| 1. |
- Holmberg, Mats, 1976-, et al.
(author)
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Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome : a study on patients with acute chest pain and presumed acute coronary syndrome
- 2018
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In: BMC Cardiovascular Disorders. - : Springer. - 1471-2261 .- 1471-2261. ; 18, s. 1-10
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Journal article (peer-reviewed)abstract
- Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain 4 on the visual analogue scale. Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital.
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| 2. |
- Wireklint Sundström, Birgitta, et al.
(author)
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Anxiolytics in patients suffering a suspected acute coronary syndrome : Multi-centre randomised controlled trial in Emergency Medical Service
- 2013
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In: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 168:4, s. 3580-3587
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Journal article (peer-reviewed)abstract
- Background: The prehospital treatment of pain and discomfort among patients who suffer from acute coronary syndrome (ACS) needs a treatment strategy which combines relief of pain with relief of anxiety. Aim: The aim of the present study was to evaluate the impact on pain and anxiety of the combination of an anxiolytic and an analgesic as compared with an analgesic alone in the prehospital setting of suspected ACS. Methods: A multi-centre randomised controlled trial compared the combination of Midazolam (Mi) + Morphine (Mo) and Mo alone. All measures took part: Prior to randomisation, 15 min thereafter and on admission to a hospital. Inclusion criteria were: 1) pain raising suspicion of ACS and 2) pain score ≥4. Primary endpoint: Pain score after 15 min. Results: In all, 890 patients were randomised to Mi + Mo and 873 to Mo alone. Pain was reduced from a median of 6 to 4 and finally to 3 in both groups. The mean dose of Mo was 5.3 mg in Mi + Mo and 6.0 mg in Mo alone (p b 0.0001). Anxiety was reported in 66% in Mi + Mo and in 64% in Mo alone at randomisation (NS); 15 min thereafter in 31% and 39% (p = 0.002) and finally in 12% and 26% respectively (p b 0.0001). On admission to a hospital nausea or vomiting was reported in 9% in Mi + Mo and in 13% in Mo alone (p = 0.003). Drowsiness differed; 15% and 14% were drowsy in Mi + Mo versus 2% and 3% in Mo alone respectively (p b 0.001). Conclusion: Despite the fact that the combination of anxiolytics and analgesics as compared with analgesics alone reduced anxiety and the requirement of Morphine in the prehospital setting of acute coronary syndrome, this strategy did not reduce patients' estimation of pain (primary endpoint). More effective pain relief among these patients is warranted.
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| 3. |
- Wireklint Sundström, Birgitta, et al.
(author)
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Barn och smärta
- 2009
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In: Prehospital akutsjukvård. - : Stockholm: Liber. - 9789147084487 ; , s. 452-459
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Book chapter (other academic/artistic)
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| 4. |
- Wireklint-Sundström, Birgitta, et al.
(author)
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LINDRA-studien
- 2009
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Conference paper (peer-reviewed)abstract
- Erfarenheter av att genomföra en forskningsstudie i ambulanssjukvård. LINDRA-studien syftar till att öka ambulanssjuksköterskors möjligheter att bedöma, lindra och behandla bröstsmärta och oro hos patienter som söker ambulanssjukvård. Datainsamlingen startade i maj 2008; Ambulanssjukvården i Göteborg/SU, Skaraborgs sjukhus, Södra Älvsborgs Sjukhus och Halmstad (öster). Våren 2009 gjordes en utökning; Norra Älvsborgs Sjukhus och Uddevalla sjukhus, Kungälvs Sjukhus och Halmstad (väster). Det innebär att ca 500 ambulanssjuksköterskor ingår i studien, som i övrigt involverar 60 ambulanser och en båt i Västsverige. Hittills har knappt 600 patienter deltagit, som när studien är klar sommaren 2010 omfattar ca 1800 patienter. Preliminära resultat beräknas kunna presenteras under slutet av 2010. I hälso- och sjukvården ska forsknings- och utvecklingsarbete (FoU) ingå som en naturlig del (HSL, 1982:763). Däremot saknas tradition och rutin för FoU inom ambulanssjukvård. LINDRA-studiens genomförande har gett oss en rad erfarenheter av möjligheter och svårigheter att bedriva prehospital forskning. Vi kommer att berätta om hur ambulanssjukvård och forskning går att kombinera.
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