Recomendaciones para profesionales no anestesiólogos en procedimientos de sedoanalgesia / Recommendations for non-anaesthesia providers in sedation and analgesia procedures

El dolor, y la ansiedad que este produce, son las primeras causas de sufrimiento en los niños que acuden a los servicios de urgencias, motivando un aumento del interés de padres y sanitarios para proporcionar una adecuada analgesia y sedación.Por ello, en los últimos años se ha producido un incremento en el número de procedimientos diagnósticos y terapéuticos en niños que requieren sedoanalgesia en urgencias pediátricas, lo que ha originado una necesidad de formación de personal no anestesiólogo para cubrir ese requisito sin afectar a la seguridad del paciente.El objetivo de este documento de consenso es establecer recomendaciones basadas en la evidencia científica, elaboradas y consensuadas por el Grupo de Trabajo de Sedoanalgesia de la Sociedad Española de Urgencias de Pediatría, sobre las competencias y la capacitación del personal que realiza procedimientos de sedoanalgesia para conseguir un óptimo manejo del paciente pediátrico antes, durante y después del procedimiento en los servicios de urgencias pediátricas.El documento de consenso se ha estructurado en dos partes: la primera hace referencia a las competencias del personal no anestesiólogo que realiza procedimientos de sedoanalgesia, y la segunda, a la forma de obtener la capacitación necesaria. Se ha elaborado un listado de preguntas de investigación, se han definido unas palabras clave y se ha realizado una búsqueda bibliográfica desglosando la evidencia disponible. Los resultados se muestran como conclusiones, sometidas a votación anónima por cada uno de los miembros del Grupo de Trabajo. En cada conclusión se indica el porcentaje obtenido en la votación. (AU)

Pain and the anxiety that it produces are the main sources of suffering in children managed in emergency departments, eliciting a growing interest in parents and health care providers in the adequate provision of sedation and analgesia.In consequence, the number of diagnostic and therapeutic procedures that require sedation and/or analgesia in paediatric emergency departments has increased in recent years, which has generated a need to train non-anaesthesiologists on how to provide this care without affecting patient safety.The objective of this document is to establish evidence-based recommendations, developed by consensus by the Working Group on Sedation and Analgesia of the Sociedad Española de Urgencias de Pediatría, regarding the competencies and training of staff who perform sedation or analgesia procedures to achieve the greatest possible quality in the management of paediatric patients before, during and after these procedures in the paediatric emergency care setting.The consensus document has been structured in two parts: the first addresses the competencies of non-anaesthesiologists who perform sedoanalgesia procedures, and the second how to obtain the necessary training. A list of research questions was prepared, keywords defined and a literature search carried out to break down and summarise the available evidence. The results are presented in the form of conclusions, which were subjected to anonymous voting by each of the members of the working group. For each of the conclusions, we provide the percent agreement obtained in the voting. (AU)

Recommendations for non-anaesthesia providers in sedation and analgesia procedures.

Pain and the anxiety that it produces are the main sources of suffering in children managed in emergency departments, eliciting a growing interest in parents and health care providers in the adequate provision of sedation and analgesia. In consequence, the number of diagnostic and therapeutic procedures that require sedation and/or analgesia in paediatric emergency departments has increased in recent years, which has generated a need to train non-anaesthesiologists on how to provide this care without affecting patient safety. The objective of this document is to establish evidence-based recommendations, developed by consensus by the Working Group on Sedation and Analgesia of the Sociedad Española de Urgencias de Pediatría, regarding the competencies and training of staff who perform sedation or analgesia procedures to achieve the greatest possible quality in the management of paediatric patients before, during and after these procedures in the paediatric emergency care setting. The consensus document has been structured in two parts: the first addresses the competencies of non-anaesthesiologists who perform sedoanalgesia procedures, and the second how to obtain the necessary training. A list of research questions was prepared, keywords defined and a literature search carried out to break down and summarise the available evidence. The results are presented in the form of conclusions, which were subjected to anonymous voting by each of the members of the working group. For each of the conclusions, we provide the percent agreement obtained in the voting.

Implicación de un brote nacional de infección por Serratia marcescens asociado a clorhexidina contaminada en un hospital pediátrico / Implication of a national outbreak of Serratia marcescens associated with a contaminated solution of chlorhexidine in a paediatric hospital

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Evaluation and Impact of the "Advanced Pediatric Life Support" Course in the Care of Pediatric Emergencies in Spain.

INTRODUCTION: The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005. OBJECTIVE: To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs. METHODS: The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course. Furthermore, in December 2014, a survey was conducted through Google Drive, specifically asking APLS students about the usefulness of the APLS course in their current clinical practice. RESULTS: In the last 10 years since the APLS course was introduced in Spain, there have been 40 courses in 6 different venues. They involved a total of 1520 students, of whom 958 (63.0%) felt that the course was very useful for daily clinical practice. The survey was sent to 1,200 students and answered by 402 (33.5%). The respondent group most represented was pediatricians, 223 (55.5%), of whom 61 (27.3%) were pediatric emergency physicians, followed by pediatric residents, 122 (30.3%). One hundred three (25.6%) respondents had more than 10 years of professional practice and 291 (72.4%) had completed the course in the preceding four years. Three hundred forty-one of the respondents (84.9%: 95% confidence interval [CI], 81.9-87.9) said that they always use the pediatric assessment triangle (PAT) and 131 (32.6%: 95% CI, 28-37.1) reported that their organization has introduced this tool into their protocols. Two hundred twenty-three (55.5%: 95% CI, 50.6-60.3) believed that management of critically ill patients has improved, 328 (81.6%: 95% CI, 77.8-85.3) said that the PAT and the systematic approach, ABCDE, help to establish a diagnosis, and 315 (78.4%: 95% CI, 74.3-82.4) reported that the overall number of treatments has increased but that these treatments are beneficial for patients. Hospital professionals (191; 47.5%) include the PAT in their protocols more frequently than pre-hospital professionals (68.5% vs 55.4%; p <0.01) and consider PAT useful in the management of patients (60.2% vs 51.1%; p <0.05). Neither the time elapsed since the completion of the course, nor category and years of professional experience had any influence on the views expressed about the impact of the APLS course in clinical practice. CONCLUSIONS: Most health professionals who have received the APLS course, especially those working in the hospital setting, think that the application of the systematic methods learned, the PAT and ABCDE, has a major impact on clinical practice.

[Accidental cannabis poisoning in children: report of four cases in a tertiary care center from southern Spain]. / Intoxicación accidental por cannabis: presentación de cuatro casos pediátricos en un hospital terciario del sur de España.

INTRODUCTION: Cannabis is the most frequently consumed illicit substance in Spain. Pediatric accidental cannabis poisoning is an uncommon but life-threatening intoxication. OBJECTIVE: To describe clinical findings, diagnosis and management of children with accidental cannabis poisoning in a tertiary care pediatric hospital. We report four patients with accidental cannabis poisoning. Clinical presentation included reduced level of consciousness, drowsiness, ataxia, tremble, apnea, hypotonia, and seizures. Tetrahydrocannabinol (THC) was detected by urine screening for cannabinoids and other toxic substances in all cases. The four patients were treated with supportive care. All cases recovered uneventfully and were discharged within 24 hours of admission. CONCLUSION: The possibility of cannabis poisoning should be considered in cases of unexplained acute onset of neurological findings in previously healthy children.

Intoxicación accidental por cannabis: presentación de cuatro casos pediátricos en un hospital terciario del sur de España / Accidental cannabis poisoning in children: report of four cases in a tertiary care center from southern Spain

Introducción. El cannabis es la droga ilegal más consumida en España. La intoxicación accidental por cannabis es una forma infrecuente de intoxicación en niños; pero potencialmente grave.Objetivo. Describir la presentación clínica, diagnóstico y tratamientode niños con intoxicación accidental por cannabis en un hospital pediátrico de tercer nivel.Presentamos 4 pacientes con intoxicación accidental por cannabis.La clínica de presentación fue deterioro brusco del nivel de conciencia, tendencia al sueño, ataxia, temblor, apnea, hipotonía y convulsión. La pesquisa de tóxicos en orina detectó tetrahidrocannabinol (THC) en todos los casos. En los cuatro pacientes se establecieron medidas de soporte. Todos los casos se recuperaron satisfactoriamente y fueron dados de alta a las 24 horas del ingreso.Conclusión. Se ha de mantener un alto índice de sospecha para la intoxicación por cannabis en niños previamente sanoscon aparición brusca de síntomas neurológicos de etiología desconocida.

Intoxicación accidental por cannabis: presentación de cuatro casos pediátricos en un hospital terciario del sur de España / Accidental cannabis poisoning in children: report of four cases in a tertiary care center from southern Spain

Introducción. El cannabis es la droga ilegal más consumida en España. La intoxicación accidental por cannabis es una forma infrecuente de intoxicación en niños; pero potencialmente grave.Objetivo. Describir la presentación clínica, diagnóstico y tratamientode niños con intoxicación accidental por cannabis en un hospital pediátrico de tercer nivel.Presentamos 4 pacientes con intoxicación accidental por cannabis.La clínica de presentación fue deterioro brusco del nivel de conciencia, tendencia al sueño, ataxia, temblor, apnea, hipotonía y convulsión. La pesquisa de tóxicos en orina detectó tetrahidrocannabinol (THC) en todos los casos. En los cuatro pacientes se establecieron medidas de soporte. Todos los casos se recuperaron satisfactoriamente y fueron dados de alta a las 24 horas del ingreso.Conclusión. Se ha de mantener un alto índice de sospecha para la intoxicación por cannabis en niños previamente sanoscon aparición brusca de síntomas neurológicos de etiología desconocida.(AU)