Sefa YURTBAY, Esin DEMİRTAŞ, Fatma Mutlu KUKUL GÜVEN, İlhan KORKMAZ, Yusuf Kenan TEKİN, Erdal DEMİRTAŞ

AMBULANSTA ÇALIŞAN SAĞLIK PERSONELİNİN ELEKTROKARDİYOGRAM BİLGİ DÜZEYLERİNİN DEĞERLENDİRİLMESİ

Amaç: Akut koroner sendromlar tüm dünyada ani ölümlerin büyük bir kısmını oluşturmaktadır. Akut başlangıçlı göğüs ağrısı şikayeti olan hastada miyokard infarktüsü düşünülmüş ise en kısa zamanda perkütan koroner anjiyografi (PTCA) yapılan bir merkeze sevk edilmelidir. Akut koroner sendromlar ve ölümcül kardiyak aritmilere bağlı ölüm oranını azaltmak için, hastayı ilk değerlendiren, ambulansta ça- lışan sağlık personelinin elektrokardiyografi (EKG) bilgisi önemlidir. Biz bu nedenle, Sivas ilindeki ambu- lans personelinin elektrokardiyografi bilgi düzeyini değerlendirmek için bir anket çalışması planladık. Materyal metod: Hemşireler, paramedikler ve acil tıp teknisyenleri olmak üzere, Sivas merkez ve ilçe- lerindeki ambulanslarda çalışan toplam yüz yetmiş sekiz sağlık personeli çalışmaya dahil edildi. Katılım- cılardan, çalışma deneyimi, eğitimi, yaşı ,özel bir EKG kursunun tamamlanmasıyla ilgili sorulara cevap vermeleri istendi ve 12 farklı EKG'yi yorumlamaları beklendi. Bulgular: Anket çalışmasında doğru tanı konulan EKG oranları şöyledir; anterior ST elevasyonlu miyo- kard infarktüsü (STEMI) %84.3 (n=150), inferior STEMI %89.9 (n=160), lateral STEMI %77.5 (n=138), nor- mal EKG %64 (n=114), ventriküler fibrilasyon (VF), %28.1 (n=50), supraventriküler taşikardi (SVT) %57.3 (n=102), VT %17.4 (n=31), ve parazitli EKG %13.5(n=24). Elde edilen sonuçlara göre, paramediklerin sağ dal bloğu ve AV tam blokta doğru tanı oranlarının acil tıp teknisyenlerine ve hemşirelere göre daha yüksek olduğu (

Evaluation of Electrocardiogram Knowledge Level of Healthcare Staff Working in Ambulance

Background: Acute coronary syndromes compose a major proportion of sudden deaths globally.Patients diagnosed with myocardial infarction due to sudden chest pain should be immediately referredto percutaneous coronary angiography (PTCA) as soon as possible. In order to decrease the mortalityrate due to acute coronary syndromes and deadly cardiac arrhythmias, the electrocardiography (ECG)knowledge of the ambulance staff, who evaluated as first, is important. We aimed to evaluate the levelof electrocardiography knowledge by conducting a survey on the ambulance staff in the province ofSivas.Material-methods: A total of one hundred seventy-eight healthcare professionals working inambulances in the centre and districts of Sivas were included in the study, including nurses, paramedics,and emergency medical technicians. The participants were asked to answer survey questions abouttheir working experience, education, age, and completion of a special ECG course and they wereexpected to interpret 12 different ECGs.Results: The ratios of correct ECG diagnosis were as follows; anterior ST-elevation myocardial infarction(STEMI), 84.3% (n=150); inferior STEMI, 89.9% (n=160); lateral STEMI, 77.5% (n=138); normal ECG, 64%(n=114); ventricular fibrillation (VF) , 28.1% (n=50); supraventricular tachycardia (SVT), 57.3% (n=102);VT, 17.4% (n=31); and artificial ECG, 13.5% (n=24). According to the results, paramedics had highercorrect diagnosis ratios in right bundle branch block and AV complete block compared to EMTs andnurses (

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Smith SC, Collins A, Ferrari R, Holmes DR, Logstrup S, Mc-Ghie DV et all. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). Circulation. 2012:126(23);2769-75.
Türkiye istatistik kurumu 2015 yılı ölüm nedeni istatistikleri Sayı: 21526 24 Mart 2016
Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK et all. Adult advanced cardiovascular life support. Circula- tion.2015;132(18 suppl 2):S444-S464.
Meadows-Pitt M, Fields W. The impact of prehospital 12-lead electrocardiograms on door-to-balloon time in patients with ST-elevation myocardial infarction. Journal of Emergency Nursing. 2014:40(3):e63-e68.
Osei-Ampofo M, Cheskes S, Byers A, Drennan IR Buick JE, Verbeek PR. A Novel Approach to Improve Time to First Shock in Prehospital STEMI Complicated by Ventricular Fibrillation. Prehospital Emer- gency Care. 2016;20(2):278-82.
Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P et all. European Resuscitation Council guidelines for resuscitation 2015. Resuscitation. 2015;95:100-47.
Brown JP, Mahmud E, Dunford JV, Ben-Yehuda O. Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction. Am J Cardiol. 2008;101:158–61.
Le May MR, Davies RF, Dionne R, Maloney J, Trickett J, So D et al. Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a des- ignated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol. 2006;98:1329–33.
Dorsch MF, Greenwood JP, Priestley C, Somers K, Hague C, Blaxill JM et al. Direct ambulance admission to the cardiac catheterization laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention. Am Heart J. 2008;155:1054–8.
Lee CH, Van Gelder, Carin M, David C. “Early cardiac cath- eterization laboratory activation by paramedics for patients with ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms”. Prehospital Emergency Care 2010;14(2):153-8.
Mencl F, Wilber S, Frey J, Zalewski J, Maiers JF, Bhalla MC. Paramedic ability to recognize ST-segment elevation myocardial in- farction on prehospital electrocardiograms. Prehospital Emergency Care.2013;17(2): 203-10.
O’Donnell M, Mike L. "Reading the Electrocardiograph: Para- medics’ Descriptions of their Learning." Australasian Journal of Paramedicine. 2015:4.3
Trivedi K, Schuur JD, Cone DC. Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocar- diograms? Prehospital Emergency Care. 2009;13(2):207-14.
Cheskes S, Turner L, Foggett R, Huiskamp M, Popov D, Thomson S et all. Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarc- tion bypass to primary percutaneous coronary intervention in a Canadian emergency medical system. Prehospital Emergency Care. 2011;15(4):490-98.
Khelassi A, Yelles-chaouche SN, Benais F. Multi-arrhythmias detection with an XML rule-based system from 12-Lead Electrocar- diogram. Electronic physician. 2017;9(5):4357.
Niemann JT, Stratton SJ, Cruz B, Lewis RG. Outcome of out-of- hospital postcountershock asystole and pulseless electrical activity versus primary asystole and pulseless electrical activity. Crit Care Med:2001;29:2366-70
Perkins GD, Handley AJ, Koster RW, Castrén M, Smyth MA, Olasveengen T et all. European resuscitation council guidelines for resuscitation 2015. Section 2:Adult basic life support and automat- ed external defibrillation. Resuscitation. 2015 Oct;95:81-99
Osei-Ampofo M, Cheskes S, Byers A, Drennan IR, Buick JE, Verbeek PR. A Novel Approach to Improve Time to First Shock in Prehospital STEMI Complicated by Ventricular Fibrillation. Prehosp Emerg Care. 2016;20(2):278-82.
Daudelin DH, Sayah AJ, Kwong M, Restuccia MC, Porcaro WA, Ruthazer R et all. Improving use of prehospital 12-lead ECG for early identification and treatment of acute coronary syndrome and ST- elevation myocardial infarction. Circulation: Cardiovascular Quality and Outcomes. 2010;3(3):316-23.