Revista médica de Chile
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Revista médica de Chile · Sep 2013
Review[Initial resuscitation bundle and monitoring tissue perfusion in severe sepsis].
Sepsis is a global health problem. Despite recent advances in understanding its pathophysiology and clinical trials testing potential new therapies, mortality remains unacceptably high. ⋯ A systematic approach to the harmful triad of sepsis-related hypotension, tissue hypoperfusion and organ dysfunction, with low-cost, easy to implement, and effective interventions, can significantly improve the chances of survival. In this article, we will update the evidence supporting the initial resuscitation bundle for patients with severe sepsis, and discuss the physiological basis for perfusion monitoring during septic shock resuscitation.
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Revista médica de Chile · Jun 2012
Review[Description of clinical thinking by the dual-process theory].
Clinical thinking is a very complex process that can be described by the dual-process theory, it has an intuitive part (that recognizes patterns) and an analytical part (that tests hypotheses). It is vulnerable to cognitive bias that professionals must be aware of, to minimize diagnostic errors.
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Revista médica de Chile · Sep 2011
Review Case Reports[Venous thrombosis secondary to catheter insertion for hypothermia after cardiac arrest. Report of one case].
To improve survival and reduce neurological injury, the use of mild hypothermia following cardiac arrest has been recommended. We report a 65 years old woman who presented an out-of-hospital ventricular fibrillation and cardiac arrest. ⋯ Although no neurological impairment was observed, physical examination of the right inguinal area and echo-Doppler examination revealed an extensive catheter-related thrombophlebitis with right ileocaval vein occlusion., with high risk of massive and life threatening pulmonary embolism. We report a clinical case and review the literature to point out the need for a high index of diagnostic suspicion of deep venous thrombosis in these specific setting.
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Terminally ill patients frequently have difficulties with fluid and food intake. The indication of artificial hydration in these patients has been subject of intense debate in the past years and the clinical practice widely varies, mostly based on anecdotal data and not on clinical evidence about risks and benefits associated to artificial hydration in terminal patients. ⋯ Several topics, such as the effect of artificial hydration alleviating symptoms or reversing neurological alterations as delirium, its life prolonging effect or if it promotes unnecessary suffering, are discussed. In this review we will analyze clinical benefits and risks associated to artificial hydration in terminal patients, making reference to some ethical principles involved.
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Nocturnal sleep patterns may be a contributing factor for the epidemic of obesity. Epidemiologic ana experimental studies have reported that sleep restriction is an independent risk factor for weight gain and obesity. Moreover, sleep restriction is significantly associated with incidence and prevalence of obesity and several non-transmissible chronic diseases. ⋯ All these changes could result in a positive energy balance, leading to weight gain and a higher obesity risk in the long-term. The present article summarizes the epidemiologic and experimental evidence related to sleep deprivation and higher obesity risk. The possible mechanisms are highlighted.