Clinical Presentation to the Emergency Department Predicts Subarachnoid Hemorrhage-Associated Myocardial Injury
| Autor: | Theodore F. Lagattuta, Elizabeth Crago, Marilyn Hravnak, Khalil Yousef |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Subarachnoid hemorrhage Nursing assessment Vital signs Emergency Nursing Severity of Illness Index Article 03 medical and health sciences 0302 clinical medicine Troponin I medicine Humans Glasgow Coma Scale cardiovascular diseases Prospective Studies Intensive care medicine business.industry 030208 emergency & critical care medicine Emergency department Middle Aged Subarachnoid Hemorrhage medicine.disease Triage Female Cardiomyopathies Emergency Service Hospital business 030217 neurology & neurosurgery Emergency nursing |
| Zdroj: | Journal of Emergency Nursing. 44:132-138 |
| ISSN: | 0099-1767 |
| DOI: | 10.1016/j.jen.2017.06.005 |
| Popis: | Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is frequently seen in emergency departments. Secondary injury, such as subarachnoid hemorrhage-associated myocardial injury (SAHMI), affects one third of survivors and contributes to poor outcomes. SAHMI is not attributed to ischemia from myocardial disease but can result in hypotension and arrhythmias. It is important that emergency nurses recognize which clinical presentation characteristics are predictive of SAHMI to initiate proper interventions. The aim of this study was to determine whether patients who present to the emergency department with clinical aSAH are likely to develop SAHMI, as defined by troponin I ≥0.3 ng/mL. Methods This was a prospective descriptive study. SAHMI was defined as troponin I ≥0.3 ng/mL. Predictors included demographics and clinical characteristics, severity of injury, admission 12-lead electrogardiogram (ECG), initial emergency department vital signs, and pre-hospital symptoms at time of aneurysm rupture. Results Of 449 patients, 126 (28%) had SAHMI. Patients with SAHMI were more likely to report seizures and unresponsiveness with significantly lower Glasgow coma score and higher proportion of Hunt and Hess grades 3 to 5 and Fisher grades III and IV (all P (P P Discussion Components of the clinical presentation of subarachnoid hemorrhage to the emergency department predict SAHMI. Identifying patients with SAHMI in the emergency department can be helpful in determining surveillance and care needs and informing transfer unit care. Contribution to Emergency Nursing Practice •Neurocardiac nursing assessment in the emergency department can be utilized to triage patients with subarachnoid hemorrhage. •Emergency nurses need to be vigilant for cardiac complications in patient with unresponsiveness at the time of subarachnoid hemorrhage. •Nurses are the first step in patient care. To provide patients with the best care possible, nurses need to be highly competent in recognizing alarming symptoms. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect