NPunto

9

Authors: Redondo Castán, L.C., Porroche Urtiaga, C., Compaired Guio, A.B., Gimeno García L

The demand for assistance at the out-of-hospital level in the face of a person who presents a decrease or transient loss of the level of consciousness (PTC) is frequent in the general population. Thus, in the study by Sánchez et al., they estimate that between 3 and 4 people out of 10 will suffer an episode of PTC throughout their lives in adulthood and that 2 out of 10 young people will suffer at least one episode in adolescence (1). Transient loss of consciousness, particularly syncope, defined as transient, spontaneous loss of consciousness with rapid recovery without sequelae and due to global cerebral hypoperfusion, is usually trivial, but between 1-3% of this population will require hospital admission. For study and/or control of the event. This incidence implies that the nursing professional who attends a CTP process must know how to carry out a correct systematic nursing assessment to discriminate life-threatening situations and inform or request help from the emergency and/or emergency services (061/112) if necessary. Likewise, we will review the care quality indicators presented by the Spanish Society of Cardiology in the 2021 SEC-Primary syncope process (2). This work wants to offer a nursing assessment in CTP processes, carrying it out in a focused and systematic way through the 11 Functional Patterns of Marjory Gordon (MG) (3).

23

Authors: Menéndez Argüelles, M

Stupor and coma are a frecuent cause of consultation in emergencies. There are many elements that can cause coma, some of which are treatable, and that is why it is really useful to take them into account based on the dyagnosis to optimize the treatment. The terms lethargy, stupor and obtundation refer to states between coma and alertness, but it is better to describe the level of consciousness based on clinical scales such as GCS – Glasgow coma scale. It is relevant to the history to obtain the statements of the ones who witness the process. Information such as the possibility of a head trauma, the patient’s personal effects and prescriptions and also their medical history can be decisive. Coma is an emergency so appart from  the specific treatments based on the cause, the management should be prioritizing the ABCs- airway, breathing and circulation like in any other emergency. In the management, the priority is to distinguish structural and toxic-metabolic etiologies. The second ones usually have a progressive development, fluctuating course and abscence of focal signs. The abrupt appearance, deep and the presence of focal signs would suggest an structural cause. About the 70 % of the stupor and coma are caused by toxic and metabolic etiologies. There are many metabolic causes, such as glucose alterations (hypoglycemia and hyperglycemia),  calcium, sodium, oxygen.. Also, other patologies like liver failure and renal insufficiency, or specific diseases like porphyria and Wernicke encephalopathy might be a cause. Each one of these causes has its treatment peculiarities, which are important to be known in order to have a greater focus of the management of coma.

25

Authors: Peláez Herrero, N

Type 2 diabetes mellitus (DM2) is a disease that affects the metabolism of carbohydrates, lipids and proteins, is chronic and progressive that is accompanied by a multitude of manifestations that affect the main organs, especially the kidney, heart. Also affecting various tissues and organs other than those already mentioned. These alterations can be serious and even fatal. We can consider that DM 2 is becoming a public health epidemic worldwide, being related to microvascular and macrovascular complications that are associated with high cardiovascular morbidity and mortality. Both DM 2 and Heart Failure (HF) have a high prevalence among the population. This prevalence increases as the age of patients increases. Healthy lifestyle habits and adequate physical exercise can prevent the onset of T2DM. On the contrary, poor eating habits, sedentary lifestyle and obesity can be triggers of it. Once T2DM is diagnosed, first-line treatment is done with the oral antidiabetic drug, metformin, as long as it is indicated and tolerated by the patient. The objective is to investigate drugs that are able to adequately regulate blood glucose levels, but at the same time are capable of producing protective effects on organs that can be harmed, above all, that produce beneficial effects on the heart and metabolism in general. Therefore, in this work of bibliographic review we are going to study the inhibitors of the sodium-glucose cotransporter (iSGLT2), which will act at the level of the renal tubules preventing glucose from being reabsorbed and passing back into the blood, causing, in this way, an increase in urine glucose levels. All this will produce a significant improvement in blood glucose levels and as a consequence there will be weight loss, a reduction in blood pressure, among other benefits. The fact of these drugs to inhibit the reabsorption of glucose will produce a series of effects such as an increase in the formation of glycogen, an increase in the formation of ketone bodies, a caloric deficit that translates into weight loss and an increase in the sensitivity of cells to insulin. With respect to the cardioprotective effect, this is due to the fact that they produce hypotension, and a decrease in filling pressures. The great advantage of these drugs is that their action will not depend on the stage in which the DM2 is, since all these actions do not depend on the levels of insulin secreted by the pancreas. The action of the inhibitors of the sodium-glucose cotransporter SGLT2, at no time, will be related to the levels of the hormone insulin present in the patient, which is a great advantage, because we can use these drugs at any time of the disease. Likewise, they are able to reduce endothelial dysfunction, inflammation and oxidative stress, which significantly improves their cardiometabolic profile.  We are going to cite the studies and metanalysis that have been carried out until 2022, and we will see how the treatment in DM2 and Heart Failure (HF) is evolving, with these new active ingredients. Specifically, we will study the 4 active ingredients that are currently being marketed in Europe, namely dapagliflozin, canagliflozin, empagliflozin and ertugliflozin. However, the efficacy and safety of these active ingredients must be evaluated with daily clinical practice, since they are not exempt from adverse effects, which, in some cases, such as diabetic ketoacidosis (DKA), are more frequent than the studies analyzed say, in addition to being life-threatening. Many of these side effects require hospitalisation and patient monitoring. Therefore, we ask ourselves, is the use of ISGLT2 justified based on their efficacy/safety?