Oropharyngeal Hemorrhage and Difficult Airway Management: A Decision Not to Intubate.

BACKGROUND: Bleeding in the upper airways is an important cause of airway-related death. A higher incidence of airway management failure and complications after intubation attempts in the emergency department (ED) had been suggested. Airway management of patients with active oropharyngeal hemorrhage may be challenging, leading the clinician to modify the approach. CASE REPORT: A 57-year-old woman presented to the ED with oropharyngeal hemorrhage after an extensive invasive dental procedure. She was on long-term warfarin therapy due to aortic and mitral valve replacement, which she suspended 5 days prior and restarted the day after the procedure. Besides the active bleeding, swelling, and hematoma of the face, the patient had other signs of "difficult airway," so there were serious questions on when and how to manage the airway. Several strategies to address the airway were considered, the main point being an early versus later intubation. As the patient remained clinically stable, she was conservatively managed with local hemostasis and coagulopathy reversal. The patient was transferred to the intensive care unit, where she remained stable and was successfully discharged after restart on warfarin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When faced with an oropharyngeal hemorrhage, emergency physicians may be compelled to secure and protect the airway. This could be achieved by planning several strategies. Nevertheless, in selected patients, and considering the circumstances, not addressing the airway is a reasonable and justifiable alternative.

Atitudes dos estudantes de enfermagem perante a morte e os cuidados em fim de vida / Nursing students' attitudes towards death and end-of-life care / Actitudes de los estudiantes de Enfermería ante la muerte y los cuidados al final de la vida

Resumo Enquadramento: As vivências pessoais e em ensino clínico influenciam o modo como os estudantes de enfermagem lidam com a morte. Objetivo: Avaliar as atitudes dos estudantes de enfermagem perante a morte e os cuidados em fim de vida. Metodologia: Estudo descritivo. Os dados foram recolhidos através de um questionário online. Participaram 158 estudantes do curso de licenciatura em Enfermagem. Os dados quantitativos foram analisados com recurso ao programa IBM SPSS Statistics. Foram realizadas análises estatísticas descritivas e exploratórias dos dados através de testes paramétricos e não paramétricos. Resultados: Os estudantes evidenciam maior proximidade com atitudes de neutralidade, medo e aproximação perante a morte e menos proximidade com atitudes de evitamento e escape. Relativamente aos cuidados em fim de vida, os estudantes que já realizaram ensino clínico apresentam atitudes positivas. Conclusão: É importante utilizar metodologias de ensino/aprendizagem que permitam ao estudante expor as suas experiências com a morte e com os cuidados em fim de vida em ensino clínico.

Abstract Background: Personal and clinical experiences influence how nursing students cope with death. Objective: To assess nursing students' attitudes towards death and end-of-life care. Methods: Descriptive study. Data were collected through an online questionnaire. The sample consisted of 158 undergraduate nursing students. Quantitative data were analyzed using IBM SPSS Statistics software. Descriptive statistics and exploratory data analysis were performed through parametric and non-parametric tests. Results: Students tend more to attitudes of neutral acceptance, fear of death, and approach acceptance and less to attitudes of avoidance and escape. Regarding end-of-life care, students who had already completed clinical training showed positive attitudes. Conclusion: Teaching and learning methodologies should be used to allow students to expose their experiences with death and end-of-life care in clinical training.

Resumen Marco contextual: Las experiencias personales y en la enseñanza clínica influyen en el modo en que los estudiantes de enfermería se enfrentan a la muerte. Objetivo: Evaluar las actitudes de los estudiantes de Enfermería hacia la muerte y los cuidados al final de la vida. Metodología: Estudio descriptivo. Los datos se recogieron mediante un cuestionario en línea. Participaron un total de 158 estudiantes de la licenciatura de Enfermería. Los datos cuantitativos se analizaron con el programa IBM SPSS Statistics. Se realizaron análisis estadísticos descriptivos y exploratorios de los datos mediante pruebas paramétricas y no paramétricas. Resultados: Los estudiantes mostraron una mayor proximidad a las actitudes de neutralidad, miedo y cercanía hacia la muerte, y una menor proximidad a las actitudes de evitación y huida. Con respecto a los cuidados al final de la vida, los estudiantes que ya han realizado la enseñanza clínica tienen actitudes positivas. Conclusión: Es importante utilizar metodologías de enseñanza/aprendizaje que permitan a los estudiantes exponer sus experiencias con la muerte y los cuidados al final de la vida en la enseñanza clínica.