Caracterización clínica y epidemiológica de pacientes con Covid-19 atendidos en Servicio de Emergencia del Hospital Clínico Universidad de Chile entre marzo y mayo 2020 / Clinical and epidemiological characterization of patients with Covid-19 treated in the Emergency Service of the Hospital Clínico Universidad de Chile between March and May 2020

In December 2019, a novel coronavirus (SARS-CoV-2) emerged in China and has spread globally, creating a pandemic. The objective of this is study is to determinate clinical and epidemiological characteristics of patients with coronavirus en emergency department. The HCUCH Emergency Service treated a total of 6959 patients between March 13th and May 31th, of whom 1.278 were positive and had confirmed with coronavirus. The male sex was the most prevalent (59.7%). The most frequent symptoms in both groups were cough, myalgia and fever. In the group of ambulatory patients, headache stood out in 50% and in hospitalized patients, dyspnea with 67%. The mortality rate in hospitalized patients was 15.6%. Of these, 66.6% were older than 65 years. Regarding diagnosis of hospital discharge, 87.5% correspond to pneumonia. There is a higher prevalence of coronavirus disease in male patients. The most frequent comorbidities in hospitalized patients were HT and DM2. The highest rate of hospitalization and case fatality in people over 65 years of age. This information helps to characterize the profile of patients at risk in which prevention efforts should be focused. (AU)

Manejo inicial del politraumatizado / Initial management of politraumatized patient

Trauma is today the first cause of death in young population; Motor vehicle crashes (MVC’s) are the main specific cause. The initial approach of the trauma patient takes place in the prehospital and hospital environment, following a systematic evaluation and priorizing some systems above others. Primary evaluation (with the classic sequence: ABCDE), sets intervention priorities that ultimately target a reduction in trauma early mortality. The in-corporation of ultrasonography in the evaluation of the trauma patient, has been fundamental in searching for injuries that may have been overlooked in the primary evaluation. Injuries that compromise ventilation may cause hypoxemia and hemodynamic instability. Early bleed control is the main therapeutic target in the trauma patient with active hemorrhage, which leads to reduction of early mortality and also prevents future complications. Fluid resuscitation is the main intervention to restore tissue perfusion. Also, the use of transfusional therapy, permissive hypotension and tranexamic acid must also be considered. Emergency Ultrasound is today a fundamental instrument in the initial trauma patient evaluation, because it greatly contributes to the evaluation of ventilatory derangement and hemodynamic instability causes. Finally, one must remember that trauma is a dynamic process, and therefore reevaluating is imperative, especially because findings of neurological deficit or deterioration in time, will ultimately conduct to the diagnose of injuries that cause brain hypoperfusion...

Traslado de pacientes críticos / Critical care transport

Critical care transport is a raising need in health care because patients who have medical conditions that exceed the capabilities of the initial treating facility require timely safe transport to referral centers. Therefore, indications for inter-hospital transfer include the need for specialist intervention, a critical bed not available or ongoing support not provided in the referring hospital. The aim of transferring a critically ill patient to a reference center is to improve prognosis, and this potential benefit must outweigh potential harm derived of eventual complications or adverse events that could happen during transportation, because critically ill patients have a high risk of morbidity and mortality during transport. The most frequent indications of transfer involve time-dependent pathologies, such as Cardiovascular and Neurologic Emergencies. Pre-transport evaluation and stabilization is critical, as it contributes to minimize in-transport risks, and it must consider aspects as adequate monitoring, transportation times and conditions...