ABSTRACT
INTRODUCTION: In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved. MATERIAL AND METHODS: Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated. RESULTS: Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained. CONCLUSIONS: Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.
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Acetaminophen , Patient Care Team , Humans , Child , Prospective Studies , Patients , PainABSTRACT
TITLE: Parálisis súbita de la supraversión de la mirada en una niña de 9 años.
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Eye Movements , Paralysis , Child , Female , HumansABSTRACT
No disponible
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Humans , Male , Child , Energy Drinks/adverse effects , Seizures/chemically induced , Paresthesia/chemically induced , Caffeine/adverse effects , Electroencephalography/methodsSubject(s)
Energy Drinks/adverse effects , Seizures/etiology , Caffeine , Child , Electroencephalography , Humans , Male , Seizures/physiopathologyABSTRACT
Entre los objetivos principales de la hospitalización pediátrica en un hospital terciario se incluyen el cuidado integral de los pacientes pediátricos ingresados incluyendo aspectos diagnósticos, curativos, preventivos y de rehabilitación. La Academia Americana de Pediatría reconoció hace más de 20 años la importancia y el papel crucial de los programas de hospitalización pediátrica. Así, la Pediatría General en un hospital terciario juega un papel muy importante en el cuidado agudo de pacientes pediátricos con patologías prevalentes, pero también como coordinador e integrador del cuidado de pacientes crónicos y de alta complejidad. También creemos que la Pediatría General en un hospital terciario tiene la responsabilidad de desarrollar los programas de calidad, implantar una cultura de seguridad en Pediatría, promover protocolos y guías clínicas en patologías prevalentes, ser referentes en la educación de los familiares de nuestros pacientes así como desarrollar los programas de e-health y cooperación internacional (AU)
The main objectives of the Pediatric Hospitalist Programs within a Tertiary Hospital include comprehensive care to hospitalized pediatric patients in diagnostic, curative, preventive, and rehabilitation aspects. The American Academy of Pediatrics recognized about 20 years ago, the importance and the key role of Pediatrics Hospitalist programs. General Pediatrics plays an important role not only for the care in acute prevalent pathologies, but also as a coordinator and integrator in chronic and highly complex patients. We also believe that General Pediatrics at a Third level hospital, has the responsibility to develop quality programs, implement safety culture in hospitalized patients, promote protocols and clinical guidelines in prevalent pathologies, health education in our population, and developing e-health and international cooperation programs (AU)
Subject(s)
Humans , Male , Female , Child , Inpatient Care Units , Hospitalization , Maternal and Child Health , Maternal-Child Health Services/organization & administration , Maternal-Child Health Services/standards , International Cooperation , Hospitals, Pediatric/organization & administration , Hospitals, Pediatric/standards , Maternal-Child Health Centers/organization & administration , Hospitals/classification , Telemedicine/organization & administration , Primary Health Care/methodsABSTRACT
OBJETIVOS: Identificar precozmente y analizar las características de pacientes que precisan ingreso por bronquiolitis moderada o grave que cumplen criterios urinarios de SIADH. PACIENTES Y MÉTODOS: Estudio prospectivo observacional, realizado entre octubre de 2012-marzo de 2013 en urgencias pediátricas. Se incluyen menores de 12 meses con bronquiolitis moderada o grave que requieren ingreso. Se consideran criterios urinarios de SIADH: sodio urinario≥40mmol/l, osmolaridad urinaria>500 mOsm/kg y densidad urinaria>1.020g/l. Se recogen variables epidemiológicas y clínicas y se comparan 2 grupos definidos por cumplir o no criterios urinarios de SIADH. RESULTADOS: Se incluyen 126 pacientes con bronquiolitis moderada, 23 (18,6%) cumplen criterios urinarios de SIADH, ninguno grave ni menor de un mes. Los pacientes con criterios urinarios de SIADH tienen mayor incidencia de neumonía y/o atelectasia en la radiografía de tórax (21,7% vs. 1,9%; p = 0,002), peor respuesta al tratamiento con adrenalina (69,5% vs. 28,1%; p = 0,016), mayor asistencia respiratoria: oxigenoterapia de alto flujo (17,4% vs. 7,7%; p = 0,016) y ventilación mecánica no invasiva (13% vs. 5,8%; p = 0,034). Requieren más días oxigenoterapia (p = 0,02) y tratamiento broncodilatador (p = 0,04) y mayor ingreso en cuidados intensivos pediátricos (26,1% vs. 6,8%; p = 0,007). CONCLUSIONES: Los pacientes mayores de 1 mes con bronquiolitis moderada y con criterios urinarios de SIADH tienen peor evolución respiratoria, mayor necesidad de soporte respiratorio, ingreso en UCIP y más alteraciones radiográficas. Por ello recomendamos realizar determinaciones de orina a estos pacientes para detectar precozmente el desarrollo de SIADH y cuidar el manejo hidroelectrolítico, previniendo el desarrollo de complicaciones potencialmente graves
OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities
Subject(s)
Humans , Male , Female , Child , Bronchiolitis/complications , Bronchiolitis/diagnosis , Bronchiolitis/therapy , Inappropriate ADH Syndrome/complications , Inappropriate ADH Syndrome/diagnosis , Respiratory Syncytial Viruses , Respiratory Syncytial Viruses/immunology , Respiratory Syncytial Viruses/isolation & purification , Early Diagnosis , Prospective Studies , Osmolar Concentration , Epinephrine/therapeutic use , Oxygen/therapeutic use , Bronchodilator Agents/therapeutic useABSTRACT
OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities.
Subject(s)
Bronchiolitis/complications , Bronchiolitis/diagnosis , Inappropriate ADH Syndrome/complications , Inappropriate ADH Syndrome/diagnosis , Child , Emergency Service, Hospital , Humans , Prospective StudiesABSTRACT
No disponible
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Female , Humans , Male , Noninvasive Ventilation/methods , Clinical Clerkship/ethics , Bronchitis, Chronic/metabolism , Bronchitis, Chronic/pathology , Critical Care/methods , Noninvasive Ventilation/instrumentation , Clinical Clerkship , Bronchitis, Chronic/complications , Bronchitis, Chronic/diagnosis , Critical Care/standards , Observational StudyABSTRACT
OBJETIVOS: Estudiar la evolución durante 12 años del uso de la ventilación mecánica invasiva (VMI) y no invasiva (VNI) en niños con bronquiolitis ingresados en una unidad de cuidados intensivos pediátricos (UCIP). PACIENTES Y MÉTODOS: Estudio retrospectivo observacional de 12 años de duración (2001-2012) en el que se incluyó a todos los niños ingresados con bronquiolitis en UCIP que requirieron VMI y/o VNI. Se analizaron las características demográficas, el tipo de asistencia respiratoria y la evolución clínica, comparándose los primeros 6 años de estudio con los segundos. RESULTADOS: Se estudió a 196 pacientes. Un 30,1% requirió VMI y un 93,3% VNI. La mediana de duración de VMI fue de 9,5 días y la de VNI de 3 días. La duración de ingreso en UCIP fue de 7 días y falleció un 2% de los pacientes. La utilización de VNI aumentó del 79,4% en el primer periodo al 100% en el segundo periodo (p < 0,0001) y disminuyó el de VMI del 46% en el primer periodo al 22,6% en el segundo (p < 0,0001). La presión positiva continua en la vía aérea y el tubo endotraqueal cortado fueron la modalidad y la interfase más utilizadas, aunque en el segundo periodo aumentó significativamente el uso de ventilación con 2 niveles de presión (p < 0,0001) y de púas nasales (p < 0,0001), y disminuyó la duración de ingreso en la UCIP (p = 0,011). CONCLUSIONES: La mayor utilización de VNI en pacientes con bronquiolitis en nuestra unidad en los últimos años se asoció a una disminución de la necesidad de VMI y de la duración del ingreso en la UCIP
OBJECTIVES: The aim of the study was to analyse the evolution, over a12-year period, of the use of non-invasive (NIV) and invasive ventilation (IV) in children admitted to a Paediatric Intensive Care Unit (PICU) due to acute bronchiolitis. PATIENTS AND METHODS: A retrospective observational study was performed including all children who were admitted to the PICU requiring NIV or IV between 2001 and 2012. Demographic characteristics, ventilation assistance and clinical outcome were analysed. A comparison was made between the first six years and the last 6 years of the study. RESULTS: A total of 196 children were included; 30.1% of the subjects required IV and 93.3% required NIV. The median duration of IV was 9.5 days and NIV duration was 3 days. The median PICU length of stay was 7 days, and 2% of the patients died. The use of NIV increased from 79.4% in first period to 100% in the second period (P<.0001) and IV use decreased from 46% in the first period to 22.6% in the last 6 years (P<.0001). Continuous positive airway pressure and nasopharyngeal tube were the most frequently used modality and interface, although the use of bi-level non-invasive ventilation (P<.001) and of nasal cannulas significantly increased(P<.0001) in the second period, and the PICU length of stay was shorter (P=.011). CONCLUSION: The increasing use of NIV in bronchiolitis in our PICU during the last 12 years was associated with a decrease in the use of IV and length of stay in the PICU
Subject(s)
Child , Female , Humans , Male , Respiration, Artificial/methods , Respiration, Artificial , Bronchiolitis/complications , Bronchiolitis/diagnosis , Bronchiolitis/therapy , Continuous Positive Airway Pressure/methods , Continuous Positive Airway Pressure , High-Frequency Ventilation/methods , Intermittent Positive-Pressure Breathing/methods , Intermittent Positive-Pressure VentilationABSTRACT
No disponible
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Child , Humans , Male , Cardiac Tamponade/etiology , Thrombolytic Therapy/adverse effects , Fibrinolytic Agents/adverse effects , Hypoplastic Left Heart Syndrome/surgery , Tissue Plasminogen Activator/adverse effects , Postoperative ComplicationsABSTRACT
OBJECTIVES: The aim of the study was to analyse the evolution, over a12-year period, of the use of non-invasive (NIV) and invasive ventilation (IV) in children admitted to a Paediatric Intensive Care Unit (PICU) due to acute bronchiolitis. PATIENTS AND METHODS: A retrospective observational study was performed including all children who were admitted to the PICU requiring NIV or IV between 2001 and 2012. Demographic characteristics, ventilation assistance and clinical outcome were analysed. A comparison was made between the first six years and the last 6 years of the study. RESULTS: A total of 196 children were included; 30.1% of the subjects required IV and 93.3% required NIV. The median duration of IV was 9.5 days and NIV duration was 3 days. The median PICU length of stay was 7 days, and 2% of the patients died. The use of NIV increased from 79.4% in first period to 100% in the second period (P<.0001) and IV use decreased from 46% in first period to 22.6% in the last 6 years (P<.0001). Continuous positive airway pressure and nasopharyngeal tube were the most frequently used modality and interface, although the use of bi-level non-invasive ventilation (P<.001) and of nasal cannulas significantly increased (P<.0001) in the second period, and the PICU length of stay was shorter (P=.011). CONCLUSION: The increasing use of NIV in bronchiolitis in our PICU during the last 12 years was associated with a decrease in the use of IV and length of stay in the PICU.
Subject(s)
Bronchiolitis/therapy , Noninvasive Ventilation/trends , Acute Disease , Female , Humans , Infant , Male , Noninvasive Ventilation/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Respiration, Artificial/trends , Retrospective Studies , Time FactorsABSTRACT
No disponible
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Humans , Female , Adolescent , Emphysema/diagnosis , Pharyngeal Diseases/diagnosis , Cough/complications , Risk FactorsABSTRACT
No disponible
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Humans , Male , Child, Preschool , Pityriasis Lichenoides/complications , Pityriasis Lichenoides/diagnosis , Pityriasis Lichenoides/etiology , Dermis/pathology , Pityriasis Lichenoides/drug therapy , Pityriasis Lichenoides/physiopathologyABSTRACT
No disponible
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Humans , Female , Child, Preschool , Bell Palsy/etiology , Growth Hormone/therapeutic use , Growth Disorders/drug therapy , Risk FactorsABSTRACT
Rheumatoid disease affecting thoracic and lumbar spine (subcervical disease) is rare and clinically unapparent in general. There are some references in the literature in which more relevant lesions are described with severe clinical manifestations. We present three cases of long standing Rheumatoid Arthritis with manifestations in thoracic or lumbar spine and a review of literature. The first case presented with long standing dorsal and lumbar pain and signs of multiple discitis and arthritis of costovertebral and interapophyseal joints. The second patient presented a lumbar radicular pain related to a rheumatoid synovial cyst that was studied by pathologist after surgery. Finally the third patient presents a very symptomatic rheumatoid discitis due to interapophyseal arthritis.
La afectación vertebral reumatoide en región subcervical (columna vertebral toraco-lumbar) es poco frecuente y tiene por lo general una escasa expresión clínica. Sin embargo, algunas publicaciones sugieren una mayor importancia para estas lesiones, y en ocasiones graves repercusiones clínicas. Presentamos aquí tres casos de artritis reumatoide (AR) de larga evolución con afectación reumatoide torácica o lumbar y hacemos una revisión de la literatura al respecto. La paciente del Caso 1 presentó dorsolumbalgia crónica con signos de discitis múltiple y artritis de articulaciones costovertebrales e interapofisarias. La segunda paciente presentó dolor radicular lumbar en relación con un quiste sinovial reumatoide que precisó cirugía y pudo ser estudiado histopatológicamente. Finalmente, en el tercer caso se describe una discitis reumatoide lumbar muy sintomática con artritis interapofisaria.
