Quality of dispatcher-assisted vs. automated external defibrillator-guided cardiopulmonary resuscitation: a randomised simulation trial.

BACKGROUND: Quality of hands-only cardiopulmonary resuscitation (CPR) is an important determinant of resuscitation outcome for cardiac arrest patients cared for by lay rescuers. We designed a simulation trial to assess and compare the quality of CPR among untrained lay people under two different scenarios: automated external defibrillator (AED)-guided and dispatcher-assisted CPR. PATIENTS AND METHODS: A simulation study was performed involving 42 volunteers selected by non-probabilistic sampling. Participants were randomized into two CPR simulation scenarios with a manikin: (A) AED-guided CPR and (T) dispatcher-assisted CPR. The quality of CPR was evaluated by metric monitoring of the chest compressions and timing of actions. Content analysis of the telephone instructions was performed by two independent researchers using a checklist. RESULTS: CPR was started in 20 of the 21 cases in scenario A and in all cases in scenario T. In total, 12 053 chest compressions were applied, 57.6% corresponding to scenario A. The proportion of compressions that were of an adequate depth was low in both cases, 15.3% in scenario A vs. 31.7% in scenario T (P < 0.001), while complete chest recoil was allowed in 66 and 72% (P < 0.001) of compressions, respectively. The AED advised to shock 91 times, and shocks were delivered in all cases. CONCLUSIONS: Although guided CPR helps untrained people to initiate resuscitation manoeuvres, the quality of CPR was poor in both groups. Telephone guidance improved the proportion of compressions that achieved adequate chest compression and recoil but did not optimise the compression rate.

Development and validation of a weight estimation tool for paediatric emergency care. / Desarrollo y validación de una fórmula de estimación del peso para emergencias pediátricas.

OBJECTIVE: To develop and validate a weight estimation tool applicable in paediatric emergency care. METHODS: Using anthropometric data from a computerized database of the primary health care paediatric services, Bilbao (Basque Country, Spain), linear regression models were developed with the objective of estimating weight from height. Subsequently, these models were prospectively validated using a consecutive sample of children attended in the emergency department of two tertiary hospitals. Estimated weights were compared with actual weights, calculating the intraclass correlation coefficient (ICC), mean difference and percentages of estimations falling within 10% and 20% of the actual weight. RESULTS: Using anthropometric data from 15522 children two weight predictive formulas were developed (Bilbao Formulas). The formulas were validated on a sample of 780 children and estimated weight values with a high degree of intraclass correlation with the real weight (ICC=.93, P<.001) and a mean difference of .63 (SD: 4.3). The percentages of estimations falling within 10% and 20% of the actual weight of the child was 62.2% (95% CI: 58.7-65.6) and 93.1% (95% CI: 91.1-94.8), respectively. Weight estimations were more accurate using Bilbao Formulas than other classical formulas. CONCLUSIONS: Bilbao Formulas would be a valid tool for estimating weight in children in the emergency department and predict weight more accurately than other more commonly used age-based formulas.

Impact of football matches on number of visits to an emergency department. / Impacto de los partidos de fútbol en la frecuentación de pacientes a un servicio de urgencias.

OBJECTIVES: To analyze the impact of a local football team's matches on patient demand for hospital emergency department care in Bilbao, in the Spanish province of Biscay. MATERIAL AND METHODS: Retrospective analysis. We retrieved the number of patients coming to the emergency department on the days and hours of matches played by Bilbao's Athletic Club during the 2017-2019 and 2018-2019 seasons and compared the caseloads with those on the same days of the weeks before and after the matches (control days). RESULTS: Ninety-five match days were studied. Nineteen of the matches were considered key events. Visits by adults to the emergency department fell by a statistically significant 7.5% (95% CI, 4.6%-11.6%) when matches were being played in Bilbao. The decrease was 8.4% (95% CI, 5.3%-12.6%) when matches were played away. The decrease in pediatric emergencies was 32.7% (95% CI, 7.4%-68.3%) in the hours while important matches were played outside the city. CONCLUSION: The impact of football on the number of visits to our hospital emergency department was modest, except during important away matches.

OBJETIVO: Analizar el impacto que tienen los partidos de fútbol del equipo local en la frecuentación de pacientes al servicio de urgencias hospitalario (SUH) de Bilbao (Bizkaia). METODO: Estudio analítico retrospectivo. Se comparó la afluencia al servicio de urgencias durante los días y horas de partido del Athletic Club de Bilbao de las temporadas 2017/18 y 2018/19 con la de los mismos días de las semanas previas y posteriores a los eventos deportivos (controles). RESULTADOS: Fueron estudiadas 95 días de partido celebrados, donde 19 fueron considerados de alta relevancia. En pacientes adultos, cuando el partido se jugó en Bilbao se registró una disminución estadísticamente significativa del 7,5% (IC95% 4,6-11,6) en el número de urgencias y del 8,4% (IC95% 5,3-12,6) cuando el partido se celebró en otra ciudad. En pacientes pediátricos, se halló un descenso de la afluencia del 32,7% (IC95% 7,4-68,3) en las horas correspondientes al desarrollo del partido cuando este era relevante y se jugaba fuera de la ciudad. CONCLUSIONES: El fútbol tiene una limitada capacidad moduladora de la frecuentación de pacientes al SUH tan solo cuando se trata de partidos de alta relevancia.

Validity of approaches to estimating weight in children attended in the emergency department. / Validez de las estrategias de estimación de peso en pacientes pediátricos atendidos en urgencias.

OBJECTIVES: To determine the validity of different ways of estimating body weight in children attended in the emergency department. MATERIAL AND METHODS: Prospective cross-sectional study of a series of patients between 1 month and 14 years of age attended in 2 tertiary care hospitals in the Basque Country, Spain. We used 9 different ways to estimate body weight and compared the estimates to real weight by calculating the mean intraclass correlation coefficient, the mean difference between real and estimated weights, and the proportion of measurements within 10% and 20% of the real weight. RESULTS: Five hundred fifteen pediatric patients were weighed and their weights estimated. All estimates had a high degree of agreement with real weight. A parent's weight estimate performed best: 86.5% of parental estimates were within 10% of the real weight. The next best estimate was achieved with the cardiopulmonary resuscitation (CPR) rule developed at Hospital del Niño Jesús: 65% of the estimates were within the 10% margin. Fewer than 40% of the weight estimates based on formulas using anthropometric measurements were within the 10% margin. CONCLUSION: A parent's estimate of weight is a valid approximation in children of all ages. When this estimate is not available, the CPR rule of Hospital del Niño Jesús would be the method of choice.

OBJETIVO: Validar distintos métodos destinados a estimar el peso en pacientes pediátricos en urgencias. METODO: Serie de casos prospectivo con análisis transversal en pacientes de 1 mes hasta 14 años de edad en dos hospitales terciarios en el País Vasco (España). Se aplicaron 9 herramientas distintas de estimación de peso y se comparó el resultado con el peso real, calculando índices de concordancia (CCI), media de la diferencia y proporción de mediciones con un error del peso estimado inferior al 10% y 20% con respecto al peso real. RESULTADOS: Se realizaron mediciones en 515 pacientes pediátricos. Todas las estimaciones presentaron una alta concordancia con respecto al peso real. La estimación parental del peso resultó la estrategia con menor margen de error (86,5% de mediciones con error < 10%), seguida de la Regla RCP del Hospital del Niño Jesús (63,5% de mediciones con error <10%). Las fórmulas de estimación basadas en edad o antropometría no ofrecieron proporciones superiores al 40% de mediciones con un error < 10%. CONCLUSIONES: La estimación parental es una herramienta válida para la estimación del peso en niños. Cuando no está disponible esa opción, la Regla de RCP del Hospital del Niño Jesús sería la herramienta de elección.

Alternatives to subcutaneous injection of amino-amide or amino-ester anesthetics before arterial puncture for blood gas analysis: a systematic review. / Alternativas anestésicas a la inyección de amidas por vía subcutánea en punciones arteriales para gasometría: una revisión sistemática.

OBJECTIVES: Arterial puncture for blood gas analysis is a painful procedure in the emergency department (ED). Local subcutaneous injection of anesthetics containing amino amides or esters is the usual painrelief technique applied before arterial puncture, but it is little used in some care settings, such as the ED. We aimed to analyze the literature on anesthetic approaches other than the traditional one of local injection of amino-amide or amino-ester compounds for pain relief during arterial puncture and to assess the efficacy of the alternatives. MATERIAL AND METHODS: . A systematic review of the literature was conducted in 6 bibliographic databases. We selected randomized clinical trials (RCTs) published in English or Spanish between 2000 and 2018. The trials compared self-reported pain immediately after arterial puncture for blood gas analysis. Some form of anesthesia other than local injection of an amino-amide or -ester compound was compared to another anesthetic technique, placebo, or no anesthetic. RESULTS: We found 16 RCTs. Four compared the effect of topical anesthetic creams containing amino amides and/or amino esters, two assessed ultrasound-guided puncture, four used small-caliber needles or special syringes, one used a needle-free high-pressure anesthetic injection system, and five studied cryoanesthesia by application of ice or aerosols. CONCLUSION: The only effective alternative approaches to pain relief during arterial puncture for blood gas analysis were the use of very fine-caliber needles, the use of needle-free pressure injectors for subcutaneous delivery of amino amides, and the application of ice for at least 3 minutes.

OBJETIVO: La punción arterial para gasometría es una técnica dolorosa. La estrategia anestésica de elección consiste en la inyección local de amidas o esteres por vía subcutánea, pero resulta poco frecuente en algunos ámbitos asistenciales, como los servicios de urgencias. El objetivo de este trabajo es en describir las estrategias anestésicas distintas a la técnica clásica de inyección local de amidas o esteres y evaluar su eficacia en la punción arterial para gasometría. METODO: Se realizó una revisión sistemática de la literatura a través de 6 bases de datos bibliográficas. Fueron seleccionados ensayos clínicos publicados entre 2000 y 2018, en inglés o español, que comparasen el dolor autopercibido por el paciente inmediatamente después de una punción arterial para gasometría en función de si se les aplicó alguna medida anestésica diferente a la inyección subcutánea de amidas o esteres frente a otro procedimiento anestésico local, un placebo o ninguna intervención anestésica. RESULTADOS: Se localizaron 16 ensayos clínicos aleatorizados: 4 evaluaron la aplicación de anestésicos tópicos compuestos a base de esteres o amidas, 2 la punción ecoguiada, 4 el empleo de agujas de pequeño calibre o jeringuillas especiales, 1 el uso de inyectores a presión sin aguja y 5 la crioanestesia mediante hielo o aerosoles. CONCLUSIONES: Tan sólo el uso de agujas de calibre muy fino, la sustitución de jeringuillas clásicas por inyectores a presión sin aguja para la administración de amidas o esteres subcutáneas o la aplicación previa de hielo durante al menos 3 minutos se mostraron eficaces en la reducción del dolor derivado de la punción arterial para gasometría.

Pain scores for intravenous cannulation and arterial blood gas test among emergency department patients. / Dolor asociado a las técnicas de inserción de catéteres venosos y extracción de sangre arterial en el área de urgencias.

OBJECTIVES: To analyse vein catheterisation and blood gas test-related pain among adult patients in the emergency department and to explore pain score-related factors. METHOD: An observational and multicentre research study was performed. Patients undergoing vein catheterisation or arterial puncture for gas test were included consecutively. After each procedure, patients scored the pain experienced using the NRS-11. RESULTS: 780 vein catheterisations and 101 blood gas tests were analysed. Venipuncture was scored with an average score of 2.8 (95% CI: 2.6-3), and arterial puncture with 3.6 (95%CI 3.1-4). Iatrogenic pain scores were associated with moderate - high difficulty procedures (P<.001); with the choice of the humeral rather than the radial artery (P=.02) in the gas test and correlated to baseline pain in venipunctures (P<.001). Pain scores related to other variables such as sex, place of origin or needle gauge did not present statistically significant differences. CONCLUSIONS: Vein catheterisation and blood gas test-related pain can be considered mild to moderately and moderately painful procedures, respectively. The pain score is associated with certain variables such as the difficulty of the procedure, the anatomic area of the puncture or baseline pain. A better understanding of painful effects related to emergency nursing procedures and the factors associated with pain self-perception could help to determine when and how to act to mitigate this undesired effect.

[Ethyl chloride aerosol spray for local anesthesia before arterial puncture: randomized placebo-controlled trial]. / Eficacia del cloruro de etilo en aerosol como anestésico local previo a la punción arterial: ensayo clínico aleatorizado controlado con placebo.

OBJECTIVES: To compare the efficacy of an ethyl chloride aerosol spray to a placebo spray applied in the emergency department to the skin to reduce pain from arterial puncture for blood gas analysis. MATERIAL AND METHODS: Single-blind, randomized placebo-controlled trial in an emergency department of Hospital de Basurto in Bilbao, Spain. We included 126 patients for whom arterial blood gas analysis had been ordered. They were randomly assigned to receive application of the experimental ethyl chloride spray (n=66) or a placebo aerosol spray of a solution of alcohol in water (n=60). The assigned spray was applied just before arterial puncture. The main outcome variable was pain intensity reported on an 11-point numeric rating scale. RESULTS: The median (interquartile range) pain level was 2 (1-5) in the experimental arm and 2 (1-4.5) in the placebo arm (P=.72). CONCLUSION: Topical application of an ethyl chloride spray did not reduce pain caused by arterial puncture.

OBJETIVO: Evaluar la eficacia del cloruro de etilo en aerosol aplicado sobre la piel frente a placebo para disminuir el dolor provocado por una punción arterial durante la realización de una gasometría en el servicio de urgencias (SU). METODO: Ensayo clínico aleatorizado, simple ciego y controlado con placebo realizado en el SU del Hospital de Basurto (Bilbao, España). Se incluyeron 126 pacientes a los que se les había solicitado una gasometría arterial, asignándoles al azar al grupo de tratamiento tópico experimental con cloruro de etilo en aerosol (n = 66) o al grupo control con mezcla hidroalcohólica en aerosol (n = 60), ambos administrados inmediatamente antes de la punción arterial. La variable de resultado principal fue la intensidad del dolor autopercibido por el paciente medida por la escala NRS-11. RESULTADOS: El dolor percibido por el paciente tuvo una mediana (rango intercuartílico) de 2 (1-5) en el grupo tratado con cloruro de etilo y de 2 (1-4,5) en el grupo placebo (p = 0,72). CONCLUSIONES: La aplicación de cloruro de etilo tópico no reduce el dolor por punción arterial.

[Relationship between migrant status and social support and quality of life in Moroccans in the Basque Country (Spain)]. / Relación del estatus migratorio y del apoyo social con la calidad de vida de los marroquíes en el País Vasco.

OBJECTIVE: To analyze the effect of birth place, migrant status and the modulatory role of social support on health-related quality of life (HRQoL) and the presence of anxiety/depression symptoms. METHODS: We performed a cross-sectional study of three samples composed of 2,776 persons: 1,239 Moroccans in Morocco, 149 Moroccans in the Basque Country (Spain) and 1,388 autochthonous individuals. HRQoL and the presence of anxiety/depression symptoms were evaluated using the Short-Form-36 (SF-36) and the Mental Health Inventory-5 (MHI-5). Social support was evaluated with the Duke scale. Multivariate analyses were performed with dichotomic logistic regression (SPSS 16). RESULTS: Immigrant status, compared with living in Morocco, was a protective factor in practically all SF-36 dimensions but was also a risk factor for the development of anxiety/depression symptoms. Differences in HRQoL between Moroccans and the autochthonous population in the Basque Country were attenuated when variables of social support were included in the multivariate models. Low social support and dissatisfaction with social life increased the risk of low HRQoL scores and the presence of anxiety/depression symptoms among Moroccans in the Basque Country. CONCLUSIONS: Some health indicators are more favorable in Moroccans in the Basque Country than in those living in Morocco, but the frequency of anxiety/depression is higher in Moroccan immigrants. The key factor to understanding social inequalities in health among Moroccan immigrants is social support. Strategies to maintain optimal health in these immigrant collectives should include public policies of social inclusion.

[Chronic pathologies among cleaning and administrative personnel]. / Patologías crónicas en trabajadores de limpieza y administrativos.

Workers' health is of vital importance in order for workers to work at their utmost on their jobs. The prevalence of specific pathologies affects the normal functioning of workers, provoking incapacities and absences from work. The authors measure the prevalence of chronic type illnesses among cleaning and administrative personnel. The authors analyze differences based on gender and they evaluate its influence on the work assigned. In both labor groups, there exists a significant difference in the prevalence of varicose veins and scoliosis favorable in the feminine sex, a fact which corresponds to gender reasons and not to the type of work carried out. Arterial hypertension, on the other hand, is more prevalent among men in both groups, making them be exposed to a greater cardiovascular risk. The remaining pathologies found did not show any significant gender differences.