Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24.347
Filtrar
1.
Artigo em Alemão | MEDLINE | ID: mdl-33053588

RESUMO

Chest Trauma is a complex injury pattern whose diagnostics and therapy demand everything from an emergency response team. Chest trauma subsumes thoracic injuries in all facets from the bounce mark of a seat belt to fatal rollover trauma with contusion or disruption of organs located in the thorax. Possible causes comprise blunt or penetrating trauma, as well as decelerations, chemical and thermal damage. Sonographic assessment according to a protocol plays a major role in diagnosis of underlying conditions and treatment indications. Therapeutic management may include invasive emergency techniques: Decompression of a tension pneumothorax is a fundamental life-saving intervention. Pericardiocentesis seldomly is necessary or possible in order to drain a cardiac tamponade. In case of traumatic cardiac arrest and under defined circumstances, resuscitative thoracotomy may be indicated. The out-of-hospital management may require transfusion of blood components. As with all procedures, which are performed seldomly but under emergency conditions, invasive techniques require clear communication, precise structured working procedures and especially continuous training, team briefing, and debriefing.


Assuntos
Parada Cardíaca , Traumatismos Torácicos , Ferimentos Penetrantes , Humanos , Ressuscitação , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirurgia , Traumatismos Torácicos/terapia , Toracotomia
2.
Medicine (Baltimore) ; 99(36): e22056, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899069

RESUMO

INTRODUCTION: With the development of social economy, transportation and various infrastructures have also developed, but it has objectively increased the number of patients with head injury. Although the current craniocerebral medicine technology continues to advance, long-term bed rest and other complications have led to an insignificant decrease in the mortality rate of coma patients. It is not uncommon for patients with disturbance of consciousness caused by head injury in major hospitals. METHODS/DESIGN: This will be a retrospective, single-blind clinical observational study. We will select 50 cases that meet the subject's selection criteria. According to whether they received acupuncture treatment or not, they will be randomly divided into 2 groups, namely treatment group and control group. The control group will be given conventional Western medicine treatment, and the treatment group will be given acupuncture method of removing-stasis and resuscitating treatment on the basis of the control group. DISCUSSION: Our purpose is to observe the role of acupuncture method of removing-stasis and resuscitating in promoting the recovery of patients with severe head injury. We aim to provide more evidence-based medical evidence for acupuncture treatment of this disease. TRIAL REGISTRATION: ClinicalTrials.gov, ChiCTR2000034732, Registered on 19 July 2020.


Assuntos
Terapia por Acupuntura/métodos , Lesões Encefálicas Traumáticas/complicações , Coma/terapia , Estado Vegetativo Persistente/terapia , Ressuscitação/métodos , Adulto , Estudos de Casos e Controles , Coma/etiologia , Coma/mortalidade , Terapia Combinada , Estado de Consciência , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sob Prescrição , Estudos Retrospectivos , Índice de Gravidade de Doença , Método Simples-Cego
3.
Rev Paul Pediatr ; 38: e2020165, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32876282

RESUMO

OBJECTIVE: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE DESCRIPTION: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. COMMENTS: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Insuficiência de Múltiplos Órgãos , Pandemias , Pneumonia Viral , Ressuscitação , Choque , Síndrome de Resposta Inflamatória Sistêmica , Deterioração Clínica , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Evolução Fatal , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Recém-Nascido , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/terapia , Pneumonia Viral/sangue , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Nascimento Prematuro , Respiração Artificial/métodos , Ressuscitação/métodos , Fatores de Risco , Choque/etiologia , Choque/terapia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Tomografia Computadorizada por Raios X/métodos
5.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32907923

RESUMO

CONTEXT: Current International Liaison Committee on Resuscitation recommendations on epinephrine administration during neonatal resuscitation were derived in 2010 from indirect evidence in animal or pediatric studies. OBJECTIVE: Systematic review of human infant and relevant animal studies comparing other doses, routes, and intervals of epinephrine administration in neonatal resuscitation with (currently recommended) administration of 0.01 to 0.03 mg/kg doses given intravenously (IV) every 3 to 5 minutes. DATA SOURCES: Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and trial registry databases. STUDY SELECTION: Predefined criteria were used for selection. DATA EXTRACTION: Risk of bias was assessed by using published tools appropriate for the study type. Certainty of evidence was assessed by using Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Only 2 of 4 eligible cohort studies among 593 unique retrieved records yielded data allowing comparisons. There were no differences between IV and endotracheal epinephrine for the primary outcome of death at hospital discharge (risk ratio = 1.03 [95% confidence interval 0.62 to 1.71]) or for failure to achieve return of spontaneous circulation, time to return of spontaneous circulation (1 study; 50 infants), or proportion receiving additional epinephrine (2 studies; 97 infants). There were no differences in outcomes between 2 endotracheal doses (1 study). No human infant studies were found in which authors addressed IV dose or dosing interval. LIMITATIONS: The search yielded sparse human evidence of very low certainty (downgraded for serious risk of bias and imprecision). CONCLUSIONS: Administration of epinephrine by endotracheal versus IV routes resulted in similar survival and other outcomes. However, in animal studies, researchers continue to suggest benefit of IV administration using currently recommended doses.


Assuntos
Broncodilatadores/administração & dosagem , Epinefrina/administração & dosagem , Ressuscitação/métodos , Animais , Relação Dose-Resposta a Droga , Humanos , Recém-Nascido , Infusões Intravenosas
6.
9.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32917847

RESUMO

BACKGROUND: International guidelines for resuscitation recommend using positive end-expiratory pressure (PEEP) during ventilation of preterm newborns. Reliable PEEP-valves for self-inflating bags have been lacking, and effects of PEEP during resuscitation of term newborns are insufficiently studied. The objective was to determine if adding a new PEEP valve to the bag-mask during resuscitation of term and near-term newborns could improve heart rate response. METHODS: This randomized controlled trial was performed at Haydom Lutheran Hospital in Tanzania (September 2016 to June 2018). Helping Babies Breathe-trained midwives performed newborn resuscitation using self-inflating bags with or without a new, integrated PEEP valve. All live-born newborns who received bag-mask ventilation at birth were eligible. Heart rate response measured by ECG was the primary outcome, and clinical outcome and ventilation data were recorded. RESULTS: Among 417 included newborns (median birth weight 3200 g), 206 were ventilated without and 211 with PEEP. We found no difference in heart rate response. Median (interquartile range) measured PEEP in the PEEP group was 4.7 (2.0-5.6) millibar. The PEEP group received lower tidal volumes (4.9 [1.9-8.2] vs 6.3 [3.9-10.5] mL/kg; P = .02) and had borderline lower expired CO2 (2.9 [1.5-4.3] vs 3.3 [1.9-5.0] %; P = .05). Twenty four-hour mortality was 9% in both groups. CONCLUSIONS: We found no evidence for improved heart rate response during bag-mask ventilation with PEEP compared with no PEEP. The PEEP valve delivered a median PEEP within the intended range. The findings do not support routine use of PEEP during resuscitation of newborns around term.


Assuntos
Frequência Cardíaca/fisiologia , Respiração com Pressão Positiva/instrumentação , Respiração Artificial/métodos , Ressuscitação/instrumentação , Eletrocardiografia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Tocologia , Respiração com Pressão Positiva/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/estatística & dados numéricos , Tamanho da Amostra , Nascimento a Termo
10.
Biomed Res Int ; 2020: 2721381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32884938

RESUMO

Introduction: Emergency department (ED) triage regarding infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is challenging. During the coronavirus disease 2019 (COVID-19) outbreak in Germany, the diagnostic outcomes of critically ill patients admitted to the resuscitation room in the ED of our academic 754-bed hospital should be analyzed. Methods: All resuscitation room patients between March 1st and April 15th 2020 were included in this retrospective study. Every patient with suspicion of SARS-CoV-2 infection received a pharyngeal swab for real-time polymerase chain reaction (rt-PCR), divided in the clinical subgroups of "highly suspicious for COVID-19" and "COVID-19 as differential diagnosis." All respiratory and infectious symptoms were included as at least "differential diagnosis" as an expanded suspicion strategy. Results: Ninety-five patients were included (trauma n = 14, critically ill n = 81). Of 3 highly suspicious patients, 2 had rt-PCR positive pharyngeal swabs. In 39 patients, COVID-19 was defined as differential diagnosis, and 3 were positive for SARS-CoV-2. Of them, pharyngeal swabs were positive in 1 case, while in 2 cases, only tracheal fluid was rt-PCR positive while the pharyngeal swabs were negative. In one of these 2 cases, chest computed tomography (CT) was also negative for ground-glass opacities but showed a pulmonary abscess and pulmonary embolism. Conclusion: We recommend an expanded suspicion strategy for COVID-19 due to unexpected diagnostic outcomes. Personal protective equipment should be used in every resuscitation room operation due to unexpected cases and initial knowledge gaps. Furthermore, tracheal fluid should be tested for SARS-CoV-2 in every intubated patient due to cases with negative pharyngeal swabs and negative chest CT.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Estado Terminal , Diagnóstico Diferencial , Surtos de Doenças , Serviço Hospitalar de Emergência , Reações Falso-Negativas , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , RNA Viral/genética , RNA Viral/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Ressuscitação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Triagem
11.
Emerg Med Clin North Am ; 38(4): 739-753, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981614

RESUMO

Excellent resuscitation requires technical skills and knowledge, but also the right mindset. Expert practitioners must master their internal affective state, and create the environment that leads to optimal team performance. Leaders in resuscitation should use structured approaches to prepare for resuscitation, and psychological skills to enhance their performance including mental rehearsal, positive self-talk, explicit communication strategies, and situational awareness skills. Postevent recovery is equally important. Providers should have explicit plans for recovery after traumatic cases, including developing resilience and self-compassion. Experts in resuscitation can improve their performance (and that of their team) by consciously incorporating psychological skills into their armamentarium.


Assuntos
Conscientização , Tomada de Decisão Clínica , Equipe de Assistência ao Paciente , Ressuscitação , Esgotamento Profissional/prevenção & controle , Competência Clínica , Comunicação , Humanos , Estresse Ocupacional/prevenção & controle , Estresse Ocupacional/psicologia , Segurança do Paciente , Resiliência Psicológica
12.
Emerg Med Clin North Am ; 38(4): 783-793, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981617

RESUMO

Intravenous (IV) fluids are among the most common interventions performed in the emergency department. They are at times lifesaving, but if used recklessly can be harmful. Given their ubiquity, it is important to understand the history, physiology, and current strategies that govern the use of IV fluids during the resuscitation of the critically ill.


Assuntos
Hidratação , Ressuscitação/métodos , Coloides/uso terapêutico , Circulação Coronária/fisiologia , Soluções Cristaloides/química , Soluções Cristaloides/uso terapêutico , Eletrólitos/análise , Serviço Hospitalar de Emergência , Hidratação/história , História do Século XIX , História do Século XX , Humanos , Choque/fisiopatologia , Pressão Venosa/fisiologia
13.
Emerg Med Clin North Am ; 38(4): 795-805, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981618

RESUMO

Successful emergency transfusions require early recognition and activation of resources to minimize treatment delays. The initial goals should focus on replacement of blood in a balanced fashion. There is an ongoing debate regarding the best approach to transfusions, with some advocating for resuscitation with a fixed ratio of blood products and others preferring to use viscoelastic assays to guide transfusions. Whole-blood transfusion also is a debated strategy. Despite these different approaches, it generally is accepted that transfusions should be started early and crystalloid infusions limited. As hemodynamic stability is restored, endpoints of resuscitation should be used to guide the resuscitation.


Assuntos
Transfusão de Sangue , Choque Hemorrágico/terapia , Antifibrinolíticos/uso terapêutico , Tipagem e Reações Cruzadas Sanguíneas , Cateterismo Venoso Central , Tomada de Decisão Clínica , Protocolos Clínicos , Estado Terminal , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Humanos , Hipotensão , Infusões Intraósseas , Infusões Intravenosas , Ressuscitação , Tromboelastografia , Ácido Tranexâmico/uso terapêutico , Ferimentos e Lesões/terapia
14.
Emerg Med Clin North Am ; 38(4): 807-818, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981619

RESUMO

Sepsis care has evolved significantly since the initial early goal-directed therapy (EGDT) trials. Early fluid resuscitation, source control, and antibiotic therapy remain cornerstones of care but overall understanding is more nuanced, particularly regarding fluid selection, vasopressors, and inotropic support. Timely nutrition therapy and ventilatory support tend to receive less attention but also are important. Recent research has explored immunomodulation, ß-blockade, and vitamin supplementation. A renewed emphasis on early, aggressive resuscitation reaffirms the importance of emergency medicine providers knowledgeable and skilled in sepsis management.


Assuntos
Ressuscitação/métodos , Sepse/terapia , Angiotensina II/uso terapêutico , Antibacterianos/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Glicemia/análise , Pressão Sanguínea , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Cardiotônicos/uso terapêutico , Estado Terminal , Serviço Hospitalar de Emergência , Nutrição Enteral , Hidratação , Glucocorticoides/uso terapêutico , Hemodinâmica , Humanos , Escores de Disfunção Orgânica , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Vasoconstritores/uso terapêutico
15.
Emerg Med Clin North Am ; 38(4): 819-839, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981620

RESUMO

Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.


Assuntos
Parada Cardíaca/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Glicemia/análise , Criança , Maus-Tratos Infantis/terapia , Cardioversão Elétrica , Eletroencefalografia , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Cardiopatias Congênitas/terapia , Frequência Cardíaca , Humanos , Hipotermia/complicações , Hipotermia/terapia , Hipotermia Induzida , Pneumopatias/terapia , Pais , Exame Físico , Envenenamento/terapia , Avaliação de Processos em Cuidados de Saúde , Valores de Referência , Insuficiência Respiratória/terapia , Taxa Respiratória , Ordens quanto à Conduta (Ética Médica) , Sepse/terapia , Choque/etiologia , Choque/terapia , Vasoconstritores/uso terapêutico , Ferimentos e Lesões/terapia
16.
Emerg Med Clin North Am ; 38(4): 841-856, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981621
17.
Emerg Med Clin North Am ; 38(4): 857-869, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981622

RESUMO

The obesity pandemic now affects hundreds of millions of people worldwide. As obesity rates continue to increase, emergency physicians are called on with increasing frequency to resuscitate obese patients. This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted.


Assuntos
Obesidade/complicações , Ressuscitação/métodos , Manuseio das Vias Aéreas/métodos , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Composição Corporal , Fármacos Cardiovasculares/administração & dosagem , Doenças Cardiovasculares/complicações , Relação Dose-Resposta a Droga , Serviço Hospitalar de Emergência , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Medidas de Volume Pulmonar , Consumo de Oxigênio , Farmacocinética , Respiração com Pressão Positiva , Sepse/complicações , Sepse/terapia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
18.
Emerg Med Clin North Am ; 38(4): 871-889, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981623

RESUMO

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.


Assuntos
Hemorragia Gastrointestinal/terapia , Manuseio das Vias Aéreas , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Antifibrinolíticos/uso terapêutico , Oclusão com Balão , Fatores de Coagulação Sanguínea/administração & dosagem , Transfusão de Sangue/métodos , Cateteres , Serviço Hospitalar de Emergência , Fator Xa/administração & dosagem , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Infusões Intraósseas , Infusões Intravenosas , Anamnese , Exame Físico , Inibidores da Bomba de Prótons/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Ressuscitação , Tromboelastografia , Vasoconstritores/uso terapêutico
19.
Emerg Med Clin North Am ; 38(4): 891-901, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981624

RESUMO

Evaluating and treating traumatic cardiac arrest remains a challenge to the emergency medicine provider. Guidelines have established criteria for patients who can benefit from treatment and resuscitation versus those who will likely not survive. Patient factors that predict survival are penetrating injury, signs of life with emergency medical services or on arrival to the Emergency Department, short length of prehospital cardiopulmonary resuscitation, cardiac motion on ultrasound, pediatric patients, and those with reversible causes including pericardial tamponade and tension pneumothorax. Newer technologies such as resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion, and extracorporeal membrane oxygenation may improve outcomes, but remain primarily investigational.


Assuntos
Parada Cardíaca/terapia , Ferimentos e Lesões/complicações , Abdome/diagnóstico por imagem , Aorta , Oclusão com Balão , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Coração/diagnóstico por imagem , Parada Cardíaca/etiologia , Humanos , Guias de Prática Clínica como Assunto , Ressuscitação , Ordens quanto à Conduta (Ética Médica) , Toracotomia , Ultrassonografia
20.
Emerg Med Clin North Am ; 38(4): 903-917, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981625

RESUMO

Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.


Assuntos
Complicações na Gravidez/terapia , Ressuscitação/métodos , Manuseio das Vias Aéreas , Gasometria , Cesárea , Contraindicações de Medicamentos , Estado Terminal , Serviço Hospitalar de Emergência , Feminino , Monitorização Fetal , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Intubação Intratraqueal , Troca Materno-Fetal , Ventilação não Invasiva , Circulação Placentária , Gravidez/fisiologia , Complicações na Gravidez/diagnóstico , Insuficiência Respiratória/terapia , Choque/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA