Telecardiology on the diagnostic support of chest pain in twenty-two Emergency Care Units (UPA 24h) in the State of Rio de Janeiro / Telecardiology on the diagnostic support of chest pain in twenty-two Emergency Care Units (UPA 24h) in the State of Rio de Janeiro

Background: Telecardiology may be a useful support in diagnosis and management of chest pain. Objective: Evaluate the application of telecardiology to support the differential diagnosis of chest pain in patients admitted to Emergency Care Units. Method: Observational, retrospective and documental study of 5,816 patients admitted with supposedly cardiological chest pain in twenty two Emergency Care Units in the state of Rio de Janeiro. Data were tabulated and analyzed by Excel® software, using simple descriptive statistics, from the database of the Cardiology Consultancy Nucleus. Results: Diagnostic disagreement was found in 1,593 (27.39%) cases. Of these, 1,477 (92.72%) were diagnosed locally as non-ST-elevation myocardial infarction (non-STEMI), 74 (4.64%) as acute myocardial infarction with ST-segment elevation (STEMI), 40 (2.52%) as acute pulmonary edema (APE) and 2 (0.12%) as tachyarrhythmia. Intensive care referral was requested to 100% of these patients. After telecardiology, the diagnoses were: 385 (24.17%) unstable angina, 289 (18.14%) congestive heart failure, 212 (13.31%) APE, 174 (10.92%) STEMI, 152 (9.54%) hypertensive emergency, 113 (7.09%) acute chronic renal failure, 89 (5.59%) non-STEMI, 89 (5.59%) pneumonia, 39 (2.45%) sepsis, 26 (1.63 %) myopericarditis, 20 (1.26%) tachyarrhythmia and 5 (0.31%) orovalvar disease. The outcome after telecardiology was 1,178 discharges (73.94%), 338 (21.21%) referrals, 62 (3.90%) deaths and 15 (0.95%) unknown. Conclusion: Telecardiology was effective in chest pain diagnosis and management, optimizing hospital admission in the public health system

Aspectos da implantação de um centro de trauma na rede de urgência e emergência em região metropolitana do Rio de Janeiro / Aspects of the implementation of a trauma center in the emergency care network in the metropolitan area of Rio de Janeiro

Esta dissertação caracteriza-se como uma pesquisa, documental e bibliográfica da literatura, sobre trauma que objetivou avaliar a conformidade da proposta do centro de trauma aos parâmetros internacionais, para atendimento ao trauma e sua pertinência na política de urgência e emergência brasileira. Incluiu um estudo sobre aspectos da implantação Centro de Trauma, inaugurado no Hospital Estadual Alberto Torres, no município de São Gonçalo no estado do Rio de Janeiro, calcado no modelo norte-americano com o intuito de verificar a pertinência da proposta e contribuição na Política Nacional de Atenção às Urgências e Emergências e na linha de cuidado ao trauma proposta pelo Ministério da Saúde do Brasil em 2013. (...) A revisão mostrou que a literatura internacional apresenta estudos que examinaram o impacto do atendimento do centro de trauma na mortalidade dos pacientes desde a década de 1960 até os dias atuais e, apesar das limitações de alguns estudos, pode-se afirmar que o cuidado no centro de trauma, de mãos dadas com a implantação do sistema de trauma, foi associado com redução significativa na mortalidade relacionada com trauma; evidenciou, também, que, embora a legislação brasileira esteja atenta para o problema dos centros de trauma, ainda não estão implantados e têm uma filosofia diferente dos Centros de Trauma Internacionais. O estudo concluiu que, no Brasil, as dificuldades ainda são grandes e a implantação dos Centros de Trauma parece ser muito difícil nos moldes da Portaria 1.366, de 08 de julho de 2013, especialmente pelas limitações na articulação da rede de atendimento em urgências e emergências e os altos custos deste modelo...

This This work is characterized as a documentary and bibliographic literature on trauma that aimed to evaluate the compliance of the proposed trauma center to international standards for trauma care and its relevance in emergency policy and Brazilian emergency. In addition, a study on aspects of Trauma Center deployment, inaugurated at the State Hospital Alberto Torres, in São Gonçalo, in the state of Rio de Janeiro, based on the US model. In order, to verify the relevance of the proposal and contribute to the National Policy Attention to Emergencies and Emergency and trauma care line to the proposal by the Ministry of Health of Brazil in 2013. The articles selected dissertations and theses that examined the trauma care provided in Brazil and internationally focused in the United States. The included studies were that made reference to trauma care in the hospital network and trauma centers. (...) Despite the limitations of some studies, can be said that care at the center trauma and the trauma system, was associated with a significant reduction in mortality related to trauma. ; It showed, too, that although Brazilian law is attentive to the problem of trauma centers, are not yet in place and have a different philosophy of the International Trauma Centers. The study concluded that, in Brazil, the difficulties are still great and the deployment of Trauma Centers seems to be very difficult along the lines of law 1366 of 08 July 2013, especially by the limitations on joint service network in emergency wards and the high costs of this model. The study of the Trauma Center Alberto Torres has shown that it is within the highest international standards and that, to achieve a smooth integration into the network services, you can minimize the after-effects left by traumas in accidents...