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Factors influencing prehospital delay for patients with acute myocardial infarction

Journal of Geriatric Cardiology 2007年第1期4卷 11-13页

作者： Shujuan CHENG Lufen GUO Juyuan LIU Xiaoling ZHU Hongbing YAN Emergency Department Beijing Anzhen Hospital Beijing 100029 China Emergency Department Beijing Anzhen Hospital Beijing 100029 China Public Health and Family Medicine Department Capital Medical University Beijing 100069 China Emergency Department Beijing Anzhen Hospital Beijing 100029 China Emergency Department Beijing Anzhen Hospital Beijing 100029 China

Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI). Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

关键词： acute myocardial infarction emergency medical service risk factor prehospital delay time

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Mass Casualty Incident Primary Triage Methods in China

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Chinese Medical Journal 2015年第19期128卷 2664-2671页

作者： Jin-Hong Chen Jun Yang Yu Yang Jing-Chen Zheng Medical Department General Hospital of Chinese People's Armed Police ForcesBeijing 100039China Institute of Disaster Relief Medical Science of Chinese People·s Armed Police Forces Beijing 100039China

Objective：To evaluate the technical characteristics and application of mass casualty incident （MCI） primary triage （PT） methods applied in *** Sources：Chinese literature was searched by Chinese Academic Journal Network Publishing Database （founded in June 2014）.The English literature was searched by PubMed （MEDLINE）（1950 to June 2014）.We also searched Official Websites of Chinese Central Government＇s （http：//***/）,National Health and Family Planning Commission of China （http：//***/）,and China Earthquake Information （http：//***/）.Study Selection：We included studies associated with mass casualty events related to China,the PT applied in China,guidelines and standards,and application and development of the carding PT method in ***：From 3976 potentially relevant articles,22 met the inclusion criteria,20 Chinese,and 2 *** articles included 13 case reports,3 retrospective analyses of MCI,two methods introductions,three national or sectoral criteria,and one simulated field testing and *** were a total of 19 kinds ofMCI PT methods that have been reported in China from 1950 to *** addition,there were 15 kinds of PT methods reported in the literature from the instance of the ***：The national and sectoral current triage criteria are developed mainly for earthquake *** is not *** criteria （especially between moderate and severe injuries） operability are not *** are no triage methods and research for children and special *** is no data and evidence supported triage *** should revise our existing classification and criteria so it is clearer and easier to be grasped in order to build a real,practical,and efficient PT method.

关键词： Mass Casualty Incident prehospital Primary Triage Standards Systematic Review

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Epinephrine in out-of-hospital cardiac arrest:A critical review

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World Journal of Emergency Medicine 2013年第2期4卷 85-91页

作者： Peter M.Reardon Kirk Magee Dalhousie Medical School HalifaxB3H 4R2Nova ScotiaCanada Dalhousie Department of Emergency Medicine QEII Health Sciences Centre

BACKGROUND： Epinephrine is recommended in advanced cardiac life support guidelines for use in adult cardiac arrest, and has been used in cardiopulmonary resuscitation since 1896. Yet, despite its long time use and incorporation into guidelines, epinephrine suffers from a paucity of evidence regarding its influence on survival. This critical review was conducted to address the knowledge deficit regarding epinephrine in out-of-hospital cardiac arrest and its effect on return of spontaneous circulation, survival to hospital discharge, and neurological performance. METHODS： The EMBASE and MEDLINE （through the Pubmed interface） databases, and the Cochrane library were searched with the key words ＂epinephrine＂, ＂cardiac arrest＂ and variations of these terms. Original research studies concerning epinephrine use in adult, out-of-hospital cardiac arrest were selected for further review. RESULTS： The search yielded nine eligible studies based on inclusion criteria. This includes five prospective cohort studies, one retrospective cohort study, one survival analysis, one case control study, and one RCT. The evidence clearly establishes an association between epinephrine and increased return of spontaneous circulation, the data were conflicting concerning survival to hospital discharge and neurological outcome. CONCLUSIONS： The results of this review exhibit the paucity of evidence regarding the use of epinephrine in out of hospital cardiac arrest. There is currently insufficient evidence to support or reject its administration during resuscitation. Larger sample, placebo controlled, double blind, randomized control trials need to be performed to definitively establish the effect of epinephrine on both survival to hospital discharge and the neurological outcomes of treated patients.

关键词： Emergency medicine Epinephrine Cardiac arrest prehospital Out-of-hospita Resuscitation

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Evaluation of Google Glass^(■) with Camera Adaptor and GoPro^(■) as Teaching Tools for Endotracheal Intubation in the Austere Medical Environment

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Open Journal of Anesthesiology 2018年第8期8卷 229-239页

作者： Michael Son David Zimmer Ross McCauley Donald Zimmer Joseph Dynako Richard Skupski Bhavesh Patel Nuha Zackariya Faadil Shariff Lovely Nathalie Colas Gerson Pyram Marc Edson Augustin Carmeline Mathurin Stanley Louis Patricia Saint Louis Stanley Loriston Dan Herbstman Lucio Cervantes Shane Kappler Michael TMcCurdy Jecko Thachil Sarah Greve Mark Walsh University of Notre Dame Notre DameINUSA Memorial Hospital South BendINUSA Indiana University School of Medicine South BendINUSA Mayo Clinic PhoenixAZUSA Indiana University Bloomington BloomingtonINUSA Hospital Saint Luc Port-Au-PrinceHaiti Department of Anesthesiology Hopital Universitaire JustinienCap HaitienHaiti Third Eye Health ChicagoILUSA Adisat Colonia:Condessa Mexico CityMexico 1 University of Maryland School of Medicine BaltimoreMDUSA 1 Department of Haematology Manchester Royal InfirmaryManchesterUK 1 St Joseph Regional Medical Center MishawakaINUSA

Objective: Endotracheal intubation (ETI) is a life-saving emergency procedure, but it is a complex skill that is difficult to teach. Recent studies have shown that video laryngoscopy is effective in teaching ETI to learners at various levels of medical expertise;however, it has proven to be costly and provides images of inconsistent quality. In this educational proof of concept feasibility convenience sample pilot study, we aim to explore and compare the effectiveness of using modified Google Glass? (GG) and GoPro? (GP) technologies to visualize and teach ETI to critical care physicians in the austere medical environment of a low-income country. We propose, based on our findings, that this inexpensive technology could teach lifesaving ETI to pre-hospital providers in the austere medical environment, medical students, rural emergency physicians, critical care physicians in low-income countries, far forward military medical providers, and other learners. Methods: A case series of twenty-five patients, five in the United States (US) at Memorial Hospital in South Bend, IN and twenty at Saint Luc’s Hospital in Port Au Prince, Haiti, is presented. These patients were collected from November 1st 2015 through February 1st of 2016. The anesthesiologist and the emergency physicians in the United States utilized GG to intubate five patients in the US prior to the twenty patients intubated during two separate trips to Haiti. On the two separate trips to Haiti, the GG was trialed and modified to obtain better exposure. These adaptations resulted in the final collection of twenty patients studied with the adapted GG system and GP. Physicians graded airway visualization based on LEMON and Cormack-Lehane scores. Previously published parameters for the assessment of failed intubation risk and passage of the cords were used as data points for analysis using a Likert-Scale analysis for each parameter. The data were analyzed by averages of Likert-Scale scoring with their respective sta

关键词： Endotracheal Intubation Google Glass^(■) GoPro^(■) Cord Visualization Military Medicine Austere Medical Environment Low Income Country Rural prehospital

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Helicopter EMS beyond Trauma: Utilization of Air Transport for Non-Trauma Conditions

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International Journal of Clinical Medicine 2013年第12期4卷 511-524页

作者： Stephen H. Thomas Lori J. Whelan Emily Williams Loren Brown Department of Emergency Medicine University of Oklahoma College of Medicine Tulsa USA

Helicopter Emergency Medical Services (HEMS) use in civilian medical transport has its roots in the use of rotor-wing trauma transport in the military setting. Much of the literature and evidence based?on the use of HEMS is therefore related to scene and interfacility transport of injured patients. Regionalization of care and increased understanding of time-criticality of various non-trauma conditions has contributed to growing utilization of HEMS for non-trauma conditions over recent decades. It is common for HEMS to be utilized for a variety of non-trauma situations ranging from neonatal and obstetrics transports to cardiac and stroke transports. The purpose of this review is to overview the use of HEMS for non-trauma, focusing on situations in which there is evidence addressing possible HEMS utility.

关键词： Helicopter Emergency Medical Services Air Medical Transport prehospital Care

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The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

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Open Journal of Respiratory Diseases 2015年第2期5卷 50-54页

作者： Patrick O’Connell Adelphi University Garden City USA

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

关键词： Continuous Positive Airway Pressure Non-Invasive Ventilation Acute Pulmonary Edema Asthma Chronic Obstructive Pulmonary Disease prehospital Hospital

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