ABSTRACT
El tromboembolismo venoso (TEV), incluida la trombosis venosa profunda (TVP) y la embolia pulmonar (TEP) es una afección potencialmente letal y a tener en cuenta en mujeres embarazadas, donde la situación es favorecida por los cambios fisiológicos característicos de la gestación, el parto y el puerperio. El manejo de esta patología en este tipo de pacientes está basado en la anticoagulación, con los beneficios e inconvenientes que ello implica. Presentamos el caso de una mujer embarazada con TVP masiva e intentamos arrojar luz sobre temas como son la vía de parto (vaginal vs. cesárea) o el manejo del tratamiento (heparina de bajo peso molecular [HBPM] vs. heparina no fraccionada [HNF]) de cara a obtener la situación más segura para la paciente.(AU)
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially lethal condition to be taken into account in pregnant women, where the situation is favored by the characteristic physiological changes of the pregnancy, childbirth and the puerperium. The management of this pathology in this type of patient is based on anticoagulation, with the benefits and drawbacks that this implies. We present the case of a pregnant woman with massive DVT and the issues are discussed, such as the method of delivery (vaginal vs. cesarean section) or the management of treatment (LMWH vs. UFH) in order to obtain the safest situation for the patient.(AU)
Subject(s)
Humans , Female , Adult , Pregnant Women , Venous Thrombosis , Cesarean Section , Anesthesia, Obstetrical , Heparin , Anticoagulants , Inpatients , Physical Examination , Symptom Assessment , Echocardiography, Doppler , Anesthesiology , Anesthesia , Cardiopulmonary Resuscitation , Venous ThromboembolismABSTRACT
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially lethal condition to be taken into account in pregnant women, where the situation is favored by the characteristic physiological changes of the pregnancy, childbirth and the puerperium. The management of this pathology in this type of patient is based on anticoagulation, with the benefits and drawbacks that this implies. We present the case of a pregnant woman with massive DVT and the issues are discussed, such as the method of delivery (vaginal vs. cesarean section) or the management of treatment (LMWH vs. UFH) in order to obtain the safest situation for the patient.
Subject(s)
Heparin, Low-Molecular-Weight , Venous Thrombosis , Anticoagulants/therapeutic use , Cesarean Section , Female , Humans , Pregnancy , Pregnant Women , Venous Thrombosis/etiologyABSTRACT
Iatrogenic tracheal rupture (ITR) is a serious complication secondary to procedures such as emergent orotracheal intubation or tracheostomy, among others. The management of ITR depends on the size, extension and location of the injury, along with the patient's respiratory status and comorbidities. The priority of treatment is to keep the airway permeable to ensure adequate ventilation. We present the case of a tracheal rupture after performing a percutaneous tracheostomy, in a patient diagnosed with severe acute respiratory distress syndrome secondary to bilateral interstitial pneumonia due to SARS-Cov-2. The issues are discussed, such as the management (conservative vs. surgical) depending on the features of the injury and the patient, in the extraordinary context that the COVID-19 pandemic has entailed.
Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Iatrogenic Disease , Pandemics , Respiratory Distress Syndrome/etiology , Rupture , SARS-CoV-2 , Trachea/diagnostic imagingABSTRACT
Iatrogenic tracheal rupture is a serious complication secondary to procedures such as emergent orotracheal intubation or tracheostomy, among others. The management of iatrogenic tracheal rupture depends on the size, extension and location of the injury, along with the patient's respiratory status and comorbidities. The priority of treatment is to keep the airway permeable to ensure adequate ventilation. We present the case of a tracheal rupture after performing a percutaneous tracheostomy, in a patient diagnosed with severe acute respiratory distress syndrome secondary to bilateral interstitial pneumonia due to SARS-CoV-2. The issues are discussed, such as the management (conservative vs. surgical) depending on the features of the injury and the patient, in the extraordinary context that the COVID-19 pandemic has entailed.
ABSTRACT
ANTEDECENTES Y OBJETIVOS: La IGESAN (Inspección General de Sanidad) establece el protocolo del reconocimiento médico previo a la realización del test general de condición física que deben realizar los componentes del Ejército de Tierra. La Clínica Militar de Melilla participa en estos reconocimientos. Pretendemos estudiar el estado de salud cardiovascular del militar en Melilla; compararlo con otras muestras similares y valorar la eficiencia y eficacia de la telemedicina en la prevención de eventos cardiovasculares durante dicho test. MATERIAL Y MÉTODOS: Historia clínica, exploración física, electrocardiograma, uso de telemedicina, recogida de datos y tratamiento estadístico. RESULTADOS: Se estudiaron 634 varones entre 39 y 61 años con = 47,8. En Melilla se consideraron patológicos 58 electrocardiogramas que tras remisión por telemedicina y estudio en Cardiología de Hospital Central de la Defensa se determinó que 20 no eran aptos para el test. La hipertensión arterial se asoció (p < 0.005) con la no aptitud para las pruebas físicas. Se detectaron numerosos patrones electrocardiográficos propios de deportistas. El hábito de fumar fue el factor de riesgo prevalente. Más del 95% de los afectados por factores de riesgo vascular cumplen con el tratamiento farmacológico. CONCLUSIONES: La guarnición militar de Melilla presenta una baja prevalencia de factores de riesgo vascular comparado con estudios similares probablemente por su alto nivel de actividad deportiva. La telemedicina es un instrumento eficiente para la valoración cardiológica previa a las pruebas físicas. La prevención cardiovascular y la formación en Medicina Deportiva son fundamentales para optimizar la eficiencia del test de condición física
BACKGROUND AND AIMS: The IGESAN (General Inspectorate of the Military Health Service) sets the protocol of the medical examination prior to the annual performing of the General Test of Physical Condition that all the military members of the Army must undergo. Melilla Military Clinic participates in the carrying out of these medicals. We intend to study the cardiovascular health condition of the military in Melilla garrison; to compare it with other similar samples and evaluate the efficiency of the use of telemedicine concerning the improvement in cardiovascular event prevention during the performing of the test. MATERIAL AND METHODS: Medical history; physical examination; electrocardiogram; telemedicine; data collecting and statistical study. RESULTS: 634 male adults with an age range from 39 to 61 ( = 47.8) were studied in Melilla. 58 electrocardiograms were considered pathological and they were sent, via telemedicine, to the Cardiology Department of the Armed Forces Central Hospital where 20 out of the 58 electrocardiograms were deemed to belong to subjects unfit to perform the test. High blood pressure (p < 0.005) was associated with lack of fitness for the test. Many of the electrocardiographic patterns detected were the same as those of sports men's. Smoking was the prevalent risk factor. More than 95% of the subjects affected by vascular risk factors were following their pharmacological treatments. CONCLUSIONS: Compared to similar studies, Melilla military contingent shows a low prevalence in vascular risk factors, and this is so, probably, due to its high level of sports activities. Telemedicine is a useful and efficient tool for the cardiological evaluation prior to the test of physical condition. Cardiovascular prevention as well as knowledge on sports medicine are essential to optimize the efficiency in the general test of physical condition
