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Resumen Ante un dolor torácico agudo y evidencia de elevación del segmento ST, se debe instaurar un tratamiento de reperfusión urgente, con el objetivo de abrir la arteria ocluida y minimizar el daño miocárdico y, así, mejorar el pronóstico del paciente. Por ello, es necesario conocer aquellos patrones eléctricos de alto riesgo equivalentes a una elevación del segmento ST e indicativos de una oclusión coronaria aguda, para evitar que se produzca una demora inadmisible en los tiempos de actuación, tal y como ocurrió en el caso que se presenta.
Abstract In light of an acute chest pain and evidence of ST-segment elevation, an emergent reperfusion treatment should be started with the objective of opening the occluded artery and reducing myocardial damage, thus, improving the patients´s prognosis. Therefore, it is mandatory to keep in mind those high-risk electrical patterns equivalent to a ST-segment elevation and indicative of an acute coronary occlusion to avoid an unacceptable delay in the times of action, such was the case that is reported.
RESUMEN
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Understanding the physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. AIM: To describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of hyperinflammation and abnormal immune responses to disease progression together with a complete narrative review of the different immunoadjuvant treatments used so far in COVID-19 and their indication in severe and life-threatening subsets. METHODS: A comprehensive literature search was developed. Authors reviewed the selected manuscripts following the PRISMA recommendations for systematic review and meta-analysis documents and selected the most appropriate. Finally, a recommendation of the use of each treatment was established based on the level of evidence of the articles and documents reviewed. This recommendation was made based on the consensus of all the authors. RESULTS: A brief rationale on the SARS-CoV-2 pathogenesis, immune response, and inflammation was developed. The usefulness of 10 different families of treatments related to inflammation and immunopathogenesis of COVID-19 was reviewed and discussed. Finally, based on the level of scientific evidence, a recommendation was established for each of them. CONCLUSION: Although several promising therapies exist, only the use of corticosteroids and tocilizumab (or sarilumab in absence of this) have demonstrated evidence enough to recommend its use in critically ill patients with COVID-19. Endotypes including both, clinical and biological characteristics can constitute specific targets for better select certain therapies based on an individualized approach to treatment.
RESUMEN
AIMS: The aim of this study was to identify the main medication errors, their causality and the highest risk areas in critical care. DESIGN: A descriptive, longitudinal and retrospective study. METHODS: We performed a systematic analysis of the prescription, transcription and administration records of 2,634 dose units of medications that were administered to a total of 87 critically ill patients during 2018. RESULTS: Final results have shown important medication errors and a high number of significant drug interactions; prescription phase had the highest mistake rate (71%) and cause of errors (68%); transcription stage had a more variable error typology. A significant correlation was observed between the presence of causes and contributing factors to error during the prescription and the commission of errors during the nurse transcription, being the main risk areas the time of antibiotic administration, dilution errors, concentration and speed of administration of high-risk medications and the technique used for nasogastric tube drug administration. CONCLUSION: In critical care, an intolerable number of medication errors are still committed, placing the origin of many of them in the causality and contributing factors identified in the prescription stage. IMPACT: The origin of many of the medication errors and most interactions is in the prescription stage, being the nurse transcription (nurse intervention) in an important filter that prevents a considerable number of errors from finally reaching the patient. The schedule of administration of time-dependent antibiotics, high-risk medications and the technique of administering medications through a nasogastric tube are important risk areas for the commission of medication errors.
