Instructivo para elaborar un plan hospitalario de respuesta a emergencias de salud y desastres

En este manual, la Organización Panamericana de la Salud desarrolla todos los aspectos clave que deben considerarse en la planificación hospitalaria como parte de la capacidad operativa de los establecimientos de salud y otras infraestructuras para responder a emergencias y desastres de cualquier origen. La publicación comprende un conjunto de recomendaciones para la elaboración de un plan de operaciones de emergencia que contenga los elementos esenciales para operativizar la respuesta y la recuperación; los componentes de un plan hospitalario acorde, y los procesos para la disposición operativa hospitalaria ante una emergencia inminente. El despliegue de todos los componentes por apartados específicos y la inclusión de diversos modelos de formularios y listas de comprobación que tienen en cuenta medidas organizativas y protocolos imprescindibles para una adecuada respuesta permitirán que el personal de hospitales tanto públicos como privados y quienes integran los comités de gestión del riesgo en estas instituciones elaboren y supervisen el plan de respuesta más adecuado desde las etapas iniciales de preparación hasta su implementación y verificación. Se trata de un complemento del curso de autoaprendizaje Marco de Respuesta Multiamenaza: Planeamiento Hospitalario para la Respuesta a Emergencias en Salud y Desastres, que, en su tercera versión, expone los conocimientos y herramientas que habilitan la atención de las víctimas y la resolución de los problemas derivados de la afectación de los establecimientos de salud en caso de un incidente.

Hospital de Campaña de Castellón: análisis integral de su uso durante la pandemia por SARS-CoV-2 / Castellón Field Hospital: comprehensive analysis of its use during the SARS-CoV-2 pandemic

Fundamentos: Los hospitales de campaña, también conocidos comoalternative care sites, han supuesto un refuerzo sanitarioimportante durante la pandemia por SARS-CoV-2 a nivel mundial. En la Comunidad Valenciana se abrieron tres de estos hospitales,uno por cada provincia. Nuestro estudio pretendió hacer un análisis integral de dicho recurso en la provincia de Castellón.Métodos: Se realizó un estudio observacional retrospectivo con un componente analítico y estadístico de tres aspectos: lainfraestructura, la satisfacción de los pacientes atendidos y los datos o características clínicas de los pacientes ingresados positivospor COVID. Las fuentes de información fueron primarias, institucionales para el apartado de la infraestructura y personales para lasencuestas de satisfacción y los datos clínicos.Resultados: El tipo de infraestructura que se eligió fue un conjunto de tiendas modulares polivalentes de 6x3 metros que unidasformaban una superficie de una sola planta de unos 3.500 m 2. Aunque el hospital permaneció abierto durante aproximadamente añoy medio con diversas funciones, la mayoría en relación con la pandemia por COVID (centro de vacunación, observación de Urgencias,asistencia hospitalaria, almacén...), inició su acogida de pacientes positivos debido al virus durante la tercera ola de la pandemia,ejerciendo este papel durante once días. En el hospital ingresaron un total de 31 pacientes con una edad media de 57 años, de losque un 41,9% no tenían ninguna comorbilidad y un 54,8% necesitaron oxigenoterapia. La estancia media hospitalaria fue de tres días,encontrándose una relación estadísticamente significativa entre ésta, el flujo de oxígeno requerido durante el ingreso y la edad. Lasatisfacción se midió mediante una encuesta de diecisiete preguntas donde se obtuvo una media de 8,33/10.Conclusiones: Este es uno de los pocos estudios de la literatura en los que se abarca, desde puntos tan distintos, cómo funciona...(AU)

Background: Field hospitals, also known asalternative care sites, have been an important healthcare reinforcement during theSARS-CoV-2 pandemic worldwide. In the Valencian Community, three of these hospitals were opened, one for each province. Our studyaimed to make a comprehensive analysis of this resource in Castellon.Methods: A retrospective observational study was carried out with an analytical and statistical component of 3 aspects: infrastruc-ture, satisfaction and clinical data from COVID-positive hospitalized patients. The sources of information were primary, institutional for theinfrastructure and personal for the satisfaction surveys and clinical data.Results: A set of 6x3 metres polyvalent tents was chosen, which joined formed a single-floor area of about 3.500 m2. Althoughhospital opened for approximately a year and a half with multiple uses, most in relation to the COVID pandemic (vaccination center,emergency room observation, hospital assistance, warehouse...), reception of positive patients for the virus began during the thirdwave of the pandemic, remaining active for eleven days. A total of thirty-one patients with a mean age of 56 years were admitted.41.9% did not have any comorbidity and 54.8% needed treatment with oxygen therapy. Furthermore, the length of stay was threedays, finding a significant relationship between this one, the oxygen flow required during admission and the age. Satisfaction wasmeasured by a survey of seventeen questions where an average satisfaction of 8.33/10.Conclusions: This is one of the few studies in the literature in which a field hospital is analyzed from such different points ofview. After this analysis, it is concluded that it is an extraordinary and temporary resource whose use is useful without reflecting anincrease of morbidity/mortality among our patients and with a very favorable subjective assessment.(AU)

Packaged hospital food appears safe and feasible to reuse.

AIM: To determine the safety, operational feasibility and environmental impact of collecting unopened non-perishable packaged hospital food items for reuse. METHODS: This pilot study tested packaged foods from an Australian hospital for bacterial species, and compared this to acceptable safe limits. A waste management strategy was trialled (n = 10 days) where non-perishable packaged foods returning to the hospital kitchen were collected off trays, and the time taken to do this and the number and weight of packaged foods collected was measured. Data were extrapolated to estimate the greenhouse gasses produced if they were disposed of in a landfill. RESULTS: Microbiological testing (n = 66 samples) found bacteria (total colony forming units and five common species) on packaging appeared to be within acceptable limits. It took an average of 5.1 ± 10.1 sec/tray to remove packaged food items from trays returning to the kitchen, and an average of 1768 ± 19 packaged food items were per collected per day, equating to 6613 ± 78 kg/year of waste which would produce 19 tonnes/year of greenhouse gasses in landfill. CONCLUSIONS: A substantial volume of food items can be collected from trays without significantly disrupting current processes. Collecting and reusing or donating non-perishable packaged food items that are served but not used within hospitals is a potential strategy to divert food waste from landfill. This pilot study provides initial data addressing infection control and feasibility concerns. While food packages in this hospital appear safe, further research with larger samples and testing additional microbial species is recommended.

Profile of Hospitalizations of Children and Adolescents Victims of Transport Accidents: A Retrospective Study

Abstract Objective: To present the profile of hospitalizations due to transport accidents in individuals aged 0-19 years in a reference hospital for urgent and emergency traumatology care. Material and Methods: This retrospective study is grounded on analyzing medical records of children and adolescents hospitalized due to transport accidents in 2016 and 2017. The bivariate analyses included Chi-square and Fischer's exact tests and binary logistic regression, with a 5% significance level. Results: Four hundred and seventy-five (43.7%) of the 1,088 medical records investigated corresponded to transport accidents, and accidents involving motorcycles were the most frequent (68.3%), affecting adolescents (81.3%), while children were more involved in accidents as pedestrians (57.1%). Advancing age increases the likelihood of the outcome, with a significant association in the multivariate analysis (p<0.001). The mandible was most frequently affected in maxillofacial fractures. Conclusion: Transport accidents predominantly affect male adolescents, involving motorcycles, and the lower limbs are the most affected. The mandible was the most affected bone in maxillofacial fractures.

Perception and performance of the nursing team in caring for patients with suicide behavior

Objective: to understand the perception and performance of the Nursing team in a hospital emergency service in the care of patients after attempting suicide. Methods: exploratorystudy, with a qualitative approach, carried out through semi-structured interviews with Nursing professionals who work in an Emergency Service. The interviews were transcribed and analyzed as to their content following Bardin's thematic model. Results: seven nurses and four Nursing technicians participated in the study, with an average age of 36 years, most of them female. Suicide attempts are often associated with 'psychic pain' that is opposed to the principles of life preservation; such an attitude has caused suicidal behavior to be misinterpreted by health professionals. Conclusion: most professionals demonstrated a stereotyped 'pre-concept' and full of taboos about patients who attempted suicide, which triggered a service more directed to physical needs and protocol formalities. Few professionals reported carrying out holistic and empathic care, which is so necessary for these people. In this sense, the importance and urgency of training the team in the identification of suicide risks and in the continuity of treatment of surviving individuals is emphasized.

Perfil dos pacientes com crise hipertensiva atendidos em uma unidade de pronto atendimento / Perfil de los pacientes con crisis hipertensiva atendidos en una unidad de pronta atención / Profile of patients with hypertensive crisis seen in an emergency care unit

RESUMO Objetivo: descrever o perfil dos pacientes com crise hipertensiva atendidos em uma Unidade de Pronto Atendimento. Método: estudo transversal descritivo, realizado por meio da análise de 80 prontuários de pacientes com quadro de crise hipertensiva, atendidos em uma unidade de pronto atendimento, entre o período de março de 2018 a fevereiro de 2019. Os dados foram coletados por meio de roteiro estruturado e receberam tratamento estatístico descritivo. Resultados: Após a análise dos 80 prontuários, constatou-se que a média de idade entre os pacientes atendidos foi de 58,03, sendo a faixa etária adulta a mais prevalente (53,8%). Constatou-se que a média da pressão arterial sistólica foi significativamente maior em homens em relação às mulheres (p=0,013). Quanto à sintomatologia, a cefaleia foi a mais prevalente, com 35,0%. Verificou-se que durante o atendimento da crise hipertensiva, a maioria dos pacientes fez uso de apenas uma droga para redução da PA, sendo o inibidor adrenérgico de ação central o mais citado. Quanto ao desfecho, grande parte dos pacientes recebeu alta (93,8%) logo após o atendimento, porém, 6,3% permaneceram em internamento de curta permanência até a estabilização do quadro. Considerações finais: Este estudo possibilitou a caracterização da população com crise hipertensiva atendida em um pronto atendimento, a qual evidencia uma possível fragilidade existente entre a articulação dos níveis de atenção à saúde.

RESUMEN Objetivo: describir el perfil de los pacientes con crisis hipertensiva atendidos en una Unidad de Pronta Atención. Método: estudio transversal descriptivo, realizado por medio del análisis de 80 registros médicos de pacientes con cuadro de crisis hipertensiva, atendidos en una unidad de pronta atención, entre el período de marzo de 2018 a febrero de 2019. Los datos fueron recogidos por medio de guion estructurado y recibieron tratamiento estadístico descriptivo. Resultados: después del análisis de los 80 registros médicos, se constató que el promedio de edad entre los pacientes atendidos fue de 58,03, siendo la franja etaria adulta la más prevalente (53,8%). Se constató que el promedio de la presión arterial sistólica fue significativamente mayor en hombres que en las mujeres (p=0,013). En cuanto a la sintomatología, la cefalea fue la más prevalente, con 35,0%. Se verificó que, durante la atención de la crisis hipertensiva, la mayoría de los pacientes hizo uso de solo una droga para reducción de la PA, siendo el inhibidor adrenérgico de acción central el más relatado. Respecto al resultado, gran parte de los pacientes recibió el alta (93,8%) inmediatamente después de la atención, sin embargo, el 6,3% permaneció en internamiento de corta estancia hasta la estabilización del cuadro. Consideraciones finales: este estudio posibilitó la caracterización de la población con crisis hipertensiva atendida en una pronta atención, la cual evidencia una posible fragilidad existente entre la articulación de los niveles de atención a la salud.

ABSTRACT Objective: to describe the profile of patients with hypertensive crisis treated at an Emergency Care Unit. Method: descriptive cross-sectional study carried out through the analysis of 80 medical records of patients with hypertensive crisis, treated at an emergency care unit, between March 2018 and February 2019. Data were collected using a structured script and were subjected to descriptive statistical treatment. Results: after analyzing the 80 medical records, it was found that the mean age of the treated patients was 58.03, with the adult age group being the most prevalent (53.8%). It was found that the mean systolic blood pressure was significantly higher in men than in women (p=0.013). As for symptoms, headache was the most prevalent, with 35.0%. It was found that during the treatment of the hypertensive crisis, most patients used only one drug to reduce BP, with centrally acting antiadrenergic drugs being the most cited. Regarding the outcome, most of the patients were discharged (93.8%) soon after treatment; however, 6.3% remained in short-term hospitalization until their condition stabilized. Final considerations: this study made it possible to characterize the population with hypertensive crisis treated in an emergency room, showing a possible fragility in the articulation between health care levell

¿Son las alteraciones en la mucosa oral un signo de COVID-19? Estudio transversal en un Hospital de Campaña / Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital

Introducción La enfermedad por coronavirus-19 (COVID-19) se ha relacionado con múltiples síntomas: respiratorios, trombóticos, neurológicos, digestivos o cutáneos. Estos últimos se han clasificado en 5 tipos: lesiones acroisquémicas, lesiones vesiculares, erupción urticarial, exantema maculopapular o lesiones livedoides. Sin embargo, se han descrito mucho menos las alteraciones orales asociadas a la COVID-19. Pacientes y métodos Presentamos un estudio transversal realizado durante abril del 2020 en el Hospital de Campaña de IFEMA examinando la mucosa oral de 666 pacientes con COVID-19. Resultados En total, 78 pacientes (11,7%) presentaron alteraciones en la mucosa oral. La más frecuente fue papilitis lingual transitoria anterior en forma de U (11,5%) asociada o no a edema lingual (6,6%); estomatitis aftosa (6,9%), mucositis (3,9%) glositis con depapilación en parches (3,9%), boca urente (5,3%), lengua saburral (1,6%) y enantema (0,5%). La mayoría refería disgeusia asociada. Conclusión La cavidad oral se puede alterar por la enfermedad COVID-19, el edema lingual con papilitis lingual transitoria en forma de U o la glositis con depapilación en parches son los signos encontrados con mayor frecuencia, al igual que la sensación de ardor en la cavidad oral o boca urente. Otras manifestaciones orales que se pueden asociar a la COVID-19 son mucositis con o sin aftas o el enantema. Todos pueden ser signos clave para un diagnóstico de esta enfermedad (AU)

Background Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. Patients and methods We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. Results Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. Conclusion COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19 (AU)

Servicio de Anestesiología del Hospital de Urgencia Asistencia Pública: ¿Quiénes somos? / Anesthesia in Asistencia Pública Hospital. Who are we?

The Asistencia Pública was founded on August 7, 1911. It was conceived as a public hospital focused on emergency medicine. Its first location was a building acquired from the Franciscan community located at N° 85 San Francisco street, at the intersection with San Carlos street (later renamed as Alonso Ovalle). A new building was inaugurated on December 15, 1967 and its infrastructure allowed the development of various services and units that modernized, expanded and improved emergency patient care. Recently, a new facility was incorporated, called Torre Valech, inaugurated in February 2019, housing modern facilities for the emergency service, the surgical pavilions and the intensive care unit. The year 1936 marked a milestone for the Anesthesiology, due to the work of Ernesto Frías, MD, specialist trained in United States and Argentina, who organized for the first time an annual anesthesia course, working on an basis. Nevertheless, the true founder of the Anesthesiology Service and Intensive Care Unit of the José Joaquín Aguirre Hospital, was Dr. Max Arriagada Loyola. He was also a pioneer in allowing medical students to do the work of technical assistants in the specialty, during their undergraduate studies. During the eighties, the Asistencia Publica's Anesthesiology Service added new specialists who were filling the available positions both, during the daytime and on call hours. Incorporation of new technology also allowed to offer more complex and safer anesthesia procedures. Teaching has been a fundamental part of the activities of the service since its creation. First with of Dr. Arriagada's disciples, then, with the Ministerial Training Program for Anesthesiologists which in 1999 became the Postgraduate Program in Anesthesiology and Resuscitation of the Universidad de Santiago de Chile. In 2013 the program was accredited for the first time.

La Asistencia Pública fue fundada el 7 de agosto de 1911, pensada como un servicio hospitalario público centrado en los pacientes de urgencia. Su primera ubicación fue un local adquirido a la comunidad franciscana ubicada en calle San Francisco N° 85 esquina de calle San Carlos (hoy Alonso Ovalle). El nuevo edificio fue inaugurado el 15 de diciembre de 1967 y su infraestructura permitió el desarrollo de varios servicios y unidades que modernizaron, ampliaron y mejoraron la atención del paciente de urgencia. Finalmente, su última ampliación, la llamada Torre Valech, fue incorporada al edificio en febrero de 2019, albergando modernas instalaciones para la urgencia, los pabellones quirúrgicos y la Unidad de Tratamiento Intensivo. El año 1936 marcó un hito en la anestesiología de la Asistencia Pública, a partir del trabajo del doctor Ernesto Frías, especializado en Estado Unidos y Buenos Aires, quien organizó en forma un curso anual de anestesia. Pero el verdadero fundador de un servicio de anestesiología y, a su vez, de la Unidad de Tratamiento Intensivo del hospital José Joaquín Aguirre, fue el Dr. Max Arriagada Loyola, quien fue iniciador de la docencia en pregrado, para que alumnos de medicina hicieral la labor de auxiliares técnicos en la especialidad. Durante la década de los 80, el desarrollo del Servicio de Anestesiología de la Posta Central significó la suma de nuevos especialistas que fueron ocupando los cargos disponibles, tanto en horario diurno como de residencia, y la incorporación de nueva tecnología que permitió ofrecer anestesias más complejas y más seguras. La docencia ha formado parte de las actividades del servicio desde su creación: primero con los discípulos del Dr. Arriagada, luego con el Programa de Formación Ministerial de Anestesiólogos y, finalmente, se convirtió en el Programa de Postgrado en Anestesiología y Reanimación de la Universidad de Santiago de Chile a partir del año 1999, acreditándose por primera vez en el año 2013.

Análisis de la demanda de atención urgente en un municipio de la Cataluña Central / Analysis of the urgent attention demand in a municipality of the Central Catalonia

No disponible

Asistencia en cuidados críticos de una unidad de Sanidad Militar dentro del hospital de campaña en la Institución Ferial de Madrid durante la crisis SARS-CoV-2 / Assistance of a Military Health Unit deployed in «Institucion Ferial de Madrid» field hospital during SARS-CoV-2 crisis

INTRODUCCIÓN: Durante la pandemia por coronavirus SARS-CoV-2 que afectó a España durante la primavera del año 2020, muchos de los hospitales se colapsaron por la afluencia de estos pacientes. Por este motivo se desplegó en la Institución Ferial de Madrid (IFEMA) un hospital de campaña. La única unidad de críticos de este hospital fue militar. La unidad responsable de su montaje, mantenimiento y repliegue fue la Unidad Médica Aérea de Apoyo al Despliegue (UMAAD) de Madrid perteneciente al Ejército del Aire. OBJETIVO: Describir la asistencia médica prestada en la unidad de críticos de IFEMA. MATERIAL Y MÉTODOS: Estudio descriptivo prospectivo realizado del 19 de marzo al 30 de abril de 2020. Se consiguió la autorización militar de la Dirección de Sanidad del Ejército del Aire para la realización del estudio. RESULTADOS: Durante el periodo de estudio 25 pacientes ingresaron en la unidad durante la Operación «Balmis». La mayoría fueron varones y de raza hispana, el motivo de ingreso fue por neumonía por SARS-CoV-2. Se aisló la vía aérea en el 88% de los pacientes. Las principales complicaciones fueron trombosis, hemorragia e hipertensión, falleciendo tres pacientes durante la realización del estudio. CONCLUSIÓN: La experiencia adquirida en este despliegue, demuestra, una vez más, la importancia de los apoyos que la Sanidad Militar puede prestar a la Sanidad Civil en el que el componente sanitario de la gestión de crisis en territorio nacional

INTRODUCTION: During the coronavirus SARS-CoV-2 pandemic that affected Spain in spring of 2020, many of hospitals were collapsed by these patients. For this reason, a field hospital was deployed at the «Institución Ferial de Madrid» (IFEMA). The only critical unit of this field hospital was military. The unit responsible for its deployment, maintenance and withdrawal was UMAAD (Madrid Deployment Support Air Medical Unit belonging to the Air Force). OBJECTIVE: To describe medical assistance provided in the IFEMA critical unit. MATERIAL AND METHODS: Prospective descriptive study carried out from March 19 to April 30, 2020. The pertinent military authorization (Air Force Health Service Director) was obtained to carry out the study. RESULTS: During the study time, 25 critically ill patients were admitted. Most of them were male and Hispanic race. SARS-CoV-2 pneumonia was the reason for hospital admission. Airway was performed in 88% of patients. Principal complications were thrombosis, hemorrhage and hypertension. Three patients died during this research paper. CONCLUSION: The experience acquired in this deployment demonstrates, once again, the importance of the support that Military Health can provide to Civil Health in the component of crisis management in national territory

Evaluación de las prácticas de prevención y control de infecciones en zonas de aislamiento para COVID-19 en establecimientos de salud, 14 de abril de 2020

Las prácticas de prevención y control de infecciones necesitan implementarse para garantizar la seguridad de los trabajadores de salud y pacientes en establecimientos de salud, es fundamental prevenir la contaminación cruzada y contener la propagación del COVID 19. • Al día de esta publicación, están recomendadas las siguientes precauciones para el cuidado del paciente con sospecha o confirmación de COVID-19‡: o Para cualquier caso sospechoso o confirmado de COVID-19: precauciones estándares + contacto + precauciones en la transmisión por gotitas o Para cualquier caso sospechoso o confirmado de COVID-19 y procedimientos generadores de aerosoles: precauciones estándares + contacto + transmisión aérea (aerosoles o núcleo de gotitas) • Los resultados de la aplicación de esta herramienta de evaluación, en conjunto con otras herramientas§, proveerán una visión general sobre el cumplimiento de las actividades de prevención y control de infecciones asociadas a la atención médica en un establecimiento de salud, sin realizar juicios sobre el riesgo individual de los pacientes, o en casos particulares. Por su naturaleza, esta herramienta es sólo un diagnóstico externo de apoyo a profesionales de PCI y gerentes para evaluar las brechas y tomar medidas correctivas.

Crescimento dos leitos de UTI no paísdurante a pandemia de Covid-19: desigualdades entre o público x privado e iniquidades regionais / Growth of ICU beds in the country during the Covid-19 pandemic: inequalities between public vs. private and regional inequities

Analisou-se uma das dimensões de maior impacto no combate ao vírus e na assistência à população, a oferta de leitos de UTI disponíveis no Brasil. Com as notícias de instalação de hospitais de campanha, de criação de leitos e de tentativas de reabrir ou disponibilizar leitos públicos não utilizados, criou-se uma metodologia para investigar a expansão desses leitos em todo o país, segmentando os resultados por região geográfica.

Lesão labial por mordedura animal em criança: relato de caso / Lip injury by animal bite

As mordeduras de animais estão entre os tipos mais comuns de traumatismos, aos quais o homem está exposto, em que os ferimentos em face representam 15% dos atendimentos hospitalares de emergência, e a infecção é a principal complicação associada. Essas injúrias acometem duas vezes mais crianças, com comprometimento das regiões de nariz, orelha, bochechas e lábios. Apresentam-se desde abrasões superficiais até ferimentos profundos, causando prejuízos estéticos e funcionais às vítimas. O objetivo deste trabalho é mostrar a conduta frente a essas lesões, que ainda não é consensual, principalmente do ponto de vista do fechamento primário da ferida e da antibioticoterapia profilática para doenças infectocontagiosas, originadas a partir do contato da saliva do animal com a ferida. Paciente, 1 ano e 4 meses, vítima de mordedura animal, atendida pelo Serviço de Cirurgia e Traumatologia Buco Maxilo Facial do Hospital de Emergência e Trauma Senador Humberto Lucena, João Pessoa - PB, tratado, sob anestesia geral, por reparo primário, associado à antibioticoterapia e imunização antitetânica, evoluindo sem sinais flogísticos e com resultado estético satisfatório. Frente a casos de mordedura animal, o profissional deve estar apto a reconhecer, diagnosticar e indicar a terapia correta. Ainda para esses ferimentos em face, vale a indicação de fechamento primário destas, por questões estéticas e por se tratar de uma região ricamente vascularizada... (AU)

Animal bites are among the most common types of trauma to which the man is exposed, where face injuries account for 15% of emergency hospital visits, and infection is the main complication associated. These injuries affect children twice, with involvement of the nose, ear, cheeks and lips. They range from superficial abrasions to deep wounds, causing aesthetic and functional damage to the victims. The aim of this study is to show the behavior of these lesions, which is still not consensual, mainly from the point of view of the primary closure of the wound and the prophylactic antibiotic therapy for infectocontacting diseases, originated from the contact of the saliva of the animal with the wound. Patient, 1 year and 4 months, victim of animal bite, attended by the Service of Maxillofacial Surgery and Traumatology of the Hospital of Emergency and Trauma Senador Humberto Lucena, João Pessoa-PB, treated, under general anesthesia, by primary repair, associated with antibiotic therapy and tetanus immunization, evolving without phlogistic signs and with a satisfactory aesthetic result. Faced with cases of animal bite the professional must be able to recognize, diagnose and indicate the correct therapy. Still for these injuries in face it is worth indicating the primary closure of the same ones, for esthetic reasons and because it is a richly vascularized region... (AU)

Conhecimento sobre asma de pediatras de hospitais públicos do Rio de Janeiro / Asthma knowledge among pediatricians at public hospitals in Rio de Janeiro, Brazil

Objetivo: Avaliar o conhecimento, atitudes e práticas sobre asma de pediatras que atuavam em serviços públicos hospitalares. Métodos: Estudo descritivo transversal envolvendo 76 pediatras de quatro hospitais públicos de emergência do município do Rio de Janeiro (RJ). Foram avaliados o conhecimento global (CGA) e específico sobre asma, além de atitudes e práticas, como frequência de prescrição de ß2-agonistas através de aerossol dosimetrado (AD), encaminhamento ao especialista, uso de espaçadores e do medidor do pico de fluxo expiratório (PFE). Resultados: Em relação ao CGA, 73,7% (55/76) da amostra total obteve conceito final insuficiente. Classificação e tratamento da asma alcançaram os percentuais mais baixos de acertos, 23,7% e 14,5% respectivamente. Somente 13,2% dos participantes utilizaram o PFE frequentemente, e a prescrição de ß2-agonistas através de AD foi indicada por apenas 21,9% da amostra, porém esta prática associou-se de modo significativo com o uso frequente de espaçadores (RP = 8,75; IC 95%: 1,07-71,06; p = 0,028) e do PFE (RP = 10,80; IC 95%: 2,31-50,45; p = 0,003). Houve forte associação entre ser alergista/pneumologista pediátrico e CGA suficiente (RP = 8,28; IC 95%: 1,46-46,8; p = 0,015) e uso frequente do PFE (RP = 6,64; IC 95%: 1,22-35,95; p = 0,044). Conclusões: O nível de conhecimento sobre asma dos pediatras que atuavam nos hospitais de emergência avaliados foi insatisfatório. Houve baixa utilização do PFE e subutilização de ß2-agonistas através de AD. A especialização melhorou a compreensão global da doença. Estes resultados reforçam a necessidade de estratégias na educação médica continuada, voltada para asma infantil, nos hospitais públicos do Município do RJ.

Objective: To evaluate asthma knowledge, attitudes and practices among pediatricians working at public hospital services in Rio de Janeiro, Brazil. Methods: This cross-sectional study involved 76 pediatricians working at four publicly funded municipal emergency hospitals in Rio de Janeiro. Global knowledge on asthma (GKA) as well as specific knowledge, attitudes and practices such as frequency of prescription of inhaled ß2-agonists (in aerosol formulation), when to refer patients to specialists, use of spacers and peak expiratory flow (PEF) meters, were evaluated. Results: Regarding GKA, 73.7% of the sample (55/76) showed an insufficient final score. Asthma classification and treatment reached the lowest percentages of correct answers, with 23.7% and 14.5%, respectively. Only 13.2% of the participants used PEF meters regularly, and only 21.9% prescribed inhaled ß2-agonists; however, the latter practice was significantly associated with the use of spacers (PR = 8.75, 95%CI 1.07-71.06; p = 0.028) and PEF meters (RP = 10.80, 95%CI 2.31-50.45; p = 0.003). There was a strong association between being a pediatric allergist/ pulmonologist and having sufficient GKA knowledge (PR = 8.28, 95%CI 1.46-46.8; p = 0.015) and using a PEF meter frequently (PR = 6.64, 95%CI 1.22-35.95; p = 0.044). Conclusions: The level of asthma knowledge among pediatricians working at the emergency hospitals evaluated was unsatisfactory. There was a low frequency of use of PEF meters and also underuse of inhaled ß2-agonists. Being a specialist improved the global understanding of the illness. These results reinforce the need for continued medical education strategies focused on childhood asthma at public emergency hospitals in the city of Rio de Janeiro.

Deployment of field hospitals to disaster regions: Insights from ten medical relief operations spanning three decades.

OBJECTIVE: The Israeli Defense Force (IDF) Medical Corps developed a model of airborne field hospital. This model was structured to deal with disaster settings, requiring self-sufficiency, innovation and flexible operative mode in the setup of large margins of uncertainty regarding the disaster environment. The current study is aimed to critically analyze the experience, gathered in ten such missions worldwide. METHODS: Interviews with physicians who actively participated in the missions from 1988 until 2015 as chief medical officers combined with literature review of principal medical and auxiliary publications in order to assess and integrate information about the assembly of these missions. RESULTS: A body of knowledge was accumulated over the years by the IDF Medical Corps from deploying numerous relief missions to both natural (earthquake, typhoon, and tsunami), and man-made disasters, occurring in nine countries (Armenia, Rwanda, Kosovo, Turkey, India, Haiti, Japan, Philippines, and Nepal). This study shows an evolutionary pattern with improvements implemented from one mission to the other, with special adaptations (creativity and improvisation) to accommodate logistics barriers. CONCLUSION: The principals and operative function for deploying medical relief system, proposed over 20 years ago, were challenged and validated in the subsequent missions of IDF outlined in the current study. These principals, with the advantage of the military infrastructure and the expertise of drafted civilian medical professionals enable the rapid assembly and allocation of highly competent medical facilities in disaster settings. This structure model is to large extent self-sufficient with a substantial operative flexibility that permits early deployment upon request while the disaster assessment and definition of needs are preliminary.

Atropelamentos: análise epidemiológica dos últimos quatro anos / Atropellos: análisis epidemiológico de los últimos cuatro años / Run over: epidemiological analysis of the last four years

RESUMO O objetivo do estudo foi caracterizar os atropelamentos atendidos por serviços de urgência pré-hospitalar móvel em um município do norte do Paraná. Pesquisa retrospectiva, transversal, com abordagem quantitativa, obtida por meio dos dados do prontuário das vítimas atendidas pelo serviço pré-hospitalar móvel nos últimos quatro anos. A análise dos dados foi por meio da estatística descritiva e exploratória. Foram analisadas 1.663 ocorrências: 469 no ano de 2011, 431 em 2012, 408 em 2013 e 355 em 2014. Das ocorrências atendidas, a idade mediana foi de 39 anos, entretanto, as crianças e adolescentes foram mais acometidos. Também o episódio foi mais freqüente em ruas, na região central do município, às sextas e quartas-feiras, nos meses de março e maio, sendo mulheres no período da manhã e tarde, e homens principalmente no período noturno, provocado por automóvel, seguido por motocicleta. Destes acidentes, 3% dos condutores se evadiram do local sem prestar assistência à vítima. Identificou-se uma diminuição do evento atropelamento nos últimos quatro anos. Sugere-se intensificar a fiscalização nos pontos descritos e a elaboração de medidas preventivas, utilizando-se outros métodos e outras fontes de informação.

RESUMEN El objetivo del estudio fue caracterizar los atropellos atendidos por servicio de urgencia prehospitalario móvil en un municipio del norte de Paraná, Brasil. Investigación retrospectiva, transversal, con abordaje cuantitativo, obtenida por medio de los datos de los registros médicos de las víctimas atendidas por el servicio prehospitalario móvil en los últimos cuatro años. El análisis de los datos fue por medio de la estadística descriptiva y exploratoria. Fueron analizadas 1.663 ocurrencias: 469 en el año de 2011, 431 el 2012, 408 el 2013 y 355 el 2014. De las ocurrencias atendidas, el promedio de edad fue de 39 años, aunque los niños hayan sido los más acometidos. El hecho fue más frecuente en calles, en la región central del municipio, los viernes y miércoles, los meses de marzo y mayo, siendo las mujeres en el período de la mañana y tarde, y los hombres principalmente en el período nocturno, provocado por automóvil, seguido por motocicleta. De estos accidentes, el 3% de los conductores se evadieron del local sin prestar atención a la víctima. Se identificó una disminución del evento atropello en los últimos cuatro años. Se sugiere intensificar la fiscalización en los puntos descriptos además de la elaboración de medidas preventivas, utilizándose otros métodos y otras fuentes de información.

ABSTRACT The objective of the study was to characterize the motor vehicle accidents attended by pre-hospital emergency mobile services in a municipality in the North of Paraná. Retrospective, cross-sectional study with a quantitative approach, obtained through the medical record data of the victims attended by the pre-hospital mobile service in the last four years. The analysis of the data was through descriptive and exploratory statistics. A total of 1,663 occurrences were analyzed: 469 in 2011, 431 in 2012, 408 in 2013 and 355 in 2014. Of the occurrences attended, the median age was 39 years, however, children and adolescents were more affected. Also the most frequent episode in streets in the central region of the city, on Fridays and Wednesdays, in the months of March and may, being women in the morning and afternoon, and men mainly in the night period, caused by automobile, followed by motorcycle. Of these accidents, 3% of the drivers left without providing assistance to the victim. It was identified a decrease in motor vehicle accidents in the last four years. It is suggested to intensify the monitoring in the described points and to elaborate preventive measures, using other methods and other sources of information.

Escalón quirúrgico embarcado, experiencia en el buque de asalto anfibio L-51 «Galicia» en la operación Atalanta (julio-octubre de 2015) / Surgical Team onboard, experience from L-51 «Galicia» Landing Plataform Helicopter warship during «Atalanta Operation» from July to October 2015

INTRODUCCIÓN: La capacidad sanitaria de apoyo a un despliegue naval debe ser acorde con las características de la fuerza naval, la zona de actuación, el tipo de misión y la clase de amenaza. El objetivo de este artículo es describir el personal, material y fármacos del escalón quirúrgico embarcado en el Buque de Asalto Anfibio L-51 «Galicia» durante la Operación «Atalanta» desde julio a octubre de 2015. MATERIAL Y MÉTODOS: Descripción de personal, material y fármacos del escalón quirúrgico embarcado y revisión de la literatura relacionada. RESULTADOS: El equipo quirúrgico embarcado está compuesto por un cirujano general, un traumatólogo, un anestesiólogo, un farmacéutico (diplomado en análisis clínicos) y cuatro enfermeros. Este equipo apoya al primer escalón embarcado (un médico general, un odontólogo, dos enfermeros y dos sanitarios). La zona hospitalaria cuenta con sala de triaje, área prequirúrgica, 2 quirófanos, unidad de cuidados intensivos/reanimación con 8 camas, sala de radiología, sala de laboratorio, sala de esterilización, sala de consulta, gabinete odontológico, sala de infecciosos y varios pañoles de medicación. Se dispone de material y dispositivos sanitarios. Durante el periodo de estudio se ingresaron a 27 enfermos, se intervinieron quirúrgicamente a 2 pacientes y se realizaron 8 técnicas anestésicas. CONCLUSIÓN: Con el personal designado y con el material embarcado se puede cumplir con la misión encomendada

INTRODUCTION: Support medical capability in a maritime deployment would be according to naval forces, operation area, mission characteristics and type of damage. The objective is to describe personnel, material and drugs in the second naval echelon onboard in «Galicia» warship during «Atalanta Operation» from July to October 2015. MATERIAL AND METHODS: Description about personnel, material and drugs. RESULTS: Surgical Team onboard is composed by one general surgeon, one orthopedic surgeon, one anesthesiologist and critical care physician, one laboratory analyst, four nurses. This team helps to Role 1 (general physician, 1 dentist, 2 nurses and 2 medical assistances). The hospital zone in the warship has 1 triage room, 1 presurgical area, 2 operation rooms, 1 intensive care unit with 8 beds, 1 radiology area, 1 laboratory area, 1 sterilization area, 1 medical care room, 1 dental room, infectious area and 2 medicaments stores. Surgical team has material and medical devices. During the period of analysis 27 members were hospitalized, 2 surgical interven-tions and 8 anesthesia techniques were done. CONCLUSION: Medical mission can be accomplished with personnel and material onboard

El vapor de ruedas «Cid»: De pionero de la navegación comercial a vapor a primer vapor hospital / Paddle steamer «Cid»: pioneer of commercial steam navigation to first hospital steamship

La aparición de la máquina de vapor había hecho realidad el sueño de navegar sin depender de las fuerzas de la naturaleza. La carrera por lograr un vapor comercial eficiente había comenzado. Con retraso por la Guerra de la Independencia, España se incorporó a la carrera. Entre los primeros vapores comerciales estaba el vapor «Cid». En 1859, en la Guerra de África, ante la necesidad de una evacuación regular de bajas se designa al «Cid» como buque hospital, fue la primera vez en el mundo que se usó un vapor hospital. El Dr. Nicasio Landa fue el responsable de realizar la misión con una organización moderna, eficaz y ejemplar. Pronto los vapores de ruedas perdieron su batalla con los de hélice y el «Cid» quedó obsoleto. Sin embargo, a pesar de su corta vida operativa, poco más de quince años, escribió una importante página en la historia de la navegación en España

The advent of the steam engine had achieved to navigate without relying on the forces of nature. The race to get an efficient commercial had begun. With the delay caused by the Independence War, Spain joined the race. Among the first commercial steamboats was the «Cid». In 1859, in the African War, the need for regular casualties evacuations made the «Cid» to be designated as a hospital ship, the first hospital steamship in the world. Dr. Nicasio Landa was responsible for carrying out the mission with a modern, efficient and exemplary organization. Soon paddle steamers lost their battle against screw steamers and «Cid» became obsolete. However, despite its short operational life, little more than fifteen years, it wrote an important page in the History of sailing in Spain

La cooperación interdisciplinar en los campamentos de refugiados del Sahara / Interdisciplinary cooperation in refugee camps in the Sahara

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