Boletín de la Asociación Médica de Puerto Rico
-
This is a case of a 34 years old male Hispanic patient with history of AIDS who presented to the ER with severe right lower quadrant abdominal pain of three days of evolution, associated with fever, chills, nausea, vomiting, watery diarrhea, weakness and general malaise. Acute appendicitis, Clostridium Difficile Colitis and Ischemic Colitis were the most important clinical conditions to consider in the differential diagnosis. Abdominal CT with IV contrast demonstrated thickening of the ascending colonic wall a finding highly suggestive of a transmural inflammatory necrotizing colitis of infectious etiology. ⋯ It is important to include it in the differential diagnosis of an HIV/AIDS patient that presents with RLQ pain and fever. Contrast enhanced CT-Scan is mandatory to establish the diagnosis and to differentiate typhlitis from other intra-abdominal pathologies. Therapy needs to be individualized.
-
This is a case of 49 year-old-female with left lower quadrant pain. Initial diagnosis of acute diverticulitis entertained and treated accordingly. ⋯ Epiploic appendagitis is commonly misdiagnosed as diverticulitis and appendicitis. Non-invasive studies may lead to early diagnosis avoiding unnecessary hospitalizations, antibiotic therapy and surgical intervention.
-
Sepsis is a fairly common disease process in our population. Even with aggressive treatment, morbidity and mortality remain high. The initial evaluation of these patients with sepsis, severe sepsis and septic shock may increase survival. ⋯ Recent studies have shown that with the systematic use of aggressive fluid expansion, broad-spectrum antibiotics as well as inotropes and vasopressors a decrease in mortality may be achieved. Our efforts must be geared towards a structured early diagnosis and treatment. With the right tools and approach we will be able to keep ourselves ahead of this condition in order to improve the health of our fellow patients in Puerto Rico and the rest of the world.
-
The Emergency Severity Index (ESI) is a five-level emergency department triage algorithm that provides stratification of patients on the basis of acuity and resource needs, being ESI-1 the highest acuity and ESI-5 the lesser. The ESI triage system was recently adopted at our Emergency Department. We suspect higher acuity patients are facing inappropriate stratification and thus waiting longer to be managed and stabilized. ⋯ The ESI assigned upon arrival correlated with the median waiting time, exposing undertriaged patients to longer waiting times.
-
Historical Article
[The University of Puerto Rico Emergency Medicine Program: 15th anniversary, its history and contribution to health care in Puerto Rico].
Emergency medicine is a newly created specialty in Puerto Rico. The first training program began in 1977. Unfortunately this program was decertified by ACGME in 30 July 30 1993. ⋯ Approximately 25% of emergency rooms directors in PR are graduates. About 27% of graduates have subspecialties. It is also important to note that graduates of the program have helped to improve the quality of health care offered in emergency rooms in the country.