[Sepsis Code: dodging mortality in a tertiary hospital]. / Código Sepsis: esquivando la mortalidad en un hospital terciario.

OBJECTIVE: In the hospital of La Princesa, the "Sepsis Code" (CSP) began in 2015, as a multidisciplinary group that provides health personnel with clinical, analytical and organizational tools, with the aim of the detection and early treatment of patients with sepsis. The objective of this study is to evaluate the impact of CSP implantation on mortality and to determine the variables associated with an increase in it. METHODS: A retrospective analytical study of patients with CSP alert activation from 2015 to 2018 was conducted. Clinical-epidemiological variables, analytical parameters, and severity factors such as admission to critical care units (UCC) and the need for amines were collected. Statistical significance was established at p < 0.05. RESULTS: We included 1,121 patients. The length of stay was 16 days and 32% required admission to UCC. Mortality showed a statistically significant linear downward trend from 24% in 2015 to 15% in 2018. The predictive mortality variables with statistically significant association were lactate > 2 mmol/L, creatinine > 1.6 mg/dL and the need for amines.>5.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%. CONCLUSIONS: The implementation of Sepsis Code decreases the mortality of patients with sepsis and septic shock. The presence of a lactate > 2 mmol/L, creatinine > 1.6 mg/dL and/or the need to administer amines in the first 24 hours, are associated with an increase in mortality in the patient with sepsis.

Colecistectomía ambulatoria por minilaparotomía / Outpatient colecystectomy through mini-laparotomy

Se realiza un trabajo prospectivo en un periodo de 2 años en el Hospital Regional San Pablo de Cartagena para evaluar la seguridad y aplicabilidad de la Colecistectomia dentro de un programa de cirugia ambulatoria. Como criterios de inclusion se tomaron: colelitiasis sintomatica confirmada por ultrasonografia, ausencia de litiasis de la via biliar, riesgo anestesico ASA I-II, aceptación del metodo por el paciente y residencia de este en el perimetro urbano. Se practicaron 82 colecistectomias por minilaparotomia, se encontro un predominio del sexo femenino del 95 por ciento cuya edad promedio fue de 41 años; tiempo quirurgico inferior a 45 minutos, en el 85 por ciento. No fue posible el tratamiento ambulatorio en el 13 por ciento de los pacientes, debido a hallazgos intraoperatorios inesperados o por problemas medicos posquirurgicos. No se presentaron complicaciones con los pacientes tratados ambulatoriamente, lo que demuestra la seguridad del procedimiento cuando se realiza una adecuada seleccion y manejo integral medico-familia. La Colecistectomia ambulatoria es un procedimiento seguro y eficaz que contribuye a reducir costos de atencion medica, hospitalaria, optimizando la rotacion cama-dia en los servicios quirurgicos.

Exploración clínica del hombro en el deporte / Physical examination of the shoulder in sport

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