ABSTRACT
INTRODUCTION: A Sepsis Code (CS) is a comprehensive multidisciplinary system which has the aim of optimising the identification and intervention times of patients with sepsis, as well as improving their monitoring and treatment adjustments in order to reduce their mortality. OBJECTIVES: To present the outcomes of the first year of introducing the CS in the emergency department of a tertiary hospital. MATERIAL AND METHODS: A single-centre retrospective descriptive observational study was conducted on all patients in whom the CS was activated in the emergency department of a tertiary hospital during the first year of implementation. The variables included: demographics, CS activation, comorbidities, focus of infection, microbiology, antibiotic treatment, and mortality. RESULTS: CS was activated in 555 patients, of which 302 (54.4%) had a definitive diagnosis of sepsis or septic shock on discharge from the emergency department. The degree of completion of the protocol variables was variable (41.8-95%).The large majority (86.1%) of the patients received antibiotics in the first hour, and in 76.2% blood cultures were collected prior to the antibiotic. Of the blood cultures performed, 13.3% of the isolated germs were multi-resistant and the level of contamination of blood cultures was 9.1%. All patients received empirical treatment and recommendations were followed in patients with septic shock in 28.3%. During follow-up, 64.4% the antibiotic treatment was targeted, and 39.5% received sequential therapy. In-hospital mortality was 32.2%. CONCLUSIONS: Areas of improvement in the completion of the variables, contamination of blood cultures, and empirical treatment received were detected, with the strong points being the early administration of the antibiotic and the collection of blood cultures.
Subject(s)
Sepsis , Shock, Septic , Emergency Service, Hospital , Humans , Retrospective Studies , Sepsis/diagnosis , Sepsis/drug therapy , Shock, Septic/diagnosis , Shock, Septic/drug therapy , Tertiary Care CentersABSTRACT
La escasa rentabilidad diagnóstica de la radiografía de abdomen en patología urgente contrasta con el elevado número de exploraciones que se realizan. La mayoría arroja hallazgos normales o inespecíficos, lo que cuestiona la idoneidad de su indicación. Suele considerarse un procedimiento rutinario o incluso una herramienta 'defensiva' de cribado, cuya utilidad real se desconoce. Desde hace más de 30 años, se recomienda en la literatura científica reducir tanto el número de exploraciones como el de proyecciones realizadas, en aras a disminuir dosis de radiación, molestias innecesarias para los pacientes y costes. Radiólogos y clínicos deben conocer las importantes limitaciones de la radiografía de abdomen en el manejo diagnóstico de la patología abdominal aguda y restringir su empleo. Para ello, es imprescindible una adecuada selección clínica de los pacientes candidatos a estudio de imagen, que permite un empleo ágil de técnicas alternativas más rentables como la ecografía o la tomografía computarizada (AU)
The large number of abdominal X-ray examinations done in the emergency department is striking considering the scant diagnostic yield of this imaging test in urgent disease. Most of these examinations have normal or nonspecific findings, bringing into question the appropriateness of these examinations. Abdominal X-ray examinations are usually considered a routine procedure or even a 'defensive' screening tool, whose real usefulness is unknown. For more than 30 years, the scientific literature has been recommending a reduction in both the number of examinations and the number of projections obtained in each examination to reduce the dose of radiation, unnecessary inconvenience for patients, and costs. Radiologists and clinicians need to know the important limitations of abdominal X-rays in the diagnostic management of acute abdomen and restrict the use of this technique accordingly. This requires the correct clinical selection of patients that can benefit from this examination, which would allow better use of alternative techniques with better diagnostic yield, such as ultrasonography or computed tomograph (AU)
Subject(s)
Aged, 80 and over , Female , Humans , Male , Middle Aged , Abdomen , Abdomen, Acute , Radiography, Abdominal/instrumentation , Radiography, Abdominal/methods , Radiography, Abdominal , Emergencies/epidemiology , Emergency Medical Services/methods , Abdominal Pain , Incidental Findings , Renal Colic , Diverticulitis , Cholecystitis , Foreign Bodies , CathetersABSTRACT
The large number of abdominal X-ray examinations done in the emergency department is striking considering the scant diagnostic yield of this imaging test in urgent disease. Most of these examinations have normal or nonspecific findings, bringing into question the appropriateness of these examinations. Abdominal X-ray examinations are usually considered a routine procedure or even a "defensive" screening tool, whose real usefulness is unknown. For more than 30 years, the scientific literature has been recommending a reduction in both the number of examinations and the number of projections obtained in each examination to reduce the dose of radiation, unnecessary inconvenience for patients, and costs. Radiologists and clinicians need to know the important limitations of abdominal X-rays in the diagnostic management of acute abdomen and restrict the use of this technique accordingly. This requires the correct clinical selection of patients that can benefit from this examination, which would allow better use of alternative techniques with better diagnostic yield, such as ultrasonography or computed tomography.
Subject(s)
Radiography, Abdominal , Abdominal Pain/diagnostic imaging , Abdominal Pain/etiology , Emergencies , Emergency Service, Hospital , Humans , Radiography, Abdominal/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Humans , Diagnostic Imaging/methods , Wounds and Injuries/diagnosis , Multiple Trauma/diagnosis , Immobilization , Radiography , Ultrasonography , Magnetic Resonance Spectroscopy , Tomography, X-Ray ComputedSubject(s)
Wounds and Injuries/diagnostic imaging , Hemostatic Techniques , Humans , Imaging, Three-Dimensional/methods , Magnetic Resonance Imaging/methods , Radiography/methods , Radiology, Interventional , Tomography, X-Ray Computed/methods , Trauma Centers , Ultrasonography/methods , Whole Body Imaging/methodsABSTRACT
Objetivos: Evaluar el efecto una intervención educativa en el servicio de urgencias (SU)dirigida a implementar un protocolo de tratamiento de la hiperglucemia. La hipótesis de partida fue que la intervención educativa dirigida a los profesionales del SU permitiría aumentar el uso de la pauta basal-bolo en el tratamiento de la hiperglucemia hospitalaria. Método: Estudio cuasi-experimental con un grupo de control no equivalente, pre/post intervención formativa. Se seleccionaron dos grupos de pacientes (pre y post intervención) mediante muestreo consecutivo, mayores de 18 años y hospitalizados desde el SU con diagnóstico de diabetes tipo 2 e hiperglucemia mayor de 180 mg/dl. Las variables de resultado analizadas fueron la proporción de pacientes tratados con pauta basal-bolo y el grado de control de la glucemia [días transcurridos hasta el control de la (..) (AU)
Objectives: To assess an emergency department (ED) educational intervention leading to implementation of a hyperglycemia treatment protocol. Our hypothesis was that the ED educational intervention would increase use of basal bolus therapy for hospital management of hyperglycemia. Methods: Quasi-experimental pre-post intervention study comparing unmatched groups. Patients treated before and after the intervention were selected consecutively. All were over the age of 18 years and admitted from the ED with a diagnosis oftype-2 diabetes and a blood sugar level over 180 mg/dL. The variables analyzed were percentage of patients in each group treated with basal-bolus therapy, and the degree of glycemic control (days until blood sugar levels were brought under control, mean blood sugar levels, and number of hyperglycemic [>180 mg/dL], and hypoglycemic [<60 mg/dL] episodes).Results: A total of 96 patients (preintervention, 45; postintervention, 51) were included. The use of basal-bolus therapy (..) (AU)
Subject(s)
Humans , Hyperglycemia/epidemiology , Emergency Treatment/methods , Diabetes Mellitus, Type 2/epidemiology , Insulin/therapeutic use , Emergency Medical Services/organization & administration , Insulin Infusion Systems , Evaluation of the Efficacy-Effectiveness of Interventions , Professional Training , Clinical ProtocolsSubject(s)
Asthma/diagnosis , Asthma/physiopathology , Humans , Maximal Expiratory Flow Rate , Medical RecordsABSTRACT
The Study of Talavera de la Reina analyzes the presence of several cardiovascular risk factors (CVRF) in this city, by means of a cross-sectional study of the population within 1989 and 1990. In this paper, the results on tobacco consumption, as well as the correlation between tobacco consumption and several anthropometric and biochemical parameters, some of which are independent CVRF theirselves, are presented. Seven hundred and two people were evaluated, 332 men and 370 women, with ages between 20 and 79 years, and were randomized according to the current population census. We have carried out a survey to assess smoking habits; physical examination to measure weight and height, systolic and diastolic arterial pressure, blood analysis including total cholesterol, C-HDL, triglycerides and glucose. C-LDL was obtained using the Friedewald-Fredickson formula. Smoking habits among the younger female population is almost equal to male population. Compared by age groups and similar sex, no significant differences were observed related to anthropometric and biochemical parameters between smokers and non-smokers. The lipidic profile of non-smokers against moderate/heavy smokers (smoking 10 or more gr/day) was compared. The presence of an atherogenic profile in 30 to 39-year-old men and in 40 to 49-year-old women was verified, as well as the lower C-HDL levels among younger smokers of both sexes. This provides tobacco with an added value, as it increases the impact of other CVRF in key ages for the pathogenicity of arteriosclerosis.
Subject(s)
Cardiovascular Diseases , Smoking/epidemiology , Adult , Age Factors , Aged , Cardiovascular Diseases/epidemiology , Cholesterol/blood , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Smoking/blood , Spain/epidemiology , Triglycerides/bloodSubject(s)
Alcoholic Intoxication/drug therapy , Flumazenil/therapeutic use , Adolescent , Adult , Female , Glasgow Coma Scale , Humans , Male , Middle AgedSubject(s)
Aortic Aneurysm/diagnosis , Aortic Dissection/diagnosis , Hematoma/diagnosis , Aged , Aged, 80 and over , Aorta, Thoracic , Humans , MaleABSTRACT
The acute phase and long-term evolution of 249 patients diagnosed as having acute myocardial infarction and admitted to our hospital during the period 1981 to 1983, were studied. They were classified in 2 groups: A (non-diabetic patients) and B (diabetic patients). Several variables were analysed in order to determine the differences between both groups. The most accentuated being: diabetic patients, female sex, old age, blood hypertension history, cardiac failure, re-extended infarction. The inter-hospital mortality was higher in group B, mainly as a result of cardiogenic shock and left cardiac failure. An out-patients follow-up of acute phase survivors was carried out, between 1 to 96 months, with mean follow-up of 46.7 month in group A and 38.4 in group B, at 8 years the actuarial rate being 77.3% and 55.9% respectively. We conclude that diabetic patients with myocardial infarction register a higher long- and short-time mortality.
