“AÑO DE LA CONSOLIDACION DEL MAR DE GRAU” UNIVERSIDAD NACIONAL DE PIURA FACULTAD DE MEDICINA HUMANA
TRABAJO DE INVESTIGACIÓN “ANALISIS Y EVALUACION EVALUACION DE INDICADORES INDICADORE S BIOQUIMICOS EN PACIENTES CON QUEMADURAS DE II Y III GRADO, DEL HOSPITAL JOSE CA C AYETANO YETANO HEREDIA” ALUMNO
: PORRAS NUÑEZ, ESTRELLA CHRISTABEL
CURSO
: ESTRUCTURA Y FUNCIÓN CELULAR Y TISULARII
DOCENTE: DRA. VIOLETA MORÍN GARRIDO
PIURA- PERU 201
ESTE TRABAJO TRA BAJO ESTA DEDICADO A DIOS Y A MIS PADRES POR DARME LA OPORTUNIDAD DE SEGUIR ADELANTE CON MIS METAS Y PROPÓSITOS!
INDICE
I! DAT DATOS GENERA GENERALES LES """""""" """""""""""" """""!! "!! """""""" """"""""""" """!! !! # 1.1. 1.". 1.$. 1.'. 1.+. .+. 1.0.
Titu! Aut!#. A%&%!#. F()ut(* D&( &(#t( #t(-& -&t! ()( ()(*/-i */-i)! )!.. Lu(# *& E%tu*i!.
II! DE$INICION DE$INICION DEL DEL PROBLEMA PROBLEMA !!!!!!! !!!!!!!!!!!!!! !!!!!!!!!!!!!! !!!!!!!!!!!!!! !!!!!!!!!!!!!! !!!!!!!!!!!""""" !!!!""""""""""" """""" % 2!1! T2tu!. 2!2! At&)&*&t&%. At&)&*&t&%. 2!&! 3u%ti4i)()i5 ".'. O67&ti8!%. ".+. .+. Eu)i u)i(* (*! ! D& P#!6 #!6&-( III! MARCO TEORICO TEORICO " """"""""""""""""""" """""""""""""""""""""""""" """"""" $.1.
M(#)! C! C!)&tu(.
IV! IV! DE$INICION DE$INICION DE DE LA POBLACIÓN POBLACIÓN DE ESTUDIO ESTUDIO """""""""""""!!&2 """""""""""""!!&2 '.1. '.1. C(#() (#()t& t #2%t %ti) i)(% (% && &&#( #(& &%. %. '.1.1. C#it&#i!% *& I)u%i5. '.1.". C#it&#i!% *& E9)u%i5. '.". '.". U6i)( 6i)()i )i5 5 t&- t&-!# !#!: !:&% &%( ()i )i( (.. '.$. '.$.
D&4i D&4ii i)i )i5 5,, !&#( !&#()i )i! !( (i; i;() ()i5 i5 *& 8(#i( 8(#i(6 6&% &%..
V! DISE'O DISE'O ESTADI ESTADISTICO" STICO""""""""""" """""""""""""""""""" """"""""""""""&% """"&% +.1. .1. Ti! *& i8&%t 8&%tii()i ()i5 5.. +.". Di%&
VII!CONCLUSIONES"""""""""""""""""""""""""""!!%
VIII!
RECOMENDACIONES"""""""""""""""""""""""!!(
I)! BIBLIOGRA$*A"""""""""""""""""""""""""""!!!+
INTRODUCCION E & #&%&t& t#(6(7! %& #&(i;(#( & ((i%i% = ( &8(u()i! *& (% *i8&#%(% 8(#i(6&% 6i!>u2-i)(% >u& %& -(i4i&%t( ( -!-&t! *& &9(-i(# ( u ()i&t& >u&-(*!. L(% ?u&-(*u#(% %! & #&%ut(*! *& u t#(u-(ti%-! 42%i)! ! >u2-i)! >u& #!*u)& *&%*& u( &8& (4&)t()i5 *& ( i& @(%t( ( *&%t#u))i5 t!t( *& !% t&7i*!% i-i)(*!%. L( t!-( *& *&)i%i!&% & #&()i5 ( (6!#*(7& )2i)! *& u( &#%!( )! >u&-(*u#(% u&*& &&#(# i)&#ti*u-6#& & !% #!4&%i!(&% !# ( )!-&7i*(* >u& )!&8( u *i(5%ti)! ()&#t(*! & &9t&%i5 = #!4u*i*(* *& ( &%i5 = !# ( &&))i5 *& t#(t(-i&t! (*&)u(*!. A*&-%, (% >u&-(*u#(% %u!& & %2 -i%-(%, u i-!#t(t& i-()t! 42%i)! = %2>ui)!. P!# &%t!, %& @()& &)&%(#i( ( &8(u()i! )!%t(t& *& !% i*i)(*!#&% 6i!>ui-i)!% >u& !& & #i&%! ( ()i&t& *& %u4#i# *& u %@!) -&t(6!i)! )! )!-#!-i%! %i%t&-i)!. P(#( *(# #&%u&%t( ( &%t( &)&%i*(*, %& @( &(6!#(*! u ((i%i% & 6(%& ( !% i*i)(*!#&% 6i!>u2-i)!% #&)!i(*!% *& *i8&#%(% @i%t!#i(% )ii)(% *& ()i&t&% >u& @( t&i*! )!-#!-i%! -&t(65i)!, #&()i!(*! & )(-6i! & !% 8(!#&% *& (% 8(#i(6&% = ( (*-ii%t#()i! *& t#(t(-i&t! )! & (8()& !%iti8! ! &(ti8! >u& #&%&t(#! !% ()i&t&% ( #&%&)t!, (#( !#(# u( 8i%i! it&#( *& )u( &% & 8&#*(*&#! (6!#*(7& )ii)! = *& %&ui-i&t! >u& *&6& t&&# !% ()i&t&% )! &%t( (t!!i(.
I.
DATOS GENERALES
1.1.
TITULO
ANALISIS Y EVALUACION DE INDICADORES BIO?UIMICOS EN PACIENTES CON ?UEMADURAS DE II Y III GRADO, DEL HOSPITAL 3OSE CAYETANO HEREDIA
1.".
AUTOR PORRAS NUÑEZ, ESTRELLA CHRISTABEL
E%tu*i(t& *& -&*i)i( *& "*! A
ASESOR
MSC. Vi!&t( M!#2 G(##i*! #!4&%!#( *& )u#%! *& Bi!>u2-i)( *& ( F()ut(* D& M&*i)i( Hu-((.
1.'.
FACULTAD
M&*i)i( Hu-(( *& ( Ui8&#%i*(* N()i!( *& Piu#(.
1.+.
DEPARTAMENTO ACADEMICO
M!#4!4i%i!5i(
1.0.
LUGAR DE ESTUDIO
H!%it( R&i!( 3OSE CAYETANO HEREDIA PIURA
II.
DEFINICIÓN DEL PROBLEMA
".1.
TÍTULO
ANALISIS Y EVALUACION DE INDICADORES BIO?UIMICOS EN PACIENTES CON ?UEMADURAS DE II Y III GRADO, DEL HOSPITAL 3OSE CAYETANO HEREDIA
".".
3USTIFICACIÓN
E #&%&t& t#(6(7! ti&& )!-! 4i(i*(* !6t&&# i4!#-()i5 %!6#& !% )(-6i!% 4i%i!(t!5i)!% = 6i!>u2-i)!% >u& %& #!*u)& & & ()i&t& >u&-(*! )!-! #&%u&%t( ( &%t#/% -&t(65i)!. P&#-iti# )!!)&# )5-! %& &)u&t#( 4u)i!(*! & -&t(6!i%-! i2*i)!, #!t&i)!, *& )(#6!@i*#(t!% = & -!8i-i&t! &&)t#!2ti)! & u ()i&t& )! >u&-(*u#( #(8& *& II = III #(*!, >u& @(=( )!-#!-&ti*! u ' ! -% *& ( %ui)i& )!#!#( *&%*& %u i#&%! @(%t( %u *(*( *& (t(. A=u*(# ( it&##&t(# *& -(&#( )!##&)t( (% 8(#i(6&% 6i!>u2-i)(% >u& &%t )!-#!-&ti*(% & u ()i&t& )! >u&-(*u#( #(8&, (#( & !%t&#i!# t#(t(-i&t! *& &%t&. P!*#( & -(i4i&%t! ( i-!#t()i( *& %&ui-i&t! )!tiu! *& !% )(-6i!% *& (% 8(#i(6&% &&)t#!iti)(% (#( &8it(# ( &#*i*( *& ( 4u)i! #&( = & %@!) -&t(6!i)!. P&#-iti#( )!!)&# )u( &% ( )!##&)t( &8(u()i! *& ( 4u)i! *& )!(u()i! *& !% ()i&t&% )! >u&-(*u#( #(8&.
2!&!
OBJETIVOS
2!&!1! O./ G.3.456 A(i;(# & it&##&t(# !% i*i)(*!#&% 6i!>ui-i)!% >u& 8(#i(#! & !% ()i&t&% )! >u&-(*u#(% *& II = III G#(*! #&4&#&)i(*!% & (% @i%t!#i(% )ii)(% *& HOSPITAL III 3OSE CAYETANO HEREDIA Piu#( & & (
2!&!2! O./ .78.9;97! J J
D&t&#-i(# >u& 8(#i(6&% 6i!>u2-i)(% #&()i!(*(% ( -&t(6!i%-! #!t&i)! = *& )(#6!@i*#(t!% %& (t&#( & u ()i&t& )! >u&-(*u#( #(8&, & & @!%it( 3!%/ C(=&t(! H&#&*i( III:Piu#(.
J
D&%)#i6i# )5-! &% ( &8!u)i5 *& (% 8(#i(6&% 6i!>u2-i)(% #&()i!(*(% )! & -&t(6!i%-! #!t&i)! = *& )(#6!@i*#(t!% & !% ()i&t&% )! >u&-(*u#(% #(8&% *u#(t& %u @!%it(i;()i5. D&%)#i6i# !% )(-6i!% *& (% 8(#i(6&% *& i &&)t#!iti)! & !% ()i&t&% )! >u&-(*u#(% #(8&% *u#(t& %u @!%it(i;()i!.
D&%)#i6i# !% )(-6i!% *& (% 8(#i(6&% *& )!(u()i! & !% ()i&t&% )! >u&-(*u#(% #(8&% *u#(t& %u @!%it(i;()i!. D&%)#i6i# !% )(-6i!% 6i!>ui-i)!% i-u!!i)! i4&))i!%! & !% ()i&t&% )! >u&-(*u#(% #(8&% *u#(t& %u @!%it(i;()i!. D&%)#i6i# !% )(-6i!% *& (% 8(#i(6&% >u& )!-#!-&t& ( 4u)i! #&( & !% ()i&t&% )! >u&-(*u#(% #(8&% *u#(t& %u @!%it(i;()i!.
".'.
ENUNCIADO DEL PROBLEMA
K?u/ )(-6i!% >u& %& #!*u)& )! #&%&)t! ( (% 8(#i(6&% 6i!>u2-i)(% & !% ()i&t&% )! >u&-(*u#(% *& @!%it( III 3!%/ C(=&t(! H&#&*i(: Piu#(
".+.
HIPÓTESIS
P()i&t&% )! -(=!# %ui)i& )!#!#( >u&-(*(, #&%&t( -(=!#&% 8(#i()i!&% *& !% i*i)(*!#&% 6i!>u2-i)!% #&%&)t! *& !% 8(!#&% !#-(&%.
III! M549 T.<49 L(% i7u#i(% t/#-i)(% !)u( u u(# #&&8(t& *&t#! *& t!*!% !% ti!% *& t#(u-(ti%-!%. E E%t(*!% Ui*!% %& &%ti-( >u& (#!9i-(*(-&t& *!% -i!&% *& &#%!(% ( (u&-(*u#(% >u& #&>ui&#& (t&)i5 -/*i)(, (% )u(&% %! #&%!%(6&% *& -% *& +. u#&)i(% (t&*i*(% & !% )&t#!% @!%it((#i!% = @!%it(i;()i!&% u#&t&%. A%2 u&% t(&% ())i*&t&% %! *& u( #( i-!#t()i(. E (u!% (2%&% (ti!(-&#i)(!% %& @( #&(i;(*! i8&%ti()i!&% &i*&-i!5i)(% >u& !4#&)& u( (#!9i-()i5 *& )!-!#t(-i&t! >u& (% >u&-(*u#(% ti&& & u&%t#( #&(. A%2, %& )!!)& >u& (% )(u%(% -% 4#&)u&t&% *& >u&-(*u#(% %! & (#t& &8it(6&% =( >u& )!##&%!*& & %u -(=!#2( ( ())i*&t&% *!-/%ti)!%, i*u%t#i(&% ! *& t#(6(7! U! *& !% (&t&% -% 4#&)u&t&% %! !% 2>ui*!% & &6ui)i5, #i)i(-&t& &t#& ( !6()i5 i4(ti, %&ui*! *& 4u&! *i#&)t! = ( &&)t#i)i*(*, & ())i*&t&% *& t#(6(7!. E t!*! & -u*! -u&#& )(*( (u&-(*u#(%, >u& & #( (#t& *& !% )(%!% ! %! #(8&% = %& !*#2( #&8&i# &#! >u& & !% (2%&% *& 6(7!% = -&*i(!% i#&%!% ti&& u *&%&()& 4(t(, %& u i4!#-& u6i)(*! !# ( O#(i;()i5 Mu*i( *& ( S(u* OMSQ. L( !#(i;()i5 %&<(( >u& (% >u&-(*u#(% %! u #!6&-( -u*i( *& %(u* 6i)(, %!6#& t!*! & (% #&i!&% *& %u#&%t& (%iti)! *!*& %& )!)&t#( ( -it(* *& !% )(%!% *& -!#t(i*(* = *!*& -% %& #!*u)& u( @!%it(i;()i5 #!!(*(, (*&-% *& ( *&%4iu#()i5 = *i%)(()i*(*, >u& ( -&u*! #!8!)( ( &%ti-(ti;()i5 = & #&)@(;! %!)i(. D&%*& ( OMS %&
#!-u&8& (% it&)i!&% >u& @( *&-!%t#(*! t&&# /9it! & ( #&*u))i5 *& (% >u&-(*u#(%, (u>u& #&)u&#*( >u& &% &)&%(#i( u( -(=!# )!(6!#()i5 ( t#(8/% *& #&*&% -u*i(&% = ()i!(&% (#( (u-&t(# & -&#! *& #!#(-(% &4&)ti8!% *& #&8&)i5 *& >u&-(*u#(%. L(% -u7&#&% %! (% >u& %u4#& >u&-(*u#(% )! -% 4#&)u&)i(, !#-(-&t& %& (%!)i( )! & 4u&! *& (% )!)i(%, (% )(&4())i5 ! 8i!&)i(. L!% @!-6#&% %! -% #!&%!% ( >u&-(*u#(% & & u(# *& t#(6(7! *&6i*! ( i)&*i!% = >u&-(*u#(% >u2-i)(% = &/)t#i)(%. E %&u*! u(# %& &)!t#(#2( !% iu& %! (#ti)u(#-&t& 8u&#(6&% ( (% >u&-(*u#(%. D& @&)@! %& &%ti-( >u& (% >u&-(*u#(% %& &)u&t#( &t#& (% 1+ #i-&#(% )(u%(% *& -u&#t& & iuit( )(u%( -% )!- *& &%i!&% i4(ti&% ! -!#t(&%. L( !6#&;(, & @()i(-i&t! = ( 4(t( *& -&*i*(% *& %&u#i*(* (*&)u(*(%, ( )!!)()i5 *& (% i<(% & !% #!&% *& @!(# )!-! ( )!)i( = & )ui*(*! *& !% iu&u&-(*(% )(*( (u&-(*!% )(*( (u&-(*u#(% %! ( %&u*( &%i5 -% )!- & (% ;!(% #u#(&% *& N&(, >u& #&#&%&t( & + *& (% *i%)(()i*(*&%. L( OMS #&)u&#*( >u& (% >u&-(*u#(% %& u&*& #&8&i# =, & &%t& %&ti*!, #&)u&#*( >u& !% (2%&% *& i#&%!% (t!% @( @&)@! #!#&%!% )!%i*&#(6&% & ( #&*u))i5 *& (% t(%(% *& -u&#t&% !# >u&-(*u#(%, ( t#(8/% *& u( )!-6i()i5 *& &%t#(t&i(% *& #&8&)i5 = -&7!#(% & & )ui*(*! *& (% &#%!(% (4&)t(*(% !# >u&-(*u#(%. L( -(=!#2( *& &%t!% (8()&% & ( #&8&)i5 = ( (t&)i5 %& @( (i)(*! & (2%&% *& 6(7!% = -&*i(!% i#&%!%, &#! (4i#-( >u& %& &)&%it( -(=!#&% &%4u&#;!% (#( @()&#! =( >u& !*#2( &8(# ( #&*u))i!&% %ii4i)(ti8(% & (% t(%(% *& >u&-(*u#( #&()i!(*( )! ( -u&#t& = ( *i%)(()i*(*.
&!1! M549 C39.8/=56 L(% #&(% 6%i)(% *& &9(-& ii)i( (#( & t#(t(-i&t! *& u( >u&-(*u#( i)u=& R&i%t#(# t!*!% !% %i!% 42%i)!% -&*i6&% t&-&#(tu#(, 4#&)u&)i( )(#*i()(, t&%i5 (#t&#i(, &(*! )(i(# = *(t!% *& ( E%)(( *& G(%!Q E%t& #i-&# &9(-& &% & -% i-!#t(t&, !#>u& 6u&( (#t& *& (% *&)i%i!&% !%t&#i!#&% %& *&#i8( *& !% @((;!% ii)i(&% I*&ti4i)(# t#(u-( (%!)i(*! = t#(t(# (% &%i!&% Bu%)(# %i!% *& >u&-(*u#(% !# i@(()i5 = )!%i(#!% & ( @i%t!#i( )2i)( t!% = &%ut! )(#65i)!, >u&-(*u#(% & (% )!((%, *i%&(, &%t#i*!# (#2&!, (t&)&*&t& *& #&)it! )&##(*!, )(-6i!% & ( 8!;Q. C()u(# ( %ui)i& = ( #!4u*i*(* = #(4i)(#( -&*i(t& ( R&( *& !% Nu&8&% ! & &%>u&-( *& !#)&t(7& %& &*(* *&%)#it! !# Lu* =
B#!*&#. L( #&(i-()i5 @2*#i)( %& u&*& @()&# -&*i(t& & ))u! )! ( F5#-u( *& P(#(* 45#-u( utii;(*( (#( &%ti-(# ( )(ti*(* *& 4ui*! *& #&!%i)i5 #&>u&#i*( (#( (% #i-&#(% "' @!#(% & u ()i&t& >u&-(*! ( 4i *& (#(ti;(# >u& &#-(&;)( @&-!*i-i)(-&t& &%t(6&Q. E #!5%ti)! *& u( >u&-(*u#( &%t & 4u)i5 *& t#&% 8(#i(6&%
Sui)i& (4&)t(*( P#!4u*i*(* E*(* = (t&)&*&t&% (t!5i)!% *& >u&-(*!
S=8.4;9. 5;.9/5>5 L( &9t&%i5 *& u( >u&-(*u#( i)i*& 4u*(-&t(-&t& & & &%t(*! &&#( *& >u&-(*!. P(#( & ))u! *& ( &9t&%i5, u -/t!*! %i-& >u& u&*& utii;(#%& &% ( R&( *& !% Nu&8& *& (()&, -&*i(t& ( )u( %& )!%i*&#( >u& (% *i%tit(% #&i!&% ((t5-i)(% )!#!#(&% #&#&%&t( u )(*( u( ! u -ti! *& *& ( %ui)i& )!#!#( t!t(.
C(6&;( = )u&! T#!)! (t&#i!# 1 T#!)! !%t&#i!# 1 E9t#&-i*(* %u&#i!# 9 "Q 1 E9t#&-i*(* i4&#i!# 1 9 "Q $0 A#&( &it( 1 R&( *& !% u&8& *& (()&
E%t( #&( *& !% u&8& ! &% 8i*( & iu&-(*!% *&6& #&)!#*(#%& >u& & )i#)u%t()i(% !#*i(#i(%, (% >u&-(*u#(% -&!% &9t&%(% & i)u%! -&!#&% 1+ ( "Q u&*& %&# %&#i(% ! i)u%! 4(t(&% & u 6u& !#)&t(7& *& )(%!%, &%&)i(-&t& & ()i&t&% -(=!#&% *& 0+ (u&-(*(, ( &%ti-()i5 )ui*(*!%( *& #&( ! >u&-(*( &i-i(# &##!#&% 4#&)u&t&% *& ))u!.
P4;=3>>5> L( #!4u*i*(* *& ( i7u#i( )ut&( %& )(%i4i)( )!-! #i-&#!, %&u*! ! t&#)&# #(*!%. L( &8(u()i5 )2i)( *& ( #!4u*i*(* *& (% >u&-(*u#(% & !)(%i!&% u&*& %&# *i42)i, &#! &9i%t& (u(% u2(% (#( &8(u(# & #(*! *& >u&-(*u#(.
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S& &%t( *&4ii)i5 (% >u&-(*u#(% %& )(%i4i)( & t#&% ti!%
Q=.?5>=45 >. 84?.4 @45>! Xi)(-&t& (4&)t( ( ( &i*&#-i%. C!%i%t& & u &#it&-( *!!#!%! #!6(6&-&t& %u6%&)u&t& ( &*&-( *& ( ;!(. N! %& 4!#-( (-!(%. P!)!% *2(% *&%u/% ((#&)& ( *&%)(-()i5 = &% !%i6& >u& *&7& ;!(% @i&#i-&t(*(%. Cu#( &%!t&(-&t& ( )(6! *& $:' *2(%, %i )i)(t#i;.
Q=.?5>=45 >. 7.@=3> @45> . A4&)t( %i&-#& = (#)i(-&t& ( ( *&#-i%. Pu&*& %&# %ui)i(&% ! #!4u*(% *& ()u&#*! )! ( #!4u*i*(* *& )!-#!-i%! */#-i)!. •
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IQ L(% %ui)i(&% (4&)t( ( &i*&#-i% = )(#( %u&#i!# *& ( *&#-i%, )! 4!#-()i5 *& (-!(% = &9u*()i5 *& %u&#!. L( %ui)i& >u&-(*( &% ui4!#-&-&t& #!%(*(, %& 6(>u&( )! ( #&%i5, &% *!!#!%( = &9t#&-(*(-&t& %&%i6& ( !% i)@(;!%. E *(u&-(*( ti&& u (%&)t! i*!, %& (( i*u#(*( ! (%t!%( = ! %& 6(>u&( )! ( #&%i5 (u(% #&(% u&*& &%t(# i%&%i6&% ! (&%t&%i(*(% ( i)@(;!. S& 4!#-( u( &%)(#( 4i#-& = #u&%( = ( )i)(t#i;()i5 &% &t(. Pu&*& *&-!#(# -% *& $+ *2(% & )u#(# )!-&t(-&t&. E%t(% >u&-(*u#(% )u#( )! )i)(t#i;()i5 %&8&#(
= u&*& (%!)i(#%& )! /#*i*( &#-(&t& *& &! = *u(% %&6)&(%.
Q=.?5>=457 >. /.49.4 @45>. I-i)( *&%t#u))i5 )!-&t( *& t!*! & &%&%!# *& ( i&, i)u=&*! t!*!% %u% (/*i)&% ! (&7!% )ut&!%, = (4&)t(*! ( ( %&%i6ii*(*. A(#&)& u( &%)(#( %&)(, 6(>u&)i( ! &#( >u& u&*& t&&# u t&)@! )!-! & *& )u&#! %&)! ! %&# &9u*(ti8!. E %i! (t!!-5i)! &% ( t#!-6!%i% 8&!%( 8i%i6& ( t#(8/% *& ( i&. D&7( %i&-#& )i)(t#i; & ( ;!( = ( 8&)&% #&>ui&#& i7&#t!% )ut&!%. A &%ti-(# ( #!4u*i*(* *& (% >u&-(*u#(%, *&6& #&)!#*(#%& >u& ( &%i5 u&*& &8!u)i!(# *u#(t& (% #i-&#(% "':' @!#(% = >u& *u#(t& &%t& &#i!*! ( #&%&)i( *& &*&-( @()& &9t#&-(*(-&t& *i42)i t&&# ( (6%!ut( )&#t&;( %!6#& ( #!4u*i*(* #&( *& ( i7u#i( & &%t!% )(%!%, &% ti ( &9!#()i5 ( *!!# !# i)@(;! #u&6( *& i)@(;!Q. A*&-%, ( i%>u&-i( = ( i4&))i5 u&*& t#(%4!#-(# u( >u&-(*u#( %ui)i( & u( &%i5 -% #!4u*( *& t!*! & &%&%!#. L(% )i)(t#i)&% >u& *&7( %! i##&u(#&% )! (#t&% (t#54i)(% = !t#(% @i&#t#54i)(% ! >u&!i*&(%. Pu&*& %&# !#i& *& )!t#()tu#(% & (% (#ti)u()i!&% =, -u= !)(%i!(-&t&, %&# ( 6(%& *& u )(#)i!-( &i*&#-!i*& -u)@!% (
&!2! INTERPRETACIÓN BIOQU*MICA DE LAS VARIABLES INTERPRETACIÓN BIO?UÍMICA DE LA GLUCOSA L( @i&#u)&-i( >u& #&%&t( !% ()i&t&% %!-&ti*!% ( #i-&# (i%i%. E% *&6i*! ( >u& %& #!*u)& u( *i%-iu)i5 *& ( %&)#&)i5 *& i%ui( = t(-6i/
u( #&%i%t&)i( &#i4/#i)( ( u)!%(, )!-! !% #&>u&#i-i&t!% &&#/ti)!% (u-&t( =( >u& & )u&#! &)&%it( #&(#(# & t&7i*! &%i!(*! %& #!*u)& & u ii)i! -!8ii;()i5 *& u)5&! )!-! #i-&#( 4u&t& *& &(.u)!%(Q E (u!% )(%!% ( @i&#u)&-i( &#%i%t& ( &%(# *& ( t&#-i()i5 *& (% #&%(% *& u)5&!, *&6i*! ( >u& %& #!*u)& u i)#&-&t! & ( #!*u))i5 @&ti)( = #&( *& u)!%(, &%t& i)#&-&t! &% *&6i*! ( ( u)!&!/&%i% @&ti)( >u& ti&& u(# utii;(*! (-i!)i*!%, ()t(t!, i#u8(t! = i)&#! . L( #&%i%t&)i( &#i4/#i)( ( ( u)!%( &#%i%t&, &%t( &% #!*u)i*( !# ())i5 *& (% @!#-!(% )(t&)!(-i(% (*#&(i( , !#(*#&(i(Q &#! & (u-&t! *& ( )!)&t#()i5
*& u)!%(
(%-ti)( = ti%u(# ( (#&)&# %u&#( ( #&%i%t&)i( *& !% t&7i*!% &#i4/#i)!% ( ( &t#(*( *& u)!%( & &!%, ! >u& &#-it& ( )(t()i5 & 4!#-( &t( *& &%t& %u%t#(t! !# & t&7i*! &%i!(*! = & #&%t! *& )u&#!. INTERPRETACIÓN BIOQU*MICA DE LOS RESULTADOS RESPECTO A LAS PROTEINAS TOTALES CUADROS DE CADA PACIENTE
Du#(t& ( #&%u&%t( -&t(65i)( !%t#(u-ti)( &9i%t& u( -!8ii;()i5 -(%i8( *& it#5&! )!#!#( = u !t!#i! i)#&-&t! *& )(t(6!i%-! #!t&i)!. E it#5&! &% t#(%!#t(*! *&%*& & -%)u!, i&, it&%ti! = !t#!% t&7i*!% @()i( & @2(*! = !t#!% %iti!% )! ()ti8i*(* -&t(65i)( &&8(*(, (#( %&# utii;(*! & ( #!*u))i5 *& &( = & ( %2t&%i% #!t&i)(. E (u-&t! *& )(t(6!i%-! #!t&i)! %& &8i*&)i( !# u( &&8(*( &9)#&)i5 *& NUU, >u& &% #!!#)i!( ( #(*! *& &%t#/% = u&*& %!6#&(%(# !% ": $ *2(. E it#5&! #!8i&& &%&)i(-&t& *& -%)u!, >u& )!%titu=& ( #i)i( #&%( #!t&i)( *& !#(i%-!. E )!-!#t(-i&t! *& -&t(6!i%-! #!t&i)! & &%t(% )i#)u%t()i(% &% 6(%t(t& )!-&7!, =( >u& !# u (*! &9i%t& u (u-&t! *& )(t(6!i%-! *& (% #!t&2(% = !# !t#!, u( *i%-iu)i5 *& ( %2t&%i% #!t&i)(, t(t! *& (% #!t&2(% t!t(&% )!-! *& (% #!t&2(% 8i%)&#(&% (6-i(, #&(6-i(, t#(%4&##i(, &t).Q. Si &-6(#!, ( )(t()i5 @&ti)( *& (-i!)i*!% AAQ = ( %2t&%i% *& #!t&2(% *& 4(%& (u*( #!t&2( C #&()ti8(, (4( 1: (tit#i%i(, 4i6#i5&!, )&#u!(%-i(, &t).Q &%t (u-&t(*(%. E (!#t& *& AA &95&!% 6(7! &%t(% )!*i)i!&%, &#-it& (u-&t(# ( %2t&%i% #!t&i)( t!t( %i &-6(#!, /%t!% ! %! &4&)ti8!% & 4#&(# ( t(%( )(t(65i)( (6%!ut(. L( &#%i%t&)i( *& ( #&*u))i5 *& ( -(%( -u%)u(# &%>u&/ti)(, ( &%(# *& (!#t& *& AA &95&!%, %& *&6& ( ( ())i5 &#%i%t&t& *& !% -&*i(*!#&% #!i4(-(t!#i!% ( i8& -u%)u(#. E%t( ()ti8i*(* *i%-iui# %5! ( *&)#&)&# ( it&%i*(* *& SIRS = ! !# & (!#t& &95&! *& ut#i&t&%. INTERPRETACIÓN BIOQU*MICA DE LOS RESULTADOS RESPECTO A LA ALBUMINA L(% @!#-!(% u)(5 = (*#&(i( %! (% >u& )!-! #&%u&%t( ( ( >u&-(*u#( #!*u)i*( &%ti-u( u( ()&&#(*( i%i% *& (% #!t&2(%, (u-&t( ( -!8ii;()i5 *& (-i!)i*!% *& !% t&7i*!% &#i4/#i)!% &%&)i(-&t& *& -u%)u(# &%t#i(*! @()2( & @2(*! (#( %u utii;()i5 = 4(6#i)()i5 *& u)!%( -&*i(t& ( u)!&!/&%i% @&ti)(. E%t& (ut!)(i6(i%-! )!-i&;( *&%u/% *& !% #i-&#!% *2(% !% >u&-(*u#( = %& -(ti&& @(%t( >u& ( &%i5 %(&. P!# &%! &% >u& & &%t!% #4i)!% %& 8& >u& (% #!t&2(% (%-ti)(% )!-i&;( @( *i%-iui# *&%u/% *& ( #i-&#!% *2(% !%>u&-(*u#( = *&-!%t#(*! (%2 >u& &%t(% t(-6i/ %! utii;(*(% )!-! 4u&t& *& (-i!)i*!% (#( ( #!*u))i5 &*5&( *& u)!%(. INTERPRETACIÓN BIOQU*MICA DE LOS RESULTADOS RESPECTO A LA UREA L!% i8&&% *& u#&( (u-&t( *&6i*! ( @i&#)(t(6!i%-! ( )u( & !#(i%-! %& 8& %!-&ti*! t#(% @(6&# %u4#i*! u( >u&-(*u#(, &! !#>u& & it#5&! &% t#(%!#t(*! *&%*& & -%)u!, i&, it&%ti! = !t#!% t&7i*!% @()i( & @2(*! = !t#!% %iti!% )!
()ti8i*(* -&t(65i)( &&8(*( = u&% )!-! &% %(6i*! & #!*u)t! 4i( *& &%t& @i&#)(t(6!i%-! &% ( #&(.
INTERPRETACIÓN BIOQU*MICA DE LOS RESULTADOS RESPECTO A LA
CREATININA L( )#&(tii( Su%t()i( &&#(*( ( (#ti# *& -&t(6!i%-! *& ( )#&(ti(, #&%&t& !#-(-&t& & ( %(#&, & ( !#i( = &%&)i(-&t& & & t&7i*! -u%)u(#. E u( >u&-(*u#( #(8& &%t( %& 8& (u-&t(*( *&6i*! ( >u& %& #!*u)& u( *i%-iu)i5 *& ( -(%( -u%)u(# #!*u)t! *& )(t(6!i%-! (t&#(*! (%2 !% i8&&% *& )#&(tii(.
INTERPRETACIÓN BIOQU*MICA DE LOS RESULTADOS RESPECTO A LA
HEMOGLOBINA L( @&-!!6i( !# %&# t(-6i/ u( #!t&i( 8( ( *i%-iui# !# & @i&#)(t(6!i%-! &9i%t&t& t#(% %u4#i# u( >u&-(*u#( T.?8 >. 84/?35 TP E TP %& -i*& & %&u*!%. L( -(=!#2( *& (% 8&)&%, !% #&%ut(*!% %& *( )!-! ! >u& %& (-( 2*i)& it&#()i!( !#-(i;(*! IINQ. Si u%t&* ! &%t t!-(*! (ti)!(u(t&% )!-! (#4(#i(, & #(! !#-( (#( !% #&%ut(*!% *& TP &% •
11 ( 1$.+ %&u*!%
•
IIN *& . ( 1.1
Si u%t&* &%t t!-(*! (#4(#i( (#( #&8&i# )!u!% *& %(#&, %u -/*i)! #!6(6&-&t& !t(# !# -(t&&# %u IIN &t#& ". = $.. P#&t&& ( -/*i)! >u/ #&%ut(*! &% (*&)u(*! (#( u%t&*. L!% #(!% *& !% 8(!#&% !#-(&% u&*& 8(#i(# i&#(-&t& &t#& *i4&#&t&% (6!#(t!#i!%. Au!% (6!#(t!#i!% utii;( *i%tit(% -&*i*(% ! #u&6( -u&%t#(% *i4&#&t&%. H(6& )! & -/*i)! ()&#)( *& %ii4i)(*! *& !% #&%ut(*!% &%&)24i)!% *& %u &9(-& I3/.435/356 N4?56.> R5/ Coeficiente Normalizado Internacional INR L!% #&%ut(*!% *&6& %itu(#%& &t#& " = $ & (>u&(% &#%!(% ( >ui&&% %& @( #&%)#it! u t#(t(-i&t! (ti)!(u(t& !# (ti8it(-i( & !% )(%!% %iui&t&% P(#( #&8&i# *& 4!#-( #i-(#i( = %&)u*(#i( u( t#!-6!%i% 8&!%(, )u(*! & ()i&t& 8( ( %!-&t&#%& ( u( )i#u2( >u& )!&8( u (t! #i&%! t#!-65ti)! ! %i &%t %iui&*! u t#(t(-i&t! %&)u*(#i! *& ( t#!-6!%i% 8&!%( = *& ( &-6!i( u-!(#. E )(%! *& t#(%t!#! *& #it-! )(#*2()! ! #5t&%i% )(#*2()( *& !% t&7i*!%, 8(8u!(t2(, i4(#t! *& -i!)(#*i!, 4i6#i()i5 (u#i)u(# = 88u( (5#ti)(.
E )(-6i!, !% #&%ut(*!% *&6& %itu(#%& &t#& $ = '.+ & (>u&(% &#%!(% >u& @( %u4#i*! u( it&)i5 (#( )!!)(# u( #5t&%i% 8(8u(# -&)i)( (t! #i&%!Q ! *&6i*! ( &-6!i(% %i%t/-i)(% #&i)i*&t&% P!# ti-!, %i & 8(!# &% %u&#i!# ( +, & #i&%! @&-!##i)! &% #(*&. T.?8 >. 753@45 TS E %(#(*! !#-(-&t& %& *&ti&& &t#& 1 = -iut!%, %i &-6(#!, !% 8(!#&% u&*& 8(#i(# *& u (6!#(t!#i! ( !t#!. T.?8 854956 >. /4?8657/35 TPT E &&#(, ( )!(u()i5 *&6& !)u##i# &t#& "+ ( $+ %&u*!%. Si ( &#%!( &%t t!-(*! (ti)!(u(t&%, ( )!(u()i5 t(#*( @(%t( " 8&)&% -%.
B/.936@5 L(% u&8(% t/)i)(% (#( & t#(t(-i&t! *& (% ?u&-(*u#(% @( &8!u)i!(*!, =( >u& (@!#( &9i%t& #( 8(#i&*(* *& i7&#t!%, (#)@&% = -&-6#((%, >u& 4()iit( = ()&&#( & #!)&%! *& )i)(t#i;()i5 = #&&&#()i5 #()i(% ( %u )!-!%i)i5, !% >u&#(ti!%it!% 8i8!% &% u( 4u&t& #i)i( =( >u& &%t!% %& &)(#( *& #!*u)i# 4()t!#&% *& )#&)i-i&t! = &%ti-u( ( #!i4&#()i5 *& (% )/u(% &it&i(&% *& ( ;!( &%i!(*( *& ()i&t&.
TEMPERATURA L( t&-&#(tu#( !#-( *& )u&#! 8(#2( %& ( &#%!(, ( &*(*, ( ()ti8i*(* = ( @!#( *& *2(. L( t&-&#(tu#( )!#!#( !#-( #!-&*i! >u& &&#(-&t& %& ()&t( &% *& .0[ F $\ CQ. Au!% &%tu*i!% @( *&-!%t#(*! >u& ( t&-&#(tu#( !#-( *& )u&#! u&*& t&&# u( (-i( (-(, *&%*& [ F $0.1[ CQ ( [ F $."[ CQ. U( t&-&#(tu#( !# &)i-( *& 1.'[ F $[ CQ ( -&u*! %ii4i)( >u& ( &#%!( ti&& u( 4i&6#& )(u%(*( !# u( i4&))i5 ! u( &4&#-&*(*. L( t&-&#(tu#( )!#!#( !#-(-&t& )(-6i( ( ! (#! *& *2(.
PRESION ARTERIAL L( #&%i5 (#t&#i( &% ( 4u&#;( >u& &7&#)& ( %(#& )!t#( (% (#&*&% *& (% (#t&#i(%. E%t( *&&*& *& !% %iui&t&% 4()t!#&% 1. D/ 77/<69 8!u-& *& &=&))i5 *& 8&t#2)u! i;>ui&#*! Q ". D7/.376>5> >. 65 54/5 F >. 657 @453>.7 54/.457.
$. R.77/.395 579=654 8.4;495, &%&)i(-&t& ( i8& (#t&#i!(#, >u& &% )!t#!(*( !# & %i%t&-( i!%! (ut!5-i)!. '. V6.?5 8!u-& *& %(#& *&t#! *& %i%t&-( (#t&#i(Q. S& *i%tiu& u( #&%i5 %i%t5i)( = !t#( *i(%t5i)(. L( 84.7<3 77/<695 &% ( #&%i5 -9i-( >u& %& ()(;( & & %2%t!&. E%t( *&&*& 4u*(-&t(-&t& *& */6it! %i%t5i)!, ( 8!&-i( = ( *i%t&%i6ii*(* *& ( (!#t( = (% #(*&% (#t&#i(%. L( 84.7<3 >57/<695 &% ( -2i-( #&%i5 *& ( %(#& )!t#( (% (#t&#i(% = !)u##& *u#(t& & *i%t!&. D&&*& 4u*(-&t(-&t& *& ( #&%i%t&)i( 8(%)u(# &#i4/#i)(. E ( &)tu#( *& ( #&%i5 (#t&#i( %& utii;( (-6!% -&#!%, ( #&%i5 %i%t5i)( = *i(%t5i)(. E &&#(, ( #&%i5 %i%t5i)( %& -&)i!( #i-&#! ! &)i-( *& ( *i(%t5i)(. U( &)tu#( )! 8(!#&% *& • • •
11 ! -&!% &% )!%i*&#(*( #&%i5 (#t&#i( !#-( 1' ! -% %& )!%i*&#( @i&#t&%i5 (#t&#i( Et#& 1" = 1$ (#( & -&#! -% &&8(*!, ! &t#& = (#( & -&#! -% 6(7! &% #&:@i&#t&%i5. L( #&:@i&#t&%i5 %ii4i)( >u& u&*& *&%(##!(# #&%i5 (#t&#i( (t(, ( -&!% >u& t!-& -&*i*(%. L( @i&#t&%i5 (#t&#i( ! %u&& t&&# %2t!-(%, &#! u&*& )(u%(# #!6&-(% %&#i!% )!-! *&##(-&% )&#&6#(&%, i%u4i)i&)i( )(#*i()(, i4(#t! & i%u4i)i&)i( #&(.
L!% 8(!#&% !#-(&% *& (-6(% #&%i!&% %!
Presión sistólica: &t#& 1 = 1' -- *& H ! i*&( %( t&&# u( #&%i5
%i%t5i)( >u& ! %u&#(#( !% 1" -- H, !, ( !% -%, !% 1$ -- HQ. Presión diastólica: &t#& 0 = -- *& H ! i*&( %( t&&# u( #&%i5
*i(%t5i)( !# *&6(7! *& !% -- HQ. S& )!%i*&#( >u& u ()i&t& &%t )!-&;(*! ( %&# @i&#t&%! )u(*! %u #&i%t#! &% iu( ! -(=!# *& 1' -- *& H. Au(% &#%!(%, &%&)i(-&t& -u7&#&% 758&&%, ti&& #&%i!&% >u& !#-(-&t& %! 6(7(% 10 -- H ! i)u%! -&!%Q. E !t#(% %itu()i!&%, ( #&%i5 6(7( &% u( -(i4&%t()i5 *& shock ! )!(%! )i#)u(t!#i!, &#! & &%t!% )(%!%, %& #&%&t( %i!% *& -(( u%i5 ti%u(# )!-#!-i%! *& )!)i&)i(, &9t#&-i*(*&% 4#2(%, *iu#&%i% &%)(%(Q.
PRESION ARTERIAL MEDIA E t/#-i! *& ( #&%i5 (#t&#i( -&*i( PAMQ, %& u&*& *&%)#i6i# %i-&-&t& )!-! ( #&%i5 (#t&#i( -&*i( #&i%t#(*( & u i*i8i*u!. U )i)! )(#*2()! %!! %& t!-( & )!%i*&#()i5 (#( & ))u! *& ( #&%i5 (#t&#i( -&*i(. L( #&%i5 (#t&#i( -&*i( &% !t#! t/#-i! utii;(*! (#( #&4&#i#%& ( ( PAM. E ))u! *& ( PAM &% i-!#t(t& (#( t&&# u( i*&( ()&#)( *& ( %(u* *& u( &#%!(. L( 45#-u( (#( )()u(# ( #&%i5 (#t&#i( -&*i( &% ( %iui&t&
PAM CO SVR CVP E ( 45#-u( (t&#i!# %& -&)i!( !% t/#-i!% *& CO, SVR = CVP, >u& #&#&%&t( & (%t! )(#*2()!, ( #&%i%t&)i( 8(%)u(# %i%t/-i)( = ( #&%i5 8&!%( )&t#(. V(-!% ( &t&*&# ! >u& %ii4i)( &%t!% t/#-i!%. El gasto cardíaco: E% ( -&*i*( *& 8!u-& *& ( %(#&, >u& %& 6!-6&(
*&%*& & )!#(;5 *u#(t& 1 -iut!. E (%t! )(#*2()! %& -i*& & !% t/#-i!% *& *- )6i)! &% *&)i#, 1 it#!Q. E i8& *& #&*i-i&t! )(#*2()!, %& -i*& =( %&( !# & 8&t#2)u! i;>ui&#*! ! & *&#&)@! *u#(t& u ti&-! *(*!. L( !t&)i( -&*i( )(#*i()( & ( 4(%& *& #&!%! (#( !% @!-6#&%, &% *& +,0 -i, u i8&, >u& (#( (% -u7&#&% &% *& ', -i. La resistencia vascular sistémica: E t/#-i! *& ( #&%i%t&)i( 8(%)u(# %&
u%( & #&4&#&)i( )! ( #&%i%t&)i( &4#&t(*( !# & 4u7! *& ( %(#& & & %i%t&-( )i#)u(t!#i!. E9i%t& *!% ti!% *& #&%i%t&)i( 8(%)u(# ( #&%i%t&)i( 8(%)u(# %i%t/-i)( = ( #&%i%t&)i( 8(%)u(# u-!(#. L( #&%i%t&)i( 8(%)u(# %i%t/-i)(, &% ( -&*i*( *& ( #&%i%t&)i( #&%ut(t& *& ( )i#)u()i5 *& ( %(#& &#i4/#i)(. L( #&%i%t&)i( 8(%)u(# u-!(#, t(-6i/ !4#&)& ( #&%i%t&)i( *& ( )i#)u()i5 *& ( %(#&. La presión venosa central: L( #&%i5 *& ( %(#& & ( 8&( )(8( t!#)i)(
)&#)( *& ( (u#2)u( *&#&)@(Q, %& )!!)&, )!-! ( #&%i5 8&!%( )&t#(. E%t& 4()t!# ( #&%i5 8&!%( )&t#(Q i4u=& & ( #&%i5 (#t&#i( -&*i( !# u( &>u&<( )(ti*(*. E i8& -&*i! *& ( #&%i5 (#t&#i( !#-( &% *& ( 11 -- H. U( PAM -2i-( *& 0 -- H, &% &)&%(#i( (#( u( u%i5 ! & 4u7! %(u2&!Q (*&)u(*( & !% *i%tit!% 5#(!%, )!-! !% #i
$RECUENCIA CARDIACA L5 ;4.9=.395 954>595 .7 =3 >. 3=.7/47 7@37 /56.7 F 7. >.;3. 9? .6 3?.4 >. .9.7 84 ?3=/ K=. 3=.7/4 945<3 65/. 7. 93/45.! E7/5 %& i)#&-&t( )! & &%4u&#;!, )! & !67&ti8! *& #!8&&# *& -% !92&! = &( (#( ( ()ti8i*(* >u& %& &%t/ *&%&-&<(*!. T(-6i/ u&*& *i%(#(#%& *& 4!#-( *#%ti)( )!-! #&%u&%t( ( ( (*#&(i(. L( 4#&)u&)i( )(#*i()( !#-( & &%t(*! *& #&!%! (#( !% (*ut!% i)u=&*! (*ut!% -(=!#&% = i
Et#& u! = !)& -&%&% :10
Et#& u! = *!% (
Et#& t#&% = )u(t#! (
Et#& )i)! = %&i% (
Et#& %i&t& = u&8& (
A (#ti# *& !% *i&; (
At&t(% 6i& &t#&(*!% ':0 (ti*!% !# -iut!.
L( 4#&)u&)i( )(#*2()( !#-( &9&#i-&t( 8(#i()i!&% >u& %& )!%i*&#( !#-(&%, )!-! )u(*! (u-&t( & #&%u&%t( ( )i&#t(% )!*i)i!&% i)u=&*! & &7&#)i)i!, ( t&-&#(tu#( )!#!#(, ( !%i)i5 *& )u&#! )!-! !)u##& *u#(t& u 6#&8& &#i!*! *& ti&-! ( i)!#!#(#%& #i*(-&t&Q = (% &-!)i!&% )!-! ( (%i&*(* = ( &9)it()i5Q.
$RECUENCIA RESPIRATORIA F#&)u&)i( #&%i#(t!#i( t(-6i/ )!!)i*( )!-! t(%( *& 8&ti()i5, t(%( #&%i#(t!#i(, t(%( *& #&%i#()i5, t(%( *& 8&ti()i5 u-!(# = 4#&)u&)i( *& #&%i#()i5 ! F#Q &% ( )(ti*(* *& #&%i#()i!&% >u& u( &#%!( #&(i;( *u#(t& u -iut!. U%u(-&t& %& -i*& & &%t(*! *& #&!%! = %&t(*!.
L!% i6#!% *& -&*i)i( %ui&#& >u& ( t(%( *& #&%i#()i5 !#-( (#( (*ut!% &% t( %5! 1" #&%i#()i!&% !# -iut! & &%t(*! *& #&!%!. L!% i6#!% -% (tiu!% &&#(-&t& #&!#t( 8(!#&% -&!#&% &7. :1 #&%i#()i!&% !# -iut!Q. L( -(=!#2( *& !% (*ut!% -!*&#!% #&%i#( -u)@! -% #i*! )&#)( *& 1+:" #&%i#()i!&% !# -iut!Q !# &)i-( *& %u 4#&)u&)i( *& #&%i#()i5 !#-(. L(% 4#&)u&)i(% *& #&%i#()i5 & !% &4&#-!% %! u%u(-&t& %u&#i!#&%, &&#(-&t& )&#)( *& " #&%i#()i!&% !# -iut!, ! -%. Nu-&#!%!% &%tu*i!% t&%ti4i)( >u& (% t(%(% *& #&%i#()i5 & &4&#-!% )! ))&# t&#-i(, %i*(:VIH, 4i6#!%i% >u2%ti)( = !t#(% )!*i)i!&% u%u(-&t& %& &)u&t#( !# &)i-( *& $ #&%i#()i!&% !# -iut!.
L!
SATURACION DE O2 L( %(tu#()i5 *& !92&! &% ( -&*i*( *& ( )(ti*(* *& !92&! *i%!i6& & & t!##&t& %(u2&!. Cu(*! ( %(#& %& 6!-6&( *&%*& & )!#(;5 ( )u&#!, #i-&#! (%( ( t#(8/% *& !% u-!&%, *!*& (% -!/)u(% *& !92&! %& u& ( (% )/u(% #!7(% *& ( %(#& &#it#!)it!%Q )! & 4i *& %&# &8(*! ( #&%t! *& )u&#!. E !#)&t(7& *& &#it#!)it!% >u& &%t )!-&t(-&t& %(tu#(*!% )! !92&! %& )!!)& )!-! %(tu#()i5 (#t&#i( *& !92&! ! i8& *& !92&! & %(#&. L( %(tu#()i5 *& !92&! & ( %(#& %(u*(6& = !#-( &% *& &t#& u + = u 1, &#! !% ()i&t&% )! &4&#-&*(* u-!(# ( -&u*! ti&& u !#)&t(7& -% 6(7! ( -&!% >u& utii)& !92&! %u&-&t(#i!. U -&*i*!# (-(*! !92-&t#! *& *&*! ! *& u%!Q %& utii;( &&#(-&t& (#( *&t&#-i(# ( %(tu#()i5 *& !92&!. S& t#(t( *& u &>u&u& %& %u7&t( & & 56u! *& *&*! ! ( !#&7( *& ()i&t& = (;( *!% #(=!% *& u;, u! #!7! = !t#! i4#(##!7!, ( t#(8/% *& ( i& *& ()i&t&. L!% @()&% *& u; &#-it& ( u%i!92-&t#! &&# &>u&u& ( %u 8&; #!!#)i!( u( &%ti-()i5 i-&*i(t( *& ( %(tu#()i5 *& !92&! & ( %(#&. L!% !92-&t#!% *& *&*! %! -% #&)i%!% )u(*! & u%! &% 4u&#t&. P(#( u( &)tu#( -% #&)i%( *& ( %(tu#()i5 *& !92&! (#t&#i(, %& u&*& #&(i;(# u( (%!-&t#2(. E%t( #u&6( u&*& %&# u !)! -% *!!#!%( >u& !t#!% (i%i% *& %(#& =( >u& %& &9t#(& *& u( (#t&#i( = ! *& u( 8&(Q
&#! ( #u&6( &% #i*( = &&#(-&t& 6i& t!&#(*( = )! u #i&%! -2i-! (#( & ()i&t&. L!% #&%ut(*!% *& u( (%!-&t#2( &%t *i%!i6&% & )u&%ti5 *& -iut!%. L!% ()i&t&% )! i8&&% *& !92&! & %(#& !# *&6(7! *& %(tu#()i5 *& !92&! 6(7(Q %& )!%i*&#( >u& ti&& @i!9&-i(, = u i8& *& !92&! & ( %(#& !# *&6(7! *& %& )!!)& )!-! @i!9&-i( %&8&#(. L( *i4i)ut(* (#( #&%i#(# &% & %2t!-( #i)i( *& ( @i!9&-i(. H(= 8(#i(% )(u%(% (#( &%t( &4&#-&*(*, )!-! ( &4&#-&*(* )(#*2()( )!/it(, u 6(7! (%t! )(#*2()! = ( &4&#-&*(* u-!(# it&#%ti)i(. Ot#(% &4&#-&*(*&% u-!(#&% >u& !*#2( )(u%(# @i!9&-i( %! 4i6#!%i% u-!(#, &4i%&-(, &4&#-&*(* u-!(# !6%t#u)ti8( )#5i)( EPOCQ, %2*#!-& *& *i%t#/% #&%i#(t!#i! (u*! SDRAQ, (&-i(, !6%t#u))i5 *& (% 82(% #&%i#(t!#i(%, )!(%! u-!(#, ()u-u()i5 *& 2>ui*! & !% u-!&%, = (&( *& %u&u& %&# t#(t(*( 6(7! & (%&%!#(-i&t! *& u &%&)i(i%t( )! & 4i *& -(t&&# u( %(u* 5ti-(.
DE)TROSA L( u)!%( ! *&9t#!%( &% ( )(ti*(* *& (;)(# >u& & !#(i%-! (6%!#6& ( (#ti# *& !% (i-&t!%, )! ( 4i(i*(* *& (!#t(#& ( &( &)&%(#i( (#( !*&# #&(i;(# *i4&#&t&% 4u)i!&%. E 8(!# !#-( *& u)!%( %& %it( &t#& (0 F 10% ?@>6 & 758&&% = &#%!(% (*ut(%. E i6. S& )!%i*&#( 8@6=9.?5 ( ( u)!%( >u& %& %it( *&6(7! *& #0-%0 ?@>6. S& )!%i*&#( 8.4@6=9.?5 i8&&% (t!% *& u)!%(Q !% 8(!#&% -% (t!% *& 12+ ?@>6. T(-6i/ &9i%t& 8(!#&% &%t*(#&% *& u)!%( (#( &#%!(% %((%, )! #&: *i(6&t&% = )! *i(6&t&%, &%t!% %! Si *i(6&t&% E (=u(%%i )!%u-i# (i-&t!Q :11 -* P!%t#(*i(*!% @!#(% *&%u/% *& )!-&#Q -&!% *& 1' -* P#&:*i(6&t&% E (=u(% %i )!%u-i# (i-&t!Q 1:1"+ -* P!%t#(*i( *!% @!#(% *&%u/% *& )!-&#Q 1':1 -* •
•
•
•
•
Di(6&t&% E (=u(% %i )!%u-i# (i-&t!Q -% *& 1"0 -* P!%t#(*i( *!% @!#(% *&%u/% *& )!-&#Q -% *& " -*
Ni8&&% (t&#(*!% *& u)!%( i*i)( >u& &9i%t& u -&t(6!i%-! i&4i)(; *& (;)(# & %(#&. S& ( S&)#&t(#2( *& S(u* %& )!%i*&#( *i(6&t&% )u(*! & (=u(% %& ti&& )(ti*(*&% -(=!#&% *& 1"0 -*, ! )u(*! *!% @!#(% *&%u/% *& )!-&# %& ti&& %& ti&& )(ti*(*&% *& -% *& " -*.
DIURESIS D&%*& & ut! *& 8i%t( )u(it(ti8!, ( *iu#&%i% @()& #&4&#&)i( ( •
•
L( )!-!%i)i5 *& ( !#i( (u(, i!&%, )!-u&%t!% !#i)!% ... E t#(=&)t! 2t&#! *& ( !#i( 4!#-()i5 *& ( !#i( & & #i<5, t#(%!#t& !# & u#/t&# , (-()&(7& & ( 8&7i( = 4i(-&t& &i-i()i5 !# -&*i! *& ( u#&t#( -&*i(t& ( -i))i5.
D&%*& & ut! *& 8i%t( )u(tit(ti8!, %& @(6( *& 4u7! *& !#i( -&*i*! & it#!%*2(, -iiit#!%*2( ! -iiit#!%-iut!Q. E flujo urinario = & flujo de diuresis %! %i5i-!%. U 4u7! u#i(#i! !#-( )!-#&*& &t#& - = 1+ - ( *2(, *&&*i&t& *& ( )(ti*(* *& 4ui*! >u& %& (6%!#6(. E & )(%! *& (4&))i!&% #&(&%, ( *iu#&%i% %& 8& &#tu#6(*( •
P!iu#i( *iu#&%i% %u&#i!# ( ",+ *i(#i!%
•
Oiu#i( *iu#&%i% i4&#i!# ( 0 - *i(#i!%
•
•
Au#i( *iu#&%i% u( ! i4&#i!# ( 1 - *i(#i!% Diu#&%i% !%-5ti)( Au-&t! *& 8!u-& u#i(#i! )!%&)uti8! ( ( &&8()i5 *& ( #&%i5 !%-5ti)( *& (%-( %(u2&!. L( @i&#t!2( !%-5ti)( *& ( !#i(, #&%ut(t& *& &%t& (u-&t! & ( u; *& tu6! #!9i-( *& #i<5 %& !!& ( ( #&(6%!#)i5 *& (u( = #!*u)& %u &i-i()i5 #!!#)i!( (u-&t( & */6it! u#i(#i!, *& ( -i%-( 4!#-( >u& & */6it! !%-5ti)! = ( !#i( %& 8u&8& #!#&%i8(-&t& i%!t5i)( )! & (%-(. E% u( *iu#&%i% ()u!%(, !6#& & %!*i! N(Q = & )!#! CQ. S!6#&8i&& & & )u#%! *& )i&#t(% &4&#-&*(*&% >u& %& ()!-(<( *& @i&#t!2( !%-5ti)( *& (%-( !# &7&-! *i(6&t&% )! u)&-i( = u)!%u#i( &&8(*(%, %!6#&)(#( it#!&(*( *& ( %(#&, &t). Pu&*& %&# #!8!)(*( !# ( (*-ii%t#()i5 *& u)!%(, *& u#&(, *& -(it!
L( *iu#&%i% 8(#2( & 4u)i5 *& (!#t& @2*#i)! = *& (% /#*i*(% &9t#(##&(&%. Et&*&-!% !# !iu#i( ( &9)#&)i5 *& u( )(ti*(* &9)&%i8( *& (u( (#( u( *&t&#-i(*( %itu()i5 )2i)(, )! 8(!#&% %u&#i!#&% ( " --" !# *2( ! ( " -@ & & -(=!# *& u (u& )!##&%!*& ( 1 - *& 4it#(*! !-&#u(# FGQ &% u -/t!*! &9)&&t&, &#! (#( @()&#! %& #&>ui&#& )!!)&# (% )!)&t#()i!&% *& )#&(tii( & %(#& C# %Q = !#i( C# !Q. S& )()u( -&*i(t& ( 45#-u( VFG ] ^C# % 9 1Q C# !_ = ! !#-( (#( !% i
.Di(5%ti)! = T#(t(-i&t! *& P()i&t& ?u&-(*! & ( F(%& Au*( VALORES NORMALES DE LOS INDICADORES DEL METABOLISMOS DEL CUERPO
GLUCOSA!
PROTEINAS TOTALES
N4?56: (0 10%?@>6
N!#-( a0.1 :.'b#*
H8.4@6=9.?5 6..:10% 1%0?@>6
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H8.4@6=9.?5 @45.: 1%0 2%0?@>6
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H8.4@6=9.?5 7..45 .7/5> 94/9 2%0 ?@>6
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ALBMINA
GLOBULINA
N4?56: &!% #!+@4>6
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55 @45> II @45.: 2!1 2!@4!>6
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55 @45> III7..45: 2!1@4>6
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UREA
CREATININA!
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HB
LEUCOCITOS
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SODIO
POTASIO
1&%-1#% ?.K6
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CLORO
CALCIO
100-10 ?.K6
',+:+,+ -&>
BICARBONATO
PH
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PCO2
PO2
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TPT
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"+ ( $+ %&u*!%
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TP 11 ( 1$.+ %&u*!% IIN *& . ( 1.1
VN T° PA PAM
36.1°C (97°F)-37.2°C (99°F) P.Sistolica: 100-140 mm P.iast!lica: 60-90 mm de Hg de Hg 70-110 mm de Hg
FC
FR S O2 Dx DIURES IS
P"ime" mes de #ida: 70-190 $%t"e &%o ' o%ce meses: 0-160 $%t"e &%o ' dos aos de edad: 0-130 $%t"e t"es ' c&at"o aos de edad: 0-120 $%t"e ci%co ' seis aos de edad: 7*-11* $%t"e siete ' %&e#e aos de edad: 70-110 + ,a"ti" de los die aos de edad ' e% ad<os: 60-100 +tletas ie% e%t"e%ados: 40-60 latidos ,o" mi%&to -12 "es,i"acio%es/mi% 9*-100 70-10* mg/dl Hi,ogl&cemia: me%os de 40-*0 mg/dl Hi,e"gl&cemia: ms de 12 mg/dl 00-1*00 ml/dia Poli&"ia: di&"esis s&,e"ios a 2.*/dia lig&"ia:di&"esis i%e"io" a 600 ml/dia +%&"ia: di&"esis %&la o i%e"io" a 100 ml/dia
IV.
DEFINICION DE LA POBLACION DE ESTUDIO
'.1.
CARACTERÍSTICAS GENERALES.
#!1!1! CRITERIOS DE INCLUSIÓN: T!*(% (% @i%t!#i(% )2i)(% *& !% ()i&t&% @!%it(i;(*!% &t#& !% (u&-(*u#(% *& II = III #(*! & & @!%it( C(=&t(! H&#&*i( III:Piu#(, )! &%t()i( #!!(*( >u& @(=( %i*! *(*! *& (t(. #!1!2!
CRITERIOS DE E)CLUSIÓN:
L(% @i%t!#i(% )2i)(% *& P()i&t&% >u& ! %& &)u&t#& #&i%t#(*(%, ! >u& @(=( %i*! &(*(% !# !% 4(-ii(#&% ! & 7&4& &)(#(*! *& #&(, =( %&( !# %&# )!4i*&)i(i*(*, !# (%ut!% #i8(*!% u !t#!%.
'.". UBICACIÓN TIEMPO : ESPACIAL. E &%tu*i! %& #&(i;5 & & H!%it( *& E%:S(u* 3!%/ C(=&t(! H&#&*i( & ( Ciu*(* *& Piu#(.
#!&! DE$INICIN, OPERACIONALIACIN DE VARIABLES
VARIABLE. VARIABLES
DEFINICION
DEFINICION
INDICADOR
CONCEPTUAL OPERACIONAL Miden la Análisis de los '()*+!A.
BIOQUÍMICAS concentración de los parámetros bioquímicos %ormal: -/ 012mg3dl 4iperglucemia le5e:01 / 012gm3dl principales en sangre del 4iperglucemia gra5e: 01 / constituyentes de metabolismo: 61/2mg3dl 7isminución se5era8 estado critico92 naturaleza proteica, glucosa, proteínas 61 mg3dl lipídica, de "&+#$%A! +A(#! totales, albúmina, carbohidratos, %ormal: .0 ;-.<2gr3dl urea, 7isminución le5e:1.6 /.02gr3dl electrolitos y de globulina, 7isminución gra5e: <.1 /1.62gr3dl coagulación de los creatina, leucocitos, 7isminución se5era8 estado critico9 <.1gr3dl líquidos corporales electrolitos, !, ", " A(=>M$%A como por ejemplo la # $%&. %ormal: ?.1 /<..@2gr3dl sangre. 7isminución le5e:6.@;?.12gr3dl 7isminución gra5e: 6.0/6.@2gr3dl 7isminución se5era 8estado critico9 6.0gr3dl )&#A
%ormal: 01 / ?12mg3dl $ncremento le5e: ?1/ 1 /2mg3dl. $ncremento gra5e: 1/ @2mg3dl. $ncremento se5ero 8estado critico9 2@mg3dl. *&#A$%$%A. %ormal hombres: .- /0.?2 mg3dl %ormal mujeres.1 / 0.62mg3dl. incremento le5e:0.? / 6.2mg3dl incremento gra5e: 6. / ?.12mg3dl incremento .se5ero 8estado critico9 2 ?.1mg3dl 4#M+'(+=$%A %ormal hombres: 0< / 02 g3dl %ormal mujeres06/ 0<2gr3dl. hemoglobina baja 0 le5e: / 062gr3dl hemoglobina baja 6/ gra5e: 1 /.2gr3dl hemoglobina baja ?/ se5era: 1 gr3dl (#)*+*$+! %ormal:1, / 0,2cel3mm? leucopenia le5e:<, / 12cel3mm? leucopenia gra5e: 6,@/
SUPERFICIE !uperBicie del cuerpo!uperBicie quemada
<2cel3mm? leucopenia se5era6,@ cel3mm? leucocitosis 2 0, !+7$+ 0?1;0<1 meq3l "+A!$+ ?,1;<,1 meq3l *(+&+ 0;0 meq3l *A(*$+ <,1;1,1 meq3l =$*A&=+%A+ 66;6meq3l "4 -,?1;-,<1 "*+6 ?1;<1mm4g "+6 @;0mm4g ! 0 y minutos " 61 a ?1 segundos " 00 a 0?.1 segundos $%& , a 0,? !)"#&C$*$# D)#MA7A.
CORPORAL aBectada
;06E.
; <
;1E
; 66E
QUEMADA
por
una
quemadura
;?1E
%! DISE'O ESTADISTICO +.1 TIPO DE INVESTIGACIÓN. - Po" s& 5%alidad: sico. - e ac&e"do al ,"oceso de ca,taci!% de i%o"maci!%: et"os,ecti#o - e ac&e"do a la medici!% de los eleme%tos: o%git&di%al. - e ac&e"do al %8me"o de ,olacio%es est&diadas: esc"i,ti#o. - Po" i%te"e"e%cia del i%#estigado": +%altico. (se"#acio%al). - Po" el diseo metodol!gico: Caso co%t"ol
+." UNIVERSO -
odos los ,acie%tes de c&al;&ie" edad< =os,italiados co% el
diag%!stico de ;&emad&"a< ate%didos e% el Hos,ital >os? Ca'eta%o He"ediaPi&"a.
+.$ POBLACIÓN -
odos los ,acie%tes de c&al;&ie" edad < ;&e =a'a% sido
=os,italiados co% el diag%!stico
de ;&emad&"a de @@ ' @@@ g"ado< e% el
Hos,ital >os? Ca'eta%o He"edia.
%!#! MTODOS ESTAD*STICOS A USARSE - os datos se"% ,"ese%tados e% c&ad"os ' g"5cos estadsticos co% s& "es,ecti#a desc"i,ci!% ' a%lisis de cada #a"iale.
CASO CLÍNICO 4 – GRAN QUEMADO EPICRISIS Fec=a de i%g"eso: 09/01/13 Fec=a de de&%ci!%: 16/01/13 HC: 6141006 AS: +B iag%ostico 5%al: A"a% &emado B/- 0 SC Dom"e: &es;&e% +g&ila"< Sa%d"o E 3 +os Si% ,atologa ,"o#e%ie%te Eie%t"as ma%i,&laa co""osi#o ,o" "&,t&"a de ma%g&e"a co% acido s&l&"ico e%t"a e% co%tacto total e i%=alaci!% de =&mos. iag%ostico 5%al: "o%co%e&mo%a se#e"a ,o" %e&mo%itis ;&mica ,o" A"a% ;&emado co% co""osi#o ;&e ma%i,&laa cido s&l8"ico< co% com,licacio%es ,o" i%=alacio% de #a,o"es de acido s&l&"ico ,&l#e"iado "atamie%to: +siste%cia m<isist?mica
SEGUIMIENTO EMERGENCIA
lega al H. Ca'eta%o He"edia a laS 11:1* am co% &% tiem,o de e#ol&ci!% ma'o" a 1 =o"a
$% la o"de% de t"a%se"e%cia se "ee"e%cia ;&e al ,acie%te se le admi%ist"o DP< CD+ 9 1000 40 A+SGS< icloe%aco 7* mg 1E< Eetamiol 2 g" 1E< Ce,t"iao%a 2 g" $I o e%#a% co% &%a o"de% de i%te"co%s<a ,a"a @P
HISTORIA CLINICA DE EMERGENCIA PACIENTE TRASLADADO DEL Ant!"nt# $%t&'&()!&#* Diega E#t%"& +%#%' Sat 2: 97
P+: 140/ 0
F: 20
PJS: 91
R'%t& Pacie%te s&"e accide%te co% ;&emad&"a ,o" cido s&l8"ico. P"ese%ta ;&emad&"as de seg&%do g"ado ' ,"ime" g"ado e% ca"a< t!"a< miem"os s&,e"io"es e i%e"io"es ' ge%itales.
SNC* "ie%tado< ;&eK&m"oso Q,-%",.%* L7* SC • • • • •
&emad&"a de ,"ime" ' seg&%do g"ado e% ca"a ' gloos oc&la"es Si% ;&emad&"a e% osas %asales %i oca &emad&"a de seg&%do g"ado e% c&ello ' todo adome% &emad&"a de ,"ime" g"ado e% ge%itales Eo#ilia "aos
Int./n!)0n " En1.-.% Eo%ito"eo de FI< #alo"aci!% del dolo"< admi%ist"aci!% de a%alg?sicos< "i%da" comodidad ' co%o"t< ma%te%e" =id"ataci!%< colocaci!% de Fole'< se t"amita @/JC@< se t"amita @/@P
Int./n!)0n IPO &e"atoco%K&%ti#itis ;&mica eti%a a,licada. Do se #e% detalles c/ %itide. "atamie%to: a#ado oc&la" cada 2 =o"as co% DaCl 9 Ci,"oMoaci%o 1g" c/3 =o"as ag"imas a"ti5ciales(=&m'l&) cada =o"a C&"i" oKos co% gasa este"il =&medecida(camia" cada 4 =o"as) Co%t"ol B/- 2 dias
Int./n!)0n UCI Pacie%te es e#al&ado ,o" medico de JC@< i%dica s& =os,italiaci!%. $E$A$DC@+- S@ADS I@+$S FJDC@D$S I@+$S ++DC$ H@@C H+
E + O + D +
: + 7 $
11:1* am 12:00 ,m 1:00 ,m 2:00 ,m 2:20 ,m
D+C
@J$S @S
I. E$C+D@C + F@2
P+
FC
S2
131/7 132/7 4 140/7 6 130/7 0 12/7 0
7 96
100 97
2
96
-
6
9*
21
4
9
$. A+SA N
21 3000
1000
00
400
-
2
T.%t%-)nt& Se le a,lica"o% 10 mg de Eo"5%a ,a"a el dolo". DaCl 4000 a 60 gotas
Int.$.t%!)&n* Fc de%t"o del "a%go< P+ alta< tie%e &% ala%ce =id"olect"olitico de B2400 ,o" la maa%a ' de B 600 ,o" la ta"de< la sat&"aci!% del oige%o esta %o"mal< ' %o es ,"eoc&,a%te. +;& lo mas im,o"ta%te es ma%te%e" co%sta%te el mo%ito"eo =d"ico< 'a ;&e #a a se" lo ,"ime"o ;&e se alte"e< deido a la edematiacio%< ' ;&e el c&e",o %ecesita ma%te%e" la osmola"idad< e%to%ces la al&mi%a i%te"%a< ;&e esta e% e;&ili"io co% la al&mi%a ete"%a em,iea a esca,a"se< =acie%do ;&e co% ella ,lasma salga de los #asos sa%g&%eos ' ,o" co%sig&ie%te se ,"od&ca el edema. $l Fi2< %o "e,"ese%ta ;&e la &%ci!% "es,i"ato"ia a&% %o esta m&' g"a#e< deido a ;&e s& #alo" solo es de 2< te%ie%do ;&e los #alo"es %o"males so% 21< a ,esa" de ;&e el acido s&l8"ico al disi,a"se #iole%tame%te< le =a e%t"ado al sistema "es,i"ato"io ' est ;&ema%do ,o" de%t"o al sistema "es,i"ato"io< lo ;&e #a a ,"o#oca" ,oste"io"me%te &%a &e"te acidosis "es,i"ato"ia< ;&e &%ida a la acidosis metaolica ,"o#ocada ,o" el =i,e"cataolismo< #a a alte"a" el estado ge%e"al< deido a ;&e %o"malme%te el c&e",o =&ma%o a%te &%a acidosis metaolica< =ace &%a alcalosis "es,i"ato"ia como medio com,e%sato"io< ,e"o e% este caso el ,acie%te %o #a a ,ode" "ealia" esa alcalosis "es,i"ato"ia< lo ;&e #a a em,eo"a" s& ,"oceso de "ec&,e"aci!%.
SEGUIMIENTO UCI – DIA 3536 @%g"esa a JC@ co% 36 ° C de em,e"at&"a< &%a P+ de 106/7< &%a P+E de 92< &%a FC de 93< &%a S2 de 16 ' C2 $ 9*.
PA
TEMPERAT URA
PAM
FC
FR
SO2
36 36<6 36<6 36<7 37<7 37<4 37<4 37<6 37<6 37<6 37<7 37<6 37<6 36< 37<3
92 94 3 6 9* 96 96 92 91 96 111 100 10 96
93 92 97 102 106 10* 10* 100 104 106 11* 10 104 104 104
16 16 20 20 24 24 23 22 1 22 22 22 22 21 22
9* 96 9* 96 96 92 92 94 9 9 96 96 9 99 9
106/7 116/* 124/6* 126/66 12/62 116/73 116/72 110/70 106/63 106/70 134/74 127/77 127/77 122/ 11/69
In(.#&# 7 (.#&# UCI In(.#&# O.%' SF
TTO
RETO
683
63
9833
233 T&t%' 983
833
4333 9:3 4833 9;3
2333 8833
E(.#&# D),. SNG #)# 62 633 3 6:83 983 642 698 3
VALORES NORMALES Eritrocitos(mil H: 4<3-*<9 lon) E: 3<*-*.* NUTRICI
Hemoglobina Hematocrito
COAGULACI
Plaquetas +%tit"omi%a @@@
TP
09-e%e *.7
H: 13<*-17<* g/100ml 1 g/dl E: 12-16 g/100ml H: 41-*3 *2.00 E: 36-46 1*0<00269000 400<000/mm3 17-30 11 ( 1$.+ 17.4 seg
%&u*!%
INR
, ( 1,$ 4<1*-11 Leucocitos 3 1000/mm =asta 7 Abastonados IMMUNOLOGICO Segmentados *4-62 INFECCIOSO5INFLAM Eosinóflos 1-3 ATORIO Basóflos 0-0<7* Linocitos 2*-33 !onocitos 3-7 ENERG=TICA "lucosa 70-10* mg/100ml 7 ' 20 mg/dl #rea I+$S $reatinina DE+$S I+$S %rina DE+$S &albumina %rina& I+$S 'ematies DE+$S I+$S orina DE+$S leucocitos orina ceto& I+$S bilirrub DE+$S
AGA>GASEOMETRIA ARTERIAL>PERFIL ELECTROLICTICO
BA$TERIAS P#S Potasio Sodio $loro calcio Bicarbonato P$% P' P%
?,1;<,1 meq3l 0?1;0<1 meq3l 0;0 meq3l <,1;1,1 meq3l 22-26 me;/l 3*-4* mmHg 7<3*-7<4* 0-100 mmHg
1.67
2.30 10 66 1 0 20 3 19* 20 1.09 D$A D$A 0-1 C+EP D$A D$A D$A *.2 133 122 1.02 9.3
* +,-.* 113
UCI 53652369 4$SCA: 1* ,ts E&' temo"oso< com&%icati#o< #e%tila%do es,o%t%eame%te co% a,o'o CD F12 2< s,2 90< Fc Do"mal< %o"mote%so< %o"moglicemo< "e5e"e sed. $: D+C 9 1000 #ia ,e"i?"ica
Do i%dica dolo"< ,"ese%ta #omito alime%ticio< adome% diste%dido< co% ole' o"i%a cla"a. Se coloca sil#e"deg"e% B gasa co% a"co ,"otecto". a#ado oc&la" co% DaCl B com,"esas e% oKos< a&% %o t"ae% las gotas otlmicas. Se "ealia +A+
N&!? Sig%os #itales estales < CIC e% emo"al< ClDa 9 10 gotas< "e5e"e sed< li;&idos ' "e,osicio% ClDa 9. P"ese%ta #omito< o"i%a< ama"illo clo"a< se "e5e"e ,&ede da" ClDa 9.
INTERPRETACION
T-$.%t,.% 3 37.* 37 36.* 36 3*.* 3*
em,e"at&"a
1 2 3 4 * 6 7 9 10111213141*
FC 140 120 100 0 60 40 20 0
FC
1 2 3 4
* 6 7 9 10 11 12 13 14 1*
FR 30 2* 20 1* 10 * 0
F
1
2
3
4
*
6
7
9 10 11 12 13 14 1*
SO2 100 9 96 94 92 90
S2
1 2 3 4 * 6 7 9 10 11 12 13 14 1*
Pacie%te =emoco%ce%t"ado< co% acidosis metaolica se#e"a< co% &% P ele#ado ' el @D ele#ado ' s& sat&"aci!% de oige%o =a em,eado a dismi%&i"< ,e"o se log"a "eg&la" co% el a&me%to de la "ec&e%cia "es,i"ato"ia< se ma%tie%e ta;&ica"dico< ' e"il< el c&e%teo ,la;&eta"io es %o"mal. $%co%t"amos &% t"a%sto"%o elect"oltico< e% do%de el Da esta 2 me;/l ,o" deaKo< el ,otasio esta 0<7 me;/l ,o" a""ia< el clo"o se e%c&e%t"a 16 me;/l ,o" e%cima ' el calcio se e%c&e%t"a 3.3 me;/l ,o" deaKo. $l ica"o%ato se e%c&e%t"a m&' ,o" deaKo< a 12.7 ,o" deaKo< la PC2 tamie% es aKa ' el P= es totalme%te acido ' la ,"esi!% del ige%o esta ele#ada< se ,&ede deci" ;&e esta co% &%a acidosis metaolica ' "es,i"ato"ia. Se e%c&e%t"a co% &%a gl&cosa de 19*< ,o" e%cima de lo %o"mal< lo ;&e %o me "e,"ese%ta g"a#edad< si%o ;&e el c&e",o esta "eaccio%a%do al est"?s.
UCI 6353652369 VALORES NORMALES
09-e%e
10-e%e
Eritrocitos(mil H: 4<3-*<9 lon) E: 3<*-*.* Hemoglobina Hematocrito Proteinas totales Albumina
*.7
H: 13<*-17<* g/100ml 1 g/dl E: 12-16 g/100ml H: 41-*3 *2.00 E: 36-46
4.9 1*.*0 44
+%tit"omi%a @@@
3<*-* g/100ml 2.0-3.* g/100 ml 1*0<00400<000/mm3 17-30
TP
11 ( %&u*!%
INR
, ( 1,$
1.67
1.6
TPT
"+ ( $+ %&u*!%
46.6
2<3
1<7
10 66 1 0 20 3
* 2 0 0 10 3
19*
130
20
21
Alo&li%a
Plaquetas
1$.+
I+$S DE+$S I+$S otro DE+$S 4<1*-11 Leucocitos 3 1000/mm Abastonados =asta 7 Segmentados *4-62 Eosinóflos 1-3 Basóflos 0-0<7* Linocitos 2*-33 !onocitos 3-7 P$R Q1.0 mg/. I+$S /S" DE+$S 70-10* mg/100ml "lucosa $olesterol 140-240 total mg/100ml H:40-160 mg/100ml Trigliceridos E: 3*-13* mg/100ml H0L colesterol 30-70 mg/100ml L0L colesterol 6*-17* mg/100ml /L0L * ' 40 mg/d. 1cido 2rico 4<*-<2 mg/100ml 1+ $+ -* #rea
269000
14000
17.4 seg
16. seg
TS&T"
$reatinina %rina &albumina %rina& 'ematies orina leucocitos orina ceto& bilirrub BA$TERIAS P#S
. 1.$ -* I+$S DE+$S I+$S DE+$S I+$S DE+$S I+$S DE+$S
T3"
I+$S DE+$S
3osatasa alcalina "%T "PT $alcio BT B0 Bicarbonato 3ósoro Potasio Sodio $loro calcio !agnesio Bicarbonato P$% P' P%
1<09
0<7
D$A D$A 0-1 C+EP D$A D$A D$A
20-70 &/l -20 &/l -20 &/l <4-10<2 mg/dl #alo"es %o"males #alo"es %o"males #alo"es %o"males 3-4<* mg/dl
?,1;<,1 meq3l 0?1;0<1 meq3l 0;0 meq3l <,1;1,1 meq3l
*.2 133 122 1.02
3.3 142 124 0.76
9-106 me;/l 22-26 me;/l
9.3
1
3*-4* mmHg 7<3*-7<4*
* +,-.*
29<3 7.31
0-100 mmHg
113
7
T° 70 60 *0 40
°
30 20 10 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
FR *0 4* 40 3* 30 2* 20 1* 10 * 0 1
F
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
FC 160 140 120 100 FC
0 60 40 20 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
S O2 3000 2*00 2000 S 2
1*00 1000 *00 0
1
3
*
7
7 9 1 3 9 1 1 1 3 1 * 1 1 2 2
M%@%n% Pacie%te des,ie"to com&%icati#o SCA 1* ,&%tos< a;&ica"dia< %o"mote%so< F %o"mal< s&e"il< "e5e"e sed a&me%tada< "io< %o dolo". $dema ge%e"aliado. Ie%tila es,o%t%eame%te co% a,o'o CD Fi2 40 S,2 96< se "i%da li;&idos a #ol&%tad. Do #omita< co% CIC emo"al i;.< etos de M&idos B =id"ataci!% a 0gotas. Fole'< o"i%a cla"a M&Ko ace,tale. ecie medicame%to. "i%da c&idados otalmol!gicos< ,&,ilas %o "eacti#as a la l&< "e5e"e ;&e #e co% di5c<ad. Ci"&Ka%o ,lstico "ealia "ee"e%cia.
Se "ealia c&"aci!% co% Sil#e"diai%a. Do"moglicemo< e"il 37<* °C.
T%." Pacie%te des,ie"to< SCAR10/1* ,tos Ie%tilacio% es,o%ta%ea co% a,o'o CD Fi2 36< Sat R94-96< edema e% a&me%to< ,"ese%ta #omito ,o" %o tole"a" a%is. P"e5e"e li;&idos a tole"a%cia. Fl&Ko o"i%a"io aKo ,a"a s& ,eso.
N&!? Pacie%te =emodi%amica estale< e"il< ta;&ica"dia< ,at"!% "es,i"ato"io adec&ado< co% a,o'o 2 CD S,2 9*-96 < edema a&me%tado ge%e"aliado
Int.$.t%!)&n En ' %'%n! ?".)!& t,/& ,n t&t%' " 9B;3 )n(.#&# 7 2382 (.#&# a =emogloi%a 'a se esta =emodil&'e%do< co% a'&da del =emaccel ;&e i%te%ta "e,o%e" el ,lasma e% sa%g"e< ' el e;&ili"io e%t"e el DaCl 9 ' la &"osamida ;&e ,"om&e#e la di&"esis. as ,la;&etas est% desce%die%do< ,e"o sig&e% e% s&s #alo"es %o"males< los le&cocitos aKa% d"sticame%te< ,e"o se ma%tie%e% e% le&cocitosis. a gl&cosa aKa a 130< ,e"o se ma%tie%e &% ,oco ,o" e%cima< ,e"o sig&e sie%do co%side"ale deido al est"?s al ;&e esta sometido el ,acie%te. $l P =a desce%dido &% ,oco< ,e"o sig&e m&' ,o" e%cima de los ID< al ig&al ;&e el @D< ' el P< lo ;&e me dem&est"a ;&e ese ,acie%te tie%e m&' daadas las #as de la coag&laci!%.
a &"ea ' la c"eati%i%a est% de%t"o del "a%go< lo ;&e %os seala ;&e "i!% est &%cio%a%do de ma%e"a co""ecta. $l ,otasio ;&e estaa ,o" e%cima de los ID desce%di! totalme%te ' se e%c&e%t"a ,o" deaKo del "a%go< $l sodio a&me%ta ' 'a se e%c&e%t"a de%t"o de los ID< el clo"o sig&e asce%die%do< ' el calcio tie%e s&s #alo"es ,o" los s&elos. $l ica"o%ato =a s&ido s& co%ce%t"aci!%< ' el PH tami?%< lo ;&e i%dica ;&e la acidosis se esta co%t"ola%do. a P+ est&#o %o"mal. @%icia &% ,oco ae"e%tado< l&ego "ealia =ace altas ' aKas de tem,e"at&"a< te"mi%a%do co% &%a tem,e"at&"a de 37< 2. a FC se e%c&e%t"a ele#ada ' la F #a"ia e%t"e los #alo"es %o"males< lo ;&e %os ma%i5esta &%a e#ol&ci!% ,ositi#a. P"ese%ta &%a sat&"aci!% del 2 aKa<;&e a ,a"ti" de la 1,m %o ,asa de 9*< ' &% Fi2 de 40< lo ;&e "e,"ese%ta ;&e se esta em,ea%do a ag"a#a" ,o";&e %ecesita"a e% &% &t&"o &% so,o"te de #e%tilacio% mec%ica< si %o se a""egla el Fi2. $l ,acie%te se em,eo"a e% la %oc=e< s& ,"oceso edematoso es ete%so< s& Sat2 #a"ia e%t"e 93-94. +&%;&e s& F se e%c&e%t"a %o"maliada< co% ta;&ica"dia ' la P+E se e%c&e%t"a% e% el "a%go.
UCI 6653652369 VALORES NORMALES Eritrocitos(mil H: 4<3-*<9 lon) E: 3<*-*.* Hemoglobina Hematocrito Proteinas totales Albumina Alo&li%a
Plaquetas +%tit"omi%a @@@
TP
10-e%e
11-e%e
4.9
*.26
H: 13<*-17<* g/100ml 1*.*0 E: 12-16 g/100ml H: 41-*3 44 E: 36-46
16.10 47
3.24
3<*-* g/100ml 2.0-3.* g/100 ml 1*0<00400<000/mm3 17-30
1.*4 1.70
11 ( %&u*!%
1$.+
14000
16. seg
121000
INR TPT
, ( 1,$
"+ ( $+ %&u*!%
I+$S DE+$S I+$S otro DE+$S 4<1*-11 Leucocitos 3 1000/mm Abastonados =asta 7 Segmentados *4-62 Eosinóflos 1-3 Basóflos 0-0<7* Linocitos 2*-33 !onocitos 3-7 P$R Q1.0 mg/. I+$S /S" DE+$S 70-10* mg/100ml "lucosa 140-240 $olesterol total mg/100ml H:40-160 mg/100ml Trigliceridos E: 3*-13* mg/100ml H0L colesterol 30-70 mg/100ml L0L colesterol 6*-17* mg/100ml /L0L * ' 40 mg/d. 1cido 2rico 4<*-<2 mg/100ml 7 ' 20 mg/dl #rea I+$S $reatinina DE+$S I+$S %rina DE+$S &albumina %rina& I+$S 'ematies DE+$S orina I+$S leucocitos DE+$S orina ceto& I+$S bilirrub DE+$S
1.6 46.6
TS&T"
BA$TERIAS P#S T3" 3osatasa alcalina "%T "PT $alcio
1<7
9<*
* 2 0 0 10 3
3 7* 2 0 14 6
130
1*0
21
27
0<7
0<6 D$A 100 C+EP 2*-30 C+EP D$A 1 2
I+$S DE+$S 20-70 &/l -20 &/l -20 &/l <4-10<2 mg/dl
BT
#alo"es %o"males
B0
#alo"es %o"males
Bicarbonato 3ósoro Potasio Sodio $loro calcio !agnesio Bicarbonato P$% P' P%
#alo"es %o"males 3-4<* mg/dl
Amilasa li4asa L0H $5 $P5&!B Tro4onina I !iosina Tro4onina T
0.39 D H+U $+C@I
?,1;<,1 meq3l 0?1;0<1 meq3l 0;0 meq3l <,1;1,1 meq3l
3.3 142 124 0.76
3.6 139 121 0.94
9-106 me;/l 22-26 me;/l 3*-4* mmHg
1 29<3
19.3 29.*
7<3*-7<4*
7.31
7.33
0-100 mmHg
7
29.*
Q100 &;/ 13-60 &;/ 60-120 &/ 26-140 &/ 0-2* &/ 0<1 %g/ml #alo"es %o"males 0<1 &g/
TEMPERATURA 70 60 *0 40
$EP$+J+
30 20 10 0 1
3
*
7
9 1 1 1 3 1 * 1 7 1 9 2 1 2 3
FC 10 160 140 120 100 0 60 40 20 0
FC
1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
FR *0 4* 40 3* 30 2* 20 1* 10 * 0
F
1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
SO2 140 120 100 0
S2
60 40 20 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
M%@%n% : %-* Pacie%te SCAR14 ,tos. Po"ta CIC Femo"al @;. Pomalse B JP c& E$A CD Fi2 36 Sat 2R 94. e5"ie%do sed co%sta%teme%te
; %-* Se%t"a c&e",oB edematiado di5c<%dole ,a"a "es,i"a". Se ,"o,o"cio%a li;&idos I< #omita%do e%seg&ida
%-* Eedico e#al&a ;&e decide c&"a"le ' "ealia" ,"ocedimie%to de esca"otomia.
63 %-: Pacie%te se e%t&lsa co%ecta a JE 3mm com,leme%ta"io. P"ocede c&"aci!% ' ,"ocede a esca"otomia de to"a a%te"io". ecie t"atamie%to adec&ado. P"ese%ta aote%si#o< eto co% ClDa 9 B Hemacel
62 %-* Com&%ica a amilia"es de estado delicado del ,acie%te co% sedoa%algesia desadec&ado.
-3,ts<
M&Ko
&"i%a"io
SF2
cole%cia.
Fl&Ko
T%." Pcte. aKo eectos de sedoa%algesia R -4,ts P&g&la" %o e#al&ales. Co%ectado c/JEV...+&me%to e% W C&". "eto"a DaCl 9 1*0 cc/=. og&camimicoc&oc&l'e%do sec"ecio%es ;&e =ace. "e%a%do sc"ecio% se"o=emetica ,o" lesio%es ;&emad&"as. ecie tto estilotico. co%se"#ado.
Pcte.
S&e"il<
M&Ko
&"i%a"io
col&"ico<
B$HA 7 mg/dl Se com&%ica se ce%t"e =id"ataci!% Ft * 30 gt
N&!? Pacie%te e% m&' mal estado ge%e"al< ,"ese%ta ,ico e"il< BJE sec&e" t&o escasa ,a"a oca c&al;&ie" M&idos se ose"#a ;&emad&"as co% a&me%tada ,e"dida de e,ide"mis. Se "ealia c&"aci!% co% medidade ase,sia.
ecie tto adec&ado< o"a d&esta ,ost al&mi%a co% &lla des,ie"ta al d&%tico
Int.$.t%!)&n Pcte. a las 1*:00 =o"as ,"ese%ta de i%s&5cie%cia "es,i"ato"ia ag&da @P+ sec&%da"ia. +&% ,"ese%ta acidosis metaolica< co% ta;&ica"dia< co% mala e#ol&ci!%< se "ealia c&"aci!% de esca"ectomia to"cica adomi%al< deido a ;&e el edema =a ido a&me%ta%do. $l Fi2 =a sido s&ido a 70< la Sat del 2 #a"ia de 92 a 9< co% &% ,&%to c"itico de 90. Pacie%te dee"il< co% acidosis metaolica< co% ta;&ica"dia< co% ica"o%ato 19< co% lactato 1.7< co% &% 0<1 ,o" e%cima de lo %o"mal. P"ese%ta =i,oal&mi%emia se#e"a< es ,o" eso ;&e se le em,iea a a,lica" al&mi%a e!ge%a< esto es deido al =i,e"cataolismo ' a ;&e ,a"a ma%te%e" la osmosis la al&mi%a esca,a. a =emogloi%a #ol#i! a s&i"< deido a ;&e esta so"e=id"atado ' la ,e"dida de al&mi%a< ;&e =ace esca,a" al ,lasma. ie%e &%a aKa de g"ado@@@(se#e"a) de las ,"ote%as totales< deido al =i,e"cataolismo. as ,la;&etas =a% dismi%&ido co%side"aleme%te< se e%c&e%t"a% ,o" deaKo de las 1*00000< lo ;&e %os dem&est"a tami?% el a#a%ado estado de =i,e"cataolismo. Iemos &%a aKa tami?% e% los le&cocitos< ;&e los coloca e%t"e los #alo"es %o"males. a &"ea sig&e ele#ada< ,e"o la c"eati%i%a se e%c&e%t"a e% los #alo"es %o"males< lo ;&e %o %os "e,"ese%ta &%a alla "e%al. $l sodio see%c&e%t"a de%t"o de los #alo"es %o"males< ' el ,otasio se =a "eestalecido< ,o" la sol&ci!% eto < el clo"o =a dismi%&ido< ,e"o sig&e alto< ' el calcio tami?% =a a&me%tado< ,e"o sig&e aKo. $l ica"o%ato =a a&me%tado < ,e"o sig&e aKo< este a&me%to del ica"o%ato =ace s&i" la PC2 a 29<*mmHg. Como el P= se e%c&e%t"a e% 7.33 es &%a acidosis metaolica.
UCI 6253652369
VALORES NORMALES Eritrocitos(mil H: 4<3-*<9 lon) E: 3<*-*.* Hemoglobina Hematocrito Proteinas totales Albumina Alo&li%a
Plaquetas +%tit"omi%a @@@
TP INR TPT
11-e%e
12-e%e
*.26
3.7*
H: 13<*-17<* g/100ml 16.10 E: 12-16 g/100ml H: 41-*3 47 E: 36-46
3.24
3<*-* g/100ml 2.0-3.* g/100 ml 1*0<00400<000/mm3 17-30
1.*4 1.70
11 ( %&u*!%
11.70 33
121000
126000
9<*
3<9
3 7* 2 0 14 6
4 6 0 0 26 2
1*0
112
27
39
1$.+
, ( 1,$
"+ ( $+ %&u*!%
I+$S DE+$S I+$S otro DE+$S 4<1*-11 Leucocitos 3 1000/mm Abastonados =asta 7 Segmentados *4-62 Eosinóflos 1-3 Basóflos 0-0<7* Linocitos 2*-33 !onocitos 3-7 P$R Q1.0 mg/. I+$S /S" DE+$S 70-10* mg/100ml "lucosa 140-240 $olesterol mg/100ml total H:40-160 mg/100ml Trigliceridos E: 3*-13* mg/100ml H0L colesterol 30-70 mg/100ml L0L colesterol 6*-17* mg/100ml /L0L * ' 40 mg/d. 1cido 2rico 4<*-<2 mg/100ml #rea 7 ' 20 mg/dl
TS&T"
I+$S DE+$S %rina I+$S &albumina DE+$S I+$S %rina& DE+$S 'ematies orina I+$S leucocitos DE+$S orina ceto& I+$S bilirrub DE+$S
$reatinina
0<6
0<62
D$A 100 C+EP 2*-30 C+EP
D$A
BA$TERIAS P#S
1 2 I+$S DE+$S
T3" 3osatasa alcalina "%T "PT $alcio BT
20-70 &/l -20 &/l -20 &/l <4-10<2 mg/dl 1mg
B0
#alo"es %o"males
Bicarbonato 3ósoro Potasio Sodio $loro calcio !agnesio Bicarbonato P$% P' P%
#alo"es %o"males 3-4<* mg/dl
0.39 D H+U $+C@I
?,1;<,1 meq3l 0?1;0<1 meq3l 0;0 meq3l <,1;1,1 meq3l
3.6 139 121 0.94
4 146 121 1.12
9-106 me;/l 22-26 me;/l 3*-4* mmHg
19.3 29.*
21 4*
7<3*-7<4* 0-100 mmHg
7.33 70<6
7.31 73
T°C 0 60 40 20 0 1
°C
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
FR *0 40 30 20 10 0
F
1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
FC 140 120 100 0 60 40 20 0
FC
1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
S O2 140 120 100 0 60 40 20 0 1
S 2
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
M%@%n% Pcte. Sedado R -4,tos ,&,ilas 20 e#al&ales. Co% /IE. Fi2 70Q Sa2 9 e% ta;&ica"dia< s& e"il "ecie =id"ataci!% * 90 cc/=o"a ' sedoa%algesia 1*cc/=o"a. Eo#ilia escasas sec"ecio%es se"o=ematicas ,o" oca. . Fl&Ko &"i%a"io col&"ico HA 66mg/dl
ecie tto medic"eol C&"acio% de gloos oc&la"es Pcte se dee "ealia" c&"aci!% ' camio de coe"to"es Pcte. ecie "etos "etos DaCl 9< se ,o%e =emacel. S2 96Q Se deKa e% se"#acio%
T%." 6$-* Pcte. +d<o co% E$A. Se e%c&e%t"a co% IE e% modo +/C. Eo#ilia%d Eo#ilia%do o sec"ecio%e sec"ecio%es s ama"ille%ta ama"ille%tas s oca ' < se ose"#a ose"#a co% gasa =&medecidas co% sec"eci!% se"osa< ,acte desat&"a%do e% E$A Se le "i%da c&idados de e%e"me"a de so,o"te c&m,le te"a,ia te"a,ia i%dicada< i%dicada< ;&eda e% ose"#aci ose"#aci!% !% aKo eecto :$-* Se c&m,le de sedaci!%< =i,ote%so e% E$A.
N&!? R -4 ,tos. Co%ectado a IE. P"ese%ta escasas sec"ecio%es ,o" ' =ace S2 70Q< =i,ot?"mico. =i,ot?"mico. ecie tto e%telmotico. Hid"atacio% *Q D&le" 'mol SEA cR0 Se "eta e% Hemacel ecie +l=ome B &me%ol Pcte. EeKo"a M&Ko &"i%a"io. HA: 76 ml/=
Int.$.t%!)&n* $l dia dia a%te a%te""io" io" se le =a =ec= =ec=o o esca esca""ecto ectomi mia a desco escom, m,""esi# esi#a< a< c/,a"met"os c/,a"met"os #e%tilato"ios altos. Hi,oal&mi%emia se#e"a. P"ese%ta +: 91/6< FCL100X. a tem,e"at&"a ma%tie%e &% ,"omedio de 36° C de tem,e"at&"a< s& F se ma%tie%e e% los ,a"met"os %o"males< ma%tie%e la ta;&ica"dia< la sat&"aci!% del oige%o descie%de< llega a #alo"es ,o" deaKo del 0< se le
a =emo =emogl glo oi% i%a a desc desce% e%di di!< !< dei deido do a ;&e ;&e el M&Ko M&Ko di&" di&"?t ?tic ico o es di%mico< ' =a sido "eo"ado co% &"osamida< se le #e co% a%emia. P"es P"ese% e%ta ta &%a &%a le&co le&coci cito to,e ,e%i %ia a se#e se#e"a "a<< Co% Co% &%a &%a dism dismi% i%&c &ci! i!% % de la gl&cosa< ,e"o e% los ID< la &"ea sig&e a&me%ta%do< ' la c"eati%i%a descie%de< ,e"o %o ,"ese%ta ,"olemas ,"olemas "e%ales. P"ese%ta &%a dismi%&ci!% de la ili""&i%a total< lo ;&e %os ,od"a ma%iesta" ;&e la &%ci!% =e,tica esta com,"ometida. as ,la;&etas =a% s&ido co% "es,ecto al dia a%te"io"< ,o" el =emacel< ,e"o sig&e% aKas. $l ,acie%te tie%e se,sis e% ,"og"esi!%. Si% dete"io"o =emodi%mico Se ma%tie%e co% i%s&5cie%cia "es,i"ato"ia Co% M&Ko &"i%a"io #a"iale a &"ea &"ea sig& sig&e e e% a&me a&me%t %to< o< ' la c"ea c"eati ti%i %i%a %a desc descie ie%d %de< e< ,e" ,e"o se ma%tie%e e% #alo"es %o"males< %o ma%iesta%do allo "e%al. Ea%tie%e la acidosis metaolica co% &% PH de 7.31< &% ica"o%ato de 21< este sig&e aKo< ,o" la gl&co%eog?%esis< lle#a%do al mo#imie%to li,dico< adems de ;&e la al&mi%a 'a la =aamos e%co%t"ado aKa< la PC2 PC2 sig& sig&e e e% a&me a&me%t %to o < dei deido do a ;&e ;&e el ica ica" "o% o%at ato o sig& sig&e e a&me%ta%do. a gl&c gl&cos osa a =a desc desce% e%di dido do<< dei deido do a ;&e ;&e el ica ica" "o% o%at ato o se esta esta estailia%do.
UCI 6953652369 Pcte. co% dis&%ci!% m<io"ga%ica ' se,sis se#e"a. @%s&5cie%cia "es,i"ato"ia co% IE. Si% e#al&aci!% de lao"ato"io.
T 70 60 *0 40
30 20 10 0 1 2 3 4 * 6 7 9 10 11 12 13 14 1* 16 17 1 19 20 21 22
FC 160 160 140 140 120 120 100 100 FC
0 60 40 20 0 1 2 3 4 * 6 7 9 10111213141*1617119202122
FR 4* 40 3* 30 2* 20 1* 10 * 0
F
1 2 3 4 * 6 7 9 10 11 12 13 14 1* 16 17 1 19 20 21 22
SO2 120 100 0 S2
60 40 20 0 1 2 3 4 * 6 7 9 10111213141*1617119202122
Pcte. e% E$A co% IE e% c&ad"o +/C ' eecto de sedaci!% co% R -3,tos< sec"ecio%es cla"as 60cc ' Pcte. e% E$A co% IE e% c&ad"o +/C Pee, * Fi2 *0 sat 2 93-96 Co% tem,e"at&"a co%sta%te< &%a sat&"aci!% de oige%o cada #e ,eo"< ' mas aKa< %o se le ,&ede "e,o%e" a &%a sat&"aci!% %o"mal< la F se ma%tie%e %o"males.
UCI 6453652369 VALORES NORMALES Eritrocitos(mil H: 4<3-*<9 lon) E: 3<*-*.* Hemoglobina Hematocrito Proteinas totales Albumina Alo&li%a
Plaquetas +%tit"omi%a @@@
TP
14-e%e
3.7*
4.70
H: 13<*-17<* g/100ml 11.70 E: 12-16 g/100ml H: 41-*3 33 E: 36-46
3<*-* g/100ml 2.0-3.* g/100 ml 1*0<00400<000/mm3 17-30
11 ( %&u*!%
INR TPT
, ( 1,$
TS&T"
I+$S DE+$S I+$S
otro
12-e%e
1$.+
"+ ( $+ %&u*!%
126000
13.20 3
333000
DE+$S 4<1*-11 Leucocitos 3 1000/mm =asta 7 Abastonados Segmentados *4-62 1-3 Eosinóflos Basóflos 0-0<7* Linocitos 2*-33 !onocitos 3-7 P$R Q1.0 mg/. I+$S /S" DE+$S "lucosa 70-10* mg/100ml 140-240 $olesterol mg/100ml total H:40-160 mg/100ml Trigliceridos E: 3*-13* mg/100ml H0L colesterol 30-70 mg/100ml L0L colesterol 6*-17* mg/100ml /L0L * ' 40 mg/d. 4<*-<2 mg/100ml 1cido 2rico 7 ' 20 mg/dl #rea I+$S $reatinina DE+$S I+$S %rina DE+$S &albumina %rina& I+$S 'ematies DE+$S orina I+$S leucocitos DE+$S orina ceto& I+$S bilirrub DE+$S
BA$TERIAS P#S T3" 3osatasa alcalina "%T "PT $alcio BT B0 Bicarbonato 3ósoro
I+$S DE+$S 20-70 &/l -20 &/l -20 &/l <4-10<2 mg/dl #alo"es %o"males #alo"es %o"males #alo"es %o"males 3-4<* mg/dl
3<9 4 6 0 0 26 2
6<9 12 63 2 0 16 4
112
139
39
*3
0<62
0<**
Potasio
?,1;<,1 meq3l
4
3.9
Sodio
0?1;0<1 meq3l
146
147
$loro
0;0 meq3l
121
122
calcio
<,1;1,1 meq3l
1.12
1.14
!agnesio
9-106 me;/l
Bicarbonato P$% P' P%
22-26 me;/l
21
20<
3*-4* mmHg 7<3*-7<4*
4* 7.31
43 7<30
0-100 mmHg
73
74
T° 70 60 *0 40
°
30 20 10 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
FC 120 100 0 FC
60 40 20 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
FR 60 *0 40 F
30 20 10 0 1 2 3 4 * 6 7 9 10111213141*161711920212223
S O2 120 100 0 S 2
60 40 20 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
Int.$.t%!)&n $l ,acie%te sig&e e% mal estado ge%e"al< co% Fi2 de 60< e% la %oc=e la Sat2 69-70 a F as ,la;&etas a&me%ta"o%< ' se ma%tie%e% e%t"e los ID< a =emogloi%a se ele#a< s&,e"a%do la a%emia< el =ematoc"ito tami?% meKo"a< los le&cocitos s&e%< ' se coloca% e% a gl&cosa a&me%ta< la &"ea sig&e e% a&me%to< la c"eati%i%a dismi%&'e< lo ;&e %os m&est"a ;&e la &%ci!% "e%al se ma%tie%e ' %o se com,"omete. $l ,otasio sig&e simila"< el sodio a&me%ta< el calcio a&me%ta< el ica"o%ato descie%de deido a ;&e la gl&cosa a&me%ta ,o";&e 'a esta com,"ometida la al&mi%a.
a F %o aKa de 20< ' llega =asta 2*< la sat&"aci!% del oige%o e% &% mome%to llega =asta 9 ,e"o l&ego %o ,asa de 94. Co%ti%&a e% acidosis metaolica
UCI 6853652369 VALORES NORMALES Eritrocitos(mil H: 4<3-*<9 lon) E: 3<*-*.* Hemoglobina Hematocrito Proteinas totales Albumina Alo&li%a
Plaquetas +%tit"omi%a @@@
TP INR TPT TS&T" otro Leucocitos Abastonados Segmentados Eosinóflos Basóflos Linocitos !onocitos P$R /S" "lucosa $olesterol total Trigliceridos
14-e%e
1*-e%e
4.70
3.*
H: 13<*-17<* g/100ml 13.20 E: 12-16 g/100ml H: 41-*3 3 E: 36-46
3<*-* g/100ml 2.0-3.* g/100 ml 1*0<00400<000/mm3 17-30 11-13<* seg&%dos I+$S DE+$S I+$S DE+$S I+$S DE+$S I+$S DE+$S 4<1*-11 3 1000/mm =asta 7 *4-62 1-3 0-0<7* 2*-33 3-7 Q1.0 mg/. I+$S DE+$S 70-10* mg/100ml 140-240 mg/100ml H:40-160 mg/100ml
333000
6<9 12 63 2 0 16 4
139
11.0 3*
*4000
1*<7 26 62 2 0 6 4
114
E: 3*-13* mg/100ml H0L colesterol 30-70 mg/100ml L0L colesterol 6*-17* mg/100ml * ' 40 mg/d. /L0L 1cido 2rico 4<*-<2 mg/100ml #rea 7 ' 20 mg/dl *3 I+$S $reatinina 0<** DE+$S %rina I+$S &albumina DE+$S %rina& I+$S 'ematies DE+$S orina I+$S DE+$S leucocitos orina ceto& I+$S bilirrub DE+$S
*1 0<76
BA$TERIAS P#S T3" 3osatasa alcalina "%T "PT $alcio BT B0 Bicarbonato 3ósoro Potasio Sodio $loro calcio !agnesio Bicarbonato P$% P' P% Amilasa li4asa L0H $5 $P5&!B
I+$S DE+$S 20-70 &/l -20 &/l -20 &/l <4-10<2 mg/dl #alo"es %o"males
0.*0 D H+U $+C@I
#alo"es %o"males #alo"es %o"males 3-4<* mg/dl 1<3-2<1 me;/l 3<*-*<1 me;/l 137-147 me;/l 9-106 me;/l 22-2 me;/l
3.9 14* 122 1.11 20<
3*-4* mmHg 7<3*-7<4*
43 7<30
0-10* mmHg
74
Q100 &;/ 13-60 &;/ 60-120 &/
20
26-140 &/ 0-2* &/
362 139
T 70 60 *0 40
30 20 10 0 1 2 3 4 * 6 7 9 10111213141*16171192021222324
FR *0 4* 40 3* 30 2* 20 1* 10 * 0
F
1 2 3 4 * 6 7 9 10111213141*1617119202122
FC 120 100 0 FC
60 40 20 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
SO2 120 100 0 S2
60 40 20 0 1
3
*
7
9
1 1
3 1
* 1
7 1
9 1
1 2
3 2
Se e%c&e%t"a ili""&i%a total aKa< deido a ;&e 'a %o =a' e"it"ocitos< ' esta dest"&cci!% =ace ;&e 'a %o se e%c&e%t"e e% sa%g"e. Se ,"ese%ta %&e#ame%te a%emia< las ,la;&etas est% ,o" los s&elos< deido a ;&e la =emogloi%a esta aKa< ' el =ematoc"ito tami?% esta aKo< la sat&"aci!% del oige%o< co% =i,oemia< la FC se e%c&e%t"a %o"mal< la F se e%c&e%ta ele#ada. Hi,ote"mo< e =i,ote%so< ma%tie%e desat&"acio%< =emodi%amicame%te i%estale.
UCI 6B53652369
T° *0 4* 40 3* 30 2* 20 1* 10 * 0
°
1
2
3
4
*
6
7
9
10
11
12
FC 100 90 0 70 60 *0 40 30 20 10 0
FC
1
2
3
4
*
6
7
9
10
11
12
FR *0 4* 40 3* 30 2* 20 1* 10 * 0
F
1
2
3
4
*
6
7
9
10
11
12
S O2 90 0 70 60 *0 40 30 20
S 2
10 0 1
2
3
4
*
6
7
9
10
11
12
Pacie%te desa%t&"a%do< ago%ico< =i,ote%so e =i,ote"mo. Fallece a las 6:40 ,m.
CONCLUSIONES
$% "es&me%< e% las ;&emad&"as mode"adas ' g"a#es alte"a% la casi totalidad de los !"ga%os ' sistemas ' &%a desc"i,ci!% detallada se e%c&e%t"a e% die"e%tes ca,t&los ' e% el ca,t&lo de com,licacio%es e% ;&emad&"as. $l co%ocimie%to de las alte"acio%es ma"ca% la ,a&ta ,a"a di"igi" el t"atamie%to ,"e#e%ti#o ' ,e"mite toma" las medidas te"a,?&ticas &%dame%tales ,a"a dismi%&i" s& mo"ilidad ' mo"talidad.
os ,acie%tes co% ;&emad&"as g"a#es R 40.e% las ,"ime"as =o"as de
s&
i%g"eso
al
=os,ital
Ea'o"ita"iame%te
,"ese%ta%
=i,e"gl&cemia.$l Pacie%te A"a% &emado dee ma%eKa"se como ,acie%te ag&do< as%dose e% s& 5sio,atologa
Ea%eKo i%icial adec&ado meKo"a el "es<ado 5%al del ,acie%te ;&emado< eect&ado e% o"ma ,"eco. a =i,e"gl&cemia tie%e &%a "elaci!% di"ecta co% la co%ce%t"aci!% de &"ea. $% los ,acie%tes co% ;&emad&"a L 40< los %i#eles de c"eati%i%a
so% %o"males e% las
,"ime"as =o"as de s& i%te"%amie%to ' se alte"a% e% los das ' sema%as sig&ie%tes.
$% los ,acie%tes co% ;&emad&"a R 40.< los %i#eles de glo&li%a se alte"a% e% los ,"ime"os das des,&?s de oc&""ida la lesi!% ' comie%a% a "ec&,e"a"se e% las sema%as sig&ie%tes =asta llega" a %i#el %o"males.as ,"ote%as totales ' la al8mi%a em,iea% a alte"ase des,&?s de los ,"ime"os das ,"od&cida la ;&emad&"a.
os %i#eles de &"ea ele#ados es i%dicado" de la cata!lica ;&e se ,"od&ce e% los ,acie%tes co% ;&emad&"a g"a#e R 40.
RECOMENDACIONES
R&)!-i&*! ( (% )2i)(% = @!%it(&% *& >u& (#( & )(%! *& ()i&t&% )! >u&-(*u#(% #(8&% #&(i;(#&% & *!%(& *& (% 8(#i(6&% 6i!>u2-i)(% -% i-!#t(t&% >u& %& (t&#( )!-! %! ( (6-i(, u#&(, u)!%(, )#&(tii(, #!t&2(% t!t(&%, AGL Y t#ii)/#i*!% (#( !*&# *(# u t#(t(-i&t! &4i)i&t& = &4i)(; (#( &%t!% ti!% *& t#(u-(ti%-!%. L!% @((;!% &)!t#(*!% & & #&%&t& t#(6(7! *&6& %i# )!-! #&)&*&t& (#( &%tu*i!% *& -(=!# &8&#(*u#( *&*i)(*!% ( -&7!#(# & t#(t(-i&t! *& !% ()i&t&% )! &%t& ti! *& &%i!&% )!-! %! (% >u&-(*u#(%.
P(#( & &t&*i-i&t! *& &%t& t#(6(7! %& #&)!-i&*( #&8i%(# i6#!% *& 6i!>u2-i)(.
