Pre-hospital Delivering Thrombolytic Therapy of S-Elevation Myocardial Infarction - Essay Example

Evidence Based Practice Assignment Three Evidence Based Initiative: Pre-hospital Delivering Thrombolytic Therapy of S-Elevation Myocardial Infarction(STEMI) in the early stages Name Student Number Table of Contents Introduction 3 Thrombolytic Agent 6 Search Strategy 6 Evidence of STEMI 8 Reasons for Use Thrombolytic Therapy Into Pre-Hospital Care 12 Barriers and issues 13 Implementation of Practice Initiative 15 Conclusion 16 References 16 Evidence Based Initiative: Pre-hospital Delivering Thrombolytic Therapy of S-Elevation Myocardial Infarction (STEMI) in the early stages Introduction ST-Segment Elevation Myocardial Infarction (STEMI) is a from of heart attack, which in most cases occurs due to blockage of the coronary artery because of blood clotting. The outcome leads to infarction or damage of the heart muscle connected to that particular artery (Van de Werf, Topol & Sobel, 2009). The therapists determine the infection by carrying out the electrocardiogram (ECG) test, to determine the intensity of artery blockage (Bång, Grip, Herlitz, Kihlgren, Karlsson, Caidahl & Hartford, 2008). Heart attacks occur in many froms, but STEMI is the most severe and prominent amongst the patients. In most frequent times, the diseases associated with the heart occur at an expected time, hence the need for the action from the emergency medical services, which include the pre-hospital care (Walker & Jenings, 2008). In Australia, the St. John Ambulance in United Kingdom plays a critical role in facilitating the pre-hospital care services to the patient population ranging between three to four million, residing in both towns and suburb areas (Kushner & Smith, 2009). The services provided by this facility include the urgent rescue services as well as the safe delivery of the patient to the nearest health facility for urgent medical attention. Other than immediate delivery of critical patients to nearby health facilities, St. John Ambulance paramedics ensures the invention and implementation of immediate measures associated with first hand medication services(Pre-hospital emergency care (Stern et al, 2012). The pre-hospital care services facilitated to the patients vary from one individual to another, depending on the intensity and the urgency of the condition. Among the clinical issues that are quite threatening, when they occur is the ST-Elevation Myocardial Infarction, more so during the early stages (Bång et al. 2008). Due to the critical nature of STEMI, there is an urgent need for Evidence-based Practice (EBP) initiative to engineer for the quality, as well as the improvement of pre-hospital medication services. In doing so, the patients shall be relieved of the pains and the deteriorating conditions that could be fatal, if left for a long time, in the course of conveying patients to various hospitals (Kushner & Smith, 2009). As a result, St Johns Ambulance of United Kingdom is committed to reviewing the clinical strategies to enhance efficient management of pre-hospital services, more so in patients with STMI. The studies taking effect are evidence-based and at the same time accurate. Among the major reports, include the Pre-hospital Delivering Thrombolytic Therapy to patients who succumb to sudden fatal attacks (Weaver et al, 1993). Thrombolytic therapy has proved effective more so in reducing the intensity of the pains in a particular patient, more so during the early stages of the attack. Other than STEMI, various conditions in association with the heart attack significantly benefit from the application of thrombolytic therapy, with the outcome being self-fulfilling (Zijlstra et al, 2012). However, after elaborate discussion with the Senor Medical Manager in the department of Clinical governance in our organization, we arrived at the decision that the discussion shall be based on Delivering Thrombolytic Therapy for ST- Elevation Myocardial Infarction (STEMI) in the early stages (Boland, Dundar, Bagust, Haycox , Hill & Mota, 2003). Again, this paper shall focus on the management of the approach in the pre-hospital environment (Bång et al. 2008). In focusing on the review, the proposal elaborated the effect of Thrombolytic therapy in the pre-hospital environment, more so with the problem associated with STEMI. In order to determine the effect of the application of Thrombolytic therapy in the patients with STEMI in the pre-hospital environment, it is significant to understand first, the meaning of STEMI. Elevation Myocardial Infarction is a protracted disorder, which occurs in the arteries leading to the heart. In most cases, it occurs due to a blood clot, which takes place in the arteries (Bonnefoy et al, 2009). Eventually, the clot causes the blockage of the arteries as well as the death or infarction of the muscle tissues serving the arteries to the chambers of the heart (Bång et al. 2008). As a result, a patient perceives the pains in the chest as well as other parts of the body, including the joints. The disorder is common in older generations, but it also occurs in young individuals (Boland et al, 2003). The problem is not only dominant in United Kingdom, but it is a challenge that faces the entire globe. According to statistics, about 3.7million people are reported to be with STEMI. In 2010/2011, the England alone recorded about 2500 cases of the patient with STEMI infection. Other than the challenges associated with health, the disease brings forth the economic burden to the patients involved as well as the entire community (Becker et al. 1995). In most cases, the patients use a lot of money to purchase the drugs that are meant to contain the situation, more so to ease the pain. Among the traumas that the patients experience include the strains in the chest, breathing complications as well as dizziness (Boland et al, 2003). The signs mentioned can occur concurrently, thereby making the patient to experience pain with the demand for pre-hospital services by the emergency rescue team before the real medication at the hospitals. The intensity and occurrence of S-Elevation Myocardial Infarction varies in various patients. It can occur in mild condition state in some, while others experience worsening situations that require swift action from the paramedics (Bonnefoy et al, 2009). In most cases, the pre-hospital emergency services strive to reduce the pains of the patient, as the same time restores the hypotensive level, before the patient receives the actual medication in Hospital (Bång et al. 2008). Due to the pains, the patients access the administered with drugs like Aspirin, Morphine as well as Glyceryl Trinitrate (Becker et al. 1995). Again, the patients further receive r-PA units with a couple of heparin units. The application of the Thrombolytic therapy as so far been proved as the most efficient method through which the pre-hospital emergency services can apply to help to aid in the reduction of the first- hand pains before the actual treatment. Thrombolytic Agent Presently, the thrombolytic recommended by St John Ambulance United Kingdom is Tenecteplase. The agent that occurs as the third generation after Streptokinase and Tissue Plasminogen Activator (t-PA) is useful since it is a mutant of t-PA. Other than being a mutant, the agent reduces the plasma clearance and doubles the specificity of fibrin. Again, it lowers or reduces sensitivity to plasminogen activator inhibitor-1. A comparison was conducted by the experts to determine the most favorable agent between bolus Tenecteplase and the accelerated dose t-PA in about 20,445 patients affected with STEMI (Bång et al. 2008). The outcome proved that Tenecteplase was equal to t-PA, for those patients who experience 35 days of bleeding, as well as the mortality rate. However, when the patients were administered with the dosage of Tenecteplase after the first 5 hours of the commencement of the symptoms, the death rate reduced significantly as compared to when medication was conducted using t-PA. The percentage of Tenecteplase to that of t-PA was 0.7% to 9.2%respectively (Coronary intervention, 2005). The outcome favors Tenecteplase as the efficient Thrombolytic agent that works well in the management of STEMI (Boland et al, 2003). Search Strategy An answerable clinical question was devised, this being What level of evidence is there to support pre-hospital to use Thrombolytic Therapy in S-Elevation Myocardial Infarction (STEMI)? The search involved the use of MeSH device to explore PubMed. Other resources utilized include The Cumulative Index to Nursing and Allied Health Literature as well as the exploitation of Cochrane Library together with the use of PICO (Patient Intervention, Comparison and outcome of interest) to conduct the analysis (Becker et al. 1995). The terms used include: ((“STEMI” [Mesh]) AND “Thrombolytic therapy” [Mesh]) AND “Tenecteplase” [Mesh] For the evidence located to be declared appropriate, a criteria was devised to determine the efficiency, and it was as follows The research study must be of evidence I (Systematic review of randomized controlled trials) or level of evidence II (Well designed randomized controlled trials) The study must take effect in the emergency environment The study must focus on S-Elevation Myocardial Infarction (STEMI): Other causes of the heart attack were not included in the search It had to involve human studies only Both Adults and the children were participating in the study with equal presentation The outcome of treatment measures was to be specified regardless of success or failure Studies considered were those undertaken in the past 13 years (Bång et al. 2008). The dosage of Tenecteplase must be equal to the one recommended by the Clinical Practice Guideline for Tenecteplase Only the research conducted in English could be involved in the study. The search was to range in the scope of 13 years to encompass the evidence from the stakeholders, including the recommendations of Joint Royal Colleges Ambulance of U.K and the National STEMI Movement United Kingdom (Boland et al, 2003). Again, the scope of the research involved other emergent facts, which may contradict the study. The evidence level selected was in line with The National STEMI Movement in United Kingdom descriptions. About 230 citations were discovered and out of those, about 200 of them were immaterial hence were sidelined from the proposal. The remaining 20 citations were qualified for sampling to get the right content for the study. For the first five citations, they had connections with randomized controlled trials, conducted using the hospitalized patients, or the patients who had received the first aid prior to the giving of Tenecteplase (Becker et al. 1995). The rest five were with some anomalies which included the over-dosing of the thrombolytic agent, which was against the set prescriptions (Wander & Chhabra, 2012). The citations were disqualified since they could not fit into use by means of Prehospital care in the urban area. The selection of the citation favored only ten collections. These quotes contained the evidence that was at the same standard as the evidence-based recommendations. They encompassed the studies that were associated with both adults and children patients. Evidence of STEMI The proof of the effectiveness of Pre-hospital Delivering Thrombolytic Therapy for S-Elevation Myocardial Infarction (STEMI) was achieved during the comparison of thrombolysis with percutaneous coronary intervention in randomized controlled trials in both the adults and children (Walker, Jennings, Kerr, Kelly & Edington, 2008). In 2003, Keeley, Boura, and Grines conducted randomized trials (Level of Evidence II), making a comparison of Percutaneous coronary intervention (PPCI) with thrombolysis using Tenecteplase. The outcome indicated that when used in a pre-hospital state, a documented meta-analysis of six randomized trials favored PHT (Scuffham & Tippett, 2007). The PHT reduced the mortality rate by 45 minutes as compared to In-Hospital Thrombolysis. The outcome further indicated the trial could safe or preserves the myocardial tissues and better the result (Bång et al. 2008). Out of the tests conducted, it is just a single test that is, the Comparison of Angioplasty and Pre-hospital Thrombolysis in Acute Myocardial Infection (CAPTIM). This made a comparison of PHT and PPCI (Walker et al, 2003). According to the outcome, the patients who obtained thrombolysis within one and half hours of the signs and symptoms commencement experience a 30-day reduction in mortality rate as compared to those undertaken PPCI (Castle, 2007a). However beyond 2 hours, the difference between the groups was increasingly reversed, thereby making the PHT be effective during the initial stages when the symptoms service (Boland et al, 2003). In another evidence based on systematic review of randomized controlled trials (Level of Evidence I) as explained by Raveen Naidoo and Nicholas Castle (2012), gives a clear evidence about the relevance of using thrombolytic therapy in Pre-hospital emergency services. The research about pre-hospital thrombolysis entailed the randomized management of about 700, 000 components of Tenecteplase were undertaken (Walker et al, 2003). The patients that received the medication less than I hour after the commencement of discomfort had a relatively higher ejection fraction (54±13 VS. 44±11 %; P Read More