RT info:eu-repo/semantics/doctoralThesis
T1 Marcadores biológicos y escalas de gravedad para la detección del paciente grave
A1 Brío Ibáñez, Pablo del
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Medicina de urgencia
K1 Atención médica ambulatoria
K1 Prehospital care
K1 Atención prehospitalaria
K1 Lactic acid
K1 Ácido láctico
K1 Clinical deterioration
K1 Deterioro clinico
K1 3205 Medicina Interna
AB Urgent Care services are the link in the health care chain ready to care for the critical patient, as they initiate the care that must be continued with a Comprehensive Emergency System, constituted and guided in our country by a set of activities that begin outside the hospital. The optimization of healthcare is achieved during the care of patients in a critical or unstable situation or those in whom rapid clinical deterioration can be foreseen or with pathologies that are time-dependent with early diagnosis or treatment.The way to improve the quality of care lies in the appropriate classification of one's patients in relation to their pathology and health status.As most of the standardized and normalized classification systems are the achievement of the unification of different regional or national triage systems that, in order to be used internationally, use a uniform terminology.During the first contact with the patient after an unplanned incident, triage systems are not always able to detect the real severity of victims with severe acute pathology since, at that time, the imbalance in relation to their physiological parameters is not yet apparent. Acute deterioration of patients is often preceded by subtle changes in physiological parameters such as pulse, blood pressure, respiratory rate and level of consciousness. The subjective assessment of clinical signs leads to an underestimation of the patient's actual condition and thus to delayed decision-making, increasing the risk of mortality. The problem is that there are no diagnostic tests with which we can be sure that there is physiological deterioration. This is where rapid response systems (RRS) led by track-and-trigger systems (TTS) come in. Thus, these alert systems evaluate a set of characteristics to generate a timely response, monitoring vital signs with the aim of alerting about a possible clinical deterioration of the patient. The main representative of this type of aggregated weighted TTS is the Early Warning Scoring Systems (EWS).The implementation of complementary tests at the POCT point of care marks a breakthrough and allows optimising the results obtained with EWS. Serum lactate level is an indicator of mortality. Measurement of lactate by POCT appears to reduce time to initiation of rescue therapy and also reduces mortality compared to patients who were managed with traditional laboratory testing. In conclusion EWS is necessary for risk stratification and prediction of physiological decline in potentially critically ill patients, but its prediction needs to be improved with the combination of other scales or the use of easily available analytical values such as lactic acid in order to calculate DLA and refine the predictive potential in advance of worsening.
YR 2022
FD 2022
LK https://uvadoc.uva.es/handle/10324/59780
UL https://uvadoc.uva.es/handle/10324/59780
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 17-jul-2024