Emotional response to a high-fidelity trauma simulation: An observational study. / Respuesta emocional a una simulación de alta fidelidad en trauma: Un estudio observacional.

INTRODUCTION: The emotional environment created during a simulation session can influence learning. Positive emotions improve perceptual processing and facilitate learning, while negative emotions can reduce working memory, resulting in poorer learning outcomes. OBJECTIVES: The aim of this study was to investigate the impact of simulation training on emotions during all phases of a high-fidelity simulation using standard prebriefing and «good judgement debriefing ¼ techniques. METHODS: This was an observational study that included 74 anesthesiologists participating in a simulation-based training. A standardized prebriefing was followed by «good judgement debriefing¼. In order to assess emotions, we used the circumplex model of emotion, and asked participants to complete the affect grid scale before prebriefing (Stage 1), before starting the simulation (Stage 2), before debriefing (Stage 3) and following debriefing (Stage 4). RESULTS: The affect grid scores obtained from 67 participants were analyzed. Following debriefing, the experience of the polytrauma patient simulation was significantly more pleasant compared to previous stages (P<0.01). In addition, participants perceived the activity as becoming increasingly active as it progressed (P<0.01). CONCLUSIONS: High-fidelity trauma simulation creating a safe environment using a standardized prebriefing and «good judgement debriefing¼ is experienced as a pleasant and active activity at all stages of the simulation. Further investigation is needed to assess the impact of these results on learning.

[Unintentional drowning by immersion. Epidemiological profile of victims attended in 21 Spanish emergency departments]. / Ahogamientos por inmersión no intencional. Análisis de las circunstancias y perfil epidemiológico de las víctimas atendidas en 21 servicios de urgencias españoles.

OBJECTIVES: To determine the frequency of accidental drowning seen in paediatric emergency departments, to define the epidemiological profile of the victims, and to analyse the circumstances related to prognosis and survival. PATIENTS AND METHODS: A multicentre, prospective and descriptive study was conducted on victims of accidental drowning seen in 21 paediatric emergency departments between June and September 2009 and 2010. We collected personal, environmental, safety, security data, as well as the need for cardiopulmonary resuscitation (CPR), hospitalisation rate, sequelae and mortality. RESULTS: Out of 234,566 emergency department cases, 53 were due to accidental drowning (frequency: 2.2/10,000 consultations during the summer period, 64.2% males). The median age was 3.5 years (p25-75: 2.6-8.4), with 34 had less than 6 years. Thirty-two children were hospitalised. Most drowning occurred in the afternoon (40), in freshwater (49), in private pools (33) and unprotected (33). The victims, mostly healthy children (40), did not know how to swim (38) and were not wearing flotation systems (37/38). There was lack of supervision in 42 cases. Acidosis (20) and hypoxaemia (18) were the most frequent findings. Five children died, 4 were healthy, none knew how to swim or had a float device, and none were supervised. Thirty six children required CPR, mostly applied by family (15). In the children who died, CPR was started after 3 min. Two survivors had hemiparesis. CONCLUSIONS: Accidental drowning was a rare cause of consultation in paediatric emergency departments. In children less than 6 years, who did not know how to swim, did not use flotation devices in unprotected private pools, and were not properly supervised, there is an increased of suffering from accidental drowning and its associated morbidity. An immersion time> 10 min, starting CPR > 3 min, acidosis, hyponatraemia, and hypothermia on arrival at the emergency department increases mortality. Training family members in cardiopulmonary resuscitation can be useful.

Bronquiolitis: factores predictivos de la duración del ingreso hospitalario / Predictive factors of duration of hospital admission for bronchiolitis

Objetivo. Determinar qué parámetros son más útiles en el momento del ingreso de niños con bronquiolitis para prever la duración de la estancia hospitalaria. Metodología. Estudio retrospectivo por revisión de historias clínicas. Se incluyen los pacientes ingresados en nuestro centro por bronquiolitis durante el año 1999. Los enfermos se dividen en dos grupos según la duración de la estancia hospitalaria: el grupo I con una estancia de 3 días o menos y el II, con más de 3 días. Se analizan datos clínicos, analíticos y radiológicos según el protocolo realizado para este estudio. Resultados. Se incluyen un total de 271 pacientes, 73 pertenecen al primer grupo y 198 al segundo. Se objetivan diferencias estadísticamente significativas en la duración de la estancia hospitalaria con relación al antecedente de prematuridad, la edad del paciente, la existencia de VRS positivo, la presencia de fiebre, la puntuación en la escala de gravedad para bronquiolitis HSJD, el hallazgo de alteraciones radiológicas, la realización de analítica y la necesidad de tratamiento con antibióticos, oxígeno y alimentación por sonda nasogástrica. No hay diferencias en cuanto al sexo, los antecedentes de cardiopatía o displasia broncopulmonar (DBP), los resultados analíticos y la necesidad de tratamiento con broncodilatadores. La presencia de tres de los siguientes factores de riesgo: prematuridad, VRS positivo, fiebre, radiografía de tórax alterada, edad 6, tiene una sensibilidad del 63.5% y una especificidad del 79.5% como predictor de la duración superior a 72 horas de un ingreso por bronquiolitis. Si se tienen en cuenta sólo dos de los factores, aumenta la sensibilidad hasta el 89.8% en detrimento de la especificidad, que baja al 46.6%. Conclusión. Analizar conjuntamente determinados factores de riesgo en el momento del ingreso de una bronquiolitis mejora las previsiones en cuanto a la duración de la estancia en el hospital y facilita una distribución más adecuada de los recursos disponibles

Objectives. To determine the clinical factors that may help anticipate the length of hospital stay in children with bronchiolitis. Methods. Retrospective study based on the analysis of medical records of all children admitted to St Joan de Deu Hospital (SJDH) with the diagnosis of bronchiolitis in 1999. Patients were divided into two groups according to the duration of the admission. Group I: children who were hospitalized for >= 3 days. Group II: children who were hospitalised for > 3 days. Clinical, laboratory, and radiological data were reviewed. Results. 271 cases (Group I, 73; Group II, 198) were reviewed. We identified a significant relationship between the length of stay and the following parameters: prematurity, age, respiratory syncitial virus (RSV) infection, fever, high score in the SJDH bronchiolitis scale, abnormal imaging, need for laboratory evaluation, administration of antibiotics, need for oxygen supplementation, and need for nasogastric tube feeding. No relationship with duration of admission was found for gender, presence of congenital heart disease, bronchopulmonary dysplasia (BPD), results of laboratory evaluation, and need for bronchodilators. These results indicate a sensitivity of 63.5% and a specificity of 79.5% as predictor of admission > 72 hours if the patient has 3 of the following risk factors: prematurity, RSV infection, fever, radiological abnormalities, age < 2 months, and more than 6 points in the SJDH bronchiolitis score at the time of admission. The presence of two risk factors increases sensitivity to 89.8%, but the specificity decreases to 46.6%. Conclusion. The analysis of risk factors at the time of admission of patients with bronchiolitis may help in anticipating the duration of stay and facilitates the allocation of resources