Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Algoritmos SVCA 2008
Algoritmos SVCA 2008
.Aprerule y
'V,i'Ve8.'M
[La, ,AC.lE Big IUln oarnpo ,Ic:ie,nt'ffj'col di:nlami'c:QI ,1:a;8, ,doshs, die IliO.s~, 'fa.rma,lc~os y SU :LJIS;O~,
",<A,I'"Qrit ...
....... • --_ ... ---
--:---
---------
__
·· i_p.ara·
.--_".
- - ---. -- --. -
braC1li¢:.*tdb.
.... ._--_._ ----
--
--- ---_.
-::
---,-
.
. -
. "- --~ 1
::=-.
--
..=-- ..
_l
-t'Ir-8llnSVell'OS:O' .
:O"(),Mlt'rliBJWly,enl
,8 -Ufl
~.
• 'C:onsfl'dI1e;re' c,ons.lulltar
_~ _ _ _ c
e-:-xiperto, ~
..... _ .-'. _
_.
~~
~..
_ _.
_~-...........I.._
@ 2NDOa '6di~ffi6n Qdglir1lal en ingl'~$I~,A;nle'ri'e~[lJ11 11"'II@o'.an A.ss'QCmUo'H~ ACLS CallidtSllC Am'I~S.'~'!1 Arli1l1lyl,hrnli3~, a 1Ilhe:ir Tr:~rrl~nl (8o..1692)'~ @ 211DB[~k::I¢:tI, en B"'pai1ot! .Amerie~n ~·1~aurt,A~ci)~tiOlni. S~.fCA, [ParoL ca,fid'i~o., ~lriitrni',a~, y Silill ~m:t,~mi,~nto., P~diUEcoie:nedi (:o.."i~I:Plrous &i~"n\ee,.,
IBanrce:!on3iu Esp',3r ~
I~
liSBN: 0-,87 ~93.-:56 'II-:X'~Imp,re9QI en I::E..lUU. - Printedl 'in IUSA:: Ilf1I,h~~:t:acQ'hJir'L~dl. ;:}2'II 10 ~ nno,v.artni'!ite lliiJa,V., M~5Quite., 'lX, '75'149~, C6d:lgo d~' ~duCl0' en res,p,anot 80,=,:231 B l[ I die 21~ 3"7~550ej-~n,p~',aj"(es, ()2l00.,
No de8fibr~lab~e
--1
C'on:sigalun IDIEAJ o qwel e$to 10 h~:,ga '5;'(;glmdo reanimador (s~hay ono pr!semre)
e~
jdm'i~i~
,;;It
1148~~~rna
• MOOQ'·~5i~ll:soo J '
ID'EA~~p~rfita ~,~
dt6~AlSl~iwo
~l
10
~'~jm 4Qllj
RU6d&~rniI~'.)
,(1~sJSde VB!$OP~
~OlT_.~ltl!ar-
Tiene
. I a 'tiene pulsC)
I
. Ii
~f'~ssi~: $tq~, Rea~u~;e, RG:P rJirneaia:l~m~f1ft~lh,s, la rard~s~r'PJ rainiai~"I~~!l~AtP_l01nes,delnmedimn Si sadi$'~e' ~9'una l,Iia·i~A~~.~ a8mjn~tJle unvasupreoor
~ Man~D4~~: '~Gffia.a ~ [adar di~pe~L~ (d~s' i9rJa1 Of!S1:lperki :a'~a!H~Itl ~rim~ ~~~l
~Ii~l;W I~ I\]JfiI~
-.
oI'i,
'!.I'
des~ib~ila'bh~,
_a,
FVm'
1-
• Sl bay IB~~~dJitd !l~mG'a~, vemrq:1J~,el puloo. log~1cdeJa~rn€r(~ r_[~a ~shHt~i~r:e~al~nl' . ,31 n,o D31i PUISD,1 wya a M~tdlia/~E5P iI""""----.. • ,SI h~' :pu~sa)'l'niGie·la ate.ru~[6npOSlml.m~9C-i,Qnl
,-
• ,Sj. hay
iasiSl-oUa
j '~;
I. A'SistQliaf:&sP'
~mt:.a; ~
~ - J!Jo.l:.io~=",'\
,~~ ra~~ril'n~ra!
I
• Ij\~{
$S,petl\a para(~~rd~~stWlQ
:j
Desfi:bri1a ble
N: ' 1_ esfibrlla Ie
.' M@llbfi~{i;jlttJ R~a~~t~;e JiOPwmediata~te .~cIfaSJad,~~aro; lla ,gal r~irniQ[el.iliSj;~Dm,re~@llfesitlrrre~tm ~e ~id~re.tigmi~ls~jar amjamtm~~~ jijmifUg;I trete-sd~ranIg t~,ROP:~mflj Q ~~~de I~
,.=
c~.m,pR,sio)n,~$
Ides.~} .
~.~~~
~1r~~~$ ~fjlm~.
- "Ilaumafl~
.1_JJ
i
'l~bll~M~dOO1s,.'
mg Lv.Alt ~i~~mt~iE.~;eJc L
i '~e'~~Ju~
Hi
1]
Los recuad
'con
'~'~(.~1l11 .' ~~l
'11
me'nOII!" Iinrtefil5id
4"
n~'f"a lr,J~.-..
hOI~ pi~
_aliano, t--
7
,lIIIi;
1,3
,~ ... ~ , II ven IllII!~:J" U S~ I~~'''!' ~'"iil.iI':iic-::'~iP.'",~,...IIl'li:a ... ~ IS~h ,ai'YI!.c:~'b, '·'!il ,,;':~l :' _ hJ:r!li:l,ao~on,aru'nC,IUI!!:i81;r coOn abeliTalnc;i~, triic IwdaiIF'10 ritm,o '~:n,e'ie;t1:o ConsUitte tlTa,qulicarcUa lrre'.' A 'm--; - d,~, ·~,n,a - ~Af n, rno 1 Y. ~n- 10" rrun , ' "Y' I :~. ~ ," ~ '~ll 15 Q Jtar de comp~lejo estrecho,u R'~·p.ita$Ieg;un eea (,Re,cuadra 11)
III
,m
II mente'
I.
,e
~.~~[I;.
~II
~f
_.
'g",
->
~'"
'W' li~
.1."
c,o'm:p,~:ejo e:stJre·eho, :Plr()'bab~erne nle 00, trete (J e fiib:tiil,alc:i6n aUIri.cu~la_r0 !~sible f~!!lJttet(.a~leteO)1 ::l:1u ••Il:~iilcul 0 ta'q u ica!rd ia : ar
'
I
.!
I~
~_~_._
,° iO,';1,,;1'
.1 ~1I,
"
.:
~-...
-~'~'
a!lJri"o'U!!la:i'"
nlu!ltifocal
,:i
,~
" Oons.idefti3 consuH"ia:r a un experto Con~fro'he' ~'a rrecuencta cardiaoa ~J:H)r,ej"em pto, '¢I i1.1;ii':a;a!,em: beta b Ifo,que·antie·s,: uti ric e I'os:
betabloqt_ueante's co,n: p're...
'Prelpam·~e'
've;r5~IO:1111'1iClr'onlZB. 5n
S;i: hay fib,_"U,acii:IC);n atu·'~·c'u~ar C10n 'W' -PIIo,IIILfIi pre,eKIc;!!!:,~c::~gni ('L,jIi;. Ii M~"¥ ";11' , S,e aoonse]a ,c.onsut:'b!; r a 'Uin
~;"~3;, ,.
___.o:
experto
Ev,ite
electiva
i
'G-
:1018. faJlr.t1300S
('v,aya ai Recu,adro 7)
C;onsi-d'e:r~ ad,mi:nistrat ant~:su~i'"'i'lmlic 6"8 i(p or e:jeITI,plt:>'j a U1liolda::t'c,na 150 m.g tv. :en. ii 0' min) En ca~o ~'~' ,plo!I'i:~.'OI:r1li~~ I :reC~l.._U"'J"iente, IFnda. ayud,a a un
!:~_
lD
Sie~ iri'tm,o re'v~en::e~, iPT,o,ba'b,l,e,_..'
exoerto
En oaso de tOJ;"738'des de pOJ:n'tes", ad,!m~nmstre m:agnesh~J' (ca,rga, con ~2 9 durante' 5 ... 60 rnlrs, dl9~pues iflfus;ion)
I·
I
m:en ... s,e'llrate die un,a ~aquicar-' ~e d'i~ ,sliJpr'ar~leniricUlila~ (TS,'-,":," 'p,ar Ir,eentrada,;
Observe'
Ci'
mas.
S,i e~' ritJmo !_I_O revie;rt:e~ posib1h&.,rften·te :se trate' ,d·e ft. 'Her (aetec, ,a,u:r-;-iular, 'ta' u:ie.aFdia' ill. ,;r:ii Q,U ~,ar.~>Ic:.t6p;ic-a: o ¥an:-":-;cardlii,ade I,a 'I: i6,-~'"" ) Ccntl-role lea 'fre'eue~, i·,a. ardiae a (po,r ec e]empl;o~ dliltia2lem~ betab,lo'qu'ea:n,' ',es~ ufil~c'elos, betabl,oqueantes con pf'enauoion en caso de: e;nfe,.!"n,~ad puJ'.mon1ar G ICG) P Trattte fa causa 6u,by'a;C'entt.e
I
I.
Oo,ns~de'.reconsuuar
a un exoerto
;Recuad,ro
4",
·,t·
1lJ.ACE es lun tampo oienlffioo dinamioo - comp~uebe e~ prospecto, per,e e~lInbio~n ~ las dosis. de, ~os',·armaoos y SQJ usa
. .
d ~na'mica ~e'onda, 1":: e;~eva;da, 11. ...... " !t1Bpeolill aJ lie ~sque1tJiIlna,
.
.• -
r·····=-=-~--":"-·--;;;;;;&I,-
.AI:.gQritm,Q"
.._.-.... -.
--~'-r
~~.
~I
' ..
riesg:o ~Merm,edhl'bajo
l
_. -._---_-_ .... .
..
- - -__
..
-_
.. -
-.
indlc, u I~ l
ComieMf~etrata~ient'
I
ad)~·
5i
No ~ lht
III ~1I11~~ll
~rn'
f'Ii
"~..JI I'·· ~un5~:~aM ~i, ItJ'IgMio enlun~ unioad de dolor I ~lar~0'1to en ·una ~:.a 0
,0'.
_-~----.------
.. -_
--_
.. _----
n~lO d COlfl~ m~ d 0
Lll
d It)
IPI~$lga:.
tclln II
1 hor
• Marcador$S: c~rdlacoo
:mertaoos oncluida
c
'tfGPiWJ1't[1!~)
I
mitib,mie~to ,general ijnmediato' ,,·n la sals de eme~ge,reu~ias Jt 'Comh:Jice €Qn Qxlgsno a 4 Vmi n; maf1mng~.situ lracian O~,>9ij% .•' As;plrina 1'6m~ l2S r'ml rrrasticadm (si m> la ad ministf~ e~SEM~ ~,o t1ay'
Ii
•.CQ~dere p~ruebade
E9~nt( Ii I d
k
a~tg~as rr~Ih!iStoriad'e sangrado gas tro~m~inJJrec,ente) 1 N:lrojHoorina suolln9L1ct~, sPJay 0 i,~, .' MIQr1na i.Vi si el dolor ne cede oon ntt~(lglrcetlna
Ij
11
II N ~r~!~tl(
esfueao
'ffii
In Itu"m
Desvi~c~nel ~; re~_'" d
nld lu
til
Ii
.~
6~~P'
~leuldJ~
li
. i;TlrQ'-QAtna P'Qs~lrwa~ ,
51, rMl 'IKistt Ivi'..
--------~
• IC,m ~'II1\tJu It) I lr III~nh Ilto~ , d~i~I~' mto V~ ...1 CNb1lbqu lut ~hIn
1
COJ~I~nue~,nAU, heplnllia o
IIECNl}loQueaAit. dr.1a
anglntBnsina
~eun I~M
,d, :14 I ~~l~ l~l~II OJ nl( 'I ~ III [ In ~III) Ifl' Ilrl1~l)111 Ii Inhlh dnl d ~HHMO
~ ~a, Eiiid6~~im1 ~ ~J~ ~1i$'bfIH~rI AwltlalH);l. JiCLS Awl~ Corc)"laJy ~~,.&
O~
~! . . r'
rl1~PJt n hll
dlelneia, de isque mh~'0, inf~r1ol' 51!' pus·de dar lei alta co-n ,seguiM tento
iii
H~1I1H ~
S1r~ 1OO''Ul9'2~
Eld, 3210~iroo' WID/, ~~,
8·g~
'B'1,~
,t\.~I-:e~,
~IN))
~'KIn.,~\fCASJ'wiI~~
3iI~~3'1~~
~\I
PlOd~ ~~OO3kPr:oos
'[i\~~i\lt ('.~ UM
~
B:~,
00 tJlI~.
QfI
Inf,~
1
rx
.
nhib~dor d:&Ii M,MI~~GaA ruductasa ~htami!'1tG G(rl, ~1~)lflUml.S) t i no tt~ne wi. atMl: ~r1I~I~
DOi1
una a carGl~ogra~fi
'1~MI~fic~ci6n de ~i@,&g0,
... -
------
1_
Pa '8':-.0
'._
l.·~-.:....:.t
'_ ~
, ...
u·-'··-:n·· ·'O··i'·
.I _ ," ,,~
_'"
'."
. 'I!ill
liIi!l
i:~'~
....
,~
....~.
.-
-':8.- 5 ....0.
'. ~:.
1
._.... r
d
::_!
0'.. "
" ...
··s·····.!!!I!
"
I
'Iif,
·~:lile.
~I
r:
ID,:j·'f;ereln,ciia. errtre preaion arterial s,iis,t:,61~liica ·e~1brazo len ide'lrsclh!o y ,el izqulerdo supertor :8. , ·5, mrn Igi ,d" e~:.:..· 1··.. ·.'.II"'u·1 'r'a- ,_,ll~ An' ···'t~,e"~·c···~.e"-··'d-J-e·~'n:-'t"e=·~· IS""[n'I<e·· ·.. Ir·' m'.:. e·:····,d··:l 'a" Id"'~estruc d [ !iB. ·SISit=9lma n·19.FV'IIOI.S .. oerrtrat I O
. 1', __ , .••• ,"_, ',._._ ,' • ," .II~I ",'", ',". "_
..... S·~
.
.
..
','
I~ '.'
.J
,I
'".1
I:
J"
"_
••
}"_
~~"
•••.•
"
• __
"_
"I
.~
,i'
,.
Traumatlsrno
NID' NOi
Traurnattsmo rnayor rs,c'j'9Inlte' (UI~ti·I11,as. 6·s,'e.ma·nas)~ oiruqla IIu ~ 1~lnIC· [i.··a ,', .... . .. ortarrno II"" ."_."uoa~ - oon.. I...,.I-I... "'~.' ). h .. as,er'~lelm!or·ralg-"·I.a~.. (..'~ .....,... '"dl cll:ru'g:~II~a ft II . .......~ _.Ollg' -"::..:: g;a,stlroli rrteati rial 0 Iglen itou rina ria Sang", rado ,0 p'"rob[l,e'm'a die ic:oag!-.iul~a,c~6In si osta m,e,di',caidoi 0 ........... _.: J .. ''-'_ a ". .....10"' ,a ' 1-~ .t....' :"9;' 0:0'' =-': ·.,1, ·n,-· .'. n It 'C:-C::·, :1 '~"_ .....u.... Q n'~ ....."·8"'-'"
.:..c.' .:._.'
-.'''0 N········
. .
1'-.
'..:._ .c.:...
'._'
'.:c_ .. ..:
.. :.:
_:)
',
, •. '_:"
."
.,.',
.....•.••..
'.'
.)..
_._
:_:.
..
1 : .. _
..,:.. _'.'
g". '.
S'I~
I
N··;O·-~: _ NO"':'
J
N
._ ~J
·..·-·· ·O·· ,
.•.. .
'
.
j
.~.
••••
",I
•
.
· ....
.,
Enferrneclad s;ilstslm,iica, 'gr:a,ve (como cancer avanzacio/terrninal, entermedao hepatlca ,0 renal grB.v,e)
N"·O·,-",·
".:'
"
.. '
,_.'1'1
tre·'·s···,~
II. _ .. '_ -,__
1
a 1010
..: '< ..
I'
"'I,si'
.
'~
p' . .I:-'.~·
BJt"'1a
i'~'J
.1_[ ..
,~I
"".
". .
.~~.
1·'.:>1
IC,o__ --ai~_,-' -t
Ii;,
iIC:sci,OI,-leSi
al-.
,S;
'-I ..
,aSi
C'ualquier h rnorraqia intracrari a~provia. d - Lles~oln, es,tr'ullc,t,u,r,B,:'e' ,18, va IC,IU '1 ,atura oere bral orai (por ejernplo. malforrnaclon a,rte!ri'O'V'eno,s,a),~
-I -I -II 1
c"on,OCIL=.,
ld a
Ne,oplla:sii,a,rrtraoranesal rnallqna (prlrnarla 10 metaataaloe) oonoolda. i ······Ir·e·:-b·'r.'-'a·' Iii iIIIC.o .'. ... ···· P" "Ir' e·····v' EX' ...~..:.:..·.·::__..·l_·ll_ ..C I, ,""" :_.~.-: .• III_-.__:_. ': _. r-"A- ta q ._.~,-'u1e"" "'e'~,_.:_-', _ __:_,_::_I-,~,ii·s.'··:'q··lue·~lm··:· eri 110""IS'_' " -3'._-_ :: me·-"s'e:- ----S·'· '.:~.I'_I,'io :_::>, 'I_,...:...~·,.···,:···· "'IEp:'TI'O;' ,atalq'ue, ,c:e:r'sbr,all ~~s,q![u,emic:,o,a,gu,do en ~as 3 hor,as pr'e'v'!i:as,~,
IC"
_::_.I:~ _ __:__'.:__.~. __ '__
I::__."I::____:.__:_.· __ . ,_I.,__:_. '-:.___'..:_-::-__._
.'
l_
..... ~
'1.....:
dI l!!'s:··\le',-::I~O,~:I·lln···· a-sort :I!I"C--,B .•... :ICI--' c·:· ··'·' ;H' .ernorracaa' ,arc, rva 101 d- I~!,al-,elslls, h···"',-'.'"-""-" . " " '.." ',",',"_-'.,'', aotb .. ,: .... 1"'~t-I',·.'--:r-----··iOlt" rernorraqroa
.._..-
d·J,e.· •• ,
...
.,
..
..
,_
't'
"-".
<~
'1"~"""'I'_"';O;,··_,····
1(1' .,<.;-J
dr"'" ·,8XCIIUII~'..... ia
1
-t'
0'-'" ,_I.,.:
10"
'.~'_'>~.
f'-'a~' sclal s·-···,ililg-··'n·iii3f~iII!c' __ ',~,., .:.e--n- ' .ativo ,1_1 ,I: __ (,.~, ~ ' __"
:_,1
:.'-=-11
1~IO"":'s'" 3"','
,1·.:,.::,
I,.)
1_,
:-:-::-_::'.<':
I,
_-:::'"
_'_''::_'''''"
d:
....
_',
-.'-;811 __ j
iii!
IIiIi 1'__
,8'_:1'
tl!i ,as,
.' ,Aln't,e,ce,deln't:es,
die 'hiilplelrt:,e'n,sil,onl
Hioertenelon Igra'v[e rio oontrolada eri le~ rnornerito diS' la preaentacion (:AS >1180 rnrnl-lq 0 PA.O' »: 110 mm '~g).t . -. A,;··:,',:···.n··'t~e···,[c.'=,e:·ld·.1 .•.. d e,:-; rtaq" errte ..UiS····' IC".='e,·~··,lr··,e.-,b.~ ;is:_'q··.,'u.l,e,,j'·I,m·j-·'I"'IC'-:-,o····:·j' '>.'",.. ,,3 m' Ie.'""S,.--IB··.·'"s'-', ' •..r' a.-::III Ip.irevlo ', dernenola [0 ,af'e,c'taciion i'nl't,r!a,cr',a,nle!a~ 'COn'QI'C,~dl,a Inial rnerioloriacla en la._'..' "'. 10"0':""'. :_-.'., ntrI .....' . ' cllc acion le'-·,s-·:··' _" ::_. '.:" .--_~ " - aln .- .'.
,c' _;'_ '.__ '.' .. ' '_ ." ,_ ,_, _
.1
. ',_
','
'_'"
;_,
"..
'_
. '.'
.::.;_
I._::_ .'.'_
-'
"1_
. _ '.'
. _I
._:_.
"
.'
'.-'.'
,_.
._:_:_'
__
'_;_;_.'
._:_;_
_;_:_ .. _.
'S'~'"
..1..
-,
1.'-. ''_;
.'
.,:-
1 ' ....
-.'_/':'-
...
«,3
proloriqada
- I: 'em,o'lr-ra,gl~l
I
- mterria r ,'c:ii'8,nt,
(d,e,nlt:ro
,S
previaa) .. ,
_ Punoion vaaoular nllQI compreslble. .' IE:I-n--:' 'C":-"'a'" 1_1.1' e':.,"". '"sstre ',,' ':'p.". rto ·:·c····'n--:'a.'~s'sa/ : .'..In:" .'tre ~,'.."a'" Ii ' :..':"""p-' ..-_.',II~ 1.1. :"1\,1 n' ". '_ ····Ir"s· ~, : e <-__ :...; ' ,_,I~/ /a II., ..... :' S', e' '":;- ;.'. »slo "'X : 0' 1""0" IP" > . svia __,_' :...~_,:_I,_ d:· 8'-'0':-'" I • .~I.l ,5- ..' .. ·' g, (>-:. ,d····- Ia _-',-S·:·, la···. -n°I" t le:-:s~·:·,,)' 0 Ire'e:'"a·:·:.:' IC···.··~,;10:;"":· n'" ,a····llllle~)·r·lg,'·1; Ic':~',a/; 'P"':, r'" 'e":,V"', ;:~I""la' 1 a";, e······:8····..t 0......1' 9..., '.'','" a'".: ',:::~""I'S":-,'.' ·n· . ,'.te····:--.s':'·- ,,.. ,. '.' ' a ·:2 • rn b'. '...:..r"a-'z.o
.11_' .:_'I. .'. '_~'
ij
1 ,.
"":-',_
_'--
!I . '_"
'.
.. -_,...
.'
1 '.'
'. '._
C····.·;:
_ I.·...
_,~I
:..~~,
,<
'.'/
-",
,'_ J
-. .
.-',
---,
"
"I
"::':' .....
!_·I~~
.• :
~.'
-j'.",:_: ..
I.]
'#'
'II
Uti izaoiori
de-'
'c'
_. _ . :._',.1
:-::.~>.,:I ~:._!
a1c·tul;alll
".
de alnt:~,co,alg'ul~a,'ntle,s,:
a rnayor IINIR~rnayor
Iril9,sgo
_',
g" ':_:..'~
_-'I
I_'~..' __....
.:.......:.>,~., ':_.~.
I~J
PA,S::: Pr'es,iio,n ,arterriiaJ s,iis't6,illi'ca;' PA,DI: P'-es,i'o'n ,B,lrte!ri,a,1 d,iia,st611,ica; ~NIR:: IR,e:acii,on interrraclonat normattzade .. *CO'lnlis,ideradacomo ,a.,dlv',ertelnle~:a. para II a, tome ,d,e docletonos c,11 iilniii,cB:S puecle no SIB'Ir" to,tallm,e:nlt'e oorriplefe '0 d 'irutlva.
'II
tpl-'.'IO·:···d· .1 ._:_-'_
eer
.'._
-'_,
..-c·
,......'lllo·iI':,n 'a;···b·,····s·····o··:,·I-lu1~'-a:·-·e" _ pi'-,··a·'lc· ·~·I,·e.-··ln'··l'__. n"l i-'--"d' b>'8· J"IO'' :' ' __ ,,__ ' . 1-,,- !_, _~ _, t,.8·:'·8····· ·'e·:, _,_:___~._ .· ,,:.. c
_I
rlees g'i
_
_,_,-=.'__.
10'--'
'.\
C":'01 - in
__
. ,_:
"1
d:
'-,e""
_
.,squ',eml'h!l,~
..ICloronari:a
iizqu,j lsrol:a,
'rIllll ,I. ,..... . _.
'delilecha
C'O'Ii",o,nialr'i '
i't'1lfelr'iior ~11:j)Ini~aVIF
AAI1teri
10'1"
V:l~V~
II ~~M:IIUie':ml ilta,1
III
~ 11'
. a'V' -
III L.iI'
UII
m,
aV'P
d:e'Fe,c:ha
....... '
etrcu nfl.eia
()clu$iOn Idle ta
::Ja1.~~
IOCIIUslO'r1
vo
.-.COfllon,8:ria, ': ,
iC'end'en'te
taln J:!ri'o"r
dereeha
P-aJ~edl i'nfledor
aiVR
"'Woi.
1~1'!.;ol
...... ~~
",",0·1 n' ... ~I'~o;;lI!,. ""·~o~ 0' ~n 1;01 ~! natom II. ','I ~,~'~,
I~ '""""~
'!;#' _ ,..... ;0;
'~'iii:i
IQ
~
I
~llegi,aida
al
- $i,i
:lI!'va':I::uaIC:~'D':n 'Q1lSl'lnle!rOII ,Bsta]'b,jII iilz8Icii['D,nl i'nllme'idji I,als V , iind itf),8[,do • E:'vadlu,le' ABICt .Sii:g:nJOS vital,e's ,;Ie,a,iic,e' Uinl8 eV;ilru',_~c~D,n _ uFoll,,6gli c,a n, .' E:ill, 108;80' de niilplo:xen'da,[I 'suml,En'jl:str,e
I
G,,:xj'QI,eno
~~::;t.l. LII-'~nla,,-"Id:-~' a'-~' II.a,s,a~,a d,ie
I···.~ ._
.i
'. Ob,t,en'g,iQ, a,t,oaSilo i~'v." 'Y' ImIU,estr&s de, s,a,n'glr,s: -,., '\le-ri,'fli'q-','ue' ~~a' 'r.1,lu:co,sar Ira.tle si les,ta
l
I, ~
.' A~e:rb~a~1 eQUliplo Idl ~' ': f.: ,'J" e 'e' i",eb,.,-'_11 .' Scdicii e' ,una Tt(~ di, .'"Ole " " ,:~ _' e'nne'rgenlc'il,a s,j:nl co,nt, , cst" ' .' IR',e'edlice iU.ln E'CG ,de 112,d_'_,ri-u', ,cdonlSJ.s
erme:rg,e:ncias
Evs;1lual!c:i,o In' 'n~leUllro,116!lgilo,ailnl:ml,ed~art -'- rp,ol:r p,alrte, de ataql1u'e' ,c:Q,Ii':e:b·:r,a:1 0 Ipe'rS'Q'n a II ,de'siig:nt!i3u:::Ilo ,2,5
,d,e~elCiI 'i1Ipl'-.·
II • ,A,Ie;p\aspe: ~os:antec'ed'erntes d-e'! pac::iilein,te .. ·E's:ta:b~az:c,a,la hora :d,e 6'0ml'i'et;'iJ;~'o' dlle': Ilo,s, slinton-las,
• p,~;o:al'lr1tiilq'u'e ,eX8,'me:n rJleurre'I,!Q'gl:ic,o (lEs,ea.ll-a, Ljn' NiH ,0 Ese,a~:a, neluro~6glilca c,aln,~diiie:nsie')1
,@'Im,elig"enc~,as
a,glulido;'
,dlle
Co,nsiul'te 'calrnl IU~' ,erUll1'i6~logl'o 10,' Inet:J~ro,= n C.il~lu;'a,n!ol;sd Ina ,estlsn ,dis'IPoni ,·'~e's, : c;o'nS,'-,d,e:re 'trasla,ldlar a III_ '_ ict~lm'a
.. IF{tep:i'ta: le~ e{:f(SIlmit$!lin In~Q-rQI!o,g'ijoQI: ("Ios clefic'ilts, se reviertelM ,rap~d,alr.nen.te ,a' II1Q·rm:,all:?
'CJIj'.--
[l£;Ij
~,
d":-;I~'
..... :..
I~
tI:I
';i!3
,w,
elliil-le'lrg,e,n,o:ias
inic~e secule'~'1'c~'a Idle: :ataqu,- ere '!e,birall la, .; S:i e~:ta,d'"s,ponri'b~e' iinrgrrese a, I!a 'vi'ciijma
,S'ln
60 rrrirt
luna
ce:reb'lra~
crabla 4)
allll"i!!e'~n' .'~ilf-II~,
II~
!iiiiiiiiiiiiO
,. A!CI[.ml'Alis,·re tpA ,. N Q adliT:li!i]R~StJ~,a.otb3,j9,Qig til a:rn1tea nIi trata rru 9'Ai:'G[ ,a;Rft'p~aGflfetar:·0: ,durra,1!I1te 2r4;. h,Q:ra.s
caso ,d.e,dlet,eriro,ro ,
s,€'
8,jj
e's, n'8oo®!sa,r'i,g,
adfll1]lnist:n;~' "tratamlt1eto, '.' Inioi:e tlfa1!am~e·n,to, ,de, ,S'Opolrte:; _Ir'at~ illsS c,o:m,olric'li!ililldl,a,ldi 9S
I
.' us Ic,e:IrQJ' _.
'.~
':1
,no·· ).
.~ "tIi,
I
'.' IN .•
~IOSI
idll,e,n·tesi
.sonrfa)::
In0' S'8
. ·-,~.I
:Ii
~O:SIojoe
.'
.'
IN r .1 . hi :<IIII,_I,zl-'
.~:[ _'~
111_'_I
..
I_'I,'=-,Z'os, rrureveri se ii,gu,a~, 10' no, ,8·e rnueveri (ot rio S, ·•· •. I--,e·I-ls,ii 6nl de rnarios 'e'n pronacton, puecleri ,g,e'r utllee)
I
--'f; ~.,Z.IO'
no
,SIB
rnu,s,ve,
,0 C8 e
1 1
ue e,11 p,Bciie'nt,le Id]'ga '~'e',1 porro Ids: S,a.n R.oqlus: no 'til,ene ~ ld ·,.I'~~,nl::-Ja"s C:QI[nOICII- ,a,eri S'U zoria):). m ",._'._.' utlllze
i
,,'.1 .. -
'~-",-~,,~~."' ' : ,., , ;1 oic "O' S'::' «ioe ,'''0'-:'S·-'e· -llt~Z p:.'a.··'r. ,~·vall,lJar .-, liDS, ,Sl/rJ1f..OI7l,as ,ne,U,rO"lIOI,gl'l, :"'1-.' a····g·····'u· n·····o· tree -rn-,·,-,··.fft'~'-,--, ,n,o 'ODI11,B,l,i=' "'/.': 1-I-t'·I'P-, a _ :-·a' ,~, '·'~I!l·., U CflJC,D,S}! s·!o's'~. ,re,s,p,o' "de ~1'St'" (o "Deeconocldo") ,Si ia tiodos' ~'OIS~clriterliID(S;de! 1 ,a, 16, avlae al hosplta reoep ·,t,Qlrante,s do ta Ueg:--Isdl,a,dlell Ip-~Io·siibll,e,p-i,aiciiie·nte, con ataq •• '-ilul'ece,re'blral~,~ ,Si allg--Iulnoi t'iien'9 C:,OJmIO, reslP,uesta "No", sii'ga ,9,11' protooolo dl'9 trat.a.mi!9,nto ap~o,:pliald'otnterpretecion: Ell 193 % die II[os p- aoi 9t1te,s, oort ataoue c,9·r:ebrall IP~'reselnlta hlsJ lazcsoe p-: oaitivoe [Bin la iu\'PS,S, (s'e,nlsi'lbiiI! Id,adl ~ 93%.)" y e,I'9 7% Id:e ,aq:ullelll,Q"s oori h,a,llll:azg[Q(s positlvos B'n II a IP'SS tlerre 'un ataq ue c'e reb rail (··,es:p······IBc···:i;ficiida,dl '~' '9'7: . ')11 Ell 'p·····ac'iienlte :p',ued,e, ,e!sta'r eutriondo un a··aque t cerebral a,~:"LI'n"q"lul'e-:': cumpta :-1. _".. 110'"':,s"<, _ rio c.. _. .riterloe d·····:e·c.:_.:::,p",S, .' ·····S:-II a I LA"'- .' -·, _ ~l.·..
1c-. :_· . IU'l-~ ··• , ., •. '. ,-,fiQU.,
"-1,,-,,:-'-,;--'1 ..". , ',.', ',.' - .. •. '- ..' ...., . . ,'" '.' " ," 1_'" . .. .. ',_", -,' " . . . ", , ,', " , ,., . , , , .. : .,' ,
_':_ •. _l
:",'t".
,"-.:.
""',
I,
.~l·.
""I
:.,','
,'!13
"_
..
'':
_,"
::.'
.....:..:. .•
' __
'_ ..-
l·
.:..-:....1
,.= .. .. :
~_':
..:_ ..
__.:."
_"
-'__:
ees-
'.~
_: :
_'
..
_,..:....._
..
)~.
':"
•....••
_..
,,1,"
..••.
:.
'r,:
:._',
',"
".'."_l·,"
",_
,._.
._:.
',J
j:':'"
....:..:.
:__:','_,
_1
...
1,
,.=_
_I
',:.
'.1',.'
_ ..
'
"',_,
..
I"".:_-
',:
_,I_"
'~,.
':.'
.._ '''''_'.'
,,_'.
:_.,,:_
:_'_'"
,.:,,_'_"'.:::_.j
_',
::___, .:_:_' ..
~'
"
'_
,'_,,~,
-._
I"
':'.,'
",:
.,'
.. ':
.""_
...
','
I'
':.'
__ ...
',':
"
."
: "",._
1'_:._1
I!J.-
",-
,......
I.~
I.
'~I'
.:"
",','
","
.•••••
)~
•.•
'
_._"_
"
J.."_ ...iI!
I.:
_",_
:_",'
_,_
••
l."'
1_
~.. -
1•••••
'~l
,·····.0
>. ·41 :·is·.·' 1. Ed,-:-:lla--ld'-:' 5 a'·-:: n'' ' ' ' 0'.' ,2~ AUSie'nlc:i',a do anteoederrtes die cOlnJ'vu:!lls,iionle's 0 epilepeia ' ... - _,' <2:,4 ho!'ra,s 3. DIluraic,iI1o,n Ide, 10',8 ,Slil!n,t,IQllm"as, ,A,~tnlcto, le- [p\ac~enlte, rro 18s:ta en s;i1~~a, ruodas Idle, nl poetrado en lie oarria
.:. ':,.': ,.' I.'.
c.:·:'
".'
"
..
"
:-1
.. _'I
II
5. G'llulcle'~"liia
8:nltrs' 60 y 4 00
1 1
16'10 As'i"lefrfa' ,evide,n"e (d,e~rechla, flr/elnte, ,e ~'zq'ui,erda) ,9'- Ic,ual'quier:a Idie lae s~gu~ente\s Ic,atelglori,B,s Idie ,3, ,evai,u,'a,lc~6'ln (debe, se'r - '~niilat:eral):
··· ". --!!!i"aI'" ,_1I1111ueca ,_,a'c '-"1-1-1 So,nlrl:S'"_ .'.:., ... -, .. :-".._. -,~.~.- ~H_ Pre:-n: . S'. ~,o:;rn'"
, " ,'.. I
-b-'"'I' ~- -d ' -hD"e. II:·· iill':<.. d!,B 1"16!C a ,Asi: rrjetrfa Prslns,ii6n de,!b,i'll ,S,j'n pre nl:S ilQ,;nl
l
1
-._-1
D'8'S,c:l,s!nde,
I·C:·,a-'I.s····l Ir··a,::'lp·.';wd:--: ·a··(,m:--·':--·I~i-n---;-·t-I~ __ .' _ 1._". ,_'
1_, _~_ .. -~
IDe:b,ii i,dad izq iiielrd,a .. I· Aslrnetrfa ~ Pire:n,s,i'o,n [dle'biii~1 I S,i,nl pren.s'i1o'nl D, Defs,c:Ie'n,de
Ca"e: ra,piii,da.rmen'te
II:...r&..I'
_ ..
,'[.1 tl~
... ~
',ii
'[iIIl
t.
.~"".iif)i''~[I
fl.
l!r
,10'
' .....
.'1
t.
, •.....
'"
.1,
K.'id~"e~1 CS~ ,S:aV'191F,JL~ SChl:ul:ble·rt: 'G'B~ Eeks"eiinl M" Stark,ml,an S,. IDe,s,ilg'n a,lnd, Ir-etrlolspiectivle, s_ .all'ysi:s of tfre L'Q(sAnlg,e~:e!s prenospttat stroke screen (U\P',S.S.),,,, P'l~eho'sp ,Em',B'Yg ,Ca're'., 1'9'9 8";:2'::2'6·l-2'73,,, K,id~l'e,111 C,Sf S,t:a,rkm;a."n S:~ Eck,st:e!iln IMII~'lVe'a'ms, K" S"ave'F ,J:L" ~Idenitij'fyrning atroke in ·,:hi9 fiie'I'd: plro:spiect~v'e .L'-' A'" n .. I··· P:·I .. h'-;..' ....'.' ··..t· -II S":t""k-" "8:"" '.' _. ('c-LA; p,':S' :-"S:--;,,) S·-,··,t- '-'k'" -. ',::,1.,'·"O·""·.!':)':- ·'7"1-I '7'6:C-:' 2·O' v,al -I~d--·-t"···-· - .. 0'1'- t-~Bl lo,n 1-lllJE3. _'(Ji:S ~'' .. lgl~heis .. ,F1I3 ospl~la Ir'o'e ·:cre'9'n . "-"'" ::, ,~_"_~,,;·.:J'~,e,,,, -'O ,iO-' ~ t '..',.,
1
l':
-.,J:;:
I I
II
I
G]' ?t~e~~0, ~e -~fir:nte~ ~ 'IGS -sUM:t~tna:;;;~l!IaA~[0.13~·:~cle1ltfa,fl~le:~i~~ellll:~dQ~ermal ~r _C 1~~tih1:Ra .It>rem5':5,1 ,ab, '~ld0"~a ~~. S() ,f'tumUliGs, ,(3,. hIQI,f'a~l arotes ·d:e:, 'InJICe te'~lrllrc'OII'dell:tmt~lm[le:nrt'f)? Vle~) .0..:1;0 ~tb.Q. *Ml~n~~.nl~' l'v'~ I~Q~'f'II~:SIi~'It"i~o ".J:Ql IG~ I~~~" ,c~~~J~'F1IiI~''!!! ~"fr"l:~, .. CF.:.:Ii.~·'iI"",i;a"':'ls:::;p~ J~;"'~-~-'\ :r:'u· . se,..'';:,n ..l~~~
~~r,~II~~·.-·.J _"". 1~.1
JiI!!:!fI.?riI;r ..
~.~~j ~
,,~~i~Si,~ ·'f:J.~,l;tv~fI!
~~',jl"~oJ""'C
~~1f
.._~~~'~!~,I
'-"~'V'iW~~
~jJ-~I~j
;tj~"I:~"
¥-flll
~~I~-IQj
,~,~,~'111.~~~/~
:n"~,:n':1I:r1"'~!I'1 ,~~,,gI';:'n:"I,..;I;~~I,~jr~~~'€!'1J!!
~~'I
.-1
i~
.. IIl,t~~~IJ~(.h'It~~~1
.' Lo~,s;il1terrnas ~)re:I,_at~~lle Ge,~e'b~r.a,I":s'Qnlev.e:s '0, ooeJcu;sn .:ritapiiltlamertte (sa· .[esu\al"\(eJfn;_~J7JLe'1K1l:tan:ea,~n'oo!tel[i, ~ ~ '.' D1efltrch tle,·.·tlml~ ~b'arst'~a:s;--tmJa 'iA~~IDJ!et.liICi:~~tll <qIUi;fIJllJrWli~,a 'm,aygr. 'fJl urn t,r,a'l~rna.tMs_nr~iMQIgJr.'av"B""
,,4
-.
.... ~
"-~,,
-'~"
~ ".;;a;.
\;I
",~i+:'~,
-
I ,.
,'_-
.. " ,
_.
. ,i
,-
,-
,i',
+:-
~;,,'I,-
~.
-_-.-
("IIe'fli"[G-' d" '8- as-·,2 ,~II,as p,~'e'VtIO~ t"" , 2·t1-' ......:.I~.--. ," , .. , , )
•.
,i",
~
_'
•.
=.0
.,_.
~.
~~~J~~U,I~
:aliaIll1IlflA"rji"
!~t~:
~,
m~i~' ~~ ~R~ ~
1~1~,~:m;C"" ·!lIlJIi~t~~ro
,,~~jl~I,~-.!I~~1i'iJ
n~r\Ij!i~lm'Cli"
:8, g, >(22'112
Iil1I.iA,'O I ,)~ r II
:M!Sn,telniQ'., @'n' 'ob,s:eJrva,ci,6:n, eXlce~rpt,o sii ,h,a'!l af:'Bcta,ci'o'l1 de· ot.r;o'6,'!Orga''''''' :nI'O'S, d'iianl,a, (bbanl'c,'o) (plor eJ~m':plol" ,d!'~s,ej1c,c,ii6,na,Qlrt'~c:a", lrrfarto ,aguldo Idle mlocer diio~! eld'Slm'iil de pllu~mloni,; e'nlcef:a~,o,piatiia hJi erte Insi'v'a)", p • Trate e:~ reeto ,d,e loe sfntomae ,d',e~taque c,ereltb:r-a,1 (por elernplo, a lC:iefa;le!a.~ dolor, ;a,git:aciion'l naueeae, vomltos), • Trate e~reeto ,d\s' lias compttcactonee agu"cl,as Idel~ ,ataq u"9: c,e!rreb,r.a.~~ in~'clllljldla. ~Ia.h ipo,xi'a:, aumento ,de! .. p,resi'6n:,intna.era,:n,ea,~ ,co,lil!vulisiiones, i l a •
1 j;
,0
lhillpo'gillulc:,elm:iia.,.
'. La.b,et,a.~,o,~,10 a ,20 Imgl i.v. lent 1 a ,2 mlrurtoe. • P:ulteldl'E!' Ire,p1etlili' 10, dup~ic',arI,a ,do,siis, c,acia '110 miilnult)o·s i(dl,ols,liis, ,maxJr.na ·3,00 mi'QI) ~
'. NI".G:ar:d~p~nlo por "'nfluEdoln l.v, 'd:e 51 mlg\lhl como doals i:ni·,c~,a·I'": ;a~Ulstar ta ,d:ols~s hasta aicanzar ;elli;@,felcto dl,@s,eado- aumentando 2:,-5·'mLg!lh,cada S mlnutos haata urn max,iimIQ, de 15 mgi"hl., l '~ ,~ ,..,.d:,e'II 1·0'"'oL ,a 1" II!:'():.L '.: :,fl 'Ie, '. , ~ IU 0 b,.,..... d e·bid s:ler o!g.ria,r tlln,a, rei· UC'C:ill,on ::lleLI~v',O,_ :_, ie ),:;~,{,o ~ J 170 d S prealon a rte ri alii,. .
1 ,I '.1
'
I.,
Lab etal
0I
:PA,· >11',13
.' 'Verwf'i;,qiu11sII , preston a artisriiaJI cada 1:5 rnlnutos durante 2. horae .. desp,uIB~S;c,a;,da 30 rnirurtoa durraln!'t'e: '6· Ih'Ollra:s; y 'tina,i'lmente c'a,d';a h'01riQ , ,durr:a.nte' '116; :ho,ra's,~ .. N'~lr'op'rusi:a,to ,d:e eodlo 01,5 !1-J9lk'g/lm1t'n por i:'nfuI:sii6n' l,v. como dosle ~'r1Ii:c~aIJ' I:u,ego, ajuste la, dosts hasta ,a lcanzar la presion a,rte:riiall
de:s,ead:a,.
......2:-;~,O·::,
~:.-~
.. ".
'.1
N~ d~ " 1_ ~c:alr(1IPllinio,,par ~
0'
lha,sta, allc,a,n.z·ar . cloals en 2:,5 m!g/!h oacla 5 mlrnrtoss hlast.a'ogiF,a.r un im,a:xiiJlll1l ode 1,5 m'!g/h:;' s,i ell :niicsirdilpiilno rio lio,glra clQ!lntroil,ar la, pf'es;jIQI'n alrteri:a,~:~CIQ,n,-, eld 'e'·-re' ,. el nltroprustato Id 'e· d .. I.: I., aod lo :
l
'1_,
Ilni~l,J.s~o"n
"#,
L ~,
d II,.~V:~ e ·.I_._
~
5- m,Q'······ ' ,c·omo d aSIS, ~ ., '~II y d' ,~ .. '/h ~•. r ,.• ~ ~nl:II'C'E,a_ ,~·:eSIPIUIt#S _ .. e'._ efec:to d'eseia"d!o!~ s:u·imle·n·talnd,o ~,a.
·j
"
._
••
,'
••
,OJ
....
'1'
.....
:,C.1
l~
.. [.(.:)
!J I
\'I.!,
:'11Ij
ni"A ~"...
,S·.···"1...I '8..·':_:u,~ :. ..
1
)iiF'iIl
)~~i
2<'~'1(]1 ..:Ii. .
- L'b,.ll.II"'O· ~a.l-eILa,IO
h,8S,t,BJ
'!,I.
P'::I' Ii'
~l"'
'alc,an,za,run maxlmo de ,3 0.0 m'g!"" 0 ,adlmlnii.strar una doels lnlC'iilsd die! I~a.betalll·ol y Ilue:lgl'o gota1o'" 2 a B; Imglm'i1nl:.
1