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Allergol. immunopatol ; 48(1): 3-7, ene.-feb. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-186585


Background: Anaphylaxis is a sudden, severe, and potentially life-threatening allergic reaction, affecting a portion of allergic patients. Adrenaline is the first-line medication for anaphylaxis and available in many parts of the world as adrenaline autoinjectors (AAIs). Objective: Aim of this study was to determine attitudes and knowledge levels of patients/parents regarding the use of AAIs, frequency, and rate of appropriate AAI use and to give a standardized and better education by improving on mistakes during administration. Method: 190 patients aged 1-18 years who were prescribed AAIs for any reason between 2012 and 2017 in Hacettepe University Pediatric Allergy Unit. Demographic data were collected during face-to-face interview or by telephone. Parents completed a mini-survey regarding use, carriage, and storage of AAI. Results: Some 190 patients (64.7% male) aged 7.83 (4.99-12.08) years, median (inter-quartile), were included in the study. The indications for AAI prescription were food allergy (78.9%); venom allergy (14.2%); idiopathic anaphylaxis (3.7%); mastocytosis (2.1%); and drug allergy (1.0%). One-fourth of AAI-prescribed patients experienced anaphylaxis requiring the use of AAI within the past five years. However, only 30% of the patients dared to use AAI; only three-quarters of whom had managed to use it correctly. Conclusion: After prescription of AAI and initial training, patients and parents' concerns and fears should be taken into consideration and necessary support should be provided. At every opportunity and each clinical visit, not only should training sessions be repeated but also the patients and parents should be psychologically supported

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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Epinefrina/uso terapêutico , Autoadministração/métodos , Anafilaxia/tratamento farmacológico , Hipersensibilidade Alimentar/tratamento farmacológico , Asma , Rinite , Dermatite Atópica
Cir. mayor ambul ; 24(1): 14-18, ene.-abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-187697


INTRODUCCIÓN: La cirugía adenoamigdalar constituye una de las intervenciones quirúrgicas más frecuentes en la edad pediátrica. El dolor posoperatorio, junto con la hemorragia amigdalar, son complicaciones relativamente frecuentes que aumentan la morbilidad. El empleo de infiltración de anestésicos locales en el lecho quirúrgico ha sido ampliamente utilizado para reducir el dolor posoperatorio y las comorbilidades. OBJETIVO: El objetivo de este estudio es demostrar que la infiltración de anestésico local en combinación con adrenalina reduce tanto el dolor posoperatorio como el sangrado posquirúrgico en pacientes pediátricos sometidos a cirugía amigdalar. MATERIALES Y MÉTODOS: Estudio observacional prospectivo, doble ciego y aleatorizado con 90 pacientes entre 6 y 14 años, ASA I y II, divididos en dos grupos: 45 pacientes fueron sometidos a una infiltración periamigdalar con bupivacaína 0,25 % y adrenalina y otros 45 pacientes fueron sometidos a infiltración amigdalar son suero fisiológico. Se evaluó la eficacia analgésica, así como los efectos secundarios presentados durante las primeras 6 horas del posoperatorio inmediato. RESULTADOS Y ANÁLISIS: Durante su estancia en la unidad de recuperación posanestésica (URPA) el 80 % de los pacientes que recibieron infiltración de suero salino necesitaron analgesia suplementaria frente al 13,4 % de los que recibieron infiltración con bupivacaína, siendo esta diferencia estadísticamente significativa (p < 0,05). En nuestro estudio, tres pacientes presentaron sangrado posoperatorio, todos ellos procedentes del grupo que había recibido suero salino. Dentro de los 90 pacientes incluidos, de estos tres solo dos tuvieron que ser reintervenidos para controlar el sangrado. Así, la incidencia de sangrado en este estudio fue del 3,33 %, ligeramente inferior a los hallazgos de otros estudios de la literatura actual. CONCLUSIÓN: La infiltración periamigdalar de bupivacaína con vasoconstrictor es un método seguro y eficaz para el control analgésico posoperatorio en población pediátrica sometida a cirugía amigdalar en comparación con la terapia analgésica convencional. El impacto de esta medida en la reducción del sangrado arroja nuevos estudios para aclarar el papel de los vasoconstrictores en la reducción del sangrado posoperatorio

INTRODUCTION: The adenotonsillar surgery constitutes one of the most frequent surgical interventions in the pediatric age. Postoperative pain (1) together with tonsillar hemorrhage are two relatively frequent complications that increase morbidity. The use of local anesthetic infiltration in the surgical bed has been widely used to reduce postoperative pain and comorbidities. OBJECTIVE: The objective of this study is to demonstrate that infiltration of local anesthetic in combination with adrenaline reduces both postoperative pain and post-surgical bleeding in pediatric patients undergoing tonsillar surgery.Materials and methods: Prospective, double-blind, randomized observational study with 90 patients between 6 and 14 years old, ASA I and II, divided into two groups: 45 patients underwent periamigdalar infiltration with 0.25 % bupivacaine and adrenaline and 45 other patients underwent tonsillar infiltration with physiological saline.The analgesic efficacy was evaluated, as well as the side effects presented during the first 6 hours of the immediate postoperative period. RESULTS: During their stay in the post-anesthesia recovery unit (PACU), 80 % of patients who received saline infiltration needed supplemental analgesia com-pared to 13.4 % of those who received infiltration with bupivacaine, this difference being statistically significant (p < 0.05). In our study, 3 patients presented postoperative bleeding, all of them from the group that had received saline. Within the 90 patients included, of these 3 only 2 had to be reoperated to control bleeding. Thus, the incidence of bleeding in this study was 3.33%, slightly lower than the findings of other studies in the current literature (2,3). CONCLUSION: Periamigdalar infiltration of bupivacaine with vasocontrictor is a safe and effective method for postoperative analgesic control in pediatric popu-lation undergoing tonsillar surgery compared to conventional analgesic therapy. The impact of this measure on the reduction of bleeding yields no significant results, although it is true that there seems to be a lower incidence of bleeding in patients treated with adrenaline. New studies are needed to clarify the role of vasoconstrictors in the reduction of postoperative bleeding

Humanos , Masculino , Feminino , Criança , Adolescente , Tonsilectomia/métodos , Anestésicos Locais/administração & dosagem , Epinefrina/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Hemorragia/prevenção & controle , Método Duplo-Cego , Resultado do Tratamento
Allergol. immunopatol ; 47(1): 60-63, ene.-feb. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-180773


Background: Food allergy is a very frequent and increasingly common disease in children and adolescents. It affects quality of life and can even be life-threatening. Given that 10-18% of allergic/anaphylactic food reactions take place in schools, it is essential to provide school personnel with training on the management of reactions. Methods: The Allergy Unit of Hospital Universitario de Fuenlabrada, Spain, organized a conference entitled "Management of Food Allergy in Children and Adolescents in School Centers" during which teachers, cooks, cafeteria monitors, and summer-camp leaders underwent a training course. Attendees filled out a questionnaire with eight questions before and after the course to assess their self-efficacy in management of food allergy and anaphylaxis. The results were compared. Results: A total of 191 people participated (51% dining-room monitors, 24% teachers, 13% cooks, and 12% other professions). The areas in which the attendees presented the lowest confidence before receiving the course were recognition of symptoms and treatment of the reactions/anaphylaxis. The mean score for each of the eight concepts evaluated improved after the training course. This improvement was significant in the management of anaphylaxis. Conclusions: Our study demonstrates the usefulness of a self-efficacy scale in school personnel as a tool to assess the ability to manage food allergy and anaphylaxis. It can help to identify problem areas in which more specific training programs can be implemented

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Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Anafilaxia/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Professores Escolares , Instituições Acadêmicas , Capacitação de Professores , Educação Profissionalizante , Eficiência Organizacional , Epinefrina/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Espanha/epidemiologia , Inquéritos e Questionários
Allergol. immunopatol ; 47(1): 64-72, ene.-feb. 2019. graf
Artigo em Inglês | IBECS | ID: ibc-180774


Background: Component resolved diagnosis (CRD) allows to precisely identify the sensitization to specific molecules of a given allergenic source, resulting in an important improvement in clinical management, particularly of polysensitized subjects. This will end in the correct prescription of allergen immunotherapy (AIT) for respiratory allergy and in adequate avoidance diets or prescription of self-injectable adrenaline in food allergy. Objective: The aim of this multicenter, real life study is to evaluate the percentage change of the diagnostic-therapeutic choice in polysensitized patients with respiratory allergy and in patients with food allergy, after using CRD compared to a first level diagnosis, along with an economic analysis of the patient's overall management according to the two different approaches. Methods: An overall number of 462 polysensitized patients, as suggested by skin prick tests (SPT), and with clinical symptoms related to a respiratory (275 pts) or food (187 pts) allergy, were recruited. All patients underwent CRD for specific IgE against food or inhalant recombinant molecules, which were chosen according to medical history and positivity to SPT. The first diagnostic-therapeutic hypothesis, based only on medical history and SPT, was recorded for each patient while the final diagnostic-therapeutic choice was based on the results from CRD. The rate of change of the diagnostic-therapeutic choice from the first hypothesis to the final choice was statistically evaluated. The economic impact of CRD on the overall management of the allergic patients was analyzed to evaluate whether the increase in the diagnostic costs would be compensated and eventually exceeded by savings coming from the improved diagnostic-therapeutic appropriateness. Results: An approximate 50% change (k index 0.54) in the prescription of AIT for respiratory allergy as well as a change in the prescription of self-injectable adrenaline (k index 0.56) was measured; an overall saving of financial resources along with a higher diagnostic-therapeutic appropriateness was also detected. Conclusion: There is moderate agreement concerning prescription of AIT and self-injectable adrenaline before and after performing CRD: this highlights the usefulness of CRD, at least in polysensitized patients, in indicating the risk assessment and therefore the correct therapy of respiratory and food allergy, which results in a cost-saving approach

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Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Asma/diagnóstico , Uso de Medicamentos/estatística & dados numéricos , Hipersensibilidade Alimentar/diagnóstico , Imunoterapia/economia , Asma/epidemiologia , Asma/terapia , Custos e Análise de Custo , Epinefrina/uso terapêutico , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/terapia , Imunoterapia/estatística & dados numéricos , Itália/epidemiologia , Patologia Molecular/estatística & dados numéricos , Testes Cutâneos , Melhoria de Qualidade
Rev. esp. anestesiol. reanim ; 66(2): 62-71, feb. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-177294


Introducción: La cirugía protésica de mama es un procedimiento de cirugía plástica muy común, cuyo manejo analgésico postoperatorio es un reto para el equipo quirúrgico. El propósito del presente estudio fue validar la eficacia analgésica del bloqueo de los nervios pectorales y plano del serrato en mamoplastia de aumento retropectoral. Pacientes y métodos: Se diseñó un ensayo clínico, controlado, aleatorizado, triple ciego, que incluyó a 30 pacientes intervenidas mediante mamoplastia de aumento retropectoral. En ambos grupos se realizaron bloqueo pectoral modificado y bloqueo del plano serrato con un volumen total de 40ml por mama. En 15 de ellas se inyectó bupivacaína 0,25% con epinefrina (GPEC), y en las otras 15 se administró suero fisiológico (GC). Se hizo manejo estandarizado de la anestesia y la analgesia postoperatoria. Se midieron parámetros hemodinámicos intraoperatorios, necesidad de analgesia postoperatoria y la escala numérica verbal a su llegada a reanimación, a las 3, 6 y 24h, así como la calidad percibida por los pacientes y cirujanos. Resultados: En el postoperatorio inmediato, se pudo percibir una disminución del dolor en las pacientes del GPEC (5,3±2,3 vs. 2,9±2,7; p=0,018). No se observaron diferencias significativas a las 3, 6 y 24h. Los cirujanos valoraron la calidad anestésico-analgésica como muy buena en el 80% de los casos en el GPEC frente al 33% en el GC (p=0,01). Conclusiones: El uso de estos bloqueos es una buena estrategia analgésica perioperatoria en el manejo multimodal en la mamoplastia de aumento retropectoral

Introduction: Prosthetic breast surgery is a very common plastic surgery procedure, but its postoperative analgesic management is a challenge for the surgical team. The purpose of the present study is to validate the analgesic efficacy of pectoral block and serratus plane block in retropectoral mammoplasty. Patients and methods: A randomised, controlled, triple-blind, clinical trial was designed, and included 30 patients undergoing retropectoral augmentation mammoplasty. All of them had a modified PECII block and a serratus plane block with a total volume of 40ml per breast. In 15 of them bupivacaine 0.25% (GPEC) was injected and in the other 15 patients saline was used (GC). Standardised management of anaesthesia and postoperative analgesia was performed. Intra-operative haemodynamic parameters required for postoperative analgesia, and a numeric verbal scale on arrival in the recovery unit were measured and at 3, 6, and 24h. The quality perceived by patients and surgeons was also measured. Results: Post-operative pain was significantly better in GPEC (5.3±2.3 vs. 2.9±2.7; P=.018). No significant differences were observed at 3, 6, and 24h. The surgeons rated the anaesthetic-analgesic quality as very good in 80% of the cases in GPEC versus 33% in CG (P=.01). Conclusions: The use of these blocks is a good perioperative analgesic strategy in the multimodal management of retropectoral augmentation mammoplasty

Humanos , Feminino , Mamoplastia/métodos , Anestesia por Condução/métodos , Bloqueio Nervoso/métodos , Nervos Torácicos , Bupivacaína/administração & dosagem , Epinefrina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Reconstrutivos/métodos
Acta pediatr. esp ; 76(9/10): 109-113, sept.-oct. 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-177418


Introducción: Numerosos estudios concluyen que no hay diferencias significativas entre los distintos aerosoles utilizados en el tratamiento de las bronquiolitis. Sin embargo, en protocolos recientes, la adrenalina ha demostrado mayor eficacia que el placebo y los beta-2 agonistas a corto plazo, con una mejoría en los síntomas en los primeros 60 minutos. Objetivos: Demostrar que el uso de adrenalina nebulizada en los pacientes ingresados por bronquiolitis produce una mejoría subjetiva percibida por los cuidadores (en calidad del sueño, ingesta y estado general) e interfiere en los días de ingreso, respecto al uso de suero salino fisiológico (SSF). Pacientes y métodos: Estudio experimental, prospectivo, aleatorizado y simple ciego, en el que se incluyeron lactantes menores de 12 meses ingresados en nuestro hospital entre el 15 de octubre de 2015 y el 31 de marzo de 2016. Resultados: La muestra final fue de 58 niños, un 62% varones. La mediana de edad al ingreso fue de 2 meses (rango intercuartílico: 3), el 62% recibió adrenalina y el 38% SSF. No se hallaron diferencias en el número de días de oxigenoterapia ni en el de días de ingreso entre ambos grupos. Respecto a la apreciación de los padres sobre la ingesta, el sueño y el estado general, no encontramos diferencias estadísticamente significativas entre ambos aerosoles. Conclusiones: El uso de adrenalina no produce una mejoría subjetiva percibida por los cuidadores frente al uso de SS

Introduction: Several studies have concluded that there are no significant differences between the different aerosols used in the treatment of bronchiolitis. However, in recent protocols epinephrine has shown more short-term efficiency than the placebo and beta2-agonists, with an improvement of symptoms within the first 60 minutes. Objectives: To prove that the use of nebulized epinephrine in patients admitted with bronchiolitis leads to a subjective improvement as perceived by caregivers (regarding quality of sleep, food intake and general state of health) and that it affects the days of hospitalization, compared with the use of physiological saline solution (PSS). Patients and methods: Experimental, prospective, randomized, single-blind study. It includes breastfed babies <12 months old who were admitted in our hospital from 15th October 2015 to 31st March 2016. Results: 58 patients, 62% male in total. The median age at admission was 2 months (interquartile range 3). 62% received epinephrine and 38% were given PSS. No differences were found regarding the days of oxygen therapy or the days of admission between both groups. With regard to the parents' assessment of food intake, sleeping and general state of health, we did not find statistically significant differences between different aerosols. Conclusions: The use of epinephrine does not lead to a subjective improvement perceived by the caregivers compared with the use of PSS

Humanos , Masculino , Feminino , Lactente , Bronquiolite/diagnóstico , Bronquiolite/terapia , Epinefrina/administração & dosagem , Resultado do Tratamento , Conhecimentos, Atitudes e Prática em Saúde , Pais/psicologia , Indicadores Básicos de Saúde , Estudos Prospectivos , Método Simples-Cego , Projetos de Pesquisa , Oxigênio/uso terapêutico
Acta pediatr. esp ; 76(7/8): e109-e112, jul.-ago. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-177409


Introducción: La causa de estridor congénito más frecuente es la laringomalacia, pero también puede originarse a partir de quistes en la vallécula, laringoceles y quistes saculares congénitos, hemangiomas y otras anomalías congénitas de la laringe. Caso clínico: Niña lactante de 41 días de vida, llevada al servicio de urgencias del hospital por presentar un estridor inspiratorio progresivo, con un componente postural de empeoramiento significativo, apneas y dificultad para la alimentación. En la interconsulta urgente con ORL, se realiza una nasofibroscopia, en la que se detecta una tumoración posiblemente quística en el repliegue aritenoepiglótico izquierdo. Se deriva a la paciente al hospital de referencia, donde se confirma la lesión mediante una nueva nasofibrolaringoscopia más tomografía computarizada cervical preoperatoria. Se opera con incisión y marsupialización. El estudio anatomopatológico descartó la presencia de malignidad y confirmó la sospecha diagnóstica. La evolución postoperatoria fue buena. Conclusión: El alto índice de sospecha en las anomalías congénitas de la laringe reviste una gran importancia para realizar un diagnóstico precoz y disminuir la morbimortalidad. El quiste sacular congénito es una lesión inusual, que hay que considerar en el diagnóstico diferencial en los casos de estridor y dificultad respiratoria progresiva en neonatos y lactantes

Introduction: Laryngomalacia is the most common congenital anomaly of the larynx and is also called congenital laryngeal stridor. A less common aetiology of stridor in newborns and infants are laryngocele, congenital laryngeal saccular cyst, hemangiomas, and others congenital anomalies of the larynx. Case report: A 41-days old female presented with progressive stridor, history of postural component of significant worsening, apneas, and feeding difficulty. In the urgent consultation with ENT, flexible fiberoptic laryngoscopy showed a swelling of the left arytenoepiglotic fold. The diagnosis was confirmed at tertiary referral hospital by a cervical CT scan and direct laryngoscopy. The surgical procedure consisted of an incision in the cyst and marsupialization. The histopathological study ruled out malignancy and confirmed the suspected diagnosis. She presented a good postoperative evolution. Conclusion: The high index of suspicion in the congenital anomalies of the larynx is of great importance to make an early diagnosis and decrease morbidity and mortality. The saccular congenital cyst is an unusual lesion. Although rare, it should be included in the differential diagnosis of stridor and progressive obstruction of the airway in neonates and infants

Humanos , Feminino , Lactente , Sons Respiratórios/etiologia , Obstrução das Vias Respiratórias/complicações , Apneia/complicações , Cistos/congênito , Cistos/diagnóstico por imagem , Doenças da Laringe/congênito , Laringoscopia , Epinefrina/administração & dosagem , Dexametasona/administração & dosagem , Intubação Intratraqueal , Cistos/cirurgia , Traqueostomia , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia
Pediatr. aten. prim ; 20(supl.27): 95-103, jun. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174734


La anafilaxia en la infancia es una enfermedad grave, potencialmente mortal, que precisa ser diagnosticada y recibir tratamiento del pediatra de modo inmediato. La principal causa de anafilaxia en la infancia es la alergia a los alimentos. Su diagnóstico es fundamentalmente clínico y se debe sospechar cuando de modo agudo, en minutos o pocas horas, aparecen en un niño manifestaciones cutáneas (urticaria, angioedema) acompañadas de manifestaciones respiratorias o circulatorias. Ocasionalmente la clínica cutánea puede no aparecer, lo cual dificulta el diagnóstico. El tratamiento de elección es la administración precoz, ante la sospecha, de adrenalina intramuscular en la cara externa del muslo. En la edad pediátrica no existe ninguna contraindicación para el uso de adrenalina ante un caso de anafilaxia. La administración de cualquier otro tratamiento no es prioritaria y su uso dependerá de la evolución de la anafilaxia y siempre después de haber administrado adrenalina intramuscular. Todo niño con anafilaxia deberá acudir a un hospital, aunque su anafilaxia haya mejorado o revertido tras la adrenalina, y permanecerá unas horas en observación. Será dado de alta con un informe escrito en donde se especifiquen los posibles desencadenantes del cuadro y cómo evitarlos, y se le prescribirá al menos un autoinyector de adrenalina adecuado a su peso. Deben ser instruidos, tanto el niño como su familia y cuidadores, en el manejo del autoinyector de adrenalina al alta y posteriormente de modo regular por su pediatra por medio de simuladores. Siempre tiene que ser remitido para valoración y estudio a un especialista en Alergia Infantil

Anaphylaxis in childhood is a serious, life-threatening disease that needs to be diagnosed and treated immediately by the pediatrician. The main cause of anaphylaxis in childhood is food allergy. Its diagnosis is fundamentally clinical and should be suspected when, in minutes or a few hours, acute skin manifestations appear in a child (urticaria, angioedema), accompanied by respiratory or circulatory manifestations. Occasionally the cutaneous clinic may not appear, which makes diagnosis difficult. The treatment of choice is the early administration, on suspicion, of intramuscular adrenaline on the outer side of the thigh. In the pediatric age there is no contraindication for the use of adrenaline in the case of anaphylaxis. The administration of any other treatment is not a priority and its use will depend on the evolution of anaphylaxis and always after administering intramuscular adrenaline. Every child with anaphylaxis should go to a hospital, even if their anaphylaxis has improved or reversed after adrenaline, and will remain in observation for a few hours. They will be discharged with a written report specifying the possible triggers of the box and how to avoid them, and they will be prescribed at least one adrenaline autoinjector appropriate to their weight. They must be instructed, both the child and his family and caregivers, in the handling of the adrenaline autoinjector at discharge and later on a regular basis by his pediatrician through simulators. They always have to be sent for assessment and study to a specialist in Child Allergy

Humanos , Criança , Epinefrina/administração & dosagem , Anafilaxia/tratamento farmacológico , Hipersensibilidade Alimentar/tratamento farmacológico , Cursos/análise , Anafilaxia/epidemiologia , Sumários de Alta do Paciente Hospitalar/normas , Tratamento de Emergência/métodos
Arch. Soc. Esp. Oftalmol ; 93(3): 143-146, mar. 2018. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-172248


Caso clínico: Varón de 32 años sin antecedentes de interés que sufre accidente de tráfico con trauma craneoencefálico leve, con herida inciso-contusa supraciliar izquierda que se extiende al párpado superior izquierdo sin pérdida de visión. Tras la inyección anestésica palpebral se produjo disminución de agudeza visual súbita del ojo izquierdo e hiposfagma localizado entre la I-III a 4 mm del limbo, con aumento de la presión intraocular. En el fondo de ojo se observó una lesión blanquecina con un punto hemorrágico central que se correspondía con el área del hiposfagma. Discusión: La infiltración anestésica durante la reparación palpebral puede complicarse con la penetración inadvertida del globo ocular. La mepivacaína y epinefrina intravítreas pueden causar lesiones maculares y retinianas por sí solas, así como por el aumento súbito de la presión intraocular (AU)

Case report: The case is presented of a 32 year-old male with no medical history of interest who suffered a traffic accident with mild traumatic brain injury. He had a left supraciliary incised and contused wound that extended to the left upper eyelid, with no loss of vision. After palpebral anaesthetic injection, there was a sudden visual acuity decrease in the left eye and hyposphagma located between I-III at 4 mm from the limbus, with increased intraocular pressure. A whitish lesion with a central haemorrhagic focus was observed in the ocular fundus, corresponding to the area where the hyposphagma was located. Discussion: Anaesthetic injection during palpebral repair may be complicated by inadvertent penetration of the eyeball. Intravitreal mepivacaine and adrenaline could cause macular and retinal lesions (AU)

Humanos , Masculino , Adulto , Retina/lesões , Pálpebras/lesões , Ferimentos Penetrantes Produzidos por Agulha/complicações , Anestesia/efeitos adversos , Mepivacaína/efeitos adversos , Epinefrina/efeitos adversos
Rev. clín. med. fam ; 11(1): 25-27, feb. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-171572


Presentamos un caso de inyección accidental en un dedo de la mano en personal sanitario resuelto con inmersión del dedo en agua caliente y aplicación tópica de pomada nitroglicerina. Los síntomas más habituales son el dolor, palidez y frialdad a nivel local, aunque se han descrito complicaciones graves por vasoconstricción severa como la necrosis isquémica, que obliga a tratamientos más agresivos como la administración de fentolamina. El uso cada vez más extendido de autoinyectores de adrenalina para el tratamiento de reacciones anafilácticas severas ha hecho que aumenten los casos de inyección accidental de estos dispositivos, siendo recomendable el conocimiento del manejo de estas situaciones por los profesionales de Atención Primaria y de los Servicios de Urgencia (AU)

We present the case of an accidental injection of adrenaline into a digital finger in health personnel, solved by immersion of the finger in warm water and topical application of nitroglycerine intment. Most common symptoms are local pain, pallor and coldness, although some cases may present serious complications due to severe vasoconstriction, such as ischemic necrosis, which requires more aggressive treatments, including administration of phentolamine. The increased use of adrenaline auto-injectors for the treatment of severe anaphylactic reactions has caused an increasing incidence of accidental injection from these devices. It is therefore advisable that Primary Care and Emergency Department professionals are knowledgeable about the management of these situation (AU)

Humanos , Feminino , Pessoa de Meia-Idade , Epinefrina/efeitos adversos , Ferimentos Penetrantes Produzidos por Agulha/complicações , Fentolamina/uso terapêutico , Isquemia/tratamento farmacológico , Traumatismos Ocupacionais/etiologia , Traumatismos dos Dedos/etiologia , Autoadministração/efeitos adversos , Anafilaxia/tratamento farmacológico , Isquemia/induzido quimicamente
J. investig. allergol. clin. immunol ; 28(4): 246-252, 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174470


Background: Few studies have evaluated adherence to anaphylaxis guidelines in emergency departments (EDs). Objective: The objective of this study was to evaluate adherence to anaphylaxis guidelines in the ED of a tertiary hospital. Methods: Medical records of patients attended in the ED of University Hospital of Salamanca, Spain were reviewed. Those patients fulfilling the anaphylaxis criteria proposed by the NIAID/FAAN were selected. Results: During a 1-year period, we identified 89 patients (74 adults and 15 children). The anaphylactic reaction was moderate in 65% of adults, severe in 34%, and very severe in 1%. In children, all reactions were moderate. Fewer than half of the patients (42%) received adrenaline in the ED; this was administered intramuscularly in only 19% of cases. As for the severity of the reaction, 65% of patients with moderate reactions and 42% with severe reactions were not treated with adrenaline. At discharge from the ED, an adrenaline auto-injector was recommended to only 5.6% of patients. Fifty-two percent of patients received a documented allergy referral (57% adults vs 27% children, P=.047), 29% instructions about avoidance of triggers (31% adults vs 20% children, NS), and 51% written instructions for recognition of anaphylaxis warning signs (41% adults vs 100% children, P<.001). Conclusion: The results of the study show a large discrepancy between recommendations in guidelines and management of anaphylaxis in the ED. Additional training efforts are needed to improve the treatment of patients with anaphylactic reactions

Antecedentes: Pocos estudios han evaluado el cumplimiento de las recomendaciones de las guías clínicas de anafilaxia en los servicios de urgencias. Objetivo: El objetivo de este estudio fue conocer el cumplimiento de las guías de anafilaxia en el servicio de urgencias (SU) de un hospital terciario. Métodos: Se revisaron los informes de los pacientes atendidos en el SU del Hospital Universitario de Salamanca durante un año y se seleccionaron los que cumplían los criterios de anafilaxia propuestos por el NIAID/FAAN. Resultados: Se identificaron 89 pacientes, 74 adultos y 15 niños. El 65% de los adultos presentó una reacción moderada, el 34% grave y el 1% muy grave; en todos los niños la gravedad fue moderada. Menos de la mitad de los pacientes (42%) fueron tratados con adrenalina, solo el 19% por vía intramuscular. El 65% de las reacciones moderadas y el 42% de las graves no recibieron adrenalina. Al alta, se recomendó un auto-inyector de adrenalina al 5,6% de los pacientes, se remitió al Servicio de Alergia al 52% (57% adultos frente a 27% niños, p=0,047), se dieron indicaciones para evitar posibles desencadenantes al 29% (31% adultos frente a 20% niños, p=.5) e instrucciones para reconocer los signos de alarma de una reacción anafiláctica al 51% (41% adultos frente a 100% niños, P<0,001). Conclusión: Los resultados del estudio muestran importantes discrepancias entre las recomendaciones de las guías clínicas y el manejo de la anafilaxia en un SU hospitalario. Es necesario un mayor esfuerzo en educación para mejorar el tratamiento de los pacientes con anafilaxia

Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tratamento de Emergência/normas , Anafilaxia/tratamento farmacológico , Epinefrina/uso terapêutico , Guias de Prática Clínica como Assunto , Injeções Intradérmicas , Conhecimentos, Atitudes e Prática em Saúde , Anafilaxia/complicações , Corticosteroides/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico