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1.
Rev. enferm. UERJ ; 28: e50191, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1119613

RESUMO

Objetivo: conhecer as concepções do enfermeiro frente à utilização de protocolos de urgência psiquiátrica no atendimento préhospitalar móvel. Métodos: estudo qualitativo, descritivo exploratório, com enfermeiros do Serviço de Atendimento Móvel de Urgência. Os dados foram coletados por meio de entrevista semiestruturada e submetidos à análise de conteúdo. Resultados: foram elencadas duas categorias: Protocolos de atendimento de urgência psiquiátrica e seu emprego no serviço de atendimento pré-hospitalar; e Fatores que influenciam o atendimento de urgência e emergência psiquiátrica. Os protocolos se direcionam contra os preceitos da reforma psiquiátrica e colocam sua aplicabilidade como fator de interferência no manejo da pessoa em crise, dando continuidade à ação ideológica social da contenção física. Considerações finais: o estudo mostrou o contexto da prática dos enfermeiros nas urgências psiquiátricas e evidenciou que os enfermeiros do Serviço de Atendimento Móvel de Urgência não estão devidamente instrumentalizados para atuarem nas urgências/emergências psiquiátricas.


Objective: to ascertain nurses' conceptions regarding the use of psychiatric emergency protocols in mobile pre-hospital care. Methods: in this qualitative, descriptive exploratory study of nurses in a Mobile Emergency Care Service, data were collected through semi-structured interviews and submitted to content analysis. Results: two categories were listed: Psychiatric emergency care protocols and their use in the pre-hospital care service; and Factors that influence emergency care and psychiatric emergency. The protocols are at odds with the tenets of psychiatric reform and frame its applicability as a factor that interferes with management of persons in crisis, thus serving to perpetuate the ideological social action of physical restraint. Final considerations: the study showed the context of nurses' practice in psychiatric emergencies and showed that nurses of the Mobile Emergency Care Service are not properly equipped to work in psychiatric emergencies.


Objetivo: conocer las concepciones de las enfermeras sobre el uso de protocolos de emergencia psiquiátrica en la atención prehospitalaria móvil. Métodos: en este estudio cualitativo, descriptivo, exploratorio de enfermeras en un Servicio Móvil de Atención de Emergencias, los datos fueron recolectados a través de entrevistas semiestructuradas y sometidos a análisis de contenido. Resultados: se enumeraron dos categorías: protocolos de atención de urgencias psiquiátricas y su uso en el servicio de atención prehospitalaria; y Factores que influyen en la atención de emergencia y la emergencia psiquiátrica. Los protocolos están en desacuerdo con los principios de la reforma psiquiátrica y enmarcan su aplicabilidad como un factor que interfiere con el manejo de las personas en crisis, sirviendo así para perpetuar la acción social ideológica de la restricción física. Consideraciones finales: el estudio mostró el contexto de la práctica de las enfermeras en emergencias psiquiátricas y mostró que las enfermeras del Servicio Móvil de Atención de Emergencias no están debidamente equipadas para trabajar en emergencias psiquiátricas.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Serviços Médicos de Emergência/normas , Serviços de Emergência Psiquiátrica/normas , Enfermeiras e Enfermeiros , Brasil , Protocolos Clínicos , Pesquisa Qualitativa , Cuidados de Enfermagem
2.
J Stroke Cerebrovasc Dis ; 29(10): 105151, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912531

RESUMO

BACKGROUND: Understanding and improving EMS stroke care requires linking data from both the prehospital and hospital settings. In the US, such data is collected in separate de-identified registries that cannot be directly linked due to lack of a common, unique patient identifier. In the absence of unique patient identifiers two common approaches to linking databases are deterministic matching, which uses combinations of non-unique matching variables to define matches, and probabilistic matching, which generates estimates of match probability based on the degree of similarity between records. This analysis seeks to compare these two approaches for matching EMS and stroke registry data. METHODS: Stroke cases transported by EMS to Michigan hospitals participating in the Michigan Coverdell Acute Stroke Registry were linked to records from Michigan's EMS Information System (MI-EMSIS) between January 2018 and June 2019. Destination hospital, date-of-service, patient age, date-of-birth, and sex were used to perform deterministic and probabilistic linkages. Match rates and representativeness of the matched samples were compared between the two matching strategies. Multivariable logistic regression was used to identify characteristics associated with successful matching. RESULTS: During the 18-month study period there were 8,828 EMS transported confirmed stroke cases in the registry and 620,907 EMS transports to 38 Coverdell registry-participating hospitals. The probabilistic match linked 5985 (67.7%) strokes to EMS records; the deterministic match linked 4012 (45.5%). Within each strategy the characteristics of matched and unmatched cases were similar, with the exception that deterministically matched cases were less likely to be older than 89 (adjusted odds ratio [aOR]=0.3), white (aOR=0.8), and more likely to have subarachnoid hemorrhage (aOR=1.4) than unmatched cases. CONCLUSION: Probabilistic matching resulted in higher match rates and a more representative sample of EMS transported strokes, suggesting it may be superior in assessing EMS stroke care compared to a deterministic approach.


Assuntos
Mineração de Dados/métodos , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/normas , Registro Médico Coordenado , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/normas , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Probabilidade , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
4.
Arch. argent. pediatr ; 118(4): 234-239, agosto 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1118171

RESUMO

Introducción. El abordaje de las emergencias pediátricas requiere recursos especializados y son frecuentes los errores relacionados con la medicación.Objetivos. Describir el contenido de los carros de emergencia (CE) en un hospital pediátrico y compararlo luego de una intervención educativa.Métodos. Se incluyeron CE de 9 salas de internación. Se elaboró una lista de cotejo con 30 drogas. Se relevaron los CE determinando presencia o ausencia de drogas y si las cantidades eran suficientes. Luego se realizó una intervención educativa y relevamientos 30 y 90 días posintervención.Resultados. La medición basal arrojó una proporción global de drogas adecuadas del 43,9 % (intervalo de confianza ­IC­ del 95 %: 38,4-49,4) con una variación entre CE del 29 % al 54,8 % y del 15 % al 85 % en los grupos de drogas. A los 30 días, la proporción correcta alcanzó el 70,3 % (IC 95 %: 65,2-75,4), con amplia variación entre los diferentes CE y grupos de drogas (del 51,6 % al 93,5 % y del 50 % al 95 %, respectivamente). A los 90 días, los porcentajes fueron similares. La comparación entre la primera y segunda medición mostró mejoría en todos los CE (rango: del 3,2 % al 45,1 %), odds ratio 3,73 (IC 95 %: 2,5-5,6), p < 0,001. Los resultados fueron similares entre la segunda y tercera medición.Conclusiones. En la medición inicial, se evidenció bajo nivel de adecuación de drogas de los CE. Luego de la intervención, mejoró significativamente y se mantuvo durante el período evaluado.


Introduction. The approach to pediatric emergencies requires specialized resources, and medication errors are common.Objectives. To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention.Methods. The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention.Results. The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [CI]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.2-75.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurementshowed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement.Conclusions. The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period


Assuntos
Humanos , Preparações Farmacêuticas , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/normas , Garantia da Qualidade dos Cuidados de Saúde , Emergências , Serviços Médicos de Emergência/organização & administração , Equipamentos e Provisões , Lista de Checagem , Ensaios Clínicos Controlados não Aleatórios como Assunto
5.
Epidemiol Infect ; 148: e174, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32762783

RESUMO

Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.


Assuntos
Infecções por Coronavirus/terapia , Serviços Médicos de Emergência/métodos , Arquitetura Hospitalar/métodos , Pneumonia Viral/terapia , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Surtos de Doenças , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Febre/diagnóstico , Febre/etiologia , Febre/terapia , Arquitetura Hospitalar/normas , Humanos , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Ensino , Fatores de Tempo , Triagem/métodos , Ventilação/normas , Fluxo de Trabalho , Recursos Humanos/organização & administração , Recursos Humanos/normas
6.
Epidemiol Infect ; 148: e161, 2020 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-32713366

RESUMO

After the 2003 SARS epidemic, China started constructing a primary-level emergency response system and focused on strengthening and implementation of policies, resource allocation. After 17 years of restructuring, China's primary-level response capabilities towards public health emergencies have greatly improved. During the coronavirus disease 2019 epidemic, primary-level administrative and medical personnel, social organisations, volunteers, etc. have played a significant role in providing professional services utilising the primary-level emergency response system of 17 years. However, China's organisations did not learn their lesson from the SARS epidemic, and certain problems are exposed in the system. By analysing the experience and shortcomings of China's disease prevention and control system at the primary level, we can focus on the development of disease control systems for major epidemics in the future.


Assuntos
Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/normas , Epidemias/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Saúde Pública/normas , China , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/tendências , Política de Saúde/tendências , Humanos , Disseminação de Informação/métodos , Tecnologia da Informação/tendências , Populações Vulneráveis
7.
Clin J Sport Med ; 30(4): 296-304, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639439

RESUMO

INTRODUCTION: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. METHODS: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. RESULTS: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved. CONCLUSIONS: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.


Assuntos
Traumatismos em Atletas/terapia , Serviços Médicos de Emergência/métodos , Traumatismos da Coluna Vertebral/terapia , Traumatismos em Atletas/prevenção & controle , Técnica Delfos , Remoção de Dispositivo , Serviços Médicos de Emergência/normas , Socorristas/educação , Dispositivos de Proteção da Cabeça , Humanos , Equipamentos de Proteção , Restrição Física , Traumatismos da Coluna Vertebral/prevenção & controle , Transporte de Pacientes , Estados Unidos
8.
Arch. esp. urol. (Ed. impr.) ; 73(5): 353-359, jun. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-189691

RESUMO

INTRODUCCIÓN: La crisis del coronavirus SARS-CoV-2 causante del COVID-19 está poniendoa prueba los sistemas sanitarios de todo el mundo. En un gran esfuerzo por estandarizar las pautas de manejo y tratamiento, las distintas autoridades sanitarias y asociaciones científicas han tratado de dictar unas recomendaciones sobre como actuar en este nuevo y complejo escenario. OBJETIVO: Sintetizar la evidencia y recomendaciones existentes acerca de la cirugía de urgencia urológica durante la situación de pandemia COVID-19. Además, proponemos un protocolo de actuación general para estos pacientes. MATERIAL Y MÉTODOS: El documento se basa en la escasa evidencia sobre SARS/Cov-2 y la experiencia de los autores en el manejo de COVID-19 en sus instituciones incluyendo especialistas de Andalucía, Cantabria, Madrid y País Vasco. Se realizó una búsqueda web y en PubMed utilizando las palabras clave "SARSCoV-2", "COVID19", "COVID Urology", "COVID19 surgery" y "emergency care". Se realizó una revisión narrativa de la literatura hasta el día 30 de Abril de2020 incluyendo solo artículos y documentos escritos en lengua española e inglesa. Tras técnica de grupo nominal modificada debido a las restricciones extraordinarias se realizó un primer borrador para unificar criterios. Finalmente, se realizó una versión definitiva, consensuada por todos los autores el 12 Mayo 2020. RESULTADOS: Se exponen unos principios generales de actuación, así como unas recomendaciones específicas para los procedimientos urológicos urgentes más frecuentes. CONCLUSIONES: Dado el carácter excepcional de la situación, existe un déficit de evidencia respecto al óptimo manejo del paciente con patología urológica urgente. La información es cambiante, según avanza el conocimiento epidemiológico de la enfermedad. Es recomendable el establecimiento de comités multidisciplinares quirúrgicos que desarrollen e implementen protocolos de actuación adecuados a los distintos recursos y situaciones particulares de cada centro. Del mismo modo, estos comités deben evaluar de forma individualizada cada posible situación de urgencia quirúrgica urológica y velar por el cumplimiento de las medidas de protección para el paciente y resto del personal sanitario


INTRODUCTION: The crisis in the SARSCoV-2 coronavirus causing COVID-19 is putting health systems around the world to the test. In a great effort to standardize the management and treatment guidelines, the different health authorities and scientific associations have tried to issue recommendations on how to act in this new and complex scenario. OBJECTIVE: To synthesize the existing evidence and recommendations about urological emergency surgery during the COVID-19 pandemic situation. Furthermore, we propose a general action protocol for these patients. MATERIAL AND METHODS: The document is based on the scarce evidence on SARS/Cov-2 and the experience of the authors in the management of COVID-19 in their institutions, including specialists from Andalusia, Cantabria, Madrid and the Basque Country. A web and PubMed search was performed using the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery" and "emergency care". A narrative review of the literature was carried out until April 30, 2020, including only articles and documents written in Spanish and English. After the nominal group technique modified due to the extraordinary restrictions, a first draft was made to unify criteria. Finally, a definitive version was made, agreed by all the authors on May 12, 2020. RESULTS: General principles of action are set out, as well as specific recommendations for the most frequent urgent urological procedures. CONCLUSIONS: Given the exceptional nature of the situation, there is a lack of evidence regarding the optimal management of the patient with urgent urological pathology. The information is changing, as the epidemiological knowledge of the disease advances. The establishment of multidisciplinary surgical committees that develop and implement action protocols appropriate to the different resources and particular situations of each center is recommended. Likewise, these committees must individually assess each possible urological surgical emergency situation and ensure compliance with rotective measures for the patient and other healthcare personnel


Assuntos
Humanos , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias , Doenças Urológicas/cirurgia , Serviços Médicos de Emergência/normas
11.
Rev Col Bras Cir ; 47: e20202576, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491028

RESUMO

The World Health Organization recognized in March 2020 the existence of a pandemic for the new coronavirus that appeared in China, in late 2019, and whose disease was named COVID-19. In this context, the SBAIT (Brazilian Society of Integrated Care for Traumatized Patients) conducted a survey with 219 trauma and emergency surgeons regarding the availability of personal protective equipment (PPE) and the role of the surgeon in this pandemic by means of an electronic survey. It was observed that surgeons have been acting under inadequate conditions, with a lack of basic supplies as well as more specific equipment such as N95 masks and facial shields for the care of potential victims who may be contaminated. The latter increases the risk of contamination of professionals, resulting in potential losses in the working teams. Immediate measures must be taken to guarantee access to safety equipment throughout the country, since all trauma victims and/or patients with emergency surgical conditions must be treated as potential carriers of COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Serviços Médicos de Emergência/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Traumatologia/normas , Brasil , Infecções por Coronavirus/epidemiologia , Humanos , Equipamento de Proteção Individual/normas , Pneumonia Viral/epidemiologia , Inquéritos e Questionários
12.
Prehosp Disaster Med ; 35(4): 451-453, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32507122

RESUMO

Coronavirus Disease 2019 (COVID-19), a new respiratory disease, is spreading globally. In France, Emergency Medical Service (EMS) teams are mobile medicalized resuscitation teams composed of emergency physician, nurse or anesthesiologist nurse, ambulance driver, and resident. Four types of clinical cases are presented here because they have led these EMS teams to change practices in their management of patients suspected of COVID-19 infection: cardiac arrest, hypoxia on an acute pneumonia, acute chronic obstructive pulmonary disease (COPD) exacerbation with respiratory and hemodynamic disorders, and upper function disorders in a patient in a long-term care facility. The last case raised the question of COVID-19 cases with atypical forms in elderly subjects. Providers were contaminated during the management of these patients. These cases highlighted the need to review the way these EMS teams are responding to the COVID-19 pandemic, in view of heightening potential for early identification of suspicious cases, and of reinforcing the application of staff protection equipment to limit risk of contamination.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Serviços Médicos de Emergência/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Planejamento em Desastres , Serviços Médicos de Emergência/normas , Tratamento de Emergência/normas , Feminino , França/epidemiologia , Humanos , Masculino , Pandemias , Equipamento de Proteção Individual , Técnicas de Planejamento , Pneumonia Viral/epidemiologia
15.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Artigo em Francês | MEDLINE | ID: covidwho-612987

RESUMO

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Assistência ao Convalescente/normas , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Cuidados Críticos/métodos , Cuidados Críticos/normas , Técnicas de Diagnóstico do Sistema Respiratório/normas , Gerenciamento Clínico , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Prioridades em Saúde , Hospitalização , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Terapia Respiratória/métodos , Terapia Respiratória/normas , Avaliação de Sintomas/métodos , Avaliação de Sintomas/normas , Tromboembolia/prevenção & controle , Trombofilia/tratamento farmacológico , Trombofilia/etiologia
16.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Artigo em Francês | MEDLINE | ID: covidwho-274082

RESUMO

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Assistência ao Convalescente/normas , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Cuidados Críticos/métodos , Cuidados Críticos/normas , Técnicas de Diagnóstico do Sistema Respiratório/normas , Gerenciamento Clínico , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Prioridades em Saúde , Hospitalização , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Terapia Respiratória/métodos , Terapia Respiratória/normas , Avaliação de Sintomas/métodos , Avaliação de Sintomas/normas , Tromboembolia/prevenção & controle , Trombofilia/tratamento farmacológico , Trombofilia/etiologia
18.
Rev Mal Respir ; 37(6): 505-510, 2020 Jun.
Artigo em Francês | MEDLINE | ID: covidwho-260298

RESUMO

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Assistência ao Convalescente/normas , Assistência Ambulatorial/métodos , Assistência Ambulatorial/normas , Doenças Cardiovasculares/prevenção & controle , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Cuidados Críticos/métodos , Cuidados Críticos/normas , Técnicas de Diagnóstico do Sistema Respiratório/normas , Gerenciamento Clínico , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Prioridades em Saúde , Hospitalização , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Terapia Respiratória/métodos , Terapia Respiratória/normas , Avaliação de Sintomas/métodos , Avaliação de Sintomas/normas , Tromboembolia/prevenção & controle , Trombofilia/tratamento farmacológico , Trombofilia/etiologia
19.
Acta Chir Orthop Traumatol Cech ; 87(2): 120-126, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32396513

RESUMO

PURPOSE OF THE STUDY The purpose of the study is to verify the sensitivity of pre-hospital triage algorithm used in the Czech Republic, which decides on directing the patients at risk of a failure of vital functions into a trauma centre. Another aim is to find out whether the triage algorithm extension by items F4-persistent traumatic paralysis and M7-buried under heavy objects, implemented in 2015, resulted in an increased sensitivity of triage. MATERIAL AND METHODS It is a retrospective, observational, monocentric study. Included in the study were all the trauma patients with the National Advisory Committee on Aeronautics (NACA) score 3-6 treated in the given period, directed by the emergency medical service to the trauma centre. Two groups of patients were compared. In the first group, triage was performed in line with the Bulletin of the Ministry of Health of 2008, while in the second group it was performed in line with the updated version published in the Bulletin of the Ministry of Health in 2015. Both the groups were later compared with the Injury Severity Score (ISS) obtained after the diagnosis of injury in the Trauma Centre of the University Hospital Ostrava. In the second group, also certain selected parameters were assessed. Group A: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2013 to 31 December 2014 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2008. Group B: Patients treated by the Emergency Medical Service of the Moravia-Silesia Region in the period from 1 January 2016 to 31 December 2017 who met the NACA 3-6 criterion and were identified by paramedics as triage positive in line with the pre-hospital triage 2015. In Group B, also monitored was the number of patients identified as triage positive only based on F4 and M7. RESULTS The first group included 3,475 patients, of whom 435 were triage positive. In the respective period, the Trauma Centre of the University Hospital Ostrava identified 262 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 210 patients. 19.9% were false negative (52/262). The mean ISS was 33.1±9.4, median 34, IQR 25.5--1. In Group A, the sensitivity of triage criteria reached 80.2% (95% IS: 74.7-84.7%), the specificity was 93.0% (95% IS: 92.0-93.8%). The second group included 3,816 patients, of whom 586 were triage positive. In the monitored period, the Trauma Centre of the University Hospital Ostrava identified 363 patients with ISS greater than 15 points. The pre-hospital triage and ISS greater than 15 points corresponded in 313 patients. 13.8% were false negative (50/363). The mean ISS was 43.7±12.0, median 42, IQR 33-54. In Group B, the sensitivity of triage criteria reached 86.2% (95% IS: 82.1-89.5%), the specificity was 98.5% (95% IS: 97.9-98.8%). In Group B, 11 patients were identified as triage positive based on F4 and M7 items. No statistically significant difference was found (chi-squared test, p = 0.257) after adding the F4 and M7 items to the algorithm. CONCLUSIONS The triage system for pre-hospital care in the Czech Republic in line with the applicable pre-hospital triage has high sensitivity as well as specificity and the results correspond to the latest triage algorithms used abroad. Increased sensitivity as a result of adding the new triage items was not confirmed. Key words: pre-hospital triage.


Assuntos
Serviços Médicos de Emergência/normas , Escala de Gravidade do Ferimento , Centros de Traumatologia/normas , Triagem/normas , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Algoritmos , República Tcheca , Serviços Médicos de Emergência/métodos , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Traumatologia/organização & administração , Triagem/métodos
20.
J Emerg Manag ; 18(3): 237-245, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32441040

RESUMO

The network of international urban search and rescue (USAR) teams, International Search and Rescue Advisory Group (INSARAG), has started its unique classification system called INSARAG External Classification (IEC) since 2005. In IEC, teams are classified into Heavy or Medium category, and as of the end of 2018, more than 50 teams have been classified. It seems that, through IEC, INSARAG successfully implements the standards such as the IN-SARAG Guidelines although the document is nonbinding. This article analyzes why IEC has got strong support from international USAR teams and what are the keys to successful implementation of standards in international emer-gency management. It concludes that it has been successful because, for example, INSARAG carefully gains a con-sensus from the member states when creating the standards, reiterates the minimum standards instead of the best practices, and sets the clear goal. The endorsement at the UN General Assembly Resolution also contributed to gaining support. Although there are some issues which need to be considered to maintain the system in the future, the lessons of the IEC model can be used for other fields of international disaster and emergency management.


Assuntos
Desastres , Serviços Médicos de Emergência/normas , Socorristas , Humanos , Internacionalidade , Reforma Urbana
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