Acute coronary syndromes in the practice of the emergency medical team

Abstract

An acute coronary syndrome (ACS) is described when myocardial ischemia occurs due to impeding blood flow through the coronary vessels, which in turn results in insufficient supply of oxygen. As a disease entity, it causes almost half of all deaths in Poland. The high mortality of ACS is primarily in the pre-hospital setting. The classification of acute coronary syndromes is based on criteria such as clinical symptoms, the nature and type of changes in the electrocardiogram, and indicators of myocardial necrosis. In the conditions of the emergency medical team, the division is based on the image of the ECG test. On this basis, ACS with elevation of the ST segment (STEMI) and without ST segment elevation (NSTEMI) are defined. Pre-hospital diagnosis of ACS includes an interview with the patient and a 12-lead ECG performed preferably in no more than 10 minutes since the first medical contact. The task of the emergency medical team is to quickly recognize, perform teletransmission to the interventional cardiology centre and implement pharmacological treatment, and then provide transport to the nearest centre of invasive cardiology, where the procedure should be performed to clear the blocked coronary artery. Therefore, it is important that the staff of medical emergency teams have appropriate knowledge and proper equipment for ambulances. KEY WORDS: acute coronary syndrome, ischemic heart disease, myocardial infarction, emergency medical teams, pre-hospital treatment, STEMI, NSTEMI Disaster Emerg Med J 2018; 3(2): 61-66

Is low voltage ventricular fibrillation still a diagnostic problem?

“…According to the studies by Vukmir, ventricular fibrillation accounts for nearly 45% of the rhythms initiating cardiac arrest [1]. Rapid interpretation of ECG and the implementation of appropriate management determines the effectiveness of cardiopulmonary resuscitation [2,3]. In the case of ventricular fibrillation, both the American Heart Association (AHA) and the European Resuscitation Council (ERC) guidelines recommend defibrillation as soon as possible [4].…”