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Introducción. El manejo perioperatorio de las urgencias hepatobiliares por parte del cirujano general es una competencia esperada y se considera un reto por su relativa frecuencia, impacto en la salud del individuo y la economía, así como las implicaciones en el ejercicio clínico confiable y de alta calidad. Se desconocen los aspectos formales de la educación en cirugía hepatobiliar para el cirujano general en Colombia. El objetivo del presente estudio fue explorar la perspectiva de los cirujanos hepatobiliares sobre esta problemática. Métodos. Se realizó un estudio cualitativo, mediante entrevistas semiestructuradas con 14 especialistas en cirugía hepatobiliar colombianos, en donde se exploraron los desafíos del entrenamiento, el tiempo y las características de una rotación, la evaluación de la confiabilidad, el número de procedimientos y el rol de la simulación. Se hizo un análisis temático de la información. Resultados. Los expertos mencionaron la importancia de la rotación obligatoria por cirugía hepatobiliar para los cirujanos en formación. El tiempo ideal es de tres meses, en el último año de residencia, en centros especializados, con exposición activa y bajo supervisión. Conclusiones. Por las características epidemiológicas del país y la frecuencia de enfermedades hepatobiliares que requieren tratamiento quirúrgico, es necesario que el cirujano general cuente con una formación sólida en este campo durante la residencia. El presente estudio informa sobre las características ideales del entrenamiento en este campo desde la visión de los expertos colombianos.
Introduction. The perioperative management of hepatobiliary emergencies by the general surgeon is an expected competence and is considered a challenge due to its relative frequency, impact on the individual health and the economy, as well as the implications for reliable and high-quality clinical practice. The formal aspects of education in hepatobiliary surgery for the general surgeon in Colombia are unknown. The objective of the present study was to explore the perspective of hepatobiliary surgeons on this problem. Methods. A qualitative study was carried out through semi-structured interviews with 14 Colombian hepatobiliary surgery specialists, where the challenges of training, time and characteristics of the rotation, evaluation of reliability, number of procedures and role of simulation. A thematic analysis of the information was carried out. Results. The experts mentioned the importance of mandatory rotation for hepatobiliary surgery for surgeons in training. The ideal duration was three months, during the last year of residency, in specialized centers with active exposure and under supervision. Conclusions. Due to the epidemiological characteristics of the country and the frequency of hepatobiliary diseases that require surgical treatment, it is necessary for the general surgeon to have solid training in this field during residency. The present study reports on the ideal characteristics of training in this field from the perspective of Colombian experts.
الموضوعات
Humans , Biliary Tract Surgical Procedures , Education, Medical, Graduate , General Surgery , Biliary Tract Diseases , Emergency Treatment , Simulation Trainingالملخص
Introdução: O trauma de mão constitui uma epidemia, ocorrendo por diversos fatores, como acidentes de trabalho e violência urbana. Isso gera um impacto significativo por ser uma unidade anatômica vulnerável e importante na realização de atividades cotidianas e para o trabalho. Desse modo, faz-se necessária uma avaliação epidemiológica mais aprofundada no que tange, sobretudo, às fraturas de mãos, entendendo sua elevada morbidade. Método: Estudo descritivo e retrospectivo, feito por análise de prontuários de pacientes conduzidos em um hospital terciário no período de janeiro de 2018 a dezembro de 2020. Resultados: Participaram do estudo 290 pacientes, sendo 85,7% do sexo masculino e 14,3% do sexo feminino. 138 indivíduos tinham entre 20 e 39 anos, representando um total de 47,6%. 51,6% eram do interior do estado do Ceará e 48,4% eram da capital. O principal mecanismo de trauma associado às fraturas foram os acidentes de trânsito (36,4%), seguidos por acidentes de trabalho (26,9%) e ferimentos por arma de fogo (14%). Em relação aos ossos fraturados, houve uma acentuada prevalência do acometimento das falangeanas, em todas as faixas etárias, representando 210 pacientes (72,4%). Conclusão: O presente estudo corrobora com os dados presentes na literatura. Desse modo, é evidenciada a repetição de prevalência de faixa etária, principais mecanismos de trauma envolvidos, bem como ossos acometidos nas fraturas de mão.
Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.
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Introducción: Durante la práctica estomatológica pueden presentarse urgencias médicas relacionadas con los procederes realizados o las enfermedades de base de los pacientes; sin embargo, existen deficiencias en la atención a estos afectados. Objetivo: Exponer las generalidades del curso de posgrado para estomatólogos sobre urgencias médicas durante la práctica profesional y los criterios emitidos por sus participantes. Métodos: Se realizó una investigación descriptiva de corte pedagógico, donde participaron 62 estudiantes de la Facultad de Estomatología de la Universidad de Ciencias Médicas de La Habana, desde noviembre del 2018 hasta diciembre del 2022. Se analizaron las siguientes variables: temas, objetivos y sistema de conocimientos y habilidades. Además, se utilizó la técnica de positivo, negativo e interesante. Resultados: Este curso contó con 5 temas: el primero, dedicado a las generalidades de las urgencias médicas más frecuentes durante la atención estomatológica y las características particulares en la confección de historia clínica; el segundo y el tercero, a los factores de riesgo y a la atención a estas urgencias; el cuarto, al uso de medicamentos y las posibles interacciones y, el quinto, a experiencias clínicas. Los educandos aportaron criterios positivos, negativos e interesantes. Conclusiones: El curso diseñado ofreció conocimientos y habilidades al educando, que no se proporcionan en las asignaturas de pregrado y posgrado de las especialidades, lo cual contribuyó a mejorar la atención estomatológica integral de los pacientes. Los participantes aportaron criterios favorables sobre la estructura, la pertinencia y el valor científico de dicho curso.
Introduction: During stomatological practice, medical emergencies can be presented related to the procedures carried out or the patients' underlying diseases; however, there are deficiencies in the care to them. Objective: To expose the generalities of the postgraduate course for stomatologists about medical emergencies during the professional practice and the criteria emitted by their participants. Methods: A descriptive pedagogic investigation was carried out, where 62 students from the Faculty of Stomatology of the University of Medical Sciences in Havana participated, since November, 2018 to December, 2022. The following variables were analyzed: topics, objectives and system of knowledge and abilities. Also, the technique of positive, negative and interesting was used. Results: This course had 5 topics: the first one, dedicated to the most frequent medical emergencies generalities during dental care and the particular characteristics when making the medical record; the second and third topics were dedicated to the risk factors and care to these emergencies; the fourth, to the use of medications and possible interactions and, the fifth, to clinical experiences. The students contributed positive, negative and interesting criteria. Conclusions: The designed course offered knowledge and abilities to the student that are not provided in undergraduate and postgraduate subjects of the specialties, which contributed to improve the comprehensive dental care of patients. The participants offered favorable criteria about the structure, relevance and scientific value of this course.
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In order to analyze the clinical characteristics of death cases in the oral emergency depart-ment of the stomatological hospital,and to improve the first aid technique before and in hospitals,we col-lected the clinical data of death cases in the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2010 to January 2023 for retrospective analysis.General cha-racteristics,such as the patients'gender,age,chief complaint,maxillofacial diseases,systemic under-lying diseases,rescue situation,cause of death and seasonal distribution of death were summarized.The results showed that a total of 8 death cases(5 males and 3 females)occurred during the 13-year period,ranging in age from 40 to 86 years,with a median age of 66 years.Among the 8 patients,5 reported bleeding from oral cancer,1 reported chest tightness and dyspnea after oral cancer surgery,1 reported loss of consciousness after maxillofacial trauma,and 1 reported oral erosion and aphagia.All the 8 pa-tients had one or more underlying diseases,such as hypertension,coronary heart disease,diabetes,renal failure,and cerebral infarction,etc.and 2 of them showed dyscrasia.Among them,the cause of death in 5 cases was respiratory and circulatory failure caused by oral cancer rupture and hemorrhage or poor sur-gical wound healing and hemorrhage;1 case was uremia and hyperkalemia leading to circulatory failure;1 case was asphyxia caused by swelling of oral floor tissue after maxillofacial trauma;and the other case was acute myocardial infarction caused circulatory failure after oral cancer surgery.According to the vital state at the time of treatment,6 patients had loss of consciousness,respiratory and cardiac arrest before hospital,and 2 patients suffered from loss of consciousness,respiratory and cardiac arrest during treat-ment.All the patients received cardiopulmonary resuscitation and some advanced life support measures,and the average rescue time was 46 min.Due to the low incidence of death in the oral emergency depart-ment,medical personel have little experience in first aid.First aid training and drills and assessment should be organized regularly.First aid facilities should be always available and regularly maintained by special personnel,such as electrocardiogram(ECG)monitor,defibrillator,simple breathing apparatus,oxygen supply system,negative pressure suction system,endotracheal intubation and tracheotomy equip-ment.The death cases mainly occurred in the elderly patients with oral cancer bleeding and systemic un-derlying diseases.Education of emergency awareness for the elderly patients with oral cancer after surgery should be enhanced.Medical staff should strengthen first aid awareness and skills.
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Objective:The study retrospectively analyzed the etiology, clinical manifestations, emergency treatment and etiological treatment of a large sample of cases with hypercalcemic crisis.Methods:The clincial data of patients with hypercalcaemia cirisis who were administered in First Medical Center of Chinese PLA General Hospital from January 2009 to July 2022 were analyzed, inculding the general data, clinical manifestations, etiology, photographic examination, emergency treatment, etiological treatment, serological examination before and after treatment, pathological immunohistochemical findings and prognosis.Results:A total of 143 hypercalcaemia crisis patients(84 males and 59 females) with a mean age of 53.51±16.60 were enrolled. The most common disease was hyperparathyroidism(62/143), followed by solid malignancy(57/143) and multiple myeloma(12/143). Patients presented with digestive system symptoms at 76.91%, followed by neurological symptoms at 63.60%, urinary system symptoms at 58.76%, musculoskeletal symptoms at 55.23%, and cardiovascular system symptoms at 32.91%. After emergency calcium-lowering treatment, the remission rate of hypercalcemic crisis in 143 patients was 100%(143/143), and after etiological treatment, the remission rate of hypercalcemia was 85.31%(122/143).Conclusion:Early identification, emergency treatment and etiology treatment of hypercalcaemia crisis are essential. Effective treament with comprehensive calcium reduction can quickly relieve clinical symptoms and create opportunities for treatment for the cause. Targeted etiological interventions can lead to the correction or long-term remission of hypercalcemia.
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Objective:To investigate the effect of risk warning management mode on patients undergoing an emergency enhanced CT examination.Methods:This is a case-control study. A total of 40 patients who underwent emergency enhanced CT examination using routine management mode at No. 1 People's Hospital of Pinghu from January 2020 to June 2021 were included in the routine group. An additional 40 patients who underwent emergency enhanced CT examinations using risk warning management mode at the same hospital from July 2021 to December 2022 were included in the study group. The two groups were compared in terms of CT examination, image quality, adverse reactions, patient satisfaction, Self-rating Depression Scale score, and Self-rating Anxiety Scale score.Results:The Self-rating Depression Scale and Self-rating Anxiety Scale scores in the study group were significantly lower than those in the routine group ( t = -3.17, -2.90, both P < 0.05). The waiting time for CT examination, primary CT scan time, secondary CT scan time, and tertiary CT scan time in the study group were significantly shorter than those in the routine group ( t = 18.15, 4.89, 2.24, all P < 0.05). The completion rate of CT scans in the study group was 100% (40/40), which was significantly higher than that in the routine group [90% (36/40)], χ2 = 4.21, P < 0.05). The excellent and good image quality rate in the study group was 98% (39/40), which was significantly higher compared with the routine group [85% (34/40)], χ2 = 3.91, P < 0.05). The incidence of adverse reactions in the study group was 5% (2/40), which was significantly lower compared with the routine group [23% (9/40), χ2 = 5.17, P < 0.05]. Conclusion:The risk warning management mode for emergency CT enhanced examination can shorten the examination time, increase the completion rate of CT scans, enhance image quality, improve patients' psychological status, and reduce adverse reactions.
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SUMMARY OBJECTIVE: The aim of this study was to analyze the prescription of packed red blood cells performed by emergency physicians for adults with sickle cell anemia. METHODS: Transfusions performed in adults with sickle cell anemia treated at an emergency service in São Bernardo do Campo, São Paulo Brazil, between January 2018 and January 2022 were evaluated. For data comparison, the chi-square2 test was used. The significance level adopted was 5%. RESULTS: A total of 114 transfusions were performed. The mean age was 41.8±16.4 years, and pretransfusion hemoglobin was 6.1±1.23 g/dL. Regarding the indication, the adequacy of transfusions performed in symptomatic individuals was significantly higher compared to asymptomatic individuals (100% vs. 3.9%, p<0.001). Symptomatic individuals received excessive volumes of packed red blood cells less frequently than asymptomatic individuals (17.5% vs. 56.9%, p<0.001). The filtered subtype, indicated for sickle cell anemia, was prescribed in only a quarter of the patients. However, non-indicated subtypes were frequently prescribed. CONCLUSION: This study found low adequacy in the indication and calculation of the transfusion volume of packed red blood cells in asymptomatic individuals. Few patients received filtered red blood cells, resulting in increased risks of transfusion reactions. On the contrary, non-indicated subtypes were prescribed in a quarter of transfusions, which resulted in higher costs and delay in receiving packed red blood cells.
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ABSTRACT Objective: To evaluate the knowledge of pedodontists and residents in the face of pediatric medical emergencies. Material and Methods: This descriptive-analytical study was conducted on pedodontists and residents participating in the Congress. The knowledge evaluation tool was a researcher-made questionnaire with acceptable validity and reliability. The questionnaire consisted of seven sections on information and education, prevention, office staff readiness, practical abilities, cardiopulmonary resuscitation skills and intravenous access, medicines, and emergency treatment equipment. After completing the questionnaires, the data were analyzed using SPSS 21. Chi-squared test, t-test, ANOVA, correlation test, and linear regression were used for data analysis (P<0.05). Results: The study examined 150 specialists, 88 residents, and 62 pedodontists. The level of knowledge of specialists and pedodontic residents in the face of pediatric medical emergencies was 35.3% (moderate) and 31.7 (weak), respectively. The specialists' scores on the entire questionnaire and areas of information, medicine, and equipment were significantly higher than those of residents. Moreover, participation in lectures and reading papers significantly increased general awareness. Conclusion: The results indicated that specialists' awareness and pedodontic residents about pediatric medical emergencies during dentistry were at a different level, necessitating more practical and theoretical training.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Quality of Health Care , Health Knowledge, Attitudes, Practice , Clinical Competence , Dentists , Emergency Treatment , Linear Models , Surveys and Questionnaires , Analysis of Varianceالملخص
RESUMEN Introducción: Los tratamientos para fracturas de órbita se basan en la corrección del defecto de las lesiones orbitarias de tipo blow in y blow out (o de estallido), mediante diversas placas y mallas biocompatibles con el organismo, dándose una cicatrización de primera generación evitando un callo óseo y una fijación más rígida. Para el diagnóstico de este tipo de lesiones tenemos inflamación periorbitaria, enoftalmos, diplopía, equimosis, hemorragia subconjuntival. Existen diversos materiales reconstructivos siendo estos compuestos por distintas materias primas, como son los aloplásticos y autógenos; donde encontramos varios tipos como placas de titanio y las placas reabsorbibles siendo estas las más comunes y usadas actualmente, por su bajo estímulo a reabsorciones óseas y evitando efectos secundarios a largo plazo. Estas placas presentan diversos grados de ductilidad y resistencia. Se informó sobre varias complicaciones según el tipo de placas como es la cicatrización, las cirugías postquirúrgicas en caso de placas de titanio, etc. El objetivo de esta revisión es la evaluación de la eficacia las placas reabsorbibles versus placas de titanio en fracturas de órbita. Materiales y métodos: La investigación es de carácter documental, descriptivo y no experimental. En el cual se emplea una metodología de identificación e inclusión de artículos científicos tipo prisma. Resultados y conclusiones: Se verificaron las ventajas y desventajas tanto de las placas reabsorbibles como las de titanio siendo estas similares en la biocompatibilidad con el organismo humano, así como también varias diferencias como el soporte, fuerzas, resistencia de estas, concluyendo que es debatible el material ideal para tratar fracturas de órbita. Se seleccionaron artículos tomando en cuenta el título y objetivos; considerando estudios comparativos, revisiones sistemáticas, revisiones de literatura, los cuales comprendían criterios con respecto a fracturas de órbita y tratamientos quirúrgicos. La búsqueda arrojó 55 artículos en PubMed, 65 en Google, 4 en Scielo y 29 en Science direct, de los cuales se excluyeron libros, monografías, estudios experimentales, dando como resultado 21 artículos para el desarrollo de esta revisión bibliográfica. Y que fueron leídos y analizados en su totalidad, estudiando los objetivos, metodología y conclusión de cada uno de ellos para la posterior comparación.
ABSTRACT Introduction: Treatments for orbit fractures are based on the correction of the defect of blow in and blow out orbital injuries, by means of various plates and meshes biocompatible with the organism, giving a first-generation healing avoiding a bony callus and a more rigid fixation. For the diagnosis of this type of lesions we have periorbital inflammation, enophthalmos, diplopia, ecchymosis, subconjunctival hemorrhage. There are several reconstructive materials being these composed of different raw materials, such as alloplastic and autogenous, where we find several types such as titanium plates and resorbable plates being these the most common and currently used, for its low stimulus to bone resorption and avoiding long-term side effects. These plates have different degrees of ductility and resistance. Several complications have been reported depending on the type of plates, such as scarring, post-surgical surgeries in the case of titanium plates, etc. The objective of this review is to evaluate the efficacy of resorbable versus titanium plates in orbital fractures. Materials and methods: This research are a documentary, descriptive and non-experimental nature. A prism-type methodology of identification and inclusion of scientific articles was used. Results and conclusions: The advantages and disadvantages of both resorbable and titanium plates were verified, being these similar in biocompatibility with the human organism, as well as several differences such as support, forces, resistance of the same, concluding that it is debatable. The ideal material to treat orbital fractures. Articles were selected considering the title and objectives; considering comparative studies, systematic reviews, literature reviews, which included criteria regarding orbital fractures and surgical treatments. The search yielded 55 articles in PubMed, 65 in Google, 4 in Scielo and 29 in Science direct, from which books, monographs, experimental studies were excluded, resulting in 21 articles for the development of this bibliographic review. The 21 articles were read and analyzed in their entirety, studying the objectives, methodology and conclusion of each one of them for subsequent comparison.
الموضوعات
Humans , Orbit/injuries , Bone Plates , Titanium , Biocompatible Materials/therapeutic use , Fractures, Bone/surgeryالملخص
Objective@#To understand the current situation regarding emergency visits to a university hospital in Beijing, and to provide a basis for the standardized construction and formulation of emergency visit measures to university hospitals.@*Methods@#This study carried out a retrospective investigation and analysis of 73 emergency visits from September 2020 to December 2022 at a university hospital in Beijing.@*Results@#A total of 17 cases(23.3%) exhibited the most common of symptoms associated with convulsions during emergency visits to university hospital, while nine cases of abdominal pain(12.3%) and eight cases of dizziness( 11.0 %) were recorded. The proportion of males and females who presented to the emergency department was 60.3% and 39.7%, respectively. The top three diseases among emergency department outpatients included nervous system diseases(40 cases), gynecological diseases(seven cases), depression and alcoholism(six cases). The peak number of emergency visits occurred in April, May, September and November. The most frequent emergency visits presented from 13:00 to 18:00(32.9%), followed by 7:00 to 12:00(30.1%). Following emergency care, 12 cases improved, 54 cases were transferred to higher level hospitals for treatment, 2 depressive patients were taken home, 5 cases refused referral.@*Conclusion@#University hospitals should develop emergency plans for diseases related to emergency visits, provide targeted training for doctors and health education for teachers and students, and improve the emergency treatment capabilities.
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【Objective】 To explore the emergency treatment of penoscrotal avulsion injury based on the American Association for Surgery and Trauma (AAST) penoscrotal injury grade. 【Methods】 Data of 30 patients with penoscrotal avulsion injury treated in our hospital with in-situ suture, skin grafting or skin flap during Oct.2003 and Dec.2017 were reviewed. 【Results】 Among the 30 patients, 29 received emergency surgery, including in-situ suturein 15 grade Ⅰ-Ⅲ cases, skin graft in 8 grade Ⅳ-Ⅴ cases, and skin flap in 6 cases;1 case received delayed operation due to wound infection on admission. In the perioperative period,25 cases had more than 90% wound healing, 3 cases had 70% wound healing after wound dressing change, and 2 cases had complete necrosis. Second-stage skin graft yielded satisfactory penoscrotal appearance. 【Conclusion】 According to the specific conditions of patients, reasonable surgical methods can be selected. For grade Ⅰ-Ⅲ patients, in-situ suture can be used, while for grade Ⅳ-Ⅴ patients, wound condition, age, fertility and other factors should be taken into consideration so as to preserve the function of testis to the maximum extent.
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【Objective】 To explore the timing of surgical drainage for ureteral calculi with upper urinary tract infection. 【Methods】 Clinical data of 117 cases of ureteral calculi with upper urinary tract infection treated in our hospital during Jan.2018 and Jan.2020 were retrospectively analyzed. According to different treatment methods, the patients were divided into surgical drainage group and non-surgical drainage group. The patients’ age, gender, side of calculi, peak body temperature, time of onset, white blood cell (WBC) count, C-reactive protein (CRP) and other clinical indicators were compared between the two groups. The cutoff value of surgical drainage was determined with receiver operator characteristic (ROC) curve. 【Results】 The patients’ age, peak body temperature, WBC count and CRP level were the influencing factors of surgical drainage (P<0.05). Regression analysis showed that CRP (P<0.001), age (P=0.003) and WBC count (P=0.014) were independent risk factors for surgical drainage. The area under the ROC curve (AUC) of CRP, age, and WBC count were 0.923, 0.601, and 0.796, respectively. The cutoff value of CRP was 29.87 mg/L (sensitivity 79.4%, specificity 90.0%). Logistic regression model showed CRP was a significant clinical predictor. 【Conclusion】 Ureteral calculi with upper urinary tract infection need to be diagnosed and treated in time. Positive anti-infection should be performed during emergency treatment, and surgical drainage could be selected according to the value of CRP.
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Objective:To analyze the relationship between skin cleaning status and wound infection after emergency treatment of skin wounds, so as to provide guidance for clinical work and home care of patients.Methods:Using retrospective research methods, a total of 349 patients with skin wounds admitted to the Department of Emergency Medicine of Lishui People′s Hospital from January 2016 to February 2022 were selected for cross-sectional investigation. And the wound-infected patients were set as the wound-infected group and the non-wound-infected patients were set as the non-wound-infected group. The patients′ clinical data, skin cleaning status and wound infection status were collected to compare the differences in the basic data between the two groups and further analyze whether there was an association between skin cleaning and wound infection using binomial Logistic regression.Results:There were 134 cases of wound infection in 349 patients with skin trauma, accounting for 38.40%, including 66 cases of acute wound infection and 68 cases of chronic wound infection.The cleaning frequency of 1 time/week, 2 times/week and ≥ 3 times/week in open wound bath cleaning was 2.99%(4/134), 0.74% (1/134) and 0 in the wound-infected group, respectively, which was significantly different from 2.79%(6/215), 7.91% (17/215) and 1.86%(4/215) in the non-wound-infected group ( χ2 = 11.42, P<0.05). Multifactorial analysis revealed that trauma area ≥8 cm 2, total cortical damage, long duration of trauma, and antibiotic treatment were independent risk factors for wound infection after emergency management of skin trauma ( OR values were 1.05-2.02, all P<0.05), the protective factors for wound infection after emergency treatment of skin trauma were bath cleaning of open wound and its cleaning times 2 times/week ( OR = 0.54, 0.62, both P<0.05). Conclusions:The choice of warm water bath cleaning after emergency treatment of skin trauma does not increase the risk of wound infection. On the contrary, it helps to prevent wound infection, but it should be noted that local disinfection should be carried out in time after the completion of cleaning.
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Objective:To explore the risk factors of hospital death in patients with acute Upper gastrointestinal bleeding, analyze the role of emergency endoscopy, and provide reference for grass-roots hospitals to carry out related work.Methods:A total of 370 patients with acute Upper gastrointestinal bleeding hospitalized in the Xinghua People′s Hospital from January to December 2022 were included, 278 of whom underwent emergency gastroscopy. The common causes and locations of acute Upper gastrointestinal bleeding were analyzed, and the influencing factors of death from acute upper gastrointestinal bleeding were analyzed by logistic regression.Results:Among 370 patients with acute Upper gastrointestinal bleeding, the majority were male [67.3%(249/370)], the median age was 70(57-78)years old, and the median hemoglobin level at admission was 72(57-96)g/L. Among them, 278 patients underwent gastroscopy, and 130 patients received blood transfusion treatment of 2(1.5-3.5)units of red blood cells transfusion. The median length of stay was 5(4-7)days. The age of the endoscopic group was younger than that of the non endoscopic group ( P<0.001), and the hemoglobin level was higher than that of the non endoscopic group ( P<0.001). The proportion of hemostatic drug use and blood transfusion was lower than that of the non endoscopic group ( P=0.027, P<0.001). In patients undergoing gastroscopy, the causes of upper gastrointestinal bleeding included 144 cases (51.8%) of ulcer related bleeding, 61 cases (22.0%) of bleeding caused by acute mucosal lesions, 27 cases (9.7%) of bleeding caused by tumors, 12 cases (4.3%) of bleeding caused by cardiac tears, 5 cases (1.8%) of bleeding caused by vascular malformations, and 29 cases (10.4%) of bleeding caused by varices. The bleeding sites included: 170 cases (61.1%) had bleeding from the stomach, 53 cases (19.1%) from the esophagus, 54 cases (19.4%) from the duodenum, and 1 case (0.4%) from gastroduodenal compound ulcer bleeding. Among all patients, 19 died in the hospital, and among 92 patients who did not undergo emergency gastroscopy, 16 died, with a mortality rate of 17.4%; Among 278 patients who underwent emergency gastroscopy, 3 died, with a mortality rate of 1.08%. Logistic single factor regression analysis found that the elderly (>70 years old), low hemoglobin (<70 g/L), blood transfusion and emergency gastroscopy were the influencing factors of hospital death in patients with acute upper gastrointestinal bleeding. Multivariate regression analysis showed that emergency gastroscopy ( OR=0.043, 95% CI: 0.010-0.198, P<0.001) could reduce the hospital death of patients with acute upper gastrointestinal bleeding. Conclusions:Acute upper gastrointestinal bleeding is common in elderly patients. On the basis of stable hemodynamics and early endoscopic examination, identifying the cause and combining traditional drugs for endoscopic hemostasis can improve the prognosis of patients and reduce the mortality of acute upper gastrointestinal bleeding.
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Objective:To investigate the risk factors for postoperative complications in emergency surgery for traumatic colon injury.Methods:In this study, a retrospective cohort study was used to collect the case data of 59 patients diagnosed with traumatic colon injury and emergency surgery in the PLA General Hospital from March 1, 2011 to March 31, 2023. According to whether complications occurred after emergency surgery, the patients were divided into the complication group( n=30)and the non-complication group( n=29). The main observation indexes were complication rate, Clavien-Dindo classification of complications, and risk factors related to complications. Normally distributed measurements were expressed as mean±standard deviation( ± s), and t-test was used for comparison between groups. Count data were compared between groups using the chi-square test. Clinically significant risk factors for predicting the occurrence of postoperative complications were determined by univariate and using multivariate logistic regression analysis. Results:A total of 56 occurrences of complications in 30 cases. 15 cases had multiple complications. Clavien-Dindo classification consisted of 23 cases of grade Ⅱ(41.1%), 1 cases of grade Ⅲa(1.8%), 6 cases of grade Ⅲb(10.7%), and 1 case of grade V(1.8%). The top three complication rates were 16 cases(28.6%) of pneumonia and(or) pleural effusion, 12 cases(21.4%) of incision infection, and 9 cases(16.1%) of postoperative bleeding. Univariate analysis showed that body mass index<24 kg/m 2, operation duration>235 min, intraoperative blood loss>100 mL, AAST-OIS grade≥4, preoperative serum albumin<35 g/L, preoperative white blood cell count>10×10 9/L, and preoperative procalcitonin≥2 ng/mL were risk factors for postoperative complications in traumatic colon injury underwent emergency surgery( P<0.05). Multivariate logistic regression analysis showed that body mass index<24 kg/m 2( OR=144.047, 95% CI: 3.695-5 614.986, P=0.008), preoperative serum albumin <35 g/L( OR=116.430, 95% CI: 3.582-3 784.038, P=0.007), preoperative procalcitonin≥2 ng/mL( OR=13.412, 95% CI: 1.030-174.662, P=0.047), and AAST-OIS grade≥4( OR=134.509, 95% CI: 3.934-4 599.473, P=0.007) were risk factors for postoperative complications in traumatic colon injury underwent emergency surgery. Conclusion:body mass index<24 kg/m 2, preoperative serum albumin<35 g/L, preoperative procalcitonin>2 ng/mL and AAST-OIS grade≥4 are risk factors for postoperative complications of traumatic colon injury. Early targeted treatment for patients with risk factors can help improve prognosis.
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Objective:To analyze the construction and operation of the 19th Hangzhou Asian Games designated hospitals, and to discuss the medical emergency security work of large-scale sports events, so as to provide references for the planning of designated hospitals in future large-scale sports events.Methods:Retrospective analysis was made on the establishment principles, requirements, selection of medical support personnel, and training exercises of the designated hospitals, focusing on the key links such as organizational system, staffing, designated areas, and drug management.Results:Total of 40 designated hospitals have successfully completed the task of medical security by rebuilding the medical security area of the Asian Games, elevating the process, equipping facilities, and strengthening staff training. During the Asian Games, 349 people were transferred to designated hospitals by ambulance, 54 people were hospitalized, 19 people underwent surgery, and 1022 people went to designated hospitals by themselves.Conclusion:The construction of the designated hospitals during the 19th Hangzhou Asian Games was of high quality, efficient and smooth operation. It is suggested that efforts should be made in the reconstruction of the medical security area for the Asian Games to be "relatively independent". The treatment process of self-visiting patients should be fully considered and the flat urgent emergency response mechanism needs to be established.
الملخص
Objetivo: Identificar pistas para o rastreamento de eventos adversos em serviços de emergência. Material e Método: Revisão integrativa, realizada em fevereiro de 2020, por meio de uma busca sistemática de estudos de pesquisa nos portais BVS e Pubmed e nas bases de dados CINAHL, Embase, Scopus e Web of Science, sem limite temporal. Resultados: Entre 148 artigos localizados, nove compuseram a amostra; identificou-se 171 pistas que foram agrupadas em seis módulos (clínico, cirúrgico, trauma, procedimento, administração de medicamento e laboratorial). Os estudos destacam como pistas de eventos adversos em serviços de emergência assuntos relacionados à hospitalização ou transferência, tempo de permanência, investigação de intoxicação por fármacos, alteração de exames laboratoriais, agravamento clínico, uso de contenção mecânica, emprego de suporte ventilatório e vascular. Conclusões: Os resultados contribuem para a seleção de pistas relevantes para rastrear eventos adversos, são aplicáveis em pesquisas epidemiológicas e no uso sistematizado na prática assistencial de enfermagem e saúde. O estudo também pode ajudar a melhorar a gestão da qualidade em serviços de emergência e promover a segurança do paciente.
Objective: To identify clues to screen adverse events in the emergency services. Materials and Methods: Integrative review, conducted in February 2020, through a systematic search of research studies available in the BVS and Pubmed portals, as well as in the CINAHL, Embase, Scopus and Web of Science databases, with no time restriction regarding publication. Results: Of the 148 articles found, nine were selected for the sample; 171 clues were identified and then classified into six modules (clinical, surgical, trauma, procedure, drug administration, and laboratory). The following clues were identified: hospitalization or transfer, length of stay, use of research therapies for drug intoxication, falsification of laboratory test results, clinical deterioration, use of mechanical restraint, and use of ventilatory and vascular support. Conclusions: The results contribute to the selection of relevant clues to screen adverse events, their application in research studies, and to their systematic use in the health care practice. This study can also help to improve quality management in emergency services and promote patient safety.
Objetivo: Identificar pistas para rastrear eventos adversos en los servicios de emergencia. Material y Método: revisión integradora, realizada en febrero de 2020, por búsqueda sistemática de investigaciones disponibles en los portales BVS y Pubmed y en las bases de datos CINAHL, Embase, Scopus y Web of Science, sin límite de tiempo de publicación. Resultados: De los 148 artículos encontrados, nueve conformaron la muestra; se identificaron 171 pistas, que se agruparon en seis módulos (clínico, quirúrgico, traumas, procedimiento, administración de medicamentos y laboratorio). Se destacaron las siguientes pistas: hospitalización o transferencia, tiempo de permanencia, uso de terapias de investigación para la intoxicación por drogas, adulteración de resultados en pruebas de laboratorio, empeoramiento clínico, uso de contención mecánica, uso de soporte ventilatorio y vascular. Conclusiones: Los resultados contribuyen a la selección de pistas relevantes para rastrear eventos adversos, son aplicables a la investigación y a las prácticas sistemáticas de la atención de la salud. Este estudio colabora con la gestión de la calidad en los servicios de emergencia y la promoción de la seguridad del paciente.
الملخص
ABSTRACT Objective: to analyze the characteristics of the activation of the yellow code in wards and identify the factors associated with adverse events after the Rapid Response Team. Methods: a cross-sectional study with retrospective analysis of medical records of adults admitted to medical or surgical clinic wards of the University Hospital of São Paulo. Results: among the 91 patients, the most frequent signs of triggers (n=107) were peripheral oxygen saturation of less than 90% (40.2%) and hypotension (30.8%). Regarding the associated factors the research identified each minute of attendance of the Rapid Response Team in the wards increased by 1.2% odds of adverse events (twenty-four unplanned admission in the ICU and one cardiac arrest) in the sample (p=0.014). Conclusions: decreased oxygen saturation and hypotension were the main reasons for the triggering, and the length of care was associated with the frequency of adverse events.
RESUMEN Objetivo: analizar características de la activación del código amarillo en unidades de internación e identificar factores relacionados a ocurrencia de eventos adversos después de la atención del Equipo de Respuesta Rápida. Métodos: estudio transversal con análisis retrospectivo de prontuarios de adultos internados en enfermerías de Clínica Médica o Quirúrgica de hospital universitario de São Paulo. Resultados: entre 91 pacientes, los signos más frecuentes de las activaciones (n=107) fueron saturación periférica de oxígeno inferior a 90% (40,2%) y hipotensión arterial (30,8%). Cuanto a factores relacionados, identificado que cada minuto de atención del Equipo de Respuesta Rápida en enfermerías aumentó en 1,2% la chance de ocurrencia de eventos adversos (24 admisiones no planeadas en Unidad de Cuidado Intensivo y un paro cardíaco) en la amuestra (p=0,014). Conclusiones: caída de saturación de oxígeno e hipotensión arterial fueron los principales motivos de activación, y tiempo de ateción fue relacionado a ocurrencia de eventos adversos.
RESUMO Objetivo: analisar as características do acionamento do código amarelo em unidades de internação e identificar os fatores associados à ocorrência de eventos adversos após o atendimento do Time de Resposta Rápida. Métodos: estudo transversal com análise retrospectiva de prontuários de adultos internados em enfermarias de Clínica Médica ou Cirúrgica de hospital universitário de São Paulo. Resultados: entre os 91 pacientes, os sinais mais frequentes dos acionamentos (n=107) foram saturação periférica de oxigênio inferior a 90% (40,2%) e hipotensão arterial (30,8%). Quanto aos fatores associados, identificou-se que cada minuto de atendimento do Time de Resposta Rápida nas enfermarias aumentou em 1,2% a chance de ocorrência de eventos adversos (24 internações não planejadas em Unidade de Terapia Intensiva e uma parada cardiorrespiratória) na amostra (p=0,014). Conclusões: queda da saturação de oxigênio e hipotensão arterial foram os principais motivos de acionamento, e o tempo de atendimento foi associado à ocorrência de eventos adversos.
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Abstract Background The treatment of acute ischemic stroke with cerebral reperfusion therapy requires rapid care and recognition of symptoms. Objective To analyze the effectiveness of implementing protocols for acute ischemic stroke in reducing care time. Methods Systematic review, which was performed with primary studies in Portuguese, English, and Spanish published between 2011 and 2020. Inclusion criteria: study population should comprise people with acute ischemic stroke and studies should present results on the effectiveness of using urgent care protocols in reducing care time. The bibliographic search was conducted in June 2020 in the LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier, and SocINDEX databases. The articles were selected, and data were extracted by two independent reviewers; the synthesis of the results was performed narratively. The methodological quality of articles was evaluated through specific instruments proposed by the Joanna Briggs Institute. Results A total of 11,226 publications were found, of which 35 were included in the study. Only one study reported improvement in the symptoms-onset-to-door time after protocol implementation. The effectiveness of the therapeutic approach protocols for ischemic stroke was identified in improving door-to-image, image-to-needle, door-to-needle and symptoms-onset-to-needle times. The main limitation found in the articles concerned the lack of clarity in relation to the study population. Conclusions Several advances have been identified in in-hospital care with protocol implementation; however, it is necessary to improve the recognition time of stroke symptoms among those who have the first contact with the person affected by the stroke and among the professionals involved with the prehospital care.
Resumo Antecedentes O tratamento do acidente vascular cerebral (AVC) isquêmico com terapia de reperfusão requer rápido atendimento e reconhecimento dos sintomas. Objetivo Analisar a efetividade da implementação de protocolos para AVC isquêmico agudo na redução do tempo de atendimento. Métodos Revisão sistemática realizada com estudos primários em português, inglês e espanhol publicados entre 2011 e 2020. Critérios de inclusão: a população do estudo foi constituída por pessoas com AVC isquêmico agudo e estudos que apresentassem resultados sobre a efetividade da implantação de protocolos no tempo de atendimento. A pesquisa bibliográfica foi realizada em junho de 2020 nas bases de dados LILACS, MEDLINE, Embase, Scopus, CINAHL, Academic Search Premier e SocINDEX. A seleção dos artigos e a extração dos dados foram feitas por dois revisores independentes; a síntese dos resultados foi feita de forma narrativa. A qualidade metodológica dos artigos foi avaliada por meio de instrumentos do Joanna Briggs Institute. Resultados Foram encontradas 11.226 publicações, das quais 35 foram incluídas no estudo. Apenas um estudo relatou melhora no tempo início dos sintomas-porta após a implementação do protocolo, no entanto, foi efetiva na melhora dos tempos porta-imagem, imagem-agulha, porta-agulha e início dos sintomas-agulha. A principal limitação encontrada nos artigos diz respeito à falta de clareza quanto à população de estudo. Conclusões Vários avanços foram identificados no atendimento intra-hospitalar com implantação de protocolo; porém, é necessário melhorar o tempo de reconhecimento dos sintomas do AVC entre aqueles que têm o primeiro contato com a pessoa acometida e entre os profissionais envolvidos com o atendimento pré-hospitalar.
الملخص
O tratamento do angioedema hereditário tem início com a educação dos pacientes e familiares sobre a doença, pois é fundamental o conhecimento da imprevisibilidade das crises, assim como os seus fatores desencadeantes. O tratamento medicamentoso se divide em terapia das crises e profilaxia das manifestações clínicas. As crises devem ser tratadas o mais precocemente possível com o uso do antagonista do receptor de bradicinina, o icatibanto ou o concentrado de C1-inibidor. É necessário estabeler um plano de ação em caso de crises para todos os pacientes. A profilaxia de longo prazo dos sintomas deve ser realizada preferencialmente com medicamentos de primeira linha, como concentrado do C1-inibidor ou o anticorpo monoclonal anti-calicreína, lanadelumabe. Como segunda linha de tratamento temos os andrógenos atenuados. Na profilaxia de curto prazo, antes de procedimentos que podem desencadear crises, o uso do concentrado de C1-inibidor é preconizado. Existem algumas restrições para uso desses tratamentos em crianças e gestantes que devem ser consideradas. Novos medicamentos baseados nos avanços do conhecimento da fisiopatologia do angioedema hereditário estão em desenvolvimento, devendo melhorar a qualidade de vida dos pacientes. O uso de ferramentas padronizadas para monitorização da qualidade de vida, do controle e da atividade da doença são fundamentais no acompanhamento destes pacientes. A criação de associações de pacientes e familiares de pacientes com angioedema hereditário tem desempenhado um papel muito importante no cuidado destes pacientes no nosso país.
The treatment of hereditary angioedema begins with the education of patients and their families about the disease, as it is essential to know the unpredictability of attacks as well as their triggering factors. Drug treatment is divided into attack therapy and prophylaxis of clinical manifestations. Attacks should be treated as early as possible with the bradykinin receptor antagonist icatibant or C1-inhibitor concentrate. An action plan needs to be established for all patients with attacks. Long-term prophylaxis of symptoms should preferably be performed with first-line drugs such as C1-inhibitor concentrate or the anti-kallikrein monoclonal antibody lanadelumab. Attenuated androgens are the second line of treatment. In short-term prophylaxis, before procedures that can trigger attacks, the use of C1-inhibitor concentrate is recommended. There are some restrictions for the use of these treatments in children and pregnant women that should be considered. New drugs based on advances in knowledge of the pathophysiology of hereditary angioedema are under development and are expected to improve patient quality of life. The use of standardized tools for monitoring quality of life and controlling disease activity is essential in the follow-up of these patients. The creation of associations of patients and families of patients with hereditary angioedema has played a very important role in the care of these patients in Brazil.