Torsades de pointes inducidas por sevoflurano / Torsades de pointes induced by sevoflurane

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[Training in the care of the critical and multiple-injured patient: role of clinical simulation]. / Formación en la asistencia al paciente crítico y politraumatizado: papel de la simulación clínica.

Clinical simulation is suggested as a new educational instrument to learn and train in different medical skills. It is conceived as a new method that integrates scientific knowledge and human factors. Experience with these systems has been limited up to now, but it is now being widely accepted since it seems to accelerate acquisition of skills and knowledge in a safe setting, that is, without risk for the patient. However, its effect on clinical performance has not been validated yet. They are two types of simulators for intensive cares: screen based and human patient simulator (HPS). These systems make it possible to simulate different situations that require the application of action protocols or the management of new drugs in the clinical practice, promoting the rational use of resources in urgent care of the critical and multiple-injured patients. The limiting factors that prevent the expansion of the simulation for clinical training are its high cost, human resources needed, and the difficulties to assess the effectiveness of the training in real situations.

[Purulent pericarditis and pleural empyema due to Streptococcus pneumoniae]. / Pericarditis purulenta y empiema pleural por Streptococcus pneumoniae.

We present the case of a 59 year old woman with no previous clinical history of disease who was admitted in our ICU due to respiratory failure and hemodynamic instability. She was found to have purulent pericarditis due to Streptococcus pneumoniae, complicated by massive pericardial effusion and pleural empyema. A pericardial tap was performed unsuccessfully and finally pericardial effusion was evacuated by surgical drainage. Pleural empyema was also evacuated. She received antibiotic treatment and recovered with normalisation of heart function.

Pericarditis purulenta y empiema pleural por Streptococcus pneumoniae / Purulent pericarditis and pleural empyema due to Streptococcus pneumoniae

Presentamos el caso clínico de una mujer de 59 años de edad sin historia clínica previa que ingresó en nuestra Unidad de Cuidados Intensivos (UCI) al presentar un cuadro de insuficiencia respiratoria e inestabilidad hemodinámica. Se le diagnosticó una pericarditis purulenta causada por Streptococcus pneumoniae complicada con un derrame pericárdico masivo y un empiema pleural. Se realizó una punción pericardica que no fue efectiva y el derrame pericárdico se evacuó finalmente mediante drenaje quirúrgico. El empiema pleural fue igualmente evacuado. Recibió tratamiento antibiótico y se recuperó, normalizandose la función cardiaca

We present the case of a 59 years old woman with no previous clinical history of disease who was admitted in our ICU due to respiratory failure and hemodynamic inestabillity. She was found to have purulent pericarditis due to Streptococcus pneumoniae, complicated by masive pericardial effusion and pleural empyema. A pericardial tap was performed unsuccessfully and finally pericardial effusion was evacuated by surgical drainage. Pleural empyema was also evacuated. She received antibiotical treatment and recovered with normalisation of heart function

[Herpetic encephalitis in adults: 23 cases]. / Encefalitis herpética en adultos: 23 casos.

OBJECTIVE: To study the clinical presentation, diagnosis, treatment and prognosis of the herpetic encephalitis in our environment. MATERIAL AND METHOD: During the past 12 years, 23 adults (age > 15 years) were treated for herpetic encephalitis in our centre. RESULTS: There were 14 males and 9 females. Ages ranged from 18 to 84 years (mean, 52.30 +/- 18.64 years). The hospital stay ranged from 5 to 64 days (mean, 26.74 +/- 15.41 days). Eleven patients were managed in the intensive care unit and nine patients required mechanical ventilation. The most frequent clinical features they were the level of conscience decrease and fever. The lymphocytic pleiocytosis was the most frequent discovery in cerebrospinal fluid. The temporal lobe lesions in the computed tomography scan appeared in 14 patients (61%). Four patients died, seven patients were asymptomatic or with minimum sequels and twelve patients developed they were disabled. CONCLUSIONS: The herpetic encephalitis is an uncommon illness. Intravenous acyclovir is recommended treatment and the corticosteroids use is controverted. The delay in the treatment beginning worsens the prognosis. Less than a third of the patients achieve the functional independence to discharge hospital.

Fractura-estallido de tibia y peroné por arma de fuego / Gunshot tibio-fibular burst-fracture

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