Tuliko taas turha päivystyskäynti? : Analyysi X-4 tehtävistä Jokilaaksojen Pelastuslaitokselle

Terveydenhuollon kulut kasvavat Suomessa väestön ikääntyessä. Kulujen kasvun hillitsemiseksi, Suomen hallitus on valmistelemassa suurta sosiaali- ja terveysalan uudistusta. Myös ensihoidon osalta on tarve miettiä mahdollisia säästöjä kulujen hillitsemiseksi, potilasturvallisuudesta tinkimättä. On myös syytä pohtia, että voidaanko ensihoidon kotiin vietäviä palveluita jotenkin laajentaa ja näin vähentää mahdollisia päivystyskäyntejä sekä mahdollistaa tehokkain resurssien käyttö. Opinnäytetyö tehtiin Jokilaaksojen pelastuslaitokselle. Tämän tutkimuksen tarkoituksena oli analysoida Jokilaaksojen pelastuslaitoksen ensihoitoyksiköiden suorittamia X-4 suoritteeseen johtaneita ensihoitotehtäviä. Työn tavoitteena oli selvittää mitkä tekijät ja millaiset ensihoitotehtävät johtivat päivystyskäyntiin ensihoitoyksikön sijaan, muulla kuljetuksella. Tulosten perusteella tuli lisäksi miettiä, että olisiko päivystyskäynti voitu jollain kotona suoritettavalla hoitotoimella välttää. Tutkimuksessa analysoitiin Jokilaaksojen pelastuslaitoksen ensihoitoyksiköiden suorittamat tuoreet ensihoitokertomukset lokakuulta 2018, jotka olivat johtaneet X-4 suoritteeseen. Tutkimusaineistossa käytiin läpi 170 ensihoitokertomusta ja niistä koostettiin tarvittavat tiedot excel - tiedonkeruulomakkeelle. Työssä käytettiin määrällisen tutkimuksen metodeja. Eniten X-4 suoritteisia ensihoitotehtäviä oli tullut koodeilla kaatuminen ja äkillinen yleistilan lasku. Yleisin tehtävän kiireellisyysluokka oli ollut C ja potilas oli laitettu useimmin lauantaina vaihtoehtoisella kuljetusmuodolla päivystykseen. Virka-ajan ulkopuolella annettuja tehtäviä oli 78%. Ensihoitajat olivat kirjanneet hallitsevimmaksi oireeksi vamma 15,9%, haava 12,9% ja yleistilan lasku / kotona pärjäämättömyys 10%. Potilaan tutkimuksista yleisimmin tehtyjä oli GCS ja pulssi. Harvinaisin tutkimus oli alkometri-puhallutus. Lisäksi lääkäriä oli konsultoitu 18% tehtävistä ja potilaalle oli tehty jokin hoitotoimenpide 12% tehtävistä. Tulosten mukaisena kehitysehdotuksena on haavojen tunnistukseen, hoitoon ja ompeluun koulutusta sekä tarvittavan välineistön hankkimista ensihoitoyksiköihin. Jatkotutkimusaiheeksi esitämme vastaanottavaan hoitolaitokseen kyselyä, jolla kartoitetaan potilaalle tehdyt tutkimukset ja kuljetusmuodon asianmukaisuus

Central aortic hemodynamics following acute lower and upper-body exercise in a cold environment among patients with coronary artery disease

Exercise is beneficial to cardiovascular health, evidenced by reduced post-exercise central aortic blood pressure (BP) and wave reflection. We assessed if post-exercise central hemodynamics are modified due to an altered thermal state related to exercise in the cold in patients with coronary artery disease (CAD). CAD patients (n = 11) performed moderate-intensity lower-body exercise (walking at 65–70% of HRmax) and rested in neutral (+ 22 °C) and cold (− 15 °C) conditions. In another protocol, CAD patients (n = 15) performed static (five 1.5 min work cycles, 10–30% of maximal voluntary contraction) and dynamic (three 5 min workloads, 56–80% of HRmax) upper-body exercise at the same temperatures. Both datasets consisted of four 30-min exposures administered in random order. Central aortic BP and augmentation index (AI) were noninvasively assessed via pulse wave analyses prior to and 25 min after these interventions. Lower-body dynamic exercise decreased post-exercise central systolic BP (6–10 mmHg, p < 0.001) and AI (1–6%, p < 0.001) both after cold and neutral and conditions. Dynamic upper-body exercise lowered central systolic BP (2–4 mmHg, p < 0.001) after exposure to both temperatures. In contrast, static upper-body exercise increased central systolic BP after exposure to cold (7 ± 6 mmHg, p < 0.001). Acute dynamic lower and upper-body exercise mainly lowers post-exercise central BP in CAD patients irrespective of the environmental temperature. In contrast, central systolic BP was elevated after static exercise in cold. CAD patients likely benefit from year-round dynamic exercise, but hemodynamic responses following static exercise in a cold environment should be examined further. Clinical trials.gov: NCT02855905 04/08/2016.Peer reviewe

Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease

Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 +/- 7.0 yr, means +/- SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%-70% of max heart rate (HR)] performed at +22 degrees C and -15 degrees C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg.beats/min) was 17% higher during exercise in the cold (18,080 +/- 3540) compared with neutral (15,490 +/- 2,940) conditions (P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature (P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients.</p

Central aortic hemodynamics following acute lower and upper-body exercise in a cold environment among patients with coronary artery disease

Abstract Exercise is beneficial to cardiovascular health, evidenced by reduced post-exercise central aortic blood pressure (BP) and wave reflection. We assessed if post-exercise central hemodynamics are modified due to an altered thermal state related to exercise in the cold in patients with coronary artery disease (CAD). CAD patients (n = 11) performed moderate-intensity lower-body exercise (walking at 65–70% of HRmax) and rested in neutral (+ 22 °C) and cold (− 15 °C) conditions. In another protocol, CAD patients (n = 15) performed static (five 1.5 min work cycles, 10—30% of maximal voluntary contraction) and dynamic (three 5 min workloads, 56–80% of HRmax) upper-body exercise at the same temperatures. Both datasets consisted of four 30-min exposures administered in random order. Central aortic BP and augmentation index (AI) were noninvasively assessed via pulse wave analyses prior to and 25 min after these interventions. Lower-body dynamic exercise decreased post-exercise central systolic BP (6–10 mmHg, p &lt; 0.001) and AI (1–6%, p &lt; 0.001) both after cold and neutral and conditions. Dynamic upper-body exercise lowered central systolic BP (2–4 mmHg, p &lt; 0.001) after exposure to both temperatures. In contrast, static upper-body exercise increased central systolic BP after exposure to cold (7 ± 6 mmHg, p &lt; 0.001). Acute dynamic lower and upper-body exercise mainly lowers post-exercise central BP in CAD patients irrespective of the environmental temperature. In contrast, central systolic BP was elevated after static exercise in cold. CAD patients likely benefit from year-round dynamic exercise, but hemodynamic responses following static exercise in a cold environment should be examined further

Cardiovascular responses to cold and submaximal exercise in patients with coronary artery disease

Abstract Regular year-round exercise is recommended for patients with coronary artery disease (CAD). However, the combined effects of cold and moderate sustained exercise, both known to increase cardiac workload, on cardiovascular responses are not known. We tested the hypothesis that cardiac workload is increased, and evidence of ischemia would be observed during exercise in the cold in patients with CAD. Sixteen men (59.3 ± 7.0 yr, means ± SD) with stable CAD each underwent 4, 30 min exposures in a randomized order: seated rest and moderate-intensity exercise [walking, 60%–70% of max heart rate (HR)] performed at +22°C and −15°C. Systolic brachial blood pressure (SBP), HR, electrocardiogram (ECG), and skin temperatures were recorded throughout the intervention. Rate pressure product (RPP) and ECG parameters were obtained. The combined effects of cold and submaximal exercise were additive for SBP and RPP and synergistic for HR when compared with rest in a neutral environment. RPP (mmHg·beats/min) was 17% higher during exercise in the cold (18,080 ± 3540) compared with neutral (15,490 ± 2,940) conditions (P = 0.001). Only a few ST depressions were detected during exercise but without an effect of ambient temperature. The corrected QT interval increased while exercising in the cold compared with neutral temperature (P = 0.023). Recovery of postexercise blood pressure was similar regardless of temperature. Whole body exposure to cold during submaximal exercise results in higher cardiac workload compared with a neutral environment. Despite the higher RPP, no signs of myocardial ischemia or abnormal ECG responses were observed. The results of this study are useful for planning year-round exercise-based rehabilitation programs for stable CAD patients