Premessa: in Area Critica la rilevazione dell’EtCO2(CO2 fine espirio- End Tidal CO2) è considerata un Gold Standard, in relazione alle raccomandazioni internazionali AARC - Clinical Practice Guideline del 2011. Vi sono almeno tre momenti principali in cui è raccomandata la capnometria nel paziente ventilato meccanicamente:1. Verifica del corretto posizionamento di presidi per la pervietà delle vie aeree.2. Analisi della condizione di circolazione polmonare e ventilatoria.3. Ottimizzazione della ventilazione meccanica.
To present an atypical case of paracentral acute middle maculopathy occurred upon awakening in the morning within hours after phosphodiesterase-5 (PDE-5) inhibitor consumption at bedtime.Multimodal retinal imaging findings, including fluorescein angiography, spectral domain optical coherence tomography, optical coherence tomography angiography, and microperimetry of a particular case of paracentral acute middle maculopathy lesion that follow the distribution of the cilioretinal artery.A 52-year-old healthy man presented with an acute paracentral scotoma in his left eye upon awakening in the morning, after the use of a PDE-5 inhibitor pill the previous night. Spectral domain optical coherence tomography illustrated a hyperreflective band-like lesion at the level of the inner nuclear layer, consistent with a diagnosis of paracentral acute middle maculopathy, along the course of the cilioretinal artery that appeared normally perfused with fluorescein angiography. Optical coherence tomography angiography showed a perfusion deficit and capillary pruning of the retinal deep capillary plexus, with preserved intermediate capillary plexus, that colocalized with the paracentral scotoma confirmed with microperimetry.To our knowledge, this is the first report of paracentral acute middle maculopathy after the use of PDE-5 inhibitor. Nocturnal arterial hypotension exacerbated by the vasodilatory effect of the PDE-5 inhibitor may have caused transient cilioretinal artery hypo/nonperfusion and insufficiency. Paracentral acute middle maculopathy may represent the earliest form of ischemia in the central macular region, occurring after a milder vascular insult.
Background: Acute pain is common among patients requiring assistance from prehospital emergency medical services (EMS). Nonetheless, the undertreatment of pain in this context remains a frequent phenomenon. Timely and effective analgesia is a crucial feature in emergency medicine. To ensure analgesia provision, prehospital paramedics and nurses can administer analgesics via standard operating protocols or under a physician’s remote supervision. Information about such protocols in Italian EMS is lacking. Objective: Evaluation of the availability of nurse’s standard analgesia protocols in Italy’s prehospital EMS settings. Methods: A cross-sectional online survey involved all 74 Italian emergency medical dispatch centres (EMDCs). Aside from descriptive statistics, we used χ 2 -analysis and Spearman-rank correlation to look for associations between geographical areas’ dependence upon independent variable categories and their correlations. Results: Of all the 74 Italian EMDCs, 70 (94.6%) completed the survey, covering 100 provinces out of a total of 107 (93.5%). Operating nurses’ prehospital analgesia protocols are available in 46 provinces (46.0%). The availability of prehospital analgesia protocols is more extended in northern Italy EMDCs (n=30, 66.7%) than in central Italy (n=9, 42.8%) and southern Italy and islands (n=7, 20.6%). Morphine (76.1% for medical patients and 95.7% for trauma) and paracetamol (89.1% for both) are the most common drugs included in the prehospital analgesia protocols. Conclusion: Despite international consensus on the necessity, efficacy, and safety of nurses’ prehospital analgesia provision, nurse-administered analgesia protocols are available in less than half of Italian provinces, with substantial differences between northern, central, and southern areas. These results indirectly indicate potential undertreatment of prehospital pain in Italy and yield practice improvements. Keywords: nurses, pain management, analgesia, pain relief, prehospital emergency care, emergency medical services
Purpose To evaluate safety and efficacy of a new non‐invasive ultrasound device for the surgical treatment of glaucoma. Methods This is a multicenter prospective study conducted at the University of Bologna and Genoa including 30 eyes of 30 patients with uncontrolled glaucoma. Of these, 15 patients were affected by primary open angle glaucoma (POAG), 10 by angle closure glaucoma (ACG) and 5 by neovascular glaucoma (NVG). The procedure was performed by an ultrasound generator probe with 6 piezoeletric transducers activated for 4, 6 or 8 sec (EyeOP1, EyeTechCare, Rillieux‐la‐Pape, France). Intraocular pressure (IOP) measurements were performed before and 1 day, 1–2 weeks, 1–3–6 months after the procedure. Primary outcomes were mean IOP reduction, qualified success (IOP reduction ≥20% without hypotensive medication adjunction) and complete success (as above plus IOP < 21 mmHg). Secondary outcomes were the correlations with glaucoma subtypes and exposure treatment time. Results The mean pre‐operative IOP was 30.1 mmHg (mean numbers of hypotensive drops and acetazolamide tablets were 2.7 and 0.8 respectively). Six months after treatment, mean IOP value was 20.2 mmHg (mean number of hypotensive drops and acetazolamide tablets were 2 and 0.3 respectively). IOP reduction was significant regardless glaucoma subtypes and exposure time (p < 0.001). In particular, higher IOP reductions were found in patients affected by ACG or treated with 8 sec exposure time (always p < 0.05). Qualified success was reached in 18 eyes, complete success in 6 eyes. Two patients had no IOP reduction with the need of subsequent surgery or increased number of drops. No major complications occurred. Conclusions This procedure appear to be safe and effective in reducing IOP in all glaucoma subtypes. In particular, IOP reduction was shown to be higher in ACG and 8 sec exposure groups.
Introduzione: l’infermiere specialista clinico, figura individuata attraverso la legge 43 del febbraio 2006, rappresenta a tutt’oggi uno degli aspetti controversi della formazione post laurea di primo livello;nonostante il riconoscimento normativo e la diffusione di numerosi percorsi di specializzazione attraverso master universitari, il ruolo e le competenze dei professionisti specialisti vengono raramente riconosciuti in maniera formale nelle organizzazioni sanitarie.
Introduzione: il dolore è un fenomeno soggettivo, individuale e complesso. È la prima causa di accesso ai Dipartimenti di Emergenza di tutto il mondo. Una precoce gestione del dolore da parte dell’infermiere tramite l’utilizzo di protocolli ha esiti positivi sulla soddisfazione dei pazienti. L’obiettivo dello questo studio è analizzare la percezione degli infermieri di Pronto Soccorso circa il dolore dei pazienti adulti afferenti al servizio, evidenziando le barriere principali all’obiettività della valutazione e le modalità utilizzate per gestirlo, al fine di migliorare il corretto management del dolore. Materiali e Metodi: il disegno di studio è di tipo qualitativo con analisi fenomenologica interpretativa attraverso la conduzione di interviste libere e narrative, strutturato secondo le indicazioni della checklist COREQ-32. Risultati: sono stati intervistati 20 infermieri di Pronto Soccorso appartenenti a due aziende sanitarie della regione Veneto. Dalle interviste sono emersi sette temi principali: protocolli per la somministrazione di terapia, gestione del dolore nel bambino, procedure non farmacologiche, differenze tra pazienti con dolore acuto e cronico, caregiver e pazienti anziani o con deficit cognitivo, esperienze personali di dolore del personale sanitario, obiettività della valutazione infermieristica. Conclusioni: dall’analisi delle interviste sono emersi fattori ostacolanti una ottimale gestione del dolore legati al contesto, come il sovraffollamento dei Pronto Soccorso, o a particolari categorie di pazienti di difficile gestione, come bambini o anziani con deficit cognitivi. Sono inoltre emerse esperienze positive, come l’utilità delle tecniche non farmacologiche e il ruolo partecipativo di familiari e caregiver, in particolare nella valutazione del dolore.
Introduzione: la società moderna ha un trend sempre più marcato nell’utilizzo delle terapie complementari, influenzando inevitabilmente i modelli sanitari. Dunque è strategico conoscere quali siano le opinioni degli infermieri sulle CAM.
Background: Intensive care unit (ICU) patients' pain and sedation management is a significant nursing challenge. Sedatives and muscle relaxants administration has been long used for improving patients' comfort and tolerance to mechanical ventilation. This practice led to an increase in adverse ICU outcomes in terms of health status, hospitalization stay, infections, and mortality. The use of appropriate ICU pain and sedation assessment tools is limited.
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