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Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.

Niveles de Alerta Antiterrorista en España. Nivel Actual 4 de 5.
Fuente Ministerio de Interior de España

lunes, 12 de agosto de 2013

Effective Prehospital Care for a Scorpion Sting. Are antivenins always necessary?

Scorpion Centruroides exilicauda

Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P | From the April 2013 Issue | Wednesday, March 27, 2013
There’s much more to Las Vegas than the casinos, bars and the bright lights of the Strip. Many wonderful parks and unique points of interest are nearby and offer respite from the constant grind of the city. One such park is the Valley of Fire State Park located just north of Las Vegas. This is a beautiful and striking collection of rocks and escarpments and is often used for movie and television shoots.
During the early summer, a 24-year-old Canadian tourist was visiting the park and climbing the various trails that wind through the wondrous rock formations. Evidently, the patient reached up onto a rock and felt a severe burning sensation on the dorsal surface of her right hand. She immediately withdrew her hand and saw a scorpion fall to a rock below. The burning sensation soon became intense pain and itching, and she developed shortness of breath followed by generalized hives. Her boyfriend was at her side and quickly scooped up the scorpion into a paper cup and helped his girlfriend down to the base of the trail. By that time, she was more short of breath and slightly diaphoretic. He placed her into their car and drove quickly to a nearby convenience store. There, the clerk summoned local EMS.
Prehospital Care
First responders arrived approximately eight to 10 minutes following the initial call. They began their primary assessment, administered supplemental oxygen and awaited arrival of paramedics. They questioned the patient about whether she had an EpiPen or similar epinephrine auto injector. She didn’t.
Soon, paramedics arrived and took over assessment. Their primary assessment revealed the patient to be anxious, short of breath and diaphoretic, with hives. The initial vital signs were a blood pressure of 100/68, a pulse of 100, respirations of 24, and SpO2 of 95% on a non-rebreather mask. The paramedics promptly placed an IV line and administered 0.3 mg of epinephrine 1:1000 intramuscularly. The patient had an episode of transient tachycardia; however, her breathing improved and most of the hives disappeared. Although her breathing was better, the pain from the scorpion sting was increasing fairly quickly. In addition, she had developed some unusual twitches and jerkiness. As paramedics inspected the patient’s right hand, they noted it to be swollen and extremely tender. There was an area at the center of the swelling that appeared to be the location of the sting.
The paramedics administered a one-liter fluid bolus of normal saline followed by 5 mg of morphine sulfate via IV. The patient was somewhat nauseated and received 4 mg of ondansetron (Zofran) via IV. This resulted in improvement of her pain and normalization of her vital signs. She was subsequently transported to University Medical Center (UMC) for additional care.
Hospital Course
At UMC, the emergency medicine staff promptly evaluated the patient. Although she improved initially following the prehospital care provided, her pain and shortness of breath were starting to recur. An additional 5 mg dose of morphine was provided and standard laboratory tests were obtained. Examination of the right hand revealed swelling and a small area of ecchymosis. The pulses remained strong and the patient was fully alert. In addition, the patient again became nauseated and subsequently vomited. Following this, 1.25 mg of droperidol (Inapsine) was administered via IV. Her nausea and vomiting resolved.
On physical exam, the patient was in considerably more distress than what paramedics had reported on scene. She was carefully reassessed to try to determine whether her signs and symptoms were due to an allergic reaction to the scorpion sting or due to scorpion envenomation. The venom from scorpions in the U.S. is neurotoxic yet rarely fatal. Although rare, envenomation from certain scorpion species (e.g., bark scorpion) can cause uncontrolled muscle jerking, eye twitching (called opsoclonus) and increased salivation in addition to the localized pain, swelling and itching. Based on the examination, the patient didn’t have signs of envenomation.
Although an antivenin is available for scorpion stings, it wasn’t deemed necessary in this case. The patient received additional fluids as well as 25 mg of diphenhydramine (Benadryl) and 125 mg of methylprednisolone (Solu-Medrol) via IV. She was observed in the emergency department for approximately four hours and discharged home with medications for pain as well as antihistamines and corticosteroids.
Scorpions, which are eight-legged venomous invertebrates that are related to spiders and ticks, are common in the southwestern U.S., and the second-most common cause of poisonous stings worldwide. In the U.S., only four deaths in 11 years have occurred as a result of scorpion stings. Interestingly, in Mexico, approximately 1,000 deaths from scorpion stings occur per year.1
Scorpions primarily live in the desert and have adapted to the heat and lack of water. There are approximately 70 species of scorpions in the U.S. Of these, only the bark scorpion (Centruroides exilicauda) can cause clinically significant signs and symptoms. In actuality, significant scorpion envenomation is rare in the U.S. When it does occur, infants, children and the elderly are at increased risk.
The signs and symptoms of envenomation usually occur within 15 minutes following the sting. The severity of the symptoms depends on the amount of venom injected. For most people, the signs and symptoms of a scorpion sting are localized and include pain, swelling and itching.
In rare instances, significant envenomation from a bark scorpion sting can cause systemic signs and symptoms. These include the various neurologic symptoms detailed earlier. An antivenin (Anascorp) is available for significant stings. It’s derived from horse serum and is effective. However, it’s expensive and has associated allergic/anaphylactic risks because it’s derived from animal sources. It’s reserved only for severe, life-threatening envenomation where the benefits clearly outweigh the risks. It shouldn’t be used routinely unless neurotoxic signs and symptoms are noted. Most hospitals in the southwestern U.S. stock or have access to this antivenin.2,3
The use of antivenins in EMS is controversial. There are antivenins available for the bites and stings of numerous dangerous animals. These include snakes, spiders and scorpions. In some situations, such in the Australian state of Queensland, it makes sense for EMS providers to carry and administer antivenin. There are jellyfish species, primarily the box jellyfish (Chironex fleckeri), in the waters off Queensland and other parts of Australia that are extremely toxic, and stings can be rapidly fatal. In such cases, antivenin administration can be lifesaving. However, in most of the U.S., patients are able to access a hospital fairly rapidly and can receive antivenin there as needed.
Certainly, some rural EMS systems have prolonged out-of-hospital times and respond in areas where poisonous animals are found. In these systems, there may be a role for antivenin based on transport times and the types of indigenous poisonous species found in the region. Most of these cases would certainly be due to snakes, with insect bites and stings being less common.
It’s important to remember that the administration of antivenin isn’t always simple and without risk. Allergic reactions and other systemic reactions are common. In addition, many of these antivenin products are expensive and require special preparation to administer.
Interestingly, Miami-Dade (Fla.) Fire Rescue (MDFR) operates the world-recognized Venom Response Program.4 It consists of highly specialized paramedic/firefighters who are trained in the response, management and treatment of envenomations.
The program is necessary because Miami-Dade County is home to numerous venomous and poisonous animals, and is also the point of entry for a wide variety of venomous animals imported into the U.S. As in Miami, all EMS providers should be familiar with the identification and treatment of common animal bites and envenomations that can occur in their response area.
The case detailed here is relatively straightforward. We describe the case of a tourist who sustained a scorpion sting in a local state park. Her symptoms were more significant than typically seen with simple scorpion stings. The scorpion that was caught by her boyfriend was later determined to be a bark scorpion. However, following adequate prehospital treatment and detailed evaluation in the emergency department, the patient improved. It was determined that scorpion antivenin wasn’t indicated because of the lack of systemic signs and symptoms. The patient ultimately did well and completed her vacation in Las Vegas.
1. Chippaux JP, Goyffon M. Epidemiology of scorpionism: A global apprasial. Acta Trop. 2010;107:71–79.
2. Quan D. North American Poisonous Bites and Stings. Crit Care Clin. 2012;28:633–659.
3. Boyer LV, Theodorou AA, Berg RA, et al. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med. 2009;360:2090–2098.
4. Miami-Dade Venom Response Program. (Jan 19, 2012). In Miami-Dade County. Retrieved Feb. 17, 2013, from
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Patient Care

sábado, 10 de agosto de 2013

Diseño de una cabina de helicóptero para servicios médicos de emergencia

Diseño de una cabina de helicóptero para servicios médicos de emergencia

by  on  • 9:36 am

Fuente medgadget
El diseño del espacio limitado en una cabina de helicóptero debe ser eficiente y facilitar el acceso a los monitores y otros dispositivos médicos. Thomas Weig y Prueckner Stephan son dos médicos de alto nivel en el departamento de anestesiología de la Universidad Ludwig-Maximilians-Universität en Munich y ambos trabajan como médicos de la medicina del aire en DRF Luftrettung en Filderstadt, Alemania. Junto con un graduado del departamento de diseño industrial en Weissensee Kunsthochschule en Berlín, analizaron los procesos de trabajo y el flujo de trabajo que se sucede en la cabina del helicóptero cuando está en el aire, y publicaron sus resultados a principios de este mes en el Air Medical Journal. 

Su análisis se basó en un registro de vídeo con 4 cámaras durante las misiones, entrevistas estructuradas de la tripulación después de completarse las misiones, y el análisis de la documentación del vídeo con las fotografías obtenidas. Para este proyecto se utilizó un Eurocopter EC 145, un helicóptero bimotor de tamaño mediano. Esta es una máquina regular utilizada principalmente para la transferencia interhospitalaria o para los servicios médicos de emergencia. El interior del helicóptero fue desarrollado por Aerolite AG, Ennetbürgen, Suiza.

Uno de los cuellos de botella que identificaron parece ser la carga y descarga de los pacientes mientras están conectados a los monitores y con líneas de infusión intravenosa. Otros estudios anteriores también sugieren muchas desconexiones programadas o accidentales durante la carga y descarga de los pacientes.

Con respecto a estos resultados, el nuevo concepto de diseño se centra en 2 puntos principales: el uso práctico e intuitivo del monitor y la máxima seguridad y comodidad para el paciente durante su carga y descarga. Se construyo una maqueta a escala y se instaló en un EC 145 vacío para comprobar la viabilidad.

El último concepto funciona como un cajón: los dispositivos médicos están montados en un carril guía y están conectados a una distancia fija con la camilla de transporte. Todo esto entra con el paciente al helicóptero. Los dispositivos de monitorización de pacientes utilizan conexiones inalámbricas y son completamente desconectables. Este concepto de diseño final integra una mejor comodidad y seguridad para el paciente y el personal.

Artículo traducido por: Tilo Febres-Cordero
Servicio Navarro de Salud Helicóptero Sanitario

New federal guidelines cover occupational exposure to HIV

New federal guidelines cover occupational exposure to HIV 

Link to download The New federal guidelines cover occupational exposure to HIV  pdf format

New guidelines from the United States Public Health Service update the recommendations for the management of healthcare personnel with occupational exposure to HIV and the use of postexposure prophylaxis. 

The guidelines, published in the September issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, emphasize the immediate use of a postexposure prophylaxis regimen containing three or more antiretroviral drugs after any occupational exposure to HIV. 

The PEP regimens recommended in the guidelines encourage the consistent use of a combination of three or more antiretroviral agents, which are said to be better tolerated than those recommended in the previously published guidelines from 2005, for all occupational exposures to HIV. Eligible antiretrovirals are from the following six classes of drugs: nucleoside and nucleotide reverse-transcriptase inhibitors, nonnucleoside reverse-transcriptase inhibitors, protease inhibitors, a fusion inhibitor, an integrase strand transfer inhibitor and a chemokine (C-C motif) receptor 5 antagonist. 

The guidance eliminates the previous recommendation to assess the level of risk associated with individual exposures to help determine the appropriate number of drugs recommended for PEP. 

“Preventing exposures should be the leading strategy to prevent occupational HIV infections,” David Kuhar, MD, an author of the guidelines and a medical epidemiologist with the CDC’s Division of Healthcare Quality Promotion, said in a news release. “However, when exposure occurs, it should be considered an urgent medical concern and a PEP regimen should be started right away, ideally within hours of the potential exposure.”

Expert consultation should be sought, but not at the expense of delaying treatment, according to the guidelines. Exposed healthcare personnel taking HIV PEP should complete a full four-week regimen and undergo follow-up HIV testing, monitoring for drug toxicity and counseling, beginning with follow-up appointments within 72 hours of the exposure. 

If a newer fourth-generation HIV antigen/antibody combination test is used for follow-up testing, an option to conclude HIV testing at four months, rather than the recommended six months after exposure, is provided. Many of the revised recommendations are intended to make the PEP regimen better tolerated, increasing the possibility that healthcare personnel complete the full regimen. 

The guidelines were developed by an interagency Public Health Service working group comprised of representatives from the CDC, National Institutes of Health, FDA and the Health Resources and Services Administration, in consultation with an external expert panel. The updated revisions were based upon expert opinion. 

Many HCP exposures to HIV occur outside of health clinic hours of operation, and initial exposure management often is overseen by emergency physicians or other providers who are not experts in the treatment of HIV infection or the use of antiretroviral medications, according to the news release. As such, the updated guidelines should be distributed and made readily available to emergency physicians and other providers as needed.

viernes, 9 de agosto de 2013

Científicos logran avances hacia una vacuna contra la malaria

mosquito anopheles malaria

  • Sólo puede administrarse por vía intravenosa. 
  • Una enfermedad que infecta a más de 200 millones de personas y mata a un millón por año en todo el mundo, según la revista 'Science'. 
  • Hasta ahora la única protección duradera es permitir que el mosquito portador del parásito pique a los humanos estimulando su inmunidad.

EFE. 09.08.2013 - 01:04h 

Los científicos han logrado avances hacia una vacuna altamente eficiente contra la malaria, una enfermedad que infecta a más de 200 millones de personas y mata a un millón por año en todo el mundo, según un artículo que publica la revista Science.

Gran número de los casos de malaria se deben al parásito Plasmodium falciparum (Pf) transmitido a los humanos por la picadura de los mosquitos infectados. La nueva vacuna solo puede administrarse por vía intravenosa, a diferencia de las vacunas más comunes que se inyectan por vía intramuscular o intradermal o se infunden por la nariz, pero abre la senda a una prevención de la malaria que podría aplicarse extensamente. La vacuna, conocida como PfSPZ, la desarrollaron científicos de la firma Sanaria, en Rockville (Maryland, Estados Unidos). La evaluación clínica la condujeron investigadores del Instituto Nacional de Alergia y Enfermedades Infecciosas en colaboración con el Instituto Walter Reed de Investigación, del Ejército, y el Centro Naval de Investigación Médica. Hasta ahora la única protección duradera contra la malaria ha sido permitir que los mosquitos portadores de esporocitos Pf, las células que se desarrollan en la glándula salival del mosquito Anófeles, piquen a los humanos estimulando su inmunidad. Por más de cuatro décadas los científicos han sabido de la eficacia de este proceso, pero no podían avanzar la técnica más allá de la picadura de mosquito porque no podían manufacturar parásitos suficientemente debilitados como para usarlos en una vacuna inyectable, pero vivos y activos metabólicamente.
"En la prueba inicial participaron voluntariamente 57 adultos sanos"

En la prueba inicial participaron voluntariamente 57 adultos sanos, con edades de 18 a 45 años, que jamás habían tenido malaria. Cuarenta de los participantes recibieron la vacuna y 17 no la recibieron. Para evaluar la seguridad de la vacuna, algunos de los participantes recibieron cuatro dosis de la vacuna completa de esporocitos y otros recibieron cinco. Seis de los voluntarios que recibieron cinco dosis intravenosas no contrajeron la malaria cuando quedaron expuestos al parásito, en tanto que tres de los nueve que recibieron cuatro dosis sí contrajeron la enfermedad.
Cuanto mayor fue el número de dosis más anticuerpos específicos de los esporocitos pudieron detectarse en la sangre de los participantes. El nivel de protección de esta vacuna experimental sólo se había alcanzado anteriormente mediante la inmunización con el esporocito Pf completo a través de la picadura de mosquito. Los autores del artículo advirtieron de que se necesitan más estudios para determinar cuánto durará la protección de esta vacuna y cuán efectiva podría ser contra otras cepas del parásito Plasmodium falciparum. Asimismo, señalaron que queda por verse si una vacuna que ha de administrarse por vía intravenosa puede usarse de manera amplia entre las poblaciones que más la necesitan.
"Cuanto mayor fue la dosis, más anticuerpos pudieron detectarse"


miércoles, 7 de agosto de 2013

Guía de práctica clínica: Tratamiento del síndrome de abstinencia alcohólica, 2ª edición

Guía de práctica clínica:  Tratamiento del síndrome de abstinencia alcohólica, 2ª edición

Situación: Incluida

Nº ID: 504

Fecha de 1ª edición: 01/10/2003

Fecha de edición: 29/04/2011

Fecha de caducidad: 28/04/2016

Entidad(es) elaboradora(s): Sociedade Galega de Medicina Interna
Autores: Rafael Monte Secades, Ramón Rabuñal Rey
Objetivos: El síndrome de abstinencia alcohólica es un aspecto de los problemas derivados de la adicción al alcohol que ha recibido poca atención en nuestro medio. La escasez de estudios clínicos al respecto y de guías de práctica clínica sobre su tratamiento en la literatura, ha propiciado que exista una gran variabilidad en su manejo, no sólo entre diferentes países sino también entre los diferentes centros hospitalarios y aún entre diferentes clínicos. Por ello, es habitual que el tratamiento del síndrome de abstinencia alcohólica descanse en la adopción de medidas terapéuticas derivadas de experiencias clínicas individuales o de grupos reducidos. La necesidad derivada de la práctica diaria de estandarizar en lo posible el tratamiento de estos pacientes impulsó la realización de esta Guía de Práctica Clínica sobre el Tratamiento Hospitalario del Síndrome de Abstinencia Alcohólica en el año 2003, cuyo objetivo era ofrecer unas recomendaciones que paliasen la falta de información y de homogeneidad sobre su manejo y que ahora se revisa y actualiza con el fin de integrar las nuevas evidencias publicadas al respecto en los últimos 7 años.
Condición: Síndrome de abstinencia alcohólica: expresión clínica de la interrupción brusca o disminución de la ingesta de alcohol en un paciente que ha desarrollado una dependencia física al mismo.
Observaciones: Esta es una versión actualizada de otra previa editada en el 2003 y que ya se encuentra caducada.
Articulo relacionado: 

Tratamiento Intoxicación Alcohólica Aguda