References

Correspondence / American Journal of Emergency Medicine 33 (2015) 290-304

297

Ufberg JW, Vilke GM, Chan TC, Harrigan RA. Anterior Shoulder dislocations: beyond traction-countertraction. J Emerg Med 2004;27:301-6.

Neil C. A new drug free technique for reducing anterior shoulder dislocations. Emerg

Med J 2003;15:521-4.

Chechik O, Khashan M, Amar E, Dolkart O, Mozes G, Maman E. Primary Anterior shoulder dislocation. Harefuah 2011;150:117-21.

Norte GE, West A, Gnacinski M, van der Meijden OA, Millett PJ. On-field manage- ment of the acute anterior glenohumeral dislocation. Phys Sportsmed 2011;39 (3):151-62.

He D, Veiersted KB, Hostmark AT, Medb JI. Effect of acupuncture treatment on chronic neck and shoulder pain in sedentary female workers: a 6-month and 3-year follow-up study. Pain 2004;109(3):299-307.

Hidalgo-Lozano A, Fernandez-de-las-Penas C, Diaz-Rodriguez L, Gonzalez-Iglesias J, Palacios-Cena D, Arroyo-Morales M. Changes in pain and pressure pain sensitivity after manual treatment of active Trigger points in patients with unilateral shoulder impingement: a case series. J Bodyw Mov Ther 2011;15:399-404.

Ramsey MAE, Savage TH, Simpson BRG, Goodwin R. Controlled sedation with alphaxalone and alphadolone. Br Med J 1974;2:656-9.

James ND, Sharon K. Complementary and alternative pain therapy in the emergency department. Emerg Med Clin North Am 2005;23:529-49.

Zhang X. Acupuncture: review and analysis of reports on Controlled clinical trials World Health Organization. http://apps.who.int/medicinedocs/pdf/s4926e/s4926e.pdf; 2002. [accessed on March 24, 2014].

Cabioglu MT, Ergene N, Tan U. The mechanism of acupuncture and clinical applica- tions. Int J Neurosci 2006;116:115-25.

Dorsher PT. Can classical acupuncture points and trigger points be compared in the treatment of pain disorders? Birch’s analysis revisited. J Altern Complement Med 2008;14:353-9.

Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points for pain: correlations and implications. Pain 1977;3:3-23.

Impact of an information campaign on delays and ambulance use in acute coronary syndrome?,??

To the Editor,

The initiation of early reperfusion treatment is crucial for the out- come in acute coronary syndrome (ACS) [1,2]. One major obstacle to early treatment is related to the patient’s decision-making process [3,4]. An information campaign designed to inform the public about how to act when faced by an ACS was conducted in a county in Sweden in 2005. We evaluated the Long-term effects of the intervention in terms of patient decision time, Prehospital delay, and ambulance use in ACS. We did also describe the number of patients seeking the emer- gency department (ED) for acute chest pain.

This was an intervention study with a quasi-experimental design. Data were collected through questionnaires, medical records, and regis- ters. One hundred sixteen patients with ACS completed the question- naire before the campaign and 122 three years after. Register data were collected from the Swedish Register of Cardiac intensive care to evaluate ambulance use in patients with ACS and from the ambulance and the patient administration register to evaluate ambulance use and number of patients seeking the ED because of chest pain.

The campaign “IF Heart attack-symptoms and life-saving advices” consisted of a leaflet with a practical information section that could be removed and put in an easily accessible place, a videodisk and posters. The content of the material was informative, was not frightening, and contained an urgent request not to ignore symptoms and not to hesitate to call for an ambulance. It included (1) what causes a myocardial in- farction and (2) why early treatment is important (preferably within 30 minutes after symptom onset); (3) signs of a myocardial infarction including the fact that symptoms do not have to be severe; (4) how to act, that is, call the emergency number for an ambulance and do not wait until the symptoms disappear; (5) why calling for an ambulance, that is, earlier start of treatment, is important and the hospital is pre- pared; and (6) that it is always the right thing to call the emergency

? Conflicts of interests: None.

?? This work was supported by the Research Committee of Orebro County Council.

Fig. 1. Proportion of patients who used ambulance. *The Swedish Register of Cardiac intensive care, patients with a diagnosis of ACS in intervention hospital. **The Swedish Reg- ister of Cardiac intensive care, patients with a diagnosis of ACS in the rest of the country.

***Ambulance register, patients with chest pain admitted to the ED in intervention hospital.

number for an ambulance or advice, the emergency operator can help to decide if you are “ill enough” and decide on the need for an ambu- lance. Information was spread via TV, radio, local newspapers (initially), lectures for the public, printed material via direct mail, hospitals, prima- ry care, pharmacies, and others.

Neither patient decision time nor prehospital delay decreased signif- icantly. Twenty percent of the patients who completed the question- naire after the campaign had actually heard of the campaign and tended to act more appropriately.

An increase in ambulance use was found during the campaign and the following 3 years (Fig. 1). When comparing the period before the campaign (2002-2005) with the period 1 to 3 years after the campaign (excluding campaign year), ambulance use increased by 7.4% in patients with ACS (58% vs 63%, P = .017). This was not found in the rest of the country during the same period. The number of patients seeking in the ED for chest pain increased during and after the campaign compared with the period before the campaign (Fig. 2).

An explanation of why a reduction in patient decision time or prehospital delay was not found may be the relatively small percentage of patients who had actually heard of the campaign. Previous studies have produced contradictory results with regard to the influence of in- formation and educational interventions on prehospital delay. Most community EDucations [5,6], as well as the education of high-risk pa- tients [7], failed to reduce the prehospital delay. A few studies, however, report success with reduction in prehospital delay during [8-10] and after the intervention [9].

With regard to ambulance use, the clinical relevance of an increase of 7.4% can be discussed. Because delay to treatment and mortality will most probably be reduced when using an ambulance [11,12], it should be interpreted as clinically relevant. In addition, early reperfusion treat- ment is possible primarily because of direct transfer to the percutaneous coronary intervention laboratory, thereby bypassing the ED. Prior re- search has reported contradictory results relating to campaigns or has not evaluated ambulance use [5,6]. The previous campaign in Sweden did not change ambulance use, despite a slogan containing the message “Heart-pain-call 90 000” (the emergency number at the time) [13].

The increase in the number in ED visits some years after the cam- paign suggests an increased awareness of taking chest pain symptoms seriously. The campaign may have contributed to this finding. Other previous interventions did not result in an increase in ED visits [7,14].

To improve future outcome in ACS, a behavioral change during the initial phase is necessary. This relatively small community information campaign designed to inform people about how to act when faced by

298 Correspondence / American Journal of Emergency Medicine 33 (2015) 290-304

Fig. 2. Number of patients seeking in the ED because of chest pain, per year.

an ACS did not result in a reduction in patient decision time, but it appeared to increase ambulance use in ACS and the number of patients seeking the ED for acute chest pain.

Marie Thuresson, RN, PhD

Dept of Cardiology, Faculty of Medicine and Health, Orebro University

Orebro, Sweden Corresponding author. Department of Cardiology Orebro University Hospital, SE-701 85 Orebro, Sweden Tel.: +46 19 602 10 00; fax: +46 19 6022407

E-mail address: [email protected]

Pernilla Haglund, RN

Department of Cardiology, Orebro University Hospital, Orebro, Sweden

Britta Ryttberg, MD

Department of Cardiology, Orebro University Hospital, Orebro, Sweden

Johan Herlitz, MD, PhD The Centre of Pre-hospital Research in Western Sweden, University of Boras and Sahlgrenska University Hospital, Goteborg, Sweden

Ulrica Nilsson, RNA, PhD

School of Health and Medical Sciences, Orebro University, Orebro, Sweden

http://dx.doi.org/10.1016/j.ajem.2014.11.001

References

1. Fibrinolytic therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994;343:311-22.
2. De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109:1223-5.
3. Herlitz J, Thuresson M, Svensson L, Lindqvist J, Lindahl B, Zedigh C, et al. Factors of im- portance for patients’ decision time in acute coronary syndrome. Int J Cardiol 2010; 141:236-42.
4. Thuresson M, Jarlov MB, Lindahl B, Svensson L, Zedigh C, Herlitz J. Factors that influence the use of ambulance in acute coronary syndrome. Am Heart J 2008; 156:170-6.
5. Kainth A, Hewitt A, Sowden A, Duffy S, Pattenden J, Lewin R, et al. Systematic review of interventions to reduce delay in patients with suspected heart attack. Emerg Med J 2004;21:506-8.
6. Caldwell MA, Miaskowski C. Mass media interventions to reduce help-seeking delay in people with symptoms of acute myocardial infarction: time for a new approach? Patient Educ Couns 2002;46:1-9.
7. Dracup K, McKinley S, Riegel B, Moser DK, Meischke H, Doering LV, et al. A random- ized clinical trial to reduce patient prehospital delay to treatment in acute coronary syndrome. Circ Cardiovasc Qual Outcomes 2009;2:524-32.
8. Gaspoz JM, Unger PF, Urban P, Chevrolet JC, Rutishauser W, Lovis C, et al. Impact of a public campaign on pre-hospital delay in patients reporting chest pain. Heart 1996; 76:150-5.
9. Blohm M, Hartford M, Karlson BW, Karlsson T, Herlitz J. A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI. Am J Emerg Med 1994;12:315-8.
10. Naegeli B, Radovanovic D, Rickli H, Erne P, Seifert B, Duvoisin N, et al. Impact of a nationwide public campaign on delays and outcome in Swiss patients with acute coronary syndrome. Eur J Cardiovasc Prev Rehabil 2011;18:297-304.
11. Bjorklund E, Stenestrand U, Lindback J, Svensson L, Wallentin L, Lindahl B. Pre- hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction. Eur Heart J 2006;27:1146-52.
12. Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ. Mortality and prehospital thrombolysis for acute myocardial infarction: a meta-analysis. JAMA 2000;283:2686-92.
13. Herlitz J, Blohm M, Hartford M, Karlson BW, Luepker R, Holmberg S, et al. Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction. Eur Heart J 1992;13:171-7.
14. Luepker RV, Raczynski JM, Osganian S, Goldberg RJ, Finnegan JR, Hedges Jr JR, et al. Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. JAMA 2000;284:60-7.

    The significance of negative myeloperoxidase antineutrophil cytoplasmic antibodies and the role of cyclophosphamide in eosinophilic

    

    granulomatosis with polyangiitis ?,??,?,??

    To the Editor,

    We read with great interest the article by Dr Bouabdallaoui et al [1] on “Cardiogenic shock, asthma, and hypereosinophilia” published in The American Journal of Emergency Medicine. The authors described a case of Eosinophilic granulomatosis with polyangiitis (EGPA) or former- ly known as Churg-Strauss syndrome presenting with cardiogenic shock. The patient’s condition was markedly improved with high doses of corticosteroids and intravenous cyclophosphamide (CYP).

    In this case presentation, we would like to emphasize the role of CYP in the treatment of EGPA and the significance of myeloperoxidase antineutrophil cytoplasmic antibodies (ANCA) for the diagnosis EGPA. Eosinophilic granulomatosis with polyangiitis is a rare primary systemic vasculitis with an annual incidence of 0.11 to 2.66 new cases per million per year [2]. Early recognition of EGPA is crucial to prevent permanent organ damage, particularly the cardiovascular system, which is responsi- ble for approximately 50% of all mortality in patients with EGPA [2]. Interestingly, myeloperoxidase ANCA is not common in patients with car- diac involvement as in the case presentation [1]. Moreover, negative ANCA status is associated with the absence of renal and pulmonary involvements, which are hallmarks of ANCA-associated vasculitis [2]. Therefore, physicians should be aware that a negative ANCA does not ex- clude the possibility of EGPA. In addition, the role of CYP treatment in EGPA is highly recommended in the presence of cardiac or central ner- vous system involvement. Adjunctive CYP therapy for 6 to 12 pulses [3] has been shown to improve patients’ survival.

    Narat Srivali, MD

    Department of Pulmonary and Critical Care Medicine, Mayo Clinic

    Rochester, MN 55901 Corresponding author. Tel.: +1 607 435 5149. E-mail address: [email protected]

    ? Funding: None.

    ?? Conflict of interest statement for all authors: We do not have any financial or nonfi-

    nancial potential conflicts of interest.

    ? Authors’ contributions: All authors had access to the data and a role in writing the

    article. All authors approve the article.

    ?? This article is original research that has not been published and is not under consid-

    eration elsewhere.