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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

viernes, 6 de agosto de 2021

Oxygen Toxicity. EMSWORLD



EMSWORLD


Oxygen Toxicity

What EMS providers need to know about possible complications from oxygen administration

This CE activity is approved by EMS World Magazine, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS), for 1.5 CEUs. There are two ways to take the CE test that accompanies this article and receive 1.5 hours of CE credit accredited by CECBEMS: 1. Click here to download a PDF of the test. The PDF has instructions for completing the test. 2. Or go towww.rapidce.com to take the test and immediately receive your CE credit. Questions? E-maileditor@EMSWorld.com.
Objectives
  • Review oxygen absorption and consumption physiology
  • Introduce complications including oxygen toxicity, absorbative atelectasis and carbon dioxide narcosis
  • Explain unique situations of oxygen toxicity in hyperbaric medicine and neonatology
  • Identify techniques to prevent complications
Oxygen is an essential tool in prehospital care and the most commonly administered drug in the out-of-hospital setting. Prehospital providers administer oxygen to correct hypoxemia and hypoxia, and also as an adjunctive treatment in pain management. When administered, oxygen can decrease both the work of breathing and myocardial workload. However, like all drugs, oxygen has side effects. Used incorrectly, oxygen can cause serious harm.

Oxygen Absorption

Adequate oxygen delivery and absorption is essential for proper function at the cellular, tissue and organ levels. The body tolerates inadequate oxygen availability for a short period; however, when demand exceeds oxygen availability for greater than a few minutes, hypoxia will develop, leading to cellular and organ dysfunction, including eventual cellular death.
When a breath is taken or artificial ventilation is delivered, air passes through the mouth and the trachea entering the respiratory system. The tracheobronchial tree first divides at the carina; there are a total of 23 divisions in each branch before finally reaching the alveoli. Air that does not pass though all 23 divisions does not participate in gas exchange and constitutes the “dead space.” Gas exchange occurs when air reaches the alveoli; oxygen diffuses into the bloodstream while carbon dioxide diffuses from the bloodstream into the alveoli. Recall from the EMS classroom that both oxygen (~21%) and carbon dioxide (\< 1%) make up only a small percentage of the air we breathe. By far, nitrogen makes up the majority of the air at nearly 79%. This nitrogen is actually quite important to oxygen absorption, for nitrogen is not as easily absorbed by the body and is the primary gas that creates the pressure inside the alveoli which allows it to stay inflated. Alveoli experiencing atelectasis are not inflated and do not participate in oxygen or carbon dioxide exchange. Pulmonary surfactant, excreted by alveolar cells, coats the alveoli, making it easier to remain open.
It is possible to measure the amount of oxygen absorbed by the body. The majority of the body’s oxygen is attached to hemoglobin as oxyhemoglobin and is measured via arterial oxygen saturation (SaO2). Pulse oximetry (SpO2) is very similar but cannot distinguish between oxygen and carbon monoxide attached to hemoglobin. In prehospital care, in the absence of suspected carbon monoxide cases, SpO2and SaO2 should be essentially the same. Normally less than 5% of oxygen available in the bloodstream is not attached to hemoglobin; rather it is dissolved in the plasma. This dissolved oxygen is measured as the pressure of arterial oxygen, called PaO2, and is measured in millimeters of mercury (mm Hg). A normal PaO2 is 80–100 mm Hg but can decrease to as little as 60 mm Hg without significant clinical symptoms. Under normal conditions, a PaO2 of 60 mm Hg is associated with a SpO2 of 90%. When supplemental oxygen is administered, more and more oxygen is dissolved into the bloodstream increasing the PaO2. There is no maximum PaO2 value when supplemental oxygen is applied.
Oxygen consumption, abbreviated VO2, is the total amount of oxygen used by the body and is determined by oxygen demand, oxygen availability, and the body’s ability to extract oxygen from hemoglobin and plasma. The inability to extract oxygen from hemoglobin occurs in sickle-cell anemia and other similar conditions, but is otherwise beyond the scope of this article. For more information on anemia, review the previous EMS World CE articles.
Unfortunately it is not possible to precisely measure cellular oxygen demand. However it is well understood that oxygen demand increases when the body is stressed, such as during serious injury or illness, following surgery, due to infection and while experiencing pain and/or anxiety. Oxygen demand decreases whenever metabolism slows; this is one reason why patients are cooled following cardiac arrest. More information on the benefits of therapeutic hypothermia will be in a CE article later this year.
Cellular oxygen consumption depends on an adequate oxygen supply. Cells do not function as effectively when oxygen supplies become inadequate because the cells must then shift to anaerobic metabolism. Anaerobic metabolism creates a cellular oxygen debt, which exacerbates tissue dysfunction and hypoxia. Clinically there are several signs and symptoms of oxygen debt, including: anxiety, shortness of breath, tachypnea, tachycardia, hypertension, confusion and cyanosis (late).2
Some progressive EMS systems have begun carrying an iSTAT, which allows paramedics to determine certain lab values. Two of these, lactic acid and pH, can help identify an oxygen debt. In anaerobic metabolism, which occurs when cells are hypoxic, the metabolism byproduct lactic acid rises significantly. The consequence of a rising lactic is a decline in pH, which is why over time anaerobic metabolism leads to the development of a metabolic acidosis. When capable, determine a lactic acid level as well as a pH; lactic acid is considered elevated at levels exceeding 2.2 mm/L, and a pH consistent with acidosis is \
Not surprisingly, cells function poorly in low oxygen environments, and extremely efficiently in oxygen-rich environments. As oxygen availability increases, cellular function increases until they are functioning at full capacity. Essentially, the more oxygen that is available, the better the cell functions. However, there is a point of oxygen administration where additional oxygen does not provide any additional benefit, and over time this supplemental oxygen can become harmful.
The point at which additional oxygen is unnecessary can be estimated in the prehospital setting. To begin, administer supplemental oxygen to restore a normal SpO2, which the American Heart Association currently recommends as at least 94%.3 Once SpO2 is normal, slowly decrease the amount of oxygen being administered and identify the lowest oxygen delivery rate that maintains SpO2 at 94%.1 When a patient can maintain an SpO2 of 94% on room air, supplemental oxygen is generally unnecessary.3
In the hospital setting, cellular oxygen consumption is determined by comparing oxygen content in the arteries and veins. The difference between the two is the amount of oxygen the body takes from the blood for use. These blood draws are referred to as arterial and venous blood gasses respectively.
There is a reason to go through all of this information about what happens to the cells in a hypoxic environment, and how to determine how much oxygen to give to patients. Supplemental oxygen is needed to prevent hypoxia and keep cells functioning properly. However, during normal cellular metabolism oxygen is systematically changed and an O2molecule is produced as a byproduct, which is oxygen with an extra negatively charged electron. This oxygen molecule is considered a free radical “toxic” molecule because it has the ability to damage cell membranes. Normally the body avoids damage from these toxic oxygen molecules because enzymes within each cell are produced that quickly destroy the “toxic” oxygen molecule.4 However, these enzymes are produced at a fixed rate that does not increase when metabolism (oxygen consumption) increases.

Complications of Oxygen Delivery

Like every other drug, oxygen administration has complications. Common complications include skin irritation and breakdown as well as a drying of the mucous membranes. Less common but more serious complications include oxygen toxicity, absorbative atelectasis and carbon dioxide narcosis.
The most common complications are a consequence of the delivery systems. Plastic systems, oxygen masks and nasal cannulas are used, and all of these devices are skin irritants which can cause significant skin irritation and breakdown when used long term. Patients who are on long-term oxygen systems often try to prevent skin irritation by padding their delivery systems, such as by padding their nasal cannula behind the ears with nasal tissues. Other common areas of skin breakdown are across the bridge of the nose and beneath the nares.
Typically oxygen systems deliver oxygen that has nearly zero moisture content. When this oxygen passes through the mucous membranes in the mouth and nose, it is humidified by pulling moisture from the mucous membranes so it is humid by the time it reaches the alveoli. While this protects the alveoli and bronchioles, the nasal and oral mucous membranes quickly dry out. Dry mucous membranes lose their ability to humidify the air we breathe and also become uncomfortable. Applying oxygen via a humidifier can help prevent this from occurring.

Oxygen Toxicity

Recall from earlier in this article that under high oxygen environments, cells metabolize oxygen more quickly. This is because there is an increased pressure from the dissolved oxygen, the PaO2, forcing oxygen into the cell, thereby increasing oxygen consumption and the production of the toxic oxygen molecule byproduct O2-. Since production of the enzyme to eliminate O2- is fixed, the toxic molecules build up over time.4 After roughly 24 hours of this oxygen-rich environment, enough toxic molecules accumulate to clinically see evidence of cellular damage.1
An oxygen-rich environment is determined by looking at how much oxygen a patient receives. Delivering less than 60% oxygen to otherwise healthy lungs is generally considered a low oxygen delivery rate and typically is not associated with the development of clinical oxygen toxicity. However, diseased or injured lungs have been shown to develop symptoms of oxygen toxicity when receiving 50% oxygen or more.4
An early result of oxygen toxicity is capillary leakage, which leads to edema throughout the body, particularly pulmonary edema. Pulmonary edema generally appears first and when untreated can lead to acute lung injury and acute respiratory distress syndrome (ARDS).1 Central nervous system symptoms include altered mental status, respiratory depression and seizures. When awake, some patients also experience visual and auditory disturbances.
Oxygen toxicity has been well documented since the early 1900s and still today remains clinically significant for patients on ventilator support, premature infants and patients receiving hyperbaric oxygen treatment.4 A detailed discussion of ventilator management is beyond the scope of this article. However, EMS is seeing a rise in patients being managed with hyperbaric oxygen and newborns are regularly born outside of the hospital setting.

Toxicity in Hyperbaric Medicine

Hyperbaric oxygen therapy is an important tool in modern medicine for management in a variety of situations including diving emergencies, wound management and carbon monoxide toxicity. Regardless of what hyperbaric medicine is being used to manage, its goal is to increase oxygen availability to organ tissues by increasing oxygen dissolved in the plasma through an increase in the atmospheric pressure. To illustrate this, administering 100% oxygen at sea level, or 1 atmospheric pressure, can produce a maximum PaO2 of 510 mm Hg. By increasing the environment to 3 atmospheric pressures, PaO2 can be increased to 1,530 mm Hg.4 This increase speeds healing by allowing tissues to have increased oxygen available for metabolism. Specifically in diving-related emergencies, hyperbaric medicine compresses nitrogen bubbles that may have formed in the patient’s body tissues to allow the body to more easily eliminate nitrogen that may cause pain (i.e., the bends) and emboli.
While hyperbaric oxygen has true benefits, there are legitimate dangers to its utilization as well. As stated above, hyperbaric oxygen increases oxygen available at the tissue level. Also recall from earlier that the more oxygen available, the faster the cell will metabolize oxygen, and over time this can lead to an accumulation of free oxygen radicals. At normal atmospheric pressures (1 atmosphere) this takes 12 to 16 hours of constant 100% oxygen exposure; this timeframe is reduced to 3 to 6 hours at 2 atmospheres.4This is significant because the same valuable treatments can become dangerous; thus the utilization of hyperbaric oxygen must be closely monitored and controlled.

Neonatal Oxygen Administration

A host of changes occur during and shortly after the birth of a neonate. The neonate’s fetal hemoglobin has a higher affinity for oxygen than adult hemoglobin, which allows them to tolerate lower measured oxygen levels better.4 In reality, measured blood gasses are quite different for the neonate than in the adult and the normal blood gasses are summarized in Table I. The most significant numbers for EMS providers to note are that the neonate’s normal SaO2 and PO2 are much lower than normal adult values. Healthy neonates tolerate these low values well and transition to adult values within about a week.4
Administering supplemental oxygen to neonatal patients has been common, particularly during resuscitation. However, supplemental oxygen can bring the neonate’s oxygen levels well beyond their established normal levels; one of the side effects of this is vascular constriction. This vascular constriction can cause a temporary loss of blood flow in the neonatal retina, leading to long-term vision problems. This occurs in addition to traditional oxygen toxicity, which is also a risk for the neonate because they are not capable of managing increased PO2 levels as well as an adult.4
In response to this risk, and based on fairly recently published data that showed neonates resuscitated with room air had a higher survivability than those resuscitated with 100% oxygen, the American Heart Association changed their recommendations in regards to oxygen administration during neonatal resuscitation. Immediate 100% oxygen is no longer recommended. Instead, they suggest initiating resuscitation with room air, and only administer oxygen if the neonate’s heart rate stays 60 after 90 seconds of resuscitation. Once it’s administered, continue administering oxygen until the heart rate normalizes.5

Absorbative Atelectasis

Not all alveoli are used on a minute-to-minute basis. For example, when resting and sleeping fairly shallow breaths are taken and only a fraction of the body’s alveoli participate in gas exchange. When exercising more oxygen is needed so deeper breaths are taken to increase the volume of air inhaled, and thus more alveoli participate in gas exchange.
As mentioned earlier, nitrogen helps create pressure inside the lungs to keep alveoli propped open because nitrogen does not easily pass though the alveolar membranes. Inactive alveoli, which are those not being ventilated with the average resting breath, contract and have a reduced air volume. However, some nitrogen still remains in these alveoli to keep them open and ready for use.
When supplemental oxygen is administered, less nitrogen is inhaled. At 50% oxygen, there is still roughly 50% nitrogen in inhaled air. However, once greater than 50% oxygen is delivered, oxygen replaces nitrogen as the primary gas in the lungs. The term for this is nitrogen washout, because the oxygen literally pushes out the nitrogen over time. Complete nitrogen washout takes 15 minutes when breathing 100% oxygen.
With the nitrogen washed out, the gas helping keep alveoli inflated is eliminated and alveoli begin to collapse. Absorbative atelectasis, also called denitrogenation absorption atelectasis, is the collapse of the alveoli due to the loss of the partial pressure of nitrogen within the lungs.4 Thus at higher oxygen levels fewer alveoli are available to participate in gas exchange.
Absorbative atelectasis has clinically significant applications for prehospital providers. It is difficult to identify when absorbative atelectasis has occurred since the only sign is a decreased inspiratory volume. However, there are clues that it may be taking place. Patients who are breathing spontaneously may complain of increased shortness of breath or anxiety when oxygen levels are increased. Another clue may be that an increased ventilator rate is needed when delivering 100% oxygen compared to when using lower oxygen levels. While these subtle changes are unlikely to be noticed during short transports, providers whose systems include longer transport times (greater than 30 minutes), and those who participate in interfacility transports, may observe these changes, indicating a need to decrease oxygen delivery rates.

Carbon Dioxide Narcosis/Oxygen-Induced Hypercapnia

Chemoreceptors are discussed in both EMT and paramedic classes. Peripheral chemoreceptors, located in the carotid arteries and the aortic arch, are sensitive to oxygen changes and trigger breaths when PaO2drops below 60 mm Hg. Central chemoreceptors have primary control over breathing and are located in the medulla of the brain and bathed in cerebral spinal fluid. When the CO2 levels rise, hydrogen ion levels rise, causing a pH decrease, and the brain’s respiratory center is triggered to “blow off” carbon dioxide via respiration. In patients with chronically high CO2 levels and low PaO2 levels, such as patients with advanced COPD, the central chemoreceptors can become desensitized because their pH is persistently low due to excessive hydrogen ions in their cerebral spinal fluid. When this occurs, their respirations are triggered, in theory, by peripheral chemoreceptors sensing hypoxia.2
Patients who have chronic ventilatory failure, defined as a chronically increased PaCO2 exceeding 50 mm Hg and decreased PaO2 below 55 mm Hg, need oxygen when their oxygen levels fall below the patient’s established baseline.They also need titrated oxygen when they present in respiratory distress. A recent synopsis of research on patients experiencing an exacerbation of COPD found that 45 minutes of prehospital-administered high-flow oxygen (8 liters per minute) increased patient mortality. The research found decreased mortality when SpO2 was maintained between 88%–92% using titrated oxygen via nasal cannula alone instead of high-flow oxygen and led to recommendations of avoiding high-flow oxygen during prehospital care of patients with advanced COPD.6,7
On occasion, a relatively rare condition known as oxygen-induced hypercapnia can develop in these patients, which results from oxygen administration. When oxygen is administered for an extended period (hours to days) the patient’s already high carbon dioxide levels rise even further, which leads to lethargy and slow and shallow breathing. Without intervention, respiratory arrest develops. Although the exact mechanism for oxygen-induced hypercapnia is not clearly known, it is thought to be a combination of the suppression of the theoretical hypoxic drive as well as an oxygen-induced pulmonary perfusion mismatch.2 Other texts suggest that when oxygen is applied to the asymptomatic patient with a history of an advanced COPD, their lungs are exposed to an increased oxygen saturation. The body quickly recognizes that it can maintain the same PaO2 without having to work as hard, and over time the body adjusts to the alveolar oxygen levels to maintain their arterial oxygen levels as their baseline. The net result of this can be a decreased respiratory rate.4
The well documented and clinically important piece of this condition is that oxygen-induced hypercapnia most commonly occurs in otherwise asymptomatic, relaxed and unstimulated patients, such as a patient who is sleeping. It does not occur in patients with acute respiratory distress, who often are experiencing a catecholamine release stimulating increased respiratory and circulatory rates.2
Clinical symptoms of oxygen-induced hypercapnia include a rising CO2 level, which can be measured with a side-stream CO2 device, altered mental status including confusion, complaints of headaches, and a somnolent appearance.1

Prevention of Complications

Preventing complications from oxygen administration is fairly straightforward. To start, whenever possible, pad the straps and tubing of oxygen delivery systems, particularly on patients who receive oxygen long term. Also, consider increasing the use of humidified oxygen to prevent drying out mucous membranes. Oxygen humidifiers are inexpensive and greatly increase patient comfort. Also, elevating a patient’s head and chest at least 30 degrees promotes lung expansion and helps prevent aspiration.
Never withhold oxygen from patients who are in respiratory distress or hypoxic. Oxygen is truly a lifesaving drug. During major resuscitations, such as cardiac arrest and major traumas, 100% oxygen is indicated. However, for most all other patients, consider limiting oxygen to maintain SpO2 in the 90%–95% range; this also keeps the PaO2 above 60 mm Hg.1Research has consistently shown that oxygen’s maximum benefit is obtained when delivered in the 22%–50% range4, and its benefit is limited after 6 hours of administration.3
Neonatal patient management requires special consideration. Whenever possible, utilize room air when initiating resuscitation. Only administer oxygen when the neonate remains bradycardic after 90 seconds of resuscitation efforts.5

Summary

The administration of oxygen is safe and effective for patients who are in respiratory distress or who are hypoxic. Never feel that oxygen needs to be withheld. However, keep in mind that there are real consequences to the long term utilization of high-flow oxygen. To help prevent potential complications from oxygen administration, reach for the nasal cannula before the non-rebreather mask, and apply just enough oxygen to maintain normal saturations.
References
1. Morton PG, et al, eds., Critical Care Nursing, a Holistic Approach, 8th edition. Philadelphia, PA: Lippincott, Williams & Wilkins, 2005.
2. Des Jardins T, Burton GG. Clinical Manifestations and Assessment of Respiratory Disease, 5th edition. St. Louis, MO: Elsevier, 2006.
3. O’Connor RE, et al. Acute Coronary Syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation 122: S787–817, 2010.
4. Shapiro BA, et al. Clinical Application of Blood Gases, 5th Edition. St. Louis, MO: Elsevier, 1994.
5. Kattwinkel J, et al, Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation 122: S909–S919, 2010.
6. Ntoumenopolus G. Using titrated oxygen instead of high flow oxygen during an acute exacerbation of chronic obstructive pulmonary disease (COPD) saves lives. J Physiother57(1):55, 2011.
7. Austin MA, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomized controlled trial. BMJ 341: c5462, 2010.
Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the performance improvement coordinator for Vitalink/Airlink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. Contact him at kcollopy@colgatealumni.org.
Sean M. Kivlehan, MD, MPH, NREMT-P, is an emergency medicine resident at the University of California San Francisco and a former New York City paramedic for 10 years. Contact him atsean.kivlehan@gmail.com.
Scott R. Snyder, BS, NREMT-P, is the EMS education manager for the San Francisco Paramedic Association in San Francisco, CA. Scott has worked on numerous publications as an editor, contributing author and author, and enjoys presenting on both clinical and EMS educator topics. Contact him atscottrsnyder@me.com.










jueves, 5 de agosto de 2021

INFOGRAFIA: DECALOGO DE SEGURIDAD INFANTIL EN LA PISCINA

 

INFOGRAFIA: DECALOGO DE SEGURIDAD INFANTIL EN LA PISCINA


También puede ver Infografía: 
INFOGRAFIA: DECALOGO DE SEGURIDAD INFANTIL EN LA PLAYA

INFOGRAFIA: DECALOGO DE SEGURIDAD INFANTIL EN LA PLAYA

 

INFOGRAFIA: DECALOGO DE SEGURIDAD INFANTIL EN LA PLAYA 


INFOGRAFIA: DECALOGO DE SEGURIDAD INFANTIL EN LA PISCINA

SE ESTA MURIENDO LA GENERACIÓN DE HIERRO, PARA DARLE PASO A LA GENERACION DE CRISTAL.

 

SE ESTA MURIENDO LA GENERACIÓN DE HIERRO, PARA DARLE PASO A LA GENERACION DE CRISTAL.
https://pin.it/2LA8GaB

La generación que sin estudios educó a sus hijos.

La que, a pesar de la falta de todo, nunca permitió que faltara lo indispensable en casa .

La que enseñó valores; empezando por Amor y Respeto.

Se esta muriendo la gente que enseñaba a los hombres el valor de una mujer y a las mujeres, el valor de los hombres.

Se están muriendo los que podían vivir con pocos lujos, sin sentirse frustrados por ello.

Los que trabajaron desde temprana edad y enseñaron el valor de las cosas, no el precio.

Mueren los que pasaron por mil dificultades y sin rendirse nos enseñaron cómo vivir con dignidad.

Los que después de una vida de sacrificio y penurias, se van con las manos arrugadas y la frente en alto.

domingo, 1 de agosto de 2021

Italia, Aprobada 'Ley Del Buen Samaritano': 'No Punibilidad' Para Cualquier Persona Que Utilice Un Desfibrilador DEA. La nueva ley obliga tambien la enseñanza de Primeros Auxilios y RCP en las Escuelas

 


Se ha aprobado AED, la llamada 'Ley del Buen Samaritano', la legislación que modifica el uso de dispositivos de salvamento: se excluye la responsabilidad legal de quienes prestan ayuda

Senado, se aprueba la Ley del Buen Samaritano sobre desfibriladores externos automáticos (DEA)

La Comisión de Asuntos Sociales de la Cámara de Diputados está llamada a dar el visto bueno final, pero la 'luz verde' de facto del Senado, que acaba de producirse, es un paso fundamental en el proceso de aprobación de la ley que introduce la 'inmunidad 'para cualquier persona que utilice desfibriladores externos automáticos (DEA) para proporcionar ayuda.

Un fuerte impulso para la aprobación de esta ley provino del Irc (consejo italiano de reanimación) y otras organizaciones científicas y voluntarias.

La inmunidad es la innovación más importante introducida por el proyecto de ley 1441 sobre desfibriladores (Disposiciones sobre el uso de desfibriladores semiautomáticos y automáticos en entornos extrahospitalarios).

Pero la Ley del Buen Samaritano también introduce la obligación de enseñar maniobras para salvar vidas en las escuelas.



AED, Good Samaritan Law: la firme convicción de IRC

En Europa se producen anualmente unos 400,000 paros cardiacos (60,000 en Italia) y se estima que solo el 58% de los casos de los que asisten intervienen con maniobras de salvamento (masaje cardiaco, ventilación) y el 28% de los casos con un desfibrilador.

La tasa de supervivencia es del 8%.


Por lo tanto, las medidas de la nueva ley tienen como objetivo involucrar más a los ciudadanos en los primeros auxilios y brindarles las herramientas para hacerlo: además de los 10 millones de euros para la instalación de DEA en lugares públicos concurridos, la obligación de enseñar maniobras de primeros auxilios en las escuelas , y la obligación de los clubes deportivos de equiparse con desfibriladores, existe, por ejemplo, la obligación de que los 118 servicios de urgencias proporcionen a los ciudadanos instrucciones telefónicas sobre cómo reconocer el paro cardíaco, cómo dar masaje cardíaco y cómo utilizar el DEA. y la introducción de aplicaciones para la geolocalización de DEA.

La ley también estipula que, en ausencia de personal sanitario o no sanitario formado en primeros auxilios, los ciudadanos corrientes que no hayan recibido formación específica también pueden utilizar los DEA.

Muchas de estas innovaciones también están presentes en las nuevas directrices europeas sobre primeros auxilios recientemente actualizadas y publicadas por el European Resuscitation Council (ERC), del que IRC es miembro, en base a las recomendaciones del International Liaison Committee on Resuscitation (ILCOR).

Irc ha editado la traducción italiana del documento.

Por tanto, la nueva ley sitúa a Italia a la vanguardia de la reforma de los primeros auxilios.


Italia, Aprobada La 'Ley Del Buen Samaritano': 'No Punibilidad' Para Cualquier Persona Que Utilice Un Desfibrilador DEA By Cristiano Antonino On Jul 29, 2021



War surgery: working with limited resources in armed conflict and other situations of violence. ICRC VOLUME 1 and 2


War surgery: working with limited resources in armed conflict and other situations of violence. ICRC VOLUME 1 and 2


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War surgery: working with limited resources in armed conflict and other situations of violence. ICRC
ICRC surgical programmes for war victims have been developed over many years, based on "appropriate" responses for a given situation. This often involves making the best of limited resources in an austere environment. Volume 1 of this new publication covers the basics of managing war injuries, as well as general topics. 
  • Author(s): Christos Giannou, Marco Baldan
  • Copyright: ICRC
  • Release year: 2009
  • Production locations: Geneva
  • Languages available: English, French, Spanish
  • Type of product: Book
  • Price: CHF 10.-
  • Reference: 0973





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PATIENT SAFETY IN EMS by NAEMT (Free Pdf)

PATIENT SAFETY IN EMS by NAEMT (Free Pdf)


Help Protect All EMS Practitioners With These Convenient Resources

PATIENT SAFETY IN EMS by NAEMT (Free Pdf)
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TRIBUTO a Dr. Henry J. Heimlich, MD 1920-2016

TRIBUTO a Dr. Henry J. Heimlich, MD 1920-2016
El médico estadounidense Henry Heimlich, responsable de la maniobra que lleva su nombre y que ha salvado las vidas de miles de personas afectadas por un súbito atragantamiento, ha fallecido a los 96 años, según ha informado su familia. 
Heimlich, nacido el 3 de febrero de 1920, ha muerto en el Christ Hospital de Cincinnati a causa de las complicaciones derivadas de un ataque cardíaco que padeció el pasado lunes en su casa, de acuerdo con las primeras informaciones que publican medios estadounidenses.
Se graduó de la Universidad de Cornell, recibió su Doctorado en Medicina en el instituto Weill Cornell Medical College en 1943 y se especializó en cirugía. Su carrera estuvo marcada por la creación en los años 70 de la llamada maniobra de Heimlich, una técnica de compresión abdominal para desbloquear los conductos respiratorios en caso de obstrucción, clave en todas las prácticas de primeros auxilios en casos de asfixias por atragantamiento.
Heimlich publicó por primera vez su hallazgo en 1974 y solo una semana después un periódico publicó que había salvado una vida. Hasta 2005, la maniobra de Heimlich era la única recomendada para la obstrucción traqueal por parte de la Asociación Estadounidense del Corazón y la Cruz Roja Estadounidense. A partir de 2006, varias instituciones han puesto en duda su eficacia. La propia autoría de la maniobra no ha estado exenta de controversia: el doctor Edward Patrick, un colega de Heimlich que murió en 2009, afirmó durante años ser el coinventor de la maniobra.
Al margen de las vidas de decenas de miles de personas anónimas, la maniobra Heimlich ha sido usada en personalidades como Ronald Reagan, Elizabeth Taylor, Goldie Hawn, Jack Lemmon, Cher, Nicole Kidman o Halle Berry. Durante su carrera, Heimlich publicó más de 100 trabajos que le hicieron acreedor, en 1993, de su incorporación al Hall of Fame de la Sanidad y la Seguridad Personal.
En 2014, Heimlich publicó sus memorias. Buena parte de su autobiografía —titulada Heimlich's Maneuvers: My Seventy Years of Lifesaving Innovation (Las maniobras de Heimlich: Mis setenta años de innovación)— se centra en la maniobra que lleva su nombre. Heimlich contó que las miles de muertes que se producían al año por obstrucción de la tráquea lo llevaron en 1972 a buscar una solución.
Durante los dos años siguientes, al frente de un equipo de investigadores en el Hospital Judío de Cincinnati, probó con éxito la técnica al meter un tubo con un globo en un extremo por la tráquea de un perro anestesiado hasta que se le obstruyó esa vía. Entonces usó la maniobra para obligar al perro a expeler la obstrucción. "En 1974 sabía que tenía que informar al público de la maniobra tan pronto como fuera posible para salvar vidas", contó durante la presentación del libro. "Estoy seguro que la maniobra salva vidas y quiero que se use y se preserve.Tuve la idea de hacer un libro para que la gente tenga la información correcta", explicó el doctor.
El pasado mes de mayo, el médico empleó por última vez su famosa maniobra para salvar a una mujer en una residencia de ancianos. Heimlich fue capaz de ejercer la fuerza suficiente sobre el pecho de la víctima, Patty Ris, de 87, como para que expulsara el trozo de hamburguesa con el que se estaba asfixiando. "Por lo general es algo que hacemos la gente de la plantilla", explicó al Cincinnati Inquirer el cocinero Perry Gaines, quien asistió en directo a la ejecución de la maniobra. "Pero... es que era el doctor Heimlich".
Padre de cuatro hijo, uno de ellos, Peter, ha sido muy crítico con su padre, al que ha dedicado una web para descubrir lo que él llama "los fraudes médicos de Heimlich".

sábado, 31 de julio de 2021

¿COMO AYUDAR A LOS NIÑOS A CONFRONTAR UNA CATASTROFE By FEMA y American Red Cross

¿COMO AYUDAR A LOS NIÑOS A CONFRONTAR UNA CATASTROFE  By FEMA y American Red Cross










Cómo ayudar a los niños a confrontar una catástrofe 
FEMA
American Red Cross
Enlace para bajar en pdf

Cortesía
EMS España / Emergency Medical Services en España
@EMSESP 
Follow me / INVITA A TUS AMIGOS A SEGUIRNOS
@drramonreyesdiaz 
https://www.facebook.com/drramonreyesdiaz

martes, 27 de julio de 2021

BAJAR: Presentaciones y Material Curso B-Con Control de Sangrados ESPAÑOL




Presentaciones y Material Curso B-Con Control de Sangrados 

Siguiendo el mandato de los Consensos de Hartford y las recomendaciones del Colegio Americano de Cirujanos, mediante su COMITE DE TRAUMA, la NAEMT desarrolla estas herramientas gratuitas para reducir las muertes por sangrados prevenibles, es por ello que nos hacemos parte de estas lineas interinstitucionales y ponemos a la disposicion de los profesionales de la salud para la difusion de los nuevos conceptos en materia de control de hemorragias. 

TCCC-PHTLS Faculty 



Presentación y Material Curso B-Con Español 

Bajar Presentación PPT del antiguo curso BCon-NAEMT 
Solo entre al grupo en TELEGRAM y allí obtendrá el enlace




PAGINA VERIFICACION Y BAJAR CERTIFICADOS DE LOS CURSOS
http://emssolutionsint.blogspot.com.es/2017/01/pagina-verificacion-certificados.html

BAJAR: Presentaciones y Material Curso B-Con Control de Sangrados ESPAÑOL
BAJAR: Presentaciones y Material Curso B-Con Control de Sangrados ESPAÑOL
BAJAR: Presentaciones y Material Curso B-Con Control de Sangrados ESPAÑOL


BAJAR: Presentaciones y Material Curso B-Con Control de Sangrados ESPAÑOL



BAJAR: Presentaciones y Material Curso B-Con Control de Sangrados ESPAÑOL


BAJAR: Presentaciones y Material Curso B-Con Control de Sangrados ESPAÑOL