Assessment of triage accuracy by Nurses, and delay care of acute myocardial infarction patients admitted to Emergency Department: retrospective analysis from Shifa International Hospital, Pakistan

Background: Coronary vascular disease (CVD) is the premier cause of fatality in the world. In Pakistan, 30 to 40% of all deaths occur due to CVD. The emergency department triage is carried out to prioritize the care of critical patients. Errors during triage may lead to mortality and morbidity of the patient. The current study's objective is to determine the triage process of acute myocardial infarction patients and its associated accuracy and delays during the acute myocardial infarction process of care in the emergency department. Methods: In this descriptive study, data were collected retrospectively from Shifa International Hospital. The consent was taken from participating Registered nurses (RNs) who were involved in the triage process. Nurses with experience of less than 1 year in the emergency department were not part of the study, while only those patients with symptoms indicative of Acute Myocardial Infarction and age of 21 years or older were included in the current study. EMR system was used on a daily basis as a method to capture data for the study. The actual clock time in minutes from arrival until triage and obtain ECG as greater than 10 minutes was identified as a delay. Results: The 8 R.N. participated in the current study with a mean age and experience of 28.11 years and 4.77 years. The patients' age was 22-74 years, which consist of 58.9% male and 41.1% female. Out of 224 patients, 20.53% of patients were smokers, 39.3% were diabetic, 44.6% were CVD, and 78.5% were reported for chest pain. Delay care such as the mean triage and ECG time recorded was 6.75, and 7.30 min, the mean E.R. physician and Cardiology resident assessment was 11 min and 25.19 min, respectively, which were significantly found according to the recommended guidelines of AHA. The triage accuracy in the current study was recorded as 80.35%. Conclusion: In Pakistan, no proper triage system is developed, and no time limits and guidelines are defined for the completion of the triage process. In the current study, the triage level designations, ECG delay, E.R. and cardiology resident assessment delay were found insignificant, and triage designation was found inaccurate with 19.6% of patients, which lead to delay the re-perfusion therapy. In patients with AMI symptoms, triage accuracy and quick ECG helps E.R. physician assessment to take a quick better decision for cardiac care. It helps patients to get re-perfusion therapy on time for acute myocardial infarction.

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Diagnostic accuracy of D-dimer assay in detection of pulmonary embolism in patients presenting in emergency department

10.53350/pjmhs2115123250 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3250-3252

Author(s):

Umair Asghar ◽

Hamid Khalil ◽

Kashif Zafar ◽

Syed Mahmood-ul-Hassan

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Pulmonary Embolism ◽

Diagnostic Accuracy ◽

Gold Standard ◽

Predictive Accuracy ◽

Dark Spot ◽

The Mean ◽

D Dimer

Background: Pulmonary embolism is the lethal condition that is associated with higher rate of mortality in cardia patients. The diagnosis of the acute pulmonary embolism is frequently observed in patients presenting in emergency department or during hospitalization. Level of D-dimer may be assessed by blood test to help the physicians to diagnose the thrombosis. Literature showed variable evidence regarding predictive accuracy of D-dimer for detection of pulmonary embolism. So to get local data, we conducted this study. Aim: To determine the diagnostic accuracy of D-dimer assay for detection of pulmonary embolism in patients of acute myocardial infarction presenting in emergency department taking CTPA as gold standard Methods: Cross - sectional study conducted in Cardiology Department , Punjab Institute of Cardiology, Lahore for a period of six months from 1-9-2018 to 1-3-2019. One hundred patients, fulfilled the selection criteria were enrolled from emergency. Then blood sample was taken for evaluation of D-dimer level. Reports were checked and D-dimer level was noted. Pulmonary embolism was labeled as positive on D-dimer, if D-dimer level ≥500 and was labeled as negative if D-dimer level <500. Then all patients underwent CTPA. Pulmonary embolism labeled as positive if there was mass filling defects detected as dark spot on angiogram. All the data was collected by using the proforma. Data analysis as done in SPSS v. 21. Results: The mean age of patients was 54.03±10.26years. There were 40 (40) males and 60 (60%) females. The mean BMI of patients was 27.57±4.35kg/m2. There were 46 (46%) patients with diabetes mellitus while 61 (61%) patients had hypertension. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of D-dimer were 82.6%, 72.2%, 71.7%, 83.0% and 77.0%, respectively taking CTPA as gold standard. Conclusion: Thus the D-dimer is accurate enough that it can help to predict pulmonary embolism and can help to prevent at least negative cases to undergo CTPA. Keywords: Acute myocardial infarction, pulmonary embolism, D-dimer, computed tomography pulmonary angiography

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Analysis of mortality in the emergency department at a university hospital in Pleven

Journal of International Medical Research ◽

10.1177/0300060517707901 ◽

2017 ◽

Vol 45 (5) ◽

pp. 1553-1561 ◽

Cited By ~ 1

Author(s):

Petko Hristov Stefanovski ◽

Radev Vladimir Radkov ◽

Tsankov Lyubomir Ilkov ◽

Tonchev Pencho Tonchev ◽

Todorova Yoana Mladenova ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Terminally Ill ◽

University Hospital ◽

Age Group ◽

The Mean ◽

Demographic Patterns ◽

Oncological Pathology

Objective To identify the demographic patterns of mortality, the time spent before death in the emergency department (ED), and the causes of fatal outcomes. Methods We performed a 5-year (01/01/2011 to 01/01/2016) retrospective analysis of all non-traumatic deaths in the ED of the UMHAT – Pleven. To extract the necessary information, we used the registers in the ED until the patients’ death. Results Among 156,848 patients in the study period, 381 died and the mortality rate was 2.4/100000. The male:female ratio was 1.48:1. The 71–80 years age group was the most affected. The mean (SD) age of patients who died in the ED was 69.9 ± 8.4 years. Most non-traumatic deaths (222 cases) were due to cardiovascular disease. Most patients (70.9%) died within 2.3 h after arrival. The factors contributing to mortality included poverty, transporting the patient to hospital too late, and a lack of developed care centres for terminally ill patients. Conclusion Most patients die within approximately 2 h after arrival at the ED. The main cause of death is acute myocardial infarction. Pulmonary embolism remains unrecognized in most patients (69%). Oncological pathology is among the main causes (7.4%) of mortality.

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Influence of Acute Myocardial Infarction and rt-PA Therapy on Circulating Fibrinogen

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651605 ◽

1993 ◽

Vol 69 (04) ◽

pp. 321-327 ◽

Cited By ~ 3

Author(s):

E Seifried ◽

M Oethinger ◽

P Tanswell ◽

E Hoegee-de Nobel ◽

W Nieuwenhuizen

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Thrombolytic Agent ◽

Degradation Products ◽

Maximum Plasma ◽

Normal Range ◽

Fibrinogen Degradation Products ◽

Fibrin Degradation Products ◽

Rebound Phenomenon ◽

The Mean

SummaryIn 12 patients treated with 100 mg rt-PA/3 h for acute myocardial infarction (AMI), serial fibrinogen levels were measured with the Clauss clotting rate assay (“functional fibrinogen”) and with a new enzyme immunoassay for immunologically intact fibrinogen (“intact fibrinogen”). Levels of functional and “intact fibrinogen” were strikingly different: functional levels were higher at baseline; showed a more pronounced breakdown during rt-PA therapy; and a rebound phenomenon which was not seen for “intact fibrinogen”. The ratio of functional to “intact fibrinogen” was calculated for each individual patient and each time point. The mean ratio (n = 12) was 1.6 at baseline, 1.0 at 90 min, and increased markedly between 8 and 24 h to a maximum of 2.1 (p <0.01), indicating that functionality of circulating fibrinogen changes during AMI and subsequent thrombolytic therapy. The increased ratio of functional to “intact fibrinogen” seems to reflect a more functional fibrinogen at baseline and following rt-PA infusion. This is in keeping with data that the relative amount of fast clotting “intact HMW fibrinogen” of total fibrinogen is increased in initial phase of AMI. The data suggest that about 20% of HMW fibrinogen are converted to partly degraded fibrinogen during rt-PA infusion. The rebound phenomenon exhibited by functional fibrinogen may result from newly synthesized fibrinogen with a high proportion of HMW fibrinogen with its known higher degree of phosphorylation. Fibrinogen- and fibrin degradation products were within normal range at baseline. Upon infusion of the thrombolytic agent, maximum median levels of 5.88 μg/ml and 5.28 μg/ml, respectively, were measured at 90 min. Maximum plasma fibrinogen degradation products represented only 4% of lost “intact fibrinogen”, but they correlatedstrongly and linearly with the extent of “intact fibrinogen” degradation (r = 0.82, p <0.01). In contrast, no correlation was seen between breakdown of “intact fibrinogen” and corresponding levels of fibrin degradation products. We conclude from our data that the ratio of functional to immunologically “intact fibrinogen” may serve as an important index for functionality of fibrinogen and select patients at high risk for early reocclusion. Only a small proportion of degraded functional and “intact fibrinogen”, respectively, is recovered as fibrinogen degradation products. There seems to be a strong correlation between the degree of elevation of fibrinogen degradation products and the intensity of the systemic lytic state, i.e. fibrinogen degradation.

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The Quantitation of Platelet Aggregation Induced by Four Compounds: A Study in Relation to Myocardial Infarction

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655660 ◽

1966 ◽

Vol 16 (03/04) ◽

pp. 752-767 ◽

Cited By ~ 23

Author(s):

J. R O’Brien ◽

F. C Path ◽

Joan B. Heywood ◽

J. A Heady

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Platelet Aggregation ◽

Platelet Rich Plasma ◽

Myocardial Infarct ◽

Control Groups ◽

The Mean ◽

Platelet Shape

SummaryMethods for measuring and comparing day to day differences in the response of platelet aggregation in platelet-rich plasma to added ADP, 5-H.T., adrenaline and collagen are reported. Platelet aggregation induced by ADP, 5-H.T. and adrenaline was studied in patients with acute myocardial infarction and in others 3 months to 5 years after an infarct; some were receiving anti-coagulants and others not: these three groups were compared with three control groups. The mean platelet shape was rounder and the response to ADP and to 5-H.T. and one parameter of the response to adrenaline was significantly greater in all groups of patients with myocardial infarct taken together than in the controls. The platelet-rich plasma from patients with recent infarction were most responsive to ADP and 5-H.T. immediately after the infarct. Anti-coagulants had no effect on these tests. However, there was wide variation within the individuals and much overlap between groups, and these tests can only reliably distinguish between groups and not between individuals. The significance of these findings is discussed.

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National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

Journal of the American Heart Association ◽

10.1161/jaha.120.017208 ◽

2020 ◽

Vol 9 (20) ◽

Author(s):

Akshay Pendyal ◽

Craig Rothenberg ◽

Jean E. Scofi ◽

Harlan M. Krumholz ◽

Basmah Safdar ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Length Of Stay ◽

Real World ◽

The United States ◽

Emergency Department Care ◽

Care Processes ◽

Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

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Rapid and Safe Discharge From the Emergency Department: A Single Troponin to Exclude Acute Myocardial Infarction

Heart Lung and Circulation ◽

10.1016/j.hlc.2017.06.593 ◽

2017 ◽

Vol 26 ◽

pp. S299

Author(s):

L. Brichko ◽

H. Schneider ◽

J. Seah ◽

D. Smit ◽

J. Stevens ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department

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Emergency department thrombolysis critical pathway reduces door-to-drug times in acute myocardial infarction

Clinical Cardiology ◽

10.1002/clc.4960220108 ◽

1999 ◽

Vol 22 (1) ◽

pp. 17-20 ◽

Cited By ~ 36

Author(s):

Christopher P. Cannon ◽

E. Blair Johnson ◽

Benjamin M. Scirica ◽

Monica Cermignani ◽

Mark J. Sagarin ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Critical Pathway

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Effect of COVID-19 outbreak on emergency department attendances in an Italian academic hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.207 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Poletto ◽

G Perri ◽

F Malacarne ◽

B Bianchet ◽

A Doimo ◽

...

Keyword(s):

Emergency Department ◽

Initial Phase ◽

Mainland China ◽

Hospital Setting ◽

Academic Hospital ◽

Significant Difference ◽

Before And After ◽

Life Threatening ◽

The Mean ◽

Critical Patients

Abstract Background Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was discovered during the 2019 outbreak in Mainland China and the first cases were reported in Italy on February 21, 2020. This study evaluates the emergency department (ED) attendances of an academic hospital in northern Italy before and after media reported the news of the first infected patients in Italy. Methods Adult attendances in ED in February 2020 were analysed dividing the period into 4 weeks (days 1-7, 8-14, 15-21, 22-28) compared with the same periods in 2019. The visits were analysed separately according to the Italian colour code of triage: white (non-critical), green (low-critical), yellow (medium critical), red (life-threatening). The mean weekly number of attendances was compared with t-test. Results February 2020 total ED attendances compared with February 2019 were 4865 vs 5029 (-3.3%), of which white codes were 834 vs 762 (+9.4%), green 2450 vs 2580 (-5.0%), yellow 1427 vs 1536 (-7.1%), red 154 vs 151 (+2.0%). February 2020 weekly mean ED attendances compared with February 2019 had statistically significant difference only in the fourth week (days 22-28) for green codes (75 vs 92, p = 0.007) and yellow codes (41 vs 52, p = 0.047), not for white (27 vs 26, p = 0.760) and red codes (5 vs 5, p = 0.817). The first three weeks of February 2020 compared with 2019 showed no statistically significant difference in weekly mean ED attendances. Conclusions There was a significant reduction of green and yellow codes attendances at ED in the fourth week of February 2020, corresponding to the initial phase of Italian COVID-19 outbreak. The fear of contracting SARS-CoV-2 by attending the ED probably acted as a significant deterrent in visits, especially for low and medium critical patients. Additional data are required to better understand the phenomenon, including the behaviour of non-critical attendances. Key messages A reduction of green and yellow codes attendances was reported during initial phase of COVID-19 outbreak in an Italian academic hospital. Fear of contracting COVID-19 infection in a hospital setting could impact on emergency department attendances.

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