The polk county screening tool screening for detecting subarachnoid hemorrhage.

IF 2 Q2 EMERGENCY MEDICINE
Krish Patel, Sanjana Konda, Latha Ganti, Anjali Banerjee, Paul Banerjee
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引用次数: 0

Abstract

Introduction: The subarachnoid space in the brain contains crucial blood vessels and cerebrospinal fluid. Aneurysms in these vessels can lead to subarachnoid hemorrhage (SAH), a serious stroke subtype with high morbidity and mortality rates. SAH treatment includes procedures like coiling and clipping, but these are available only at comprehensive stroke centers (CSCs), necessitating urgent diagnosis and transfer to specialized facilities.

Methods: This IRB-approved study was conducted by Polk County Fire Rescue (PCFR) in Florida. PCFR, serving an 850,000-person population, implemented a three-step SAH protocol. The protocol uses both Ottawa SAH criteria and recurring symptoms, such as new-onset seizures and high systolic blood pressure, that were identified by EMS. Acute management included administering labetalol, levetiracetam, and ondansetron.

Results: Of 2175 stroke patients, 80 screened positive for SAH and were eligible for transfer. Patients had a median age of 66, and 33% had an initial systolic BP over 220 mmHg. The interfacility transfer rate dropped from 12.9 to 3.6% after implementing the protocol.

Conclusion: The PCFR protocol's effectiveness suggests its potential for nationwide implementation. Early SAH recognition and prompt transfer to CSCs reduce complications and improve outcomes. Accurate field diagnosis by EMTs can prevent unnecessary transfers and enhance patient care. Future improvements may include portable diagnostic tools and enhanced EMT training to further improve SAH patients' pre-hospital care.

用于检测蛛网膜下腔出血的波尔克县筛查工具。
简介大脑蛛网膜下腔包含重要的血管和脑脊液。这些血管中的动脉瘤可导致蛛网膜下腔出血(SAH),这是一种严重的中风亚型,发病率和死亡率都很高。蛛网膜下腔出血的治疗包括卷曲和剪切等手术,但这些手术只有综合卒中中心(CSCs)才能提供,因此必须进行紧急诊断并转至专业机构:佛罗里达州波尔克县消防救援队(PCFR)开展了这项经 IRB 批准的研究。PCFR 服务于 85 万人口,实施了三步 SAH 方案。该方案采用了渥太华 SAH 标准和急救中心发现的反复出现的症状,如新出现的癫痫发作和收缩压过高。急性处理包括使用拉贝洛尔、左乙拉西坦和昂丹司琼:在 2175 名中风患者中,有 80 人筛查出 SAH 阳性,符合转院条件。患者的中位年龄为 66 岁,33% 的患者初始收缩压超过 220 mmHg。实施该方案后,医院间转院率从 12.9% 降至 3.6%:PCFR方案的有效性表明其有可能在全国范围内实施。早期识别 SAH 并及时转送至 CSC 可减少并发症并改善预后。由急救医生进行准确的现场诊断可以避免不必要的转院,并加强对患者的护理。未来的改进措施可能包括便携式诊断工具和加强 EMT 培训,以进一步改善 SAH 患者的院前护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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