Características y evolución de las paradasc ardiorrespiratorias pediátricas extrahospitalarias en Galicia / Outpatient paediatric cardiorespiratory arrest in Galicia: characteristics and evolution

Objetivos: Conocer las características de las paradas cardiorrespiratorias(PCR) pediátricas y los resultados de la reanimación cardiopulmonar (RCP) en Galicia e intentar identificar factores pronósticos de supervivencia. Métodos: Se incluyeron todos los niños, con edades entre recién nacidoy 16 años, que sufrieron una PCR extrahospitalaria en Galicia y fueron atendidos por el personal de la Fundación Pública Urgencias Sanitarias de Galicia-061 (FPUS-061), entre junio de 2002 y febrero de2005. Los datos fueron recogidos de forma prospectiva siguiendo el estilo Utstein. Resultados: 31 casos (incidencia: 3.4 PCR por 100.000 niños y año),de los cuales respiratoria en 5 (16,1%) y cardiaca en 26 (83,9%). PCR en domicilio en 18 (58,1%). Tiempo PCR-RCP inferior a 10 minutos en10 (32,2%) y superior a 20 minutos en 9 (29,0%). En 7 (22,6%) se realizó RCP inicial por un testigo. El primer ritmo detectado asistolia en 21(67,7%). 25 casos (80,6%) fueron ventilados con bolsa y mascarilla, y fueron intubados 27 (87%). En 21 ocasiones (67,7%) se consiguió una vía venosa periférica y en 5 (16,1%) una vía intraósea. 29 casos (93,5%) recibieron adrenalina. Recuperaron la circulación espontánea (..) (AU)

Background and aims: Cardiorespiratory arrest (CRA) is a rare event in childhood, and its characteristics are not well known. The aim of our present work was to assess the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation(CPR) in Galicia and to identify prognostic factors for survival. Methods: All children aged from newborn to 16 years old who had suffered outpatient CRA and had been assisted by the Medical Emergencies of Galicia - 061 Public Foundation (Fundación Pública Urgencias Sanitarias en Galicia - 061, FPUS-061) between June 2002 and February2006 were included in the study. Data were prospectively recorded according to the Utstein guidelines. Results: The study population encompasses 31 cases of CRA (incidence rate: 3.4 CRA’s per 100.000 children and year); 5 cases were respiratory in origin (16.1%) and 26 (83.9%) were cardiac. There were 18 cases of at-home CRA (58.1%). The CRA to CPR interval was less than 10 minutes in 10cases (32.2%) and greater than 20 minutes in 9 (29.0%). The initial CPR was performed by a bystander in 7 cases (22.6%). The first recorded cardiac rhythm was a systolia in 21 cases (67.7%). Bag-and-mask ventilation was applied in 25 cases (80.6%), and 27 (87%) were intubated. A peripheral venous access was achieved in 21 cases (67.7%), and an intraosseous (..) (AU)

[Long-term consequences of pediatric trauma requiring intensive care]. / Consecuencias a largo plazo de los traumatismos pediátricos que precisaron cuidados intensivos.

INTRODUCTION: Trauma is a major cause of pediatric morbidity. The aim of the present study was to determine the long-term effects of severe trauma in children and their families. PATIENTS AND METHODS: We performed an observational, cross sectional study of 209 children admitted to our pediatric intensive care unit due to trauma between 1999 and 2003. Family members and/or children were interviewed at least 2 years after the event. Functional situation was assessed by means of the Pediatric Overall Performance Category (POPC) scale and neurological status by means of the Pediatric Cerebral Performance Category (PCPC) scale. Subjective perception of quality of life was also evaluated. RESULTS: At assessment, patient age was 13+/-4 years. The causes of trauma were traffic accidents (42.6%), falls (30.1%), bicycle accidents (15.3%) and other causes (12%). The trauma affected the brain and cranium in 78.9%, skeleton in 20.2%, abdomen in 16.3% and other body regions in 15.3% of the patients. At assessment, 1.5 % of the patients were in a persistent vegetative state, 0.5% had severe disability, and 1% had moderate disability. A total of 9.5% had some type of persistent psychological disorder and 3.8 % needed some kind of help to perform daily activities. The median (range) score for self-estimated quality of life by the family was 3 (0-6) for the group of children with moderate or severe disability, while 12.9% of parents reported serious alterations of family dynamics related to the trauma event. CONCLUSIONS: Most children who survive after severe trauma achieve a good functional situation in the long term. Although the number of children with severe sequelae is small, these children have serious difficulties in achieving normal social adaptation and their quality of life is clearly impaired.

Consecuencias a largo plazo de los traumatismos pediátricos que precisaron cuidados intensivos / Long-term consequences of pediatric trauma requiring intensive care

Introducción Los traumatismos causan una gran morbilidad pediátrica. El presente estudio pretende estimar la repercusión a largo plazo de los traumatismos graves sobre el niño y su familia. Pacientes y métodos Estudio observacional y transversal que incluyó a 209 niños ingresados en nuestra unidad de cuidados intensivos pediátricos entre 1999 y 2003 por traumatismos. Al menos 2 años después, los familiares y/o los pacientes fueron entrevistados, evaluándose su situación funcional y neurológica con las escalas Pediatric Overall Performance Category (POPC) y Pediatric Cerebral Performance Category (PCPC), así como la percepción de calidad de vida. Resultados Los pacientes tenían 13 ± 4 años cuando fueron estudiados. Las causas del traumatismo fueron por accidentes de tráfico (42,6 %), caídas (30,1 %), accidentes de bicicleta (15,3 %) y otros (12 %). La localización fue craneoencefálica (78,9 %), esquelética (20,2 %), abdominal (16,3 %) y otra (15,3 %). En la evaluación, 1,5 % de los pacientes estaban en estado vegetativo persistente, 0,5 % tenían discapacidad grave y 1 % discapacidad moderada. El 9,5 % presentaba alguna alteración psicológica persistente y el 3,8 % precisaba ayuda para realizar sus actividades diarias. La mediana (rango) de la estimación de la calidad de vida por la familia fue de 3 (0-6) en los casos con discapacidad moderada o grave. El 12,9 % de los padres refirieron una alteración seria de la dinámica familiar en relación con el episodio traumático. Conclusiones La mayoría de los niños que sobreviven a un traumatismo grave mantienen una buena situación funcional a largo plazo. Aunque son pocos los pacientes con secuelas importantes, dichos niños sufren serias dificultades para su adaptación social y ven mermada su calidad de vida

Introduction Trauma is a major cause of pediatric morbidity. The aim of the present study was to determine the long-term effects of severe trauma in children and their families. Patients and methods We performed an observational, cross sectional study of 209 children admitted to our pediatric intensive care unit due to trauma between 1999 and 2003. Family members and/or children were interviewed at least 2 years after the event. Functional situation was assessed by means of the Pediatric Overall Performance Category (POPC) scale and neurological status by means of the Pediatric Cerebral Performance Category (PCPC) scale. Subjective perception of quality of life was also evaluated. Results At assessment, patient age was 13 ± 4 years. The causes of trauma were traffic accidents (42.6 %), falls (30.1 %), bicycle accidents (15.3 %) and other causes (12 %). The trauma affected the brain and cranium in 78.9 %, skeleton in 20.2 %, abdomen in 16.3 % and other body regions in 15.3 % of the patients. At assessment, 1.5 % of the patients were in a persistent vegetative state, 0.5 % had severe disability, and 1 % had moderate disability. A total of 9.5 % had some type of persistent psychological disorder and 3.8 % needed some kind of help to perform daily activities. The median (range) score for self-estimated quality of life by the family was 3 (0-6) for the group of children with moderate or severe disability, while 12.9 % of parents reported serious alterations of family dynamics related to the trauma event. Conclusions Most children who survive after severe trauma achieve a good functional situation in the long term. Although the number of children with severe sequelae is small, these children have serious difficulties in achieving normal social adaptation and their quality of life is clearly impaired

Hiperactivos sin tratamiento, ¿fracaso escolar y futuros inadaptados? Papel del médico de Atención Primaria: a propósito de un caso / No disponible

El trastorno por déficit de atención e hiperactividad (TDAH) es la enfermedad psiquiátricamás frecuente en pediatría y la causa principal de fracaso escolar. Es causa y coexiste enocasiones con procesos más graves como el trastorno oposicional desafiante (TOD) y el trastornodisocial (TC). Este último se presenta en menores de 10 años y adolescentes y producefalta de integración escolar, ruptura de normas sociales e incluso comisión de actos delictivos.Se presenta el caso clínico de un niño de 10 años que consulta por fracaso escolar y alteracionesde la conducta en casa y en el colegio. Con el diagnóstico preliminar de trastorno deconducta disruptiva, se deriva a la Unidad de Salud Mental Infanto-Juvenil donde se estableceel diagnóstico definitivo de trastorno disocial en niño no socializado. El tratamiento conmetilfenidato mejora notablemente tanto su rendimiento académico como su comportamiento.El papel del pediatra de Atención Primaria ante el TDAH debe consistir en la detecciónprecoz, el inicio del tratamiento cuando sea oportuno y el seguimiento para verificar larespuesta terapéutica. En este proceso es esencial un diagnóstico precoz ya que puede facilitarel desarrollo normal del paciente y evitar la evolución hacia un trastorno más grave

Attention deficit/hyperactivity disorder (ADHD) is the most common psychiatric diseasein childhood and the first cause of scholar failure. It is the cause and coexist sometimes withother severe conditions like oppositional-deafiant disorder (ODD) and conduct disorder (CD).The last one appears in adolescents and in children younger than 10 years and causes lack ofschool integration, rupture of social norms and even commission of criminal acts. Case report:a 10 year-old boy with scholar failure, home and school disturbances in behaviour that includedphysic violence directed to mates and teachers. A preliminary diagnosis of disruptive behaviour disorder was made and the patient was referred for specialized psychiatric evaluation.The final diagnosis was dissocial behavior disorder in an unsocialized child. Metylphenidatetreatment resulted in an evident improvement of behaviour and academic performance.When faced with a possible ADHD case, the Primary Care pediatrician’s role should be earlydetection, starting of treatment when indicated and assessment of therapeutic results. Earlydiagnosis is of the most importance in this disorder because it can drives to a normal developmentof the patient avoiding the evolution to a more severe condition

Niños y motos. ¿Podemos hacer algo más para prevenir los accidentes? / Children and two-wheeled motorized vehicles. Can more be done to prevent accidents?

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Minimotos: un nuevo aspecto de un viejo problema / Minimotorcycles: A new feature of an old problem

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