An Sist Sanit Navar
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In this article, the authors explore the factors that, in their opinion, currently explain the complexity of emergency care in Spain. Since the start of the XXI century, and in spite of the fact that accident and emergency medicine in the world is undergoing considerable scientific-technical progress, accident and emergency care in Spain is immersed in a care maelstrom acting on a terrain that is ill-prepared for the successive emergent technological advances to take root and develop. ⋯ Due to all of this, advances are frequently achieved more through inertia, or through the overflow of information from other disciplines, than due to the initiative of the professionals of emergency medicine in Spain. Similarly, there is a growing tendency amongst these professionals to move to other disciplines or fields of care that offer better working conditions or simply better professional expectations.
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Hyperammonemia causes several alterations, mainly in the central nervous system. If hepatic failure is not its etiology, other less frequent causes must be investigated in the search for a definitive diagnosis. ⋯ The complex management of hyperammonemia and the high morbidity and mortality involved require a multidisciplinary approach. Only early treatment and identification of the hyperammonemia's etiology can avoid high morbidity and mortality in these patients.
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Intraoperative neurophysiological monitoring (IONM) makes it possible to determine the status of neurological function during surgery. It guides the surgeon and minimises the risk of injury. This paper describes the different techniques available for IONM in spine surgery (somatosensory evoked potentials, motor evoked potentials, neurography, electromyography, reflexes and dermatomic evoked potentials), which neurophysiologists employ depending on the nerve structures at risk. ⋯ In the event of IONM registering alterations, the neurophysiologist must first check the integrity of the recording system. The anaesthetist should then assess blood pressure, oxygen levels, ventilation and haematocrit values, and revert recent anaesthetic changes. Finally, the surgeon must stop the procedure and try to determine the cause of the event, and correct it if possible.
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An Sist Sanit Navar · Jan 2009
[Intraoperative neurophysiological monitoring: methods in neurosurgery].
IONM uses different neurophysiological techniques during surgery time, thus avoiding possible lesions to the neurological structures, making surgery safer and better. We describe two types of IONM: mapping techniques and monitoring techniques, as well as their advantages, disadvantages and complications. We look into the more useful techniques in this field, as well as providing orientation about its use according to the surgical areas and the neurological structures under risk. In conclusion, we affirm that IONM is one of the most important advances in modern neurosurgery.
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Endotracheal intubation using direct laryngoscopy continues to be the "gold standard" amongst all the techniques for isolating the airway. Generally this is a secure manoeuvre, but it might become a situation of extreme emergency when dealing with an unexpected difficult airway. ⋯ Its advantages over the Macintosh laryngoscope have been demonstrated in patients with an airway that it is difficult to manage and in adverse situations outside the surgical setting, when endotracheal intubation has been achieved in a simple way following unsuccessful attempts with conventional laryngoscopes. The greatest benefits in using the Airtraq laryngoscope have been shown in patients with a pronounced limitation of cervical mobility, and in those where the airway is distorted for anatomical reasons, such as pregnant women and obese patients.