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2.
Discov Med ; 29(158): 201-209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007195

RESUMO

Sepsis is an important disorder in intensive care medicine, and the emphasis is not on infections but the imbalance in body reactions and life-threatening organ dysfunction. The infection, the imbalance in the body's reaction, and the deadly organ dysfunction are three aspects of sepsis. Currently, there is still a debate on suitable criteria for the diagnosis of patients with sepsis with continuing changes in the guidelines on sepsis management. Here we summarize recent advances on the definitions, diagnosis, and treatment in the clinical practice of sepsis management in the emergency department. We also highlight future research directions on sepsis. In particular, given the global outbreak of coronavirus disease 2019 (COVID-19), we briefly describe the relationship between COVID-19 and sepsis. How to manage sepsis caused by emerging pathogens such as COVID-19 is a new challenge for care professionals in the emergency department.


Assuntos
Betacoronavirus/patogenicidade , Doenças Transmissíveis Emergentes/terapia , Infecções por Coronavirus/terapia , Tratamento de Emergência/métodos , Pneumonia Viral/terapia , Sepse/terapia , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/métodos , Doenças Transmissíveis Emergentes/complicações , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sepse/diagnóstico , Sepse/virologia , Índice de Gravidade de Doença
3.
J Obstet Gynaecol Can ; 42(8): 1017-1020, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32736852

RESUMO

Health care team training and simulation-based education are important for preparing obstetrical services to meet the challenges of the COVID-19 pandemic. Priorities for training are identified in two key areas. First, the impact of infection prevention and control protocols on processes of care (e.g., appropriate and correct use of personal protective equipment, patient transport, preparation for emergency cesarean delivery with the potential for emergency intubation, management of simultaneous obstetric emergencies, delivery in alternate locations in the hospital, potential for increased decision-to-delivery intervals, and communication with patients). And second, the effects of COVID-19 pathophysiology on obstetrical patients (e.g., testing and diagnosis, best use of modified obstetric early warning systems, approach to maternal respiratory compromise, collaboration with critical care teams, and potential need for cardiopulmonary resuscitation). However, such training is more challenging during the COVID-19 pandemic because of the requirements for social distancing. This article outlines strategies (spatial, temporal, video-recording, video-conferencing, and virtual) to effectively engage in health care team training and simulation-based education while maintaining social distancing during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Parto Obstétrico , Controle de Infecções/métodos , Obstetrícia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Treinamento por Simulação , Desenvolvimento de Pessoal/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Parto Obstétrico/educação , Parto Obstétrico/métodos , Tratamento de Emergência/métodos , Feminino , Humanos , Práticas Interdisciplinares/métodos , Obstetrícia/educação , Obstetrícia/métodos , Pandemias/prevenção & controle , Simulação de Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Treinamento por Simulação/métodos , Treinamento por Simulação/organização & administração
4.
Aging (Albany NY) ; 12(15): 15771-15783, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32805726

RESUMO

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.


Assuntos
Abdome Agudo , Infecções por Coronavirus , Tratamento de Emergência , Gastroenteropatias , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Operatórios , Abdome Agudo/diagnóstico , Abdome Agudo/epidemiologia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Idoso , Betacoronavirus/isolamento & purificação , Testes de Coagulação Sanguínea/métodos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Humanos , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/tendências
5.
PLoS One ; 15(8): e0237604, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790732

RESUMO

This study investigated the efficiency of a portable nitric oxide (NO) inhalation device through optimizing its design and structure. The portable rescue device could be used in clinical applications in outbreaks of viral pneumonia such as SARS. To reduce energy consumption for battery-powered portable usage, NO micro-channel plasma reactions induced by a continuous discharge arc were employed. A single-use airway tube could be combined with an intubation tube in clinical applications. In the experiment, a switching transistor controlled high frequency DC (12.5 kHz) was used to create a continuous discharge arc between two stainless steel electrodes (1-mm separation) after high-voltage breakthrough. A rotate instrument was employed to change the direction angle between the airflow and discharge arc, tube filled with Calcium hydroxide connected with gas outlet for reducing NO2, gas flow rate and input voltage were evaluated separately with concentration of NO and NO2/NO ratio. Results showed that a 2 L/min air flow direction from the cathode to the anode of electrodes (direction angle was zero) under 4 V input voltages produced 32.5±3.8 ppm NO, and the NO2/NO ratio reduced to less than 10%, stable output of nitric oxide might be convenient and effective for NO inhalation therapy. Modularization of the design produced a portable NO inhalation device that has potential for use in clinical applications as it is low cost, easy to disinfect, consumes low levels of energy and is ready to use.


Assuntos
Tratamento de Emergência/instrumentação , Desenho de Equipamento , Óxido Nítrico/metabolismo , Gases em Plasma/química , Pneumonia Viral/terapia , Terapia Respiratória/instrumentação , Ventiladores Mecânicos , Administração por Inalação , Tratamento de Emergência/métodos , Humanos , Óxido Nítrico/administração & dosagem , Terapia Respiratória/métodos
7.
Rev. esp. quimioter ; 33(4): 267-273, ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192949

RESUMO

OBJETIVO: Identificar qué biomarcadores realizados en la primera analítica de urgencias ayudan a estratificar según riesgo de mortalidad a pacientes COVID 19. MÉTODO: Estudio observacional descriptivo y transversal realizado con datos recogidos de los pacientes con sospecha de COVID-19 en el Servicio de Urgencias del 24 de febrero al 16 de marzo del 2020. Se realizó el estudio univariante y multivariante para encontrar los marcadores independientes de mortalidad y calcular el riesgo mediante la construcción de una escala de gravedad. RESULTADOS: Se incluyeron 163 pacientes de los que fallecieron 33 y 29 de ellos resultaron positivos para la prueba PCR COVID-19. Obtuvimos como posibles factores para conformar el score de riesgo de mortalidad edad>75 años ((OR ajustada=12,347, IC95%: 4,138-36,845 p = 0.001), leucocitos totales> 11.000 cel/mm3 (OR ajustada=2,649, IC95%: 0,879-7,981 p = 0,083), glucosa> 126 mg/dL (OR ajustada=3,716, IC95%: 1,247-11,074 p = 0,018) y creatinina>1,1 mg/dL (OR ajustada= 2,566, IC95%: 0,889-7,403, p = 0,081). Este score se denominó COVEB (COVID, Edad, perfil Básico analítico) con un AUC 0,874 (IC95%: 0,816-0,933, p < 0.001; punto de corte= 1 (sensibilidad= 89,66% (IC95%: 72,6%-97,8%), especificidad= 75,59% (IC95%: 67,2%-82,8%). Un score < 1 posee un valor predictivo negativo = 100% (IC95%: 93,51%-100%) y un valor predictivo positivo = 18,59% (IC95%: 12,82%-25,59%). CONCLUSIONES: Las escalas clínicas de gravedad, los biomarcadores de función renal, los parámetros del recuento leucocitario, el ratio neutrófilos totales/linfocitos y procalcitonina son factores de riesgo tempranos de mortalidad. Destacan las variables edad, glucosa, creatinina y leucocitos totales como mejores predictores de mortalidad. Un score COVEB< 1 indica con un 100% de probabilidad, que el paciente con sospecha de COVID-19 no va a fallecer en los próximos 30 días


OBJECTIVE: Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. METHOD: Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. RESULTS: A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). CONCLUSIONS: Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days


Assuntos
Humanos , Infecções por Coronavirus/mortalidade , Biomarcadores/análise , Tratamento de Emergência/métodos , Risco Ajustado/métodos , Indicadores de Morbimortalidade , Infecções por Coronavirus/diagnóstico , Prognóstico , Índice de Gravidade de Doença , Estudos Transversais , Testes de Função Renal/estatística & dados numéricos , Fatores de Risco , Reação em Cadeia da Polimerase/estatística & dados numéricos
8.
Rev. esp. quimioter ; 33(4): 274-277, ago. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-192950

RESUMO

INTRODUCTION: Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid. MATERIAL AND METHODS: This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate. RESULTS: A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts. CONCLUSION: The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department


INTRODUCCIÓN: Los cambios en las recomendaciones de Salud Pública pueden haber modificado la cantidad de visitas y los casos diagnosticados por COVID-19 en un servicio de urgencias de Madrid. MATERIAL Y MÉTODOS: Estudio retrospectivo de series de casos que incluyó a todos los pacientes atendidos de manera consecutiva en un servicio de urgencias terciario y urbano en Madrid, del 1 al 31 de marzo. La muestra se dividió: no COVID-19, COVID-19 no investigado, COVID-19 posible, COVID-19 probable, COVID-19 confirmado. Las diferencias entre los diferentes periodos establecidos por Salud Pública se evaluaron por el test de ANOVA para cada cohorte, incluyendo el número porcentual de test de PCR como covariable. RESULTADOS: Se incluyeron un total de 7.163 casos (4.071 no COVID-19, 563 COVID-19 no investigados, 870 posibles, 648 probables y 1.011 confirmados COVID-19). Las medidas de Salud Pública aplicadas durante cada período mostraron un claro efecto en la proporción de casos para las cinco cohortes. CONCLUSIÓN: La variabilidad de las definiciones de casos y los criterios de las pruebas de diagnóstico pueden tener un impacto en la cantidad de visitas a urgencias y en los casos diagnosticados de COVID-19 en el servicio de Urgencias


Assuntos
Humanos , Atenção à Saúde , Pacotes de Assistência ao Paciente/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/diagnóstico , Vírus da SARS/isolamento & purificação , Espanha/epidemiologia , Avaliação do Impacto na Saúde/métodos , Vírus da SARS/patogenicidade , Tratamento de Emergência/métodos , Estudos Retrospectivos , Reação em Cadeia da Polimerase/estatística & dados numéricos
9.
Rev. esp. cardiol. (Ed. impr.) ; 73(7): 569-576, jul. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187328

RESUMO

La infección por SARS-CoV-2, denominada COVID-19 (Coronavirus Infectious Disease-19), es una enfermedad desconocida hasta diciembre de 2019 a la que nos enfrentamos en España desde el 31 de enero de 2020 -fecha del primer caso diagnosticado en nuestro país- y que ya ha causado la muerte de 7.340 personas (a 30 de marzo de 2020), sobre todo mayores. Es importante tener en cuenta que, dado que la información evoluciona con extremada rapidez en este campo, lo expuesto en el presente documento puede estar sujeto a modificaciones. La población de mayor edad es especialmente susceptible a la infección por COVID-19, así como a desarrollar criterios de gravedad. Este aumento de morbimortalidad en el paciente mayor se ha asociado tanto con las comorbilidades, especialmente la enfermedad cardiovascular, como con la situación de fragilidad, que conlleva una respuesta inmunológica más pobre. La situación actual, tanto por los países afectados como por el número de casos, constituye una pandemia y supone una emergencia sanitaria de primer nivel. Como España es uno de los países más envejecidos del mundo, la COVID-19 se ha convertido en una emergencia geriátrica. El presente documento se ha elaborado conjuntamente entre la Sección de Cardiología Geriátrica de la Sociedad Española de Cardiología y la Sociedad Española de Geriatría y Gerontología


SARS-CoV2 infection, also known as COVID-19 (coronavirus infectious disease-19), was first identified in December 2019. In Spain, the first case of this infection was diagnosed on 31 January, 2020 and, by 30 March 2020, has caused 7340 deaths, especially in the elderly. Due to the rapidly evolving situation regarding this disease, the data reported in this article may be subject to modifications. The older population are particularly susceptible to COVID-19 infection and to developing severe disease. The higher morbidity and mortality rates in older people have been associated with comorbidity, especially cardiovascular disease, and frailty, which weakens the immune response. Due to both the number of affected countries and the number of cases, the current situation constitutes an ongoing pandemic and a major health emergency. Because Spain has one of the largest older populations in the world, COVID-19 has emerged as a geriatric emergency. This document has been prepared jointly between the Geriatric Cardiology Section of the Spanish Society of Cardiology and the Spanish Society of Geriatrics and Gerontology


Assuntos
Humanos , Pneumonia Viral/diagnóstico , Síndrome Torácica Aguda/diagnóstico , Infecções por Coronavirus/epidemiologia , Avaliação Geriátrica/métodos , Avaliação de Sintomas/métodos , Indicadores de Morbimortalidade , Infecções por Coronavirus/complicações , Pandemias , Tratamento de Emergência/métodos , Estratégias Mundiais , Cuidados Críticos/métodos
10.
Am J Emerg Med ; 38(9): 1703-1709, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32721781

RESUMO

STUDY OBJECTIVE: We sought to examine the frequency of pediatric critical procedures performed in a national group of emergency physicians. METHODS: We performed a retrospective analysis of an administrative billing and coding dataset for procedural performance documentation verification from 2014 to 2018. We describe and compare incident rates of pediatric (age <18 years) patient critical procedure performance by emergency physicians in general emergency departments (EDs), pediatric EDs, and freestanding ED/urgent care centers. Critical procedures were endotracheal intubation, electrical cardioversion, central venous placement, intraosseous access, and chest tube insertion. RESULTS: Among 2290 emergency physicians working in 186 EDs (1844 working in 129 general EDs, 125 in 8 pediatric EDs, and 321 in 49 freestanding EDs/urgent cares), a total of 2233 pediatric critical procedures were performed during the study period. Many physicians at general EDs and freestanding EDs/urgent cares performed zero pediatric procedures per year (53.9% and 89% respectively). Per 1000 ED visits seen (All patient ages), physicians working in general EDs performed fewer pediatric critical procedures than physicians in pediatric EDs (0.12/1000 visits vs 0.68/1000 visits; rate difference = 0.56, 95% confidence interval [CI] 0.51-0.61). Per 1000 clinical hours worked, physicians working in general EDs performed 0.26 procedures compared to 1.66 for physicians in pediatric EDs (rate difference = 1.39; 95% CI 1.27-1.52). CONCLUSION: Pediatric critical procedures are rarely performed by emergency physicians and are exceedingly rare in general EDs and freestanding EDs/urgent cares. The rarity of performance of these skills has implications for ED pediatric readiness.


Assuntos
Instituições de Assistência Ambulatorial , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
11.
Pediatr Emerg Med Pract ; 17(Suppl 6-1): 1-27, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32496723

RESUMO

Although there is still much that is not understood, experience with previous coronavirus outbreaks and available data on COVID-19 indicate a reduced propensity to affect children. Nonetheless, serious complications­although rare­are being seen in pediatric patients. This review, written with the emergency medicine clinician in mind, describes the epidemiology, clinical features, and management implications for COVID-19 in pediatric patients. It includes a discussion of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, as well as other aspects of the COVID-19 pandemic that are affecting children and families, such as poisonings, childhood immunizations, mental health, nonaccidental trauma, and neglect.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Tratamento de Emergência/métodos , Saúde Mental , Pandemias , Pneumonia Viral , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/terapia , Emergências , Saúde da Família , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Pneumonia Viral/terapia
12.
PLoS One ; 15(6): e0234984, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569319

RESUMO

Emergency Care Networks (ECNs) were created as a response to the increased demand for emergency services and the ever-increasing waiting times experienced by patients in emergency rooms. In this sense, ECNs are called to provide a rapid diagnosis and early intervention so that poor patient outcomes, patient dissatisfaction, and cost overruns can be avoided. Nevertheless, ECNs, as nodal systems, are often inefficient due to the lack of coordination between emergency departments (EDs) and the presence of non-value added activities within each ED. This situation is even more complex in the public healthcare sector of low-income countries where emergency care is provided under constraint resources and limited innovation. Notwithstanding the tremendous efforts made by healthcare clusters and government agencies to tackle this problem, most of ECNs do not yet provide nimble and efficient care to patients. Additionally, little progress has been evidenced regarding the creation of methodological approaches that assist policymakers in solving this problem. In an attempt to address these shortcomings, this paper presents a three-phase methodology based on Discrete-event simulation, payment collateral models, and lean six sigma to support the design of in-time and economically sustainable ECNs. The proposed approach is validated in a public ECN consisting of 2 hospitals and 8 POCs (Point of Care). The results of this study evidenced that the average waiting time in an ECN can be substantially diminished by optimizing the cooperation flows between EDs.


Assuntos
Assistência à Saúde/organização & administração , Países em Desenvolvimento , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência , Setor Público/organização & administração , Tratamento de Emergência/economia , Tratamento de Emergência/métodos , Humanos , Rede Social , América do Sul
13.
J Vasc Surg ; 72(3): 790-798, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32497747

RESUMO

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Síndrome do Desfiladeiro Torácico/diagnóstico , Triagem/normas , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Descompressão Cirúrgica/normas , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Tratamento de Emergência/métodos , Tratamento de Emergência/normas , Humanos , Controle de Infecções/normas , Comunicação Interdisciplinar , Salvamento de Membro/métodos , Salvamento de Membro/normas , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Telemedicina/normas , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/terapia , Terapia Trombolítica/métodos , Terapia Trombolítica/normas , Tempo para o Tratamento/normas
14.
Heart Fail Clin ; 16(3): 295-303, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32503753

RESUMO

Continuous-flow left ventricular assist devices are frequently used for management of patients with advanced heart failure with reduced ejection fraction. Although technologic advancements have contributed to improved outcomes, several complications arise over time. These complications result from several factors, including medication effects, physiologic responses to chronic exposure to circulatory support that is minimally/entirely nonpulsatile, and dysfunction of the device itself. Clinical presentation can range from chronic and indolent to acute, life-threatening emergencies. Several areas of uncertainty exist regarding best practices for managing complications; however, growing awareness has led to development of new guidelines to reduce risk and improve outcomes.


Assuntos
Tratamento de Emergência/métodos , Insuficiência Cardíaca , Coração Auxiliar , Choque Cardiogênico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
15.
Heart Fail Clin ; 16(3): 305-315, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32503754

RESUMO

Acute aortic syndromes are life-threatening medical conditions that include classic acute aortic dissection (AAD), aortic intramural hematoma, penetrating aortic ulcer, and even aortic pseudoaneurysm and traumatic aortic injury. The European Society of Cardiology has designed a multiparametric diagnostic algorithm to provide stepwise diagnosis. All patients with AAD should receive aggressive medical therapy to control blood pressure and heart rate. Urgent surgical repair is recommended for type A AAD. Uncomplicated type B AAD requires aggressive medical therapy. In contrast thoracic endovascular repair is recommended for complicated type B. AAD should be considered a lifelong disease that affects the entire aorta.


Assuntos
Doenças da Aorta , Procedimentos Cirúrgicos Cardiovasculares/métodos , Tratamento de Emergência/métodos , Procedimentos Endovasculares/métodos , Algoritmos , Doenças da Aorta/classificação , Doenças da Aorta/diagnóstico , Doenças da Aorta/fisiopatologia , Doenças da Aorta/terapia , Humanos , Imagem Multimodal
16.
Heart Fail Clin ; 16(3): 331-346, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32503756

RESUMO

Cardiovascular emergencies represent life-threatening conditions requiring a high index of clinical suspicion. In an emergency scenario, a simple stepwise biomarker/imaging diagnostic algorithm may help prompt diagnosis and timely treatment along with related improved outcomes. This article describes several clinical cases of cardiovascular emergencies, such as coronary stent thrombosis-restenosis, takotsubo syndrome, acute myocarditis, massive pulmonary embolism, type A acute aortic dissection, cardiac tamponade, and endocarditis.


Assuntos
Técnicas de Imagem Cardíaca/métodos , Doenças Cardiovasculares , Emergências/classificação , Tratamento de Emergência/métodos , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/terapia , Humanos
17.
Int Urol Nephrol ; 52(11): 2059-2064, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32583371

RESUMO

PURPOSE: It is reported that surgical procedures performed during the COVID-19 pandemic are accompanied by high complications and risks. In this study, the urological interventions applied with appropriate infrastructure and protocols during the pandemic in the pandemic hospital that is carrying out the COVID-19 struggle are analyzed. METHODS: Urological interventions were reviewed in the 5-week period between March 11 and April 16. The distribution of outpatient and interventional procedures was determined by weeks concurrently along with the COVID-19 patient workload, and data in the country, subgroups were further analyzed. Patients intervened were divided into four groups as Emergency, High, Intermediate, and Low Priority cases according to the EAU recommendations. The COVID-19-related findings were recorded; staff and patient effects were reported. RESULTS: Of the 160 interventions, 65 were minimally invasive or open surgical intervention, 95 were non-surgical outpatient intervention, and the outpatient admission was 777. According to the priority level, 33 cases had emergency and high priority, 32 intermediate and low priority. COVID-19 quarantine and follow-up were performed at least 1 week in 22 (33.8%) operated patients at the last week, 43 (66.2%) patients who were operated in the previous 4 weeks followed up at least 2 weeks. No postoperative complications were encountered in any patient due to COVID-19 during the postoperative period. CONCLUSION: In the COVID-19 pandemic, precautions, isolation, and algorithms are required to avoid disruption in the intervention and follow-up of urology patients; priority urological interventions should not be disrupted in the presence of necessary experience and infrastructure.


Assuntos
Assistência Ambulatorial , Procedimentos Cirúrgicos Ambulatórios , Infecções por Coronavirus , Controle de Infecções , Pandemias , Pneumonia Viral , Doenças Urológicas , Procedimentos Cirúrgicos Urológicos , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios/métodos , Betacoronavirus , Gestão de Mudança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Turquia/epidemiologia , Doenças Urológicas/epidemiologia , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos
18.
Oral Oncol ; 107: 104784, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32414642

Assuntos
Obstrução das Vias Respiratórias/terapia , Infecções por Coronavirus/prevenção & controle , Tratamento de Emergência/métodos , Neoplasias de Cabeça e Pescoço/complicações , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Traqueostomia/normas , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/normas , Tratamento Conservador/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Tratamento de Emergência/instrumentação , Tratamento de Emergência/normas , Glucocorticoides/administração & dosagem , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Índia/epidemiologia , Controle de Infecções/instrumentação , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Salas Cirúrgicas/normas , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Cuidados Pré-Operatórios/normas , Índice de Gravidade de Doença , Oncologia Cirúrgica/normas , Fatores de Tempo , Tempo para o Tratamento/normas , Traqueostomia/instrumentação
19.
PLoS One ; 15(5): e0232510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365136

RESUMO

In the obese, the evidence for the choice of the optimal emergency front-of-neck access technique is very limited and conflicting. We compared cannula and scalpel-bougie emergency front-of-neck access techniques in an anaesthetised porcine model with thick pretracheal tissue. Cannula and scalpel-bougie cricothyroidotomy techniques were performed in 11 and 12 anaesthetised pigs, respectively. Following successful tracheal access, oxygenation was commenced and continued for 5 min using Rapid-O2 device for cannula and circle breathing system for scalpel-bougie study groups. The primary outcome was a successful rescue oxygenation determined by maintenance of arterial oxygen saturation >90% 5 min after the beginning of oxygenation. Secondary outcomes included success rate of airway device placement, time to successful airway device placement, and trauma to the neck and airway. The success rate of rescue oxygenation was 18% after cannula, and 83% after scalpel-bougie technique (P = 0.003). The success rate of airway device placement was 73% with cannula and 92% with scalpel-bougie technique (P = 0.317). Median (inter-quartile-range) times to successful airway device placement were 108 (30-256) and 90 (63-188) seconds (P = 0.762) for cannula and scalpel-bougie emergency front-of-neck access, respectively. Proportion of animals with iatrogenic trauma additional to the procedure itself was 27% for cannula and 75% for scalpel-bougie technique (P = 0.039). Thus, in the porcine model of obesity, the scalpel-bougie technique was more successful in establishing and maintaining rescue oxygenation than cannula-based technique; however, it was associated with a higher risk of severe trauma.


Assuntos
Manuseio das Vias Aéreas/métodos , Modelos Anatômicos , Sus scrofa/cirurgia , Manuseio das Vias Aéreas/instrumentação , Animais , Cartilagem Cricoide/cirurgia , Tratamento de Emergência/instrumentação , Tratamento de Emergência/métodos , Feminino , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Modelos Animais , Pescoço/cirurgia , Obesidade/cirurgia , Oxigênio/administração & dosagem , Instrumentos Cirúrgicos , Fatores de Tempo , Traqueostomia/instrumentação , Traqueostomia/métodos
20.
J Cardiothorac Surg ; 15(1): 100, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414388

RESUMO

OBJECTIVE: The study objective was to investigate the incidence and risk factors of continuous renal replacement therapy (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. METHODS: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed postoperative CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. RESULTS: Before propensity score matching, univariate analysis showed that there were significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 h after surgery and ventilator time between two groups. All were higher in the CRRT group (P < 0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr and CPB time were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P < 0.001) and long-term overall cumulative survival (P < 0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003). CONCLUSION: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Valva Mitral/cirurgia , Terapia de Substituição Renal/efeitos adversos , Adulto , Idoso , Aneurisma Dissecante/mortalidade , Procedimentos Cirúrgicos Cardíacos/mortalidade , Ponte de Artéria Coronária/mortalidade , Creatinina/sangue , Tratamento de Emergência/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pontuação de Propensão , Terapia de Substituição Renal/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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