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1.
Rev Col Bras Cir ; 46(3): e20192163, 2019 Aug 05.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31389523

RESUMO

OBJECTIVE: to describe the teaching strategy based on the Multiple Victims Incident (MVI) simulation, discussing and evaluating the performance of the students involved in the initial care of trauma victims. METHODS: a cross-sectional, and quantitative study was performed. A realistic MVI simulation involving students, and professionals from nursery and medical schools, as well as a prehospital care team was performed. RESULTS: it was possible to notice that the classification according to the START method (Simple Triage and Rapid Treatment) was correct in 94.1% of the time from the analysis of 17 preestablished checklists. Following the primary evaluation with the ABCDE mnemonic, all steps were performed correctly in 70%. However, there was only supply of oxygen in high flow in 64.7% of the examination. The search for visible and hidden bleeding was performed in 70.6% of the examination. The neurological evaluation with the Glasgow coma scale and pupillary evaluation occurred in 70.6% of the victims. The victims exposure was performed in 70.6% of the examination. CONCLUSION: a simulated environment allows the consolidation and improvement of professional skills, especially when we are talking about a poorly trained area during the undergraduate program, such as the MVI. Early training and teamwork encourage clinical thinking, integration and communication, essential abilities when facing chaotic situations.


Assuntos
Competência Clínica , Serviços Médicos de Emergência/métodos , Simulação de Paciente , Treinamento por Simulação/métodos , Triagem/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Estudantes de Medicina , Estudantes de Enfermagem , Universidades
2.
Rev. Ciênc. Plur ; 5(1): 52-70, jun. 2019. ilus, tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1007343

RESUMO

Introdução:Os serviços de emergência médica exigem do profissional da saúde uma pronta resposta às demandas de cada paciente. Nesse contexto, o estresse laboral pode ser extremamente destrutivo não só para o trabalhador, mas também para o serviço de saúde prestado.Objetivo:Assim, este estudo tem como objetivo analisar os fatores desencadeantes do estresse laboral em profissionais de saúde que trabalham em serviços de emergência médica.Metodologia:Para isso, foi realizada uma revisão integrativa de literatura, tendo como fonte as basesde dados Lilacs, MedLinee Scielo. Foram incluídos estudos transversais ou longitudinais em inglês, português ou espanhol sem restrição de período de publicação que tinham como objetivo avaliar os níveis de estresse em profissionais de saúde que trabalham em serviços de emergência médica. Logo, nove artigos transversais e dois longitudinais foram incluídos, totalizando onze artigos.Resultados:Como resultado, observou-se que uma série de fatores ambientais (más condições de trabalho, atividades de administração) e pessoais(união estável, menor tempo de serviço) são associados ao estresse laboral. Todavia, principalmente os fatores relacionados ao ambiente são passíveis de intervenção.Conclusões:Dessa forma, surge a necessidade de políticas de melhoria do ambiente de trabalho e de empoderamento do profissional de saúde que trabalha em serviços de emergência médica (AU).


Introduction:The emergency medical services require the health professional to respond promptly to the demands of each patient. In this context, work stress can be extremely destructive not only for the worker, but also for the health service provided. Objective:Thus, this study aims to analyze the factors that trigger work stress in health professionals working in emergency medical services.Methods:For this, a integrative review of the literature was performed, based on the Lilacs, MedLineand Scielodatabases. We included cross-sectional or longitudinal studies in English, Portuguese or Spanish without restriction of publication period that aimed to evaluate stress levels in health professionals working in emergency medical services. Therefore, nine transverse and two longitudinal articles were included, totaling eleven articles.Results:As a result, it was observed that a series of environmental factors (poor working conditions, administration activities) and personal factors (stable union, shorter working time) are associated with work stress. However, mainly environmental factors are amenable to intervention.Conclusions:Thus, there is a need for policies to improve the work environment and the empowerment of the health professional working in emergency medical services (AU).


Assuntos
Pessoal de Saúde , Pessoal de Saúde/psicologia , Serviços Médicos de Emergência/métodos , Estresse Ocupacional/psicologia , Brasil , Saúde Pública , Revisão
3.
J Stroke Cerebrovasc Dis ; 28(9): 2388-2397, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31320270

RESUMO

OBJECTIVE: Improve prehospital identification of acute ischemic stroke patients with large vessel occlusion (LVO) by using a trauma system-based emergency communication center (ECC) to guide the emergency medical service (EMS). METHODS: We trained 24 ECC paramedics in the Emergency Medical Stroke Assessment (EMSA). ECC-guided EMS in performance of the EMSA on patients with suspected stroke. During the second half of the study, we provided focused feedback to ECC after reviewing recorded ECC-EMS interactions. We compared the sensitivity, specificity, and area under the receiver operator characteristics curve (AUC) and 95% confidence interval of ECC-guided EMSA to the NIH Stroke Scale (NIHSS) for predicting a discharge diagnosis of LVO. RESULTS: We enrolled 569 patients from September 2016 through February 2018. Of 463 patients analyzed, 236 (51%) had a discharge diagnosis of stroke and 227 (49%) had a nonstroke diagnosis. There were 45 (19%) stroke patients with LVO. For predicting LVO, there was no significant difference between the EMSA AUC = .68 (.59-.77) and the NIHSS AUC = .73 (.65-.81). An EMSA score greater than or equal to 4 had sensitivity = 75.6 (60.5-87.1) and specificity = 62.4 (57.6-67.1) for LVO. During the first 9 months of the study, the EMSA AUC = .61 (.44-.77) compared to an AUC = .74 (.64-.84) during the second 9 months. CONCLUSIONS: ECC-guided prehospital EMSA is feasible, has similar ability to predict LVO compared to the NIHSS, and has sustained performance over time.


Assuntos
Arteriopatias Oclusivas/diagnóstico , Isquemia Encefálica/diagnóstico , Competência Clínica , Sistemas de Comunicação entre Serviços de Emergência , Serviços Médicos de Emergência/métodos , Auxiliares de Emergência/educação , Capacitação em Serviço/métodos , Acidente Vascular Cerebral/diagnóstico , Idoso , Arteriopatias Oclusivas/fisiopatologia , Arteriopatias Oclusivas/psicologia , Arteriopatias Oclusivas/terapia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/psicologia , Isquemia Encefálica/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Acidente Vascular Cerebral/terapia , Tempo para o Tratamento
4.
Am Surg ; 85(6): 638-644, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267906

RESUMO

As the roles of trauma/acute care surgeons continue to evolve, it is imperative that health-care systems adapt to meet workforce needs. Tailoring retention strategies that elicit workforce satisfaction ensure continued coverage that is mutually beneficial to surgeons and health-care systems. We sought to elicit factors related to career characteristics and expectations of the trauma/acute care surgery (ACS) workforce to assist with such future progress. In this study, 1552 Eastern Association for the Surgery of Trauma members were anonymously surveyed. Data collected included demographics, career expectations, and motivators of trauma/ACS. Four hundred eight (26%) Eastern Association for the Surgery of Trauma members responded. Respondents were 78 per cent male and had a median age of 47.3 years. Forty-six per cent of surgeons reported earning $351K-$475K and 23 per cent >$475K. At this point in their career, 49 per cent of surgeons felt quality of life was "most important", followed by 31 per cent career ambitions and 13 per cent salary. Prominent career satisfiers were patient care and teaching. Greatest detractors were burnout, bureaucracy, and work environment. Eighty per cent would change jobs in the final 10 years of practice, 31 per cent because of family/retirement, 29 per cent because of professional growth, 24 per cent because of workload, and 7 per cent because of salary. This study could be used to help develop trauma/ACS workforce strategies. This workforce remains mobile into late career; personal happiness and patient ownership overshadow financial rewards, and most prefer a total and shared patient care model compared with no patient ownership. Burnout, bureaucracy, and work environment are dominant detractors of job satisfaction among surveyed trauma/ACS surgeons.


Assuntos
Qualidade de Vida , Cirurgiões/psicologia , Inquéritos e Questionários , Recursos Humanos , Ferimentos e Lesões/cirurgia , Adulto , Fatores Etários , Atitude do Pessoal de Saúde , Esgotamento Profissional , Escolha da Profissão , Compreensão , Serviços Médicos de Emergência/métodos , Pesquisas sobre Serviços de Saúde , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Medição de Risco , Fatores Sexuais , Estados Unidos , Carga de Trabalho
5.
Pan Afr Med J ; 32: 98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223388

RESUMO

Introduction: In South Africa in 2016, injuries accounted for 4 483 deaths of children aged 0-4 years. Prior studies have reported that, in some parts of the country, poor pre-hospital clinical care is a key contributor to the morbidity and mortality of critically ill and injured children. A key component of a coordinated emergency health care system are emergency medical care (EMC) personnel. Here, we assess the knowledge of EMC personnel employed by the Free State Department of Health on aspects of paediatric pre-hospital emergency care. Methods: This descriptive study used a questionnaire survey to obtain data on the knowledge of Free State EMC personnel on aspects of paediatric pre-hospital emergency care. Results: Only 197 of the initial 250 questionnaires distributed were returned, giving a response rate of 78.8%. More than half (51.2%) of the participants across the five districts had inadequate knowledge of paediatric pre-hospital emergency care. The majority of EMC personnel could not calculate the paediatric blood pressure for age and did not know the paediatric Glasgow Coma Scale (74.0% and 53.4% respectively; P < 0.0001 in both cases). Participants attributed inadequate knowledge to limited exposure to paediatrics cases, insufficient training, limited scope of practice, and lack of equipment. Conclusion: Enhancing the knowledge and skills of EMC personnel in paediatrics pre-hospital care through a short learning programme or continuous professional development programme, and providing adequate paediatric emergency equipment, will ensure that comprehensive pre-hospital emergency care is given to paediatric patients in the province.


Assuntos
Competência Clínica , Serviços Médicos de Emergência/métodos , Auxiliares de Emergência/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Pré-Escolar , Estado Terminal , Auxiliares de Emergência/educação , Auxiliares de Emergência/normas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pediatria , África do Sul , Inquéritos e Questionários , Adulto Jovem
6.
Nurse Educ Today ; 78: 44-49, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31071584

RESUMO

INTRODUCTION: Simulation has been used extensively to train students and health professionals in the assessment and early intervention of patients with acutely deteriorating conditions. These simulations evoke psychophysiological stress in learners which may affect performance. We examined the relationship between stress variables, confidence, and performance during repeated scenarios in clinically-based emergency simulations. METHODS: Twenty-six registered nurses completed three simulation scenarios focussing on life-threatening clinical events in a single group pre-test/post-test study design. Trait anxiety was measured at baseline. Visual analogue ratings of anxiety and stress were measured before ('pre'), recalled 'during', and immediately following ('post') each simulation scenario, with a self-rating of confidence completed after each simulation scenario. Heart rate was measured continuously throughout the simulation program. Participants self-rated their clinical performance prior to and following the simulation program ('pre' and 'post'). RESULTS: Participants' trait anxiety was not elevated at baseline (mean: 39.6, SD 6.1). Across the three simulation scenarios, anxiety and stress was elevated 'during' simulation compared to 'pre' and 'post' time points. However, the magnitude of elevation of stress and anxiety during all time points ('pre', 'during' and 'post' simulation) decreased significantly (p < 0.05) with progressive simulations. Heart rate increased significantly during all simulations compared to 'pre'-levels but returned to similar levels following the simulation. The amount of increase in heart rate over progressive simulations was attenuated during simulation 3 compared with 1 and 2 (Sim 1: 103.6 bpm (SD 22.1), Sim 2: 101.9 bpm (SD 18.9), and Sim 3: 99.5 bpm (SD 23.4)). Confidence increased across the three simulations (p < 0.001), with most of the increase observed after the first two simulations. Performance scores increased by 19.0% 'pre-post' simulation program (p < 0.001) and were not confounded by previous ALS or simulation experience. DISCUSSION: We observed temporal-dependent changes in psychophysiological stress variables across the simulation scenarios, with decreased magnitudes of elevations of psychological (self-reported anxiety and stress) and physiological (heart rate) stress variables during successive simulation scenarios. This study has shown that simulation increased stress, especially before and during scenarios; however, the learning effect decreased the magnitude of the stress response with repeated simulation scenarios. Simulation educators need to create simulations that change stress in a purposeful manner to enhance learning.


Assuntos
Serviços Médicos de Emergência/normas , Enfermeiras e Enfermeiros/psicologia , Simulação de Paciente , Estresse Psicológico/etiologia , Desempenho Acadêmico/psicologia , Desempenho Acadêmico/normas , Adulto , Estudos de Coortes , Educação Continuada em Enfermagem/métodos , Educação Continuada em Enfermagem/normas , Avaliação Educacional/métodos , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Autoeficácia , Estresse Psicológico/psicologia
7.
Pediatr Emerg Med Pract ; 16(Suppl 5): 1-2, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31038892

RESUMO

Children with penetrating trauma to the torso require careful evaluation of the chest, abdomen, pelvis, and genital structures for system-specific injuries that may contribute to rapid decompensation and influence the order of emergent resuscitation. Care of the injured child and the effect on clinical outcomes starts in the prehospital setting, with hemorrhage control and IV fluid resuscitation. The evaluation and disposition of the patient in the ED will depend on the mechanism of injury and the severity of trauma. This issue reviews the diagnostic evaluation and management of pediatric patients with penetrating injuries to the torso. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice.]


Assuntos
Ressuscitação/métodos , Tronco/lesões , Ferimentos Penetrantes/terapia , Adolescente , Criança , Pré-Escolar , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Ferimentos Penetrantes/diagnóstico
8.
R I Med J (2013) ; 102(4): 20-22, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042339

RESUMO

Few events in pre-hospital medicine inspire as much attention and resources as out-of-hospital cardiac arrest (OHCA), yet the survival rate for such events has remained stagnant and unacceptably low. The first links in the chain of survival are early recognition and early CPR; yet EMS services do not arrive to the scene of a medical call for on average 7 minutes. Emergency dispatchers are generally the first trained individuals involved in medical emergencies; they can provide pre-arrival instructions, specifically telecommunicator CPR (T-CPR), and represent the potential to double the bystander CPR rate and increase return of spontaneous circulation. Yet, according to survey data, fewer than half of all public safety answering points (PSAPs) provide any T-CPR and even fewer provide hands-only CPR instruction.1 This article will provide a brief overview, history and introduction to the evidence supporting the use of T-CPR to improve outcomes in OHCA.


Assuntos
Reanimação Cardiopulmonar/história , Operador de Emergência Médica , Linhas Diretas , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/métodos , História do Século XX , História do Século XXI , Humanos , Taxa de Sobrevida/tendências , Estados Unidos
9.
Scand J Trauma Resusc Emerg Med ; 27(1): 53, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046804

RESUMO

BACKGROUND AND PURPOSE: Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES). METHODS: Consecutive stroke and TIA patients (n = 3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient's neighbourhood (postcode area). RESULTS: The median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3 h 47 min (95% confidence interval (CI) 3 h 30 min to 4 h 05 min) for patients within the lowest SES tertile and 3 h 17 min (95% CI 3 h 00 min to 3 h 37 min) for the highest tertile (p < 0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p < 0.05) and had lower rates of prehospital recognition of stroke/TIA (p < 0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport. CONCLUSIONS: We found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses' ability to recognise stroke/TIA may partly explain the observed inequities.


Assuntos
Serviços Médicos de Emergência/métodos , Disparidades em Assistência à Saúde/economia , Sistema de Registros , Acidente Vascular Cerebral/terapia , Adulto , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/epidemiologia , Suécia/epidemiologia , Adulto Jovem
10.
Scand J Trauma Resusc Emerg Med ; 27(1): 55, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068199

RESUMO

BACKGROUND: Obtaining accurate information from a 112 caller is key to correct tasking of Helicopter Emergency Medical Services (HEMS). Being able to view the incident scene via video from a mobile phone may assist HEMS dispatch by providing more accurate information such as mechanism of injury and/or injuries sustained. The objective of this study is to describe the acceptability and feasibility of using live video footage from the mobile phone of a 112 caller as an HEMS dispatch aid. METHODS: Live footage is obtained via the 112 caller's mobile phone camera through the secure GoodSAM app's Instant-on-scene™ platform. Video footage is streamed directly to the dispatcher, and not stored. During the feasibility trial period, dispatchers noted the purpose for which they used the footage and rated ease of use and any technical- and operational issues they encountered. A subjective assessment of caller acceptance to use video was conducted. RESULTS: Video footage from scene was attempted for 21 emergency calls. The leading reasons listed by the dispatchers to use live footage were to directly assess the patient (18/21) and to obtain information about the mechanism of injury and the scene (11/21). HEMS dispatchers rated the ease of use with a 4.95 on a 5-point scale (range 4-5). All callers gave permission to stream from their telephone camera. Video footage from scene was successfully obtained in 19 calls, and was used by the dispatcher as an aid to send (5) or stand down (14) a Helicopter Emergency Medical Services team. CONCLUSION: Live video footage from a 112 caller can be used to provide dispatchers with more information from the scene of an incident and the clinical condition of the patient(s). The use of mobile phone video was readily accepted by the 112 caller and the technology robust. Further research is warranted to assess the impact video from scene could have on HEMS dispatching.


Assuntos
Aeronaves , Telefone Celular , Emergências , Despacho de Emergência Médica/métodos , Sistemas de Comunicação entre Serviços de Emergência/organização & administração , Serviços Médicos de Emergência/métodos , Gravação em Vídeo/métodos , Resgate Aéreo , Estudos de Viabilidade , Humanos
11.
BMC Public Health ; 19(1): 572, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088520

RESUMO

BACKGROUND: Cardiorespiratory arrest (CRA) is a health emergency with high mortality. Mortality depends on time of initiation and quality of cardiopulmonary resuscitation (CPR) manoeuvres and the use of the automated external defibrillator (AED). METHODS: The aim of the study is to determine the effectiveness of an automatically activated network of volunteers using smartwatch and smartphone applications on the reduction of time of initiation of cardiopulmonary resuscitation manoeuvres. The protocol will be developed in four phases: 1) validation of an application (App) for smartwatch that automatically generates a health alert in case of out-of-hospital cardiorespiratory arrest (OHCA); 2) training course for laypersons on CPR manoeuvres and AED use; 3) creation of a network of volunteers trained in CPR and AED use that covers our city; and 4) simulation in which the network of volunteers is automatically activated via smartphone to attend simulated OHCAs. A total of 134 health alerts will be generated; on 67 occasions the alert will be directed to the emergency health services and to the network of trained volunteers (Intervention Group) and on 67 occasions the alert will be solely directed to the emergency health services (Control Group). The arrival time of the first rescuer, category of first rescuer (emergency services versus network of volunteers), initiation time of manoeuvres and competence will be recorded. DISCUSSION: CPR training for laypersons is advised, especially for relatives and people close to patients with heart disease, to reduce time of initiation of CPR and to improve OHCA survival rates. This study aims to verify that the initiation time of CPR manoeuvres and AED use is shorter in the intervention than in the control group. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT03828305 . Trial registered on February 1, 2019 (retrospective register).


Assuntos
Reanimação Cardiopulmonar/educação , Serviços Médicos de Emergência/métodos , Socorristas/educação , Parada Cardíaca Extra-Hospitalar/terapia , Tempo para o Tratamento/estatística & dados numéricos , Voluntários/educação , Adulto , Desfibriladores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Programas e Projetos de Saúde , Smartphone , Taxa de Sobrevida , Fatores de Tempo , Adulto Jovem
12.
Ulus Travma Acil Cerrahi Derg ; 25(3): 303-306, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135944

RESUMO

Emergency thoracotomy can be a life-saving procedure in critically injured patients who present with chest injuries. Currently, the indications for an on-the-scene thoracotomy are penetrating trauma of the chest or upper abdomen with cardiac arrest that has occurred in the presence of an emergency team or within 10 minutes prior to their arrival. The indications for an emergency thoracotomy in blunt chest trauma are less clearly defined. In the present case, a helicopter emergency medical service (HEMS) team performed an emergency thoracotomy at the scene. To the best of our knowledge, it is the first description of such a procedure in Poland. A 41-year-old male was crushed in a tractor accident. Though all available measures were taken, a sudden cardiac arrest occurred. The HEMS team performed an emergency thoracotomy at the scene as an integral part of prehospital cardiopulmonary arrest management. The patient survived, and was later discharged from the hospital in good physical condition. No neurological deficit was identified (cerebral performance category 1). The patient returned to his previous activities with no complications or deficits. The presence of a fully trained crew allows for the performance of a potentially critical on-the-scene emergency thoracotomy. In a well-selected group of patients with blunt thoracic injury, a prehospital emergency thoracotomy may be a significant and life-saving procedure.


Assuntos
Aeronaves , Lesões por Esmagamento/cirurgia , Serviços Médicos de Emergência/métodos , Toracotomia/métodos , Acidentes , Adulto , Humanos , Masculino
13.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, may.-june. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1005940

RESUMO

Background: The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model , with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência/métodos , Infarto do Miocárdio
14.
Medicine (Baltimore) ; 98(21): e15452, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124928

RESUMO

OBJECTIVE: To analyze clinical and sociodemographic properties of the patients as measured by the "Hospital Anxiety and Depression Scale-HADS" including the subscale regarding anxiety (HAD-A) in emergency department (ED) and to detect the effect of a session of Benson relaxation method (BRM) on high anxiety level. METHODS: Adult patients presented to the state hospital ED in seven days were recruited in this prospective study. Patients with high (≥8) scores were randomized to the treatment or control groups. They were asked to pursue BRM to alleviate anxiety. RESULTS: Six hundred thirty-four patients were recruited (mean age 44.1 and 52% were female). Patients with acute exacerbation or with psychiatric illness, with a systemic disease and higher acuity level had higher HAD-A scores (P < .05). BRM group had a mean score change higher than controls (7.2 ±â€Š2.9 vs 3.4 ±â€Š2.6, t test, P = .026). CONCLUSIONS: Patients who underwent BRM had larger decreases in HAD-A scores than others.


Assuntos
Doença Aguda/psicologia , Ansiedade/terapia , Serviços Médicos de Emergência/métodos , Psicoterapia Breve/métodos , Terapia de Relaxamento/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
15.
Scand J Trauma Resusc Emerg Med ; 27(1): 45, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992028

RESUMO

BACKGROUND: Recommendations regarding decompression of tension pneumothorax in small children are scarce and mainly transferred from the adult literature without existing evidence for the paediatric population. This CT-based study evaluates chest wall thickness, width of the intercostal space (ICS) and risk of injury to vital structures by needle decompression in children. METHODS: Chest wall thickness, width of the intercostal space and depth to vital structures were measured and evaluated at 2nd ICS midclavicular (MCL) line and 4th ICS anterior axillary line (AAL) on both sides of the thorax using computed tomography (CT) in 139 children in three different age groups (0, 5, 10 years). RESULTS: Width of the intercostal space was significantly smaller at the 4th ICS compared to the 2nd ICS in all age groups on both sides of the thorax. Chest wall thickness was marginally smaller at the 4th ICS compared to the 2nd ICS in infants and significantly smaller at 4th ICS in children aged 5 years and 10 years. Depth to vital structure for correct angle of needle entry was smaller at the 4th ICS in all age groups on both sides of the thorax. Incorrect angle of needle entry however is accompanied by a higher risk of injury at 2nd ICS. Furthermore, in some children aged 0 and 5 years, the heart or the thymus gland were found directly adjacent to the thoracic wall at 2nd ICS midclavicular line. CONCLUSION: Especially in small children risk of iatrogenic injury to vital structures by needle decompression is considerably high. The 4th ICS AAL offers a smaller chest wall thickness, but the width of the ICS is smaller and the risk of injury to the intercostal vessels and nerve is greater. Deviations from correct angle of entry however are accompanied by higher risk of injury to intrathoracic structures at the 2nd ICS. Furthermore, we found the heart and the thymus gland to be directly adjacent to the thoracic wall at the 2nd ICS MCL in a few children. From our point of view this puncture site can therefore not be recommended for decompression in small children. We therefore recommend 4th ICS AAL as the primary site of choice.


Assuntos
Descompressão Cirúrgica/métodos , Serviços Médicos de Emergência/métodos , Agulhas , Pneumotórax/cirurgia , Parede Torácica/diagnóstico por imagem , Toracostomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pneumotórax/diagnóstico
16.
Scand J Trauma Resusc Emerg Med ; 27(1): 46, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30992042

RESUMO

BACKGROUND: There is a growing demand for emergency medical services (EMS) and patients are repeatedly transported by ambulance services. For many patients, especially those with chronic disease, there may be better ways of delivering care. We examined the symptom at time of emergency call and the hospital diagnosis for those ambulance users who repeatedly received an ambulance. METHODS: Population-based historic cohort study of patients receiving an ambulance after an emergency call between 2011 and 2014: one-time users (i.e. one ambulance run in any 12 month period) were compared to two-time users (two runs in any 12 month period) and frequent users (>two runs). The presenting symptom according to the Danish Index for Emergency Care from the EMS calls and the hospital ICD-10 discharge diagnoses were obtained from patient records. RESULTS: We included 52 533 patients (65 932 emergency ambulance runs). Repeated users constituted 16% of the patients (two-time users 11% and frequent users 5%) and one third of all ambulance runs. The symptoms showing the largest increase in frequency with increasing ambulance use were breathing difficulty (N = 3 905-15% were frequent users); seizure (N = 2 437-10% were frequent users), chest pain (N = 7 616-17% were frequent users), and alcohol intoxication (N = 1 998-5% were frequent users). The hospital diagnoses with a corresponding increase were respiratory diseases (N = 4 381) - 13% were frequent users), mental disorders (predominately abuse of alcohol) (N = 3 087-10% were frequent users) and neurological diseases (predominately epilepsy) (N = 2 207-6% were frequent users). 5% of one-time users, 12% of two-time users and 16% of frequent users had a Charlson Comorbidity Index > = 3. CONCLUSION: Repeated use of ambulance services was common and associated with chronic health problems such as chronic respiratory diseases, epilepsy, mental disorders with alcohol abuse and comorbidity. Alternative methods of caring for many of these patients should be considered. TRIAL REGISTRATION: None.


Assuntos
Ambulâncias/estatística & dados numéricos , Call Centers/estatística & dados numéricos , Doença Crônica/terapia , Serviços Médicos de Emergência/métodos , Vigilância da População , Transporte de Pacientes/métodos , Doença Crônica/epidemiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade
17.
Scand J Trauma Resusc Emerg Med ; 27(1): 40, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961651

RESUMO

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) affects some 275,000 individuals in Europe each year. Time from collapse to defibrillation is essential for survival. As emergency medical services (EMS) response times in Sweden have increased, novel methods are needed to facilitate early treatment. Unmanned aerial vehicles (i.e. drones) have potential to deliver automated external defibrillators (AED). The aim of this simulation study was to explore bystanders' experience of a simulated OHCA-situation where a drone delivers an AED and how the situation is affected by having one or two bystanders onsite. METHODS: This explorative simulation study used a mixed methodology describing bystanders' experiences of retrieving an AED delivered by a drone in simulated OHCA situations. Totally eight participants were divided in two groups of bystanders a) alone or b) in pairs and performed CPR on a manikin for 5 minutes after which an AED was delivered by a drone at 50 m from the location. Qualitative data from observations, interviews of participants and video recordings were analysed using content analysis alongside descriptive data on time delays during bystander interaction. RESULTS: Three categories of bystander experiences emerged: 1) technique and preparedness, 2) support through conversation with the dispatcher, and 3) aid and decision-making. The main finding was that retrieval of an AED as delivered by a drone was experienced as safe and feasible for bystanders. None of the participants hesitated to retrieve the AED; instead they experienced it positive, helpful and felt relief upon AED-drone arrival and were able to retrieve and attach the AED to a manikin. Interacting with the AED-drone was perceived as less difficult than performing CPR or handling their own mobile phone during T-CPR. Single bystander simulation introduced a significant hands-off interval when retrieving the AED, a period lasting 94 s (range 75 s-110 s) with one participant compared to 0 s with two participants. CONCLUSION: The study shows that it made good sense for bystanders to interact with a drone in this simulated suspected OHCA. Bystanders experienced delivery of AED as safe and feasible. This has potential implications, and further studies on bystanders' experiences in real cases of OHCA in which a drone delivers an AED are therefore necessary.


Assuntos
Reanimação Cardiopulmonar/métodos , Tomada de Decisões , Desfibriladores/provisão & distribução , Cardioversão Elétrica/instrumentação , Serviços Médicos de Emergência/métodos , Modelos Teóricos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Humanos , Incidência , Masculino , Manequins , Parada Cardíaca Extra-Hospitalar/epidemiologia , Suécia/epidemiologia , Gravação em Vídeo
18.
Rev Bras Enferm ; 72(suppl 1): 143-150, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942356

RESUMO

OBJECTIVE: To describe the facilities and difficulties of the counter-referral of an Emergency Care Unit in Santa Catarina State. METHOD: Descriptive, qualitative study, with the participation of three nurses and 17 physicians. The data were collected through a semi-structured interview and analyzed using the Discourse of the Collective Subject technique. For the theoretical basis, the Política Nacional de Atenção às Urgências (National Policy of Emergency Care) and the Rede de Atenção às Urgências (Network of Care to the Emergencies) was used. RESULTS: The facilities of the counter-referral correspond to the strategies of communication with the Primary Care: embracement; good interpersonal relationships; and electronic medical record network. The difficulties are related to the deficiencies of Primary Care and specialized services, such as the insufficient number of physicians and the delay in scheduling consultations and more complex exams. FINAL CONSIDERATIONS: The difficulties highlighted indicate significant challenges of the local health system in the search for integration between emergency care points.


Assuntos
Serviços Médicos de Emergência/métodos , Pessoal de Saúde/psicologia , Encaminhamento e Consulta/normas , Adulto , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Feminino , Pessoal de Saúde/tendências , Humanos , Entrevistas como Assunto/métodos , Masculino , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/tendências , Médicos/psicologia , Médicos/tendências , Pesquisa Qualitativa
19.
Rev Bras Enferm ; 72(suppl 1): 307-314, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942377

RESUMO

OBJECTIVE: To assess the strategies used by the Nursing team to minimize medication errors in emergency units. METHOD: Integrative literature review in the PubMed, BDenf, Cochrane and LILACS databases. Timeless research, without language limitation, performed by peers. Articles published in full that answered the guiding question were included in research. RESULTS: Educational strategies (conducting campaigns, elaborating explanatory manuals, creating a multidisciplinary committee involved in the prevention and reduction of adverse drug events); organizational (meetings, Deviance positive, creation of protocols and changes in the work process) and new technologies (implementation of prescription by computerized system, introduction of the unit doses and of the bar code in the administration of medicines) were evidenced in the studies with the purpose of minimizing medication errors in an emergency unit. CONCLUSION: The strategies identified were effective in minimizing medication errors in emergency units.


Assuntos
Serviços Médicos de Emergência/métodos , Erros de Medicação/prevenção & controle , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/tendências , Humanos , Erros de Medicação/enfermagem , Preparações Farmacêuticas , Qualidade da Assistência à Saúde/normas
20.
In Vivo ; 33(3): 723-729, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31028189

RESUMO

BACKGROUND/AIM: Haemostatic dressings for the uniformed and rescue services are an integral part of life-saving equipment for controlling post-traumatic haemorrhage. The aim of this study was to assess the influence of active constituent substances and materials of haemostatic dressings on muscle tissue and muscle regeneration after traumatic injury. MATERIALS AND METHODS: Three hemostatic dressing prototypes were analysed: OBR/G/S sponge: dressing material sponge made of Na-Ca chitosan/algal composite microfibers and nanofibers; OBR/MBT/S: tactic gauze modified with a polymer mixture of Na-Ca chitosan/algal composite microfibers and nanofibers, impregnated with a moderate amount of procoagulants (22.9 g/m2); and OBR/MS/S: seton gauze modified with a polymer mixture of Na-Ca chitosan/algal composite microfibers and nanofibers, impregnated with a moderate amount of procoagulants (18.0 g/m2), with chitosan (ChitoClearhqg 95) and sodium alginate (Protanal LF10/60 FT) as the coagulants. The experiment was conducted on 20 pigs which were euthanised 24 h, 7 or 14 days after wound dressing. Samples of porcine muscle tissue were subjected to qualitative histopathological analysis. RESULTS: Histopathological analysis of muscle tissues from the experimental pigs revealed that the application of modified seton (OBR/MS/S) produced the most satisfactory results. The observed changes were similar on all dates that samples were collected and in all experimental groups, and minor differences in their extent were observed between groups. Regenerative processes were most advanced, and retrograde changes were least apparent in animals treated with OBR/MS/S. CONCLUSION: Modified seton (OBR/MS/S) induced the least tissue reaction and was most effective in promoting tissue regeneration after injury.


Assuntos
Bandagens , Serviços Médicos de Emergência , Hemostáticos , Animais , Modelos Animais de Doenças , Serviços Médicos de Emergência/métodos , Hemorragia/etiologia , Hemorragia/terapia , Histocitoquímica , Músculos/lesões , Músculos/patologia , Regeneração , Suínos , Cicatrização
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