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Emerg Med Clin North Am ; 38(1): 193-206, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757250


Many orthopedic injuries can have hidden risks that result in increased liability for the emergency medicine practitioner. It is imperative that emergency medicine practitioners consider the diagnoses of compartment syndrome, high-pressure injury, spinal epidural abscess, and tendon lacerations in the right patient. Consideration of the diagnosis and prompt referrals can help to minimize the complications these patients often develop.

Emergências , Tratamento de Emergência/métodos , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Procedimentos Ortopédicos/legislação & jurisprudência , Gestão de Riscos/legislação & jurisprudência , Ferimentos e Lesões/terapia , Humanos , Procedimentos Ortopédicos/métodos
Undersea Hyperb Med ; 46(5): 709-712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683371


We describe the emergency management of a man who experienced acute vision loss diagnosed as direct traumatic optic neuropathy (TON) in his right eye (no light perception) after falling from a height. TON is caused by a high-impact mechanism of injury. Clinical findings include acute vision loss, which is typically immediate, afferent pupillary defect, decreased color vision, and visual field defects. Treatment is controversial because of the lack of strong evidence supporting intervention over observation. In this case report, our treatment strategy comprised immediate hyperbaric oxygen (HBO2) and daily high doses of a steroid. On the second day, minocycline was added to the treatment regimen for its neuroprotective effects. The patient was discharged after receiving six HBO2 treatments and six days of intravenous solumedrol transitioned to oral prednisone. After the third HBO2 treatment, his vision improved to 20/100; after the fourth treatment, it was 20/40 and plateaued. At the time of discharge, it was 20/40. At two-month follow-up, his corrected visual acuity was 20/60+2 in the affected eye. Immediate HBO2 for ischemic and mechanical injury to the optic nerve following trauma is a therapeutic option.

Cegueira/terapia , Glucocorticoides/administração & dosagem , Hemissuccinato de Metilprednisolona/administração & dosagem , Minociclina/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Traumatismos do Nervo Óptico/terapia , Acidentes por Quedas , Doença Aguda , Adulto , Cegueira/etiologia , Terapia Combinada/métodos , Tratamento de Emergência/métodos , Humanos , Masculino , Traumatismos do Nervo Óptico/complicações , Prednisona/administração & dosagem , Recuperação de Função Fisiológica
J Athl Train ; 54(10): 1074-1082, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31633408


CONTEXT: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown. OBJECTIVE: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams. DESIGN: Cross-sectional survey. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training. MAIN OUTCOME MEASURE(S): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid). RESULTS: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training (P < .001). CONCLUSIONS: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.

Traumatismos em Atletas/terapia , Reanimação Cardiopulmonar , Desfibriladores/provisão & distribução , Tratamento de Emergência , Tutoria , Esportes Juvenis/lesões , Adulto , Reanimação Cardiopulmonar/instrumentação , Reanimação Cardiopulmonar/métodos , Estudos Transversais , Tratamento de Emergência/métodos , Tratamento de Emergência/normas , Feminino , Humanos , Masculino , Tutoria/métodos , Tutoria/organização & administração , Tutoria/normas , Competência Profissional , Inquéritos e Questionários , Estados Unidos , Universidades
Am Surg ; 85(10): 1146-1149, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657312


Cirrhosis is associated with adverse outcomes after emergency general surgery (EGS). The objective of this study was to determine the safety of laparoscopic cholecystectomy (LC) in EGS patients with cirrhosis. We performed a two-year retrospective cohort analysis of adult patients who underwent LC for symptomatic gallstones. The primary outcome was the incidence of intraoperative complications. Of 796 patients, 59 (7.4%) were cirrhotic, with a median model for end-stage liver disease (MELD) score of 15 (IQR, 7). On unadjusted analysis, patients with cirrhosis were older, more likely to be male (both P < 0.01), diabetic (P < 0.001), had a higher incidence of preadmission antithrombotic therapy use (P < 0.02), and experienced a longer time to surgery (3.2 vs 1.8 days, P < 0.001). Coarsened exact matching revealed no difference in intra- or postoperative complications between groups (P = 0.67). Operative duration was longer in patients with cirrhosis (162 vs 114 minutes, P = 0.001), who also had a nonsignificant increase in the rate of conversion to an open cholecystectomy (14% vs 4%, P = 0.07). The results of this study indicate that LC may be safely performed in EGS patients with cirrhosis.

Colecistectomia Laparoscópica/efeitos adversos , Tratamento de Emergência/efeitos adversos , Cálculos Biliares/cirurgia , Complicações Intraoperatórias/epidemiologia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Fatores Etários , Ductos Biliares/lesões , Conversão para Cirurgia Aberta/estatística & dados numéricos , Tratamento de Emergência/métodos , Feminino , Fibrinolíticos/uso terapêutico , Cálculos Biliares/etiologia , Hemorragia/epidemiologia , Humanos , Incidência , Intestinos/lesões , Complicações Intraoperatórias/etiologia , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Segurança , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos
Mayo Clin Proc ; 94(9): 1786-1798, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31486381


OBJECTIVE: To compare recall of complications and surgical details discussed during informed consent and perception of the consent process in patients undergoing emergent vs elective surgery. METHODS: Studies were identified from PubMed, Cochrane, Web of Science, and Scopus from January 1, 1966, through April 18, 2018. Included studies compared patient recall and perception regarding informed consent in those undergoing emergent vs elective surgery. Pooled odds ratios (ORs) were calculated for recall of complications and surgical details, patient satisfaction, perception of sufficient information being delivered on surgical risks, report of having read written consent, and factors that interfered with consent. RESULTS: Eleven observational studies (3178 patients) were included. The rate of recall of surgical complications (255 of 504 [50.6%] vs 321 of 446 [72.0%]; OR, 0.29; 95% CI, 0.11-0.80) was lower in patients undergoing emergent vs elective surgery. Meta-analysis revealed a decreased rate of patient satisfaction with the consent process (319 of 459 [69.5%] vs 882 of 1064 [82.9%]; OR. 0.53; 95% CI, 0.34-0.83) and fewer patients having read the consent form (130 of 395 [32.9%] vs 424 of 714 [59.4%]; OR, 0.35; 95% CI, 0.27-0.46) when undergoing emergent compared with elective surgery. Patients undergoing emergent surgery listed pain, analgesic medications, and fatigue as factors likely to interfere with consent. CONCLUSION: Patients undergoing emergent surgery have poor recall of the informed consent process and surgical complications. Furthermore, patients report lower rates of satisfaction, and with fewer patients reading written consent documentation, our findings illuminate problems with the current communication process. There is a need to develop effective tools to improve informed consent in emergency surgery.

Procedimentos Cirúrgicos Eletivos/métodos , Tratamento de Emergência/métodos , Consentimento Livre e Esclarecido , Rememoração Mental , Determinação de Necessidades de Cuidados de Saúde , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Segurança do Paciente , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Medição de Risco , Estados Unidos
Expert Rev Clin Pharmacol ; 12(9): 901-908, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31422705


Introduction: The current emphasis on combatting the opioid epidemic in the United States and across the globe is well warranted, but rates and variations of other drugs and substances of abuse may be inadvertently increasing as well. These drugs and substances deserve equal attention in the literature to equip healthcare practitioners with the knowledge to provide optimal care in overdose patients. Areas covered: This evaluation includes loperamide, gabapentin, and modafinil and was accomplished through a comprehensive literature review of PubMed, MEDLINE, SCOPUS, ProQuest Central, ProQuest Dissertations, and CINAHL. The results of forty-four pieces of literature are included in this evaluation. The objective of this review is to provide a repository of standard and emerging treatment modalities for loperamide, gabapentin and modafinil for the emergency medicine team. Expert opinion: Loperamide, gabapentin, and modafinil are becoming drugs of abuse, and as such, should be on the radar of healthcare providers. Recognizing their unique toxicity profiles is imperative in providing optimal resuscitative care.

Gabapentina/envenenamento , Loperamida/envenenamento , Modafinila/envenenamento , Overdose de Drogas/terapia , Tratamento de Emergência/métodos , Humanos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
Prehosp Disaster Med ; 34(4): 407-414, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389326


BACKGROUND: Outdoor music festivals (OMFs) attract large numbers of guests and benefit from the help of large numbers of volunteers. Studies have previously described the injury patterns at OMFs, but no studies have described the use of medication and sales from on-site pharmacies at a large OMF. METHOD: The usage of medication and prescriptions in the Medical Health Care Organization (MHCO), including sales from the on-site pharmacy, at the Roskilde (Denmark) Festival 2015 were prospectively recorded. RESULTS: In excess of 130,000 attendees (guests and volunteers) participated in the Roskilde Festival 2015. The number of attendees contacting the MHCO was 15,133, of which 3,723 (25%) had a consultation with a doctor. Of all attendees evaluated by a doctor, 669 attendees received some form of medication in relation to the consultation. The MHCO administered and/or handed out a total of 6,494 units of prescription and over-the-counter medication, of which analgesics represented nearly 51%. Asthma was the condition with the highest proportion of attendees requiring pharmaceutical treatment, as 28 out of 48 (58%) received medication during the consultation. Sixty-five attendees received both medicine and a prescription. The MHCO handed out 562 prescriptions. In total, 609 prescriptions were redeemed at the on-site pharmacy. Antibiotics represented more than 78% of all redeemed prescriptions at the on-site pharmacy. CONCLUSION: The most utilized medications were analgesics and antibiotics. The data indicate a need for on-site prophylaxis using tetanus toxoid in combination with diphtheria toxoid vaccine and an on-site pharmacy. The content of the formulary at a mass-gathering event should be based on: evacuation time by ambulance/helicopter to hospitals with the level of competence needed; types of conditions to be treated on-site; level of competencies of festival medical staff; expected incidence and type of illness and injuries; and treatment of acute, life-threatening illnesses and or injuries.

Serviços Médicos de Emergência/organização & administração , Tratamento de Emergência/métodos , Férias e Feriados , Música , Preparações Farmacêuticas/administração & dosagem , Ferimentos e Lesões/tratamento farmacológico , Adulto , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Aglomeração , Dinamarca , Feminino , Humanos , Masculino , Estudos Prospectivos , Medição de Risco , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia
Radiología (Madr., Ed. impr.) ; 61(4): 286-296, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185306


Las complicaciones posquirúrgicas del cáncer colorrectal son frecuentes en los servicios de urgencias. La tomografía computarizada multidetector tiene un papel fundamental en el seguimiento de los pacientes operados, ya que hace posible el reconocimiento de complicaciones y recidiva. Es importante que el radiólogo esté familiarizado con las diferentes técnicas quirúrgicas y los cambios postoperatorios normales, con objeto de diferenciarlas de potenciales complicaciones y recidivas. El objetivo de este trabajo es revisar los hallazgos en tomografía computarizada multidetector que pueden considerarse normales tras la intervención quirúrgica, y hacer una revisión de las complicaciones tempranas que con mayor frecuencia encontramos en los servicios de urgencias

Complications after surgery for colorectal cancer are common in emergency departments. Multidetector computed tomography plays a fundamental role in the follow-up of patients after surgery, because it enables the detection of relapse and complications. Radiologists need to be familiar with different surgical techniques and the normal postsurgical changes so that we can differentiate them from potential complications and relapse. This article reviews the multidetector computed tomography findings that can be considered normal after surgical intervention for colorectal cancer as well as the most common early complications seen in postsurgical colorectal cancer patients presenting at emergency departments

Humanos , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Colorretais/cirurgia , Colectomia/métodos , Anastomose Cirúrgica/métodos , Colostomia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Tratamento de Emergência/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem
Radiología (Madr., Ed. impr.) ; 61(4): 333-336, jul.-ago. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185311


La enfermedad de Crohn es una patología de etiología autoinmunitaria, con afectación predominante del aparato digestivo. Se trata de una enfermedad que se diagnostica a edad temprana y presenta un curso crónico con reagudizaciones. Estos brotes se suelen manejar de forma similar a un abdomen agudo en los pacientes que acuden a los servicios de urgencias, y no existe un consenso sobre cuáles serían las pruebas de imagen más adecuadas. Debido a esta controversia, se ha decidido realizar una revisión de la bibliografía actual sobre cuáles serían las pruebas de imagen indicadas (ya sea por rendimiento diagnóstico o por menor exposición a radiación ionizante) en el brote agudo de pacientes con enfermedad de Crohn

Crohn's disease is an autoimmune disease that predominantly affects the gastrointestinal tract. Crohn's disease is diagnosed at a young age and runs a chronic course with acute flare-ups. When patients with Crohn's disease present with flare-ups at the emergency department, they are usually managed in a way similar to patients with acute abdomen; there is no consensus about the most appropriate imaging work-up for patients with flare-ups of Crohn's disease. Thus, we decided to review the literature about the imaging tests indicated (whether related to their diagnostic performance or to lower exposure to ionizing radiation) for acute flare-ups in patients with Crohn's disease

Humanos , Dor Abdominal/diagnóstico por imagem , Doença de Crohn/diagnóstico por imagem , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Tratamento de Emergência/métodos , Exacerbação dos Sintomas , Diagnóstico por Imagem/métodos
Am Surg ; 85(6): 595-600, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267899


Interhospital transfer of emergency general surgery (EGS) patients is a common occurrence. Modern individual hospital practices for interhospital transfers have unknown variability. A retrospective review of the Maryland Health Services Cost Review Commission database was undertaken from 2013 to 2015. EGS encounters were divided into three groups: encounters not transferred, encounters transferred from a hospital, and encounters transferred to a hospital. In total, 380,405 EGS encounters were identified, including 12,153 (3.2%) encounters transferred to a hospital, 10,163 (2.7%) encounters transferred from a hospital, and 358,089 (94.1%) encounters not transferred. For individual hospitals, percentage of encounters transferred to a hospital ranged from 0 to 30.05 per cent, encounters transferred from a hospital from 0.02 to 14.62 per cent, and encounters not transferred from 69.25 to 99.95 per cent of total encounters at individual hospitals. Percentage of encounters transferred from individual hospitals was inversely correlated with annual EGS hospital volume (P < 0.001, r = -0.59), whereas percentage of encounters transferred to individual hospitals was directly correlated with annual EGS hospital volume (P < 0.001, r = 0.51). Individual hospital practices for interhospital transfer of EGS patients have substantial variability. This is the first study to describe individual hospital interhospital transfer practices for EGS.

Tratamento de Emergência/métodos , Cirurgia Geral/organização & administração , Transferência de Pacientes/organização & administração , Qualidade da Assistência à Saúde , Estudos de Coortes , Bases de Dados Factuais , Emergências , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Relações Interinstitucionais , Tempo de Internação , Masculino , Maryland , Estudos Retrospectivos , Contrato de Transferência de Pacientes
Ann Thorac Surg ; 108(3): 687-692, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31173755


BACKGROUND: Preoperative anemia and red blood cell (RBC) transfusion are both associated with in-hospital mortality after cardiac surgery. The aim of this study was to investigate the interactions between preoperative anemia and RBC transfusion and their effect on the long-term survival of patients undergoing cardiac surgery. METHODS: Between 2005 and 2012, 1170 patients with anemia who underwent elective or urgent cardiac surgery were included. A matched group of 1170 nonanemic patients was used as a control group. A binary logistic regression model was used. RESULTS: The median follow-up period was 64 months (range, 0-127). Anemic patients had higher mortality (45%, n = 526) than nonanemic patients (32%, n = 374; P < .001). Preoperative anemia was independently associated with long-term mortality (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.46-2.1; P < .001), with both moderate (OR, 2.27; 95% CI, 1.72-2.99; P < .001) and mild anemia (OR, 1.39; 95% CI, 1.13-1.71; P = .002) contributing significantly. RBC transfusion was not associated with long-term mortality (OR, 1.07; 95% CI, 0.88-1.31; P = .49). There was no interaction between preoperative anemia and RBC transfusion (P = .947). CONCLUSIONS: Long-term mortality is significantly high in patients who are anemic, regardless of their transfusion status. Preoperative anemia is a strong, independent predictor of mortality and therefore should be managed before cardiac surgery.

Anemia/cirurgia , Transfusão de Sangue/mortalidade , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transfusão de Eritrócitos/efeitos adversos , Adulto , Anemia/diagnóstico , Anemia/mortalidade , Transfusão de Sangue/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos de Casos e Controles , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/métodos , Tratamento de Emergência/métodos , Tratamento de Emergência/mortalidade , Transfusão de Eritrócitos/métodos , Feminino , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
Rev. andal. med. deporte ; 12(2): 117-120, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184510


Objetivo: Describir las características clínico-epidemiológicas de los pacientes rescatados que presentaban luxación de hombro, así como el abordaje terapéutico. Método: Estudio descriptivo retrospectivo de los pacientes atendidos durante el periodo julio 2010-diciembre 2016 que presentaban una luxación de hombro. Resultados: Se analizan 57 pacientes. Las luxaciones de hombro suponen un 42.5% de las lesiones en extremidades superiores y un 2.7% del total de rescates. La edad media es 40.7±11.9 años; 96.4% varones. El senderismo, barranquismo y esquí de montaña son las actividades con más luxaciones. El 98.2% eran tipo glenohumeral anterior. La reducción fue exitosa en 80.9%, siendo la maniobra de Kocher la más empleada. El tiempo medio hasta el primer intento de reducción cuando maniobra fue exitosa fue de 87 minutos y 142 minutos cuando fracasa. Conclusiones: Se observa un aumento en las luxaciones de hombro, siendo la mayoría reducidas en el lugar del accidente, sin existir una maniobra de elección, y mayor éxito cuanto menor tiempo hasta maniobra. Reducir sin radiografía es seguro y eficaz

Objective: To describe the clinical-epidemiological characteristics of the rescued patients with shoulder dislocation, as well as the therapeutic approach. Method: A retrospective descriptive study of the patients treated during the period July 2010-December 2016, who presented with a shoulder dislocation. Results: A total of 57 patients were analysed. Shoulder dislocations account for 42.5% of upper extremity injuries and 2.7% of total rescues. The mean age being 40.7±11.9 years; 96.4% were male. Hiking, canyoning and mountain skiing are the activities in which most of the dislocations occur. 98.2% of the dislocations were anterior glenohumeral type. The reduction was successful in 80.9%, with the Kocher manoeuvre being the most used. The mean time until the first reduction attempt was successful was 87 minutes and 142 minutes when the manoeuvre failed. Conclusions: An increase in the number of shoulder dislocation was observed, most of them reduced at the accident site, there is no evidence of a single most successful manoeuvre over another. The quicker the reduction is attempted the more success is achieved. A reduction without performing an X-ray is safe and efficient

Objetivo: Descrever as características clínico-epidemiológicas e abordagem terapêutica em pacientes resgatados com luxação do ombro. Método: Estudo descritivo retrospectivo dos pacientes que apresentaram luxação de ombro, atendidos no período de julho de 2010 a dezembro de 2016. Resultados: Um total de 57 pacientes foram analisados. Luxações do ombro representam 42.5% das lesões da extremidade superior e 2.7% do total de resgates. A médiade idade foi de 40.7 ± 11.9 anos; 96.4% eram do sexo masculino. Caminhadas, canyoning e esqui de montanha são as atividades nas quais a mayoría das luxações ocorre. 98.2% das luxações foram do tipo glenoumeral anterior. A redução foi bem sucedida em 80.9%, sendo a manobra de Kocher a mais utilizada. O tempo médio até a primeira tentativa de redução foi de 87 minutos e 142 minutos quando a manobra falhou. Conclusões: Um aumento no número de luxações do ombro foi observado e a maioria delas reduzidas no local do acidente. Não há evidência de uma única manobra de maior sucesso em detrimento de outra. Quanto mais rápidaa redução é realizada, maior é o sucesso alcançado. Uma redução sem a realização de um raio X é segura e eficiente

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Assistência Pré-Hospitalar/métodos , Montanhismo/estatística & dados numéricos , Traumatismos em Atletas/epidemiologia , Luxação do Ombro/epidemiologia , Fixação de Fratura/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Retrospectivos
Rev. andal. med. deporte ; 12(2): 128-130, jun. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184512


La luxación esternoclavicular posterior es una patología extremadamente infrecuente, que se presenta, sobre todo, en varones jóvenes como consecuencia de un traumatismo de alta energía. Hasta en un 25% de los casos pueden aparecer complicaciones potencialmente letales por compresión de estructuras mediastínicas, que requieren de la reducción urgente de la luxación. El diagnóstico radiográfico puede ser difícil, siendo de gran utilidad la tomografía computerizada para determinar el tipo y grado de desplazamiento, así como la relación anatómica con las estructuras mediastínicas. Se presenta el caso de una paciente de 14 años de edad que presentó una luxación esternoclavicular posterior traumática aguda tras una caída practicando karate

Posterior sternoclavicular joint dislocation is an extremely rare condition, usually seen in males after high energy concussion. Potentially lethal complications may appear in 25% of cases, due to compression of mediastinic structures. Radiological diagnose may be difficult, why computed tomography is usually used to determine type and grade of displacement and relation with mediastinic structures. We present a case of a 14 year-old woman who presented a posterior sternoclavicular dislocation due to a fall while playing karate

A luxação posterior esternoclavicular é a condição extremamente rara, que ocorre principalmente em homens jovens, como resultado de trauma de alta impacto. Em até 25% dos casos, podem acontecer complicações potencialmente fatais por compressão de estruturas do mediastino, que exigem a redução urgente da luxação. O diagnóstico radiográfico pode ser difícil, sendo a tomografia computadorizada considerada útil para determinar o tipo e grau de deslocamento e a relação anatômica com as estruturas do mediastino. Aqui se apresenta o caso de um jovem de 14 anos que apresentou uma luxação esternoclavicular posterior traumática aguda após uma queda durante a prática de karatê

Humanos , Feminino , Adolescente , Luxação do Ombro/diagnóstico , Articulação Esternoclavicular/lesões , Traumatismos em Atletas/diagnóstico , Artes Marciais , Luxações Articulares/diagnóstico , Tratamento de Emergência/métodos , Restrição Física/métodos
Pediatr. aten. prim ; 21(82): e77-e79, abr.-jun. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-184592


La insuficiencia cardiaca es una patología poco frecuente en las consultas médicas pediátricas. Las formas en las que se expresa clínicamente esta incapacidad son muy diversas, sin embargo, en el paciente adulto suelen detectarse a través de síntomas clásicos como la disnea. En el caso del paciente pediátrico este espectro de presentación es mucho más amplio e inespecífico. El porcentaje de pacientes que no son correctamente diagnosticados en la primera consulta médica asciende hasta el 50%, y muchos de ellos reciben terapia antibiótica al haber sido etiquetado de infección bacteriana. Por ello presentamos el caso de un niño de tres años diagnosticado de insuficiencia cardiaca en nuestro servicio de urgencias pediátricas

Heart failure is an uncommon pathology in medical pediatric consultations. The forms in which this disability is clinically expressed are diverse, however, in the adult patient it is often detected through classic symptoms such as dyspnea. In the case of the pediatric patient this spectrum of presentation is much wider and non-specific. The percentage of patients who are not correctly diagnosed at the first medical consultation amounts to 50%, receiving many of them antibiotic therapy after having been labelled as bacterial infection. Therefore, we present the case of a three-year-old child diagnosed with heart failure in our pediatric emergency department

Humanos , Masculino , Pré-Escolar , Insuficiência Cardíaca/diagnóstico , Insuficiência da Valva Mitral/diagnóstico , Cardiomiopatia Dilatada/diagnóstico , Tratamento de Emergência/métodos , Dor Abdominal/etiologia , Diagnóstico Tardio , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Prog. obstet. ginecol. (Ed. impr.) ; 62(3): 254-259, mayo-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185007


Objective: To study the characteristics of patients attended for sexual assault in the Emergency Department of Miguel Servet Maternity Hospital. Material and methods: Descriptive cross-sectional study of sexual assaults managed between October 2016 and April 2018 at Miguel Servet Maternity Hospital. Results: We attended 52 cases of sexual assault in 50 women. Patients were generally young women with an average age of 28 years (24% were minors), had been assaulted by penetration (57.7%) by a single assailant (80.8%), and had received no observable physical lesions on the genitals (86.5%) or other parts of the body (65.4%). Fifty percent of the assaults took place during the weekend, and 63.5% of the patients came to the emergency department within 24 hours of the incident. In 75% of cases, the women reported the assault to the police. In 48% of cases, the patient did not undergo serology testing after visiting the emergency department; of those who did, 81% did not undergo repeat testing 3 months later. Conclusions: We observed a lack of agreement between the overall rate of sexual assault and the number of patients who came to the Emergency Department for this reason. Patients were mostly young, with no secondary physical lesions, and had been assaulted by penetration by a single assailant. Patients' adherence to medical indications was poor. Appropriate coordination between health workers, the police, and forensic experts is essential for appropriate management of sexual assaults are

Objetivo: estudiar las características de las pacientes atendidas en el Servicio de Urgencias del Hospital Maternal Miguel Servet por agresión sexual. Material y métodos: estudio descriptivo de las agresiones sexuales entre octubre de 2016 hasta abril de 2018 en el Hospital Maternal Miguel Servet. Resultados: se atendieron 52 urgencias de 50 pacientes diferentes. El perfil de la paciente fue: mujer joven, con una edad media de 28 años (el 24% fueron menores de edad), mediante penetración (57,7%), por un agresor único (80,8%) y sin lesiones físicas objetivables en genitales (86,5%) ni otras partes del cuerpo (65,4%). El 50% de agresiones se produjeron durante el fin de semana y el 63,5% acudió al Servicio de Urgencias en las primeras 24 horas tras la agresión. El 75% denunció los hechos a la policía. El 48% de las pacientes no se realizó serologías tras la visita al Servicio de Urgencias, y de las que lo hicieron, el 81% no repitió la determinación a los 3 meses. Conclusiones: existe una discordancia entre la tasa de agresión sexual global y el número de mujeres que acudió a Urgencias por este motivo. Las pacientes fueron en su mayoría jóvenes, sin lesiones físicas secundarias y agredidas mediante penetración por un agresor único. Fue observada una baja adherencia a las indicaciones médicas por parte de las pacientes. Una adecuada coordinación entre profesionales sanitarios, policía y especialistas en Medicina Legal y Forense es fundamental para un correcto manejo de la situación

Humanos , Feminino , Adolescente , Adulto Jovem , Delitos Sexuais/estatística & dados numéricos , Estupro/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Transversais , Ciências Forenses/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Epidemiologia Descritiva , Distribuição por Idade
BMJ Case Rep ; 12(5)2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-31142483


Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.

Laparoscopia , Ruptura Espontânea/cirurgia , Ruptura Uterina/cirurgia , Adulto , Cicatriz , Diagnóstico Diferencial , Emergências , Tratamento de Emergência/métodos , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Cuidado Pré-Natal/métodos , Doenças Raras