Abstract Body

BACKGROUND
Digoxin is a cardiotonic glycoside that is mainly used in the treatment of heart failure,
atrial fibrillation, flutter, and paroxysmal atrial tachycardia. Intoxication due to digoxin
excess is a common problem in clinical practice because it is therapeutically effective
within a narrow dose range, Acute toxicity is more likely to result in a younger
individual following an overdose. Chronic digoxin toxicity frequently occurs in the
elderly as a result of declining renal function or drug-drug interactions, is harder to
diagnose, and has a more insidious onset of symptoms. Gastrointestinal symptoms can
be less pronounced than in acute toxicity. Neurologic manifestations, such as lethargy,
fatigue, confusion, and weakness, are common. Hyperkalemia or hypokalemia can be
observed.

LEARNING OBJECTIVES
– Managing drug-drug interactions
– Precognition of clinical signs or symptoms
– Signs of poisoning in the electrocardiogram
– Analysing blood tests if suspicion of poisoning

ORGANIZATION
– We will make an introduction with a clinical case and explaning
characteristic features, diagnosis, and management.
– We will make 4 groups and provide to each group a different clinical case
and ask to make an evaluation, management, afterwards each group make a
presentation and discuss the case with the other groups, realizing a group
debate.
– Finally we will use Kahoot and ask everyone to participate and evaluate if
the principal topics have been learned.

CONCLUSIONS
We aim that the participants will be able to monitor Digital, recognice clinical
symptoms, what to request in blood test, and read an electrocardiogram, all key tools in
the diagnosis of poisoning of Digital.

Abstract Body

BACKGROUND
Head trauma occurs often in childhood, concussions, considered a type of mild traumatic
brain injury (TBI) , are increasing in incidence in pediatric population and becoming a health
problem globally, most of the concussions are minor and not associated to brain injury but an
small number of children may have a clinically important brain injury in wich case is a principal
cause of disability and death. Family Doctors usually are the first in evaluate children who has
suffered a concussion, must be competent in the evaluation and management of concussions
during the initial presentation, the recognition of clinical signs or symptoms are fundamental
to make a clinical diagnosis and appropriate referral.
LEARNING OBJECTIVES
– Management of concussions
– Recognition of clinical signs or symptoms in an initial evaluation.
– Make a correct referral if necessary

ORGANIZATION
– We will make an introduction with a clinical case and explaning characteristic
Features, Diagnosis, and Management.
– We will make 4 groups and provide to each group a different clinical case and ask
to make an evaluation, management and if it is necessary a correct referral,
afterwards each group make a presentation and discuss the case with the other
groups, realizing a group debate.
– Finally We will use Kahoot and ask everyone to participate and evaluating if the
principal topics have been learned.

CONCLUSIONS
We aim that the participants will be able to manage and evaluate a children who has suffered
a concussion, providing key tools following evidence-based medicine.

Abstract Body

Multiple myeloma, characterized by the clonal proliferation of plasma cells, producing a monoclonal paraprotein, is the second most common hematologic malignancy, is more frequently in men and the average age at diagnosis is 60 years. The diagnosis is established by blood and urine exams and medullary biopsy. Typical clinical features include anemia, renal failure, hypercalcemia, and skeletal lytic lesions, bone pain, fatigue. Treatment involves irradiation and chemotherapy Despite significant advances in treatment it has high morbidity and mortality.

Case presentation:

A 76 year old man, not previous disease, with a 1 month history of left shoulder pain, without any trauma, repetitive stress or trigger factors, and worsened with time He was peviously treated with Acetaminophen, Dexketoprofen, and intramuscular betamethasone, persisting a partial limitation of mobility, an X-ray was made with not findings, Subsequently an MRI revealed numerous lytic lesions in the humerus diaphysis, acromion, CT scan showed multiple lytic lesions throughout the bony skeleton but also a left cervical mass lesion involving from the C2 to the C6 vertebral bodies with canal stenosis and spinal cord compression. Concurrently the patient noted dysphonia, hypophonia and a progressive weakness of right upper extremity. bone marrow biopsies were undertaken, demonstrating infiltration by plasma cells, Thus a diagnosis of aggressive multiple myeloma was made, intiating palliative radiotherapy

Conclusions

Multiple myeloma is a diagnosis based on clinical, laboratory, and radiographic assessment, This case stresses the importance of supplementary tests in a patient with severe pain with not reponse to painkillers

Abstract Body

Backgrounds and purpose:

Spontaneous epidural hematoma is a very rare entity that involves a neurological emergency. Its presentation is highly variable, from back pain to quadriplegia, depending on the severity and level of compression. In Spain is highly common the use of acenocumarol in the treatment of atrial fibrilation but routinely measured International normalised ratio (INR) values are the basic parameter for individual quality and stability assessment, an INR out of range >3 patients had significantly increased risk of major bleeding

Case presentation

A 86 years-old-woman, who has initiated haloperidol 3 days before, while she is eating suddenly presents at first weakness in the upper right extremity and in the next hour developed painless severe tetraparesis at the emergency room arrives with a GCS 5/15 (3-1-1), mutism, persisting tetraparesis without involvement of cranial nerves, ECG with a pacemaker rhythm, INR 6,3, prothrombin time 78,4 seg. An head CT scan with not acute findings, is kept under observation thinking in a side effect of haloperidol, after 12 hrs starts with acute breathing difficulties and a cervical scan es performed, It showed an hematoma involving from the C2 to the C5 with spinal cord compression, She is kept in the ICU but after 48 hours is deceased.

Conclusions:

In an patiente with an anticoagulant treatment and the onset of sudden teraparesis is necessary to realize a cervical CT scan. The possibility of bleeding is always present in patients with an INR >3. It is important a correct follow up of these patients.