Generalidades y manejo inicial del shock / Generalities and initial shock management

El shock es un síndrome multifactorial que requiere un enfrentamiento sistematizado para su identificación, clasificación y tratamiento adecuado. A pesar de los avances en medicina, distintos estudios y series clínicas indican que la mortalidad puede llegar hasta un 50p or ciento. La única variable que ha mostrado ser consistente en disminuir la mortalidad, independiente de la causa del shock, es su reconocimiento y manejo precoz. Este manuscrito pretende dar un marco teórico acerca de la presentación del paciente en shock en el servicio de urgencia, describir sus principales características y orientar el estudio y tratamientos tiempo-dependientes desde su primera evaluación por el equipo médico. Inicia con la exposición de casos clínicos relevantes al tema. Luego revisa la fisiopatología del fenómeno del shock y sus subtipos. Finalmente ofrece herramientas para su evaluación y tratamiento en el servicio de Urgencia.(AU)

Shock is a complex syndrome that requires a systematic and structured approach for its identification, classification and management. Despite advances in medical science, studies show that mortality could be as high as 50 percent and, up until now, early recognition and adequate management of shock is the only consistent variable proven to be effective in lowering mortality rates. This article aims to review the presentation of shocked patients in the Emergency Department, describe its main physiologic characteristics and guide its diagnosis and treatment timely since the very first minute the patient steps into the hospital. It will present clinical scenarios, review shock's unique physiopathology and present its subtypes. Finally, this article will handle valuable tools for evaluation and treatment strategies in shocked patients while they stay in the Emergency Department.(AU)

Advanced Trauma Life Support

Among the deaths from trauma, 50% were dead at the scene, 30% in several hours, and 20% in a few weeks by multiple organ failure. The 30% occurring in several hours may be saved with rapid assessment and management of injuries. Trauma deaths could be reduced through an organized trauma system and standardized and systemic approach by physicians involved in the initial assessment and management of trauma. This is likely to present emergent and general traumatic care to increase the ability of treating trauma patients on the base of Advanced Trauma Life Support (ATLS) by the American College of Surgeons (ACS). Thus, both legal and systemic reform with an establishment of trauma centers or use of the ATLS program in intra-hospital trauma team is necessary to maximize operation of the medical team. Introduction of and emphasis on the skill oriented ATLS program in the medical school curriculum is also needed to prepare for real situations rather than knowledge-orientated education.