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Pre-CCU

Progress in AMI Care. Pre-CCU. 220,000*. CCU Defibrillation ß-blockers. ST  Placebo. 110,000*. ST  Lytics. ST  PTCA. 70,000*. 50.000*. 30.000*. Pre-thrombolytic. Post-thrombolytic. * assuming ~1.1 million AMI’s per year. Progress in AMI Care. Pre- Hospital. Pre- CCU.

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Pre-CCU

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  1. Progress in AMI Care Pre-CCU 220,000* CCU Defibrillation ß-blockers ST  Placebo 110,000* ST  Lytics ST  PTCA 70,000* 50.000* 30.000* Pre-thrombolytic Post-thrombolytic * assuming ~1.1 million AMI’s per year

  2. Progress in AMI Care Pre- Hospital Pre- CCU 225,000* CCU Defibrillation ß-blockers ST  Placebo ST  Lytics ST  PTCA 30.000* Pre-thrombolytic Post-thrombolytic * assuming ~1.1 million AMI’s per year

  3. Acute MI Unstable angina Plaque rupture progressive angina stable angina Pathophysiology of CAD

  4. Stage II Stage III Stage I Barriers to Care Patient Bystanders In-hospital EMS

  5. Patient Initiated Emergency Response SystemMost Elegant 911 EMS Dispatcher

  6. Use of Medical Informatics and New Technology to Reduce Treatment Delay in ACS National Library of Medicine & National Heart, Lung and Blood Institute

  7. Patient-Initiated Emergency Response System PIERS

  8. Patient-Initiated Emergency Response SystemPIERS The concept behind PIERS is to bring elements of the ED critical to making the diagnosis of ACS to the patient.

  9. Patient Initiated Emergency Response System PIERS System Concept

  10. EMS ED PMD RouteInformation StoreInformation Gather Information Basic Emergency Mode Design ECG harness Central Server “voice” Personal Patient Module PPM Patient Disposition

  11. PIERSModes of Operation • Mode 1 • set up and testing mode • Mode 2 • monitoring of chronic coronary artery disease • Mode 3 • ACS mode

  12. Acute MI Unstable angina System - Mode 3 System - Mode 2 Plaque rupture progressive angina stable angina

  13. Diagnosis of ACS • Historical Information • risk factor profile • past medical history • current history • Electrocardiographic information • comparison of current with baseline ECG

  14. Angina: frequency severity provocation Heart Failure Class ECG: new Q waves ST-segment changes PMD Data Trend Review Alert Automated Interrogation new ECG Data Processing MODE 2 Operation - chronic disease monitoring

  15. ER ACS AMI Central Server MODE 3 Operation - ACS event

  16. Patient Initiated Emergency Response SystemMost Elegant System Doesn’t Work • Average symptom-to-treatment time >120 minutes • Reasons for delay • Stage I • denial • uncertainty (embarrassment) • attempting to contact physician/loved one • being single • Stage II • EMS - related • Stage III • identification • obtain ECG • review ECG / consultation • recruit treatment team

  17. Minimizing Treatment Delay • 911 system • ubiquitous, easy to use, inexpensive • Education + 911 • REACT Trial (Rapid Early Action for Coronary Treatment Trial)

  18. Early Education Studies

  19. JAMA 2000 Jul 5;284(1):60-7

  20. Minimizing Treatment Delay • 911 system • ubiquitous, easy to use, inexpensive • Education (REACT) • necessary but not sufficient • Shahal Experience

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