Jefe de Servicio de Medicina Interna, para el Hospital Universitario

Jefe de Servicio de Medicina Interna, para el Hospital
Universitario del Sureste
4A8IB = 4
%$2(-/ 7 &/.4(.+'/ '( &$'$ 5.$ '( ,$3 )$3(3
)&
<S\]X[SKU Y[XPO\SXWKU "Y^W]^KMSoW Vk`SVK$ 0( Y^W]X\#
K# 8`YO[SOWMSK Y[XPO\SXWKU "Y^W]^KMSoW Vk`SVK$ ,( Y^W]X\#2
)& CO[mXNX NO PX[VKMSoW YX[ OU \S\]OVK NO [O\SNOWMSK OW UK O\YOMSKUSNKN "\XUX LK%
[OVKLUO OU YO[mXNX MXVYUO]X Z^O RKLSUS]K[O YK[K XL]OWO[ OU ]m]^UX NO 8\YOMSK%
US\]K#2 . Y^W]X\&
*& FSOVYX NO \O[_SMSX\ Y[O\]KNX\ "\O MXW]OVYUK[k UK P[KMMSoW MX[[O\YXWNSOW]O
SWPO[SX[ KU KnX WK]^[KU$ \XUX YX[ VO\O\ MXVYUO]X\#2
K&
CX[ MKNK KnX MXVYUO]X NO \O[_SMSX\ Y[O\]KNX\ MXVX @lNSMX 8\YOMSKUS\]K
OW @ONSMSWK =W]O[WK2 *$, Y^W]X\'KnX&
L& CX[ MKNK KnX MXVYUO]X NO \O[_SMSX\ Y[O\]KNX\ MXVX @lNSMX ;OWO[KU OW
k[OK\ NO UK O\YOMSKUSNKN Z^O \O MXW_XMK$ MXW KW]O[SX[SNKN NO UK XL]OWMSoW NOU
]m]^UX NO @lNSMX 8\YOMSKUS\]K OW @ONSMSWK =W]O[WK$ KU KVYK[X NOU DOKU 7O%
M[O]X ),1/')111$ NO *, NO \OY]SOVL[O2 ($1. Y^W]X\'KnX&
M& CX[ MKNK KnX MXVYUO]X NO \O[_SMSX\ Y[O\]KNX\ MXVX 9KM^U]K]S_X 8\YOMSKUS\%
]K NO M^YX OW UK\ k[OK\ NO UK O\YOMSKUSNKN Z^O \O MXW_XMK2 ($1. Y^W]X\'KnX&
N& CX[ MKNK KnX MXVYUO]X NO \O[_SMSX\ Y[O\]KNX\ OW =W\]S]^MSXWO\ EKWS]K[SK\
CpLUSMK\ MXVX @lNSMX 8\YOMSKUS\]K OW @ONSMSWK =W]O[WK OW =W\]S]^MSXWO\
WX EKWS]K[SK\2 ($/* Y^W]X\'KnX&
O& CX[ MKNK KnX MXVYUO]X NO \O[_SMSX\ Y[O\]KNX\ OW OU NO\OVYOnX NO YUKbK
NO 9KM^U]K]S_X NO MK[kM]O[ K\S\]OWMSKU X MXVX 9KM^U]K]S_X 8\YOMSKUS\]K OW
X][K 8\YOMSKUSNKN OW M^KUZ^SO[ =W\]S]^MSoW$ X NO MXX[NSWKMSoW a NS[OMMSoW
NO Y[XQ[KVK\ NO MXXYO[KMSoW SW]O[WKMSXWKU$ K\m MXVX UX\ \O[_SMSX\ Y[O\%
]KNX\ MXVX 9KM^U]K]S_X _XU^W]K[SX X MXXYO[KW]O OW OU MKVYX \KWS]K[SX$
]KW]X OW OU ]O[[S]X[SX WKMSXWKU MXVX OW OU SW]O[WKMSXWKU2 ($*, Y^W]X\'KnX&
?X\ \O[_SMSX\ Y[O\]KNX\ MXW WXVL[KVSOW]X X MXW][K]X NO K]OWMSoW MXW]S%
W^KNK X Q^K[NSK\ VlNSMK\ \O MXVY^]K[kW MXW OU M[S]O[SX NO OZ^S_KUOWMSK
NO ^W VO\ MXVYUO]X YX[ MKNK ),( RX[K\ ][KLKTKNK\ OW NSMRX VO\$ X UK YK[%
]O Y[XYX[MSXWKU Z^O MX[[O\YXWNK K UK P[KMMSoW& ES NOW][X NO ^W VO\ WK]^%
[KU \O [OKUSbK[XW Vk\ NO ),( RX[K\$ \XUKVOW]O YXN[k _KUX[K[\O ^W VO\$ \SW
Z^O Y^ONK \O[ KYUSMKNX OU O`MO\X YK[K OU MoVY^]X NO \O[_SMSX\ Y[O\]KNX\
OW X][X VO\& ?X\ MO[]SPSMKNX\ KM[ONS]K]S_X\ NOLO[kW O`Y[O\K[\O OW RX[K\
NS\][SL^SNK\ YX[ VO\O\ WK]^[KUO\& ?K Y^W]^KMSoW KW^KU "MXVY^]kWNX\O UK
P[KMMSoW Z^O MX[[O\YXWNK VOW\^KUVOW]O# \O[k UK VS\VK NOYOWNSOWNX NO
OW Z^l SW\]S]^MSoW a MK]OQX[mK Y[XPO\SXWKU \O Y[O\]KW O\]X\ \O[_SMSX\ NO
d\XUX Q^K[NSK\e&
4 UX\ OPOM]X\ NO _KUX[KMSoW NO O\]O KYK[]KNX$ WX YXN[kW _KUX[K[\O \SV^U]k%
WOKVOW]O UX\ \O[_SMSX\ Y[O\]KNX\ OW NX\ X Vk\ \^LKYK[]KNX\ \S \XW MXSW%
MSNOW]O\ OW OU VS\VX NmK a'X OW Y^O\]X\ SWMXVYK]SLUO\ OW][O \m$ NO MXW%
PX[VSNKN MXW UK WX[VK]S_K _SQOW]O K UX\ OPOM]X\&
+& CUKbK\ XL]OWSNK\ YX[ MXWM^[\X X \^YO[KMSoW NO Y[XMO\X \OUOM]S_X [OQUKNX OW
=W\]S]^MSXWO\ EKWS]K[SK\ CpLUSMK\2 ) Y^W]X'YUKbK&
,& CX[ \O[ VSOVL[X NO 6XVS\SXWO\ 6UmWSMK\2 ($+ Y^W]X\ YX[ KnX NO YO[]OWOWMSK
"MXW ^WK Y^W]^KMSoW Vk`SVK NO + Y^W]X\#&
-& CX[ XM^YK[ Y^O\]X NO [O\YXW\KLSUSNKN OW ;O\]SoW "MXW ^W Vk`SVX )- Y^W]X\#2
K& >OPO NO EOMMSoW2 ($- Y^W]X\'KnX&
L& >OPO NO EO[_SMSX X MK[QX NS[OM]S_X OW =W\]S]^MSXWO\ EKWS]K[SK\2 ) Y^W]X'KnX2
?X\ YO[mXNX\ MO[]SPSMKNX\ OW O\]X\ Y^O\]X\ Y^W]^K[kW OW O\]O \^LKYK[]KNX
NOU LK[OVX a WX OW \O[_SMSX\ Y[O\]KNX\ OW YUKbK Lk\SMK NO PKM^U]K]S_X NOU
\^LKYK[]KNX K#&*& 8W WSWQpW MK\X YXN[kW Y^W]^K[ \SV^U]kWOKVOW]O OW UX\
NX\ \^LKYK[]KNX\&
ES UK Y^W]^KMSoW Vk`SVK \O \XL[OYK\K[K$ O\]K \O RK[k OZ^S_KUOW]O K ,(
Y^W]X\$ MXW\SQWkWNX\O UK\ [O\]KW]O\ OW P^WMSoW NOU MXOPSMSOW]O XL]OWSNX&
L# 4M]S_SNKN NO PX[VKMSoW a NXMOWMSK "Y^W]^KMSoW Vk`SVK$ *( Y^W]X\#2
c ;[KNX NO 7XM]X[2 * Y^W]X\$ \S \O KM[ONS]K Z^O UK MKUSPSMKMSoW XL]OWSNK P^O NO \X%
L[O\KUSOW]O X dKY]Xe dM^V UK^NOe \O UO X]X[QK[k UK Y^W]^KMSoW KNSMSXWKU NO ($Y^W]X\&
c C[XPO\X[ MXUKLX[KNX[ OW UK ^WS_O[\SNKN OW NXMOWMSK NO Y[OQ[KNX2 ($) Y^W]X\'
KnX&
c 6^[\X 7XM]X[KNX MXVYUO]X2 ($+ Y^W]X\'M^[\X&
c C[XPO\X[ 4\XMSKNX X \SVSUK[2 ($* Y^W]X\'KnX&
c C[XPO\X[ FS]^UK['6K]ON[k]SMX2 ($+ Y^W]X\'KnX&
c 4\S\]OWMSK K M^[\X\ NO 9X[VKMSoW 6XW]SW^KNK2
! 6^[\X\ OW][O ,( a )(( RX[K\2 ($) Y^W]X\'M^[\X&
! 6^[\X\ OW][O )() a +(( RX[K\2 ($* Y^W]X\'M^[\X&
! 6^[\X\ OW][O +() a .(( RX[K\2 ($- Y^W]X\'M^[\X&
! 6^[\X\ \^YO[SX[O\ K .(( RX[K\2 ) Y^W]X'M^[\X&
c C[XPO\X[ OW M^[\X\ NO PX[VKMSoW MXW]SW^KNK2 ($(- Y^W]X\'RX[K UOM]S_K&
c B[QKWSbKMSoW a 7S[OMMSoW NO M^[\X\2
! 6^[\X\ OW][O ,( a )(( RX[K\2 ($, Y^W]X\'M^[\X&
! 6^[\X\ OW][O )() a +(( RX[K\2 ($0 Y^W]X\'M^[\X&
! 6^[\X\ OW][O +() a .(( RX[K\2 * Y^W]X\'M^[\X&
! 6^[\X\ \^YO[SX[O\ K .(( RX[K\2 , Y^W]X\'M^[\X&
c F^]X[ NO [O\SNOW]O\2 ($* Y^W]X\'KnX&
c 8\]KWMSK\ NXMOW]O\ OW RX\YS]KUO\ ^WS_O[\S]K[SX\2 ($-( Y^W]X\'][SVO\][O "Vk`S%
VX$ + Y^W]X\#&
c 5OMK\ NXMOW]O\2 ) Y^W]X'LOMK&
ES UK Y^W]^KMSoW Vk`SVK \O \XL[OYK\K[K$ O\]K \O RK[k OZ^S_KUOW]O K *( Y^W]X\$
MXW\SQWkWNX\O UK\ [O\]KW]O\ OW P^WMSoW NOU MXOPSMSOW]O XL]OWSNX&
M# 4M]S_SNKN MSOW]mPSMK "Y^W]^KMSoW Vk`SVK$ *( Y^W]X\#2
?X\ ][KLKTX\ MSOW]mPSMX\ a NO SW_O\]SQKMSoW KYK[OMSNX\ OW Y^LUSMKMSXWO\ a [O_S\]K\
VlNSMK\ X OW USL[X\$ K\m MXVX KYX[]KMSXWO\ K [O^WSXWO\ a MXWQ[O\X\ MSOW]mPSMX\$
\SOVY[O [OUKMSXWKNX\ MXW UK O\YOMSKUSNKN Z^O \O MXW_XMK$ \O _KUX[K[kW NO KM^O[NX
MXW UX\ Y^W]X\ NO UK ]KLUK \SQ^SOW]O2
'*)1/*7,!,%&*-,%+
-?=D>94249?>6B!2!4?>8A6B?B!
1D3<94249?>6B!6>!A6E9BC2B!
-2@HCD<?!56!<93A?B!
.93A?B!
-?>76A6>492B!
/6B2B!A65?>52B,!/?56A25?A!
/6B2B!A65?>52B,!1?>6>C6!
0A82>9F249I>!56!4?>8A6B?B#;?A>252B!496>CH7942B!
'*)1/*7,!*,0(.,%&*-,%+!
#"24 %6534
$"3 %6534
#"24 %6534!
$"3!%6534!
$"%$!
$"&$!
$"'$!
%"&$!
$"&$!
$"$)!
$"%$!
$")$!
$"$)!
$"%$!
$"%)!
$"*$!
!
!
!
!
$"&$!
$"($!
$")$!
&"$$!
$"($!
$"%$!
$"&$!
$"+$!
$"%$!
$"&$!
$"&)!
%"$$!
!
!
!
!
CX[ LOMK\ YK[K UK SW_O\]SQKMSoW [OMSLSNK\ NO X[QKWS\VX\ XPSMSKUO\ "9=E$ GWSoW
8^[XYOK$ 6XV^WSNKNO\ 4^]oWXVK\#$ ($. Y^W]X\ \S O\ =W_O\]SQKNX[ C[SWMSYKU$ a ($+
Y^W]X\ OW X][X\ MK\X\&
ES UK Y^W]^KMSoW Vk`SVK \O \XL[OYK\K[K$ O\]K \O RK[k OZ^S_KUOW]O K *( Y^W]X\$ MXW%
\SQWkWNX\O UK\ [O\]KW]O\ OW P^WMSoW NOU MXOPSMSOW]O XL]OWSNX&
FX]KU 4 " 5 " 6 # 0( Y^W]X\
*& C[XaOM]X FlMWSMX NO ;O\]SoW "Y^W]^KMSoW Vk`SVK$ )*( Y^W]X\#
K# EO Y^W]^K[k ^W Vk`SVX NO -( Y^W]X\$ OU NXM^VOW]X a \^ Y[O\OW]KMSoW$ ]OWSOWNX OW
M^OW]K UK KNOM^KMSoW NOU VS\VX K UX\ XLTO]S_X\ NOU EO[_SMSX a K UX\ XLTO]S_X\ SW\%
]S]^MSXWKUO\ NOU MOW][X&
?K 6XVS\SoW NO EOUOMMSoW O\]KLUOMO[k ^W WS_OU VmWSVX O`SQSLUO KU O_KU^K[ OU C[X%
aOM]X FlMWSMX NO ;O\]SoW$ NO KM^O[NX MXW UX\ M[S]O[SX\ NO _KUX[KMSoW O\]KLUOMSNX\
OW OU 4WO`X = 5&
L# 6XWPX[VO KU KYK[]KNX * NO UK LK\O \OQ^WNK$ UK 6XVS\SoW NO EOUOMMSoW$ N^[KW]O OU
NSkUXQX Z^O Y^ONK VKW]OWO[ MXW OU K\YS[KW]O$ ][K\ UK O`YX\SMSoW NO \^ C[XaOM]X$
]OWN[k OW M^OW]K a _KUX[K[k$ OW][O X][X\$ UX\ \SQ^SOW]O\ K\YOM]X\2 F[KaOM]X[SK Y[X%
PO\SXWKU NOU K\YS[KW]O$ UK MKUSNKN$ NO\NO OU Y^W]X NO _S\]K MSOW]mPSMX%]lMWSMX a NO
QO\]SoW$ NOU C[XaOM]X FlMWSMX NO ;O\]SoW Y[O\OW]KNX a OU MXW]OWSNX NO UX\ SWPX[%
VO\ K UX\ Z^O \O [OPSO[O OU KYK[]KNX *&M# NO O\]O 4WO`X = 4& ?K Y^W]^KMSoW Vk`S%
VK K X]X[QK[ OW O\]O \^LKYK[]KNX \O[k NO -( Y^W]X\&
M# B][K\ _KUX[KMSXWO\ "Vk`SVX$ *( Y^W]X\#2
8U [O\]X$ *( Y^W]X\$ RK\]K ^W Vk`SVX NO )*($ Z^ONK[k K T^SMSX NO UK 6XVS\SoW NO
EOUOMMSoW$ _KUX[KWNX2
c 4\YOM]X\ M^KUS]K]S_X\ NOU M^[[mM^UX&
c 4NOM^KMSoW KU YO[PSU NO UK YUKbK&
c 7X\ SWPX[VO\ \XUSMS]KNX\ KU'UX\ >OPO'\ NO EO[_SMSX'EOMMSoW a KU VSOVL[X NO UK
6XVS\SoW YO[]OWOMSOW]O KU EO[_SMSX Z^O ][KW\VS]K OU \OW]S[ VKaX[S]K[SX NO UK
GWSNKN [O\YOM]X K UX\ MKWNSNK]X\& ES OU MKWNSNK]X P^O[K O`]O[WX$ UK 6XVS\SoW
YONS[k UX\ SWPX[VO\ Z^O MXW\SNO[O YO[]SWOW]O\& 8\]X\ SWPX[VO\ NOLO[kW [O\%
YXWNO[ K UX\ \SQ^SOW]O\ K\YOM]X\2
! 7ONSMKMSoW K UK UKLX[ NOU EO[_SMSX2 4\S\]OWMSKU$ NXMOW]O O SW_O\]SQKNX[K&
! G]SUSbKMSoW NO [OM^[\X\&
! 7S\YXWSLSUSNKN&
! 6KYKMSNKN X[QKWSbK]S_K&
! 6KYKMSNKN SWWX_KNX[K&
! 6KYKMSNKN NO USNO[KbQX&
! DOUKMSXWO\ R^VKWK\&
?K\ MKUSPSMKMSXWO\ K K\SQWK[ K O\]X\ K\YOM]X\ NO UX\ SWPX[VO\ YXN[kW \O[2 7OPS%
MSOW]O$ KNOM^KNK$ X \K]S\PKM]X[SK&
4A8IB = 5
02/7(&4/ 4H&.+&/ '( *(34+I. '( ,$ 5.+'$' $3+34(.&+$,#
&2+4(2+/3 '( 6$,/2$&+I.
8W UK VOVX[SK X[QKWSbK]S_K \O _KUX[K[k2
)& ?K\ O\][K]OQSK\ NO KYUSMKMSoW KU MXW]OWSNX NOU 6XW][K]X NO ;O\]SoW NO 4]OWMSoW 8\%
YOMSKUSbKNK&
*& 7O\K[[XUUX NO UX\ XLTO]S_X\ K\S\]OWMSKUO\ MXW]OWSNX\ OW OU 6XW][K]X NO ;O\]SoW$ OW%
][O X][X\2
c 6K[]O[K NO EO[_SMSX\&
c =WNSMKNX[O\ NO ^]SUSbKMSoW&
c =WNSMKNX[O\ NO OPSMSOWMSK&
+& 7O\K[[XUUX X[QKWSbK]S_X a NO QO\]SoW NS[SQSNX K2
c @OTX[K NO KMMO\SLSUSNKN& DOSWQOWSO[mK NO Y[XMO\X\&
c @X]S_KMSoW NOU YO[\XWKU&
c ?mWOK\ X[QKWSbK]S_K\ SW]O[WK\&
c 6XX[NSWKMSoW MXW UX\ \O[_SMSX\ YO]SMSXWK[SX\'K\S\]OWMSKUO\&
c CUKW NO ^]SUSbKMSoW OPSMSOW]O NO UX\ [OM^[\X\ K\SQWKNX\ KU EO[_SMSX&
,& =VYUKW]KMSoW a NO\K[[XUUX NO ^W \S\]OVK NO MKUSNKN2
c EOQ^[SNKN NOU YKMSOW]O'Y[XPO\SXWKUO\&
c =VYUKW]KMSoW NO Y[X]XMXUX\&
c 6KUSNKN MSOW]mPSMX%]lMWSMK&
c 4NOM^KMSoW OW UK ^]SUSbKMSoW NO [OM^[\X\ NSKQWo\]SMX\&
c 7O\K[[XUUX NO Y[X]XMXUX\ \XL[O OU ^\X NO VONSMKMSoW O\YOMmPSMK&
c ;O\]SoW NO NOVX[K\&
c ;O\]SoW NO [OMUKVKMSXWO\&
c =WPX[VKMSoW K YKMSOW]O\ a PKVSUSK[O\&
-& 7XMOWMSK O =W_O\]SQKMSoW&