Evaluación de las cargas de enfermería en la atención del intoxicado en un servicio de urgencias / Assessment of the nursing burden in the care of intoxicated patients in the emergency department

Objetivos: Medir la intensidad de los cuidados enfermeros que precisan los intoxicados que acuden a Urgencias. Método: Durante cuatro meses se registraron los intoxicados remitidos a Urgencias y se seleccionó un subgrupo en el que se midieron los tiempos consumidos por enfermería en cada una de las actividades asistenciales. Resultados: Se registraron 155 intoxicados. La intoxicación medicamentosa fue más frecuente en días laborables (p < 0.05) y la alcohólica en los no laborables (p < 0.05). Al 72 % se les realizó una extracción de sangre y al 55 % de orina para identificar la presencia de tóxicos. Al 79 % se le administró alguna medicación y al 25% carbón activado. El consumo de tiempo en la comunicación verbal fue mayor en el grupo intoxicado con fármacos (p < 0.001). Conclusiones: La ingesta de fármacos ha sido la intoxicación atendida con mayor frecuencia, en particular en días laborables. El intoxicado por medicamentos es el que requiere más tiempo de comunicación verbal

Objectives: To describe and measure the intensity of nursing care in intoxicated patients attended by different levels of emergency care, depending on the day of admission and type of poison involved. Methods: Observational, cross-sectional, descriptive study. For four months, patients referred to the emergency department for acute poisoning were recorded. Of the total patients, a subgroup in which the nursing time used in each activity of the care process were measured was selected. Epidemiological variables (sex, age, date and time of admission to the emergency room), toxicology (type of poison), level of triage, nursing activities and patient outcomes were recorded. Results: 155 cases of poisoning were recorded. Drug poisoning was more common in working days (p < 0.05) and alcoholic in nonworking (p < 0.05). 72 % of patients underwent a blood test and 55 % a urine test to detect the presence of toxic substances. 79 % was administered any medication and 25 % activated carbon. The use of time in verbal communication was greater in patients consuming medicaments (p < 0.001) compared with patients consuming alcohol or illicit drugs. Conclusions: The intake of drugs has been the most frequently attended poisoning, particularly on working days. The intoxicated by drugs is the most time-consuming verbal communication

Eficacia diagnóstica y manejo posoperatorio de los pacientes sometidos a biopsia cerebral en un hospital universitario / Diagnostic yield and postoperative management of patients submitted to brain biopsy in a university hospital

Objetivo: Determinar la eficacia diagnóstica y la incidencia de complicaciones perioperatorias en pacientes sometidos a biopsia cerebral cerrada o por craneotomía, y valorar la duración de la vigilancia intensiva, para el diagnóstico precoz y el manejo de las complicaciones posoperatorias. Material y método: Estudio observacional retrospectivo, incluyendo todos los pacientes sometidos a biopsia cerebral entre enero de 2006 y julio de 2012. Se recogieron los datos demográficos, enfermedad asociada, tipo de biopsia, datos relevantes del intraoperatorio, el resultado de la anatomía patológica, la realización de prueba de imagen cerebral y su resultado, y la presencia, tipo y momento de aparición de las complicaciones posoperatorias. Resultados: Se analizaron un total de 76 biopsias (51 «cerradas», 25 «abiertas») en 75 pacientes. La efectividad diagnóstica fue del 98% en las «cerradas» y del 96% en las «abiertas». La mortalidad relacionada con el procedimiento fue de 3,9 y 4%, respectivamente. La incidencia de complicaciones mayores fue del 3,9% en biopsias «cerradas» y del 8% en biopsias «abiertas», apareciendo la mitad de ellas dentro de las primeras 24 h del posoperatorio, durante el ingreso en la Unidad de Cuidados Intensivos. La edad fue el único factor de riesgo para la aparición de complicaciones (p = 0,04). No encontramos diferencias de morbimortalidad entre los 2 grupos analizados. Conclusiones: La eficacia diagnóstica de nuestra serie ha sido muy alta. Dada la importancia del diagnóstico precoz de las complicaciones, recomendamos una vigilancia monitorizada en las primeras 24 h tras la realización de una biopsia cerebral tanto «abierta» como «cerrada»

Objective: To assess the diagnostic yield and the incidence of perioperative complications in patients undergoing an open or closed cerebral biopsy and to determine the length of intensive care monitoring, for early diagnosis and fast management of perioperative complications. Material and method: This was a retrospective analysis of all the patients that underwent brain biopsy between January 2006 and July 2012. We recorded demographic data, comorbidities, modality of biopsy, intraoperative clinical data, histological results, computed tomography scanning findings and occurrence, and type of perioperative complications and moment of appearance. Results: Seventy-six brain biopsies in 75 consecutive patients (51 closed and 25 open) were analysed. Diagnostic yield was 98% for closed biopsies and 96% for open biopsies. Mortality related to the procedures was 3.9 and 4%, respectively. The incidence of major complications was 3.9% for closed biopsies and 8% for open biopsies; half of these appeared within the first 24 postoperative hours, during patient stay in the Intensive Care Unit. Age was the only risk factor for complications (P = .04) in our study. No differences in morbimortality were found between the studied groups. Conclusions: Diagnostic yield was very high in our series. Because the importance of early diagnosis of complications for preventing long-term sequelae, we recommend overnight hospital stay for observation after open or closed brain biopsy

[Diagnostic yield and postoperative management of patients submitted to brain biopsy in a university hospital]. / Eficacia diagnóstica y manejo posoperatorio de los pacientes sometidos a biopsia cerebral en un hospital universitario.

OBJECTIVE: To assess the diagnostic yield and the incidence of perioperative complications in patients undergoing an open or closed cerebral biopsy and to determine the length of intensive care monitoring, for early diagnosis and fast management of perioperative complications. MATERIAL AND METHOD: This was a retrospective analysis of all the patients that underwent brain biopsy between January 2006 and July 2012. We recorded demographic data, comorbidities, modality of biopsy, intraoperative clinical data, histological results, computed tomography scanning findings and occurrence, and type of perioperative complications and moment of appearance. RESULTS: Seventy-six brain biopsies in 75 consecutive patients (51 closed and 25 open) were analysed. Diagnostic yield was 98% for closed biopsies and 96% for open biopsies. Mortality related to the procedures was 3.9 and 4%, respectively. The incidence of major complications was 3.9% for closed biopsies and 8% for open biopsies; half of these appeared within the first 24 postoperative hours, during patient stay in the Intensive Care Unit. Age was the only risk factor for complications (P=.04) in our study. No differences in morbimortality were found between the studied groups. CONCLUSIONS: Diagnostic yield was very high in our series. Because the importance of early diagnosis of complications for preventing long-term sequelae, we recommend overnight hospital stay for observation after open or closed brain biopsy.

Detección de embolismo aéreo venoso y de foramen oval permeable en pacientes neuroquirúrgicos intervenidos en posición de sedestación / Detection of venous air embolism and patent foramen ovale in neurosurgery patients in sitting position

INTRODUCCIÓN: La detección precoz del embolismo aéreo venoso (EAV) durante las intervenciones neuroquirúrgicas en sedestación disminuye la gravedad de sus complicaciones. OBJETIVOS: Analizar la detección de EAV y sus repercusiones en pacientes intervenidos en sedestación. Comprobar la frecuencia de aspiración de aire a través de una vía venosa central. Valorar la viabilidad del uso del Doppler transcraneal (DTC) en quirófano para el diagnóstico del foramen oval permeable (FOP). MATERIAL Y MÉTODOS: Estudio prospectivo de intervenciones neuroquirúrgicas consecutivas realizadas durante 5 años en sedestación. Como método diagnóstico del EAV se empleó el Doppler precordial y el CO2 espirado. El FOP se exploró tras la inducción anestésica mediante DTC. RESULTADOS: Ciento treinta y seis pacientes fueron intervenidos en sedestación, 93 craneotomías y 43 cirugías de columna cervical. Veintidós pacientes (16,2%) fueron diagnosticados de EAV (21,5% de las craneotomías y 4,7% de las cirugías de columna; p = 0,013). En el 59% de los casos se aspiró aire a través del catéter venoso central. Hubo afectación hemodinámica en 3 pacientes, alteración de la oxigenación en 4 y neumoencéfalo clínicamente relevante en 5. Dos pacientes (1,4%) fueron diagnosticados de FOP, pero no presentaron episodios de EAV ni embolia aérea paradójica. CONCLUSIONES: Confirmamos una mayor incidencia de EAV en craneotomías que en cirugía de columna cervical en sedestación. Obtuvimos aire a través del catéter venoso central en más de la mitad de los casos. Con nuestra sistemática, ningún paciente presentó complicaciones críticas intraoperatorias. La baja incidencia de FOP detectada con DTC requerirá modificar nuestro protocolo realizado con el paciente anestesiado

INTRODUCTION: Early detection of venous air embolism (VAE) during neurosurgical procedures in sitting position decreases the severity of its complications. OBJECTIVES: our aim was to analyse the detection of VAE and its impact on patients operated in a sitting position, verify air aspiration through a central venous catheter and assess the feasibility of the routine use of transcranial Doppler (TCD) for intraoperative diagnosis of patent foramen ovale (PFO). MATERIAL AND METHODS: We performed a prospective study of consecutive neurosurgical procedures performed in the sitting position for 5 years. Precordial Doppler and end-tidal carbon dioxide were the diagnostic methods for VAE. PFO was explored by TCD after anaesthetic induction. RESULTS: 136 patients were operated in the sitting position, 93 craniotomies and 43 cervical spine procedures. Twenty-two patients (16.2%) were diagnosed with VAE (21.5% of craniotomies and 4.7% of spinal surgeries; p = .013). In 59% of cases, air was aspirated through the central venous catheter. There was haemodynamic involvement in 3 patients, impaired oxygenation in 4 and clinically relevant pneumocephalus in 5 of them. Two patients (1.4%) were diagnosed with PFO, but did not present episodes of VAE or paradoxical air embolism. CONCLUSIONS: The series analysed confirmed a higher incidence of VAE in craniotomies than in cervical spine surgery in a sitting position. We were able to aspirate air through the central venous catheter in more than half the cases. No patients suffered critical intraoperative complications following our approach. The low incidence of PFO detected with TCD will imply a modification of our protocol performed on anaesthetised patients

[Detection of venous air embolism and patent foramen ovale in neurosurgery patients in sitting position]. / Detección de embolismo aéreo venoso y de foramen oval permeable en pacientes neuroquirúrgicos intervenidos en posición de sedestación.

INTRODUCTION: Early detection of venous air embolism (VAE) during neurosurgical procedures in sitting position decreases the severity of its complications. OBJECTIVES: our aim was to analyse the detection of VAE and its impact on patients operated in a sitting position, verify air aspiration through a central venous catheter and assess the feasibility of the routine use of transcranial Doppler (TCD) for intraoperative diagnosis of patent foramen ovale (PFO). MATERIAL AND METHODS: We performed a prospective study of consecutive neurosurgical procedures performed in the sitting position for 5 years. Precordial Doppler and end-tidal carbon dioxide were the diagnostic methods for VAE. PFO was explored by TCD after anaesthetic induction. RESULTS: 136 patients were operated in the sitting position, 93 craniotomies and 43 cervical spine procedures. Twenty-two patients (16.2%) were diagnosed with VAE (21.5% of craniotomies and 4.7% of spinal surgeries; p=.013). In 59% of cases, air was aspirated through the central venous catheter. There was haemodynamic involvement in 3 patients, impaired oxygenation in 4 and clinically relevant pneumocephalus in 5 of them. Two patients (1.4%) were diagnosed with PFO, but did not present episodes of VAE or paradoxical air embolism. CONCLUSIONS: The series analysed confirmed a higher incidence of VAE in craniotomies than in cervical spine surgery in a sitting position. We were able to aspirate air through the central venous catheter in more than half the cases. No patients suffered critical intraoperative complications following our approach. The low incidence of PFO detected with TCD will imply a modification of our protocol performed on anaesthetised patients.