Perfil dos pacientes com crise hipertensiva atendidos em uma unidade de pronto atendimento / Perfil de los pacientes con crisis hipertensiva atendidos en una unidad de pronta atención / Profile of patients with hypertensive crisis seen in an emergency care unit

RESUMO Objetivo: descrever o perfil dos pacientes com crise hipertensiva atendidos em uma Unidade de Pronto Atendimento. Método: estudo transversal descritivo, realizado por meio da análise de 80 prontuários de pacientes com quadro de crise hipertensiva, atendidos em uma unidade de pronto atendimento, entre o período de março de 2018 a fevereiro de 2019. Os dados foram coletados por meio de roteiro estruturado e receberam tratamento estatístico descritivo. Resultados: Após a análise dos 80 prontuários, constatou-se que a média de idade entre os pacientes atendidos foi de 58,03, sendo a faixa etária adulta a mais prevalente (53,8%). Constatou-se que a média da pressão arterial sistólica foi significativamente maior em homens em relação às mulheres (p=0,013). Quanto à sintomatologia, a cefaleia foi a mais prevalente, com 35,0%. Verificou-se que durante o atendimento da crise hipertensiva, a maioria dos pacientes fez uso de apenas uma droga para redução da PA, sendo o inibidor adrenérgico de ação central o mais citado. Quanto ao desfecho, grande parte dos pacientes recebeu alta (93,8%) logo após o atendimento, porém, 6,3% permaneceram em internamento de curta permanência até a estabilização do quadro. Considerações finais: Este estudo possibilitou a caracterização da população com crise hipertensiva atendida em um pronto atendimento, a qual evidencia uma possível fragilidade existente entre a articulação dos níveis de atenção à saúde.

RESUMEN Objetivo: describir el perfil de los pacientes con crisis hipertensiva atendidos en una Unidad de Pronta Atención. Método: estudio transversal descriptivo, realizado por medio del análisis de 80 registros médicos de pacientes con cuadro de crisis hipertensiva, atendidos en una unidad de pronta atención, entre el período de marzo de 2018 a febrero de 2019. Los datos fueron recogidos por medio de guion estructurado y recibieron tratamiento estadístico descriptivo. Resultados: después del análisis de los 80 registros médicos, se constató que el promedio de edad entre los pacientes atendidos fue de 58,03, siendo la franja etaria adulta la más prevalente (53,8%). Se constató que el promedio de la presión arterial sistólica fue significativamente mayor en hombres que en las mujeres (p=0,013). En cuanto a la sintomatología, la cefalea fue la más prevalente, con 35,0%. Se verificó que, durante la atención de la crisis hipertensiva, la mayoría de los pacientes hizo uso de solo una droga para reducción de la PA, siendo el inhibidor adrenérgico de acción central el más relatado. Respecto al resultado, gran parte de los pacientes recibió el alta (93,8%) inmediatamente después de la atención, sin embargo, el 6,3% permaneció en internamiento de corta estancia hasta la estabilización del cuadro. Consideraciones finales: este estudio posibilitó la caracterización de la población con crisis hipertensiva atendida en una pronta atención, la cual evidencia una posible fragilidad existente entre la articulación de los niveles de atención a la salud.

ABSTRACT Objective: to describe the profile of patients with hypertensive crisis treated at an Emergency Care Unit. Method: descriptive cross-sectional study carried out through the analysis of 80 medical records of patients with hypertensive crisis, treated at an emergency care unit, between March 2018 and February 2019. Data were collected using a structured script and were subjected to descriptive statistical treatment. Results: after analyzing the 80 medical records, it was found that the mean age of the treated patients was 58.03, with the adult age group being the most prevalent (53.8%). It was found that the mean systolic blood pressure was significantly higher in men than in women (p=0.013). As for symptoms, headache was the most prevalent, with 35.0%. It was found that during the treatment of the hypertensive crisis, most patients used only one drug to reduce BP, with centrally acting antiadrenergic drugs being the most cited. Regarding the outcome, most of the patients were discharged (93.8%) soon after treatment; however, 6.3% remained in short-term hospitalization until their condition stabilized. Final considerations: this study made it possible to characterize the population with hypertensive crisis treated in an emergency room, showing a possible fragility in the articulation between health care levell

Experiencia del manejo del trauma vesical en Hospital de Urgencia Asistencia Pública: revisión de cinco años, 2005- 2009 / Bladder trauma: management experience of Hospital de Urgencia Asistencia Publica: five years review, 2005- 2009

INTRODUCCIÓN: El trauma vesical es escaso, representa el 2-3 por ciento de traumatismos abdominales y es frecuente su asociación a fractura de pelvis. Con diagnóstico precoz tiene baja tasa de mortalidad. OBJETIVO: Describir el manejo de los pacientes con trauma vesical en el Hospital de Urgencia Asistencia Pública, Santiago, Chile. MATERIAL Y MÉTODO: Estudio retrospectivo, descriptivo de los registros de 16 pacientes con diagnóstico de egreso de trauma vesical, durante periodo 2005-2009. Los datos recopilados fueron sometidos a análisis estadístico simple en Microsoft Office® Excel 2010. RESULTADOS: El promedio de edad fue 29 años. Del total de pacientes, 13 son de sexo masculino. El mecanismo de lesión fue de tipo contuso en 11, siendo el accidente de tránsito el más frecuente con nueve. Los traumas penetrantes se presentaron en cinco pacientes, de los cuales cuatro fueron por arma de fuego. La hematuria es un signo frecuente, en nueve de ellos se presentó. El diagnóstico se realizó con ecotomografía abdominal en ocho y en cinco fue intraoperatorio. El manejo realizado fue quirúrgico en 15 casos, que abarca la totalidad del trauma penetrante, sólo tres pacientes presentaron complicaciones que correspondieron a sangrado activo. El trauma vesical se sospechó al ingreso en tres pacientes. DISCUSIÓN: El trauma vesical se presenta en pacientes jóvenes de sexo masculino, el mecanismo más frecuente es el contuso por accidente de tránsito. El diagnóstico se realiza principalmente con ecotomografía abdominal. El manejo es quirúrgico. La sospecha de trauma vesical es baja y se requieren exámenes de imágenes para confirmar.

INTRODUCTION: Bladder trauma is infrequent. Its incidence is estimated at 2-3 percent of all abdominal trauma and is strongly associated with pelvic fracture. If bladder trauma is suspected and identified, it has low mortality rate. OBJECTIVE: To describe the management of patients with bladder trauma in Hospital de Urgencia Asistencia Pública. MATERIAL AND METHOD: Descriptive, retrospective study of patients with discharge diagnosis of bladder trauma, between 2005 – 2009. RESULTS: Mean age was 29 years. Of all patients, 13 were male. Eleven patients presented blunt trauma, being traffic accidents the most frequent in nine. Penetrating trauma was present in five patients, of which four were by firearm. Hematuria is a frequent sign, being present in nine patients. For diagnosis, abdominal ultrasonography was used in eight cases and in five was made intraoperatively. Surgery was performed in 15 patients, which covers all cases of penetrating trauma. Three patients resented complications, all of them secondary to active bleeding. On admission, only three patients had suspicion of bladder trauma. DISCUSSION: Bladder trauma mainly occurs in young male patients and the most frequent injury mechanism are traffic accidents. Abdominal ultrasonography is the main diagnostic tool and it requires surgical resolution. Bladder trauma requires a high level of suspicion and imaging studies to make the diagnosis.

Post-earthquake injuries treated at a field hospital --- Haiti, 2010.

On January 12, 2010, a 7.0-magnitude earthquake struck Haiti, resulting in an estimated 222,570 deaths and 300,000 persons with injuries. The University of Miami Global Institute/Project Medishare (UMGI/PM) established the first field hospital in Port-au-Prince, Haiti, after the earthquake. To characterize injuries and surgical procedures performed by UMGI/PM and assess specialized medical, surgical, and rehabilitation needs, UMGI/PM and CDC conducted a retrospective medical record review of all available inpatient records for the period January 13-May 28, 2010. This report describes the results of that review, which indicated that, during the study period (when a total of 1,369 admissions occurred), injury-related diagnoses were recorded for 581 (42%) admitted patients, of whom 346 (60%) required a surgical procedure. The most common injury diagnoses were fractures/dislocations, wound infections, and head, face, and brain injuries. The most common injury-related surgical procedures were wound debridement/skin grafting, treatment for orthopedic trauma, and surgical amputation. Among patient records with documented injury-related mechanisms, 162 (28%) indicated earthquake-related injuries. Earthquake preparedness planning for densely populated areas in resource-limited settings such as Haiti should account for injury-related medical, surgical, and rehabilitation needs that must be met immediately after the event and during the recovery phase, when altered physical and social environments can contribute to a continued elevated need for inpatient management of injuries.

The mobile army surgical hospital humanitarian assistance mission in Pakistan: the primary care experience.

Military surgical field hospitals are frequently deployed for humanitarian missions. Current Department of Defense doctrine and World Health Organization policy question the appropriateness of their use, because the majority of patients require nonsurgical care. We describe our experiences during the deployment of a mobile army surgical hospital in response to the October 8, 2005, earthquake in Pakistan. More than 20,000 patients received care during a 4-month period. An initially high surgical workload quickly decreased while the volume of primary care patients increased, eventually accounting for 90% of patient visits. Our experience supports deploying primary care-oriented units for humanitarian missions.

Descriptive summary of patients seen at the surgical companies during Operation Iraqi Freedom-1.

The Navy-Marine Corps Combat Trauma Registry is a data repository summarizing information from data sets describing injuries sustained and treatments administered to casualties from the point of injury to rehabilitation. Among the medical facilities contributing data to the Combat Trauma Registry during Operation Iraqi Freedom were the Marine Corps forward surgical companies. The surgical companies offer resuscitative surgery, medical treatment, and temporary holding facilities, in addition to preparing patients for evacuation. This article reviews the types of patients admitted and treatments provided at the surgical companies during the major combat period of Operation Iraqi Freedom. The surgical companies saw an average of 15 to 17 patients per day during this period. Less than 20% of the U.S. casualties seen were wounded in action. In contrast, >75% of the enemy prisoner of war presentations were for battle injuries. Less than 15% of the patients were held at the facilities for >24 hours.

Caracterización de pacientes hospitalizados en Clínica Dávila por ley de urgencia, 2003 / Characterization of patients admitted to Clínica Dávila under the medical emergency law (ley de urgencia), 2003

Antecedentes: La Ley de Urgencia vigente ampara la vida en situaciones de riesgo, independiente de la capacidad de pago. Objetivo: Realizar seguimiento y conocer las características de los pacientes hospitalizados por concepto de Ley de Urgencia en Clínica Dávila durante 2003. Material y Método: Se aplicó una encuesta a los pacientes hospitalizados durante 2003 utilizando además la base de datos de Clínica Dávila para completar información. Resultados: La población total fue de 165 pacientes, de los cuales se aplicó efectivamente la encuesta a 102. La edad promedio fue de 61 años, distribuyéndose en 41.8 (%) hombres y 58.18% mujeres. Los diagnósticos principales correspondieron a enfermedades cardiovasculares (34,5%) neurológicas (20 por ciento), respiratorias (14.5%, infecciosas (7.2 (%)), Diabetes Mellitus descompensada (6%) y patología quirúrgica (9.6%). El control de patología crónica en la población estudiada -previo a la hospitalización- fue de 53.8 (%), siendo en un 44.8 (%) en consultorios de atención primaria. El control posterior al alta de la Clínica fue de 85.7 (%), en un 39.7 (%) en la misma Clínica. De los pacientes fallecidos posterior al alta, 72.72 (%) no estaba en control y la mediana de edad fue 77 años. Discusión: Estos resultados indican que los principales beneficiarios de la Ley de Urgencia fueron pacientes de la tercera edad con alguna enfermedad crónica cuyo control parece insuficiente. El traspaso de pacientes del sistema público al privado, así como el impacto de la atención otorgada por el nivel primario, son situaciones a estudiar para propender a optimizar los recursos.

Background: The Medical Emergency Law which is currently in force protects life at-risk, irrespectively of the solvency of the patient. Purpose: To carry out a follow-up and to know the characteristics of patients admitted to Clínica Dávila under the protection of the Medical Emergency Law, during 2003. Materials and Methods: A survey was implemented within all inpatients admitted during 2003. Information data was completed with Clínica Dávila database. Results: The total population of inpatients under the protection of the Law was 165. A total of 102 patients were effectively surveyed. Patient mean age was 61; 41.8% were males while 58.18% were female. The main diagnoses were cardiovascular diseases (34,5%), neurological disorders (20%), respiratory diseases (14.5%), infectious diseases (7.2%), decompensated Diabetes Mellitus (6%) and surgical pathologies (9.6%). Among the study population, 53.8% of patients were under control for chronic diseases prior to admission; 44.8% of such controls were carried out at primary care outpatient facilities. After discharge, 85.7% of the study population carried out regular controls, in 39.7% of the cases, within the same admission Hospital. A total of 72.72% of the patients deceased after discharge was not undergoing any control, and the median age of such population was 77. Discussion: The results indicate that the main beneficiaries of the Medical Emergency Law were senior patients with a chronic disease who wouldn’t be undergoing a sufficient control of their condition. Transfer of patients from the public to the private health system, as well as the impact of the medical assistance delivered by the primary care level are situations that need further research to aim at optimizing the resources available.

Characterisation of patients treated at the Red Cross field hospital in Kashmir during the first three weeks of operation.

OBJECTIVE: To evaluate the characteristics of patients treated at a field hospital in the first month after a major earthquake. METHODS: Age, sex, diagnosis, and operations performed on patients admitted to the field hospital of the International Committee of the Red Cross in Pakistani Kashmir between 21 October and 10 November 2005 were recorded and the data analysed. RESULTS: During the three week period of this study, 316 patients were treated at the hospital; 246 were women and children (77.9%). Two thirds were hospitalised, over 90% because of the need for surgery or surgical consultation. Altogether 345 operations were performed on 157 patients. The majority of patients had infected wounds with or without fractures. CONCLUSIONS: Most patients need medical evaluation in consequence of earthquake-related trauma even weeks after the catastrophe, especially in areas difficult of access.

The experience of the US Marine Corps' Surgical Shock Trauma Platoon with 417 operative combat casualties during a 12 month period of operation Iraqi Freedom.

BACKGROUND: The Forward Resuscitative Surgical System (FRSS) is a small, mobile trauma surgical unit designed to support modern US Marine Corps combat operations. The experience of two co-located FRSS teams during 1 year of service in Operation Iraqi Freedom is reviewed to evaluate the system's efficacy. METHODS: Between March 1, 2004, and February 28, 2005, two FRSS teams and a shock trauma platoon were co-located in a unit designated the Surgical Shock Trauma Platoon (SSTP). Data concerning patient care before and during treatment at the SSTP was maintained prospectively. Prospective determination of outcomes was obtained by e-mail correspondence with surgeons caring for the patients at higher echelons. The Los Angeles County medical center (LAC) trauma registry was queried to obtain a comparable data-base with which to compare outcomes. RESULTS: During the year reviewed there were 895 trauma admissions to the SSTP. Excluding 25 patients pulseless on arrival and 291 minimally injured patients, 559 of 579 (97%) combat casualties survived; 417 casualties underwent 981 operative procedures in the two SSTP operating shelters. There were 79 operative patients with a mean injury severity score of 26 (range, 16-59) and mean revised trauma score of 6.963 (range, 4.21-7.841) who had sustained severe injuries. Ten (12.7%) of these casualties died while 43 of 337 (12.8%) deaths were seen with comparable cases treated at LAC. CONCLUSIONS: Small task-oriented surgical units are capable of providing effective trauma surgical care to combat casualties. Further experience is needed to better delineate the balance between early, forward-based surgical intervention and more prolonged initial casualty evacuation to reach more robust surgical facilities.

Post-tsunami medical care: health problems encountered in the International Committee of the Red Cross Hospital in Banda Aceh, Indonesia.

INTRODUCTION: When the Tsunami struck Asia on 26 December 2004, Aceh, Indonesia suffered more damage than did any other region. After the Tsunami, many humanitarian organizations provided aid in Aceh. For example, the International Committee of the Red Cross (ICRC), along with the Indonesian and Norwegian Red Cross opened a field hospital in Banda Aceh on 16 January 2005. This study describes the illnesses seen in the out-patient department/casualty department (OPD/CD) of the ICRC hospital nine weeks after the Tsunami. It describes the percentage of people seen for problems directly related to the Tsunami, and includes a basic screening for depression and post-traumatic stress disorder (PTSD). METHODS: A prospective, five-day study was performed from 01-05 March 2005. Patients registering in the ICRC field hospital in Banda Aceh were considered for the study. Data collected included: (1) age; (2) gender; (3) diagnosis in the OPD/CD; and (4) whether or not the problem was related directly to the Tsunami. Seven basic questions were asked to screen for depression and PTSD symptoms. RESULTS: Twelve percent of the problems seen in the OPD/CD nine weeks after the Tsunami still were related directly to the Tsunami. Sixty-three percent of patients in the study were male. The medical problems included: (1) urological (19%); (2) digestive (16%); (3) respiratory (12%); and (4) musculoskeletal (12%). Although <2% of patients were diagnosed with a mental health problem, 24% had at least four or more of the seven depression/PTSD symptoms addressed in the study. CONCLUSIONS: Post-earthquake and post-tsunami health problems and medical needs differ from those found in conflict zones. After the Tsunami, both surgical and primary healthcare teams were needed. Many problems were chronic medical problems, which may be indicative of the lack of healthcare infrastructure before the Tsunami. The findings suggest that mental health issues must be taken into consideration for future planning. The ethical issues of performing research in complex emergencies also need further development at the international level.

Operation Enduring Freedom: the 48th Combat Support Hospital in Afghanistan.

OBJECTIVE: To examine the experience of the 48th Combat Support Hospital (CSH) while deployed to Afghanistan, with an emphasis on trauma care. MATERIALS AND METHODS: Before redeployment, a retrospective review was performed on the medical records of all patients treated at the 48th CSH from December 6, 2002 through June 7, 2003. RESULTS: During the 6-month period, 10,679 patients were evaluated and/or treated. There were 477 hospital admissions (adults, 387; children, 90; trauma, 204) and 634 operating room procedures. The most common mechanisms of injury were land mines/unexploded ordinance (74 = 36%) and gunshot wounds (41 = 20%). Extremities were the most common site. A total of 358 cases was performed on 168 trauma patients (mean, 2 cases per patient; range, 1-12). There were 63 complications in 40 trauma patients and 11 patients died. CONCLUSIONS: The 48th CSH supported military and humanitarian operations with an ongoing process of re-evaluation, adaptation, and medical education that resulted in low morbidity and mortality rates.

Attendances at a field hospital emergency department during operations in Iraq November 2003 to March 2004 (Operation Telic III).

OBJECTIVE: This study investigated the types of presentations; time lines and disposal of patients from the international, local and military community in Southern Iraq. METHODS: All presentations to the Emergency Department (ED) were clinically and demographically coded and entered onto an electronic database. RESULTS: During the period studied the emergency department dealt with 1455 new presentations of which 75% were UK Armed Forces personnel. CONCLUSIONS: This represented a busy period in the field hospitals time in Iraq and offered valuable training to emergency medicine trainees in an unusual environment.

Operation Iraqi Freedom: surgical experience of the 212th Mobile Army Surgical Hospital.

Seven hundred one patients were treated at and 394 were admitted to the 212th Mobile Army Surgical Hospital in Central Iraq during the combat phase of Operation Iraqi Freedom. Ninety of those patients underwent 100 operations, with 187 procedures in 19 days. At the peak of hostilities, 48 patients were admitted, 15 operations were performed, and 56 patients were medically evacuated during different 24-hour periods. Thirty-three patients required the surgical expertise of a general or thoracic surgeon. Although 82% of injuries and 70% of the procedures were orthopedic in nature, orthopedic operating room utilization was only 60% of total operating room time (156 hours). The general and thoracic injuries were labor-intensive, frequently requiring two surgeons. Although orthopedic injury remains the predominant reason for surgical intervention on the battlefield, there remains a need to forward-deploy general and thoracic surgeons, because of the presence and complexity of nonorthopedic trauma.

Burn support for Operation Iraqi Freedom and related operations, 2003 to 2004.

Thermal injury historically constitutes approximately 5% to 20% of conventional warfare casualties. This article reviews medical planning for burn care during war in Iraq and experience with burns during the war at the US Army Burn Center; aboard the USNS Comfort hospital ship; and at Combat Support Hospitals in Iraq and in Afghanistan. Two burn surgeons were deployed to the military hospital in Landstuhl, Germany, and to the Gulf Region to assist with triage and patient care. During March 2003 to May 2004, 109 burn casualties from the war have been hospitalized at the US Army Burn Center in San Antonio, Texas, and US Army Burn Flight Teams have moved 51 critically ill burn casualties to the Burn Center. Ten Iraqi burn patients underwent surgery and were hospitalized for up to 1 month aboard the Comfort, including six with massive wounds. Eighty-six burn casualties were hospitalized at the 28th Combat Support Hospital for up to 53 days. This experience highlights the importance of anticipating the burn care needs of both combatants and the local civilian population during war.

Extremity injuries remain a high surgical workload in a conflict zone: experiences of a British Field Hospital in Iraq, 2003.

BACKGROUND: During this conflict 34 Field Hospital, the sole Coalition field hospital located in Iraq, received and treated casualties with a wide range of injuries. Located very close to the front line during the period of combat hostilities, it was potentially going to deal with relatively fewer battle-injured extremities. METHOD: A retrospective review of battle casualties admitted to the hospital was carried out based on casualty records and operating theatre logbooks. Data was collected for the period between the 26th March and the 8th May, focusing on casualties who had surgery for battle-injured extremities during the conflict. RESULTS: Sixty eight (55%) of the 124 casualties who underwent surgery did so for battle injuries to extremities. 139 (58%) of all operating theatre episodes and 189 (53%) of all surgical procedures undertaken were for battle-injured extremities. Fourteen major limb amputations were carried out from a total of 87 battle-injured limbs that had surgery, giving an amputation rate of sixteen percent (14/87). CONCLUSION: The experience at 34 Field Hospital confirms that extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma.

Dental emergency rates at two expeditionary medical support facilities supporting operations enduring and Iraqi Freedom.

This study reports dental emergency rates and distribution of causes of dental emergencies at two expeditionary medical support facilities supporting operations Enduring Freedom/ Iraqi Freedom. A retrospective cohort analysis of 9948 soldiers deployed to Prince Sultan Air Base, Kingdom of Saudi Arabia, and 1467 soldiers at Baghdad International Airport, Iraq, was accomplished from a phased deployment from January 2003 to September 2003. Procedures were divided into 11 categories: endodontic, extraction of teeth other than third molars, extraction of third molar teeth, restoration of teeth (caries), restoration of broken teeth (not caries), orthodontic bracket/wire problem, sensitive teeth, temperomandibular pain, periodontal, oral pathology, and prosthodontic. The dental emergency rates for Prince Sultan Air Base and Baghdad International Airport were 153 and 145 dental emergencies per 1000 soldiers per year, respectively. Most of the emergencies were because of dental caries. Pain from third molars was the second most common reason for visiting the dental clinic.

Israeli Defense Forces Medical Corps humanitarian mission for Kosovo's refugees.

In April 1999, during the crisis in Kosovo, the Israeli government launched a medical, field hospital in order to provide humanitarian aid to the Albanian refugees that fled from their homes in Kosovo. This facility was set up by the Medical Corps of the Israeli Defense Forces, in a refugee camp located in Northern Macedonia. During the 16 days during which the hospital functioned, the medical staff treated 1,560 patients and hospitalized >100. The field hospital served as a referral center for all of the other primary clinics that were hastily erected in the camp and its surroundings. This communication elaborates on the various aspects of the humanitarian medical aid that were provided by this medical facility and the conclusions that learned from such a mission.

Forward surgical team (FST) workload in a special operations environment: the 250th FST in Operation ENDURING FREEDOM.

PURPOSE: Forward Surgical Teams (FST) deploy to support conventional combat units of at least regimental size. This report examines the injuries and treatments of an FST in an environment of unconventional tactics, limited personal protection, and extended areas of responsibility during Operation ENDURING FREEDOM. METHODS: A prospective evaluation of the personal protective measures, mechanisms of injury, types of injuries, and times to treatment in Operation ENDURING FREEDOM. Additionally, per-surgeon caseloads, operative interventions, and outcomes are examined. The first phase of this deployment involved co-locating with an Air Force Expeditionary Medical Squadron at Seeb Air Base, Oman (SABO). The second phase involved stand-alone operations at Kandahar International Airport (KIA). Participants include U.S. Special Forces, conventional U.S forces, coalition country special forces, and anti-Taliban Afghan soldiers. RESULTS: During the deployment, the FST performed 68 surgical procedures on 50 patients (19 SAB, 31 KIA). There were 35 orthopedic cases (2 to 28 per surgeon), 30 general surgery cases (2 to 10 per surgeon), and 3 head/neck cases. Mechanism of injury included non-battle injury (13), bomb blast (13), gunshot wounds (8), mine (8), and grenades (5). Primary injuries were to the extremities in 27, torso in 9, and head/neck in 11. Three patients had appendicitis. Five patients were wearing body armor, whereas 4 wore helmets. The mean Relative Trauma Score was 7.4. Thirty-one patients were treated at KIA with a mean time to operative treatment of 2.7 +/- 2.7 hours, whereas 19 were treated in SABO with a mean time to operative treatment of 12.4 +/- 15.1 hours. Nine patients received transfusions. Three nonoperative patients died of wounds. CONCLUSION: Despite the lack of personal protective gear, most patients had extremity wounds as their primary injuries. In this special operations environment, time to operative treatment was significantly longer than expected.

Hipertensión arterial en el servicio de Emergencia del hospital "Dr. Enrique Garces"

Se realizo un estudio retrospectivo y transversal, para conocer las caracteristicas de la hipertensión arterial en pacientes que acudieron al servicio de emergencia del Hospital Dr. Enrique Garcés en el período comprendido entre enero de 1994 y enero de 1995. Se analizaron 2475 historias clínicas, de las cuales 152 correspondieron a pacientes hipertensos. En relación a la edad, 82 (54.0 por ciento) estuvieron comprendidos entre 35 y 65 años, y en cuanto al sexo hubo predominio del femenino al masculino (2.5:1). Las urgencias hipertensivas [n=123 (80.9 por ciento)] tuvieron mayor frecuencia en relacion a las emergencias hipertensivas [n=29 (19.1 por ciento)], y dentro de este grupo, el accidente cerebro-vascular y la encefalopatia hipertensiva fueron las mas frecuentes (62por ciento y 17 por ciento respectivamente). Se concluye que la hipertensión arterial es una enfermedad con repercusiones severas en órganos vitales, siendo imprescindible un diagnostico y tratamiento adecuados para reducir la morbimortalidad asociada a esta patología.

Avaliaçäo em saúde mental: investigaçäo de novos indicadores / Evaluation in mental health: investigation on news indicators

A avaliaçäo em saúde mental nas instituiçöes públicas tem se resumido a quantificar a cobertura, através de taxas e índices hospitalares (taxa de ocupaçäo, média de permanência, média paciente / dia...), e o número de atendimentos realizados, no caso dos serviços de Emergência e Ambulatório. Se isso revela um zelo administrativo e contábil, passa ao largo no que se refere à qualidade da assistência prestada e, por conseguinte, do próprio grau de resolubilidade. Em razäo disso, o censo dos atendimentos de um dia foi realizado nos serviços de saúde mental da Rede Estadual da Capital, nos níveis de Emergência, Ambulatório e Internaçäo. Objetivou-se, pois, a investigaçäo de novos indicadores da qualidade da assistência. Algumas características dos pacientes atendidos e da assistência realizada foram investigadas através de três questionários, para cujas respostas utilizaram-se os prontuários dos pacientes. Os resultados permitiram uma análise descritiva da procedência do tipo de atendimento, do intervalo interconsultas, do absenteísmo, da duraçäo do tratamento, da correlaçäo entre os níveis de atençäo, da média de permanência hospitalar, do tempo de doença e da média de atendimento das diversas categorias profissionais constitutivas da Equipe Multidisciplinar de saúde mental (EM). Algumas sugestöes foram feitas com respeito à EM e ao sistema de regionalizaçäo e hierarquizaçäo das açöes. Recomendou-se finalmente que outros trabalhos da natureza do presente sejam empreendidos para melhor subsidiar-se um sistema de avaliaçäo

Disaster medical assistance teams: providing health care to a community struck by Hurricane Iniki.

STUDY OBJECTIVE: To describe the type of medical care that disaster medical assistance teams (DMATs) provided to a community struck by a major hurricane. STUDY DESIGN: A prospective study describing the use of DMAT field clinics by a population affected by a major hurricane. Data regarding the type of medical care provided to disaster victims and the acuity of each patient's medical condition were abstracted from medical charts at each field clinic. SETTING: Three DMAT field clinics that provided medical care to residents of Kauai, Hawaii, after Hurricane Iniki struck the island on September 11, 1992. RESULTS: From September 16 to 19, 1992, three DMATs provided medical care to 614 people. The patients' average age was 34 years, and 60% were male. The largest treatment categories were injury (40.4%), illness (38.6%), and preventive services (9.0%). Most illnesses and injuries were minor, and 99% of the patients were ambulatory. Only 33 patients (5.4%) were referred to another medical provider. Referrals were generally for procedures not available in DMAT field clinics rather than for life-threatening conditions. CONCLUSION: DMATs sent to assist with the medical needs of a US community struck by a major hurricane should be prepared to deliver basic medical services and primary health care. The need for these medical services will continue beyond the impact phase of a hurricane disaster.