Online-conference “Hypertensive crisis under control”
On 4th of December for emergency medical care doctors, cardiologists and anesthesiologists was held the first Interdisciplinary Online-conference on cardiological issues “Hypertensive crisis under control”!
- Complicated hypertensive crisis is one of the main reasons of death and disablement in Ukraine
- Annually about 110-130 thousands of hypertensive crises are registered, and almost the third part of them among working age individuals
- 30-40% of patients with hypertensive disease die because of complications: cerebrovascular disturbance, acute myocardial infarction, renal irritation
- 100% of patients with hypertensive disease seek help from emergency medical care
- The cumulative loss of Ukraine’s economy from stroke can amount to UAH 100 billion per year!
Hypertensive crisis in Ukraine is an acute clinical situation demanding attention and sustainable actions.
During the scientific event, interdisciplinary council, consisting of Emergency Medical Care Doctors, Anesthesiologists, and Cardiologists the following issues were discussed:
- clinical route of patients with complicated hypertensive crisis
- management of the complicated hypertensive crisis at the stage of emergency medical care
- interesting clinical cases
- STEMI\NSTEMI management at the hospital level
Conclusions and decisions based on discussion of reports:
1. According to the conducted research “Analysis of cardiopulmonary resuscitation conducted at the pre-hospital stage in Ukraine” a sudden circulatory arrest (defibrillation rhythms) is usually caused by acute coronary syndrome – 144 persons out of 185 (77,8%), and non-defibrillation rhythms in case of acute coronary syndrome – 47 persons out of 199 (23,6%). The number of successful resuscitations in 2020 is equal to 799 persons.
The principal criteria of success are:
- Early diagnostics and beginning of CPR
- Ratio of chest compressions to "mouth to mouth" ventilation of the lung is 30:2
- Chest compressions shall be performed on all unconscious persons who are not breathing
- The probability of successful resuscitation is determined by the size of the perfusion (myocardium, brain) created at the moment of chest compression
2. Approved amendments to delivery of primary, secondary and tertiary medical care and cardiac rehabilitation “Acute coronary syndrome with ST segment elevation” dated September 14, 2021 № 1936.
Amendments to delivery of primary and tertiary medical care and cardiac rehabilitation “Acute coronary syndrome without ST segment elevation” dated September 15, 2021 № 1957.
The main change at the pre-hospital and hospital stage of emergency medical services is adding of beta-blocker Esmolol bolus in the amount of 500 mcg/kg 1 min and maintaining dose in the amount of 50 mcg/kg/min.
3. The research “Hemodynamic stabilization of AMI patients in the early period: impact of Esmolol infusion in patients regardless of arterial hypertension upon admission” was conducted.
If Esmolol is used for patients with ACS admitted to the hospital with elevated heart rate and having high, moderate, elevated and normal arterial blood pressure, administration of Esmolol helps to stabilize haemodynamics faster, to reduce the sympathetic overdrive and to make better prognosis even if there is no reperfusion and there was late admission of a patient.
The program of the event consisted of 5 reports:
- A sudden circulatory arrest at a pre-hospital stage – the state of the problem in Ukraine (Vitaliy Kryliuk, MD, PhD., the Head of Instructors Training Department of SE "Ukrainian Scientific and Practical Center of Emergency Medical Services and Disaster Medicine of the Ministry of Health of Ukraine", Instructor of the European Resuscitation Council)
- Review of principal amendments to the EMS Protocols since 2021 (Vitaliy Kryliuk)
- Management of a patient with a complicated hypertensive crisis at the stage of emergency medical care (Halyna Tsymbaliuk, PhD, the Head of Simulation Training Center of the I. Horbachevskyi Ternopil National Medical University, Director of ALS Course, the doctor of medicine of emergency, the member of the Coordination Council of NGO “All-Ukrainian Council on Resuscitation and Emergency Medical Services”)
- Possibilities of the initial drug-induced treatment in hemodynamic stabilization of patients with glucocorticosteroids: evaluation of Esmolol administration efficiency (Olena Koval, MD, PhD, Professor of the Internal Medicine Department No 3 of the Dnipro State Medical University)
- Practical case of Esmolol administration experienced by the doctor of emergency medical care (Yaroslav Kureza, Emergency Medical Care Doctor of PNE “Center of Emergency Medical Services and Disaster Medicine”, Kyiv)
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