Bloqueo del nervio ciático poplíteo ecoguiado en urgencias en un paciente pediátrico con dolor severo producido por una picadura de escorpión / Ultrasound-guided sciatic popliteal block performed at the Emergency Department in a patient with a scorpion bite and severe pain

Presentamos el caso de un paciente pediátrico que acudió a urgencias con dolor severo en la extremidad inferior derecha causado por la picadura de un escorpión. Ante la ausencia de respuesta a los analgésicos administrados se optó por realizar un bloqueo poplíteo ecoguiado, lo que consiguió una analgesia completa y permitió el manejo ambulatorio del paciente, sin referir efectos adversos. Las familias de escorpiones presentes en nuestro país no suponen un riesgo vital para el ser humano, pero su picadura produce una reacción local con dolor autolimitado a unas 24-48h que puede ser severo. El manejo prioritario es realizar una correcta analgesia. Las técnicas anestésicas regionales son de utilidad para el control del dolor agudo y pueden representar una colaboración eficaz entre los servicios de anestesiología y urgencias.(AU)

We report the case of a paediatric patient who presented at the Emergency Department with severe pain in the right lower extremity caused by a scorpion sting. Analgesics were ineffective, so we decided to perform an ultrasound-guided popliteal block. This, which achieved complete analgesia and allowed the patient to be followed up in the outpatient department, with no adverse effects. The sting of the species of scorpion found in Spain is not dangerous to human life; however, it causes self-limiting localised pain that lasts for 24-48hours, and can be severe. The first-line treatment is effective analgesia. Regional anaesthesia techniques are useful in the control of acute pain, and are an example of effective collaboration between the Anaesthesiology and Emergency services.(AU)

Ultrasound-guided sciatic popliteal block performed at the Emergency Department in a patient with a scorpion bite and severe pain.

We report the case of a paediatric patient who presented at the Emergency Department with severe pain in the right lower extremity caused by a scorpion sting. Analgesics were ineffective, so we decided to perform an ultrasound-guided popliteal block, which provided complete analgesia and allowed the patient to be followed up in the outpatient department, with no adverse effects. The sting of the species of scorpion found in Spain is not dangerous to human life; however, it causes self-limiting localised pain that lasts for 24-48h, and can be severe. The first-line treatment is effective analgesia. Regional anaesthesia techniques are useful in the control of acute pain, and are an example of effective collaboration between the Anaesthesiology and Emergency services.

Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model.

Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. METHODS: Observational unicentric study of a cohort of CS patients. SOFA, SAPS II and APACHE II scores were calculated in the first 24 h of CCU admission. RESULTS: 130 patients with CS were included. SOFA, SAPS II and APACHE II scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; P = .6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases. Acute coronary syndrome, lactate serum values, SAPS II score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). CONCLUSION: In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.

Utilidad de las escalas de gravedad en la predicción de mortalidad intrahospitalaria en el shock cardiogénico. Propuesta de un nuevo modelo pronóstico / Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model

El shock cardiogénico (SC) es una entidad que comprende múltiples etiologías y asocia elevada mortalidad. Algunas escalas de gravedad han demostrado ser buenos predictores de mortalidad hospitalaria en pacientes ingresados en Unidades de Cuidados Intensivos (UCI). El objetivo principal de este estudio es analizar su utilidad y validez en una cohorte de pacientes en SC. Métodos: Estudio observacional unicéntrico. Se calcularon las escalas SOFA, SAPSII y APACHEII en las primeras 24horas de ingreso en UCI. Resultados: Se incluyeron 130 pacientes con SC. Las escalas SOFA, SAPSII y APACHEII mostraron buena discriminación para la mortalidad hospitalaria, obteniendo valores de área bajo la curva (AUC) ROC similares (AUC: 0,711, 0,752 y 0,742, respectivamente; p=0,6). La calibración, estimada por el test de Hosmer-Lemeshow, fue adecuada en todos los casos, SOFA (p=0,787), SAPSII (p=0,078) y APACHEII (p=0,522). Resultaron: predictores independientes de mortalidad intrahospitalaria: el síndrome coronario agudo (SCA), los valores de lactato sérico, el SAPSII y el índice de vasoactivos inotrópicos (VIS) en las primeras 24horas de ingreso en UCI.Con estas variables se desarrolló un indicador pronóstico específico para el SC (SAPS-2-LIVE) que mejora la capacidad predictiva de mortalidad en nuestra serie (AUC) ROC, 0,825 (IC 95% 0,752-0,89). Conclusión: En esta cohorte contemporánea de SC, las escalas SOFA, SAPSII y APACHEII han demostrado una buena capacidad de predicción de mortalidad hospitalaria. Estos hallazgos podrían contribuir a una mejor estratificación del riesgo en el SC.(AU)

Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. Methods: Observational unicentric study of a cohort of CS patients. SOFA, SAPSII and APACHEII scores were calculated in the first 24hours of CCU admission. Results: 130 patients with CS were included. SOFA, SAPSII and APACHEII scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; p=0.6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases.Acute coronary syndrome, lactate serum values, SAPSII score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). Conclusion: In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.(AU)

Un momento para la reflexión. Aspectos éticos en la pandemia SARS-CoV-2/COVID-19 en nuestra práctica clínica / A moment for reflection. Ethical aspects in the pandemic SARS-CoV-2/COVID-19 in our clinical practice

El mundo entero ha sufrido la acción devastadora de la pandemia SARS-CoV-2/COVID-19. Estamos en un momento de la situación en que se puede vivir con cierta calma, aunque la tormenta persiste. Es el momento perfecto para reaccionar, para preguntarnos qué ha pasado y cómo hemos actuado. Hay que reflexionar sobre qué podría pasar y cómo deberíamos actuar. En este trabajo se realiza una reflexión ética a través de la experiencia clínica de profesionales dedicados a la atención del paciente críticamente enfermo. Se analizan los valores y las categorías morales implicados en la toma de decisiones en situación de limitación de recursos y se plantea la necesidad y algunas estrategias para acercar la bioética a la práctica cotidiana, facilitando así la toma de decisiones por parte del profesional sanitario y una atención justa y adecuada al paciente en situaciones de especial vulnerabilidad, como las vividas en esta crisis sanitaria y social.(AU)

The entire world has suffered the devastating action of the SARS-CoV-2/COVID-19 pandemic. This is the ideal moment to stop and ask ourselves what happened and how we acted; to reflect on what we have learned not only for similar situations but for all of our clinical practice. This work is an ethical reflection via the clinical experience of professionals dedicated to the care of critical patients in one of the countries most affected by the SARS-CoV-2/COVID-19 pandemic in the world. Some of the moral values and categories involved in decision-making in situations of limited resources are analysed, and the need for bioethics to be a part of daily practice is proposed, along with some strategies for doing so, thus facilitating decision-making by the health professional and fair and appropriate care for the patient in situations of particular vulnerability such as those experienced in this health and social crisis.(AU)

A moment for reflection. Ethical aspects in the pandemic SARS-CoV-2/COVID-19 in our clinical practice. / Un momento para la reflexión. Aspectos éticos en la pandemia SARS-CoV-2/COVID-19 en nuestra práctica clínica.

The entire world has suffered the devastating action of the SARS-CoV-2/COVID-19 pandemic. This is the ideal moment to stop and ask ourselves what happened and how we acted; to reflect on what we have learned not only for similar situations but for all of our clinical practice. This work is an ethical reflection via the clinical experience of professionals dedicated to the care of critical patients in one of the countries most affected by the SARS-CoV-2/COVID-19 pandemic in the world. Some of the moral values and categories involved in decision-making in situations of limited resources are analysed, and the need for bioethics to be a part of daily practice is proposed, along with some strategies for doing so, thus facilitating decision-making by the health professional and fair and appropriate care for the patient in situations of particular vulnerability such as those experienced in this health and social crisis.

Experience in anaesthetic management of non-cardiac surgery in patients with ventricular assist devices. / Experiencia en manejo anestésico para cirugía no cardiaca en pacientes con asistencias ventriculares.

Heart failure (HF) is a syndromic condition with a high incidence in current medicine. When the symptoms of HF progress, and become refractory, cardiac transplant is the best therapeutic option. However, due to the shortage of donors and the long waiting lists, many of those patients are candidates for implantation of ventricular assist devices as a bridge to the cardiac transplant, or when this is not an option, as a definitive therapy. A series of four clinical cases of patients with ventricular assist devices that required surgical intervention, is presented. Three of them were assisted with long-term care: two EXCOR (pulsatile and para-corporeal) and one HEARTWARE (non-pulsatile and intra-corporeal), and the last one with short-term assistance; CentriMag biventricular Levitronix. There is no significant literature on the peri-operative implications of these patients when they undergo urgent or scheduled surgery. The experience in our centre leads us to raise the need to determine a series of aspects: operation of each device, emphasising the correct placement of the cannulas during the surgery; the proper management of any medication, emphasising the importance of anticoagulant and anti-platelet therapies; the Pathophysiological changes at cardiopulmonary level due to the implantation of these devices; and the importance of the administration of a correct antibiotic therapy. Given the complexity of these cases, the limited experience in this field, and the few cases that exist in these situations, it is recommended to create protocols to ensure their proper management.