Tuesday, May 31, 2011

Golden hours in medical practice

One should not ignore warning signals as “time is life” in medical science.  The three cardinal warning signals are: anything which is unusual, anything which cannot be explained and any symptom appearing for the first time in life. Time is life is an old saying. In heart attack time is muscle and in brain time is brain.

Most acute emergencies will require emergent evaluation and treatment. Delay in treatment even of minutes can take away the life. In emergency one should not waste time to think, rush to a bigger hospital with full facilities and make sure that the person is attended to in time. Many hospitals may have ill equipped emergency departments or may have inadequately trained staff. In nursing homes the ER doctor may be from other systems of medicine.

In emergency medicine, the golden hour refers to the first hour following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death. If bleeding can be stopped and person can be infused enough fluids within first hour most trauma death can be avoided.

Platinum ten minutes refers to first ten minutes after trauma and refers to  the importance of starting first aid within ten minutes to reduce the chances of death.

Door to ECG Time is an important terminology in the treatment of heart attack. One should get an ECG within 10 minutes of chest pain. A prolonged door-to-ECG time is associated with an increased risk of clinical outcomes in patients with ST elevation heart attack.

Door-to-Doctor Time in Stroke is another term. In emergency department arrival to initial physician evaluation should be less than 10 minutes in stroke or the mortality will be high.
Door to neurologist time is for the specialist. In emergency department arrival to Paralysis Stroke Team Notification time should be less than 15 minutes.
Door to CT scan time is the time before which the CT should be done in suspected paralysis. In the emergency department arrival to CT Scan initiation in stroke should be less than   25 minutes. Door-to-CT Interpretation in stroke should be < 45 minutes
Door to tPA time is the treatment window in paralysis: 80% of eligible paralysis  patients presenting to the emergency department should be treated with tPA clot dissolving drug within 60 minutes.
Door to antibiotic time in community acquired pneumonia is the time to start antibiotics. Practice guidelines suggest that all patients hospitalised with community-acquired pneumonia should receive antibiotics within 4 h of admission
Door to antibiotic time in meningitis of more than 6 hour is linked to high mortality (8.64 times).
Door to needle time in acute heart attack is the time before which the clot dissolving drug should be given:  In ST elevation heart attack recommended that the door-to-needle time should be less than 30 minutes.
Door to balloon time is for angioplasty. Primary percutaneous coronary intervention  is now preferred for most patients if it can be performed by an experienced operator with less than a 90 minute delay from presentation to the emergency department.

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