ABSTRACT
TEXT: 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.
TEXTO: En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como "la Declaración de Guadalajara".
Subject(s)
Emergency Medicine , Physicians , Sepsis , Humans , Sepsis/diagnosis , Sepsis/therapy , Emergency Service, HospitalABSTRACT
En noviembre del año 2021, la Surviving Sepsis Campaign (SSC) publicó una actualización de sus recomendaciones y directrices de 2016. Estas fueron recibidas con una enorme expectativa en todo el mundo, especialmente entre los médicos de urgencias y emergencias (MUE). Recientemente, en el marco del CIMU 2022 (33 Congreso Mundial de Medicina de Urgencias celebrado en marzo de 2022 en Guadalajara México) se ha revisado y analizado, desde la perspectiva del MUE, la Guía SSC de 2021. Los expertos que realizaron esa tarea y también consensuaron algunos de los puntos clave que más interesan y preocupan a los MUE en la actualidad han elaborado este documento. Su objetivo principal es analizar de forma constructiva diez de los puntos clave y recomendaciones de la SSC 2021 para complementarlas con argumentos y propuestas desde la experiencia, evidencia y perspectiva del urgenciólogo. Además, de forma secundaria, pretende ser el punto de partida de la elaboración de las guías para detectar, prevenir la progresión y atender a los pacientes con infección grave y sepsis en urgencias, que supone la meta final de lo que desde la MUE ya se conoce como la Declaración de Guadalajara. (AU)
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 physicians reviewed and analyzed the 2021 SSC guidelines from our specialtys 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 reviews 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. (AU)
Subject(s)
Humans , Sepsis/diagnosis , Sepsis/mortality , Sepsis/prevention & control , Shock, Septic , Emergency Medical Services , Early WarningABSTRACT
No disponible
Subject(s)
Humans , Emergency Medicine/education , Education, Medical, Graduate/trends , Models, Educational , Specialization , Education, Medical, Graduate/organization & administrationABSTRACT
No disponible
Subject(s)
Emergencies/epidemiology , Emergency Medical Services/legislation & jurisprudence , Emergency Medical Services/organization & administration , Emergency Medicine/legislation & jurisprudence , Societies, Medical/legislation & jurisprudence , Societies, Medical/standardsSubject(s)
Accreditation , Emergency Medicine , Forecasting , Emergency Medicine/standards , Emergency Medicine/trends , Europe , SpainABSTRACT
BACKGROUND: Studying the impact of demographic changes and progress in the management of stroke patients is necessary in order to organize care structures for the coming years. Consequently, we analyzed the prognostic trends of patients admitted to the Stroke Unit of a tertiary hospital in the last ten years. METHODS: The University Clinical Hospital of Santiago de Compostela is the referral hospital for stroke in a catchment area that accounts for 16.5% of the population of Galicia. Data from patients admitted to the Stroke Unit were registered prospectively. A multinomial logistic regression was performed to determine the influence of new trends in demographic factors and in the management of patients with acute stroke. For the expected trend of progression, a 2008-2011 and 2012-2017 time series model was made by selecting the most appropriate model. RESULTS: In the last 10 years, the age of stroke onset has only increased in women (from 74.4 ± 2.2 years in 2008 to 78.8 ± 2.1 years in 2017; p = 0.037), and the same happens with the severity of neurological symptoms (ischemic stroke (IS), p < 0.0001; from 14 [10, 19] in 2008 to 19 [15, 26] in 2017), with a higher percentage of cardioembolic strokes (40.7% vs. 32.2% of cardioembolic strokes in women vs. men, p < 0.0001). In a multiple linear regression model, hospital improvement was mainly associated with the use of reperfusion treatment (B 53.11, CI 95% 49.87, 56.36, p < 0.0001). A differentiated multinomial logistic regression analysis conducted for the whole sample with ischemic strokes in the two time periods (2008-2011 and 2012-2017) showed no differences in the influence of factors associated with higher morbidity and mortality. The modeling of time series showed a distinct falling trend in mortality, with a slight increase in good outcome as well as morbidity in both ischemic and hemorrhagic stroke. CONCLUSIONS: Our results showed that mortality decreased in the entire sample; however, although outcome at discharge improved in ischemic stroke, severe disability also increased in these patients. Importantly, this tendency towards increased morbidity seems to be confirmed for the coming years.
Subject(s)
Stroke/epidemiology , Tertiary Care Centers/trends , Age of Onset , Aged , Female , Hospitalization/trends , Hospitals, University/trends , Humans , Logistic Models , Male , Middle Aged , Patient Discharge/trends , PrognosisABSTRACT
EN: Stroke is the main cause of morbidity and mortality in Spain and in Galicia in particular. Tissue viability after stroke depends on the time taken to restore circulation. The widely dispersed and aging population of this region challenges efforts to provide equal care for patients with time-sensitive emergencies such as stroke. Two regional hospitals (Hospital do Salnés and Hospital do Barbanza) and the reference Hospital Clínico de Santiago launched a telestroke pilot program in 2011 in which patients whose treatment was guided at a distance were discharged with lower levels of stroke severity and mortality. That outcome was probably attributable to more rapid diagnosis. Given those preliminary results and the characteristics of the population, the centrally coordinated Galician Stroke Care Plan was launched in 2016 to provide a telemedicine service that connects all hospitals in the health system of Galicia. This paper summarizes the experience of developing and implementing the program.
ES: El ictus es la principal causa de morbimortalidad en Galicia y en España. Cuando se produce un ictus isquémico, la viabilidad del tejido está condicionada por el tiempo que transcurre hasta la revascularización. Galicia tiene una población envejecida y con gran dispersión. Ambos hechos suponen un reto para garantizar la equidad en la atención a pacientes con patologías tiempo-dependientes como el ictus. En el año 2011 se inició un proyecto piloto entre dos hospitales comarcales (Salnés y Barbanza) y el Hospital Clínico de Santiago. Se observó que los pacientes tratados a través del teleictus tendieron a una menor gravedad y mortalidad al alta, a expensas probablemente de una mayor agilidad en el proceso diagnóstico. Teniendo en cuenta estos resultados y las condiciones de la población gallega, en 2016 se inició el Plan Gallego de Atención al Ictus con la creación de un centro coordinador de atención al ictus y una red de telemedicina en todos los hospitales del Servicio Gallego de Salud. Este artículo resume la experiencia en el desarrollo e implantación de dicho plan.
Subject(s)
Interdisciplinary Communication , Stroke/drug therapy , Telemedicine , Thrombolytic Therapy , Acute Disease , Aged , Early Diagnosis , Female , Hospitals, University , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Pilot Projects , Population Dynamics , Spain , Stroke/epidemiology , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Time-to-Treatment , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Emergencies/epidemiology , Emergencies/history , Emergency Medicine/methods , Emergency Medicine/trends , Emergency Medicine/education , Emergency Medicine/historyABSTRACT
El ictus es la principal causa de morbimortalidad en Galicia y en España. Cuando se produce un ictus isquémico, la viabilidad del tejido está condicionada por el tiempo que transcurre hasta la revascularización. Galicia tiene una población envejecida y con gran dispersión. Ambos hechos suponen un reto para garantizar la equidad en la atención a pacientes con patologías tiempo-dependientes como el ictus. En el año 2011 se inició un proyecto piloto entre dos hospitales comarcales (Salnés y Barbanza) y el Hospital Clínico de Santiago. Se observó que los pacientes tratados a través del teleictus tendieron a una menor gravedad y mortalidad al alta, a expensas probablemente de una mayor agilidad en el proceso diagnóstico. Teniendo en cuenta estos resultados y las condiciones de la población gallega, en 2016 se inició el Plan Gallego de Atención al Ictus con la creación de un centro coordinador de atención al ictus y una red de telemedicina en todos los hospitales del Servicio Gallego de Salud. Este artículo resume la experiencia en el desarrollo e implantación de dicho plan (AU)
Stroke is the main cause of morbidity and mortality in Spain and in Galicia in particular. Tissue viability after stroke depends on the time taken to restore circulation. The widely dispersed and aging population of this region challenges efforts to provide equal care for patients with time-sensitive emergencies such as stroke. Two regional hospitals (Hospital do Salnés and Hospital do Barbanza) and the reference Hospital Clínico de Santiago launched a telestroke pilot program in 2011 in which patients whose treatment was guided at a distance were discharged with lower levels of stroke severity and mortality. That outcome was probably attributable to more rapid diagnosis. Given those preliminary results and the characteristics of the population, the centrally coordinated Galician Stroke Care Plan was launched in 2016 to provide a telemedicine service that connects all hospitals in the health system of Galicia. This paper summarizes the experience of developing and implementing the program (AU)
Subject(s)
Humans , Stroke/epidemiology , Stroke/therapy , Emergency Medical Services/methods , Telemedicine/methods , Delivery of Health CareABSTRACT
No disponible
Subject(s)
Poisoning/complications , Poisoning/epidemiology , Carbon Monoxide Poisoning/epidemiology , Carbon Monoxide Poisoning/prevention & control , Carboxyhemoglobin/toxicity , Hyperbaric Oxygenation/instrumentation , Hyperbaric Oxygenation/methods , Asthenia/complications , Asthenia/diagnosis , Asthenia/therapy , Neurocirculatory Asthenia/complications , Mass Screening/methods , Mass Screening/prevention & control , Hyperbaric Oxygenation/standards , Hyperbaric Oxygenation/trends , Hyperbaric OxygenationABSTRACT
Introducción. La intoxicación por monóxido de carbono es la más frecuente en nuestro medio a consecuencia de la exposición a gases tóxicos. Los efectos de la intoxicación por monóxido de carbono no se limitan a la exposición aguda porque, tras la aparente recuperación de la intoxicación, pueden aparecer alteraciones neurológicas o del comportamiento. Pacientes y métodos. Se realizó un estudio de las intoxicaciones por monóxido de carbono en un área sanitaria de 80.000 habitantes durante un período de 10 años. Posteriormente se hizo un seguimiento de estos pacientes y se valoró la aparición de síndrome neurológico tardío (SNT) y su relación con diferentes variables en la exposición inicial al monóxido de carbono, en el tratamiento administrado o en la gravedad de la intoxicación. Resultados y conclusiones. Se observó que el 9,1% de los intoxicados por monóxido de carbono detectados en el área sanitaria de Salnés desarrollan el SNT, que es más frecuente en los pacientes con criterios analíticos de gravedad y muy poco probable en los que no los tienen. Los pacientes con SNT no expresaron manifestaciones clínicas ni analíticas diferentes a los que no presentaron el síndrome; tampoco se observaron diferencias en relación con la terapia con oxígeno administrada. La tasa de SNT en el área sanitaria de Salnés entre 2002 y 2012 es de 0,84 casos por 100.000 habitantes y año (AU)
Introduction. Poisoning by carbon monoxide is the most frequent form of intoxication in our milieu as a result of exposure to poisonous gases. The effects of carbon monoxide poisoning are not limited to acute exposure, since, following apparent recovery from the acute intoxication, neurological or behavioural disorders may appear. Patients and methods. A study was conducted to examine the cases of carbon monoxide poisoning that had occurred in a healthcare area of 80,000 inhabitants over a 10-year period. These patients were then submitted to a follow-up to appraise the appearance of delayed neurological syndrome (DNS) and its relationship with different variables in the initial exposure to the carbon monoxide, in the treatment that was administered or in the severity of the intoxication. Results and conclusions. It was observed that around 9.1% of those intoxicated by carbon dioxide detected within the healthcare district of Salnés went on to develop DNS, which is more frequent in patients with severe analytical criteria and very unlikely in those who do not have them. Patients with DNS did not express any clinical or analytical manifestations that differed from those who did not have the syndrome; no differences were observed in relation to the oxygen therapy that was administered. The rate of DNS within the healthcare district of Salnés between 2002 and 2012 is 0.84 cases per 100,000 inhabitants per year. (AU)
Subject(s)
Adult , Female , Humans , Male , Carbon Monoxide Poisoning/diagnosis , Carbon Monoxide Poisoning/therapy , Carbon Monoxide Poisoning/epidemiology , Neurotoxicity Syndromes/diagnosis , Neurotoxicity Syndromes/epidemiology , Neurotoxicity Syndromes/physiopathology , Neurotoxicity Syndromes/immunology , Oxygen Inhalation Therapy , Central Nervous System/physiopathology , Carbon Monoxide/toxicity , Toxic Gases , Chemical Compound Exposure , Risk Factors , Retrospective Studies , Medical History Taking , Hyperbaric Oxygenation , Hypoxia , HeatersABSTRACT
No disponible
