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These recommendations are designed to be of assistance to doctors in ICUs when making first evaluations of these patients. They are mainly intended to assist with early diagnosis, risk stratification and initial treatment. The need for individualised treatment is at present one of the main objectives in the management of Acute Coronary Syndrome (ACS), with or without ST elevation, and this is why we believe the recommendations should be of a predominantly practical nature, given that they affect decision making in the day to day practice of medicine.

Objetivo Analizar la frecuencia, la etiologia, la asociacion con arritmias y la mortalidad del syndrome de QT largo (SQTL) adquirido en la Unidad de Cuidados Intensivos (UCI). Diseno Estudio retrospectivo. Ambito Una UCI medica de 17 camas. Pacientes y metodo Pacientes ingresados en la UCI entre enero de 1997 y julio de 2004 que desarrollaron SQTL. Se considero SQTL un QT largo para la frecuencia cardiaca o un QT corregido (QTc) > 0,45 segundos en hombres o > 0,46 segundos en mujeres. Variables de interes principales Las variables estudiadas fueron edad, genero, motivo de ingreso, cardiopatia asociada, asociacion a farmacos y clase implicada, presencia de arritmias y tratamiento empleado, mortalidad en la UCI. Resultados Se incluyeron 88 pacientes (48 mujeres y 40 hombres con edad media de 55,8 ± 19,8 anos). El principal motivo de ingreso fue la intoxicacion medicamentosa. La etiologia se asocio a farmacos en 54 casos (61,4%), siendo los mas frecuentemente asociados: psicotropos, 41 ocasiones (75,9%), antiarritmicos, 22 (40,7%), antimicrobianos, 4 (7,4%) y otros, 6 (11,1%). El 50% de los pacientes mostro alguna arritmia, siendo la taquicardia ventricular (TV) la mas frecuente en 26 ocasiones (59,1%), seguida de torsades de Pointes (TdP) en 15 casos (34,1%). Esta arritmia fue significativamente mas frecuente en el sexo femenino. Precisaron tratamiento 53 pacientes (60,2%), de ellos 29 (33%) recibieron tratamiento ionico, 14 (26,4%) sobreestimulacion con marcapasos y 15 (17%) necesitaron cardioversion. La mortalidad fue del 6,8%. Conclusiones Los psicofarmacos, fundamentalmente los antidepresivos, son los mas frecuentemente relacionados con SQTL en nuestro medio. La arritmia mas frecuente es la TV.

There are few Spanish studies on acute poisoning in the elderly despite the associated risk factors of this group of patients.Retrospective descriptive study of acute poisonings treated in the Emergency Service of the University Hospital of Zaragoza from 1995 to 2009 on patients 65 years old or older.A total of 762 patients were selected in the study (4.74% of all acute poisonings) with a mean age of 74.16 (SD ± 6) years. Ingestion was the major route of exposure (85%) and alcohol overdose (28,7%) was the most frequent type of poisoning. A trend was also observed showing a lower emetic treatment and gastric lavage and an increase in activated charcoal. Benzodiazepines (14.3%) and toxic household products (11%) with caustic properties were also the main toxics found in the study.Acute poisonings in the elderly required more hospitalizations, have a higher mortality and more autolytic attempts which result in death.

Fundamento. Los estudios sobre la intoxicacion aguda en sujetos de edad avanzada en nuestro pais son escasos, a pesar de los riesgos asociados que presenta este grupo de pacientes. Material y metodos. Estudio descriptivo retrospectivo de las intoxicaciones agudas atendidas en el servicio de Urgencias del Hospital Clinico Universitario de Zaragoza entre 1995 y 2009, en pacientes con edad igual o mayor a 65 anos. Resultados. Se registraron 762 casos, el 4,74% del total de intoxicados, con una edad media de 74,16 (SD ± 6) anos. La via oral fue la mas frecuente (85%) y por tipo de intoxicacion, la sobredosis de alcohol (28,7%). Junto a este, las benzodiacepinas (14,3%) y los productos causticos (11%) fueron los principales toxicos involucrados. El 21% de los pacientes recibieron tratamiento especifico antitoxico, no precisando ingreso el 82,4%. Se observo en la evolucion temporal una tendencia que apuntaba a la disminucion del tratamiento emetico y del lavado gastrico y un aumento del carbon activado. La mortalidad de la serie fue del 1,04%. Conclusiones. Las intoxicaciones en pacientes mayores presentan una mayor morbimortalidad, precisando mas ingresos y mas tentativas autoliticas con resultado de muerte.

La intoxicacion por metanol es poco frecuente pero de una gran morbimortalidad. Suele ocurrir accidentalmente al manipular productos industriales como anticongelantes o disolventes. En Espana la forma de intoxicacion mas habitual es el intento autolitico. Presentamos dos casos fatales que presentaban coma y acidosis metabolica importante (pH

These recommendations are designed to be of assistance to doctors in ICUs when making first evaluations of these patients. They are mainly intended to assist with early diagnosis, risk stratification and initial treatment. The need for individualised treatment is at present one of the main objectives in the management of Acute Coronary Syndrome (ACS), with or without ST elevation, and this is why we believe the recommendations should be of a predominantly practical nature, given that they affect decision making in the day to day practice of medicine.

Several studies point out the importance of what is called rescue angioplasty or fibrinolysis when thrombolysis has been ineffective in acute myocardial infarction. Therefore, it is necessary to make use of new non-invasive methods to asses reperfusion and to safely establish that such a treatment has not been effective.We present a work which is based on the assessment of patients with acute myocardial infarction treated with or without fibrinolysis. After determining cardiac enzymatic profiles of creatine kinase and MB isoform (time course, peak, appearance rate constant time-activity: K1). With cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography pre and post treatment after to calculating myocardium at risk, salvage and relationship.In patients treated with fibrinolysis, the salvage myocardium was higher (8.3% vs 3.0%; p0.05). Considering that an improvement in perfusion defect (salvaged myocardium/myocardium at risk) higher than 30% can be viewed as an effective reperfusion, we can see that the percentage in the group treated with fibrinolysis being 45.8%, and the percentage in the group under conventional treatment being just 6.7%. Patients with acute myocardial infarction treated with fibrinolysis show much shorter start of rise-peak time and pain-peak time, all this with very significant differences for the creatine kinase (p0.0001) as well as for the MB (p0.001). Patients with reperfusion show a rapid increase in activity enzymatic, as demonstrated by the pain-peak time variable and the appearance rate constant time-activity (K1), with very significant differences in the latter (p0.0001). In relation with gammagraphy, values of K1 higher or equal to 0.19 for the creatine kinase and 0.14 for the MB isoform, achieved a sensibility of 83% and 91%, and a specificity of 85% and 80% respectively, to asses reperfusion.We think that cardiac imaging gammagraphy with isonitriles as well as as determination of the appearance rate enzymatic constant time-activity, can be useful in monitoring treatment with fibrinolysis in infarction patients. New studies are needed to assess these same aspects, with a lesser number of enzymatic determinations.

Several studies point out the importance of what is called rescue angioplasty or fibrinolysis (FB) when thrombolysis has been ineffective in acute myocardial infaction (AMI). Therefore, it is necessary to make use of new methods to asses reperfusion and to safely establish that such a treatment has not been effective. We present a work which is based on the assessment of patients with acute coronary heart disease: AMI patients treated with FB (N = 48), without FB (N = 15), unstable angina (N = 9); after determining cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography (MIBI-SPECT) pre and post treatment, to assess myocardium at risk (MR), salvage (MS) and the existence or not of gammagraphic reperfusion. Unstable angina patients show a myocardial perfusion that is similar to AMI patients. However, in the case of unstable angina, perfusion is practically of a 100% 48 hours later, having almost completely saved the myocardium at risk (MS/MR = 81.5% +/- 27.7%), and with a non-existent residual myocardium (3.2% +/- 5.8%). In AMI patients treated with FB the salvage myocardium was higher [8.3 vs 3.0; p0.05). Considering that an improvement in perfusion defect (MS/MR)] higher than 30% can be viewed as an effective reperfusion, we can see that all the patients with unstable angina show reperfusion, the percentage in the AMI group treated with FB being 45.8%, and the percentage in the AMI group under conventional treatment being just 6.7%. Gammagraphy with 99mTc-MIBI-SPECT at admission allowed assessing regional perfusion in AMI patients during the early stage of their evolution. With a second exploration we could determine the amount of salvage myocardium and the existence of secondary reperfusion to FB treatment.