stemi e rete interospedaliera: centri hub e centri spoke i ... mondo scientifico/27 e 28-10...antman...
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STEMI e rete interospedaliera:STEMI e rete interospedaliera:centri Hub e centri Spokei tempi di trasferimento
Carolina PrevaldiPS San Donà di Piave
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L'angioplastica primaria (pPCI) è il
STEMI:RACCOMANDAZIONI PER
pPCIL'angioplastica primaria (pPCI) è iltrattamento riperfusivo più efficacenei pazienti con infarto miocardicoacuto con sopraslivellamento deltratto ST (STEMI)tratto ST (STEMI)
ACC/AHA Guidelines. J Am Coll Cardiol 2006;47:e1
Classe I A
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RACCOMANDAZIONI PER pPCI inSTEMI
entro 12 ore dall'insorgenza di sintomi
entro 90-120 min dalla presentazione (time-to-entro 90-120 min dalla presentazione (time-to-balloon inflation)
da personale esperto (> 75 pPCI/anno/operatore)
in un laboratorio di emodinamica idoneo(>200/400 pPCI/anno di cui 36 primarie per
Antman EM, 2007 Focused Update of the ACC/AHA 2004 Guidelines for the management of patient with ST-Elevation MyocardialInfarction. Circulation 2008;117: 296-329.
Classe I A
(>200/400 pPCI/anno di cui 36 primarie perSTEMI
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ULSS 10 VENETO-ORIENTALE
NON DISPONE DI EMODINAMICAINTERVENTISTICAFUNZIONANTE H/24 E QUINDIFUNZIONANTE H/24 E QUINDIDISPONIBILE PER pPCI
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Spoke
Hubb
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Problemi logistici ed organizzativipotrebbero influenzare i risultati clinici.
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ULSS 10 VENETO-ORIENTALE
1.062,2 Kmq
215.611 abitanti
20 Comuni
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Le spiagge
Jesolo Lido
Eraclea Mare
Caorle Caorle
Bibione
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Le spiagge
15.000.000 digiornate di presenzagiornate di presenzaturistica all’anno
punte giornaliere dioltre 200.000 personenei mesi estivinei mesi estivi
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Emergenza:
PS San Dona' di Piave PS San Dona' di Piave PS Portogruaro PS Jesolo PPI Caorle (Maggio-Settembre) PPI Bibione (Maggio-Settembre)
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Trasferimento Stemi per pPCI:San Donà di Piave
H 8-20: ambulanza medicalizzatainfermiere e medico del PSinfermiere e medico del PS
20-8: un medico in PS, scendemedico del reparto, autistareperibile, laboratorio reperibile,reperibile, laboratorio reperibile,Rx reperibile
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Trasferimento Stemi per pPCI:Portogruaro
8-20: ambulanza medicalizzatainfermiere e medico del PSinfermiere e medico del PS
20-8: un medico del PS, attivatareperibilità.
Autista reperibile, laboratorio Autista reperibile, laboratorioreperibile, Rx reperibile
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Trasferimento Stemi per pPCIJesolo
Ambulanza medicalizzata(d'estate)(d'estate)
8-20/20-8 unico medico del PS,scende medico del reparto
Invio ECG telematico/elisoccorso Autista reperibile, laboratorio
reperibile,Rx reperibile,elisoccorso
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Trasferimento Stemi per pPCICaorle/Bibione
Ambulanza medicalizzata (nonsempre)sempre)
Invio ECG telematico/elisoccorso H 24 1/2 medico del PS o
elisoccorso o infermiere areaelisoccorso o infermiere areacritica
Autista, elisoccorso (Leone)
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Organizzazione
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DICREPANZA FRA LINEE-GUIDAE MONDO REALE
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MISURE DI INDICATORI DIPERFORMANCE
QUANTE pPCI?
QUALI PAZIENTI ? QUALI PAZIENTI ?
COME?
TEMPI
APPROPRIATEZZA
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CHI SONO I NOSTRI PAZIENTI ?
21 PTZ
12 M, 9 F 12 M, 9 F
ETA' MEDIA 61,5 (45-82)
DONNE 60,25 UOMINI 56,15
19/21 a Mestre ( 2 casi a Mirano)
ANNO 2010 dati S Donà di Piave
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COME ARRIVANO IN PS?
44,6% CON MEZZODEL 118DEL 118
55,4% CON MEZZIPROPRI
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DA QUANTO TEMPO ERA INIZIAT0IL DOLORE?
con ambulanza mediana 120 min
con mezzo proprio mediana 60 min
In 16 ptz tempo medio 125 min In 16 ptz tempo medio 125 min
In 5 paz difficile determinazione
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I TEMPI INTEROSPEDALIERI
MEDIANA 90 min MEDIANA 90 min
MEDIANA 100 min
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GOAL ENTRO 90 MIN
55,3 %
41,5 %
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GOAL ENTRO 120 MIN
77,7 %
83,3 %
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PercorsiDolore da 60min (mediana)
14 min
100 min(mediana)
PS
14 min
ECG
goal
goal
Dolore da120 min(mediana)
90 min(mediana)
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La peggior performance
In un paziente per evercrowding nel proprioospedale (spoke) 150ospedale (spoke) 150
In un paziente per overcrowding nell'ospedaledi riferimento (hub) 180 min
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CONCLUDENDO...grazie perl'attenzione