Résumé
Based on the Consensus of the Chilean Respiratory Society, this article summarizes the main topics of the ambulatory management of patients with COPD. The Consensus proposes operative definitions in order to prevent the most frequent conceptual errors, specially those related to the confusion between patients with chronic bronchitis without chronic obstruction and those with COPD. Among the diagnostic criteria, the consensus emphasizes the importance of demonstrating irreversible airway obstruction through spirometry, as well as strategies to the differential diagnosis between COPD and asthma. The Consensus summarizes the therapeutic interventions used in the ambulatory setting, including smoking cessation, bronchodilators, corticosteroids, antibiotics, vaccination, oxygen therapy, respiratory rehabilitation and environmental management. The Consensus emphasizes the importance of patient education in order to involve them in their own management. Some criteria for referral of patients are given and the role of exceptional therapeutical interventions, such as non invasive mechanical ventilation and lung reduction surgery are mentioned. The Consensus states that a significative improvement of the quality of life can be achieved with a proper combination of therapeutic interventions
Sujets)
Humains , Soins ambulatoires , Bronchopneumopathies obstructives/thérapie , Spirométrie , Théophylline/usage thérapeutique , Exercices respiratoires , Bronchodilatateurs/usage thérapeutique , Fumer/effets indésirables , Éducation du patient comme sujet , Facteurs de risque , Arrêter de fumer , Hormones corticosurrénaliennes/usage thérapeutique , Bronchopneumopathies obstructives/diagnostic , Bronchopneumopathies obstructives/étiologie , Bronchopneumopathies obstructives/prévention et contrôle , OxygénothérapieRésumé
Se presentan 18 pacientes con lesiones de la glándula suprarrenal causadas por trauma penetrante 10 casos, o cerrado 8 casos. Se trata de un grupo de pacientes de alta gravedad, expresada por una incidencia de schock al ingreso del 66,6 por ciento, un índice de trauma, Trauma Score promedio de 11, un requerimiento transfusional promedio de 20 unidades, 4,3 lesiones asociadas por paciente, 50 por ciento de complicaciones y una mortalidad del 16,7 por ciento. Quince pacientes requerieron exploración quirúrgica y la suprarrenal lesionada pudo ser reparada en 7 de ellos. Se analizan las características de estas lesiones y su manejo