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1.
Rev Esp Anestesiol Reanim ; 46(5): 205-14, 1999 May.
Artigo em Espanhol | MEDLINE | ID: mdl-10379187

RESUMO

That hospital cardiopulmonary resuscitation (CPR) should be supported by an organized plan rather than on the skills of individual health care personnel is a universally agreed-upon principle. Such a plan should guarantee that needed materials are available and in working order in all departments and that the team assigned to carry out CPR arrives promptly. Personnel other than the specialized team should also receive CPR training appropriate to their posts. The main features of a CPR plan are related to the five steps in the chain of survival: a) identification of a patient to be resuscitated, a matter that has important ethical ramifications; b) early recognition of cardiac arrest; c) early defibrillation; d) basic CPR, and e) advanced CPR. The CPR plan should incorporate the automatic recording of system, population, event and outcome variables. Task forces responsible for establishing and maintaining the plan and its quality control will periodically review the data with the aim of detecting errors, correcting them or introducing improvements. Various international societies and CPR committees have recently suggested a uniform way (the Utstein style) of recording and presenting data to allow comparisons either from hospital to hospital or over time within a single center.


Assuntos
Reanimação Cardiopulmonar , Cardioversão Elétrica , Departamentos Hospitalares/organização & administração , Reanimação Cardiopulmonar/educação , Reanimação Cardiopulmonar/instrumentação , Administração de Caso/organização & administração , Cardioversão Elétrica/instrumentação , Equipamentos e Provisões Hospitalares/provisão & distribuição , Ética Médica , Controle de Formulários e Registros , Parada Cardíaca/terapia , Sistemas de Comunicação no Hospital , Equipe de Assistência ao Paciente , Recursos Humanos em Hospital/educação , Garantia da Qualidade dos Cuidados de Saúde , Gestão de Riscos
2.
Chest ; 113(4): 1078-83, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9554650

RESUMO

STUDY OBJECTIVES: To validate capnometric recirculating gas tonometry (CRGT) for continuously monitoring gut intramucosal PCO2 (PiCO2) in a septic shock model, and to compare gastric vs esophageal PCO2 vs intramucosal-arterial PCO2 gradients. INTERVENTIONS: CRTG catheters were placed in the stomach and esophagus of six anesthetized dogs. A saline solution filled balloon tonometry (ST) catheter was also placed in the stomach. After equilibration, 3 mg/kg Escherichia coli lipopolysaccharide (LPS) was administered IV. PiCO2 measurements were made at 0, 45, and 90 min post-LPS by ST and continuously by CRGT. RESULTS: Baseline PiCO2 was 41.5+/-1.9 (+/-SE) in the stomach by CRGT, 38.0+/-1.0 by ST, and 43.0+/-4.4 mm Hg in the esophagus (p=not significant). Gastric PiCO2 by CRGT increased to 47.0+/-2.4 mm Hg by 25 min post-LPS (p<0.05), whereas gastric (ST) and esophageal PiCO2 increased significantly by 45 min post-LPS. Good agreement was observed between gastric CRGT and ST measurements (mean bias, 1.3 mm Hg). The PiCO2-PaCO2 gradient increased post-LPS, but was significant only for gastric CRGT measurements 90 min post-LPS infusion. CONCLUSION: CRGT provided continuous gastric PiCO2 measurements that were in close agreement with ST but detected changes earlier than the conventional technique. Continuous esophageal PiCO2 represents a valid alternative for assessing gastric PiCO2.


Assuntos
Endotoxemia/metabolismo , Esôfago/metabolismo , Mucosa Gástrica/metabolismo , Choque Séptico/metabolismo , Animais , Dióxido de Carbono/análise , Modelos Animais de Doenças , Cães , Endotoxemia/fisiopatologia , Hemodinâmica , Concentração de Íons de Hidrogênio , Monitorização Fisiológica/métodos , Mucosa , Oxigênio/análise , Choque Séptico/fisiopatologia
3.
J Trauma ; 44(4): 696-700, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9555845

RESUMO

BACKGROUND: As systemic oxygen delivery (DO2) is reduced, oxygen consumption (VO2) is maintained until a critical level is reached (DO2crit) below which VO2 becomes supply-dependent and anaerobic metabolism ensues. We examined the relationship between gastric intramucosal PCO2 (PiCO2) and the onset of systemic supply dependency. We also compared PiCO2 to mixed venous and portal venous blood PCO2 (PmvCO2 and PpvCO2) to assess their utility as premonitory indicators of supply dependency. METHODS: Six dogs were subjected to stepwise hemorrhage to effect a progressive decrease in DO2. Inflection points for changes in VO2, PiCO2, PmvCO2, and PpvCO2 versus DO2 were determined. RESULTS: Mean DO2crit was 6.0 +/- 0.7 mL x kg(-1) x min(-1), whereas the DO2 at which inflection points occurred for PiCO2 and PpvCO2 were 13.2 +/- 1.4 and 11.2 +/- 1.5 mL x kg(-1) x min(-1), respectively (p < 0.05 for both). CONCLUSION: Continuous monitoring of PiCO2 using capnometric recirculating gas tonometry can serve as an early indicator of systemic hypoperfusion before the onset of systemic supply dependency.


Assuntos
Dióxido de Carbono/análise , Mucosa Gástrica/metabolismo , Hemorragia/metabolismo , Consumo de Oxigênio , Limiar Anaeróbio , Animais , Gasometria , Dióxido de Carbono/metabolismo , Modelos Animais de Doenças , Cães , Mucosa Gástrica/química , Hemodinâmica , Hemorragia/fisiopatologia , Concentração de Íons de Hidrogênio , Monitorização Fisiológica , Oxigênio/análise , Oxigênio/metabolismo , Circulação Esplâncnica
5.
Shock ; 8(6): 427-31, 1997 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-9421856

RESUMO

When oxygen delivery (DO2) critically decreases, oxygen consumption (VO2) becomes supply dependent. We examined whether end-tidal PCO2 (PetCO2) would identify supply dependency during shock. Five dogs (Group I) underwent progressive hemorrhage to decrease DO2 until they could no longer maintain a stable blood pressure. Five additional animals (Group II) were bled until VO2 decreased to 70% of baseline, followed by resuscitation. The PetCO2 versus time inflection point was compared with the DO2 at onset of supply dependency (DO2crit). DO2crit for Groups I and II were 6.9 +/- .4 and 8.1 +/- 1.3, respectively (p = NS), and not statistically different from the DO2 values at which PetCO2 decreased (6.6 +/- .7 and 6.3 +/- .7 mL/kg per min, respectively). AT constant minute volume, PetCO2 effectively indicated the onset of supply dependency and rapidly increased during resuscitation, paralleling the changes in VO2 in this model of hemorrhagic shock.


Assuntos
Dióxido de Carbono/sangue , Consumo de Oxigênio/fisiologia , Ressuscitação , Choque Hemorrágico/sangue , Choque Hemorrágico/fisiopatologia , Animais , Transfusão de Sangue , Cães , Hemodinâmica , Ácido Láctico/sangue , Oxigênio/administração & dosagem , Pressão Parcial , Análise de Regressão , Respiração/fisiologia , Volume de Ventilação Pulmonar
6.
Rev Clin Esp ; 193(7): 380-2, 1993 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-8290759

RESUMO

We present a patient with primary amyloidosis and sleep-inhibiting apnea and review the only two cases for which adequate references have been made in the medical literature. The importance of a complete anamnesis on the characteristics of sleep are stressed, and it is suggests that treatment with positive pressure applied via the nose (cPAP), as in the case presented here, can mean an important symptomatic improvement in a disease with an unfortunate prognosis.


Assuntos
Amiloidose/terapia , Respiração com Pressão Positiva/métodos , Doenças Respiratórias/terapia , Síndromes da Apneia do Sono/terapia , Administração Intranasal , Idoso , Amiloidose/complicações , Evolução Fatal , Humanos , Masculino , Doenças Respiratórias/complicações , Síndromes da Apneia do Sono/complicações
7.
Med Clin (Barc) ; 101(12): 459-61, 1993 Oct 16.
Artigo em Espanhol | MEDLINE | ID: mdl-8231370

RESUMO

Giant cell myocarditis is a rare disease of unknown etiology, which develops as a myocardial isolated affection or associated to different diseases. Its characteristics are such as necrosis, inflammation and giant cell presence in the myocardium. We present the case of a woman who suffered of giant cell myocarditis, thymoma, myasthenia gravis, chronic lymphocytic thyroiditis, giant cell myositis, granulomatous infiltration in the lymph nodes of the hilus of the lung and hypogammaglobulinemia; multiple association that we have not found in any published medical paper and that suggest the autoimmune origin of this illness. The cardiovascular symptoms and the associated diseases are revised, and we discussed the diagnostic and therapeutic topics, pointing out the necessity to take it into account for any patient with thymoma or myasthenia gravis developing to heart failure or arrhythmias.


Assuntos
Granuloma/diagnóstico , Miocardite/diagnóstico , Agamaglobulinemia/diagnóstico , Agamaglobulinemia/patologia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/patologia , Feminino , Granuloma/patologia , Humanos , Linfonodos/patologia , Pessoa de Meia-Idade , Miastenia Gravis/diagnóstico , Miastenia Gravis/patologia , Miocardite/patologia , Miocárdio/patologia , Necrose , Timoma/diagnóstico , Timoma/patologia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/patologia , Tireoidite Autoimune/diagnóstico , Tireoidite Autoimune/patologia
8.
Arch Otolaryngol Head Neck Surg ; 119(1): 69-72, 1993 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8417747

RESUMO

We studied the relationship of natural killer cell activity from peripheral blood mononuclear cells with the clinical and pathologic stage of disease in 23 male patients with previously untreated carcinoma of the larynx and 22 healthy male control subjects. Levels of natural killer cell activity against K-562 target cells were similar in control subjects and patients, regardless of stage, tumor size, and clinical cervical adenopathies. Natural killer cell activity, however, was significantly decreased in patients with pathologic cervical lymph node involvement. The number of natural killer cells, as estimated by CD16 and CD56 monoclonal antibodies, was similar in all groups of subjects. We conclude that in patients with laryngeal carcinoma, there is a correlation between deficient natural killer cell activity and nodal metastases, which may represent a prognostic indicator in these patients.


Assuntos
Carcinoma de Células Escamosas/imunologia , Células Matadoras Naturais/imunologia , Neoplasias Laríngeas/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD/análise , Carcinoma de Células Escamosas/patologia , Citotoxicidade Imunológica , Humanos , Imunofenotipagem , Neoplasias Laríngeas/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade
10.
Med Clin (Barc) ; 97(17): 660-2, 1991 Nov 16.
Artigo em Espanhol | MEDLINE | ID: mdl-1762461

RESUMO

A patient with thalassemia minor (TM) is reported who ingested 80 g of alcohol/day and presented an important overload of iron with deposits and a hepatic iron ratio compatible with primary hemochromatosis. The results obtained from the study of histocompatibility antigens, clinical manifestations and family analysis discarded the possibility of two genetic diseases, beta-thalassemia and primary hemochromatosis, being concomitantly present in the same progeny. Thalassemia minor and alcoholic hepatopathy are considered as having acted together and being responsible for the iron overload. The relation between alcohol ingested, TM and iron deposits is discussed.


Assuntos
Saúde da Família , Hemocromatose/etiologia , Talassemia/genética , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Hemocromatose/sangue , Humanos , Masculino , Linhagem , Talassemia/sangue , Talassemia/complicações
16.
Rev Esp Cardiol ; 43(5): 356-8, 1990 May.
Artigo em Espanhol | MEDLINE | ID: mdl-2203123

RESUMO

We report a case with systemic sclerosis (scleroderma) presented with an acute pericarditis and pericardial tamponade with haemodynamic impairment that required pericardial drain. The frequency of pericardial disease in scleroderma is high, but the clinical recognition is rare, and tamponade with haemodynamic impairment requiring aspiration for relief is exceptional, but should be considered in patients with scleroderma that present an acute pericarditis. It is suggested that pericardial fibrosis in scleroderma may predispose to pericardial tamponade.


Assuntos
Tamponamento Cardíaco/complicações , Pericardite/complicações , Escleroderma Sistêmico/complicações , Doença Aguda , Feminino , Humanos , Pessoa de Meia-Idade
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