ABSTRACT
Fundamento: la reanimación cardiopulmocerebral es el conjunto de maniobras para asegurar la oxigenación de los órganos cuando la circulación de la sangre se detiene. La reanimación cardiopulmocerebral intrahospitalaria es una intervención que salva vidas. Objetivo: caracterizar la atención médica durante la reanimación cardiopulmocerebral en pacientes que presentan parada cardiaca dentro del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Método se realizó un estudio descriptivo, transversal en las cinco unidades de cuidados intensivos de la Vicedirección de Urgencias, entre enero hasta junio del 2020. Se estudiaron 152 pacientes que realizaron un paro cardiorespiratorio. Se estudiaron las variables relacionadas con el paciente, los síntomas y signos previos al PCR presentados por los pacientes así como signos vitales. Resultados la media de edad fue de 62,66 años, en el 54,6 % predominó el sexo masculino. La hipertensión arterial fue la comorbilidad más frecuente con un 60,5 %. El 32,9 % tuvo un tiempo de estadía previo al evento de más de 72 horas. En orden de frecuencia los signos o síntomas previos al evento de PCR con más presencia fueron: bradicardia (32,2 %); pulsos débiles (15,1 %); inconciencia (12,5 %) y cianosis con 10,5 %. El servicio de mayor de ocurrencia fue la Unidad de Cuidados Intensivos Clínica. La asistolia constituyó el ritmo eléctrico inicial más común (57,9 %). En el 100 % de los casos se realizó manejo avanzado de la vía aérea con tubo endotraqueal. La desfibrilación estuvo indicada en 42 pacientes donde el 15,1 % de estos recibió la primera desfibrilación en menos de 5 minutos. La causa de la suspensión de la reanimación en 95 de los pacientes estudiados fue el fallecimiento. Conclusiones: la atención médica ante el paro cardiorrespiratorio debe seguir perfeccionándose, a través de la superación del personal sanitario y el desarrollo de acciones organizativas hacia el proceso de reanimación cardiopulmocerebral intrahospitalaria.
Background: cardiopulmonary-cerebral resuscitation is the set of maneuvers to ensure oxygenation of organs when blood circulation stops. In-hospital cardiopulmonary-cerebral resuscitation is a life-saving intervention. Objective: to characterize medical care during cardiopulmonary-cerebral resuscitation in patients with cardiac arrest at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Method: a descriptive, cross-sectional study was carried out in the five intensive care units of the Emergency Department, from January to June 2020. 152 patients who suffered cardiorespiratory arrest were studied. The variables related to the patient, the symptoms and signs presented by the patients prior to the PCR, as well as vital signs, were studied. Results: the average age was 62.66 years, in 54.6% the male sex predominated. Arterial hypertension was the most frequent comorbidity with 60.5%. 32.9% had a length of stay prior to the event of more than 72 hours. In order of frequency, the most prevalent signs or symptoms prior to the PCR event were: bradycardia (32.2%); weak pulses (15.1%); unconsciousness (12.5%) and cyanosis with 10.5%. The service with the highest occurrence was the Clinical Intensive Care Unit. Asystole was the most common initial electrical rhythm (57.9%). In 100% of the cases, advanced airway management was performed with an endotracheal tube. Defibrillation was indicated in 42 patients where 15.1% of these received the first defibrillation in less than 5 minutes. The cause of suspension of resuscitation in 95 of the patients studied was death. Conclusions: medical care in the face of cardiorespiratory arrest must continue to be improved, through the improvement of health personnel and the development of organizational actions towards the process of intrahospital cardiopulmonary-cerebral resuscitation.
ABSTRACT
Introducción: en el año académico 2016-2017 se introduce el plan D y el curso propio Reanimación cardiopulmocerebral en la carrera de medicina. Objetivos: describir los resultados de la implementación del curso en Cienfuegos y fundamentar los cambios realizados al proyecto nacional. Métodos: se realizó una investigación prospectiva, descriptiva, mixta en métodos, desarrollada en la Universidad de Ciencias Médicas de Cienfuegos, entre septiembre y diciembre del 2016. Se utilizó la técnica de grupo focal con informantes clave y un cuestionario a 350 (77,95 por ciento) de los estudiantes de primer año. El claustro se constituyó con 18 profesores de experiencia, el cual durante tres semanas, capacitó de forma intensiva a 449 estudiantes. Las propuestas de cambio del plan nacional fueron justificadas y fundamentadas. Se enfatizó en las actividades prácticas, donde fueron evaluadas 10 habilidades como parte de la evaluación formativa Resultados: fueron buenos académicamente y los alumnos consideraron como positivo la utilidad en su formación (41,71 por ciento), las clases prácticas (14,29 por ciento), y la preparación de los profesores (11,43 por ciento). Fue valorado como negativo el poco tiempo de la asignatura (23,71 por ciento) y el tener un examen final teórico (17,71 por ciento). Conclusiones: la enseñanza de la reanimación cardiopulmocerebral es factible, importante y considerada muy necesaria para el desarrollo profesional de los futuros profesionales. El diseño del curso en Cienfuegos permitió cumplir con calidad los objetivos propuestos. La experiencia fue positiva para profesores y estudiantes, los cuales consideraron las actividades prácticas como lo más destacado en el logro de los resultados(AU)
Introduction: For the academic year 2016-2017, the Plan of Study D is presented together with the introduction of the course on cardiopulmonary-cerebral resuscitation in the medical major. Objectives: To describe the results of the course implementation in Cienfuegos and set the foundations for the changes made to the national project. Methods: A prospective, descriptive research using mixed methods was carried out at Cienfuegos University of Medical Sciences, between September and December 2016. The focus group technique was used with key informants and a questionnaire conducted on 350 (77.95 percent) among the first-year students. The faculty was made up by 18 experienced professors, who intensively trained 449 students for three weeks. The proposals for change to the national plan were supported and explained. Emphasis was placed on practical activities, where ten skills were evaluated as part of the training assessment. Results: The results were good academically and the students considered the usefulness in their training (41.71 percent), the practical classes (14.29 percent), and the professor's preparation (11.43 percent) as positive. The subject's short time (23.71 percent) and the theoretical final exam (17.71 percent) were evaluated as negative. Conclusions: The teaching of cardiopulmonary-cerebral resuscitation is feasible, important and considered very necessary for the upgrading of the forthcoming professionals. The design of the course in Cienfuegos allowed to fulfill the proposed objectives with high standards. The experience was positive for both professors and students, who considered the practical activities as the most outstanding aspects in the achievement of the results(AU)
Subject(s)
Humans , Cardiopulmonary Resuscitation/education , Curriculum , Education, MedicalABSTRACT
Introducción: en el año académico 2016-2017 se introduce el plan D y el curso propio Reanimación cardiopulmocerebral en la carrera de medicina. Objetivos: describir los resultados de la implementación del curso en Cienfuegos y fundamentar los cambios realizados al proyecto nacional. Métodos: se realizó una investigación prospectiva, descriptiva, mixta en métodos, desarrollada en la Universidad de Ciencias Médicas de Cienfuegos, entre septiembre y diciembre del 2016. Se utilizó la técnica de grupo focal con informantes clave y un cuestionario a 350 (77,95 por ciento) de los estudiantes de primer año. El claustro se constituyó con 18 profesores de experiencia, el cual durante tres semanas, capacitó de forma intensiva a 449 estudiantes. Las propuestas de cambio del plan nacional fueron justificadas y fundamentadas. Se enfatizó en las actividades prácticas, donde fueron evaluadas 10 habilidades como parte de la evaluación formativa Resultados: fueron buenos académicamente y los alumnos consideraron como positivo la utilidad en su formación (41,71 por ciento), las clases prácticas (14,29 por ciento), y la preparación de los profesores (11,43 por ciento). Fue valorado como negativo el poco tiempo de la asignatura (23,71 por ciento) y el tener un examen final teórico (17,71 por ciento). Conclusiones: la enseñanza de la reanimación cardiopulmocerebral es factible, importante y considerada muy necesaria para el desarrollo profesional de los futuros profesionales. El diseño del curso en Cienfuegos permitió cumplir con calidad los objetivos propuestos. La experiencia fue positiva para profesores y estudiantes, los cuales consideraron las actividades prácticas como lo más destacado en el logro de los resultados(AU)
Introduction: For the academic year 2016-2017, the Plan of Study D is presented together with the introduction of the course on cardiopulmonary-cerebral resuscitation in the medical major. Objectives: To describe the results of the course implementation in Cienfuegos and set the foundations for the changes made to the national project. Methods: A prospective, descriptive research using mixed methods was carried out at Cienfuegos University of Medical Sciences, between September and December 2016. The focus group technique was used with key informants and a questionnaire conducted on 350 (77.95 percent) among the first-year students. The faculty was made up by 18 experienced professors, who intensively trained 449 students for three weeks. The proposals for change to the national plan were supported and explained. Emphasis was placed on practical activities, where ten skills were evaluated as part of the training assessment. Results: The results were good academically and the students considered the usefulness in their training (41.71 percent), the practical classes (14.29 percent), and the professor's preparation (11.43 percent) as positive. The subject's short time (23.71 percent) and the theoretical final exam (17.71 percent) were evaluated as negative. Conclusions: The teaching of cardiopulmonary-cerebral resuscitation is feasible, important and considered very necessary for the upgrading of the forthcoming professionals. The design of the course in Cienfuegos allowed to fulfill the proposed objectives with high standards. The experience was positive for both professors and students, who considered the practical activities as the most outstanding aspects in the achievement of the results(AU)
Subject(s)
Cardiopulmonary Resuscitation/education , Curriculum , Education, MedicalABSTRACT
Una de las situaciones más graves y comprometidas para la vida, es la parada cardiorrespiratoria. El objetivo de esta charla es hacer una actualización sobre la enseñanza de la reanimación cardiopulmonar y cerebral. Se visitó la página web de la Biblioteca Médica Nacional de los Estados Unidos (PubMed) con las siguientes palabras clave en inglés: teaching AND reanimation, y con el filtro activado para los últimos cinco años, en humanos y a texto completo. La enfermedad coronaria es la primera causa de muerte en el mundo. Su manifestación más grave es la muerte súbita, y la fibrilación ventricular es el ritmo electrocardiográfico más frecuente. Su principal tratamiento es la reanimación cardiopulmonar efectiva y la desfibrilación precoz. Parece necesario instaurar métodos más eficaces de instrucción, donde el empleo de escenarios clínicos simulados puede ser una herramienta útil para mejorar el aprendizaje, así como la evaluación de las competencias terminales del egresado de medicina
The cardiorespiratory arrest is one of the most serious and compromised situations in life. The purpose of this work is to make an update on the teaching of cardiopulmonary cerebral resuscitation. The website of the National Medical Library of the United States (PubMed) was visited with the following keywords: teaching and reanimation, and with the filter activated for the last five years, in humans and complete text. The coronary heart disease is the leading cause of death in the world. Its most severe manifestation is sudden death, and ventricular fibrillation is the most frequent electrocardiographic pace. Its main treatment is the effective cardiopulmonary resuscitation and early defibrillation. It seems necessary to establish effective methods of instruction, where the use of simulated clinical scenarios can be a useful tool to enhance learning and assessment of terminal skills for the medicine graduated
Subject(s)
Teaching , Cardiopulmonary ResuscitationABSTRACT
Background: Cardiopulmonary arrest (CPA) is common in veterinary critical care and cardiopulmonary cerebral resuscitation (CPCR) aims to achieve survival and continued quality of life. However, reported survival rate to discharge is very low for veterinary patients. We present a case of successful CPCR after CPA in a bitch undergoing cesarean section and ovariohysterectomy.Case: A four-year old Pit Bull bitch undergoing labor for two days was referred to the veterinary hospital for a cesarean section and ovariohysterectomy. Laboratory exams revealed anemia, leucopenia, hypoglycemia and increased values of alkaline phosphatase and urea. Pre-anesthetic medication consisted of intramuscular (IM) morphine (0.3 mg kg-1) and midazolam (0.2 mg kg-1), and 2.5% glucose in Ringers lactated solution (10 mL kg-1 hour-1) was administered intravenously (IV). Following induction with propofol (2 mg kg-1) and midazolam (0.2mg kg-1) IV, the trachea was intubated and anesthesia was maintained with isofl urane in 100% oxygen. Fentanyl (3g kg-1) associated with 2% lidocaine (4 mg kg-1) was administered epidurally in the lumbo-sacral space. During anesthesia, heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), electrocardiogram (ECG) and systolic arterial pressure (SAP) were monitored. At the start of surgery, blood was transfused. During the procedure, hypotension (SAP 3
Background: Cardiopulmonary arrest (CPA) is common in veterinary critical care and cardiopulmonary cerebral resuscitation (CPCR) aims to achieve survival and continued quality of life. However, reported survival rate to discharge is very low for veterinary patients. We present a case of successful CPCR after CPA in a bitch undergoing cesarean section and ovariohysterectomy.Case: A four-year old Pit Bull bitch undergoing labor for two days was referred to the veterinary hospital for a cesarean section and ovariohysterectomy. Laboratory exams revealed anemia, leucopenia, hypoglycemia and increased values of alkaline phosphatase and urea. Pre-anesthetic medication consisted of intramuscular (IM) morphine (0.3 mg kg-1) and midazolam (0.2 mg kg-1), and 2.5% glucose in Ringers lactated solution (10 mL kg-1 hour-1) was administered intravenously (IV). Following induction with propofol (2 mg kg-1) and midazolam (0.2mg kg-1) IV, the trachea was intubated and anesthesia was maintained with isofl urane in 100% oxygen. Fentanyl (3g kg-1) associated with 2% lidocaine (4 mg kg-1) was administered epidurally in the lumbo-sacral space. During anesthesia, heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), electrocardiogram (ECG) and systolic arterial pressure (SAP) were monitored. At the start of surgery, blood was transfused. During the procedure, hypotension (SAP 3
ABSTRACT
Background: Cardiopulmonary arrest (CPA) is common in veterinary critical care and cardiopulmonary cerebral resuscitation (CPCR) aims to achieve survival and continued quality of life. However, reported survival rate to discharge is very low for veterinary patients. We present a case of successful CPCR after CPA in a bitch undergoing cesarean section and ovariohysterectomy.Case: A four-year old Pit Bull bitch undergoing labor for two days was referred to the veterinary hospital for a cesarean section and ovariohysterectomy. Laboratory exams revealed anemia, leucopenia, hypoglycemia and increased values of alkaline phosphatase and urea. Pre-anesthetic medication consisted of intramuscular (IM) morphine (0.3 mg kg-1) and midazolam (0.2 mg kg-1), and 2.5% glucose in Ringers lactated solution (10 mL kg-1 hour-1) was administered intravenously (IV). Following induction with propofol (2 mg kg-1) and midazolam (0.2mg kg-1) IV, the trachea was intubated and anesthesia was maintained with isofl urane in 100% oxygen. Fentanyl (3g kg-1) associated with 2% lidocaine (4 mg kg-1) was administered epidurally in the lumbo-sacral space. During anesthesia, heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), electrocardiogram (ECG) and systolic arterial pressure (SAP) were monitored. At the start of surgery, blood was transfused. During the procedure, hypotension (SAP 3
Background: Cardiopulmonary arrest (CPA) is common in veterinary critical care and cardiopulmonary cerebral resuscitation (CPCR) aims to achieve survival and continued quality of life. However, reported survival rate to discharge is very low for veterinary patients. We present a case of successful CPCR after CPA in a bitch undergoing cesarean section and ovariohysterectomy.Case: A four-year old Pit Bull bitch undergoing labor for two days was referred to the veterinary hospital for a cesarean section and ovariohysterectomy. Laboratory exams revealed anemia, leucopenia, hypoglycemia and increased values of alkaline phosphatase and urea. Pre-anesthetic medication consisted of intramuscular (IM) morphine (0.3 mg kg-1) and midazolam (0.2 mg kg-1), and 2.5% glucose in Ringers lactated solution (10 mL kg-1 hour-1) was administered intravenously (IV). Following induction with propofol (2 mg kg-1) and midazolam (0.2mg kg-1) IV, the trachea was intubated and anesthesia was maintained with isofl urane in 100% oxygen. Fentanyl (3g kg-1) associated with 2% lidocaine (4 mg kg-1) was administered epidurally in the lumbo-sacral space. During anesthesia, heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), electrocardiogram (ECG) and systolic arterial pressure (SAP) were monitored. At the start of surgery, blood was transfused. During the procedure, hypotension (SAP 3