ANAIS DO IV CONGRESSO MÉDICO DA REGIÃO CENTRO SUL-RESUMOS

INTRODUCTION: Primary hypoparathyroidism in an endocrine-metabolic disorder caused by insufficient paratormone secretion (PTH), characterized by hypocalcemia and hyperphosphatemia. The manifestations results from hypocalcemia and the symptoms are paraesthesia, cramp, asthenia and in severe cases with carpopedal spasm, convulsive seizures and long QT. Serum calcium, phosphate and magnesium dosages are resourses for laboratory diagnosis. Complications may occur due to treatment failure in hypoparathyroids and after thyroidectomy or parathyroidectomy, and can result in death by hypocalcemia. CASE REPORT: Patient, 26 years old, female, morbid obese with diagnosis of primary hypoparathyroidism in treatment with Calcitriol and Calcium Carbonate. Submitted to bariatric surgery, normocalcemic, presented difficulty to ingest medication in post-surgery. Admitted at Biocor Institute Hospital with asthenia, right limbs paresthesia, positive Trousseau sign, long QT, hypocalcemia and hyperphosphatemia. Admitted and treated with Calcium Gluconate for three days with improvement of the condition. LITERATURE REVIEW: The control of hypoparathyroidism is outpatient, however, cases with complications requires hospital interventions. The appropriate diagnostic approach, with electrolytes dosages at admission, and individualized treatment are essential for favorable outcomes in a context of urgency of primary hypoparathyroidism, by avoiding investigations and treatments unsuitable to the patient. DISCUSSION: The directed anamnesis with the laboratory diagnosis reduces the complications in case of primary hypoparathyroidism by enabling an early treatment and minimizing the time of hypocalcemia. The hospital therapy changes according to serum calcium and phosphate levels, closely linked to inadequate PTH secretion, and it finishes when electrolytes levels are normalized. Because of the risk of serious complications the post-surgery control and the appropriate follow-up of patients in treatment for hypoparathyroidism should be systematically performed in order to avoid unfavorable developments in reversible clinical contexts. RESUMO INTRODUÇÃO: O hipoparatireoidismo primário é um distúrbio endócrino-metabólico por secreção insuficiente de paratormônio (PTH), caracterizado por hipocalcemia e hiperfosfatemia. As manifestações decorrem da hipocalcemia e tem como sintomas a parestesia, câimbra, astenia e em casos mais graves espasmo carpopedal, crises convulsivas e alargamento do intervalo QT. Dosagens séricas de cálcio, fosfato e magnésio são recursos para o diagnóstico laboratorial. As complicações agudas podem ocorrer por falha do tratamento em hipoparatireoideos e após tireoidectomia ou paratireoidectomia, podendo culminar em óbito por hipocalcemia. RELATO DE CASO: Paciente, 26 anos, sexo feminino, obesa mórbida com diagnóstico de hipoparatireoidismo primário em tratamento com Calcitriol e Carbonato de Cálcio. Paciente submetida à cirurgia bariátrica, normocalcêmica, apresentou no pós-operatório dificuldade para ingerir a medicação. Deu entrada no Hospital Biocor Instituto com astenia, parestesia dos membros direitos, sinal de Trousseau positivo, alargamento do intervalo QT, hipocalcemia e hiperfosfatemia. Foi realizada internação e tratamento com infusão de Gluconato de Cálcio por três dias com melhora do quadro. REVISÃO DE LITERATURA: O controle do hipoparatireoidismo é ambulatorial, entretanto, casos com complicação requerem intervenções hospitalares. A abordagem diagnóstica adequada, com dosagem de eletrólitos na admissão, e uma terapêutica individualizada são fundamentais para desfechos favoráveis em um contexto de urgência do hipoparatireoidismo primário, por evitar investigações e tratamentos inadequados ao paciente. DISCUSSÃO: A anamnese dirigida junto ao diagnóstico laboratorial reduz as complicações nos casos de hipoparatireoidismo primário por viabilizar uma conduta precoce e minimizar o tempo de hipocalcemia. A terapêutica na internação varia de acordo com os níveis séricos de cálcio e fosfato, intimamente ligados à secreção inadequada do PTH, e é suspensa quando normalizados os níveis dos eletrólitos. Pelo risco de complicações graves o controle pós-operatório e o acompanhamento adequado de pacientes em tratamento para hipoparatireoidismo devem ser realizados sistematicamente a fim de evitar evoluções desfavoráveis em contextos clínicos reversíveis. Luísa Hemetrio Lazarini1, Luísa Rabelo Patrus1, Priscila Diniz Teixeira de Oliveira1, Ronaldo Martins Ferreira2 Primary hypoparathyroidism complicated after bariatric surgery: case report Hipoparatireoidismo primário complicado após realização de cirurgia bariátrica: relato de caso.

Lucas Augusto Moris Afonso1, Rachel Rodrigues Pereira1, Tânia Maria Gonçalves Quintão2 Mechanical complication of interventricular communication after acute myocardial infarction in a patient with atypical symptoms: case report Complicação mecânica de comunicação interventricular pós infarto agudo do miocárdio em paciente com sintomatologia atípica: relato de caso ABSTRACT Atrial septal defect. Is a congenital defect in interatrial septum that allows blood lo leak from the left atrium to the right. Ostium Secundum represents about 10-12% of all congenital heart defects, located in foramen ovale. It is a cardiopathy with pulmonary hyperflow, which results in a volumetric overload of right chambers, mostly asymptomatic in the pediatric age group. Therefore, in large communications, it is common to find late complications as pulmonary hypertension, which may progress irreversibly to right-to-left deviation (Eisenmenger Syndrome). Patient, 49 years old, female, complaining of dyspnea for 1 year, associated with dry cough and lower limb edema. She has Systemic Arterial Hypertension, controlling with Propranolol 80mg, Furosemide 40mg and Spironolactone 25mg. In the family history, reported that the father was "heart disease", his mother is hypertensive. In cardiac auscultation, hypophonetic sounds were found and the presence of a more audible systolic murmur in the pulmonary focus with fixed unfolding of B2. In respiratory auscultation, decreased vesicular murmur was observed in the pulmonary bases. Associated with the physical examination, the echocardiogram showed the presence of Ostium Secundum-type Atrial Septal Defect with repercussions in the right heart chambers and pulmonary hypertension, making her case a state of urgency. Due to hemodynamic repercussions, the patient was referred for surgical correction, which may reduce pulmonary hypertension, improve dyspnea and chronic cough. Although Ostium Secundumtype Atrial Septal Defect is a common birth defect, its difficulty in diagnosis involves symptoms that initially go unnoticed, delaying treatment and increasing the chance of patient mortality. With the more accessible use f echocardiography, early diagnosis in asymptomatic adults is becoming increasingly frequent, which helps to reduce possible late complications.

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INTRODUCTION: Ingestion of foreign bodies is a common urgency in pediatrics. Often, children accidentally eat objects they are investigating, up to 40% of the time they were not found by parents or guardians. As coins are foreign bodies most often due to their easy access by children. Commonly such objects pass through the gastrointestinal tract spontaneously, but some cases may impact, such as at the sites of greatest esophageal construction, at the cricopharyngeal muscle level (75%), at the aortic arch level, or at the gastric-spherical junction. CASE REPORT: Male patient, 8 years and 7 months, treated in the emergency room 50 minutes after entering a penny, relating and that she herself is stuck in her throat, with concomitant sensation of ear pressure. Denied food and fluid intake after the episode. Tried to vomit 2 times, the last being effective and denied subsequent bleeding. Physical examination: flushed, hydrated, oropharynx without alteration. Abdominal and chest radiography were requested, showing that a coin was trapped in the esophagus. It was then endoscopically removed at 10:00 the next day, but the coin has shifted and will be eliminated naturally. DISCUSSION: Ingestion of foreign bodies is quite frequent in the pediatric age group and a detailed description of the clinical history directed to propedeutic complementary. The signs and symptoms of presentation displayed from asymptomatic to asphyxiation. Early diagnosis of foreign body respiration is essential because delayed recognition and treatment may incur definitive sequel or fatal damage. Most cases of foreign body ingestion have benign evolution with good prognosis. However, doctors must be able to identify the types of objects that are most at risk and need early approach. Diagnosis and conduct of foreign body ingestion in child: case report Diagnóstico e conduta de ingestão de corpo estranho na infância: relato de caso ABSTRACT INTRODUCTION: Acute pancreatitis is caused by pancreatic self-digestion, commonly caused by biliary lithiasis and alcoholism. They are classified as edematous and necrohemorrhagic forms, the last one is responsible for 10-20% of cases, behaving as a multisystemic disease that leads to Systemic Inflammatory Response Syndrome (SIRS), with a lethality of up to 60%. CASE REPORT: MGS, female, 49 years old, admitted at the emergency room with diffuse pain in the upper abdomen, stabbing, radiating to the back, started 15 hours after meal. Presents sweating, chills, nausea and intense vomiting. Physical Exam: regular general condition, dehydrated (++ / 4+), 115 bpm, 26 irpm without effort, threadlike pulses and blood pressure of 100 x 70 mmHg. Painful abdomen on palpation, with no signs of peritonitis. Referral to a referral hospital suspected of acute cholelithiasis. In the unit, she was admitted to a ward where she received venous hydration, stabilizing the condition. At night, after eating, she presented with lowering of consciousness and cardiorespiratory arrest, being reversed with resuscitation maneuvers. She was transferred to ICU for stabilization of the condition. After 24 hours, computed tomography (CT) showed acute necrotized pancreatitis. Exploratory laparotomy with necrosectomy was indicated. On the 6th postoperative day, she had fever (38.8ºC) and worsening of her general condition. New CT suggested infected necrosis and extensive abdominal abscess. Two new laparotomies were performed for debridement of necrotic material. After 42 days after the condition, the patient developed septic shock refractory to treatment and later death. DISCUSSION: Early and correct diagnosis of acute pancreatitis is fundamental. Cholelithiasis is an important differential diagnosis and cause of the disease. There is no specific treatment, but suspension of feeding and proper support is essential. The necrohemorrhagic form is the most severe and is accentuated by infection of the necrosis by translocad bacteria from the gut, which increases the chance of SIRS, shock and death.

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INTRODUCTION: The Meckel's ileal diverticulum is the most common congenital anomaly of the gastrointestinal tract, and it is estimated that its prevalence is 2% in the world population. It arises from an error during the involution of the yolk sac, which will result in a blind evagination composed of the three layers of the intestinal wall. Although most cases are asymptomatic, some of them present as acute abdomens. CASE REPORT: MAF, 58 years old, female, was admitted at the hospital for diffuse abdominal pain, colic, beginning 6 hours before the admission, associated with nausea and stopped eliminating flatus and feces. On physical examination, had great abdominal distension, absent airway sounds in the lower right quadrant, diffuse pain at palpation and presence of inguinal hernia on the right side. The leukogram showed 25,000 leukocytes with 1% of rods, abdominal radiography in dorsal and orthostatic decubitus revealed intestinal obstruction evidenced by the presence of air-fluid levels and intestinal loop edema. An exploratory laparotomy was indicated, an internal hernia was found approximately 60 cm from meckel's diverticulum, which was in the terminal ileum, which was observed in this surgical procedure, besides multiple intestinal adhesions. The adhesions and resection of the diverticulum were released. Microscopy revealed a histological picture compatible with Meckel's ileal diverticulum, chronically inflamed, without atypia. At macroscopy the diverticular lesion was 2x2x1,5 cm. DISCUSSION: Some risk factors increase the chances of development of symptoms by the diverticulum: male gender, age below 50 years, abnormal histological tissue and length over than 2cm. However, the patient of the described case does not fit the risk factors and, therefore, it is an atypical case. Thus, it is important to emphasize the relevance of the case to suspect different distinct diagnoses when approaching an acute abdomen. Meckel's ileal diverticulum as differential diagnosis in the approach of acute abdomens: case report Divertículo ileal de Meckel como diagnóstico diferencial na abordagem de abdomens agudos: relato de caso ABSTRACT Introduction: The Type 1 glucose transporter deficiency syndrome (GLUT1-DS) or De Vivo syndrome is a rare genetic disease, with approximately 500 cases reported in the world since 1991. In the absence of the GLUT 1 transporter, glucose does not exceed the blood-brain barrier, which may lead to convulsive crisis. Case report: Patient, female, two months sold, presented in an emergency service, a fixed gaze followed by flashing and clonic movements in the upper limbs, developing to convulsive status, which was resolved after administration of midazolam, hidantal and phenobarbital. Subsequently, it developed to recurrent focal crises requiring the use of levetiracetam. Cerebrospinal fluid examination showed hypoglycorrachia. Laboratory examination showed increased blood lactate and normal glycemia. In addition, computed tomography and cranial magnetic resonance imaging were performed, which did not show any alteration. With the verification of hypoglycorrachia associated with early on set epilepsy, the hypothesis of De Vivo syndrome was raised. This treatment started with ketogenic diet. To confirm the diagnosis, a genetic test was requested, which accused alteration of the SLC2A1 gene. Discussion: De Vivo's syndrome is a genetic disorder characterized by impaired glucose through the hemato encephalic barrier resulting in generalized epilepsy and developmental delay associated with movement. The low level of glucose in the cerebrospinal fluid suggests this diagnosis. Symptoms typically appear in childhood. At least 1/3 children with GLUT1-DS have characteristic episodes of paroxy small movements of the head and eyes as an initial symptom in the first year of life, which may facilitate the early diagnosis of this treatable syndrome. Therefore, it is extremely important to have a rapid diagnosis and early intervention to avoid worsening of symptoms and lethal complications. Keywords: GLUT1-DS, convulsion, hypoglycorrachia.

Reconhecimento e manejo da Síndrome de De Vivo na urgência e emergência -relato de caso
Recognition and management of De Vivo Syndrome in urgency and emergency -case report Physical aggression is one of the major causes of emergency care. Currently, there is an increase in the use of white weapons due to the growth of violence, associated with greater control and difficulty in acquiring firearms. Although the firearm is potentially more lethal, whiteweapon wounds, which predominate in men between the ages of 20 and 29, require special care as their manifestations may be late. Thus, the emergency sector must prioritize the care of these patients to reduce the burden of these events. CASE REPORT: J.S.S., male, 27, alcoholic, user of marijuana and cocaine, victim of physical aggression by scissors, about 20 minutes before entering the Emergency Room. He had a penetrating incision wound in the sternal furcula, of about 1 cm, with minimal local bleeding. He was conscious and oriented in time and space, with mild mucosal cutaneous paleness, hypotension, tachycardia and hypophonectic heart sounds. It evolved with accentuation of pallor, arterial hypotension, worsening of tachycardia, fine pulses, dyspnea, lowering of the sensorium, without loss of consciousness. Chest X-ray showed mediastinal enlargement, blurring of the cardiac silhouette, pleuropulmonary fields with preserved weft and free costophrenic sinuses. Contrasted computed tomography scan showed hemomediastinum. Hemoglobin 10.6 g / dl, hematocrit 32%, leukogram 15600 without deviation and platelets 220000. It was immediately transferred to reference service distant 100 km. Approximately two hours after the first care, a thoracotomy was performed with 2 cm wound raffia in the aortic crossa, blood transfusion and volume replacement. Patient survived without sequelae. DISCUSSION: Any penetrating white stick injury in the chest, or other region that has large vessels in its compartment, should be promptly attended, with imaging and blood counts, and an immediate surgical approach. Such conduct greatly increases the chances of survival of victims of such trauma. Primary hypoparathyroidism complicated after bariatric surgery: case report Hipoparatireoidismo primário complicado após realização de cirurgia bariátrica: relato de caso.
ABSTRACT INTRODUCTION: Thoracic trauma is an important cause of preventable death, which affects young males under 40 years of age. This lesion is basically subdivided into open trauma, related to injuries caused by firearms and white arms; and closed trauma, which is usually associated with vehicles accidents. The latter may result in blunt cardiac trauma and lead to serious complications such as cardiac tamponament and valve injury. CASE REPORT: LMT, 28 years old, male, was admitted to the Joao XXIII hospital with signs of acute right heart failure after automobile trauma. A transthoracic echocardiogram showed signs suggestive of contusion in the right ventricle with severe dysfunction, flail valve of the septal leaflet of the tricuspid valve with significant insufficiency, and signs of pericarditis, characterizing the diagnosis of acute tricuspid insufficiency due to blunt cardiac trauma. Therefore, the patient was transferred to the Hospital FelícioRocho for hospitalization and stabilization of the condition, with a subsequent surgical approach, referring to tricuspid valvuloplasty and correction of the pleural-pericardial fistula on the right. DISCUSSION: Blunt cardiac trauma, which consists of non-transfixation of the heart, can occur with several pathologies, such as cardiac tamponade, which occurs, for example, due to rupture of the cardiac chamber and interatrial and interventricular septa, arrhythmias, or pericardial rupture with or without herniation of the heart. The isolated valve lesion is rare and the aortic valve is most frequently affected, followed by the mitral and tricuspid, so that it can affect the valve leaflet, the tendon cord and, when present, the papillary muscles. These situations may manifest, according to the affected valve, with acute left or right heart failure; and abrupt or late onset of onset, which may be noticed months or years after the trauma, thus delaying the treatment. Vegetable injury in mouth -identification and management in a basic health unit: case report Lesão vegetante em boca -identificação e manejo em unidade básica de saúde: relato de caso ABSTRACT INTRODUCTION: Depression of consciousness caused by anesthetics leads to reduction of airway protective reflexes (VA), leading to pulmonary aspiration of gastric contents (GC). Even rare this can cause serious complications. Thus, it is very important that measures of prevention and protection of VA are carried out. CASE REPORT: A male patient, 61 years old, admitted for gastrectomy due to gastric cancer. Smoker and alcoholic, deny previous surgeries or allergies. Admitted for operation with normal ECG, blood pressure, heart rate and sp02. Realized thoracic epidural puncture (T11-T12) and analgesic injection with morphine (3mg), fentanyl (100mcg), clonidine (150mcg) and bupivacaine 0.125% (25mg). Denervation and venous induction with lidocaine 1% (60mg), fentanyl (100mcg), propofol (110mg) and cisatracurium (10mg). As soon as the manual ventilation under the facial mask was started, it presented massive regurgitation of GC. Oral cavity aspiration and immediate intubation were performed. Pulmonary auscultation remained normal as well as ventilatory and mechanical ventilation was established. There was no evidence of bronchospasm or respiratory obstruction. The patient was extubated and taken to the recovery room where he remained for 2 hours until he went to bed with 10 points on the modified Aldrette scale. Hospital discharge in 1 week. DISCUSSION: Bronchoaspiration presents greater morbidity and can be attenuated by the identification of risk patients and the application of measures such as fasting, drugs to reduce and increase gastric pH, maintenance of the nasogastric tube and anesthesia technique of awake intubation or intubation of fast sequence and Sellick maneuver. Ventilatory monitoring is a non-invasive method and has importance in ventilatory mechanics. As it was not observed a change in VA hysteresis, complacency or resistance, was deduced that regurgitation did not lead to aspiration of regurgitated contents, which was confirmed by an excellent patient evolution.

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INTRODUCTION: The advent of videolaparoscopic techniques in the last decade represents a radical change in the surgical scenario because it has several advantages over the conventional method. However, complications are likely to occur and are related to pneumoperitoneum (PP), such as respiratory, hemodynamic, metabolic and thermal changes. CASE REPORT: A male patient, 83 years old, BMI = 16, was admitted for videolaparoscopic rectosigmoidectomy due to rectal cancer. In the pre-anesthetic evaluation: negative comorbidities, allergies, past anesthetic-surgical and medication use. Exams without changes. In the surgical room: left subclavian vein puncture, single and median lumbar puncture (in L3-L4 with Quincke needle 25G) and intrathecal injection of morphine (50mcg) + 0.5% hyperbaric bupivacaine (5mg) diluted without liquid. Monitoring: pulse oximetry, continuous cardioscopy, PAM (right radial artery catheter), PVC, capnometry, hourly diuresis, serial blood count and ionogram. Venous induction with fentanyl (100mg) + etomidate (10mg) + cisatracurium (7mg) following IOT without occurrences. When PP was established (up to 15 mmHg) , the patient experienced severe hemodynamic instability (MAP = 40 mmHg). Ephedrine was injected intravenously, boluses of 10mg to 50mg, without response. Immediate emptying of the abdominal cavity and injected adrenaline venous bolus (50mcg) was performed, with improvement of the condition. An attempt was made to install the PP again, but the instability was repeated and only improved when the gas was withdrawn. Was opted for open surgery, without intercurrences. Patient extubated at the end of the procedure and sent to the ICU, stable and without complaints. DISCUSSION: One of the first steps of videolaparoscopy is the insufflation of the abdominal cavity with CO2 to obtain PP. High intra-abdominal pressure causes a number of physiological reactions, such as intra-abdominal compression, resulting in decreased venous return. It is believed that this has been the main mechanism by which our patient should not have tolerated the PP, even if still with normal inflation pressures. Keywords: videolaparoscopy. Pneumoperitoneum. anesthesiology.

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INTRODUCTION: Any injury incident to the organism caused by exogenous action isdefined as trauma. In this way, it is determined as a group of sudden agitations with physical or chemical causes of diverse etiologies, such as automobile accidents, that when they do not lead to death, cause transient or permanent sequels. In Brazil, regarding the external causes of death in adolescence, traffic accidents occupy the first place in the age range of 10 to 14 years. CASE REPORT: Adolescent, 12 years old, small vehicle passenger, collision victim with fixed object (stake), followed by rollover, without seat belt and other protective devices, found to the ground far from the scene and driven by the emergency service to the hospital. She was admitted confused, anisocoric, Glasgow 8, polytraumatized, reporting two episodes of convulsions, evolving with shock. Images of the skull, thorax, abdomen and spine were performed. Left frontal subgaleal hematoma, left frontal fracture with associated bone misalignment and sinking, fracture in the orbit and maxillary sinus were observed. In addition to a fisical fracture in the left ankle, pelvis and L2/L3 listhesis. The patient has received a red blood cell concentrate O+ afterhypovolemic shockand also, laboratory examination, which has indicated anemia and thrombocytopenia. Beyond to conservative treatment and respiratory physiotherapy, surgeries for the correction of ankle fractures and an open fracture of the skull were performed. After 19 days of hospitalization, which remained 15 days sedated and intubated, the patient was discharged with elective cranioplasty. DISCUSSION: Studies have shown that 90% of accidents could be avoided with simple prevention measures, as a way to reduce the risk of serious injuries and deaths, through the adoption of safe behaviors, changes in the environment and use of protective equipment, since the high frequency that this kind of accident occurs.

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Introduction. The diaphragmatic rupture by blunt trauma is the result of an impact with distortion of the thoracic wall, increased intra-abdominal pressure, and consequent phrenic injury. The diagnosis of this lesion, although desirable, is difficult. Most are not early diagnosed, since the signs and symptoms, including radiologic, are not specific. Thus, diaphragmatic rupture may not be recognized and treated immediately. This paper discusses the importance of early diagnosis of diaphragmatic rupture by blunt trauma and review the literature on the subject. Case report. MFCL, 20 years old, male, victim of automobile accident, polytraumatized. He presented an open fracture of the left tibia and left fibula with severe vascular lesion and complained of left thoracic pain and diffuse abdominal pain. Noncyanotic, Glasgow 15, isochoric and photoreactive pupils, blood pressure 144x94mmHg, heart rate 92bpm, respiratory rate 26irpm, SatO2=100%. Reduced heart murmurs at the base of left hemithorax; abdomen was normotensive, tympanic, painful on palpation in hypogastrium. Abdominal USG and chest X-ray without alterations. He was submitted to amputation of the left lower limb. Three days later, CT scan showed pulmonary contusion, atelectasis and traumatic diaphragmatic hernia, allon the left side. Exploratory laparotomy was performed, blood was found in the peritoneal cavity, a complex rupture of the diaphragm of approximately 20cm was diagnosed and the transverse colon, the stomach and the spleen were inside the thoracic cavity. Discussion. Diaphragmatic lesions represent a diagnostic challenge due to the variability of their clinical presentation and imaging exams, which are often little suggestive at the first moment. As most patients are polytraumatized, the severe state in which they arrive at the hospital, prevents there being time for thorough examination. Thus, without the early diagnosis of these lesions and the patient's entry in the latent period, the chances of complications are higher, such as incarceration of abdominal content hernias, ischemia and perforations, as well as compressive atelectasis and pleural effusion. Therefore, the early diagnosis of diaphragmatic rupture is fundamental for an uneventful evolution. ABSTRACT INTRODUCTION: Yellow fever is an acute infectious disease, with arboviruses as its etiology. Brazil experienced a major outbreak of this disease in 2018. The severe form is characterized by manifestations of hepatic and renal insufficiency, often fatal. Due to the lack of specific treatment, vaccination is their form of prevention. CASE REPORT: A 39-year-old male patient, unmarried, a farmer, was admitted to the emergency room with a history of fever, headache for 3 days, with diarrhea, vomiting and oliguria. Ethnic, smoker, with no history of vaccination for yellow fever. Exams revealed thrombocytopenia, marked increase of hepatic transaminases, urea and creatinine. The patient was on ICU, hemodynamically unstable, with nor adrenaline at 10 ml / h. He was hypotensive, bradycardic, eupneic, dehydrated, hypocritical, slightly jaundiced and confused. Prescribed ceftazidime and fluconazole for 12 days. He attended with bleeding in accesses, being necessary transfusion of cryoprecipitate, plasma and platelets in 2 occasions. Dialysis was initiated because it was anuric. A large amount of volume was administered, with a positive water balance, associated with a gradual decrease in the need for norepinephrine. Ultrasonography performed at the bedside for cardiopulmonary evaluation and interstitial fluid. He was discharged from ICU with improvement of thrombocytopenia, hepatic function, but with oliguria in a hemodialysis program. DISCUSSION: Patient with suspected yellowfever presenting hemodynamic instability, hemorrhage and severe condition, which constitutes a state of urgency. A standard protocol was initially and modified, leaving the water balance always positive. Dialysis, however, did not eliminate the fluid in the procedure and monitored by ultrasonography at the bedside, daily, for volume monitoring. The patient presented complete improvement of symptoms after 1 month. The handling of the disease is incipient, requires study, however, we should consider measures such as hyper hydration in the conduct, without increasing the concentration of vasoactive drugs, since this patient was the only one with complete recovery of the hemodynamic functions. Urgent treatment of yellow fever in a center of intensive therapy: case report Tratamento de urgência de febre amarela em centro de terapia intensiva: relato de caso 1 -Acadêmicas da Faculdade