Physician Attitudes About Prehospital 12-Lead ECGs in Chest Pain Patients

2002 ◽  
Vol 17 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Andrew H. Brainard ◽  
Philip Froman ◽  
Maria E. Alarcon ◽  
Bill Raynovich ◽  
Dan Tandberg
Keyword(s):  
Chest Pain ◽  
Confidence Intervals ◽  
Standard Of Care ◽  
Physician Attitudes ◽  
Emergency Physicians ◽  
Hypothesis Tests ◽  
Electrocardiogram Ecg ◽  
Pain Patients

AbstractIntroduction:The prehospital 12-lead electrocardiogram (ECG) has become a standard of care. For the prehospital 12-lead ECG to be useful clinically, however, cardiologists and emergency physicians (EP) must view the test as useful. This study measured physician attitudes about the prehospital 12-lead ECG.Hypothesis:This study tested the hypothesis that physicians had “no opinion” regarding the prehospital 12-lead ECG.Methods:An anonymous survey was conducted to measure EP and cardiologist attitudes toward prehospital 12-lead ECGs. Hypothesis tests against “no opinion” (VAS = 50 mm) were made with 95% confidence intervals (CIs), and intergroup comparisons were made with the Student-t-test.Results:Seventy-one of 87 (81.6%) surveys were returned. Twenty-five (67.6%) cardiologists responded and 45 (90%) EPs responded. Both groups of physicians viewed prehospital 12-lead ECGs as beneficial (mean = 69 mm; 95% CI = 65–74mm). All physicians perceived that ECGs positively influence preparation of staff (mean = 63 mm; 95% CI = 60–72mm) and that ECGs transmitted to hospitals would be beneficial (mean = 66 mm; 95% CI = 60–72mm). Cardiologists had more favorable opinions than did EPs. The ability of paramedics to interpret ECGs was not seen as important (mean = 50 mm; 95% CI = 43–56mm). The justifiable increase in field time was perceived to be 3.2 minutes (95% CI = 2.7–3.8 minutes), with 23 (32.8%) preferring that it be done on scene, 46 (65.7%) during transport, and one (1.4%) not at all.Conclusions:Prehospital 12-lead ECGs generally are perceived as worthwhile by cardiologists and EPs. Cardiologists have a higher opinion of the value and utility of field ECGs. Since the reduction in mortality from the 12-lead ECG is small, it is likely that positive physician attitudes are attributable to other factors.

Abstract 104: Survey of Emergency Physician Cardiac Imaging Technology and Guideline Knowledge

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Carolyn Martin ◽  
Michael Lacey ◽  
James Spalding ◽  
Breanna Essoi
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Radionuclide Imaging ◽  
Cardiac Imaging ◽  
Emergency Physician ◽  
Emergency Physicians ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Stress Echo ◽  
Pain Patients

Objectives: Chest pain is among the most common reasons for emergency room presentation. Providing emergency physicians with the tools necessary to evaluate and triage chest pain patients is a key component of health care efficiency. The study objective was to increase understanding of the clinical tools available to evaluate chest pain in the emergency setting. Methods: A total of 630 emergency physicians were invited to participate in a web-based survey. Eligible respondents must have had at least 3 years of experience and spend at least 30% of time providing direct patient care. Over the course of 2 days, 163 physicians responded; 101 were eligible and completed the survey. The survey consisted of 3 screening questions and 11 survey questions. Survey questions included: experience with chest pain patients, cardiac imaging technologies as well as knowledge and use of the appropriate use criteria (AUC) for cardiac radionuclide imaging. Findings: Over ¾ of all respondents were male, averaged 46 years of age, and had been practicing emergency medicine for nearly 15 years. On average, the respondents saw 20 chest pain patients per week and 72% of those were of unknown cardiac etiology. Diagnostic Catheterization and Stress ECG were the most common evaluation tools available in the emergency department (72% and 71% respectively). When available, stress ECG was the most commonly used evaluation tool in the emergency department. MPI-SPECT was only available to 27% of respondents, and of those, only used 44% of the time. Respondents selecting the “other” response most commonly reported that imaging evaluation was not done in the emergency department. Older physicians (> 61 years) were less likely to report access to stress ECHO; physicians with fewer years of experience (20 or less) were more likely to have access to stress ECHO and diagnostic catheterization. Rural physicians were less likely to report the availability of MPI, CT or diagnostic catheterization. Less than half of emergency physicians (42%) were familiar with the cardiac radionuclide imaging appropriate use criteria, and 80% rarely or never use them. AUC knowledge and use did not differ by years in practice but did differ by age. Physicians in rural practices were the least likely to have knowledge or use the AUC. Conclusions: Despite the frequency of chest pain patients presenting to the emergency department, access to imaging tools for evaluation of cardiac etiology is limited. Knowledge and use of AUC guidelines was also limited. These results question the current clinical paradigm which appears to limit the emergency physician knowledge and use of imaging technology to evaluate the chest pain patient despite the high frequency of presentation.

Analysis of factors affecting emergency physicians?? decisions in the management of chest pain patients

2006 ◽  
Vol 13 (4) ◽  
pp. 214-217 ◽  
Author(s):  
Cenker Eken ◽  
Yesim Ercetin ◽  
Tolga Ozgurel ◽  
Isa Kilicaslan ◽  
Oktay Eray
Keyword(s):  
Chest Pain ◽  
Emergency Physicians ◽  
Factors Affecting ◽  
Pain Patients

scholarly journals P055: Canadian emergency physician attitudes toward endotracheal intubation for aspiration prophylaxis

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S84-S84
Author(s):  
M. Munn ◽  
J. Laraya ◽  
G. Boivin-Arcouette ◽  
E. van der Linde ◽  
A. Lund ◽  
...  
Keyword(s):  
Alcohol Intoxication ◽  
Standard Of Care ◽  
Physician Attitudes ◽  
Future Research ◽  
Emergency Physicians ◽  
Aspiration Risk ◽  
Canadian Association ◽  
Objective Evidence ◽  
Clinical Instability ◽  
Level Of Consciousness

Introduction: Emergency patients with decreased level of consciousness often undergo intubation purely for airway protection from aspiration. However, the true risk of aspiration is unclear and intubation poses risks. Anecdotally, experienced emergency physicians often defer intubation in these patients while others intubate to decrease the perceived clinical and medico-legal consequences. No literature exists on the intubation practices of emergency physicians in these cases. Methods: An online questionnaire was circulated to members of the Canadian Association of Emergency Physicians. Participants were asked questions regarding two common clinical cases with decreased level of consciousness : (1) acute, uncomplicated alcohol intoxication and (2) acute, uncomplicated seizure. For each case, providers’ perceptions of aspiration risk, the standard of care, and the need for intubation were assessed. Results: 128 of the 1546 Canadian physicians contacted (8.3%) provided responses. Respondents had a median of 15 years of experience, 88% had CCFP-EM or FRCPC certification, and most worked in urban centers. When intubating, 98% agreed they were competent and 90% agreed they were well supported. A minority (17.4%) considered GCS < 8 an independent indication for intubation. For the alcohol intoxication case, 88% agreed that aspiration risk was present but only 11% agreed they commonly intubate. Only 17% agreed intubation was standard care, and only 0.8% felt their colleagues always intubate such patients. For the seizure case, 65% agreed aspiration risk existed but only 3% agreed they commonly intubate, 1% felt colleagues always intubated, and 5% agreed intubation was standard of care. Additional factors felt to compel intubation (394 total) and support non-intubation (366 total) were compiled and categorized; the most common themes emerging were objective evidence of emesis or aspiration, other standard indications for intubation, head trauma, co-ingestions, co-morbidities and clinical instability. Conclusion: It is acceptable and standard practice to avoid intubating a select subset of intoxicated and post-seizure emergency department patients despite aspiration risk. Most physicians do not view the dogma of “GCS 8, intubate” as an absolute indication for intubation in these patients. Future research is aimed at identifying key factors and evidence supporting intubation for the prevention of aspiration, as well as the development of a validated clinical decision rule for common emergency presentations.

scholarly journals ALaRMED: adverse events in low-risk chest pain patients receiving continuous ECG monitoring in the emergency department: a survey of Canadian emergency physicians

CJEM ◽  
2008 ◽  
Vol 10 (05) ◽  
pp. 413-419 ◽  
Author(s):  
Clare L. Atzema ◽  
Michael J. Schull
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Mail Survey ◽  
Good Evidence ◽  
Low Risk ◽  
Emergency Physicians ◽  
Cross Sectional ◽  
Electrocardiographic Monitoring ◽  
Canadian Association ◽  
Pain Patients

ABSTRACT Objective: Current guidelines suggest that most patients who present to an emergency department (ED) with chest pain should be placed on a continuous electrocardiographic monitoring (CEM) device. We surveyed emergency physicians to determine their perception of current occupancy rates of CEM and to assess their attitudes toward prescribing monitors for low-risk chest pain patients in the ED. Methods: We conducted a cross-sectional, self-administered Internet and mail survey of a random sample of 300 members of the Canadian Association of Emergency Physicians. Main outcome measures included the perceived frequency of fully occupied monitors in the ED and physicians' willingness to forgo CEM in certain chest pain patients. Results: The response rate was 66% (199 respondents). The largest group of respondents (43%; 95% confidence interval [CI] 36%–50%) indicated that monitors were fully occupied 90%–100% of the time during their most recent ED shift. When asked how often they were forced to choose a patient for monitor removal because of the limited number of monitors, 52% (95% CI 45%–60%) of respondents selected 1–3 times per shift. Ninety percent (95% CI 84%–93%) of respondents indicated that they would forgo CEM in certain cardiac chest pain patients if there was good evidence that the risk of a monitor-detected adverse event was very low. Conclusion: Emergency physicians report that monitors are often fully occupied in Canadian EDs, and most are willing to forgo CEM in certain chest pain patients. A large prospective study of CEM in low-risk chest pain patients is warranted.

Sign in / Sign up

Export Citation Format

Share Document