ABSTRACT
On 13 May 2012, the Quarterly Cardiology Conference program was organized by the Trinidad and Tobago Medical Association and The University of the West Indies, St. Augustine. The program provided a forum for discussion of issues related to the implementation of best practices in the management of patients requiring cardiac catheterization laboratory (Cathe Lab ) procedures. The participants who were stakeholders in the management of patients referred for catheter-based procedures reviewed best practice guidelines for patients, identified local barriers to the implementation of these best practices and made recommendations for the implementation of these best practice guidelines
Subject(s)
Cardiac CatheterizationABSTRACT
Shortage of Coronary Care Unit (CCU) beds prompted a study (I) to determine the number of patients with a suspected acute myocardial infarction (SAMI) who could not be placed in the CCU, but qualified for intravanous (IV) B-Blocker therapy, and (II) to assess the safety of such therapy in a general medical ward. During a six-month period, 34 patients with chest pain and E.C.G. changes of SAMI could not be placed in the CCU. Criteria for exclusion from B-Blocker therapy were the presence of >= 1 of the following: (1) age > 70 years, (2) Systolic B.P. < 100 mmHg, (3) Heart rate < 60 /min., (4) Cardiac failure, (5) Heart block, (6) Poor peripheral circulation, (7) Asthma or chronic bronchitis, and (8) Prior therapy with B-Blocker or calcium antagonists. 15 (44 percent) patients were excluded from therapy based on the above criteria. 19 (56 percent) received 5-10 mg atenolol IV within 3-10 hours of onset of chest pain and atenolol 100 mg daily was started immediately and continued indefinitely. 12 of these patients had an anterior wall, and 3 an inferior wall infarction. 3 developed congestive cardiac failure and none required anti-arrhythmic therapy. There were 2 deaths - 1 from ventricular asystole, and the other from cardiogenic shock 8 and 12 hours respectively after IV atenolol. While this small-scale study highlights the need for more CCU beds for optimum care, our results suggest that selected patients with SAMI managed in the general medical wards can still safely obtain the benefits of IV B-Blockade. (AU)
Subject(s)
Humans , Myocardial Infarction/therapy , Adrenergic beta-Antagonists/therapeutic use , Coronary Care Units/supply & distribution , Trinidad and Tobago , Intensive Care Units , Treatment OutcomeABSTRACT
A ten-year survey of the magnitude and causes of obstetrical deaths at Mount Hope revealed a maternal mortality rate of 33.3 per 100,000 live births. The leading causes of death were the hypertensive disorders, and the most common identifiable factors were inadequate antenatal care and substandard clinical management.
PIP: Obstetrical deaths at the Mount Hope Women's Hospital, Trinidad, were reexamined from records over 1981-1990, and discussed under the categories poor prenatal care, clinical management or provision of medical facilities. There were 19 obstetrical deaths out of 57,012 live births, giving a maternal mortality rate of 33.3/100,000 in this tertiary care hospital. Most of the deaths occurred in women aged 30-34, para 5 or more. 73.7% were related to hypertension in pregnancy, 8 with severe eclampsia and 6 with eclampsia, and the other 5 were due to placental abruption, postpartum hemorrhage, anesthesia complication, acute fatty liver and amniotic fluid embolism. Cases classified as substandard care included the 14 women with hypertensive disorders, none of whom had antenatal care at this specialized unit. In 3 referral by the practitioner was delayed, and 3 others did not comply. A woman listed under failed medical facilities had massive abruptio placenta, and no fresh blood was available, and another had an anaphylactic reaction to a mismatched blood transfusion. Other avoidable deaths were 3 associated with general anesthesia: one woman having emergency cesarean section for severe pre-eclampsia had anoxia and severe brain damage; another short, obese woman had cardiac arrest during a failed attempt at endotracheal intubation; a third died from aspiration of gastric fluid. The high mortality among women with hypertensive disorders is regrettable, considering lack of referral to this specialized unit, but the prognosis of eclamptics even with expert aggressive treatment is poor. This maternal mortality rate ranks midway between those of developed countries and developing countries. It is about four times that of the U.S.
Subject(s)
Hospital Mortality/trends , Maternal Mortality/trends , Adolescent , Adult , Cause of Death , Female , Hospitals, Special , Humans , Jamaica , Retrospective StudiesABSTRACT
A ten-year survey of the magnitude and causes of obstetrical deaths at Mount Hope revealed a maternal mortality rate of 33.3 per 100,000 live births. The leading causes of death were the hypertensive disorders, and the most common identifiable factors were inadequate antenatal care and substandard clinical management. (AU)
Subject(s)
Humans , Pregnancy , Female , Maternal Mortality/etiology , Pre-Eclampsia/mortality , Eclampsia/mortality , Prenatal Care , Trinidad and TobagoABSTRACT
A ten-year survey of the magnitude and causes of obstetrical deaths at Mount Hope revealed a maternal mortality rate of 33.3 per 100,000 live births. The leading causes of death were the hypertensive disorders, and the most common identifiable factors were inadequate antenatal care and substandard clinical management.
