El Holter toma protagonismo ante la indicación definitiva de estimulación cardíaca / Holter takes cente stage into final indication of cardiac stimulation

El estudio se realiza con miras a obtener datos concretos que confirmen la influencia en el diagnóstico de muchas patologías cardiacas detectadas por el Holter de frecuencia cardiaca. El Holter de frecuencia cardiaca de 24 horas es un dispositivo electrónico, de pequeño tamaño, que registra y almacena un trazado electrocardiográfico de dos o tres derivaciones, mientras el paciente realiza sus actividades de la vida cotidiana. La causa de esta investigación es el aumento de solicitudes en nuestro hospital y los numerosos informes que han ayudado en el diagnóstico de nuestros pacientes. El estudio se fundamenta en datos estadísticos. Se han fabricado dos bases de datos, una que recoge el total de estudios que se realizaron en 2013 y otra con los pacientes diagnosticados con necesidad de estimulación cardiaca y que se remiten a ello. Al cruzar estas dos bases de datos se obtiene una tercera con los pacientes enviados a estimulación cardiaca con Holter de frecuencia cardiaca realizado. Podemos con estos datos afirmar que, cuando se solicita esta prueba, tiene una gran influencia en el diagnóstico final (el 87 %) y existe una probabilidad alta de encontrar hallazgos significativos, sin olvidarnos de la clínica y con los aspectos personales de cada paciente (AU)

The study was performed in order to obtain specific data confirming the influence in the diagnosis of many cardiac pathologies detected by Holter heart rate. Holter heart rate of 24 hours is an electronic device, of small size, which records and stores an electrocardiographic tracing two or three leads, while the patient activities of daily life. It leads us to conduct this study increased requests we’ve had in our hospital and the numerous reports that have helped in the diagnosis of our patients. We base the study with statistical data, therefore, produce two databases, one that reflects the total of studies conducted in 2013 and another with patients diagnosed with cardiac stimulation and need to refer to it. Crossing these two databases get third with patients referred for cardiac stimulation Holter heart rate realized. With these data we can say that, when this test is requested, it has a great influence on the final diagnosis (87%) and there is a high probability of finding significant findings, without forgetting the clinical and personal aspects of each patient (AU)

Perioperative cardiopulmonary arrest competencies.

Although basic life support skills are not often needed in the surgical setting, it is crucial that surgical team members understand their roles and are ready to intervene swiftly and effectively if necessary. Ongoing education and training are key elements to equip surgical team members with the skills and knowledge they need to handle untimely and unexpected life-threatening scenarios in the perioperative setting. Regular emergency cardiopulmonary arrest skills education, including the use of checklists, and mock codes are ways to validate that team members understand their responsibilities and are competent to help if an arrest occurs in the OR. After a mock drill, a debriefing session can help team members discuss and critique their performances and improve their knowledge and mastery of skills.

Pacientes con tratamiento anticoagulante oral. ¿qué saben sobre su tratamiento? / Profile of women with breast disease wich does self-exploration. Which are the factors associated with this practice?

Introducción. Los pacientes anticoagulados con tratamiento oral (ACO) deben tener unos conocimientos de los riesgos que dicho tratamiento conlleva. Para ello el personal sanitario debe formar tanto al paciente como a su familia. Objetivos. Determinar el nivel de adhesión terapéutica que tienen los pacientes tratados con ACO en una consulta de atención primaria (AP) y en un área de salud urbana, como Plasencia. Material y método. Se realizó un estudio observacional descriptivo retrospectivo con 34 pacientes con tratamiento ACO. Se recogen datos de patologías, parámetros biométricos de las historias clínicas y entrevistas a los sujetos que acuden a la consulta de enfermería. Resultados. Una vez analizados los datos, el número de pacientes –según el sexo– estaba igualado; no sucedía lo mismo por edades donde la población entre 80-90 años constituía el 26,5 % del total; dentro de las patologías de las que se deriva el tratamiento, la fibrilación auricular (FA) es la más frecuente, con un 50%, siguiéndole el tromboembolismo pulmonar, con un 23%. El control de los resultados se distribuía de la siguiente manera: los más jóvenes se controlaban en atención especializada (AE), en su hospital de referencia; los de mayor edad en AP. En relación con la adhesión al tratamiento y la patología principal, quienes padecían FA y portaban una prótesis valvular cumplían el tratamiento en mayor número. Discusión. Para el profesional sanitario es necesario conocer el perfil del paciente con ACO, y si este sabe los riesgos que conlleva el tratamiento. Los enfermos jóvenes con patología cardiovasculares son controlados en el hospital por sus mayores oscilaciones en los resultados; la población mayor es vigilada en la consulta de atención primaria (AP), y los residentes en zonas rurales cuentan con una mayor adherencia y un mejor control. Con una completa información el personal sanitario puede efectuar intervenciones que ayuden a la adhesión, seguimiento del control y tratamiento, así como a la colaboración de familiares(AU)

Background/Aims: In recent decades the fight against breast cancer has focused primarily on the treatment and secondary prevention (early detection mainly). In the case of breast self-examination, althought it has not been prove to reduce mortality, it is important in cases detected by women themselves (it is estimated 90% of total), mainly in the interval cancers. Objectives: To identify within women with breast cancer, how many do self-examination and identify associated factors. Describe the clinical and pathological features of cancers in women who do perform self-examination. Methodology: In women diagnosed with breast cancer during 2007 in a hospital in the province of Cadiz, Spain, is reconstructed in retrospect the story related the cancer process: symptoms, psychosocial factors that determine the contact with the health system, preventive practices (self-examination, mammography screening). A description of the pathological tumor: presenting symptom, tumor size, node negative, grade of differentiation… Results: We studied 149 women with breast cancer, from whom 52% did self-exploration. Women who performed self-examination were younger (54.78 years) against the women who did not (65.63 years), married (66.2%), active workers and have a higher educational level. The assessment of the first symptoms in these women as «important» is positively correlated with those women who practice self-examination. For other preventive practices, women who does self-examination are also the most actives in early detection programs (74.4% against 29.5% which didn’t do self-examination). For the pathologic characteristics of tumor in women who did self-examination: the tumor size was 2.5 cm, 50.7 / are well differentiated, and 59.1% of cases the nodes are negative. Conclusions: Women who does self-examination are younger, have higher educational level, are married, are active workers and are often involved in other preventive practices. On them, the tumors diagnosed have a smaller size, are diagnosed at earlier stages and usually present better degree of differentiation (AU)

Nurse-initiated defibrillation: are nurses confident enough?

OBJECTIVES: To determine the capability of nurses to identify ventricular fibrillation (VF) and ventricular tachycardia (VT) rhythms on an ECG and carry out subsequent defibrillation on their own as soon as they identify and confirm cardiac arrest. METHODS: This was a prospective cohort study to determine the capability of emergency department (ED) nurses to recognise VF or pulseless VT correctly and their willingness to perform defibrillation immediately in an ED of a teaching hospital in Hong Kong. A questionnaire was completed before and after a teaching session focusing on the identification of rhythms in cardiac arrest and defibrillation skills. Correct answers for both ECG interpretation and defibrillation decisions scored one point for each question. The differences in mean scores between the pre-teaching and post-teaching questionnaires of all nurses were calculated. RESULTS: 51 pre-teaching and 43 post-teaching questionnaires were collected. There were no statistically significant changes in ECG scores after teaching. For defibrillation scores, there was an overall improvement in the defibrillation decision (absolute mean difference 0.42, p=0.014). Performance was also improved by the teaching (absolute mean difference 0.465, p=0.046), reflected by the combination of both scores. Two-thirds (67%) of nurses became more confident in managing patients with shockable rhythms. CONCLUSION: Nurses improve in defibrillation decision-making skills and confidence after appropriate brief, focused in-house training.

ICU nurses' perceptions of potential constraints and anticipated support to practice defibrillation: a qualitative study.

AIM: The study examines the experience of intensive care nurses in caring for patients in cardiac arrest, and their perceptions of introducing nurse-led defibrillation. METHOD: This was a descriptive, exploratory and qualitative study at an intensive care unit (ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were purposefully selected for interview. RESULTS: Although all the participants were trained in basic life support, only 50% were trained in advanced cardiac life support (ACLS), and those trained in ACLS described having limited opportunities to apply their defibrillation knowledge. Whilst participants believed that they were theoretically prepared to influence the patient's resuscitation outcomes, newly qualified nurses were reluctant to be accountable for defibrillation. In contrast, experienced nurses were more willing to perform nurse-led defibrillation. Support from management, cooperation between nurses and doctors, regular in-hospital 'real-drill' programmes, sponsorship for training, and the use of alternative defibrillation equipment should be considered to encourage nurse-led defibrillation in ICU settings. CONCLUSION: Nurse-led defibrillation is an approach of delivering prompt care to critically ill patients, and a way ahead for intensive care nursing in Hong Kong. Emphasis on a consistent policy to promote nurse-led defibrillation practice is needed.

Ventricular arrhythmias and sudden death in patients with chronic kidney disease.

One in four dialysis patients will die suddenly. Most do not fall into the high-risk categories that are associated with sudden death in the general population. The cause of sudden death in the dialysis population is unknown. It may be related to factors associated with chronic kidney disease (CKD) itself, for example, inflammation, vascular stiffness, left ventricular hypertrophy, coronary artery disease, electrolyte/fluid abnormalities or autonomic dysfunction. Studies of patients with implantable cardioverter defibrillators have shown that patients with CKD are more likely to use their devices for ventricular arrhythmias but in spite of this still have a high associated mortality. Until a comprehensive risk stratification strategy is understood, minimising risk by good control of basic parameters such as fluid balance, electrolytes and blood pressure, along with careful assessment of all patients for evidence of coronary artery disease and heart failure is the mainstay of management of the CKD patient.

Electrocardiographic evaluation of cardiovascular status.

The electrocardiogram (ECG) is indispensable for the diagnosis and management of patients with a wide variety of cardiac and noncardiac diseases. The purpose of this paper is focused on recent research that used ECG, specifically the long-QT interval and microvolt T wave alternans, for the evaluation of life-threatening ventricular arrhythmias. Although remaining to be validated, QT prolongation along with other emerging electrocardiographic indices such as T wave morphology, T peak-to-T end time, or beat-to-beat QT variability may be sensitive indicators of malignant polymorphic ventricular tachyarrhythmia, torsade de pointes. Microvolt T wave alternans may provide important information in identifying a low-risk group with left ventricular dysfunction who is unlikely to benefit from unnecessary prophylactic implantable cardioverter defibrillator therapy. These ECG markers have the potential to aid in the safe administration of individualized medications, avoidance of sudden cardiac death, and provision of a noninvasive strategy to identify patients who are most and least likely to benefit from expensive prophylactic implantable cardioverter defibrillator placement.

A revised role for the hospital cardiac arrest team?

This prospective study assesses the role of the hospital cardiac arrest team. We have determined who is responsible for return of spontaneous circulation in those patients who survive to discharge. A total of 83 adult patients were analysed over a 5 month period. Fifty-five patients had cardiopulmonary resuscitation after an in hospital cardiac arrest and circulation was restored in 14 (25.5%). Eight (14.5%) patients survived to discharge. All eight survivors had circulation restored by the first responder before arrival of the cardiac arrest team. Six survivors had witnessed ventricular fibrillation and successful defibrillation by nursing staff. The two other survivors had cardiac arrests in the presence of doctors. Twenty-eight patients had pre-hospital cardiac arrests and were attended by the cardiac arrest team in the emergency department. Six patients had circulation restored by the emergency medical services prior to hospital arrival and four (14%) survived to discharge. Two patients had circulation restored in the emergency department by the arrest team and none survived to discharge. All the survivors to hospital discharge had first responder return of spontaneous circulation. We suggest a revised role for the cardiac arrest team.