Manuel Pardo Ríos

Variability and diversity of the electrical cardiac systole

The electrical cardiac systole originates from the beginning of the P wave (atrial depolarisation) until the end of the downward branch of the T wave (ventricular repolarisation). It includes, therefore, succession P-QRS-T and its corresponding intervals and segments: PQ, ST, and QT. The mathematical possibilities of variability in the length of the electrical systole of the heart may be diverse. It is well documented and established that such changes in length may make the myocardial cells more vulnerable and unstable, and may also cause serious cardiac arrhythmias and even sudden death. The current presentation illustrates these electrocardiographic entities with significant variations in the length of its waves and intervals: short PQ and QT intervals, short PQ and long QT, long PQ and long QT. All parameters appeared in young adult males.

Relatives of people with spinal cord injury: a qualitative study of caregivers’ metamorphosis

Qualitative study. To detect the major challenges and needs reported by family member caregivers of people with spinal cord injury (SCI). Family member caregivers of people with SCI and expert professionals were evaluated. This study was conducted in Spain, and most of the participants attended the National Paraplegics Hospital of Toledo. We performed 25 semi-structured interviews. The data were analyzed from a phenomenological perspective using the Colaizzi method. The metamorphosis of the caregiver is a complex personal and family-related process. Analysis of the adjustment phase of the caregiving role allowed us to describe three stages, patterns, and trends. Five basic needs were identified. People with SCI and their primary caregivers experienced changes in every sphere of their lives. Their most important needs were psychological support, social support, economic resources, information, training throughout the process of suffering, and the creation of informal groups of mutual aid.Study designQualitative study.ObjectiveTo detect the major challenges and needs reported by family member caregivers of people with spinal cord injury (SCI).SettingFamily member caregivers of people with SCI and expert professionals were evaluated. This study was conducted in Spain, and most of the participants attended the National Paraplegics Hospital of Toledo.MethodsWe performed 25 semi-structured interviews. The data were analyzed from a phenomenological perspective using the Colaizzi method.ResultsThe metamorphosis of the caregiver is a complex personal and family-related process. Analysis of the adjustment phase of the caregiving role allowed us to describe three stages, patterns, and trends. Five basic needs were identified.ConclusionsPeople with SCI and their primary caregivers experienced changes in every sphere of their lives. Their most important needs were psychological support, social support, economic resources, information, training throughout the process of suffering, and the creation of informal groups of mutual aid.

Randomised clinical simulation designed to evaluate the effect of telemedicine using Google Glass on cardiopulmonary resuscitation (CPR)

Aim Through a clinical simulation, this study aims to assess the effect of telematics support through Google Glass (GG) from an expert physician on performance of cardiopulmonary resuscitation (CPR) performed by a group of nurses, as compared with a control group of nurses receiving no assistance. Methods This was a randomised study carried out at the Catholic University of Murcia (November 2014–February 2015). Nursing professionals from the Emergency Medical Services in Murcia (Spain) were asked to perform in a clinical simulation of cardiac arrest. Half of the nurses were randomly chosen to receive coaching from physicians through GG, while the other half did not receive any coaching (controls). The main outcome of the study expected was successful defibrillation, which restores sinus rhythm. Results Thirty-six nurses were enrolled in each study group. Statistically significant differences were found in the percentages of successful defibrillation (100% GG vs 78% control; p=0005) and CPR completion times: 213.91 s for GG and 250.31 s for control (average difference=36.39 s (95% CI 12.03 to 60.75), p=0.004). Conclusions Telematics support by an expert through GG improves success rates and completion times while performing CPR in simulated clinical situations for nurses in simulated scenarios.

Association of short PR interval, long QT interval and sudden cardiac death in a young male.

A 26-year-old man came to our hospital for paroxysmal palpitations accompanied by profuse sweating, dry heaves, and considerable psychomotor agitation unrelated to effort (sudden onset during physiological sleep). He was transferred to the recovery unit for assessment and symptom management. During the patient’s stay in the unit, his overall condition deteriorated unexpectedly, ventricular tachycardia caused by torsade de pointes appeared simultaneously on the electrocardiographic monitor (lead II), and he experienced cardiopulmonary arrest. He recovered following cardiac electric defibrillation (3 shocks of 200, 200, and 360 J of energy, respectively) and pharmacological treatment (2 g of sulfate magnesium in a bolus over 2 min, followed by prescribed intravenous perfusion of 500 mL of saline solution with 2 mg of sulfate magnesium, together with 1.5 μg of isoproterenol/min). He recovered completely, and there were no changes compared to the baseline QTc value. The patient had experienced another ventricular fibrillation episode 3 years earlier, from which he recovered by electric defibrillation in another hospital. The ECG prior to the ventricular tachycardia presented electrical abnormalities with a short PR interval and long QT interval. This ECG pattern remained stable throughout the patient’s follow-up, and was not a finding on admission (Figure 1). Once the event stabilized, the patient was transferred from the emergency room to the cardiology department, where he underwent an electrocardiographic study and a series of protocolbased tests for similar lesions: laboratory workup (basic, ions, electrolytes, thyroid, cardiac), Holter monitoring, stress test, echocardiography, tilt test, and single photon emission computed tomography. None of these examinations showed significant cardiac alterations. Genetic and electrophysiologic studies were also carried out. The genetic studies showed no abnormalities in genes currently considered to cause short PR interval (PRKAG2) or in specific genes known to cause long QT interval (LQT1 [KCNQ1], LQT2 [HERG + MiRP1], LQT3 [SCN5A], and LQT4 [anchor protein Ankyrin B]). LETTERS TO THE EDITOR

Comparative study of a simulated incident with multiple victims and immersive virtual reality

OBJECTIVES The main objective of the study is to determine the efficiency in the execution of the START (Simple Triage and Rapid Treatment) triage, comparing Virtual Reality (VR) to Clinical Simulation (CS) in a Mass Casualty Incident (MCI). The secondary objective is to determine the stress produced in the health professionals in the two situations described. MATERIALS A comparative study on the efficiency and the stress during triage in a MSI was conducted. The basal and post levels of salivary α-amylase (sAA) activity were measured in all the participants before and after the simulation. RESULTS The percentage of victims that were triaged correctly was 87.65% (SD = 8.3); 88.3% (SD = 9.65) for the Clinical Simulation with Actors (CSA) group and 87.2% (SD = 7.2) for the Virtual Reality Simulation (VRG) group, without any significant differences (p = 0.612) between both groups. The basal sAA was 103.26 (SD = 79.13) U/L with a significant increase (p < 0.001) with respect to the post-simulation levels (182.22, SD = 148.65 U/L). The increase of sAA was 80.70 (SD = 109.67) U/mL, being greater for the CSA group than the VRG group. CONCLUSION The results show that virtual reality method is as efficient as clinical simulation for training on the execution of basic triage (START model). Also, based on the sAA results, we can attest that clinical simulation creates a more stressful training experience for the student, so that is should not be substituted by the use of virtual reality, although the latter could be used as a complementary activity.

Changes in foot posture during pregnancy and their relation with musculoskeletal pain: A longitudinal cohort study

AIM To examine foot posture changes during the three trimesters of pregnancy and to determine whether there is a relationship between these changes and the pain experienced in this period. METHODS The study sample consisted of 62 pregnant women who attended the Gynaecology Service at Hospital ​Santa María del Puerto (Cádiz, Spain), between January 2013 and May 2014. In their first visit, the following sociodemographic and anthropometric data were recorded: age, weight, height and foot size. In addition, information was obtained regarding pain in the lower back, knees, ankles and feet. In this first visit, too, the Foot Posture Index (FPI) was assessed, and three subsequent controls were performed during the first, second and third months of pregnancy (termed Stages 1, 2 and 3, respectively). RESULTS In Stage 1, the average foot size (i.e., shoe size) was 38.3 (SD 1.5). This size did not change between Stages 1, 2 and 3. However, body weight and BMI did present statistically significant changes during this period (p<0.0001). The FPI varied during pregnancy but no relation was observed between these changes and the onset of pain. CONCLUSIONS During pregnancy, pronation increases but this does not appear to influence the onset of pain in the lower limbs.

Effect of training in advanced trauma life support on the kinematics of the spine: A simulation study

Abstract More than 7.5 million people in the world are affected by spinal cord injury (SCI). In this study, we aimed to analyze the effect of training in advanced trauma life support (ATLS) on the kinematics of the spine when performing different mobilization and immobilization techniques on patients with suspected SCI. A quasi-experimental study, clinical simulation, was carried out to determine the effect of training in ATLS on 32 students enrolled in the Masters program of Emergency and Special Care Nursing. The evaluation was performed through 2 maneuvers: placing of the scoop stretcher (SS) and spinal board (SB), with an actor who simulated a clinical situation of suspected spinal injury. The misalignment of the spine was measured with the use of a Vicon 3D motion capture system, before (pre-test) and after (post-test) the training. In the overall misalignment of both maneuvers, statistically significant differences were found between the pre-test misalignment of 62.1° ± 25.9°, and the post-test misalignment of 32.3° ± 10.0°, with a difference between means of 29.7° [(95% confidence interval, 95% CI 22.8–36.6°), (P = .001)]. The results obtained for the placing of the SS showed that there was a pre-test misalignment of 65.1° ± 28.7°, and a post-test misalignment of 33.2° ± 10.1°, with a difference of means of 33.9° [(95% CI, 23.1–44.6°), (P = .001)]. During the placing of the SB, a pre-test misalignment of 59.0° ± 28.7° and a post-test misalignment of 33.4° ± 10.0° were obtained, as well as a difference of means of 25.6° [(95% CI 16.6–34.6°), (P = .001)]. The main conclusion of this study is that training in ATLS decreases the misalignment provoked during the utilization of the SS and SB, regardless of the device used.

Drones at the service for training on mass casualty incident: A simulation study

Abstract Mass casualty incidents (MCI) are characterized by a large number of victims with respect to the resources available. In this study, we aimed to analyze the changes produced in the self-perception of students who were able to visualize aerial views of a simulation of a MCI. A simulation study, mixed method, was performed to compare the results from an ad hoc questionnaire. The 35 students from the Emergency Nursing Master from the UCAM completed a questionnaire before and after watching an MCI video with 40 victims in which they had participated. The main variable measured was the change in self-perception (CSP). The CSP occurred in 80% (28/35) of the students (P = .001). Students improved their individual (P = .001) and group (P = .006) scores. They also described that their personal performance had better results than the group performance (P = .047). The main conclusion of this study is that drones could lead to CSP and appraisal of the MCI simulation participants.

Asociación de intervalo PR corto, intervalo QT largo y muerte súbita en un varón joven

Un varón de 26 años de edad acudió a nuestro hospital por la aparición de palpitaciones paroxísticas acompañadas de sudoración profusa, náusea improductiva y gran agitación psicomotriz sin relación con el esfuerzo (aparición súbita durante el sueño fisiológico). Fue trasladado a sala de recuperación para valoración y manejo del cuadro. Durante su estancia en dicha sala presentó un deterioro inesperado de su estado general, con aparición simultánea en la tira de monitor electrocardiográfico (sobre D II) de taquicardia ventricular por torsade de pointes y una parada cardiorrespiratoria recuperada mediante desfibrilación eléctrica cardiaca (tres choques de 200-200 y 360 J de energía respectivamente) y administración farmacológica (2 g de sulfato magnésico en bolo de 2 min y luego perfusión intravenosa pautada de 500 ml de SSF con 2 mg de sulfato magnésico, junto con 1,5 μg de isoproterenol/min); la recuperación fue total y no se observó modificación alguna respecto al valor QTc basal. El paciente había tenido otro episodio de fibrilación ventricular hacía unos 3 años del que fue recuperado mediante desfibrilación eléctrica en otro hospital. El ECG previo a la taquicardia ventricular presentaba anomalías eléctricas, con un intervalo PR corto y un intervalo QT largo. Este patrón del ECG se mantuvo estable en todo momento durante el seguimiento del paciente, y no fue un hallazgo puntual del día del ingreso (fig. 1). Una vez estabilizado del evento, se lo trasladó desde el servicio de emergencias al servicio de cardiología, donde se le practicó, además del estudio electrocardiográfico, una batería de pruebas protocolizadas en lesiones parecidas: perfiles analíticos (básico, iónico, electrolítico, tiroideo, cardiaco), estudio Holter, ergometría, ecocardiografía, tilt test y SPECT; en ninguna de ellas se apreciaron alteraciones cardiacas significativas. Asimismo se llevaron a cabo estudios genéticos y electrofisiológicos. En los estudios genéticos evaluados, no se detectaron alteraciones en genes considerados hasta hoy supuestas causas del intervalo PR corto1 (PRKAG2) ni en los genes específicos bien conocidos como causa de intervalo QT largo2 (LQT1 [KCNQ1], LQT2 [HERG + MiRP1], LQT3 [SCN5A] y LQT4 [anchor protein Ankyrin B]). Mediante estudio electrofisiológico, después de bloqueo autonómico con esmolol y posterior estimulación con adenosina, no se indujo ningún tipo de arritmia cardiaca específica (incluida fibrilación Cartas al Editor