Evaluación y tratamiento del dolor de origen traumático en medicina prehospitalaria / Prehospital evaluation and treatment of pain due to trauma

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Visión subjetiva de la reanimación cardiopulmonar durante el entrenamiento. ¿Qué podemos aprender para mejorar la formación? / A subjective view of cardiopulmonary resuscitation during training. What can we learn to improve this?

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Asistencia telefónica y complicaciones de la resucitación cardiopulmonar / Telephone assistance and complications of cardiopulmonary resuscitation

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Atrofia muscular espinal y fracaso respiratorio. ¿Cómo actúan los pediatras de atención primaria en un escenario simulado? / Spinal muscular atrophy and respiratory failure. How do primary care pediatricians act in a simulated scenario?

Introducción: La atrofia muscular espinal tipo 1 (AME-1) suele ser mortal en el primer año de vida sin soporte ventilatorio. La decisión de iniciar dicho soporte o no supone un conflicto ético para los profesionales sanitarios. Material y métodos: Se incluyó un escenario de fracaso respiratorio agudo en un lactante con AME-1 en un programa de formación mediante simulación avanzada para pediatras de atención primaria (PAP). Se analizaron de forma sistemática las actuaciones de 34 grupos de 4 pediatras que participaron en 17 cursos. Se valoraron los aspectos clínicos, éticos y de comunicación con los padres. Resultados: La asistencia técnica inicial (administración de oxígeno y soporte ventilatorio inmediato) fue realizada correctamente por el 94% de los equipos. Sin embargo, los PAP tuvieron problemas al abordar los aspectos éticos del caso. Del 85% de los equipos que plantearon el conflicto ético a los padres, lo hizo por iniciativa propia el 29%, el 23% los excluyó de forma activa y solo el 6% los implicaron y tuvieron en cuenta su opinión en la toma de decisiones. Solo el 11,7% preguntó por la calidad de vida del niño y el 12% por su conocimiento del pronóstico de la enfermedad. Ninguno les explicó las alternativas de tratamiento ni trató de contactar con el pediatra de referencia. Conclusiones: Ante un caso simulado de AME-1, los PAP tienen dificultades para interactuar con la familia e implicarla en la toma de decisiones. La formación práctica de todos los pediatras debería incluir problemas de ética clínica (AU)

Introduction: Spinal muscular atrophy type 1 (SMA-1) tends to be fatal in the first year of life if there is no ventilatory support. The decision whether to start such support is an ethical conflict for healthcare professionals. Material and methods: A scenario of acute respiratory failure in an infant with SMA-1 has been included in a training program using advanced simulation for Primary Care pediatricians (PCP). The performances of 34 groups of 4 pediatricians, who participated in 17 courses, were systematically analyzed. Clinical, ethical and communication aspects with parents were evaluated. Results: The initial technical assistance (Administration of oxygen and immediate ventilatory support) was correctly performed by 94% of the teams. However, the PCP had problems in dealing with the ethical aspects of the case. Of the 85% of the teams that raised the ethical conflict with parents, 29% did so on their own initiative, 23% actively excluded them, and only 6% involved them and took their opinion into account in making decisions. Only 11.7% asked about the quality of life of children and 12% for their knowledge of the prognosis of the disease. None explained treatment alternatives, nor tried to contact the pediatrician responsible for the child. Conclusions: When faced with a simulated SMA-1 infant with respiratory failure, PCP have difficulties in interacting with the family, and to involve it in the decision making process. Practical training of all pediatricians should include case scenarios with an ethical clinical problema (AU)

Recommendations in dispatcher-assisted bystander resuscitation from emergency call center.

Dispatch-assisted bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest has been shown as an effective measure to improve the survival of this process. The development of a unified protocol for all dispatch centers of the different emergency medical services can be a first step towards this goal in our environment. The process of developing a recommendations document and the realization of posters of dispatch-assisted cardiopulmonary resuscitation, agreed by different actors and promoted by the Spanish Resuscitation Council, is presented.

Cronobiología de la parada cardíaca en Galicia atendida con desfibriladores semiautomáticos externos / Chronobiology of out-of-hospital cardiac arrest in Galicia with semi-automatic external defibrillators

Objetivo: Analizar la cronobiología de las paradas cardíacas extrahospitalarias (PCE) en las que se utilizó un desfibrilador externo semiautomático en Galicia. Método: Estudio descriptivo retrospectivo de las PCE atendidas por el Servicio de Emergencias Médicas, en las que se utilizó un desfibrilador externo semiautomático durante un período de 5 años (2007-2011). Datos estilo Utstein. Se estudiaron como variables independientes el sexo, la edad, la fecha y hora del suceso, la localización, la PCE presenciada, el inicio de maniobras por los primeros intervinientes, el primer ritmo cardíaco monitorizado, los tiempos de alerta y asistenciales, la intubación y la recuperación de la circulación espontánea. Resultados: Se incluyeron 2.005 casos (0,14/1.000 habitantes-año). La franja horaria con más frecuencia de PCE fue entre 09-11 (18,4%). Los meses con más casos fueron enero (10,4%) y diciembre (9,8%). Fue significativamente más probable que la PCE ocurriera en el domicilio entre 00-08, y en la calle entre 08-16. La asistolia fue más frecuente en la franja nocturna (00-08), mientras que los ritmos desfibrilables lo fueron por la tarde (16-00). La probabilidad de muerte tras la PCE fue mayor entre 00-08, siendo más probable la recuperación de la circulación espontánea entre 16-00. El tiempo entre la alerta y la asistencia fue más prolongado en horario nocturno. Conclusiones: En Galicia, la PCE es más frecuente en los meses de invierno y en horario matinal. Existe una distribución circadiana de las PCE y los ritmos detectados en el momento de la primera asistencia, siendo más frecuente la asistolia en horario nocturno, y los ritmos desfibrilables, por la tarde. La cronobiología de las PCE debería ser tenida en cuenta para organizar la distribución y el horario de los recursos asistenciales (AU)

Objective: To analyze the chronobiological variations of out-hospital cardiac arrest in which an automated external defibrillator was used in Galicia.
Method: Descriptive retrospective study of the cardiac arrest attended by the Emergency Medi- cal Service in which an automated external defibrillator was in use during a period of 5 years (2007-2011). An Utstein style database was used. The sex, age, date and hour of the event, location, cardiac arrest attended, beginning of resuscitation by the professional, first monitored rhythm, emergency team activation time and care, endotracheal intubation, and recovery of spontaneous circulation were studied as independent variables. Results: A total of 2,005 cases (0.14/1,000 population-year) was recorded. Time slot with more frequency of cardiac arrest: between 09-11 hrs (18.4%). Months with more cases: January (10.4%) and December (9.8%). It was significantly more probable that the cardiac arrest occurred in the home between 00-08 hrs, and in the street between 08-16 hrs. Asystole was more frequent in the night period (00-08 hrs), whereas the shockable rhythm was in the evening (16-00 hrs). There is more probability of death after cardiac arrest between 00-08 hrs, with recovery of spontaneous circulation being more probable between 16-00 hrs. The time between the emergency team activation and time care was longer in night schedule. Conclusions: In Galicia, cardiac arrest is more frequent in the winter months and in morning schedule. There is a circadian distribution of the cardiac arrest and the rhythm detected at the time of the first assistance, with asystole being more common in night schedule and the shockable rhythm in the evening. The chronobiology of the cardiac arrest should be taken into account in order to organize the distribution and the schedule of the healthcare resources (AU)

[Spinal muscular atrophy and respiratory failure. How do primary care pediatricians act in a simulated scenario?]. / Atrofia muscular espinal y fracaso respiratorio. ¿Cómo actúan los pediatras de atención primaria en un escenario simulado?

INTRODUCTION: Spinal muscular atrophy type 1 (SMA-1) tends to be fatal in the first year of life if there is no ventilatory support. The decision whether to start such support is an ethical conflict for healthcare professionals. MATERIAL AND METHODS: A scenario of acute respiratory failure in an infant with SMA-1 has been included in a training program using advanced simulation for Primary Care pediatricians (PCP). The performances of 34 groups of 4 pediatricians, who participated in 17 courses, were systematically analyzed. Clinical, ethical and communication aspects with parents were evaluated. RESULTS: The initial technical assistance (Administration of oxygen and immediate ventilatory support) was correctly performed by 94% of the teams. However, the PCP had problems in dealing with the ethical aspects of the case. Of the 85% of the teams that raised the ethical conflict with parents, 29% did so on their own initiative, 23% actively excluded them, and only 6% involved them and took their opinion into account in making decisions. Only 11.7% asked about the quality of life of children and 12% for their knowledge of the prognosis of the disease. None explained treatment alternatives, nor tried to contact the pediatrician responsible for the child. CONCLUSIONS: When faced with a simulated SMA-1 infant with respiratory failure, PCP have difficulties in interacting with the family, and to involve it in the decision making process. Practical training of all pediatricians should include case scenarios with an ethical clinical problem.

[Chronobiology of out-of-hospital cardiac arrest in Galicia with semi-automatic external defibrillators]. / Cronobiología de la parada cardíaca en Galicia atendida con desfibriladores semiautomáticos externos.

OBJECTIVE: To analyze the chronobiological variations of out-hospital cardiac arrest in which an automated external defibrillator was used in Galicia. METHOD: Descriptive retrospective study of the cardiac arrest attended by the Emergency Medical Service in which an automated external defibrillator was in use during a period of 5 years (2007-2011). An Utstein style database was used. The sex, age, date and hour of the event, location, cardiac arrest attended, beginning of resuscitation by the professional, first monitored rhythm, emergency team activation time and care, endotracheal intubation, and recovery of spontaneous circulation were studied as independent variables. RESULTS: A total of 2,005 cases (0.14/1,000 population-year) was recorded. Time slot with more frequency of cardiac arrest: between 09-11 hrs (18.4%). Months with more cases: January (10.4%) and December (9.8%). It was significantly more probable that the cardiac arrest occurred in the home between 00-08 hrs, and in the street between 08-16 hrs. Asystole was more frequent in the night period (00-08 hrs), whereas the shockable rhythm was in the evening (16-00 hrs). There is more probability of death after cardiac arrest between 00-08 hrs, with recovery of spontaneous circulation being more probable between 16-00 hrs. The time between the emergency team activation and time care was longer in night schedule. CONCLUSIONS: In Galicia, cardiac arrest is more frequent in the winter months and in morning schedule. There is a circadian distribution of the cardiac arrest and the rhythm detected at the time of the first assistance, with asystole being more common in night schedule and the shockable rhythm in the evening. The chronobiology of the cardiac arrest should be taken into account in order to organize the distribution and the schedule of the healthcare resources.

Evaluación sistemática de la actuación de los pediatras ante un caso simulado de taquicardia supraventricular / Systematic assessment of the paediatrician’s performance during simulated supraventricular tachycardia

Objetivo: El presente estudio persigue dos objetivos: a) analizar mediante una lista estructurada de tareas la calidad del manejo clínico en un escenario simulado de la taquicardia supraventricular (TSV) aguda y b) identificar posibles errores y áreas de mejora sobre las que incidir en el entrenamiento. Material y métodos: Se han revisado y valorado de forma sistemática los escenarios simulados de TSV realizados en los cursos de simulación avanzada pediátrica llevados a cabo entre junio2008 y abril 2010. Se programaron en el sistema SimBaby(R) tres escenarios de dificultad creciente: TSV estable (TSV-E), TSV inicialmente estable que progresa a inestable (TSV-EI) y TSV inestable (TSV-I). La evaluación del escenario se basó en una lista de 18 tareas derivadas de las recomendaciones del ILCOR. Resultados: Se analizaron 45 escenarios (15 escenarios de TSV-E, 25 de TSV e-I y 5 de TSVI),en los que participaron 167 pediatras. Se completaron correctamente 328 de 551 (59,5%) tareas posibles. El porcentaje medio (desviación estándar) de tareas correctas por escenario varió en función del caso: 63,4 (16,7) en la TSV-E, 47,8 (20,3) en la TSV-EI y 38,6 (31) en la TSV-I (p = 0,028). No se observaron diferencias significativas entre los pediatras de atención primaria y los de atención hospitalaria. La mayoría de los participantes diagnosticaron correctamente la TSV; sin embargo, se cometieron errores importantes como no identificar la inestabilidad hemodinámica en 20 de 43 (48%) escenarios, dosis incorrectas de adenosina en 18 de 39 (48%) escenarios, la administración inadecuada de adenosina en 23 de 39 (59%) escenarios y no reconocer la indicación de cardioversión inmediata en 15 de 31 (48%) escenarios. Conclusiones: Los pediatras saben identificar una TSV pero precisan mejorar su capacitación para tratarla de forma adecuada. El análisis sistemático de la actuación de los profesionales ante un caso simulado permite detectar tanto sus puntos fuertes como las áreas en las que es preciso reforzar la enseñanza (AU)

Introduction: The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured task-based checklist and to b) detect pitfalls and grey areas where reinforcement in training maybe needed. Material and methods: We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby(R) simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations. Results: A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p = 0.028). There were no significant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identified non-sinus rhythm as SVT. However, important pitfalls wereobserved, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardio version in 15 out of 31 (48%).Conclusions: Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identification of strengths, as well as weak points, where reinforcement is needed(AU)

Evaluación de la actuación de los pediatras de atención primaria en un escenario simulado de trauma pediátrico / Assessment of primary care paediatricians performance in a paediatric trauma simulation

Introducción: La enseñanza mediante simulación avanzada puede mejorar la capacitación de los pediatras, disminuir los errores e incrementar la seguridad del paciente. La atención inicial es un factor pronóstico esencial en el niño traumatizado. Material y método: Dentro de un programa nacional de formación continuada con simulación avanzada dirigido a pediatras de atención primaria, se ha incluido el escenario de un niño politraumatizado. Se han analizado de forma retrospectiva y sistemática las actuaciones de156 pediatras, agrupados en 39 equipos, en los cursos realizados entre mayo de 2008 y febrero de 2010. La evaluación del escenario se basó tanto en la evaluación primaria sugerida por el Grupo de Trabajo de Politrauma de la SECIP, como en la lista de 8 tareas validadas en el programa de entrenamiento de politrauma del hospital pediátrico de Cincinnati. Resultados: En el 100% de las actuaciones se colocó un pulsioxímetro, se indicó la canalización de una vía intravenosa/intraósea, se tomó la presión arterial y se administró oxígeno. En el 87,1%de las actuaciones se indicó una carga de volumen, la escala de Glasgow se realizó en el 5,1% y la protección frente a la hipotermia en 25,6% de las mismas. La inmovilización cervical bilateral fue inadecuada en 35 sesiones (89,7%). Solo un 2,5% de los grupos realizaron correctamente toda la secuencia de atención al trauma. La puntuación según la escala de Cincinnati fue de5,3±1,8 sobre un máximo de 16. Conclusiones: Los pediatras de atención primaria tienen dificultades para aplicar la secuencia ABCDE de atención al trauma y las maniobras de control cervical en un caso simulado de niño traumatizado. En los programas de formación pediátrica se deberían reforzar los aspectos prácticos de la atención inicial al trauma(AU)

Introduction: Training by means of advanced simulation can improve the paediatrician’s abilities in the management of paediatric trauma patients, as well as decreasing errors and increasing patient safety. The initial management is an essential factor in the outcome of an injured child. Material and methods: A trauma patient scenario was included in a national simulation training program. The performances of 156 paediatric primary care providers, divided into 39 teams, who participated in the courses carried out from May 2008 until February 2010 were retrospectively analysed. The evaluation of the scenario was based both on the primary survey suggested by the Working Group on Trauma of the SECIP, and in the 8 main targets of a simulation evaluation tool from the Cincinnati Children’s Hospital trauma care program. Results: A pulse oximeter was placed, the intravenous/intraosseous access was indicated, the blood pressure was checked, and the oxygen was applied In 100% of the scenarios. An intravenous fluid bolus was indicated in 87% of the scenarios. The Glasgow scale was performed in 5.1%, and the appropriate warming measures in 25.6%. The bilateral cervical immobilisation was incorrect in 35% of the scenarios (89.7%). The primary survey (ABCDE) was checked correctly in only one scenario. With a top score of 16, based on Cincinnati Hospital, the teams mean score was 5.3±1.8.Conclusions: Primary care paediatricians have problems applying the primary ABCDE trauma care sequence and the cervical spine precautions in a trauma simulation scenario. Educational programs for paediatricians must improve the practical check points of the initial approach to trauma management(AU)

[Systematic assessment of the paediatrician's performance during simulated supraventricular tachycardia]. / Evaluación sistemática de la actuación de los pediatras ante un caso simulado de taquicardia supraventricular.

INTRODUCTION: The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured task-based checklist and to b) detect pitfalls and grey areas where reinforcement in training may be needed. MATERIAL AND METHODS: We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby® simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations. RESULTS: A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p=0.028). There were no significant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identified non-sinus rhythm as SVT. However, important pitfalls were observed, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardioversion in 15 out of 31 (48%). CONCLUSIONS: Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identification of strengths, as well as weak points, where reinforcement is needed.

[Assessment of primary care paediatricians performance in a paediatric trauma simulation]. / Evaluación de la actuación de los pediatras de atención primaria en un escenario simulado de trauma pediátrico.

INTRODUCTION: Training by means of advanced simulation can improve the paediatrician's abilities in the management of paediatric trauma patients, as well as decreasing errors and increasing patient safety. The initial management is an essential factor in the outcome of an injured child. MATERIAL AND METHODS: A trauma patient scenario was included in a national simulation training program. The performances of 156 paediatric primary care providers, divided into 39 teams, who participated in the courses carried out from May 2008 until February 2010 were retrospectively analysed. The evaluation of the scenario was based both on the primary survey suggested by the Working Group on Trauma of the SECIP, and in the 8 main targets of a simulation evaluation tool from the Cincinnati Children's Hospital trauma care program. RESULTS: A pulse oximeter was placed, the intravenous/intraosseous access was indicated, the blood pressure was checked, and the oxygen was applied In 100% of the scenarios. An intravenous fluid bolus was indicated in 87% of the scenarios. The Glasgow scale was performed in 5.1%, and the appropriate warming measures in 25.6%. The bilateral cervical immobilisation was incorrect in 35% of the scenarios (89.7%). The primary survey (ABCDE) was checked correctly in only one scenario. With a top score of 16, based on Cincinnati Hospital, the teams mean score was 5.3 ±1.8. CONCLUSIONS: Primary care paediatricians have problems applying the primary ABCDE trauma care sequence and the cervical spine precautions in a trauma simulation scenario. Educational programs for paediatricians must improve the practical check points of the initial approach to trauma management.

Simulación avanzada para pediatras de atención primaria. Desarrollo de un programa itinerante y opinión de los participantes / Advanced simulation for primary care paediatricians. Development of an itinerant program and opinions of participants

Introducción y objetivos: La simulación avanzada (SA) es una metodología docente útil para la capacitación de profesionales en el ámbito hospitalario, con aplicación limitada en atención primaria (AP). Nuestro objetivo ha sido desarrollar un proyecto de SA orientado a los pediatras de AP y conocer las opiniones de los alumnos como uno de los elementos para valorar su idoneidad. Material y métodos: Fase 1: Se organizó un grupo de trabajo multidisciplinario, auspiciado por la Sociedad Española de Pediatría de Atención Primaria, para diseñar y poner en práctica el curso. Fase 2: Se pusieron en marcha cursos itinerantes por distintas ciudades españolas. Al finalizar cada curso se realizó una encuesta anónima de opinión, centrada en los aspectos motivacionales y la adecuación del programa y la metodología. Cada ítem se puntuó de 0 (muy mal) a 10 (muy bien). Período de estudio: mayo de 2008 a mayo de 2009. Resultados: Tras analizar las necesidades formativas de la población diana, el tiempo disponible, el material docente existente y la metodología de simulación y análisis de casos, se diseñó un modelo de curso y se programaron los casos. Se realizaron 12 cursos en 12 ciudades. Asistieron 186 profesionales y 177 (95,2%) contestaron la encuesta. La puntuación media de los ítems principales fue la siguiente: organización general (9,23±0,50), objetivos en relación con las expectativas (9,29±0,43), curso útil para la situación laboral (9,42±0,43), casos cercanos a la realidad laboral (9,18±0,42) y buena relación docentes-alumnos (9,68±0,20). Conclusiones: El curso de SA para pediatría de AP, con el formato propuesto, es factible y se adapta a las necesidades de la población diana. Los pediatras de AP consideran a esta enseñanza una herramienta útil para su formación continuada y la mejora de su capacitación (AU)

Introduction and objectives: Advanced simulation (AS) is a teaching methodology that has shown to be useful for training health staff at hospital level; however, its application in primary care paediatrics is very limited. Our objective was the development of an AS project focused on the learning needs of the primary care paediatricians, as well as to know the participants’ opinions as one of the elements to assess its appropriateness. Material and methods: Phase 1: A multidisciplinary working group was organized and sponsored by the SEPEAP to design and put the course into practice. Phase 2: Itinerant courses were carried out in several cities in Spain. At the end of each course, a survey was carried out that was focused on motivation aspects, pertinence of contents and methodology. Each item was scored on a numerical scale from 0 (very bad) to 10 (very good). Study period: May 2008 to May 2009. Results: After analysing the potential learning needs of target population, available time, teaching material available and methodology of simulation and debriefing, a course model was designed and the cases were programmed. Twelve courses were carried out in 12 cities. The total number of participants was 186; of them, 177 (95.2%) answered the survey. Mean±SD scores for main items were: organization (9.23±0.50), objectives related to prior expectation (9.29±0.43), usefulness of course program to work activity (9.42±0.43), cases that resemble reality (9.18±0.42) and good instructors-participants relationship (9.68±0.20). Conclusions: The AS course for primary care paediatrics, with the proposed format, is feasible and well adapted to the needs of the target population. Primary care paediatricians consider this type of teaching and learning activity as a useful tool for their continuing education and for improving their professional abilities (AU)

[Advanced simulation for primary care paediatricians. Development of an itinerant program and opinions of participants]. / Simulación avanzada para pediatras de atención primaria. Desarrollo de un programa itinerante y opinión de los participantes.

INTRODUCTION AND OBJECTIVES: Advanced simulation (AS) is a teaching methodology that has shown to be useful for training health staff at hospital level; however, its application in primary care paediatrics is very limited. Our objective was the development of an AS project focused on the learning needs of the primary care paediatricians, as well as to know the participants' opinions as one of the elements to assess its appropriateness. MATERIAL AND METHODS: Phase 1: A multidisciplinary working group was organized and sponsored by the SEPEAP to design and put the course into practice. Phase 2: Itinerant courses were carried out in several cities in Spain. At the end of each course, a survey was carried out that was focused on motivation aspects, pertinence of contents and methodology. Each item was scored on a numerical scale from 0 (very bad) to 10 (very good). STUDY PERIOD: May 2008 to May 2009. RESULTS: After analysing the potential learning needs of target population, available time, teaching material available and methodology of simulation and debriefing, a course model was designed and the cases were programmed. Twelve courses were carried out in 12 cities. The total number of participants was 186; of them, 177 (95.2%) answered the survey. Mean+/-SD scores for main items were: organization (9.23+/-0.50), objectives related to prior expectation (9.29+/-0.43), usefulness of course program to work activity (9.42+/-0.43), cases that resemble reality (9.18+/-0.42) and good instructors-participants relationship (9.68+/-0.20). CONCLUSIONS: The AS course for primary care paediatrics, with the proposed format, is feasible and well adapted to the needs of the target population. Primary care paediatricians consider this type of teaching and learning activity as a useful tool for their continuing education and for improving their professional abilities.

Demandas aditivas en Pediatría de Atención Primaria. Un estudio multicéntrico / No disponible

Objetivo: cuantificar las demandas aditivas (“ya que”, “de paso”) en Pediatría de AtenciónPrimaria y las variables que las determinan, y su influencia en el tiempo disponible delprofesional y en la calidad asistencial.Pacientes y métodos: en el estudio fueron incluidos todos aquellos pacientes con cita,atendidos en las consultas de cuatro pediatras en cinco centros de salud durante 20 días laborablesentre abril-mayo de 2008 (n = 950). El tipo de estudio es analítico transversal. Se recogieronlas siguientes variables: pediatra, género, edad, motivo de consulta (por enfermedad oadministrativa), hora de entrada en la consulta, tipo de acompañante, número de demandasaditivas (DA) y hora de salida de la consulta. Para el análisis de los resultados se empleó lamedia con su desviación estándar (DE), la prueba de Ji-cuadrado, la prueba t, el análisis de varianzay la regresión logística.Resultados: el 55,3% de los pacientes eran varones, siendo la edad media global de 5,6años (DE = 4,2). En un 16,3% de las consultas se realizaron DA. Mediante la regresión logísticase comprobó que las DA son más frecuentes en las consultas administrativas y según la pediatra.El tiempo medio de consulta varió significativamente según no se realizaran DA (8´6´´), arealizar una (9´43´´) y a realizar dos o más (15´12´´).Conclusiones: en las DA influyen el tipo de consulta y el profesional consultor. A su vez, lasDA producen un aumento significativo del tiempo de esa consulta y una disminución de la calidadasistencial(AU)

Objective: to assess the additional reasons for consultation (“by the way”) and its associationwith other variables.Patients and methods: all the patients with appointment, attended by four pediatriciansin five health centres during 20 working days in April-May 2008 (n = 950), were included inthe study. It is an analytic cross-sectional study. The following variables were recorded in eachvisit: pediatrician, gender, age, reason for consultation (pathology/bureaucratic), entrance time,kind of companion, number of additional requests (AR) and exit time. For the analysis ofthe results we used the mean with its standard deviation (SD), chi-square test, independentsamplest test, analysis of variance and logistic regression.Results: the males comprised 55.3%, being the global age mean 5.3 years (SD = 4.2).Sixteen point three percent of the consultations made AR. By means of logistic regression weproved that the AR were more frequent in bureaucratic consultations and depended on thepediatrician. The average time varied significantly depending on the number of AR: none(8´6´´), one (9´43´´) and two or more (15´12´´).Conclussions: the reason for consultation and the pediatrician have influence in the AR.Also, the AR increase the consultation time(AU)

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