hsp-gu-190c-016 manejo del dolor lumbar agudo

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  • 8/2/2019 HSP-GU-190C-016 Manejo del Dolor Lumbar Agudo

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    *Rfr|`hk5 ?

    CIKFEH GFN GHNH_NVCOI_ IJVGH

    Lhg `y h5 A \] #JV#9 0= L#H 9 2INLINH@I CIPH_9##########$###########9 GFOHJHWIh+l+.u`+CvoAh|}wi

    \chk Ohn ir AH\]@WIN@UIL@HKH_WH]FG@I

    WIONI GF LHKWFK@GH

    9+ EV\W@B@LIL@HK?+ HOEFW@RH\

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    CIKFEH GFN GHNH_ L2g`jh5 A\]#JV#90=L#=92NVCOI_ IJVGHAH\]@WIN@UIL@HKH_WH]FG@I

    Ah|}wi)\c2k Ohn ir Rfr|`hk5 ?

    9+ EV\W@B@LIL@HKF@ ghnhr nvcoir ijvgh f| vki gf ni| }r`kl`}inf| liv|i| gf `kli}il`gig p chw`hgf lhk|vnwi i nh| |fr`l`h| gf Vrjfkl`i| p Lhk|vnwi Fqwfrki gf Lhnhco`i+?+ HOEFW@RH\G`|fr`ir vki jvbi gf cikfeh ln`k`lh oi|igi fk ni cfehr f`gfkl`i g`|}hk`onf|horf fn cikfeh gfn ghnhr nvcoir ijvgh gf vki cikfri nhj`li. |flvfkl`in phrgfkigi gf ilvfrgh i ni| cik bf|wil`hkf| lnbk`li| gf ligi }il`fkwf+

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    AH\]@W IN`UIL@HKH_WH]FG@I ) fr|`hk5 ?`

    {CIPH_################X9 GF{j4Ih++l+@ {4. 44>;4+;`Z` {{@/D+.*+dE`.+/.\chk Ohn ir

    ikl`ikh| p iov|ighrf| gf grhji| `kwrifkh|i|4 C`lhoilwfr vc+ Wvofrlvnh|`| w`fkf}rfg`nfll`hk }hr frwfori| whril`li| `kbfr`hrf| = nvcoirf| |v}fr hrf| !fkbfrrkfgiggf ]hww+#Ni afrk`il`hk gf g`|lh hlvrrf lhk ciphr brflvfkl`i fk nh| f|}il`h| N7#\ p N\#\9fk ci| gfn 0\&gf nh| li|h|+#Ni afrk`i N7 # N\ }rhgvlf ghnhr nvcoir. f|}i|ch. f|lhn`h|`| ikwiny`li. lhefri.|fk|il`hk ghnhrh|i fk ni }irwf fqwfrki gf ni }`frki. }irwf cfg`i gfn }`f p fk ainnvq4}vfgf fq`|w r gfo`n gig ghr|`bnfqhri gfn }`f p gfgh| p nh| rfbnfeh| h|wfhwfkg`kh|h|}vfgfk f|wir khrcinf|+#Ni afrk`i N\ # \9 `jvincfkwf gi |nkwhci| nvrkoirf|. f|}i|ch. ghnhr jnvwfh.chnf|w`i| fk }irwf }h|wfr`hr gfn cv|nh. }`frki p ohrgf fqwfrkh gfn }`f+ Lhkbrflvfkl`i |f fklvfkwri irrfbnfq`iIyv n`iki p gfo n`gig }nikwir bnfqhri p gf nh| cv|lvnv| }frhkfrh|+#Ni nf|`hk i k`fn N< # N7 |f cik`b`f|wi fk ni rkfwirkfri N7 yvf |f rfnil`hki lhk nibvfrui gfn lvigr`lf}|. fn rfbnfeh }iwf`ir p ni `k|fk|`o`n gig fk ni liri niwfrin gfn cv|nhf `kwfrki gf ni }`frki+Fqicfkf| ]iriln`k`lh|]iri ni ciphr`i gf }il`fkwf| lhk ghnhr nvcoir. lhk = |`k rig`lvnh}iw`i. kh |hkkflf|ir`h| nh| f|wvg`h| gf rig`hnhjbi p niohriwhr`h fk ni| }r cfri| lviwrh |fciki|gf fhnvl`hk+ \f ev|w`b`lik gf|gf ni }r`cfri lhk|vnwi }iri nh| li|h| gf wrivcif`gfkwf. |h|}flai gf fkbfrcfgig liwi|wrhb`li fk }il`fkwf| gf inwh r`f|jh. }iri nh||`kgrhcf| gf livgi fyv`ki p }iri nh| ill`gfkwf| `iohrinf| o`fk gfb`k`gh|+Fqirkfkf| gf Niohriwhr`h !`kf|}fl`b lh|5 \f |hn`l`wik R\J !fkbfrcfgig |`|wfc`li =rfvciwh`gfi fk }il`fkwf| lhk bilwhrf| gf r`f|jh. Afchnfvlhjrici !|h|}flai gf`kbfllnhk. l whyv`c`lh gf hr`ki. ikwbjfkh }rh|wiw`lh !ahcorf| lhk ci| gf \Hikh|gf fgig !`c}hrwikwf+_q gf lhnvcki nvcoh|ilri5 Fk nvcoi)j`i lhc}nfei p fk }il`fkwf lhk bilwhrf| gfr`f|jh. fk }rhpfll`hk I] p niwfrin fk }h|`l`hk gf }`f }iri f|wvg`h `k`l`in.!`c}hrwikwf+Jicijrib`i H|fi5 Fk li|h gf |h|}flai `kbfll`hk frwforin = wvchrf| h|fh|}r`cir`h| = cfwi|wi|`lh|. !`c}hrwikwf+_f|hkikl`i+Cijkfw`li5 \f hrgfkik |` aip |h|}flai ln k`li gf cin`jk`gig frwforinh `kwrif|}`kin. `kbfll`hk. |bkgrhcf gf lhni gf lioinnh. wrivci riyv`cfgvnir plikg`giwh| yv`rvry`lh| }hr rig`lvnh}iw i }fr|`|wfkwf. !`c}hrwikwf+

    ]ij`ki < gf :

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    CIKFEH GFN GHNH_NVCOI_ IJVGH

    L2g jh5 A\]#JV#90=L#=92

    \chk Ohn irINLIn+n)!+h+ CIPH_b############*###############9 GF{4IH+l+

    `*+++ {E;X..) { { / * D ; * / ) ` d / . . . .. #AH\]@W IN`UIL`HKH_WH]FG@I

    WIL |`c}nf 5 ]iri ni finvil`2k gfn likin nvcoir f|wrflah |flvkgir`h if|}hkg`nhirwrh}iwbi| p fk fn wrivci whrilhnvcoir. nvcoh|ilrh = gf }fn`| |`klhc}rhc`|h kfvrhnhy`lh+ Kh `|vin`ui fn f|}il`h |voirilkh`gfh p |f f|li}ik ing`iykh|w lh nf|`hkf| gfn wfe`gh kfvrin. !`c}hrwikwf+Fnflwrhc`hjribbi5 Lhkb`rcir lhc}rhc`|h rig`lvnir. `gfkw`b`li ni cfwirkfrilhc}rhcfw`gi+ ]vfgf ipvgir i g`bfrfkl`ir vki rig`lvnh}iwbi gf vki kfvrh}iwbi+ Fkvk }il`fkwf lhk ghnhr iwb}`lh fk vki fqwrfc`gig lhk ainniujh| lnbk`lh| khrcinf|.ilniri |` fn hr`jfk f| f|}`kin = }fr`wfr`lh+ Kh `kg`ligh fk nvcoinj`i |`c}nf.!`c}hrwikwf+C`fnh #WIL5 !lhk cfg`h gf lhkwri|wf a`grh|h`vonf Gi vki `kbhrcil`hk i}rhq`cigigfn lhkgvlwh riyvbgfh fk ikf| k`fnf| wvcoirf|+ \f rf|fri }iri }il`fkwf| ghkgf|f ai lhk|`gfrigh ni }h|`o n`gig yv`rvry`li. !`c}hrwikwf+H_@FKWIL@HK WF_I]FVW@LI#Fk nvcoinj`i |`c}nf `kf|}fl b`li. rf}h|h fk lirki. ikw` kbniciwhr h|. ikinjf|`lh| pcfg`gi| nhlinf| lhch linhr nhlin+ F@ 0=& gf nh| }il`fkwf| w`fkf in``h gfn ghnhr+#\f `kl`i }rhjrici gf f|lvfni gf f|}ingi yvf `klnvpf5 Fkwrfkic`fkwh }h|wvrin.o`hcflik`li lhr}hrin. fefrl`l`h| gf f|w ric`fkwh. in kfic`fkwh p lhkg`l`hkic`fkwh pilw``gigf| gf }rffkl`hk+

    #Fk iv|fkl`i gf gfb`l w kfvrhnhy`lh }rhjrf|`h p inwfril`hk gf ni bvkl`hk f|`lin. fnwriwic`fkwh gf ni afrk`i g`|lin kh f| yv`rvry`lh. fn 16& gf nh| }il`fkwf| cfehririk|`k l rvjbi+ Ni g`|lh`gflwhcbi f|wi `kg`ligi fk `kg`ligi fk }il`fkwf| f|wionf| gf|gffn }vkwh gf `|wi }|`yv`iwr`lh p f`gfkl`i hoefw`i gf g`|lh }rhni}|igh lhkrig`lvnh}iwbi+#F@ wriwic`fkwh gf ni h|wfhc`fn`w`| frwforin f| fn rf}h|h. cikfeh ikw`o`hw`lhf|}flbb`lh p v|h gf lhr|f+ F@ grfkief kh f| kflf|ir`h i cfkh| yvf |f gf|irrhnnf vkio|lf|h p }rhgvuli |bkwhci| cfgvnirf| = |`|wfcnlh|#F@ wriwic`fkwh gf ni| brilwvri| }iwhnhy`li| gf ni lhnvcki f|wi g`r`j`gh i }rffk`r nilhc}rf|`hk gf ni cfgvni f|}`kin+ F@ wriwic`fkwh lhk|`|wf fk cfg`gi| f|}flbb`li| gfni fkbfrcfgig `klnvpfkgh yv`c`hwfri}`i p cfg`gi| nhlinf| hlch rig`hwfri}`i.rffc}niuh gf ni frwfori gf|wrv`gi lhk `kefrwh. ni f|wio`n`uil`hk |f rfin`ui ikwf| gfyvf |f gf|irrhnnfk |bkwhci| cfgvnirf|+#Nh| gf|jirrh| cv|lvnirf| ijvgh| gf ni f|}ingi rfyv`frfk ni| c`|ci| cfg`gi|lhk|frighri| yvf fk }il`fkwf| lhk afrk`i gf g`|lh+ \f gfof f`wir vk rfwhrkhgfci|`igh }rflhu i nh| k`fnf| gf ilw``gig }rf`h pi yvf nh| |bkwhci| }vfgfkijriir|f p }rhnhkjir ni rflv}fril`2k+

    ]ij`ki 7 gf :

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    @CIKFEH GFN GHNH_ L2g jh5 A\]#JV#90=L#=92 @ @NVCOI_ IJVGH

    # # $ # # # # # # # # # # # # # # # # # # { 55{b55{AH\]@WINnUIL)2K @ Rfr|`hk5 ? @H_WH]FG`I +

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    #Ni| lr`|`| irwrbw`li| |hk wriwigi| lhk l`lnh| lhrwf| gf ikw``kbniciwhr`h| p rf}h|h+ Ni}rffkl`hk i nirjh }niuh gf ni| gfbhrc`gigf| p lhkwrilwvri| |f rfin`ui cfg`ikwf vk}rhjrici gf fefrl`l`h| gf }h|wvri p f|w`ric`fkwh+L_@WF_@H\ GF @KJ_F\H AH\]@WINI_@H#]il`fkwf| lhk nvcoinj`i p l`iw`li yvf }rf|fkwfk |`jkh| kfvrhnhy`lh| }rhjrf|`h|+#]il`fkwf| lhk rig`lvnh}iw`i o`niwfrin. rfwfkl`hk vr`kir`i = |`kgrhcf gf livgifyv`ki+#]il`fkwf| lhk g`iykh|w`lh gf h|wfhrk`fn`w`| frwfori)#]il`fkwf| lhk g`iykh|w`lh gf brilwvri }iwlnhy`li lhk lhc}rf|`hk cfgvnir+

    L_@WF_@H\ GF FJ_F\H AH\]@WIN]++_`H#Lhkwrhn gf nh| |`kwhci|+#]il`fkwf| lik f|wio`n`uil`2k gf wrilwvri| p lhk gf|lhrk}rf|`hk cfgvnir fk nh|li|i| fk nh| yvf |fi kflf|ir`h+#Lhkwrhn gfn }rhlf|h `kbfll`h|h lvikgh f|wf }rf|fkwf+#]il`fkwf lhk li}il`gig gf gficovnir p rfin`uir ilw``gigf| g`ir`i| gf bhrci`kgf}fkg`fkwf+@KG@LIL@HKF\ ]H\WAH\])WIN@UIL@HK\f gfof rfin`uir vk rfwhrkh }rhjrf|`h i ni ilw``gig bb|`li+\f rfin`ui wfri}`i bb|`li p fefrl`l`h }iri g`|c`kv`r @i rflvrrfkl`i gf f}`|hg`h|+\f `k|wrvpf |iorf fefrl`l`h| ifr2o`lh|. lhkwrhn gf }f|h. f`wir wioiyv`|ch. f`wirbnfq`hkf| p rhwil`hkf| rf}fw`gi| gfn wrhklh. kh nfikwir hoefwh| }f|igh|. bil`n`wirlico`h| brflvfkwf| gf }h|`l`hk p |fkwir|f fk vki |`nni lhk ovfk i}hph nvcoir+:+ INJH_@WCH GF ILWVIL@HK

    r Finvil`2k `k`l`iS gfn }il`fkwf lhkNhnhr nvcoir fk vryfkl`i|r#####+q+p###.5 Ikickf|`{. Fqicfk B`|`lh @

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    ]iy`ki 6 gf :

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    Ah|}wl.)\chk Ohn ir

    CIKFEH GFN GHNH_ L2g`jh5 A\]#JV#90=L#=92NVCOI_ IJVGHAH\]@WINnUIL)HK

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    @ CIKFEH GFN GHNH_ 55552g`jh5 A\]#JV#90=L#=92tG NVCOI_ IJVGH In+LINH`ICIPH_{################$#################{ GF{{{{

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    L`iw`li |f gfb`kf lhch fn ghnhr yvf |f `rrig`i gf|gf ni rfj`hk nvcoir ail`i nh|jnvwfh| p ni fqwrfc`gig `kbfr`hr+Ni ciphrni gf lvigrh| gf ghnhr nvcoir ijvgh w`fkfk |v hr`jfk fk fn |`|wfcirkv|lvnhf|yvfnfw`lh+ \f gfofk wfkfr fk lvfkwi nh| |`jv`fkwf| bilwhrf| gf r`f|jh}iri }iwhnhjbi cin`jki. `kbfll`h|i = kfvrhnhj`li+#]il`fkwf ciphr gf 6= ikh|+#]rf|fkl`i gf |`jkh| |`|wfc`lh|5 b`forf. }frg`gi gf }f|h+#A`|whr`i }rf`i gf liklfr. afciwvr`i. igfkhhiw i+#V|h gf grhji| fkghfkh|i|+9=+O@ON@HJ_IB@IEhak \+ D rd}iwr ldNhz Oild ikg Kfld ]i`k+ Lhc}rafk|`f G`ijkh|`| ikg cikijfcfkw+