evidenced. With the presentation of this case, we seek to highlight the importance of the association of thunder-type headache with possible vascular conditions such as aortic dissection in the emergency department.


Descrevemos o caso de uma paciente de 70 anos que consultou por quadro de cefaleia súbita, tipo trovão, sem alteração do estado de consciência, acompanhada de dor torácica de uma hora de evolução e de baixa intensidade. Na admissão, foi tratado como cefaleia em trovoada, que é classificada, em termos de atenção, como bandeira vermelha. A me-dição da troponina foi negativa e uma tomografia de crânio foi lida como normal. Desde a admissão apresentava sinais vitais normais, quando ia receber alta ficou hipotenso (totalmente assintomático) e devido ao seu sintoma cardinal (cefaleia), que se associou a dores torácicas ligeiras e não anginosas, foi solicitada angiografia toracoabdominal, com cujo aneurisma dissecante da aorta foi demonstrado. Com a apresentação deste caso, o objetivo é destacar a importância no pronto-socorro da associação da cefaleia do tipo trovão com afecções vasculares como a dissecção da aorta.


Assuntos
Humanos , Aneurisma Dissecante , Aorta , Dor no Peito , Angiografia , Cefaleia
15.
BMC Emerg Med ; 21(1): 112, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620086

RESUMO

BACKGROUND: Currently, the risk stratification of critically ill patient with chest pain is a challenge. We aimed to use machine learning approach to predict the critical care outcomes in patients with chest pain, and simultaneously compare its performance with HEART, GRACE, and TIMI scores. METHODS: This was a retrospective, case-control study in patients with acute non-traumatic chest pain who presented to the emergency department (ED) between January 2017 and December 2019. The outcomes included cardiac arrest, transfer to ICU, and death during treatment in ED. In the randomly sampled training set (70%), a LASSO regression model was developed, and presented with nomogram. The performance was measured in both training set (70% participants) and testing set (30% participants), and findings were compared with the three widely used scores. RESULTS: We proposed a LASSO regression model incorporating mode of arrival, reperfusion therapy, Killip class, systolic BP, serum creatinine, creatine kinase-MB, and brain natriuretic peptide as independent predictors of critical care outcomes in patients with chest pain. Our model significantly outperformed the HEART, GRACE, TIMI score with AUC of 0.953 (95%CI: 0.922-0.984), 0.754 (95%CI: 0.675-0.832), 0.747 (95%CI: 0.664-0.829), 0.735 (95%CI: 0.655-0.815), respectively. Consistently, our model demonstrated better outcomes regarding the metrics of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F1 score. Similarly, the decision curve analysis elucidated a greater net benefit of our model over the full ranges of clinical thresholds. CONCLUSION: We present an accurate model for predicting the critical care outcomes in patients with chest pain, and provide substantial support to its application as a decision-making tool in ED.


Assuntos
Dor no Peito , Resultados de Cuidados Críticos , Aprendizado de Máquina , Idoso , Estudos de Casos e Controles , Dor no Peito/terapia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Estudos Retrospectivos , Triagem
16.
Am J Cardiol ; 161: 12-18, 2021 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-34635312

RESUMO

The sensitivity of triage systems in identifying acute cardiovascular events in patients presented to the emergency department with chest pain is not optimal. Recently, a clinical score, the Emergency Department Assessment of Chest Pain Score (EDACS), has been proposed for a rapid assessment without additional instruments. To evaluate whether the integration of EDACS into triage evaluation of patients with chest pain can improve the triage's predictive validity for an acute cardiovascular event, a single-center prospective observational study was conducted. This study involved all patients who needed a triage admission for chest pain between January 1, 2020, and December 31, 2020. All enrolled patients first underwent a standard triage assessment and then the EDACS was calculated. The primary outcome of the study was the presence of an acute cardiovascular event. The discriminatory ability of EDACS in triage compared with standard triage assessment was evaluated by comparing the areas under the receiver operating characteristic curve, decision curve analysis, and net reclassification improvement. The study involved 1,596 patients, of that 7.3% presented the study outcome. The discriminatory ability of triage presented an area under the receiver operating characteristic curve of 0.688 that increased to 0.818 after the application of EDACS in the triage assessment. EDACS improved the baseline assessment of priority assigned in triage, with a net reclassification improvement of 33.6% (p <0.001), and the decision curve analyses demonstrated that EDACS in triage resulted in a clear net clinical benefit. In conclusion, the results of the study suggest that EDACS has a good discriminatory capacity for acute cardiovascular events and that its implementation in routine triage may improve triage performance in patients with chest pain.


Assuntos
Dor no Peito/diagnóstico , Medição de Risco/métodos , Triagem/normas , Dor no Peito/epidemiologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC
20.
Scand J Trauma Resusc Emerg Med ; 29(1): 157, 2021 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717716

RESUMO

BACKGROUND: The emergency medical services (EMS) use guidelines to describe optimal patient care for a wide range of clinical conditions and symptoms. The intent is to guide personnel to provide patient care in line with best practice. The aim of this study is to describe adherence to such guidelines among prehospital emergency nurses (PENs) when caring for patients with chest pain. OBJECTIVE: To describe guideline adherence among PENs when caring for patients with chest pain. To investigate whether guideline adherence is associated with patient age, sex or final diagnosis of acute myocardial infarction on hospital discharge. METHODS: Guideline adherence in terms of patient examination and pharmaceutical treatment was analysed in a cohort of 2092 EMS missions carried out in 2018 in Region Halland, Sweden. Multivariate regression was used to describe how guideline adherence is associated with patient age, sex and diagnosis on hospital discharge. RESULTS: Guideline adherence was high regarding examination of vital signs (93%) and electrocardiogram (ECG) registration (96%) but lower in terms of pharmaceutical treatment (ranging from 28 to 90%). Adherence was increased in cases in which the patient ended up with acute myocardial infarction (AMI) as diagnosis on discharge. Patients with AMI were given acetylsalicylic acid by PENs in 50% of cases. Women were less likely than men to receive treatment with acetylsalicylic acid and oxycodone. CONCLUSIONS: Guideline adherence among PENs when caring for patients with chest pain is satisfactory in terms vital signs and ECG registration. Regarding pharmaceutical treatment guideline adherence is defective. Improved adherence is mainly associated with male sex in patients and a diagnosis of AMI on hospital discharge. Defective adherence excludes measures known to improve patients' prognoses such as treatment with acetylsalicylic acid.


Assuntos
Serviços Médicos de Emergência , Enfermeiras e Enfermeiros , Dor no Peito/diagnóstico , Estudos de Coortes , Eletrocardiografia , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Estudos Prospectivos
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