La simulación clínica como herramienta de aprendizaje / Simulation based-training in Medicinie: a teaching tool

El aprendizaje mediante la simulación en las áreas de la medicina es un tema en auge desde hace unos años. Radica en la recreación de un evento clínico o el entrenamiento de una técnica de la forma más fidedigna posible. La enseñanza es activa, ya que son los alumnos, mediante sus actos y decisiones, los que desarrollan la simulación y además garantiza la “enseñanza segura”, ya que los actos no se realizan sobre pacientes sino sobre maniquís más o menos sofisticados. Recientes estudios demuestran la traslación de estos conocimientos adquiridos mediante la simulación a la práctica clínica diaria, por lo que distintos sistemas nacionales de salud lo están implantando como herramienta no solo de aprendizaje si no de formación continuada y como evaluación de los profesionales (AU)

Simulation based-training in the medicine areas is a subject on the rise since a few years. It’s defined like the recreation of an event or a clinical training the most accurate as possible. It’s an active teaching, the students through their actions and decisions, which develop the simulation. It’s also a “safe teaching”, because the acts are not performed on patient, only on mannequins, which are more or less sophisticated. Recent studies have shown the transfer of learning to the clinical setting, so, different national health systems have implemented as a tool not only for learning, also like continuous training and professionals assessment (AU)

[Perioperative treatment of a man receiving a left-lung transplant combined with coronary revascularization without use of extracorporeal circulation: with a brief review of pathophysiology and the literature]. / Tratamiento perioperatorio de un paciente para trasplante unipulmonar izquierdo combinado con revascularización coronaria sin empleo de circulación extracorpórea. Breve revisión fisiopatológica y de la bibliografía.

Patients with significant coronary artery disease were once traditionally rejected as candidates for lung transplants because of higher risk of morbidity and mortality. We report the case of a man who received a left lung transplant and coronary revascularization without extracorporeal circulation in a combined surgical procedure after being diagnosed with significant coronary disease during the preoperative study for acceptance as a candidate for lung transplantation. We review the history of such combination procedures, which are changing clinicians' attitudes as to appropriate therapeutic approaches to take for complex patients. We also discuss the possible advantages of performing surgery without extracorporeal circulation. To our knowledge, this is the first report of a combined procedure that took place in a Spanish hospital.

Tratamiento perioperatorio de un paciente para trasplante unipulmonar izquierdo combinado con revascularización coronaria sin empleo de circulación extracorpórea. Breve revisión fisiopatológica y de la bibliografía / Perioperative treatment of a man receiving a left-lung transplant combined with coronary revascularization without use of extracorporeal circulation: with a brief review of pathophysiology and the literature

Los pacientes con enfermedad coronaria relevanteeran tradicionalmente rechazados como candidatos altrasplante pulmonar por el riesgo de incremento de lamorbimortalidad. Presentamos el caso de un paciente alque se le realizó un trasplante pulmonar izquierdo ycirugía de revascularización coronaria sin circulaciónextracorpórea en un procedimiento combinado, tras serdiagnosticado de enfermedad coronaria significativadurante su estudio para inclusión como candidato atrasplante pulmonar. Se revisan los antecedentes descritosde este tipo de procedimientos, que están permitiendoun cambio en el enfoque terapéutico de estos pacientescomplejos, así como las posibles ventajas de larealización del procedimiento sin circulación extracorpórea.En nuestro conocimiento es el primer caso deeste tipo de intervenciones combinadas descrito ennuestro país(AU)

Patients with significant coronary artery disease wereonce traditionally rejected as candidates for lungtransplants because of higher risk of morbidity andmortality. We report the case of a man who received aleft lung transplant and coronary revascularizationwithout extracorporeal circulation in a combinedsurgical procedure after being diagnosed with significantcoronary disease during the preoperative study foracceptance as a candidate for lung transplantation. Wereview the history of such combination procedures,which are changing clinicians’ attitudes as toappropriate therapeutic approaches to take for complexpatients. We also discuss the possible advantages ofperforming surgery without extracorporeal circulation.To our knowledge, this is the first report of a combinedprocedure that took place in a Spanish hospital(AU)

[Epidural anesthesia in labor and conversion disorder]. / Analgesia epidural en trabajo de parto y trastorno de conversión.

A 37-year-old woman came to our hospital at the beginning of labor. She reported a history of depression with attempted suicide some years earlier and had also undergone dilation and curettage following an abortion; on admission to our hospital, she was euthymic and not receiving treatment. The patient requested epidural analgesia. Several hours later, she reported dorsal foot numbness and difficulty performing dorsal flexion. After an organic cause had been ruled out, a diagnosis of conversion disorder was considered. The incidence of this psychiatric disorder is high, though it is usually underdiagnosed. Conversion disorder involves at least 1 neurologic symptom suggestive of organic disease. Symptoms are not feigned and cannot be ascribed to a medical disease, the effects of a toxic substance, or culturally normal behavior, yet there is significant clinical, social, and occupational deterioration.

Analgesia epidural en trabajo de parto y trastorno de conversión / Epidural anesthesia in labor and conversion disorder

Una gestante de 37 años acudió al hospital al iniciar eltrabajo de parto. Como antecedentes personales de interésrefería una depresión con un intento autolítico unosaños antes, estando eutímica sin necesidad de tratamientoal ingreso; y un legrado por un aborto. La pacientesolicitó analgesia epidural y horas después de realizar latécnica presentó anestesia en zona dorsal del pie y dificultadpara la flexión dorsal del mismo. Tras descartarpatología orgánica, se consideró el diagnóstico de trastornoconversivo, una enfermedad psiquiátrica de granincidencia pero habitualmente infradiagnosticada y quese caracteriza por uno o más déficit neurológicos quesugieren enfermedad orgánica, que no son intencionadosni fingidos y que no pueden ser achacados a una enfermedadmédica, a los efectos de una sustancia tóxica o aun comportamiento culturalmente normal; causando undeterioro significativo a nivel clínico, social y ocupacional(AU)

A 37-year-old woman came to our hospital at thebeginning of labor. She reported a history of depressionwith attempted suicide some years earlier and had alsoundergone dilation and curettage following an abortion;on admission to our hospital, she was euthymic and notreceiving treatment. The patient requested epiduralanalgesia. Several hours later, she reported dorsal footnumbness and difficulty performing dorsal flexion. Afteran organic cause had been ruled out, a diagnosis ofconversion disorder was considered. The incidence ofthis psychiatric disorder is high, though it is usuallyunderdiagnosed. Conversion disorder involves at least 1neurologic symptom suggestive of organic disease.Symptoms are not feigned and cannot be ascribed to amedical disease, the effects of a toxic substance, orculturally normal behavior, yet there is significantclinical, social, and occupational deterioration(AU)