Emergencias
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This objective was to analyze prehospital management of acute childhood poisonings. Poisonings treated in 59 pediatric emergency departments participating in the Toxicology Observation Project of the Spanish Society of Pediatric Emergency Medicine were registered prospectively between 2008 and 2014. We analyzed consultations made and treatments received before the patient arrived in the emergency department. ⋯ About half the cases that consulted a poisoning service but did not receive treatment before coming to a hospital did receive treatment in the hospital emergency department. We conclude that a substantial percentage of patients who seek care for childhood poisoning from an emergency department have also consulted a prehospital service. Better prehospital management of such cases could facilitate earlier treatment when required and also preempt unnecessary trips to pediatric emergency departments.
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This case series explored the usefulness of an inhaled dose of 9.1 mg of loxapine administered outside the hospital to treat psychomotor agitation related to schizophrenia, bipolar disorder, or schizoaffective disorder. The Clinical Global Impression Scale and the Positive and Negative Syndrome Scale (excitement component) were used to assess the effects of treatment in 14 patients. ⋯ Mechanical restraint and parenteral medication can be avoided after use of this drug. Loxapine treatment shortens the agitation episode and attenuates the impact on the patient, facilitating ambulance transfer.
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The new European Union directives affecting clinical trials of medicines introduced important changes for Spain, leading to the publication of a Royal Decree regulating the conduct of clinical trials that went into effect in January 2016. The decree sets out the principles for complying with the EU directives, regulates the work of institutional review boards (IRBs) or ethics committees that review research proposals, introduces means to facilitate clinical research, and clarifies the role of the Spanish register of clinical trials, among other topics. ⋯ These concepts may be particularly useful for clinical trials designed by emergency medicine physicians. We also comment on changes affecting vulnerable populations and the documents that must be presented to both the researchers' IRB and the Spanish Agency for Medicines and Health Care Products.
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Acute heart failure (AHF) has become a public health problem of the first magnitude: it is the main cause of emergencies and hospitalization in patients over the age of 65. Various guidelines for managing AHF have been drafted in recent years, yet we continue to see high readmission and mortality rates. ⋯ Few studies have analyzed precipitating factors in AHF and their role in prognosis. This review analyzes the prevalence of precipitating factors and their relation to readmission and mortality.
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Randomized Controlled Trial Comparative Study
[Ethyl chloride aerosol spray for local anesthesia before arterial puncture: randomized placebo-controlled trial].
To compare the efficacy of an ethyl chloride aerosol spray to a placebo spray applied in the emergency department to the skin to reduce pain from arterial puncture for blood gas analysis. ⋯ Topical application of an ethyl chloride spray did not reduce pain caused by arterial puncture.