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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.143-148.
Monography in Portuguese | LILACS | ID: biblio-1349467
2.
Arq. neuropsiquiatr ; 79(10): 871-878, Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345317

ABSTRACT

Abstract Background: The cuneiform nucleus is located in the center of the circuit that mediates autonomic responses to stress. Hemorrhagic hypotension leads to chemoreceptor anoxia, which consequently results in the reduction of baroreceptor discharge and stimulation of the chemoreceptor. Objective: Using the single-unit recording technique, the neuronal activities of the cuneiform nucleus were investigated in hypotensive states induced by hemorrhage and administration of an anti-hypertensive drug (hydralazine). Methods: Thirty male rats were divided into the control, hemorrhage, and hydralazine groups. The femoral artery was cannulated for the recording of cardiovascular responses, including systolic blood pressure, mean arterial pressure, and heart rate. Hydralazine was administered via tail vein. The single-unit recording was performed from the cuneiform nucleus. Results: The maximal systolic blood pressure and the mean arterial pressure significantly decreased and heart rate significantly increased after the application of hydralazine as well as the following hemorrhage compared to the control group. Hypotension significantly increased the firing rate of the cuneiform nucleus in both the hemorrhage and hydralazine groups compared to the control group. Conclusions: The present data indicate that the cuneiform nucleus activities following hypotension may play a crucial role in blood vessels and vasomotor tone.


RESUMO Antecedentes: O núcleo cuneiforme está localizado no centro do circuito que media as respostas autonômicas ao estresse. A hipotensão hemorrágica leva à anóxia dos quimiorreceptores, que, consequentemente, resulta na redução da descarga dos barorreceptores e estimulação do quimiorreceptor. Objetivo: Utilizando a técnica de registro em unidade única, as atividades neuronais do núcleo cuneiforme foram investigadas em estados de hipotensão induzida por hemorragia e administração de um anti-hipertensivo (hidralazina). Métodos: Trinta ratos machos foram divididos nos grupos controle, hemorragia e hidralazina. A artéria femoral foi canulada, para o registro de respostas cardiovasculares, incluindo pressão arterial sistólica, pressão arterial média e frequência cardíaca. A hidralazina foi administrada na veia da cauda. O registro de unidade única foi realizado a partir do núcleo cuneiforme. Resultados: A pressão arterial sistólica máxima e a pressão arterial média diminuíram significativamente, e a frequência cardíaca aumentou significativamente após a aplicação de hidralazina, bem como a hemorragia seguinte, em comparação com o grupo controle. A hipotensão aumentou significativamente a taxa de disparo da população do núcleo cuneiforme em ambos os grupos de hemorragia e hidralazina, em comparação com o grupo de controle. Conclusões: Os presentes dados indicam que as atividades do núcleo cuneiforme após hipotensão podem desempenhar um papel crucial nos vasos sanguíneos e no tônus vasomotor.


Subject(s)
Animals , Male , Rats , Midbrain Reticular Formation , Hypotension , Blood Pressure , Hypovolemia , Heart Rate
3.
Rev. cuba. med. mil ; 50(3): e1095, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1357318

ABSTRACT

Introducción: El carcinoma hepatocelular es un tumor hipervascular compuesto por vasos sanguíneos anormales, constituye la forma más frecuente de cáncer primario del hígado. Alrededor del 90 por ciento de estos tumores se desarrollan sobre una enfermedad hepática previa. Un aumento en la carga vascular debido a la hipertensión portal conlleva a sangrado. Objetivo: Presentar un paciente a quien se le practicó laparotomía exploradora de urgencia por hemoperitoneo de gran cuantía secundario a una rotura intratumoral sobre un hígado cirrótico. Caso clínico: Paciente de 66 años de edad, con antecedentes patológicos de diabetes mellitus tipo 2, hiperplasia benigna de próstata, alcoholismo crónico y cirrosis hepática. Acudió al cuerpo de guardia por dolor abdominal difuso y signos de hipovolemia aguda. Se realizó laparotomía de urgencia y se constata hemoperitoneo de gran cuantía, secundario a una rotura intratumoral. Se le realizó aspiración de contenido hemático, electrocoagulación y compresión por empaquetamiento. Se controló el sangrado. El paciente tuvo una evolución tórpida y falleció 24 horas posteriores a la laparotomía. Conclusiones: El hemoperitoneo secundario a rotura de un carcinoma hepatocelular, es una complicación poco frecuente, pero fatal; por lo que se hace necesario su estudio para lograr un diagnóstico y tratamiento oportuno(AU)


Introduction: Hepatocellular carcinoma is a hypervascular tumor made up of abnormal blood vessels. It is the most frequent form of primary liver cancer. About 90 percent of these tumors develop over a previous liver disease. An increase in vascular load due to portal hypertension leads to bleeding. Objective: To present a patient who underwent emergency exploratory laparotomy due to large hemoperitoneum secondary to an intratumoral rupture of a cirrhotic liver. Clinical case: A 66-year-old male patient with a pathological history of type 2 diabetes mellitus, benign prostatic hyperplasia, chronic alcoholism and liver cirrhosis. He came to emergency due to diffuse abdominal pain, as well as signs of acute hypovolemia. An emergency laparotomy was performed, confirming a large hemoperitoneum secondary to an intratumoral rupture. Blood content aspiration, electrocoagulation and compression by packing were performed, managing to control bleeding. He had a torpid evolution, dying 24 hours after the laparotomy. Conclusions: Hemoperitoneum secondary to rupture of a hepatocellular carcinoma is a rare, but fatal complication; therefore, its study is necessary to achieve a timely diagnosis and treatment(AU)


Subject(s)
Humans , Male , Aged , Prostatic Hyperplasia , Carcinoma, Hepatocellular , Hypovolemia , Hemoperitoneum , Liver Cirrhosis , Liver Neoplasms
4.
Repert. med. cir ; 30(2): 173-179, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1362765

ABSTRACT

Objetivo: describir el caso de un paciente del Hospital de San José de Bogotá con hemorragia del tracto digestivo superior secundaria a lesión de Dieulafoy, que presentó cuadro compatible con neuropatía óptica anterior isquémica no arterítica (NOIANA). Metodología: se hace una revisión narrativa y búsqueda sistemática de la literatura para determinar las características clínicas, demográficas, tratamiento y pronóstico visual de los pacientes con NOIANA. Materiales y métodos: reporte de caso, revisión narrativa y búsqueda sistemática de la literatura en las bases de datos Medline (vía Ovid) y Embase de NOIANA secundaria a hipovolemia. Se analizaron las variables sociodemográficas, clínicas, diagnóstico, condiciones asociadas, tratamiento y pronóstico visual. El análisis estadístico se realizó mediante frecuencias absolutas y relativas. Resultados: la mejoría de agudeza visual final en los pacientes que presentaron un episodio de NOIANA es incierta. En 42% hubo algún tipo de mejoría de la agudeza visual, independiente del tratamiento recibido. Menos del 50% de los casos clínicos reportados incluidos en este estudio que recibieron tratamiento con corticoides intravenosos mejoraron la visión. Discusión: la NOIANA por choque hipovolémico es una entidad infrecuente y poco reportada que puede generar cambios irreversibles en la agudeza visual, por lo que es importante sospecharla y detectarla para dar un manejo oportuno. Conclusión: este caso de NOIANA es uno de los pocos descritos como secundarios a hemorragia digestiva y el primero asociado con lesión de Dieulafoy.


Objetive: to describe the case of a patient from Hospital de San José in Bogotá with upper gastrointestinal tract bleeding secondary to a Dieulafoy ́s lesion, who presented symptoms compatible with a non-arteritic anterior ischemic optic neuropathy (NA-AION). Methodology: a narrative review and systemic search of the literature was conducted to determine the clinical and demographic characteristics, treatment and visual prognosis in patients with NA-AION. Materials and methods: case report, narrative review and systematic search of the literature in Medline via Ovid and Embase databases on NA-AION secondary to hypovolemia. Sociodemographic and clinical variables, diagnosis, associated conditions, treatment and visual prognosis were analyzed. A statistical analysis was performed using absolute and relative frequencies. Results: improvement of final visual acuity in patients who presented a NA-AION episode was uncertain. In 42% there was some kind of visual acuity improvement regardless of treatment received. Vision improved in less than 50% of the reported clinical cases included in this study that received treatment with intravenous steroids. Discussion: hypovolemic NA-AION is a rare and underreported entity that may generate irreversible changes in visual acuity, so it is important to suspect and detect it to provide timely management. Conclusion: this case of NA-AION is one of the few described as secondary to gastrointestinal bleeding and the first associated with a Dieulafoy ́s lesion.


Subject(s)
Humans , Male , Middle Aged , Optic Nerve Diseases , Hypovolemia , Gastrointestinal Hemorrhage , Vision, Ocular , Visual Acuity
5.
Rev. cir. (Impr.) ; 72(1): 11-16, feb. 2020. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1092884

ABSTRACT

Resumen Objetivo Establecer la medición ecográfica del diámetro de la vena cava inferior como factor predictor del shock en pacientes politraumatizados. Materiales y Método Estudio de corte transversal donde se determinó la medición ecográfica de la vena cava inferior a 40 pacientes que ingresaron a la Unidad de Politraumatizados (UPT) del Hospital General del Este "Dr. Domingo Luciani", en el período entre enero y abril de 2018. Se seleccionaron 2 grupos; el grupo 1: pacientes en shock , aquellos con tensión arterial sistólica menor a 90 mm Hg al ingreso, y el grupo 2: pacientes controles que mantuvieron cifras tensionales normales. El estudio de imagen de la vena cava inferior se realizó con el equipo de ecografía ALOKA prosound SSD-a5 y con el ultrasonido portátil MicroMaxx SonoSite , en el cual se midió el índice de colapsabilidad. Los hallazgos se registraron en la hoja de recolección de datos. El análisis estadístico se hizo con la prueba de t de student para muestras independientes y la valoración de puntos de corte diagnóstico se hizo con la prueba de ROC. Resultados La media del Índice de colapsabilidad (IC) de la VCI para el grupo control y de shock fue de 26 ± 12,7% y de 58,5 ± 5,9%, respectivamente; El índice de colapsabilidad fue > 50% en todos los pacientes del grupo de shock . Conclusiones La medición del diámetro de la VCI es un predictor de shock , siendo el IC el parámetro más sensible y específico.


Aim To establish the sonographic measurement of the diameter of the inferior vena cava as a predictor of shock in trauma patients. Materials and Method A cross-sectional study to determined the sonographic measurement of the inferior vena cava to 40 patients attended at Hospital Domingo Luciani trauma unit, in the period between January and April of 2018. Two groups were selected; group 1: shock patients, those with systolic blood pressure lower than 90 mm Hg, and the group 2: control patients that kept normal blood pressure. The image study of the inferior vena cava was carried out with the ALOKA prosound ultrasound equipment SSD a5 and with the portable ultrasound MicroMaxx SonoSite, in which the collapsibility index was measured. The findings were recorded in the data collection sheet. The statistical analysis proposed for the comparison of averages was made with the student's t-test for independent samples and the assessment of diagnostic cut-off points was made with a ROC curve. Results the mean of collapsability index of de IVC for control and shock group were 26 ± 12,7% and 58,5 ± 5,9%, respectively; The collapsability index (CI) was > 50% in all patients of shock group. Conclusions The measurement of the ICV diameter is a predictor of shock, being the IC the most sensitive and specific parameter.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Vena Cava, Inferior/diagnostic imaging , Wounds and Injuries/physiopathology , Hypovolemia/diagnostic imaging , Shock/therapy , Wounds and Injuries/surgery , Wounds and Injuries/therapy , Cross-Sectional Studies , Ultrasonography , Arterial Pressure , Fluid Therapy/methods
7.
Arq. bras. med. vet. zootec. (Online) ; 71(2): 404-410, mar.-abr. 2019. tab
Article in English | LILACS, VETINDEX | ID: biblio-1011287

ABSTRACT

The present study assessed and compared the effects of hypotonic enteral electrolyte solutions administered by nasoesophageal tube in continuous flow in dogs submitted to water restriction on packed cell volume; total serum protein and serum osmolarity concentrations; blood volume; plasma glucose and lactate levels; blood gas analysis, anion gap, and strong ion difference. Six adult dogs were used (four males and two females). All animals were submitted to both proposed treatments in a crossover design 6×2. The treatments were as follows: ESmalt consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g maltodextrin that were diluted in 1.000mL water (measured osmotic concentration of 215mOsm L−1) and ESdext consisting of 5g sodium chloride, 1g potassium chloride, 1g calcium acetate, 0.2g magnesium pidolate, and 9.6g dextrose that were diluted in 1.000mL water (measured osmotic concentration of 243mOsm L−1). All solutions were administered at 15ml kg−1 h−1 for 4 hours. Both solutions increased the plasma volume in dehydrated dogs without causing adverse effects. However, ESmalt was more effective in promoting the increase in blood volume.(AU)


O presente estudo avaliou e comparou os efeitos de soluções eletrolíticas enterais hipotônicas, administradas por sonda nasoesofágica em fluxo contínuo em cães submetidos a restrição hídrica, sobre o hematócrito, proteínas totais séricas, osmolaridade sérica, volemia, glicose e lactato plasmáticos, hemogasometria, ânion gap e DIF. Foram utilizados seis cães adultos (quatro machos e duas fêmeas). Todos os animais foram submetidos aos dois tratamentos propostos, em um delineamento crossover 6×2. Os tratamentos foram os seguintes: SEmalt - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de maltodextrina, diluídos em 1.000mL de água (osmolaridade mensurada: 215mOsm L -1 ); SEdext - 5g de cloreto de sódio, 1g de cloreto de potássio, 1g de acetato de cálcio, 0,2g de pidolato de magnésio e 9,6g de dextrose, diluídos em 1.000mL de água (osmolaridade mensurada: 243mOsm L -1 ). Todas as soluções foram administradas no volume de 15mL kg -1 hora -1 , durante quatro horas, em fluxo contínuo. Ambas as soluções aumentaram o volume plasmático em cães desidratados, sem gerar o aparecimento de efeitos adversos. Porém, a SEmalt foi mais eficaz em promover a expansão da volemia.


Subject(s)
Animals , Dogs , Dehydration/therapy , Dehydration/veterinary , Fluid Therapy/methods , Fluid Therapy/veterinary , Hypotonic Solutions/therapeutic use , Hypovolemia/veterinary , Intubation, Gastrointestinal/veterinary
8.
Article in English | WPRIM | ID: wpr-785368

ABSTRACT

BACKGROUND: Hydroxyethyl starch (HES), a class of synthetic colloid solutions, has been widely used to treat perioperative hypovolemia. The use of HES, however, is associated with the risk of allergic reactions.CASE: An 83-year-old man was scheduled to undergo an open reduction and internal fixation of a pertrochanteric fracture under spinal anesthesia. He had no history of allergy. Five minutes after HES administration, hypotension, agitation, and skin rash were developed. HES infusion was terminated due to a suspected anaphylactic reaction. The vital signs recovered following administration of phenylephrine, dexamethasone, and hydrocortisone. Serum tryptase and total immunoglobulin E levels were elevated in plasma samples collected following the commencement of the allergic reaction during surgery.CONCLUSIONS: In the present report, the risk of anaphylactic reaction with HES and the laboratory tests needed to support the diagnosis are highlighted.


Subject(s)
Aged, 80 and over , Anaphylaxis , Anesthesia , Anesthesia, Spinal , Colloids , Dexamethasone , Diagnosis , Dihydroergotamine , Exanthema , Humans , Hydrocortisone , Hypersensitivity , Hypotension , Hypovolemia , Immunoglobulin E , Immunoglobulins , Phenylephrine , Plasma , Starch , Tryptases , Vital Signs
9.
Article in English | WPRIM | ID: wpr-760877

ABSTRACT

Juvenile polyps are the most common types of polyps in children, and patients usually present with lower gastrointestinal (GI) bleeding as the predominant symptom. These lesions, which are referred to as hamartomas, usually measure approximately 2 cm in size and are benign tumors located mainly in the rectum and sigmoid colon. The most common symptom of a juvenile polyp is mild intermittent rectal bleeding. It is rare for anemic patients because the amount of blood loss is small and often not diagnosed immediately. We present the case of a 6-year-old girl with a juvenile polyp in the distal transverse colon, who developed hypovolemic shock due to massive lower GI bleeding. Pediatricians must perform colonoscopy for thorough evaluation of polyps, because their location and size can vary and they can cause massive bleeding.


Subject(s)
Anemia , Child , Colon, Sigmoid , Colon, Transverse , Colonoscopy , Female , Hamartoma , Hemorrhage , Humans , Hypovolemia , Polyps , Rectum , Shock
10.
Rev. bras. cir. plást ; 33(3): 423-427, jul.-set. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-965628

ABSTRACT

Introdução: A incidência de queimaduras em gestantes não é bem estabelecida na literatura mundial, mas estima-se que varie entre 3% e 7%. Os cuidados da gestante queimada representam um grande desafio com impacto significante nos resultados e prognóstico materno-fetais. Relato de Caso: No presente estudo relatamos dois casos de gestantes vítimas de queimaduras que foram tratadas na unidade de tratamento de queimaduras na Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), uma no primeiro trimestre e a outra no terceiro trimestre. Conclusão: Em ambos os casos, as gestantes receberam tratamento especializado para queimaduras em conjunto com acompanhamento clínico da equipe da obstetrícia, com boa evolução materno-fetal.


Introduction: The incidence of burns involving pregnant women is not well established in the literature, but is estimated to be between 3% and 7%. The management of burns in pregnancy represents a great challenge with significant impact on outcomes and maternal-fetal prognosis. Case Report: In the present study, we report two cases of pregnant burn victims who were treated in the burn unit in the Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP). One patient was treated in the first trimester and the other in the third trimester. Conclusion: In both cases, the pregnant women received specialized treatment for burns in conjunction with clinical follow-up by the obstetrics team, with good maternal-fetal outcomes.


Subject(s)
Humans , Female , Adult , Pregnancy Complications/surgery , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/rehabilitation , Transplantation/methods , Wounds and Injuries , Hypovolemia/diagnosis , Fetus/surgery , Patients , Burn Units , Pregnancy , Pregnancy, High-Risk
11.
Acta méd. (Porto Alegre) ; 39(1): 419-429, 2018.
Article in Portuguese | LILACS | ID: biblio-911652

ABSTRACT

Introdução: O choque hipovolêmico é o principal tipo de choque no trauma. Seu manejo é fundamental visto que é uma das principais causas de mortes evitáveis. Objetivos: Definir conceitos relacionados à reanimação no choque hipovolêmico, como coagulopatia precoce no trauma, controle de danos, hipotensão permissiva, uso de cristaloides e hemoderivados, ácido tranexâmico e protocolo de transfusão maciça. Metodologia: Busca na base de dados bibliográfica Medline/Pubmed e LILACS no período de maio de 2018, incluindo artigos de revisão, revisões sistemáticas e guidelines cuja publicação seja em inglês ou português e remeta os últimos 5 anos. Os descritores foram "permissive hypotension" ou "damage control resuscitation". "hypovolemic shock". Os artigos foram selecionados com busca direta, considerando relevância do tema à proposta e revista com fator de impacto mensurado. Resultados: Foram apresentados 342 resultados da busca de dados, nos quais 15 artigos foram selecionados. Na conduta do choque hipovolêmico, responsável por 30 a 40% das mortes no período de 24 horas após o trauma, adota-se a hipotensão permissiva e preconiza-se o controle de danos. Conclusões: O entendimento da coagulopatia no trauma, do uso limitado de cristaloides, da reanimação balanceada, da hipotensão permissiva, da correta indicação do ácido tranexâmico e da aplicação do protocolo de transfusão maciça é fundamental na reanimação volêmica do paciente traumatizado.


Introduction: The hypovolemic shock is the main type of shock in trauma patients. Its management is fundamental given that hemorrhagic shock is one of the main causes of death that can be avoided. Aims: To define concepts related to resuscitation in hypovolemic shock, such as early coagulopathy in trauma, damage control, permissive hypotension, use of crystalloids and blood derivatives, tranexamic acid and massive transfusion protocol. Methods: Search in the bibliographic database Medline/Pubmed and LILACS in the period of May 2018, including review articles, systematic reviews and guidelines published in either English or Portuguese in the last 5 years. The descriptors were "permissive hypotension" or "damage control resuscitation". Of the 342 results, 15 articles were selected with direct search, considering relevance of the theme to the proposal and reviewed with measured impact factor. Results: From 342 results in database, 10 articles have been selected. The management of hypovolemic shock, responsible for 30-40% of deaths within 24 hours of trauma, permissive hypotension and damage control have been recommended. Conclusion: The understanding of coagulopathy in trauma, of limited use of crystalloids, of balanced resuscitation, of permissive hypotension, of the correct indication of tranexamic acid and of the application of the protocol of massive transfusion is essential in the resuscitation of the trauma patient.


Subject(s)
Hypotension , Resuscitation/methods , Shock , Hypovolemia , Resuscitation/adverse effects
12.
Braz. j. med. biol. res ; 51(1): e6258, 2018. tab, graf
Article in English | LILACS | ID: biblio-889008

ABSTRACT

The pathophysiological mechanisms associated with the effects of red blood cell (RBC) transfusion on cardiopulmonary function and inflammation are unclear. We developed an experimental model of homologous 14-days stored RBC transfusion in hypovolemic swine to evaluate the short-term effects of transfusion on cardiopulmonary system and inflammation. Sixteen healthy male anesthetized swine (68±3.3 kg) were submitted to controlled hemorrhage (25% of blood volume). Two units of non-filtered RBC from each animal were stored under blood bank conditions for 14 days. After 30 min of hypovolemia, the control group (n=8) received an infusion of lactated Ringer's solution (three times the removed volume). The transfusion group (n=8) received two units of homologous 14-days stored RBC and lactated Ringer's solution in a volume that was three times the difference between blood removed and blood transfusion infused. Both groups were followed up for 6 h after resuscitation with collection of hemodynamic and respiratory data. Cytokines and RNA expression were measured in plasma and lung tissue. Stored RBC transfusion significantly increased mixed oxygen venous saturation and arterial oxygen content. Transfusion was not associated with alterations on pulmonary function. Pulmonary concentrations of cytokines were not different between groups. Gene expression for lung cytokines demonstrated a 2-fold increase in mRNA level for inducible nitric oxide synthase and a 0.5-fold decrease in mRNA content for IL-21 in the transfused group. Thus, stored homologous RBC transfusion in a hypovolemia model improved cardiovascular parameters but did not induce significant effects on microcirculation, pulmonary inflammation and respiratory function up to 6 h after transfusion.


Subject(s)
Animals , Male , Pneumonia/physiopathology , Respiratory Physiological Phenomena , Blood Preservation/methods , Cardiovascular Physiological Phenomena , Erythrocyte Transfusion/methods , Hypovolemia/therapy , Swine , Blood Preservation/adverse effects , Enzyme-Linked Immunosorbent Assay , Cytokines/blood , Treatment Outcome , Erythrocyte Transfusion/adverse effects , Disease Models, Animal , Hemodynamics
13.
Rev. cuba. pediatr ; 89(2): 214-223, abr.-jun. 2017. ilus
Article in Spanish | LILACS | ID: biblio-845096

ABSTRACT

Introducción: la exanguinación es una entidad clínica dramática que requiere rapidez de pensamiento y acción para obtener buenos resultados.Presentación del caso: se reporta el caso de un paciente de 13 años que sufrió accidente automovilístico y fue atendido en el Hospital Pediátrico Eliseo Noel Camaño , de la provincia de Matanzas, Cuba. El niño llegó con múltiples traumas en miembros superiores e inferiores, y una herida penetrante en el cuello que requirió tratamiento quirúrgico inmediato para controlar hemorragia. Se necesitó un acceso multidisciplinario de intensivistas, anestesiólogos, cirujanos pediátricos, neurocirujanos y cirujanos vasculares, porque la cuantía del sangrado y la localización de la lesión hicieron sospechar una afección traumática de la arteria vertebral. El niño sobrevivió a la lesión exanguinante, y actualmente se encuentra en proceso de recuperación.Conclusiones: la lesión penetrante del cuello puede provocar ruptura traumática de la arteria vertebral, entidad infrecuente que requiere alta sospecha diagnóstica para lograr éxito en su tratamiento. Consideramos vital la visión multidisciplinaria, en la que deben prevalecer maniobras seguras, rápidas y eficientes(AU)


Introduction: exsanguination is a dramatic clinical condition that requires quick analysis and action to achieve good results.Case report: this is a 13 years/old patient who suffered a car accident and was seen at Eliseo Noel Camano pediatric hospital in Matanzas province, Cuba. The teenager had many upper and lower limb traumas and a penetrating neck injury that required immediate surgery to control hemorrhage. It was necessary to involve intensive care experts, anesthesiologists, pediatric surgeons, neurosurgeons, and vascular surgeons because the amount of bleeding and the location of injury aroused the suspicion of traumatic damage of the vertebral artery. The teenager managed to survive from the exsanguinating injury and is currently in his recovery process.Conclusions: the penetrating neck injury may cause traumatic rupture of the vertebral artery, an uncommon condition that requires great diagnostic suspicion in order to succeed in treatment. It is vital to have a multidisciplinary vision in which safe, rapid and effective procedures should prevail(AU)


Subject(s)
Humans , Male , Adolescent , Hypovolemia/surgery , Neck Injuries/surgery , Vertebral Artery/injuries
14.
Rev. Asoc. Méd. Argent ; 130(1): 30-33, mar. 2017. ilus
Article in Spanish | LILACS | ID: biblio-973067

ABSTRACT

Los angiomiolipomas renales son formaciones renales que se presentan de forma aislada o asociadas con otras patologías como esclerosis tuberosa o enfermedad de Von Hippel Lindau. Los angiomiolipomas renales se pueden presentar clínicamente con un shock hipovolémico por lesión de uno de sus vasos o con dolor abdominal por efecto masa debido a su tamaño. La resolución de los angiomiolipomas puede ser de manera programada o de urgencia, siendo las vías elegidas la nefrectomía parcial o la embolización arterial selectiva, dependiendo siempre de los recursos que se tengan y la experiencia del equipo quirúrgico.


Renal angiomyolipomas are kidney formations presented in isolation or associated with other diseases such as tuberous sclerosis or Von Hippel Lindau disease. Renal angiomyolipoma may present clinically with hypovolemic shock due to injury of one of its vessels or with abdominal pain due to mass effect because of its size. Angiomyolipomas can be resolved on scheduled basis or emergency, where the chosen ways are partial nephrectomy or selective arterial embolization, always depending on the resources you count on and the experience of the surgical team.


Subject(s)
Female , Humans , Young Adult , Kidney/surgery , Tuberous Sclerosis/complications , Tuberous Sclerosis/surgery , Angiomyolipoma/diagnosis , Angiomyolipoma/surgery , Urogenital Abnormalities/surgery , Organ Sparing Treatments , Emergencies , Sex Distribution , Hypovolemia , Sepsis
15.
Article in English | WPRIM | ID: wpr-217847

ABSTRACT

Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.


Subject(s)
Anemia, Hemolytic , Autopsy , Classification , Conjunctiva , Emergencies , Female , Fetus , Gestational Age , HELLP Syndrome , Humans , Hypertension , Hypertension, Pregnancy-Induced , Hypovolemia , Korea , Liver , Parity , Perinatal Mortality , Pre-Eclampsia , Pregnancy , Pregnancy, Twin , Pregnant Women , Rupture , Rupture, Spontaneous , Skin
16.
Article in English | WPRIM | ID: wpr-203990

ABSTRACT

Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia. We report a case of PEA during the induction of general anesthesia in a patient with ALS who presented for dental treatment and discuss the causes of PEA and necessary considerations for general anesthesia in patients with ALS.


Subject(s)
Acidosis , Amyotrophic Lateral Sclerosis , Anesthesia, General , Hypoxia , Emergencies , Humans , Hypovolemia , Muscles , Nervous System , Peas , Respiratory System
17.
Article in English | WPRIM | ID: wpr-211158

ABSTRACT

Pulmonary artery aneurysms (PAAs) are rare, and massive hemoptysis can lead to death if appropriate diagnosis and treatment is not provided. PAAs can be of congenital, acquired, or idiopathic origin, and the clinical symptoms are various. Among all reported cases, one-third of the patients died due to rupture. Optimal treatment or guidelines for PAAs remain uncertain. Herein, we report autopsy findings from a woman with PAA. The patient was taking medication for tuberculosis. On bronchoscopy, a polypoid lesion was found, suspected to be an inflammatory polyp. Biopsy was performed and massive bleeding into the airway occurred. The bleeding could not be controlled by bronchoscopic suction, and cardiac arrest occurred 30 minutes after biopsy; the patient subsequently died. Autopsy revealed a round, calcified PAA in the bronchus of the right middle lobe; the end of the PAA was torn. Hypovolemic signs, including weak postmortem lividity and pallor of the skin and conjunctivae, were observed. Visual inspection and histopathological examination of the right lung revealed tuberculosis and congestion. Cases related PAA are not uncommon, but autopsy cases of death occurring after biopsy of PAA mimicking bronchial polyps are rarely reported.


Subject(s)
Aneurysm , Autopsy , Biopsy , Bronchi , Bronchoscopy , Conjunctiva , Diagnosis , Estrogens, Conjugated (USP) , Female , Heart Arrest , Hemoptysis , Hemorrhage , Humans , Hypovolemia , Lung , Pallor , Polyps , Pulmonary Artery , Rupture , Skin , Suction , Tuberculosis
18.
Med. leg. Costa Rica ; 33(1): 25-34, ene.-mar. 2016. tab, ilus
Article in Spanish | LILACS | ID: lil-782660

ABSTRACT

El hemotórax es una patología que de no ser diagnosticada y tratada a tiempo amenaza la vida del paciente, "los traumas torácicos son el 25% de los tipos de trauma en los pacientes politraumatizados" (Greenfield, 2011).Por lo tanto, es de suma importancia realizar un adecuado examen físico primario y secundario, para así poder descartar lesiones que ameriten una actitud resolutiva de emergencia; asimismo, el diagnóstico es clínico y radiológico, siempre tomando en consideración la condición global del paciente. Lo anterior, para elegir el método más práctico, rápido y fidedigno para apoyar el diagnóstico clínico; el tratamiento con sello de tórax es el manejo de elección inicial, el cual dependiendo de la evolución clínica del paciente seguirá una serie de métodos para realizar la completa evacuación del mismo y evitar, en la medida de lo posible, las complicaciones. Además, es de gran interés realizar un tratamiento rápido y eficaz para evitar que el líquido se coagule, lo cual puede producir un empiema o fibrotórax. Por esta razón, todos los proveedores de la salud, en especial los médicos encargados de emergencias y los cirujanos deben tener en mente el probable desarrollo de un hemotórax en pacientes quienes sufran síntomas inexplicables de hipovolemia, específicamente en politraumatizados, por esto se debe conocer a profundidad las características de esta patología.


Hemothorax is a disease in which if not diagnosed and treated in time, threatens the patient's life. Thoracic traumas account for 25% of trauma in politraumatized patients (Greenfield, 2011), it is paramount to perform an adequate first and secondary physical examination, so we can rule out any problems that merit an emergency operative attitude. The diagnosis is clinical and radiological, taking always into consideration the overall condition of the patient, to choose the most convenient treatment, the fastest and most reliable method to support the clinical diagnosis. The chest tube is the initial choice method, depending on the clinical evolution of the patient a number of other methods can be perform in order to complete the evacuation of the collection and avoid as much as possible the complications; it is very important to make a fast and effective treatment to prevent the liquid from clotting, which can cause empyema or fibrothorax. All health providers and more the physicians in charge of the emergency department and the surgeons, should keep in mind the likely development of a hemothorax in patients suffering unexplained symptoms of hypovolemia in trauma cases, that is why is important to know in depth the characteristics of this disease.


Subject(s)
Humans , Hemothorax , Hypovolemia
19.
Article in English | WPRIM | ID: wpr-770969

ABSTRACT

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.


Subject(s)
Depression , Hemodynamics , Humans , Hypovolemia , Lactates , Logic , Physical Examination , Physiology , Sepsis , Shock , Shock, Septic
20.
Article in English | WPRIM | ID: wpr-23448

ABSTRACT

BACKGROUND: The use of extracorporeal life support (ECLS) in the setting of cardiopulmonary resuscitation (CPR) has shown improved outcomes compared with conventional CPR. The aim of this study was to determine factors predictive of survival in extracorporeal CPR (E-CPR). METHODS: Consecutive 85 adult patients (median age, 59 years; range, 18 to 85 years; 56 males) who underwent E-CPR from May 2005 to December 2012 were evaluated. RESULTS: Causes of arrest were cardiogenic in 62 patients (72.9%), septic in 18 patients (21.2%), and hypovolemic in 3 patients (3.5%), while the etiology was not specified in 2 patients (2.4%). The survival rate in patients with septic etiology was significantly poorer compared with those with another etiology (0% vs. 24.6%, p=0.008). Septic etiology (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.49 to 5.44; p=0.002) and the interval between arrest and ECLS initiation (HR, 1.05 by 10 minutes increment; 95% CI, 1.02 to 1.09; p=0.005) were independent risk factors for mortality. When the predictive value of the E-CPR timing for in-hospital mortality was assessed using the receiver operating characteristic curve method, the greatest accuracy was obtained at a cutoff of 60.5 minutes (area under the curve, 0.67; 95% CI, 0.54 to 0.80; p=0.032) with 47.8% sensitivity and 88.9% specificity. The survival rate was significantly different according to the cutoff of 60.5 minutes (p=0.001). CONCLUSION: These results indicate that efforts should be made to minimize the time between arrest and ECLS application, optimally within 60 minutes. In addition, E-CPR in patients with septic etiology showed grave outcomes, suggesting it to be of questionable benefit in these patients.


Subject(s)
Adult , Cardiopulmonary Resuscitation , Extracorporeal Circulation , Heart Arrest , Hospital Mortality , Humans , Hypovolemia , Methods , Mortality , Risk Factors , ROC Curve , Sensitivity and Specificity , Sepsis , Survival Rate
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