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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

Dr. Ramon A. Reyes, MD

Dr. Ramon A. Reyes, MD
Responsable del Blog

lunes, 31 de mayo de 2021

Compendio de Leyes y Reglamentos Colegio Medico de Honduras

 

Compendio de Leyes y Reglamentos Colegio Medico de Honduras


Colegio Médico de Honduras


Edificio Colegio Médico de Honduras, frente a Mall Las Cascadas, CA 6 Bulevar Fuerzas Armadas Apartado Postal No. 810 Tegucigalpa M.D.C., Honduras, C.A.

contacto@colegiomedico.hn


+1 (504) 2269-1831,1832,1833,1834,1835; 2228-0866, 2230-0128, 2230-0588; Fax: 2269-1833

https://www.colegiomedico.hn/


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Protocolo de Actuacion en Caso de Maltrato Infantil, España

domingo, 30 de mayo de 2021

The dangers of too much O2. EMSWORLD.COM

The dangers of too much O2

More Oxygen Can’t Hurt…Can It?

What have we learned about oxygen? The dangers of too much O2

It was 0635. Larry and Adriane always got to the station early to check out the truck and, if a late call came in, take it so Greg and Chad could get off on time. This was an arrangement the Medic 2 crews shared, and it worked well for them.
As Adriane checked out the D cylinders and M tank, she said offhandedly, “Better be sure we have plenty of Os. We’re due for a chest pain call.” “Watch your mouth,” said Larry, grinning as he tossed her the last of the Twinkies he’d saved. “You know what happens when you say things like that.”
Twenty minutes later they were at the home of Doris, one of their regular patients, a 64-year-old type 2 diabetic who was, in fact, experiencing chest pain she described as 5 on a scale of 0–10.
While Larry attached the 12-lead, Adriane noted the pulse oximeter read 97% on room air, so she put Doris on a non-rebreather mask and turned the oxygen on at 15 liters per minute. “You can’t have enough of this good stuff,” she said. “Let’s get that sat up to 100% for those heart cells.”
After giving an aspirin, starting an IV and giving a squirt of nitroglycerin, they transported Doris to the nearby Level III hospital, where she went immediately to the cath lab, got a stent in her right coronary artery, went to the CCU and eventually returned home three days later, feeling great.
“Good job, folks,” Dr. Chutney said at the chart review the next week, “but here’s something I need to pass along to you: We don’t do 15 liters per minute by non-rebreather for routine chest pain patients anymore.”
“Why?” said Adriane. “In my book it says not to worry about problems from too much oxygen, that they only develop after several days of more than 50% inspired oxygen delivered at higher-than-normal pressures.”
“What book are you reading from, Adriane?” asked Dr. Chutney.
“From my Orange Book,” said Adriane, “Emergency Care and Transportation of the Sick and Injured, seventh edition, from my EMT class back in 2000.”

The Problem

In 2000 that was what we were taught about oxygen therapy for patients with chest pain. But times have changed. We now know that while some oxygen may be good, more is not necessarily better.
We have always known that oxygen is necessary for all animal life, and that lack of oxygen damages tissues. It is beyond argument that patients who are hypoxic must receive supplemental oxygen. What we’ve not always known is that too much oxygen can harm patients in a number of ways.
One is through reactive oxygen species (ROS), often called free radicals. A radical is an atom that has one or more unpaired electrons. Oxygen has two unpaired electrons that make it susceptible to radical formation. When ROS form in cells, damage can occur. Hypoxic cells are greatly susceptible to ROS. These can damage tissues throughout the body, but of particular concern are lung, heart and brain tissues. Not all radicals are bad, and the role of radicals is far beyond the scope of this article, but we know that damage to the plasma membranes, mitochondria and endomembrane systems by ROS is significant.
High oxygen concentrations can also cause atelectasis. Air is about 21% oxygen and 79% nitrogen. The alveoli depend on nitrogen to maintain surfactant production and alveolar patency; when high concentrations of oxygen are administered, oxygen may “wash out” nitrogen and leave the alveoli susceptible to a lack of gas as oxygen diffuses into the blood, causing them to collapse. This “washout” may be desirable temporarily in patients being preoxygenated for rapid- or delayed-sequence intubation, but over time atelectasis may occur, and this is not good. Once intubation is accomplished, a natural mixture of gases must be allowed to reconstitute in the lungs to avoid collapse of alveoli and atelectasis. There is little to be gained by achieving an oxygen pressure of greater than 100 mmHg.

Trauma Patients

 Over the last 20 years we’ve been in the habit of giving high-flow oxygen to just about everybody. Every trauma patient gets oxygen at 15 lpm by non-rebreather mask, regardless of their blood oxygen saturation. What many do not realize is that this was taught not because it was beneficial, but because it was considered an acceptable risk when time limitations necessitated deletion of much of the medical theory during the 1994 revision of the EMT-Basic curriculum. Everyone was taught to deliver high-flow oxygen by non-rebreather without understanding why it was beneficial…or potentially harmful. There is no medical evidence to support this practice unless the patient is hypoxic or in shock.

In 2004, Tulane MDs Zsolt Stockinger and Norman McSwain monitored 5,090 trauma patients not requiring assisted ventilation to see whether supplemental oxygen improved their outcomes. The results showed those who received oxygen did no better or worse than those who did not. The authors concluded supplemental oxygen does not improve survival in traumatized patients who are not in respiratory distress.1

Chest Pain Patients

It has been our traditional practice to give high concentrations of oxygen to patients with chest pain and MI, for reasons no better than “this is how we’ve always done it.” As Israeli physician Chaim Lotan said at a conference in 2011, “We have been brainwashed into using oxygen” even though recent data suggests it has harmful effects that are mediated primarily by coronary artery vasoconstriction. “Before I started looking into the data,” Lotan said, “I didn’t understand how much damage we were causing by giving oxygen.”2
In fact, it is true that 100% oxygen given by non-rebreather reduces coronary artery flow by 30% after 5 minutes. It also reduces the effects of vasodilators such as nitroglycerin.3
This is not exactly a result we’d desire while treating a patient with coronary artery disease. For this reason, the American Heart Association’s emergency cardiac care guidelines have, since 2010, recommended as follows: There is insufficient evidence to support [oxygen’s] routine use in uncomplicated ACS. If the patient is dyspneic, hypoxemic or has obvious signs of heart failure, providers should titrate therapy, based on monitoring of oxyhemoglobin saturation, to ≥94% (Class I, LOE C).4
In a Cochrane review of the literature, researchers in New Zealand led by Meme Wijesinghe found that, although evidence is limited, it suggests that routine use of high-flow oxygen in uncomplicated MI may result in a greater infarct size and possibly increase the risk of mortality.5 These authors concluded it is well-established that arterial oxygen tension is a major determinant of coronary artery blood flow and that high-flow oxygen therapy can cause a reduction in cardiac output and stroke volume. They concluded there is insufficient evidence to support the routine use of high-flow oxygen in the treatment of uncomplicated MI, and that it may increase mortality.

Stroke Patients

Stroke patients should be managed similarly. Administer supplemental oxygen to stroke patients who are hypoxemic or when oxygen saturations are not obtainable; the goal is to maintain a saturation of 94% or greater.

COPD Patients

The role of oxygen in chronic obstructive pulmonary disease (COPD) patients has been debated for decades. Issues such as a theoretical “hypoxic drive” in patients with COPD and chronic hypercarbia have led to controversies over how much oxygen to give them. While hypoxia must be corrected quickly when it exists, the definition of hypoxia in terms of oxygen saturation has been unclear. For example, a normal person without a respiratory condition breathing room air will usually have a saturation varying from 97%–99%, depending on tidal volume and other normal respiratory variances. It is almost impossible to achieve 100% saturation by breathing room air. We know a saturation of 90% correlates to approximately 60 mmHg pressure, and that is the normal threshold of respiratory distress. However, COPD patients may be accustomed to less saturation, and they typically do well at 88%–92%.
In a study of 405 patients in Australia published in 2010, Dr. Michael Austin and colleagues compared the outcomes of COPD patients who were given standard high-flow oxygen treatment with those given titrated oxygen treatment by paramedics. Titrated oxygen treatment reduced mortality compared with high-flow oxygen by 58% for all patients.6


In a 2012 study of prehospital noninvasive ventilation in patients with pulmonary edema and/or COPD, asthma and pneumonia, a team led by Dr. Bryan Bledsoe found that use of CPAP with a low oxygen percentage (FiO2) of 28%–32% was highly effective in treatment of respiratory emergencies by medics. Since most CPAP setups deliver 100% oxygen, it may be worthwhile for services to explore the value of using setups with a lower oxygen percentage.7

Post-Cardiac Resuscitation Patients

Finally, the role of oxygen after cardiac resuscitation must be mentioned. At one time we attempted to push as much oxygen as possible into cardiac arrest patients on the theory that myocardial oxygen supplies were quickly dwindling, and that if we wanted to save people, we had to replenish the missing oxygen. During arrest, and if we were fortunate enough to get a return of spontaneous circulation, we bagged patients as fast and hard as we could, thinking we were restoring oxygen to ischemic cardiac and brain cells.
Now we know that while ischemia is responsible for most cases of cardiac arrest, managing reperfusion of ischemic cardiac cells is more complicated than we thought. Because of the role of ROS (free radicals), we now understand that a flood of oxygen into previously ischemic cardiac cells is harmful.
The latest post-cardiac arrest care guidelines from AHA recommend the following: Avoid excessive ventilation. Start at 10–12 breaths/min and titrate to target PetCO2 of 35–40 mmHg. When feasible, titrate FiO2 to minimum necessary to achieve SpO2 equal to or greater than 94%.8

Conclusion

In Adriane’s copy of Emergency Care and Transportation, pulse oximetry was not even mentioned because it was not routinely available on ambulances then. Now that we routinely monitor SpO2 for most patients and know what we do about the dangers of hyperoxygenation, it makes sense to give only as much oxygen as the patient requires.
In the early days of EMS, venturi masks were popular and routinely used for COPD and cardiac patients. Following the 1994 revision of the EMT National Standard Curriculum, these were largely abandoned because it was felt high concentrations of oxygen were an acceptable risk, given the curriculum’s time limitations. We may see a return of venturi masks to EMS as we become more aware of the need to limit oxygen percentages in our therapy.
In the past 20 years, the debate in oxygen therapy has largely been confined to high-flow versus low-flow. Given the current research and assessment tools available to us, it would seem the debate should shift to low-flow versus no supplemental oxygen at all. We have the means to titrate oxygen therapy to patients’ needs, and those needs most often can be met by low-flow oxygen.
By no means do we suggest that patients who need oxygen be denied it. Hypoxia must be corrected immediately. But you can have too much of a good thing.

References

1. Stockinger ZT, McSwain NE Jr. Prehospital supplemental oxygen in trauma patients: its efficacy and implications for military medical care. Mil Med, 2004 Aug; 169(8): 609–12.
2. Hughes S. Oxygen for MI: More harm than good? TheHeart.org, www.theheart.org/article/1270299.do.
3. McNulty PH, et al. Effects of supplemental oxygen administration on coronary blood flow in patients undergoing cardiac catheterization. Am J Physiol Heart Circ Physiol, 2005; 288: H1057–62.
4. Circulation, 2010; 122: S787–817.
5. Wijesinghe M, Perrin K, Ranchord A, Simmonds M, Weatherall M, Beasley R. Routine use of oxygen in the treatment of myocardial infarction: systematic review. Heart, 2009; 95: 198–202.
6. Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomized controlled trial. BMJ, 2010 Oct 18; 341: c5462.
7. Bledsoe BE, Anderson E, Hodnick R, Johnson L, Johnson S, Devendorf E. Low-fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting. Prehosp Emerg Care, 2012 Apr–Jun; 16(2): 217–21.
8. Circulation, 2010; 122: S768–86.
William E. “Gene” Gandy, JD, LP, has been a paramedic and EMS educator for more than 30 years. He has implemented a two-year associate degree paramedic program for a community college, served as both a volunteer and paid paramedic, and practiced in both rural and urban settings and in the offshore oil industry. He has testified in court as an expert witness in a number of cases involving EMS providers and lectures on medical/legal aspects of EMS. He lives in Tucson, AZ.


Steven “Kelly” Grayson, NREMT-P, CCEMT-P, is a critical care paramedic for Acadian Ambulance in Louisiana. He has spent the past 14 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the Louisiana Association of Nationally Registered EMTs. He is a frequent EMS conference speaker and author of the book En Route: A Paramedic’s Stories of Life, Death, and Everything In Between, and the popular blog A Day in the Life of an Ambulance Driver.

Information from: EMSWORLD.COM

Una guia para mejorar la conduccion de la bici en las calles de la ciudad. Infografia

una guia para mejorar la conduccion de la bici en las calles de la ciudad

El uso del casco previene dos de cada tres lesiones graves en ciclistas
La DGT quiere que sea obligatorio en las zonas urbanas, lo que pone en pie de guerra a ciclistas y ayuntamientos

Un 20% de los fallecidos en accidente entre 10 y 14 años iba sin casco en la bicicleta, España
El uso del casco al montar en bicicleta reduce el riesgo de lesión craneal y cerebral en hasta en un 90% y el riesgo de fallecimiento en un 26%. La Asociación Española de Pediatría (AEP) ha dado a conocer una serie de consejos específicos sobre su utilización entre menores detalles en en el enalce http://emssolutionsint.blogspot.co.uk/2013/04/un-20-de-los-fallecidos-en-accidente.html

Manejo de Intoxicación por Plaguicidas by Bayer CropScience


 Manejo de Intoxicación por Plaguicidas by Bayer CropScience


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sábado, 29 de mayo de 2021

⚠️ Ministerio de Salud Publica de la Republica Dominicana a través de la Dirección General de Epidemiología (DIGEPI) emite un aviso sobre la circulación de nuevas variantes de SARS-COV-2 en territorio dominicano y una serie de recomendaciones a tomar en cuenta.

 

⚠️ Ministerio de Salud Publica de la Republica Dominicana a través de la Dirección General de Epidemiología (DIGEPI) emite un aviso sobre la circulación de nuevas variantes de SARS-COV-2 en territorio dominicano y una
 serie de recomendaciones a tomar en cuenta.


Salud Pública informa 4 nuevas variantes del COVID-19 circulan en RD: británica, brasileña, neoyorquina y californiana


El Ministerio de Salud Pública emitió un aviso sobre la circulación de cuatro nuevas variantes de coronavirus en el país de alto interés epidemiológico. Destaca que las nuevas variantes detectadas son de alta gravedad y fácil de transmitir.

La variante británica, la cual presenta un 50% de aumento de transmisión, aumenta la gravedad en función de las hospitalizaciones y las tasas de letalidad.


La variante brasileña, que presenta una disminución significativa de la susceptibilidad a la combinación del tratamiento con algunos anticuerpos monoclonales e impacta mínimamente en la neutralización por sueros convalecientes y postvacunación..

La variante neoyorquina circula en el Distrito Nacional, Santiago, Monte Cristi y Valverde. Esta variante tiene un patrón diferente de mutaciones en comparación con la cepa original secuenciada de China, incluida una llamada L452R que parece ayudar al virus a infectar células más fácilmente mientras al mismo tiempo, dificulta el ataque de los anticuerpos.

La variante californiana, que se ha apodado como ‘el diablo’ y poco se sabe de sus características. Se sospecha que tiene más capacidad de contagiar que la clásica de Wuhan y se cree que podría presentar resistencia a las vacunas, pero aún no hay evidencias sólidas de estos dos riesgos.

Estas variantes se han detectado en: Distrito Nacional, Santiago, Monte Cristi, Valverde, Santo Domingo, San Juan de la Maguana, Independencia, Dajabón, Puerto Plata, Hermanas Mirabal, María Trinidad Sánchez, Hato Mayo, Pedernales, San Pedro de Macorís, Peravia, San Cristóbal, Sánchez Ramírez y El Seibo.


https://somospueblo.com/salud-publica-informa-4-nuevas-variantes-del-covid-19-circulan-en-rd-britanica-brasilena-neoyorquina-y-californiana/













Aplica estas medidas preventivas para evitar el COVID-19. Cara con máscara médica Usa mascarilla. Flecha izquierda y derecha Mantén el distanciamiento social. Jabón Lávate las manos con agua y jabón o con gel a base de alcohol. Personal de asistencia sanitaria hombre Si presentas síntomas, acude a tu médico.






¿Por qué la repetición y sumergirse en los extremos es importante en el entrenamiento?

 

"¿Por qué la repetición y sumergirse en los extremos es importante en el entrenamiento? Simple, nuestro cerebro reptil, cuando se somete a un estrés (extremo), se enfocará en la supervivencia y podrá completar tareas familiares y grabadas en la memoria muscular. Por lo tanto , enseñar a las personas la teoría de la medicina táctica y someterlas a un entrenamiento sin los factores abrumadores del estrés y la sobrecarga sensorial no las preparará para el acto real de la medicina táctica. Y aunque estamos entrenando a las personas para ese 0,01% de probabilidad de que alguna vez tendremos que usar un TQ en un entorno de alto impacto, estoy seguro de que ninguno de nosotros quiere convertirnos en una estadística o un caso del que la gente hable ... queremos contar la historia nosotros mismos. Al final, "las habilidades avanzadas son sólo lo básico, realizado en escenarios extremos "(escuchado de Michael Shertz). Entrena desagradable, porque por un breve momento, ¡la vida también lo será!"

Los antiguos egipcios trataban a algunos pacientes comiendo pan mohoso

 

"Los antiguos egipcios trataban a algunos pacientes comiendo pan mohoso, y nadie entendía por qué". "Hasta el año 1928, cinco mil años después, llegó la ciencia moderna y el científico Alexander Fleming descubría que la penicilina tenía un gran efecto como antibiótico en las bacterias". ¿Cuál es la relación del pan con el tema? "Cuando el pan se pudre, secreta un hongo llamado Penicillium, del cual se deriva la penicilina, el antibiótico más famoso usado hasta ahora para tratar algunos tipos de bacterias
conocidas por los egipcios hace 5.000 años🍞


viernes, 28 de mayo de 2021

Estudio publicado concluye relacion entre Paracetamol en el Embarazo y TEA Trastorno Espectro Autista/TDAH

Prolonged use of Paracetamol during pregnancy is associated with an increased risk for autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), new research shows.

Investigators reviewed studies of mother-child pairs and found a 30%   increase in relative risk for ADHD and a 20% increase for ASD in  children whose mothers took Paracetamol during pregnancy, compared to children whose mothers did not. The mean duration of exposure, calculated from three studies, ranged from 4 to 7 days.

Solutions for pain in Pregnancy:

  • Have Chiropractic care and  Massage
  • Take Vitamin D, a Practitioner Probiotic and Multivitamin to  reduce rick of cold or flu. 
  • If you are sick during Pregnancy, you are not healthy enough to have a healthy baby.
  • Use Magnesium for safe pain relief
Hoy se está hablando mucho en redes del artículo que trata sobre el uso del #paracetamol durante la gestación y su relación con el desarrollo del #TDAH o #autismo

Me gustaría hacer notar lo laborioso y pertinente que resulta y, sobre todo, resaltar sus conclusiones:
«Si bien el paracetamol no debe suprimirse en mujeres embarazadas o niños, debe usarse solo cuando sea necesario».

El artículo (https://lnkd.in/eyM86xZ) es un buen ejemplo de cómo, en el neurodesarrollo los factores ambientales actúan a través de los biológicos y viceversa; y de lo dificilísimo que resulta conocer en qué medida contribuye cada factor a la aparición de un trastorno del neurodesarrollo.
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Factores genéticos: progenitores con síntomas sutiles, muy difíciles de detectar, p. ej, fenotipo ampliado autismo o con rasgos leves de TDAH.

Factores ambientales: infecciones leves (virus), dolor muscular/articular (inflamación), cefalea tensional (ansiedad)

Todos ellos están reconocidos como de riesgo para que el niño tenga un trastorno del neurodesarrollo, en este caso TEA o TDAH.

Y es muy probable que, además tengan un efecto sumatorio.

Es muy difícil atribuir a la sola acción del paracetamol sobre el sistema nervioso en desarrollo la aparición de trastornos en el espectro autismo o TDAH.

by 

María José Mas Salguero

 
1st degree connection
Neuropediatra - ejercicio privado en Fontanet - Medicina y Fisioterapia
https://www.linkedin.com/in/mjmas/

https://www.elmundo.es/ciencia-y-salud/salud/2021/05/28/60afc94cfdddffd1258b4632.html

El paracetamol durante el embarazo aumenta las probabilidades de que el bebé nazca con autismo y TDAH

Los niños expuestos al paracetamol mientras estaban en el vientre materno tienen un 19% más de posibilidades de desarrollar trastornos del espectro autista y un 21% de desarrollar trastornos por déficit de atención.

by Antena 3 Noticias

Publicado: 28.05.2021 12:18


Un estudio publicado por el European Journal of Epidemiology concluye que Los niños expuestos al paracetamol antes de nacer tienen un 19% más de posibilidades de desarrollar trastornos del espectro autista (TEA) y un 21% de desarrollar trastornos por déficit de atención (TDAH).

La investigación se basa en el estudio de 73.881 niños de diferentes países europeos (Reino Unido, Dinamarca, Países Bajos, Italia, Grecia y España) de los que se ha hecho un seguimiento desde antes de nacer y a lo largo de sus primeros años de vida.

Durante la realización del estudio se han considerado las variables que pueden influir en la aparición de TEA o TDAH y el motivo por el que la madre tomaba paracetamol durante el embarazo. Sin embargo, el estudio no indica una causalidad, ya que no se prueba que el riesgo sea absoluto.

Otro estudio publicado en Nature genetics, presentó el primer mapa genético del TDAH donde se demuestra que la patología tiene una correlación genética entre las migrañas, esquizofrenia, autismo, trastorno bipolar, depresión severa. Este es uno de los trastornos psiquiátricos más comunes en la infancia y adolescencia y afecta a cerca del 5 % de los niños y al 2,5 % de los adultos.


Más datos sobre el paracetamol

El paracetamol es uno de los medicamentos a los que más recurrimos cuando estamos enfermos. Por eso, se han realizado diferentes estudios en los que se han observado cómo afecta en las personas el uso de este fármaco. En Ohio encontraron que el paracetamol tiene efectos sobre la capacidad de empatía positiva, es decir, ante el dolor ajeno, nuestra capacidad de sentir ese mismo dolor se reduciría en comparación con otra persona que no haya ingerido el medicamento.


OCTOBER 30, 2019

expert reaction to study looking at paracetamol in pregnancy and autism, ADHD and other developmental disabilities in children

https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-paracetamol-in-pregnancy-and-autism-adhd-and-other-developmental-disabilities-in-children/