Dolor torácico en el Servicio de Urgencia / Chest pain in urgency service

According to the literature, chest pain corresponds to an estimate of 5 to 9 percent of presenting complaints in Emergency Departments (ED) in the United States. In spite of the high rate of admission, there is still a 0,4 to 4 percent of patients who are discharged from an ED with a missed Acute Myocardial Infarction. Diagnostic etiologies range from benign to life-threatening conditions, so there is the need for a clinical approach that is both safe and cost-effective. The diagnostic strategies are based on three elements: anamnesis and physical examination, Electrocardiography and chest X-ray. This article presents an Emergency Medicine-oriented perspective in the hopes of offering to the physician a strategie focused in ruling out life-threatening conditions in the first place and then define patient disposition in an efficient and safe manner...

Dolor abdominal en urgencia / Abdominal pain in urgency

Abdominal pain is one of the most important and frequent complaints that seek resolution in the emergency departments arround the globe. Despite its high frequency and the improvement in diagnostic resources, delays and pitfalls are still present now a days. Emergency Medicine approach towards these patients focusses in ruling out severe and life threatening pathology, and appropriate management (amount of exams either blood tests or images), and pain medication of those patients which are rated as with minor risk. One of the most important goals is fast and effective pain management, while the use of new complementary diagnostic tools allow risk stratification, specially considering atypical presentations, as elderly population, immunocompromised patients or those with previous bariatric surgery...

Traslado de pacientes críticos / Critical care transport

Critical care transport is a raising need in health care because patients who have medical conditions that exceed the capabilities of the initial treating facility require timely safe transport to referral centers. Therefore, indications for inter-hospital transfer include the need for specialist intervention, a critical bed not available or ongoing support not provided in the referring hospital. The aim of transferring a critically ill patient to a reference center is to improve prognosis, and this potential benefit must outweigh potential harm derived of eventual complications or adverse events that could happen during transportation, because critically ill patients have a high risk of morbidity and mortality during transport. The most frequent indications of transfer involve time-dependent pathologies, such as Cardiovascular and Neurologic Emergencies. Pre-transport evaluation and stabilization is critical, as it contributes to minimize in-transport risks, and it must consider aspects as adequate monitoring, transportation times and conditions...