THE PIONEERS OF PREHOSPITAL CARE by EMSWORLD

 

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Investigation into acute hepatitis of unknown aetiology in children in England Technical briefing 25 April 25 by UK Health Security Agency

Investigation into acute hepatitis of unknown aetiology in children in England Technical briefing 25 April 25 by UK Health Security Agency

 Publicado el día 25 de abril el #documento #técnico de #investigación de los casos de #hepatitis de #origen no conocido en #Reino #Unido.

Interesantes las hipótesis de trabajo que se manejan en orden de prioridad. Aunque la principal hipótesis es que la hepatitis esté relacionada con un adenovirus, puede que un cofactor esté ayudando a provocar que un adenovirus normal produzca una presentación clínica más grave en niños pequeños más susceptibles debido al confinamiento y exposición reducida a los virus. Este cofactor podría ser la variante ómicron u otro virus. De hecho desde Dic de 2021 se ha notificado un notable incremento de adenovirus, enterovirus, metapneumovirus, rinovirus y norvirus en niños de menos de 10 años de edad

1. A cofactor affecting young children which is rendering normal adenovirus infections more severe or causing them to trigger immunopathology. The cofactor may be:
a. susceptibility, for example due to lack of prior exposure during the pandemic
b. a prior infection with SARS-CoV-2 or another infection, including an Omicron restricted effect
c. a coinfection with SARS-CoV-2 or another infection
d. a toxin, drug or environmental exposure
2. A novel variant adenovirus, with or without a contribution from a cofactor as listed
above.
3. A drug, toxin or environmental exposure.
4. A novel pathogen either acting alone or as a coinfection.
5. A new variant of SARS-CoV-2.

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Indicación de Transporte Sanitario (medico) Aéreo

Trauma Hawk Sikorsky S76 Condado de Palm Beach, Florida

INDICACIONES DEL TRANSPORTE AEREO

La OACI y la OMS publican una declaración conjunta sobre laCOVID-19Para publicación inmediataSede de la OACI, Montreal, 6 de marzo de 2020 – La Organización Mundial de la Salud (OMS) yla Organización de Aviación Civil Internacional (OACI) publicaron hoy un comunicado conjunto en elque facilitan orientaciones actualizadas sobre la COVID-19 y la aviación civil.

Los pacientes que más se benefician del transporte aéreo son los que precisan estabilización precoz "in situ" o/y tratamiento definitivo en los Centros de Referencia, ya que el medio aéreo lo posibilita con mayor ventaja que el terrestre.
En el transporte primario no está justificado el uso de helicópteros si la crona no se reduce significativamente con respecto a la respuesta en UVI-movil terrestre. El factor determinante es el acortamiento del intervalo de tiempo hasta la instauración del tratamiento preciso en la escena y/o hasta la estabilización y evacuación al Centro competente . El mecanismo de lesion, las condiciones del paciente, la localización del incidente, la distancia al Centro competente, las condiciones atmosféricas, los recursos locales y los costos, son algunos de los factores que intervienen en la decisión de realizarlos
No debe potenciarse un uso indiscriminado del transporte aéreo, ya que, además del elevado coste y los riesgos inherentes a este servicio, no aporta beneficios a la mayoría de los pacientes, si bien, la utilización del Servicio de Helicópteros puede proporcionar considerables beneficios a pacientes seleccionados
En principio, estará indicado el transporte aéreo de pacientes críticos, entre ellos, los traumatizados graves, los neonatos y los pacientes cardiacos, sobre todo, cuando se encuentran en áreas rurales distantes de un centro hospitalario de referencia.
En cuanto a los grandes traumatizados, el transporte aéreo primario o secundario, no ofrece dudas, empero, el siempre cuestionado uso rutinario de helicópteros, lo es en mayor medida en pacientes con patologías cardiovasculares. 

Todas nuestras publicaciones sobre Covid-19 en el enlace

https://emssolutionsint.blogspot.com/2020/03/todos-los-enlaces-covid-19-coronavirus.html

AVISO IMPORTANTE A NUESTROS USUARIOS

Este Blog va dirigido a profesionales de la salud y publico en general EMS Solutions International garantiza, en la medida en que puede hacerlo, que los contenidos recomendados y comentados en el portal, lo son por profesionales de la salud. Del mismo modo, los comentarios y valoraciones que cada elemento de información recibe por el resto de usuarios registrados –profesionales y no profesionales-, garantiza la idoneidad y pertinencia de cada contenido.

Es pues, la propia comunidad de usuarios quien certifica la fiabilidad de cada uno de los elementos de información, a través de una tarea continua de refinamiento y valoración por parte de los usuarios.

Si usted encuentra información que considera erronea, le invitamos a hacer efectivo su registro para poder avisar al resto de usuarios y contribuir a la mejora de dicha información.

El objetivo del proyecto es proporcionar información sanitaria de calidad a los individuos, de forma que dicha educación repercuta positivamente en su estado de salud y el de su entorno. De ningún modo los contenidos recomendados en EMS Solutions International están destinados a reemplazar una consulta reglada con un profesional de la salud.

Tratamiento de las enfermedades infecciosas 2020-2022. Octava Egidio by PAHO/OPS

 

Tratamiento de las enfermedades infecciosas 2020-2022. Octava Egidio by PAHO/OPS 

Las sustancias antimicrobianas son aquellas producidas por microorganismos (por ejemplo, antibióticos producidos por bacterias, hongos o actinomicetos) o sintetizadas químicamente (sulfamidas, quinolonas), que tienen la capacidad de destruir, impedir o retrasar la multiplicación de otros microorganismos. En la práctica médica ambos se denominan antibióticos. Los antimicrobianos conforman un gran grupo de compuestos de estructuras diversas y numerosos mecanismos de acción que interfieren en el crecimiento de bacterias, virus, hongos y parásitos. Según su uso, se denominan antibióticos, antivirales, antifúngicos o antimicóticos y antiparasitarios, respectivamente. A su vez, los antibióticos se pueden clasificar según la clase y el espectro de microorganismos sobre los que actúan, el camino bioquímico que interfieren y la estructura química que se une al sitio de acción...

 

Esta publicación fue posible gracias a la contribución financiera del Gobierno de Canadá, a través de su Departamento de Asuntos Mundiales.

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Infografía: MAPA DE LUCHA CONTRA EL TERRORISMO YIHADISTA EN ESPAÑA

 

--> Mapa de la lucha contra el #terrorismo yihadista
--> Operaciones y Detenidos en España 2022
--> Datos actualizados 28mar2022 @interiorgob
#RiesgosyAmenazasSN --> Terrorismo y Radicalización Violenta https://bit.ly/3NI3fJA

Heart Failure Guideline by American College of Cardiology and Heart Failure Society of America

 

Heart Failure Guideline by American College of Cardiology and Heart Failure Society of America

The new Heart Failure Guideline, published jointly today with American College of Cardiology and Heart Failure Society of America, focuses on prevention, updates treatment options, and emphasizes care coordination with HF specialty team.

Read more about the new guidelines here: http://spr.ly/6040KvUWq

ACC, AHA, HFSA Issue Heart Failure Guideline

New ACC/AHA/HFSA guideline redefines heart failure stages to focus on prevention, updates treatment options and emphasizes care coordination with a heart failure specialty team

WASHINGTON and DALLAS (April 1, 2022) — A new joint guideline published today from the American College of Cardiology, the American Heart Association, and the Heart Failure Society of America, increases the focus on preventing heart failure (HF) in people who are showing early signs of “pre-heart failure,” and updates treatment strategies for people with symptomatic heart failure to include SGLT-2 inhibitor (SGLT2i) medicines. The guideline also offers recommendations for managing cardiac amyloidosis, cardio-oncology complications, comorbidities in the setting of heart failure, as well as consideration for implantable devices and advanced therapies for people with stage D heart failure.

Heart failure is a chronic condition that is usually manageable with medication and lifestyle changes. The most common causes of heart failure include narrowed heart arteries, heart attack, high blood pressure and valvular heart disease. Other causes can include, but are not limited to, familial or genetic cardiomyopathies, amyloidosis, metabolic disease, autoimmune disorders or exposure to cardiotoxic agents, such as chemotherapy or other medications. Primary prevention is important for those at risk of HF or pre-HF.

“One primary goal with the new guideline was to use recently published data to update our recommendations for the evaluation and management of heart failure,” said Paul A. Heidenreich, MD, MS, guideline writing committee chair. “One focus was prevention of heart failure through optimizing blood pressure control and adherence to a healthy lifestyle.”

The ACC/AHA stages of heart failure, from A – D, emphasize the development and progression of the disease, with advanced stages indicating more serious disease and reduced survival rate. The new guideline revised these stages to identify HF risk factors early, which is stage A, at risk for HF, and to provide treatment before structural changes or signs of decreased heart function occur, which is stage B, pre-HF. The stages are:

• Stage A: At Risk for HF. At risk but without symptoms, structural heart disease or blood tests indicating heart muscle injury. This includes people with high blood pressure, diabetes, metabolic syndrome and obesity, exposure to medications or treatments that may damage the heart (i.e., chemotherapy drugs), or hereditary risk for heart failure.
• Stage B: Pre-HF. No symptoms or signs of HF, but evidence of one of the following: structural heart disease, such as reduced ejection fraction, enlargement of the heart muscle, abnormalities in heart muscle contraction, or valve disease; increased filling pressures as measured via ultrasound; or risk factors from stage A plus increased levels of B-type natriuretic peptide or persistently elevated cardiac troponin, an indicator of heart muscle injury.
• Stage C: Symptomatic HF. Structural heart disease with current or previous symptoms of heart failure. Symptoms include shortness of breath, persistent cough, swelling (in the legs, feet, abdomen), fatigue and nausea.
• Stage D: Advanced HF. HF with symptoms that interfere with daily life, are difficult to control and result in recurrent hospitalizations despite continued guideline-directed medical therapy.

New York Heart Association classification (Class I – IV) is used when people reach symptomatic (stage C) or advanced (stage D) HF, to describe their functional capacity and determine treatment strategies.

With approximately 121.5 million people in the U.S. with high blood pressure, 100 million with obesity, and 28 million with diabetes, a large proportion of the U.S. population can be categorized as stage A and at risk for HF. For people in this category the guideline recommends blood pressure control according to the latest guidelines. A normal resting blood pressure should be below 120/80 mmHg. People with Type 2 diabetes and either established cardiovascular disease or at high cardiovascular risk are recommended to consider SGLT2i medicines, which are shown to improve survival in these populations. In general, the mainstays of cardiovascular disease prevention are recommended to reduce HF risk: healthy lifestyle habits such as physical activity, healthful dietary patterns, avoiding smoking and maintaining a healthy weight.

While stage A (at risk) recommendations are also applicable for those in stage B, people who have pre-HF have an opportunity to incorporate additional medications to prevent symptomatic HF. For people with stage B HF with left ventricle ejection fraction (LVEF) ≤40%, ACE-inhibitors (angiotensin-converting-enzyme inhibitors, or ACEi) should be used to prevent HF symptoms from developing. Angiotensin receptor blockers (ARBs) may be prescribed for individuals with an intolerance or contraindication to ACEi. Both medications help relax the blood vessels and reduce blood pressure. Cholesterol-lowering statins are recommended for people with a history of heart attack or acute coronary syndrome.

People who have progressed to stage C with HF symptoms should receive care from multidisciplinary teams to facilitate guideline-directed medical therapy and self-care support for learning to manage symptoms. Self-care support includes understanding the importance of taking medicine as directed and maintaining healthy behaviors such as restricting sodium intake and staying physically active. They should also understand how to monitor themselves for signs of worsening HF and what to do about these symptoms. Screenings to identify potential medical or social barriers for effective self-care are recommended, as well as education and support reduce rehospitalization and improve survival. Individuals with stage C HF should be fully vaccinated against respiratory illnesses including COVID-19.

“In recent years, there has been an increase in rigorous science assessing how best to treat symptomatic heart failure. With this new guideline, the writing committee hopes to inform better treatment options for a broader number of our patients with heart failure,” Heidenreich said.

Left ventricular ejection fraction (LVEF) informs prognosis and response treatments for people with HF. The left ventricle of the heart is responsible for pumping blood out to the rest of the body. The percentage of blood that is pumped out of the left ventricle is measured as a percentage called ejection fraction. In general, LVEF of ≥50-55% is considered normal.

For individuals with stage C HF, the new guideline refines the current four classifications of HF based on LVEF with new terminology:

• HF with reduced ejection fraction (HFrEF) includes people with LVEF ≤40%.
• HF with improved ejection fraction (HFimpEF) includes individuals with previous LVEF ≤40% and a follow-up measurement of LVEF >40%.
• HF with mildly reduced ejection fraction (HFmrEF) includes people with LVEF 41-49% and evidence of increased LV filling pressures.
• HF with preserved ejection fraction (HFpEF) includes individuals with LVEF ≥50% and evidence of increased LV filling pressures.

“After careful evaluation of new evidence, guideline-directed medical therapy now includes four medication classes that include SGLT-2 inhibitors. Irrespective of diabetes status, the DAPA-HF and EMPEROR-HF trials have shown the benefit of treating patients with HFrEF with SGLT-2 inhibitors, showing a 30% reduction in heart failure rehospitalization. This is a major step forward in reducing mortality rates in this vulnerable population,” said Biykem Bozkurt, MD, PhD, guideline writing committee vice-chair.

Pharmacological treatment for people with HFrEF includes four classes of medications, in addition to diuretics, which are recommended for patients with fluid retention. Use of angiotensin receptor-neprilysin inhibitors (ARNi) is recommended, and if not feasible, the use of ACEi is recommended. ARBs are recommended for individuals with an intolerance or potential adverse reaction to ACEi medicines. Mineralocorticoid receptor antagonists (MRA) or beta blockers are also recommended as in the prior guideline. SGLT2i are now recommended for people with symptomatic chronic HFrEF regardless of the presence of Type 2 diabetes.

Individuals with HFmrEF or those with LVEF 41-49% should be treated first with an SGLT2i along with diuretics as needed. ARNi, ACEi, ARB, MRA and beta blockers are considered weaker recommendations in this population, as the evidence in this population is less robust. As LVEF may change over time, people with HFmrEF should have repeat evaluations of LVEF.

People with HFpEF and hypertension should aim for blood pressure targets in accordance with clinical guidelines. For people with HFpEF, SGLT2i may be beneficial in decreasing HF hospitalization and cardiovascular mortality. Management of atrial fibrillation can also improve symptoms. In select individuals with HFpEF, MRAs, ARBs and ARNi may be considered, particularly among people with LVEF on the lower end of the spectrum of HFpEF.

The guideline also includes recommendations for implantable cardiac devices and cardiac revascularization therapy, diagnosis and treatment of cardiac amyloidosis, specialty referrals for individuals with stage D advanced HF, and recommendations for management of atrial fibrillation and valvular heart disease in HF and cardio-oncology.

This new heart failure guideline replaces the 2013 ACCF/AHA Guideline for the Management of Heart Failure and the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. The guideline is targeted to all clinicians who are involved in the care of people with cardiovascular disease with or without heart failure.

The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” will publish simultaneously in the Journal of the American College of Cardiology, the American Heart Association’s flagship journal Circulation and the Journal of Cardiac Failure.

Additional Resources:

• After April 1, 2022, view the manuscript online in JACC, Circulation or JCF.
• ACC.org Guideline Hub (after embargo - Friday, April 1, 2022, 2 p.m. ET)
• JACC.org Guideline Hub (after embargo - Friday, April 1, 2022, 2 p.m. ET)
• CardioSmart.org (after embargo - Friday, April 1, 2022, 2 p.m. ET)
• The guideline will be discussed at ACC.22 during the session, “Party Like It’s 2022: The Latest Guidance in Heart Failure Care” on Saturday, April 2 at 4:15 p.m. ET.
• Commentary in Circulation (Available at embargo lift)
• Warning signs of HF
• Healthier Living with HF
• AHA Professional Heart Daily
• AHA Guidelines and Statements
• HFSA Heart Failure Guideline Resources
• Commentary in Journal of Cardiac Failure (after embargo - Friday, April 1, 2022, 2 p.m. ET)

About the American College of Cardiology
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

About the American Heart Association
The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

About the Heart Failure Society of America 
The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested in heart function, heart failure, and congestive heart failure (CHF) research and patient care. The mission of HFSA is to provide a platform to improve and expand heart failure care through collaboration, education, innovation, research, and advocacy. HFSA members include physicians, scientists, nurses, nurse practitioners, pharmacists, trainees, other healthcare workers and patients. For more information, visit hfsa.org. 

###

Media Contacts:

• ACC: Sam Roth, sroth@acc.org, 202-375-6582
• AHA: Maggie Francis, maggie.francis@heart.org, 214-706-1382
• HFSA: Laura Poko, lpoko@hfsa.org, 301-798-4493

LIBROS GRATIS #PDF solo dirígete al enlace de las fotos y allí tienes el enlace en donde puedes descargar de forma legal y sin trucos tu libro. Dr. Ramon Reyes, MD @DrRamonReyesMD https://lnkd.in/eVpFyzZ #DrRamonReyesMD Blog EMS SOLUTIONS INTERNATIONAL ¿Quién es el Dr. Ramon Reyes, MD? Blog 8,302,914 visitas por IP https://lnkd.in/daWAMq9 Twitter 422 seguidores https://lnkd.in/ekwWq-f LinkedIn 5451 seguidores https://lnkd.in/dnPGwGY Pinterest 4170 seguidores Mas de 628,000 visitas mensuales https://lnkd.in/dareieA Instagram 3728 seguidores https://lnkd.in/eQsjZsz Facebook 99329 seguidores https://lnkd.in/e7P6RTa Facebook del Blog EMS SSOLUTIONS INTERNATIONAL 62852 seguidores https://lnkd.in/dyeuGFwh Grupo de TELEGRAM EMERGENCIAS 4327 miembros https://lnkd.in/eVUqu5a Grupo de TELEGRAM TACMED 613 miembros https://t.me/CIAMTO

GUÍA CLÍNICA DE CONSENSO DE ANTICOAGULACIÓN ORAL

GUÍA CLÍNICA DE CONSENSO DE ANTICOAGULACIÓN ORAL

Dr. Ramon Reyes, MD

La Guía pretende servir de ayuda a la hora de tomar decisiones en la práctica clínica de los pacientes con tratamiento anticoagulante oral, realidad cada vez más frecuente por los avances diagnósticos y el progresivo envejecimiento de la población, evitando en lo posible la variabilidad y aumentando la seguridad.

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LIBROS GRATIS #PDF solo dirígete al enlace de las fotos y allí tienes el enlace en donde puedes descargar de forma legal y sin trucos tu libro. Dr. Ramon Reyes, MD @DrRamonReyesMD https://lnkd.in/eVpFyzZ #DrRamonReyesMD
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