FERIDAS SUPERFICIAIS: FATORES TÉCNICOS ASSOCIADOS A COMPLICAÇÕES LOCAIS

Background: Trauma is a serious public health problem with relevant social and economic consequences. The open cutaneous wounds, despite less severe, are not different, because they have high prevalence, and the patients often need to be away from their functions. This study aims to evaluate these wounds, establishing relations between technique factors of the initial management with unwanted scar and local complications. Methods: A prospective, longitudinal, observational and analytical analysis was performed. Data were collected at Hospital do trabalhador (Curitiba/PR), through two questionnaires: the first was filled in the emergency care, and the second in the outpatient clinic return, within 05 to 11 days. Results: 232 patients were evaluated, and 87 returned to outpatient clinic. Considering the total, the epidemiological profile was male (81.5%) with mean age of 38.5 years. Related to the wound, 55% were cut-blunt, located at hands and frontispiece (62.7%), and 86.7% were less than 06 cm length. The initial treatment was cleaning with saline solution (94.7%), wound’s closure with simple interrupted suture (98.85%),  in a number of 06 or less (75.7%), with 3-0 or 4-0 (85.2%) nylon (98.25%). Antibiotic was prescribed to 42.7% of the patients. In outpatient clinic, it was found stitches dehiscence in 13.80%, infection signs in 14.95% and necrosis in 19.5%. Conclusions: Greater amount of stitches in suture, topical substances in home care and use of systemic antibiotics were related with high rates of necrosis, as well as application of hydrogen peroxide with hight rates of necrosis. Introdução: O trauma é um grave problema de saúde pública com relevantes consequências sociais e econômicas. As feridas cutâneas traumáticas, apesar de menor gravidade, não fogem esta regra, pois além da grande prevalência em atendimentos emergenciais, suas vítimas, não raro, necessitam de afastamento de suas funções. Este estudo objetiva avaliar o atendimento inicial dessas feridas, estabelecendo correlações entre fatores técnicos empregados e resultado cicatricial não desejado ou presença de complicações locais. Métodos: Foi realizada uma análise prospectiva, longitudinal, observacional e analítica. Os dados foram coletados no Hospital do Trabalhador (Curitiba/PR) através de dois questionários: o primeiro no atendimento inicial no pronto socorro, e o segundo no retorno ambulatorial em 05 a 11 dias. Resultados: Foram avaliados 232 pacientes, com seguimento ambulatorial de 87. Do total da amostra, a maioria foi de homens (81,5%) com idade média de 38,5 anos. Quanto aos ferimentos, 55% foram corto-contusos, localizados em mãos e face (62,7%), e 86,7% menores do que 6,0 cm. O manejo inicial realizado foi limpeza com soro fisiológico (94,7%), sutura com ponto simples (98,85%), em número menor ou igual a 06 (75,7%), utilizando fio de nylon (98,25%) de tamanho 3-0 e 4-0 (85,2%). Antibioticoterapia foi prescrita para 42,7% dos pacientes. No retorno, observou-se deiscência de pontos em 13,80%, sinais de infecção em 14,95% e necrose em 19,5%. Conclusão: Maior quantidade de pontos na sutura, uso de substâncias tópicas domiciliares e antibioticoterapia apresentaram possível correlação com altas taxas de necrose, assim como aplicação de peróxido de hidrogênio com altas taxas de infecção

Perfil epidemiológico de acidentes com material biológico entre estudantes de medicina em um pronto-socorro cirúrgico

OBJECTIVE: To evaluate the accidents with biological material among medical students interning in a trauma emergency room and identify key related situations, attributed causes and prevention. METHODS: we conducted a study with a quantitative approach. Data were collected through a questionnaire applied via internet, with closed, multiple-choice questions regarding accidents with biological material. The sample comprised 100 students. RESULTS: thirty-two had accidents with biological material. Higher-risk activities were local anesthesia (39.47%), suture (18.42%) and needle recapping (15.79%). The main routes of exposure to biological material were the eyes or mucosa, with 34%, and syringe needle puncture, with 45%. After contamination, only 52% reported the accident to the responsible department. CONCLUSION: The main causes of accidents and routes of exposure found may be attributed to several factors, such as lack of training and failure to use personal protective equipment. Educational and preventive actions are extremely important to reduce the incidence of accidents with biological materials and improve the conduct of post-exposure. It is important to understand the main causes attributed and situations related, so as general and effective measures can be applied.OBJETIVO: avaliar os acidentes com material biológico entre estudantes de medicina estagiando em um pronto-socorro de trauma e identificar as principais situações relacionadas, causas atribuídas e prevenção. MÉTODOS: estudo com abordagem quantitativa. Os dados foram coletados através de um questionário, aplicado via internet, contendo perguntas fechadas de escolha múltipla, referentes a acidentes com material biológico. A amostra obtida foi 100 estudantes. RESULTADOS: trinta e dois se acidentaram com materiais biológicos. As atividades de maior risco foram anestesia local (39,47%), sutura (18,42%) e recapeamento de agulha (15,79%). As principais vias de exposição ao material biológico foram contato com olho ou mucosa, com 34%, através de seringa com agulha com 45%. Após a contaminação, apenas 52% notificaram o acidente ao setor responsável. CONCLUSÃO: as principais causas de acidente encontradas e vias de exposição podem ser atribuídas a diversos fatores, como falta de treinamento e ao não uso de equipamentos de proteção individual. Ações preventivas e educativas são de extrema importância para diminuir a incidência dos acidentes com materiais biológicos e melhorar a conduta pós-exposição. É preciso entender as principais causas atribuídas e situações relacionadas a fim de implantar medidas gerais e eficazes.Universidade Estadual Paulista Júlio de Mesquita FilhoUniversidade PositivoUniversidade Federal do ParanáUniversidade Estadual Paulista Júlio de Mesquita Filh

Prehospital Trauma Care Registry Problems in South Brazil

ABSTRACTBackgroundTrauma registry remains a great problem to most countries that are implementing trauma systems. Nondigital data assessment and storage may lead to information deterioration along the process. In order to verify the missing registry in prehospital trauma rescuers’ form, we ran this study.Study designA prospective observational noncontrolled study with 288 random trauma cases brought to a Level 1 Trauma Center in Curitiba, between May 28th and June 10th 2006. We analyzed data registered in the prehospital rescue team form. The including criteria were all patients delivered to the trauma center by ambulances. The excluding criteria were patients not transported by ambulances and those without the proper form filled out. Statistical analysis was performed using the Chi-square for discrete, and the student's t-test for continuous variables.ResultsTwo hundred and eighty-eight trauma cases were observed. Twelve patients were excluded. Of the 276 patients who met the including criteria, 75% were men with a mean age of 27-year-old. In only 8.34% of times patients were brought by doctors, while in 91.66% by paramedics. 63.4% of patients were traffic injuries victims, followed by 12.31% falls, 6.52% falls from the high, 5.79% gunshot wounds, 5.34% assaults, 3.62% stab wounds, 2.89% others. Impressively, 16 patients (5.89%) had no records of respiratory rate from the prehospital care assessment, 20 (7.24%) had no data of systolic blood pressure and 13(4.71%)had no pulse registry. Furthermore, 31.25% of the RR not registered were abnormal in the hospital admission evaluation, as well as 15% of the SBPs, and 23% of HR. None of the cases had information regarding time from the scene to the hospital.ConclusionElectronic data collection shall make checklists consistently filled out. It is not well understood the importance of registering data for most of healthcare providers working in the field, especially when they do not follow the in-hospital care of trauma patients.How to cite this articleAbreu-Reis P, Tomasich FS, Nasr A, Collaco I. Prehospital Trauma Care Registry Problems in South Brazil. Panam J Trauma Crit Care Emerg Surg 2014;3(3):97-100.</jats:sec

Corrections to: The Trauma Golden Hour

The affiliation of co-editors Nicholas Namias and Antonio Marttos was incorrectly updated in the book front matter and this is corrected as follows

The Trauma Golden Hour A Practical Guide

The Golden Hour is a well-established concept in emergency medicine, related to the critical period of one hour after an injury, accident or trauma. This term implies that the mortality rates increase substantially if efficient care is not provided within 60 minutes after the trauma. This book is intended as a practical manual in Trauma Care within the context of the golden hour, addressing all trauma types and all body parts. Readers will find essential decision-making algorithms and protocols with commentary for traumas, along with easily accessible information on how to treat patients in a very practical and handy fashion. Furthermore, the content is presented in a didactic way suitable for a wide audience, from medical students who want to learn about the basics of trauma care to experienced surgeons seeking a comprehensive guide to trauma-related interventions. The book combines contributions from experts at two renowned Trauma Centers, the Hospital do Trabalhador at Curitiba, Brazil, and the Ryder Trauma Center in Miami, USA. Therefore, considering the different local environments and resources, the book provides distinct perspectives for several injuries, presenting the state of the art in Trauma Care. The diversity of perspectives in this book contributes to a global health care approach suitable for trauma-related events from developed countries to remote areas. The Trauma Golden Hour - A Practical Guide celebrates the Centennial Anniversary of the Federal University of Parana (Brazil), the 25th Anniversary of the Ryder Trauma Center (USA) and the 20th Anniversary of the Hospital do Trabalhador (Brazil)

Damage Control Surgery

Damage control surgery (DCS) is an abbreviated laparotomy for patients who have life-threating bleeding, injuries, and septic sources. The procedure consists of hemorrhage control, by procedures like hemostasis, packing, clamping, and ligation; limits contamination by simple resections, primary suturation, closed absorbent systems, and external drainage; and leads to temporary abdominal closure as quickly as possible. The non-life-threatening injuries are delayed to a reoperation. The main purpose of the damage control surgery is to prevent complications of the lethal triad: coagulopathy, acidosis, and hypothermia

Extra-curricular supervised training at an academic hospital: is 200 hours the threshold for medical students to perform well in an emergency room?

Abstract Introduction Due to high number of jobs in Emergency Medicine (EM) and the lack of specialist to work in this field, recent graduates work in the emergency room straight after medical school. Additional courses on EM are available through Academic Leagues. This organizations offer lectures and supervised extra-curricular practical activities in their teaching university-affiliated hospital. The objectives of the present study are to assess the influence of hours undertaken in the extra-curricular practical activities on the performance and confidence of students in carrying out the different procedures in the emergency department, and on their own perception of how well they did. Also, to assess the influence the practical activities have on student´s future choice of specialty. Methods A Cross-sectional study conducted by collecting data through a questionnaire. 102 eligible individuals were included and divided into two groups according to the number of extra-curricular hours performed (Group 1- up to 200 hours and Group 2- over 200 hours). Results Students in Group 2 (over 200 hours) had a greater number of procedures performed on all variables evaluated, in particular, initial patient care (mean 363.8 vs.136.905 in Group 1 - p = 0.001), Simple Sutures (mean of 96.2 vs 33.980 respectively) ( p = 0.00003). To determine patient follow-up by the student, the number of initial patient care was correlated with number of discharge procedures performed (in Group 1, 49.6% of patients were not followed up and discharged by the same students who first talked to them in the hospital. While in Group 2, this value becomes 29.4 % - values for Group 1 - p = 0.011 and Group 2 - p = 0.117). Regarding the influence of the practical extra-curricular activities, 76.5% of the total reported that it had influenced their choice of future specialty. Conclusions The aptitude, confidence and skill of students are closely linked to the practice time (number of training hours served). Two hundred hours appeared to be a relatively significant time for the student to demonstrate good conduct and ability. Practical extra-curricular activities had the ability to influence the future choice of specialty, either positively or negatively.</p

ABDOME AGUDO OBSTRUTIVO POR MUCORMICOSE EM PACIENTE IMUNOSSUPRIMIDO PÓS-COVID-19

Introdução: A pandemia por COVID-19 vem trazendo novas etiologias para síndromes relativamente conhecidas pelo cirurgião. Dentre elas, infecções fúngicas como a mucormicose, antes relatadas principalmente em acometimento extra intestinal, em vigência de corticoterapia prolongada no tratamento pelo SARS-CoV-2, pode se apresentar de forma atípica e deve ser considerada diagnóstico diferencial em inúmeros contextos. Relato do caso: No presente caso, em paciente pós-transplante de medula óssea, por leucemia mieloide crônica, com infecção prévia por COVID-19, evoluiu com abdome agudo oclusivo com necessidade de laparotomia exploradora com enterectomia segmentar. Após estudo anatomopatológico foi realizado o diagnóstico de mucormicose e iniciado tratamento antifúngico endovenoso, com resolução eficaz do quadro. Conclusão: Dessa forma, o estudo objetiva incluir novos diagnósticos no arsenal de causas já conhecidas para quadros abdominais, considerando o contexto pós-pandemia.</jats:p