scholarly journals Kounis syndrome: A case report and literature review of pre-hospital treatment

2018 ◽  
Vol 15 (4) ◽  
Author(s):  
Matthew Luke Di Toro ◽  
Dion Stub
Keyword(s):  
Acute Coronary Syndrome ◽  
Case Report ◽  
Literature Review ◽  
Emergency Medical Services ◽  
Literature Search ◽  
Medical Services ◽  
Hospital Treatment ◽  
Kounis Syndrome ◽  
Coronary Syndrome ◽  
Emergency Medical

IntroductionKounis syndrome is an uncommon clinical presentation of acute coronary syndrome secondary to an allergic or hypersensitivity reaction, especially anaphylaxis. It results when inflammatory mediators are released following mast cell activation, some of these mediators cause coronary artery vasospasm and may initiate thrombus formation in susceptible individuals. Although Kounis syndrome is becoming more widely known, many clinicians are still unaware of its existence. We present a case report and a literature review of the pre-hospital treatment of Kounis syndrome by emergency medical services.MethodsA literature search of the EMBASE, MEDLINE and PubMed electronic medical databases was conducted using the terms ‘Kounis syndrome’, ‘allergic acute coronary syndrome’ and ‘allergic myocardial infarction’. The purpose of the literature search was to identify the pre-hospital treatment of Kounis syndrome by emergency medical services. We included case reports of Kounis syndrome that described the medical treatment provided by emergency medical services, published any time up to October, 2017.ResultsAnaphylaxis is the most commonly treated component of Kounis syndrome by emergency medical services (66% of reported cases). Both components of Kounis syndrome, anaphylaxis and acute coronary syndrome, were treated in 16% of reported cases. No specific treatment was provided for either component of Kounis syndrome in 16% of reported cases.ConclusionThe pre-hospital treatment of Kounis syndrome by emergency medical services is infrequently reported in the literature. Kounis syndrome involves two distinct clinical conditions, both of which should be considered during treatment.

Historical aspects of the teaching of acute coronary syndrome

2020 ◽  
Vol 21 (3) ◽  
pp. 140-142
Author(s):  
N. Y. Stognii ◽  
◽  
S. B. Tsiryateva ◽  
D. V. Krasheninin ◽  
G. F. Tkachenko ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Mortality Rate ◽  
Literature Review ◽  
Emergency Medical Services ◽  
Cardiac Care ◽  
Historical Aspects ◽  
Pathogenetic Mechanisms ◽  
Coronary Syndrome ◽  
Emergency Medical

The milestones of evolution of acute coronary syndrome doctrine were summarized in the literature review. The contribution of national and foreign scientists in understanding of pathogenetic mechanisms of this disease was introduced. The role of emergency medical services, intensive cardiac care units, reperfusion interventions and up to date pharmacotherapy in reducing the mortality rate of acute coronary syndrome patients was highlighted.

scholarly journals Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for patients with chest pain: a systematic literature review

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045815
Author(s):  
Ahmed Alotaibi ◽  
Abdulrhman Alghamdi ◽  
Charles Reynard ◽  
Richard Body
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Emergency Medical Services ◽  
Prediction Models ◽  
Medical Services ◽  
Telephone Triage ◽  
Coronary Syndrome ◽  
Emergency Medical ◽  
Life Threatening

ObjectiveTo systematically appraise the available evidence to determine the accuracy of decision aids for emergency medical services (EMS) telephone triage of patients with chest pain suspected to be caused by acute coronary syndrome (ACS) or life-threatening conditions.DesignSystematic review.Data sourcesElectronic searches were performed in Embase 1974, Medline 1946 and CINAHL 1937 databases from 3 March 2020 to 4 March 2020.Eligibility criteriaThe review included all types of original studies that included adult patients (>18 years) who called EMS with a primary complaint of chest pain and evaluated dispatch triage priority by telephone. Outcomes of interest were a final diagnosis of ACS, acute myocardial infarction or other life-threatening conditions.Data extraction and synthesisTwo authors independently extracted data on study design, population, study period, outcome and all data for assessment of accuracy, including cross-tabulation of triage priority against the outcomes of interest. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 assessment tool.ResultsSearches identified 553 papers, of which 3 were eligible for inclusion. Those reports described the evaluation of three different prediction models with variation in the variables used to detect ACS. The overall results showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions, even though they are used to triage signs and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions, and therefore, prediction models showed better sensitivity and negative predictive value than dispatch triage tools.ConclusionWe have identified three prediction models for telephone triage of patients with chest pain. While they have been found to have greater accuracy than standard EMS dispatch systems, prospective external validation is essential before clinical use is considered.PROSPERO registration numberThis systematic review was pre-registered on the International prospective register of systematic reviews (PROSPERO) database (reference CRD42020171184).

scholarly journals (Retrospective analysis of interventions of the Prague Emergency Medical Services in patients with acute coronary syndrome)

Cor et Vasa ◽  
2021 ◽  
Vol 63 (1) ◽  
pp. 49-52
Author(s):  
David Peřan ◽  
David Doubek ◽  
Roman Sýkora ◽  
Jaroslav Pekara ◽  
Petr Kolouch
Keyword(s):  
Acute Coronary Syndrome ◽  
Emergency Medical Services ◽  
Retrospective Analysis ◽  
Medical Services ◽  
Coronary Syndrome ◽  
Emergency Medical

scholarly journals Ambulance use, distance and outcomes in patients with suspected cardiovascular disease: a registry-based geographic information system study

2018 ◽  
Vol 9 (1_suppl) ◽  
pp. 45-58 ◽  
Author(s):  
Nariman Sepehrvand ◽  
Wendimagegn Alemayehu ◽  
Padma Kaul ◽  
Rick Pelletier ◽  
Aminu K Bello ◽  
...  
Keyword(s):  
Information System ◽  
Acute Coronary Syndrome ◽  
Geographic Information System ◽  
Emergency Medical Services ◽  
Travel Distance ◽  
Medical Services ◽  
Coronary Syndrome ◽  
Clinical Events ◽  
Emergency Medical ◽  
Services Use

Background: Despite guideline recommendations, the majority of patients with symptoms suggestive of acute coronary syndrome do not use emergency medical services to reach the emergency department (ED). The aim of this study was to investigate the factors associated with EMS utilisation and subsequent patient outcomes. Methods: Using administrative data, all patients who presented to an ED in the metropolitan areas of Edmonton and Calgary in the years of 2007–2013 with main ED diagnosis of acute coronary syndrome, stable angina or chest pain were included. The travel distance was estimated using the geographic information system method to approximate the distance between the ED and patient home. The clinical endpoints were the 7-day and 30-day all-cause events (death, re-hospitalisation and repeat ED visit). Results: Of 50,881 patients, 30.5% presented by emergency medical services. Patients with older age, female sex, ED diagnosis of acute coronary syndrome, more comorbidities and lower household income were more likely to use emergency medical services to reach the hospital. Longer travel distance was associated with higher emergency medical services use (odds ratio 1.09, 95% confidence interval 1.09–1.10), but it was not a predictor of clinical events. After adjustment for covariates and inverse propensity score weighting, emergency medical services use was associated with a higher risk of 7-day and 30-day clinical events. Conclusion: Several demographic and clinical features were associated with higher emergency medical services use including geographical variation. Although longer travel distance was shown to be linked to higher emergency medical services use, it was not an independent predictor of patient outcome. This has implications for the design of emergency medical services systems, triage and early diagnosis and treatment options.

03 The prehospital 12 lead electrocardiogram is associated with improved outcomes in patients with acute coronary syndromes presenting to emergency medical services: a nationwide linked cohort study

2021 ◽  
Vol 38 (9) ◽  
pp. A2.1-A2
Author(s):  
Tom Quinn ◽  
Timothy Driscoll ◽  
Lucia Gavalova ◽  
Mary Halter ◽  
Chris P Gale ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Medical Services ◽  
Population Based ◽  
Medical Services ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Emergency Medical ◽  
St Segment ◽  
Coronary Syndromes ◽  
Audit Project

BackgroundUse of the Pre-Hospital 12-lead Electrocardiogram (PHECG) is recommended in patients presenting to emergency medical services (EMS) with suspected acute coronary syndrome (ACS).ObjectivesTo investigate differences in mortality between those who did/did not receive PHECG.MethodsPopulation-based, linked cohort study using Myocardial Ischaemia National Audit Project (MINAP) data from 2010-2017.ResultsOf 330,713 patients, 263,420 (79.6%) had PHECG, 67,293 (20.3%) did not. 30-day mortality was 7.8% overall, 7.1% with PHECG vs 10.9% without PHECG (adjusted Odds Ratio [aOR] 0.772, 95% confidence interval [CI] 0.748-0.795, p<0.001). 1 year mortality was 16.1% overall, 14.2% with PHECG vs 23.2% without (aOR 0.692, 95% CI 0.676-0.708, p<0.001). 144,254 patients had ST segment elevation myocardial infarction (STEMI); 130,240 (90.2%) had PHECG, 30 day mortality 8.8% overall, 8.0% with PHECG vs 15.9% without (aOR 0.588, 95% CI 0.557-0.622, p<0.001), 1 year mortality 13.1% overall, 12.1% with PHECG vs 22.8% without (aOR 0.585, 95% CI 0.557-0.614, p<0.001). 186,459 patients had non-STEMI; 133,180 (71.4%) had PHECG. 30-day mortality 7.1% overall, 6.1% with PHECG vs 9.6% without (aOR 0.677, 95%CI 0.652-0.704, p<0.001), 1 year mortality 18.3% overall, 16.3% with PHECG vs 23.3% without (aOR 0.694, 95% CI 0.676-0.713, p<0.001). 110,571 STEMI patients received primary PCI, 103,741 (93.8%) had PHECG. 30 day mortality 5.4% overall, 5.3% with PHECG vs 7.0% without (aOR 0.739, 95% CI 0.667-0.829, p<0.001). 1 year mortality 8.5% overall, 8.4% with PHECG vs 9.8% without (aOR 0.833, 95% CI 0.762-0.911, p<0.001). 26,127 (18.1%) STEMI patients received no reperfusion; 19,873 (76%) had PHECG. Mortality at 30 days 22.1% overall, 21.3% with PHECG vs 24.7% without (aOR 0.911, 95% CI 0.847-0.980, p=0.013), 1 year mortality 32.2% overall, 30.9% with PHECG, 36.4% without (aOR 0.865, 95% CI 0.810-0.925, p<0.001).ConclusionPHECG was associated with lower mortality at 30 days and 1 year in both STEMI and non-STEMI patients.

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