Emergencias
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Although 4769 transplants were performed in Spain in 2015 and the organ donor rate reached 39.7 per million population, thousands of patients remain on wait lists. Currently 65% of donors die from strokes and the mean donor age is 64 years. This profile calls for strategies to detect candidates outside the intensive care unit (ICU) and it justifies an ever stronger role for the participation of emergency services in the procurement process. Spain's National Transplant Organization (ONT) and the Spanish Society of Emergency Medicine (SEMES) have drafted recommendations whose purposes are to define the responsibilities of emergency staff in this process, to establish protocols for multidisciplinary cooperation that facilitate the identification of candidate donors, and to consolidate a new approach to patient care that will facilitate optimal management of the donor prior to ICU admission.
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To compare the frequency and characteristics of prehospital and hospital deaths and assess whether injury severity and age can predict mortality when prehospital deaths are included or excluded from total mortality. ⋯ Most deaths from injuries occur before patients reach a hospital. The main characteristics of prehospital and hospital deaths differ. Including data for prehospital deaths in regression models does not change survival prediction based on injury severity and age.
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Abdominal pain conditions that fall into the category of acute abdomen (AA) are the most important ones to identify quickly. Diagnostic delay can lead to death or significant complications. Biological markers have the potential to improve the diagnostic and prognostic capacity of clinical assessment and the conventional complement of tests. ⋯ The kinetics of CRP make it the most sensitive biomarker and one that is appropriate for assessing severity before the onset of clinical signs of severe sepsis or altered hemodynamics. Lactate is a marker of poor tissue perfusion, a key element in the management of severe sepsis and septic shock in AA. Since lactate testing is easy and inexpensive, this important biomarker is useful in the emergency department.