ABSTRACT
Abstract: Status epilepticus (SE) is the state of continuous seizures, whether they are convulsive or non-convulsive, lasting longer than 5 minutes without return to the neurologic baseline between seizures. This neurologic emergency accounts for 20% of emergency department (ED) admissions and requires the clinician's expeditious recognition and prompt management in order to prevent irreversible neurological damage and further complications related to the prolonged hospital stay. This paper reviews the most recent and up-to-date information aimed at caring for these critically ill patients.
Resumen: El estado epiléptico, es una enfermedad convulsiva continua, que puede ser convulsiva o no, de más de cinco minutos de duración sin retorno al estado neurológico basal entre las crisis convulsivas. Esta emergencia neurológica representa el 20% de las admisiones del departamento de emergencias y requiere del inmediato reconocimiento del médico y de un pronto manejo para evitar daño neurológico irreversible y mayores complicaciones relacionadas con una estancia hospitalaria prolongada. Este trabajo revisa la información más reciente y actualizada sobre el cuidado de estos pacientes críticos.
Resumo: O estado epiléptico é uma desordem de apreensão contínua, que pode ser convulsiva ou não, de mais de 5 minutos de duração, sem retorno ao estado neurológico basal entre as crises. Esta emergência neurológica é responsável por 20% das internações do departamento de emergência e requer o reconhecimento imediato do médico e de um rápido tratamento para evitar danos neurológicos irreversíveis e complicações maiores associadas com a hospitalização prolongada. Este estudo analisa as informações mais recentes e actualizadas sobre os cuidados a estes pacientes em estado crítico.
ABSTRACT
Sepsis is among the most common reason for admission to intensive care units throughout the world. In the US and most Western nations sepsis is largely a disease of the elderly. Management of elderly patients with severe sepsis is challenging. Early recognition of this syndrome, together with the early administration of appropriate antibiotics and cautious fluid resuscitation is the cornerstone of therapy. Echocardiography together with non-invasive or invasive hemodynamic monitoring is recommended in patients who have responded poorly to fluids or have significant underlying cardiac disease. This paper reviews the hemodynamic changes that characterize sepsis, particularly as they apply to elderly patients and provides recommendations for the management of these patients.
ABSTRACT
The daily practice of cardiopulmonary resuscitation (CPR) in elderly patients has brought up the attention of outcome research and resource allocation. Determinants to predict survival have been well identified. There has been empirical evidence that CPR is of doubtful utility in the geriatric population, more studies have showed controversial data. Sometimes situations in which CPR needs to be given in the elderly, causes stress to healthcare providers, due to lack of communication of the patient's wishes and the belief that it will not be successful. It is of importance to state that we have the duty to identify on time the patients that will most likely benefit from CPR, and find out the preferences of the same. Whenever it is possible to institute these guidelines, we will avoid patient suffering.
ABSTRACT
Se presentan las historias de tres pacientes con oclusión de la carótida cervical, motivados dos de ellos por intentos de ahorcamiento y el otro por un trauma cervical sin fractura. Las oclusiones de los vasos cerebrales por trauma son poco frecuentes, en particular las secundarias a traumas cerrados. Las heridas por proyectiles de arma de fuego o por arma blanca producen lesiones vasculares con mayor frecuencia y en las guerras son lesiones frecuentes. Cuando hay fracturas del macizo facial también es relativamente frecuente la lesión de los vasos carotideos