ABSTRACT
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
Subject(s)
Airway Management , Humans , Airway Management/standards , Airway Management/methods , Emergency Medicine/standards , Adult , Intubation, IntratrachealABSTRACT
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
Subject(s)
Airway Management , Humans , Airway Management/standards , Airway Management/methods , Emergency Medicine/standards , Adult , Intubation, IntratrachealABSTRACT
OBJECTIVE: Our aim was to reach expert consensus on specific learning outcomes (LOs) that can be achieved through clinical simulation aimed at developing the competencies that medical students need to be able to successfully manage patients and assume general clinical responsibilities. MATERIALS AND METHODS: The six-member scientific committee peer-reviewed Spanish reference documentation (in line with the Bologna Process) on required competencies in medical undergraduate students to select an initial set of 16 competencies that could feasibly be developed through simulation and a corresponding set of 75 LOs. Snowball sampling was used to identify candidates for an international panel of simulation experts. Applying a set of pre-defined criteria, 19 panelists from seven Spanish-speaking regions were recruited to participate in a modified two-round Delphi procedure based on electronic questionnaires and aimed at reaching formal consensus on appropriate LOs for simulated medical training. RESULTS: Final agreement between the panelists was high: no mean score fell below 7.26 of a maximum of 9, and all 75 LOs were agreed on, 74 in the first round and only one requiring the second round. The 16 LOs with mean scores in the top 25th percentile were selected as a set of core LOs to attain via simulation. CONCLUSIONS: This Ibero-American consensus on observable and measurable LOs, reflecting competencies that can feasibly be developed via clinical simulation, is a framework that aims at helping medical schools' plans and delivering specific kinds of undergraduate medical training through simulation. It is also proposed in a set of core LOs as a starting point for less experienced schools to design a simulated training program.
Subject(s)
Education, Medical, Undergraduate , Students, Medical , Clinical Competence , Consensus , Delphi Technique , HumansABSTRACT
La capnografía es una monitorización no invasiva complementaria a la pulsioximetría, ya que esta valora la oxigenación, y mediante la capnografía se analiza la ventilación del paciente, midiendo el dióxido de carbono exhalado. Además, puede valorar la perfusión y el metabolismo del paciente en algunos casos. La capnografía se emplea desde hace más de 30 años para monitorizar al paciente intubado en el quirófano, donde es estándar de atención. El avance tecnológico ha permitido desarrollar capnógrafos portátiles fáciles de usar que ofrecen lecturas precisas tanto en pacientes intubados como con ventilación espontánea. Estos capnógrafos se están empezando a emplear en los servicios de emergencia médica (SEM) de España en los últimos años. La presente revisión bibliográfica ofrece una visión actual de la capnografía para colaborar en la formación de los profesionales sanitarios en esta monitorización de la ventilación que se encuentra en pleno surgimiento en los SEM españoles (AU)
Capnography is a non-invasive monitoring technique used in conjunction with pulse oximetry since the latter measures oxygenation whereas capnography is used to assess the patient¿s ventilation by measuring exhaled carbon dioxide. In some cases, it can also be used to measure the patient¿s perfusion and metabolism. Capnography has been used for over 30 years to monitor intubated patients during surgery where it is seen as a standard of care. Technological advances have led to the development of easy-to-use, portable capnographs that provide accurate readings both for intubated and spontaneously breathing patients. Over recent years, Emergency Medical Services (EMS) in Spain have begun using these capnographs. This bibliographical review offers a current overview of capnography that can be used to train healthcare professionals in the use of this ventilation monitoring technique, which is rapidly emerging in Spanish EMS (AU)
Subject(s)
Female , Humans , Male , Capnography/ethics , Capnography/instrumentation , Ambulatory Care , Ambulatory Care/methods , Societies/ethics , Societies/policies , Clinical Clerkship , Clinical Clerkship/methods , Technology, Radiologic , Technology, Radiologic/methods , Capnography/nursing , Capnography , Ambulatory Care/psychology , Ambulatory Care , Societies/classification , Societies/prevention & control , Clinical Clerkship/ethics , Clinical Clerkship/standards , Technology, Radiologic/instrumentation , Technology, Radiologic/standardsABSTRACT
En esta investigación se estudian los aspectos psicológicos y fisiológicos relacionados con la muerte y con la parada cardiorrespiratoria. Se aporta un protocolo psicológico de estimulación verbal para aplicarlo al sujeto, durante la reanimación de su parada cardiorrespiratoria y los datos preliminares sobre la eficacia de dicha intervención, con una muestra de 30 pacientes, que presentaban una parada cardiorrespiratoria extrahospitalaria. Los resultados obtenidos aconsejan continuar con la investigación aumentando la muestra de sujetos. (AU)
