[Chronobiology of out-of-hospital cardiac arrest in Galicia with semi-automatic external defibrillators]. / Cronobiología de la parada cardíaca en Galicia atendida con desfibriladores semiautomáticos externos.

OBJECTIVE: To analyze the chronobiological variations of out-hospital cardiac arrest in which an automated external defibrillator was used in Galicia. METHOD: Descriptive retrospective study of the cardiac arrest attended by the Emergency Medical Service in which an automated external defibrillator was in use during a period of 5 years (2007-2011). An Utstein style database was used. The sex, age, date and hour of the event, location, cardiac arrest attended, beginning of resuscitation by the professional, first monitored rhythm, emergency team activation time and care, endotracheal intubation, and recovery of spontaneous circulation were studied as independent variables. RESULTS: A total of 2,005 cases (0.14/1,000 population-year) was recorded. Time slot with more frequency of cardiac arrest: between 09-11 hrs (18.4%). Months with more cases: January (10.4%) and December (9.8%). It was significantly more probable that the cardiac arrest occurred in the home between 00-08 hrs, and in the street between 08-16 hrs. Asystole was more frequent in the night period (00-08 hrs), whereas the shockable rhythm was in the evening (16-00 hrs). There is more probability of death after cardiac arrest between 00-08 hrs, with recovery of spontaneous circulation being more probable between 16-00 hrs. The time between the emergency team activation and time care was longer in night schedule. CONCLUSIONS: In Galicia, cardiac arrest is more frequent in the winter months and in morning schedule. There is a circadian distribution of the cardiac arrest and the rhythm detected at the time of the first assistance, with asystole being more common in night schedule and the shockable rhythm in the evening. The chronobiology of the cardiac arrest should be taken into account in order to organize the distribution and the schedule of the healthcare resources.

[Assessment of primary care paediatricians performance in a paediatric trauma simulation]. / Evaluación de la actuación de los pediatras de atención primaria en un escenario simulado de trauma pediátrico.

INTRODUCTION: Training by means of advanced simulation can improve the paediatrician's abilities in the management of paediatric trauma patients, as well as decreasing errors and increasing patient safety. The initial management is an essential factor in the outcome of an injured child. MATERIAL AND METHODS: A trauma patient scenario was included in a national simulation training program. The performances of 156 paediatric primary care providers, divided into 39 teams, who participated in the courses carried out from May 2008 until February 2010 were retrospectively analysed. The evaluation of the scenario was based both on the primary survey suggested by the Working Group on Trauma of the SECIP, and in the 8 main targets of a simulation evaluation tool from the Cincinnati Children's Hospital trauma care program. RESULTS: A pulse oximeter was placed, the intravenous/intraosseous access was indicated, the blood pressure was checked, and the oxygen was applied In 100% of the scenarios. An intravenous fluid bolus was indicated in 87% of the scenarios. The Glasgow scale was performed in 5.1%, and the appropriate warming measures in 25.6%. The bilateral cervical immobilisation was incorrect in 35% of the scenarios (89.7%). The primary survey (ABCDE) was checked correctly in only one scenario. With a top score of 16, based on Cincinnati Hospital, the teams mean score was 5.3 ±1.8. CONCLUSIONS: Primary care paediatricians have problems applying the primary ABCDE trauma care sequence and the cervical spine precautions in a trauma simulation scenario. Educational programs for paediatricians must improve the practical check points of the initial approach to trauma management.

[Advanced simulation for primary care paediatricians. Development of an itinerant program and opinions of participants]. / Simulación avanzada para pediatras de atención primaria. Desarrollo de un programa itinerante y opinión de los participantes.

INTRODUCTION AND OBJECTIVES: Advanced simulation (AS) is a teaching methodology that has shown to be useful for training health staff at hospital level; however, its application in primary care paediatrics is very limited. Our objective was the development of an AS project focused on the learning needs of the primary care paediatricians, as well as to know the participants' opinions as one of the elements to assess its appropriateness. MATERIAL AND METHODS: Phase 1: A multidisciplinary working group was organized and sponsored by the SEPEAP to design and put the course into practice. Phase 2: Itinerant courses were carried out in several cities in Spain. At the end of each course, a survey was carried out that was focused on motivation aspects, pertinence of contents and methodology. Each item was scored on a numerical scale from 0 (very bad) to 10 (very good). STUDY PERIOD: May 2008 to May 2009. RESULTS: After analysing the potential learning needs of target population, available time, teaching material available and methodology of simulation and debriefing, a course model was designed and the cases were programmed. Twelve courses were carried out in 12 cities. The total number of participants was 186; of them, 177 (95.2%) answered the survey. Mean+/-SD scores for main items were: organization (9.23+/-0.50), objectives related to prior expectation (9.29+/-0.43), usefulness of course program to work activity (9.42+/-0.43), cases that resemble reality (9.18+/-0.42) and good instructors-participants relationship (9.68+/-0.20). CONCLUSIONS: The AS course for primary care paediatrics, with the proposed format, is feasible and well adapted to the needs of the target population. Primary care paediatricians consider this type of teaching and learning activity as a useful tool for their continuing education and for improving their professional abilities.

[Automated external defibrillation in children]. / Desfibrilación semiautomática en niños.

Ventricular fibrillation is an infrequent arrhythmia in cardiac arrest occurring in the out-of-hospital setting in infants and small children. However, outcome is good provided early defibrillation is performed; consequently, this procedure is one of the main links in the chain of survival in children with a shockable rhythm. Automated external defibrillators are small devices that can analyze heart rhythm and deliver a dose of electric energy when considered timely by the operator. Automated external defibrillators are easy to use and can be operated, if necessary, by anyone. Therefore, all pediatricians should be aware of how these devices work and be able to use them safely and effectively, following the current defibrillation protocol.

[Semiautomatic defibrillation in children]. / Desfibrilación semiautomática en niños.

The main survival factor in cardiac arrest secondary to ventricular fibrillation (VF) is the interval between collapse and defibrillation; consequently, this treatment constitutes one of the most important links in the survival chain in adults. Although VF is a rare cause of out-of-hospital cardiac arrest in children, its detection and treatment is essential because in the pediatric cardiac arrest scenario, VF is the dysrhythmia with the best prognosis. Automated external defibrillators (AED) are simple devices that allow cardiac rhythm to be analyzed; they can also determine whether it is shockable or not with high sensitivity and specificity in adults and children. Currently available evidence has prompted the recommendation of AED use in children older than 1 year without signs of circulation, mainly in the pre-hospital setting and ideally with a dose-limiting device.