Obravnava pacienta z akutnim koronarnim sindromom v Prehospitalni enoti Obala : diplomsko delo

Kapel, Marijan (avtor), Starc, Andrej (mentor), Rubelli Furman, Matej (komentor)

Uvod: Akutni koronarni sindrom (AKS) povzroči erozija ali ruptura aterosklerotičnega koronarnega plaka, na katerem nastane krvni strdek, ki delno ali popolnoma zapre svetlino koronarne arterije. Pacientom je skupna značilna pekoča, tiščeča ali stiskajoča prsna bolečina. Veriga preživetja vključuje takojšni klic nujne medicinske pomoči. Ekipa nujne medicinske pomoči pri pacientu posname 12-kanalni elektrokardiogram, ki potrdi ali ovrže srčni infarkt z dvigom ST-spojnice, ki zahteva čimprejšnje odprtje koronarne arterije z izvedbo primarne perkutane koronarne intervencije v najbližjem kardiološkem laboratoriju. Namen: V diplomskem delu je bil namen prikazati obolenje in obravnavo pacienta z akutnim koronarnim sindromom v Prehospitalni enoti Obala (PHE-MoE REA). V nadaljevanju je bil namen s pomočjo deskriptivne statistike preveriti trenutno veljavne smernice obravnave akutnega koronarnega sindroma ter upoštevanje le-teh v PHE-MoE REA. Metode dela: Teoretični del diplomske naloge temelji na uporabi deskriptivne metode, metodi kompilacije ter neposrednega zbiranja podatkov in protokolov nujnih intervencij. Podatki iz protokolov nujnih intervencij so nam omogočili pridobiti zaključke ali PHE-MoE REA, ki upošteva veljavne smernice pri obravnavani pacienta z AKS. Podatke iz protokolov nujnih intervencij smo zbirali v pisarni PHE-MoE REA za obdobje od januarja 2012 do decembra 2016. Vključeni so bili vsi pacienti z napoteno diagnozo akutni koronarni sindrom. Podatki so bili zbrani in obdelani s programom Microsoft Office Excel 2013. Rezultati: Vzorec predstavlja 388 nujnih intervencij, ki so povezane z AKS. V opazovanem obdobju beležimo večjo prisotnost AKS pri moški populaciji, kot pri ženski populaciji. Povprečna starost pacientov je bila 66 let. Večji delež pripada STEMI, najmanjši delež vrste koronarnega obolenja pa predstavljajo pacienti z nestabilno angino pektoris. Pacienti, ki so potrebovali primarno perkutano koronarno intervencijo, so bili prepeljani do Splošne bolnišnice Izola (SBI), Univerzitetnega kliničnega centra Ljubljana (UKCL) ali v Bolnišnico Cattinaro (Trst – Italija - CATT). PHE-MoE REA je opravila 225 prevozov v UKCL, 32 v SBI ter 10 prevozov v Bolnišnico Cattinaro. V celoten čas trajanja intervencije je vključen čas sprejema klica, čas obravnave pacienta na terenu, ter čas, ki je bil potreben za prevoz v posamezno bolnišnico. Najhitrejši čas celotne intervencije do SBI je trajal 50 minut in najdaljši 64 minut. V primeru, ko je pacient potreboval transport v UKCL, je bil najhitrejši čas intervencije 164 minut, najdaljši pa 232 minut. Pri tujih državljanih, ki so bili transportirani v CATT, je najhitrejši čas celotne intervencije znašal 64 minut in najdaljši 100 minut. Med najbolj pogoste zdravstvene zaplete v povezavi z AKS beležimo srčni zastoj. Razprava in sklep:. Obalna regija ima dodeljeno eno ekipo nujnega reševalnega vozila z zdravnikom (PHE-MoE REA), ki je aktivirana ob sumu na AKS. V primeru, da pacient potrebuje transport v UKCL, obalna regija ostane brez ekipe PHE-MoE REA. V času nedosegljivosti izvajanje NMP prevzamejo terenski zdravniki posameznih zdravstvenih domov, skupaj z aktivacijo nujnega reševalnega vozila brez zdravnika (MoE NRV). Ugotavljamo, da je pacient, ki potrebuje primarno perkutano koronarno intervencijo, pripeljan v kardiološki laboratorij znotraj veljavnih smernic obravnave pacienta z AKS (v 90 minutah od stika s pacientom). V primeru transporta v UKCL je PHE-MoE REA na voljo v povprečju po 198 minutah. Ugotavljamo, da če bi SBI imela vzpostavljen 24-urni delujoč kardiološki laboratorij, bi ekipa PHE-MoE REA bila ponovno na voljo v 50 minutah ali 64 minutah, kolikor traja celotna intervencija v primeru prevoza v SBI.

• Jezik: Slovenski jezik
• Ključne besede: akutni koronarni sindrom, prehospitalna enota, zdravstvena obravnava, nujna medicinska pomoč
• Vrsta gradiva: Diplomsko delo/naloga
• Organizacija: ZF - Zdravstvena fakulteta
• Leto izida: 2017
• PID: 20.500.12556/RUL-98863
• COBISS.SI-ID: 5384043
• Datum objave v RUL: 09.12.2017

KAPEL, Marijan, 2017, Obravnava pacienta z akutnim koronarnim sindromom v Prehospitalni enoti Obala : diplomsko delo [na spletu]. Diplomsko delo. [Dostopano 21 april 2025]. Pridobljeno s: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=slv&id=98863

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Managment of patients with acute coronory syndrom at Pre-hospital unit Obala : diploma work

Izvleček

Introduction: Acute coronary syndrome (ACS) is caused by the erosion or rupture of the atherosclerotic coronary plaque where a blood clot can also be formed. A blood clot can partially or completely close the coronary artery. Patients feel stinging or squeezing chest pain. The chain of survival consists of an immediate call to an emergency centre for medical help. The emergency medical team then records a 12-channel electrocardiogram. Electrocardiogram either confirms or refutes a diagnosis of a heart attack by looking at ST-segment elevation (STEMI). STEMI requires an opening of the coronary artery with a primary percutaneous coronary intervention in the nearest cardiac laboratory. Purpose: The purpose of the BA thesis is to present the illness and the wholesome approach to treating a patient with an ACS in the Pre-Hhospital Unit Obala. By means of descriptive statistics we examined the current guidelines for treating ACS and its application in the Pre-Hospital Unit Obala (PHE-MoE REA). Methods: The thesis is based on the descriptive method, compilation method, as well as on collected data and data about protocols of emergency interventions. The data collected from emergency intervention protocols gave us a conclusion about using the guidelines for managing and treating patients with ACS in PHE-MoE REA. The data about the emergency intervention protocols were collected in the office of PHE-MoE REA during the period from January 2012 to December 2016. Data were collected from ACS diagnosed patients. Data were collected and processed with Microsoft Office Excel 2013. Results: The sample consists of 388 interventions related to ACS. During the observed period, a presence of ACS was more common in male than in female population. The average age of patients was 66 years. A majority of patients were diagnosed with STEMI and the minority were diagnosed with unstable angina pectoris. Patients who needed percutaneous coronary intervention were transported to the General Hospital of Izola (GHI), University Clinical Centre Ljubljana (UCCL), or to Hospital Catinarra (Trieste – Italy – HC). PHE-MoE REA transported 225 patients to UCCL, 32 to GHI, and 10 to HC. The duration of an entire intervention consisted of: time of call, time spent with a patient on the field and time needed for the transportation to the hospital. The quickest complete intervention to GHI lasted 50 minutes and the slowest 64 minutes. When the patient needed transport to UCCL, the quickest complete intervention lasted 164 minutes and the slowest 232 minutes. Citizens from different countries were transported to HC. The quickest complete intervention to HC lasted 64 minutes and the slowest 100 minutes. Heart failure was among the most common health complications associated with ACS. Discussion and conclusion: Pre-Hospital Unit Obala has one team which includes an emergency rescue vehicle with a doctor (PHE-MoE REA). The team from PHE-MoE REA is always activated by a dispatcher when there is a possibility of ACS. When patient needs a transport to UCCL, Obala region is left without a MoE REA team. During such occasions, the emergency medical help is provided by doctors from individual health centres (Koper, Izola and Piran), along with an activation of an emergency vehicle without a doctor (MoE NRV). Our findings show that PHE-MoE REA are using guidelines for managing and treating ACS patients correctly. All patients who needed primary percutaneous coronary intervention, were transported in 90 minutes (from the physical contact with thepatient) to the nearest cardiac laboratory. When the patient needed a transport to UCCL, PHE-MoE REA was available on average after 198 minutes. Our findings suggest that if there was a 24-hour working cardiac laboratory in the General hospital Izola, PHE-MoE REA would be available again in 50 or 64 minutes, which is the duration of a complete intervention.

• Ključne besede: acute coronary syndrome, pre-hospital unit, health management, emergency medical service