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3.
Instr Course Lect ; 70: 611-622, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33438939

RESUMEN

Orthopaedic surgeons perform a variety of procedures where life-threatening or limb-threatening clinical scenarios or complications are relatively rare. Because these devastating complications and disaster presentations are infrequent, the occurrence can lead to concerns regarding training and preparedness. This chapter will provide a general knowledge base of common intraoperative disasters as well as life-threatening and/or limb-threatening conditions related to the upper extremity, pelvis, and lower extremity. Fundamental clinical and surgical management strategies are explored with respect to these conditions to provide a level of preparedness to help any orthopaedic surgeon control a potentially devastating complication or emergency.


Asunto(s)
Planificación en Desastres , Desastres , Ortopedia , Urgencias Médicas , Humanos , Quirófanos
4.
MMWR Morb Mortal Wkly Rep ; 69(5152): 1653-1656, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33382675

RESUMEN

On December 18, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Moderna COVID-19 (mRNA-1273) vaccine (ModernaTX, Inc; Cambridge, Massachusetts), a lipid nanoparticle-encapsulated, nucleoside-modified mRNA vaccine encoding the stabilized prefusion spike glycoprotein of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). This vaccine is the second COVID-19 vaccine authorized under an EUA for the prevention of COVID-19 in the United States (2). Vaccination with the Moderna COVID-19 vaccine consists of 2 doses (100 µg, 0.5 mL each) administered intramuscularly, 1 month (4 weeks) apart. On December 19, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation* for use of the Moderna COVID-19 vaccine in persons aged ≥18 years for the prevention of COVID-19. To guide its deliberations regarding the vaccine, ACIP employed the Evidence to Recommendation (EtR) Framework,† using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.§ Use of all COVID-19 vaccines authorized under an EUA, including the Moderna COVID-19 vaccine, should be implemented in conjunction with ACIP's interim recommendations for allocating initial supplies of COVID-19 vaccines (3). The ACIP recommendation for the use of the Moderna COVID-19 vaccine under EUA is interim and will be updated as additional information becomes available.


Asunto(s)
/administración & dosificación , Inmunización/normas , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Sistemas de Registro de Reacción Adversa a Medicamentos , Comités Consultivos , Anciano , Anciano de 80 o más Años , /efectos adversos , Centers for Disease Control and Prevention, U.S. , Ensayos Clínicos Fase III como Asunto , Aprobación de Drogas , Urgencias Médicas , Humanos , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Estados Unidos/epidemiología , United States Food and Drug Administration , Adulto Joven
6.
J Endod ; 47(1): 3-10, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33045270

RESUMEN

INTRODUCTION: The management of endodontic emergencies has been particularly challenging during the coronavirus disease 2019 (COVID-19) outbreak because of the possible generation of airborne particles and aerosols. The aim of this report was to contribute to the practice of endodontics by proposing a general protocol for the management of emergencies showing the rationale for remote diagnosis, clinical procedures, and the use of personal protective equipment and barriers at the dental office during the COVID-19 outbreak. METHODS: A review of the literature was conducted up to May 2020 on relevant institutional sites, aiming to retrieve the best updated evidence. The reporting considered the Reporting Tool for Practice Guidelines in Health Care statement. RESULTS: Recommendations from Cochrane Oral Health, the American Dental Association, and the Centers for Disease Control and Prevention were included along with the American Association of Endodontists resources and scientific articles that addressed the issue. CONCLUSIONS: The proposed protocol could contribute to the management of endodontic emergencies at the dental office during the COVID-19 outbreak.


Asunto(s)
Endodoncistas , Brotes de Enfermedades , Urgencias Médicas , Humanos
7.
Med Oral Patol Oral Cir Bucal ; 26(1): e114-e117, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33037804

RESUMEN

BACKGROUND: Odontology practice has been severely compromised by the pandemic caused by COVID-19 and Spain is one of the countries with higher incidence. Our aim with this study is to find out the number of cases and type of odonto-stomatological emergencies (OSE) treated in four dental clinics of the Madrid capital area and region (CAM) in the period covered between March 17th and 4th of May. MATERIAL AND METHODS: We search the cases in the demographic/epidemiological databases of the CAM regional government and the Illustrious Official College of Dentists and Stomatologists of the First Region (Madrid). RESULTS: We found that the most prevalent pathology was acute apical periodontitis whereas odontogenic abscess showed the lowest frequency. Prosthetic-orthodontic OSE represented 14% of cases. CONCLUSIONS: In this period of time, the most prevalent pathology acute apical periodontitis, odontogenic abscess reported the lowest frequency and prosthetic-orthodontic treatments were the third in number of cases. Most of OSE were resolved, without referring the patient to a hospital emergency department.


Asunto(s)
Urgencias Médicas , Clínicas Odontológicas , Humanos , España
8.
Emerg Med Clin North Am ; 39(1): 133-154, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33218654

RESUMEN

Management of acute neurologic disorders in the emergency department is multimodal and may require the use of medications to decrease morbidity and mortality secondary to neurologic injury. Clinicians should form an individualized treatment approach with regard to various patient specific factors. This review article focuses on the pharmacotherapy for common neurologic emergencies that present to the emergency department, including traumatic brain injury, central nervous system infections, status epilepticus, hypertensive emergencies, spinal cord injury, and neurogenic shock.


Asunto(s)
Servicio de Urgencia en Hospital , Enfermedades del Sistema Nervioso/tratamiento farmacológico , Anticonvulsivantes/uso terapéutico , Lesiones Traumáticas del Encéfalo/tratamiento farmacológico , Infecciones del Sistema Nervioso Central/tratamiento farmacológico , Urgencias Médicas , Humanos , Presión Intracraneal/efectos de los fármacos , Neurofarmacología , Estado Epiléptico/tratamiento farmacológico
9.
Emerg Med Clin North Am ; 39(1): 47-65, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33218662

RESUMEN

The diagnosis and management of neurologic conditions are more complex at the extremes of age than in the average adult. In the pediatric population, neurologic emergencies are somewhat rare and some may require emergent consultation. In older adults, geriatric physiologic changes with increased comorbidities leads to atypical presentations and worsened outcomes. The unique considerations regarding emergency department presentation and management of stroke and altered mental status in both age groups is discussed, in addition to seizures and intracranial hemorrhage in pediatrics, and Parkinson's disease and meningitis in the geriatric population.


Asunto(s)
Urgencias Médicas , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedad Aguda , Factores de Edad , Anciano , Niño , Demencia/diagnóstico , Demencia/terapia , Servicio de Urgencia en Hospital , Humanos , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/terapia , Meningitis/diagnóstico , Meningitis/terapia , Enfermedades del Sistema Nervioso/terapia , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/terapia , Convulsiones/diagnóstico , Convulsiones/terapia , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia
12.
Psychiatry Res ; 295: 113581, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33250208

RESUMEN

The SARS-CoV-2 pandemic has caused an unprecedented clinical situation. A retrospective cross-sectional study was designed with the aim to evaluate psychiatric emergencies from March 14 to May 1, 2020, coinciding with the start of the emergency state and the lockdown until the attenuation of the confinement. Data obtained during this period were compared with the emergencies attended in the same period of 2019. A total of 213 psychiatric emergencies were attended in 2020 compared with 367 in 2019. The mean number of emergencies per day was significantly lower during the COVID-19 outbreak in 2020 (M=4.35, SD= 2.04) vs. the same period in 2019 (M=7.50, SD= 3.18). A higher percentage of patients with schizo/psychotic disorders (34.3% in 2020, vs. 24.3% in 2019), as well as a lower percentage of patients with anxiety/adaptive disorders (25.4% in 2020 vs. 35.4% in 2019) was observed during the outbreak. A significant lower mean discharge/emergency ratio (M=42.17, SD= 26.94 in 2020 vs. M=63.43, SD= 17.64 in 2019) and a higher referral to Internal Medicine/emergency ratio (M=20.55, SD= 22.16 in 2020 vs. M=3.32, SD= 6.63 in 2019) was observed. The results suggest important changes in psychiatric emergencies during the most critical period of the COVID-19 outbreak in Spain.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Alta del Paciente/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Estudios Transversales , Urgencias Médicas/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología
13.
Surg Endosc ; 35(1): 1-17, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33170335

RESUMEN

BACKGROUND: COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts' opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic. METHODS: Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement. RESULTS: A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus. CONCLUSION: The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems.


Asunto(s)
Control de Infecciones/normas , Procedimientos Quirúrgicos Mínimamente Invasivos/normas , /epidemiología , Técnica Delfos , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/normas , Urgencias Médicas , Salud Global , Asignación de Recursos para la Atención de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Humanos , Control de Infecciones/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Pandemias
15.
Br J Radiol ; 94(1117): 20200520, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33095674

RESUMEN

OBJECTIVES: Life-threatening emergencies are relatively uncommon in the radiology department, but when encountered, require timely intervention. With an increasing number of critically unwell patients visiting the radiology department each year for both diagnostic and interventional procedures, it is vital that radiology staff are trained to provide basic resuscitation before further assistance arrives. Simulation training is a well-validated, effective method for rehearsing low-frequency, high-acuity events in a supportive and safe environment. The aim of our study was to investigate whether the introduction of a focussed, multidisciplinary simulation course would improve healthcare professional's knowledge and confidence when managing common medical emergencies; including cardiac arrest, anaphylaxis and airway obstruction. METHODS: A multidisciplinary group of radiology staff attended a dedicated simulation teaching course. Participants completed a pre- and post-test questionnaire which assessed a range of knowledge domains and their perceived confidence with dealing with the clinical scenarios. The delegates were then asked to repeat this questionnaire 6 months after taking part in the course to assess their retention of skills and knowledge. RESULTS: Knowledge scores increased by a mean difference of 4 points (p < 0.001). The mean pre- and post-course perceived confidence scores were 4.4/10 and 8/10, respectively. ADVANCES IN KNOWLEDGE: This study suggests that embedding simulation training into the radiology curriculum improves healthcare professional's knowledge and perceived confidence when dealing with common medical emergencies. Although previous studies have looked at the use of simulation training for radiology trainees in the management of selected medical emergencies, to the authors' knowledge, this is the first study to demonstrate these benefits across a range of clinical scenarios, within an interprofessional environment.


Asunto(s)
Urgencias Médicas , Personal de Salud/educación , Enseñanza Mediante Simulación de Alta Fidelidad/métodos , Radiología/educación , Resucitación/educación , Enfermedad Aguda , Competencia Clínica/estadística & datos numéricos , Curriculum , Humanos
17.
BMC Oral Health ; 20(1): 355, 2020 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-33276770

RESUMEN

BACKGROUND: Better understanding of the frequency of dental emergencies and the procedures performed during those emergency visits can help providers, insurers, and policymakers understand workforce and care provision needs. METHODS: Procedures performed at an emergency dental encounter and in the encounter following that encounter are assessed. Emergency dental encounters are those with a CDT code of D0140, D0160, or D0170. Data was analyzed from the IBM Watson Medicaid Marketscan data from 2013 to 2017, a nationally representative dental and medical claims database from 13 deidentified states in the United States. RESULT: Consistently over time, about 10% of all dental encounters are due to a dental emergency. 28% of emergency dental encounters had no other procedure performed during those encounters. When other procedures were performed during the encounter, the majority were diagnostic in nature, primarily radiographs. Among patients who returned to the dentists following an emergency visit, 43% returned for more definitive dental treatment, most within 30 days. CONCLUSIONS: The majority of dental emergency encounters do not result in definitive treatment, rather patients often return to the dentist at a later date for that treatment. Where possible, dental providers could utilize teledental services to triage patients to appropriate care.


Asunto(s)
Atención Odontológica/tendencias , Urgencias Médicas , Medicaid , Adolescente , Adulto , Niño , Preescolar , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto Joven
18.
J Spec Oper Med ; 20(4): 73-76, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33320316

RESUMEN

The Portland, Oregon, Bureau of Fire & Rescue (PF&R) established a tactical emergency medical support team embedded within the Police Bureau's Rapid Response Team (RRT). The authors describe the team's training and their recent work.


Asunto(s)
Servicios Médicos de Urgencia , Medicina de Emergencia , Tumultos , Urgencias Médicas , Humanos , Policia
19.
Medicina (Kaunas) ; 56(12)2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33322462

RESUMEN

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Italy has proven to be one of the countries with the highest coronavirus-linked death rate. To reduce the impact of SARS-CoV-2 coronavirus, the Italian Government decision-makers issued a series of law decrees that imposed measures limiting social contacts, stopped non-essential production activities, and restructured public health care in order to privilege assistance to patients infected with SARS-CoV-2. Health care services were substantially limited including planned hospitalization and elective surgeries. These substantial measures were criticized due to their impact on individual rights including freedom and autonomy, but were justified by the awareness that hospitals would have been unable to cope with the surge of infected people who needed treatment for COVID-19. The imbalance between the need to guarantee ordinary care and to deal with the pandemic, in a context of limited health resources, raises ethical concerns as well as clinical management issues. The emergency scenario caused by the COVID-19 pandemic, especially in the lockdown phase, led the Government and health care decision-makers to prioritize community safety above the individuals' rights. This new community-centered approach to clinical care has created tension among the practitioners and exposed health workers to malpractice claims. Reducing the morbidity and mortality rates of the COVID-19 pandemic is the priority of every government, but the legitimate question remains whether the policy that supports this measure could be less harmful for the health care system.


Asunto(s)
/prevención & control , Política de Salud , Derechos del Paciente , Administración en Salud Pública/ética , Cuarentena/ética , /mortalidad , Urgencias Médicas , Humanos , Italia/epidemiología , Administración en Salud Pública/legislación & jurisprudencia , Cuarentena/legislación & jurisprudencia
20.
J Coll Physicians Surg Pak ; 30(10): 164-167, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33291196

RESUMEN

OBJECTIVE:  To evaluate the effect of COVID-19 on the working of a tertiary care hospital. STUDY DESIGN: Audit study. PLACE AND DURATION OF STUDY:  Services Hospital, Lahore from 1st March to 30th June 2020. METHODOLOGY:  We calculated and compared various parameters of hospital working. Two time periods were selected. The study period was defined as the time after first confirmed case of COVID-19 in Pakistan. The control period was defined as one year prior to the first case being reported, taken from 1st March 2019 to 29th February, 2020. The parameters we studied included were number of number of hospital admissions, emergency patients, OPD patients, major surgeries, total surgeries, radiological investigations done, laboratory investigations done, births and mortalities. All parameters were calculated by taking monthly average during each time period and then compared. RESULTS:   A decrease in almost all parameters was seen when the cases of the two time periods were compared. There was a decrease in the average hospital admission by 51%, while the patients seen in OPD fell by almost 60%. A slight decrease of 25% was seen in the cases presenting to the emergency. The most marked decrease was in the elective surgeries, which was 66% closely followed by average monthly mortality which decreased by 64%. Average monthly minor surgeries and births were decreased by 33% and 35%, respectively. CONCLUSION:  There had been a decrease in the number of patients presenting to the hospital across the board with the most marked increase being in elective surgeries. Key Words: COVID-19, Hospital working, Patient load, Elective surgery.


Asunto(s)
/epidemiología , Urgencias Médicas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias , Centros de Atención Terciaria/estadística & datos numéricos , Carga de Trabajo/estadística & datos numéricos , Humanos , Pakistán/epidemiología , Estudios Retrospectivos
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