Taquiarritmia grave en la unidad de reanimación en paciente portador de tubo orotraqueal herniado de manera inadvertida

La mala posición del tubo orotraqueal (TOT) es una complicación que aparece en el 12 al 15% de las intubaciones realizadas en la Unidad de Cuidados Críticos. El bisel del tubo orotraqueal debe estar ubicado 4 a 5 cm. por encima de la carina, equivalente al nivel de la tercera o cuarta vértebra dorsal. Debe documentarse la profundidad de la inserción, distancia en centímetros a nivel del incisivo superior o a nivel de los labios en paciente sin dientes. También, una vez colocado, se debe marcar el TOT, preferentemente, a nivel del incisivo superior o en su defecto, a nivel de los labios para tener idea de la profundidad correcta del mismo. La posición del tip o punta del TOT es dependiente de la posición de la cabeza y del cuello. La flexión hacia delante desciende el TOT en un promedio de 1,9 cm. y la extensión hacia atrás eleva el tip en una distancia semejante. La radiografía de tórax siempre debe realizarse después de la confirmación primaria y secundaria de colocación del tubo y obviamente en un paciente estabilizado cervicalmente. En el paciente con el TOT colocado en la vía aérea, la placa de tórax (visión anteroposterior) únicamente nos dice a cuántos centímetros de la carina se encuentra el tip o extremo distal del tubo, y si está desplazado al bronquio derecho, pero de ningún modo nos asegura que se encuentre dentro de la vía aérea. La confirmación primaria se realiza a través de la auscultación del tórax. La confirmación secundaria se hace a través de la detección de CO2 en el aire espirado. La profundidad en la que se encuentra el TOT en el hombre debe ser de 23 cm. y de 21 cm. en la mujer, sin embargo la profundidad debe evaluarse siempre individualmente, particularmente teniendo en cuenta la estatura del paciente. Cuando el TOT se hernia, dicha situación se asocia con cuadros de obstrucción de vía aérea aguda con una inmediata caída del ETCO2, seguida del descenso del % de SatO2 con aumento concomitante de la presión en la vía aérea y fallo en el ciclado del respirador, objetivándose silencio auscultatorio en ambos campos pulmonares y aumento de la resistencia a la ventilación manual si la herniación es completa (extubación)

Measurements of Higgs boson production cross sections and couplings in the diphoton decay channel at root s=13 TeV

Measurements of Higgs boson production cross sections and couplings in events where the Higgs boson decays into a pair of photons are reported. Events are selected from a sample of proton-proton collisions at root s = 13TeV collected by the CMS detector at the LHC from 2016 to 2018, corresponding to an integrated luminosity of 137 fb(-1). Analysis categories enriched in Higgs boson events produced via gluon fusion, vector boson fusion, vector boson associated production, and production associated with top quarks are constructed. The total Higgs boson signal strength, relative to the standard model (SM) prediction, is measured to be 1.12 +/- 0.09. Other properties of the Higgs boson are measured, including SM signal strength modifiers, production cross sections, and its couplings to other particles. These include the most precise measurements of gluon fusion and vector boson fusion Higgs boson production in several different kinematic regions, the first measurement of Higgs boson production in association with a top quark pair in five regions of the Higgs boson transverse momentum, and an upper limit on the rate of Higgs boson production in association with a single top quark. All results are found to be in agreement with the SM expectations.Peer reviewe

Search for electroweak production of charginos and neutralinos in proton-proton collisions at s \sqrt{s} = 13 TeV

A direct search for electroweak production of charginos and neutralinos is presented. Events with three or four leptons, with up to two hadronically decaying τ leptons, or two same-sign light leptons are analyzed. The data sample consists of 137 fb$^{−1}$ of proton-proton collisions with a center of mass energy of 13 TeV, recorded with the CMS detector at the LHC. The results are interpreted in terms of several simplified models. These represent a broad range of production and decay scenarios for charginos and neutralinos. A parametric neural network is used to target several of the models with large backgrounds. In addition, results using orthogonal search regions are provided for all the models, simplifying alternative theoretical interpretations of the results. Depending on the model hypotheses, charginos and neutralinos with masses up to values between 300 and 1450 GeV are excluded at 95% confidence level

Measurements of Higgs boson production cross sections and couplings in the diphoton decay channel at s=\sqrt{s} = 13 TeV

Measurements of Higgs boson production cross sections and couplings in events where the Higgs boson decays into a pair of photons are reported. Events are selected from a sample of proton-proton collisions at $\sqrt{s}=$ 13 TeV collected by the CMS detector at the LHC from 2016 to 2018, corresponding to an integrated luminosity of 137 fb$^{-1}$. Analysis categories enriched in Higgs boson events produced via gluon fusion, vector boson fusion, vector boson associated production, and production associated with top quarks are constructed. The total Higgs boson signal strength, relative to the standard model (SM) prediction, is measured to be 1.12$\pm$0.09. Other properties of the Higgs boson are measured, including SM signal strength modifiers, production cross sections, and its couplings to other particles. These include the most precise measurements of gluon fusion and vector boson fusion Higgs boson production in several different kinematic regions, the first measurement of Higgs boson production in association with a top quark pair in five regions of the Higgs boson transverse momentum, and an upper limit on the rate of Higgs boson production in association with a single top quark. All results are found to be in agreement with the SM expectations

Search for electroweak production of charginos and neutralinos in proton-proton collisions at s=\sqrt{s} = 13 TeV

A direct search for electroweak production of charginos and neutralinos is presented. Events with three or four leptons, with up to two hadronically decaying $\tau$ leptons, or two same-sign light leptons are analyzed. The data sample consists of 137 fb$^{-1}$ of proton-proton collisions with a center of mass energy of 13 TeV, recorded with the CMS detector at the LHC. The results are interpreted in terms of several simplified models. These represent a broad range of production and decay scenarios for charginos and neutralinos. A parametric neural network is used to target several of the models with large backgrounds. In addition, results using orthogonal search regions are provided for all the models, simplifying alternative theoretical interpretations of the results. Depending on the model hypotheses, charginos and neutralinos with masses up to values between 300 and 1450 GeV are excluded at 95% confidence level

Measurements of Z bosons plus jets using variables sensitive to double parton scattering in pp collisions at 13 TeV

Double parton scattering is investigated using events with a Z boson and jets. The measurements are performed with proton-proton collision data recorded by the CMS experiment at the LHC at $\sqrt{s}=$ 13 TeV, corresponding to an integrated luminosity of 35.9 fb$^{-1}$ collected in the year 2016. Differential cross sections of Z + $\geq$1 jet and Z + $\geq$2 jets are measured with transverse momentum of the jets above 20 GeV and pseudorapidity $|\eta|\lt$ 2.4. Several distributions with sensitivity to double parton scattering effects are measured as functions of the angle and the transverse momentum imbalance between the Z boson and the jets. The measured distributions are compared with predictions from several event generators with different hadronization models and different parameter settings for multiparton interactions. The measured distributions show a dependence on the hadronization and multiparton interaction simulation parameters, and are important input for future improvements of the simulations

Search for electroweak production of charginos and neutralinos in proton-proton collisions at s \sqrt{s} = 13 TeV

International audienceA direct search for electroweak production of charginos and neutralinos is presented. Events with three or four leptons, with up to two hadronically decaying τ leptons, or two same-sign light leptons are analyzed. The data sample consists of 137 fb$^{−1}$ of proton-proton collisions with a center of mass energy of 13 TeV, recorded with the CMS detector at the LHC. The results are interpreted in terms of several simplified models. These represent a broad range of production and decay scenarios for charginos and neutralinos. A parametric neural network is used to target several of the models with large backgrounds. In addition, results using orthogonal search regions are provided for all the models, simplifying alternative theoretical interpretations of the results. Depending on the model hypotheses, charginos and neutralinos with masses up to values between 300 and 1450 GeV are excluded at 95% confidence level.[graphic not available: see fulltext