2024-03-28T13:12:48Zhttps://repository.urosario.edu.co/oai/requestoai:repository.urosario.edu.co:10336/182212021-03-01T14:22:56Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2018
https://doi.org/10.48713/10336_18221
http://repository.urosario.edu.co/handle/10336/18221
Grace
Troponina
Síndrome coronario agudo
Sesgo del GRACE-score en Síndrome Coronario Agudo debido al uso de la troponina primera, segunda o delta
oai:repository.urosario.edu.co:10336/104722021-06-03T00:46:10Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2015
INTRODUCTION. Ultrasound is essential in emergency medicine. However, learning curve to obtain technical and operative is unknown. ACEP suggests a minimum of 25 repeats by every ultrasound window. This study evaluated learning curve for ultrasound window of Inferior Vena Cava (IVC). AIM: To establish learning curve in emergencies medical residents needed to obtain a proportion of success above 80% in ultrasound window for IVC, measured by ACEP scale for quality assurance. METHODS: An experimental non-comparative study was designed to evaluate the success proportion of IVC ultrasound window after repetitive attempts. An expositive class of the technique was made prior to the experiment. Videos were assessed based on ACEP scales. For statistical analysis a multilevel logistic model was used for success proportion grouped by data and subject. RESULTS: Data were obtained from 8 residents. Each one made 25 repeats to 3 randomized healthy models. Learning curve adjusted by subject and number of repeats showed a proportion of 0. 81 (range from 0. 57 to 0. 93) after 11 repeats and 0. 9 (0. 75 to 0. 96) after 21 repeats. CONCLUSION: For a success proportion of 80 and 90% in IVC ultrasound window, 11 and 21 repeats are needed, respectively.
https://doi.org/10.48713/10336_10472
http://repository.urosario.edu.co/handle/10336/10472
curva de aprendizaje
ultrasonido
Medicina de Emergencias
Indice de vena cava inferior
Vena cava inferior.
Curva de aprendizaje para ventana ecográfica de la vena cava inferior, en residentes de medicina de emergencias
oai:repository.urosario.edu.co:10336/335692022-03-08T11:16:09Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Background: Triage is a system used in the emergency department to classify patients promptly and prioritize those who require immediate attention to offer them a better outcome and avoid delays in care. Worldwide, the most widely used triage systems are composed of 5 levels of complexity. their processes have been standardized to the point of establishing decision-making algorithms. Although there is descriptive literature on the different Triage scales, there is no data that establishes the operational performance of these systems, therefore, it is not clear which one is the most accurate when it comes to demonstrating better clinical results. Objective: To evaluate the operational performance of the Triage - Emergency Severity Index (ESI) scale used in the Fundación Santa Fe de Bogotá when comparing it against the clinical outcomes of the patients, resources used, and final diagnoses. Methods: A diagnostic test study was carried out where the operational performance of the ESI Triage scale was evaluated by evaluating the medical records of those adult males and female patients who were admitted to the emergency service of the Fundación Santa Fe de Bogotá in the year 2018. Results: A sample of 400 patients was analyzed, of which 0% triage 1, 4.5% triage 2, 35.5% triage 3, 52.5% triage 4, and 7.5% triage 5. The percentage of sub-triage for triage 2 is 0 % and over-triage 16.67%, for triage 3 the under-triage was 4.23% and over-triage 11.97%, for triage 4 the under-triage was 37.8% and the over-triage was 25.36, and for triage 5 the under-triage was 29.03 % and 0% overtriage. The weighted percentage of agreement was 85.67% and the weighted kappa coefficient was 49.28%. Conclusions: The concordance of the Emergency Severity Index with the clinical outcome in the adult population in our institution in 2018 had a moderately acceptable performance, which can be explained by the experience in the use of the triage tool and the high-quality institutional standards.
https://doi.org/10.48713/10336_33569
https://repository.urosario.edu.co/handle/10336/33569
Triage
Emergencias
Emergency Severity Index
Desempeño del Emergency Severity Index como herramienta de Triage en la Fundación Santa Fe de Bogotá en el año 2018
oai:repository.urosario.edu.co:10336/132072021-06-03T00:47:30Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2017
INTRODUCTION: In the shock, the ACEP proposes from the measurement of the diameter inferior vena cava in the acoustic subxiphoid zone or the right anterior midaxillary line zone, calculate the caval index in which permits an estimation of the central venous pressure. Accepting the vena cava as a cylinder, it has been assumed that measurements from any of the two regions are equivalent and equally reliable, but there are no studies to prove this.
OBJECTIVE: To determine the concordance of diameters in inspiration and expiration of the inferior vena cava, to be examined of two differents approach: the subxiphoid zone or the right anterior midaxillary line zone between the seventh and ninth intercostal space, in a population of healthy individuals.
METHODS: There was a study of transversal observation, type: concordance. In this design a concordance expected of minimum 0.7 for significant values was searched; it was realized by intraclass correlation.
RESULTS: According to the values of CI in the subxiphoid zone was 29 and for the right anterior midaxillary line zone it was 22. For the values of the smaller diameters of the vena cava inferior were 10 mm for subxiphoid zone and 12mm for the right anterior midaxillary line zone.
CONCLUSION: For the population of students of the Quinta de Mutis of the Universidad Del Rosario, there aren’t in statical significant concordance between the subxiphoid zone and the right anterior midaxillary line zone for the measurement of the taller and smaller diameters; neither for the caval index.
https://doi.org/10.48713/10336_13207
http://repository.urosario.edu.co//handle/10336/13207
Diámetro de la vena cava inferior
Ultrasonido
Índice de vena cava inferior
Región subxifoidea
Región línea medio axilar derecha
Concordancia del diámetro de la vena cava inferior medida desde dos ventanas ecográficas distintas
oai:repository.urosario.edu.co:10336/337782022-03-08T11:16:10Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Introduction: the pandemic generated by the SARS CoV 2 virus, has generated changes in the way of providing health services, within these, the expansion of areas for the provision of services and additionally, the implementation of protective equipment was adopted staff for health personnel. The main mechanism of transmission of the virus is direct contact with an infected person, however, there are asymptomatic patients who can spread the virus. In Colombia, we have so far more than three million infected people, a fatality of 3.1% has been determined. In different countries of the world, research has been carried out on the different characteristics of the patients who consult for this pathology, however, upon review of the literature in Colombia, there is no such study, just as in the Clinic there is no have found studies that describe the characteristics of the patients, therefore, it is intended to establish the characteristics of these patients. Objective: to describe the clinical and sociodemographic characteristics of the patients diagnosed with COVID-19 at the Colombia University Clinic, who consulted in the period between January 1 and June 30, 2021. The secondary objectives are to describe the characteristics of the patients who required admission to the intensive care unit, mechanical ventilation; which were the destinations of service egress. Methodology: it is an observational, descriptive, retrospective study; It will be carried out at the Colombia University Clinic, between August and September 2021, taking data from the medical records of patients who consulted in the period of time between January 1 and June 30, 2021, in patients older than 18 years, with a positive diagnosis for Covid 19. Results: the average age of presentation was 53 years, the majority of people who consulted the service were women in 55%, although men were more compromised, most cases were mild and could be managed on an outpatient basis, vital signs ( blood pressure, heart rate, respiratory rate) upon admission of the patients were found to be within normal limits despite the fact that on many occasions they were admitted desaturated; the people who had more complications were patients with some comorbidity; In general, patients do not die in the emergency department and patients from all socioeconomic strata were treated, with a predominance of stratum 3.
https://doi.org/10.48713/10336_33778
https://repository.urosario.edu.co/handle/10336/33778
SARS-CoV-2
Covid-19
Sala de emergencias
Prestación de servicios de salud
Características clínicas de pacientes adultos atendidos en el servicio de urgencias por Covid-19 en la Clínica Universitaria Colombia entre el 1 de enero y el 30 de junio de 2021
oai:repository.urosario.edu.co:10336/27262021-06-03T00:46:17Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2011
INTRODUCTION: The diagnosis of pulmonary thromboembolism (PTE) has been a clinical challenge despite advances in diagnostic modalities and therapeutic options, PE remains an under-diagnosed and lethal entity. The measurement of D-dimer blood, with a cutoff of 500 mcg / L, therefore is an excellent screening test for patients in the emergency department. This initial assessment should be complemented with the performance of CT angiography of the chest, a decision that must be taken early to prevent life threatening complications
METHODOLOGY: We performed a retrospective study of diagnostic tests which reviewed the medical records of 109 adult patients from the Fundación Santa Fe de Bogota in whom chest CT angiography was performed with PET protocol with diagnostic probability of pulmonary embolism by low or intermediate criteria Wells and also have dimer D. We calculated the sensitivity and specificity of D-dimer given the pretest clinical probability calculated by Wells criteria, and calculated positive and negative likelihood ratio for each dimer cutoff D.
RESULTS: The study showed a sensitivity of 100% for D-dimer values ¿¿less than 1100 mcg / L, in patients with low probability and sensitivity of 100% for values ¿¿less than 700 mcg / L in patients with intermediate probability.
DISCUSSION: Patients with low pretest probability for Wells criteria D-dimer values ¿¿less than 1100 mcg / L and intermediate probability values ¿¿less than 700 mcg / L do not require additional studies, which decreases significantly making CT angiography care and reduce costs.
https://doi.org/10.48713/10336_2726
TEME 0005 2012
http://repository.urosario.edu.co/handle/10336/2726
Dimero D
Embolismo pulmonar
Criterios wells
Angiotac
Utilidad del dímero D en el diagnóstico de tromboembolismo pulmonar en la Fundación Santa Fé de Bogotá
oai:repository.urosario.edu.co:10336/106532021-06-03T00:47:45Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2015
Introduction: Emergency Severity Index 4.0 (ESI) is a triage tool that offers a good safety scope for patients in Emergency departments. Our aim is to evaluate the application of the ESI score in Fundación Santa Fe de Bogotá emergency department, in terms of time of attention and, resource consumption compare these results with actual standard parameters.
Methodology: Observational analytical cross-sectional study 385 randomized patients were included according level of triage. Data on demographics, number of resources needed and destination were collected and analyzed.
Results: An average of age was 44.9 IC95%42.9 – 46.9, 54.5% were women. We found an average waiting time of 1.39 min for level 1, 22.9 min for level 2, 41.9 min for level 3, and 56.9 min for level 4 y 52.1 min for level 5. Visit time was 5.9 hours and 78.9% of consults needed resources. Comparing waiting times with standards, time of attention since assignation level was measured and compared with standards and found for the level 1,2 and 3 significant higher levels (p<0,05), for level 4 is similar (p0,51) y for level 5 is significantly lower (p=0,00)
Discussion: Emergency Severity Index 4.0 (ESI), has a similar behavior in terms of waiting times and resources consumption compared with literature reports and according to care standards worldwide.
https://doi.org/10.48713/10336_10653
http://repository.urosario.edu.co/handle/10336/10653
Triage
Escalas
Severidad
Tiempo
Recursos
Emergencias
Comparación de parámetros de atención en una escala de triage de 5 niveles con los parámetros estándar
oai:repository.urosario.edu.co:10336/126852021-06-03T00:46:46Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2016
Introduction: Boarding is the phenomenon that occurs when there are in the emergency department inpatient without a bed which can be move them, in world literature it has been identified as a factor affecting the quality and safety of care in emergency. This paper aims to describe the prevalence of this phenomenon in the emergency department in the Fundación Santa fe de Bogotá. Methodology: Observational trial of prevalence. We included patients attended by specialists in Emergency Medicine in the Fundación Santa Fe de Bogota in October of 2015 were taken data by shift (morning, afternoon and evening), and data of the emergency department for its descriptionResults: Median occupancy by boarding in the emergency room was 68%, with an interquartile range 54-75%; in minutes the median was 1, 054 minutes, with an interquartile range 621-1490. There are numerical differences of time in minutes according of the shift (morning: 519 992. 77 afternoon: DE 1000. 27 1584. 13 night: 2126. 43 1304. 13 DE). Discussion: Boarding time reported in the Fundación Santa Fe de Bogota is comparatively higher than described in world literature, this data should be explored in analytical studies as well as subsequent factors or variables that are associated with the presence of this phenomenon.
https://doi.org/10.48713/10336_12685
http://repository.urosario.edu.co/handle/10336/12685
Congestión
Departamento de Urgencias
Calidad de la atención
Administración de servicios de salud
Descripción de la prevalencia del boarding en la fundación Santa Fe de Bogotá
oai:repository.urosario.edu.co:10336/63782021-06-03T00:45:39Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2014
Introduction: Patients with acute thermal injuries have physiological disorders that make difficult characterizing their acid-base status and identifying factors of poor prognosis. Studies with non-conclusive results have being done on base deficit (BD) and a serum lactate. Due to the complexity of the pathophysiological characteristics that define burn patients; the physic-chemical analysis of the acid-base status may hypothetically provide a higher accuracy in detecting metabolic and perfusion disturbances as well as in predicting bad outcomes than the other methods.
Methodology: We performed the acid-base analysis of 15 patients older than 15 years-old, with a burned body surface area greater than 20% that were admitted to a burn intensive care unit within 48 hours after the injury. The analysis was performed by using three methods: 1) Conventional method based on Henderson-Hasselbalch’s theory, 2) Anion-Gap (AG),and albumin-corrected AG, and 3) Physic-chemical approach of Stewart’s acid-base state theory.
Results: After using the Henderson-Haselbach’s method: 8 patients had metabolic acidosis, 4 patients had a low BD, 5 patients had medium BD, and 5 patients had severe BD elevations. When AG analysis was performed, only 5 patients showed an abnormal AG. In contrast, implementing the albumin-corrected AG it increased the number of patients with abnormal AG to 13 patients. Strong-ion difference was abnormally elevated in all the patients.
Conclusions:A higher agreement between abnormal acid-base statuses was observed when using the albumin-corrected AG method and Physic-chemical approach of Stewart’s acid-base state theory.
https://doi.org/10.48713/10336_6378
http://repository.urosario.edu.co/handle/10336/6378
por Quemaduras
equilibrio ácido-base
Brecha Aniónica
Descripción del estado acido base en pacientes con quemaduras térmicas agudas: serie de casos
oai:repository.urosario.edu.co:10336/325142021-09-24T03:02:40Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Problem: Characteristics of patients with urolithiasis symptoms who underwent a urinary tract tomography in the emergency department of an IV level institution of complexity, to describe hospitalized patients, treated with antibiotics or surgically treated, and additionally, patients without urolithiasis on tomography or with radiological findings consistent with a different diagnosis than urolithiasis. Objective. Renoureteral colic is a frequent diagnosis in Emergency Rooms (ER), however, in Colombia little research has characterized patients. In this investigation, patients with a Non-contrast tomography result were characterized by a presumed diagnosis of renoureteral colic in the emergency department. Methodology. A descriptive study was carried out with data obtained from the medical records of patients treated between July-November / 2018 in the ER of the Santa Fe de Bogotá Foundation. Demographic and clinical characteristics were described and compared according to need for hospitalization, presence of stones in Non-contrast tomography, and diagnoses other than urolithiasis. Results. 396 patients were identified, mainly men or young adults with urinary symptoms, nausea / vomit and ≈50% with previous urolithiasis. Pain intensity (VAS) was ≥8 in> 70%, stones were observed in 77.3% of the patients (median diameter 4mm), 10-20% were hospitalized or required surgery, and <5% re-consulted the ER. Patients hospitalized or with the presence of stones in the Non-contrast tomography were characterized by having urolithiasis (90,4%) or previous surgeries (20,5%), additionally ,higher VAS, higher systolic blood pressure and higher serum creatinine. Furthermore, proximal (39%) or medium (18,7%) ureterolithiasis and surgical (82,1%) or antibiotic (19,4%) treatments were more frequent in hospitalized patients. Approximately 6% of the patients presented alternative diagnoses to urolithiasis grouped mainly in the genitourinary and gastrointestinal systems. Conclusion. Hospitalized patients with renoureteral colic, studied with UROTAC, were characterized as being middle-aged adult men, with a history of urolithiasis, more than half with the presence of one to two stones smaller than 10 mm, located mainly in the distal ureter. or proximal, hospitalized for very high intensity pain, serum creatinine concentrations> 1.1 mg / dL or for surgical or antibiotic management, and the main differential diagnoses are grouped in the genitourinary and gastrointestinal systems. Disussion. Renoureteral colic is the expression of urinary lithiasis in the ER, the clinical or surgical history, as well as the physiological and serological changes with the imaging findings are essential to guide the treatment process and the need for hospitalization.
https://doi.org/10.48713/10336_32514
https://repository.urosario.edu.co/handle/10336/32514
Urolitiasis
UROTAC
Cálculo urinario
Cólico renal agudo
Diagnostico por imágenes en el tratamiento de urolitiasis o litiasis renal
Diagnostico de cálculos urinarios mediante tomografía
Sala de emergencias
Caracterización de pacientes con clínica de Urolitiasis posterior a tomografía de vías de urinarias en un servicio de emergencias
oai:repository.urosario.edu.co:10336/102262021-06-03T00:45:33Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2015
Introduction: Early management of patients with severe sepsis and septic shock
emergency room under the "early goal-directed therapy" proposed by Rivers in his guide
"Surviving Sepsis Campain" seems to be related with a decrease in mortality in the first 28
days of care. The aim of this study was to measure the adherence to these recommendations
in an emergency department of fourth level hospital.
Methodology: Using adescriptive observational cross-sectional study, medical records of a
group of patients with severe sepsis and septic shock who were admitted in 2013 to the
emergency room of a hospital of fourth level of Bogotá, Colombia, were reviewed. The
proportion of patients in wich the international recommendations were fully followed, were
calculated. Correlation between adherence and proportions of mortality were estimated.
Results: From 3000 records, 130 clinical records were included and evaluated. 15.4% of
patients received attention according to international guidelines for early resuscitation.
Mortality from severe sepsis and septic shock was 10.7%. Mortality in patients who were
treated according to guidelines was 15% compared to 10% who were not (p> 0.05)
Conclusions: Adherence to international recommendations proposed by Rivers are low.
Educational campaigns and training for medical and paramedical staff of the emergency
room should be conducted in order to improve survival in this group of patients.
https://doi.org/10.48713/10336_10226
http://repository.urosario.edu.co/handle/10336/10226
sepsis
sepsis severa
choque séptico
terapia temprana dirigida por metas.
Adherencia a las guías de reanimación temprana dirigida por metas, en un hospital de Bogotá, Colombia
oai:repository.urosario.edu.co:10336/419682024-01-16T16:05:46Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
The COVID-19 pandemic has represented a serious public health problem. Since the 1918 pandemic, humanity has not faced an epidemic event with repercussions on all sectors of the population, with the health sector being one of the most affected, especially in emergency services. The objective of this study was to analyze the behavior of emergency care in a level IV hospital in Bogotá between March 2020 and March 2021. Materials and methods: cross-sectional and descriptive observational study that was carried out with information from the emergency service. adult emergencies in a level IV hospital in a period of one year during the COVID-19 pandemic.
Results: During the time analyzed the main diagnosis corresponded to respiratory infections; Of the cases attended to in the evaluated period, the majority corresponded to cases belonging to EPS. The smallest number of cases occurred in April 2020. Low ratings of warmth of care were presented compared to the hospital's goal. The day of the week with the highest unmet demand corresponded to Monday and the day of the day with the highest unmet demand corresponded to the afternoon. Conclusions: the dynamics of case care in the emergency department was related to the measures implemented by health authorities. It is important to monitor the warmth of care, clarification of doubts and patient satisfaction.
https://repository.urosario.edu.co/handle/10336/41968
Atención en urgencias
COVID-19
Pandemia
Aislamiento
Comportamiento de la atención de urgencias en un hospital universitario de IV nivel de bogotá durante la pandemia covid-19 entre marzo de 2020 y marzo de 2021
oai:repository.urosario.edu.co:10336/325132021-09-24T03:02:38Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Introduction: Subarachnoid hemorrhage (SAH) consists of bleeding in the brain cavity below the arachnoid. Patients who present with SAH are admitted to the various emergency services presenting headaches in up to 25% of cases, with SAH being the cause of this headache in 1-3%. Establishing the diagnosis is important since the outcomes can be fatal. For this reason, the use of simple skull tomography (CT) has been on the rise in recent decades as an effective and rapid diagnostic method for the study of multiple acute neurological pathologies. Objective: To establish the interobserver agreement between clinical physicians and the definitive report by the radiologist on the detection of SAH within an image bank of a specific 4th level care institution in Bogota city. Method: The evaluation of the bank of computed tomography of the simple skull taken in the emergency department for non-traumatic causes was carried out in a period between January and June 2018; of these 619 images, 1.62% corresponded to HSA; 195 images were taken comparing the interpretation between clinical physicians (emergency physicians and residents of Emergency Medicine), with non-probabilistic sampling and with random selection of the evaluated simple skull tomographies. Results: The percentage according to the interpretation of the simple skull tomography for diagnosis of SAH between the clinician and the radiologist was 81.5%, with a percentage expected by chance of 55% and a Cohen's Kappa of 0.58 (CI 95% 0.71-0.46), p <0.000). In the exploratory evaluation by subgroups between emergenciologists and radiologists versus residents and radiologists, a similar behavior is observed with a Kappa of 0.59 and 0.57, respectively. Discussion: The result of this study contributes to the knowledge and tomographic interpretation of clinicians versus radiologists, one of them being subarachnoid hemorrhage, showing moderate concordance as a point of improvement, focused on offering the patient the best and most timely therapeutic conduct possible.
https://doi.org/10.48713/10336_32513
https://repository.urosario.edu.co/handle/10336/32513
Hemorragia subaracnoidea
Concordancia interobservador
Tomografía
Diagnóstico
Sensibilidad
Especificidad
Kappa
Comparativo entre la interpretación tomográfica de radiólogos y médicos clínicos
Concordancia en la detección de hemorragia subaracnoidea no traumática por medio de tomografías computarizadas de cráneo simple entre clínicos y el reporte radiológico definitivo en un hospital de 4º nivel de atención en Bogotá D.C, Colombia: 2020
oai:repository.urosario.edu.co:10336/23322021-06-03T00:46:15Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2011
Up to this moment in Colombia, it is unknown the quality of emergency medicine resident interpretation of arterial blood gases. Arterial blood gases is one of the most used laboratory at the emergency department. It is essential to evaluate high prevalence diseases like respiratory problems or sepsis. A wrong interpretacion of this exam could lead to errors in the management of critical patients. Because of that, an evaluation of the trainning of emergency medicine residentes to interpretate arterial blood gases is requierd. A prospective, cross-sectional study was undertaken, seeking a way to evaluate the concordance between the arterial blood gases interpration of the emergency medicine resident of the Rosario University with the one made by an intensive care specialist, and if their emergency medicine residency trainning influenced this results. A total of 60 arterial blood gases taken at patients who were hospitalized at the intensive care unit of Fundación Santa Fe de Bogotá were analysed looking for the concordance between residents and intensive care speacialist interpratation of the exam. The results show a moderate concordance (r 0.445 y 0.442,) in the second and third year residents (p:0,000y0,01)..(MESH: Blood Gas Análisis, Emergency Medical Services, Education, Medical, Graduate)
https://doi.org/10.48713/10336_2332
TEME 0019 2011
http://repository.urosario.edu.co/handle/10336/2332
Análisis de gases arteriales
Servicio de emergencias
Concordancia en la interpretación de los gases arteriales entre residentes de medicina de emergencias y el intensivista
oai:repository.urosario.edu.co:10336/41622021-06-03T00:47:19Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2013
Introduction: Colombia doesn’t have studies to show the effect of overcrowding in emergency departments about the opportunities in treatment. This study aimed to evaluate the effect of overcrowding in an emergency department in Bogotá over the time of administration of the first dose of antibiotic and/or analgesic, also proposed to determine the percentage of patients who left the service without medical evaluation.
Methods: It was raised, a time study at the event, using survival analysis methodology to determine if there were significant delay in the administration of the first dose of treatment according the occupancy of the emergency room, also evaluated the proportion of patients who leave the emergency service without being seen.
Results: 127 patients needed application of an antibiotic and 982 of an analgesic. The median delay in the first dose was 364 minutes and 104 minutes, respectively. The analysis in the survival’s curves showed that there were no statistical differences in the opportunity to administration of the first dose of antibiotic (p = 0.3908) or analgesic (p = 0.3924) between three levels of NEDOCS congestion scale simultaneously. The proportion of people who left the service without being seen was 2.35%, equivalent to 92 persons.
Discussion: The median time of chance of treatment were higher that quality standards and reports in previous studies. No differences were found in the delay in the administration of antibiotic or analgesic but we hope that this work will be useful for decision making, seeking benefit patients attending the emergency department with timely initiation of treatment.
https://doi.org/10.48713/10336_4162
http://repository.urosario.edu.co/handle/10336/4162
sobrecupo
urgencias
infecciones
dolor
Congestión en el servicio de urgencias ¿retrasa la primera dosis de antibiótico o analgésico?
oai:repository.urosario.edu.co:10336/347442022-12-02T01:01:01Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
The care in the Emergency Services (ES) is a reflection of the health systems. The objective of this research was to characterize the care provided in the SE (a_SE) of Colombia during a five-year period. Methodology. A retrospective descriptive design was carried out using data from the morbidity cube of the SISPRO database filtered by emergency care during the 2015-2019 period. The frequency of care was described during the five-year period and in each year by demographic, social and administrative variables. Results. 118 million a_SE were provided, distributed in 16.5 million patients (Intensity: 7.08 visits/five years). The majority of a_SE was provided during 2019 (25.8%), in the Andean region (48%), to patients 45 and over (44.5%), men (57.6%), affiliated with the subsidized regime (53.1%), in the urban area (76.7%). Unspecified conditions (ICD-10) and injuries due to external causes grouped the highest frequency of a_SE, but the highest intensity of care was observed among cardiovascular and mental illnesses. Discussion. Trends and patterns of a_SE were identified during a five-year period, useful for organizing and establishing strategic plans to improve the provision of health services in emergency services
https://doi.org/10.48713/10336_34744
https://repository.urosario.edu.co/handle/10336/34744
Servicios de emergencias
Servicios de salud para la comunidad
Análisis del sistema de salud en Colombia
Estadísticas de uso de los servicios de urgencias 2015-2019
Indicadores de morbilidad y mortalidad
Calidad de la salud pública
Tendencia y características sociodemográficas de las atenciones prestadas en los servicios de emergencia de Colombia durante el periodo 2015-2019
oai:repository.urosario.edu.co:10336/182982021-03-01T14:22:55Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2018
Aim: Colombia has an immature trauma system, that could result in the presence of factors related to death with severe injury (Injury Severity Score-ISS>15) or with highest ISS score (75 points); we determinate the probability of death with ISS-75 and factors related. Methods: A retrospective descriptive design it was carried out, using data obtained from necropsy records of violent deaths (veracious method to calculate ISS), make in National Institute of Legal Medicine and Forensic Sciences (INMLCF) during year 2013 (Bogota). Frequency of ISS-75 or minus was determinate and differences among socio-demographics and clinical factor were evaluated (X2, p<0.05). A Bayesian Model (BM) was applied to calculate the probability of ISS-75 among all factors evaluated (Orange – Data Mining Fruitful & Fun). Results: 443/557 necropsy records were selected after apply eligibility criteria; the median age 33.8 years, 86.7% were male; manner of death-homicide and penetrating type were present in 62.8% and 61.6%, respectively; injury occurred at night in 55.5% (CI95%,49.6-61.3%) and death at night in 66.9% (CI95%,61.2-72.2%) of victims (incomplete data). Firearm projectile (42.4%), blunt (35.9%) and cutting-stabbing (18.5%), were the main causes of deaths. According to BM, the probability of death with an ISS-75 was 90%; the factors positively related to ISS-75 were: cause of death (firearm projectile, cutting-stabbing), manner of death (homicide), penetrating injury, 28.5-38.5 years old and death occurred in <0.5 hours after of injury. Discussion: Using necropsy records to calculate ISS, we identify that most of victims had the highest ISS score, probably for the nature of injury or because with a necropsy could be identify the really severity of injury, including hidden or missed injuries. Nevertheless, proportion of victims with ISS-75 is very high, we identify some factors related to this threshold and that may imply an adjustment in the control measures of social determinants of trauma.
https://doi.org/10.48713/10336_18298
http://repository.urosario.edu.co/handle/10336/18298
ISS
Severidad del trauma calculada con registros de necropsia en diferentes tipos de lesión, Bogotá, 2013
oai:repository.urosario.edu.co:10336/310782021-03-12T03:03:04Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Background: Tomography is the most accurate method for diagnosis of acute appendicitis, however, ther are clinical prediction rules that combine symptoms, physical examination and paraclinics to optimize its use. Our objective was to compare the frequency of tomography before and after the implementation of the appendicitis guide in the emergency room of a fourth level hospital in the city of Bogotá. Methods: Observational, analytical, historical cohort study, comparing 2 independent groups. Includes adults with abdominal pain and suspected acute appendicitis. We used simple random probability sampling, we compared the percentage of requested CT scans and the time elapsed between admission and the definition of the destination, and we calculated the proportion of readmissions. Results: There were no significant differences with respect to gender. Right iliac fossa pain was the most frequent finding, leukocytosis was only observed in 38.5% of the patients. Tomography was performed in two thirds of all patients, with no significant difference before or after the implementation of the guideline. The median length of stay in the emergency room was 4 hours shorter in the after group. The rate of readmissions did not exceed 1%. Conclusion: The implementation of the acute appendicitis guide did not significantly change the use of tomography in the study of these patients, however, it did significantly reduce the length of stay in the emergency room.
https://doi.org/10.48713/10336_31078
https://repository.urosario.edu.co/handle/10336/31078
Uso de guías de diagnostico para la apendicitis
Reglas de decisión clínica en el diagnostico primario de Apendicitis
Protocolos de atención en servicios médicos de urgencia
Tomografía Computarizada por Rayos X en el diagnostico de apendicitis aguda
¿La implementación de la guía institucional disminuyó el uso de tomografía para el diagnóstico de apendicitis aguda?
oai:repository.urosario.edu.co:10336/130992021-06-03T00:47:27Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2017
Abstract: Emergency rooms characterizes for rapid and efficient patient attention assuring high quality of care and satisfaction for the patients. In Santa Fe foundation of Bogotá various different models of patient attention have been applied with an objective of improving quality of care. The present Paper evaluates the impact of new model of attention which has an Emergency medicine specialist as the in charge of the emergency room.
Method: This is a Cross sectional study comparing two models of patient attention with general practitioner as in charge, with one with Emergency specialist as in charge. The information was obtained from digital clinical history registers. The impact was evaluated by measuring the variation in the Wait time, time to definite management plan, y number readmissions.
Result: A reduction of 22% of consultation was observed in 2013 in comparison to 2012, the Wait Time was reduced by 11%, and time to definite management plan was reduced by 13%, with 25% fewer doctors and 5% more consultations for each professional. The Emergency specialist model of attention had specific diagnosis at the time of hospital discharge with a reduction of 9% in the number of readmission.
Conclusion: The wait time for the consult and time for the definite management plan for the patients classified as Yellow Triage increased by 13%, and 11%, respectively, with a 25% lower staff and an increase in consultations performed by a professional of 5% and fewer patients presented in the emergency room for readmission (28%).
https://doi.org/10.48713/10336_13099
http://repository.urosario.edu.co/handle/10336/13099
Sala de emergencias
Modelos de atención
Calidad
Eficiencia
Urgencias
Evaluación del impacto de un nuevo modelo de atención de urgencias en un hospital de cuarto nivel
oai:repository.urosario.edu.co:10336/42772021-06-03T00:45:59Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2013
Introduction: Upper gastrointestinal bleeding (HVDA) is the leading cause of acute complications among patients with cirrhosis. Characterizing the acid-base status of these patients would be of help in reflecting the severity of the bleeding and in identifying those patients under high risk for complications. Objective: To describe the acid-base status in patients who were admitted to the emergency department with decompensated cirrhosis due to upper gastrointestinal bleeding, and who were subsequently managed in the intensive care unit (ICU) or died. Methods: Acid-base status of ten selected patients (n=10) was analyzed by using three different biochemical approaches. Results: The salient acid-base profiles found in most of the patients can be summarized: metabolic acidosis due to unmeasured ions, lactic acidosis, and alkalosis due to hypoalbuminemia and elevated anion gap. Conclusions: The biochemical approach based on Henderson-Hasselbalch theory was not sufficient enough in identifying those patients under high risk for complications. As an integrated assessment, the anion-gap calculation, base-deficit estimation, and physicochemical analysis should be all performed concomitantly to improve the understanding of the acid-base status among these patients.
http://repository.urosario.edu.co/handle/10336/4277
cirrosis hepática
Hemorragia Digestiva
Equilibrio acido base
Ácido láctico
anion gap
Perfil acido-base de pacientes con cirrosis descompensada por hemorragia digestiva alta en el departamento de emergencias: serie de casos
oai:repository.urosario.edu.co:10336/50192021-06-03T00:45:40Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2014
Introduction: Syncope is a common complaint in the emergency
department, defining the proper studies and destination of these patients
is still a matter of debate. There have been various tools designed to
help establish which of these patients are at risk of having an adverse
outcome, and therefore require admission. In this study ther are
compared the operative characteristics of 4 scales for the
decisión to hospitalize patients with syncope that they consult to
a emergency department of an III/IV level hospital
Methods: Analytic cross study, in which 4 risk scales were applied to
patients consulting with a chief complaint of syncope in the emergency
department, and were admitted during a 6 month period in a single
institution. The results were evaluated with Epidat 3.1 to calculate
sensitivity and specificity, Youden index.
Results: 91 patients were included in total. The sensibility of the scales
San Francisco, OESIL, EGSYS and the institutional one for the
requirement of hospitalization was 79 %, 87 %. 63 % and 95 %
respectively and the specificity was 52 %, 40 %, 64 % and 14 %. THE
risk of mortality was not detected adequately by the scale of San
Francisco.
Conclusions: None of the scales applied to the hospitalized patients
who consulted for sìncope to urgencies overcame the clinical judgment
to define the hospitalization. Nevertheless, the scale OESIL and the
institutional one can help to corroborate the clinical decision to
hospitalize in this population.
https://doi.org/10.48713/10336_5019
http://repository.urosario.edu.co/handle/10336/5019
Sìncope
Escalas de riesgo
Decisiones en Urgencias
Comparación de cuatro escalas de riesgo en pacientes que consultaron por síncope al servicio de urgencias
oai:repository.urosario.edu.co:10336/144332021-06-03T00:48:10Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2018
The term used since the 70's Burnout is defined as an inadequate response to chronic stress characterized by 3 dimensions: fatigue or emotional exhaustion, depersonalization or dehumanization and lack or reduction of personal accomplishment at work (Maslach and Jackson); this in response to prolonged emotional and interpersonal stressors at work exposure, a situation that can lead to decreased productivity and job dissatisfaction. This syndrome occurs most often in people in direct contact with people (teachers or staff area of health, among others). (1). It has been determined that health personnel are at risk of making mistakes during its service processes, given the high levels of stress to which they are subjected, the long working hours and the ability to work in more than one site; for this reason the autors made the next question: What is the incidence of Burnout in the Institute of Emergency Medical Services and Trauma in the Hospital Fundación Santa Fe de Bogotá, and possible triggers?
To that end, surveys were carried out to measure Burnout and job satisfaction. A large percentage of the staff were at risk for Burnout, the data that will serve to prevent the presentation of this pathology and take measures to strengthen the mental health of the worker of health area.
https://doi.org/10.48713/10336_14433
http://repository.urosario.edu.co/handle/10336/14433
Burnout
Medicina de emergencias
Incidencia de Burnout en el departamento de emergencias de un hospital de alta complejidad (año 2016)
oai:repository.urosario.edu.co:10336/18152021-06-03T00:46:46Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2010
https://doi.org/10.48713/10336_1815
TEME 0025 2010
http://repository.urosario.edu.co/handle/10336/1815
Intoxicacion por metanol
Factores de asociación
Predictores diagnósticos
Diagnóstico Temprano
Factores asociados al diagnóstico de intoxicación por metanol comparado con intoxicación por etanol
oai:repository.urosario.edu.co:10336/122382021-06-03T00:47:54Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2016
The acute aortic syndrome can present as a characteristic clinical picture of a vascular emergency, or on the contrary as a completely atypical form, where the diagnosis challenges the emergency physician, leading to fatal mistakes by ignoring the diagnosis of this entity. In order to show the usefulness of ultrasound performed at the patient bedside in the diagnosis of aortic dissection, we described 9 cases of patients admitted to the emergency department and who were diagnosed with acute aortic syndrome, thanks to the initial ultrasonographic assessment made by residents and specialists in emergency medicine in one hospital in Bogotá, Colombia. This case report shows that ultrasound at the patient bedside, is a noninvasive diagnostic method, accessible and useful for early detection of this disease in the emergency services.
https://doi.org/10.48713/10336_12238
http://repository.urosario.edu.co/handle/10336/12238
Síndrome Aórtico Agudo
Disección de Aorta
Diagnóstico
Imágenes de Ecografía
Dolor torácico
Ultrasonido a la cabecera del paciente, una herramienta diagnóstica de disección aórtica en el departamento de emergencias
oai:repository.urosario.edu.co:10336/325522021-09-28T03:03:09Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Introduction: The approach of patients between Triage levels depends on the severity of their clinical status. The shock index identifies patients with intrinsic severity and risk of deterioration. Its importance in describing the characteristics of patients who will require hospital admission is unknown. Methods: Descriptive retrospective longitudinal observational trial of triage 3 febrile patients admitted to the emergency room between January 01 - December 31, 2017. The shock index was calculated and they were grouped according to admission diagnosis and adopted destiny. Data are shown by frequency distribution, averages and standard deviations. Results: 246 triages met the inclusion criteria. The average age was 54.2 years. The gender with the highest prevalence was male (52.03%). 141 patients were admitted to the general hospitalization room and 10 to the ICU. The shock index value 0.9 was the most frequent for admission to hospital wards; while 1.0 was for UCI. The exploratory analysis was significant for the value of the shock index between admission to hospital wards compared to admission to the ICU (p = 0.0037). Discussion: shock index was less than 1.0 in those admitted to hospital wards; while ICU admissions presented higher values. An analytical design is required to find significant associations between the shock index and destiny after emergency medical care.
https://doi.org/10.48713/10336_32552
https://repository.urosario.edu.co/handle/10336/32552
Triage
Índice de choque
Hospitalización
UCI
Análisis del índice de choque de pacientes que requieren atención UCI u hospitalización
Evaluación de la clasificación de triage en pacientes febriles
Índice de choque en la caracterización de la población febril triage 3 que ingresa a urgencias. fundación santa fe de Bogotá, año 2017.
oai:repository.urosario.edu.co:10336/189982021-03-01T14:22:55Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2019
Introduction: patients with electrical injuries present a high risk of amputations. Amputation is usually a complication derived from thermal injury, especially in cases in which extensive lesions occur. Methods: unicentric, observational analytical retrospective cohort study, which aimed to determine the cumulative incidence of amputation in patients with electrical injuries treated in the Burns Unit of the USS Simón Bolívar Hospital during the years 2007 to 2013. We described the frequency of amputation and the clinical and paraclinical variables of patients. The variables associated with the development of limb amputation during the observation time were determined. Results: 456 patients were found, mostly from the years 2011 and 2012. In total in the 7 years, the requirement for amputation occurred in 6.1% of patients, however the proportion of the event was less than expected. The greatest number of people injured by electricity was found in the economically productive young population (71.5% of the patients are under 40 years of age). 57 patients (12.5%) had an extension equal to or greater than 20% ASCQ. The remaining number of patients, 91 (20.6%), presented values of CPKmax greater than 10,000 IU / L. The maximum creatine kinase as well as the compartment syndrome showed a statistically significant difference presenting an OR 1.00005 (95% CI 1.00002-1.0007) and OR 36.42 (95% CI 2.634-503.74) respectively. Conclusions: as in other studies, our study confirms that compartmental syndrome and total creatine kinase are associated with the requirement for amputation, presenting a higher frequency in male patients of economically productive age.
https://doi.org/10.48713/10336_18998
http://repository.urosario.edu.co/handle/10336/18998
Rabdomiólisis
Quemaduras eléctricas
Lesiones eléctricas
Amputación
Creatina-fosfocinasa
Creatina-cinasa
CPK
Incidencia y factores de riesgo de amputación de extremidades en pacientes mayores de 15 años con lesiones eléctricas
oai:repository.urosario.edu.co:10336/312292022-05-10T12:57:18Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Introduction. The opportunity for attention and transfer in patients with stroke is related to the time to treatment for thrombolysis (TTT). We determined if admission to the Emergency Room (ER), by ambulance [Amb] versus own means (Om) affected TTT. Methods. In a retrospective (historical) analytical observational study of cohorts, using clinical data of stroke patients admitted into the ER service of Fundación Santa Fe de Bogotá, during the period between 2017-2019, the median TTT (p25-p75) of patients admitted by Amb Vs Om (U Mann-Whitney) were compared. Additionally, the effect of the median TWT of variables associated with the means od admission was analyzed (p-value: <0.05). Results. 174 records were analyzed, 106 patients admitted by Om (60.9%). The median age was 74 years, predominantly men, and respectively, the NIHSS and the backround of arterial hypertension (HT) were lower (p:0.002) and less frequent in Om patients (p:04045). 80% of patients had a VTT ≤4.5 horas, the median TTT in Om patients (1.98 [1.06-3.81]) was lower than in Amb patients (2.45 [1.60-4.11]). Additionally, Om patients without HT (p: 0.010) or with NIHSS >19 (p: 0.009) presented lower TTT than Amb patients. Conclusion. Establishing that Om patients are admitted with a lower median TTT tan Amb patients, suggests exploring the public perception of prehospital care service (PCS), designing an investigation to identify factors associated with this phenomenon and potentially adjusting the PCS model for attention of cerebrovascular emergencies.
https://doi.org/10.48713/10336_31229
https://repository.urosario.edu.co/handle/10336/31229
Análisis del modelo de atención a Accidente Cerebrovascular (ACV)
Correlación Tiempo de tratamiento en ACV ventana terapéutica para trombólisis (VTT)
incidencia de la Atención Prehospitalaria (APH) en las VTT medianas (p25-p75)
Protocolos de atención a emergencias cerebrovasculares
Comparación en periodo de ventana terapéutica según medio de traslado en pacientes con ataque cerebrovascular en una institución de Bogotá entre 2017 – 2019.
oai:repository.urosario.edu.co:10336/41862021-06-03T00:47:19Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2012
https://doi.org/10.48713/10336_4186
http://repository.urosario.edu.co/handle/10336/4186
cálculo ureteral
obstrucción urinaria
urotac
estudios de casos y controles
necesidad de hospitalización.
¿Qué factores inciden en la hospitalización de pacientes con cálculos ureterales menores a 10 mm en Fundación Santa Fe?
oai:repository.urosario.edu.co:10336/22862021-06-03T00:46:15Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2011
Compare the number of images taken from a group of patients with acute appendicitis who received analgesia before definitive diagnosis versus patients without this intervention, which came to the adult emergency department of the University Hospital Fundación Santa Fe de Bogotá, between January and December 2006. Materials and Methods. Retrospective cohort study in which patients take a census year and described variables are measured, the results were analyzed by SPSS 19 version. Was taken as a significance 0.05. Results. 40% received early analgesia. No statistically significant difference was found between the number of scans taken in patients with and without analgesia (p = 0.016), 49.2% vs 50.8% respectively, while the number of abdominal CT was higher in the group not received analgesia (56.8% vs 43.2%) but without statistical significance, p = 0.507. Conclusions. The use of early analgesia in the emergency room with abdominal pain in patients with acute appendicitis is not associated with an increase in decision-ultrasound as a diagnostic method, the association was not demonstrable with axial tomography. The group of patients who received analgesia had a lower length of stay in emergency room without defined surgical treatment.
https://doi.org/10.48713/10336_2286
TEME 0084 2010
http://repository.urosario.edu.co/handle/10336/2286
apendicitis
analgesia
dolor abdominal
Aumenta la toma de imágenes diagnósticas el uso de analgesia en pacientes con apendicitis aguda?
oai:repository.urosario.edu.co:10336/398322023-06-16T03:02:23Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
The 30% of sepsis cases are of urinary origin, 25-35% progress to shock faster than other infectious foci, 4.7 (±) 2.4 vs 7.2 (±) 4.5 hours, their mortality at 30 days from the emergency care is 10%, but in severe cases 25-50%.
Objectives: To identify the demographic and clinical characteristics of cases with urosepsis at the Hospital Clínica San Rafael, during the study period.
Materials - Methods: A retrospective cross-sectional study was carried out for 12 months, random probabilistic sampling was applied to 70 patients, performing univariate analysis, qualitative variables were described in absolute and relative frequencies. The frequency of the isolated microorganisms was presented in a bar chart. Numerical variables were described using median and interquartile range (IQR). Results were presented stratified by mortality. Positive results were obtained in blood and urine cultures of 34.2% and 84.2% respectively. 21.4% progressed to shock. The median SOFA was 3.0. Fatal outcomes were found more frequently with: Male sex (14.2% vs 7.1%), altered consciousness (11.4 vs 7.1%), septic shock (12.8% vs 8.5%) and age over 79.5 years with a mortality of 21.4 % of the population studied.
Conclusion: Urosepsis in our population was more prevalent in women, older adults and diabetics, 21.4% progressed to shock and in the same proportion to death, mortality was more frequently evidenced in men, older than 79 years and patients with alteration of awareness.
https://doi.org/10.48713/10336_39832
https://repository.urosario.edu.co/handle/10336/39832
Sepsis
Tracto urinario
Emergencias
Descripción
Población
Emergencias en hospital de alta complejidad
Urosepsis
Describir características clínicas en pacientes con urosepsis en emergencias en hospital de alta complejidad, Bogotá (2018-2019)
oai:repository.urosario.edu.co:10336/125862021-06-03T00:45:23Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2015
To improve and adapt different types of trauma care systems,
based on international guidelines and to avoid significant
increase in mortality and disability, we focus on a subgroup
of patients who are abdominal trauma patients that present
with hemodynamic stability. In recent years abdominal
ultrasonography (FAST has managed to reduce time in
decision-making, and reduce complication rate in these
patients. In our observational study of 65 patients with high
mechanism blunt thoracoabdominal trauma and negative
EFAST, only 3% required further
https://doi.org/10.48713/10336_12586
http://repository.urosario.edu.co/handle/10336/12586
FAST-E
Trauma abdominal cerrado estable
FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia
oai:repository.urosario.edu.co:10336/101542021-06-03T00:45:48Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2015
Hospitals are an essential pillar in the care of victims of case of emergencies or disaster. Health institutions are considered essential to the population, so they must be prepared to operate not only under normal conditions but also in alert situations, as often happens in natural disasters such as earthquakes.
The relevance of the problem, is that according to the seismic hazard of Colombia, Bogotá is located in an area of intermediate seismic hazard, current natural events such as the earthquake in Haiti which left 300,000 dead and over 700,000 injured, and Chile earthquake, makes us think about the importance of hospital preparedness for mass casualty event.
The overall objective of the study is to identify the capacity of district hospital response in Bogota for a mass casualty event (earthquake). Further improvement opportunities were identified to optimize hospital response according to their level of care. The research was conducted by a cross-sectional study, where a sample of the District hospital network was made for convenience, under the application of a targeted survey. The results were compiled in a database of Excel 2013, and analyzed under statistical software STATA 12.0, where variables, categorical and quantitative ratings were evaluated.
As a result an occupancy rate of over 100% in 25% of hospitals were found. The 16 hospitals surveyed have emergency hospital committee, as well as emergency plans and have reviewing and implemented these. 50% of hospitals contemplated within the structure plan for emergencies, the Incident Command System; Only 18.8% of hospitals have structural reinforcement, and 81.2% of hospitals reported having cooperation with local or external organizations. Only 4 of the 16 hospitals have protocols for diagnosis and medical treatment in disasters. The contingency plan for an earthquake, its a priority of all the effort given by the secretary of health and FOPAE in information and training throughout the district hospitals, this is why the 93.85 of all hospitals have earthquake response plan.
In making the overall analysis, the hospital network is not capable of an adequate response in the event of a mass casualty event, the scene of a major earthquake, considering the current occupancy rate where 25% of the district hospital system has overcrowding and 50% are at the top of their installed capacity. As for responsiveness, they do not have protocols; making an assessment by levels of care, only level III hospitals would be moderately prepared and able to respond to a mass casualty event.
https://doi.org/10.48713/10336_10154
http://repository.urosario.edu.co/handle/10336/10154
Desastre
Respuesta Hospitalaria
Servicios de urgencias
Planes de emergencia
Preparación en desastres
Terremoto
Capacidad de respuesta hospitalaria distrital en Bogotá ante un evento con múltiples victimas
oai:repository.urosario.edu.co:10336/46282021-06-03T00:46:02Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2013
The electrocardiogram is a basic tool in the study of chest pain, there is no evidence that probes if the electrocardiographic interpretation of the emergency medicine and internal medicine specialist are similar to the cardiologist in cases of ACS. The purpose of this study is to determine if there is concordance between the interpretation of the most frequent electrocardiographic findings in the acute phase of the coronary syndromes. Methods: Retrospective study of diagnostic electrocardiographic concordance performed in a fourth level university hospital. The most frequent electrocardiographic findings in acute coronary syndrome were chosen to be evaluated by three different specialties and the concordance analysis were carried out through a kappa statistical analysis. Results: 200 randomized electrocardiograms of patients with acute coronary syndrome were analyzed between November of 2012 to April of 2013. The average age of the patients were 65 years, the male population were greater (62, 5%), the most frequent comorbidities were high blood pressure and coronary disease. The concordance between cardiologist vs emergency medicine specialist and cardiologist vs internal medicine were moderated (k= 0. 61 -0. 80, p < 0, 001) except in subendocardic injury (k = 0. 11 y 0. 24 respectively), there were a weak concordance level between emergency medicine and internal medicine (k = 0. 41 – 0. 60, p < 0. 001). The best level of concordance found in the study were the left branch blockage (k > 0. 81). Conclusion: There is a moderated degree of concordance level in the electrocardiographic interpretation in the majority of variables in the cases of acute coronary syndromes among the specialist in internal medicine and emergency medicine compared with cardiologists.
https://doi.org/10.48713/10336_4628
http://repository.urosario.edu.co/handle/10336/4628
concordancia
electrocardiograma
Concordancia en interpretación electrocardiográfica en síndromes coronarios agudos entre especialistas del servicio de urgencias y cardiólogos
oai:repository.urosario.edu.co:10336/46322021-08-27T08:23:53Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2013
FACTORS ASSOCIATED WITH EMERGENCY DEPARTMENT VISITS TIME IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
INTRODUCTION: Cardiovascular diseases are the leading cause of death worldwide, heart disease being the most representative. With advances in invasive treatments, it has managed to reduce overall morbidity and mortality, being crucial time for completion of those therapies from the time of onset of symptoms. It is therefore necessary to determine the factors associated with delays in seeking care. METHODOLOGY: An observational analytic cross sectional study in patients hospitalized for acute coronary event a tertiary university hospital in Bogota for 6 months. The query time was dichotomized between less equal and more than 6 hours from the onset of symptoms, were performed bivariate and logistic regression to assess association variables being studied query time. RESULTS: 100 patients were included in the study, with an average age of 68 years. Most with some degree of education, with marital status married / cohabiting and history of hypertension (HT). The average consultation time was 14 hours, with 48% within 6 hours. There was a trend of marital status, type transportation, history of hypertension and time of onset of symptoms with early check DISCUSSION: In this population, we found a significant delay in the time of consultation in patient with myocardial infarction, with factors that may be related and would be subject to intervention in primary care of these patients. More studies are needed to validate the results of people here found.
https://doi.org/10.48713/10336_4632
http://repository.urosario.edu.co/handle/10336/4632
Infarto de miocardio
tardanza prehospitalatria
tiempo de consulta
Factores asociados con el tiempo de consulta a urgencias en pacientes con infarto agudo de miocardio
oai:repository.urosario.edu.co:10336/316652021-06-23T03:03:10Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Introduction. Frequent ED users (FU) are responsible for the overcrowding and overuse of the services in the emergency room. There are currently no standard rules to identify them. We identify risk factors (RF) and construct a score to discriminate this FUs (FACCE Score).
Methods. With a design of Cases [≥10_ERvisits / year] and Controls [hospital] randomly selected from a database with more than 100,000 visits / year, sociodemographic and clinical data of patients treated in three SE of a private clinic in Bucaramanga. Santander were collected. A logistic regression model (LRM) was applied to identify RF associated with CC (ORa; 95%CI). With the z-scores of each FR [MRL] the FACCE score was constructed.
Results. 200 cases [CC] and 207 controls were selected, the CC were older than 42 years of age (OR: 1.02[1.01-1.03]) and predominantly, married or in common-law union [C/UL], had home care plans and were hospitalized (P-value <0.05). The RF associated with CC were marital status C/UL [2.06; 1.37-3.11], comorbidity [2.40; 1.52-3.79], general non-traumatic disease [4.10; 2.18-7.71], history of smoking [4.17; 1.14-15.1] and the primary diseases: neoplasia [4.32; 1.41-13.1], epilepsy [10.6; 1.28-87.7], mental illness [3.23; 1.46-7.16] and chronic kidney [8.18; 1.02-65.7]. The median [p25-p75] of the FACCE score [13.4; 9.6-16.8] was higher in Cases [16.0; 13.0-17.6] Vs Controls [12.6; 9.14-13.9] (∆ 3.79 [95%CI, 3.26-4.29]) (AUC: 0.78; OR: 1.23; 1.14-1.32; P-value <0.001).
Discussion. We identified sociodemographic and clinical RF associated with FU, which together [score_FACCE] demonstrated usefulness to discriminate them in the ED. New investigations will allow an external validation of the FACCE, as well as an improvement in the operational capacities and calibration to discriminate FU in the ED.
https://doi.org/10.48713/10336_31665
https://repository.urosario.edu.co/handle/10336/31665
Consultantes crónicos
Usuarios frecuentes
Casos-Controles
Factores de riesgo
Puntaje
Emergencias
FACCE: Puntaje de factores asociados a consultantes crónicos del servicio de emergencias: estudio de casos y controles.
oai:repository.urosario.edu.co:10336/422932024-02-28T03:02:59Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
In Colombia, the use of ultrasound for non-radiological medical professionals, particularly emergency doctors, is limited due to limited resources and lack of training. Despite its utility in patient monitoring, there is a lack of evidence in hospital emergency centers. Cardiac arrest is a common emergency with poor prognosis, with shockable rhythms having better survival rates than non-shockable ones. The use of ultrasound in patient monitoring has led to the development of two types: true and pseudo-active electrical non-pulse activity (PEA).
https://repository.urosario.edu.co/handle/10336/42293
Ultrasonido
Sala de reanimación
Ritmos de paro
Pseudo-actividad eléctrica sin pulso
Ritmos de paro y el pronóstico del paciente con paro cardio - respiratorio, énfasis en la pseudo-actividad eléctrica sin pulso, otra razón para el uso del ultrasonido en las salas de emergencia en Colombia
oai:repository.urosario.edu.co:10336/113342021-06-03T00:45:32Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2015
Background The working hours produce a cognitive and functional deterioration in people, with obvious consequences on health services; it is one of the disciplines that has a higher risk of mistakes during its care processes. We intended to assess the impact of working time on the attention capacity in some emergency physicians.
Methods A cross-sectional study was performed, using the Psychomotor Vigilance Test to assess the ability to care for people after performing different activities, measured by the response time in milliseconds. The population of study was the emergency medical personnel of Santa Fe de Bogota Foundation. benchmarked with themselves in different shifts.
Results: The average response time at the start of the day shift was 436.6 ms (95 % CI 401-477), and at the end of the day was 443.1 ms (95 % CI 388-484).At night, work, the average initial response time was 422.8 ms (95 % CI 403-457), and at the end of the night shift was 467.44 ms (95 % CI 423-501).
Discussion: There was significant differences in response time between the day shift and the night shift. Therefore we recommend creating state policies to manage the labor hours of health personnel to prime the safety and quality of patient care, avoiding any possibility of any medical error.
https://doi.org/10.48713/10336_11334
http://repository.urosario.edu.co/handle/10336/11334
Psychomotor vigilance test
urgencias
médicos
Impacto del horario laboral en la capacidad de atención en médicos de urgencias de la Fundación Santa Fe
oai:repository.urosario.edu.co:10336/16602021-06-03T00:46:57Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2010
https://doi.org/10.48713/10336_1660
TEME 0002 2010
http://repository.urosario.edu.co/handle/10336/1660
Dolor oncológico
VAS
Opiodes
AINES
Terapia adyuvante
Impacto de los opioides vs no opioides en dolor oncológico en urgencias de la FSFB
oai:repository.urosario.edu.co:10336/346872022-08-31T07:06:44Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Objetive: Troponin is the most accurate biomarker available to approach the diagnosis and management of acute myocardial injury in the emergency room (ER), however, the interpretation is doubtful in patients with chronic kidney disease (CKD). We evaluate the behavior of Troponin I levels in patients treated for Acute Myocardial Infarction (AMI) with and without CKD. Methodology: With a historical cohort design, patients treated for AMI in the ER of Fundación Santa Fe de Bogotá (years=2016-2018) were studied. Sociodemographic and clinical characteristics related to patients classified with CKD (Glomerular Filtration Rate, CKD-EPI) were identified; the median concentration of the first and second troponin I in patients with or without CKD was compared, and the relationship between patients with or without CKD and the frequency of positive troponin delta (cutoff points=20%) was determined. Results: A total of 423 patients diagnosed with non-ST elevation acute myocardial infarction were reviewed, of whom 194 were excluded for not meeting the inclusion criteria; the frequency of chronic kidney disease was 71.6%. No differences were identified when comparing the frequency of patients with or without CKD who had troponin delta of ±20%. Regarding the associated comorbidities, arterial hypertension was the most frequent associated with chronic kidney disease (P value <0.05). Conclusion: There were no differences in troponin delta for the diagnosis of non-ST elevation myocardial infarction when comparing patients with or without CKD.
https://doi.org/10.48713/10336_34687
https://repository.urosario.edu.co/handle/10336/34687
Infarto agudo de miocardio
Enfermedad renal crónica
Troponina
Enfermedades cardiacas
Comportamiento de la troponina, en pacientes con infarto agudo de miocardio, con y sin enfermedad renal crónica, FSFB, 2016 - 2018
oai:repository.urosario.edu.co:10336/129282021-06-03T00:46:33Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2017
Introduction: In recent years new oral anticoagulants are available for atrial fibrillation. In Colombia, the usage has become more frequent since 2013. This paper aims to characterize patients with nonvalvular atrial fibrillation in the era of new oral anticoagulantsMethodology: The electronic medical records were reviewed for patients who consulted the emergency department of the Santa Fe University Hospital in Bogotá. Specifically, patients with a primary or secondary diagnosis of atrial fibrillation between January 2013 and March 2015. Results: The prevalence of atrial fibrillation was 0. 29%. 229 patients were analyzed of which 54. 59% were men. 75. 1% were over 65 and those over 80 represented 41% of the population size. Warfarin was the most commonly used oral anticoagulant followed by dabigatran, rivaroxaban and apixaban. There were only 4 cases of major bleeding in anticoagulated patients; 2 with warfarin and 2 with dabigatran. 4 anticoagulated patients had a new ischemic stroke, 1 with warfarin, 1 with dabigatran and 2 with rivaroxaban. Discussion: In Colombia, the use of new anticoagulants is limited due to health care regulations. More similar or concurrent studies are required to be able to have enough data to support the use of these drugs in the country, without the need to extrapolate data from other sources.
https://doi.org/10.48713/10336_12928
http://repository.urosario.edu.co/handle/10336/12928
Fibrilación auricular
Nuevos anticoagulantes orales
Urgencias
Caracterización fibrilación auricular y nuevos anticoagulantes orales en urgencias - Fundación Santa Fe de Bogotá
oai:repository.urosario.edu.co:10336/41432021-06-03T00:46:55Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2013
Background: The Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have a impact on the respiratory system and the recommendations for mechanical ventilation of patients with IAH/ACS remain unclear. Our study characterize the influence of elevated intra-abdominal pressure (IAP) and positive end-expiratory pressure (PEEP) on airway plateau pressure (PPLAT) and bladder pressure (PBLAD). Methods: Nine (n=9) deeply anesthetized swine were mechanically ventilated via tracheostomy: volume-controlled mode at tidal volume = 10 ml/kg, frequency=15, Inspiratory:Expiratory ratio=1:2 and PEEP of 1 and 10 cmH2O (PEEP1 and PEEP10, respectively). A tracheostomy tube was place in the peritoneal cavity and different levels of IAP were applied utilizing a CPAP system. Measurements were performed during both PEEP1 and PEEP10. Results: PBLAD increased as experimental IAP rose. Minimal underestimation of IAP by PBLAD was observed. Applying PEEP10 did not significantly affect the correlation between experimental IAP and PBLAD. PBLAD (in cmH2O) was reflected by changes in PPLAT regardless of the PEEP.
https://doi.org/10.48713/10336_4143
http://repository.urosario.edu.co/handle/10336/4143
Intra-abdominal hypertension
plateau airway pressure
La Presión Intra-abdominal Influye Sobre los Limites de la Presión de la Vía Aérea Durante la Ventilación Protectora Pulmonar
oai:repository.urosario.edu.co:10336/90332021-06-03T00:47:46Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2014
Introduction: Quality assistance in the emergency department is possible only if physicians have received a high quality education. The PHEEM (Postgraduate Hospital Educational Environment Measure) scale is a valid and reliable instrument used internationally to measure the educational environment in postgraduate medical education. Materials and methods: A cross-sectional study used the Spanish version of the scale PHEEM for meet educational environment of emergency programs. Cronbach`s alpha coefficient was calculated to determine internal consistency. Descriptive statistics is applied globally, by category and items of the scale PHEEM. The results were compared by gender, year of residence and program. Results: 94 (94%) residents filled the questionnaire. The mean score of the PHEEM was 93, 91 ± 23, 71 (58, 1% of the maximal score) which is considered the educational environment more positive than negative, with capability of improvement. There was a statistically significant difference in the perception of educational environment among residency by programs (p=0. 01). The instrument is highly reliable (Cronbach´s alpha = 0. 952). The most common barrier was overcrowding teaching and assessment was perceived in order to meet standards. Discussion: The results of this study provided evidence of the internal validity of the scale PHEEM in the Colombian context. This study demonstrated how the measurement of the educational environment in a medical-surgical specialty, with the use of a quantitative tool, can provide information regarding the strengths and weaknesses of the program.
https://doi.org/10.48713/10336_9033
http://repository.urosario.edu.co/handle/10336/9033
ambiente educativo
medicina de urgencias
enseñanza
Percepción de residentes de medicina de urgencias en Colombia del ambiente educativo en los servicios de urgencias
oai:repository.urosario.edu.co:10336/327302021-10-12T03:01:23Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Introduction: It is known as “boarding”, the hospitalization of patients in the emergency department (ED) due to the lack of availability of a bed or room in the hospitalization areas. This type of hospitalization has negative consequences in terms of quality and the outcome of patients. Methodology: Observational, descriptive, historical cohort study. The objective was to establish the frequency and time of boarding in the HUFSFB, during the period from January to June 2018. Boarding was defined as hospitalization time greater than 6 hours. Results: Of 4,777 hospitalization cases, 1,177 patients (24.6%) meet the boarding criteria. The variable time in boarding presents an asymmetric distribution to the right (p <0.001). The median was 9.40 hours (IQR. 7,195 - 14,138 hrs). Minimum and maximum value of 6.01 and 23.98 hrs respectively. The frequency of "boarding" increases significantly as the complexity of the patient decreases (p <0.001). There are no significant differences in the frequency (p = 0.182) or time (p = 0.187) of boarding, between 6 different clinical diagnostic categories. January was the month with the least frequency and time for boarding. Conclusions: About ¼ of the patients admitted to the emergency room meet the boarding criteria. The most frequent pathologies of "boarding" are related to internal medicine. Knowing the characteristics of this phenomenon will allow adjusting to improve the quality of care in emergency services.
https://doi.org/10.48713/10336_32730
https://repository.urosario.edu.co/handle/10336/32730
Calidad de la atención de salud
Atención de urgencias
Administración hospitalaria
Lista de espera
Descripción del Boarding en la fundación Santa Fe de Bogotá, en el primer semestre de 2018
oai:repository.urosario.edu.co:10336/383752023-04-29T03:02:42Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Heart failure contributes to morbidity and mortality and costs to the health system. The main source of care is the emergency department, where scales have been devised for clinical conduct, such as the MEESSI-AHF, which is intended to assess 30-day mortality. To date, there are no studies that show the behavior of this scale in our population. We included patients with a diagnosis of heart failure in the emergency department between 2021 and 2022, for whom the MEESSI-AHF scale was calculated, evaluating the mortality obtained with
the predicted mortality and calculating the goodness of fit. A total of 267 patients were analyzed, mostly women, with a mean age of 79 years. The mortality observed in the studied population was higher than expected in the groups of low risk (5.69% vs2.1%), intermediate risk (19.37% vs 7.6%), and high risk (50% vs 20.1%), but with adequate performance in the first risk quintile; The goodness of fit test of the model was adequate with an area under the curve of 0.9306 95% (CI: 0.8922-0.969). When applying the MEESSI-AHF scale, we found a higher mortality than expected by risk group.Therefore, it must be a support tool, clinical behavior must be supported by institutional protocols and individual clinical judgment, until additional studies or regional scales are carried out.
https://doi.org/10.48713/10336_38375
https://repository.urosario.edu.co/handle/10336/38375
Falla cardiaca aguda
Falla cardiaca crónica agudizada
MEESSI-AHF
Evaluación de la mortalidad
Insuficiencia cardiaca
Desempeño de la escala MEESSI-AHF en pacientes con falla cardíaca de la Fundación Santa Fe de Bogotá
oai:repository.urosario.edu.co:10336/201722021-08-29T01:01:14Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2019
Introduction Ureterolithiasis is a highly frequent pathology. Due to the association of hematuria with the presence of urolithiasis, the low cost and high availability of uroanalysis, its performance was evaluated for the diagnosis of urolithiasis . Methodology Cross-sectional study of diagnostic test. Adult patients who entered consecutively with a diagnostic impression of urolithiasis from July 2017 to December 2017 were included, UroTAC was defined as gold standard. The diagnostic performance of uroanalysis was determined calculating the operative characteristics of hematuria and the presence of crystals. Results 466 patients were evaluated, the median age was 45 years (RIQ: 36-55 years). 257 patients (55.1%) presented a history of urolithiasis. Urolithiasis was confirmed in 340 patients (73.0%) by UroTAC. In 314 cases (67.4%) hematuria occurred. The sensitivity and specificity of hematuria are 75.9% and 55.6% respectively. The VPP and VPN are 82.2% and 46.1% respectively. The presence of crystals has a sensitivity of 10% and specificity or 93.7%, PPV and NPV of 81.0% and 27.8% respectively. The simultaneous presence of hematuria and crystals did not improve the test performance Conclusion Although it is plausible that uroanalysis can serve as diagnostic support for the clinical suspicion of ureterolithiasis, this study shows that the presence of hematuria and cylindruria, have a very low yield and therefore, its use should be reassessed in a population with clinical symptoms of renoureteral colic.
https://doi.org/10.48713/10336_20172
http://repository.urosario.edu.co/handle/10336/20172
Uroanálisis
Hematuria
Cólico renoureteral
Urolitiasis
Rendimiento del uroanálisis en pacientes con sospecha diagnóstica de cólico renoureteral en el servicio de urgencias
oai:repository.urosario.edu.co:10336/94892021-03-01T14:22:55Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2006
http://repository.urosario.edu.co/handle/10336/9489
Comparación de indicador “demanda no atendida” en urgencias, antes y después del especialista en emergencias
oai:repository.urosario.edu.co:10336/22502021-06-03T00:46:51Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2010
Introduction: In Colombia, there isn´t a tool to quantify the degree of congestion of the emergency services that apply to your reality. For this reason, this work seeks to determine if the scale NEDOCS is a valid tool to measure the degree of congestion in this environment
Methods: We estimated the scale during a period of three weeks for 6 times a day at the same time in the three institutions. For validation, we compared the level NEDOCS against two Likert scales of 6 questions. In addition, he described the percentage of unmet demand and the number of complaints.
Results: For the scale, the variability is explained by 88%. On the other hand, the correlation between the severity of congestion in the last 3 items of the scale with the subjective opinions was direct and significant (r = 1.000., P <0.000). We obtained a significant correspondence with the following variables: a) availability of beds (r = 0.7, p <0,001); b) Average waiting time (r = 0.56, p <0.021).
Discussion: Since there is no gold standard, measurements of the scale compared to the views of staff NEDOCS show that the scale applied in the emergency department Colombians is useful to measure congestion. Special phenomenon was observed that staff are accustomed to "live with congestion, so the staff considers as congestion of the service times of high work stress.
https://doi.org/10.48713/10336_2250
TEME 0071 2010
http://repository.urosario.edu.co/handle/10336/2250
congestion
servicio de urgencias
Escala NEDOCS para medir congestión en urgencias: estudio de validación en Colombia
oai:repository.urosario.edu.co:10336/106382021-06-03T00:46:18Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2015
AbstractIntroduction: Patients after liver transplantation have multiple hemodynamic changes and electrolyte disturbances that generate changes in acid-base status. This paper seeks to describe the acid-base behavior in patients after liver transplantation through the analysis of Stewart model, focused on etiological search of each disorder and suggesting possible ways to optimize the management in Intensive Care (ICU). Methodology: Observational, descriptive, retrospective Trial, of the arterial blood gases for patients in postoperative liver transplant for any reason, played by Stewart method. It is with the universe of patients admitted in 2014 in La Fundaciòn Santa Fe de Bogotà. Results: A total of 24 patients were included, from 1 January to 31 September 2014. The median pH was 7. 36 with a minimum value of 7. 05 and maximum of 7. 49. 41% of patients on admission to intensive care with normal lactate (less than 2), and 88% had low levels of albumin. The most common electrolyte disorder was hyperchloremia (58%), followed by hypomagnesemia (25%). Conclusions: Arterial blood gas analysis by Stewart model allows a diagnosis of a specific disorder and additionally, allows you to search the etiology of the disorder. This case series showed that 95% of patients had a metabolic disorder on admission, the most frequent metabolic acidosis (66%).
https://doi.org/10.48713/10336_10638
http://repository.urosario.edu.co/handle/10336/10638
Trasplante hepático
Modelo de Stewart
Equilibrio ácido base
Acidosis láctica
Descripción del estado ácido base por modelo de Stewart en pacientes postoperatorio de trasplante hepático
oai:repository.urosario.edu.co:10336/90382021-06-03T00:47:38Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
2014
Introduction: The technical development allows performing effective procedures in critical emergency patients such as canalizing main vessels by echography. This procedure when compared to the blind technique offers advantages as the reduction of complication, better success rate and reduced procedure duration. There are various approach techniques: transversal, longitudinal and oblique, which provides differences in the effectiveness and success rates on each one of them.
Materials and methods: An experiment was performed in simulated models with specialists and residents of last year of emergency medicine. Subsequently to standardizing the concepts and approaches of each one of the techniques, the models were exposed in order to determine which technique displays the greatest success rates and effectiveness for channeling the jugular vein with echography guidance.
Results: The procedure was effective on 175 replications (97.2%) distributed as follows: success 133(73.9%), redirection 37(20.6%) and second puncture requirement on 5(2.8%). Within the transversal technique the effectiveness was 96.7% (n=58), in the longitudinal was 100%(n=60) and in the oblique of 95.0%(n=57), (p=0.377). For residents the effectiveness was 95.6% (n=86) and for specialists the effectiveness was 95.6%(n=89), (p=0.184). The distribution of success rates displayed that on specialists it was greater by 18.9% than it was on residents (p=0.004), by gender men have a greater success rate with 18.7% than women (p=0.009, OR=3.12, IC95%: 1.30, 7.52).
Discussion: No significant difference was found in the use of any technique, but the trend favors the longitudinal technique, which obtained the greatest percentage of effectiveness and success.
https://doi.org/10.48713/10336_9038
http://repository.urosario.edu.co/handle/10336/9038
Guía ecográfica
Acceso vaso central
Simulación
Efectividad en la canalización yugular guiada por ecografía usando tres diferentes técnicas. Experimento en modelos simulados.
oai:repository.urosario.edu.co:10336/307882022-11-03T10:30:23Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Objective. The approach to the diagnosis of acute bleeding (AS) manifested with nonspecific symptoms, using the hematocrit as a support laboratory is a challenge in the Emergency Room (SE). Hematocrit and platelet radius / hematocrit (PLHER) operational capabilities were compared to discriminate patients with AS. Methods. With a design of diagnostic precision, patients with and without AS seen in the SE of the Clínica del Occidente S.A. were compared. during 2017. The disease spectrum (EDx) included negative controls [group_0], general population with or without closed orthopedic trauma [groups_1-2], patients with closed orthopedic trauma [group_3], with gynecological AS [group_4], gastrointestinal AS [group_5] and positive controls [groups_6-7]. The operational capabilities of PLHER and hematocrit were compared to discriminate patients with AS. Results. 655 patients were selected, mainly men. There were no differences between the hematocrit medians of group_0 with groups 1-2; Compared with group 0, the median PLHER was higher in all EDx groups. (p: <0.05). With cut-off points ≥6.037 and ≥6.348, the PLHER AUC to discriminate patients with possible AS [groups 1-3] or any EDx group [groups 1-7] was 0.709 and 0.766, respectively. The hematocrit AUCs to discriminate patients with possible AS or any EDx group were 0.682 and 0.755, respectively. Discussion. The PLHER presented better operational capabilities than the hematocrit to discriminate patients with AS. It could be useful to identify patients with AS seen with nonspecific signs and symptoms in ES.
https://doi.org/10.48713/10336_30788
https://repository.urosario.edu.co/handle/10336/30788
Sangrado agudo
Hematocrito
PLHER
Hemorragia
Precisión diagnostica
Emergencias
Pruebas diagnosticas para sangrado agudo
PLHER (radio plaquetas/hematocrito): una herramienta para discriminar pacientes adultos atendidos en la sala de emergencias con o sin sangrado agudo.
oai:repository.urosario.edu.co:10336/380282024-02-19T09:14:02Zcom_10336_925com_10336_562col_10336_1574
00925njm 22002777a 4500
dc
Introduction The emergency service is the gateway to the Colombian health system. The increase in antimicrobial resistance, the different underlying pathological conditions promote the incidence of infectious diseases. Objectives To describe the etiology, clinical characteristics, pre-existing conditions, and sociodemographic characteristics of patients with infectious diseases who are treated in the emergency room of a tertiary hospital in Bogotá. Methodology A descriptive study of adult patients who consulted in the emergency department of a tertiary hospital in Bogotá from January to December 2020, who underwent a diagnosis of infectious pathology. Outcomes Over the period observed viral pathologies were found in 56.63%. SARS-COV-2 was even related to 36.22% of the total pathologies. Women predominated with 52.6%. Arterial hypertension was the most common comorbidity (31.12%). The most used antibiotic was Ampicillin sulbactam (9.69%). The median length of hospital stay was 4 days. 42.85% required hospitalization. 11.73% were transferred to the intensive care unit and 9.18% died. Conclusions Viral infections were the most prevalent, being generated in a notable percentage by SARS-COV-2. The start of the SARS-COV-2 pandemic means that the data obtained in this period do not correspond to the behavior previously observed in other studies of these characteristics. The results of our research do not differ from those reported in the literature.
https://doi.org/10.48713/10336_38028
https://repository.urosario.edu.co/handle/10336/38028
Infecciones
Servicio de urgencias en hospital de tercer nivel
Enfermedades infecciosas
Patologías
Características clinico-epidemiológicas de enfermedades infecciosas en urgencias de un hospital de tercer nivel