Evaluation Of Electrocardiogram Knowledge Level Of Healthcare Staff Working In Ambulance,
Öz
Abstract:
Acute coronary syndromes compose a major proportion of sudden deaths, globally. Patients diagnosed with myocardial infarction due to sudden chest pain should be immediately referred to percutaneous coronary angiography (PTCA) as soon as possible. In order to decrease the mortality rate due to acute coronary syndromes and deadly cardiac arrhythmias, the electrocardiography (ECG) knowledge of the ambulance staff who transfer the patients to the hospitals is important. As such, we aimed to evaluate the level of electrocardiography knowledge by conducting a survey on the ambulance staff in the province of Sivas.
A total of one hundred seventy-eight healthcare professionals working in ambulances in the centre and districts of Sivas were included in the study, including nurses, paramedics and emergency medical technicians. The participants were asked to answer survey questions about their working experience, education, age, and completion of a special ECG course and they were expected to interpret 12 different ECGs.
The ratios of correct ECG diagnosis were as follows; anterior ST-elevation myocardial infarction (STEMI), 84.3% (n=150); inferior STEMI, 89.9% (n=160); lateral STEMI, 77.5% (n=138); normal ECG, 64% (n=114); ventricular fibrillation (VF) , 28.1% (n=50); supraventricular tachycardia (SVT), 57.3% (n=102); VT, 17.4% (n=31); and artificial ECG, 13.5% (n=24). According to the results, paramedics had higher correct diagnosis ratios in right bundle branch block and AV complete block compared to EMTs and nurses (<0,001), and EMTs were better in correctly diagnosing left ventricular hypertrophy (p=0,011).
In our study, it was shown that profession, working experience and status of ECG education in the recent year did not make a significant difference on ECG assessment results, suggesting to revise the in-service training.
Anahtar Kelimeler
Kaynakça
- References :
- 1) Smith, S. C., Collins, A., Ferrari, R., Holmes, D. R., Logstrup, S., McGhie, D. V., ... & Wood, D. A. (2012). Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Circulation, 126(23), 2769-2775.
- 2) Türkiye istatistik kurumu 2015 yılı ölüm nedeni istatistikleri Sayı: 21526 24 Mart 2016
- 3 Link, M. S., Berkow, L. C., Kudenchuk, P. J., Halperin, H. R., Hess, E. P., Moitra, V. K., ... & White, R. D. (2015). Part 7: adult advanced cardiovascular life support. Circulation, 132(18 suppl 2), S444-S464.
- 4) Meadows-Pitt M., Fields W. (2014). The impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction. Journal of Emergency Nursing, 40(3), e63-e68.
- 5) Osei-Ampofo, M., Cheskes, S., Byers, A., Drennan, I. R., Buick, J. E., & Verbeek, P. R. (2016). A Novel Approach to Improve Time to First Shock in Prehospital STEMI Complicated by Ventricular Fibrillation. Prehospital Emergency Care, 20(2), 278-282
- 6 Soar, J., Nolan, J. P., Böttiger, B. W., Perkins, G. D., Lott, C., Carli, P., ... & Sunde, K. (2015). European Resuscitation Council guidelines for resuscitation 2015. Resuscitation, 95, 100-147.
- 7) Brown JP, Mahmud E, Dunford JV, Ben-Yehuda O. Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in STsegment elevation acute myocardial infarction. Am J Cardiol. 2008;101:158–61.
- 8) Le May MR, Davies RF, Dionne R, et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol. 2006;98:1329–33.
- 9) Dorsch MF, Greenwood JP, Priestley C, et al. Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. Am Heart J. 2008;155:1054–8.
- 10) Lee, Christopher H., Carin M. Van Gelder, and David C. Cone. "Early cardiac catheterization laboratory activation by paramedics for patients with ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms." Prehospital Emergency Care 14.2 (2010): 153-158.
- 11) Mencl, F., Wilber, S., Frey, J., Zalewski, J., Maiers, J. F., & Bhalla, M. C. (2013). Paramedic ability to recognize ST-segment elevation myocardial infarction on prehospital electrocardiograms. Prehospital Emergency Care, 17(2), 203-210.
- 12) O’Donnell, Madeleine, and Mike Lawson. "Reading the Electrocardiograph: Paramedics’ Descriptions of their Learning." Australasian Journal of Paramedicine 4.3 (2015).
- 13) Trivedi, K., Schuur, J. D., & Cone, D. C. (2009). Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms?. Prehospital Emergency Care, 13(2), 207-214.
- 14) Cheskes, S., Turner, L., Foggett, R., Huiskamp, M., Popov, D., Thomson, S., ... & Verbeek, R. (2011). Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehospital Emergency Care, 15(4), 490-498.
- 15) Khelassi, A., Yelles-chaouche, S. N., & Benais, F. (2017). Multi-arrhythmias detection with an XML rule-based system from 12-Lead Electrocardiogram. Electronic physician, 9(5), 4357.
- 16) Niemann JT, Stratton SJ, Cruz B, et al. Outcome of out-of-hospital postcountershock asystole and pulseless electrical activity versus primary asystole and pulseless electrical activity. Crit Care Med2001;29:2366-70
- 17) Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, Monsieurs KG, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. European resuscitation council guidelines for resuscitation 2015:Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015 Oct;95:81-99
- 18) Osei-Ampofo M, Cheskes S, Byers A, Drennan IR, Buick JE, Verbeek PR.A Novel Approach to Improve Time to First Shock in Prehospital STEMI Complicated by Ventricular Fibrillation. Prehosp Emerg Care. 2016;20(2):278-82.
- 19) Daudelin, D. H., Sayah, A. J., Kwong, M., Restuccia, M. C., Porcaro, W. A., Ruthazer, R., ... & Selker, H. P. (2010). Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST-elevation myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 3(3), 316-323.
Ambulansta Çalışan Sağlık Çalışanlarının Elektrokardiyogram Bilgi Düzeylerinin Değerlendirilmesi
Öz
Özet:
Akut koroner sendromlar, tüm dünya ani ölümlerin büyük bir kısmını oluşturmaktadır. Ani göğüs ağrısı nedeniyle miyokard infarktüsü tanısı konan hastalara en kısa zamanda perkütan koroner anjiyografi(PTCA) yapılan bir merkekeze hemen ulaştırılmalıdır. Akut koroner sendromlar ve ölümcül kardiyak aritmilere bağlı ölüm oranını azaltmak için, hastaları hastanelere taşıyan ambulans personelinin elektrokardiyografi (EKG) bilgisi önemlidir. Biz bu nedenle, Sivas ilindeki ambulans personelinin elektrokardiyografi bilgi düzeyini değerlendirmek için bir anket çalışması planladık.
Hemşireler, paramedikler ve acil tıp teknisyenleri de dahil olmak üzere, Sivas merkez ve ilçelerindeki ambulanslarda çalışan toplam yüz yetmiş sekiz sağlık uzmanı çalışmaya dahil edildi. Katılımcılardan, çalışma deneyimi, eğitimi, yaşı ve özel bir EKG kursunun tamamlanmasıyla ilgili sorulara cevap vermeleri istendi ve 12 farklı EKG'yi yorumlamaları beklendi.
Anket çalışmasında doğru tanı konulan EKG oranları şöyledir; anterior ST yükselmeli miyokard infarktüsü (STEMI),% 84.3 (n = 150); inferior STEMI,% 89.9 (n = 160); lateral STEMI,% 77.5 (n = 138); normal EKG,% 64 (n = 114); ventriküler fibrilasyon (VF),% 28.1 (n = 50); supraventriküler taşikardi (SVT),% 57.3 (n = 102); VT,% 17.4 (n = 31); ve yapay EKG,% 13.5 (n = 24). Elde edilen sonuçlara göre, paramediklerin sağ dal bloğu ve AV tam blokta doğru tanı oranlarının acil tıp teknisyenlerine ve hemşirelere göre daha yüksek olduğu (<0,001) ve acil tıp teknisyenlerinin sol ventrikül hipertrofisi tanısında daha iyi olduğu saptandı (p = 0,011).
Bizim çalışmamızda ise çalışanların mesleki alanı, çalışma tecrübesi ve son 1 yıl içinde aldıkları EKG eğitimlerinin EKG değerlendirme sonuçları üzerinde anlamlı bir fark yaratmadığı gösterilmiştir. Bu da bize hizmet içi eğitimlerin etkinliği gözden geçirilmelidir.
Anahtar Kelimeler
elektrokardiyogram hastane öncesi acil saglık hizmetleri paramedik
Kaynakça
- References :
- 1) Smith, S. C., Collins, A., Ferrari, R., Holmes, D. R., Logstrup, S., McGhie, D. V., ... & Wood, D. A. (2012). Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Circulation, 126(23), 2769-2775.
- 2) Türkiye istatistik kurumu 2015 yılı ölüm nedeni istatistikleri Sayı: 21526 24 Mart 2016
- 3 Link, M. S., Berkow, L. C., Kudenchuk, P. J., Halperin, H. R., Hess, E. P., Moitra, V. K., ... & White, R. D. (2015). Part 7: adult advanced cardiovascular life support. Circulation, 132(18 suppl 2), S444-S464.
- 4) Meadows-Pitt M., Fields W. (2014). The impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction. Journal of Emergency Nursing, 40(3), e63-e68.
- 5) Osei-Ampofo, M., Cheskes, S., Byers, A., Drennan, I. R., Buick, J. E., & Verbeek, P. R. (2016). A Novel Approach to Improve Time to First Shock in Prehospital STEMI Complicated by Ventricular Fibrillation. Prehospital Emergency Care, 20(2), 278-282
- 6 Soar, J., Nolan, J. P., Böttiger, B. W., Perkins, G. D., Lott, C., Carli, P., ... & Sunde, K. (2015). European Resuscitation Council guidelines for resuscitation 2015. Resuscitation, 95, 100-147.
- 7) Brown JP, Mahmud E, Dunford JV, Ben-Yehuda O. Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in STsegment elevation acute myocardial infarction. Am J Cardiol. 2008;101:158–61.
- 8) Le May MR, Davies RF, Dionne R, et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol. 2006;98:1329–33.
- 9) Dorsch MF, Greenwood JP, Priestley C, et al. Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. Am Heart J. 2008;155:1054–8.
- 10) Lee, Christopher H., Carin M. Van Gelder, and David C. Cone. "Early cardiac catheterization laboratory activation by paramedics for patients with ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms." Prehospital Emergency Care 14.2 (2010): 153-158.
- 11) Mencl, F., Wilber, S., Frey, J., Zalewski, J., Maiers, J. F., & Bhalla, M. C. (2013). Paramedic ability to recognize ST-segment elevation myocardial infarction on prehospital electrocardiograms. Prehospital Emergency Care, 17(2), 203-210.
- 12) O’Donnell, Madeleine, and Mike Lawson. "Reading the Electrocardiograph: Paramedics’ Descriptions of their Learning." Australasian Journal of Paramedicine 4.3 (2015).
- 13) Trivedi, K., Schuur, J. D., & Cone, D. C. (2009). Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms?. Prehospital Emergency Care, 13(2), 207-214.
- 14) Cheskes, S., Turner, L., Foggett, R., Huiskamp, M., Popov, D., Thomson, S., ... & Verbeek, R. (2011). Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehospital Emergency Care, 15(4), 490-498.
- 15) Khelassi, A., Yelles-chaouche, S. N., & Benais, F. (2017). Multi-arrhythmias detection with an XML rule-based system from 12-Lead Electrocardiogram. Electronic physician, 9(5), 4357.
- 16) Niemann JT, Stratton SJ, Cruz B, et al. Outcome of out-of-hospital postcountershock asystole and pulseless electrical activity versus primary asystole and pulseless electrical activity. Crit Care Med2001;29:2366-70
- 17) Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T, Monsieurs KG, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. European resuscitation council guidelines for resuscitation 2015:Section 2. Adult basic life support and automated external defibrillation. Resuscitation. 2015 Oct;95:81-99
- 18) Osei-Ampofo M, Cheskes S, Byers A, Drennan IR, Buick JE, Verbeek PR.A Novel Approach to Improve Time to First Shock in Prehospital STEMI Complicated by Ventricular Fibrillation. Prehosp Emerg Care. 2016;20(2):278-82.
- 19) Daudelin, D. H., Sayah, A. J., Kwong, M., Restuccia, M. C., Porcaro, W. A., Ruthazer, R., ... & Selker, H. P. (2010). Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST-elevation myocardial infarction. Circulation: Cardiovascular Quality and Outcomes, 3(3), 316-323.