Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
sábado, 14 de septiembre de 2013
Incendios en cirugía/Surgical fires
Fuego quirúrgico. Un reto intraoperatorio
Surgical fires: An ongoing intra-operative challenge.
Abdulrasheed I, Lawal AM, Eneye AM.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:1-5.
Abstract
Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.
Keywords: Fire triangle, fuel, ignition, oxidizer, prevention, surgical fire
http://www.archintsurg.org/text.asp?2013/3/1/1/117117
Fuegos quirúrgicos. La comunicación perioperatoria es esencial para prevenir esta complicación pero devastadora
Surgical fires: perioperative communication is essential to prevent this rare but devastating complication.
Bruley ME.
Accident and Forensic Investigation, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA. mbruley@ecri.org
Qual Saf Health Care. 2004 Dec;13(6):467-71.
Abstract
A fire on or within a surgical patient is a continuing risk in modern surgery. Unfortunately, the sensitivity of surgical and anaesthesia staff to this hazard has waned over the past 25 years with cessation of the use of flammable anaesthetic agents. Prevention of surgical fires requires understanding the risks and effective communication between surgical, anaesthesia, and operating nursing staffs. Preventive measures exist but have yet to diffuse sufficiently across professional boundaries. Based on a review of relevant databases, decades of experience from field investigations, and a review of the medical literature, this paper discusses the incidence of surgical fires, the responsibility for prevention in the perioperative setting, and the procedures for surgical fire prevention and extinguishment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743921/pdf/v013p00467.pdf
Pensando en tres de: Cambios en las prácticas de seguridad del paciente quirúrgico en el complejo quirófano moderno.
Thinking in three's: changing surgical patient safety practices in the complex modern operating room.
Gibbs VC.
Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. verna.gibbs@va.gov
World J Gastroenterol. 2012 Dec 14;18(46):6712-9. doi: 10.3748/wjg.v18.i46.6712.
Abstract
The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgicalsafety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.
KEYWORDS:
Complex adaptive systems, Retained foreign bodies, Retained foreign objects, Retained surgical items, Safety checklist, Surgical fires, Surgical patient safety, Wrong site surgery
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520159/pdf/WJG-18-6712.pdf
Soluciones quirúrgicas a base de alcohol y el riesgo de incendio en la sala de operaciones. Informe de un caso
Alcohol based surgical prep solution and the risk of fire in the operating room: a case report.
Batra S, Gupta R.
Department of Orthopaedic Surgery, Central Institute of Orthopaedics, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi - 110029, India. sumitbatra104@rediffmail.com.
Patient Saf Surg. 2008 Apr 26;2:10. doi: 10.1186/1754-9493-2-10.
Abstract
A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377238/pdf/1754-9493-2-10.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Surgical fires: An ongoing intra-operative challenge.
Abdulrasheed I, Lawal AM, Eneye AM.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:1-5.
Abstract
Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.
Keywords: Fire triangle, fuel, ignition, oxidizer, prevention, surgical fire
http://www.archintsurg.org/text.asp?2013/3/1/1/117117
Fuegos quirúrgicos. La comunicación perioperatoria es esencial para prevenir esta complicación pero devastadora
Surgical fires: perioperative communication is essential to prevent this rare but devastating complication.
Bruley ME.
Accident and Forensic Investigation, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA. mbruley@ecri.org
Qual Saf Health Care. 2004 Dec;13(6):467-71.
Abstract
A fire on or within a surgical patient is a continuing risk in modern surgery. Unfortunately, the sensitivity of surgical and anaesthesia staff to this hazard has waned over the past 25 years with cessation of the use of flammable anaesthetic agents. Prevention of surgical fires requires understanding the risks and effective communication between surgical, anaesthesia, and operating nursing staffs. Preventive measures exist but have yet to diffuse sufficiently across professional boundaries. Based on a review of relevant databases, decades of experience from field investigations, and a review of the medical literature, this paper discusses the incidence of surgical fires, the responsibility for prevention in the perioperative setting, and the procedures for surgical fire prevention and extinguishment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743921/pdf/v013p00467.pdf
Pensando en tres de: Cambios en las prácticas de seguridad del paciente quirúrgico en el complejo quirófano moderno.
Thinking in three's: changing surgical patient safety practices in the complex modern operating room.
Gibbs VC.
Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. verna.gibbs@va.gov
World J Gastroenterol. 2012 Dec 14;18(46):6712-9. doi: 10.3748/wjg.v18.i46.6712.
Abstract
The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgicalsafety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.
KEYWORDS:
Complex adaptive systems, Retained foreign bodies, Retained foreign objects, Retained surgical items, Safety checklist, Surgical fires, Surgical patient safety, Wrong site surgery
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520159/pdf/WJG-18-6712.pdf
Soluciones quirúrgicas a base de alcohol y el riesgo de incendio en la sala de operaciones. Informe de un caso
Alcohol based surgical prep solution and the risk of fire in the operating room: a case report.
Batra S, Gupta R.
Department of Orthopaedic Surgery, Central Institute of Orthopaedics, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi - 110029, India. sumitbatra104@rediffmail.com.
Patient Saf Surg. 2008 Apr 26;2:10. doi: 10.1186/1754-9493-2-10.
Abstract
A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377238/pdf/1754-9493-2-10.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
domingo, 8 de septiembre de 2013
Embarazo/Pregnancy
El ojo y el sistema visual durante el embarazo. ¿Que esperara? Una revisión profunda
The eye and visual system in pregnancy, what to expect? An in-depth review.
Samra KA.
Oman J Ophthalmol [serial online] 2013 [cited 2013 Aug 20];6:87-91.
Abstract
Pregnancy represents a real challenge to all body systems. Physiological changes can involve any of the body organs including the eye and visual system. The ocular effect of pregnancy involves a wide spectrum of physiologic and pathologic changes. The latter might be presenting for the first time during pregnancy such as corneal melting and corneal ectasia, or an already existing ocular pathologies that are modified by pregnancy such as diabetic retinopathy and glaucoma. In addition, pregnancy can affect vision through systemic disease that are either specific to the pregnant state itself such as the pre-eclampsia/eclampsia and Sheehan's syndrome, or systemic diseases that occur more frequently in relation to pregnancy such as Graves' disease, idiopathic intracranial hypertension, anti-phospholipid syndrome, and disseminated intravascular coagulation.
Keywords: Complications, eye, ocular effect, pregnancy
http://www.ojoonline.org/text.asp?2013/6/2/87/116626
Apendicitis aguda en el embarazo
Acute appendicitis in pregnancy
Sanda RB, Garba SE.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:6-10.
Abstract
Background: Frequently, a general surgeon is called upon to consider the diagnosis of appendicitis in a girl or woman who is pregnant or has recently delivered. The burden of clinical decision-making and execution of treatment would rest on the general surgeon, with other specialists playing peripheral, but important supportive roles. This condition is relatively rare in pregnancy. A delay in operative intervention is often incurred in view of the risk of general anesthesia and operation on the fate of the pregnancy. Promptly diagnosed in a patient who sought medical assistance early in the evolution of the disease, acute appendicitis in pregnancy (AAP) should not pose an operative challenge to the contemporary surgeon or risk to the woman and her unborn child. It is the aim of this review to appraise AAP in the light of contemporary evidence based medicine and to demystify it with a view to encouraging general surgeons to boldly confront a potentially lethal disease and not to add to the patient's suffering by hiding behind unnecessary laboratory and imaging investigations. Materials and Methods: Many search engines are used such as MedLine, PubMed and Google scholar to search out discussions related to AAP. All the acquired information was processed to arrive at the conclusions drawn here in this essay. Results: AAP can be promptly diagnosed and treated with high index of suspicion. Awareness of this condition in pregnant patients must be high. The condition if diagnosed early and treated promptly can have a good outcome. Conclusion: Acute appendicitis is a relatively rare condition in pregnancy; surgeons must have a high index of suspicion as early diagnosis and treatment are important factors in a safe outcome of this condition.
Keywords: Acute abdomen, acute appendicitis, fetal outcome, early diagnosis, pregnancy
http://www.archintsurg.org/text.asp?2013/3/1/6/117120
Tratamiento psicológico de la diabetes durante el embarazo
Psychosocial management of diabetes in pregnancy.
Kalra B, Sridhar G R, Madhu K, Balhara YS, Sahay RK, Kalra S.
Indian J Endocr Metab [serial online] 2013 [cited 2013 Aug 29];17:815-8.
Abstract
This consensus based national guideline addresses the need for psychological, psychiatric and social assessment, as well as management, in antenatal women with diabetes. It builds upon the earlier Indian guidelines on psychological management of diabetes, and should be considered as an addendum to the parent guideline.
Keywords: Depression, gestational diabetes mellitus, stress
http://www.ijem.in/text.asp?2013/17/5/815/117216
Tratamiento anestésico de cesárea en una gestante diabética con miocardiopatía hipertrófica y disfunción diastólica restrictiva
C.M. Holgadoa, S. Covesba
Servicio de Anestesiología y Reanimación, Hospital Universitario de Tarragona Juan XXIII,
Rev Esp Anestesiol Reanim. 2012.
Resumen
Los cambios hemodinámicos que se producen durante el embarazo son máximos entre las 28.a y 34.a semanas. En una gestante con enfermedades asociadas o coincidentes, como cardiopatía hipertensiva y diabetes pregestacional estos cambios pueden dar lugar a una hipertensión pulmonar y edema agudo de pulmón de difícil control. Presentamos el caso de una gestante diabética tipo 1 de varios años de evolución, que presentó un cuadro de preeclampsia en un embarazo anterior y que desarrolló una miocardiopatía hipertensiva desde entonces. Había ingresado en la 30.a semana de gestación para control metabólico y de la presión arterial desarrollando una insuficiencia cardiaca congestiva tras la administración de betametasona para maduración pulmonar fetal. Se le realizó un ecocardiograma transtorácico que mostró un ventrículo izquierdo hipertrófico no dilatado con buena función sistólica, alteración diastólica restrictiva e hipertensión arterial pulmonar moderada. Cuando se consiguió mejorar su estado general se decidió realizar una cesárea con anestesia regional para evitar las complicaciones de la hipertensión arterial pulmonar y sistémica. Exponemos el tratamiento anestésico y la resolución de las complicaciones aparecidas tras la administración de oxitocina.
http://www.elsevier.es/sites/default/files/elsevier/eop/S0034-9356(12)00088-6.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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