Trauma en obstetricia / Obstetric trauma

Mayo 26, 2018. No. 3092

Cirugía general urgente durante el embarazo Emergency general surgery in pregnancy. Skubic JJ1, Salim A1. Author information Trauma Surg Acute Care Open. 2017 Nov 2;2(1):e000125. doi: 10.1136/tsaco-2017-000125. eCollection 2017. Abstract It is often that the acute care surgeon will be called on to evaluate the pregnant patient with abdominal pain. Most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery; however, there are important differences in the pregnant patient to be aware of to avoid pitfalls which can lead to complications for both mother and fetus. This review hopes to describe the most common emergencies facing the surgeon caring for the pregnant patient and the latest management options. KEYWORDS: emergency general surgery; emergency surgery; pregnancy; pregnant PDF  Indicadores clínicos de shock hemorrágico en el embarazo Clinical indicators of hemorrhagic shock in pregnancy. Jenkins PC1, Stokes SM1, Fakoyeho S1, Bell TM1, Zarzaur BL1. Author information Trauma Surg Acute Care Open. 2017 Nov 7;2(1):e000112. doi: 10.1136/tsaco-2017-000112. eCollection 2017 Abstract BACKGROUND: Several hemodynamic parameters have been promoted to help establish a rapid diagnosis of hemorrhagic shock, but they have not been well validated in the pregnant population. In this study, we examined the association between three measures of shock and early blood transfusion requirements among pregnant trauma patients.  We found that patients with SI>1 were significantly more likely to receive blood transfusions compared with patients with SI<1 (OR 10.35; 95% CI 1.80 to 59.62), whereas ROPE>3 was not associated with blood transfusion compared with ROPE≤3 (OR 2.92; 95% CI 0.28 to 30.42). Furthermore, comparison of area under the ROC curve for SI (0.68) and ROPE (0.54) suggested that SI was more predictive than ROPE of blood transfusion. CONCLUSION: We found that an elevated SI was more closely associated with early blood product transfusion than SBP and ROPE in injured pregnant patients. KEYWORDS: hemorrahgic shock; pregnancy; shock management PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information Congreso Nacional de Residentes de Anestesiología 7 al 9 de junio, 2018. Lima, Perú  Informes / Information  V Congreso Internacional de Vía Aérea, EVALa, México Junio 7-9, 2018. Guadalajara. México Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información/ Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Hemorragia obstétrica / Obstetric hemorrhage

Abril 21, 2017. No. 2666

Manejo del sangrado masivo en pacientes obstétricas Testigos de Jehova. La abrumadora importancia de un protocolo multidisciplinario preestablecido. Management of massive bleeding in a Jehovah's Witness obstetric patient: the overwhelming importance of a pre-established multidisciplinary protocol. Belaouchi M1, Romero E1, Mazzinari G1, Esparza M1, García-Cebrían C1, Gil F2, Muñoz M3. Blood Transfus. 2016 Jul 12;14(6):541-544. doi: 10.2450/2016.0229-15. [Epub ahead of print] Introduction Life-threatening massive bleeding is doubtlessly one of the biggest challenges in health care, especially in patients who reject allogeneic transfusion, such as Jehovah's Witnesses. However, according to the principle of patients' autonomy, our job is to accept their decision and provide them with the best possible assistance. We present a protocol for the management of massive post-operative bleeding successfully applied in a Jehovah's Witness after a Caesarean section (CS). PDF Listas de verificación y desempeño multidisciplinario del equipo durante la hemorragia obstétrica simulada. Checklists and multidisciplinary team performance during simulated obstetric hemorrhage. Hilton G1, Daniels K2, Goldhaber-Fiebert SN3, Lipman S3, Carvalho B3, Butwick A3. Int J Obstet Anesth. 2016 Feb;25:9-16. doi: 10.1016/j.ijoa.2015.08.011. Epub 2015 Aug 21. Abstract BACKGROUND: Checklists can optimize team performance during medical crises. However, there has been limited examination of checklist use during obstetric crises. In this simulation study we exposed multidisciplinary teams to checklist training to evaluate checklist use and team performance during a severe postpartum hemorrhage. METHODS: Fourteen multidisciplinary teams participated in a postpartum hemorrhage simulation occurring after vaginal delivery. Before participating, each team received checklist training. The primary study outcome was whether each team used the checklist during the simulation. Secondary outcomes were the times taken to activate our institution-specific massive transfusion protocol and commence red blood cell transfusion, and whether a designated checklist reader was used. RESULTS: The majority of teams (12/14 (86%)) used the checklist. Red blood cell transfusion was administered by all teams. The median [IQR] times taken to activate the massive transfusion protocol and transfuse red blood cells were 5min 14s [3:23-6:43] and 14min 40s [12:56-17:28], respectively. A designated checklist reader was used by 7/12 (58%) teams that used the checklist. Among teams that used a checklist with versus without a designated reader, we observed no differences in the times to activate the massive transfusion protocol or to commence red blood cell transfusion (P>0.05). CONCLUSIONS: Although checklist training was effective in promoting checklist use, multidisciplinary teams varied in their scope of checklist use during a postpartum hemorrhage simulation. Future studies are required to determine whether structured checklist training can result in more standardized checklist use during a postpartum hemorrhage. KEYWORDS: Checklist; Multidisciplinary; Obstetrics; Postpartum hemorrhage; Simulation PDF  Manejo transfusional y de la coagulación en hemorragia obstétrica severa Transfusion and coagulation management in major obstetric hemorrhage. Butwick AJ1, Goodnough LT. Curr Opin Anaesthesiol. 2015 Jun;28(3):275-84. doi: 10.1097/ACO.0000000000000180. Abstract PURPOSE OF REVIEW: Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. RECENT FINDINGS: Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9-2.3%), and investigators have questioned whether a predelivery 'type and screen' is cost-effective for all obstetric patients. Instead, blood ordering protocols specific to obstetric patients can reduce unnecessary antibody testing. When severe PPH occurs, a massive transfusion protocol has attracted interest as a key therapeutic resource by ensuring sustained availability of blood products to the labor and delivery unit. During early postpartum bleeding, recent studies have shown that hypofibrinogenemia is an important predictor for the later development of severe PPH. Point-of-care technologies, such as thromboelastography and rotational thromboelastometry, can identify decreased fibrin clot quality during PPH, which correlate with low fibrinogen levels. SUMMARY: A massive transfusion protocol provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula-driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH. PDF Foro Internacional de Medicina Crítica Ciudad de México, Julio 13-15, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org