[Acute pain in myocardial infarction: analysis of concept]

Morphine Use Did Not Eliminate the Effect of Pain on Complications After Acute Myocardial Infarction

Background:

Patients with Acute Myocardial Infarction (AMI) are usually present complaining of severe chest pain. This pain results from an imbalance between oxygen supply and demand, leading to severe complications. Different guidelines recommend using Morphine as a drug of choice for treating this pain.

Objective:

This study aimed to check the effect of chest pain and Morphine use on complications rate after AMI.

Methods:

This was a prospective observational study with a consecutive sample of 300 patients with AMI. Data were collected by direct patients interview and medical records review in the emergency departments & Intensive Care Units (ICU). Any complication developed within the hospital stay and after AMI was recorded. All correlated variables were analyzed using the binary logistic regression model.

Results:

The sample included 176 (58.7%) men and 124 (41.3%) women with a mean age of 56.92±12.13 years. A total of 83 patients (27.7%) developed one or more in-hospital complications. Acute recurrent ischemia was the most frequent complication; 70 (23.3%). Severe chest pain (≥ 7), duration of chest pain (more than 5 minutes), history of previous MI, and history of hypertension increased the occurrence of complications by 13%, 7%, 63%, and 25%, respectively. However, the use of Morphine did not have any protective effect against the development of these complications.

Conclusion:

The severity and duration of chest pain increased the occurrence of complications. Morphine administration did not have any protective effect against the development of these complications. Thus, it is recommended to update different policies and guidelines to use other types of chest pain relief methods, e.g., treating the underlying cause of chest pain and addressing the imbalance between oxygen supply and demand.

An analysis of the descriptors of acute myocardial infarction used by South Africans when calling for an ambulance from a private emergency call centre

Introduction

Acute myocardial infarction (AMI) is a time sensitive emergency. In resource limited settings, prompt identification and management of patients experiencing AMI in the pre-hospital setting may minimise the negative consequences associated with overburdened emergency medical and hospital services. Expedited care thus, in part, relies on the dispatch of appropriate pre-hospital medical providers by emergency medical dispatchers. Identification of these patients in call centres is challenging due to a highly diverse South African society, with multiple languages, cultures, and levels of education. The aim of this study was therefore, to describe the terms used by members of the South African public when calling for an ambulance for patients suffering an AMI.

Methods

In this qualitative study, we performed content analysis to identify keywords and phrases that callers used to describe patients who were experiencing an advanced life support (ALS) paramedic-diagnosed AMI. Using the unique case reference number of randomly selected AMI cases, original voice recordings between the caller and emergency medical dispatcher at the time of the emergency were extracted and transcribed verbatim. Descriptors of AMI were identified, coded and categorised using content analysis, and quantified.

Results

Of the 50 randomly selected calls analysed, 5 were not conducted in English. The descriptors used by callers were found to fall into three categories; Pain: Thorax, No pain: Thorax and Ill- health. The code that occurred most often was no pain, heart related (n = 16; 23.2%), followed by the code describing pain in the chest (n = 15; 21.7%).

Conclusion

South African callers use a consistent set of descriptors when requesting an ambulance for a patient experiencing an AMI. The most common of these are non-pain descriptors related to the heart. These descriptors may ultimately be used in developing validated algorithms to assist dispatch decisions. In this way, we hope to expedite the correct level of care to these time- critical patients and prevent the unnecessary dispatch of limitedly available ALS paramedics to inappropriate cases.

Diagnósticos de enfermagem segundo a teoria do autocuidado em pacientes com infarto do miocárdio

Objetivo: identificar los diagnósticos de enfermería en personas con infarto de miocardio en emergencia hospitalaria, según la teoría del autocuidado de Orem. Materiales y método: estudio transversal, realizado de febrero a agosto del 2016, con 50 pacientes infartados y que estaban en condiciones de participar en la investigación. La recolección de datos ocurrió a través de entrevista, utilizando cuestionario según la teoría del autocuidado, y se formularon diagnósticos de enfermería con base en la Taxonomía de la NANDA-I. Resultados: la mayoría de los pacientes eran mujeres (54 %), con edades de 60 a 69 años (34 %), ingreso familiar de uno a dos salarios mínimos (88 %), con enseñanza básica (70 %) y jubilados (76 %). Hubo alta frecuencia de hipertensión arterial (62 %), inactividad física (76 %) y tabaquismo (70 %). La prueba rápida para troponina fue positiva en 16 personas (32 %). Muchos infartados presentaban déficits de autocuidado que apuntaron 10 diagnósticos de enfermería, destacándose estilo de vida sedentario (80 %), movilidad física perjudicada (76 %) y riesgo de intolerancia a la actividad (76 %). Los comportamientos de salud propensos al riesgo y la autonegligencia tuvieron relación con tres requisitos de autocuidado. Conclusión: los pacientes necesitaban de asistencia en salud para cambios en el estilo de vida, medidas de confort y realización de actividad y reposo.

Analysis of the concept of powerlessness in individuals with stroke

OBJECTIVES

To identify and analyze the concept of the powerlessness in individuals with stroke, according to the NANDA-I Taxonomy.

METHODS

Concept analysis from online access of four databases using the descriptors: impotence; helplessness, learned; Stroke, depression in languages: Portuguese, English and Spanish.

RESULTS

The critical attributes of the feeling of powerlessness are: fragility, helplessness, lack of control, and power to achieve the proposed results for recovery and adaptation. Eleven new antecedents were found. It is recommended to reformulate three antecedents present in the taxonomy. Fourteen consequent were found. It is suggested to amend three consequential from the review.

CONCLUSIONS

With the analysis, a more complete concept of the powerlessness was elaborated allowing clarifying the critical attributes that, in turn, will help the rehabilitating nurse to recognize the signs and symptoms and to strengthen mechanisms of tolerance and resistance to stress.