¿Elegimos una talla de traje adecuada en la atención de un incidente con riesgo biológico? / Are we choosing the right size of protective clothing to use during emergencies that confer biological risk?

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Analysis of the early warning score to detect critical or high-risk patients in the prehospital setting.

The early warning score can help to prevent, recognize and act at the first signs of clinical and physiological deterioration. The objective of this study is to evaluate different scales for use in the prehospital setting and to select the most relevant one by applicability and capacity to predict mortality in the first 48 h. A prospective longitudinal observational study was conducted in patients over 18 years of age who were treated by the advanced life support unit and transferred to the emergency department between April and July 2018. We analyzed demographic variables as well as the physiological parameters and clinical observations necessary to complement the EWS. Subsequently, each patient was followed up, considering their final diagnosis and mortality data. A total of 349 patients were included in our study. Early mortality before the first 48 h affected 27 patients (7.7%). The scale with the best capacity to predict early mortality was the National Early Warning Score 2, with an area under the curve of 0.896 (95% CI 0.82-0.97). The score with the lowest global classification error was 10 points with sensitivity of 81.5% (95% CI 62.7-92.1) and specificity of 88.5% (95% CI 84.5-91.6). The early warning score studied (except modified early warning score) shows no statistically significant differences between them; however, the National Early Warning Score 2 is the most used score internationally, validated at the prehospital scope and with a wide scientific literature that supports its use. The Prehospital Emergency Medical Services should include this scale among their operative elements to complement the structured and objective evaluation of the critical patient.

Índice de perfusión en una reanimación con riesgo biológico, como medida de mala tolerancia fisiológica / Perfusion index in a resuscitation with biological risk, as a measure of poor physiological tolerance

Introducción: Realizar de una forma adecuada una reanimación cardiopulmonar precisa unos conocimientos técnicos y unas mínimas condiciones físicas. Realizar esta reanimación un equipo de protección individual frente a riesgos biológicos nivel D colocado aumenta el sobresfuerzo al que se ven sometidos los reanimadores.El objetivo de este estudio es comprobar la existencia de un patrón de mala tolerancia fisiológica al uso de los equipos de protección nivel D, categoría 4-5-6B para la actuación en incidentes con riesgo biológico objetivado mediante la medición del índice de perfusión antes y después de una reanimación simulada.Material y métodos: Se ha realizado un estudio cuasiexperimental no controlado sobre 96 voluntarios elegidos mediante un muestreo aleatorio estratificado por sexo, nivel de formación y categoría profesional, estudiantes de Medicina y Enfermería y profesionales Médicos y Enfermeros. Se realizó una toma del índice de perfusión antes de realizar la reanimación y otra después de la reanimación simulada.Resultados: Un 15% de los voluntarios presentaron un índice de perfusión posterior más bajo al basal, lo que se traduce en una situación de vasoconstricción periférica después de la realización del ejercicio físico que supuso el caso clínico, cuando lo esperable era una vasodilatación para aumentar la perfusión.Conclusiones: Extrapolando estos datos, podemos concluir que, en la muestra de estudio que nos ocupa, los voluntarios que presentan menos índice de perfusión al finalizar que al comenzar no toleran bien el esfuerzo que supone el caso clínico

Introduction: Perform a cardiopulmonary resuscitation requires technical knowledge and minimal physical conditions. Perform this resuscitation a team of individual protection against biological risks level D placed increases the overexertion that encourage rescuers are subjected.The objective of this study is to prove the existence of a pattern of poor physiological tolerance to the use of personal protective equipment level D, category 4-5-6B for action in incidents with biological risk objectified by measuring the perfusion index before and after a simulated resuscitation.Material and methods: We have performed a quasiexperimental not controlled on 96 volunteers chosen through a random sampling, stratified by sex, level of education and professional category, medical and nursing students and professionals doctors and nurses.A decision of the perfusion index before performing the resuscitation and other simulated after resuscitation.Results: A 15% of the volunteers presented a perfusion index lower back to baseline, which translates into a situation of peripheral vasoconstriction after the completion of the physical exercise that involved the clinical case, when expected was a vasodilatation to Increase perfusion.Conclussion: Extrapolating these data, we can conclude that, in the sample for the study, the volunteers who have less perfusion index at the end of that at the beginning do not tolerate well the effort involved in the case

Does Gender Influence Physiological Tolerance in Resuscitators When Using Personal Protection Equipment against Biological Hazards?

INTRODUCTION: Certain professions, such as those related to emergency services, have usually been performed by men, progressively incorporating women into these professions. The main objective of our study was to determine, according to gender, how the use of level D biohazard personal protection equipment (PPE) affects emergency professionals during the performance of resuscitation. MATERIALS AND METHODS: An uncontrolled quasi-experimental study was performed on 96 volunteers selected by means of random sampling stratified by gender. Baseline and final vital signs of the assessment activity were analyzed. This activity involves volunteers performing a simulated resuscitation in a controlled environment whilst wearing personal protective suits in a biohazard situation. RESULTS: Analyzing the physiological tolerance pattern parameter by parameter, and according to gender, through a univariate model, we can observe that there is no interaction between tolerance and gender; that is, having good or bad tolerance does not depend on gender. Conclusion. This specialized skilled work can be performed by any properly trained professional.

¿Afecta el uso de un equipo de protección individual frente a riesgos biológicos nivel D a la realización de una reanimación cardiopulmonar? / Does level D personal protective equipment guard against hazardous biologic agents during cardiopulmonary resuscitation?

Objetivo. Determinar cómo afecta el uso de los equipos de protección individual (EPI) nivel D a los trabajadores de la salud cuando realizan una reanimación. Métodos. Estudio cuasiexperimental no controlado sobre 96 voluntarios elegidos mediante un muestreo aleatorio estratificado por sexo, nivel de formación y categoría profesional, de una muestra de oportunidad de 164 voluntarios, 40 hombres (41,66%) y 56 mujeres (58,33%), con una edad media de 31 (DE 11) años, estudiantes de medicina y enfermería y profesionales médicos y enfermeros. Mediante el uso de un protocolo Conconi con cicloergometría se obtuvo la frecuencia cardiaca (FC) del umbral anaeróbico de los voluntarios, y después se comparó con la FC máxima de los voluntarios durante la realización de una reanimación con el EPI colocado. Resultados. Durante los minutos correspondientes a la realización del masaje cardiaco externo durante la reanimación en el caso clínico, un 46,9% de los voluntarios sobrepasan la FC máxima recomendable obtenida mediante la ciclo ergometría. Conclusiones. Nuestro estudio encontró que la realización de una reanimación con un EPI nivel D supone un sobresfuerzo físico muy intenso. Es necesario tener contemplado en los protocolos estas situaciones especiales e implementar un entrenamiento específico para aquellos reanimadores que deban trabajar con este tipo de pacientes (AU)

Objective. Our aim was to determine the usefulness of level D personal protective equipment (PPE) in safeguarding health care staff who perform cardiopulmonary resuscitation (CPR). Methods. Quasi-experimental, uncontrolled trial in 96 volunteers chosen randomly and stratified by sex, level of training, and professional category. The subjects were selected from a convenience sample of 164 nurses, physicians, and students of nursing and medicine (40 men [41.66%] and 56 women [58.33%]). The mean (SD) age was 31 (11) years. The Conconi test was used to determine heart rate (HR) at the anaerobic threshold on a cycle ergometer. That HR was then compared to each volunteer's maximum HR during performance of CPR while wearing PPE. Results. While the volunteers were performing CPR, 46.9% of them surpassed their maximum recommendable HR recorded during the cycle ergometer test. Conclusions. We found that performing CPR while wearing level D PPE requires intense physical effort. Special situations should be taken into consideration when developing protocols for situations that require staff to wear PPE. Staff who must perform CPR under these conditions should be given specific training (AU)

Does level D personal protective equipment guard against hazardous biologic agents during cardiopulmonary resuscitation? / ¿Afecta el uso de un equipo de protección individual frente a riesgos biológicos nivel D a la realización de una reanimación cardiopulmonar?

OBJECTIVES: Our aim was to determine the usefulness of level D personal protective equipment (PPE) in safeguarding health care staff who perform cardiopulmonary resuscitation (CPR). MATERIAL AND METHODS: Quasi-experimental, uncontrolled trial in 96 volunteers chosen randomly and stratified by sex, level of training, and professional category. The subjects were selected from a convenience sample of 164 nurses, physicians, and students of nursing and medicine (40 men [41.66%] and 56 women [58.33%]). The mean (SD) age was 31 (11) years. The Conconi test was used to determine heart rate (HR) at the anaerobic threshold on a cycle ergometer. That HR was then compared to each volunteer's maximum HR during performance of CPR while wearing PPE. RESULTS: While the volunteers were performing CPR, 46.9% of them surpassed their maximum recommendable HR recorded during the cycle ergometer test. CONCLUSION: We found that performing CPR while wearing level D PPE requires intense physical effort. Special situations should be taken into consideration when developing protocols for situations that require staff to wear PPE. Staff who must perform CPR under these conditions should be given specific training.

OBJETIVO: Determinar cómo afecta el uso de los equipos de protección individual (EPI) nivel D a los trabajadores de la salud cuando realizan una reanimación. METODO: Estudio cuasiexperimental no controlado sobre 96 voluntarios elegidos mediante un muestreo aleatorio estratificado por sexo, nivel de formación y categoría profesional, de una muestra de oportunidad de 164 voluntarios, 40 hombres (41,66%) y 56 mujeres (58,33%), con una edad media de 31 (DE 11) años, estudiantes de medicina y enfermería y profesionales médicos y enfermeros. Mediante el uso de un protocolo Conconi con cicloergometría se obtuvo la frecuencia cardiaca (FC) del umbral anaeróbico de los voluntarios, y después se comparó con la FC máxima de los voluntarios durante la realización de una reanimación con el EPI colocado. RESULTADOS: Durante los minutos correspondientes a la realización del masaje cardiaco externo durante la reanimación en el caso clínico, un 46,9% de los voluntarios sobrepasan la FC máxima recomendable obtenida mediante la ciclo ergometría. CONCLUSIONES: Nuestro estudio encontró que la realización de una reanimación con un EPI nivel D supone un sobresfuerzo físico muy intenso. Es necesario tener contemplado en los protocolos estas situaciones especiales e implementar un entrenamiento específico para aquellos reanimadores que deban trabajar con este tipo de pacientes.