Key Points
Prehospital cath lab activation for STEMI reduces total ischemic time but at the cost of frequent false‐positive activations.
In this study, half of the prehospital STEMI ECGs did not ...result in cath lab activation after cardiologist review, and that this decision was correct 96‐97% of the time.
Health care will benefit from automation in some contexts but primarily when integrated with human decision making.
ZusammenfassungHintergrundChirurgen erleben in ihrem Arbeitsalltag eine hohe psychische Belastung. Die Herzfrequenzvariabilität (HRV) ist als vegetativer Beanspruchungsparameter zur Erfassung von ...psychischen Belastungen etabliert. Eine geringe HRV ist ein Indikator für hohen Stress.Ziel der ArbeitZiel der Querschnittsstudie war es, die Aktivierung des autonomen Nervensystems als stressinduzierte Antwortreaktion und das Stressniveau bei chirurgisch tätigen Ärzten verschiedener Qualifikationsstufen während ihrer Tätigkeit anhand der HRV zu untersuchen.Material und MethodenEs wurde die HRV aus 31 EKG-Aufnahmen von 5 freiwilligen, klinisch gesunden männlichen Herzchirurgen während 25 aortokoronarer Bypassoperationen (ACB-OP) und der Stationsarbeit analysiert. Als Einschlusskriterium galt die Tätigkeit als Assistenzarzt bzw. Oberarzt, die berechtigt sind, herzchirurgische Eingriffe durchzuführen. Relevante Medikamente und Vorerkrankungen, die den Herzrhythmus beeinflussen und die Häufigkeit von Extrasystolen im EKG (> 1 % ) waren Ausschlusskriterien. Die Tätigkeit während der Operation und Nicht-Operationsphase wurde schriftlich dokumentiert. Bei der statistischen Auswertung kamen der Mann-Whitney-U-Test und das Allgemeine Lineare Modell mit der Anpassung nach Bonferroni unter Berücksichtigung der ärztlichen Funktion und der Art der Tätigkeit während der Operation als Kovariaten zur Anwendung.ErgebnisseEine reduzierte HRV während der ACVB-OP fand sich bei den zeitbezogenen Parametern RMSSD (Root Mean Square of Successive Differences) und pNN50 (Prozentsatz der NN-Intervalle mit mindestens 50 ms Abweichung vom vorausgehenden NN-Intervall), dem frequenzbezogenen Parameter LF (Low Frequency) power sowie dem nichtlinearen Kurzzeitvariabilitätsparameter SD1 (Standard Deviation oder die Breite der Punktwolke) für Assistenzärzte im Vergleich zu den Oberärzten. 50,8 % der Arbeitszeit war im OP für die Assistenzärzte als hohe Stresssituation gekennzeichnet (Oberärzte: 11,7 %; p = 0,015). Die Beanspruchungsreaktion bei der Stationsarbeit zeigte sich als deutlich geringer ausgeprägt, wobei diese in beiden Gruppen vergleichbar war.DiskussionEs zeigt sich eine höhere stressinduzierte Antwortreaktion während der ACB-OP bei Assistenzärzten im Vergleich zu Oberärzten. Es sollten frühzeitig präventive und gesundheitsfördernde Maßnahmen bei hoher arbeitsbezogener Stressbelastung bei chirurgisch tätigen Ärzten insbesondere in der Facharzt-Weiterbildungsphase eingeleitet werden.
A conversational, reader-friendly, clinical approach to electrocardiography. A how-to-read ECGs teaching tool that provides lessons from basic to advanced.
This study was designed to examine the RR interval signal qualities of a Holter device and a heart rate chest belt monitor at rest and during exercise. Ten healthy individuals completed five low- to ...high-intensity activities while simultaneously using the medilog
®
AR12plus Holter monitor and the Polar H10 heart rate monitor. The RR interval signal quality was based on the quantification of the missing RR intervals and RR interval detection errors. Therefore, both measurement systems were compared against visual inspection of the raw electrocardiography signal. The missing and wrong R-wave peak detections were counted manually for both measurement systems. RR interval signal quality was defined as the relative number of correctly detected RR intervals. Overall, RR interval signal qualities of 94.6% and 99.6% were demonstrated for the medilog
®
AR12plus and the Polar H10. During the high-intensity activities, the RR interval signal quality of the medilog
®
AR12plus dropped to 89.8%, whereas the Polar H10 maintained a signal quality of 99.4%. The correlation between both systems was high (
r
= 0.997,
p
> 0.001). The excellent RR interval signal quality during low- to moderate-intensity activities in the medilog
®
AR12plus and during low- to high-intensity activities in the Polar H10 demonstrates both measurement systems’ validity for the detection of RR intervals throughout a wide range of activities. A simple chest strap such as the Polar H10 might be recommended as the gold standard for RR interval assessments if intense activities with strong body movements are investigated.
Objective: Serious ingestion of hydroxychloroquine is uncommon. Although rarely reported, few cases have confirmatory levels. We report a characteristic case with confirmatory testing to help ...appreciate the toxicodynamic/toxicokinetic relationship. Case report: A 45 year old man with sar-coidosis and gout was found lethargic on a park bench. He admitted to attempting suicide by ingesting a bottle of his medications with ethanol approximately 1.5 hours prior to arrival but couldn't remember which medication. He took prednisone, colchicine and hydroxychloroquine at unknown doses. Initial vital signs were: temperature, 98.6 F; pulse, 80/min; respirations, 18/min; blood pressure, 148/94 mmHg; and pulse oximetry, 97% on room air. He was somnolent, but arousable and answered questions appropriately. The physical examination was unremarkable. Electrocardiography revealed a sinus rhythm. The QRS interval was 128 msec and the QTc was 576 msec. T-wave flattening in leads v3-v4, I and avL with T-wave inversion in leads V5-V6, II, III and avF were noted. Laboratory results included: sodium, 145 mEq/L; potassium, 2.6 mEq/L; chloride, 104 mEq/L; bicarbonate, 18 mEq/L; blood urea nitrogen, 15 mg/dL; creatinine, 0.115 mmol/L; glucose, 2.94 mmol/L; calcium, 2.2 mmol/L; and magnesium, 2.1 mEq/L. Aspirin and paracetamol levels were negative, but ethanol was 1.71 g/L. The patient was treated with potassium and glucose. His somnolence resolved over several hours. He remained without complaints during his hospital stay. Since his presentation was inconsistent with prednisone or colchicine toxicity a hydroxychloroquine concentration was drawn approximately nine hours post-ingestion. It was 2.0 mcg/mL (therapeutic 0.1-1.0 mcg/mL). On hospital day two, the patient was hemodynamically stable. His ECG returned to normal and he was transferred to psychiatry. Conclusion: Hypokalemia and hypoglycemia with ECG changes is suggestive of hydroxychloroquine poisoning. Serious hydroxychloroquine poisoning resembles chloroquine poisoning with rapid cardiovascular collapse. There is insufficient data to prognosticate patients based on dose or levels. This case suggests that a level twice the upper limit of therapeutic is well tolerated. We encourage obtaining blood levels to help better define the toxicokinetic/toxicodynamic relationship.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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