Berlim-Myocardial Infartion

8/7/2019 Berlim-Myocardial Infartion

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Myocardial Infarction pre hospital intervention

Pre Hospital Emergency Medical Team

Hospital S. Francisco XavierPortugal

Three years review

F. Barros; A. Lufinha; C. Febra; C. Armada; N. Catorze


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Porto

Coimbra

Lisboa

Faro

Pre Hospital Emergency structure in Portugal

CODUURGENT PATIENT ORIENTATION CENTER

Medical Emergency Centers responsible for providing medicalsupport in response to the national emergency number


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CODU

VMERMedical Emergency and Resuscitation Vehicles

Helicopters

Ambulances

CIAVPoisons Information Centre

Height risk Neonatal

CODU offshore


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Lisboa

In the Year of 2003

344.916 Emergency calls 9.017 Calls for chest pain 6.522 Activations for chest pain 5.472 Ambulances 1.050 Medical Emergency vehicle

Responds to a population of 2.922.137 habitants


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Special protocolsAcute coronary disease

In Portugal the number of MI in 2003 was of 7.103, with 47%of ST elevation MI

All 112 calls for chest pain received in any CODU are submitted to a standardized

questionnaire that characterizes the pain and determines the existence of severity signs

According to this characterization, an ambulance or a medical team is sent to the field,performing the correspondent therapeutics

The feed back from this teams reporting an MI, leads to the search from the CODU of a

coronary unit that receives the patient



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VMER SFXS. Francisco Xaviers Hospital

Medical Emergency and Resuscitation Vehicle

Nurse or Emergency Medical TechnicianDriverDoctor

Anaesthesiologists (8)Internists (5)Surgeons (5)

General Practitioners (3)

Emergency departmentOperation roomEM Technicians


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Material and Methods

Retrospective analysis of the registers of attended myocardial infarction(MI), from the 1st of January 2001 to the 31th of December 2003, by S.Francisco Xaviers Hospital Medical Emergency vehicle


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5810775

5411164

509961

Myocardial InfartionUnstable anginaIsquemic heart disease

162


2001

2002

2003


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0

10

20

30

40

50

60

30 - 39 40 - 49 50 - 59 60 - 69 70 -79 80 - 89 Years

Myocardial InfarctionDistribution per Age



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Activation Local

Call Hospital

4,2 min. 8,3 min. 24 min.



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Myocardial InfarctionECG registers

Not registered

MI with ST elevation

94%

6%



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0 20 40 60 80 100

Salicylic acid

Nitroglycerin sl

Morphine

Isosorbide dinitrate ev

furosemide

Metoclopramide

Diazepam

Captopril

Epinepherine

Atropine

Midazolam

Myocardial Infarction

Drugs administered


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104 patients were referenced to coronary units (64%) Two deaths from cardiopulmonary arrest before reaching the Hospital

0 5 10 15 20 25 30

Respiratory or

cardiac arrest

Disritmias

Hypertension

Pulmonary

oedema

Myocardial Infarction

Associated complications


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Conclusions

Good average time of arrival and intervention2/3 of the patients referenced to Coronary units

The number of MI attended to is clearly inferior to realityUnconsciousness of the population to call 112 ?

CODU screening accuracy ?

Misleading records of our data base ?

Berlim-Myocardial Infartion

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