Medicina intensiva
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Second level therapeutic maneuvres for controlling intracranial hypertension (ICH) proposed by the European Brain Injury Consortium and the American Association of Neurological Surgeons include barbiturates, moderate hypothermia and more recently the decompressive craniectomy (DC). In most patients, ICP can be maintained below 25 mmHg after a DC. However, the exact effect of DC on brain oxygenation (PtiO2) still unclear. From our point of view the ptIo2 monitoring with the probe located in the healthy area of the most severely damaged cerebral hemisphere is not only a important tool for timing craniectomy in the future but also for evaluating the therapeutic effectivity of DC.
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To analyze casualties from firearm and explosives injuries who were admitted to the Intensive Care Unit in the Spanish ROLE-2E from December 2005 to December 2008 and to evaluate which damaging agent had produced the highest morbidity-mortality in our series using score indices with anatomical base (ISS and NISS). ⋯ No significant differences were observed in the need for admission and stay in the ICU according to the damaging agent. The importance of the strategy, care and logistics of the intensive care military physician in Intensive Medicine in the Operating Room in Afghanistan is stressed.
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The clinical case of a 19-year old woman with the clinical criteria of Cytomegalovirus (CMV) viral associated with Hemophagocytic syndrome (VAHS) is presented. The clinical outcome was poor and rapidly progressive, ending in exitus letalis. The principal concepts and characteristics of the Hemophagocytic syndrome are discussed, stressing the current consensus rules and the variations in management according to international guidelines.
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Letter Case Reports
[Septic shock due to primary myonecrosis of psoas].