Subject(s)
Humans , Altitude Sickness/epidemiology , Chronic Disease , Acute Disease , Spain/epidemiologySubject(s)
Asphyxia/etiology , Posture , Wounds and Injuries/complications , Adult , Fatal Outcome , Female , HumansABSTRACT
La hipotermia accidental es una patología ambiental con unos principios básicos de clasificación y reanimación que sirven tanto para el medio montañoso, marítimo o urbano. Esta patología ha formado parte, junto a la acidosis y la coagulopatía, de la famosa «tríada letal» de las víctimas traumáticas en situación crítica. En su manejo y asistencia está implicada toda una cadena asistencial que se extiende desde la medicina de urgencia prehospitalaria hasta la medicina intensiva, llegando incluso hasta la cirugía cardiaca y/o a los programas de circulación extracorpórea. Una buena clasificación prehospitalaria del grado de hipotermia facilitará su manejo inicial y evitará traslados interhospitalarios o secundarios innecesarios. Lo fundamental es trasladar, con la mayor urgencia posible, a las víctimas hipotérmicas en asistolia o fibrilación ventricular hasta aquellos hospitales que tengan la capacidad tecnológica adecuada para el tratamiento de estas especiales situaciones clínicas. Este artículo, trata de sentar las bases que faciliten un manejo adecuado de la hipotermia accidental desde la primera asistencia prehospitalaria hasta tratamiento final hospitalario, incluyendo la reanimación y el recalentamiento con circulación extracorpórea (AU)
Accidental hypothermia is an environmental condition with basic principles of classification and resuscitation that apply to mountain, sea or urban scenarios. Along with coagulopathy and acidosis, hypothermia belongs to the lethal triad of trauma victims requiring critical care. A customized healthcare chain is involved in its management, extending from on site assistance to intensive care, cardiac surgery and/or the extracorporeal circulation protocols. A good classification of the degree of hypothermia preceding admission contributes to improve management and avoids inappropriate referrals between hospitals. The most important issue is to admit hypothermia victims in asystolia or ventricular fibrillation to those hospitals equipped with the medical technology which these special clinical scenarios require. This study attempts to establish the foundations for optimum management of accidental hypothermia from first emergency care on site to treatment in hospital including, resuscitation and rewarming with extracorporeal circulation (AU)
Subject(s)
Humans , Hypothermia/diagnosis , Hypothermia/therapy , Critical Care/methods , Rewarming , Cardiopulmonary Resuscitation , Extracorporeal CirculationABSTRACT
Accidental hypothermia is an environmental condition with basic principles of classification and resuscitation that apply to mountain, sea or urban scenarios. Along with coagulopathy and acidosis, hypothermia belongs to the lethal triad of trauma victims requiring critical care. A customized healthcare chain is involved in its management, extending from on site assistance to intensive care, cardiac surgery and/or the extracorporeal circulation protocols. A good classification of the degree of hypothermia preceding admission contributes to improve management and avoids inappropriate referrals between hospitals. The most important issue is to admit hypothermia victims in asystolia or ventricular fibrillation to those hospitals equipped with the medical technology which these special clinical scenarios require. This study attempts to establish the foundations for optimum management of accidental hypothermia from first emergency care on site to treatment in hospital including, resuscitation and rewarming with extracorporeal circulation.
Subject(s)
Hypothermia/therapy , Resuscitation/methods , Accidents , Algorithms , Avalanches , Combined Modality Therapy , Critical Care/methods , Disease Management , Emergency Medical Services , Extracorporeal Circulation , Extracorporeal Membrane Oxygenation , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Hypothermia/classification , Hypothermia/complications , Hypothermia/physiopathology , Patient Transfer , Practice Guidelines as Topic , Rewarming/methods , Severity of Illness Index , Ventricular Fibrillation/etiology , Ventricular Fibrillation/therapy , Wounds and Injuries/complications , Wounds and Injuries/therapyABSTRACT
Objetivo: La técnica de resucitación con volúmenes pequeños (RVP) consiste en la administración de 250 ml de suero salino hipertónico al 7,5% acompañado o no de distintos coloides. Peculiaridades de nuestro sistema de trabajo nos hicieron plantear la posibilidad iniciar el uso de sueros hipertónicos. Métodos: Revisión bibliográfica no sistemática de fuentes primarias y secundarias, por medio de cuestiones propuestas previamente para conocer, los mecanismos de acción y describir las indicaciones en el ámbito extrahospitalario. Resultados: Valorando los estudios clínicos hasta la fecha, parece que la técnica de resucitación con volúmenes pequeños es superior al tratamiento estándar, ya que mejora más rápido la microcirculación y con ello el funcionamiento de cada órgano, particularmente en los pacientes con traumatismo craneoencefálico e hipotensión en ámbito extrahospitalario. Conclusiones: La RVP por medio de sodio hipertónico y coloide asociado ha sido estudiada con anterioridad y comercializada en otros países. Esta técnica en nuestras circunstancias de trabajo es segura y más beneficiosa que el tratamiento convencional del shock hipovolémico asociado al traumatismo cráneoencefálico (TCE) (AU)
The resuscitation with small volumes (RSV) technique is well known; it involves the administration of 250 ml 7.5% hypertonic saline with or without various associated colloids. A number of peculiarities in our work system led us to proposing the possibility of using hypertonic saline. Through a non-systematic bibliographic review of primary and secondary sources using previously defined questions we tried to ascertain the mechanisms of action and to describe the indications in the extrahospitalary environment. After an assessment of clinical studies to date, it would appear hat the RSV technique is superior to the standard therapy, as it achieves faster improvement of microcirculation and thus of the function of each organ, particulary in patients with cranio-encephalic traumatism and arterial hypotension in the extrahospitalary setting. RSV using hypertonic saline and an associated colloid has been studied previously and has been marketed in other countries. In our work conditions, this technique is safe and achieves more benefit than conventional management of hypovolemic shock associated to cranio-encephalic traumatism (AU)
