Efficacy of a Novel Surgical Manikin for Simulating Emergency Surgical Procedures.

The practical component of the Advanced Trauma Life Support (ATLS®) course typically includes a TraumaMan® manikin. This manikin is expensive; hence, a low-cost alternative (SurgeMan®) was developed in Brazil. Our primary objective was to compare user satisfaction among SurgeMan, TraumaMan, and porcine models during the course. Our secondary objective was to determine the user satisfaction scores for SurgeMan. This study included 36 ATLS students and nine instructors (4:1 ratio). Tube thoracostomy, cricothyroidotomy, pericardiocentesis, and diagnostic peritoneal lavage were performed on all the three models. The participants then rated their satisfaction both after each activity and after the course. The porcine and TraumaMan models fared better than SurgeMan for all skills except pericardiocentesis. In the absence of ethical or financial constraints, 58 per cent of the students and 66 per cent of the instructors indicated preference for the porcine model. When ethical and financial factors were considered, no preference was evident among the students, whereas 66 per cent of instructors preferred SurgeMan over the others. The students gave all three models an overall adequacy rating of >80 per cent; the instructors gave only the animal models an adequacy rating of <80 per cent. Although the users were more satisfied with TraumaMan than with SurgeMan, both were considered acceptable for the ATLS course.

O tratamento inicial de pacientes hipovolêmicos: emprego da soluçäo hipertônica de NaCl a 7,5% / Initial treatment of hypovolemic patients with 7,5% solution of NaCl

Trinta e três pacientes admitidos ao Serviço de Emergência em choque hipovolémico (pressäo arterial média PAM < 60mmHg) foram distribuídos ao caso em grupo I (18 pacientes) que recebeu soluçäo hipertônica de NaCl a 7,5% por veia periférica, ou em Grupo II (15 pacientes) que recebeu soluçäo isotômica de NaCl, ambas infundidas na velocidade de 10 ml/min durante 15 minutos. Os pacientes näo recebiam outras soluçöes após a infusäo, a menos que a PAM diminuisse a níveis < 80 mmHg, ou quando o paciente era encaminhado para o centro cirúrgico. Os pacientes eram excluídos do estudo täo logo eles recebiam outros volumes. A PAM era medida de 2 em 2 minutos. A osmolalidade, o sódio, o hematócrito e as protéinas plasmáticas foram determinados antes e após a infusäo. A PAM apresentou uma elevaçäo significativa durante a infusäo (p < 0,001) em 15/18 pacientes do Grupo I, enquanto que a PAM no Grupo II näo atingiu o nível de 80 mmHg em nenhum paciente durante este período. Concluimos que a infusäo de soluçäo hipertônica de NaCl a 7,5% é eficiente no tratamento inicial de pacientes hipovolêmicos. O local da infusäo na veia periférica näo mostrou sinais inflamatórios durante evoluçäo dos pacientes