Decrease in the Number of Patients Presenting With ST-Segment Elevation Myocardial Infarction Across Catheterization Centers in Indonesia During the Coronavirus Disease 2019 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has become a global problem, put a heavy burden on the health care system, and resulted in many fatalities across the globe. A reduction in the number of cardiac emergencies, especially ST-segment elevation myocardial infarction (STEMI), is observed worldwide. In this study, we aimed to analyze the trends of cases and presentation of STEMI across several cardiac catheterization centers in Indonesia.Method: This retrospective study was performed by combining medical record data from five different hospitals in Indonesia. We compared data from the time period between February to June 2019 with those between February and June 2020. Patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention (PPCI) procedures were included in the study.Results: There were 41,396 emergency department visits in 2019 compared with 29,542 in 2020. The number of patients with STEMI declined significantly from 338 in 2019 to 190 in 2020. Moreover, the total number of PPCI procedures reduced from 217 in 2019 to 110 in 2020. The proportion of PPCI was not significantly reduced (64.2 vs. 57.9%). The majority of the patients were men, with a mean age of 54 years in 2019 and 55 years in 2020. We observed a significantly longer door-to-balloon time in 2020 than in 2019 (p < 0.001). We also observed a difference in the door-to-balloon time and ischemic time between the two periods.Conclusion: We observed a decline in the number of patients presenting with STEMI to our centers. However, we observed no significant decline in the percentage of PPCI performed across our centers during this pandemic.

Out-of-Hospital Management of Diabetic Emergencies in Germany: Structural and Process Quality

Aims To collect and analyse representative data of structural and process quality in the management of diabetic emergencies in Germany in 2020. Methods A standardised questionnaire comprising detailed items concerning clinically relevant parameters on the structural and process quality of out-of-hospital management of diabetic emergencies was sent nationwide to medical directors of emergency medical service districts (EMSDs). Results were compared with those from a similar study conducted in 2001. Results The return rate of the questionnaires represented 126 EMSDs, serving a total population of > 40.1 million. Only 4% of ambulances carried glucagon (6% in 2001). In 2020, blood glucose determination increased significantly to 71% of all emergency interventions and to 29% of suspected cardiac emergencies (24% and 15%, respectively, in 2001). In 100% of EMSDs severe hypoglycaemia (SH) was treated by paramedics by administering intravenous dextrose before the arrival of a doctor compared to 63% in 2001. The potential value of nasal glucagon was acknowledged by 43% of responders. In selected patients, treatment of SH was conducted without hospital admission in 78% of EMDs (60% in 2001). Fifty-three percent of medical directors acknowledged the need for further training in diabetic emergencies (47% in 2001). Cooperation for medical education between emergency teams and a diabetes centre was reported by 14% (41% in 2001). Conclusion Structural and process quality of the management of diabetic emergencies in Germany has improved considerably since 2001. Persisting deficiencies could be improved by providing better medical equipment in ambulances and ongoing education to the entire emergency teams.

Obstetric Anesthesia and Heart Disease: Practical Clinical Considerations

Maternal morbidity and mortality as a result of cardiac disease is increasing in the United States. Safe management of pregnancy in women with heart disease requires appropriate anesthetic, cardiac, and obstetric care. The anesthesiologist should risk stratify pregnant patients based upon cardiac disease etiology and severity in order to determine the appropriate type of hospital and location within the hospital for delivery and anesthetic management. Increased intrapartum hemodynamic monitoring may be necessary and neuraxial analgesia and anesthesia is typically appropriate. The anesthesiologist should anticipate obstetric and cardiac emergencies such as emergency cesarean delivery, postpartum hemorrhage, and peripartum arrhythmias. This clinical review answers practical questions for the obstetric anesthesiologist and the nonsubspecialist anesthesiologist who regularly practices obstetric anesthesiology.

Emergency cardiac pharmacology for nurses

Cardiac emergencies are a relatively common occurrence in emergency practice, and cardiac drugs are essential in the management of these patients. Knowledge and understanding of the pharmacology of these drugs is important for the veterinary nurse, so that they can support the veterinary surgeon and give the best care to their patient, by being prepared and organised. Each medication needs to be carefully considered by the veterinary surgeon before use and each patient assessed accordingly. These medications have the potential to do great good, but as with most drugs, can cause harm. This article will discuss some of the more commonly used cardiac drugs in the emergency room.

Assessment of Risk and Emergency Knowledge Level - Cardiovascular Emergencies in Rural Communities Sungai Nagara, Margasari Village, Tapin, South Kalimantan

Background Cardiovascular disease contributes to a massive mortality rate in the world and also in Indonesia. Assessment of the risk and level of knowledge of cardiac emergency symptoms needs to be carried out, especially in rural areas where access to cardiovascular treatment is far.Purposes This study aims to assess risk stratification and the level of knowledge. The method of measuring risk and level of knowledge was carried out on 100 Margasari Ilir respondent who were over 40 years old and carried out using the stratified random sampling method during September 2020—measuring risk using the instrument Framingham Risk Score and the level of knowledge using the ACS Response Index.Result The average age of respondents was 54.98 years, 30 men (30%) and 70 women (70%), 22 smokers (22%), seven diabetes mellitus (7%), 11 people ( 11%) had high cholesterol, 41 people (41%) had hypertension, and 33 people (33%) had low HDL levels. The number of people who have a high risk of emergency - cardiovascular emergency is seven people (7%), 24 people are at moderate risk (24%), and 69 people are at low risk (69%). The level of knowledge about cardiac emergencies is in the low category of 80 people (80%), 19 people (19%), and one high (1%).Conclusion It is necessary to increase public knowledge about cardiovascular emergencies.

Cardiac emergencies in pregnancy

In high income countries, cardiac disease is the most important indirect cause of maternal mortality and occurs most commonly in women with no cardiac history, but with significant risk factors. The fall in blood pressure and consequent increase in cardiac output induced by pregnancy increases cardiac work significantly, this and other pregnancy-induced changes may unmask undiagnosed heart disease or induce heart disease de novo. Admission to the intensive cardiac care unit is a rare event (0.1-0.9%) during pregnancy but is associated with a significant mortality (3.5 to 21%). The fetus may be adversely affected by the heart disease, either directly through impaired uterine perfusion or indirectly through the need for early delivery, specific therapies or diagnostic tests. In this chapter, we have described the presentation and optimal management of the most common cardiac emergencies that arise during pregnancy.

It’s Not All about Echocardiography. Open the Lung Window for the Cardiac Emergencies

In the acute cardiac care setting, undifferentiated clinical presentations such as dyspnea, chest pain, shock, and cardiac arrest are common diagnostic challenges for the clinician. Lung ultrasonography is a well-established diagnostic tool which can be integrated in simplified decision making algorithms during the initial approach of the patient, in order to differentiate accurately cardiac from non-cardiac causes and improve the management of time-sensitive cardiovascular emergencies.