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2.
Med Intensiva ; 41(9): 559-568, 2017 Dec.
Article in English, Spanish | MEDLINE | ID: mdl-28318674

ABSTRACT

Despite major advances in our understanding of the physiopathology of brain death (BD), there are important controversies as to which protocol is the most appropriate for organ donor management. Many recent reviews on this subject offer recommendations that are sometimes contradictory and in some cases are not applied to other critically ill patients. This article offers a review of the publications (many of them recent) with an impact upon these controversial measures and which can help to confirm, refute or open new areas of research into the most appropriate measures for the management of organ donors in BD, and which should contribute to discard certain established recommendations based on preconceived ideas, that lead to actions lacking a physiopathological basis. Aspects such as catecholamine storm management, use of vasoactive drugs, hemodynamic objectives and monitoring, assessment of the heart for donation, and general care of the donor in BD are reviewed.


Subject(s)
Brain Death , Practice Guidelines as Topic , Tissue Donors , Tissue and Organ Procurement/methods , Brain Death/diagnosis , Catecholamines/metabolism , Critical Care/standards , Enteral Nutrition , Hemodynamics , Humans , Terminal Care/standards , Thyroid Hormones/therapeutic use , Tissue and Organ Harvesting , Tissue and Organ Procurement/standards , Vasoconstrictor Agents/therapeutic use
3.
Puesta día urgenc. emerg. catastr ; 9(2): 89-92, abr.-jun. 2009.
Article in Spanish | IBECS | ID: ibc-74866

ABSTRACT

El arsénico es un metal que se encuentra ampliamente distribuido por la naturaleza. Actualmente la mayoría de las intoxicaciones, tanto agudas como crónicas, se ven en el medio laboral, pudiendo darse casos de intoxicación no industrial, a partir de la contaminación de productos domésticos o alimenticios por desechos industriales con arsénico o sus derivados. Sin embargo son excepcionales las intoxicaciones suicidas como el caso que nosotros describimos u homicidas por vía digestiva. En estos casos el tratamiento antídoto, basado en la reactividad química que poseen los agentes quelantes para formar complejos atóxicos e hidrosolubles que se eliminan por la orina, es vital para poder evitar las graves consecuencias incluso letales de dicha intoxicación aguda(AU)


Arsenic is a metal that is widely distributed in nature. Nowadays, most of the poisonings, both acute and chronic, can be seen in the work environment, with some cases of non-industrial contamination reported, caused by contamination of domestic or food products from industrial wastes containing arsenic or its derivatives. Even though, cases of self-poisoning via the digestive tract like the one we describe, or homicide, are exceptional. In these cases, antidotes based on the chemical reactivity owned by the chelating agents to form a non-toxic and water-soluble complex that can be eliminated in urine, are vital to avoid serious or even lethal consequences caused by acute poisoning(AU)


Subject(s)
Humans , Male , Female , Arsenic/adverse effects , Arsenic Poisoning/epidemiology , Arsenic Poisoning/prevention & control , Chelating Agents/adverse effects , Chelating Agents/toxicity , Occupational Health/legislation & jurisprudence , Waste Products/analysis , Waste Products/classification , Toxic Wastes/analysis , Toxic Wastes/prevention & control , Poisoning/complications , Poisoning/diagnosis
4.
Med Intensiva ; 32 Spec No. 1: 45-52, 2008 Feb.
Article in Spanish | MEDLINE | ID: mdl-18405538

ABSTRACT

Once analgesia is assured, sedation has special relevance in the critically ill ventilated patient's global treatment. Sedatives should be adjusted to individual needs, by administering minimal effective doses to achieve the AIM. This aim must be clearly identified, defined at the beginning of the treatment and revised on a regular basis, ideally at least once per shift. Sedation strategies should foresee the different needs throughout the day within dynamic sedation concept framework. Required sedation depth depends on the patient's psychological characteristics, foreseen evolution and patient tolerance to the support techniques used in treatment. Sedation monitoring permits identification and correction of under- or over-sedation, either of which could negatively influence critically ill patient evolution. The over-sedation concept must be applied to all situations where patients receive more sedation than required. This Spanish Society of Critical Care Medicine's Analgesia and Sedation Work Group recommends the Richmond Agitation Sedation Scale, due to its interrelationship with the Confusion Assessment Method Scale (CAM-ICU), for sedation monitoring in patients under light sedation while it recommends bispectral index sedation monitoring in patients under deep sedation. In the latter case, maintaining values under 40 on the bispectral index doesn't produce any benefits except in patients who require a maximum decrease in neuronal metabolism. To avoid recall phenomena, bispectral monitoring is highly advisable in patients treated with neuromuscular blockers.


Subject(s)
Critical Illness , Monitoring, Physiologic/methods , Patient Care/methods , Deep Sedation/methods , Humans
5.
Med Intensiva ; 32 Spec No. 1: 69-76, 2008 Feb.
Article in Spanish | MEDLINE | ID: mdl-18405540

ABSTRACT

The use of neuromuscular blockers (NMB) is a frequent practice in Intensive Care Units. However most of the experience with the use of these agents come from the operating room used to deal with patients with different characteristics from those admitted in the ICU. Recent advances on neuromonitoring and the commercialization of newer agents make necessary the update in the management of NMB in the ICU. The NMB agent should be chosen attending to its pharmacokinetics and the physiopathology of the critically ill patient. Those NMB with organ-independent metabolism as well as those with rapid onset of action are the preferred ones for the use in the critically ill patient substituting older depolarizing agents and those whose metabolism is dependent on the liver and/or kidney, organs frequently impaired in the critically ill patients. Neuromuscular blocking in the critically ill patient should be done according to protocols and monitor its effects in order to avoid complications related to its prolonged use.


Subject(s)
Critical Illness , Monitoring, Physiologic , Neuromuscular Blocking Agents/administration & dosage , Algorithms , Humans , Intensive Care Units , Oxygen Consumption
6.
Med. intensiva (Madr., Ed. impr.) ; 32(supl.1): 45-52, feb. 2008. tab, graf
Article in Spanish | IBECS | ID: ibc-137074

ABSTRACT

Una vez asegurada la analgesia, la sedación adquiere especial relevancia en el tratamiento integral del paciente crítico ventilado. Los sedantes se deben ajustar a las necesidades individuales del paciente, administrando la mínima dosis necesaria para conseguir el objetivo. Este objetivo debe ser claramente identificado, definido al inicio de la terapéutica y revisado de forma regular, idealmente al menos una vez por turno. La estrategia de sedación debe prever las distintas necesidades a lo largo del día, enmarcándose dentro del contexto de la denominada sedación dinámica. La profundidad de sedación necesaria dependerá de las características psicológicas del paciente, de la naturaleza y gravedad de su situación clínica, de la evolución prevista y de su tolerancia a las técnicas de soporte usadas para el tratamiento. La monitorización de la sedación permite identificar y corregir situaciones de infra o sobresedación que pueden influir negativamente en la evolución de los pacientes críticos. El concepto de sobresedación deberá aplicarse a toda aquella situación en la que al paciente se le administre más sedación de la que realmente necesite. La Richmond agitation sedation scale, por su conexión con el Confusion Assessment Method para la Unidad de Cuidados Intensivos (CAM-ICU), es la recomendada por el Grupo de Trabajo para la monitorización de los pacientes con necesidades de sedación no profunda y la monitorización con el análisis biespectral (BIS®) en los que necesitan sedación profunda. En este caso, valores inferiores de 40 en el BIS® no aportan beneficios, salvo en aquellos pacientes en los que se requiera disminuir al máximo el metabolismo neuronal. La monitorización con BIS® es muy recomendable en los pacientes tratados con bloqueo neuromuscular para impedir los fenómenos de recall (AU)


Once analgesia is assured, sedation has special relevance in the critically ill ventilated patient’s global treatment. Sedatives should be adjusted to individual needs, by administering minimal effective doses to achieve the aim. This aim must be clearly identified, defined at the beginning of the treatment and revised on a regular basis, ideally at least once per shift. Sedation strategies should foresee the different needs throughout the day within dynamic sedation concept framework. Required sedation depth de- pends on the patient’s psychological characteristics, foreseen evolution and patient tolerance to the support techniques used in treatment. Sedation monitoring permits identification and correction of under- or over-sedation, either of which could negatively influence critically ill patient evolution. The over-sedation concept must be applied to all situations where patients receive more sedation than required. This Spanish Society of Critical Care Medicine’s Analgesia and Sedation Work Group recommends the Richmond Agitation Sedation Scale, due to its interrelationship with the Confusion Assessment Method Scale (CAM-ICU), for sedation monitoring in patients under light sedation while it recommends bispectral index sedation monitoring in patients under deep sedation. In the latter case, maintaining values under 40 on the bispectral index doesn’t produce any benefits except in patients who re- quire a maximum decrease in neuronal metabolism. To avoid recall phenomena, bispectral monitoring is highly advisable in patients treated with neuromuscular blockers (AU)


Subject(s)
Female , Humans , Male , Conscious Sedation/ethics , Conscious Sedation/methods , Critical Illness/mortality , Critical Illness/nursing , Clinical Protocols/classification , Endocrine Cells/metabolism , Conscious Sedation/mortality , Conscious Sedation , Critical Illness/classification , Critical Illness/psychology , Mortality/ethnology , Clinical Protocols/standards , Endocrine Cells
7.
An Med Interna ; 22(7): 332-4, 2005 Jul.
Article in Spanish | MEDLINE | ID: mdl-16288579

ABSTRACT

Addison's disease is a set of symptoms which is produced due to the destruction of the suprarenal cortex, of a mainly autoimmune origin, on account of the presence of antibodies which attack it. This destruction takes place in a generally slow manner, causing symptoms to appear in an insidious way, added to the fact that these symptoms tend to be unspecific. Therefore it is easy to understand that its diagnosis at an early stage will be very difficult and is often interpreted as another disease. It is only when the deficit is important and adrenal crisis develop that we can reach the right diagnosis in a situation where the death risk is considerably high. We presented a clinical case as an example of what has been described previously. After several months of progressively deteriorating symptoms and several visits to different medical units, the patient is diagnosed as having an adrenal crisis and is immediately admitted to the intensive care unit.


Subject(s)
Addison Disease/diagnosis , Adult , Humans , Male
8.
An. med. interna (Madr., 1983) ; 22(7): 332-334, jul. 2005. ilus
Article in Es | IBECS | ID: ibc-040486

ABSTRACT

La enfermedad de Addison es un cuadro que se produce debido a la destrucción de la corteza suprarrenal, de origen principalmente auto inmune, por la presencia de anticuerpos contra la misma. Dicha destrucción tiene lugar de forma generalmente muy lenta por lo que la aparición de los síntomas es insidiosa, si añadimos el hecho de que estos síntomas suelen ser inespecíficos, es fácil entender que su diagnóstico en fases precoces sea muy difícil, con frecuencia interpretado como otra entidad clínica y sólo cuando el déficit es importante, dando lugar al desarrollo de las crisis adrenales, llegamos al diagnóstico correcto en una situación en la que el compromiso vital no es nada desdeñable. Presentamos un caso clínico ejemplo de lo anteriormente descrito, en el que tras varios meses de clínica progresiva y varias visitas a distintos servicios médicos, se diagnostica finalmente al presentar una crisis adisoniana que hace necesario su ingreso en una Unidad de Cuidados Intensivos


Addison 's disease is a set of symptoms which is produced due to the destruction of the suprarenal cortex, of a mainly autoimmune origin, on account of the presence of antibodies which attack it. This destruction takes place in a generally slow manner, causing symptoms to appear in an insidious way, added to the fact that these symptoms tend to be unspecific, Therefore it is easy to understand that its diagnosis at an early stage will be very difficult and is often interpreted as another disease, It is only when the deficit is important and adrenal crisis develop that we can reach the right diagnosis in a situation where the death risk is considerably high. We presented a clinical case as an example of what has been described previously, After several months of progressively deteriorating symptoms and several visits to different medical units, the patient is diagnosed as having an adrenal crisis and is immediately admitted to the intensive care unit


Subject(s)
Humans , Addison Disease/diagnosis , Early Diagnosis , Addison Disease/physiopathology , Addison Disease/drug therapy , Autoimmune Diseases/complications , Adrenal Cortex/physiopathology
10.
Emergencias (St. Vicenç dels Horts) ; 16(2): 95-97, abr. 2004. tab
Article in Es | IBECS | ID: ibc-32445

ABSTRACT

El coma mixedematoso es una situación de hipotiroidismo extremadamente grave, que se caracteriza por tener un pronóstico muy grave con una mortalidad elevada; por ello ha de considerarse una emergencia médica y sospecharlo clínicamente para poder reconocerlo precozmente e instaurar el tratamiento adecuado, preferentemente en una Unidad de Cuidados Intensivos. Presentamos un caso que se corresponde a lo descrito clásicamente en los textos de Medicina y que se pudo resolver con éxito inicialmente, aunque posteriormente presentó una hemorragia cerebral fatal (AU)


Subject(s)
Aged , Female , Humans , Myxedema/complications , Coma/complications , Hypothyroidism/complications , Emergency Medical Services
12.
Emergencias (St. Vicenç dels Horts) ; 16(3): 116-125, jun. 2004. ilus, tab
Article in Spanish | IBECS | ID: ibc-93271

ABSTRACT

El golpe de calor es una emergencia médica y causa tratable de fracaso multiorgánico (FMO). Se caracteriza por un incremento de la temperatura corporal central por encima de 40ºC y alteraciones del sistema nervioso central donde predomina la encefalopatía y es típico el coma. Es fundamental el diagnóstico precoz y, si no se toman las medidas iniciales oportunas, la tasa de mortalidad es muy alta (hasta el 70%). Las dos formas habituales de presentación son: 1ºen relación con el ejercicio en ambientes calurosos (que afecta fundamentalmente a individuos jóvenes sanos) y 2º la forma clásica (que afecta a ancianos o individuos con enfermedades debilitantes) durante intensas olas de calor. Puede clasificarse dentro de los síndromes inducidos por el calor ambiental y su presentación es consecuencia del fracaso del sistema termorregulador. El tratamiento se basa en el enfriamiento inmediato junto con el soporte de órganos y sistemas (AU)


Heat stroke is a medical emergency and a treatable cause of multiorganicfailure (MOF). It is caracterized by an increase in central bodytemperature (above 40oC) and alterations in the central nervous system where encephalopathy is predominate and comatous states are typical. An early diagnosis is vital and if the right initial measures are not taken the death rate tends to be very high (according to different series arround70%). It is habitually found in two types. Firstly in relation to exercise in hot atmospheres (which affects young healthy people fundamentally) and secondly the more classical situation (which affects young healthly people fundamentally)and secondly the more classical situation (which affects the elderly or people with weakening illnesses) during severe heat weaves. It can be classified within syndromes induced by the heat in the atmosphere and occurs as a consequence of a thermo regulating system failure. The treatment is based on an immediate cooling process and supportive measures view to recovering all organs from their state of insufficiency (AU)


Subject(s)
Humans , Heat Stroke/epidemiology , Fever/epidemiology , Emergency Treatment/methods , Brain/physiopathology , Body Temperature Regulation , Coma/etiology , Multiple Organ Failure/etiology
16.
Emergencias (St. Vicenç dels Horts) ; 12(2): 130-132, abr. 2000. ilus
Article in Es | IBECS | ID: ibc-21981

ABSTRACT

Recientemente se ha comercializado la mascarilla laríngea de intubación (ILMA), (LMA-Fastrach). Una de las diferencias más importantes con la mascarilla laríngea tradicional es que permite la introducción a su través de un tubo orotraqueal con lo que se puede conseguir la intubación orotraqueal sin necesidad de la maniobra de laringoscopia. Presentamos nuestra experiencia con su empleo en dos pacientes críticos con intubación difícil. En uno de los pacientes se consiguieron los objetivos rápidamente pero en el otro se fracasó en el intento de ventilación e intubación. Se discute la utilidad de la ILMA y sus probables limitaciones en el ámbito de los cuidados críticos (AU)


Subject(s)
Male , Middle Aged , Humans , Respiration, Artificial/methods , Intubation, Intratracheal/methods , Laryngeal Masks , Subarachnoid Hemorrhage/complications , Guillain-Barre Syndrome/complications , Respiratory Insufficiency/therapy , Respiratory Insufficiency/etiology
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