ABSTRACT
Background: In 2006, the burn unit of an emergency public hospital in Chile standardized its medical and surgical treatment protocols. Aim: To analyze the evolution of mortality among patients admitted to the unit after the standardization process. Material and Methods: Patients admitted to the unit between March 2005 and March 2006, were analyzed. An early surgical debridement was performed, according to the guide-lines, after a standardized reanimation with Lactate Ringer using Parkland formula (4 ml/kg/ percent burn surface area). All patients were monitored. An algorithm was used to decide the indication of vasoactive drugs or invasive monitorization. Results: Eighty eight patients aged 43 +/- 19 years (65 percent males) were admitted. The estimated percentage body burned was 30 +/- 21 percent, deep in 12.5 +/- 17 percent. A mean of 9.122 +/- 6.930 mi of fluid were administered in the first 24 hours. The first surgical debridement was performed at 48 hours (range 1 to 15 days). The first escharotomy was performed at 4.2 days (range 3 hours -15 days), the first covering at 3.8 days (range 3 hours-19 days) the first auto graft at 18 days (range 4-26 days). Operative times in the first three surgical procedures were less than 87 min. Global mortality was 37 percent. Conclusions: The standardized treatment of burns resulted in an absolute reduction of mortality.
Introducción: En el 2005 el Servicio de Quemados del HUAP inició un proceso de modernización. Durante el primer año se intervino en el protocolo terapéutico médico y quirúrgico. Se analizarán la mortalidad observada en este período. Materiales y Métodos: Se analizaron los pacientes admitidos en Cuidados Intermedios e Intensivos de nuestra unidad desde el Iº de marzo de 2005 a Iº de marzo de 2006. Se realizó aseo quirúrgico precoz, según protocolo, previa reanimación estandarizada con Ringer Lactato usando la fórmula de Parkland, 4 cc/kg/ por ciento SCT (superficie corporal total). Todos los casos fueron monitorizados, guiados por diuresis y con algoritmo para decidir inicio de drogas vasoactivas o monitorización invasiva. Resultados: Ingresan 88 pacientes, 58 por ciento trasladados de otros centros. Edad promedio 43 +/- 18,9 años; hombres 65 por ciento, mujeres 35 por ciento; superficie corporal quemada 30 +/- 21 por ciento, profunda 12,5 +/- 17 por ciento. Se administró en promedio 9.122 +/- 6.930 ce durante las primeras 24 hrs. Primer aseo se realizó a las 48 hrs (1 hr -15 días), Ia escarectomía a los 4,2 días (3 hrs - 15 días), Ia cobertura a los 3,8 días (3 hrs - 19 días), 1er autoinjerto a los 18 días (4 - 26 días). Tiempos operatorios promedio en las 3 primeras cirugías inferiores a 87 min. Mortalidad absoluta disminuyó a 19 por ciento. Mortalidad global 37 por ciento. Conclusiones: Luego del primer año del proceso de modernización, con reanimación estandarizada, equipos quirúrgicos proporcionales a la SCT quemada con disminución de los tiempos quirúrgicos, asociado a un manejo multidisciplinario, se logró una disminución de la mortalidad global.
Subject(s)
Humans , Male , Female , Adult , Burns/surgery , Burns/mortality , Burn Units/standards , Algorithms , Body Surface Area , Clinical Protocols , Chile/epidemiology , Critical Care/standards , Burns/therapy , Resuscitation/standards , Severity of Illness Index , Survival RateABSTRACT
Every year almost three thousand people get burned in Chile. In this group, about 40 percent of the critical burned patients also suffer inhalation injury. This number is expected to grow bigger among the adult population in the next few years. Inhalation injury significantly increases mortality in burned patients. The prevalence, pathophysiology, clinical characteristics, treatment, and prognosis of this pathology have not been incorporated in the undergraduate curses of Chilean medical schools. Therefore, this subject is pooly known by most of our physicians. Because this disease will be included in the explicit warranties health plan of the public health care system in Chile, we decide to write this review about this pathological condition.
Cada año casi tres mil personas sufren quemaduras en Chile. En la población adulta se estima que este número se incrementará en los próximos años. En este grupo, cerca del 40 por ciento de las quemaduras graves se asocian a injuria inhalatoria. la injuria inhalatoria aumenta significativamente la mortalidad en los pacientes quemados. la prevalencia, fisiopatologia, cuadro clínico, manejo y pronóstico de esta patología no han sido incorporados en los estudios de pregrado de las escuelas de medicina y son temas desconocidos para la mayoría de los médicos. En el contexto de la próxima incorporación de este tipo de dolencias en el plan de garantías explícitas en la salud chilena hemos realizado una actualización del tema.
Subject(s)
Humans , Burns, Inhalation/complications , Burns, Inhalation/physiopathology , Burns, Inhalation/therapy , Prognosis , Burns, Inhalation/diagnosisABSTRACT
Background: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. Aim: To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. Patients and methods: In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. Results: One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6±5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium. Conclusions: Delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients.