Background: Training of health care teams who work in prehospital medical care and in emergency u... more Background: Training of health care teams who work in prehospital medical care and in emergency units plays an important role to reduction of trauma-related deaths. The purpose of this study is to share the design method, the content and the evaluation results of an Advanced Trauma Life Support (ATLS) course which was developed based on the “European Trauma Course the Team Approach” course. Methods: This study has a one-shot case study design. In the instructional design of the course, the ADDIE model was used. The course was evaluated with the participants’ feedback obtained through the survey and the test scores they obtained from the pre-test, post-test and practice exam. Participants' mean pre- and post-test scores were compared with the paired-sample t test. Results: The evaluation of the participants’ perceptions of competence related to trauma management revealed that 39.2 % of them (n = 40) considered themselves as completely confident, 57.8 % (n = 59) as confident and ...
ABSTRACT:
Background: Trauma is one of the most encountered
and fatal cases in prehospital area... more ABSTRACT:
Background: Trauma is one of the most encountered
and fatal cases in prehospital area.
The objective of this study is the evaluation of
the “Trauma Advanced Life Support Training
(TALST)” which is a learner focused, little
group study natured, practice and simulation
predominated training program implemented
to aim interfering trauma, facilitating the far
transfer of the knowledge of the learners and
internalizing life time learning.
Methods: TALST which was implemented 4
times in the time period between June-October
2015 with 89 participants were included as investigation
material. IBM Statistical Package
for the Social Sciences (SPSS) 21.0 were used
as statistical analyses. Frequency distribution
were calculated for pre-test, post-test and pratic
examination. Chi square test was used for comparing
analysis.
Results: In statistical analysis, there were significant
diversities in all success rates of pretest
and post-test means of the four courses. The
lowest post-test success rate mean of all courses
was over 85 which is the official success limit.
Conclusions: TALST is the first 4C-ID designed
training program in our country. Due to the one
by one correspondence of trauma training by
the pattern of 4C-ID educational design model
purposed for complex learning, a succesful and
effective training program occured.
Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada amaç, ambulans servisi çalışanlarının " kardiyopulmoner... more Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada amaç, ambulans servisi çalışanlarının " kardiyopulmoner resusitasyon (CPR) " bilgi düzeyleri ve kaliteli göğüs basısı uygulaması konusundaki bilgi ve becerilerini objek-tif yapılandırılmış yöntemlerle belirlemek ve verilen eğitimin etkisini değerlendirmektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmada 30 acil tıp teknisyeni ve 25 paramedik yer almıştır. Katılımcıların sosyode-mografik özellikleri saptanmış, CPR ile ilgili bilgi ve psikomotor beceri düzeyleri gelişmiş, hasta si-mülatörü niteliğinde bir maket aracılığıyla ölçülmüş ve kayıt altına alınmıştır. İstatistiksel analizde, ki-kare, Student t-testi, ANOVA, tekrarlanan ölçümlerde miksed ANOVA ve lineer regresyon yön-temleri kullanılmıştır. B Bu ul lg gu ul la ar r: : Çalışmada katılımcıların ön-test ve son-test puanları karşılaştırıl-mış; ön-test puan ortalaması 8,10 (ss=1,26), son-test puan ortalaması ise 9,55 (ss=0,90) olarak bulunmuş ve anlamlı istatistiksel farklılık gözlenmiştir. İdeal bası derinliğine ulaşma açısından ise, erkekler kadınlardan birinci ölçümde 1,39 kat; ikinci ölçümde 17,33 kat ve üçüncü ölçümde 6,22 kat daha başarılı bulunmuştur. Katılımcıların yaşı, ideal bası derinliğine ulaşma performansı ile iliş-kili bulunmamıştır. Diğer yandan, bası sayısı ve bası yeri doğruluk oranı performansları hiçbir ba-ğımsız değişkenle istatistiksel olarak ilişkili bulunmamıştır. S So on nu uç ç: : Bu çalışmada, hastane öncesi ambulans hizmetlerinde çalışanların özellikle bası derinliği performanslarının cinsiyet, ağırlık ve ça-lışma süresi bağımsız değişkenlerinden etkilendiği saptanmıştır. Bu bulgu daha geniş gruplarla ya-pılacak çalışmalarda mutlaka analiz edilmeli ve belki de hastane öncesi acil sağlık hizmetlerine işe alımda boy ve ağırlık gibi bedensel özellikler dikkate alınmalıdır. Ayrıca becerinin uzun vadede kalıcılığının sınandığı, hasta başı performansın değerlendirildiği ve eğitimin topluma ve hastalara yararını değerlendirme açısından hastaların iyileşme durumlarının gözden geçirildiği ileri çalış-malara da gereksinim vardır. A An na ah ht ta ar r K Ke el li im me el le er r: : Kardiyopulmoner resusitasyon; acil tıbbi servisler; canlandırma A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim is to identify and record the CPR knowledge level and quality chest compression skills of the staff ambulance service staff by objective structured methods and to evaluate the influence of the training. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: In this study, 30 emergency medical technician (EMT) and 25 paramedics were included. Participants' social and demographic characteristics were determined. Their cognitive and psychomotor skill levels of CPR were measured and recorded by an advanced patient simulator manikin. Chi square test, Student t-test, ANOVA, mixed ANOVA for repeated measurements and linear regression tests were used as statistical analysis. R Re es su ul lt ts s: : When pre-test and post-test scores of the participants were compared; pre-test average score 8.10 (sd=1.26), post-test average score 9.55 (sd=0.90) significant statistical difference was determined. According to the assessment of compression depth component, men were 1.39 times more successful than women in first measurement, 17.33 times in second measurement and 6.22 times in third measurement. There were no statistical differences between independent variables about performances of compression rate and rate of true compression area. C Co on nc cl lu us si io on n: : Compression depth performance of prehospital medical service staff was affected by physical characteristics like sex, employment time and body weight. Such finding must be analysed by studies done with larger groups. Also some special characteristics like weight and height should be considered while recruiting ambulance staff. It's determined that age of the participant is not related with the performance to reach the ideal depth of compression. On the other hand, performances of compression rate and compression place accuracy rate are not related to any independent variable statistically. K Ke ey y W Wo or rd ds s: : Cardiopulmonary resuscitation; emergency medical services; resuscitation T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J A An ne es st t R Re ea an ni im m 2 20 01 16 6; ;1 14 4((3 3)): :6 69 9-7 77 7
WHAT TO DO IN THE FIRST HOUR IN PATIENTS WITH ACS ?
Okan Ok M.D.
Medical Education Department of ... more WHAT TO DO IN THE FIRST HOUR IN PATIENTS WITH ACS ? Okan Ok M.D. Medical Education Department of Aegean University & Emergency Medical Department of İzmir Ambulance Service Aim: The aim of this presentation is to determine the first hour implementations of the patients with ACS. Results: There are three different entities of acute coronary syndrome (ACS) encompassing the acute manifestation of coronary heart disease: ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction and unstable angina pectoris (UAP). In first hour after onset of symptoms, out of hospital treatment and initial therapy in emergency department may differ according to resources and local capabilities. Typical symptoms of ACS are radiating chest pain, shortness of breath and sweating. However, 12-lead ECG and cardiac biomarker testing should be part of the initial evaluation of all patients with symptoms cardiac ischaemia. For diagnosing myocardial infarction in the first hours after the onset of symptoms, there should be no delay in release of biomarkers from damaged myocardium. Effective screening techniques of patients with suspected ACS, but with negative ECG and negative cardiac biomarkers are non invasive imaging techniques like CT angiography, cardiac magnetic resonance, myocardial perfusion imaging, and echocardiography. Also, echocardiography should be routinely available in emergency department for all patients with suspected ACS. Conclusion: For treatment of ACS one of the therapeutic agents is glyceryl trinitrate. If the systolic blood pressure (SBP) is above 90 mmHg and the patient has ongoing ischaemic chest pain glyceryl trinitrate may be considered. For nitrate-refractory pain morphine is the choice for analgesia and also has calming effects on the patient making sedatives unnecessary. At the same time morphine is a dilator of venous capacitance vessels, it may have benefit in patients with pulmonary congestion. Patients with presumed ACS do not need supplemental oxygen unless they have signs of hypoxia, dyspnoea or heart failure. But if ACS is complicated with cardiac arrest, hypoxia develops therefore during CPR adequate oxygenation is essential. 100% inspired oxygen should be used until arterial blood oxygen saturation is achieved in the range of 94–98%. For inhibition of platelet aggregation, acetylsalicylic acid (ASA) and ADP receptor inhibitors may be used. Oral loading dose of ASA (150 to 300 mg of a non-enteric coated formulation) or 150 mg of an IV preparation should be given as soon as possible to all patients with suspected ACS unless the patient has a known allergy to ASA or has active bleeding. ASA may be given by the first healthcare provider, bystander or by dispatcher assistance according to local protocols. Clopidogrel and prasugrel may be used as ADP receptor inhibitors also. Antithrombins like unfractionated heparin (UFH) which in combination with ASA is used as an adjunct with fibrinolytic therapy or PPCI and is an important part of treatment of unstable angina and STEMI. Also enoxaparin, fondaparinux and bivalirudin are the agents of antithrombins used in ACS. Reperfusion should be initiated as soon as possible using the most appropriate available strategy for patients presenting with STEMI within 12 h of symptom onset. Reperfusion may be implemented with fibrinolysis, with primary percutaneous coronary intervention (PPCI), or a combination of both. Efficacy of reperfusion therapy is profoundly dependent on the time interval from symptom onset to reperfusion. Fibrinolysis is effective specifically in the first 2 to 3 h after symptom onset; PPCI is less time sensitive. As a result, sufficient management of ACS using sufficient drugs and interventions especially in first hour of onset may be life saving. Keywords: Acute coronary syndrome, ACS treatment References 1. Nikolaou NI, Arntz H-R, Bellou A, Beygui F, Bossaert LL, Cariou A. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation [Internet]. 2015;95:264–77. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957215003421
Background: Training of health care teams who work in prehospital medical care and in emergency u... more Background: Training of health care teams who work in prehospital medical care and in emergency units plays an important role to reduction of trauma-related deaths. The purpose of this study is to share the design method, the content and the evaluation results of an Advanced Trauma Life Support (ATLS) course which was developed based on the “European Trauma Course the Team Approach” course. Methods: This study has a one-shot case study design. In the instructional design of the course, the ADDIE model was used. The course was evaluated with the participants’ feedback obtained through the survey and the test scores they obtained from the pre-test, post-test and practice exam. Participants' mean pre- and post-test scores were compared with the paired-sample t test. Results: The evaluation of the participants’ perceptions of competence related to trauma management revealed that 39.2 % of them (n = 40) considered themselves as completely confident, 57.8 % (n = 59) as confident and ...
ABSTRACT:
Background: Trauma is one of the most encountered
and fatal cases in prehospital area... more ABSTRACT:
Background: Trauma is one of the most encountered
and fatal cases in prehospital area.
The objective of this study is the evaluation of
the “Trauma Advanced Life Support Training
(TALST)” which is a learner focused, little
group study natured, practice and simulation
predominated training program implemented
to aim interfering trauma, facilitating the far
transfer of the knowledge of the learners and
internalizing life time learning.
Methods: TALST which was implemented 4
times in the time period between June-October
2015 with 89 participants were included as investigation
material. IBM Statistical Package
for the Social Sciences (SPSS) 21.0 were used
as statistical analyses. Frequency distribution
were calculated for pre-test, post-test and pratic
examination. Chi square test was used for comparing
analysis.
Results: In statistical analysis, there were significant
diversities in all success rates of pretest
and post-test means of the four courses. The
lowest post-test success rate mean of all courses
was over 85 which is the official success limit.
Conclusions: TALST is the first 4C-ID designed
training program in our country. Due to the one
by one correspondence of trauma training by
the pattern of 4C-ID educational design model
purposed for complex learning, a succesful and
effective training program occured.
Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada amaç, ambulans servisi çalışanlarının " kardiyopulmoner... more Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmada amaç, ambulans servisi çalışanlarının " kardiyopulmoner resusitasyon (CPR) " bilgi düzeyleri ve kaliteli göğüs basısı uygulaması konusundaki bilgi ve becerilerini objek-tif yapılandırılmış yöntemlerle belirlemek ve verilen eğitimin etkisini değerlendirmektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmada 30 acil tıp teknisyeni ve 25 paramedik yer almıştır. Katılımcıların sosyode-mografik özellikleri saptanmış, CPR ile ilgili bilgi ve psikomotor beceri düzeyleri gelişmiş, hasta si-mülatörü niteliğinde bir maket aracılığıyla ölçülmüş ve kayıt altına alınmıştır. İstatistiksel analizde, ki-kare, Student t-testi, ANOVA, tekrarlanan ölçümlerde miksed ANOVA ve lineer regresyon yön-temleri kullanılmıştır. B Bu ul lg gu ul la ar r: : Çalışmada katılımcıların ön-test ve son-test puanları karşılaştırıl-mış; ön-test puan ortalaması 8,10 (ss=1,26), son-test puan ortalaması ise 9,55 (ss=0,90) olarak bulunmuş ve anlamlı istatistiksel farklılık gözlenmiştir. İdeal bası derinliğine ulaşma açısından ise, erkekler kadınlardan birinci ölçümde 1,39 kat; ikinci ölçümde 17,33 kat ve üçüncü ölçümde 6,22 kat daha başarılı bulunmuştur. Katılımcıların yaşı, ideal bası derinliğine ulaşma performansı ile iliş-kili bulunmamıştır. Diğer yandan, bası sayısı ve bası yeri doğruluk oranı performansları hiçbir ba-ğımsız değişkenle istatistiksel olarak ilişkili bulunmamıştır. S So on nu uç ç: : Bu çalışmada, hastane öncesi ambulans hizmetlerinde çalışanların özellikle bası derinliği performanslarının cinsiyet, ağırlık ve ça-lışma süresi bağımsız değişkenlerinden etkilendiği saptanmıştır. Bu bulgu daha geniş gruplarla ya-pılacak çalışmalarda mutlaka analiz edilmeli ve belki de hastane öncesi acil sağlık hizmetlerine işe alımda boy ve ağırlık gibi bedensel özellikler dikkate alınmalıdır. Ayrıca becerinin uzun vadede kalıcılığının sınandığı, hasta başı performansın değerlendirildiği ve eğitimin topluma ve hastalara yararını değerlendirme açısından hastaların iyileşme durumlarının gözden geçirildiği ileri çalış-malara da gereksinim vardır. A An na ah ht ta ar r K Ke el li im me el le er r: : Kardiyopulmoner resusitasyon; acil tıbbi servisler; canlandırma A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim is to identify and record the CPR knowledge level and quality chest compression skills of the staff ambulance service staff by objective structured methods and to evaluate the influence of the training. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: In this study, 30 emergency medical technician (EMT) and 25 paramedics were included. Participants' social and demographic characteristics were determined. Their cognitive and psychomotor skill levels of CPR were measured and recorded by an advanced patient simulator manikin. Chi square test, Student t-test, ANOVA, mixed ANOVA for repeated measurements and linear regression tests were used as statistical analysis. R Re es su ul lt ts s: : When pre-test and post-test scores of the participants were compared; pre-test average score 8.10 (sd=1.26), post-test average score 9.55 (sd=0.90) significant statistical difference was determined. According to the assessment of compression depth component, men were 1.39 times more successful than women in first measurement, 17.33 times in second measurement and 6.22 times in third measurement. There were no statistical differences between independent variables about performances of compression rate and rate of true compression area. C Co on nc cl lu us si io on n: : Compression depth performance of prehospital medical service staff was affected by physical characteristics like sex, employment time and body weight. Such finding must be analysed by studies done with larger groups. Also some special characteristics like weight and height should be considered while recruiting ambulance staff. It's determined that age of the participant is not related with the performance to reach the ideal depth of compression. On the other hand, performances of compression rate and compression place accuracy rate are not related to any independent variable statistically. K Ke ey y W Wo or rd ds s: : Cardiopulmonary resuscitation; emergency medical services; resuscitation T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J A An ne es st t R Re ea an ni im m 2 20 01 16 6; ;1 14 4((3 3)): :6 69 9-7 77 7
WHAT TO DO IN THE FIRST HOUR IN PATIENTS WITH ACS ?
Okan Ok M.D.
Medical Education Department of ... more WHAT TO DO IN THE FIRST HOUR IN PATIENTS WITH ACS ? Okan Ok M.D. Medical Education Department of Aegean University & Emergency Medical Department of İzmir Ambulance Service Aim: The aim of this presentation is to determine the first hour implementations of the patients with ACS. Results: There are three different entities of acute coronary syndrome (ACS) encompassing the acute manifestation of coronary heart disease: ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction and unstable angina pectoris (UAP). In first hour after onset of symptoms, out of hospital treatment and initial therapy in emergency department may differ according to resources and local capabilities. Typical symptoms of ACS are radiating chest pain, shortness of breath and sweating. However, 12-lead ECG and cardiac biomarker testing should be part of the initial evaluation of all patients with symptoms cardiac ischaemia. For diagnosing myocardial infarction in the first hours after the onset of symptoms, there should be no delay in release of biomarkers from damaged myocardium. Effective screening techniques of patients with suspected ACS, but with negative ECG and negative cardiac biomarkers are non invasive imaging techniques like CT angiography, cardiac magnetic resonance, myocardial perfusion imaging, and echocardiography. Also, echocardiography should be routinely available in emergency department for all patients with suspected ACS. Conclusion: For treatment of ACS one of the therapeutic agents is glyceryl trinitrate. If the systolic blood pressure (SBP) is above 90 mmHg and the patient has ongoing ischaemic chest pain glyceryl trinitrate may be considered. For nitrate-refractory pain morphine is the choice for analgesia and also has calming effects on the patient making sedatives unnecessary. At the same time morphine is a dilator of venous capacitance vessels, it may have benefit in patients with pulmonary congestion. Patients with presumed ACS do not need supplemental oxygen unless they have signs of hypoxia, dyspnoea or heart failure. But if ACS is complicated with cardiac arrest, hypoxia develops therefore during CPR adequate oxygenation is essential. 100% inspired oxygen should be used until arterial blood oxygen saturation is achieved in the range of 94–98%. For inhibition of platelet aggregation, acetylsalicylic acid (ASA) and ADP receptor inhibitors may be used. Oral loading dose of ASA (150 to 300 mg of a non-enteric coated formulation) or 150 mg of an IV preparation should be given as soon as possible to all patients with suspected ACS unless the patient has a known allergy to ASA or has active bleeding. ASA may be given by the first healthcare provider, bystander or by dispatcher assistance according to local protocols. Clopidogrel and prasugrel may be used as ADP receptor inhibitors also. Antithrombins like unfractionated heparin (UFH) which in combination with ASA is used as an adjunct with fibrinolytic therapy or PPCI and is an important part of treatment of unstable angina and STEMI. Also enoxaparin, fondaparinux and bivalirudin are the agents of antithrombins used in ACS. Reperfusion should be initiated as soon as possible using the most appropriate available strategy for patients presenting with STEMI within 12 h of symptom onset. Reperfusion may be implemented with fibrinolysis, with primary percutaneous coronary intervention (PPCI), or a combination of both. Efficacy of reperfusion therapy is profoundly dependent on the time interval from symptom onset to reperfusion. Fibrinolysis is effective specifically in the first 2 to 3 h after symptom onset; PPCI is less time sensitive. As a result, sufficient management of ACS using sufficient drugs and interventions especially in first hour of onset may be life saving. Keywords: Acute coronary syndrome, ACS treatment References 1. Nikolaou NI, Arntz H-R, Bellou A, Beygui F, Bossaert LL, Cariou A. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation [Internet]. 2015;95:264–77. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957215003421
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Papers by Okan Ok
Background: Trauma is one of the most encountered
and fatal cases in prehospital area.
The objective of this study is the evaluation of
the “Trauma Advanced Life Support Training
(TALST)” which is a learner focused, little
group study natured, practice and simulation
predominated training program implemented
to aim interfering trauma, facilitating the far
transfer of the knowledge of the learners and
internalizing life time learning.
Methods: TALST which was implemented 4
times in the time period between June-October
2015 with 89 participants were included as investigation
material. IBM Statistical Package
for the Social Sciences (SPSS) 21.0 were used
as statistical analyses. Frequency distribution
were calculated for pre-test, post-test and pratic
examination. Chi square test was used for comparing
analysis.
Results: In statistical analysis, there were significant
diversities in all success rates of pretest
and post-test means of the four courses. The
lowest post-test success rate mean of all courses
was over 85 which is the official success limit.
Conclusions: TALST is the first 4C-ID designed
training program in our country. Due to the one
by one correspondence of trauma training by
the pattern of 4C-ID educational design model
purposed for complex learning, a succesful and
effective training program occured.
Conference Presentations by Okan Ok
Okan Ok M.D.
Medical Education Department of Aegean University & Emergency Medical Department of İzmir Ambulance Service
Aim: The aim of this presentation is to determine the first hour implementations of the patients with ACS.
Results: There are three different entities of acute coronary syndrome (ACS) encompassing the acute manifestation of coronary heart disease: ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction and unstable angina pectoris (UAP). In first hour after onset of symptoms, out of hospital treatment and initial therapy in emergency department may differ according to resources and local capabilities. Typical symptoms of ACS are radiating chest pain, shortness of breath and sweating. However, 12-lead ECG and cardiac biomarker testing should be part of the initial evaluation of all patients with symptoms cardiac ischaemia. For diagnosing myocardial infarction in the first hours after the onset of symptoms, there should be no delay in release of biomarkers from damaged myocardium. Effective screening techniques of patients with suspected ACS, but with negative ECG and negative cardiac biomarkers are non invasive imaging techniques like CT angiography, cardiac magnetic resonance, myocardial perfusion imaging, and echocardiography. Also, echocardiography should be routinely available in emergency department for all patients with suspected ACS.
Conclusion: For treatment of ACS one of the therapeutic agents is glyceryl trinitrate. If the systolic blood pressure (SBP) is above 90 mmHg and the patient has ongoing ischaemic chest pain glyceryl trinitrate may be considered. For nitrate-refractory pain morphine is the choice for analgesia and also has calming effects on the patient making sedatives unnecessary. At the same time morphine is a dilator of venous capacitance vessels, it may have benefit in patients with pulmonary congestion. Patients with presumed ACS do not need supplemental oxygen unless they have signs of hypoxia, dyspnoea or heart failure. But if ACS is complicated with cardiac arrest, hypoxia develops therefore during CPR adequate oxygenation is essential. 100% inspired oxygen should be used until arterial blood oxygen saturation is achieved in the range of 94–98%. For inhibition of platelet aggregation, acetylsalicylic acid (ASA) and ADP receptor inhibitors may be used. Oral loading dose of ASA (150 to 300 mg of a non-enteric coated formulation) or 150 mg of an IV preparation should be given as soon as possible to all patients with suspected ACS unless the patient has a known allergy to ASA or has active bleeding. ASA may be given by the first healthcare provider, bystander or by dispatcher assistance according to local protocols. Clopidogrel and prasugrel may be used as ADP receptor inhibitors also. Antithrombins like unfractionated heparin (UFH) which in combination with ASA is used as an adjunct with fibrinolytic therapy or PPCI and is an important part of treatment of unstable angina and STEMI. Also enoxaparin, fondaparinux and bivalirudin are the agents of antithrombins used in ACS. Reperfusion should be initiated as soon as possible using the most appropriate available strategy for patients presenting with STEMI within 12 h of symptom onset. Reperfusion may be implemented with fibrinolysis, with primary percutaneous coronary intervention (PPCI), or a combination of both. Efficacy of reperfusion therapy is profoundly dependent on the time interval from symptom onset to reperfusion. Fibrinolysis is effective specifically in the first 2 to 3 h after symptom onset; PPCI is less time sensitive. As a result, sufficient management of ACS using sufficient drugs and interventions especially in first hour of onset may be life saving.
Keywords: Acute coronary syndrome, ACS treatment
References
1. Nikolaou NI, Arntz H-R, Bellou A, Beygui F, Bossaert LL, Cariou A. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation [Internet]. 2015;95:264–77. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957215003421
Background: Trauma is one of the most encountered
and fatal cases in prehospital area.
The objective of this study is the evaluation of
the “Trauma Advanced Life Support Training
(TALST)” which is a learner focused, little
group study natured, practice and simulation
predominated training program implemented
to aim interfering trauma, facilitating the far
transfer of the knowledge of the learners and
internalizing life time learning.
Methods: TALST which was implemented 4
times in the time period between June-October
2015 with 89 participants were included as investigation
material. IBM Statistical Package
for the Social Sciences (SPSS) 21.0 were used
as statistical analyses. Frequency distribution
were calculated for pre-test, post-test and pratic
examination. Chi square test was used for comparing
analysis.
Results: In statistical analysis, there were significant
diversities in all success rates of pretest
and post-test means of the four courses. The
lowest post-test success rate mean of all courses
was over 85 which is the official success limit.
Conclusions: TALST is the first 4C-ID designed
training program in our country. Due to the one
by one correspondence of trauma training by
the pattern of 4C-ID educational design model
purposed for complex learning, a succesful and
effective training program occured.
Okan Ok M.D.
Medical Education Department of Aegean University & Emergency Medical Department of İzmir Ambulance Service
Aim: The aim of this presentation is to determine the first hour implementations of the patients with ACS.
Results: There are three different entities of acute coronary syndrome (ACS) encompassing the acute manifestation of coronary heart disease: ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction and unstable angina pectoris (UAP). In first hour after onset of symptoms, out of hospital treatment and initial therapy in emergency department may differ according to resources and local capabilities. Typical symptoms of ACS are radiating chest pain, shortness of breath and sweating. However, 12-lead ECG and cardiac biomarker testing should be part of the initial evaluation of all patients with symptoms cardiac ischaemia. For diagnosing myocardial infarction in the first hours after the onset of symptoms, there should be no delay in release of biomarkers from damaged myocardium. Effective screening techniques of patients with suspected ACS, but with negative ECG and negative cardiac biomarkers are non invasive imaging techniques like CT angiography, cardiac magnetic resonance, myocardial perfusion imaging, and echocardiography. Also, echocardiography should be routinely available in emergency department for all patients with suspected ACS.
Conclusion: For treatment of ACS one of the therapeutic agents is glyceryl trinitrate. If the systolic blood pressure (SBP) is above 90 mmHg and the patient has ongoing ischaemic chest pain glyceryl trinitrate may be considered. For nitrate-refractory pain morphine is the choice for analgesia and also has calming effects on the patient making sedatives unnecessary. At the same time morphine is a dilator of venous capacitance vessels, it may have benefit in patients with pulmonary congestion. Patients with presumed ACS do not need supplemental oxygen unless they have signs of hypoxia, dyspnoea or heart failure. But if ACS is complicated with cardiac arrest, hypoxia develops therefore during CPR adequate oxygenation is essential. 100% inspired oxygen should be used until arterial blood oxygen saturation is achieved in the range of 94–98%. For inhibition of platelet aggregation, acetylsalicylic acid (ASA) and ADP receptor inhibitors may be used. Oral loading dose of ASA (150 to 300 mg of a non-enteric coated formulation) or 150 mg of an IV preparation should be given as soon as possible to all patients with suspected ACS unless the patient has a known allergy to ASA or has active bleeding. ASA may be given by the first healthcare provider, bystander or by dispatcher assistance according to local protocols. Clopidogrel and prasugrel may be used as ADP receptor inhibitors also. Antithrombins like unfractionated heparin (UFH) which in combination with ASA is used as an adjunct with fibrinolytic therapy or PPCI and is an important part of treatment of unstable angina and STEMI. Also enoxaparin, fondaparinux and bivalirudin are the agents of antithrombins used in ACS. Reperfusion should be initiated as soon as possible using the most appropriate available strategy for patients presenting with STEMI within 12 h of symptom onset. Reperfusion may be implemented with fibrinolysis, with primary percutaneous coronary intervention (PPCI), or a combination of both. Efficacy of reperfusion therapy is profoundly dependent on the time interval from symptom onset to reperfusion. Fibrinolysis is effective specifically in the first 2 to 3 h after symptom onset; PPCI is less time sensitive. As a result, sufficient management of ACS using sufficient drugs and interventions especially in first hour of onset may be life saving.
Keywords: Acute coronary syndrome, ACS treatment
References
1. Nikolaou NI, Arntz H-R, Bellou A, Beygui F, Bossaert LL, Cariou A. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation [Internet]. 2015;95:264–77. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0300957215003421