Pre-hospital delays are the longest in the ACS chain and thus the greatest time benefits can be achieved within this section. The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. There are several ways a patient with symptoms suspected of ACS can reach out for help and be referred to the hospital.
What is considered a hospital-outpatient ACS treatment?
The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement.
What is the role of observation in the treatment of ACS?
Jun 21, 2021 · Which segment of ACS treatment can have the longest delay? The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement.
When to use aPTT and nste-ACS?
therapy occur during 3 intervals: from onset of symptoms to patient recognition, during prehospital transport, and during emergency department (ED) evaluation. Patient-based delay in recognition of ACS and activation of the emergency medical services (EMS) system often constitutes the longest period of delay to treatment.5With
What is the Ed’s role in preventing ACS readmissions?
The delay in seeking treatment for ACS has changed little in recent decades, despite increased public awareness of the benefits of reperfusion therapy. 15,47 In the United States, median delay time from symptom onset to hospital arrival ranges from 1.5 to 6.0 hours. 9,14,42,48 Data from the Atherosclerosis Risk in Communities Study indicate no ...
Which of the following is a possible delay in in hospital care to definitive treatment for patients experiencing an acute myocardial infarction?
Three areas of delay in the treatment of patients with in-hospital STEMI that merit particular attention are: Delays in ECG acquisition, Delays in ECG interpretation, and. Delays in activation of existing STEMI systems of care.Feb 23, 2018
How long is ACS treatment?
Treatment should be given for a minimum of 48 hours and up to eight days. Additional acute treatment options include supplemental oxygen, nitroglycerin, intravenous morphine, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins.Feb 15, 2017
What is the immediate treatment for ACS?
In the presence of ischaemic ECG changes or elevation of cardiac troponin, patients with an ACS should be treated immediately with both aspirin (300 mg loading dose) and ticagrelor (180 mg loading dose).Dec 14, 2020
What are the different types of ACS?
The term acute coronary syndrome (ACS) is applied to patients in whom there is a suspicion or confirmation of acute myocardial ischemia or infarction. Non-ST-elevation myocardial infarction (NSTEMI), ST-elevation MI (STEMI), and unstable angina are the three traditional types of ACS.Aug 25, 2020
What is dual antiplatelet therapy?
Dual antiplatelet therapy (also called DAPT) is a treatment to help stop harmful blood clots from forming. This involves taking 2 types of antiplatelet medicines. One of these medicines is usually ASA (aspirin) and the other is a special type of medicine called a P2Y12 inhibitor.
How is anterior STEMI treated?
Aspirin: 162 to 325 mg loading and 81 mg daily maintenance indefinitely. Clopidogrel: 600 mg as early as possible or at the time of PCI and 75 mg daily maintenance dose OR. Prasugrel: 60 mg at the time of PCI and 10 mg daily maintenance dose OR.Feb 12, 2022
What is the initial drug therapy for ACS ACLS?
Morphine (or fentanyl) for pain control, oxygen, sublingual or intravenous (IV) nitroglycerin, soluble aspirin 162-325 mg, and clopidogrel with a 300- to 600-mg loading dose are given as initial treatment.Sep 30, 2020
Which treatment has proven superior for patients with ST segment elevation myocardial infarction?
Primary percutaneous coronary intervention (p-PCI) has become the treatment of choice for patients presenting with ST-segment elevation myocardial infarction (STEMI) when it can be performed expeditiously by an experienced team.Nov 30, 2010
How is ST-elevation treated?
What are the treatment options for a STEMI?Option 1: Percutaneous coronary intervention (PCI) First, we look for where the blockage is located. ... Option 2: Thrombolysis. ... Option 3: Medications. ... Option 4: Coronary bypass surgery.
Is ACS and AMI the same?
Acute coronary syndrome (ACS) is an umbrella term used to describe chest pain caused by either an acute myocardial infarction (AMI) or unstable angina.
What is MI and ACS?
Acute coronary syndrome is a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. One such condition is a heart attack (myocardial infarction) — when cell death results in damaged or destroyed heart tissue.May 18, 2021
Is ACS and CAD the same?
Although health professionals frequently use both terms CAD and ACS interchangeably, as well as CHD, they are not the same. ACS is a subcategory of CAD, whilst CHD results of CAD.
1.1. Pathophysiology
Over the last decade the rate of NSTEMI has increased and has surpassed the STEMI incidence (60 vs 40%) [11]. STEMI and NSTEMI patients moreover differ in mortality: STEMI patients have higher short-term mortality rates [12], while NSTEMI patients have higher long-term mortality [12], [13].
1.2. Delays in STEMI patients
Delays in the reperfusion of STEMI patients increase the mortality [15], [16], [17]. Earlier reperfusion results in superior clinical outcomes, better recovery of left ventricular ejection fraction, less heart failure and less re-occlusions [15], [17].
1.3. Delays in NSTEMI patients
Numerous studies have analyzed the timing of angioplasty in NSTEMI patients. There are three major meta-analyses, which together include ten randomized-controlled trials and four observational studies [22], [23], [24]. Most studies define early intervention as immediate or within 24 h and define later intervention as more than 24 h.
1.4. Chest pain prevalence
Referring all patients with chest pain without restriction to reduce delays in ACS, however, is not feasible as chest pain in the community is a common symptom with an incidence of 23 to 28% [26]. Around 50 up to 80% of the patients at the ED with suspected ACS are diagnosed with a non-cardiac diagnosis [9], [10], [27].
1.5. Patient delay
The longest delay in the ACS-chain is the patient delay, with a median varying between two to five hours [35], [36], [37], [38]. Only around 25% of the patients wait less than an hour and up to 60% exceed a delay of 6 h [39].
1.6. General practitioner
Primary care based health systems are widely implemented in Europe and thus the GP has an important role in the system delay of patients with chest pain. The primary care facilities in Europe are organized in GP practices during the day and GP cooperatives, rota groups or deputizing services for out-of-hours care [5].
1.7. Triage
The great challenge for GP and EMT triage is to distinguish between patients with ACS, who require prompt referral to a (PCI-capable) hospital, and patients with NCCP.
When was the ACS study published?
A comprehensive review of studies published from January 1981 to March 2000, focusing on delay in seeking treatment among acute ischemic stroke patients, revealed findings of prehospital delay that were similar to those for ACS patients.
Why are delay studies based on patient chart reviews and EMS records?
The importance of social, cognitive, and emotional factors, particularly in the context of a situational or circumstantial analysis, cannot be overemphasized. Because age, sex, marital status, race, and sometimes education, income, health history, insurance status, and presenting complaints are usually available to researchers, the vast majority of delay studies are based on patient chart reviews and EMS records. Incorporating interviews and questionnaires into study designs provides an opportunity to go beyond demographic correlations. Studies attempting to go beyond demographically based analyses are frequently smaller and at present do not have the statistical power to convince researchers to look further than demographic associations for explanations of delay in seeking care. Understandably, it is much more expensive to interview patients and family members, but to move knowledge forward in this area, such investigations need to be undertaken.
What is the number one cause of death in the United States in 2020?
The burden of cardiovascular disease is growing worldwide. Ischemic heart disease is the No. 1 cause of death in the United States and other developed countries and is projected to emerge as the No. 1 cause of death worldwide by the year 2020. 1,7 Stroke is the No. 3 cause of death and a major cause of disability. 1.
How is prehospital delay influenced by stroke?
Prehospital delay is influenced by stroke symptoms because some stroke symptoms render the patient unable to call for help. In some studies, shorter delays were associated with an array of factors, including sudden onset of symptoms 26,115 and impaired consciousness. 17,118,119 Greater stroke severity, measured in a variety of ways, was associated with shorter prehospital delays in most 19,26,116,117,119,120 but not all studies. 24,110,111,113 Findings on the differences in delay time by type of stroke are mixed. Although not shown with absolute consistency, short prehospital delays were found with hemorrhagic stroke in most studies. 20,24,26,114,118–120 A history of transient ischemic attack 19 or prior stroke 115 was related to shorter prehospital delay in 2 studies yet was unrelated to prehospital delay in many more studies. 19–21,25,110,113,114,116–118 Other preexisting comorbidities were generally unrelated to prehospital delay for stroke, including AMI, 19,20 congestive heart failure, 20 atrial fibrillation, 22 and diabetes. 19 Risk factors for stroke, such as hypertension, 19,24 hypercholesterolemia, 24 alcohol consumption, 19 and smoking, 19,22,24 were also generally unrelated to prehospital delay.
Does having a prior AMI delay care seeking?
The preponderance of evidence indicates that having a prior AMI does not facilitate care seeking. 77 In general, chronic health conditions such as diabetes, hypertension, and high cholesterol, as well as high-risk behaviors such as smoking, are associated with additional delay in seeking treatment. 43 A history of heart failure or angina also appears to delay care seeking.
What are the phases of delay in stroke care?
These phases include the time intervals from (1) symptom onset to the decision to seek medical attention, (2) from the decision to seek medical attention to first medical contact, and (3) from first medical contact to hospital arrival. Transportation to the hospital consumes only a very small proportion of prehospital delay. 42–45 Once patients arrive for care, the in-hospital phase of delay to treatment is small compared with the other phases. 46 The longest phase of delay continues to be the time from symptom recognition to the decision to seek care, and it is in this phase that the most improvement could be achieved.
How does the presence of witnesses to the onset of stroke affect prehospital delay?
Findings are inconsistent with regard to how the presence of witnesses to the onset of stroke symptoms affects prehospital delay. In some studies, prehospital delay was reduced when the witness, rather than the patient, identified the problem. 112,120 In other studies, no impact on delay was evident on the basis of who recognized the problem as stroke. 26,117 If the first action after symptom onset was to contact another person, including a family member or a physician, then prehospital delay was significantly longer than in cases where a different action was taken. 25,26,120 Living alone or being alone when symptoms first occurred was associated with longer delays in some 19,111 but not most studies. 6,20,22,51,114,121 Use of EMS was associated with significantly shorter prehospital delay times. 20,22,26,110–114,117,118,120
How long does it take to treat a swollen ear?
Treatment should be given for a minimum of 48 hours and up to eight days. Additional acute treatment options include supplemental oxygen, nitroglycerin, intravenous morphine, beta blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins.
Can fondaparinux be used for PCI?
Fondaparinux (Arixtra) should not be used as sole anticoagulation therapy in patients undergoing PCI because of the risk of catheter thrombosis. 4 For patients receiving fibrinolytic therapy for STEMI, unfractionated heparin, enoxaparin (Lovenox), or fondaparinux can be used.
Is NSTEMI a ST elevation?
The term non–ST elevation acute myocardial infarction (NSTEMI) is no longer used in the American College of Cardiology/American Heart Association (ACC/AHA) guidelines as a broad category with separate treatment guidelines.
What is the best treatment for ACS?
Aspirin. Aspirin is the first choice for platelet inhibition in suspected cases of ACS. Its effects are rapid and predictable, and the side effect profile for acute usage is benign. All patients presenting with suspected ACS should receive 162-325 mg of aspirin unless they are allergic.
What are the symptoms of ACS?
Some patients, including the elderly, women, and diabetics, may present with atypical symptoms, including fatigue, abdominal pain, weakness, and nausea in the absence of chest pain. Physical signs are rarely helpful in the diagnosis of ACS.
What is the leading cause of death in the United States?
Heart disease, which includes acute coronary syndromes (ACS), is the leading cause of death in the United States. Chest pain is a common complaint in patients at primary care offices, emergency departments, and inpatient medical services. However, the majority of patients with chest pain will not have ACS.
Can a negative D-dimer rule out pulmonary embolism?
In a patient at low-to-moderate risk for pulmonary embolism, a negative quantitative d-dimer can effectively rule out the disease. Aortic Dissection – pain is generally excruciating, sharp, and radiating to the back. If the coronary ostia are involved, ECG changes may occur.
What biomarkers are used in ACS?
Outside of suspected STEMI, cardiac biomarkers must be evaluated in the setting of suspected ACS. These are intracellular proteins that are released into circulation upon myocardial necrosis. They may be energy enzymes (CK, CK-MB) or structural proteins (troponin, myoglobin). Cardiac troponin (either I or T) is preferred for the initial diagnosis of ACS due to its superior sensitivity and specificity. CK-MB can be used for diagnosing re-infarction, or if cardiac troponin is not available. CK should not be used by itself to diagnose MI. Myoglobin may detect MI earlier than troponin; however, it is not specific to cardiac myocytes and elevation can also occur with skeletal muscle injury or renal failure.
Is anxiety a diagnosis of exclusion?
Unless the patient is quite young, with very atypical features, anxiety should remain a diagnosis of exclusion. The onset of symptoms with emotional distress is not sufficient to attribute the patient’s chest pain to psychiatric disease as opposed to cardiac disease.
What is the difference between antiplatelet and anticoagulant?
Antiplatelet agents work on the various receptors on the platelet surface to inhibit successful platelet aggregation, whereas anticoagulants will target the thrombin-fibrin cascade along different points, depending on the agent. The use of these medications requires balancing the preservation of coronary artery blood flow with the increased risk of bleeding associated with them.