Manejo de la vía aérea ante un caso de paro respiratorio en un escenario clínico simulado. Experiencia en una residencia de pediatría / Airway management during a respiratory arrest in a clinical simulation scenario. Experience at a pediatric residency program

Introducción. La insuficiencia respiratoria es la causa más común de paro cardíaco en pediatría; su reconocimiento y el manejo adecuado son cruciales. La simulación se utiliza para mejorar las habilidades médicas. El objetivo del trabajo fue determinar la proporción de residentes de pediatría que reconocieron un paro respiratorio (PR) pediátrico en un centro de simulación. Métodos. Se realizó un estudio observacional con 77 médicos residentes. Se utilizó un caso simulado de un paciente con dificultad respiratoria que progresa a PR. Resultados. De los 77 participantes, 48 reconocieron el paro respiratorio (62,3 %). El tiempo medio para reconocer el PR fue de 34,43 segundos. Conclusión. El 62,3 % de los participantes logró reconocer el paro respiratorio. Entre aquellos que lo identificaron, el tiempo promedio fue de 34,43 segundos. Se observaron graves deficiencias en algunas de las intervenciones esperadas.

Introduction. Respiratory failure is the most common cause of cardiac arrest in pediatrics. Recognizing and managing it adequately is critical. Simulation is used to improve medical skills. The objective of this study was to establish the proportion of pediatric residents who recognized a respiratory arrest in a child at a simulation center. Methods. This was an observational study in 77 residents. A simulation of a patient with respiratory distress that progressed to respiratory arrest was used. Results. Among the 77 participants, 48 recognized respiratory arrest (62.3%). The mean time to recognize respiratory arrest was 34.43 seconds. Conclusion. Respiratory arrest was recognized by 62.3% of participants. Among those who did so, the average time was 34.43 seconds. Severe failures were noted in some of the expected interventions.

Análisis comparativo del conocimiento de RCP en legos y personal médico de una universidad y un hospital de Santo Domingo, República Dominicana, durante el período febrero-abril 2015 / Comparative Analysis of the Knowledge of CPR in Layman and Medical Staff of a University and Hospital of Santo Domingo, Dominican Republic, during the period February-April 2015

Introducción: el nivel de conocimiento en legos y personal médico incide en la calidad y eficacia de la Reanimación Cardiopulmonar (RCP). Objetivo: comparar el nivel de conocimiento y técnicas de RCP en legos y personal médico de una universidad y un hospital de Santo Domingo, República Dominicana, durante el período febrero-abril 2015. Material y métodos: fue un estudio prospectivo, experimental y de corte longitudinal en el que se evaluaron 30 legos de una universidad de Santo Domingo y 17 residentes de emergenciología de un hospital de la misma ciudad. Resultados: sin ninguna intervención 12 de 30 legos evaluados (40 %), tuvieron dominio del conocimiento básico de RCP. 12 de 17 (70.58 %), tuvieron un conocimiento básico de RCP. Por otra parte, tanto el 100 % de los residentes como de los legos presentaron un conocimiento acertado de RCP luego de la intervención. Conclusiones: el nivel de conocimiento en una población estudiantil antes de una intervención presentó valores menores en relación con un personal médico ya entrenado. Sin embargo, estos valores sufrieron un cambio luego de la intervención realizada a la población estudiantil provocando un aumento de los valores en la comparación con legos y personal médico

Introduction: The level of knowledge in laymen and medical personnel affects the quality and efficacy of Cardiopulmonary Resuscitation (CPR). Objective: Is to compare the level of knowledge and techniques of CPR in laymen and medical personnel of a university and a hospital in Santo Domingo, Dominican Republic, during the period February-April 2015. Material and Methods: This was a prospective, experimental and longitudinal cutting study in which 30 laymen from a university in Santo Domingo and 17 emergency residents from a hospital were evaluated. Results: Without intervention, 12 of 30 laypersons (40 %) had basic knowledge of CPR. 12 of 17 (70.58 %) had a basic understanding of CPR. On the other hand, both 100 % of the residents and the laymen, presented an accurate knowledge of CPR after the intervention. Conclusions: The level of knowledge in a student population before an intervention presented lower values in relation to a medical staff already trained. However, these values underwent a change after the intervention made to the student population causing an increase in the values in comparison with laymen and medical personnel

Review of code blue system and audit

Background: Code Blue systems are communication systems that ensure the most rapid and effective resuscitation of a patient in respiratory or cardiac arrest. Code blue was established in Bharati Hospital and Research Centre in Sept 2011 in order to reduce morbidity and mortality in wards. The aim of the study was to evaluate the current code blue system and suggest possible interventions to strengthen the system.Methods: It was retrospective observational descriptive study. The study population included all consecutive patients above the age of 18 years for whom code blue had been activated. Data was collected using code blue audit forms. The data was analysed using SPSS (Statistical Package for social sciences) software.Results: A total of 260 calls were made using the blue code system between September 2011 to December 2012. The most common place for blue code activation was casualty. The wards were next, followed by dialysis unit and OPD. The indications for code blue team activation were cardio-respiratory arrest (CRA) (88 patients, 33.84%), change in mental status (52 patients, 20%), road traffic accidents RTA (21, 8.07%), convulsions (29 patients 11.15%), chest pain (19 patients, 8.46%), breathlessness (18 patients,6.92%) and worry of staff about the patient (17 patients, 6.53%), presyncope (10 patients, 3.84%), and others (6 patients, 2.30%). The average response time was 1.58±0.96 minutes in our study. Survival rate was more in medical emergency group 46.15% than in CRA group 31.61%. Initial success rate was 35.2% and a final success rate was 34.6%.Conclusions: Establishment of code blue team in the hospital enabled us to provide timely resuscitation for patients who had “out of ICU” CRA. Further study is needed to establish the overall effectiveness and the optimal implementation of code blue teams. The increasing use of an existing service to review patients meeting blue code criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization.

Comparison of the effect of two different ways of cardiopulmonary resuscitation during cardiac arrest / 中国基层医药

Objective To compare the effect of two different types of cardiopulmonary resuscitation (CPR)in cardiac arrest.Methods 150 patients with cardiac arrest were selected.The patients were divided into two groups according to the random number table method,each group in 75cases.The patients in the control group were treated with CPR.The patients in the observation group were treated with CPR machine.The body temperature,hemoglobin concentration,hematocrit,arterial blood gas analysis and resuscitation were compared between the two groups after 10min and 30min.Results There were no statistically significant differences in body temperature,hemoglobin and hematocrit between the control group and the observation group at 10min and 30min after CPR (t10min =1.44,2.01,1.23,t30min =1.69,1.81,1.02,all P ＞ 0.05).There were no statistically significant differences in PaCO2 between the two groups at 10 min and 30 min after resuscitation (t =1.54,1.02,all P ＞ 0.05).The arterial blood pH[(7.02 ±0.14)],PaO2 [(16.29 ± 4.38) kPa],HCO3 [(5.66 ± 1.73) kPa] and SaO2 [(0.84 ± 0.05) ％] of the control group recovered 30 min were significantly lower than recovered 10 min (t =7.14,6.55,6.20,7.03,all P ＜ 0.05).The arterial blood pH[(7.11 ± 0.1)],PaO2 [(18.36 ± 4.55) kPa],HCO3 [(6.34 ± 2.15) kPa],SaO2 [(0.86 ±0.04) ％] of the observation group recovered 30 min were significantly lower than recovered 10 min (t =6.75,6.21,6.01,6.60,all P ＜0.05).The arterial blood pH,PaO2,HCO3 and SaO2 of the observation group were significantly higher than those in the control group at 10 min and 30 min,the differences were statistically significant (t10min =6.03,7.34,7.88,6.10,t30min =6.21,8.20,7.10,6.11,all P ＜ 0.05).The effective rate of CPR in the observation group was 69.33％,which was significantly higher than 46.67％ in the control group,the difference was statistically significant (x2 =9.34,P ＜ 0.05).Conclusion Compared with artificial heart and lung resuscitation,CPR machine is more effective for patients with heartbeat respiratory arrest.It is more effective in cycling support and can improve the efficacy of CPR and is worthy of clinical application.

Embolismo de líquido amniótico / Amniotic fluid embolism

Se valoró un caso de una femenina quien es internada por embarazo en vías de prolongación para inducción del mismo, posterior a su labor presenta sangrado transvaginal abundante por lo que es ingresada a sala de operaciones, no se le encuentra sitio de sangrado, le realizan histerectomía y fallece; es enviada para su respectiva autopsia, se determina como causa de muerte: embolismo de líquido amniótico. Este artículo pretende revisar la etiología de esta patología, fisiopatología, criterios diagnósticos del mismo, factores de riesgo, diagnósticos diferenciales y su tratamiento.

A case of a female who is hospitalized for pregnancy-way extension for induction thereof, after their work presents TVB abundant so it is entered into operating room were assessed, you will not find the bleeding site, we performed hysterectomy and dies; is sent to the respective autopsy determined the cause of death: amniotic fluid embolism. This article reviews the etiology of this pathology, pathophysiology, diagnostic criteria thereof, risk factors, differential diagnosis and treatment.

Critical illness in energy metabolism genetic disorder: rhabdomyolysis, acute kidney injury, respiratory arrest / Enfermedad crítica por trastorno genético en el metabolismo de la energía: rabdomiolisis, lesión renal aguda, paro respiratorio

In very long-chain acylCoA dehydrogenase deficiency (VLCAD), the activity of this enzyme is either reduced or absent with the inability to use long-chain fatty acids as energy substrates. A 25-year old male with VLCAD was admitted to the Emergency Department of Policlinico Teaching Hospital (Modena, Italy) for generalized weakness and oliguria, after a period of physical and mental stress and inadequate compliance to a long-chain fatty acid free diet. Laboratory tests were compatible with acute kidney injury. Seventy-two hours after admission, the subject had an episode of chest pain with elevated markers of myocardial necrosis. The rapid deterioration of muscular strength and the subsequent worsening respiratory failure necessitated ventilator support within the local Medical Intensive Care Unit. There, the patient showed a prompt normalization of respiratory parameters and a steady improvement of renal function. An inadequate compliance to lifestyle and dietary restriction in VLCAD may trigger severe and potentially lethal crisis. The in-hospital management of these patients calls for early intensive care admission as their conditions may deteriorate without warning.

En el caso de deficiencia de acylCoA deshidrogenasa de cadena muy larga (VLCAD), o bien se reduce la actividad de esta enzima, o la misma se halla ausente con la consiguiente incapacidad para utilizar los ácidos grasos de cadena larga como sustratos de energía. Un hombre de 25 años fue ingresado con VLCAD fue admitido en el Departamento de emergencia del Hospital Policlínico Docente Hospital de Modena, en Italia, a causa de presentar debilidad generalizada y oliguria, después de un período de estrés físico y mental, y por no cumplir adecuadamente con una dieta libre de ácidos grasos de cadena larga. Las pruebas de laboratorio eran compatibles con una lesión renal aguda. Setenta y dos horas después de su ingreso, el sujeto tuvo un episodio de dolor en el pecho con marcadores elevados de necrosis miocárdica. El rápido deterioro de la fuerza muscular, y el posterior empeoramiento de la insuficiencia respiratoria requirieron el apoyo de un ventilador en la Unidad de Cuidados Médicos Intensivos. Una vez allí, el paciente mostró una pronta normalización de los parámetros respiratorios, y una constante mejoría de la función renal. Un inadecuado cumplimiento con las restricciones dietéticas y el estilo de vida en los casos de VLCAD, pueden desatar una crisis grave y potencialmente fatal. El tratamiento intrahospitalario de estos pacientes requiere un ingreso temprano en cuidados intensivos, ya que sus condiciones pueden deteriorarse sin previo aviso.

Acute toxicity of Bisphenol A in rats.

Bisphenol A (BPA), an estrogenic compound, is used in manufacturing plastics and is known to produce toxic effects on various systems in man and animals. Since the use of plastics in day-to-day life is increasing, exposure to BPA will also increase. Therefore, this study was undertaken to determine the median lethal dose (LD50) of BPA via intraperitoneal and intravenous route in adult rats (by Dixon’s up and down method) and also to know the acute systemic changes (in blood pressure, respiration and ECG) produced by lethal dose of BPA. Adult female albino rats of Charles Foster strain were used in the study. LD50 of BPA was 841 and 35.26 mg/kg body weight for ip and iv route, respectively. Injection of lethal dose of BPA (40 mg/kg body weight) produced acute toxicity manifesting as immediate respiratory arrest and hypotension after the injection of BPA followed by bradycardia. The animals died within 7.3 ± 0.7 min. Volume of ethanol (vehicle; 0.1 mL) present in the lethal dose of BPA was not lethal and had no effect on respiration, blood pressure and heart rate. The results provide evidence that the acute exposure to BPA produces lethality with a very narrow range of lethal and survival dose for iv route. Further, the lethality appears to be due to respiratory arrest and hypotension.

Controlled transient respiratory arrest along with rapid right ventricular pacing for improving balloon stability during balloon valvuloplasty in pediatric patients with congenital aortic stenosis - A retrospective case series analysis.

Rapid right ventricular pacing is safe, effective, and established method to provide balloon stability during balloon aortic valvuloplasty (BAV). Controlled transient respiratory arrest at this point of time may further reduce left ventricular stroke volume, providing an additional benefit to maintain balloon stability. Two groups were studied. Among the 10 patients, five had rapid pacing alone (Group A), while the other five were provided with cessation of positive pressure breathing as well (Group B). The outcomes of BAV in the two groups of patients were studied. One patient in Group A had failed balloon dilatation even after the fourth attempt, while in Group B there were no failures. The peak systolic gradient reduction was higher in Group B (70.05% in comparison to 52.16% of group A). In Group A, five subjects developed aortic regurgitation (grade 2 in four and grade 3 in one, while no grade 3 aortic regurgitation developed in any patient in Group B). Controlled transient respiratory arrest along with rapid ventricular pacing may be effective in maintaining balloon stability and improve the outcome of BAV.

Respiratory Arrest due to Tension Pneumoperitoneum and Pneumomediastinum without Pneumothorax: Complication of the Lumbar Spinal Surgery

The authors present a case of respiration arrest after posterior lumbar interbody fusion. This rare complication occurred because of the tension pneumoperitoneum and pneumomediastinum. We report the pathophysiology and treatments.

Acute Respiratory Arrest and Brain Sequale Ocurred after General Anesthesia in Diabetic Autonomic Neuropathy Patient: A Case Report / 대한구급학회지

The incidence of autonomic neuropathy is high in diabetic patients. Cardiovascular complications including sudden cardiorespiratory arrest, bradycardia, hypotension can occur in diabetic patients complicated with autonomic neuropathy. The causes of sudden deaths in diabetics may not always be due to silent myocardial infarction but may also be due to autonomic neuropathy. Patients with diabetic autonomic neuropathy are less able to withstand hypoxia compare to normal people due to sympathetic nerve system damage. We present a case of acute respiratory arrest that occured in a 38 years old diabetic autonomic neuropathy patient after general anesthesia. Even though the patient was carried rapid and adequate airway management within 5 minutes, the patient had severe brain sequale. We conclude that the diabetic autonomic neuropathy patients require more careful monitoring and management for the hypoxia and cardiovascular status because they are more sensitive in hypoxia.

Sudden Respiratory Arrest after Surgery for Cerebellar Cystic Astrocytoma

The authors experienced a case of cystic cerebellar astrocytoma which showed sudden respiratory arrest after an uneventful operation. Preoperative cerebrospinal fluid diversion was not performed despite moderate hydrocephalus because we thought that complete removal of tumor enables the cerebrospinal fluid pathway to be reconstitute. After full awakening from anesthesia postoperatively, the patient's mentality deteriorated again rapidly with sudden respiratory arrest. Brain CT scan taken immediately after revealed no specific finding except moderate hydrocephalus which was the same degree as the preoperative one. This hydrocephalus was alleviated and the patient recovered slowly. We postulate several pathogenic mechanisms for this unusual event. First, chronic compression of fourth ventricle resulted in marked subependymal gliosis and obliteration of outlets of fourth ventricle. Therefore, postoperative reaccumlation of cerebrospinal fluid in ventricles caused serious pressure effect on the lower brain stem with resultant sudden respiratory arrest. Second, sudden decompression of brain stem might induce marked hemodynamic change in the brain stem. Third, there was some traction injury to brain stem by gravity in the sitting position. We suggest that preoperative cerebrospinal fluid diversion and its adeqaute postoperative maintenance is important in posterior fossa tumor surgery in cases with obliteration of perimesencephalic cistern and fourth ventricle, and with brain stem compression or angulation in preoperative magnetic resonance images.