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1.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1128-1130, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081904

RESUMO

On April 6, 2020, a case of severe crush injuries in head, neck, chest and right upper extremity was admitted to Qingzhou Hospital Affiliated to the First Medical University of Shandong Province. In addition to the crush injuries, the case also suffered from shock, crush syndrome, trauma-induced coagulopathy (TIC), and acute respiratory distress syndrome (ARDS). The female patient was 44 years old, and was admitted to the hospital at 07:00 on April 6, 2020 due to traffic accident with head, neck, chest, right upper limb injuries with disturbance of consciousness for 1 hour. Admission physical examination: body temperature was 35.6 centigrade. The patient was drowsy, with swelling and cyanosis around the right orbit and right cheek. The skin was severely abraded with blood seepage. The conjunctiva was pale. The lips were slightly cyanotic. The right chest collapsed and deformed with abnormal breathing. The skin of chest wall was blue and purple with extensive feeling of holding snow under the skin. The breath sound of right lung was low and dry and wet rales could be heard. Laboratory examination: routine blood test showed that white blood cell count (WBC) was normal, red blood cell count (RBC), hemoglobin (Hb) and platelet count (PLT) decreased, blood glucose increased; urine routine examination showed glucose +++, urine occult blood +++, urinary protein +++, visible transparent and granular tube type; coagulation indicators and blood biochemical examination were abnormal. Arterial blood gas analysis showed that pH and arterial partial pressure of oxygen (PaO2) decreased. X-ray showed comminuted fracture of distal humerus and proximal end of right ulna and radius with dislocation of right elbow joint. CT showed swelling of soft tissue around the right orbit and depressed fracture of inner wall. After admission, single-lung ventilation, tracheotomy and prone ventilation were applied to increase oxygenation level and relieving ARDS. Fluid of damage control for resuscitation was applied to reverse shock and blood transfusion was used to control hemorrhage and TIC. According to the patient's conditions and theory of damage control surgery, right chest drainage and amputation of the right upper extremity amputation were performed in time. Then, the resection in the middle and lower part of right lung, lung repairment, and internal rib fixation were performed. Finally, selective operation was performed to cover the open wound with healing dressing, using negative pressure for suction and carrying out "stamp" skin grafting on the right chest. After treatment, the patient was out of danger, and satisfactory clinical results were achieved in the end.


Assuntos
Traumatismo Múltiplo , Ventilação Monopulmonar , Adulto , Drenagem , Feminino , Humanos , Traumatismo Múltiplo/terapia
2.
Praxis (Bern 1994) ; 109(13): 1039-1049, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32787532

RESUMO

Care Management for Polytrauma Patients in a Level-1 Trauma Centre Abstract. In our level-1 trauma institution, polytrauma patients with an Injury Severity Score of 16 or higher are facing waiting times for transfer to a rehabilitation facility, causing a negative financial outcome for our institution. The purpose of this study is to stimulate rapid transfer to a rehabilitation facility. In a single-centre case study, care management for (poly)trauma patients was started to ensure time-directed treatment for trauma patients related to Diagnosis-Related Groups (DRG). In the period of 2013-2018 there was an increase in trauma admissions up to 14 % (n = 16 157) with a mean length of hospital stay of 6.4 days, together with a reduction in the number of trauma bed capacity from 50 to 42. In relation to the DRGs, regular trauma patients who were not in need of a stationary rehabilitation facility stayed in line with the expected time of hospital stay. But (poly)trauma patients (n = 1831) with the need of a stationary stay in a rehabilitation centre were faced with waiting times before they could be transferred. The average excess waiting time in relation to DRG for polytrauma patients was 5.1 days. Trauma patients for a rehabilitation centre have a higher Case Mix Index (CMI) compared to those who do not require inpatient rehabilitation (4.22 versus 1.04, p <0.0001). With about 280 trauma patients annually waiting an extra 5.1 days for transfer to a rehabilitation facility, the financial burden for our department amounts to Swiss francs 885,360 without reimbursement. Since no extra bed capacities in rehabilitation facilities are available in our area, it may be advised to set up an early in-hospital trauma rehabilitation program in a level-1 trauma centre in order to reduce financial loss.


Assuntos
Traumatismo Múltiplo , Centros de Traumatologia , Grupos Diagnósticos Relacionados , Hospitalização , Humanos , Tempo de Internação , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/terapia
3.
Am J Respir Crit Care Med ; 202(7): 1005-1012, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32614246

RESUMO

Rationale: Tissue Doppler imaging (TDI) is an echocardiographic method that measures the velocity of moving tissue.Objectives: We applied this technique to the diaphragm to assess the velocity of diaphragmatic muscle motion during contraction and relaxation.Methods: In 20 healthy volunteers, diaphragmatic TDI was performed to assess the pattern of diaphragmatic motion velocity, measure its normal values, and determine the intra- and interobserver variability of measurements. In 116 consecutive ICU patients, diaphragmatic excursion, thickening, and TDI parameters of peak contraction velocity, peak relaxation velocity, velocity-time integral, and TDI-derived maximal relaxation rate were assessed during weaning. In a subgroup of 18 patients, transdiaphragmatic pressure (Pdi)-derived parameters (peak Pdi, pressure-time product, and diaphragmatic maximal relaxation rate) were recorded simultaneously with TDI.Measurements and Main Results: In terms of reproducibility, the intercorrelation coefficients were >0.89 for all TDI parameters (P < 0.001). Healthy volunteers and weaning success patients exhibited lower values for all TDI parameters compared with weaning failure patients, except for velocity-time integral, as follows: peak contraction velocity, 1.35 ± 0.34 versus 1.50 ± 0.59 versus 2.66 ± 2.14 cm/s (P < 0.001); peak relaxation velocity, 1.19 ± 0.39 versus 1.53 ± 0.73 versus 3.36 ± 2.40 cm/s (P < 0.001); and TDI-maximal relaxation rate, 3.64 ± 2.02 versus 10.25 ± 5.88 versus 29.47 ± 23.95 cm/s2 (P < 0.001), respectively. Peak contraction velocity was strongly correlated with peak transdiaphragmatic pressure and pressure-time product, whereas Pdi-maximal relaxation rate was significantly correlated with TDI-maximal relaxation rate.Conclusions: Diaphragmatic tissue Doppler allows real-time assessment of the diaphragmatic tissue motion velocity. Diaphragmatic TDI-derived parameters differentiate patients who fail a weaning trial from those who succeed and correlate well with Pdi-derived parameters.


Assuntos
Estado Terminal , Diafragma/diagnóstico por imagem , Contração Muscular/fisiologia , Ultrassonografia Doppler/métodos , Desmame do Respirador , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos , Coma/fisiopatologia , Coma/terapia , Diafragma/fisiologia , Diafragma/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/fisiopatologia , Traumatismo Múltiplo/terapia , Procedimentos Neurocirúrgicos , Período Pós-Operatório , Pressão , Reprodutibilidade dos Testes , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Sepse/fisiopatologia , Sepse/terapia , Resultado do Tratamento
4.
JAAPA ; 33(6): 27-29, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32452958

RESUMO

Spinal subdural hematomas (SSDH) are a rare radiographic finding that can lead to significant long-term disability. Many clinicians are unfamiliar with this condition and the available treatment options. This article describes one approach to managing a patient with an SSDH.


Assuntos
Tratamento Conservador , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Agudo/terapia , Acidentes de Trânsito , Adulto , Vértebras Cervicais/diagnóstico por imagem , Hematoma Subdural Agudo/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/terapia , Compressão da Medula Espinal , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Scand J Trauma Resusc Emerg Med ; 28(1): 42, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448190

RESUMO

BACKGROUND: Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the chest and concomitant immobilization due to spinal instability, pain or neurological dysfunction, impairing the respiratory system individually and together. Thus, we proposed that an early stabilization of thoracolumbar spine fractures will result in significant benefits regarding respiratory organ function, multiple organ failure and length of ICU / hospital stay. METHODS: Patients documented in the TraumaRegister DGU®, aged ≥16 years, ISS ≥ 16, AISThorax ≥ 3 with a concomitant thoracic and / or lumbar spine injury severity (AISSpine) ≥ 3 were analyzed. Penetrating injuries and severe injuries to head, abdomen or extremities (AIS ≥ 3) led to patient exclusion. Groups with fractures of the lumbar (LS) or thoracic spine (TS) were formed according to the severity of spinal trauma (AISspine): AISLS = 3, AISLS = 4-5, AISTS = 3 and AISTS = 4-5, respectively. RESULTS: 1740 patients remained for analysis, with 1338 (76.9%) undergoing spinal surgery within their hospital stay. 976 (72.9%) had spine surgery within the first 72 h, 362 (27.1%) later on. Patients with injuries to the thoracic spine (AISTS = 3) or lumbar spine (AISLS = 3) significantly benefit from early surgical intervention concerning ventilation time (AISLS = 3 only), ARDS, multiple organ failure, sepsis rate (AISTS = 3 only), length of stay in the intensive care unit and length of hospital stay. In multiple injured patients with at least severe thoracic spine trauma (AISTS ≥ 4) early surgery showed a significantly shorter ventilation time, decreased sepsis rate as well as shorter time spend in the ICU and in hospital. CONCLUSIONS: Multiply injured patients with at least serious thoracic trauma (AISThorax ≥ 3) and accompanying spine trauma can significantly benefit from early spine stabilization within the first 72 h after hospital admission. Based on the presented data, primary spine surgery within 72 h for fracture stabilization in multiply injured patients with leading thoracic trauma, especially in patients suffering from fractures of the thoracic spine, seems to be beneficial.


Assuntos
Traumatismo Múltiplo/terapia , Fraturas da Coluna Vertebral/terapia , Traumatismos Torácicos/terapia , Adulto , Idoso , Cuidados Críticos , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Sistema de Registros , Fraturas da Coluna Vertebral/complicações , Traumatismos Torácicos/complicações , Vértebras Torácicas/lesões , Tempo para o Tratamento
6.
Cas Lek Cesk ; 159(1): 17-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32290668

RESUMO

Higher incidence of injury in trauma patients older than 65 years is connected with growing morbidity and mortality, first of all in polytrauma. Incidence of preexisting diseases play a great role in development of postinjury reaction. There are risk factors for genesis of postinjury complications and also mortality of victims. Growing number of polytrauma patients older than 65 years admitted to Trauma Centre Faculty Hospital Královské Vinohrady was reason for evaluation of epidemiological data and their comparison with data regarding to victims younger than 65 years. In retrospective study was evaluated 239 injured patients with polytrauma, admitted in Emergency unit Department of anesthesiology and resuscitation. From overall number was 47 victims older than 65 years (29/61 %).  75 years was an average age in victims older than 65 years. Primary admission to Trauma Centre was in case of 42 (85 %) victims older than 65 years. Between causes of injury were most frequent traffic accidents and falls. Most frequent injury in geriatric patients was craniocerebral injury in 36 patients (76 %) and thoracic trauma in 38 patients (80 %). Skeletal fractures of extremities were found in 21 (44 %) victims. From comparison of APACHE II score in both group of patients (19 in group of younger patients vs. 27,2 in group of older victims) is possible to establish higher incidence of preexisting diseases in patients older than 65 years. Average ISS score evaluated serious of trauma was without statistic significant difference (22 vs. 21). Number of deaths was 42 (22 %) in group of victims younger than 65 years and 22 (47 %) in group of victims older than 65 years. Older victims (over 65 years old) were exposed higher mortality in comparison with younger patients. On the result of treatment participate preexisting diseases besides age. Mechanism of injury and from this resulting type of trauma in older population need new strategy in postinjury care. Performance of primary admission of older victims with polytrauma to Trauma Centre is tend to this strategy.


Assuntos
Traumatismo Múltiplo , Centros de Traumatologia , Idoso , República Tcheca , Docentes , Hospitais , Humanos , Traumatismo Múltiplo/terapia , Estudos Retrospectivos
7.
Chin J Traumatol ; 23(3): 149-151, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307226

RESUMO

Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient's morbidity or mortality.


Assuntos
Glândulas Suprarrenais/lesões , Tratamentos com Preservação do Órgão/métodos , Ferimentos por Arma de Fogo/terapia , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Desbridamento , Hemorragia/etiologia , Hemorragia/terapia , Hemostasia Cirúrgica , Humanos , Laparotomia , Masculino , Traumatismo Múltiplo/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto Jovem
8.
J Trauma Acute Care Surg ; 88(6): 875-887, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32176167

RESUMO

BACKGROUND: Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. This guideline evaluates several aspects of BCVI diagnosis and management including the role of screening protocols, criteria for screening cervical spine injuries, and the use of antithrombotic therapy (ATT) and endovascular stents. METHODS: Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a taskforce of the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of currently available evidence. Four population, intervention, comparison, and outcome questions were developed to address diagnostic and therapeutic issues relevant to BCVI. RESULTS: A total of 98 articles were identified. Of these, 23 articles were selected to construct the guidelines. In these studies, the detection of BCVI increased with the use of a screening protocol versus no screening protocol (odds ratio [OR], 4.74; 95% confidence interval [CI], 1.76-12.78; p = 0.002), as well as among patients with high-risk versus low-risk cervical spine injuries (OR, 12.7; 95% CI, 6.24-25.62; p = 0.003). The use of ATT versus no ATT resulted in a decreased risk of stroke (OR, 0.20; 95% CI, 0.06-0.65; p < 0.0001) and mortality (OR, 0.17; 95% CI, 0.08-0.34; p < 0.0001). There was no significant difference in the risk of stroke among patients with Grade II or III injuries who underwent stenting as an adjunct to ATT versus ATT alone (OR, 1.63; 95% CI, 0.2-12.14; p = 0.63). CONCLUSION: We recommend using a screening protocol to detect BCVI in blunt polytrauma patients. Among patients with high-risk cervical spine injuries, we recommend screening computed tomography angiography to detect BCVI. For patients with low-risk risk cervical injuries, we conditionally recommend performing a computed tomography angiography to detect BCVI. We recommend the use of ATT in patients diagnosed with BCVI. Finally, we recommend against the routine use of endovascular stents as an adjunct to ATT in patients with Grade II or III BCVIs. LEVEL OF EVIDENCE: Guidelines, Level III.


Assuntos
Traumatismo Cerebrovascular/terapia , Traumatismos Cranianos Fechados/terapia , Traumatismo Múltiplo/terapia , Sociedades Médicas/normas , Traumatologia/normas , Traumatismo Cerebrovascular/diagnóstico , Traumatismo Cerebrovascular/etiologia , Angiografia por Tomografia Computadorizada/normas , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/normas , Fibrinolíticos/uso terapêutico , Traumatismos Cranianos Fechados/diagnóstico , Traumatismos Cranianos Fechados/etiologia , Humanos , Programas de Rastreamento/normas , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Stents , Traumatologia/métodos , Estados Unidos
9.
Medicine (Baltimore) ; 99(5): e19070, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000456

RESUMO

RATIONALE: Extracorporeal membrane oxygenation (ECMO) in multiple trauma patients with post-traumatic respiratory failure can be quite challenging because of the need for systemic anticoagulation, which may lead to excessive bleeding. In the last decade, there is a growing body of evidence that veno-venous ECMO (VV-ECMO) is lifesaving in multiple trauma patients with acute respiratory distress syndrome, thanks to technical improvements in ECMO devices. PATIENT CONCERNS: We report a case of a 17-year-old multiple trauma patient who was drunken and had confused mentality. DIAGNOSES: She was suffered from critical respiratory failure (life-threatening hypoxemia and severe hypercapnia/acidosis lasting for 70 minutes) accompanied by cardiac arrest and trauma-induced coagulopathy during general anesthesia. INTERVENTIONS: We decided to start heparin-free VV-ECMO after cardiac arrest considering risk of hemorrhage. OUTCOMES: She survived with no neurologic sequelae after immediate treatment with heparin-free VV-ECMO. LESSONS: Heparin-free VV-ECMO can be used as a resuscitative therapy in multiple trauma patients with critical respiratory failure accompanied by coagulopathy. Even in cases in which life-threatening hypoxemia and severe hypercapnia/acidosis last for >1 hours during CPR for cardiac arrest, VV-ECMO could be considered a potential lifesaving treatment.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Traumatismo Múltiplo/terapia , Adolescente , Transtornos da Coagulação Sanguínea/terapia , Feminino , Parada Cardíaca/terapia , Humanos , /terapia
12.
J Surg Res ; 248: 90-97, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31877435

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) and Abdominal Aortic and Junctional Tourniquet (AAJT) have received much attention in recent as methods for temporary control of junctional hemorrhage. Previous studies typically used the animal's shed blood for resuscitation. With current interest in moving REBOA to prehospital environment, this study aimed to evaluate the hemodynamic and metabolic responses to different resuscitation fluids used with these devices. METHODS: In swine (Sus scrofa), shock was induced using a controlled hemorrhage, femur fracture, and uncontrolled hemorrhage from the femoral artery. Infrarenal REBOA or AAJT was deployed for 60 min during which the arterial injury was repaired. Animals were resuscitated with 15 mL/kg of shed whole blood (SWB) or fresh frozen plasma (FFP) or 30 mL/kg of a balanced crystalloid (PlasmaLyte). RESULTS: Animals in the AAJT and REBOA groups did not show any measurable differences in hemodynamics, metabolic responses, or survival with AAJT or REBOA treatment; hence, the data are pooled and analyzed among the three resuscitative fluids. SWB, FFP, and PlasmaLyte groups did not have a difference in survival time or overall survival. The animals in the SWB and FFP groups maintained higher blood pressure after resuscitation, (P < 0.001) and required significantly less norepinephrine to maintain blood pressure than those in the PlasmaLyte group (P < 0.001). The PlasmaLyte resuscitation prolonged prothrombin time and decreased thromboelastography maximum amplitude. CONCLUSIONS: After 60 min, infrarenal REBOA or AAJT aortic occlusion SWB and FFP resuscitation provided better blood pressure support with half of the resuscitative volume of PlasmaLyte. Swine resuscitated with SWB and FFP also had a more favorable coagulation profile. These data suggest that whole blood or component therapy should be used for resuscitation in conjunction with REBOA or AAJT, and administration of these fluids should be considered if prehospital device use is pursued.


Assuntos
Técnicas Hemostáticas , Traumatismo Múltiplo/terapia , Ressuscitação , Choque Hemorrágico/terapia , Animais , Feminino , Plasma , Substitutos do Plasma , Suínos
13.
Br J Hosp Med (Lond) ; 80(12): 703-706, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31822166

RESUMO

Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.


Assuntos
Traumatismo Múltiplo/terapia , Equipe de Assistência ao Paciente/organização & administração , Centros de Traumatologia/organização & administração , Tomada de Decisão Clínica , Cuidados Críticos/organização & administração , Humanos , Relações Interprofissionais , Traumatismo Múltiplo/mortalidade , Melhoria de Qualidade/organização & administração , Radiologia/organização & administração , Reabilitação/organização & administração , Cirurgiões/organização & administração , Reino Unido
14.
BMC Geriatr ; 19(1): 359, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856739

RESUMO

BACKGROUND: The demographic changes towards ageing of the populations in developed countries impose a challenge to trauma centres, as geriatric trauma patients require specific diagnostic and therapeutic procedures. This study investigated whether the integration of new standard operating procedures (SOPs) for the resuscitation room (ER) has an impact on the clinical course in geriatric patients. The new SOPs were designed for severely injured adult trauma patients, based on the Advanced Trauma Life Support (ATLS) and imply early whole-body computed tomography (CT), damage control surgery, and the use of goal-directed coagulation management. METHODS: Single-centre cohort study. We included all patients ≥65 years of age with an Injury Severity Score (ISS) ≥ 9 who were admitted to our hospital primarily via ER. A historic cohort was compared to a cohort after the implementation of the new SOPs. RESULTS: We enrolled 311 patients who met the inclusion criteria between 2000 and 2006 (group PreSOP) and 2010-2012 (group SOP). There was a significant reduction in the mortality rate after the implementation of the new SOPs (P = .001). This benefit was seen only for severely injured patients (ISS ≥ 16), but not for moderately injured patients (ISS 9-15). There were no differences with regard to infection rates or rate of palliative care. CONCLUSIONS: We found an association between implementation of new ER SOPs, and a lower mortality rate in severely injured geriatric trauma patients, whereas moderately injured patients did not obtain the same benefit. TRIAL REGISTRATION: Clinicaltrials.gov NCT03319381, retrospectively registered 24 October 2017.


Assuntos
Geriatria/normas , Escala de Gravidade do Ferimento , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/terapia , Centros de Traumatologia/normas , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Geriatria/tendências , Humanos , Masculino , Traumatismo Múltiplo/diagnóstico por imagem , Estudos Prospectivos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/tendências , Centros de Traumatologia/tendências
16.
Rev. bras. cir. plást ; 34(4): 504-508, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047913

RESUMO

Introdução: Lesões geradas por queimaduras representam um importante problema de saúde pública, constituindo a quarta causa de morte na infância no Brasil e Estados Unidos. Além disso, poucas são as doenças que trazem prejuízos tão importantes, com considerável morbidade pelo desenvolvimento de sequelas físicas e psicossociais. Diante disso, o objetivo deste estudo é traçar o perfil epidemiológico de crianças de 0-18 anos atendidas em um hospital escola de Curitiba, Paraná. Métodos: Estudo transversal e retrospectivo realizado através da análise de 625 prontuários de internação de crianças de 0-18 anos vítimas de queimaduras, entre janeiro de 2010 a dezembro de 2017. Foram coletadas informações sobre idade, sexo, tempo de internação, óbito, região corporal atingida, extensão da superfície corporal, grau de profundidade, agente etiológico e abordagem terapêutica. Resultados: A maior parte da amostra era composta por lactentes (43%), com média de idade de 12,6 anos. O sexo mais afetado foi o masculino e os pacientes permaneceram cerca de 14,5 dias internados. No estudo, 98% das queimaduras apresentaram como etiologia o agente térmico, principalmente por líquido quente. Em relação ao grau de profundidade, a maioria das queimaduras foram de 2º grau (61,3%), atingindo até 25% de superfície corporal queimada (SCQ), sendo o tronco o mais afetado. Dentre as modalidades de tratamento, 44% dos pacientes necessitaram de intervenção cirúrgica com debridamento e enxertia. Conclusão: Crianças mais novas são mais propensas a sofrerem queimaduras principalmente no ambiente domiciliar e, além disso, uma equipe preparada e capacitada é de crucial importância no prognóstico destes doentes.


Introduction: Injuries caused by burns represent a significant public health problem, constituting the fourth leading cause of childhood death in Brazil and the United States. In addition, few diseases carry such substantial losses as burns, with considerable morbidity due to the development of physical and psychosocial sequelae. This study aimed to outline the epidemiological profile of 0­18-year-old children treated for burns at a teaching hospital in Curitiba, Paraná. Methods: This cross-sectional, retrospective study involved analysis of 625 medical records of 0­18-year-old children who were victims of burns from January 2010 to December 2017. Information was collected on age, sex, length of hospitalization, death, body region affected, burned body surface area (BSA), depth, etiologic agent, and therapeutic approach. Results: A plurality of the sample were infants (43%), and the average age of the sample was 12.6 years. Most of the sample was comprised males, and the patients remained hospitalized for an average of 14.5 days. Of the burns, 98% were caused by thermal agents, particularly hot liquids. Most burns were second-degree burns (61.3%), reaching up to 25% of the BSA, and the most affected region was the trunk. Among the treatment modalities, 44% of the patients needed surgical intervention with debridement and grafting. Conclusion: Younger children are more prone to burns, especially in the home environment. A prepared and qualified team is of crucial importance for optimizing outcomes in these patients.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , História do Século XXI , Cirurgia Plástica , Perfil de Saúde , Queimaduras , Traumatismo Múltiplo , Inquéritos Epidemiológicos , Cirurgia Plástica/métodos , Cirurgia Plástica/estatística & dados numéricos , Queimaduras/cirurgia , Queimaduras/terapia , Traumatismo Múltiplo/cirurgia , Traumatismo Múltiplo/terapia , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos
17.
Rev. esp. anestesiol. reanim ; 66(10): 521-527, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192105

RESUMO

INTRODUCCIÓN: El entorno emocional que se crea en una sesión de simulación puede afectar al proceso de aprendizaje. Las emociones positivas mejoran el proceso de percepción y facilitan el aprendizaje. Sin embargo, las emociones negativas pueden disminuir la memoria de trabajo, lo que da lugar a menor adquisición de aprendizaje. OBJETIVOS: El objetivo del estudio fue investigar el impacto que la simulación tiene sobre las emociones durante todas las fases de una simulación de alta fidelidad, usando un prebriefing estandarizado y el debriefing «con buen juicio». MÉTODOS: Es un estudio observacional que incluyó a 74 anestesiólogos que participaron en una sesión de simulación. Se utilizó un prebriefing estandarizado y el debriefing «con buen juicio». Para evaluar las emociones, usamos el modelo circumplejo de las emociones aplicando la escala Affect Grid, que se utilizó antes del prebriefing (estadio 1), antes del caso (estadio 2), antes del debriefing (estadio 3) y después de él (estadio 4). RESULTADOS: La muestra final fueron los resultados de la escala Affect Grid obtenidos de 67 participantes. Tras el debriefing, esta simulación sobre un caso de paciente politraumatizado fue experimentada de manera significativamente más placentera que en estadios previos (p <0,01). Además, se percibió como una actividad cada vez más activa según iba avanzando (p <0,01). CONCLUSIONES: El entrenamiento en atención al trauma grave mediante simulación en un entorno seguro con un prebriefing estandarizado y el debriefing «con buen juicio» fue experimentado como una actividad placentera y activa durante todas las fases de la simulación. Se necesitan nuevas investigaciones para evaluar el impacto de estos resultados en el aprendizaje


INTRODUCTION: The emotional environment created during a simulation session can influence learning. Positive emotions improve perceptual processing and facilitate learning, while negative emotions can reduce working memory, resulting in poorer learning outcomes. OBJECTIVES: The aim of this study was to investigate the impact of simulation training on emotions during all phases of a high-fidelity simulation using standard prebriefing and «good judgement debriefing » techniques. METHODS: This was an observational study that included 74 anesthesiologists participating in a simulation-based training. A standardized prebriefing was followed by «good judgement debriefing». In order to assess emotions, we used the circumplex model of emotion, and asked participants to complete the affect grid scale before prebriefing (Stage 1), before starting the simulation (Stage 2), before debriefing (Stage 3) and following debriefing (Stage 4). RESULTS: The affect grid scores obtained from 67 participants were analyzed. Following debriefing, the experience of the polytrauma patient simulation was significantly more pleasant compared to previous stages (P<0.01). In addition, participants perceived the activity as becoming increasingly active as it progressed (P<0.01). CONCLUSIONS: High-fidelity trauma simulation creating a safe environment using a standardized prebriefing and «good judgement debriefing» is experienced as a pleasant and active activity at all stages of the simulation. Further investigation is needed to assess the impact of these results on learning


Assuntos
Humanos , Anestesiologistas/psicologia , Emoções , Traumatismo Múltiplo/psicologia , Treinamento por Simulação/métodos , Cuidados de Suporte Avançado de Vida no Trauma/psicologia , Análise de Variância , Anestesiologistas/educação , Traumatismo Múltiplo/terapia , Sensação
18.
J Trauma Nurs ; 26(6): 312-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31714492

RESUMO

Considering that traumatic injuries are the leading cause of death among young adults across the globe, emergency department care of polytrauma patients is a crucial aspect of optimized care and premature death prevention. Unfortunately, many studies have highlighted important gaps in collaboration among different trauma team professionals, posing a major quality-of-care challenge. Using the conceptual framework for interprofessional teamwork (IPT) of , the aim of this qualitative descriptive exploratory study was to better understand IPT from the perspective of health professionals in emergency department care of polytrauma patients, specifically by identifying factors that facilitate and impede IPT. Data were collected from a sample of 7 health professionals involved in the care of polytrauma patients through individual interviews and a focus group. In the second phase, 2 structured observations of polytrauma patient care were conducted. Following a thematic analysis, results revealed multiple factors affecting IPT, which can be divided into 5 broad categories: individual, relational, processual, organizational, and contextual. Individual factors, a category that is not part of the conceptual framework of , also emerged as playing a major part in IPT.


Assuntos
Cuidados Críticos/psicologia , Serviços Médicos de Emergência/organização & administração , Pessoal de Saúde/psicologia , Relações Interprofissionais , Traumatismo Múltiplo/psicologia , Traumatismo Múltiplo/terapia , Equipe de Assistência ao Paciente/organização & administração , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico , Quebeque , Adulto Jovem
20.
Rev Esp Anestesiol Reanim ; 66(10): 521-527, 2019 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31677738

RESUMO

INTRODUCTION: The emotional environment created during a simulation session can influence learning. Positive emotions improve perceptual processing and facilitate learning, while negative emotions can reduce working memory, resulting in poorer learning outcomes. OBJECTIVES: The aim of this study was to investigate the impact of simulation training on emotions during all phases of a high-fidelity simulation using standard prebriefing and «good judgement debriefing ¼ techniques. METHODS: This was an observational study that included 74 anesthesiologists participating in a simulation-based training. A standardized prebriefing was followed by «good judgement debriefing¼. In order to assess emotions, we used the circumplex model of emotion, and asked participants to complete the affect grid scale before prebriefing (Stage 1), before starting the simulation (Stage 2), before debriefing (Stage 3) and following debriefing (Stage 4). RESULTS: The affect grid scores obtained from 67 participants were analyzed. Following debriefing, the experience of the polytrauma patient simulation was significantly more pleasant compared to previous stages (P<0.01). In addition, participants perceived the activity as becoming increasingly active as it progressed (P<0.01). CONCLUSIONS: High-fidelity trauma simulation creating a safe environment using a standardized prebriefing and «good judgement debriefing¼ is experienced as a pleasant and active activity at all stages of the simulation. Further investigation is needed to assess the impact of these results on learning.


Assuntos
Anestesiologistas/psicologia , Emoções , Traumatismo Múltiplo/psicologia , Treinamento por Simulação/métodos , Cuidados de Suporte Avançado de Vida no Trauma/psicologia , Análise de Variância , Anestesiologistas/educação , Humanos , Traumatismo Múltiplo/terapia , Sensação
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