Propuesta de abordaje en la evaluación del paciente hospitalizado con ultrasonido en el punto de atención (POCUS) para el diagnóstico diferencial del shock indiferenciado
Fecha
2023-05-17
Tipo
tesis
Autores
Granados Apú, Joshua
Título de la revista
ISSN de la revista
Título del volumen
Editor
Resumen
El ultrasonido en el punto de atencio n (POCUS) es una tecnologí a que ayuda a los
me dicos especialistas y no especialistas en el abordaje de diferentes patologí as, realizar
procedimiento con mayor seguridad y disminucio n de complicaciones.
xv
El principio del POCUS es responder una pregunta concreta al pie de la cama del
paciente, confirmar o descartar dicha hipo tesis y poder con la mayor prontitud de lo
posible avanzar en el abordaje diagno stico y terape utico.
Las ventajas del POCUS es que el aprendizaje sea sencillo y evaluable, que el
estudio pueda ser repetido con poca variabilidad entre los operadores y que los mismos
este n disponibles en cualquier momento.
El estado de shock indiferenciado es la manifestacio n inicial de muchas
patologí as que, dentro del abordaje inicial, no es tan evidente mediate la historia clí nica,
examen fí sico y estudios complementarios que se tiene a mano con prontitud, el
ultrasonido mejora la toma de decisiones al pie de la cama del paciente y a la postre
mejorando el tratamiento.
El POCUS viene a esclarecer el abordaje clí nico en los diferentes tipos de shock,
siempre teniendo en cuenta la historia clí nica, examen fí sico y el lugar donde el paciente
consulte y/o se encuentra, ayuda a dar mayor e nfasis a un o rgano u otro, por ejemplo,
el servicio de emergencias donde se valora paciente politraumatizado, la presencia de
shock se debe de buscar causa de sangrado que se identifique con rapidez un shock
hemorra gico, así como en los salones de medicina interna que a pesar que se puede
encontrar todo tipo de shock ante la presencia de un paciente internado por un proceso
infeccioso (infeccio n urinaria, neumoní a, celulitis, entre otros), la causa ma s posible es
determinar la presencia de shock se ptico.
El shock tiene una tasa de mortalidad muy alta segu n el tipo que sea. Las
evaluaciones ra pidas de la etiologí a, el control y la correccio n ra pida son importantes
para disminuir la tasa de mortalidad y mejorar la seguridad del paciente.
Point-of-care ultrasound (POCUS) is a technology that helps specialists and nonspecialists in the approach to different pathologies, perform procedures with greater safety and decrease complications. The principle of the POCUS is to answer a specific question at the patient's bedside, confirm or rule out said hypothesis and be able to advance in the diagnostic and therapeutic approach as soon as possible. xvi The advantages of POCUS are that learning is simple and assessable, that the study can be repeated with little variability between operators, and that they are available at any time. The undifferentiated state of shock is the initial manifestation of many pathologies that, within the initial approach, is not so evident through the clinical history, physical examination and complementary studies that are readily available, ultrasound improves decision-making at the foot of the patient's bed and improving the treatment. The POCUS comes to clarify the clinical approach in the different types of shock, always taking into account the clinical history, physical examination and the place where the patient consults, helps to give greater emphasis to one organ or another, example, the emergency service where multiple trauma patients are evaluated, the presence of shock must be sought for the cause of bleeding so that a hemorrhagic shock is quickly identified, as well as in internal medicine rooms that, despite the fact that all kinds of shock in the presence of a patient hospitalized for an infectious process (urinary infection, pneumonia, cellulitis, among others), the most possible cause is to determine the presence of septic shock. Shock has an extremely high mortality rate depending on the type. Rapid assessment of etiology, monitoring, and prompt correction are important to decrease the mortality rate and improve patient safety.
Point-of-care ultrasound (POCUS) is a technology that helps specialists and nonspecialists in the approach to different pathologies, perform procedures with greater safety and decrease complications. The principle of the POCUS is to answer a specific question at the patient's bedside, confirm or rule out said hypothesis and be able to advance in the diagnostic and therapeutic approach as soon as possible. xvi The advantages of POCUS are that learning is simple and assessable, that the study can be repeated with little variability between operators, and that they are available at any time. The undifferentiated state of shock is the initial manifestation of many pathologies that, within the initial approach, is not so evident through the clinical history, physical examination and complementary studies that are readily available, ultrasound improves decision-making at the foot of the patient's bed and improving the treatment. The POCUS comes to clarify the clinical approach in the different types of shock, always taking into account the clinical history, physical examination and the place where the patient consults, helps to give greater emphasis to one organ or another, example, the emergency service where multiple trauma patients are evaluated, the presence of shock must be sought for the cause of bleeding so that a hemorrhagic shock is quickly identified, as well as in internal medicine rooms that, despite the fact that all kinds of shock in the presence of a patient hospitalized for an infectious process (urinary infection, pneumonia, cellulitis, among others), the most possible cause is to determine the presence of septic shock. Shock has an extremely high mortality rate depending on the type. Rapid assessment of etiology, monitoring, and prompt correction are important to decrease the mortality rate and improve patient safety.
Descripción
Palabras clave
POCUS, Shock Indiferenciado, MEDICINA PREVENTIVA