Name: Marielle Sierralta

Subject: Comprensin y redaccin en ingls.

Professor: Nicols Reyes

Implementation of a protocol of action in cardiovascular disease
in the emergency room.

Abstract:
In the emergency room at a hospital site you can find various types of cardiovascular diseases that
can be fatal if not treated quickly and effectively, both diagnosis and treatment. For this purpose,
encourages the implementation of a protocol for action in the onset of these diseases, both acute
mild , intermediate and , for appropriate timely care , and follow a procedure to reduce the
incidence of possible pathology , providing measures to improve quality of life , drugs or required
operations . For its realization data is used from the detection of pathology if risk of death or to be
derived, taking exams etc. this in order not to make wrong decisions under pressure depending on
the urgency. This paper deals with the realization of a basic protocol to be implemented in any
health center that has emergency area so if you choose to make must be measured in the
response effectiveness of health personnel manager.
Keywords: Protocol, cardiovascular pathology , Urgent Care , Detection, GES , quality of life ,
prevention, MINSAL , Referral, Medical history, Therapies , Cardiologist , Emergency Room ,
Fonasa , Risk Factors , First Aid, medical equipment maintenance electrocardiographic evaluation ,
Nurses , cardiac arrest, physical examination , anamnesis , arrhythmias , cardiac physical
overexertion , cardiac arrest .






Introduction
Cardiac diseases in our country have increased in recent years as well as around the world, this is
reflected in the practices we do every day, and we see every day in the community, some
examples of this are bad ways power that is reflected especially in children, sedentary lifestyle and
not enough exercise is carried high consumption of alcohol, cigarettes and junk food and other risk
factors which translates to a low quality of life in population, which is dangerous because of the
large number of diseases may occur.
Because we know that different cardiac diseases are included within the 80 GES also associated
as hypertension or diabetes (Explicit Guarantees in Health) diseases, these diseases were given by
the Ministry of Health of the Chilean government for all health institutions, the cardiac pathologies
are diagnosed with a first event in the emergency room as people get used to not continually
checked to see their health and the population is very little preventing such diseases. Another
important factor is coming from the source and not necessarily from a poor quality of life of the
person, or overexertion that generates an alteration is our heartbeat.
From the above history is planned for a basic protocol to respond to emergencies that come to
the emergency room of a hospital, as appropriate diagnoses are not fatal to the patient if they are
above, but emergencies can have results death.
So based on manuals cardiovascular emergencies National Institute of Cardiology of the city
Mexico and other reports of minor diseases seen in emergency rooms of our country, is the
creation of a protocol for the most common diseases that occur in the unit.
This paper will present the basis for the realization of the protocol in our country and examples of
how they should be performed generally for traders or professionals on duty in the emergency
department can perform a quick task.









Development.
1.1 Cardiovascular disease
Cardiovascular disease refers to heart disease and diseases of the blood vessels (arteries,
capillaries, veins) around the body such as the brain, legs and lungs. "Cardio" refers to the heart
and "vascular" blood vessel system.
Heart problems and blood vessels do not happen quickly. Over time, the arteries that carry blood
to the heart and brain can become blocked due to the accumulation of cells, fat and cholesterol.
The decrease in blood flow to the heart due to clogged arteries cause heart attacks. The lack of
blood flow to the brain caused by a blood clot or bleeding in the brain due to rupture of blood
vessels is what causes a stroke.
Unfortunately cardiovascular disease have no symptoms and are manifested through a heart
attack or brain as mentioned earlier, when treatment options are minimal and improvement; but
the sooner you seek medical center after an event, the more likely to survive.
According to the World Health Organization (WHO) in 2005 some 17 million people died due to
coronary heart disease, 30% of all deaths recorded that year; why is projected that by 2015, this
number increased to 20 million, mainly due to cardiovascular events.
1.2 Risk Factors
These increase the likelihood of cardiovascular disease if not taken with caution
Not modifiable: These are age, sex and family-genetic history as it has been shown that there is a
familial tendency to develop cardiovascular disease.
Modifiable: We can change by any intervention to prevent negative influence on our health. These
include: Smoking, Diabetes mellitus, arterial hypertension, high cholesterol or dyslipidemia
Obesity, Sedentary lifestyle, psychosocial factors.
1.3 Cardiovascular disease in Chile
Currently, cardiovascular disease remains the leading cause of death in Chile, which are
manifested as follows most prevalent:
1) HYPERTENSION
The prevalence of hypertension in Chile, for the general adult population is 26.9% Where In 90% of
hypertensive patients, this system is affected by external factors such as obesity and excessive salt
intake. In the remaining 10%, there is a specific disease that causes the problem.


2) CORONARY ARTERY DISEASE AND ACUTE INFARCTION
Only in Chile more than 11,900 strokes occur annually, the patient's life will depend largely on the
action of the medical staff in the emergency room.
3) CEREBRO-VASCULAR ACCIDENTS.
These types of accidents occur when blood flow to part of the brain stops. When this happens,
that body stops receiving blood and oxygen, causing permanent death of brain cells.
4) VALVULAR PATHOLOGIES.
Within this group are all diseases that affect the heart valves, which are responsible for blood to
travel in the right direction to avoid being returned. These conditions are repaired primarily with
drugs and surgeries scheduled and can be detected early and treatment can be followed.
1.4 Warranties cardiovascular pathologies and explicit health (GES)
The explicit guarantee health of our country with regard to cardiovascular disease occurs in the
following conditions:
1) Acute Myocardial Infarction: All secured from access, diagnosis and treatment.
2) Hypertension: to be a major risk factor ensures diagnosis and treatment for 15 years or more.
3) Ischemic cerebrovascular accident: diagnosis and treatment monitoring insured for 15 years or
more
4) Surgical Treatment of Chronic Injuries Aortic Valve once confirmed, treatment and follow-
insured for 15 years or more.
5) Surgical Treatment of Chronic Injuries of the Tricuspid and Mitral Valves, once confirmed,
treatment and follow-insured for 15 years or more.
6) Type 1 Diabetes Mellitus is a major risk factor. Diagnosis and treatment is assured.
Only the first point corresponds to a rapid emergency care, as these must be diagnosed at the
time. The points if left untreated can result in long-term myocardial infarction, but because of the
explicit guarantees these have their own procedures to minimize the risk status of patients.
In the following figure we can see cases per 100,000 beneficiaries in the period 2011 to June 2012,
where we can see the prevalence of acute myocardial infarction diseases (800) and diabetes
mellitus (715) and hypertension (1598) as risk factors important.


Figure 1: Number of cases of disease in GES per 100 beneficiaries.
1.5 Diseases in emergency room:
With the above background, we can say that it is necessary for professionals in emergency room
very familiar proceedings before a cardiac emergency mostly these are myocardial infarction and
ventricular / atrial fibrillation, arrhythmias and stroke (stroke), for this reason encouraged to
perform a protocol for particular diseases as it should act as quickly as possible.
1.6 Protocol with diseases that arrive at the emergency room:
We can mention some examples for the formation of this protocol are the cardiac arrest and when
you have chest pain in the emergency department and should be diagnosed quickly, it is
noteworthy that this procedure is in compressed form exemplary.









Example 1
Stop-cardiorespiratory (PCR)
The cardiopulmonary arrest (CPA) is the sudden disappearance of the contractile activity of the
heart and spontaneous ventilation. The most common cause is ventricular fibrillation / pulseless
ventricular tachycardia present in up to 90% of cases in the first 10 minutes of evolution; is
common later degenerate into asystole
Procedure:
Defibrillation: To perform defibrillation should apply conductive gel between the blades and the
skin properly attach the blades with skin and avoid as much as mobilizing accidental at the time of
discharge; also be applied to the vane pressure of about 5 to 10 pounds on the chest wall.
Technique:
Should follow the steps in an orderly in order to minimize accidents and complications secondary
to the application of this therapy.
1. Identify rhythm of ventricular fibrillation or pulseless ventricular tachycardia, and not confuse it
with artifacts.
2. Request the defibrillator.
3. Igniting the defibrillator.
4. Taking the blades, place a sufficient amount of gel to each and position on the patient's chest.
5. If necessary, charge the defibrillator to an initial energy of 200 J, then 200 J to 300 J and 360 J
to finish, if required. After the above PCR was performed for one minute, and then, if needed, a
new download is performed 360 J.
6. When it is ready for downloading, prior notice is given to the medical team, and for that the
operator himself watching anyone is in contact with the patient. It is important that the operator
gives directions for a clear, precise and with sufficient volume to receive the attention of all crew
voice.
7. Toggle the use of the defibrillator with CPR even vasoactive and antiarrhythmic drugs in the
following sequence: rhythm-drug-resuscitation cardiopulmonary recirculation-download it.
8. As long rhythm of ventricular fibrillation is important to continue this therapy, which is
suspended once you get perfusing rhythm or asystole ensues.
DRUGS:
Vasopressors or antiarrhythmic.
Example 2
Chest pain in the emergency department. (<10 minutes)
Immediate evaluation
Measure vital signs (standard sphygmomanometer / automatic); connected to a monitor.
Measure oxygen saturation (the fifth vital sign).
Obtain intravenous access.
Take a 12-lead electrocardiogram (and analyze).
Conduct a brief interrogation and directed, in addition to a clinical examination; lead with focus
set to approve or discard the patient to fibrinolytic therapy.
Take a sample to measure serum macromolecular markers of myocardial injury (myoglobin, CPK,
CPK-MB, troponin T and I).
Assess electrolytes and clotting times.
If the situation permits, request a portable chest radiograph
(<30 min)
Two. Immediate General treatment
Administer supplemental oxygen at 4 L per minute.
Aspirin, 160-325 mg (ordered to chew and swallow).
IV nitroglycerin dose-response.
Morphine (if the pain does not subside with nitroglycerin).






Results.
Investigating some health centers, has found some existing protocols including emergency
cardiac pathologies, as well as the diagnosis of this which is a long procedure and must also be met
by the patient and meet special diets and medications.
It also takes referrals from a boom 2003 protocol called "MANAGEMENT OF PATIENTS WITH
ACUTE MYOCARDIAL WITH ST SEGMENT ELEVATION", so integrating multiple protocols can
perform a general one that can be delivered by the health ministry.
Still shows that in Chile have begun to develop this type of document, which can always be helpful
to the official, yet not present in all health care facilities.

Conclusions.
Cardiovascular diseases are strongly present in our country by the style and quality of life of the
Chilean population, they are trying to prevent in the course of life with regular surveys and
diagnostics for people to know their health status voluntarily made.
Finally carelessness of the population end in illnesses like hypertension or diabetes which may end
up with a type of heart disease, which can be triggered quietly suddenly in the body triggering an
arrhythmia or ventricular fibrillation that can lead to death.
For arrival in the emergency room is the quickest and timely manner possible, encourages the
creation of protocols action in cardiac pathologies in the emergency room that are high risk for
officials to respond quickly and timely.
In our country the existence of a national protocol does not exist because each hospital depends
on its realization, even if you are protocols for the diagnosis and monitoring of these which can be
supplemented.
Internationally the existence of a manual of cardiovascular emergencies is important for health,
and to act efficiently officials.
Data from cardiovascular disease in our country give rise to the creation of this protocol based on
previous articles from more developed countries in this field, once developed should be measured
the effectiveness of this and if given the emergency system improvements.



References
1) Operating cardiovascular emergencies, 3rd edition, mc Graw hil, National Institute of Cardiology
"Ignacio Chavez"
2) Document "AUGE 80", obtained from the page www.minsal.cl
3) Document "Management of patients with acute myocardial infarction with ST segment
elevation" of the product obtained
http://www.nutricionistasdechile.cl/documentos/protocolos/PROT_IAMdesnST1.pdf











.