RESUMO
INTRODUCTION: Stroke is a development of an acute focal neurological deficit with an ischemic or hemorrhagic origin. Thrombolysis within 4.5 h of ischemic stroke onset improves outcome. Guidelines recommend administration of intravenous recombinant tissue plasminogen activator within 60 min upon arrival at the hospital, meaning the door-to-needle time (DNT) should be less than 60 min. In this study, a stroke protocol was introduced at the emergency department of the Ghent University Hospital with a primary goal to shorten the DNT. METHODOLOGY: This study was an uncontrolled before-after cohort study. A 'Code Stroke' protocol (CSP) was implemented and the results from the pre-code stroke protocol period (Pre-CSP period, from 15 August 2016 until 5 March 2017) were compared with the results from the post-code stroke protocol period (Post-CSP period, from 6 March 2017 until 16 July 2017). RESULTS: The median DNT decreased significantly from 57 min in the Pre-CSP period to 33 min in the Post-CSP period (p < 0.001). The door-to-triage time (DTT), triage-to-emergency physician time (TET), emergency physician-to-CT time (ECT) and CT-to needle time (CNT) decreased significantly Post-CSP compared to Pre-CSP. When adjusting the results for other variables that might have an influence on these time intervals, the TET, ECT and CNT also decreased significantly. There was a statistically significant effect of the implementation of the CSP on the number of patients treated with a DNT within 20, 30, 45 and 60 min (p = 0.008). CONCLUSION: A significant decrease in DNT can be achieved with the implementation of this stroke protocol.
Assuntos
Fibrinolíticos/uso terapêutico , AVC Isquêmico/tratamento farmacológico , Terapia Trombolítica/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Ativador de Plasminogênio Tecidual/uso terapêutico , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada , Medicina de Emergência , Enfermagem em Emergência , Serviço Hospitalar de Emergência/organização & administração , Estudos de Viabilidade , Feminino , Humanos , AVC Isquêmico/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neurologistas , Equipe de Assistência ao Paciente/organização & administração , Imagem de Perfusão , Radiologistas , Tomografia Computadorizada por Raios X , Triagem/organização & administraçãoRESUMO
In the literature, possible systemic effects on health of inhalation or ingestion of white spirit are well described. Only a few case reports discuss the toxic skin effects that can occur following massive ingestion. Ingestion of large amounts of white spirit produces a watery diarrhoea with a high concentration of white spirit, resulting in perineal skin burns when there is prolonged contact. We describe a patient who developed partial thickness perineal skin burns after ingestion of white spirit and review the literature. The present data indicate that conservative therapy of the skin burns is recommended.
