miércoles, 28 de julio de 2010

Resuscitation/Acupuncture



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The New England Journal of Medicine
NEJM Resident E-Bulletin

TEACHING TOPICS from the New England Journal of Medicine

Teaching Topics | July 29, 2010

Resuscitation: Was there any survival advantage between chest compressions alone and chest compressions with rescue breathing?

Acupuncture: According to traditional Chinese medicine, how is acupuncture thought to work?

Teaching Topic

Resuscitation

Original Article

CPR with Chest Compression Alone or with Rescue Breathing

T.D. Rea and Others

CME Exam  

Out-of-hospital cardiac arrest claims hundreds of thousands of lives each year worldwide. Successful resuscitation is challenging but achievable, requiring an interdependent set of actions that consist of early arrest recognition, early cardiopulmonary resuscitation (CPR), early defibrillation, expert advanced life support, and timely postresuscitation care.

Clinical Pearls

Clinical Pearl  What is the potential advantage of chest compression alone for CPR?

Chest compression alone may be more acceptable to some laypersons and has the potential physiological advantage of fewer compression interruptions, so that circulation is increased, as compared with traditional CPR, although at a possible cost to oxygenation.

Clinical Pearl  Was there any survival advantage between chest compressions alone and chest compressions with rescue breathing?

No. In this multicenter, randomized trial, CPR instructions consisting of chest compression alone did not increase the rate of survival to hospital discharge overall, as compared with instructions consisting of chest compression plus rescue breathing.

Morning Report Questions

Q. What was the overall rate of survival to hospital discharge among patients with cardiac arrest?

A. The authors observed no significant difference in the rate of survival to hospital discharge (12.5% for instructions to perform chest compression alone and 11.0% for instructions to perform chest compression plus rescue breathing, P=0.31) or the rate of survival to discharge with a favorable neurologic status (14.4% for chest compression alone and 11.5% for chest compression plus rescue breathing, P=0.13).

Q. Which group of patients appeared to have a better outcome when treated with chest compressions alone as compared to chest compressions with rescue breathing?

A. According to subgroup analysis, among patients whose arrest had a cardiac cause, there was a trend toward an increased rate of survival to hospital discharge (15.5%, vs. 12.3% for patients with other causes of arrest; P=0.09) and an increased rate of survival with a favorable neurologic status at discharge (18.9% vs. 13.5%, P=0.03) with chest compression alone.

Table 3. Outcomes.

Teaching Topic

Acupuncture

Clinical Therapeutics

Acupuncture for Chronic Low Back Pain

B.M. Berman and Others

CME Exam  

Traditional Chinese medicine espouses an ancient physiological system (not based on Western scientific empiricism) in which health is seen as the result of harmony among bodily functions and between body and nature. Internal disharmony is believed to cause blockage of the body's vital energy, known as qi, which flows along 12 primary and 8 secondary meridians.

Clinical Pearls

Clinical Pearl  According to traditional Chinese medicine, how is acupuncture thought to work?

The insertion of acupuncture needles at specific points along the meridians is supposed to restore the proper flow of qi.

Clinical Pearl  What pathophysiological phenomena have been identified in association with acupuncture?

Local anesthesia at needle-insertion sites completely blocks the immediate analgesic effects of acupuncture, indicating that these effects are dependent on neural innervation. Acupuncture has been shown to induce the release of endogenous opioids in brain stem, subcortical, and limbic structures. Acupuncture also causes effects on local tissues, including mechanical stimulation of connective tissue, release of adenosine at the site of needle stimulation, and increases in local blood flow.

Morning Report Questions

Q. What do the data from the most recent well-powered clinical trials of acupuncture conclude?

A. The most recent well-powered clinical trials of acupuncture for chronic low back pain showed that sham acupuncture was as effective as real acupuncture. The simplest explanation of such findings is that the specific therapeutic effects of acupuncture, if present, are small, whereas its clinically relevant benefits are mostly attributable to contextual and psychosocial factors, such as patients' beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.

Q. What guidance do the American College of Physicians and the American Pain Society provide for the use of acupuncture for chronic low back pain?

A. The American College of Physicians and the American Pain Society have issued joint clinical practice guidelines recommending that clinicians consider acupuncture as one possible treatment option for patients with chronic low back pain who do not have a response to self-care. The level of supporting evidence for this recommendation was characterized as fair.

Figure 1. Acupuncture Meridians.

quote of the week

Quote of the Week

"Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing."

T.D. Rea and Others, Original Article,
"CPR with Chest Compression Alone or with Rescue Breathing"

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Curso Taller experimental de Ventilacion de Alta Frecuencia Oscilatoria HNERM

https://mail.google.com/mail/?ui=2&ik=14d8f0f8db&view=att&th=12a1a672ec0cdcf5&attid=0.1&disp=attd&realattid=786535d73f61c320_0.1&zw

Estimados amigos:
 
Es un gusto saludarlos.
 
En esta ohttps://mail.google.com/mail/?ui=2&ik=14d8f0f8db&view=att&th=12a1a672ec0cdcf5&attid=0.1&disp=attd&realattid=786535d73f61c320_0.1&zwportunidad la presente es para invitarlos al curso de alto nivel en ventilacion mecanica, especificamente sobre el uso y aplicacion de los Ventiladores de Alta Frecuencia Oscilatoria (VAFO), que el Departameento de UCIG del Hospital Rebagliati realizaremos los dias 6 y 7 de Agosto.
 
Tendremos como ponentes a los Doctores Edgar Jimenez y el Dr. Hugo Silva de la UCI de Orlando USA, expertos en esta tecnologia y quienes lideran los estudios de investigacion sobre VAFO a nivel mundial.
 
El 6 de agosto se reaizara las clases teoricas y practicas de perillaje con el VAFO.
 
El 7 de agosto realizaremos el taller experimental animal, en el que tendremos la oportunidad de interactuar en circuito cerrado de imagenes y audio. con nuestros invitados cuando se realice un modelo experimental de SDRA en un cerdo y como se realiza el manejo de esta compleja patologia en forma convencional y luego con el VAFO, con lo que quedaremos mucho mejor preparados para nuestra practica clinica.
 
Los esperamos en el auditorio N° 2 del HNERM, los dias 6 y 7 de Agosto.
 
Un fuerte abrazo:
Fernando Gutierrez m
 
 



Curso Taller experimental de Ventilacion de Alta Frecuencia Oscilatoria HNERM


Estimados amigos:
 
Es un gusto saludarlos.
 
En esta oportunidad la presente es para invitarlos al curso de alto nivel en ventilacion mecanica, especificamente sobre el uso y aplicacion de los Ventiladores de Alta Frecuencia Oscilatoria (VAFO), que el Departameento de UCIG del Hospital Rebagliati realizaremos los dias 6 y 7 de Agosto.
 
Tendremos como ponentes a los Doctores Edgar Jimenez y el Dr. Hugo Silva de la UCI de Orlando USA, expertos en esta tecnologia y quienes lideran los estudios de investigacion sobre VAFO a nivel mundial.
 
El 6 de agosto se reaizara las clases teoricas y practicas de perillaje con el VAFO.
 
El 7 de agosto realizaremos el taller experimental animal, en el que tendremos la oportunidad de interactuar en circuito cerrado de imagenes y audio. con nuestros invitados cuando se realice un modelo experimental de SDRA en un cerdo y como se realiza el manejo de esta compleja patologia en forma convencional y luego con el VAFO, con lo que quedaremos mucho mejor preparados para nuestra practica clinica.
 
Los esperamos en el auditorio N° 2 del HNERM, los dias 6 y 7 de Agosto.
 
Un fuerte abrazo:
Fernando Gutierrez m
 
 


Preventing Catheter-Related Bloodstream Infections outside the Intensive Care Unit: Expanding Prevention to New Settings [Archivo adjunto 1]


reenviado ----------
 
[Más abajo se incluyen archivos adjuntos de EDDIE ANGLES]

Preventing Catheter-Related Bloodstream Infections outside the Intensive Care Unit: Expanding Prevention to New Settings

HEALTHCARE EPIDEMIOLOGY

CID 2010:51 (1 August) 335

 

Atentamente


 
 
Eddie A. Angles Y.
Medico Infectologo / Tropicalista 
Hospital Nacional Arzobispo Loayza (HNAL)
Grupo de Investigacion Peruano de Enfermedades Infecciosas y Tropicales (GIPEIT)
Cel. 511-996470205
 
www.gipeit.com


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Archivos adjuntos de EDDIE ANGLES

Archivo 1 de 1

Conferencia: Accidentes en Automovil, Envenenamientos y Violencia en Pediatría



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Estimado Ganso e Interno Medico y rRsidentes  te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. Continuamos el Programa 2010, el día 28 de Julio las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia  Accidentes en Automóvil Envenenamientos y Violencia, por el "Dr. Andrés Blanco Montero" Pediatra de la Cd de México DF. La sesión inicia puntualmente a las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador
 http://connectpro60196372.na5.acrobat.com/r28983256/

2.- "Entra como Invitado" Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice "Entrar en la Sala"
5.-
A disfrutar la conferencia

6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


 
Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

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TRIPTICO CURSO [Archivos adjuntos 2]



 
[Más abajo se incluyen archivos adjuntos de legua quispe jose carlos]



 

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Archivos adjuntos de legua quispe jose carlos

Foto 2 de 2


CURSO MONITOREO MINIMAMENTE INVASIVO - HNGAI -PROGRAMA SPOT AFICHE [Archivos adjuntos 3]


 
[Más abajo se incluyen archivos adjuntos de legua quispe jose carlos]



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Archivos adjuntos de legua quispe jose carlos

Foto 1 de 1

Archivo 2 de 2

curso monitoreo minimamente invasivo en paciente critico

 


CURSO TALLER SOBRE UN AREA MUY IMPORTANTE

LES ENVIO LOS LINKS PUBLICITARIOS DEL TALLER Y DEL CURSO MONITOREO HEMOD.
ASIMISMO EL AFICHE Y TRIPTICO

Link del Spot Publicitando TALLER de Monitoreo Hemodinámico.
 

http://www.vimeo.com/13665942

Link del Spot Publicitando CURSO de Monitoreo Hemodinámico.
 

http://vimeo.com/13346341

LES AGRADECERE DIFUNDIRLOS ENTRE TODOS LOS CONTACTOS QUE PODRIAN ESTAR

INTERESADOS EN ASISTIR .O EN GRUPOS MEDICOS O DE ENFERMERIA DEL CUAL SON MIEMBROS.

POR MOTIVO DE SER FERIADO ESTA SEMANA LOS INFORMES E INSCRIPCIONES SE PODRAN REALIZAR EN EL Tfno: 2747682

NUEVAMENTE DESDE EL DIA LUNES EN SECRETARIA DEL HOSPITAL G. ALMENARA.

SE ENTREGARA VIDEOS DEL CURSO Y DEL TALLER(GRABADOS DE TODO EL EVENTO) PARA LOS ASISTENTES

AGRADECIENDOLES DE ANTEMANO Y SALUDOS PARA TODOS UDS

Luis Zegarra Uceda
Coordinador del curso