ST升高心肌梗塞患者的农村医院间转移用于皮肤冠状动脉再血管:国家心脏计划
Frank V Aguirre1, Joji J Varghese, Michael P Kelley
1Prairie Cardiovascular Consultants, Ltd, PO Box 19420, Springfield, IL 62794-9420, USA. faguirre@prairieheart.com
Circulation
|February 13, 2008
概括
在美国农村环境中,将ST升高心肌梗塞 (STEMI) 患者的跨医院转移到具有PCI能力的医院是可行的. 这一策略确保了及时的再输血治疗,改善了STEMI患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 医疗保健系统 医疗保健系统
背景情况:
- 初级皮肤穿透冠状动脉干预 (PCI) 的医院间转移是欧洲ST升高心肌梗塞 (STEMI) 患者的优质再输血策略.
- 在美国,这种STEMI转移计划的可行性还不清楚.
研究的目的:
- 评估美国农村社区STEMI患者医院间转移协议的可行性和安全性.
- 评估通过这种转移策略实现的反的及时性.
主要方法:
- 一项对230名被认为是STEMI患者的观察性队列研究,这些患者在农村非PCI能力和PCI能力医院之间转移.
- 实施了用于初级PCI或救援PCI的快速医院间转移的标准协议.
- 分析了关键时间间隔,包括转诊护理,运输和接受医院护理.
主要成果:
- 在STEMI确诊的患者中,87.7%进行了初级PCI;8.5%接受了纤维解析,56%接受了救援PCI.
- 1号门到出发时间的中位数为46分钟;运输时间为29分钟;2号门到气球时间为35分钟.
- 门1到气球时间的中位数为117分钟; 58%的患者在120分钟内实现了再注血.
- 在医院间运输期间没有发生任何不良临床事件.
结论:
- 对于STEMI患者来说,急诊室医生发起的医院间转移在美国农村环境中是可行的.
- 该协议安全执行,在协调的医疗保健网络中及时实现反射.
- 这种方法证明了在服务不足的地区改善STEMI护理的可行策略.
相关概念视频
01:30Acute Coronary Syndrome I: Introduction
2.1K
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
2.1K
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
943
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
943
01:30Acute Coronary Syndrome III: Diagnostic Studies
495
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
495
01:28Acute Coronary Syndrome IV: Interprofessional Care
522
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
522
01:26Acute Coronary Syndrome V: Nursing Management
619
Nursing Assessment:Nursing management of acute coronary syndrome (ACS) involves taking the patient's history, focusing on primary complaints such as chest pain, dyspnea, and excessive sweating (diaphoresis), as well as other symptoms like back or jaw pain, nausea, vomiting, palpitations, dizziness, and fatigue. The nurse also reviews the patient's history of cardiac events, risk factors such as hypertension, diabetes, smoking, family history, and current medications.In the objective assessment,...
619
01:20Angina V: Nursing Management
555
Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...
555