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Rapid coronary reperfusion therapy reduces morbidity and mortality in ST elevation myocardial infarction (STEMI) patients. Paramedics obtaining a 12 lead electrocardiogram (ECG) in the field on STEMI patients may expedite their care. If the results of the paramedic 12 lead ECG indicates the patient is having a STEMI, the hospital can be informed by the paramedics in the field, and prepare for the patient's arrival. The purpose of this study was to explore if the paramedic 12 lead ECG indicates that the patient is having a STEMI, and that information is relayed to the hospital, does this reduce door to balloon time, as compared to the patient who self transports to the emergency department (ED). It also examines how long STEMI patients wait to seek medical care after the onset of their symptoms. This study was a comparative evaluation of the differences in onset of symptoms to balloon time, and door to balloon time, of STEMI patients that had a 12 lead ECG done by paramedics in the field, and STEMI patients that self transported to the hospital. The sample population consisted of STEMI patients from one hospital between October 2006 and December 2009. The sample size consisted of 367 patients, 62% (n=228) in the group that arrived by paramedic ambulance, and 38% (n=139) in the group that self transported to the hospital. Comparing time of onset of pain to balloon time in the two groups, the group that was transported by paramedics had a mean of 5.87 hours (SD=26.04). In the self transported group of patients, the time of onset of symptoms to balloon time had a mean of 14.52 hours (SD=32.83). The group transported by paramedics were found to seek help over 8 hours sooner than those that self transported (p=.006). When comparing the door to balloon time, the STEMI patients transported by paramedics had a mean door to balloon time of 52.45 minutes (SD=17.7), with 98% of the group having a door to balloon time of less than 90 minutes. For the STEMI patients that self transported to the hospital, the mean door to balloon time was 82.42 minutes (SD=28.26). Seventy four percent of the patients in this group had a door to balloon time of less than 90 minutes. The door to balloon time was 30 minutes less for those patients had a prehospital 12 lead ECG and were transported by paramedics, versus those that self transported to the hospital (p
This book is open access under a CC BY 4.0 license. This quick-reference handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology. Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.
Now that state of the art equipment can be carried in ambulances, prehospital emergency staff are able to perform an ECG soon after arrival on scene, enabling the EMS provider to gather important diagnostic information that can not only guide prehospital therapy but also direct hospital-based treatment. This book exclusively addresses ECGs for prehospital emergencies, ranging from basic rhythm diagnosis to critical care applications of the electrocardiogram and advanced 12-lead ECG interpretation in the ACS patient. It provides self testing traces covering all these conditions seen in prehospital and hospital- based environments. It includes 200 randomly presented cases mirroring real life situations, with the answers set out separately together with additional invaluable information. Written by highly experienced emergency physicians with EMS qualifications and experience, this text is an ideal learning tool for trainees and fully qualified staff alike, including ground EMS advanced life support providers, aeromedical staff, and inter-facility critical care transport personnel.
The 12-lead electrocardiogram (ECG) is a cornerstone of modern pre-hospital emergency care. Its ability to provide crucial insights into the electrical activity of the heart makes it an indispensable tool for paramedics and emergency medical technicians (EMTs) in diagnosing and managing cardiac emergencies. The goal of "Pre-Hospital 12- Lead ECG" is to equip pre-hospital care providers with the knowledge and skills necessary to effectively utilize this powerful diagnostic tool in the field. This book is structured to provide a comprehensive understanding of the 12-lead ECG, starting from the fundamental anatomy and physiology of the heart to the advanced techniques of ECG interpretation and application in various pre-hospital scenarios. The syllabus is meticulously designed to cover the essential aspects of ECG acquisition and interpretation, with a focus on practical, real-world application. Chapter 1: Anatomy and Physiology of the Heart lays the foundation by exploring the structure and function of the cardiac conduction system, cardiac anatomy relevant to 12- lead ECG interpretation, and the electrophysiology of cardiac muscle contraction. A solid understanding of these concepts is crucial for accurate ECG interpretation.
This issue of Interventional Cardiology Clinics, guest edited by Dr. Timothy Henry, will cover controversies in the management of STEMI. Topics discussed in this issue include: Systems of care; false positive activation; time to treatment; in hospital STEMI; optimal antiplatelet; advanced cardiogenic shock; out of hospital cardiac arrest; and global challenges, among other topics.
The Second Edition of Primary Angioplasty provides an update on the rationale, techniques, and effectiveness of direct percutaneous mechanical revascularization for acute myocardial infarction. Through the use of "real world" methods, clinical perspectives, and mechanical support, this comprehensive resource guides interventional cardiologists and
This new edition provides complete coverage of prehospital care in a single, comprehensive text. It explains the paramedic's role, the unique characteristics of prehospital care & emergency care of acutely ill & traumatically injured patients.
This scenario-based text provides answers to urgent and emergent questions in acute, emergency, and critical care situations focusing on the electrocardiogram in patient care management. The text is arranged in traditional topics areas such as ACS, dysrhythmia, etc yet each chapter is essentially a question with several cases illustrating the clinical dilemma – the chapter itself is a specific answer to the question. This is a unique format among textbooks with an ECG focus. The clinical scenarios cover the issues involved in detecting and managing major cardiovascular conditions. Focused, structured discussion then solves these problems in a clinically relevant, rapid, and easy to read fashion. This novel approach to ECG instruction is ideal for practicing critical care and emergency physicians, specialist nurses, cardiologists, as well as students and trainees with a special interest in the ECG.
Benefit from this concise yet comprehensive manual, designed to improve the practice and process of STEMI interventions Understand the varied pharmacological options available in managing STEMI patients, including newer anti-coagulants Improve your STEMI procedure technique through expert guidance, including stent choice, and other techniques such as trans radial procedures Provides an overview of STEMI networks internationally and how to set up a STEMI program Reviews future perspectives for STEMI and the role of telemedicine for STEMI procedures
The two-volume Emergency Medical Services: Clinical Practice and Systems Oversight delivers a thorough foundation upon which to succeed as an EMS medical director and prepare for the NAEMSP National EMS Medical Directors Course and Practicum. Focusing on EMS in the 'real world', the book offers specific management tools that will be useful in the reader's own local EMS system and provides contextual understanding of how EMS functions within the broader emergency care system at a state, local, and national level. The two volumes offer the core knowledge trainees will need to successfully complete their training and begin their career as EMS physicians, regardless of the EMS systems in use in their areas. A companion website rounds out the book's offerings with audio and video clips of EMS best practice in action. Readers will also benefit from the inclusion of: A thorough introduction to the history of EMS An exploration of EMS airway management, including procedures and challenges, as well as how to manage ventilation, oxygenation, and breathing in patients, including cases of respiratory distress Practical discussions of medical problems, including the challenges posed by the undifferentiated patient, altered mental status, cardiac arrest and dysrhythmias, seizures, stroke, and allergic reactions An examination of EMS systems, structure, and leadership