Membrana de oxigenación extracorpórea venovenosa como puente a la reparación de una fístula bronquial traumática / Venovenous extracorporeal membrane oxygenation as a bridge to traumatic bronchial fistula closure

Las lesiones traqueobronquiales traumáticas ocurren en el 1% de los pacientes con traumatismo torácico, y la mayoría de ellos fallecen en el lugar del trauma. En este caso clínico presentamos a una paciente de 26 años de edad, ingresada en UCI debido a un traumatismo torácico cerrado causando hipoxemia y acidosis grave, decidiéndose implantar la membrana de oxigenación extracorpórea percutánea venovenosa. El uso de membrana de oxigenación extracorpórea percutánea venovenosa, iniciado con un objetivo de anticoagulación más bajo, permitió el diagnóstico y tratamiento de una fístula broncopleural en condiciones de estabilidad respiratoria y hemodinámica sin complicaciones hemorrágicas, obteniendo una asistencia rápida y adecuada para la supervivencia de la paciente

Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient

Venovenous extracorporeal membrane oxygenation as a bridge to traumatic bronchial fistula closure. / Membrana de oxigenación extracorpórea venovenosa como puente a la reparación de una fístula bronquial traumática.

Traumatic tracheobronchial injuries occur in 1% of patients with thoracic trauma, most of them dying at the site of the trauma. In this case report, we present a 26-year-old female patient admitted to the ICU due to a blunt chest trauma causing life threatening hypoxaemia and acidosis; deciding to implant percutaneous venovenous extracorporeal membrane oxygenation. The use of percutaneous venovenous extracorporeal membrane oxygenation, implemented with a lower anticoagulation target, allowed the diagnosis and treatment of a bronchopleural fistula under conditions of respiratory and hemodynamic stability without haemorrhagic complications, obtaining a fast and adequate assistance achieving the survival of the patient.

[Paraquat poisoning and hemoperfusion with activated charcoal]. / Envenenamiento por Paraquat y hemoperfusión con carbón activado.

Paraquat is a common herbicide in Spain. In our country there are a few cases of this intoxication and it presents a high mortality even if the patients ingest a minimal amount. We present two cases of accidental poisoning with paraquat. These patients were admitted three hours after ingestion of toxin. They were treated with with orogastric lavage, activated charcoal, N-acetylcysteine, Fuller's earth, cathartics, support measures and hemoperfusion with activated charcoal. With these treatments both patients had a undetectable levels of paraquat 48 hours after and improvement of their symptoms, gastric and intestinal predominantly . We present the graphics of evolution of the plasma and urine levels of paraquat in both patients. We review the different aspects of treatment and update of this poisoning.

Envenenamiento por paraquat y hemoperfusión con carbon activado / Paraquat intoxications and hemoperfusion with activated charcoal

El Paraquat es un herbicida del grupo de los biperidilicos, de los más utilizados en nuestro pais.En España existen muy pocos casos descritos de esta intoxicación y presenta una alta mortalidad incluso con la ingestión de mínimas cantidades.Presentamos dos casos de intoxicación por ingesta accidental de este producto, que llegan a nuestro hospital en las tres horas posteriores. Se instaura tratamiento con lavado gástrico, carbón activado, N acetil cisteina, tierra de Fuller, catárticos, medidas de apoyo y hemoperfusión con carbón activado; consiguiendose niveles indetectables del tóxico 48 horas después y mejorando su sintomatología, predominantemente gastrointestinal.Se comentan los casos clínicos durante su estancia en U.C.I así como aspectos clínicos de estas intoxicaciones, su tratamiento actual y últimas tendencias y factores pronósticos (AU)

The Paraquat is a herbicide more using in Spain. In our country there are a few cases this intoxication and it presents a hight mortality even if the patients ingest a minimal amount. We present two cases of casual poisoning with paraquat. These patients were admited three hours after ingestion of toxic. They were treated with with orogastric lavage, activated charcoal, N-acetil-cysteina, Fuller´s earth, catartics, support measuring and hemperfusion with activated charcoal, with this treatments both patients had a indetectable levels of paraquat 48 hours after and yours symptoms that was gastric and intestinal predominantly had missing. We present the graphics of evolution the plasmatic and urine levels of paraquat the both patients. We review the differents aspects of treatment and update of this intoxication (AU)

Estudio de las intoxicaciones etílicas agudas en un servicio de urgencias / A stude of the acute ethanol intoxication at the emergency room

Objetivo: Conocer la frecuencia de las intoxicaciones etílicas agudas en nuestro servicio, así como sus características epidemiológicas, clínicas, y problemas asociados. Método: Se estudiaron una serie de variables en los pacientes mayores de 14 años que fueron atendidos en urgencias por intoxicación etílica, separándolos en dos grupos de edad. Resultados: Se atendieron 472 casos (0,55 porciento de los motivos de consulta), siendo hombres el 84,1 porciento y un 40 porciento 25 años, la distribución semanal es más homogénea y hay un mayor número por las tardes. La relación con traumatismo cráneo-encefálico es menor en el grupo de los jóvenes. No hubo diferencias significativas en el número de accidentes de tráfico. El porcentaje de ingresos fue del 17 porciento en los >25 años frente al 5 porciento en los menores de esta edad. No se obtuvieron variaciones con significación estadística en cuanto al número de agresiones, intentos de autolisis, sobredosis o asociación a otras sustancias tóxicas. Conclusiones: Las intoxicaciones etílicas muestran unas características diferenciadas según ocurran en jóvenes (25 años). En los primeros se trata fundamentalmente de la consecuencia de una conducta "recreativa de las noches del fin de semana", mientras que en los segundos hay una mayor asociación a traumatismos e ingresos sin que éstos se justifiquen por una mayor incidencia de accidentes de tráfico (AU)

[Early enteral nutrition and immunonutrition]. / Nutrición enteral precoz e inmunonutrición.

The repercussions of nutrition on the immunological system are described. The current situation is discussed with regard to the handling of the immuno-inflammatory response to aggression and the improvement of the immune response. The goal pursued by nutritional manipulation of the immune system is to improve the prognosis and reduce the complications in critical patients subjected to surgical or traumatic aggression or sepsis. The following points are reviewed: the importance of preserving the axis from the liver to the digestive tract, the advantages of particularly early enteral nutrition over parenteral nutrition, the substances currently considered as immunonutrients and the available clinical evidence on their use, with a series of conclusions for current decisions and future developments.

[Acute ethanol intoxication at an emergency room]. / Estudio de las intoxicaciones etílicas agudas en un servicio de urgencias.

OBJECTIVE: To know the frequency of the acute ethylic intoxications in our service, as well as their epidemiologic, clinical characteristics, and associate problems. METHOD: A series of variables in patients older than 14 years were studied. These patients were assisted at the emergency room by ethylic intoxication, and they were separated in two age groups. RESULTS: 472 cases were assisted (0.55% of the consultation reasons). 84.1% were men and 40% < 26 years. Most of the intoxications in this age group happened during the weekends, fundamentally at night, while in the > 25 years, the weekly distribution is more homogeneous and there is a bigger number in the afternoons. The relationship with traumatic brain injury is smaller in the group of the youths. There were not significant differences in the number of traffic accidents. The percentage of admissions was 17% in the > 25 years opposite to 5% in people younger than this age. Variations with statistical significance were not obtained if we consider the number of aggressions, parasuicides, overdoses or association with other toxic substances. CONCLUSIONS: The ethylic intoxications show some different characteristics depending on the age of the patient (< 26 years old vs. > 25 years old). In the young people ethylic intoxication is the consequence of a "recreational behaviour at weekend's night" fundamentally, and in the adults there is a stronger association with traumatisms and admissions and we can't say that these one are justified for a bigger incidence of traffic accidents.

Myocardial rupture after pulling out a tined atrial electrode with continuous traction.

Transvenous traction for the removal of retained pacemaker electrodes is common practice with few reported complications. This case reports a patient with a DDD pacemaker with extruded electrodes, who died of a myocardial rupture at the atrial lead site after prolonged (i.e., after 24 hours) traction was applied.