La ambulancia, con su profesional médico, acudió en respuesta a una llamada de una paciente mayor que se quejaba de mareo y palpitaciones. Como es lógico, además de la evaluación anamnésica y física, se practicó un electrocardiograma que mostró una fibrilación auricular con respuesta ventricular rápida, sin inestabilidad hemodinámica.
Inmediatamente el médico inició lo que entendió debería ser su actuación. Además de la indicación de oxígeno y la correspondiente vía venosa periférica, administró un bolus endovenoso de 300 mg de amiodarona, seguido, ante la falta de respuesta, de una dosis de carga de digoxina, también por vía endovenosa.
No pondré en duda el criterio médico seguido para la administración de estos fármacos antiarrítmicos. A la luz de las guías, directrices o guidelines de la Sociedad Europea de Cardiología, la AHA o el ACEP, la digoxina, por ejemplo, tiene un campo estrecho de uso en estas situaciones. Pero ese no es mi punto de atención.
Me cuestiono como médico de urgencias la necesidad de actuar en esta situación de entorno domiciliario, extra-hospitalario por definición, sobre una paciente posiblemente pluripatológica, quien además sería trasladada a un Servicio de Urgencias, sin otra opción.
El riesgo de complicaciones en entornos no adecuados es mayor que en el ambiente relativamente controlado del hospital, donde está claro que se cuenta con recursos y el soporte de todo un sistema de atención inmediata y compleja. No hay necesidad alguna de correr ese riesgo, a menos que la acción implique que el beneficio de la medida aplicada sea mayor que el propio riesgo, en especial de las drogas antiarrítmicas.
Además las acciones aplicadas no evitarán, en este y otros casos, el traslado al hospital, pero en cambio provocarán un retardo innecesario y peligroso en la atención médica apropiada.
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