ABSTRACT
Objetivo: averiguar los factores asociados con «vía venosa difícil» (VVD) en pacientes adultos atendidos en el servicio de urgencias, así como describir el uso que las enfermeras hacen de las técnicas de punción asistidas por ultrasonido (técnica eco-facilitada -EF- y técnica eco-guiada -EG-) y el grado de éxito de cada una frente a la técnica de canalización tradicional. Método: estudio descriptivo transversal realizado en pacientes adultos con «vía venosa difícil» atendidos en el servicio de urgencias del Hospital de Manacor (Mallorca). La enfermera que realizaba la canalización cumplimentaba un registro anónimo con variables relacionadas con su intervención, con la salud del paciente y con el éxito en cada una de las técnicas. Las pruebas de contraste de hipótesis utilizadas para determinar la asociación fueron la U de Mann-Whitney para variables cuantitativas y Chi cuadrado para categóricas. Resultados: se analizaron 51 casos. Las variables vinculadas a VVD fueron: no encontrar venas a la palpación (72,6%), no encontrar venas visibles (66,7%), historia previa de dificultad (66,7%) y más de dos intentos fallidos de canalización (49%). el factor agudo más común fue la hipotensión (29,4%), los factores crónicos más habituales fueron la obesidad (45,1%), tratamiento con quimioterapia (29,4%) y diabetes (23,5%). En 40 pacientes se utilizó la técnica «ciega» y en 39 casos se usaron técnicas asistidas por ecografía, que resultaron más eficaces que el abordaje habitual (p<0.05). Conclusiones: hay indicios de la existencia de factores asociados a la dificultad en la función periférica, las técnicas ecográficas permiten solucionar eficazmente estos casos provocando menor número de punciones (AU)
Objective: to find out the factors associated with «difficult venous access» (DVA) in adult patients managed at the Emergency Unit, as well as to describe the use by nurses of ultrasound-assisted puncture techniques (ultrasound-assisted (UA) technique and ultrasound-guided (UG) technique), and the degree of success of each one vs. the traditional catheterisation technique. Method: a descriptive transversal study conducted in adult patients with «difficult venous access» seen at the Emergency Unit of the Hospital de Manacor (Majorca). The nurse conducting the catheterization completed an anonymous record with variables associated with their intervention, the health of the patient, and success in each one of the techniques. the contrast hypothesis tests used to determine association were Mann-Whitneys U for quantitative variables and Square Chi for categorical variables. Results: dirty-one (51) cases were studied. The DVA-associated variables were: not finding veins at palpation (72.6%), not finding visible veins (66.7%), previous history of difficulty (66.7%) and >2 failed catheterization attempts (49%). The most common acute factor was hypotension (29.4%), the most usual chronic factors were obesity (45.1%), chemotherapy treatment (29.4%) and diabetes (23.5%). The «blind» technique was used in 40 patients, and ultrasound-assisted techniques were used in 39 cases, which were more effective than the usual approach (p<0.05). Conclusions: there are signs of the presence of factors associated with difficulty in peripheral puncture; ultrasound techniques offer an effective solution for these cases, leading to a lower number of punctures (AU)
Subject(s)
Humans , Female , Male , Adult , Catheterization, Peripheral/methods , Ultrasonography , Pain/prevention & control , Surgery, Computer-Assisted/methods , Punctures/methods , Practice Patterns, Nurses' , Nursing Assessment/methodsABSTRACT
El citomegalovirus (CMV) es un virus perteneciente a la familia de los Herperviridae. La infección puede causar una enfermedad grave en inmunodeprimidos, sin embargo también puede afectar a inmunocompetentes, y da lugar a cuadros clínicos generalmente autolimitados, aunque se han descrito casos graves que pueden llevar a la muerte. Presentamos un caso de ileítis por CMV con manifestaciones clínicas graves que motivaron intervención quirúrgica urgente en un paciente inmunocompetente(AU)
Cytomegalovirus (CMV) is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient(AU)
Subject(s)
Humans , Male , Aged, 80 and over , Ileitis/complications , Ileitis/diagnosis , Cytomegalovirus/immunology , Cytomegalovirus/pathogenicity , /methods , Immunohistochemistry , Ileitis/immunology , Cytomegalovirus/isolation & purification , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/immunologyABSTRACT
Autoimmune enteropathy (AIE) is an infrequent cause of malabsorption that is usually associated with the presence of circulating autoantibodies and a predisposition to autoimmune disorders. This disease is more frequent in children. The diagnosis of this disorder is based on five criteria: chronic diarrhea (>6 weeks), malabsorption, specific histological findings, exclusion of similar disorders, and the presence of specific antibodies such as anti-enterocyte and anti-goblet cell antibodies. We present the case of a 63-year-old patient with chronic diarrhea, weight loss and significant deterioration of nutritional status.
Subject(s)
Polyendocrinopathies, Autoimmune , Atrophy , Autoantibodies/analysis , Biopsy , Capsule Endoscopy , Celiac Disease/diagnosis , Chronic Disease , Diagnosis, Differential , Diarrhea/etiology , Humans , Hyperplasia , Intestine, Small/pathology , Lymphocytosis/etiology , Malabsorption Syndromes/etiology , Male , Methylprednisolone/therapeutic use , Middle Aged , Polyendocrinopathies, Autoimmune/complications , Polyendocrinopathies, Autoimmune/diagnosis , Polyendocrinopathies, Autoimmune/drug therapy , Polyendocrinopathies, Autoimmune/pathology , Weight LossABSTRACT
El diagnóstico de esta entidad se basa en cuatro criterios, la presencia de diarrea crónica (más de 6 semanas), un cuadro clínico compatible con malabsorción, una histología específica, la exclusión de otras enfermedades que pueden cursar de forma similar y la presencia de autoanticuerpos específicos como pueden ser los anticuerpos entienterocito y anticélula caliciforme. Presentamos a continuación el caso de un paciente de 63 años de edad con un cuadro clínico que consiste en diarrea crónica, pérdida de peso e importante repercusión en su estado nutricional (AU)
Autoimmune enteropathy (AIE) is an infrequent cause of malabsorption that is usually associated with the presence of circulating autoantibodies and a predisposition to autoimmune disorders. This disease is more frequent in children.The diagnosis of this disorder is based on five criteria: chronic diarrhea (>6 weeks), malabsorption, specific histological findings, exclusion of similar disorders, and the presence of specific antibodies such as anti-enterocyte and anti-goblet cell antibodies. We present the case of a 63-year-old patient with chronic diarrhea, weight loss and significant deterioration of nutritional status (AU)
Subject(s)
Humans , Male , Middle Aged , Autoimmune Diseases/diagnosis , Malabsorption Syndromes/etiology , Autoantibodies/analysis , Diarrhea/etiology , Weight LossABSTRACT
Emphysematous pancreatitis is a severe and rare complication of acute pancreatitis. This entity is diagnosed on clinical grounds and on the basis of the radiologic finding of gas in the retroperitoneum. Infected pancreatic necrosis is potentially lethal, with mortality rates of more than 35%. Surgery is associated with significant morbidity and mortality in these critically ill patients. Endoscopic ultrasonography techniques, laparoscopic surgery and percutaneous drainage have the potential to offer a safe and effective alternative treatment modality. However, the precise role of these procedures requires further investigation. The treatment of these patients should be individualized, dynamic and multidisciplinary. We present two cases of emphysematous pancreatitis with distinct therapeutic management.
Subject(s)
Emphysema/therapy , Pancreatitis/therapy , Aged, 80 and over , Emphysema/complications , Emphysema/surgery , Female , Humans , Male , Middle Aged , Pancreatitis/complications , Pancreatitis/surgeryABSTRACT
La pancreatitis enfisematosa (PE) es una complicación grave y rara de la pancreatitis aguda. El diagnóstico se basa en los datos clínicos y en el hallazgo radiológico de gas en el retroperitoneo. La necrosis pancreática infectada es potencialmente letal, con una tasa de mortalidad superior al 35%. La cirugía en estos pacientes asocia una alta morbimortalidad. La ultrasonografía endoscópica, el tratamiento quirúrgico laparoscópico y el drenaje percutáneo ofrecen una modalidad de tratamiento alternativo a la cirugía, seguro y eficaz. Sin embargo, se requieren más estudios para definir el lugar que ocupan estas técnicas en el tratamiento de estos pacientes, que debe ser individualizado, dinámico y multidisciplinario. Presentamos 2 casos de PE con distinto tratamiento terapéutico(AU)
Emphysematous pancreatitis is a severe and rare complication of acute pancreatitis. This entity is diagnosed on clinical grounds and on the basis of the radiologic finding of gas in the retroperitoneum. Infected pancreatic necrosis is potentially lethal, with mortality rates of more than 35%. Surgery is associated with significant morbidity and mortality in these critically ill patients. Endoscopic ultrasonography techniques, laparoscopic surgery and percutaneous drainage have the potential to offer a safe and effective alternative treatment modality. However, the precise role of these procedures requires further investigation. The treatment of these patients should be individualized, dynamic and multidisciplinary. We present two cases of emphysematous pancreatitis with distinct therapeutic management(AU)
