[Acute poisoning in patients over 65 years of age]. / Intoxicaciones agudas en pacientes mayores de 65 años.

BACKGROUND: There are few Spanish studies on acute poisoning in the elderly despite the associated risk factors of this group of patients. MATERIAL AND METHODS: Retrospective descriptive study of acute poisonings treated in the Emergency Service of the University Hospital of Zaragoza from 1995 to 2009 on patients 65 years old or older. RESULTS: A total of 762 patients were selected in the study (4.74% of all acute poisonings) with a mean age of 74.16 (SD ± 6) years. Ingestion was the major route of exposure (85%) and alcohol overdose (28,7%) was the most frequent type of poisoning. A trend was also observed showing a lower emetic treatment and gastric lavage and an increase in activated charcoal. Benzodiazepines (14.3%) and toxic household products (11%) with caustic properties were also the main toxics found in the study. CONCLUSIONS: Acute poisonings in the elderly required more hospitalizations, have a higher mortality and more autolytic attempts which result in death.

Intoxicaciones agudas en pacientes mayores de 65 años / Acute poisoning in patients over 65 years of age

Fundamento: Los estudios sobre la intoxicación aguda en sujetos de edad avanzada en nuestro país son escasos, a pesar de los riesgos asociados que presenta este grupo de pacientes. Material y métodos: Estudio descriptivo retrospectivo de las intoxicaciones agudas atendidas en el servicio de Urgencias del Hospital Clínico Universitario de Zaragoza entre 1995 y 2009, en pacientes con edad igual o mayor a 65 años. Resultados: Se registraron 762 casos, el 4,74% del total de intoxicados, con una edad media de 74,16 (SD ± 6) años. La vía oral fue la más frecuente (85%) y por tipo de intoxicación, la sobredosis de alcohol (28,7%). Junto a éste, las benzodiacepinas (14,3%) y los productos cáusticos (11%) fueron los principales tóxicos involucrados. El 21% de los pacientes recibieron tratamiento específico antitóxico, no precisando ingreso el 82,4%. Se observó en la evolución temporal una tendencia que apuntaba a la disminución del tratamiento emético y del lavado gástrico y un aumento del carbón activado. La mortalidad de la serie fue del 1,04%. Conclusiones: Las intoxicaciones en pacientes mayores presentan una mayor morbimortalidad, precisando más ingresos y más tentativas autolíticas con resultado de muerte (AU)

Background: There are few Spanish studies on acute poisoning in the elderly despite the associated risk factors of this group of patients. Material and methods: Retrospective descriptive study of acute poisonings treated in the Emergency Service of the University Hospital of Zaragoza from 1995 to 2009 on patients 65 years old or older. Results: A total of 762 patients were selected in the study (4.74% of all acute poisonings) with a mean age of 74.16 (SD ± 6) years. Ingestion was the major route of exposure (85%) and alcohol overdose (28,7%) was the most frequent type of poisoning. A trend was also observed showing a lower emetic treatment and gastric lavage and an increase in activated charcoal. Benzodiazepines (14.3%) and toxic household products (11%) with caustic properties were also the main toxics found in the study. Conclusions: Acute poisonings in the elderly required more hospitalizations, have a higher mortality and more autolytic attempts which result in death (AU)

Recomendaciones para el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST / The recommendations regarding non-ST segment elevation acute coronary syndrome have been reviewed

Se han revisado las recomendaciones referentes al síndrome coronario agudo (SCA) sin elevación del segmento ST. Estas recomendaciones están diseñadas para ayudar a los médicos de las unidades de cuidados intensivos cuando hacen las primeras evaluaciones de estos pacientes. Fundamentalmente son para ayudar al diagnóstico precoz, la estratificación de riesgo y el tratamiento inicial. La necesidad para un tratamiento individualizado es en este momento uno de los objetivos primarios en el abordaje del SCA, con o sin elevación del segmento ST, y ésta es la razón por la que creemos que las recomendaciones deben ser de una naturaleza predominantemente práctica dado que afectan la toma de decisiones en la práctica diaria de la medicina (AU)

These recommendations are designed to be of assistance to doctors in ICUs when making first evaluations of these patients. They are mainly intended to assist with early diagnosis, risk stratification and initial treatment. The need for individualised treatment is at present one of the main objectives in the management of Acute Coronary Syndrome (ACS), with or without ST elevation, and this is why we believe the recommendations should be of a predominantly practical nature, given that they affect decision making in the day to day practice of medicine (AU)

[The recommendations regarding non-ST segment elevation acute coronary syndrome have been reviewed. SEMICYUC. Spanish Society for Intensive Medicine, Critical Care and Coronary Units]. / Recomendaciones para el diagnóstico y tratamiento del síndrome coronario agudo sin elevación del segmento ST. SEMICYUC. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias.

These recommendations are designed to be of assistance to doctors in ICUs when making first evaluations of these patients. They are mainly intended to assist with early diagnosis, risk stratification and initial treatment. The need for individualised treatment is at present one of the main objectives in the management of Acute Coronary Syndrome (ACS), with or without ST elevation, and this is why we believe the recommendations should be of a predominantly practical nature, given that they affect decision making in the day to day practice of medicine.

Síndrome de QT largo adquirido en pacientes ingresados en UCI / Long QT syndrome acquired in patients admitted to the ICU

Objetivo. Analizar la frecuencia, la etiología, la asociación con arritmias y la mortalidad del síndrome de QT largo (SQTL) adquirido en la Unidad de Cuidados Intensivos (UCI). Diseño. Estudio retrospectivo.Ámbito. Una UCI médica de 17 camas. Pacientes y método. Pacientes ingresados en la UCI entre enero de 1997 y julio de 2004 que desarrollaron SQTL. Se consideró SQTL un QT largo para la frecuencia cardíaca o un QT corregido (QTc) > 0,45 segundos en hombres o > 0,46 segundos en mujeres. Variables de interés principales. Las variables estudiadas fueron edad, género, motivo de ingreso, cardiopatía asociada, asociación a fármacos y clase implicada, presencia de arritmias y tratamiento empleado, mortalidad en la UCI. Resultados. Se incluyeron 88 pacientes (48 mujeres y 40 hombres con edad media de 55,8 ± 19,8 años). El principal motivo de ingreso fue la intoxicación medicamentosa. La etiología se asoció a fármacos en 54 casos (61,4%), siendo los más frecuentemente asociados: psicotropos, 41 ocasiones (75,9%), antiarrítmicos, 22 (40,7%), antimicrobianos, 4 (7,4%) y otros, 6 (11,1%). El 50% de los pacientes mostró alguna arritmia, siendo la taquicardia ventricular (TV) la más frecuente en 26 ocasiones (59,1%), seguida de torsades de Pointes (TdP) en 15 casos (34,1%). Esta arritmia fue significativamente más frecuente en el sexo femenino. Precisaron tratamiento 53 pacientes (60,2%), de ellos 29 (33%) recibieron tratamiento iónico, 14 (26,4%) sobreestimulación con marcapasos y 15 (17%) necesitaron cardioversión. La mortalidad fue del 6,8%. Conclusiones. Los psicofármacos, fundamentalmente los antidepresivos, son los más frecuentemente relacionados con SQTL en nuestro medio. La arritmia más frecuente es la TV

Objective. Analyze the frequency, etiology, association with arrhythmias and mortality of long QT syndrome (LQTS) acquired in the Intensive Care Unit (ICU).Design. Retrospective study.Scope. A 17-bed medical ICU.Patients and methods. Patients admitted to the ICU between January 1997 and July 2004 who developed LQTS. LQTS was considered to be a long QT for the heart rate or corrected QT (QTc) > 0.45 seconds in men and > 0.46 seconds in women.Principal variables of interest. The variables studied were age, gender, reason for admission, associated heart disease, association to drugs and class involved, presence of arrhythmias and treatment used, mortality in ICU. Results. A total of 88 patients (48 women and 40 men with mean age of 55.8 ± 19.8 years) were included. The main reason for admission was drug poisoning. The etiology was associated to drugs in 54 cases (61.4%), the most frequently associated ones being: psychotropics, 41 times (75.9%), antiarrhythmics, 22 (40.7%), antimicrobial, 4 (7.4%) and others, 6 (11.1%). A total of 50% of the patients showed some arrhythmia, ventricular tachycardia (VT) being the most frequent in 26 occasions (59.1%), followed by torsades de Pointes (TdP) in 15 cases (34.1%). This arrhythmia was significantly more frequent in the female gender. A total of 53 patients (60.2%) required treatment. Twenty nine (33%) of them received ionic treatment, 14 (26.4%) overstimulation with pacemakers and 15 (17%) needed cardioversion. Mortality was 6.8%. Conclusions. Psychodrugs, basically antidepressives, are the most frequently related with LQTS in our setting. The most frequent arrhythmia is VT

Cuidados Intensivos en pacientes con infección por el VIH durante la era de la terapia HAART / Intensive Care in HIV patients during the HAART therapy era

No disponible

Intoxicación por metanol / Methanol poisoning

La intoxicación por metanol es poco frecuente pero de una gran morbimortalidad. Suele ocurrir accidentalmente al manipular productos industriales como anticongelantes o disolventes. En España la forma de intoxicación más habitual es el intento autolítico. Presentamos dos casos fatales que presentaban coma y acidosis metabólica importante (pH < 7) al ingreso. En ambos casos la sospecha diagnóstica fue tardía y en ningún caso se instauró tratamiento específico.Queremos destacar la importancia de sospechar de forma precoz esta intoxicación ante un cuadro de coma con acidosis metabólica importante. Parece aceptado que la toxicidad del metanol depende de sus metabolitos. Con frecuencia, los intoxicados presentan síntomas de embriaguez antes de presentar síntomas atribuibles a los metabolitos. Además, el tiempo de latencia hasta la aparición de los síntomas que aparece en la bibliografía oscila entre una y 72 h. Esto hace pensar que puede existir una toxicidad temprana atribuible al metanol per se (AU)

[Non-invasive methods for evaluating reperfusion in acute myocardial infarct: enzymes and MIBI-SPECT cardiac gammagraphy]. / Métodos no invasivos de valorar la reperfusión en el infarto agudo de miocardio: enzimas y gammagrafía cardíaca con MIBI-SPECT.

INTRODUCTION: Several studies point out the importance of what is called rescue angioplasty or fibrinolysis when thrombolysis has been ineffective in acute myocardial infarction. Therefore, it is necessary to make use of new non-invasive methods to asses reperfusion and to safely establish that such a treatment has not been effective. PATIENTS AND METHOD: We present a work which is based on the assessment of patients with acute myocardial infarction treated with or without fibrinolysis. After determining cardiac enzymatic profiles of creatine kinase and MB isoform (time course, peak, appearance rate constant time-activity: K1). With cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography pre and post treatment after to calculating myocardium at risk, salvage and relationship. RESULTS: In patients treated with fibrinolysis, the salvage myocardium was higher (8.3% vs 3.0%; p < 0.05). Considering that an improvement in perfusion defect (salvaged myocardium/myocardium at risk) higher than 30% can be viewed as an effective reperfusion, we can see that the percentage in the group treated with fibrinolysis being 45.8%, and the percentage in the group under conventional treatment being just 6.7%. Patients with acute myocardial infarction treated with fibrinolysis show much shorter start of rise-peak time and pain-peak time, all this with very significant differences for the creatine kinase (p < 0.0001) as well as for the MB (p < 0.001). Patients with reperfusion show a rapid increase in activity enzymatic, as demonstrated by the pain-peak time variable and the appearance rate constant time-activity (K1), with very significant differences in the latter (p < 0.0001). In relation with gammagraphy, values of K1 higher or equal to 0.19 for the creatine kinase and 0.14 for the MB isoform, achieved a sensibility of 83% and 91%, and a specificity of 85% and 80% respectively, to asses reperfusion. CONCLUSION: We think that cardiac imaging gammagraphy with isonitriles as well as as determination of the appearance rate enzymatic constant time-activity, can be useful in monitoring treatment with fibrinolysis in infarction patients. New studies are needed to assess these same aspects, with a lesser number of enzymatic determinations.

[Cardiac radionuclide scanning with 99mTc-MIBI-SPECT in acute myocardial infarction]. / Gammagrafía cardiaca con 99mTc-MIBI-SPECT en el infarto agudo de miocardio.

Several studies point out the importance of what is called rescue angioplasty or fibrinolysis (FB) when thrombolysis has been ineffective in acute myocardial infaction (AMI). Therefore, it is necessary to make use of new methods to asses reperfusion and to safely establish that such a treatment has not been effective. We present a work which is based on the assessment of patients with acute coronary heart disease: AMI patients treated with FB (N = 48), without FB (N = 15), unstable angina (N = 9); after determining cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography (MIBI-SPECT) pre and post treatment, to assess myocardium at risk (MR), salvage (MS) and the existence or not of gammagraphic reperfusion. Unstable angina patients show a myocardial perfusion that is similar to AMI patients. However, in the case of unstable angina, perfusion is practically of a 100% 48 hours later, having almost completely saved the myocardium at risk (MS/MR = 81.5% +/- 27.7%), and with a non-existent residual myocardium (3.2% +/- 5.8%). In AMI patients treated with FB the salvage myocardium was higher [8.3 vs 3.0; p < 0.05). Considering that an improvement in perfusion defect (MS/MR)] higher than 30% can be viewed as an effective reperfusion, we can see that all the patients with unstable angina show reperfusion, the percentage in the AMI group treated with FB being 45.8%, and the percentage in the AMI group under conventional treatment being just 6.7%. Gammagraphy with 99mTc-MIBI-SPECT at admission allowed assessing regional perfusion in AMI patients during the early stage of their evolution. With a second exploration we could determine the amount of salvage myocardium and the existence of secondary reperfusion to FB treatment.