Efectividad de la formación teórico-práctica en soporte vital básico a monitoras de comedores escolares desde Atención Primaria / Effectiveness of theoretical-practical training in basic life support for school canteen monitors from Primary Care

Introducción: las enfermedades cardiovasculares constituyen un problema de salud pública a nivel mundial y dentro de ellas destaca la parada cardiorrespiratoria (PCR). Los comedores escolares son espacios con potencial riesgo de presenciar una PCR. Materiales y métodos: estudio analítico cuasiexperimental de intervención. Las participantes recibieron formación mediante una plataforma virtual interactiva y una sesión de simulación clínica presencial sobre maniobra de Heimlich, reanimación cardiopulmonar (RCP) básica y uso del desfibrilador externo semiautomático (DESA). Se realizó un análisis descriptivo de la población a estudio y un análisis estadístico comparativo entre el resultado obtenido en un test previo y otro posterior a la formación virtual. Se creó una variable restando la puntuación obtenida antes de la formación a la obtenida después de la misma. Se analizó mediante observación directa la simulación clínica. Se definió la significación estadística con una p <0,05. Análisis estadístico con SPSS versión 19.0. Se siguieron los principios de la Declaración de Helsinki y las directrices sobre buenas prácticas clínicas. Resultados: la totalidad de la muestra eran mujeres con edad mediana de 48,50 años. La nota mediana del test previo fue de 6,7/10 y el test posterior tuvo un resultado constante de 10/10. La diferencia entre el test posterior y el previo tuvo una mediana de 3,3 (p 0,01) y se constató en la simulación que el aprendizaje fue óptimo. Conclusiones: la formación en RCP es una estrategia de impacto social, relacionada con una mejora en la respuesta ante un caso de PCR, disminuyendo la morbimortalidad que esta implica. (AU)

Introduction: cardiovascular diseases constitute a public health problem worldwide, among which cardiopumonary arrest (CPA) stands out. School canteens are spaces where there is a possibility of witnessing CPA. Materials and methods: quasi-experimental interventional and analytical study. Participants received training through an interactive virtual platform and a face-to-face clinical simulation session on the Heimlich manoeuvre, basic cardiopulmonary resuscitation (CPR) and the use of the semiautomatic external defibrillator (SAED). We carried out a descriptive analysis of the study population and a comparative statistical analysis of the results obtained in the tests conducted before and after the virtual training. We created variable corresponding to the subtraction of the pre-training score from the post-training score. Clinical simulation was analysed by direct observation. Statistical significance was defined as p < 0.05. The statistical analysis was carried out with SPSS version 19.0. The study adhered to the principles of the Declaration of Helsinki and the guidelines on good clinical practice. Results: the entire sample consisted of women with a median age of 48.50 years. The median score in the pre-test was 6.7/10, and the score in the post-test was uniformly 10/10. The median difference between the pre- and post-training tests was of 3.3 points (p 0.01) and the simulation evinced that the learning was optimal. Conclusions: training in CPR is a strategy that has social impact in terms of the improvement in the response to a CPA events, achieving a reduction in the associated morbidity and mortality. (AU)

Exploring eye-tracking data as an indicator of situational awareness in nursing students during a cardiorespiratory arrest simulation.

AIM: To examine the components of visual attention that maintain situational awareness during simulation training in undergraduate nursing students with different instruction levels. BACKGROUND: Eye-tracking can provide deep insight into the nurses' attention during simulated practice. Knowing which gaze patterns promote situational awareness can significantly improve nurse instruction. DESIGN: A comparative observational study investigated the role of visual attention on the performance quality, psychophysiological parameters (vital signs, anxiety and stress) and socioemotional competencies (cognitive workload, motivation and self-efficacy) of nursing students with various experience levels. METHODS: Thirty nursing students divided into two groups according to their academic level: first cycle (n=14) and second-cycle (n=16) faced a clinical simulation scenario to resolve a cardiorespiratory arrest event. Eye tracking-based analysis required the selection of six areas of interest. The monitorization of vital signs included measuring blood pressure, heart rate, respiratory rate and oxygen saturation before and after the simulation practice. Participants completed the socioemotional questionnaire (NASA-TLX). They answered the state subscale of the State-Trait Anxiety Inventory (STAI), the Visual Analogue Scale (VAS) of stress, the Situational Motivation Scale (SIMS) and the Baessler and Schwarzer General Self-Efficacy Scale. RESULTS: The first-cycle group displayed higher vital sign scores than the second cycle, apart from the post-simulation respiratory rate. All physiological parameters increased in mean value after the clinical simulation, except oxygen saturation. Anxiety was the only parameter in the socioemotional domain to present a statistically significant difference between the groups. First-year nursing students showed greater anxiety, stress, mental workload, identified regulation and intrinsic motivation, while second-year students showed higher levels of amotivation, external regulation and perceived self-efficacy. Eye-tracking data (revisits, gaze and duration of fixations) exhibited statistically significant differences depending on the area of interest in both groups (p =. 05). The performance outcomes showed a negative and moderate association with gaze the total number of gazes in the second-cycle group (rho = -0.640, p = 0.010). CONCLUSION: Eye-tracking-based analysis can help to predict performance quality while maintaining situational awareness during nursing instruction.

[The Paris RACE registry]. / Le registre RACE Paris.

The Register of Cardiac Accidents of Endurance Races in Paris (RACE Paris), an observational prospective cohort study collected sudden deaths and life-threatening accidents from five major Parisian endurance races over 10 years.

Uso das escalas design e autoconfiança na simulação clínica em parada cardiorrespiratória* / Use of the design and self-confidence scales in clinical simulation of cardiac arrest* / Utilización de las escalas de diseño y autoconfianza en la simulación clínica de la parada cardiorrespiratoria*

RESUMO Objetivo: avaliar a percepção dos participantes frente ao design da simulação, satisfação e autoconfiança na aprendizagem pela simulação clínica em parada cardiorrespiratória. Método: Pesquisa de natureza descritiva e exploratória, de abordagem quantitativa, um quase experimento de grupo único, tipo antes e depois, realizada em 2022, na grande São Paulo, Brasil. O estudo foi realizado com 24 participantes profissionais de enfermagem e estagiários da graduação em duas unidades básicas de saúde. Resultados: identificou-se aumento significativo (p<0,05) no nível de conhecimento após a simulação. Na avaliação da escala de design observou-se média de 4,55 na concordância e 4,55 na importância com a simulação clínica. Observou-se uma média de 4,56 na escala de satisfação e autoconfiança percebida pelos participantes na simulação clínica. Conclusão: a simulação clínica potencializa o aprendizado dos participantes, promove satisfação e autoconfiança e o uso de instrumentos para avaliação e aplicação do cenário são norteadores para uma simulação clínica eficaz.

ABSTRACT Objective: To evaluate participants' perception of design satisfaction and self-confidence in learning through clinical simulation in cardiac arrest. Method: This is a descriptive and exploratory study with a quantitative approach, a quasi-experiment of a single group, before and after type, carried out in 2022 in the greater São Paulo area, Brazil. The study was carried out with 24 participants who were nursing professionals and undergraduate trainees at two basic health units. Results: There was a significant increase (p<0.05) in the level of knowledge after the simulation. When evaluating the design scale, an average of 4.55 was found for agreement and 4.55 for importance with the clinical simulation. There was an average score of 4.56 on the scale of satisfaction and self-confidence perceived by the participants in the clinical simulation. Conclusion: Clinical simulation enhances participants' learning, promotes satisfaction and self-confidence, and using instruments to evaluate and apply the scenario are guidelines for effective clinical simulation.

RESUMEN Objetivo: Evaluar la percepción de los participantes sobre el diseño de la simulación, la satisfacción y la autoconfianza en el aprendizaje mediante simulación clínica en parada cardiorrespiratoria. Método: Estudio descriptivo y exploratorio con enfoque cuantitativo, cuasiexperimento con un único grupo, de tipo antes y después, realizado en 2022, en el área metropolitana de São Paulo, Brasil. El estudio se llevó a cabo con 24 participantes que eran profesionales de enfermería y estudiantes de graduación en prácticas en dos unidades básicas de salud. Resultados: se produjo un aumento significativo (p<0,05) del nivel de conocimientos tras la simulación. La evaluación de la escala de diseño mostró una media de 4,55 para el acuerdo y de 4,55 para la importancia con la simulación clínica. Hubo una puntuación media de 4,56 en la escala de satisfacción y autoconfianza percibida por los participantes en la simulación clínica. Conclusión: La simulación clínica mejora el aprendizaje de los participantes, fomenta la satisfacción y la autoconfianza, y el uso de instrumentos para evaluar y aplicar el escenario son pautas para una simulación clínica eficaz.

Características de la atención médica durante la reanimación cardio-pulmo-cerebral intrahospitalaria

Fundamento: la reanimación cardiopulmocerebral es el conjunto de maniobras para asegurar la oxigenación de los órganos cuando la circulación de la sangre se detiene. La reanimación cardiopulmocerebral intrahospitalaria es una intervención que salva vidas. Objetivo: caracterizar la atención médica durante la reanimación cardiopulmocerebral en pacientes que presentan parada cardiaca dentro del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Método se realizó un estudio descriptivo, transversal en las cinco unidades de cuidados intensivos de la Vicedirección de Urgencias, entre enero hasta junio del 2020. Se estudiaron 152 pacientes que realizaron un paro cardiorespiratorio. Se estudiaron las variables relacionadas con el paciente, los síntomas y signos previos al PCR presentados por los pacientes así como signos vitales. Resultados la media de edad fue de 62,66 años, en el 54,6 % predominó el sexo masculino. La hipertensión arterial fue la comorbilidad más frecuente con un 60,5 %. El 32,9 % tuvo un tiempo de estadía previo al evento de más de 72 horas. En orden de frecuencia los signos o síntomas previos al evento de PCR con más presencia fueron: bradicardia (32,2 %); pulsos débiles (15,1 %); inconciencia (12,5 %) y cianosis con 10,5 %. El servicio de mayor de ocurrencia fue la Unidad de Cuidados Intensivos Clínica. La asistolia constituyó el ritmo eléctrico inicial más común (57,9 %). En el 100 % de los casos se realizó manejo avanzado de la vía aérea con tubo endotraqueal. La desfibrilación estuvo indicada en 42 pacientes donde el 15,1 % de estos recibió la primera desfibrilación en menos de 5 minutos. La causa de la suspensión de la reanimación en 95 de los pacientes estudiados fue el fallecimiento. Conclusiones: la atención médica ante el paro cardiorrespiratorio debe seguir perfeccionándose, a través de la superación del personal sanitario y el desarrollo de acciones organizativas hacia el proceso de reanimación cardiopulmocerebral intrahospitalaria.

Background: cardiopulmonary-cerebral resuscitation is the set of maneuvers to ensure oxygenation of organs when blood circulation stops. In-hospital cardiopulmonary-cerebral resuscitation is a life-saving intervention. Objective: to characterize medical care during cardiopulmonary-cerebral resuscitation in patients with cardiac arrest at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Method: a descriptive, cross-sectional study was carried out in the five intensive care units of the Emergency Department, from January to June 2020. 152 patients who suffered cardiorespiratory arrest were studied. The variables related to the patient, the symptoms and signs presented by the patients prior to the PCR, as well as vital signs, were studied. Results: the average age was 62.66 years, in 54.6% the male sex predominated. Arterial hypertension was the most frequent comorbidity with 60.5%. 32.9% had a length of stay prior to the event of more than 72 hours. In order of frequency, the most prevalent signs or symptoms prior to the PCR event were: bradycardia (32.2%); weak pulses (15.1%); unconsciousness (12.5%) and cyanosis with 10.5%. The service with the highest occurrence was the Clinical Intensive Care Unit. Asystole was the most common initial electrical rhythm (57.9%). In 100% of the cases, advanced airway management was performed with an endotracheal tube. Defibrillation was indicated in 42 patients where 15.1% of these received the first defibrillation in less than 5 minutes. The cause of suspension of resuscitation in 95 of the patients studied was death. Conclusions: medical care in the face of cardiorespiratory arrest must continue to be improved, through the improvement of health personnel and the development of organizational actions towards the process of intrahospital cardiopulmonary-cerebral resuscitation.

Conhecimento da equipe de enfermagem sobre reanimação cardiopulmonar antes e após capacitação / Conocimiento del equipo de enfermería sobre reanimación cardiopulmonar antes y después de capacitación / Knowledge of the nursing team on cardiopulmonary resuscitation before and after training

Objetivo: avaliar o conhecimento dos profissionais da equipe de enfermagem no atendimento à parada cardiorrespiratória e comparar antes e após capacitação. Método: pesquisa prospectiva e comparativa, realizada em um hospital público em São Paulo, em 2021, com 68 profissionais. Foi aplicado um questionário sobre parada cardiorrespiratória antes e após capacitação, para comparação. Resultados: a maioria dos profissionais reconhece os sinais clássicos de parada cardiorrespiratória e a sequência correta de atendimento, todavia, teve dificuldade em identificar os ritmos chocáveis e as ações após a desfibrilação. A média de acertos antes e após a realização da capacitação foi de 43,65 e 66,11, respectivamente, e corrobora com a eficácia da ação educativa. Conclusão: é extremamente relevante ofertar, sistematicamente, capacitações à equipe, de modo a garantir uma assistência mais segura e eficaz.

Objetivo: evaluar el conocimiento de los profesionales del equipo de enfermería en la atención a la parada cardiorrespiratoria y comparar antes y después de capacitación. Método: investigación prospectiva y comparativa, realizada en un hospital público en São Paulo, en 2021, con 68 profesionales. Se aplicó un cuestionario sobre parada cardiorrespiratoria antes y después de capacitación, para comparación. Resultados: la mayoría de los profesionales reconocen los signos clásicos de parada cardiorrespiratoria y la secuencia correcta de atención, sin embargo, tuvo dificultad en identificar los ritmos chocables y las acciones después de la desfibrilación. El promedio de aciertos antes y después de la realización de la capacitación fue de 43,65 y 66,11, respectivamente, y corrobora con la eficacia de la acción educativa. Conclusión: es extremadamente relevante ofrecer, sistemáticamente, capacitaciones al equipo, de modo a garantizar una asistencia más segura y eficaz.

Objective: to evaluate the knowledge of nursing staff professionals in the care of cardiorespiratory arrest and to compare before and after training. Method: prospective and comparative research, conducted in a public hospital in São Paulo, in 2021, with 68 professionals. A questionnaire on cardiorespiratory arrest before and after training was applied for comparison. Results: most professionals recognize the classic signs of cardiorespiratory arrest and the correct sequence of care, however, had difficulty identifying the shockable rhythms and actions after defibrillation. The average number of correct answers before and after the training was 43.65 and 66.11, respectively, and corroborates the effectiveness of the educational action. Conclusion: it is extremely relevant to systematically offer training to the team in order to ensure safer and more effective care.

Clinician Wire Puncture Injury to the Hand from Chest Compressions on a Patient with a Median Sternotomy: A Case Report.

Standard precautions, including protections from blood and body fluid exposure, are designed to protect health care providers from infections. Sharps safety practices rarely include the potential for the unconscious patient's own body to be a potential source of clinician percutaneous injury from sharp objects outside of the perioperative setting. This case report reviews a percutaneous injury to the hand of a physician who was performing chest compressions on a patient with an out-of-hospital cardiac arrest. The 76-year-old patient in cardiac arrest had undergone a medial sternotomy surgery 15 years before the arrest. The sternal wire rotated owing to the initial chest compressions, breaking the clinician's nitrile glove and producing an open wound on the thenar region of the clinician's right hand. Application of a 10 × 10 12-ply gauze pack on the chest of the patient in cardiac arrest allowed the resuscitation team to continue with the compressions with no further wounds from the wire. This case report is a novel contribution to the published literature and advances standard precautions considerations in patients with out-of-hospital cardiac arrest, with the sternotomy wire from previous surgery as a source of percutaneous clinician injury during chest compression.

Evolution of physiologic and autonomic phenotype in rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation over a decade from age at diagnosis.

Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare cause of syndromic obesity with risk of cardiorespiratory arrest and neural crest tumor. No ROHHAD-specific genetic test exists at present. Rapid weight gain of 20-30 pounds, typically between ages 2-7 years in an otherwise healthy child, followed by multiple endocrine abnormalities herald the ROHHAD phenotype. Vigilant monitoring for asleep hypoventilation (and later awake) is mandatory as hypoventilation and altered control of breathing can emerge rapidly, necessitating artificial ventilation as life support. Recurrent hypoxemia may lead to cor pulmonale and/or right ventricular hypertrophy. Autonomic dysregulation is variably manifest. Here we describe the disease onset with "unfolding" of the phenotype in a child with ROHHAD, demonstrating the presentation complexity, need for a well-synchronized team approach, and optimized management that led to notable improvement ("refolding") in many aspects of the child's ROHHAD phenotype over 10 years of care. CITATION: Khaytin I, Stewart TM, Zelko FA, et al. Evolution of physiologic and autonomic phenotype in rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation over a decade from age at diagnosis. J Clin Sleep Med. 2022;18(3):937-944.

Shock mixto en paciente con infarto agudo de miocardio: intervenciones enfermeras / Mixed shock in patients with acute myocardial infarction: Nursing interventions

El tratamiento del shock cardiogénico incluye el uso de terapias de asistencia circulatoria cuando el tratamiento médico ha sido insuficiente y pueden ser un puente a decisión ya que conceden tiempo para evaluar la situación del paciente y tener en cuenta las diferentes opciones terapéuticas existentes. El objetivo de este artículo es desarrollar un plan de cuidados óptimo e individualizado utilizando la taxonomía NANDA-NOC-NIC. Observación clínica Se realizó una valoración enfermera según las necesidades de Virginia Henderson donde destacaron 2 necesidades alteradas: respiración y circulación, ya que la paciente precisó de ventilación mecánica invasiva (VMI) y requirió soporte de asistencia circulatoria mecánica. Intervenciones De acuerdo con las necesidades destacadas, se priorizaron 5 diagnósticos según la taxonomía NANDA utilizando el modelo de Análisis de Resultado del Estado Actual (AREA): riesgo de disminución del gasto cardíaco, deterioro de la ventilación espontánea, deterioro de la integridad tisular, riesgo del síndrome de desuso, riesgo de infección y riesgo de hipotermia. Discusión y conclusiones Los criterios de resultados evidenciaron una evolución favorable pasadas 96h. El desarrollo del lenguaje estandarizado NANDA-NOC-NIC nos permitió organizar el plan de cuidados enfermero. (AU)

Introduction and objectives We present a clinical case of a 40-year-old woman diagnosed with acute myocardial infarction (AMI) in Killip I who was admitted to our hospital. She experienced complications in the haemodynamic lab and in the operating room, including cardiogenic and anaphylactic shock requiring ventricular assist support. Conservative management support with inotropes and vasopressors in cardiogenic shock has been shown to be insufficient in many patients to maintain adequate perfusion and prevent irreversible multiple organ dysfunction syndrome. For this reason, short-term mechanical circulatory support systems are increasing substantially. The objective of this article is to develop optimal and individualised care plans using the NANDA, NOC, NIC taxonomies. Clinical observation An evaluation based on Virginia Hendersońs basic needs was made, and two altered needs stood out: breathing and circulation. The patient required mechanical ventilation and mechanical circulatory support. Interventions In relation to the highlighted needs, six diagnoses were prioritized according to the NANDA taxonomy using the Análisis de Resultado del Estado Actual (AREA) (Outcome-Present State Test (OPT)) model: risk of decreased cardiac output, impaired spontaneous ventilation, impaired tissue integrity, risk of disuse syndrome, risk of infection and risk of hypothermia. Discussion and conclusions Outcome criteria scores showed a favourable evolution after 96h. The development of a standardized NANDA-NOC-NIC language allowed us to organize the nursing care plan. (AU)

Aprendizagem de estudantes de ensino médio sobre parada cardiorrespiratória e reanimação após treinamento teórico e prático / Learning from high school students about cardiorrespiratory stop and reanimation after theoretical and practical training / Aprendizaje de estudiantes de la escuela secundaria sobre la parada respiratoria cardiorial y la reanimación de animación post teórica y práctica

Objetivos: Verificar o conhecimento de estudantes do ensino médio sobre parada cardiorrespiratória e reanimação cardiopulmonar e avaliar o aprendizado de forma imediata e tardia após treinamento teórico e prático. Métodos: Estudo experimental longitudinal, prospectivo, quantitativo, realizado em uma instituição pública e uma privada, por meio de questionário sobre suporte básico de vida. A estatística foi descritiva e inferencial por Teste Friedman e Mann Whitney. Resultados: Os estudantes possuíam conhecimentos insuficientes, apresentando uma melhora significativa de forma imediata e tardia. As duas instituições apresentaram desempenho equivalente quanto aos acertos nos períodos pós-treinamento imediato e tardio. Os sinais de parada, manobras de reanimação e passos para utilização do desfibrilador externo tiveram menores índices de acertos. Conclusões: Após treinamento, os estudantes demonstraram conhecimento para atuar diante de uma parada cardíaca e reanimação cardiopulmonar. (AU)

Objective: To verify the knowledge of high school students about cardiopulmonary arrest and cardiopulmonary resuscitation and to evaluate learning immediately and late after theoretical and practical training. Methods: Longitudinal, prospective, quantitative experimental study, carried out in a public and a private institution, using a questionnaire on basic life support. The statistics were descriptive and inferential by the Friedman and Mann Whitney tests. Results: The students had insufficient knowledge, showing a significant improvement immediately and late. The two institutions had an equivalent performance in terms of correct answers in the immediate and late post-training periods. The stop signs, resuscitation maneuvers and steps to use the external defibrillator had lower success rates. Conclusion: After training, students demonstrated knowledge to act in the face of cardiac arrest and cardiopulmonary resuscitation. (AU)

Objetivo: Identificar los conocimientos previos de los estudiantes de secundaria sobre el paro cardiopulmonar y la reanimación cardiopulmonar y verificar el grado de aprendizaje inmediatamente y tarde después de la capacitación teórico-práctica. Métodos: Estudio experimental longitudinal, prospectivo, cuantitativo, realizado en una institución pública y privada, utilizando un cuestionario sobre soporte vital básico. Las estadísticas fueron descriptivas e inferenciales por las pruebas de Friedman y Mann Whitney. Resultados: Los estudiantes tenían conocimientos insuficientes, mostrando una mejora significativa inmediata y tardía. Las dos instituciones tuvieron un desempeño equivalente en términos de respuestas correctas en los períodos inmediatos y tardíos posteriores a la capacitación. Las señales de alto, las maniobras de reanimación y los pasos para usar el desfibrilador externo tuvieron tasas de éxito más bajas. Conclusión: Después del entrenamiento, los estudiantes demostraron conocimiento para actuar frente al paro cardíaco y la reanimación cardiopulmonar. (AU)

Mixed shock in patients with acute myocardial infarction: Nursing interventions.

INTRODUCTION AND OBJECTIVES: We present a clinical case of a 40-year-old woman diagnosed with acute myocardial infarction (AMI) in Killip I who was admitted to our hospital. She experienced complications in the haemodynamic lab and in the operating room, including cardiogenic and anaphylactic shock requiring ventricular assist support. Conservative management support with inotropes and vasopressors in cardiogenic shock has been shown to be insufficient in many patients to maintain adequate perfusion and prevent irreversible multiple organ dysfunction syndrome. For this reason, short-term mechanical circulatory support systems are increasing substantially. The objective of this article is to develop optimal and individualised care plans using the NANDA, NOC, NIC taxonomies. CLINICAL OBSERVATION: An evaluation based on Virginia Henderson's basic needs was made, and two altered needs stood out: breathing and circulation. The patient required mechanical ventilation and mechanical circulatory support. INTERVENTIONS: In relation to the highlighted needs, six diagnoses were prioritized according to the NANDA taxonomy using the Análisis de Resultado del Estado Actual (AREA) (Outcome-Present State Test (OPT)) model: risk of decreased cardiac output, impaired spontaneous ventilation, impaired tissue integrity, risk of disuse syndrome, risk of infection and risk of hypothermia. DISCUSSION AND CONCLUSIONS: Outcome criteria scores showed a favourable evolution after 96 h. The development of a standardized NANDA-NOC-NIC language allowed us to organize the nursing care plan.

Mixed shock in patients with acute myocardial infarction: Nursing interventions. / Shock mixto en paciente con infarto agudo de miocardio: intervenciones enfermeras.

INTRODUCTION AND OBJECTIVES: We present a clinical case of a 40-year-old woman diagnosed with acute myocardial infarction (AMI) in Killip I who was admitted to our hospital. She experienced complications in the haemodynamic lab and in the operating room, including cardiogenic and anaphylactic shock requiring ventricular assist support. Conservative management support with inotropes and vasopressors in cardiogenic shock has been shown to be insufficient in many patients to maintain adequate perfusion and prevent irreversible multiple organ dysfunction syndrome. For this reason, short-term mechanical circulatory support systems are increasing substantially. The objective of this article is to develop optimal and individualised care plans using the NANDA, NOC, NIC taxonomies. CLINICAL OBSERVATION: An evaluation based on Virginia Hendersons basic needs was made, and two altered needs stood out: breathing and circulation. The patient required mechanical ventilation and mechanical circulatory support. INTERVENTIONS: In relation to the highlighted needs, six diagnoses were prioritized according to the NANDA taxonomy using the Análisis de Resultado del Estado Actual (AREA) (Outcome-Present State Test (OPT)) model: risk of decreased cardiac output, impaired spontaneous ventilation, impaired tissue integrity, risk of disuse syndrome, risk of infection and risk of hypothermia. DISCUSSION AND CONCLUSIONS: Outcome criteria scores showed a favourable evolution after 96h. The development of a standardized NANDA-NOC-NIC language allowed us to organize the nursing care plan.

Subvalvular mitral aneurysm a rare pathology.

We present a rare and challenging case of left ventricular aneurysm in an African child with no history of previous infection or trauma, admitted for surgical treatment, who presented non reversible cardiorespiratory arrest with cardiorespiratory resuscitation before surgery.

A 5-Month-Old Infant with Cardiorespiratory Arrest Caused by Food Protein-Induced Enterocolitis Syndrome to Cow's Milk Proteins.

Food protein-induced enterocolitis syndrome (FPIES) is a nonimmunoglobulin E cell-mediated food allergy, which occurs predominantly in infants and young children. The most commonly incriminated triggers are cow's milk (CM), soy, and grains. Acute FPIES can be potentially life-threatening and culminate in shock requiring fluid resuscitation in at least 15% of the cases. To our knowledge, there have been no reports in literature of cardiorespiratory arrest induced by acute FPIES. We describe the first case of cardiorespiratory arrest occurred after accidental ingestion of a CM-based formula in a 5-month-old infant with previous diagnosis of FPIES to CM.

Protocolo de colocación de tubo laríngeo / Procedure in the placement of the laryngeal tube

Mundialmente el reconocimiento de la importancia de contar con una vía aérea permeable en una situación de emergencia o urgencia ha llegado a su punto máximo. Es por esto mismo que la búsqueda de alternativas a los métodos tradicionales para la obtención de esta misma, es un desafío para los profesionales de la salud. Se han descripto múltiples dispositivos para lograr este objetivo, dentro de los cuales se encuentra el tubo laríngeo, presentando diversas ventajas y mínimas desventajas, respaldado por distintos y variados estudios que han probado su eficiencia frente a otros dispositivos que tienen el mismo fin. El objetivo del presente trabajo es lograr la unificación del procedimiento en la colocación del tubo laríngeo por parte del personal Profesional de Enfermería[AU]

Globally, the recognition of the importance of having a permeable airway in an emergency or urgent situation has reached its peak. It is for this reason that the search for alternatives to traditional methods for obtaining it is a challenge for health professionals. Multiple devices have been described to achieve this objective, among which is the laryngeal tube, presenting various advantages and minimal disadvantages, supported by different and varied studies that have proven their efficiency against other devices that have the same purpose. The aim of the present work is to achieve the unification of the procedure in the placement of the laryngeal tube by the Professional Nursing staff[AU]

Globalmente, o reconhecimento da importância de ter uma via aérea permeável em uma situação de emergência ou urgência atingiu seu auge. É por isso que a busca por alternativas aos métodos tradicionais de obtenção é um desafio para os profissionais de saúde. Vários dispositivos têm sido descritos para atingir esse objetivo, entre os quais está o tubo laríngeo, apresentando diversas vantagens e desvantagens mínimas, amparados por diversos e variados estudos que comprovaram sua eficácia contra outros dispositivos com a mesma finalidade. O objetivo do presente trabalho é alcançar a unificação do procedimento na colocação da sonda laríngea pela equipe de profissionais de enfermagem[AU]

Postmortem diagnosis of PPA2-associated sudden cardiac death from dried blood spot in a neonate presenting with vocal cord paralysis.

Biallelic variants in inorganic pyrophosphatase 2 (PPA2) are known to cause infantile sudden cardiac failure (OMIM #617222), but relatively little is known about phenotypic variability of these patients prior to their death. We report a 5-wk-old male with bilateral vocal cord paralysis and hypertension who had a sudden unexpected cardiac death. Subsequently, molecular autopsy via whole-genome sequencing from newborn dried blood spot identified compound heterozygous mutations in PPA2, with a paternally inherited, pathogenic missense variant (c.514G > A; p.Glu172Lys) and a novel, maternally inherited missense variant of uncertain significance (c.442A > T; p.Thr148Ser). This report expands the presenting phenotype of patients with PPA2 variants. It also highlights the utility of dried blood spots for postmortem molecular diagnosis.

Desafíos de la reanimación cardiopulmonar avanzada en pacientes con la COVID-19 / Challenges in the advanced cardiopulmonary resuscitation in patients with the COVID-19

Con este trabajo se pretende complementar las normativas generales impuestas por las autoridades sanitarias cubanas en cuanto a la reanimación cardiopulmonar, donde es necesario hacer hincapié, desde el punto de vista individual, para lograr una correcta actuación frente a la COVID-19. La reanimación cardiopulmonar es una práctica que genera partículas en aerosol provenientes de la vía aérea, lo cual incrementa el riesgo de contagio por el nuevo coronavirus SARS-CoV-2. Para la confección del presente se consultaron las recomendaciones internacionales sobre el tema acerca de compresiones, ventilación, terapia eléctrica e incluso farmacológica en pacientes con paro cardiaco y diagnóstico de la COVID-19, a fin de lograr no solo el bienestar del paciente, sino también la seguridad del personal de salud.

With this work it is intended to supplement the general norms imposed by the Cuban sanitary authorities as for the cardiopulmonary resuscitation, where it is necessary to make stress, from the individual point of view, to achieve a correct performance in front of COVID-19. The cardiopulmonary resuscitation is a practice that generates particles in aerosol coming from the air ways, which increases the infection risk by the new coronavirus SARS-CoV-2. For the present work, the international recommendations were consulted on the topic about compressions, ventilation, electric and even pharmacological therapy in patients with cardiac arrest and diagnosis of COVID-19, in order to achieve not only the patient's well-being, but also the security of the health staff.

[Effectiveness of practical theoretical teaching in high-school about cardiopulmonary resuscitation.] / Eficacia de la enseñanza teórico-práctica en institutos de reanimación cardiopulmonar.

OBJECTIVE: Cardiovascular diseases is one of the most important health problems among population. Most preventable deaths which take place in a context different from the hospital are related to coronary heart diseases. Training the population in cardiopulmonary resuscitation (CPR) may well result in an increase in the survival rate before a cardiorespiratory arrest. METHODS: An observational study -both prospective and analytical- was conducted through a sample of students in the fourth year of compulsory secondary education. They were divided in two groups: a first group was trained with a theoretical-practical course on CPR, the second group only a theoretical course on CPR. Three surveys on CPR knowledge were conducted, the first one prior to a CPR course, the second one after the course and the third carried out two months after completing it. The results were compared between the three surveys to examine the degree of acquisition and maintenance of knowledge. RESULTS: 326 students, 213 theoretical-practical group and 113 theoretical group, whose average age was 15.6 years (DE=0.7, R 15-17) and 56% were girls. The average scores of the questionnaires were: 5.1 points (DE=1.8, R 0-10) on first exam, 8.2 points (DE=1.6, R 3-10) on second exam of the theoretical-practical group versus 7.7 points (DE=1.9, R 0-10) of the theoretical group, and 7.2 points (DE=3.8, R 1-10) on third exam. In the first exam, 5.2% of them knew the frequency of chest compressions and ventilations in CPR, improving to 68.1% in the second questionnaire of the theoretical-practical group, and a 79.6% of the theoretical group. CONCLUSIONS: Increased knowledge in cardiopulmonary resuscitation reflect in an increase of 3.1 points of average after the theoretical-practical sessions and in 2.1 points two months later. The theoretical-practical group obtain a better score in the post-course exam (8.2 points) compared to the theoretical group (7.7 points).

OBJETIVO: Las enfermedades cardiovasculares constituyen uno de los problemas de salud más importantes para la población. La mayoría de las muertes evitables se deben a enfermedades coronarias en el medio extrahospitalario. Formar a la población sobre la reanimación cardiopulmonar (RCP) supone un aumento de la tasa de supervivencia ante una parada cardiorrespiratoria. METODOS: Se realizó un estudio observacional, prospectivo y analítico, en una muestra de alumnos de cuarto curso de Educación Secundaria Obligatoria a los que se dividió en dos grupos. A un primer grupo se les realizó un curso teórico-práctico sobre RCP; al segundo grupo, un curso solo teórico de RCP. Se realizaron tres cuestionarios sobre conocimiento de RCP: el primero, previo al curso; el segundo, tras el curso; y el tercero, a los dos meses de finalizar el curso. Se compararon los resultados entre los cuestionarios para analizar el grado de adquisición y mantenimiento de conocimientos. RESULTADOS: Se seleccionó una muestra de 326 alumnos, 213 en el grupo teórico-práctico y 113 en el teórico. La edad media fue de 15,6 años (DE=0,7, R 15-17) y el 56% eran niñas. La puntuación media de los cuestionarios fue: primer cuestionario, 5,1 puntos (DE=1,8, R 0-10); segundo cuestionario, en el grupo teórico-práctico 8,2 puntos (DE=1,6, R 3-10) frente al grupo teórico con 7,7 puntos (DE=1,9, R 0-10); y tercer cuestionario, 7,2 puntos (DE=1,8, R 1-10). En el primer cuestionario, un 5,2% conocían la frecuencia de las compresiones torácicas y ventilaciones en la RCP, mejorando al 68,1% en el segundo cuestionario en el grupo teórico-práctico, y un 79,6% en el grupo teórico. CONCLUSIONES: Tras el curso teórico-práctico sobre RCP, aumenta en 3,1 puntos la nota media en los cuestionarios de conocimientos en RCP, y en 2,1 puntos tras dos meses de la realización del curso. El grupo teórico-práctico obtiene una puntuación mejor en la encuesta poscurso (8,2 puntos) respecto al grupo teórico (7,7 puntos).

Paro cardiorrespiratorio por electrocución tratado con éxito extrahospitalariamente / Cardiorespiratory Arrest Caused by Electrocution Successfully Treated in an Extra-Hospital Situation / Parada cardiorrespiratória por eletrocussão tratada com sucesso de maneira extra-hospitalar

Resumen Introducción: son pocos los datos documentados sobre los resultados de la reanimación cardiopulmonar en el paro cardiorrespiratorio extrahospitalario por causa de electrocución. El paro cardiorrespiratorio se produce cuando una descarga eléctrica interrumpe de forma abrupta la actividad eléctrica normal del corazón, lo que genera una electrocución y una alteración en los movimientos cardiacos y, por consiguiente, bombeo anormal de sangre y oxígeno a los tejidos. Ello constituye una emergencia clínica que puede ocasionar nefastas consecuencias de no tomarse medidas enérgicas e inmediatas. Presentación del caso: hombre con paro cardiorrespiratorio producido por electrocución y manejado en un ámbito extra-hospitalario, quien respondió con éxito a las maniobras aplicadas. Personal técnico y de salud iniciaron precozmente la reanimación cardiopulmonar y luego fue reforzada por personal médico, que aplicó desflbrilación en dos ocasiones con desflbrilador externo automático (DEA). Con ello se logró recuperar los signos vitales del paciente y trasladarlo a un centro asistencial para continuar su manejo intrahospitalario. Conclusión: la realización de una reanimación precoz y la desfibrilación de pacientes electrocutados, así como las medidas encaminadas a la protección del cerebro, son la norma prioritaria en la asistencia pre-hospitalaria de estos pacientes, quienes son potencialmente recuperables. Por tal razón, es importante que la comunidad, en general, esté preparada y que el personal de salud se reentrene en soporte vital básico, que incluye el manejo del DEA para dar oportunidad de sobrevivir a personas que sufran un paro cardiorrespiratorio extrahospitalario.

Abstract Introduction: There are few the documented data about the cardiopulmonary resuscitation results in the cardiorespiratory arrest extra-hospital due to the electrocution. The cardiorespiratory arrest occurs when the heart's normal electrical activity is abruptly interrupted by electric shocks generated by electrocution, causing the disturbance in the cardiac movements and, consequently, abnormal pumping of blood and oxygen to the tissues. The cardiorespiratory arrest due to electrocution is one clinic emergency that can cause disastrous consequences, if energetic measures are not taken immediately. Case presentation: A man with cardiorespiratory arrest produced by electrocution and managed in an extra-hospital area, who responded successfully to the maneuvers applied. The cardiopulmonary resus-citation maneuvers were precociously started by the health technical staff; next, reinforced by medical it, applying the defibrillation on two occasions, with external automatic defibrillator (AED), recovering the patient's vital signs and allowing his transfer to a healthcare center to continue in-hospital management. Conclusion: The performing of early resuscitation and defibrillation of electrocuted patients, as well as the measures aimed at protecting the brain, are the priority rules in the pre-hospital scene of these patients, who are potentially recoverable. For this reason, it is important that the community, in general, be ready, and the health staff gets trained in basic vital support that includes the management of AED to give the opportunity of surviving to people that suffer a cardiorespiratory arrest.

Resumo Introdução: são poucos os dados documentados sobre os resultados da reanimação cardiopulmonar na parada cardiorrespiratória extra-hospitalar por causa de eletrocussão. A parada cardiorrespiratória se produz quando a atividade elétrica normal do coração é interrompida abruptamente pela descarga elétrica que gera a eletrocussão causando alterado nos movimentos cardíacos e por conseguinte bombeamento anormal de sangue e oxigeno aos tecidos. A parada cardiorrespiratória causada por eletrocussão é uma emergência clínica que pode ocasionar nefastas consequências, de não tomar medidas enérgicas e imediatas. Apresentação do caso: homem com parada cardiorrespiratória, produzida por eletrocussão e manejado em um âmbito extra-hospitalar, quem respondeu com sucesso ás manobras aplicadas. A rearrumação cardiopulmonar foi iniciada precocemente por pessoal técnico de saúde, posteriormente reforjadas por pessoal médico, aplicando a desfibrilação em duas ocasiões, com desfibrilador automático externo (DEA), recuperando os signos vitais do paciente e permitindo seu traslado e um centro assistencial para continuar manejo intra-hospitalar. Conclusão: a realizado de uma rearrumação precoce e desfibrilação de pacientes eletrocutados, assim como as medidas encaminhadas á proteção do cérebro, são a norma prioritária na assistência pré-hospitalar destes pacientes, os quais são potencialmente recuperáveis; por esta razão é importante que a comunidade, em geral, esteja preparada e que o pessoal de saúde se retreine em suporte vital básico que inclua o manejo do DEA para dar oportunidade de sobrevida a pessoas que sofram uma parada cardiorrespiratória extra-hospitalar.

[Recommendations on cardiopulmonary resuscitation in patients with suspected or confirmed SARS-CoV-2 infection (COVID-19). Executive summary]. / Recomendaciones sobre reanimación cardiopulmonar en pacientes con sospecha o infección confirmada por SARS-CoV-2 (COVID-19). Resumen ejecutivo.

The SARS-CoV-2 pandemic has created new scenarios that require modifications to the usual cardiopulmonary resuscitation protocols. The current clinical guidelines on the management of cardiorespiratory arrest do not include recommendations for situations that apply to this context. Therefore, the National Cardiopulmonary Resuscitation Plan of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), in collaboration with the Spanish Group of Pediatric and Neonatal CPR and with the Teaching Life Support in Primary Care program of the Spanish Society of Family and Community Medicine (SEMFyC), have written these recommendations, which are divided into 5 parts that address the main aspects for each healthcare setting. This article consists of an executive summary of them.