The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes

Body, Richard; Carley, Simon; Wibberley, Christopher; McDowell, Garry; Ferguson, Jamie; Mackway‐Jones, Kevin

doi:10.1016/j.resuscitation.2009.11.014

Cited by 101 publications

(80 citation statements)

References 20 publications

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“…Numerous studies do not support the use of any clinical signs and symptoms independent of electrocardiograph (ECG) tracings, cardiac biomarkers, or other diagnostic tests to rule in or rule out ACS in prehospital or emergency department (ED) settings. [215][216][217][218][219][220][221][222][223][224][225][226][227][228] To improve ACS outcome, all dispatchers and EMS providers must be trained to recognize ACS symptoms, even if atypical. It is reasonable for dispatchers to advise patients with potential cardiac symptoms to chew an aspirin (160 to 325 mg), providing the patient has no history of aspirin allergy and no signs of active or recent gastrointestinal bleeding (Class IIa, LOE C).…”

Section: Special Resuscitation Situations Acute Coronary Syndromesmentioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

698

495

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Basic life support (BLS) is the foundation for saving lives following cardiac arrest. Fundamental aspects of BLS include immediate recognition of sudden cardiac arrest (SCA) and activation of the emergency response system, early cardiopulmonary resuscitation (CPR), and rapid defibrillation with an automated external defibrillator (AED). Initial recognition and response to heart attack and stroke are also considered part of BLS. This section presents the 2010 adult BLS guidelines for lay rescuers and healthcare providers. Key changes and continued points of emphasis from the 2005 BLS Guidelines include the following:• Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing (ie, the victim is not breathing or only gasping) Despite important advances in prevention, SCA continues to be a leading cause of death in many parts of the world. 1 SCA has many etiologies (ie, cardiac or noncardiac causes), circumstances (eg, witnessed or unwitnessed), and settings (eg, out-of-hospital or in-hospital). This heterogeneity suggests that a single approach to resuscitation is not practical, but a core set of actions provides a universal strategy for achieving successful resuscitation. These actions are termed the links in the "Chain of Survival." For adults they include When these links are implemented in an effective way, survival rates can approach 50% following witnessed out-ofhospital ventricular fibrillation (VF) arrest. 2 Unfortunately survival rates in many out-of-hospital and in-hospital settings fall far short of this figure. For example, survival rates following cardiac arrest due to VF vary from approximately 5% to 50% in both out-of-hospital and in-hospital settings. 3,4 This variation in outcome underscores the opportunity for improvement in many settings.Recognition of cardiac arrest is not always straightforward, especially for laypersons. Any confusion on the part of a rescuer can result in a delay or failure to activate the emergency response system or to start CPR. Precious time is lost if bystanders are too confused to act. Therefore, these adult BLS Guidelines focus on recognition of cardiac arrest with an appropriate set of rescuer actions. Once the lay bystander recognizes that the victim is unresponsive, that bystander must immediately activate (or send someone to activate) the emergency response system. Once the healthcare provider recognizes that the victim is unresponsive with no breathing or no normal breathing (ie, only gasping) the healthcare provider will activate the emergency response system. After activation, rescuers should immediately begin CPR.Early CPR can improve the likelihood of survival, and yet CPR is often not provided until the arrival of professional emergency responders. 5 Chest compressions are an especially critical component of CPR because perfusion during CPR

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Section: Special Resuscitation Situations Acute Coronary Syndromesmentioning

confidence: 99%

Part 5: Adult Basic Life Support

Berg¹,

Robin²,

Abella³

et al. 2010

Circulation

698

495

View full text Add to dashboard Cite

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“…Studies have shown that chest pressure and radiation to the arms to be predictive of AMI. 25,26 Patients were assigned 2 points if they met 3, 1 point if they met 2, and 0 points if they met 1 or none of the criteria.…”

Section: Modified Hs Criteriamentioning

confidence: 99%

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

McCord

Cabrera

Lindahl

et al. 2017

Circ: Cardiovascular Quality and Outcomes

Self Cite

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Background— The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. Methods and Results— Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs ( P =0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs ( P =0.03). Conclusions— Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.

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“…As this was a planned substudy, no formal power calculation was undertaken, however previous observational studies reporting the diagnostic utility of chest pain characteristics have typically recruited upwards of 400 participants (13,14,(16)(17)(18)(19). Chi-squared analyses were used to generate 2 x 2 tables for the calculation of sensitivity, specificity, 95% confidence intervals are reported.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, evidence examining the value of typical symptoms in patients presenting with chest pain in the acute setting have demonstrated a poor correlation with the final diagnosis of acute coronary syndrome (3,(13)(14)(15)(16)(17)(18)(19). However, these studies have tended to either include patients with diagnostic ECG changes , focus on specific chest pain characteristics rather than overall typicality, or use M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 5 research nurses to extract this information.…”

Section: Introductionmentioning

confidence: 99%