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1.
Curr Opin Anaesthesiol ; 33(4): 561-565, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32628403

RESUMO

PURPOSE OF REVIEW: General anesthesia and monitored anesthesia care (MAC) are the most widely used techniques in nonoperating room anesthesia (NORA). However, regional anesthesia is slowly finding viable applications in this field. This review aims at providing an update on the current practice of regional anesthesia techniques outside of the operating theatre. RECENT FINDINGS: Some anesthetic departments have implemented the use of regional anesthesia in novel applications outside of the operating room. In most cases, it remains an adjunct to general anesthesia but is sometimes used as the sole anesthetic technique. The use of the paravertebral block during radiofrequency ablation of different tumors is a recent application in interventional radiology. In emergency medicine, regional anesthesia is gaining traction in analgesia for trauma patients. SUMMARY: Regional anesthesia is finding its way into broader applications every day, offering a range of potential benefits in anesthetic care. Its implementation in NORA is promising and may aid in decreasing patient morbidity. However, great care should be taken in applying the recommended safety precautions for regional anesthesia in any setting.


Assuntos
Anestesia por Condução/tendências , Anestesiologia/tendências , Medicina de Emergência , Humanos , Salas Cirúrgicas , Segurança do Paciente , Radiologia Intervencionista
5.
MEDICC Rev ; 22(2): 64-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32478712

RESUMO

The days are long and arduous, with end-less patients to attend, often in a foreign language, always on foreign shores. Far from family and the familiar. Sleep is fi tful at best for health profession-als serving in emergency situations-when sickness obeys no clock and patients' pain haunts even the quiet moments. The crisis scenario varies: post-earthquake, hurricane or tsunami; amid a cholera or Ebola epidemic. The countries vary: Haiti, Pakistan, Guatemala, Mozambique, Sierra Leone. What does not vary is the answer to the calls for help and Cuban professionals' commitment to care for the most vulner-able. These aren't armchair musings or a political pat on the back: they are my own conclusions after living for weeks in close-quarter tents with Cuban doctors, nurses and biomedical engineers in post-earth-quake Pakistan and Haiti, and witnessing their work.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Medicina de Emergência , Cooperação Internacional , Pandemias , Pneumonia Viral , Cuba , Humanos , Recursos Humanos
6.
Schmerz ; 34(4): 303-313, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32488422

RESUMO

The corona pandemic has led to a number of restrictions and prohibitions, which in turn place large psychosocial or spiritual burdens on patients with COVID-19, their families and relatives and the treating personnel in the healthcare system. Patients with COVID-19 are not allowed to receive visitors and many hospitals and nursing homes have completely banned visitors. Many support services have been reduced or stopped completely. Necessary treatment interventions for other patients with critical and life-limiting diseases have been delayed or suspended in order to free resources for the expected COVID-19 patients; however, these people need to feel social connectedness with their relatives. Palliative care patients should be exempted from any ban on visitors. Families should be able to visit dying patients even on intensive care units or isolation wards, using adequate protective equipment. Alternative options, such as video telephone calls or via social media should be explored for patients in isolation. Families should also be enabled to say goodbye to the deceased with adequate protective equipment or should be offered alternative real or virtual options for remembrance and commemoration. Health care professionals coping with the exceptional stress should be continuously supported. This requires clear communication and leadership structures, communication training, psychosocial support, but most of all optimal framework conditions for the clinical work.


Assuntos
Infecções por Coronavirus/psicologia , Pesar , Cuidados Paliativos , Pneumonia Viral/psicologia , Betacoronavirus , Aconselhamento , Medicina de Emergência , Terapia Familiar , Alemanha , Humanos , Neoplasias , Estresse Ocupacional , Medicina Paliativa , Pandemias , Psico-Oncologia , Serviço Social , Visitas a Pacientes
9.
Harefuah ; 159(5): 376-379, 2020 05.
Artigo em Hebraico | MEDLINE | ID: mdl-32431131

RESUMO

INTRODUCTION: In this short review, in honor of Israel's 70th anniversary, more than a hundred years after the establishment of the first and largest HMO in Israel (Kupat Cholim Clalit), the 100th anniversary of Hadassah Hospital in Jerusalem (and its first Emergency Room) and 30 years after the first steps to build real Emergency Medicine (EM) in Israel, we review the short history of EM, its current position here and now, among other aspects of the health system and its vision. Proceeding from the Emergency Room towards the Emergency Department, from unwanted neglected tasks of frustrated physicians to essential clinical profession and from routine technical daily activities to advanced innovative futuristic emergency diagnosis and treatment. The point of view and impression is 100% personal. It is that of one physician who grew up in the system and was actively involved in the development of EM. The author is currently leading "Laniado" ER to be a modern department serving the rapidly growing population of Netanya and it's neighborhood.


Assuntos
Medicina de Emergência , Médicos , Aniversários e Eventos Especiais , Serviço Hospitalar de Emergência , Humanos , Israel
12.
Artigo em Alemão | MEDLINE | ID: mdl-32434262

RESUMO

Unwanted drug interactions are responsible for a high rate of hospitalization. The rate of unwanted interactions increases with the number of drugs taken. Drug interactions occur on pharmacodynamic and pharmacokinetic levels. They can be caused by an emergency treatment and can be the cause of a necessary emergency treatment. To avoid unwanted drug interactions, electronic databases and smartphone apps could be helpful.


Assuntos
Interações Medicamentosas , Medicina de Emergência , Gerenciamento de Dados , Humanos
13.
Postgrad Med J ; 96(1137): 384-386, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404498

RESUMO

The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year's end.


Assuntos
Competência Clínica/normas , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Educação Médica Continuada/tendências , Medicina , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Medicina de Emergência/educação , Pesquisa sobre Serviços de Saúde , Humanos , Infectologia/educação , Inovação Organizacional , Pneumonia Viral/epidemiologia , Medicina Preventiva/educação , Psiquiatria/educação , Pneumologia/educação
15.
Sr Care Pharm ; 35(6): 240-242, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32456752

RESUMO

A medication-focused review of older patients in the emergency department is important in identifying medication-related problems, differential diagnoses, and associated complications. With rapid triage, assessment, and diagnosis, the emergency department is inherently an area of empirical prescribing. Emergency department pharmacists are uniquely placed to review patients on presentation with a focus on both acute problem management and identifying and addressing long-standing medication issues.


Assuntos
Medicina de Emergência , Farmacêuticos , Serviço Hospitalar de Emergência , Humanos , Triagem
16.
AJOB Empir Bioeth ; 11(3): 148-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369433

RESUMO

Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.


Assuntos
Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/normas , Pneumonia Viral/terapia , Padrão de Cuidado , Suspensão de Tratamento/ética , Centros Médicos Acadêmicos , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/ética , Medicina de Emergência/normas , Grupos Focais , Humanos , Entrevistas como Assunto , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Qualidade de Vida , Respiração Artificial/normas , Terapia Respiratória/normas , Padrão de Cuidado/ética , Triagem/métodos , Triagem/normas
19.
Emerg Med Australas ; 32(3): 520-524, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32275805

RESUMO

EDs fulfil a frontline function during public health emergencies (PHEs) and will play a pivotal role during the COVID-19 pandemic. This perspective article draws on qualitative data from a longitudinal, ethnographic study of an Australian tertiary ED to illustrate the clinical and ethical challenges faced by EDs during PHEs. Interview data collected during the 2014 Ebola Virus Disease PHE of International Concern suggest that ED clinicians have a strong sense of professional responsibility, but this can be compromised by increased visibility of risk and sub-optimal engagement from hospital managers and public health authorities. The study exposes the tension between a healthcare worker's right to protection and a duty to provide treatment. Given the narrow window of opportunity to prepare for a surge of COVID-19 presentations, there is an immediate need to reflect and learn from previous experiences. To maintain the confidence of ED clinicians, and minimise the risk of moral injury, hospital and public health authorities must urgently develop processes to support ethical healthcare delivery and ensure adequate resourcing of EDs.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus , Surtos de Doenças/ética , Medicina de Emergência/ética , Serviço Hospitalar de Emergência/ética , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Ventiladores Mecânicos/ética , Betacoronavirus , Coronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Tomada de Decisões , Surtos de Doenças/prevenção & controle , Serviços Médicos de Emergência , Doença pelo Vírus Ebola/epidemiologia , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Saúde Pública , Ventiladores Mecânicos/estatística & dados numéricos
20.
Emerg Med Clin North Am ; 38(2): 363-382, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336331

RESUMO

Simulation has been steadily changing the safety culture in the healthcare industry and allowing individual clinicians and interdisciplinary teams to be proactive in the culture of risk reduction and improved patient safety. Literature has demonstrated improved patient outcomes, improved team based skills, systems testing and mitigation of latent safety threats. Simulation may be incorporated into practice via different modalities. The simulation lab is helpful for individual procedures, in situ simulation (ISS) for system testing and teamwork, community outreach ISS for sharing of best practices and content resource experts. Serious medical gaming is developing into a useful training adjunct for the future.


Assuntos
Medicina de Emergência , Simulação de Paciente , Gestão de Riscos , Medicina de Emergência/educação , Medicina de Emergência/métodos , Medicina de Emergência/organização & administração , Humanos , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração
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