ST-segment elevation acute coronary syndromes: Prehospital management strategies

Prehospital management of ST-segment elevation myocardial infarction is a complex issue. Many components are involved, beginning with information of the public on the symptoms of heart attack, up to the choice of the final pathway and destination of the patients, with many intermediate steps including the regulation of emergency calls, the implementation of optimal diagnostic strategies, the choice of reperfusion therapy and of adjuvant medications. In recent years, optimization of these different components has led to improved patients' outcomes in this still life-threatening condition.     

Out-of-hospital use of an automated chest compression device: facilitating access to extracorporeal life support or non-heart-beating organ procurement

ObjectiveThe aim of the study was to assess the ease-of-use, safety, and usefulness of an automated external chest compression device for cardiopulmonary resuscitation.MethodsAdults with out-of-hospital cardiac arrest (OHCA) were included prospectively. The emergency medical services (EMS) in a large suburb northeast of Paris (France) recorded data for standard criteria for EMS care for CA and specific criteria on device use—application time, ease of application and use (visual analog scale score: 0, impossible; 5, very easy), technical incidents, and clinical complications.ResultsWe attended 4868 OHCA patients (January 2005 to April 2010) and used the device in 285 patients (6%) (212 males [74%], 73 females [26%]; median age, 56 [43-70] years). Results (medians with 25-75 percentiles) were as follows: time to apply device, 30 seconds (20-60); ease of application and activation, 5 (4-5) and 5 (5-5), respectively; duration of use, 30 (20-41) minutes; return to spontaneous circulation (ROSC), 76 patients (27%); and time to ROSC, 19 (12-32) minutes after placement. Twenty-seven patients (9%) with refractory CA benefited from extracorporeal life support. Overall, 32 patients were alive after 24 hours, 11 at 7 days, and 3 at 1 month. An additional 23 patients (8%) with refractory CA were selected for non–heart-beating kidney procurement. Ten patients were used to harvest kidneys and 15 were transplanted. There were 21 technical incidents (7%) and 19 clinical complications (7%).ConclusionThe device was easy to use in routine emergency practice and of particular value in facilitating access to extracorporeal life support or non–heart-beating organ procurement. These uses should be itemized in all OHCA studies.     

Compliance with a morphine protocol and effect on pain relief in out-of-hospital patients

This study was carried out to evaluate the compliance with a morphine protocol and its effects on pain relief in pre-hospital care. In this prospective study, pain intensity was evaluated by the Visual Analog Scale (VAS) from the beginning and every 5 min until hospital arrival (Tend). Group 1: No major deviation from the protocol (intravenous morphine as a first bolus of 0.05 mg/kg followed by repeated boluses every 5 min until VAS < or = 30 mm). Group 2: Major deviation from the protocol. There were 216 patients included. The mean dose of morphine was 9.0 +/- 5.7 mg. The morphine protocol was respected in 123 patients (57%). The mean VAS score was significantly better at Tend in Group 1 vs. Group 2 (27.8 +/- 21.1 mm vs. 37.8 +/- 22.1 mm, respectively), the degree of pain relief was significantly better (73% vs. 53%, respectively) and the initiation time for pain relief was significantly shorter in Group 1 vs. Group 2 (10 min [5-15] vs. 15 min [10-26], respectively). Satisfaction was significantly better in patients expressing pain relief than in unrelieved patients (94% vs. 61%, respectively). Out-of-hospital pain management using morphine depends on careful attention to dosage and the time interval between re-injections. Emergency teams may employ these data to improve the quality of pain relief in the field.     

川藏香茶菜中双聚对映贝壳杉烯的结构鉴定

从川藏香茶菜的干叶和嫩枝中,分离得到了一个对映贝壳杉烯的双聚体,命名为川藏香茶菜戊素,经光谱解析和化学证明确定了其结构为川藏香茶菜甲素的Diels-Alder双聚体。     

Functional outcome measures for distal radius fractures: A systematic review

Objective: This systematic review aimed to identify and describe the utility of functional outcome measures reported in intervention trials between 2010 and 2020, and to map these measures to the International Classification of Functioning, Disability and Health (ICF) model.Method: The search was carried out on MEDLINE, CINAHL and Cochrane Register of Clinical Trials. Peer-reviewed intervention studies detailing the functional outcome measures used for any treatment for distal radius fracture were selected. Participant characteristics, outcome measures reported and the trends in their use over time and geographical locations were extracted.Results: This review analysed 119 studies. Thirty-one functional outcome measures were used across 36 countries. Ninety-two percent of studies measured both the Body Function/Structure and Activity/Participation domains of the ICF. The most frequently used measures were the Disabilities of the Arm, Shoulder and Hand Questionnaire, Range of Motion and Grip Strength. There is a lack of measures on successful return to meaningful occupation.Conclusion: The outcome measures identified were equally spread across the ICF domains. There is a growing importance of Patient-Reported Outcome Measures to supplement performance-based measures, but a lack of measure on successful return to meaningful occupation.