Medicina intensiva
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Spain has a rate of 34.4 donors per million population, making it the country with the highest rate of organ donation all over the world. In spite of these values, need of lungs for transplantation is always greater than the number of organs obtained. ⋯ In all the potential lung donors, the Apnea Test with CPAP should be done and the criteria for the donation of the lung under ideal conditions and with expanded criteria lung donors are reviewed. The protocol of aggressive maintenance including a protective ventilation strategy, restricted fluid intake, use of prophylactic antibiotics, corticosteroids and the systematic use of measures aimed at avoiding alveolar collapse together with maneuvers aimed at achieving better lung recruitment can improve the management of the lung donor and obtain a greater number of organs for transplantation.
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Controlled Clinical Trial
[Enoxaparin vs. non-fractionated heparin in primary angioplasty of acute myocardial infarction].
The objective of this study is to compare the effectiveness of intravenous enoxaparin (ENX) and Non-fractionated Heparin (NFH) in primary angioplasty (PA) of acute myocardial infarction (PA-AMI). ⋯ Primary angioplasty can be safely sued with the intravenous administration of ENX, no significant differences being found between both treatments in mortality and bleeding complications.
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Blood derivatives are clinical products that are currently used, for which their lack of availability, clinical relevance and presence of associated side effect that make it necessary to known and evaluate their utility rigorously are characteristic. ⋯ Strong consideration must be made about transfusion and its over use should be avoided. For this purpose, educational guidelines and consensus meetings are necessary to establish recommendations on the use of blood products and their pharmacological alternatives.
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Interventricular septum rupture following blunt chest trauma is a rare cardiac injury that sometimes is difficult to diagnose. It has a high mortality rate, especially when in cases of hemodynamic instability requiring early surgical repair. ⋯ He was diagnosed of traumatic rupture of interventricular septum that had not been detected in the initial echocardiography, but was suspected after the right heart catheterism. Urgent cardiac surgery was performed 72 hours later because of hemodynamic instability.