Ciencias de la Salud
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Item Embarazo Ectópico Abdominal y Shock Hipovolémico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-11-01) Aucapiña Rodríguez, Luz Cecilia; Gavilanes Sáenz, Víctor Patricio Dr.The abdominal ectopic pregnancy is an exceptional anomaly that represents 1% of ectopic pregnancies; it is associated with high morbidity and mortality, maternal and fetal. The risk of maternal mortality is 7 to 8 times greater than a tubal pregnancy and it is 90 ectopic times greater than an intrauterine pregnancy. This is a pathology of difficult diagnosis that, in many cases, belatedly established and it is considered an obstetric emergency. Female patient of 23 years old who presents an abdominal pain of 2 months evolution and amenorrhea of approximately 17 weeks, she is admitted to Hospital General Puyo by abdominal pain in study and hypovolemic shock, βHCG is performed with positive result and eco FAST showing free liquid in abdominal cavity and an appearance of embryo outside the uterine cavity with movement, so it is considered a probable accident ectopic pregnancy. On physical examination is hypotensive, tachycardic with generalized pallor, Algic facies, oral mucosal semihumid. An Emergency exploratory laparotomy with identification of abdominal ectopic pregnancy, salpingectomy, right oophorectomy, partial omentectomy is performed. Also, compensation with blood products for trans-surgical cardiovascular instability is indicated. The patient is transferred to intensive therapy to control and manage cardiovascular. Presenting a satisfactory evolution and at 17 hours of admission she is discharged to continue handling by gynecology and obstetrics where she remains hospitalized 2 days and sent homeItem Embarazo Ectópico Accidentado mas Shock Hipovolémico(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Hidalgo Noroña, Tránsito Maricela; González Guevara, Laura Catalina Dra.Ectopic pregnancy is defined as the implantation of the fertilized egg outside the uterine cavity. In Ecuador, according to data released by the INEC in 2014, ectopic pregnancy is the fourth leading cause of maternal death with a result of 6.02%. The most common location of ectopic pregnancy is in the fallopian tube. There are multiple factors related to ectopic pregnancy and the prevalence of such factors is increasing, it correlates with a history of sexually transmitted diseases, ectopic pregnancy, tubal surgery, adult women and snuff disease. It is one of the most important causes of acute abdomen in obstetrics and despite progress in diagnostic and therapeutic methods, ectopic pregnancy continues to represent worldwide problem of maternal morbidity and mortality in the first trimester of pregnancy. This case describes a female patient of 29 years old with no medical history of importance, date of last menstruation know, go to the emergency room because of abdominal pain for about 2 hours, accompanied by tachycardia, hypotension and generalized pallor. Laboratory tests which report leukocytosis, decreased hemoglobin, hematocrit and positive BHCG are made. In addition to reporting abdominal ultrasound performed rugged ectopic pregnancy. Patient is assessed by emergency obstetric resulting test income is decided to surgical center for emergency laparotomy for ectopic pregnancy injured more hypovolemic shock finding free bleeding cavity more clots approximately 3000 milliliters, is administered crystalloid and packed red blood cells plus thereby controls the patient hemodynamically. Approximately 24 hours after the patient has difficulty breathing and chest x-ray desaturation is valued by internal medicine and cardiology who diagnostic acute pulmonary edema, treatment is established it is done. Patient course and is discharged 5 days later. Despite scientific advances in diagnosis, prevention and treatment of this disease is still left unnoticed patients of this kind, either suspicion at the time of care, delay in referral to areas of higher resolution, or perhaps for lack diagnostic tools that enable us to reach a concrete analysis quick and timely manner, it is important to consider the relevance of the investigation of this case report that aims to create a clear and precise understanding of the diagnosis and management of ectopic pregnancy for early intervention, for the benefit of the patient.Item Óbito Fetal y Shock Hipovolémico Secundario a Desprendimiento Normoplacentario(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Barragán Quishpe, Fanny Gabriela; Mera Ramos, Gerardo Vinicio Dr.Placental abruption or placental abruption refers to bleeding in the decidual-placental interface that causes the release of partial or total placental, the main clinical findings are bleeding associated with abdominal pain or severe and persistent dorsal, sustained uterine contraction and signs of suffering fetal.6 In many cases the source of bleeding is a small blood vessel or feto-placental vessel breaks, where the result is that the decidual progressively dissected hematoma formed, leaving a thin layer in contact with the maternal face the placenta and the rest remains attached to the myometrium, the detached part of the placenta is unable to exchange gases and nutrients, when the remaining fetoplacental unit is not able to compensate for this loss, is compromised. In 5% of pregnancies occur bleeding before delivery and 1.2% are abruption.6-8 The placental abruption is an important cause of morbidity and mortality maternal and perinatal. The perinatal mortality rate is approximately 20%. In Ecuador according to the Ecuadorian Institute of Statistics and Censuses in 2013 3.23% of maternal deaths was caused by the placental abruption.12 The main risk factors are a history of abruption, hypertensive disorders of pregnancy, advanced maternal age, multiparity, premature labor and premature rupture of membranes due to inflammation or sudden decompression of the uterus, alcohol, snuff and cocaine among otros.15 The following case describes a female patient 25 years old with surgical history, two previous cesareans with no medical history of importance and gynecological and obstetrical history: menarche at age 11, regular menstrual cycles for 5 days, beginning the sexual life 15, pregnang: 3 (with the current) vaginal: 0 cesareans: 2 abortions: 0, course with urinary tract infection in pregnancy, with last menstrual period (LMP): 05 / Aug / 2015. Current Gestation: Pregnancy 39.2 weeks LMP, the patient comes aforementioned Health Center La Mana by dark red vaginal bleeding present in moderate amount, no odor, no apparent cause of approximately 12 hours of evolution followed by abdominal pain contraction type, progressive intensity that radiates lumbar region of about 3 hours of evolution, along with signs and symptoms of hypovolemic shock due to haemorrhage (tachycardia, hypotension and generalized pallor), with this clinical picture is received in gynecologic Emergencies Provincial General Hospital in Latacunga, he decided to send him to proceed with cesarean surgery is performed showing dead male product and complete abruption. The blood loss is offset by the administration of crystalloid, colloid, packed red blood cells and plasma. As a complication of surgery presents difficult control of hemostasis upper right pedicle, difficult removal of the cervix, friable tissue, uterine atony, subtotal hysterectomy is performed. In its evolution at 24 hours post-surgery blood count which draws attention hemoglobin 7.4 mg / dl and hematocrit of 23.2%, which is why they decide to spend two more packed red blood cells is performed. The patient remained hospitalized for seven days, recovering their hemoglobin which reached the fourth day, hemodynamically stable without symptoms or signs of possible complications are decided high. So we can say that the patient predisposing risk factors that could cause abruption being multiparity, smoking and alcoholism and the failure in planning and antenatal care unit primary care found. Within the management of hemorrhagic shock we can say that was indicated to restore blood volume to the patient agrees to set standards.Item Óbito Fetal y Shock Hipovolémico Secundario a Desprendimiento Normoplacentario(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Barragán Quishpe, Fanny Gabriela; Mera Ramos, Gerardo Vinicio Dr.Placental abruption or placental abruption refers to bleeding in the decidual-placental interface that causes the release of partial or total placental, the main clinical findings are bleeding associated with abdominal pain or severe and persistent dorsal, sustained uterine contraction and signs of suffering fetal.6 In many cases the source of bleeding is a small blood vessel or feto-placental vessel breaks, where the result is that the decidual progressively dissected hematoma formed, leaving a thin layer in contact with the maternal face the placenta and the rest remains attached to the myometrium, the detached part of the placenta is unable to exchange gases and nutrients, when the remaining fetoplacental unit is not able to compensate for this loss, is compromised. In 5% of pregnancies occur bleeding before delivery and 1.2% are abruption.6-8 The placental abruption is an important cause of morbidity and mortality maternal and perinatal. The perinatal mortality rate is approximately 20%. In Ecuador according to the Ecuadorian Institute of Statistics and Censuses in 2013 3.23% of maternal deaths was caused by the placental abruption.12 The main risk factors are a history of abruption, hypertensive disorders of pregnancy, advanced maternal age, multiparity, premature labor and premature rupture of membranes due to inflammation or sudden decompression of the uterus, alcohol, snuff and cocaine among otros.15 The following case describes a female patient 25 years old with surgical history, two previous cesareans with no medical history of importance and gynecological and obstetrical history: menarche at age 11, regular menstrual cycles for 5 days, beginning the sexual life 15, pregnang: 3 (with the current) vaginal: 0 cesareans: 2 abortions: 0, course with urinary tract infection in pregnancy, with last menstrual period (LMP): 05 / Aug / 2015. Current Gestation: Pregnancy 39.2 weeks LMP, the patient comes aforementioned Health Center La Mana by dark red vaginal bleeding present in moderate amount, no odor, no apparent cause of approximately 12 hours of evolution followed by abdominal pain contraction type, progressive intensity that radiates lumbar region of about 3 hours of evolution, along with signs and symptoms of hypovolemic shock due to haemorrhage (tachycardia, hypotension and generalized pallor), with this clinical picture is received in gynecologic Emergencies Provincial General Hospital in Latacunga, he decided to send him to proceed with cesarean surgery is performed showing dead male product and complete abruption. The blood loss is offset by the administration of crystalloid, colloid, packed red blood cells and plasma. As a complication of surgery presents difficult control of hemostasis upper right pedicle, difficult removal of the cervix, friable tissue, uterine atony, subtotal hysterectomy is performed. In its evolution at 24 hours post-surgery blood count which draws attention hemoglobin 7.4 mg / dl and hematocrit of 23.2%, which is why they decide to spend two more packed red blood cells is performed. The patient remained hospitalized for seven days, recovering their hemoglobin which reached the fourth day, hemodynamically stable without symptoms or signs of possible complications are decided high. So we can say that the patient predisposing risk factors that could cause abruption being multiparity, smoking and alcoholism and the failure in planning and antenatal care unit primary care found. Within the management of hemorrhagic shock we can say that was indicated to restore blood volume to the patient agrees to set standards.Item Shock Séptico Secundario a Neumonía(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Moreno Caballeros, Evelyn Nataly; Lozano Heredia, Rebeca Dra. Esp.Female patient 11 months old emergency attends with his mother which refers thermal rise, irritability. Physical examination saturation of 84% to ambient air temperature 35.9 °, rhythmic heart sounds no heart murmurs, vesicular murmur preserved with diagnostic impression of acute respiratory infection to rule out community-acquired pneumonia. You are asking for a standard chest radiography, paracetamol 20 drops every 8 hours and return with X-ray results, returns at 15 hours referring watery rhinorrhea, but patient leaves the office while attention was performed. Attends private clinic where they treat the patient pathology but unfavorably evolves so is transferred to Hospital Básico IESS Latacunga. Pneumonia is a widespread localized infection or lung parenchyma with predominantly alveolar commitment, is a frequent cause of morbidity and mortality especially in populations with high risk factors such as: low socioeconomic status, low birth weight, absence of breastfeeding, the lower age, lack of immunizations, intra and extra home pollution, etc. Under these conditions there is a predominance of bacterial causes and cases of greater severity, in the winter months. So it is necessary to diagnose and treat in time to avoid complications. Finally we know for a diagnosis and make timely treatment of pneumonia have diagnostic criteria, additional tests which help us to avoid the complications of this disease and death in this case.Item Shock Hipovolémico Secundario a Hemorragia Obstétrica por Inversión Uterina en Sala de Partos(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Toalombo Eugenio, Graciela Estefanía; González Guevara, Laura Catalina Dra. ESP.Postpartum hemorrhage, mostly caused by uterine atony is the most common preventable cause of maternal mortality worldwide, and the second leading cause of maternal death in Ecuador. 4-6 Among the causes of postpartum hemorrhage is uterine inversion, a rare and serious complication that occurs in the third stage of labor, has an incidence of 1: 20,000 -1: 25,000 partos.13 This case is a female patient of 22 years old, born in Santo Domingo and living in Puyo, without personal pathological or family history of importance, is in her second pregnancy of 40.1 weeks last menstrual period (LMP), during his pregnancy was hospitalized for threatened preterm delivery more urinary tract infection. Go to gynecological emergencies present labor decided to send him to proceed to cefalovaginal birth, left in spontaneous evolution, resulting in childbirth at three hours and forty-five minutes, I received newborn anthropometric parameters of a newborn macrosomia with good general condition, in the period lasts more than 30 minutes delivery by retained placenta, is extracted manually incompletely, the vaginal touch incomplete uterine inversion palpating under short general anesthesia review is done and reduced manually uterus with maneuver Johnson, curettage and Bakri balloon placement is done. Patient signs of moderate hypovolemic shock with a loss of approximately 2000 milliliters blood crystalloid solutions so more globular packages are administered and plasma cool to recover blood volume; warrants admission to ICU, hypovolemic shock is persistent, a new uterine inversion, which is determined with the help of relaxation and bleeding, the conditions of the user warrant mechanical ventilatory support invasive, remains under observation without ruling hysterectomy evidence . Remains in ICU for 3 days thereafter to monitor their discharge is decided by the department of gynecology where it is kept under observation without improving clinical symptoms or signs of possible complications and decides high. In its evolution goes for outpatient control being in good general condition.Item “criterios aplicados comparadamente para el manejo de pacientes con shock hipovolémico de origen obstétrico admitidas en la unidad de terapia intensiva del hospital regional docente ambato, durante el periodo enero – agosto 2012”.(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2016-02-01) Miranda Solís, Edwin Marcelo; Dr. Mera Ramos, Gerardo Vinicio