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El SARS COV 2, tomó por sorpresa al mundo, con impacto en el sector salud, generándose una gran crisis sanitaria, golpeados por escasez de insumos, de equipos, de personal y capacidad instalada insuficiente para la atención de la contigencia. Ademas, la infodemia, el pánico y el miedo con sus respectivas consecuencias, se empodero de la sociedad civil, situación que no es ajena a sector salud, por ello, este relato de experiencia tuvo objetivo describir la gestión del servicio de medicina crítica de un hospital de Guayaquil- Ecuador durante la pandemia por el Coronavirus. En los centros asitenciales, el personal se enfrenta all desafío sanitario, principalmente en la gestión del servicio de medicina crítica. Al ser nombrado hospital centinela, con una capacidad instadala redujo de 494 a 200 camas, y se creó además el área de hospitalización de infectología; La interrelación de profesionales de la enfermería, médicos infectólogos, médicos neumólogos, servicios de terapia física y rehabilitación, servicios de nutrición, y los terapistas respiratorios, fue fundamental para afrontar la crisis, para vela por el bienestar del paciente, no solo en la parte física, sino psicología y de humanización. No obtante, el miedo a lo desconocido inherente a la especie humana, se transforma en pánico ante esta enfermedad provocando emociones, sentimientos, vivencias exacerbadas, y la inseguridad y desconfianza en que el sistema sanitario(AU)

SARS COV 2 took the world by surprise, with an impact on the health sector, generating a major health crisis, hit by a shortage of supplies, equipment, personnel and insufficient installed capacity for contingency care. In addition, the infodemic, panic and fear with their respective consequences, empowered civil society, a situation that is not unrelated to the health sector, therefore, this experience report aimed to describe the management of the critical medicine service of a Guayaquil-Ecuador hospital during the Coronavirus pandemic. In care centers, the staff faces the health challenge, mainly in the management of the critical medicine service. Being named a sentinel hospital, with an installed capacity it was reduced from 494 to 200 beds, and the infectious disease hospitalization area was also created; The interrelation of nursing professionals, infectious disease doctors, pulmonologists, physical therapy and rehabilitation services, nutrition services, and respiratory therapists, was essential to face the crisis, to ensure the well-being of the patient, not only in the physics, but psychology and humanization. However, the fear of the unknown inherent in the human species is transformed into panic in the face of this disease, causing emotions, feelings, exacerbated experiences, and insecurity and distrust in the health system(Au)

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RESUMEN Introducción: El síndrome de burnout es conceptualizado como la forma inadecuada de afrontar el estrés crónico dado por exposición crónica a condiciones laborales inadecuadas. Afecta la salud mental, general y el rendimiento laboral de las personas. Objetivo: Determinar la presencia de síndrome de burnout en el personal de medicina interna y la Unidad de Cuidados Intensivos del Hospital Provincial General Docente de Riobamba, Chimborazo, Ecuador. Métodos: Se realizó una investigación básica, no experimental, transversal, descriptiva y correlacional en un universo de 77 trabajadores, de los cuales 65 conformaron la población de estudio. Se aplicaron cuestionarios para identificar presencia de síndrome de burnout, depresión y rendimiento laboral. Se utilizó la prueba de correlación de Pearson para identificar relación entre variables. Resultados: Predominio de pacientes con síndrome de burnout (52,31 %), depresión posible (47,69 %) y autopercepción de rendimiento laboral como adecuado (44,62 %). Dentro de las subescalas de la enfermedad la de mayor afectación fue la de realización personal con un 47,69 % de trabajadores en nivel medio y 39,23 % en nivel alto. Conclusiones: Existió predominio de trabajadores con síndrome de burnout y se identificó una correlación positiva fuerte entre las variables depresión y síndrome de burnout, así como entre esta variable y rendimiento laboral. Entre las variables depresión y rendimiento laboral la correlación obtenida fue positiva media.

ABSTRACTS Introduction: Burnout syndrome is conceptualized as the inadequate way of coping with chronic stress caused by chronic exposure to inadequate working conditions. It affects the mental and general health and the work performance of the people. Objective: to determine the presence of Burnout syndrome in the internal medicine staff and the intensive care unit of the Provincial General Teaching Hospital of Riobamba, Chimborazo, Ecuador. Methods: A basic, non-experimental, cross-sectional, descriptive and correlational research was carried out in a universe of 77 workers, of which 65 made up the study population. Questionnaires were applied to identify the presence of burnout syndrome, depression and work performance. Pearson's correlation test was used to identify a relationship between variables. Results: prevalence of patients with burnout syndrome (52.31%), possible depression (47.69%) and self-perception of work performance as adequate (44.62%). Within the subscales of the disease, the one with the greatest affectation was that of personal fulfillment with 47.69% of workers in the medium level and 39.23% in the high level. Conclusions: there was a predominance of workers with burnout syndrome and a strong positive correlation was identified between the variables depression and burnout syndrome, as well as between this variable and job performance. Among the variables depression and work performance, the correlation obtained was positive medium.

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OBJECTIVE: To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). METHODS: A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non-SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. RESULTS: SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7-16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55-0.98); specificity was 0.76 (95% CI 0.50-0.93). CONCLUSION: Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.

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