domingo, 31 de octubre de 2010

Ayuda Pancreatitis


 

Que te consigan este

Pancreatology. 2010 Oct 23;10(5):523-535. [Epub ahead of print]

Practical Guidelines for Acute Pancreatitis.

Pezzilli R, Zerbi A, Di Carlo V, Bassi C, Delle Fave GF.

Italian Association for the Study of the Pancreas.

Abstract

Introduction: The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and surgical management of acute pancreatitis. Statements: Clinical features together with elevation of the plasma concentrations of pancreatic enzymes are the cornerstones of diagnosis (recommendation A). Contrast-enhanced computed tomography (CT) provides good evidence for the presence of pancreatitis (recommendation C) and it should be carried out 48-72 h after the onset of symptoms in patients with predicted severe pancreatitis. Severity assessment is essential for the selection of the proper initial treatment in the management of acute pancreatitis (recommendation A) and should be done using the APACHE II score, serum C-reactive protein and CT assessment (recommendation C). The etiology of acute pancreatitis should be able to be determined in at least 80% of cases (recommendation B). An adequate volume of intravenous fluid should be administered promptly to correct the volume deficit and maintain basal fluid requirements (recommendation A); analgesia is crucial for the correct treatment of the disease (recommendation A). Enteral feeding is indicated in severe necrotizing pancreatitis and it is better than total parenteral nutrition (recommendation A). The use of prophylactic broad-spectrum antibiotics reduces infection rates in CT-proven necrotizing pancreatitis (recommendation A). Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention, including surgery and radiological drainage (recommendation B). Conclusions: The participants agreed to revise the guidelines every 3 years in order to re-evaluate each question on the management of acute pancreatitis patients according to the most recent literature. and IAP.

Copyright © 2010 S. Karger AG, Base

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NUEVAS GUIAS RCP 2010 [Archivo adjunto 1]

 
[Más abajo se incluyen archivos adjuntos de Edwin Villacorta]





--- El mar, 10/19/10, Jessica Bedoya <jessbeve@hotmail.com> escribió:

ULTIMO MINUTO..!!!!!!!!
NUEVAS GUIAS RCP 2010

 

Queridos Amig@s:

 

Hoy 18 de Octubre a las 00.00 horas dieron a conocer las NUEVAS GUIAS DE LA RESUCITACIÓN CARDIOPULMONAR VERSION 2010, por ello, El Comite Directivo del Consejo Peruano de Reanimacion, consciente de su mision, quiere hacer llegar de manera especial a todos sus visitantes, el contenido de las mismas incluyendo el texto completo version en ingles, lo pueden descargar gratuitamente visitando nuestra pag web: www.cpr.com.pe  y hacer sus comentarios.


            Asi mismo, agradecemos tengan a bien difundirlas, invitando nos visiten a nuestra web

 

             Jorge Vigo Ramos
Presidente del Consejo Peruano de Reanimacion

                www.cpr.com.pe

 

 


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Archivos adjuntos de Edwin Villacorta

Archivo 1 de 1

 

Protocolos - MEDICINE


 

http://www.medicineonline.es/medicine/images/logo.gif
Medicine.2010; 10
Protocolo diagnóstico de la disnea aguda
M. González Viñolis.  C. Villasante.  J.M. Pino.
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Protocolo diagnóstico de la disnea crónica
L. Bravo.  S. Alcolea.  R. Álvarez-Sala.
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Protocolo de interpretación clínica de la gasometría arterial en la insuficiencia respiratoria
D. Barros.  C. García Quero.  F. García Río.
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Indicaciones de las diversas técnicas de asistencia mecánica no invasora
D. Féliz.  M.A. Gómez-Mendieta.  C. Carpio.
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Indicaciones de la oxigenoterapia a domicilio. Seguimiento clínico
I. Lucena.  A. Santiago.  R. Álvarez-Sala.
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    Insuficiencia respiratoria 20010


     

    Insuficiencia respiratoria aguda
    C. Carpio.  D. Romera.  J. Fernández-Bujarrabal.
    Medicine.2010; 10 :4332-8
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    Insuficiencia respiratoria crónica

    C. Llontop.  C. Prados.  I. Fernández Navarro.
    Medicine.2010; 10 :4339-44
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    sábado, 30 de octubre de 2010

    Insuficiencia respiratoria 2010


     

    Insuficiencia respiratoria aguda
    C. Carpio.  D. Romera.  J. Fernández-Bujarrabal.
    Medicine.2010; 10 :4332-8
    pulse sobre visualizar documento.

    Insuficiencia respiratoria crónica

    C. Llontop.  C. Prados.  I. Fernández Navarro.
    Medicine.2010; 10 :4339-44
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    domingo, 24 de octubre de 2010

    Debemos estar TODOS....RCP + DEA Salvemos vidas! (para difusion)



     

    SoyUnHeroe

    ¡¡¡¡Cardiothon Héroes!!!! 28 de Noviembre Primer entrenamiento gratuito en Reanimación Cardiopulmonar Básica del adulto - Guías Internacionales 2010 ILCOR ERC AHA - Inscripciones abiertas vía el link:

     http://www.surveymonkey.com/s/TXCD9C2

     


     

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    solicita libros



    ----------
     

      
    Principles and Practice of Mechanical Ventilation, 2nd Edition
    by: Martin J. Tobin
    en
    2008-03-23 18:41
     
      
    Lung Biology in Health & Disease Volume 152 Long-Term Mechanical Ventilation
    by: Hill
    en | Dekker
    2008-05-05 11:06
     
      
    Noninvasive Mechanical Ventilation
    by: John R. Bach MD
    en | Hanley & Belfus
    2010-05-18 09:36
     
      
    Noninvasive Mechanical Ventilation: Theory, Equipment, and Clinical Applications
    by: Antonio Matías Esquinas
    en | Springer
    2010-08-19 08:01
     
      
    Clinics in Perinatology Vol 34 Issue 01 / 2007 Surfactant and Mechanical Ventilation
    by: S. Donn, T. Wiswell,
    en | Elsevier
    2007-05-05 17:41
     
      
    Mechanical Ventilation (Update in Intensive Care Medicine)
    by: Arthur S. Slutsky (Editor), Laurent Brochard (Editor)
    en
    2006-10-12 20:05
     
      
    Core Topics in Mechanical Ventilation
    by: Iain Mackenzie
    en
    2008-12-09 10:51
     
      
    Mechanical Ventilation: Clinical Applications and Pathophysiology
    by: Peter J. Papadakos MD, B. Lachmann MD PhD
    en | Saunders
    2010-08-07 00:19
     
      
    Fundamentals of Mechanical Ventilation: A Short Course on the Theory and Application of Mechanical Ventilators
    by: Robert L. Chatburn
    en
    2008-06-08 21:47
     
      
    Understanding Mechanical Ventilation: A Practical Handbook 2nd Edition
    by: Ashfaq Hasan
    en | Springer
    2010-02-02 23:40
      
    The Intensive Care Manual
    by: Michael J. Apostolakas Peter J. Papadakos
    en
    2006-05-26 06:01
     
      
    Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple
    by: Richard Arthur Preston
    en | Medmaster
    2006-07-10 10:34
     
      
    Fluids and Electrolytes Demystified
    by: Joyce Y. Johnson
    en
    2008-02-28 12:08
     
      
    Fluid and Electrolytes in Pediatrics: A Comprehensive Handbook (Nutrition and Health)
    by: Leonard G. Feld, Frederick J. Kaskel
    en | Humana Press
    2009-12-18 00:02
     
      
    Lange Instant Access: Acid-Base, Fluids, and Electrolytes (Lange Instant Access)
    by: Robert F. Reilly, Mark Perazella
    en | McGraw-Hill Professional
    2008-03-10 18:57
     
     
      
    Clinical Physiology of Acid-Base and Electrolyte Disorders
    by: Burton David Rose, Theodore Post, Burton Rose,
    en | McGraw-Hill Professional
    2007-06-12 08:22
     
     
     

     

             gorjussScaryCutiesRochy.gif picture by rochymauricio        

     

    "There comes a point in your life when you realize who matters, who never did, who won't anymore, and who always will. So don't worry about people from your past, there's a reason they didn't make it to your future"

    Amor no es encontrar a alguien con quien vivir, amor es encontrar a alguien que tu sientas no puedes vivir sin el..."


    sábado, 23 de octubre de 2010

    Critical Care Considerations of the Morbidly Obese



    Infinitas Gracias Amigo César Murillo, era justo lo que buscaba ... Obesidad Mórbida en Críticos... Gracias !!!!!!!!!!!!!!!!
     !!!!!!!!!!!!!
     
    LUIS A.B.F...



    De: Murillo Santucci Cesar de Assunção <murilloa@uol.com.br>
    Para: salud loreto <SALUD_LORETO@yahoogroups.com>; interno_residente_medico_PERU@yahoogroups.com
    Enviado: jue,21 octubre, 2010 23:39
    Asunto: [SALUD_LORETO] Critical Care Considerations of the Morbidly Obese



    Critical Care Considerations of the Morbidly Obese

    07490704_00260004_cov150h.gif 
    Critical Care Clinics Volume 26, Issue 4, Pages e1-e10, 583-742 (October 2010)

    Critical Care Considerations of the Morbidly Obese

            Contents  
    5 The Obesity Paradox 
    Dennis E. Amundson, Svetolik Djurkovic, Gregory N. Matwiyoff
    Open Show preview  |   PDF (108 K)   |   Related articles  |  Related reference work articles
    The term "obesity paradox" refers to the observation that, although obesity is a major risk factor in the development of cardiovascular and peripheral vascular disease, when acute cardiovascular decompensation occurs, for example, in myocardial infarction or congestive heart failure, obese patients may have a survival benefit. In addition, it has been suggested that obese patients tend to fare better after certain surgical procedures, such as coronary artery bypass surgery. Moreover, it appears that obese men with chronic hypertensive heart disease live longer than men of normal weight. Mounting evidence shows that obesity alone may confer a survival benefit independent of age, medical care, or therapy. Perhaps the definition of obesity needs to be revisited, and it is also possible that all fat is not equal.
    Effects of Obesity by System and Critical Care Considerations

    6         Pulmonary System and Obesity
    Doyle D. Ashburn, Angela DeAntonio, Mary Jane Reed
    Open Show preview  |   PDF (67 K)   |   Related articles  |  Related reference work articles
    There are several challenges in the management of respiratory failure in the obese population. Pulmonary physiology is significantly altered leading to reduced lung volumes, decreased compliance, abnormal ventilation and perfusion relationships, and respiratory muscle inefficiency. These complications can lead to a prolonged requirement for mechanical ventilation and increased intensive-care-unit length of stay.

    7 Cardiovascular Considerations in Critically Ill Obese Patients
    Mitchell K. Craft, Mary Jane Reed
    Open Show preview  |   PDF (42 K)   |   Related articles  |  Related reference work articles
    With a growing obese population, preventative and therapeutic strategies need to be developed to combat the complex cardiac pathophysiology related to obesity. This is paramount in the management of critically ill obese patients. This article highlights these strategies.

    8 Acute Kidney Injury in the Critically Ill, Morbidly Obese Patient: Diagnostic and Therapeutic Challenges in a Unique Patient Population 
    Ion D. Bucaloiu, Robert M. Perkins, William DiFilippo, Taher Yahya, Evan Norfolk
    Open Show preview  |   PDF (148 K)   |   Related articles  |  Related reference work articles
    The growing burden of morbid obesity (body mass index >40 kg/m2) on critical care resources translates to a significant incidence of acute kidney injury (AKI) in morbidly obese (MO), critically ill patients. This article examines the literature pertinent to AKI in critically ill MO patients. After a concise review of the available epidemiologic data regarding the incidence of acute renal injury in MO individuals, the authors review the limitations and available tools for estimation of renal function in the MO population (with emphasis on the critical illness). Also described are several specific types of renal injury previously described in this population that are applicable to the critical care setting. Lastly, the authors review some of the challenges and limitations in providing renal support to critically ill MO individuals, and identify potential areas for future research in this population.

    9         Gastrointestinal System and Obesity
    Pages 625-627
    Doyle D. Ashburn, Mary Jane Reed
    Open Show preview  |   PDF (44 K)   |   Related articles  |  Related reference work articles
    Several significant changes occur in the gastrointestinal system with obesity that can effect management in critical illness. This population is at risk for gastroesophageal reflux disease (GERD), abdominal compartment syndrome, nonalcoholic fatty liver disease (NAFLD), and an increased incidence of cholelithiasis. It is important for critical care providers to be aware of these potential complicating factors.

    10        Immunologic Changes in Obesity
    Pages 629-631
    Mitchell K. Craft, Mary Jane Reed
    Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
    A growing body of literature suggests multifaceted alterations to the immune function in obese patients compared with a lean cohort. Although treatment in the intensive care unit has an associated risk of infectious complications, which, if any, of these immunologic alterations are causal is unclear. Obesity clearly causes abundant alterations to the immune system. Overall, the aggregate effect seems to be chronic activation of inflammatory mediators.

    11        Endocrine System and Obesity
    Pages 633-636
    Doyle D. Ashburn, Mary Jane Reed
    Open Show preview  |   PDF (50 K)   |   Related articles  |  Related reference work articles
    Obesity is associated with significant alterations in endocrine function. An association with type 2 diabetes mellitus and dyslipidemia has been well documented. This article highlights the complexities of treating endocrine system disorders in obese patients.

    12        Venous Thromboembolic Disease and Hematologic Considerations in Obesity
    Mitchell K. Craft, Mary Jane Reed
    Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
    Venous thromboembolic disease continues to be a major source of morbidity and mortality, with obese patients who are critically ill presenting some of the most at-risk patients. As the literature evolves, it has become clear that there is a complex relationship between obesity and thrombosis and atherogenesis. It is true that many of these conditions are reversible with weight loss; however, obesity remains on the rise. Management of obese patients must incorporate and consider these intricate changes in an attempt to improve patient outcomes.

    13         Airway Management in the Obese Patient
    William A. Loder
    Open Show preview  |   PDF (409 K)   |   Related articles  |  Related reference work articles
    Any patient can have a difficult airway, but obese patients have anatomic and physiologic features that can make airway management particularly challenging. Obesity does not seem to be an independent risk factor for difficult intubation but is one of the several factors that need to be considered as part of an airway evaluation. To effectively manage airways in obese patients, health care providers working in the intensive care unit setting must be proficient in airway evaluation and management in all types of patients. This article discusses the risk factors for a difficult airway and the methods of managing the airway.

    Procedures in the Morbidly Obese Critically Ill

    14         Vascular Procedures in the Critically Ill Obese Patient
    Omar Rahman, Laurel Willis
    Open Show preview  |   PDF (109 K)   |   Related articles  |  Related reference work articles
    The increasing societal prevalence of obesity is consequential to the increasing number of critically ill obese patients. Vascular procedures are an essential aspect of care in these patients. This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed.

    15         Ultrasound-Assisted Lumbar Puncture in Obese Patients
    Robert Strony
    Open Show preview  |   PDF (442 K)   |   Related articles  |  Related reference work articles
    The use of ultrasound to mark landmarks for diagnostic lumbar puncture has been described in emergency medicine as well as in the anesthesia literature. One of the most difficult scenarios arises when obese patients with a body mass index (BMI) of greater than 30 present to an acute care setting, such as the emergency department or intensive care unit and require diagnostic LP. This article discusses lumbar puncture in patients with a high BMI.

    16         Bedside and Radiologic Procedures in the Critically Ill Obese Patient
    Michelle Olson, Chris Pohl
    Open Show preview  |   PDF (43 K)   |   Related articles  |  Related reference work articles
    Performance of procedures upon the obese critically ill patient in the ICU or in the radiology suite, require certain considerations. Additional staff, equipment and proper ergonomics are often necessary to perform these procedures safely for both patient and staff.

    17         Tracheostomy in Critical Ill Morbidly Obese
    Michael Clark, Scott Greene, Mary Jane Reed
    Open Show preview  |   PDF (125 K)   |   Related articles  |  Related reference work articles

    18         Nutrition in Critically Ill Obese Patients
    Naeem Raza, Peter N. Benotti, Christopher D. Still
    Open Show preview  |   PDF (68 K)   |   Related articles  |  Related reference work articles
    Critically ill obese patients require timely nutrition in the intensive care unit. Hypocaloric, high protein nutritional feeding might have a role in critically ill obese patients. Although critically ill obese patients need special medical and nutritional care as do nonobese patients in the ICU, there are some differences in the literature about the initiation, routes, and nature of nutritional support. This article reviews the norms of nutritional care among critically ill obese patients and the differences between these patients and those with a normal BMI.

    19         Pharmacotherapy in the Critically Ill Obese Patient
    Charles J. Medico, Patrick Walsh
    Open Show preview  |   PDF (90 K)   |   Related articles  |  Related reference work articles
    Despite the growing epidemic of obesity in the United States, dosing medications in such patients remains poorly studied and understood. Most recommendations are based on small independent studies, case reports, and expert opinion. Applying manufacturer kinetics and dosing recommendations in the obese patient may result in toxicity or treatment failure, leading to increased morbidity, mortality, and hospital length of stay.

    Special Populations

    20         Trauma in Obese Patients
    Christine C. Toevs
    Open Show preview  |   PDF (50 K)   |   Related articles  |  Related reference work articles
    As the American population grows larger in terms of weight and body mass index each year, a greater percentage of patients admitted to the trauma service are overweight or obese. Obese patients do not have the same injury patterns or outcomes of normal-weight patients. This article reviews some of the latest data regarding the injury patterns, outcomes, and areas of further studies in the obese trauma population.

    21         Bariatric Surgery Patients in the ICU
    Mary Jane Reed, Jon Gabrielsen
    Open Show preview  |   PDF (187 K)   |   Related articles  |  Related reference work articles
    As the incidence of bariatric surgery continues to increase, the medical community should be aware of the most common procedures, resultant anatomy, and possible complications to be better prepared to care for these patients in all situations.

    22         Special Considerations in the Critically Ill Morbidly Obese Child
    Karen Allison Bailey
    Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
    Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specific concern and require special consideration when the morbidly obese child becomes critically ill.

    23         Critical Care of the Morbidly Obese in Disaster
    James Geiling
    Open Show preview  |   PDF (89 K)   |   Related articles  |  Related reference work articles
    The prevalence of obesity in the United States is increasing, with extreme morbid obesity of body mass index greater than 40 increasing twice as fast as obesity in general. With the increased weight comes an increased risk of comorbidities, including type 2 diabetes mellitus, cardiovascular disease, respiratory problems such as obstructive sleep apnea or restrictive lung disease, skin disorders such as intertrigo and cellulitis, and urinary incontinence. Thus, patients exposed to a variety of disasters not only are increasingly overweight but also have an associated number of coexistent medical conditions that require increased support with medical devices and medications. This article focuses on management of the morbidly obese patients during disasters.

    24         Special Populations Critical Care Considerations of the Morbidly Obese Pregnant Patient
    Marie R. Baldisseri, Margaret D. Larkins-Pettigrew
    Open Show preview  |   PDF (123 K)   |   Related articles  |  Related reference work articles
    The critically ill pregnant patient poses a unique challenge to the clinician, requiring a thorough understanding of normal and abnormal maternal and fetal physiology associated with pregnancy. The morbidly obese patient presents even greater challenges to the clinician, and morbidity and mortality are proportionately increased. Because increased numbers of obese pregnant women are now admitted to intensive care units, practitioners must be aware of the physiology associated with both pregnancy and obesity. A multidisciplinary approach is imperative to prevent both maternal and fetal morbidity and mortality for these very complex patients, especially when they are admitted to the ICU with critical illness.

    25         Afterword: Sensitivity in Caring for the Obese Patient  
    Page 733
    Michele Chamberlain
    Open Show preview  |   PDF (27 K)   |   Related articles  |  Related reference work articles

    26         Index  
    Open Show preview  |   PDF (44 K)   |   Related articles  |  Related reference work articles

    27         Indirect Calorimetry Measurements in the Ventilated Critically Ill Patient: Facts and Controversies—The Heat is On  
    Shaul Lev, Jonathan Cohen, Pierre Singer
    Open Show preview  |   PDF (84 K)   |   Related articles  |  Related reference work articles
    The provision of nutrition to critically ill patients in the ICU often receives lower priority compared with hemodynamic and ventilation control. This frequently results in a significant calorie deficit. Overestimation of daily energy expenditure may also result in adverse outcomes. In many centers, nutritional decision making is based on predictive formulas, which have been shown to underestimate true energy requirements. Such estimations are ideally performed using indirect calorimetry. Nevertheless, the use of indirect calorimetry has been limited owing to costs and technical difficulties. Controversies about its actual clinical benefits are the focus of recent clinical studies and recommendations. The aim of this review was to describe the advantages of measuring indirect calorimetry within the concept of energy–protein goal-oriented therapy.

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    Murillo Santucci Cesar de Assunção
    Unidade de Terapia Intensiva adulto
    Disciplina de Anestesiologia, Dor e Terapia Intensiva
    Escola Paulista de Medicina
    Rua Napoleão de Barros,715
    Vila Clementino - São Paulo - CEP: 04024-002
    Tel/Fax: +55-11-55757768
    Tel/Fax: +55-11- 55764069










    Murillo Santucci Cesar de Assunção
    Unidade de Terapia Intensiva adulto
    Disciplina de Anestesiologia, Dor e Terapia Intensiva
    Escola Paulista de Medicina
    Rua Napoleão de Barros,715
    Vila Clementino - São Paulo - CEP: 04024-002
    Tel/Fax: +55-11-55757768
    Tel/Fax: +55-11- 55764069











    jueves, 21 de octubre de 2010

    Nosologia

    Nosología

    La nosología es la ciencia que —formando parte del cuerpo de conocimientos de la medicina— tiene por objeto describir, explicar, diferenciar y clasificar la amplia variedad de enfermedades y procesos patológicos existentes, entendiendo estos como entidades clínico-semiológicas, generalmente independientes e identificables según criterios idóneos.

    [editar] Concepto

    Implica una sistematización de las entidades por los conocimientos que se tiene de ellas, basados en supuestos teóricos sobre la naturaleza de los procesos patológicos.

    Nosotaxia: se ocupa de mostrar como están clasificados y como se ubican sistemáticamente las enfermedades, cualquier desorden o trastorno en la salud. La nosología se identifica como la ciencia taxonómica de las enfermedades. Comporta una organización coherente de los fenómenos patológicos según un contexto más o menos establecido donde enmarcarlos.

    • Descripción: intenta conocer las características
    • Diferenciación: identificación
    • Clasificación: relaciones con otros procesos

    [editar] Reseña histórica

    La Nosología surgió en el siglo XVIII con la clasificación de las especies animales y vegetales. Los primeros "usuarios" de la nosología fueron los dermatólogos, pero su utilización corriente sólo se da en el siglo XIX.

    [editar] Subdisciplinas y campos

    De una manera general, la Nosología es un campo de conocimientos de la medicina, pero también forma parte de otras ciencias de la salud, como la veterinaria.

    La nosología comporta varias áreas internas e interrelacionadas, con diferentes competencias cada una, a saber: nosonomía, nosotaxia, nosografía y nosognóstica. Esquemáticamente:

    1. Nosonomia (concepto de enfermedad). Concepto de vida y ser vivo. Evolución histórica del concepto de enfermedad. Salud y enfermedad. Individuo sano e individuo enfermo. Nominación de enfermedades, sinonimia y prefijos y sufijos más utilizados en Patología.
    2. Nosotaxia (clasificación de las enfermedades).
    3. Nosografía (descripción de la enfermedad: etiología, patogenia, nosobiótica, semiótica y patocronia).
      1. Etiología General (causas de la enfermedad). Concepto de causa morbífica. Clasificación de las causas morbíficas.
      2. Patogenia [nosogenia] (génesis y desarrollo de la enfermedad). Doctrinas patogénicas. La reacción viva local y general. El síndrome general de adaptación. Patología de la adaptación.
      3. Nosobiótica (alteraciones que conlleva la enfermedad). Alteraciones morfológicas. Alteraciones o perturbaciones funcionales. Insuficiencia funcional. El dolor en Patología.
      4. Semiótica (síntomas y signos clínicos). Concepto de síntoma y de signo clínico. Concepto de síndrome y cuadro sintomático. Semiotecnia y semiología.
      5. Patocronia (evolución de la enfermedad). Periodo de comienzo. Periodo clínico: complicaciones y metástasis. Periodo de terminación: por curación (recaídas y recidivas) o por muerte (agonía, muerte y metagonía).
    4. Nosognostica (calificación de la enfermedad). Los juicios clínicos (diagnóstico, pronóstico y terapéutico) y sus fuentes, tipos y procedimientos.

    El primer campo (la nosología) constituye un discurso completo sobre la enfermedad que tiene en cuenta la semiología (los síntomas), la etiología (el origen de la enfermedad), la patogenia (o patogenesia: mecanismo según el cual un agente causa una enfermedad).

    El segundo campo (la nosografía) define, con ayuda de información precisa, una clasificación a menudo puesta en entredicho a causa de los numerosos descubrimientos que se refieren un virus, una bacteria o una enfermedad mental por ejemplo.

    [editar] Clasificación

    Las clasificaciones internacionales que nos permiten agrupar las diferentes etiquetas diagnósticas son:

    Critical Care Considerations of the Morbidly Obese

    Critical Care Considerations of the Morbidly Obese

    07490704_00260004_cov150h.gif 
    Critical Care Clinics Volume 26, Issue 4, Pages e1-e10, 583-742 (October 2010)

    Critical Care Considerations of the Morbidly Obese

            Contents  
    5 The Obesity Paradox 
    Dennis E. Amundson, Svetolik Djurkovic, Gregory N. Matwiyoff
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    The term "obesity paradox" refers to the observation that, although obesity is a major risk factor in the development of cardiovascular and peripheral vascular disease, when acute cardiovascular decompensation occurs, for example, in myocardial infarction or congestive heart failure, obese patients may have a survival benefit. In addition, it has been suggested that obese patients tend to fare better after certain surgical procedures, such as coronary artery bypass surgery. Moreover, it appears that obese men with chronic hypertensive heart disease live longer than men of normal weight. Mounting evidence shows that obesity alone may confer a survival benefit independent of age, medical care, or therapy. Perhaps the definition of obesity needs to be revisited, and it is also possible that all fat is not equal.
    Effects of Obesity by System and Critical Care Considerations

    6         Pulmonary System and Obesity
    Doyle D. Ashburn, Angela DeAntonio, Mary Jane Reed
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    There are several challenges in the management of respiratory failure in the obese population. Pulmonary physiology is significantly altered leading to reduced lung volumes, decreased compliance, abnormal ventilation and perfusion relationships, and respiratory muscle inefficiency. These complications can lead to a prolonged requirement for mechanical ventilation and increased intensive-care-unit length of stay.

    7 Cardiovascular Considerations in Critically Ill Obese Patients
    Mitchell K. Craft, Mary Jane Reed
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    With a growing obese population, preventative and therapeutic strategies need to be developed to combat the complex cardiac pathophysiology related to obesity. This is paramount in the management of critically ill obese patients. This article highlights these strategies.

    8 Acute Kidney Injury in the Critically Ill, Morbidly Obese Patient: Diagnostic and Therapeutic Challenges in a Unique Patient Population 
    Ion D. Bucaloiu, Robert M. Perkins, William DiFilippo, Taher Yahya, Evan Norfolk
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    The growing burden of morbid obesity (body mass index >40 kg/m2) on critical care resources translates to a significant incidence of acute kidney injury (AKI) in morbidly obese (MO), critically ill patients. This article examines the literature pertinent to AKI in critically ill MO patients. After a concise review of the available epidemiologic data regarding the incidence of acute renal injury in MO individuals, the authors review the limitations and available tools for estimation of renal function in the MO population (with emphasis on the critical illness). Also described are several specific types of renal injury previously described in this population that are applicable to the critical care setting. Lastly, the authors review some of the challenges and limitations in providing renal support to critically ill MO individuals, and identify potential areas for future research in this population.

    9         Gastrointestinal System and Obesity
    Pages 625-627
    Doyle D. Ashburn, Mary Jane Reed
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    Several significant changes occur in the gastrointestinal system with obesity that can effect management in critical illness. This population is at risk for gastroesophageal reflux disease (GERD), abdominal compartment syndrome, nonalcoholic fatty liver disease (NAFLD), and an increased incidence of cholelithiasis. It is important for critical care providers to be aware of these potential complicating factors.

    10        Immunologic Changes in Obesity
    Pages 629-631
    Mitchell K. Craft, Mary Jane Reed
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    A growing body of literature suggests multifaceted alterations to the immune function in obese patients compared with a lean cohort. Although treatment in the intensive care unit has an associated risk of infectious complications, which, if any, of these immunologic alterations are causal is unclear. Obesity clearly causes abundant alterations to the immune system. Overall, the aggregate effect seems to be chronic activation of inflammatory mediators.

    11        Endocrine System and Obesity
    Pages 633-636
    Doyle D. Ashburn, Mary Jane Reed
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    Obesity is associated with significant alterations in endocrine function. An association with type 2 diabetes mellitus and dyslipidemia has been well documented. This article highlights the complexities of treating endocrine system disorders in obese patients.

    12        Venous Thromboembolic Disease and Hematologic Considerations in Obesity
    Mitchell K. Craft, Mary Jane Reed
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    Venous thromboembolic disease continues to be a major source of morbidity and mortality, with obese patients who are critically ill presenting some of the most at-risk patients. As the literature evolves, it has become clear that there is a complex relationship between obesity and thrombosis and atherogenesis. It is true that many of these conditions are reversible with weight loss; however, obesity remains on the rise. Management of obese patients must incorporate and consider these intricate changes in an attempt to improve patient outcomes.

    13         Airway Management in the Obese Patient
    William A. Loder
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    Any patient can have a difficult airway, but obese patients have anatomic and physiologic features that can make airway management particularly challenging. Obesity does not seem to be an independent risk factor for difficult intubation but is one of the several factors that need to be considered as part of an airway evaluation. To effectively manage airways in obese patients, health care providers working in the intensive care unit setting must be proficient in airway evaluation and management in all types of patients. This article discusses the risk factors for a difficult airway and the methods of managing the airway.

    Procedures in the Morbidly Obese Critically Ill

    14         Vascular Procedures in the Critically Ill Obese Patient
    Omar Rahman, Laurel Willis
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    The increasing societal prevalence of obesity is consequential to the increasing number of critically ill obese patients. Vascular procedures are an essential aspect of care in these patients. This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed.

    15         Ultrasound-Assisted Lumbar Puncture in Obese Patients
    Robert Strony
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    The use of ultrasound to mark landmarks for diagnostic lumbar puncture has been described in emergency medicine as well as in the anesthesia literature. One of the most difficult scenarios arises when obese patients with a body mass index (BMI) of greater than 30 present to an acute care setting, such as the emergency department or intensive care unit and require diagnostic LP. This article discusses lumbar puncture in patients with a high BMI.

    16         Bedside and Radiologic Procedures in the Critically Ill Obese Patient
    Michelle Olson, Chris Pohl
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    Performance of procedures upon the obese critically ill patient in the ICU or in the radiology suite, require certain considerations. Additional staff, equipment and proper ergonomics are often necessary to perform these procedures safely for both patient and staff.

    17         Tracheostomy in Critical Ill Morbidly Obese
    Michael Clark, Scott Greene, Mary Jane Reed
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    18         Nutrition in Critically Ill Obese Patients
    Naeem Raza, Peter N. Benotti, Christopher D. Still
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    Critically ill obese patients require timely nutrition in the intensive care unit. Hypocaloric, high protein nutritional feeding might have a role in critically ill obese patients. Although critically ill obese patients need special medical and nutritional care as do nonobese patients in the ICU, there are some differences in the literature about the initiation, routes, and nature of nutritional support. This article reviews the norms of nutritional care among critically ill obese patients and the differences between these patients and those with a normal BMI.

    19         Pharmacotherapy in the Critically Ill Obese Patient
    Charles J. Medico, Patrick Walsh
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    Despite the growing epidemic of obesity in the United States, dosing medications in such patients remains poorly studied and understood. Most recommendations are based on small independent studies, case reports, and expert opinion. Applying manufacturer kinetics and dosing recommendations in the obese patient may result in toxicity or treatment failure, leading to increased morbidity, mortality, and hospital length of stay.

    Special Populations

    20         Trauma in Obese Patients
    Christine C. Toevs
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    As the American population grows larger in terms of weight and body mass index each year, a greater percentage of patients admitted to the trauma service are overweight or obese. Obese patients do not have the same injury patterns or outcomes of normal-weight patients. This article reviews some of the latest data regarding the injury patterns, outcomes, and areas of further studies in the obese trauma population.

    21         Bariatric Surgery Patients in the ICU
    Mary Jane Reed, Jon Gabrielsen
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    As the incidence of bariatric surgery continues to increase, the medical community should be aware of the most common procedures, resultant anatomy, and possible complications to be better prepared to care for these patients in all situations.

    22         Special Considerations in the Critically Ill Morbidly Obese Child
    Karen Allison Bailey
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    Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specific concern and require special consideration when the morbidly obese child becomes critically ill.

    23         Critical Care of the Morbidly Obese in Disaster
    James Geiling
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    The prevalence of obesity in the United States is increasing, with extreme morbid obesity of body mass index greater than 40 increasing twice as fast as obesity in general. With the increased weight comes an increased risk of comorbidities, including type 2 diabetes mellitus, cardiovascular disease, respiratory problems such as obstructive sleep apnea or restrictive lung disease, skin disorders such as intertrigo and cellulitis, and urinary incontinence. Thus, patients exposed to a variety of disasters not only are increasingly overweight but also have an associated number of coexistent medical conditions that require increased support with medical devices and medications. This article focuses on management of the morbidly obese patients during disasters.

    24         Special Populations Critical Care Considerations of the Morbidly Obese Pregnant Patient
    Marie R. Baldisseri, Margaret D. Larkins-Pettigrew
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    The critically ill pregnant patient poses a unique challenge to the clinician, requiring a thorough understanding of normal and abnormal maternal and fetal physiology associated with pregnancy. The morbidly obese patient presents even greater challenges to the clinician, and morbidity and mortality are proportionately increased. Because increased numbers of obese pregnant women are now admitted to intensive care units, practitioners must be aware of the physiology associated with both pregnancy and obesity. A multidisciplinary approach is imperative to prevent both maternal and fetal morbidity and mortality for these very complex patients, especially when they are admitted to the ICU with critical illness.

    25         Afterword: Sensitivity in Caring for the Obese Patient  
    Page 733
    Michele Chamberlain
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    26         Index  
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    27         Indirect Calorimetry Measurements in the Ventilated Critically Ill Patient: Facts and Controversies—The Heat is On  
    Shaul Lev, Jonathan Cohen, Pierre Singer
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    The provision of nutrition to critically ill patients in the ICU often receives lower priority compared with hemodynamic and ventilation control. This frequently results in a significant calorie deficit. Overestimation of daily energy expenditure may also result in adverse outcomes. In many centers, nutritional decision making is based on predictive formulas, which have been shown to underestimate true energy requirements. Such estimations are ideally performed using indirect calorimetry. Nevertheless, the use of indirect calorimetry has been limited owing to costs and technical difficulties. Controversies about its actual clinical benefits are the focus of recent clinical studies and recommendations. The aim of this review was to describe the advantages of measuring indirect calorimetry within the concept of energy–protein goal-oriented therapy.

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    Murillo Santucci Cesar de Assunção
    Unidade de Terapia Intensiva adulto
    Disciplina de Anestesiologia, Dor e Terapia Intensiva
    Escola Paulista de Medicina
    Rua Napoleão de Barros,715
    Vila Clementino - São Paulo - CEP: 04024-002
    Tel/Fax: +55-11-55757768
    Tel/Fax: +55-11- 55764069










    Murillo Santucci Cesar de Assunção
    Unidade de Terapia Intensiva adulto
    Disciplina de Anestesiologia, Dor e Terapia Intensiva
    Escola Paulista de Medicina
    Rua Napoleão de Barros,715
    Vila Clementino - São Paulo - CEP: 04024-002
    Tel/Fax: +55-11-55757768
    Tel/Fax: +55-11- 55764069