[Tremor and epidural anesthesia]. / Temblores y anestesia epidural.

To evaluate the influence of temperature of the injected anesthetic solution on the development of tremor during epidural anesthesia, 66 patients divided in three homogeneous groups were evaluated: group I (n = 22; bupivacaine 4 degrees C), group II (n = 24; bupivacaine 20 degrees C), and group III (n = 24; bupivacaine 37 degrees C). The incidence of tremor was 20% (4 patients) in group I, 9% (2 patients) in group II and 12.5% (3 patients) in group III. No significant differences were found between the groups. The overall incidence was 13.6%. The epidural injection of 5 ml of saline at 37 degrees C achieved the attenuation and/or disappearance of tremor in three (3/4) group I patients (4 degrees C) and in one (1/3) group III patient (37 degrees C), whereas it was ineffective in one patient from group I and one from group III. In the two patients from group II (20 degrees C) and in one from group III (37 degrees C), tremor was self-limited. We conclude that the incidence of tremor during epidural anesthesia is not correlated with the temperature of anesthetic solutions, and that the epidural injection of saline at 37 degrees C may give some therapeutic benefit.

[Geriatric physical performance assessment in an emergency department]. / Valoración geriátrica de la función física en un Servicio de Urgencias.

BASIS: Premorbid situation with regard to daily life activities is an important prognostic factor in elderly people who needs medical care. This work analyzes the way the parameter evaluation of core processes of daily life (CPDL) is made in patients over 70 years cared in an Emergency Service because of diverse medical conditions. PATIENTS AND METHODS: A prospective study, carried out in a third level medical institution, on 200 patients over 70 years cared in the Emergency medical Service, with questioning a group of 60 physicians on duty (POD) about the informal or subjective assessments of five parameters of CPDL (to get dressed, to be fed, sphincter control, walking, and transfer). POD evaluation is compared with evaluation carried out formally by the research physician. Assessments are evaluated, grouping the patients according to the degree of dependency, age, or sex. RESULTS: 82% of most dependent patients and 53% of those older than 80 years were poorly assessed, and both parameters were statistically significant. The analysis with multiple linear regression showed that the intensity of these errors is only determined by a variable: the greater degree of dependency. CONCLUSIONS: Correct performance assessment of elderly patients in emergency services, especially of those older and most dependent, requires a specific training of professionals in this regard and the use of formal instruments of evaluation.

Geriatrización de los Servicios de Urgencias / Geriatrization of Emergency Services

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Valoración geriátrica de la función física en un Servicio de Urgencias / Geriatric physical performance assessment in an emergency department

Fundamento. Entre la población anciana que precisa atención médica, la situación premórbida, respecto a las actividades de la vida diaria, tiene un importante factor pronóstico. Este trabajo analiza cómo se realiza la evaluación de parámetros de actividades básicas de la vida diaria en pacientes de más de 70 años que acuden por patología médica a un Servicio de Urgencias. Pacientes y métodos. Estudio prospectivo, realizado en un hospital de tercer nivel, con 200 pacientes de más de 70 años atendidos en el Servicio de Urgencias médicas, interrogando a un grupo de 60 médicos de guardia de medicina las valoraciones informales o subjetivas de 5 parámetros de actividades básicas de la vida diaria (vestirse, alimentarse, control de esfínteres, deambulación y transferencias). Se compara la evaluación de los médicos de guardia con la realizada de manera formal por el médico investigador. Se evalúan las valoraciones, agrupando a los pacientes según el grado de dependencia, edad o sexo. Resultados. El 82% de los pacientes con más dependencia y el 53% de los mayores de 80 años estaban mal valorados; ambos hallazgos eran estadísticamente significativos. El análisis con regresión lineal múltiple detecta que la gravedad de dichos errores sólo está determinada por una variable: el mayor grado de dependencia. Conclusiones. La correcta valoración funcional de los pacientes ancianos en los servicios de urgencias, especialmente de los más mayores y más dependientes, exige la formación de los profesionales en este sentido y el uso de instrumentos formales de evaluación (AU)

Basis. Premorbid situation with regard to daily life activities is an important prognostic factor in elderly people who needs medical care. This work analyzes the way the parameter evaluation of core processes of daily life (CPDL) is made in patients over 70 years cared in an Emergency Service because of diverse medical conditions. Patients and methods. A prospective study, carried out in a third level medical institution, on 200 patients over 70 years cared in the Emergency medical Service, with questioning a group of 60 physicians on duty (POD) about the informal or subjective assessments of five parameters of CPDL (to get dressed, to be fed, sphincter control, walking, and transfer). POD evaluation is compared with evaluation carried out formally by the research physician. Assessments are evaluated, grouping the patients according to the degree of dependency, age, or sex. Results. 82% of most dependent patients and 53% of those older than 80 years were poorly assessed, and both parameters were statistically significant. The analysis with multiple linear regression showed that the intensity of these errors is only determined by a variable: the greater degree of dependency. Conclusions. Correct performance assessment of elderly patients in emergency services, especially of those older and most dependent, requires a specific training of professionals in this regard and the use of formal instruments of evaluation (AU)