2 research outputs found
Subclavian-Brachial Bypass for Chronic Limb Threatening Ischemia Associated with an Old Motorcycle Accident
Chronic limb-threatening ischemia is rarely associated with previous traumatic injury. We present a case of a 28-year-old male with progressive digit ulcers, a weak pulse, cyanosis, and a cold limb. Eight months prior, he had a motorcycle accident resulting in a right clavicle fracture and brachial plexus injury. Computed tomography angiography revealed occlusion of the right subclavian artery near a surgically implanted reduction plate. The patient underwent an open subclavian-brachial bypass with a reversed saphenous vein graft. His postoperative recovery was uneventful. After 3 months, he had a euthermic right hand with a palpable pulse and his ulcers had completely healed. This case reinforces the need for patients with a neurological deficit in the upper extremity caused by blunt trauma to undergo thorough vascular examination to identify potential arterial injury and compromised perfusion
Recomendaciones generales apra mejorar la calidad de la atención obstétrica
INTRODUCTION. Maternal care means roughly a half of medical
interventions, hospital discharges and surgery realized in Mexico. Obstetrics
reached the second place (14.5%) in malpractice complaints in National
Commission of Medical Arbitration (CONAMED). OBJECTIVE: To analize the
CONAMED�s experience about obstetric care claims, and profit
recommendations for medical practice. METHOD: The authors revised 1431
complaints ob/gin-related, placed in CONAMED between june 1996 to
june 2001, and selected a sampling of 121 cases of ruling reports. We
describe sociodemographic, institutional, clinical, communication and lawattach
indicators. RESULTS. Complaints were originated in third quarter of
pregnancy (82.8%), in social-security services (72.1%), in second level
hospitals (62.3%). Fifty seven percent were high risk pregnancies, with
previous cesarean section as frequent medical historial (21.5%). The
complications were predictable in almost half of cases. First medical error
was a deficient labor surveillance (22.3%). Malpractice was identified in
54.5%, ethical mistakes in 30%, institutional insufficiencies in 40.5%,
inaccurate medical records in 45% and inadequate communication in 76%.
CONCLUSIONS. An accurate obstetric care is composed by proffesional
sense of duty and ethics, conscientious patient care, identify high risk
pregnancies, recognize personal and institutional skill restrictions, to know
health laws, and effective physician - patient communication. We declare
9 recommendations for medical and paramedical who care obstetric
patients.ANTECEDENTES. La atención materna representa aproximadamente la
mitad de las intervenciones médicas, egresos hospitalarios y las cirugías
que se realizan en México. Las demandas por mala práctica relacionadas
con atención obstétrica alcanzaron el segundo lugar (14.5%) de los asuntos
atendidos por CONAMED. OBJETIVO. Analizar la experiencia de
CONAMED sobre conflictos por atención obstétrica y expresar recomendaciones
para la atención de estas pacientes. METODOLOGÍA. Se revisaron
1431 inconformidades relacionadas con atención ginecoobstétrica, radicadas
en CONAMED entre junio de 1996 hasta junio de 2001. Se seleccionó
una muestra dirigida de 121 casos concluidos por dictamen pericial. Se
describen indicadores sociodemográficos, institucionales, clínicos, de comunicación
y apego a reglamentación vigente. RESULTADOS. Las
inconformidades se originaron en el tercer trimestre de gestación (82.8%),
en la seguridad social en 72.1%, en hospitales de 2º nivel (62.3%). La
calificación de riesgo fue elevado en 57%, con cesárea previa como antecedente
más frecuente (21.5%). Las complicaciones eran previsibles en
casi la mitad de los casos. La principal desviación fue vigilancia deficiente
del trabajo de parto (22.3%). Se identificó mala práctica en 54.5%, desviaciones
éticas en 30%, deficiencias institucionales en 40.5%, expedientes
mal integrados en 45% y mala comunicación en 76%. CONCLUSIONES.
Una atención obstétrica adecuada requiere: compromiso y ética profesional,
atención minuciosa, identificar los casos de riesgo, reconocer limitaciones
personales e institucionales, conocer la normatividad y una
comunicación médico-paciente efectiva. Se presentan 9 recomendaciones,
dirigidas al personal médico y paramédico que atiende pacientes obstétricas