Medicina intensiva
-
Multicenter Study
[The effectiveness of training schemes in the treatment of acute coronary syndrome at health centers].
A preliminary evaluation of the impact of a training program on pre-hospitalization care of acute coronary syndrome (ACS). ⋯ A training scheme for general practitioners (GP) is essential to ensure appropriate care of patients with this condition.
-
Hemodynamic monitoring is a key element in the care of the critical patients, providing an unquestionable aid in the attendance to diagnosis and the choice of the adequate treatment. Minimally invasive devices have been emerging over the past few years as an effective alternative to classic monitoring tools. The esophageal echoDoppler is among these. ⋯ Although several studies have demonstrated the usefulness of the esophageal Doppler in the surgical scene, there is scarce and dispersed evidence in the literature on its benefits in critical patients. Nevertheless, its advantages make it an attractive element to take into account within the diagnostic arsenal in the intensive care. The purpose of the following article is to describe how it works, its degree of validation with other monitoring methods and the role of esophageal echoDoppler as a minimally invasive monitoring tool for measuring cardiac output in the daily clinical practice, contributing with our own experience in the critical patient.
-
Alcohol and other substance abuse that alters behavior make up the principal risk factor to suffer serious traumas. Patients who have had an alcohol or other drug consumption related accident have a high risk of recidivism. ⋯ A brief psychological intervention made during the bedridden period may modify the behavior and decrease the risk of new accidents. Therefore, establishing secondary prevention programs should be considered a priority objective in sites that receive traumatized patients.
-
Case Reports
[Acute inferior myocardial infarction masking the J wave syndrome. Based on four observations].
The J wave syndrome is characterized by a prominent J wave accompanied by ST-segment elevation in the absence of structural heart disease. It includes the benign early repolarization syndrome, the highly arrhythmogenic Brugada syndrome and idiopathic ventricular fibrillation. Although acute coronary syndromes are one of the leading causes of ST-segment deviation, no clinical reports that specifically describe the modulating effects of an ischemic injury current on the ECG manifestations of the J wave syndrome have been found. ⋯ Later, these precordial ECG alterations disappeared and were progressively replaced by prominent J (R') waves and anterior ST-segment elevations, suggesting the presence of a J wave syndrome. In conclusion, the J wave syndrome may be obscured by an acute inferior myocardial infarction with concomitant ST-segment depression in the right precordial leads. In such circumstances, early detection of the J wave (or depressed J point) may be used as ECG marker of the early repolarization syndrome or Brugada syndrome.