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Un caso particular de broncoaspiración de cuerpo extraño en el paciente politraumatizado
An unusual case of bronchoaspiration of a foreign body in a polytraumatized patient
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B) Piedra de 1<span class="elsevierStyleHsp" style=""></span>cm de diámetro mayor que fue extraída mediante fibrobroncoscopia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En los pacientes politraumatizados se han descrito casos de broncoaspiración de piezas dentales<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a>, pero la aspiración de otro tipo de cuerpos extraños es menos frecuente. La sospecha clínica, una historia clínica detallada y una evaluación exhaustiva de las pruebas diagnósticas son los pilares para descartar aspiraciones en este tipo de enfermos<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Presentamos el caso de un varón de 45 años de edad que ingresó en la unidad de medicina intensiva por politraumatismo secundario a accidente de alta energía. Presentaba una escala de coma de Glasgow 8, anisocoria, hematoma periorbitario y erosiones faciales. Se aseguró la vía aérea con control cervical y se administró sedoanalgesia y manitol para control de la hipertensión intracraneal. Se realizó estudio radiológico que mostró traumatismo craneoencefálico grave y traumatismo facial. La revisión de la tomografía torácica reveló una imagen radio-opaca en la carina traqueal (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>A). Se exploró cavidad oral y no se objetivó pérdida de piezas dentales. Se efectuó fibrobroncoscopia flexible que mostró que correspondía a una piedra de 1<span class="elsevierStyleHsp" style=""></span>cm de diámetro mayor. El cuerpo extraño se había desplazado hasta el bronquio principal derecho por lo que se empleó un balón para llevarlo hasta la carina y desde ahí fue extraído (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>B). Una vez retirado se revisó nuevamente el árbol bronquial con fibrobroncoscopia sin evidenciar otros fragmentos. El paciente evolucionó favorablemente siendo factible la extubación a las 48<span class="elsevierStyleHsp" style=""></span>h de ingreso.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 643 "Ancho" => 1500 "Tamanyo" => 118499 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Corte sagital de la tomografía torácica que muestra cuerpo extraño radio-opaco en la carina. B) Piedra de 1<span class="elsevierStyleHsp" style=""></span>cm de diámetro mayor que fue extraída mediante fibrobroncoscopia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii: bcr2012008393" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory failure following traumatic tooth aspiration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Madan" 1 => "A.N. Aggarwal" 2 => "H. Bhagat" 3 => "N. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "BMJ Case Rep" "fecha" => "2013" "volumen" => "201" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnose of occult bronchial foreign body: A rare case report of undetected Chinese medicine aspiration for 10 long years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Wang" 1 => "B. Pudasaini" 2 => "X.F. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Medicine (Baltimore)" "fecha" => "2016" "volumen" => "95" "paginaInicial" => "e4076" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005300000007/v2_201706291228/S0300289617300091/v2_201706291228/es/main.assets" "Apartado" => array:4 [ "identificador" => "45361" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005300000007/v2_201706291228/S0300289617300091/v2_201706291228/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289617300091?idApp=UINPBA00003Z" ]
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