A fin de tener una adecuada organización en desastres y su similitud a la pandemia Covid-19 para enfrentar una siguiente ola, el contenido de esta ponencia mostrará los puntos clave en el manejo de emergencias y desastres adaptados a la pandemia del Covid-19, el triaje en desastres y pandemias 2014, triaje Covid-19 2020, triaje terciario, la alerta roja y sus lineamientos y gestión del riesgo en el Hospital Cayetano Heredia

The current understanding of acid-base physiology states that all changes in the blood, pH, as well as variations in a healthy state and during disease occur through changes in 3 variables: (a) Carbon dioxide (CO2), (b) electrolyte relative concentration, and (c) weak acid concentration. Internal milieu and acid-base disturbances generate alterations inthree areas: a) direct damage in multiple organs and systems, (b) a compensatory response to the disturbance, which may be suitable or incomplete, and (c) functional alterations in immune cells. The classically used Henderson-Hasselbalch equation for the classification of acid-base disorders in respiratory (abnormal CO2) and metabolic (abnormalbicarbonate) and for the “anion gap” calculation, but this equilibrium  equation assumes that albumin and phosphate concentrations are very close to normal, a condition that is not necessari...

Introduction: noninvasive mechanical ventilation is a technique with a fan interface - patient through a nasal or facial mask. This reduces the morbidity associated with conventional mechanical ventilation associated with endotracheal intubation and sedation of the patient relaxation. Objectives: To assess morbidity and mortality of patients undergoing non-invasive mechanical ventilation (NIMV), in the General Intensive Care Unit (GICU) of Hospital Nacional Cayetano Heredia (HNCH) from June 2007 to May 2008. Material and method: We obtained data from the GICU files from June 2007 to May 2008. We recorded physiological values when beginning and finishing NIMV and we defined success and failure when using NIMV. Results: During the one-year study, 30 patients required NIMV, their average age was 49.7± 2 years, and 63.3 per cent were women. When NIMV was started, APACHE II sc...

Introduction: noninvasive mechanical ventilation is a technique with a fan interface - patient through a nasal or facial mask. This reduces the morbidity associated with conventional mechanical ventilation associated with endotracheal intubation and sedation of the patient relaxation. Objectives: To assess morbidity and mortality of patients undergoing non-invasive mechanical ventilation (NIMV), in the General Intensive Care Unit (GICU) of Hospital Nacional Cayetano Heredia (HNCH) from June 2007 to May 2008. Material and method: We obtained data from the GICU files from June 2007 to May 2008. We recorded physiological values when beginning and finishing NIMV and we defined success and failure when using NIMV. Results: During the one-year study, 30 patients required NIMV, their average age was 49.7± 2 years, and 63.3 per cent were women. When NIMV was started, APACHE II sc...

The current understanding of acid-base physiology states that all changes in the blood, pH, as well as variations in a healthy state and during disease occur through changes in 3 variables: (a) Carbon dioxide (CO2), (b) electrolyte relative concentration, and (c) weak acid concentration. Internal milieu and acid-base disturbances generate alterations inthree areas: a) direct damage in multiple organs and systems, (b) a compensatory response to the disturbance, which may be suitable or incomplete, and (c) functional alterations in immune cells. The classically used Henderson-Hasselbalch equation for the classification of acid-base disorders in respiratory (abnormal CO2) and metabolic (abnormalbicarbonate) and for the “anion gap” calculation, but this equilibrium  equation assumes that albumin and phosphate concentrations are very close to normal, a condition that is not necessari...

La dapsona es una sulfona utilizada en una variedad de enfermedades dermatológicas que incluye el pénfigo, la metahemoglobinemia es un síndrome clínico potencialmente mortal debido a la disminución del aporte de oxígeno desde la sangre hacia los tejidos; la metahemoglobinemia adquirida es la forma más frecuente y es un conocido efecto adverso del uso de dapsona. Describimos el caso de un varón con pénfigo foliáceo y tratamiento reciente con dapsona, que presentó cianosis, disnea y choque circulatorio ante concentraciones elevadas de metahemoglobina(21%); el tratamiento inicial incluyó oxigenoterapia, soporte ventilatorio invasivo, hemodinámico y administración de azul de metileno intravenoso, ante la ausencia de respuesta clínica se realizó exanguinotransfusión como terapia de segunda línea con respuesta óptima, el nivel sérico de metahemoglobina fue 2,3% tres h...