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1.
Enferm Clin ; 2020 Feb 28.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32122768

RESUMO

OBJECTIVE: To develop and validate a weight estimation tool applicable in paediatric emergency care. METHODS: Using anthropometric data from a computerized database of the primary health care paediatric services, Bilbao (Basque Country, Spain), linear regression models were developed with the objective of estimating weight from height. Subsequently, these models were prospectively validated using a consecutive sample of children attended in the emergency department of two tertiary hospitals. Estimated weights were compared with actual weights, calculating the intraclass correlation coefficient (ICC), mean difference and percentages of estimations falling within 10% and 20% of the actual weight. RESULTS: Using anthropometric data from 15522 children two weight predictive formulas were developed (Bilbao Formulas). The formulas were validated on a sample of 780 children and estimated weight values with a high degree of intraclass correlation with the real weight (ICC=.93, P<.001) and a mean difference of .63 (SD: 4.3). The percentages of estimations falling within 10% and 20% of the actual weight of the child was 62.2% (95% CI: 58.7-65.6) and 93.1% (95% CI: 91.1-94.8), respectively. Weight estimations were more accurate using Bilbao Formulas than other classical formulas. CONCLUSIONS: Bilbao Formulas would be a valid tool for estimating weight in children in the emergency department and predict weight more accurately than other more commonly used age-based formulas.

2.
Appetite ; 147: 104543, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31794819

RESUMO

The influence of unhealthy food environments on residents' eating behaviors has been previously documented. Yet, socioeconomic differences across areas are less studied. Participatory studies provide relevant knowledge to better inform future nutrition interventions. We conducted a participatory Photovoice project in which residents interpreted the influence of the local food environment on eating behaviors across three neighborhoods of contrasting area-level socioeconomic status (SES) in Bilbao, Spain. From April to July 2017, a total of 23 residents participated in the three Photovoice groups. Each group critically discussed their photographs (N = 110) in groups of 6-9 participants along six group sessions. Through a consensus-building process, participants identified 27 emerging categories choosing finally 39 related photographs, which followed six conceptual main themes characterizing their local food environment: 1) unhealthy eating behaviors, 2) cultural diversity, 3) retail transformation, 4) social relationships, 5) precariousness, and 6) healthy eating. Although high food quality and fresh products may portray a general healthy food environment in all three neighborhoods, participants discussed why some residents still adopt unhealthy eating behaviors characterized by an excessive consumption of alcohol (high-SES area), sugar loaded foods (high- and middle-SES) and fast food (middle and low-SES). This photovoice participatory methodology helps highlighting important similarities and differences regarding food environment perceptions in the whole socioeconomic spectrum of any given city. This type of participatory approach helps guiding local policies and interventions promoting healthier local food environments.

3.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 429-434, dic. 2019. tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-185142

RESUMO

El objetivo de este trabajo es comparar las legislaciones autonómicas españolas en materia de formación, utilización y obligatoriedad de la instalación de desfibriladores externos automatizados (DEA) fuera del ámbito sanitario y analizar la variabilidad territorial con que se han desarrollado las regulaciones. Llevamos a cabo una revisión de las normativas publicadas en los boletines oficiales de las 17 comunidades autónomas y las 2 ciudades autónomas de España hasta mayo de 2019, extrayendo datos referidos a la regulación de la formación, el uso y la instalación de los DEA fuera del ámbito sanitario. Observamos que médicos y enfermeros están autorizados a utilizar los DEA, salvo en Murcia, donde únicamente tienen autorizado su uso los médicos. En 14 comunidades autónomas también se consideran habilitados los técnicos en emergencias sanitarias. Excepto en el País Vasco, donde cualquier ciudadano puede utilizar un DEA previa alerta a los servicios de emergencia, es necesario realizar un curso inicial acreditado para estar habilitado en el uso de estos dispositivos (cuya duración varía, según la comunidad, entre 4 y 9 horas) y debe ser renovado con una periodicidad que oscila entre uno y 3 años. Sin embargo, 11 comunidades permiten que, en caso de emergencia y en ausencia de personal habilitado, cualquier ciudadano pueda utilizar un DEA, previa alerta a los servicios de emergencia. Once autonomías regulan la obligación de instalar DEA fuera del ámbito sanitario. Se concluye que si bien todas las comunidades autónomas de España disponen de una normativa reguladora del uso y la acreditación de DEA, el mapa legislativo es muy diverso, por lo que sería deseable una política armonizadora para unificar criterios e incentivar el uso de estos dispositivos en caso de necesidad


We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain’s 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain’s autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed


Assuntos
Humanos , Desfibriladores/normas , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/normas
4.
Emergencias ; 31(6): 429-434, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31777216

RESUMO

ABSTRACT: We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain's 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain's autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed.

5.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 239-244, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182764

RESUMO

Objetivos: Validar distintos métodos destinados a estimar el peso en pacientes pediátricos en urgencias. Metodología: Serie de casos prospectivo con análisis transversal en pacientes de 1 mes hasta 14 años de edad en dos hospitales terciarios en el País Vasco (España). Se aplicaron 9 herramientas distintas de estimación de peso y se comparó el resultado con el peso real, calculando índices de concordancia (CCI), media de la diferencia y proporción de mediciones con un error del peso estimado inferior al 10% y 20% con respecto al peso real. Resultados: Se realizaron mediciones en 515 pacientes pediátricos. Todas las estimaciones presentaron una alta concordancia con respecto al peso real. La estimación parental del peso resultó la estrategia con menor margen de error (86,5% de mediciones con error < 10%), seguida de la Regla RCP del Hospital del Niño Jesús (63,5% de mediciones con error <10%). Las fórmulas de estimación basadas en edad o antropometría no ofrecieron proporciones superiores al 40% de mediciones con un error < 10%. Conclusiones: La estimación parental es una herramienta válida para la estimación del peso en niños. Cuando no está disponible esa opción, la Regla de RCP del Hospital del Niño Jesús sería la herramienta de elección


Objectives: To determine the validity of different ways of estimating body weight in children attended in the emergency department. Methods: Prospective cross-sectional study of a series of patients between 1 month and 14 years of age attended in 2 tertiary care hospitals in the Basque Country, Spain. We used 9 different ways to estimate body weight and compared the estimates to real weight by calculating the mean intraclass correlation coefficient, the mean difference between real and estimated weights, and the proportion of measurements within 10% and 20% of the real weight. Results: Five hundred fifteen pediatric patients were weighed and their weights estimated. All estimates had a high degree of agreement with real weight. A parent's weight estimate performed best: 86.5% of parental estimates were within 10% of the real weight. The next best estimate was achieved with the cardiopulmonary resuscitation (CPR) rule developed at Hospital del Niño Jesús: 65% of the estimates were within the 10% margin. Fewer than 40% of the weight estimates based on formulas using anthropometric measurements were within the 10% margin. Conclusions: A parent's estimate of weight is a valid approximation in children of all ages. When this estimate is not available, the CPR rule of Hospital del Niño Jesús would be the method of choice


Assuntos
Humanos , Masculino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pesos e Medidas Corporais/métodos , Medicina de Emergência Pediátrica/métodos , Medicina de Emergência Pediátrica/organização & administração , Indicadores Básicos de Saúde , Antropometria/métodos , Estudos Prospectivos , Estudos Transversais , Epidemiologia Descritiva , Serviços Médicos de Emergência/estatística & dados numéricos
6.
Emergencias ; 31(4): 239-244, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31347803

RESUMO

OBJECTIVES: To determine the validity of different ways of estimating body weight in children attended in the emergency department. MATERIAL AND METHODS: Prospective cross-sectional study of a series of patients between 1 month and 14 years of age attended in 2 tertiary care hospitals in the Basque Country, Spain. We used 9 different ways to estimate body weight and compared the estimates to real weight by calculating the mean intraclass correlation coefficient, the mean difference between real and estimated weights, and the proportion of measurements within 10% and 20% of the real weight. RESULTS: Five hundred fifteen pediatric patients were weighed and their weights estimated. All estimates had a high degree of agreement with real weight. A parent's weight estimate performed best: 86.5% of parental estimates were within 10% of the real weight. The next best estimate was achieved with the cardiopulmonary resuscitation (CPR) rule developed at Hospital del Niño Jesús: 65% of the estimates were within the 10% margin. Fewer than 40% of the weight estimates based on formulas using anthropometric measurements were within the 10% margin. CONCLUSION: A parent's estimate of weight is a valid approximation in children of all ages. When this estimate is not available, the CPR rule of Hospital del Niño Jesús would be the method of choice.

7.
Emergencias ; 31(2): 115-122, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30963740

RESUMO

OBJECTIVES: Arterial puncture for blood gas analysis is a painful procedure in the emergency department (ED). Local subcutaneous injection of anesthetics containing amino amides or esters is the usual painrelief technique applied before arterial puncture, but it is little used in some care settings, such as the ED. We aimed to analyze the literature on anesthetic approaches other than the traditional one of local injection of amino-amide or amino-ester compounds for pain relief during arterial puncture and to assess the efficacy of the alternatives. MATERIAL AND METHODS: . A systematic review of the literature was conducted in 6 bibliographic databases. We selected randomized clinical trials (RCTs) published in English or Spanish between 2000 and 2018. The trials compared self-reported pain immediately after arterial puncture for blood gas analysis. Some form of anesthesia other than local injection of an amino-amide or -ester compound was compared to another anesthetic technique, placebo, or no anesthetic. RESULTS: We found 16 RCTs. Four compared the effect of topical anesthetic creams containing amino amides and/or amino esters, two assessed ultrasound-guided puncture, four used small-caliber needles or special syringes, one used a needle-free high-pressure anesthetic injection system, and five studied cryoanesthesia by application of ice or aerosols. CONCLUSION: The only effective alternative approaches to pain relief during arterial puncture for blood gas analysis were the use of very fine-caliber needles, the use of needle-free pressure injectors for subcutaneous delivery of amino amides, and the application of ice for at least 3 minutes.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Coleta de Amostras Sanguíneas/efeitos adversos , Dor Processual/prevenção & controle , Anestésicos Locais/uso terapêutico , Humanos , Injeções Subcutâneas , Medição da Dor , Dor Processual/diagnóstico , Resultado do Tratamento
8.
Emergencias (Sant Vicenç dels Horts) ; 31(2): 115-122, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182529

RESUMO

Introducción y objetivo: La punción arterial para gasometría es una técnica dolorosa. La estrategia anestésica de elección consiste en la inyección local de amidas o esteres por vía subcutánea, pero resulta poco frecuente en algunos ámbitos asistenciales, como los servicios de urgencias. El objetivo de este trabajo es en describir las estrategias anestésicas distintas a la técnica clásica de inyección local de amidas o esteres y evaluar su eficacia en la punción arterial para gasometría. Método: Se realizó una revisión sistemática de la literatura a través de 6 bases de datos bibliográficas. Fueron seleccionados ensayos clínicos publicados entre 2000 y 2018, en inglés o español, que comparasen el dolor autopercibido por el paciente inmediatamente después de una punción arterial para gasometría en función de si se les aplicó alguna medida anestésica diferente a la inyección subcutánea de amidas o esteres frente a otro procedimiento anestésico local, un placebo o ninguna intervención anestésica. Resultados: Se localizaron 16 ensayos clínicos aleatorizados: 4 evaluaron la aplicación de anestésicos tópicos compuestos a base de esteres o amidas, 2 la punción ecoguiada, 4 el empleo de agujas de pequeño calibre o jeringuillas especiales, 1 el uso de inyectores a presión sin aguja y 5 la crioanestesia mediante hielo o aerosoles. Conclusión: Tan sólo el uso de agujas de calibre muy fino, la sustitución de jeringuillas clásicas por inyectores a presión sin aguja para la administración de amidas o esteres subcutáneas o la aplicación previa de hielo durante al menos 3 minutos se mostraron eficaces en la reducción del dolor derivado de la punción arterial para gasometría


Background and objective: Arterial puncture for blood gas analysis is a painful procedure in the emergency department (ED). Local subcutaneous injection of anesthetics containing amino amides or esters is the usual painrelief technique applied before arterial puncture, but it is little used in some care settings, such as the ED. We aimed to analyze the literature on anesthetic approaches other than the traditional one of local injection of amino-amide or amino-ester compounds for pain relief during arterial puncture and to assess the efficacy of the alternatives. Methods: A systematic review of the literature was conducted in 6 bibliographic databases. We selected randomized clinical trials (RCTs) published in English or Spanish between 2000 and 2018. The trials compared self-reported pain immediately after arterial puncture for blood gas analysis. Some form of anesthesia other than local injection of an amino-amide or -ester compound was compared to another anesthetic technique, placebo, or no anesthetic. Results: We found 16 RCTs. Four compared the effect of topical anesthetic creams containing amino amides and/or amino esters, two assessed ultrasound-guided puncture, four used small-caliber needles or special syringes, one used a needle-free high-pressure anesthetic injection system, and five studied cryoanesthesia by application of ice or aerosols. Conclusion: The only effective alternative approaches to pain relief during arterial puncture for blood gas analysis were the use of very fine-caliber needles, the use of needle-free pressure injectors for subcutaneous delivery of amino amides, and the application of ice for at least 3 minutes


Assuntos
Humanos , Amidas/administração & dosagem , Injeções Subcutâneas/métodos , Gasometria/instrumentação , Resultado do Tratamento , Gasometria/métodos , Crioanestesia/instrumentação , Manejo da Dor
9.
Enferm. clín. (Ed. impr.) ; 28(6): 359-364, nov.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-181656

RESUMO

Objetivos: Analizar el dolor asociado a la inserción de catéteres venosos y extracción de sangre arterial en pacientes adultos que acuden a urgencias, y explorar posibles factores relacionados con su intensidad. Método: Estudio observacional multicéntrico. Se incluyeron consecutivamente pacientes que requerían un catéter venoso periférico y/o una extracción de sangre arterial para gasometría. Se preguntó por el dolor experimentado después de cada técnica, empleando la escala NRS-11. Resultados: Se evaluaron 780 canalizaciones venosas y 101 gasometrías. Las venopunciones obtuvieron una puntuación media de 2,8 (IC 95%: 2,6-3) y las gasometrías de 3,6 (IC 95%: 3,1-4). El nivel de dolor iatrogénico se asoció a la dificultad técnica media o alta del procedimiento (p<0,001), a la elección de la arteria humeral en lugar de la radial (p=0,02) en las gasometrías y se correlacionó con el dolor basal en las venopunciones (p<0,001). El nivel de dolor en función de otras variables como el sexo, la procedencia o el calibre de la aguja no presentó diferencias estadísticamente significativas. Conclusiones: El dolor derivado de la cateterización venosa y la punción arterial para gasometría es leve-moderado y moderado, respectivamente, y su intensidad se asocia a variables como la dificultad del procedimiento, el lugar de punción o el dolor basal. Un mayor conocimiento de los efectos dolorosos derivados de cada procedimiento de enfermería durante la asistencia en urgencias y de los factores que se asocian a la autopercepción del mismo podría ayudar a determinar cuándo y cómo debería intervenirse para mitigar este efecto indeseado


Objectives: To analyse vein catheterisation and blood gas test-related pain among adult patients in the emergency department and to explore pain score-related factors. Method: An observational and multicentre research study was performed. Patients undergoing vein catheterisation or arterial puncture for gas test were included consecutively. After each procedure, patients scored the pain experienced using the NRS-11. Results: 780 vein catheterisations and 101 blood gas tests were analysed. Venipuncture was scored with an average score of 2.8 (95% CI: 2.6-3), and arterial puncture with 3.6 (95%CI 3.1-4). Iatrogenic pain scores were associated with moderate - high difficulty procedures (P<.001); with the choice of the humeral rather than the radial artery (P=.02) in the gas test and correlated to baseline pain in venipunctures (P<.001). Pain scores related to other variables such as sex, place of origin or needle gauge did not present statistically significant differences. Conclusions: Vein catheterisation and blood gas test-related pain can be considered mild to moderately and moderately painful procedures, respectively. The pain score is associated with certain variables such as the difficulty of the procedure, the anatomic area of the puncture or baseline pain. A better understanding of painful effects related to emergency nursing procedures and the factors associated with pain self-perception could help to determine when and how to act to mitigate this undesired effect


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Gasometria/instrumentação , Cateteres Venosos Centrais/efeitos adversos , Dor/etiologia , Medição da Dor , Flebotomia/efeitos adversos , Estudos Transversais , Serviço Hospitalar de Emergência
10.
Enferm Clin ; 28(6): 359-364, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29279250

RESUMO

OBJECTIVES: To analyse vein catheterisation and blood gas test-related pain among adult patients in the emergency department and to explore pain score-related factors. METHOD: An observational and multicentre research study was performed. Patients undergoing vein catheterisation or arterial puncture for gas test were included consecutively. After each procedure, patients scored the pain experienced using the NRS-11. RESULTS: 780 vein catheterisations and 101 blood gas tests were analysed. Venipuncture was scored with an average score of 2.8 (95% CI: 2.6-3), and arterial puncture with 3.6 (95%CI 3.1-4). Iatrogenic pain scores were associated with moderate - high difficulty procedures (P<.001); with the choice of the humeral rather than the radial artery (P=.02) in the gas test and correlated to baseline pain in venipunctures (P<.001). Pain scores related to other variables such as sex, place of origin or needle gauge did not present statistically significant differences. CONCLUSIONS: Vein catheterisation and blood gas test-related pain can be considered mild to moderately and moderately painful procedures, respectively. The pain score is associated with certain variables such as the difficulty of the procedure, the anatomic area of the puncture or baseline pain. A better understanding of painful effects related to emergency nursing procedures and the factors associated with pain self-perception could help to determine when and how to act to mitigate this undesired effect.


Assuntos
Gasometria/instrumentação , Cateteres Venosos Centrais/efeitos adversos , Medição da Dor , Dor/etiologia , Flebotomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Emergencias ; 29(3): 161-166, 2017 06.
Artigo em Espanhol | MEDLINE | ID: mdl-28825235

RESUMO

OBJECTIVES: To compare the efficacy of an ethyl chloride aerosol spray to a placebo spray applied in the emergency department to the skin to reduce pain from arterial puncture for blood gas analysis. MATERIAL AND METHODS: Single-blind, randomized placebo-controlled trial in an emergency department of Hospital de Basurto in Bilbao, Spain. We included 126 patients for whom arterial blood gas analysis had been ordered. They were randomly assigned to receive application of the experimental ethyl chloride spray (n=66) or a placebo aerosol spray of a solution of alcohol in water (n=60). The assigned spray was applied just before arterial puncture. The main outcome variable was pain intensity reported on an 11-point numeric rating scale. RESULTS: The median (interquartile range) pain level was 2 (1-5) in the experimental arm and 2 (1-4.5) in the placebo arm (P=.72). CONCLUSION: Topical application of an ethyl chloride spray did not reduce pain caused by arterial puncture.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Artérias/lesões , Cloreto de Etil/administração & dosagem , Dor/prevenção & controle , Punções/efeitos adversos , Administração Cutânea , Adolescente , Adulto , Aerossóis , Idoso , Etanol/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Método Simples-Cego , Falha de Tratamento , Adulto Jovem
12.
Emergencias (St. Vicenç dels Horts) ; 29(3): 161-166, jun. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-163934

RESUMO

Objetivos. Evaluar la eficacia del cloruro de etilo en aerosol aplicado sobre la piel frente a placebo para disminuir el dolor provocado por una punción arterial durante la realización de una gasometría en el servicio de urgencias (SU). Método. Ensayo clínico aleatorizado, simple ciego y controlado con placebo realizado en el SU del Hospital de Basurto (Bilbao, España). Se incluyeron 126 pacientes a los que se les había solicitado una gasometría arterial, asignándoles al azar al grupo de tratamiento tópico experimental con cloruro de etilo en aerosol (n = 66) o al grupo control con mezcla hidroalcohólica en aerosol (n = 60), ambos administrados inmediatamente antes de la punción arterial. La variable de resultado principal fue la intensidad del dolor autopercibido por el paciente medida por la escala NRS-11. Resultados. El dolor percibido por el paciente tuvo una mediana (rango intercuartílico) de 2 (1-5) en el grupo tratado con cloruro de etilo y de 2 (1-4,5) en el grupo placebo (p = 0,72). Conclusiones. La aplicación de cloruro de etilo tópico no reduce el dolor por punción arterial (AU)


Objective. To compare the efficacy of an ethyl chloride aerosol spray to a placebo spray applied in the emergency department to the skin to reduce pain from arterial puncture for blood gas analysis. Material and methods. Single-blind, randomized placebo-controlled trial in an emergency department of Hospital de Basurto in Bilbao, Spain. We included 126 patients for whom arterial blood gas analysis had been ordered. They were randomly assigned to receive application of the experimental ethyl chloride spray (n=66) or a placebo aerosol spray of a solution of alcohol in water (n=60). The assigned spray was applied just before arterial puncture. The main outcome variable was pain intensity reported on an 11-point numeric rating scale. Results. The median (interquartile range) pain level was 2 (1-5) in the experimental arm and 2 (1-4.5) in the placebo arm (P=.72). Conclusion. Topical application of an ethyl chloride spray did not reduce pain caused by arterial puncture (AU)


Assuntos
Humanos , Punções/métodos , Dor/tratamento farmacológico , Cloreto de Etil/farmacocinética , Gasometria/métodos , Administração Tópica , Crioterapia/métodos , Medição da Dor
14.
Emergencias (St. Vicenç dels Horts) ; 27(5): 325-331, oct. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-143251

RESUMO

Tradicionalmente se ha considerado que el esmalte de uñas puede absorber luz emitida por los pulsioxímetros e interferir en la detección y medida de la hemoglobina oxigenada. Mediante la realización de una revisión sistemática se ha pretendido evaluar la influencia del esmalte de uñas en los valores de saturación de oxígeno (SpO2) en pacientes sometidos a pulsioximetría. Se elaboró un protocolo de búsqueda para ser utilizado en seis bases de datos (Medline, Embase, WOS, Scopus, CINAHL e IBECS), y se consideraron ensayos clínicos o estudios observacionales publicados entre enero de 1999 y febrero de 2014. Fueron incluidos 12 ensayos clínicos no aleatorizados realizados en voluntarios sanos, salvo en dos estudios: uno empleó pacientes críticos sometidos a ventilación mecánica y otro utilizó personas con enfermedad pulmonar obstructiva crónica (EPOC) estables. Además, con excepción de un ensayo que recreó condiciones de hipoxia leve en altitud, el resto de trabajos se realizó en condiciones de normoxia. Se observaron diferencias en función del modelo de pulsioxímetro y del tipo de cosmético utilizado. Excepto en dos estudios, el esmalte de uñas produjo una reducción estadísticamente significativa de la SpO2 en al menos un color. Sin embargo, estas variaciones se presentaron dentro del rango de error estándar de los pulsioxímetros (± 2,0%). Existe consenso entre los autores de los estudios en que, aunque la laca de uñas puede producir una alteración estadísticamente significativa de los valores de saturación de oxígeno, estas variaciones carecen de relevancia clínica (AU)


Nail polish has traditionally been assumed to absorb light emitted by pulse oximeters and to interfere with the detection and measurement of oxygenated hemoglobin. In a systematic review of the literature we aimed to assess the influence of nail polish on the measurement of oxygen saturation by pulse oximetry (SpO2). A search protocol for online databases (MEDLINE, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, and IBECS [the Spanish health sciences index]) was established to find clinical trials or observational studies published between 1999 and February 2014. Twelve nonrandomized clinical trials were found. Ten were in healthy volunteers. One of the remaining 2 studies was in critical patients undergoing mechanical ventilation, and the other was in patients with stable chronic obstructive pulmonary disease. One study recreated the low oxygen level of high altitudes, while the others were done in normal atmospheric conditions. Differences between pulse oximeters and type of nail polish were found. Nail polish was associated with a statistically significant decrease in SpO2 for at least 1 color in all but 2 studies. However, the differences were within the standard error (±2.0%) of the pulse oximeters used. The authors of the studies all concluded that although nail polish might change SpO2 readings significantly, the variations are not clinically significant (AU)


Assuntos
Humanos , Oximetria , Produtos para Unhas e Cutículas , Gasometria/métodos , Erros de Diagnóstico/estatística & dados numéricos , Fatores de Risco
15.
Emergencias ; 27(5): 325-331, 2015 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-29087059

RESUMO

EN: Nail polish has traditionally been assumed to absorb light emitted by pulse oximeters and to interfere with the detection and measurement of oxygenated hemoglobin. In a systematic review of the literature we aimed to assess the influence of nail polish on the measurement of oxygen saturation by pulse oximetry (SpO2). A search protocol for online databases (MEDLINE, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, and IBECS [the Spanish health sciences index]) was established to find clinical trials or observational studies published between 1999 and February 2014. Twelve nonrandomized clinical trials were found. Ten were in healthy volunteers. One of the remaining 2 studies was in critical patients undergoing mechanical ventilation, and the other was in patients with stable chronic obstructive pulmonary disease. One study recreated the low oxygen level of high altitudes, while the others were done in normal atmospheric conditions. Differences between pulse oximeters and type of nail polish were found. Nail polish was associated with a statistically significant decrease in SpO2 for at least 1 color in all but 2 studies. However, the differences were within the standard error (±2.0%) of the pulse oximeters used. The authors of the studies all concluded that although nail polish might change SpO2 readings significantly, the variations are not clinically significant.

16.
Emergencias (Sant Vicenç dels Horts) ; 26(4): 307-316, ago. 2014. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-181347

RESUMO

Revisión sistemática sobre casos clínicos de pacientes en parada cardiaca que experimentaron una recuperación espontánea de la circulación tras el cese de las maniobras de reanimación o en ausencia de las mismas, y descripción de sus principales características. Se elaboró un protocolo de búsqueda dirigido a extraer de las bases de datos bibliográficas casos clínicos de autorresucitación publicados, sin límites de idioma ni restricciones de fecha hacia el pasado. Se recuperaron 38 artículos que aportaron 49 descripciones de casos de autorresucitación. Se extrajeron datos relativos a las características de los pacientes, la atención proporcionada y su evolución clínica. En tres casos el fenómeno se produjo en ausencia de reanimación cardiopulmonar previa y en el resto tras su cese. El 51% (n = 25) de los pacientes eran hombres y la edad media 63,3 años (DE: 23,1; rango: 9 meses-94 años). Tres casos correspondieron a pacientes pediátricos. El intervalo de tiempo desde el cese de la circulación o cese de los esfuerzos de reanimación hasta la recuperación de la circulación espontánea varió entre "algunos segundos" y un máximo de 33 minutos, el 67,3% (n = 33) sucedió durante los primeros 10 minutos. El 63,3% (n = 31) de los casos no sobrevivió al alta hospitalaria y tan sólo 11 (22,4%) lo hicieron sin secuelas o con afectaciones neurológicas leves. A pesar de que los artículos recuperados muestran una calidad de evidencia pobre, parece recomendable la monitorización de los pacientes en parada cardiaca durante un tiempo razonable de 5-10 minutos tras el cese de la reanimación para comprobar la persistencia de asistolia antes de la certificación de la defunción


This systematic review includes case reports involving patients in cardiac arrest who recovered circulation spontaneously in the absence of cardiopulmonary resuscitation (CPR) or after attempts had been abandoned. We describe the characteristics of these patients. Following our search protocol we collected case reports of spontaneous resuscitation from databases of published medical articles; no language limits were set. Thirty-eight articles describing 49 cases of spontaneous resuscitation were found. Data on patient characteristics, care characteristics, and clinical course were extracted. Circulation returned without prior CPR in 3 patients; the others recovered circulation after CPR had been stopped. Twenty-five (51%) of the patients were male, and the mean (SD) age was 63.3 (23.1) years (range, 9 months-94 years). Three were pediatric patients. Time from loss of circulation or termination of CPR attempts until spontaneous return ranged from "several seconds" to 33 minutes; 33 patients (67.3%) recovered circulation within 10 minutes. Thirty-one of the patients (63.3%) died while hospitalized; only 11 (22.4%) were discharged alive without complications or with only slight neurologic impairment. Although the articles analyzed offer a low level of evidence, they do suggest that it seems advisable to monitor patients in cardiac arrest for a reasonable time of 5 to 10 minutes after stopping CPR in order to confirm asystole before certifying death


Assuntos
Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Reanimação Cardiopulmonar , Parada Cardíaca/reabilitação
17.
Int J Neuropsychopharmacol ; 16(5): 1093-104, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23040084

RESUMO

Dysfunctional noradrenergic transmission is related to several neuropsychiatric conditions, such as depression. Nowadays, the role of G protein-coupled inwardly rectifying potassium (GIRK)2 subunit containing GIRK channels controlling neuronal intrinsic excitability in vitro is well known. The aim of this study was to investigate the impact of GIRK2 subunit mutation on the central noradrenergic transmission in vivo. For that purpose, single-unit extracellular activity of locus coeruleus (LC) noradrenergic neurons and brain monoamine levels using the HPLC technique were measured in wild-type and GIRK2 mutant mice. Girk2 gene mutation induced significant differences among genotypes regarding burst activity of LC neurons. In fact, the proportion of neurons displaying burst firing was increased in GIRK2 heterozygous mice as compared to that recorded from wild-type mice. Furthermore, this augmentation was even greater in the homozygous genotype. However, neither the basal firing rate nor the coefficient of variation of LC neurons was different among genotypes. Noradrenaline and serotonin basal levels were altered in the dorsal raphe nucleus from GIRK2 heterozygous and homozygous mice, respectively. Furthermore, noradrenaline levels were increased in LC projecting areas such as the hippocampus and amygdale from homozygous mice, although not in the prefrontal cortex. Finally, potency of clonidine and morphine inhibiting LC activity was reduced in GIRK2 mutant mice, although the efficacy remained unchanged. Altogether, the present study supports the role of GIRK2 subunit-containing GIRK channels on the maintenance of tonic noradrenergic activity in vivo. Electric and neurochemical consequences derived from an altered GIRK2-dependent signalling could facilitate the understanding of the neurobiological basis of pathologies related to a dysfunctional monoaminergic transmission.


Assuntos
Potenciais de Ação/genética , Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/genética , Canais de Potássio Corretores do Fluxo de Internalização Acoplados a Proteínas G/metabolismo , Locus Cerúleo/citologia , Neurônios/metabolismo , Norepinefrina/metabolismo , Potenciais de Ação/efeitos dos fármacos , Adrenérgicos/farmacologia , Animais , Relação Dose-Resposta a Droga , Locus Cerúleo/metabolismo , Camundongos , Camundongos Mutantes , Morfina/farmacologia , Entorpecentes/farmacologia , Neuroquímica , Neurônios/efeitos dos fármacos , Técnicas de Patch-Clamp
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