We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
Suicide is a common cause of death. Every year, around one million people across the world die of suicide. It remains the biggest external cause of death in our country (Spanish National Institute of Statistics - INE, 2017). It is estimated that suicide attempts (SA) are 10-20 times more common than suicide. Within a broad spectrum of suicidal behaviour, we find highly lethal SAs (those which are closest to suicide).
Medically serious suicide attempts (MSSA) or highly lethal suicide attempts (SA) are characterised by the fact that they present a serious organ compromise, regardless of their psychiatric severity.
MSSAs, in the broad spectrum of suicide attempts, are the closest to consummate suicide, being two populations with overlapping characteristics. MSSAs also have greater risk of death by suicide compared to low lethality suicide attempts.
An important aspect to bear in mind is that assessing survivors of serious suicidal behaviour allows us to obtain information directly from the survivor, unlike consummate suicides, in which the assessment is performed indirectly through third persons (psychological autopsy). The fact that we are able to assess people so close to suicide is hugely valuable to find out more about the psychological mechanisms of serious suicidal behaviour and the warning signs, in order to avoid suicide.
In a large proportion of these people, a prevalence of psychiatric pathology has been observed. These mainly consist of affective disorders (depression), followed by personality disorders and other disorders related to the consumption of substances. There are also other socio-environmental, non-psychiatric risk factors that should be assessed: presence of serious/chronic medical pathology, functional limitations and their adaptation (people with some sort of physical disability or older people) and social support.
Most patients present clinical depression that does not always coincide with the presence of a stressful event. They may have a history of suicide attempts. Prior to the MSSA, they may have shown thoughts of wanting to die or a more structured idea of how they would commit suicide.
People with an unstable/untreated psychiatric disorder: Unipolar affective disorders (depression) may have a greater predisposition towards suicidal behaviour.
The presence of an underlying psychiatric disorder should be assessed and treated following an MSSA.
Once the patient has recovered from a life threatening situation, a comprehensive approach should be taken, focused on clinical and socio-environmental aspects. The presence of a psychiatric pathology should be assessed and treated. It is also important, following medical discharge, to refer the patient to the mental health network and activate the Suicide Risk Code, allowing follow-up after hospitalisation.
Medical and psychiatric history and psychological assessment.
Avoid the myths that proliferate the social stigma surrounding suicide and assess the presence of suicidal thoughts with clinical and socio-demographic risk factors.
Venous thromboembolic disease refers to the process characterised by the formation of a thrombus (blood clot) in the deep vein system that can grow or fragment, interrupting the normal circulation of blood and causing various alterations.
The main manifestations of thromboembolic disease are deep vein thrombosis (DVT) and pulmonary embolism. DVT occurs when a thrombus or blood clot forms inside a deep vein, usually in the legs (although it can also occur in the arms, abdomen, ilium, vena cavas, etc.), obstructing normal blood circulation in these veins.
A thrombus that forms in a deep vein can become fragmented or rupture and break off. The detached embolism travels through the veins towards the heart, reaching the lungs through the pulmonary veins. The clot stops in the lungs and obstructs the interior of one or more pulmonary arteries, preventing blood from passing. This process is known as pulmonary embolism (PE).
Vein trombosis:
- Swelling or inflammation of the affected leg
- Pain or sensitivity in the leg, often starting in the lower leg
- Increased temperature in the leg
- Changes in skin colour (reddened or bluish, shiny)
Pulmonary embolism :
- Shortness of breath or sudden onset drowning (dyspnoea).
- Increased breathing rate
- Increased heart rate
- Acute chest pain
- Dry cough with blood
- Loss of consciousness (syncope)
Incidence (number of cases/year) of venous thromboembolic disease in the general population, including any of its manifestations, is estimated to be between one or two cases for every 1,000 people in Spain. This means that there are more than 80,000 cases a year in Spain, with about 70% of these being deep vein thrombosis and the rest being pulmonary embolism.
DVT:
The patient’s symptoms are analysed, as well as conducting a blood test and imaging tests. The most commonly used test of choice is Doppler ultrasound (eco-Doppler), an imaging technique that allows the deep veins to be seen and confirms or rejects the diagnosis.
PE:
If suspicions point to a possible pulmonary embolism, the diagnosis will be confirmed using tests such as a chest CT (scan) or pulmonary scintigraphy.
When a clot is produced, whatever type it may be, the main aim of treatment is to dissolve the thrombosis and re-establish blood flow to avoid further complications.
Anticoagulants are the treatment of choice for venous thromboembolic disease. Anticoagulants are medication that modify blood clotting so that a thrombus or clot does not form inside the blood vessels, helping to break up clots that have already formed.
Laboratory tests such as D-dimer. Imaging tests such as Doppler ultrasound, CT and pulmonary scintigraphy.
THROMBOPHILIA BLOOD TEST in some cases, a blood test is also performed to determine if the patient has any alterations in their clotting proteins that may predispose them to thrombosis.
Knowing the risk factors of venous thromboembolic disease is crucial to be able to act and control this risk. One of the cheapest and most effective recommendations that helps to prevent possible thromboembolic episodes is walking, as moving around helps avoid clot formation.
Asthma is a disorder of the passage of air through the respiratory tract, particularly in small-calibre bronchial tubes. It causes difficulty breathing and the patient feels like they are drowning and must increase their effort in an attempt to breathe better.
Asthma is a chronic inflammatory disorder of the airways that results in variable airflow obstruction. It often changes throughout the day (it can get worse at night) and improves with treatment and then reappears later.
The illness is basically caused by an inflammatory mechanism.
Three phenomena occur in the airways of patients with asthma:
1. Decreased bronchial diameter, which restricts air flow.
2. Inflammation, with increased thickness of the bronchial wall, which also contributes to restricting air flow.
3. Increased activity in the glands that produce mucus, with increased secretions contributing further to breathing difficulty.
Cells that circulate in the blood are involved in the local inflammation observed in asthma: T lymphocytes, mast cells and eosinophils. These cells are responsible for the body’s normal defence and their activity is increased in asthma. Medication for asthma attempts to regulate this activity.
According to the degree of restriction, the person affected will experience breathing difficulty and a sensation of lack of air. Also characteristic of asthma are wheezing, which is the sharp whistle-like sound of the air as it passes through the smaller airways, and increased bronchial secretion.
Asthma can affect all age groups and sometimes overlaps with bronchitis. On many occasions it can be allergic in origin or come as a result of exposure to an environmental or chemical agent.
Spirometry, chest x-ray, allergy tests.
Some basic questions for diagnosis:
1) Have you ever had a whistling sound in your chest?
2) Have you been coughing, especially at night?
3) Have you had a cough, whistling sound, difficulty breathing at some times of the year or in contact with animals, plants, tobacco or whilst at work or after exercise?
4) Have you had colds that last more than 10 days or are "chesty"?
5) Have you used inhaled medication?
Treatment is based on using bronchodilators, in the form of an inhaler or tablets. Anti-inflammatory drugs also have an important role.
The most common diagnostic tests for asthma are based on:
1) Spirometry: Measures air flow on inhaling and exhaling and detects any restrictions in the airway, one of the characteristics of asthma.
2) Bronchodilator test: Tests if spirometry improves with drugs to dilate the airway.
3) Bronchial challenge test, the same test in the opposite direction with drugs that cause a slight airway obstruction, detected by spirometry.
To prevent asthma, it is fundamental not to smoke and avoid exposure to allergens that precipitate it, which are detected with the allergy tests that form part of the asthma exam.
The Inherited Heart Disease Unit is basically devoted to providing care. We have a team of two cardiologists, three interns and two nurses, one full-time and one part-time. This Unit addresses all myocardiopathies in general, and inherited cases in particular.
Myocardiopathies are diseases where the myocardium is weak, dilated or has some other structural problem. Often, the heart is unable to pump or work properly. In the case of inherited myocardiopathies, due to the fact they are often treated as part of uncommon diseases, specialist management is not within the scope of all clinical cardiologists. It requires specific treatment and involves specific technology.
We promote day surgery as it is an increasingly common alternative to traditional hospital admissions and is more convenient for patients. The facilities, technology and running of the whole centre are focused on maximising this kind of walk-in surgery.
How to get there
Vall d’Hebron’s Day Surgery Unit (UCSI), currently situated in the Pere Virgili Major Outpatient Surgery and Rehabilitation Centre, offers an alternative to the usual hospital admissions process. The 2,330 m2 Unit boasts the latest cutting edge technology, and facilities designed specifically with ambulatory surgery in mind. The centre has 6 operating rooms, 3 surgeon’s offices and 4 outpatient rooms for nursing, anaesthesia and surgical specialities. The unit currently performs over 13,700 procedures a year.
Whilst always under supervision, all patients can return home to continue their recovery a few hours after treatment. This surgery service is focused on convenience for patients, so they can recover in their normal environment without having to be admitted to hospital.
The surgical teams at the Day Surgery Unit come from other departments and units at Vall d’Hebron. Ambulatory surgery related to various parts of the Hospital is currently carried out here, such as General and Digestive Surgery, Maxillofacial Surgery, Dermatology, Ophthalmology, Otolaryngology, Urology and Vascular Surgery from the General Hospital; Orthopaedic foot, ankle, hand, shoulder and knee surgery, and Plastic and Reconstructive Surgery from the Traumatology, Rehabilitation and Burns Hospital; and Gynaecological Surgery, Fertility and Breast Disorder Surgery from the Maternity and Children’s Hospital.
The Day Surgery Unit also actively participates in specialised medical training through the Resident Medical Intern (MIR) programme in the different surgical specialisations.
Bone marrow is a diffuse organ present in the small cells of the bones and which contains the stems cells which form the cells that circulate in the blood. Accessing this part of our bones can provide information about blood precursor cells, and also tell us if there are any unusual cells or microorganisms of an invasive nature.
This test is used to see all stages of blood cell maturity, both for diagnosis and to evaluate the response to treatment in neoplastic disease.
It is also used to rule out or confirm the presence of cells that should not normally be present.
With local anaesthesia for spinal cord aspiration and under sedation for bone marrow biopsy. A puncture and aspiration of a bone area rich in precursor cells is performed.
Bone marrow aspiration can be done both in the sternum bone and in the iliac crest (back of the pelvis). A bone marrow biopsy can be performed in the iliac crest. A sample of bone tissue and marrow blood is taken from these areas through the puncture.
The procedure lasts between 10 and 15 minutes, after which the puncture site is strongly compressed for a few minutes and a dressing is applied, which must be removed after 24 hours.
It is necessary to bear in mind that, until 24 hours after the test has been conducted, no effort or weight should be put on that area. After this time, you can lead a normal life. In the event of pain or discomfort, pain killers can be taken.
An exposure test is the controlled administration of a medication or food to diagnose allergic reactions.
Controlled exposure testing with foods or drugs is used for confirming or ruling out allergic reactions, when a conclusive diagnosis could not be reached with the other tests.
The first thing that has to be done when carrying out a controlled exposure test is inform the patient about the test, its usefulness and associated risks. Patients should be provided with an information sheet and asked to sign an informed-consent form.
The tests are carried out in the nursing office, located on the second floor of the Old School of Nursing (Antiga Escola d'Infermeria), where a nurse will carry out the skin tests and some food and medication challenges, or at the Allergology Day Hospital, which has all of the tools for diagnosing and treating any adverse reaction, as well as a doctor and nursing staff who are trained to carry out this procedure.
With drug trials, allergen will be administered through the safest route (orally or intravenously). When necessary, the dose will be divided or the speed of administration reduced, according to the documented adverse reaction and the type of drug being studied.
Once the drug has been administered, patients should remain under observation for several hours so that any delayed reactions can be diagnosed.
Since the procedure is not without risks, the risk-benefit ratio needs to be assessed before an exposure test can be carried out. As for studies with medications, such testing will only be done with important drugs, meaning, in cases where one medication is more effective than other alternatives (if there are any).
Most reactions triggered by the test are mild, and then diagnosed and treated early. However, severe reactions can occur, such as anaphylaxis and anaphylactic shock.
There are no alternatives to exposure tests, since they represent the last stage of a diagnostic process. However, if a diagnosis can be obtained from the previous tests (skin or blood testing), it may not be necessary to carry these out.
Skin tests are important procedures to confirm allergic sensitisation mediated by immunoglobulin E (IgE) antibodies in patients who suffer from rhinoconjunctivitis, asthma, hives, anaphylaxis, atopic eczema or allergies to foods or drugs.
Skin tests are ordered when there is a suspected allergic reaction or disorder after t a medical history has been taken (through questions) and the patient examined. Skin tests, thus, give us an objective confirmation of sensitisation to an allergen, although the relevance of that sensitisation has to be interpreted with the patient’s history borne in mind, so that the appropriate advice on avoidance and treatment can be given.
There are two main types of skin tests:
The results are read after 15-20 minutes. If the patient is “sensitised”, the substance will induce a local reaction with itching, redness, swelling, etc. This reaction is compared with tests done with physiological serum (negative control that should not cause a reaction) and histamine (positive control that should cause a reaction).
The patient should not take antihistamines (anti-allergy medications) for 5-7 days prior to the test.
The risk with these tests is very low. Only in extremely allergic patients, and usually while testing medications, is there a certain risk of their causing a serious and generalised allergic reaction.
In some cases, blood can analysed to assess its sensitisation.
This test is used for assessing secondary involvement in this disease and ruling out similar processes. It may also help to find trapped peripheral nerves that usually result from overloading of the joints and, in particular, the upper limbs.
For helping to confirm diagnoses.
Through electrical stimulations with surface electrodes and electrodes inserted into muscles with very fine needles.
Secondary pain during the procedure and a little bleeding (haematoma).
There are no other techniques that can replace EMGs in diagnosing poliomyelitis and post-polio syndrome.
Skin tests are the technique most commonly used to begin diagnosing an allergy. Following a meticulous clinical history, it is decided which skin tests may be useful, depending on the case.
Skin allergy tests serve to find out if a patient is "sensitised" to a particular substance, if their body recognises the substance and reacts when it comes into contact with it. These tests DO NOT DIAGNOSE an allergy. They are only positive if accompanied by one of the symptoms compatible with an allergy, helping a diagnosis to be reached.
There are two main types:
The risk of these tests is very low. Only in extremely allergic patients and usually with drug testing, there is a certain risk of serious and widespread allergic reaction.
In some cases, blood tests can be conducted to assess blood sensitisation.
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