Cuando una persona con neumonia adquirida en la comunidad debe ser internado?

Fuente: When should a person with community acquired pneumonia be admitted to hospital?
Answer: The CKS guideline on chest infections in adults contains a substantial section on the management of community acquired pneumonia. Concerning deciding on referral to secondary care or admittance to hospital, CKS recommends using the CRB-65 scoring system: “Assess the CRB-65 score for all people diagnosed with pneumonia: One point is awarded for each of the following features: Confusion — recent. Respiratory rate 30 breaths/min or greater. Blood pressure — systolic of 90 mmHg or less or a diastolic of 60 mmHg or less. 65 years of age or older. For people with a CRB-65 score of 3 or more, arrange urgent admission to hospital. For people with a CRB-65 score of 2, arrange same-day assessment in secondary care. Secondary care options include short-stay inpatient treatment or hospital-supervised outpatient treatment. For people with a CRB-65 score of 0 or 1, treatment at home may be appropriate, depending on clinical judgement and available social support. For people over the age of 50 years who smoke and do not require admission to hospital: Check for possible underlying lung cancer by: Assessing clinical features of underlying lung cancer. Arranging a chest X-ray at the time of presentation. Arranging a follow-up chest X-ray at 6 weeks if the initial X-ray does not detect an underlying malignancy. For further information see How should I follow-up? Refer urgently under the 2 week waiting rule if there are any clinical or radiographic features of lung cancer.” CKS provides the following additional information: • “The CRB-65 system should not be used to replace clinical judgement in deciding if a person should be admitted. Other factors should also be considered in making the decision. These include: o The person’s wishes. o Their social support. o Pre-existing conditions. o Pregnancy. o General frailty. • Clinical features of underlying lung cancer include: o Hemoptysis. o Weight loss. o Voice hoarseness. o Finger clubbing. o Cervical and/or supraclavicular lymphadenopathy. o Features suggestive of metastasis. • For further information on assessment and management of people with suspected lung cancer, see the CKS topic on Lung cancer – suspected.” [1] This section also outlines the evidence supporting these recommendations (please see Basis for Recommendation). Reference 1. CKS. Chest infections – adult. August 2007. (http://www.cks.library.nhs.uk/chest_infections_adult/)
The NLH Question Answering Service aims to answer questions quickly, it is not a systematic review. If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. The NLH and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document

Medicina Respiratoria basada en la evidencia

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Evidence-Based Respiratory Medicine (just the book no CD)
Stationary Office | Pages: 608 | 2006-11-01 | ISBN:072791605X | 5 MB
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Evidence-Based Respiratory Medicine with CD-ROM (Evidence-Based Medicine)
By Peter G. Gibson, Michael Abramson, Richard Wood-Baker, Jimmy Volmink, Michael Hensley, Ulrich Costabel

* Publisher: BMJ Books
* Number Of Pages: 608
* Publication Date: 2006-11-01
* ISBN-10 / ASIN: 072791605X
* ISBN-13 / EAN: 9780727916051
* Binding: Hardcover

Book Description:

* First major evidence-based text in adult respiratory medicine
* Comprehensive, authoritative summary of the best treatments for the major respiratory diseases
* Compiled by specialists from the Cochrane Airways Management Group
* Easy-to-use format, with key clinical implications summarised in each chapter
* Kept up-to-date online

Compiled by specialists from the Cochrane Collaboration Airways Management Group, Evidence-based Respiratory Medicine is the first major evidence-based text in adult respiratory medicine.

Providing a comprehensive summary of the best treatments for the most important respiratory diseases, some of the world’s leading physicians review the evidence for a broad range of treatments using evidence-based principles. Essential information is presented in an easy-to-understand format, with the most important clinical implications summarised in each chapter.

Evidence-based Respiratory Medicine tackles the big clinical questions in diagnosis and treatment, presenting treatment options which take into account the individual patient’s needs.

Evidence-Based Series: Evidence-based Respiratory Medicine, part of the acclaimed series BMJ Evidence-based medicine textbooks that have revolutionised clinical medicine literature, comes with a fully searchable CD-ROM of the whole text.

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Surgical Complications: Diagnosis and Treatment

Surgical Complications: Diagnosis and Treatment

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Publisher: Imperial College Press
Number Of Pages: 1016
Publication Date: 2007-03-22
Sales Rank: 1789911
ISBN / ASIN: 1860946925
EAN: 9781860946929
Binding: Hardcover
Manufacturer: Imperial College Press
Studio: Imperial College Press
Average Rating: 0
Total Reviews: 0

Product Description:

As Professor Owen H Wangensteen, one of the greatest academic surgeons of the 20th century, said: You are a true surgeon from the moment you are able to deal with your complications. Prompt and accurate diagnosis, as well as effective treatment, of surgical complications is one of the most important elements of surgical practice. This is today more important than at any other time, since over the last 20 years we have witnessed the development of new surgical sub-specialties, the performing of complicated operations in very challenging patients, the introduction of new technologies in surgical practice and, last but not least, an increasing interest in monitoring the quality, medico-legal implications, and ethical dimensions of surgical practice and malpractice. As surgical complications have been presented briefly and sporadically in various books and only as a small part of chapters dealing with surgical techniques, there is a pressing need for a modern textbook dealing with the diagnosis, treatment, auditing, medico-legal implications and ethical problems related to surgical complications. Written by internationally known authors, the chapters deal with both the general issues regarding the surgical complications and the specific issues related to each surgical specialty. Each chapter includes: clinical presentation; diagnosis (clinical, laboratory investigations, imaging); treatment (conservative, surgical); and outcome.
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