Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias最新文献

{"title":"Should we banish morphine from the treatment of acute pulmonary oedema?","authors":"Miguel Lorenzo, Julio Núñez-","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"4-5"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9112415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality risk model validation in a prospective cohort of patients from the sixth wave of the COVID-19 pandemic in a hospital emergency department.","authors":"Leticia Fresco, Gina Osorio, Daniel N Marco, Lourdes Artajona, Dora Sempertegui, Daniela Piñango, Natalija Demidenoka, Julia García-Gozalbes, Míriam Carbó, Milagrosa Perea, Mª Del Mar Ortega Romero","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To validate risk factors for mortality in patients treated for COVID-19 in a hospital emergency department during the sixth wave of the pandemic.</p><p><strong>Material and methods: </strong>Prospective observational noninterventional study. We included patients over the age of 18 years with a confirmed diagnosis of COVID-19 between December 1, 2021, and February 28, 2022. For each patient we calculated a risk score based on age 50 years or older (2 points) plus 1 point each for the presence of the following predictors: Barthel index less than 90 points, altered level of consciousness, ratio of arterial oxygen saturation to fraction of inspired oxygen less than 400, abnormal breath sounds, platelet concentration less than 100 × 109/L, C-reactive protein level of 5 mg/dL or more, and glomerular filtration rate less than 45 mL/min. The model was assessed with the area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Of the 1156 patients included, 790 (68%) had received at least 2 vaccine doses. The probability of 30-day survival was 96%. A risk score was calculated for 609 patients. Four hundred seventeen patients were at low risk of death, 180 were at intermediate risk, and 10 were at high risk. The probability of death within 30 days was 1%, 13%, and 50% for patients in the 3 risk groups, respectively. The sensitivity, specificity, and positive and negative predictive values of a risk score of 3 points or less were 88%, 72%, 19%, 99%, respectively.The AUC for the model was 0.87.</p><p><strong>Conclusion: </strong>The risk model identified low risk of mortality and allowed us to safely discharge patients treated for COVID-19 in our tertiary-care hospital emergency department.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"15-24"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine detection in urine samples from patients poisoned by recreational drugs: epidemiologic, clinical, and toxicologic profiles.","authors":"Isabel Gomila Muñiz, Juan Ortega Pérez, Jordi Puiguriguer Ferrando, Jesús González, Gaspar Tuero León, Bernardino Barceló Martín","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the epidemiologic, clinical, and toxicologic profiles of patients who used recreational ketamine and experienced acute poisoning.</p><p><strong>Material and methods: </strong>Retrospective observational study of patients attended by several emergency medical services in the Balearic Islands for analytically confirmed acute poisoning after using ketamine between January 2016 and December 2020. Urine samples were analyzed by immunoassay and combined gas chromatography and mass spectrometry.</p><p><strong>Results: </strong>One hundred twenty-two patients were studied. The mean (SD) age was 26.7 (6.5) years. The majority were men (77.9%) and not residents of the Balearic Islands (74.6%). Poisoning cases occurred mainly in the summer and in the island of Ibiza (84.4%). Ketamine use was declared by the patient or clinically suspected in 40.2%. The most common clinical signs were tachycardia (43.4%), hypertension (28.7%), mydriasis (27.0%), altered consciousness (25.4%), agitation/aggressiveness (25.4%), and hypothermia (21.3%). Seven patients (5.73%) required admission to the intensive care unit. The drugs most often detected along with ketamine were cocaine, in 93.4%, and 3,4-methylenedioxymethamphetamine (MDMA), in 78.7%. Multiple-drug use combining ketamine, cocaine, and MDMA, or on occasion additional substances, was detected in 98.4%.</p><p><strong>Conclusion: </strong>Detection of ketamine in urine samples from patients poisoned by recreational drugs is associated with a characteristic profile: young men who are not residents of the Balearic Islands, who attend electronic music concerts, and who have taken multiple drugs. A substantial percentage of such patients are unaware of drug intake.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"6-14"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of assessing risk for a poor COVID-19 outcome in the post-vaccination era.","authors":"Juan González Del Castillo","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From hell to paradise.","authors":"Julia Villalobos Santos","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"72-73"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10690207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On reseaarach in emergency medicine: good intentions vs reality.","authors":"José Ignacio Ruiz Azpiazu, Fernando Rosell-Ortiz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"80"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9457210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Guadalajara Declaration on sepsis: emergency physicians' constructive comments on the Surviving Sepsis Campaign's 2021 updated guidelines.","authors":"Agustín Julián-Jiménez, Luis Antonio Gorordo-Delsol, Graciela Merinos-Sánchez, Diego Armando Santillán-Santos, Fabián Andrés Rosas Romero, Daniel Sánchez Arreola, Jesús Daniel López Tapia, Manuel José Vázquez Lima, Darío Eduardo García, Juan González Del Castillo, Edgardo Menéndez, Pascual Piñera Salmerón, Francisco Javier Candel González, Rafael Rubio Díaz, Ricardo Juárez González","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Text: </strong>The Surviving Sepsis Campaign (SSC) published a 2021 update of its 2016 recommendations. The update was awaited with great anticipation the world over, especially by emergency physicians. Under the framework of the CIMU 2022 (33rd World Emergency Medicine Conference) in Guadalajara, Mexico in March, emergency physiciansreviewed and analyzed the 2021 SSC guidelines from our specialty's point of view. In this article, the expert reviewers present their consensus on certain key points of most interest in emergency settings at this time. The main aims of the review are to present constructive comments on 10 key points and/or recommendations in the SSC 2021 update and to offer emergency physicians' experience- and evidence-based proposals. Secondarily, the review's recommendations are a starting point for guidelines to detect severe sepsis in emergency department patients and prevent progression, which is ultimate goal of what has become known as the Guadalajara Declaration on sepsis.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"53-64"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving emergency department care of infants with acute bronchiolitis by reducing the use of unrecommended drugs: a quality-of-care initiative in a Spanish autonomous community.","authors":"David Andina Martínez, Rosa María Calderón Checa, Clara Ferrero García Loygorri, Yago Arnaiz Diumenjo, Raquel Porto Abal, Cristina Muñoz López, Ana Barrios Tascon, María Rodríguez Mesa, Diego Bautista Lozano, Almudena Lagares Velasco, María Belén Hernández Rupérez, Hemir David Escobar Pirela, Alberto Sánchez Calderón, Esther Casado Verrier, Carlos Rivas Crespo, Shaila Prieto Martínez, Sara Ruiz González, Belén Joyanes Abancens, María García Baro Huarte, María Ángeles García Herrero, Rebeca Villares Alonso, Sinziana Stanescu, Rubén Moreno Sánchez, Carmen Sara Gallego Fernández, Mercedes De la Torre Espi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis.</p><p><strong>Material and methods: </strong>Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started.</p><p><strong>Results: </strong>A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001).</p><p><strong>Conclusion: </strong>The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"31-38"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9457208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune thrombotic thrombocytopenic purpura: clinical suspicion and basic management in emergency departments - an expert review and consensus statement from the Spanish societies of hematology and hemotherapy (SEHH) and emergency medicine (SEMES).","authors":"Cristina Pascual-Izquierdo, Pascual Piñera Salmerón, Francisco Temboury Ruiz, David Valcárcel Ferreiras, Sonia Jiménez Hernández, Ramón Salinas Argente, Carmen Del Arco Galán, Javier de la Rubia Comos","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Text: </strong>Acquired or immune thrombotic thrombocytopenic purpura (TTP) are thrombotic microangiopathies associated with high mortality if treatment is not started early. Onset is usually sudden, meaning that the condition is often diagnosed in hospital emergency departments, where TTP must be suspected as early as possible. These guidelines were drafted by specialists in emergency medicine and hematology to cover the diagnosis, referral, and treatment of patients suspected of immune-mediated TTP who require emergency care. Immune TTP should be suspected whenever a patient presents with hemolytic microangiopathy and has a negative Coombs test, and thrombocytopenia, possibly in conjunction with fever and neurologic and cardiac alterations. If one of the existing diagnostic algorithms indicates there is a high probability that the patient has immune TTP, plasma exchange therapy should be started along with immunosuppressants. Treatment with caplacizumab should also be considered. The patient should be referred immediately to the hematology department within the same hospital or a referral hospital.</p>","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"44-52"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9112418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical management of accidental hypothermia.","authors":"Robert Blasco Mariño, Iñigo Soteras Martínez","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11644,"journal":{"name":"Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias","volume":"35 1","pages":"69-71"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}