Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Rev Chil Pediatr ; 90(1): 44-51, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095218

RESUMO

INTRODUCTION: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. OBJECTIVE: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. MATERIAL AND METHOD: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. RESULTS: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). CONCLUSIONS: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Competência Clínica/estatística & dados numéricos , Epinefrina/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Simpatomiméticos/uso terapêutico , Argentina , Criança , Estudos Transversais , Emergências , Pesquisas sobre Serviços de Saúde , Hospitais Pediátricos , Humanos , Injeções Intramusculares , Pediatras/normas , Pediatras/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas
2.
Pediatr Emerg Care ; 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31058761

RESUMO

OBJECTIVE: Guidelines adherence in emergency departments (EDs) relies partly on the availability of resources to improve sepsis care and outcomes. Our objective was to assess the management of pediatric septic shock (PSS) in Latin America's EDs and to determine the impact of treatment coordinated by a pediatric emergency specialist (PEMS) versus nonpediatric emergency specialists (NPEMS) on guidelines adherence. METHODS: Prospective, descriptive, and multicenter study using an electronic survey administered to PEMS and NPEMS who treat PSS in EDs in 14 Latin American countries. RESULTS: We distributed 2164 surveys with a response rate of 41.5%, of which 22.5% were PEMS. Overall American College of Critical Care Medicine reported guidelines adherence was as follows: vascular access obtained in 5 minutes, 76%; fluid infusion technique, 60%; administering 40 to 60 mL/kg within 30 minutes, 32%; inotropic infusion by peripheral route, 61%; dopamine or epinephrine in cold shock, 80%; norepinephrine in warm shock, 57%; and antibiotics within 60 minutes, 82%. Between PEMS and NPEMS, the following differences were found: vascular access in 5 minutes, 87.1% versus 72.7% (P < 0.01); fluid infusion technique, 72.3% versus 55.9% (P < 0.01); administering 40 to 60 mL/kg within 30 minutes, 42% versus 29% (P < 0.01); inotropic infusion by peripheral route, 75.7% versus 56.3% (P < 0.01); dopamine or epinephrine in cold shock, 87.1% versus 77.3% (P < 0.05); norepinephrine in warm shock, 67.8% versus 54% (P < 0.01); and antibiotic administration within first 60 minutes, 90.1% versus 79.3% (P < 0.01), respectively. Good adherence criteria were followed by 24%. The main referred barrier for sepsis care was a failure in its recognition, including the lack of triage tools. CONCLUSIONS: In some Latin American countries, there is variability in self-reported adherence to the evidence-based recommendations for the treatment of PSS during the first hour. The coordination by PEMS support greater adherence to these recommendations.

3.
Arch Argent Pediatr ; 117(1): e14-e23, 2019 02 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30652450

RESUMO

In the past two years, different organizations have updated their clinical practice guidelines for hemodynamic support in pediatric septic shock. The studies conducted in adults have questioned the initial management of sepsis in accordance to protocols based on achieving various goals. However, the usefulness of these protocols in children has been demonstrated. The possibility of adhering to guidelines may vary depending on patients and facilities, so it is necessary to update the general aspects of initial care for children with sepsis. The proposal is to shift the paradigm from an "individual practice guideline," which is universal for all, to an "institutional practice guideline" and to assess the factors that should be improved at each facility. This manuscript is divided into two parts. The first part analyzes the bundles for the early detection of septic shock. Part two addresses treatment, stabilization, referral, and process analysis.

4.
Arch Argent Pediatr ; 117(1): e24-e33, 2019 02 01.
Artigo em Espanhol | MEDLINE | ID: mdl-30652451

RESUMO

In 2016, the Surviving Sepsis Campaign and the National Institute for Health and Care Excellence (NICE) developed clinical practice guidelines for the management of pediatric septic shock. In 2017, the American College of Critical Care Medicine (ACCM) updated its recommendations for hemodynamic support of pediatric shock. Recognizing septic shock is critical, as well as an optimal, time-sensitive treatment. An adequate consultation with a pediatric specialist and/or a timely referral to a facility with a higher level of care are also critical for an appropriate outcome in the management of this condition. Here we analyze the bundles used in the management of these patients, which are essential to improve the quality of care.

5.
Rev. chil. pediatr ; 90(1): 44-51, 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-990885

RESUMO

Resumen: Introducción: La anafilaxia es una emergencia. De acuerdo con las últimas recomendaciones internacionales el reconocimiento de los criterios clínicos y el tratamiento temprano con adrenalina intramuscular se asocian a mayor sobrevida. Objetivo: Determinar el conocimiento de los médicos pediatras de un Hospital Pediátrico de tercer nivel sobre los criterios diagnósticos y el tratamiento de la anafilaxia. Material y Método: Estudio descriptivo transversal que considera diseño, aplicación y validación de una encuesta anónima a médicos con residencia completa en pediatría que realizan guardias en un hospital de tercer nivel. Los ítems de la Encuesta comprendieron tres dimensiones, experiencia del operador (2 ítems), manejo farmacológico (3 ítems) e identificación del cuadro (4 ítems). El análisis estadístico utilizó el programa SPSS v.21, presentando medidas de tendencia cen tral (mediana, rango y tabla de frecuencias) y para su comparación prueba de Chi cuadrado. Se con sideró significativo un valor de p < 0,05. Resultados: Se encuestaron 71 médicos con una mediana de 3 años transcurridos desde el fin de la residencia. 35% identificó todos los criterios clínicos; 99% (70) indicó adrenalina, 73% por vía intramuscular y 55% a dosis correcta (solo el 48% contestó la dosis y vía correctamente). En forma global la adecuación para identificación más manejo correcto fue del 21%. Los médicos con menos de 5 años de experiencia tuvieron mejor desempeño en la administración de adrenalina intramuscular (83% vs 52% p = 0,005) y en la detección de síntomas gastrointestinales (60%vs35% p = 0,043). Conclusiones: Existen dificultades para la identificación y el manejo apropiado de la anafilaxia por pediatras de un Hospital de tercer nivel en un escenario teórico. Aunque la mayoría eligió la adrenalina como droga de primera línea, la mitad no la indicó de forma correcta y solo un tercio reconoció el cuadro en todos sus escenarios.


Abstract: Introduction: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. Objective: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. Material and Method: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. Results: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). Conclusions: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.

6.
Emerg Med J ; 2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30327413

RESUMO

OBJECTIVE: To describe senior paediatric emergency clinician perspectives on the optimal frequency of and preferred modalities for practising critical paediatric procedures. METHODS: Multicentre multicountry cross-sectional survey of senior paediatric emergency clinicians working in 96 EDs affiliated with the Pediatric Emergency Research Network. RESULTS: 1332/2446 (54%) clinicians provided information on suggested frequency of practice and preferred learning modalities for 18 critical procedures. Yearly practice was recommended for six procedures (bag valve mask ventilation, cardiopulmonary resuscitation (CPR), endotracheal intubation, laryngeal mask airway insertion, defibrillation/direct current (DC) cardioversion and intraosseous needle insertion) by at least 80% of respondents. 16 procedures were recommended for yearly practice by at least 50% of respondents. Two procedures (venous cutdown and ED thoracotomy) had yearly practice recommended by <40% of respondents. Simulation was the preferred learning modality for CPR, bag valve mask ventilation, DC cardioversion and transcutaneous pacing. Practice in alternative clinical settings (eg, the operating room) was the preferred learning modality for endotracheal intubation and laryngeal mask insertion. Use of models/mannequins for isolated procedural training was the preferred learning modality for all other invasive procedures. Free-text responses suggested the utility of cadaver labs and animal labs for more invasive procedures (thoracotomy, intercostal catheter insertion, open surgical airways, venous cutdown and pericardiocentesis). CONCLUSIONS: Paediatric ED clinicians suggest that most paediatric critical procedures should be practised at least annually. The preferred learning modality depends on the skill practised; alternative clinical settings are thought to be most useful for standard airway manoeuvres, while simulation-based experiential learning is applicable for most other procedures.

7.
Arch. argent. pediatr ; 116(4): 298-300, ago. 2018. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-1038435

RESUMO

La Emergentología Pediátrica se ha desarrollado en el mundo como una subespecialidad de la pediatría durante las últimas décadas. Los registros muestran una creciente necesidad de sus servicios. Esta orientación tuvo su empuje inicial en Estados Unidos de América y nuestro país ha continuado por el mismo camino, así como muchos otros países latinoamericanos. Aun así, habrá que intensificar su promoción y trabajar en el desarrollo de la investigación y la docencia relacionadas con el área para promover el bienestar de los niños, sus familias y de la sociedad en general.


Pediatric Emergency Medicine has developed around the world as a subspecialty of pediatrics. There is plenty of data reflecting a growing need for its services. The subspecialty was initiated in the United States and Argentina, together with other Latin American countries, followed the same path. Nevertheless, there is yet much to be done. It is necessary to strengthen its promotion and to stimulate research and teaching activities in order to continue improving the quality of care delivered to the pediatric population, their families and society as a whole.

8.
Arch Argent Pediatr ; 116(4): 298-300, 2018 Aug 01.
Artigo em Espanhol | MEDLINE | ID: mdl-30016049

RESUMO

Pediatric Emergency Medicine has developed around the world as a subspecialty of pediatrics. There is plenty of data reflecting a growing need for its services. The subspecialty was initiated in the United States and Argentina, together with other Latin American countries, followed the same path. Nevertheless, there is yet much to be done. It is necessary to strengthen its promotion and to stimulate research and teaching activities in order to continue improving the quality of care delivered to the pediatric population, their families and society as a whole.

9.
Buenos Aires; Médica Panamericana; 2018. 180 p. ilus.
Monografia em Espanhol | LILACS | ID: biblio-882735

RESUMO

La patología respiratoria presenta un gran desafío para las instituciones de salud, por su frecuencia, su complejidad diagnóstica y terapéutica y la carga que representa en costos económicos y vitales. Estos conceptos se extienden a todos los grupos etarios y sus características han ido cambiando a lo largo del tiempo ante los avances producidos en las inmunizaciones, los métodos diagnósticos y los tratamientos. Aún así, las infecciones respiratorias bajas son todavía la causa más frecuente de consulta, internación, morbilidad crónica, discapacidad y mortalidad en pediatría. Este nuevo volumen aborda esta temática especial y entre sus características se destacan: El estudio de las patologías más frecuentes en los diferentes ámbitos de atención pero en particular en el primer nivel, con una exposición centrada en los aspectos que facilitan el diagnóstico rápido y el tratamiento adecuado, con el menor uso de recursos y con pautas que fijan la derivación oportuna hacia el especialista o hacia una institución de mayor complejidad. El desarrollo de importantes temas, como la patología obstructiva de la vía aérea superior, su estudio diagnóstico y sus formas recurrentes; bronquiolitis; las intercurrencias respiratorias en pacientes con condiciones clínicas especiales; y la supuración pleuropulmonar. La inclusión, en todos los capítulos, de casos clínicos con su evolución y desenlace, textos destacados con los principales conceptos y puntos claves para recordar. Una obra sólida y práctica, que transmite la experiencia de los profesionales de una institución del prestigio internacional del Hospital dePediatría Prof. Dr. Juan P. Garrahan, dedicada a todos los pediatras, dondequiera que trabajen al servicio de la salud de los niños.


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Obstrução das Vias Respiratórias , Argentina , Asma , Bronquiolite , Hemoptise , Laringe/anormalidades , Doenças Neuromusculares , Oxigenoterapia , Derrame Pleural , Doença Pulmonar Obstrutiva Crônica , Testes de Função Respiratória , Sons Respiratórios , Infecções Respiratórias , Traqueostomia
11.
Arch Argent Pediatr ; 108(3): 249-54, 2010 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-20544141

RESUMO

Sepsis is the most common cause of death in children. Its adequate management has a significant impact on morbidity and mortality. Pediatricians who take initial contact with these patients play a fundamental role in the chain of actions that start at the Emergency Area and finish in the Intensive Care Unit. In recent years, some strategies have been developed to achieve staggered targets: clinical, hemodynamic, biochemical, and oxygenation. The correct interpretation of each affected component will allow the most appropriate intervention. The aggressive management with fluids and the early indication of inotropes are the basis for the management of shock. This paper summarizes primary interventions in the Emergency Department.


Assuntos
Hemodinâmica , Choque Séptico/terapia , Criança , Protocolos Clínicos , Humanos , Fatores de Tempo
12.
Arch. argent. pediatr ; 108(3): 249-254, jun. 2010. tab
Artigo em Espanhol | BINACIS | ID: bin-125712

RESUMO

La sepsis es la causa más común de muerte en pediatría. Conocersu manejo adecuado tendrá un fuerte impacto en la morbimortalidad.El pediatra que toma contacto inicial con estosniños cumple un rol fundamental en la cadena de acciones que suele iniciarse en el Area de Emergencias y finalizar en Cuidados Intensivos. En los últimos años se elaboraron estrategias para cumplir objetivos escalonados. Las metas por alcanzar son clínicas, hemodinámicas, bioquímicas y de oxigenación. La correcta interpretación de cada componente afectado permitirá la intervención más apropiada. La administración intensiva de fluidos y la precoz indicación de inotrópicos resultan pilares esenciales. Este trabajo resume las principales intervenciones en el Area de Emergencias.(AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Choque Séptico/terapia , Hemodinâmica , Catecolaminas/administração & dosagem , Cardiotônicos , Sepse
13.
Arch. argent. pediatr ; 108(3): 249-254, jun. 2010. tab
Artigo em Espanhol | LILACS | ID: lil-557708

RESUMO

La sepsis es la causa más común de muerte en pediatría. Conocersu manejo adecuado tendrá un fuerte impacto en la morbimortalidad.El pediatra que toma contacto inicial con estosniños cumple un rol fundamental en la cadena de acciones que suele iniciarse en el Área de Emergencias y finalizar en Cuidados Intensivos. En los últimos años se elaboraron estrategias para cumplir objetivos escalonados. Las metas por alcanzar son clínicas, hemodinámicas, bioquímicas y de oxigenación. La correcta interpretación de cada componente afectado permitirá la intervención más apropiada. La administración intensiva de fluidos y la precoz indicación de inotrópicos resultan pilares esenciales. Este trabajo resume las principales intervenciones en el Área de Emergencias.


Assuntos
Humanos , Masculino , Feminino , Criança , Cardiotônicos , Catecolaminas/administração & dosagem , Hemodinâmica , Sepse , Choque Séptico/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA