Manejo del paciente

quemado e intoxicaciones
agudas
Maria Jose Calderon Cordoba
Maria Camila Castro Acuña
Contenido

Plan de
01 Caso clinico 02 Diagnostico 03 manejo

04 Tema
CASO CLINICO
Adolescente de 14 años, sexo femenino, quien en un intento de suicidio se toma 30 tabletas de
Aspirina de 500 mg hace 18 horas por una discusión con su novio. Sin embargo, solo hasta la mañana
siguiente le cuenta a su mamá lo sucedido. La madre acude de inmediato al servicio de urgencias de la
UAP de Fontibón donde usted se encuentra laborando como médico rural.

Revisión por sistemas: nauseas y dolor abdominal desde hace 3 horas. Refiere cefalea intensa en
hemicráneo derecho. Desde la madrugada con alteración del estado de conciencia. Tos y dificultad
progresiva para respirar desde hace 2 horas. Al momento de su ingreso al triage presenta episodio
convulsivo tónico en hemicuerpo izquierdo de 10 minutos de duración con pérdida de conciencia
motivo por el cual es trasladada a reanimación.

No antecedentes de importancia
CASO CLINICO
Al examen físico de ingreso al servicio de urgencias: Paciente en regulares condiciones
generales, deshidratada y con marcada palidez mucocutánea. Peso: 45 kg Tensión arterial:
150/100 Frecuencia cardíaca: 56 latidos/minuto Frecuencia respiratoria: 10 respiraciones/minuto
con patrón respiratorio irregular y superficial Temperatura: 36.8 grados centígrados Saturando:
80% al 21% Ruidos cardíacos rítmicos. Estertores crepitantes difusos en ambos campos
pulmonares. Abdomen: blando, depresible. Hígado palpable 3 cm por debajo del reborde costal
derecho. No se palpan masas ni signos de irritación peritoneal. Extremidades: pulsos centrales y
periféricos imperceptibles. Llenado capilar de 8 segundos. Neurológico: estuporosa, pupilas
derecha de 3 mm e izquierda de 6 mm, fijas. Hipertonía generalizada con reflejos
osteotendinosos de +++/++++.

Presenta el siguiente ritmo cardíaco al monitoreo del visoscopio:


Estuporosa, con esfuerzo
respiratorio, palida
Traslado a UCI, oxigeno por
Dificultad respiratoria
canula nasal de alto flujo,
Shock?
glucometria, bolo 10cc/kg
de LR.

Secreciones, no cuerpos Enf del

Algoritmo de paro
extraños, FR 10 rpm, Sat: 80%, parenquima:Edema
Furosemida 1 mg/ kg
patron irregular y superficial, pulmonar
IOT
estertores crepitantes difusos en Shock cardiogenico
Bolo 3 cc / kg SS 3%
ambos campos pulmonares, FC: compensado
Radiografia de torax
56 lpm, con FV en monitor, Alteracion del estado
TAC craneo
pupilas anisocoricas, hipertonia con conciencia
Fibrilacion ventricular

Difultad respiratoria desde ayer,

somnolienta dsde hace 2 horas,
Gases arteriales
nauseas y dolor abdominal hace
Intoxicacion por Funcion hepatica
3 horas, cefalea en hemicraneo
salicilatos Electrolitos
derecho, consumo de 30 tab de
Ver algoritmo
aspirina el dia de ayer
Diagnósticos:
1. Paro cardiorespiratorio
1.2 Fibrilacion ventricular
2. Intoxicacion por salicilatos
2.1 Edema pulmonar
2.2 Edema cerebral
2.2.1 Hernia trastentorial central?
3. Intento de suicidio
3.1 Trastorno de depresion?
Plan de manejo:
1. UCIP
2. Cabecera 30°
3. Radiografia de torax
4. TAC craneo
5. Cuadro hematico
6. Tiempos de coagulacion
7. Gases arteriales
8. Electrolitos
9. Funcion hepatica
10. Funcion renal
11. Sistematico de orina (pH y screening de tóxicos)
12. Bicarbonato de sodio 1 mEq/kg
13. Hemodialisis
14. En caso de otra convulsion diazepam
15. Control signos vitales
16. Ficha de notificacion
01
INTOXICACIÓN
POR SALICILATOS
Generalidades

Definicion Presentaciones Epidemiologia

Compuestos Subsalicilato de bismuto, salicilato de
Tasas de morbilidad y
mortalidad asociadas con
derivados del acido metilo, acido salicílico, acido acetil
intoxicación aguda son 16% y
salicílico, salicilato de dietilamina,
salicilico salicilato de sodio.
1%, respectivamente.

Efectos
Intoxicacion En niños
Terapeuticos A partir de 150 mg/kg
Puede ocasionar
Antinflamatorio, analgésico, caracterizado por síntomas
inhibidor de la agregación gastrointestinales sindrome de Reye
plaquetaria y antipirético
Dosis tóxica
Generalidades en farmacología

Absorcion Distribucion
En tracto GI o vía dérmica. Biodisponibilidad oral Tiene una unión a proteínas
80-100%. El tiempo para alcanzar la plasmáticas del 90 % pero en
concentración plasmática máxima (t max) es 1-2 dosis tóxicas es de 75%.
horas. Es retardada o prolongada en sobredosis volumen de distribución es de
0.15-0.4 L/kg

Metabolismo Eliminacion
Renal. Semivida 15 a
Hepático. Primer paso
30 min (20 a 30 horas
con citocromo p450
en concentraciones
y CYP tóxicas)
Fisiopatología
 Equilibrio acido base
Interfieren con el metabolismo aeróbico del ciclo de Krebs→ ↓ producción de
ATP
Desacoplan fosforilación oxidativa mitocondrial→ ↑Metabolismo anaeróbico →
↑lactato = Acidosis láctica
↑de la tasa metabolica: Hipertermia
↑ consumo de O2 y producción de CO2
↑Metabolismo de ácidos grasos→ Cetoácidos
Aceleración de glucolisis y glucogenolisis→ Hiperglucemia inicial
↑demanda de glucosa→ ↑Gluconeogénesis
↓ de glucogeno→ hipoglicemia
↑catabolismo proteico con ↑ de aminoácidos en sangre (inhibición de
aminotransferasas)→ Aminoaciduria
Resultado: Acidosis metabolica
Fisiopatologia
Sistema Hematopoyético
Inhiben COX→ Disfunción de plaquetas y
pérdida de la protección de la mucosa
estomacal
Interfiere con el metabolismo de la vitamina
K→ Alterando la síntesis de factores de
coagulación→ Hemorragias
Líquidos y electrolitos
Toxicidad severa = Deshidratación mayor del
5 al 10%
Alteraciones hidroelectrolíticas secundarias a
alcalosis respiratoria y orina alcalina
(↑eliminacion de HCO3, Na y K)→
Hiponatremia e hipokalemia
Fisiopatologia

SNC
Inicialmente estimula el centro
respiratorio provocando
hiperventilación: Alcalosis respiratoria
(transitoria) + deshidratación + acidosis
metabólica compensatoria
↓ph sanguíneo→ ↑Forma no
ionizada→ Atraviesa pasivamente la
BHE → Acidosis del SNC = Edema
cerebral y convulsiones
Respiratorio
Taquipnea + hiperpnea→ Acidosis
respiratoria por edema pulmonar
no cardiogénico
Debido a ↑en permeabilidad
capilar e inhibición de
prostaciclinas
Clinica
Clasificación
 Diagnóstico
Clinico
Fases

Otros
Rx tórax en caso de intoxicación severa,
edema pulmonar o hipoxemia.
ECG: alteraciones secundarias a hipocaliemia
(ondas U, ondas T aplanadas, QT alargado), y
arritmias ventriculares.

Pruebas confirmatorias
La prueba rápida en orina con cloruro férrico (FeCl3)
a 10% consiste en adicionar 1ml de este reactivo a 5
ml de orina, se calienta la orina ligeramente. Si los
salicilatos están presentes, un color morado-violeta
aparecerá.
Concentración sérica de salicilatos. Exclusivo en
pacientes con alta sospecha
● Hemograma: Encontrando neutrofilia y
leucocitosis
● Gases arteriales: Primero alcalosis
respiratoria seguido de acidosis metabólica
● Glucemia: hipoglicemia
● Función renal: aumento de creatinina y
nitrógeno ureico
● Tiempos de coagulación: prolongados
predominantemente PT
● CPK puede estar aumentada por proceso
de rabdomiolisis
● Calcio: hipocalcemia total e ionizado
● Anión gap mayor a 16 mEq/L
Tratamiento
Gracias
 Body Thoughts Feelings

Mercury is the closest Venus has a beautiful Despite being red, Mars is
planet to the Sun and the name and is the second actually a cold place. It’s
smallest of them all planet from the Sun full of iron oxide dust
 Day 1
Venus is very hot
01

Day 3 Day 2
Mars is very cold
03 02 Jupiter is a big planet

Day 4
04 Saturn is a gas giant
 Thinking
problems
Jupiter is a gas giant
and also is the biggest Severe
planet of them all
anxiety
Mercury is the closest
Muscle planet to the Sun in all
the Solar System
weakness
Despite being red,
Planet Mars is actually
a cold place
ABOUT THE DISEASE
Critical ill patients PICS Family

Survivors
Physical Mental
impairments impairments
Cognitive
impairments

Long term
prognosis
SYMPTOMS OF THE DISEASE
Delirium
Venus has a beautiful name and is the
second planet from the Sun

Dementia
Neptune is the farthest planet from the
Sun. It's also the fourth-largest

Depression
Jupiter is a gas giant and the biggest
planet in the Solar System
RISKS FACTORS
40% 30%
1st risk 2nd risk
Despite being Venus is the
red, Mars is a second planet
cold place from the Sun

20% 10%
3rd risk 4th risk
Jupiter is the Earth is the
biggest planet of place where we
them all currently live

Follow the link in the graph to modify its data and then paste the new one here. For more info, click here
TREATMENT

Medicine A Medicine B Medicine C

Patient 1 0.6 gr 0.3 gr 0.3 gr

Patient 2 0.1 gr 0.5 gr 0.3 gr

Patient 3 1.2 gr 1.4 gr 1.2 gr

A PICTURE IS WORTH
A THOUSAND WORDS
A PICTURE
ALWAYS
REINFORCES
THE CONCEPT
Images reveal large amounts of data, so
remember: use an image instead of a long
text. Your audience will appreciate it
KEY NUMBERS

33%
of this problem
50% 50%
of all patients of patients stay in the
occurs in all patients admitted with severe ICU for at least
on ventilators infection too one week
PREVALENCE
55%
Venus
Venus is the second
planet from the Sun

45%
Mars
Despite being red,
Mars is a cold place
 CONCLUSIONS
Take the time to learn about your loved
one's illness and treatment options. This
information will assist you in making
decisions, feeling confidence in your
choices, and reducing stress
OUR TEAM

Jenna Doe Timmy Jimmy Susan Bones

You can speak a bit about You can speak a bit about You can speak a bit about
this person here this person here this person here
REFERENCES

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