Formación y seguridad en transporte pediátrico / Training and safety in pediatric transport

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Quemaduras graves relacionadas con la terapia inhalatoria con vahos / Severe burns related to steam inhalation therapy

INTRODUCCIÓN: Todavía se emplean vahos con agua caliente como tratamiento de procesos respiratorios banales, a pesar del riesgo de ocasionar quemaduras y de no haberse demostrado su efectividad. OBJETIVOS: Caracterizar los casos de quemaduras relacionadas con vahos (QRV) en una población de niños quemados con el objeto de formular criterios para su prevención. PACIENTES Y MÉTODOS: Revisión de pacientes ingresados por QRV en una unidad de quemados durante el periodo 2006-2012. Se analizó: epidemiología, clínica, gravedad y evolución. RESULTADOS: Ingresaron 530 pacientes quemados; 375 (70%) con escaldaduras y 15 con QRV (2,8% del total; 4% de las escaldaduras). Los vahos fueron indicados mayoritariamente para tratar episodios catarrales banales. La edad mediana fue 7 años (2,5 meses-14 anos). La superficie corporal quemada (SCQ) fue ≥ 10% en el 60% de los casos (SCQ máxima 22%). Las quemaduras afectaron al tronco, a los genitales y a las extremidades y solo en un caso afectó a la cara. La estancia media hospitalaria fue de 14 días (3-30 d). Cinco niños (33%) ingresaron en la UCIP, la mayoría (60%) menores de 3 años. Ocho casos (53%) requirieron intervención quirúrgica (injerto de piel). Un paciente de 12 años fue diagnosticado de tos ferina y otro de 2,5 años presentó un shock tóxico estafilocócico. No hubo fallecimientos. Todos los pacientes evolucionaron satisfactoriamente. CONCLUSIONES: Las QRV pueden ser graves y consumir importantes recursos. Los profesionales de la atención al niño, particularmente los pediatras, deben velar por su prevención, absteniéndose de indicar los vahos como tratamiento y educando a los padres para que no los utilicen por sí mismos

INTRODUCTION: Despite lack of proven effectiveness and its potential to cause severe burns, steam inhalation therapy (SIT) is still used as a treatment for benign respiratory conditions. OBJECTIVE: To characterize cases of burns related to steam inhalation therapy (BRSIT) in order to formulate appropriate preventive criteria. PATIENTS AND METHODS: A review was conducted on cases of BRSIT admitted to a Burns Unit between 2006 and 2012, analysing epidemiological data, clinical aspects, severity and course. RESULTS: A total of 530 patients were admitted; 375 (70%) with scalds, and 15 with BRSIT (2.8% of burns; 4% of scalds). SIT was indicated in most cases for mild upper airway infections. The median age of patients was 7 years (2.5 m-14 y). The burned area (BA) was ≥ 10% in 60% of cases (max. BA 22%). Injuries involved trunk, genital area, and extremities; only in one case was the face affected. The mean hospital length-of-stay was 14 days (3-30d). Five patients (33%) were admitted to the PICU, most of them (60%) younger than 3 years. Eight patients (53%) underwent surgical treatment (skin grafting). In a 12-year-old patient whooping cough was diagnosed in the Burns Unit, and a 2.5-year-old patient developed staphylococcal toxic shock syndrome. No patient died. The final course was satisfactory in all patients. CONCLUSIONS: BRSIT can be severe and cause significant use of health resources. Professionals caring for children, particularly paediatricians, should seriously consider their prevention, avoiding treatments with SIT, and educating parents in order not to use it on their own

[Severe burns related to steam inhalation therapy]. / Quemaduras graves relacionadas con la terapia inhalatoria con vahos.

INTRODUCTION: Despite lack of proven effectiveness and its potential to cause severe burns, steam inhalation therapy (SIT) is still used as a treatment for benign respiratory conditions. OBJECTIVE: To characterize cases of burns related to steam inhalation therapy (BRSIT) in order to formulate appropriate preventive criteria. PATIENTS AND METHODS: A review was conducted on cases of BRSIT admitted to a Burns Unit between 2006 and 2012, analysing epidemiological data, clinical aspects, severity and course. RESULTS: A total of 530 patients were admitted; 375 (70%) with scalds, and 15 with BRSIT (2.8% of burns; 4% of scalds). SIT was indicated in most cases for mild upper airway infections. The median age of patients was 7 years (2.5m-14 y). The burned area (BA) was ≥10% in 60% of cases (max. BA 22%). Injuries involved trunk, genital area, and extremities; only in one case was the face affected. The mean hospital length-of-stay was 14 days (3-30 d). Five patients (33%) were admitted to the PICU, most of them (60%) younger than 3 years. Eight patients (53%) underwent surgical treatment (skin grafting). In a 12-year-old patient whooping cough was diagnosed in the Burns Unit, and a 2.5-year-old patient developed staphylococcal toxic shock syndrome. No patient died. The final course was satisfactory in all patients. CONCLUSIONS: BRSIT can be severe and cause significant use of health resources. Professionals caring for children, particularly paediatricians, should seriously consider their prevention, avoiding treatments with SIT, and educating parents in order not to use it on their own.

Hacia el pleno desarrollo del transporte pediátrico en España / Towards the full development of paediatric transport in Spain

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Un año de registro de traumatismos graves en Cataluña. Análisis de los primeros resultados / TraumCat: preliminary analysis of a year of severe trauma registry in Catalonia

Objetivo: Evaluar los resultados del primer año de implantación de un registro poblacional hospitalario de traumatismos graves en Cataluña (TraumCat). Método: Un total de 15 hospitales han recogido de forma prospectiva información sobre pacientes traumáticos graves, adultos y pediátricos (menores de 16 años), durante un periodo de un año (del 1 julio 2012 al 1 julio 2013) y la han introducido en un registro informatizado accesible en red. Resultados: Se han registrado 1.106 casos de pacientes con traumatismos de alta energía(12,2% en menores de 16 años). Un 84% de los traumatismos fueron no intencionales en adultos jóvenes. El 54,4% de los traumatismos se originaron en accidentes de circulación y el26,9% en precipitaciones. Un 5,4% correspondían a agresiones. Un 46% de pacientes presentaban un ISS mayor a 15, mientras que el NISS era mayor a 15 en un 51%. La tasa media de mortalidad fue del 10%. Sin embargo, en mayores de 60 años la tasa alcanzó el 25,2%.Conclusiones: TraumCat permite conocer la dimensión y evaluar el proceso asistencial en torno al traumatismo grave en Cataluña. Es preciso avanzar en la consolidación y mejora de esta herramienta como estrategia de monitorización del proceso asistencial y análisis de resultados (AU)

Objective: To analyze results of the first year’s use of the Hospital Population-Based Registry of Severe Trauma in Catalonia (TraumCat).Methods: Fifteen hospitals prospectively collected information on adults and children (< 16 years of age) with severetrauma for 1 year (July 1, 2012 to July 1, 2013). The information was stored in an online database. Results: The registry received 1106 cases of high-energy trauma (12.2% under the age of 16 years) were registered. Eight-four percent of the injuries in young adults were accidental; in the full cohort, 54.4% of the patients were injured in traffic accidents and 26.9% in falls. Personal violence accounted for 5.4%. The Injury Severity Score was over 15 in46% of the patients, and the New Injury Severity Score was over 15 in 51%. Mortality was 10% overall, but in patients aged over 60 years, mortality was 25.2%.Conclusions: TraumCat reveals the scope of severe trauma in Catalonia and facilitates analysis of the process of treatment of these injuries. This tool should be more firmly established and improved as a strategy for monitoring trauma care and outcomes (AU)

Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a review of the experience with paediatric patients in a university hospital.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug reactions considered to be part of the spectrum of a single pathological process. OBJECTIVE: To describe the clinical and epidemiological characteristics of SJS/TEN in children attended at our hospital. MATERIALS AND METHODS: Retrospective study of children diagnosed with SJS/TEN between 1999 and 2009 in a University Hospital provided with regional-level burn and paediatric intensive care units. RESULTS: We found 14 paediatric patients (eight SJS and six TEN). They presented an average of 60% of the body surface area affected and 31% of epidermal sloughing. The average of suspected drugs was 1.7 per patient, anticonvulsants (carbamazepine, phenytoin and lamotrigine) and antibiotics (penicillin and macrolides) being the most frequent ones. Silver sulfadiazine was the topical treatment most frequently used, 86% of patients received systemic steroids and 28.5% intravenous immunoglobulins. One patient died. CONCLUSIONS: The SJS/TEN complex is a true dermatological critical condition that also affects children. Any drug can be the causative agent, more frequently anticonvulsants and antibiotics. Depending on the extension of the affected body surface, patients should be rapidly admitted to a critical care area with experience in the care of burn patients. Discontinuation of the suspected offending drugs is mandatory. Optimal supportive care and management of denuded skin areas are still the mainstay of treatment. The use of specific therapies remains controversial. Compared with adults, the disease in children seems to be milder with lower mortality.

[Pneumococcal endocarditis in a previously healthy 17-month-old boy]. / Endocarditis neumocócica en niño de 17 meses previamente sano.

Invasive pneumococcal infection is a severe disease and its incidence may be increasing. Endocarditis due to Streptococcus pneumoniae is uncommon, particularly in children without risk factors. Etiologic diagnosis is difficult when cultures are negative. We report the case of a previously healthy, 17-month-old boy not vaccinated against pneumococcus who, during the course of pneumonia treated with beta-lactam antibiotics, developed cardiorespiratory deterioration and heart murmur. Mitral valve vegetation was identified by transthoracic echocardiography. Endocarditis was diagnosed and new antibiotics were given for 6 weeks (cefotaxime, gentamycin and vancomycin). Cultures were negative. Because of lack of improvement, prosthetic mitral replacement was indicated. S. pneumoniae was identified by polymerase chain reaction (PCR) in the pathological specimen. Outcome was favorable, and the patient remained symptom-free after 6 months of follow-up. The possibility of endocarditis as an invasive pneumococcal infection should be considered in children without risk factors. PCR is a useful technique to establish the etiology when cultures are negative.

Endocarditis neumocócica en niño de 17 meses previamente sano / Pneumococcal endocarditis in a previously healthy 17-month-old boy

La enfermedad invasora neumocócica es una entidad grave y cuya incidencia parece en aumento. La endocarditis por Streptococcus pneumoniae es infrecuente, particularmente en niños sin factores de riesgo. Su caracterización etiológica resulta difícil ante cultivos negativos. Se presenta un niño de 17 meses, previamente sano, no vacunado frente a neumococo. Durante una neumonía tratada con betalactámicos aparecen deterioro cardiorrespiratorio progresivo y soplo cardíaco. La ecocardiografía transtorácica muestra una vegetación mitral. Se diagnostica endocarditis y se adecua la antibioterapia (cefotaxima, gentamicina y vancomicina, mantenidas 6 semanas). Los cultivos resultan negativos. Ante la no mejoría se interviene, colocándose una prótesis. En la válvula resecada, mediante técnica de reacción en cadena de polimerasa (PCR), se identifica S. pneumoniae. La evolución es buena, permaneciendo asintomático a los 6 meses de seguimiento. Debe considerarse la posibilidad de endocarditis como forma invasora de infección neumocócica en niños sin factores de riesgo, y la utilidad de la PCR para establecer su etiología ante cultivos negativos

Invasive pneumococcal infection is a severe disease and its incidence may be increasing. Endocarditis due to Streptococcus pneumoniae is uncommon, particularly in children without risk factors. Etiologic diagnosis is difficult when cultures are negative. We report the case of a previously healthy, 17-month-old boy not vaccinated against pneumococcus who, during the course of pneumonia treated with beta-lactam antibiotics, developed cardiorespiratory deterioration and heart murmur. Mitral valve vegetation was identified by transthoracic echocardiography. Endocarditis was diagnosed and new antibiotics were given for 6 weeks (cefotaxime, gentamycin and vancomycin). Cultures were negative. Because of lack of improvement, prosthetic mitral replacement was indicated. S. pneumoniae was identified by polymerase chain reaction (PCR) in the pathological specimen. Outcome was favorable, and the patient remained symptom-free after 6 months of follow-up. The possibility of endocarditis as an invasive pneumococcal infection should be considered in children without risk factors. PCR is a useful technique to establish the etiology when cultures are negative

[Cardiorespiratory arrest in children with trauma]. / Parada cardiorrespiratoria secundaria a traumatismos en niños. Características y evolución.

OBJECTIVE: To analyze the characteristics and outcome of cardiorespiratory arrest secondary to trauma in children. PATIENTS AND METHODS: We performed a secondary analysis of data from a prospective, multicenter study of cardiorespiratory arrest in children. Data were recorded according to the Utstein style. Twenty-eight children (age range: 7 days to 16 years) with cardiorespiratory arrest secondary to trauma were evaluated. The outcome variables were return of spontaneous circulation, sustained (more than 20 minutes) return of spontaneous circulation (initial survival), and survival at hospital discharge (final survival) in relation to the characteristics of the cardiorespiratory arrest and cardiopulmonary resuscitation. Neurological and general performance outcome was assessed by means of the Pediatric Cerebral Performance Category scale and the Pediatric Overall Performance Category scale. RESULTS: Return of spontaneous circulation was obtained in 18 patients (64.2 %), initial survival was achieved in 14 (50 %) and final survival was achieved in three (10.7 %) (two without neurological sequelae and one with vegetative status). Final survival was significantly higher in patients with respiratory arrest (33.3 %) than in those with cardiac arrest (4.5 %), p = 0.04. Final survival was also higher in patients with a duration of cardiopulmonary resuscitation shorter than 20 minutes (27.2 %) than in the remaining patients (0 %), p =0.05. The two survivors without neurologic sequelae had respiratory arrest. CONCLUSIONS: Survival until hospital discharge in children with cardiorespiratory arrest secondary to trauma is lower than that in children with cardiorespiratory arrest. Patients with respiratory arrest when resuscitation is started and those with a duration of cardiopulmonary resuscitation of less than 20 minutes showed better survival than the remaining patients.

Asistencia inicial al traumatismo pediátrico y reanimación cardiopulmonar / Initial pediatric trauma care and cardiopulmonary resuscitation

Los accidentes son la causa más frecuente de muerte en niños por encima del año de edad. Las causas más importantes de muerte por accidente son los accidentes de tráfico, el ahogamiento, las lesiones intencionadas, las quemaduras y las caídas. La reanimación cardiopulmonar es una parte más del conjunto de acciones de estabilización inicial en un niño con traumatismo. La parada cardiorrespiratoria en los primeros minutos después del accidente, ocurre generalmente por obstrucción de la vía aérea o mala ventilación, pérdida masiva de sangre o lesión cerebral grave, y tiene muy mal pronóstico. La parada en las horas siguientes al traumatismo está generalmente producida por hipoxia, hipovolemia, hipotermia, hipertensión intracraneal o alteraciones hidroelectrolíticas. La primera respuesta ante el traumatismo, tiene tres componentes: proteger (valoración del escenario y establecimiento de medidas de seguridad), alarmar (activación del sistema de emergencias) y socorrer (atención inicial al traumatismo). La atención inicial al traumatismo se divide en reconocimiento primario y secundario. El reconocimiento primario incluye los siguientes pasos secuenciales: A. control cervical, alerta y vía aérea; B: respiración; C: circulación y control de la hemorragia; D: disfunción neurológica, y E: exposición. El reconocimiento secundario consiste en la evaluación del accidentado mediante la anamnesis, exploración física ordenada desde la cabeza a las extremidades y práctica de exámenes complementarios. Durante la atención al traumatismo se pueden precisar algunas maniobras específicas que no suelen ser necesarias en otras situaciones de emergencia como son maniobras de extracción y movilización, control cervical mediante inmovilización cervical bimanual y colocación del collarín cervical y retirada del casco. Si durante la asistencia inicial al traumatismo ocurre una parada cardiorrespiratoria las maniobras de reanimación cardiopulmonar se realizarán de forma inmediata adaptándose a las características específicas del niño traumatizado

Accidents are a frequent cause of death in children older than 1 year. The most frequent causes of death by accident are traffic accidents, drowning, intentional injuries, burns, and falls. Cardiopulmonary resuscitation is one component of the set of actions needed to obtain initial stabilization of a child with serious trauma. In the first few minutes after the accident, cardiorespiratory arrest can occur due to airway obstruction or inadequate ventilation, massive blood loss or severe brain damage; cardiorespiratory arrest in this setting has a dismal outcome. When arrest occurs hours after trauma, it is usually caused by hypoxia, hypovolemia, hypothermia, intracranial hypertension, or electrolyte disturbances. The first response to trauma should include three objectives: to protect (scenario assessment and implementation of safety measures), to alert (activation of the emergency medical system) and to help (initial trauma care). Initial trauma care includes primary and secondary surveys. The primary survey involves several consecutive steps: A. airway and cervical spine stabilization, B. breathing, C. circulation and hemorrhage control, D. neurological dysfunction, and E. exposure. The secondary survey consists of assessment of the victim by means of anamnesis, sequential physical examination (from head to limbs) and complementary investigations. During emergency trauma care, specific procedures such as extrication and mobilization maneuvers, cervical spine control by means of bimanual immobilization, and cervical collar placement or helmet removal. If a cardiorespiratory arrest occurs during initial trauma care, resuscitation maneuvers must be immediately started with the specific adaptations indicated in children with trauma

Parada cardiorrespiratoria secundaria a traumatismos en niños. Características y evolución / Cardiorespiratory arrest in children with trauma

Objetivo Analizar las características y evolución de la parada cardiorrespiratoria secundaria a traumatismo en niño. Pacientes y métodos Análisis secundario de un estudio prospectivo observacional multicéntrico sobre la parada cardiorrespiratoria en niños siguiendo las recomendaciones del estilo Utstein. Se estudiaron 28 niños de edades entre 7 días y 16 años con parada cardiorrespiratoria secundaria a traumatismo. Se analizaron la recuperación de la circulación espontánea, la supervivencia inicial (recuperación de la circulación espontánea más de 20 min) y la supervivencia final (supervivencia al alta del hospital) en relación a las características de la parada cardiorrespiratoria y la reanimación cardiopulmonar. La situación funcional cerebral y global de los supervivientes se evaluó mediante las escalas pediátricas de estado neurológico y funcional. Resultados Se consiguió recuperación de la circulación espontánea en 18 pacientes (64,2 %), supervivencia inicial en 14 (50 %) y supervivencia a largo plazo en 3 (10,7 %) (2 sin secuelas neurológicas y uno en estado vegetativo). La supervivencia al alta del hospital fue mayor en los niños con parada respiratoria en el momento del diagnóstico (33,3 %) que en los que presentaban parada cardíaca (4,5 %) p 5 0,04, y también en los que la reanimación cardiopulmonar duró menos de 20 min (27,2 %) que en los que fue más prolongada (0 %), p 5 0,05. Los 2 supervivientes sin secuelas neurológicas presentaron parada respiratoria en el momento del diagnóstico inicial. Conclusiones La supervivencia de los niños con parada cardiorrespiratoria secundaria a traumatismo es menor que la del resto de pacientes con parada cardiorrespiratoria. Los niños en situación de parada respiratoria en el momento del diagnóstico y aquéllos con una duración de la reanimación cardiopulmonar menor de 20 min tienen una supervivencia mayor que el resto de los pacientes

Objective To analyze the characteristics and outcome of cardiorespiratory arrest secondary to trauma in children. Patients and methods We performed a secondary analysis of data from a prospective, multicenter study of cardiorespiratory arrest in children. Data were recorded according to the Utstein style. Twenty-eight children (age range: 7 days to 16 years) with cardiorespiratory arrest secondary to trauma were evaluated. The outcome variables were return of spontaneous circulation, sustained (more than 20 minutes) return of spontaneous circulation (initial survival), and survival at hospital discharge (final survival) in relation to the characteristics of the cardiorespiratory arrest and cardiopulmonary resuscitation. Neurological and general performance outcome was assessed by means of the Pediatric Cerebral Performance Category scale and the Pediatric Overall Performance Category scale. Results Return of spontaneous circulation was obtained in 18 patients (64.2 %), initial survival was achieved in 14 (50 %) and final survival was achieved in three (10.7 %) (two without neurological sequelae and one with vegetative status). Final survival was significantly higher in patients with respiratory arrest (33.3 %) than in those with cardiac arrest (4.5 %), p 5 0.04. Final survival was also higher in patients with a duration of cardiopulmonary resuscitation shorter than 20 minutes (27.2 %) than in the remaining patients (0 %), p 5 0.05. The two survivors without neurologic sequelae had respiratory arrest. Conclusions Survival until hospital discharge in children with cardiorespiratory arrest secondary to trauma is lower than that in children with cardiorespiratory arrest. Patients with respiratory arrest when resuscitation is started and those with a duration of cardiopulmonary resuscitation of less than 20 minutes showed better survival than the remaining patients

[Characteristics and evolution of cardiopulmonary arrest in children in Spain: comparison between autonomous communities]. / Características y evolución de la parada cardiorrespiratoria infantil en España: comparación entre Comunidades Autónomas.

INTRODUCTION: In Spain there are many differences between autonomous regions in terms of geography, population distribution and health care organisation. We do not know if these differences could have influenced the characteristics and evolution of cardiopulmonary arrest in children. PATIENTS AND METHODS: A secondary analysis of data from a prospective, multicenter and previously published study, analysing cardiorespiratory arrest in children was made to compare the characteristics and evolution of cardiopulmonary arrest in children depending on the region where the arrest occurred. We studied 283 children aged between 7 days and 17 years who suffered respiratory or cardiopulmonary arrest. Data were recorded according to the international Utstein style recommendations. Patients were classified according to the autonomous region where the cardiac arrest occurred: Catalonia (94 cases), Andalusia (64 cases), Madrid (61 cases) and the rest of the regions (64 patients). A statistical analysis was performed to compare the characteristics of cardiac arrest, resuscitation, evolution and survival between the four groups. RESULTS: Sixty percent of patients initially survived the cardiac arrest episode and 33% (94 patients) were still alive one year later. No significant differences in the characteristics of arrest, resuscitation and evolution were found when the autonomous regions were compared. Even though the differences were not statistically significant, there was a tendency to less than expected survival in Andalusia and higher than expected survival in Catalonia. CONCLUSIONS: There are no important differences in the characteristics of pediatric cardiopulmonary arrest, resuscitation, evolution and survival between the autonomous regions in Spain. Additional studies are needed to analyze the hypothetical influence of health care organization and life support training on survival.

[Initial pediatric trauma care and cardiopulmonary resuscitation]. / Asistencia inicial al traumatismo pediátrico y reanimación cardiopulmonar.

Accidents are a frequent cause of death in children older than 1 year. The most frequent causes of death by accident are traffic accidents, drowning, intentional injuries, burns, and falls. Cardiopulmonary resuscitation is one component of the set of actions needed to obtain initial stabilization of a child with serious trauma. In the first few minutes after the accident, cardiorespiratory arrest can occur due to airway obstruction or inadequate ventilation, massive blood loss or severe brain damage; cardiorespiratory arrest in this setting has a dismal outcome. When arrest occurs hours after trauma, it is usually caused by hypoxia, hypovolemia, hypothermia, intracranial hypertension, or electrolyte disturbances. The first response to trauma should include three objectives: to protect (scenario assessment and implementation of safety measures), to alert (activation of the emergency medical system) and to help (initial trauma care). Initial trauma care includes primary and secondary surveys. The primary survey involves several consecutive steps: A. airway and cervical spine stabilization, B. breathing, C. circulation and hemorrhage control, D. neurological dysfunction, and E. exposure. The secondary survey consists of assessment of the victim by means of anamnesis, sequential physical examination (from head to limbs) and complementary investigations. During emergency trauma care, specific procedures such as extrication and mobilization maneuvers, cervical spine control by means of bimanual immobilization, and cervical collar placement or helmet removal. If a cardiorespiratory arrest occurs during initial trauma care, resuscitation maneuvers must be immediately started with the specific adaptations indicated in children with trauma.

[Pediatric trauma life support and cardiopulmonary resuscitation]. / Asistencia inicial al trauma pediátrico y reanimación cardiopulmonar.

Accidents are the most frequent cause of mortality among children older than one year. Thus, the need to proceed to cardiopulmonary resuscitation (CPR) during the early phases of trauma life support (TLS) is always a possibility. Trauma is a special situation in CPR: expected problems (i.e., hemorrhage, pneumo-hemothorax, hypothermia, and difficult intubation and vascular access), specific therapeutic actions (i.e., helmet retrieval and cervical spine immobilization), and exceptions to standard CPR guidelines (i.e., contraindication for the head tilt-chin lift manoeuvre) can arise. Therefore, TLS and CPR interventions must be appropriately integrated. TLS is considered a method (much like CPR). It combines organization and leadership with competent, structured and timely actions. Appropriate intervention within the first few moments ("platinum half-hour" and " golden hour") and first day ("silver day") is essential. As in CPR, two modalities can be distinguished: basic TLS (on the scene, without technical resources) and advanced TLS (with resources). The acronym PAA summarizes basic TLS: Protect-Alert-Aid. The advanced TLS sequence includes the following: primary survey and initial stabilization, secondary survey, triage, transport, and definitive care. The main objective of the primary survey and initial stabilization phase is the identification and treatment of injuries with immediate potential to cause death. CPR in the context of TLS should be adapted to the special features of trauma. Particular attention should be paid to the cervical spine. While not specific for trauma care, the early and generous administration of oxygen should be emphasized.

Asistencia inicial al trauma pediátrico y reanimación cardiopulmonar / Pediatric trauma life support and cardiopulmonary resuscitation

Los accidentes son la causa más frecuente de muerte en niños de más de 1 año. Así, es posible tener que proceder a la reanimación cardiopulmonar (RCP) durante la asistencia inicial al trauma pediátrico (AITP). El trauma constituye una situación especial en cuanto a la RCP: problemas esperables (p. ej., hemorragia, neumo-hemotórax, hipotermia, dificultades para la intubación o el acceso vascular), acciones terapéuticas particulares (p. ej., retirada de casco, colocación de collarín cervical), y excepciones a las recomendaciones generales de reanimación (p. ej., contraindicación de la maniobra frente-mentón).Por ello, es necesario saber integrar AITP y RCP.La AITP es un método de actuación (como la RCP) que combina organización y liderazgo con actuación competente, estructurada y oportuna. La actuación en los primeros momentos ("media hora de platino" y " hora de oro") y durante el primer día ("día de plata") es esencial. Como en la RCP se distinguen dos modalidades: AITP básica (en el escenario, sin recursos materiales) y AITP avanzada (con recursos). La AITP básica se resume en el acrónimo PAS: Proteger-Alertar-Socorrer. La secuencia de AITP avanzada incluye: reconocimiento primario y estabilización inicial, segundo reconocimiento, categorización, transporte y cuidados definitivos. La fase de reconocimiento primario y estabilización inicial tiene por objetivo la identificación y el tratamiento de lesiones de riesgo vital inmediato. La RCP debe adaptarse a las particularidades del trauma antes aludidas. En particular, debe tenerse un cuidado exquisito con la columna cervical. En todo caso, debe enfatizarse que el oxígeno es el medicamento fundamental (AU)

[Cardiac tamponade in children as a complication of central venous catheterization. Report of four cases]. / Taponamiento cardiaco en niños como complicación de la cateterización venosa céntral. Presentación de cuatro casos.

Very few cases of children with cardiac tamponade from central venous catheterization have been reported. Four cases are described. In 3 patients the diagnosis was suspected, a pericardiocentesis was performed and they survived. The other patient died and, at autopsy, diagnosis was made. The available literature on cardiac tamponade from central venous catheters in children is reviewed, preventive measures are considered in detail and the need for a high index of suspicion is highlighted.