Clinical guidelines for stroke management: chapter 1 of 8: pre-hospital care

The Stroke Foundation is a national charity that partners with the community to prevent, treat and beat stroke. We stand alongside stroke survivors and their families, healthcare professionals and researchers. We build community awareness and foster new thinking and innovative treatments. We support survivors on their journey to live the best possible life after stroke. We are the voice of stroke in Australia and we work to: • Raise awareness of the risk factors, signs of stroke and promote healthy lifestyles. • Improve treatment for stroke to save lives and reduce disability. • Improve life after stroke for survivors. • Encourage and facilitate stroke research. • Advocate for initiatives to prevent, treat and beat stroke. • Raise funds from the community, corporate sector and government to continue our mission. The Stroke Foundation has been developing stroke guidelines since 2002 and in 2017 released the fourth edition. In order for the Australian Government to ensure up-to-date, best-practice clinical advice is provided and maintained to healthcare professionals, the NHMRC requires clinical guidelines be kept current and relevant by reviewing and updating them at least every five years. As a result, the Stroke Foundation, in partnership with Cochrane Australia, have moved to a model of living guidelines, in which recommendations are continually reviewed and updated in response to new evidence. This approach was piloted in a three year project (July 2018 - June 2021) funded by the Australian Government via the Medical Research Future Fund. This online version of the Clinical Guidelines for Stroke Management updates and supersedes the Clinical Guidelines for Stroke Management 2017. The Clinical Guidelines have been updated in accordance with the 2011 NHMRC Standard for clinical practice guidelines and therefore recommendations are based on the best evidence available. The Clinical Guidelines cover the whole continuum of stroke care, across 8 chapters. Review of the Clinical Guidelines used an internationally recognised guideline development approach, known as GRADE (Grading of Recommendations Assessment, Development and Evaluation), and an innovative guideline development and publishing platform, known as MAGICapp (Making Grade the Irresistible Choice). GRADE ensures a systematic process is used to develop recommendations that are based on the balance of benefits and harms, patient values, and resource considerations. MAGICapp enables transparent display of this process and access to additional practical information useful for guideline recommendation implementation.

La visión de los profesionales sanitarios del proceso diagnóstico de las mujeres con cáncer de ovario en Catalunya: estudio cualitativo / Health professionals’ perspective about women's experiences during the diagnostic process of ovarian cancer in Catalonia: Qualitative study

Objetivo: Identificar las oportunidades perdidas en el diagnóstico del cáncer de ovario (CO) en el sistema sanitario público de Catalunya mediante el análisis de la visión de los profesionales sobre el relato de las experiencias de las pacientes con CO. Diseño: Estudio cualitativo exploratorio-descriptivo, con dos grupos focales. Emplazamiento: Atención primaria, noviembre de 2017. Participantes: Treinta y cuatro profesionales en base a un muestreo teórico: 21médicos de familia, 8profesionales de centros de salud sexual y reproductiva y 5ginecólogos de hospital. Métodos: Los participantes debatieron sobre diferentes itinerarios de procesos diagnósticos de mujeres con CO mediante la exposición de tres flujogramas elaborados a partir de los relatos obtenidos en entrevistas a pacientes. Se realizó un análisis de contenido temático. Resultados: Se identificaron tres temas con diversos subtemas: a)falta de sospecha diagnóstica (desconocimiento de los síntomas, obviar la anamnesis y la exploración física, fragmentación de la atención y sesgos y prejuicios); b)dificultades para activar el proceso diagnóstico (acceso limitado a pruebas, accesibilidad desigual a ginecología y falta de seguimiento), y c)ausencia de circuitos rápidos preestablecidos. Conclusiones: Los resultados ofrecen una visión de las dificultades del diagnóstico precoz del CO en nuestro ámbito. Creemos que su identificación permitirá la elaboración de estrategias para mejorar la precisión diagnóstica y la calidad de la atención en las mujeres con CO en nuestro medio.(AU)

Objective: To identify missed opportunities in the diagnosis of ovarian cancer (OC) in the public health system of Catalonia, through the analysis of the perceptions of health professionals on the stories's experiences of OC patients. Design: Qualitative exploratory-descriptive study, with two focus groups. Setting: Primary Care, November 2017. Participants: Thirty-four professionals based on theoretical sampling: 21 family doctors, 8 professionals from sexual and reproductive health centres and 5 hospital gynaecologists. Methods: Participants discussed the different diagnostic pathways for women with OC through the presentation of flowcharts which were developed with three storie's and experiences of OC patients. Results: Three themes with various sub-themes were identified as follow: a)lack of cancer diagnostic suspicion (lack of knowledge of symptoms of OC, anamnesis and physical examination overlooked, fragmentation of patient's care and bias and prejudice); b)difficulties in activating the diagnostic process (limited access to tests, unequal accessibility to gynaecology and lack of follow-up); and c)absence of fast-track referral system.Conclusions: The results offer insight into the difficulties of early diagnosis of OC in our setting. We believe that their identification will allow the development of strategies to improve diagnostic accuracy and quality of care for women with OC in our setting.(AU)

Fatores relacionados às readmissões ao Serviço de Atendimento Móvel de Urgência / Factores relacionados con los retornos al Servicio Móvil de Atención de Urgencias / Factors related to readmissions to the Mobile Emergency Care Service

Resumo Objetivo analisar os fatores associados à readmissão de atendimento ao Serviço de Atendimento Móvel de Urgência (SAMU). Método estudo epidemiológico, do tipo seccional. Analisaram-se dados de 600 pacientes adultos atendidos pelo serviço de um município do interior de São Paulo, Brasil, no ano de 2015. Uma regressão logística múltipla identificou os fatores associados à readmissão. Resultados predominaram o atendimento de ocorrências clínicas, pacientes do sexo masculino e média de idade de 55,5 anos. Identificou-se um retorno de 26,7% nos seis meses seguintes ao atendimento no serviço pré-hospitalar. As readmissões se associaram aos fatores clínicos dos pacientes, aos procedimentos realizados no ambiente pré-hospitalar móvel e ao fluxo intra-hospitalar. Ademais, foi possível verificar relação com a região da cidade na qual o estudo foi realizado. Conclusão e implicações para a prática a análise mostrou um perfil de atendimentos a pacientes com idade média de 55 anos e acometidos por doenças crônicas não transmissíveis. A chance de retorno se associou à natureza clínica da doença, aos fluxos assistenciais e à região do atendimento. Estudos como este auxiliam no planejamento e na elaboração de políticas públicas e ações em saúde condizentes com as necessidades identificadas, com potencial de auxiliar na diminuição da sobrecarga dos serviços de urgência.

Resumen Objetivo analizar los factores asociados al retorno al Servicio de atención móvil de urgencias. Método estudio epidemiológico transversal. Se analizaron datos de 600 pacientes adultos atendidos por el servicio en una ciudad del interior de São Paulo, Brasil, en 2015. La regresión logística múltiple identificó factores asociados con el retorno. Resultados predominó la asistencia a eventos clínicos, sexo masculino y edad media de 55,5 años. Se identificó un retorno del 26,7% a los seis meses de atención en el servicio prehospitalario. Las recaídas se asociaron con los factores clínicos de los pacientes, los procedimientos realizados en el ambiente prehospitalario móvil y el flujo intrahospitalario. También es posible verificar una relación con la región de la ciudad en la que se realizó el estudio. Conclusión e implicaciones para la práctica el análisis mostró un perfil de atención para pacientes con una edad promedio de 55 años y afectados por enfermedades crónicas no transmisibles. La posibilidad de retorno se asoció con la naturaleza clínica de la enfermedad, los flujos de atención y la región de atención. Estudios como este ayudan en la planificación y elaboración de políticas públicas y acciones de salud acordes con las necesidades identificadas, con el fin de reducir la sobrecarga de los servicios de emergencia.

Abstract Objective to analyze the factors associated with readmission to the Mobile Emergency Care Service. Method this is an epidemiological, cross-sectional study. Data from 600 adult patients served by the service in a municipality in the countryside of São Paulo, Brazil, in 2015 were analyzed. Multiple logistic regression identified the factors associated with readmission. Results clinical occurrences, male sex, and a mean age of 55.5 years predominated. A 26.7% return rate within six months of prehospital service was identified. Readmissions were associated with patients' clinical factors, procedures performed in the mobile prehospital environment, and intra-hospital flow. Additionally, a relationship with the region of the city where the study was conducted was observed. Conclusion and implications for the practice the analysis revealed a profile of patients with a mean age of 55 years and afflicted by chronic non-communicable diseases. The likelihood of return was associated with the clinical nature of the disease, care flows, and the service region. Studies similar to this one assist in planning and developing public policies and health actions in line with identified needs, aiming to reduce the burden on emergency services.

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

Introduction: Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research. Methods: We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data. Results: Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, p < 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted. Conclusion: A CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Introduction: Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. Methods: In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants' perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. Results: Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. Conclusion: Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.

De un centro de trauma a un sistema de trauma en el suroccidente colombiano / From a Trauma Center to a Trauma System in Southwest Colombia

Introducción. El objetivo de este estudio fue evaluar el impacto sobre la mortalidad según el perfil de ingreso a un centro de trauma del suroccidente colombiano, como método para entender las dinámicas de atención del paciente con trauma. Métodos. Se realizó un subanálisis del registro de la Sociedad Panamericana de Trauma asociado a un centro de trauma en el suroccidente colombiano. Se analizaron los pacientes atendidos entre los años 2012 y 2021. Se compararon los pacientes con condición de ingreso directo y aquellos que ingresaron remitidos. Se hicieron análisis de poblaciones de interés como pacientes con trauma severo (ISS > 15) y pacientes con/sin trauma craneoencefálico. Se evaluó el impacto de los pacientes remitidos y su condición al ingreso sobre la mortalidad. Resultados. Se incluyeron 10.814 pacientes. La proporción de pacientes remitidos fue del 54,7 %. Los pacientes que ingresaron remitidos presentaron diferencias respecto a la severidad del trauma y compromiso fisiológico al ingreso comparado con los pacientes con ingreso directo. Los pacientes remitidos tienen mayor riesgo de mortalidad (RR: 2,81; IC95% 2,44-3,22); sin embargo, es el estado fisiológico al ingreso lo que impacta en la mortalidad. Conclusión. Los pacientes remitidos de otras instituciones tienen un mayor riesgo de mortalidad, siendo una inequidad en salud que invita a la articulación de actores institucionales en la atención de trauma. Un centro de trauma debe relacionarse con las instituciones asociadas para crear un sistema de trauma que optimice la atención de los pacientes y la oportunidad

Introduction. This study aims to evaluate the impact on mortality by admission profile to a trauma center in Southwest Colombia between direct and referred patients, as a method to understand the dynamics of trauma care.Methods. A sub-analysis of the Panamerican Trauma Society registry associated with a trauma center in Southwest Colombia was performed. Patients attended between 2012-2021 were analyzed. Patients with direct admission and referred condition were compared. Analyses of populations of interest such as patients with severe trauma (ISS > 15) and patients with/without brain trauma were made. The impact of referred patients and their admission status on mortality was evaluated. Results. A total of 10,814 patients were included. The proportion of referred patients was 54.7%. Patients admitted referred vs. with direct admission have differences regarding trauma severity and physiological compromise on admission. The referred patient has a higher risk of mortality (RR: 2.81; 95% CI 2.44-3.22). There is a high proportion of penetrating trauma by gunshot wounds. However, it is the physiological state at admission that impacts mortality. Conclusion. Patients referred from other institutions have a higher mortality risk, being a health inequity that invites the articulation of institutional actors in trauma care. A trauma center should relate to partner institutions to create a trauma system that optimizes care and timeliness

Assistência de urgência e emergência: desafios no atendimento a múltiplas vítimas / Urgency and emergency assistance: challenges in caring for multiple victims / Urgencias y emergencias: retos en la atención a múltiples víctimas

A urgência e emergência, por sua vez, se faz como ocorrência imprevista com ou sem risco potencial à vida, onde o indivíduo necessita de assistência e pressupõem atendimento rápido, proporcional a sua gravidade. O presente trabalho tem o objetivo de promover reflexões acerca dos desafios que surgem diante do atendimento a múltiplas vítimas nos serviços médicos de urgência e emergência. Trata-se de uma revisão integrativa da literatura. Realizou-se uma análise de materiais já publicados na literatura e artigos científicos divulgados em bases de dados: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e Localizador de informação em Saúde. Foram encontradas nas bases de dados, 25 estudos completos, após a leitura dos resumos, 21 artigos foram selecionados para análise na íntegra, sendo 17 eleitos para integrar a revisão integrativa. Diante dos resultados obtidos, observou que as equipes de atendimento pré- hospitalar vivenciam desafios para atender múltiplas vítimas, e dentro desse paradigma existem várias etapas que devem ser seguidas, que envolvem comunicação desde um protocolo de atendimento inicial ao transporte final. Portanto, observa-se a necessidade de maiores estudos e desenvolvimento de novas tecnologias que auxiliam na assistência a múltiplas vítimas, como também o prepara e atualização dos profissionais.

Urgency and emergency, in turn, is made as an unforeseen occurrence with or without potential risk to life, where the individual needs assistance and quick care, in turn, proportional to its severity. The work of emergency care and the need to respond to problems presented in urgent and emergency services. This is an integrative literature review. An analysis was performed of materials already published in the literature and articles published in databases: Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online and Health Information Locator. All studies were complete, after reading the studies,21 articles were selected for full analysis, with 17 studies elected to integrate the integrative review. Results obtained, observed that pre care teams experience challenges to support various hospital communication protocols, and within these paradigms from initial care to transport. Therefore, there is a need for studies and development of technologies that assist in the installation of larger and more up-to-date devices, there is a need for studies and development of new technologies, as well as preparation.

La atención de urgencia y emergencia es un suceso imprevisto con o sin riesgo potencial para la vida, en el que el individuo necesita asistencia y requiere una atención rápida, proporcional a su gravedad. Este documento pretende promover la reflexión sobre los retos que surgen al tratar con múltiples víctimas en los servicios médicos de urgencia y emergencia. Se trata de una revisión bibliográfica integradora. Se ha realizado un análisis de los materiales publicados en la literatura y los artículos científicos divulgados en las bases de datos: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online y Localizador de información en Salud. Se encontraron en las bases de datos, 25 estudios completos, después de leer los resúmenes, se seleccionaron 21 artículos para el análisis en su totalidad, siendo 17 elegidos para integrar la revisión integradora. A partir de los resultados obtenidos, se observa que los equipos de atención prehospitalaria viven desafíos para atender a múltiples víctimas, y dentro de este paradigma existen varias etapas que deben seguirse, que implican la comunicación desde un protocolo de atención inicial hasta el transporte final. Por lo tanto, se observa la necesidad de realizar más estudios y desarrollar nuevas tecnologías que ayuden en la asistencia a las múltiples víctimas, así como la preparación y actualización de los profesionales.

Evaluación y satisfacción del debriefing facilitado por un instructor frente al facilitado por iguales / Assessment and satisfaction regarding the debriefing provided by an instructor vs. the one provided by peers

Objetivo: comparar la evaluación y la satisfacción de las personas participantes del debriefing facilitado por iguales frente al realizado por instructores en simulación clínica de alta fidelidad en un postgrado en Enfermería en Emergencias Extrahospitalarias. Método: estudio cuasiexperimental realizado en 2019 en la Universidad Rey Juan Carlos (Madrid). La población fueron todos los enfermeros matriculados por primera vez. Se asignaron a grupo control (debriefing facilitado por instructoras experimentadas - GC) o grupo intervención (facilitado por iguales a quienes se formó dos horas en debriefing - GI). Tras cada simulación (cuatro en total) se evaluaron los debriefing mediante el cuestionario EDSS© (29 ítems de mín. 1 a máx. 7 puntos) y la satisfacción (mín. 1 a máx. 7 puntos). Se efectuó estadística descriptiva y comparación de los resultados globales de las cuatro sesiones en ambos grupos. Resultados: participaron las 30 personas matriculadas. La evaluación con el cuestionario EDSS© fue similar en ambos grupos, excepto en la capacidad del facilitador para establecer un ambiente de aprendizaje estimulante (GC = 6,61; GI = 6,23; p= 0,019) y en el nivel de conocimientos de este y su empleo para ayudar al participante a mejorar su rendimiento futuro (GC = 6,74; GI = 6,33; p= 0,003). La satisfacción global fue similar en ambos grupos (GC = 6,63; GI = 6,55; p= 0,374). Conclusiones: el debriefing facilitado por un igual supone una alternativa al debriefing tradicional en la formación de enfermeras de postgrado en relación con los resultados de evaluación de participantes y su satisfacción, si bien han de evaluarse también otros aspectos.(AU)

Objective: to compare the assessment and satisfaction by participants for the debriefing provided by peers vs. the one conducted by instructors in a high fidelity clinical simulation at a post-graduate Nursing course on Out-of-Hospital Emergencies. Method: a quasi-experimental study conducted in 2019 at the Universidad Rey Juan Carlos (Madrid). The population consisted in nurses who had been enrolled for the first time. They were assigned to a control arm (debriefing provided by experienced instructors – CA) or an intervention arm (provided by peers who received a 2-hour training on debriefing – IA). After each simulation (four in total) debriefings were assessed through the EDSS© questionnaire (29 items from 1 to 7 scores), and satisfaction (from 1 to 7 scores). Descriptive statistics was conducted as well as comparison for the overall results of the four sessions in both arms. Results: all the 30 persons enrolled participated in the study. The evaluation with the EDSS© questionnaire was similar in both arms, except in the ability of the facilitator to establish a stimulating learning environment (CA = 6.61; IA = 6.23; p= 0.019) and in the level of knowledge of the facilitator and how they used it to help the participants to improve their future performance (CA = 6.74; IA = 6.33; p= 0.003). Overall satisfaction was similar in both arms (CA = 6.63; IA = 6.55; p= 0.374). Conclusions: debriefing facilitated by a peer represents an alternative to traditional debriefing in post-graduate nurse training, based on the evaluation results of participants and their satisfaction; however, other aspects should also be assessed.(AU)

Desgaste laboral en personal prehospitalario en México durante la pandemia de 2020 / Burnout in prehospital staff in Mexico during the 2020 pandemic

El burnout (desgate emocional) es una problemática que tiene consecuencias en las y los trabajadores expuestos a determinados riesgos y exigencias. Durante la pandemia por COVID-19 en México aumentó la carga laboral del personal de salud, por lo que esta investigación tiene como propósito explorar la relación entre los datos sociodemográficos, de salud, de las condiciones laborales y burnout entre los profesionales de salud de atención prehospitalaria a inicios de la pandemia en México. Materiales y Métodos: Estudio cuantitativo y descriptivo, se realizó una encuesta en línea en la que participaron 80 trabajadores/as del área prehospitalaria de un universo de aproximadamente 21 mil personas para indagar sus condiciones laborales y la exposición a factores estresantes, así como la prevalencia de la despersonalización, el agotamiento emocional y la realización personal, dimensiones emocionales que definen el burnout. Resultados: El 11.25% de la muestra presenta burnout de acuerdo con el instrumento; en el resto de la muestra destaca que un porcentaje alto de participantes, no tienen burnout, refieren niveles elevados de despersonalización y agotamiento emocional, lo que indica un síndrome en proceso, por lo que es importante dar seguimiento para evitar el avance del burnout en el personal de salud en general y el prehospitalario en particular. Conclusiones: El personal prehospitalario reconoce su trabajo como actividad de riesgo, no obstante, también destacan que su labor favorece la realización personal y la ayuda a otros, que funcionan como factores protectores(AU)

Burnout (emotional exhaustion) is a problem that has consequences for workers, exposed to certain risks and demands. During the COVID-19 pandemic in Mexico, the workload of health workers increased, so this research aims to explore the relationship between sociodemographic, health, working conditions and burnout syndrome data between prehospital care health professionals at the beginning of the pandemic in Mexico. Materials and Methods: Quantitative and descriptive study, an online survey was carried out in which 80 workers from the pre-hospital area participated to investigate their working conditions and exposure to stressors, as well as the prevalence of depersonalization, exhaustion emotional and personal fulfillment, which are the emotional dimensions that define burnout. Results: 11.25% of the sample presents burnout according to the instrument; In the rest of the sample, it stands out that a high percentage of participants, who do not have burnout, report high levels of depersonalization and emotional exhaustion, which indicates a syndrome in process, so it is important to follow up to avoid the progression of burnout in health personnel in general and pre-hospital personnel in particular. Conclusions: The prehospital staff recognize their work as a risky activity; however, they also emphasize that their work favors personal fulfillment and helps others, which function as protective factors(AU)

Norma técnica de salud de la atención pre-hospitalaria y transporte asistido de pacientes con diagnóstico o Sospecha de Covid-19. NTS Nº 186-MINSA/DIGTEL/2022 / Technical health standard for pre-hospital care and assisted transport of patients with a diagnosis or suspicion of Covid-19. NTS No. 186-MINSA/DIGTEL/2022

La norma contiene los procesos, procedimientos y condiciones especificas para la atención prehospitalaria y el transporte asistido de pacientes con diagnóstico o sospecha de COVID-19

Caracterização de vídeos no youtube sobre o transporte aeromédico do politraumatizado / Caracterización de videos en youtube sobre el traslado aeromédico del politraumatizado / Characterization of videos on youtube about the aeromedical transport of multiple trauma patients

Objetivo: caracterizar os vídeos do YouTube sobre o transporte aeromédico do politraumatizado. Método: estudo descritivo e quantitativo, realizado mediante acesso à plataforma de vídeos YouTube, entre julho e setembro de 2021, com utilização de instrumento composto por 13 variáveis que foram tabuladas e analisadas de maneira descritiva por software. Resultados: foram encontrados quatro vídeos, postados entre 2018 e 2021, dos quais a maioria foi postada em canais pessoais, em sua maior parte destinados aos profissionais da saúde, com predominância de médicos na narração. Os vídeos com mais inscritos nos canais e aqueles mais curtos obtiveram maior número de visualizações. Conclusão: os vídeos da plataforma YouTube sobre o transporte aeromédico do politraumatizado foram voltados aos profissionais da saúde, no entanto, há carência de citação de portarias, conselhos profissionais, legislações, além de atribuições dos profissionais que atuam no cuidado de saúde ao paciente com múltiplos traumas nesse tipo de transporte(AU)

Objective: to characterize YouTube videos about the aeromedical transport of polytraumatized patients. Method: descriptive and quantitative study, carried out through access to the YouTube video platform, between July and September 2021, using an instrument composed of 13 variables that were tabulated and analyzed in a descriptive way by software. Results: four videos were found, posted between 2018 and 2021, most of which were posted on personal channels, mostly aimed at health professionals, with a predominance of doctors in the narration. The videos with the most subscribers on the channels and the shortest ones got the most views. Conclusion: the videos on the YouTube platform about the aeromedical transport of polytraumatized patients were aimed at health professionals, however, there is a lack of citation of ordinances, professional advice, legislation, in addition to the attributions of professionals who work in health care for patients with multiple trauma in this type of transport(AU)

Objetivo: caracterizar videos de YouTube sobre el transporte aeromédico de pacientes politraumatizados. Método: estudio descriptivo y cuantitativo, realizado a través del acceso a la plataforma de videos YouTube, entre julio y septiembreVde 2021, utilizando un instrumento compuesto por 13 variables que fueron tabuladas y analizadas de forma descriptiva porVsoftware. Resultados: se encontraron cuatro videos, publicados entre 2018 y 2021, la mayoría de los cuales fueron publicadosVen canales personales, en su mayoría dirigidos a profesionales de la salud, con predominio de médicos en la narración. LosVvideos con más suscriptores en los canales y los que eran más cortos tenían la mayor cantidad de vistas. Conclusión: los videosVen la plataforma de YouTube sobre el transporte aeromédico de pacientes politraumatizados fueron dirigidos a los profesionalesVde la salud, sin embargo, falta la citación de ordenanzas, consejos profesionales, legislación, además de las atribuciones de losVprofesionales que actúan en la atención de la salud para pacientes politraumatizados en este tipo de transporte.(AU)

Factores asociados a la mortalidad intrahospitalaria y reingreso en una cohorte tratada con ventilación no invasiva en urgencias extrahospitalarias y hospitalarias: estudio VentilaMadrid / Factors associated with in-hospital mortality and readmission in a cohort of patients treated with noninvasive ventilation during emergency department or out-of-hospital emergency care: the VentilaMadrid study

Objetivo. Describir las características clínicas, evolutivas y los factores pronóstico de una cohorte de pacientes trata- dos con ventilación no invasiva (VNI) en servicios de urgencias extrahospitalarios (SUEH) y hospitalarios (SUH). Método. Estudio de cohortes multicéntrico, prospectivo con inclusión consecutiva de pacientes con edema agudo de pulmón o agudización de enfermedad pulmonar obstructiva crónica tratados con VNI entre noviembre 2018 y noviembre de 2020 en SUEH y SUH de la Comunidad de Madrid. Se recogieron características basales, del episodio agudo, así como variables de resultado incluyendo la mortalidad hospitalaria y el reingreso a 30 días. Resultados. Se incluyeron 317 pacientes, 132 (41,6%) en SUEH y 185 (58,4%) en SUH. Hubo 47 muertes intrahospi talarias (16,3%) y 78 reingresos a los 30 días (28,8%). No hubo diferencias en la mortalidad, pero el grupo VNI-SUEH tuvo menor reingreso a 30 días. En el análisis multivariado la mortalidad intrahospitalaria se asoció con la dependen- cia previa (OR = 2,4; IC 95%: 1,11-5,27) y el SAPS-II bajo-moderado frente al alto-muy alto (OR = 2,69; IC 95%: 1,26- 5,77). En la cohorte extrahospitalaria, la mortalidad intrahospitalaria se asoció con la retirada de la VNI en la transferencia del paciente (OR = 8,57; IC 95%: 2,19-33,60). Los reingresos a los 30 días se asociaron con inicio de VNI en el hospital (OR = 3,24; IC 95%: 2,62-6,45) y dependencia previa (OR = 2,08; IC 95%: 1,02-4,22). Conclusiones. Los pacientes de ambos grupos, SUH y SUEH, tienen un perfil clínico basal similar, aunque con mayor gravedad del episodio en el grupo SUEH. No se encontraron diferencias estadísticamente significativas en la mortalidad intrahospitalaria. Se asociaron a una mayor mortalidad la dependencia, la escala SAPS-II > 52 y la retirada de la VNI. El reingreso se asoció con la dependencia y pertenecer al grupo SUH.

Objective. To describe clinical, outcome, and risk factors in a cohort of patients treated with noninvasive ventilation (NIV) in a hospital emergency department (ED) or by out-of-hospital emergency medical services (OHEMSs). Methods. Multicenter, prospective cohort study enrolling consecutive patients with acute pulmonary edema and/or exacerbated chronic obstructive pulmonary disease who were treated with NIV between November 2018 and November 2020 in a hospital ED or OHEMS setting in Madrid. We recorded baseline data, variables related to the acute episode, and outcome variables, including in-hospital mortality and 30-day readmission. Results. A total of 317 patients were included; 132 (41.6%) were treated in an OHEMS setting and 185 (58.4%) in a hospital ED. Forty-seven (16.3%) in-hospital deaths occurred, and 78 patients (28.8%) were readmitted within 30 days. Mortality in the hospital ED and OHEMS subsamples did not differ, but the patients who received NIV in an OHEMS setting had a lower 30-day readmission rate. On multivariate analysis, in-hospital mortality was associated with prior dependence in activities of daily living in the multivariate analysis (odds ratio [OR], 2.4; 95% CI, 1.11– 5.27) and a low-moderate score on the Simplified Acute Physiology Score II (SAPS II) versus a high-very high one (OR, 2.69; 95% CI, 1.26–5.77). Mortality after OHEMS ventilation was associated with discontinuance of NIV during transfer (OR, 8.57; 95% CI, 2.19–33.60). Readmission within 30 days was associated with group (in-hospital ED application of NIV) (OR, 3.24; 95% CI, 2.62–6.45) and prior dependence (OR, 2.08; 95% CI, 1.02–4.22). [...]

Assistência de enfermagem ao paciente politraumatizado / Nursing assistance to the polytraumated patient / Asistencia de enfermería al paciente politraumado

Introdução: Politrauma é uma das maiores causas de mortalidade em pessoas adolescentes e adultos jovens, podendo levar a consequências e danos permanentes e gerar mudanças significativas na rotina pessoal, quando não ocorre o óbito. O cuidado de enfermagem é fundamental e importante a esses pacientes, a ser realizado por meio de conhecimentos específicos, visando auxiliar a qualidade assistencial. Objetivo: Descrever e destacar a importância da assistência de enfermagem a pacientes politraumatizados. Material e Método: Estudo de revisão de literatura, descritiva com abordagem qualitativa, sendo a coleta de dados realizada na base de dados BVS. Resultados: Os 8 artigos selecionados foram submetidos a Análise Temática de Conteúdo, sendo trabalhadas duas categorias temáticas: Assistência de enfermagem ao paciente politraumatizado e, Processo de enfermagem na assistência a politraumatizados. Identificou-se que o cuidado assistencial de enfermagem a esses pacientes é essencial, devendo ser prestado de maneira ágil, eficaz e segura, exigindo, portanto, treinamento e capacitação prévia do enfermeiro para identificar junto a equipe, lesões existentes, garantir a estabilização no menor tempo possível e manter a sobrevida, durante o atendimento pré-hospitalar e posteriormente no ambiente hospitalar. O processo de enfermagem inclui avaliação primária no atendimento, seguida pela secundária e as fases do processo de enfermagem devem ser asseguradas contemplando os objetivos propostos, durante todo o tratamento. Conclusão: A assistência a pacientes politraumatizados deve ser desenvolvida por meio de protocolos específicos, ordenados sequencialmente, buscando-se como medida, determinar a responsividade do indivíduo. A temática é significativa, complexa e requer novos estudos e atualizações. (AU)

Introduction: Polytrauma is one of the major causes of mortality in adolescents and young adults, and can lead to permanent consequences and damage and generate significant changes in personal routine, when death does not occur. Nursing care is fundamental and important for these patients, to be carried out through specific knowledge, aiming to help the quality of care. Objective: To describe and highlight the importance of nursing care for polytraumatized patients. Material and Method: A descriptive literature review study with a qualitative approach, with data collection carried out in the VHL database. Results: The 8 selected articles were submitted to Thematic Content Analysis, with two thematic categories being worked on: Nursing care for the polytraumatized patient and, Nursing process in the care of polytraumatized patients. It was identified that nursing care care for these patients is essential, and must be provided in an agile, effective and safe way, therefore requiring training and prior qualification of nurses to identify existing injuries with the team, ensure stabilization in the smallest possible time and maintain survival, during pre-hospital care and later in the hospital environment. The nursing process includes primary assessment in care, followed by secondary and the phases of the nursing process must be ensured, considering the proposed objectives, throughout the treatment. Conclusion: Assistance to polytraumatized patients must be developed through specific protocols, ordered sequentially, seeking as a measure, to determine the individual's responsiveness. The theme is significant, complex and requires further studies and updates.(AU)

Introducción: El politraumatismo es una de las principales causas de mortalidad en adolescentes y adultos jóvenes, pudiendo tener secuelas y daños permanentes y generar cambios significativos en la rutina personal, cuando la muerte no se presenta. El cuidado de enfermería es fundamental e importante para estos pacientes, siendo realizado a través de conocimientos específicos, con el objetivo de ayudar y mejorar la calidad del cuidado. Objetivo: Describir y resaltar la importancia del cuidado de enfermería al paciente politraumatizado. Material y Método: Estudio descriptivo de revisión bibliográfica con abordaje cualitativo, con recolección de datos realizada en la base de datos de la BVS. Resultados: Los 8 artículos seleccionados fueron sometidos al Análisis de Contenido Temático, siendo trabajadas dos categorías temáticas: Atención de Enfermería al politraumatizado y Proceso de Enfermería en el cuidado al politraumatizado. Se identificó que el cuidado de enfermería a estos pacientes es fundamental, y debe ser brindado de forma ágil, eficaz y segura, por lo que se requiere de capacitación y calificación previa de los enfermeros para identificar las lesiones existentes con el equipo, garantizar la estabilización en los más pequeños en tanto posible...(AU)

Perfil dos atendimentos pré-hospitalares em serviço de atendimento móvel de urgência no nordeste do Brasil / Perfil de la atención prehospitalaria en servicio de atención móvil de urgencia en el nordeste de Brasil / Profile of pre-hospital care in a mobile emergency care service in northeast Brazil

RESUMO Objetivo: Descrever o perfil epidemiológico dos atendimentos pré-hospitalares realizados por um serviço móvel de emergência no município de Picos, Piauí, Brasil. Métodos: Trata-se de um estudo transversal, documental e retrospectivo com abordagem quantitativa, realizado nos meses de abril e maio de 2020. Foram analisados 4.220 registros com base nos atendimentos realizados pelo Serviço de Atendimento Móvel de Urgência às ocorrências que aconteceram no período de janeiro de 2019 a março de 2020. Os dados foram coletados das fichas de atendimento individuais da instituição, organizados por meio de um formulário e analisados à luz da estatística descritiva. Resultados: Foi observada frequência de ocorrências ligeiramente maior em indivíduos do sexo masculino (50,3%), predominância das faixas etárias de 20 a 30 anos (30,7%) e maior de 60 anos (34,2%), atendimentos realizados pela Unidade de Suporte Básico (65,9%). As ocorrências traumáticas provenientes de acidentes de transporte (68,5%) e as clínicas cardiológicas (18%) se apresentaram em maior percentual em relação às demais. As ocorrências traumáticas foram mais frequentes no período de outubro a dezembro e as clínicas nos meses de fevereiro e março. Conclusão: O perfil epidemiológico dos atendimentos corresponde à população do gênero masculino e faixa etária maior ou igual a 60 anos. Predominaram as ocorrências de natureza clínica, principalmente cardiológicas.

RESUMEN Objetivo: describir el perfil epidemiológico de la atención prehospitalaria realizada por un servicio de atención móvil de urgencia en el municipio de Picos, Piauí, Brasil. Métodos: se trata de un estudio transversal, documental y retrospectivo con enfoque cuantitativo, realizado en los meses de abril y mayo de 2020. Se analizaron 4.220 registros con base en las atenciones realizadas por el Servicio de Atención Móvil de Urgencia a los casos que ocurrieron en el período de enero de 2019 a marzo de 2020. Los datos fueron recolectados de las fichas de atención individuales de la institución, organizados por medio de un formulario y analizados a la luz de la estadística descriptiva. Resultados: fue observada frecuencia de casos ligeramente mayor en individuos del sexo masculino (50,3%), predominancia de las franjas etarias de 20 a 30 años (30,7%) y mayor de 60 años (34,2%), atenciones realizadas por la Unidad de Soporte Básico (65,9%). Los incidentes traumáticos provenientes de accidentes de transporte (68,5%) y las clínicas cardiológicas (18%) se presentaron en mayor porcentaje con relación a los demás. Los incidentes traumáticos fueron más frecuentes en el período de octubre a diciembre y las clínicas en los meses de febrero y marzo. Conclusión: el perfil epidemiológico de las atenciones corresponde a la población del género masculino y franja etaria mayor o igual a 60 años. Predominaron los incidentes de naturaleza clínica, principalmente cardiológicas.

ABSTRACT Objective: To describe the epidemiological profile of pre-hospital care performed by a mobile emergency service in the municipality of Picos, Piauí, Brazil. Methods: This is a cross-sectional, documentary and retrospective study with a quantitative approach, conducted in April and May 2020. We analyzed 4,220 records based on the visits performed by the Mobile Emergency Care Service to the occurrences that occurred between January 2019 and March 2020. Data were collected from the institution's individual care forms, organized through a form and analyzed in the light of descriptive statistics. Results: A slightly higher frequency of occurrences was observed in males (50.3%), predominance of the age groups from 20 to 30 years (30.7%) and higher than 60 years (34.2%), attendances performed by the Basic Support Unit (65.9%). Traumatic occurrences resulting from traffic accidents (68.5%) and cardiologic clinics (18%) were higher in percentage in relation to the other ones. Traumatic occurrences were more frequent from October to December and clinics in February and March. Conclusion: The epidemiological profile of the visits corresponds to the male population and age group greater than or equal to 60 years. Occurrences of a clinical nature, especially cardiac, predominated.