NPunto

9

Authors: Redondo Castán, L.C

ST-segment elevation acute coronary syndrome, hereinafter ACSEST, is an entity whose diagnosis is frequently made at the prehospital level and, therefore, decisions about the therapeutic strategy are made before arrival at the hospital by the care team primary and/or prehospital emergency team. The highest lethality occurs in the prehospital setting. For all these reasons, those involved in the process must act in an efficient and coordinated way.(1). The healthcare team that cares the patient in the prehospital phase must recognize and identify ACSEST (2) and know the updated care protocol for this time-dependent pathology in order to start the most appropriate treatment as soon as possible. If the indicated reperfusion strategy is a primary percutaneous coronary intervention, it is necessary to monitor the times of clinical onset and transfer to a useful hospital, in addition to coordinating care with the catheterization team that will receive the patient. The case of a 35-year-old patient who activated 112 due to chest pain of 2 hours of evolution is described. The speed of diagnosis, the activation of the Infarction Code, the early initiation of therapy, the transfer to a useful center with the availability of a Hemodynamics Unit, and the treatment of complications improved patient survival and avoided a fatal outcome. Objective To present a real clinical case of a young patient suffering  ACSEST. Know the importance of the role of nursing professionals at the prehospital level in an emergency situation. Know how to assess, anticipate and act against the potential complications that may occur in patients with ACSEST. Conclusions The role of prehospital nursing requires up-to-date training in processes and time-dependent pathology, knowing how to correctly and exhaustively assess the patient in an urgency and/or emergency situation, carry out the appropriate interventions and anticipate the potential complications that the acute cardiac process implies. All this allows the patient with a STEACS to receive assistance and care of excellent quality until the definitive treatment is established.

20

Authors: Ruigómez Cruzado, E

Stroke is a cerebrovascular disease caused by the decrease or obstruction of blood flow in an area of the brain and as a result, nerve cells do not receive the necessary oxygen and stop working (2). It is a global socio-health problem that mainly affects people over 55 and the risk increases with age. However, we also found stroke in young patients, although it is usually rare, according to different studies the prevalence is between 1% and 12% (1). This group represents the majority of the economically active population and contributes to the development of a country. The average age of onset of stroke has been decreasing in recent years due to an increase in the prevalence of vascular risk factors (3).

23

Authors: Solís Marquínez, M.N

Ischemic heart disease is the leading cause of death and disability in the developed world. According to population aging, individuals over 65 years of age now reach 20% of the total population and are expected to continue increasing in the coming decades. In recent years, the treatment of acute coronary syndrome has been implemented with a significant improvement in the prognosis of these patients, however, the quality and quantity of scientific evidence of treatment in the elderly is limited, due to the limited inclusion of patients in this age group in clinical trials. In addition, although there are studies in the elderly that show a greater survival with an intensive than conservative management, without showing significant differences in terms of bleeding complications, it is common to see a lower indication of these therapies due to an increased perceived risk of adverse effects. In order to avoid this subjectivity of the perceived risk and the correct classification of elderly patients in an intervention group or not, we must use the bleeding and ischemic risk scales, but also those of physical dependence, instrumental capacity, comorbidity, cognitive impairment, fragility and one’s own life expectancy at the time of diagnosis of acute coronary syndrome. On the other hand, the patient’s medication must always be reviewed jointly, relying on the STOPP-START criteria, as well as an adequate adjustment of the dose of the different active ingredients. Thus, in the majority of elderly patients with acute myocardial infarction, an early invasive strategy with coronary angiography and revascularization should be considered if necessary, in addition to antiplatelet treatment adapted to the characteristics of the patient, given the favorable risk-benefit relationship in terms of prognosis and complications inherent in it. For these reasons, future research should be directed to a greater inclusion of elderly patients in clinical studies and trials, given the progressive increase in this population group, the higher life expectancy and the high incidence of cardiovascular pathology together with its high mortality.