Endophthalmitis related to lemon allergy in a heroin addict.

BACKGROUND: Heroin and its contaminants may be an important source of allergens in young people. We present a case of severe endophthalmitis in a patient that also suffered from anaphylactoid symptoms (hypotension, urticaria, glottic oedema) whenever he ingested lemon. METHODS: Prick tests with a battery of 42 aeroallergens including fruits and citrus fruits (orange, mandarin, grapefruit and lemon) and specific IgE to these allergens were carried out. Immunodetection was performed using the patient's serum and the following allergens: lemon, Candida, Aspergillus, Penicillium and Alternaria recombinant Alt 1 (Laboratories Diater). RESULTS: Skin tests were negative for Candida, Penicillium, Aspergillus and Cladosporium (ALK-Spain) as were specific IgE antibodies for CAP (Thermofisher, Sweden) and positive only for lemon and, doubtfully, to Candida. Specific IgE tests to pollen, arthropods, fungi, dander and foods were positive only for lemon (0.49kU/L). Serological study of fungi ruled out fungal infection at that time. The immunodetection showed that the patient's serum recognised a protein of approximately 25kDa of lemon peel, one of approximately 12-13kDa of Penicillium, and perfectly recognised Alt a 1. CONCLUSIONS: Lemon surface can be contaminated by Candida and other fungi. In heroin addicts with positive skin tests for lemon, the possibility of these serious complications should be taken into account.

[The intra bone passage and nursing]. / La vía intraósea y enfermería.

The authors confirm the utility of the intra bone passage as a means of emergency vascular access when the installation of a peripheral and/or central venous passage is difficult or impossible when attending critically ill patients as another additional technique available to Nursing when caring for a critically ill patient. From the reference articles reviewed, the authors deduce that intra bone vascular access provides a passage to the vascular system which permits rapid, easy and efficient access, especially when attending children under the age of six. The use of the intra bone passage is justified whenever medical personnel take more than 90 seconds or have three failed tries to insert a peripheral venous tube in patients who are critically ill or unstable. The anatomical zones which are the most appropriate to puncture in children are the proximal and distal part of the tibia and the distal section of the femur. This intra bone passage permits the administering of liquids and drugs, just as a peripheral venous passage does. Both the complications and the countermeasures are minimal.

Presencia familiar durante maniobras de reanimación: Estudio en el ámbito extrahospitalario en la Comunidad Autónoma Vasca / Presence of relatives during resuscitation manoeuvres: a study in the extrahospitalary environment in the Basque Autonomous Community

Objetivos: Los objetivos de este estudio son conocer las opiniones y actitudes de los profesionales de los Equipos de Emergencias (EE) de la Comunidad Autónoma Vasca (CAV) con relación a la presencia familiar durante maniobras de reanimación cardiopulmonar (RCP) en ámbito domiciliario, recoger información a través de los mismos de la actitud de la familia y analizar posibles diferencias de opinión según la categoría profesional. Métodos: Encuesta de opinión anónima e individual dirigida a 112 profesionales de Emergencias de la CAV. Resultados: La participación fue del 76,79%. El 60,47% de los encuestados no impiden que la familia presencie la reanimación de su pariente. Los médicos ven más ventajas que inconvenientes a la presencia familiar. Opinan que la familia siente que acompaña a su ser querido (45,46%), que asumen mejor la muerte de su familiar (60,61%) lo que facilita la notificación del fallecimiento (81,82%) y considera que puede haber menos reclamaciones legales (54,55%). El 71,43% del personal de enfermería, piensa que se debe ofertar a los familiares la oportunidad de estar presentes en la RCP de su familiar. El 52% de los técnicos no impiden que la familia presencie la reanimación; y el 44% de estos opinan que impedir o facilitar la presencia familiar no entra dentro de sus funciones. Cuando el familiar es sanitario actúa por lo general, de forma diferente presentándose y manifestando su deseo de presenciar la reanimación y colaborar. Conclusiones: Los profesionales de los EE piensan que los familiares tienen derecho a estar presentes durante las maniobras de RCP, que esa presencia beneficia tanto a la familia como al equipo reanimador; y que, en general la familia no interfiere en su labor. El objetivo inicial de los EE es el paciente a reanimar, pero no podemos descuidar la atención al resto de la familia, permitiendo su presencia, si así lo solicitan, y brindándoles la información precisa, de forma que puedan tomar conciencia y elaborar el duelo de la forma menos traumática posible (AU)

Aim: To assess the opinions and attitudes of the Emergency Team professionals in the Basque Autonomous Community (BAC) regarding (ET) the presence of relatives during at-home cardiopulmonary resuscitation manoeuvres (CPR), to gather from the same sources information about the relatives’ attitude and to analyse possible differences in opinion according to professional category. Methods: Anonymous and individual opinion survey performed on 112 ET professionals in the BAC. Results: The participation rate was 76.79%. Among those professionals completing the survey, 60.47% do not prevent relatives from being present during CPR. Physicians consider that there are more advantages than disadvantages to the presence of relatives. They hold that the family considers they are accompanying and supporting their veloved one (45.46%), that they cope better with their relative’s demise (60.61%) –which renders the notification of death easier (81.82%)–, and that less legal reclamations arise (54.55%). Among the nursing personnel, 71.43% believe the family members should be offered the opportunity to be present during CPR of their relative. As regards the technicians, 52% do not prevent relatives from being present during resuscitation, and 44% consider that preventing or facilitating the presence of relatives is not one of their functions. When the relative is sanitary him(her)self as such and expresses a desire to be present and to help. Conclusiones: The ET professionals consider that relatives have a righg to be present during CPR manoeuvres, that their presence benefits both the family and the resuscitation team, and that generally the relatives do not interfere in their task. The initial target of the ET is the patient to be resuscitated, but we should never put aside the attention to the family, allowing their presence if so requested and provinding the required information (AU)