Informática en Medicina de Urgencias y Emergencias: Gestión de la información y aplicaciones en el siglo XXI / Emergency Medicine Informatics: Information Management and Applications

La informática en Medicina de Urgencias y Emergencias (IMUE) es la recogida, gestión, procesamiento y aplicación de los datos de la atención prestada a los pacientes urgentes, así como los datos operativos. La IMUE está transformando y mejorando nuestros sistemas de atención prehospitalaria y las intervenciones de los servicios de urgencias hospitalarios(SUH). Es fundamental para la vigilancia de la salud pública, y nos permitirá ampliarla investigación clínica en las instituciones, regiones y naciones. La IMUE es una de nuestras herramientas más importantes para mejorar la atención de emergencias y repercutirá positivamente en la salud de la población. Para la atención prehospitalaria, los sistemas IMUE proporcionan información para analizar la relación coste-eficacia de las intervenciones clínicas, para organizar las operaciones del servicio médico de emergencias (SME),para coordinar la comunicación en las solicitudes de servicio, vigilar el control de calidad y las necesidades educativas, y para el seguimiento de la evolución de los pacientes. La práctica de la Medicina de Urgencias y Emergencias en el SUH requiere la captura de muchos datos y elementos temporales para que la atención del SUH sea eficiente. Los módulos IMUE apoyan el seguimiento y la precisión del triaje, el seguimiento del paciente, el control de médicos y enfermeros, la decisión clínica, el orden de entrada, las instrucciones de alta y la generación de prescripciones. Debe haber coordinación del IMUE con el hospital, laboratorio y los sistemas de información del servicio de radiología, así como con los registros sobre acceso al hospital y a las clínicas ambulatorias. La información clínica se debe agregar a una base de datos del SUH que luego se puede utilizar para (..) (AU)

Emergency Medicine Informatics (EMI) is the collection, management, processing, and application of emergency patient care and operational data. EMI is transforming and improving our prehospital care systems and emergency department(ED) operations, is critical for public health surveillance, and will enable us to expand clinical research in our institutions, regions, and nations. EMI is one of our most important tools for improving emergency care and positively impacting the health of the public. For prehospital care, EMI systems provide information to analyze the cost-effectiveness of clinical interventions, to organize EMS operations, to coordinate communication for service requests, to monitor quality control and educational needs, and to track patient outcomes. The practice of emergency medicine in the ED requires the capture of many data and time elements so that ED care is efficient. EMI modules support triage acuity and tracking, patient tracking, nurse and physician charting, clinical decision support, order entry, and discharge instructions and prescription generation. There must be coordination of the EMI with hospital, laboratory, and radiology reporting systems, and access to hospital and ambulatory clinic records. Clinical information should be aggregated into an ED Database which can then be used for clinical investigation. The cooperation and support of the hospital information services department, hospital administration, emergency medicine physicians, and emergency medicine researchers, is necessary so that the ED database will be well constructed, and most importantly, well used to improve patient care. Because the information from (..) (AU)

Sildenafil citrate and Torsade de pointes

Sildenafil citrate is a drug used in the treatment of erectile dysfunction. It is an inhibitor of the enzyme phosphordiesterase-5; it slows down the breakdown of c-GMP and nitrous oxide. The cardiac effects associated with Sildenafil citrate have been extensively studied in medical literature, especially its potent vasodilatory effect when combined with nitrate-based medications, producing intractable hypotension, but a lesser known and potentially lethal side effect is prolonged cardiac repolarization when used at dosage greater than recommended, leading to QT prolongation that could theoretically lead to dangerous cardiac dysrrhythmias and sudden death in men with coronary artery disease. The authors present the case of a 49-year-old hypertensive Hispanic man who arrived to our emergency department with the chief complaint of acute epigastric pain for 3 hours of evolution after ingestion of Sildenafil citrate 50 milligrams (mg). The patient was found to have an acute ST elevation inferior myocardial infarction (STEMI). Shortly after diagnosis the patient developed a polymorphic ventricular tachycardia (Torsade de pointes) before thrombolytic administration. We present this case followed by a brief discussion, to heighten awareness of the possible association of acute inferior STEMI and the development of Torsade de Pointes after the use of Sildenafil citrate.

Head trauma and hemophilia B: case report about a challenging hematologic emergency

Bleeding emergencies are common chief complaints in visits to the Emergency Department (ED) but hemophilia, a rare congenital bleeding disorder requires immediate treatment. Hemophilia B is characterized by a deficiency of coagulation Factor IX. As emergency medicine physicians we must be prepared to deal with such emergencies. One of the most feared complications in this population is the spontaneous or post-traumatic development of intracranial hemorrhage (ICH). We present a case of a 69 year-old man with a past medical history of hemophilia B who presented to the emergency department after suffering a head trauma with development of acute and delayed ICH.

Automated external defibrillators in public places: an overview

Cardiovascular disease is the leading cause of death for adults 40 years of age or greater in the United States and in Puerto Rico. There are approximately 165,000 out-of-hospital cardiac arrest (OHCA) events every year in the US. Since more than 30 years cardiopulmonary resuscitation (CPR) skills have saved thousands of lives. The majority of cardiac arrest events occur out of the hospital and without early access to CPR and a defibrillator these patients don't have a chance of survival and the majority will die before reaching the hospital. The development of CPR in the 1960's and the invention of automated external defibrillators (AED) in the 1970's revolutionized the means to approach OHCA victims. For the last 10 years the deployment of AEDs in public locations has been a successful model addressing this major public health concern. This article reviews the role AEDs play in the early management of OHCA victims and why public access defibrillation (PAD) programs are necessary.