Patient used for 82 years. Emergency service to present a time of illness of 15 days with hyporexia, dysarthria, rigidity of upper and lower limbs, general condition, periodic with edema, skin lesions and sensory disorder, bradycardia. sustained Therefore, at the beginning, it presents as a problem of respiratory insufficiency, sensory disorder to rule out a stroke. Patient worsens with greater sensory and hemodynamic compromise refers to myxedema coma by applying the Clinical Score of Coma Mixedematoso, treatment is started, patient dies.

Paciente varón de 82 años que ingresa al Servicio de Emergencia por presentar un tiempo de enfermedad de 15 días con hiporexia, disartria, rigidez de miembros superiores e inferiores, en mal estado general, pícnico con edema, lesiones en piel y trastorno del sensorio, bradicardia sostenida; por lo cual al inicio se plantea como problema de insuficiencia respiratoria, trastorno del sensorio a descartar un accidente cerebro vascular. Paciente empeora con mayor compromiso del sensorio y hemodinámico se plantea diagnóstico de Coma Mixedematoso aplicando el Score Clínico de Coma Mixedematoso, se inicia tratamiento, paciente fallece.

La readmisión de pacientes al servicio de emergencia es frecuente, costosa y prevenible. Disminuye la calidad de atención y pone en riesgo la atención oportuna. Objetivos: Determinar el porcentaje de pacientes con readmisión frecuente, categorizarlos según tiempo, describir factores relacionados y determinar la mortalidad intrahospitalaria. Materiales y métodos: Estudio retrospectivo en pacientes admitidos en salas de observación de emergencia adultos, entre enero y diciembre del 2012. Readmisión frecuente se considera a cinco o más admisiones durante el año, evaluando variables sociodemográficas y motivo de ingreso del sistema estadístico institucional. Programa estadístico utilizado SPSS 20.0, pruebas estadísticas: Chi-cuadrado y T-Student. Cumpliendo el principio de confidencialidad. Resultados: Ingresaron 17550 pacientes y 20,82% tuvo más de una admisión en el año. E...

La readmisión de pacientes al servicio de emergencia es frecuente, costosa y prevenible. Disminuye la calidad de atención y pone en riesgo la atención oportuna. Objetivos: Determinar el porcentaje de pacientes con readmisión frecuente, categorizarlos según tiempo, describir factores relacionados y determinar la mortalidad intrahospitalaria. Materiales y métodos: Estudio retrospectivo en pacientes admitidos en salas de observación de emergencia adultos, entre enero y diciembre del 2012. Readmisión frecuente se considera a cinco o más admisiones durante el año, evaluando variables sociodemográficas y motivo de ingreso del sistema estadístico institucional. Programa estadístico utilizado SPSS 20.0, pruebas estadísticas: Chi-cuadrado y T-Student. Cumpliendo el principio de confidencialidad. Resultados: Ingresaron 17550 pacientes y 20,82% tuvo más de una admisión en el año. E...

Objective. To determine the demand for medical care in the last decade. Design. Retrospective study. Participants. Patients aged 14 years or more attended at the Emergency Service of a tertiary hospital. Interventions. The institutional system was reviewed and analyzed with SPSS 21.0. Main outcome measures. Number of patients, demand profile, time slot, day and month of visit, destination, emergency room stay, and mortality. Results. 164 370 attentions were recorded during 2015, the patient’s average age was 57 years (SD 20), female 57.5%, came preferably in the morning, most often in laboring days (Monday), with a similar frequency every month, which declined in national holidays and Christmas. The daily average of attended, admitted and overnight staying patients in observation rooms increased respectively in 49%, 8%, and 78% in the last decade; the average of overnight patients decr...

Context: Terminally ill patients (TIP) frequently visit the emergency department (ED), but the prevalence of these visits is unclear. Objective: To determine the prevalence of TIP visiting the ED. Methods: Systematic review of observational studies published between 1998 and 2018 reporting adults TIP who used the hospital ED, searching in PubMed, CINAHL, SciELO, LILACS, and Cochrane. Three evaluators selected and extracted data (kappa concordance 0.63). The quality of the studies was evaluated with the Newcastle–Ottawa scale and global estimates were made, calculating combined prevalence (95% confidence interval [CI]) and heterogeneity of the studies (I2). Results: We identified 2429 publications, ultimately including 31 studies in 14 countries; 79% were from high-income countries, 21% from medium-income countries, and none from low-income countries. Most were from 2015. We found that ...

Introduction. The educational environment in hospital medical services has an impact on the resident physician’s training, performance, satisfaction and skillsacquisition. Objectives. To know the resident physician’s perception of the learning and educational environment and associated factors during duties in theEmergency Department of Hospital EsSalud Edgardo Rebagliati Martins, Lima, during April-May 2019. Methods. Observational, cross-sectional study,applying Postgraduate Hospital Educational Environment Measure (PHEEM) instrument, to resident physicians of medical specialties who perform dutiesin Emergency Department. Population, 141 residents, obtaining 131 surveys. Results. Average age 30.74 years. Male sex 57.25%. From Lima 52.67%.Undergraduate in National University 45.04%. Specialties: critical areas 21.37%, internal medicine 25.2%, other medical specialties 53.44%. PHEEM&n...

Introduction. Patients with advanced chronic disease (cancer and non-cancer) often go to emergency services. Objectives. To determine terminal chronic disease in those admitted to emergency, reason for admission, treatment and destination, comparing cancer with non-cancer. Methods. Observational study in people over 18 year old admitted to the emergency department of a tertiary hospital. Instrument: Supportive and Palliative Care Indicators Tool. Statistical analysis: Chi-square and U Mann-Whitney tests, considering p <0.05. Results. Of 4925 admissions, 271 (5,5%) met criteria. 233 patients were analyzed, median age 77 years [28-99], female sex 59%. Cancer diagnosis 42%, dementia 23%, neurological sequelae 15%, liver cirrhosis 12% and another 8%. Reason for admission was 48% infection, 9% uncontrolled pain and 7% bleeding. Antibiotics were used in 48...

Introducción: La etapa final de pacientes oncológicos genera elevados costos, sobre todo en hospitales. Objetivos: Determinar la diferencia de costos de atención al final de la vida de pacientes oncológicos en el hospital versus el domicilio. Material y métodos: Estudio retrospectivo de análisis de costos en pacientes fallecidos por cáncer en estadio clínico IV de un hospital terciario de la seguridad social, marzo 2018. Se comparó un grupo domiciliario (GD) de un programa paliativo con un grupo hospitalario (GH) admitido por emergencia. Se estimaron costos directos de servicios profesionales, hospitalización, procedimientos, exámenes auxiliares y medicamentos. Para el análisis estadístico se utilizó Chi cuadrado y T de Student, considerando un valor p<0,05 y utilizando SPSS 24.0. Resultados: Se incluyeron 81 pacientes en GD y 22 en GH, edad entre 36 y 96 años, con una med...

Background: The final stage of cancer patients generates high costs, especially in hospitals. Objectives: To determine the difference in care costs at the end of life for cancer patients in the hospital versus at home. Material and methods: Retrospective cost analysis study in patients who died of clinical stage IV cancer in a tertiary social security hospital, March 2018. A home group (Home) of a palliative program was compared with a hospital group (Hospital) admitted from the emergency department. Direct costs of professional services, hospitalization, procedures, auxiliary exams, and medications were estimated. Chi square and Student's T were used for statistical analysis, considering a value of p<0.05 and using SPSS 24.0. Results: 81 patients in Home and 22 in Hospital were included, aged between 36 and 96 years, with a median of 72 years in Home and 77 in Hospital (p=0.97), fema...