关于急性大动脉综合征患者的医院间转移的共识声明:TRAVERSING Delphi研究
Aleksandra Staniszewska1, Kamran Gaba2, Benjamin Patterson2
1South Mersey Arterial Network, Countess of Chester Hospital NHS Foundation Trust, Chester, UK.
Emergency medicine journal : EMJ
|December 5, 2023
概括
将急性大动脉综合征 (AAS) 患者转移到专科中心的标准化至关重要. 这一共识为更安全,更有效的紧急转诊给大动脉大容量单位提供了国家指导方针.
科学领域:
- 心血管医学 心血管医学
- 血管外科 血管外科
- 紧急医疗 紧急医疗
背景情况:
- 英格兰NHS建议标准化急性大动脉综合征 (AAS) 的转诊途径.
- 目前用于将AAS患者的医院间转移到专业中心的途径需要优化.
- 该研究旨在建立关于AAS患者转移的跨学科共识.
研究的目的:
- 为AAS患者的医院间转移制定国家跨学科建议.
- 提高紧急转诊到专业的大动脉中心的标准化和安全性.
- 促进英国专家在转移期间就AAS患者管理达成共识.
主要方法:
- 利用德尔菲方法实现跨学科的共识.
- 涉及全国患者慈善机构和英国各地的专家 (外科医生,医生,放射科医生,心脏病专家,重症治疗师,麻醉师).
- 进行了三轮电子调查,对212,101和58名受访者进行了调查.
主要成果:
- 在关于AAS患者转移的声明中,达到了51% (60/117) 的共识.
- 建议直接转移到专业中心的AAS患者已知的大动脉疾病或之前的干预.
- 制定了救护车类别 (类别2) 的指导方针,转移人员,心脏骤停协议和4小时的转移时间目标.
结论:
- 这份共识声明为医院间AAS患者转移提供了第一个国家跨学科建议.
- 预计实施将提高紧急转诊途径的安全性和标准化.
- 旨在通过将AAS病例转移到大量的专业大动脉病房来改善患者的治疗结果.
相关概念视频
Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
Acute Coronary Syndrome III: Diagnostic Studies
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...
Acute Coronary Syndrome IV: Interprofessional Care
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...
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...


