[Delay in the administration of thrombolytics in myocardial infarct]. / Retraso en la administración de trombolíticos en el infarto de miocardio.

OBJECTIVE: To evaluate whether fast track of patients with myocardial infarction, from the emergency department to the intensive care unit, significantly decreased the intrahospital delay in the administration of anti-thrombolytic agents. PATIENTS AND METHODS: Descriptive study performed in two phases (12 and 15 months, respectively) in a second-level hospital serving a community of 260,000 inhabitants (78,000 emergencies/year). RESULTS: A total of 264 patients with myocardial infarction participated (79.2% males); the intrahospital delay in the administration of anti-thrombolytic agents was 206.1 minutes (SD: 115.8) in 1995, versus 74.9 minutes (SD: 38.5) during 1997-1998, already with the fast track system in operation (difference of 2 hours statistically significant [p < 0.001]). Only five patients received therapy before 30 minutes. CONCLUSIONS: Although fast track at the intensive care unit notable decreased the delay in the administration of anti-thrombolytic agents, this delay is still excessive (over half and hour). Therefore, the authors propose the administration of the thrombolytic agents at the emergency department as additional strategy to reduce the delay.

The effect of rescuer fatigue on the quality of chest compressions.

OBJECTIVE: The aim of this study was to evaluate the influence of rescuer fatigue on the quality of chest compressions and the influence of the rescuer's gender, age, weight, height or professional status on the reduction of quality of chest compressions caused by fatigue. MATERIAL AND METHODS: The study was carried out with the Laerdal Skillmeter Resusci Anne manikin. The participants were doctors and nurses who work in the Intensive Care and Emergency departments, with an age ranging from 25 to 45 years and trained in cardiopulmonary resuscitation (CPR). Statistical analysis of results includes analysis variance and three models of multiple linear regression. RESULTS: Thirty-eight people took part in the experiment; 20 (52.6%) were females; 15 (39.5%) staff physicians, 15 (39.5%) nurses and eight residents. Mean age was 34.1 years (SD = 4.1). We found a significant reduction in correct compression performance over the course of time: in the first minute 79.7%, in the second 24.9%, in the third 18%, in the fourth 17.7% and in the last minute 18.5%. There were no differences related to the rescuer's gender or profession. The median interval until rescuers appreciated the effect of the fatigue on chest compressions quality was 186 s (SD = 84.1); that appreciation was not influenced by gender, age, weight, height or profession. There were no differences in the percentage of correct compressions related to gender (P = 0.07), insufficient sternal depression (P = 0.23) or total number of compressions in the first minute. DISCUSSION: A decrease of compressions quality after the first minute of CPR is produced. This effect does not depend on gender, age, weight, height or rescuer's profession and it is not adequately perceived by the person who performs the chest compressions.

Competence of health professionals to check the carotid pulse.

Our objective was to establish the proportion of Emergency Room and Intensive Care doctors and nurses able to locate the carotid pulse in less than 5 s, and identify the variables that influence this ability. The method followed was locating the carotid pulse in a healthy male adult volunteer with normal blood pressure in two situations (stretcher or floor) and with the neck in either a neutral or in an extended position. We recorded the gender, age, and previous training in cardiopulmonary resuscitation (CPR) of each participant and the time spent in detecting the pulse in each of the four possible positions. A model of logistic regression was constructed to determine if the patient's position had any influence on the proportion of health workers capable of finding the pulse within 5 s. The average age of the 72 subjects studied was 33.4 years (SD = 6.6); 80% of the participants had CPR training. Thirty-one participants (43.1%; CI 95%, 31.4-55.3%) required more than 5 s to detect the pulse, although only three (4.2%; CI 95%, 0.9-11.7%) required more than 10 s. The variable 'no CPR training' was associated with the inability to detect the pulse within 5 s. The detection of the pulse was easier with an extended neck. A significant proportion of nurses and doctors were slow to locate the carotid pulse on a healthy, young volunteer with normal blood pressure. No relation was found between gender or age of the participants. More attention should be given to carotid pulse detection in CPR training.

Oral findings in Mexican AIDS patients with cancer.

Oral findings of 42 Mexican AIDS patients with cancer were reviewed. Kaposi's sarcoma (KS) was the most frequent malignancy (81%) followed by non-Hodgkin's lymphoma (NHL) (12%). All cases of NHL were of high or intermediate grade and most of them were extranodal. Out of the 34 individuals with KS, 22 (65%) showed oral KS and in 21 of them the palate was involved. The clinical features of oral KS including site, appearance and size are described. Pseudomembranous candidosis (PC), hairy leukoplakia (HL) and exfoliative cheilitis (ECh) were also found in these patients. There was no association of these lesions with any type of cancer. A strong association of oral candidosis and history of this infection was found, RR = 7.0 (1.3-4.1). There was evidence of severe immunosuppression in most patients, with mean average CD4 counts of 116 mm3 (range 4-841/mm3). Oral KS, ECh, PC and HL were more common in patients with lower CD4 counts. Our findings illustrate the most frequent oral lesions associated with HIV-1 infection in patients with AIDS and cancer, and further support the importance of oral examination in HIV infected patients.

[Sarcoidosis. Retrospective study of 30 cases in Salamanca and comparison with other national series]. / Sarcoidosis. Estudio retrospectivo de 30 casos en Salamanca y comparación con otras series nacionales.

Sarcoidosis is a disease which presents important clinical differences according to its geographical distribution. Thus, the objective of this study was to evaluate the epidemiologic, clinical, radiologic, and diagnostic characteristics in a series of 30 sarcoidosis patients in the province of Salamanca (representing the Castilla-Leon region). The most relevant results are the following: a) in our region, sarcoidosis predominates in females and furthermore, the presenting age in females is greater than in males; b) there is a clear predominance of the disease in the rural area; c) the prevalence of smoking habit in these patients is low (10%); d) the clinical manifestations are similar to other Spanish series with the exception, however of a high incidence of hypercalciuria; e) there is no correlation between the increase in sedimentation rate and the degree of sarcoidosis activity; f) there is a predominance of the radiologic type 11 of the disease and there is a high number of atypic radiologic patterns. The results obtained are with regard to the pathogeny are discussed as well as the differences and similarities of this series with other preceding from other regions.