| 1. |
- Axelsson, C, et al.
(författare)
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Dispatch codes of out-of-hospital cardiac arrest should be diagnosis related rather than symptom related.
- 2010
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Ingår i: European journal of emergency medicine : official journal of the European Society for Emergency Medicine. - : Lippincott Williams & Wilkins, Ltd.. - 1473-5695 .- 0969-9546. ; 17:5, s. 265-9
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Tidskriftsartikel (refereegranskat)abstract
- To describe the characteristics and outcome in out-of-hospital cardiac arrest (OHCA) in relation to (i) whether OHCA was coded by the dispatcher as a diagnosis or as a symptom and (ii) the delay until the first unit was alerted at the dispatch centre.
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| 2. |
- Berg, Lena M, et al.
(författare)
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An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments
- 2012
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Ingår i: European journal of emergency medicine. - London : Chapman & Hall. - 0969-9546 .- 1473-5695. ; 19:4, s. 246-251
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians.Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses’ and doctors’ offices were the most common locations for multitasking in the emergency department.Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.
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| 3. |
- Berglin Blohm, Marianne, et al.
(författare)
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The possibility of influencing components of hospital delay time within emergency departments among patients with ST-elevation in the initial electrocardiogram.
- 1998
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Ingår i: European journal of emergency medicine : official journal of the European Society for Emergency Medicine. - : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 5:3, s. 289-96
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the possibility of influencing components of hospital delay time within the emergency department (ED) among patients with ST-elevation on the initial electrocardiogram (ECG). Nurses recorded seven patient time points: (1) ED admission; (2) ECG recording; (3) decision by nurse/ED physician; (4) cardiologist ED arrival; (5) decision of coronary care unit (CCU) admission; (6) ED departure; (7) CCU arrival. After special training in ECG, nurses in the ED were subsequently delegated to send patients directly to the CCU if showing ST-elevation on the admission ECG without contacting either the physician in ED or the cardiologist on call (intervention). Delay times between hospital admission and admission to the CCU were evaluated during the 9 months prior to and during the 6 months after the start of this intervention. Fifty patients (66% men) participated in the first study during 3 months (prior to intervention). Patients with suspected or confirmed acute myocardial infarction (AMI) in the ED had a median delay time from ED arrival to CCU arrival of 55.5 minutes (34.5 minutes for patients with confirmed AMI; ST elevation on admission). Time interval from decision to admit to CCU and ED departure was an average of 31% of the total delay. A mean of 21% of total delay occurred between ED decision to cardiologist arrival, and 19% during the time interval from cardiologist ED arrival until decision to CCU admission. Among patients receiving thrombolysis, the median delay time from hospital admission to CCU admission was reduced from 40 minutes during the 9 months prior to start of the intervention (nurses sending patients directly to the CCU) to 22 minutes during the 6 months thereafter (p = 0.02). The largest proportion of hospital delay components for acute coronary syndrome patients occurred between the cardiologist's decision to admit to the CCU and departure from the ED, and the interval following the decision by the nurse or physician to the cardiologist ED arrival. When nurses were delegated to transfer patients with ST-elevation on admission directly to the CCU without contacting a physician, the delay time from ED admission to CCU admission was reduced by nearly 50%.
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| 4. |
- Bodetoft, Stefan, et al.
(författare)
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Effects of oxygen inhalation on cardiac output, coronary blood flow and oxygen delivery in healthy individuals, assessed with MRI.
- 2011
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Ingår i: European Journal of Emergency Medicine. - 0969-9546. ; 18, s. 25-30
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Oxygen (O2) is a cornerstone in the treatment of critically ill patients, and the guidelines prescribe 10-15 l of O2/min even to those who are initially normoxic. Studies using indirect or invasive methods suggest, however, that supplemental O2 may have negative cardiovascular effects. The aim of this study was to test the hypothesis, using noninvasive cardiac magnetic resonance imaging, that inhaled supplemental O2 decreases cardiac output (CO) and coronary blood flow in healthy individuals. METHODS: Sixteen healthy individuals inhaled O2 at 1, 8 and 15 l/min through a standard reservoir bag mask. A 1.5 T magnetic resonance imaging scanner was used to measure stroke volume, CO and coronary sinus blood flow. Left ventricular (LV) perfusion was calculated as coronary sinus blood flow/LV mass. RESULTS: The O2 response was dose-dependent. At 15 l of O2/min, blood partial pressure of O2 increased from an average 11.7 to 51.0 kPa with no significant changes in blood partial pressure of CO2 or arterial blood pressure. At the same dose, LV perfusion decreased by 23% (P=0.005) and CO decreased by 10% (P=0.003) owing to a decrease in heart rate (by 9%, P<0.002), with no significant changes in stroke volume or LV dimensions. Owing to the decreased CO and LV perfusion, systemic and coronary O2 delivery fell by 4 and 11% at 8 l of O2/min, despite the increased blood oxygen content. CONCLUSION: Our data indicate that O2 administration decreases CO, LV perfusion and systemic and coronary O2 delivery in healthy individuals. Further research should address the effects of O2 therapy in normoxic patients.
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| 5. |
- Bohm, Katarina, et al.
(författare)
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Dispatcher-assisted telephone-guided cardiopulmonary resuscitation: an underused lifesaving system.
- 2007
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Ingår i: Eur J Emerg Med. - 0969-9546. ; 14:5, s. 256-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Our purpose with this investigation was to (i) estimate how often telephone-guided cardiopulmonary resuscitation was offered from emergency medical service dispatchers in Stockholm, (ii) study the willingness to perform cardiopulmonary resuscitation, and (iii) assess factors that could mislead the dispatcher in identifying the patient as a cardiac arrest victim. METHODS: In this prospective study, 313 consecutive emergency calls of out-of-hospital cardiac arrest were obtained from the Swedish Cardiac Arrest Register. Seventy-six cases of out-of-hospital cardiac arrest fulfilled the inclusion criteria. All alarm calls were tape-recorded and analyzed according to a standardized protocol. RESULTS: Dispatchers offered bystanders telephone instructions for cardiopulmonary resuscitation in 47% (n=36) of the cases and, among these, cardiopulmonary resuscitation instructions were given in 69% (n=25). Only 6% (n=2) of bystanders were not willing to perform cardiopulmonary resuscitation. Signs of breathing (suspected agonal breathing) were described in 45% of the cases. Cardiopulmonary resuscitation was offered to 23% (n=10) of patients with signs of breathing versus 92% (n=23) of those who were not breathing (P<0.001). CONCLUSIONS: Despite the fact that the vast majority of bystanders are willing to take part in telephone-guided cardiopulmonary resuscitation, emergency medical service dispatchers offer telephone-guided cardiopulmonary resuscitation in about only half of cases. Signs of breathing (agonal breathing) are often mistaken for normal breathing and are a cause of delay in the diagnosis of cardiac arrest.
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| 6. |
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| 7. |
- Bång, A, et al.
(författare)
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Evaluation of dispatcher assisted cardiopulmonary resuscitation
- 1999
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 6:3, s. 175-183
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Tidskriftsartikel (refereegranskat)abstract
- The outcome of out-of-hospital cardiac arrest (CA) following cardiopulmonary resuscitation (CPR) initiated by dispatcher-provided telephone instructions (T-CPR) in the area of Gothenburg, Sweden was studied. During a period of 27 months, 475 cases categorized by the dispatchers at the Emergency Co-ordination and Dispatch Centre as being suspected CA were offered T-CPR and were included in one of the following groups: (1) T-CPR completed (caller without previous CPR training); (2) T-CPR completed (caller with previous CPR training); (3) T-CPR started, but not completed; (4) T-CPR declined by caller due to previous CPR training; (5) T-CPR declined by caller due to other reasons; or, (6) T-CPR not offered. Of the patients, 473 could be followed up and of them 427 fulfilled the criteria for CA on ambulance arrival. Among the latter cases, 10% were hospitalized alive, 4% could be discharged from hospital, and the distribution among groups was: (1) 7%; (2) 18%; (3) 5%; (4) 11%; (5) 3%; and (6) 1%. The study concludes that although more attention should be paid to the detection of CA patients by the dispatchers, when the dispatchers suspected CA, their accuracy was high. Half of the witnesses accepted the offer of T-CPR and one-third completed T-CPR. More efforts and research are needed, however, to increase the percentages of callers completing CPR. The impact of T-CPR on survival might be limited. Indeed, the comparison of 'resuscitable' patients in whom T-CPR played an important role in supporting bystanders (i.e. groups 1 and 2) with 'resuscitable' patients in whom T-CPR was not performed (i.e. groups 3, 5 and 6) suggests an increase in survival from 6% (groups 3, 5 and 6) to 9% (groups 1 and 2).
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| 8. |
- Cedercrantz-Borna, Catharina, et al.
(författare)
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High-sensitivity troponin T as a diagnostic tool for acute coronary syndrome in the real world: an observational study.
- 2014
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Ingår i: European Journal of Emergency Medicine. - 0969-9546. ; 21:3, s. 181-188
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The 2011 European Society of Cardiology guidelines state that acute coronary syndrome (ACS) may be excluded with a rapid 3 h high-sensitivity troponin T (HsTnT) sampling protocol. We aimed to evaluate the diagnostic and prognostic performance of HsTnT in patients with chest pain admitted with possible ACS in routine care. METHODS: A total of 773 consecutive patients admitted for in-hospital care for chest pain suspicious of ACS were included retrospectively. HsTnT values at admission and at 3-4 and 6-7 h were analysed for diagnostic performance. In addition, prognostic performance towards a combined 60-day endpoint of ACS, nonelective revascularization or death of all causes was studied. RESULTS: Twenty-three per cent of the patients had ACS during the hospital stay and 1.6% had an endpoint after discharge but within 60 days. The sensitivity of HsTnT for ACS at admission, 3-4 and 6-7 h was only 68, 79 and 81%, respectively. Sensitivity and negative predictive value for acute myocardial infarction alone were 80 and 93% on admission and 97 and 99% at 3-4 h. Among patients aged 75 years and older, 63% had a positive HsTnT on admission, but only 39% of these had an ACS during hospital stay. CONCLUSION: Our data confirm that prolonged testing with HsTnT after 3-4 h does not improve diagnostic performance for ACS. However, although sensitivity for acute myocardial infarction was very good, sensitivity for ACS was insufficient to rule out ACS even at 6-7 h. Less than half of all recorded positive HsTnT were true positives. On the basis of these results, we find it unlikely that HsTnT has improved the diagnosis of ACS in the emergency care setting.
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| 9. |
- Cone, David C, et al.
(författare)
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Comparison of the SALT and Smart triage systems using a virtual reality simulator with paramedic students
- 2011
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins. - 0969-9546 .- 1473-5695. ; 18:6, s. 314-321
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Virtual reality systems may allow for organized study of mass casualty triage systems by allowing investigators to replicate the same mass casualty incident, with the same victims, for a large number of rescuers. The study objectives were to develop such a virtual reality system, and use it to assess the ability of trained paramedic students to triage simulated victims using two triage systems.METHODS: Investigators created 25 patient scenarios for a highway bus crash in a virtual reality simulation system. Paramedic students were trained to proficiency on the new 'Sort, Assess, Life saving interventions, Treat and Transport (SALT)' triage system, and 22 students ran the simulation, applying the SALT algorithm to each victim. After a 3-month washout period, the students were retrained on the 'Smart' triage system, and each student ran the same crash simulation using the Smart system. Data inputs were recorded by the simulation software and analyzed with the paired t-tests.RESULTS: The students had a mean triage accuracy of 70.0% with SALT versus 93.0% with Smart (P=0.0001). Mean overtriage was 6.8% with SALT versus 1.8% with Smart (P=0.0015), and mean undertriage was 23.2% with SALT versus 5.1% with Smart (P=0.0001). The average time for a student to triage the scene was 21 min 3 s for SALT versus 11 min 59 s for Smart (P=0.0001).CONCLUSION: The virtual reality platform seems to be a viable research tool for examining mass casualty triage. A small sample of trained paramedic students using the virtual reality system was able to triage simulated patients faster and with greater accuracy with 'Smart' triage than with 'SALT' triage.
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| 10. |
- Djärv, Therese, et al.
(författare)
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Decreased general condition in the emergency department : high in-hospital mortality and a broad range of discharge diagnoses
- 2015
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins. - 0969-9546 .- 1473-5695. ; 22:4, s. 241-246
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Decreased general condition (DGC) is a frequent presenting complaint within the Adaptive Triage Process. DGC describes a nonspecific decline in health and well-being, and it is common among elderly patients in the emergency department (ED).AIM: The aim of this study was to compare the in-hospital mortality among patients presenting with DGC with that among patients in the corresponding triage category presenting with other complaints to an ED. The secondary aim was to describe the discharge diagnoses of patients presenting with DGC.METHODS: All patients admitted to Södersjukhuset from the ED in 2008 were included. The difference in the in-hospital mortality rate was stratified for triage category at the ED, between patients with DGC (n=1182) and those with all other presenting complaints (n=20 775), and assessed with sex-adjusted and age-adjusted logistic regression models. Discharge diagnoses were assessed as the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) in the medical discharge notes.RESULTS: A total of 1182 patients with DGC at the ED were admitted for in-hospital care, and they had a four-fold risk of suffering an in-hospital death [odds ratio 4.74 (95% confidence interval 3.88-5.78)] compared with patients presenting with other presenting complaints. The most common discharge diagnoses were diseases of the circulatory system (14%), respiratory system (14%), and genitourinary system (10%).INTERPRETATION: Patients presenting with DGC to an ED often receive low triage priority, frequently require admission for in-hospital care, and, because of the three-fold increased risk of in-hospital death compared with others, belong to a high-risk group.
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