Point‑of‑care ultrasound in cardiorespiratory arrest (POCUS‑CA): narrative review article.

The POCUS-CA (Point-of-care ultrasound in cardiac arrest) is a diagnostic tool in the Intensive Care Unit and Emergency Department setting. The literature indicates that in the patient in a cardiorespiratory arrest it can provide information of the etiology of the arrest in patients with non-defibrillable rhythms, assess the quality of compressions during cardiopulmonary resuscitation (CPR), and define prognosis of survival according to specific findings and, thus, assist the clinician in decision-making during resuscitation. This narrative review of the literature aims to expose the usefulness of ultrasound in the setting of cardiorespiratory arrest as a tool that allows making a rapid diagnosis and making decisions about reversible causes of this entity. More studies are needed to support the evidence to make ultrasound part of the resuscitation algorithms. Teamwork during cardiopulmonary resuscitation and the inclusion of ultrasound in a multidisciplinary approach is important to achieve a favorable clinical outcomepost-print2391 K

Intoxicación por fluoroacetato de sodio, un reporte de caso

  Introduction: Sodium fluoroacetate, known as compound 1080, was discovered in Germany during the Second World War. It is usually used as a rodenticide, it is an odorless and tasteless substance, with a lethal dose in humans of 2 mg / kg that is why it was withdrawn from the market in some countries, including Colombia; however, it is obtained illegally. This substance has biochemical and physiological effects at the cellular level that alter the transport of citrate at the mitochondrial level, generating accumulation of lactic acid and alteration of the glucose use. The clinical manifestations are nonspecific since there is no any cardinal symptom. Therefore, its diagnosis is made due to high clinical suspicion associated with establishment of exposure to the compound in view of the difficulty to obtain paraclinical confirmation in a timely manner. Methods: We present a case report of intentional ingestion of sodium fluoroacetate in an adolescent that is associated with an infection added to the bloodstream by methicillin- sensitive Staphylococcus aureus (MSSA). The patient developed multiple complications that lead to support in the Intensive Care Unit (ICU) with a satisfactory outcome. In view of the lack of a specific antidote, she was treated with ethanol in order to increase the level of acetate; thus, offering an alternative substrate to the Krebs cycle. It is suggested that the ethanol offers benefits in the acute treatment of these patients. Results: The patient with sodium fluoroacetate poisoning and kidney failure received renal replacement therapy with a favorable evolution and survival at discharge from the intensive care unit of a third-level hospital in the city of Pereira, Risaralda, Colombia. Conclusions: Sodium fluoroacetate poisoning is relatively rare and can cause acute kidney injury and multi-organ failure with a high rate of complications and death. A case of self-inflicted poisoning that received a timely manner continuous renal replacement therapy with a favorable outcome in terms of ICU survival was presented.Introducción:  El fluoroacetato de sodio ⎯conocido como compuesto 1080⎯, fue descubierto en Alemania durante la segunda guerra mundial, suele ser  utilizado como raticida y se caracteriza por ser una sustancia inodora e insabora. En humanos, una dosis  de 2 a mg/kg  es letal; debido a su toxicidad fue retirado del mercado en algunos países, incluyendo Colombia,  no obstante,  se consigue de forma ilegal.  Esta sustancia tiene efectos bioquímicos y fisiológicos a nivel celular que altera el transporte del citrato a nivel mitocondrial, generando acumulación de ácido láctico y alteración en la utilización de la glucosa. Las manifestaciones clínicas son inespecíficas y  no existe un síntoma cardinal. Por ende,  su diagnóstico se realiza por alta sospecha clínica, asociado al establecimiento de la exposición al compuesto, ya que la confirmación paraclínica es difícil de realizar oportunamente. Métodos: Se presenta un reporte de caso de ingestión intencional en un adolescente, asociado con infección agregada al torrente sanguíneo por Estafilococos Aureos Meticilino Sensible (EAMS). El paciente  desarrolló múltiples complicaciones y  requirió asistencia  en Unidad de Cuidados Intensivos (UCI) con desenlace satisfactorio. Ya que no  se cuenta con antídoto específico , se le dio tratamiento con etanol para aumentar el nivel de acetato, ofreciendo así un sustrato alterno al ciclo de Krebm. Se estima que el etanol  puede ofrecer beneficios en el tratamiento agudo de estos pacientes. Resultados: Paciente con intoxicación por fluoroacetato de sodio e insuficiencia renal, recibe terapia de reemplazo renal con un evolución favorable y supervivencia al alta de la Unidad de Cuidados Intensivos de un hospital de tercer nivel en la ciudad de Pereira, Risaralda, Colombia. Conclusiones: La intoxicación por fluoroacetato de sodio es relativamente poco frecuente y puede causar injuria renal aguda y falla multiorgánica con alta tasa de complicaciones y muerte. Se presentó un caso de intoxicación autoinfligida que recibió terapia de reemplazo renal continua temprana con un desenlace favorable en términos de supervivencia en la UCI

Intoxicación por fluoroacetato de sodio, un reporte de caso

  Introduction: Sodium fluoroacetate, known as compound 1080, was discovered in Germany during the Second World War. It is usually used as a rodenticide, it is an odorless and tasteless substance, with a lethal dose in humans of 2 mg / kg that is why it was withdrawn from the market in some countries, including Colombia; however, it is obtained illegally. This substance has biochemical and physiological effects at the cellular level that alter the transport of citrate at the mitochondrial level, generating accumulation of lactic acid and alteration of the glucose use. The clinical manifestations are nonspecific since there is no any cardinal symptom. Therefore, its diagnosis is made due to high clinical suspicion associated with establishment of exposure to the compound in view of the difficulty to obtain paraclinical confirmation in a timely manner. Methods: We present a case report of intentional ingestion of sodium fluoroacetate in an adolescent that is associated with an infection added to the bloodstream by methicillin- sensitive Staphylococcus aureus (MSSA). The patient developed multiple complications that lead to support in the Intensive Care Unit (ICU) with a satisfactory outcome. In view of the lack of a specific antidote, she was treated with ethanol in order to increase the level of acetate; thus, offering an alternative substrate to the Krebs cycle. It is suggested that the ethanol offers benefits in the acute treatment of these patients. Results: The patient with sodium fluoroacetate poisoning and kidney failure received renal replacement therapy with a favorable evolution and survival at discharge from the intensive care unit of a third-level hospital in the city of Pereira, Risaralda, Colombia. Conclusions: Sodium fluoroacetate poisoning is relatively rare and can cause acute kidney injury and multi-organ failure with a high rate of complications and death. A case of self-inflicted poisoning that received a timely manner continuous renal replacement therapy with a favorable outcome in terms of ICU survival was presented.Introducción:  El fluoroacetato de sodio ⎯conocido como compuesto 1080⎯, fue descubierto en Alemania durante la segunda guerra mundial, suele ser  utilizado como raticida y se caracteriza por ser una sustancia inodora e insabora. En humanos, una dosis  de 2 a mg/kg  es letal; debido a su toxicidad fue retirado del mercado en algunos países, incluyendo Colombia,  no obstante,  se consigue de forma ilegal.  Esta sustancia tiene efectos bioquímicos y fisiológicos a nivel celular que altera el transporte del citrato a nivel mitocondrial, generando acumulación de ácido láctico y alteración en la utilización de la glucosa. Las manifestaciones clínicas son inespecíficas y  no existe un síntoma cardinal. Por ende,  su diagnóstico se realiza por alta sospecha clínica, asociado al establecimiento de la exposición al compuesto, ya que la confirmación paraclínica es difícil de realizar oportunamente. Métodos: Se presenta un reporte de caso de ingestión intencional en un adolescente, asociado con infección agregada al torrente sanguíneo por Estafilococos Aureos Meticilino Sensible (EAMS). El paciente  desarrolló múltiples complicaciones y  requirió asistencia  en Unidad de Cuidados Intensivos (UCI) con desenlace satisfactorio. Ya que no  se cuenta con antídoto específico , se le dio tratamiento con etanol para aumentar el nivel de acetato, ofreciendo así un sustrato alterno al ciclo de Krebm. Se estima que el etanol  puede ofrecer beneficios en el tratamiento agudo de estos pacientes. Resultados: Paciente con intoxicación por fluoroacetato de sodio e insuficiencia renal, recibe terapia de reemplazo renal con un evolución favorable y supervivencia al alta de la Unidad de Cuidados Intensivos de un hospital de tercer nivel en la ciudad de Pereira, Risaralda, Colombia. Conclusiones: La intoxicación por fluoroacetato de sodio es relativamente poco frecuente y puede causar injuria renal aguda y falla multiorgánica con alta tasa de complicaciones y muerte. Se presentó un caso de intoxicación autoinfligida que recibió terapia de reemplazo renal continua temprana con un desenlace favorable en términos de supervivencia en la UCI

Rhabdomyolysis caused by exercise

Introduction: rhabdomyolysis is a clinical and paraclinical syndrome characterized by the presence ofskeletal muscle necrosis that leads to the consequent release of intracellular muscle components witha variable clinical presentation and complications that put life at risk such as acute kidney injury. Methods: we present a case report of a patient with rhabdomyolysis with severe elevation of muscle enzymes and secondary acute kidney injury who was subsequently documented (initial Total CK189,000 u/L) after extreme physical activity (CrossFit), who developed multiple complications and theneed for support in the Intensive Care Unit (ICU) with satisfactory outcome. Results: Patient with kidney failure, receiving renal therapy with a favorable evolution and survival atdischarge from the intensive care unit of a third-level hospital in the city of Pereira, Risaralda, Colombia. Conclusions: Rhabdomyolysis is a clinical and paraclinical syndrome characterized by the presence ofskeletal muscle necrosis. The main cause is severe direct traumatic injury or crushes injuries; however,other conditions such as infections, intoxication, muscle ischemia, neuroleptic malignant syndrome, malignant hyperthermia, metabolic disorders, and genetic pathologies can also cause it, and particularly, extended rest, immobilization or strenuous exercise. The clinical presentation and complications are variable.Introducción: la rabdomiólisis es un síndrome clínico y paraclínico caracterizado por la presencia de necrosis del músculo esquelético que lleva a la liberación de componentes muscularesintracelulares, con una presentación clínica variable y complicaciones que ponen en riesgo lavida, como la insuficiencia renal aguda. Métodos: presentamos un caso clínico de un paciente con rabdomiólisis con elevación severade enzimas musculares y lesión renal aguda secundaria que posteriormente se documentó (CKTotal inicial 189.000 u/L) luego de actividad física extrema (CrossFit), quien desarrolló múltiplescomplicaciones y la necesidad de apoyo en la Unidad de Cuidados Intensivos (UCI) con evolución satisfactoria. Resultados: Paciente con insuficiencia renal, que recibe terapia renal con una evolución favorable y supervivencia al egreso de la unidad de cuidados intensivos de un hospital de tercer nivelde la ciudad de Pereira, Risaralda, Colombia. Conclusiones: La rabdomiólisis es un síndrome clínico y paraclínico caracterizado por la presencia de necrosis del músculo esquelético. La causa principal son las lesiones traumáticas directasseveras o las lesiones por aplastamiento; sin embargo, otras condiciones como las infecciones,la intoxicación, la isquemia muscular, el síndrome neuroléptico maligno, la hipertermia maligna,los trastornos metabólicos y las patologías genéticas también pueden causarla, y en particular,el reposo prolongado, la inmovilización o el ejercicio extenuante. La presentación clínica y lascomplicaciones son variables

Diagnóstico toxicológico del paciente crítico: el desafio

Introduction: A high percentage of patients who survived poisoning will be transferred to the Intensive Care Unit (ICU) to continue their management in relation to the severity of the poisoning, and possible complications that arise in this scenario. The clinical results will depend on several factors, such as the ingested dose, the characteristics of the substance, the time of medical attention, and the pre-existing state of health of the patient. Objective: To review the clinical behavior of poisonings in the critically ill patient. Recent findings: The data bases that yielded relevant bibliographical results were Web of Sciences, Scopus, PubMed, SciELO, and bibliographic references published between 2012 and 2020 were chosen. Conclusions: The clinical behavior of poisonings in the critically ill patient is atypical. The intensivist must have an in-depth knowledge of the behavior and pathophysiology of the toxins since making a medical diagnosis on the stage of the critically ill patient is challenging. The integration of all possible medical tools is required to achieve this in the absence of clinical history, and the implementation of early management strategies is necessary to reach physiological restoration by using a continuous evaluation approach. The severity of poisoning in the critically ill patient demands interdisciplinary management that includes assessment by Clinical Toxicology. &nbsp

Diagnóstico toxicológico del paciente crítico: el desafio.

Introduction: A high percentage of patients who survived poisoning will be transferred to the Intensive Care Unit (ICU) to continue their management in relation to the severity of the poisoning, and possible complications that arise in this scenario. The clinical results will depend on several factors, such as the ingested dose, the characteristics of the substance, the time of medical attention, and the pre-existing state of health of the patient. Objective: To review the clinical behavior of poisonings in the critically ill patient. Recent findings: The data bases that yielded relevant bibliographical results were Web of Sciences, Scopus, PubMed, SciELO, and bibliographic references published between 2012 and 2020 were chosen. Conclusions: The clinical behavior of poisonings in the critically ill patient is atypical. The intensivist must have an in-depth knowledge of the behavior and pathophysiology of the toxins since making a medical diagnosis on the stage of the critically ill patient is challenging. The integration of all possible medical tools is required to achieve this in the absence of clinical history, and the implementation of early management strategies is necessary to reach physiological restoration by using a continuous evaluation approach. The severity of poisoning in the critically ill patient demands interdisciplinary management that includes assessment by Clinical Toxicology. &nbsp