“Medicina táctica: directrices basadas en la competencia”

Medicina Tactica

Schwartz, Richard Bruce; McManus Jr, John G.; Croushorn, John; Piazza, Gina; Coule, Phillip L.; Gibbons, Mark; Bollard, Glenn; Ledrick, David; Vecchio, Paul; Brooke Lerner, E. Prehospital Emergency Care (ed. esp.).2011; 04 :93-114

Enlace para bajar documento en formato pdf 

 

FDA approves less-invasive heart defibrillator

FDA approves less-invasive heart defibrillator

New device uses wires that sit just below skin's surface and do not need to be threaded through heart's blood vessels

 September 30, 2012

 The Associated Press

WASHINGTON — The Food and Drug Administration says it has approved a first-of-a-kind heart-zapping implant from Boston Scientific that that does not directly touch the heart.

Implantable defibrillators use thin wires to send electrical signals that disrupt dangerous heart rhythms. Surgeons have traditionally connected the wires to the heart through a blood vessel in the upper chest.

The new device from Boston Scientific uses wires that sit just below the skin's surface and do not need to be threaded through the heart's blood vessels.

Natick, Mass.-based Boston Scientific Corp. acquired the device through a $150 million buyout of San Clemente, Calif.-based Cameron Health. Under the terms of the deal, Boston Scientific will pay an additional $150 million for FDA approval, plus up to $1 billion in payments based on future sales figures.

Link information web

Copyright 2012 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Related:

EU Issues OK for Minimally Invasive Subcutaneous Implantable Defibrillator

Antibiotics for early-onset neonatal infection: antibiotics for the prevention and treatment of early-onset neonatal infection August 2012 / Guía NICE para uso de antibióticos en sepsis neonatal temprana Agosto 2012

Antibiotics for early-onset neonatal infection: antibiotics for the prevention and treatment of early-onset neonatal infection August 2012 

NICE Clinical Guideline 2012

 Published by the Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s
Park, London NW1 4RG
www.rcog.org.uk
Registered charity no. 213280
First published 2012
© 2012 National Collaborating Centre for Women’s and Children’s Health

Link to download the guide in pdf format

Cuatro grandes razones para limitar la ingesta de azúcar

Azúcar Peligros

Cuatro razones por las cuales hay que limitar el consumo de azúcar 

Fuente Blog de Farmacia Medicina Natural y Nutrición

El exceso de consumo de azúcar pone tu cuerpo en peligro de muchas enfermedades potencialmente fatales.
A continuación, presentamos 4 razones por las cuales el azúcar debe ser restringido en la dieta.
Presión arterial alta – Los niveles normales de óxido nítrico mantienen los vasos sanguíneos saludables y abiertos. El exceso de azúcar en la dieta disminuye los niveles de óxido nítrico, causando que los vasos sanguíneos se estrechen, lo que hace que la presión arterial se eleve y aumente el riesgo de enfermedad cardiaca.

1. Presión arterial alta – Los niveles normales de óxido nítrico mantienen los vasos sanguíneos saludables y abiertos. El exceso de azúcar en la dieta disminuye los niveles de óxido nítrico, causando que los vasos sanguíneos se estrechen, lo que hace que la presión arterial se eleve y aumente el riesgo de enfermedad cardiaca.
2. Colesterol alto – Las personas que consumen demasiada azúcar son más propensas a tener niveles más bajos de HDL, o colesterol bueno, niveles más altos de LDL, o colesterol malo, y niveles más altos de triglicéridos o grasas en sangre. Esto obstruye las arterias y los vasos sanguíneos, lo que lleva a la enfermedad cardíaca.
3. Enfermedades del hígado – Una dieta alta en azúcar se cree que agrava la enfermedad de hígado graso. Demasiada azúcar causa picos de insulina y conduce la grasa hacia las células del hígado, lo que causa inflamación y cicatrización, causando finalmente que el hígado se torne cirrótico.
4. Resistencia a la insulina – Cuando el azúcar entra en el cuerpo, la insulina abre la puerta para permitir que el azúcar llegue a las células. Sin embargo, cuando hay picos continuos de azúcar, la insulina se vuelve menos eficaz. El azúcar no puede entrar en las células y se “atascan” en el cuerpo, produciendo efectos tóxicos que conducen a la obesidad y el riesgo de diabetes.

Excesivo Consumo de analgésicos produce más dolores de cabeza

Dolores de Cabeza "CEFALEAS"

ADVERTENCIA | Consumo excesivo

Abusar de los analgésicos produce más dolores de cabeza

• Expertos señalan que el abuso de estos fármacos potencia las cefaleas
• Ibuprofeno, paracetamol o aspirina, 15 o más días al mes, cronifican el dolor
• Las migrañas y las cefaleas deben diagnosticarse y tratarse por el neurólogo 
  
  Ángeles López | Madrid
  Actualizado viernes 21/09/2012 05:23 horas 
   
  Fuente Informacion  ELMUNDO.ES

Si usted es de los que cada dos por tres toma paracetamol, aspirina o ibuprofeno, solos o en un 'combinado', para su cefalea o migraña y, a pesar de todo, sigue con un perenne dolor de cabeza debería saber que el origen de su problema está en su intento de solucionarlo: la medicación. Los expertos advierten de que el abuso de fármacos para combatir este trastorno es una lucha inadecuada y contraproducente o, como se diría popularmente, que es peor el remedio que la enfermedad.
No es anecdótico. Se estima que hasta una de cada 50 personas tiene cefalea causada por la ingesta excesiva de analgésicos. Esta semana los Institutos Nacionales de Salud británicos, más conocidos por sus siglas NICE, advertían en un comunicado sobre los riesgos del abuso de analgésicos para tratar las cefaleas o las migrañas y publicaban unas guías informativas para médicos de Atención Primaria y para el público en general. Tomar estos medicamentos con demasiada frecuencia, la mitad de los días del mes (día arriba, día abajo), empeora el dolor de cabeza. Hecho que en España es bien conocido por los neurólogos.
"La cefalea por abuso de medicación está descrita desde hace tiempo en la clasificación de estos trastornos realizada por la Sociedad Internacional de Cefaleas. Es bien conocida por los médicos, sobre todo por los neurólogos. El problema es que en el Reino Unido hay muy pocos neurólogos en comparación con España, no sé exactamente las cifras, pero la relación podría ser de un especialista allí por cada cinco aquí. Por este motivo, comunicados como este los hacen con relativa frecuencia para informar a los médicos de Atención Primaria, que son quienes tratan a estos pacientes", explica Patricia Pozo, secretaria del Grupo de Estudio de Cefaleas de la Sociedad Española de Neurología.
De ahí que en las nuevas guías elaboradas por NICE se establezcan cuáles son los criterios para considerar que una persona está en riesgo de sufrir una cefalea por abuso de medicación. De esta manera, establecen dos grupos. El formado por paracetamol, aspirina y antiinflamatorios no esteroideos, como el ibuprofeno, que, cuando se toman "15 o más días al mes, pueden causar dolor de cabeza por abuso", explica Martin Underwood, médico y profesor de Atención Primaria de la Warick Medical School y uno de los autores de la guía del NICE.
El segundo grupo, compuesto por medicamentos más fuertes, como los triptanos, opiáceos o una combinación de analgésicos, no debe tomarse 10 o más días al mes, ya que de lo contrario es probable que generen una cefalea constante en las personas que ya padecen este problema o tienen migraña.
Aunque la cefalea es el problema neurológico más frecuente al que se enfrentan tanto los médicos de primaria como los neurólogos, "muchas personas no reciben el diagnóstico correcto", afirma el doctor Gillian Leng, subdirector ejecutivo del NICE. "Esperamos que nuestras guías sirvan para ayudar a estos profesionales a diagnosticar adecuadamente el tipo de cefalea y reconocer mejor a los pacientes cuyas cefaleas puedan ser originadas por una sobredependencia a los medicamentos".

Cefalea "Dolor de Cabeza"

Tratamientos para cada uno

Cada tipo de cefalea requiere un tratamiento específico y un control distinto. "La cefalea en tensión o tensional, aquella generada por el estrés y que la suelen tener de forma esporádica la mayoría de las personas, puede tratarse con analgésicos habituales. Sin embargo, para la cefalea en racimos, con un dolor más intenso focalizado en un lado de la cara (zona frontotemporal) cuya duración oscila de una a tres horas y se asocia a lagrimeo y enrojecimiento de ojos, el tratamiento adecuado consiste en [fármacos denominados] triptanes u oxígeno inhalado a unas pautas concretas", explica Pozo.
Y luego están las migrañas, que afectan al 12% de la población, y que deben tratarse con fármacos triptanes o con antiinflamatorios.
Pero, estos medicamentos, tal y como señala la neuróloga española, son los que están indicados para los episodios esporádicos de cefaleas o migrañas. "Otra cosa es el tratamiento preventivo que debe considerarse cuando los dolores son muy frecuentes o incapacitantes. Tanto el uno como el otro lo debe pautar el médico, pero es con la medicación preventiva como se puede evitar, o paliar, la aparición de cefalea o migraña recurrente. Con un tratamiento adecuado, no aparecerá la cefalea por abuso de fármacos", aclara.

Cefaleas Tipos

Origen multifactorial

El problema es que hay varios factores que conducen al abuso de este tipo de fármacos. "Todo el mundo sabe que hay productos que se pueden tomar cuando tienen dolor. Además, estos medicamentos se pueden comprar sin receta y no son caros. Por otro lado, en algunos casos, la migraña y algunos tipos de cefalea son recurrentes y es fácil anticiparse al dolor, por lo que mucha gente los consumen para prevenir el dolor, es más, muchas personas nada más levantarse se toman una pastilla con este fin", señala Pozo.
También está el hecho de que las migrañas si no se tratan pronto el dolor no termina de marcharse. Además, "los médicos hemos insistido mucho en esto. Pero el mensaje correcto es que hay que tomar la medicación cuando empiece el dolor, no antes. Por todas estas razones, en muchos casos se abusa de los analgésicos. Sobre todo, lo hacen las personas con migrañas".
De llegar al consumo que los médicos determinan peligroso (ingerir analgésicos fuertes 10 días al mes y 15, para los otros), en un plazo corto, de unos tres meses, esa cefalea o migraña inicial se puede transformar en un problema crónico conocido con el nombre de cefalea por abuso de medicación.
"Espero que la guía mejore la conciencia de que se abusa de estos fármacos tanto en Atención Primaria como por el público en general, porque la prevención es simple y el tratamiento es difícil. Hay que explicar al paciente que deberá dejar de golpe su medicación, que con ello su dolor de cabeza empeorará durante las siguientes semanas pero que luego mejorará", afirma Underwood.

Intranasal Drug Administration EMSWORLD

How to give nasal spray narcan

Intranasal Drug Administration: An Innovative Approach to Traditional Care 

 Information from EMSWORLD

by Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT and Scott R. Snyder, BS, NREMT-P
Created: April 5, 2011

Intranasal drug administration offers all levels of EMS providers a safe and effective alternative for drug delivery

Emergency medical providers across the country use a variety of drugs to help manage patients in the prehospital setting. Depending on each service’s region and level of care, the number of drugs available to a given provider can range from as few as five to as many as 100. As prehospital care grows and expands, medical directors, EMTs, paramedics and managers are all looking for ways to grow the quality of care delivered prior to emergency department arrival. Improving the quality of care does not always mean expanding someone’s scope of practice by adding more interventions and more drugs to a provider’s toolbox. It can also mean finding new ways to deliver current interventions more efficiently and safely. Previously, this has included the transition to needleless intravenous (IV) line med-ports, auto-retracting IV needles, utilization of emergency medical dispatch to eliminate the unnecessary use of lights and sirens, and the ever-changing tweaks to cardiopulmonary (perhaps soon to be called cardiocerebral) resuscitation.

This continuing education article will discuss intranasal drug administration—a delivery route that has not seen widespread EMS utilization, but which offers all levels of EMS providers a safe and effective alternative for drug delivery in a variety of emergency settings.

Intranasal Drugs

The idea of intranasal (IN) drug administration is not completely new. An article in the April 2007 issue of EMS Magazine by Rob Curran called for its widespread introduction and use.1 Curran cited then-recent research that suggested IN drug administration was safe and could be nearly as effective as IV administration; however, to date, widespread use has not caught on. While there are a variety of reasons that could be argued, probably the most simple is that EMS as a system can be slow to change. Another reason is that the administration of intranasal drugs is considered off-label, since few drugs have been specifically presented to the FDA for approval via the intranasal route. Remember, though, many drugs used in emergency medicine are considered off-label. Since Curran’s article, more research has been completed on both understanding how IN drug administration works and what drugs are effective via the IN route.

The nasal cavity has two primary functions: olfaction, or sense of smell, and warming, humidifying and filtering the air we breathe. It is the latter function that is important when discussing intranasal drug administration. Inside the nasal cavities are turbinates, which are highly vascular and convoluted passageways lined with a warm, moist mucosal layer. The moist mucosal layer moisturizes air as it passes though the turbinates, and the dense capillary beds allow heat transfer into the air. Additionally, the highly vascular turbinates allow for rapid drug absorption into the bloodstream because the capillaries within the turbinates are specifically designed to allow the rapid shift of fluids (medicines) across the capillary membranes. Turbinates increase the nasal mucosal surface area from what would likely be only a few square inches to over 180 cm2.2

Intranasal drug administration, like intravenous administration, avoids first-pass metabolism by allowing drugs to enter directly into systemic circulation rather than requiring them to be absorbed through the GI tract and filtered by the liver. When a drug is absorbed through the gastrointestinal tract, it must pass through the liver prior to entering central circulation. When a drug passes through the liver, it is filtered. Liver filtration leads to a portion of the drug dose being metabolized into waste before it can be beneficial for the patient. Intravenous drug administration, like intranasal drug administration, avoids first-pass metabolism by introducing the drug directly into the central circulation. Avoiding first-pass metabolism increases the amount of drug that can benefit the body, because first-pass metabolism is a process by which the drug’s serum concentration is greatly decreased as it passes through the liver for the first time.
Drugs in central circulation are still eventually metabolized by the liver into other chemicals. The goal of therapeutic drug administration is to have enough of the drug remaining after it circulates through the liver so the drug is beneficial to the patient. Because the nasal mucosa is so close to the central nervous system, drugs given IN have an opportunity to reach their target organ, which is often the brain, prior to being exposed to first-pass metabolism.
Additionally, the olfactory tissues relay sense of smell signals directly to the central nervous system. Olfactory mucosa is on the superior aspect of the nasal cavity and actually extends through the skull’s cribiform plate and into the cranial cavity. When drugs impact this olfactory mucosa, they are absorbed directly through these tissues into the cranial cavity and are diffused in the cerebral spinal fluid. This pathway allows for the rapid onset of drugs that impact the central nervous system and also allows drugs to bypass the blood-brain barrier.2

Delivery Methods

There are three primary methods for drug delivery to the IN route. Many EMS providers have managed patients who have snorted drugs like cocaine. While inhaling dry powder is a method for delivering drugs to the nasal mucosa, crushing up and snorting medications is not routinely recommended, as there is little control over the actual amount of medication delivered, and it should not be employed by prehospital providers.
Another delivery method is with a syringe and dropper; the syringe can double as the dropper. With this method, a specific drug amount can be drawn up using the syringe, which allows for precise drug dosing. However, to properly deliver the drug using this method, drops of the medication must be delivered onto the mucosa one at a time. Delivering the drops too fast will cause the drug to drip into the back of the throat and it will not be absorbed into the bloodstream. Proper delivery also requires that the patient be positioned with their head tilted backward so the medicine drips through the turbinates and not back out of the nose. This can pose a problem with patients who cannot lie still with their head backward—particularly seizing patients, children and noncooperative patients. For years this was the preferred nasal delivery system and is one reason IN delivery did not become popular.
Syringe and atomizer devices have been developed over the past several years and have drastically simplified the delivery route. Spray-tipped atomizers can be attached onto syringes and break the drug into fine particles. These particles more broadly distribute the medication across the nasal mucosa, which increases the drug’s bioavailability compared to the syringe and dropper method. Bioavailability refers to the amount of drug that actually makes it into the bloodstream and is available to the body. There is an increased bioavailability because the atomizer reduces the loss of drug droplets into the back of the throat. Also, with an atomizer the drug can be delivered with the patient’s head in any position; it does not have to be tilted backward like with the syringe and dropper. deally, intranasal medications administered by prehospital providers should be administered with an atomizer device. However, even with these devices, there are a few keys to delivery to keep in mind:2

• Use as highly concentrated a form of the drug as possible
• Limit the fluid volume delivered to a nostril to 1 mL or less
• Divide the total amount of fluid to be delivered evenly between both nostrils
• Atomizers may have “dead space” within them and should be flushed with saline to deliver all of the medication
• Allow 15 minutes before administering subsequent intranasal doses.
  
  The intranasal drug route is more than just an administration route. There are unique benefits for IN delivery. The anatomy of the nasal mucosa allows for rapid drug absorption, and its location allows drugs to be delivered directly into the bloodstream and bypass the blood-brain barrier, all without the need for establishing IV access. Bypassing the blood-brain barrier allows many drugs to more rapidly benefit the patient by speeding their action on the central nervous system. This is particularly beneficial when administering benzodiazepines for patients experiencing seizures.
  Another benefit of the route is its safety. No needles are needed, such as with IV, subcutaneous and intramuscular drug delivery. The absence of needles increases provider safety, particularly when the need arises to administer drugs to combative or seizing patients. Eliminating needles decreases the chances of accidental needlesticks both on scene and while managing patients during transport.
  The disadvantage to intranasal drug delivery is that a limited number of drugs can be delivered to the nasal mucosa. Not every drug used by prehospital providers can be atomized for absorption and provide the same intended effects. Additionally, patients with diseased or unhealthy nasal mucosa, such as from long-term drug abuse or cancer, will likely have impaired drug absorption, as their turbinates can be destroyed or damaged from disease processes. Foreign debris, such as blood and other fluids in the nasal cavity, can also impair drug absorption.
  Intranasal drug administration has a variety of beneficial prehospital indications, including pain management, seizure control, narcotic drug reversal and hypoglycemia management.
  

  Pain Management

  A great deal of research has demonstrated that pain control can be obtained through intranasal drug administration in a safe and effective manner with few side-effects.2 There are a variety of different pain medication choices, including opiates and nonsteroidal antiinflammatory drugs that provide analgesia and can be administered intranasally.
  One of the most serious concerns with opiate drug administration is the potential for significant respiratory depression leading to hypoxia. However, the slower absorption of IN drugs, compared to IV administration, is enough of a delay that the risk of respiratory depression decreases significantly. When a drug is administered at the recommended intranasal dose, which is 1.5–2 times the IV dose, respiratory depression does not occur.3,4 Additionally, despite the slower absorption rate, the time saved by eliminating the need for IV access actually allows for the patient to experience a drug’s effects faster.5
  

  Analgesic Options

  Recently, ketorolac (Toradol) was FDA-approved for intranasal administration. Ketorolac is a nonsteroidal antiinflammatory drug that is effective in managing short-term moderate and severe pain. When given via IV, it has near-immediate onset, with full effect reached in 20–45 minutes, and has a half-life of 6–8 hours. When administered intranasally, ketorolac has the same onset and half-life. In one study, ketorolac was found to reduce the need for opiate analgesia when 30 mg was administered intranasally.6 This represents great potential benefit for EMS providers. Since ketorolac does not have any of the side-effects opiate drugs have, including hypotension and potential respiratory depression, it may be a reasonable drug for basic and intermediate life support providers to administer intranasally. By decreasing the number of patients requiring opiates for analgesia, fewer patients require intravenous access for analgesia, and fewer needles means increased safety. Ketorolac also does not have the addictive property of opioids, which decreases the potential for provider theft and misuse.
  Fentanyl is a synthetic opioid analgesic that has a shorter duration and half-life than morphine. It is associated with less cardiac instability than morphine, but otherwise functions similarly and has effects on the body nearly identical to morphine and is effective in treating moderate to severe pain. The typical IN dose for fentanyl is 2–4 micrograms per kilogram. Remember, intranasal doses are 1.5–2 times normal doses.
  

  A team led by Australian ambulance researcher Paul Middleton compared the effectiveness of IV morphine to IN fentanyl and inhaled methoxyflurane for prehospital analgesia and found that IV morphine dosed initially at 5 mg and repeated at 2.5–5mg every 2 minutes was slightly more effective than an initial IN dose of 240 micrograms of fentanyl. Both were significantly more effective than methoxyflurane. Prior to beginning the study, the researchers noted that IN absorption rates of fentanyl can be variable. To control this they limited IN fentanyl doses to 90 micrograms (0.3 mL) per medication atomization per nostril. Subsequent doses of 60–90 micrograms were given every 5 minutes as needed. Results demonstrated that while IV morphine was more effective, IN fentanyl does not require IV access and can be administered more rapidly. Further, when a statistical analysis was performed, morphine was not statistically more effective than IN fentanyl for total pain control, which in practical terms means the drugs provide equivalent relief. Morphine was, however, more effective for a greater number of patients.7 This study demonstrated that intranasal fentanyl provides analgesia as effectively as intravenous morphine. Also, no untoward effects were observed during the study period, helping to demonstrate that IN fentanyl is safe as well.
  Interestingly, both fentanyl and morphine failed to adequately control pain in nearly 20% of patients who received the drugs. This truly signals an area for improvement in prehospital pain management and suggests the need for advanced providers to have multiple analgesic medicines available, with the ability to switch medicines when the first is not working.
  Another study compared morphine and fentanyl for safety and effectiveness and found that both produced similar pain control; however, more fentanyl was required compared to morphine to achieve the same level of pain control when doses were standardized. This study used 5 mg morphine as equivalent to 50 mcg fentanyl. Fentanyl was associated with fewer adverse effects, 6.6% to 9.9%, with nausea being the most common adverse effect for both medicines. The researchers also concluded that both medicines provide adequate prehospital analgesia with low rates of side-effects.8
  

  Seizure Control

  Traditionally, prehospital providers manage status epilepticus with rectal diazepam when IV access cannot be obtained. Our anecdotal experiences support the claim that rectal diazepam does not always provide seizure control. A 2007 study compared administration of rectal diazepam to intranasal midazolam (Versed) for management of prehospital pediatric seizures. This study found that IN midazolam achieved 100% seizure control compared to 78% for rectal diazepam. Diazepam was also associated with a 33% intubation rate, while no patients managed with midazolam required intubation.9 The researchers determined that IN midazolam was more effective in seizure control, was safer to administer, faster, and more socially acceptable than rectal diazepam administration. This study does not compare intravenous diazepam administration to IN midazolam. When an IV is already in place, IV benzodiazepines remain the gold standard for seizure management. However, when no IV is in place, as when prehospital providers arrive on scene, it is just as safe and faster to attempt IN drug administration than to attempt IV access in an actively seizing patient.
  One study released in February 2011 compared IN and IV lorazepam for seizure management in pediatric patients. Using the same drug for both administration routes allowed researchers to directly compare administration routes. Results demonstrated that from the time the drug is given there is no statistical difference in the time it takes to terminate seizures between IV and IN lorazepam. The researchers also noted that there was a delay (median 4 minutes) to establish IV access for IV lorazepam administration, while there is no delay for IN administration.10
  This study demonstrates that the overall fastest time from recognizing status epilepticus to termination with drugs can be achieved with administration of intranasal benzodiazepines when an IV is not already in place. A patient can rapidly become hypoxic during a seizure, and rapid seizure termination is essential. Research now shows there is a faster method to achieve this, and it is important to consider implementing this into prehospital seizure management.
  

  Narcotic Overdose

  Patients who overdose on narcotic-based drugs can range from the chronic IV drug abuser or experimenting teenager to an elderly woman who mismanages her pain medications. At times, it can be very difficult to establish IV access on these patients, and some can be quite combative, creating a situation where introducing an IV needle is unsafe. Additionally, narcotic overdose can cause serious respiratory depression leading to hypoxia. It is not uncommon for patients who overdosed on narcotics to require ventilations. Fortunately, this respiratory depression can be rapidly reversed with the administration of naloxone, which is an opioid antagonist that blocks the opioid receptor sites in the central nervous system. Traditionally, 0.4–2 mg of naloxone is given intravenously; however, it can also be given IN when no IV is available.
  

  The difference between effects of IN and IV naloxone was recently studied. This study looked at the time from patient contact until respiratory depression was reversed for the two administration routes. The researchers found that the total time from patient contact to clinical response was shorter when naloxone was given IN. The time from administration to response is faster with IV administration, but this was an expected result. Additionally, they felt that IN administration was safer because the need for needle use around a drug abuser is eliminated.5
  During a 2002 prospective study of 30 patients in Denver, IN naloxone was evaluated as a first-line agent for prehospital narcotic overdose. This study found that 91% of patients responded to IN naloxone alone, and 64% did not require prehospital IV access.11 This study raises debate over the potential benefit for basic life support providers to have a prefilled syringe of naloxone available for IN administration to patients with respiratory depression following opioid overdose. Currently, New Mexico allows BLS providers, police officers and family members of known addicts to carry naloxone for IN administration. Boston EMS also provides its BLS providers with IN naloxone.2
  

  Hypoglycemia Management

  When prehospital providers cannot establish IV access for dextrose administration to patients experiencing hypoglycemia, their options include oral glucose or administration of glucagon. Oral glucose, as is well known, cannot be given when patients lack the ability to swallow (although it can be applied along the gum line and absorbed buccally in extreme situations).
  Traditionally, glucagon is given as a 2 mg intramuscular injection; it can also be administered intranasally (2 mg IN is comparable to 1 mg intramuscular glucagon). Several studies have demonstrated that intramuscular glucagon produces a faster and larger rise in blood glucose levels than IN glucagon.2 Thus, when providers are properly trained, IM glucagon is preferred. First responders, however, can benefit from having a needleless system available for glucagon administration in unresponsive hypoglycemic patients. Additionally, IN glucagon may be beneficial in some unique circumstances. One example is when a patient is hypothermic and has poor peripheral circulation. Administering an IM drug to that patient would cause an extremely delayed drug response. Other examples of situations where nasal administration may be preferred include when a patient is contaminated and an adequate site cannot be cleaned, when a patient is combative, or when, because of extenuating circumstances, clothing cannot be removed to access an IM administration site.
  

  Summary

  Intranasal drug administration is safe and effective and has many applications to prehospital providers of all levels. Administered drugs do take longer to take effect than drugs administered intravenously; however, the time saved by not needing to establish an IV offsets this difference. When evaluating your system’s protocols, consider adding IN drug administration, and particularly consider its benefit in patients who may be seizing, hypoglycemic, experiencing a narcotic overdose or in pain.
  
  Related Information 
  

  Study: New York EMTs Giving Intranasal Narcan Doses

Ensayarán vacuna contra el alzhéimer en 2013

alzhéimer

España ensayará en humanos la vacuna contra el alzhéimer en 2013

 Los ensayos en humanos de la vacuna contra el alzhéimer llegarán a España a partir de 2013. El grupo Grifols ha diseñado este prototipo clínico, basado en la inmunización contra las proteínas beta-amiloides. Tras probarse en animales, está a la espera de aprobación por parte de la Agencia Española del Medicamento.

 20 septiembre 2012 11:19

Los responsables de la farmacéutica española Grifols anunciaron ayer, en una rueda de prensa celebrada en Barcelona, que ensayarán en humanos un prototipo de vacuna que frene la aparición del alzhéimer durante el primer trimestre de 2013.

El objetivo del medicamento es conseguir la inmunización contra las proteínas tau y beta-amiloides 40 y 42, que en las personan afectadas se acumulan en el cerebro y provocan la destrucción de las neuronas.

La vacuna ya ha pasado la fase de experimentación animal - ha sido probado con éxito en ratones - y está pendiente de ser aprobada por la Agencia Española del Medicamento para iniciar los ensayos clínicos en humanos.

Este prototipo clínico ha sido diseñado para su utilización en los estadios asintomáticos y preclínicos del alzhéimer. En estas fases, los pacientes aún no manifiestan los signos característicos de la enfermedad, como la pérdida de memoria o la apraxia, la incapacidad de realizar movimientos voluntarios.

La vacuna está pendiente de ser aprobada por la Agencia Española del Medicamento

Anteriores intentos de vacuna

La compañía catalana no ha sido la primera en desarrollar y probar un prototipo contra el alzhéimer. El pasado mes de junio, Bengt Winblad, del Instituto Karolinska de Estocolmo (Suecia), dirigió una investigación sobre el funcionamiento de la vacuna CAD106, que también estimulaba el sistema inmunitario para que reaccionara contra las beta-amiloides.

Sus resultados mostraron que, de los pacientes que recibieron el tratamiento -todos ellos sufrían la enfermedad en su etapa leve o moderada-, el 80% desarrolló anticuerpos contra esas proteínas sin sufrir efectos secundarios.

Otros métodos contra la enfermedad

Grifols aprovechó para informar sobre otra de sus apuestas contra el alzhéimer en fases leves o moderadas, los tratamientos con hemoderivados. La empresa participa en ensayos de terapias que combinan la hemaféresis –un modelo de extracción de sangre- con albúmina e inmunoglobulina intravenosa.

Se trata de una técnica novedosa con la que extraen una cantidad limitada de plasma del paciente con la reposición de dos de las principales proteínas del plasma, albúmina o inmunoglobulina intravenosa. Tras esa restauración se consigue un ‘mecanismo de triple acción’ que “permitiría producir una movilización del beta-amiloide del cerebro para su posterior eliminación”, aseguran desde Grifols.

430.000 españoles con alzhéimer

La  búsqueda de una vacuna contra el alzhéimer es sólo uno de los caminos de estudio en torno a este tipo de demencia que, según la Organización Mundial de la Salud (OMS), sufren 24,3 millones de personas en el mundo. En España la cifra es alarmante: aproximadamente 430.000 españoles padecen la enfermedad, según datos del Centro Nacional de Epidemiología (CNE).

La edad es uno de los factores determinantes en su aparición y evolución. Según la Asociación del Alzheimer, “el 10% de las personas mayores de 65 años sufren esta enfermedad y ese porcentaje asciende hasta el 30% entre la franja mayor de 65 años”.

La OMS advierte que, dado el progresivo envejecimiento de la población, en 2050 más de 115 millones de personas en todo el mundo podrían padecer algún tipo de demencia, entre ellas el alzhéimer.

Fuente de la informacion: Agenciasinc.es 

Extreme temperatures may raise risk of premature cardiovascular death

September 18, 2012

Study Highlights:

• Extreme temperatures may increase the risk of premature cardiovascular death.
• Heat waves pose a greater risk of cardiovascular-related death than do cold spells.

EMBARGOED UNTIL 3 pm CT/4 pm ET, Tuesday, September 18, 2012 

DALLAS, Sept. 18, 2012 — Extreme temperatures during heat waves and cold spells may increase the risk of premature cardiovascular disease (CVD) death, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

 

The study in Brisbane, Australia, is the first in which researchers examined the association between daily average temperature and “years of life lost” due to CVD.  Years of life lost measures premature death by estimating years of life lost according to average life expectancy.

 

The findings are important because of how the body responds to temperate extremes, the growing obesity trend and the earth’s climate changes, said Cunrui Huang, M.Med., M.S.P.H., the study’s lead researcher and a Ph.D. scholar at the School of Public Health and Institute of Health and Biomedical Innovation at Queensland University of Technology (QUT) in Brisbane, Australia. 

 

Exposure to extreme temperatures can trigger changes in blood pressure , blood thickness, cholesterol  and heart rate , according to previous research.

 

“With increasing rates of obesity and related conditions, including diabetes, more people will be vulnerable to extreme temperatures and that could increase the future disease burden of extreme temperatures,” Huang said.

 

Researchers collected data on daily temperatures in Brisbane, Australia between 1996 and 2004 and compared them to documented cardiovascular-related deaths for the same period.

 

Brisbane has hot, humid summers and mild, dry winters. The average daily mean temperature was 68.9 degrees Fahrenheit (20.5 degrees Celsius), with the coldest 1 percent of days (53 °F /11.7 °C) characterized as cold spells and the hottest 1 percent (84.5°F/ 29.2 °C ) heat waves.

 

Per 1 million people, 72 years of life were lost per day due to CVD, researchers said. 

 

Risk of premature CVD death rose more when extreme heat was sustained for two or more days, researchers found.

 

“This might be because people become exhausted due to the sustained strain on their cardiovascular systems without relief, or health systems become overstretched and ambulances take longer to reach emergency cases,” said Adrian G. Barnett, Ph.D., co-author of the study and associate professor of biostatistics at QUT. “We suspect that people take better protective actions during prolonged cold weather, which might be why we did not find as great a risk of CVD during cold spells.”

 

Spending a few hours daily in a temperate environment can help reduce heat- and cold-related illnesses and deaths, Barnett said.

Researcher acknowledged that the findings may not apply to other communities and that they only considered deaths where CVD was the underlying cause.

 

Other co-authors are: Xiaoming Wang, Ph.D. and Shilu Tong, Ph.D. Funding and author disclosures are on the manuscript.

 

Learn about protecting your heart in the heat  and the impact of cold weather on cardiovascular disease . For the latest heart and stroke news, follow us on twitter: @HeartNews .

 

###

 

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding .

 

Addtional resources, including multimedia, are available on the right column of this link:

http://newsroom.heart.org/pr/aha/_prv-extreme-temperatures-may-raise-238569.aspx

Emergenciologos Registrados en Republica Dominicana

LISTADO EMERGENCIOLOGOS EN REPÚBLICA DOMINICANA

Más información http://www.sodoem.org/

Consenso sobre la vacunación frente a la gripe en el personal sanitario. España 2012

Enlace para bajar documento en pdf
Consenso sobre la vacunación frente a la  gripe en el personal sanitario
España 2012

NY se quiere unir a San Francisco en contra de la comida chatarra para niños

• La prohibición se mantendría mientras no mejoren sus contenidos nutricionales.
• Hay menús infantiles de más de 1.000 calorías y con alto contenido en sal.
• Uno de cada tres niños de Nueva York tiene sobrepeso. La obesidad preocupa.

Las autoridades de Nueva York estudian prohibir que las cadenas de comida rápidaregalen juguetes en los menús infantiles, a no ser que tengan un reducido número de calorías, y sería la segunda gran ciudad de EE UU en aplicar esta medida, después de San Francisco.

El legislador neoyorquino Leroy Comrie defendió este miércoles una propuesta por la que se prohibiría a las cadenas de comida rápida regalar juguetes u otros reclamos con los menús infantiles, a no ser que éstos cumplan con ciertos requisitos nutricionales, entre ellos tener menos de 500 calorías y un reducido contenido en sal.

La obesidad infantil es un problema que preocupa a Estados Unidos y sólo en la ciudad de Nueva York cerca de uno de cada tres niños tienen sobrepeso, según argumentó el propio legislador, quien también padece ese problema y aboga por establecer multas que podrían alcanzar los 2.500 dólares.

Valor nutritivo

San Francisco (California) ya tiene implantada una prohibición similar, que obliga a las cadenas de comida rápida a mejorar el valor nutritivo de sus comidas para niños si quieren seguir promocionando sus menús con juguetes

La normativa de la ciudad californiana impide a los establecimientos dar regalos asociados a alimentos infantiles que tengan más de 640 miligramos de sodio, 600 calorías o un 35% de sus calorías de origen graso.

"Yo soy un ejemplo. Si me miran, podrán ver que disfruto de la comida rápida e insana", apuntó el propio Comrie al presentar su propuesta, que señala que esos menús pueden llegar a tener en determinados casos 1.090 calorías en los establecimientos de McDonald's, 1.460 en Burger King, 1.080 en Wendy's y 680 en KFC.

Detallar calorías

Nueva York ya exige a las cadenas de comida rápida que detallen las calorías de sus menús, una iniciativa que la semana pasada la Agencia de Medicamentos y Alimentos de Estados Unidos (FDA) anunció que extenderá a partir de 2012 a todo el país.

Los estadounidenses consumen un tercio de todas sus calorías en comidas preparadas fuera de la casa, según la FDA, que calcula que la medida afectará a 280.000 establecimientos.

La lucha contra la obesidad es una de las prioridades de la Administración del presidente Barack Obama ante el preocupante incremento de ese problema entre la población, especialmente entre los más

Un informe del Centro de Control y Prevención de Enfermedades (CDC) detalla que el número de personas adultas obesas en Estados Unidos era de 2,4 millones al final de 2010.

McDonald's vende 5.000 millones de dólares en menús infantiles al añoLa primera dama Michelle Obama lanzó el pasado año el programa "Let's Move", dirigido especialmente a los niños, que busca instaurar hábitos alimenticios más saludables y fomentar el ejercicio.

"Cada año McDonald's vende más de 5.000 millones de dólares en menús infantiles con el reclamo de juguetes de regalo (...) y se gasta cerca de 1.000 millones en promociones comerciales dirigidas a los niños", dijo el martes en un comunicado Deborah Lapid, de Corporate Accountability International, una asociación para la defensa de los consumidores en Estados Unidos.

Enlace 20minutos.es

Emergency AmbiCycle

Emergency AmbiCycle 

Emergency AmbiCycle Designed to Save Lives in Tight Spots

The AmbiCycle is an alternative compact transportation device specifically designed to transport patients from the scene to the hospital

COLLEGE STATION, TX — From small villages with long dirt roads to crowded cities with traffic at a standstill, maneuvering today’s ambulance during an emergency simply may not be an option. But promptly reaching patients to treat them effectively is nonnegotiable.

That’s where the AmbiCycle comes in. An alternative compact transportation device specifically designed to transport patients from the scene to the hospital, it’s about the width of a Harley-Davidson motorcycle, nine feet long and has three wheels.

Mark Benden, PhD, CPE, assistant professor at the Texas A&M Health Science Center (TAMHSC) School of Rural Public Health, and Eric Wilke, M.D., medical director of College Station (TX) EMS, began design efforts on the AmbiCycle in summer 2008.

During a volunteer medical trip to Uganda a few months earlier, Dr. Wilke saw a need for an emergency transportation vehicle that could navigate crowded and narrow streets in rural areas.

Ambulances in the United States are typically around 13 feet long, eight feet high and struggle to maneuver through congested traffic. These bulky vehicles also face difficulties getting to patients in rural areas fast enough, sometimes taking more than 30 minutes to arrive.

Alternatives to ambulances had been attempted in rural and metropolitan areas but produced major setbacks. Trailers attached to bikes were not safe on modern roads with motorized traffic. Motorcycle sidecars had a width almost equal to a car and were difficult to maneuver.

After scratching ideas for trailers pulled by a moped or bike, Dr. Wilke and Dr. Benden focused on a vehicle that could offer improved performance compared to trailers and sidecars.

“The AmbiCycle becomes more stable to drive when a patient is loaded,” Dr. Benden said. “All the others have the opposite effect.”

The AmbiCycle is more stable since its compact body allows the driver and patient to be on the same plane and maintain visual contact. This small device is designed to evacuate patients from areas at risk, damaged by storms and under heavy traffic with inadequate emergency medical services.

“The AmbiCycle is the only patient transport that might make it through gridlocked traffic to get a patient to care during the ‘golden hour,’ ” Dr. Benden said.

This type of patient transport is an affordable alternative to a full ambulance. While a standard size ambulance costs $75,000, the AmbiCycle target cost is around $5,000. This vehicle gives users the option of either electric or gas power and gets 83 miles per gallon.

Medical accessories were specifically designed for the AmbiCycle, including helmets, unique litters, backboards and restraints. Patient covers and filtered air options are included in the designs, while high-tech medical monitoring and treatment devices are additional options.

The AmbiCycle isn’t just designed for everyday use, either; 36 can fit onto a single 53-foot trailer, making it ideal for disaster relief. It’s also an option for military wounded soldier transport.

Currently, a commercial prototype of the AmbiCycle has been developed using a platform from Automoto, a California company. This street legal vehicle has three wheels, two of which are in the front. The Automoto vehicle is used as a platform and modified into a prototype of the AmbiCycle.

This vehicle is U.S. patent pending, and a fourth-generation prototype is currently being evaluated by medics, emergency room doctors and nurses, and multiple international health care organizations, including several in the Middle East, South America and Africa.

“The idea at this point is to produce a scalable, deployable vehicle that can be affordable at purchase and during maintenance. We hope this evacuation solution will save lives all over the developing world,” Dr. Benden said.

About Texas A&M Health Science Center
The Texas A&M Health Science Center provides the state with health education, outreach and research through campuses in Bryan-College Station, Dallas, Temple, Houston, Round Rock, Kingsville, Corpus Christi and McAllen. Its six colleges are the Baylor College of Dentistry, College of Medicine, College of Nursing, School of Graduate Studies, Irma Lerma Rangel College of Pharmacy and School of Rural Public Health. Other units include the Institute of Biosciences and Technology and Coastal Bend Health Education Center.

Link this info was taken emsworld.com

No más saleros en Restaurantes de Buenos Aires Argentina

El gobierno de la provincia de Buenos Aires, en Argentina, inició este lunes un programa que eliminará a los saleros de las mesas de los restaurantes.
El objetivo de la medida –que se enmarca dentro del Programa Provincial de Hipertensión Arterial- es lograr una reducción en el consumo de sal y con ello reducir los riesgos cardíacos de la población.
Enlace para ampliar información desde BBCmundo.com

MANEJO DEL PACIENTE EN EL PARO CARDIORESPIRATORIO / RCP AVANZADA. Dr. Ovaldo Rois. Fundación EMME

RCP AVANZADA ACLS

RCP AVANZADA ACLS

RCP AVANZADA

FUNDACION EMME

By Dr. Osvaldo Rois

Fundación EMME Argentina

Enlace para bajar documento completo 

MANEJO DEL PACIENTE EN EL PARO CARDIORESPIRATORIO pdf

Enlace para bajar Guia RCP 2010