Chenaitia H.,Clavary General Hospital |
Brun P.-M.,Prehospital Emergency Medical Service |
Querellou E.,Prehospital Emergency Medical Service |
Leyral J.,Laveran Military Hospital |
And 5 more authors.
Resuscitation | Year: 2012
Background: In emergency medicine, the gastric tube (GT) has many purposes, however in prehospital settings, the only indication is gastric decompression. To date, there is lack of recommendation on the diagnostic methods to verify correct GT placement in prehospital. The aim of this study is to estimate diagnostic accuracy of ultrasound in confirming gastric tubes placement in a prehospital setting. Method: This was a prospective multicentre study conducted in two French towns (Marseille and Grasse) over a one-year period from May 2010 to May 2011. Results: One hundred and thirty patients were included in the study with an M/F sex ratio of 77/53 and a mean age of 55.7 ± 19.8 years. The GT position was confirmed by ultrasound, with direct visualization in the gastric area in 116 of the 130 patients. In 14 cases, the ultrasound failed to visualize the tip of the GT; these results were due in 2 cases to gas interposition and in 12 cases the GT was shown by final X-ray to be located in the end of the oesophagus. Direct visualization by ultrasound thus has a sensitivity of 98.3% [94-99.5] and a specificity of 100% [75.7-100], a positive predictive value of 100% and a negative predictive value of 85.7%, Youden's index of 0.98. GT size affects ultrasound visualization; the larger the GT, the easier it is to see. Conclusion: Bedside ultrasound thus appears to constitute an effective and reliable diagnostic procedure for confirming correct gastric tube placement in prehospital settings. © 2012 Elsevier Ireland Ltd.
Botker M.T.,Prehospital Emergency Medical Service |
Botker M.T.,Aarhus University Hospital |
Kirkegaard H.,Aarhus University Hospital |
Christensen E.F.,Prehospital Emergency Medical Service |
Terkelsen C.J.,Aarhus University Hospital
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2015
Background Electrocardiogram (ECG) based telemedicine is a cornerstone in pre-hospital triage of patients with suspected ST-elevation myocardial infarction (STEMI). An ECG transmitted from the ambulance is reviewed by a cardiologist on-call in case of ongoing or recent chest pain, resuscitation from cardiac arrest, acute dyspnea of unknown origin and other suspicion of STEMI. We hypothesize that unresolved dyspnea is an independent predictor of mortality in this prehospital setting and that the mortality is higher in patients with acute dyspnea of unknown origin than in patients with chest pain. Methods Population based follow-up study. We included patients triaged using ECG based telemedicine in the Central Denmark Region from June 1, 2008 to January 1, 2013 in our analyses. Mortality-data was obtained from the Danish Civil Registration System. Since survival curves did not fulfill the proportional hazards assumption, Cox proportional hazards regression was waived. Instead, to determine relative risks, we used a generalized linear regression model using pseudo-observations. Results A total of 17,361 patients were triaged by use of ECG based telemedicine. The indication was chest pain in 12,204 (70%) of the patients, acute dyspnea of unknown origin in 1,461 (8 %), resuscitated from cardiac arrest in 163 (1%) and other suspicion of STEMI in 3,533 (20%). When adjusting for age, sex, systolic blood pressure and Charlson Comorbidity Index (p<0.001), 30-day mortality was higher in patients with unresolved dyspnea than in patients with chest pain with a RR 2.55 (CI 2.09-3.10). This difference remained significant at 4 years with a RR of 1.34 (CI 1.24-1.45). Conclusion Acute dyspnea of unknown origin in the pre-hospital setting is an independent predictor of mortality and the mortality is higher than in patients with chest pain. Future research should focus on possibilities for improving early diagnosis and treatment of these patients. © 2015 Bøtker et al.
Laut K.G.,Aarhus University Hospital |
Engstrom T.,Rigshospitalet |
Jensen L.O.,University of Southern Denmark |
Hansen H.-H.T.,University of Aalborg |
And 16 more authors.
American Journal of Cardiology | Year: 2014
System delay (delay from emergency medical service call to reperfusion with primary percutaneous coronary intervention [PPCI]) is acknowledged as a performance measure in ST-elevation myocardial infarction (STEMI), as shorter system delay is associated with lower mortality. It is unknown whether systemdelay also impacts ability to stay in the labor market. Therefore, the aim of the study was to evaluate whether system delay is associated with duration of absence from work or time to retirement from work among patients with STEMI treated with PPCI. We conducted a population-based cohort study including patients ≤67 years of age who were admitted with STEMI from January 1, 1999, to December 1, 2011 and treated with PPCI. Data were derived from Danish population-based registries. Only patients who were full-or part-time employed before their STEMI admission were included. Association between system delay and time to return to the labor market was analyzed using a competing-risk regression analysis. Association between system delay and time to retirement fromwork was analyzed using a Cox regression model. A total of 4,061 patients were included. Ninety-three percent returned to the labor market during 4 years of follow-up, and 41% retired during 8 years of follow-up. After adjustment, system delay >120 minutes was associated with reduced resumption of work (subhazard ratio 0.86, 95% confidence interval 0.81 to 0.92) and earlier retirement from work (hazard ratio 1.21, 95% confidence interval 1.08 to 1.36). In conclusion, systemdelay was associated with reduced work resumption and earlier retirement. This highlights the value of system delay as a performance measure in treating patients with STEMI. © 2014 Elsevier Inc. All rights reserved.