Revista clínica española
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Revista clínica española · Sep 2020
ReviewPulmonary embolism treatment. Detection of chronic thromboembolic pulmonary hypertension.
The correct stratification of pulmonary embolism risk (PE) is essential for decision-making, regarding treatment and defining the patient's place of admission. In high-risk PE, urgent re-establishment of pulmonary circulation and admission to a critical unit is required. The reperfusion treatment of choice is systemic thrombolysis, although in certain situations, especially when there is a contraindication for it, we will evaluate a surgical embolectomy or one of the catheter-guided therapies. ⋯ In cases of PE with cardiorespiratory arrest and / or cardiogenic shock, whenever available at our center, we must consider the indication of extracorporeal membrane oxygenation. The recent creation of PE response teams (PERT team), have meant an improvement in the care of patients with intermediate-high and high risk PE. During the follow-up of patients with PE, it is essential to perform a correct screening of chronic thromboembolic pulmonary hypertension, in order to perform a correct diagnostic and therapeutic approach.
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Revista clínica española · Aug 2020
Burnout syndrome in internal medicine specialists and factors associated with its onset.
Burnout is a psychosocial syndrome caused by stressful working conditions and affects 30-60% of medical personnel. The aim of this study was to assess the burnout rate of Spanish internists and the factors related to its onset. ⋯ Burnout syndrome affects 33.4% of internists in Spain, and its onset is independently related with age, poor work environment, a lack of professional progress, insufficient financial remuneration and experiencing threats by patients or colleagues.
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In the prevention of cardiovascular disease, determining the cardiovascular risk is the cornerstone of preventive interventions. In this risk estimation, detecting subclinical cardiovascular damage represents a complementary tool to classic stratification based on risk factors. ⋯ The clinical practice guidelines for cardiovascular risk prevention recommend the use of ultrasonography for assessing atheromatous plaques and left ventricular hypertrophy as modulators of cardiovascular risk. Ultrasonography also has other relevant applications in cardiovascular risk, including the diagnosis of abdominal aortic aneurysms, kidney assessments for patients with chronic kidney disease or suspected secondary arterial hypertension and the detection of steatosis when nonalcoholic fatty liver disease is suspected.