scholarly journals Eletrocardiogram gate time in patients with thoracic pain in the emergency

2018 ◽  
Vol 12 (4) ◽  
pp. 1027
Author(s):  
David Bernar Oliveira Guimarães ◽  
Tatyanne Silva Rodriguês ◽  
Sarah Carolline Mazza Oliveira ◽  
Fernanda Valéria Silva Dantas Avelino
Keyword(s):  
Chest Pain ◽  
Angina Pectoris ◽  
Emergency Room ◽  
Web Of Science ◽  
Prehospital Care ◽  
Developed Countries ◽  
Thoracic Pain ◽  
De Se ◽  
Gate Time ◽  
Cardiac Disorders

ABSTRACT Objective: to identify electrocardiogram gate time in patients with chest pain in the emergency room. Method: integrative review, using PVO technique, carried out in February 2017, in the VHL Portal and Medline, Web of Science, ScieLO and CIHNAL sites, using the descriptors Chest Pain, Electrocardiography, Emergencies, identified in the MeSH, in the title CINAHL , coinciding with the DeCS, using the Boolean operator AND in all associations. Results: according to the search strategies, ten articles with origin in developed countries and only one Brazilian were identified. Conclusion: the literature defines that the electrocardiogram for patients with chest pain in the emergency room should be done within ten minutes. There is a need to develop further studies on the performance of the ECG in prehospital care in order to carry out conducts directed to cardiac disorders. Descritores: Angina Pectoris; Emergencies; Electrocardiography; Nursing Care; Emergency Nursing; ST Elevation Myocardial Infarction.RESUMOObjetivo: identificar o tempo porta eletrocardiograma em pacientes com dor torácica na emergência. Método: revisão integrativa, utilizando técnica PVO, realizada em fevereiro de 2017, no Portal da BVS e nos sites Medline, Web of Science, ScieLo e CIHNAL, com o uso dos descritores dor no peito, eletrocardiografia, emergências, identificados no MeSH, no título CINAHL, coincidindo com os DeCS, utilizando o operador booleano AND em todas as associações. Resultados: segundo as estratégias de busca, identificaram-se dez artigos de origem em países desenvolvidos e somente um brasileiro. Conclusão: a literatura define que a realização do eletrocardiograma para pacientes com dor torácica na emergência deve ser feita em até dez minutos. Há a necessidade de se desenvolverem mais estudos sobre a realização do ECG no atendimento pré-hospitalar para se tomarem condutas direcionadas diante a agravos cardiológicos. Descritores: Angina Pectoris; Emergências; Eletrocardiografia; Cuidados de Enfermagem; Enfermagem em Emergência; Infarto do Miocárdio com Supradesnível do Segmento ST. RESUMEN Objetivo: identificar el tiempo puerta-electrocardiograma en pacientes con dolor torácico en la emergencia. Método: revisión integrativa, utilizando técnica PVO, realizada en febrero de 2017 en los servicios, en el Portal de la BVS, y en los sitios, Medline, Web of Science, ScieLo y CIHNAL, con el uso de los descriptores dolor en el pecho, electrocardiografía, emergencias, identificados en el MeSH, en el título CINAHL, coincidiendo con los DeCS, utilizando el operador booleano AND en todas las asociaciones. Resultados: según las estrategias de búsqueda, se identificaron diez artículos, los cuales son de origen en países desarrollados y sólo uno es brasileño. Conclusión: la literatura define que la realización del electrocardiograma para pacientes con dolor torácico en la emergencia debe ser hecha en hasta 10 minutos. Hay la necesidad de desarrollar más estudios sobre la realización del ECG en la atención prehospitalaria para tomar conductas dirigidas ante agravios cardiológicos. Descritores: Angina de Pecho; Urgencias Médicas; Electrocardiografía; Atención en Enfermería; Enfermería de Urgencia; Infarto del Miocardio con Elevación del ST.

scholarly journals Primary Aortoesophageal Fistula: Is a High Level of Suspicion Enough?

2020 ◽  
Author(s):  
Ana Sara Monteiro ◽  
Rute Martins ◽  
Catarina Martins da Cunha ◽  
Jorge Moleiro ◽  
Henrique Patrício
Keyword(s):  
Chest Pain ◽  
Emergency Room ◽  
Fatal Outcome ◽  
Rare Condition ◽  
Massive Bleeding ◽  
Aortoesophageal Fistula ◽  
Thoracic Pain ◽  
Ct Findings ◽  
High Level ◽  
Work Up

Aortoenteric fistula (AEF) is a rare condition with a high mortality rate. AEFs are classified according to their primary and secondary causes, the former being less frequent. Primary AEFs occur in a native aorta and their causes include aneurysms, foreign bodies, tumours, radiotherapy and infection. The classic triad of aortoesophageal fistulas, a subtype of AEFs, are mid-thoracic pain and sentinel haemorrhage, followed by massive bleeding after a symptom-free interval. We present the case of a 41-year-old male patient who presented in the emergency room after successive episodes of abundant haematemesis. He was hypovolemic, hypothermic and acidotic at presentation. His medical history included an emergency room visit the week before with chest pain but no relevant anomalies on work-up, active intravenous drug use and chronic hepatitis. Esophagogastroduodenoscopy (EGD) showed a bulging ulcerated lesion suspicious for aortoesophageal fistula, confirmed by computed tomography (CT) angiography, which revealed a saccular aortic aneurysm with a bleeding aortoesophageal fistula. The patient underwent urgent thoracic endovascular aortic repair. The sentinel chest pain, leucocytosis and CT findings hinted at the presence of a mycotic aneurysm, despite the negative blood cultures. It was most likely caused by a septic embolus due to the patient’s risk factors. While a high level of suspicion for aortoesophageal fistula is needed to prompt a fast diagnosis, EGD and CT findings were crucial to establish it and allow a life-saving intervention. We conclude that chest pain cannot be disregarded in a patient aged 41 years with multiple comorbidities, despite normal work-up, to prevent a fatal outcome.

scholarly journals Efficacy of thrombolytics in patients with acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Vasin ◽  
O Mironova ◽  
V Fomin
Keyword(s):  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Thrombolytic Therapy ◽  
Prehospital Care ◽  
Optimal Choice ◽  
Hospital Treatment ◽  
Complication Rates ◽  
Coronary Syndrome ◽  
Thrombolytic Drug ◽  
Systemic Thrombolytic Therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: The optimal choice of the thrombolytic drug for emergency revascularization in patients with acute coronary syndrome (ACS) still remains to be defined. Percutaneous coronary intervention is a more safe and effective method of reperfusion compared with thrombolytic therapy, that’s why the last is relatively not common nowadays. But in the COVID-19 era in a number of cases some patients with ACS can’t be quickly hospitalized due to different reasons like the absence of the nearest available cardiovascular center, or lack of an ambulance. A long period of chest pain forces the doctors to use systemic thrombolytic therapy. Purpose This study investigates the efficacy and safety of Alteplase, Prourokinase, Tenecteplase, and Streptokinase in patients with acute coronary syndrome. Methods A retrospective, open, non-randomized cohort study was conducted. We have analysed 600 patients with ACS, who underwent systemic thrombolytic therapy at the prehospital and in-hospital stages from 2009 to 2011. Patients were divided into several groups according to the thrombolytic agent administered: Alteplase (254 patients), Prourokinase (309 patients), Tenecteplase (6 patients), Streptokinase (31 patients). Treatments were to be given as soon as possible. The ECG reperfusion criterion was a decrease in the ST segment by 50% or more from the initial elevation. Results  Among 600 patients (mean age, 61 years (SD = 20); 119 women [19.7%]), 440 had successful reperfusion. The median time from chest pain onset to the start of treatment was 3 hours (P < 0.001). The percentages of successful thrombolysis for each agent were similar: Alteplase 74,4% Prourokinase 71,2%, Tenecteplase 83%, Streptokinase 74,2%. No statistical differences were observed in thrombolytic results among these groups (OR: 0.60, 95% CI: 0,2868 to 1,217; P = 0.17). At the same time, the hospital treatment with prourokinase was more effective than prehospital care with prourokinase: 110 successful reperfusions in 138 patients (79.7%) and 110 successful reperfusions in 171 patients (64.3%), respectively. Regardless of the onset of the attack (OR: 0.45, 95% CI: 0,2004 to 0,9913; P = 0.05). The effectiveness of the other thrombolytics cannot be compared between prehospital care and hospital treatment due to the rare use at the hospital stage in our cases. In the study, there was also no statistical difference in complication rates among the treatment groups. Among all patients, there were 9 fatal outcomes (1.5%): Alteplase 3,15% Prourokinase 1,9%, Streptokinase 3,22%. Conclusion(s): In patients with ACS, all thrombolytic drugs showed similar effectiveness. There is no difference in the safety and efficacy among the agents in our study, but there is a difference in cost and route of administration. However, upcoming prospective trials with long follow-up periods might be expected to determine the most appropriate systemic thrombolytic drug.

Chronic kidney disease as a risk factor for acute coronary syndromes in patients presenting to the emergency room with chest pain

2012 ◽  
Vol 159 (5) ◽  
pp. 391-396 ◽  
Author(s):  
Sherezade Khambatta ◽  
Michael E. Farkouh ◽  
R. Scott Wright ◽  
Guy S. Reeder ◽  
Peter A. McCullough ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Chest Pain ◽  
Kidney Disease ◽  
Emergency Room ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes

Evaluation of a new troponin-T test strip in patients with chest pain in the emergency room

1994 ◽  
Vol 109 (1-2) ◽  
pp. 303
Author(s):  
M. Lebrun ◽  
D. Geadah ◽  
D. Gossard ◽  
P. Ross ◽  
G. Turcotte
Keyword(s):  
Chest Pain ◽  
Emergency Room ◽  
Troponin T ◽  
Test Strip ◽  
T Test

MODULAÇÃO DA MICROBIOTA INTESTINAL COMO ESTRATÉGIA DE RESPOSTA IMUNOLÓGICA À COVID-19

2021 ◽  
Author(s):  
Mayra Garcia Maia Costa ◽  
Janaina Sobreira Rocha
Keyword(s):  
Web Of Science ◽  
De Se

Introdução: O intestino é o maior órgão que estabelece uma interface com o ambiente externo e é também uma barreira dinâmica que abriga uma complexa comunidade microbiana. Estima-se que o intestino de um indivíduo adulto contenha aproximadamente 1014 micro-organismos (10 vezes mais células do que todo o corpo humano). O intestino pode ser considerado também um dos mais importantes órgãos relacionados a resposta imunológica e tem recebido destaque na relação com a Covid-19, doença causada pela espécie SARS CoV2. Dentre os sintomas causados pela Covid-19, está a disbiose que resulta na supressão de micro-organismos benéficos, em detrimento ao crescimento de patógenos oportunistas. Objetivo: Avaliar o impacto da microbiota intestinal na resposta imunológica à Covid-19. Material e métodos: Este estudo trata-se de uma revisão bibliográfica realizada nas bases de dados Web of Science, Science Direct e PUBMED fazendo uso da estratégia de busca com descritores: COVID-19, Microbiota Intestinal, Probióticos e SARS-CoV-2. Resultados: Alterações significativas da microbiota intestinal de pacientes com Covid-19 foram evidenciadas pelo fato de que SARS-CoV-2 é capaz de se multiplicar tanto nas vias respiratórias como nos tratos digestivos, consequentemente afetando a anatomia e fisiologia do trato gastrointestinal. Além disso, estudos demonstram persistência por período prolongado de SARS-CoV-2 no íleo e duodeno de pacientes após a infecção inicial. Evidências sugerem relação entre o eixo intestino-pulmão, que até certo ponto pode ser modulado por probióticos, amenizando sintomas gastrointestinais e protegendo o sistema respiratório. Conclusão: O equilíbrio da microbiota intestinal parece estar fortemente associado a efetiva resposta imunológica de pacientes com Covid-19. Alterações metabólicas preexistente podem atuar como fatores de estresse a microbiota benéfica e resultar no aumento de espécies microbianas prejudiciais. Estes dados indicam que a adoção de estratégias para modulação da microbiota intestinal, através de uma alimentação saudável que favoreça a microbiota intestinal benéfica e outras estratégias como o uso de probióticos, pode reduzir a gravidade da doença Covid-19.

The Importance of Creatine Kinase Determination in Identifying Acute Myocardial Infarction among Patients Complaining of Chest Pain in an Emergency Room

Cardiology ◽  
1987 ◽  
Vol 74 (2) ◽  
pp. 100-110 ◽  
Author(s):  
Sami Viskin ◽  
Karin Heller ◽  
David Gheva ◽  
Avi Hassner ◽  
Itzhak Shapira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Emergency Room
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