A case report: Nursing interventions on a patient with anaphylactic shock in ICU. / A propósito de un caso: intervenciones enfermeras a una paciente con shock anafiláctico en la UCI.

INTRODUCTION AND OBJECTIVES: The care plan of a 42-year-old woman with anaphylactic shock, secondary to ingestion of amoxicillin/clavulanic acid, with upper airway involvement due to laryngeal angioedema, is presented. Previously she had had two episodes of angioedema of unknown origin. The incidence of this phenomenon is between 3.2 and 10 cases/100,000 people/year. CLINICAL OBSERVATION: An evaluation was made and three altered necessities stood out: breathing and circulation (she needed mechanical ventilation and noradrenalin perfusion), elimination (she required furosemide to keep an acceptable diuresis time), and hygiene and skin protection (she presented generalised hyperaemia, lip, lingual and oropharyngeal oedema). The hospital's Clinical Research Ethics Committee requested the patient's informed consent to access her clinical history. INTERVENTIONS: According to the altered necessities, seven diagnoses were prioritised according to NANDA taxonomy: risk of allergic response, risk of infection, risk of ineffective renal perfusion, decreased cardiac output, impaired spontaneous ventilation, risk of unstable blood glucose level, and risk of dysfunctional gastrointestinal motility. DISCUSSION AND CONCLUSIONS: Scores of outcome criteria showed a favourable evolution after 24hours. The development of a standardised NANDA-NOC-NIC language in the clinical case presented allowed us to organise the nursing work, facilitating recording and normalising clinical practice. As a limitation of this case, we didn't have serial plasma levels of histamine and tryptase to assess the evolution of anaphylactic symptoms. Highlight the importance of health education in a patient with a history of angioedema.

Ceftriaxone-induced Kounis syndrome: A case report and review of the literature.

Kounis syndrome is defined as cardiovascular symptoms that occur secondary to allergic or hypersensitivity insults, and is also called allergic angina and allergic myocardial infarction. We report a case of pre-operative ceftriaxone-induced Kounis syndrome with no evident dermatological manifestation, and describe our diagnostic dilemma. The patient was symptomatically managed and discharged in stable condition with a warning against future use of ceftriaxone.

[Anafilaxia perioperatoria a sevoflurano, un caso muy raro].

Background: Perioperative anaphylaxis can be life-threatening. The global incidence is estimated to be 1 in 10,000-20,000 procedures. The most common agents are neuromuscular blockers, latex, and antibiotics. There are very few reports of allergies to inhaled anesthetics such as sevoflurane, which is considered relatively safe in patients with drug allergies. Case report: 12-year-old patient, admitted to oncology, diagnosed with acute lymphoblastic leukemia. History of two perioperative hypersensitivity reactions. In the first event, lidocaine and rupivacaine were administered, he presented urticaria, managed with an antihistamine. On the second occasion, he received only sevoflurane and presented anaphylaxis, treated with intramuscular adrenaline. Later during intrathecal therapy, he received sevoflurane, he presented rash and arterial hypotension, managed again with adrenaline, with total remission of symptoms. Retrospectively Brighton criteria level I of certainty, classified as serious by Brown. Hypersensitivity to sevoflurane was suspected, ruling out other anesthetics such as lidocaine and rupivacaine with negative intradermal skin tests. Molecular components for latex were requested with negative results for Hev b 1, Hev b 3, Hev b 6. Due to the above and associated with the characteristics of the drug, a basophil activation test for sevoflurane was performed with an activation percentage of 50% (positive). Perioperative anaphylaxis due to sevoflurane is confirmed. Conclusion: All drugs involved in perioperative hypersensitivity reactions should be considered to establish adequate and safe treatment alternatives for this small group of patients.

Antecedentes: La anafilaxia perioperatoria puede amenazar la vida del paciente. La incidencia global se estima 1 entre 10.000-20.000 procedimientos. Los agen- tes más frecuentes son bloqueadores neuromusculares, látex y antibióticos. Hay muy pocos reportes de alergia a anestésicos inhalados como el sevoflurano, el cual se considera relativamente seguro en pacientes con alergia a fármacos. Reporte de caso: Paciente de 12 años, ingresó en oncología, diagnóstico de leucemia linfoblástica aguda. Antecedente de dos reacciones de hipersensibilidad perioperatorias. En primer evento se administró lidocaína y rupivacaína, presentó urticaria, manejado con antihistamínico. Segunda ocasión recibió sólo sevo- fluorano y presentó anafilaxia, tratado con adrenalina intramuscular. Posteriormente durante terapia intratecal, recibió sevoflurano, presentó rash e hipotensión arterial, manejo nuevamente con adrenalina, con remisión total de síntomas. Retrospectivamente criterios de Brighton nivel I de certeza, clasificada grave por Brown. Se sospechó hipersensibilidad a sevoflurano, descartando otros anestésicos como lidocaína y rupivacaina con pruebas cutáneas intradérmicas negativas. Se solicitaron componentes moleculares para látex con resultados negativos para Hev b 1, Hev b 3, Hev b 6. Por lo anterior y asociado a las características del fármaco se realiza prueba de activación de basófilos para sevoflurano con un porcentaje de activación del 50% (positivo). Se confirma anafilaxia perioperatoria por sevoflurano. Conclusión: Deben considerarse todos los fármacos involucrados en las reacciones de hipersensibilidad perioperatoria, para establecer alternativas adecuadas y seguras de tratamiento de este pequeño grupo de pacientes.

[¿Anafilaxia perioperatoria? Serie de casos].

Objective: Identify the causative agent of POH, to avoid re-exposure and assess the use of alternative treatment. Methods: 10 cases of immediate POH are described, in all of them a history of previous surgical procedures, carrying out a 3-step protocol: 1st documenting the surgical record to identify exposures, 2nd performing skin and/or epicutaneous tests and 3rd searching for an alternative treatment. treatment if a new surgical procedure is required and in selected cases challenge tests. Results: Of a total of 10 patients with immediate POH, tests were performed according to the case: neuromuscular blockers, anesthetics, opioids, NSAIDs, anti- biotics, diuretics, latex, isodine, and chlorhexidine; finding positive tests in 7 (70%) patients: in 4 (40%) neuromuscular blockers, one of them also positive for latex, in 2 (20%) anesthetics and finally finding a pharmacological alternative in 2 (2%) and recommending free operating room latex in 2 cases (20%), the rest (30%) were classified as related to the surgical procedure and medication management. Conclusions: The study of POH is focused on ensuring safety in subsequent exposures, so in addition to identifying the causative agent, the role of the allergist also leads to a search for a safe alternative in patient management.

Objetivo: Identificar agente causal de POH, para evitar reexposición y valorar uso de alternativa de tratamiento. Métodos: Se describen 10 casos de POH inmediata, en todos antecedente de procedimientos quirúrgicos previos, realizándose protocolo de 3 pasos: 1°docu- mentar registro quirúrgico para identificar exposiciones, 2° realización de pruebas cutáneas y/o epicutáneas y 3° búsqueda de alternativa de tratamiento en caso de requerir nuevo procedimiento quirúrgico y en casos seleccionados pruebas de reto. Resultados: De un total de 10 pacientes con POH inmediata, se realizaron pruebas según el caso: bloqueadores neuromusculares, anestésicos, opioides, AINE, antibióticos, diuréticos, látex, isodine y clorhexidina; encontrando pruebas positivas en 7 pacientes (70%): en 4 (40%) bloqueadores neuromusculares, uno de ellos también positivo para látex, en 2 (20%) anestésicos y finalmente encontrando alternativa farmacológica en 2 (2%) y recomendando quirófano libre de látex en 2 casos (20%), el resto (30%) fueron catalogados como relacionados con procedimiento quirúrgico y manejo de medicamentos. Conclusiones: El estudio de las POH está enfocado en asegurar seguridad en exposiciones posteriores, por lo que además de la identificación de agente causal, el papel del alergólogo también conlleva a una búsqueda de alternativa segura en el manejo del paciente.

Severe perioperative anaphylaxis: Incidence in a tertiary hospital in Spain over a 20-year period. A historical cohort study.

OBJECTIVE: To assess the incidence of severe perioperative anaphylaxis, the mechanisms involved, the value of laboratory/skin tests, and the most effective treatments. METHODS: A historical cohort study conducted in a tertiary public hospital in Spain. Patients that had undergone anaesthesia during the 20-year period were included. In these patients, 66 cases of severe anaphylaxis were found. In patients with suspicion of severe anaphylaxis, levels of blood histamine at less than 15min and serum tryptase at 2, 6, and 24h following the reaction were determined. Skin and specific IgE tests were performed between 4 and 8 weeks later. RESULTS: Over the 20-year period, 288 594 anaesthetic procedures were performed. We observed cases of 66 severe anaphylaxis reaction (59% men; age, 60.8±17.3 years. Symptoms observed were cardiovascular (86%), respiratory (73%), and mucocutaneous (56%). Elevated serum tryptase levels were associated with degree of severity at 2 (P<.0001) and 6h (P=.026) and were highest in IgE-mediated reactions (P=.020). All patients required treatment, and 3 events were fatal. In 84.8% of patients, skin and/or specific IgE tests were positive for antibiotics (35.8%), non-steroidal anti-inflammatory drugs (23.1%), neuromuscular blocking agents (15.4%) and latex (15.4%). CONCLUSIONS: The incidence of severe anaphylaxis in our hospital was 1 in 4.373 anaesthetic procedures, with a death rate of 4.5%. All cases required treatment. Serum tryptase was a good predictor of reaction severity. The most frequent causative agents were antibiotics, non-steroidal anti-inflammatory drugs, neuromuscular blocking agents and latex.

[Perioperative aspects of anaphylaxis]. / Az anafilaxia perioperatív vonatkozásai.

Anaphylaxis is a generalized, severe, life-threatening reaction, mostly with an allergic origin. Triggers are usually drugs, insect bites, poisons, contrast material and food. It is caused by various mediators (histamine, prostaglandins, leukotrienes etc.) released from mast cells, basophilic granulocytes. Histamine plays a central role in its creation. Immediate recognition and specific treatment instantaneously are essential for successful treatment. In severe conditions, the clinical features are very similar, regardless of their allergic/non-allergic origin. The incidence can vary over time and between patient populations. Its incidence is extremely variable, approximately 1/10 000 anaesthesia. Most studies cite neuromuscular blocking agents as the most common causative factor. In England, the results of the 6th National Audit Project revealed that the most common causes were antibiotics (1/26 845), followed by neuromuscular junction blocking drugs (1/19 070), chlorhexidine (1/127 698), and Patent Blue paint (1/6863). It occurs within 5 minutes in 66% of cases, 6-10 minutes in 17%, 11-15 minutes in 5%, 16-30 minutes in 2%, but usually within 30 minutes. Antibiotic allergy is a growing problem, especially to teicoplanin (16.4/100 000) and co-amoxiclav (8.7/100 000). The risk of anaphylactic shock should not be a determining factor in choosing the type of muscle relaxant drug. The patient's anaesthesia classification, physical condition, obesity, use of beta-blockers and ACE inhibitors influence the clinical characteristics. The initial symptoms can be extremely varied in terms of the effectiveness of the treatment, early recognition and commencement of therapy are the keys to success. Asking about a preoperative allergy history can reduce the risk and incidence of anaphylaxis. Orv Hetil. 2023; 164(22): 871-877.

Nursing care for patients with Kounis syndrome.

Kounis syndrome (KS) is defined as the occurrence of a coronary event secondary to a severe allergic reaction. This syndrome is described as poorly known, underdiagnosed and with a low prevalence whose aetiology is difficult to know due to the large number of causative agents. The objective is to create an individualized care plan for a patient with Kounis syndrome. The nursing assessment was performed on admission using Virginia Henderson's need theory. A care plan was developed following the NANDA-NOC-NIC taxonomy. After the planning and execution phase, the proposed activities were evaluated, thus verifying that the objectives had been achieved.

Alpha-gal syndrome. Allergy to red meat and gelatin.

INTRODUCTION: Alpha-gal syndrome is a potentially severe food allergy caused by the presence of alpha-gal-specific IgE. The aim of this study is to describe our series of 13 patients. MATERIAL AND METHODS: This work is a retrospective study of patients diagnosed in 2016 and 2017. Skin tests were performed with commercial extract and gelaspan as well as specific IgE determination for alpha-gal and different types of meat. RESULTS: Thirteen patients diagnosed with alpha-gal syndrome were analyzed; 9 of them had anaphylaxis, 6 of whom had been diagnosed with idiopathic anaphylaxis. All had a positive skin test with gelaspan, though this was not true with the commercial extracts, whose results were less conclusive. CONCLUSIONS: We believe that a diagnosis of idiopathic anaphylaxis may prevent the identification of patients with alpha-gal syndrome. The gelaspan skin test is more useful than commercial extracts.

[Invisible barriers - food allergies in children in family context]. / Láthatatlan akadályok ­ súlyos gyermekkori ételallergia a családban.

Childhood food allergy is a chronic immunological condition that affects approximately 6-8% of children. Food protein-induced immune reactions can vary in intensity from mild to fatal. There is a risk of anaphylactic shock in the case of severe food allergies, which requires immediate emergency intervention. In the lack of symptoms, food allergy is invisible to outsiders, which could often cause difficulties in communication and avoidance behavior in involved families. Parents are responsible for representing their child's condition in everyday life. The current study focuses on the caregiver's perspective and draws attention to the challenges of severe childhood food allergies and the complexity of adaptive disease management. The study aims to provide insight into what difficulties the affected parents face, what characteristics they show, and what psychological methods and techniques can help them adapt and cope better, according to the existing recommendations and intervention studies. In this way, adequate adherence to medical treatments is also ensured, contributing to the healthier personality development of children. Orv Hetil. 2022; 163(47): 1855-1861.

Mixed shock in patients with acute myocardial infarction: Nursing interventions.

INTRODUCTION AND OBJECTIVES: We present a clinical case of a 40-year-old woman diagnosed with acute myocardial infarction (AMI) in Killip I who was admitted to our hospital. She experienced complications in the haemodynamic lab and in the operating room, including cardiogenic and anaphylactic shock requiring ventricular assist support. Conservative management support with inotropes and vasopressors in cardiogenic shock has been shown to be insufficient in many patients to maintain adequate perfusion and prevent irreversible multiple organ dysfunction syndrome. For this reason, short-term mechanical circulatory support systems are increasing substantially. The objective of this article is to develop optimal and individualised care plans using the NANDA, NOC, NIC taxonomies. CLINICAL OBSERVATION: An evaluation based on Virginia Henderson's basic needs was made, and two altered needs stood out: breathing and circulation. The patient required mechanical ventilation and mechanical circulatory support. INTERVENTIONS: In relation to the highlighted needs, six diagnoses were prioritized according to the NANDA taxonomy using the Análisis de Resultado del Estado Actual (AREA) (Outcome-Present State Test (OPT)) model: risk of decreased cardiac output, impaired spontaneous ventilation, impaired tissue integrity, risk of disuse syndrome, risk of infection and risk of hypothermia. DISCUSSION AND CONCLUSIONS: Outcome criteria scores showed a favourable evolution after 96 h. The development of a standardized NANDA-NOC-NIC language allowed us to organize the nursing care plan.

Managing urticaria in the emergency department: recommendations of a multidisciplinary expert panel. / Manejo de la urticaria en urgencias: recomendaciones de un grupo multidisciplinar de expertos.

Urticaria and angioedema account for many visits to emergency departments. It is important to diagnose and treat them properly at this level of care and to suggest treatments and guidance that can make additional visits unnecessary. A panel of experts in dermatology and emergency medicine reviewed the main guidelines and publications on urticaria and angioedema. The panel then developed and reached consensus on practical approaches and tools for managing urticaria, angioedema, and anaphylaxis in the emergency department. The resulting statement is a guide to management, with algorithms for differential diagnosis and treatment and recommendations for patient referral. Implementing these guidelines, which are supported by the Spanish Academy of Dermatology and Venereology (AEDV) and the Spanish Society of Emergency Medicine (SEMES) will facilitate optimal management of emergency department patients with urticaria and angioedema as well as improve interdepartmental relations.

La urticaria y el angioedema ocasionan consultas frecuentes en los servicios de urgencias. Por ello, es importante que sean diagnosticados y tratados correctamente en este nivel asistencial y ofrecer un tratamiento y unas pautas de derivación adecuados para evitar visitas adicionales. Un grupo de expertos en dermatología y en medicina de urgencias y emergencias ha revisado las principales guías y publicaciones, y ha desarrollado y consensuado una herramienta práctica para el abordaje de la urticaria, el angioedema y la anafilaxia en urgencias. Presentamos una guía de manejo, un algoritmo basado en el diagnóstico diferencial, un algoritmo terapéutico y unas recomendaciones de derivación de los pacientes. La implementación de esta guía, avalada por la Sociedad Española de Dermatología (AEDV) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), permitirá optimizar el manejo de los pacientes con urticaria y angioedema en urgencias, y mejorará la interrelación con otros servicios.

Mixed shock in patients with acute myocardial infarction: Nursing interventions. / Shock mixto en paciente con infarto agudo de miocardio: intervenciones enfermeras.

INTRODUCTION AND OBJECTIVES: We present a clinical case of a 40-year-old woman diagnosed with acute myocardial infarction (AMI) in Killip I who was admitted to our hospital. She experienced complications in the haemodynamic lab and in the operating room, including cardiogenic and anaphylactic shock requiring ventricular assist support. Conservative management support with inotropes and vasopressors in cardiogenic shock has been shown to be insufficient in many patients to maintain adequate perfusion and prevent irreversible multiple organ dysfunction syndrome. For this reason, short-term mechanical circulatory support systems are increasing substantially. The objective of this article is to develop optimal and individualised care plans using the NANDA, NOC, NIC taxonomies. CLINICAL OBSERVATION: An evaluation based on Virginia Hendersons basic needs was made, and two altered needs stood out: breathing and circulation. The patient required mechanical ventilation and mechanical circulatory support. INTERVENTIONS: In relation to the highlighted needs, six diagnoses were prioritized according to the NANDA taxonomy using the Análisis de Resultado del Estado Actual (AREA) (Outcome-Present State Test (OPT)) model: risk of decreased cardiac output, impaired spontaneous ventilation, impaired tissue integrity, risk of disuse syndrome, risk of infection and risk of hypothermia. DISCUSSION AND CONCLUSIONS: Outcome criteria scores showed a favourable evolution after 96h. The development of a standardized NANDA-NOC-NIC language allowed us to organize the nursing care plan.

Amoxicillin-clavulanic acid-induced type II Kounis syndrome during general anaesthesia complicated with hypoxic-ischaemic encephalopathy. / Síndrome de Kounis del tipo II inducido por amoxicilina-ácido clavulánico complicado con encefalopatía hipóxico-isquémica durante anestesia general.

Anaphylaxis is a severe acute multisystem syndrome involving massive mediator release from mast cells and basophils. Although the entire arterial system can be affected, when coronary arteries are the main targets, Kounis syndrome needs to be considered. Cerebral artery involvement has also been suggested in rarer MC-mediator release episodes; so-called 'Kounis-like' syndrome. Cerebral ischaemic lesions can then result from low blood pressure or direct proinflammatory and/or vasoconstrictive mediator action in the cerebral arterial system. Diagnosis can be difficult in anaesthetised patients, as low blood pressure can have multiple causes. Treatment is also challenging, as administering adrenaline can worsen ischaemia. We report the first case of amoxicillin-clavulanic acid-induced type II Kounis syndrome under general anaesthesia, complicated with severe, irreversible and subsequently fatal encephalopathy of ischaemic origin. This case can contribute to awareness of less common Kounis syndrome manifestations, including severe cerebral involvement, or other anaphylactic reactions with atypical presentations.

Safety in Dermatologic Procedures: Anaphylaxis, Vasovagal Reaction, and Hyperventilation. / Seguridad en procedimientos dermatológicos: anafilaxia, reacción vasovagal e hiperventilación.

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is the vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included.

Safety in dermatologic procedures: anaphylaxis, vasovagal reaction, and hyperventilation.

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is fainting due to a vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included.

[Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment]. / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) ­ Parte I: tratamento e orientação pós­crise.

Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.

[Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis]. / Atualização sobre reações de hipersensibilidade perioperatória: documento conjunto da Sociedade Brasileira de Anestesiologia (SBA) e Associação Brasileira de Alergia e Imunologia (ASBAI) ­ Parte II: etiologia e diagnóstico.

This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

[Patent blue V dye anaphylaxis: a case report and literature review]. / Anafilaxia por corante azul patente V: relato de caso e revisão da literatura.

BACKGROUND: Anaphylaxis is a constant perioperative concern due to the exposure to several agents capable of inducing hypersensitivity reactions. Patent blue V (PBV), also known as Sulfan Blue, a synthetic dye used in sentinel node research in breast surgery, is responsible for 0.6% of reported anaphylactic conditions. We present a case of a 49-year-old female patient who underwent left breast tumorectomy with sentinel lymph node staging using PBV and experienced an anaphylactic reaction. METHODS: We conducted a literature search through PubMed for case reports, case series, reviews, and systematic reviews since 2005 with the keywords "anaphylaxis" and "patent blue". We then included articles found in these publications' reference sections. RESULTS: We found 12 relevant publications regarding this topic. The main findings are summarized, with information regarding the clinical presentation, management, and investigation protocol. Hypotension is the most common clinical manifestation. The presentation is usually delayed when compared with anaphylaxis from other agents, and cutaneous manifestations are occasionally absent. Patients may have had previous exposure to the dye, used also as a food, clothes and drug colorant. CONCLUSION: The diagnosis of anaphylaxis in patients under sedation or general anesthesia may be difficult due to particularities of the perioperative context. According to the published literature, the presentation of the reaction is similar in most cases and a heightened clinical sense is key to address the situation appropriately. Finding the agent responsible for the allergic reaction is of paramount importance to prevent future episodes.

[Schoolchildren with chronic diseases; what are teachers worried about?] / Escolares con enfermedades crónicas, ¿qué les preocupa a sus profesores?

INTRODUCTION: As the number of schoolchildren with chronic diseases is constantly increasing, teachers must be aware of this new reality and of the special needs of these children. However, there is very little information about the knowledge, skills, and concerns of teachers when faced with a possible urgent situation that could occur in a child with a chronic disease. For this reason, this study has been conducted. METHODS: An anonymous questionnaire with simple questions about seizures, diabetes, anaphylaxis, and basic cardiopulmonary resuscitation (CPR) was completed by 244 primary and secondary school teachers. They subsequently participated in short workshops focused on the management of medical emergencies in relation to these conditions. RESULTS: The majority (60%) of the teachers had at least one child in their classroom with a chronic disease, with epilepsy being the most frequent. Their main concern was not knowing how to act in a potentially serious situation. As regards hypoglycaemic crises and anaphylaxis, teachers who had at-risk pupils were not sure if they would be able to use the recommended medication, although they knew how to use it. CONCLUSIONS: Teachers of the study were concerned about not knowing what to do in an emergency event in a schoolchild with chronic illness. Although some had received information about the medication to be administered, they were not sure if they would be able to do so. The training and self-confidence of teachers should be improved in order to cope with possible critical situations in schoolchildren with chronic diseases.