E. I. García Criado’s research while affiliated with Distrito Sanitario Granada-Metropolitano and other places

Optimum management of the airway and ventilation in critical patients continues to be a basic cornerstone in survival, evolution and prognosis. orotracheal intubation (OTI) is the “gold standard”in these situations. Knowing the position, maneuvers and material that “facilitate”the OTI and how to perform previous adequate oxygen-ventilation and sedoanalgesia will significantly increase the possibilities of success. There are times when, although being orthodox in the technique performance, we do not achieve the desired purpose (no intubation, no ventilation), defining such a situation as difficult airway (DAW). Primary Health Care physicians and nurses should be prepared for this and have the necessary material and training to face this critical moment in the management of severe patients. Taking the clinical guidelines of the principal scientific societies into account in the management of the airway (Spanish Group for the Management of the Airway [GEMVA], American Society of Anesthesiology [ASA], and the American College of Surgeons), we present a review of the alternatives recommended, focusing on a brief description of the material and a more extensive presentation of the technique.

The risk of osteoporotic fracture in the remaining life time of a white 50-year-old woman is estimated to be approximately 50%, this being 20% for the man. The higher morbidity and mortality and resulting economic costs have encouraged the development of effective interventions to reduce the risk of fracture. Identifying patients with a greater risk of fracture and guaranteeing adherence (compliance and persistence) of the established treatment are essential in the treatment of osteoporosis. Data from longitudinal, retrospective or prospective studies show that compliance and persistence in the treatment of osteoporosis is very poor. In a survey conducted in 9,859 women, it was observed that more than half of the women dropped out of the treatment in the first six months. This dropout increases over time. Only 20% of the patients continue with the treatment without interrupting it. Therapeutic noncompliance, with poor adherence, and minimum persistence in the treatment of osteoporosis is a serious problem of public health that negatively affects the goal of decreasing osteoporotic fracture. The drug dosage for the treatment of osteoporosis plays an important role in its adherence. The easier its administration and the less frequent the dosage, the better the adhe-rence, (assuming that adherence to a preventive treatment is always low). The weekly administration of biphosphonates is associated with better appearance then the daily administration. Monthly administration increases compliance and is as effective as the daily one in the increase of bone mass and reduction of remodeling markers. Furthermore, together with the easy administration of the drug, detailed information must be given to the patient in order for the patient to assume part of the responsibility for his/her disease and together with the professional increase inherence to the esta-blished treatment, increasing bone mass and reducing the risk of fracture, which is, finally, the goal we pursue with the treatment of osteoporosis.

The routine use of non-invasive ventilation (NIV) should begin as soon as possible in the hospital or prehospital Urgency and Emergency setting, both by emergency teams or in primary health care emergency sites. After a suitable selection of the patient, the best form should be applied for the disease in case, either continuous positive airway pressure (CPAP) or BiPAP model (two levels of pressure). The most practical and easy method to be used in primary health care emergency service is CPAP, through which we try to improve the situation of respiratory failure (basically in acute lung edema) without invading the airway. If we apply CPAP in the prehospital setting, we gain time as we use it in the first level of care, as early as possible, and this is beneficial to the patient.

We present the case of a 70-year-old patient with histories of arterial hypertension (HTN), electrocardiographic left ventricular hypertrophy (LVH), trigeminal neuralgia, and with controlled blood pressure. In the last year, she has undergone several changes in her hypertensive treatment in response to gradual BP elevations. She attends the consult for reasons of physical weakness, stress intolerance, malaise, paresthesias and muscular cramps of several months evolution which had been becoming worse. After a detailed study, it becomes evident that we are dealing with beta-blocker side effects, together with a secondary hyponatremia resulting from the use of diuretics and carbamazepine. We also note that the assumption of “good blood pressure control” was incorrect. A simple home self-measurement with a validated automatic device revealed continued morning rises in BP. After appropriate treatment modifications and a later follow-up, symptoms are observed to disappear and ionic alterations are normalized.