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Abstract(s)
Introdução Na União Europeia as doenças cardiovasculares são responsáveis por 23% da morbilidade, sendo as doenças coronárias a principal causa de morte. Nesse sentido, várias guidelines preconizam que a rapidez na avaliação e orientação dos doentes que se apresentam com dor torácica (DT), no serviço de urgência, melhora o seu prognóstico e fixam como alvo do tempo da porta ao ECG (T.ECG) 10 minutos. Este foi estudado na Urgência Geral do Centro Hospitalar Cova da Beira (UGCHCB), bem como a prioridade atribuída pelo Sistema de Triagem de Manchester (STM) aos doentes com DT. Também se estudou o fluxograma e a prioridade atribuídos pelo STM aos doentes cujo diagnóstico de alta foi enfarte agudo do miocárdio (EAM). Materiais e métodos
Este estudo foi transversal e exploratório. Durante os primeiros três meses de 2008 foram registados 755 episódios de DT de prioridade emergente, muito urgente ou urgente na UGCHCB referentes a utentes com mais de 17 anos. Foram estudadas as seguintes variáveis: sexo, idade, prioridade, tempo da triagem à observação médica e tempo da prescrição à execução do electrocardiograma (ECG), entre outras. Em relação aos episódios com o diagnóstico de alta de EAM, durante o mesmo período (n=11), foram estudadas as seguintes variáveis: idade, sexo, fluxograma e prioridade na admissão à UGCHCB e T.ECG. Os dados foram recolhidos através da base de dados do Alert® ER e a análise estatística foi feita com o SPSS Statistics 17.0® para Windows®. Resultados A idade média dos 755 episódios estudados foi 58,30 anos e 52,7% eram referentes a mulheres; 83,4% foram triados como DT urgente. Em 217 episódios não foi executado nenhum procedimento. Os doentes dos episódios urgentes eram mais novos (57,67 vs 61,48 anos, p=0,020). O tempo médio da primeira triagem à primeira observação médica foram 20m40s, sendo maior nos episódios urgentes (p<0,001). O tempo médio da prescrição à execução do ECG foram 14m41s, sendo maior nos episódios urgentes (p<0,001). O fluxograma da maior parte dos doentes com EAM (n=7) não foi DT. Conclusão Os casos muito urgentes e emergentes foram alvo de um tratamento mais rápido que os urgentes mas ainda persiste uma demora excessiva, em relação às recomendações, no que toca ao T.ECG na DT. Consequentemente, foi desenvolvido um protocolo de abordagem ao EAM que inclui recomendações para os casos de DT, ainda que a maioria dos casos de EAM não se apresente com o fluxograma DT.
Introduction In the European Union cardiovascular diseases are responsible for 23% of morbidity and coronary heart disease is the leading cause of death. Accordingly, several guidelines state that fast evaluation and management of patients presenting to the emergency room (ER) with chest pain (CP) improves acute coronary syndrome's outcome and place target door-to-ECG time (T.ECG) in 10 minutes. T.ECG was studied in Hospital of Covilha's ER as well as Manchester Triage System’s (MTS) priority of CP patients. MTS chief complain and priority were also studied in patients discharged with the diagnosis of acute myocardial infarction (AMI). Materials and Methods This was a transversal and exploratory study. During the first three months of 2008, 755 episodes of immediate, very urgent or urgent CP were recorded in Covilhã's Hospital's ER – patients more than 17 years. Data collected for each of these episodes was: sex, age, priority, time from triage to first medical observation and time from prescription to electrocardiogram (ECG) execution, among others. Regarding the episodes in which ER's dispatch diagnosis was AMI, during the same period (n=11), the following variables were also studied: age, sex, chief complaint, priority on admission to the ER and time from triage to ECG. Data was collected using Alert®'s database and statistical analysis was done with SPSS Statistics 17.0® for Windows®. Results Mean age of the 755 CP episodes was 58,30 years old and 52,7% were women. 83,4% were triaged as urgent CP. In 217 episodes no procedure was performed. Urgent episodes’ patients were younger (57,67 vs 61,48 years of age, p=0,020). Mean time from first triage to first medical observation was 20m40s being greater in urgent episodes (p<0,001). Mean time from ECG’s prescription to its execution was 14m41s being greater in urgent episodes (p<0,001). The most prevalent chief complaint of AMI patients was not CP (n=7). Conclusion Very urgent and immediate cases had faster treatment than urgent ones but there is still some excess time over the recommendations on T.ECG in CP. As a result, an AMI protocol that includes a CP protocol has been created in ER, although the majority of the AMI did not present with CP as chief complaint.
Introduction In the European Union cardiovascular diseases are responsible for 23% of morbidity and coronary heart disease is the leading cause of death. Accordingly, several guidelines state that fast evaluation and management of patients presenting to the emergency room (ER) with chest pain (CP) improves acute coronary syndrome's outcome and place target door-to-ECG time (T.ECG) in 10 minutes. T.ECG was studied in Hospital of Covilha's ER as well as Manchester Triage System’s (MTS) priority of CP patients. MTS chief complain and priority were also studied in patients discharged with the diagnosis of acute myocardial infarction (AMI). Materials and Methods This was a transversal and exploratory study. During the first three months of 2008, 755 episodes of immediate, very urgent or urgent CP were recorded in Covilhã's Hospital's ER – patients more than 17 years. Data collected for each of these episodes was: sex, age, priority, time from triage to first medical observation and time from prescription to electrocardiogram (ECG) execution, among others. Regarding the episodes in which ER's dispatch diagnosis was AMI, during the same period (n=11), the following variables were also studied: age, sex, chief complaint, priority on admission to the ER and time from triage to ECG. Data was collected using Alert®'s database and statistical analysis was done with SPSS Statistics 17.0® for Windows®. Results Mean age of the 755 CP episodes was 58,30 years old and 52,7% were women. 83,4% were triaged as urgent CP. In 217 episodes no procedure was performed. Urgent episodes’ patients were younger (57,67 vs 61,48 years of age, p=0,020). Mean time from first triage to first medical observation was 20m40s being greater in urgent episodes (p<0,001). Mean time from ECG’s prescription to its execution was 14m41s being greater in urgent episodes (p<0,001). The most prevalent chief complaint of AMI patients was not CP (n=7). Conclusion Very urgent and immediate cases had faster treatment than urgent ones but there is still some excess time over the recommendations on T.ECG in CP. As a result, an AMI protocol that includes a CP protocol has been created in ER, although the majority of the AMI did not present with CP as chief complaint.
Description
Keywords
Dor torácica Enfarte agudo do miocárdio Síndrome coronário agudo Dor torácica - Sistema de triagem de Manchester
Citation
Publisher
Universidade da Beira Interior