Vomiting as a diagnostic aid in acute ischaemic cardiac pain.

“…This was unrecognized at the time, presumably due to the prominence at this initial presentation of vomiting, fever, and leukocytosis, which led to a diagnosis of gastroenteritis. Vomiting, fever, and leukocytosis, however, are not uncommon with myocardial infarction and are consistent with the initial diagnosis [6][7][8]. The persistent fever and leukocytosis beyond 1 wk, however, suggest the possibility of pericarditis of myocardial infarction, and this is also suggested by his chest pain with recumbency.…”

Section: Discussionsupporting

confidence: 63%

Subacute ventricular free-wall rupture presenting as tamponade without frank hemopericardium

Tate

Lawton

DeGent

et al. 1998

Cathet. Cardiovasc. Diagn.

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“…For example, "She/he is unhealthy but is snoring, moving or vomiting". This may interfere with a dispatcher's proper recognition of cardiac arrest and may lead to "no further exploration" by the dispatcher because snoring, abnormal motion or convulsions, and emesis are common symptoms of acute illnesses other than cardiac arrest [31,32]. These failures may be minimised by teaching dispatchers that agonal breathing, anoxic convulsions and emesis or regurgitation often occur in OHCA patients [8][9][10][27][28][29].…”

mentioning

confidence: 99%

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

et al. 2012

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(CQI) project for telephone-assisted cardiopulmonary resuscitation (telephone-CPR), which included instruction on chest-compression-only CPR, education on how to recognise out-of-hospital cardiac arrests (OHCAs) with agonal breathing, emesis and convulsion, recommendations for on-line or redialling instructions, and feedback from emergency physicians. This study aimed to investigate the effect of this project on the incidence of bystander CPR and the outcomes of OHCAs.Materials and Methods: The baseline data were prospectively collected on 4995 resuscitation-attempted OHCAs, which were recognised or witnessed by citizens rather than emergency medical technicians during the period of February 2004 to March 2010. The incidence of telephone-CPR and bystander CPR, as well as the outcomes of the OHCAs, were compared before and after the project.Results: The incidence of telephone-CPR and bystander CPR significantly increased after the project (from 42% to 62% and from 41% to 56%, respectively). The incidence of failed telephone-CPR due to human factors significantly decreased from 30% to 16%. The outcomes of OHCAs significantly improved after the projects. A multiple logistic regression analysis revealed that the CQI project is one of independent factors associated with one-year (1-Y) survival with favourable neurological outcomes (odds ratio = 1.81, 95% confidence interval = 1.20-2.76).Conclusions: The CQI project for telephone-CPR increased the incidence of bystander CPR and improved the outcome of OHCAs. A CQI project appeared to be essential to augment the effects of telephone-CPR.Keywords: Telephone-CPR; Continuous quality improvement; Cardiopulmonary resuscitation; Dispatcher; Emergency medical service; Out-of-hospital cardiac arrest INTRODUCTION Currently, medical control (MC) for the emergency medical service system (EMS) is active in Japan.However, MC, including education, is mainly targeted to emergency medical technicians (EMTs) and is rarely targeted to dispatchers in Japan. Since February 2004, the Ishikawa MC Council has requested that fire departments collect the reasons why dispatchers failed to provide telephone-assisted instruction on cardiopulmonary resuscitation (telephone-CPR). Telephone-CPR has been shown to increase the incidence of bystander CPR and is expected to improve the outcomes of out-of-hospital cardiac arrests (OHCAs) [1][2][3][4][5].There are no special qualifications or authorisations required for fire department staff to be dispatchers in Japan. Some dispatchers have no experience as EMTs. An educational program for dispatchers has not been established. In some fire departments, the actual condition of the OHCA patient, discovered by EMTs during a post-arrival interview, is not relayed back to the dispatchers.In March of 2007, the Ishikawa MC Council initiated the Continuous Quality Improvement (CQI) project for telephone-CPR. The project included the following: 1) a standardized manual for instruction on chest-compression-only CPR (CC-only CPR), 2) education on how to recognise OH...

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Vomiting as a diagnostic aid in acute ischaemic cardiac pain.

Cited by 40 publications

References 4 publications

Study on site of acute myocardial infarction associated with arrhythmias and outcome

Study on site of acute myocardial infarction associated with arrhythmias and outcome

Subacute ventricular free-wall rupture presenting as tamponade without frank hemopericardium

The continuous quality improvement project for telephone-assisted instruction of cardiopulmonary resuscitation increased the incidence of bystander CPR and improved the outcomes of out-of-hospital cardiac arrests

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