A rapid response team (RRT) has the function to attend to the assessment of the hospitalized patient that presents clinical deterioration signs, this is in order to avoid further, preventable critical events and so reduce in hospital morbidity and mortality. The aim of this paper is to evaluate the effectiveness of the RRT in Hospital Ángeles Pedregal. For this, we performed an observational, retrospective and transversal study from the period of February 1 2014 to June 30 2015. We analized the survival of the patients admitted to the ICU comparing a group of patients that were evaluated for a RRT against a group that were not evaluated. We identifi ed better survival in patients who received a RRT evaluation (37.7 versus 21.2% respectively) and this was independent of the severity of illness. Thus we conclude that the RRT works with effectiveness making possible an early detection of the patient with clinical deterioration, achieving a timely admission of the patient to Intensive Care Unit and a better survival.

Guías «primera línea» para la atención de SARS-CoV-2 COVID-19. Evaluación de la hipoxemia grave, necesidad de intubación y respuesta rápida Frontline guides for SARS-CoV-2. Critical Care Assessment of hypoxemia, necessity intubation and rapid response Guias de «primeira linha» para o cuidado da SARS-CoV-2 COVID-19. Avaliação de hipoxemia grave, necessidade de intubação e resposta rápida

RESUMENLa sepsis representa una crisis de salud global, pues de 27 a 30 millones de personas al año la desarrollan, mientras que siete a nueve millones fallecen y una persona muere cada 3.5 segundos. El retraso en el inicio de tratamiento impacta de manera directa en la mortalidad y uso de recursos. La implementación de equipos de respuesta rápida (ERR) constituye una oportunidad para la detección y tratamiento adecuado. Existen varias herramientas para la activación de un ERR y un código sepsis, dentro de las más destacadas se encuentran quick SOFA, SIRS, CARS, MEWS y NEWS que constituyen escalas de gravedad para permitir la detección de sepsis con base en criterios; aunque es importante mencionar que la escala NEWS ha demostrado superioridad. Los resultados de distintos estudios realizados tras la implementación de código sepsis reportan un impacto positivo en el inicio temprano de antibióticos y cumplimiento de metas, así como en mortalidad. Un área de oportunidad para mejorar la eficacia del ERR está en la activación mediante dispositivos automatizados. Lo anterior consolida y fortalece una cultura de seguridad en el paciente hospitalizado. Palabras clave: Sepsis, equipo de respuesta rápida, escalas de gravedad. SUMMARY Sepsis represents a global health crisis: 27 to 30 million people a year develop it, seven to nine million die, one person dies every 3.5 seconds. The delay in the initiation of treatment has a direct impact on mortality and the use of resources. The implementation of Rapid Response Teams (RRT) constitutes a window of opportunity for the detection and timely treatment.There are several tools for activating an RRT and a sepsis code. Among the most important are quick SOFA, SIRS, CARS, MEWS and NEWS that constitute severity scales that allow the detection of sepsis based on criteria. The NEWS scale has shown superiority. The results of different studies conducted after the implementation of sepsis code report a positive impact on early initiation of antibiotics and compliance with goals, as well as mortality. One area of opportunity to improve the effectiveness of the RRT is the activation by automated devices. Sepsis code an RRT consolidates and strengthens the culture of safety in the hospitalized patient.

Implementación de una escala de gravedad para la activación del equipo de respuesta rápida: NEWS 2 Implementation of an early warning score for rapid response team triggering: NEWS 2 Implementação de uma escala de gravidade para ativação da equipe de resposta rápida: NEWS 2

Circulatory shock is defi ned as a syndrome precipitated by a systemic collapse of the perfusion, resulting in widespread cell hypoxia and multiple organ dysfunction. It is classifi ed into hypovolemic, obstructive, cardiogenic and distributive. The point at which the management of each of them coincides is the infusion of fl uids. It is important to mention that an inadequate quantity of fl uids, either defi cient or excessive, has deleterious effects on the patient; therefore, it is extremely important to know the principles to guide the management of shock. The aim of this review is to present in an orderly manner the goals that must be set to avoid fl uid overload. To achieve this, fl uid resuscitation is classifi ed into four stages that will be reviewed in detail.