El Blog De La Enfermera

Manejo del paciente Politraumatizado

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<span style="font-family: Verdana, sans-serif; line-height: 24px;"><b>PROPÓSITOS</b></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Identificar
rápidamente al paciente traumatizado con lesiones críticas y establecer
prioridades de atención, tendientes a la estabilización esencial, adecuada y
eficiente tanto en el sitio de la escena como en el trayecto al centro
hospitalario. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Promover la
secuencia correcta sobre la evaluación técnica, estabilización, reanimación y
transporte de pacientes traumatizados como de enfermedades repentinas</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Enfatizar
la necesidad de EVALUACION RAPIDA DE PACIENTE CRITICAMENTE TRAUMATIZADO -
TRATAMIENTO DEL ESTADO DE SHOCK Y DE LA HIPOXEMIA - RAPIDO TRANSPORTE A UN
CENTRO HOSPITALARIO ADECUADO.<i> </i></span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">OBJETIVOS</span></b><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">        </span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Realizar
acciones encaminadas a salvar la vida.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">        </span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Desarrollar
el hábito de evaluar y manejar al paciente politraumatizado de forma lógica,
ordenada y secuencial.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> DEFINICION</span></b><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Se define politraumatismo a la coexistencia de
lesiones traumáticas múltiples producidas por un mismo accidente, comportando,
aunque sólo sea una de ellas, riesgo vital para el paciente. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">EVALUACIÓN EN EL LUGAR DE LA ESCENA</span></b><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Consiste en la identificación y valoración de
problemas que implican riesgo vital para el paciente. La norma básica de
realización inexcusable es la identificación del problema, seguido del
tratamiento y sin interrumpir la valoración realizar una valoración global de
un evento teniendo en cuenta:</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Protección
personal universal (guantes, monogafas y tapabocas)</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Evaluar
general de la escena (M.E.E.)</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Seguridad
evaluación de peligros y asegurarse que no haya ninguna que amenace su vida.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Escena
evaluación de número de vehículos implicados, fuerzas involucradas, tipo de
daños.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Situación
Que paso, edad, mecanismo de lesión y numero de personas involucradas.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Activar
el Sistema de Emergencia Medico, solicitar apoyo necesario.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Evaluación
primaria del paciente, </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Establecer
el nivel de conciencia (AVDI)</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><br /></span></div>
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<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Mantener la vía aérea permeable:</span></b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> (A: Airway, vía aérea) e
inmovilización con collar cervical.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">El primer
paso es comprobar si su vía aérea está obstruida. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Limpiar
la boca de posibles cuerpos extraños. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Colocar
una cánula de Guedel si el paciente esta inconciente para impedir la
obstrucción de la laringe por la lengua, y administrar oxígeno según la
necesidad del paciente y los medios técnicos a nuestra disposición: mascarilla
con efecto Venturi (Ventimask), BVM (ambú), etc. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
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<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">La intubación oro-traqueal, si no hay medico para el procedimiento, continuar con
BVM hasta que llegue a un centro hospitalario.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Siempre
que administremos oxígeno con cualquiera de estas medidas a estos pacientes,
debemos administrarlo según la necesidad, con objeto de lograr una buena
saturación de oxígeno a nivel tisular.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l7 level1 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Adecuado
control cervical. Evitar el producir o agravar una posible lesión cervical.
Para cualquier maniobra evitaremos extensiones y flexiones del cuello. Además,
si disponemos de un collarín cervical, lo colocaremos, siempre en la maniobra
de colocación sin movilizar el cuello del paciente. El hecho de traumatismo en
cabeza o cuello, o de tratarse de accidente de transito o traumatismo violento,
haya o no clínica, es motivo suficiente para colocar collarín hasta que
exámenes subsiguientes y/o pruebas complementarias demuestren lo contrario.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Mantener correcta ventilación-oxigenación</span></b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">: (B: Breathing, ventilación).
Una vez controlada la vía aérea, debemos asegurar un adecuado nivel de
intercambio gaseoso a nivel alvéolo-capilar. Para ello es imprescindible,
asegurar la administración de oxígeno según la necesidad. Pero aún hay algo más
importante: debemos valorar aquí, por inspección y auscultación, la simetría y
correcta ventilación con los movimientos respiratorios de ambos hemitórax. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Mantener buen control hemodinámica</span></b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">: tratar el shock y controlar
puntos externos de sangrado profuso. (C: Circulation, circulación) </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">NO DEBE
INTERRUMPIR LA RESPUESTA DE EVALUACION CON EXCEPCIÓN DE OBSTRUCCION DE VIA
AEREA Y PARO RESPIRATORIO </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Es decir,
tratar el shock, que salvo escasas situaciones, será un shock hipovolémico por
sangrado interno o externo.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Si existe
una hemorragia externa profusa, la primera medida será la compresión local, si
se dispone de ello con material estéril (vendas, gasas, compresas,). si la
compresión local se efectúa con decisión y la presión se mantiene, suele ser
suficiente hasta el traslado a un centro hospitalario adecuado, aún cuando el
sangrado se encuentre activo.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Si hay
shock y no hay hemorragia externa, y descartamos otras causas de shock, como un
neumotórax a tensión, sospecharemos una hemorragia interna.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Evaluar
pulsos: por variaciones halladas en pulsos dístales, tensión arterial,
respiración, color de la piel, temperatura, llenado capilar, color de mucosas,
nivel de conciencia, diuresis, etc</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Otros tipos de shock, menos frecuentes</span></b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">: son: shock cardiogénico
(contusión cardiaca, taponamiento cardíaco), shock neurógeno (lesión medular
cervical).</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Conducta
inicial a seguir ante un paciente politraumatizado en estado de shock
hipovolémico; tras seguir los pasos del “ABC”, procederemos a controlar puntos
externos de sangrado profuso si los hubiese mediante compresión o clampaje. Es
imprescindible la consecución de dos accesos venosos periféricos.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Los
sitios preferibles son en venas ante cubitales. Siempre hay que iniciar dos
vías venosas en un paciente politraumatizado, y los catéteres de elección son gruesos
y cortos, por ejemplo catéter # 14 ó 16. Por ellos se pueden trasfundir gran
cantidad de líquidos en poco tiempo.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Dependiendo
del grado de shock hemorrágico (hay numerosas clasificaciones basadas en
diversos parámetros) se perfunden distintos tipos de fluidos, y a diferente
velocidad. El objetivo es conseguir una hemodinámica adecuada (diuresis
aceptable, pulso y tensión arterial correcta, llenado capilar óptimo, etc.).</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Saber que
las soluciones isotónicas como la solución salina 0.9% son de elección en
traumatismo. Se comienza administrando una dosis de unos 1500-2000 cc en bolo
si el shock es severo, y se observa la respuesta. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l6 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Si se
estabiliza el paciente, proseguimos infundiendo dichos cristaloides a menor
velocidad. Si no hay respuesta o es inadecuada se sigue con la infusión de
cristaloides y se añaden soluciones coloides.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Nivel de conciencia</span></b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> (Déficit neurológico):_ examen neurológico Escala
del Coma de Glasgow. Este primer examen debe ser rápido haciéndose en pocos
segundos. Aquí interesa valorar el nivel de conciencia, pupilas (simetría del
tamaño y reacción a la luz), y realizar la evaluación de la Escala de Coma de
Glasgow</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 23.8pt; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-yfti-tbllook: 1184;">
 <tbody>
<tr style="height: 12.5pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
  <td style="border: solid black 1.0pt; height: 12.5pt; mso-border-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Apertura
  ocular</span></b><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-left: none; border: solid black 1.0pt; height: 12.5pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Espontánea</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-left: none; border: solid black 1.0pt; height: 12.5pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">4</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 15.65pt; mso-yfti-irow: 1;">
  <td style="border-top: none; border: solid black 1.0pt; height: 15.65pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 15.65pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Al
  llamado</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 15.65pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">3</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 2;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Al
  estimulo doloroso</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">2</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 3;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">No
  responde</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">1</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 20.6pt; mso-yfti-irow: 4;">
  <td style="border-top: none; border: solid black 1.0pt; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Mejor
  respuesta motora</span></b><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Obedece
  ordenes</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">6</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 5;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Localiza
  dolor</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">5</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 20.6pt; mso-yfti-irow: 6;">
  <td style="border-top: none; border: solid black 1.0pt; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Retira
  al dolor</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">4</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 7;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Flexión
  anormal o decorticar</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">3</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 8;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Extensión
  anormal o Descerebrar</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">2</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 20.6pt; mso-yfti-irow: 9;">
  <td style="border-top: none; border: solid black 1.0pt; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">No
  responde</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">1</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 10;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Mejor
  respuesta verbal</span></b><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Orientado</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">5</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 11;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Desorientado
  </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">4</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 20.6pt; mso-yfti-irow: 12;">
  <td style="border-top: none; border: solid black 1.0pt; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">inapropiada</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">3</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 13;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">incomprensible</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">2</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 20.6pt; mso-yfti-irow: 14;">
  <td style="border-top: none; border: solid black 1.0pt; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">No
  responde </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 20.6pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">1</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
<tr style="height: 19.95pt; mso-yfti-irow: 15; mso-yfti-lastrow: yes;">
  <td style="border-top: none; border: solid black 1.0pt; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 155.7pt;" valign="top" width="208"><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;">
<span style="font-family: Verdana, sans-serif;"><b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Total
  minimo</span></b><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 153.0pt;" valign="top" width="204"></td>
  <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 19.95pt; mso-border-alt: solid black .75pt; mso-border-left-alt: solid black .75pt; mso-border-top-alt: solid black .75pt; padding: 0cm 3.5pt 0cm 3.5pt; width: 64.05pt;" valign="top" width="85"><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: center;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">3/ 15 </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; font-size: 9.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
</td>
 </tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo8; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Un Trauma
Craneoencefálico severo corresponderá a un Glasgow menor de 8 el cual
necesitara lo antes posible de una intubación oro-traqueal. </span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo8; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Un Trauma
Craneoencefálico moderado corresponderá a un Glasgow de 9 a 12 hay que darle
soporte ventilatorio por medio de una vía aérea permeable y buena
ventilación-oxigenación con mascarilla.</span><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"> <o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo8; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 11.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: ES-MX;">·<span style="font-size: 7pt; line-height: normal;">               
</span></span><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Un Trauma
Craneoencefálico leve corresponderá a un Glasgow 13 -15 hay que observar y dar
indicaciones de precaución. </span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo8; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<b><span lang="ES-MX" style="font-family: Verdana, sans-serif; font-size: 11.0pt; line-height: 115%; mso-ansi-language: ES-MX; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><br /></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo8; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span lang="ES-MX" style="font-family: "Times New Roman","serif"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><o:p></o:p></span>

<b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: ES-MX; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Exposición total: </span></b><span lang="ES-MX" style="font-family: "Tahoma","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: ES-MX; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;">Es primordial desvestir al paciente para poder
valorar lesiones que de otro modo pasarían desapercibidas, auscultar los campos
pulmonares adecuadamente, iniciar accesos venosos, inmovilizaciones, etc. Por
supuesto, siempre con correcto control de columna cervical. Aplicación de
sondas nasogástrica y sonda vesical es opcional según ordenes medica CRU o
medico tripulante, Historia clínica SAMPLE etc.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.9pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo8; tab-stops: list 36.0pt; text-align: justify; text-indent: 0cm;">
<span lang="ES-MX" style="font-family: Verdana, sans-serif; font-size: 11.0pt; line-height: 115%; mso-ansi-language: ES-MX; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: ES-MX;"><br /></span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 0.0001pt 7.9pt; text-align: justify; text-indent: 0cm;">
<span style="font-family: Verdana, sans-serif;"><span style="font-size: 15px; line-height: 16.866666793823242px;">Fuente:// </span><span style="background-color: white; font-size: 13px; line-height: 17px;"><i>Assistant Professor Ponce School of Medicine Medicina de Emergencia</i></span></span></div>

Manejo del paciente Politraumatizado

PROPÓSITOS · Identificar rápidamente al paciente traumatizado con lesiones críticas y establecer prioridades de a...

lunes, marzo 03, 2014

VALORACION DE ENFERMERIA DEL SISTEMA CARDIOVASCULAR

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<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">       <td style="background: #ccccff; border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: windowtext 1pt solid; mso-border-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" valign="top" width="211"><div align="center" class="MsoNormal" style="tab-stops: 495.0pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">INTERROGATORIO                            </span></b></div>
</td>        <td style="background: #ccccff; border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: windowtext 1pt solid; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" valign="top" width="408"><div align="center" class="MsoNormal" style="tab-stops: 495.0pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">SIGNIFICADO                            </span></b></div>
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<tr style="mso-yfti-irow: 1;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Alergias</span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
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<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Para la administración de medicamentos, medios de contraste diagnósticos                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">               </span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></b></td>     </tr>
<tr style="mso-yfti-irow: 2;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">               </span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></b><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Antecedentes de tabaquismo.                            </span></b></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Medicamentos                            </span></b></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">               </span></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></b></td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Factor de riesgo de trastornos cardiovasculares                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Niveles tóxicos; influyen los síntomas                         </span></div>
</td>     </tr>
<tr style="mso-yfti-irow: 3;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Dolor                            </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Localización:<span style="mso-spacerun: yes;">    </span>tórax, pantorrillas                         </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Irradiación:<span style="mso-spacerun: yes;">      </span>brazos, mandíbula, cuello                         </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Descripción:<span style="mso-spacerun: yes;">     </span>presión, indigestión, opresión, ardor                         </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";"><span style="mso-spacerun: yes;">                         </span>angina, infarto del miocardio,                          </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";"><span style="mso-spacerun: yes;">               </span><span style="mso-spacerun: yes;">          </span>trombos<span style="mso-spacerun: yes;">     </span>embolia<span style="mso-spacerun: yes;">  </span>                         </span></div>
</td>     </tr>
<tr style="mso-yfti-irow: 4;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Disnea                            </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Insuficiencia cardiaca del lado izquierdo, edema pulmonar o embolia                        </span></div>
</td>     </tr>
<tr style="mso-yfti-irow: 5;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Fatiga                            </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Disminución del gástrico                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 6;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Palpitaciones – Mareo                            </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Arritmias                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 7;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">               </span></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">             </span></b><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Aumento de peso                            </span></b></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">               </span></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">             </span></b></td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Insuficiencia cardiaca del lado derecho                        </span></div>
</td>     </tr>
<tr style="mso-yfti-irow: 8;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">               </span></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">             </span></b></td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 9;">       <td style="background: #ccccff; border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" valign="top" width="211"><div align="center" class="MsoNormal" style="tab-stops: 495.0pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Valoración física                            </span></b></div>
</td>        <td style="background: #ccccff; border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" valign="top" width="408"><div align="center" class="MsoNormal" style="tab-stops: 495.0pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Hallazgos anormales posibles                            </span></b></div>
</td>     </tr>
<tr style="mso-yfti-irow: 10;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Signos vitales                            </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Bradicardia, taquicardia, hipotensión, hipertensión, taquipnea, apnea, choque                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 11;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Ritmo cardiaco                            </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" valign="top" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Arritmias                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 12;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">               </span></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">             </span></b><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Edema-                            </span></b></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Distensión de la vena yugular                            </span></b></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">               </span></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">             </span></b></td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Insuficiencia cardiaca del lado derecho                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 13;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Ruidos respiratorios                            </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" valign="top" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Estertores, sibilancias con insuficiencia cardiaca del lado izquierdo                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 14;">       <td style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 158.4pt;" width="211"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">Tos -<span style="mso-spacerun: yes;">  </span>esputo                             </span></b></div>
</td>        <td style="border-bottom: windowtext 1pt solid; border-left: medium none; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 306pt;" valign="top" width="408"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Insuficiencia cardiaca aguda: tos seca, esputo rosa espumoso                        </span></div>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></div>
<br />
<span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">           </span></td>     </tr>
<tr style="mso-yfti-irow: 15;">       <td colspan="2" style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 464.4pt;" valign="top" width="619"><div align="center" class="MsoNormal" style="tab-stops: 495.0pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif";">ASPECTOS A TENER PRESENTE<span style="mso-spacerun: yes;">  </span><a href="https://www.blogger.com/blogger.g?blogID=1364576542301823956#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: navy; font-family: "Bodoni MT","serif"; font-size: 11pt; mso-ansi-language: es; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: ar-sa; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: es;">[1]</span></b></span></span></span></a>                             </span></b></div>
</td>     </tr>
<tr style="mso-yfti-irow: 16; mso-yfti-lastrow: yes;">       <td colspan="2" style="border-bottom: windowtext 1pt solid; border-left: windowtext 1pt solid; border-right: windowtext 1pt solid; border-top: medium none; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding-bottom: 0cm; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0cm; width: 464.4pt;" valign="top" width="619"><div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">               </span></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></b><br />
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Seis puntos que caracterizan la enfermedad vascular periférica                            </span></b></div>
<ol style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="color: black; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt left 495.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="ES" style="font-family: "Bodoni MT","serif";">Dolor                                </span></b></li>
<li class="MsoNormal" style="color: black; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt left 495.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="ES" style="font-family: "Bodoni MT","serif";">Poiquilotermia                                </span></b></li>
<li class="MsoNormal" style="color: black; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt left 495.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="ES" style="font-family: "Bodoni MT","serif";">Ausencia del pulso                                </span></b></li>
<li class="MsoNormal" style="color: black; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt left 495.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="ES" style="font-family: "Bodoni MT","serif";">Palidez                                </span></b></li>
<li class="MsoNormal" style="color: black; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt left 495.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="ES" style="font-family: "Bodoni MT","serif";">Parálisis                                </span></b></li>
<li class="MsoNormal" style="color: black; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt left 495.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="ES" style="font-family: "Bodoni MT","serif";">Parestesia (disminución de la sensación)                                </span></b></li>
</ol>
<div class="MsoNormal" style="tab-stops: 495.0pt;">
<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">               </span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">             </span></b><br />
<div align="center" class="MsoNormal" style="tab-stops: 495.0pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">Identificación del paciente                                </span></i></b></div>
<div align="center" class="MsoNormal" style="tab-stops: 495.0pt; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">                 </span></i></b></div>
<br />
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="ES" style="color: black; font-family: "Bodoni MT","serif";">               </span></i></b></td>     </tr>
</tbody></table>
<div style="mso-element: footnote-list;">
<br clear="all" />
<span lang="ES" style="font-size: 9pt;">     </span><br />
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<span lang="ES" style="font-size: 9pt;">   </span></div>
LLIAMS LINDA, HOPPER PAULA. Enfermería Medicoquirúrgica tercera edición. Pág. 371WILLIAMS LINDA, HOPPER PAULA. Enfermería Medicoquirúrgica tercera edición. Pág. 368

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