RESUMO
INTRODUCTION: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. METHODS: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. RESULTS: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. CONCLUSION: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs.
Assuntos
Educação de Pós-Graduação em Medicina/normas , Medicina de Emergência/educação , Internato e Residência/normas , Desenvolvimento de Programas/normas , Colômbia , Currículo , Medicina de Emergência/normas , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
El fluoroacetato de sodio es conocido como compuesto 1080, fue descubierto por químicos alemanes durante la segunda guerra mundial. Es un compuesto inodoro e insaboro, soluble en agua, la dosis letal 50 en humanos es de 2 a 4 mg/kg. Debido a su letalidad, ha sido retirado del mercado en algunos países incluyendo Colombia. Este compuesto causa efectos bioquímicos y fisiológicos como acumulación de citrato, alteración de los trasportadores mitocondriales del citrato, acumulación de acido láctico, alteración de la regulación de la glucosa y alteraciones hidrioelectroliticas (principalmente en los niveles de calcio). Las manifestaciones clínicas de intoxicación por esta sustancia son inespecíficas, lo que dificulta su identificación y tratamiento oportuno, aumentando su letalidad. El etanol aumenta el nivel de acetato, ofreciendo así un sustrato alterno al ciclo de Krebs y puede ofrecer beneficios en el tratamiento agudo de estos pacientes. Sin embargo, el manejo de soporte es el pilar fundamental del manejo de estos casos. Se presenta un caso de ingestión intencional en un adolescente con diagnóstico tardío y con desenlace satisfactorio.
Sodium fluoroacetate is known as compound 1080; it was discovered by the German chemicals during World War II. It is a compound soluble in water, odorless and tasteless. The lethal dose 50 in humans is 2 to 4 mg/kg. Because of its lethality, it has been recalled in several countries including Colombia. This compound causes biochemical and physiological effects as citrate accumulation, altered mitochondrial Citrate transporter, the accumulation of lactic acid, impaired glucose regulation and hidroelectrolyte disorders (mainly calcium disturbances). The clinical manifestations of poisoning by this substance are non-specific, which males their identificacion and treatment difficult, making it to increase its lethality. Ethanol increases the level of acetat, thus providing an alternative substrate Krebs cycle and may offer benefits in the acute treatment of these patients; however, management support is the mainstay of management of these cases. Here it is reported a case of intentional ingestion in an adolescent, with delayed diagnosis a successful outcome.
RESUMO
Las intoxicaciones por alcohol metílico son raras, pueden ser secundarias a intentos suicidas, accidentes e incluso a envenenamientos endémicos, tienen consecuencias severas que incluyen la muerte, secundarias a productos de la degradación del alcohol metílico por la alcohol deshidrogenasa, a continuación, presentamos un caso de intoxicación por alcohol metílico que como secuelas presentó alteraciones neurológicas y muerte. (Acta Med Colomb 2012; 37: 211-214).
Methyl alcohol poisoning is rare and may be secondary to suicide attempts, accidents and is also caused by endemic poisonings. It has severe consequences including death secondary to degradation products of methyl alcohol by alcohol dehydrogenase. We present a case of methyl alcohol poisoning that presented neurological alterations and death. (Acta Med Colomb 2012; 37: 211-214).
RESUMO
En este artículo se presenta el caso de un paciente con intoxicación crónica por plomo, cuya principal manifestación clínica fue dolor abdominal. Esta es una intoxicación quegeneralmente se presenta en pacientes que están en contacto laboral con este metal. En este artículo se revisan las manifestaciones clínicas más frecuentes y el manejo de estapatología, ya que de no identificarse y tratarse de forma oportuna, cursa con una alta morbimortalidad...
This article presents a case of chronic lead poisoning, which principal manifestation was abdominal pain. This usually occurs in patient who works with the metal. We reviewed the most frequent clinical manifestation and management. If is untreated thispoisoning has a high morbidity and mortality...
