Acute epiglottitis in a 47‐year‐old male: Case report

@#Acute epiglottitis (AE), an inflammation of the epiglottis and adjacent supraglottic structures, can lead to a fatal airway obstruction. We report the case of a 47­year­old male who developed AE after experiencing a sore throat, odynophagia, and high­grade fever for a week. The patient came in with late signs of AE, suggesting a poor prognosis. Laryngoscopy revealed a swollen epiglottis obstructing the patient’s tracheal opening. He had cardiopulmonary arrest due to the airway obstruction. The patient was successfully resuscitated but had several episodes of generalized seizure after the return of spontaneous circulation. He was discharged in a persistent vegetative state. Because AE is unusual in the adult population, a clinician's high index of suspicion for the diagnosis and the emergency team’s prompt intervention are crucial factors in the management approach to AE. Physicians working in the emergency room must be equipped with skills in establishing a definitive airway, especially in securing a surgical airway.

In-hospital interventions to promote relational practice with families in acute care settings: A scoping review

Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families' needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions. Contribution: The scoping review has highlighted specific elements of relational practice that have been overlooked in the mapped interventions. This provides guidance on where future interventional research may be focused.

A low phase angle determined by bioelectrical impedance analysis is associated with oropharyngeal dysphagia among institutionalized older adults

SUMMARY OBJECTIVE The aim was to evaluate the prevalence of oropharyngeal dysphagia (OD) and its association with body composition by bioelectrical impedance analysis (BIA) and functionality among institutionalized older adults. METHODS A cross-sectional study was conducted. The swallowing function and diagnosis of OD were evaluated with a volume-viscosity swallow test. Activities of daily living were evaluated by the Barthel Index. Body composition was evaluated by BIA, and phase angle (PhA) was determined. RESULTS Eighty institutionalized older adults were evaluated. The mean age of the study population was 82±9.5 years, and 65% were females. The OD prevalence was 30%, dependence was 30%, and sarcopenia was 16%. In the multivariate analysis, a low PhA (<3.5°) was independently associated with the presence of OD adjusted by sex and age (OR: 2.60, 95%CI 2.41-2.90, p=0.01). CONCLUSIONS A higher prevalence of OD was found. Significant and independent associations were found between low PhA, dependence, and sarcopenia with the presence of OD among institutionalized older persons.

Descriptive analysis of the adherence to the acute care protocol for adult female sexual abuse patients seen at the OB admitting section in a tertiary public hospital in the Philippines / Philippine Journal of Obstetrics and Gynecology

Background@#There has been an increasing trend in reported sexual abuse patients in the Philippines in the past 20 years. Patient evaluation is critical from health care providers and it is imperative to have an acute care protocol that heath care providers can use in managing these patients.@*Objective@#To assess the adherence to the acute care protocol as applied to adult female sexual abuse patients who consulted at the Philippine General Hospital OB Admitting Section from March to August 2019@*Methods@#The study design used was an observational, cross-sectional study via descriptive analysis using a designed questionnaire. Relevant data regarding compliance to the acute care protocol was assessed from patient experience via the questionnaire after undergoing the standard services of the hospital. Data was then documented, tabulated and processed via Microsoft Excel data sheets.@*Results@#In terms of patient perspective, 96.2 % of all cases (n=27) were provided service by OBGYNs and psychiatrists and 100% were assessed by social workers. Although stated in the protocol, legal and/or police assistance was not provided by the hospital during patient consult.@*Conclusion@#The institution was able to adhere to the acute care protocol services of patients in terms of obstetric and gynecologic, psychiatric and social worker services but not legal and/or police assistance.

Awareness and Difficulties of Nurses in the Outpatient Setting of University Hospital A, Which Provides Advanced Acute Care / 日本プライマリ・ケア連合学会誌

Introduction: The purpose of this study was to clarify the awareness and difficulties of home care support in outpatient nursing at an advanced acute care hospital.Methods: An anonymous questionnaire survey of outpatient nurses at a university hospital was conducted using a detention method.Results: In total, 195 questionnaires were analyzed (effective response rate: 89.9%). The number of years of outpatient nursing experience was within 1 to 3 years for 40%, being the highest. Regarding the importance of outpatient care in supporting home care, approximately 97% of the subjects answered that they 'always think' or 'sometimes think' that it is important. On the other hand, approximately 50% of subjects answered that they 'always' or 'sometimes' perform home care support. Eight difficulties in outpatient home care support were identified: [insufficient manpower], [shortage of time], [difficulties in understanding which patients need home care support], [lack of knowledge], [difficulties in in-hospital and community collaboration], [support not keeping up with current medical change], [number of outpatients], and [time-consuming support].Conclusion: It is necessary to improve the individual skills of outpatient nurses in order to provide seamless medical care and systematically improve the outpatient nursing system, including streamlining work, and facilitating in-hospital and community collaboration.

Review and inspirations of the payment mechanism of Long-Term Care Hospital of Medicare of the United States / 中华医院管理杂志

A type of designated hospitals in Medicare is referred to as Long-Term Care Hospital (LTCH). LTCH is one of Post-Acute Care settings(I. e. Intermediate care)and the only facilities certified by length of stays. This article reviewed the milestones and payment methods of Medicare Long-Term Care Hospital payment system, for perfection of the medical insurance and construction of China′s intermediate care system.

Care experiences of an old patients with acute illness and frailty based on the acute care for the elderly unit / 中国实用护理杂志

Objective Summing up the care experience about a patients with acute illness and frailty. Methods Taking care of the patients based on the acute care for the elderly unit model (ACE), using the methods of admission assessment, interdisciplinary team, function-centered care model, ward environment design, early care transition planning and meeting with family members. Results The patient was discharged 10 days later, without function decline or complication related to admission. Conclusions ACE unit model is a successful care model which take a holistic care for old patients in order to maintain the function during hospitalization.

What do caregivers value and is there agreement in perception of met needs between nurses and caregivers?

INTRODUCTION@#There is an increasing reliance on informal caregivers to continue the care of patients after discharge. This is a huge responsibility for caregivers and some may feel unprepared for the role. Without adequate support and understanding regarding their needs, patient care may be impeded. This study aimed to identify the needs valued by caregivers and if there was agreement between acute care nurses and caregivers in the perception of whether caregiver needs were being met.@*METHODS@#We conducted face-to-face interviews with 100 pairs of acute care nurses and caregivers. Participants were recruited from inpatient wards through convenience sampling. Questionnaires included demographic data of nurses and caregivers, patients' activities of daily living, and perception of caregiver needs being met in six domains of care. Independent t-test was used to compare mean values in each domain, and intraclass correlation coefficient was used to compare agreement in perception.@*RESULTS@#Caregivers valued reassurance the most. Three domains of care needs showed significant differences in perception of caregiver needs being met:reassurance (p = 0.002), honesty and timeliness (p = 0.008), and kindness and genuine care (p = 0.026). There was poor agreement in all six domains of caregiver needs being met between nurses and caregivers.@*CONCLUSION@#Although caregivers valued reassurance the most, there was poor agreement between acute care nurses and caregivers in the perception of caregiver needs being met. Hence, more attention should be paid to the caregiver's needs. Further studies can examine reasons for unmet caregiver needs and interventions to improve support for them.

Intravenous fluid selection rationales in acute clinical management / 世界急诊医学杂志（英文）

BACKGROUND:Intravenous fluid (IVF) is commonly used in acute clinical management. This study aimed to review the choice and primary considerations in IVF prescriptions and to evaluate the adequacy of guidelines and trainings on it in the New Territories West Cluster (NTWC) of Hong Kong. METHODS:This is a descriptive study based on data collected from an online survey. Data were processed by SPSS for statistical analysis. This study focused on a general description and doctor-nurse between group comparison. Participants were asked the choice of IVF for nine acute clinical scenarios and provide reason. A 1–10 scale was used to assess the sufficiency of guideline, training and information, and time for revision on IVF prescription. RESULTS:0.9％ sodium chloride was the most familiar IVF (36％), followed by 5％ Dextrose solution (26％). In the nine scenarios, the most chosen IVF was 0.9％ sodium chloride (37％–61％). There was significant difference in the choice of IVF between doctors and nurses in 7 cases. The second most chosen IVF for doctors was Plasma-Lyte A while that for nurses was Gelofusine. Departmental practice was the most chosen reason to account for the prescription. The adequacy of guideline, information and training, and time for revision was rated 5. Doctors had significantly more time at work than nurses to update knowledge in IVF prescription (5.41 versus 4.57). CONCLUSION:0.9％ sodium chloride was mostly chosen. The choice of IVF was mainly based on departmental practice. Adequacy of guideline, information and training, and time for revision on IVF prescription were average, indicating significant training deficit.

Acute Care Surgery: Implementation in Korea

The concept of acute care surgery (ACS) incorporates trauma, surgical critical care, and emergency general surgery. It was designed in the early 2000s by the United States as a solution to the looming crisis of trauma care and non-trauma emergency surgery. Reduced surgical opportunities for trauma surgeons resulted in a decreased interest in trauma surgery. Surgical sub-specialization further accelerated an indifference towards trauma and emergency general surgery. Started in 2008, the trauma center project in Korea is still in its infancy. Although the need for ACS was presented since the inception of the trauma center project, there was a lack of implementation at trauma centers due to government regulations. However, ACS has been initiated at several non-trauma center hospitals and is mainly operated by surgical intensivists. Studies demonstrate that adding emergency surgery to a trauma service does not compromise the care of the injured patients, despite an increase in trauma volume. Positive impacts of ACS are reported by numerous researches. We believe that the development and advancement of trauma centers will necessitate a discussion for the implementation of the ACS model at trauma centers in Korea.

Overview and development situation of acute care of the elderly unit / 中国实用护理杂志

This paper introduced the basic concept, development background, development situation and pattern of acute care of the elderly unit, so as to improve the public cognition and development of acute care of the elderly unit.The practices of acute care of the elderly unit could improve the hospital outcome of elderly patients and enhance the quality of life.

Simulation in pediatrics: Is it about time.

Pediatrics is a challenging field where “Time is Essence” and the interplay of time-bound dynamics has a huge influence on the outcomes, particularly in an acutely ill child. In this context, simulation based training appears to play a major role in training young Paediatricians to develop critical decision making skills and learning in a risk-free environment. In present times and in future, it is expected that simulation is used by practically every healthcare provider at some or multiple points in the training and certification process.

Acute Care/Trauma Surgeon's role in obstetrical/ gynecologic emergencies (The OBCAT Alert) / 世界急诊医学杂志（英文）

@#BACKGROUND: Overwhelming hemorrhage or other intra-abdominal complications may be associated with obstetrical or gynecologic (OB/GYN) procedures and may require the surgical training of an Acute Care/Trauma Surgeon. The OB Critical Assessment Team (OBCAT Alert) was developed at our institution to facilitate a multidisciplinary response to complex OB/GYN cases. We sought to review and characterize the Acute Care/Trauma Surgeon's role in these cases. METHODS: We conducted a retrospective review of all emergency consults during an OB/GYN case at our institution from 2008 to 2015. An OBCAT is a hospital based alert system designed to immediately notify OB/GYN, anesthesiology, Acute Care/Trauma, the intensive care unit (ICU), and the blood bank of a potential emergency during an OB/GYN case. RESULTS: There were 7±3 OBCAT alerts/year. Seventeen patients required Acute Care/Trauma surgery intervention for hemorrhage. Thirteen patients required damage control packing during their hospitalization. Blood loss averaged 6.8±5.5 L and patients received a total of 21±14 units during deliveries with hemorrhage. There were 17 other surgical interventions not related to hemorrhage; seven of these cases were related to adhesions or intestinal injury. Seven additional cases required evaluation post routine OB/GYN procedure; the most common reason was for severe wound complications. There were three deaths during this study period. CONCLUSION: Emergency OB/GYN cases are associated with high morbidity and may require damage control or other surgical techniques in cases of overwhelming hemorrhage. Acute Care/Trauma Surgeons have a key role in the treatment of these complex cases.

Acute care needs in an Indian emergency department: A retrospective analysis / 世界急诊医学杂志（英文）

@#BACKGROUND: Emergencies such as road traffic accidents (RTAs), acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are the most common causes of death and disability in India. Robust emergency medicine (EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department (ED) is needed.METHODS: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences (KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed.RESULTS: A total of 1196 ED patient charts were analyzed. Of these patients, 55.35％ (n=662) were male and 44.7％ (n=534) were female. The majority (67.14％,n=803) were adults, while only 3.85％ (n=46) were infants. The most common chief complaints were fever (21.5％, n=257), renal colic (7.3％,n=87), and dyspnea (6.9％,n=82). The most common ED diagnoses were gastrointestinal (15.5％,n=185), pulmonary (12.3％,n=147), tropical (11.1％,n=133), infectious disease and sepsis (9.9％,n=118), and trauma (8.4％,n=101).CONCLUSION: The patient demographics, diagnoses, and distribution of resources identifi ed by this study can help guide and shape Indian EM training programs and faculty development to more accurately refl ect the burden of acute disease in India.

Changing models of care for emergency surgical and trauma patients in Singapore

The last 15 years have seen changing patterns of injury in emergency surgery and trauma patients. The ability to diagnose, treat and manage these patients nonoperatively has led to a decline in interest in trauma surgery as a career. In addition, healthcare systems face multiple challenges, including limited resources, an ageing population and increasing subspecialisation of medical care, while maintaining government-directed standards and managing public expectations. In the West, these challenges have led to the emergence of a new subspecialty, 'acute care surgery', with some models of care providing dedicated acute surgical units or separating acute and elective streams with the existing manpower resources. The outcomes for emergency surgery patients and efficiency gains are promising. In Singapore, Khoo Teck Puat Hospital has implemented its first dedicated acute surgical unit. This article outlines the evolution of acute care surgery and its relevance to Asia.

A cross-sectional study on the relationship between stress and the level of job satisfaction among the burn unit staff of UP-PGH

OBJECTIVES: This study looked into the relationship between stress and the level of job satisfaction among the Burnt Unit staff of UP-PGH. Emphasis was placed in identifying the common stressors that the Burn Unit Staff of UP-PGH experience as a result of their day to day work in a critical care setting.The level of job satisfaction among staff was also determined.METHODOLOGY: Questionnaires assessing stress and job satisfaction were handed out to all the 31 participants of the study. The study population included 10 doctors and 21 nurses who had worked at the Burn Unit during the period of March to September 2007. Odds ratios were computed to determine if the presence of stress affects the level of job satisfaction among the Burn Unit Staff of UP-PGH. The resulting odds ratios were further tested for statistical significance using Fisher exact test and confidence limits.RESULTS: Of the 31 survey forms initially handed out to the Burn Unit staff, only 28 forms were completed and returned to the investigator at the end of the study period. Two items in the Stressful Situations Questionnaire were rated to be "stressful" by majority (>50%) of the respondents. Twenty-five percent of the respondents obtained positive scores in the Job Dissatisfaction Scale and were classified as being "dissatisfied" with their jobs. Twenty-two situations in the Stressful Situations Questionnaire were found to be significantly associated with job dissatisfaction among the Burn Unit staff of UP-PGH. These situations concerned the following areas: relationship with patients, family rejection, identification with the patient, deterioration and complications, job criticism, workspace, daily work, and therapeutic decisions.CONCLUSIONS: From the results of the study, recommendations were made to promote a system of stress-reduction for the Burn Unit staff. Regular group psychosocial processing sessions can be provided to allow the staff to ventilate their thoughts and feelings regarding personal and professional concerns. Team building activities for the staff can likewise be scheduled regularly to help solidify the group and resolve interpersonal conflicts among them. Future researchers could explore if a difference exists between the nurses and surgery residents in terms of their perceived stressors and their level of job satisfaction with their work in the Burn Unit.

Causes of access block and Emergency department overcrowding in Beijing: a two year study / 中华急诊医学杂志

Objective To study the causes of emergency department (ED) overcrowding and access block in Beijing.Methods This was a multi-center cross sectional study.The studied cohort of patients included all ED visiting patients from 18 municipal teaching hospital EDs in Beijing from 2012 to 2013.Patient' s characteristics and medical care settings were analyzed.Results The urgent care cases accounted for only 4.6 ％ (71 224/1 554 387) of the emergency annual visits in 2012 and 5.5 ％ (88 190/1 615 571) in 2013.The total number of observation patients in EDs was 185 277 and 211 900 in 2012 and 2013 respectively,with an increase of 14.4 ％ (P ＜ 0.01).The total ED-admission inpatients only accounted for 2.97％ and 2.89 ％ of total annual visits in 2012 and 2013 respectively.The average time of ED-admission took 37.1 hours and 36.2 hours in 2012 and 2013 respectively.The average time of ED stay for observation was 4.9 days and 5.4 days in 2012 and 2013 respectively.Upper respiratory tract infection was the leading illness in annual visits.The leading cause of ED stay for observation was bedridden with pneumonia.Conclusions The ED settings in Beijing are different from other countries.The EDs actually assume the task of the clinic and ED service for 24 hours thereby made EDs terribly overcrowded.The main causes are large number of non-emergency patients visiting the ED and patients in the ED are difficulty to be hospitalized.Patients with end-stage disease and multiple organ failure stayed in the ED due to nursing home shortage.

Future agenda for emergency medical service in Korea: from silos to systems

The primary role of the emergency medical services system in Korea is to provide quality urgent medical care. However, this system is regularly called on to perform additional roles such as responding to public health emergencies like the MERS-CoV outbreak and contributing to suicide prevention and chronic disease management. Despite substantial increases in the quantity and utilization of emergency medical services such as ambulances, the quality of the services has not improved significantly in the past decade. Overcrowding in Korea's emergency departments has threatened patient safety, particularly in large hospitals, with delayed care for patients and an increased risk of hospital-spread infections. To address these problems, the capacity of regional emergency medical centers must be augmented and an even distribution of quality achieved nationwide. The establishment of an organized delivery system for emergency medical services will improve pre-hospital transportation of patients and patient transfers between hospitals. Moreover, the introduction of an incentive system and the active involvement of emergency medical specialists in quality assessment programs are required to encourage providers to improve the quality of emergency medical services. Lastly, to meet the growing demands for emergency medical services, a system of integration between emergency medical care and general medical care should be instituted.

Terapia ocupacional en un hospital general de agudos de la Ciudad Autónoma de Buenos Aires, Argentina / Occupational therapy in acute care at Ciudad Autónoma de Buenos Aires, Argentina

Introducción: El rol de Terapia Ocupacional (T.O.) como lo llevamos a cabo en nuestros hospitales generales de agudos de la CABA(Ciudad Autónoma de Buenos Aires, Argentina), sea por falta de recursos humanos, características institucionales, o causas socioeconómicas, posee características particulares; es por ello que las intervenciones tienen un perfil diferente a los que encontramos en las publicaciones disponibles (Affleck, A., Lieberman, J.P. & Rohrkeper, K., 1986; Bondac, S., Hermann, V., Frost, L., Lashgari, D., Finnen, L. & Alexander, H., 2009; Eyres, L. & Unsworth, C., 2005; Giesbrecht, B., 2006; Raush, G. & Melvin, J., 1986). Objetivos: a) Estimar la distribución de frecuencias y cantidad de intervenciones de T.O. b) Determinar si el promedio de edad y la presencia de cuidador son diferentes según el tipo de intervenciones de Terapia Ocupacional. Material y Método: Se incluyeron 141 registros de pacientes adultos internados en un Hospital de Agudos que hayan recibido al menos 1 intervención (junio 2008-junio 2009). Estudio cuantitativo, analítico (comparativo a muestras independientes), prospectivo, longitudinal y observacional de cohorte (no experimental). Resultados: las intervenciones más prevalentes son la realización de interconsultas para pedir información; el uso de las actividades de la vida diaria; educación en desacondicionamiento; posicionamiento; sugerencia o realización de adaptaciones ambientales, férulas entre otras. Se hallaron diferencias significativas entre la edad y uso de actividades de la vida diaria, educación en uso adecuado de la mecánica corporal, posicionamiento, estimulación del alerta, educación en conservación de energía y protección articular, entre otras. Así mismo se encontraron diferencias significativas entre la presencia de cuidador y educación en desacondicionamiento por un lado y consultoría en organización de cuidados por el otro. Conclusiones: el trabajo muestra de acuerdo a la realidad institucional y estadio...

Introduction: The role of the Occupational Therapy (OT) in our acute care hospitals in Argentina has peculiar features, whether due to: lack of human resources, institutional characteristics or socioeconomic causes. Therefore the interventions have a different profile to those found in the available literature.(Affleck, A. , Lieberman, J.P. & Rohrkeper, K., 1986; Bondac, S. , Hermann, V. , Frost, L., Lashgari, D. , Finnen, L. & Alexander, H. , 2009; Eyres, L. & Unsworth, C. , 2005; Giesbrecht, B. , 2006; Raush, G. & Melvin, J. , 1986). Objetives: a) To estimate the frequency distribution and the number of OT interventions. b) To determine if the average age and the presence of a caregiver differ depending on the type of OT interventions. Material and Methods: 141 records of adult inpatients from the Acute Care Hospital who had at least one intervention were included. Comparative study to independent samples, prospective observational and longitudinal (june 2008-june 2009). Results: The most prevalent are interconsultations for information, use of daily life activities, education on deconditioning, positioning, suggestion or conducting for environmental adaptations, splints, among others. Major differences were observed between the age and the use of daily life activities, education on the proper use of body mechanics, positioning, stimulation of the awareness, training for energy conservation and joint protection, along with others. Also, significant differences were found between the presence of a caregiver and education on deconditioning and consultancy on care management. Conclusions: The study shows the most prevalent interventions in an acute care hospital, taking into account the institutional situation and the state of patients. Significant relationship between inpatients’ age and the different interventions such as use of daily life activities, education on the proper use of body, positioning, stimulation of the awareness was found.

La cardiopatía coronaria en México y su importancia clínica, epidemiológica y preventiva / Coronary heart disease in Mexico and the clinical, epidemiological and preventive relevance

La cardiopatía coronaria en el país es la patología cardiovascular dominante, un problema de prevención y control. Las estadísticas generales informan que las Enfermedades del Corazón figuran en 1er. Lugar, como causa de muerte, desde hace más de 20 años. El problema, ahora se agrava gradualmente, al ritmo de entonces y sin indicio de control. La aterosclerosis en todas sus formas es responsable de por lo menos la cuarta parte de todos los fallecimientos del país. Los datos combinados de mortalidad y morbilidad, general y hospitalaria, indican que la letalidad hospitalaria llega a ser de 25% por infarto agudo de miocardio (IAM). La atención, antes de morir, la recibe sólo 8 de cada 100, testimonio del certificado de defunción. El restante 92% no acude a ningún hospital, por algún motivo. La incidencia anual de IAM se estima en 140,000 casos; considerando que por cada fallecido (35,000) sobreviven 3. Las tasas de mortalidad por IAM, estandarizadas por edad, son más altas que EEUU y Canadá, lo cual crea una expectativa de mayor preocupación. La explicación más plausible sobre la situación es la deficiencia de la atención preventiva, misma que se debe incluir en las situaciones de urgencia y antes de llegar al hospital. Las formas agudizadas de hipertensión arterial, accidentes cerebrovasculares y diabetes mellitus comparten la misma suerte. La atención temprana y adecuada para estas condiciones críticas, puede contribuir importantemente a disminuir la mortalidad cardiovascular del país, a corto y mediano plazo. El enfoque preventivo debe considerarse tanto en lo crónico como en lo urgente y lo crítico. Conviene incluir en el fomento a la salud la cultura por un corazón saludable y paralelamente promover una conciencia colectiva acerca de los problemas sobreagudos. La prestación de cuidados oportunos salva vidas y miocardios. El refuerzo a la atención pre-hospitalaria reducirá el tiempo de retraso en la llegada de casos con IAM. Llevar a cabo estas actividades es compatible con los programas existentes de reanimación cardiopulmonar, cadena de supervivencia y capacitación a técnicos en urgencias médicas.

Coronary heart disease is dominant among heart diseases in the population, a problem to control. Heart diseases have been first place in the general mortality for the last 20 years. The trend show an annual increase without control. Atherosclerosis is responsible for at least for one fourth of all deaths in the country. The combined data of mortality and morbidity, from hospital discharges or the whole country, disclose that one out of three die of acute myocardial infarction (AMI). While only 8% of all deaths registered were admitted to a hospital. Most, 92% were never admitted to any hospital for some reason. The estimated annual incidence of AMI cases is 140,000, on the basis of 3 cases surviving for each case death, accounted by the Death Certification System, which rounds 35,000. Standardized mortality rates of AMI in Mexico are greater than in USA o Canada creating a more concerned worry. The most probable explanation to that situation is lack of preventive care, which should also include the acute care and before reaching the hospital facilities. Running the same chances are hypertension crisis and strokes and diabetic complications. The appropriate care for critical situations might reduce significantly the cardiovascular mortality in the country, in a short and middle term. Prevention is not only for chronic conditions but for acute and critical situations. The programs of preventive care should also include cultural promotion and community awareness. The timely care is life and myocardium saving. The reinforcement of prior to hospital care reduces the delay for AMI adequate intervention. These activities agree quite well with the ongoing programs of CPR, organizing the surviving chain and the training programs for paramedical emergency technicians. (Arch Cardiol Mex 2003; 73:105-114).