Epidemiología del trauma maxilofacial, tratado quirúrgicamente en el Hospital de Urgencia Asistencia Pública: 3 años de revisión / Epidemiology of maxillofacial trauma, surgically treated in the Emergency Hospital Public Assistance: 3 years of revision

Resumen Introducción: El trauma maxilofacial (TMF) constituye un problema de relevancia en los centros hospitalarios de alta complejidad. Objetivo: Evidenciar y actualizar la epidemiología del trauma maxilofacial de resolución quirúrgica bajo anestesia general, en pabellón central tratado en el Hospital de Urgencia Asistencia Pública durante el período comprendido entre diciembre de 2014 a diciembre de 2017 y compararla con la realidad epidemiológica de otros centros hospitalarios de alta complejidad en Chile y en el extranjero. Materiales y Método: Se realizó un estudio retrospectivo en el que se analizaron los protocolos operatorios de los pacientes intervenidos quirúrgicamente por trauma maxilofacial, en pabellón central, bajo anestesia general, en un período de 37 meses. Las variables analizadas fueron diagnóstico, edad, género, tercio facial y zona anatómica afectada. Resultados: Se realizaron 127 procedimientos quirúrgicos, para resolver 259 fracturas. La edad promedio de los pacientes intervenidos fue de 33 años, con predominio del género masculino (85,8%); el tercio inferior fue el más afectado (77,2%), específicamente en la zona parasinfisiaria mandibular (22,4%). Discusión: Los resultados expuestos concuerdan con estudios realizados internacionalmente, pero tiene discordancia en relación a la zona anatómica más afectada al comparalo con los otros centros que analizaron su epidemiología. Conclusión: Resulta necesario continuar la investigación epidemiológica de estas patologías y unificar criterios de diagnóstico y tratamiento para poder establecer políticas de prevención y tratamiento eficientes en relación a cada servicio y en conjunto a nivel de salud pública.

Introduction: Maxillofacial trauma (MFT) is a relevant problem in highly complex hospital centers. Aim: To show and update the epidemiology of the maxillofacial trauma of surgical resolution under general anesthesia, in a major operating room, treated in the Emergency Hospital Public Assistance during the period from December 2014 to December 2017 and to compare it with the epidemiological reality of other high complexity hospital centers in Chile and abroad. Materials and Method: A retrospective study was carried out and the surgical protocols of the patients operated for maxillofacial trauma, in a major operating room, under general anesthesia, in a period of 37 months, were analyzed. The variables considered were diagnosis, age, gender, facial third and affected anatomic area. Results: 127 surgical procedures were performed, for the resolution of 259 fractures. The average age of the operated patients was 33 years, with predominance of the male gender (85.8%), the lower third was the most affected (77.2%), specifically in the parasymphysis area (22.4%). Discussion: The exposed results agree with studies carried out internationally, but it has discordance in relation to the most affected anatomical area at national level comparing it with the other hospitals that analyzed its epidemiology. Conclusion: It is necessary to continue the epidemiological investigation of these pathologies and to unify diagnostic and treatment criteria in order to establish efficient prevention and treatment policies in relation to each service and jointly at the level of public health.

Rapid, remote education for point-of-care ultrasound among non-physician emergency care providers in a resource limited setting

Introduction : Access to high-quality emergency care in low- and middle-income countries (LMIC) is lacking. Many countries utilise a strategy known as "task-shifting" where skills and responsibilities are distributed in novel ways among healthcare personnel. Point-of-care ultrasound (POCUS) has the potential to significantly improve emergency care in LMICs.Methods:POCUS was incorporated into a training program for a ten-person cohort of non-physician Emergency Care Providers (ECPs) in rural Uganda. We performed a prospective observational evaluation on the impact of a remote, rapid review of POCUS studies on the primary objective of ECP ultrasound quality and secondary objective of ultrasound utilisation. The study was divided into four phases over 11 months: an initial in-person training month, two middle month blocks where ECPs performed ultrasounds independently without remote electronic feedback, and the final months when ECPs performed ultrasounds independently with remote electronic feedback. Quality was assessed on a previously published eight-point ordinal scale by a U.S.-based expert sonographer and rapid standardised feedback was given to ECPs by local staff. Sensitivity and specificity of ultrasound exam findings for the Focused Assessment with Sonography for Trauma (FAST) was calculated.Results:Over the study duration, 1153 ultrasound studies were reviewed. Average imaging frequency per ECP dropped 61% after the initial in-person training month (p = 0.01) when ECPs performed ultrasound independently, but rebounded once electronic feedback was initiated (p = 0.001), with an improvement in quality from 3.82 (95% CI, 3.32­4.32) to 4.68 (95% CI, 4.35­5.01) on an eight-point scale. The sensitivity and specificity of FAST exam during the initial training period was 77.8 (95% CI, 59.2­83.0) and 98.5 (95% CI, 93.3­99.9), respectively. Sensitivity improved 88% compared to independent, non-feedback months whereas specificity was unchanged.Conclusions : Remotely delivered quality assurance feedback is an effective educational tool to enhance provider skill and foster continued and sustainable use of ultrasound in LMICs

Cuidados de enfermagem em crise hipertensiva: uma revisão integrativa / Nursing care hypertensive crisis: an integrative review

As formas agudas de hipertensão arterial constituem-se nas crises hipertensivas (CH), as quais representam uma causa frequente de emergência e consultas de atenção primária. O presente estudo teve como objetivo analisar as evidências científicas sobre os cuidados de enfermagem em CH publicadas na literatura nos últimos 10 anos. Trata-se de uma revisão integrativa desenvolvida a partir das etapas propostas pela literatura. Foram utilizadas as bases de dados Public Medline ou Publisher Medline (PubMed), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SCIELO) e selecionados os artigos publicados entre 2008 e 2018. Foram encontrados 10 artigos, sendo 40% deles nacionais, 50% dos Estados Unidos e 10% do México. Os achados apontam que os cuidados de enfermagem com o paciente em crise hipertensiva se referem à abordagem inicial do paciente em sala de emergência, avaliação inicial, intervenções da enfermagem relacionadas aos cuidados emergenciais, educação em saúde e medida de pressão arterial. É necessária a realização de estudos que abordem a atuação do enfermeiro frente aos cuidados prestados em CH, a fim de construir evidências para garantir a melhor forma de avaliar o cliente, identificar os diagnósticos de enfermagem para, então, propor intervenções eficazes

Acute forms of hypertension constitute hypertensive crises (HC), which represent a frequent cause of emergency and primary care consultations. This study aims to analyze scientific evidence relating to nursing care in HC published in the literature in the last ten years. This is an integrative review developed based on the stages proposed in the literature. The databases used were Public Medline or Publisher Medline (PubMed), Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SCIELO), selecting articles published between 2008 and 2018. Ten articles were found; 40% from Brazil, 50% from the United States and 10% from Mexico. The findings indicate that the nursing care of patients in hypertensive crisis relate to the initial approach to the patient in the emergency room, initial evaluation, nursing interventions related to emergency care, health education and blood pressure measurement. Studies are needed that address nurses' actions in relation to HC care, in order to construct evidence to ensure the best form of evaluating the client, identify the nursing diagnoses, and then propose effective interventions

Ultrasonido de urgencia realizado por cirujanos en pacientes ingresados en el Departamento de Urgencia / Surgeon-performed emergency ultrasonography on patients admitted to the Emergency Department

Introducción: a nivel mundial, el uso del ultrasonido en el departamento de urgencia se considera una herramienta importante para la evaluación inicial del paciente con patologías quirúrgicas. En nuestro país, por diferentes cuestiones, se hace difícil la realización rápida de este proceder. Objetivo: determinar si el uso del ultrasonido por cirujanos generales es un método de diagnóstico eficaz en pacientes ingresados en el departamento de urgencia. Método: se realizó un estudio observacional, descriptivo, longitudinal, de carácter prospectivo, en el departamento de urgencia del Hospital Universitario Dr. Miguel Enríquez desde 1 enero hasta 30 abril de 2017 con una totalidad de 96 pacientes. Se efectuó estudios ultrasonográficos a los pacientes que presentaron criterio para su uso. Se determinó la coincidencia entre el diagnóstico clínico, quirúrgico y el ultrasonográfico. Resultados: se analizaron 96 pacientes con predominio del sexo femenino 50 (52,1 por ciento). El diagnóstico clínico más frecuente encontrado fueron las afecciones por traumas 41 (42,7 por ciento). Se logró una mejor coincidencia entre el diagnóstico clínico y ultrasonográfico en las afecciones traumáticas (p= 0,021) y ginecológicas (p= 0,034). Todas las variables de manera general presentaron buena coincidencia entre el diagnóstico posquirúrgico y ultrasonográfico. Conclusiones: la utilización del ultrasonido por parte de los cirujanos resultó ser un estudio favorable para complementar el diagnóstico en los pacientes atendidos en el departamento de urgencia()AU)

Introduction: The use of ultrasonography at the emergency department is worldwide considered an important tool for the initial evaluation of patients with surgical pathologies. In our country, due to different issues, it is difficult to carry out this procedure quickly. Objective: To determine if the use of ultrasonography by general surgeons is an effective diagnostic method in patients admitted to the emergency department. Method: An observational, descriptive, longitudinal, prospective study was carried out in the Emergency Department of Dr. Miguel Enríquez University Hospital, from January 1st to April 30, 2017, on a total of 96 patients. Ultrasonographic studies were performed on patients who presented criteria for its usage. The coincidence between clinical, surgical and ultrasonographic diagnosis was determined. Results: 96 patients, with a predominance of the female sex (50, 52.1 percent) were analyzed. The most frequent clinical diagnosis found was traumatic affections (41, 42.7 percent). A better coincidence between clinical and ultrasonographic diagnosis was achieved in traumatic (p=0.021) and gynecological (p=0.034) conditions. General speaking, all the variables presented fair coincidence between the postoperative and ultrasonographic diagnosis. Conclusions: The usage of ultrasonography by surgeons turned out to be a favorable study to complement the diagnosis in patients seen in the emergency department(AU)

Manuseio de emergências cardiológicas em hospitais gerais do estado do Paraná / Management of cardiologic emergencies in general hospitals in the state of Paraná

JUSTIFICATIVA E OBJETIVOS: As diretrizes sobre as condutas em reanimação cardiopulmonar (RCP) foram baseadas na grande evolução dos estudos nessa área, sendo atualizadas em certos períodos de tempo. É por isso que o manuseio correto de uma parada cardíaca depende apenas da atualização do profissional que a atende. O objetivo deste estudo foi avaliar a condutados profissionais responsáveis pelo primeiro atendimento frente a emergências cardiológicas em alguns serviços hospitalares. MÉTODO: Foram avaliados 80 médicos de hospitais gerais, tomando-se como padrão as normas do Advanced Cardiologic Life Support (ACLS) e comparando o índice de acertos em um questionário com alguns quesitos de formação e trabalho do profissional. Os profissionais foram identificados com idade, sexo, estado civil, tempo de formação e local de trabalho, e em seguida responderam a seis questões referentes às condutas utilizadas. RESULTADOS: O índice de acertos foi tabulado e comparado, apresentando uma média de acertos de 3,5 questões. O mínimo de acertos foi zero, e o máximo foram seis questões. Houve correlação inversa significativa entre a idade e o número de acertos, ou seja, médicos mais jovens acertaram mais questões que os médicos de mais idade. Não houve associação significativa entre sexo, estado civil, tempo de formação e local de trabalho em relação ao número de acertos. CONCLUSÃO: Portanto, há a necessidade de atualizações entre os profissionais, buscando o melhor atendimento emergencial.

BACKGROUND AND OBJECTIVES: The cardiopulmonary resuscitation (CPR) guidelines were based on the large evolution of the studies in this area, being updated in certain periods of time. That is why the correct management of a cardiac arrest only depends on the professionals updating. The goal of the study was to evaluate the behavior of professionals responsible for primary care when they are faced with cardiologic emergencies in some hospitals. METHOD: Eighty physicians of general hospitals were evaluated, taking as base the Advance Cardiologic Life Support (ACLS) guidelines and comparing the rates of correct answers in a questionnaire with questions about professional training and work. The professionals were identified by age, gender, civil state, time of training and work place, and then they answered six questions about the procedures undertaken. RESULTS: The correct answers were tabulated and compared, demonstrating an average number of right answers of 3.5. The minimum was zero right answers and the maximum, six. There was a significant inverse correlation between the age and the number of correct answers, i.e., younger physicians had more correct answers than older ones. There were not significant relations among gender, civil state, time of training, and work place and number of correct answers. CONCLUSION: Therefore, professionals should keep themselves updated in order to deliver better emergency care.

Novas recomendações para o atendimento ao paciente pediátrico gravemente enfermo / New recommendations for critically ill pediatric patient care

A American Heart Association publicou em outubro de 2010 uma nova versão das diretrizes para a reanimação cardiorrespiratória e emergência cardiovascular, visando garantir a alta qualidade da reanimação e otimização das condições clínicas do paciente com o retorno da circulação. Para o atendimento de urgências ou emergências na faixa etária pediátrica, o profissional de saúde deve receber treinamento específico e buscar atualizações frequentes, Este artigo tem por objetivo apresentar e discutir as novas diretrizes para a faixa etária pediátrica. Foram realizadas revisão e análise crítica dos pontos mais importantes referentes ao suporte básico e avançado de vida em pediatria, As manobras de reanimação cardiorrespiratória devem ser instituídas rapidamente, de forma efetiva e com alta qualidade, ou seja, com compressões torácicas fortes e rápidas (mínimo de 100 compressões por minuto), permitindo retorno do tórax à posição inicial e com mínimas interrupções. A sequência de atendimento à parada mudou para "CAS", iniciando as manobras pela compressão torácica, a seguir abrindo vias aéreas e fornecendo ventilações. No suporte avançado algumas recomendações foram publicadas relativas ao monitoramento do paciente e das ações, oferta de oxigênio e doses de medicações. A assistência ao paciente pediátrico gravemente enfermo deve ser planejada pelos diversos serviços, sendo recomendada a elaboração de protocolos institucionais baseados nas melhores evidências. Os profissionais envolvidos devem receber treinamento com a utilização da simulação, práticas de vivência emocional e trabalho em equipe...

American Heart Association published last October new guidelines for cardiopulmonary resuscitation and emergency cardiovascular care, aimed at ensuring the high quality of resuscitation and optimization of clinical conditions regarding the patients return circulation. For urgent or emergency care in pediatric patients, health professionals should receive specific training and get frequent updates. This articte aims to present and discuss the new guidelines for pediatric patients. It also reviews and offers the critica I analysis of the most important sup- port for the basic and advanced life support in pediatrics. The cardiopulmonary resuscitation should be instituted quickly, effectively and with high quality, i.e., hard and fast chest compres- sions (at least 100 compressions per minute), allowing the chest return to the starting position, and with minimal interruptions. The sequence for cardiopulmonary resuscitation changed to "CAB" maneuvers starting by chest compression, then opening the airway and providing ventilation. In advanced support some recommendations were published on monitoring and actions for ill pediatric patient, oxygen supply and doses of medications. The assistance to critically ill pediatric patient should be planned by several services and the development of local protocols based on literature data should be recommended. The professionals involved should be trained using of simulation, practicing emotiona! experience and teamwork...

Intubação orotraqueal e a técnica da sequência rápida: uma revisão para o clínico / Orotracheal intubation and rapid sequence technique: a review for the internist

JUSTIFICATIVA E OBJETIVOS: O médico clínico frequentemente se depara com a necessidade do acesso a via aérea em situações de urgência e emergência. O objetivo deste estudo foi rever as principais publicações sobre acesso às vias aéreas nessas situações descrevendo as melhores evidências para a execução deste procedimento.CONTEÚDO: Foram selecionados artigos na base de dados Medline (1950-2010), por meio das palavras-chave: intubação orotraqueal, sequência rápida, laringoscopia. Adicionalmente,referências desses artigos, capítulos de livros e artigos históricos foram avaliados. Foram identificados e revisados 68 artigos. Foram considerados ensaios clínicos da língua inglesa, estudos retrospectivose de revisão. Os artigos foram avaliados por análisede método e determinação de limitações de desenho. Por se tratar de uma revisão narrativa, foram apresentadas as conclusões mais relevantes dos principais estudos e metanálises, sem a interferência direta da análise pessoal dos autores deste estudo.CONCLUSÃO: A técnica de acesso a via aérea é indispensável para o clínico. Os conhecimentos sobre sua anatomia, condição ideal para a laringoscopia envolvendo o melhor posicionamento e técnicas que podem ser utilizadas deve ser rotineiro ao clínico. O clinico pode se deparar muitas vezes com o paciente com risco de aspiração pulmonar e deve conhecer também a técnica de sequência rápida envolvendo todas as suas particularidades e aspectos de segurança.(AU)

BACKGROUND AND OBJECTIVES: The internist frequently comes across with the necessity for emergency airway access.The objective of this study was to review the major publications about airway access in these conditions describing the best evidencesto execute this procedure.CONTENTS: We selected articles in Medline (1950-2010), by means of keywords: orotracheal, rapid sequence intubation and laryngoscopy. Additionally, references to these articles, chapters of books and historical articles were evaluated. We identified and reviewed 68 articles. We considered clinical trials, retrospective studies and clinical reviews in English. Articles were analyzing basedin methods and determination of design limitations. As a narrative review, we presented the most relevant findings of major studiesand meta-analyses without involving our personal point of view.CONCLUSION: The technique of airway access is a vital procedureto the internist. Knowledge of the airways anatomy and ideal scenario for laryngoscopy involving the best positioning and techniques,that can should be used as a routine for the clinical practice. The internist many times may get with the patient at risk for pulmonary aspiration and should know the technique of rapid sequence intubation,involving all its particularities and safety aspects.(AU)

Comportamiento clínico del síndrome dolor disfunción del aparato temporomandibular en una consulta de urgencias estomatológicas / Clinical behavior of the dysfunction pain temporomandibular joint syndrome assessed in a Stomatology emergence consultation

El síndrome dolor disfunción del aparato temporomandibular (SDDAT) comprende el conjunto de signos y síntomas como resultado de las alteraciones cuantitativas y cualitativas de la función de los componentes del aparato masticatorio. Se presenta con frecuencia y resulta molesto para el paciente, por lo que se realiza este estudio, con el objetivo de caracterizarlo clínicamente. Métodos: se realizó un estudio prospectivo, descriptivo, de corte transversal, con los pacientes que acudieron al Servicio de Urgencias de la Clínica Estomatológica de Artemisa, en el período comprendido entre julio de 2007 hasta marzo de 2008 con el diagnóstico de SDDAT. Resultados: del total de pacientes atendidos solo el 1,1 por ciento presentó un diagnóstico de SDDAT. El intervalo de edad de mayor frecuencia fue el de 22 a 59 años, el dolor a la masticación y el ruido articular fueron el síntoma y el signo predominante, respectivamente. Se identificaron como factores de riesgo principales el estrés y el bruxismo. Más del 67 por ciento de los pacientes eran del sexo femenino, en las cuales apareció la mayor recurrencia del síndrome. Conclusiones: la población del municipio de Artemisa presentó una baja incidencia del SDDAT en la consulta de urgencias estomatológicas, encontrándose una asociación estadísticamente significativa entre el sexo femenino y la aparición de este síndrome, donde el estrés desempeña un papel importante(AU)

Dysfunction pain temporomandibular joint syndrome (DPTJS) includes signs and symptoms as a result of quantitative and qualitative alterations of the masticatory tract component function. Is frequently present and annoying for patient, thus we made this study to clinically characterize it. We made a cross-sectional, descriptive and prospective study of patients seen in Emergence Service of Stomatology Clinic in Artemisa municipality from July, 2007 and March, 2008 diagnosing DPTJS. Results: From the total of patients seen only the 1,1 percent was diagnosed with DPTJS. The more frequent age-interval was that of 22-59 years, mastication pain, and the articulation noise were the more frequent syndrome, respectively. As major risk factors we identified the stress and the bruxism. More than 67 percent of patients were of female sex with the greatest syndrome frequency. Conclusions: Population from Artemisa municipality had a low incidence of DPTJS in Stomatology emergence consultations; there was a significant statistically association between female sex and appearance of this syndrome where stress plays a mayor role(AU)

Comparison between Kidney and Hemoperfusion for Paraquat Elimination

The mortality rate of acute paraquat (PQ) poisoning depends on the PQ concentration in the blood. It has been shown that the kidneys eliminate PQ effectively. However, early renal function deterioration is frequently observed in acute PQ intoxication. This study is designed to compare the efficacy of PQ elimination with hemoperfusion (HP) and kidneys, taking into account the functional deterioration of the kidneys. The amount of renal and HP excretion of PQ were measured during the procedure of HP in patients with acute PQ intoxication. The PQ clearance and the actual amount of PQ elimination by the HP cartridge during the HP procedure were 111+/-11 mL/min (range; 13.2-162.2 mL/min) and 251.4+/-506.3 mg (range; 4.6- 1,655.7) each. While, the renal clearance and actual amount of renal elimination of PQ was 79.8+/-56.0 mL/min (range; 9.7-177.0) and 75.4+/-73.6 mg (range; 4.9- 245.8). As the creatinine clearance decreased, the PQ elimination by HP was as effective as or more effective than the renal elimination. In conclusion, early HP must be provided for life saving treatment in patients with acute PQ intoxication.

Diagnosis and treatment of 42 cases of multiple injuries with pancreatic injury / 华中科技大学学报（医学）（英德文版）

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures (52.3%), shock (50%), multiple fractures (47.6%), and severe brain injury (26.1%). In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases (97.6%) were cured (including 40 cases receiving surgical operation and one case receiving the conservative treatment). Postoperative complications occurred in 16 cases (21 cases/times): pancreatic fistula (5 cases/times) and incisional wound infection (5 cases/times), intra-abdominal infection (3 cases/times), stress ulcer (3 cases/times), pleural effusion (3 cases/times), pulmonary infection (one case) and wound dehiscence (1 case). The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.

Emergency in malaria.

Malaria is still the most prevalent and devastating parasitic disease worldwide. In recent years drug resistance Plasmodium falciparum malaria has returned to most of the tropical countries of the globe with a vengeance. Due to various atypical manifestations the diagnosis has become confusing and hence the treatment delayed leading to various complications and increased mortality and morbidity. Patient presents with features of severe complicated malaria with multiorgan involvement in the form of malarial crisis needs emergency management in ICU. All fever cases with possible malaria should be investigated and to be treated with intravenous quinine/artimisinine pending confirmation of diagnosis. Any emergency situation that develops during treatment should be treated aggressively as medical emergency.