Las técnicas ecoguiadas, una herramienta muy útil también para enfermería / Ultrasound-guided techniques, also a very useful tool for nursing

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Ecografía de los grandes vasos abdominales / Ultrasound of the large abdominal vessels

La ecografía se ha convertido en los últimos tiempos en una herramienta indispensable para el médico de familia, tanto si ejerce en atención primaria como en urgencias; y del mismo modo se ha extendido a muchas otras especialidades: medicina interna, cuidados intensivos, neurología, neumología, digestivo, etc., ya que los ultrasonidos han demostrado ser una herramienta segura y tener gran capacidad diagnóstica. Nosotros creemos firmemente que la ecografía realizada a 'pie de cama' del paciente, realizada por el médico de familia, puede complementar en gran medida la exploración física y mejorar sobremanera la eficacia del clínico, permitiendo al explorador una visión inmediata a la anatomía y fisiología de determinadas estructuras. Es dentro de este contexto donde cobra especial relevancia el estudio ecográfico de la aorta y de los grandes vasos abdominales, realizado por el propio médico de familia o de urgencias, que vamos a desarrollar a lo largo de este artículo (AU)

Ultrasound has recently become an indispensable tool for the family physician, whether exercised in primary care and emergency department; and likewise it has spread to many other specialties: internal medicine, critical care, neurology, pneumology, digestive, etc. and that ultrasound has proven to be a safe diagnostic tool and have great capacity. We firmly believe that ultrasound done to 'bedside' the patient by the family doctor, can greatly complement the physical examination and greatly improve clinical effectiveness, allowing the browser an immediate view of the anatomy and physiology of certain structures. It is within this context is particularly relevant ultrasonography of the Aorta and large abdominal vessels, made by the family doctor or the emergency itself, which will develop along this chapter (AU)

La ecografía clínica en urgencias ante un paciente séptico / Clinical ultrasound in the emergency room on a septic patient

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[Ultrasound of the large abdominal vessels]. / Ecografía de los grandes vasos abdominales.

Ultrasound has recently become an indispensable tool for the family physician, whether exercised in primary care and emergency department; and likewise it has spread to many other specialties: internal medicine, critical care, neurology, pneumology, digestive, etc. and that ultrasound has proven to be a safe diagnostic tool and have great capacity. We firmly believe that ultrasound done to «bedside¼ the patient by the family doctor, can greatly complement the physical examination and greatly improve clinical effectiveness, allowing the browser an immediate view of the anatomy and physiology of certain structures. It is within this context is particularly relevant ultrasonography of the Aorta and large abdominal vessels, made by the family doctor or the emergency itself, which will develop along this chapter.

Parálisis periódica hipopotasémica. A propósito de un caso / Hypokalemic periodic paralysis. A case report

Las parálisis periódicas son un trastorno poco frecuente que cursa con episodios de debilidad muscular aguda que puede confundirse con otras enfermedades como la epilepsia o la miastenia gravis, entre otras. Dentro de ellas se incluyen las parálisis hiper e hipopotasémicas, dividiéndose estas últimas a su vez en periódicas (familiar, tirotóxica o esporádica) y no periódicas. A este respecto, presentamos un caso de parálisis periódica hipopotasémica familiar en una mujer de 18 años que había sido diagnosticada en la infancia de epilepsia y que, además, había presentado un hipotiroidismo subclínico meses atrás por el que había recibido tratamiento sustitutivo. La anamnesis, siempre fundamental, y la objetivación de hipopotasemia permitieron el diagnóstico (AU)

Periodic paralysis is a rare disorder that causes episodes of severe muscle weakness that can be confused with other diseases, including epilepsy or myasthenia gravis. Hyperkalemic and hypokalemic paralysis are included within these diseases, the latter being divided intoperiodic paralysis (familial, thyrotoxic or sporadic) and non-periodic paralysis. In this regard, we present a case of familial hypokalemic periodic paralysis in an eighteen year-old female who was diagnosed with epilepsy in childhood, as well as a subclinical hypothyroidism (for which she received replacement therapy) months ago. The diagnosis was made by the anamnesis and the confirmation of hypokalemia (AU)

Valor de la ecocardiografía en el diagnóstico etiológico de la parada cardiorrespiratoria con actividad eléctrica sin pulso / Echocardiography in the etiological diagnosis of cardiorespiratory arrest with electrical activity without a pulse

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[Hypokalemic periodic paralysis. A case report]. / Parálisis periódica hipopotasémica. A propósito de un caso.

Periodic paralysis is a rare disorder that causes episodes of severe muscle weakness that can be confused with other diseases, including epilepsy or myasthenia gravis. Hyperkalemic and hypokalemic paralysis are included within these diseases, the latter being divided into periodic paralysis (familial, thyrotoxic or sporadic) and non-periodic paralysis. In this regard, we present a case of familial hypokalemic periodic paralysis in an eighteen year-old female who was diagnosed with epilepsy in childhood, as well as a subclinical hypothyroidism (for which she received replacement therapy) months ago. The diagnosis was made by the anamnesis and the confirmation of hypokalemia.

Diagnóstico ecográfico del infarto pulmonar en urgencias. A propósito de un caso / Ultrasound diagnosis of pulmonary infarction in emergencies. A case presentation

El infarto pulmonar es una lesión isquémica del parénquima que acontece en el contexto de un tromboembolismo pulmonar cuando la obstrucción arterial priva de perfusión a dicha zona y la circulación bronquial adyacente no aporta el flujo necesario. Aparece aproximadamente en un 40% de los tromboembolismos pulmonares. Como médicos de Urgencias podríamos diagnosticar el infarto pulmonar a pie de cama del paciente de forma rápida, sencilla, inocua y eficiente con la disponibilidad de ecógrafos en nuestras urgencias y centros de salud. La posibilidad de aproximarnos al diagnóstico etiológico con una primera sospecha clínica sumando factores de riesgo, sintomatología, signos clínicos y radiológicos y el uso de pruebas de imagen in situ, incrementa notablemente nuestra sensibilidad y especificidad (AU)

Pulmonary infarction is a parenchymal ischemic lesion that occurs in the context of a pulmonary embolism when arterial blockage deprives perfusion to that area and the adjacent bronchial circulation does not provide the necessary flow. It appears in approximately 40% of pulmonary embolisms. Emergency Physicians are able to diagnose a pulmonary infraction at the patient bedside, in a quick, easy, safe and efficient way with the availability of ultrasound in our Emergency Rooms and Health Centres. The possibility of approaching the aetiology, firstly with a clinical suspicion then adding risk factors, symptoms, clinical and radiological signs and the use of in situ imaging, increases the sensitivity and specificity of the diagnosis (AU)

[Ultrasound diagnosis of pulmonary infarction in emergencies. A case presentation]. / Diagnóstico ecográfico del infarto pulmonar en urgencias. A propósito de un caso.

Pulmonary infarction is a parenchymal ischemic lesion that occurs in the context of a pulmonary embolism when arterial blockage deprives perfusion to that area and the adjacent bronchial circulation does not provide the necessary flow. It appears in approximately 40% of pulmonary embolisms. Emergency Physicians are able to diagnose a pulmonary infraction at the patient bedside, in a quick, easy, safe and efficient way with the availability of ultrasound in our Emergency Rooms and Health Centres. The possibility of approaching the aetiology, firstly with a clinical suspicion then adding risk factors, symptoms, clinical and radiological signs and the use of in situ imaging, increases the sensitivity and specificity of the diagnosis.

Pericarditis lúpica: a propósito de un caso / No disponible

El derrame pericárdico (DP) es una entidad que se diagnostica con poca frecuencia en Urgencias. Presentamos este caso, en el que gracias a la adquisición de nuevas técnicas innovadoras por parte de los médicos especialistas en urgencias, la ecocardiografía, se consigue llegar al diagnóstico de DP y cuantificarlo como grave, sin compromiso hemodinámico, en el mismo Servicio de Urgencias. Posteriormente, en planta, se establece el diagnóstico etiológico, al cumplir la paciente 4 criterios diagnósticos de lupus eritematoso sistémico (LES). El LES es una enfermedad autoinmune, inflamatoria, crónica y con afectación multisistémica, de causa desconocida, siendo la pericarditis la afectación cardiaca más frecuente, aunque es raro que se llegue a una situación de taponamiento cardiaco. El curso clínico de esta enfermedad es variable, dependiendo el pronóstico de la gravedad y del tipo de órganos implicados. El tratamiento se basa en el uso de antiinflamatorios no esteroideos(AINE), corticoides, antipalúdicos e inmunosupresores (AU)

Pericardial effusion (Pericardial effusion (PE) is a condition that is rarely diagnosedin the Emergency Department. We present this case inwhich thanks to the new technologies developed by theEmergency Department medical personnel, it was possible toreach the diagnosis of PE using the echocardiography and todetermine its severity, without compromising the hemodynamicswithin the Emergency Department itself.Once the patient had been transferred out of the EmergencyDepartment, the etiological diagnosis was established asthe patient had 4 Systemic Lupus Erythematosus criteria(SLE). SLE is an autoimmune, inflammatory, chronic illnesswith multisystemic effect, of unknown origin. Pericarditis isthe most frequent heart condition (although it is unusual fora cardiac tamponade to develop). The clinical course for thisillness varies, depending on the severity and type of organsinvolved. Treatment is based on the use of NSAIDs, corticoids,antimalarial and immunosuppressive medications (AU)