Chest tubes in COVID-19 times: a safe way to protect the team.

INTRODUCTION: What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS: A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS: This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS: Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.

Leptospirose em Bocaina do Sul ­ SC, particularidades da serra catarinense: análise de três casos / Leptospirosis in Bocaina do Sul - SC, particularities of serra catarinense: analysis of three cases

INTRODUÇÃO: A leptospirose é uma doença caracterizada por síndrome febril com início abrupto associado a calafrios, artralgias, mal estar, mialgia intensa, principalmente nas panturrilhas, anictérica em 90 a 95% dos casos e ictérica em 5 a 10% dos casos1 com período de incubação de 7 a 30 dias. MÉTODO: O objetivo desse estudo foi analisar 3 casos diagnosticados na cidade de Bocaina do Sul as particularidades na transmissão da doença. Realizada a análise prospectiva dos casos de síndrome febril abrupta, atendidos no período de julho a dezembro de 2019. Foram avaliados dados epidemiológicos, sinais e sintomas, tempo de duração da febre, sorologia, evolução, abordagem inicial e acompanhamento. RESULTADOS: Caso 1: paciente com contágio em atividade ocupacional: agricultura em área alagada, Caso 2 e 3: Contágio durante manejo de animais com finalidade econômica. DISCUSSÃO: A leptospirose é uma doença veiculada pela água contaminada com urina de animais, principalmente roedores. No estado de Santa Catarina há maior incidência da doença em áreas urbanas, A forma mais comum de transmissão é através do contato com águas de enchente e alagamentos. Em Bocaina do Sul a transmissão se deu através de exposição ocupacional nos casos avaliados. CONCLUSÃO: Observamos que os fatores de risco dos pacientes avaliados estão relacionados à exposição ocupacional e que podem ser prevenidos com a adoção de medidas de controle e de prevenção. Alto índice de suspeição e início precoce de antibióticos é fundamental em paciente com suspeita de Leptospirose.

Leptospirosis is a disease characterized by febrile syndrome with abrupt onset associated with chills, arthralgia, malaise, severe myalgia, especially in the calves, anicteric in 90 to 95% of cases and jaundice in 5 to 10% of cases1 with an incubation period of 7 to 30 days. METHOD: The objective of this study was to analyze 3 cases diagnosed in the city of Bocaina do Sul-SC particularities in the transmission of the disease. Prospective analysis of abrupt fever´s cases, attended from July to December 2019. Data were evaluated epidemiological, signs and symptoms, duration of fever, serology, evolution, initial approach and monitoring. RESULTS: Case 1: patient with contagion in occupational activity: wetland agriculture, Case 2 and 3: Contagion during animal management for the economic purpose. DISCUSSION: Leptospirosis is a disease transmitted by water contaminated with animal urine, mainly rodents. In the state of Santa Catarina there is a higher incidence of the disease in urban areas, the most common form of transmission is through contact with flood waters and flooding. In Bocaina do Sul, transmission occurred through occupational exposure in cases evaluated. CONCLUSION: We observed that the risk factors of the evaluated patients are related to occupational exposure and that can be prevented with the adoption of control and prevention. High index of suspicion and early antibiotic initiation is fundamental in patient with suspected leptospirosis.

Chest tubes in COVID-19 times: a safe way to protect the team

SUMMARY INTRODUCTION What has been published so far regarding safe methods to deal with chest tube insertion during COVID-19. METHODS A descriptive study of the literature available in the Medline/PubMed, Lilacs, Scopus databases and specialized books. The search was carried out using the terms "infectious diseases"; "COVID-19"; "Chest tubes". RESULTS This paper aggregates and consolidates some old concepts to new tactics to minimize the contamination of teams who deal with chest tubes, before, during, and after the procedure. CONCLUSIONS Health officials are under increasing pressure to control the spread of COVID-19, which is a very virulent disease. Our analysis brought together old rules against contamination along with new tactics for professionals who deal with chest drains in order to minimize the contamination of teams during the Pandemic.

Subcutaneous emphysema, a different way to diagnose.

INTRODUCTION: Subcutaneous emphysema (SE) is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the type of pathology. The most common site is under the skin that covers the chest wall or neck. It is characterized by painless swelling of tissues. The classic clinical sign is a crackling sensation upon touch, resembling that of touching a sponge beneath your fingers. OBJECTIVE: To describe a new way to diagnose subcutaneous emphysema. METHOD: Our finding was a matter of serendipity while inspecting a patient with subcutaneous emphysema using a stethoscope. Instead only hearing the patient's chest, the stethoscope was gently pressed against the skin with SE and so we were able to detect a different sound. RESULTS: This new way to diagnose subcutaneous emphysema consists in pressing the diaphragm part of stethoscope against the patient's skin where SE is supposed to be. Thus, we are able to hear a sound of small bubbles bursting. Crackle noise has an acoustic emission energy that varies between 750-1,200 Hz, considered high frequency. CONCLUSION: Although currently the use of imaging methods is widespread worldwide, we would like to strengthen the value of clinical examination. Auscultation is an essential diagnostic method that has become underestimated with the advances of healthcare and medicine as a whole. We therefore propose a different approach to diagnose SE.

Subcutaneous emphysema, a different way to diagnose / Enfisema subcutâneo: uma forma diferente de diagnosticar

Summary Introduction: Subcutaneous emphysema (SE) is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the type of pathology. The most common site is under the skin that covers the chest wall or neck. It is characterized by painless swelling of tissues. The classic clinical sign is a crackling sensation upon touch, resembling that of touching a sponge beneath your fingers. Objective: To describe a new way to diagnose subcutaneous emphysema. Method: Our finding was a matter of serendipity while inspecting a patient with subcutaneous emphysema using a stethoscope. Instead only hearing the patient's chest, the stethoscope was gently pressed against the skin with SE and so we were able to detect a different sound. Results: This new way to diagnose subcutaneous emphysema consists in pressing the diaphragm part of stethoscope against the patient's skin where SE is supposed to be. Thus, we are able to hear a sound of small bubbles bursting. Crackle noise has an acoustic emission energy that varies between 750-1,200 Hz, considered high frequency. Conclusion: Although currently the use of imaging methods is widespread worldwide, we would like to strengthen the value of clinical examination. Auscultation is an essential diagnostic method that has become underestimated with the advances of healthcare and medicine as a whole. We therefore propose a different approach to diagnose SE.

Resumo Introdução: O enfisema subcutâneo é uma condição clínica que ocorre quando o ar entra nos tecidos sob a pele. Isso pode ocorrer em qualquer parte do corpo, dependendo do tipo de patologia. O local mais comum é sob a pele que cobre a parede torácica ou o pescoço. É caracterizado por inchaço indolor de tecidos. O sinal clínico clássico é a sensação de crepitação quando se toca a região afetada, assemelhando-se à sensação de se tocar uma esponja. Objetivo: Descrever uma nova maneira de diagnosticar enfisema subcutâneo. Método: Este achado foi uma serendipidade, caracterizada por inspeção clínica de pacientes com enfisema subcutâneo com uso de estetoscópio. Além da auscultação do tórax do paciente, o estetoscópio foi suavemente pressionado contra a pele com enfisema subcutâneo, sendo possível detectar um ruído diferente. Resultados: Essa nova maneira de diagnosticar enfisema subcutâneo consiste em pressionar o diafragma do estetoscópio contra a pele do paciente supostamente afetada por enfisema subcutâneo, sendo possível ouvir o ruído de pequenas bolhas estourando. O ruído de crepitações tem uma energia de emissão acústica que varia de 750-1.200 Hz, considerada alta frequência. Conclusão: Atualmente, o uso de métodos de imagem é generalizado em todo o mundo, mas gostaríamos de fortalecer o valor do exame clínico. Embora a ausculta seja um método de diagnóstico essencial, foi subestimado à medida que os cuidados de saúde e os medicamentos avançaram. Propomos uma maneira diferente de diagnosticar enfisema subcutâneo.