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Myocardial Infarction pre hospital intervention
Pre Hospital Emergency Medical Team
Hospital S. Francisco XavierPortugal
Three years review
F. Barros; A. Lufinha; C. Febra; C. Armada; N. Catorze
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Porto
Coimbra
Lisboa
Faro
Pre Hospital Emergency structure in Portugal
CODUURGENT PATIENT ORIENTATION CENTER
Medical Emergency Centers responsible for providing medicalsupport in response to the national emergency number
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Pre Hospital Emergency structure in Portugal
CODU
VMERMedical Emergency and Resuscitation Vehicles
Helicopters
Ambulances
CIAVPoisons Information Centre
Height risk Neonatal
CODU offshore
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Lisboa
In the Year of 2003
344.916 Emergency calls 9.017 Calls for chest pain 6.522 Activations for chest pain 5.472 Ambulances 1.050 Medical Emergency vehicle
Responds to a population of 2.922.137 habitants
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Special protocolsAcute coronary disease
In Portugal the number of MI in 2003 was of 7.103, with 47%of ST elevation MI
All 112 calls for chest pain received in any CODU are submitted to a standardized
questionnaire that characterizes the pain and determines the existence of severity signs
According to this characterization, an ambulance or a medical team is sent to the field,performing the correspondent therapeutics
The feed back from this teams reporting an MI, leads to the search from the CODU of a
coronary unit that receives the patient
Pre Hospital Emergency structure in Portugal
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VMER SFXS. Francisco Xaviers Hospital
Medical Emergency and Resuscitation Vehicle
Nurse or Emergency Medical TechnicianDriverDoctor
Anaesthesiologists (8)Internists (5)Surgeons (5)
General Practitioners (3)
Emergency departmentOperation roomEM Technicians
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Myocardial Infarction pre hospital intervention
Material and Methods
Retrospective analysis of the registers of attended myocardial infarction(MI), from the 1st of January 2001 to the 31th of December 2003, by S.Francisco Xaviers Hospital Medical Emergency vehicle
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5810775
5411164
509961
Myocardial InfartionUnstable anginaIsquemic heart disease
162
Myocardial Infarction pre hospital intervention
2001
2002
2003
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0
10
20
30
40
50
60
30 - 39 40 - 49 50 - 59 60 - 69 70 -79 80 - 89 Years
Myocardial InfarctionDistribution per Age
Myocardial Infarction pre hospital intervention
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Activation Local
Call Hospital
4,2 min. 8,3 min. 24 min.
Myocardial Infarction pre hospital intervention
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Myocardial InfarctionECG registers
Not registered
MI with ST elevation
94%
6%
Myocardial Infarction pre hospital intervention
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Myocardial Infarction pre hospital intervention
0 20 40 60 80 100
Salicylic acid
Nitroglycerin sl
Morphine
Isosorbide dinitrate ev
furosemide
Metoclopramide
Diazepam
Captopril
Epinepherine
Atropine
Midazolam
Myocardial Infarction
Drugs administered
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Myocardial Infarction pre hospital intervention
104 patients were referenced to coronary units (64%) Two deaths from cardiopulmonary arrest before reaching the Hospital
0 5 10 15 20 25 30
Respiratory or
cardiac arrest
Disritmias
Hypertension
Pulmonary
oedema
Myocardial Infarction
Associated complications
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Myocardial Infarction pre hospital intervention
Conclusions
Good average time of arrival and intervention2/3 of the patients referenced to Coronary units
The number of MI attended to is clearly inferior to realityUnconsciousness of the population to call 112 ?
CODU screening accuracy ?
Misleading records of our data base ?