Boletín de la Asociación Médica de Puerto Rico
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Sepsis is a fairly common disease process in our population. Even with aggressive treatment, morbidity and mortality remain high. The initial evaluation of these patients with sepsis, severe sepsis and septic shock may increase survival. ⋯ Recent studies have shown that with the systematic use of aggressive fluid expansion, broad-spectrum antibiotics as well as inotropes and vasopressors a decrease in mortality may be achieved. Our efforts must be geared towards a structured early diagnosis and treatment. With the right tools and approach we will be able to keep ourselves ahead of this condition in order to improve the health of our fellow patients in Puerto Rico and the rest of the world.
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The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides stratification of patients on the basis of acuity and resource needs, being ESI-1 the highest acuity and ESI-5 the lesser. The ESI triage system was recently adopted at our Emergency Department. We suspect higher acuity patients are facing inappropriate stratification and thus waiting longer to be managed and stabilized. ⋯ The ESI assigned upon arrival correlated with the median waiting time, exposing undertriaged patients to longer waiting times.
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Historical Article
[The University of Puerto Rico Emergency Medicine Program: 15th anniversary, its history and contribution to health care in Puerto Rico].
Emergency medicine is a newly created specialty in Puerto Rico. The first training program began in 1977. Unfortunately this program was decertified by ACGME in 30 July 30 1993. ⋯ Approximately 25% of emergency rooms directors in PR are graduates. About 27% of graduates have subspecialties. It is also important to note that graduates of the program have helped to improve the quality of health care offered in emergency rooms in the country.
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EMTALA (Emergency Medical Treatment and Active Labor Act) is a law born during the mid-eighties as an anti-discrimination law. Initially, its intention was to protect the uninsured population from being denied medical care due to inability to pay medical bills. ⋯ EMTALA is a Federal Law that has been interpreted and adapted for its use in Puerto Rico. It is the intention of this article to describe the events that led to the Law's creation, explains how it is applied in our hospitals, and describes the implications of EMTALA in our daily practice.
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Renal stones (nephrolithiasis) are a relatively common problem and a frequent Emergency Department (ED) diagnosis in patients who present with acute flank/abdominal pain. The goal of this topic review is to provide physicians with an evidence-based diagnostic approach for the evaluation and management of patients with nephrolithiasis. ⋯ Pain management can be achieved by using NSAIDs, opioids or a combination of both. Several factors will help you determine if emergent urology evaluation is warranted; size and location of renal calculi, persistence of colic pain, impaired renal function and signs of infection.