manual practico urgencias medicina interna muy bueno

229
(PHUJHQ JHQFLDV Z Z Z Z Z Z H H P P H H U U J J H H Q Q F F L L D D V V H H V V Y Y J J Z Z Z Z Z Z H H P P H H U U J J H H Q Q F F L L D D V V H H V V R R U U J J -RVp5DPyQ$JXLODU 0iODJD(VSDxD

Upload: yefer-s

Post on 29-Jun-2015

1.989 views

Category:

Documents


4 download

TRANSCRIPT

Page 1: Manual practico urgencias medicina interna muy bueno

((PPHHUUJHQJHQFFLLDDVVZZZZZZ��HHPPHHUUJJHHQQFFLLDDVV��HHVV��YYJJZZZZZZ��HHPPHHUUJJHHQQFFLLDDVV��HHVV��RRUUJJ

-RVp�5DPyQ�$JXLODU����0iODJD��(VSDxD

Page 2: Manual practico urgencias medicina interna muy bueno

3URWRFRORV�&OtQLFRV�GHO�6HUYLFLR�GH�0HGLFLQD�,QWHUQDGHO�&RPSOHMR�+RVSLWDODULR�GH�$OEDFHWH6HJXQGD�(GLFLyQ

(GLWRUHV��-DYLHU�6ROHUD�$QWRQLR�$ODPLOOR�)HUQDQGR�0DWHRV,JQDFLR�+HUPLGD

(QHUR������

Page 3: Manual practico urgencias medicina interna muy bueno

3UHIDFLR� �-DYLHU�6ROHUD�6DQWRV������������������������������������������������������������������������������������������������������������������� �,QVXILFLHQFLD�FDUGtDFD�DJXGD�\�FUyQLFD��������������������������������������������������������������������������������������� �/RXUGHV�6iH]��&DUORV�/DIXHQWH��%HDWUL]�9LOD������������������������������������������������������������������������������ �7UDWDPLHQWR�GH�OD�ILEULODFLyQ�DXULFXODU�FUyQLFD������������������������������������������������������������������������� ��$OEHUWR�*DWR��&DUORV�/DIXHQWH� ������������������������������������������������������������������������������������������������� ��&DUGLRSDWtD�LVTXpPLFD��DQJRU�SHFWRULV������������������������������������������������������������������������������������� ��0LJXHO�$QJHO�%DUED��0DQXHO�$JXLOHUD�\�$PDOLD�1DYDUUR� �������������������������������������������������������� ��&DUGLRSDWtD�LVTXpPLFD��LQIDUWR�DJXGR�GH�PLRFDUGLR���������������������������������������������������������������� ��0DQXHO�$JXLOHUD��0LJXHO�$QJHO�%DUED�\�$PDOLD�1DYDUUR ��������������������������������������������������������� ��'LDJQyVWLFR�\�WUDWDPLHQWR�GH�OD�HQGRFDUGLWLV�LQIHFFLRVD��(,�������������������������������������������������� ��9LUWXGHV�0DUWt��)HUQDQGR�0DWHRV� �������������������������������������������������������������������������������������������� ��6tQFRSH������������������������������������������������������������������������������������������������������������������������������������������ ��3HGUR�)HUUHUDV�������������������������������������������������������������������������������������������������������������������������� ��(QIHUPHGDG�SXOPRQDU�REVWUXFWLYD�FUyQLFD��(32&������������������������������������������������������������������ ��)HUQDQGR�0XxR]��,JQDFLR�+HUPLGD��5DLPXQGR�7LUDGR� ����������������������������������������������������������� ��7UDWDPLHQWR�GH�OD�DJXGL]DFLyQ�JUDYH�GHO�DVPD��$*$�������������������������������������������������������������� ��-HV~V�0DUWtQH]� 0RUDWDOOD� ������������������������������������������������������������������������������������������������������� ��(VWXGLR�GH�ORV�GHUUDPHV�SOHXUDOHV �������������������������������������������������������������������������������������������� ��9LYHV�0DQXHO��&OtQLFD�5HFROHWDV���������������������������������������������������������������������������������������������� ��0DQHMR�GH�OD�KHPRSWLVLV�HQ�HO�KRVSLWDO������������������������������������������������������������������������������������� ��$QD�1~xH]��0DQXHO�+DUR��-HV~V�-LPpQH]��0DQXHO�9L]FD\D���������������������������������������������������� ��(QIHUPHGDG�WURPERHPEyOLFD� ���������������������������������������������������������������������������������������������������� ��0DLFDV�0��0DVHJRVD�$��$ODPLOOR�$��+DUR�0��9HJD�(��-XOLi�(��/L]iQ�0� ��������������������������������� ��1HXPRQtD�DGTXLULGD�HQ�OD�FRPXQLGDG��GLDJQyVWLFR�\�WUDWDPLHQWR� ��������������������������������������� ��)UDQFLVFR�0HGUDQR� ������������������������������������������������������������������������������������������������������������������ ��1HXWURSHQLD�IHEULO������������������������������������������������������������������������������������������������������������������������� ��-RVH�-DYLHU�%ODQFK��&DUPHQ�$ORQVR��5DLPXQGR�7LUDGR�5��&DUORV�-DUD� ��������������������������������� ��)LHEUH�GH�RULJHQ�GHVFRQRFLGR��)2'������������������������������������������������������������������������������������������ ��-RVp�$QWRQLR�6iH]�%DUFHORQD��(OLVD�0DUWtQH]� ������������������������������������������������������������������������ ��7UDWDPLHQWR�DQWLUUHWURYLUDO�HQ�OD�LQIHFFLyQ�SRU�HO�YLUXV�GH�OD�LQPXQRGHILFLHQFLD�KXPDQD����$UULED�--��0DUWtQH]�$OIDUR�(��0DWHRV�)� ��������������������������������������������������������������������������������� ���'LDJQyVWLFR�\�WUDWDPLHQWR�GH�OD�PHQLQJLWLV�DJXGD����������������������������������������������������������������� ���(��*yPH]� 0HULQR��-XOLDQ�6ROLV��-DYLHU�6ROHUD��)HUQDQGR�0DWHRV� ��������������������������������������� ���0DQHMR�GH�OD�LQIHFFLRQ�XULQDULD������������������������������������������������������������������������������������������������� ���-RVp�-DYLHU�%ODQFK������������������������������������������������������������������������������������������������������������������ ���3URWRFROR�GH�DGHQRSDWtDV ��������������������������������������������������������������������������������������������������������� ���)UDQFLVR�0HGUDQR��-XDQ�&DUORV�6HJXUD��(OR\�&DPLQR� ��������������������������������������������������������� ���0DQHMR�GH�ODV�KHPRUUDJLDV�GLJHVWLYDV�DOWDV��������������������������������������������������������������������������� ���$QJHO�)HUQiQGH]��0DU�9LFHQWH� ���������������������������������������������������������������������������������������������� ���3DQFUHDWLWLV�DJXGD��3$�������������������������������������������������������������������������������������������������������������� ���

Page 4: Manual practico urgencias medicina interna muy bueno

-XDQ�0D\RU� ���������������������������������������������������������������������������������������������������������������������������� ���7UDWDPLHQWR�GH�OD�+HSDWLWLV�&UyQLFD�SRU�9LUXV������������������������������������������������������������������������ ���-DYLHU�6ROHUD��(OLVD�0DUWtQH]�$OIDUR� �������������������������������������������������������������������������������������� ���'LDUUHD�DJXGD�\�FUyQLFD� ����������������������������������������������������������������������������������������������������������� ���/RXUGHV�6iH]�������������������������������������������������������������������������������������������������������������������������� ���6RSRUWH�1XWULFLRQDO�������������������������������������������������������������������������������������������������������������������� ���5DLPXQGR�7LUDGR �������������������������������������������������������������������������������������������������������������������� ���&HWRDFLGRVLV�GLDEpWLFD�\�VtQGURPH�KLSHUJOXFpPLFR�KLSHURVPRODU�QR�FHWyVLFR���������������� ���-XDQ�&DUORV�6HJXUD��$QJHO�)HUQiQGH]�)~QH]��$QWRQLR�+HUQiQGH]�������������������������������������� ���(TXLOLEULR�KLGURHOHFWUROtWLFR ������������������������������������������������������������������������������������������������������ ���0DUtD�0HOHUR��������������������������������������������������������������������������������������������������������������������������� ���)UDFDVR�UHQDO�DJXGR��)5$�� ������������������������������������������������������������������������������������������������������ ���0DU�&DUPRQD� ������������������������������������������������������������������������������������������������������������������������� ���(SLOHSVLD��'LDJQyVWLFR�\�WUDWDPLHQWR��������������������������������������������������������������������������������������� ���0DQXHO�=RULWD� ������������������������������������������������������������������������������������������������������������������������� ���7UDWDPLHQWR�GHO�LFWXV����������������������������������������������������������������������������������������������������������������� ���3HGUR�9LOODQXHYD��������������������������������������������������������������������������������������������������������������������� ���'HOLULXP�HQ�HO�DQFLDQR��GLDJQyVWLFR�\�PDQHMR������������������������������������������������������������������������ ���/XLV�5RPHUR��&DUPHQ�/XHQJR��3HGUR�$EL]DQGD�������������������������������������������������������������������� ���$QHPLDV��������������������������������������������������������������������������������������������������������������������������������������� ���0DUtD�0HOHUR��������������������������������������������������������������������������������������������������������������������������� ���&RQWURO�GH�VtQWRPDV�HQ�PHGLFLQD�SDOLDWLYD����������������������������������������������������������������������������� ���%HDWUL]�9LOD�0HL]RVR��&ULVWLQD�1HULQ�6iQFKH]������������������������������������������������������������������������ ���

Page 5: Manual practico urgencias medicina interna muy bueno

$JUDGHFLPLHQWR�DO�'U��(OR\�&DPLQR�&DOGHUyQ�'HGLFDPRV�HVWD�VHJXQGD�HGLFLyQ�GH�ORV 3URWRFRORV�&OtQLFRV�GHO�6HUYLFLR�GH�0HGLFLQD�,QWHUQD�GHO�&RPSOHMR�+RVSLWDODULR�GH�$OEDFHWH�DO�'U��'RQ�(OR\�&DPLQR�&DOGHUyQ��(O�'U��&DPLQR�HV�HO�PLHPEUR� HQ� DFWLYR� PiV� DQWLJXR� GHO� 6HUYLFLR� GH� 0HGLFLQD� ,QWHUQD� \� XQR� GH� VXV� PLHPEURV�IXQGDGRUHV�� $� OR� ODUJR� GH� VXV� ~OWLPRV� ��� DxRV� KD� UHDOL]DGR� XQ� HVIXHU]R� FDSLWDO� SDUD� TXH� OD�FDOLGDG� DVLVWHQFLDO� \� HO� UHQGLPLHQWR� GH� HVWH� 6HUYLFLR� VHD� GH� ORV�PHMRUHV� GHO� SDtV��9DOJD� HVWH�EUHYH�FRPHQWDULR�FRPR�PXHVWUD�GH�SURIXQGR�DJUDGHFLPLHQWR�GH�WRGRV�ORV�PLHPEURV�GHO�6HUYLFLR�

/H

1RWD�/D� PHGLFLQD� HV� XQD� FLHQFLD� VRPHWLGD� D� XQ� FDPELR� FRQVWDQWH�� $� PHGLGD� TXH� OD�LQYHVWLJDFLyQ� \� OD� H[SHULHQFLD� FOtQLFD� DPSOtDQ� QXHVWURV� FRQRFLPLHQWRV�� VRQ� QHFHVDULRV�FDPELRV�HQ�ORV�WUDWDPLHQWRV�\�OD�IDUPDFRWHUDSLD��/RV�DXWRUHV�GH�HVWD�REUD�KDQ�FRQWUDVWDGR�VXV� UHVXOWDGRV� FRQ� IXHQWHV� FRQVLGHUDGDV� GH� FRQILDQ]D�� HQ� XQ� HVIXHU]R� SRU� SURSRUFLRQDU�LQIRUPDFLyQ�FRPSOHWD�\�JHQHUDO��GH�DFXHUGR�FRQ�ORV�FULWHULRV�DFHSWDGRV�HQ�HO�PRPHQWR�GH�OD�SXEOLFDFLyQ��6LQ�HPEDUJR��GHELGR�D� OD�SRVLELOLGDG�GH�TXH�H[LVWDQ�HUURUHV��R�VH�SURGX]FDQ�FDPELRV� HQ� ODV� FLHQFLDV�PpGLFDV�� ORV� DXWRUHV� GH� HVWD� REUD� QR� SXHGHQ�JDUDQWL]DU� TXH� OD�LQIRUPDFLyQ� FRQWHQLGD� HQ� OD�PLVPD� VHD�H[DFWD� \� FRPSOHWD�HQ� WRGRV� ORV� DVSHFWRV��QL� VRQ�UHVSRQVDEOHV�GH�ORV�HUURUHV�X�RPLVLRQHV��QL�GH�ORV�UHVXOWDGRV�GHULYDGRV�GHO�HPSOHR�GH�GLFKD�LQIRUPDFLyQ��3RU�HOOR�� VH� UHFRPLHQGD�D� ORV� OHFWRUHV�TXH�FRQWUDVWHQ�GLFKD� LQIRUPDFLyQ�FRQ�RWUDV� IXHQWHV��(Q�SDUWLFXODU�VH�DFRQVHMD� UHYLVDU�HO�SURVSHFWR� LQIRUPDWLYR�TXH�DFRPSDxD�D�FDGD�PHGLFDPHQWR�TXH�YD\D�D�DGPLQLVWUDUVH��SDUD�DVHJXUDU�TXH�OD�LQIRUPDFLyQ�FRQWHQLGD�HQ� HVWH� OLEUR� HV� FRUUHFWD� \� GH� TXH� QR� VH� KDQ� SURGXFLGR� PRGLILFDFLRQHV� HQ� OD� GRVLV�UHFRPHQGDGD�R�HQ�ODV�FRQWUDLQGLFDFLRQHV�SDUD�OD�DGPLQLVWUDFLyQ�

�RV� DXWRUHV� DJUDGHFHQ� D� +2(&+67� VX� FRODERUDFLyQ� HQ� OD� SXEOLFDFLyQ� GH�VWD�REUD

Page 6: Manual practico urgencias medicina interna muy bueno

3UHIDFLR�-DYLHU�6ROHUD�6DQWRV1RV�HQFRQWUDPRV�HQ�XQD�pSRFD�GH�FDPELR�GHO�VLVWHPD�VDQLWDULR��/D�FDOLGDG��FRQWHQFLyQ�GH�FRVWHV�\�VDWLVIDFFLyQ�GH� ORV�SDFLHQWHV�VRQ�PHWDV�TXH�GHEHPRV�WHQHU�SUHVHQWH�HQ�QXHVWUR�TXH�KDFHU� FOtQLFR� GLDULR�� /D� SXEOLFDFLyQ� GH� JXtDV� R� SURWRFRORV� FOtQLFRV� SRU�PXOWLWXG� GH� VRFLHGDGHV�FLHQWtILFDV�� KRVSLWDOHV�� JUXSRV� GH�PpGLFRV�� H� LQFOXVR� SRU� ORV� UHVSRQVDEOHV� GH� ORV� VHUYLFLRV� GH�VDOXG�SUHWHQGHQ�HYLWDU�OD�YDULDELOLGDG�QR�MXVWLILFDGD�GH�OD�SUiFWLFD�FOtQLFD�DVHJXUDQGR�HVWiQGDUHV�GH�FDOLGDG�HQ�OD�DWHQFLyQ�GH�ORV�SDFLHQWHV�\�HYLWDQGR�FRVWHV�LQQHFHVDULRV�/DV��JXtDV�GH�SUiFWLFD�FOtQLFD��VH�KDQ�GHILQLGR�FRPR��QRUPDV�GHVDUUROODGDV�VLVWHPiWLFDPHQWH�ODV�FXDOHV DVLVWHQ�D�ORV�FOtQLFRV�\�D�ORV�SDFLHQWHV�HQ�OD�WRPD�GH�GHFLVLRQHV�DFHUFD�GHO�WUDWDPLHQWR�DSURSLDGR�HQ�FRQGLFLRQHV�HVSHFtILFDV���/DV�JXtDV�GH�SUiFWLFD�FOtQLFD�VH�GHEHQ�HQWHQGHU�FRPR�VX�QRPEUH� LQGLFD� FRPR� �JXtDV�� \� QR� FRPR� LQVWUXFFLRQHV� R� FRPDQGRV�� 6RQ� XQD� D\XGD� SHUR� QR�SXHGHQ�VXVWLWXLU�HO�MXLFLR�FOtQLFR�(VWH� SHTXHxR� OLEUR� HV� XQ� HVER]R� GH� ORV� IXWXURV� SURWRFRORV� R� JXtDV� GH� SUiFWLFD� FOtQLFD� GHO�6HUYLFLR�GH�0,�GHO�&+$��(Q�pO�VH�UHFRJHQ�GH�IRUPD�VLVWHPiWLFD�ODV�SDXWDV�DFWXDOHV�GHO�PDQHMR�GLDJQyVWLFR�\�WHUDSpXWLFR�GH�SUREOHPDV�IUHFXHQWHV��6X�HQIRTXH�HV�IXQGDPHQWDOPHQWH�SUiFWLFR�\�SDUWHQ�GH�OD�H[SHULHQFLD�GH�QXHVWUR�KRVSLWDO�HQ�ORV�WHPDV�VHOHFFLRQDGRV�(VWDV�JXtDV�GH�SUiFWLFD�FOtQLFD�VRQ�HO�SURGXFWR�GH�XQ�HVIXHU]R�FROHFWLYR�GHO�6HUYLFLR�GH�0,�\�GH� RWURV� 6HUYLFLRV� GHO� iUHD� 0HGLFD� �'LJHVWLYR�� &DUGLRORJtD�� 8UJHQFLDV�� e��� /RV� DXWRUHV� KDQ�UHDOL]DGR�XQD�H[FHOHQWH�ODERU�GH�VtQWHVLV�TXH�UHFRJH�ODV�VXJHUHQFLDV�SODQWHDGDV�HQ�GLIHUHQWHV�VHVLRQHV� GH� WUDEDMR�� +HPRV� LQWHQWDGR� TXH� OD� ILORVRItD� GH� WUDEDMR� HQ� OD� HODERUDFLyQ� GH� HVWDV��JXtDV�� LQFOX\D� HO� DERUGDMH� PXOWLGLVFLSOLQDULR� \� OD� FRQVHFXFLyQ� GH� OD� Pi[LPD� ILDELOLGDG��DSOLFDELOLGDG� FOtQLFD�� IOH[LELOLGDG� \� FODULGDG� GH� ORV� WHPDV��1R� REVWDQWH�� OD� FDOLGDG� \� XWLOLGDG� GH�HVWDV� �JXtDV�� GHEH� FRQWUDVWDUVH� HQ� OD� SUiFWLFD� GLDULD� \� VXV� GHILFLHQFLDV� X� RPLVLRQHV� GHEHQ�UHIOHMDUVH�HQ�SUy[LPDV�HGLFLRQHV�/D� PHGLFLQD� HV� XQD� FLHQFLD� HQ� FRQWLQXR� FDPELR� \� OD� DFWXDOL]DFLyQ� GH� HVWDV� �JXtDV�� SDUD�LQFRUSRUDU�WRGDV�ODV�QRYHGDGHV�UHOHYDQWHV�HQ�HO�GLDJQyVWLFR�\�WUDWDPLHQWR�GH�QXHVWURV�SDFLHQWHV�HV�REOLJDGD��(VWH�HV�XQ�UHWR�LPSRUWDQWH�TXH�PHUHFH�HO�HVIXHU]R�GH�WRGRV�-DYLHU�6ROHUD��-HIH�GH�6HUYLFLR�GH�0,��&RPSOHMR�+RVSLWDODULR�GH�$OEDFHWH�

1RWD�D�OD�VHJXQGD�HGLFLyQ�(Q�HVWD�HGLFLyQ��UHDOL]DGD����PHVHV�GHVSXpV�GH�OD�SULPHUD��VH�KDQ�LQFRUSRUDGR�QXHYRV WHPDV�\�VH�KDQ�DFWXDOL]DGR�DOJXQRV�GH�ORV�SUHYLRV��$JUDGHFHPRV�D�ORV�DXWRUHV�\�D�ORV�PpGLFRV�GH�ORV�6HUYLFLRV� GH� 0HGLFLQD� ,QWHUQD�� &DUGLRORJtD�� 'LJHVWLYR�� 8&,� \� 8UJHQFLDV� VXV� DSRUWDFLRQHV� R�FRPHQWDULRV�FUtWLFRV�

Page 7: Manual practico urgencias medicina interna muy bueno

,QVXILFLHQFLD�FDUGtDFD�DJXGD�\�FUyQLFD�/RXUGHV�6iH]��&DUORV�/DIXHQWH��%HDWUL]�9LOD����&RQFHSWRV�,QVXILFLHQFLD�FDUGtDFD��,&���6tQGURPH�FDUDFWHUL]DGR�SRU� OD�SUHVHQFLD�GH�VtQWRPDV�\�VLJQRV�GH� KLSHUWHQVLyQ� YHQRVD� SXOPRQDU� \�R� VLVWpPLFD� R� GH� JDVWR� FDUGtDFR� EDMR� DWULEXLEOHV� D� OD�GLVIXQFLyQ�PHFiQLFD� GHO� FRUD]yQ�� 7DPELpQ� SRU� OD� REVWUXFFLyQ�PHFiQLFD� DO� IOXMR� �HVWHQRVLV�YDOYXODUHV�� PLRFDUGLRSDWtD� KLSHUWUyILFD� REVWUXFWLYD�� PL[RPD�� HWF��� (O� IUDFDVR� GH� ORV�PHFDQLVPRV� GH� FRPSHQVDFLyQ� FDUGtDFRV� \� HVSHFLDOPHQWH� GH� ORV� H[WUDFDUGtDFRV� �VLVWHPD�UHQLQD�DQJLRWHQVLQD�DOGRVWHURQD� \� WRQR� VLPSiWLFR��� FRQWULEX\HQ� D� OD� SHUSHWXDFLyQ� \�HPSHRUDPLHQWR�GH�OD�,&�'LVIXQFLyQ�YHQWULFXODU�VLVWyOLFD��'HELGD�D�OD�SpUGLGD�GH�IXHU]D�FRQWUiFWLO�GHO�PLRFDUGLR��6H�FDUDFWHUL]D�SRU�GLODWDFLyQ�YHQWULFXODU�\�GHWHULRUR�GH�OD�IUDFFLyQ�GH�H\HFFLyQ��)(���JHQHUDOPHQWH�LQIHULRU�DO������'LVIXQFLyQ� YHQWULFXODU� GLDVWyOLFD�� 'HELGD� D� XQD� GLILFXOWDG� SDUD� OD� UHODMDFLyQ� R� OD�GLVWHQVLELOLGDG�YHQWULFXODU��PDQWHQLHQGR�XQD�)(�QRUPDO�,&�DJXGD��3UHVHQWDFLyQ�UiSLGD��6XHOH�HTXLYDOHU�DO�HGHPD�DJXGR�GHO�SXOPyQ��($3��,&�FUyQLFD��HVWDELOLGDG�FOtQLFD�GH�OD�,&��LQGHSHQGLHQWHPHQWH�GH�VX�VHYHULGDG�,&� GH� SUHGRPLQLR� L]TXLHUGR�� DTXHOOD� HQ� OD� TXH� SUHGRPLQDQ� ORV� VLJQRV� \� VtQWRPDV� GH�FRQJHVWLyQ�YHQRVD�SXOPRQDU��GLVQHD��RUWRSQHD��'31��HVWHUWRUHV�FUHSLWDQWHV�,&� GH� SUHGRPLQLR� GHUHFKR�� 3UHGRPLQDQ� ORV� VLJQRV� \� VtQWRPDV� GH� FRQJHVWLyQ� YHQRVD��LQJXUJLWDFLyQ�\XJXODU���KHSDWRPHJDOLD��HGHPDV�SHULIpULFRV��(GHPD� DJXGR� GH� SXOPyQ�� 6LWXDFLyQ� FOtQLFD� JUDYH� FDUDFWHUL]DGD� SRU� HGHPD� DOYHRODU�SURYRFDGR�SRU�XQD�GLVIXQFLyQ�YHQWULFXODU�DJXGD�R�SRU�XQD�GHVFRPSHQVDFLyQ�DJXGD�GH�XQD�,&�FUyQLFD��6KRFN� FDUGLRJpQLFR�� 'LVIXQFLyQ� R� ,&� DJXGD� FRQ� FDtGD� GHO� JDVWR�FDUGtDFR� \� GH� OD� WHQVLyQ�DUWHULDO� �7$���PiV�DOOi�GH�ORV� OtPLWHV�FRPSDWLEOHV�FRQ�XQD�QRUPDO�SHUIXVLyQ�WLVXODU�SHULIpULFD��6LWXDFLyQ�FOtQLFD�JUDYH����'LDJQyVWLFR�/D�HYDOXDFLyQ�LQLFLDO�GHO�SDFLHQWH�FRQ�VRVSHFKD�GH�,&�FRPSUHQGH�

$�� (VWDEOHFHU� FRQ� VHJXULGDG� HO� GLDJQyVWLFR� GH� ,&� TXH VH� EDVD� HQ� OD� DQDPQHVLV�� OD�H[SORUDFLyQ� ItVLFD�� UDGLRJUDItD� VLPSOH� GH� WyUD[�� (&*�� DQDOtWLFD� �KHPRJUDPD�� FRDJXODFLyQ��XUHD��FUHDWLQLQD��HQ]LPDV�PLRFiUGLFDV��LRQHV��VLVWHPiWLFR�GH�RULQD�\�KRUPRQDV��WLURLGHDV�� VL�ILEULODFLyQ�DXULFXODU�R� LQVXILFLHQFLD�FDUGtDFD� LQH[SOLFDEOH��\�HFRFDUGLRJUDPD��(O�GLDJQyVWLFR�EDVDGR�~QLFDPHQWH�HQ�FULWHULRV�FOtQLFRV�WLHQH�XQ�JUDQ�SRUFHQWDMH�GH�HUURUHV�IDOVRV�SRVLWLYRV��VREUH� WRGR�HQ� ODV�PXMHUHV��DQFLDQRV� \� HQ� REHVRV�� HQ� ORV� TXH� OD� GLVQHD� VXHOH� WHQHU� RWUR�RULJHQ�� JHQHUDOPHQWH� UHVSLUDWRULR�� 3RU� HOOR�� OD� 6RFLHGDG� (XURSHD� GH� &DUGLRORJtD� KD�DGRSWDGR�XQRV�FULWHULRV�GLDJQyVWLFRV��TXH�VH�UHIOHMDQ�HQ�OD�WDEOD�VLJXLHQWH�

Page 8: Manual practico urgencias medicina interna muy bueno

/D�JUDYHGDG�GH� OD� ,&�VH�H[SUHVD�HQ� WpUPLQRV�GH�FDSDFLGDG� IXQFLRQDO�GH� ORV�SDFLHQWHV��6H�FODVLILFD�HQ���JUDGRV��VHJ~Q� OD�DSUHFLDFLyQ�VXEMHWLYD�GHO�PpGLFR�D�SDUWLU�GH� OD�DQDPQHVLV�\�VHJ~Q�ORV�FULWHULRV�GH�OD�1<+$��1HZ�<RUN�+HDUW�$VVRFLDWLRQ��&OD&ODFDP&OD&OD%�� %XFXUDELVTXpFRQJp&�� 'FDUGLR

7DEOD�,��&ULWHULRV�GH�OD�6RFLHGDG�(XURSHD�GH�&DUGLRORJtD�SDUD�HO�GLDJQyVWLFR�GH�OD�LQVXILFLHQFLD�FDUGtDFD'LDJQyVWLFR�SURYLVLRQDO��D�HVSHUD�GH�FRQILUPDFLyQ�HFRFDUGLRJUiILFD��+LVWRULD�GH�GLVQHD��IDWLJD�\�R�HGHPDV�PDOHRODUHV��HQ�UHSRVR�R�DO�HVIXHU]R�6LJQRV�GH�KLSHUWHQVLyQ�YHQRVD�SXOPRQDU�(VWHUWRUHV� FUHSLWDQWHV� ELEDVDOHV� HQ� PiV� GH� XQ� WHUFLR� GH� ORV� FDPSRV�SXOPRQDUHV��\�R6LJQRV�GH�FRQJHVWLyQ�YHQRVD�SXOPRQDU�HQ�OD�5[�GH�WyUD[6LJQRV�GH��KLSHUWHQVLyQ�YHQRVD�VLVWpPLFD,QJXUJLWDFLyQ�\XJXODU+HSDWRPHJDOLD(GHPDV�HQ�PLHPEURV�LQIHULRUHV��DVFLWLV�(YLGHQFLD� GH�FDUGLRSDWtD� FDXVDO� REVWUXFWLYD�\�R� GH� VLJQRV� GH�GLVIXQFLyQ�YHQWULFXODU�6LVWyOLFD�� FDUGLRPHJDOLD�� ULWPR� GH� JDORSH� SRU� ��� UXLGR�� WDTXLFDUGLD�SHUVLVWHQWH�'LDVWyOLFD�� ULWPR� GH� JDORSH� SRU� FXDUWR� UXLGR�� RQGD� YHQRVD� ³D´�SURPLQHQWH��HQ�DXVHQFLD�GH�FDUGLRPHJDOLD�6H� UHIXHU]D� VL� VH� H[FOX\HQ� RWUDV� FDXVDV� GH� GLVQHD�� IDWLJD� R� HGHPDV��FRPR�

VH�,��1R�KD\�OLPLWDFLyQ�GH�OD�DFWLYLGDG�ItVLFD�KDELWXDO��VH� ,,�� /LJHUD� OLPLWDFLyQ� GH� OD� DFWLYLGDG� ItVLFD� KDELWXDO� �SXHGH� VXELU� DO�PHQRV� �� SLVR� R�LQDU���PDQ]DQDV���VH�,,,��/LPLWDFLyQ�QRWDEOH�GH�OD�DFWLYLGDG�ItVLFD��VH�,9��/RV�VtQWRPDV�HVWiQ�SUHVHQWHV�LQFOXVR�HQ�UHSRVR�VFDU� OD� FDUGLRSDWtD� VXE\DFHQWH�� DQWH� OD� SRVLELOLGDG� GH� XQD� HWLRORJtD� SRWHQFLDOPHQWH�OH��(Q�OD�DFWXDOLGDG��H[LVWHQ�FLQFR�JUDQGHV�FDXVDV�GH�,&�HQ�QXHVWUR�PHGLR��&DUGLRSDWtD�PLFD� �OD� PiV� IUHFXHQWH��� KLSHUWHQVLYD�� PLRFDUGLRSDWtDV�� YDOYXORSDWtDV� \� FDUGLRSDWtDV�QLWDV�HWHUPLQDU� ODV� FDXVDV� \� IDFWRUHV� SUHFLSLWDQWHV� R� DJUDYDQWHV TXH� DFW~DQ� VREUH� XQD�SDWtD�HVWDEOH�SUHYLDPHQWH�

Page 9: Manual practico urgencias medicina interna muy bueno

���)DFWRUHV�UHODFLRQDGRV�FRQ�HO�SDFLHQWH�6REUHFDUJD�GH�VRGLR�R�GH�OtTXLGRV�HQ�OD�GLHWD�$EDQGRQR�GHO�WUDWDPLHQWR��$XPHQWR� GH� ODV� GHPDQGDV� PHWDEyOLFDV� SRU� H[FHVLYR� HMHUFLFLR� ItVLFR�� ILHEUH��DQHPLD��LQIHFFLRQHV��KLSHUWLURLGLVPR��REHVLGDG�R�HPEDUD]R�,��5HQDO�DJXGD�\�FUyQLFD�(PEROLD�SXOPRQDU��+7$��DUULWPLDV�FDUGtDFDV�&DUGLRSDWtD�LVTXpPLFD��,$0��HWF���)DFWRUHV� UHODFLRQDGRV� FRQ� HO� PpGLFR�� 3DXWD� WHUDSpXWLFD� R� GRVLV� LQHILFDFHV��HGXFDFLyQ�LQVXILFLHQWH��VREUHFDUJD�GH�OtTXLGRV�LQWUDYHQRVRV����� )DFWRUHV� UHODFLRQDGRV� FRQ� RWURV� IiUPDFRV�� IiUPDFRV� GHSUHVRUHV� FDUGtDFRV���EHWDEORTXHDQWHV�� DQWDJRQLVWDV� GH� FDOFLR�� HWF��� IiUPDFRV� FDUGLRWy[LFRV� R�\� TXH�UHWLHQHQ�VRGLR�R�LQKLEHQ�ODV�SURVWDJODQGLQDV��JOXFRFRUWLFRLGHV��$,1(V��HWF������7UDWDPLHQWR�GH�OD�,&�FUyQLFD�/RV�REMHWLYRV�VRQ��6XSULPLU�ORV�VtQWRPDV�\�PHMRUDU�OD�FDSDFLGDG�IXQFLRQDO \�OD�FDOLGDG�GH�YLGD3UHYHQLU�OD�SURJUHVLyQ�GHO�GDxR�PLRFiUGLFR�R�OD�FDtGD�HQ�,&3UHYHQLU�ODV�FRPSOLFDFLRQHV��HO�ULHVJR�GH�PXHUWH�\�OD�QHFHVLGDG�GH�KRVSLWDOL]DFLyQ�6H�EDVD�HQ�WUHV�DVSHFWRV�&RQWURO�GH�ORV�IDFWRUHV�SUHFLSLWDQWHV�&RUUHFFLyQ�GH�OD�HQIHUPHGDG�VXE\DFHQWH��&RQWURO� GHO� IDOOR� FDUGtDFR� FRQ� HO� WUDWDPLHQWR� GH� ORV� VtQWRPDV�� TXH� VH� GHVFULELUi� FRQ� PiV�GHWDOOH�D�FRQWLQXDFLyQ��/DV�GLIHUHQWHV�PHGLGDV�WHUDSpXWLFDV�VH�DSOLFDQ�D�ORV�SDFLHQWHV�DWHQGLHQGR�D�OD�FODVH�IXQFLRQDO�HQ�OD�TXH�VH�HQFXHQWUDQ��1<+$�� WDO�FRPR�VH�YH�HQ�OD�ILJXUD�������(O�WUDWDPLHQWR�QR�IDUPDFROyJLFR GH�ORV�SDFLHQWHV�FRQ�,&�VH�EDVD�HQ�WUHV�SLODUHV��OD�GLHWD��HMHUFLFLR�DHUyELFR�UHJXODU�\�DVLVWHQFLD�SVLFROyJLFD�DGHFXDGD�/D� GLHWD� GHEH� VHU� KLSRVyGLFD� PRGHUDGD� ������� JU� GH� VDO� �GtD��� KD� GH� FRQVHJXLU� XQD�GLVPLQXFLyQ�GHO�VREUHSHVR�������.J��VHPDQD���UHVWULQJLU�HO�DJXD�VL�H[LVWH�KLSRQDWUHPLD�FRQ�1D�������P(T�/��6H�GHEH�OLPLWDU�OD�LQJHVWD�GH�JUDVDV�VDWXUDGDV�\�VXSULPLU�HO�WDEDFR�\�HO�DOFRKRO�/D�DFWLYLGDG�ItVLFD�PiV�FRQYHQLHQWH�HQ�ORV�SDFLHQWHV�FRQ�,&�HV�XQ�WHPD�FRQWURYHUWLGR��OR�PiV�DFHSWDGR�HV�OD�VLJXLHQWH��DWHQGLHQGR�D�OD�FODVH�IXQFLRQDO�HQ�TXH�VH�HQFXHQWUH��&)�,��UHVWULQJLU�OD�DFWLYLGDG�GHSRUWLYD��&)�,,�,,,��UHVWULQJLU�OD�DFWLYLGDG�SURIHVLRQDO��&)�,9�UHSRVR�HQ�FDPD�(O�HMHUFLFLR�DHUyELFR�UHJXODU� �SDVHDU�R�DQGDU�HQ�ELFLFOHWD���PHGLD�KRUD���YHFHV�SRU�VHPDQD�SXHGH�VHU�EHQHILFLRVR�VL�QR�HV�H[FHVLYR��/D�LQWHQVLGDG�LQLFLDO�GHEH�VHU�PRGHUDGD��VLQ�TXH�OD�IUHFXHQFLD�FDUGtDFD�VXSHUH�HO��������GH�OD�FDSDFLGDG�IXQFLRQDO�\�QXQFD�GHEH�OOHJDU�D�VHQWLU�GLVQHD�QL�IDWLJD��3RU�HMHPSOR��HPSH]DU�SRU�FRUWRV�SHUtRGRV�GH�����PLQXWRV�\�����PLQXWRV�GH�UHSRVR��\�DXPHQWDU�JUDGXDOPHQWH�OD�GXUDFLyQ�FDGD���VHPDQDV�KDVWD�����KRUD�GH���D���YHFHV�D�OD�VHPDQD�

Page 10: Manual practico urgencias medicina interna muy bueno

/D�HGXFDFLyQ�GHO�SDFLHQWH�\�OD�IDPLOLD�VREUH�OD�HQIHUPHGDG�HV�IXQGDPHQWDO�HQ�HO�WUDWDPLHQWR�GH� SDFLHQWH�FRQ� ,&&� \� SXHGH� WDPELpQ� EHQHILFLDUVH� GH� DVLVWHQFLD� SVLFROyJLFD� \� WHUDSLDV�GH�JUXSR�SHUR��OD�PHGLGD�PiV�HIHFWLYD�HV�XQ�FRQWURO�FHUFDQR�SRU�SDUWH�GH�ORV�PpGLFRV�

����7UDW/RV�,(HYLWDU�SRVLEOREHVLG(O�XVR����7UDW/RV��GH�HOHL]TXLH&DSW���� PD]RWH$5$�/D�1D�� /EORTX�����7UDW$��,QK'HEVLVWKDQ

)LJX,(5H%H5HItV'L'L,QYD

UD����7UDWDPLHQWR�GH�OD�LQVXILFLHQFLD�FDUGtDFD�DWHQGLHQGR�D�OD�FODVH�IXQFLRQDO�GH�OD�1<+$&ODVH�, &ODVH�,,&ODVH�,,, &ODVH�,9&$V � � � �VWULFFLyQ�LQJHVWD�1D � � �WD�EORTXHDQWHV � �VWULFFLyQ�DFWLYLGDG�LFD rr � ��JR[LQD � � �XUpWLFRV � � �RWUySLFRV�,�9��\�VRGLODWDGRUHV�L�Y� � ��

��

DPLHQWR�GH�ORV�SDFLHQWHV�FRQ�GLVIXQFLyQ�YHQWULFXODU�DVLQWRPiWLFD�&$�VRQ�ORV�IiUPDFRV�GH�HOHFFLyQ��7DPELpQ�VH�WRPDUiQ�PHGLGDV�QR�IDUPDFROyJLFDV�SDUD�OD�SURJUHVLyQ�GH�OD�GLVIXQFLyQ�YHQWULFXODU��FRPR�VRQ��5HGXFLU�OD�LQJHVWD�GH�VDO�R�FRPEDWLU�HV�IDFWRUHV�TXH�SXHGHQ�SRWHQFLDU�OD�SURJUHVLyQ GH�OD�HQIHUPHGDG�FRPR�OD�+7$��DOFRKRO��DG��HWF��GH�GLXUpWLFRV�HVWi�FRQWUDLQGLFDGR��DPLHQWR�GH�ORV�SDFLHQWHV�FRQ�,&�HQ�FODVH�IXQFLRQDO�,�GH�OD�1<+$�LQKLELGRUHV�GH�OD�HQ]LPD�FRQYHUWLGRUD�GH�OD�DQJLRWHQVLQD��,(&$6�VRQ�HO�WUDWDPLHQWR�FFLyQ��'HEHQ�DGPLQLVWUDUVH�D�WRGRV�ORV�SDFLHQWHV�FRQ�GLVIXQFLyQ�VLVWyOLFD�GHO�YHQWUtFXOR�UGR�VLJQLILFDWLYD��&RPHQ]DU�FRQ�GRVLV�EDMDV�H�LQFUHPHQWDU�JUDGXDOPHQWH�RSULO�������y������PJ���K�\�D�OR�ODUJR�GH�VHPDQDV�DXPHQWDU�KDVWD�����PJ��K��(QDODSULOJ���� K� \� DXPHQWDU� KDVWD� ��� PJ���� K�� 6L� QR� VH� WROHUDQ� �KLSRWHQVLyQ� VLQWRPiWLFD��PLD��KLSHUNDOLHPLD�� WRV��HUXSFLyQ�R�HGHPD�DQJLRQHXUyWLFR�� GDU�QLWUDWRV�H�KLGUDODFLQD�R�,,��XWLOL]DFLyQ�GH�GLXUpWLFRV�VyOR�VL�QR�VH�FRUULJHQ�ORV�VtQWRPDV�FRQJHVWLYRV�FRQ�UHVWULFFLyQ�GH�D� GLJR[LQD� HV� XQ� IiUPDFR�GH�JUDQ�XWLOLGDG�VL�HO�SDFLHQWH�HVWi�HQ�)$��(O�XVR�GH�EHWD�HDQWHV�QR�HVWi�GHO�WRGR�DFODUDGD�HQ�HVWH�JUXSR�GH�SDFLHQWHV�DPLHQWR�GH�ORV�SDFLHQWHV�FRQ�,&�HQ�FODVH�IXQFLRQDO�,,�,9 �)LJXUD����LELGRUHV�GH�OD�HQ]LPD�FRQYHUVRUD�GH�OD�DQJLRWHQVLQD��,(&$6���HQ�FRQVLGHUDUVH�HO� WUDWDPLHQWR� LQLFLDO�HVWiQGDU�GH� OD� ,&�VLQWRPiWLFD�\�GH� OD�GLVIXQFLyQ�yOLFD�GH�9,�VLJQLILFDWLYD��)(����������VL�QR�H[LVWH�FRQWUDLQGLFDFLRQHV��'LVWLQWRV�HQVD\RV��GHPRVWUDGR�TXH�ORV�,(&$�V�VRQ�HILFDFHV�HQ�OD�UHGXFFLyQ�GH�OD�PRUWDOLGDG��OD�SUHYHQFLyQ�

H�FD

Page 11: Manual practico urgencias medicina interna muy bueno

��

GH�OD�GLODWDFLyQ�YHQWULFXODU��OD�SUHYHQFLyQ�GH�ODV�UHFDtGDV�\�HQ�OD�UHGXFFLyQ�GH�OD�IUHFXHQFLD�GH�UHLQJUHVRV�KRVSLWDODULRV��)LJXUD����,(&$�V�HQ�SDFLHQW HV�FRQ�,&����)(�������

(O�WUDWDPLHQWR�KD�GH�EXVFDU�ODV�GRVLV�Pi[LPDV�GH�IRUPD�SURJUHVLYD�TXH�HO�SDFLHQWH�WROHUH��$TXHOORV�SDFLHQWHV�TXH�PDQWHQJDQ�WHQVLRQHV�VLVWyOLFDV�GH�������PP+J��VL�VRQ�ELHQ�WROHUDGDV��GHEH�PDQWHQHUVH�VX�DGPLQLVWUDFLyQ�FRQ�HO�DMXVWH GH�GRVLV�TXH�VHD�SUHFLVR��/DV�GRVLV�KDELWXDOHV�DSDUHFHUiQ�HQ�OD�7DEOD�,,�&RQWUDLQGLFDFLRQHV��$QJLRHGHPD��HVWHQRVLV�GH�OD�DUWHULD�UHQDO�ELODWHUDO�\�HPEDUD]R�3UHFDXFLRQHV��7$6����PP+J��&U!�PJ�GO�H�KLSHUNDOHPLD

7�$��6LVWyOLFD�����PP+J ��������PP+J!����PP+J�y�DXPHQWR�&U� �y�LQWHQVD�GLXUHVLV�'RVLV�EDMD 'RVLV�LQLFLDO�KDELWXDO'RVLV�LQWHUPHGLD9P�FRUWD 9P�FRUWD�R�ODUJD9P�FRUWD�R�ODUJD

6HJXLPLHQWR�FDGD�����VHPDQDV(VWDELOLGDG�GH+LSRWHQVLyQ�VLQWRPiWLFD7$�\�)�UHQDOy�DXPHQWR�GH�&Un GRVLV�,(&$65HWHQFLyQ�GH�OtTXLGRV6HJXLPLHQWR�����VHPDQDVUHVLGXDO'RVLV�Pi[LPD�WROHUDGD 6t1R

6 L yQ�GH�,(&$ 6 L yQ�GL pWLFRV

Page 12: Manual practico urgencias medicina interna muy bueno

��

5(&25'$5��0HMRUD� OD� WROHUDQFLD�FRQ�HO�XVR�SURORQJDGR�� UHWUDVR�GH�����PHVHV�HQ�YHU� OD�UHVSXHVWD�FOtQLFD�\�DXQTXH�QR�VH�REMHWLYH�PHMRUtD�GHEH�PDQWHQHUVH�HO�WUDWDPLHQWR�%� /RV�DQWDJRQLVWDV�GH�ORV�UHFHSWRUHV�GH�OD�DQJLRWHQVLQD�,,��$5$�,,��(VWRV� DJHQWHV� EORTXHDQ� HO� VLVWHPD� UHQLQD�DQJLRWHQVLQD� GH� XQD�PDQHUD�PiV� HVSHFtILFD� \�HILFD]�D�QLYHO�GH�ORV�UHFHSWRUHV�GH�PHPEUDQD���$7���GH�OD�DQJLRWHQVLQD�,,���6RQ��OD�DOWHUQDWLYD�D�ORV�,(&$�VL�ORV�SDFLHQWHV�SUHVHQWDQ�LQWROHUDQFLD�D�HVWRV��1R�KD\�HYLGHQFLD�FODUD�GH�TXH�VHDQ�HTXLYDOHQWHV�R�VXSHULRUHV�D�ORV�,(&$�HQ�HO WUDWDPLHQWR�GH�OD�,&��(O�SURWRWLSR�HV�HO�/RVDUWDQ��HO�~QLFR�DSUREDGR�SDUD�HO�WUDWDPLHQWR�GH�OD�,&��DYDODGR�SRU�HO�HVWXGLR�(/,7(�TXH�PXHVWUD�XQD�UHGXFFLyQ�GH�OD�PRUWDOLGDG�HQ�SDFLHQWHV�HQ� ,&�GH�FODVHV� ,,�,,,��6H�LQLFLD�FRQ������PJ�DO�GtD��SDUD�DXPHQWDU�KDVWD�XQ�Pi[LPR�GH����PJ�GLDULRV�6L� QR� VH� WROHUDQ�� GDU� QLWUDWRV� H� KLGUDOD]LQD�� &RPHQ]DU� FRQ� ����� PJ� �� �K� GH� QLWUDWR� GH�LVRVRUELGH�\����PJ���K�GH�KLGUDOD]LQD��VL�VH�WROHUDQ�DXPHQWDU�JUDGXDOPHQWH�KDVWD����PJ����K�GH�GLQLWUDWR�\����PJ����K�GH�KLGUDOD]LQD�&��'LXUpWLFRV�6H� UHFRPLHQGD� VX� XVR� HQ� SDFLHQWHV� HQ� ,&� VROR� FXDQGR� DSDUHFHQ� HGHPDV� R� VtQWRPDV�VHFXQGDULRV�D�OD�FRQJHVWLyQ�SXOPRQDU��GLVQHD��RUWRSQHD��HWF����6H� SXHGH� FRPHQ]DU� FRQ� XQD� WLD]LGD �� +LGURFORURWLD]LGD�� &ORUWDOOLGRQD�HWF�� VL� HO� ILOWUDGR�JORPHUXODU�HV PD\RU�GH�������P/�PLQ��VL�HV�PHQRU�VH�XWLOL]D�)XURVHPLGD�R�7RUDVHPLGD��/D�GRVLV�VH�DMXVWD�KDVWD�VXSULPLU�ORV�VtQWRPDV�FRQJHVWLYRV�VLQ�SURYRFDU�GLVPLQXFLyQ�H[FHVLYD�GH�OD� WHQVLyQ� DUWHULDO� R� DXPHQWR� GH� OD� FUHDWLQLQD�� 'RVLV� \� GXUDFLyQ� GHEHQ� OLPLWDUVH� DO�PtQLPR�HILFD]���9HU�WDEOD�,,��/RV� GLXUpWLFRV� DKRUUDGRUHV� GH� .� QR� VRQ� ~WLOHV� FRPR� ~QLFRV� GLXUpWLFRV�� 5HFLHQWHPHQWH� HO�HVWXGLR�5$/(6�KD�FRQILUPDGR�HO�HIHFWR�EHQHILFLRVR�GH�OD�DGLFFLyQ�GH�OD�HVSLURODFWRQD�D�GRVLV�GH�������PJ�DO�GtD�HQ�HO�WUDWDPLHQWR�GH�OD�,&�VHYHUD�VREUH�OD�PRUWDOLGDG��6H�GHEHQ�WRPDU�XQD�VHULH�GH�SUHFDXFLRQHV��� FRQWURO�GLDULR�GHO�SHVR��XQ�DXPHQWR�GH�����NJ� LQGLFD�TXH�VH�GHEH�DXPHQWDU� OD�GRVLV�GH�PDQWHQLPLHQWR�GHO�GLXUpWLFR��� DVHJXUDU�XQD�UHVWULFFLyQ�GH�VRGLR�DO�PHQRV�GH���JU���GtD�� VL�H[LVWH�UHVLVWHQFLD�D�GLXUpWLFRV���DGPLQLVWUDU�WLD]LGD���HVSLURQRODFWRQD���GLXUpWLFR�GHO�DVD�\�YtD�,9�\�VL�HV�SUHFLVR�XWLOL]DU�HQ�SHUtRGRV�FRUWRV�IiUPDFRV�TXH�DXPHQWHQ�HO�IOXMR�UHQDO��S�H��GRSDPLQD�\�GREXWDPLQD��� VL�H[LVWH�XQ�DXPHQWR�GHVSURSRUFLRQDGR�GH� OD�XUHD� UHVSHFWR�D� OD�FUHDWLQLQD��GLVPLQXLU�HO�GLXUpWLFR�DQWHV�TXH�GLVPLQXLU�R�VXVSHQGHU�HO�,(&$�(Q�FXDQWR�DO�FRQWURO�GHO�SRWDVLR��� 3UHYHQLU� OD� KLSRNDOLHPLD�� PDQWHQHU� .� HQ� ������ P(T�/� FRQ� ������ P(T� GH� &O.�� SXHGH�XWLOL]DUVH�DOWHUQDWLYDPHQWH�DPLORULGH��WULDPWHUHQH�R�HVSLURQRODFWRQD�� SXHGH�SURGXFLUVH�KLSHUNDOLHPLD�FXDQGR� ORV� ,(&$6�VH�XWLOL]DQ�HQ�FRPELQDFLyQ�FRQ�HVWRV�IiUPDFRV�R�JUDQGHV�GRVLV�GH�.�RUDO��&RQWUDLQGLFDGD��HQ�SULQFLSLR�OD�DVRFLDFLyQ�GH�,(&$V���GLXUpWLFRV�DKRUUDGRUHV�GH�.�

Page 13: Manual practico urgencias medicina interna muy bueno

��

� (Q�JHQHUDO�� ORV�DQWLLQIODPDWRULRV�QR�HVWHURLGHRV�GHEHQ�HYLWDUVH�HQ�SDFLHQWHV�FRQ�,&��SRU�KLSHUSRWDVHPLD�\�UHWHQFLyQ�GH�VRGLR��6H�GHEH�FRUUHJLU�OD�KLSRPDJQHVHPLD�VL�HO�PDJQHVLR�HV�PHQRU�D�����P(T�/�'��%ORTXHDQWHV�EHWD�DGUHQpUJLFRV,QGLFDGRV�HQ� WRGRV� ORV�SDFLHQWHV�FRQ�,&�HVWDEOH�\�JUDGR�IXQFLRQDO�,,�,,,��SHUR�QR�HQ�,9���SRU�GLVIXQFLyQ�VLVWyOLFD�GHO�9,�D�PHQRV�TXH�HVWpQ�FRQWUDLQGLFDGRV��KLSRWHQVLyQ��EUDGLFDUGLD��HQI��GHO� VHQR�� EORTXHR�$9�DYDQ]DGR�GH� JUDGR� ,,� \� ,,,�� DVPD��(32&�� R� H[LVWD� LQFDSDFLGDG�SDUD�WROHUDU�HO�WUDWDPLHQWR��6H�XVDQ�MXQWR�D�GLXUpWLFRV�H�,(&$�V�HQ�HO�WUDWDPLHQWR�FUyQLFR�GH�OD�,&�$XQTXH�FRQ�GLYHUVRV�EHWD�EORTXHDQWHV�KDQ�GHPRVWUDGR�VHU�HIHFWLYRV�HQ�HO�WUDWDPLHQWR�GH�OD�,&��VyOR�HO�FDUYHGLORO KD�VLGR�DSUREDGR�SDUD�HO�PDQHMR�GH�OD�,&&�SRU�OD�)'$��/RV�HVWXGLRV�FRQ�HO�FDUYHGLORO�KDQ�GHPRVWUDGR�XQD�PHMRUtD�GH� OD�)(�� UHGXFFLyQ�GH�OD�PRUELOLGDG�SRU�,&�\� ORV�VtQWRPDV�� PHMRUtD� HQ� OD� FDOLGDG� GH� YLGD� \� UHWUDVR� GH� OD� SURJUHVLyQ� GH� OD� ,&�� 7DPELpQ� HO�PHWRSURORO�\�HO�ELVRSURORO SXHGHQ�VHU�~WLOHV�D�GRVLV�EDMDV�H�LU�VXELHQGR�OHQWDPHQWH�(O�WUDWDPLHQWR�FRQ�FDUYHGLORO�SXHGH�LQLFLDUVH�HQ�UpJLPHQ�DPEXODWRULR�D�GRVLV�EDMDV��������PJ�FDGD���K�GH�FDUYHGLORO�GXUDQWH�GRV�VHPDQDV�FRPR�PtQLPR���TXH�VH�DXPHQWDQ�JUDGXDO�\�PX\�OHQWDPHQWH� FDGD� GRV� VHPDQDV� KDVWD� DOFDQ]DU� OD� GRVLV�Pi[LPD�GH�������PJ�GH� FDUYHGLORO�FDGD����K��1R�HV�H[FHSFLRQDO�TXH�DO�SULQFLSLR�HPSHRUH� OD�VLQWRPDWRORJtD��GHELGR�DO�HIHFWR�GHSUHVRU�GHO�EHWDEORTXHR��3UHFLVD�XQD�PRQLWRUL]DFLyQ�GH�OD�7$��)FDUGtDFD�\�GLXUHVLV��5HFRUGDU� TXH� HO� HIHFWR� EHQHILFLRVR� SRGUtD� QR� VHU� YLVWD� KDVWD� ORV ���� PHVHV� \� TXH� ORV�EHWDEORTXHDQWHV� UHGXFHQ� OD� SURJUHVLyQ� GH� OD� HQIHUPHGDG� DXQTXH� QR� ORJUHQ� FRQWURODU� ORV�VtQWRPDV��$�SHVDU�GH�WRGR��VH�GHEH�HVSHUDU�D�QXHYRV�HVWXGLRV�TXH�FRUURERUHQ�OD�HIHFWLYLGDG�GH�ORV�EHWDEORTXHDQWHV�DQWHV�GH�VX�XWLOL]DFLyQ�JHQHUDOL]DGD��(��'LJR[LQD'HEH� DxDGLUVH� D� ORV� ,(&$6� HQ� FDVR� GH� SHUVLVWLU� ORV� VtQWRPDV� \� HQ� SDFLHQWHV� FRQ� ,&� \�ILEULODFLyQ� DXULFXODU�� (V� HILFD]� HQ� PXFKRV� SDFLHQWHV� FRQ� GLVIXQFLyQ� VLVWyOLFD� GHO� YHQWUtFXOR�L]TXLHUGR�\�ULWPR�VLQXVDO��HV�LQHILFD]�HQ�OD�,&�GLDVWyOLFD�3UHFDXFLyQ�HQ�DTXHOORV�SDFLHQWHV�FX\D�GLVIXQFLyQ�9,�VHD�GH�RULJHQ�LVTXpPLFR�\D�TXH�HO�ULHVJR�GH�DUULWPLDV�YHQWULFXODUHV�JUDYHV�HV�PD\RU�/RV�HVWXGLRV�FRQILUPDQ�TXH�PHMRUD�ORV�VtQWRPDV�VREUH�WRGR�\�TXH�DO�PHQRV�QR�HPSHRUD�OD�VXSHUYLYHQFLD�FRPR�RWURV�LQRWURSRV LQYHVWLJDGRV�/D�GLJLWDOL]DFLyQ�SXHGH�UHDOL]DUVH�FRQ�XQD�SDXWD�OHQWD�R�UiSLGD��/D�UiSLGD��VH�UHDOL]D�YtD�L�Y���VH�XWLOL]D�HQ�OD�LQVXILFLHQFLD�FDUGtDFD�DJXGD�FRQ�ILEULODFLyQ�DXULFXODU�UiSLGD��OD�GRVLV�GH�FDUJD�HV�GH����������PJ�HQ����KRUDV��6H�LQLFLD�FRQ�����PJ�L�Y�HQ�EROR�VHJXLGR�GH������������PJ�L�Y��UHSDUWLGR�FDGD���KRUDV��/D�GLJLWDOL]DFLyQ� OHQWD�VH�UHDOL]D�FRQ�GRVLV�GH����������PJ�GtD�Y�R���FRQVHJXLpQGRVH�OD�GLJLWDOL]DFLyQ�DO�FDER�GH�XQRV�GtDV�)��)iUPDFRV�LQRWUySLFRV1R� GHEHQ� XWLOL]DUVH� HQ� HO� WUDWDPLHQWR� GH� OD� ,&� FUyQLFD�� SXHV� ORV� HQVD\RV� GHPXHVWUDQ� TXH�DXPHQWDQ�OD�PRUWDOLGDG�

Page 14: Manual practico urgencias medicina interna muy bueno

��

6yOR�HVWiQ� LQGLFDGRV�HQ�HO� WUDWDPLHQWR�GH� OD� ,&�HQ�FODVH� IXQFLRQDO� ,,,� LQHVWDEOH�\�HQ�HO�($3�FXDQGR�ODV�RWUDV�PHGLGDV�WHUDSpXWLFDV�QR�HVWiQ�VLHQGR�HILFDFHV��/DV�GRV�PiV�XWLOL]DGDV VRQ�OD�GREXWDPLQD�\�OD�GRSDPLQD���9HU�GHVSXpV�*��$QWLFRDJXODFLyQ�,QGLFDFLyQ� DEVROXWD� HQ� SDFLHQWHV� TXH� SRVHHQ� KLVWRULD� GH� HPEROLD� SXOPRQDU� R� VLVWpPLFD��ILEULODFLyQ� DXULFXODU� SDUR[tVWLFD� R� FUyQLFD� \� HYLGHQFLD� HFRFDUGLRJUDILFD� GH� WURPER�PXUDO��(Q�SDFLHQWHV� FRQ� GLVIXQFLyQ� YHQWULFXODU� VLVWyOLFD� VHYHUD� �)(������� VH� GHMD� D� FULWHULR� GHO�IDFXOWDWLYR�� ,QLFLDUHPRV� DQWLFRDJXODFLyQ� FRQ� KHSDULQD� VyGLFD�� VHJXLGR� GH� GLFXPDUtQLFRV�EXVFDQGR�XQ�,15�GH�����+��$QWDJRQLVWDV�GHO�FDOFLR�/RV� GH� SULPHUD� JHQHUDFLyQ� �QLIHGLSLQR�� GLOWLDFHQ�� YHUDSDPLO�� HVWiQ� FRQWUDLQGLFDGRV� HQ�SDFLHQWHV�FRQ�,&�R�GLVIXQFLyQ�YHQWULFXODU�VLQWRPiWLFD�SXHV�SXHGHQ�SUHFLSLWDU�R�DJUDYDU�OD�,&��(QWUH�ORV�GH�VHJXQGD�JHQHUDFLyQ��HQ�HO�HVWXGLR�35$,6(��OD�DGPLQLVWUDFLyQ�GH�DPORGLSLQR�������PJ�DO�GtD��D�SDFLHQWHV�FRQ�,&�QR�LED�DFRPSDxDGR�GH�HIHFWRV�DGYHUVRV�VREUH�OD�PRUELOLGDG�R� OD�PRUWDOLGDG�� SUHVHQWDQGR�VLQ�HPEDUJR�XQ�HIHFWR� IDYRUDEOH�VREUH� OD�VXSHUYLYHQFLD�HQ� OD�FDUGLRPLRSDWtD�GLODWDGD�QR�LVTXpPLFD��3RU�HO�PRPHQWR�VH�GHEH�UHFRPHQGDU�SUXGHQFLD�HQ�VX�XVR�HQ�OD�,&���� /D� ,&� UHIUDFWDULD VH�GHILQH� FRPR�DTXHOOD� TXH�QR� UHVSRQGH�DO� WUDWDPLHQWR�KDELWXDO� �,(&$V��PHGLGDV�KLJLpQLFR�GLHWpWLFDV��GLJR[LQD�\�GLXUpWLFRV���$QWHV�GH�FRQVLGHUDU�TXH�XQ�SDFLHQWH�SDGHFH�XQD�LQVXILFLHQFLD�FDUGtDFD�UHIUDFWDULD�GHEHPRV�GHVFDUWDU�TXH�H[LVWDQ�FDXVDV�TXH�OD�SURYRTXHQ��HVWHQRVLV�PLWUDO�R�DyUWLFD�VLOHQWHV��FDUGLRSDWtD�LVTXpPLFD��HQGRFDUGLWLV�LQIHFFLRVD��KLSHUWHQVLyQ�R�WLURWR[LFRVLV���TXH�H[LVWD�XQD�FRPELQDFLyQ�GH�IDFWRUHV�SUHFLSLWDQWHV�TXH�SHUSHW~HQ�OD�LQVXILFLHQFLD�FDUGtDFD��LQIHFFLRQHV�SXOPRQDUHV�\�XULQDULDV��HPEROLVPRV�SXOPRQDUHV�GH�UHSHWLFLyQ��KLSR[HPLD��DUULWPLDV� R� DQHPLD���R� TXH H[LVWDQ�FRPSOLFDFLRQHV� GHULYDGDV�GHO� WUDWDPLHQWR�H[KDXVWLYR�FRPR�LQWR[LFDFLyQ�GLJLWiOLFD��KLSRYROHPLD�R�GHVHTXLOLEULR�KLGURHOHFWUROtWLFR��WDPELpQ�VH�GHEH��HO�SODQ�GH�WUDWDPLHQWR�\�VX�FXPSOLPLHQWR��6H�DFRQVHMD�VX�KRVSLWDOL]DFLyQ���/D�KLSRQDWUHPLD�HV�XQD�PDQLIHVWDFLyQ��GH�LQVXILFLHQFLD�FDUGtDFD�UHIUDFWDULD�\�WDPELpQ�SXHGH�VHU�XQD�FRPSOLFDFLyQ�GH�XQ�WUDWDPLHQWR�GHPDVLDGR�DJUHVLYR��(O�WUDWDPLHQWR�GH�OD�PLVPD�UHTXLHUH�PHMRUDU�OD�IXQFLyQ�FDUGtDFD��LQFOX\HQGR�OD�XWLOL]DFLyQ�GH�GURJDV�LQRWUySLFDV�SRU�YtD�LQWUDYHQRVD���DVt�FRPR�HO�FHVH�GHO�WUDWDPLHQWR�GLXUpWLFR�\�OD�UHGXFFLyQ�GHO�DSRUWH�GH�DJXD�&XDQGR� XQ� SDFLHQWH� SUHVHQWD� XQD� FODVH� IXQFLRQDO� ,9�� VLQ� UHVSXHVWD� D� ODV� PHGLGDV� DQWHV�PHQFLRQDGDV�KD�GH�WHQHUVH�HQ�FXHQWD�HO� WUDVSODQWH�FDUGtDFR��FRQVLGHUDQGR�GH�IRUPD�JOREDO� OD�VLWXDFLyQ�GHO�SDFLHQWH����(O� WUDWDPLHQWR� GH� ORV� SDFLHQWHV�FRQ� LQVXILFLHQFLD�FDUGtDFD�\�DUULWPLDV HV�HO� VLJXLHQWH��HQ�FDVR�GH� ILEULODFLyQ�DXULFXODU��SDUD�HO�FRQWURO�GH� OD� IUHFXHQFLD�FDUGtDFD�VH�SXHGH�XVDU�GLJR[LQD��GLOWLD]HP�R�EHWD�EORTXHDQWHV�\�HQ�FDVR�GH�ILEULODFLyQ�DXULFXODU�GH�UHFLHQWH�FRPLHQ]R�R�GXUDFLyQ�LQFLHUWD�LQWHQWDU�OD�UHYHUVLyQ�D�ULWPR�VLQXVDO��3DUD�OD�UHDOL]DFLyQ�GH�XQD�FDUGLRYHUVLyQ�HOpFWULFD�VH�QHFHVLWD�UHDOL]DU�SUHYLDPHQWH�XQD�HFRFDUGLRJUDItD�WUDQVHVRIiJLFD�TXH�GHVFDUWH�OD�H[LVWHQFLD�GH�

Page 15: Manual practico urgencias medicina interna muy bueno

��

XQ�WURPER�DXULFXODU��DVLPLVPR�GHEH�DQWLFRDJXODUVH�DO�SDFLHQWH�GXUDQWH���VHPDQDV�DQWHV�GH�OD�FDUGLRYHUVLyQ�\���VHPDQDV�GHVSXpV�SDUD�PLQLPL]DU�HO�ULHVJR�GH�HPEROL]DFLyQ�� /RV�H[WUDVtVWROHV�YHQWULFXODUHV�DSDUHFH�HQ�HO������GH�ORV�SDFLHQWHV�FRQ�,&��PLHQWUDV�TXH�OD�WDTXLFDUGLD�YHQWULFXODU�VRVWHQLGD�VH�SURGXFH�HQ�HO������GH�HOORV��/RV�SDFLHQWHV�TXH�QR�SUHVHQWDQ�VtQWRPDV� HQ� UHODFLyQ� FRQ� OD� DUULWPLD� QR� GHEHQ� WUDWDUVH�� &XDQGR� GDQ� VtQWRPDV� R� VRQ�SRWHQFLDOPHQWH�PDOLJQDV�UHDOL]DU�WUDWDPLHQWR�DQWLDUUtWPLFR�HQ�8&,����7UDWDPLHQWR�GH�OD�,QVXILFLHQFLD�FDUGtDFD�GLDVWyOLFD�7LHQH�FLHUWDV�SHFXOLDULGDGHV�D�� /D� IUHFXHQFLD� FDUGtDFD� HV� FUtWLFD� \� GHEH� PDQWHQHUVH� HQWUH� ��� \� ��� OSP�� FRQ�FDOFLRDQWDJRQLVWDV��EHWDEORTXHDQWHV�R�GLJR[LQD��HQ�DOJXQRV�FDVRV�E��(V�PX\�LPSRUWDQWH�PDQWHQHU�HO�ULWPR�VLQXVDO��&XDQGR�HQWUH�HQ�)$��VH�GHEH�LQWHQWDU�XQD�FDUGLRYHUVLyQ� IDUPDFROyJLFD� VL� OD� WROHUDQFLD� KHPRGLQiPLFD� HV�DFHSWDEOH�R�HOpFWULFD�FXDQGR�HVWp PX\�VLQWRPiWLFR�F��HQ�FDVR�GH�SUHFLVDU�PDUFDSDVRV��GHEH�LPSODQWDUVH�XQ�'''�R�TXH�PDQWHQJD�HO�VLQFURQLVPR�$9��9''��G�� /D� SUHFDUJD� SXHGH� WDPELpQ� VHU� GHFLVLYD� HQ� HO� FRQWURO� GH� OD� GLVIXQFLyQ� YHQWULFXODU�� 8QD�GLXUHVLV�YLJRURVD�SXHGH�VXSULPLU�ORV�VtQWRPDV�FRQJHVWLYRV��SHUR�SXHGH�VHU�FRQWUDSURGXFHQWH�VL�GHSULPH�H[FHVLYDPHQWH�OD�SUHVLyQ�YHQRVD�R�GH�OOHQDGR��GH�OD�TXH�GHSHQGH�PXFKDV�YHFHV�HO�PDQWHQLPLHQWR�GHO�JDVWR�FDUGtDFR��H��/D�GLJR[LQD�QR�SDUHFH�MXVWLILFDGD��D�PHQRV�TXH�VHD�QHFHVDULR�HQOHQWHFHU�OD�IUHFXHQFLD SRU�XQD�WDTXLDUULWPLD�VXSUDYHQWULFXODU���I�� /RV� ,(&$� QR� VH� KD� GHPRVWUDGR�TXH� WHQJDQ�QLQJ~Q�HIHFWR� EHQHILFLRVR�� SHUR�SXHGHQ�VHU�~WLOHV�HQ�OD�FDUGLRSDWtD�KLSHUWHQVLYD����6HJXLPLHQWR�DPEXODWRULR�D�ODUJR�SOD]R�/D�IUHFXHQFLD�GH�ORV�FRQWUROHV�HYROXWLYRV�YDULDUi�VHJ~Q�OD�JUDYHGDG�GH�OD�,&�EDViQGRVH�VREUH�WRGR�HQ�OD�KLVWRULD�FOtQLFD�\�HQ�OD�H[SORUDFLyQ�ItVLFD��/D�5[�GH�WyUD[�\�DQDOtWLFD�VH�KDUiQ�VL�VH�VRVSHFKDQ�FRPSOLFDFLRQHV�/D� UHSHWLFLyQ� SHULyGLFD� GHO�(&*� �FDGD������PHVHV��VyOR� VH� MXVWLILFD� DQWH� XQD� ,0�R� DyUWLFD�JUDGR� ,,,�,9� SHQGLHQWHV� GH� YDORUDFLyQ� TXLU~UJLFD� \� XQD� FDUGLRPLRSDWtD� HQ� IDVHV� LQFLSLHQWHV��WDPELpQ�DQWH�OD�DSDULFLyQ�GH�QXHYRV�VRSORV�R�HPSHRUDPLHQWR�GH�ORV�VtQWRPDV�

Page 16: Manual practico urgencias medicina interna muy bueno

��

7DEOD�,,��)iUPDFRV�HPSOHDGRV�HQ�OD�LQVXILFLHQFLD�FDUGLDFD)iUPDFR 'RVLV 3UHSDUDGR�FRPHUFLDO&DSWRSULO ,QLFLR������������PJ���K0DQWHQ����������� &DSWRSULO�1RUPRQ������&DSWRSULO�&HSD&DSWRSULO�5DWLRSKDUP���������&DSRWHQ�\�&HVSOyQ����������������(QDODSULO ,QLFLR������PJ����K0DQWHQ�����PJ�������K 5HQLWHF��&ULQRUHQ���\����PJ/LVLQRSULO ,QLFLR���������PJ�GtD0DQWHQ���������PJ�GtD =HVWULO�FRPSV���\����PJ5DPLSULO ,QLFLR�������PJ����K� &DUDVHO��$FRYLO��������PJ)XURVHPLGD ��������PJ�GtD 6HJXULO�FRPSV����PJ��DPS����\����)XURVHPLGD����,QLEVD����PJ�DPS�7RUDVHPLGD ,QLFLR��������PJ�GtD0DQWHQ��������PJ�GtD 'LOXWRO��6XWULO��,VRGLXU��������\����PJ�FRP�$PSROODV����\����PJ+LGURFORURWLD]LGD ,QLFLR���������PJ�GtD +LGURVDOXUHWLO����PJ&ORUWDOLGRQD �������PJ�GtD +LJURWRQD����\�����PJ��FRPSV(VSLURQRODFWRQD �������PJ�GtD�F������K $OGDFWRQH����\�����PJ��FRPSV�/RVDUWDQ ,QLFLR������PJ�GtD &R]DDU�FRPSV������\����PJ1LWURJOLFHULQD 6�O�������������VH�SXHGH�UHSHWLU�HQ����PLQXWRV7UDQVGHUPLFD�������PJ�GtD,QWHUYDOR�OLEUH�GH������KRUDV

&DILQLWULQD�FRPSV���PJ9HUQLHV�SHUODV����1LWURGHUP�77V���\����PJ1LWURGXU���\����PJ1LWUDGLVF���\����PJ'LDIXVRU����������PJ��PRQRQLWUDWR�GH�LLVRVRUELGH ������PJ������KRUDV�y����PJ�GtD 8QLNHW�FRPSV�������PJ8QLNHW�UHWDUG�FRPSV����PJ'LQLWUDWR�GH�,VRVRUELGH ������PJ���KRUDV��Pi[LPR��������PJ�GtD ,VRODFHU�FRPSV���PJ�,VRODFHU�UHWDUG�FRPSV����\����PJ+LGUDODFLQD �������PJ�����KRUDV +\GUDSUHV�FRPSV����\�����PJ'LJR[LQD �����PJ�GtD 'LJR[LQD�FRPSV������PJ'LJR[LQD�DPS�������PJ/DQDFRUGtQ�FRPSV������PJ/DQDFRUGtQ�SHGtDWULFR������PJ�PO�&DUYHGLORO ,QLFLR������������PJ����K�0DQWHQ�����PJ����K�6L�!���.J�����PJ����K�&RURSUHV�FRPSV������\����PJ�.UHGH[�FRPSV������\����PJ�

Page 17: Manual practico urgencias medicina interna muy bueno

��

���7UDWDPLHQWR�GHO�HGHPD�DJXGR�GH�SXOPyQ��($3�'HEH�FRQVLGHUDUVH�FRPR�XQD�XUJHQFLD�PpGLFD�HQ�OD�TXH�HO�GLDJQyVWLFR�KD�GH�DFRPSDxDUVH��SUiFWLFDPHQWH�GH�IRUPD�VLPXOWiQHD��GH�XQD�VHULH�GH�PHGLGDV�WHUDSpXWLFDV�0HGLGDV�JHQHUDOHV�3DFLHQWH�LQFRUSRUDGR�D��������R�VHQWDGR�FRQ�ODV�SLHUQDV�FROJDQGR�HQ�OD�FDPD�2[LJHQRWHUDSLD��D�DOWR�IOXMR�\�DOWD�FRQFHQWUDFLyQ��6XSHULRU�DO��������/D�YHQWLODFLyQ�FRQ�SUHVLyQ�SRVLWLYD�PHMRUD�OD�R[LJHQDFLyQ�\�UHGXFH�HO�HGHPD�SXOPRQDU�(Q� DOJXQRV� FDVRV� SXHGHQ� HVWDU� LQGLFDGRV� WRUQLTXHWHV� URWDWRULRV� FDGD� �� PQ� HQ� ODV� WUHV�H[WUHPLGDGHV�D�XQD�SUHVLyQ�HQWUH�GLDVWyOLFD�\�VLVWyOLFD�0RQLWRUL]DFLyQ�GH�7$�\�FRQWURO�GH�GLXUHVLV��&DQDOL]DFLyQ�GH�YtD�,9�%LRTXtPLFD�FRQ�&U��XUHD��LRQHV��HQ]LPDV�FDUGLDFDV��*$%��KHPRJUDPD�\�FRDJXODFLyQ��(&*�\�5[�GH�WyUD[��0HGLGDV�IDUPDFROyJLFDV�$��0RUILQD����PJ�LY��VHJXLGR�GH�����PJ�FDGD���PLQXWRV��KDVWD�XQ�Pi[LPR�GH�������PJ�HQ����PLQXWRV��&RQWURO� GH� OD� IXQFLyQ� UHVSLUDWRULD� �WHQHU� GLVSRQLEOH�1DOR[RQD�SDUD� \XJXODU� SRVLEOH�VREUHGRVLILFDFLyQ�%�� 1LWURJOLFHULQD�� 3XHGH� LQLFLDOPHQWH� DGPLQLVWUDUVH� XQD� GRVLV� VXEOLQJXDO� GH� ������ PJ� GH�QLWURJOLFHULQD�� SDUD� SRVWHULRUPHQWH� SRQHU� XQD� SHUIXVLyQ� FRQWLQXD�� 6H� GLOX\HQ� ��� PJ� GH�1LWURJOLFHULQD� ��� DPSROODV� GH� 6ROLQLWULQD� GH� �� PJ�� HQ� ���� FF� GH� JOXFRVDGR� ����� PJ�FF���HPSH]DQGR� FRQ� ��� PLFURJU�PLQ� ��� PO�K��� $XPHQWR� SURJUHVLYR� GH� ��� HQ� ��� PFJ� KDVWD�FRQVHJXLU� UHVSXHVWD� WHUDSpXWLFD� VLQ� LQGXFLU� KLSRWHQVLyQ�� KDVWD� ����PLFURJU�PLQ� �����PO�K���HVWDQGR�ODV�GRVLV�KDELWXDOHV�HQWUH����\����PLFURJU�PLQ��������PO�K���&��'LXUpWLFRV�GHO�DVD��)XURVHPLGD�����PJ�L�Y�LQLFLDOHV��UHSHWLEOHV�VHJ~Q�UHVSXHVWD�FOtQLFD��'�� 'LJR[LQD�� (V� HVSHFLDOPHQWH� ~WLO� HQ� ORV� SDFLHQWHV� FRQ� WDTXLFDUGLD� VXSUDYHQWULFXODU� \�UHVSXHVWD�YHQWULFXODU�UiSLGD��(�� $TXHOORV� SDFLHQWHV� FRQ� ($3� UHIUDFWDULR� D� ODV� PHGLGDV� FRQYHQFLRQDOHV� \� OD� FDXVD�IXQGDPHQWDO� HV� XQ� GHIHFWR� GH� OD� IXQFLyQ� VLVWyOLFD� YHQWULFXODU�� HVWi� LQGLFDGR� LQLFLDU� VRSRUWH�LQRWUySLFR�FRQ�'REXWDPLQD�\��UDUDPHQWH�FRQ 'RSDPLQD�'REXWDPLQD� ,QRWURSR�GH�HOHFFLyQ�HQ�OD�,&��$PLQD�FRQ�XQ�SRWHQWH�HIHFWR��EHWD���\�EHWD���DVt� FRPR� XQ� SRWHQWH� HIHFWR� YDVRGLODWDGRU� DUWHULDO� VLVWpPLFR� \� SXOPRQDU�� 1R� HMHUFH�YDVRGLODWDFLyQ�UHQDO��'RVLV�LQLFLDO�GH���PLFURJU�.J�PLQ�\�VH�DXPHQWD�KDVWD�ORJUDU�HO�HIHFWR�GHVHDGR�� QR� VXSHUDQGR� ORV� ������ PLFURJU�.J�PLQ�� 3URGXFH� PHQRV� WDTXLILOD[LD� \� PHQRV�DUULWPLDV�� SRU� OR� TXH� HV� HVSHFLDOPHQWH� ~WLO� � HQ� SDFLHQWHV� FRQ� ,&� VHYHUD� UHIUDFWDULD� VLQ�KLSRWHQVLyQ�� 6H� XWLOL]D� XQD� GLOXFLyQ� GH� ���� PJ� ��� DPS�� GH� 'REXWUH[�� HQ� ���� FF� GH�JOXFRVDGR����������PLFURJU�FF����'RSDPLQD��$PLQD�HQGyJHQD�FRQ�HIHFWR�GRSDPLQpUJLFR�D�GRVLV�EDMDV������PLFURJU�NJ�PLQ��SURGXFLHQGR� SUHGRPLQDQWHPHQWH� HIHFWR� YDVRGLODWDGRU� UHQDO�� $� GRVLV� LQWHUPHGLDV� ������PLFURJU�.J�PLQ��WLHQH�XQ�HIHFWR�SUHGRPLQDQWHPHQWH�EHWD���\���TXH�EHQHILFLD�D�ORV�SWHV�FRQ�,&�VHYHUD�UHIUDFWDULD��'RVLV�VXSHULRUHV�D����PLFURJU�.J�PLQ��WLHQHQ�XQ�PDUFDGR�HIHFWR�DOID��

Page 18: Manual practico urgencias medicina interna muy bueno

��

$� ODV� GRVLV� LQWHUPHGLDV�� VXHOH� KDEHU� WDPELpQ� XQ� DXPHQWR�GH� ODV� UHVLVWHQFLDV� SHULIpULFDV��3URGXFH� XQ� DXPHQWR� GH� OD 3&3� \� DXPHQWD� OD� IUHFXHQFLD� FDUGtDFD�� SRU� OR� TXH� SRGUtD�HPSHRUDU� OD�VLWXDFLyQ�GH�HGHPD�DJXGR�GH�SXOPyQ�� �6H�XWLOL]D�XQD��GLOXFLyQ�GH�GRSDPLQD��$SULFDO�'RSDPLQD�DPS����PJ����DPS�HQ�����PJ�GH�VXHUR�JOXFRVDGR����D������PFJ�PLQ�1R�ROYLGDU�TXH�WUDV�HO�WUDWDPLHQWR�GH�OD�HPHUJHQFLD�VH�KD�GH�HVWDEOHFHU�HO�GLDJQyVWLFR�GH�OD�FDUGLRSDWtD� GH� EDVH� \� ORV� IDFWRUHV� SUHFLSLWDQWHV� TXH� KDQ� GHVHQFDGHQDGR� HO� HSLVRGLR� GH�HGHPD�DJXGR�GH�SXOPyQ�

%LEOLRJUDItD���)URãKOLFK�('��7KH�KHDUW��LQ�K\SHUWHQVLRQ��1�(QJO�-�0HG����������������������� *XtD�SDUD�HO�GLDJQyVWLFR��FODVLILFDFLyQ�\�WUDWDPLHQWR�GH�OD� LQVXILFLHQFLD�FDUGtDFD�\�GHO�VKRFN��5HY�(VS�&DUGLRO�����������6XSOHP��������$&&�$+$�SUDFWLFH�JXLGHOLQHV����6PLWK�7:��HW�DO��0DQDJHPHQW�RI�KHDUW� IDLOXUH��HQ�+HDUW�'LVHDVH����WK�HG��( %UDXQZDOG��HG���3KLODGHOSKLD��6DXQGHUV������������������� 6WHYHQVRQ� /:�� &ROXFFL� :6�� 0DQHJHPHQW� RI� SDWLHQWV� KRVSLWDOL]HG� ZLWK� KHDUW� IDLOXUH�� LQ�&DUGLRYDVFXODU�7KHUDSHXWLFV��7:�6PLWK��HG���3KLODGHOSKLD��6DXQGHUV������������������� &RQVHQVXV� UHFRPPHQGDWLRQV� IRU� � WKH� PDQDJHPHQW� RI� FKURQLF� KHDUW� IDLOXUH�� 7KH� $P� -� RI�&DUGLRORJ\�����������$���$�

Page 19: Manual practico urgencias medicina interna muy bueno

��

7UDWDPLHQWR�GH�OD�ILEULODFLyQ�DXULFXODU�FUyQLFD�$OEHUWR�*DWR��&DUORV�/DIXHQWH����'HILQLFLyQ��(V�OD�ILEULODFLyQ�DXULFXODU�GH�GXUDFLyQ�VXSHULRU�D�VHLV�PHVHV����([SORUDFLRQHV�FRPSOHPHQWDULDV��� +HPRJUDPD�� &RDJXODFLyQ�� %LRTXtPLFD�KHPiWLFD��SHUILO�����UDGLRJUDItD�GH�WyUD[�76+���7�O�OLPLWDGD�D�SDFLHQWHV�FRQ�VRVSHFKD�GH�KLSHUWLURLGLVPR��� HFRFDUGLRJUDPD��6H�KD�GH�UHDOL]DU�VLHPSUH�HQ�ODV�VLJXLHQWHV�VLWXDFLRQHV���6RVSHFKD�GH�FDUGLRSDWtD�HVWUXFWXUDO�GH�EDVH���(Q�SDFLHQWHV�FDQGLGDWRV�D�DQWLFRDJXODFLyQ�FUyQLFD�VL����1R�H[LVWH�LQGLFDFLyQ�SRU�FULWHULRV�FOtQLFRV�GH�DQWLFRDJXODFLyQ����([LVWH�LQGLFDFLyQ�SRU�FULWHULRV�FOtQLFRV�\�FRQWUDLQGLFDFLyQ�UHODWLYD�� (&*�KROWHU�VL�H[LVWHQ�SDOSLWDFLRQHV�� (UJRPHWUtD�VL�KD\�PDOD�WROHUDQFLD�DO�HMHUFLFLR����7UDWDPLHQWR�DQWLDUUtWPLFR�(O�REMHWLYR�GHO�PLVPR�HV�FRQVHJXLU�XQD�IUHFXHQFLD�FDUGtDFD�GH�������ODWLGRV�SRU�PLQXWR�HQ�UHSRVR�SHUPLWLHQGR�OD�WDTXLFDUGL]DFLyQ�KDVWD�����ODWLGRV�SRU�PLQXWR�FRQ�HO�HVIXHU]R�OHYH��(Q�OD�ILJXUD���VH�SURSRQH�XQ�DOJRULWPR�WHUDSpXWLFR��/DV�GRVLV�GH�ORV�DQWLDUUtWPLFRV�PiV�XWLOL]DGRV�VRQ�ODV�VLJXLHQWHV�� 3URSUDQRORO���������PJ�����K� $WHQRORO��������PJ��GtD� 9HUDSDPLO���������PJ�����K��3UHSDUDGRV�5HWDUG���������PJU���������K� 'LOWLD]HP���������PJ�����K��3UHSDUDGRV�5HWDUG���������PJU������K���7UDWDPLHQWR�DQWLWURPEyWLFR��([LVWHQ�XQD�VHULH�GH�IDFWRUHV�SUHGLVSRQHQWHV�D�ORV�HYHQWRV�HPEyOLFRV�HQ�ORV�SDFLHQWHV�FRQ�ILEULODFLyQ�DXULFXODU�FUyQLFD�� &OtQLFRV�(GDG�PD\RU�D����DxRV+7$,QVXILFLHQFLD�FDUGtDFD�UHFLHQWH������PHVHV�(PEROLD�SUHYLD'LDEHWHV�PHOOLWXV��"�� (FRFDUGLRJUiILFRV�

Page 20: Manual practico urgencias medicina interna muy bueno

��

'LODWDFLyQ�GH�OD�DXUtFXOD�L]TXLHUGD��!�����FP�P� y�!����PP��GH�GLiPHWUR�'LVIXQFLyQ�YHQWULFXODU�L]TXLHUGD3UHVHQFLD�GH�WURPER�HQ�OD�DXUtFXOD�L]TXLHUGD�

&RQ�DUUHJOR�D�ORV�IDFWRUHV�GH�ULHVJR�DQWHV�PHQFLRQDGRV�VH�SXHGH�HVWDEOHFHU�XQD�HVWUDWLILFDFLyQ�GHO�ULHVJR�SDUD�OD�HPEROL]DFLyQ��H[SUHVDGD�HQ�����DxR��)LEULODFLyQ�DXULFXODU�DLVODGD�HQ�PHQRUHV�GH����DxRV��������

����8WLOL]DU�EHWDEORTXHDQWHV��YHUDSDPLO�R�GLOWLD]HP�D�GRVLV�EDMDV���3XHGH�UHWLUDUVH�ODGRVLV�QRFWXUQD��6L�VH�XWLOL]D�YHUDSDPLO�UHDOL]DU�GLJR[LQHPLD�D�ORV������GtDV����0HMRU�WROHUDQFLD�DO�HMHUFLFLR�TXH�FRQ�EHWDEORTXHDQWHV�����3ODQWHDU�VLHPSUH�SRVLEOHV�FRQWUDLQGLFDFLRQHV�)LJXUD����7UDWDPLHQWR�DQWLDUUtWPLFR�HQ�OD�)$&

)LEULODFLyQ�DXULFXODU!���OSP�HQ�UHSRVR ����OSP�HQ�UHSRVR

1R�WUDWDU (FRFDUGLRJUDPD�\�76+&DUGLRSDWtD

6Ì 12'LJR[LQD

1R�FRQWURO�)&'LJR[LQD���EHWDEORTXHDQWHV�R�YHUDSDPLO�R�GLWLD]HP����

$FWLYR�-RYHQ $QFLDQR�VHGHQWDULR +LSHUWLURLGLVPR9HUDSDPLO�GLOWLD]HP��� %HWD�%ORT���� 'LJR[LQD %HWD�%ORTXHDQWH��Â

1R�FRQWURO�)&1R�FRQWURO�)& 2SWLPL]DU�GRVLV $EODFLyQ�QyGXOR�$9

Page 21: Manual practico urgencias medicina interna muy bueno

��

9DORUDQGR�IDFWRUHV�GH�ULHVJR�FOtQLFRV���1LQJXQR�������������������������������������������8QR���������������������������������������������������y�PiV����������������������������������������9DORUDQGR�IDFWRUHV�GH�ULHVJR�FOtQLFRV�\�HFRFDUGLRJUiILFRV���1LQJXQR��������������������������������������������y���������������������������������������������������y�PiV����������������������������������������(Q�OD�ILJXUD���VH�HVSHFLILFD�HO�PDQHMR�GH�OD�WHUDSLD�DQWLWURPEyWLFD��

)LJXUD����WUDWDP LHQWR�DQWLWURPEyWLFR�HQ�OD�)$&�

)LEULODFLyQDXULFXODU��' LODWDFLyQ�GH �$,�R�WURP ER��9DOYXORSDWtD�P LWUD O��0 LRFDUGLRSDWtD�G LOD WDGD��0 LRFDUGLRSDWtD�K LSH UWUyILFD��&DUGLRSDWLD�LVTXpP LFD��,QVX ILFLHQF LD�FDUG tDFD��+7$��' LDEH WH V�PH OOLWXV��(PEROLD�SUHYLD

6 L$QWLFRDJXODF LyQFRQ �,15� � ��

6L

&RQWUD LQGLFDFLyQ�SDUDDQWLFRDJX ODFLyQ$VSLULQD�����PJ�

1R�����DxRV ������DxRV t ���DxRV

1DGD�RDVS LULQD�����PJ� $VSLULQD�����PJ� $VSLULQD�����PJ ��RDQWLFRDJX ODFLyQ�VHJ~Q�ULHVJRVDQJUDGR�

%LEOLRJUDItD���$WULDO�)LEULOODWLRQ�,QYHVWLJDWRUV��5LVN�IDFWRUV�IRU�VWURNH�DQG�HIILFDF\�RI�DQWLWKURPERWLF�WKHUDS\�LQ�DWULDO� ILEULOODWLRQ��$QDO\VLV�RI�SRROHG�GDWD�IURP�ILYH�UDQGRPL]HG�FRQWUROOHG�WULDOV��$UFK�,QWHUQ�0HG������������������������� 7KH� 6WURNH� 3UHYHQWLRQ� LQ� $WULDO� )LEULOODWLRQ� ,QYHVWLJDWRUV�� 3UHGLFWRUV� RI� WKURPERHPEROLVP� LQ�DWULDO�ILEULOODWLRQ��FOLQLFDO�IHDWXUHV�RI�SDWLHQWV�DW�ULVN��$QQ�,QWHUQ�0HG����������������

Page 22: Manual practico urgencias medicina interna muy bueno

��

&DUGLRSDWtD�LVTXpPLFD��DQJRU�SHFWRULV0LJXHO�$QJHO�%DUED��0DQXHO�$JXLOHUD�\�$PDOLD�1DYDUUR����&RQFHSWR�GH�DQJLQD�/D� 6RFLHGDG� (VSDxROD� GH�&DUGLRORJtD� GHILQH� OD� DQJLQD� FRPR� ³GRORU� R� PDOHVWDU� SUHFRUGLDO�DWULEXLEOH�D�LVTXHPLD�PLRFiUGLFD´�����&ODVLILFDFLyQ�GH�OD�DQJLQD�$QJLQD� HVWDEOH� $QJLQD� GH� HVIXHU]R� HQ� OD� TXH�QR� KD� KDELGR� FDPELRV� HQ� VX� SDWUyQ� HQ� HO�~OWLPR�PHV�GH�HYROXFLyQ��/D�DQJLQD�GH�HVIXHU]R�SXHGH�FODVLILFDUVH�VHJ~Q�VX�VHYHULGDG�HQ�*UDGR�,��/D�DFWLYLGDG�ItVLFD�RUGLQDULD�QR�FDXVD�GRORU�*UDGR�,,��+D\�XQD�OLPLWDFLyQ�OLJHUD�GH�OD�DFWLYLGDG�ItVLFD�RUGLQDULD�*UDGR�,,,��+D\�XQD�OLPLWDFLyQ�LPSRUWDQWH�GH�OD�DFWLYLGDG�ItVLFD�RUGLQDULD��*UDGR�,9��(O�SDFLHQWH�HV�LQFDSD]�GH�OOHYDU�D�FDER�FXDOTXLHU�DFWLYLGDG�ItVLFD�VLQ�DQJLQD��'H�IRUPD�RFDVLRQDO��SXHGH�DSDUHFHU�DQJLQD�HQ�UHSRVR�$QJLQD�LQHVWDEOH�7RGDV� DTXHOODV� IRUPDV� TXH� VH� DSDUWDQ� FODUDPHQWH� GHO� SDWUyQ� WtSLFR� GH� DQJLQD� HVWDEOH�� (O�FRQFHSWR�GH�LQHVWDELOLGDG�OOHYD�DSDUHMDGR�HO�GH�SURQyVWLFR�LQFLHUWR��DXQTXH�QR�QHFHVDULDPHQWH�GHVIDYRUDEOH��'HQWUR�GH�OD�DQJLQD�LQHVWDEOH�OD�6RFLHGDG�(VSDxROD�GH�&DUGLRORJtD UHFRQRFH�ODV�VLJXLHQWHV�IRUPDV�$QJLQD�GH�HVIXHU]R�GH�UHFLHQWH�FRPLHQ]R� (V�DTXHOOD�FX\D�DQWLJ�HGDG�HV�LQIHULRU�D�XQ�PHV��3DUD�LQFOXLUOD�FRPR�LQHVWDEOH�VH�H[LJH��DGHPiV��TXH�ORV�VtQWRPDV�FRUUHVSRQGDQ�D�XQ�JUDGR�IXQFLRQDO�DYDQ]DGR��,,,�R�,9���$QJLQD�SURJUHVLYD� (V� OD�DQJLQD�TXH�KD�HPSHRUDGR�GXUDQWH�HO�~OWLPR�PHV�HQ�FXDQWR�D�OD�IUHFXHQFLD��LQWHQVLGDG��GXUDFLyQ�R�XPEUDO�GH�HVIXHU]R�$QJLQD�GH�UHSRVR��(V�OD�TXH�DSDUHFH�GH�IRUPD�HVSRQWiQHD��VLQ�GHVHQFDGHQDQWH�DSDUHQWH��&XDQGR�KD�WUDQVFXUULGR�PiV�GH�XQD�VHPDQD�VLQ�VtQWRPDV��VH�FRQVLGHUD�TXH�HO�HQIHUPR�VH�KD�HVWDELOL]DGR��8QD�IRUPD�HVSHFLDO�GH�DQJLQD�LQHVWDEOH�HQ�UHSRVR�HV�OD�DQJLQD�SURORQJDGD��TXH�HV�DTXHOOD�FX\RV�HSLVRGLRV�RFXUUHQ�HQ�UHSRVR�\�SRU�VX�ODUJD�GXUDFLyQ��JHQHUDOPHQWH�VXSHULRU�D����PLQXWRV���VLPXODQ�XQ�LQIDUWR�DJXGR�GH�PLRFDUGLR�$QJLQD� YDULDQWH� (Q� HOOD� ORV� HSLVRGLRV� RFXUUHQ� HQ� UHSRVR� \� FXUVDQ� FRQ� HOHYDFLyQ� GHO�VHJPHQWR� 67� GXUDQWH� OD� FULVLV�� (Q� VX� SDWRJHQLD� HVWi� LPSOLFDGR� HO� HVSDVPR� IRFDO� VREUH�OHVLRQHV�DWHURVFOHUyWLFDV�TXH�SXHGHQ�RVFLODU�GHVGH�PtQLPDV�D�VXEWRWDOHV�$QJLQD�SRVWLQIDUWR� (V�OD�TXH�DSDUHFH�GHVSXpV�GH�ODV�SULPHUDV����KRUDV�GHO�LQIDUWR�DJXGR�GH�PLRFDUGLR�\�GXUDQWH�VX�SULPHU�PHV�GH�HYROXFLyQ�

(Q�HO�iPELWR�DQJORVDMyQ�OD�FODVLILFDFLyQ GH PD\RU�GLIXVLyQ�\�PiV�HPSOHDGD�HV�OD�SURSXHVWD�SRU�%UDXQZDOG�� FX\D� SULQFLSDO� YHQWDMD� HV� LQWHQWDU� DJUXSDU� GH�PHQRU� D�PD\RU�JUDYHGDG�D� ORV�SDFLHQWHV�FRQ�DQJLQD�LQHVWDEOH�H�LQWHQWDU�GLIHUHQFLDU�GLYHUVDV�ILVLRSDWRORJtDV�

Page 23: Manual practico urgencias medicina interna muy bueno

��

&ODVLILFDFLyQ�GH�%5$81:$/'�GH�OD�$QJLQD�,QHVWDEOH����6HJ~Q�OD�VHYHULGDG�&ODVH�,��$QJRU�GH�HVIXHU]R��GH�PHQRV�GH���PHVHV�GH�DQWLJ�HGDG��FRQ�YDULRV�HSLVRGLRV�GLDULRV��SRU�HMHUFLFLRV�FDGD�YH]�PHQRUHV��SHUR�QXQFD�HQ�UHSRVR��'HVGH�HO�FRPLHQ]R�FODVH�,,,�R�,9�GH�OD�&&6�&ODVH�,,� $QJLQD�GH�UHSRVR�VXEDJXGD�GH�PHQRV�GH���PHV�GH�HYROXFLyQ��SHUR�VLQ�DQJRU�HQ�ODV�~OWLPDV����KRUDV�&ODVH�,,,� $QJLQD�GH�UHSRVR�DJXGD��FRQ�HSLVRGLR�GH�DQJRU�HQ�ODV�~OWLPDV����KRUDV����6HJ~Q�ODV�FLUFXQVWDQFLDV�FOtQLFDV�&ODVH� $� $QJLQD� LQHVWDEOH� VHFXQGDULD�� FRQ� XQD� FRQGLFLyQ� H[WUtQVHFD� FODUDPHQWH�LGHQWLILFDEOH�TXH�LQWHQVLILTXH�OD LVTXHPLD�PLRFiUGLFD�&ODVH�%� $QJLQD�LQHVWDEOH�SULPDULD�&ODVH�&� $QJLQD�LQHVWDEOH�SRVWLQIDUWR��HQ�ODV���SULPHUDV�VHPDQDV�WUDV�HO�,$0�����6HJ~Q�OD�LQWHQVLGDG�GHO�WUDWDPLHQWR�6XEJUXSR����$XVHQFLD�R�PtQLPR�WUDWDPLHQWR�DQWLLVTXpPLFR�6XEJUXSR����&RQ�WUDWDPLHQWR�HVWiQGDU�SDUD�DQJLQD�GH�HVIXHU]R�HVWDEOH�6XEJUXSR����&RQ�WUDWDPLHQWR�DQWLDQJLQRVR�D�GRVLV�Pi[LPDV��LQFOX\HQGR�QLWURJOLFHULQD�,�9����6HJ~Q�HO�(&*�GXUDQWH�ODV�FULVLV��6H�FODVLILFDQ�VHJ~Q�OD�SUHVHQFLD�R�DXVHQFLD�GH�FDPELRV�HQ�HO�VHJPHQWR�67�X�RQGD�7�

���7UDWDPLHQWR�GH�OD�DQJLQD�HVWDEOH������(Q�HO�SDFLHQWH�FRQ�DQJLQD�GH�SHFKR�HVWDEOH��DGHPiV�GHO�WUDWDPLHQWR�IDUPDFROyJLFR�GH�OD�PLVPD�� HV� IXQGDPHQWDO� HO� FRQWURO� GH� ORV� IDFWRUHV� GH� ULHVJR� FRURQDULR�� +7$�� WDEDTXLVPR��KLSHUOLSHPLDV� �VL� HO� /'/�FROHVWHURO� HV� VXSHULRU� D� ����PJ�GO�� FRQ� HO� REMHWLYR� GH� /'/�FROHVWHURO�LQIHULRU�D�����PJ�GO���'0��VHGHQWDULVPR��REHVLGDG���������� (Q� WRGRV� ORV� SDFLHQWHV�� HQ� DXVHQFLD� GH� FRQWUDLQGLFDFLRQHV�� VH� UHFRPLHQGD� HO� XVR� GH�DVSLULQD D� GRVLV� EDMDV� ����� D� ���� PJ�GtD��� /D� WLFORSLGLQD QR� KD� GHPRVWUDGR� GLVPLQXLU� ORV�HSLVRGLRV�DGYHUVRV�FDUGLRYDVFXODUHV�HQ�SDFLHQWHV�FRQ�DQJRU�HVWDEOH��&ORSLGRJUHO ����PJ�GtD���SXHGH� VHU� XQD� DOWHUQDWLYD� D� OD� DVSLULQD�� FXDQGR� pVWD� HVWi� DEVROXWDPHQWH� FRQWUDLQGLFDGD�� /D�HILFDFLD�GH�ORV�QXHYRV�DJHQWHV�DQWLWURPEyWLFRV�\�DQWLSODTXHWDULRV��LQKLELGRUHV�GH�OD�JOLFRSURWHtQD�,,E�,,,D�\�OD�KLUXGLQD�UHFRPELQDQWH��QR�KD�VLGR�D~Q�HVWDEOHFLGD�HQ�HVWRV�SDFLHQWHV������(Q�IXQFLyQ�GH�OD�IUHFXHQFLD�\�VHYHULGDG�GH�ORV�HSLVRGLRV�DQJLQRVRV��������6L�HVWRV�VRQ�SRFR� IUHFXHQWHV�\�R�GH�FDUiFWHU� OHYH��HO� WUDWDPLHQWR�DQWLDQJLQRVR�SXHGH� OLPLWDUVH� D� XQ� IiUPDFR�� VLHQGR� GH� HOHFFLyQ� HO� EHWDEORTXHDQWH�� DGHPiV� GH� OD�17*�V�O��VHJ~Q�VHD�QHFHVDULR�\�GH�IRUPD�SURILOiFWLFD�HQ�VLWXDFLRQHV�TXH�SUHFLSLWHQ�OD�DQJLQD��&RPR�DOWHUQDWLYD�DO�EHWDEORTXHDQWH�HQ�FDVR�GH�FRQWUDLQGLFDFLyQ�R�LQWROHUDQFLD�D�ORV�PLVPRV��VH�XWLOL]DUiQ�ORV�DQWDJRQLVWDV�GHO�FDOFLR�R�QLWUDWRV��/DV�GLKLGURSLULGLQDV�GH�YLGD�PHGLD�FRUWD�SXHGHQ�DXPHQWDU�HO�ULHVJR�GH�HSLVRGLRV�FDUGLDFRV�DGYHUVRV�\�GHEHQ�HYLWDUVH��QR�DVt�ODV�GH�YLGD�PHGLD ODUJD�R�GH�OLEHUDFLyQ�UHWDUGDGD�

Page 24: Manual practico urgencias medicina interna muy bueno

��

�������6t�HO�SDFLHQWH�FRQWLQXD�VLQWRPiWLFR��DXPHQWDUHPRV�SURJUHVLYDPHQWH�OD�GRVLV�GHO�IiUPDFR�HOHJLGR��R�ELHQ�DVRFLDUHPRV�GRV�IiUPDFRV�GH�GLVWLQWR�JUXSR�IDUPDFROyJLFR��������� (Q� HO� SDFLHQWH� TXH� SUHVHQWD� DQJLQD� JUDGR� ,,,� R ,9�� GH� HQWUDGD� VH� XWLOL]DUi� OD�FRPELQDFLyQ�GH�GRV�IiUPDFRV��(Q�HVWDV�~OWLPDV�IRUPDV�GH�DQJLQD�VHYHUD��VREUH�WRGR�VL�VRQ� UHIUDFWDULDV� D� OD� DVRFLDFLyQ� GH� GRV� IiUPDFRV�� GHEHUtD� FRQVLGHUDUVH� OD�UHYDVFXODUL]DFLyQ�PLRFiUGLFD�� �'XUDQWH� OD�HVSHUD�GH�pVWD�R�FXDQGR VH�GHVFDUWD�HVWD�RSFLyQ��SXHGH�VHU�~WLO�OD�DVRFLDFLyQ�GH�WUHV�IiUPDFRV������$VRFLDFLyQ�GH�IiUPDFRV�DQWLDQJLQRVRV�������5HFRPHQGDGDV�� 1LWUDWRV� \� EHWDEORTXHDQWHV�� /D� DGLFLyQ� GH� XQ� EHWDEORTXHDQWH� FRQ� YLGD� PHGLD�SURORQJDGD�SURSRUFLRQD�SURWHFFLyQ�DGLFLRQDO GXUDQWH�ODV�KRUDV�HQ�TXH�ORV�QLWUDWRV�QR�OR�KDFHQ�SRU�ODV�SDXWDV�LQWHUPLWHQWHV�UHFRPHQGDGDV�SDUD�SUHYHQLU�OD�WROHUDQFLD��� 1LWUDWRV�\�YHUDSDPLO�R�GLOWLD]HP�� %HWDEORTXHDQWH�\�DQWDJRQLVWD�GHO�FDOFLR�GLKLGURSLULGtQLFR������� 1R�UHFRPHQGDGDV�� %HWDEORTXHDQWH� \� YHUDSDPLO� R� GtOWLD]HP�� 3XHGH� SUHFLSLWDU� LQVXILFLHQFLD� FDUGtDFD��GLVIXQFLyQ� VLQXVDO� R� EORTXHR� $9�� SRU� OR� TXH� HVWD� DVRFLDFLyQ� VH� XWLOL]DUi� VyOR� HQ� HO�iPELWR�KRVSLWDODULR�EDMR�HVWULFWR�FRQWURO�PpGLFR�� 1LWUDWR�\�QLIHGLSLQD��3XHVWR�TXH�DPERV�IiUPDFRV�DXPHQWDQ�OD�)&�GH�IRUPD�UHIOHMD�DO�VHU�SRWHQWHV�YDVRGLODWDGRUHV��FRQ�OR�TXH�DXPHQWDQ�HO�FRQVXPR�PLRFiUGLFR�GH�R[tJHQR����7UDWDPLHQWR�GH�OD�DQJLQD�HVWDEOH�VHJ~Q�OD�VLWXDFLyQ�FOtQLFD�R�HQIHUPHGDG�DVRFLDGD�/D� VHOHFFLyQ� GHO� IiUPDFR� DQWLDQJLQRVR� DGHFXDGR� SDUD LQLFLDU� HO� WUDWDPLHQWR� GHEH�LQGLYLGXDOL]DUVH�VHJ~Q�OD�VLWXDFLyQ�FOtQLFD�GHO�SDFLHQWH������(QIHUPHGDG�GHO�VHQR�R�WUDVWRUQRV�GH�FRQGXFFLyQ�$9�6H�GHEHQ�XWLOL]DU�DQWDJRQLVWDV�GHO�FDOFLR�GHO�JUXSR�GH�ODV�GLKLGURSLULGLQDV�R�QLWUDWRV��GHVHVWLPiQGRVH�ORV�EHWDEORTXHDQWHV��HO�YHUDSDPLO�\�HO�GLOWLD]HP������ 7DTXLDUULWPLDV� VXSUDYHQWULFXODUHV� 8WLOL]DUHPRV� YHUDSDPLO�� GLOWLD]HP� R� EHWD�EORTXHDQWHV������$UULWPLDV�YHQWULFXODUHV��6H�XWLOL]DUiQ�SUHIHULEOHPHQWH�ORV�EHWDEORTXHDQWHV�����,QVXILFLHQFLD�FDUGtDFD� 6L�OD�)(�HV�PD\RU�R�LJXDO�DO�����VH�XWLOL]DUDQ�SUHIHUHQWHPHQWH�ORV�EHWDEORTXHDQWHV��&XDQGR�OD�)(�HV�LQIHULRU�DO�����VH�XWLOL]DUi�HO�DPORGLSLQR�R�IHORGLSLQR��SXGLHQGR� VHU� XQD� DOWHUQDWLYD� HO� XVR� GH� QLWUDWRV�� HYLWiQGRVH� HO� XVR� GHO� 9HUDSDPLO� \� GHO�'LOWLD]HP������ 9DOYXORSDWtDV�� (Q� OD� HVWHQRVLV� DyUWLFD� VHYHUD� GHEHQ� XWLOL]DUVH� FRQ� SUHFDXFLyQ� ORV�YDVRGLODWDGRUHV��LQFOXLGRV�ORV�QLWUDWRV��(Q�OD�LQVXILFLHQFLD�DyUWLFD�\�PLWUDO�VH�UHFRPLHQGDQ�ODV�GLKLGURSLULGLQDV�GH�YLGD�PHGLD�ODUJD�R�OLEHUDFLyQ�UHWDUGDGD����� 0LRFDUGLRSDWtD� KLSHUWUyILFD� 6RQ� GH� HOHFFLyQ� ORV� EHWDEORTXHDQWHV�� YHUDSDPLO� R�GLOWLD]HP��GHELpQGRVH�HYLWDU�ORV�QLWUDWRV�\�ODV�GLKLGURSLULGLQDV�

Page 25: Manual practico urgencias medicina interna muy bueno

��

����+7$� (V�SUHIHULEOH�LQLFLDU�HO�WUDWDPLHQWR�FRQ�XQ�EHWDEORTXHDQWH�R�FRQ�XQ�DQWDJRQLVWD�GHO�FDOFLR�� SXHVWR� TXH�DPERV� FRPSXHVWRV� GLVPLQX\HQ� OD� SUHVLyQ� DUWHULDO�� DGHPiV�GH� HMHUFHU�HIHFWRV�DQWLDQJLQRVRV�����(32&�R�DVPD�EURQTXLDO� (Q�JHQHUDO��VH�HYLWDUiQ�ORV�EHWDEORTXHDQWHV�\�VH�XVDUiQ�ORV�DQWDJRQLVWDV�GHO�FDOFLR�\�ORV�QLWUDWRV�SDUD�HO�WUDWDPLHQWR�GH�OD�DQJLQD�����&ODXGLFDFLyQ�LQWHUPLWHQWH�R�GLDEHWHV�PHOOLWXV�LQVXOLQGHSHQGLHQWH�6H�UHFRPLHQGDQ�ORV� DQWDJRQLVWDV� GHO� FDOFLR� \� ORV� QLWUDWRV�� GHELpQGRVH� HYLWDU� ORV� EHWDEORTXHDQWHV�� \� VL� HV�QHFHVDULR�HO�XVR�GH�HVWRV��GHEHUiQ�VHU�FDUGLRVHOHFWLYRV������&HIDOHDV�VHYHUDV�SUHH[LVWHQWHV� 6H�UHFRPLHQGDQ�ORV�EHWDEORTXHDQWHV��XWLOL]iQGRVH�FRPR�DOWHUQDWLYD�HO�GLOWLD]HP�R�HO�YHUDSDPLOR������+LSHUWLURLGLVPR� %HWDEORTXHDQWHV������6tQGURPH�GH�5D\QDXG� $QWDJRQLVWDV�GHO�FDOFLR�GHO�WLSR�GH�ODV�GLKLGURSLULGLQDV�\�FRPR�DOWHUQDWLYD�ORV�QLWUDWRV������'HSUHVLyQ�LPSRUWDQWH��LPSRWHQFLD�R�LQVRPQLR� 6H�SUHIHULUi�HQ�HVWRV�SDFLHQWHV�ORV�QLWUDWRV�R�ORV�DQWDJRQLVWDV�GHO�FDOFLR��GHELpQGRVH�HYLWDU�ORV�EHWDEORTXHDQWHV����(YDOXDFLyQ�SURQyVWLFD�GH�OD�DQJLQD�HVWDEOH����� (V� GHVHDEOH� TXH� WRGR� SDFLHQWH� FRQ� DQJLQD� HVWDEOH� VHD� VRPHWLGR� D� XQD� YDORUDFLyQ�SURQyVWLFD��/RV�IDFWRUHV�TXH�PHMRU�SUHGLFHQ�OD�VXSHUYLYHQFLD�D�ODUJR�SOD]R�HQ�OD�FDUGLRSDWtD�LVTXpPLFD��VRQ�OD�IXQFLyQ�VLVWyOLFD�GHO�YHQWUtFXOR�L]TXLHUGR�\�OD�H[WHQVLyQ�\�VHYHULGDG�GH�OD�LVTXHPLD�� 7RGR� SDFLHQWH� FRQ� DQJLQD� HVWDEOH� GHEH VHU� VRPHWLGR� D� XQD�SUXHED�GH� HVWUpV��ItVLFR�R�IDUPDFROyJLFR���DVRFLDGD�R�QR�D�WpFQLFDV�GH�LPDJHQ��SDUD�HO�HVWXGLR�GH�OD�LVTXHPLD�PLRFiUGLFD�� 3DUD� DXPHQWDU� OD� VHQVLELOLGDG� GH� OD� SUXHED� GH� HVIXHU]R�� HQ� JHQHUDO�� GHEHQ�UHWLUDUVH�SUHYLDPHQWH�ORV�IiUPDFRV�DQWLDQJLQRVRV�����&ULWHULRV�GH�PDO�SURQyVWLFR�GH�OD�HUJRPHWUtD�X�RWUDV�WpFQLFDV�GH�LPDJHQ�� $QJLQD�\�R�GHVFHQVR�GHO�67�PD\RU�R�LJXDO�D���PP�HQ�HO�HVWDGLR�,�GHO�SURWRFROR�GH�%UXFH�R�FRQ�XQD�IUHFXHQFLD�FDUGLDFD�LQIHULRU�D�����OSP��VLQ�EHWDEORTXHDQWHV��� 'HVFHQVR�GHO�67�GH���PP�R�PiV�� 67�TXH�VH�PDQWLHQH�GHVFHQGLGR�GXUDQWH�PiV�GH���PLQXWRV�GXUDQWH�OD�UHFXSHUDFLyQ�� 'HVFHQVR�GHO�67�HQ�PDV�GH���GHULYDFLRQHV�GHO�(&*�� &DtGD�GH�OD�7$�LJXDO�D�VXSHULRU�D����PP�+J�GXUDQWH�ORV�SULPHURV���HVWDGLRV�GHO�SURWRFROR�GH�%UXFH��R�QR�VXSHUDU�ORV�����PP�+J�� ,QFDSDFLGDG�SDUD�DOFDQ]DU�XQD�FDUJD�GH���0(76�R�XQD�IUHFXHQFLD�FDUGLDFD�GH�����OSP��LQFOXVR�HQ�DXVHQFLD�GH�DQJLQD�R�GHVFHQVR�GHO�67�� $SDULFLyQ� GH� GHIHFWRV� GH� SHUIXVLyQ� DPSOLRV� UHYHUVLEOHV� HQ� ORV� HVWXGLRV� LVRWySLFRV�� DVt�FRPR�HO�DXPHQWR�GH� OD�FDSWDFLyQ�SXOPRQDU�GHO�7DOLR�����UHIOHMDQGR�GLVIXQFLyQ�YHQWULFXODU�L]TXLHUGD�LQGXFLGD�SRU�HO�HMHUFLFLR����,QGLFDFLRQHV�GH�OD�FRURQDULRJUDItD�HQ�OD�DQJLQD�HVWDEOH�� $QJLQD�GH�HVIXHU]R�JUDGR�,,,�R�,9�VLQ�XQD�UHVSXHVWD�DGHFXDGD�DO�WUDWDPLHQWR�PpGLFR�

Page 26: Manual practico urgencias medicina interna muy bueno

��

� $QJLQD�GH�HVIXHU]R�JUDGR� ,�R� ,,� FRQ�KLVWRULD�GH� LQIDUWR�GH�PLRFDUGLR�R�FRQ�HYLGHQFLD�GH�LVTXHPLD�GH�DOWR�ULHVJR�SRU�HUJRPHWUtD�R�WpFQLFDV�GH�LPDJHQ�� $UULWPLDV�YHQWULFXODUHV�VHYHUDV�R�HSLVRGLR�GH�SDUR�FDUGLDFR�UHFXSHUDGR�� $QWHV�GH�LQWHUYHQFLRQHV�GH�FLUXJtD�YDVFXODU�PD\RU��VL�FRH[LVWH�DQJLQD�R�KD\�HYLGHQFLD�GH�LVTXHPLD�PLRFiUGLFD�� 5HFXUUHQFLD� GH� DQJLQD� JUDGR� ,,,� R� ,9� HQ� SDFLHQWHV� VRPHWLGRV� SUHYLDPHQWH� D�UHYDVFXODUL]DFLyQ��$&73�R�FLUXJtD��� 'LVIXQFLyQ�YHQWULFXODU�VHYHUD�FRQ�VRVSHFKD�GH�RULJHQ�LVTXpPLFR�� (QIHUPRV�FRQ�GRORU� WtSLFR�R�DWtSLFR�HQ�ORV�TXH�QR VH�SXHGHQ�REWHQHU�GDWRV�GLDJQyVWLFRV�VXILFLHQWH�SRU�RWURV�PpWRGRV����,QGLFDFLRQHV�GH�OD�UHYDVFXODUL]DFLyQ�PLRFiUGLFD�HQ�OD�DQJLQD�HVWDEOH�� &XDQGR�OD�DQJLQD�QR�SXHGH�FRQWURODUVH�FRQ HO�WUDWDPLHQWR�PpGLFR�\�R�LQWHUILHUH�OD�DFWLYLGDG�FRWLGLDQD�GHO�SDFLHQWH��$&73�R�FLUXJtD���� &XDQGR� SRGHPRV� PHMRUDU� OD� HVSHUDQ]D� GH� YLGD�� SDFLHQWHV� FRQ� DQJLQD� HVWDEOH� TXH�SUHVHQWDQ�XQD�HVWHQRVLV�HQ�HO�WURQFR�FRP~Q�GH�OD�FRURQDUtD�L]TXLHUGD�VXSHULRU�DO�����GH�VX�OX]�R�XQD�HVWHQRVLV�LJXDO�R�VXSHULRU�DO�����HQ�ODV�WUHV�FRURQDUtDV�SULQFLSDOHV��'$��&'�\�&[���VREUH�WRGR�HQ�SUHVHQFLD�GH�XQD�IXQFLyQ�YHQWULFXODU�L]TXLHUGD�GHSULPLGD��(Q�HVWRV�SDFLHQWHV�HVWi�LQGLFDGD�OD�FLUXJtD�GH�UHYDVFXODUL]DFLyQ�FRURQDULD����7UDWDPLHQWR�GH�OD�DQJLQD�LQHVWDEOH�/D�HGDG�QR HV�XQ�OLPLWDQWH�GH�OD�DFWLWXG�D�WRPDU��VLQR�HO�SURQyVWLFR�YLWDO��/D�FRPRUELOLGDG�FRQ�XQ� SURQyVWLFR� YLWDO� LQIHULRU� D� �� DxRV� �QHRSODVLD� QR� FXUDGD�� GHPHQFLD�� FLUURVLV� HVWDGLR� &��LQVXILFLHQFLD� UHQDO� FUyQLFD� VHYHUD� (32&� FRQ� R[tJHQR� GRPLFLOLDULR� R� $&9� PX\� OLPLWDQWH��FRQGLFLRQD�HO�JUDGR�GH�LQWHUYHQFLRQLVPR�TXH�VH�DGRSWH�

����,QJUHVR�$TXHOORV�SDFLHQWHV�FRQ�DQJLQD�LQHVWDEOH��UHTXLHUHQ�JHQHUDOPHQWH�LQJUHVR�KRVSLWDODULR��SUHIHUHQWHPHQWH�HQ�OD�8QLGDG�&RURQDULD���/DV�FDUDFWHUtVWLFDV�GH�JUDYHGDG�GHO�DQJRU�LQHVWDEOH�VRQ��DQJLQD�SRVWLQIDUWR��GRORU�SURORQJDGR�HQ�UHSRVR��VXSHULRU�D����PLQXWRV���($3��DQJLQD�FRQ�KLSRWHQVLyQ��DQJLQD�GH�UHSRVR�FRQ�FDPELRV�HQ�HO�67�PD\RU�R�LJXDO�D���PP��DSDULFLyQ�GH�WHUFHU�UXLGR�R�GH�XQ�VRSOR�GH�UHJXUJLWDFLyQ�PLWUDO�R�DXPHQWR�GH�OD�LQWHQVLGDG�GH�XQR�SUHH[LVWHQWH������0HGLGDV�JHQHUDOHV�5HSRVR�GXUDQWH�DO�PHQRV����KRUDV�$GPLQLVWUDU�OD[DQWHV�VXDYHV��'XSKDODF��$GPLQLVWUDU�DQVLROtWLFRV�(IHFWXDU� GHWHUPLQDFLRQHV� VHULDGDV� GH� HQ]LPDV� FDGD� ���� KRUDV� SDUD� GHVFDUWDU� XQ�LQIDUWR��HVSHFLDOPHQWH�HQ�ORV�FDVRV�GH�DQJLQD�SURORQJDGD�

Page 27: Manual practico urgencias medicina interna muy bueno

��

(&*�FDGD����KRUDV�\�VLHPSUH�TXH�HO�SDFLHQWH�SUHVHQWH�UHFXUUHQFLD�GH�VXV�VtQWRPDV�R�XQ�FDPELR�HQ�VX�HVWDGR�FOtQLFR�'LDJQRVWLFDU� \� WUDWDU� ODV� FRQGLFLRQHV� TXH� SXHGDQ� DXPHQWDU� WUDQVLWRULDPHQWH� ODV�GHPDQGDV�PLRFiUGLFDV�GH�R[tJHQR� �ILHEUH�� LQIHFFLyQ�� DQHPLD��DUULWPLDV��KLSHUWHQVLyQ��DQVLHGDG��KLSHUWLURLGLVPR��KLSR[HPLD���������0HGLGDV�IDUPDFROyJLFDV�1LWURJOLFHULQD�� 'LOXLU� ��� PJ� GH� QLWURJOLFHULQD� HQ� ���� FF� GH� JOXFRVDGR� DO� ����FRPHQ]DQGR� FRQ XQD� YHORFLGDG� GH� SHUIXVLyQ� GH� ��� PO�KRUD�� VXELpQGRVH�SURJUHVLYDPHQWH�GH����HQ����PO�KRUD�FDGD����PLQXWRV�KDVWD�TXH�VH�FRQWUROH�OD�DQJLQD�R� DSDUH]FDQ� HIHFWRV� VHFXQGDULRV� �KDVWD� XQD� GRVLV�Pi[LPD� GH� ���PO�KRUD� R� LQFOXVR�VXSHULRU�HQ�IXQFLyQ�GH�OD�UHVSXHVWD�FOtQLFD���7UDV�OD�HVWDELOL]DFLyQ�GHO�SDFLHQWH�WUDV�������KRUDV��VH�SXHGHQ�XWLOL]DU�ODV�YtDV�RUDO�R�WUDQVGpUPLFD�$VSLULQD��6H�XWLOL]D�XQD�GRVLV�LQLFLDO�GH�FKRTXH�GH�����PJ��VHJXLGD�GH�XQD�GRVLV�GLDULD�GH� �������� PJ� SRU� YtD� RUDO�� &RPR� DOWHUQDWLYD� D� OD� $VSLULQD� SXHGH� XWLOL]DUVH� OD�7LFORSLGLQD�� ���� PJ� FDGD� ��� KRUDV�� � (Q� HO� PRPHQWR� DFWXDO� QR� VH� KD� HYDOXDGR� HO�&ORSLGRJUHO�HQ�OD�DQJLQD�LQHVWDEOH�+HSDULQD��(Q�HO�PRPHQWR�DFWXDO��\�VHJ~Q�OD�PHMRU�HYLGHQFLD�GLVSRQLEOH��ODV�KHSDULQDV�GH� EDMR� SHVR� PROHFXODU� �+%30�� VRQ� VXSHULRUHV� IUHQWH� D� SODFHER� \� OD� KHSDULQD� QR�IUDFFLRQDGD�� SDUD� UHGXFLU� OD� LQFLGHQFLD� GH� HSLVRGLRV� LVTXpPLFRV� R�PXHUWH� HQ� OD� IDVH�DJXGD�GH� OD�DQJLQD� LQHVWDEOH�R�HO� ,$0�QR�4��$Vt�PLVPR��WDPSRFR�H[LVWHQ�HYLGHQFLDV�TXH� DSR\HQ� OD� H[LVWHQFLD� GH� XQ� HIHFWR� GH� FODVH SDUD� WRGDV� ODV� +%30�� VLHQGR� VyOR�UHFRPHQGDEOHV�OD�GDOWHSDULQD��)5$*0,1�����8,�NJ�VF�FDGD����KRUDV��R�OD�HQR[DSDULQD��&/(;$1(����PJ�NJ�GRV�YHFHV�DO�GtD�SRU�YtD�VXEFXWiQHD��%HWDEORTXHDQWHV��5HGXFHQ�ORV�HSLVRGLRV�GH�DQJLQD��HVWDELOL]DQ�pVWD�\�GLVPLQX\HQ�OD�LQFLGHQFLD� GH� LQIDUWR�� SRU� OR� TXH� HVWiQ� HVSHFLDOPHQWH� LQGLFDGRV� HQ� DXVHQFLD� GH�FRQWUDLQGLFDFLyQ�� 6H� SXHGH� XWLOL]DU� FXDOTXLHU� SUHSDUDGR�� DMXVWiQGRVH� OD� GRVLV� HQ�IXQFLyQ�GH�OD�VHYHULGDG�GH�OD�DQJLQD�\�OD�UHVSXHVWD�GH�FDGD�SDFLHQWH��/D�HOHFFLyQ�GH�XQ�IiUPDFR� GHWHUPLQDGR� QR� HV� WDQ� LPSRUWDQWH� FRPR� HO� DVHJXUDU� TXH� ORV� FDQGLGDWRV�DGHFXDGRV�UHFLEHQ�GLFKR�WUDWDPLHQWR��8VDU�IiUPDFRV�GH�YLGD�PHGLD�FRUWD��3URSUDQRORO��VL�KD\�GXGDV�VREUH�OD�WROHUDQFLD�GHO�SDFLHQWH�D�ORV�PLVPRV�&DOFLRDQWDJRQLVWDV��(VSHFLDOPHQWH�LQGLFDGRV�HQ�FDVR�GH�VRVSHFKD�GH�YDVRHVSDVPR�FRURQDULR�\�VRQ�IiUPDFRV�GH�VHJXQGD�HOHFFLyQ�FRPR�DOWHUQDWLYD�D�ORV�EHWDEORTXHDQWHV�HQ� FDVR� GH� FRQWUDLQGLFDFLyQ� D� HVWRV�� SDFLHQWHV� TXH� FRQ� QLWURJOLFHULQD� \�EHWDEORTXHQDQWHV� SHUVLVWHQ� VLQWRPiWLFRV� R� FRQ� 7$� VLVWyOLFD� VXSHULRU� D� ����PP�+J��'HEHQ�HYLWDUVH�HQ�FDVR�GH� LQVXILFLHQFLD�FDUGLDFD��VDOYR� ODV�GLKLGURSLULGLQDV�GH�~OWLPD�JHQHUDFLyQ��,QKLELGRUHV�GH�ORV�UHFHSWRUHV�,,E�,,,D��7RGRV�ORV�SDFLHQWHV�TXH�UHTXLHUHQ�DQJLRSODVWLD�SDUHFHQ�EHQHILFLDUVH� GH� HVWD� FODVH� GH� WUDWDPLHQWR�� LQGHSHQGLHQWHPHQWH�GHO�SHUILO�GH�ULHVJR�GHO�SDFLHQWH�R�GH�OD�LQGLFDFLyQ�GH�UHYDVFXODUL]DFLyQ��\�ORV�EHQHILFLRV�FOtQLFRV�VRQ�LQGHSHQGLHQWHV� GHO� GLVSRVLWLYR� XVDGR� �$&73� FRQ� EDOyQ�� DWHURWRPR�� VWHQW��� /RV�

Page 28: Manual practico urgencias medicina interna muy bueno

��

SDFLHQWHV� VRPHWLGRV� D� $&73� SRU� VtQGURPHV� FRPR� OD� DQJLQD LQHVWDEOH� R� HO� ,$0� VLQ�RQGD�4�VRQ�ORV�PDV�EHQHILFLDGRV�GH�HVWD�PRGDOLGDG�WHUDSpXWLFD�����,QGLFDFLRQHV�GH�FRURQDULRJUDItD�HQ�OD�DQJLQD�LQHVWDEOH�&XDQGR�QR�VH�FRQVLJXH�XQD�PHMRUtD�DSUHFLDEOH�GXUDQWH� ODV� SULPHUDV�������KRUDV��D�SHVDU�GH�XQ�WUDWDPLHQWR�PpGLFR�FRUUHFWR�'XUDQWH� ODV� FULVLV�� HO� SDFLHQWH� GHVDUUROOD� LQVXILFLHQFLD� FDUGLDFD�� LQVXILFLHQFLD� PLWUDO�VHYHUD�R�DUULWPLDV�JUDYHV�'XUDQWH�OD�FULVLV�VH�REVHUYD�XQD�HOHYDFLyQ�VLJQLILFDWLYD�GHO�VHJPHQWR�67�%DMR�XQ�WUDWDPLHQWR�IDUPDFROyJLFR�FRPSOHWR��HO�SDFLHQWH�SUHVHQWD�DQJLQD�SURORQJDGD�6L� HO� SDFLHQWH� KD� VLGR� VRPHWLGR� SUHYLDPHQWH� D� XQ� SURFHVR� GH� UHYDVFXODUL]DFLyQ�PLRFiUGLFD��$&73�R�FLUXJtD��8QD�YH]�HVWDELOL]DGR�HO�SDFLHQWH� ����KRUDV�VLQ�DQJLQD���VH�HIHFW~D�XQD�HUJRPHWUtD�X�RWUD�WpFQLFD�GH�LPDJHQ��HVWXGLR�FRQ�LVyWRSRV���6L�VH�HYLGHQFLD�LVTXHPLD�D�EDMR�QLYHO�GH�HMHUFLFLR� X� RWURV� PDUFDGRUHV� GH� PDO� SURQyVWLFR�� HVWi� WDPELpQ� LQGLFDGD� OD�FRURQDULRJUDItD�

%LEOLRJUDItD���� $]SLWDUWH� $OPDJUR� -�� &DEDGpV� 2�&DOODJKDQ� $�� /ySH]� 0HULQR�� 9� HW� DO�� $QJLQD� GH� SHFKR��&RQFHSWR�\�FODVLILFDFLyQ��5HY�(VS�&DUGLRO����������������������&RUGR�0ROODU�-&��$VtQ�&DUGLHO�(��)HUQiQGH]�3DORPHTXH�&�HW�DO��0pWRGRV�GLDJQyVWLFRV�HQ�OD�DQJLQD�GH�SHFKR��5HY�(VS�&DUGLRO���������������������� 5LEHLUR� 3$�� 6KDK� 30�� 8QVWDEOH� DQJLQD�� QHZ� LQVLJKWV� LQWR� SDWRKS\VLRORJLF� FKDUDFWHULVWLF��SURJQRVLV�DQG�PDQDJHPHQW�VWUDWHJLHV��&XUUHQW�3UREOHPV�LQ�&DUGLRORJ\���������������������������5HFRPHQGDWLRQV�RI� WKH�7DVN�)RUFH�RI� WKH�(XURSHDQ�6RFLHW\�RI�&DUGLRORJ\��0DQDJHPHQW�RI�VWDEOH�DQJLQD�SHFWRULV��(XU�+HDUW�-���������������������� 0DUWtQ� /XHQJR�&�� $EH\WXD� -LPpQH]�0�� %RVFK�*HQRYHU� ;� HW� DO�� 7UDWDPLHQWR�PpGLFR� GH� OD�DQJLQD�GH�SHFKR��5HY�(VS�&DUGLRO���������������������� %UDXQZDOG� (�� -RQHV� 5+�� 0DUN� 'E� HW� DO�� 'LDJQRVLQJ� DQG� PHQDJLQJ� XQVWDEOH� DQJLQD��&LUFXODWLRQ�������������������� %UDXQZDOG�(��8QVWDEOH�$QJLQD��$Q�HWLRORJLF�DSSURDFK�WR�PDQDJHPHQW��&LUFXODWLRQ�������������������������7KpURX[�3��)XVWHU�9��$FXWH�FRURQDU\�6\QGURPHV��&LUFXODWLRQ�������������������������=DDFNV�60��/LHEVRQ�35��&DOYLQ�-(��3DUULOOR�-(��.OHLQ�//.��8QVWDEOH�DQJLQD�DQG�QRQ�4�:DYH�0\RFDUGLDO� ,QIDUFWLRQ�� 'RHV� WKH� &OLQLFDO� 'LDJQRVLV� +DYH� 7KHUDSHXWLF� ,PSOLDWLRQV"� -� $P� &RO�&DUGLRO�������������������0DUtQ�/HyQ� ,��*ULOR�5HLQD�$��&DOGHUyQ�6DQGXEHWH�(��HQ�QRPEUH�GHO�JUXSR�&$0%,(��*XtD�SUiFWLFD� EDVDGD� HQ� OD� HYLGHQFLD� VREUH� HO�PDQHMR� GH� OD� DQJLQD� LQHVWDEOH�� 6HYLOOD�� $JHQFLD� GH�(YDOXDFLyQ�GH�7HFQRORJtDV�6DQLWDULDV�������

Page 29: Manual practico urgencias medicina interna muy bueno

��

���� &RPLWWHH� RQ�0DQDJHPHQW� RI� 3DWLHQWV�:LWK� &KURQLF� 6WDEOH� $QJLQD�� $&&�$+$�$&3�$6,0�JXLGHOLQHV�IRU� WKH�PDQDJHPHQW�RI�SDWLHQWV�ZLWK�FKURQLF�VWDEOH DQJLQD��$�UHSRUW�RI�WKH�$PHULFDQ�&ROOHJH�RI�&DUGLRORJ\�$PHULFDQ�+HDUW�$VVRFLDWLRQ�7DVN�IRUFH�RQ�3UDFWLFH�*XLGHOLQHV��-�$P�&ROO�&DUGLRO����������������������

Page 30: Manual practico urgencias medicina interna muy bueno

��

&DUGLRSDWtD�LVTXpPLFD��LQIDUWR�DJXGR�GH�PLRFDUGLR0DQXHO�$JXLOHUD��0LJXHO�$QJHO�%DUED�\�$PDOLD�1DYDUUR���5HFRPHQGDFLRQHV�DQWH�OD�VRVSHFKD�GH�XQ�LQIDUWR�DJXGR�GH�PLRFDUGLR�� $� ORV� SDFLHQWHV�FRQ�VRVSHFKD�GH� ,$0�VH� OHV� GHEHUtD� UHDOL]DU� XQD�DQDPQHVLV�RULHQWDGD�\�FRQFLVD��MXQWR�D�XQD�H[SORUDFLyQ�ItVLFD�TXH�SHUPLWD�YDORUDU�OD�VLWXDFLyQ�GH�JUDYHGDG��1R�GHEH�SHUGHUVH�HO�WLHPSR�HQ�REWHQHU�GDWRV�LUUHOHYDQWHV�� 0RQLWRUL]DFLyQ� HOHFWURFDUGLRJUiILFD�� UHDOL]DU� XQ� (&*� \� FRORFDU� XQ� GHVILEULODGRU� HQ� ODV�SUR[LPLGDGHV�GHO�SDFLHQWH�� &RQWDFWDU�FRQ�HO�PpGLFR�HQFDUJDGR�GH�OD�8QLGDG�&RURQDULD��VLQ�HVSHUDU�D�OD�UHDOL]DFLyQ�GHH[SORUDFLRQHV�FRPSOHPHQWDULDV�TXH�UHWUDVHQ�OD�OOHJDGD�GHO�SDFLHQWH�D�GLFKD�8QLGDG�� &DQDOL]DU� XQD� YtD� SHULIpULFD� HQ� XQD� YHQD� TXH� SXGLHUD� FRPSULPLUVH� HQ� FDVR� QHFHVDULR��([WUDHU�VDQJUH�SDUD�KHPRJUDPD��LRQHV��FUHDWLQLQD��XUHD��JOXFRVD��HQ]LPDV�\�FRDJXODFLyQ��1R�GHEHQ�UHDOL]DUVH�SXQFLRQHV�DUWHULDOHV�SDUD�JDVRPHWUtDV��1R�GHEH�DGPLQLVWUDUVH�PHGLFDFLyQ�SRU�YtD�,�0�� $GPLQLVWUDU�R[tJHQR�� $GPLQLVWUDU�QLWURJOLFHULQD�V�O��/D�GRVLV�VH�UHSHWLUi�VL�SHUVLVWH�GRORU�\�OD�7$�VLVWyOLFD�HV�PD\RU�GH����PP�+J��� 'HEH�DGPLQLVWUDUVH�XQD�GRVLV�GH���������PJ�GH�DVSLULQD��(Q�FDVR�GH�DOHUJLD�D�OD�DVSLULQD�SXHGH�XWLOL]DUVH�FRPR�DOWHUQDWLYD�WLFORSLGLQD������PJ����KRUDV��R�FORSLGRJUHO�����PJ����KRUDV���� 6L�SHUVLVWH�HO�GRORU�VH�GHEH�DGPLQLVWUDU�����PJ�GH�FORUXUR�PyUILFR�,�9��OHQWDPHQWH����DPS� �O��PJ���UHSLWLHQGR�OD�GRVLV�FDGD�������PLQXWRV�VL�SHUVLVWH�HO�GRORU�KDVWD�XQ�Pi[LPR�GH����PJ��(Q�HO�,$0�LQIHULRU�FRQ�VLQWRPDWRORJtD�YDJDO��SXHGH�VHU�PiV�~WLO�OD�DGPLQLVWUDFLyQ�GH�������PJ�,�9��GH�PHSHULGLQD��&RPR�DOWHUQDWLYD��VH�SXHGH�DGPLQLVWUDU���DPSROOD�GH�1RORWLO� OHQWDPHQWH�SRU�YtD�,�9�� 6H�XWLOL]DUi� OD� DWURSLQD� �������PJ� ,�9�� HQ�FDVR�GH�� �EUDGLFDUGLD�VLQXVDO� VLQWRPiWLFD��R�FRQ�H[WUDVtVWROHV�YHQWULFXODUHV�IUHFXHQWHV��,$0�LQIHULRU�FRQ�EORTXHR�$9�GH�VHJXQGR�JUDGR�WLSR�,�R�GH�WHUFHU�JUDGR�VLQWRPiWLFR��QDXVHDV�\�R�YyPLWRV�WUDV�OD�DGPLQLVWUDFLyQ�GH�PRUILQD�� 'H� IRUPD� SDUDOHOD� \� VLPXOWiQHD� GHEH� RUJDQL]DUVH� HO� WUDVODGR� GHO� SDFLHQWH� D� OD� XQLGDG�FRURQDULD�OR�DQWHV�SRVLEOH��VLQ�SHUGHU�HO�WLHPSR�HQ�SUDFWLFDU�UDGLRJUDItDV�GH�WyUD[�R�HVSHUDU�ORV�UHVXOWDGRV�GH�ODV�DQDOtWLFDV�

,QGLFDFLRQHV�GH�OD�WURPEROLVLV�HQ�HO�,$0�� (QIHUPRV�FRQ�GRORU�SUHFRUGLDO�VXJHVWLYR�GH�LVTXHPLD�PLRFiUGLFD�GH�PiV�GH����PLQXWRV�GH�GXUDFLyQ�� DFRPSDxDGR�GH� HOHYDFLyQ� GHO�67�GH�PiV�GH���PP�� HQ� GRV� R�PiV�GHULYDFLRQHV�FRQWLJXDV� TXH�QR UHYLHUWH�FRQ�QLWURJOLFHULQD��GXUDQWH�ODV�SULPHUDV����KRUDV� WUDV�HO� LQLFLR�GHO�FXDGUR��VLHQGR�OD�LQGLFDFLyQ�DEVROXWD�HQ�ODV�SULPHUDV���KRUDV�� &XDGUR�VXJHVWLYR�GH�LQIDUWR�DJXGR�GH�PLRFDUGLR�HQ�SUHVHQFLD�GH�EORTXHR�GH�UDPD�L]TXLHUGD��GXUDQWH�ODV����KRUDV�WUDV�HO�LQLFLR�GHO�FXDGUR��VLHQGR�OD�LQGLFDFLyQ�DEVROXWD�HQ�ODV�SULPHUDV���KRUDV�&RQWUDLQGLFDFLRQHV�DEVROXWDV�GH�OD�WURPEROLVLV�

Page 31: Manual practico urgencias medicina interna muy bueno

��

� $&9�KHPRUUiJLFR�SUHYLR�HQ�FXDOTXLHU�PRPHQWR��$&9�QR�KHPRUUiJLFR�HQ�HO�~OWLPR�DxR�� 1HRSODVLD�LQWUDFUDQHDO�� +HPRUUDJLD�LQWHUQD�DFWLYD��QR�VH�LQFOX\H�OD�PHQVWUXDFLyQ��� 6RVSHFKD�GH�GLVHFFLyQ�DyUWLFD�,QGLFDFLRQHV�GH�OD�$&73�SULPDULD�&RPR� DOWHUQDWLYD� D� OD� WURPEROLVLV� HQ� SDFLHQWHV� FRQ� ,$0� \� HOHYDFLyQ� GHO� VHJPHQWR�67� R�EORTXHR� GH� UDPD� L]TXLHUGD� GH� QXHYD� DSDULFLyQ� TXH� SXHGHQ� VHU� VRPHWLGRV� D� $&73� GH� OD�DUWHULD� UHODFLRQDGD� FRQ� HO� LQIDUWR� GHQWUR� GH� ODV� ��� SULPHUDV� KRUDV� GHO� FRPLHQ]R� GH� ORV�VtQWRPDV�R�GHVSXpV�GH�ODV�SULPHUDV����KRUDV�VL�SHUVLVWHQ�ORV�VtQWRPDV�GH�LVTXHPLD��VLHPSUH�\� FXDQGR� VH� SXHGD� OOHYDU� D� FDER� GHQWUR� GH� ODV� �� KRUDV� GHO� LQJUHVR�� HQ� XQ� ODERUDWRULR� GH�KHPRGLQiPLFD�DGHFXDGR�\�SRU�XQ�SHUVRQDO�VXILFLHQWHPHQWH�H[SHULPHQWDGR�(Q�SDFLHQWHV�TXH�HVWiQ�GHQWUR�GH�ODV�SULPHUDV����KRUDV�GH�SURGXFLUVH�XQ�,$0�FRQ�RQGD�4�R�FRQ�%5,�GH�QXHYD�DSDULFLyQ��TXH�GHVDUUROODQ�XQ�VKRFN�FDUGLRJpQLFR��WLHQHQ�PHQRV�GH����DxRV�GH� HGDG�� \� SXHGHQ� VHU� VRPHWLGRV� D� UHYDVFXODUL]DFLyQ� GHQWUR� GH� ODV� SULPHUDV����KRUDV�GHO�FRPLHQ]R�GHO�VKRFN�&RPR�HVWUDWHJLD�GH�UHSHUIXVLyQ�HQ�SDFLHQWHV�FRQ�LQGLFDFLyQ�SDUD�pVWD��TXH�SUHVHQWDQ�XQD�FRQWUDLQGLFDFLyQ�SDUD�OD�WURPEROLVLV�

���(VWUDWLILFDFLyQ�GHO�ULHJR�SRVWLQIDUWR��/RV� WUHV� IDFWRUHV� GH� ULHVJR� SULQFLSDOHV� GH� SUHVHQWDU� XQ� UHLQIDUWR� R�PXHUWH� FDUGtDFD� HQ� ORV�SDFLHQWHV�TXH�VXSHUDQ�OD�IDVH�DJXGD�GH�XQ�LQIDUWR�VRQ��SRU�HVWH�RUGHQ�8QD�PDOD�IXQFLyQ�YHQWULFXODU�/D�LVTXHPLD�PLRFiUGLFD�UHVLGXDO/D�SUHVHQFLD�GH�DUULWPLDV�YHQWULFXODUHV��0pWRGRV�GH�HVWXGLR��(FRFDUGLRJUDItD�� 1RV� SHUPLWH� YDORUDU� OD� IXQFLyQ� YHQWULFXODU� L]TXLHUGD� DVt� FRPR� ODV�FRPSOLFDFLRQHV�PHFiQLFDV�GHO� LQIDUWR�GH�PLRFDUGLR��6H�UHDOL]DUi�HQ� WRGR�SDFLHQWH�TXH�KD�VXIULGR�XQ�,$0�(UJRPHWUtD�� 6H� UHDOL]DUi� DQWHV� GHO� DOWD� �HQWUH� HO� ��� \� ����� HQ� ORV� SDFLHQWHV� TXH�QR� KDQSUHVHQWDGR� HYLGHQFLD� FOtQLFD� GH� LVTXHPLD�PLRFiUGLFD� R� GLVIXQFLyQ� YHQWULFXODU� GXUDQWH� ORV�SULPHURV�GtDV�GH�KRVSLWDOL]DFLyQ��6H�UHDOL]DUi�SUHIHULEOHPHQWH�VLQ�WUDWDPLHQWR�DQWLDQJLQRVR��GHELpQGRVH�VXVSHQGHU�ORV�EHWDEORTXHDQWHV����KRUDV�DQWHV�GH�OD�SUXHED�3UXHED�GH�HVIXHU]R�FRQ�LVyWRSRV��6H�LQGLFDUi�VLHPSUH�TXH�H[LVWDQ�DOWHUDFLRQHV�EDVDOHV�GH�OD�UHSRODUL]DFLyQ�TXH�QR�SHUPLWDQ�XQD�LQWHUSUHWDFLyQ�FRUUHFWD�GH�OD�SUXHED�GH�HVIXHU]R�FRQYHQFLRQDO��(Q�FDVR�GH�LQFDSDFLGDG�SDUD�HIHFWXDU�XQD�SUXHED�GH�HVIXHU]R��VH�OOHYDUi�D�FDER�PHGLDQWH�HVWUpV�IDUPDFROyJLFR��GREXWDPLQD��GLSLULGDPRO�R�DGHQRVLQD��+ROWHU� 1R�HV�XQD�H[SORUDFLyQ� UXWLQDULD��3XHGH�FRQVLGHUDUVH�HQ SDFLHQWHV�FRQ�GLVIXQFLyQ�YHQWULFXODU�VHYHUD�R�DUULWPLDV�YHQWULFXODUHV�JUDYHV��6LQ�HPEDUJR�� OD�GHWHFFLyQ�GH�DUULWPLDV�HQ�SDFLHQWHV�DVLQWRPiWLFRV�QR�HV�DUJXPHQWR�SDUD�LQGLFDU�WUDWDPLHQWR�DQWLDUUtWPLFR�

Page 32: Manual practico urgencias medicina interna muy bueno

��

,QGLFDFLRQHV�GH�FRURQDULRJUDItD��� 3DFLHQWHV� FRQ� HSLVRGLRV� GH� LVTXHPLD� PLRFiUGLFD� HVSRQWiQHRV� R� SURYRFDGRV� SRU�PtQLPR�HMHUFLFLR��GXUDQWH�OD�UHFXSHUDFLyQ�GHO�LQIDUWR�� (Q�SDFLHQWHV�FRQ�FRPSOLFDFLRQHV�PHFiQLFDV��URWXUD�GH�OD�SDUHG�OLEUH��URWXUD�VHSWDO��R�LQVXILFLHQFLD�PLWUDO�DJXGD��� 3DFLHQWHV�FRQ�LQHVWDELOLGDG�KHPRGLQiPLFD�SHUVLVWHQWH�� 6XSHUYLYLHQWHV� GH� XQ� ,$0� FRQ� )(� GH� YHQWUtFXOR� L]TXLHUGR� LQIHULRU� R� LJXDO� DO� �����LQVXILFLHQFLD� FDUGLDFD� FRQJHVWLYD�� UHYDVFXODUL]DFLyQ� SUHYLD�� R� DUULWPLDV� YHQWULFXODUHV�PDOLJQDV�� 6XSHUYLYLHQWHV�GH�XQ�,$0�TXH�SUHVHQWDURQ�FOtQLFD�GH�LQVXILFLHQFLD�FDUGLDFD�GXUDQWH�OD�IDVH� DJXGD�� SHUR� HQ� ORV� TXH� SRVWHULRUPHQWH� VH� FRPSUREy� XQD� IXQFLyQ� VLVWyOLFD� GHO�YHQWUtFXOR�L]TXLHUGR�FRQVHUYDGD� 3UXHED�GH�HVIXHU]R�SRVLWLYD�FRQ�FULWHULRV�GH�VHYHULGDG��QR�DOFDQ]DU�XQD�)&�PD\RU�GH����� OSP�� QR� DOFDQ]DU� HO� ,� HVWDGLR� GH� %UXFH�� QR� DXPHQWDU� OD� 7$� ���PP�+J� R�PiV��GHSUHVLyQ�GHO�67�PD\RU�GH���PP�FRQ�HO�HMHUFLFLR�R�DQJLQD�LQGXFLEOH�GHVGH�HO�,�HVWDGLR�GH�%UXFH�����3UHYHQFLyQ�VHFXQGDULD�SRVWLQIDUWR�GH�PLRFDUGLR�/D� SUHYHQFLyQ� VHFXQGDUtD� SRVWLQIDUWR� FRPSUHQGH� WRGDV� DTXHOODV� PHGLGDV� GHVWLQDGDV� D�GLVPLQXLU�OD�PRUEL�PRUWDOLGDG�GH�ORV�SDFLHQWHV�TXH�KDQ�VXIULGR�XQ�,$0���,QFOX\H�QR�VRODPHQWH�HO�FRQWURO�GH�ORV�IDFWRUHV�GH�ULHVJR�FRURQDULR��VLQR�WDPELpQ�DTXHOODV�DFWXDFLRQHV�WHUDSpXWLFDV��IDUPDFROyJLFDV�R�GH�UHYDVFXODUL]DFLyQ�PLRFiUGLFD��TXH�LQWHQWDQ�GLVPLQXLU� OD�PRUELOLGDG�\� OD�PRUWDOLGDG�GH�HVWRV�SDFLHQWHV�

����FRQWURO�GH�ORV�IDFWRUHV�GH�ULHVJR�7RGRV� ORV� HQIHUPRV� TXH� KDQ� VXIULGR� XQ� LQIDUWR� GHEHQ� FRQWURODU� ORV� IDFWRUHV� GH� ULHVJR�FRURQDULR�SDUD�HYLWDU� OD�SURJUHVLyQ�GH�OD�HQIHUPHGDG��'HEHQ�GHMDU�GH�IXPDU��FRQWURODU� ORV�QLYHOHV�GH�FROHVWHURO��ODV�FLIUDV�GH�WHQVLyQ�DUWHULDO��OD�GLDEHWHV��OD�REHVLGDG�\�HO�HVWUpV������WUDWDPLHQWR�IDUPDFROyJLFR��5HFRPHQGDFLRQHV�DFWXDOHV$VSLULQD��GHEH�XWLOL]DUVH�HQ�WRGRV�ORV�SDFLHQWHV�TXH KDQ�VXIULGR�XQ�LQIDUWR�GH�PLRFDUGLR�VL�QR� KD\� FRQWUDLQGLFDFLyQ�� 6H� XWLOL]DUiQ� HQ� XQD� GRVLV� GH� ���� D� ���� PJ� GLDULRV� GH� IRUPD�LQGHILQLGD�$QWLFRDJXODQWHV�� VH� XWLOL]DUiQ� FRPR� DOWHUQDWLYD� D� OD� DVSLULQD� HQ� DTXHOORV� SDFLHQWHV� FRQ�ULHVJR� WURPERHPEyOLFR� DOWR� �WURPERV� PXUDOHV�� ILEULODFLyQ� DXULFXODU�� HPEROLD� SUHYLD��DQHXULVPDV� YHQWULFXODUHV�� LQIDUWRV� DQWHULRUHV� H[WHQVRV�� LQVXILFLHQFLD� FDUGtDFD� \� GHSUHVLyQ�VHYHUD�GH�OD�IXQFLyQ�VLVWyOLFD�GHO�YHQWUtFXOR�L]TXLHUGR���6DOYR�HQ�HO�FDVR�GH�ORV�SDFLHQWHV�HQ�ILEULODFLyQ�DXULFXODU�HQ� ORV�TXH� OD�DQWLFRDJXODFLyQ�VH�PDQWHQGUi�GH�IRUPD� LQGHILQLGD��HQ�HO�UHVWR� GH� JUXSRV� JHQHUDOPHQWH� VH� UHFRPLHQGD�PDQWHQHU� HVWD� GXUDQWH� XQ� SHULRGR� GH� ����PHVHV�

Page 33: Manual practico urgencias medicina interna muy bueno

��

%HWDEORTXHDQWH�� GHEHQ� XWLOL]DUVH� HVSHFLDOPHQWH� HQ� ORV� VXEJUXSRV� GH� SHRU� SURQyVWLFR��HGDG�DYDQ]DGD��GLVIXQFLyQ�YHQWULFXODU�L]TXLHUGD��DQJLQD�UHFXUUHQWH��DUULWPLDV�YHQWULFXODUHV��WDTXLFDUGLD�VLQXVDO��GLDEHWHV�H�KLSHUWHQVLyQ�DUWHULDO���'HEHQ�XWLOL]DUVH�GH� IRUPD� LQGHILQLGD��1R� GHEHQ� HPSOHDUVH� ORV� TXH� WLHQHQ� ,6$�� /DV� GRVLV� GH� ORV� EHWDEORTXHDQWHV� PiV�FRP~QPHQWH�XWLOL]DGRV�VRQ��$WHQRORO���������PJ����KRUDV��0HWRSURORO���������PJ����KRUDV��3URSUDQRORO�������PJ���KRUDV�9HUDSDPLO�R GLOWLD]HP��SXHGH�XWLOL]DUVH�FRPR�DOWHUQDWLYD�D�ORV�EHWDEORTXHDQWHV��HQ�FDVR�GH�TXH�HVWH�HVWp�FRQWUDLQGLFDGR��VL� OD�IXQFLyQ�VLVWyOLFD�GHO�YHQWUtFXOR�L]TXLHUGR�HV�QRUPDO�\�HO�SDFLHQWH� QR� SUHVHQWy� LQVXILFLHQFLD� FDUGLDFD�� (O� GLOWLD]HP� SXHGH� XWLOL]DUVH� HQ� ORV� ,$0� VLQ�RQGD�4�� LQLFLiQGRVH� OD� WHUDSLD�HQ� ODV�SULPHUDV����KRUDV�\�FRQWLQXiQGROD�GXUDQWH�XQ�DxR��WHQLHQGR� HQ� FXHQWD� TXH� HQ� FDVR GH� GLVIXQFLyQ� VLVWyOLFD� GHO� YHQWUtFXOR� L]TXLHUGR� R�LQVXILFLHQFLD�FDUGLDFD�HVWDUi�FRQWUDLQGLFDGR��,(&$�� GHEHQ� XWLOL]DUVH� HQ� ORV� SDFLHQWHV� FRQ� LQIDUWR� DQWHULRU�� GLVIXQFLyQ� VLVWyOLFD� GHO�YHQWUtFXOR�L]TXLHUGR�R�TXH�SUHVHQWDURQ�LQVXILFLHQFLD�FDUGLDFD��6H�PDQWHQGUi�HO�,(&$�GXUDQWH�XQ�SHULRGR�GH���VHPDQDV�HQ�DTXHOORV�SDFLHQWHV�HQ�ORV�TXH�VH�LQLFLy�HO�WUDWDPLHQWR�HQ�OD�IDVH�DJXGD�GHO�,$0�\�TXH�QR UH~QHQ�ORV�DQWHULRUHV�FULWHULRV��6H�LQLFLDUi�FRQ�XQD�GRVLV�GH������PJ�GH�&DSWRSULO�FDGD���KRUDV�\�VHJ~Q� OD� UHVSXHVWD� LU�VXELHQGR�OD�GRVLV�KDVWD�DOFDQ]DU��VL�HV�SRVLEOH��XQD�GRVLV�GH�PDQWHQLPLHQWR�GH�������PJ����KRUDV��R�XWLOL]DU�XQD�GRVLV�HTXLYDOHQWH�GH�XQ�,(&$�GH�YLGD�PHGLD�ODUJD��1LWUDWRV�� VX� DGPLQLVWUDFLyQ� FUyQLFD� HVWDUi� LQGLFDGD� HQ� DTXHOORV� SDFLHQWHV� TXH� KDELHQGR�VXIULGR�XQ�LQIDUWR�GH�PLRFDUGLR��SUHVHQWDQ�DQJLQD�GH�SHFKR�\�R�LQVXILFLHQFLD�FDUGLDFD�+LSROLSHPLDQWHV��VH�UHFRPLHQGD�WUDWDPLHQWR�IDUPDFROyJLFR��HQ�WRGRV�ORV�SDFLHQWHV�TXH�KDQVXIULGR� XQ� LQIDUWR� GH�PLRFDUGLR� TXH�PDQWLHQHQ�XQ� QLYHO� GH� /'/�FROHVWHURO� VXSHULRU�D ����PJ�GO� D� ORV� GRV�PHVHV� GHO� HYHQWR�� D� SHVDU� GH� OOHYDU� D� FDER�XQD�GLHWD�DGHFXDGD��FRQ�HO�REMHWLYR� GH� UHGXFLU� ORV� QLYHOHV� GH� /'/� D� PHQRV� GH� ���� PJ�GO�� (Q� ORV� SDFLHQWHV� FRQ�DQWHFHGHQWHV�GH�KLSHUFROHVWHUROHPLD��VH�LQVWDXUDUi�HO�WUDWDPLHQWR�KLSROLSHPLDQWH�GH IRUPD�PiV�SUHFR]�����5HFRPHQGDFLRQHV�VHJ~Q�ULHVJR��7RGRV� ORV� SDFLHQWHV� TXH� KDQ� VXIULGR� XQ� LQIDUWR� GHEHQ� FRQWURODU� ORV� IDFWRUHV� GH� ULHVJR�FRURQDUOR�DGHPiV�GH�UHFLELU�GH�IRUPD�LQGHILQLGD�DVSLULQD�D�GRVLV�EDMDV�(QIHUPRV�GH�PX\�EDMR�ULHVJR� DTXHOORV�TXH�KDQ�SUHVHQWDGR�VX�SULPHU�LQIDUWR�GH�PLRFDUGLR��WLHQHQ� XQD� IXQFLyQ� YHQWULFXODU� DGHFXDGD�� VLQ� DQJLQD�� SUXHED� GH� HVIXHU]R� QHJDWLYD� \� VLQ�H[WUDVtVWROHV� YHQWULFXODUHV�� SRVLEOHPHQWH� QR� QHFHVLWHQ� QLQJ~Q� RWUR� WUDWDPLHQWR�� VLHQGR�GXGRVR�TXH�ORV�EHWDEORTXHDQWHV�R�ORV ,(&$�DxDGDQ�DOJ~Q�EHQHILFLR�3DFLHQWHV� FRQ� LVTXHPLD�PLRFiUGLFD� UHVLGXDO� \� IXQFLyQ�YHQWULFXODU� L]TXLHUGD� QRUPDO�GHEHQ� VHU� WUDWDGRV� FRQ�EHWDEORTXHDQWHV�D� ORV� TXH�VH� OHV� SXHGHQ�DxDGLU�QLWUDWRV�� �&RPR�DOWHUQDWLYD� D� ORV� EHWDEORTXHDQWHV�� HVSHFLDOPHQWH� VL� HVWiQ FRQWUDLQGLFDGRV�� VH� SXHGH�FRQVLGHUDU�HO�XVR�GH�YHUDSDPLO�R�GLOWLD]HP�

Page 34: Manual practico urgencias medicina interna muy bueno

��

/RV�SDFLHQWHV�FRQ�LVTXHPLD�UHVLGXDO�\�FRQ�GLVIXQFLyQ�YHQWULFXODU�L]TXLHUGD� GHEHQ�VHU�WUDWDGRV� FRQ� ,(&$� \� EHWDEORTXHDQWHV�� SXGLpQGRVH� DxDGLU� QLWUDWRV� HQ� FDVR� GH� TXH� VHD�QHFHVDULR�/RV� SDFLHQWHV� FRQ� GLVIXQFLyQ� YHQWULFXODU� L]TXLHUGD� VLQ� LVTXHPLD� UHFLELUiQ� ,(&$� \�EHWDEORTXHDQWHV�/RV�HQIHUPRV�FRQ�LQVXILFLHQFLD�FDUGLDFD�FRQJHVWLYD�VHUiQ�WUDWDGRV�FRQ�,(&$�D�ORV�TXH�VH�OHV�SXHGH�DxDGLU�QLWUDWRV��DSDUWH�GHO�WUDWDPLHQWR�WUDGLFLRQDO�GH�OD�LQVXILFLHQFLD�FDUGLDFD�/RV� SDFLHQWHV� FRQ� DUULWPLDV� YHQWULFXODUHV GHEHQ� VHU� WUDWDGRV� FRQ� EHWDEORTXHDQWHV��6H�SXHGH� XWLOL]DU� FRPR� DOWHUQDWLYD� OD� $PLRGDURQD� SDUD� OD� VXSUHVLyQ� GH� DUULWPLDV� VHYHUDV��VLQWRPiWLFDV��SUHILULpQGRVH�HO�EHWDEORTXHDQWH�VL�QR�H[LVWH�FRQWUDLQGLFDFLyQ��%LEOLRJUDItD���7KH�7DVN�)RUFH�RQ�WKH�0DQDJHPHQW�RI�$FXWH�0LRFDUGLDO�,QIDUFWLRQ�RI�WKH�(XURSHDQ�6RFLHW\�RI�&DUGLRORJ\��$FXWH�P\RFDUGLDO� LQIDUFWLRQ�� SUH�KRVSLWDO�DQG� LQ�KRVSLWDO�PDQDJHPHQW��(XU�+HDUW�-�������������������*XLGHOLQHV� IRU� WKH�PDQDJHPHQW� RI� SDWLHQWV�ZLWK� DFXWH�P\RFDUGLDO� LQIDUFWLRQ�� D� UHSRUW�RI� WKH�$PHULFDQ�&ROOHJH�RI�&DUGLROJ\�$PHULFDQ�+HDUW�$VVRFLDWLRQ�7DVN�)RUFH�RQ�SUDFWLFH�JXLGHOLQHV��-�$P�&ROO�&DUGLRO������������������������%RVK�%-��)HUQiQGH]�$YLOpV�)��%HUPHMR�*DUFtD�-�HW�DO� 7UDWDPLHQWR�GHO�LQIDUWR�GH�PLRFDUGLR�QR�FRPSOLFDGR��5HY�(VS�&DUGLRO�����������6XSO�,�����������0DUWtQ�+XHUWD�(��9DOOH�7XGHOD�9��$EH\WXD�-LPpQH]�0�HW�DO��(VWUDWLILFDFLyQ�SURQyVWLFD�GHVSXpV�GHO�LQIDUWR�GH�PLRFDUGLR��3UHYHQFLyQ�VHFXQGDULD�\�UHKDELOLWDFLyQ��5HY�(VS�&DUGLRO�����������6XSO�,������������$OHJUtD�(]TXHUUD�(��/ySH]�%HVFyV�/��$VtQ�&DUGLHO�(�HW�DO��1RUPDV�GH�DFWXDFLyQ�HQ�HO�SDFLHQWH�FRQ�LQIDUWR�DJXGR�GH�PLRFDUGLR��5HY�(VS�&DUGLRO�����������6XSO�,��������$&&�$+$�*XLGHOLQHV�IRU�WKH�0DQDJHPHQW�RI�3DWLHQWV�:LWK�$FXWH�0\RFDUGLDO�,QIDUFWLRQ��$�5HSRUW�RI� WKH� $PHULFDQ� &ROOHJH� RI� &DUGLRORJ\�$PHULFDQ� +HDUW� $VVRFLDWLRQ� 7DVN� )RUFH� RQ� 3UDFWLFH�*XLGHOLQHV��:HE�9HUVLRQ�������

Page 35: Manual practico urgencias medicina interna muy bueno

��

'LDJQyVWLFR�\�WUDWDPLHQWR�GH�OD�HQGRFDUGLWLV�LQIHFFLRVD��(,��9LUWXGHV�0DUWt��)HUQDQGR 0DWHRV���&RQFHSWR�H�LPSRUWDQFLD��&RORQL]DFLyQ� VpSWLFD� GH� ODV� YiOYXODV� FDUGLDFDV�� HO� HQGRFDUGLR�PXUDO� R� GHIHFWRV� VHSWDOHV��WDQWR�SRU�EDFWHULDV�FRPR�SRU�KRQJRV��/D�LQIHFFLyQ�GH�VKXQWV�DUWHULDOHV��DQHXULVPDV�R�FRDUWDFLyQ�GH�DRUWD�VH�GHQRPLQD�HQGDUWHULWLV \�SURGXFH�XQ�FXDGUR�FOtQLFR�VLPLODU�6H�WUDWD�GH�XQD�HQIHUPHGDG�GH�FDSLWDO�LPSRUWDQFLD�SDUD�HO�FOtQLFR���LQIUHFXHQWH�SHUR�JUDYH����(O�GLDJQyVWLFR�R�OD�VRVSHFKD�GLDJQyVWLFD�HV�YLWDO�SDUD�HO�SDFLHQWH��'HEH�VRVSHFKDUVH�DQWH�WRGR�VtQGURPH�IHEULO�VLQ�IRFR�HYLGHQWH�R�FXDQGR�KD\�VRSORV�R�IHQyPHQRV�HPEyOLFRV����&ODVLILFDFLyQ��(Q�OD�7DEOD�� DSRUWDPRV�XQD�FODVLILFDFLyQ�DWHQGLHQGR�DO�WLSR�GH�YiOYXOD�DIHFWDGD��QDWXUDO�R�DUWLILFLDO��\�DO�SDFLHQWH�HQ�HO�TXH�DSDUHFH��XVXDULR�R�QR�GH�GURJDV�SRU�YtD�SDUHQWHUDO��

9iOYXOD�SURWpVLFD9iOYXOD�QDWXUDO1R�8'93(GDG*pUPHQHV

8'93!����DxRV

����������(VWUHSWRFRFRV�������YLULGDQV������ERYLV����������(VWDILORFRFRV����������(QWHURFRFRV���������2WURV����*UXSR�+$&(.�� VSS����$QDHURELRV��1HXPRFRFRV��+RQJRV�

����������(VWDILORFRFRV����������(VWUHSWRFRFRV�HQWHURFRFRV����������%DFLORV�JUDPQHJDWLYRV����������+RQJRV�

�����(VWDILORFRFRV�����2WURV���%*1��+RQJRV��&RULQHEDFWHU�0X\�UDURV�ORVHVWUHSWRFRFRV

6LPLODU�D�OD�GHYiOYXOD�QDWXUDO

-yYHQHV !����DxRV3UHFR]������GtDV� 7DUGtD�!���GtDV�

7DEOD����7LSRV�GH��HQGRFDUGLWLV� LQIHFFLRVD

%*1 EDFLORV�JUDPQHJDWLYRV+$&(. 8'93 8VXDULR�GH�GURJDV�SRU�YtD�SDUHQWHUDO�(QWUH�SDUpQWHVLV��HO�JpUPHQ�PiV�IUHFXHQWH�FRQ�GLIHUHQFLD�GHO�JUXSR�

6��DXUHXV(�IDHFDOLV%UXFHOOD&R[LHOOD�EXUQHWWL&DQGLGD$VSHUJLOOXV VSS�VSS�

(��IDHFDOLV�(�IDHFLXP6�DXUHXV3VHXGRPRQDV6HUUDWLD VSS�VSS�&DQGLGD�SDUDSVLORVLV

6�HSLGHUPLGLV

+DHPRSKLOXV�$FWLQREDFLOOXV�&DUGLREDFWHULXP�(LNHQHOOD�.LQJHOOD���'LDJQyVWLFR������&OtQLFD�6RVSHFKDU� (�,�� HQ� SUHVHQFLD� GH� XQ� FRQWH[WR� FOtQLFR� DSURSLDGR�� IXQGDPHQWDOPHQWH� SRU� OD�DSDULFLyQ�GH�ILHEUH�\�OD�GHWHFFLyQ�GH�XQ�VRSOR�RUJiQLFR�HQ�OD�DXVFXOWDFLyQ�FDUGtDFD�/D� PD\RUtD� GH� ORV� SDFLHQWHV� FRQ� (,� SUHVHQWDQ� ILHEUH�� 3XHGH� QR� DSDUHFHU� HQ� DQFLDQRV��WUDWDPLHQWR�DQWLELyWLFR�SUHYLR��LQVXILFLHQFLD�FDUGtDFD��LQVXILFLHQFLD�UHQDO�R�FDTXH[LD��

Page 36: Manual practico urgencias medicina interna muy bueno

��

$VLPLVPR��HQ�OD�PD\RUtD�SXHGH�DXVFXOWDUVH�XQ�VRSOR�FDUGtDFR��H[FHSWR�VL�OD�YiOYXOD�DIHFWD�HV�XQD�YiOYXOD�WULF~VSLGH�R�SXOPRQDU��S��HM��(,�HQ�XVXDULRV�GH�GURJDV�SRU�YtD�SDUHQWHUDO��(O� FRQWH[WR� FOtQLFR� DSURSLDGR GHULYD� GH� GRV� HOHPHQWRV� FODYH� HQ� OD� SDWRJHQLD� GH� OD�HQGRFDUGLWLV��H[LVWHQFLD�GH�XQD�FDUGLRSDWtD�SUHGLVSRQHQWH�\�SURGXFFLyQ�GH�XQD�EDFWHULHPLD��(Q�OD�WDEOD���VH�GHWDOOD�HO�ULHVJR�GH�HQGRFDUGLWLV�DWHQGLHQGR�D�OD�SDWRORJtD�GH�EDVH��(Q�OD�WDEOD�� VH�UHFRJH�HO�ULHVJR�GH�EDFWHULHPLD�WUDV�GLIHUHQWHV�SURFHGLPLHQWRV�GLDJQyVWLFRV�\�WHUDSpXWLFRV�3UyWHVLV�YDOYXODU(,�SUHYLD (,�L]TXLHUGD� SUHYLD(,�SRU 6��DXUHXV SUHYLD(,�SRU�KRQJRV� SUHYLD&DUGLRSDWtD� FRQJpQWLFD� FLDQyWLFD6KXQW�VLVWpPLFR�SXOPRQDU

3URODSVR�GH� YiOYXOD�PLWUDO&RURQDULRSDWtD3ODFDV�GH� DWHURPD0DUFDSDVRV� HQGRFDYLWDULR&RPXQLFDFLyQ� LQWHUDXULFXODU9iOYXODV� UHSDUDGDV�QR� SURWpVLFDV'HULYDFLRQHV�R� LQMHUWRV�FRURQDULRV

5LHVJR�HOHYDGR 5LHVJR�PRGHUDGR7DEOD����5LHVJR�GH�HQGRFDUGLWLV�DWHQGLHQGR�D�OD�SDWRORJtD�GH�EDVH5LHVJR�EDMR

�(,��HQGRFDUGLWLV� LQIHFFLRVD7DEOD����3URFHGLPLHQWRV�GLDJQyVWLFRV�R��WHUDSpXWLFRV�FRQ�ULHVJR�HOHYDGR�GH�EDFWHULHPLD���3URFHGLPLHQWRV�GHQWDOHV�FRQ�SUREDELOLGDG�GH�SURGXFLU�VDQJUDGR���%LRSVLDV�R�FLUXJtD�GH�YtDV�UHVSLUDWRULDV�DOWDV��S�H��DPLJGDOHFWRPLD��DGHQRLGHFWRPtD����3DUWR��DERUWR��OHJUDGR��LQVHUFLyQ�R�H[WUDFFLyQ�GH�',8�HQ�SUHVHQFLD�GH�LQIHFFLyQ�SHOYLDQD���+LVWHUHFWRPtD�YDJLQDO���&DWHWHULVPR�XULQDULR���&LUXJtD�DEGRPLQDO���'UHQDMH�GH�DEVFHVRV

�����3UXHEDV�FRPSOHPHQWDULDV�EiVLFDV/DV�GRV�SUXHEDV�FRPSOHPHQWDULDV�EiVLFDV�VRQ�ORV�KHPRFXOWLYRV�\�OD�HFRFDUGLRJUDItD��������+HPRFXOWLYRV�/D� SUXHED� GH� ODERUDWRULR� PiV� ~WLO� SDUD� HO� GLDJQyVWLFR�� (Q� FRQGLFLRQHV� GH� DGHFXDGD�UHFRJLGD� VRQ� SRVLWLYRV� HQ� XQ� ������� GH� ODV� (,�� 3DUD� REWHQHU� HVWD� DOWD� UHQWDELOLGDG� GHEHQ�REVHUYDUVH�YDULDV�FRQGLFLRQHV��LQGLFDGDV�HQ�OD�WDEOD�����1R�HV�SUHFLVR�UHDOL]DU�OD�WRPD�GH�KHPRFXOWLYRV�GXUDQWH�HO�SLFR�IHEULO����(O�FXOWLYR�GHEH�UHDOL]DUVH�SRU�SXQFLyQ�GH�XQD�YHQD�SHULIpULFD�QR�FDWHWHUL]DGD�\�FRQ�XQ�LQWHUYDOR��PtQLPR�GH����PLQXWRV�HQWUH�ODV�WRPDV���������6L�HO�HQIHUPR�QR�HVWi�UHFLELHQGR�DQWLPLFURELDQRV�\�HO�FXUVR�HV�VXEDJXGR�GHEHQ�UHDOL]DUVH��������H[WUDFFLRQHV�HQ����KRUDV���������6L�HO�FXUVR�HV�DJXGR�ODV�H[WUDFFLRQHV�GHEHQ�KDFHUVH�DQWHV�GH�ODV�SULPHUDV�WUHV�KRUDV����������6L�HO�HQIHUPR�HVWi�UHFLELHQGR�DQWLPLFURELDQRV�\�HO�FXUVR�HV�VXEDJXGR�VH�SXHGH�UHDOL]DUVH�XQD�������YHQWDQD�WHUDSpXWLFD��HV�GHFLU�VXVSHQGHU�pVWRV�GXUDQWH�������KRUDV��

7DEOD����+HPRFXOWLYR�HQ�OD�HQGRFDUGLWLV�EDFWHULDQD

�������(FRFDUGLRJUDItD

Page 37: Manual practico urgencias medicina interna muy bueno

��

7pFQLFD� GH� LPDJHQ� GH� HOHFFLyQ�� 0X\� HVSHFtILFD� �\D� TXH� SHUPLWH� OD� LGHQWLILFDFLyQ� GH� ODV�YHJHWDFLRQHV�FRQ�XQ�EDMR�SRUFHQWDMH�GH�IDOVRV�SRVLWLYRV��SHUR�FRQ�XQD�VHQVLELOLGDG�OLPLWDGD��\D�TXH� HO� OtPLWH� GH� GHWHFFLyQ� GH� YHJHWDFLRQHV� HV� GH� �� PP��� 3HUPLWH� OD� LGHQWLILFDFLyQ� GH�FRPSOLFDFLRQHV�ORFDOHV��VREUH�WRGR�GH�ORFDOL]DFLyQ�DyUWLFD��/D�HFRFDUGLRJUDItD�SRU�YtD�WUDQVHVRIiJLFD�WLHQH�PD\RU�VHQVLELOLGDG�TXH�OD�UHDOL]DGD�SRU�YtD�WUDQVWRUiFLFD��WDQWR�HQ�OR�TXH�UHVSHFWD�D�OD�GHWHFFLyQ�GH�YHJHWDFLRQHV�FRPR�SDUD�OD�GHWHFFLyQ�GH�FRPSOLFDFLRQHV�ORFDOHV��(Q�OD�WDEOD�� VH�GHWDOODQ�ODV�LQGLFDFLRQHV�GH�OD�HFRFDUGLRJUDItD�HQ�OD�(,�VREUH�YiOYXOD�QDWLYD�\�SURWpVLFD�FRQ�QLYHOHV GH�HYLGHQFLD�,�y�,,�

(,91��HQGRFDUGLWLV� LQIHFFLRVD VREUH YiOYXOD QDWLYD�(,93��HQGRFDUGLWLV� LQIHFFLRVD VREUH YiOYXOD SURWqVLFD� �/D�HFRFDUGLRJUDILD� WUDVHVRIDJLFD�SXHGH� SURSRUFLRQDU� LQIRUPDFLyQ� DGLFFLRQDO�D�ODREWHQLGD�FRQ�OD� WUDVWRUiFLFD�

,1',&$&,21���'HWHFFLRQ�\� FDUDFWHUL]DFLyQ�GH� OHVLRQHVYDOYXODUHV�� DOWHUDFLyQ�KHPRGLQiPLFD��\�R�DO�WHUDFLyQ�YHQWULFXODU� ����'HWHFFLyQ�GH� YHJHWDFLRQHV�\� FDUDFWHUL]D�FLyQ�GH� OHVLRQHV�HQ� SDFLHQWHV�FRQ� FDUGLRSD�WtDV�FRQJpQLWDV�HQ� ODV�TXH�VH�VRVSHFKD�HQ�GRFDUGLWLV���'HWFFLyQ�GH� DQRUPDOLGDGHV�DVRFLDGDV�S��HM��DEVFHVRV��VKXQWV��HWF�� ����5HHYDOXDFLyQ�HQ�HQGRFDUGLWLV�JUDYHV��S�� HMJHUPHQHV� YLUXOHQWRV�� OHVLRQHV�KHPRGLQiPL�FDV�VHYHUDV�� OHVLyQ�DyUWLFD�� ILHEUH�R�EDFWHULH�PLD�SHUVLVWHQWH�R� GHWHULRUR�FOtQLFR�����(YDOXDFLyQ�GH� SDFLHQWHV�FRQ� DOWD� VRVSHFKDGH�HQGRFDUGLWLV�FRQ� FXOWLYRV�QHJDWLYRV� ���(YDOXDFLyQ�GH�EDFWHULHPLD�GH� RULJHQ�GHV�FRQRFLGR ���(VWUDWLILFDFLyQ� GHO�ULHVJR�HQ�HQGRFDUGLWLV ���5HHYDOXDFLyQ�GH� UXWLQD�HQ�HQGRFDUGLWLV�QRFRPSOLFDGDV� GXUDQWH�OD� WHUDSLD�DQWLELyWLFD ����(YDOXDFLyQ�GH� ILHEUH�SHUVLVWHQWH�VLQHYLGHQFLD�GH�EDFWHULHPLD�R� QXHYR�VRSOR� �

(,91(9,'(1&,$,

,,,,,,D,,D,,E

(9,'(1&,$,

,,

,,

,,E,,D

7DEOD����(FRFDUGLRJUDItD�HQ�ODV HQGRFDUGLWLV� (,93

�����&ULWHULRV�GLDJQyVWLFRV��

Page 38: Manual practico urgencias medicina interna muy bueno

��

(O�GLDJQyVWLFR�GH�(,�VH�EDVD�HQ�OD�DSOLFDFLyQ�GH�YDULRV�FULWHULRV��FOtQLFRV��HFRFDUGLRJUiILFRV��PLFURELROyJLFRV�H�KLVWROyJLFRV��TXH�SHUPLWHQ�XQD�DSUR[LPDFLyQ�SUREDELOtVWLFD�DO�SUREOHPD��WDEOD����

&ULWHULRV�PD\RUHV���+HPRFXOWLYRV�SRVLWLYRV�����������D��0LFURRUJDQtVPRV�WtSLFRV�GH�HQGRFDUGLWLV�LQIHFFLRVD�HQ���KHPRFXOWLYRV�VHSDUDGRV���������������D���������������������������������������+$&(.���������������D������������������������������������������������DGTXLULGRV�HQ�OD�FRPXQLGDG�HQ�DXVHQFLD�GH�IRFR�SULPDULR�����������E��+HPRFXOWLYRV�SHUVLVWHQWHPHQWH�SRVLWLYRV�����������������E���+HPRFXOWLYRV�H[WUDtGRV�FRQ�PiV�GH����KRUDV�GH�VHSDUDFLyQ����������������E�������KHPRFXOWLYRV�SRVLWLYRV�R�OD�PD\RUtD�GH���y�PiV�KHPRFXOWLYRV�VHSDUDGRV�����������������VLHPSUH�TXH�HQWUH�HO�SULPHUR�\�HO�~OWLPR�KD\D�DO�PHQRV���KRUD����(YLGHQFLD�GH�DIHFWDFLyQ�HQGRFiUGLFD�����������D��(FRFDUGLRJUDItD�SRVLWLYD����������������D���9HJHWDFLyQ�HQ�YiOYXOD�R�HVWUXFWXUDV�DG\DFHQWHV�R�HQ�HO�FKRTXH�GHO�MHW�����������������������0DWHULDO�HQ��RWUDV��ORFDOL]DFLRQHV���VLHPSUH�TXH�QR�H[LVWD�RWUD�H[SOLFDFLyQ�DQDWyPLFD�����������������D���$EVFHVR����������������D���1XHYD�GHKLVFHQFLD�SDUFLDO�GH�XQD�YiOYXOD�SURWpVLFD������������E��1XHYD�UHJXUJLWDFLyQ�YDOYXODU��HO�LQFUHPHQWR�R�FDPELR�HQ�XQ�VRSOR�SUH�H[LVWHQWH�QR�HV������������������FRQVLGHUDGR�FULWHULR�PD\RU��

���6�YLULGDQV��6�ERYLV6��DXUHXV���(QWHURFRFFXV

&ULWHULRV�PHQRUHV���3UHGLVSRVLFLyQ��FDUGLRSDWtD�SUHH[LVWHQWH�R�XVR�GH�GURJDV�SRU�YtD�SDUHQWHUDO����7HPSHUDWXUD�!�����&����)pQRPHQRV�YDVFXODUHV��pPERORV�HQ�DUWHULDV�PD\RUHV��LQIDUWRV�SXOPRQDUHV�VpSWLFRV��DQHXULVPDV�����PLFyWLFRV��KHPRUUDJLD�LQWUDFUDQHDO��KHPRUUDJLD�FRQMXQWLYDO�\�OHVLRQHV�GH�-DQHZD\����)HQyPHQRV�LQPXQROyJLFRV��JORPHUXORQHIULWLV��QyGXORV�GH�2VOHU��PDQFKDV�GH�5RWK�\�IDFWRU�UHX�������PDWRLGH�SRVLWLYR����(FRFDUGLRJUDPD�VXJHVWLYR�GH�HQGRFDUGLWLV�LQIHFFLRVD�VLQ�DOFDQ]DU�ORV�FULWHULRV�PD\RUHV�DQWHV������PHQFLRQDGRV�����(YLGHQFLD�PLFURELROyJLFD��KHPRFXOWLYRV�SRVLWLYRV�TXH�QR�FXPSOHQ�ORV�FULWHULRV�PD\RUHV��H[FOX\HQ������GR�XQ�~QLFR�KHPRFXOWLYR�FRQ�HVWDILORFRFR�FRDJXODVD�QHJDWLYR�\�PLFURRUJDQLVPRV�QR�DVRFLDGRV�FRQ�����HQGRFDUGLWLV�LQIHFFLRVD��R�HYLGHQFLD�VHUROyJLFD�GH�LQIHFFLyQ�FRQ�XQ�PLFURRUJDQLVPR�SURGXFWRU�GH�����HQGRFDUGLWLV�LQIHFFLRVD�

7DEOD�����&ULWHULRV�GLDJQyVWLFRV�GH�HQGRFDUGLWLV�LQIHFFLRVD(QGRFDUGLWLV�LQIHFFLRVD�GHILQLWLYD$��&ULWHULRV�SDWROyJLFRV����������$���0LFURRUJDQLVPRV�GHPRVWUDGRV�HQ�OD�YHJHWDFLyQ�SRU�FXOWLYR�R�KLVWRORJtD�R�HQ�XQ�pPEROR�����������������SHULIpULFR�R�HQ�XQ�DEVFHVR�LQWUDFDUGtDFR����������$���9HJHWDFLyQ�R�DEVFHVR�LQWUDFDUGtDFR�FRQILUPDGRV�SRU�KLVWRORJtD�%��&ULWHULRV�FOtQLFRV�������������FULWHULRV�PD\RUHV�R�������������FULWHULR�PD\RU�\���FULWHULRV�PHQRUHV�R�������������FULWHULRV�PHQRUHV�

3UHVHQFLD�GH�$�R�%

���7UDWDPLHQWR�\�PDQHMR��/D�FXUDFLyQ�GH�OD�(,�VH�EDVD�IXQGDPHQWDOPHQWH�HQ�OD�WHUDSLD�DQWLPLFURELDQD��SUHFLVDQGR�HQ�RFDVLRQHV�GH�OD�FLUXJtD�(Q�OD�ILJXUD�� VH�LQGLFD�HO�PDQHMR�LQLFLDO�GH�ORV�SDFLHQWHV�FRQ�(,�

Page 39: Manual practico urgencias medicina interna muy bueno

��

(VWDGR�FOtQLFR$FHSWDEOH

$ODUPDQWH

(VSHUDUKHPRFXOWLYR,QVXI��FDUGtDFDFODVH�,�,, ,QVXI��FDUGtDFDFODVH�,,,�,9,QVXI��DyUWLFD�RPLWUDO�VHYHUDV

(QIHUPR�HVWDEOH 3URJUHVLyQ�DFODVH�,,,�,9 &LUXJtD�YDOYXODUXUJHQWH 1R�UHVSXHVWDHQ�������K (QIHUPR�HVWDEOH&RQWLQXDU�WUDWDPLHQWR0RGLILFDU�GH�DFXHUGR�FRQKHPRFXOWLYR&RQWLQXDU�WUDWDPLHQWR0RGLILFDU�GH�DFXHUGR�FRQ�KHPRFXOWLYR

0LHQWUDV�VH�HVSHUD�HO�UHVXOWDGR�GHO�KHPRFXOWLYR���0DQWHQHU�FRQWDFWR�FRQ�FLUXMDQR�FDUGLRYDVFXODU��&RQWURO�GLDULR�GHO�HQIHUPR�FRQ�YLJLODQFLD�HVSHFLDO�GH�OD�IXQFLyQ�FDUGtDFD��%XVFDU�XQD�SXHUWD�GH�HQWUDGD�\�IRFRV�PHWDVWiWLFRV1XQFD�DQWLFRDJXODU��H[FHSWR�HQ�FDVR�GH�SUyWHVLV�YDOYXODU�VL�HVWi�DQWLFRDJXODGR

7UDWDPLHQWR�PpGLFR�HPStULFR�9DQFRPLFLQD����PJ�.J�,9�����K��*HQWDPLFLQD���PJ�.J�,9���K

)LJXUD����0DQHMR�LQLFLDO�GH�ORV�SDFLHQWHV�FRQ�HQGRFDUGLWLV�LQIHFFLRVD

$EVFHVR�DyUWLFR�RIDOVR�DQHXULVPD

7UDWDPLHQWR�PpGLFR�HPStULFR�3HQLFLOLQD�*��������0�LY�GLDULRV�FDGD���K��&OR[DFLOLQD����J�LY�FDGD���K��*HQWDPLFLQD���PJ�.J�,9���K7UDWDPLHQWR�PpGLFR�HPStULFR�&OR[DFLOLQD����J�LY�FDGD���K��*HQWDPLFLQD���PJ�.J�,9���K

(,91 (,�HQ�8'93 (,93

(,91��HQGRFDUGLWLV�LQIHFFLRVD�VREUH�YiOYXOD�QDWXUDO(,��HQGRFDUGLWLV�LQIHFFLRVD8'93��XVXDULR�GH�GURJDV SRU YtD�SDUHQWHUDO(,93��HQGRFDUGLWLV�LQIHFFLRVD VREUH YiOYXOD SURWpVLFD(Q� OD� WDEOD� � VH� LQGLFD� HO� WUDWDPLHQWR� HVSHFtILFR� GH� OD�(,� VHJ~Q�HO�JHUPHQ�DLVODGR�HQ�HO�KHPRFXOWLYR�

Page 40: Manual practico urgencias medicina interna muy bueno

��

(VWUHSWRFRFRV�FRQ�&0,�GH�SHQLFLOLQD�*��������J�P/$��(VWiQGDU3HQLFLOLQD�*��������0�LY�GLDULRV�FDGD���K��PiV�JHQWDPLFLQD����PJ�.J�LY�FDGD���K��y�HVWUHSWRPLFLQD������PJ�.J�LP�FDGD����K��GXUDQWH���VHPDQDV���%��,��UHQDO��DOWHUDFLyQ�GHO�9,,,�SDU�y�HGDG�!����DxRV3HQLFLOLQD�*�VROD��FRPR�HQ�UpJLPHQ�$��SHUR�GXUDQWH���VHPDQDV���&�9DULDQWHV�QXWULFLRQDOHV�GHILFLHQWHV��HYROXFLyQ�!���PHVHV��UHFDtGDV�R�FRPSOLFDFLRQHV5pJLPHQ�$��SHUR�FRQWLQXDU�SHQLFLOLQD���VHPDQDV�PiV'��+LSHUVHQVLELOLGDG�UHWDUGDGD�D�SHQLFLOLQD��UDVK�FXWiQHR��&HID]ROLQD������J�LY�y�LP�FDGD���X���K��GXUDQWH���VHPDQDV(��+LVWRULD�GH�UHDFFLyQ�DQDILOiFWLFD�D�SHQLFLOLQD9DQFRPLFLQD�����PJ�.J�LY�FDGD����KRUDV��GXUDQWH���VHPDQDV(VWUHSWRFRFRV�FRQ�&0,�GH�SHQLFLOLQD�*�!�����SHUR���������J�P/(��5pJLPHQ�&��6L�DOHUJLD�D�SHQLFLOLQD��UpJLPHQ�((VWUHSWRFRFRV�FRQ�&0,�GH�SHQLFLOLQD�*�!�������J�P/�R�HQWHURFRFRV*��(VWiQGDU3HQLFLOLQD�*��������PLOORQHV�LY�GLDULRV��y�DPSLFLOLQD�����J�LY�GLDULRV��HQ�GRVLV�IUDFFLRQDGDV�FDGD���K��PiV�JHQWDPLFLQD�����PJ�.J�LY�FDGD���K��GXUDQWH���VHPDQDV�����VHPDQDV�VL�HYROXFLyQ�!���PHVHV�R�FRPSOLFDFLRQHV�+��+LSHUVHQVLELOLGDG�D�SHQLFLOLQD9DQFRPLFLQD�����PJ�.J�LY�FDGD����KRUDV��PiV�JHQWDPLFLQD���PJ�.J�LY�FDGD���K��GXUDQWH���VHPDQDV�����VHPDQDV��VL�HYROXFLyQ�!���PHVHV�R�FRPSOLFDFLRQHV�

(VWUHSWRFRFRV�JUXSR�$��QHXPRFRFR�R�1HLVVHULD3HQLFLOLQD�*�����PLOORQHV�LY�GLDULRV�IUDFFLRQDGRV�FDGD���K��GXUDQWH���VHPDQDV��6L�DOWD�SUHYDOHQFLD�GH�UHVLVWHQFLD�D�SHQLFLOLQD��FHIWULD[RQD��S�H��QHXPRFRFR�\�1HLVVHULD�HQ�(VSDxD�

(VWDILORFRFR�PHWLFLOtQ�VHQVLEOH,��(VWiQGDU&OR[DFLOLQD����J�LY�FDGD���K��GXUDQWH���VHPDQDV����VHPDQDV�VL�FRPSOLFDFLRQHV��0X\�GLVFXWLGD��DXQTXH�SUHGRPLQDQ��ORV�GHWUDFWRUHV��OD�DVRFLDFLyQ�GH���PJ�.J�LY�GH�JHQWDPLFLQD�FDGD���KRUDV�ORV�����SULPHURV�GtDV�GH�WUDWDPLHQWR�-��+LSHUVHQVLELOLGDG�UHWDUGDGD�D�SHQLFLOLQD��UDVK�FXWiQHR�&HID]ROLQD����J�LY�FDGD���K��GXUDQWH���VHPDQDV����VHPDQDV�VL�FRPSOLFDFLRQHV��&RQ�R�VLQ�JHQWDPLFLQD�FRPR�HQ�UpJLPHQ�,��.��+LVWRULD�GH�UHDFFLyQ�DQDILOiFWLFD�D�SHQLFLOLQD9DQFRPLFLQD�����PJ�.J�LY�FDGD����KRUDV��GXUDQWH���VHPDQDV����VHPDQDV�VL�FRPSOLFDFLRQHV���&RQ�R�VLQ�JHQWDPLFLQD�FRPR�HQ�UpJLPHQ�,�(VWDILORFRFR�PHWLFLOtQ�UHVLVWHQWH�R�FRULQHEDFWHULDV/��,JXDO�TXH�UpJLPHQ�.3UyWHVLV�YDOYXODU��(VWUHSWRFRFRV�FRQ�&0,�GH�SHQLFLOLQD�*��������J�P/��UpJLPHQHV�&��'��(�\�)�SHUR��SHQLFLOLQD�D�OD�GRVLV�PiV�HOHYDGD�������VHPDQDV�GH�GXUDFLyQ�\�VLHPSUH�DPLQRJOXFyVLGR�ODV�GRV�SULPHUDV�VHPDQDV����(VWUHSWRFRFRV�FRQ�&0,�GH�SHQLFLOLQD�*�!�������J�P/�R�HQWHURFRFRV��UHJtPHQHV�*�\�+��SHUR�GXUDQWH���VHPDQDV����(VWDILORFRFR��UHJtPHQHV�,��-��.�\�/��SHUR�GXUDQWH�����VHPDQDV�\�VLHPSUH�FRQ�JHQWDPLFLQD�ODV�GRV�SULPHUDV�VHPDQDV�����6yOR�VL�6��HSLGHUPLGLV��DxDGLU�ULIDPSLFLQD������PJ�YR�FDGD���K��GXUDQWH�����VHPDQDV��PX\�FRQWURYHUWLGR�FRQ�6��DXUHXV�

��6L�UHVLVWHQFLD�D�DPLQRJOXFyVLGRV�HQ�*�y�+��H[FOXLU�pVWRV�\�WUDWDU�����VHPDQDV�

%DFLORV�JUDPQHJDWLYRV��(QWHUREDFWHULDV��FHIDORVSRULQD�GH�WHUFHUD�JHQHUDFLyQ�PiV�DPLQRJOXFyVLGR��GXUDQWH�����VHPDQDV����+$&(.��DPSLFLOLQD�R�FHIWULD[RQD��PiV�JHQWDPLFLQD��GXUDQWH���VHPDQDV����3VHXGRPRQD��FHIWD]LGLPD�R�XUHLGRSHQLFLOLQD��PiV�DPLQRJOXFyVLGR��GXUDQWH���VHPDQDV��6L�(,�L]GD��VLHPSUH�TXLU~UJLFD���$QDHURELRV����6HQVLEOHV�D�SHQLFLOLQD��SHQLFLOLQD�*��GXUDQWH�����VHPDQDV���������������������������5HVLVWHQWHV�D�SHQLFLOLQD�y�%��IUDJLOLV��PHWURQLGD]RO��GXUDQWH�����VHPDQDV��2WURV��%UXFHORVLV��9DORUDFLyQ�TXLU~UJLFD��'R[LFLFOLQD�PiV�HVWUHSWRPLFLQD�PiV�ULIDPSLFLQD�GXUDQWH������VHPDQDV����)LHEUH�4��5HHPSOD]DPLHQWR�YDOYXODU��'R[LFLFOLQD��PiV�VHSWULP��IOXRUTXLQRORQD�R�ULIDPSLFLQD����DxR�FRPR�PtQLPR����+RQJRV��9DORUDFLyQ�TXLU~UJLFD��$QIRWHULFLQD�%����IOXFLWRVLQD�RSFLRQDO��R�LPLGD]ROHV����/HJLRQHOOD��'R[LFLFOLQD�R�HULWURPLFLQD������PHVHV��9DORUDFLyQ�TXLU~UJLFD�SRU�GDxR�YDOYXODU�SHUPDQHQWH��

7DEOD����7UDWDPLHQWR�GH�OD�HQGRFDUGLWLV�LQIHFFLRVD�VHJ~Q�HO�JpUPHQ�FDXVDO

Page 41: Manual practico urgencias medicina interna muy bueno

��

/DV�LQGLFDFLRQHV�GHO�WUDWDPLHQWR�TXLU~UJLFR�VH�HVSHFLILFDQ�HQ�OD�7DEOD���

,1',&$&,21����,QVXILFLHQFLD�DyUWLFD�R�PLWUDO�DJXGDV�FRQ��LQVXILFLHQFLD�FDUGtDFD����,QVXILFLHQFLD�DyUWLFD�DJXGD�FRQ�WDTXLFDUGLD��\�FLHUUH�SUHFR]�GH�OD�YDOYXOD�PLWUDO����(QGRFDUGLWLV�I~QJLFD����(YLGHQFLD�GH�DEVFHVR�DyUWLFR�R�IDOVR�DQHX��ULVPD�����(YLGHQFLD�GH�GLVIXQFLyQ�YDOYXODU�H�LQIHFFLyQ�SHUVLVWHQWH�WUDV�XQ�SHULRGR�SURORQJDGR�������GtDV��GH�DQWLELRWHUDSLD�FRUUHFWD��DVL�FRPR�SRU�ILHEUH��OHXFRFLWRVLV�\�EDFWHULHPLD�WUDV�GHVFDUWDU�RWUDV�FDXVDV�GH�LQIHFFLyQ�����(PEROLD�UHFXUUHQWH�SHVH�D�WUDWDPLHQWR�DQWLELyWLFR�FRUUHFWR�����,QIHFFLyQ�SRU�JUDP�QHJDWLYRV�R�PLFURRUJDQLVPRV�FRQ�SREUH�UHVSXHVWD�D�ORV�DQWLELyWLFRV�\�HYLGHQFLD�GH�GLVIXQFLyQ�YDOYXODU�����9HJHWDFLRQHV�PyYLOHV�!����PP��

(QGRFDUGLWLV�HQ�YiOYXOD�QDWLYD (QGRFDUGLWLV�HQ�YiOYXOD�SURWpVLFD(9,'(1&,$�,�

,�,�,�,�

,,D�,,D�,,E�

,1',&$&,21����(QGRFDUGLWLV�SUHFR]������PHVHV�WUDV�FLUXJtD�����,QVXILFLHQFLD�FDUGLDFD�FRQ�GLVIXQFLyQ�YDOYXODU�SURVWpWLFD�����(QGRFDUGLWLV�I~QJLFD����(QGRFDUGLWLV�HVWDILORFyFLFD�TXH�QR�UHVSRQGH�D�OD�WHUDSLD�DQWLELyWLFD�����(YLGHQFLD�GH�IXJD�SDUDYDOYXODU��DEVFHVR�DyUWLFR��ItVWXOD�R�DOWHUDFLRQHV�QXHYDV�HQ�HO�VLVWHPD�GH�FRQGXFFLyQ�����,QIHFFLyQ�SRU�JUDPQHJDWLYRV�R�SRU�RUJDQLVPRV�FRQ�SREUH�UHVSXHVWD�D�OD�WHUDSLD�DQWLELyWLFD����%DFWHULHPLD�SHUVLVWHQWH�WUDV�WUDWDPLHQWR�DQWLELyWLFR�FRUUHFWR�\�SURORQJDGR�������GtDV��XQD�YH]�GHVFDUWDGDV�FDXVDV�H[WUDFDUGLDFDV�����(PEROLDV�SHULIpULFDV�UHFXUUHQWHV�SHVH�DO�WUDWDPLHQWR�����9HJHWDFLRQHV�GH�FXDOTXLHU�WDPDxR�R�FHUFD�GH�OD�SUyWHVLV�

(9,'(1&,$�,�,�,�,�,�,�,,D�,,D�,,E�

7DEOD����5HFRPHQGDFLRQHV�TXLU~UJLFDV�HQ�ODV�HQGRFDUGLWLV

(Q�OD ILJXUD�� VH�SURSRQH�XQD�JXtD�SDUD�HO�VHJXLPLHQWR�GH�XQD�(,��YHU�DO�ILQDO�GHO�SURWRFROR�����3UHYHQFLyQ�/DV�LQGLFDFLRQHV�GH�OD�SURILOD[LV�GH�(,�VH�FHQWUDQ�HQ�ORV�SDFLHQWHV�TXH�WHQJDQ�IDFWRUHV�GH�ULHVJR��WDEOD����\�TXH�YD\DQ�D�VHU�VRPHWLGRV�D�DOJ~Q�SURFHGLPLHQWR�GLDJQyVWLFR�R�WHUDSpXWLFR�GH�HOHYDGR�ULHVJR��WDEOD�����(Q�ORV�SURFHGLPLHQWRV�GH�EDMR�ULHVJR�VyOR�HVWi�LQGLFDGD�OD�SURILOD[LV�HQ�ORV�SDFLHQWHV�GH�PX\�HOHYDGR�ULHVJR��(O�WLSR�GH�WUDWDPLHQWR�SURILOiFWLFR�VH�UHFRJH�HQ�OD�WDEOD���

Page 42: Manual practico urgencias medicina interna muy bueno

��

3URFHGLPLHQWRV�RUDOHV��GHQWDOHV�\�GHO�WUDFWR�UHVSLUDWRULRL

3URFHGLPLHQWRV�JHQLWRXULQDULRV�\�JDVWURLQWHVWLQDOHV

(O�SDFLHQWH�HV�FDSD]�GH�WRPDU�PHGLFDFLyQ�SRU�YtD�RUDO

(O�SDFLHQWH�QR�HV�FDSD]�GH�WRPDU�PHGLFDFLyQ�SRU�YtD�RUDO��3DFLHQWH�QR�DOpUJLFR�D�SHQLFLOLQD���$PR[LFLOLQD���JUDPRV�YtD�RUDO���KRUD�DQWHV�GHO�SURFHGLPLHQWR�VHJXLGR�GH�����JUDPRV���KRUDV�GHVSXpV��3DFLHQWH�DOpUJLFR�D�SHQLFLOLQD���(ULWURPLFLQD���JUDPR�YtD�RUDO���KRUDV�DQWHV�GHO�SURFHGLPLHQWR�VHJXLGD�GH�OD�PLWDG�GH�OD�GRVLV���KRUDV�GHVSXpV��y��&OLQGDPLFLQD������PJ���KRUD�DQWHV�\�OD�PLWDG�GH�OD�GRVLV���KRUDV�GHVSXpV���3DFLHQWH�QR�DOpUJLFR�D�SHQLFLOLQD���$PSLFLOLQD���JUDPRV�LQWUDYHQVRV�R�LQWUDPXVFXODUHV����PLQXWRV�DQWHV�GHO�SURFHGLPLHQWR�VHJXLGR�SRU��J�LY�y�LP�GH�DPSLFLOLQD�y�����JUDPRV�GH�DPR[LFLOLQD�RUDO���KRUDV�GHVSXpV���3DFLHQWH�DOpUJLFR�D�SHQLFLOLQD���9DQFRPLFLQD���JUDPR�LY�GXUDQWH���KRUD��DGPLQLVWUDGD���KRUD�DQWHV�GH�OD�WpFQLFD�LQVWUXPHQWDO�

3DFLHQWH�GH� ULHVJR�EDMR��&RQWURYHUVLDV���3DFLHQWH�QR�DOpUJLFR�D�SHQLFLOLQD���$PR[LFLOLQD���JUDPRV�YtD�RUDO���KRUD�DQWHV�GHO�SURFHGLPLHQWR�VHJXLGR�GH�����JUDPRV���KRUDV�GHVSXpV3DFLHQWH�GH� ULHVJR�PRGHUDGR�R�HOHYDGR��3DFLHQWH�QR�DOpUJLFR�D�SHQLFLOLQD���$PSLFLOLQD���JUDPRV�LQWUDYHQRVRV�R�LQWUDPXVFXODUHV�\�JHQWDPLFLQD�����PJ�.J�LQWUDYHQRVRV�RLQWUDPXVFXODUHV����PLQXWRV�DQWHV�GHO�SURFHGLPLHQWR�VHJXLGR�GH�����JUDPRV�GH�DPR[LFLOLQD�YtD�RUDO��KRUDV�GHVSXpV�GHO�SURFHGLPLHQWR��R�ELHQ�OD�PLVPD�SDXWD�LQLFLDO�DGPLQLVWUDGD���KRUDV�GHVSXpV���3DFLHQWH�DOpUJLFR�D�SHQLFLOLQD���9DQFRPLFLQD���JUDPR�LQWUDYHQRVR�OHQWR�D�SDVDU�HQ�XQD�KRUD��\�JHQWDPLFLQD�����PJ�.J��LQLFLiQGRORV�XQDKRUD�DQWHV�GH�FRPHQ]DU�HO�SURFHGLPLHQWR��UHSLWLHQGR� OD�GRVLV���KRUDV�GHVSXpV&LUXJtD�FDUGtDFD�GH� UHFDPELR�YDOYXODU��SDUFKHV�RW 9DQFRPLFLQD���JUDPR�LQWUDYHQRVR�OHQWR�D�SDVDU�HQ�XQD�KRUD� LQLFLiQGROD���KRUD�DQWHV�GH�LQLFLDU�HO�SURFHGLPLHQWR�����PJ�DO�WHUPLQDU�\�OXHJR���GRVLV�GH�����PJ�FRQ�LQWHUYDORV�GH���KRUDV��6H�DxDGH�JHQWDPLFLQD�LY�����PJ�.J�HQWRGDV�ODV�GRVLV�

7DEOD����3URILOD[LV�GH�OD�HQGRFDUGLWLV� LQIHFFLRVD

%LEOLRJUDItD��� %D\HU�$6��%ROJHU�$)��7DXEHUW� .$��HW�DO��'LDJQRVLV�DQG�PDQDJHPHQW�RI�LQIHFWLYH�HQGRFDUGLWLV�DQG�LWV�FRPSOLFDWLRQV��&LUFXODWLRQ������������������������ %RQRZ�52��&DUDEHOOR�%��&�GH�/HRQ�$��HW�DO��*XLGHOLQHV�IRU�WKH�PDQDJHPHQW�RI�SDWLHQWV�ZLWK�YDOYXODU�KHDUW�GLVHDVH��&LUFXODWLRQ������������������������ 'DMDQL�$6��7DXEHUW�.$��:LOVRQ�:��HW�DO��3UHYHQWLRQ�RI�EDFWHULDO�HQGRFDUGLWLV��UHFRPHQGDWLRQV�E\�WKH�$PHULFDQ�+HDUW�$VVRFLDWLRQ��-$0$������������������������ 'XUDFN�'7��/XNHV�$6��%ULJWK�'.��1HZ�FULWHULD�IRU�GLDJQRVLV�RI�LQIHFWLYH�HQGRFDUGLWLV��XWLOL]DWLRQ�RI�VSHFLILF�HFKRFDUGLRJUDSKLF�ILQGLQJV��$P�-�0HG�������������������� 6KDQVRQ�'&��1HZ�JXLGHOLQHV� IRU� WKH�DQWLELRWLF�WUHDWPHQW�RI�VWUHSWRFRFFDO��HQWHURFRFFDO�DQG�VWDSK\ORFRFFDO�HQGRFDUGLWLV��-$&���������������������� 6KLYHO\� %.�� *XUXOH� )7�� 5ROGDQ� &$�� /HJJHWW� -+�� 6FKLOOHU� 1%�� 'LDJQRVWLF� YDOXH� RI� WUDQV�HVRSKDJHDO�FRPSDUHG�ZLWK� WUDQVWKRUDFLF�HFKRFDUGLRJUDSK\� LQ� LQIHFWLYH�HQGRFDUGLWLV�� -�$P�&ROO�&DUGLRO���������������������� :DWDQDNXQDNRUQ�&��%XUNHUW�7��,QIHFWLYH�HQGRFDUGLWLV�DW�D�ODUJH�FRPPXQLW\�WHDFKLQJ�KRVSLWDO�������������$�UHYLHZ�RI�����HSLVRGHV��0HGLFLQH��%DOWLPRUH�������������������

Page 43: Manual practico urgencias medicina interna muy bueno

��

��� :LOVRQ� :5�� .DUFKPHU� $:�� 'DMDQL� $6�� HW� DO�� $QWLELRWLF� WUHDWPHQW� RI� DGXOWV� ZLWK� LQIHFWLYH�HQGRFDUGLWLV� GXH� WR� VWUHSWRFRFFL�� HQWHURFRFFL�� VWDSKLORFRFFL�� DQG� +$&(.� PLFURRUJDQLVPV��$PHULFDQ�+HDUW�$VVRFLDWLRQ��-$0$����������������������6HJXLPLHQWR�GHO�WUDWDPLHQWR�GH�XQD�HQGRFDUGLWLV�LQIHFFLRVD

��&RQWURO�FOtQLFR���������)LHEUH���������(VWDGR�FDUGLRYDVFXODU��������6LJQRV�GH�WR[LFLGDG�DQWLELyWLFD���&RQWURO�PLFURELROyJLFR���������+HPRFXOWLYRV�VHPDQDOHV���������'HWHUPLQDU�OD�&0,�\�&0%�GH�ORV�DQWLELyWLFRV��������HPSOHDGRV����������&DSDFLGDG�EDFWHULFLGD�GHO�VXHUR��������������3ODQWHDPLHQWR�TXLU~UJLFR�VHJ~Q�OR�GHWDOODGR�HQ�WDEOD�FRUUHVSRQGLHQWH�&RPSOLFDFLRQHV�FDUGtDFDV��,QVXILFLHQFLD�FDUGtDFD��SULQFLSDO����FDXVD�GH�PXHUWH���������6XVWLFWXFLyQ�YDOYXODU���$QRPDOtDV�GH�OD�FRQGXFFLyQ���������9DORUDU�DEVFHVR�PLRFiUGLFR���3HULFDUGLWLV

)LHEUH�SHUVLVWHQWH�R�UHFXUUHQWH��)DOOR�DQWLELyWLFR�����*pUPHQHV�UHVLVWHQWHV���,QIHFFLyQ�LQWHUFXUUHQWH�����)OHELWLV�����,QIHFFFLyQ�XULQDULD�����,QIHFFFLyQ�UHVSLUDWRULD���(PEROLD�VpSWLFD�UHFXUUHQWH�R�����DEVFHVR�ORFDO���)LHEUH�PHGLFDPHQWRVD�����FDXVD�PiV�IUHFXHQWH������(OLPLQDU�IiUPDFRV�QR�LPSUHVFLQGLEOHV�����(Q�FRPELQDFLRQHV��HOLPLQDU�SULPHUR������HO�DPLQRJOLFyVLGR�����+DELWXDOPHQWH�FHGHQ�HQ�����GtDV

��VHPDQD�GH�REVHUYDFLyQ��TXH�SXHGH�UHDOL]DUVH�YtD�DPEXODWRULD��WUDV�ILQDOL]DU�WUDWDPLHQWR�DQWLPLFURELDQR�������5HSHWLU�KHPRFXOWLYRV��D�ODV����K�\�D�OD�VHPDQD�GH�ILQDOL]DGR�HO�����WUDWDPLHQWR�,QVWUXLU�VREUH�OD�SURILOD[LV�DQWLPLFURELDQR�DQWH�PDQLREUDV�GH�ULHVJR�\�HQWUHJDU�SDXWD�D�UHDOL]DU�SRU�HVFULWR��5HSHWLU�KHPRFXOWLYRV�DO�PHV�\�D�ORV�WUHV�PHVHV)LJXUD����6HJXLPLHQWR�GHO�WUDWDPLHQWR�GH�OD�HQGRFDUGLWLV�LQIHFFLRVD�

(YROXFLyQ�IDYRUDEOH�VL������0HMRUtD�FOtQLFD�����'HVDSDULFLyQ�GH�ILHEUH�����1HJDWLYL]DFLyQ�GH�ORV�KHPRFXOWLYRV������$QHPLD������(VSOHQRPHJDOLD������3HWHTXLDV������1yGXORV�GH�2VOHU������(PEROLVPR������$QHXULVPD�PLFyWLFR�

(Q�����GtDV��KDVWD�GRV�VHPDQDV�HQ��LQIHFFLyQ�HVWDILORFyFLFD�1R�LQGLFDQ�IDOOR�WHUDSpXWLFR�SXGLHQGR�GHVDSDUHFHU�PHVHV�GHVSXpV�

Page 44: Manual practico urgencias medicina interna muy bueno

��

6tQFRSH�3HGUR�)HUUHUDV��� 'HILQLFLyQ�� SpUGLGD� GH� FRQFLHQFLD� \� GHO� WRQR�PXVFXODU�� GH� LQLFLR� UiSLGR� \� V~ELWR�� GH� FRUWD�GXUDFLyQ� \� GH� UHVROXFLyQ� HVSRQWiQHD�� VLQ� VHFXHODV�� GHELGR� D� OD� GLVPLQXFLyQ� DJXGD�� FUtWLFD� \�WUDQVLWRULD�GHO�IOXMR�VDQJXtQHR�FHUHEUDO�6H�GHILQH�SUHVtQFRSH�� �PDUHR��R��YDKtGR��FRPR� OD�VLWXDFLyQ�SUHYLD�FRQ�VHQVDFLyQ�GH�YLVLyQ�ERUURVD�� GLDIRUHVLV� \� SHUFHSFLyQ� GH� LQPLQHQWH� SpUGLGD� GH� FRQFLHQFLD�� 3UHFHGH�� DXQTXH� QRVLHPSUH�DO�VtQFRSH����,PSRUWDQFLD��(O�VtQFRSH�FRQVWLWX\H�XQ�SUREOHPD�PpGLFR�IUHFXHQWH��$SUR[LPDGDPHQWH�HO����GH�ODV�FRQVXOWDV�HQ�XQ�VHUYLFLR�GH�XUJHQFLDV��\�HO�����GH�ORV�LQJUHVRV�KRVSLWDODULRV��3XHGH�VHU�HO�UHVXOWDGR�GH�XQ�SURFHVR�EDQDO�R�ELHQ�VHU� OD�H[SUHVLyQ�GH�XQD�HQIHUPHGDG�JUDYH��(QFLHUUD�XQ�DPSOLR�HVSHFWUR�GH�FDXVDV�TXH�VH�VXPDUL]DQ�HQ�OD�7DEOD�,����(O�HVWXGLR�GH�XQ�SDFLHQWH�FRQ�VtQFRSH GHEH�FRQVWDU�GH�8QD� EXHQD� DQDPQHVLV� FRQ� XQD� H[SORUDFLyQ� ItVLFD� FXLGDGRVD� \� XQ� (&*�SURSRUFLRQDUiQ� OD�FDXVD�R�OD�FODYH�GLDJQyVWLFD�HQ�OD�PD\RUtD�GH�ORV�FDVRV�(Q�OD�DQDPQHVLV�VH�GHEHQ�UHFRJHU�ORV�VLJXLHQWHV�GDWRV����QR�ROYLGDU�OD�REWHQFLyQ�GH�GDWRV�GH�IDPLOLDUHV�R�WHVWLJRV�SUHVHQFLDOHV���GHWHUPLQDFLyQ��VL�HV�SRVLEOH��GH�ODV�FLUFXQVWDQFLDV�H[DFWDV�HQ�ODV�TXH�VH�SURGXMR�OD�SpUGLGD�GH�FRQFLHQFLD����DQWHFHGHQWHV�GH�VtQFRSHV�SUHYLRV�DO�DFWXDO����GHWHUPLQDU�OD�H[LVWHQFLD�GH�HQIHUPHGDGHV�SUHGLVSRQHQWHV����UHFRJLGD�GH�WRGRV�ORV� IiUPDFRV�TXH�FRQVXPH�HO�SDFLHQWH��\�VREUH�WRGR��� LQYHVWLJDU� OD�SRVLEOH�H[LVWHQFLD�GH FDUGLRSDWtD�GH�EDVH(Q�OD�H[SORUDFLyQ�LQVLVWLU�HQ����WRPD�GH�SXOVR�WHQVLyQ�DUWHULDO�\�WHPSHUDWXUD��GH�VXPD�LPSRUWDQFLD�����UHVSHFWR�DO�SXOVR��HV�IXQGDPHQWDO�OD�SDOSDFLyQ�FXDOLWDWLYD�\�FRPSDUDWLYD�GH�SXOVRV�FDURWtGHRV�\�SHULIpULFRV���� (Q� UHODFLyQ� FRQ� OD� WRPD� GH� OD� 7$� HVWD� GHEHUtD� HIHFWXDUVH� GH� IRUPD� VLVWHPiWLFD� HQ� DPERV�PLHPEURV�VXSHULRUHV��HQ�SRVLFLyQ�GH�GHF~ELWR�VXSLQR�\�HQ�ELSHGHVWDFLyQ��WUDV�XQ�SHUtRGR�GH������PLQXWRV�GH�SRVLFLyQ�VXSLQD�'HEHPRV� WHQHU� HQ� FXHQWD� TXH� HQ� VLWXDFLyQ� GH� QRUPDOLGDG�� OD� ELSHGHVWDFLyQ� GLVPLQX\H�OLJHUDPHQWH�OD�SUHVLyQ�VLVWyOLFD�������PP+J��\�DXPHQWD�D�GLDVWyOLFD�PtQLPDPHQWH������PP�+J��\�WRGR�HOOR�FRQ�DXPHQWR�GH�OD�IUHFXHQFLD�FDUGtDFD�GH�KDVWD����ODWLGRV�PLQXWR��/D�GLVPLQXFLyQ�GH�OD�SUHVLyQ�DUWHULDO� VLVWyOLFD�HQ����PP�+J�R�PiV��FRQ�EUDGLFDUGLD�\�PDQLIHVWDFLRQHV�QHXUROyJLFDV�KDUi�VRVSHFKDU�OD�KLSRWHQVLyQ�RUWRVWiWLFD��VL�SRU�HO�FRQWUDULR�VH�SURGXFH�OD�KLSRWHQVLyQ�RUWRVWiWLFD�FRQ�DXPHQWR�GH�OD�IUHFXHQFLD�FDUGtDFD�VRVSHFKDU�XQ�RULJHQ�KLSRYROpPLFR�

Page 45: Manual practico urgencias medicina interna muy bueno

��

�� (Q� FDVR� GH� UHDOL]DU� HVWLPXODFLyQ� GHO� VHQR� FDURWtGHR� VH� GHEH� GLVSRQHU� GH�� YtD� LQWUDYHQRVD��UHJLVWUR�(&*��PRQLWRUL]DFLyQ�GH�OD�7$��\�GLVSRQHU�GH�DWURSLQD�\�GHVILEULODGRU��&XDQGR� GH� OD� DQDPQHVLV�� H[SORUDFLyQ� \� (&*� QR� WHQJDPRV� QLQJXQD� FODYH� GLDJQyVWLFD�� OD�HYDOXDFLyQ�PiV�SURIXQGD�VH�GHEHUi�FHQWUDU�HQ�OD�GHWHFFLyQ�GH�DUULWPLDV��SRU�VX�SHRU�SURQyVWLFR��HQ�HO�VtQFRSH�YDVRYDJDO�\�FRQ�PHQRU�IUHFXHQFLD�HQ�DIHFFLRQHV�SVLTXLiWULFDV����3UXHEDV�FRPSOHPHQWDULDV TXH�VH�SXHGH�UHDOL]DU�HQ�ORV�SDFLHQWHV�FRQ�VtQFRSH��+HPRJUDPD�\�ELRTXtPLFD�HOHPHQWDO��GH�HVFDVD�UHQWDELOLGDG�GLDJQyVWLFD��SHUR�GH�UHDOL]DFLyQ�DFRQVHMDEOH��((*���SXHGH�VHU�~WLO�SDUD�GLIHUHQFLDU�ORV�VtQFRSHV�GH�ODV�FULVLV�HSLOpSWLFDV�5[�GH�WyUD[��HVFDVD�UHQWDELOLGDG�GLDJQyVWLFD��QR�HV�DFRQVHMDEOH�UXWLQDULDPHQWH�(FRFDUGLRJUDPD�� VLUYH SDUD� GHVFDUWDU� SDWRORJtD� HVWUXFWXUDO� H� LQGLUHFWDPHQWH�WURPERHPEROLVPR�SXOPRQDU��0RQLWRUL]DFLyQ�(&*�SURORQJDGD��+ROWHU�FDUGtDFR�GH����KRUDV���(VWXGLRV� HOHFWURILVLROyJLFRV� LQYDVLYRV�� ,QGLFDGRV� HQ� SDFLHQWHV� FRQ� VtQFRSHV� GH� SUREDEOH�RULJHQ�DUULWPRJpQLFR HQ� ORV�TXH� OD�HYDOXDFLyQ� LQFUXHQWD�VHD�VXJHVWLYD�DXQTXH�QR�GHILQLWLYD�GH�HVWH� RULJHQ�� (Q� HVWH� VHQWLGR� VH� LQFOXLUiQ� HQ� OtQHDV� JHQHUDOHV� DTXHOORV� FDVRV� FRQ�� FOtQLFD� GH�SDOSLWDFLRQHV� SDUR[tVWLFDV�� SUHFHGLHQGR� R� LQPHGLDWDPHQWH� GHVSXpV� GHO� HSLVRGLR� VLQFRSDO��SUHVHQFLD� GH� DOWHUDFLRQHV�(&*�GHO� WLSR�GH� WUDVWRUQRV�GH� OD�FRQGXFFLyQ�R�VtQGURPH�GH�:3:��SDFLHQWHV�FRQ�FDUGLRSDWtD�HVWUXFWXUDO��SDFLHQWHV�FRQ�DUULWPLDV�VLJQLILFDWLYDV�HQ�HO�+ROWHU�\�HQ�ORV�TXH�QR�VH�KD\D�SRGLGR�FRPSUREDU�XQD�UHODFLyQ�GLUHFWD�DUULWPLDV�VtQWRPDV�(UJRPHWUtD��,QGLFDGD�HQ��VtQFRSHV�WUDV�HVIXHU]R��GHVSXpV�GH�GHVFDUWDU�OD�FDXVD�REVWUXFWLYD��DQWH�OD�VRVSHFKD�GH�GLVIXQFLyQ�VLQXVDO�SDUD�YDORUDU�OD�IUHFXHQFLD�FDUGtDFD�\�HQ�OD�YDORUDFLyQ�GH�SRVLEOH�FDUGLRSDWtD�LVTXpPLFD�VXE\DFHQWH�&DWHWHULVPR� FDUGtDFR� \� FRURQDULRJUDItD� �D� YDORUDU� IXQGDPHQWDOPHQWH� HQ� SDFLHQWHV� FRQ�VRVSHFKD� GH� VtQFRSH� GH� RULJHQ� FDUGLRJpQLFR� HQ� ORV� TXH� ODV� SUXHEDV� DQWHULRUHV� QR� KDQ� VLGR�FRQFOX\HQWHV��7$&� FUDQHDO�� 510�� DQJLRJUDItD� FHUHEUDO� \� GRSSOHU� GH� ORV� JUDQGHV� WURQFRV� YDVFXODUHVVXSUDDyUWLFRV� DQWH� OD� VRVSHFKD�GH� FOtQLFD� QHXUROyJLFD�� -HUDUTXL]DQGR� OD� UHDOL]DFLyQ�GH�GLFKDV�SUXHEDV�*DPPDJUDItD� \�R� DQJLRJUDItD� SXOPRQDU� \� 7$&$5� HQ� SDFLHQWHV� HQ� TXH� VH� VRVSHFKD�� FRQ�DUUHJOR�D�ODV�H[SORUDFLRQHV�EiVLFDV���OD�H[LVWHQFLD�GH�XQ�WURPERHPEROLVPR�SXOPRQDU�3UXHED�GH�7LOW�R�WDEOD�EDVFXODQWH��FRQ�PRQLWRUL]DFLyQ�GH�OD�WHQVLyQ�DUWHULDO�\�GH�OD�IUHFXHQFLD�FDUGtDFD��,QGLFDGR�DQWH�OD�VRVSHFKD�GH�VtQFRSH�YDVR�YDJDO�UHFXUUHQWH�

��� )LQDOPHQWH�� VH� UHVDOWDQ� UHFRPHQGDFLRQHV� VREUH� HO� VtQFRSH�� DOJXQDV� � HPLWLGDV� SRU� HO�&ROHJLR�GH�0pGLFRV�$PHULFDQRV�HQ������$QDPQHVLV�FXLGDGRVD��H[SORUDFLyQ�\�HO�(&*�VRQ�HO�FHQWUR�SDUD�OD�HODERUDFLyQ�GHO�HVWXGLR�GHO�VtQFRSH��

Page 46: Manual practico urgencias medicina interna muy bueno

��

(O�VtQFRSH�HQ�OD�YHMH]��D�PHQXGR�UHVXOWD�GH�SROLIDUPDFLD�\�UHVSXHVWDV�ILVLROyJLFDV�DQRUPDOHV�\�SXHGH�WHQHU�XQ�FDUiFWHU�PXOWLIDFWRULDO�

(Q�OD�ILJXUD�� VH�DSRUWD�XQ�HVTXHPD�JXtD�SDUD�GLULJLU�HO�HVWXGLR�GHO�VtQFRSH�'LILFXOWDG�GLDJQyVWLFD�HWLROyJLFD��OOHJDQGR�DOJXQDV�VHULHV�KDVWD�XQ������TXH�TXHGDQ�FRPR�GH�HWLRORJtD�GHVFRQRFLGD��D�SHVDU�GH�TXH�VH�UHDOLFH�WRGD�OD�EDWHUtD�GH�HVWXGLRV�/D�HYDOXDFLyQ�SVLTXLiWULFD�SXHGH�GHWHFWDU�GHVRUGHQ�PHQWDO�DVRFLDGR�FRQ�VtQFRSH�HQ�XQ������GH�ORV�FDVRV�/D�KRVSLWDOL]DFLyQ�SXHGH�HVWDU� LQGLFDGD�HQ�SDFLHQWHV�FRQ�DOWR� ULHVJR�GH�VtQFRSH�FDUGLRJpQLFR��DTXHOORV�FRQ�(&*�DQRUPDO��HQIHUPHGDG�FDUGtDFD�RUJiQLFD��GRORU�WRUiFLFR��KLVWRULD�GH�DUULWPLDV���R�FRQ�VLJQRV�QHXUROyJLFRV�DJXGRV��(O�SURQyVWLFR�GHSHQGH�IXQGDPHQWDOPHQWH�GH�OD�SUHVHQFLD�R�QR�GH�FDUGLRSDWtD�HVWUXFWXUDO�GH�EDVH��$Vt��OD�PRUWDOLGDGG�WRPDGD�D�XQ�DxR�SDUD�HO�VtQFRSH�GH�RULJHQ�FDUGtDFR�RVFLOD�HQWUH�HO���������PLHQWUDV�TXH�EDMD�D�������HQ�ORV�VtQFRSHV�QR�FDUGLRJpQLFRV��\�DOUHGHGRU�GHO����HQ�ORV�GH�FDXVD�QR�ILOLDGD

%LEOLRJUDItD��� $OSHUW�0$�� 6tQFRSH�� &RQVLGHUDFLRQHV� FOtQLFDV�� ILVLRSDWROyJLFDV� \� WHUDSpXWLFD� FDUGLRYDVFXODU��5HYLHZV�5HSRUWV��HG�HVS��������������������

6tQFRSH$QDPQHVLV([SORUDFLyQ(&*

'LDJQyVWLFR 6 LYR6LWXDFLRQDO &DUGLRSDWtD 1HXUROyJLFR+LSHUVHQVLELOLGDG 9DVRYDJDO)DUPDFRLQGXFLGRHQR� 7yUD[ ((*0DVDMH�VHQR 3UXHED�7LOW+ROWHU 7pFQLFDVFDURWtGHR (FRFDUGLR ,PDJHQ(UJRPHWUtD(VWXGLR(OHFWURILVLROyJLFR

Page 47: Manual practico urgencias medicina interna muy bueno

��

��� $OSHUW� 0$�� 6tQFRSH�� &RQVLGHUDFLRQHV� FOtQLFDV�� ILVLRSDWROyJLFDV� \� WHUDSpXWLFDV� �,���&DUGLRYDVFXODU��5HYLHZV�5HSRUWV��HG�HVS�����������������������'ULVFROO�'7��6\QFRSH�LQ�FKLOGUHQ�DQG�DGROHVFHQWV��-�$P�&DUGLRO�����������������������*DUFtD�&LYHUD�HW�DO��6tQFRSH��(G�0&5��6�$����������.DSRRU�HW�DO��(YDOXDWLRQ�DQG�PDQDJHPHQW�RI�WKH�SDWLHQW�ZLWK�V\QFRSH��-$0$�������������������������.LHQ]OH�0*��6tQFRSH��0HFDQLVPRV�\�PDQLIHVWDFLRQHV��+RVSLWDO�3UDFWLFH��(G�HVS����������������������� /LQ]HU� 0�� HW� DO�� 'LDJQRVLQJ� V\QFRSH� SDUW� ��� YDOXH� RI� KLVWRU\�� SK\VLFDO� H[DPLQDWLRQ�� DQG�HOHFWUDFDUGLRJUDSK\��&OLQLFDO�(IILFDF\��$VVHVVPHQW�SUR\HFW�RI�WKH�$PHULFDQ�&ROOHJH�RI�SK\VLFLDQV��$QQ�,QWHUQ�0HG�����������������������������3UHEOLF�6DOLE�&��HW�DO��'LIIHUHQWLDO�GLDJQRVLV�DQG�PDQDJHPHQW�VWUDWHJLHV��(PHUJ�0HG�&OLQ�1RUWK�$P�������������������������7RUQHU�0RQWR\D�3��3URWRFROR�GLDJQyVWLFR�GHO�VtQFRSH��0HGLFLQH�������������������

Page 48: Manual practico urgencias medicina interna muy bueno

7DEOD�,��&ODVLILFDFLyQ�GHO�VtQFRSH �&$5',2*e1,&2� 0HFiQLFR 6HFXQGDULR2EVWUXFFLyQ�DO�IOXMR�GH�VDOLGD�L]TXLHUGR (QIHUPHGDG�GHO�61&�SHULIpULFR'LDEHWHV�PHOOLWXV(VWHQRVLV�DyUWLFD $OFRKROLVPR0LRFDUGLRSDWtD�KLSHUWUyILFD (VFOHURVLV�P~OWLSOH0L[RPD�DXULFXODU�L]TXLHUGR 7DEHV�GRUVDO(VWHQRVLV�PLWUDO (QI�GH�3DUNLQVRQ'LVHFFLyQ�DyUWLFD 6LULQJRPLHOLD2EVWUXFFLyQ�DO�IOXMR�GH�VDOLGD�GHUHFKR (QI�GH�:HUQLFNH$PLORLGRVLV�VLVWpPLFD&DUGLRSDWtD�FRQJpQLWD�FRQ�VKXQW�LQYHUWLGR ,QVXILFLHQFLD�VXSUDUUHQDO6LPSDWHFWRPtD�TXLU~UJLFD(VWHQRVLV�SXOPRQDU %ORTXH�IDUPDFROyJLFR�GHO�(PEROLD�SXOPRQDU *DQJOLR�DXWRQyPLFR+LSHUWHQVLyQ�DUWHULDO�SXOPRQDU )DUPDFRV�YDVRGLODWDGRUHV�H�0L[RPD�DXULFXODU�GHUHFKR KLSRWHQVRUHV(VWHQRVLV�WULFXVStGHD 1LWUDWRV$PEDV�FDYLGDGHV &DOFLRDQWDJRQLVWDV'LVIXQFLyQ�SURWpVLFD�YDOYXODU ,QKLELGRUHV�GH�OD�(&$7DSRQDPLHQWR�FDUGtDFR� &ORQLGLQD� $UUtWPLFR 0HWLOGRSD$UULWPLDV�KLSRDFWLYDV %ORTXHDGRUHV�DOID'LVIXQFLyQ�VLQXVDO�PDUFDGD %ORTXHDGRUHV�EHWD%$9�FRPSOHWR�R�DYDQ]DGR 7UDQTXLOL]DQWHV$UULWPLDV�KLSHUDFWLYDV 6HGDQWHV7DT��VXSUDYHQWULFXODUHV� +LSQyWLFRV7DTXLFDUGLDV�YHQWULFXODUHV $QWLGHSUHVLYRV�WULFtFOLFRV �12�&$5',2*e1,&2 'HF~ELWR�SURORQJDGR9DVRYDJDO� 6HGHVWDFLyQ7tSLFR (PEDUD]R$WtSLFR 5HGXFFLyQ�YROXPHQ�FLUFXODQWH� 5HIOHMR��PLFFLRQDO��GHIHFDFFLRQDO��WXVtJHQR��HVWRUQXGR��GHJOXWLYR��SRVWSUDQGLDO��QHXUDOJLD�JORVRIDUtQJHD�\�GHO�WULJpPLFR��RFXORYDJDO��HPEDUD]R�D�WpUPLQR��VRQLGR�DF~VWLFR��9DOVDOYD��LQPHUVLyQ�DFXRVD��HQGRVFRSLDV��LUULWDFLyQ�SOHXUDO��SHULWRQHDO�R�SHULFiUGLFD

�GLDUUHD�� YRPLWR�� KHPRUUDJLD� \� GLXUHVLV�PX\�DEXQGDQWH&HUHEURYDVFXODU�$&9�WUDQVLWRULR(QIHUPHGDG�GH�7DND\DVX6tQGURPH�GHO�URER�GH�OD�VXEFODYLD�6tQGURPH�GHO�DUFR�DyUWLFR��+HPLFUDQHD�+LSHUVHQVLELOLGDG�GHO�VHQR�FDURWtGHR 1HXURSVLTXLFR2UWRVWiWLFR� (SLOHSVLD� DQVLHGDG��KLVWHULD��GHSUHVLyQPD\RU��GHVRUGHQ�GH�SiQLFR,GLRSiWLFR 0HWDEyOLFR�'HILFLHQFLD�DXWRQyPLFD�SULPLWLYD� +LSHUYHQWLODFLyQ��KLSRJOXFHPLD�6tQGURPH�GH�6K\�'UDJHU ,QGHWHUPLQDGR

��

Page 49: Manual practico urgencias medicina interna muy bueno

��

(QIHUPHGDG�SXOPRQDU�REVWUXFWLYD�FUyQLFD��(32&��)HUQDQGR�0XxR]��,JQDFLR�+HUPLGD��5DLPXQGR�7LUDGR����&RQFHSWR��3URFHVR�FDUDFWHUL]DGR�SRU�XQ�GHVFHQVR�GH�ORV�IOXMRV�UHVSLUDWRULRV�TXH�QR�FDPELDQ�GH�PDQHUD�QRWDEOH�GXUDQWH�SHULRGRV�GH�YDULRV�PHVHV�GH�VHJXLPLHQWR��/D�PD\RU�SDUWH�GH�HVWD�OLPLWDFLyQ� GHO� IOXMR� DpUHR� HV� OHQWDPHQWH� SURJUHVLYD� \� SRFR� UHYHUVLEOH�� (VWH� WpUPLQR� LQFOX\H��EURQTXLWLV�FUyQLFD��HQILVHPD�SXOPRQDU�\�HQIHUPHGDG�GH�ODV�SHTXHxDV�YtDV�DpUHDV��

Page 50: Manual practico urgencias medicina interna muy bueno

��

,QGLFDFLyQ��(32&�FRQ� LQVXILFLHQFLD� UHVSLUDWRULD�FUyQLFD��/D� LQGLFDFLyQ�QR�GHEH�FRQVLGHUDUVH�GHILQLWLYD� KDVWD� DO� PHQRV� WUHV� PHVHV� GH� WUDWDPLHQWR�� /D� LQGLFDFLyQ� GHEH� UHSODQWHDUVH� VL� HQ�FXDOTXLHU�PRPHQWR�GH�OD�HYROXFLyQ�VH�PDQWLHQH�3D2��!����PP�+J��UHVSLUDQGR�DLUH�DPELHQWH��3UHPLVDV�SDUD�OD�LQGLFDFLyQ���WUDWDPLHQWR�PpGLFR�FRUUHFWR�\�FRPSOHWR��VXSUHVLyQ�GHO�WDEDTXLVPR��VLWXDFLyQ�FOtQLFD�HVWDEOH��DFWLWXG�FRODERUDGRUD�GHO�SDFLHQWH3DUiPHWURV�TXH�GHILQHQ�OD��LQGLFDFLyQ���3D2�������PP+J��3D2��HQWUH�������PP+J�FRQ�HYLGHQFLD�GH���+LSHUWHQVLyQ�DUWHULDO�SXOPRQDU���&RU�SXOPRQDOH�FUyQLFR��LQVXILFLHQFLD�FDUGtDFD�FRQJHVWLYD��DUULWPLDV��KHPDWRFULWR�!������7LHPSR�GH�DGPLQLVWUDFLyQ��HO�Pi[LPR�SRVLEOH��LQFOX\HQGR�SHUtRGRV�GH�VXHxR��1XQFD�LQIHULRU�D����KRUDV�DO�GtD����([SORUDFLRQHV�FRPSOHPHQWDULDV�EiVLFDV�HQ�HO�iUHD�GH�XUJHQFLDV�*DVRPHWUtD�DUWHULDO��EDVDO��UHVSLUDQGR�DLUH�DPELHQWH��R��VL�HO�SDFLHQWH�UHFLEH�2&'��VH�UHDOL]DUi�GHVSXpV�GH� FRPR�PtQLPR����PLQXWRV� WUDV� UHFLELU�2��HQ�PDVFDULOOD�DO������R�ELHQ�FRQ�JDIDV�QDVDOHV�D�������/�PLQ�5[� GH� WyUD[�� QRV� SHUPLWLUi� GHVFXEULU� XQD� SRVLEOH� FDXVD� GH� OD� GHVFRPSHQVDFLyQ� �QHXPRQtD��QHXPRWyUD[��GHUUDPH�SOHXUDO��\�D�GHVFDUWDU�FRPSOLFDFLRQHV�X�RWUDV�SDWRORJtDV�DVRFLDGDV��,&&��+HPRJUDPD� FRPSOHWR�� YDORUDU� OD� PDJQLWXG� GH� OD� OHXFRFLWRVLV� \� FRUUHODFLRQDUOD� FRQ� RWURV�KDOOD]JRV��ILHEUH��FRQGHQVDFLyQ�SXOPRQDU��\�GHVFXEULU�SROLJOREXOLD��KLSR[HPLD�FUyQLFD��,RQRJUDPD�FRQ�IXQFLyQ�UHQDO�\�JOXFHPLD��PXFKRV�SDFLHQWHV�WRPDQ�GLXUpWLFRV��HO�WUDWDPLHQWR�FRQ� FRUWLFRLGHV� SXHGH� GHVFRPSHQVDU� XQD� '0�� GRVLV� DOWDV� GH� VLPSDWLFRPLPpWLFRV� SXHGHQ�SURGXFLU�KLSRSRWDVHPLD�(&*��GHWHFWDU�FDUGLRSDWtD� LVTXpPLFD�QR�FRQRFLGD�� WUDVWRUQRV�GHO�ULWPR��YDORUDU�&RU�SXOPRQDOH��/RV�EHWD���DGUHQpUJLFRV�\�ODV�WHRILOLQDV�SXHGHQ�GHVHQFDGHQDU�R�DJUDYDU�XQD�DUULWPLD�*UDP�GH�HVSXWR��HQ�QHXPRQtD�R�LQIHFFLyQ�UHVSLUDWRULD����7UDWDPLHQWR�GH�ODV�DJXGL]DFLRQHV�GH�OD�(32&�(O�WUDWDPLHQWR�YD�GLULJLGR�D��FRUUHJLU�OD�KLSR[HPLD��WUDWDU�OD�HQIHUPHGDG�GH�EDVH�\�ORV�IDFWRUHV�GHVHQFDGHQDQWHV�&RUUHFFLyQ� GH� OD� KLSR[HPLD�� /D� ILQDOLGDG� HV�PDQWHQHU� OD� 3D2�� HQ� ������PP+J� �6DW� 2��DOUHGHGRU�GHO��������6H�DGPLQLVWUDUi�HQ�JDIDV�QDVDOHV��*1��D�XQ�IOXMR�GH�����/�PLQ�R�ELHQ�FRQ�

Page 51: Manual practico urgencias medicina interna muy bueno

��

PDVFDULOOD�WLSR�9HQWXUL��90��DO����������(V�SUHIHULEOH�HQ�ORV�PRPHQWRV�LQLFLDOHV�OD�90�IUHQWH�D�ODV�*1�\D�TXH�DSRUWD�XQ�IOXMR�GH�2��PiV�ILDEOH�/D� HILFDFLD� GHO� VXSOHPHQWR� GH�2�� VH� YDORUDUi� HQWUH� ������PLQXWRV� FRQ�*DVRPHWUtD� DUWHULDO� R�SXOVLR[LPHWUtD�GHVSXpV�GH�FDGD�DXPHQWR�GH�OD�)L2��7UDWDPLHQWR� GH� OD� HQIHUPHGDG� GH� EDVH�� 6H� UHDOL]D� XWLOL]DQGR� EURQFRGLODWDGRUHV��DQWLLQIODPDWRULRV�\�SRVLELOLWDQGR�OD�PRYLOL]DFLyQ�GH�ODV�VHFUHFLRQHV���%HWD�DGUHQpUJLFRV��6RQ�ORV�GH�SULPHUD�HOHFFLyQ��LQLFLDOPHQWH�SRU�YtD�LQKDODWRULD�VL�HO�HVWDGR�GHO�SDFLHQWH�SHUPLWH�XQD�FRUUHFWD�DGPLQLVWUDFLyQ�GHO�IiUPDFR���6L�HO�SDFLHQWH�QR�HV�XQ�UHWHQHGRU�GH�&2���VDOEXWDPRO�VROXFLyQ������P/����PJ��������P/�GH�6)�HQ�QHEXOL]DGRU�D�XQ�IOXMR�GH�2������/�PLQ��(Q�OD��ª�KRUD�VH�SXHGH�UHSHWLU�FDGD����PLQ��3RVWHULRUPHQWH�FDGD���K���SXGLpQGRVH�GLVPLQXLU�ODV�GRVLV�LQLFLDOHV�D�����P/���6L�HV�XQ�UHWHQHGRU�FUyQLFR�GH�&2���VH�DGPLQLVWUDUiQ�ODV�PLVPDV�GRVLV�HQ�QHEXOL]DGRU�XOWUDVyQLFR��\D�TXH�XWLOL]D�XQD�)L2��GHO�������(Q�FDVR�GH TXH�HO�HVWDGR�GHO�SDFLHQWH�QR�SHUPLWD�XQD�FRUUHFWD�DGPLQLVWUDFLyQ�GHO�WUDWDPLHQWR�YtD�LQKDODWRULD�XVDUHPRV�OD�YtD�SDUHQWHUDO��VDOEXWDPRO�VXEFXWiQHR��DPS���P/� �����PJ���SDXWiQGRVH�FDGD���K��/D�YtD�HQGRYHQRVD�VH�UHVHUYDUi�HQ�ORV�FDVRV�JUDYHV�\�HQ�XQLGDGHV�FRQ�FRQWURO�HVWUHFKR�GHO�SDFLHQWH��� $QWLFROLQpUJLFRV�� 6LHPSUH� DVRFLDGRV� D� EHWD� DGUHQpUJLFRV�� /D� GRVLV� UHFRPHQGDGD� HQ�VROXFLyQ� HV� GH� ���� PJ��� FRQ� ODV� PLVPDV� SDXWDV� TXH� ORV� EHWD� DGUHQpUJLFRV�� /DV� GRVLV� FRQ�LQKDODGRUHV�WLSR�FDUWXFKR�SUHVXUL]DGR�VRQ�GH�����LQK���������PJ��HQ�FiPDUD�H[SDQVRUD���PLQ��GHVSXpV�GH�ORV�EHWD�DGUHQpUJLFRV��� &RUWLFRLGHV�� 6H� XWLOL]DUiQ� HQ� FDVR� GH� DJXGL]DFLRQHV� JUDYHV�� SUHVHQFLD� GH� VLELODQFLDV��KLVWRULD� GH� KLSHUUHDFWLYLGDG� EURQTXLDO� �+5%�� R� HRVLQRILOLD� HQ� VDQJUH� SHULIpULFD�� 1R� KD\� � XQDV�SDXWDV�ILMDV��SHUR�XQ�HMHPSOR�D�VHJXLU�VHUtD��GRVLV�LQLFLDO�GH�KLGURFRUWLVRQD���������PJ�LY�\�VHJXLU�FRQ�PHWLOSUHGQLVRORQD� ������PJ�LY����� KRUDV� VL� KD\� VLELODQWHV� R�+5%�� ���PJ�LY�������K� VL� QR�HVWiQ�SUHVHQWHV��(Q�HO�WUDWDPLHQWR�LQLFLDO�GH�OD�(32&�DJXGL]DGD�HQ�iUHD�GH�XUJHQFLDV�QR�WLHQH�VHQWLGR�OD�XWLOL]DFLyQ�GH�FRUWLFRLGHV�YtD�LQKDODGD��� 7HRILOLQDV�� )iUPDFR� GH� �ª� OtQHD�� 6L� HO� SDFLHQWH� QR� ODV� WRPDED� SUHYLDPHQWH� VH� KD� GH�UHDOL]DU�XQD�FDUJD�VRQ�XQD�GRVLV�LQLFLDO�GH���PJ�.J�GLOXLGR�HQ�����P/�GH�6*����D�SDVDU�HQ���PLQXWRV�� OD� GRVLV� GH� PDQWHQLPLHQWR� HV� GH� ���� PJ�.J�K� GLOXLGR� HQ� 6*�� JHQHUDOPHQWH� VH�DGPLQLVWUD�D�LQWHUYDORV�GH��� KRUDV��6L�HO�SDFLHQWH�\D�WRPDED�WHRILOLQDV�SDVDU�GLUHFWDPHQWH�D�OD�GRVLV�GH�PDQWHQLPLHQWR��7HQHU�HQ�FXHQWD�OD�LQWHUDFFLyQ�IDUPDFROyJLFD�\�HIHFWRV�FRODWHUDOHV�TXH�SXHGHQ� YHUVH� LQFUHPHQWDGRV� HQ� FDVR� GH� LQVXILFLHQFLD� FDUGtDFD� R� KHSiWLFD� �PLWDG� GH� GRVLV���5HDOL]DU�FRQWUROHV�GH�WHRILOLQHPLD�� 0RYLOL]DFLyQ� GH� ODV� VHFUHFLRQHV�� &RQVLVWH� EiVLFDPHQWH� HQ� OD� KLGUDWDFLyQ� \D� VHD� RUDO� R�SDUHQWHUDO��6L�KD\�JUDQ�GLILFXOWDG�SDUD�H[SHFWRUDU�VH�SXHGHQ�XWLOL]DU�IOXLGLILFDQWHV��PXFRIOXLG���FF�����FF�6)��KD\�TXH�WHQHU�HQ�FXHQWD�TXH�SXHGHQ�SURYRFDU�XQD�EURQFRFRQVWULFFLyQ��0DQLREUDV�GH�HVWLPXODFLyQ�FRQ�SHUFXVLyQ�PDQXDO�VREUH�OD�SDUHG�WRUiFLFD���FODSSLQJ���SXHGHQ�HVWDU� LQGLFDGDV�HQ�FDVR�GH�JUDQGHV�KLSHUVHFUHWRUHV��EURQTXLHFWDVLDV���HVWDQGR�FRQWUDLQGLFDGDV�HQ�SUHVHQFLD�GH�EURQFRHVSDVPR�R�+5%��1R�HVWiQ�LQGLFDGRV�ORV�H[SHFWRUDQWHV�

Page 52: Manual practico urgencias medicina interna muy bueno

��

7UDWDPLHQWR�GH�ORV�IDFWRUHV�GHVHQFDGHQDQWHV� &RPR�SXGLHUD�VHU�XQD�LQVXILFLHQFLD�FDUGtDFD��QHXPRQtD� H� LQFOXVR� XQ� QHXPRWyUD[�� KD\� TXH� DxDGLU� HO� WUDWDPLHQWR� HVSHFtILFR� SDUD� FDGD�SDWRORJtD�(O�XVR�GH�DQWLELyWLFRV� HQ� ODV� H[DFHUEDFLRQHV�GH� OD�(32&�ORV�DSOLFDUtDPRV�HQ�EDVH�D�XQRV�FULWHULRV�� VL� KD\� LQFUHPHQWR� GH� OD� GLVQHD� \� HVSXWR� HQ� XQ�(32&� VHYHUR�PX\� VHYHUR�� SUHVHQWD�IUHFXHQWHV�H[DFHUEDFLRQHV��!����DxR��R�HV�PD\RU�GH����DxRV��(Q�FDVR�GH�XQ�(32&�PRGHUDGR�VH�DxDGLUiQ�VL�DGHPiV�VH�DFRPSDxD�GH�FDPELR�HQ�OD�FRORUDFLyQ�GHO�HVSXWR�(O� DQWLELyWLFR� D� XWLOL]DU� GHEHUtD� FXEULU� ORV� JpUPHQHV� PiV� KDELWXDOHV� HQ� HVWH� WLSR� GH�DJXGL]DFLRQHV��6�SQHXPRQLDH��+�LQIOXHQ]DH \�0�FDWKDUUDOLV��/DV�DPLQRSHQLFLOLQDV�FRQ�LQKLELGRUHV�GH�EHWDODFWDPDVDV�FRPR�DPR[L�FODYXOiQLFR�VRQ�ORV�GH�SULPHUD�HOHFFLyQ��FHIDORVSRULQDV�FRPR�OD�FHIXUR[LPD� \� FHSRGR[LPD�� GH� ORV� PDFUyOLGRV� FXEUHQ� ORV� WUHV� JpUPHQHV� OD� FODULWURPLFLQD� \� OD�D]LWURPLFLQD��� &ULWHULRV�GH�LQJUHVR�HQ�8&,�(V�LPSUHVFLQGLEOH�FRPXQLFDU�D�8&,�OD�H[LVWHQFLD�GH�XQ�SDFLHQWH�FDQGLGDWR�D�LQJUHVR�SDUD�TXH�VHD�YDORUDGR�GH�IRUPD�FRQMXQWD��WHQLHQGR�LQGLFDFLyQ�DTXHOORV�TXH�SUHVHQWHQ�'LVQHD�LQWHQVD�TXH�QR�UHVSRQGH�DO�WUDWDPLHQWR�LQLFLDO�GH�XUJHQFLDV�&RQIXVLyQ��OHWDUJR�\�IDWLJD�GHO�P~VFXOR�UHVSLUDWRULR��HVWD�~OWLPD�FDUDFWHUL]DGD�SRU�XQ�PRYLPLHQWR�SDUDGyMLFR�GHO�GLDIUDJPD��+LSR[HPLD� SHUVLVWHQWH� R� SURJUHVLYD� D� SHVDU� GHO� 2�� VXSOHPHQWDULR�� R� DFLGRVLV� UHVSLUDWRULD�LQWHQVD�\�R�SURJUHVLYD�1HFHVLGDG�GH�YHQWLODFLyQ�PHFiQLFD�\D�VHD�PHGLDQWH�LQWXEDFLyQ�HQGRWUDTXHDO�R�WpFQLFDV�QR�LQYDVLYDV��� 9HQWLODFLyQ�QR�LQYDVLYD��91,��/D�91,�SXHGH�UHSUHVHQWDU�XQD�DOWHUQDWLYD�D�OD�LQWXEDFLyQ�HQ DOJXQRV�SDFLHQWHV�FRQ�(32&�H�LQVXILFLHQFLD� UHVSLUDWRULD� DJXGD�� /D� XWLOL]DFLyQ� GH� SUHVLyQ� SRVLWLYD� GHVFDUJD� ORV� P~VFXORV�UHVSLUDWRULRV�\�HYLWD�OD�REVWUXFFLyQ�GH�OD�YtD�DpUHD�VXSHULRU��3DUD�JDUDQWL]DU�VX�p[LWR�\�VHJXULGDG�VH�GHEHQ�FXPSOLU�XQD�VHULH�GH�UHTXLVLWRV�3UHSDUDFLyQ�DGHFXDGD�GHO�SHUVRQDO�VDQLWDULR�SDUD�SURSRUFLRQDU�OD�91,�'RWDFLyQ� GH� SHUVRQDO� VXILFLHQWH� SDUD� SRGHU� OOHYDU� D� FDER� ODV� WpFQLFDV�� TXH� UHTXLHUHQ� XQD�HVWULFWD�VXSHUYLVLyQ�GHO�SDFLHQWH��FXLGDGRV�HQ� OD�FDEHFHUD�GH�OD�FDPD�\�SUHSDUDFLyQ�SDUD�XQD�LQWXEDFLyQ�GH�XUJHQFLD��\�ILQDOPHQWH&DUDFWHUtVWLFDV� LQWUtQVHFDV� GHO� SDFLHQWH�� FRPR� OXFLGH]� PHQWDO�� WROHUDQFLD� D� ORV� DSDUDWRV� QR�LQYDVLYRV� �VLQ� DJLWDFLyQ��� HVWDELOLGDG� KHPRGLQiPLFD�� FDSDFLGDG� SDUD� FRQWURODU� OD� YtD� DpUHD� \�HOLPLQDU�VHFUHFLRQHV��DXVHQFLD�GH�VHFUHFLRQHV�FRSLRVDV�6L� QR� FXPSOHQ� HVWDV� FRQGLFLRQHV�� OD� LQWXEDFLyQ�\� OD�YHQWLODFLyQ�FRQ�SUHVLyQ�SRVLWLYD�VLJXHQ�VLHQGR�HO�WUDWDPLHQWR�GH�HOHFFLyQ�SDUD�OD�LQVXILFLHQFLD�UHVSLUDWRULD�DJXGD����&ULWHULRV�GH�DOWD�GH�XUJHQFLDV�\�GH�LQJUHVR�KRVSLWDODULR�

Page 53: Manual practico urgencias medicina interna muy bueno

��

3DFLHQWHV��VLQ�2&'�TXH�GH�HQWUDGD�SUHVHQWDQ�3D2��EDVDO�!����R�DTXHOORV�FRQ�2&'�TXH�FRQ�PDVFDULOOD� DO� ����� WLHQHQ�SD2��!� ����6L� GHVSXpV�GH� ���� KRUDV� GH� WUDWDPLHQWR�KDQ�PHMRUDGR�FOtQLFDPHQWH��QR�SUHVHQWDEDQ�DFLGRVLV�UHVSLUDWRULD�DO�LQJUHVR�\�KD�GLVPLQXLGR�HO�EURQFRHVSDVPR��SXHGHQ�GDUVH�GH�DOWD��1R�HV�QHFHVDULR�SUDFWLFDU�XQD�JDVRPHWUtD�SUH�DOWD��3DFLHQWHV�TXH�DO�LQJUHVR�SUHVHQWDQ�3D2��������EDVDO�VL�QR�UHFLEHQ�2&'��R�FRQ�PDVFDULOOD�DO���� �� VL� OR� WLHQHQ��� 6L� GHVSXpV� GH� ���� KRUDV� GH� WUDWDPLHQWR� KDQ�PHMRUDGR� FOtQLFDPHQWH� \� OD�JDVRPHWUtD� GH� FRQWURO� �EDVDO� R� DO� ���� VL�2&'��PXHVWUD�3D2�� !� ��� VLQ� DFLGRVLV� UHVSLUDWRULD�SXHGH�GDUVH�GH�DOWD��6L�3D2�������VHUi�SUHFLVR�LQJUHVR�&XDOTXLHUD� TXH� VHD� OD� 3D2�� GH� HQWUDGD� VLHPSUH� TXH�HO� SDFLHQWH�FRQWLQ~H� FRQ�GLVQHD�GH�UHSRVR�\�WRV�LQWHQVD�WUDV�����KRUDV�GH�WUDWDPLHQWR�VHUi�QHFHVDULR�LQJUHVR�,QJUHVR� VL�� DXQTXH� OD� 3D2�� HVWp� DOUHGHGRU� GH� ���� H[LVWH� XQD� 3D&2�� !� ��� FRQ� DFLGRVLV�UHVSLUDWRULD�(Q� ORV� FDVRV� GH� &RU� SXOPRQDOH� GH� UHFLHQWH� GLDJQyVWLFR�� R� HQ� ORV� FUyQLFRV� GHVFRPSHQVDGRV��HGHPDV������HV�SUHFLVR�HO�LQJUHVR�7DPELpQ�LQJUHVDUiQ�OyJLFDPHQWH�DTXHOORV�SDFLHQWHV�TXH�SUHVHQWHQ�XQD�FRPSOLFDFLyQ�LPSRUWDQWH��S�HM��QHXPRQtD��LQGHSHQGLHQWHPHQWH�GH�VX�HVWDGR�JDVRPpWULFR�)LQDOPHQWH��ORV�SDFLHQWHV�TXH�SRU�VX�VLWXDFLyQ�VRFLRFXOWXUDO��QR�QRV�JDUDQWLFHQ�XQ�WUDWDPLHQWR�DGHFXDGR�GH�OD�DJXGL]DFLyQ�HQ�VX�GRPLFLOLR��GHEHUiQ�WDPELpQ�SHUPDQHFHU�LQJUHVDGRV�%LEOLRJUDItD���&HOOL�%U��6QLGHU�*1��+HIIQHU�-��=LPHQW�,��0DNH�%��2OVHQ�*�HW�DO��6WDQGDUGV�IRU�WKH�GLDJQRVLV�DQG� FDUH� RI� SDWLHQWV�ZLWK FKURQLF� REVWUXFWLYH� SXOPRQDU\� GLVHDVH�� $P� -�5HVSLU�&ULW�&DUH�0HG������������6���6�������)HUJXVRQ�*7��&KHUQLDFN�50��0DQJHPHQW�RI�FKURQLF�REVWUXFWLYH�SXOPRQDU\�GLVHDVH��1�(QJO�-�0HG�������������������������0RQWHPD\RU�7��$OIDMHPH�,��(VFXGHUR�&��0RUHUD�-��6iQFKH]�/��*UXSR�GH�WUDEDMR�GH�OD�6(3$5��1RUPDWLYD� VREUH� HO� GLDJQyVWLFR� \� WUDWDPLHQWR� GH� OD� HQIHUPHGDG�SXOPRQDU� REVWUXFWLYD�FUyQLFD��$UFK�%URQFRQHXPRO����������������������3HDUVRQ�0*��$OGHUVGDOH�5��$OOHQ�6&��$SSV�0&��%DUQHV�*��%HOODP\�'�HW�DO��%76�JXLGHOLQHV�IRU�WKH�PDQDJHPHQW�RI�FKURQLF�REVWUXFWLYH�SXOPRQDU\�GLVHDVH��7KRUD[����������6����� 6iQFKH]� /�� &RUQXGHOOD� 5�� (VWRSp�5�� 0ROLQV� /�� 6HUYHUD� (�� 1RUPDWLYD� SDUD� OD� LQGLFDFLyQ� \�HPSOHR�GH�OD�R[LJHQRWHUDSLD�FRQWLQXD�GRPLFLOLDULD��2&'���$UFK�%URQFRQHXPRO�������������������9LGDO�5��$OYDUH]�6DOD�-/��0DVD�-)��0LUDYLWOOHV�0��0ROLQD�-��5RMDV�2��HW�DO��(32&��FODVLILFDFLyQ�\�HVWUDWHJLDV��&RQFOXVLRQHV�GH�XQ�JUXSR�GH�WUDEDMR�PXOWLGLVFLSOLQDU��3KDUPD�&RQVXOW�6HUYLFHV�6$��(GLSKDUPD������

Page 54: Manual practico urgencias medicina interna muy bueno

��

7UDWDPLHQWR�GH�OD�DJXGL]DFLyQ�JUDYH�GHO�DVPD��$*$��-HV~V�0DUWtQH]� 0RUDWDOOD���� 'HILQLFLyQ�� /RV� FULWHULRV� TXH� GHILQHQ� OD� DJXGL]DFLyQ� DVPiWLFD� VRQ� HO� HPSHRUDPLHQWR�SURJUHVLYR��GH�DOJXQR�R�WRGRV�ORV�VtQWRPDV�UHODFLRQDGRV�FRQ�HO�DVPD��GLVQHD��WRV��VLELODQFLDV�\�RSUHVLyQ�WRUiFLFD��\�OD�GLVPLQXFLyQ�GHO�IOXMR�DpUHR�HVSLUDWRULR�GHO�SDFLHQWH��6H� GHILQH� OD� $*$� FRPR� DTXHOOD� TXH� SUHVHQWD� GDWRV� GH� ULHVJR� YLWDO� LQPLQHQWH� R� XQ� IOXMR�HVSLUDWRULR�Pi[LPR��)(0��LQIHULRU�D������GHO�WHyULFR�R�PHQRU�D�����/�PLQ�(O� HVWXGLR� LQLFLDO� GH� WRGR� SDFLHQWH� FRQ� $*$ GHEH� LU� HQFDPLQDGR� D� REWHQHU� PHGLDQWH� OD�DQDPQHVLV��OD�H[SORUDFLyQ�ItVLFD�\�OD�PHGLGD�GH�OD�IXQFLyQ�SXOPRQDU��ORV�GDWRV�TXH�SHUPLWDQ�&RQILUPDU�HO�GLDJQyVWLFR�GH�DVPD'HWHUPLQDU�OD�LPSRUWDQFLD�GH�OD�FULVLV'LVWLQJXLU�ORV�SDFLHQWHV�SRWHQFLDOPHQWH�JUDYHV����$QDPQHVLV �FRQFLVD�\�UiSLGD���3UHJXQWDU�SRU�OD�FRQGLFLyQ�GH�DVPiWLFR��(VWDEOHFHU�HO�LQLFLR�\�OD�HYROXFLyQ�WHPSRUDO�GH�OD�FULVLV��,QYHVWLJDU�OD�WRPD�GH�DVSLULQDV��DQWLLQIODPDWRULRV�R�EHWDEORTXHDQWHV��LQFOXVR�HQ�FROLULRV���&RQRFHU�ORV�IiUPDFRV�FRQ�ORV�TXH�HO�SDFLHQWH�UHFLEtD�WUDWDPLHQWR�DQWLDVPiWLFR�&XDQWLILFDU�HO�Q~PHUR�GH�LQJUHVRV�KRVSLWDODULRV��LQJUHVRV�HQ�8&,�H�LQWXEDFLyQ�RURWUDTXHDO����([SORUDFLyQ�6LJQRV� TXH� LQGLFDQ� ULHVJR� LQPLQHQWH�� GLVPLQXFLyQ� GHO� QLYHO� GH� FRQFLHQFLD�� GHWHULRUR� GH�IUHFXHQFLD� FDUGtDFD� \� UHVSLUDWRULD�� XWLOL]DFLyQ� GH� PXVFXODWXUD� DFFHVRULD�� SXOVR� SDUDGyMLFR��'HWHFFLyQ�GH�VLELODQFLDV��QR�H[LVWH�EXHQD�FRUUHVSRQGHQFLD�HQWUH�VX�LQWHQVLGDG�FRQ�OD�GH�OD�$*$��� (VWXGLR�GH�OD�IXQFLyQ�UHVSLUDWRULD�&RPSUHQGH�OD�GHWHUPLQDFLyQ�GHO�JUDGR�GH�REVWUXFFLyQ��D�WUDYpV� GH� OD�PHGLGD� GHO� IOXMR� HVSLUDWRULR�Pi[LPR� �)(0�� \� HO� DQiOLVLV�GH� OD� JDVRPHWUtD� DUWHULDO��*$��� (O� YDORU� LQLFLDO� GHO� )(0� \� VX� UHVSXHVWD� DO� WUDWDPLHQWR� HV� HO� ~QLFR� IDFWRU� FRQ� FDSDFLGDG�SUHGLFWLYD� HQ� OD� HYROXFLyQ� GH� OD� $*$�� (Q IXQFLyQ� GHO� )(0� LQLFLDO� REWHQLGR� VH� GLVWLQJXHQ� WUHV�QLYHOHV�GH�JUDYHGDG�GH�OD�FULVLV��OHYH���PRGHUDGD���JUDYH��7DEOD�,���/D�XWLOLGDG�H�LQGLFDFLyQ�GH�OD�*$�TXHGD�UHVWULQJLGD�D�DTXHOORV�SDFLHQWHV�FRQ�XQ�)(0���������PDOD�UHVSXHVWD�WHUDSpXWLFD�R�FXDQGR�VRVSHFKDPRV�SDWRORJtD�DxDGLGD��/D�GLVSRQLELOLGDG�GH�XQ�SXOVLR[tPHWUR� SHUPLWH� XQD� PRQLWRUL]DFLyQ� QR� DJUHVLYD� GHO� WUDWDPLHQWR�� VLHPSUH� \� FXDQGR� OD�VDWXUDFLyQ�GH�R[tJHQR�VHD�!���������3UXHEDV�FRPSOHPHQWDULDV�

Page 55: Manual practico urgencias medicina interna muy bueno

��

/D�UDGLRJUDItD�GH�WyUD[�VyOR�HV�~WLO�HQ�HO�FDVR�GH�SDWRORJtD�DxDGLGD��HVWi�LQGLFDGD�FXDQGR�QR�KD\�UHVSXHVWD�DGHFXDGD�DO� WUDWDPLHQWR�R�FXDQGR�H[LVWDQ�HQ� OD�DQDPQHVLV�R�HQ OD�H[SORUDFLyQ�GDWRV�TXH�VXJLHUDQ�DOJXQD�FRPSOLFDFLyQ��GRORU�WRUiFLFR��HVSXWR�SXUXOHQWR��ILHEUH��HWF��(O�KHPRJUDPD�VyOR�VH�UHDOL]DUi�HQ�FDVR�GH�ILHEUH�R�VRVSHFKD�GH�LQIHFFLyQ�SXOPRQDU�DxDGLGD��/D�ELRTXtPLFD��FRPR�OD�GHWHUPLQDFLyQ�GH�SRWDVLR��VH�UHFRPLHQGD�HQ�ORV�SDFLHQWHV�TXH�VH�DVRFLD�HQIHUPHGDG� FDUGLRYDVFXODU� R� TXH� WRPHQ� UHJXODUPHQWH� GLXUpWLFRV� \D� TXH� OD� DGPLQLVWUDFLyQ�IUHFXHQWH�GH�EHWD��� DGUHQpUJLFRV�SXHGH�FDXVDU�XQ�GHVFHQVR�WUDQVLWRULR�GH�SRWDVLR����&ODVLILFDFLyQ GH�OD�JUDYHGDG�GH�OD�FULVLV�&XDOTXLHU� UHDJXGL]DFLyQ� HV� SRWHQFLDOPHQWH� JUDYH� KDVWD� VX� FRQWURO�� (O� H[DPHQ� ItVLFR� \�IXQFLRQDO� DQWHV� GHVFULWR� WLHQH� FRPR� REMHWR� IXQGDPHQWDO� HVWLPDU� OD� JUDYHGDG� GH� OD� FULVLV�� /RV�SXQWRV�EiVLFRV�VRQ�HO�YDORU�GHO�)(0�\�OD�*$��/D�XWLOL]DFLyQ�GH�ORV�VLJQRV�FOtQLFRV�HV�GH�HVSHFLDO�LQWHUpV�SDUD�GHWHFWDU�ORV�SDFLHQWHV�FRQ�ULHVJR�YLWDO��GHWHULRUR�GHO�QLYHO�GH�FRQFLHQFLD��EUDGLFDUGLD��FLDQRVLV��LPSRVLELOLGDG�GH�FRQFOXLU�ODV�SDODEUDV�DO�KDEODU�R�OD�SUHVHQFLD�GH�VLOHQFLR�DXVFXOWDWRULR����YHU�7DEOD�,�7DEOD�,�� &ODVLILFDFLyQ�GH�OD�JUDYHGDG�GH�OD�DJXGL]DFLyQ�DVPiWLFD

���(Q�OD�)LJXUD�� VH�PXHVWUD�HO�DOJRULWPR�GHO�WUDWDPLHQWR�GH�OD�FULVLV�HQ�HO�+RVSLWDOVHJ~Q�OD�6RFLHGDG�(VSDxROD�GH�3DWRORJtD�5HVSLUDWRULD��6(3$5���UHFWLILFDGR�HQ�XQ�VROR�SXQWR��DO�VXSULPLU�ODV�[DQWLQDV�HQ�HO�WUDWDPLHQWR�GH�OD�DJXGL]DFLyQ�JUDYH�GHO�DVPD�\D�TXH��HQ�XQ�SDFLHQWH�DO�TXH�VH�OH�DGPLQLVWUDQ�GRVLV�DGHFXDGDV�GH�EHWD� LQKDODGR�QR�VH�HYLGHQFLD�PHMRUtD�HQ�OD�EURQFRGLODWDFLyQ�\� VL� VH� KD� GHPRVWUDGR� TXH� SXHGHQ� DXPHQWDU� HIHFWRV� FRODWHUDOHV�� (VWH� DOJRULWPR�� XQD� YH]�PRGLILFDGR� HV� VXSHUSRQLEOH� D� ORV� SURSXHVWRV� SRU� OD�*OREDO� ,QLWLDWLYH� IRU� $VWKPD�±UHYLVDGD�HQ�����± \� SRU� 3KDUPDFRORJLF� 7KHUDS\�� (Q� HVWH� FDStWXOR� GHVFULELPRV� OD� DFWXDFLyQ� DQWH� OD�DJXGL]DFLyQ� JUDYH� GH� DVPD�� GH� WRGDV� IRUPDV�� XQD� YH]� FRQRFLGRV� ORV� IiUPDFRV� \� IRUPDV� GH�DGPLQLVWUDFLyQ��HV�VHQFLOOR�VHJXLU�OD�SDXWD�SDUD�ODV�DJXGLD]DFLRQHV�OHYH�\�PRGHUDGD��REVHUYDQGR�ORV�SDVRV�GHO�iUERO�GH�GHFLVLRQHV�

/HYH PRGHUDGD JUDYH'LVQHD &DPLQDU +DEODU 5HSRVR0~VFXORV�DFFHVRULRV 1R 6t 6t3XOVR�SDUDGyMLFR ����PP ������PP !���PP6LELODQFLDV PRGHUDGDV LQWHQVDV LQWHQVDV)UHFXHQFLD�&DUGtDFD ���� ������� !���)UHFXHQFLD�UHVSLUDWRULD DXPHQWDGD DXPHQWDGD !��3D2� 1RUPDO !�� ���3D�&2� ��� ��� !��)(9� !��� ������ ����)(0 ����/�PLQ ��������/�PLQ �����/�PLQ

Page 56: Manual practico urgencias medicina interna muy bueno

��

� 6L� ORV�VLJQRV�FOtQLFRV�SRQHQ�GH�PDQLILHVWR�XQD�FULVLV�PX\�JUDYH�FRQ�ULHVJR�YLWDO� LQPLQHQWH�VH�FRQVLGHUD�OD�LQWXEDFLyQ�RURWUDTXHDO�\�VX�WUDVODGR�D�8&,�SDUD�YHQWLODFLyQ�PHFiQLFD�� (O�HVTXHPD�WHUDSpXWLFR�GH�OD�DJXGL]DFLyQ�JUDYH��VH�DSOLFDUi�VLHPSUH�TXH�H[LVWD�DOJXQR�GH�ORV�VLJXLHQWHV�GDWRV�)(0�LQLFLDO�LQIHULRU�DO������GHO�WHyULFR�R�SRU�GHEDMR�GH�����O���PLQ�,QVXILFLHQFLD�UHVSLUDWRULD��3D�2�������PP�+J�\���R�3D&2��!����PP�+J�6LJQRV�LQGLFDWLYRV�GH�JUDYHGDG�6L�HQ�FXDOTXLHU�PRPHQWR�ORV�VLJQRV�FOtQLFRV�SRQHQ�GH�PDQLILHVWR�XQD�FULVLV�PX\�JUDYH��FRQ�ULHVJR�YLWDO�LQPLQHQWH��VH�GHEH�UHDOL]DU�XQD�LQWXEDFLyQ�RURWUDTXHDO�\�WUDVODGR�GHO�SDFLHQWH�D�8&,�SDUD�YHQWLODFLyQ�PHFiQLFD�(Q�HO� UHVWR� GH� SDFLHQWHV� XQD� YH]� UHDOL]DGD� OD�*$�� \� WUDWDGRV�FRQ�2���SUHIHULEOHPHQWH�FRQ�PDVFDULOOD�IDFLDO�WLSR�9HQWXUL��D�FRQFHQWUDFLRQHV�DOWDV��VXILFLHQWHV�SDUD�FRQVHJXLU�VDWXUDFLRQHV�GH�2��!������ VH�DGPLQLVWUDUiQ�%HWD� �� DGUHQpUJLFRV� LQKDODGRV� GH� DFFLyQ� FRUWD �VDOEXWDPRO� R� WHUEXWDOLQD��� (V� HO�WUDWDPLHQWR�GH�HOHFFLyQ��/D�IRUPD�GH DGPLQLVWUDFLyQ�PiV�FRP~Q�HV�QHEXOL]DQGR�OD�VROXFLyQ�FRQ�R[tJHQR�D�IOXMRV�DOWRV����O�P���/DV�GRVLV�UHFRPHQGDGDV�SDUD�FDGD�XQR�GH�HOORV�VRQ�6DOEXWDPRO� ���PJ�GLOXLGRV�HQ���PO�GH�VXHUR�ILVLROyJLFR��7HUEXWDOLQD� ����PJ�GLOXLGRV�HQ���PO�GH�VXHUR�ILVLROyJLFR(Q�DXVHQFLD�GH�GLVSRVLWLYRV�GH�QHEXOL]DFLyQ��pVWRV�IiUPDFRV�VH�SXHGHQ�DGPLQLVWUDU�PHGLDQWH�OD� XWLOL]DFLyQ� GH� FDUWXFKRV� SUHVXUL]DGRV� XQLGRV� D� XQD� FiPDUD� GH� LQKDODFLyQ�� (Q� HVWXGLRV�FRPSDUDWLYRV�DPEDV�IRUPDV�GH�DGPLQLVWUDFLyQ�VH�KDQ�PRVWUDGR�LJXDOPHQWH�HILFDFHV��/D�SDXWD�UHFRPHQGDGD�HV����GLVSDURV�FRQVHFXWLYRV�GH�EHWD�DGUHQpUJLFR�VHSDUDGRV�HQWUH�Vt�SRU�LQWHUYDORV�GH� ��� VHJXQGRV�� VHJXLGR� GH� XQ� GLVSDUR� FDGD�PLQXWR� KDVWD� TXH�PHMRUH� HO� EURQFRHVSDVPR�R�KDVWD�TXH�DSDUH]FDQ�HIHFWRV�VHFXQGDULRV��+DELWXDOPHQWH�QR�HV�QHFHVDULR�UHDOL]DU�PiV�DOOi�GH������LQKDODFLRQHV�/D� XWLOL]DFLyQ� GH�%HWD� ��DGUHQpUJLFRV� SRU� YtD� SDUHQWHUDO �LQWUDYHQRVD� R� VXEFXWiQHD�� VH�DVRFLD�D�XQ�PD\RU�Q~PHUR�GH�HIHFWRV�VHFXQGDULRV��PLHQWUDV�TXH�OD�HILFDFLD�FRQ�UHVSHFWR�D�OD�YtD�LQKDODWRULD�HV�VLPLODU� 6X�XVR��SRU�WDQWR��TXHGD��OLPLWDGR�D�ORV�SDFLHQWHV�FRQ�GHWHULRUR�GHO�QLYHO�GH�FRQFLHQFLD� R� D� DTXHOORV� TXH� VHDQ� LQFDSDFHV�GH� UHDOL]DU� XQD�PDQLREUD� LQVSLUDWRULD�HILFD]��/DV�GRVLV�XWLOL]DGDV�HQ�HVWH�FDVR�VRQ��$GUHQDOLQD� �����PO�SRU�YtD�VF�6DOEXWDPRO� ���PJ���.J�SRU�YtD�LY��GXUDQWH����PLQXWRV�7HUEXWDOLQD� �����������PJ�SRU�YtD�LY��GXUDQWH����PLQXWRV�&RUWLFRLGHV�VLVWpPLFRV D�GRVLV�DOWDV��6H�DGPLQLVWUDUi�XQ�EROXV� LQLFLDO�GH�FXDOTXLHUD�GH�ORV�VLJXLHQWHV�HVWHURLGHV�0HWLOSUHGQLVRORQD�����PJ�.J�SRU�YtD�L�Y�+LGURFRUWLVRQD������PJ��SRU�YtD�L�Y�$QWLFROLQpUJLFRV�LQKDODGRV��$xDGLHQGR�DOWDV�GRVLV�GH�EURPXUR�GH�LSUDWURSLR�±����PJ� D�XQDVROXFLyQ� GH� XQ� EHWD�±DGUHQpUJLFR�� VH� KD� GHPRVWUDGR� XQD� DFFLyQ� EURQFRGLODWDGRUD� DGLFLRQDO��SDUWLFXODUPHQWH� HQ� DTXHOORV� LQGLYLGXRV�FRQ�XQD�VHYHUD�REVWUXFFLyQ�DO� IOXMR�DpUHR��7DPELpQ�VH�

Page 57: Manual practico urgencias medicina interna muy bueno

��

SXHGH�DGPLQLVWUDU�PHGLDQWH�FDUWXFKR�SUHVXUL]DGR�FRQ�HVSDFLDGRU������LQKDODFLRQHV�FRQVHFXWLYDV�>����PJ�LQK@����9DORUDFLyQ�GH�OD�UHVSXHVWD�DO�WUDWDPLHQWR�,��7UDQVFXUULGRV����PLQ��GHVSXpV�GHO�WUDWDPLHQWR��VH�YXHOYH�D�YDORUDU�DO�SDFLHQWH� �6L�HO�)(0�!�����GHO�WHyULFR�\�QR�KD\�VLJQRV�FOtQLFRV�GH�JUDYHGDG�6H�PDQWHQGUi�DO�SDFLHQWH�HQ�REVHUYDFLyQ�GXUDQWH�XQ�SHULRGR�DSUR[LPDGR�GH����PLQ��$O�ILQDO� GH� HVWH� SHULRGR�� VL� QR� H[LVWH� HPSHRUDPLHQWR� FOtQLFR� \� HO� )(0� VLJXH� VLHQGR�VXSHULRU�DO������HO�SDFLHQWH�SXHGH�VHU�\D�LQJUHVDGR�HQ�SODQWD��(Q�FDVR�TXH�H[LVWLHVHQ�DQRPDOtDV�HQ�OD�*$�VH�UHDOL]DUi�XQD�VHJXQGD�H[WUDFFLyQ�SDUD�FRPSUREDU�VX�PHMRUtD��\�HO� WUDWDPLHQWR� GXUDQWH� ODV� SULPHUDV� ��� KRUDV� FRQVLVWLUi� HQ� EHWD��� DGUHQpUJLFRV�QHEXOL]DGRV��������PJ����K���FRUWLFRLGHV�VLVWpPLFRV��PHWLOSUHGQLVRORQD�����PJ�.J�GtD�R�HTXLYDOHQWHV��\�2[tJHQR�VL�SUHFLVDUD� �6L�HO�)(0�QR�PHMRUD�R�HV�LQIHULRU�DO������6H�DGPLQLVWUDUi�QXHYDPHQWH�XQD�VHJXQGD�GRVLV�GH�EHWD���DGUHQpUJLFRV�QHEXOL]DGRV�\�VH� DxDGH� EURPXUR� GH� LSUDWURSLR� HQ� HO� FDVR� GH� TXH� QR� VH� KD\D� DGPLQLVWUDGR�SUHYLDPHQWH�,,�� $� ORV� ���PLQ�� GH� OD� VHJXQGD�GRVLV� GH� EHWD��� DGUHQpUJLFRV� YXHOYH� D�YDORUDUVH� DO� SDFLHQWH��UHDOL]DQGR�XQD�VHJXQGD�*$�\�PHGLHQGR�HO�)(0 �6L�HO�)(0�KD�HPSHRUDGR�R�HV�LQIHULRU�DO������(V� FRQYHQLHQWH� TXH�HO� SDFLHQWH�VHD� LQJUHVDGR�HQ� OD� XQLGDG�GH�FXLGDGRV� LQWHQVLYRV��8&,�� �6L�HO�)(0�KD�PHMRUDGR�SHUR�D~Q�VH�PDQWLHQH�HQ�YDORUHV�GH���������6H�DGPLQLVWUDUi�XQD�WHUFHUD�GRVLV�GH�EHWD�� ��DGUHQpUJLFRV�,,,��1XHYDPHQWH�VH�YDORUDUi�DO�SDFLHQWH�WUDQVFXUULGRV�RWURV����PLQ��\ �6L�HPSHRUD��VH�WUDVODGDUi�D�OD�8&,���PLHQWUDV�TXH �6L�SHUPDQHFH�LJXDO�R�PHMRUD�VH�LQJUHVDUi�HQ�SODQWD�FRQ�HO�VLJXLHQWH�WUDWDPLHQWR�GXUDQWH�ODV�SULPHUDV� ��� K�� EHWD�DGUHQpUJLFRV� QHEXOL]DGRV� �������PJ����K�� FRUWLFRLGHV� VLWpPLFRV� �PHWLO�SUHGQLVRORQD� ����PJ�.J�GtD� R� HTXLYDOHQWHV�� EURPXUR� GH� LSUDWURSLR� ��� LQK� ��K�� \� R[LJHQR�VL�SUHFLVDUD����9HQWLODFLyQ�PHFiQLFD�,QGLFDFLRQHV�DEVROXWDV�'LVPLQXFLyQ�GHO�QLYHO�GH�FRQFLHQFLD)DWLJD�PXVFXODU�SURJUHVLYD3DUDGD FDUGLRUUHVSLUDWRULD,QGLFDFLyQ�UHODWLYD�5HVSXHVWD�LQDGHFXDGD�DO�WUDWDPLHQWR��FRPSUREDGR�IXQFLRQDOPHQWH�����&ULWHULRV�GH�KRVSLWDOL]DFLyQ�)(0�������R�VLJQRV�GH�ULHVJR�YLWDO�LQPLQHQWH�GHVSXpV�GH�OD�DGPLQLVWUDFLyQ�LQLFLDO�GH�EHWD��DGUHQpUJLFRV�QHEXOL]DGRV�

Page 58: Manual practico urgencias medicina interna muy bueno

��

3HUVLVWHQFLD�GH�REVWUXFFLyQ�YHQWLODWRULD��)(0�������R�UHVSXHVWD�FOtQLFD�LQDGHFXDGD�SHVH�D�WUDWDPLHQWR�3DFLHQWHV�FRQ� IDFWRUHV�GH�ULHVJR�GH�DVPD� IDWDO��H[DFHUEDFLyQ�UHFLHQWH��Q~PHUR�HOHYDGR�GH�H[DFHUEDFLRQHV�HQ�HO�~OWLPR�DxR��LQJUHVR�SUHYLR�HQ�8&,��XWLOL]DFLyQ�GH�FRUWLFRLGHV�RUDOHV�HQ�HO�PRPHQWR�GH�OD�FULVLV��GXUDFLyQ�GH�ORV�VtQWRPDV�PiV�GH�XQD�VHPDQD�R�PHQRV�GH���KRUDV�\�SUREOHPDV�SVLFRVRFLDOHV�SDUD�OD�FXPSOLPHQWDFLyQ�GHO�WUDWDPLHQWR�HQ�ODV����KRUDV�VLJXLHQWHV�

)LJXUD����WUDWDPLHQWR�GHO DVPD DJXGR HQ�HO KRVSLWDO��QRUPDWLYD�6(3$5�

1LYHO�GH�FRQFLHQFLD6LJQRV�YLWDOHV&LDQRVLV&DSDFLGDG�GH�KDEODU7yUD[�VLOHQWH,QWXEDFLyQ�\YHQWLODFLyQ�PHFiQLFD5LHVJR�YLWDOLQPLQHQWH

0HGLFLyQ�GHO�IOXMR�HVSLUDWRULR�Pi[LPR)(0��������� )(0�������)(0�������2[tJHQR�D�DOWDV�FRQFHQWUDFLRQHV%����DGUHQ LQKDODGRV� %����DGUHQ�LQK�&RUWLFRLGHV�VLVWpPLFRV %��DGUHQpUJLFRV�LQKDODGRV&RUWLFRLGHV�VLVWpPLFRV*DVHV�DUWHULDOHV���PLQ� ���PLQ� ���PLQ�)(0�������

)(0��!����$/7$%��DGUHQ�LQK�DGHPDQGD�&RUWLFRLGHV�LQK

)(0����������%��$GUHQ )(0�������)(0�!���$/7$%��LQKDODGRV�DGHPDQGD&RUWLFRLGHV�LQK!�����PJ)(0�!���$/7$%��LQK�D�GHPDQGD�&RUW�LQK�!����PJ&RUW�RUDOHV)(0���������,1*5(62%��$GUHQpUJLFRV&RUWLFRLGHVVLVWpPLFRV

5[�WyUD[*DVRPHWUtD�DUWHULDO%��$GUHQpUJLFRV%URPXUR�,SUDWURSLR

%����DGUHQ%URPXUR�LSDWURSLR )(0���!����

)(0���������8&,

���PLQ� ,1*5(62%��DGUHQpUJLFRV&RUWLFRLGHV�VLVWpPLFRV)(0����������*DVHV�DUWHULDOHV%���DGUHQ�

����1R�HVWiQ�UHFRPHQGDGRV�HQ�JHQHUDO�0HWLO[DQWLQDV�� 7HRILOLQD� �DPLQRILOLQD�� QR� SHUHFHQ� SURSRUFLRQDU� EHQHILFLRV� DGLFLRQDOHV� D� OD�WHUDSLD�RSWLPD�GH� ORV�EHWD���DGUHQpUJLFRV� LQKDODGRV�\� ��VLQ�HPEDUJR��SXHGHQ�DXPHQWDU� ORV�

Page 59: Manual practico urgencias medicina interna muy bueno

��

HIHFWRV� DGYHUVRV� �)DQWD� HW� DO�� ������ 5RVVLQJ� HW� DO� ������ 0XUSK\� HW� DO�� ������ 5RULJR� DQG�5RGULJR�������&ROHULGJH�HW�DO�������$QWLELyWLFRV��VL�QR�VH�VRVSHFKD�LQIHFFLyQ�GHO�WUDFWR�UHVSLUDWRULR�+LGUDWDFLyQ�DJUHVLYD��DGPLQLVWUDFLyQ�RUDO�R�LY�GH�JUDQGHV�FDQWLGDGHV�GH�YROXPHQ�)LVLRWHUDSLD� UHVSLUDWRULD�� 1R HV� EHQHILFLRVD� HQ� HVWRV�PRPHQWRV� XD� TXH� SXHGHQ� SURGXFLU�PD\RU�GLILFXOWDG�UHVSLUDWRULD�DO�SDFLHQWH�0XFROtWLFRV�HM��DFHWLOFLVWHLQD��,RGXUR�SRWiVLFR��\D�TXH�SXHGHQ�HPSHRUDU�OD�WRV�R�OD�REVWUXFFLyQ�GH�OD�YtD�DpUHD6HGDFLyQ�� (Q� OD� DJXGL]DFLyQ� VHYHUD� QR� HVWiQ� UHFRPHQGDGRV� ORV� DQVLROtWLFRV� \� ODV� GURJDV�KLSQyWLFDV�SRU�VX�HIHFWR�GH�GHSUHVLyQ�VREUH�HO�FHQWUR�UHVSLUDWRULR������ &RQVHMRV�DO�DOWD�'DU�VLHPSUH�HO�WUDWDPLHQWR�SRU�HVFULWR�5HPLWLU�VLHPSUH�D�PpGLFR�GH�DWHQFLyQ�SULPDULD�HVSHFLDOLVWD�SDUD�VHJXLPLHQWR�HQ�ODV�VLJXLHQWHV����KRUDV�&RPSUREDU�ODV�WpFQLFDV�GH�LQKDODFLyQ�\�HO�HPSOHR�GHO�PHGLGRU�GHO�)(0�$YHULJXDU� VL� FRQRFH� ODV� PDQLIHVWDFLRQHV� GH� HPSHRUDPLHQWR� GHO� DVPD� \� ORV� IDFWRUHV�GHVHQFDGHQDQWHV��GDQGR�FRQVHMRV�SDUD�HYLWDUORV�%LEOLRJUDItD���'H�'LHJR�$��$JXGL]DFLyQ�JUDYH�GHO�DVPD��$VPD�OR�HVHQFLDO����'H�'LHJR�$��&DVDQ�3��'XFH�)��*DOGL]�-%��/ySH]�$��0DQUHVD�)��HW�DO��5HFRPHQGDFLRQHV�SDUD�HO�WUDWDPLHQWR�GH�OD�DJXGL]DFLyQ�DVPiWLFD��$UFK�%URQFRQHXPRO�����������6XSSO������������6(3$5� $UHDV�GH�WUDEDMR� $VPD� 1RUPDWLYD�VREUH�GLDJQyVWLFR�\�WUDWDPLHQWR�GHO�DVPD��� 3KDUPDFRORJLF� 7KHUDS\��0DQDJLQJ�([DFHUEDWLRQV� RI� $VWKPD� �(PHUJHQF\� � GHSDUWPHQW� DQG�KRVSLWDO� EDVHG�FDUH����������*OREDO� ,QLWLDWLYH� IRU� $VWKPD�� 3RFNHW� JXLGH� IRU� DVWKPD� PDQDJHPHQW� DQG� SUHYHQWLRQ��0DQDJHPHQW RI�DVWKPD�DWWDFNV��+RVSLWDO� %DVHG�&DUH��������3K\VLFLDQV�GHVN�UHIHUHQFH���$WURYHQW�����������)DQWD�&+��5RVVLQJ�7+��0F�)DGHQ(5�-U��7UHDWPHQW�RI�DFXWH�DVWKPD��LV�FRPELQDWLRQ�WKHUDS\�ZLWK�V\PSDWKRPLPHWLFV�DQG�PHWK\[DQWKLQHV�LQGLFDWHG"�$P�-�0HG������������������&ROHULGJH�-��&DPHURQ�3��(SVWHLQ�-�7HLFKWDKL+��,QWUDYHQXRV�DPLQRSKLOLQH�FRQIHUV�QR�EHQHILW�LQ�DFXWH�DVWKPD�QR� WUHDWHG�ZLWK� LQWUDYHQRXV�VWHURLGV�DQG� LQKDOHG�EURQFKRGLODWRUV�$XVW�1=�-�0HG�������������������+XDQJ�'��2�%ULHQ�5*��+DUPDQ�(�� HW� DO��'RHV�DPLQRSK\OOLQH� EHQHILW� DGXOWV�DGPLWWHG� WR� WKH�KRVSLWDO�IRU�DQ�DFXWH�H[DFHUEDWLRQ�RI�DVWKPD"�$QQ�,QWHUQ�0HG���������������������'L�*LXOLR�*$��.HUFVPDU�&0��.UXJ�6(��$OSHUW�6(��0DU[�&0��+RVSLWDO�WUHDWPHQW�RI�DVWKPD��ODFN�RI� EHQHILW� IURP� WKHRSK\OOLQH� JLYHQ� LQ� DGGLWLRQ� WR� QHEXOL]HG� DOEXWHURO� DQG� LQWUDYHQRXVO\�DGPLQLVWHUHG�FRUWLFRVWHURLG�-�3HGULDWU���������������

Page 60: Manual practico urgencias medicina interna muy bueno

��

Page 61: Manual practico urgencias medicina interna muy bueno

��

(VWXGLR�GH�ORV�GHUUDPHV�SOHXUDOHV0DQXHO�9LYHV���&OtQLFD�5HFROHWDV����'HILQLFLyQ�$QWH�XQ�HQIHUPR�FRQ�GHUUDPH�SOHXUDO��'3���HO�SULPHU�SDVR�GHEH�VHU�GLVFHUQLU�VL�VH�WUDWD�GH�XQ�WUDVXGDGR�R�GH�XQ�H[XGDGR��SDUD� OR�FXDO� ORV�FULWHULRV�GH�/LJKW FRQWLQ~DQ�VLHQGR� OD� ³UHJOD�GH�RUR´�� 8Q� OtTXLGR� SOHXUDO� �/3�� VHUi� XQ H[XGDGR VL� FXPSOH�� DO� PHQRV�� XQR� GH� ORV� VLJXLHQWHV�FULWHULRV����(O�FRFLHQWH�HQWUH�HO�YDORU�GH�ODV�SURWHtQDV�HQ�/3�\�VX�YDORU�HQ�VXHUR�HV�PD\RU�GH�������(O�FRFLHQWH�HQWUH�OD�ODFWDWR�GHVKLGURJHQDVD��/'+��SOHXUDO�\�OD�/'+�VpULFD�HV�PD\RU�GH�������(O�YDORU�DEVROXWR�GH�/'+�SOHXUDO�HV�PD\RU�GH�����GHO�OtPLWH�VXSHULRU�GH�OD�QRUPDOLGDG�HQ�HO�VXHUR��6L�QR�FXPSOH�QLQJXQR�GH�ORV���FULWHULRV��VH�FODVLILFDUi�FRPR�WUDVXGDGR��6L�HO�SDFLHQWH�WLHQH�XQ�H[XGDGR��GHEHQ�FRQVLGHUDUVH�RWUDV�FDUDFWHUtVWLFDV�GHO�OtTXLGR�SOHXUDO�FRPR�VX�DVSHFWR��UHFXHQWR�\�IyUPXOD�OHXFRFLWDULD��QLYHOHV�GH�JOXFRVD�\�DPLODVD��FLWRORJtD�\�FXOWLYR�(Q�OD�)LJXUD���VH�SURSRQH�XQ�DOJRULWPR�GLDJQyVWLFR�GHO�GHUUDPH�SOHXUDO����'LDJQyVWLFR��7DEOD�,��/D GHVFULSFLyQ�GHO�OtTXLGR�SOHXUDO GHEH�LQFOXLU�VX�RORU��8Q�RORU�S~WULGR�LQGLFD�LQIHFFLyQ�SRU�DQDHURELRV�\�XQ�RORU�D�DPRQLDFR�VXJLHUH�XULQRWyUD[��6L�HO�OtTXLGR�HV�LQWHQVDPHQWH�KHPiWLFR��KD\�TXH� PHGLU� VX� KHPDWRFULWR�� SXHV� YDORUHV� VXSHULRUHV� DO� ���� GHO� GH� VDQJUH� SHULIpULFD� VRQ�GLDJQyVWLFRV�GH�KHPRWyUD[ \�REOLJDQ�D�FRORFDU�LQPHGLDWDPHQWH�XQ�WXER�GH�GUHQDMH�SOHXUDO��6L�HV�WXUELR�� GHEH�FHQWULIXJDUVH�� OD�SHUVLVWHQFLD�GH� OD� WXUELGH] RULHQWD�KDFLD� OD�SUHVHQFLD�GH�QLYHOHV�HOHYDGRV�GH�OtSLGRV�SRU�XQ�TXLORWyUD[�R�XQ�SVHXGRTXLORWyUD[��PLHQWUDV�TXH�XQ�VREUHQDGDQWH�FODUR�LQGLFD� TXH� OD� WXUELGH]�HVWi�RFDVLRQDGD�SRU�XQ�JUDQ�Q~PHUR�GH�FpOXODV� R�GH�GHWULWRV�FHOXODUHV�FRPR�RFXUUH�HQ�ORV�HPSLHPDV� �6L�HQ�HO�UHFXHQWR�GLIHUHQFLDO�GH�OHXFRFLWRV�SUHGRPLQDQ�ORV SROLPRUIRQXFOHDUHV��HO�SDFLHQWH�WLHQH�XQD�SDWRORJtD�SOHXUDO�DJXGD�6L�KD\�XQ�LQILOWUDGR�SXOPRQDU��SHQVDU�HQ�'3�SDUDQHXPyQLFR7URPERHPEROLD�SXOPRQDU��7(3�&DUFLQRPD�EURQTXLDO��/D�DXVHQFLD�GH�LQILOWUDGR�SXOPRQDU�DPSOtD�ODV�SRVLELOLGDGHV�GLDJQyVWLFDV�\�REOLJD�D�KDFHU�XQ�HVWXGLR�DEGRPLQDO�GH�LPDJHQ��HFRJUDItD�R�7&��7(3,QIHFFLyQ�YLUDO(QIHUPHGDG�JDVWURLQWHVWLQDO$VEHVWRVLV1HRSODVLD7XEHUFXORVLV�SOHXUDO�DJXGD

Page 62: Manual practico urgencias medicina interna muy bueno

��

�8Q SUHGRPLQLR�GH�FpOXODV�PRQRQXFOHDGDV LQGLFD�XQ�SURFHVR�FUyQLFR�&iQFHU7XEHUFXORVLV7(3,QIHFFLyQ�EDFWHULDQD�FUyQLFD��6L�ORV�FXOWLYRV��OD�SUXHED�GH�OD�WXEHUFXOLQD�� ODV�FLWRORJtDV�GH�/3�\�OD�JDPPDJUDItD�GH�9�4�QR�FRQGXFHQ�DO�GLDJQyVWLFR��KDEUi�TXH�UHFXUULU�D�SUXHEDV� LQYDVLYDV�FRPR� OD�ELRSVLD�SOHXUDO�� OD�EURQFRVFRSLD�R�OD�WRUDFRVFRSLD� �/D�PD\RU�SDUWH�GH�ORV�SDFLHQWHV�FRQ�PiV�GH�XQ�����GH�HRVLQyILORV HQ�/3�KDQ�WHQLGR�DLUH�R�VDQJUH� HQ� OD� FDYLGDG� SOHXUDO� �S�HM�� GHVSXpV� GH� XQD� FLUXJtD� WRUiFLFD��� VL� QR� HV� DVt�� KD\� TXH�FRQVLGHUDU�5HDFFLyQ� PHGLFDPHQWRVD� �QLWURIXUDQWRtQD�� GDQWUROHQR�� PHWLVHUJLGD�� EURPRFULSWLQD��SURFDUED]LQD��DPLRGDURQD�3DUDJRQLPLDVLV6tQGURPH�GH�&KXUJ�6WUDXVV�6LQ�HPEDUJR��HQ�OD�PD\RUtD�GH�ORV�'3�HRVLQRItOLFRV�QR�VH�OOHJDUi�D�QLQJ~Q�GLDJQyVWLFR� �8Q�QLYHO�GH�JOXFRVD SOHXUDO�������PJ�GO�UHGXFH�ODV�SRVLELOLGDGHV�GLDJQyVWLFDV�D�VLHWH�'3�SDUDQHXPyQLFR1HRSODVLD7XEHUFXORVLV$UWULWLV�UHXPDWRLGH��$5�+HPRWyUD[3DUDJRQLPLDVLV6tQGURPH�GH�&KXUJ�6WUDXVV�� �8QD�DPLODVD SOHXUDO�HOHYDGD�LQGLFD�WUHV�GLDJQyVWLFRV�(QIHUPHGDG�SDQFUHiWLFD�DJXGD�R�FUyQLFD5XSWXUD�HVRIiJLFD(QIHUPHGDG�PDOLJQD��/D�DPLODVD�HV�GH�RULJHQ�SDQFUHiWLFR�HQ�HO�SULPHU�FDVR�\�VDOLYDO�HQ�ORV�GRV�UHVWDQWHV�(Q�FDVRV�FRQFUHWRV��UHVXOWDQ�~WLOHV�SDUD�HO�GLDJQyVWLFR�GLIHUHQFLDO�RWUDV�SUXHEDV�HQ�HO�/3�/D� GHWHUPLQDFLyQ� GH� DGHQRVLQD� GHVDPLQDVD� �$'$� HV� UHQWDEOH� SDUD� HVWDEOHFHU� HO�GLDJQyVWLFR�GH�WXEHUFXORVLV�SOHXUDO�6L� VH� VRVSHFKD� TXLORWyUD[� R� SVHXGRTXLORWyUD[�� GHEHUi�PHGLUVH� HO� QLYHO� GH�FROHVWHURO \� GH�WULJOLFpULGRV HQ�OtTXLGR�SOHXUDO�\�EXVFDU�FULVWDOHV�GH�FROHVWHURO�HQ�HO�VHGLPHQWR�GHO�OtTXLGR�7DQWR�XQ�WtWXOR�SOHXUDO�GH�DQWLFXHUSRV�DQWLQXFOHDUHV��$1$��LJXDO�R�VXSHULRU�D�������FRPR�XQ�FRFLHQWH�GH�$1$�HQ�SOHXUD�UHVSHFWR�DO�WtWXOR�H[LVWHQWH�HQ�VXHUR�VXSHULRU�D���VRQ�PX\�VXJHVWLYRV�GH�SOHXULWLV�O~SLFD��HVSHFLDOPHQWH�VL�HO�SDWUyQ�GH�LQPXQRIOXRUHVFHQFLD�HV�KRPRJpQHR�/RV� WHVWV� GH� LQPXQRKLVWRTXtPLFD FRQ�DQWLFXHUSRV�PRQRFORQDOHV� \� OD�FLWRPHWUtD�GH� IOXMRUHVXOWDQ�PX\�~WLOHV�SDUD�HVWDEOHFHU�HO�GLDJQyVWLFR�GH�'3�PDOLJQR��

Page 63: Manual practico urgencias medicina interna muy bueno

��

'HVSXpV�GH�DJRWDGDV�WRGDV�HVWDV�SUXHEDV��DOJXQRV�SDFLHQWHV�FRQWLQ~DQ�VLQ�XQ�GLDJQyVWLFR�\�HV� HQWRQFHV� FXDQGR� GHEHQ� WHQHUVH� HQ� FXHQWD� FDXVDV� LQXVXDOHV� GH� '3� FRPR� DVEHVWRVLV��PHVRWHOLRPD�� VtQGURPH� GH� 'UHVVOHU�� XUHPLD�� VtQGURPH� GH� ODV� XxDV� DPDULOODV� \� VtQGURPH� GH�SXOPyQ�DWUDSDGR��$XQ�DVt��KDVWD�XQ ����GH�ORV�SDFLHQWHV�FRQ�XQ�H[XGDGR�SOHXUDO�TXHGDQ�VLQ� XQ� GLDJQyVWLFR� HWLROyJLFR� /D� PD\RU� SDUWH� GH� HOORV� VH� UHVROYHUiQ� HVSRQWiQHDPHQWH� \�SUREDEOHPHQWH�FRUUHVSRQGDQ�D�SURFHVRV�YLUDOHV�DXWROLPLWDGRV��HQ� ORV� UHVWDQWHV��HO�GLDJQyVWLFR�SXHGH�VHU�HYLGHQWH�D�FRUWR�SOD]R�JHQHUDOPHQWH�HQ�UHODFLyQ�FRQ�XQD�QHRSODVLD�PDOLJQD����0DQHMR�GH�XQ�GHUUDPH�SOHXUDO�SDUDQHXPyQLFR��7DEOD�,,��8Q GHUUDPH� SOHXUDO� SDUDQHXPyQLFR� �'33� HV� DTXpO� TXH� VH� DVRFLD� FRQ� XQD� QHXPRQtD�EDFWHULDQD��XQ�DEVFHVR�SXOPRQDU�R�EURQTXLHFWDVLDV��6L�HQ�OD�UDGLRJUDItD�HQ�GHF~ELWR�ODWHUDO�WLHQH�PiV�GH����PP�GH�HVSHVRU��HV�LPSUHVFLQGLEOH�UHDOL]DU�XQD�WRUDFRFHQWHVLV�XUJHQWH SDUD�GHFLGLU�OD�LQVHUFLyQ�GH�XQ�WXER�GH�GUHQDMH��8OWLPDPHQWH�VH�KD�SURSXHVWR�TXH�HVWD�WRUDFRFHQWHVLV�LQLFLDO�VHD� WHUDSpXWLFD��H[WUDHU� WRGR�HO�/3�SRVLEOH��VLQ�H[FHGHU�GH���D�����OLWURV�SDUD�HYLWDU�XQ�HGHPD�SXOPRQDU�H[�YDFXR���VL�QR�VH�UHDFXPXOD�HO�/3�QR�KD\�TXH�SUHRFXSDUVH�PiV�GHO�'3��DGHPiV��OD�UDGLRJUDItD�SRVWHYDFXDFLyQ�D\XGDUi�D�LGHQWLILFDU�OD�SUHVHQFLD�GH�ORFXODFLRQHV���(O�/3�VH�UHPLWLUi�DO� ODERUDWRULR��WUDQVSRUWDGD�FRQ�KLHOR�\�HQ�MHULQJD�KHSDULQL]DGD��SDUD�WLQFLyQ�GH�*UDP�\�FXOWLYR��UHFXHQWR� \� IyUPXOD� OHXFRFLWDULD� �SDUD� H[FOXLU� RWURV� GLDJQyVWLFRV��� \� GHWHUPLQDFLyQ� GH� JOXFRVD��/'+�\�S+��6L�QR�VH�DtVODQ�EDFWHULDV�\�HO�/3�WLHQH�S+�!��¶�� JOXFRVD�!����PJ�GO�\�/'+��������8�O��VH� WUDWD�GH�XQ�'33�QR�FRPSOLFDGR \�QR�KD\�TXH�UHSHWLU� OD� WRUDFRFHQWHVLV��VDOYR�TXH�HO�'33�UHFXUUD� UiSLGDPHQWH� R� HO� SDFLHQWH� SHUPDQH]FD� VpSWLFR� D� SHVDU� GHO� WUDWDPLHQWR� DQWLELyWLFR�FRUUHFWR��6L�VH�LGHQWLILFDQ�EDFWHULDV�SRU�WLQFLyQ�R�FXOWLYR�R�HO�/3�WLHQH�S+����¶���HQ�DXVHQFLD�GH�DFLGRVLV� HQ� VXHUR�� \�R� JOXFRVD� �� ��� PJ�GO� �R� ���� GH� OD� VpULFD��� HVWDPRV� DQWH� XQ� '33�FRPSOLFDGR \� HO� SDFLHQWH� UHTXLHUH� OD� LQVHUFLyQ� GH� XQ� WXER� GH� GUHQDMH� SOHXUDO�� VLHQGR�SUREDEOHPHQWH� VXILFLHQWH� SDUD� HOOR� XQ� FDWpWHU� GH� SHTXHxR� FDOLEUH� ������ )�� LQWURGXFLGR� EDMR�FRQWURO� UDGLROyJLFR� �HFRJUDItD� R� 7&��� OD� LUULJDFLyQ� IUHFXHQWH� GHO� WXER� FRQ� VROXFLyQ� VDOLQD� \� HO�HPSOHR�GH� ILEULQROtWLFRV� UHGXFHQ� ODV� SRVLELOLGDGHV�GH�TXH�VH�REVWUX\D��6L�HO�/3�HV�SXV� IUDQFR��HVWDPRV�DQWH�XQ�HPSLHPD \�VH�GHEH�GUHQDU�FRQ�XQ�FDWpWHU� GH�FDOLEUH�JUXHVR��������)���/RV�'33�ERUGHUOLQH WLHQHQ�S+�HQWUH��¶��\��¶��\�R�/'+�!������8�O�FRQ�JOXFRVD�!����PJ�GO�\�UHTXLHUHQ��REVHUYDFLyQ�FRQ�WRUDFRFHQWHVLV�GLDJQyVWLFDV�UHSHWLGDV��3RU�OR�JHQHUDO��HO�WXER�GH�GUHQDMH�QR�VH�TXLWD�KDVWD�TXH�HO�GpELWR�HV�LQIHULRU�D����PO����KRUDV�\�HO�OtTXLGR�SOHXUDO�WLHQH�XQ�FRORU�DPDULOOR�FODUR��(Q�ORV�SDFLHQWHV�FRQ�'33�ORFXODGR� VH�GHEHQ�HQVD\DU�DJHQWHV�ILEULQROtWLFRV�D�WUDYpV�GHO�WXER�GH�WRUDFRVWRPtD��HVWUHSWRTXLQDVD ��������8�R�8URTXLQDVD���������8�GLOXLGDV�HQ��������PO�GH� VXHUR� ILVLROyJLFR��� ���� YHFHV� DO� GtD� GXUDQWH� ���� GtDV�� VL� OD� SOHXUR�ILEULQROLVLV� IUDFDVD� HO�SURFHGLPLHQWR�GH�HOHFFLyQ�HV�OD�WRUDFRVFRSLD�HQ�XQ�LQWHQWR�GH�URPSHU�ODV�DGKHUHQFLDV�SOHXUDOHV�\�FRQ�OD�RSFLyQ�GH�WUDQVIRUPDUOD�HQ�XQD�WRUDFRWRPtD�DELHUWD�VL�HO�'33�HVWi�HQ�IDVH�RUJDQL]DWLYD��/D� WRUDFRWRPtD� FRQ� GHFRUWLFDFLyQ HQ� ODV� SULPHUDV� VHPDQDV� VH� UHVHUYD� SDUD� FRQWURODU� XQD�VHSVLV�SOHXUDO�HQ�OD�TXH�KDQ�IUDFDVDGR�ODV�PHGLGDV�DQWHULRUHV��VyOR�VH�HPSOHDUi�SDUD�VROXFLRQDU�XQ�HQJURVDPLHQWR�SOHXUDO�VL�GHVSXpV�GH���PHVHV�OD�SOHXUD�FRQWLQ~D�VXILFLHQWHPHQWH�HQJURVDGD�FRPR�SDUD�OLPLWDU�GH�IRUPD�VLJQLILFDWLYD�OD�FDSDFLGDG�IXQFLRQDO�SXOPRQDU�GHO�SDFLHQWH�

Page 64: Manual practico urgencias medicina interna muy bueno

��)LJXUD����$OJRULWPR�GLDJQyVWLFR�GHO�GHUUDPH�SOHXUDO�

725$&2&(17(6,6�',$*1Ï67,&$¢&803/(�$/*812�'(�/26�6,*8,(17(6"��&RFLHQWH�SURWHtQDV�/3�VXHUR�!�¶��&RFLHQWH�GH�/3+�/3�VXHUR�!�¶�/'+�HQ�/3!�����HO�OtPLWH�VXSHULRU�QRUPDO�HQ�VXHUR

(;8'$'2&RQWLQXDU�SURFHGLPLHQWRV�GLDJQyVWLFRVS+��JOXFRVD��DPLODVD�\�$'$�HQ�/3��&LWRORJtD�GH�/3�5HFXHQWH�\�IyUPXOD�OHXFRFLWDULD�&XOWLYRV�\�WLQFLyQ�GH�*UDP�GH�/3

75$68'$'27UDWDU�OD�FDXVD

$0,/$6$�(/(9$'$�&RQVLGHUDU5RWXUD�HVRIiJLFD'3�GH�RULJHQ�SDQFUHiWLFR3�*/8&26$������0*�'/&RQVLGHUDU'3�PDOLJQR'3�SDUDQHXPyQLFR7XEHUFXORVLVV�$'$�!���8,�/�\�HGDG�d���DxRV�7UDWDU�FRPR�'3�WXEHUFXORVR�VL�VH�KDQ�H[FOXLGR�RWUDV�FDXVDV

12�',$*1Ï67,&2$1$�<�)5�SOHXUDO��&RQVLGHUDU/(6�VL�!������y�!$1$�VXHUR5� L�!� ����y� 5�*$00$*5$)Ë$�38/021$5�9�37URPERHPEOROLD�SXOPRQDU%,236,$�3/(85$/�&21�$*8-$7XEHUFXORVLV1HRSODVLD�

12�',$*1Ï67,&2%URQFRVFRSLD�VL��,QILOWUDGRV�SXOPRQDUHV+HPRSWLVLV'3�PDVLYR&RQVLGHUDU�9LGHR�7RUDFRVFRSLD

Page 65: Manual practico urgencias medicina interna muy bueno

��

7DEOD�,��'LDJQyVWLFR�GLIHUHQFLDO�GHO�GHUUDPH�SOHXUDO'3�75$68'$7,926 ,QGXFLGRV�SRU�PHGLFDPHQWRV,QVXILFLHQFLD�FDUGLDFD�FRQJHVWLYD 1LWURIXUDQWRtQD&LUURVLV�KHSiWLFD 'DQWUROHQR6tQGURPH�QHIUyWLFR 0HWLVHUJLGD(PEROLD�SXOPRQDU %URPRFULSWLQD2EVWUXFFLyQ�GH�YHQD�FDYD�VXSHULRU $PLRGDURQD0L[HGHPD 3URFDUEDFLQD8ULQRWyUD[ 0HWRWUH[DWR0LVFHOiQHD'3�(;8'$7,926 ([SRVLFLyQ�DO�DVEHVWR3DUDQHXPyQLFR 6tQGURPH�GH�'UHVVOHU1HXPRQtD�EDFWHULDQD 6tQGURPH�GH�0HLJV$EVFHVR�SXOPRQDU 6tQGURPH�GH�ODV�XxDV�DPDULOODV%URQTXLHFWDVLDV�LQIHFWDGDV 6DUFRLGRVLV0DOLJQR (QIHUPHGDG�SHULFiUGLFD3XOPyQ 3RVW�FLUXJtD�GH�E\SDVV�FRURQDULR0DPD 3RVW�WUDVSODQWH�GH�SXOPyQ2YDULR�\�2WURV 'HUUDPH�SOHXUDO�IHWDO/LQIRPD 8UHPLD0HVRWHOLRPD 3XOPyQ�DWUDSDGR7XEHUFXORVLV 5DGLRWHUDSLD7URPERHPEROLD�SXOPRQDU 6G�KLSHUHVWLPXODFLyQ�RYiULFD2WUDV�LQIHFFLRQHV 'HUUDPH�SOHXUDO�SRVWSDUWR,QIHFFLRQHV�YLUDOHV $PLORLGRVLV,QIHFFLRQHV�PLFyWLFDV 4XHPDGXUDV�HOpFWULFDV,QIHFFLRQHV�SDUDVLWDULDV /HVLyQ�\DWUyJHQD(QIHUPHGDG�JDVWURLQWHVWLQDO +HPRWyUD[(QIHUPHGDG�SDQFUHiWLFD 7UDXPiWLFR$EVFHVR�LQWUDDEGRPLQDO <DWUyJHQR3RVW�FLUXJtD�DEGRPLQDO &RDJXORSDWtD3HUIRUDFLyQ�HVRIiJLFD 4XLORWyUD[(QI��GHO�WHMLGR�FRQHFWLYR /LQIRPD$UWULWLV�UHXPDWRLGH 7UDXPiWLFR/XSXV�HULWHPDWRVR�VLVWpPLFR &RQJpQLWR)LHEUH�PHGLWHUUiQHD�IDPLOLDU6tQGURPH�GH�&KXUJ�6WUDXVV*UDQXORPDWRVLV�GH�:HJHQHU0RGLILFDGR� GH�� /LJKW� 5:�� 5RGULJXH]� 50�� 0DQDJHPHQW� RI� SDUDSQHXPRQLF� HIIXVLRQV�� &OLQ� &KHVW� 0HG� ���������������� �GLDJQyVWLFRV�PiV�IUHFXHQWHV�7DEOD�,,��(VTXHPD�GHO�WUDWDPLHQWR�SDUD�GHUUDPHV�SDUDQHXPyQLFRV��'33��\�HPSLHPDV�&ODVH &DUDFWHUtVWLFDV 7UDWDPLHQWR

Page 66: Manual practico urgencias medicina interna muy bueno

��

��,QVLJQLILFDQWH 5[�GHF~ELWR�ODWHUDO������PP 1R�SUHFLVD�WRUDFRFHQWHVLV���'33�QR�FRPSOLFDGR *OXFRVD!����S+!�����/'+�����*UDP�\�FXOWLYR�QHJDWLYRV�

6yOR�DQWLELyWLFRV���'33�ERUGHUOLQH �¶��S+��¶��\�R�/'+!����*OXFRVD!���*UDP�\�FXOWLYRV�QHJDWLYRV�

$QWLELyWLFRV�\�WRUDFRFHQWHVLV�VHULDGDV���'33�FRPSOLFDGR�VLPSOH S+��¶��\�R�*OXFRVD����\�R�*UDP�R�FXOWLYRV�SRVLWLYRV�1R�SXV�QL�ORFXODFLRQHV�

7XER�GH�WRUDFRVWRPtD��ILQR��\�DQWLELyWLFRV���'33�FRPSOLFDGR�ORFXODGR ,JXDO�TXH��� SHUR�FRQ�ORFXODFLRQHV� 7XER�GH�WRUDFRVWRPtD�\�SOHXUR�WURPEROLVLV���(PSLHPD�VLPSOH 3XV�IUDQFR�VLQ�ORFXODFLRQHV� 7XER�GH�WRUDFRVWRPtD�JUXHVR��3ODQWHDU�GHFRUWLFDFLyQ���(PSLHPD�ORFXODGR 3XV�IUDQFR�FRQ�ORFXODFLRQHV�P~OWLSOHV� 7XER�GH�WRUDFRVWRPtD�\�SOHXUR�WURPEROLVLV��)UHFXHQWHPHQWH�UHTXLHUHQ�WRUDFRVFRSLD�R�GHFRUWLFDFLyQ�%LEOLRJUDItD�/LJKW�5:��3OHXUDO�GLVHDVHV���WK�HGLWLRQ��%DOWLPRUH��:LOOLDPV�DQG�:LONLQV������3RUFHO� -0� $SUR[LPDFLyQ� GLDJQyVWLFD� \� WHUDSpXWLFD� D� XQ� SDFLHQWH� FRQ� GHUUDPH� SOHXUDO�� 07$�PHGLFLQD�LQWHUQD������������������+HIIQHU�-(��%URZQ�/.��%DUELHUL�&$��'LDJQRVWLF�YDOXH�RI�WHVWV�WKDW�GLVFULPLQDWH�EHWZHHQ�H[XGDWLYH�DQG�WUDQVXGDWLYH�SOHXUDO�HIIXVLRQV��&KHVW��������������������'H�0LJXHO� -��$ORQVR�(�� ,]TXLHUGR�-/��6HUUDQR�-$��8WLOLGDG�GH� ORV�PDUFDGRUHV�ELROyJLFRV�HQ�HO�GHUUDPH�SOHXUDO��5HY�&OLQ�(VS������������������/LJKW� 5:�� 5RGUtJXH]� 50�� 0DQDJHPHQW� RI� SDUDSQHXPRQLF� HIIXVLRQV�� &OLQ� &KHVW� 0HG� �����������������0RGLILFDGR�GH��/LJKW�5:��5RGUtJXH]�50��0DQDJHPHQW�RI�SDUDSQHXPRQLF�HIIXVLRQV��&OLQ�&KHVW�0HG������������������0RGLILFDGR�GH��/LJKW�5:��'LVRUGHUV�RI�WKH�SOHXUD��PHGLDVWLQXP��DQG�GLDSKUDJP��,Q��,VVHOEDFKHU�.��0DUWLQ�-��)DXFL�$��:LOVRQ�-��.DVSHU�'��+DXVHU�6��DQG�/RQJR�'��HGV��+DUULVRQ¶V�3ULQFLSOHV�RI�,QWHUQDO�0HGLFLQH����WK�HG��1HZ�<RUN��0F*UDZ�+LOO��,QF��������

Page 67: Manual practico urgencias medicina interna muy bueno

��

0DQHMR�GH�OD�KHPRSWLVLV�HQ�HO�KRVSLWDO$QD�1~xH]��0DQXHO�+DUR��-HV~V�-LPpQH]��0DQXHO�9L]FD\D����&21&(372��'HILQLPRV� OD�KHPRSWLVLV�FRPR�OD�H[SXOVLyQ�GH�VDQJUH�SRU� OD�ERFD�PHGLDQWH�OD�WRV��OR�TXH�LPSOLFD�XQ�RULJHQ�WUDTXHREURQTXLDO�LQGHSHQGLHQWHPHQWH�GH�VX�YROXPHQ��6XSRQH�HO�������� GH� ODV� FRQVXOWDV� HQ� 1HXPRORJtD� \� SXHGH� VHU� PDQLIHVWDFLyQ� GH� JUDQ� FDQWLGDG� GH�HQIHUPHGDGHV�� FRQ� XQ� FXUVR� FOtQLFR� LPSUHGHFLEOH� DXQTXH�VHD�GH�HVFDVD�FDQWLGDG�D�VX� LQLFLR��SUHVHQWDQGR�GHVGH�XQD�UHVROXFLyQ�HVSRQWiQHD�KDVWD�XQD�HYROXFLyQ�IDWDO�FRQ�VKRFN�KLSRYROpPLFR�R�PiV�IUHFXHQWHPHQWH��SRU�DVIL[LD��&XDOTXLHU�KHPRSWLVLV��SRU��HVFDVD�TXH�VHD�SXHGH�FRQYHUWLUVH�HQ�PDVLYD�R�DPHQD]DQWH�$QWH�WRGD�KHPRSWLVLV�KHPRV�GH�FRQVLGHUDU�ORV�VLJXLHQWHV�DVSHFWRV�D��&RQILUPDU�TXH�HV�XQD�KHPRSWLVLV \�GHVFDUWDU�TXH�HO�VDQJUDGR�SURFHGD�GH�OD�RURIDULQJH��QDVRIDULQJH� R� HVRIDJRJiVWULFR� �IDOVDV� KHPRSWLVLV� R� SVHXGRKHPRSWLVLV��� D\XGDQGR� D� VX�GLDJQyVWLFR�GLIHUHQFLDO�� �+HPDWHPHVLV��PH]FOD�FRQ�DOLPHQWRV��S+�iFLGR��DVRFLDGR�D�QiXVHDV�\�YyPLWRV��SUHVHQFLD�GH�DQHPLD�H�KLVWRULD�GH�HQIHUPHGDG�GLJHVWLYD�� � +HPRSWLVLV�� VDQJUH� HVSXPRVD� FRQ� OD� WRV�� PH]FOD� FRQ� HVSXWR� FRQ� SUHVHQFLD� GH�PDFUyIDJRV� \� QHXWUyILORV�� S+� DOFDOLQR�� UDUD� DQHPLD�� SRVLEOH� GLVQHD� R� DVIL[LD�� UDGLRJUDItD�DQRUPDO�\�DQWHFHGHQWHV�GH�SDWRORJtD�UHVSLUDWRULD�� �(SLVWD[LV��8Q�VDQJUDGR�SRVWHULRU�GHO�FDYXP�VREUH�OD�RURIDULQJH�SURYRFD�WRV�\�H[SXOVLyQ�GH�VDQJUH�SRU�OD�ERFD��/D�H[SORUDFLyQ�25/�OR�DFODUDUi�E��9DORUDU�VX�VHYHULGDG FRQGLFLRQDGD�SRU� OD�FDQWLGDG��YHORFLGDG�GHO� VDQJUDGR�\� OD� UHVHUYD�IXQFLRQDO�UHVSLUDWRULD�GHO�SDFLHQWH��'H�IRUPD�DUELWUDULD��WRGD�KHPRSWLVLV�SXHGH�FODVLILFDUVH�HQ�/HYH ����FF�GtD��XQ�HVSXWR�KHPRSWRLFR�HTXLYDOH�D�� FF�0RGHUDGD �������FF�GtD�$PHQD]DQWH !����FF�GtD��VXSRQH�ULHVJR��SDUD�OD�YLGD�GHO�SDFLHQWH��0DVLYD !��������PO�KRUD��y�!����PO�HQ�������KRUDVF��/RFDOL]DFLyQ GHO�VDQJUDGR�SDUD�DGRSWDU�ODV�PHGLGDV�WHUDSpXWLFDV�LQLFLDOHV�G��(VWDEOHFHU�XQ�GLDJQyVWLFR�HWLROyJLFR����(7,2/2*Ì$��([LVWHQ�P~OWLSOHV�FDXVDV�GH�KHPRSWLVLV�FRQ�XQD� IUHFXHQFLD�YDULDEOH��7DEOD�,���/DV� FDXVDV�PiV� IUHFXHQWHV� VRQ� ODV� LQIHFFLRVDV� R� LQIODPDWRULDV�� HQWUH� ODV� TXH�SUHGRPLQDQ� ODV�DVRFLDGDV� D� ODV� EURQTXLWLV� SRU� HQFLPD� GH� OD� WXEHUFXORVLV� R� EURQTXLHFWDVLDV�� (O� FDUFLQRPD�EURQFRJpQLFR�HV�PiV�IUHFXHQWH�HQ�SDFLHQWHV�PD\RUHV�GH����DxRV�\�IXPDGRUHV��/D�KHPRSWLVLV�PDVLYD� VXHOH� DVRFLDUVH� D� WXEHUFXORVLV� �7%&��� EURQTXLHFWDVLDV�� DVSHUJLORPD� \� FDUFLQRPD�EURQFRJpQLFR�

Page 68: Manual practico urgencias medicina interna muy bueno

��

7DEOD�,�� &DXVDV�GH�KHPRSWLVLV,QIHFFLRVDV�,QIODPDWRULDV %URQTXLWLV�$JXGD�\�&UyQLFD��EURQTXLHFWDVLDV��QHXPRQtDV��DEVFHVR��7%&�R�VXV�VHFXHODV��DVSHUJLORPD��ILEURVLV�TXtVWLFD�1HRSODVLDV &DUFLQRPD�EURQFRJpQLFR��DGHQRPD�EURQTXLDO��WXPRU�FDUFLQRLGH��PHWiVWDVLV�&DUGLRYDVFXODUHV 7(3�R�LQIDUWR�SXOPRQDU��+7�YHQRVD��,&&9��(VWHQRVLV�0LWUDO����9DVFXODUHV��+LSHUWHQVLyQ�SXOPRQDU��$QHXULVPDV�R�)tVWXODV�$9�&RQJpQLWDV 4XLVWHV�EURQTXLDOHV��6HFXHVWURV�9DVFXOLWLV�\�HQI��6LVWpPLFDV 6G��*RRGSDVWXUH��(QI��:HJHQHU��(QI��%HKoHW�+HPRUUDJLDV DOYHRODUHV 9DVFXOLWLV��KHPRVLGHURVLV�LGLRSiWLFD��FRODJHQRVLV��IiUPDFRV��$PLRGDURQD��1LWURIXUDQWRtQD�R�'�SHQLFLODPLQD�&XHUSRV�H[WUDxRV��'LiWHVLV�KHPRUUiJLFDV &RDJXORSDWtDV��&,'��WURPERSHQLD�7UDXPDWLVPRV +HULGDV�DELHUWDV�R�FHUUDGDV��'LVHFFLyQ�DQHXULVPD�DRUWD�<DWUyJHQDV %LRSVLD�EURQFRVFySLFDV��SXQFLRQHV�WUDQVWRUiFLFDV��3$$)���FDWHWHULVPR�SXOPRQDU��ELRSVLD�SXOPRQDU�0LVFHOiQHD (QGRPHWULRVLV��VDUFRLGRVLV��QHXPRFRQLRVLV���DPLORLGRVLV��

��� ',$*1Ð67,&2� (O� PDQHMR� GH� OD� KHPRSWLVLV� H[LJH� XQD� HYDOXDFLyQ� FOtQLFD� LQLFLDO� TXH� QRV�RULHQWDUi�VREUH�VX�VHYHULGDG��GLDJQyVWLFR�HWLROyJLFR�\�ORFDOL]DFLyQ�GHO�VDQJUDGR�D��+LVWRULD�FOtQLFD� $QDPQHVLV�GLULJLGD�TXH�UHVSRQGD�D� ��$QWHFHGHQWHV�IDPLOLDUHV��1HRSODVLD�R�7%&�� �$QWHFHGHQWHV�SHUVRQDOHV��(QIHUPHGDGHV�VLVWpPLFDV��SDWRORJtD�UHQDO��RQFROyJLFD��YtD�DpUHD�VXSHULRU��FRDJXORSDWtD������,QPRYLOL]DFLyQ��$QWHFHGHQWHV�GH�7(3�R�793�� �+LVWRULD�QHXPROyJLFD��7DEDTXLVPR��([SRVLFLyQ�ODERUDO��QtTXHO��FURPR��DVEHVWR�R�DUVpQLFR���7RV��H[SHFWRUDFLyQ��EURQFRUUHD��VLELODQWHV��GLVQHD��7%&�R�KHPRSWLVLV�SUHYLD�� �+HPRSWLVLV��&DQWLGDG��YHORFLGDG�R�WLHPSR�GH�HYROXFLyQ��'DWRV�TXH�VXJLHUDQ�VX�ORFDOL]DFLyQ��6tQWRPDV� DVRFLDGRV� �HSLVRGLR� FDWDUUDO�� ILHEUH�� HVFDORIUtRV��H[SHFWRUDFLyQ� SXUXOHQWD�� GLVQHD��VtQGURPH�FRQVWLWXFLRQDO��KHPDWXULD�����E�� ([SORUDFLyQ� )tVLFD��6H� KDUi� XQD� H[SORUDFLyQ� FRPSOHWD� SUHVWDQGR� HVSHFLDO� DWHQFLyQ D� OD�YDORUDFLyQ�GHO��&RPSURPLVR�UHVSLUDWRULR��IUHFXHQFLD�UHVSLUDWRULD��WLUDMH��WROHUDQFLD�DO�GHF~ELWR�R�FLDQRVLV

Page 69: Manual practico urgencias medicina interna muy bueno

��

&RPSURPLVR�KHPRGLQiPLFR��IUHFXHQFLD�FDUGtDFD��WHQVLyQ�DUWHULDO��SHUIXVLyQ�SHULIpULFD�RVLJQRV�GH��LQVXILFLHQFLD�FDUGLDFD�GHUHFKD�L]TXLHUGD�25/��GHVFDUWDU�VDQJUDGR�EXFRIDUtQJHR��VLQXVLWLV�R�JUDQXORPDV�IRVDV�QDVDOHV��:HJHQHU��$FURSDTXLD� �VXJHVWLYD� GH� QHRSODVLD� R� EURQTXLHFWDVLDV��� DGHQRSDWtDV� �OLQIRPD�� 7%&� R�QHRSODVLD��� VtQGURPH� GH� YHQD� FDYD� VXSHULRU� �QHRSODVLD� R� OLQIRPD��� WHODQJLHFWDVLDV� �5HQGX�2VOHU���FKDSHWDV�PDODUHV��HVWHQRVLV�PLWUDO���HTXtPRVLV��SHWHTXLDV�R�HVSOHQRPHJDOLD��GLiWHVLV�KHPRUUiJLFDV���OHVLRQHV�FXWiQHDV��YDVFXOLWLV��\�DQRPDOtDV�QHXUROyJLFDV��RFXODUHV�R�DUWLFXODUHV��FRODJHQRVLV��$XVFXOWDFLyQ�FDUGtDFD��SUHVHQFLD�GH�VRSORV�R����UXLGR��$XVFXOWDFLyQ�UHVSLUDWRULD��HVWULGRU��VRSORV��KLSRIRQHVLV��URQFXV��VLELODQWHV�R�HVWHUWRUHV�GLIXVRV�R�ORFDOL]DGRV�VXJHUHQWHV�GH�XQD�ORFDOL]DFLyQ�GHWHUPLQDGD�((,,��VLJQRV�GH�793�R�LQVXILFLHQFLD�FDUGLDFD��F��([SORUDFLRQHV�&RPSOHPHQWDULDV�*HQHUDOHV�5[�7yUD[� 2ULHQWD�D�OD�ORFDOL]DFLyQ�\�R�HWLRORJtD�GHO�VDQJUDGR�0DVD�1yGXOR� �QHRSODVLD���/HVLRQHV�FDYLWDULDV� �DEVFHVR�R�FDUFLQRPD�QHFURVDGR��� ,QILOWUDGR�DOYHRODU�� VHJPHQWDULR�OREDU� �QHXPRQtD�� 7(3��� SDUFKHDGR� �KHPRVLGHURVLV� SXOPRQDU�LGLRSiWLFD�� *RRGSDVWXUH��� DOYHROR�LQWHUVWLFLDO� ELODWHUDO� �LQVXILFLHQFLD� FDUGtDFD�� R� LQWHUVWLFLDO��+LVWLRFLWRVLV� ;�� 7%&� PLOLDU��� $GHQRSDWtDV� KLOLR�PHGLDVWtQLFDV� � R� HQJURVDPLHQWR� KLOLDU��QHRSODVLD���(Q�HO��������GH�ORV�FDVRV�OD�UDGLRJUDItD�HV�QRUPDO�*$%��6L�OD�KHPRSWLVLV�HV�DPHQD]DQWH��PDVLYD�R�VRVSHFKDPRV�LQVXILFLHQFLD�UHVSLUDWRULD2WURV�$QDOtWLFD�JHQHUDO��KHPRJUDPD��FRDJXODFLyQ�\�ELRTXtPLFD���0LFURELRORJtD�GH�HVSXWR��%.�VHULDGRV��JUDP�\�FXOWLYR��3UXHED�GH�0DQWRX[��(&*��VLJQRV�FUHFLPLHQWR�\�VREUHFDUJD�FDYLGDGHV�GHUHFKDV�R�KLSHUWHQVLyQ�SXOPRQDU�G��([SORUDFLRQHV�HVSHFtILFDV��/DERUDWRULR���6HJ~Q�OD�VRVSHFKD�HWLROyJLFD�0DUFDGRUHV�WXPRUDOHV��&($��6&&�y�(1(�+HPRFXOWLYRV�VL�ILHEUH�\�VHURORJtDV�VL�VH�VRVSHFKD�XQD�QHXPRQtD�%URQFRVFRSLD��(V� OD� WpFQLFD� PiV� ~WLO� SDUD� HYDOXDU� R� GHVFDUWDU� XQD� HWLRORJtD�� ORFDOL]DU� HO�VDQJUDGR��HQ�HO�����GH�ORV�FDVRV�VL�VH�UHDOL]D�DQWHV�GH����KRUDV��\�SHUPLWH�OD�DSOLFDFLyQ�GH�PHGLGDV�WHUDSpXWLFDV��6LHPSUH�GHEHUi�UHDOL]DUVH�HQ�OD�KHPRSWLVLV�DPHQD]DQWH�R�PDVLYD�\�HQ�OD�OHYH�FRQ�UDGLRJUDItD�GH�WyUD[�SDWROyJLFD�R�GXGRVD��6L�OD�UDGLRJUDItD�HV�QRUPDO��VH�UHDOL]DUi�VL�H[LVWHQ�GXGDV�R�QR�H[LVWH�XQD�FDXVD�R�GLDJQyVWLFR�SUHYLRV���VXSHUD�D�ORV���GtDV��PD\RU�D���FF�GtD��HV�UHFLGLYDQWH�X�RFXUUH�HQ�IXPDGRUHV�GH�PiV�GH����DxRV��HO�����GH�ORV�FDUFLQRPDV�EURQFRJpQLFRV�FRQ�KHPRSWLVLV�WLHQHQ�XQD�5[�QRUPDO��7$&�WRUiFLFD� (V�~WLO�HQ�OD�ORFDOL]DFLyQ�\�GLDJQyVWLFR�HWLROyJLFR��VREUH�WRGR�HQ�ORV�SDFLHQWHV�FRQ�XQD�QHRSODVLD�SXOPRQDU��EURQTXLHFWDVLDV��HQIHUPHGDG� LQWHUVWLFLDO� GLIXVD�R�HQ�SDWRORJtD�YDVFXODU�VL�VH�UHDOL]D�FRQ�FRQWUDVWH��7(3��DQHXULVPDV�\�PDOIRUPDFLRQHV�DUWHULRYHQRVDV��

Page 70: Manual practico urgencias medicina interna muy bueno

��

*DPPDJUDItD� 9�4� \� HVWXGLR� YDVFXODU� ((,,� �HFR�GRSSOHU� R� IOHERJUDItD���6RVSHFKD� GH�HQIHUPHGDG�WURPERHPEyOLFD�YHQRVD(FRFDUGLRJUDItD��6RVSHFKD�FDUGLRSDWtD��YDOYXORSDWtD�R�KLSHUWHQVLyQ�SXOPRQDU��$UWHULRJUDItD� EURQTXLDO� \� SXOPRQDU�� &RQILUPD� OD� SUHVHQFLD� GH� DQRPDOtDV� YDVFXODUHV�SXOPRQDUHV�R�OD�VRVSHFKD�GH�7(3��/D�DUWHULRJUDItD�EURQTXLDO�ORFDOL]D�HO�YDVR�VDQJUDQWH�3UXHEDV�)XQFLRQDOHV�5HVSLUDWRULDV��8QD� YH]� FRQWURODGR�HO� VDQJUDGR�� SXHGH� FRQILUPDU� R�VXJLHUH�XQ�GLDJQyVWLFR�\�HVWDEOHFH�HO�HVWDGR�IXQFLRQDO�UHVSLUDWRULR�GHO�SDFLHQWH�����75$7$0,(172�/RV�REMHWLYRV� GHO� WUDWDPLHQWR� VRQ��PDQWHQHU� OD� SHUPHDELOLGDG� GH� OD�YtD�DpUHD��PDQWHQHU� OD�HVWDELOLGDG�KHPRGLQiPLFD��ORFDOL]DU�\�FRQWURODU�HO�VDQJUDGR��\�WUDWDU�OD�FDXVD�GHO�VDQJUDGR�D��8ELFDFLyQ�GHO�SDFLHQWH��$� VX� OOHJDGD� D� 8UJHQFLDV� UHDOL]DUHPRV� XQD� SULPHUD� HYDOXDFLyQ� GH� VX� VHYHULGDG� VHJ~Q� HO�YROXPHQ�R�YHORFLGDG�GHO�VDQJUDGR��HVWDGR�IXQFLRQDO�\�VRVSHFKD�HWLROyJLFD���7DEOD�,,�$OWD�� (Q� XQD�KHPRSWLVLV� OHYH� FRQ�%(*��HVWDELOLGDG�KHPRGLQiPLFD��XQD�5[�QRUPDO�\�XQD�FODUD� VRVSHFKD�HWLROyJLFD�TXH� OR�SHUPLWD��6L� OD�5[�HV�DQRUPDO�� OD�FDXVD�GH� OD�KHPRSWLVLV�GHEH� VHU� FRQRFLGD� R� FUyQLFD�� QR� SURJUHVLYD�� FRQ� XQ� WUDWDPLHQWR� HIHFWLYR� \� VLQ� ULHVJR� GH�VDQJUDGR�PD\RU�HQ�VX�GRPLFLOLR�GRQGH�GHEH�LQLFLDU�XQ�WUDWDPLHQWR�HWLROyJLFR��DQWLELyWLFR�VL�VRVSHFKDPRV�XQD�LQIHFFLyQ���VLQWRPiWLFR�FRQ�DQWLWXVtJHQRV��FRGHtQD���FRPS��������KRUDV���UHSRVR�GRPLFLOLDULR�\�UHPLWLU�D�FRQWUROHV�DPEXODWRULRV�HQ�������KRUDV��,QJUHVR��HQ�XQD�KHPRSWLVLV�DPHQD]DQWH��PDVLYD�R�TXH�QR�FXPSOD�ORV�FULWHULRV�DQWHULRUHV�SDUD�HO�DOWD��7DEOD�,,,��E��0HGLGDV�JHQHUDOHV�$VHJXUDU�OD�SHUPHDELOLGDG�GH�OD�YtD�DpUHD�9tD�YHQRVD��5HVHUYD�GH�VDQJUH�HQ�OD�KHPRSWLVLV�PDVLYD�0HGLGDV�SRVWXUDOHV��5HSRVR�DEVROXWR�\�GHF~ELWR� ODWHUDO� GHO� ODGR�HQ�TXH�VRVSHFKDPRV�HO�RULJHQ�GHO�VDQJUDGR�R�VXSLQR�VL�QR�H[LVWH�XQD�ORFDOL]DFLyQ�HYLWDQGR�OD�VHGHVWDFLyQ�&RQVWDQWHV�FDGD�����KRUDV�'LHWD�DEVROXWD�VL�KHPRSWLVLV DPHQD]DQWH�R�PDVLYD�DQWH�OD�SRVLELOLGDG�GH�SUHFLVDU�WpFQLFDV�LQYDVLYDV��EURQFRVFRSLD�R�DUWHULRJUDItD��R�HPSHRUDPLHQWR�&XDQWLILFDFLyQ�GLDULD�GH�OD�KHPRSWLVLV�$QWLWXVtJHQRV��FRGHtQD�����FRPSULPLGRV�FDGD������KRUDV�YR�$SRUWH�GH�2� VXSOHPHQWDULR�VL�HV�SUHFLVR�F��7UDWDPLHQWR�HWLROyJLFR�VL�HV�SRVLEOH�G��&RQWURO�GHO�VDQJUDGR

Page 71: Manual practico urgencias medicina interna muy bueno

��

0HGLGDV�JHQHUDOHV�%URQFRVFRSLD �KHPRVWDVLD�HQGRVFySLFD��$UWHULRJUDItD� EURQTXLDO �SRVLEOH� HPEROL]DFLyQ� GH� ODV� DUWHULDV� VDQJUDQWHV� R� DQyPDODV��LQGLFDGD�FXDQGR�QR�H[LVWH�XQD�ORFDOL]DFLyQ�\�QR�VH�FRQVLJXH�HO�FHVH�GHO�VDQJUDGR�FRQ�ODV�PHGLGDV� SUHYLDV�� KHPRSWLVLV� UHFLGLYDQWHV�� VDQJUDGR� FRQ� GHWHULRUR� KHPRGLQiPLFR� R�KHPRSWLVLV�GH�PiV�GH�����FF���GtD��&LUXJtD� 5HVHUYDGD�FRPR�~OWLPR�UHFXUVR�HQ�ORV�FDVRV�GH�KHPRSWLVLV�DPHQD]DQWH�R�PDVLYD�HQ� ORV� TXH� IDOODURQ� WRGDV� ODV� PHGLGDV� DQWHULRUHV� \� TXH� HO� HQIHUPR� FXPSOD� FULWHULRV� GH�RSHUDELOLGDG�UHVHFDELOLGDG�� H[LVWD� XQD� ORFDOL]DFLyQ� \� XQD� HWLRORJtD� VXVFHSWLEOH� GH� HVWH�WUDWDPLHQWR�FRQ�XQD�VXSHUYLYHQFLD�HVWLPDGD�PD\RU�GH���PHVHV�

Page 72: Manual practico urgencias medicina interna muy bueno

��

7DEOD�,,��$OJRULWPR�GH�PDQHMR�GH�KHPRSWLVLV�HQ�XUJHQFLDV+HPRSWLVLV�&RQILUPDFLyQ&XDQWLILFDFLyQ

$PHQDQ]DQWH+��&OtQLFD+HPRJUDPD&RDJXODFLyQ%LRTXtPLFD*$%%$$5�HVSXWR5[�WyUD[

+��&OtQLFD+HPRJUDPD&RDJXODFLyQ%LRTXtPLFD*$%%$$5�HVSXWR5[�WyUD[

,1*5(62(678',275$7$0,(172�7DEOD�,,,�

5[�QRUPDO(VWDELOLGDG(QIHUPHGDG (QIHUPHGDG�+HPRGLQiPLFD DJXGD�QRFUyQLFD6 KD�GH�HWLRO tD DEOH

$/7$&��([WHUQD7WR�(WLROyJLFR&RGHtQD���FS������KRUDV,1*5(62�7DEOD�,,,� $/7$&��([WHUQD7WR�HWLROyJLFR��&RGHtQD

Page 73: Manual practico urgencias medicina interna muy bueno

��

7DEOD�,,,��$OJRULWPR�GH�PDQHMR�GH�KHPRSWLVLV�DO�LQJUHVR+HPRSWLVLV,QJUHVR(VWXGLR�GH�ORFDOL]DFLyQ (VWXGLR\�FRQWURO�GHO�VDQJUDGR0DVLYD�R�DPHQD]DQWH 1R�PDVLYD

0HGLGDV�JHQHUDOHV�)%����������KRUDV 0HGLGDV�JHQHUDOHV�)LEUREURQFRVFRSLD/RFDOL]D�VDQJUDGR 1R�ORFDOL]D�VDQJUDGR��!����FF�K��GHWHULRUR�KHPRGLQiPLFR�R�UHFLGLYDQWH

0HGLGDV�ORFDOHV $UWHULRJUDItD�\�HPEROL]DFLyQ&HVD�6DQJUDGR (IHFWLYD

&LUXJtD7WR�(VSHFtILFR 2WURV��3$$)��&LUXJtD��VHJXLPLHQWR�FRQVXOWDV�H[WHUQDV

1R�&HVD�6DQJUDGR 1R�HIHFWLYD

'LDJQyVWLFR�HWLROyJLFR 1R�GLDJQyVWLFR

)LEUREURQFRVFRSLD7$&/DERUDWRULR��0DUFDGRUHV�WXPRUDOHV�LQPXQROyJLFRV��VHURORJtD��*DPPDJUDItD�9�4(VWXGLR�((,,3UXHEDV�IXQFLyQ�UHVSLUDWRULD33'%$$5

Page 74: Manual practico urgencias medicina interna muy bueno

��

(QIHUPHGDG�WURPERHPEyOLFD�0DLFDV�0��0DVHJRVD�$��$ODPLOOR�$��+DUR�0��9HJD�(��-XOLi�(��/L]iQ�0��� ,PSRUWDQFLD�GHO�SUREOHPD,QFLGHQFLD�HQWH�HO�����\�����SRU�������FRQ��������FDVRV�DQXDOHV�HQ�(VSDxD�6XSRQH�XQ�������GH�ORV�LQJUHVRV�KRVSLWDODULRV��FRQ�XQ�FRVWH�TXH�VXSRQH�HQWUH�HO������GHO�WRWDO�GHO�JDVWR�VDQLWDULR��LQFOX\HQGR�VtQGURPH�SRVWIOHEtWLFR�����'LDJQyVWLFR�7URPERVLV� YHQRVD� SURIXQGD� �)LJXUD� ���� DQWH� OD� VRVSHFKD� GH� 793� VH� UHFXUULUi�SUHIHUHQWHPHQWH� DO� HVWXGLR� HFRGRSSOHU� FRORU�� \� HQ� FDVR�GH� QHJDWLYLGDG�GHO�PLVPR�R� TXH� VHD�GXGRVR�VH�UHDOL]DUi�IOHERJUDItD��/D�IOHERJUDItD�HVWDUi�LQGLFDGD�GLUHFWDPHQWH�HQ�OD�VRVSHFKD�GH�UHWURPERVLV�\�DQWHV�GH�LQLFLDU�WUDWDPLHQWR�WURPEROtWLFR�

)LJXUD����DOJRULWPR�GH�PDQHMR GH�OD�793

6RVSHFKD�FOtQLFD�GH793(VWXGLR�LQFUXHQWR�SUHIHUHQWHPHQWH�FRQ(FR�GRSSOHU�FRORU3RVLWLYR

1HJDWLYD7UDWDPLHQWR

3RVLWLYD)OHERJUDItD

1HJDWLYR'XGRVR

,QYHVWLJDU�RWUDVFDXVDV(PEROLVPR�SXOPRQDU��)LJXUD�����DQWH�OD�VRVSHFKD�GH�HPEROLVPR�SXOPRQDU�UHFXUULUHPRV�D�OD�JDPPDJUDItD�GH�YHQWLODFLyQ�\�SHUIXVLyQ�FRPR�WpFQLFD�GH�HOHFFLyQ�GLDJQyVWLFD��(Q�DTXHOORV�FDVRV�GH� EDMD� R� PHGLD� SUREDELOLGDG� VH� GHVFDUWDUi� WURPERVLV� YHQRVD� SURIXQGD� GH� H[WUHPLGDGHV�LQIHULRUHV�� ELHQ� VHD� FRQ� WpFQLFDV� LQYDVLYDV� �IOHERJUDItD�� R� QR� LQYDVLYDV� �HFRGRSSOHU� FRORU���(Q�FDVRV�GH�QRUPDOLGDG�\�FRQ�DOWD�VRVSHFKD�FOtQLFD�VH�UHDOL]DUi�HVWXGLR�QR�LQYDVLYR�SDUD�GHVFDUWDU�

Page 75: Manual practico urgencias medicina interna muy bueno

��

793�

)LJXUD����DOJRULWPR�GH�PDQHMR�GHO�7(3�

6RVSHFKD�FOtQLFD�GH�7(3��� ([SORUDFLRQHV� EiVLFDV�5[��(&*��*DVRPHWUtD�*DPPDJUDItD�GHYHQWLODFLyQ�SHUIXVLy

1RUPDO

3RVLWLYD

1HJDWLYR

7UDWDPLHQWR

$OWD�VRVSHFKDFOtQLFD'HVFDUWDU�793�((,,�HVWXGLR�QR�LQYDVLYRFRQ�HFR�GRSSOHU�FRORU� 'HVFDUWDU�793�((,,�HVWXGLRLQYDVLYR�R�QR�HFR�GRSSOHU�FRORU�R�IOHERJUDItD�

$OWDSUREDELOLGDG%DMD�PHGLDSUREDELOLGDG

3RVLWLYD 1HJDWLYD 1HJDWLYD1R�7(3 7UDWDPLHQWR $UWHULRJUDItD

$OWD�VRVSHFKDFOtQLFD

7UDWDPLHQWR

���'LDJQyVWLFR�HWLROyJLFR�&DXVDV�KHPDWROyJLFDV��6H� UHDOL]DUi� HO� HVWXGLR� HQ� DTXHOORV� FDVRV� FRQ� KLVWRULD� IDPLOLDU� GH� HSLVRGLRV� WURPEyWLFRV��WURPERVLV�GH�UHSHWLFLyQ�LGLRSiWLFD��WURPERVLV�GH�ORFDOL]DFLyQ�DWtSLFD�\�PHQRUHV�GH����DxRV�6H�UHDOL]DUi�HO�HVWXGLR�GH�773D��WLHPSR�GH�SURWURPELQD��ILEULQyJHQR��DQWLWURPELQD�,,,��3URWHtQD�&�� 3URWHtQD� 6�� SODVPLQyJHQR�� $OID��� DQWLSODVPLQD�� DQWLFXHUSRV� DQWLIRVIROtSLGRV�� DQWLFXHUSRV�DQWLFDUGLROLSLQDV��UHVLVWHQFLD�D�OD�SURWHtQD�&�DFWLYDGD�\�GRVLILFDFLyQ�GH�IDFWRUHV�&DXVDV�VLVWpPLFDV�QR�KHPDWROyJLFDV�

Page 76: Manual practico urgencias medicina interna muy bueno

��

6H� UHDOL]DUi� HVWXGLR� HQ� WRGRV� ORV� SDFLHQWHV� VLQ� FDXVD� FODUD� UHVSRQVDEOH� GH� VX� WURPERVLV��LQPRYLOL]DFLyQ�� FLUXJtD�� YHQGDMHV�� DOWHUDFLRQHV� GH� OD� FRDJXODFLyQ��� WURPERVLV� UHFXUUHQWH� VLQ�FDXVD�ORFDO�TXH�OD�SURYRTXH�(O�HVWXGLR� LQFOXLUi�XQD�DQDPQHVLV�GHWDOODGD��H[SORUDFLyQ�ItVLFD��KHPRJUDPD�FRQ�96*��SHUILO�����PDUFDGRUHV� WXPRUDOHV� �&$� ������&($��$OID�IHWRSURWHtQD��36$�HQ�YDURQHV�\�&$�����\�&$������ HQ� PXMHUHV��� VLVWHPiWLFR� GH� RULQD�� 5[� GH� WyUD[�� HFRJUDItD� DEGRPLQDO� \� SpOYLFD� \� WRGDV�DTXHOODV�H[SORUDFLRQHV�TXH�SRU�OD�KLVWRULD�FOtQLFD�VHD�QHFHVDULR�6H� SURSRQH� XQ� VHJXLPLHQWR� GH� GRV� DxRV�� FRQ� XQ� HVWXGLR� LQLFLDO� \� XQD� UHYLVLyQ� FDGD� VHLV�PHVHV����3URILOD[LV�GH�OD�WURPERVLV�YHQRVD�SURIXQGD�6H�UHDOL]DUi�FRQ�KHSDULQD�GH�EDMR�SHVR�PROHFXODU��D�GRVLV�EDMDV��/D�GRVLV�D�DGPLQLVWUDU�VHUi�GH������8����KRUDV�GH�'DOWHSDULQD�VyGLFD��)UDJPLQ��R�%R[RO���R���PJ����KRUDV� GH�(QR[DSDULQD� �&OH[DQH���SDUD�SDFLHQWHV�GH� ULHVJR�PRGHUDGR�\�GH���������K�SDUD�ORV�GH�DOWR�ULHVJR����&ODVLILFDFLyQ�GH�ORV�SDFLHQWHV�VHJ~Q�HO�ULHVJR�GH�SDGHFHU�XQD�793�%DMR�ULHVJR��3DFLHQWHV�TXH�QR�SUHFLVDQ�UHSRVR�DEVROXWR5LHVJR�PRGHUDGR���2EHVLGDG��9DULFHV��&LUXJtD�DEGRPLQDO�R�SpOYLFD��(32&��,QVXILFLHQFLD�FDUGtDFD��'LDEHWHV�0HOOLWXV��+LSHUWHQVLyQ�DUWHULDO��,QWHUYHQFLyQ�GH�URGLOOD��WLELD�\�SLH��$QRYXODWRULRV��1HRSODVLDV��6HSVLV�R�LQWHUYHQFLyQ�VpSWLFD��+HPDWRFULWR�!�������3ODTXHWDV�!���������)LEULQyJHQR�!�����PJ��$OWR�ULHVJR��$QWHFHGHQWHV�WURPERHPEyOLFRV��,QWHUYHQFLRQHV�HQ�FDUGLRSDWtD�HPEROtJHQD��$UWURSODVWLD��(QIHUPRV�HQFDPDGRV�LQPyYLOHV��,QWHUYHQFLyQ�GH�FROXPQD��FDGHUD�\�IpPXU

Page 77: Manual practico urgencias medicina interna muy bueno

��

��7RGR�SDFLHQWH�FRQ�GRV�PiV�IDFWRUHV�GHO�VHJXQGR�JUXSR����7UDWDPLHQWR�GH�OD�WURPERVLV�YHQRVD�SURIXQGD5HSRVR�HQ�FDPD�KDVWD�OD�GHVDSDULFLyQ�GHO�HGHPD0HGLDV� GH� FRQWHQFLyQ� HOiVWLFD�� DO� FRPHQ]DU� OD� GHDPEXODFLyQ�\� VL� QR� FHGH�HO�HGHPD�HQ���GtDV�7UDWDPLHQWR�FRQ�KHSDULQD�GH�EDMR�SHVR�PROHFXODU���6H�LQVWDXUDUi�VLQ�FRQILUPDFLyQ�GLDJQyVWLFD�GH�ODV�H[SORUDFLRQHV�FRPSOHPHQWDULDV���+HSDULQD�GH�EDMR�SHVR�PROHFXODU�D�GRVLV�GH�����8�,���.J����KRUDV��6LQWURP�DO�WHUFHU�GtD�GHO�GLDJQyVWLFR�FOtQLFR�VLHPSUH�TXH�QR�KD\D�FOtQLFD�GH�HPEROLVPR�R�DO�TXLQWR�VL�H[LVWH�GLFKD�FOtQLFD��D�OD�GRVLV�TXH�FRQVLJD�XQ�WLHPSR�GH�SURWURPELQD�HVWDEOH�HQ�UDQJR�WHUDSpXWLFR�HQ�GRV�GHWHUPLQDFLRQHV���6H�PDQWHQGUi�WUDWDPLHQWR�FRQ�6LQWURP�GXUDQWH���PHVHV�VL�QR�KD\�IDFWRUHV�GH�ULHVJR�\�QR�HVWiQ�FRPSOLFDGDV��R�GXUDQWH���PHVHV�FRQ�IDFWRUHV�GH�ULHVJR�R�FRQ�7(3���(Q�SDFLHQWHV�FRQ�QHRSODVLDV� WHUPLQDOHV��GH�DOWR� ULHVJR�GH�VDQJUDGR��VHQLOHV� R�GH GLItFLO�FRQWURO�GH�DQWLFRDJXODFLyQ�RUDO�VH�UHFRPLHQGD�LQLFLDU�XQ�WUDWDPLHQWR�FRQ�KHSDULQD�QR�IUDFFLRQDGD�D�ODUJR�SOD]R�7UDWDPLHQWR�WURPEROtWLFR���(Q�WURPERVLV�SUR[LPDOHV��LOHRIHPRUDO�R�YHQD�FDYD���HQ�SDFLHQWHV�MyYHQHV�\�SURGXFLGDV�HQ�ODV����KRUD�SUHYLDV��� (Q� WURPERVLV� GH� H[WUHPLGDGHV� VXSHULRUHV� �GH� HVIXHU]R� R�PHFiQLFDV�� GH�PHQRV� GH� ��KRUDV����7UDWDPLHQWR�GHO�WURPERHPEROLVPR�SXOPRQDU+HSDULQD��1R�IUDFFLRQDGDV��D� ODV�GRVLV�KDELWXDOHV��FRQ�FRQWUROHV�GH�773$��DxDGLpQGRVH�6LQWURP�DO�WUDWDPLHQWR�DO�TXLQWR�GtD��\�PDQWHQLpQGROR�GXUDQWH�XQ�PtQLPR�GH���PHVHV�7UDWDPLHQWR�ILEULQROtWLFR���([LJH�GLDJQyVWLFR�GH�(7(9�GH�FHUWH]D�UHFLHQWH���7(9�PDVLYR��PD\RU�GHO�������R�TXH�DIHFWH�D�GRV�R�PiV�OyEXORV�X�REVWUXFFLyQ�GH�XQD�UDPD�SULQFLSDO�GH�OD�DUWHULD�SXOPRQDU�R�tQGLFH�GH�0LOOHU���������7(9�KHPRGLQiPLFDPHQWH� LQHVWDEOH��FRQ�VKRFN�\�R�SUHVLyQ�DUWHULDO�SXOPRQDU��3$3V���PJ�+J��SUHVLyQ�DXUtFXOD�GHUHFKD�PHGLD��3$'P���PP�+J��R�tQGLFH�FDUGtDFR�������/�PLQ���7(3�QR�PDVLYR�FRQ�SDWRORJtD�FDUGtDFD�R�SXOPRQDU�SUHYLD���6H�UHDOL]DUi�ELHQ�FRQ�(VWUHSWRTXLQDVD��8URNLQDVD�R�UW�3$��SUHILULpQGRVH�pVWD�~OWLPD�SRU�VX�PD\RU�UDSLGH]�GH�DFFLyQ���5HVSHWDU�FRQWUDLQLGDFLRQHV��YHU�GHVSXpV���\�HQ�FXDOTXLHU�FDVR�YDORUDU�ULHVJR��EHQHILFLR����&RQWUDLQGLFDFLRQHV�GHO�WUDWDPLHQWR�WURPEROtWLFR$EVROXWDV���6DQJUDGR�DFWLYR�LQWHUQR��$FFLGHQWH�FHUHEURYDVFXODU�UHFLHQWH��PHQRU�GH���PHVHV�

Page 78: Manual practico urgencias medicina interna muy bueno

��

��3DWRORJtD�LQWUDFUDQHDO�5HODWLYDV�PD\RUHV��&LUXJtD�PD\RU��SDUWR�R�ELRSVLD�GH�yUJDQR�UHFLHQWH��PHQRV�GH����GtDV����7URPERV�HQ�FDYLGDGHV�L]TXLHUGDV��8OFHUD�SpSWLFD�R�SDWRORJtD�JDVWURLQWHVWLQDO��7UDXPDWLVPR�PD\RU�UHFLHQWH��+LSHUWHQVLyQ�DUWHULDO�QR�FRQWURODGD5HODWLYDV�PHQRUHV��&LUXJtD�R�WUDXPDWLVPR�PHQRUHV��5HVXFLWDFLyQ�FDUGLRSXOPRQDU�UHFLHQWH��(QIHUPHGDG�YDOYXODU�PLWUDO�FRQ�ILEULODFLyQ�DXULFXODU��(QGRFDUGLWLV�EDFWHULDQD��$OWHUDFLRQHV�GH�OD�KHPRVWDVLD��HQIHUPHGDG�KHSiWLFD�R�UHQDO����5HWLQRSDWtD�GLDEpWLFD�KHPRUUiJLFD��(PEDUD]R�%LEOLRJUDItD���&RQVHQVXV�7UDWDPLHQWR�(7(9��&RQFOXVLRQHV��6DQWLDJR�GH�&RPSRVWHOD�����GH�DEULO�GH��������� &RUQX]� -�� HW� DO�� ,PSRUWDQFH� WR� ILQGLQJV� RQ� WKH� LQLWLDO� HYDOXDWLRQ� IRU� FDQFHU� LQ� SDWLHQWV� ZLWK�V\PSRWRPDWLF�LGLRSDWKLF�GHHS�YHQRXV�WKURPERVLV��$QQ�,QWHUQ�0HG�����������������������*UXSR�GH�WUDEDMR��7(3�GH�OD�6(3$5��&RRUGLQDGRU�-�%ODQTXHU�2OLYDV��(VWUDWHJLD�WHUDSpXWLFD�HQ�OD�HQIHUPHGDG�WURPERHPEyOLFD�YHQRVD��(7(9���$UFK�%URQFRQHXPRO��������������������� *UXSR� GH� WUDEDMR� GH� 7(3� GH� OD� 6(3$5�� (VWUDWHJLD� GLDJQyVWLFD� HQ� OD� HQIHUPHGDG�WURPERHPEyOLFD�YHQRVD��$UFK�%URQFRQHXPRO����������������������/HQVLQJ�$��0DUWLQ�+3��'DYLRGVRQ�%/��+LUVK�-��7UHDWPHQW�RI�GHHS�YHQRXV�WKURPERVLV�ZLWK�ORZ�PROHFXODU�ZHLJXW�KHSDULQV��$UFK�,QWHUQ�0HG����������������������� � 0RQUHDO� 0�� HW� DO�� 2FFXOW� FDQFHU� LQ� SDWLHQWV� ZLWK� GHHS� YHQRXV� WKURPERVLV�� $� V\VWHPDWLF�DSSURDFK��&DQFHU������������������ 1DVFKLW]� -�� HW� DO�� 'LRDJQRVLV� RI� &DQFHU� $VVRFLDWHG� YDVFXODU� GLVRUGHUV�� &DQFHU� ������ �����������������3UDQGRQL�3��HW�DO��'HHS�YHLQ�WKURPERVLV�DQG�WKH�LQFLGHQFH�RI�VXEVHTXHQW�V\PWRPDWLF�FDQFHU��1�(QJO�-�0HG����������������������

Page 79: Manual practico urgencias medicina interna muy bueno

��

1HXPRQtD�DGTXLULGD�HQ�OD�FRPXQLGDG��GLDJQyVWLFR�\�WUDWDPLHQWR�)UDQFLVFR�0HGUDQR����,PSRUWDQFLD�\�MXVWLILFDFLyQ�6X� IUHFXHQFLD�HV�GH����FDVRV�SRU���������KDELWDQWHV�DO�DxR��VXSRQH�HQWUH�HO������GH� ORV�LQJUHVRV�HQ�HO�KRVSLWDO�\�HO�������GH�ORV�LQJUHVRV�HQ�ORV�VHUYLFLRV�GH�0HGLFLQD�,QWHUQD��\�HV�XQR�GH�ORV�GLDJQyVWLFRV�SULQFLSDOHV�HPLWLGRV�HQ�QXHVWUR�6HUYLFLR�����GLDJQyVWLFR�PiV�IUHFXHQWH��������GHVSXpV�GH�(32&���'XUDQWH�HO�DxR������VH�DWHQGLHURQ�DSUR[LPDGDPHQWH�����SDFLHQWHV�FRQ�1$&� HQ� 8UJHQFLDV� GH� QXHVWUR� +RVSLWDO�� GH� ORV� TXH� LQJUHVDURQ� ����� /D� PRUWDOLGDG� HV�FRQVLGHUDEOH��GXUDQWH�������HQ�ORV�SDFLHQWHV�TXH�LQJUHVDURQ�IXH�GH����������'LDJQyVWLFR VLQGUyPLFR \ GLIHUHQFLDO�6H�SUHFLVD�XQ�FXDGUR�VXJHVWLYR�GH�LQIHFFLyQ�GHO�WUDFWR�UHVSLUDWRULR�LQIHULRU�\�XQ�QXHYR�LQILOWUDGR�SXOPRQDU�HQ�OD�5;�GH�WyUD[��FRQVLGHUDQGR�VLHPSUH�RWURV�SURFHVRV��VREUH�WRGR�FXDQGR�DSDUHFHQ�PDQLIHVWDFLRQHV�H[WUDSXOPRQDUHV�LPSRUWDQWHV��SDWURQHV�UDGLROyJLFRV�DWtSLFRV�\�PDOD�UHVSXHVWD�D�ORV�DQWLELyWLFRV��DWHOHFWDVLD��LQIDUWR�SXOPRQDU��EURQTXLROLWLV�REOLWHUDQWH�FRQ�QHXPRQtD�RUJDQL]DGD��QHXPRQtDV� HRVLQyILODV�� QHXPRQLWLV�SRU� KLSHUVHQVLELOLGDG�� QHXPRQLWLV�SRU� IiUPDFRV�� QHXPRQLWLV�SRVUDGLDFLyQ��SURWHLQRVLV�DOYHRODU�\�RWURV�����'LDJQyVWLFR HWLROyJLFR�(Q�XQD�VHULH�GH�����SDFLHQWHV�GH�QXHVWUR�+RVSLWDO��VH�REWXYR�HO�GLDJQyVWLFR�HWLROyJLFR�HQ�HO�����GH� ORV� FDVRV�� VLHQGR� ORV� JpUPHQHV�PiV� IUHFXHQWHV� HO�QHXPRFRFR��������&KODP\GLD�VS������� \� 0�� WXEHUFXORVLV� ������ VHJXLGRV� GH� /HJLRQHOOD� VS�� ������ &R[LHOOD� EXUQHWWL� ������ +��LQIOXHQ]DH� ������ 0\FRSODVPD� SQHXPRQLDH� ������ 6�� DXUHXV� ����� \� RWURV�� /D� DVSLUDFLyQ� IXH�GLDJQRVWLFDGD�HQ�HO����/DV�FODYHV�GHO�GLDJQyVWLFR�HWLROyJLFR�VRQ�ORV�GDWRV�FOtQLFRV �7DEOD�����GDWRV UDGLROyJLFRV��7DEOD����\�GDWRV PLFURELROyJLFRV �7DEOD����

'HWHUPLQDFLRQHV�HQ�WRGRV�ORV�SDFLHQWHV�TXH�LQJUHVHQ�+HPRJUDPD��ELRTXtPLFD�FRPSOHWD�\�DQiOLVLV�GH�RULQD��JDVRPHWUtD�DUWHULDO��D�FULWHULR�GHO�FOtQLFR�KHPRFXOWLYRV����VHURORJtD�SDUD�0��SQHXPRQLDH��&KODP\GLD�VS��&R[LHOOD�EXUQHWWL�\�/HJLRQHOOD�VS�����PXHVWUD�HQ�OD�IDVH�DJXGD�\����D�ORV����GtDV�GH�OD�SULPHUD \�RWUDV�VL�VH�FRQVLGHUDVH�QHFHVDULR��H[DPHQ�EDFWHULROyJLFR�GH�HVSXWR�FXDQGR�VHD�SRVLEOH��*UDP��%$$5�\�FXOWLYR��FRQ�,)'�\�FXOWLYR�HQ�%&<(�VL�VH�VRVSHFKD�/HJLRQHOOD�RWUDV�SUXHEDV�FXDQGR�HVWpQ�LQGLFDGDV��FRPR�H[DPHQ�GH� OtTXLGR�SOHXUDO��\�RWUDV�FXDQGR�HVWpQ�GLVSRQLEOHV� �'HWHUPLQDFLyQ� GH� $J� QHXPRFyFLFR� HQ� VDQJUH�� RULQD� \� OtTXLGR� SOHXUDO�� DVt�FRPR�$J�GH�/HJLRQHOOD�HQ�RULQD��

Page 80: Manual practico urgencias medicina interna muy bueno

��

0pWRGRV�LQYDVLYRV�&DWpWHU� WHOHVFySLFR� R� %$/�� FRQVLGHUDQGR� HQ� QR� LQWXEDGRV� OD� SXQFLyQ� WUDQVWRUiFLFD�� $�FRQVLGHUDU�HQ�SDFLHQWHV�FRQ�QHXPRQtD�JUDYH�\�ULHVJR�GH�SDGHFHU�XQ�FXDGUR�GH�HWLRORJtD�QR�KDELWXDO��DQFLDQRV��HQIHUPHGDGHV�FUyQLFDV���TXH�QR�KD�UHVSRQGLGR�D�XQ�WUDWDPLHQWR�HPStULFR�FRUUHFWR�� FRQ� DOWHUDFLRQHV� UDGLROyJLFDV� VXJHVWLYDV� GH� SURFHVR� QR� KDELWXDO� �FDYLWDFLyQ�� R�QHXPRQtD�HQ�SDFLHQWH�FRQ�LQPXQRGHILFLHQFLD�VHYHUD�\�HQ�HO�TXH�ODV�WpFQLFDV�QR�LQYDVLYDV�QR�SHUPLWHQ�XQ�GLDJQyVWLFR�HWLROyJLFR����7UDWDPLHQWR�HPStULFR�������1HXPRQtD�VLQ�FULWHULRV�LQJUHVR��1HXPRQtD�QR�JUDYH��7UDWDPLHQWR�DPEXODWRULR�'HWHUPLQDFLRQHV��2SFLRQDO�HVSXWR��KHPRFXOWLYRV�\�VHURORJtD�7UDWDPLHQWR�HPStULFR��0DFUyOLGR�R�DPR[LFLOLQD�R�FHIXUR[LPD���GtDV�7UDWDPLHQWR�DOWHUQDWLYR��/HYRIOR[DFLQR�YR���GtDV�&RQWUROHV��FOtQLFR�D� ORV� ��\����GtDV��5;�D� ORV����GtDV�\� SRVWHULRUPHQWH�PHQVXDO�KDVWD� OD�UHVROXFLyQ������ 1HXPRQtD� FRQ FULWHULRV� GH� LQJUHVR� SHUR� QR� GH� JUDYHGDG�� 1HXPRQtD� QR� JUDYH��,QJUHVR�HQ�SODQWD'HWHUPLQDFLRQHV�� +HPRJUDPD�� ELRTXtPLFD� \� RULQD�� *DVRPHWUtD� DUWHULDO� RSFLRQDO�� (VSXWR��KHPRFXOWLYRV�\�VHURORJtD��2WUDV�SUXHEDV�PLFURELROyJLFDV�VL�HVWiQ�LQGLFDGDV�7UDWDPLHQWR�HPStULFR��&HID����R�DPR[LFODYXOiQLFR�r 0DFUyOLGR�7UDWDPLHQWR�DOWHUQDWLYR��/HYRIOR[DFLQR�LY�R�YR�������GtDV������1HXPRQtD�JUDYH��,QJUHVR�HQ�SODQWD�\�YDORUDFLyQ�GH�8&,'HWHUPLQDFLRQHV��KHPRJUDPD��ELRTXtPLFD��RULQD��JDVRPHWUtD�DUWHULDO��HVSXWR��KHPRFXOWLYRV��VHURORJtD��RWUDV�SUXHEDV�PLFURELROyJLFDV�VL�HVWiQ�LQGLFDGDV�\�YDORUDFLyQ�GH�LQJUHVR�HQ�8&,�7UDWDPLHQWR� HPStULFR�� &HID� ��� R� ���� DPR[LFLOLQD� FODYXOiQLFR�� FHIWD]LGLPD� R� LPLSHQHP� ��PDFUyOLGR���$0*���FOLQGDPLFLQD���FRWULPR[D]RO���FOR[DFLOLQD��7UDWDPLHQWR�DOWHUQDWLYR��/HYRIOR[DFLQR�LY����GtDV�6L�FULWHULRV�8&,��EHWDODFWiPLFR���0DFUyOLGR�R�/HYRIOR[DFLQR���7UDWDPLHQWR�HVSHFtILFR�5HFRPHQGDFLRQHV�PRGLILFDGDV�GH�-*�%DUWOHWW��7DEOD�������&RPSOLFDFLRQHV�\�PRUWDOLGDG�(Q�QXHVWUD�VHULH��DSDUHFLHURQ�FRPSOLFDFLRQHV�HQ�HO������SXOPRQDUHV�����\�H[WUDSXOPRQDUHV������ \� IDOORV� GHO� WUDWDPLHQWR� HQ� HO� ����� OD� PD\RUtD� WHPSUDQRV�� /D� PRUWDOLGDG� YDUtD�GHSHQGLHQGR�GH� OD� SREODFLyQ� HVWXGLDGD� �� \� DVt�HQ� SDFLHQWHV� KRVSLWDOL]DGRV�PH]FODGRV�FRQ�DPEXODWRULRV� HV� GHO� ���� HQ�KRVSLWDOL]DGRV�VROR�GHO�����\�HQ� ORV� TXH� LQJUHVDQ�HQ�8&,�GHO������(Q�HO�HVWXGLR�GH�0-�)LQH�1(-0����� �� OD�PRUWDOLGDG�YDUtD�GHSHQGLHQGR�GHO�JUXSR�GH�JUDYHGDG�GHVGH����������HQ�HO�,�DO��������HQ�HO�9��(Q�QXHVWUR�HVWXGLR�IXH�GHO�������)DFWRUHV�SURQyVWLFRV��(Q� HO� HVWXGLR� GH�0-� )LQH�-$0$� ���� HQFRQWUDURQ� UHODFLyQ� FRQ� OD� HWLRORJtD�� OD� HGDG� \� ���IDFWRUHV� �VH[R� YDUyQ�� GRORU� WRUiFLFR� SOHXUtWLFR�� PiV� GH� ��� UHV�PLQ�� KLSRWHQVLyQ� VLVWyOLFD��

Page 81: Manual practico urgencias medicina interna muy bueno

��

WHPSHUDWXUD� �� ���&�� '0�� QHRSODVLD�� HQIHUPHGDG� QHXUROyJLFD�� OHXFRSHQLD�� EDFWHULHPLD� \�DIHFFLyQ�5;�GH�PiV�GH�XQ OyEXOR���(Q�RWUR�DUWtFXOR�GHO�PLVPR�DXWRU��OD�SUHVHQFLD�GH�HGDG�!����DxRV��HQIHUPHGDG�GH�EDVH�JUDYH��GHWHUPLQDGDV�DOWHUDFLRQHV�HQ�OD�H[SORUDFLyQ�ItVLFD�\�HQ�ORV�GDWRV� GH� ODERUDWRULR� \� OD� SUHVHQFLD� GH� GHUUDPH� SOHXUDO�� VH� FRPSRUWDUtDQ� FRPR� IDFWRUHV�SURQyVWLFRV��(Q� QXHVWUD� VHULH� IXHURQ� IDFWRUHV� LQGHSHQGLHQWHV� GH�PRUWDOLGDG� OD�PDOQXWULFLyQ�SURWHLFR�FDOyULFD��OD�HWLRORJtD�SRU�DVSLUDFLyQ��OD�SUHVHQFLD�GH�FRPSOLFDFLRQHV�H[WUDSXOPRQDUHV�\�XQ�DXPHQWR�GHO�QLYHO�SODVPiWLFR�GH�XUHD�DO�LQJUHVR�����&ULWHULRV�GH�LQJUHVR�KRVSLWDODULR �6(3$5��� 6HQLOLGDG�� (QIHUPHGDG� FUyQLFD� R� JUDYH� �(32&�� LQVXILFLHQFLD� FDUGtDFD�� FLUURVLV� KHSiWLFD�� ,5&�� '0��DOFRKROLVPR��R�LQPXQRGHSUHVLyQ�� )DFWRUHV�GH�JUDYHGDG�� )DOWD�GH�UHVSXHVWD�D�XQ�WUDWDPLHQWR�FRUUHFWR��������K��� $OWHUDFLRQHV�5;��GHUUDPH�SOHXUDO��FDYLWDFLyQ�R�DIHFFLyQ�GH�PiV�GH�XQ�OyEXOR��� 6RVSHFKD�GH�DVSLUDFLyQ�� 3UREOHPD�VRFLDO�R�SVLTXLiWULFR���&ULWHULRV�GH�JUDYHGDG��6(3$5 ���3DFKyQ��� ,QHVWDELOLGDG�KHPRGLQiPLFD��7$6������7$'������SXOVR�!������ ,QVXILFLHQFLD�UHVSLUDWRULD��S2�����PP+J��S2��)L2������HQ�(32&��5HV�!���PLQ��� ,QVXILFLHQFLD�UHQDO�DJXGD�� $OWHUDFLyQ�FRQFLHQFLD�� %DFWHULHPLD�\�R�FRPSOLFDFLRQHV�VpSWLFDV�� 2WURV�GDWRV��7��!���R������&��S+�������� $IHFFLyQ�5;�GH�PiV�GH�XQ�OyEXOR��GHUUDPH�R�FDYLWDFLyQ�� $QHPLD��OHXFRSHQLD��XUHD�!����1D�������JOXFRVD�!����R�DOE~PLQD�����������&ULWHULRV�GH�LQJUHVR�HQ�8&, �6(3$5 ���� $OWHUDFLyQ�LPSRUWDQWH�GH�OD�FRQFLHQFLD�� ,QVXILFLHQFLD�UHVSLUDWRULD�JUDYH��!���UHV�PLQ��XWLOL]DFLyQ�GH�OD�PXVFXODWXUD�DFFHVRULD��IDWLJD�PXVFXODU�GLDIUDJPiWLFD��S2��)L2�������R������HQ�(32&��� ,QHVWDELOLGDG�KHPRGLQiPLFD�JUDYH��UHTXHULPLHQWR�GH�IiUPDFRV�YDVRDFWLYRV�!��K�R�GLXUHVLV�����PO�K�R�����PO�HQ��K��� &,'��LQVXILFLHQFLD�UHQDO�DJXGD�R�PHQLQJLWLV�����&ULWHULRV�GH�DOWD��0-�)LQH�HW�DO��$UFK�,QWHUQ�0HG�������� (67$%,/,'$'�&/,1,&$� 3XOVR������PLQ�� 5HVSLUDFLyQ�����PLQ�� 7HPSHUDWXUD������&�� &DSDFLGDG�LQJHVWD�RUDO�� (VWDGR�PHQWDO�QRUPDO�R�SUHYLR�� S2��!���R�62�!���

Page 82: Manual practico urgencias medicina interna muy bueno

��

����6HJXLPLHQWR�DPEXODWRULR�6LHPSUH� GHEH� FRPSUREDUVH� OD� FXUDFLyQ� GH� OD� HQIHUPHGDG�� SDUD� OR� FXDO� GHEH� UHYLVDUVH� DO�HQIHUPR�WUDV�HO�DOWD��FRPSUREiQGRVH�OD�UHVROXFLyQ�FOtQLFR�UDGLROyJLFD��'HVGH�PDU]R�GH������IXQFLRQD� XQD� FRQVXOWD� HQ� 0HGLFLQD� ,QWHUQD� �&RQVXOWD� GH� 1HXPRQtDV�SDUD� HVWH� SURSyVLWR��&RQWURO�FOtQLFR�D�ORV�������GtDV��D�ORV����GtDV�\�SRVWHULRUPHQWH PHQVXDOHV�KDVWD�OD�UHVROXFLyQ����� VHURORJtD� D� ORV� ��� GtDV�� &RQWURO� UDGLROyJLFR� D� ORV� ������ GtDV�� ��� GtDV� \� SRVWHULRUPHQWH�PHQVXDOHV�KDVWD�OD�UHVROXFLyQ��(Q� QXHVWUR� 6HUYLFLR� H[LVWH� XQ� JUXSR� TXH� WLHQH� H[SHULHQFLD� HQ� HO� HVWXGLR� GH� OD� QHXPRQtD�H[WUDKRVSLWDODULD��IUXWR�GHO�FXDO�VH�GLVHxy�XQ�VHJXQGR�HVWXGLR�TXH�FRPHQ]y�D�ILQDOHV�GH������FRQ� HO� REMHWLYR� GH� GHWHUPLQDU� SHULyGLFDPHQWH� OD� HWLRORJtD� \� OD� PRUWDOLGDG� GH� OD� QHXPRQtD�H[WUDKRVSLWDODULD�HQ�QXHVWUR�PHGLR��\�D� OD�YH]�VHJXLU�HVWXGLDQGR�ORV� IDFWRUHV�SURQyVWLFRV�GH�PRUWDOLGDG��8Q�WHUFHU�HVWXGLR�HV�HO�SURSXHVWR�SDUD�HO�DxR�������%LEOLRJUDItD���� 0HGUDQR� )�� *iOYH]� *�� 3XUDV� $�� /D�PDOQXWULFLyQ� FRPR� IDFWRU� SURQyVWLFR� GH�PRUWDOLGDG� HQ�SDFLHQWHV�FRQ�QHXPRQtD�H[WUDKRVSLWDODULD�TXH�SUHFLVDQ�LQJUHVR��(Q�9,�&RQJUHVR�GH�OD�6RFLHGDG�0DGULG�FDVWLOOD�/D�0DQFKD�GH�0HGLFLQD�,QWHUQD��$OEDFHWH��������GH�VHWLHPEUH�GH���������0DULH�7-��&RPPXQLW\�$FTXLUHG�3QHXPRQLD��&OLQLFDO�,QIHFWLRXV�'LVHDVHV����������������������5HVHDUFK�&RPPLWWHH�RI�WKH�%ULWLVK�6RFLHW\�DQG�3XEOLF�+HDOWK�/DE�6HUFLH�&RPPXQLW\�DFTXLUHG�SQHXPRQLD�LQ�DGXOWV�LQ�%ULWLVK�KRVSLWDOV�LQ������������$�6XUYH\�RV�DHWLRORJ\��PRUWDOLW\��SURJQRVWLF�IDFWRUV�DQG�RXWFRPH��4�-�0HG���������������������)DQJ�*'��)LQH�0��2UORII�-��$ULVXPL�'��<X�9/��.DSRRU�:��HW�DO��1HZ�DQG�HPHUJLQJ�HWLRORJLHV�IRU�FRPPXQLW\�DFTXLUHG�SQHXPRQLD�ZLWK�LPSOLFDWLRQHV�IRU�WKHUDS\��$�SURVSHFWLYH�PXOWLFHQWHU�VWXG\�RI�����FDVHV��0HGLFLQH��%DOWLPRUH�����������������������%DUWOHWW�-*��0XQG\�/0��&RPPXQLW\�$FTXLUHG�3QHXPRQLD��1�(QJO�-�0HG�������������������)LQH�0-��HW�DO��3URJQRVLV�DQG�RXWFRPHV�RI�SDWLHQWV��ZLWK�FRPPXQLW\�DFTXLUHG�SQHXPRQLD��$�PHWD�DQDO\VLV��-$0$����������������������� 'RUFD� -�� HW� DO��'LDJQyVWLFR�\� WUDWDPLHQWR� GH� OD� QHXPRQtD� DGTXLULGD� HQ� OD� FRPXQLGDG��$UFK�%URQFRQHXPRO����������������������)LQH�0-��$�SUHGLFWLRQ�UXOH�WR�LGHQWLI\�ORZ�ULVN�SDWLHQWV�ZLWK�FRPPXQLW\�$FTXLUHG�SQHXPRQLD��1�(QJO�-�0HG�����������������������3DFKRQ�-��3UDGRV�)��&DSRWH�)��&XHOOR�-$��*DUQDFKR�-��9HUDQR�$��6HYHUH�FRPPXQLW\�DFTXLUHG�SQHXPRQLD��(WLRORJ\��SURJQRVLV��DQG�WUHDWPHQW��$P�5HY�5HVSLU�'LV������������������������ )LQH� 0-�� HW� DO�� 7KH� KRVSLWDO� GLVFKDUJH� GHFLVLRQ� IRU� SDWLHQWV� ZLWK� FRPPXQLW\�DFTXLUHG�SQHXPRQLD��$UFK�,QWHUQ�0HG������������������

Page 83: Manual practico urgencias medicina interna muy bueno

��

7DEOD����'DWRV�FOtQLFRV�~WLOHV�SDUD�HO�GLDJQyVWLFR�HWLROyJLFR�)DFWRUHV�DPELHQWDOHV([SRVLFLyQ�D�IXHQWHV�DFXRVDV�HQ�DHURVRO([SRVLFLyQ�D�JDWRV��JDQDGR�ERYLQR�X�RYLQR�SDUWXULHQWRV�LQIHFWDGRV'HVSXpV�GH�WRUPHQWDV�HQ�iUHD�HQGpPLFDV�(SLGHPLD�GH�1(+�HQ�UHIXJLRV�R�DOEHUJXHV�SDUD�SREUHV�R�FiUFHOHV(SLGHPLD�GH�1(+�HQ�FDPSRV�PLOLWDUHV

/HJLRQHOOD�SQHXPRSKLOD&R[LHOOD�%XUQHWWL&RFFLGLRGHV�LQPLWLV6WUHSWRFRFFXV�SQHXPRQLDH�0\FREDFWHULXP�WXEHUFXORVLV��6��3QHXPRQLDH��&KODP\GLD�SQHXPRQLDH&RQWDFWR�FRQ�DQLPDOHV([SRVLFLyQ�D�PXUFLpODJRV�GH�FDYHUQDV�FRQWDPLQDGRV�R�H[FDYDFLRQHV�HQ�iUHDV�HQGpPLFDV�([SRVLFLyQ�D�SROORV��SDYRV��SDWRV�R�SiMDURV�H[yWLFRV([SRVLFLyQ�D�IOXLGRV�FRUSRUDOHV�GH�DQLPDOHV�LQIHFWDGRV��FRQHMRV��OLHEUHV��]RUURV��DUGLOODV��R�SLFDGXUDV�GH�PRVFDV�R�JDUUDSDWDV��,QJHVWLyQ�GH�FDUQH�GH�DQLPDOHV�LQIHFWDGRV�LQVXILFLHQWHPHQWH�FRFLGD

+LVWRSODVPD�FDSVXODWXP&KODP\GLD�SVLWDFFL)UDQFLVHOOD�WXODUHQVLV

9LDMHV�9LDMHV�DO�6XGHVWH�DVLiWLFR�\�$PpULFD�GHO�6XU,QPLJUDFLyQ�GH�$VLD�X�RWUDV�]RQDV�

3VHXGRPRQDV�SVHXGRPDOOHL��PHOLRLGRVLV�0��7XEHUFXORVLV�+LVWRULD�ODERUDO�3HUVRQDO�VDQLWDULRV�TXH�WUDEDMD�FRQ�SDFLHQWHV�9,+�HQ�JUDQGHV�FLXGDGHV� 0\FREDFWHULXP�WXEHUFXORVLV�(QIHUPHGDG�GH�%DVH�&HWRDFLGRVLV�GLDEpWLFD$OFRKROLVPR

(32&7UDQVSODQWH�GH�yUJDQR�VyOLGR(QIHUPHGDG�GH�FpOXODV�IDOFLIRUPHV�,QIHFFLyQ�9,+�FRQ�&'�������)LEURVLV�TXtVWLFD3URWHLQRVLV�DOYHRODU

6��SQHXPRQLDH��VWDI��$XUHXV6��SQHXPRQLDH��.�SQHXPRQLDH��6��$XUHXV6��SHQXPRQLDH��+��LQIOXHQ]DH��0RUD[HOOD�FDWDUUKDOLV�6��SQHXPRQLDH��+��,QIOXHQ]DH��/HJLRQHOOD�VS��3QHXPRF\VWLV�FDULQLL��&LWRPHJDORYLUXV��6WURQJ\ORLGHV�VWHUFRODULV�6��SQHXPRQLDH3QHXPRF\VWLV�FDULQLL��6��3QHXPRQLDH��+��,QIOXHQ]DH��&U\SWRFRFFXV�QHRIRUPDQV��0\FREDFWHULXP�WXEHUFXORVLV��5KRGRFRFFXV�HTXL3VHXGRPRQD�DHUXJLQRVD��VWDSKLORFRFFXV�DXUHXV�1RFDUGLD�VS��&RQWLQ~D�HQ�OD�SiJLQD�VLJXLHQWH�

Page 84: Manual practico urgencias medicina interna muy bueno

��

([SORUDFLyQ�ItVLFD(QIHUPHGDG�SHULRGRQWDO�FRQ�HVSXWR�IpWLGR0LULQJLWLV�EXOORVD$XVHQFLD�GH�UHIOHMR�QDXVHRVR��DOWHUDFLyQ�GHO�QLYHO�GH�FRQFLHQFLD�R�FRQYXOVLyQ�UHFLHQWH(QFHIDOLWLV$WD[LD�FHUHEHORVD(ULWHPD�PXOWLIRUPH(ULWHPD�QRGRVR(FWLPD�JDQJUHQRVR1yGXORV�VXEFXWiQHRV��DEVFHVRV��\�DOWHUDFLyQ GHO�61&�

$QDHURELRV�\�DHURELRV0��SQHXPRQLDH$QDHURELRV�\�DHURELRV��0�SQHXPRQLDH0�SQHXPRQLDH��&�%XUQHWWL��/�SQHXPRSKLOD0�SQHXPRQLDH��/�SQHXPRSKLOD0�SQHXPRQLDH&�SQHXPRQLDH��0�WXEHUFXORVLV�3VHXGRPRQDV�DHUXJLQRVD��VHUUDWLD�PDUFHQVHV1RFDUGLD�VS�0RGLILFDGR� GH� 7-� 0DUULH�� &RPPXQLW\�$FTXLUHG� 3QHXPRQLD�� &OLQ� ,QIHFW� 'LV� ������ ���� �������� &OXHV� WR� WKH�HWLRORJ\�RI�SQHXPRQLD�IURP�WKH�PHGLFDO�KLVWRU\�DQG�SK\VLFDO�H[DPLQDWLRQ�ILQGLQJV�

7DEOD����3DWURQHV�UDGLROyJLFRV�HQ�OD�QHXPRQtD�H[WUDKRVSLWDODULD�2SDFLGDG�IRFDO 6WUHSWRFRFFXV�SQHXPRQLDH��0\FRSODVPD�SQHXPRQLDH��/HJLRQHOOD�SQHXPRSKLOD��6WDSK\ORFRFFXV�DXUHXV��&KODP\GLD�SQHXPRQLDH��0\FREDFWHULXP�WXEHUFXORVLV��%ODVWRP\FHV�GHUPDWLWLGLV2SDFLGDGHV�PXOWLIRFDOHV 6��DXUHXV��&R[LHOOD�EXUQHWWL��/��SQHXPRSKLOD��V��3QHXPRQLDH,QWHUVWLFLDO 9LUXV��0��SQHXPRQLDH��3QHXPRF\VWLV�FDULQLL��&KODP\GLD�SVLWWDFL0LOLDU 0�WXEHUFXORVLV��9DULFHOOD�]RVWHU,QWHUVWLFLDO�FRQ�OLQIDGHQRSDWtD 9LUXV�GH�(SVWHLQ�%DUU��)UDQFLVHOOD�WXODUHQVLV����&��SVLWWDFL��0��SQHXPRQLDH6HJPHQWDULD�R�OREDU�FRQ�OLQIDGHQRSDWtD 0�WXEHUFXORVLV��LQIHFFLyQ�SULPDULD���UXEHROD��KRQJRV&DYLWDFLyQ $QDHURELRV��DEVFHVR�GH�SXOPyQ���%*1�DHURELRV��0��7XEHUFXORVLV��/��3QHXPRSKLOD��FULSWRFRFRFXV�QHRIRUPDQV��QRFDUGLD�DVWHURLGHV��DFWLQRQRP\FHV�LVUDHOLL��3��&DULQLL�1HXPDWRFHOHV 6�DXUHXV��6WUHSWRFRFFXV�S\RJHQHV��S��&DULQLL�/HVLRQHV�UHGRQGHDGDV &��EXUQHWWL��6��SQHXPRQLDH��/��3QHXPRSKLOD��6��DXUHXV��$ERPEDPLHQWR�GH�FLVXUD .OHEVLHOOD�SQHXPRQLDH��/��SQHXPRSKLOD7-� 0DUULH�� &RPPXQLW\ �$FTXLUHG� 3QHXPRQLD�� &OLQ� ,QIHFW� 'LV� ����� ����������� &RQVLGHUDWLRQV� LQ� WKH�GLIIHUHQWLDO� GLDJQRVLV� IRU� SDWLHQWV� ZKRVH� FOLQLFDO� FRQGLWLRQV� DUH� VXJJHVWLYH� RI� SQHXPRQLD� DQG� ZKRVH� FKHVW�UDGLRJUDSKV� UHYHDO� DQ\� RI� WKH� FRPPRQ� SDWWHUQV� OLVWHG� EHORZ��2QO\� WKH� SRVVLEOH�PLFURELDO� FDXVHV� DVVRFLDWHG�

Page 85: Manual practico urgencias medicina interna muy bueno

��

ZLWK� WKH� YDULRXV� UDGLRJUDSKLF� SDWWHUQV� DUH� JLYHQ�� HDFK� SDWWHUQ� LV� DOVR� DVVRFLDWHG� ZLWK� DQ� H[WHQVLYH� QRQ �LQIHFWLRXV�GLVHDVH�GLIIHUHQWLDO�GLDJQRVLV�0RGLILFDGR��HOLPLQDGDV�ODV�PLFRVLV�QR�HQGpPLFDV�7DEOD����&ULWHULRV�GH�GLDJQyVWLFR�HWLROyJLFR6(*852���&XDOTXLHU�RUJDQtVPR�DLVODGR�GH�VDQJUH��OtTXLGR�SOHXUDO�R�ELRSVLD�SXOPRQDU����1HXPRFRFR��FXDQGR�HO�$J�HQ�VXHUR�X�RULQD�HV�SRVLWLYR����/HJLRQHOOD�HQ�FXOWLYR�GH�HVSXWR�X�RWUDV�PXHVWUDV�UHVSLUDWRULDV����/HJLRQHOOD��FXDQGR�OD�,)'�GH�HVSXWR�HV�SRVLWLYD���WtWXOR�DLVODG R�GH�VHURORJtD�HOHYDGR����0\FRSODVPD�HQ�FXOWLYR�GH�PXHVWUDV�UHVSLUDWRULDV����&KODP\GLD�HQ�FXOWLYR�GH�DVSLUDGR�QDVRIDUtQJHR����9LUXV�HQ�FXOWLYR�GH�DVSLUDGR�QDVRIDUtQJHR����3QHXPRF\VWLV�FDULQLL�HQ�%$/����9LUXV��/HJLRQHOOD��0\FRSODVPD��&KODP\GLD� \�&R[LHOOD��FXDQGR�HQ�GRV�PXHVWUDV�GH�VXHUR�VH�REVHUYD�XQ�DXPHQWR�R�GLVPLQXFLyQ�GH�FXDWUR�YHFHV�HO�WtWXOR�LQLFLDO�352%$%/(���&XDOTXLHU�JHUPHQ�FRPSDWLEOH�DVLODGR�HQ�P~OWLSOHV�HVSXWRV�HQ�ORV�WUHV�SULPHURV�GtDV�GH�KRVSLWDOL]DFLyQ����1HXPRFRFR��FXDQGR�VH�DtVOD�HQ�HVSXWR�R�VH�GHWHFWD�VX�$J�HQ�HVSXWR����+�LQIOXHQ]DH�R�6�DXUHXV�HQ�FXOWLYR�GH�HVSXWR����2WURV�JpUPHQHV�FXDQGR�VRQ�ORV�RUJDQLVPRV�SUHGRPLQDQWHV�HQ�HO�*UDP�GH�HVSXWR�\�FUHFHQ�HQ�FXOWLYR�GH�IRUPD�SXUD�R�SUHGRPLQDQWH�R�GH�IRUPD�OLJHUD�SHUR�FRQ�*UDP�F RPSDWLEOH����$LVODPLHQWR�GH�JHUPHQ�FRPSDWLEOH�GH�PXHVWUDV�REWHQLGDV�SRU�377UD��377RU��FDWpWHU� WHOHVFySLFR�R�%$6��HQ�ORV�GRV�~OWLPRV�QHFHVDULR�!��� XIF�PO�����/HJLRQHOOD�FRQ�XQ�~QLFR�WtWXOR�SRU�,),�GH�!�������!������VL�OD�VHURSUHYDOHQFLD�HV�DOWD�����/HJLRQHOOD��VL�HO�$J�HQ�RULQD�HV�SRVLWLYR����0\FRSODVPD��FXDQGR�VH�GLVSRQH�GH�XQ�~QLFR�WtWXOR�GH�!�R� �������SRU�)&�R�������SRU�DJOXWLQDFLyQ����&KODP\GLD��FXDQGR�VH�GLVSRQH�GH�XQ�~QLFR�WtWXOR�HQ�IDVH�DJXGD�GH�!�����SRU�PLFUR,)�,J0�����&R[LHOOD�FRQ�XQ�~QLFR�WtWXOR�SRU�)&�!�R� ������R������SRU�DJOXWLQDFLyQ����� (Q� HO� FDVR� GH� P~OWLSOHV� SDWyJHQRV� HQ� HVSXWR� FUHFLHQGR� HQ� LJXDO� PDJQLWXG�� VL� KD\� XQ� JHUPHQ�SUHGRPLQDQWH� YLVWR� HQ� HO� *UDP� HVWH� HV� HO� UHVSRQVDEOH�� 6L� HO� *UDP� PXHVWUD� P~OWLSOHV� JpUPHQHV�FRQVLVWHQWHV�FRQ�ORV�TXH�DSDUHFHQ�HQ�HO�FXOWLYR��VH�FRQVLGHUDQ�SDWyJHQRV�D�WRGRV�HOORV�0RGLILFDGR� GH� 5HVHDUFK� &RPPLWWHH� RI� WKH� %ULWLVK� 6RFLHW\� DQG� 3XEOLF� +HDOWK� /DE� 6HUYLFH��&RPPXQLW\�DFTXLUHG�SQHXPRQLD�LQ�DGXOWV�LQ�%ULWLVK�KRVSLWDOV�LQ������������$�6XUYH\�RI�DHWLRORJ\��PRUWDOLW\��SURJQRVWLF�IDFWRUV�DQG�RXWFRPH��4�-�0HG�������������������\)DQJ�*'��)LQH�0��2UORII�-��$ULVXPL�'��<X�9/��.DSRRU�:��HW�DO��1HZ�DQG�HPHUJLQJ�HWLRORJLHV�IRU�FRPPXQLW\�DFTXLUHG�SQHXPRQLD�ZLWK�LPSOLFDWLRQV�IRU�WKHUDS\��$�SURVSHFWLYH�PXOWLFHQWHU�VWXG\�RI�����FDVHV��0HGLFLQH��%DOWLPRUH��������������������

Page 86: Manual practico urgencias medicina interna muy bueno

��

7DEOD��� 7UDWDPLHQWR�HVSHFtILFR�GH�OD�QHXPRQtD�H[WUDKRVSLWDODULD�3DWyJHQR (OHFFLyQ $OWHUQDWLYR &RPHQWDULR6WU��SQHXPRQLDH 3HQLFLOLQD &HIDORVSRULQDV0DFUyOLGRV'R[LFLFOLQD9DQFRPLFLQD3DUD�FHSDV�FRQ�QLYHOHV�LQWHUPHGLRV�GH�5�D�SHQLFLOLQD��$OWDV�GRVLV�GH�SHQLFLOLQD��FHIRWD[LPD�R�FHIWULD[RQD�3DUD�FHSDV�DOWDPHQWH�UHVLVWHQWHV��9DQFRPLFLQD�+DHP��,QIOXHQ]DH &HIDORVSRULQDV����R����JHQHUDFLyQ )OXRUTXLQRORQDV'R[LFLFOLQD 3URGXFWRU�GH�EHWDODFWDPDVD�FRQ�UHVLVW��D�DPR[LFLOLQD�HQ�HO��������6WDSK��DXUHXV &OR[DFLOLQD�FRQ�R�VLQ�JHQWDPLFLQD &HID]ROLQD�R�FHIXUR[LPD�9DQFRPLFLQD 0HWLFLOLQ�5HVLVWHQWH�UDUD�HQ�FHSDV�FRPXQLWDULDV�0RU��&DWDUUKDOLV &HIDORVSRULQDV�GH����R����JHQHUDFLyQ&RWULPR[D]RO

0DFUyOLGRV)OXURTXLQRORQDV'R[LFLFOLQD3URGXFFLyQ�GH�EHWDODFWDPDVD�FRQ�5�D�DPSLFLOLQD�HQ�HO��������

$QDHURELRV &OLQGDPLFLQD 3HQLFLOLQD�0HWURQLGD]RO$PR[L�FODYXOiQLFR3HQLFLOLQD�R�DPR[LFLOLQD%DFLORV�*1 &HIDORVSRULQDV�GH����R����JHQHUDFLyQ���FRQ�R�VLQ�DPLQRJOXFyVLGR)OXRUTXLQRORQD,PLSHQHP&HIWD]LGLPD

6H�UHTXLHUHQ�SUXHEDV�GH�VHQVLELOLGDG�LQ�YLWUR/HJLRQHOOD�VS� (ULWURPLFLQD��/HYRIOR[DFLQR &ODULWURPLFLQD�R�D]LWURPLFLQD $PSOLD�H[SHULHQFLD�VyOR�FRQ�HULWURPLFLQD0��SQHXPRQLDH 'R[LFLFOLQD(ULWURPLFLQD &ODULWURPLFLQD�R�D]LWURPLFLQD��)OXRUTXLQRORQD&KO��SQHXPRQLDH 'R[LFLFOLQD(ULWURPLFLQD &ODULWURPLFLQD�R�D]LWURPLFLQD��)OXRUTXLQRORQD1RFDUGLD 6XOIRQDPLGD&RWULPR[D]RO 'R[LFLFOLQD,PLSHQHP�FRQ�R�VLQ�DPLNDFLQD&KO��SVLWWDFL 'R[LFLFOLQD &ORUDQIHQLFRO&R[��EXUQHWWL 'R[LFLFOLQD &ORUDQIHQLFRO,QIOXHQ]D�$ $PDQWDGLQD�R�ULPDQWDGLQD (ILFDFLD�QR�HVWDEOHFLGD+DQWDYLUXV $JHQWHV�LQRWURSRV�\�YDVRSUHVRUHV 5LEDYLULQD��H[SHULPHQWDO�

Page 87: Manual practico urgencias medicina interna muy bueno

��

Page 88: Manual practico urgencias medicina interna muy bueno

��

1HXPRQtD�H[WUDKRVSLWDODULD&5,7(5,26�'(�,1*5(62��6HQHVFHQFLD�(QIHUPHGDG�FUyQLFD�R�JUDYH��(32&��,QVXILFLHQFLD�FDUGtDFD��FLUURVLV�KHSiWLFD��,5&��'0��$OFRKROLVPR� R�LQPXQRGHSUHVLyQ��)DFWRUHV�GH�JUDYHGDG��)DOWD�GH�UHVSXHVWD�D�XQ�WWR�FRUUHFWR��������KRUDV���$OWHUDFLyQ�UDGLROyJLFD��GHUUDPH�SOHXUDO��FDYLWDFLyQ�R�DIHFFLyQ�GH�PiV�GH�XQ�OyEXOR��6RVSHFKD�GH�DVSLUDFLyQ��3UREOHPD�VRFLDO�R�SVLTXLiWULFR�

1(8021,$�12�*5$9(��75 $7$0,(172�$0%8/$725,2��'(7(50,1$&,21(6��2SFLRQDO�HVSXWR��KHPRFXOWLYRV�\�VHURORJtD��75$7$0,(172�(03,5,&2��0DFUyOLGR�R�DPR[LFLOLQD�R�FHIXUR[LPD����GtDV��$OWHUQDWLYD��/HYRIOR[DFLQR�YR���GtDV��&RQWURO�FOtQLFR��D�ORV���\����GtDV��5[�D�ORV����GtDV�\�SRVWHULRUPHQWH�PHQVXDOHV�KDVWD�OD�UHVROXFLyQ�

&216,'(5$5�275$6�326,%,/,'$'(6��LQIDUWR�SXOPRQDU��DWHOHFWDVLD��HGHPD�SXOPRQDU��QHRSODVLD��FRODJHQRVLV��YDVFXOLWLV��%212��QHXPRQtDV�HRVLQyILODV��QHXPRQLWLV�SRU�KLSHUVHQVLELOLGDG�R�SRU�IiUPDFRV��SURWHLQRVLV�DOYHRODU��QHXPRQLWLV�SRVWUDGLDFLyQ�

&5,7(5,26�'(�*5$9('$'�� ,QHVWDELOLGDG�KHPRGLQiPLFD��7$6�����7$'�����SXOVR!����� ,QVXILFLHQFLD�UHVSLUDWRULD��S2�������S2��)L2������HQ�(32&��5(6!���� ,QVXILFLHQFLD�UHQDO�DJXGD��$OWHUDFLyQ�GH�OD�FRQFLHQFLD��%DFWHULHPLD�\�R�FRPSOLFDFLRQHV�VpSWLFDV��2WURV�GDWRV��7��!���R������&��S+�������$IHFFLyQ�5[�GH�PiV�GH�XQ�OyEXOR��GHUUDPH�R�FDYLWDFLyQ��$QHPLD��+E����OHXFRSHQLD����������R�OHXFRFLWRVLV��JUDYH��!��������7URPERFLWRSHQLD�� 8UHD�!����1D�������*OXFRVD!����y�DOE~PLQD�����

1(8021,$�*5$9(���9$/2 5$&,Ð1�8&,� �LQLFLDOPHQWH�VLHPSUH�FRQ�GRV�R�PiV�FULWHULRV�HQ�QHJULWD�'(7(0,1$&,21(6�+HPRJUDPD�ELRTXtPLFD��RULQD*DVRPHWUtD�DUWHULDO�(VSXWR��KHPRFXOWLYRV�\�VHURORJtD�2WUDV�SUXHEDV�PLFURELROyJLFDV9DORUDU�PpWRGRV�LQYDVLYRV��FDWpWHU�WHOHVFRSDGR��%$/��75$7$0,(172�(03Ë5,&2�&HID����R�����DPR[LFLOLQD�FODYXOiQLFR�FHIWD]LGLPD��LPLSHQHP���PDFUyOLGR���$0*����FOLQGDPLFLQD����FRWULPR[D]RO����FOR[DFLOLQD�$OWHUQDWLYD��/HYRIOR[DFLQR�LY����GtDV�6L�FULWHULRV�8&,��EHWDODFWiPLFR����PDFUyOLGR�R�OHYRIOR[DFLQR��

&5,7(5,26�'(�$/7$��3XOVR��������PLQ��5HVSLUDFLRQHV������PLQ�7��������&��&DSDFLGDG�LQJHVWD�RUDO��(VWDGR�PHQWDO�QRUPDO��32������R�62�!���

&21752/(6�$0%8/$725,26�&RQWURO�FOtQLFR�D�ORV�������GtDV��D�ORV����GtDV�\�GHVSXpV�PHQVXDOHV�KDVWD�UHVROXFLyQ���&RQWURO�5[�������\����GtDV�\�SRVWHULRUPHQWH�PHQVXDOHV�KDVWD�UHVROXFLyQ��6HJXQGD�VHURORJtD�D�ORV����GtDV�

1(8021,$�12�*5$9(��,1*5(62�(1�3/$17$��'(7(50,1$&,21(6+HPRJUDPD��ELRTXtPLFD��RULQD�*DVRPHWUtD�DUWHULDO�RSFLRQDO�(VSXWR��KHPRFXOWLYRV�\�VHURORJtD�2WUDV�SUXHEDV�PLFURELROyJLFDV���75$7$0,(172�(03,5,&2� &HID����R�DPR[LFODYXOiQLFR�r PDFUyOLGR�� $OWHUQDWLYD�/HYRIOR[DFLQR��YR�R�LY����GtDV�

�1R�6t

�6t

�6t

�1R

�1R

Page 89: Manual practico urgencias medicina interna muy bueno

��

$QH[R��

&ULWHULRV�GH�LQJUHVR�HQ�8&,$OWHUDFLyQ�LPSRUWDQWH�GH�OD�FRQFLHQFLD�,QVXILFLHQFLD�UHVSLUDWRULD�JUDYH��!���UHVS�PLQ��XWLOL]DFLyQ�GH�OD�PXVFXODWXUD�DFFHVRULD��IDWLJD�PXVFXODU�GLDIUDJPiWLFD��S2��)L2��������R������HQ�(32&�,QHVWDELOLGDG�KHPRGLQiPLFD�JUDYH��UHTXHULPLHQWR�GH�IiUPDFRV�YDVRDFWLYRV�!��K�R�GLXUHVLV������PO�K�R������PO�HQ���K��&,'��,QVXILFLHQFLD�UHQDO�DJXGD��PHQLQJLWLV�X�RWURV�IDOORV�RUJiQLFRV�JUDYHV

Page 90: Manual practico urgencias medicina interna muy bueno

��

1HXWURSHQLD�IHEULO�-RVH�-DYLHU�%ODQFK��&DUPHQ�$ORQVR��5DLPXQGR�7LUDGR�5��&DUORV�-DUD����&RQFHSWR��6H�GHILQH�OD�QHXWURSHQLD�IHEULO�FRPR�OD�WHPSHUDWXUD�DLVODGD������&�HQ�XQD�RFDVLyQ��R� WUHV� WRPDV� ��� �&�GHQWUR�GH�XQ�SHULRGR�GH����KRUDV��\�VHSDUDGDV�SRU�DO�PHQRV���KRUDV�GH�GLIHUHQFLD�HQ�XQ�SDFLHQWH�FRQ�UHFXHQWR�GH�QHXWUyILORV�LJXDO�R�PHQRU�D �����/��1R�VH�LQFOX\H�HQ�OD�QHXWURSHQLD�IHEULO�OD�SURYRFDGD�SRU�WUDVIXVLyQ�GH�KHPRGHULYDGRV����/D�LQWHQVLGDG�\�GXUDFLyQ GH�OD�QHXWURSHQLD�HV�HO�SULQFLSDO�IDFWRU�GH�ULHVJR�UHFRQRFLEOH�SDUD�LQIHFFLRQHV� EDFWHULDQDV� \� I~QJLFDV�� /RV� WHVWV� GLDJQyVWLFRV� DFWXDOPHQWH� GLVSRQLEOHV� QR� VRQ� OR�VXILFLHQWHPHQWH�UiSLGRV��VHQVLEOHV�QL�HVSHFtILFRV�SDUD�LGHQWLILFDU�R�H[FOXLU�XQD�FDXVD�LQIHFFLRVD�GHO�HSLVRGLR�IHEULO��/D�PD\RUtD�����������GH�ORV�HSLVRGLRV�GH�ILHEUH�HQ�SDFLHQWHV�QHXWURSpQLFRV�TXHGDQ�VLQ�H[SOLFDFLyQ�HWLROyJLFD�D�SHVDU�GH�XQD�LQYHVWLJDFLyQ�H[KDXVWLYD��(QWUH�HO���������GH�ORV�SDFLHQWHV�QHXWURSpQLFRV�TXH�SUHVHQWDQ�ILHEUH�WLHQHQ�XQD�LQIHFFLyQ�RFXOWD�R�HYLGHQWH��3RU�WDO�PRWLYR�VLHPSUH�KD\�TXH�GDU�WUDWDPLHQWR�DQWLELyWLFR�D�HVWRV�SDFLHQWHV���� (WLRORJtD�� 0iV� GHO� ��� �� GH� ODV� LQIHFFLRQHV� VH� GHEHQ D� OD� IORUD� HQGyJHQD�� TXH� VXHOH�PRGLILFDUVH� WUDV� OD� DGPLVLyQ� GHO� SDFLHQWH� HQ� HO� KRVSLWDO�� +D� KDELGR� FDPELRV� HQ� HO� HVSHFWUR�PLFURELDQR� HQ� ODV� ~OWLPDV� GpFDGDV�� 'HVGH� ORV� DxRV� ��� ORV� *UDP�SRVLWLYRV� VRQ� ORV� PiV�IUHFXHQWHV�HQ�OD�PD\RUtD�GH�ORV�FHQWURV��HVSHFLDOPHQWH 6��DXUHXV \�ORV�HVWDILORFRFRV�FRDJXODVD�QHJDWLYRV� VL� ORV� SDFLHQWHV� WLHQHQ� FDWpWHUHV� LQWUDYDVFXODUHV� LPSODQWDGRV�� 9D� HQ� DXPHQWR� OD�LPSRUWDQFLD�GH�ORV�HVWUHSWRFRFRV�DOID�KHPROtWLFRV��VREUH�WRGR�6��PLWLV \ 6��VDQJXLV HQ�SDFLHQWHV�TXH�KDQ�UHFLELGR�WUDWDPLHQWR�FRQ�$UD�&��SUHVHQFLD�GH�GLDUUHD�R�PXFRVLWLV�RUDO��DGPLQLVWUDFLyQ�GH�DQWL�+��� \� DTXHOORV� TXH� KDQ� UHFLELGR� SURILOD[LV� FRQ� FRWULPR[D]RO� R� TXLQRORQDV�� /RV� KRQJRV�DSDUHFHQ�HQ�ORV�FDVRV�GH�QHXWURSHQLD�SURORQJDGD�R�FXDQGR�HO�SDFLHQWH�KD�UHFLELGR�YDULDV�WDQGDV�GH�DQWLELyWLFRV��6RQ�IXQGDPHQWDOPHQWH�&DQGLGD VSS��$VSHUJLOOXV VSS��&U\SWRFRFFXV�QHRIRUPDQV\�ORV�3K\FRP\FHWHV�����/RV�OXJDUHV�PiV�IUHFXHQWHV�GH�LQIHFFLyQ YDUtDQ�VHJ~Q�ODV�VHULHV�FRQVXOWDGDV��VLQ�HPEDUJR��OD�WHQGHQFLD�HV�OD VLJXLHQWH��RURIDULQJH��������WUDFWR�UHVSLUDWRULR��������FDWpWHUHV�LQWUDYDVFXODUHV�\�SLHO���������UHJLyQ�SHULDQDO���������WUDFWR�XULQDULR�����������QDUL]���VHQRV�SDUDQDVDOHV�������\�WUDFWR�JDVWURLQWHVWLQDO��������� 6H� SXHGH� HVWUDWLILFDU� HQ� JUXSRV� GH� ULHVJR�� (O� SULQFLSDO� IDFWRU� GH� ULHVJR� HV� OD� GXUDFLyQ�SUHYLVWD�GH�OD�QHXWURSHQLD��(Q�OD�7DEOD�, VH�PXHVWUDQ�ORV�GLIHUHQWHV�IDFWRUHV�GH�ULHVJR��

Page 91: Manual practico urgencias medicina interna muy bueno

��

��� /RV� SURFHGLPLHQWRV� GLDJQyVWLFRV DFRQVHMDEOHV� D� UHDOL]DU� DO� LQJUHVR� VRQ�� KHPRJUDPD��FRDJXODFLyQ�� ELRTXtPLFD�� DQiOLVLV� HOHPHQWDO� GH� RULQD�� UDGLRJUDItD� GH� WyUD[�� KHPRFXOWLYRV�LQFOX\HQGR� OD� YtD� FHQWUDO� VL� OD� KXELHUD� �XQD� WRPD� GH� FDGD� OX]�� \� XURFXOWLYR�� &RSURFXOWLYR� \�GHWHUPLQDFLyQ�GH�WR[LQD�GH�&�GLIILFLOH VL�HO�SDFLHQWH�SUHVHQWD�GLDUUHD��6H�UHFRPLHQGD�FXOWLYR�GHO�DVSLUDGR R�ELRSVLD�GH�FXDOTXLHU� VLWLR�DFFHVLEOH�\�VXJHVWLYR�GH�VHU� HO�RULJHQ�GH� OD� LQIHFFLyQ��6L�SHUVLVWH�OD�ILHEUH�ORV�KHPRFXOWLYRV�VH�UHSHWLUiQ�D�ODV����KRUDV��6H�UHFRPLHQGD�UHSHWLU�DQDOtWLFDV�

HQ�IXQFLyQ�GH�OD�HYROXFLyQ�FOtQLFD�GHO�SDFLHQWH���� 7UDWDPLHQWR� DQWLELyWLFR� HPStULFR� LQLFLDO�� (Q� SULQFLSLR�� OD� FDWHJRUtD� GH� ULHVJR� QR� LPSOLFD�GLIHUHQFLDV�HQ� OD�SDXWD� LQLFLDO�� VLQR�PiV�ELHQ�HQ� OD�GXUDFLyQ�GHO� WUDWDPLHQWR�R�HQ� ODV�SULPHUDV�PRGLILFDFLRQHV� XOWHULRUHV�� 'DGR� HO� DOWR� ULHVJR� GH� LQIHFFLRQHV� EDFWHULDQDV� JUDYHV�� WRGRV ORV�SDFLHQWHV�QHXWURSpQLFRV�FRQ�ILHEUH�VH�WUDWDUiQ�FRQ�DQWLELyWLFRV�EDFWHULFLGDV�GH�DPSOLR�HVSHFWUR�SRU�YtD�LQWUDYHQRVD�\�D�GRVLV�Pi[LPDV���HYLGHQFLD�$��,,���([LVWHQ� SRFRV� GDWRV� TXH� VXJLHUDQ� TXH� XQD� SDXWD� DQWLELyWLFD� VHD� VXSHULRU� D� RWUD�� 3DUD�VHOHFFLRQDU� HO� WUDWDPLHQWR� PiV� DGHFXDGR� VH� GHEHUtD� FRQRFHU� HO� SDWUyQ� GH� UHVLVWHQFLD� D� ORV�DQWLPLFURELDQRV�GH�ORV�JpUPHQHV�PiV�IUHFXHQWHV�GHO�KRVSLWDO��'DGR� TXH� QR� KD\� GLIHUHQFLDV� HQWUH� OD� PRQRWHUDSLD� \� HO� WUDWDPLHQWR� FRPELQDGR� FRQ� YDULRV�IiUPDFRV��OD�PRQRWHUDSLD�SXHGH�FRQVLGHUDUVH�HO�WUDWDPLHQWR�HVWiQGDU��$��,���(Q�OD�PD\RUtD�GH�ORV�WUDEDMRV�VH�UHFRPLHQGD�&HIWD]LGLPD�R�,PLSHQHP�FLODVWDWLQD��2WURV�IiUPDFRV�~WLOHV�SXHGHQ�VHU�OD�FHIHSLPD� \� HO�PHURSHQHP��1XHVWUD� UHFRPHQGDFLyQ� D� OD� YLVWD� GH� ORV� SDWyJHQRV�KDELWXDOHV�HQ�QXHVWUR�PHGLR�VHUtD�&HIWD]LGLPD�D�GRVLV�GH���JU�LY���K�/D�9DQFRPLFLQD�VH�XWLOL]DUi��GRVLV������PJ����KRUDV�D�SDVDU�DO�PHQRV�HQ�XQD�KRUD��DMXVWDU�QLYHOHV�GHVSXpV�GH�OD����GRVLV�DGPLQLVWUDGD��GH�HQWUDGD�HQ�GHWHUPLQDGRV�FDVRV�FRPR�SDFLHQWHV�FRQ� LQIHFFLyQ� HYLGHQWH� GHO� FDWpWHU� FHQWUDO�� HQ� SDFLHQWHV� FRQ�PXFRVLWLV� JUDYH�� HQ� ORV� TXH� KDQUHFLELGR� SURILOD[LV� FRQ� TXLQRORQDV�� HQ� DTXHOORV� FRQ� KLSRWHQVLyQ� X� RWURV� GDWRV� GH� JUDYHGDG�� R�

7DEOD�,��*UXSRV�GH�ULHVJR�HQ�ORV�SDFLHQWHV�FRQ�QHXWURSHQLD�IHEULO%DMR�ULHVJR $OWR�ULHVJR'XUDFLyQ�DQWLFLSDGD�GH�QHXWURSHQLD�d��GtDV 'XUDFLyQ�DQWLFLSDGD�GH�QHXWURSHQLD�!���GtDV7XPRU�VyOLGR�R�OHXFHPLD�HQ�WUDWDPLHQWR�GH�PDQWHQLPLHQWR /HXFHPLD�FRQ�4XLPLRWHUDSLD�GH�LQGXFFLyQ�R�702�$XVHQFLD�GH�HQIHUPHGDGHV�DVRFLDGDV &RQGLFLRQHV�PpGLFDV�FRPyUELGDV��KLSRWHQVLyQ��VLWXDFLyQ�PHQWDO�DOWHUDGD��FDPELRV�QHXUROyJLFRV��LQVXILFLHQFLD�UHVSLUDWRULD��GHVKLGUDWDFLyQ��GRORU�DEGRPLQDO��KHPRUUDJLD��FRPSURPLVR�FDUGtDFR�R�DUULWPLDV��LQIHFFLyQ�GHO�W~QHO�GH�FDWpWHU�X�RWUD�FHOXOLWLV�H[WHQVD��LQVXILFLHQFLD�UHQDO�R�KHSiWLFD)LHEUH�GH�RULJHQ�QR�GHWHUPLQDGR %DFWHULHPLD�QHXPRQtD�\�RWUDV�LQIHFFLRQHV�JUDYHV�GRFXPHQWDGDV�(GDG�!���DxRV"3DFLHQWH�LQJUHVDGR�HQ�HO�PRPHQWR�GH�OD�QHXWURSHQLD�IHEULO�/D�SRVLWLYLGDG�GH�FXDOTXLHU�FULWHULR��FRQVLGHUDU�FRPR�DOWR�ULHVJR�

Page 92: Manual practico urgencias medicina interna muy bueno

��

FXDQGR�H[LVWH�FRORQL]DFLyQ�GHPRVWUDGD�GH�QHXPRFRFRV�UHVLVWHQWHV�D�SHQLFLOLQD�\�FHIDORVSRULQDV�R 6��DXUHXV PHWLFLOLQ�UHVLVWHQWH��(Q�WRGRV�ORV�FDVRV�DQWHULRUHV�VH�UHFRPLHQGD�HO�LQLFLR�HPStULFR�GH�9DQFRPLFLQD��$��,,���/D�FRPELQDFLyQ�PiV�UHFRPHQGDGD�HV�&HIWD]LGLPD�PiV�9DQFRPLFLQD��$��,�� \D� TXH� FXEUH� XQ� DPSOLR� HVSHFWUR� \� WLHQH� DPSOLR� PDUJHQ� GH� VHJXULGDG�� 6H� UHWLUDUi� OD�9DQFRPLFLQD�VL�QR�KD\�HYLGHQFLD�PLFURELROyJLFD�GH�LQIHFFLyQ�SRU�*UDP�SRVLWLYRV��(Q� ORV� SDFLHQWHV� DOpUJLFRV� D� ODV� SHQLFLOLQDV� OD� FRPELQDFLyQ� LGHDO� VHUtD� 9DQFRPLFLQD� PiV�$]WUHRQDP��(Q�OD�7DEOD�,, VH�H[SRQHQ�ORV�SULQFLSDOHV�DJHQWHV�DQWLPLFURELDQRV�HPSOHDGRV�HQ�OD�QHXWURSHQLD�IHEULO����0DQHMR�GHO�SDFLHQWH GXUDQWH�OD�SULPHUD�VHPDQD��6H�SXHGHQ�HVWDEOHFHU�GRV�JUDQGHV�JUXSRV�HQ�IXQFLyQ�GH�OD�SHUVLVWHQFLD�R�QR�GH�OD�ILHEUH�D�ODV����KRUDV��6L�KD�TXHGDGR�DIHEULO�HQ�ORV�GH�EDMR�ULHVJR�VH�SXHGH�SDVDU�D�DQWLELyWLFRV�SRU�YtD�RUDO��FHIL[LPD�R�TXLQRORQDV��FRQ�YLVWDV�D�DOWD�SUHFR]��(Q� ORV�GH�ULHVJR�HOHYDGR�DIHEULOHV�VH�PDQWHQGUiQ�ORV�PLVPRV�DQWLELyWLFRV��(Q� WRGRV�ORV�FDVRV�FRQ�GHVDSDULFLyQ�GH�OD�ILHEUH�DO��ó�GtD�VH�UHFRPLHQGD�PDQWHQHU�HO�WUDWDPLHQWR XQD�VHPDQDV�R�KDVWD�TXH�HO�UHFXHQWR�GH�QHXWUyILORV�HVWp�GH�QXHYR�SRU�HQFLPD�GH�������/��VDOYR�FXDQGR�KD\D�GDWRV� GH� LQHVWDELOLGDG� R� HO� UHFXHQWR� VHD� LQIHULRU� D� ���� ��/� TXH� VH� PDQWHQGUiQ� KDVWD� OD�UHFXSHUDFLyQ��7RGDV�ODV�UHFRPHQGDFLRQHV�DQWHULRUHV�VRQ�$��,,��VDOYR�OD�GXUDFLyQ�GHO�WUDWDPLHQWR�TXH�HV�%�,,�(Q�HO�FDVR�GH�TXH�SHUVLVWD� OD� ILHEUH�D� ODV����KRUDV�VLQ�XQ� IRFR�HYLGHQWH�KD\�TXH�UHHYDOXDU�FOtQLFDPHQWH�DO�SDFLHQWH��FRQ�QXHYDV�PXHVWUDV�GH�KHPRFXOWLYRV�\�GHWHUPLQDFLyQ�GH�QLYHOHV�GH�DQWLELyWLFRV��6L�QR�KD\�FDPELRV�FOtQLFRV�HQ�HO�SDFLHQWH�R�HV�GH�EDMR�ULHVJR�VH�FRQWLQXDUi�FRQ�OD�PLVPD� SDXWD� DQWLELyWLFD� �%�� ,,,��� 6L� KD\� GHWHULRUR� VH� FDPELDUiQ� ORV� DQWLELyWLFRV� �DxDGLHQGR�9DQFRPLFLQD�� FDPELDQGR� &HIWULD[RQD� SRU� ,PLSHQHP�� HWF��� 6L� KD\� GDWRV� FOtQLFRV� HYLGHQWHV� GH�PXFRVLWLV��DxDGLU�DQWLPLFURELDQR�FRQ�FREHUWXUD�DQDHURELD��VL�QR�UHFLEH�\D�,PLSHQHP��/D�GXUDFLyQ�GH�ORV�DQWLELyWLFRV�HQ�HVWH�JUXSR�GH�SDFLHQWHV�FRQ�ILHEUH�D�ODV����KRUDV�VHUtD�GH���VHPDQDV�\�SRVWHULRU�UHHYDOXDFLyQ��%��,,���3XHGH�VHU�DOJR�PHQRU�VL�HO�SDFLHQWH�KD�UHFXSHUDGR�ODV�FLIUDV�GH�QHXWUyILORV��6H�UHFRPLHQGD�DxDGLU�$QIRWHULFLQD�%��GRVLV�GH����� O�PJU�.J��SHVR�GtD�KDVWD�XQD�GRVLV�DFXPXODGD�GH�������JU�DO� WUDWDPLHQWR��FXDQGR�SHUVLVWH� OD�ILHEUH�WUDV�XQD�VHPDQD�GH�WUDWDPLHQWR�\�QR�KD\�UHVROXFLyQ�GH�OD�QHXWURSHQLD���/D�UHFLGLYD�R�SHUVLVWHQFLD�GH�OD�LQIHFFLyQ�HV�LPSUREDEOH�FRQ�UHFXHQWRV�VXSHULRUHV�D�������/�WUDV�����GtDV�GH�WUDWDPLHQWR�DQWLELyWLFR��(QWRQFHV��VH� SXHGHQ� VXVSHQGHU� � D� ORV� ���� GtDV� GH� OD� UHFXSHUDFLyQ� GHO� UHFXHQWR� DXQTXH� SHUVLVWDQ� FRQ�ILHEUH��(Q�OD�)LJXUD���VH�SURSRQH�XQ�DOJRULWPR�GH�PDQHMR�GH�OD�QHXWURSHQLD�IHEULO���� 1R� VH� UHFRPLHQGD� HO�XVR� HPStULFR� GH� DQWLYLUDOHV VL� QR� KD\� HYLGHQFLD� GH� LQIHFFLyQ� YtULFD��%�,,��� 1R� REVWDQWH�� VL� DSDUHFHQ� OHVLRQHV� FXWiQHDV� R� HQ�PXFRVDV� VXJHVWLYDV� GH� 9+6� R� 99=��IUHFXHQWHV� FXDQGR� KD\�PXFRVLWLV� VXE\DFHQWH�� HVWi� LQGLFDGR�HO� WUDWDPLHQWR� FRQ�$FLFORYLU� SDUD�HYLWDU�XQD�SXHUWD�GH�HQWUDGD�D�EDFWHULDV�X�KRQJRV�����$LVODPLHQWR�GH�SDFLHQWHV� /D�QHXWURSHQLD�IHEULO�QR�UHTXLHUH�PHGLGDV�GH�DLVODPLHQWR��'HEH�HIHFWXDUVH�XQ�ODYDGR�GH�PDQRV�VLVWHPiWLFR�DQWHV�GH�FDGD�PDQLREUD�GH�H[SORUDFLyQ�GHO�SDFLHQWH��

Page 93: Manual practico urgencias medicina interna muy bueno

��

6H� SXHGH� FRQVLGHUDU� XQD� PHGLGD� SUXGHQWH� VX� LQJUHVR� HQ� KDELWDFLyQ� LQGLYLGXDO� �VLQ� PHGLGDV�HVSHFLDOHV��

Page 94: Manual practico urgencias medicina interna muy bueno

����(Q�FXDQWR�DO�XVR�GH�*�&6) �%��,,���DFRUWD�HQ�XQ�VyOR�GtD�HO�WLHPSR�GH�QHXWURSHQLD�\�QR�VH��KD�GHPRVWUDGR�LPSDFWR�UHDO�HQ�OD�VXSHUYLYHQFLD�JOREDO�R�GLVPLQXFLyQ�GH�OD�LQFLGHQFLD�GH�LQIHFFLRQHV�JUDYHV�� 3RU� WDQWR�� QR� HVWi� LQGLFDGD� GH� PDQHUD� UXWLQDULD� OD� DGPLQLVWUDFLyQ� GH� *�&6)� D� ORV�SDFLHQWHV� FRQ� QHXWURSHQLD� IHEULO� VDOYR� HQ� DTXHOORV� FRQ� QHXPRQtD�� GDWRV� FOtQLFRV� GH� VHSVLV��F\%�6

7DEOD�,,��DQWLPLFURELDQRV�PiV�XVDGRV�HQ�OD�QHXWURSHQLD�IHEULO&ODVH�GH�DQWLELyWLFR $JHQWH�KDELWXDO (VSHFWUR 'RVLV��PD[�GtD� &RPHQWDULR&HIDORVSRULQDV�GH�����JHQHUDFLyQ

&HIWD]LGLPD�)RUWDP��� %DFWHULDV�HQWpULFDV��DOJXQRV�*UDP�QHJDWLYRV�\�S��$HUXJLQRVD��1R�FXEUH�DQDHURELRV����JU���K����LY����JU�GtD�

6ROR�FHIWD]LGLPD�\�FHIRSHUD]RQD�FXEUH�3�DHUXJLQRVD��%XHQD�SHQHWUDFLyQ�HQ�/&5&HIDORVSRULQDV�GH����JHQHUDFLyQ

&HIHSLPD &RFRV�*UDP���JUDQ�YDULHGDG�GH�EDFWHULDV ��JU����K�LY���JU�GtD�� %XHQD�SHQHWUDFLyQ�HQ�/&5$PLQRJOXFyVLGRV $PLNDFLQD�%LFOLQ���� %DFLORV�*UDP����HVSHFLDOPHQWH�EDFLORV�HQWpULFRV��1R�FXEUH�DQDHURELRV�

����PJ�NJ���K�LY ([FHOHQWH�SHQHWUDFLyQ�SOHXURSXOPRQDU��SREUH�HQ�/&5��0RQLWRUL]DU�QLYHOHV�&DUEDSHQHPV ,PLSHQHP�7LHQDP��� /D�PD\RU�SDUWH�GH�*UDP���\�*UDP�± DHURELRV��LQFOX\HQGR�3�DHUXJLQRVD�\�HQWHURFRFRV��([FHOHQWH�FREHUWXUD�DQDHUyELFD�

����PJ���K�LY����JU�GtD�� 6ROR�6�PDOWRSKLOOD�\�%�FHSDFHD�QR�FXELHUWDV��$xDGLU�$PLQRJOXFyVLGRV�SDUD�WUDWDPLHQWR��3�DHUXJLQRVD�%DMRV�QLYHOHV�/&53HQLFLOLQDVGH�DPSOLR�HVSHFWUR3LSHUDFLOLQD�7D]REDFWDP�7D]RFHO����

$HURELRV�HQWpULFRV��LQFOX\HQGR�3�DHUXJLQRVD�HQWHUREDFWHU�\�VHUUDWLD�����JU������K�LY����JU�GtD�

6H�GHEH�DxDGLU�DPLQRJOLFyVLGR�SDUD�WUDWDPLHQWR�3�DHUXJLQRVD��%DMRV�QLYHOHV�HQ�/&5�0RQREDFWDPV $]WUHRQDP�$]DFWDP��� *UDP�± DHURELRV�O LYDP WH�� ����JU����K�LY���JU�GtD� 5HTXLHUD�DxDGLU�DJHQWH�WLYR�I W H�* P����

��

HOXOLWLV�R�VLQXVLWLV�JUDYHV��LQIHFFLyQ�I~QJLFD�VLVWpPLFD�R�HQ�DTXHOORV�TXH�SHUVLVWHQ�QHXWURSpQLFRV��WLHQHQ�XQD�LQIHFFLyQ�GRFXPHQWDGD�TXH�QR�UHVSRQGH�DO�WUDWDPLHQWR�DQWLPLFURELDQR�LEOLRJUDItD�� )UHLIHOG�$*��:DOVK�7-��3L]]R�3$��,QIHFWLRQV�LQ�WKH�&DQFHU�3DWLHQW��(Q��'H�9LWD�97�-U��+HOOPDQ���5RVHPEHUJ�6$��HG��&DQFHU��3ULQFLSOHV�DQG�3UDFWLFH�RI�2QFRORJ\�����HG�

Page 95: Manual practico urgencias medicina interna muy bueno

��

��� *LOOHVSLH�7��0DVWHUWRQ�5*�� ,QYHVWLJDWLRQ�RI� LQIHFWLRQ� LQ� WKH�QHXWURSHQLF�SDWLHQW�ZLWK�IHYHU��-�+RVS�,QIHFW�������������������� +HUQiQGH]�%URFKXG� 0�� HG�� &DUH� RI� WKH� SDWLHQW� WUHDWHG� ZLWK� LQWHQVLYLW\� FKHPRWHUDSK\��*DUGLQHU�&DOGZHOO�FRPXQLFDWLRQV�OLPLWHG����������� +XJKHV�:7�HW�DO�������*XLGHOLQH�IRU�WKH�XVH�RI�DQWLPLFURELDO�DJHQWV�LQ�QHXWURSHQLF�SDWLHQWV�ZLWK�XQH[SODLQHG�IHYHU��&OLQ�,QIHFW�'LV���������������������� .ODVWHUVN\�-$��HG��)HEULOH�QHXWURSHQLD��3HUOtQ��6SULQJHU�9HUODJ���������� /DOOD�)��$QWLELRWLF� WUHDWPHQW� RI� IHEULOH�HSLVRGHV� LQ�QHXWURSHQLF�FDQFHU�SDWLHQWV��&OLQLFDO�DQG�HFRQRPLF�FRQVLGHUDWLRQV��'UXJV���������������������� 5RYLUD�0��&DUUHUDV�(��6,HUUD�-��8UEDQR�,VSt]XD�$��3URWRFROR�WHUDSpXWLFR�HPStULFR�GH�OD�ILHEUH�HQ�HO�SDFLHQWH�QHXWURSpQLFR��0HGLFLQH����������������������� 7DOFRWW�-$��2XWSDWLHQW�PDQDJHPHQW�RI�IHEULOH�QHXWURSHQLD��VKRXOG�EH�FKDQJHG�WKH�VWDQGDUG�RI�FDUH��7KH�2QFRORJLVW�����������������

Page 96: Manual practico urgencias medicina interna muy bueno

��

)LJXUD����$OJRULWPR�GLDJQyVWLFR�GH�GH�OD�1HXWURSHQLD�)HEULO1HXWURSHQLD�IHEULO(YDOXDFLyQ¢5HTXLHUH�YDQFRPLFLQD

6t9DQFRPLFLQD�&HIWD]LGLPD

&HIWD]LGLPD�2�,PLSHQHP5HHYDOXDFLyQ�D�ORV���GtDV

$IHEULO%DMR�ULHVJR $OWR�ULHVJR&LSUR�RUDO������PJ����K���'XUDFLyQ�KDVWD�QHXWUyILORV�!������9DORUDU�DOWD

&RQWLQXDU�LJXDO�WUDWDPLHQWR���GtDV��6L�QHXWURI�������PDQWHQHU�WWR�KDVWD�UHFXHQWR�QRUPDO&RQWLQXDU�WWR�DQWLELyWLFR�LQLFLDO��9DORUDU�UHWLUDU�9DQFRPLFLQD

&DPELDU�DQWLELyWLFRV

5HHYDOXDFLyQ�DO����GtD3ODQWHDU�DxDGLU�$QIRWHULFLQD�

Page 97: Manual practico urgencias medicina interna muy bueno

��

)LHEUH�GH�RULJHQ�GHVFRQRFLGR��)2'��-RVp�$QWRQLR�6iH]�%DUFHORQD��(OLVD�0DUWtQH]����'HILQLFLyQ��8WLOL]DUHPRV�OD�FOiVLFD�GH�3HWHUVGRUI�\�%HHVRQ������WHPSHUDWXUD�PD\RU�GH������&�HQ� DO� PHQRV� WUHV� RFDVLRQHV�� TXH� GXUD� DO� PHQRV� �� VHPDQDV�� HQ� OD� TXH� QR� VH� DOFDQ]D� XQ�GLDJQyVWLFR�GHVSXpV�GH�XQD�VHPDQD�GH�LQJUHVR�KRVSLWDODULR��&RPR�DOWHUQDWLYD�DO�~OWLPR�FULWHULR�GH� HVWD� GHILQLFLyQ� �TXH� QR� SHUPLWH� KDFHU� XQ� GLDJQyVWLFR� DPEXODWRULR� GH� )2'�� WDPELpQ�FRQVLGHUDUHPRV� TXH� XQ� SDFLHQWH� WLHQH� )2'� FXDQGR� FXPSOD� ORV� GRV� SULPHURV� FULWHULRV� GH�3HWHUVGRUI�\�%HHVRQ�\�QR�VH�DOFDQFH�HO�GLDJQyVWLFR�GHVSXpV�GH�XQD�DQDPQHVLV�\�H[SORUDFLyQ�ItVLFD�FRPSOHWDV��\�GHWHUPLQDFLRQHV�GH�KHPRJUDPD�FRQ�96*��SHUILO�����DQRUPDOHV�\�VHGLPHQWR�GH� RULQD�� XURFXOWLYR�� VHURORJtD� D�%UXFHOOD��0DQWRX[� \�5[� GH� WyUD[��6H�H[FOX\H� D� ORV� SDFLHQWHV�LQPXQRGHSULPLGRV�� \D� TXH� HQ� HOORV� ODV� FDXVDV� GH� ILHEUH� VRQ� GLIHUHQWHV�� &RQVLGHUDUHPRV�LQPXQRGHSULPLGRV�D�DTXHOORV�SDFLHQWHV�TXH�FXPSODQ�DOJXQR�GH�ORV�VLJXLHQWHV�FULWHULRV�����D�� 1HXWURSHQLD� ��� ����� OHXFRFLWRV� R� �� ���� QHXWUyILORV�� P/�� GH� DO� PHQRV� XQD� VHPDQD� GH�GXUDFLyQ�GXUDQWH�ORV�WUHV�PHVHV�SUHYLRV�DO�LQLFLR�GH�OD�ILHEUH�E��,QIHFFLyQ�SRU��HO�YLUXV�GH�OD�LQPXQRGHILFLHQFLD�KXPDQD��9,+��F��+LSRJDPPDJOREXOLQHPLD��FRQ ,J*�������G�� 7UDWDPLHQWR� FRQ� ��� PJ�GtD� R� PiV� GH� SUHGQLVRQD� R� HTXLYDOHQWH� GXUDQWH� DO� PHQRV� ��VHPDQDV�DQWHV�GHO�FRPLHQ]R�GH�OD�ILHEUH�H��7UDWDPLHQWR�FRQ�RWURV�IiUPDFRV�1R�KDFHPRV� UHIHUHQFLD� D� ODV� QXHYDV� FDWHJRUtDV� GH�)2'�GHILQLGDV� SRU�'XUDFN� \�6WUHHW� �����)2'�QRVRFRPLDO��HQ�QHXWURSpQLFRV�\�HQ�OD�LQIHFFLyQ�9,+��7DEOD�,���\D�TXH�VRQ�FXDGURV�IHEULOHV�HQ�SREODFLRQHV�HVSHFLDOHV��FRQ�XQD�HWLRORJtD�GLVWLQWD�GH�OD�)2'�FOiVLFD�TXH�UHTXLHUHQ��SRU�WDQWR��XQ�HQIRTXH�GLDJQyVWLFR�\�WHUDSpXWLFR�GLIHUHQWH��������(WLRORJtD��(O�HVSHFWUR�GH�HQIHUPHGDGHV�TXH�FDXVDQ�)2'�HVWi�GHWHUPLQDGR�SRU�OD�GHILQLFLyQ�XWLOL]DGD�� IDFWRUHV� JHRJUiILFRV� \� FDPELRV� D� OR� ODUJR� GHO� WLHPSR� �DSDULFLyQ� GH� QXHYRV�SURFHGLPLHQWR�GLDJQyVWLFRV�\�QXHYDV�VLWXDFLRQHV�FOtQLFDV���7UDGLFLRQDOPHQWH� ODV�HQIHUPHGDGHV�LQIHFFLRVDV�HUDQ�OD�FDXVD�PiV�IUHFXHQWH�GH�)2'��6LQ�HPEDUJR��HQ�ORV�~OWLPRV�DxRV�H[LVWH�XQD�WHQGHQFLD�D�TXH�DXPHQWHQ�ODV�HQIHUPHGDGHV�LQIODPDWRULDV�QR�LQIHFFLRVDV�FRPR�FDXVD�GH�)2'�\�D� TXH� HO� Q~PHUR� GH� FDVRV� TXH� TXHGDQ� VLQ� GLDJQyVWLFR� VHD� PD\RU� ����� (Q� (VSDxD� VH� KD�FRQVWDWDGR�HQ� ORV�~OWLPRV�DxRV�XQ�DXPHQWR�VLJQLILFDWLYR�GH�ODV�FRODJHQRVLV�\�QHRSODVLDV��\�XQ�GHVFHQVR�GH�ODV�HQIHUPHGDGHV�LQIHFFLRVDV�FRPR�FDXVDV�GH�)2'������7DEOD�,,��

Page 98: Manual practico urgencias medicina interna muy bueno

0HQFLyQ�DSDUWH�PHUHFH�OD�)2'�HQ�SDFLHQWHV�PD\RUHV�GH����DxRV��\D�TXH��DXQTXH�HO�HVSHFWUR�GH�HQIHUPHGDGHV�TXH�SXHGHQ�FDXVDUOD�HV�HO�PLVPR�TXH�HQ�OD�SREODFLyQ�JHQHUDO��OD�IUHFXHQFLD�UHODWLYD� GH� GHWHUPLQDGRV� FXDGURV� HV�PXFKR�PD\RU� ������ �7DEOD� ,,,��� OR� TXH� VH� GHEH� WHQHU� HQ�F�� �� �G

7DEOD�,��'HI LQLFLRQHV�GH�)2'�\�VXV�FDWHJRUtDV3HWHUVGRUI�\�%HHVRQ��7HPSHUDWXUD�PD\RU�t ������&�FRPSUREDGD�HQ�GLYHUVDV�RFDVLRQHV���'XUDFLyQ�t��VHPDQDV���$XVHQFLD�GH�GLDJQyVWLFR�SHVH�D�XQD�VHPDQD�GH�HVWXGLR�KRVSLWDODULR�R�XQD�VHPDQD�GH�HVWXGLR�LQWHQVLYR�H�LQWHOLJHQWH�HQ�OD�FRQVXOWD�H[WHUQD'XUDFN�\�6WUHHW)2'�FOiVLFD���7HPSHUDWXUD�t ������&�FRPSUREDGD�HQ�GLYHUVDV�RFDVLRQHV��'XUDFLyQ�t ��VHPDQDV���$XVHQFLD�GH�GLDJQyVWLFR�D�SHVDU�GH�XQ�HVWXGLR�DGHFXDGR�HQ�DO�PHQRV�WUHV�YLVLWDV�HQ�OD�FRQVXOWD�H[WHUQD�R���GtDV�GH�KRVSLWDOL]DFLyQ�)2'�HQ�OD�LQIHFFLyQ�9,+���,QIHFFLyQ�FRQILUPDGD�SRU�HO�9,+���7HPSHUDWXUD�t ������&�FRPSUREDGD�HQ�GLYHUVDV�RFDVLRQHV���'XUDFLyQ�t ��VHPDQDV�HQ�HO�SDFLHQWH�KRVSLWDOL]DGR�\�t��VHPDQDV�HQ�HO�SDFLHQWH�H[WHUQR���$XVHQFLD�GH�GLDJQyVWLFR�WUDV���GtDV�GH�HVWXGLR�DGHFXDGR��LQFOX\HQGR�HQ�HOORV���GtDV�GH�LQFXEDFLyQ�GH�FXOWLYRV�PLFURELROyJLFRV)2'�UHODFLRQDGD�FRQ�QHXWURSHQLD���������QHXWUyILORV�PO�HQ�VDQJUH�SHULIpULFD�R�ULHVJR�GH�TXH�EDMHQ�GH�HVWD�FLIUD�HQ�XQ�SOD]R�GH�� ���GtDV���7HPSHUDWXUD�t ������&�FRPSUREDGD�HQ�GLYHUVDV�RFDVLRQHV���$XVHQFLD�GH�GLDJQyVWLFR�WUDV���GtDV�GH�HVWXGLR�DGHFXDGR��LQFOX\HQGR�HQ�HOORV���GtDV�GH�LQFXEDFLyQ�GH�FXOWLYRV�PLFURELROyJLFRV��)2'��QRVRFRPLDO���7HPSHUDWXUD�t ������&�FRPSUREDGD�HQ�GLYHUVDV RFDVLRQHV�HQ�XQ�SDFLHQWH�KRVSLWDOL]DGR�\�VRPHWLGR�D�FXLGDGRV�DJXGRV���$XVHQFLD�HQ�HO�PRPHQWR�GHO�LQJUHVR�GH�LQIHFFLyQ�R�LQFXEDFLyQ�GH�HOODV�$XVHQFLD�GH�GLDJQyVWLFR�WUDV���GtDV�GH�HVWXGLR�DGHFXDGR��LQFOX\HQGR�HQ�HOORV���GtDV�GH�LQFXEDFLyQ�GH�FXOWLYRV PLFURELROyJLFRV�)2'�HSLVyGLFD�UHFXUUHQWH��/RV�FULWHULRV�GH�OD�GHILQLFLyQ�GH�)2'�GH�3HWHUVGRUI�\�%HHVRQ���3DWUyQ�IOXFWXDQWH�GH�ILHEUH��FRQ�LQWHUYDORV�GH�DSLUH[LD�GH�DO�PHQRV���VHPDQDV�

��

XHQWD�D�OD�KRUD�GH�HODERUDU�HO�SODQ�GLDJQyVWLFR�\�WHUDSpXWLFR���(Q�OD�7DEOD�,9 VH�FLWDQ�ORV�GDWRV�EiVLFRV�HQ�OD�KLVWRULD�FOtQLFD�GHO�SDFLHQWH�FRQ�)2'���([SORUDFLRQHV� FRPSOHPHQWDULDV�� 1R� H[LVWH� XQ� MXHJR� GH� H[SORUDFLRQHV� FRPSOHPHQWDULDVUXWLQDULDV�� SDUD� DSOLFDU� D� ORV� SDFLHQWHV� FRQ� )2'� ������� 6HJ~Q� WRGRV� ORV� H[SHUWRV� HO� WUDEDMRLDJQyVWLFR�HQ�HVWRV�FDVRV�GHEH�EDVDUVH�HQ�

Page 99: Manual practico urgencias medicina interna muy bueno

D�� /D� UHSHWLFLyQ� GH� OD� DQDPQHVLV�� H[SORUDFLyQ� ItVLFD� \� ODV� H[SORUDFLRQHV� FRPSOHPHQWDULDV�HOHPHQWDOHV��)LJXUD����E��(O�VHJXLPLHQWR�GH�ODV�FODYHV�GLDJQyVWLFDV�TXH�YD\DQ�DSDUHFLHQGR��HQ�OD�UHYLVLyQ�GH�&XQKD�����SXHGHQ�HQFRQWUDUVH�WDEODV�GH�FODYHV�GLDJQyVWLFDV�~WLOHV��F��(O�GHVSLVWDMH�GH�ODV�FDXVDV�PiV�IUHFXHQWHV�/OHYDU� XQD� VLVWHPiWLFD� GH� HVWH� WLSR� HV� PHMRU� TXH� UHDOL]DU� PXFKDV� H[SORUDFLRQHV� FRPR�VFUHHQLQJ� HQ� OD� HVSHUDQ]D��� OD�PD\RUtD�GH�ODV� RFDVLRQHV�YDQD��GH�TXH�DOJXQD�DOWHUDFLyQ�QRV�SURSRUFLRQH� HO� GLDJQyVWLFR�� 6RODPHQWH� XQD�VHULH� KD� HVWXGLDGR� GH� IRUPD� SURVSHFWLYD� OD�XWLOLGDG� GLDJQyVWLFD� GH� ODV� SUXHEDV� TXH�KDELWXDOPHQWH� VH� UHDOL]DQ� HQ� OD�)2'�FXDQGR�VRQ� RUGHQDGDV� FRPR� WHVW� GH� VFUHHQLQJ� �HV�GHFLU�� VLQ� TXH� KD\D� GDWRV� TXH� KDJDQVRVSHFKDU�TXH�YDQ�D�UHVXOWDU�DQRUPDOHV��(Q� HVWH� HVWXGLR� VRODPHQWH� VHLV� SUXHEDV�WXYLHURQ�DOJXQD�XWLOLGDG�GLDJQyVWLFD�%LRSVLD�GH�DUWHULD�WHPSRUDO�HQ�SDFLHQWHV�PD\RUHV�GH����DxRV�)RQGR�GH�RMR6HURORJtD� VRILVWLFDGD� D� <HUVLQLD�HQWHURFROtWLFD��LQPXQREORW��$XQTXH� HV� SUREDEOH�� TXH� HQ DXVHQFLD� GH�ODYHV� GLDJQyVWLFDV�� HO� SURWRFROR� GH� SUXHEDV�

7DEOD�,,��&DXVDV�GH�)2'�HQ����VHULHV�HVSDxRODV��Q ����(QIHUPHGDG�7XEHUFXORVLV��1HRSODVLDV�KHPDWROyJLFDV

(

&ULRJOREXOLQDV%LRSVLD�GH�PpGXOD�yVHD7$&�WyUDFR�DEGRPLQDO�F

��,QIHFFLRQHV�EDFWHULDQDV�GLYHUVDV�1HRSODVLDV�VyOLGDV�%UXFHORVLV���$EVFHVRV�

7DEOD�,,,��&DXVDV�GH�)2'�HQ�PD\RUHV�GH����

��

SXHGD� OLPLWDUVH� ULJXURVDPHQWH�� QR� KD\� GDWRV�VXILFLHQWHV� HQ� OD� OLWHUDWXUD� SDUD� UHFRPHQGDU�HVWDV�SUXHEDV�FRPR� ODV�~QLFDV�REOLJDWRULDV�HQ�HO�HVWXGLR�GH�SDFLHQWHV�FRQ�)2'�WUDV�OD�SULPHUD�HWDSD�GH�SUXHEDV�REOLJDGDV�EiVLFDV�(Q�HO�SURWRFROR�GLDJQyVWLFR�H[LVWHQ�SUXHEDV�FRPSOHPHQWDULDV� REOLJDWRULDV� EiVLFDV� �7DEOD�9��

DxRV��Q ���QIHUPHGDG�$7�305 ��7XEHUFXORVLV��1HRSODVLDV��)LHEUH�PHGLFDPHQWRVD�$EVFHVRV

Page 100: Manual practico urgencias medicina interna muy bueno

���

6L�WUDV�OD�UHDOL]DFLyQ�GH�ODV�PLVPDV�DSDUHFHQ�FODYHV�GLDJQyVWLFDV�SRWHQFLDOHV�GHEH�UHDOL]DUVH�HO�GLDJQyVWLFR�GLIHUHQFLDO�GH�ODV�PLVPDV�H�LQWHQWDU�GHVFDUWDU�ODV�HQIHUPHGDGHV�SRVLEOHV�PHGLDQWH�

ORV�PHGLRV�TXH�VHDQ�QHFHVDULRV�DQWHV�GH�DSOLFDU�OD�IDVH�,�GHO�SURWRFROR��6L� FRQ� HVWR� QR� VH� OOHJD� DO� XQ� GLDJQyVWLFR� VH� DSOLFDUtD� OD� IDVH� ,� GHO� SURWRFROR� \� VH� UHSLWH�QXHYDPHQWH� HO� SURFHVR� GH� HODERUDFLyQ� GHO� GLDJQyVWLFR� GLIHUHQFLDO� \� VHJXLPLHQWR� GH� SRVLEOHV�FODYHV��6L�VHJXLPRV�VLQ�WHQHU�XQ�GLDJQyVWLFR�VH�SDVD�D�OD�IDVH�,,�GHO�SURWRFROR��6L�SHVH�D�WRGR�OD�FDXVD�GH�OD�ILHEUH�VLJXH�GHVFRQRFLpQGRVH��VH�GHFLGLUi�HQ�VHVLyQ�FOtQLFD�VL�VH�RSWD�SRU�PDQWHQHU�XQD�DFWLWXG�H[SHFWDQWH�R�SRU�LQLFLDU�XQ�WUDWDPLHQWR�HPStULFR�EDVDGR�HQ�OD�LQIRUPDFLyQ�GLVSRQLEOH�(VWi�VLVWHPiWLFD�GH�WUDEDMR�VH�UHVXPH�HQ�OD�ILJXUD���

7DEOD�,9��'DWRV�TXH�QR�GHEHQ�IDOWDU�HQ�OD�KLVWRULD�FOtQLFD�GH�XQ�SDFLHQWH�FRQ�)2'�$QDPQHVLV�3URIHVLyQ$OHUJLDV$QWHFHGHQWHV�GH�YLDMHV�UHFLHQWHV+iELWRV�VH[XDOHV+iELWRV�Wy[LFRV&RQWDFWRV�FRQ�DQLPDOHV�&RQWDFWR�FRQ�SHUVRQDV�TXH�SDGH]FDQ�HQIHUPHGDGHV�LQIHFFLRVDV,QJHVWD�GH�SURGXFWRV�OiFWHRV�\�DJXDV�VLQ�FRQWURO�VDQLWDULR0DQLSXODFLRQHV�GHQWDOHV��SURFHGLPLHQWRV�HQGRVFySLFRV��\�XUROyJLFRV�UHFLHQWHV+LVWRULD�GH�WUDVIXVLRQHV�([SORUDFLyQ�ItVLFD�([SORUDFLyQ�GH�SLHO�\�PXFRVDV��SLFDGXUDV��H[DQWHPDV��OHVLRQHV�XQJXHDOHV��DIWDV�)RFRV�VpSWLFRV�GHQWDOHV3DOSDFLyQ�GH��DUWHULDV�WHPSRUDOHV�HQ�!���DxRV�([SORUDFLyQ�PDPDULD3UHVHQFLD�GH�DGHQRSDWtDV�\�ERFLR([LVWHQFLD�GH�VRSORV�+HRSDWRHVSOHQRPHJDOLD([SORUDFLyQ�WHVWLFXODU

Page 101: Manual practico urgencias medicina interna muy bueno

7DEOD�9��([SORUDFLRQHV�FRPSOHPHQWDULDV3UXHEDV�D�UHDOL]DU�HQ�WRGRV�ORV�SDFLHQWH�FRQ�)2'+HPRJUDPD�FRPSOHWR�FRQ�96*�3HUILO�FRPSOHWR�FRQ�DPLODVD7��\�76+773$��73��ILEULQyJHQR��,153URWHLQRJUDPD��FXDQWLILFDFLyQ�GH�LQPXQRJOREXOLQDV��&��\�&�$1$��$QWL�'1$��)DFWRU�UHXPDWRLGH$QiOLVLV�HOHPHQWDO�GH�RULQD�\�VHGLPLHQWR�+HPRFXOWLYRV�����8URFXOWLYR&XWLYRV�\�SDUiVLWRV�HQ�KHFHV�VL�GLDUUHD0DQWRX[6HURORJtD�GH�%UXFHOOD5[�GH�WyUD[(&*(FRJUDItD�DEGRPLQDO)DVH�,��3UXHEDV�D�UHDOL]DU�HQ�SDFLHQWHV�VLQ�GDWRV�FODYHV�SRWHQFLDOHV�GLDQyVWLFRV�R�FRQ�GDWRV�SRWHQFLDOHV�GLDJQyVWLFRV�HTXtYRFRV0HGLGD�GH�SXOVRV�\�WHPSHUDWXUD�SRU�XQ�REVHUYDGRU)RQGR�GH�RMR�SRU�RIWDOPRORJtD5[�GH�VHQRV�SDUDQDVDOHV�\�RUWRSDQWRPRJUDItD([SORUDFLyQ�25/�SRU�RWRUULQR�,QPXQRHOHFWURIRUHVLV�HQ�VDQJUH�\�HQ�RULQD�&ULRJOREXOLQDV(&$6HURORJtDV��9,+��&09��9(%��0\FRSOVPD��7R[RSODVPD��%HUUHOLD��&R[LHOOD��7UHSRQHPD��<HUVLQLD��3VLWDFRVLV��/HLVKPDQLD��9+%��9+&+HPRFXOWLYRV�GH�ODUJD�LQFXEDFLyQ����VHPDQDV�7LQFLyQ�\�FXOWLYRV�SDUD�%.�HQ�MXJR�JiVWULFR�\�RULQD7$&�WyUDFR�DEGRPLQDO�$VSLUDGR�GH�PpGXOD�yVHD�HQ�!���DxyV�FRQ�FXOWLYR�SDUD�EDFWHULDV�FRPXQHV��P\FREDFWHULDV��EUXFHOOD��\HUVLQLD�\�KRQJRV��9LVXDOL]DFLyQ�GH�/HLVKPDQLDV�%LRSVLD�GH�DUWHULD�WHPSRUDO�HQ�!���DxRV�FRQ�96*�!��(FRFDUGLRJUDItD(FRJUDItD�SpOYLFD��JLQHFROyJLFD�SURVWiWLFD�*DPPDJUDItD�FRQ�JDOLR��QR�VH�LQGLFDUiQ�H[SORUDFLRQHV�LQYDVLYDV�EDVDGDV�~QLFDPHQWH�HQ�ORV�UHVXOWDGRV�GH�OD�JDPPDJUDItD�

���
Page 102: Manual practico urgencias medicina interna muy bueno

¢'LDJQyVWLFR" ¢&ODYHV� 3UXHEDV�REOLJDGDVVtVtVt

Vt

6t1R 5HH[SORUDU�\�UHSHWLU�SUXHEDV�EiVLFDV

¢'LDJQyVWLFR" ¢&ODYHV�'LDJQyVWLFDV"

¢'LDJQyVWLFR"

¢'LDJQyVWLFR"

¢'LDJQyVWLFR"

6t

6t

6t

1R

1R

1R

)LJX

���

¢&ODYHV�GLDJQyVWLFDV"

¢&ODYHV�GLDJQyVWLFDV"

ODYHV�GLDJQyVWLFDV"5HH[SORUDU�\�UHSHWLU�SUXHEDV�EiVLFDV

'LDJQy

6HUD����3URWRFROR�)2'

)$6(�,

)$6(�,,

¢& VWLFR

VLyQ 7WR�HPStULFR

Page 103: Manual practico urgencias medicina interna muy bueno

���

%LEOLRJUDItD����%DUEDGR�)-��9i]TXH]�--��3HQD�-0��$UQDOLFK�)��2UWL]�9D]TXH]�-��3\UH[LD�RI�XQNQRZQ�RULJLQ��FKDQJLQJ�VSHFWUXP�RI�GLVHDVHV�LQ�WZR�FRQVHFXWLYH�VHULHV��3RVWJUDG�0HG�-���������������������������&XQKD�%$��)HYHU�RI�8QNQRZQ�RULJLQ��,QIHFWLRXV�GLVHDVH�FOLQLFV�RI�1RUWK�$P����������������������'H�.OHLMQ�(0��9DQ�/LHU�+-��9DQ�GHU�0HHU�-:��7KH�1HWKHUODQGV�)82�6WXG\�*URXS��)HYHU�RI�XQNQRZQ�RULJLQ��)82���,, 'LDJQRVWLF�SURFHGXUH�LQ�D�SURVSHFWLYH�PXOWLFHQWHU�VWXG\�RI�����SDWLHQWV��0HGLFLQH��%DOWLPRUH����������������������� 'H� .OHLMQ�(0�� 9DQGHQEURXFNH�-3�� 9DQ�GHU�0HHU� -:��7KH�1HWKHUODQGV�)82�6WXG\�*URXS��)HYHU� RI� XQNQRZQ� RULJLQ� �)82��� ,�� $� SURVSHFWLYH�PXOWLFHQWHU� VWXG\� RI� ���� SDWLHQWV�ZLWK� )82��XVLQJ�IL[HG�HSLGHPLRORJLF�HQWU\�FULWHULD��0HGLFLQH��%DOWLPRUH�����������������������'XUDFN�'7��6WUHHW�$&��)HYHU�RI�XQNQRZQ�RULJLQ�UHH[DPLQHG�DQG�UHGLILQHG��(Q��5HPLQJWRQ�-6��6ZDUW]�01��HGV��&XUUHQW�&OLQLFDO�7RSLFV�LQ�,QIHFWLRXV�'LVHDVHV��%RVWRQ��%ODFNZHOO��������9,,,����������.QRFNDHUW�'&��9DQQHVWH�/-��%REEDHUV�+-��)HYHU�RI�XQNQRZQ�RULJLQ�LQ�HOGHUO\�SDWLHQWV��-�$P�*HULDWU�6RF������������������������.QRFNDHUW�'&��9DQQHVWH�/-��9DQQHVWH�6%��%REEDHUV�-��)HYHU�RI�XQNQRZQ�RULJLQ�LQ�WKH�����V��$Q�XSGDWHG�RI�WKH�GLDJQRVWLF�VSHFWUXP��$UFK�,QWHUQ�0HG���������������������1RUPDQ�'&��<RVKLNDZD�77��IHYHU�LQ�WKH�HOGHUO\��,QIHFWLRXV�'LVHDVH�&OLQLFV�RI�1RUWK�$P�������������������� 3HWHUVGRUI� 52�� %HHQVRQ� 3%�� )HYHU� RI� XQH[SOLFDWHG� RULJLQ� UHSRUW� RI� ���� FDVHV��0HGLFLQH��%DOWLPRUH��������������������� 5DPRV� -0�� 5DPRV� 5�� +HUUHUR� )�� )LHEUH� GH� RULJHQ� GHVFRQRFLGR� HQ� 0HGLFLQD� ,QWHUQD��([SHULHQFLD�GH�DXWRUHV�HVSDxROHV�GXUDQWH����DxRV��$Q�0HG�,QWHUQD��0DGULG������������������������ :RQJ� 6<�� /DP� 06� 3\UH[LD� RI� XQNQRZQ� RULJLQ�� 6LQJDSRUH� 0HG� -� ������ ���� ���������DEVWUDFW��

Page 104: Manual practico urgencias medicina interna muy bueno

���

7UDWDPLHQWR�DQWLUUHWURYLUDO�HQ�OD�LQIHFFLyQ�SRU�HO�YLUXV�GH�OD�LQPXQRGHILFLHQFLD�KXPDQD��$UULED�--��0DUWtQH]�$OIDUR�(��0DWHRV�)��� ,QWURGXFFLyQ��7UDV�HO�GLDJQyVWLFR�GH�OD�LQIHFFLyQ�SRU�HO�YLUXV�GH�OD�LQPXQRGHILFLHQFLD�KXPDQD��9,+��VH�GHEH�UHDOL]DU�XQ�HVWXGLR�DO�SDFLHQWH��SDUD�GHWHUPLQDU�HO�HVWDGLR�GH�OD�HQIHUPHGDG�\�VX�VLWXDFLyQ�EDVDO��$SDUWH� GH� XQD� DQDPQHVLV� \� H[SORUDFLyQ� ItVLFD� FXLGDGRVDV� VH� UHDOL]DUi� XQ� KHPRJUDPD��ELRTXtPLFD�EiVLFD��UDGLRJUDItD�GH�WyUD[��FRQWDMH�GH�OLQIRFLWRV�&'��\�&'���GRV�GHWHUPLQDFLRQHV�GH�QLYHOHV�GH�51$�GHO�9,+��XQ�WHVW�9'5/��SUXHED�GH�0DQWRX[�\�0XOWLWHVW�HQ�FDVR�GH�TXH�OD�SULPHUD�VHD�QHJDWLYD��VHURORJtD�GH�WR[RSODVPD��FLWRPHJDORYLUXV�\�GH�ORV�YLUXV�GH ODV��KHSDWLWLV�%�\�&��(Q�ODV�PXMHUHV�GHEH�UHDOL]DUVH�HVWXGLR�JLQHFROyJLFR�FRQ�FLWRORJtD��)RQGR�GH�RMR�VL� ORV�&'��VRQ�������FHOV�P/�(Q�OD�SULPHUD�WRPD�GH�FRQWDFWR�FRQ�HO�SDFLHQWH�FRQ�LQIHFFLyQ�9,+�WDPELpQ�VH�GHEH�LQIRUPDU�VREUH� OD� HQIHUPHGDG�� VXV�PHFDQLVPRV� GH� WUDQVPLVLyQ�� UHDOL]DU� FRQVHMR� SDUD� WHQHU� UHODFLRQHV�VH[XDOHV� VHJXUDV� \� PHGLGDV� GH� SUHFDXFLyQ� �QR� FRPSDUWLU� MHULQJXLOODV�� HQ� FDVR� GH� VHU�FRQVXPLGRUHV� GH� GURJDV� LQWUDYHQRVDV�� (Q� FDVR� QHFHVDULR� VH� DSRUWDUi� DSR\R� SVLFROyJLFR� SRU�SHUVRQDO�HVSHFLDOL]DGR�'HEHPRV� WHQHU� HQ� FXHQWD� TXH� HO� WUDWDPLHQWR� GH� HVWRV� SDFLHQWHV� VH� KD� GH� EDVDU� HQ� OD�LQIRUPDFLyQ�PiV� UHFLHQWH� \� DFWXDOL]DU� OD� WHUDSpXWLFD� GHO� SDFLHQWH� D�PHGLGD�TXH�VH� LQWURGXFHQ�LQQRYDFLRQHV����6HQWLGR�GHO�WUDWDPLHQWR�DQWLUUHWURYLUDO��7$��/RV�SDFLHQWHV� FRQ� LQIHFFLyQ�9,+�VH� GLYLGHQ�HQ� GRV� JUXSRV�� ORV� DVLQWRPiWLFRV�FRQ�&'��!�����FHOV�P/�\��ORV�VLQWRPiWLFRV��VLQWRPDWRORJtD�SURSLD�GH�OD�LQIHFFLyQ�9,+��LQIHFFLRQHV�LQWHUFXUUHQWHV��R�FRQ�&'��������FHOV�P/��(O�SURQyVWLFR�YLWDO�\�OD�SRVLELOLGDG�GH�GHVDUUROOR�GH�XQD FRPSOLFDFLyQ�GHILQLWRULD�GH�6,'$�VH�UHODFLRQDQ�HVWUHFKDPHQWH�FRQ�ORV�QLYHOHV�GH�FDUJD�YLUDO�$Vt� FRPR� HVWD� GHPRVWUDGR� TXH� HO� 7$� SURSRUFLRQD� EHQHILFLR� FOtQLFR� HQ� ORV� SDFLHQWHV� FRQ�LQIHFFLyQ�9,+�DYDQ]DGD��QR�VH�KD�GHPRVWUDGR�EHQHILFLR�D�ODUJR�SOD]R�HQ�ORV�SDFLHQWHV�TXH�WLHQHQ�PiV� GH� ���� &'��P/�� /D� PHGLFDFLyQ� GLVSRQLEOH� SRVHH� XQD� JUDQ� SRWHQFLD� HQ� WpUPLQRV� GH�GLVPLQXFLyQ�GH� OD�FDUJD�YLUDO� \�PHMRUtD�GHO�VLVWHPD� LQPXQH��6LQ�HPEDUJR��HVWD�PHGLFDFLyQ�QR�HVWi�H[HQWD�GH�HIHFWRV�VHFXQGDULRV�\�SLHUGH�HILFDFLD�VL�HO�SDFLHQWH�QR�FXPSOH�ELHQ�HO�WUDWDPLHQWR��3RU�WDQWR��HO�LQLFLR�GHO�7$�HQ�ORV�SDFLHQWHV�DVLQWRPiWLFRV�KD�GH�VHU�XQD�RSFLyQ�GH�FRQVHQVR�FRQ�HO�SDFLHQWH�WHQLHQGR�HQ�FXHQWD�ORV�ULHVJRV�\�ORV�EHQHILFLRV��(QWUH�ORV�EHQHILFLRV SRWHQFLDOHV�WHQHPRV��FRQWURO�GH�OD�UHSOLFDFLyQ�\�GH�ODV�PXWDFLRQHV�YLUDOHV��SUHYHQFLyQ�GH�OD�LQPXQRGHILFLHQFLD�SURJUHVLYD�R�UHFRQVWLWXFLyQ�GHO�VLVWHPD�LQPXQH��UHWUDVR�GH�OD�SURJUHVLyQ�D�6,'$�\�SURORQJDFLyQ�GH�OD�YLGD��GLVPLQXFLyQ�GHO�ULHVJR�GH�VHOHFFLyQ�GH�UHVLVWHQFLDV��SRVLEOH�GHVFHQVR�GH��OD�WUDQVPLVLyQ�GHO�YLUXV��3RU� RWUR� ODGR� ORV� ULHVJRV VRQ�� UHGXFLU� OD� FDOLGDG� GH� YLGD� GHO� SDFLHQWH� SRU� ORV� HIHFWRV�VHFXQGDULRV�GH�OD�PHGLFDFLyQ��GHVDUUROOR�SUHFR]�GH�UHVLVWHQFLDV�D�ORV�IiUPDFRV��OLPLWDFLyQ�IXWXUD�GH�ODV�RSFLRQHV�WHUDSpXWLFDV�SRU�ODV�UHVLVWHQFLDV�GHVDUUROODGDV��WUDQVPLVLyQ�GH�YLUXV�UHVLVWHQWHV��\�GHVFRQRFLPLHQWR�GH�OD�HILFDFLD�\�GH�ORV�HIHFWRV�VHFXQGDULRV�GHO�7$�D�ODUJR�SOD]R��

Page 105: Manual practico urgencias medicina interna muy bueno

���

(Q�ORV�SDFLHQWHV�FRQ�LQIHFFLyQ�9,+�DYDQ]DGD��FRPR�\D�KHPRV�FRPHQWDGR�SUHYLDPHQWH��VH�KD�GHPRVWUDGR�EHQHILFLR�FOtQLFR��YLUROyJLFR�H�LQPXQROyJLFR��3RU�WDQWR��HQ�HVWH�JUXSR�OD�LQGLFDFLyQ�GHO�WUDWDPLHQWR�HV�LQGXGDEOH����,QGLFDFLRQHV�SDUD�HO�LQLFLR�GHO�WUDWDPLHQWR�$FWXDOPHQWH�ODV�UHFRPHQGDFLRQHV�GH�WUDWDPLHQWR�LQHOXGLEOH�GHEHQ�LQFOXLU�D�DTXHOORV�SDFLHQWHV�FRQ�&'��������FHOV��P/��PiV�GH��������FRSLDV�GH�FDUJD�YLUDO��LQIHFFLyQ�SULPDULD�\�HPEDUD]R�(Q� ORV�SDFLHQWHV�FRQ�&'��!�����FHOV�P/�DVLQWRPiWLFRV�\�PHQRV�GH��������FRSLDV�GH�51$�9,+�� VH� GHEHQ� H[SOLFDU� ORV� ULHVJRV� \� EHQHILFLRV� GHO� 7$�� \� OOHJDU� D� XQD� VROXFLyQ� FRQVHQVXDGD�SDFLHQWH�PpGLFR�����2EMHWLYRV�GHO�WUDWDPLHQWR�8QD�YH]�TXH�VH�GHFLGH� LQLFLDU�HO� WUDWDPLHQWR� WHQGUi�FRPR�REMHWLYR�GLVPLQXLU� OD�FDUJD�YLUDO�D�QLYHOHV�LQGHWHFWDEOHV�GH�PRGR�PDQWHQLGR�\�FRQ�XQD�RSFLyQ�WHUDSpXWLFD�TXH�VHD�ELHQ�WROHUDGD�SRU�HO�SDFLHQWH��6H�GHEH EXVFDU�XQD�FDUJD�YLUDO�QHJDWLYD�FRQ�WpFQLFD�XOWUDVHQVLEOH��FDSD]�GH�GHWHFWDU����R�LQFOXVR����FRSLDV�P/�����7UDWDPLHQWR�LQLFLDO�/DV�DSUR[LPDFLRQHV�WHUDSpXWLFDV�LQLFLDOHV�HQ�ORV�SDFLHQWHV�FRQ�LQIHFFLyQ�9,+�VRQ�GRV�$JUHVLYD��HQ�OD�TXH�ORV�SDFLHQWHV�UHFLEHQ�WUDWDPLHQWR�WHPSUDQR�SRU�TXH�OD�LQIHFFLyQ�9,+�HV�YLUWXDOPHQWH�VLHPSUH�SURJUHVLYD&RQVHUYDGRUD��HQ�OD�TXH�OD�WHUDSpXWLFD�VH�UHWUDVD�DO�FRQWUDSHVDU�ORV�ULHVJRV�\�ORV�EHQHILFLRV��(Q�OD�DFWXDOLGDG�WLHQH�PiV�SUHGLFDPHQWR�OD�SULPHUD��$Vt�FXDQGR�VH�LQLFLD�XQ�WUDWDPLHQWR��VH�GHEH�FRPHQ]DU�FRQ�XQ�UpJLPHQ�TXH��UHGX]FD�OD�FDUJD�YLUDO�D�QLYHOHV�LQGHWHFWDEOHV�7HQLHQGR�HQ�FXHQWD�TXH�OD�SULPHUD�RSRUWXQLGDG�GH�WUDWDPLHQWR�HV�OD�PHMRU�\�XQD�YH]�TXH�IDOOD�QR�YD�D�LU�ELHQ��HQ�OD�SULPHUD�FRPELQDFLyQ�WHUDSpXWLFD�VH�GHEH�EXVFDU�XQD�VXSUHVLyQ�GXUDGHUD�GH�OD�FDUJD�YLUDO�/DV�RSFLRQHV�WHUDSpXWLFDV�UHFRPHQGDGDV�VRQ�ODV�H[SUHVDGDV�HQ�OD 7DEOD�,��FRPELQDQGR�XQ�JUXSR�GH�IiUPDFRV�GH�OD�FROXPQD�$�FRQ�RWUR�GH�OD�% ��HQWUH�SDUpQWHVLV�VH�HVSHFLILFD�HO�QLYHO�GH�HYLGHQFLD�TXH�DSR\D D�FDGD�IiUPDFR�R�FRPELQDFLyQ��1R� VH� UHFRPLHQGDQ� ODV� VLJXLHQWHV� FRPELQDFLRQHV� �SRU� LQWHUDFFLyQ� GH� UHVLVWHQFLDV� R�WR[LFLGDGHV�VLPLODUHV���G�7���$=7��GG&��GG,��GG&���G�7��GG&����7&���7DEOD�,��$QWLUUHWURYLUDOHV�UHFRPHQGDGRV*UXSR�$ *UXSR�%$=7��GGO��$,� 5LWRQDYLU��$,�$=7��GG&��$,� ,QGLQDYLU��$,�$=7���7&��$,� 1HOILQDYLU��$,,�'�7���GGO��$,,� 6DTXLQDYLU�FiS�EODQGD��$,,�'�7����7&��$,, (IDYLUHQ]��$,,�1HYLUDSLQD��%,,�

Page 106: Manual practico urgencias medicina interna muy bueno

���

(Q� OD� 7DEOD� ,, VH� UHVXPH� OD� SRVRORJtD� GH� ORV� DQWLUUHWURYLUDOHV� GLVSRQLEOHV� HQ� (VSDxD� HQ2FWXEUH�GH������7DEOD�,,��$QWLUUHWURYLUDOHV�GLVSRQLEOHV�HQ�RFWXEUH�GHO���)iUPDFR 1RPEUH�JHQpULFR 3UHVHQWDFLyQ 0RGR�GH�$GPyQ(SLYLU �7&�R�ODPLYXGLQD &RPSV�����PJ ��FRPSULPLGR�HQ�GHVD\XQR�\�RWUR�HQ�OD�FHQD+LYLG GG&�R�=DOFLWDELQD 7DEV������PJ ��FRPSULPLGR�HQ�GHVD\XQR��FRPLGD�\�FHQD5HWURYLU $=7�R�=LGRYXGLQD &DSV�����PJ ��FDSV�HQ�GHVD\XQR�\�RWUD�HQ�OD�FHQD9LGH] GGO�R�'LGDQRVLQD FRPSV�����\�����PJ ��������PJ�PDVWLFDGRV�R�GLVXHOWRV�DO�PHQRV�PHGLD�KRUD�DQWHV�R�GRV�KRUDV�GHVSXpV�GH�XQD�FRPLGD�FDGD����KRUDV�=HULW G�7�R�(VWDYXGLQD &DSV����\����PJ ��FDSV�HQ�GHVD\XQR�\�RWUD�HQ�FHQD9LUDPXQH 1HYLUDSLQD &RPSV�����PJ ��FRPS�GtD�GXUDQWH�GRV�VHPDQDV�\�GHVSXHV���FRPS����K�6XVWLYD (IDYLUHQ] &RPSV�����PJ ��FRPSV�GtD�HQ�XQD�VROD�WRPD�HQ�OD�FHQD�FRQ�R�VLQ�FRPLGD&UL[LYDQ ,QGLQDYLU &DSV�����PJ ��FDSV�XQD�KRUD�DQWHV�R�GRV�GHVSXpV�GH�'H��&R�\�&H��%HEHU�PiV�GH�GRV�OLWURV�GH�OtTXLGR�DO�GtD,QYLUDVH 6DTXLQDYLU�FDS�GXUD &DSV�����PJ ��FiSV�LQPHGLDWDPHQWH�GHVSXpV�GH�'H��&R�\�&H)RUWRYDVH 6DTXLQDYLU�F�EODQGD &DSV�����PJ ��FRPSV���YHFHV�DO�GtD�WRPDGRV�PHQRV�GH�GRV�KRUDV�GHVSXpV�GH�'H��&R�\�&H�1RUYLU 5LQRQDYLU 6ROXFLyQ�����PO �����PJ ����PO�HQ�GHVD\XQR�\�FHQD�RUDO��1R�HV�SUHFLVR�FRQVHUYDU�HQ�IULJRULILFR��$GPyQ�SURJUHVLYD���������GtDV������GtDV���������GtDV��\�GHVSXpV ����PO���KRUDV9LUDFHSW 1HOILQDYLU &DSV�����PO ��FRPS����KRUDV�R���FRPSV���KRUDV�7RPDU�FRQ�ODV�FRPLGDV/RV�LQKLELGRUHV�GH�ODV�SURWHDVDV��D�ORV�TXH�DQWHV�KHPRV�KHFKR�PHQFLyQ��SRVHHQ�PXOWLWXG�GH�LQWHUDFFLRQHV� IDUPDFROyJLFDV� TXH�KHPRV�GH� WHQHU� HQ� FXHQWD�DQWH� OD� SROLIDUPDFLD� D� OD� TXH�VH�VRPHWH�D�HVWRV�SDFLHQWHV���(Q�OD�7DEOD�,,, VH�UHVXPHQ�HVWDV�LQWHUDFFLRQHV��

Page 107: Manual practico urgencias medicina interna muy bueno

���

7DEOD�,,,��LQWHUDFFLRQHV�HQWUH�LQKLELGRUHV�GH�OD�SURWHDVD�\�RWURV�IiUPDFRV5LWRQDYLU�0HSHULGLQD�3ULUR[LFDP�3URSR[LIHQR�$PLRGDURQD�(QFDLQLGD�)OHFDLQLGD�3URSDIHQRQD�5LIDPSLFLQD�5LIDEXWLQD�%HSULGLO�$VWHPL]RO�7HUIHQDGLQD�&LVDSULGD�%XSURSLRQD�&OR]DSLQD�+DORSHULGRO�$OSUD]RODP�&ORUDFHSDWR�'LD]HSDP�(VWD]RODP�)OXUD]HSDP�0LGD]RODP�7ULD]RODP�=ROSLGHP�'LKLGURHUJR��WDPLQD

7LSR�VXVWDQFLD�$QDOJpVLFRV�$QWLDUUtWPLFRV�$QWLPLFURELDQRV�%ORT��FDOFLR�$QWLKLVWDPtQLFRV�3URFLQpWLFRV�$QWLGHSUHVLYRV�1HXUROpSWLFRV�3VLFRWUySLFRV�

(UJRWDPtQLFRV�

,QGLQDYLU�����

5LIDPSLFLQD���

$VWHPL]RO�7HUIHQDGLQD�&LVDSULGD�����

0LGD]RODP�7ULD]RODP�

6DTXLQDYLU�����

5LIDPSLFLQD�5LIDEXWLQD���

$VWHPL]RO�7HUIHQDGLQD�&LVDSULGD�������

1HOILQDYLU���4XLQLGLQD�5LIDPSLFLQD�

��$VWHPL]RO�7HUIHQDGLQD�&LVDSULGD���3LPR]LQD�0LGD]RODP�7ULD]RODP�

$OWHUQDWLYD�$VSLULQD��SDUDFHWDPRO��PHWLPD]RO�1R�KD\�H[SHULHQFLD�DO�UHVSHFWR�&ODULWURPLFLQD�(WDPEXWRO�$]LWURPLFLQD�1R�KD\�H[SHULHQFLD�DO�UHVSHFWR�/RUDWDGLQD�1R�KD\�H[SHULHQFLD�)OXR[HWLQD�'HVLSUDPLQD�1R�KD\�H[SHULHQFLD��/RUD]HSDP�7HPD]HSDP�

1R�KD\�DOWHUQDWLYDV���7UDWDPLHQWR�GH�UHVFDWH�/D�IDOWD�GH�HILFDFLD�WHUDSpXWLFD�VH�SXHGH�PDQLIHVWDU�FRPR��'HVDUUROOR�GH�QXHYDV�LQIHFFLRQHV�RSRUWXQLVWDV��(O�LQLFLR�GH�XQD�7$�SRWHQWH�VH�DVRFLD�VLHPSUH�D�FLHUWR�JUDGR�GH�UHFXSHUDFLyQ�GHO�VLVWHPD�LQPXQH��(Q�ORV�SDFLHQWHV�TXH�WLHQHQ�XQD�HQIHUPHGDG�DYDQ]DGD�SRU�HO�9,+�H� LQIHFFLRQHV�VXEFOtQLFDV� �SRU�HMHPSOR�� LQIHFFLRQHV�SRU�FLWRPHJDORYLUXV�R�SRU 0\FREDFWHULXP�DYLXP�LQWUDFHOXOODUH���VH�SXHGHQ�SURGXFLU�PDQLIHVWDFLRQHV�FOtQLFDV�HQ�UHODFLyQ�

Page 108: Manual practico urgencias medicina interna muy bueno

���

FRQ�OD�PHMRUtD�GHO�VLVWHPD�LQPXQH��(VWDV�PDQLIHVWDFLRQHV�QR�VH�KDQ�GH�LQWHUSUHWDU�FRPR�IDOOR�GHO�WUDWDPLHQWR�DQWLYLUDO��'LVPLQXFLyQ� VXEySWLPD� GH� OD� FDUJD� YLUDO ��� �� ORJ� D� ODV� �� VHPDQDV� y� ��������� ORJ� D� ODV� ��VHPDQDV��)UDFDVR�SDUD�VXSULPLU�ORV�QLYHOHV�GH�FDUJD�YLUDO�KDVWD�QLYHOHV�LQGHWHFWDEOHV�HQ�HO�LQWHUYDOR�GH�����PHVHV��5HDSDULFLyQ�GH�OD�FDUJD�YLUDO�WUDV�VX�QHJDWLYL]DFLyQ��,QFUHPHQWR�GH�OD�FDUJD�YLUDO UHVSHFWR�DO�QDGLU�GHO�GHVFHQVR��FXDQGR�HO�FDPELR�VH�EDVD�HQ�OD�FDUJD�YLUDO��UHSHWLUOD�DO�PHQRV���YHFHV�HQ�XQ�SHULRGR�GH�XQ�PHV�DQWHV�GH�GHFLGLU�HO�FDPELR���'HVFHQVR�GHO�Q~PHUR�GH�&'����FRQILUPDGR�HQ�DO�PHQRV�HQ�GRV�GHWHUPLQDFLRQHV��/D� SUHVHQFLD� GH� XQ� IDOOR� WHUDSpXWLFR� QR� GHEH� KDFHUQRV� SHQVDU� H[FOXVLYDPHQWH� HQ HO�GHVDUUROOR� GH� UHVLVWHQFLDV� FRPR� FDXVDQWH� GHO� PLVPR�� WDPELpQ� SXHGH� VHU� GHELGR� D� XQD�DGKHUHQFLD�LQDGHFXDGD�DO�WUDWDPLHQWR��LQWHUDFFLRQHV�IDUPDFROyJLFDV�\�DOWHUDFLyQ�HQ�OD�DEVRUFLyQ�GH�ORV�IiUPDFRV�TXH�SURYRFD�QLYHOHV�VXEySWLPRV�GH�HVWRV�8QD�YH]�TXH�KHPRV�GHVFDUWDGR�UD]RQDEOHPHQWH�ODV�RSFLRQHV�GHVFULWDV�HQ�HO�SiUUDIR�DQWHULRU��SRGHPRV��DWULEXLU�HO�IDOOR�WHUDSpXWLFR�DO�GHVDUUROOR�GH�UHVLVWHQFLDV��$GHPiV� GH� ORV� SDFLHQWHV� VXEVLGLDULRV� GH� WUDWDPLHQWR� GH� UHVFDWH� SRU� GHVDUUROOR� GH�UHVLVWHQFLDV��WDPELpQ�OR�VRQ�ORV�TXH�UHFLEHQ�PRQR�R�ELWHUDSLD��WUDWDPLHQWRV�VXEySWLPRV��/D� UHJOD� GH� RUR� HQ� HO� WUDWDPLHQWR� GH� UHVFDWH� HV� XWLOL]DU� �� y� �� QXHYRV� DQWLUUHWURYLUDOHV�� (Q�SDFLHQWHV�SROLWUDWDGRV�SXHGH�VHU�GH�XWLOLGDG�OD�UHDOL]DFLyQ�GH�HVWXGLR�GH�UHVLVWHQFLDV��JHQRWtSLFDV�R�IHQRWtSLFDV��TXH�QRV�D\XGH�HQ�OD�HOHFFLyQ�GH�ORV�IiUPDFRV�(V�LPSRVLEOH�HQXPHUDU�WRGDV�ORV�SRVLEOHV�WUDWDPLHQWRV�GH�UHVFDWH��$�FRQWLQXDFLyQ�GHWDOODPRV�DOJXQRV�GH�HOORV�6L�UHFLEtD�WUDWDPLHQWR�FRQ����DQiORJRV����1HOILQDYLU�����QXHYRV�DQiORJRV����6DTXLQDYLU���5LWRQDYLU5LWRQDYLU�,QGLQDYLU(IDYLUHQ]���5LWRQDYLU(IDYLUHQ]���,QGLQDYLU6L�UHFLEtD�WUDWDPLHQWR�FRQ���DQiORJRV���5LWRQDYLU�R�,QGLQDYLU����QXHYRV�DQiORJRV�� 6DTXLQDYLU���5LWRQDYLU�1HOILQDYLU���1HYLUDSLQD�R�(IDYLUHQ]�1HOILQDYLU���6DTXLQDYLU(IDYLUHQ]6L�UHFLEtD�WUDWDPLHQWR�FRQ���DQiORJRV���1HYLUDSLQD�(IDYLUHQ]����QXHYRV�DQiORJRV���,QKLELGRU�GH�OD�SURWHDVD�

���7UDWDPLHQWR�HQ�VLWXDFLRQHV�HVSHFLDOHV�

Page 109: Manual practico urgencias medicina interna muy bueno

���

,QIHFFLyQ�SULPDULD��+D\�TXH�WHQHU�HQ�FXHQWD�TXH�HO��������GH�ORV�FDVRV�SDVDQ�DVLQWRPiWLFRV��SRU�OR�WDQWR�KD\�PXFKRV�FDVRV�TXH�SDVDQ�GHVDSHUFLELGRV��$GHPiV�HQ�QXHVWUR�PHGLR��FXDQGR�OD�SUiFWLFD�GH�ULHVJR�HV�OD�8'93��HV�SRFR�IUHFXHQWH�TXH�HO�SDFLHQWH�FRQVXOWH�GXUDQWH�HO�HSLVRGLR�GH�SULPRLQIHFFLyQ�(Q�ORV�SDFLHQWHV�HQ�ORV�TXH�VH�GLDJQRVWLFD�OD�SULPRLQIHFFLyQ�VH�KD�FRPSUREDGR�TXH�OD�VDOLGD�GH� OD�SULPRLQIHFFLyQ�PDUFD�OD�HYROXFLyQ�SRVWHULRU� �SHRU�VL� �D� OD�VDOLGD�KD\�FLIUD�GH�&'��EDMD�\�YLUHPLD� HOHYDGD��� 3RU� HOOR�� OR� DFRQVHMDGR� HV� UHDOL]DU� WUDWDPLHQWR� WULSOH� FRQ� �� DQiORJRV� GH� ORV�QXFOHyVLGRV� \� XQ� LQKLELGRU� GH� OD� SURWHDVD� GH� PRGR� LQGHILQLGR� �QR� H[LVWHQ� HVWXGLRV� TXH�GHWHUPLQHQ�FXDQWR�WLHPSR�VH�KD�GH�PDQWHQHU�HVWH�WUDWDPLHQWR��(PEDUD]R�� HO� HVWXGLR�$&7* ���� HQ� HO� TXH� VH� XWLOL]DED�$=7�D� SDUWLU� GH� OD� ��� VHPDQD�GH�HPEDUD]R�\�KDVWD�HO�SDUWR�GHPRVWUy�TXH�VH�SURGXFtD�XQD�GLVPLQXFLyQ�GH� OD� WUDQVPLVLyQ�GH� OD�LQIHFFLyQ� 9,+� GHO� ��� DO� ���� (Q� OD� DFWXDOLGDG� H[LVWHQ� HVWXGLRV� DELHUWRV� FRQ� QXHYDV� SDXWDV�WHUDSpXWLFDV� TXH SRVHHQ� PD\RU� FDSDFLGDG� GH� UHGXFFLyQ� GH� OD� YLUHPLD� \� TXH� VHDQ� VHJXURV�GXUDQWH� HO� HPEDUD]R��(Q�HVWH� VHQWLGR�� GG,�� �7&� \� QHYLUDSLQD� SDUHFHQ� VHU� VHJXURV� GXUDQWH� HO�HPEDUD]R�(Q�FRQFOXVLyQ��SDUD�HYLWDU� OD� WUDQVPLVLyQ�PDWHUQRIHWDO�GH� OD� LQIHFFLyQ�9,+�VH�UHFRPLHQGD�OD�DGPLQLVWUDFLyQ� GH� $=7�� /D� GHFLVLyQ� GHO� WUDWDPLHQWR� DQWLUUHWURYLUDO� D� HOHJLU� SXHGH� YDULDU�FRQVLGHUDQGR�OD�FLIUD�GH�&'���\�OD�FDUJD�YLUDO�GH�OD�HPEDUD]DGD��VX�H[SRVLFLyQ�SUHYLD�D�$=7��\�D�RWURV�DQWLUUHWURYLUDOHV�\�HO�PRPHQWR�GH�OD�JHVWDFLyQ�HQ�TXH�VH HQFXHQWUD�([LVWH� XQ� SURWRFROR� HVSHFtILFR� FRQVHQVXDGR� SRU� 3HGLDWUtD�� *LQHFRORJtD� \� OD� 8QLGDG� GH�(QIHUPHGDGHV� ,QIHFFLRVDV� GRQGH� VH� GHVDUUROOD� HO� PDQHMR� GH� HVWD� VLWXDFLyQ� FOtQLFD� GH� IRUPD�GHWDOODGD�3XQFLRQHV�DFFLGHQWDOHV�HQ�HO�SHUVRQDO�VDQLWDULR�/D�H[SRVLFLyQ�DO�9,+�HQ�DFFLGHQWHV�ODERUDOHV��IXQGDPHQWDOPHQWH�WUDV�SXQFLRQHV�DFFLGHQWDOHV�TXH�LPSOLFDQ�VDQJUDGR��VH�DVRFLD�FRQ�XQ�ULHVJR�GH�LQIHFFLyQ��GH����������/D�XWLOL]DFLyQ�GH�$=7�GHPRVWUy�XQD�UHGXFFLyQ�GHO������GHO�ULHVJR�GH�FRQWDJLR�HQ�SXQFLRQHV�DFFLGHQWDOHV��3HVH�D�TXH�QR�H[LVWHQ�HVWXGLRV�TXH�GHPXHVWUHQ�OD�HILFDFLD�GH�ODV�GLVWLQWDV�SDXWDV�OD�RSFLyQ�SURSXHVWD�VHJ~Q�SURWRFROR�YLJHQWH�HQ�QXHVWUR�KRVSLWDO�LQFOX\H�XQ�WUDWDPLHQWR�FRQ���$=7����7&���,QGLQDYLU�TXH�GHEHQ�VHU�DGPLQLVWUDGRV�OR�PiV�SUHFR]PHQWH�SRVLEOH�\�GXUDQWH�XQ�SHUtRGR�GH���VHPDQDV��(Q�FDVR�GH�TXH�HO�SDFLHQWH�GHO�TXH�SURFHGH�OD�VDQJUH�GH�OD�SXQFLyQ�DFFLGHQWDO�HVWXYLHUD�HQ�WUDWDPLHQWR��VH�UHDOL]DUi�WUDWDPLHQWR�FRQ�XQD�SDXWD�VLPLODU�D�OD�GHVFULWD�SHUR�TXH�QR�LQFOX\D�ORV�PHGLFDPHQWRV�TXH�UHFLEtD�HO�SDFLHQWH�

%LEOLRJUDItD���&DUSHQWHU�&&��HW�DO��$QWLUUHWURYLUDO�WKHUDSK\�IRU�+,9�LQIHFWLRQ�LQ�������5HFRPHQGDWLRQV�RI�DQ�LQWHUQDWLRQDO�SDQHO��-$0$����������������������� &DUSHQWHU� &&�� HW� DO�� $QWLUUHWURYLUDO� WKHUDSK\� IRU� +,9� LQIHFWLRQ� LQ� ������ XSGDWHG�UHFRPPHQGDWLRQV�RI�WKH�,QWHUQDWLRQDO�$,'6�VRFLHW\�86$�SDQQHO��-$0$����������������������

Page 110: Manual practico urgencias medicina interna muy bueno

���

���&DUSHQWHU�&&��HW�DO��*XLGHOLQHV�IRU�WKH�XVH�RI�DQWLUUHWURYLUDO�DJHQWV�LQ�+,9�LQIHFWHG�DGXOWV�DQG�DGROHVFHQWV��-$0$�������������������������&HQWHUV�IRU�'LVHDVH�&RQWURO DQG�3UHYHQWLRQ��3XEOLF�+HDOWK�6HUYLFH�7DVN�)RUFH���*XLGHOLQHVV�IRU�WKH�XVH�RI�DQWLUUHWURYLUDO�DJHQWV�LQ�+,9�LQIHFWHG�DGXOWV�DQG�DGROHVFHQWV��'LF���������� &HQWHUV� IRU� 'LVHDVH� &RQWURO� DQG� 3UHYHQWLRQ�� 3XEOLF� +HDOWK� 6HUYLFH� 7DVN� )RUFH�UHFRPPHQGDWLRQV�IRU� WKH XVH�RI�DQWLUHWURYLUDO�GUXJV�LQ�SUHJQDQW�IHPDOHV�LQIHFWHG�ZLWK�+,9���IRU�PDWHUQDO�KHDOWK�DQG�IRU�UHGXFLQJ�SHULQDWDO�+,9���WUDQVPLVVLRQ�LQ�WKH�8QLWHG�6WDWHV��00:5������������55�������)DXFL�$6��%DUWOHWW�-*��*RRVE\�(3��HW�DO��*XLGHOLQHVV�IRU�WKH�XVH�RI�DQWLUUHWURYLUDO�DJHQWV�LQ�+,9�LQIHFWHG�DGXOWV�DQG�DGROHVFHQWV��0D\R���������*XOLFN�5��0HOORUV� -�� +DYOLU�'�� HW� DO�� 7UHDWPHQW� ZLWK� LQGLQDYLU�� ]LGRYXGLQH� DQG� ODPLYXGLQH� LQ�DGXOWV�ZLWK�KXPDQ�LQPXQRGHILFLHQF\�YLUXV�LQIHFWLRQ�DQG�SULRU�DQWLUHWURYLUDO�WKHUDS\��1�(QJ�-�0HG�����������������������0DQLRQ�'-��/DEULROD�')��5XL]�10��(IILFDF\�RI�(IDYLUHQ]�FRQWDLQLQJ�UHJLPHQV�LQ�SDWLHQWV�ZLWK�EDVHOLQH� SODVPD� +,9�51$� YLUDO� ORDGV� H[FHHGLQJ� �������� FRSLHV�P/�� �WK�� &RQIHUHQFH� RQ�5HWURYLUXV�DQG�2SRUWXQLVWLF�,QIHFWLRQV��&KLFDJR�)HE ������3RVWHU�������� 0HOORUV� -:�� HW� DO�� 3URJQRVLV� LQ� +,9� LQIHFWLRQ� SUHGLFWHG� E\� WKH� TXDQWLW\� RI� YLUXV� LQ� SODVPD��6FLHQFH�������������������������� 0RQWDQHU� -�� 5HLVV� 3�� &RRSHU� '�� HW� DO�� $� UDQGRPL]HG�� GRXEOHG�ELQG� WULDO� FRPSDULQJ�FRPELQDWLRQV� RI� QHYLUDSLQH� GLGDQRVLQH�� DQG� ]LGRYXGLQH� IRU�+,9�LQIHFWHG� SDWLHQV�� -$0$� �����������������������0RUHQR�6��HW�DO��5HFRPHQGDFLRQHV�VREUH�WUDWDPLHQWR�DQWLUUHWURYLUDO��0HG�&OLQ��%DUF���������������������

Page 111: Manual practico urgencias medicina interna muy bueno

���

'LDJQyVWLFR�\�WUDWDPLHQWR�GH�OD�PHQLQJLWLV�DJXGD�(��*yPH]� 0HULQR� -XOLDQ�6ROLV��-DYLHU�6ROHUD��)HUQDQGR�0DWHRV����(WLRORJtD��(Q� DGXOWRV�� OD� PD\RUtD� GH� ORV� FDVRV� GH� PHQLQJLWLV� DGTXLULGD� HQ� OD� FRPXQLGDG� HVWiQ�SURGXFLGRV�SRU�HO�PHQLQJRFRFR��QHXPRFRFR��/LVWHULD \�YDULRV�HVWUHSWRFRFRV��/RV�JpUPHQHV�HQ�ORV�FDVRV�QRVRFRPLDOHV�VRQ��EDFLORV�*UDP�QHJDWLYRV��HVWUHSWRFRFRV��6��DXUHXV R�HVWDILORFRFRV�FRDJXODVD�QHJDWLYRV��(O�+��LQIOXHQ]DH HV�XQD�FDXVD�LQIUHFXHQWH�GH�PHQLQJLWLV�HQ�ORV�DGXOWRV��\�FXDQGR�HVWi�SUHVHQWH��SXHGH�LQGLFDU�OD�SUHVHQFLD�GH�XQD�ItVWXOD�GH�/&5�/D�PHQLQJLWLV DVpSWLFD�HVWi�FDXVDGD�FRQ�IUHFXHQFLD�SRU�HQWHURYLUXV��WDO�FRPR�HO�&RVDFNLH�YLUXV R�(FKRYLUXV��6LQ�HPEDUJR��WDPELpQ�GHEHQ�VHU�FRQVLGHUDGRV�RWURV�YLUXV��+HUSHV���%UXFHOOD�VSS��0��WXEHUFXORVLV��7��SDOOLGXP��%��EXUJGRUIHUL��&U\SWRFRFFXV�QHRIRUPDQV� \�7R[RSODVPD�JRQGLL��LQIHFFLRQHV�SDUDPHQLQJHDV��KLSHUVHQVLELOLGDG�D�IiUPDFRV�\�QHRSODVLDV����'LVWULEXFLyQ�HWLROyJLFD��/D�SUHYDOHQFLD�UHODWLYD�GH�OD�PHQLQJLWLV�EDFWHULDQD�UHVSHFWR�D�OD�PHQLQJLWLV�YtULFD�YDUtD�FRQ�OD�HGDG�\�OD�HVWDFLyQ�GHO�DxR��/D�PHQLQJLWLV�YtULFD�HV�PiV�IUHFXHQWH�HQ�ORV�PHVHV�GH�YHUDQR�\�OD�EDFWHULDQD�HQ�HO�LQYLHUQR��(O�ULHVJR�GH�PHQLQJLWLV�EDFWHULDQD�HV�PD\RU�HQ�ORV�QLxRV�PHQRUHV�GH����PHVHV�\�HQ�ORV�SDFLHQWHV�DQFLDQRV����&OtQLFD��6tQGURPH� PHQtQJHR�� )LHEUH� JHQHUDOPHQWH� HOHYDGD�� SXHGH� IDOWDU HQ�� DQFLDQRV�� QLxRV�SHTXHxRV� \� VLWXDFLyQ� GH� VKRFN�� 6LJQRV� GH� LUULWDFLyQ� PHQtQJHD� �ULJLGH]� GH� QXFD�� .HUQLQJ� \�%UXG]LQVNL��� (Q� DOJXQRV� SDFLHQWHV� �QHRQDWRV�� DQFLDQRV�� QHXWURSpQLFRV�� WUDXPDWLVPR�FUDQHRHQFHIiOLFR��SXHGH�PDQLIHVWDUVH�VRODPHQWH�FRPR�DOWHUDFLRQHV GHO�QLYHO�GH�FRQFLHQFLD����3UXHEDV�FRPSOHPHQWDULDV�EiVLFDV(Q� OD� HYDOXDFLyQ� GH� ODV� PHQLQJLWLV� DJXGDV� VRQ� ODV� VLJXLHQWHV�� KHPRJUDPD�� ELRTXtPLFD�EiVLFD��FRPSOHWDU�FRQ�SURWHtQD�&�UHDFWLYD�WUDV�LQJUHVR�HQ�SODQWD��\�HVWXGLR�GH�FRDJXODFLyQ��IRQGR�GH�RMR��UDGLRJUDItD�GH�WyUD[��KHPRFXOWLYRV�\�FXOWLYR�GH�WRGRV�ORV�IRFRV�DFFHVLEOHV��7$&�FHUHEUDO�FXDQGR�OD�FOtQLFD�PHQtQJHD�VH�DVRFLD�D�GHWHUPLQDGDV�PDQLIHVWDFLRQHV��GpILFLW�QHXUROyJLFR�IRFDO��FRQYXOVLRQHV��FOtQLFD�GH�KLSHUWHQVLyQ�HQGRFUDQHDQD�R�FOtQLFD�GH�OD�HVIHUD�RWRUULQRODULQJROyJLFD�

Page 112: Manual practico urgencias medicina interna muy bueno

��7UDV� OD�VRVSHFKD�FOtQLFD�GH�PHQLQJLWLV��VX�FRQILUPDFLyQ VH�EDVD�HQ�HO�KDOOD]JR�GH�XQ�/&5�LQIODPDWRULR�� SRU� WDQWR� OD�SUXHED� IXQGDPHQWDO�HQ� OD�HYDOXDFLyQ�GH� ODV�PHQLQJLWLV�HV� OD�SXQFLyQ�

OXPEDU�TXH�SHUPLWH�HO�HVWXGLR�GHO�OtTXLGR�FHIDORUUDTXtGHR��(O�SHUILO�WtSLFR�GH�ORV�GLVWLQWRV�WLSRV�GH�PHQLQJLWLV� VH� UHVXPH� HQ� OD� 7DEOD� ,�� 1R� REVWDQWH�� GHELGR� D� TXH� H[LVWH� XQ� VRODSDPLHQWR�FRQVLGHUDEOH�HQWUH�YDORUHV��QR�VLHPSUH�HV�SRVLEOH�XQD�GLVWLQFLyQ�ILDEOH�HQWUH�ODV�GLVWLQWDV�FDXVDV�GH�PHQLQJLWLV��2WUDV�SUXHEDV�GLDJQyVWLFDV�HQ�HO�/&5�~WLOHV�VRQ��OD�WLQFLyQ�GH�*UDP��GHWHFFLyQ�GH�DQWtJHQRV� FDSVXODUHV�� WLQFLyQ� SDUD� %$$5�� $'$�� HVWXGLR� FLWROyJLFR� SRU� DQDWRPtD� SDWROyJLFD��VHURORJtD� GH� OXHV� \� %UXFHOOD� WLQFLyQ� GH� WLQWD� FKLQD� \� DQWtJHQR� FULSWRFyFLFR�� FXOWLYRV� SDUD�EDFWHULDV��PLFREDFWHULDV�\�KRQJRV��\�3&5�SDUD�YLUXV�GHO�JUXSR�+HUSHV����$LVODPLHQWR�7DQWR� ODV� PHQLQJLWLV� YtULFDV� FRPR� ODV� EDFWHULDQDV� VRQ� WUDQVPLVLEOHV�� YtD� HQWpULFD� ODV�SULPHUDV�\�YtD�UHVSLUDWRULD� ODV�VHJXQGDV��PHQLQJRFyFLFD�IXQGDPHQWDOPHQWH���$QWH�XQ�SDFLHQWH�TXH� LQJUHVH�FRQ�HO�GLDJQyVWLFR�GH�PHQLQJLWLV�PDQWHQGUHPRV�DLVODPLHQWR�UHVSLUDWRULR�\�HQWpULFR�K �U �H� �V �P �* O�

7DEOD�,��3HUILO�WtSLFR�GHO�/&5�HQ�GLVWLQWRV�WLSRV�GH�PHQLQJLWLV7LSR�GH�0HQLQJLWLV %DFWHULDQD� 9tULFD 7EF &ULSWRFyFLFD 9DORUHV�QRUPDOHV3UHVLyQ�GH�DSHUWXUD��PP�+�2� ������� ������ ������� ������� ������*OXFRVD�/&5��PJ�G/� ��� ����� ��� ��� �����3URWHtQDV��PJ�G/� !��� ������ ������� ������ �����5HFXHQWR�/HXFRFLWRV��FpOV��/� ��������� ������ ����� ����� ���7LSR�GH�FpOV�SUHGRPLQDQWH 1HXWUyILORV /LQIRFLWRV /LQIRFLWRV /LQIRFLWRV /LQIRFLWRV �/D�FRQFHQWUDFLyQ�GH�JOXFRVD�HQ�HO�/&5�SXHGH�VHU�QRUPDO�LQLFLDOPHQWH�FRQ�GHVDUU ROOR�SRVWHULRU�GH�KLSRJOXFRUUDTXLD�� �(Q�ORV�SULPHURV�HVWDGLRV�GH�XQD�PHQLQJLWLV�YtULFD�SXHGH�H[LVWLU�XQD�SUHGRPLQDQFLD��LQLFLDO��GH�QHXWUyILORV����8Q�/&5�FRQ�JOXFRVD������PJ�G/��SURWHtQDV�!�����PJ�G/��Q��OHXFRFLWRV�!�������R�!�������QHXWUyILORV��SHUPLWH�SUHVXSRQHU�0HQLQJLWLV�EDFWHULDQD�FRQ�XQD�FHUWH]D�GHO�����

���

DVWD�VX�GLDJQyVWLFR��VL�HO�GLDJQyVWLFR�HV�GH�PHQLQJLWLV�PHQLQJRFyFLFD�VH�UHDOL]DUi�DLVODPLHQWRHVSLUDWRULR�GXUDQWH����KRUDV��PLHQWUDV�TXH�VL�OD PHQLQJLWLV�HV�YtULFD�VH�PDQWHQGUiQ�SUHFDXFLRQHVQWpULFDV�GXUDQWH�XQD�VHPDQD���7UDWDPLHQWR��(Q�OD�PD\RUtD�GH�ODV�RFDVLRQHV�HO�WUDWDPLHQWR�GH�OD�PHQLQJLWLV�YtULFD�HV�VLQWRPiWLFR��6L�VHRVSHFKD�PHQLQJLWLV�SRU�YLUXV�GHO�JUXSR�+HUSHV�GHEH�LQLFLDUVH�WUDWDPLHQWR�FRQ�$FLFORYLU��GRVLV���J�.J���K���(O�WUDWDPLHQWR�GH�OD�PHQLQJLWLV�EDFWHULDQD�GHEH�JXLDUVH�SRU�ORV�GDWRV�GH�OD�WLQFLyQ�GHUDP� GHO� /&5� \� OD� GHWHUPLQDFLyQ� GH� ORV� DQWtJHQRV� FDSVXODUHV� \� GHEHUtD� WHQHU� HQ� FXHQWD� H

Page 113: Manual practico urgencias medicina interna muy bueno

���

SDWUyQ�GH�UHVLVWHQFLD�D�ORV�DQWLELyWLFRV�GH�ORV�JpUPHQHV�FRQVLGHUDGRV�\�HO�SHUILO�GH�ULHVJR�GH�ORV�SDFLHQWHV��7DEOD�,,���6L�OD�WLQFLyQ�GH�*UDP�HV�QHJDWLYD��HO�WUDWDPLHQWR�HPStULFR�GH�OD�PHQLQJLWLV�DGTXLULGD� HQ� OD� FRPXQLGDG�� HQ� DGXOWRV� MyYHQHV�� HV� XQD� FHIDORVSRULQD� GH� WHUFHUD� JHQHUDFLyQ��&HIRWD[LPD�R�&HIWULD[RQD���(Q�SHUVRQDV�PD\RUHV�\�HQ�SDFLHQWHV�LQPXQRGHSULPLGRV�GH�WRGDV�ODV�HGDGHV��TXH�SXHGHQ�SUHVHQWDU� LQIHFFLyQ� SRU�/LVWHULD�� VH� GHEH� FRPELQDU�XQD�FHIDORVSRULQD�GH�WHUFHUD�JHQHUDFLyQ�\�DPSLFLOLQD��(Q�ODV�PHQLQJLWLV�QRVRFRPLDOHV��HO� WUDWDPLHQWR�GHEH�FXEULU� ORV�EDFLORV�*UDP�QHJDWLYRV�\�ORV�HVWDILORFRFRV�

Page 114: Manual practico urgencias medicina interna muy bueno

���

7DEOD�,,��WUDWDPLHQWR�DQWLPLFURELDQR�GH�OD�PHQLQJLWLV�EDFWHULDQD6LHPSUH�SRU�YtD�LQWUDYHQRVD�D�GRVLV�Pi[LPDV��7UDWDPLHQWR�HPStULFR�LQLFLDO�HQ�XQ�WLHPSR�TXH�VH�DSUR[LPH�OR�PiV�SRVLEOH�D����PLQXWRV�*UDP�RULHQWDWLYR&RFRV�JUDPSRVLWLYRV��YDQFRPLFLQD�\�FHIDORVSRULQD���*�&RFRV�JUDPQHJDWLYRV��SHQLFLOLQD�*�%DFLORV�JUDPSRVLWLYRV��DPSLFLOLQD��R�SHQLFLOLQD�*�\�DPLQRJOLFyVLGR�%DFLORV�JUDPQHJDWLYRV��FHIDORVSRULQD����*�\�DPLQRJOLFyVLGR*UDP�QR�RULHQWDWLYR��6LQ�IDFWRUHV�GH�ULHVJR !���PHVHV�GH�HGDG��FHIRWD[LPD��y�FHIWULD[RQD�� 1HRQDWRV�\�!����DxRV��FHIRWD[LPD�PiV�DPSLFLOLQD��&RQ�IDFWRUHV�GH�ULHVJR� 7&(�FHUUDGR��ItVWXOD�/&5��&HIRWD[LPD�R�FHIWULDVRQD�� ,QPXQRGHSULPLGRV�QR�QHXWURSpQLFR��&HIRWD[ LPD���DPSLFLOLQD� 1RVRFRPLDO�� 3RVWQHXURFLUXJtD�� GHULYDFLRQHV�� 7&(� DELHUWR� R� QHXWURSHQLD�� &HIWD]LGLPD� ��YDQFRPLFLQD7UDWDPLHQWR�RULHQWDGR�VHJ~Q�JHUPHQ�\�VHQVLELOLGDG 'XUDFLyQ�UHFRPHQGDGD�GH�WUDWDPLHQWR �0HQLQJRFRFRV ��3HQLFLOLD�*�DFXRVD��6L�UHVLVWHQFLD�D�SHQLFLOLQD�FHIRWD[LPD�R�FHIWULD[RQD��6L�DOHUJLD�D�SHQLFLOLQD��FORUDQIHQLFRO�R�YDQFRPLFLQD ��GtDV� �1HXPRFRFR ��&,0�GH�SHQLFLOLQD�����o3HQLFLOLQD�*�DFXRVD ������GtDV&,0�GH�SHQLFLOLQD������o&HIRWD[LPD ������GtDV&,0�GH�SHQLFLOLQD�!�o9DQFRPLFLQD ������GtDV+��,QIOXHQ]DH ��&HIRWD[LPD�R�FHIWULDVRQD ��GtDV/LVWHULD�PRQRFLWRJHQHV ��DPSLFLOLQD���R�SHQL����DPLQRJOXFyVLGR ������GtDV(QWHUREDFWHULDV ��%*1��FHIRWD[LPD�R�FHIWULD[RQD���DPLQRJOXFyVLGR ���GtDV3VHXGRPRQD�DHUXJLQRVD ��&HIWD]LGLPD���DPLQRJOXFyVLGR ���GtDV(VWDILORFR��0HWLFLOLQ�VHQVLEOH��&OR[DFLOLQD ���GtDV0HWLFLOLQD�UHVLVWHQWH��9DQFRPLFLQD ���GtDV6WUHSWRFRFFXV�DJDODFWLDH ��$PSLFLOLQD�R�SHQLFLOLQD���DPLQRJOXFyVLGR ������GtDV'RVLV�XWLOL]DGDV�HQ�ORV�DQWLELyWLFRV�PiV�HPSOHDGRV�HQ�HO�WUDWDPLHQWR� GH�ODV�PHQLQJLWLV�EDFWHULDQDV$QWLELyWLFR�XWLOL]DGR 'RVLV�LQWUDYHQRVD�KDELWXDO$PLNDFLQD ��PJ�.J�GH�SHVR�FRUSRUDO���KRUDV$PSLFLOLQD ��JU���KRUDV�&HIRWD[LPD ��JU���KRUDV�&HIWD]LGLPD ��JU���KRUDV&HIWULD[RQD ��JU����KRUDV&OR[DFLOLQD ��JU���KRUDV*HQWDPLFLQD�R�7REUDPLFLQD ��������PJ�.J�GH�SHVR�FRUSRUDO���KRUDV�3HQLFLOLQD�* ��PLOORQHV�GH�XQLGDGHV���KRUDV�9DQFRPLFLQD ���PJ�NJ�SHVR���KRUDV

Page 115: Manual practico urgencias medicina interna muy bueno

���

���2WUDV�PHGLGDV�WHUDSpXWLFDV��(Q� ORV� QLxRV� FRQ� PHQLQJLWLV� EDFWHULDQD�� HO� WUDWDPLHQWR� DG\XYDQWH� FRQ� GH[DPHWDVRQD�GLVPLQX\H�VLJQLILFDWLYDPHQWH�HO�ULHVJR�GH�SHUGLGD�QHXURVHQVRULDO�GH�OD�DXGLFLyQ�\�DWD[LD��6LQ�HPEDUJR�� OD�XWLOLGDG�GH� ORV�FRUWLFRLGHV�HQ�ORV�DGXOWRV�HV�XQ�WHPD�GH�FRQWURYHUVLD�GHELGR�D�TXH�QR�H[LVWHQ�HQVD\RV�FOtQLFRV�HQ�HVWi�SREODFLyQ��3RU�WDQWR��\�KDVWD�TXH�HVWRV�HQVD\RV�HVWpQ�GLVSRQLEOHV�� HO� XVR� GH� FRUWLFRLGHV� HQ� DGXOWRV� GHEH� FRQVLGHUDUVH� VROR� SDUD� ORV� SDFLHQWHV� TXH�SUHVHQWHQ�HYLGHQFLD�GH�HGHPD�FHUHEUDO��(Q� ORV�FDVRV�HQ�TXH�DSDUH]FDQ�FULVLV�FRQYXOVLYDV�VH�WUDWDUiQ� ODV� PLVPDV� FRQ� )HQLWRtQD�� /DV� FRQYXOVLRQHV� VRQ� HVSHFLDOPHQWH� IUHFXHQWHV� HQ� ODV�PHQLQJLWLV�DJXGDV�SRU�QHXPRFRFR��UHFRPHQGDQGR�DOJXQRV�DXWRUHV�OD�SURILOD[LV�LQLFLDO�IUHQWH�D�ODV�PLVPDV����(Q�OD�7DEOD�,,, VH�GHWDOODQ�ORV�FRQWDFWRV�VXVFHSWLEOHV�GH�WUDWDPLHQWR�SURILOiFWLFR��HO�DQWLELyWLFR�GH� HOHFFLyQ� \� ODV� GRVLV� D� XWLOL]DU�� 'LFKD� SURILOD[LV� GHEH� UHDOL]DUVH� WDPELpQ� HQ� HO� FDVR� tQGLFH��GXUDQWH�HO�LQJUHVR�\�DO�ILQDOL]DU�HO�WUDWDPLHQWR�DQWLELyWLFR�SUHVFULWR�7DEOD�,,,��3URILOD[LV�GH�OD�PHQLQJLWLV�EDFWHULDQD�,QGLFDFLRQHV (WLRORJtD�\�HGDG0HQLQJRJRFR��FRQWDFWRV�GH�WRGDV�ODV�HGDGHV+��LQIOXHQ]DH��FRQWDFWRV�����DxRV�\�DGXOWRV�VyOR�VL�HQ�IDPLOLD�R�PHGLR�KDELWXDO�KD\�����DxRV6LWXDFLRQHV� �&RQWDFWRV�GRPpVWLFRV/RV�TXH�YLYHQ�HQ�HO�FRPLFLOLR1R�UHVLGHQWHV�TXH�KD\DQ�SDVDGR�DO�PHQRV���KRUDV�FRQ�HO�FD VR�tQGLFH�HQ�ORV�����GtDV�SUHYLRV D�VX�GLDJQyVWLFR� �&RQWDFWRV�HVWUHFKRV�1LxRV�GH�OD�JXDUGHUtD�R�GH�OD�FODVH�KDVWD�����DxRV$PLJRV&RPSDxHUR�GH�KDELWDFLyQ�R�FXDUWHO&RQWDFWRV�tQWLPRV �3HUVRQDO�VDQLWDULR�VyOR�HQ�FDVR�GH�UHVXFLWDF LyQ�ERFD�ERFD �&DVR�tQGLFH�WUDV�ILQDOL]DU�HO�WUDWDPLHQWR�\�DQWHV�GH�UHJUHVDU�D�VX�PHGLR��VDOYR�ODV�PHQLQJLWLV�SRU� PHQLQJRFRFR�GHO�VHURJUXSR�$�WUDWDGDV�FRQ�FHIWULD[RQD��\D�TXH�HVWH�WUDWDPLHQWR�HV�WDPELpQ� HILFD]�SDUD�HUUDGLFDU�HO�HVWDGR�GH�SRUWDGRU�3URWRFROR� � 0HQLQJRFRFR5LIDPSLFLQD�SRU�YtD�RUDO�GXUDQWH���GtDV��$GXOWRV�����PJ����KRUDV��!��PHV�����PJ�NJ����KRUDV������PHV���PJ�NJ����KRUDV'RVLV�~QLFD�GH�FHIWULD[RQD������PJ�LP�DGXOWRV�\�����PJ�HQ�����DxRV��'H�HOHFFLyQ�HQ�HPEDUD]R'RVLV�~QLFD GH�&LSURIOR[DFLQR����������PJ���&RQWUDLQGLFDGR�HQ�QLxRV�+��,QIO ]

Page 116: Manual practico urgencias medicina interna muy bueno

���

%LEOLRJUDItD��� &XHYDV� /(�� +DUW� &$�� &KHPRSURSK\OD[LV� RI� EDFWHULDO� PHQLQJLWLV�� -� $QWLPLFURE� &KHPRWKHU�����������6XSSO�%������������ )HUQiQGH]� 9LODGULFK� 3�� 7UDWDPLHQWR� GH� OD� PHQLQJLWLV� DJXGD� EDFWHULDQD�� $Q� 0HG� ,QWHUQ��0DGULG������������6XSO���������������� 4XDJOLDUHOOR�9-��6FKHOG�:0��7UHDWPHQW�RI�EDFWHULDO�PHQLQJLWLV��1�(QJO�-�0HG��������������������������� 6FKXFKDW�$��5RELQVRQ�.��:HQJHU�-'��+DUULVRQ�/+��)DUOH\�0��5HLQJROG�$/��HW�DO��%DFWHULDO�PHQLQJLWLV�LQ�WKH�8QLWHG�6WDWHV�LQ�������1�(QJO�-�0HG����������������������� 6SDQRV�$��+DUUHO�)(��'XUDFN�'7��'LIIHUHQWLDO�GLDJQRVLV�RI�DFXWH�PHQLQJLWLV��DQ�DQDO\VLV�IR�WKH�SUHGLFWLYH�YDOXH�RI�LQLWLDO�REVHUYDWLRQ��-$0$������������������������� 7XQNHO�$5��6FKHOG�:0��$FXWH�EDFWHULDO�PHQLQJLWLV��/DQFHW����������������������

Page 117: Manual practico urgencias medicina interna muy bueno

���

0DQHMR�GH�OD�LQIHFFLRQ�XULQDULD-RVp�-DYLHU�%ODQFK����'HILQLFLyQ�(Q� HO� WpUPLQR� ³LQIHFFLyQ� XULQDULD´� �,8�� VH� LQFOX\HQ� GLVWLQWDV� VLWXDFLRQHV� TXH� WLHQHQ� FRPR�GHQRPLQDGRU� FRP~Q� XQ� UHFXHQWR� VLJQLILFDWLYR� GH� EDFWHULDV� HQ� OD� RULQD�� FRQ� GLIHUHQFLDV� HQ� VX�HWLRSDWRJHQLD� \� H[SUHVLyQ� FOtQLFD�� OR� TXH� UHSHUFXWH� HQ� VX� HQIRTXH� WHUDSpXWLFR�� HYROXFLyQ� \�SURQyVWLFR����&RQFHSWRV�JHQHUDOHV�(WLRSDWRJHQLD�/RV�PLFURRUJDQLVPRV�SURYLHQHQ�GHO�UHVHUYRULR�LQWHVWLQDO�\�FRP~QPHQWH�VRQ�EDFWHULDV�JUDP�QHJDWLYDV� SHUWHQHFLHQWHV�D� OD� IDPLOLD�GH� ODV� HQWHUREDFWHULDFHDV�\�SVHXGRPRQDFHDV�� MXQWR�FRQ�DOJXQRV�FRFRV�JUDP�SRVLWLYRV��6��VDSURSK\WLFXV \�HQWHURFRFR���/D�IORUD�SXHGH�FDPELDU�HQ�FDVRV�GH�SDFLHQWHV�KRVSLWDOL]DGRV�(Q�FXDQWR�D�ODV�YtDV�GH�LQYDVLyQ��DXQTXH�VH�DGPLWHQ�XQD�LQIHFFLyQ�DVFHQGHQWH��KHPDWyJHQD�\�OLQIiWLFD�� HO�����VH�GHEHQ�D� OD�SULPHUD��/D�YtD�KHPDWyJHQD�RFXUUH�JHQHUDOPHQWH�GXUDQWH�XQD�EDFWHULHPLD�SRU�PLFURRUJDQLVPRV�UHODWLYDPHQWH�YLUXOHQWRV�FRPR�6��DXUHXV��TXH�SXHGHQ�GDU�OXJDU�D�DEVFHVRV�UHQDOHV�)DFWRUHV�GH�5LHVJR�(Q�DGXOWRV��ODV�PXMHUHV�VRQ����YHFHV�PiV�VXVFHSWLEOHV�TXH�ORV�YDURQHV�SDUD�SUHVHQWDU�,8V��(QWUH�ODV�VH[XDOPHQWH�DFWLYDV�WLHQHQ�PiV�ULHVJR�ODV�TXH�XVDQ�GLDIUDJPD�\�HVSHUPLFLGD��(Q�ODV�PHQRSiXVLFDV��KDVWD�XQ�����SDGHFHQ�,8�SRU�OD�DOWHUDFLyQ�GH�OD�IORUD�HQGyJHQD�(QWUH�ORV�YDURQHV��ORV�MyYHQHV�UDUD�YH]�WLHQHQ�,8��\�VXHOHQ�UHODFLRQDUVH�FRQ�KRPRVH[XDOLGDG��IDOWD�GH�FLUFXQFLVLyQ�\�H[SRVLFLyQ�D�SDUHMDV�FRQ�FRORQL]DFLyQ�DQRUPDO�GH�OD�IORUD�YDJLQDO��/RV�PD\RUHV�GH����WLHQHQ�PD\RU�Q~PHUR�GH�LQIHFFLRQHV�SRU�HQIHUPHGDGHV�GH�OD�SUyVWDWD�&DWpWHU� YHVLFDO�� 8Q� VROR� VRQGDMH� FRQOOHYD� XQ� ���GH� LQIHFFLRQHV�� \� VL� OD� VRQGD�SHUPDQHFH�LQVWDODGD�KD\�XQ�ULHVJR�HVWLPDGR�GHO����SRU��GtD�GH�FDWHWHUL]DFLyQ�&OtQLFD�/RV� WUHV� VtQGURPHV� PiV� LPSRUWDQWHV� VRQ� HO� PLFFLRQDO�� HO� GRORURVR� \� HO� IHEULO�� 1LQJXQR� HV�HVSHFtILFR�GH�XQ�WLSR�GHWHUPLQDGR�GH�LQIHFFLyQ�'LDJQyVWLFR�/D� VRVSHFKD�GH� LQIHFFLyQ� GH� RULQD� VH� WLHQH� SRU� OD� FOtQLFD� \� VH� GHEH FRQILUPDU�PHGLDQWH�HO�DQiOLVLV�GHO�VHGLPHQWR�\�EDFWHULROyJLFR�GH�OD�RULQD��/D�RULQD�FRQYLHQH�SURFHVDUOD�FXDQWR�DQWHV��3XHGH�FRQVHUYDUVH���KRUD�D� WHPSHUDWXUD�DPELHQWH�\����K��HQ�HO� IULJRUtILFR��$�SDUWLU�GH�DKt�DXPHQWDQ�ODV�SRVLELOLGDGHV�GH�FRQWDPLQDFLyQ��/D�FLIUD�OtPLWH�GH�EDFWHULXULD�VLJQLILFDWLYD��TXH�LQGLFD�XQD�LQIHFFLyQ�\�QR�VLPSOH�FRORQL]DFLyQ��GH���� 8)&�PO�� HVWDEOHFLGD� HQ� ORV� DxRV� ��� \D� VyOR� VH� FRQVLGHUD� YiOLGD� SDUD� HVWXGLRV�HSLGHPLROyJLFRV�HQ�JUXSRV�GH�SREODFLyQ�VDQD��$FWXDOPHQWH�VH�DGPLWHQ�ODV�VLJXLHQWHV�FLIUDV�

Page 118: Manual practico urgencias medicina interna muy bueno

���

%DFWHULXULD�DVLQWRPiWLFD�\�31����� 8)&�PO�&LVWLWLV� VLPSOH�� FLIUDV� WDQ� EDMDV� FRPR� ��� 8)&�PO�� VLHPSUH� TXH� VH� DFRPSDxHQ� GH�VLQWRPDWRORJtD�\�SLXULD�9DURQHV�VLQWRPiWLFRV����� 8)&�PO�3DFLHQWH�SRUWDGRU�GH�VRQGD�YHVLFDO����� 8)&�PO��HQ�SDFLHQWHV�VLQWRPiWLFRV��(VWDV�UHFRPHQGDFLRQHV�VH�UHILHUHQ�D�XQD�PXHVWUD�GH�OD�SRUFLyQ�PHGLD�GHO�FKRUUR�XULQDULR��3LXULD��VH�GHILQH�FRPR�OD�SUHVHQFLD�GH����y�PiV�OHXFRFLWRV�SRU�FDPSR�GH�JUDQ�DXPHQWR�HQ�RULQD�FHQWULIXJDGD��/D�SUXHED�GH�HVWHUDVD�GH�OHXFRFLWRV�FRQ�WLUD�FRORULPpWULFD��GLSVWLFN��HV�XQ�PpWRGR�UiSLGR�HQ�OD�GHWHFFLyQ�GH�SLXULD��\�ILDEOH��8QD�SUXHED�SRVLWLYD�VH�FRUUHODFLRQD�FRQ�XQ�PtQLPR�GH���D����OHXFRFLWRV�SRU�FDPSR��6���������(���������933�����\�931������3UXHED�GH�ORV�QLWULWRV�FRQ�WLUD�FRORULPpWULFD� 3HUPLWH�YDORUDU�OD�SUHVHQFLD�GH�EDFWHULDV�GH�PDQHUD� UiSLGD� �6� �������� (� ���������� /RV� IDOVRV� QHJDWLYRV� SXHGHQ� GHEHUVH� DO� XVR� GH�GLXUpWLFRV��D�FDQWLGDGHV�LQDGHFXDGDV�GH�QLWUDWRV�HQ�OD�GLHWD��R�D�OD�SUHVHQFLD�GH�EDFWHULDV�QR�SURGXFWRUDV�GH�QLWUDWR�UHGXFWDV��HVWDILORFRFR��HQWHURFRFR��SVHXGRPRQDV�����&ODVLILFDFLRQ'HVGH�HO�SXQWR�GH�YLVWD�GH�VX� IRUPD�GH� FRPLHQ]R�\�HYROXFLyQ� ODV� ,8V�SXHGHQ�VHU�DJXGDV��FUyQLFDV� R� UHFXUUHQWHV�� 3RU� VX� FOtQLFD�� SXHGHQ� VHU� VLQWRPiWLFDV� R� WRWDOPHQWH� LQVLGLRVDV��EDFWHULXULD�DVLQWRPiWLFD���$QDWyPLFDPHQWH�H[LVWHQ� ODV� IRUPDV�FOiVLFDV�GH�LQIHFFLRQHV�EDMDV��FLVWLWLV��XUHWULWLV��SURVWDWLWLV�\�HSLGLGLPLWLV��\�DOWDV��31���3RU�~OWLPR�� OD�LQIHFFLyQ�SXHGH�DVHQWDU�HQ� XQ DSDUDWR� XULQDULR� VLQ� QLQJXQD� DQRUPDOLGDG� VXE\DFHQWH� �,8� QR� FRPSOLFDGD��� X�RSXHVWDPHQWH� FRQ� DQRPDOtDV� DQDWRPRHVWUXFWXUDOHV� R� IXQFLRQDOHV� VXE\DFHQWHV�� TXH�SUHGLVSRQHQ��FRQGLFLRQDQ�\�SHUSHW~DQ�OD�LQIHFFLyQ��,8�FRPSOLFDGD�����SULQFLSLRV�GHO�WUDWDPLHQWR(Q�(VSDxD�ODV�WDVDV�GH�UHVLVWHQFLD�GH�(��FROL SDUD�DPSLFLOLQD�\�FRWULPR[D]RO�VRQ�GHPDVLDGR�HOHYDGDV�SDUD�FRQVLGHUDU� HVWRV�DQWLELyWLFRV�FRPR�DJHQWHV�~WLOHV� HQ�HO� WUDWDPLHQWR�HPStULFR��*RPiUL]�� ��������(Q�QXHVWUR�PHGLR�HVWH�DQWLPLFURELDQR�SUREDEOHPHQWH�VHD� OD�DPR[LFLOLQD�FODYXOiQLFR�����VLWXDFLRQHV�FOtQLFDV�PiV�FRPXQHV�$��0XMHUHV�MRYHQHV�FRQ�FLVWLWLV�DJXGD�QR�FRPSOLFDGD(O�GLDJQyVWLFR�VH�SXHGH�SUHVXPLU�SRU�OD�SUHVHQFLD�GH�SLXULD�HQ�XQD�PXMHU�VLQWRPiWLFD��6yOR�VH�UHDOL]DUi�FXOWLYR�HQ�DXVHQFLD�GH� OD�PLVPD�R�VL� OD�FOtQLFD�QR�HV�FDUDFWHUtVWLFD��1R�KDUiQ�IDOWD�FRQWUROHV�SRVWUDWDPLHQWR�D�PHQRV�TXH�ORV�VtQWRPDV�SHUVLVWDQ�R UHFXUUDQ��6WRUP����������/RV�UHJtPHQHV�GH���GtDV�VRQ�ORV�UHFRPHQGDGRV \D�TXH�VRQ�WDQ�HILFDFHV�FRPR�ORV�GH����WLHQHQ�PHQRV�HIHFWRV�VHFXQGDULRV�\�XQ�FRVWH�PHQRU��(O�WUDWDPLHQWR�HQ�GRVLV�~QLFD�HV�PHQRV�HILFD]� TXH� OD� SDXWD� GH� �� GtDV� �1RUUE\�� �������� (O� DQWLELyWLFR� GH� HOHFFLyQ� HV� DPR[LFLOLQD�FODYXOiQLFR ��������WUHV�YHFHV�DO�GtD��/DV�TXLQRORQDV��FLSURIOR[DFLQR��QRUIOR[DFLQR��WDPELpQ�VRQ�HIHFWLYDV�SHUR�PiV�FDUDV��SDUD�GRVLV�YHU�WDEOD�����6H�XVDUtDQ�SDUD�IDOORV�GH�WUDWDPLHQWR�R�LQIHFFLRQHV� UHFXUUHQWHV�� 2WUR� DQWLPLFURELDQRV� UHFRPHQGDEOHV� VRQ� OD� FHIDOH[LQD� R� HO�FRWULPR[D]RO� �HVWH�~OWLPR� VL�HO�JHUPHQ�HV�VHQVLEOH���/RV� WUDWDPLHQWRV� ODUJRV� ���GtDV��KDEUtD�

Page 119: Manual practico urgencias medicina interna muy bueno

���

TXH� FRQVLGHUDUORV� HQ�PXMHUHV�TXH�XVDQ�GLDIUDJPD�HQ� OD� UHODFLyQ�VH[XDO� R�HQ�DTXHOODV�FRQ�FOtQLFD�GH�PiV�GH���GtDV�%�� 0XMHUHV�MRYHQHV�FRQ�FLVWLWLV�UHFXUUHQWH�$UELWUDULDPHQWH�� VH� FRQVLGHUD� FLVWLWLV� UHFXUUHQWH� FXDQGR� HO� Q~PHUR� DQXDO� GH� EURWHV� HV� DO�PHQRV�GH�WUHV��/D�PD\RUtD�VRQ�UHLQIHFFLRQHV��QXHYD�LQIHFFLyQ�SRU�GLVWLQWR�PLFURRUJDQLVPR�R�GLVWLQWR� VHURWLSR��� /DV� UHFDtGDV� �LQIHFFLRQHV� SRU� HO� PLVPR� JHUPHQ�� VRQ� UDUDV� \D� TXH� VRQ�SURSLDV�GH�LQIHFFLRQHV�FRPSOLFDGDV�PDO�WUDWDGDV��1LFROOH����������3UHFLVD�XURFXOWLYR�GRFXPHQWDGR�HQ�DO�PHQRV�XQD�RFDVLyQ��5HLQIHFFLRQHV��1R�HVWiQ�LQGLFDGRV�HVWXGLRV�XUROyJLFRV�GH�PDQHUD�UXWLQDULD�6L� OD� SDFLHQWH� XVD� GLDIUDJPD� R� HVSHUPLFLGDV� VH� UHFRPLHQGD� FDPELR� HQ� HO� PpWRGR�DQWLFRQFHSWLYR�6L� HVWiQ� UHODFLRQDGDV� FRQ� HO� FRLWR� VH� DFRQVHMD� XQD� GRVLV� SURILOiFWLFD� SRVFRLWDO� GH�QLWURIXUDQWRtQD �������� PJ��� FHIDOH[LQD� ����� PJ��� DPR[LFLOLQD�FODYXOiQLFR� ���������� R�703�60;���������PJ���6WDSOHWRQ���������6L� QR� KD\� UHODFLyQ�FRQ� OD� DFWLYLGDG� VH[XDO� VH� DFRQVHMD� XQ� UpJLPHQ�GH� SURILOD[LV� GLDULD� DO�DFRVWDUVH��R�WUHV�YHFHV�HQ�VHPDQD��GXUDQWH�DO�PHQRV�VHLV�PHVHV�FRQ�QLWURIXUDQWRtQD��������PJ���� QRUIOR[DFLQR� �����PJ�� FHIDOH[LQD� �����PJ���DPR[LFLOLQD�FODYXOiQLFR� ���������� R�703�60;���������PJ���(VWH�UpJLPHQ�VHUtD�YiOLGR�SDUD�SDFLHQWHV�SRVPHQRSiXVLFDV��GRQGH�ODV� UHLQIHFFLRQHV� WDPELpQ�VRQ� IUHFXHQWHV�SRU�FDPELRV�HQ�OD�IORUD�YDJLQDO�VHFXQGDULRV�D�OD�IDOWD�GH�HVWUyJHQRV�/D LQJHVWLyQ�GH�]XPR�GH�DUiQGDQRV KD�GHPRVWUDGR�VHU�HILFD]�HQ�UHGXFLU�OD�LQFLGHQFLD�GH�,8�HQ�PXMHUHV�PD\RUHV�GHELGR�D�TXH�FRQWLHQH�XQD�VXVWDQFLD�TXH�GLVPLQX\H�OD�DGKHVLYLGDG�EDFWHULDQD�D�ODV�FpOXODV�XURWHOLDOHV��$YRUQ����������5HFDtGDV�(O�WUDWDPLHQWR�VHUi�GH�����VHPDQDV�VHJ~Q�ODV�SUXHEDV�GH�VHQVLELOLGDG�+D\�TXH�UHDOL]DU�HVWXGLRV�XUROyJLFRV�GH�PDQHUD�UXWLQDULD�\D�TXH�VXHOHQ�VHU�,8�FRPSOLFDGDV�&�� 0XMHUHV�MRYHQHV�FRQ�3LHORQHIULWLV�DJXGD�QR�FRPSOLFDGD�5HTXLHUH�VLHPSUH�XURFXOWLYR��6L�HO�HQIHUPR�HV�KRVSLWDOL]DGR�VH�H[WUDHUiQ�KHPRFXOWLYRV��1R�HV�LQGLFDFLyQ� GH� LQJUHVR� KRVSLWDODULR� VDOYR� TXH� KD\D�DIHFWDFLyQ� GHO� HVWDGR�JHQHUDO�� 7DPSRFR�UHTXLHUH�HVWXGLRV�UXWLQDULRV�GH�LPDJHQ��-RKQVRQ���������VDOYR�TXH�OD�UHVROXFLyQ�VHD�OHQWD�R�OD�SUHVHQWDFLyQ� DWtSLFD� �KHPDWXULD� SHUVLVWHQWH�� ,8� HQ� OD� LQIDQFLD��� /D� GXUDFLyQ� GHO� WUDWDPLHQWR�VHUi�GH�������GtDV��LQFOXVR�SDUD�SDFLHQWHV�FRQ�KHPRFXOWLYRV�SRVLWLYRV��3HUtRGRV�PiV�ODUJRV�QR�VRQ�PiV�HILFDFHV��6WDPP����������6H�SXHGHQ�DGPLQLVWUDU�UHJtPHQHV�PiV�FRUWRV������GtDV��HQ�DTXHOORV�SDFLHQWHV�TXH�TXHGDQ�DIHEULOHV�GH�PDQHUD�SUHFR]�����KRUDV��/RV� UHJtPHQHV� RUDOHV� DSOLFDEOHV� VHUtDQ� DPR[LFLOLQD�FODYXOiQLFR ��������� FDGD� �� K����QRUIOR[DFLQR������PJ���K���R�FLSURIOR[DFLQR� �����PJ���K���3DUHQWHUDOPHQWH�VH�SXHGHQ�XVDU��DPR[LFLOLQD�FODYXOiQLFR��JU��K��FLSURIOR[DFLQR���������PJ���K�R�FHIWULD[RQD�����J�G�'�� ,QIHFFLRQ�XULQDULD�GXUDQWH�HO�HPEDUD]R�

Page 120: Manual practico urgencias medicina interna muy bueno

���

,PSRUWDQWH�SRUTXH�XQ����GH� ODV� HPEDUD]DGDV� WLHQH�EDFWHULXULD�DVLQWRPiWLFD��\�GH�HOODV�XQ�����WLHQHQ�XQD�31�DJXGD�VL�QR�VH�WUDWDQ��$GHPiV�VH�DVRFLD�FRQ�ULHVJR�GH�SUHPDWXULGDG�\�EDMR� SHVR� DO� QDFLPLHQWR�� 5HTXLHUH� XURFXOWLYR� �!� ��� 8)&�PO���� UHFRPHQGiQGRVH� XURFXOWLYR�VLVWHPiWLFR�HQ�HO�SULPHU�WULPHVWUH�GH�HPEDUD]R�(O�DQWLELyWLFR��D�XVDU�VHUi�OD�DPR[LFLOLQD�FODYXOiQLFR R�OD�FHIDOH[LQD��2WUDV�RSFLRQHV�VRQ�HO�703�60;��GRVLV�HQ�WDEOD�����PHQRV�HVWXGLDGR�\�HYLWDQGR�DGPLQLVWUDUOR�HQ�HO�WHUFHU�WULPHVWUH��R�OD�QLWURIXUDQWRtQD��ULHVJR�GH�DQHPLD�KHPROtWLFD�HQ�FDVR�GH�GpILFLW�GH�*�3'���6H�UHFRPLHQGD�XQD�GXUDFLyQ�GH���GtDV��$QGULROH����������FRQ�XURFXOWLYR�GH�FRQWURO���VHPDQD�GHVSXpV�GHO�ILQ�GHO�WUDWDPLHQWR��UHSLWLpQGROR�FDGD�����VHPDQDV�KDVWD�HO�SDUWR��%LQW����������(�� ,QIHFFLyQ�XULQDULD�HQ�KRPEUHV'DGR� TXH� VRQ� UDUDV� HQ� PHQRUHV� GH� ��� DxRV�� WUDGLFLRQDOPHQWH� VH� KDQ� FRQVLGHUDGR� ,8�FRPSOLFDGDV�� 1R� REVWDQWH� DKRUD� VH� VDEH� TXH� KD\� GHWHUPLQDGRV� IDFWRUHV� GH� ULHVJR��KRPRVH[XDOLGDG�� IDOWD� GH� FLUFXQFLVLyQ� R� FRPSDxHUD� VH[XDO� FRORQL]DGD� SRU� XURSDWyJHQRV��SDUD� TXH� VH� SURGX]FDQ� ,8� QR� FRPSOLFDGDV� HQ� KRPEUHV� MyYHQHV� TXH� FOtQLFDPHQWH� VH�PDQLILHVWDQ�FRPR�FLVWLWLV�DXQTXH�SXHGHQ�VLPXODU�XUHWULWLV�$Vt�SXHV��HQ�KRPEUHV�MyYHQHV�VDQRV�FRQ�VtQWRPDV�GH�FLVWLWLV�VH�SXHGH�GDU�XQ�WUDWDPLHQWR�GH���GtDV��HYLWDU�SDXWDV�PiV�FRUWDV��FRQ�DPR[LFLOLQD�FODYXOiQLFR R�TXLQRORQDV�VLQ�QHFHVLGDG�GH�HYDOXDFLyQ� XUROyJLFD� GH� UXWLQD�� 6t� HV� DFRQVHMDEOH� XURFXOWLYR� SUH� \� SRVWUDWDPLHQWR� �/LSVN\���������/DV� ,8V� HQ� SDFLHQWHV� PD\RUHV� GH� ��� DxRV� VXHOHQ� GHEHUVH� D� DOWHUDFLRQHV� DQDWyPLFDV� R�QHXURJpQLFDV� �SURVWDWLVPR�� YHMLJD� QHXUyJHQD��� \� UHTXHULUtDQ� PiV� HVWXGLRV�� +D\� TXH�FRQVLGHUDUODV�,8�FRPSOLFDGDV�)�� ,QIHFFLyQ�XULQDULD�FRPSOLFDGD�$TXHOOD�TXH�RFXUUH�HQ�SDFLHQWHV�FRQ�DQRUPDOLGDGHV� IXQFLRQDOHV��PHWDEyOLFDV�R�DQDWyPLFDV�GHO�WUDFWR�XULQDULR��R�ODV�FDXVDGDV�SRU�SDWyJHQRV�UHVLVWHQWHV�D�ORV�DQWLPLFURELDQRV�XVXDOHV�3RUWDGRUHV�GH�FDWpWHU��YHVLFDO/D�SULQFLSDO�PDQHUD�GH�GLVPLQXLU�OD�PRUELPRUWDOLGDG�HV�PHGLDQWH�OD�SUHYHQFLyQ��(VWD�LQFOX\H�OD�HVWHULOLGDG�HQ� OD� LQVHUFLyQ�\�FXLGDGR�GHO� FDWpWHU� �ODYDGR�GH�PDQRV�SRU�HO�SHUVRQDO�TXH�UHDOLFH� OD� PDQLREUD� \� XVR� GH� JXDQWHV� HVWpULOHV��� OD� SURQWD� UHWLUDGD� GHO� PLVPR� �XQD� YH]�FRORFDGD�OD�VRQGD��HO�WLHPSR�HV�HO�SULQFLSDO�GHWHUPLQDQWH�GH�OD�DSDULFLyQ�GH�ODV�LQIHFFLRQHV��\�XQ�VLVWHPD�FROHFWRU�FHUUDGR�1R�HVWi�LQGLFDGR�HO�XVR�GH�DQWLPLFURELDQRV�SURILOiFWLFRV�SDUD�SUHYHQLU�R�UHWUDVDU�OD�DSDULFLyQ�GH�EDFWHULXULD��6yOR�JHQHUD�OD�DSDULFLyQ�GH�FHSDV�UHVLVWHQWHV��1LFROOH����������(O�GLDJQyVWLFR�VH�KDUi�SRU�XQ�UHFXHQWR�PD\RU�GH���� 8)&�PO�HQ�XQ�SDFLHQWH�VLQWRPiWLFR��(O�WUDWDPLHQWR�HV�LJXDO�DO�GH� ORV� QR�SDFLHQWHV�QR�FDWHWHUL]DGRV��/D�GXUDFLyQ�GHO�PLVPR�WDPELpQ�DXQTXH�VH�UHFRPLHQGD� FLFORV� FRUWRV� ��� GtDV�� SDUD� HYLWDU� OD� SUHVLyQ� DQWLPLFURELDQD� TXH� FRQOOHYH� OD�DSDULFLyQ� GH� UHVLVWHQFLDV� �1LFROOH�� �������� &RQYLHQH� UHFDPELR� GHO� FDWpWHU� VL� pVWH� OOHYD�FRORFDGR�PiV�GH���VHPDQDV�SRU�OD�FDVL�VHJXUD�H[LVWHQFLD�GH�ELRILOP�SURWHFWRU�/D�FDQGLGXULD��SUHVHQWH�HQ�XQ�JUDQ�SRUFHQWDMH�GH�SDFLHQWHV�VRQGDGRV��FDVL�QXQFD�UHTXLHUH�WUDWDPLHQWR�DQWLI~QJLFR�HVSHFtILFR�\�VXHOH�GHVDSDUHFHU�FRQ�OD�UHWLUDGD�R�HO�FDPELR�GH�VRQGD�

Page 121: Manual practico urgencias medicina interna muy bueno

���

1R�SRUWDGRUHV�GH�VRQGD�YHVLFDO(Q� WRGD� ,8� FRPSOLFDGD� OD� GXUDFLyQ� GHO� WUDWDPLHQWR�VHUi�GH������GtDV��VLQ�KDEHU�HVWXGLRV�FRPSDUDWLYRV�TXH�GHILQDQ�XQD�GXUDFLyQ�ySWLPD��1LFROOH����������(O�WUDWDPLHQWR�VHUi�H[LWRVR�VL�OD�DQRUPDOLGDG�VXE\DFHQWH�VH�FRUULJH��(Q�FDVR�FRQWUDULR�KDVWD�XQ�����UHFXUULUiQ�D�ODV�����VHPDQDV�/RV� DQWLPLFURELDQRV� XVDGRV� VRQ� ORV� PLVPRV� TXH� SDUD� ODV� ,8V� QR� FRPSOLFDGDV�� VDOYR� OD�IRVIRPLFLQD�SRU�OD�SURQWD�DSDULFLyQ�GH�UHVLVWHQFLDV�TXH�FRQOOHYD��(Q�ORV�SDFLHQWHV�FRQ�IDOOR�UHQDO� \D� HVWDEOHFLGR� HVWiQ� FRQWUDLQGLFDGRV� OD� QLWURIXUDQWRtQD� \� � ORV� DPLQRJOXFyVLGRV��/RV�DJHQWHV�GH�HOHFFLyQ�HVWRV�SDFLHQWHV�VHUtDQ�ODV�TXLQRORQDV�\� OD�DPR[LFLOLQD�FODYXOiQLFR��(O�WUDWDPLHQWR�SURILOiFWLFR��GH�PDQHUD�JHQHUDO�QR�HVWi�LQGLFDGR�6H�SXHGH�XVDU�WUDWDPLHQWR�VXSUHVRU�D�ODUJR�SOD]R�HQ�HO�FRQWH[WR�GH�OD�LQIHFFLyQ�DXQTXH�QR�VH� KD\DQ� UHVXHOWR� ODV� DQRUPDOLGDGHV� VXE\DFHQWHV� FXDQGR� KD\� ULHVJR� GH� GHWHULRUR� GH� OD�IXQFLyQ�UHQDO�(Q�HO�FDVR�GH�,8�VREUH�SDFLHQWHV�FRQ�OLWLDVLV�UHQDO�SRU�JpUPHQHV�SURGXFWRUHV�GH�XUHDVD��3��PLUDELOLV��3URYLGHQFLD�VWXDUWLL���HO� WUDWDPLHQWR� LQFOX\H� OD�HOLPLQDFLyQ�GH� ORV�FiOFXORV��6L�VRQ�SHTXHxRV�VH�SXHGH UHDOL]DU�SRU� OLWRWULFLD� WUDV� OD�TXH�VH�VHJXLUi�WUDWDPLHQWR�DQWLEDFWHULDQR�GXUDQWH���D���VHPDQDV�SDUD�HVWHULOL]DU�ODV�SDUWtFXODV�UHVLGXDOHV��6L�ORV�FiOFXORV�QR�SXHGHQVHU� HOLPLQDGRV� SRU� OLWRWULFLD� QL� FLUXJtD� XQ� WUDWDPLHQWR� VXSUHVRU� D� ODUJR� SOD]R� HYLWDUi� HO�FUHFLPLHQWR�GH�ORV�FiOFXORV�\�XQ�SRVLEOH�GHWHULRUR�GH�OD�IXQFLyQ�UHQDO��)RZOHU���������8Q�FDVR�DSDUWH�HV�HO�GHO�SDFLHQWH�FRQ�31$�\�VRVSHFKD�GH� LQIHFFLyQ�SRU�JpUPHQHV�PXOWLUUHVLVWHQWHV �VRQ� IDFWRUHV� SUHGLVSRQHQWHV� OD� LQIHFFLyQ� DGTXLULGD� HQ� HO� KRVSLWDO�� OD�PDQLSXODFLyQ�XUROyJLFD�UHFLHQWH��ORV�SRUWDGRUHV�GH�VRQGD�YHVLFDO�SHUPDQHQWH�\�ORV�TXH�KDQ�UHFLELGR� WUDWDPLHQWR� DQWLELyWLFR� SUHYLR�� \�R� LQHVWDELOLGDG� KHPRGLQiPLFD�� $TXt� VH�UHFRPLHQGD� XQD� FHIDORVSRULQD� DQWLSVHXGRPyQLFD� �FHIWD]LGLPD� R� FHIHSLPD�� R� D]WUHRQDP�DVRFLDGRV�D�DPSLFLOLQD��R�PRQRWHUDSLD�FRQ�XQ�FDUEDSHQHP��LPLSHQHP�R�PHURSHQHP��R�FRQ��SLSHUDFLOLQD�WD]REDFWDP�GXUDQWH����GtDV��6L�KD\�GDWRV�FOtQLFRV�GH�VKRFN�VpSWLFR�DxDGLU�DO�WUDWDPLHQWR�XQ�DPLQRJOXFyVLGR�*�� %DFWHULXULD�DVLQWRPDWLFD�5HTXLHUH�XQ�XURFXOWLYR�FRQ�PiV�GH���� 8)&�PO��1R�VH�GHEH� UHDOL]DU�GHVSLVWDMH�SDUD�EDFWHULXULD�DVLQWRPiWLFD�GH�PDQHUD�UXWLQDULD��\D�TXH� OD�RFXUUHQFLD�GH�FRPSOLFDFLRQHV�HV�EDMD��7HQFHU���������([FHSFLRQHV�D�HVWD�UHJOD�VRQ�HO�HPEDUD]R��\�SUHYLR�D�XQD�FLUXJtD�XUROyJLFD�\D�TXH�HQ�HVWRV�FDVRV�HVWi�GHPRVWUDGR�TXH�ODV�FRPSOLFDFLRQHV�SRVWRSHUDWRULDV��EDFWHULHPLD��GLVPLQX\HQ�VL�VH�WUDWD�3RU�WDQWR��DQWH�HO�KDOOD]JR�HQ�XQ�SDFLHQWH��VDOYR�ODV�H[FHSFLRQHV�FLWDGDV��GH�XQD�EDFWHULXULD�DVLQWRPiWLFD�OD�DFWLWXG�VHUi�GH�QR�WUDWDUOD �WDPSRFR�HQ�ORV�SRUWDGRUHV�GH�VRQGD�YHVLFDO��+�� 3URVWDWLWLV�'H� ORV� SDFLHQWHV� TXH� DFXGHQ� D� XQD� FRQVXOWD� SRU� PROHVWLDV� JHQLWRXULQDULDV� XQ� ��� WLHQHQ�SURVWDWLWLV� EDFWHULDQD� IUHQWH� DO� ����GH� ODV� QR� EDFWHULDQDV� \�HO�����FRQ�VtQGURPH�GH�GRORU�SHOYLSHULQHDO��DQWLJXD�SURVWDWRGLQLD��

Page 122: Manual practico urgencias medicina interna muy bueno

���

3DUD�VX�HYDOXDFLyQ�KD\�TXH�UHFRJHU�RULQD�DO� LQLFLR�GH� OD�PLFFLyQ� �RULQD�XUHWUDO���D�PLWDG�GHO�FKRUUR� �RULQD� YHVLFDO�� \� WUDV� PDVDMH� SURVWiWLFR�� 7UDV� pVWH� VH� UHFRJHUiQ� ODV� VHFUHFLRQHV�SURVWiWLFDV��H[SUHVLyQ�GH�OtTXLGR�SURVWiWLFR�GH�OD�XUHWUD��\�XQD�~OWLPD�PXHVWUD�GH�RULQD��3DUD�HO�GLDJQyVWLFR�GH�SURVWDWLWLV� ORV�FXOWLYRV� GH� ODV�VHFUHFLRQHV�SURVWiWLFDV�\� OD�~OWLPD�RULQD�GHEHQ�WHQHU�DO�PHQRV����YHFHV�PiV�EDFWHULDV�TXH� ODV� GRV�SULPHUDV�PXHVWUDV�GH�RULQD�� R�TXH VH�REMHWLYHQ�OHXFRFLWRV��!���FDPSR�GH�JUDQ�DXPHQWR��HQ�ODV�PXHVWUDV�SURVWiWLFDV�\�QR�HQ OD�GHO�SULPHU�FKRUUR��0HDUHV���������(O�PDVDMH�SURVWiWLFR�HVWi�FRQWUDLQGLFDGR�HQ�OD�SURVWDWLWLV�DJXGD�SRU�HO�ULHVJR�GH�EDFWHULHPLD��\�VH� UHDOL]DUi� FXDQGR� OD� ILHEUH� KD\D� UHPLWLGR� R� HO� SDFLHQWH� OOHYH� YDULRV� GtDV� FRQ� WUDWDPLHQWR�DQWLELyWLFR(O�WUDWDPLHQWR�DQWLELyWLFR�GXUDUi����GtDV�HQ�OD�SURVWDWLWLV�DJXGD�\���D ��PHVHV�HQ�OD�FUyQLFD��1DEHU����������(O�703�60;�\�ODV�TXLQRORQDV�FRQWLQ~DQ�VLHQGR�ORV�DJHQWHV�GH�HOHFFLyQ�SRU�VX�EXHQD�SHQHWUDFLyQ�HQ�HO�WHMLGR�SURVWiWLFR��(Q�OD�DJXGD�WDPELpQ SXHGH�XVDUVH�OD�DPR[LFLOLQD�FODYXOiQLFR�\D�TXH�OD�EDUUHUD�SURVWiWLFD�HV�SUiFWLFDPHQWH�LQH[LVWHQWH�%LEOLJUDILD��� $QGULROH�97�� 3DWWHUVRQ�7)��(SLGHPLRORJ\��QDWXUDO� KLVWRU\��DQG�PDQDJHPHQW� RI� XULQDU\� WUDFW�LQIHFWLRQV�LQ�SUHJQDQF\��0HG�&OLQ�1RUWK�$P������� ��������������$QGULROH�97��8ULQDU\�7UDFW�,QIHFWLRQV��,QIHFW�'LV�&OLQ�1RUWK�$P���������������� $YRUQ� -�� 0RQDQH� 0�� *XUZLW]� -0�� *O\QQ� 5-�� &KRRGQRYVNL\� ,�� /LSVLW]� /$�� 5HGXFWLRQ� RI�EDFWHULXULD�DQG�S\XULD�DIWHU�LQJHVWLRQ�RI�FUDQEHUU\�MXLFH��-$0$����������������������%DFKHOOHU�&'��%HUQVWHLQ�-0�� ,QIHFFLRQHV�GH�YtDV�XULQDULDV��0HG�&OLQ�1RUWK�$P�������������������������%DUQHWW�%-��6WHSKHQV�'6��8ULQDU\�7UDFW�,QIHFWLRQ��$Q�2YHUYLHZ��$P�-�0HG�6FL����������������������� %DUUDVD� -,�� *XHUUHUR� -/�� $VStUR]� &�� /DV� LQIHFFLRQHV� XULQDULDV� HQ� ORV� SDFLHQWHV� FRQ� VRQGD�YHVLFDO�QR�SHUPDQHQWH��\�,,���'LDJQyVWLFR��WUDWDPLHQWR��SUHYHQFLyQ�\�OtQHDV�GH�LQYHVWLJDFLyQ��0HG�&OLQ����������������������� %LQW� $-�� +LOO� '�� %DFWHULXULD� RI� SUHJQDQF\� DQ� XSGDWH� RQ� VLJQLILFDQFH�� GLDJQRVLV� DQG�PDQDJHPHQW��-�$QWLPLFURE�&KHPRWHU�����������VXSSO�$�����������'HO�5tR�3pUH]�*�� 7UDWDPLHQWR� GH� ODV� ,QIHFFLRQHV�8ULQDULDV��(Q��'UREQLF�/��HG��7UDWDPLHQWR�$QWLPLFURELDQR��6��6HEDVWLiQ�GH�ORV�5H\HV��*UXSR�%ULVWRO�0\HUV�6N\EE��������������������)RZOHU�-(��$QWLPLFURELDO�WKHUDS\�LQ�WKH�PDQDJHPHQW�RI�LQIHFWHG�UHQDO�FDOFXOL��(Q��0XOOKROODQG�6*��HGLWRU��$QWLELRWLF�WKHUDS\�LQ�XURORJ\��3KLODGHOSKLD��3$���/LSSHQFRWW�5DYHQ��������������������*RPiUL]�0��9LFHQWH�'��3pUH]�7UDOOHUR�(��,QIHFFLRQHV�XULQDULDV�QR�FRPSOLFDGDV����,QIRUPDFLyQ�7HUDSpXWLFD�GHO�6LVWHPD�1DFLRQDO�GH�6DOXG����������������������������-LPpQH]�&UX]�-)��)XVWHU�$��,QIHFFLyQ�XULQDULD��DFWXDOL]DFLyQ�GH�FRQFHSWRV�FRQ�LPSOLFDFLRQHV�WHUDSpXWLFDV��5HY�&OLQ�(VS��������������������

Page 123: Manual practico urgencias medicina interna muy bueno

���

���� -RKQVRQ� -5�� 9LQFHQW� /0�� :DQJ� .�� 5REHUWV� 3/�� 6WDPP� :(�� 5HQDO� XOWUDVRQRJUDSKLF�FRUUHODWHV�RI�DFXWH�S\HORQHSKULWLV��&OLQ�,QIHFW�'LV���������������������� /LSVN\� %$�� 8ULQDU\� WUDFW� LQIHFWLRQV� LQ� PHQ�� (SLGHPLRORJ\�� SDWKRSK\VLRORJ\�� GLDJQRVLV� DQG�WUHDWPHQW��$QQ�,QWHUQ�0HG������������������������0HDUHV�(0�-U���3URVWDWLWLV��0HG�&OLQ�1RUWK�$P�����������������������1DEHU�.*��8VH�RI�TXLQRORQHV�LQ�XULQDU\�WUDFW�LQIHFWLRQV�DQG�SURVWDWLWLV��5HY�,QIHFW�'LV�����������VXSSO�����6��������� 1LFROOH� /(�� 5RQDOG� $5�� 5HFXUUHQW� XULQDU\� WUDFW� LQIHFWLRQ� LQ� DGXOW� ZRPHQ�� 'LDJQRVLV� DQG�WUHDWPHQW��,QIHFW�'LV�&OLQ�1RUWK�$P����������������������� 1LFROOH� /(�� $� 3UDFWLFDO� *XLGH� WR� WKH�0DQDJHPHQW� RI� &RPSOLFDWHG�8ULQDU\� 7UDFW� ,QIHFWLRQ��'UXJV���������������������������1RUUE\�65��6KRUW� WHUP�WUHDWPHQW�RI�XQFRPSOLFDWHG� ORZHU�XULQDU\�WUDFW� LQIHFWLRQV� LQ�ZRPHQ��5HY�,QIHFW�'LV����������������������6WRUP�%/��&ROOLQV�0��:HVW�6/��6H[XDO�DFWLYLW\�� FRQWUDFHSWLYH�XVH��DQG�RWKHU� ULVN� IDFWRUV� IRU�V\PSWRPDWLF� DQG� DV\PSWRPDWLF� EDFWHULXULD�� $� FDVH�FRQWURO� VWXG\��$QQ� ,QWHUQ�0HG�������� ��������������� 6WDPP� :(�� 0F.HYLWW� 0�� &RXQWV� *:�� $FXWH� UHQDO� LQIHFWLRQ� LQ� ZRPHQ�� WUHDWPHQW� ZLWK�WULPHWKURSULP�VXOIDPHWKR[D]ROH�RU�DPSLFLOLQ�IRU�WZR�RU�VL[�ZHHNV��D�UDQGRPL]HG�WULDO��$QQ�,QWHUQ�0HG����������������������6WDPP�:(��+RRWRQ�7��0DQDJHPHQW�RI�XULQDU\�WUDFW�LQIHFWLRQV�LQ�DGXOWV��1�(QJO�-�0HG������������������������� 6WDSOHWRQ� $�� /DWKDP� 5+�� -RKQVRQ� &�� 6WDPP�:(�� 3RVWFRLWDO� DQWLPLFURELDO� SURSK\OD[LV� IRU�UHFXUUHQW�XULQDU\�WUDFW�LQIHFWLRQ��D�UDQGRPL]HG��GRXEOH�ELQG��SODFHER�FURQWROOHG�WULDO��-$0$������������ ����������7HQFHU�-��$V\PSWRPDWLF�EDFWHULXULD� D�ORQJ�WHUP�VWXG\��6FDQG�-�8URO�1HSKURO���������������������:DUG�7-��-RQHV�65��*HQLWRXULQDU\�7UDFW�,QIHFWLRQV��(Q��5HHVH�5(��%HWWV�5)��HG��$�3UDFWLFDO�$SSURDFK�WR�,QIHFWLRXV�'LVHDVHV�����HG��86$��/LWWOH��%URZQ������������ ��������:LVLQJHU�'%��8ULQDU\�WUDFW�LQIHFWLRQ��3RVWJUDG�0HG��������������������

Page 124: Manual practico urgencias medicina interna muy bueno

���

$JHQWH�PiV�XVDGR (VSHFWUR 'RVLV�KDELWXDO�0i[��'LDULD� &RVWH�YLDO &RPHQWDULR703�60;�6HSWULQ��$EDFWULQ� &*3�VDOYR�HQWHURFRFRV��PD\RUtD�GH�(QWHUREDFWHULDFHDH��1R�DFWLYRV�IUHQWH�3VHXGRPRQDV�QL�DQDHURELRV�

��������PJ�������K��YR�y�LY� � ���SWV��FRPS��HQ�KRVSLWDO�\����SWV�FRPS��DPEXODWRULR�� ��YLDO����SWDV��HQ�KRVSLWDO�\�����SWV�DPEXODWRULR

0X\�EXHQD�DEVRUFLyQ�RUDO��([FUHFLyQ�UHQDO��([FHOHQWHV�QLYHOHV�HQ�VHFUHFLRQHV�SURVWiWLFDV$PR[LFLOLQD�&ODYXOiQLFR�()*�

$JHQWHV�DPR[LFLOtQ�VHQVLEOHV�PiV�(��FROL��.OHEVLHOOD��0D\RUtD�GH�HVWUHSWRFRFRV�LQFOX\HQGR�HQWHURFRFRV

���������K��YR��JU����K�LY���JU����K����FRPS������PJ�����SWV�HQ�KRVSLWDO�\����SWV�DPEXODWRULR��9LDO���JU������SWV�HQ�KRVSLWDO�\�����SWV�DPEXODWRULR

%XHQD�DEVRUFLyQ�RUDO��1LYHOHV�XULQDULRV�HOHYDGRV�

&HIDOH[LQD &RFRV�JUDP�SRVLWLYRV��QR�HQWHURFRFRV��0D\RUtD�GH�SDWyJHQRV�XULQDULRV�FRPXQLWDULRV�

��������PJU���K����JU����K�� � ��FRPS������PJ�����SWV�KRVSLWDO�\�������SWV�DPEXODWRULR7REUDPLFLQD�%LFOLQ� *pUPHQHV�JUDP�QHJDWLYRV�DHURELRV � ��YLDO�GH�����PJ������SWV�HQ�HO�KRVSLWDO

,Q�YLWUR��OD�PiV�DFWLYD�IUHQWH�D�3��DHUXJLQRVD��1HIURWR[LFLGDG��RWRWR[LFLGDG&LSURIOR[DFLQR�()*� %*1��6��DXUHXV� ��������PJU�����K��YR���������PJU�����K��LY����FRPS������PJ����SWV�HQ�KRVSLWDO�\���������DPEXODWRULR� ��YLDO�����PJ�����SWV�HQ�KRVSLWDO�\�������������DPE1RUIOR[DFLQR $FWLYR�IUHQWH�D�OD�PD\RUtD�GH�XURSDWyJHQRV

����PJU����K� ��FRPS������PJ�����SWV�HQ�KRVSLWDO�\ ��������DPEXODWRULR1R�DOFDQ]D�FRQFHQWUDFLRQHV�DFHSWDEOHV�HQ�SODVPD�1LWURIXUDQWRtQD *UDPSRVLWLYRV�LQFOX\HQGR�6��DXUHXV��6��VDSURSK\WLFXV�\�HQWHURFRFRV�/D�PD\RUtD�GH�(��FROL��6DOPRQHOOD�\�6KLJHOOD�

�������PJU��K�RUDO 3URGXFH�FRQ�IUHFXHQFLD�LQWROHUDQFLD *,��3XHGH�SURGXFLU�KLSHUVHQVLELOLGDG�\�FXDGURV�GH�QHXPRQLWLV�

Page 125: Manual practico urgencias medicina interna muy bueno

���

3URWRFROR�GH�DGHQRSDWtDV)UDQFLVR�0HGUDQR��-XDQ�&DUORV�6HJXUD��(OR\�&DPLQR��(O�WpUPLQR�OLQIDGHQRSDWtD VH�XWLOL]D�SDUD�VHxDODU�HO�DXPHQWR�GH�WDPDxR��FRQVLVWHQFLD�R�Q~PHUR�GH� ORV� JDQJOLRV� OLQIiWLFRV�� DXQTXH� JDQJOLRV� EODQGRV� \� OLVRV�� VXEPDQGLEXODUHV� GH� �� �FP� R�LQJXLQDOHV�GH�KDVWD���FP��VRQ�D�PHQXGR�SDOSDEOHV�HQ�QLxRV�\�MyYHQHV�VDQRV��6H�GHILQH�FRPR�OLQIDGHQRSDWtD JHQHUDOL]DGD FXDQGR� HVWiQ� DIHFWDGDV� GRV� R� PiV� iUHDV� JDQJOLRQDUHV� QR�FRQWLJXDV��\�OLQIDGHQRSDWtD ORFDOL]DGD FXDQGR�VROR�HVWi�DIHFWD�XQ�iUHD��&DXVDV�GH� OLQIDGHQRSDWtD��7DEOD���([LVWH�EDMD�IUHFXHQFLD�GH�PDOLJQLGDG��0iV�GH�����GH�ORV�SDFLHQWHV� WLHQHQ� FDXVDV� QR� HVSHFLILFDV� R� UHDFWLYDV� R� LQIHFFLRQHV� YLUDOHV� R� EDFWHULDQDV��LQIHFFLRQHV�GH�YtDV UHVSLUDWRULDV�DOWDV��PRQRQXFOHRVLV�LQIHFFLRVD��WR[RSODVPRVLV�R�WXEHUFXORVLV��\� HO� UHVWR� WLHQHQ� XQD� HQIHUPHGDG� PDOLJQD�� /D� JUDQ� PD\RUtD� GH� SDFLHQWHV� YDQ� D� WHQHU� XQ�GLDJQyVWLFR�QR�HVSHFtILFR�UHTXLULHQGR�SRFDV�SUXHEDV�GLDJQyVWLFDV�3DVRV�LPSUHVFLQGLEOHV�SDUD OD�YDORUDFLyQ�DGHFXDGD����+LVWRULD�FOtQLFD�/RV� SXQWRV� IXQGDPHQWDOHV� VRQ� OD� HGDG�� VtQWRPDV� R� VLJQRV� GH� ORFDOL]DFLyQ�� VtQWRPDV�FRQVWLWXFLRQDOHV��GDWRV�HSLGHPLROyJLFRV�\�IiUPDFRV����([SORUDFLyQ�ItVLFD��/RFDOL]DFLyQ� \� H[WHQVLyQ� �JHQHUDOL]DGD� R� ORFDOL]DGD��� WDPDxR� �!�� FP��� FRQVLVWHQFLD�� VLJQRV�LQIODPDWRULRV��FRQIOXHQFLD�HQ�SDTXHWHV��ILVWXOL]DFLyQ�\�RWUDV�DOWHUDFLRQHV����3UXHEDV�GH�ODERUDWRULR VHJ~Q�OD�YDORUDFLyQ�FOtQLFD�SUHYLD��(Q� JHQHUDO� VH� VROLFLWDUi� KHPRJUDPD�� 96*�� ELRTXtPLFD� EiVLFD�� VHURORJtD� 9(%�� &09�� 9,+��RWURV�YLUXV��7R[RSODVPD��%UXFHOOD��HWF�\�VL�VH�VRVSHFKD�/(6�VROLFLWDU�$1$�\�DQWL'1$��\�5;�GH�WyUD[����%LRSVLD JDQJOLRQDU��&RQ�IUHFXHQFLD�HV�REOLJDGD��DXQTXH�VXV�LQGLFDFLRQHV�VRQ�LPSUHFLVDV��6H�GHEHQ�HYLWDU�HQ�OR�SRVLEOH�ORV�LQJXLQDOHV��VXEPDQGLEXODUHV�\�D[LODUHV��TXH�FRQ�IUHFXHQFLD�DXPHQWDQ�GH�WDPDxR�SRU�FDXVDV� LQHVSHFtILFDV��/D�GHFLVLyQ�GH� UHDOL]DUOD�SXHGH� WRPDUVH�GH� IRUPD� WHPSUDQD�R�UHWUDVDGD�KDVWD�XQ�SHUtRGR�VXILFLHQWH�GH�REVHUYDFLyQ������VHPDQDV���/D�ELRSVLD�WHPSUDQD�GHEH�UHDOL]DUVH�HQ�ORV�SDFLHQWHV�FRQ�KLVWRULD�\�H[SORUDFLyQ�VXJHVWLYD�GH�PDOLJQLGDG��DGHQRSDWtD�FHUYLFDO�VROLWDULD��GXUD�� QR� LQIODPDWRULD�� HQ� SDFLHQWH� YLHMR� IXPDGRU�� DGHQRSDWtD� VXSUDFODYLFXODU�� \� DGHQRSDWtDV�JHQHUDOL]DGDV�R�VROLWDULDV�TXH�VRQ�ILUPHV��PRYLEOHV��\�VXJHVWLYDV�GH�OLQIRPD�����6ROLFLWDU�H[SORUDFLyQ�25/ VL�VH�VRVSHFKD�XQ�FiQFHU�GH�FDEH]D�\�FXHOOR��

Page 126: Manual practico urgencias medicina interna muy bueno

���

���3$$)JDQJOLRQDU�*UDQ� FRQWURYHUVLD� UHVSHFWR� D� VX� XWLOLGDG�� (V� VHQFLOOD� \� SRFR� PROHVWD�� SHUR� SRFDV� YHFHV�SHUPLWH� HVWDEOHFHU� HO� GLDJQyVWLFR� GH� FHUWH]D� �H[FHSWR� HQ� ODV�PHWiVWDVLV�GH� FDUFLQRPD�� \� FRQ�IUHFXHQFLD�OR�UHWUDVD�SHOLJURVDPHQWH��/R�PiV�DFHSWDGR�HV�TXH�GHEH UHVHUYDUVH�SDUD�FRQILUPDU�OD�UHFDtGD�HQ�SDFLHQWHV�FRQ�XQ�GLDJQyVWLFR�FRQRFLGR�\�HQ�FDVR�GH� LPSRVLELOLGDG�GH�REWHQHU�XQD�ELRSVLD�����2WUDV�H[SORUDFLRQHV�~WLOHV�HQ�GHWHUPLQDGDV�RFDVLRQHV�([DPHQ�GH�02��7$&�FHUYLFDO��WRUiFLFR��R�JDPPDJUDItD�FRQ�*D�R�501�WRUiFLFD��R�DEGRPLQDO��R�HFRJUDItD�DEGRPLQDO���OLQIRJUDItD�DEGRPLQDO��ELRSVLD�KHSiWLFD�R�HVSOHQHFWRPtD�%LEOLRJUDItD��� 5REHUW� )HUUHU�� /\PSKDGHQRSDWK\�� 'LIIHUHQWLDO� GLDJQRVLV� DQG� HYDOXDWLRQ�� $PHULFDQ� )DPLO\�3K\VLFLDQ� ������ ��� ����� ���3DWULFN�+��+HQU\��'DQ�/�� /RQJR��(QODUJHPHQW� RI� O\PSK�QRGHV�DQG�VSOHHQ��(Q�+DUULVRQ¶V�3ULQFLSOHV�RI�,QWHUQDO�0HGLFLQH������(GLFLyQ�����$��8UUXWLD�\�$��*XDUJD��/LQIDGHQRSDWtD��(Q � %DVHV�SDUD�HO�GLDJQyVWLFR�HWLROyJLFR�HQ�0HGLFLQD�,QWHUQD��(G��'R\PD���������-�� 'tD]� 0HGLDYLOOD�� 6LQGURPHV� DGHQRSiWLFRV�� (Q�� 0HGLFLQD� ,QWHUQD�� )DUUHUDV�5R]PDQ�� ����HGLFLyQ�

7DEOD����&DXVDV�GH�OLQIDGHQRSDWtD���(QIHUPHGDGHV�LQIHFFLRVDV�9LUDOHV�6tQGURPHV�PRQRQXFOHyVLFRV��9(%��&09���KHSDWLWLV�LQIHFFLRVD��YLUXV�KHUSHV�VLPSOH[��YLUXV�KHUSHV����YLUXV�YDULFHOOD�]RVWHU��UXEHROD��VDUDPSLyQ��DGHQRYLUXV��9,+��TXHUDWRFRQMXQWLYLWLV�HSLGpPLFD��YDFXQD�%DFWHULDQDV� (VWUHSWRFRFR��(VWDILORFRFR��HQIHPHGDG�SRU�DUDxD]R�GH JDWR��EUXFHORVLV��WXODUHPLD��SHVWH��FKDQFURLGH��PHOLRLGRVLV��PXHUPR��WXEHUFXORVLV��PLFREDFWHULRVLV�DWLSLFD��VtILOLV�SULPDULD�\�VHFXQGDULD��GLIWHULD��OHSUD�0LFyWLFDV�+LVWRSODVPRVLV��FRFFLGLRLGRPLFRVLV��SDUDFRFFLGLRLGRPLFRVLV�&KODP\GLDV�/LQIRJUDQXORPD�YHQHUHR��WUDFRPD�3DUDVLWRV�7R[RSODVPRVLV��OHLVKPDQLDVLV��WULSDQRVRPLDVLV��ILODULDVLV�5LFNHWWVLDV�7LIXV���(QIHUPHGDGHV�LQPXQROyJLFDV��$UWULWLV�UHXPDWRLGH$UWULWLV�UHXPDWRLGH�MXYHQLO(QIHUPHGDG�PL[WD�GHO�WHMLGR�FRQHFWLYR/(6'HUPDWRPLRVLWLV6tQGURPH�GH�6MRJUHQ(QIHUPHGDG�GHO�VXHUR+LSHUVHQVLELOLGDG�D�IiUPDFRV�

Page 127: Manual practico urgencias medicina interna muy bueno

���

�GLIHQLOKLGDQWRLQD��KLGUDOD]LQD��DOORSXULQRO��SULPLGRQD��2UR��FDUEDPDFHSLQD��HWF�&LUURVLV�ELOLDU�SULPDULD(QIHUPHGDG�GH�LQMHUWR�FRQWUD�KXHVSHG5HODFLRQDGD�FRQ�LPSODQWHV�GH�VLOLFRQD���(QIHUPHGDGHV�PDOLJQDV+HPDWRORJLFDV/LQIDGHQRSDWtD�DQJLRLQPXQREOiVWLFD��HQIHUPHGDG�GH�+RGJNLQ��OLQIRPD�QR�+RGJNLQ��OHXFHPLD�OLQIRLGH�DJXGD�R�FUyQLFD��OHXFHPLD�GH�FiOXODV�SHOXGDV��KLVWLRFLWRVLV�PDOLJQD�0HWDVWDWLFDV���(QIHUPHGDGHV�SRU�GHSyVLWR�GH�OtSLGRV��(QIHUPHGDG�GH�*DXFKHU��1LHFNPDQ�3LFN��)DEU\��7DQJLHU����(QIHUPHGDGHV�HQGRFULQDV��+LSHUWLURLGLVPR���2WUDV(QIHUPHGDG�GH�&DVWOHPDQ��KLSHUSODVLD�JLJDQWH�JDQJOLRQDU�6DUFRLGRVLV/LQIDGHQLWLV�GHUPRSiWLFD*UDQXORPDWRVLV�OLQIRPDWRLGH(QIHUPHGDG�GH�.LNXFKL��OLQIDGHQLWLV�KLVWLRFtWLFD�QHFURWL]DQWH�(QIHUP�5RVDL�'RUIPDQ��OLQIDGHQRSDWtD�PDVLYD�FRQ�KLVWLRFLWRVLV�VLQXVDO�(QIHUPHGDG�GH�.DZDVDNL��VtQGURPH�PXFRFXWiQHR�JDQJOLRQDU�+LVWLRFLWRVLV�GH�FpOXODV�GH�/DQJHUKDQV)LHEUH�PHGLWHUUiQHD�IDPLOLDU+LSHUWULJOLFHULGHPLD�JUDYH3VHXGRWXPRU�LQIODPDWRULR�GH�ORV�JDQJOLRV$PLORLGRVLV

Page 128: Manual practico urgencias medicina interna muy bueno

���

$QDPQHVLV�([SORUDFLyQ�ItVLFD'LDJQyVWLFR�VXJHVWLYR�R�SUREDEOH)DULQJLWLV��FRQMXQWLYLWLV��LQIHFFLyQ�UHVSLUDWRULD��7LxD��LQIHFFLyQ�IRFDO��HQIHUPHGDG�SRU�DUDxD]R�GH�JDWR��PRQRQXFOHRVLV��VtILOLV��9,+��/LQIRPD

'LDJQyVWLFR�VXJHVWLYR�R�SUREDEOH7UDWDPLHQWR�\�UHPLVLyQ�D�VX�PpGLFR�R�FRQWUROHV�HQ�&��([WHUQD&DXVD�GHVFRQRFLGD 3UXHEDV�HVSHFtILFDV

5HYLVDU�OD�KLVWRULD��ODV�FODYHV�HSLGHPLROyJLFDV��OD�()�UHJLRQDO�+HPRJUDPD�\�VHURORJtD�D�0,��0DQWRX[��535��$1$��+EV$J��9,+��5[�7yUD[ 'LDJQyVWLFR�\�7UDWDPLHQWR

1R�ULHVJR�GH�PDOLJQLGDG�R�HQIHUPHGDG�JUDYH5LHVJR�GH�PDOLJQLGDG�R�HQIHUPHGDG�JUDYH%LRSVLD 2EVHUYDFLyQ�����VHPDQDV

1R�UHVROXFLyQ�QL�PHMRUtD 6HJXLPLHQWR6t�UHVROXFLyQ�R�PHMRUtD

��

Page 129: Manual practico urgencias medicina interna muy bueno

���

0DQHMR�GH�ODV�KHPRUUDJLDV�GLJHVWLYDV�DOWDV�$QJHO�)HUQiQGH]��0DU�9LFHQWH����&RQFHSWR�\�FODVLILFDFLyQ�3pUGLGD�GH�VDQJUH�SURFHGHQWH�GHO�DSDUDWR�GLJHVWLYR��&RQVWLWX\H�XQD�GH�ODV�XUJHQFLDV�PpGLFDV�PiV�IUHFXHQWHV�GHSHQGLHQGR�VX�SURQyVWLFR�IXQGDPHQWDOPHQWH�GH�OD�LQWHQVLGDG�R�UHFLGLYD�GH�OD�KHPRUUDJLD�\�GH�OD�H[LVWHQFLD�GH�HQIHUPHGDGHV�DVRFLDGDV�TXH�FRPSOLFDQ�OD�HYROXFLyQ�6H�FODVLILFDQ�HQ�DOWDV�\�EDMDV�DWHQGLHQGR�D�TXH�HO�SXQWR�GH�VDQJUDGR�VHD�SUR[LPDO�R�GLVWDO�DO�iQJXOR�GXRGHQR\H\XQDO�GH�7UHLW]��� 3DUiPHWURV�TXH�LQGLFDQ�JUDYHGDG�� &OtQLFRV��(GDG�!����DxRV�)RUPD�GH�SUHVHQWDFLyQ��6KRFN�KLSRYROpPLFR�FRQOOHYD�XQD�PRUWDOLGDG�GHO�����5HFLGLYD�KHPRUUiJLFD��VH�FRUUHODFLRQD�GLUHFWDPHQWH�FRQ�OD�PRUWDOLGDG�3UHVHQFLD� GH� HQIHUPHGDGHV� DVRFLDGDV�� LQVXILFLHQFLD� FDUGtDFD�� KHSDWRSDWtD�� LQVXILFLHQFLD�UHQDO�\�FRDJXORSDWtD�� (QGRVFySLFRV�� /D� SUHVHQFLD� GH� VDQJUDGR� DFWLYR� �HQ� �MHW�� R� �EDEHDQWH��� HV� HO� SULQFLSDO�SDUiPHWUR� HQGRVFRSLR� GH� JUDYHGDG�� RWURV� VRQ�� YDVR� YLVLEOH�� FRDJXOR� URMR�� FRDJXOR� SODQR�R�OHVLyQ�SLJPHQWDGD�FRQ�SXQWRV�QHJURV����$FWXDFLyQ�LQLFLDO�DQWH�XQD�KHPRUUDJLD�GLJHVWLYD�DOWD��+'$��/R� SULPHUR� TXH� GHEH� KDFHUVH� DQWH� XQD� +'$� HV� YDORUDU� ORV� VLJQRV� YLWDOHV� \� HO� HVWDGR�KHPRGLQiPLFR�GHO�SDFLHQWH��&RPR�QRUPD�JHQHUDO�3DFLHQWHV�FRQ�HVWDELOLGDG�KHPRGLQiPLFD��SpUGLGDV�GHO���������GHO�YROXPHQ�FLUFXODQWH�����������P/���5HTXLHUH�WHUDSpXWLFD�\�YLJLODQFLD�RUGLQDULDV��'LHWD�DEVROXWD��6RQGD�QDVRJiVWULFD������������PO���GtD�L�Y���PLWDG�ILVLROyJLFR�\�PLWDG�JOXFRVDGR�DO��������������PHT�GtD�GH�FON2PHSUD]RO�R�IDPRWLGLQD��������KRUDV(QHPD�FDGD����KRUDV��FRORU�KHFHV�'HWHUPLQDFLyQ�GH�WD������K�DO�LQJUHVR�\�FDGD������K�SRVWHULRUPHQWH�3DFLHQWHV�FRQ�LQHVWDELOLGDG�KHPRGLQiPLFD��SpUGLGDV�!�������!������P/���7LOW�WHVW����YDULDFLyQ�GH ���PP�+J�\����OSP�FRQ�HO�RUWRVWDWLVPR���KLSRWHQVLyQ�HQ�GHF~ELWR�\�!�����OSP��SXGLHQGR�SUHVHQWDU� SLHO� IUtD� \� SiOLGD� �YDVRFRQVWULFFLyQ� SHULIpULFD��� VXGDFLyQ�� REQXELODFLyQ�� ROLJXULD��3XHGH�SURGXFLUVH�XQ�FXDGUR�GH�VKRFN�KLSRYROpPLFR��SpUGLGDV�!������GH�OD�YROHPLD�y�!������P/���TXH�FRQOOHYD�XQD�LPSRUWDQWH�PRUWDOLGDG��!�������DVt�FRPR�IUHFXHQWHV�UHFLGLYDV������������'HEHQ�LQVWDXUDUVH�FRQ�XUJHQFLD�ODV�VLJXLHQWHV�PHGLGDV�

Page 130: Manual practico urgencias medicina interna muy bueno

���

&RORFDU�DO�SDFLHQWH�HQ�SRVLFLyQ�GH�7UHQGHOHPEXUJ�\�FRJHU�GRV�YtDV�SHULIpULFDV�JUXHVDV��XQD�SDUD�YROXPHQ�\�RWUD�SDUD�WUDQVIXQGLU��FHQWUDO�VL�VH�SUHFLVD�39&���6DFDU�VLPXOWiQHDPHQWH�XQ�KHPRJUDPD��FRDJXODFLyQ��ELRTXtPLFD�EiVLFD�\�SUXHEDV�FUX]DGDV�$GPLQLVWUDU�VXHUR�ILVLROyJLFR��D�FKRUUR�������������P/�K��KDVWD�FRQVHJXLU�XQD�7$�!������\�XQD� IUHFXHQFLD�FDUGtDFD��� ���� OSP�� GLVPLQX\HQGR�GHVSXpV� OD� YHORFLGDG�GH�SHUIXVLyQ�� 6L�SUHFLVD�FRORLGHV��KHPRFH���QR�DQWHV�GH�SUXHEDV�FUX]DGDV�6RQGD� GH� DVSLUDFLyQ� QDVRJiVWULFD� \� ODYDGR� FRQ� ���� P/� GH� VXHUR� VDOLQR� D� WHPSHUDWXUD�DPELHQWH��OD�DXVHQFLD�GH�DVSLUDGR�QR�GHVFDUWD+'$��VyOR�VL�HV�ELOLRVR�\�DEXQGDQWH��3XHGH�UHTXHULUVH�LQWXEDFLyQ�RURWUDTXHDO�SDUD�SUHYHQLU�DVSLUDFLRQHV�3URJUDPDU�JDVWURVFRSLD�XUJHQWH��YDORUDU�SRVLEOH�LQJUHVR�HQ�8&,�\�FRPHQWDU�FRQ�FLUXJtD�OD�SRVLELOLGDG�GH�XQD�XOWHULRU�LQWHUYHQFLyQ����+LVWRULD�FOtQLFD�6H�UHDOL]DUi�DQWHV��GXUDQWH�R�GHVSXpV�GH�OD�WHUDSpXWLFD�LQLFLDO��GHSHQGLHQGR�GH�OD�JUDYHGDG�GHO�SDFLHQWH��6H�OOHYDUi�D�FDER�XQD�DQDPQHVLV�\�XQD�H[SORUDFLyQ�ItVLFD�GHWDOODGDV��GLULJLGDV�D�OD�LQYHVWLJDFLyQ�HWLROyJLFD�GH�OD�KHPRUUDJLD�$QDPQHVLV��(SLVRGLRV�SUHYLRV�GH�+'$��FRQVLGHUDU�PLVPD�HWLRORJtD$QWHFHGHQWHV�GH�SLURVLV��KHUQLD�GH�KLDWR��UHIOXMR�\�HVRIDJLWLV�&OtQLFD�XOFHURVD��XOFXV�SpSWLFR��HO�GRORU�FHGH�FRQ�OD�KHPRUUDJLD��7UDXPDWLVPR��SRVWFLUXJtD��$&9��JDVWULWLV�HURVLYD�+HSDWRSDWtD� FRQRFLGD�� YDULFHV� HVRIiJLFDV�� XOFXV� SpSWLFR�� JDVWURSDWtD� FRQJHVWLYD� GH� OD�KLSHUWHQVLyQ�SRUWDO�+iELWR�HWtOLFR��FRPR�HO�DQWHULRU�PiV�JDVWULWLV�HURVLYD�\�6G��GH�0DOORU\�:HLVV��FRPLHQ]D�FRQ�YyPLWRV�QR�KHPiWLFRV��&RDJXORSDWtDV��+'$�UDUD�VLQ�SDWRORJtD�HVWUXFWXUDO�VXE\DFHQWH�&LUXJtD�SUHYLD�GH�XOFXV��XOFXV�GH�ERFD�DQDVWRPyWLFD)iUPDFRV�JDVWURHURVLYRV��$$6�R�$,1(6��R�*OXFRFRUWLFRLGHV��JDVWULWLV�HURVLYD��/$0'*��$GPLQLVWUDFLyQ�GH�.���)H���R�WHWUDFLFOLQDV��HVRIDJLWLV��~OFHUDV�HVRIiJLFDV�3UyWHVLV�YDVFXODU�DyUWLFD��ItVWXOD�DRUWRHQWpULFD�&RLQFLGHQFLD�FRQ�PHQVWUXDFLyQ��HQGRPHWULRVLV�([SORUDFLyQ�ItVLFD�,QVSHFFLRQDU�ERFD�\�QDVRIDULQJH��GHVFDUWDU�RULJHQ�25/�7DFWR�UHFWDO��FRQILUPDU�PHOHQDV%XVFDU� HVWLJPDV� GH� KHSDWRSDWtD� FUyQLFD� H� KLSHUWHQVLyQ� SRUWDO�� DUDxDV� YDVFXODUHV��FLUFXODFLyQ� FRODWHUDO�� JLQHFRPDVWLD�� SpUGLGD� GHO� YHOOR�� LFWHULFLD�� DVFLWLV�� KHSDWRHVSOHQRPH�JDOLD��IODSSLQJ��'HVFDUWDU�QHRSODVLDV�GLJHVWLYDV��SDOSDFLyQ�GH�DGHQRSDWtDV�R�PDVDV�$FDQWRVLV�QLJULFDQV��FiQFHU�GH�HVWyPDJR3~USXUD�SDOSDEOH��YDVFXOLWLV�VLVWpPLFD�

Page 131: Manual practico urgencias medicina interna muy bueno

���

7HODQJLHFWDVLDV�HStVWD[LV��HQIHUPHGDG�GH�5HQGX�2VOHU�:HEHU����3UXHEDV�FRPSOHPHQWDULDV�$QDOtWLFD��HO� YDORU� GHO� KHPDWRFULWR� QR� HV� PX\� ~WLO� DO� LQLFLR� GHO� FXDGUR� PLHQWUDV� QR� VH� SURGX]FD� OD�KHPRGLOXFLyQ� FRPSHQVDGRUD�� DSUR[LPDGDPHQWH� ���� D� ODV� �K�� ��� �� D� ODV� �� K��FRPSOHWiQGRVH� HQ� ���� GtDV�� +D\� TXH� WUDQVIXQGLU� FRQFHQWUDGRV� GH� KHPDWtHV� �&+�� KDVWD�DOFDQ]DU�XQ�+WR�GHO��������R�XQD�+E�GH����JU�� �XQ�&+�HTXLYDOH�D�����P/�GH�VDQJUH�\�DXPHQWD�XQ����HO�+HPDWRFULWR�\���JU��OD�+E�ODV� SODTXHWDV�\� ORV� OHXFRFLWRV� SXHGHQ�DXPHQWDU� UHDFWLYDPHQWH� WUDV� OD�KHPRUUDJLD��R�ELHQ�HVWDU�GLVPLQXLGRV�SRU�XQ�KLSHUHVSOHQLVPR�R�SRU�HIHFWR�GLUHFWR�GHO�DOFRKRO�XQ� 9&0� DOWR�� HQ� HVWH� FRQWH[WR�� VXHOH� LQGLFDU� KHSDWRSDWtD�� HWLOLVPR� R� UHWLFXORFLWRVLV�SRVWKHPRUUDJLD��6L�HV�EDMR�LQGLFD�DQHPLD�IHUURSpQLFD�SRU�SpUGLGDV�FUyQLFDV�OD� XUHD� DXPHQWD� YDULDV� KRUDV� GHVSXpV� GH� OD� KHPRUUDJLD�� SRU� OD� GHJUDGDFLyQ� EDFWHULDQD�LQWHVWLQDO�GH�ODV�SURWHtQDV��\�SHUPDQHFH�HOHYDGD�����GtDV��(O�FRFLHQWH�8UHD�FUHDWLQLQD�VXHOH�VHU�!�����(&*��XUJHQWH�5[�GH�WyUD[�\�DEGRPHQ�WUDV�HVWDELOL]DFLyQ�GHO�SDFLHQWH��*DVWURVFRSLD�$OFDQ]D� XQ� GLDJQyVWLFR� WRSRJUiILFR�HWLROyJLFR� HQ� HO� �������� GH� ORV� SDFLHQWHV�� GHELHQGR�UHDOL]DUVH�SUHIHUHQWHPHQWH�GHQWUR�GH� ODV�SULPHUDV�������KRUDV��%DMD�VX�UHQWDELOLGDG�VL�\D�KDQ�WUDQVFXUULGR����K�R�OD�KHPRUUDJLD�HV�PDVLYD�7LHQH�XQD�VHULH�GH�FRQWUDLQGLFDFLRQHV�$EVROXWDV�� VKRFN�� ,$0�� KLSR[HPLD� JUDYH�� FRPD�� FRQYXOVLRQHV�� SHUIRUDFLyQ�� VXEOX[DFLyQ�DWORD[RLGHD�5HODWLYDV�� SDFLHQWH� QR� FRODERUDGRU�� FRDJXORSDWtD� JUDYH�� GLYHUWtFXOR� GH� =HQNHU�� HVWHQRVLV�HVRIiJLFD� DOWD�� FDUGLRSDWtD� LVTXpPLFD�� DQHXULVPD�GH�DRUWD� WRUiFLFD�� DQHXULVPD�DEGRPLQDO�UHFLHQWH�(O� VDQJUDGR� FRSLRVR� SXHGH� LPSHGLU� OD� YLVXDOL]DFLyQ� GHO� SXQWR� VDQJUDQWH�� DGHPiV� GH�FRQOOHYDU�ULHVJR�GH�EURQFRDVSLUDFLyQ��(Q�HVH�FDVR�HVWDUtD�LQGLFDGD�XQD�DUWHULRJUDItD�$UWHULRJUDItD�/D� DUWHULRJUDItD� DEGRPLQDO� VHOHFWLYD�� JHQHUDOPHQWH� GHO� WURQFR� FHOtDFR� \� PHVHQWpULFD�VXSHULRU�� WLHQH� XQD� UHQWDELOLGDG� GLDJQyVWLFD� GHO� ��������� SHUR� SUHFLVD� XQD� YHORFLGDG� GH�VDQJUDGR��!�����P/�PLQ��5HVXOWD�PX\�~WLO�SDUD�OD�FLUXJtD�*DPPDJUDItD�,QGLFDGD�FXDQGR�HO�VDQJUDGR�HV�������P/�PLQ��6H�UHDOL]D�FRQ�KHPDWtHV�PDUFDGRV�FRQ�7F��P��)UHFXHQWHV�IDOVRV�QHJDWLYRV��VREUH�WRGR�VL�KD�UHFLELGR�WUDQVIXVLRQHV�P~OWLSOHV��7$&�&RQ�VRVSHFKD�GH�ItVWXOD�DRUWRHQWpULFD��DQHXULVPD�\�JDV�H[WUDOXPLQDO���PDVDV�/DSDURWRPtD�H[SORUDGRUD�

Page 132: Manual practico urgencias medicina interna muy bueno

���

(Q�RFDVLRQHV�HO�GLDJQyVWLFR�VyOR�VH�ORJUD�FRQ�XQD�ODSDURWRPtD�H[SORUDGRUD����7UDWDPLHQWR��GH�OD�+'$�SRUXOFXV�SpSWLFR�(O�WUDWDPLHQWR�SXHGH�VHU�GH�WUHV�WLSRV�� 0pGLFR�� HO� RPHSUD]RO� \� ORV� DQWL� +�� VRQ� ORV� ~QLFRV� IiUPDFRV� TXH� KDQ� PRVWUDGR� WHQHU�XWLOLGDG�SDUD�HOHYDU�HO�S+�IDYRUHFLHQGR�ORV�PHFDQLVPRV�KHPRVWiWLFRV�� (QGRVFySLFR��VH�KDUi�KHPRVWDVLD�GH�ODV�OHVLRQHV�VDQJUDQWHV�FRQ�VDQJUDGR�DFWLYR��)RUUHVW�,�� R� YDVR� YLVLEOH� �)RUUHVW� ,,D��� (V� HILFD]� HQ� HO� ������ �� GH� ORV� FDVRV�� ([LVWHQ� GLYHUVRV�PpWRGRV� �,Q\HFFLyQ��HQ�YDVRV�SHTXHxRV�GH�VXVWDQFLDV�HVFOHURVDQWHV��SROLGRFDQRO��HWDQRODPLQD��HWR[LHVFOHURO���YDVRFRQVWULFWRUHV��DGUHQDOLQD���SHJDPHQWRV�\�SURFRDJXODQWHV� �,QGXFFLyQ�WpUPLFD�GH�WURPERVLV�\�HVWHQRVLV��HQ�YDVRV�VDQJUDQWHV�SHTXHxRV��PHGLDQWH�HOHFWURFRDJXODFLyQ� �%,&$3��� ¢JDV� DUJyQ"�� VRQGD� FDOHIDFWRUD�� PLFURRQGDV� \� OiVHU�QHRGLPLR�<$*�TXH�HV�HO�PiV�HIHFWLYR��~WLO�WDPELpQ�HQ�OD�HFWDVLD�YDVFXODU�DQWUDO�� �0pWRGRV�PHFiQLFRV��HQ�YDVRV�JUDQGHV��FRPR�EDQGDV�HOiVWLFDV��KHPRFOLS��DVDV�VXWXUDV�R�WDSRQDPLHQWR�FRQ EDOyQ�� 4XLU~UJLFR��(Q�FLUXJtD�SURJUDPDGD�OD�PRUWDOLGDG�HV�GHO����������VL�HV�XUJHQWH�VXHOH�VHU�!�������,QGLFDGR�HQ� � +HPRUUDJLD� JUDYH�� FRQ� LQHVWDELOLGDG� KHPRGLQiPLFD� SHUVLVWHQWH� \� QHFHVLGDGHV�VLJQLILFDWLYDV�GH�WUDQVIXVLyQ� � +HPRUUDJLD� UHFLGLYDQWH� WUDV WUDWDPLHQWR� QR� TXLU~UJLFR�� TXH� SUHFLVD� WUDQVIXVLRQHV�DGLFLRQDOHV� �'LILFXOWDG�SDUD�REWHQHU�VDQJUH�FRPSDWLEOH����7UDWDPLHQWR��GH�OD�+'$�SRU�YDULFHV�HVRIiJLFDV�� (QGRVFySLFR�(VFOHURWHUDSLD�� HV� HO� WUDWDPLHQWR� GH� HOHFFLyQ�� %DMR� FRVWH� \� DOWD� HIHFWLYLGDG� �������)UHFXHQWHV�UHFLGLYDV�TXH�SUHFLVDQ�QXHYDV�VHVLRQHV�GH�HVFOHURWHUDSLD��&RPSOLFDFLRQHV��XOFHUDFLRQHV��HVWHQRVLV��SHUIRUDFLyQ��VHSVLV��HQ�HO�����ILHEUH�HQ�ODV�SULPHUDV����KRUDV�/LJDGXUD� FRQ� EDQGD� HOiVWLFD�� FRQ�HO� ILQ� GH� HVWUDQJXODU� ODV� YDULFHV� HVRIiJLFDV� JUDQGHV�LQWHUUXPSLHQGR�HO� IOXMR� VDQJXtQHR�KDFLD� OD� iFLJRV��7pFQLFD�PX\� ODERULRVD� �UHTXLHUH�XQ�VREUHWXER���QR�LQGLFDGD�HQ�HSLVRGLRV�DJXGRV��3XHGH�FRPELQDUVH�FRQ�OD�HVFOHURWHUDSLD�� )DUPDFROyJLFR9DVRSUHVLQD� R� JOLSUHVLQD� L�Y��� YDVRFRQVWULFFLyQ� JHQHUDOL]DGD�� FRQ� UHGXFFLyQ� GHO� IOXMR�VDQJXtQHR�SRUWDO��5HTXLHUH�DGPLQLVWUDFLyQ�FRQFRPLWDQWH�GH�QLWURJOLFHULQD�WySLFD�R�L�Y�6RPDWRVWDWLQD�X�RFWHyWLGR�L�Y���WDQ�HILFDFHV�FRPR�OD�YDVRSUHVLQD��H�LQFOXVR�WDQWR�FRPR�OD�HVFOHURWHUDSLD��PHQRV�FRPSOLFDFLRQHV��&RPR�SUHYHQWLYR�VH�XWLOL]DQ�ORV�EHWDEORTXHDQWHV��SURSDQRORO�\�QDGRORO��� 7DSRQDPLHQWR� FRQ� EDOyQ�� VRQGDV� GH� 6HQJVWDNHQ�%ODNHPRUH� R� GH�0LQQHVRWD� SDUD� ODV�YDULFHV� HVRIiJLFDV� �GREOH� EDOyQ��� R� GH� /LQWRQ�1DFKODV� SDUD� ODV� JiVWULFDV� �EDOyQ� ~QLFR���

Page 133: Manual practico urgencias medicina interna muy bueno

���

5HTXLHUH�LQWXEDFLyQ�SDUD�SUHYHQLU�DVSLUDFLyQ�\�DVIL[LD��5LHVJR�GH�~OFHUDV�\�QHFURVLV��UHGXFLU�SUHVLyQ�EDOyQ�GH�IRUPD�LQWHUPLWHQWH��\�UHWLUDU�SUHFR]PHQWH��� 4XLU~UJLFR�� GHVFRPSULPLHQGR� HO� VLVWHPD� SRUWD�PHGLDQWH� OD� FUHDFLyQ� GH� XQ� FRUWRFLUFXLWR�VHOHFWLYR� �HVSOHQR�UHQDO� GLVWDO�� R� QR� VHOHFWLYR� �HVSOHQR�UHQDO� SUR[LPDO� R�SRUWRFDYD� WO�R� WW���%XHQ�FRQWURO�GH�OD�KHPRUUDJLD��������SHUR�DOWD�PRUWDOLGDG�SRVWTXLU~UJLFD�XUJHQWH�������\�HQFHIDORSDWtD� KHSiWLFD� SRVWRSHUDWRULD� �GHSHQGHUi� GHO� JUDGR� GH� LQVXILFLHQFLD� KHSiWLFD�VXE\DFHQWH��� 'HULYDFLyQ� SRUWR�VLVWpPLFD� LQWUDKHSiWLFD� WUDV\XJXODU� �'36,7��� WpFQLFD� UDGLROyJLFD� TXH�FRQVLVWH�HQ�OD�LQVHUFLyQ�LQWUDYDVFXODU�GH�XQD�SUyWHVLV�H[SDQVLEOH�HQWUH�ODV�YHQDV�KHSiWLFDV�\�OD�SRUWD�GHVFRPSULPLHQGR�HVWD��6H�XWLOL]D�HQ�YDULFHV�JiVWULFDV�HQ�ORV�SDFLHQWHV�HQ�TXH�KDIUDFDVDGR�OD�HVFOHURWHUDSLD�\�VRQ�PDORV�FDQGLGDWRV��SDUD�OD�FLUXJtD��\�FRQ�YLVWDV�D�XQ�XOWHULRU�WUDVSODQWH�KHSiWLFR�%LEOLRJUDItD���� &LUHUD�<�� )HX� )�� /XFD�$��*DUFtD�3DJDQ� -&�� )HUQiQGH]�0��(VFRUVHOO� $��%RVFK�-��5RGpV� -��(IIHFWV�RI� EROXV� LQMHFWLRQ� DQG� FRQWLQRXV� LQIXVLRQV�RI� VRPDWRVWDWLQ�DQG�SODFHER� LQ�SDWLHQWV�ZLWK�FLUUKRVLV��D�GRXEOH�ELQG�KHPRG\QDPLF�LQYHVWLJDWLRQ��+HSDWRORJ\����������������������*DUFtD�-&��(VFRUVHOO�$��%RVFK�-��$FWLWXGHV�WHUDSpXWLFDV�HQ�OD�KHPRUUDJLD�GLJHVWLYD�SRU�YDULFHV�HVRIiJLFDV��0HGLFLQH����������������������/DLQH�/��3HWHUVRQ�:/��%OHHGLQJ�SHSWLF�XOFHU��1�(QJO�-�0HG�����������������������0LxR�*��-DUDPLOOR�-/��*iOYH]�&��&DUPRQD�&��5H\HV�$��'H�OD�0DWD�0��$QiOLVLV�GH�XQD�VHULH�JHQHUDO�SURVSHFWLYD�GH������KHPRUUDJLDV�GLJHVWLYDV�DOWDV��5HY�(VS�(QI�'LJHVW����������������

Page 134: Manual practico urgencias medicina interna muy bueno

���

3DQFUHDWLWLV�DJXGD��3$��-XDQ�0D\RU����&RQFHSWRV��7DEOD�,���,PSRUWDQFLD��/D�PD\RUtD�GH�ORV�FDVRV�GH�3$�VRQ�OHYHV�����������\�VH�FDUDFWHUL]DQ� SRU� HGHPD� SDQFUHiWLFR� FRQ� HVFDVD� UHSHUFXVLyQ� VLVWpPLFD� DXQTXH� XQ� SHTXHxR�JUXSR� ������� ��� FXUVD� FRQ� PD\RU� VHYHULGDG�� SURGXFLpQGRVH� QHFURVLV� JODQGXODU� FRQ�FRPSOLFDFLRQHV�LPSRUWDQWHV�WDQWR�JHQHUDOHV�FRPR�ORFDOHV�TXH�FRQGLFLRQDQ�XQ�SHRU�SURQyVWLFR����/D� LQFLGHQFLD�DQXDO HQ�QXHVWUR�SDtV��HQ�GLYHUVRV�HVWXGLRV�SURVSHFWLYRV��HV�GH�����FDVRV� ��PLOOyQ�KDELWDQWHV��SURGXFLHQGR�HQ�WRWDO�XQRV��������HSLVRGLRV�DQXDOHV��(Q�QXHVWUR�+RVSLWDO� OD FDXVD PiV�KDELWXDO�GH�3$�HVWi�DVRFLDGD�D�FROHOLWLDVLV��2WUDV�FDXVDV�VRQ� HO� DOFRKROLVPR� FUyQLFR�� IRUPDV� LGLRSiWLFDV�� SRVW� � &�3�5�(��� PHWDEyOLFDV� �KLSHUFDOFHPLD��KLSHUWULJOLFHULGHPLD��� SRU� IiUPDFRV� �LQPXQRVXSUHVRUHV�� ��$6$��� SRVWUDXPiWLFD� �OD� FDXVD� PiV�IUHFXHQWH�HQ�QLxRV���SRVWRSHUDWRULD��HWF����/D PRUWDOLGDG HV�SUiFWLFDPHQWH�QXOD�HQWUH�ORV�SDFLHQWHV�FRQ�3$�OHYH��VLHQGR�VLQ�HPEDUJR�GHO���������HQ�DTXHOORV�SDFLHQWHV�FRQ�3$�QHFURWL]DQWH��FRQ�XQD�WDVD�JOREDO�GH�PRUWDOLGDG�SDUD�OD�HQIHUPHGDG�GHO������ OR�TXH�VXSRQH�TXH�DQXDOPHQWH�HQ�(VSDxD�IDOOHFHQ�����SDFLHQWHV�FRPR�FRQVHFXHQFLD�GH�OD�3$���� (O� GLDJQyVWLFR GH� OD� 3$� FOiVLFDPHQWH� VH� HVWDEOHFH� SRU�� D�� VLQWRPDWRORJtD� WtSLFD� �GRORU�DEGRPLQDO� DOWR�� LUUDGLDGR� D� GRUVR�� FRQWLQXR�� LQWHQVR�� FRQ� YyPLWRV��� DVRFLDGD� D� E�� FULWHULR� GH�ODERUDWRULR��HOHYDFLyQ�GH�OD�FLIUD�GH�DPLODVD�HQ�VDQJUH�X�RULQD�PiV�GH���YHFHV�HO�UDQJR�QRUPDO���R� �HQ� FDVR� GH� QRUPDOLGDG� HQ]LPiWLFD�� F�� FULWHULR UDGLROyJLFR�� 7$&� DEGRPLQDO� FRQ� VLJQRV�VXJHVWLYRV�GH�3$����(O�SURQyVWLFR VH�SXHGH�HVWDEOHFHU�LQLFLDOPHQWH�FRQ�FULWHULRV�PXOWLSDUDPpWULFRV�DO�LQJUHVR�GHO�SDFLHQWH��5DQVRQ�HQ�OD�3$�DOFRKyOLFD��GH�*ODVJRZ�HQ�OD�3$�QR�DVRFLDGD�D�DOFRKROLVPR��GH�,PULH�SDUD� 3$ GH� FXDOTXLHU� HWLRORJtD� 7DEOD� ,,���� FRQ� FULWHULRV� GH� VHYHULGDG� UDGLROyJLFD� GHO� 7$&�DEGRPLQDO� �%DOWKD]DU� �7DEOD� ,,,���� \� PiV� UHFLHQWHPHQWH� FRQ� GHWHUPLQDFLRQHV� DLVODGDV� GH�ODERUDWRULR� �HODVWDVD�SROLPRUIRQXFOHDU� \� SURWHtQD�&� UHDFWLYD���1R�REVWDQWH�� OD�PHMRU�YDORUDFLyQ�SURQyVWLFD�VH�HVWDEOHFH�FRQ�HO�H[DPHQ�FOtQLFR�GHO�SDFLHQWH�D�GLDULR����/D�3$�VHYHUD�WLHQH�XQD�HYROXFLyQ�ELPRGDO��(Q�OD�IDVH�LQLFLDO�SUHGRPLQDQ�ODV�DOWHUDFLRQHV�KHPRGLQiPLFDV��VKRFN�� LQVXILFLHQFLD�UHQDO��\�UHVSLUDWRULDV��6�'�5�$���GHUUDPH�SOHXUDO��\�D�SDUWLU�GH�OD�VHJXQGD�VHPDQD�ODV�FRPSOLFDFLRQHV�VXHOHQ�VHU�ORFDOHV�\�GH�FDUiFWHU�VpSWLFR��LQIHFFLyQ�GH�FROHFFLRQHV�IOXLGDV��DEVFHVRV�����7UDV�HVWDEOHFHU�HO�GLDJQyVWLFR�GH�3$�VH�GHEH�HPLWLU�XQ�SURQyVWLFR��,PULH��%DOWKD]DU���/DV�3$�TXH�VH�FRQVLGHUDQ�VHYHUDV��GHEHUtDQ�LQJUHVDU�HQ�SULPHUD�LQVWDQFLD�HQ�PHGLFLQD�LQWHQVLYD��GDGR�

Page 135: Manual practico urgencias medicina interna muy bueno

���

TXH�HO� LQJUHVR�GLIHULGR� HQ�HVWDV�XQLGDGHV�� WUDV�GtDV�GH�HVWDQFLD�HQ�RWURV�VHUYLFLRV�FXDQGR�VH�

FRPSOLFD�OD�HYROXFLyQ��VH�DVRFLD�D�XQD�PD\RU�PRUWDOLGDG��'H�%HDX[��*XW����������0HGLGDV�JHQHUDOHV�DQWH�WRGD�3$�

7DEOD�,��1RPHQFODWXUD��FULWHULRV�GH�$WODQWD�3DQFUHDWLWLV�DJXGD��3URFHVR� LQIODPDWRULR�GHO�SiQFUHDV FRQ�XQD�DIHFWDFLyQ�YDULDEOH�GH�RWURV�WHMLGRV�\�VLVWHPDV�RUJiQLFRV�GLVWDQWHV��3XHGH�VHU�LPSRVLEOH�FRQRFHU�HQ�HO�PRPHQWR�GHO�LQJUHVR�VL�HO�SDFLHQWH�TXH� WLHQH� XQ� HSLVRGLR� LQLFLDO� GH� SDQFUHDWLWLV� WLHQH� XQD� SDQFUHDWLWLV� FUyQLFD� SUHH[LVWHQWH�� \�� HVWH�HSLVRGLR� GHEH� FRQVLGHUDUVH� XQD� 3$� KDVWD� FRQWDU� FRQ� LQIRUPDFLyQ� DGLFLRQDO� TXH� FODUDPHQWH�HVWDEOH]FD�XQ�GLDJQyVWLFR�GH�SDQFUHDWLWLV�FUyQLFD�/D�VHYHULGDG�GH�OD�SDQFUHDWLWLV�DJXGD��VH�GHILQH�HQ�WpUPLQRV�UHOHYDQWHV�SDUD�HO�FOtQLFR��VH�FRQVLGHUD�VHYHUD� VL� KD\� HYLGHQFLD GH� IDFWRUHV� GH� )5$&$62� 25*$1,&2� �6KRFN�� LQVXILFLHQFLD� SXOPRQDU��IUDFDVR� UHQDO� R� KHPRUUDJLD� JDVWURLQWHVWLQDO�� R� &203/,&$&,21(6� /2&$/(6� �1(&526,6��$%6&(62�2�36(8'248,67(���6H�FRQVLGHUDQ�VLJQRV�SURQyVWLFRV� WHPSUDQRV���R�PiV�FULWHULRV�GH�5DPVRQ��,PULH��X���R�PiV�GH�$3$&+(�,,�6H�GHQRPLQD�&2/(&&,21�)/8,'$�$*8'$�D�DTXHOOD� TXH�VH�SURGXFH� WHPSUDQDPHQWH�HQ�HO�FXUVR�GH�OD�3$��VH�ORFDOL]DQ�HQ�R�FHUFD�GHO�SiQFUHDV�\�FDUHFH�GH�SDUHG�GH�WHMLGR�GH�JUDQXODFLyQ�R�ILEURVR��(VWiQ�FRQVWLWXLGDV�SRU���R�PiV�iUHDV�PHQRUHV�GH�� FP�\� WLHQHQ�EDMD�DWHQXDFLyQ��2FXUUH�HQ�HO��������GH�WRGRV�ORV�FDVRV�GH�3$�\�HQ�OD�PD\RUtD�VH�UHVXHOYHQ�GH�PRGR�HVSRQWiQHR��(Q�HO�7$&�QR�VH�UHFRQRFH� FiSVXOD� \� VL� SHUVLVWH� GXUDQWH� PiV� GH� ���� VHPDQDV�� \� VH� HQFDSVXOD� SDVD� D� OODPDUVH�368('248,67(�/D� 1(&526,6� 3$1&5($7,&$� VH� FDUDFWHUL]D� SRU� iUHDV� GLIXVDV� R� IRFDOHV� GH� SDUpQTXLPD�SDQFUHiWLFR�RQ� YLDEOH� \�TXH�JHQHUDOPHQWH�VH�DVRFLD�D�QHFURVLV�JUDVD�SHULSDQFUHiWLFD��/D�GLVWLQFLyQ�HQWUH� 3$� LQWHUVWLFLDO� \� QHFURWL]DQWH� VH� SXHGH� UHDOL]DU� FRQ� 7$&� GLQiPLFR� WUDV� OD� DGPLQLVWUDFLyQ� GH�FRQWUDVWH�36(8'248,67(�3$1&5($7,&2�VH�GHILQH�FRPR�XQD�FROHFFLyQ�GH� MXJR�SDQFUHiWLFR�FRQWHQLGR�SRU�XQD�SDUHG�GH�WHMLGR�ILEURVR�R�GH�JUDQXODFLyQ��6XHOH�FRQWHQHU�XQD�HOHYDGD�FRQFHQWUDFLyQ�GH�HQ]LPDV�SDQFUHiWLFDV�\�XQ�JUDGR�YDULDEOH�GH�GHWULWXV�WLVXODUHV��\�OD�PD\RUtD�VRQ�HVWpULOHV�$%6&(62�3$1&5(È7,&2�HV�XQD�FROHFFLyQ�GH�SXV�FLUFXQVFULWD��LQWUDDEGRPLQDO��WUDV�XQ�HSLVRGLR�GH�SDQFUHDWLWLV� DJXGD� R� WUDXPDWLVPR� SDQFUHiWLFR�� 6XHOH� GHVDUUROODUVH� SUy[LPR� DO� SiQFUHDV� \� FRQWLHQH�HVFDVR� WHMLGR� QHFUyWLFR� /D� PD\RUtD� RFXUUHQ� PiV� WDUGH� TXH� OD� QHFURVLV� LQIHFWDGD�� DO� PHQRV� ��VHPDQDV� WUDV�HO� LQLFLR� GH� OD� SDQFUHDWLWLV� \�VXHOH�GHULYDUVH�GH� OD� LQIHFFLyQ�GH�XQ�SVHXGRTXLVWH�R�GH�QIHFFLyQ�VHFXQGDULD�\�OLFXHIDFFLyQ�GH�XQD�SHTXHxD�iUHD�QHFUyWLFD�6H�GHVHFKDQ�ORV�VLJXLHQWHV�WpUPLQRV�DPELJXRV��SVHXGRTXLVWH�LQIHFWDGR��DKRUD�GHQRPLQDGR�DEVFHVR�SDQFUHiWLFR��� SDQFUHDWLWLV� KHPRUUiJLFD� �DKRUD� 3�� QHFURWL]DQWH��� IOHPyQ� SDQFUHiWLFR� �DKRUD� QHFURVLV�SDQFUHiWLFD��

Page 136: Manual practico urgencias medicina interna muy bueno

'LHWD� DEVROXWD� KDVWD� GHVDSDULFLyQ� GH� GRORU� DEGRPLQDO� \� GHO� LOHR�� /D� � UHLQWURGXFFLyQ� GH� OD�LQJHVWD� GH� DOLPHQWRV� VH� KDUi� GH� PRGR� JUDGXDO�� VLQ� UHVWULFFLRQHV� GLHWpWLFDV� \� VLQ� TXH� VHD�QHFHVDULR� HVSHUDU� D� TXH� VH� QRUPDOLFH� OD�DPLODVHPLD�6XHURWHUDSLD� HQ� FDQWLGDG� VXILFLHQWH� SDUD�QRUPDOL]DU� OD� YROHPLD� �GH�PRGR� RULHQWDWLYR�� �����FF�GtD�HQ�XQ�SDFLHQWH�GH����.J���,QGLYLGXDOL]DU�ODV�QHFHVLGDGHV�GH�FDGD�SDFLHQWH��FRQWURODU�OD�SUHVLyQ�YHQRVD�FHQWUDO�HQ�DQFLDQRV�FRQ�FDUGLRSDWtD�$QDOJHVLD� 3HWLGLQD� R� 3HQWD]RFLQD�� HQ� FDQWLGDG�VXILFLHQWH� SDUD� DOLYLDU� HO� GRORU��6,� QR� VH� FRQVLJXH�DOLYLR�� VH� DGPLQLVWUDUi�PRUILQD� HQ�VROXFLyQ�GLOXLGD�HQ�ERPED�GH�LQIXVLyQ�YyPLWRV�R�GH�LOHR�DVRFLDGR�D�GRORU�DEGRPLQDO�WHUDO�WRWDO�HQ�ODV�SULPHUDV����KRUDV�HQ�SDFLHQWHV�FRQ�3 VL�WUDV�LQLFLDU� OD�LQJHVWD�VH�SURGXFH�QXHYR�EURWH�GH�3$�R�GH�GRORU��6H�SXHGHQ�DGPLQLVWUDU�VROXFLRQHV�GH�OtSLGRV�VLHPSUH�TXH�OD�FLIUD�GH�WULJOLFpULGR�VHD�������PJ���$QWLELRWHUDSLD� SURILOiFWLFD�� HVWXGLRV� H[SHULPHQWDOHV� �0LWK|IHU�� *DVWURHQWHURORJ\�� ������ \�FOtQLFRV��6DLQLR��/DQFHW��������UHFLHQWHV�KDQ�GHPRVWUDGR� HILFDFLD� HQ� GLVPLQXLU� ODV�FRPSOLFDFLRQHV� VpSWLFDV� \� PHMRUDU HO�SURQyVWLFR� GH� OD� 3$� VHYHUD�� 1R� REVWDQWH��WRGDYtD� QR� SXHGH� UHFRPHQGDUVH� OD�JHQHUDOL]DFLyQ�GH�HVWD�SUiFWLFD�KDVWD�TXH�VH�DQDOLFHQ� VHULHV� PiV� DPSOLDV� HQ� HVWXGLRV�FRQWURODGRV�� /RV� DQWLELyWLFRV� TXH� KDQGHPRVWUDGR�HILFDFLD�VRQ�DTXHOORV�FDSDFHV�GH�GLIXQGLU� HQ HO� WHMLGR� SDQFUHiWLFR� QHFURVDGR��FLSURIOR[DFLQR��LPLSHQHP��1R�KDQ�GHPRVWUDGR�HILFDFLD�FRQWUDVWDGD�HQ�HO�WUDWDPLHQWR�GH�OD�3$�ORV�VLJXLHQWHV�IiUPDFRV��DQWLVHFUHWRUHV� JiVWULFRV�� LQKLELGRUHV� GH� OD� VHFUHFLyQ� SDQFUHiWLFD� �JOXFDJyQ�� VRPDWRVWDWLQD���DQWLHQ]LPiWLFRV� �DSURWLQLQD�� JDEH[DWR� PHVLODWR��� R� OD� DGPLQLVWUDFLyQ� GH� SODVPD� IUHVFR� R�SODVPDIpUHVLV� FRQ� OD� LQWHQFLyQ� GH� QHXWUDOL]DU� OD� DFWLYLGDG� SURWHROtWLFD� TXH� VH� GHVHQFDGHQD�GXUDQWH�OD�3$�6L�VH�GHWHFWD�KLSRFDOFHPLD�VH�FRUUHJLUi�FRQ�JOXFRQDWR�FiOFLFR�LY��K�VyOR�HQ�HO�FDVR�GH�TXH�� OD� KLSRFDOFHPLD� VHD� GH� OD� IUDFFLyQ� LyQLFD���DPEDV��OD�FDOFHPLD�VH�QRUPDOL]D�DO�FRUUHJLU�OD�

7DEOD�,,,��&ODVLILFDFLyQ�GH�%DOWKD]DU�GH�OD�VHYHULGDG�GH�OD�3$��7$&�DEGRPLQDO�*UDGR�$��3DQFUHDV�QRUPDO�*UDGR�%��$IHFWDFLyQ�IRFDO�*UDGR�&��([WHQVLyQ�SHULSDQFUHiWLFD��*UDGR�'� 3UHVHQFLD�GH�XQD�FROHFFLyQ�*UDGR�(��'RV�R�PiV�FROHFFLRQHV�R�DEVFHVRV�

7DEOD�,,��&ULWHULRV�SURQyVWLFRV�GH�,PULH�HQ�OD�3$�� (GDG�PD\RU�GH����DxRV�� &DOFHPLD�QR�FRUUHJLGD�PHQRU�GH���PJ�GO�

���

H[LVWDQ� VtQWRPDV� R� VLJQRV� GH� WHWDQLD� \� GH� TXH'HVFDUWDU�KLSRPDJQHVHPLD�DVRFLDGD��'H�FRH[LVWLUPDJQHVHPLD�

$VSLUDFLyQ�QDVRJiVWULFD��VyOR�HQ�FDVR�GH�6RSRUWH�QXWULFLRQDO��LQLFLDU�QXWULFLyQ�SDUHQ$�VHYHUD��VL�VH�SUHYp�D\XQR�SURORQJDGR�R�

�� 8UHD�VpULFD�PD\RU�GH����PJ�GO��� /'+�VpULFD�PD\RU�GH�����8,�/��� *OXFHPLD�!����PJ�GO��� /HXFRFLWRVLV�VXSHULRU�D���������PO��� $OEXPLQHPLD�PHQRU�D����JU�/��� 3UHVLyQ�GH�R[tJHQR�PHQRU�D����PP�+J�

Page 137: Manual practico urgencias medicina interna muy bueno

���

(Q� ODV� 3$� VHYHUDV��GHEHUtD�PRQLWRUL]DUVH� FRQ�SXOVLR[tPHWUR� OD� VDWXUDFLyQ� GH�2�� \� VL�HVWD�IXHVH���������GHEHUtD�UHDOL]DUVH�JDVRPHWUtD�DUWHULDO���� 0HGLGDV�HVSHFtILFDV��� /RV� SDFLHQWHV� FRQ� 3$� DVRFLDGD� D� FROHOLWLDVLV� GHEHQ� VHU� FROHFLVWHFWRPL]DGRV� XQD� YH]�UHFXSHUDGRV�GHO�HSLVRGLR�LQIODPDWRULR��GXUDQWH�HO�PLVPR�LQJUHVR��QR�GLIHULU�OD�LQWHUYHQFLyQ����/D�HVILQWHURWRPtD�HQGRVFySLFD�HVWi�LQGLFDGD�HQ�ORV�SDFLHQWHV�FRQ�3$�ELOLDU�FRQ�FRODQJLWLV�DVRFLDGD� D� HYLGHQFLD� GH� FROHGRFROLWLDVLV�� 7DPELpQ� FRPR� DOWHUQDWLYD� D� OD� FROHFLVWHFWRPtD� HQ�SDFLHQWHV�DQFLDQRV�R�GH�DOWR�ULHVJR�SDUD�FLUXJtD���(O�WUDWDPLHQWR�TXLU~UJLFR�HQ�OD�3$�VHYHUD�FRPSOLFDGD�GHEH�DFRPHWHUVH�VL���+D\�HYLGHQFLD�GH�QHFURVLV�SDQFUHiWLFD�LQIHFWDGD�FRPSUREDGD�PHGLDQWH�3$$)��$EVFHVR�SDQFUHiWLFR��DOWHUQDWLYD��GUHQDMH�SHUFXWiQHR���� (YROXFLyQ FOtQLFD� LQFRQWURODEOH� FOtQLFDPHQWH� �LQHVWDELOLGDG� KHPRGLQiPLFD��QHFHVLGDG� GH� YHQWLODFLyQ� PHFiQLFD�� HWF�� VLQ� HYLGHQFLD� GH� LQIHFFLyQ�� WUDV� ����VHPDQDV�GH�WUDWDPLHQWR�LQWHQVLYR���/RV�SVHXGRTXLVWHV�SDQFUHiWLFRV�DVLQWRPiWLFRV��DXQTXH�VHDQ�YROXPLQRVRV��VyOR�VH FRQWURODUiQ� PpGLFDPHQWH� \� ~QLFDPHQWH� VH� WUDWDUiQ� ORV� SVHXGRTXLVWHV�FRPSOLFDGRV�FRQ�GUHQDMH�SHUFXWiQHR�R�TXLVWRVWRPtD�HQGRVFySLFD��6L� IUDFDVD�VH�GHEH�DFRPHWHU�OD�FLUXJtD�

(Q�OD�)LJXUD���VH�DSRUWD�XQ�DOJRULWPR�GH�HYDOXDFLyQ�\�PDQHMR�GH�OD�3$�

Page 138: Manual practico urgencias medicina interna muy bueno

���

)LJXUD����(YDOXDFLyQ�GH�OD�SDQFUHDWLWLV�DJXGD�

3$�VHYHUD

7UDWDPLHQWR�PpGLFR�FRQYHQFLRQDO�

3$�OHYH7$&��LQGLFDGR7$&�QR��LQGLFDGR

3$��QHFURWL]DQWH3$�LQWHUVWLFLDO

3$$)�SDUD�GHVFDUWDU�LQIHFFLyQ1R�PHMRUtD�R�GHWHULUR0HMRUtD�FOtQLFD

&RQWLQXDU�WUDWDPLHQWR�1HFURVLV�HVWpULO1HFURVLV�LQIHFWDGD

7UDWDPLHQWR�TXLU~UJLFR� &RQWLQXDU�WUDWDPLHQWR�1R�PHMRUtD�

,QJUHVR�HQ�8&,��&RQVLGHUDU�WUDWDPLHQWR�DQWLELyWLFR�

%LEOLRJUDItD��� %DQNV� 3$��$FXWH� DQG� FKURQLF� SDQFUHDWLWLV�� ,Q��*DVWURLQWHVWLQDO� DQG�/LYHU�'LVHDVH�� �� WK�� HG��6OHLVHQJHU��)RUGWUDP��:%��6DXQGHUV�&R������������������� 'H�%HDX[� $&�� 3DOPHU� .5��&DUWHU� '&��)DFWRUV� LQIOXHQFLQJ�PRUELGLW\� DQG�PRUWDOLW\� LQ� DFXWH�SDQFUHDWLWLV��DQ�DQDO\VLV�RI�����FDVHV��*XW������������������6DLQLR�9��.HPSSDLQHQ�(��3RXODNNDLQHQ�3��HW�DO��(DUO\�DQWLELRWLF�WUHDWPHQW�LQ�DFXWH�QHFURWLVLQJ�SDQFUHDWLWLV��/DQFHW�������������������6WHLQEHUJ�:��7HQQHU�6��$FXWH�SDQFUHDWLWLV�1�(QJO�-�0HG��������������������:LOVRQ� &�� +HDWK�',�� ,PULH� &:��3UHGLFWLRQ� RI� RXWFRPH� LQ� DFXWH� SDQFUHDWLWLV�� D� FRPSDUDWLYH�VWXG\� $3$&+(� ,,�� FOLQLFDO� DVVHVPHQW� DQG�PXOWLSOH� IDFWRU� VFRULQJ� V\VWHP��%U� -�6XUJ� ������ ���������

Page 139: Manual practico urgencias medicina interna muy bueno

���

7UDWDPLHQWR�GH�OD�+HSDWLWLV�&UyQLFD�SRU�9LUXV�-DYLHU�6ROHUD��(OLVD�0DUWtQH]�$OIDUR�/D� +&9� HV� UHVSRQVDEOH� GH� DO� PHQRV� OD� PLWDG� GH� ODV� PXHUWHV� DWULEXLGDV� D� HQIHUPHGDG�FUyQLFD�KHSiWLFD��\�HV�OD�LQGLFDFLyQ�PiV�IUHFXHQWH�SDUD�WUDQVSODQWH�KHSiWLFR�HQ�(XURSD�\�((88��/D� +&9� GHWHULRUD� OD� FDOLGDG� GH� YLGD� \� SXHGH� SURJUHVDU� D� FLUURVLV� R� KHSDWRFDUFLQRPD�� /D�SUHYDOHQFLD� GH� LQIHFFLyQ� FUyQLFD� SRU� 9+&� \� 9+%� HV� GH� ����� \� ������ UHVSHFWLYDPHQWH�� /D�LQIHFFLyQ� FUyQLFD� SRU� 9+'� HV� OD� PHQRV� IUHFXHQWH�� 2WURV� YLUXV� FDUHFHQ� GH� LPSRUWDQFLD� FRPR�DJHQWHV�GH�+&�,QIHFFLyQ�SRU�9+&��7DEOD���7DEOD����'LDJQyVWLFR�GH�OD�+HSDWLWLV�&&DWHJRUtD� (/,6$ 5,%$ +&9�51$ $/7+HSDWLWLV�FUyQLFD�& 3RVLWLYD 3RVLWLYD� 3RVLWLYD (OHYDGD3RUWDGRU�GH�9+& 3RVLWLYD 3RVLWLYD 3RVLWLYD 1RUPDO5HFXSHUDFLyQ�LQIHFFLyQ�9+& 3RVLWLYD 3RVLWLYD 1HJDWLYD 1RUPDO)DOVR�SRVLWLYR�DQWL�9+& 3RVLWLYD 1HJDWLYD 1HJDWLYD 1RUPDO(/,6$ DQWL�9+&�SRU� HQ]\PH�OLQNHG� LPPXQRDVVD\��5,%$ DQWL�+&9E\� UHFRPELQDQW� LPPXQREORW�DVVD\��$/7 DODQLQH�DPLQRWUDQVIHUDVH�

$��,QIHFFLyQ�DJXGD�SRU�9+&/RV�SDFLHQWHV�FRQ� LQIHFFLyQ�DJXGD�SRU�9+&� WtSLFDPHQWH�HVWiQ�DVLQWRPiWLFRV�R� WLHQH�XQD�HQIHUPHGDG�OHYH����������QR�WLHQH�VtQWRPDV����������WLHQH�LFWHULFLD�\��������WLHQH�VtQWRPDV�LQHVSHFtILFRV�FRPR�DQRUH[LD��PDOHVWDU��R�GRORU�DEGRPLQDO���/D�HQIHUPHGDG�FOtQLFD�HV�VLPLODU�D�RWURV� WLSRV� GH� KHSDWLWLV� YLUDO�� SRU� OR� TXH� HQ� FDGD� SDFLHQWH� VH� SUHFLVDQ� WHVW� VHUROyJLFRV� SDUD�GHWHUPLQDU� OD� HWLRORJtD� GH� OD� KHSDWLWLV�� (Q� HO� ���� GH� HVWRV� SDFLHQWHV�� HO� FRPLHQ]R� GH� ORV�VtQWRPDV�SXHGH�SUHFHGHU�OD�VHURFRQYHUVLyQ�$F9+&��(O�FXUVR�GH�OD�KHSDWLWLV�DJXGD�SRU�9+&�HV�YDULDEOH�� /D� *37� D� YHFHV� VH� QRUPDOL]D�� VXJLULHQGR� XQD� UHFXSHUDFLyQ� FRPSOHWD�� SHUR� FRQ�IUHFXHQFLD�VH�VLJXH�GH�XQ�DXPHQWR�GH�QXHYR�TXH�LQGLFD�XQD�SURJUHVLyQ�D�KHSDWLWLV�FUyQLFD��(O�IDOOR�KHSiWLFR�IXOPLQDQWH�FRPR�FRQVHFXHQFLD�GH�KHSDWLWLV�DJXGD�SRU�9+&�HV�UDUR�>1(-0 ���������������@�%��,QIHFFLyQ�FUyQLFD�SRU�9+&�/D�LQIHFFLyQ�FUyQLFD�SRU�9+&�VH�SUHVHQWD�HQ�HO�����DO�����GH�ORV�SDFLHQWHV�GHVSXpV�GH�OD�LQIHFFLyQ�DJXGD�\�SURJUHVD�OHQWDPHQWH�VLQ�VtQWRPDV�R�VLJQRV�HQ�ODV�SULPHUDV���R���GpFDGDV��/D�FLUURVLV�VH�GHVDUUROOD�HQ�HO���������GH�ORV�FDVRV��&RQ�IUHFXHQFLD��OD�KHSDWLWLV�FUyQLFD�SRU�9+&�QR�VH�GLDJQRVWLFD�KDVWD�TXH�XQD�SHUVRQD�DVLQWRPiWLFD�VH�LGHQWLILFD�FRPR�SRUWDGRU�GH�9+&�HQ�XQµVFUHHQLQJ¶��HMHPSOR��GRQDQWHV�GH�VDQJUH���R�DO�GHWHFWDUVH�XQD�HOHYDFLyQ�GH�*37�HQ�XQ�H[DPHQ�PpGLFR�UXWLQDULR��)DFWRUHV�SUHGLFWRUHV�GH�PD\RU�JUDYHGDG�GH�OD�KHSDWRSDWtD�VRQ�HO�FRQVXPR�GH�DOFRKRO��!��J�G���DGTXLULU�OD�LQIHFFLyQ�GHVSXpV�GH�ORV����DxRV�\�HO�VH[R�YDUyQ��0DQLIHVWDFLRQHV�H[WUDKHSiWLFDV�GH�OD�LQIHFFLyQ�FUyQLFD�SRU�HO�9+&�

Page 140: Manual practico urgencias medicina interna muy bueno

���

6H� FRQVLGHUD� TXH� VRQ� GH� RULJHQ� LQPXQROyJLFR� H� LQFOX\HQ� OD� FULRJOREXOLQHPLD��JORPHUXORQHIULWLV� PHPEUDQRSUROLIHUDWLYD�� \� SRUILULD� FXWDQHD� WDUGD�� 2WUDV� FRQGLFLRQHV�� FX\D�DVRFLDFLyQ�GHILQLWLYD�QR�KD�VLGR�SUREDGD�� LQFOX\HQ��VtQGURPH�GH�6M|JUHQ�� WLURLGLWLV�DXWRLQPXQH��OLTXHQ�SODQR��XOFHUD�FRUQHDO�GH�0RRUHQ��ILEURVLV�SXOPRQDU�LGLRSiWLFD��+DPPDQ�5LFK���SROLDUWHULWLV�QRGRVD��DQHPLD�DSOiVLFD��\�OLQIRPDV�GH�FpOXODV�%�/RV� SDFLHQWHV� FRQ� +&� SRU� 9+&� TXH� WLHQHQ� PDQLIHVWDFLRQHV� H[WUDKHSiWLFDV� WDO� FRPR�FULRJOREXOLQHPLD�PL[WD�GHEHUtDQ�UHFLELU�HO�PLVPR�WUDWDPLHQWR��/D�FULRJOREXOLQHPLD�PL[WD�HVHQFLDO�\�OD�JORPHUXORQHIULWLV�GHEHQ�PHMRUDU�FRQ�HO�WUDWDPLHQWR�FRQ�LQWHUIHUyQ�&��0DQHMR�&OtQLFR�\�7UDWDPLHQWR�GH�OD�+HSDWLWLV�&UyQLFD�SRU�9+&/RV� SDFLHQWHV� FRQ� LQIHFFLyQ� FUyQLFD� SRU� 9+&� GHEHQ� VHU� HYDOXDGRV� SDUD� GHWHUPLQDU� OD�JUDYHGDG� GH� VX� HQIHUPHGDG� KHSiWLFD� \� YDORUDU� OD� SRVLELOLGDG� GH� WUDWDPLHQWR�� 6H� UHFRPLHQGD�WUDWDPLHQWR�DQWLYLUDO�SDUD�ORV�SDFLHQWHV�TXH�WLHQHQ�XQ�PD\RU�ULHVJR�GH�SURJUHVDU�D�FLUURVLV��(VWDV�SHUVRQDV�GHEHQ�FXPSOLU�ORV VLJXLHQWHV�FULWHULRV�>00:5 ��������55����SDJ���@�$QWLFXHUSRV�9+&�SRVLWLYRV(OHYDFLyQ�GH�HQ]LPDV�KHSiWLFDV��n *37�GXUDQWH�t ��PHVHV��1LYHOHV�GHWHFWDEOHV�GH�51$�9+&�\'DWRV�HQ�OD�ELRSVLD�KHSiWLFD�GH�ILEURVLV�SRUWDO�R�HQ�SXHQWHV�R�DO�PHQRV�XQ�JUDGR�PRGHUDGR�GH�LQIODPDFLyQ�\�QHFURVLV��,.�t����(Q� ORV� SDFLHQWHV�FRQ�FDPELRV�KLVWROyJLFRV�PHQRV�JUDYHV� OD� LQGLFDFLyQ�GHO� WUDWDPLHQWR�HV�PHQRV�FODUD��/RV�SDFLHQWHV�FRQ�YDORUHV�QRUPDOHV�PDQWHQLGRV�GH�*37�QR�GHEHUtDQ�WUDWDUVH�IXHUD�GH�HQVD\RV�FOtQLFRV��7DPSRFR�VH�DFRQVHMD�HO�WUDWDPLHQWR�HQ�FLUUyWLFRV�DYDQ]DGRV�HQ�ULHVJR�GH�GHVFRPSHQVDFLyQ��HQ�HPEDUD]DGDV��\�HQ�PHQRUHV�GH���DxRV�R�PD\RUHV�GH�����(O�WUDWDPLHQWR�VH�GHEH�GHPRUDU�HQ�DOFRKyOLFRV�\�$'93�KDVWD�TXH�HVWRV�KiELWRV�VH�KD\DQ�DEDQGRQDGR��/DV� FRQWUDLQGLFDFLRQHV� SDUD�HO� WUDWDPLHQWR� FRQ�D�,)1� HQ�PRQRWHUDSLD� R� FRPELQDGR� FRQ�ULEDYLULQD�VH�UHVXPHQ�HQ�OD�WDEOD����/D�FXDQWLILFDFLyQ�GH� OD�FDUJD�YLUDO� GHO�9+&�\�HO�JHQRWLSR�QR� LQIOX\H�HQ� OD�GHFLVLyQ�GH�GDU�WUDWDPLHQWR� SHUR� VL� SXHGH� LQIOXLU� HQ� OD� GXUDFLyQ� GH� OD� FRPELQDFLyQ� GHO WUDWDPLHQWR� FRQ� ,)1� \�ULEDYLULQD��(Q�((88�OD�KHSDWLWLV�$�HV�UHVSRQVDEOH�GH�DOUHGHGRU�GHO�����GH�ORV�FDVRV�GH�+HSDWLWLV�9LUDO�$JXGD� \� OD� VXSHULQIHFFLyQ� SRU� 9+$� SXHGH� FDXVDU� IDOOR� KHSiWLFR� DJXGR� HQ� SDFLHQWHV� FRQ�HQIHUPHGDG� FUyQLFD� KHSiWLFD� >1(-0 ���������������@�� SRU� OR� TXH� HQ� HVH� SDtV� VH� KDUHFRPHQGDGR�TXH�ORV�SDFLHQWHV�TXH�VRQ�VXVFHSWLEOHV�GHEHUtDQ�YDFXQDUVH�FRQWUD�HO�9+$��\�HQ�DOJXQRV�FDVRV�FRQWUD�HO�9+%�����7UDWDPLHQWR�GH�OD�+HSDWLWLV�&�FRQ�DOID�,QWHUIHUyQ��DD�,)1��/D�PRQRWHUDSLD�FRQ�FXDOTXLHUD�GH�ORV�D�,)1�DSUREDGRV��DOID��E��DOID��D�\�UHFRPELQDWH��D�XQD� GRVLV� GH� �0� GH� 8�� VXEFXWiQHDV� �� YHFHV� HQ� VHPDQD� GXUDQWH� ��� PHVHV� FRQVLJXH� XQD�QRUPDOL]DFLyQ�GH�OD�*37��UHVSXHVWD�ELRTXtPLFD��HQ�HO�����GH�ORV�SDFLHQWHV�\�XQD�QHJDWLYL]DFLyQ�GH�OD�FDUJD�YLUDO��UHVSXHVWD�YLUROyJLFD��HQ�HO�����DO�ILQDOL]DU�HO�WUDWDPLHQWR��6LQ�HPEDUJR��t����

Page 141: Manual practico urgencias medicina interna muy bueno

���

GH�HVWRV� SDFLHQWHV� UHFDHQ�FXDQGR� ILQDOL]D�HO� WUDWDPLHQWR�\�DO�DxR�VROR�GHO��������WLHQHQ�XQD�UHVSXHVWD�VRVWHQLGD��YDORUDGD�SRU�QRUPDOLGDG�GH�OD�*37�\�51$�9+&�QHJDWLYR��>00:5���������55����SDJ���@��8QD�GXUDFLyQ�PD\RU� GHO� WUDWDPLHQWR� ���� D� ���PHVHV���GRVLV�PiV�DOWDV� �KDVWD���0�8�SRU�VHPDQD���R�XQ� WUDWDPLHQWR�GH�LQGXFFLyQ�FRQ�D�,)1�GLDULR�����08�G���VHPDQDV�D��PHVHV�� SXHGHQ� PHMRUDU� OD� UHVSXHVWD� >+HSDWRORJ\ ���������������+HSDWRORJ\ ���������������+HSDWRORJ\����������������@��1R�REVWDQWH��HVWDV�DOWHUQDWLYDV�VRQ�PX\�FRVWRVDV�\�VH�WROHUDQ�SHRU��3Uy[LPDPHQWH�VDOGUi�DO�PHUFDGR�XQ�D�,)1�GH�OHQWD�OLEHUDFLyQ��VH�DGPLQLVWUD�XQD�YH]�HQ�VHPDQD��\�TXH�SDUHFH�FRQVLJXH�PHMRUHV�UHVXOWDGRV��3(*�D�,)1��/RV� HIHFWRV� DGYHUVRV� GHO� ,)1� VRQ� IUHFXHQWHV� H� LQFOX\HQ� µVtQGURPH� JULSDO¶�� GHSUHVLyQ��FLWRSHQLDV�KHPDWROyJLFDV��\�DOWHUDFLRQHV�GHO�WLURLGHV��7DEOD���\�����7DEOD����&ULWHULRV�GH�LQFOXVLyQ�\�H[FOXVLyQ�HQ�ORV�HQVD\RV�FOtQLFRV�GH�,)1�DD��E�FRQ�R�VLQ�ULEDYLULQD�&ULWHULRV�GH�,QFOXVLyQ� &ULWHULRV�GH�H[FOXVLyQ6HURSRVLWLYRV�SDUD�HO�9+&��51$�9+&�SRU�3&5�� &LUURVLV�GHVFRPSHQVDGD%LRSVLD�KHSiWLFD�FRQ�GDWRV�GH�KHSDWLWLV�FUyQLFD� $OID�IHWRSURWHLQD�!��QJ�PO(OHYDFLyQ�GH�*37��SRU�HQFLPD�GHO�OtPLWH�QRUPDO��GXUDQWH�!� PHVHV $QHPLD��+E����JU�G/�HQ�OD�PXMHU�\����HQ�HO�YDUyQ���OHXFRSHQLD�������PP���QHXWURILORV�������PP���SODTXHWDV����������PP��

6HURSRVLWLYR�SDUD�HO�9,+��HQIHUPHGDG�SVLTXLiWULFD��HSLOHSVLD��HQIHUPHGDG�FDUGLRYDVFXODU��KHPRILOLD��'0�FRQ�PDO�FRQWURO��HQIHUPHGDG�DXWRLQPXQH��WUDQVSODQWH��QR�SRGHU�OOHYDU�XQ�PpWRGR�DQWLFRQFHSWLYR��,5&��KHPRJORELQRSDWtD1(-0������������������\��������7DEOD����(IHFWRV�DGYHUVRV�GHO�,QWHUIHUyQ�$O�FRPLHQ]R�GHO�WUDWDPLHQWR�\�IUHFXHQWHV� 7DUGtRV�\�PHQRV�IUHFXHQWHV)LHEUH�\�HVFDORIUtRV 6tQWRPDV�SVLTXLiWULFRV0LDOJLDV�\�GRORU�OXPEDU 'HSUHVLyQ)DWLJD���'HELOLGDG ,UULWDELOLGDG&HIDOHD ,QVRPQLR$QRUH[LD�\�SpUGLGD�GH�SHVR 0LHORVXSUHVLyQ6tQWRPDV�JDVWURLQWHVWLQDOHV 1HXWURSHQLD0ROHVWLDV�DEGRPLQDOHV 7URPERSHQLD,UULWDELOLGDG�\�GLILFXOWDG�SDUD�OD�FRQFHQWUDFLyQ (QIHUPHGDG�DXWRLQPXQH,QVRPQLR (QIHUPHGDG�GHO�WLURLGHV$ORSHFLD $XWRDQWLFXHUSRV5HWLQRSDWtD

Page 142: Manual practico urgencias medicina interna muy bueno

���

(QWUH� ORV� SDFLHQWHV� FRQ� XQD� UHVSXHVWD� YLUROyJLFD� VRVWHQLGD� OD� FDOLGDG� GH� YLGD� PHMRUD�>+HSDWRORJ\���������������@�\�OD�UHVSXHVWD�YLUROyJLFD��ELRTXtPLFD�H�KLVWROyJLFD�VH�PDQWLHQH�HQ�HO�����GH�ORV�SDFLHQWHV�HQ�VHJXLPLHQWR�D�ODUJR�SOD]R�>$,0�����������������@�/D�QR�QHJDWLYL]DFLyQ�GHO�51$�GHO�9+&��FDUJD�YLUDO��GHVSXpV�GH��� VHPDQDV�GH�WUDWDPLHQWR�R����VHPDQDV�GH�WHUDSLD�FRPELQDGD�HV�XQ�SUHGLFWRU�GH�QR�UHVSXHVWD�DO�WUDWDPLHQWR�D�ODUJR�SOD]R�\�VH�KD XWLOL]DGR�FRPR�XQD�UHJOD�SDUD�VXVSHQGHU�HO�PLVPR��6LQ�HPEDUJR��HQ�DXVHQFLD�GH�XQD�HUUDGLFDFLyQ�FRPSOHWD�GHO�9+&�VH�SXHGH�REVHUYDU�XQD�PHMRUtD�KLVWROyJLFD�\�XQ�HQOHQWHFLPLHQWR�GH� OD� SURJUHVLyQ� GH� OD� ILEURVLV� SRU� OR� TXH� QR� VH� SXHGH� GHVFDUWDU� XQ� HIHFWR� EHQHILFLRVR� GH�FRQWLQXDU�HO�WUDWDPLHQWR�HQ�HVWDV�VLWXDFLRQHV�7DVDV� GH� UHVSXHVWD� PHQRUHV� DO� WUDWDPLHQWR� FRQ�D�,)1� ������� VH� KDQ� HQFRQWUDGR� HQ�SDFLHQWHV�FRQ�WtWXORV�GH�51$�9+&�HOHYDGRV �!�0�FRSLDV�P/��\�JHQRWLSR����HO�PiV�IUHFXHQWH�HQ�(VSDxD���6LQ�HPEDUJR��HO� WUDWDPLHQWR�QR�GHEHUtD�QR�LQGLFDUVH�SRU�HVWRV�GDWRV��/RV�IDFWRUHV�GH�EXHQD�UHVSXHVWD�VH�UHIOHMDQ�HQ�OD�WDEOD�����7UDWDPLHQWR�GH�ORV�)DOORV�7HUDSpXWLFRV�\�5HFDtGDV�(Q� ORV� SDFLHQWHV� TXH� QR� UHVSRQGHQ� DO� ILQDO� GH� WUDWDPLHQWR�� ORV� UHWUDWDPLHQWRV� FRQ� GRVLV�HVWiQGDUHV� GH� D�,)1� VRQ� UDUDPHQWH� HIHFWLYRV�� /RV� SDFLHQWHV� TXH� WLHQHQ� QLYHOHV�SHUVLVWHQWHPHQWH�DQRUPDOHV�GH�*37�\�51$�GHO�9+&�GHWHFWDEOH�HQ�HO�VXHUR�GHVSXpV�GH�� PHVHV�GH�WUDWDPLHQWR�FRQ�D�,)1�HV�LPSUREDEOH�TXH�UHVSRQGDQ�DO�WUDWDPLHQWR�\�SXHGH�YDORUDVH��MXQWR�FRQ�HO�SDFLHQWH��OD�VXVSHQVLyQ�GHO�PLVPR��(VWDV�SHUVRQDV�GHEHQ�VHU�FDQGLGDWRV�SDUD�HQWUDU�HQ�HQVD\RV�FOtQLFRV�GH�WUDWDPLHQWRV�DOWHUQDWLYRV��(Q�ORV�SDFLHQWHV�WUDWDGRV�FRQ�PRQRWHUDSLD�FRQ�D�,)1�TXH�DOFDQ]DQ�XQ�51$�9+&�QHJDWLYR�DO�ILQDOL]DU�HO�WUDWDPLHQWR�SHUR�TXH�UHFDHQ�SRVWHULRUPHQWH�HO�WUDWDPLHQWR�FRPELQDGR�FRQ�D�,)1���5%9�GXUDQWH����VHPDQDV�R�HO�WUDWDPLHQWR�FRQ�,)1�DOIDFRQ���HQ�XQD�GRVLV�GH�����J���YHFHV�HQ�VHPDQD� GXUDQWH� ��� PHVHV� FRQVLJXH� UHVSXHVWDV� VRVWHQLGDV� HQWUH� HO� ���� \� ����UHVSHFWLYDPHQWH�>1�(QJO�-�0HG �����������������+HSDWRORJ\����������������@��(O�WUDWDPLHQWR�GH�ORV�QR�UHVSRQGHGRUHV��IDOORV� WHUDSpXWLFRV�DO� ILQDO�GHO�WUDWDPLHQWR�FRQ�,)1��FRQ�HVWDV�SDXWDV�RIUHFH�XQD�WDVD�GH�UHVSXHVWDV�VLPLODUHV�PX\�EDMDV�����������7UDWDPLHQWR�FRQ�DOID�,QWHUIHUyQ��DD�,)1��\�ULEDYLULQD��5%9��/D�FRPELQDFLyQ�GHO�D�,)1��E�D�OD�GRVLV�KDELWXDO���08�G���YHFHV�VHPDQD��\�ULEDYLULQD�������PJ�HQ����NJ�\������PJ�HQ�t��NJ��SRU�YtD�RUDO� GXUDQWH����� PHVHV�KD�PHMRUDGR� OD� WDVD�GH�UHVSXHVWD�YLUROyJLFD�VRVWHQLGD�WDQWR�HQ�SDFLHQWHV�µQDLYH¶�>1(-0 ����������������@�FRPR�HQ�ORV�TXH�KDQ�VLGR�SUHYLDPHQWH�WUDWDGRV�D�,)1�>1(-0 ���������������@�(QWUH� ORV� SDFLHQWHV�TXH�QR�KDQ�VLGR� WUDWDGRV�SUHYLDPHQWH� >1(-0 �����������������@��HO�WUDWDPLHQWR�FRPELQDGR�GXUDQWH����R����VHPDQDV�SURGXFH�XQD�UHVSXHVWD�YLUROyJLFD�VRVWHQLGD�HQ�HO�����\�����UHVSHFWLYDPHQWH�SHUR�HQ�ORV�SDFLHQWHV�FRQ�JHQRWLSR���OD�UHVSXHVWD�HV�PHQRU������FRQ����V��\�����FRQ���V��IUHQWH�D����\����FRQ�PRQRWHUDSLD�FRQ�D�,)1���/RV�JHQRWLSRV���\���

Page 143: Manual practico urgencias medicina interna muy bueno

���

WLHQHQ�UHVSXHVWDV�VRVWHQLGDV�GHO�����DO�����LQGHSHQGLHQWH�GH�TXH�OD�WHUDSLD�FRPELQDGD�HV�GH��R��� PHVHV��3RU�WDQWR��SDUD�XQ�SDFLHQWH�TXH�QR�WHQJD�HO�JHQRWLSR���VH�SUHILHUH�XQD�SDXWD�PiV�FRUWD�����VHPDQDV���/DV�PXMHUHV��ORV�PHQRUHV�GH����DxRV�\�DTXHOORV�FRQ�FDUJDV�YLUDOHV�PHQRUHV�GH��0�GH�FRSLDV�P/�VRQ�PiV�SUREDEOHV�TXH�UHVSRQGDQ�DO�WUDWDPLHQWR�FRPELQDGR�7DEOD� ��� &RPSDUDFLyQ� GH� ORV� HIHFWRV� DGYHUVRV� DVRFLDGRV� FRQ� HO� WUDWDPLHQWR�FRPELQDGR�GH�,)1�DD��E�\�ULEDYLULQD�IUHQWH�D�OD�PRQRWHUDSLD�FRQ�,)1�DD��E����(IHFWR�DGYHUVR ,)1�DD��E�������V� ,)1�DD��E���ULEDYLULQD�������V�5HWLUDGD�GHO�7UDWDPLHQWR�SRU�FXDOTXLHU�HIHFWR ���� ����5HGXFFLyQ�GH�GRVLV�SRU�DQHPLD � ���5HGXFFLyQ�GH�GRVLV�SRU�RWURV�PRWLYRV ���� �����6tQWRPDV�JULSDOHV&HIDOHD ����� �����)DWLJD ����� �����0DOHVWDU ��� ����0LDOJLDV ����� �����$UWUDOJLDV ����� �����'RORUHV�P~VFXOR�HVTXHOpWLFRV ����� �����)LHEUH ����� �����6tQWRPDV�*DVWURLQWHVWLQDOHV$QRUH[LD�� ����� �����'LVSHSVLD ��� �����9yPLWRV ����� ����1DXVHDV� ����� �����'LDUUHD ����� �����'RORU�DEGRPLQDO ����� �����6tQWRPDV�SVLTXLiWULFRV$QVLHGDG ���� �����'HWHULRUR�HQ�OD�FDSDFLGDG�GH�FRQFHQWUDFLyQ ����� �����'HSUHVLyQ ����� �����/DELOLGDG HPRFLRQDO ��� ����,QVRPQLR ����� �����,UULWDELOLGDG ����� �����6tQWRPDV�GHO�WUDFWR�UHVSLUDWRULR7RV ��� �����'LVQHD ���� �����)DULQJLWLV ���� �����6LQXVLWLV ���� ����6tQWRPDV�GHUPDWROyJLFRV$ORSHFLD ����� �����3UXULWR ��� �����5DVK ��� �����3LHO�VHFD ��� ����,QIODPDFLyQ�HQ�HO�VLWLR�GH�LQ\HFFLyQ ����� �����

Page 144: Manual practico urgencias medicina interna muy bueno

���

6ROR�VH�LQFOX\HQ�VtQWRPDV�TXH�DSDUHFHQ�DO�PHQRV�HQ�HO������1(-0��������������������/D�5%9�VH�GLVPLQX\y�D�����PJ�G�VL�+E�HQWUH�����\���JU�G/�\�VH�VXVSHQGLy�VL�+E�����JU�G/�(O� HIHFWR� VHFXQGDULR�PiV� IUHFXHQWH� GH� OD� ULEDYLULQD� HV� OD� DQHPLD� KHPROtWLFD�� DXQTXH� HV�LQIUHFXHQWH� TXH� VHD� WDQ� LQWHQVD� FRPR� SDUD� SUHFLVDU� OD� GLVFRQWLQXDFLyQ� GHO� WUDWDPLHQWR�� (VWH�HIHFWR�DGYHUVR�QR�SXHGH�SUHGHFLUVH�QL�SUHYHQLUVH�HQ�XQ�SDFLHQWH�GDGR��$GHPiV�VX�WHUDWRJHQLD�\�PXWDJHQLD�SXHGHQ�SHUVLVWLU�PHVHV�GHVSXpV�GH�ILQDOL]DU�HO�WUDWDPLHQWR�SRU�OR�TXH�GHEH�XWLOL]DUVH�FRQ�SUHFDXFLyQ�HQ�PXMHUHV�HQ�HGDG�IpUWLO��(O�DEDQGRQR�GHO�WUDWDPLHQWR�SRU�HIHFWRV�VHFXQGDULRV�VH�SURGXFH�HQ�XQ�����IUHQWH�DO����GH�ORV�SDFLHQWHV�TXH�UHFLEHQ�PRQRWHUDSLD�FRQ�,)1�>1(-0�����������������@��/D�GLVFRQWLQXDFLyQ�GHO�WUDWDPLHQWR�FRPELQDGR��D�,)1���ULEDYLULQD��PHQRV�GH���VHPDQDV�QR�GLVPLQX\H�OD�WDVD�GH�UHVSXHVWDV�(O�FRVWH�GH�OD�ULEDYLULQD�HV�PX\�HOHYDGR��������D�������SWDV��GtD��7DEOD� ��� )DFWRUHV� SUHGLFWRUHV� GH� XQD� UHVSXHVWD�PDQWHQLGD� DO� WUDWDPLHQWR� FRQ� ,)1DD HQ�SDFLHQWHV�FRQ�LQIHFFLyQ�FUyQLFD�SRU�9+&'XUDFLyQ�FRUWD�GH�OD�LQIHFFLyQ�FUyQLFD3DFLHQWHV�MyYHQHV������DxRV�0XMHUHV$/7�DQRUPDO$XVHQFLD�GH�FLUURVLV����� GH�UHVSXHVWD�YHUVXV����HQ�FLUUyWLFRV��%DMR�QLYHO�GH�51$�9+&�*HQRWLSR�GLVWLQWR�DO��E%DMD�FRQFHQWUDFLyQ�GH�KLHUUR�KHSiWLFR1HJDWLYL]DFLyQ�GH�51$�9+&�GHVSXpV�GH�����VHPDQDV�GH�WUDWDPLHQWR�,,��&DQGLGDWRV�SDUD�HO�7UDWDPLHQWR�FRQ�+HSDWLWLV�%�\�'�/RV FDQGLGDWRV�SDUD�HO�WUDWDPLHQWR�LQFOX\HQ�SDFLHQWHV�VHURSRVLWLYRV�SDUD�HO�$J+%V�\�'1$�9+%��\�TXH�WLHQHQ�HOHYDFLyQ�GH�*37�!��PHVHV�>1(-0����������������@��/D�PD\RUtD�WLHQHQ�HO�$J+%H�SRVLWLYR��DXQTXH�DOJXQRV� WLHQHQ�XQD�PXWDFLyQ�HQ�OD�UHJLyQ�GHO�SUHFRUH�GHO�9+%�SRU� OR�TXH�QR�VH�VLQWHWL]D�HO�$J+%H��(VWRV�SDFLHQWHV�VRQ�$J+%H�\�'1$�9+%�SRVLWLYRV��/D�XWLOLGDG�GH�OD�ELRSVLD� KHSiWLFD� HQ� HO� PDQHMR� GH� HVWRV� SDFLHQWHV� QR� KD� VLGR� YDORUDGD� HQ� HVWXGLRV� GH� FRVWH�HIHFWLYLGDG��/RV�SDFLHQWHV�FRQ�LFWHULFLD��DVFLWLV��HQFHIDORSDWtD�KHSiWLFD��R�KLVWRULD�GH�VDQJUDGR�SRU�YDULFHV�HVRIiJLFDV��GHEHUtDQ�UHPLWLUVH�SDUD�WUDQVSODQWH�KHSiWLFR��/D�+&�SRU�9+'�VH�LGHQWLILFD�SRU�OD�SUHVHQFLD�GH�$F�9+'�\�R�51$�9+'�HQ�SDFLHQWHV�LQIHFWDGRV�SRU�HO�9+%�$��7UDWDPLHQWR�GH�OD�+HSDWLWLV�%�(O� WUDWDPLHQWR�FRQ� ,)1�DOID��E����08�GLDULDV�R����08���YHFHV�SRU�VHPDQD�GXUDQWH���D���PHVHV�� KD� FRQVHJXLGR� XQ� DFODUDPLHQWR� GHO� YLUXV� �QR� SRU� 3&5��� XQD� SpUGLGD� GHO� $J+%H��QRUPDOL]DFLyQ�GH�OD�ELRTXtPLFD�UHVROXFLyQ�\�PHMRUtD�KLVWROyJLFD�HQ�HO��������GH�ORV�FDVRV�\�VH�FRQVLGHUD� FRVWH� HIHFWLYR�� /D� VHURFRQYHUVLyQ� GHO� $J+%H� \� HO� DFODUDPLHQWR� GHO� '1$�9+%� SRU�SUXHEDV�PiV�VHQVLEOHV��3&5��SXHGH�GHPRUDUVH�GXUDQWH�YDULRV�PHVHV�GHVSXpV�GH�FRPSOHWDU�HO�

Page 145: Manual practico urgencias medicina interna muy bueno

���

WUDWDPLHQWR��(OHYDFLyQ�WUDQVLWRULD�GH�ODV� WUDQVDPLQDVDV�SXHGH�SUHVHQWDUVH�KDVWD�HQ�HO�����GH�DTXHOORV� TXH� UHVSRQGHQ� GXUDQWH� HO� WUDWDPLHQWR�� /RV� IDFWRUHV� GH� EXHQD� R�PDOD� UHVSXHVWD� VH�UHIOHMDQ�HQ�OD�WDEOD����/D� UHGXFFLyQ� GH� OD� GRVLV� SXHGH� VHU� QHFHVDULD� SDUD�HO� FRQWURO�GH� ORV� HIHFWRV�VHFXQGDULRV�KDVWD�HQ�HO�����GH�ORV�SDFLHQWHV�WUDWDGRV��/D�WDVD�GH�UHVSXHVWD�HQ�ORV�SDFLHQWHV�FLUUyWLFRV�HV�FRPSDUDEOH� FRQ� OD� GH� ORV� SDFLHQWHV� QR� FLUUyWLFRV� \� VH� KD� PDQWHQLGR� GXUDQWH� DO� PHQRV� XQD�GpFDGD��/D�HVSHFWDQFLD�GH�YLGD�\�OD�VXSHUYLYHQFLD�OLEUH�GH�FRPSOLFDFLRQHV�HV�VLJQLILFDWLYDPHQWH�PiV�ODUJD�HQ�SDFLHQWHV�TXH�OOHJDQ�D�QHJDWLYL]DU�HO�$J+%H�>1(-0���������������@��8QD� QXHYD� RSFLyQ� WHUDSpXWLFD� HV� OD� DGPLQLVWUDFLyQ� RUDO� GH�ODPLYXGLQD �LQKLELGRU� GH� OD�WUDQVFULSWDVD�LQYHUVD�DQiORJR�GH�OD�GHR[LFLWRVLQD��GDGR�D�XQD�GRVLV�GH�����PJ�G��6H�WROHUD�ELHQ�HQ� SDFLHQWHV� FRQ� KHSDWLWLV� FUyQLFD� SRU� 9+%� FXDQGR� VH� DGPLQLVWUD� GXUDQWH� �� DxR� >1(-0��������������@��/D�*37�VH�QRUPDOL]D�HQ�HO�����GH�ORV�SDFLHQWHV��\�OD�DFWLYLGDG�QHFURLQIODPDWRULD�\�OD�SURJUHVLyQ�GH�OD�ILEURVLV�VH�UHGXFH�HQ�HO�KtJDGR��6H�REVHUYD�XQD�SpUGLGD�GHO�'1$�9+%�\�XQD�VHURFRQYHUVLyQ�$J+%H�HQ�XQD�PLQRUtD�GH�ORV�SDFLHQWHV�1R� VH� FRQRFH� OD� GXUDFLyQ� ySWLPD�GHO� WUDWDPLHQWR�FRQ� ODPLYXGLQD��SHUR�VH�SXHGH� LQWHQWDU�VXVSHQGHUOD�GHVSXpV�GH���DxR�VL�HO�SDFLHQWH�HV�$J+%H�����\�$F+%H�����\�KD\�XQD�QHJDWLYL]DFLyQ�GHO�'1$�9+%�HQ�HO�VHJXLPLHQWR��/D�ODPLYXGLQD�QR�VXSULPH�OD�PpGXOD�yVHD�\�UDUDPHQWH�LQGXFH�DXPHQWR� GH� OD�*37� GXUDQWH� HO� WUDWDPLHQWR�� $SUR[LPDGDPHQWH� XQ�����D�XQ�����GHVDUUROODQ�PXWDQWHV�GHO�9+%��YDULDQWHV�<0''���ORV�FXDOHV�SXHGHQ�R�QR�SXHGHQ�RFDVLRQDU�XQD�GLVPLQXFLyQ�GH� OD� WDVD� GH� UHVSXHVWDV� R� UHEURWHV� GH� OD� LQIHFFLyQ� FRQ� UHDSDULFLyQ� GHO� 9+%�� (O� PDQHMR� \�VLJQLILFDGR� GH� HVWD� VLWXDFLyQ� SRU� DKRUD� HV� LQFLHUWR�� (Q� XQ� HVWXGLR� UHFLHQWH� ORV� SDFLHQWHV� FRQ�QLYHOHV� GH� '1$�9+%� !���� FRSLDV� GH� JHQRPD�PO� QR� VHURFRQYLHUWHQ� �QHJDWLYL]DFLyQ� $J+%H���PLHQWUDV� TXH� DTXHOORV� FRQ� ���� FRSLDV� �PO� SDUHFH� PiV� SUREDEOH� TXH� VHURFRQYLHUWDQ� �-,'����������������

7DEOD����)DFWRUHV�SUHGLFWRUHV�GH�UHVSXHVWD�R�GH�QR�UHVSXHVWD�DO�WUDWDPLHQWR�FRQ�,)1DD HQ�SDFLHQWHV�FRQ�LQIHFFLyQ�FUyQLFD�SRU�9+%5HVSXHVWD 3UREDEOH� 3UREDEOHPHQWH�1R�5HVSXHVWD,QIHFFLyQ�DGTXLULGD�HQ�OD�HGDG�DGXOWD� ,QIHFFLyQ�DGTXLULGD�1HRQDWDO'XUDFLyQ�FRUWD�GH�OD�LQIHFFLyQ�����DxRV� 3DFLHQWHV�FRQ�FLUURVLV�GHVFRPSHQVDGD(QIHUPHGDG�KHSiWLFD�DFWLYD��$67�!����YHFHV�OR�1�� $J+%H�����FRQ�$67�QRUPDO'1$�9+%�EDMR� '1$�9+%�HOHYDGR,QPXQRFRPSHWHQWH ,QPXQRGHSULPLGR$XVHQFLD�GH�LQIHFFLyQ�9+' &RLQIHFFLyQ�FRQ�9+'0XMHU 9DUyQ$J+%H���� +,9����

Page 146: Manual practico urgencias medicina interna muy bueno

���

%��7UDWDPLHQWR�GH�OD�+HSDWLWLV�'/RV�DYDQFHV�HQ�HO�WUDWDPLHQWR�GH�OD�+HSDWLWLV�FUyQLFD�SRU�9+'�VRQ�HVFDVRV�\�OD�~QLFD�WHUDSLD�TXH�KD�GHPRVWUDGR�VHU�HIHFWLYD�HV�HO�LQWHUIHUyQ�DOID�D�GRVLV�DOWDV����0�8���YHFHV�HQ�VHPDQD�GXUDQWH�XQ�DxR�R�PiV��>3KDUPDFRWKHUDS\ ���������������@��5HVSXHVWDV�VRVWHQLGDV�VH�REVHUYDQ�HQ�XQD�PLQRUtD�GH�ORV�SDFLHQWHV��

Page 147: Manual practico urgencias medicina interna muy bueno

���

'LDUUHD�DJXGD\�FUyQLFD�/RXUGHV�6iH]�'HILQLFLyQ��DXPHQWR�GHO�SHVR�GLDULR�GH� ODV� KHFHV�D�PiV�GH���� JUV��6H�FRQVLGHUD�GLDUUHD�DJXGD�FXDQGR�GXUD�PHQRV�GH������GtDV�\�FUyQLFD�VL�GXUD�PiV�GH�����VHPDQDV�$��'LDUUHD�DJXGD����(WLRORJtD� /DV�FDXVDV�PiV�IUHFXHQWHV�VRQ��DJHQWHV�LQIHFFLRVRV�\�IiUPDFRV�R�Wy[LFRV�'HQWUR�GH�ODV�GH�FDXVD�LQIHFFLRVD��\�FODVLILFDGDV�SRU�HO�PHFDQLVPR�SDWRJpQLFR�WHQHPRV�� 3URGXFFLyQ�GH�WR[LQDV��%DFLOOXV�FHUHXV� $HURPRQDV VSS��(�FROL HQWHURWR[tJHQR��HWF���� ,QYDVLyQ�GH�PXFRVD��URWDYLUXV��&DPS\OREDFWHU�VSS��6KLJHOOD�VSS�� ,QIHFFLyQ�VLVWpPLFD��/HJLRQHOOD��3VLWDFRFLV��VtQGURPH�GHO�VKRFN�Wy[LFR�)iUPDFRV�� OD[DQWHV��DQWLiFLGRV�FRQ�PDJQHVLR��EHWDEORTXHDQWHV��KLSROLSHPLDQWHV��KRUPRQDV�WLURLGHDV��,(&$V��DQWLELyWLFRV��WHRILOLQD��HWF���� � (O�REMHWLYR� LQLFLDO� HQ� OD� HYDOXDFLyQ�GLDJQyVWLFDHQ� WRGR�HQIHUPR� FRQ�GLDUUHD� DJXGD�HV�GLIHUHQFLDU� HQWUH� DTXHOORV� SURFHVRV� FOtQLFDPHQWH� VHYHURV� R� TXH� FRQFXUUHQ� HQ� HQIHUPRV� FRQ�SDWRORJtD�VXE\DFHQWH�JUDYH�GH�DTXHOORV�RWURV�GH�QDWXUDOH]D�EHQLJQD�\�DXWROLPLWDGD�(Q�JHQHUDO�QR�HVWi� LQGLFDGD�OD�UHDOL]DFLyQ�GH�SUXHEDV�GLDJQyVWLFDV�HVSHFtILFDV�GHELGR�D�VX�HVFDVD� VHQVLELOLGDG� GLDJQyVWLFD�\� HOHYDGR�FRVWH� FXDQGR� VH� UHDOL]DQ�GH� IRUPD�QR�GLULJLGD� \� DO�FDUiFWHU�EHQLJQR����9DORUDFLyQ�FOtQLFD�&ULWHULRV�GH�JUDYHGDG�� 3UHVHQFLD�GH�VtQWRPDV R�VLJQRV�GH�GHSOHFFLyQ�GH�YROXPHQ�� 'LDUUHD�VDQJXLQROHQWD�� 7HPSHUDWXUD�!�����&� 6LJQRV�GH�SHULWRQLVPR�R�HVWDGR�VpSWLFR�7LHPSR�GH�GXUDFLyQ(SLGHPLRORJtD�� %URWH�HSLGpPLFR�R�QR� 8VR�GH�DQWLELyWLFRV�X�KRVSLWDOL]DFLyQ�UHFLHQWH� &RPSRUWDPLHQWR�VH[XDO� (GDG��HWF�6LWXDFLyQ�LQPXQH�GHO�SDFLHQWH��3DFLHQWHV�FRQ�SDWRORJtD�VXE\DFHQWH�JUDYH�R�LQPXQRGHILFLHQFLD�WLHQH� XQD�PD\RU� VXVFHSWLELOLGDG� D� SUHVHQWDU� XQD� GLDUUHD� DJXGD� GH� RULJHQ� LQIHFFLRVR� �S� HM��LQIHFFLyQ�SRU��6DOPRQHOOD VSS���GpILFLW�GH�,J$�\�ODV�LQIHFFLRQHV�SRU�*LDUGLD�����'LDJQyVWLFR�GH�ODERUDWRULR�

Page 148: Manual practico urgencias medicina interna muy bueno

���

/DV�GHFLVLRQHV�GLDJQyVWLFDV�VH�UHVXPHQ�HQ�OD�)LJXUD���

/DV�LQGLFDFLRQHV�SDUD�OD�VLJPRLGRVFRSLD�VRQ�3DFLHQWHV�FRQ�VLJQRV�R�VtQWRPDV�GH�SURFWLWLV'LDUUHD�VDQJXLQROHQWD�TXH�QR�PHMRUD�HQ����GtDV+RPRVH[XDOHV6H� WRPDUDQ�PXHVWUDV� SDUD�PLFURELRORJtD� \� SDUD� HVWXGLR� DQDWRPR�SDWROyJLFR��2IUHFH�GDWRV�DFHUFD�GH�OD�H[WHQVLyQ�GHO�SURFHVR�TXH�SXHGH�VXJHULU�RWURV�GLDJQyVWLFRV�FRPR�HQIHUPHGDG�LQIODPDWRULD�FUyQLFD�R�FROLWLV�LVTXpPLFD�+DVWD�HO������GH�ORV�FDVRV�TXHGDQ�VLQ�GLDJQyVWLFR����&ULWHULRV�GH�LQJUHVR,QWROHUDQFLD�SDUD�OD�LQJHVWD�RUDO�GH�OtTXLGRV�6LJQRV�GH�GHVKLGUDWDFLyQ�FOtQLFD�ELROyJLFD�3DFLHQWHV�FRQ�ULHVJR�GH�VHSVLV��HQ�GLDUUHDV�LQYDVLYDV�(GDG�!����DxRV�)LHEUH�!������&�PiV�OHXFRFLWRVLV�OHXFRSHQLD�FRQ�GHVYLDFLyQ�L]GD�

'LDUUHD�DJXGD� $IHFWDFLyQ�FOtQLFD�VHYHUD� ,QPXQRVXSUHVLyQ��YLDMHV��KRPRVH[XDOLGDG��GLDUUHDV�!��GtDV��EURWHV�HSLGpPLFRV�R�XVR�UHFLHQWH�GH�$0%

1R7UDWDPLHQWR�VLQWRPiWLFR�1R� LQGLFDGR� WUDWDPLHQWR�DQWLELyWLFR��1R�HVWXGLR�HWLROyJLFR

/HXFRFLWRV�HQ�KHFHV��7LQFLyQ�:ULJKW�R�D]XO�PHWLOHQR1R� 6t'$�LQIODPDWRULD�� &RQWLQXDU�WWR�VLQWRPiWLFR� 6L� QR� VH� UHVXHOYH�SHQVDU�HQ�'LDUUHD�SDUDVLWDULD�5HDJXGL]DFLyQ�'LDUUHD�&UyQLFD�(WLRORJtD�QR�LQIHFFLRVD

'$�LQIODPDWRULD�� &RSURFXOWLYR��7R[LQD�&ORVWULGLXP�GLIILFLOH� +XHYRV�SDUiVLWRV�HQ�KHFHV� 6LJPRLGRVFRSLD)LJXUD����GLDJQyVWLFR�GH�OD�GLDUUHD�DJXGD

Page 149: Manual practico urgencias medicina interna muy bueno

���

(QIHUPHGDG� GH� EDVH�� HQI�� OLQIRSUROLIHUDWLYDV�� GLDEHWHV�� FLUURVLV�� LQVXILFLHQFLD� UHQDO� FUyQLFD��LQIHFFLyQ�SRU�HO�9,+��HWF����7UDWDPLHQWR�(O�REMHWLYR�SULQFLSDO�HV�HO�UHHPSOD]DPLHQWR�GH�ODV�SpUGLGDV�GH�DJXD�\�HOHFWUROLWRV��6L�HV�OHYH�VH�UHDOL]D�WUDWDPLHQWR�FRQ�OtTXLGRV��HOHFWUROLWRV�\�JOXFRVD��VROXFLyQ�GH�OD�206�������FF�GH�DJXD�����JU��GH�JOXFRVD������JU��GH�FORUXUR�VyGLFR������JU��GH�ELFDUERQDWR�VyGLFR�\������JU��GH�FORUXUR�SRWiVLFR��8QLFDPHQWH�GHEH�VXVSHQGHUVH�WHPSRUDOPHQWH�OD�LQJHVWD�GH�DOLPHQWRV�FRQ�ODFWRVD�SRUTXH�HQ�ODV�'$�LQIHFFLRVDV�VH�SURGXFH�XQ�GpILFLW�WUDQVLWRULR�GH�ODFWDVD�/RV�DQWLELyWLFRV�HVWiQ�LQGLFDGRV�HQ�$IHFWDFLyQ�FOtQLFD�VHYHUD��SDWRORJtD�VXE\DFHQWH�JUDYH��DQFLDQRV�,QIHFFLyQ�SRU�6KLJHOOD��&�GLIILFLOH�\�9�FKROHUDH�3DUDVLWRVLV��JLDUGLDVLV�\�DPHELDVLV�3RUWDGRUHV�GH�SUyWHVLV��RUWRSpGLFDV��YDVFXODUHV�R�FDUGtDFDV��(QWHURFROLWLV�GH�WUDQVPLVLyQ�VH[XDO��JRQRFRFR��&KODP\GLD��VtILOLV��KHUSHV�VLPSOH��$QHPLDV�KHPROtWLFDV�6H�SXHGH�LQLFLDU�WUDWDPLHQWR�FRQ�7ULPHWRSULP�VXOIDPHWR[D]RO�HQ�GRVLV�GH���������PJ����K�R�&LSURIOR[DFLQR�����PJ����K�GXUDQWH�XQD�VHPDQD�1R�HV�DFRQVHMDEOH�HO�XVR�GH�DJHQWHV�DQWLGLDUUHLFRV��ORSHUDPLGD��FRGHtQD��GLIHQR[LODWR��VL�VH�VRVSHFKD�XQ�SURFHVR�HQWHURLQYDVLYR�SRU�HO�SHOLJUR�GH�DXPHQWDU�OD�FDSDFLGDG�LQYDVLYD�R�SRU�OD�SRVLELOLGDG�GH�GHVDUUROODU�XQ�tOHR�SDUDOtWLFR�R�PHJDFRORQ�Wy[LFR�%��'LDUUHD�FUyQLFD����(Q� OD�7DEOD�, VH�UHDOL]D�XQD�FODVLILFDFLyQ�GH� ODV�GLDUUHDV�FUyQLFDV�DWHQGLHQGR�DO�PHFDQLVPR�SDWRJpQLFR���� &XDOTXLHU� GLDUUHD� TXH� SHUVLVWH� GXUDQWH� VHPDQDV� R� PHVHV� WDQWR VL� HV� FRQVWDQWH� FRPR�LQWHUPLWHQWH�UHTXLHUH�HVWXGLR�6H� KD� GH� UHDOL]DU� XQD�DQDPQHVLV� \� H[SORUDFLyQ� ItVLFD GHWDOODGD� TXH� SHUPLWD� RULHQWDU� HO�SURFHVR�HQ�FXDQWR� D�VX� ORFDOL]DFLyQ�\�PHFDQLVPR�SDWRJpQLFR�\� KDFHU� XQ� XVR� UDFLRQDO� GH� ODV�SUXHEDV�GLDJQyVWLFDV����(Q�OD�DQDPQHVLV DWHQGHUi�D�)RUPD�GH�FRPLHQ]R��GXUDFLyQ�\�VHYHULGDG�GH�ORV�VtQWRPDV5HODFLyQ�FRQ�OD�GLHWD&DUDFWHUtVWLFDV�PDFURVFySLFDV�GH�ODV�KHFHV'RORU$OWHUDFLyQ�GHO�ULWPR�LQWHVWLQDO9DORUDFLyQ�GH�IHQyPHQRV�DFRPSDxDQWHV��HULWHPD�QRGRVR��LQWROHUDQFLD�DO�FDORU��HWF����(O�H[DPHQ�GH�ODV�KHFHVGHEH�LU�SUHFHGLGR�SRU�XQD�UHFRJLGD�DGHFXDGD�GH�ODV�KHFHV�\�GHEH�FRQVWDU�GH�

Page 150: Manual practico urgencias medicina interna muy bueno

���

(VWXGLR� GH� OHXFRFLWRV� HQ� KHFHV�� VH� VL� YHQ� LQGLFD� SURFHVR� LQIDPDWRULR�� FROLWLV� DVRFLDGD� D�DQWLELyWLFRV��WXEHUFXORVLV�LQWHVWLQDO��HWF��1XQFD�VH�YHQ�HQ�SURFHVRV�FRPR�FRORQ�LUULWDEOH��DEXVR�GH�OD[DQWHV��HWF�3UHVHQFLD��R�QR�GH�VDQJUH�HQ�KHFHV*UDVDV�HQ�KHFHV��FDQWLGDG�VXSHULRU�D���JU��GtD�LQGLFDQ�HVWHDWRUUHD�$OFDOLQL]DFLyQ�GH�ODV�KHFHV�VL�VH�VRVSHFKD�LQJHVWD�GH�OD[DQWHV����&ULWHULRV�TXH�VXJLHUHQ�DOWHUDFLyQ�RUJiQLFD�VL�KD\�WUHV�FULWHULRV�SHUPLWHQ�DOWD�HVSHFLILFLGDG������� \�SRFD�VHQVLELOLGDG��'LDUUHD�GH�FRUWD�GXUDFLyQ������PHVHV��'HSRVLFLRQHV�QRFWXUQDV�SUHGRPLQDQWHPHQWH�'LDUUHD�FRQWLQXD�PiV�TXH�LQWHUPLWHQWH'LDUUHD�GH FRPLHQ]R�UiSLGR3pUGLGD�GH�SHVR�!���.J3HVR�GLDULR�GH�KHFHV�!�����JU�$XPHQWR�GH�96*�R�DQHPLD�R�KLSRDOEXPLQHPLD����(Q�OD�)LJXUD�� VH�DSRUWD�HO�DOJRULWPR�GLDJQyVWLFR�LQLFLDO�SDUD�ODV�GLDUUHDV�FUyQLFDV��(Q�FDVR�GH�GHVFDUWDUVH�ORV�KHFKRV�DOOt�UHIHULGRV��VH�SURFHGHUi�D�ODV�SDXWDV�GLDJQyVWLFDV�TXH�VH�H[SRQHQ�HQ�ODV�7DEODV�,,�\�,,,�

%LEOLRJUDItD��� 'RQRZLW]�0��.RNNH�)7��6DLGL�5��&XUUHQW�FRQFHSV��HYDOXDWLRQ�RI�SDWLHQWV�ZLWK�FKURQLF�GLDUUKHD��1�(QJO�-�0HG����������������������� )ULHGPDQ� /6�� ,VVHOEDFKHU�.-�� 'LDUUKHD� DQG� FRQVWLSDWLRQ�� +DUULVRQ©V� 3ULQFLSOHV� RI� ,QWHUQDO�0HGLFLQH�����(G�������

'LDUUHD�FUyQLFD

���SDVR�DQWHV�GH�HYDOXDFLyQ'pILFLW�GH�ODFWDVD'LHWD�OLEUH�HQ�ODFWRVD

&RQVLGHUDU�� &LUXJtD�DEGRPLQDO�SUHYLD�� 5DGLDFLyQ�SUHYLD��)iUPDFRV�OD[DQWHV�(QIHUPHGDGHV�PHWDEyOLFDV,QPXQRVXSUHVLyQ�9,+

)LJXUD����GLDJQyVWLFR�GH�OD�GLDUUHD�FUyQLFD�

Page 151: Manual practico urgencias medicina interna muy bueno

��� ,ERUUD� -�� &DOHMD� -/�� &DFKR� *�� $OELOORV� $�� 3URWRFROR� GLDJQyVWLFR� GH� OD� GLDUUHD� FUyQLFD��3URWRFRORV�FOtQLFRV��0HGLFLQH��������� 3RZZHOO� ':�� $SSURDFK� WR� WKH� SDWLHQW� ZLWK� GLDUUKHD�� (Q�� <DPDGD� 7�� HG�� 7H[WERRN� RI�*DVWURHQWHURORJ\��3KLODGHOSKLD��-%�/LSSLQFRWW�&RPSDQ\���������������7DEOD�,��&ODVLILFDFLyQ�SDWRJpQLFD GH�OD�GLDUUHD�FUyQLFD0HFDQLVPR &OtQLFD (MHPSORV,1)/$0$725,$ )LHEUH'RORU�DEGRPLQDO6DQJUH�\�R�OHXFRFLWRV�HQ�KHFHV&ROLWLV�XOFHURVD(QIHUPHGDG�GH�&URKQ(QWHURFROLWLV�SRU�UDGLDFLyQ

*(�HRVLQRItOLFD,QI�DVRFLDGD�DO�9,+�260Ï7,&$ 0HMRUtD�FRQ�HO�D\XQR(VWHDWRUUHD3pUGLGD�GH�SHVR'pILFLWV�QXWULFLRQDOHV,QVXILFLHQFLD�SDQFUHiWLFD&UHFLPLHQWR�EDFWHULDQR(QIHUPHGDG�FHOtDFD'pILFLW�GH�/DFWRVD(QIHUPHGDG�GH�:KLSSOH$EHWDOLSRSURWHLQHPLD6tQGURPH�GH�LQWHVWLQR�FRUWR6(&5(725$ 'LDUUHD�DFXRVD�TXH�SHUVLVWH�FRQ�HO�D\XQR�'HVKLGDUDWDFLyQ�(IHFWRV�VLVWpPLFRV�KRUPRQDOHV�6tQGURPH�FDUFLQRLGH6tQGURPH�GH�=ROOLQJHU�(OOLVRQ�$GHQRPD�SDQFUHiWLFR�&DUFLQRPD�PHGXODU�WLURLGHV$GHQRPD�YHOORVR�GH�UHFWR&ROLWLV�PLFURVFySLFD�$/7(5$&,Ï1�'(�/$�027,/,'$' 'LDUUHD�HVWUHxLPLHQWR6tQWRPDV�QHXUROyJLFRV ,QWHVWLQR�LUULWDEOH�,PSDFWDFLyQ�IHFDO(QIHUPHGDG�QHXUROyJLFD)$&7,&,2 *HQHUDOPHQWH�PXMHUHV�'LDUUHD�DFXRVD�FRQ�+LSR�.DOLHPLD'HELOLGDG��HGHPD $EXVR�GH�OD[DQWH

���

Page 152: Manual practico urgencias medicina interna muy bueno

7DEOD�,,��HYDOXDFLyQ�GH�OD�GLDUUHD�FUyQLFD�HQ�HO�SDFLHQWH�DPEXODWRULR3ULPHU�HVFDOyQ�� (VWXGLR�GH�KHFHV��OHXFRFLWRV��SDUiVLWRV��[����WLUR[LQD��&��'LIILFLOH��SHVR��JUDVD����� (VWXGLRV�HQ�VDQJUH��KHPRJUDPD��ELRTXtPLFD��96*��KRUPRQDV�WLURLGHDV��JDVWULQD�\�RWUDV�

7DEOD�,,,��HYDOXDFLyQ�HVFDORQDGD�GH�OD�GLDUUHD�FUyQLFD�HQ�HO�SDFLHQWH�KRVSLWDOL]DGR

GHWHUPLQDFLRQHV�HVSHFtILFDV�VL�GDLUUHD�!��O�GtD��3,9��FDOFLWRQLQD��KLVWDPLQD���� (VWXGLRV� UDGLROyJLFRV�� 5[� VLPSOH� GH� DEGRPHQ� �FDOFLILFDFLRQHV� SDQFUHiWLFDV��� HVWXGLRV�EDULWDGRV�GH�WRGR�HO�WUDFWR�JDVWURLQWHVWLQDO��� (VWXGLRV�HQGRVFySLFRV��VLJPRLGRVFRSLD�\�ELRSVLD��� 2WURV��GHWHUPLQDFLyQ�GH���KLGUR[LLQGRODFpWLFR��VL�FOtQLFD�GH�IOXVK�6HJXQGR�HVFDOyQ��6L�QR�'[�HQ�HO�HVFDOyQ�DQWHULRU��� (VWXGLR�GH�KHFHV��LQYHVWLJDFLyQ�GH�*LDUGLD�SRU�(/,6$��HYDOXDFLyQ�GH�DEXVR�GH�OD[DQWHV�PHGLDQWH� GHWHUPLQDFLyQ� GH� 1D�� .�� VXOIDWR�� IRVIDWR� \� RVPRODULGDG�� HQVD\R� GH�DOFDOLQL]DFLyQ��SDUD�IHQROIWDOHtQD���� (VWXGLRV�UDGLROyJLFRV��HQWHURFOLVLV��7$&��� (VWXGLRV� HQGRVFySLFRV�� FRORQRVFRSLD� H� LOHRVFRSLD� FRQ� ELRSVLD�� HQGRVFRSLD� DOWD�LQFOX\HQGR�ELRSVLD�GH�,QWHVWLQR�GHOJDGR

���

'tD��&RQILUPDFLyQ�\�UHYLVLyQ�GH�ORV�UHVXOWDGRV�GH�OD�HYDOXDFLyQ�DPEXODWRULD��'tDV����,QVWDXUDU� GLHWD� DEVROXWD� FRQ� KLGUDWDFLyQ� LY� GXUDQWH� ��� KRUDV� �VL� OD� GLDUUHD� VH� GHWLHQH�FRPSOHWDPHQWH� HQ� ��� KRUDV� QR� HV� QHFHVDULR� FRQWLQXDU� OD� GLHWD��(Q� OD� GLDUUHD� VHFUHWRUD� D�PHQXGR�GHVFLHQGH�OD�PDJQLWXG�GH�OD�GLDUUHD�FRQ�HO�D\XQR��DXQTXH�SHUVLVWH�FRQ�PiV�GH����JU�GH�KHFHV�GtD�� PRQLWRUL]DFLyQ�GLDULD�GHO�SHVR�GH�ODV�KHFHV�'tDV����,QVWDXUDU�GLHWD�TXH�FRQWHQJD��������JUDPRV�GH�JUDVD����KRUDV�0RQLWRUL]DU�HO�SHVR�GH�ODV KHFHV�\�VX�FRQWHQLGR�HQ�JUDVD�HQ�ORV�GtDV�������

Page 153: Manual practico urgencias medicina interna muy bueno

���

6RSRUWH�1XWULFLRQDO5DLPXQGR�7LUDGR���'HVQXWULFLyQ��(V�XQ�WUDVWRUQR�GH�OD�FRPSRVLFLyQ�FRUSRUDO�SURGXFLGR�SRU�XQ�GHVHTXLOLEULR�HQWUH�OD�LQJHVWD�\�ODV�QHFHVLGDGHV�GHO�LQGLYLGXR��\�FXDQGR�QR�H[LVWH�HQ�HO�PRPHQWR�GHO�LQJUHVR�SXHGH�DSDUHFHU�FRQ�UHODWLYD�IDFLOLGDG�GXUDQWH�OD�HVWDQFLD�GHO�HQIHUPR�HQ�HO�KRVSLWDO������(Q�JHQHUDO��OD�PDOQXWULFLyQ�GHO�SDFLHQWH� KRVSLWDODULR� LPSOLFD� XQD� GLVPLQXFLyQ� GH� OD� PDVD� FHOXODU� IXQFLRQDQWH�� (O� VRSRUWH�QXWULFLRQDO�HQ�HVWRV�SDFLHQWHV�HVWD�DPSOLDPHQWH�MXVWLILFDGR�SRUTXH�H[LVWH�XQD�DVRFLDFLyQ�FDXVDO�HQWUH�HO�HVWDGR�GH�PDOQXWULFLyQ�\�HO�DXPHQWR�GH�OD�PRUEL�PRUWDOLGDG��\�SRUTXH�GLIHUHQWHV�HQVD\RV�FOtQLFRV�KDQ�GHPRVWUDGR�TXH�XQ�VRSRUWH�QXWULFLRQDO�DGHFXDGR�HV�HILFD]�SDUD�HYLWDU� ORV�HIHFWRV�GHULYDGRV�GHO�D\XQR�SURORQJDGR�\�GH�OD�VLWXDFLyQ�GH�KLSHUPHWDEROLVPR�VHFXQGDULR�DO�HVWUpV�������(VWXGLRV�UHDOL]DGRV�HQ�JUDQGHV�KRVSLWDOHV�SRQHQ�GH�PDQLILHVWR�TXH�HQWUH�XQ�WHUFLR�\�OD�PLWDG�GH� ORV� SDFLHQWHV� KRVSLWDOL]DGRV� SUHVHQWDQ� GpILFLWV� QXWULFLRQDOHV� VLJQLILFDWLYRV�� $GHPiV�� XQ�SRUFHQWDMH�VLJQLILFDWLYR� � GH� ORV�PLVPRV� VXIUH� XQ� GHWHULRUR�GH�VX�HVWDGR�QXWULFLRQDO� GXUDQWH�VX�LQJUHVR�����3RU�WDQWR��DQWH�WRGR�SDFLHQWH�KRVSLWDOL]DGR�GHEHUtDPRV�D��,GHQWLILFDU�ORV�SDFLHQWHV�TXH�WLHQHQ�R�HVWiQ�HQ�ULHVJR�GH�GHVDUUROODU�PDOQXWULFLyQ�FDOyULFR�SURWHtFD�X�RWUDV�GHILFLHQFLDV�QXWULFLRQDOHV�HVSHFtILFDV�E�� &XDQWLILFDU� ODV� SRVLEOHV� FRPSOLFDFLRQHV� PpGLFDV� UHODFLRQDGDV� FRQ� VX� HVWDGR� GH�PDOQXWULFLyQ�F��,QVWDXUDU�OD�WHUDSLD�QXWULFLRQDO�DGHFXDGD��������9DORUDFLyQ�1XWULFLRQDO������������/D�YDORUDFLyQ�QXWULFLRQDO�QRV�D\XGDUi�D�HVWDEOHFHU�HO�QXWULFLRQDO�GHO�SDFLHQWH��\�OR�TXH�HV�PiV�LPSRUWDQWH��HO�ULHJR�GHO�PLVPR�SDUD�GHVDUUROODU�IXWXUDV�FRPSOLFDFLRQHV�DVRFLDGDV�D�XQ�HVWDGR�GH�PDOQXWULFLyQ� �LQIHFFLyQ�� IOHELWLV�� HPEROLVPRV� SXOPRQDUHV�� LQVXILFLHQFLD� UHVSLUDWRULD�� SREUH�FLFDWUL]DFLyQ�GH�ODV�KHULGDV�\�IRUPDFLyQ�GH�ItVWXODV�����9DULRV� PpWRGRV� SXHGHQ� YDORUDU� HVWD� DVSHFWR�� SHUR� QLQJXQR� HV� DOWDPHQWH� VHQVLEOH QL�HVSHFtILFR�SDUD�GHWHFWDU�XQ�HVWDGR�GH�PDOQXWULFLyQ��HV�GHFLU��QR�H[LVWH�XQ�³SDWUyQ�RUR´��/D�PHMRU�FRPELQDFLyQ�GH�VHQVLELOLGDG�\�HVSHFLILFLGDG�OD�SUHVHQWD�OD�YDORUDFLyQ�VXEMHWLYD�JOREDO��96*���(O�tQGLFH�SURQyVWLFR�QXWULFLRQDO�\�HO�tQGLFH�FUHDWLQLQD�DOWXUD�WDPELpQ�SXHGHQ�VHU�~WLOHV�������/D�96*�VH�EDVD�HQ�ORV�KDOOD]JRV�GH�OD�KLVWRULD�FOtQLFD�\�GH�OD�H[SORUDFLyQ�ItVLFD��6X�REMHWLYR�HV�LGHQWLILFDU� D� ORV� SDFLHQWHV� GHVQXWULGRV� \� FRQ� PD\RU� ULHVJR� GH� VXIULU� FRPSOLFDFLRQHV� GH� OD�HQIHUPHGDG�R�GHO�WUDWDPLHQWR�LQVWDXUDGR��\�TXH�DGHPiV�VHUiQ�ORV�TXH�PiV�VH�EHQHILFLHQ�FRQ�OD�DGPLQLVWUDFLyQ�GH�QXWULFLyQ�DUWLILFLDO�����6H�EDVD�HQ���KDOOD]JRV����3pUGLGD�GH�SHVR�HQ�ORV���PHVHV�SUHYLRV�FDOLILFDGD�GH�SHTXHxD��������PRGHUDGD���������H�LPSRUWDQWH��!��������,QJHVWD�GH�DOLPHQWRV�HQ�UHODFLyQ�FRQ�HO�SDWUyQ�GLHWpWLFR�KDELWXDO�

Page 154: Manual practico urgencias medicina interna muy bueno

���

���([LVWHQFLD�GH�VtQWRPDV�*�,��DQRUH[LD��QDXVHD��YyPLWRV��������&DSDFLGDG�IXQFLRQDO�R�QLYHO�GH�HQHUJtD�TXH�SXHGH�GHVDUUROODU�HO�SDFLHQWH���*UDGR�GH�GHPDQGD�PHWDEyOLFD�GH�OD�HQIHUPHGDG�(O�JUiILFR�DGMXQWR�HVTXHPDWL]D�OR�TXH�GHEH�UHFRJHUVH�HQ�OD�96*��'H�WRGDV�IRUPDV�GHEHPRV�WHQHU�HQ�FXHQWD�

$��+,6725,$�&/Ì1,&$���3HVR�DFWXDO� 3HVR�KDELWXDO ���&DPELRV�HQ�HO�DSRUWH�GLHWpWLFR �3pUGLGD�HQ�ORV�~OWLPRV���PHVHV 1R6L�1R �6t��'XUDFLyQ VHPDQDV��GH�OD�SpUGLGD� ����'LHWD�VyOLGD�VXEySWLPD �9DULDFLyQ�HQ�ODV�~OWLPDV�GRV�VHPDQDV ����/tTXLGRV�KLSRFDOyULFRV����$XPHQWR������6LQ�FDPELR������'LVPLQXFLyQ ����/tTXLGRV�DFDOyULFRV����$\XQR���6tQWRPDV�JDVWURLQWHVWLQDOHV ���&DSDFLGDG�IXQFLRQDO�'XUDFLyQ�!��VHPDQDV�1LQJXQR $QRUH[LD &RPSOHWD1DXVHDV 9yPLWRV 'LVIXQFLyQ��'XUDFLyQ VHPDQDV�'LVIDJLD 'RORU�DEGRPLQDO 7LSR� ����7UDEDMR�OLPLWDGR'LDUUHD ����'HDPEXOD����(QFDPDGR����(QIHUPHGDG�GH�EDVH�\�VX�UHODFLyQ�FRQ�ORV�UHTXHULPLHQWR�QXWULFLRQDOHV �'LDJQyVWLFR�SULPDULR �'HPDQGDV�PHWDEyOLFDV��*UDGR�GH�HVWUpV������1LQJXQR������%DMR������0RGHUDGR������$OWR%��(;$0(1�)Ì6,&2�3DUD�FDGD�RSFLyQ�HVSHFLILFDU���� �QRUPDO���� �/HYH���� �PRGHUDGR���� �VHYHUR�3pUGLGD�GH�OD�JUDVD�VXEFXWiQHD���� �7UtFHSV��WyUD[� (GHPDV�PDOHRODUHV����(GHPDV�VDFURV����3pUGLGD�GH�PDVD�PXVFXODU��&XiGULFHSV��GHOWRLGHV� $VFLWLV���&��(VWLPDFLyQ�GH�OD�96*D�� %LHQ�QXWULGR E��0RGHUDGDPHQWH�QXWULGR F��6HYHUDPHQWH�PDOQXWULGR����8Q�GpILFLW�QHXUROyJLFR�SXHGH�LQWHUIHULU�FRQ�HVWD�PHGLGD�����3XHGH�GDU�YDORUHV�IDOVRV�HQ�SDFLHQWHV�FRQ�,&&� �/D�SpUGLGD�GH�SHVR�\�OD�GLVPLQXFLyQ�GH�OD�LQJHVWD�\�GH�OD�FDSDFLGDG�IXQFLRQDO�VRQ�ORV�IDFWRUHV�TXH�PiV�LQIOXLUiQ�HQ�OD�FODVLILFDFLyQ�GHO�SDFLHQWH�HQ�DOJXQR�GH�ORV�HVWDGLRV�����

9$/25$&,21�68%-(7,9$�*/2%$/

Page 155: Manual practico urgencias medicina interna muy bueno

���

�3DUD�DVLJQDU�D�XQ�SDFLHQWH�DO�JUXSR�&�GHEHQ�H[LVWLU�VLJQRV�HYLGHQWHV�GH�PDOQXWULFLyQ��SpUGLGD�GH�SDQtFXOR�DGLSRVR�\�GH�PDVD�PXVFXODU��HGHPDV������\�XQD�SpUGLGD�GH�SHVR�SURJUHVLYD�VXSHULRU�DO�����GHO�SHVR�KDELWXDO����� �/D�YDORUDFLyQ�GHEH�GH�VHU�0(126�6(16,%/(�\�0$6�(63(&Ë),&$��$Vt�SXHV��VL�ORV�KDOOD]JRV�FRUUHVSRQGLHQWHV�D�XQ�QLYHO�GH�SXQWXDFLyQ�%�VRQ�GXGRVRV��HQFXDGUDUtDPRV�DO�SDFLHQWH�HQ�XQ�HVWDGLR�$�3RU�VX�SDUWH�HO�HVWDGLR�&�HV�LQGLFDWLYR�GH�PDOQXWULFLyQ�VHYHUD����,QGLFDFLRQHV�GH�QXWULFLyQ�DUWLILFLDO�������/RV�REMHWLYRV�GH�LQVWDXUDU�VRSRUWH�QXWULFLRQDO�GHEHQ�VHU� �5HYHUWLU�ORV�HIHFWRV�GHO�DJRWDPLHQWR��PXHUWH�H�LQIHFFLyQ� �$OWHUDU�IDYRUDEOHPHQWH�OD�KLVWRULD�QDWXUDO�R�WUDWDPLHQWR�GH�OD�HQIHUPHGDG�/DV�LQGLFDFLRQHV�JHQHUDOHV�GHO�VRSRUWH�QXWULFLRQDO�HQ�SDFLHQWHV�KRVSLWDOL]DGRV�VRQ����3DFLHQWHV�VLQ�PDOQXWULFLyQ�TXH�KDQ�HVWDGR�VLQ�QXWULFLyQ�GXUDQWH�����GtDV���� 3DFLHQWHV� ELHQ� QXWULGRV�� FRQ� SDWRORJtD� FRQ� JUDGR� GH�HVWUpV� EDMR�� SHUR� TXH� OH� LPSLGD� OD�LQJHVWD�GXUDQWH�XQ�SHULRGR�GH�DO�PHQRV����GtDV��(Q�HOORV�VH�SUHVHUYDUD�HO�HVWDGR�QXWULFLRQDO�\�SUHYLHQH�ODV�FRPSOLFDFLRQHV�LQGXFLGDV�SRU�OD�LQDQLFLyQ���� 6L� HO� SDFLHQWH� SUHVHQWD� XQD� SpUGLGD� GH� UHFLHQWH� GH� SHVR� VXSHULRU� DO� ���� GH� VX� SHVR�KDELWXDO���� 3DFLHQWHV� LQFDSDFHV� GH� FRPHU� R� DEVRUEHU� QXWULHQWHV� GXUDQWH� XQ� SHULRGR� LQGHILQLGR�VHFXHODV� QHXUROyJLFDV� SHUPDQHQWHV�� UHFLpQ� QDFLGRV� SUHPDWXURV�� GLVIXQFLyQ� RURIDULQJHD��VtQGURPH� GHO� LQWHVWLQR� FRUWR��� (Q� HVWRV� SDFLHQWHV� HO� VRSRUWH� QXWULFLRQDO� SUHVHUYD� HO� HVWDGR�QXWULFLRQDO�\�DXPHQWD�OD�VXSHUYLYHQFLD����3DFLHQWHV�VHYHUDPHQWH�PDOQXWULGRV�TXH�KDQ�GH�VHU�VRPHWLGRV�D�FLUXJtD�PD\RU�GH�IRUPD�HOHFWLYD��GRQGH�VH�FRQVHJXLUi�XQD�GLVPLQXFLyQ�GH�ODV�FRPSOLFDFLRQHV�VpSWLFDV���� 3DFLHQWHV� FRQ� SROLWUDXPDWLVPR� LPSRUWDQWH �WUDXPD� SHQHWUDQWH�� WUDXPDWLVPR� FUDQHDO��TXHPDGXUDV������(Q�HOORV�VH�KD�GHPRVWUDGR�TXH�OD�QXWULFLyQ�HQWHUDO�HV�VXSHULRU�D�OD�SDUHQWHUDO�GLVPLQX\HQGR�OD�LQFLGHQFLD�GH�FRPSOLFDFLRQHV�VpSWLFDV��$GHPiV�PHMRUD�OD�HYROXFLyQ�FOtQLFD���� 5HFHSWRUHV� GH� WUDQVSODQWH� GH� PpGXOD� yVHD TXH� KDQ� GH� VRPHWHUVH� D� WUDWDPLHQWR�TXLPLRWHUiSLFR�LQWHQVLYR��0HMRUDUD�OD�HYROXFLyQ�FOtQLFD����6L�HO�SDFLHQWH�SUHVHQWD�XQD�SpUGLGD�UHFLHQWH�GH�SHVR�VXSHULRU�DO�����GH�VX�SHVR�KDELWXDO�(O�UHVWR�GH�SDFLHQWHV�KRVSLWDOL]DGRV�GHEHUtDQ�VHU�UHHYDOXDGRV�FDGD�����GtDV�¢4XH�SDFLHQWHV�VRQ�FDQGLGDWRV�D�VRSRUWH�QXWULFLRQDO�"��8Q�VHQFLOOR�DOJRULWPR�QRV�SXHGH�IDFLOLWDU�OD�GHFLVLyQ�

Page 156: Manual practico urgencias medicina interna muy bueno

���

6L�HO�SDFLHQWH�SUHVHQWD���GH�HVWDV�FDUDFWHUtVWLFDV�HVWDUi� MXVWLILFDGR�OD�DSOLFDFLyQ�GH�VRSRUWH�QXWULFLRQDO����&iOFXOR�GH�ORV�UHTXHULPLHQWRV�FDOyULFRV�������6LJXH�VLHQGR�YiOLGD�OD�IyUPXOD�GH�+DUULV�%HQHGLFW SDUD�HO�FiOFXOR�GHO�JDVWR�HQHUJpWLFR�EDVDO��*(%��HQ�.FDO�GtD�+RPEUHV��*(%� �����������[3HVR�HQ�NJ������[7DOOD�HQ�FP���� ����[(GDG�HQ�DxRV�0XMHUHV��*(%� �����������[3HVR�HQ�NJ��������[7DOOD�HQ�FP��� ����[(GDG�HQ�DxRV�(O� *(%� GHEH� PXOWLSOLFDUVH� SRU� IDFWRUHV� GH� FRUUHFFLyQ�� TXH� QR� VH� GHEHQ� DSOLFDU�VLPXOWiQHDPHQWH��VLQR�WRPDU�DTXHO�TXH�PiV�VH�DGDSWH�D�ODV�FRQGLFLRQHV�GHO�SDFLHQWH��R�UHFXUULU�D�OD�PHGLD�DULWPpWLFD�GH�WRGRV�ORV�IDFWRUHV�DSOLFDEOHV���7DEOD���8Q�PpWRGR�PiV� UiSLGR� HV� FRQVLGHUDU� HO�*(%�FRPR������.FDO�NJ� GH�SHVR�DO� GtD��$TXHOORV�SDFLHQWHV�VRPHWLGRV�D�XQ�JUDGR�GH�HVWUpV�OHYH�D�PRGHUDGR�UHTXHULUiQ�DSUR[LPDGDPHQWH�������NFDO�NJ�GH�SHVR�DO�GtD��6L�H[LVWLHVH�XQ�HVWUpV�JUDYH�ORV�UHTXHULPLHQWRV�FDOyULFRV�VXSHUDUiQ�ORV����NFDO�NJ�GH�SHVR�DO�GtD��*HQHUDOPHQWH�VH�DGPLQLVWUDUDQ�XQD�SURSRUFLyQ�GH�.FDO�QR�SURWHLFDV�JU�GH�QLWUyJHQR�GH��������(O�Q~PHUR�WRWDO�GH�NFDO�GtD�KD�DGPLQLVWUDU�HVWDUi�IRUPDGR�SRU� ORV�GLVWLQWRV�PDFURQXWULHQWHV�� VXSRQLHQGR� ORV� KLGUDWRV�GH�FDUERQR�XQ��������� ORV� OtSLGRV�XQ��������\� ODV�SURWHtQDV� XQ� ������� GH� ODV� PLVPDV�� 7RGDV� ODV� IyUPXODV� GHEHQ� FRQWHQHU� ODV� QHFHVLGDGHV�YLWDPtQLFDV�\�GH�ROLJRHOHPHQWRV�UHFRPHQGDGDV�SRU�OD�5'$�

+RVSLWDOL]DFLyQ�$OE~PLQD 3pUGLGD�GH�SHVR 5LHVJR�HOHYDGR0HQRU�GH���JU�GO !�������GHO�SHVR�KDELWXDO 7DEOD�,

,QGLFDFLRQHV�GH�VRSRUWH�QXWULFLRQDO�

Page 157: Manual practico urgencias medicina interna muy bueno

���

���9DORUDFLyQ�GH�OD�YtD�GH�DGPLQLVWUDFLyQ�GH�QXWULFLyQ�SDUHQWHUDO��������������5HFRPHQGDFLRQHV�QXWULFLRQDOHV�VHJ~Q�OD�SDWRORJtD�GH�EDVH����������������$��(QIHUPHGDGHV�JDVWURLQWHVWLQDOHV �6tQGURPH�GHO�,QWHVWLQR�&RUWR��6,&�� OD�QXWULFLyQ�DUWLILFLDO�SXHGH�SUHYHQLU�OD�PDOQXWULFLyQ�\�HV�IXQGDPHQWDO�SDUD� OD�VXSHUYLYHQFLD�HQ�GHWHUPLQDGRV�SDFLHQWHV�FRQ�HVWD�SDWRORJtD��6H�GHEH�DVHJXUDU� VLHPSUH�XQ�DSRUWH�RUDO� R�HQWHUDO� SDUD�HVWLPXODU� OD�DGDSWDFLyQ�GHO� WUDPR� LQWHVWLQDO�

,QGLFDFLyQ�GH�VRSRUWH�QXWULFLRQDO,QWHVWLQR�IXQFLRQDQWH 1R,QJHVWD�!�������GH�ORV�UHTXHULPLHQWRV�GLDULRV

1XWULFLyQ�SDUHQWHUDO'XUDFLyQ�SUHYLVWD��¢9tD�FHQWUDO�FDQDOL]DGD"�

�������GtDV$xDGLU�VXSOHPHQWRV�RUDOHV1XWULFLyQ�HQWHUDO'XUDFLyQ�SUHYLVWD

���VHPDQDV !��VHPDQDV

6t

6t 1R !������GtDV

2VWRPtDV6RQGD�QDVRHQWpULFD �5LHVJR�DOWR�GH�DVSLUDFLyQ �3DQFUHDWLWLV� �)tVWXOD�*,�DOWD

1R 6t

133

6RQGD�1DVRJiVWULFD 61'�R�61<

137

Page 158: Manual practico urgencias medicina interna muy bueno

���

UHVLGXDO�D�ORV�DOLPHQWRV�PHGLDQWH�XQD�KLSHUWURILD�GH�ODV�YHOORVLGDGHV�\�XQ�DXPHQWR�GHO�JURVRU�GHO� LQWHVWLQR� IXQFLRQDQWH�� /D� PD\RUtD� GH� ORV� SDFLHQWHV� UHTXLHUHQ� XQ� DSRUWH� SDUHQWHUDO� \�HQWHUDO���2OLJRPpULFD� �(QIHUPHGDG� ,QIODPDWRULD� ,QWHVWLQDO� HO� UHSRVR� LQWHVWLQDO� QR� VLHPSUH� HV� QHFHVDULR� SDUD�DOFDQ]DU�XQD�UHPLVLyQ�FOtQLFD��/DV�GLHWDV�HQWHUDOHV��ROLJRPpULFDV��PRQRPpULFDV�R�SROLPpULFDV�KDQ�PRVWUDGR�XQD�HILFDFLD�VLPLODU��SXHGHQ�VHU�WDQ�HIHFWLYDV�FRPR�OD�WHUDSLD�FRQ�FRUWLFRLGHV�D�OD�KRUD�GH�LQGXFLU�XQD�UHPLVLyQ�FOtQLFD��SHUR�HO�HIHFWR�GH�OD�PLVPD�HQ�ORV�EURWHV�\�FXUVR�FOtQLFR�QR�KD�VLGR�HYDOXDGR��(V�SUHIHULEOH�XWLOL]DU�XQD�QXWULFLyQ�HQWHUDO��VLHQGR�OD�QXWULFLyQ�SDUHQWHUDO�GH� HOHFFLyQ� HQ� VLWXDFLRQHV� FRQFUHWDV� FRPR� REVWUXFFLyQ� LQWHVWLQDO�� 6,&�� H[LVWHQFLD� GH�SHUIRUDFLyQ�LQWHVWLQDO R�PHJDFRORQ�Wy[LFR��SDQFUHDWLWLV�DJXGD��H[LVWHQFLD�GH�ItVWXODV�HQ�WUDPRV�LQWHVWLQDOHV� GLVWDOHV R� OD� QHFHVLGDG� GH� FLUXJtD� HOHFWLYD� R� SURJUDPDGD�� \D� TXH� HO�KLSHUFDWDEROLVPR� TXH� DFRPSDxD� D� OD� HQIHUPHGDG� \� D� VXV� FRPSOLFDFLRQHV�� FRORFDUi� DO�SDFLHQWH� HQ� XQ� HVWDGR� GH� GHVQXWULFLyQ� TXH� IDYRUHFHUi� OD� DSDULFLyQ� GH� FRPSOLFDFLRQHV�SRVWRSHUDWRULDV�� VL� QR� VH� FRQVLJXH� XQ� EXHQ� DSR\R� QXWULWLYR�� �3ROLPpULFD� QRUPRFDOyULFD�HQULTXHFLGD�HQ�JOXWDPLQD��iFLGRV�JUDVRV�RPHJD���\�R�ILEUD� �3DQFUHDWLWLV�DJXGD� QL� OD�QXWULFLyQ�HQWHUDO��1(��QL�OD�SDUHQWHUDO��137��KDQ�GHPRVWUDGR�XQ�HIHFWR�EHQHILFLRVR�HQ�HO�FXUVR�FOtQLFR�GH�SDFLHQWHV�FRQ�SDQFUHDWLWLV� OHYH�D�PRGHUDGD��6L�VH�SUHYp�TXH�HO�SDFLHQWH�QR�SRGUi�WROHUDU�DOLPHQWRV�GXUDQWH�XQ�SHULRGR�VXSHULRU�D����GtDV��H[LVWH�SpUGLGD� GH� SHVR� SUHYLD�� VHSVLV�� R� QRV� HQFRQWUDPRV� DQWH� XQD� SDQFUHDWLWLV� FRQ� FULWHULRV� GH�JUDYHGDG����R�PiV�FULWHULRV�GH�5DQVRQ�R�IUDFDVR�GH�DOJ~Q�yUJDQR� HVWDUi� MXVWLILFDGR�LQLFLDU�VRSRUWH�QXWULFLRQDO��6H�UHFRPLHQGDQ�GLHWDV�KLSHUFDOyULFDV�H�KLSHUSURWHLFDV��1R�GHEHQ�H[FOXLUVH�QXWULHQWHV�FRPR�ORV�OtSLGRV�TXH�SHUPLWHQ�UHGXFLU�OD�FDQWLGDG�GH�KLGUDWRV�GH�FDUERQR��HQ�HVWRV�SDFLHQWHV�HV�IUHFXHQWH�OD�KLSHUJOXFHPLD��D�DGPLQLVWUDU��$XQTXH�OD�H[LVWHQFLD�GH�tOHR�SDUDOtWLFR�QRV�SXHGH�REOLJDU�D�XVDU�137��HV�DFRQVHMDEOH�VX�SDVR�D�1(�PHGLDQWH�61<�WDQ�SURQWR�FRPR�VHD� SRVLEOH�� SDUD� HYLWDU� OD� DWURILD� GH� ODV� YHOORVLGDGHV� \� VHFXQGDULDPHQWH� OD� WUDVORFDFLyQ�EDFWHULDQD��RULJHQ�IUHFXHQWH�GH�FXDGURV�VpSWLFRV�HQ�HVWRV�SDFLHQWHV��/D�1(�D�WUDYpV�GH�XQDVRQGD�QDVR\H\XQDO� �61<�� HV� WROHUDGD� VLQ� H[DFHUEDFLRQHV� FOtQLFR�ELRTXtPLFDV�HQ�SDFLHQWHV�FRQ� SDQFUHDWLWLV� OHYH� D� PRGHUDGD� R� HQ� SDFLHQWHV� TXH� KDQ� VLGR� VRPHWLGRV� D� FLUXJtD� SRU�FRPSOLFDFLRQHV�GH�OD�SDQFUHDWLWLV��1R�VH�KDQ�HVWDEOHFLGR�GLIHUHQFLDV�HQWUD�ODV�IRUPXODFLRQHV�ROLJRPpULFDV��SROLPpULFDV��FRQ�EDMR�FRQWHQLGR�HQ�PDWHULD�JUDVD�R�QRUPDO��VL�ELHQ�HQ�HO�DFFHVR�\H\XQDO�SDUHFH�UD]RQDEOH�XWLOL]DU�XQD�IRUPXODFLyQ�ROLJRPpULFD� �+HSDWRSDWtD��XQ�VRSRUWH�QXWULFLRQDO�DGHFXDGR�HVWLPXOD� OD�UHJHQHUDFLyQ�KHSiWLFD�\PHMRUD�ORV� SDUiPHWURV� GH� IXQFLyQ� KHSiWLFD�� DXQTXH� QR� KD\� GDWRV� FRQFOX\HQWHV� TXH� LQGLTXHQ� XQD�GLVPLQXFLyQ�HQ� OD�PRUEL�PRUWDOLGDG��6L�HO� LQWHVWLQR�HVWD� IXQFLRQDOPHQWH� LQWDFWR�� OD�1(�HV�GH�HOHFFLyQ��/D�DGPLQLVWUDFLyQ�GH�IyUPXODV�HQULTXHFLGDV�HQ�DPLQRiFLGRV�GH�FDGHQD�UDPLILFDGD�QR� VH� KD� PRVWUDGR� VXSHULRU� D� OD� DGPLQLVWUDFLyQ� GH� IyUPXODV� HVWiQGDU�� H[FHSWR� HQ� ORV�SDFLHQWHV�FRQ�HQFHIDORSDWtD�KHSiWLFD�FUyQLFD�R�ODWHQWH��HQ�ORV�TXH�HVWDV�IyUPXODV�SHUPLWHQ�XQ�PD\RU�DSRUWH�GH�SURWHtQDV�VLQ�LQGXFLU�HQFHIDORSDWtD���SROLPpULFDV�R�HVSHFLDOHV� � 1HIURSDWtD��H[LVWHQ� HVWXGLRV� FRQWUDGLFWRULRV��3DUHFH� TXH� OD� DGPLQLVWUDFLyQ� GH� GLHWDV� FRQ�SUHGRPLQLR�GH�$PLQRiFLGRV�HVHQFLDOHV�SXHGH�GLVPLQXLU� OD�SURJUHVLyQ�D�GLiOLVLV�\�PHMRUDU�HO�

Page 159: Manual practico urgencias medicina interna muy bueno

���

HVWDGR�QXWULFLRQDO�GH�ORV�SDFLHQWHV�FRQ�LQVXILFLHQFLD�UHQDO�FUyQLFD��/RV�SDFLHQWHV�HQ�SURJUDPD�GH�GLiOLVLV�GHEHQ�UHFLELU�XQD�GLHWD�FRQ�XQ�FRQWHQLGR�SURWHLFR�QRUPDO�R�LQFOXVR�DXPHQWDGR�%��(QIHUPHGDGHV�GHELOLWDQWHV � 3DFLHQWHV� QHRSOiVLFRV� VRPHWLGRV� R� QR� D� UDGLRWHUDSLD� R� TXLPLRWHUDSLD�� OD� QXWULFLyQ�DUWLILFLDO� SXHGH� VHU� GH� XWLOLGDG� SDUD�PDQWHQHU� OD� KLGUDWDFLyQ�� PHMRUDU� HO� HVWDGR� QXWULFLRQDO��LQFUHPHQWDU� HO� FRQIRUW� \� PHMRUDU� OD� VXSHUYLYHQFLD� HQ� SDFLHQWHV� LQFDSDFHV� GH� FRPHU� R� GHDEVRUEHU� QXWULHQWHV� GH� IRUPD� DGHFXDGD� GXUDQWH� XQ� SHULRGR� GHWHUPLQDGR�� (Q� DTXHOORV�SDFLHQWHV� FRQ� DQRUH[LD� LQWHQVD� R� PDOQXWULFLyQ�� HVWDUtD� MXVWLILFDGR� HQ� VRSRUWH� QXWULFLRQDO� VL�H[LVWH�XQD�UD]RQDEOH�FDOLGDG�GH�YLGD�\�VXSHUYLYHQFLD��1R�GHEHPRV�ROYLGDU�TXH�HQ�SDFLHQWHV�VRPHWLGRV�D�47�OD�137�VH�KD�DVRFLDGR�D�XQ�DXPHQWR�HQ�OD�SUHYDOHQFLD�GH�VHSVLV�\�FXDGURV�QHXPyQLFRV���SROLPpULFD�X�ROLJRPpULFD� �7UDQVSODQWH�GH�PpGXOD�yVHD� HO�VRSRUWH�QXWULFLRQDO��137��GXUDQWH�FRUWRV�SHUtRGRV�SXHGH�DXPHQWDU�OD�VXSHUYLYHQFLD�\�GLVPLQXLU�HO�Q~PHUR�GH�UHFDtGDV�GHO�WXPRU��$VLPLVPR��HO�VRSRUWH�QXWULFLRQDO� DFRUWD� OD� HVWDQFLD� KRVSLWDODULD�� GLVPLQX\H� HO� Q~PHUR� GH� HSLVRGLRV� LQIHFFLRVRV� \�PHMRUD� OD� VXSHUYLYHQFLD� HQ� HVWRV� SDFLHQWHV� ����� &RPR� VLHPSUH�� VHUi� SUHIHULEOH� XQ� DFFHVR�HQWHUDO����� � 6,'$� OD� QXWULFLyQ� DUWLILFLDO� SXHGH�SUHYHQLU�R� UHYHUWLU� OD� SpUGLGD� GH�SHVR� \� UHSOHFFLRQDU� OD�PDVD�FHOXODU�FRUSRUDO�HQ�ORV�SDFLHQWHV�FRQ�XQ�DSRUWH�QXWULWLYR�SREUH�R�PDODEVRUFLyQ�\�TXH�QRSUHVHQWDQ�XQD� LQIHFFLyQ�RSRUWXQLVWD��6LQ�HPEDUJR��QR�KD\�HVWXGLRV�TXH�GHPXHVWUHQ�TXH�HO�VRSRUWH�QXWULFLRQDO�PHMRUH�ODV�H[SHFWDWLYDV�GH�VXSHUYLYHQFLD�R�UHGX]FD�HO�Q~PHUR�GH�LQJUHVRV�KRVSLWDODULRV��3UHVHUYDU�HO�HVWDGR�QXWULFLRQDO�HV�OD�~QLFD�MXVWLILFDFLyQ�SDUD�LQGLFDU�XQ�VRSRUWH�QXWULFLRQDO� HQ� HVWRV� SDFLHQWHV�� �SROLPpULFD� QRUPR� R� KLSHUSURWHLFD�� KLSHUFDOyULFD�� DUJLQLQD��JOXWDPLQD��iFLGR�RPHJD���&��(QIHUPHGDGHV�FULWLFDV�(O�VRSRUWH�QXWULFLRQDO�GHEH�VHU�LQLFLDGR�HQ�DTXHOORV�SDFLHQWHV�HQ�ORV�FXDOHV�QR�VH�HVSHUD�TXH�VH� UHVWDXUH� OD� QXWULFLyQ� RUDO� GXUDQWH� ����� GtDV� ����� (Q� HVWRV� SDFLHQWHV� D\XGD� D� IUHQDU� HO�KLSHUFDWDEROLVPR�� 6LQ� HPEDUJR�� QR� KD\� HYLGHQFLD� GH� TXH� XQ� VRSRUWH� QXWULFLRQDO� DJUHVLYR�PRGLILTXH� HO� FXUVR� GH� FOtQLFR� GH� HVWRV� SDFLHQWHV�� /RV� HVWXGLRV� PXHVWUDQ� UHVXOWDGRV�FRQWUDGLFWRULRV� HQ� FXDQWR� D� OD� DGPLQLVWUDFLyQ� GH� IRUPXODFLRQHV� HVSHFtILFDV� FRQ� PD\RU�FRQWHQLGR�GH�$F��RPHJD����DUJLQLQD��JOXWDPLQD�R�DPLQRiFLGRV�GH�FDGHQD�UDPLILFDGD� �3ROLWUDXPDWL]DGRV� OD�1(�KD�PRVWUDGR�PD\RU�HILFDFLD�TXH�OD�137�UHGXFLHQGR�HO�Q~PHUR�GH�FRPSOLFDFLRQHV�VpSWLFDV�WDOHV�FRPR�QHXPRQtD�\�VHSVLV��/D�1(�GHEHUtD�LQLFLDUWH�OR�PiV�SUHFR]�SRVLEOH��SUHIHULEOHPHQWH�HQ�ODV�SULPHUDV����KRUDV��OR�TXH�KD�GHPRVWUDGR�EHQHILFLRV�VREUH�XQ�DSRUWH�QXWULFLRQDO�PiV�WDUGtR��/D�1(�GHEH�VXVSHQGHUVH�FXDQGR�OD�DOLPHQWDFLyQ�RUDO�DVHJXUH�ORV�UHTXHULPLHQWRV�QXWULFLRQDOHV�GHO�SDFLHQWH����'��6RSRUWH�QXWULFLRQDO�SHULRSHUDWRULR��/D�137�DGPLQLVWUDGD�D�ORV�SDFLHQWHV�VHYHUDPHQWH�PDOQXWULGRV�GXUDQWH������GtDV�DQWHV�GH�OD�FLUXJtD��PRVWUy� XQD�GLVPLQXFLyQ� GH� ODV� FRPSOLFDFLRQHV� SRVWTXLU~UJLFDV� HQ�XQ����� �$���6LQ�

Page 160: Manual practico urgencias medicina interna muy bueno

���

HPEDUJR��HO�XVR�UXWLQDULR�GH�137�SRVTXLU~UJLFD�HQ�SDFLHQWHV�PDOQXWULGRV�TXH�QR�UHFLELHURQ�DSRUWH�QXWULFLRQDO�SUHTXLU~UJLFR�DXPHQWy�ODV�FRPSOLFDFLRQHV�SRVWRSHUDWRULDV�HQ�XQ������$���3RU�WDQWR��HO�VRSRUWH�QXWULFLRQDO�SRVWTXLU~UJLFR�HV�QHFHVDULR�HQ�SDFLHQWHV�LQFDSDFHV�GH�FRPHU�GXUDQWH� ODUJRV� SHULRGRV� GHVSXpV� GH� OD� FLUXJtD�� SUHYLQLHQGR� ORV� HIHFWRV� DGYHUVRV� GH� OD�LQDQLFLyQ��/RV�SDFLHQWHV�FRQ�PDOQXWULFLyQ�OHYH�QR�VH�EHQHILFLDQ�GHO�VRSRUWH�QXWULFLRQDO�%,%/,2*5$),$���� (QWUDOD� $�� 0DOQXWULFLyQ� HQHUJHWLFRSURWHLFD�� &DXVDV�� 3URQyVWLFR�� 'pILFLW� GH�PLFURQXWULHQWHV��0HGLFLQH�������������������������� 5XELR�0$��,QGLFDFLRQHV�GH�OD QXWULFLyQ�HQWHUDO��(QGRFULQRORJtD���������6XSO����������� 6DPXHO� .OHLQ� HW� DO��1XWULWLRQ� VXSSRUW� LQ� &OLQLFDO� 3UDFWLFH�� 5HYLHZ� RI� 3XEOLVKHG� 'DWD� DQG�5HFRPPHQGDWLRQV�IRU�

Page 161: Manual practico urgencias medicina interna muy bueno

���

7DEOD����3DFLHQWHV�GH�ULHVJR�GHVGH�HO�SXQWR�GH�YLVWD�QXWULFLRQDO����� 1HRSODVLD�GLJHVWLYD � 6HSVLV� )tVWXODV�HQWHURFXWiQHDV � &LUXJtD�PD\RU� (�,�,� � &iQFHU� +HSDWRSDWtDV � 3ROLWUDXPDWL]DGRV� 6tQGURPH�GH�LQWHVWLQR�FRUWR � 4XHPDGRV� (QWHULWLV�SRVWUDGLDFLyQ � (32&� 3DQFUHDWLWLV � ,QVXILFLHQFLD�UHQDO� $QFLDQRV � 'LDEHWHV�PHOOLWXV� 6,'$7DEOD����)DFWRUHV�GH�FRUUHFFLyQ�SDUD�HVWLPDU�ORV�UHTXHULPLHQWRV�HQHUJpWLFRV�D�SDUWLU�GHO�*(%6LWXDFLyQ�FOtQLFD )DFWRU�GH�FRUUHFFLyQ)LHEUH �����������SRU��&&LUXJtD�SURJUDPDGD ����� ���3HULWRQLWLV ����� ���7UDXPDWLVPR�GH�SDUWHV�EODQGDV ������ ����3ROLWUDXPDWLVPR ����� ����6HSVLV ����� ���7&(�VLQ�HVWHURLGHV ���7&(�FRQ�HVWHURLGHV ����� ���4XHPDGRV ����� ����,QDQLFLyQ ���7&(��WUDXPDWLVPR�FUDQHRHQFHIiOLFR7DEOD����3RVLEOHV�FRPSOLFDFLRQHV�GH�OD�QXWULFLyQ�HQWHUDO�����0HWDEyOLFDV 0HFiQLFDV ,QIHFFLRVDV *DVWURLQWHVWLQDOHV+LSHUJOXFHPLD+LSRQDWUHPLD &RORFDFLyQ�LQFRUUHFWD &RQWDPLQDFLyQ�EDFWHULDQD 'LDUUHD+LSHUFDOFHPLD 3HUIRUDFLyQ &RQWDPLQDFLyQ�GH�OD�VRQGD 0DODEVRUFLyQ+LSRFDOFHPLD (URVLyQ &RQWDPLQDFLyQ�GH�OD�IyUPXOD 'LVWHQVLyQ�DEGRPLQDO+LSRNDOLHPLD 1HXPRQtD�SRU�DVSLUDFLyQ 'LDUUHD�KLSHURVPRODU

Page 162: Manual practico urgencias medicina interna muy bueno

���

7DEOD����&RPSOLFDFLRQHV�GH�OD�QXWULFLyQ�SDUHQWHUDO�����5HODFLRQDGDV�FRQ�HO�FDWpWHU 0HWDEyOLFDV1HXPRWyUD[ 6HSVLV +LSHUJOXFHPLD +LSRJOXFHPLD(PEROLD�JDVHRVD DUULWPLDV *OXFRVXULD $OW��KLGURHOHFWUROtWLFDV+HPRUUDJLD 2EVWUXFFLyQ�FDWpWHU 'pILFLW�YLWDPLQDV 'pILFLW�ROLJRHOHPHQWRV7URPERVLV�YHQRVD 0DOSRVLFLyQ�FDWpWHU +LSHUOLSLGHPLD +LSHUFROHVWHUROHPLD(PEROLVPR�GHO�FDWpWHU $OW��KHSiWLFDV ,FWHULFLD�FROHVWiVLFD/HVLyQ�DUWHULD�VXEFODYLD &ROHOLWLDVLV/HVLyQ�SOH[R�QHUYLRVR &RPD�KLSHURVPRODU�QR�FHWyVLFR/HVLyQ�FRQGXFWR�WRUiFLFR 'pILFLW�GH�iFLGRV�JUDVRV�HVHQFLDOHV7DEOD����&RQWUROHV�ELRTXtPLFRV�UHFRPHQGDGRV�HQ�QXWULFLyQ�DUWLILFLDO����3DUiPHWUR )UHFXHQFLD&RQVWDQWHV��SUHVLyQ�DUWHULDO��WHPSHUDWXUD� &DGD���KRUDV%DODQFH�KtGULFR�\�SHVR 'LDULR*OXFHPLD�VL�JOXFRVXULD�SRVLWLYD &DGD���KRUDV)XQFLyQ�UHQDO�H�LRQHV��1D��.��&O� ����YHFHV�SRU�VHPDQD)XQFLyQ�KHSiWLFD��WULJOLFpULGRV��FROHVWHURO� 6HPDQDO3URWHtQDV�WRWDOHV�HQ�SODVPD��0J��&D��33URWHtQDV�YLVFHUDOHV��DOE~PLQD��WUDQVIHUULQD� 6HPDQDO3URWHtQD�WUDQVSRUWDGRUD�GHO�UHWLQRO��SUHDOE~PLQD�

Page 163: Manual practico urgencias medicina interna muy bueno

���

7DEOD���)yUPXODV�GH�QXWULFLyQ�HQWHUDO�\�RUDO3ROLPpULFD�QRUPRSURWHLFD 3ROLPpULFD�FRQ�)LEUD 3ROLPpULFD�KLSHUFDOyULFD 3ROLPpULFD�KLSHUWUyILFD(QVXUH�KQ 1XWURGULS�KQ������LQVROXEOH�\�����VROXEOH�

3HQWDGULQN������NFDO�PO� )UHVXELQ���� PFW������NFDO�PO��PFW�����)UHVXELQ�OLTXLGR��PFW� 3HQWDVHW�ILEUD��LQVROXEOH� (QVXUH�SOXV�KQ������NFDO�PO� (GDQHF����NFDO�PO�PFW����2VPROLWH�KQ��PFW� 3UHFLWHQH�ILEUD������VROXEOH� 3HQWDVHW�HQHUJpWLFR������NFDO� 3HQWDVHW�SURWHLQ�SOXV�������NFDO�PO�DJH�Z��EDMR�HQ�UHVLGXRV�3UHFLWHQH�VWDQGDUG��PFW����� (QULFK��SROLVDFiULGRV�GH�VRMD�

3UHFLWHQH�HQHUJpWLFR������NFDO�PO��PFW�����3UHFLWHQH�KLSHUSURWHLFR������NFDO�PO�PFW�����

3HQWDVHW�SROYR )UHXVELQ�LVRILEUD��DJH��PFW�����VRMD�6XVWDFDO�KF������NFDO�PO 3URPRWH �\�NFDO�PO�PFW�����

(GDQHF��PFW�����DUJ�JOXWD� )UHVXELQ�SOXV��VROXEOH�����PFW�����7UDXPDFDO�������NFDO�PO�PFW�����

3HQWDVHW�EDMR�HQ�VRGLR -HYLW\������VROXEOH�PFW�����3HQWDVHW�ORZ�HQHUJ\�������NFDO�P/��Z�� 3HQWDGULQN�ILEUD�����NFDO�P/��VROXEOH�����3HQWDVHW�0&7��0&7�����EDMD�HQ�UHVLGXRV�3HQWDVHW�ILEUD��6RMD�

3HQWDVHW�VWDQGDUG 1XWURGULS�+1������VROXEOH�3UHSHQWDVHW������NFDO�P/�3UHFLWHQH�VRMD��QR�FRQWLHQH�SURWHtQDV�DQLPDOHV�1XWURGULQN��0&7����

Page 164: Manual practico urgencias medicina interna muy bueno

���

7DEOD����)yUPXODV�GH�QXWULFLyQHQWHUDO�\�RUDO2OLJRPpULFDV��SHSWtGLFDV��KLSHUSURWHLFDV ROLJRPpULFDV��SHSWtGLFDV��QRUPRSURWHLFDV 2OLJRPpULFDV��DPLQRiFLGRV�OLEUH�$OLWUDT��\�NFDO�PO�����SURW�JOXW�DUJ� 3HSWLQDXW��\�NFDO�PO�RVP����� (OHPHQWDO�QXWULO���������RVP�����1XWULFRPS�SHSWLG��SRUW������ 3HSWLQDXW�OtTXLGR��EDMR�FRQWHQLGR�OtSLGRV� (OHPHQWDO�QXWULO����������RVP������ULFR�HQ�QD�3HSWLQXWULO���������HOHPHQWDO��SURW����� 3HSWLQDXW�YDULDQW��EDMR�FRQWHQLGR�HQ�OtSLGRV�\�VRGLR� (OHPHQWDO����3HSWLQXWULO��HOHPHQWDO�VRQGD�3HSWLQXWULO���������HOHPHQWDO�

7DEOD����)RUPXODV�HVSHFLDOHV+HSDWRSDWtD�FUyQLFD 1HIURSDWtD�FUyQLFD 'LDEHWHV�R�KLSHUJOXFHPLDV ,QVXILFLHQFLD�UHVSLUDWRULD 6LWXDFLRQHV�GH�HVWUpV+HSDWRQXWULO��PFW����DD�UDPLILFDGRV�1HIURQXWULO��PFW�����DD�HVHQFLDOHV�KLVW�

3UHFLWHQH�GLDEHW������KF�ILEUD�PFW�3XOPRFDUH������NFDO�KF�����PFW�Z��

$GYHUD�������NFDO�PO��PFW�����Z��1XWULFRPS�KHSD������NFDO�PO�PFW�����1HSUR����NFDO�PO�PFW��HVSHFLDO�SDUD�GLiOLVLV�

*OXFHUQD������KF� ,PSDFW����NFDO�PO��DUJ�PFW�Z��3HQWDVHW�EDMR�HQ�SURWHtQDV )UHVXELQ�GLDEpWLFRV 3HQWDVHW�LQWHQVLYH�������NFDO�PO�SURW�����DUJ�JOXW�PFW�Z��ILEUD�VROXEOH�H�LQVROXEOH�6XSOHQD����NFDO�PO� 3HUDWLYH������NFDO�PO��DUJ�PFW�

Page 165: Manual practico urgencias medicina interna muy bueno

���

7DEOD�����6XSOHPHQWRV&DOyULFR�SURWHtFR�YLWDPtQLFR ,QVXILFLHQFLD�UHQDO +HSDWRSDWtDV 'LDEpWLFRV(QVXUH�SXGGLQJ������NFDO�PO� 1HIURDPLQ��DDH���KLVW�SURW�����OtSLGRV����� +HSDWLF�DLG�������NFDO�PO�DDFU� 0HULWHQH�GLDEHW��ILEUD�VROXEOH�0HULWHQH�SROYR������NFDO�PO� 'LDODPLQH� +HSDWDPLQH��OtSLGRV����0HULWHQH�OtTXLGR $PLQ�DLG����NFDO�PO�DDH�KLVW�3HQWDSOXV��SURW�����

Page 166: Manual practico urgencias medicina interna muy bueno

���

&HWRDFLGRVLV�GLDEpWLFD�\�VtQGURPH�KLSHUJOXFpPLFR�KLSHURVPRODU�QR�FHWyVLFR�-XDQ�&DUORV�6HJXUD��$QJHO�)HUQiQGH]�)~QH]��$QWRQLR�+HUQiQGH]�/D� FHWRDFLGRVLV� GLDEpWLFD� � \� HO� VtQGURPH� KLSHUJOXFpPLFR� KLSHURVPRODU� QR� FHWyVLFR�VRQ� ODV�FRPSOLFDFLRQHV�DJXGDV�PiV� LPSRUWDQWHV�GH� OD�GLDEHWHV�PHOOLWXV�� WDQWR�SRU�VX�IUHFXHQFLD�FRPR�SRU�OD�PRUWDOLGDG�DVRFLDGD��$XQTXH�VH�GLVFXWHQ�SRU�VHSDUDGR��UHSUHVHQWDQ�ORV�SXQWRV�H[WUHPRV�GH� ODV� XUJHQFLDV� FDXVDGDV� SRU� HO� PDO� FRQWURO� GH� OD� GLDEHWHV�� VH FDUDFWHUL]DQ� DPEDV� SRU�LQVXOLQRSHQLD� \� VROR� GLILHUHQ� HQ� HO� JUDGR� GH� GHVKLGUDWDFLyQ� \� HQ� OD� VHYHULGDG� GH� OD� DFLGRVLV�PHWDEyOLFD�� 6H� KDQ� SURSXHVWRV� WUHV� PHFDQLVPRV� TXH� H[SOLFDUtDQ� HO� PD\RU� JUDGR� GH�GHVKLGUDWDFLyQ�\�OD�IDOWD�GH�FHWRJpQHVLV�HQ�HO�6++1&��XQ�PD\RU�QLYHO�GH�UHVHUYD�SDQFUHiWLFD�GH�LQVXOLQD��XQ�QLYHO�PiV�EDMR�GH�KRUPRQDV�FRQWUDUUHJXODGRUDV��\�OD�LQKLELFLyQ�GH�OD�OLSROLVLV�SRU�OD�PLVPD�VLWXDFLyQ�KLSHURVPRODU�$��'LDJQyVWLFR�\�WUDWDPLHQWR�GH�OD�&HWRDFLGRVLV�'LDEpWLFD��&$'������&RQFHSWR� /D�&$'�HV�XQD�FRPSOLFDFLyQ�DJXGD�\�JUDYH�HQ�OD�TXH�XQD�GHILFLHQFLD�DEVROXWD�R�UHODWLYD�GH�LQVXOLQD� MXQWR�FRQ�XQ�LQFUHPHQWR�GH�JOXFDJyQ�\�RWUDV�KRUPRQDV�FRQWUDUUHJXODGRUDV��FRQGXFH� D� OD� DSDULFLyQ� GH� KLSHUJOXFHPLD� �SURGXFLHQGR� GLXUHVLV� RVPyWLFD�� GHVKLGUDWDFLyQ� H�KLSRYROHPLD��\�FHWRVLV�RULJLQDQGR�XQD�DFLGRVLV�PHWDEyOLFD��6X�PRUWDOLGDG�VH�HVWLPD�HQ�PHQRV�GHO��������/RV�IDFWRUHV�GHVHQFDGHQDQWHVGH�OD�&$'�SRU�RUGHQ�GH�IUHFXHQFLD�VRQ��LQIHFFLRQHV����������GRVLILFDFLyQ� LQFRUUHFWD� GH� OD� LQVXOLQD� ���������� LQLFLR� GH� GLDEHWHV PHOOLWXV� ����������HQIHUPHGDGHV� LQWHUFXUUHQWHV� ��������� VREUH� WRGR� DEXVR� DOFRKRO�� ,$0�� $&9�� WUDXPDWLVPRV�JUDYHV�� DEGRPHQ� DJXGR�� FLUXJtD� PD\RU�� HQIHUPHGDGHV� HQGRFULQDV�� IiUPDFRV�±VREUH� WRGR�JOXFRFRUWLFRLGHV�\�WLD]LGDV���\�VLQ�FDXVD�DSDUHQWH�������������&OtQLFD�� /RV� VtQWRPDV� VRQ�� SROLXULD�� SROLGLSVLD�� DVWHQLD��DQRUH[LD�� YyPLWRV��GRORU�DEGRPLQDO��GLVPLQXFLyQ�GHO�HVWDGR�GH�FRQFLHQFLD� �FRPD����������(QWUH� ORV�VLJQRV�QRV�HQFRQWUDPRV�FRQ��GHVKLGUDWDFLyQ�FXWiQHR�PXFRVD��KLSRWHQVLyQ��WDTXLFDUGLD��SLHO�FDOLHQWH��UHVSLUDFLyQ�GH�.XVVPDXO�\�DOLHQWR�FHWyVLFR��(O�H[DPHQ�GHEH�LU�GLULJLGR�QR�VyOR�DO�GLDJQyVWLFR�GH�OD�&$'�VLQR�D�OD�FDXVD�GHVHQFDGHQDQWH���6H� GHEH� FRQVLGHUDU� HO� GLDJQyVWLFR� GH� &$'� HQ� WRGR� SDFLHQWH� FRQ� GLVPLQXFLyQ� GHO� QLYHO� GH�FRQFLHQFLD�R�FRQ�KLSHUYHQWLODFLyQ������(O�GLDJQyVWLFR VH�EDVD�HQ�ORV�VLJXLHQWHV�FULWHULRV��*OXFRVD�!�����PJ�GO��S+��������+&2�������PPRO�/�\�FHWRQHPLD�SRVLWLYD��!���PPRO�O���R�HQ�VX�GHIHFWR��FHWRQXULD�SRVLWLYD�!�����$GHPiV�VH�DFRPSDxD�GH�DQLyQ�*$3�FDVL�VLHPSUH�HOHYDGR�\�JOXFRVXULD�!�����

Page 167: Manual practico urgencias medicina interna muy bueno

���

��� /DV� SUXHEDV� GH� ODERUDWRULR D� UHDOL]DU� GH� IRUPD� LQPHGLDWD� VRQ� JOXFHPLD�� JOXFRVXULD� \�FHWRQXULD�FRQ�WLUDV�UHDFWLYDV�TXH�VXJLHUHQ�HO�GLDJQyVWLFR��'H� IRUPD� GLIHULGD� VH� UHDOL]DUiQ� SDUD� FRQILUPDU� HO� GLDJQyVWLFR� H� LQYHVWLJDU� OD� FDXVD�GHVHQFDGHQDQWH��JOXFHPLD���JDVRPHWUtD�DUWHULDO��XUHD�\�FUHDWLQLQD�SODVPiWLFD��LRQHV��1D��.��&,���KHPRJUDPD� FRPSOHWR�� RVPRODOLGDG� SODVPiWLFD�� DQLyQ�*$3�� DQRUPDOHV� HQ� RULQD� \� VHGLPHQWR��(&*��5[�GH�WyUD[��5[�GH�DEGRPHQ�VLPSOH���VL�VH�FRQVLGHUD�DGHFXDGD������0HGLGDV�JHQHUDOHV�GHO�WUDWDPLHQWR�� 6RQ� SUHIHULEOHV� GRV� DFFHVRV� YHQRVRV� SDUD� OD� LQIXVLyQ� GH� OD� IOXLGRWHUDSLD� \� OD� LQVXOLQD� SRU�VHSDUDGR��� %XVFDU�OD�FDXVD�GHVHQFDGHQDVWH�\�UHDOL]DU�XQ�WUDWDPLHQWR�DGHFXDGR��$QWLELRWHUDSLD�WUDV�WRPD�GH�FXOWLYRV�VL�VH�VRVSHFKD�LQIHFFLyQ��� +HSDULQL]DFLyQ�SURILOiFWLFD�VL�FRPD�R�HVWDGR�PX\�KLSHURVPRODU��� &RQWURO� GH� OD� 39&� HQ� VLWXDFLRQHV� GRQGH� HV� QHFHVDULR� FRQWURO� HVWULFWR� GH� EDODQFHV� KtGULFRV��FDUGLRSDWtD�LQHVWDEOH��HGDG�DYDQ]DGD�R�PDOD�SHUIXVLyQ�SHULIpULFD���� 6RQGDMH�QDVRJiVWULFR�VL�DOWHUDFLyQ�GHO�QLYHO�GH�FRQFLHQFLD��YyPLWRV�VHYHURV�R�tOHR�SDUDOtWLFR��� 6RQGDMH�XULQDULR�VL�VH�SUHYp�GLILFXOWDG�GH�UHFRJLGD�H[DFWD��UHWHQFLyQ�XULQDULD��GLVPLQXFLyQ�GHO�QLYHO�GH�FRQFLHQFLD��R�GLXUHVLV������PO�HQ�OD�SULPHUD�KRUD��� 3ODQWHDU�LQJUHVR�HQ�8&,�VL�S+�������R�.�����R�H[LVWH�FRPSOLFDFLyQ�TXH�OR�MXVWLILTXH��(M����,$0��VHSVLV������/RV�FRQWUROHV TXH�VH�KDQ�GH�UHDOL]DU�GXUDQWH�HO�WUDWDPLHQWR�VRQ�ORV�VLJXLHQWHV��� +RUDULRV�� JOXFHPLD� FDSLODU�� 7$�� IUHFXHQFLD� FDUGtDFD� \� UHVSLUDWRULD�� 39&� �VL� IXHUD� QHFHVDULR��GLXUHVLV��� &DGD�������������\����KRUDV��EDODQFHV�KtGULFRV��FRQWUROHV�GH�ELRTXtPLFD�VpULFD�EiVLFD� �XUHD��FUHDWLQLQD��VRGLR��SRWDVLR�\�JOXFRVD��\�JDVRPHWUtD�YHQRVD�����)OXLGRWHUDSLDD�XWLOL]DU�HQ�ORV�SDFLHQWHV�FRQ�&$'�(O�WLSR�GH�IOXLGR�D�XWLOL]DU��HQ�SULQFLSLR��VHUi�VLHPSUH�ILVLROyJLFR��1D&O���������6H�XWLOL]D�KLSRWyQLFR��1D&O���������HQ�FDVR�GH�KLSHUQDWUHPLD�VHYHUD��1D�!����P(T�/��\�GH�PDQHUD�WHPSRUDO�KDVWD�GHVFHQGHU� OD�QDWUHPLD�D������P(T�/��6L� OD�JOXFHPLD�GHVFLHQGH�SRU�GHEDMR�����PJ�GO�VH�GHEH�DVRFLDU�JOXFRVDGR�DO�����D�XQ�ULWPR�GH�����PO�K��(Q�FXDQWR�D�OD�YHORFLGDG�GH�LQIXVLyQ�GHO�IOXLGR�VHUi�OD�VLJXLHQWH��HQ�OD�SULPHUD�KRUD������PO�������PO�KRUD�HQ�ODV�WUHV�KRUDV�VLJXLHQWHV������PO�KRUD�KRUD�GHVGH�OD����D�OD����KRUD�\�GHVSXpV�����PO�FDGD���KRUDV��6H�UHFRPLHQGD�QR�VXSHUDU�ORV�����OLWURV�DO�GtD����/D�LQVXOLQRWHUDSLDGHWLHQH�OD�FHWRJpQHVLV�\�GHVFLHQGH�OD�JOXFHPLD��(O�WLSR�GH�LQVXOLQD�TXH�VH�GHEH�DGPLQLVWUDU�HV�UHJXODU��/D�YtD�GH�DGPLQLVWUDFLyQ�GH�HOHFFLyQ�HV�LQWUDYHQRVD�FRQ�ERPED�GH�LQIXVLyQ�FRQWLQXD��

Page 168: Manual practico urgencias medicina interna muy bueno

���

/D�GRVLV�D�DGPLQLVWUDU�HV�GH����8�HQ�EROR�,�9��VHJXLGR�GH�����8�.J��KRUD�HQ�LQIXVLyQ�,�9��FRQWLQXD�����8�HQ�����FF�GH�6�)��������(M������NJ�[������ ���8�K�D����PO�K���6L�OD�JOXFHPLD�QR�GLVPLQX\H�!����PJ�GO�HQ�ODV�����SULPHUDV�KRUDV��GREODU�OD�GRVLV��SUHYLD�HYDOXDFLyQ�GHO�ULWPR�GH�KLGUDWDFLyQ��&XDQGR�OD�JOXFHPLD�HV�PHQRU�GH�����PJ�GO��\�SHUVLVWD�DFLGRVLV��DVRFLDU�JOXFRVDGR�DO����D����PO�K�\�DMXVWDU�OD�GRVLV�D�����8,�KRUD�GH�LQVXOLQD�UHJXODU�SDUD�PDQWHQHU�JOXFHPLD�HQWUH���������PJ�GO�� (Q� FDVR� GH� QR� HVWDU� GLVSRQLEOH� XQ� VLVWHPD� GH� SHUIXVLyQ�� VH� UHFRPLHQGD� � OD� YtD�LQWUDPXVFXODU�HQ�ERORV�KRUDULRV������/RV�VXSOHPHQWRV�GH�SRWDVLR VH�DGPLQLVWUDUDQ�HQ�IRUPD�GH�FORUXUR�SRWiVLFR�HQ�IXQFLyQ�GH�VXV�QLYHOHV�SODVPiWLFRV��VL�HV�!�����P(T�O�QR�DGPLQLVWUDU�SHUR�PHGLU�D� OD KRUD��HQWUH���������P(T�O�����P(T�O��HQWUH���������P(T�O�����P(T�O�\�������P(T�O�����P(T�O��/D�KLSRFDOLHPLD�HV�OD�SULQFLSDO�FDXVD�PHWDEyOLFD�GH�PXHUWH�HYLWDEOH�HQ�OD�&$'��1R�VXSHUDU�ORV����P(T�����PO�VL�YtD�SHULIpULFD�QL�ORV����P(T�KRUD��(Q�FDVR�GH�DQXULD�QR�DGPLQLVWUDU�.��6L�HO�.�HV�PHQRU�GH���FRPHQWDU�FRQ�8&,�����(O�ELFDUERQDWR VH�DGPLQLVWUDUi�HQ�HO�FDVR�GH�SUHVHQWDU�UHVSLUDFLyQ�GH�.XVVPDXO�PDQLILHVWD�\�VL�HO�S+�HV�PHQRU�GH������\�R�HO�ELFDUERQDWR�HV�PHQRU�GH���PPRO�O��/DV� GRVLV�D� DGPLQLVWUDU� GHSHQGHQ�GH� ORV� QLYHOHV� GHO� S+��Vt�HVWD�HQWUH�����\���������PPRO�GH�ELFDUERQDWR�VyGLFR������PO�GH�ELFDUERQDWR�����0��D�SDVDU�HQ�XQD�KRUD������0 �������P(T�PO��MXQWR�FRQ����P(T�GH�&/.�DGLFLRQDOHV��VL�HO�S+�HV�����������PPRO�GH�ELFDUERQDWR�VyGLFR������PO�GH�ELFDUERQDWR�VyGLFR�����0��D�SDVDU�HQ�GRV�KRUDV�\����P(T�GH�&,.��1R�DGLFLRQDU�&/.�D� OD�VROXFLyQ� GH� ELFDUERQDWR�� VREUH� WRGR� VL� HV� ��0RODU�� SRU� HO� ULHVJR� GH� SUHFLSLWDFLyQ�� 'HWHQHU� OD�SHUIXVLyQ�FXDQGR�HO�S+��VHD�PD\RU�GH���������� 6H� SXHGH� FRQVLGHUDU� OD� VXVSHQVLyQ�GH� OD� SHUIXVLyQ� GH� LQVXOLQD� FXDQGR� HO� S+� !� ���� \� HO�ELFDUERQDWR�!����DXQTXH�HV�LPSUHVFLQGLEOH�DGPLQLVWUDU� OD�SULPHUD�GRVLV�GH�LQVXOLQD�VXEFXWiQHD����PLQXWRV�DQWHV�GH�VXVSHQGHU�OD�SHUIXVLyQ�GH�LQVXOLQD�6L�HO�SDFLHQWH�SXHGH�FRPHU��VH�SUHVFULEH�GLHWD�FRQ�FDORUtDV�DMXVWDGDV�DO�SHVR�\�UHSDUWLGDV�HQ��WRPDV�� DSRUWH� GH� OtTXLGRV� VHJ~Q� HO� HVWDGR� GH� KLGUDWDFLyQ� \� HOHFWUROLWRV�� FRQWUROHV� SUH� \�SRVWSUDQGLDOHV�GH�JOXFHPLD�FDSLODU�H�LQVXOLQD�SDXWDGD�� 6L�&$'�HQ�'0�GH�LQLFLR�� ,QVXOLQD� ��������8,�NJ�GtD� IUDFFLRQDGD�HQ� WUHV� GRVLV��'HVD\XQR������GH� LQVXOLQD� UiSLGD�V�F���FRPLGD������GH�LQVXOLQD�UiSLGD�V�F��\�FHQD������GH�LQVXOLQD�UiSLGD�V�F��\������GH�LQVXOLQD�13+�V�F��6L�&$'�HQ�'0�FRQRFLGR��GRVLV�GH�LQVXOLQD�SUHYLD��3HUILO�JOXFpPLFR��6L� OD� WROHUDQFLD� RUDO� HV� LQDGHFXDGD�� HV� SUHIHULEOH�PDQWHQHU� XQD� SHUIXVLyQ� GH� LQVXOLQD� UHJXODU�HQGRYHQRVD� ����� 8,�KRUD�� MXQWR� FRQ� JOXFRVDGR� DO� ��� XQ� ULWPR� DSUR[LPDGR� GH� ���� PO�KRUD��DMXVWDQGR� OD�GRVLV�GH� LQVXOLQD�SDUD�PDQWHQHU�XQD�JOXFHPLD�HQWUH���������PJU�GO��R� OR�TXH�HV�HTXLYDOHQWH��XVDU�XQD�SHUIXVLyQ�*�,�3���JOXFRVDGR�DO�������PO���KRUDV�FRQ����P(T�GH�.&O�\���8,�

Page 169: Manual practico urgencias medicina interna muy bueno

���

GH�LQVXOLQD�UHJXODU�VL�OD�JOXFHPLD�VH�PDQWLHQH��HQWUH����������FRQ�FRQWUROHV�GH�JOXFHPLD�FDSLODU�FDGD���KRUDV�DXPHQWDQGR�����8,���KRUDV�GH�LQVXOLQD�UHJXODU�XQLGDGHV�SRU�FDGD�IUDFFLyQ�GH����PJU�GO�SRU�HQFLPD�GH�����PJU�%LEOLRJUDItD���� %HUJHU��:�HW� DO��7UHDWPHQW� RI� GLDEHWLF� NHWRDFLGRVLV�DQG�QRQ�NHWRFLF�K\SHURVPRODU�GLDEHWLF�FRPD��%DLOOHUHV�&OtQLFDO�(QGRFULQRORJ\�DQG�0HWDEROLVP������������������� 'LH]�� --�� &HWRDFLGRVLV� GLDEpWLFD� \� VLWXDFLRQHV� GLDEpWLFDV� KLSHURVPRODUHV� QR� FHWyVLFDV��0HGLFLQH������������������������ *HQXWK��60��'LDEHWLF�NHWRDFLGRVLV�DQG�K\SHUJO\FHPLF�K\SHURVPRODU�FRPD���(Q�:DUGLQ�&:�HG��&XUUHQW�7KHUDS\� LQ�(QGRFULQRORJ\�DQG�0HWDEROLVP��WK HG�6W�/RXLV��0RVE\�<HDU�%RRN���������������� .LWDEFKL�$(�HW�DO��&HWRDFLGRVLV�GLDEpWLFD��&OtQLFDV�PpGLFDV�GH�1RUWHDPpULFD���������������� /HERYtW]�+(��'LDEHWHV�NHWRDFLGRVLV��/DQFHW������������������������ 6LSHUVWHLQ�0'��'LDEHWLF�NHWRDFLGRVLV�DQG�K\SHUVRPRODU�FRPD��(QGRFULQRO�0HWDE�&OLQ�1RUWK�$P��������������������� 8PSLHUUH]��*�(��HW�DO��'LDEHWLF�NHWRDFLGRVLV�DQG�K\SHUJO\FHPLF�K\SHURVPRODU�V\QGURPH��$P�-�0HG�6FL�������������������� .UHQW]�� � $�-��� 1DWWUDVV� 0�� $FXWH� FRPSOLFDWLRQV� RI� GLDEHWHV� PHOOLWXV�� GLDEHWLF� NHWRDFLGRVLV��K\SHURVPRODU� QRQ�NHWRVLF� V\QGURPH� DQG� ODFWLF� DFLGRVLV�� (Q�� 3LFNXS� -&�� :LOOLDPV� *� HGV��7H[WERRN�RI�GLDEHWHV���QG�HG��2[IRUG��%ODFNZHOO�6FLHQWLILF�3XEOLFDWLRQV�������������������%��'LDJQyVWLFR�\�WUDWDPLHQWR�GHO�VtQGURPH�KLSHUJOXFpPLFR�KLSHURVPRODU�QR�FHWyVLFR����&RQFHSWR��6H�GHILQH�HO�VtQGURPH�KLSHUJOXFpPLFR�KLSHURVPRODU�QR�FHWyVLFR��6++1&��FRPR�XQ�VtQGURPH�FOtQLFR�ELRTXtPLFR�FDUDFWHUL]DGR�SRU�HO�GHVDUUROOR�LQVLGLRVR�GH�KLSRUJOXFHPLD�JUDYH��!�����PJ�GO���KLSHURVPRODOLGDG�SODVPiWLFD��!�����P2VP�/��VLQ�FHWRVLV�VLJQLILFDWLYD��GHVKLGUDWDFLyQ�FRQ�LQVXILFLHQFLD�UHQDO�SUHUUHQDO�\�GLVPLQXFLyQ�GHO�QLYHO�GH�FRQFLHQFLD�\�R�VLJQRV�QHXUROyJLFRV�����/D�FOtQLFD�GHO�6++1&�YLHQH�GHILQLGD�SRU�VHG�LQWHQVD�\�SROLXULD��FRQ�SURJUHVLYD�GHVKLGUDWDFLyQ�H�KLSRWHQVLyQ��DOWHUDFLyQ�JUDGXDO�GHO�QLYHO�GH�FRQFLHQFLD��SRVLEOH�IRFDOLGDG�QHXUROyJLFD�UHYHUVLEOH�\�FRPD��$O� LJXDO� TXH� RFXUUtD� HQ� OD� FHWRDFLGRVLV� GLDEpWLFD� KD\� TXH� LQWHQWDU� GHVFXEULU� HO� IDFWRU�SUHFLSLWDQWH��TXH�SXHGH�VHU�DOJXQR�GH�ORV�VLJXLHQWHV��LQIHFFLRQHV�KDVWD�HQ�HO�����GH�ORV�FDVRV��VREUH�WRGR�QHXPRQtD�± ������� R�,78�± ���������HQIHUPHGDGHV�FDUGLRYDVFXODUHV��LQIDUWR�DJXGR�GH�PLRFDUGLR�� DFFLGHQWH�YDVFXODU� FHUHEUDO���DEDQGRQR�GHO� WUDWDPLHQWR�� SDQFUHDWLWLV��HPEROLVPR�SXOPRQDU��LQWHUYHQFLRQHV�TXLU~UJLFDV��WUDXPDWLVPRV��TXHPDGXUDV��LQDGHFXDGD�LQJHVWD�GH�DJXD��IiUPDFRV� �GLXUpWLFRV� WLD]tGLFRV�� FRUWLFRLGHV�� GLIHQLOKLGDQWRLQD�� DQWDJRQLVWDV� GHO� FDOFLR� \� EHWD�EORTXHDQWHV��R�SURFHGLPLHQWRV�WHUDSpXWLFRV��GLiOLVLV�R�QXWULFLyQ�DUWLILFLDO���7tSLFDPHQWH��KDVWD�HQ�XQ�����GH�ORV�FDVRV�OD�GLDEHWHV�PHOOLWXV�QR�HVWDED�GLDJQRVWLFDGD�

Page 170: Manual practico urgencias medicina interna muy bueno

���

��� /RV� GDWRV� DQDOtWLFRV TXH� HQFRQWUDPRV� HQ� ORV� SDFLHQWHV� FRQ� FRPD� KLSHURVPRODU� VRQ� ORV�VLJXLHQWHV�� JOXFHPLD� !� ���� PJ�GO�� RVPRODOLGDG� HQ� SODVPD� !� ���� P2VP�/� �FDOFXOiQGRVH� OD�RVPRODOLGDG�HIHFWLYD�FRQ�OD�IyUPXOD���[�>1D@>P(T�O@���JOXFRVD�>PJU�GO@�������/DV�PHGLGDV�JHQHUDOHV�GHO� WUDWDPLHQWR�GH�HVWRV�SDFLHQWHV�VRQ�VLPLODUHV�D� ODV�GH� OD�&$'��SHUR�VXHOH�VHU�PiV�IUHFXHQWH�OD�QHFHVLGDG�GH�FDWpWHU�SDUD�GHWHUPLQDU�SUHVLyQ�YHQRVD�FHQWUDO�\�VRQGD�YHVLFDO��/RV�FRQWUROHV�DQDOtWLFRV�VRQ VLPLODUHV�D�ORV�GHVFULWRV�HQ�OD�FHWRDFLGRVLV�GLDEpWLFD�����3DUD�OD�UHKLGUDWDFLyQ SXHGH�VHU�~WLO�HO�FDOFXOR�GHO�GpILFLW�GH�DJXD�OLEUH�PHGLDQWH�OD�VLJXLHQWH�IyUPXOD�/LWURV�D�UHSRQHU� �>�1D�DFWXDO�� 1D�GHVHDGR��[�DJXD�WRWDO@�� DJXD�WRWDO��6LHQGR�HO�DJXD WRWDO� �����[�SHVR�FRUSRUDO��6H� UHFRPLHQGD� WUDWDPLHQWR� FRQ� VXHUR� VDOLQR� �������� VL� OD� QDWUHPLD� HV�PHQRU� GH� ����P(T�O��VLJXLHQGR�OD�SDXWD�GHVFULWD�DQWHULRUPHQWH�HQ�OD�&$'��6L�OD�QDWUHPLD�HV�PD\RU�GH���� P(T�O�VH�UHDOL]DUi� WUDWDPLHQWR�FRQ�VXHUR�VDOLQR�KLSRWyQLFR����������KDVWD�TXH�OD�QDWUHPLD�VHD�LQWHULRU�D������ LQFRUSRUiQGRQRV�HQ�HVH�PRPHQWR�D�OD�SDXWD�DQWHULRU��6H�UHFRPLHQGD�QR�DGPLQLVWUDU�PiV�GHO�����GHO�SHVR�FRUSRUDO�HQ�ODV�SULPHUDV����KRUDV�8QD�YH]�TXH�HO�QLYHO�GH�JOXFHPLD�GHVFLHQGH�SRU�GHEDMR�GH����PJ�GO�VH�FRPLHQ]D�LQIXVLyQ�GH�JOXFRVDGR�DO�����D�XQ�ULWPR�GH�����PO�K�UHVWDQGR�HVWH�YROXPHQ�DO�VDOLQR�����(Q�FXDQWR�D�OD�LQVXOLQRWHUDSLDVH�XWLOL]DUi�OD�SDXWD�GHVFULWD�HQ�OD�&$'��DXQTXH�KD\�TXH�WHQHU�HQ� FXHQWD� TXH� OD� UHKLGUDWDFLyQ� SRU� VL�PLVPD� � SXHGH� UHGXFLU� OD� JOXFHPLD� HQWUH� �������HQ���KRUDV��SRU�OR�TXH�ODV�GRVLV�GH�LQVXOLQD�XWLOL]DGDV�SXHGHQ�VHU�PHQRUHV����1R�HV�DFRQVHMDEOH�LQLFLDU�WUDWDPLHQWR�FRQ�VXSOHPHQWRV�GH�SRWDVLR KDVWD�FRQRFHU�VXV�FLIUDV�HQ�VXHUR�� (O� GpILFLW� WRWDO� GH� HVWH� LRQ� SXHGH� VHU� DXQ�PD\RU� TXH� HQ OD�&$'�� /RV� VXSOHPHQWRV� GH�SRWDVLR�VH�DGPLQLVWUDUDQ�HQ�IRUPD�GH�FORUXUR�SRWiVLFR�HQ�IXQFLyQ�GH�VXV�QLYHOHV�SODVPiWLFRV��VL�HV�!�����P(T�O�QR�DGPLQLVWUDU�SHUR�PHGLU�D�OD�KRUD��HQWUH���������P(T�O�����P(T�O��HQWUH���������P(T�O�����P(T�O�\�������P(T�O�����P(T�O�����(Q�HVWH�JUXSR�GH�SDFLHQWHV�HVWi�LQGLFDGD�OD�SURILOD[LV�WURPERHPEyOLFD�FRQ�KHSDULQD�GH�EDMR�SHVR�PROHFXODU�VHJ~Q�SURWRFROR�HVWDEOHFLGR����/D� WUDQVLFLyQ�DO� WUDWDPLHQWR�GHILQLWLYR�VH� UHDOL]D�GH� IRUPD�VLPLODU�D� OD�&$'��DXQTXH�HQ�HVWH�FDVR��WUDV� OD�UHFXSHUDFLyQ�� ORV�SDFLHQWHV�VRQ�WUDQVIHULGRV�D�LQVXOLQD�VXEFXWiQHD��KDELWXDOPHQWH�����8,�NJ�GH�LQVXOLQD�13+������HQ�GHVD\XQR�\�����HQ�FHQD��PDQWHQLHQGR�HVWH�WUDWDPLHQWR�����PHVHV�KDVWD�HYDOXDU�DPEXODWRULDPHQWH�HO�WUDWDPLHQWR�FRQ�KLSRJOXFHPLDQWHVRUDOHV�%LEOLRJUDItD�

Page 171: Manual practico urgencias medicina interna muy bueno

���

��� 'LH]� --�� &HWRDFLGRVLV� GLDEpWLFD� \� VLWXDFLRQHV� GLDEpWLFDV� KLSHURVPRODUHV� QR� FHWyVLFDV�0HGLFLQH��0DGULG����������� �������������� )LJXHUROD�'��'LDEHWHV�0HOOLWXV�����(G�������%DUFHORQD��0DVVRQ��6DOYDW����� *yPH]�%DODJXHU�0��0RULOODV�&��&RPD�GLDEpWLFR�KLSHURVPRODU��(QGRFULQRORJtD����������������������� 6SHUVWHLQ�0'��'LDEHWLF�NHWRDFLGRVLV�DQG�K\SHURVPRODU�FRPD��(QGRFULQRO�0HWDE�&OLQ�1RUWK�$P���������������������� *HQXWK��60��'LDEHWLF�NHWRDFLGRVLV�DQG�K\SHUJO\FHPLF�K\SHURVPRODU�FRPD���(Q�:DUGLQ�&:�HG��&XUUHQW�7KHUDS\� LQ�(QGRFULQRORJ\�DQG�0HWDEROLVP��WK HG�6W�/RXLV��0RVE\�<HDU�%RRN���������������� 8PSLHUUH]��*�(��HW�DO��'LDEHWLF�NHWRDFLGRVLV�DQG�K\SHUJO\FHPLF�K\SHURVPRODU�V\QGURPH��$P�-�0HG�6FL�������������������� .UHQW]�� � $�-��� 1DWWUDVV� 0�� $FXWH� FRPSOLFDWLRQV� RI� GLDEHWHV� PHOOLWXV�� GLDEHWLF� NHWRDFLGRVLV��K\SHURVPRODU� QRQ�NHWRVLF� V\QGURPH� DQG� ODFWLF� DFLGRVLV�� (Q�� 3LFNXS� -&�� :LOOLDPV� *� HGV��7H[WERRN�RI�GLDEHWHV���QG�HG��2[IRUG��%ODFNZHOO�6FLHQWLILF�3XEOLFDWLRQV����������������

Page 172: Manual practico urgencias medicina interna muy bueno

���

(TXLOLEULR�KLGURHOHFWUROtWLFR0DUtD�0HOHUR,��*HQHUDOLGDGHV�GHO�WUDWDPLHQWR�FRQ�OtTXLGRV/RV� SDFLHQWHV� D� PHQXGR� QR� HVWiQ� HQ� FRQGLFLRQHV� GH� PDQWHQHU� SRU� Vt� VRORV� XQ� HTXLOLEULR�KLGURHOHFWUROtWLFR�DGHFXDGR��R�SDGHFHQ�WUDVWRUQRV�VHFXQGDULRV�DO�PLVPR��HQ�HVWRV�FDVRV��VH�KDFH�QHFHVDULR�HO�WUDWDPLHQWR�PpGLFR�FRQ�OtTXLGRV�\�HOHFWUROLWRV��/RV�SULQFLSLRV�SDUD�HO�WUDWDPLHQWR�FRQ�OtTXLGRV�\�HOHFWUROtWLFRV�VRQ�$��$GPLQLVWUDU�ORV�UHTXHULPLHQWRV�GLDULRV�EDVDOHV��(Q�FRQGLFLRQHV�QRUPDOHV��HQ�DXVHQFLD�GH� WUDVWRUQRV� KLGURHOHFWUROtWLFRV�� FXDQGR� XQ� SDFLHQWH� QR� SXHGH� R� QR� GHEH� XWLOL]DU� HO� WXER�GLJHVWLYR��VH�GHEHQ�VXSOLU�ODV�QHFHVLGDGHV�PtQLPDV�EDVDOHV�GH�DJXD��HQHUJtD�\�HOHFWUROLWRV����$JXD�� ODV�QHFHVLGDGHV�PtQLPDV�FRUUHVSRQGHQ�DO�VXPDWRULR�GHO�YROXPHQ�XULQDULR�PtQLPR�QHFHVDULR�SDUD�HOLPLQDU� OD�VREUHFDUJD�GLDULD�GH�VROXWRV������PO�G��\�ODV�SpUGLGDV�LQVHQVLEOHV��SLHO� \� DSDUDWR� UHVSLUDWRULR�� ��������� PO�G�� PHQRV� HO� DJXD� HQGyJHQD� SURGXFLGD� SRU� HO�PHWDEROLVPR������PO�G���3DUD�PDQWHQHU�XQD�GLXUHVLV�HQWUH�������\�������PO�G�VRQ�QHFHVDULRV�GH�������D�������PO�G����(OHFWUROLWRV��1D���������P(T�G��.��������P(T�G�\�&O������P(T�G����(QHUJtD����������JU�JOXFRVD�G�SDUD�UHGXFLU�DO�Pi[LPR�HO�FDWDEROLVPR�SURWHLFR�H�LPSHGLU�OD�FHWRVLV�3DUD� PDQWHQHU� HVWRV� PtQLPRV� EDVWD� FRQ� DGPLQLVWUDU� ������������ PO� GH� VXHURV�JOXFRKLSRVDOLQRV��JOXFRVD�DO����\�&O1D�DO��������R�ELHQ�DOWHUQDQGR�������PO�GH�JOXFRVDGR�DO����FRQ�JOXFRVDOLQR��JOXFRVD�����&O1D�������DxDGLHQGR����P(T�GH�&O.�HQ�FDGD�����PO�6L� OD�VLWXDFLyQ�GHO�SDFLHQWH�VH�SURORQJD�GXUDQWH�PiV�GH���GtDV��HV�QHFHVDULR�DxDGLU�FDOFLR��PDJQHVLR��IyVIRUR��YLWDPLQDV�\�SURWHtQDV�PHGLDQWH�SUHSDUDGRV�GH�QXWULFLyQ�SDUHQWHUDO��WRWDO�R�SHULIpULFD�%��5HHPSOD]DU�SpUGLGDV�\�FRUUHJLU�GpILFLWV�3DUD�FDOFXODU�ODV�SpUGLGDV�GH�DJXD��OR�PHMRU�HV�FRQWURODU� HO� SHVR� GLDULDPHQWH� GHO SDFLHQWH�� 3pUGLGDV� LQVHQVLEOHV�� VXGDFLyQ� \� DSDUDWR�UHVSLUDWRULR� ���������� PO�G��� DPEDV� GHEHQ� UHSRQHUVH� FRQ� JOXFRVDGR� DO� ��� R� KLSRVDOLQR����������SpUGLGDV�JDVWURLQWHVWLQDOHV��XULQDULDV�\�GHVSOD]DPLHQWRV�LQWHUQRV�UiSLGRV�GH�OtTXLGRV��pVWDV�GHEHQ�FRUUHJLUVH�FRQ�VDOLQR�LVRWyQLFR�&��3UHYHU�\�FRUUHJLU�SpUGLGDV�DGLFLRQDOHV��ILHEUH��VXGDFLyQ��SROLXULD���

,,��$OWHUDFLRQHV�HQ�OD�FRPSRVLFLyQ�FRUSRUDO�GH�VRGLR�\�DJXD(O�DJXD�FRUSRUDO� WRWDO� �$&3�� UHSUHVHQWD�HO�����GHO�SHVR������HQ�PXMHUHV��\�VH�GLVWULEX\H�FRPR�VLJXH������HQ�HO�OtTXLGR�LQWUDFHOXODU��/,&��\�����HQ�HO�OtTXLGR�H[WUDFHOXODU��/(&��GRQGH��D�VX�YH]��ODV�����FRUUHVSRQGHQ�DO�OtTXLGR�LQWHUVWLFLDO�\�����DO�SODVPD�/RV�FDPELRV�HQ�HO�/(&�GHSHQGHQ�GH OD�JDQDQFLD�R�SpUGLGD�GH�VRGLR�TXH�KDFH�VHFXQGDULDPHQWH�TXH�VH�JDQH�R�SLHUGD�DJXD��

Page 173: Manual practico urgencias medicina interna muy bueno

���

$��'HSOHFFLyQ�GHO�/(&6LWXDFLRQHV�HQ�ODV�TXH�VH�SLHUGH�WDQWR�VRGLR�FRPR�DJXD��&OtQLFD��$QRUH[LD��QiXVHDV��YyPLWRV��RUWRVWDWLVPR�\�VtQFRSH��HQ�FDVRV�JUDYHV�VH�SXHGH�OOHJDU�DO�VKRFN�\�FRPD��\�SpUGLGD�GH�SHVR��'LVPLQXFLyQ�GH�WXUJHQFLD�GH�OD�SLHO��KXQGLPLHQWR�RFXODU��ROLJXULD��GLVPLQXFLyQ�GH�OD�VXGDFLyQ�\�WDTXLFDUGLD��&DXVDV�� 3pUGLGDV� JDVWURLQWHVWLQDOHV�� UHQDOHV� �GLXUpWLFRV� R� QHIURSDWtDV��� HQIHUPHGDG�VXSUDUUHQDO��KHPRUUDJLD�R�IRUPDFLyQ�GH�WHUFHU�HVSDFLR�7UDWDPLHQWR�� 5HSRQHU� DJXD� \� HOHFWUROLWRV� SRU� YtD� RUDO� R� LQWUDYHQRVD� GHSHQGLHQGR� GH� OD�JUDYHGDG�%��([FHVR�GH�/(&&OtQLFD�� $XPHQWR� GH� SHVR� �HV� HO� VLJQR� PiV� VHQVLEOH� \� FRQVWDQWH��� HGHPDV� TXH� DSDUHFHQ�FXDQGR� \D� KD\� XQ�DF~PXOR� GH����� OLWURV�� RWURV��GLVQHD�� WDTXLSQHD��DXPHQWR�GH�39<�� UHIOXMR�KHSDWR\XJXODU��FUHSLWDQWHV�\�JDORSH�SRU�WHUFHU�WRQR�&DXVDV��UHWHQFLyQ�GH�VRGLR�\�DJXD��LQVXILFLHQFLD�KHSiWLFD��FDUGLDFD�\�UHQDO�\�HQ�HO�VtQGURPH�QHIUyWLFR�7UDWDPLHQWR��HWLROyJLFR�\�GLXUpWLFR�&��3ROLXULD6H� GHILQH� FRPR� XQD� GLXUHVLV� GLDULD� PD\RU� D� ���� OLWURV�� pVWD� D� VX� YH]� SXHGH� VHU� DFXRVD��RVPRODOLGDG�XULQDULD��������X�RVPyWLFD��RVPRODOLGDG�XULQDULD�!��������� 'LXUHVLV� RVPyWLFD� 'LDEHWHV� PHOOLWXV�� \DWUyJHQD� �WUDWDPLHQWR� FRQ� VDOLQR�� PDQLWRO���DOLPHQWDFLyQ�KLSHUSURWHLFD���� 'LXUHVLV� DFXRVD�� ,QIXVLyQ� GH� VROXFLRQHV� KLSRWyQLFDV�� SROLGLSVLD� SULPDULD� �JHQHUDOPHQWH�1D ����������GLXUpWLFRV�GH�DVD��GLDEHWHV�LQVtSLGD��1D ��������'��2VPRODOLGDG�SODVPiWLFD�H�KLDWR�RVPRODU/D� RVPRODOLGDG� SODVPiWLFD� QRUPDO� HV� GH� �������� PRVPRO�.J�� VH� SXHGH� FDOFXODU� HQ� HO�ODERUDWRULR�\�D SDUWLU�GH�OD�IyUPXOD���>1D���.@ ���*OXF��������%81�������&XDQGR�OD�RVPRODOLGDG�FDOFXODGD� \� OD� GHWHUPLQDGD� SRU� HO� ODERUDWRULR� GLILHUHQ� HQ� PiV� GH� ��� P2VP�/�� GHQRWD� OD�SUHVHQFLD� GH� RVPROHV� QR� FDOFXODGRV� �KLDWR� RVPRODU�� TXH� SXHGHQ� FRUUHVSRQGHU� D� PDQLWRO��JOLFLQD��OtSLGRV��SURWHtQDV�R�DOFRKROHV�Wy[LFRV�(��+LSRQDWUHPLD6H� GLFH� TXH� KD\� KLSRQDWUHPLD� FXDQGR� HO� 1D� SODVPiWLFR� HV� PHQRU� GH� ���� P(T�O�� /D�KLSRQDWUHPLD�VXHOH�DFRPSDxDUVH�GH�KLSRRVPRODOLGDG�����&OtQLFD��IXQGDPHQWDOPHQWH�QHXUROyJLFD��IRFDOLGDG�VL�H[LVWH�HQIHUPHGDG�GH�EDVH�����������1iXVHDV�\�YyPLWRV���������&HIDOHD��OHWDUJLD�\�REQXELODFLyQ

Page 174: Manual practico urgencias medicina interna muy bueno

���

���������FRQYXOVLRQHV�\�FRPD

���'LDJQyVWLFR�GLIHUHQFLDO�YHU�FXDGUR����7UDWDPLHQWR�D� &DOFXODU�GpILFLW�GH�1D�>����[�.J�[��1D� GHVHDGR�± 1D� SODVPiWLFR�@

2VPRODULGDG�3ODVPD�������3VHXGRKLSR1D +LSRQDWUHPLD�+LSRQDWUHPLD,VRWyQLFD� n 3URWHtQDV��!���J�GO� 9DORUDU� �� 7$� \� )&�� +LSHUJOXFHPLD� n/tSLGRV�JUDYH7XUJHQFLD � 7WR�FRQ�JOLFHURO 7UDWDPLHQWR�

+LSRYROHPLD +LSHUYROHPLD1D��HQ�RULQD

!��� ��� !����� !�� ����5HQDO ([WUDUUHQDO ,QV�UHQDO ,�&DUGtDFD6,$'+ 3RWRPDQtD*DVWURLQW *DVWURLQWHVWLQDO ,��+HSiWLFD 7LDFLGDV 3ROLGLSVLD���SRU�YyPLWRV 7HUFHU�HVSDFLR 6G��6DOLQR������ 5HVWULFFLyQ�KtGULFD�\�SREUH�HQ�VDO5HVWULFFLyQ�KtGULFD V�6,$'+ nn $'+&DXVDV��+LSRQDWUHPLD�KLSRWyQLFD1DXVHDV��GRORU��HVWUpVn 2VP�RULQD��!����)iUPDFRV�9LQFULVWLQD��FLFORIRVIDPLGDn1D�2ULQD��!���� $PLWULSWLOLQD

Page 175: Manual practico urgencias medicina interna muy bueno

���

E� $VLQWRPiWLFD�R�OHYH������P(T�K�KDVWD�1D ���F� &RQYXOVLRQHV�R�JUDYH�������P(T�O�UiSLGDPHQWH�������P(T�O�KG� 'HSOHFFLyQ�YROXPHQ��6DOLQRH� (GHPDWRVR��3RFD�LQJHVWD�+�2��*UDYH��6HJXULO���6DOLQR�KLSHUWyQLFR��'LiOLVLV)��+LSHUQDWUHPLD��1D�!�����P(T�/�7RGRV�ORV�HVWDGRV�GH�KLSHUQDWUHPLD�VH�DVRFLDQ�FRQ�XQ�DXPHQWR�GH�OD�RVPRODOLGDG�SODVPiWLFD��/D� FOtQLFD� HV� YDULDEOH�� WHPEORU�� LUULWDELOLGDG�� DWD[LD�� HVSDVWLFLGDG�� FRQIXVLyQ�� FRQYXOVLRQHV� \�

FRPD�� /DV� FDXVDV� SRGHPRV� GLYLGLUODV� HQ� WUHV� JUDQGHV� JUXSRV�� SpUGLGD� GH� DJXD� OLEUH�� EDMD�LQJHVWD�GH�DJXD�\�DXPHQWR�QHWR�GH�VDO��,,,��$OWHUDFLRQHV�GHO�SRWDVLR(O�SRWDVLR�FRUSRUDO� WRWDO� GH�XQ�DGXOWR�QRUPDO� HV�GH�XQRV�������P(T�.J�GH� ORV�TXH�VyOR�HO������VH�HQFXHQWUD�HQ�HO�OtTXLGR�H[WUDFHOXODU��/D�LQJHVWD�QRUPDO�HV�GH�������P(T�.J��HO�����VH�SLHUGH�HQ�ODV�KHFHV�\�HO�VXGRU�\�HO�����SRU�HO�ULxyQ�(O�SRWDVLR�VpULFR�VH�FRUUHVSRQGH�FRQ�HO�SRWDVLR�FRUSRUDO�WRWDO�VDOYR�HQ�ODV�DOWHUDFLRQHV�GHO�S+��GRQGH�XQ�GHVFHQVR�GH�����HQ�HO�S+�VXSRQH�XQ�DXPHQWR�GHO�SRWDVLR�VpULFR�GH����������\�XQ�DXPHQWR�GHO S+�GH�����VXSRQH�XQ�GHVFHQVR�HQ�LJXDO�SURSRUFLyQ�GHO�SRWDVLR�VpULFR�

���'LDJQyVWLFR� 1D�!�����P(T�Onn /(& pp /(&2ULQD��n 9RO��n 1D��n2VP&DXVDV��7WR�ELFDUERQDWR�R�VDOLQR�KLSHUWyQLFR+LSHUDOGRVWHURQLVPR�SULPDULR&XVKLQJ p7WR��'LXUpWLFRV���JOXFRVDGR���

([WUDUUHQDO5HQDO� 3pUGLGDV�2ULQD�p9RO��2VP�!�����1D�p��� 5HGLVWULEXFLyQ��(MHUFLFLR��UDEGRPLyOLVLV��2ULQDFRQYXOVLRQHV�� $OWV�PHFDQLVPR�VHGnn9RO�\�nn2VP� nn 9RO�\�pp2VP'LXUHVLV�R ',�F WUDO �'LDEHWHV�LQVtSLGD FDUDFWHUtVWLFDV 3ROLXULD��\�SROLGLSVLD

2VP�2�������P2VP2VP�3�n 7WR� &HQWUDO ''$93� ����� PJU������� K�LQWUDQDVDO��VF�R�LY� 5HQDO &RUUHJLU� +LSR��R�

Page 176: Manual practico urgencias medicina interna muy bueno

���

$�+LSRSRWDVHPLD��.��������

���$SUR[LPDFLyQ�GLDJQyVWLFR�HWLROyJLFD3RU�FDGD�P(T�GH�SRWDVLR�SRU�GHEDMR�GHO� OtPLWH�QRUPDO�H[LVWH�XQD�SpUGLGD� WRWDO�GH���������P(T���&OtQLFD��$SDUHFH�FXDQGR�HO�SRWDVLR�VpULFR�HV�PHQRU�GH������

3RWDVLR�XULQDULR([WUDUUHQDO 3pUGLGD�UHQDO��R������

$F�%DVH�QRUPDO $F��0HWDERO$F�EDVH�YDULDEOH �,QJHVWD�LQDGHF �'LDUUHD �$GHQRPD�YHOORVR �$QRUH[LD �$EXVR�OD[DQWHV �'LHWD�WH�\�W WDGDV $OF�PHWDERO $F�PHWDEyOLFD $F�EDVH�YDULDEOH$FLGRVLV�WXEXODU�UHQDO 6G�GH�)DQFRQL�'LVWDO�R�SUR[LPDO� )DVH�GLXUpWLFD&O� XULQDULR�EDMR &O�XU��DOWR,QKLELGRUHV�$& 17$�����P(T�GtD� �!���P(T�GtD� &HWRDFLGRVLV�GLDE3RVWREVWUXFFLyQ9yPLWRV��61*8UHWHURVLJPRLGRVWRPtD 1HIULWLV�LQWHUVWLFLDO3RVW�KLSHUFDUELD 7$�nn 2WURV)iUPDFRV /HXFHPLD'LXUpWLFRV �([FHVR�GH 'LXUpWLFRV 'HSOHFFLyQ�GH�0J�'LDUUHD�SLHUGH�&O� PLQHUDORFRUWLF� 6G��%DUWWHU 'HSOHFFLyQ� GH� .��JUDYH

$OGRVWHURQD�DOWD$OGRVWHURQD�EDMD�R�QRUPDO([FHVR�GH�'2&$�R�FRUWLFRVWHURQD$F��*OLFLUUtQLFR��UHJDOL]�D� D�D ��

Page 177: Manual practico urgencias medicina interna muy bueno

���

0DOHVWDU�JHQHUDO��IDWLJD��DOWHUDFLRQHV�PXVFXODUHV��GHELOLGDG��KLSRUUHIOH[LD��SDUHVWHVLDV��FDODPEUHV��VG��GH�SLHUQDV�LQTXLHWDV��SDUiOLVLV��LQVXILFLHQFLD�UHVSLUDWRULD��UDEGRPLyOLVLV�*DVWURLQWHVWLQDOHV��HVWUHxLPLHQWR��LOHR��YyPLWRV(QFHIDORSDWtD�KHSiWLFD&DUGLRYDVFXODUHV��+LSRWHQVLyQ�RUWRVWiWLFD��DUULWPLDV��VREUH�WRGR�VL�VH�DVRFLD�D�WWR�GLJLWiOLFR���DOWHUDFLRQHV� HOHFWURFDUGLRJUiILFDV� �DSODQDPLHQWR� GH� OD�7�� GLVPLQXFLyQ� GHO�456�\�GHSUHVLyQ�67��5LxyQ� \� HOHFWUROLWRV�� DOFDORVLV� PHWDEyOLFD�� DOWHUDFLRQHV� GH� FRQFHQWUDFLyQ� GH� OD� RULQD� FRQ�SROLXULD��GLVPLQXFLyQ�GH�OD�ILOWUDFLyQ�JORPHUXODU��LQWROHUDQFLD�D�OD�JOXFRVD������7UDWDPLHQWRD��+LSRNDOLHPLD�OHYH��.� !������&ORUXUR�SRWiVLFR�SRU�YtD�RUDO��VL�H[LVWH�DOFDORVLV�PHWDEyOLFD�\�EDMR� OtTXLGR� H[WUDFHOXODU���'LXUpWLFRV� DKRUUDGRUHV� GH�SRWDVLR� �VL� KD\� SpUGLGDV� UHQDOHV���6L�KD\� LQWROHUDQFLD� RUDO� &ORUXUR� SRWiVLFR� ,�9��� ���P(T�K� D� XQD� FRQFHQWUDFLyQ� GH� ���P(T�/��DGPLQLVWUDU�HQ�VXHUR�QR�JOXFRVDGR�E��+LSRNDOLHPLD� JUDYH� �.������� \� DOWHUDFLRQHV� (&*� R� VtQWRPDV� QHXURPXVFXODUHV� JUDYHV��&ORUXUR� SRWiVLFR� ���P(T�K� ����P(T�/��� (Q� YtDV� JUDQGHV� �IHPRUDO�� OHMRV� GHO� FRUD]yQ�� VH�SXHGHQ�LQWURGXFLU�KDVWD�����P(T�/������P(T�K�%��+LSHUSRWDVHPLD��.�!�����&OtQLFD��&RQ� SRWDVLR� VpULFR� PD\RU� GH� ���� DSDUHFH� GHELOLGDG�� SDUHVWHVLDV�� DUUHIOH[LD�� SDUiOLVLV�DVFHQGHQWH� \� DOWHUDFLRQHV� FDUGLRYDVFXODUHV�� EUDGLFDUGLD�� LQFOXVR� DVLVWROLD�� DXPHQWR� GH�FRQGXFFLyQ�$9�FRQ�EORTXHR�FRPSOHWR�\�ILEULODFLyQ�YHQWULFXODU����$OWHUDFLRQHV�HOHFWURFDUGLRJUiILFDV�.�VpULFR��������2QGDV�7�SLFXGDV�\�DFRUWDPLHQWR�47.�VpULFR������35�ODUJR�\�HQVDQFKDPLHQWR�GHO�456.�VpULFR��������$SODQDPLHQWR�GH�OD�7�\�PD\RU�HQVDQFKDPLHQWR�GHO�456.�VpULFR�!����2QGD�ELIiVLFD��SRU�IXVLyQ�GHO�456�HQVDQFKDGR�\�OD�RQGD�7���SDUR�LQPLQHQWH�(VWDV�DOWHUDFLRQHV�VRQ�PD\RUHV�VL�VH�DVRFLD�FRQ�KLSRQDWUHPLD��KLSRFDOFHPLD�\�DFLGRVLV����7UDWDPLHQWRD��+LSHUNDOLHPLD� OHYH� ����������� UHVWULQJLU� SRWDVLR� GH� OD� GLHWD�� UHVLQFDOFLR� SRU� YtD� RUDO�� ���JU��K��R�HQ�HQHPD�������JU���K�HQ�����FF�GH�DJXD�E� +LSHUNDOLHPLD�PRGHUDGD� ����������� VXHUR� JOXFRVDGR� DO� ����� ���� FF���� 8,� DFWUDSLG�� D�SDVDU� HQ� XQD� KRUD��� %LFDUERQDWR� VyGLFR� ��0��������PO� ������������0�� HQ���¶� �VL� H[LVWH�DFLGRVLV���0DQWHQHU�ODV�PHGLGDV�GH�KLSHUNDOLHPLD�OHYH�F� +LSHUNDOLHPLD�JUDYH��!�������JOXFRQDWR�FiOFLFR�,�9��SDUD�FRQWUDUUHVWDU�ORV�HIHFWRV�VREUH�HO�FRUD]yQ� ��� DPSROOD� DO� ���� HQ� ����PLQ�� TXH� VH� SXHGH� UHSHWLU� D� ORV� ��PLQXWRV�� R� ELHQ� ��DPSROODV� GH� &DOFLXP� 6DQGR]� ���� HQ� ��� FF� JOXFRVDGR� D� SDVDU� HQ� ��� PLQXWRV�� 6H�PDQWLHQHQ�ODV�PHGLGDV�DQWHULRUHV��+HPRGLiOLVLV�VL�IUDFDVDQ�ODV�PHGLGDV�DQWHULRUHV�R�QR�VH�SXHGH�DSOLFDU�R�DSDUHFH�KLSHUSRWDVHPLD�GH�UHERWH�

Page 178: Manual practico urgencias medicina interna muy bueno

���

G�� /RV� FDVRV� FUyQLFRV� �LQVXILFLHQFLD� UHQDO��� WUDWDPLHQWR� HWLROyJLFR� �UHVWULFFLyQ� GLHWpWLFD� \�GLXUpWLFRV�GH�DVD��,9��$OWHUDFLRQHV�GHO�HTXLOLEULR�iFLGR�EDVH/RV�WUDVWRUQRV�GHO�HTXLOLEULR�DFLGREiVLFR�VRQ�PX\�FRPXQHV�HQ�OD�SUiFWLFD�FOtQLFD��HQ�HVSHFLDO�HQ� SDFLHQWHV� KRVSLWDOL]DGRV�� 6X� SUHVHQFLD� SXHGH� VRVSHFKDUVH� EDViQGRVH� HQ� OD� HYDOXDFLyQ�HIHFWXDGD D� OD� FDEHFHUD� GHO� HQIHUPR�� SHUR� HQ�HO�DQiOLVLV� ILQDO� SDUD�HO�GLDJQyVWLFR�H[DFWR�\�HO�WUDWDPLHQWR�DSURSLDGR�VH�UHTXLHUHQ�GDWRV�GH�ODERUDWRULR�ILDEOHV��7RGRV�ORV�GtDV�VH�SURGXFHQ�DSUR[LPDGDPHQWH���P(T�.J�GH�iFLGRV�ILMRV�QR�YROiWLOHV�D�SDUWLU�GHO�PHWDEROLVPR�GH�DPLQRiFLGRV� D]XIUDGRV� \� GH� ORV� KLGUDWRV� GH� FDUERQR�\�JUDVDV�TXH�QR�VH�R[LGDQ� WRWDOPHQWH� D�&2�� \� DJXD� \� VH� H[FUHWDQ� SRU� HO� ULxyQ�� /D� UHJXODFLyQ� GHO� S+� GHQWUR� GH�OtPLWHV�PX\�UHGXFLGRV�GHSHQGH�GH�ORV�SXOPRQHV��ULxRQHV�\�GLYHUVRV�VLVWHPDV�GH�WDPSRQDPLHQWR��(O�DQKtGULGR�FDUEyQLFR��SURGXFWR�ILQDO�GH� OD�KLGUyOLVLV�GHO�iFLGR�FDUEyQLFR��HV�HOLPLQDGR�SRU� ORV�SXOPRQHV��ORV�GHPiV�iFLGRV�VH�H[FUHWDQ�SRU�HO�ULxyQ�TXH�HV��HQ�~OWLPD�LQVWDQFLD��HO�HQFDUJDGR�GH�FRUUHJLU�ODV�DOWHUDFLRQHV�GHO�HTXLOLEULR�iFLGR�EDVH�+����&2�+�� +�&2��� &2����+�2(Q�FRQGLFLRQHV�QRUPDOHV��HO�S+�YDUtD�HQWUH������\�������OD�S&2��HQWUH����\����\�HO�&2��WRWDO�HQWUH����\�����VL�OD�JDVRPHWUtD�HV�YHQRVD��ORV�YDORUHV�QRUPDOHV�TXHGDQ�FRPR�VLJXH��S+�������������S&2����������&2��WRWDO��������

+,3(5.$/,(0,$5HGLVWULEXFLyQ� 3VHXGRKLSHU.5HWHQFLyQ�GH�3RWDVLR$FLGRVLV +HPyOLVLV'pILFLW�GH�LQVXOLQD 7URPERFLWRVLV )*�����PO�PLQ)*�!���PO�PLQ%ORTXHR�E DGUHQpUJLFR /HXFRFLWRVLV 2OLJXULD,QIXVLyQ�GH�DUJLQLQD6REUHFDUJD�.�6XFFLQLOFROLQD$OGRVWHURQD�EDMD $OGRVWHURQD6REUHGRVLV�GH�GLJLWDO�PDVLYD$GGLVRQ 1�y�nn3DUiOLVLV�SHULyGLFD�KLSHUSRWDVpPLFD+LSRDOGRVWHURQLVPR $OW��7XEXODU���

KLSRUUHQLQpPLFR �$GTXLULGRV)iUPDFRV �&RQJpQLWRV

Page 179: Manual practico urgencias medicina interna muy bueno

���

/RV�WUDVWRUQRV�SULPDULRV�GHO�HTXLOLEULR�iFLGR�EDVH�DSDUHFHQ�HQ�HVWDGRV�HQ�ORV�TXH�VH�PRGLILFD�HO� ELFDUERQDWR� �DOFDORVLV� \� DFLGRVLV� PHWDEyOLFD�� R� OD� S&2�� �DFLGRVLV� \� DOFDORVLV� UHVSLUDWRULD���(VWRV�GHWHUPLQDQ�XQ�GHVSOD]DPLHQWR�GHO�S+�VDQJXtQHR�\�JHQHUDQ�UHVSXHVWDV�FRPSHQVDWRULDV�TXH�PDQWLHQHQ�HO�S+�GHQWUR�GHO�UDQJR�QRUPDO�DXQTXH�GH�IRUPD�LQFRPSOHWD��$��$FLGRVLV�PHWDEyOLFD'HVFHQVR� GHO� ELFDUERQDWR� TXH� UHIOHMD� XQD� DFXPXODFLyQ� GH� iFLGRV� ILMRV� R� XQD SpUGLGD� GH�EDVHV��/D�UHVSXHVWD�FRPSHQVDWRULD�FRQVLVWH�HQ�XQ�DXPHQWR�GH�OD�YHQWLODFLyQ�FRQ�GHVFHQVR�GH�OD�S&2���(VWD�UHVSXHVWD�FRPLHQ]D�HQ�XQD�R�GRV�KRUDV�\�DOFDQ]D�VX�YDORU�Pi[LPR�HQ�������KRUDV���� &OtQLFD� GLItFLO� GH� VHSDUDU� GH� OD� FDXVD� GH� EDVH� SHUR� SXHGH� DIHFWDU� D� ORV� VLVWHPDV�UHVSLUDWRULR��FDUGLRYDVFXODU��HVTXHOpWLFR�\�QHUYLRVR��/D�FRPSHQVDFLyQ�UHVSLUDWRULD�SURGXFH�UHVSLUDFLyQ� SURIXQGD� �.XVVPDXO��� OD� IUHFXHQFLD� UHVSLUDWRULD� DXPHQWD� \� VH� SURGXFH� HQ�RFDVLRQHV� GLVQHD� \�� HQ� ~OWLPD� LQVWDQFLD�� LQVXILFLHQFLD� UHVSLUDWRULD�� $Vt�PLVPR�� H[LVWH� XQD�PD\RU� VHQVLELOLGDG� D� ODV� DUULWPLDV�� GLVPLQXFLyQ� GH� OD� FRQWUDFWLOLGDG� PLRFiUGLFD� \� EDMD�UHVSXHVWD�D�ORV� LQRWUySLFRV��/D�GLVPLQXFLyQ�GHO�S+�FHUHEUDO�SURGXFH�GHWHULRUR�GHO�QLYHO�GH�FRQFLHQFLD�� /D� DFLGRVLV� FUyQLFD� SURGXFH� GLVPLQXFLyQ� GHO� FDOFLR� yVHR� \� DXPHQWD� HO�FDWDEROLVPR�GHO�P~VFXOR�HVTXHOpWLFR���� +LDWR� DQLyQLFR� D\XGD� DO� GLDJQyVWLFR� GLIHUHQFLDO� GH� OD� DFLGRVLV� PHWDEyOLFD��(V� XQD�PHGLGD�LQGLUHFWD�GH�ORV�DQLRQHV�SODVPiWLFRV�TXH�QR�VH�GHWHFWDQ�HQ�ODV�SUXHEDV�UXWLQDULDV�GH�ODERUDWRULR�\�VH�GHILQH�FRPR�OD�GLIHUHQFLD�HQWUH�OD�FRQFHQWUDFLyQ�GH�VRGLR�\�OD�VXPD�GH�ODV�FRQFHQWUDFLRQHV� GH� FORUR� \� ELFDUERQDWR�� HQ� FRQGLFLRQHV� QRUPDOHV� VX� YDORU� HV� GH� ���r ��P(T�O�'LDJQyVWLFR�GH�OD�DFLGRVLV�PHWDEyOLFD�DJXGD��p &2�+���p S&2������PP�GH�+J�SRU�P(T�GH�ELFDUERQDWR�SRU�GHEDMR�GH�OR�QRUPDO��&DXVDV��niFLGR��DQLRQ�JDS�HOHYDGR�VDOYR�HQ�DFLGRVLV�KLSHUFORUpPLFD��R�SpUGLGD�GH�iOFDOLV����7UDWDPLHQWR�DFLGRVLV�PHWDEyOLFD�DJXGD�D� 7UDWDPLHQWR�GH�OD�HQIHUPHGDG�FDXVDO��GLDEHWHV��DFLGRVLV�OiFWLFD��2� WLVXODU���6L�QR�HV�VXILFLHQWH��DGPLQLVWUDU�ELFDUERQDWR��0�R�����0�>�P(T��FF@�KDVWD�FRQVHJXLU�S+# �����E� &DOFXODU�HO�GpILFLW�GH�ELFDUERQDWR� > �����[�.J�[� �ELFDUERQDWR�QRUPDO�� ELFDUERQDWR�SODVPiWLFR�@�\�UHSRQHU�OD�PLWDG�HQ����KRUDVF� 6L�S+��������FRQWLQXDU�VHJ~Q�FRQWUROHV�IUHFXHQWHV(Q� JHQHUDO�� VH� DxDGHQ� ���� DPSROODV� GH� ELFDUERQDWR� VyGLFR� DO� ����� ������ P(T��DPSROOD��D�������PO�JOXFRVDGR�DO�����/D�PLWDG�GHO�GpILFLW�FDOFXODGR�VH�DGPLQLVWUD�HQ�ODV�SULPHUDV�����KRUDV��VL�QR�KD\�LQVXILFLHQFLD�FDUGLDFD�JUDYH��1R�GHEH�DGPLQLVWUDUVH�ELFDUERQDWR�XQD�YH]�TXH�HO�S+�KD�DOFDQ]DGR�XQ�YDORU�GH������WDPSRFR�KD\�TXH�ROYLGDU�TXH�HO�SRWDVLR�GHVFLHQGH�DO�FRUUHJLU� OD�DFLGRVLV�\�TXH�HO�FDOFLR�SXHGH�GLVPLQXLU�HQ�OD�DOFDORVLV�

Page 180: Manual practico urgencias medicina interna muy bueno

���

G� (Q�OD�DFLGRVLV�OiFWLFD��OD�FRUUHFFLyQ�GHO�S+�VpULFR�SRU�HQFLPD�GH�����SXHGH�RFDVLRQDU�

XQD�DOFDORVLV�GH�UHERWH�SXHV�DO�FRUUHJLU�OD�FDXVD�HO�ODFWDWR�VH�R[LGD�\�VH�UHJHQHUD�HQ�ELFDUERQDWR�����7UDWDPLHQWR�GH�OD�DFLGRVLV�PHWDEyOLFD�FUyQLFD�(Q�OD�DFLGRVLV�PHWDEyOLFD�FUyQLFD�HO�REMHWLYR�HV�PDQWHQHU�XQ�ELFDUERQDWR�DOUHGHGRU�GH���P(T�O� SDUD� HYLWDU� OD� SpUGLGD� GH� FDOFLR� yVHR� \� HO� FDWDEROLVPR� PXVFXODU�� 3DUD� HOOR� VH�DGPLQLVWUD� ELFDUERQDWR� VyGLFR� RUDO� ����� JU�GtD��� HQ� OD DFLGRVLV� WXEXODU� UHQDO� WLSR� ,9� VH�SUHFLVD��DGHPiV�����D�IOXRUKLGURFRUWLVRQD��%��$OFDORVLV�PHWDEyOLFD(Q� OD�DOFDORVLV�PHWDEyOLFD�H[LVWH�XQ�DXPHQWR�SULPDULR�GH�ELFDUERQDWR�\�HV�FRQVHFXHQFLD�GH�XQD� SpUGLGD� GH� iFLGR� R�� PiV� UDUDPHQWH�� XQD� JDQDQFLD� GH� ELFDUERQDWR�� /D� UHVSXHVWD�FRPSHQVDWRULD� FRQVLVWH� HQ� XQD� KLSRYHQWLODFLyQ� FRQ� UHWHQFLyQ� GH� FDUEyQLFR�� HO� JUDGR� GH�KLSRYHQWLODFLyQ�GLVPLQX\H�HQ�FDVR�GH�KLSR[LD���� (WLRORJtD� ,QJHVWD� GH� iOFDOLV�� SpUGLGDV� GH� iFLGR� FORUKtGULFR� �UHQDO� R� JDVWURLQWHVWLQDO�� R�FRQWUDFFLyQ GHO�YROXPHQ�H[WUDFHOXODU�FRQ�XQ�FRQWHQLGR�VDQJXtQHR�ILMR�GH�ELFDUERQDWR��(O�ULxyQ�FRQVHUYD� VX� FDSDFLGDG� SDUD� H[FUHWDU� HO� H[FHVR� GH� ELFDUERQDWR�� SHUR� HVWD� VH� DOWHUD� SRU� OD�FRQWUDFFLyQ� GH� YROXPHQ� H[WUDFHOXODU�� OD� KLSRSRWDVHPLD�� OD� GHSOHFFLyQ� GH� FORUXURV� R� ORV�FXDGURV�FRQ�XQ�H[FHVR�GH�PLQHUDO�R�JOXFRFRUWLFRLGHV����&OtQLFD�6HFXQGDULD�D�SpUGLGDV�GH�OtTXLGR�H[WUDFHOXODU�H�KLSRSRWDVHPLD��OD�DOFDOHPLD�SHU�Vp�GLVPLQX\H�HO�QLYHO�GH�FRQFLHQFLD�\�SURGXFH�KLSRWHQVLyQ��DUULWPLDV��KLSRYHQWLODFLyQ�\�GHVFHQVR�GHO�FDOFLR�LyQLFR����'LDJQyVWLFR�GLIHUHQFLDO�9HU�JUDItFR���7UDWDPLHQWRD� 7UDWDPLHQWR�GH�OD�HQIHUPHGDG�FDXVDO�

$QLyQ�*DS$OWR1RUPDOpp pp5HQDO 9HU�.�&HWRDFLGRVLV��&HWRQXULD���FHWRQHPLD�'LDEHWHV1�y�nn pp$OFRKRO+LSHUFORUHPLD 9HU�S+�RULQD$\XQR

Page 181: Manual practico urgencias medicina interna muy bueno

���

E� &RUUHJLU�KLSRNDOLHPLD��6L�H[LVWH�DXPHQWR�GH�DOGRVWHURQD�DGPLQLVWUDU� HVSLURQRODFWRQD�R�DPLORULGH�F��6L�S+!����VH�WUDWD�GH�XQD�DOFDORVLV�JUDYH�SUHFLVDQGR�OD�DGPLQLVWUDFLyQ�GH�iFLGRV��VREUH�WRGR�VL�QR�VH�SXHGH�DGPLQLVWUDU�VDO��FRPR�HQ�OD�LQVXILFLHQFLD�FDUGLDFD�R�UHQDO�����&DOFXODU�HO�GpILFLW�GH�KLGURJHQLRQHV������[�.J�[��%LF�UHDO�� %LF�GHVHDGR����� $GPLQLVWUDU� OD� PLWDG� GHO� GpILFLW� HQ� ODV� SULPHUDV� ��� KRUDV� SRU� PHGLR� GH� iFLGR�FORUKtGULFR������PO�����1�HQ�XQ�OLWUR�GH�DJXD�HVWpULO�D�WUDYpV�GH�XQD�YtD�FHQWUDO�D�XQDYHORFLGDG�QR�PD\RU�GH�����P(T�.J�K��G��+HPRGLiOLVLV�HQ�SDFLHQWHV�FRQ�LQVXILFLHQFLD�UHQDO�

&��$FLGRVLV�UHVSLUDWRULD(Q�OD�DFLGRVLV�UHVSLUDWRULD�KD\�XQ�DXPHQWR�SULPDULR�GH�FDUEyQLFR�TXH�DSDUHFH�HQ�SURFHVRV�TXH�LQWHUILHUHQ� HQ� OD� HOLPLQDFLyQ� SXOPRQDU� GH�&2��� OD� UHVSXHVWD� FRPSHQVDWRULD� TXH� WLHQH� OXJDU�GXUDQWH� YDULRV� GtDV�� FRQVLVWH� HQ� XQ� DXPHQWR� GH� OD� UHDEVRUFLyQ� \� SURGXFFLyQ� UHQDO� GH�ELFDUERQDWR�GDQGR�OXJDU�D�XQ�DXPHQWR�GH�pVWH�HQ�VXHUR���� (WLRORJtD��GHSUHVLyQ� GHO� 61&� �IiUPDFRV�� LQIHFFLRQHV�� WUDXPDWLVPRV� FUDQHR�HQFHIiOLFRV��REHVLGDG��� WUDVWRUQRV� QHXURPXVFXODUHV� �PLRSDWtDV�� 6G�� *XLOODLQ�%DUUp�� FULVLV� PLDVWpQLFD��KLSRSRWDVHPLD�����R�HQIHUPHGDGHV�SXOPRQDUHV��(32&��DSQHD�GHO�VXHxR��DVPD��FLIRHVFROLRVLV��SQHXPRWyUD[�������&OtQLFD��$JLWDFLyQ�� DVWHUL[LV�� HGHPD� GH� SDSLOD�� FHIDOHD�� VRPQROHQFLD��+7$�� WDTXLFDUGLD�� LQVXILFLHQFLD�FDUGLDFD�\�DUULWPLDV�����'LDJQyVWLFR��

&O� RULQD�����P(T�GtD!����P(T�GtD�'HSOHFFLyQ�GH�YROXPHQ��6DOLQR�VHQVLEOH��6DOLQR�UHVLVWHQWH� pp

+LGUDWDU�FRQ�VDOLQR�r&O.$FHWD]RODPLGD�VL�QR�KD\�KLSRYROHPLD 7$�QRUPDO nn7$�'LDPR[������������FRPS�������KRUDV�pp'LXUpWLFRV�SLHUGH�&O�6G�%DUWWHU $OGRVWHURQD+LSHUDOLPHQWDFLyQ

Page 182: Manual practico urgencias medicina interna muy bueno

���

*$%�FRQ�S+�EDMR�\�S&2��DOWD��&RQYLHQH�GHWHUPLQDU�VL� ORV�FDPELRV�GHO�S+�VRQ�DSURSLDGRV�SDUD�OD�YDULDFLyQ�GH�OD�S&2��D�ILQ�GH�GLIHUHQFLDU�XQ�WUDVWRUQR�DJXGR�GHO�FUyQLFR�\�GHWHFWDU�XQ�SRVLEOH�WUDVWRUQR�PL[WR��(Q�JHQHUDO��HO�ELFDUERQDWR�VpULFR�FRPSHQVDGR�QR�VXSHUD����PPRO�O��VL�HV�PD\RU��GHEH�VRVSHFKDUVH�XQD�DOFDORVLV�PHWDEyOLFD�DVRFLDGD����7UDWDPLHQWR�D��0HMRUDU�OD�IXQFLyQ�YHQWLODWRULDE��$GPLQLVWUDU�ELFDUERQDWR�SXHGH�VHU�SHUMXGLFLDO�SRUTXH�HO�GHVFHQVR�GHO�S+�FRQVWLWX\H�XQ�HVWtPXOR�HVHQFLDO�SDUD�OD�YHQWLODFLyQ�SXOPRQDU��SXHGH�VHU�QHFHVDULR�VL�HO�S+�HVPHQRU�GH�������������P(T����y����PLQXWRV�F��(Q�SDFLHQWH�FRQ�YHQWLODFLyQ�DVLVWLGD�� SXHGH� UHVXOWDU� ~WLO� OD�DGPLQLVWUDFLyQ�GH�SHTXHxDV�GRVLV� GH� ELFDUERQDWR� SDUD� PHMRUDU� OD� UHVSXHVWD� D� ORV� EURQFRGLODWDGRUHV� DGUHQpUJLFRV� \�HYLWDU�HO�EDURWUDXPD�'��$OFDORVLV�UHVSLUDWRULD/D�DOFDORVLV�UHVSLUDWRULD�VH�FDUDFWHUL]D�SRU�XQ�GHVFHQVR�SULPDULR�GHO�DQKtGULGR�FDUEyQLFR�FRPR�FRQVHFXHQFLD�GH�KLSHUYHQWLODFLyQ�SULPDULD�� OD�UHVSXHVWD��TXH�GXUD�YDULRV�GtDV��FRQVLVWH�HQ�XQ�DXPHQWR�GH�OD�H[FUHFLyQ�GH�ELFDUERQDWR�SRU�HO�ULxyQ��ORTXH�GLVPLQX\H�HO�ELFDUERQDWR�HQ�VXHUR����(WLRORJtD��$OWHUDFLRQHV�GHO�61&��DQVLHGDG��WXPRUHV�GH�WURQFR��LQIHFFLRQHV����)iUPDFRV��VDOLFLODWRV��WHRILOLQDV��FDWHFRODPLQDV��SURJHVWHURQD����+LSR[HPLD(QIHUPHGDGHV�SXOPRQDUHV��QHXPRQtD��7(3��HGHPD�SXOPRQDU��HQI��LQWHUVWLFLDOHV�6HSVLV�SRU�*UDP�QHJDWLYRV2WUDV��KHSDWRSDWtD��HPEDUD]R��YHQWLODFLyQ�PHFiQLFD�H[FHVLYD��FRUUHFFLyQ�UiSLGD�GH�DFLGRVLV�PHWDEyOLFD�FUyQLFD�������&OtQLFD�2EQXELODFLyQ��SDUHVWHVLDV��HVSDVPRV��WHWDQLD��VtQFRSH��FRQYXOVLRQHV��DUULWPLDV���'LDJQyVWLFR��*$%�FRQ�S+�DOWR�\�S&2��EDMR��&RQYLHQH�VDEHU�VL�OD�FRPSHQVDFLyQ�UHQDO�HV�DGHFXDGD�R�VH�WUDWD�GH�XQ� WUDVWRUQR�PL[WR��*HQHUDOPHQWH�HO�ELFDUERQDWR�QR�GHVFLHQGH�SRU�GHEDMR�GH����D�PHQRV�TXH�H[LVWD�DFLGRVLV�PHWDEyOLFD�DVRFLDGD����7UDWDPLHQWR�(WLROyJLFR$JXGR�VL�S+�!����6L�QR�KD\�KLSR[LD��UHVSLUDU�OHQWDPHQWH�HQ�XQD�EROVD�6L� OD�FRUUHFFLyQ�GH� OD�S&2��HQ�XQ�SDFLHQWH�FRQ�DOFDORVLV�UHVSLUDWRULD�FUyQLFD�VH�KDFH�UiSLGDPHQWH�� VH� LQGXFH� XQD� DFLGRVLV� PHWDEyOLFD� FRPR� FRQVHFXHQFLD� GH� OD�FRPSHQVDFLyQ�PHWDEyOLFD�SUHYLD�

Page 183: Manual practico urgencias medicina interna muy bueno

���

(��7UDVWRUQRV�PL[WRV6RQ� IUHFXHQWHV� HQ� SDFLHQWHV� FRQ� SURFHVRV� DJXGRV� \� VXHOHQ� GLDJQRVWLFDUVH� SRU� ODV�PDQLIHVWDFLRQHV�FOtQLFDV��(V�QHFHVDULR�FRPSUREDU�ORV�FDPELRV�FRPSHQVDWRULRV�UHDOHV�GH�S+��S&2��\�ELFDUERQDWR�FRQ�ORV�WHyULFRV�7UDVWRUQR�SULPDULR $OWHUDFLyQ�LQLFLDO 5HVSXHVWD�FRPSHQVDWRULD$FLGRVLV�PHWDEyOLFD p +&2�� p S&2��GH�������PP�+J�SRU�FDGD�P(T�GH�+&2�� p$OFDORVLV�PHWDEyOLFD n +&2�� n S&2��GH���������PP�+J�SRU�FDGD�P(T�GH�+&2�� n$FLGRVLV�UHVSLUDWRULD�DJXGD n S&2� n +&2�� HQ���P(T�SRU�FDGD����PP+J�S&2��n$FLGRVLV��UHVSLUDWRULD�FUyQLFD n S&2� n +&2�� HQ���������P(T�SRU�FDGD����PP+J�S&2��n$OFDORVLV�UHVSLUDWRULD�DJXGD p S&2� p +&2�� HQ�������P(T�SRU�FDGD����PP+J�S&2��p$OFDORVLV�UHVSLUDWRULD�FUyQLFD p S&2� p +&2�� HQ�����P(T�SRU�FDGD����PP+J�S&2��p'H� WRGRV�PRGRV��D� YHFHV�� YDORUHV� GHQWUR� GHO� LQWHUYDOR� WHyULFR� GH�XQ� WUDVWRUQR�VLPSOH�SXHGHQ�UHSUHVHQWDU�XQ�WUDVWRUQR�PL[WR��$Vt�PLVPR��GHEHQ�GHWHUPLQDUVH�ORV�HOHFWUROLWRV�VpULFRV�\�FDOFXODU�HO�KLDWR�DQLyQLFR��

&DXVDV�IUHFXHQWHV�GH�WUDVWRUQRV�PL[WRV����$FLGRVLV�UHVSLUDWRULD�\�PHWDEyOLFD��SDUDGD�FDUGLRUUHVSLUDWRULD��HQIHUPHGDGHV�SXOPRQDUHV�FRQ�KLSR[HPLD�JUDYH��VKRFN�FRQ�LQVXILFLHQFLD�UHVSLUDWRULD������ $OFDORVLV� UHVSLUDWRULD� \� DFLGRVLV� PHWDEyOLFD�� ,QVXILFLHQFLD� KHSiWLFD�� LQWR[LFDFLyQ� SRU�VDOLFLODWRV��VHSVLV�SRU�*UDP�QHJDWLYRV������$OFDORVLV�UHVSLUDWRULD�\�DOFDORVLV�PHWDEyOLFD��WUDWDPLHQWR�GH�OD�FLUURVLV�FRQ�GLXUpWLFRV���$OFDORVLV�\�DFLGRVLV�PHWDEyOLFDV��YyPLWRV�\�GHSOHFFLyQ�GH�YROXPHQ�%LEOLRJUDItD����0DQXDO�GH�GLDJQyVWLFR�\�WHUDSpXWLFD�PpGLFD�����GH�RFWXEUH�����HGLFLyQ���(O�PDQXDO�:DVKLQJWRQ����HGLFLyQ��0DVVRQ��+DUULVRQV��3ULQFLSOHV�RI�,QWHUQDO�0HGLFLQH�����WK�HGLWLRQ�

Page 184: Manual practico urgencias medicina interna muy bueno

���

)UDFDVR�UHQDO�DJXGR��)5$��0DU�&DUPRQD���� &RQFHSWR�� 'HWHULRUR� EUXVFR� GH� OD� ILOWUDFLyQ� JORPHUXODU� FRQ� OD� FRQVHFXHQWH� UHWHQFLyQ� GH�PHWDEROLWRV�GHO�QLWUyJHQR��%81��FUHDWLQLQD�����&ULWHULRV�GLDJQyVWLFRV�(OHYDFLyQ�GH�OD�FUHDWLQLQD�SODVPiWLFD�t ����PJ�G/�VREUH�HO�QLYHO�SUHYLR�(OHYDFLyQ�GH�OD�FUHDWLQLQD�SODVPiWLFD�t �����VREUH�HO�QLYHO�SUHYLR�'LVPLQXFLyQ�GHO�DFODUDPLHQWR�GH�FUHDWLQLQD�t ��������,PSRUWDQFLD��&RPSOLFD� HO� ���� �� GH� ORV� SDFLHQWHV� LQJUHVDGRV� GH� IRUPD� JHQHUDO�� KDVWD� XQ� ���� GH� ORV�SDFLHQWHV�LQJUHVDGRV�HQ�8&,�(O������GH�ORV�)5$�TXH�VH�SURGXFHQ�HQ�HVWRV�SDFLHQWHV�VRQ�\DWUyJHQRV�0RUWDOLGDG�JOREDO�GHO���������&ODVLILFDFLyQ� )5$�SUHUUHQDO��FDUDFWHUL]DGR�SRU�KLSRSHUIXVLyQ�UHQDO�FRQ�LQWHJULGDG�GHO�SDUpQTXLPD�����������)5$� SDUHQTXLPDWRVR� R� D]RHPLD� UHQDO�� SURGXFLGR� SRU� HQIHUPHGDGHV� TXH� DIHFWDQ� DO�SDUpQTXLPD�UHQDO�����������)5$�SRVWUHQDO�RFDVLRQDGR�SRU�REVWUXFFLyQ�GHO�VLVWHPD�FROHFWRU�XULQDULR������������$SUR[LPDFLyQ�GLDJQyVWLFD�� 'HVFDUWDU� OD� ,QVXILFLHQFLD� UHQDO� FUyQLFD� �KLVWRULD� FOtQLFD�� UHFLHQWH� LQFUHPHQWR� GH� XUHD� \�FUHDWLQLQD� SODVPiWLFDV�� RWURV� GDWRV� DQDOtWLFRV� �DQHPLD�� KLSHUIRVIRUHPLD�� KLSRFDOFHPLD���GLVPLQXFLyQ�GHO�WDPDxR�UHQDO��VLJQRV�GH�HQIHUPHGDG�FUyQLFD��RVWHRSDWtD��QHXURSDWtD���'LIHUHQFLDU�HQWUH�WUDVWRUQR�SUHUUHQDO��SDUHQTXLPDWRVR�X�REVWUXFWLYR���$QDPQHVLV�\�H[SORUDFLyQ�ItVLFD���'DWRV�DQDOtWLFRV��7DEOD�,���'DWRV�GHO�DQiOLVLV�GH�RULQD�TXH�SXHGHQ�D\XGDU�DO�GLDJQyVWLFR�GLIHUHQFLDO���)5$�SUHUUHQDO��JHQHUDOPHQWH�HO�VHGLPHQWR�HV�QRUPDO���)5$�REVWUXFWLYR��VRQ�IUHFXHQWHV�OD�KHPDWXULD�\�OD�SLXULD���)5$�SDUHQTXLPDWRVR��ORV�FLOLQGURV�JUDQXORVRV�SLJPHQWDGRV�\�GH�FpOXODV�WXEXODUHV�VRQ� FDUDFWHUtVWLFRV� GH� OD� QHFURVLV� WXEXODU� DJXGD�� JHQHUDOPHQWH� DVRFLDGRV� FRQ� SURWHLQXULD�PRGHUDGD� ��� �� JU�G�� \� KHPDWXULD� PLFURVFySLFD�� /RV� FLOLQGURV� KHPiWLFRV� VXHOHQ� LQGLFDU�HQIHUPHGDG�JORPHUXODU��DXQTXH�SXHGHQ�DSDUHFHU�HQ�QHIULWLV�LQWHUVWLFLDOHV��6H�SXHGHQ�REVHUYDU�FLOLQGURV�OHXFRFLWDULRV�\�JUDQXORVRV�QR�SLJPHQWDGRV�HQ�OD�QHIULWLV�LQWHUVWLFLDOHV��/D�HRVLQRILOXULD�HV�FDUDFWHUtVWLFD� GH� OD� QHIULWLV� DOpUJLFD� LQWHUVWLFLDO�� 3URWHLQXULD� !� �� JU�GtD� VXJLHUHQ� SDWRORJtD�

Page 185: Manual practico urgencias medicina interna muy bueno

���

JORPHUXODU��H[FUHFLyQ�GH�FDGHQDV�OLJHUDV HQ�HO�PLHORPD�R�QHIULWLV�LQWHUVWLFLDO�DOpUJLFD�SRU�$,1(V��/D�SUHVHQFLD�GH�JUDQGHV�FDQWLGDGHV�GH�FULVWDOHV�GH�XUDWR�GHEH�KDFHU�VRVSHFKDU�XQD�QHIURSDWtD�SRU�XUDWRV��HQ�WDQWR�TXH�ORV�FULVWDOHV�GH�R[DODWR�H�KLSXUDWR�VXJLHUHQ�WR[LFLGDG�SRU�HWLOHQJOLFRO��6H�GHEH� VRVSHFKDU� OD� H[LVWHQFLD� GH� KHPRJORELQXULD� R� PLRJORELQXULD� VL� HO� VLVWHPiWLFR� GH� RULQD�GHWHFWD�KHPDWXULD�IXHUWHPHQWH�SRVLWLYD�\�VH�REVHUYDQ�SRFRV�KHPDWtHV�HQ�HO�VHGLPHQWR�7DEOD�,��GDWRV�DQDOtWLFRV SDUD HO GLDJQyVWLFR HQ�HO�)5'HQVLGDG��R�6RGLR��R�()1$ &U�R��&U�SO�8UHD��R��8UHD��SO�8UHD��SO��&U�SO�ËQGLFH�GH�)UDFDVRUHQDO�

!�����!�����PRVP�.J�����P(T�/����!���!�!����

3UHUUHQDO� � 3DUHQTXLPDWRVR�� 3RVWUHQDO����������PRVP�.J!���P(T�/!��������������!��

�����������!��������

�,QGLFH�GH�IUDFDVR�UHQDO��,)5���1D��R��[� &U�S���&U��R� �([FUHFLyQ�IUDFFLRQDO�GH�VRGLR��()1$���1D�R��[�&U��S��[������1D��S�[�&U��R���7pFQLFDV�GH�LPDJHQ��VH�UHFRPLHQGD�HO�HVWXGLR�PHGLDQWH�HFRJUDItD��7$&�R�510��FRQ�HO�ILQ�GH�H[FOXLU�OD�XURSDWtD�REVWUXFWLYD��/D�GLODWDFLyQ�SLHORFDOLFLDO�HV�IUHFXHQWH�HQ�OD�REVWUXFFLyQ�GH�YtDV�XULQDULDV��VHQVLELOLGDG�GHO�������SHUR�SXHGH�HVWDU�DXVHQWH�HQ�ODV�IDVHV�LQLFLDOHV�GH�OD�REVWUXFFLyQ�R� HQ� HO� FDVR� GH� TXH� HVWD� VHD�GHELGD� D� HQJOREDPLHQWR� GHO� XUpWHU��&XDQGR� VH� VRVSHFKH�HVWD�SRVLELOLGDG�KDEUi�TXH�UHDOL]DU�SLHORJUDItD�UHWUyJUDGD�R�DQWHUyJUDGD���%LRSVLD�UHQDO��HV�HVSHFLDOPHQWH�~WLO�FXDQGR�WRGRV�ORV�GDWRV�GH�OD�KLVWRULD�FOtQLFD��DQDOtWLFRV�\� GH� LPDJHQ� VXJLHUHQ� XQD� HWLRORJtD� GLVWLQWD� D� OD� LVTXpPLFD� R� QHIURWy[LFD� \� VH� VRVSHFKD� OD�H[LVWHQFLD�GH�SDWRORJtD�TXH�SXHGH�EHQHILFLDUVH�GH�XQ�WUDWDPLHQWR�HVSHFtILFR�(O�DOJRULWPR�GLDJQyVWLFR�GHO�)5$�TXHGD�H[SXHVWR�HQ�OD�)LJXUD����� 0DQHMR�GHO�)5$�7UDWDPLHQWR�GH�VRSRUWH�%DODQFH�GH�IOXLGRV��(V�PX\�LPSRUWDQWH�WHQHU�FRQVWDQFLD�H[DFWD�GH�ODV�HQWUDGDV�\�SpUGLGDV�GH� OtTXLGR��(Q�HO�FDVR�GH�TXH�VH�SURGX]FD�XQD�VREUHFDUJD�KtGULFD�FRQ�HGHPD�SXOPRQDU��pVWH�GHEH�WUDWDUVH�FRQ�IXURVHPLGD��PRUILQD��R[LJHQRWHUDSLD�\�HYHQWXDOPHQWH�GLiOLVLV�'LHWD�� 6H� GHEHQ� SURSRUFLRQDU� FDORUtDV� VXILFLHQWHV� SDUD� HYLWDU� HO� FDWDEROLVPR� \� OD�FHWRDFLGRVLV�� SHUR� DO� PLVPR� WLHPSR� VH� GHEH� UHGXFLU� DO� PtQLPR� OD� SURGXFFLyQ� GH�PHWDEROLWRV�

Page 186: Manual practico urgencias medicina interna muy bueno

���

QLWURJHQDGRV�� 3DUD� HOOR� UHVWULQJLU� ODV� SURWHtQDV� GH� DOWR� YDORU� ELROyJLFR D� ���� J�.J� GH� SHVR� \�SURSRUFLRQDU�OD�PD\RU�SDUWH�GH�FDORUtDV�HQ�IRUPD�GH�FDUERKLGUDWRV��XQRV�����J�GtD��+LSHUSRWDVHPLD��3DUD�YDORUDU� OD� LPSRUWDQFLD� GH� OD� KLSHUNDOLHPLD�VRQ�PiV� LPSRUWDQWHV� ORV�FDPELRV�(&*�TXH� ORV� QLYHOHV�VpULFRV�GH�SRWDVLR��(O�SULPHU� FDPELR�HV� OD�DSDULFLyQ�GH�RQGD�7�SXQWLDJXGD�\� OXHJR�DOWD�� OD�WR[LFLGDG�VHYHUD�VH�PDQLILHVWD�FRPR�SURORQJDFLyQ�GHO� LQWHUYDOR�35��GHSUHVLyQ� GHO� VHJPHQWR� 67� \� HQVDQFKDPLHQWR� GH� ORV� FRPSOHMRV� 456�� HQ� ODV� VLWXDFLRQHV�KLSHUDJXGDV�VH�REVHUYD�DVLVWROLD�DWULDO�\�EORTXHRV�LQWUDYHQWULFXODUHV��SDUR�FDUGtDFR�LQPLQHQWH����+LSHUSRWDVHPLD�OHYH��������P(T�/���UHVWULFFLyQ�GHO�SRWDVLR�HQ�OD�GLHWD���+LSHUSRWDVHPLD�PRGHUDGD����������P(T�/�VLQ�DOWHUDFLyQ�(&*���UHVLQDV�GH�LQWHUFDPELR�LyQLFR��5HVLQ�FDOFLR�������J��K�YR�R��������J�����P/�GH�DJXD�HQ�HQHPD��R�VRUELWRO��3XHGHQ�VHU�~WLOHV�ORV�GLXUpWLFRV�GHO�DVD���+LSHUSRWDVHPLD�LPSRUWDQWH��!����P(T�/�R�DOWHUDFLRQHV�(&*���� 6LWXDFLyQ� KLSHUDJXGD�� JOXFRQDWR� FiOFLFR� DO� ������ ������P/� HQ� ����PLQXWRV� �HO�HIHFWR�HV�LQPHGLDWR��SHUR�GH�FRUWD�GXUDFLyQ����6LWXDFLyQ�DJXGD���,QVXOLQD�JOXFRVD�ELFDUERQDWR������P/�GH�6*����������8�GH�LQVXOLQD�UiSLGD������P/�HQ�OD�SULPHUD�KRUD��OXHJR�������P/�K���������P(T�GH�+&2�1D��0�HQ����PLQXWRV��� +&2�1D�� LQIXVLyQ� UiSLGD� VHJ~Q� ORV� QLYHOHV� GH� ELFDUERQDWR� HQ� VDQJUH��GHVSXpV�GH�OD�PHGLGD�DQWHULRU����$OEXWHURO�L�Y������PJ�HQ���PLQXWRV��R�LQKDODGR�������PJ�HQ�QHEXOL]DGRV��QR�GLVSRQLEOH�HQ�(VSDxD��$FLGRVLV� PHWDEyOLFD�� VyOR� KD\� TXH� WUDWDU� FRQ� XQD� LQIXVLyQ� GH� +&2�1D� VL� HO� ELFDUERQDWR�SODVPiWLFR�HV�LQIHULRU�D����P(T�/�'pILFLW�GH�ELFDUERQDWR� ������[�SHVR��[���+&2� GHVHDGR� +&2� DFWXDO��,QGLFDFLRQHV�GH�OD�GLiOLVLV��� 0DQLIHVWDFLRQHV� FOtQLFDV� GH� XUHPLD� �HQFHIDORSDWtD�� GLiWHVLV� KHPRUUiJLFD��HQWHURSDWtD��HWF����($3�TXH�QR�UHVSRQGH�D�WUDWDPLHQWR�PpGLFR��� +LSHUSRWDVHPLD� VHYHUD� R� DFLGRVLV� PHWDEyOLFD� TXH� QR� UHVSRQGH� D�WUDWDPLHQWR�PpGLFR���%81�!���������PJ�G/�R�&U�S��!������PJ�G/��LQGLFDFLyQ�UHODWLYD��7UDWDPLHQWR�HWLROyJLFR��)5$�SUHUUHQDO��PHGLGDV�HQFDPLQDGDV�D�FRQVHJXLU�PHMRUD�HQ�HO�YROXPHQ�FLUFXODQWH�\�HO�JDVWR�FDUGtDFR��UHKLGUDWDFLyQ�LQWHQVLYD��FDUGLRWyQLFRV��HWF��)5$�REVWUXFWLYR��VRQGDMH�YHVLFDO��QHIURVWRPtD�GH�GHVFDUJD��SUyWHVLV�XUHWHUDOHV��HWF�)5$� SDUHQTXLPDWRVR�� HQ� UHDOLGDG� ORV� ~QLFRV� WUDWDPLHQWRV� HWLROyJLFRV� HQ� HO� )5$�SDUHQTXLPDWRVR� HVWDEOHFLGR� VRQ� OD VXVSHQVLyQ� GH� IiUPDFRV� QHIURWy[LFRV� \� OD�

Page 187: Manual practico urgencias medicina interna muy bueno

���

UHVWDXUDFLyQ� GHO� IOXMR� SODVPiWLFR� UHQDO�� ODV� GHPiV� PHGLGDV� YDQ� HQFDPLQDGDV� D�LQWHUUXPSLU�HO�SURFHVR�ILVLRSDWROyJLFR�TXH�FRQGXFH�DO�GHWHULRUR�ILQDO�GH�OD�IXQFLyQ�UHQDO��/RV� IiUPDFRV� SXHGHQ� VHU� HIHFWLYRV� HQ� ODV� SULPHUDV� ��� KRUDV� GH� LQVWDXUDFLyQ� GHO�SURFHVR�FXDQGR�SUHGRPLQDQ�ORV�IDFWRUHV�JORPHUXODUHV�HQ�OD�SDWRJHQLD�GHO�)5$���'LXUpWLFRV�GHO�DVD�\�PDQLWRO��KDQ�GHPRVWUDGR�VX�HIHFWLYLGDG�HQ�ODV�SULPHUDV����KRUDV�GHO�SURFHVR�\�DQWHV�GH�TXH� OD�&U� �S��H[FHGD�ORV���PJ�G/��GHVSXpV�VyOR�VH�FRQVLJXH�WUDQVIRUPDU� OD� LQVXILFLHQFLD� UHQDO� ROLJ~ULFD� HQ� QR� ROLJ~ULFD�� (Q� OD� LQVXILFLHQFLD� UHQDO�SXHGHQ�VHU� QHFHVDULDV�GRVLV�GH�KDVWD���������PJ�GH� IXURVHPLGD�HQ�EROR�SXGLHQGR�UHSHWLUVH� OD� GRVLV� � GRV� R� WUHV� YHFHV� DO� GtD��8QD�DOWHUQDWLYD�PiV�HILFD]� SXHGH� VHU� OD�SHUIXVLyQ� FRQWLQXD� HQ� SDFLHQWHV� UHIUDFWDULRV� D� ORV� ERORV� GH� IXURVHPLGD�� 6H� GHEHQ�XWLOL]DU� GRVLV� SURJUHVLYDPHQWH� FUHFLHQWHV� GH� IXURVHPLGD� �������� PJ�.J�K��� 6L� VH�UHVWDEOHFH�OD�GLXUHVLV�VH�PDQWHQGUi�SHUIXVLyQ�GH�IXURVHPLGD�DxDGLHQGR�0DQLWRO�DO�����D�GRVLV�GH����P/�K���'RSDPLQD��D�GRVLV�UHQDOHV�������J�.J�PLQ��LQGXFH�YDVRGLODWDFLyQ�UHQDO�\�DXPHQWD�OD�H[FUHFLyQ� GH� HOHFWUROLWRV� SRU� LQKLELFLyQ� GHO� WUDQVSRUWH� GH�1D� YtD� $03F��(Q�PRGHORV�DQLPDOHV� OD� GRSDPLQD�KD�GHPRVWUDGR� WHQHU� LQIOXHQFLD�HQ�HO� FXUVR�GH� OD� ,5�� SHUR� ORV�UHVXOWDGRV�VRQ�FRQWURYHUWLGRV�HQ�KXPDQRV��� $QWDJRQLVWDV� GHO� FDOFLR�� HO� WUDWDPLHQWR� D� ODUJR� SOD]R� FRQ�'LOWLD]HP� UHVXOWD� HQ� XQD�PHMRU� IXQFLyQ� GHO� LQMHUWR� UHQDO� �PHQRUHV� QLYHOHV� GH� &US�� PHQRU� VHYHULGDG� GH� OD�WR[LFLGDG�SRU�FLFORVSRULQD HQ�ODV�ELRSVLDV��PHMRU�VXSHUYLYHQFLD�GHO� LQMHUWR�D�ORV�FXDWUR�DxRV��� 6RQ� SRU� HOOR� ORV� IiUPDFRV� GH� HOHFFLyQ� SDUD� HO� WUDWDPLHQWR� GH� OD� +7$� HQ�SDFLHQWHV� WUDVSODQWDGRV�� (V� GXGRVD� VX� XWLOLGDG� HQ� OD� SUHYHQFLyQ� GH� OD� QHIURSDWtD�LQGXFLGD�SRU�FRQWUDVWHV�LY���2WURV��IDFWRU�QDWULXUpWLFR�DWULDO�R�ORV�IDFWRUHV�GH�FUHFLPLHQWR��HSLGpUPLFR��LQVXOLQ�OLNH�\�KHSDWRFLWDULR���� 6H� HQFXHQWUDQ� HQ� IDVH� GH� H[SHULPHQWDFLyQ�� &RUWLFRLGHV� H�LQPXQRPRGXODGRUHV� VRQ� ~WLOHV� HQ� HO� WUDWDPLHQWR� GH� DOJXQDV� HQIHUPHGDGHV�JORPHUXODUHV��� +HPRGLiOLVLV� LQWHUPLWHQWH� YV LQWHUFDPELR� FRQWLQXR� �KHPRILOWUDFLyQ� R� KHPRGLiOLVLV�DUWHULRYHQRVD��YHQRYHQRVD�R�XOWUDILOWUDFLyQ� OHQWD���VH�KD�VXJHULGR�TXH�OD�KHPRGLiOLVLV�SXHGH� SURORQJDU� HO� FXUVR� GHO� )5$� GHELGR� D� XQ� GHIHFWR� HQ� OD� DXWRUUHJXODFLyQ� GH� OD�SUHVLyQ� GH� SHUIXVLyQ� UHQDO� HQ� VLWXDFLRQHV� GH� KLSRWHQVLyQ� VLVWpPLFD� HQ� ORV� ULxRQHV�LVTXpPLFRV��3RU�HVWH�PRWLYR�VH�KD�SHQVDGR�TXH�ODV�WpFQLFDV�GH�LQWHUFDPELR�FRQWLQXR�SRGUtDQ� VHU� ~WLOHV� HQ� SDFLHQWHV� KHPRGLQiPLFDPHQWH� LQHVWDEOHV� HQ� ORV� TXH� OD�KHPRGLiOLVLV�LQWHUPLWHQWH�VXSRQGUtD�XQ�PD\RU�HVWUpV�KHPRGLQiPLFR��/RV�UHVXOWDGRV�GH�ORV�HVWXGLRV�UHDOL]DGRV�KDVWD�HO�PRPHQWR�QR�VRQ�FRQFOX\HQWHV����3UHYHQFLyQ�6H� UHDOL]DUiQ�HQ� WRGRV� ORV� SDFLHQWHV��HVSHFLDOPHQWH� HQ� ORV� GH�PiV�HGDG�R�TXH�SUHVHQWHQ�YDULRV�IDFWRUHV�GH�ULHVJR�DVRFLDGRV�

Page 188: Manual practico urgencias medicina interna muy bueno

���

2SWLPL]DFLyQ� GH� OD� IXQFLyQ� FDUGLRYDVFXODU� \� GHO� YROXPHQ� LQWUDYDVFXODU�� /D� GHSOHFFLyQ� GH�YROXPHQ� HV� XQ� IDFWRU� GH� ULHVJR�SDUD� OD� LQVXILFLHQFLD� UHQDO� QHIURWy[LFD� LQGXFLGD� SRU� FRQWUDVWHV�UDGLROyJLFRV�� DFLFORYLU�� DPLQRJOLFyVLGRV�� DQIRWHULFLQD� %�� FLVSODWLQR�� UDEGRPLyOLVLV�� $F�� ~ULFR��PLHORPD�H�KLSHUFDOFHPLD�&XLGDGR� FRQ� HO� XVR� GH� GLXUpWLFRV�� $,1(V� H� ,(&$V� HQ� SDFLHQWHV� FRQ� SHUIXVLyQ� UHQDO�FRPSURPHWLGD�0RQLWRUL]DU�QLYHOHV�GH� IiUPDFRV�QHIURWy[LFRV�FXDQGR�GHEDQ�VHU�XWLOL]DGRV��DPLQRJOLFyVLGRV��FLFORVSRULQD��5DEGRPLROLVLV��IRU]DU�GLXUHVLV�\�DOFDOLQL]DU�OD�RULQD�

)LJXUD����$OJRULWPR�GLDJQyVWLFR�GHO�IUDFDVR�UHQDO�DJXGR

3UHUUHQDO��&OtQLFD�GH�GHSOHFFLyQ�GHYROXPHQ�R�VtQGURPHVHGHPDWRVRV�R����HVSDFLR��()1$��������,)5������6HGLPHQWR�QRUPDO��%XHQD�UHSXHVWD�D�ODFRUUHFFLyQ�KHPRGLQDPLFD

$QDPQHVLV�\�H[SORUDFLyQ6HGLPHQWR�GH�RULQD,RQHV�\�&U�HQ� VDQJUH�\�RULQD�()1$��,)5(FRJUDItD�UHQDO3DUHQTXLPDWRVR��7UDVWRUQR�KHPRGLQiPLFRPDQWHQLGR���)iUPDFRV�QHIURWy[LFRV��0DQLIHVWDFLRQHV�VLVWpPLFDVGH�HQIHUPHGDGHVSDUHQTXLPDWRVDV��()1$�!������,)5�!����6HGLPHQWR�SDWROyJLFR��5HVSXHVWD�QXOD�D�ODFRUUHFFLyQ�KHPRGLQiPLFD

2EVWUXFWLYR��&OtQLFD�XUROyJLFD��DQXULDR�DQXULD�LQWHUPLWHQWH

��'LODWDFLyQ�GH�OD� YtDXULQDULD��HFRJUDItD���6HGLPHQWR�FRQ�SLXULD�RKHPDWXULD��0HMRULD�WUDV�ODGHULYDFLyQ�GH�OD�YtD�%LRSVLD�UHQDO 7$&�R�5013LHORJUDItD�VL�VH� VRVSHFKDHQJOREDPLHQWR� GHO�XUHWHU

%LEOLRJUDItD

Page 189: Manual practico urgencias medicina interna muy bueno

���

���$ONKXQDL]L�$0��6FKULHU�5:��0DQDJHPHQW�RI�DFXWH�UHQDO�IDLOXUH��QHZ�SHUVSHFWLYH��$P�-�.LGQH\�'LV�������������������������%UDG\�+5��%UHQQHU�%0��,QVXILFLHQFLD�UHQDO�DJXGD��(Q�+DUULVRQ�3ULQFLSLRV�GH�0HGLFLQD�,QWHUQD��9RO�,,������(G��0F*UDZ�+LOO��������� %XUWRQ� '5�� &OLQLFDO� XVH� RI� GLXUHWLFV�� (Q� &OLQLFDO� 3K\VLRORJ\� RI� DFLG�EDVH� DQG� HOHFWURO\WH�GLVRUGHUV���ª�HG��0F*UDZ�+LOO���������.LHUGRUI�+��6LHEHUWK�+*��&RQWLQRXV� WUHDWPHQW�PRGDOLWLHV� LQ�DFXWH� UHQDO� IDLOXUH��1HSKURO�'LDO�7UDVSODQW������������������������.MHOOVWUDQG�&��0DGUHQDV�-��6ROH]�.��3URQyVWLFR�\�WUDWDPLHQWR�GH�OD�LQVXILFLHQFLD�UHQDO�DJXGD��1HIURORJtD�������������������������0HPROL�%��/LEHWWD�&��&RQWH�*��$QGUHXFFL�9(��/RRS�GLXUHWLFV�DQG�UHQDO�YDVRGLODWRUV�LQ�DFXWH�UHQDO�IDLOXUH��1HSKURO�'LDO�7UDVSODQW���������6���������������6LPRQ�((��1HZ�DVSHFWV�RI�DFXWH�UHQDO�IDLOXUH��$P�-�0HG�6FL�����������������������

Page 190: Manual practico urgencias medicina interna muy bueno

���

(SLOHSVLD��'LDJQyVWLFR�\�WUDWDPLHQWR0DQXHO�=RULWD�/D��(SLOHSVLD�HV�XQD�HQIHUPHGDG�TXH�QR�WLHQH�XQD�GHILQLFLyQ�FRQVHQVXDGD��&ULVLV�HSLOpSWLFD�HV�OD�PDQLIHVWDFLyQ�FOtQLFD�GH�OD�KLSHUDFWLYLGDG�SDUR[tVWLFD�GH�XQ�JUXSR�GH�QHXURQDV�FHUHEUDOHV��3XHGH� PDQLIHVWDUVH� SRU� XQD� PRGLILFDFLyQ� EUXVFD� GHO� HVWDGR� GH� FRQFLHQFLD�� SRU� IHQyPHQRV�PRWRUHV�\�R�VHQVLWLYR�VHQVRULDOHV�LQDSURSLDGRV��R�SRU�XQD�DOWHUDFLyQ�GH�OD�UHVSXHVWD�GHO�LQGLYLGXR�D�VX�HQWRUQR��� &RQFHSWR�GH�HSLOHSVLD�HV�OD�FRQGLFLyQ�HQ�TXH�ODV�FULVLV��WLHQGHQ�D�UHSHWLUVH�FUyQLFDPHQWH�������,QFLGHQFLD������������SHUVRQDV�DxR���3UHYDOHQFLD�� ���GH�OD�SREODFLyQ��/DV�FULVLV�HSLOpSWLFDV�VRQ�PiV�IUHFXHQWHV�HQ�ORV�H[WUHPRV�GH�OD�YLGD��DQWHV�GH�ORV����\�GHVSXpV�GH�ORV����DxRV����&ODVLILFDFLyQ���3DUD�HQWHQGHU�\�PDQHMDU�D�XQ SDFLHQWH�HSLOpSWLFR�HV�QHFHVDULR�GHWHUPLQDU��SRU�KLVWRULD��YtGHR��HWF��HO�WLSR�GH�DWDTXHV�TXH�VXIUH��SDUD�HOOR�HV�QHFHVDULR�UHFRUGDU�XQ�HVTXHPD�GH�OD�FODVLILFDFLyQ�GH�FULVLV�HSLOpSWLFDV�VHJ~Q�/�,�&�(����&ULVLV�SDUFLDOHV �FRPLHQ]R�IRFDO��VLQ�SpUGLGD�GH�FRQFLHQFLD�PRWRUDVVHQVLWLYDV&ULVLV�SDUFLDOHV FRPSOHMDV���SpUGLGD�GH�FRQFLHQFLD��DXWRPDWLVPRV�&ULVLV�SDUFLDOHV�VHFXQGDULDPHQWH�JHQHUDOL]DGDV�&ULVLV�JHQHUDOL]DGDV ��SpUGLGD�GH�FRQFLHQFLD��1R�FRQYXOVLYDV���DXVHQFLDV��&RQYXOVLYDV�WyQLFDV��FOyQLFDVWyQLFR�FOyQLFDVPLRFORQtDVDWyQLFDV��DNLQpWLFDV����'RVLILFDFLyQ�GH�ORV�GLVWLQWRV�IiUPDFRV���� 1LYHOHV&DUEDPDFHSLQD���7HJUHWRO� ���������PJV�GtD �����PJ�PO$F��9DOSURLFR���'HSDNLQH� ���������PJV�GtD ������PJ�PO�)HQLWRtQD��(SDQXWtQ� �������PJV�GtD �����PJ�PO�)HQREDUELWDO��/XPLQDO� �������PJV�GtD �����PJ�PO�9LJDEDWULQD��6DEULOH[� ��������PJV�GtD�(WR[XVLPLGD��=DURQWLQ� ��������PJV�GtD7RSLUDPDWR��7RSDPD[� �������PJV�GtD/DPRWULJLQD��/DPLFWDO� �������PJV�GtD7LDJDELQD��*DELWULO� ������PJV�GtD&ORED]iQ��1RLDIUHQ� ������PJV�GtD&ORQD]HSiQ��5LYRWULO� ������PJV�GtD

Page 191: Manual practico urgencias medicina interna muy bueno

���

)LJXUD�� 'LDJQyVWLFR� ILUPH� GH�(SLOHSVLD����¢,QLFLDU�WUDWDPLHQWR"����

12 6Ë6HJXLPLHQWR 1XHYD�&ULVLV(OHJLU�0HGLFDFLyQ����1RWDV������ (O� GLDJQyVWLFR� GH� HSLOHSVLD� QR� VH� GHEH� HVWDEOHFHU� KDVWD� TXH� VH� KD\DK� SURGXFLGR�� SRU� OR�PHQRV��GRV�FULVLV����(O� WUDWDPLHQWR�QR�HVWi� LQGLFDGR�VL�VROR�VH�KDQ�SURGXFLGR�GRV�FULVLV�FRQ�XQ�LQWHUYDOR�VXVWDQFLDO�HQWUH�HOODV�����/RV�IDUPDFRV�LQGLFDGRV�VHJ~Q�HO�WLSR�GH�YULVLV�VRQ�3DUFLDOHV�\�SDUFLDOHV�FRPSOHMDV�� &DUEDPDFHSLQD��IHQLWRtQD��iFLGR�YDOSURLFR�6HJXQGD�HOHFFLyQ��9LJDEDWULQD��WRSLUDPDWR��WLDJDELQD�$XVHQFLDV� ÈFLGR�YDOSURLFR��HWRVX[LPLGD��FRQWUDLQGLFDGDV��)HQLWRtQD��&DUEDPDFHSLQD��*HQHUDOL]DGDV��&DUEDPDFHSLQD��iFLGR�YDOSURLFR��IHQLWRtQD��IHQREDUELWDO�6HJXQGD�HOHFFLyQ��/DPRWULJLQD��&ORED]DP�3DUFLDOHV�VHFXQGDULDPHQWH�JHQHUDOL]DGDV�� &DUEDPDFHSLQD��IHQLWRtQD��iFLGR�YDOSURLFR�6HJXQGD�HOHFFLyQ��9LJDEDWULQD��WRSLUDPDWR��WLDJDELQD�

)LJXUD�� /DV�FULVLV�QR�UHVSRQGHQ�DO�PHGLFDPHQWR�LQLFLDO$xDGLU�RWUR�IiUPDFR�KDVWD�QLYHOHV�WHUDSpXWLFRV�

e[LWR)UDFDVR5HWLUDU�IiUPDFR�LQLFLDO�OHQWDPHQWH,QWHQWDU�WHUFHUD�HOHFFLyQ0DQWHQHU�QXHYR�IiUPDFR��0RQRWHUDSLD�6LQ�FULULV�PiV�GH�GRV�DxRV��((*��,QWHQWDU�QXHYRV�IiUPDFRV([SORUDFLyQ�QRUPDOHV��UHWLUDU�OHQWDPHQWH 3ROLWHUDSLD�0HGLFDFLyQ6L�KD\�OHVLyQ�IRFDO��SODQWHDU�

Page 192: Manual practico urgencias medicina interna muy bueno

���

���6WDWXV�HSLOHSWLFXV����8Q�SDFLHQWH�HQ�VWDWXV�HSLOHSWLFXV�HV�DTXHO�TXH� WLHQH�DWDTXHV�FRQWLQXDGRV�R�TXH�VH�UHSLWHQ�FRQ�IUHFXHQFLD��2WUD�IRUPD�GH�H[SUHVDUOR�VHUtD�SRU�OD�SUHVHQFLD�GH�DWDTXHV�FRQWLQXRV�TXH�GXUDQ�PiV� GH� FLQFR PLQXWRV� �� R� GRV� R� PiV� DWDTXHV� GH� PHQRU� GXUDFLyQ�� SHUR� HQWUH� ORV� FXDOHV� HO�SDFLHQWH�QR�UHFXSHUD�FRQFLHQFLD�(O�VWDWXV�VH�GHEH�FRQVLGHUDU�XQD�VLWXDFLyQ�GH�XUJHQFLD�TXH�SXHGH�SRQHU�HQ�SHOLJUR�OD�YLGD�GHO�SDFLHQWH��(QWUH�ORV�DGXOWRV��XQ����DO�����SUHVHQWDQ�XQ�VWDWXV�HSLOpSWLFR�FRPR�SULPHU�VtQWRPD�GH�VX�HSLOHSVLD��/D�FDXVD�PiV�IUHFXHQWH�GH�VWDWXV�HQ�HSLOpSWLFRV�\D�FRQRFLGRV�HV�HO�DEDQGRQR�GHPHGLFDFLyQ�+DELWXDOPHQWH�� ORV� SDFLHQWHV� HQ� VWDWXV� HVWiQ� HQ� FRPD� \� SUHVHQWDQ� FULVLV� WyQLFDV� R�WyQLFR�FOyQLFDV�� /RV� PHQRV�� QR� WLHQHQ� DFWLYLGDG� PRWRUD� DQRUPDO� REVHUYDEOH� \�� SDUD� VX�GLDJQyVWLFR��VH�UHTXLHUH�SUDFWLFDU�XQ�((*��(VWRV�SDFLHQWHV�FRUUHQ�WDPELpQ�HO�ULHVJR�GH�GDxDU�VX�VLVWHPD�QHUYLRVR�\�UHTXLHUHQ�OD�PLVPD�XUJHQFLD�GH�WUDWDPLHQWR�TXH�ORV�TXH�WLHQHQ�FRQYXOVLRQHV��/D�PRUWDOLGDG�GHO�VWDWXV��HQ�DGXOWRV��HV�DSUR[LPDGDPHQWH�GH�����%LEOLRJUDItD�(SLOHSV\��7KH�/DQFHW������&RPPLVVLRQ� RQ� FODVVLILFDWLRQ� DQG� WHUPLQRORJ\� RI� WKH� ,QWHUQDWLRQDO� /HDJXH� $JDLQVW� (SLOHSV\��(SLOHSVLD�����������������3ULQFLSLRV� JHQHUDOHV� GHO� WUDWDPLHQWR� IDUPDFROyJLFR� GH� OD� HSLOHSVLD�� $�� 5LFKHQV�� (�� 3HUXFFD��6DQRIL�:LQWKURS�������&DUO�:��%D]LO��7LPRWK\�$��3HGOH\��������$GYDQFHV� LQ� WKH�PHGLFDO� WUHDWPHQW�RI�HSLOHSV\��$QQX��5HY��0HG��������������'DQLHO�+��/RHVWHLQ��%ULDQ�.��$OOUHGJH��������6WDWXV�HSLOHSWLFXV��5HYLHZ�DUWLFOH��1HZ�(QJO��-���0HG��������������

Page 193: Manual practico urgencias medicina interna muy bueno

���

7DEOD����$OJRULWPR�SDUD�HO�WUDWDPLHQWR�LQLFLDO�GHO�6WDWXV�HSLOHSWLFXV

$EULU�YtD�YHQRVD

,QLFLDU WUDWDPLHQWR�DQWLFRQYXOVLYDQWH+LVWRULD�FOtQLFD�\�H[SORUDFLyQ $QDOtWLFD

0DQWHQHU�OD�YtD�DpUHD�&RQWURO�GH�FRQVWDQWHV&RQWURO� (&*� \� VL� HV� SRVLEOH��R[LPHWUtD3UDFWLFDU�JOXFHPLD�XUJHQWH

$GPLQLVWUDU�WLDPLQD������PJ��\�JOXFRVD�����PO�GH�GH[WURVD�DO�����

¢HSLOHSVLD�X�RWUD�HQIHUPHGDG"�¢7UDXPDWLVPR"�¢)RFDOLGDG�QHXUROyJLFD"�¢(QIHUPHGDG�PpGLFD��LQIHFFLyQ��DIHFWDFLyQ�KHSiWLFD�R�UHQDO��GURJDV�"5HFXHQWR�\�IyUPXOD,RQHV�\�FDOFLR*DVHV�HQ�VDQJUH3UXHEDV�GH�IXQFLyQ�KHSiWLFD�3UXHEDV�GH�IXQFLyQ�UHQDO�7R[LFRORJtD�1LYHOHV�GH�DQWLHSLOpSWLFRV�

Page 194: Manual practico urgencias medicina interna muy bueno

��

��

��

��

� ��� ������ ���� ��� �� ��7LHPSR�HQ�PLQXWRV )LJXUD���� 7UDWDPLHQWR�FRQ�DQWLHSLOpSWLFRV�HQ�HO�6WDWXV�(SLOpSWLFXV/D�EDUUD�KRUL]RQWDO�LQGLFD�OD�GXUDFLyQ�DSUR[LPDGD�GH�OD�LQIXVLyQ

'LDFHSiQ���PJ�,9��PJ�PLQ6L�QR�KD\�PiV�FULVLV�QR�HV�SUHFLVD�RWUD�PHGLFDFLyQ

)HQLWRtQD�����PJ�N�,9�D����PJ�PLQ��R)RVIRIHQLWRtQD����PJ�N�,9�D����PJ�PLQ�

&RQWLQXDQ�ODV�FULVLV

&RQWLQXDQ�ODV�FULVLV

)HQLWRtQD�R�)RVIRIHQLWRtQD$xDGLU������PJ�N�,9

7UDVODGR�D�89,��$QHVWHVLD�FRQ�0LGD]ROiP�R�3URSRIRO

&RQWLQXDQ�FULVLV

���

Page 195: Manual practico urgencias medicina interna muy bueno

���

7UDWDPLHQWR�GHO�LFWXV�3HGUR�9LOODQXHYD����(WLRORJtD�(VWDEOHFHU�OD�SUREDEOH�HWLRORJtD�GH�XQ�LFWXV�HV�EiVLFR�SDUD�HO�FRUUHFWR�WUDWDPLHQWR�GHO�SDFLHQWH�TXH�OR�VXIUH��'H�XQ�PRGR�JHQHUDO�GHILQLPRV���WLSRV�GH�LFWXV��LVTXpPLFR�\�KHPRUUiJLFR��6yOR�HO�HVWXGLR�GH�QHXURLPDJHQ�HQ�HO�PRPHQWR�DJXGR�SXHGH�GLIHUHQFLDU�DPERV�GH�IRUPD�HILFD]�,FWXV� LVTXpPLFR�� 'LVWLQJXLPRV� ILVLRSDWROyJLFDPHQWH� �� WLSRV�� /D� FODVLILFDFLyQ� GHO� LFWXV�LVTXpPLFR� VHJ~Q� HVWRV� PHFDQLVPRV� SDWROyJLFRV� �WUDV� HO� HVWXGLR� FOtQLFR�� WLHQH� VXPD�LPSRUWDQFLD�SRU�OD�LPSOLFDFLyQ�WHUDSpXWLFD�SRVWHULRU��SUHYHQFLyQ���������� $WHURWURPEyWLFR�� 3DWRORJtD� GH� JUDQGHV� DUWHULDV�� KDELWXDOPHQWH� H[WUDFUDQHDOHV���FDUyWLGD� LQWHUQD�� YHUWHEUDOHV��FD\DGR�DyUWLFR������ FRPR� IXHQWH�GH�pPERORV�DUWHULD�DUWHULD�R�SURYRFDQGR�XQ�FRPSURPLVR�KHPRGLQiPLFR�D�GLVWDQFLD������/DFXQDU�� 3DWRORJtD�GH�SHTXHxR�YDVR�LQWUDFUDQHDO��FRQ�IRUPDV�FOtQLFDV�GH�SUHVHQWDFLyQ�HVWHUHRWLSDGDV�\�ELHQ�GHILQLGDV��KHPLSDUHVLD�SXUD��GLVDUWULD�PDQR�WRUSH�������1RUPDOPHQWH�VH�SUHVHQWDQ�HQ�SDFLHQWHV�KLSHUWHQVRV������&DUGLRHPEROLD�� &XDQGR�HO�SDFLHQWH�SUHVHQWD�SDWRORJtD�FDUGLDFD�HPEROtJHQD��ILEULODFLyQ�DXULFXODU�� YDOYXORSDWtDV�� ,$0� UHFLHQWH������ \� H[FOXLPRV� SDWRORJtD� DWHURPDWRVD� FDURWtGHD�VHYHUD��HVWHQRVLV�!�����,FWXV�KHPRUUiJLFRV� 'H�IRUPD�HVSRQWiQHD�VH�SURGXFHQ�OD�KHPRUUDJLD�SDUHQTXLPDWRVD�\�OD�VXEDUDFQRLGHD��/D�KHPRUUDJLD�VXEGXUDO�\�OD�HSLGXUDO�VXHOHQ�WHQHU�XQ�RULJHQ�WUDXPiWLFR������+HPRUUDJLD�SDUHQTXLPDWRVD�� /D�ORFDOL]DFLyQ�HQ�JDQJOLRV�EDVDOHV�VXHOH�WHQHU�XQ�RULJHQ�KLSHUWHQVLYR��/D� ORFDOL]DFLyQ� OREDU��VREUH� WRGR�VL�VH�WUDWD�GH�SDFLHQWHV�MyYHQHV�\�VLQ�+7$��QRV�REOLJD�D�SHQVDU�HQ�PDOIRUPDFLRQHV�YDVFXODUHV�VXE\DFHQWHV������+HPRUUDJLD�VXEDUDFQRLGHD�� 'HEH�LQYHVWLJDUVH�OD�SUHVHQFLD�GH�DQHXULVPDV�HQ�DUWHULDV�GHO�SROtJRQR�GH�:LOOLV����$FWLWXG�GLDJQRVWLFD�DQWH�XQ�SDFLHQWH�FRQ�LFWXV

$QDPQHVLV�5HFRJHU� ORV� GpILFLWV� REVHUYDGRV� SRU� HO� SDFLHQWH� R� IDPLOLDUHV�� VREUH� WRGR� HQ� HO� FDVR� GH�DFFLGHQWHV�LVTXpPLFRV�WUDQVLWRULRV�HQ�ORV�TXH�OD�H[SORUDFLyQ�VHUi�QRUPDO�7LHPSR�GH�LQVWDXUDFLyQ��QRV�RULHQWD�D�SHQVDU�HQ�HO�RULJHQ�YDVFXODU�GHO�GpILFLW�QHXUROyJLFR��GH�VHJXQGRV�D�KRUDV��(V�PX\�LPSRUWDQWH�UHFRJHU�HQ�ORV�DQWHFHGHQWHV�ORV�IDFWRUHV�GH�ULHVJR�YDVFXODU��+7$��GLDEHWHV�PHOOLWXV��SDWRORJtD�FDUGLDFD��WDEDTXLVPR��HQROLVPR��VtQGURPH�GH�DSQHD�GHO�VXHxR��HVWDGRV�GH�KLSHUFRDJXODELOLGDG��KHPDWRFULWR�HOHYDGR�HQ�YDURQHV��OD�FRPELQDFLyQ�HQ�PXMHUHV�GH�PLJUDxD���WRPD�GH�DQWLFRQFHSWLYRV�RUDOHV���WDEDTXLVPR�

Page 196: Manual practico urgencias medicina interna muy bueno

���

([SORUDFLyQ�ItVLFD�6LVWpPLFD� QR� KDQ� GH� IDOWDU� OD� UHFRJLGD� GH� FRQVWDQWHV� �7�$��� SXOVR�� WHPSHUDWXUD��� OD�DXVFXOWDFLyQ�FDUGLDFD�\�OD�GH�WURQFRV�VXSUDDyUWLFRV��FDURWtGHRV�\�VXSUDFODYLFXODUHV��1HXUROyJLFD� GHILQLU� HO� QLYHO� GH� FRQVFLHQFLD�� H[LVWHQFLD� GH� VLJQRV�PHQtQJHRV� ORV� VLVWHPDV�IXQFLRQDOHV� DIHFWDGRV� �OHQJXDMH�� VLJQRV� GH� KHPLQHJOLJHQFLD� \� WUDVWRUQRV� FDPSLPpWULFRV�YLVXDOHV�� SDUHV� FUDQHDOHV� �LGHQWLILFDQGR� SRVLEOHV� SUREOHPDV� HQ� OD� GHJOXFLyQ��� IXHU]D� \� VX�JUDGR� GH� DOWHUDFLyQ�� VHQVLELOLGDG�� FRRUGLQDFLyQ� \� PDUFKD�� \� OD� SUHVHQFLD� GH� XQ� VLJQR� GH�%DELQVNL��([SORUDFLRQHV�FRPSOHPHQWDULDV�(&*�5;�WyUD[$QDOtWLFD�JHQHUDO�FRQ�LRQHV��JOLFHPLD��IXQFLyQ�UHQDO��KHPRJUDPD�\�FRDJXODFLyQ�7$&�&UDQHDO��SRU�VLVWHPD�GHEH�UHDOL]DUVH�GH�IRUPD�XUJHQWH��VDOYR�HQ�FDVRV�GH�HQIHUPHGDG�WHUPLQDO�R GHPHQFLD�YDVFXODU�\D�GLDJQRVWLFDGD��3HUPLWH�OD�GLVWLQFLyQ�HQWUH�LFWXV�LVTXpPLFRV�\�KHPRUUiJLFRV��ODERU�HQ�OD�TXH�OD�FOtQLFD�VH�KD�PRVWUDGR�LQVXILFLHQWH��DVt�FRPR�LGHQWLILFDU�RWURV�SURFHVRV�TXH�SXHGHQ�VLPXODU�XQ�SURFHVR�YDVFXODU��WXPRUHV�\�PHWiVWDVLV��DEVFHVRV������'HEH�UHSHWLUVH�D�ORV�SRFRV�GtDV�VL�D��7$&� LQLFLDO�QR�GLDJQyVWLFD�\�H[LVWH�XQD�DOWD�VRVSHFKD�GH�LVTXHPLD��VDOYR�LQGLFDFLyQ�GH�UHVRQDQFLD�PDJQpWLFD��E��$QWH�OD�VRVSHFKD�GH�WUDQVIRUPDFLyQ�KHPRUUiJLFD��FDUGLRHPEROLD��FHIDOHD��F��1HFHVLGDG�GH�DQWLFRDJXODU��FDUGLRHPEROLD��G��6L�VH�SURGXFH�GHWHULRUR�QHXUROyJLFR�5HVRQDQFLD� 0DJQpWLFD� GHEH� UHDOL]DUVH� FXDQGR� OD� 7$&� &5$1($/� HV� LQVXILFLHQWH� SDUD� HO�GLDJQyVWLFR��HQ�LFWXV�GHO�WHUULWRULR�9(57(%52�%$6,/$5��HQ�VRVSHFKDV�GH�WURPERVLV�YHQRVDV�FHUHEUDOHV�� GLVHFFLRQHV� GH� WURQFRV� FHUYLFR�FHIiOLFRV�� PDOIRUPDFLRQHV� DUWHULR�YHQRVDV� \� HQ�RFDVLRQHV�SXHGH�GHWHFWDU�DQHXULVPDV�HQ�FDVRV�GH�KHPRUUDJLD�VXEDUDFQRLGHD��SHUR�QR�GHEH�VXVWLWXLU�D�OD�DUWHULRJUDItD��(Q�ORV�SDFLHQWHV�FRQ�,FWXV�LVTXpPLFR VH�UHDOL]DUi�'233/(5 GH�WURQFRV�VXSUDDyUWLFRV� �9DORUDU�DUWHULRJUDItD�FHUHEUDO VL�(VWHQRVLV�FDURWtGHD�!���6RVSHFKD�GH�GLVHFFLyQ�FDURWtGHD6RVSHFKD�GH�DQJLRSDWtDV�QR�DWHURPDWRVDV��GLVSODVLD�ILEURPXVFXODU��YDVFXOLWLV����� �(FRFDUGLRJUDPD VL�6RVSHFKD�GH�FDUGLRHPEROLD� �SDUD�DVHJXUDU DO�Pi[LPR�HO�GLDJQyVWLFR�GH�FDUGLRHPEROLD� OD�PD\RUtD�GH�DXWRUHV�FRQVLGHUDQ�RSRUWXQR�H[FOXLU�SDWRORJtD�DWHURPDWRVD�FDURWtGHD�LSVLODWHUDO�VHYHUD��!�����,FWXV�HQ�SDFLHQWHV� MyYHQHV� ������DxRV���SDUD�GHVFDUWDU� IRUDPHQ�RYDO� SHUPHDEOH��PL[RPD�DXULFXODU��PLRFDUGLRSDWtDV����

Page 197: Manual practico urgencias medicina interna muy bueno

���

� 6L� ,FWXV� KHPRUUiJLFR UHSHWLU� 7$&� FUDQHDO� VL� H[LVWH� GHWHULRUR� QHXUROyJLFR� R�VRVSHFKD�GH�SURFHVR�H[SDQVLYR�VXE\DFHQWH �DUWHULRJUDItD�FHUHEUDO(Q� KHPRUUDJLD� VXEDUDFQRLGHD�� IXHUD� GHO� SHULRGR� GH� YDVRHVSDVPR� �HQWUH� HO� ��� \� ���� GtD�DSUR[LPDGDPHQWH��\�GH� ORV� �� WURQFRV�DUWHULDOHV� HQFHIiOLFRV��6L� OD�SULPHUD�DUWHULRJUDItD�QR�GHPXHVWUD�DQHXULVPD�R�PDOIRUPDFLyQ�YDVFXODU�SXHGH�UHSHWLUVH�D�ODV�����VHPDQDV��DOJXQRV�HVWXGLRV� HQFXHQWUDQ� HQWUH� XQ� ������ GH� DQRPDOtDV� YDVFXODUHV� HQ� SDFLHQWHV� FRQ�SULPHUD�DUWHULRJUDItD�QHJDWLYD��(Q� KHPRUUDJLDV� SDUHQTXLPDWRVDV� FRQ� VRVSHFKD� GH� PDOIRUPDFLyQ� YDVFXODU� VXE\DFHQWH��KHPDWRPDV�OREDUHV��SDFLHQWHV�MyYHQHV�VLQ�+7$����$FWLWXG�WHUDSpXWLFD�

�����LFWXV�LVTXpPLFR�$� 0HGLGDV�JHQHUDOHV5HSRVR�UHODWLYR�GXUDQWH�ODV�SULPHUDV������ KRUDV��OLJHUDPHQWH�LQFRUSRUDGR�1R�GHVFHQGHU�OD�7�$��D�QR�VHU�TXH�VREUHSDVH�FLIUDV�GH���������PP+J��'HEH�SURFXUDUVH�HQ�WDOHV� FDVRV� XQ� GHVFHQVR� OHQWR� GH� 7�$�� FRQ� IiUPDFRV� SRU� YtD� RUDO� �,(&$� GH� HOHFFLyQ��FDSWRSULO� ����� PJ���K�� HQDODSULO� �� PJ���K��� 6ROR� HQ� FDVR� GH� HPHUJHQFLDV� KLSHUWHQVLYDV��LQVXILFLHQFLD�UHQDO�R�LQVXILFLHQFLD�FDUGLDFD�JUDYH��XWLOL]DUHPRV�OD�YtD�,9��ODEHWDORO����PJ�HQ�����PLQXWRV�� UHSLWLHQGR�GRVLV����PLQ� KDVWD� XQ�Pi[LPR�GH� ��������PJ�GtD���(O� GHVFHQVR�EUXVFR�GH�OD�7HQVLyQ�$UWHULDO�SXHGH�WHQHU�FRQVHFXHQFLDV�GHVDVWURVDV��DXPHQWDQGR�HO�iUHD�GH�QHFURVLV�SRU�HO�GHVFHQVR�GH�OD�SUHVLyQ�GH�SHUIXVLyQ�9DORUDU� HO� JUDGR� GH� DOWHUDFLyQ� GH� OD� GHJOXFLyQ�� (YLWDU� VREUH� WRGR� ORV� OtTXLGRV� �XWLOL]DU�HVSHVDQWH��FRORFDQGR�XQD�VRQGD�QDVRJiVWULFD�HQ�FDVR�GH�ULHVJR�GH�EURQFRDVSLUDFLyQ�(YLWDU�HO�VXHUR�JOXFRVDGR��UHFRPHQGDGR��GXUDQWH�ODV�SULPHUDV�������KRUDV�GH�HYROXFLyQ�GHO�LFWXV��VDOYR�VL�H[LVWH�KLSRJOLFHPLD�����PJ����/D�KLSHUJOLFHPLD�VH�KD�UHODFLRQDGR�FRQ�PD\RU�PRUELOLGDG� \�PRUWDOLGDG� �WUHV� YHFHV�PD\RU�� \� HQ�PRGHORV� DQLPDOHV� VH� KD� REMHWLYDGR�TXH�DXPHQWD�HO�iUHD�LQIDUWDGD�(YLWDU�HO�WUDWDPLHQWR�FRQ�HVWHURLGHV�+HSDULQD�GH�EDMR�SHVR�PROHFXODU�FRPR�SURILOD[LV�GH�WURPERVLV�YHQRVD�SURIXQGD��793��FRQ�GRVLV� HQWUH� ���������� XL���K� VXEFXWiQHDV�� /RV� HQVD\RV� FOtQLFRV� GHPXHVWUDQ� XQ� FODUR�EHQHILFLR�UHVSHFWR�D�SODFHER��UHGXFFLyQ�HQ�WRUQR�DO������GH�793���(YLWDU OD�KLSHUWHUPLD��!������&��FRQ�PHGLGDV�ItVLFDV�\�IDUPDFROyJLFDV��PHWDPL]RO���J��K�LY�\�R� SDUDFHWDPRO� ���� PJ��K� Y�R��� DVt� FRPR� WUDWDQGR� ODV� LQIHFFLRQHV� LQWHUFXUUHQWHV�� (Q�PRGHORV�DQLPDOHV�VH�KD�FRPSUREDGR�TXH�HO�Q~PHUR�GH�QHXURQDV�GHVWUXLGDV�HQ�HO�iUHD�GH�LVTXHPLD�DXPHQWD�GH�IRUPD�H[SRQHQFLDO�FRQ�FDGD��&�GH�WHPSHUDWXUD�DXPHQWDGR�

Page 198: Manual practico urgencias medicina interna muy bueno

���

%� 7UDWDPLHQWR�IDUPDFROyJLFR�HQ�OD�IDVH�DJXGD�(Q�HO�PRPHQWR�DFWXDO�VRQ�PX\�SRFRV�ORV�IiUPDFRV�TXH KDOODQ�GHPRVWUDGR�VX�HIHFWLYLGDG�HQ�OD� IDVH� DJXGD� GHO� LFWXV� LVTXpPLFR�� (VWiQ� HQ� IDVH� GH� HVWXGLR� SURWHFWRUHV� QHXURQDOHV� TXH�SURORQJXHQ� OD� YHQWDQD� WHUDSpXWLFD� �YLDELOLGDG� QHXURQDO�� SDUD� DFWXDU� SRVWHULRUPHQWH� FRQ�WURPEROLVLV�3XHGH�DGPLQLVWUDUVH�1LPRGLSLQR ����PJ�GtD�9�2��DQWHV�GH����KRUDV�GHVGH�HO� LQLFLR�GHO�LFWXV��SXHVWR�TXH�DOJXQRV�HVWXGLRV�KDQ�GHPRVWUDGR�PHMRU�SURQyVWLFR�IXQFLRQDO�UHVSHFWR�D�SODFHER��DXQTXH�FRQ�PXHVWUDV�SHTXHxDV�(QVD\RV�FOtQLFRV�UHFLHQWHV�KDQ�HYDOXDGR�OD�HIHFWLYLGDG�GH�DVSLULQD \�KHSDULQD�D�� ORV� HVWXGLRV� ,67� \� &$67� FRLQFLGHQ� HQ� TXH� OD� DVSLULQD� HQ� GRVLV� EDMDV� ����PJ�GLD��DGPLQLVWUDGD�GH�IRUPD�SUHFR]�GLVPLQX\H�OD�PRUWDOLGDG��\�OD�UHFXUUHQFLD�GH�LFWXV�GXUDQWH�ODV���SULPHUDV�VHPDQDV��DXQTXH�FRQ�XQ�EHQHILFLR�HVFDVR�UHVSHFWR�D�SODFHER�����HYHQWRV�SRU�FDGD��������$GHPiV�HO�SURQyVWLFR�IXQFLRQDO�D�ODUJR�SOD]R����PHVHV��HUD�PHMRU�HQ�HO�JUXSR�GH�DVSLULQD�E��5HVSHFWR�DO�YDORU�GHO�WUDWDPLHQWR�FRQ�KHSDULQD�GH�EDMR�SHVR�PROHFXODU�HQ�HO�HVWXGLR�GH� .D\� UHDOL]DGR� HQ�+RQJ�.RQJ� \� SXEOLFDGR� HQ� �����HQ�1(-0�REVHUYDURQ� XQ�PHMRU�SURQRVWLFR� IXQFLRQDO� D� ORV� �� PHVHV� FRQ� GRVLV� GH� ����� XL���K� R� ����XL���K� GH�QDGURSDULQD��REVHUYDQGR�XQ�HIHFWR�GRVLV�GHSHQGLHQWH��(Q�HO�HVWXGLR�,67�QR�VH�REVHUYy�QLQJ~Q�EHQHILFLR�FOtQLFR�DO�XWLOL]DU�KHSDULQD�FiOFLFD�VXEFXWiQHD�&� 7UDWDPLHQWR�IDUPDFROyJLFR�D�ODUJR�SOD]R$QWH� ODV� SRFDV� DUPDV� WHUDSpXWLFDV� SDUD� OD� IDVH� DJXGD�� QXHVWURV� HVIXHU]RV� KDQ� GH� LU�HQFDPLQDGRV� D� OD� 35(9(1&,21� ��� �HYLWDU� QXHYRV� LFWXV��� /RV� HVWXGLRV� HSLGHPLROyJLFRV�GHPXHVWUDQ� TXH�HO� ULHVJR�GH� UHSHWLFLyQ� HV�Pi[LPR�GXUDQWH HO� SULPHU� DxR��GHVFHQGLHQGR�OHQWDPHQWH�GHVSXpV��SHUR�VLHQGR�VXSHULRU�D� OD�SREODFLyQ�JHQHUDO�DO�PHQRV�GXUDQWH� ORV���SULPHURV�DxRV��ULHVJR�DFXPXODGR�HQWUH����������$OJXQRV�HVWXGLRV�FOtQLFRV� LQGLFDQ�TXH�HO�ULHVJR�HV�PX\�DOWR�HQ�ORV�SULPHURV����GtDV�WUDV�HO�LFWXV����������HVWDV�UHFXUUHQFLDV�SUHFRFHV�DXPHQWDQ� OD� PRUWDOLGDG� GH� IRUPD� LPSRUWDQWH�� SURORQJDQ� ODV� HVWDQFLDV� KRVSLWDODULDV� \�GLVSDUDQ�ORV�FRVWHV�VDQLWDULRV�(Q� HVWH� VHQWLGR� HV� PX\� LPSRUWDQWH� LQVLVWLU� HQ� HO� FRQWURO� GH� IDFWRUHV� GH� ULHVJR� YDVFXODU��WDEDTXLVPR��PXOWLSOLFD�HO�ULHVJR�GH�QXHYR�LFWXV�HQWUH���\���YHFHV�VHJ~Q�ODV�VHULHV���+�7�$���GLDEHWHV��FRQVXPR�H[FHVLYR�GH�DOFRKRO�\�FDUGLRSDWtDV��(Q�PHQRU�JUDGR�LQIOX\HQ�GLVOLSHPLDV��REHVLGDG� \� VHGHQWDULVPR�� KLSHUXULFHPLD�� HVWDGRV� GH� KLSHUFRDJXODELOLGDG�� KHPDWRFULWR�HOHYDGR�\�HO�VtQGURPH�GH�DSQHD�GHO�VXHxR��������$WHURWURPEyWLFR�$�� &RQ�HVWHQRVLV�FDURWtGHD�������DQWLDJUHJDFLyQ�$$6 ����PJ�GtD��HYLWDU�VL�DQWHFHGHQWHV�GH�XOFXV���1R�H[LVWH�FRQVHQVR�DFHUFD�GH�OD�GRVLV�LGHDO�SRU�XQD�IDOWD�GH�FRPSDUDELOLGDG�GH�ORV�UHVXOWDGRV��/tQHDV�GH�LQYHVWLJDFLyQ�UHFLHQWHV�DERJDQ�SRU�GRVLV�PD\RUHV�D�ODV�XWLOL]DGDV�HQ�ORV�HVWXGLRV�GH�FDUGLRSDWtD�LVTXpPLFD�����D�

Page 199: Manual practico urgencias medicina interna muy bueno

���

���PJ�GLD���/D�DVSLULQD�VH�KD�GHPRVWUDGR�HIHFWLYD�HQ�HVWXGLRV�TXH�LQFOXtDQ�$,7�R�LFWXV�PLQRU��HVFDVD�UHSHUFXVLyQ�IXQFLRQDO�� SHUR�QR�FRQ�LFWXV�H[WHQVRV��7LFORSLGLQD ����PJ���K��VL�XOFXV�R�HVWHQRVLV�VHYHUDV�QR�TXLU~UJLFDV���/D�WLFORSLGLQD�VH�KD�PRVWUDGR�PiV�HILFD]�TXH�OD�DVSLULQD�HQ�OD�SUHYHQFLyQ�GH�UHFXUUHQFLDV�WUDV�$,7�R�LFWXV�PLQRU� �HO� HVWXGLR� 7$66� PXHVWUD� UHGXFFLyQ� DSUR[LPDGD� ���� D� ORV� �� DxRV�� \� HQ� ODV�UHFLGLYDV�WUDV�LFWXV�H[WHQVRV��HVWXGLR�&$76�XQD�UHGXFFLyQ�����UHVSHFWR�D�SODFHER�&ORSLGRJUHO ���PJ���K��(V�XQ�IiUPDFR�UHFLHQWHPHQWH�FRPHUFLDOL]DGR�HQ�QXHVWUR�SDtV��DQiORJR� GH� OD� WLFORSLGLQD� \� TXH�� FRPR� YHQWDMDV� IUHQWH� D� pVWD�� SUHVHQWD�PHQRV�HIHFWRV�VHFXQGDULRV��VH�HYLWDQ� ORV�FRQWUROHV�KHPDWROyJLFRV�VHULDGRV�DO�SULQFLSLR�GHO�WUDWDPLHQWR�SDUD� GHVFDUWDU� QHXWURSHQLDV��� (Q� HO� HVWXGLR� &$35,(� VH� FRPSDUy� FORSLGRJUHO� ���PJ��IUHQWH�D�$$6������PJ��\�SODFHER�HQ�OD�SUHYHQFLyQ�GH�HYHQWRV�YDVFXODUHV��FDUGLROyJLFRV��FHUHEURYDVFXODUHV� \� YDVFXODUHV� SHULIpULFRV��� 6H� REVHUYy� XQD� UHGXFFLyQ� GHO� ����� GH�ULHVJR�UHODWLYR�GHO�WRWDO�GH�HYHQWRV�HQ�HO�JUXSR�GH�FORSLGRJUHO�UHVSHFWR�DO�GH�$$6�\�XQD�UHGXFFLyQ� GHO� ���� GH� HYHQWRV�DxR������ SDFLHQWHV�� /D� WDVD� GH� KHPRUUDJLDV�JDVWURLQWHVWLQDOHV�IXH�PHQRU�HQ�HO�JUXSR�GH�FORSLGRJUHO��������TXH�HQ�HO�GH�$$6���������/DV�QHXWURSHQLDV� IXHURQ�PHQRUHV�HQ�HO�JUXSR�GH�FORSLGRJUHO��������TXH�HQ�HO�GH�$$6���������� (Q� OD� DFWXDOLGDG� VH� FRQVLGHUD� D� HVWH� IiUPDFR� FRPR� XQD� EXHQD� RSFLyQ� HQ�SDFLHQWHV�TXH�UHSLWHQ�LFWXV�$,7�HVWDQGR�HQ�WUDWDPLHQWR�FRQ�$$6�R�ELHQ�HQ�SDFLHQWHV�FRQ�DQWHFHGHQWHV�XOFHURVRV�R�GH�VDQJUDGR�JDVWURLQWHVWLQDO�7ULIOXVDO����PJ�����K��%�� &RQ�HVWHQRVLV�FDURWtGHD�!�����HQGDUWHUHFWRPtD � DQWLDJUHJDFLyQ �$$6��WLFORSLGLQD�R�WULIOXVDO�� (Q� SDFLHQWHV� FRQ� GpILFLW� PLQRU� \� ���� DxRV� VLQ� SDWRORJtD� EDVDO� JUDYH�� 'RV� DPSOLRV�HVWXGLRV��(&67�\�1$6&(7��KDQ�GHPRVWUDGR�OD�HILFDFLD�GH�OD�HQGDUWHUHFWRPtD�FDURWtGHD�UHVSHFWR�D�OD�DQWLDJUHJDFLyQ�VROD�FXDQGR�VH�FXPSOHQ�XQRV�FULWHULRV�GH�FDOLGDG�SRU�SDUWH�GHO�HTXLSR�TXLU~UJLFR��PRUELPRUWDOLGDG�������FRPR�HV�HO�FDVR�GH�OD�VHFFLyQ�GH�&LUXJtD�9DVFXODU�GH�QXHVWUR�FHQWUR��������/DFXQDU� FRQWURO�HVWULFWR�GH�FLIUDV�WHQVLRQDOHV�\�DQWLDJUHJDFLyQ��FRPR�HQ��������������&DUGLRHPEROLD��$QWLFRDJXODFLyQ �UHSHWLU� 7$&� FUDQHDO� DQWHV� GH� LQLFLDUOD� SDUD� GHVFDUWDU� OHVLyQ� H[WHQVD��GHELHQGR� HVSHUDU� HQ� VX� FDVR� ���� VHPDQDV��� (PSH]DU� FRQ� KHSDULQD� VyGLFD� ��������8,�NJ�GtD� VLHQGR� DFRQVHMDEOH� OD� LQIXVLyQ� FRQWLQXD�� 'HEH�PDQWHQHUVH� XQD� UDWLR� GH� 773$�HQWUH� ������� 6H� PDQWLHQH� XQD� VHPDQD� \� OXHJR� VH� SDVD� D� WUDWDPLHQWR� SRU� YtD� RUDO� FRQ�GLFXPDUtQLFRV��(O�ULHVJR�GH�QXHYD�HPEROLD�HV�GHO����GLDULR�HQ�ORV�SULPHURV�GtDV�HQ�FDVRV�GH�ILEULODFLyQ�DXULFXODU����'HEHPRV�GHVFDUWDU�VLHPSUH�KHPRUUDJLD�FHUHEUDO�R�LQIDUWR�KHPRUUiJLFR�PHGLDQWH�7$&�FUDQHDO����6L�HO�SDFLHQWH�\D�UHFLEtD�DQWLFRDJXODFLyQ�SUHYLD�GHEHUi�PDQWHQHUVH�

Page 200: Manual practico urgencias medicina interna muy bueno

���

���5HSHWLU�OD�7$&�FUDQHDO�HQ����KRUDV�� 6L�LQIDUWR�GH�WDPDxR�SHTXHxR�R�PHGLDQR� DQWLFRDJXODFLyQ��SUHFR]� 6L�LQIDUWR�GH�JUDQ�WDPDxR��GHPRUDU�DQWLFRDJXODFLyQ���GtDV� 6L LQIDUWR�KHPRUUiJLFR��VH�UHFRPLHQGD�HVSHUDU���VHPDQDV$QWLDJUHJDFLyQ FXDQGR� HVWp� FRQWUDLQGLFDGD� OD� DQWLFRDJXODFLyQ� �HGDG� DYDQ]DGD� \�GLILFXOWDGHV�GH�FRQWURO�SHULyGLFR�GHO�WLHPSR�SURWURPELQD��+7$�PDO�FRQWURODGD��������LFWXV�KHPRUUiJLFR�������KHPRUUDJLD�SDUHQTXLPDWRVD5HSRVR�DEVROXWR�GXUDQWH������GtDV�VHJ~Q�OD�H[WHQVLyQ�GH�OD�KHPRUUDJLD��1R�GHVFHQGHU�OD�7�$��D�QR�VHU�TXH�VREUHSDVH�FLIUDV�7$�VLVWyOLFD�GH�����PP+J��GXUDQWH�ODV�SULPHUDV�������KRUDV��'HVSXpV�PDQWHQHU�XQ�FRQWURO�HVWULFWR�GH�7$�9LJLODU�OD�GHJOXFLyQ�FRPR�HQ�HO�LFWXV�LVTXpPLFR�$QDOJpVLFRV� FRQ� FHIDOHD� �PHWDPL]RO� �J��K� ,9�� \� DQWLHPpWLFRV� VL� QiXVHDV� R� YyPLWRV��PHWRFORSUDPLGD�LY��(YLWDU� ORV� FRUWLFRLGHV�� QR� VH� KDQ� GHPRVWUDGR� HILFDFHV� \� SXHGHQ� DXPHQWDU� ODV�FRPSOLFDFLRQHV�(Q� FDVR� GH� GHWHULRUR� QHXUROyJLFR� DOJXQRV� DXWRUHV� UHFRPLHQGDQ� HO� XVR� GH� DJHQWHV�RVPyWLFRV� ,9� �0DQLWRO� DO� ��� y� ������DXQTXH� VH� KD� VXJHULGR� TXH�SXHGHQ�DXPHQWDU� HO�KHPDWRPD�SRU�VX�HIHFWR�GH�UHERWH��DXPHQWR�GH�7$�SRVWHULRU��1R� HVWi� MXVWLILFDGR� HO� XVR� VLVWHPiWLFR� GH� DQWLHSLOpSWLFRV�� GHELHQGR� XWLOL]DUVH� VyOR� VL�DSDUHFHQ�FULVLV�HSLOpSWLFDV�1R�H[LVWHQ�FULWHULRV�GHILQLGRV�SDUD�HO�GUHQDMH�TXLU~UJLFR�GH�KHPDWRPDV��SXHGH�SODQWHDUVH�HQ� KHPDWRPDV� OREDUHV� HQ� ORV� TXH� DSDUHFH� GHWHULRUR� QHXUROyJLFR�� QR� PHMRUD� OD�UHFXSHUDFLyQ�IXQFLRQDO�DXQTXH�VL�GHVFLHQGH�OD�PRUWDOLGDG��(Q�KHPRUUDJLDV�FHUHEHORVDV�SXHGH�SODQWHDUVH�HQ�FDVR�GH�KLGURFHIDOLD�R�GHWHULRUR�QHXUROyJLFR�������KHPRUUDJLD�VXEDUDFQRLGHD5HSRVR�DEVROXWR� GXUDQWH� ��� GtDV��$QDOJpVLFRV� \� DQWLHPpWLFRV� FRPR�HQ� OD�KHPRUUDJLD�SDUHQTXLPDWRVD��/D[DQWHV�SDUD�HYLWDU�HO�HVWUHxLPLHQWR��/DFWXORVD�Y�R���iFLGR�SLFRVXOI~ULFR��(YDFXRO���(O� ULHVJR� GH� UHVDQJUDGR� HV� Pi[LPR� GXUDQWH� OD� SULPHUD� VHPDQD�� ([LVWH� XQ� FRQVHQVR�JHQHUDOL]DGR�HQ�TXH�HO�WUDWDPLHQWR�TXLU~UJLFR�HQGRYDVFXODU�QR�GHEH�GHPRUDUVH�XQD�YH]�LGHQWLILFDGR�HO�DQHXULVPD��6H�DFRQVHMD�XQD�DUWHULRJUDItD�XUJHQWH�\�WUDWDPLHQWR�DQWHV�GHO����GtD�GH�HYROXFLyQ��HYLWDQGR�OD�IDVH�GH�YDVRHVSDVPR�GHO����DO�����GtD���6L�VH�KD�HQWUDGR�HQ�OD�IDVH�GH�YDVRHVSDVPR�HV�DFRQVHMDEOH�GHPRUDU�HO�WUDWDPLHQWR�VREUH�HO�DQHXULVPD�D�OD������VHPDQD�GH�HYROXFLyQ�7UDWDPLHQWR�GHO�YDVRHVSDVPR��1LPRWRS�,9�HPSH]DQGR�FRQ���PO�KRUD����KRUDV��\�VL�QR�KLSRWHQVLyQ�SDVDU�D����PO�K��0DQWHQHUOR����GtDV�\�OXHJR�SDVDU�D�YtD�RUDO����FRPS��KRUDV��GXUDQWH���VHPDQD�PiV��(O�QLPRGLSLQR�KD�GHPRVWUDGR�XQD�UHGXFFLyQ�HQ�OD�PRUWDOLGDG�\�PRUELOLGDG�SRU�LVTXHPLD��YDVRHVSDVPR��HQ�OD�KHPRUUDJLD�VXEDUDFQRLGHD�

Page 201: Manual practico urgencias medicina interna muy bueno

���

%LEOLRJUDItD���0DQHMR�GHO�SDFLHQWH�FRQ�HQIHUPHGDG�YDVFXODU�FHUHEUDO�DJXGD��5HFRPHQGDFLRQHV�������*UXSR�GH�HVWXGLR�GH�(QIHUPHGDGHV�&HUHEURYDVFXODUHV��6RFLHGDG�(VSDxROD�GH 1HXURORJtD����-��&DVWLOOR��$��'DYDORV��'��7RQL��0DQDJHPHQW�RI�DFXWH�LVFKHPLF�VWURNH��6SULQJHU�9HUODJ�,EHULFD��%DUFHORQD���������7KH�,QWHUQDWLRQDO�6WURNH�7ULDO��,67���/DQFHW�������0D\��������������������������� � -�� 3�� 0RKU�� 5�/�� 6DFFR� ³&ODVVLILFDWLRQ� RI� LVFKHPLF� VWURNHV´� ,Q� 6WURNH�� SDWKRSK\VLRORJ\��GLDJQRVLV�DQG�PDQDJHPHQW����%DUQHWW�+-0�HW�DO���&KXUFKLOO�/LYLQJVWRQH�,QF��1HZ�<RUN����������.D\�HW�DO��+HSDULQD�GH�EDMR�SHVR�PROHFXODU�HQ�HO�WUDWDPLHQWR�GHO�LFWXV�DJXGR��1�(QJO�-�0HG������������������������� 0DVXKU�)� HW� DO��'LIIHUHQFHV� LQ�PHGLFDO�DQG�VXUJLFDO� WKHUDS\� IRU� VWURNH�SUHYHQWLRQ�EHWZHHQ�OHDGLQJ�H[SHUWV�LQ�1RUWK�$PHULFD�DQG�:HVWHUQ�(XURSH��6WURNH��������������������:HLU�&-�HW�DO�� ,V�K\SHUJO\FDHPLD�DQ�LQGHSHQGHQW�SUHGLFWRU�RI�SRRU�RXWFRPH�DIWHU�DFXWH VWURNH"�5HVXOWV�RI�D�ORQJ�WHUP�IROORZ�XS�VWXG\��%0-������0D\��������������������������-RQDWKDQ� <�� 6WUHLIOHU�� $QWKRQ\� -�� )XUODQ�� +HQU\� -�0�� %DUQHWW�� ³&DUGLRJHQLF� EUDLQ� HPEROLVP���LQFLGHQFH��YDULHWLHV��WUHDWPHQW�´�,Q�6WURNH��SDWKRSK\VLRORJ\��GLDJQRVLV�DQG�PDQDJHPHQW���%DUQHWW�+-0�HW�DO��&KXUFKLOO�/LYLQJVWRQH�,QF��1HZ�<RUN������&$35,(�6WHHULQJ�FRPPLWWHH��$�UDQGRPLVHG��EOLQGHG��WULDO�RI�FORSLGRJUHO�YHUVXV�DVSLULQ�LQ�SDWLHQWV�DW�ULVN�RI�LVFKDHPLF�HYHQWV��&$35,(���/DQFHW����������������������

Page 202: Manual practico urgencias medicina interna muy bueno

���

'HOLULXP�HQ�HO�DQFLDQR��GLDJQyVWLFR�\�PDQHMR/XLV�5RPHUR��&DUPHQ�/XHQJR��3HGUR�$EL]DQGD���,QWURGXFFLyQ�(O�GHOLULXP�VH�FDUDFWHUL]D�SRU�XQD�DOWHUDFLyQ�GH� OD�FRQFLHQFLD�\�XQ�FDPELR�GH�ODV� IXQFLRQHV�FRJQRVFLWLYDV�TXH�VH�GHVDUUROODQ�D�OR�ODUJR�GH�XQ�EUHYH�SHULRGR�GH�WLHPSR�\�TXH�QR�SXHGH�VHU�H[SOLFDGR�SRU�OD�SUHH[LVWHQFLD�R�GHVDUUROOR�GH�XQD�GHPHQFLD�(Q������VH�SXEOLFD�HO�'60,9 TXH�HVWDEOHFH�FRPR�FULWHULRV�GLDJQyVWLFRV�GH��GHOLULXP�&ULWHULR�$��$OWHUDFLyQ�GH�OD�FRQFLHQFLD�MXQWR�D�XQD�GLVPLQXFLyQ�GH�OD�FDSDFLGDG�SDUD�FHQWUDU��PDQWHQHU�R�GLULJLU�OD�DWHQFLyQ�&ULWHULR� %�� &DPELR� HQ� ODV� IXQFLRQHV� FRJQRVFLWLYDV� R� SUHVHQFLD� GH� XQ� WUDVWRUQR� GH� OD�SHUFHSFLyQ�TXH�QR�VH�H[SOLFD�SRU�XQD�GHPHQFLD�SUHH[LVWHQWH��HVWDEOHFLGD�R�HQ�GHVDUUROOR�&ULWHULR�&� OD�DOWHUDFLyQ�VH�GHVDUUROOD�HQ�FRUWR�SHULRGR�GH�WLHPSR�\�WLHQGH�D�IOXFWXDU�D�OR�ODUJR�GHO�GtD�&ULWHULR�'��'HPRVWUDFLyQ�D�WUDYpV��GH�OD�KLVWRULD��GH�OD�H[SORUDFLyQ�ItVLFD�\�GH�ODV�SUXHEDV�GH�ODERUDWRULR�GH�TXH�OD�DOWHUDFLyQ�HVWi�FDXVDGD�SRU�(QIHUPHGDG�0pGLFD�,QWR[LFDFLyQ�SRU�VXVWDQFLDV�R�HIHFWRV�VHFXQGDULRV�GH�ORV�IiUPDFRV�6tQGURPH�GH�DEVWLQHQFLD�0~OWLSOHV�HWLRORJtDV�(WLRORJtD�LQFLHUWD�

/D� FDUDFWHUtVWLFD� HVHQFLDO� GHO� GHOLULXP� FRQVLVWH� HQ� XQD� DOWHUDFLyQ� GH� OD� FRQFLHQFLD� TXH� VH�PDQLILHVWD�SRU�GLVPLQXFLyQ�GH� OD�FDSDFLGDG�GH�DWHQFLyQ�KDFLD�HO�HQWRUQR�TXH�VH�GHVDUUROOD�HQ�EUHYH�SHULRGR�GH�WLHPSR��KRUDV�R�GtDV��\�WLHQH�XQ�FXUVR�IOXFWXDQWH��6H�DFRPSDxD�GH�FDPELR�HQ�ODV� IXQFLRQHV� FRJQRVFLWLYDV� �GHWHULRUR� GH� OD� PHPRULD�� VREUH� WRGR� GH� ILMDFLyQ�� GHVRULHQWDFLyQ�WHPSRUDO��HVSDFLDO�\�HQ�SHUVRQD� DOWHUDFLyQ�GHO�OHQJXDMH�\�SHQVDPLHQWR�GHVRUJDQL]DGR���3XHGHQ�DSDUHFHU� DOWHUDFLRQHV� GH� OD� SHUFHSFLyQ� �LQWHUSUHWDFLRQHV� HUUyQHDV�� LOXVLRQHV� R� DOXFLQDFLRQHV�VREUH� WRGR� YLVXDOHV�� GHOLULRV� SDUDQRLFRV� R� GH� SHUVHFXFLyQ� TXH� VXHOHQ� VHU� WUDQVLWRULRV� \� SRFR�VLVWHPDWL]DGRV��� DVt� FRPR� RWURV� VtQWRPDV� \� WUDVWRUQRV� DVRFLDGRV� �DOWHUDFLyQ� GHO� ULWPR� VXHxR�YLJLOLD��WUDVWRUQRV�HPRFLRQDOHV�\�DOWHUDFLRQHV�YHJHWDWLYDV��(O� ULHVJR� GH� PRUEL�PRUWDOLGDG� KRVSLWDODULD� GHSHQGH� GH� OD� JUDYHGDG� GHO� SURFHVR� HWLROyJLFR�VXE\DFHQWH�� \� HV� XQ� IDFWRU� LQGHSHQGLHQWH� GH� GHWHULRUR� IXQFLRQDO� �DO� PHQRV� D� ODUJR� SOD]R���DGHPiV� SXHGH� LGHQWLILFDU� SDFLHQWHV� FRQ� PD\RU� ULHVJR� GH� GHWHULRUR� FRJQLWLYR� \� VX� SUHVHQFLD�GXUDQWH�HO�LQJUHVR�KRVSLWDODULR�LPSOLFD�XQD�PD\RU�SUREDELOLGDG�GH�LQVWLWXFLRQDOL]DFLyQ�DO�DOWD�\�HQ�HO�VHJXLPLHQWR�D�ORV�VHLV�PHVHV����(WLRORJtD��(V� FRPSOHMD� \� PXOWLIDFWRULDO� GHELGD� HQ� PXFKDV� RFDVLRQHV� D� IDFWRUHV� SUHFLSLWDQWHV��VREUHSXHVWRV�D�XQ�DQFLDQR�YXOQHUDEOH�FRQ�IDFWRUHV�SUHGLVSRQHQWHV�

Page 203: Manual practico urgencias medicina interna muy bueno

���

$��)DFWRUHV�SUHGLVSRQHQWHV�� (GDG�DYDQ]DGD�� 'HWHULRUR�FRJQLWLYR�SUHH[LVWHQWH�� 'HSULYDFLyQ�VHQVRULDO�� (QIHUPHGDGHV�FUyQLFDV�JUDYHV��KHSiWLFDV�R�UHQDOHV�� 'HWHULRUR�IXQFLRQDO�SUHYLR�DO�LQJUHVR�� ,QIHFFLRQHV��LQFOXLGDV�9,+�\�6,'$�� (QIHUPHGDGHV�GHO�61&��3DUNLQVRQ��$&9$��� $OWHUDFLRQHV�HOHFWUROtWLFDV��DXPHQWR�GH�XUHD�\�FUHDWLQLQD��� ,QWHUYHQFLyQ�TXLU~UJLFD�UHFLHQWH�� 7UDXPD��LQFOX\HQGR�TXHPDGXUDV�\�IUDFWXUD�GH�FDGHUD��� 8VR�R�GHSHQGHQFLD�GH�DOFRKRO��KLSQyWLFR�VHGDQWHV��RSLiFHRV��%��)DFWRUHV�SUHFLSLWDQWHV�6RQ�IDFWRUHV�H[WUtQVHFRV�DO�SDFLHQWH��JHQHUDOPHQWH�PXOWLIDFWRULDOHV��3XHGHQ�VHU�DWULEXLGRV�D�FXDOTXLHU�HQIHUPHGDG�R�PHGLFDFLyQ��DXQTXH�QR�HV�UDUR�QR�HQFRQWUDU�FDXVD�TXH�OR�MXVWLILTXH�7DEOD����3ULQFLSDOHV�(QIHUPHGDGHV�DVRFLDGDV�FRQ�DSDULFLyQ�GH�GHOLULXP�HQ�HO�DQFLDQR���1HXUROyJLFDV�9DVFXODUHV�$&9$�,VTXpPLFR��/yEXOR�SDULHWDO�GHUHFKR�\�VXSHUILFLH�LQIHURPHGLDO�GHO�OyEXOR�RFFLSLWDO��+HPDWRPD�LQWUDSDUHQTXLPDWRVR�+HPRUUDJLD�VXEDUDFQRLGHD�,QIHFFLRQHV��0HQLQJLWLV��HQFHIDOLWLV�7UDXPDWLVPRV�&UDQHRHQFHIiOLFRV�7XPRUHV�SULPDULRV�R�PHWDVWiVLFRV�(SLOHSVLD�\�HVWDGRV�SRVW�LFWDOHV����&DUGLRSXOPRQDU�,$0��,&&��7(3��1HXPRQtDV��(QFHIDORSDWtD�KLSHUWHQVLYD�6LWXDFLRQHV�GH�KLSRWHQVLyQ�VHYHUD���*DVWURLQWHVWLQDO�(QFHIDORSDWtD�KHSiWLFD�,PSDFWDFLyQ�IHFDO�JUDYH�

���*HQLWRXULQDULR�,QVXILFLHQFLD�UHQDO�,78�5HWHQFLyQ�XULQDULD�JUDYH����5HXPDWROyJLFDV�9DVFXOLWLV����,QIHFFLRVDV�� &XDOTXLHU�SURFHVR����0HWDEyOLFDV�$OWHUDFLRQHV�KLGURHOHFWUROtWLFDV�'pILFLWV�YLWDPtQLFRV�VHYHURV�\�R�0DOQXWULFLyQ�+LSHUJOXFHPLD�R�KLSRJOXFHPLD�+LSHU�KLSRWLURLGLVPR����1HRSODVLDV����'RORU�VHYHUR�SRVWRSHUDWRULR�

Page 204: Manual practico urgencias medicina interna muy bueno

���

7DEOD�����)iUPDFRV�\�7y[LFRV�TXH�SXHGHQ�FDXVDU�GHOLULXP���+LSQyWLFRV�\�VHGDQWHV�%HQ]RGLDFHSLQDV�YLGD�PHGLD�ODUJD%DUELW~ULFRV�+LGUDWR�GH�&ORUDO����1DUFyWLFRV� 0HSHULGLQD��0RUILQD���)iUPDFRV�HIHFWR�DQWLFROLQpUJLFR�$QWLKLVWDPtQLFRV��'LIHQKLGUDPLQD��KLGUR[LFLQD�$QWLHVSDVPyGLFRV��'LIHQR[LODWR��KLRVFLQD�7ULFtFOLFRV��$PLWULSWLOLQD��LPLSUDPLQD��GR[HSLQD�)HQRWLDFLQDV��7LRULGDFLQD�%HQ]RWURSLQD��WULKH[LIHQLGLOR$QWLDUUtWPLFRV��TXLQLGLQD��GLVRSLUDPLGD��OLGRFDLQD����)iUPDFRV�FDUGLRYDVFXODUHV�'LJR[LQD�D�QLYHOHV�Wy[LFRV��$PLRGDURQD�3URSUDQRORO��0HWLOGRSD��UHVHUSLQD����$QWLELyWLFRV�3HQLFLOLQDV��FHIDORVSRULQDV��DPLQRJOXFyVLGRV��6XOIDPLGDV�

���%URQFRGLODWDGRUHV�$OWDV�GRVLV�DQWLFROLQpUJLFRV�LQKDODGRV�1LYHOHV�DOWRV�GH�WHRILOLQD����0LVFHOiQHD�&LPHWLGLQD0HWRFORSUDPLGD(VWHURLGHV$,1(6�D�DOWDV�GRVLV��VDOLFLODWRV$QWLFRQYXOVLYDQWHV��VREUH�WRGR�IHQLWRtQD�GRVLV�DOWDV$PDQWDGLQD/HYRGRSD�\�DJRQLVWDV�GRSDPLQpUJLFRV&ORURTXLQD$QWLGLDEpWLFRV�RUDOHV�H�LQVXOLQD���7y[LFRV�$QWLFROLQHVWHUDVDV,QVHFWLFLGDV�RUJDQRIRVIRUDGRV0RQy[LGR�R�GLy[LGR�GH�FDUERQR6XVWDQFLDV�YROiWLOHV��JDVROLQD��SLQWXUD7DEOD����)DFWRUHV�UHODFLRQDGRV�FRQ�OD�+RVSLWDOL]DFLyQ� DOWHUDFLRQHV�VHQVRULDOHV���GHSULYDFLyQ��VREUHFDUJD�� GHSULYDFLyQ�GH�VXHxR�� HQWRUQR�QR�IDPLOLDU�� FDPELRV�IUHFXHQWHV�GH�KDELWDFLyQ�� LQFRQWLQHQFLD�� GRORU� LQPRYLOL]DFLyQ�� YtDV�LQWUDYHQRVDV�� XVR�GH�VRQGDV�� HVWUpV�SVLFRVRFLDO�

���$SUR[LPDFLyQ�GLDJQyVWLFD�/D�IXQFLyQ�GHO�FOtQLFR�YD�HQFDPLQDGD�D�D�� ,GHQWLILFDU�SDFLHQWHV�GH�ULHVJR�E�� 5HFRQRFLPLHQWR�GHO�GHOLULXP�

Page 205: Manual practico urgencias medicina interna muy bueno

���

F�� ,GHQWLILFDFLyQ�GHO�SURFHVR�VXE\DFHQWH�����+LVWRULD�FOtQLFD��H[SORUDFLyQ�ItVLFD�\�QHXUROyJLFD��3UHVWDQGR� HVSHFLDO� DWHQFLyQ� DO� XVR� GH� IiUPDFRV� \� KiELWRV� Wy[LFRV�� HVWDGR� PHQWDO� \� OD�H[LVWHQFLD� R� QR� GH� HSLVRGLRV� DQWHULRUHV� GH� GHOLULXP�� %~VTXHGD� VLVWHPiWLFD� GH� VLJQRV� GH�LQIHFFLyQ�� ,&&�� ,$0�� GHVKLGUDWDFLyQ�� UHWHQFLyQ� DJXGD�GH� RULQD� R� LPSDFWDFLyQ� IHFDO�� ,QIDUWRV�IRFDOHV�HQ� UHJLyQ� WHPSRUR�RFFLSLWDO� LQIHULRU� R�HQ� OD� UHJLyQ�SDULHWDO��SUHIURQWDO��VXEFRUWLFDO�GH�KHPLVIHULR�GHUHFKR�SXHGH�FDXVDU�XQD�DOWHUDFLyQ�GLIXVD�GH�OD�DWHQFLyQ�����([SORUDFLyQ�PHQWDO�1LQJXQR�GH�ORV�WHVWV�SVLFRPpWULFRV�H[LVWHQWHV�HVWDEOHFH�HO�GLDJQyVWLFR��HO�006(�QR�SHUPLWH�HO�GLDJQyVWLFR�GLIHUHQFLDO�HQWUH�GHPHQFLD�\�GHOLULXP�\�QXQFD�GHEH�UHDOL]DUVH�HQ�HO PRPHQWR�HQ�TXH�HO�SDFLHQWH�WLHQH�XQ�GHOLULXP�([LVWHQ� HVFDODV� GLVHxDGDV� SDUD� LQWHQWR� GH� GHWHFFLyQ� UiSLGD� GHO� VtQGURPH�� '56� �'HOLULXP�UDWLQJ�VFDOH���'6,� �'HOLULXP�V\PSWRP�,QWHUYLHZ���R�HO�&$0��&RQIXVLRQ�$VVHVVPHQW�0HWKRG���(VWD� ~OWLPD� HVWi� YDOLGDGD� HVSHFtILFDPHQWH� SDUD� GHOLULXP�� HV� FDSD]� GH� GLVWLQJXLU� HQWUH�GHPHQFLD�\�GHOLULXP��YDORUD�P~OWLSOHV�FDUDFWHUtVWLFDV�GHO�GHOLULXP�\�HV�IDFWLEOH�VX�UHDOL]DFLyQ�HQ�SDFLHQWHV� FRQ� GHOLULXP�� 6H� FUHy� EDViQGRVH� HQ� ORV� FULWHULRV� GLDJQyVWLFRV� GHO� '60�,,,� 5� H�LQFOX\H�,QLFLR�DJXGR�\�FXUVR�IOXFWXDQWH�,QDWHQFLyQ�3HQVDPLHQWR�GHVRUJDQL]DGR�1LYHO�GH�FRQFLHQFLD�DOWHUDGR�(O� GLDJQyVWLFR� VH� UHDOL]D� VL� FXPSOH� ������ y� ��� 1R� REVWDQWH� WLHQH� XQ� XVR� OLPLWDGR� SDUD� HO�GLDJQyVWLFR�GH�GHOLULXP�EDVDGR�HQ�ORV�FULWHULRV�GLDJQyVWLFRV�GHO�'60�,9� \D�TXH�HQ�pVWH�VH�UHTXLHUH�XQ�WUDVWRUQR�GH�FRQFLHQFLD�SDUD�HO�GLDJQyVWLFR�\�DGHPiV�WDPSRFR�VH�YDORUD�HQ�HVWH�WHVW�HO�HVWDGR�FRJQLWLYR��6����������(���������933���������931���������([LVWHQ� WDPELpQ� RWURV� WHVW� VHQFLOORV� �VHULHV� GH� �� Q~PHURV��QRPEUDU� DO� UHYpV� ORV� GtDV� GH� OD�VHPDQD��R�ORV�PHVHV�GHO�DxR�����SHUR�TXH�VyOR�YDORUDQ�OD�DWHQFLyQ�\�QR�VH�SXHGH�UHDOL]DU�HQ�SDFLHQWHV�JUDYHV�R�OHWiUJLFRV�����(VWXGLR�LQLFLDO��1R� H[LVWH� DFXHUGR� HQWUH� ORV� DXWRUHV� FRQ� UHVSHFWR� D� OD� H[WHQVLyQ� GH� ODV� H[SORUDFLRQHV�FRPSOHPHQWDULDV� D� UHDOL]DU�� (O� HVWXGLR� GHEHUi� VHU� LQGLYLGXDOL]DGR� \� EiVLFDPHQWH�FRPSUHQGHUtD�� +HPRJUDPD�\�96*�� )XQFLyQ�UHQDO��KHSiWLFD��&D�\�3��*OXFRVD��LRQHV��&3.��/'+�� 6HGLPHQWR�GH�2ULQD�� 5[�7yUD[�� (OHFWURFDUGLRJUDPD�

Page 206: Manual practico urgencias medicina interna muy bueno

���

����2WUDV�H[SORUDFLRQHV�FRPSOHPHQWDULDV�$�UHDOL]DU�HQ�GHWHUPLQDGDV�FLUFXQVWDQFLDV�\�QXQFD�GH�IRUPD�UXWLQDULD�$PLODVD��$PRQLDFR��0J��%����iFLGR�IyOLFR��KRUPRQDV�WLURLGHDV��JDVRPHWUtD�DUWHULDO�1LYHOHV�GH�GURJDV�\�Wy[LFRV�(VWXGLRV�6HUROyJLFRV��+,9��6tILOLV�&XOWLYR�GH�/tTXLGRV�RUJiQLFRV�7pFQLFD�GH�QHXURLPDJHQ��7$&��501��63(&7�(VWXGLR�GH�/&5�(OHFWURHQFHIDORJUDPD�6H�GHEH�SODQWHDU�SUXHEDV�GH�QHXURLPDJHQ�HQ�ODV�VLJXLHQWHV�FLUFXQVWDQFLDV�� $QWHFHGHQWH�GH�7&(�� 6LJQRV�R�VtQWRPDV�IRFDOHV�� (WLRORJtD�QR�DFODUDGD�� 6tQWRPDV�DWtSLFRV�R�SURORQJDGRV�5HVSHFWR�DO�HVWXGLR�GH�/&5��HV�XQD�WpFQLFD�GH�EDMR�UHQGLPLHQWR�HQ�DQFLDQR��SODQWHiQGRVH�VX�UHDOL]DFLyQ� HQ� SDFLHQWHV� FRQ� ILHEUH� VLQ� HQFRQWUDU� IRFR� REYLR�� 6H� JHQHUD� HQ� JHQHUDO� SROpPLFD�UHVSHFWR�GH�VL�VH�GHEH�UHDOL]DU�D�WRGR�SDFLHQWH�FRQ�ILHEUH�\�GHOLULXP��\D�TXH�HQ�PiV�GHO�����GH�ORV�FDVRV�ODV�FDXVDV�PiV�IUHFXHQWHV�VRQ�LQIHFFLyQ��GHVKLGUDWDFLyQ�\�DOWHUDFLRQHV�PHWDEyOLFDV�(O� HOHFWURHQFHIDORJUDPD PXHVWUD� XQ� HQOHQWHFLPLHQWR� GLIXVR� GH� OD� DFWLYLGDG� GH� EDVH�FRQ�H[FHSFLyQ�GH�OD�GHSULYDFLyQ DOFRKyOLFD�R�LQWR[LFDFLyQ�FRQ�KLSQyWLFR�VHGDQWHV��TXH�VH�UHODFLRQD�FRQ�OD�VHYHULGDG�GHO�GpILFLW�FRJQLWLYR��DXQTXH�FDUHFH�GH�HVSHFLILFLGDG��6H�SXHGH�UHDOL]DU�SDUD�� 'LIHUHQFLDU�FDXVDV�IRFDOHV�R�JOREDOHV�GH�GHOLULXP�� 'HVFDUWDU�FULVLV�RFXOWDV�QR�FRQYXOVLYDV�� (QFHIDORSDWtD�KHSiWLFD��XUpPLFD��� ,QIHFFLyQ�GHO�61&��HMHPSOR�HQFHIDOLWLV�KHUSpWLFD�� 'LDJQyVWLFR�GLIHUHQFLDO�GHO�GHOLULXP�GH�OD�HQIHUPHGDG�SVLTXLiWULFD�IXQFLRQDO�

���'LDJQyVWLFR�GLIHUHQFLDO����'HPHQFLD� /D�GHPHQFLD�\�HO�GHOLULXP�VRQ�ORV���WUDQVWRUQRV�PHQWDOHV�PiV�IUHFXHQWHV�HQ�OD�SREODFLyQ�DQFLDQD��+DVWD�XQ�����GH�ODV�GHPHQFLDV�DO�LQJUHVR�WLHQHQ�XQ�GHOLULXP�DVRFLDGR�\�HQWUH�HO��������GH�ORV�GHOLULXP�WLHQHQ�XQD�GHPHQFLD�GH�EDVH��/D�GLILFXOWDG�SDUD�GLIHUHQFLDU�HVWDV� GRV� HQWLGDGHV� HV� XQ� SUREOHPD� PX\� IUHFXHQWH� HQ� OD� SUiFWLFD� FOtQLFD� GLDULD�� 6HUi�QHFHVDULD�XQD�KLVWRULD�FOtQLFD�GHWDOODGD�D�SDUWLU�GH�IDPLOLDU�R�FXLGDGRU��\�DWHQGHU�D�XQD�VHULH�GH�DVSHFWRV�UHIOHMDGRV�HQ�OD�WDEOD����

Page 207: Manual practico urgencias medicina interna muy bueno

���

7DEOD����'LDJQyVWLFR�GLIHUHQFLDO�HQWUH�GHOLULXP�\�GHPHQFLD&$5É&7(5Ì67,&$6 '(0(1&,$ '(/,5,80,QLFLR ,QVLGLRVR EUXVFR'XUDFLyQ /DUJD EUHYH&XUVR�HQ����K� (VWDEOH )OXFWXDQWH��SHRU�SRU�OD�QRFKH&RQFLHQFLD &ODUD GLVPLQXLGD$WHQFLyQ 1RUPDO�H[FHSWR�VHYHURV $OWHUDGD�JOREDOPHQWH&RJQLWLYR 'HWHULRUR�JOREDO $OWHUDGD�JOREDOPHQWH$OXFLQDFLRQHV $�PHQXGR�DXVHQWHV 9LVXDOHV��UDUD�DXGLWLYDV'HOLULRV $�PHQXGR�DXVHQWHV )XJDFHV��SRFR�VLVWHPDWL]DGRV2ULHQWDFLyQ $�PHQXGR�DOWHUDGD $OWHUDGD$FWLYLGDG�SVLFRPRWRUD $�PHQXGR�QRUPDO $XPHQWDGD�\�R�GLVPLQXLGD/HQJXDMH $IDVLDV��SHUVHYHUDFLyQ ,QFRKHUHQWH��OHQWR�R�UiSLGR0RYLPLHQWRV�LQYROXQWDULRV $�PHQXGR�DXVHQWHV )UHFXHQWHV(QIHUPHGDG�IiUPDFRV $�PHQXGR�DXVHQWHV 8QR�y�PiV�SUHVHQWHV6XHxR 0HQRV�DOWHUDGR $OWHUDGR���5HDFFLyQ�FDWDVWUyILFD��6H�WUDWD�GH�XQD�UHDFFLyQ�IUHQWH�DO�DPELHQWH�R�VLWXDFLRQHV�GH�HVWUpV�GH�XQ�GHPHQWH��5DUDV�DOXFLQDFLRQHV�\�HO�((*�HV�QRUPDO��5HVSRQGHQ�DO�FDPELR�GH�DPELHQWH����'HSUHVLyQ��6LPXOD�XQ�GHOLULXP�KLSRDFWLYR��1R�GDWRV�GH�HQIHUPHGDG�RUJiQLFD�R�LQWR[LFDFLyQ�SRU� IiUPDFRV�� FRQVHUYD� DWHQFLyQ� \� FRQFLHQFLD�� QR� WUDQVWRUQRV� GH SHUFHSFLyQ� \� HO� ((*� HV�QRUPDO���� $QVLHGDG�� 6LPXOD� XQ� GHOLULXP� KLSHUDFWLYR�� $O� LJXDO� TXH� HQ HO� FDVR� DQWHULRU� FRQVHUYD�DWHQFLyQ�\�FRQFLHQFLD�\�QR�VXHOHQ�WHQHU�WUDVWRUQRV�GH�OD�SHUFHSFLyQ���� 7UDVWRUQRV� 3VLFyWLFRV� (VTXL]RIUHQLD�� SVLFRVLV� UHDFWLYDV�� 6LPXODQ GHOLULXP� KLSHUDFWLYR��6XHOHQ�FRQVHUYDU�OD�FRQFLHQFLD��OD�DWHQFLyQ�SXHGH�HVWDU�DOWHUDGD��ORV�GHOLULRV�VRQ�VRVWHQLGRV�\�HVWiQ�VLVWHPDWL]DGRV��(O�((*�HV�QRUPDO�\�HO�FXUVR�HV�PiV�HVWDEOH����7UDVWRUQRV�2UJiQLFRV��$OXFLQRVLV�RUJiQLFDV��LQWR[LFDFLyQ�SRU�DQIHWDPLQDV��6tQGURPH�GH�.RUVDNRII��KLSHUWLURLGLVPR�DSiWLFR��(Q�HVWRV�FDVRV�OD�DWHQFLyQ�VXHOH�HVWDU�FRQVHUYDGD�

���3UHYHQFLyQ�HQ�SDFLHQWH�KRVSLWDOL]DGR�/D�SUHYHQFLyQ�GHO�GHOLULXP�LQFOX\H�,GHQWLILFDFLyQ�GH�SDFLHQWHV�DQFLDQRV�GH�DOWR�ULHVJR�/LPLWDU� HO� Q~PHUR� GH� IiUPDFRV�� HQ� HVSHFLDO� DQWLFROLQpUJLFRV�� VHGDQWHV�KLSQyWLFRV� \�QDUFyWLFRV�7UDWDPLHQWR� HWLROyJLFR� GH� OD� SDWRORJtD� TXH� PRWLYD� HO� LQJUHVR� \� SUREOHPDV� PpGLFRV�DVRFLDGRV�

Page 208: Manual practico urgencias medicina interna muy bueno

���

&RUUHJLU� IDFWRUHV� DPELHQWDOHV�� GpILFLW� VHQVRULDOHV�� JDIDV�� DXGtIRQRV�� IDYRUHFHU� YLVLWDV�IDPLOLDUHV��XVR�GH�HVWtPXORV�RULHQWDGRUHV��FDOHQGDULRV��UHORMHV��LOXPLQDFLyQ�DGHFXDGD�6XMHFLRQHV��EDUUDV��1R�VRQ�GH�HOHFFLyQ�\D�TXH�SXHGHQ�DXPHQWDU�ORV�HSLVRGLRV�GH�DJLWDFLyQ��SHUR� HQ� GHWHUPLQDGDV� RFDVLRQHV� \� VL� QR� KDQ� VLGR� HILFDFHV� RWUDV� PHGLGDV�� KD\� TXHXWLOL]DUODV��VREUH�WRGR�VL�H[LVWH�ULHVJR�GH�DXWROHVLRQHV�R�FDtGDV�(Q� OD�VLJXLHQWH� WDEOD�VH�SURSRQH�XQ�HMHPSOR�GH�SURWRFROR�GH� LQWHUYHQFLyQ�DQWH� IDFWRUHV�GH�ULHVJR�GH�GHOLULXP��,QRX\H�HW�DO��1(-0������������������7DEOD����)DFWRUHV�GH�ULHVJR�SDUD�GHOLULXP�\�SURWRFROR�GH�LQWHUYHQFLyQ�)$&725(6�'(�5,(6*2 35272&2/2�'(�,17(59(1&,Ð1'HWHULRUR�FRJQLWLYR 3URWRFROR�GH�RULHQWDFLyQ��&DOHQGDULRV�\� OLVWD�GH�PLHPEURV�GHO�HTXLSR�3URWRFROR� GH� DFWLYLGDGHV�� $FWLYLGDGHV� GH� HVWLPXODFLyQ��FRJQLWLYD��GLVFXVLyQ�GH�QRWLFLDV� MXHJR�SDODEUDV�'HSULYDFLyQ�GH�VXHxR 0DQHMR�QR�IDUPDFROyJLFR��EHELGD�FDOLHQWH�D�OD�KRUD�GHO�VXHxR��UHODMDFLyQ�PXVLFDO��PDVDMH�HQ�HVSDOGD�3URWRFROR�SDUD�PHMRUDU�HO�VXHxR��(VWUDWHJLDV�GH�UHGXFFLyQ�GH�UXLGR�\�DMXVWH�GH�KRUDULRV�SDUD�SHUPLWLU�HO�VXHxR��HM��FDPELR�HQ�HO�KRUDULR�GH�PHGLFDFLyQ�,QPRYLOLGDG 3URWRFROR� GH�PRYLOL]DFLyQ� SUHFR]� FRQ�PtQLPR�XVR�SRVLEOH�GH�HOHPHQWRV�TXH�IDYRUHFHQ�OD�LQPRYLOLGDG��VRQGDV����'HWHULRUR�YLVXDO 3URWRFROR� GH� 9LVLyQ�� $\XGDV� YLVXDOHV�JDIDV� R� OHQWHV� GH�FRQWDFWR��\�DGDSWDFLRQHV�LOXPLQDFLyQ����'HWHULRUR�DXGLWLYR 3URWRFROR� GH� DXGLFLyQ�� 8VR�GH�DXGtIRQRV��GHVLPSDFWDFLyQ�GH�WDSRQHV�GH�FHUD�\�WpFQLFDV�GH�FRPXQLFDFLyQ'HVKLGUDWDFLyQ 3URWRFROR� GH� GHVKLGUDWDFLyQ�� 7HPSUDQR� UHFRQRFLPLHQWR� \�DGHFXDGD�UHSOHFLyQ��SRU�92�VL�IXHVH�SRVLEOH�

���75$7$0,(172�)$50$&2/Ð*,&2�6H�XVD�VyOR�GXUDQWH�HO�HSLVRGLR��SDUD�UHYHUWLU�VLJQRV�\�VtQWRPDV�SVLFyWLFRV��WUDWDU�OD�DQVLHGDG�\�DJLWDFLyQ��FXDQGR�ODV�DQWHULRUHV�PHGLGDV�KDQ�VLGR�LQVXILFLHQWHV��6H�GHEH�XVDU� OD�PtQLPD�GRVLV�GXUDQWH�HO�PHQRU�WLHPSR�SRVLEOH����1(852/e37,&26�6RQ�ORV�IiUPDFRV�GH�HOHFFLyQ�1HXUROpSWLFRV�GH�DOWD�SRWHQFLD�'H� HOHFFLyQ� FXDQGR� VH� SUHVHQWDQ� VtQWRPDV� SVLFyWLFRV�� WLHQHQ� SRFRV� HIHFWRV� VHGDQWHV�� QR�HIHFWRV�KLSRWHQVRUHV�SHUR�WLHQHQ�PiV�HIHFWRV�H[WUDSLUDPLGDOHV�$��+$/23(5,'2/��'RVLV�WRWDO�YDULDEOH�����������PJ�

Page 209: Manual practico urgencias medicina interna muy bueno

���

� 2UDO��3LFR�GH�DFFLyQ�����K�� 'RVLV�������PJ�������y���YHFHV�GtD����JRWD ����PJ��� ,�0��3LFR�GH�DFFLyQ�������PLQXWRV�� 'RVLV�������PJ��>��DPSROOD ��PJ���PO�@�$XQTXH�QR�KD�VLGR�DSUREDGR�VX�XVR�LY��HQ�89,�VH�KD�YLVWR�TXH�HV�VHJXUR�\�HILFD]�(IHFWRV� VHFXQGDULRV�� GLVWRQtDV�� DFDWLVLD�� GLVNLQHVLD� WDUGtDV�� VtQGURPH� QHXUROpSWLFR�PDOLJQR6H�UHFRPLHQGD�XQD�GRVLV� LQLFLDO�GH�����PJ��9�2��R�,0��SXGLpQGRVH�UHSHWLU�R�GREODU� OD�GRVLV�D�LQWHUYDORV�GH����PLQXWRV�KDVWD�FRQWURO�GH�OD�DJLWDFLyQ�%��5,63(5,'21$���5LVSHUGDO���7LHQH�OD�YHQWDMD�UHVSHFWR�DO�DQWHULRU�HQ�ORV�HVFDVRV�HIHFWRV�H[WUDSLUDPLGDOHV��SHUR�OLPLWDGR�VX�XVR�SRU�VROR�GLVSRQHU�GH�OD�YtD�RUDO�SDUD�VX�DGPLQLVWUDFLyQ�'RVLV�LQLFLDO�����PJ����K��TXH�VH�SXHGH�DXPHQWDU�KDVWD�����PJ���K�1HXUROpSWLFRV�GH�EDMD�SRWHQFLD�&RPSDUDGRV�FRQ�ORV�GH�DOWD�SRWHQFLD�WLHQHQ�PHQRV�HIHFWRV�H[WUDSLUDPLGDOHV�SHUR�PiV�HIHFWRV�VHGDQWHV��PiV�HIHFWRV�DQWLFROLQpUJLFRV��OR�FXDO�SXHGH�DJUDYDU�HO�GHOLULXP��\�FDUGLRYDVFXODUHV��KLSRWHQVLyQ��$��7,25,'$&,1$��0HOHULO��'RVLV�������PJ�HQ�����GRVLV�GtD��0i[LPD�����PJ�GtD�>��JRWD �PJ��&RPSULPLGRV�����������PJ@%��/(920(3520$&,1$��6LQRJiQ��'RVLV�LQLFLDO�������PJ�G�'RVLV�WRWDO��������PJ�G����JRWD �PJ��>&RPSULPLGRV����\�����PJ����DPSROOD ���PJ�@&��&/253520$&,1$�/DUJDFWLO��'RVLV�LQLFLDO�������PJ�GtD�'RVLV�KDELWXDO��������PJ�HQ�����Y�GtD��'RVLV�,0��������PJ���JRWD �PJ��>&RPS�����\�����PJ����DPSROOD ���PJ�@

���%(1=2',$&(3,1$6�'H�XVR�SDUD�FRQWURODU�GH�IRUPD�LQPHGLDWD�OD�DJLWDFLyQ��DQVLHGDG�R�SDUD�DVHJXUDU�HO�VXHxR��(V�HO�IiUPDFR�GH�HOHFFLyQ�HQ�ORV�FDVRV�GH�GHSULYDFLyQ�GH�VHGDQWHV�KLSQiWLFRV�\�DOFRKRO��\�VRQ�~WLOHV�FRPR�DG\XYDQWHV�GH�ORV�QHXUROpSWLFRV�'H�HOHFFLyQ�ODV�GH�YLGD�PHGLD�FRUWD��/RUDFHSDP�2UILGDO���������PJ�(Q�GHPHQFLDV�SXHGH�KDEHU�UHVSXHVWDV�SDUDGyMLFDV�\�DXPHQWDU�HO�GHOLULXP�(O�0LGD]RODP�'RUPLFXP��WLHQH�XQD�YLGD�PHGLD�FRUWD��VH�KDQ�XVDGR�EDMR�FRQWURO�HVWULFWR�SHUR�VLQ� HPEDUJR� VH� KDQ� DVRFLDGR� FRQ� XQ� DOWR� ULHVJR� GH� GHSULYDFLyQ� FXDQGR� VH� VXVSHQGH� \� FRQ�DJLWDFLyQ� SDUDGyMLFD� FXDQGR� VH� XVD� HQ� SDFLHQWHV� FRQ GHSULYDFLyQ� SRU� VHGDQWHV�KLSQyWLFRV��

Page 210: Manual practico urgencias medicina interna muy bueno

���

DGHPiV�SURGXFH�PHWDEROLWRV� DFWLYRV�TXH�SXHGHQ�DFXPXODUVH�HQ�SDFLHQWHV�FRQ�KHSDWRSDWtD�\�FDXVDU� WR[LFLGDG��3HUPLWH�OD�DGPLQLVWUDFLyQ�LY�SHUR�KD\�TXH�WHQHU�HQ�FXHQWD�HO�HIHFWR�GHSUHVRU�GHO�61&����&/20(7,$=2/��'LVWUDQHXULQH��8VR�HQ�GHOLULXP�SRU�GHSULYDFLyQ�GH�DOFRKRO��'LVWUDQHXULQH�VROXFLyQ�LQ\HFWDEOH�DO����������PO��&RPHQ]DU�FRQ�������PJ�PLQ��������JRWDV�PLQXWR��KDVWD�FRQVHJXLU�XQ�VXHxR�VXSHUILFLDO��OD�GRVLV�GH�PDQWHQLPLHQWR�YDUtD�GH�����PJ�PLQ��������JRWDV�PLQ��7DPELpQ�WLHQH�HIHFWR�KLSQyWLFR�SDUD�DVHJXUDU�HO�VXHxR����27526� 8VR�PiV�OLPLWDGR�\�SXQWXDO�SDUD�FRQWURO�GH�GHWHUPLQDGRV�VtQWRPDV�� 75$=2'21$��*ROSHWHRV�R�DODULGRV�� ),6267,*0,1$��8VR�OLPLWDGR�HQ�GHOLULXP�SRU�DQWLFROLQpUJLFRV�� &$5%$0$&(3,1$��$JUHVLyQ�R�KLSHUDFWLYLGDG��VL�DOWHUDFLRQHV�((*�� 1$5&Ï7,&26���%(7$%/248($17(6��1R�FODUR�HIHFWR�EHQHILFLRVR� 7,$0,1$��LP� LY�HQ�GHSULYDFLyQ�HWtOLFD��SDUD�SUHYHQLU�6tQGURPH�GH�.RUVDNRII%,%/,2*5$)Ì$���� $PHULFDQ� 3V\TXLWULF� $VVRFLDWLRQ�� 'LDJQRVWLF� DQG� 6WDWLFDO� 0DQXDO� RI� 0HQWDO� GLVRUGHUV�� �� WK�HGLWLRQ��:DVKLQJWRQ��'&���������� &KDQ� '�� %UHQQDQ� 1-�� 'HOLULXP�� 0DNLQJ� WKH� GLDJQRVLV�� LPSURYLQJ� WKH� SURJQRVLV�� *HULDWULFV����������PDU�����������,QRX\H�6.�HW�DO��&ODULI\LQJ�&RQIXVLRQ��7KH�&RQIXVLRQ�$VVHVVPHQW�0HWKRG��$�QHZ�PHWKRG�IRU�GHWHFWLRQ�RI�GHOLULXP��$Q�,QWHU�0HG���������������������� ,QRX\H�6.��&KDUSHQWLHU�3$��3UHFLSLWDWLQJ� IDFWRUV� IRU�GHOLULXP� LQ�KRVSLWDOL]HG�HOGHUO\�SHUVRQV��3UHGLFWLYH�PRGHO�DQG�LQWHUUHODWLRQVKLS��ZLWK�EDVHOLQH�YXOQHUDELOLW\��-$0$��������������������� ,QRX\H� 6.� HW� DO�� $� 0XOWLFRPSRQHQW� LQWHUYHQWLRQ� WR� SUHYHQW� GHOLULXP� LQ� KRVSLWDOL]HG� ROGHU�SDWLHQV��1(-0��������������������2�.HHIIH�6��/DYDQ�-��7KH�SURJQRVWLF�VLJQLILFDQFHH�RI�GHOLULXP�LQ�ROGHU�KRVSLWDO�SDWLHQV��-$*6��������������������5XPPDQV�7$�HW�DO� 'HOLULXP� LQ�HOGHUO\�SDWLHQV��HYDOXDWLRQ�DQG�PDQDJHPHQW��0D\R�&OLQ�3UR������������������

Page 211: Manual practico urgencias medicina interna muy bueno

���

$QHPLDV0DUtD�0HOHUR$��'HILQLFLyQ��'LVPLQXFLyQ�GH�OD�PDVD�GH�KHPDWtHV�FLUFXODQWHV��+E�������+WFR��������PXMHUHV��+E������+WFR�������%�� &DXVDV�� $QRPDOtDV� KHUHGLWDULDV� R� DGTXLULGDV� GH� ORV� KHPDWtHV� R� VXV� SUHFXUVRUHV� R�FRQVHFXHQFLD�GH�SDWRORJtDV�VXE\DFHQWHV��p SURGXFFLyQ��DQHPLD�DSOiVLFD��DQHPLD�IHUURSpQLFD��WDODVHPLDV��6tQGURPHV�PLHORGLVSOiVLFRV��$QHPLD� VLGHUREOiVWLFD�� $QHPLDV� PHJDOREOiVWLFDV�� $QHPLD� GH� OD� LQVXILFLHQFLD� UHQDO��$QHPLDV�GH�HQIHUPHGDG�FUyQLFD�\�WWR�FRQ�$=7�R�TXLPLRWHUiSLFR��n SpUGLGD�R�GHVWUXFFLyQ��+HPRUUDJLD+HPyOLVLV�+HUHGLWDULD�+HPRJORELQRSDWtDV$OWHUDFLRQHV�GH�OD�PHPEUDQD(Q]LPRSDWtDV$GTXLULGD�$XWRLQPXQHV3RU�IiUPDFRV0LFURDQJLRSiWLFD7UDXPiWLFD+HPRJORELQXULD�SDUR[tVWLFD�QRFWXUQD&�� &OtQLFD�� 9DULDEOH� GHSHQGLHQGR� GHO� JUDGR� \� UDSLGH]� GH� LQVWDXUDFLyQ�� VLJQRV� \� VtQWRPDV�VHFXQGDULRV� D� KLSR[LD� WLVXODU� �IDWLJDELOLGDG�� DVWHQLD�� FHIDOHD�� SDOLGH]�� VtQFRSH�� WDTXLFDUGLD����� \�VLJQRV�\�VtQWRPDV�SURSLRV�GH�OD�SDWRORJtD�VXE\DFHQWH�'��$SUR[LPDFLyQ�GLDJQyVWLFD�+LVWRULD��DQWHFHGHQWHV�SHUVRQDOHV�H[SRVLFLyQ�D�IiUPDFRV�\�DQWHFHGHQWHV�IDPLOLDUHV�([SORUDFLyQ�ItVLFD6LJQRV�GH�KHPRUUDJLD%~VTXHGD�GH�DGHQRSDWtDV��PHJDOLDV��LFWHULFLD��GRORU�yVHR��VtQWRPDV�QHXUROyJLFRV���+DFHU�VLHPSUH�WDFWR�UHFWDO/DERUDWRULR�+HPRJUDPD���+E��+WFR��+&0��&+&0��9&0��SRU�IURWLV�5HWLFXORFLWRV�DEVROXWRV����[�KHPDWtHV���!��������� �KLSHUSUROLIHUDWLYDËQGLFH�GH�UHWLFXORFLWRV��$EVROXWR�[�+HPDWRFULWR�SDFLHQWH��+HPDWRFULWR�QRUPDO

�!����� �n SURGXFFLyQ

Page 212: Manual practico urgencias medicina interna muy bueno

���

����� �p SURGXFFLyQ(�7UDWDPLHQWR(WLROyJLFR�VLHPSUH�6LQWRPiWLFR�� WUDQVIXVLyQ� VyOR� HQ� FDVRV� LQGLFDGRV�� /D� GHFLVLyQ� VREUH� HO� WUDWDPLHQWR�WUDQVIXVLRQDO�GHEH�VHU� LQGLYLGXDOL]DGR��1R�REVWDQWH��FRPR� LQGLFDGRUHV�RULHQWDWLYRV�SRGHPRV�HVWDEOHFHU�ORV�VLJXLHQWHV�FULWHULRV�+E����� 1R�SUHFLVD�WUDWDPLHQWR+E� ������ 9DORUDU� OD� VLWXDFLyQ� FOtQLFD�� 6LHPSUH� UHDOL]DU� HVWXGLRV� GLDJQyVWLFRV� DQWHV� GH�WUDQVIXQGLU+E������,QGLFDFLyQ�GH�WUDQVIXVLyQ��VDOYR�H[FHSFLRQHV����$1(0,$�)(5523e1,&$$�� &DXVDV�� �ODV�PiV�IUHFXHQWHV�%DMD�LQJHVWD$XPHQWR�GH�GHPDQGD3pUGLGDV� 'LJHVWLYD��VREUH�WRGR�YDURQHV��*HQLWRXULQDULDV��VREUH�WRGR�PXMHUHV��PHWURUUDJLD� �!�����PO�FLFOR�R�!����WDPSRQHV�FLFOR��2WUDV��KHPyOLVLV�LQWUDYDVFXODU��+31��SUyWHVLV�HQGRYDVFXODUHV����'LVPLQXFLyQ�GH�DEVRUFLyQ�LQWHVWLQDO��HQWHURSDWtDV�%��&/Ì1,&$'DWRV�FRPXQHV�D�WRGDV�ODV�DQHPLDV'DWRV�GH�OD�HQIHUPHGDG�VXE\DFHQWH6G��3OXPPHU�9LQVRQ��TXHLOLWLV�DQJXODU���GLVIDJLD�SRU�PHPEUDQD�HVRIiJLFD���JORVLWLV5DUR��FRLQROLTXLD�\�SLFD�&��',$*1Ð67,&2+HPRJUDPD�/HXFRFLWRV�QRUPDOHV�R�EDMRV��3ODTXHWDV�DXPHQWDGDV���������9&0�\�&+&0�EDMRV��VL�+E������JU�G/��5HWLFXORFLWRV�QRUPDOHV�R�EDMRV)URWLV��PLFURFLWRVLV�H�KLSRFURPtD�%LRTXtPLFD��KLHUUR�EDMR��IHUULWLQD�EDMD�\�WUDQVIHUULQD�DOWD%XVFDU�VLHPSUH�OD�FDXVD'��75$7$0,(172(WLROyJLFR6LQWRPiWLFR�9LD�RUDO��VXOIDWR�IHUURVR��)HURJUDGXPHW£������PJ���KRUDV����KRUD�DQWHV�GH�ODV�FRPLGDV��6L�LQWROHUDQFLD��SUREDU�D�GLVPLQXLU�OD�GRVLV�R�FRLQFLGLU�OD�PHGLFDFLyQ�FRQ�ODV�FRPLGDV��

Page 213: Manual practico urgencias medicina interna muy bueno

���

9tD� SDUHQWHUDO�� VL� FRQWUDLQGLFDGD� OD� RUDO�� SUHVHQFLD� GH�PDODEVRUFLyQ� R� LQWROHUDQFLD�QR�FRQWURODGD��+LHUUR�GH[WUDQR��GRVLV���+E�QRUPDO�± +E�SDFLHQWH��[�SHVR�[�������������PJ�IUDFFLRQDGR�HQ�YDULDV�GRVLV�LQWUDPXVFXODUHV�GLDULDV��R�L�Y��HQ�EROR�(IHFWRV�VHFXQGDULRV���������$UWUDOJLDV�TXH�UHVSRQGHQ�D�DFHWDPLQRIHQ����UHDFFLyQ�DQDILOiFWLFD7UDQVIXVLyQ�VyOR�HQ�KHPRUUDJLD�DJXGD�JUDYH�R�FLUXJtD�XUJHQWH�HQ�SDFLHQWHV�FRQ�DQHPLD�FUyQLFD�\�VtQWRPDV�FDUGLDFRV6L�HQ������VHPDQDV�QR�VH�FRUULJH�OD�DQHPLD�$VHJXUDU�FXPSOLPLHQWR�GHO�WUDWDPLHQWR%XVFDU�RWUDV�FDXVDV�GH�DQHPLD�PLFURFtWLFD��%XVFDU�GpILFLW�GH�%����IyOLFR�R�SURFHVR�FUyQLFR��'XUDFLyQ�GHO�WUDWDPLHQWR��DO�PHQRV���PHVHV�WUDV�OD�UHFXSHUDFLyQ�GH�OD�DQHPLD�SDUD�UHSRQHU�ORV�GHSyVLWRV�

���$1(0,$�0(*$/2%/É67,&$�����'pILFLW�GH�%��$��&DXVDV��%DMD�LQJHVWD��YHJHWDULDQRV���$XPHQWR�GH�ORV�UHTXHULPLHQWRV��'LVPLQXFLyQ�GH�OD�DEVRUFLyQ� $QHPLD�SHUQLFLRVD��*DVWUHFWRPtD�6G��=ROOLQJHU�(OOLVRQ��6tQGURPH�GH�DVD�FLHJD6SUXH�2WUDV��SDQFUHDWLWLV�FUyQLFD��IiUPDFRV��FROFKLFLQD���DOFRKROLVPR�'pILFLW�KHUHGLWDULR�GH�WUDQVFREDODPLQD%��&OtQLFD6LJQRV�\�VtQWRPDV�FRPXQHV�D�OD�DQHPLD'HJHQHUDFLyQ�VXEDJXGD�GHO�VLVWHPD�QHUYLRVR�FHQWUDO�1HXULWLV�SHULIpULFD�'HJHQHUDFLyQ�GH�FRUGRQHV�SRVWHULRUHV�\�ODWHUDOHV�GH�OD�PpGXOD�HVSLQDO�$OWHUDFLRQHV�FHUHEUDOHV�&��'LDJQyVWLFR)URWLV�n 9&0��KLSHUVHJPHQWDFLyQ�GH�ORV�QHXWUyILORV�5HWLFXORFLWRV�EDMRV��/HXFR�\�WURPERSHQLD�OHYHV��%LRTXtPLFD�

Page 214: Manual practico urgencias medicina interna muy bueno

���

KLHUUR��ELOLUUXELQD�\�/'+�DOWDV�%���EDMD����� IyOLFR�EDMR��7HVW�GH�6FKLOOLQJ��DQWLFXHUSRV�DQWL�FpOXODV�SDULHWDOHV�\�DQWL�IDFWRU�LQWUtQVHFR'��7UDWDPLHQWR2SWRYLWH�%����������JDPPDV�L�P��DO�GtD�GXUDQWH���VHPDQD��SRVWHULRUPHQWH�������JDPPDV�LP�D�OD�VHPDQD�GXUDQWH�XQ�PHV��R�KDVWD�QRUPDOL]DFLyQ�GH�OD�KHPRJRELQD��\�GHVSXpV�������JDPPDV�LP�DO�PHV�GH�SRU�YLGD��6L�KD\�DOWHUDFLRQHV�QHXUROyJLFDV��������JDPPDV�FDGD���VHPDQDV�GXUDQWH���PHVHV(IHFWRV�VHFXQGDULRV��KLSHUXULFHPLD��KLSRSRWDVHPLD�����'pILFLW�GH�iFLGR�IyOLFR$��&DXVDV%DMD�LQJHVWD��DQFLDQRV��KHPRGLiOLVLV��DOFRKROLFRV ��$XPHQWR�GH�ORV�UHTXHULPLHQWRV�$OWHUDFLRQHV�GH�OD�DEVRUFLyQ��(QIHUPHGDGHV�GHO�\H\XQR��$OFRKRO��)iUPDFRV��GLIHQLOKLGDQWRtQD��DQWLFRQFHSWLYRV�RUDOHV�\�WXEHUFXORVWiWLFRV(UURUHV�FRQJpQLWRV�GHO�PHWDEROLVPR)iUPDFRV��PHWURWUH[DWH����PHUFDSWRSXULQD��KLGUR[LXUHD��$=7��$FLFORYLU���%��'LDJQyVWLFR,JXDO�TXH�HQ�HO�GpILFLW�GH�%��p ÈFLGR�IyOLFR�&��7UDWDPLHQWR$FLGR�IyOLFR������PJ�GtD�YtD�RUDO6LHPSUH�KDFHU�SURILOD[LV�HQ�HPEDUD]R��DOFRKROLVPR��KHPRGLiOLVLV�\�KHPyOLVLV�FRQ���PJ�G�GH�iFLGR�IyOLFR(Q�JHQHUDO��VH�GHEH�HYLWDU�WUDQVIXQGLU�HQ�ODV�DQHPLDV�PHJDOREOiVWLFDV��VREUH�WRGR�HQ�OD�SHUQLFLRVD��SRU�DOWR�ULHVJR�GH�HGHPD�SXOPRQDU����$1(0,$�'(�(1)(50('$'�&5Ð1,&$��$��&DXVDV(QIHUPHGDGHV� LQIODPDWRULDV� �DUWULWLV� UHXPDWRLGH�� OXSXV� HULWHPDWRVR� VLVWpPLFR��VDUFRLGRVLV����(QIHUPHGDGHV�LQIHFFLRVDV��WXEHUFXORVLV��SLHORQHIULWLV��PLRFDUGLWLV��RVWHRPLHOLWLV����1HRSODVLDV��OLQIRPDV�\�FDUFLQRPDV�%��0HFDQLVPR�GH�DFFLyQ0XOWLIDFWRULDO��'LVPLQXFLyQ�GH�OD�YLGD�PHGLD�GH�ORV�KHPDWtHV��IDOOR�HQ�OD�HULWURSR\HVLV�\�EDMD�ELRGLVSRQLELOLGDG�GHO�KLHUUR��EORTXHDGR�SRU�HO�VLVWHPD�PRQRQXFOHDU�IDJRFtWLFR�7RGR�HOOR�VHFXQGDULR�DO�HIHFWR�GH�OD�LQWHUOHXNLQD�,�VHJUHJDGD�SRU�PRQRFLWRV�\�PDFUyIDJRV�DFWLYDGRV�FUyQLFDPHQWH

Page 215: Manual practico urgencias medicina interna muy bueno

���

&��'LDJQyVWLFR+HPRJUDPD��DQHPLD�PRGHUDGD�������JU�G/��FRQ�UHWLFXORFLWRV�QRUPDOHV�R�EDMRV�%LRTXtPLFD��KLHUUR��WUDQVIHUULQD�\�VDWXUDFLyQ�GH�WUDQVIHUULQD�EDMRV��IHUULWLQD�HOHYDGD�0pGXOD�yVHD��DXPHQWR�GH�ORV�GHSyVLWRV�GH�KLHUUR�\�VLEHUREODVWRV�EDMRV�(ULWURSR\HWLQD�QRUPDO��EDMD�FRQ�UHVSHFWR�DO�JUDGR�GH�DQHPLD�'��7UDWDPLHQWR&DXVDO(Q�DOJXQRV�FDVRV��'DQD]RO����PJ���KRUDV�YR��R� (ULWURSR\HWLQD� ��� XQLGDGHV�.J� WUHV�YHFHV�D�OD�VHPDQD(Q�RFDVLRQHV��VH�DVRFLD�IHUURSHQLD�HQ�SDFLHQWHV�FRQ�DQHPLD�SRU�HQIHUPHGDG�FUyQLFD��(Q�SDFLHQWHV�FRQ�HQIHUPHGDGHV� LQIODPDWRULDV� OD� IHUULWLQD��FRPR�UHDFWDQWH�GH�IDVH�DJXGD��PRGLILFD�ORV� FULWHULRV� KDELWXDOHV� HQ� HO� GLDJQyVWLFR� GH� IHUURSHQLD� GH�PRGR�TXH�HO� SDFLHQWH� SXHGH� WHQHU�QLYHOHV� IDOVDPHQWH�HOHYDGRV�GH� IHUULWLQD�\� WHQHU� IHUURSHQLD��(Q�HVWRV�FDVRV��GHEH�FRUUHJLUVH�HO�QLYHO� GH� IHUULWLQD� HQ� EDVH� D� OD� YHORFLGDG� GH� VHGLPHQWDFLyQ� JOREXODU� X� RWURV� SDUiPHWURV� GH��DFWLYLGDG�GHO� SURFHVR� LQIODPDWRULR�� 'H� IRUPD�JHQHUDO��QR�REVWDQWH�� VH�KD�HVWLPDGR�TXH�HQ�XQ�SDFLHQWH�FRQ�HQIHUPHGDG� FUyQLFD�� XQD� IHUULWLQD�PHQRU�GH����QJ�PO� LPSOLFD� IHUURSHQLD� �����HQ�FDVR�GH�DUWULWLV�UHXPDWRLGH����275$6�$1(0,$6����1HIURSDWtD$��0HFDQLVPR0XOWLIDFWRULDO�'pILFLW�GH�HULWURSR\HWLQD�8UHPLD��UHGXFH�OD�YLGD�PHGLD�GH�ORV�KHPDWtHV�$OWHUDFLyQ�SODTXHWDU���TXH�FRQGLFLRQD�KHPRUUDJLDV��+HPRGLiOLVLV��GpILFLW�GH�iFLGR�IyOLFR�\�KHPRGLOXFLyQ%��'LDJQyVWLFR+HPRJUDPD��DQHPLD�QRUPRFUyPLFD�FRQ�UHWLFXORFLWRV�EDMRVp +LHUUR�\�WUDQVIHUULQD�&��7UDWDPLHQWR(ULWURSR\HWLQD����8�.J�WUHV�YHFHV�HQ�VHPDQD�VXEFXWiQHD�R� L�Y��VL�KHPRGLiOLVLV��� WDPELpQ�FRUULJH�HO�WLHPSR�GH�KHPRUUDJLD�+LHUUR�VL�H[LVWHQ�SpUGLGDV�$FLGR�IyOLFR�VLHPSUH�����2WUDV$��$OFRKROLVPR�\�KHSDWRSDWtDV0HFDQLVPR�PXOWLIDFWRULDO�6H�FDUDFWHUL]D�SRU PDFURFLWRVLV�(O�WUDWDPLHQWR�YD�GLULJLGR�D�OD�HQIHUPHGDG�GH�EDVH

Page 216: Manual practico urgencias medicina interna muy bueno

���

%��(QIHUPHGDGHV�HQGRFULQDV+LSRWLURLGLVPR�H�KLSRSLWXLWDULVPR��0HFDQLVPR��IDOWD�HULWURSR\HWLQD��6H�DVRFLD�D�DQHPLD�SHUQLFLRVD�\�IHUURSHQLD�VHFXQGDULD�D�DFORUKLGULD&��1HRSODVLDV0HFDQLVPR�PXOWLIDFWRULDO��HQI��&UyQLFD��SpUGLGDV��PLHORSWLVLV��VG�PLHORGLVSOiVLFR����'��,QYDVLyQ�PHGXODU&DXVDV��(QIHUPHGDGHV�KLVWLRFLWDULDV�(QIHUPHGDGHV�GH�GHSyVLWR��1HRSODVLDV�KHPDWROyJLFDV�0HWiVWDVLV�GH�FDUFLQRPDV�\�VDUFRPDV��,QIHFFLRQHV��WXEHUFXORVLV�PLOLDU��KLVWRSODVPRVLV��PXFRUPLFRVLV���'LDJQyVWLFR��+HPRJUDPD��SDQFLWRSHQLD��)URWLV��GDFULRFLWRV�\�OHXFRHULWUREODVWRVLV��0pGXOD�yVHD��DVSLUDGR�VHFR��$1(0,$6�+(02/Ì7,&$6&ODVLILFDFLyQ�$��&RQJpQLWDV�$���$OWHUDFLRQHV�GH�PHPEUDQD��KHPyOLVLV�H[WUDYDVFXODU�\�HQ�PpGXOD�yVHD��7LSRV��HVIHURFLWRVLV��HOLSWRFLWRVLV��SLURSRLTXLORFLWRVLV��HVWRPDWRFLWRVLV���/DERUDWRULR��HOHYDFLyQ�GH�ELOLUUXELQD��DXPHQWR�GH�UHWLFXORFLWRV��XURELOLQyJHQR�HQ�RULQD�7UDWDPLHQWR�� (VSOHQHFWRPtD� VL� DQHPLD� QR� FRPSHQVDGD� �QR� DQWHV� �� DxRV� \� SUHYLD�YDFXQDFLyQ�DQWLQHXPRFyFLFD��$FLGR�IyOLFR���PJ�G�GH�SRU�YLGD$���'pILFLWV�HQ]LPiWLFRV������3LUXYDWR�TXLQDVD��$QHPLD�KHPROtWLFD�QR�HVIHURFtWLFD�+HPyOLVLV�FUyQLFD�'LDJQyVWLFR�SRU�DQiOLVLV�HQ]LPiWLFR�FXDOLWDWLYR��7UDWDPLHQWR��iFLGR�IyOLFR��HVSOHQHFWRPtD"����*�3'+��&ULVLV�KHPROtWLFDV�FRQ�LQJHVWD�GH�KDEDV��IDYLVPR��R�IiUPDFRV�R[LGDQWHV����*OXWDWLRQ�UHGXFWDVD$��+HPRJORELQRSDWtDV��D�WDODVHPLD��7LSRV��3RUWDGRU�DVLQWRPiWLFR��DDDB��

Page 217: Manual practico urgencias medicina interna muy bueno

���

5DVJR�WDODVpPLFR��DDB�B��0LFURFLWRVLV�OHYH��p +E�$��+E�+��E����D B�B B���(VSOHQRPHJDOLD��n ELOLUUXELQD��GLDJQyVWLFR�SRU�HOHFWURIRUHVLV��+LGURSV�IHWDOLV��B�B�B�B�E�WDODVHPLDV��� 0LQRU��KHWHURFLJRWRV���$VLQWRPiWLFRV��0LFURFLWRVLV�H�KLSRFURPtD��n +E�$���1R�GDU�KLHUUR�QL�WUDWDU��� 0D\RU��KRPRFLJRWRV��$QHPLD�KLSRFURPD VHYHUD��+HSDWRHVSOHQRPHJDOLD��$OWHUDFLRQHV�yVHDV��6REUHFDUJD�GH�KLHUUR��n +E�$��\�nn +E�)��7UDWDPLHQWR��7UDQVIXVLRQHV��+E�!������(VSOHQHFWRPLD�VL�KLSHUHVSOHQLVPR��4XHODQWHV�GH�KLHUUR���� DF��$VFyUELFR��702��� ,QWHUPHGLD��$QHPLD�PRGHUDGD�������JU�G/���7UDWDPLHQWR��WUDQVIXVLyQ�VL�SUHFLVD� 2WUDV��+E�6��DQHPLD�GH�FpOXODV�IDOFLIRUPHV���+E�&��+E�(��+HPRJORELQDV�LQHVWDEOHV%��$GTXLULGDV�%���+31���KHPRJORELQXULD�SDUR[tVWLFD�QRFWXUQD�'HIHFWR� DGTXLULGR� GH� PHPEUDQD� �DXPHQWR� VHQVLELOLGDG� D� KHPyOLVLV� SRU�FRPSOHPHQWR��&OtQLFD�$QWHFHGHQWHV�GH�DQHPLD�DSOiVLFD�FRQ�PXFKD�IUHFXHQFLD�+HPyOLVLV�FUyQLFD�\�DJXGD�LQWHUPLWHQWH��&RPSOLFDFLRQHV��7URPERVLV��+HPRUUDJLDV��

Page 218: Manual practico urgencias medicina interna muy bueno

���

'pILFLW�GH�KLHUUR��)UDFDVR�UHQDO�DJXGR�������/0$��'LDJQyVWLFR��+HPRJUDPD��OHXFR�\�WURPERSHQLD��%LRTXtPLFD��n /'+��ELOLUUXELQD�LQGLUHFWD��+E�OLEUH�SODVPD��pKDSWRJORELQD�2ULQD��+HPRJORELQD�OLEUH��KHPRVLGHULQXULD�7HVW�GH�+DP�\�VXFURVD��7UDWDPLHQWR��7UDQVIXVLyQ�VL�KHPyOLVLV�VHYHUD��KHPDWtHV�ODYDGRV���$QGUyJHQRV��(VWHURLGHV��iFLGR�IyOLFR��DQWLFRDJXODFLyQ�VL�IHQyPHQRV�WURPEyWLFRV��702%���'DxR�PHFiQLFR�0DUFKD�\�HMHUFLFLR�H[WHQXDQWH��9DOYXORSDWtDV��SUyWHVLV�HQGRYDVFXODUHV�%,%/,2*5$)Ë$���0HGLFLQD�,QWHUQD��)DUUHUDV�5R]PDQ��(G�������������3ULQFLSOHV�RI�,QWHUQDO�0HGLFLQH��+DUULVRQ¶V��(G��������������(O�0DQXDO�:DVKLQJWRQ�����HGLFLyQ���������5HDVRQLQJ�DQG�GHFLVLRQ�PDNLQJ�LQ�KHPDWRORJ\�

Page 219: Manual practico urgencias medicina interna muy bueno

���

&RQWURO�GH�VtQWRPDV�HQ�PHGLFLQD�SDOLDWLYD%HDWUL]�9LOD�0HL]RVR��&ULVWLQD�1HULQ�6iQFKH]��� '2/25

(VFDOHUD�$QDOJpVLFD�GH�OD�206�PRGLILFDGD��*yPH]�6DQFKR�D��3ULPHU�HVFDOyQ��DQDOJpVLFRV�SHULIpULFRV�QR�RSLRLGHV �$$6� 'RORU�GH�LQWHQVLGDG�OHYH�PRGHUDGD0X\�HIHFWLYR�HQ�GRORUHV�yVHRV'RVLV�Pi[LPD����JU���K,1<(635,0�25$/�)257(� ���JU� �3$5$&(7$02/�� &XDQGR�QR�VH�SXHGH�XWLOL]DU�$$6'RVLV�Pi[LPD����JU���K7(50$/*,1� R��())(5$/*$1� ����� �����PJ �0(7$0,=2/�� 0X\�HIHFWLYR�HQ�GRORUHV�YLVFHUDOHV'RVLV�Pi[LPD����JU�GtD12/27,/���FiSVXODV� �����PJ��VXSRVLWRULRV� ���JU��DPSROODV� ���JU �,%8352)(12��� %XHQD�DQDOJHVLD�HQ�SLFRV�GRORURVRV6H�SXHGHQ�GDU�KDVWD�WUHV�GRVLV FRQVHFXWLYDV�FRQ�LQWHUYDORV�GH�����KRUD'RVLV�Pi[LPD�������PJ�GtD(63,',)(1� VREUHV� ���������PJ��1(2%58)5(1� FiSVXODV�\�VREUHV� �����PJ� �1$352;(12�� 'RVLV�Pi[LPD������PJ

12�23,2,'(6r &RDQDOJpVLFRV�23,2,'(6�'e%,/(6r 12�RSLRLGHVr &RDQDOJpVLFRV

23,2'(6�327(17(6r 12�RSLRLGHV�r &RDQDOJpVLFRV� � �

$WHQFLyQ�D�OD�IDPLOLD���VRSRUWH�HPRFLRQDO���&RPXQLFDFLyQ

Page 220: Manual practico urgencias medicina interna muy bueno

���

1$3526<1���FiSVXODV��\�VREUHV� �����PJ��E��6HJXQGR�HVFDOyQ��DQDOJpVLFRV�RSLRLGHV GpELOHV �&2'(,1$� 'RVLV�Pi[LPD�����PJ���K&2'(,6$1� ����PJ�FiSVXOD �',+,'52&2'(Ë1$�� 'RVLV�Pi[LPD������PJ�����K&2178*(6,&� ������� �����PJ �75$0$'2/� $JRQLVWD�RSLRLGH�FRQ�DFFLyQ�QR�RSLRLGH'RVLV�Pi[LPD������PJ����K75$0$'2/��()*�FiSVXODV�GH����PJ$'2/217$� R�75$/*,2/���FiSVXODV� ����PJ��VXSRVLWRULRV�\�DPSROODV� �����PJ��6ROXFLyQ�GH����\����FF�����JRWDV� ����PJ�$'2/217$�5(7$5'�R�75$'21$/�5HWDUG��������������PJ���K �3$5$&(7$02/�����PJ����&2'(,1$����PJ�&2'�())(5$/*$1� HQ�FRPSULPLGRV�HIHUYHVFHQWHVF� 7HUFHU��HVFDOyQ��DQDOJpVLFRV�RSLRLGHV�SRWHQWHV �025),1$��(V�HO�IiUPDFR�GH�HOHFFLyQ$xDGLU�VLHPSUH�OD[DQWH�\�DQWLHPpWLFR ��'RVLV� FRPLHQ]R� KDELWXDO�� � ������ PJ�GtD� YtD� RUDO� �VHJ~Q� OD� GRVLV� SUHYLD� GH�RSLiFHRV�PHQRUHV��2UDO��/LEHUDFLyQ� LQPHGLDWD �GDU� FDGD���KRUDV��VLUYH�SDUD� LQLFLDU� 77��\�SDUD�GRVLV�H[WUDV62/8&,Ï1� 25$/� DO� ��� ��� PJ��� FF��� SUHSDUDFLyQ� HQ� IDUPDFLD��0DQWHQHU�HQ�QHYHUD6(95('2/����FS�GH����\����PJ(VTXHPD�GH�GRVLILFDFLyQ��SDFLHQWH�FRQ����PJ���K�GH�FRGHtQD�R�FRQ�����PJ���� K� GH� GLKLGURFRGHtQD�� VLQ� DOLYLR� GH� VX� GRORU�� VXVSHQGHU� HVWRV�IiUPDFRV�H�LQLFLDU�WUDWDPLHQWR�FRQ�6HYUHGRO�������PJ���K�KDVWD�SDVDU�D�067�HQ�LJXDO�GRVLV�GLDULD�/LEHUDFLyQ�UHWDUGDGD���GDU�FDGD����KRUDV��SDUD�77��GH�PDQWHQLPLHQWR067�&217,186����FS�GH������������������PJ6.(1$1����FiSVXODV�FRQ�PLFURJUiQXORV�������������� ����PJ6L� WUDWDPLHQWR� SUHYLR� FRQ�0)� SDUHQWHUDO�� FRPHQ]DU� FRQ� XQD� GRVLV� GH�067�LQFUHPHQWDGD�DO����������067����PJ���K�������������K����� ������K���������������K���������������K������������K��������������K3DUHQWHUDO�$GPLQLVWUDFLyQ�FDGD���KRUDV�R�HQ�SHUIXVLyQ�FRQWLQXD��,9��,0�y� 6%&�&ORUXUR�PyUILFR�DPSROODV�DO����FRQ��FF� ����PJ���FRQ���FF� ����PJ���FF� ����PJ

Page 221: Manual practico urgencias medicina interna muy bueno

���

��FF� �����PJ7UDQVGpUPLFRV�)(17$1,/2�� 3UHVHQWDFLyQ�HQ�SDUFKHV�WUDQVGpUPLFRV�TXH�VH�FDPELDQ�FDGD����KRUDV'852*(6,&�� ���������7DEOD�GH�HTXLYDOHQFLDV'26,6�(48,$1$/*e6,&$6�GH�PRUILQD0)�UHWDUGDGD�UiSLGD� ��� ����PJ����K� ����PJ���K�0)�RUDO�UHFWDO ��� ����PJ� ����PJ�0)�RUDO�VF ��� ����PJ� ����PJ�0)�RUDO�,9 ��� ����PJ� ����PJ�0)�RUDO�HSLGXUDO ���� ����PJ� ���PJ�0)�RUDO�PHWDGRQD�RUDO� ��� ����PJ� ���PJ�0)�RUDO�GLKLGURFRGHtQD� ���� ����PJ� �����PJ�0)�RUDO�WUDPDGRO ���� ����PJ� �����PJ�0)�RUDO�FRGHtQD ���� ����PJ� �����PJ�(TXLYDOHQFLDV�PRUILQD�YR�IHQWDQLOR�WUDQVGpUPLFR0RUILQD�RUDO��PJ�GtD� )HQWDQLOR�WUDQVGpUPLFR�� ���� ����� ����� ������ ������ ������ ������ ���

G��&RDQDOJpVLFRV)iUPDFRV�TXH� VH� SXHGHQ�XWLOL]DU� FRQMXQWDPHQWH�FRQ� ORV� DQDOJpVLFRV�GH�FXDOTXLHU�HVFDOyQ��$OJXQRV�VRQ�HO�WUDWDPLHQWR�GH�HOHFFLyQ�GH�DOJXQRV�WLSRV�GH�GRORU&257,&2,'(6�'(;$0(7$621$��)RUWHFRUWtQ���FS�GH���PJ�\�DPSROODV�GH������PJ���0(7,/35('1,62/21$���8UEDVRQ���6ROXPRGHUtQ��'()/$=$&257��=DPHQH���'H]DFRU��$17,'(35(6,926�$0,75,37,/,1$��7U\SWL]RO����FRPHQ]DU�FRQ����PJ��QRFKH'RORU�QHXURSiWLFR��FRQWLQXR��TXHPDQWH��GLVHVWpVLFR�'RORU�FRPSOLFDGR�FRQ�GHSUHVLyQ�R�LQVRPQLR

Page 222: Manual practico urgencias medicina interna muy bueno

���

(VSDVPRV�YHVLFDOHV��LQFRQWLQHQFLD�\�XUJHQFLD�PLFFLRQDO$17,&2198/6,9$17(6�&/21$=(3$0��5LYRWULO��9$/352$72�1D��'HSDNLQH��*$%$3(17,1$��1HXURQWLQ��&$5%$0$&(3,1$��7HJUHWRO����HO�PiV�XWLOL]DGR��'RORUHV�QHXURSiWLFRV��SDUHVWpVLFRV��ODQFLQDQWHV�FRQ�GLVHVWHVLD��WLSR�³SXxDODGD�LQWHUPLWHQWH´���&RPHQ]DU�FRQ�����PJ�QRFKH)(127,$=,1$6��&/253520$&,1$��/DUJDFWLO�����*RWDV����JRWD� ���PJ��&S�GH����\�����PJ�\�DPSROODV����PJ�� 12�VF�'RORU�SRU�WHQHVPR�UHFWDO��HVSDVPRV�YHVLFDOHV��GRVLV�EDMDV�QRFWXUQDV�����PJ�QRFKH�,QVRPQLR�UHEHOGH���� 6Ì1720$6�',*(67,926D��$QRUH[LD� 3URQyVWLFR�GH�YLGD�����PHV��'(;$0(7$621$�����PJ�GtD�R�35('1,62/21$�������PJ��GtD� 3URQyVWLFR�GH�YLGD�!���PHV� $FHWDWR�PHJHVWURO��0$<*$&(� R�0(*()5(1�������PJ������K�E��(VWUHxLPLHQWR '83+$/$&����FF;�35(3��� FF+2'(51$/����FF6L�QR�WROHUD�MDUDEHV��3856(1,'� ����FS������K�\�R�'8/&2/$;2� ��VXSRVLWRULR��QRFKHF�1DXVHDV�\�YyPLWRV�(VWUHxLPLHQWR /D[DQWHV2SLRLGHV� +DORSHULGRO� &ORUSURPD]LQD��ODUJDFWLO��6DOLFLODWRV�� 'DU�$$6�VROXEOH�5DQLWLGLQD�3RU�OD�WRV� $QWLWXVtJHQRV�(YLWDU�PXFROtWLFRV�LUULWDQWHV+LSHUWHQVLyQ�,& &RUWLFRLGHV�5DGLRWHUDSLD+LSHUFDOFHPLD +DORSHULGRO� ��77��KLSHUFDOFHPLD573��407� +DORSHULGRO� 0HWRFORSUDPLGD�&RUWLFRLGHV3VLFyJHQRV�� $QVLROtWLFRV�'LiORJR�FRQ�OD�IDPLOLD'URJDV�DQWLHPpWLFDV��� +,26&,1$��EXVFDSLQD���HVFRSRODPLQD��6G��9HUWLJLQRVR�R�YyPLWRV�GH�PRYLPLHQWR2EVWUXFFLyQ�LQWHVWLQDO'RVLV�������PJ���K��RUDO��VF�R�LY��GH�EXVFDSLQD��������PJ�����K��VF�R�LY��GH�HVFRSRODPLQD�

Page 223: Manual practico urgencias medicina interna muy bueno

���

�� +,'52;,&,1$��DWDUD[��$OWHUDFLRQHV�YHVWLEXODUHV,QGXFLGR�SRU�PRUILQD'RVLV�����PJ��K�\�����PJ�QRFKH�YtD�RUDO�� &/253520$&,1$��ODUJDFWLO��(Q�FiQFHU�DYDQ]DGR��WDPELpQ�HIHFWR�VHGDQWH(ILFD]�SDUD�YyPLWRV�LQGXFLGRV�SRU�PRUILQD'RVLV�FRPLHQ]R�����JRWDV�QRFKH�� +$/23(5,'2/��KDORSHULGRO��&RQWURO�GH�OD�HPHVLV�LQGXFLGD�SRU�PRUILQD��SHULRGR�YHQWDQD��FRQ�PiV�SRGHU�DQWLHPpWLFR�\�PHQRV�VHGDFLyQ�TXH�HO�ODUJDFWLO�77��GHO�6G��FRQIXVLRQDO��YyPLWRV�GH�RULJHQ�FHQWUDO��SRVW�573��SRVW407�\�SRVW�4JLFRV�'RVLV�GH�FRPLHQ]R�����JRWDV������PJ������DPS�VF�����PJ������K��� 0(72&/235$0,'$��SULPSHUDQ��$FFLyQ�SHULIpULFD��9yPLWRV�SRU�UHWUDVR�HQ�YDFLDPLHQWR����D�OD�PRUILQD'RVLV�����PJ������� K RUDO�R�VF� �URWDQGR�HO� OXJDU�GH�SXQFLyQ�\�QR�PiV�GH����K�HQ� LQIXVLyQ�FRQWLQXD��� '203(5,'21$��PRWLOLXP��0iV�SRWHQWH��PHQRV�HIHFWR�H[WUDSLUDPLGDO��YLGD�PHGLD�PiV�ODUJD���K��TXH�3ULPSHUDQ'RVLV��������PJ������K��YtD�RUDO�R�UHFWDO��� %(1=2',$&(3,1$6��GLDFHSDP��ORUDFHSDP��DOSUD]RODP�5HGXFHQ�DQVLHGDG�HQ�YyPLWRV�FRQ�LQIOXHQFLD FRUWLFDO��RORU��YLVWD��VREUHSURWHFFLyQ�IDPLOLDU��� &257,&2,'(6�(Q�YyPLWRV�FHQWUDOHV�SRU�407��HGHPD�FHUHEUDO�HWF��9yPLWRV�SRU�FRPSUHVLyQ�GH�YtVFHUDV�� 21'$16(17521��*5$1,6(7521��]RIUDQ���NLWULO��9yPLWRV�SRU�407�R�573$FFLyQ�FHQWUDO�\�SHULIpULFD����2EVWUXFFLyQ�,QWHVWLQDO77��4XLU~UJLFR��VHJ~Q�FRQGLFLRQHV�JHQHUDOHV�GHO�SDFLHQWH77��SDOLDWLYR�VLQWRPiWLFR��'(;$0(7$621$����PJ�GtD�,9�6&��LU�GLVPLQX\HQGR�GRVLV�VHJ~Q�UHVSXHVWD�025),1$+$/23(5,'2/�����PJ�������K�YtD�VF+,26&,1$��EXVFDSLQD�R�HVFRSRODPLQD����DPS���K�VF(QHPD�GH�OLPSLH]D���'LDUUHD� 7y[LFD��FDUEyQ�DFWLYDGR� 6HFXQGDULD�D�UDGLRWHUDSLD��$$6�R�1DSUR[HQR

Page 224: Manual practico urgencias medicina interna muy bueno

���

� 23,2,'(6��/RSHUDPLGD��)RUWDVHF����&RGHtQD�R�PRUILQD� (VWHDWRUUHD��3DQNUHyQ������FSV�FDGD�FRPLGD� 'LDUUHD�ELOLDU��&ROHVWLUDPLQD��/LVPRO�������VREUHV��GtD���6tQGURPH�GH�DSODVWDPLHQWR�JiVWULFR�� 'LHWD��SRFD�FDQWLGDG�YDULDV�YHFHV�DO�GtD� 0HWRFORSUDPLGD� &RUWLFRLGHV� 5DQLWLGLQD��KLGUy[LGR�GH�DOXPLQLR� 0RUILQD���%RFD�GRORURVD� (QMXDJXHV�FRQ�VROXFLyQ�DQHVWpVLFD��QR�LQJHULU��JXDUGDU�HQ�QHYHUD�QR PiV�GH����K�����OLWUR�GH�PDQ]DQLOOD����IUDVFR�GH�0\FRVWDWLQ�������DPSROODV�GH�6FDQGLFDLQ����%RFD�VpSWLFD�\�VHFD� /DYDGRV�FRQ�2UDOGLQH�� GLOXLGR�HQ�DJXD� 6ROXFLyQ�GHVEULGDQWH SDUD�SODFD�GH�GHWULWXV��QR�LQJHULU��VH�SXHGH�DSOLFDU�FRQ�WRUXQGD�������GH�DJXD������+�2�����FXFKDUDGD�GH�ELFDUERQDWR(QMXDJDU�GXUDQWH�������VHJ��6L�VH�SXHGH��DxDGLU�XQDV�JRWDV�GH�OLPyQ��6L�UHVXOWD�PROHVWR��VH�SXHGH�GLVPLQXLU�OD�FDQWLGDG�GH�+�2����&DQGLGLDVLV�RUDO�� 0\FRVWDWLQ� �� �� FXFKDUDGD� GH� VROXFLyQ� �� �� KRUDV� �~WLO� FRQJHODU� HQ� FXELWRV� GH� KLHOR� SDUD�FKXSDU�� 'LIOXFDQ��������� PJ����FS�GtD�GXUDQWH���GtDV�����7HQHVPR�UHFWDO�%XVFDSLQD� ����FS����K���/DUJDFWLO���������JRWDV���QRFKH��$GRORQWD�����FS�����KRUDV��VL�GRORU�DXPHQWDU�KDVWD�FDGD���KRUDV��� 6Ì1720$6�85,1$5,26D��,QFRQWLQHQFLD� 7U\SWL]RO���������PJ�QRFKH�� 1DSUR[\Q�������PJ���KE��(VSDVPR�9HVLFDO� 7U\SWL]RO���������PJ����K�� %XVFDSLQD� ����FS����K�� /DUJDFWLO������JRWDV���QRFKH

Page 225: Manual practico urgencias medicina interna muy bueno

���

� 1DSUR[\Q�������PJ���KF��7HQHVPR�8ULQDULR� 35$=26,1��0LQLSUHV����HO�GH�HOHFFLyQ���������PJ�������K���HPSH]DU�FRQ�GRVLV�QRFWXUQD��� 3,5,'267,*0,1$� DQWLFROLQHVWHUiVLFR��0HVWLQyQ� ����������PJ�����K�YtD�RUDO�� 6RQGDMH�YHVLFDO��� 6Ì1720$6�1(85236,&2/Ð*,&26D��,QVRPQLR� 0,'$=2/$0��'RUPLFXP����DFFLyQ�FRUWD� /25$=(3$0��2UILGDO����DFFLyQ�LQWHUPHGLD� ',$=(3$0��9DOLXP����DFFLyQ�SURORQJDGDE� (VWDGR�&RQIXVLRQDO�$JXGR� +$/23(5,'2/����GH�HOHFFLyQ��0iV�~WLO�FXDQGR�HO�SDFLHQWH�SUHVHQWD�DOXFLQDFLRQHV�\�R�LGHDFLyQ�SDUDQRLGH��'RVLV�LQLFLDO����PJ�92���QRFKH��0DQWHQLPLHQWR���������PJ�GtD�HQ�����WRPDV��HQ�DQFLDQRV�GRVLV�PiV�EDMDV���(Q�WXPRU�FHUHEUDO��DVRFLDGR�D�XQ�DQWLFRQYXOVLYDQWH�� /$5*$&7,/�� ����&XDQGR�VH�UHTXLHUH�XQ�HIHFWR�VHGDWLYR��'RVLV�LQLFLDO��������PJ����K�92���KDVWD�����PJ�92F��$QVLHGDG� 3ULPHUD�HOHFFLyQ��',$=(3$0���9DOLXP������'RVLV�GH�����PJ�QRFKH�92��KDVWD�GRVLV�WRWDOHV�GLDULDV�GH�������PJ�92�HQ���WRPDV� 6HJXQGD�HOHFFLyQ���/25$=(3$0����2UILGDO�����'RVLV�GH�����PJ�92�H�LU�DXPHQWDQGR�KDVWD����PJ�GtD�HQ���WRPDV� &RQ�QDXVHDV�\�YyPLWRV��+DORSHULGRO���/DUJDFWLO�� &RQ�LQVRPQLR��'RUPLFXP�� &RQ�VtQWRPDV�VRPiWLFRV��6XPLDO���� 6Ì1720$6�5(63,5$725,26D��'LVQHD� ',$=(3$0�������PJ�������92��VHJ~Q�UHVSXHVWD�GHO�SDFLHQWH��9DORUDU�YtD�UHFWDO� /25$=(3$0��VO� 025),1$�� �6L�\D�OD�HVWDED�WRPDQGR��DXPHQWDU�OD�GRVLV�HQ�XQ���� �6L�QR�OD�WRPDED����PJ���K�H�LU�DXPHQWDQGR�XQ�����KDVWD�REWHQHU�OD�UHVSXHVWD�GHVHDGD�� &257,&2,'(6���'H[DPHWDVRQD������PJ�92��8UEDVyQ������PJ�GtD

Page 226: Manual practico urgencias medicina interna muy bueno

���

'LVQHD�DJXGD� 0RUILQD����PJ�6%&$XPHQWDU�OD�GRVLV�HQ�XQ����'RUPLFXP����PJ�6%&E��7RV�� +~PHGD�� �&DSD]�GH�WRVHU����1�$&(7,/�&,67(,1$ �,QFDSD] GH�WRVHU�� &2'(,1$�������PJ����K',+,'52&2'(,1$�����PJ����K025),1$� � � �����PJ� ���K� � �067� ����PJ����K� +,26&,1$����������PJ���K��VF�� 6HFD��&2'(,1$����PJ� ���PJ�GH�PRUILQD�SDUD�HIHFWR�DQWLWXVtJHQR�',+,'52&2'(,1$025),1$�£1R�PH]FODU�RSLRLGHV���� 6L�QR�KD\�GRORU�QL�GLVQHD��'(;7520(752)$12��5RPLODU��F��+LSR7UDWDPLHQWR�VHJ~Q�FDXVD�� 'LVWHQVLyQ�JiVWULFD��35,03(5$1� ���FF������K0$$/2;� ���FF��GHVSXpV�GH�ODV�FRPLGDV� 7XPRU�FHUHEUDO��&257,&2,'(6� ,QIHFFLyQ��$17,%,Ï7,&266XSUHVLyQ�FHQWUDO�GHO�UHIOHMR�GHO�KLSR��/$5*$&7,/� ������PJ�����K9$/352$72�1D�����������PJ�DO�DFRVWDUVH��VL�WXPRU�FHUHEUDO�F��+HPRSWLVLV� /HYH�\�PRGHUDGD���%ORTXHDU�OD�WRV��$F��7UDQH[iPLFR�R�DPLQRFDSURLFR��573� 0DVLYD��VHGDFLyQG��(VWHUWRUHV� 'HF~ELWR�ODWHUDO�FRQ�OD�FDEH]D�OLJHUDPHQWH�LQFOLQDGD�KDFLD�GHODQWH� +,26&,1$� %XVFDSLQD������PJ����DPS����K�VF(VFRSRODPLQD�������PJ����DPS�����K��VF�� 6('$&,Ð1� &/25852�025),&2� 0,'$=2/$0��'RUPLFXP����������PJ�����K� (6&232/$0,1$��GRVLV�Pi[LPD���PJ�����DPSROODV�� /(923520$=,1$��6LQRJiQ��

Page 227: Manual practico urgencias medicina interna muy bueno

���

�6HGDFLyQ�GH�³HPHUJHQFLD´��'RUPLFXP� ������PJ�,9�� 27526�6Ì1'520(6D��6tQGURPH�GH�&RPSUHVLyQ�PHGXODU� '(;$0(7$621$������PJ�,9�\�OXHJR����PJ��K�,9�GXUDQWH���GtDV��'HVSXpV���PJ���K� 573�� /DPLQHFWRPtD���6L SURJUHVD�D�SHVDU�GH�573�\�GRVLV�DOWDV�GH�';0��5HFLGLYD�WUDV�OD�GRVLV�Pi[LPD�GH�573��0HWiVWDVLV�VROLWDULD��'LDJQyVWLFR�GXGRVR� (Q�HQFDPDGR�VyOR�TXLWDU�HO�GRORUE��6tQGURPH�GH�FRPSUHVLyQ�YHQD�FDYD�VXSHULRU� 573� 407� '(;$0(7$621$�D�DOWDV�GRVLVF��+LSHUFDOFHPLD� (Q�ORV�FDVRV�GH�KLSHUFDOFHPLD�VHYHUD��SUHJXQWDUQRV�VL�HVWi�MXVWLILFDGD�OD�FRUUHFFLyQ�VHJ~Q�OD�VLWXDFLyQ�GHO�SDFLHQWH�

Page 228: Manual practico urgencias medicina interna muy bueno

���

$OJRULWPR�SDUD�HO�WUDWDPLHQWR�FRQ�PyUILFRV

,QLFLR�FXDQGR�'RVLV�Pi[LPDV�GHO�VHJXQGR�HVFDOyQ�\�SHUVLVWH�GRORU'RORU�PX\�LQWHQVR�GHVGH�HO�SULQFLSLR6XVSHQGHU� RSLiFHRV� GpELOHV�� 6H�SXHGHQ�\�GHEHQ�GH�PDQWHQHU� IiUPDFRV�GHO�SULPHU�HVFDOyQ�\�FRDQDOJpVLFRV�VL�ORV�OOHYDED�(PSH]DU�FRQ�PRUILQD�GH�OLEHUDFLyQ�LQPHGLDWD��6HYUHGRO�� ���PJ���KRUDV�x (Q�DQFLDQRV�PX\�GHELOLWDGRV�HPSH]DU�FRQ���PJ���KRUDV�x /D� GRVLV� QRFWXUQD� GH� ODV� ��� KRUDV� VH�GXSOLFDUi�SDUD�HYLWDU� GHVSHUWDU� DO� HQIHUPR�GXUDQWH� OD�QRFKH�x $xDGLU�VLHPSUH�XQ�DQWLHPpWLFR�ORV SULPHURV�GtDV��\�VLHPSUH�XQ�OD[DQWH�x 6L�GRORU�LQWHQVR�GDU�GRVLV�H[WUDV �UHVFDWH� ����������GH�OD�GRVLV�FRUUHVSRQGLHQWH�D���KRUDV� �����GH�OD�GRVLV�WRWDO�GLDULD�x 6L�!���LQWHUGRVLV�H[WUDV��GXSOLFDU�OD�GRVLV�GH�PRUILQD�HQ�OD�WRPD�VLJXLHQWH6RPQROHQFLD�H[FHVLYD   GRVLV�XQ����

&RQWURO1R�FRQWURO��GRVLV�XQ��������PJ���KRUDV�

3DVDU�D�067�����PJ����K��'RVLV�H[WUDV��UHVFDWH��FRQ�VHYUHGRO�6L�LQWROHUDQFLD�RUDO��LPSRVLEOH�GHJOXFLyQ��QDXVHDV�YyPLWRV�SHUVLVWHQWHV��HWF���JUDQ�HVWDGR�FRQIXVLRQDO�R�DJRQtD3DVDU�D�PRUILQD�VXEFXWiQHD����GH�OD�GRVLV�RUDO�SUHYLD� (Q� SHUIXVLyQ� FRQWLQXD�FRQ�LQIXVRU(Q�ERORV���KRUDV

Page 229: Manual practico urgencias medicina interna muy bueno

���

$YLVR/RV� DXWRUHV� GH� HVWRV� �3URWRFRORV� GHO� 6HUYLFLR� GH� 0HGLFLQD� ,QWHUQD� GHO�&RPSOHMR�+RVSLWDODULR�GH�$OEDFHWH� KDQ�SXHVWR�HVSHFLDO�DWHQFLyQ�HQ�TXH�ODV�SDXWDV�GH�WUDWDPLHQWR�\�ODV�GRVLV�GH�ORV�IiUPDFRV�GHVFULWRV�HVWpQ�GH�DFXHUGR�FRQ�ODV�QRUPDV�DFHSWDGDV�HQ�HO�PRPHQWR�GH�VX�SXEOLFDFLyQ�/RV� SURGXFWRV� FLWDGRV� HQ� HVWH� PDQXDO� GHEHUiQ� XWLOL]DUVH� FRQIRUPH� D� ODV�UHFRPHQGDFLRQHV�GHO� IDEULFDQWH��1R�SRGHPRV�KDFHUQRV�UHVSRQVDEOHV�GH�ODV�FRQVHFXHQFLDV�TXH�SXHGDQ�GHULYDUVH�GH�FXDOTXLHU�HUURU�HQ�HO�WH[WR�TXH�KD\D�SRGLGR�SDVDU�LQDGYHUWLGR