aqui subo mi mapa mental de EPOC.

atte. César Sifuentes R1MI

Tarea metodológica para R1 solamente

Los R1 deberán buscar y seleccionar un artículo de casos y controles. Lo mejor es que sea 1 por cada sede. Subirlo a la carpeta de Dropbox en una carpeta que se llame: Estudios de casos y controles
Al Blog deberán subir una breve descripción del trabajo, enfatizando sus aciertos y debilidades por cada sede, esto en no más de unos 15 renglones del cuadro de diálogo que está en el apartado de acceso del blog.
Posteriormente, todos nos daremos a la terea de opinar sobre los trabajos elegidos y los acuerdos o desacuerdos con lo que los R1 hayan anotado.
El artículo deberá subirse a más tardar el 12 de julio y tendremos hasta el 20 de julio para hacer la discusión y realimentación.

Bienvenidos a sus nuevas rotaciones.

Evaluación del mes de mayo.

En la carpeta de Dropbox de Sesiones bibliográficas les dejo las instrucciones para la evaluación de mayo.

Saludos

Sesion de Patología Proximo martes 5 de Julio

Resumen sesión patología.

Paciente: J.A.B.E

Edad: 32 años

Género: Masculino

Antecedentes heredofamiliares:

Padre finado por Ca gástrico

Personales no patológicos:

Tabaquismo activo con índice tabáquico de 4, consumo de bebidas alcocholicas 1 vez por semana, 40 grs.

Personales patológicos:

Múltiples alergias alimentarias, amigdalectomía a los 5 años de edad, asma remitida en la adolescencia, reumatismo palindrómico diagnosticado en 2007 sin tratamiento.

Padecimiento actual: Inició su padecimiento actual el día 22 de marzo de 2011 súbitamente con diaforesis nocturna, odinofagia, disfagia, aumento en la secreción nasal, sin cambios en las características del mismo, es manejado en el servicio de urgencias como resfriado con sintomático y aine, la sintomatología continua agregándose nausea y vomito en 10 ocasiones el día 03 de abril de contenido gastrobiliar. Con disfagia al parecer esofágica. A su ingreso se documenta elevación de azoados aislada y se sugiere proteinuria en el ego motivo por el cual es hospitalizado

En su evaluación inicial se reportó: Leucos 9.53 Neutrófilos 6.3 linfocitos 1.7 Hb 13.8 plaq 225. Glu 86 BUN 26 urea 55.6 Creatinina 2.57, TGO 13 TGP 20 DHL 423 fa 102 Amilasa 37 BT 0.47 Na 138 K 3.9 Cl 99 EGO con proteinuria 75 mg/dl, ph 5.0 sedimento 6 eritrocitos y 12 leucos por campo. Tiempos de coagulación top de 15 TTP 26.2. EKG en bradicardia sinusal.

Estudios de imagen y Patología se presentarán durante la sesión.

Presenta el caso:

Ignacio Alfredo Valerio Morales

Residente Medicina Interna HCSAE PEMEX

05-07-2011

13:30hrs Auditorio del Hospital.

El significado de la p

The earth is round, p<0.05

El manuscrito...

http://www.megaupload.com/?d=VL8QI39D

Consejos para el Residente de Medicina Interna

Residentes y Maestros:

Una serie de consejos para el residente de medicina interna. Creo que todos deben leerlo, pero me parece particularmente útil para los residentes que llegan al programa.

1. Embrace your fear. You have good reason to be scared. You are directly responsible for the lives of others. These others are very sick, or they wouldn't be in a hospital. But remember that you aren't alone. Your colleagues can and will help you, and you can help them. Support each other. And remember that your senior resident and attending physician are there to help you, whether they act like it or not. Never be afraid to ask for help, but when you call, have your information in hand; anticipate questions. If you don't know what to do about a cardiac dysrhythmia, make sure you have an EKG and have ordered some labs before you call the cardiac fellow. It will save you time and embarrassment, and will get the patient help more quickly.
2. Listen to the nurses and ancillary staff. They spend much more time with the patient than you do, they've seen many years of interns come and go. They can help you, but if they sense you don't respect them or that you aren't caring for their patients well, they will hurt you. They will do whatever they can to help their patients, and they will not care if they make you miserable in the process. They will often know more than you do. If you don't trust what they tell you, verify it. You do posses a different sort of knowledge, one that you can combine with theirs to help your patients.
3. Read up on your cases. You may not have a lot of time for formal reading and studying. Read up on the diseases your own patient has, and soon you will have an impressive breadth and depth of knowledge. Listen on rounds, especially when your colleagues are presenting their patients and you'll get more bang for your buck. Teach the medical students if you have them and you'll learn even more.
4. Sleep when you can. Sleepiness harms both you and the patient. I cannot emphasize enough the value of sleep. Go to bed early, nap if you can. If you're too tired to drive home, don't.
5. Don't abuse substances other than caffeine. Even caffeine isn't that good, but if you are susceptible to substance abuse, the stress of internship can be dangerous. Be honest with yourself, and if you develop a problem, seek help from your program. You'd be surprised how much help you can get.
6. Eat well and exercise. Even if it's only taking the stairs (three down, two up), exercise will help you. You'll need it. Try to avoid all the crappy free food at conferences. Go for the healthy choices at the cafeteria.
7. Wash your hands. If a patient asks you if you did, don't be offended. Thank them for the reminder and do it again. If you can, wash them in front of the patient so they can see that you care enough to do it. Remember that certain pathogens, such as C. difficle, sporulate and will not be killed by topical alcohol solutions but must be physically scrubbed off.
8. Learn to live with uncertainty. In the hospital you get used to having information at your fingertips. You can order stat labs, get X-rays and other studies quickly. You can't do that in the clinic. Not every patient will present classically. It is more common for an common disease to present uncommonly than an uncommon disease to present commonly. Dig?
9. Trust no one. Patients will come up from the ER "pre-packaged", work up done, diagnosis made. Don't believe it. Verify it for yourself. Start from the beginning, because leaning on others' workups simply perpetuates errors.
10. Corollary: examine every patient yourself, and do it right. The exam can be focused, but do it. If your resident or student says that the skin is intact, turn the patient over and search for bed sores. Listen to the lungs. Check the mouth for thrush. Be confident in your skills, skills which will improve every day as you use them.
11. Senior residents, remember the interns are the interns, not you. Let them do their work. Let them answer their own questions. While they are pre-rounding, do your own pre-rounding, checking labs, checking in on patients. This way, when you pimp the intern on Mr. Smith's potassium and she doesn't know it, your team will realize that not only are you on top of things, but you're watching them, both to help and to make sure they stay on task.
12. Wikipedia is not a valid medical reference. I'm sorry I have to even say this.
13. Ars longa vita brevis. Enjoy the art. Medicine is interesting. It's fun. And there are no bad patients. It's just as important to learn how to manage a drug-seeking sociopath as it is to treat an acute MI. There is always something to learn, even if that "something" is that you don't want to be a gerontologist.

SESION CULTURAL 24-06-2011

AQUI LES DEJO LA SESION CULTURAL DE JUNIO PARA AQUELLOS Q NO LA VIERON SALUDOS A TODOS EN ESPECIAL A LOS COLEGAS QUE ESTAN EN PROVINCIA LOS ESPERAMOS PRONTO POR ACA

Internet

Y ahora que se nos acaba el internet, alguien sabe qué vamos a hacer ?

Sesion patologia 07.06.11

Es el caso que discutiremos con los radilogos y patologos; R1 estudien

http://www.megaupload.com/?d=D7VAWQP1

Uso de mediciones compuestas en ensayos clínicos

En varias ocasiones ha surgido la pregunta de la validez de las mediciones compuestas (pooled measurements, composite index, composed end-points, etc.) en las sesiones. Hemos comentado acerca de los beneficios y perjuicios de esta estrategia.
Les adjunto un artículo que comenta acerca de este tópico por uno de los genios de la metodología, el Dr. Gordon G Guyatt.
Ojalá tengan tiempo de poderlo revisar.

Lo deposito en la carpeta de Dropbox de sesiones. Espero no haya inconveniente.