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Titolo:
Electrocardiographic ST-segment elevation: Correct identification of acutemyocardial infarction (AMI) and non-AMI syndromes by emergency physicians
Autore:
Brady, WJ; Perron, AD; Chan, T;
Indirizzi:
Univ Virginia, Med Ctr, Dept Emergency Med, Charlottesville, VA 22908 USA Univ Virginia Charlottesville VA USA 22908 Charlottesville, VA 22908 USA Univ Calif San Diego, Dept Emergency Med, San Diego, CA 92103 USA Univ Calif San Diego San Diego CA USA 92103 Med, San Diego, CA 92103 USA
Titolo Testata:
ACADEMIC EMERGENCY MEDICINE
fascicolo: 4, volume: 8, anno: 2001,
pagine: 349 - 360
SICI:
1069-6563(200104)8:4<349:ESECIO>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACUTE CARDIAC ISCHEMIA; THROMBOLYTIC THERAPY; MISSED DIAGNOSES; CHEST PAIN; MULTICENTER; CRITERIA; ROOM;
Keywords:
electrocardiogram; ST-segment elevation; emergency physicians; diagnosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
20
Recensione:
Indirizzi per estratti:
Indirizzo: Brady, WJ Univ Virginia, Med Ctr, Dept Emergency Med, Box 523-21, Charlottesville, VA 22908 USA Univ Virginia Box 523-21 Charlottesville VA USA 22908 22908 USA
Citazione:
W.J. Brady et al., "Electrocardiographic ST-segment elevation: Correct identification of acutemyocardial infarction (AMI) and non-AMI syndromes by emergency physicians", ACAD EM MED, 8(4), 2001, pp. 349-360

Abstract

Objective: To determine the emergency physician's (EP's) ability to identify the cause of ST-segment elevation (STE) in a hypothetical chest pain patient. Methods: Eleven electrocardiograms (ECGs) with STE were given to EPs;the patient in each instance was a 45-year-old male with a medical historyof hypertension and diabetes mellitus with the chief complaint of chest pain. The EP was asked to determine the cause of the STE and, if due to acutemyocardial infarction (AMI), to decide whether thrombolytic therapy (TT) would be administered (the patient had no contraindication to such treatment). Rates of TT administration were determined; appropriate TT administration was defined as that occurring in an AMI patient, while inappropriate TT administration was defined as that in the non-AMI patient. Results: Four hundred fifty-eight EPs completed the questionnaire; levels of medical experience included the following: postgraduate year 2-3, 193 (42%); and attending, 265 (58%). The overall rate of correct interpretation of the study ECGs was 94.9% (4,782 correct interpretations out of 5,038 instances). Acute myocardial infarction with typical STE, ventricular paced rhythm, and right bundle branch block were never misinterpreted. The remaining conditions were misinterpreted with rates ranging between 9% (left bundle branch block, LBBB) and 72% (left ventricular aneurysm, LVA). The overall rate of appropriatethrombolytic agent administration was 83% (1,525 correct administrations out of 1,832 indicated administrations). The leading diagnosis for which thrombolytic agent was given inappropriately was LVA (28%), followed by benignearly repolarization (23%), pericarditis (21%), and LBBB without electrocardiographic AMI (5%). Thrombolytic agent was appropriately given in all cases of AMI except when associated with atypical STE, where it was inappropriately withheld 67% of the time. Conclusions: In this survey, EPs were askedwhether they would give TT based on limited information (ECG). Certain syndromes with STE were frequently misdiagnosed. Emergency physician electrocardiographic education must focus on the proper identification of these syndromes so that TT may be appropriately utilized.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/03/20 alle ore 09:03:04