Efecto de la capacitación del curso AIRE en la intubación orotraqueal del paciente adulto en urgencias

Los médicos responsables del manejo de la vía aérea en urgencias se pueden beneficiar de una capacitación específica para ese fin, como lo es el curso de Apoyo Integral Respiratorio en Emergencias (AIRE). Objetivos: Establecer si la capacitación ofrecida por el curso AIRE genera cambios en la técnica de intubación orotraqueal. Métodos: Estudio prospectivo de intervención, en el cual, antes y después del curso, se evaluó a los participantes del curso AIRE sobre conocimientos teóricos en técnica de intubación y en secuencia rápida de intubación. Se midió el número de intentos de intubación, el tiempo requerido para una intubación exitosa y el grado de laringoscopia obtenido empleando la secuencia rápida de intubación (SRI). Resultados: El tiempo de intubación final fue 28 segundos menor que el inicial (p = 0,010); el número de intubaciones en el primer intento final fue de 93,1%, en comparación con el 75% inicial (p = 0,047). El grado de laringoscopia final fue I: 75,9%, II: 24,1%, en comparación con la inicial, I: 37,2%, II: 48,3% y III: 10,3 (p = 0,000). El promedio del examen teórico final fue 1,91 mayor que en el examen teórico inicial (p = 0,000). Conclusiones: El curso AIRE mejoró significativamente la técnica del manejo de la vía aérea, y la convirtió en una herramienta útil para el personal médico de urgencias

La Ecosonografía en el diagnóstico de apendicitis aguda, departamento de emergencia del Hospital Vicente Corral Moscoso, 2005

Se realiza estudio ecosonográfico con transductor lineal multifrecuencial de 7 - 9Mhz, a 118 pacientes que llegaron al servicio de emergencia del Hospital Vicente Corral Moscoso, con sospecha de apendicitis aguda, se realizó tratamiento quirúrgico a todo paciente diagnosticado clínicamente por anatomía patológica de la pieza anatómica (como prueba de oro). De los 118 pacientes sometidos a este estudio se obtuvo 86 con resultado verdaderos positivos, 4 verdaderos negativos, 2 falsos positivos y 26 falsos negativos. Se obtuvo una sensibilidad del 76-79, una especificidad del 66.67, un valor predictivo positivo del 97.73, y un valor predictivo negativo del 13.33. Conclusiones: Tomando en cuneta las disponibilidades del hospital y que la ecografía es una técnica no invasiva, de bajo costo, fácil realización, recomendaríamos a la combinación entre ecografía, examen de laboratorio (Indice de Gibson) como la de mayor rendimiento ante un paciente con sospecha clínica de apendicitis aguda. La ecografía está aindicada en pacientes con sospecha clínica de apendicitis aguda, con alto valor diagnóstico y predictivo positivo para hallazgos intraoperativos y patologías concomitantes, siendo de mayor utilidad en pacientes femeninas en edad reaproductiva y patologías dudosas

La vía aérea, un reto en el servicio de urgencias indicaciones, manejo y complicaciones

INTRODUCCIÓN: El control rápido y seguro de la vía aérea es una de las habilidades más importantes que se debe tener para el manejo de pacientes críticamente enfermos y traumatizados en los departamentos de emergencias de todo el mundo, en nuestro medio no contamos con estadísticas que cuantifiquen el éxito y complicaciones en este aspecto. METODOLOGIA: Se realizo un estudio observacional, descriptivo, prospectivo, que recolecto los datos de las intubaciones realizadas en la sala de emergencias del Hospital Universitario Mayor “Mederi” por parte de especialistas en medicina de emergencias, medicina interna, médicos generales o personal en entrenamiento, durante el periodo comprendido entre noviembre de 2010 y junio de 2011. RESULTADOS: Se recolecto una muestra de 92 pacientes en el estudio, la causa mas frecuente de intubación orotraqueal fue falla respiratoria 77,2%, el éxito en el primer intento fue de 51,5%, se uso secuencia de intubación rápida como método de intubación en el 56,5% de los pacientes y se presento alguna complicación en el 61% de los pacientes. DISCUSIÓN: El éxito en la intubación orotraqueal es menor y las complicaciones superiores a los de países desarrollados, esto puede estar en relación con la falta del desarrollo de la medicina de emergencias y programas de entrenamiento formal en el manejo de la vía aérea.

Del artículo de revisión a la recomendación profesional: La uniformación y material de protección individual para los equipos del ámbito prehospitalario de urgencias y emergencias

The Spanish Society of Nursing Emergency (SEEUE) has several lines documentaries that can be consulted on its web page and that have been spread through various publications: Statutes, scientific recommendations, professional recommendations, statements and allegations, grounds for nursing emergency, guarantees and rules, documents of interest and legislation. Set this that composed the regulatory environment, legal and recommendations which society poses to the collective nurse from the area of the emergency, as well as the rest of actors associated with urgent assistance (institutional and administratively) and through what has been the work of conceptualization and definition in our area the past few years. Part of this documentation offer possibilities for scientific endorsement and professional and invites to continue building knowledge and evidence. It is in this sense in which this work can and should be defined from a literature review approach and under the scheme of "review article". The working Group in Primary Care (PC) of the SEEUE, decided to build a Professional Recommendation (PR) in one of the areas of "uncertainty/variability" in the employment context and historical demand of nurses and other emergency care team on security issues: "The uniform and personal protective equipment for professional teams on prehospital emergency areas”.

Prescripción enfermera en el contexto de las urgencias y emergencia

The area of the urgencies and emergencies, assisted from all levels and care settings raises, if possible, patterns of work and ways that collaboration between professionals and teamwork make nurse prescription, often pharmacological, a legislative needs in response to increased scientific evidence and through internationally accepted performance algorithms. Enabling the nurse to act according to these concepts and beyond any "doubt and suspicion" of illegality. Taking a consensus necessary training and development and according to professional specialization and differentiation in this area and as arguments to remove any doubt still remains the subject without enclosing any sense and in many sectors.

Guía para el desarrollo de Programas de intercambio de Jeringuillas (PIJ) desde la consulta de triage de los Dispositivos de Cuidados Críticos y Urgencias (DCCU)

There are exceptional situations where emergency services are required Primary Care in the application of material used by drug-dependent patients, being the response to this demand is something that many of the cases, to individual discretion and the randomness and variability every situation leads to an answer. It calls for a response commensurate to public services and preventive health philosophy in most cases will be carried out by the nurse to perform assistance Devices Critical Care (DCCU), often this first contact these patients and slots at the supply of resources diminishes the possibilities of acquisition of such material to them. That is why, and in the absence in this area of patient safety and professional, a workflow model and according to the prevailing philosophy of working in primary care in terms of prevention policies and recruitment of patients concerned, this project raises guidance for the development of a needle exchange program from the triage consultations DCCU.

Prescripción enfermera en el entorno de las urgencias y emergencias. Marco conceptual vs entorno legislado en España

The prescription, widely discussed and defined conceptually in recent years in an environment of widening the spectrum of responsibilities nurse, has capacity for integration and definition in the area of accident and emergency care and carried out over the patient urgently, about emergencies and life-long commitment. Be necessary to frame throughout the legal framework, following the amendment of the Twelfth Additional Provision of Law 29/2006 of guarantees and rational use of drugs and medical devices, can be waived and implementation required, provided under model and through the nursing process and method and as an exponent and endorsementn of science and advanced clinical practice, to join the idea of interdisciplinary professional consensus that the law posed by the preparation and implementation of standardized protocols, algorithms and / or clinical practice guidelines in the context of what has come to be called "collaborative standard prescription": Prescription to the nurse in certain clinical situations in terms of a performance protocol, agreed with multidisciplinary team care health of the population (Group Protocols), which can be considered an intermediate step in the evolution towards independent nurse prescribing, providing nurses experience of a prescription under these protocols and demonstrating their capabilities.

Gestión de pacientes de un Servicio de Urgencias Hospitalarias

[ES] Un servicio de urgencias de una zona ofrece asistencia sanitaria y tiene como principal objetivo atender la patología urgente que acude al hospital y el nivel de compromiso que se asume consiste en diagnosticar, tratar y estabilizar, en la medida posible, dicha patología urgente. Otro objetivo es gestionar la demanda de atención urgente por parte del ciudadano a través de un sistema de selección prioritaria inicial (Triaje) que selecciona, prioriza, organiza y gestiona la demanda de atención. Para poder controlar y realizar el trabajo de la forma más eficaz se utilizan herramientas de gestión necesarias para el control de los pacientes, desde que se realiza su ingreso en el servicio de urgencias hasta el alta del mismo. Las aplicaciones desarrolladas son las siguientes: Gestión de Pacientes en Urgencias: Esta aplicación asignará un estado inicial al paciente y permitirá ir cambiando el estado del mismo usando el método del Triaje (valoración), el más difundido en la medicina de urgencias. Además, se podrán solicitar pruebas diagnósticas y la visualización de marcadores de analíticas para comprobar su evolución. Finalmente, se podrá desarrollar un informe de alta para el paciente. Informadores de Urgencias: La aplicación gestiona la localización física del paciente dentro del servicio de urgencias, permitiendo asimismo el cambio entre las distintas localizaciones y el control para la información a los familiares de los mismos, pudiendo almacenar los familiares y teléfonos de contactos para que estos puedan ser informados. El desarrollo se ha realizado utilizando el MVC (modelo - vista - controlador) que es patrón de arquitectura que separa los datos de una aplicación, la interfaz gráfica de usuario y la lógica de control de componentes. El software utilizado para el desarrollo de las aplicaciones es CACHÉ de Intersystems que permite la creación de una base de datos multidimensional. El modelo de objetos de Caché se basa en el estándar ODMG (Object Database Management Group, Grupo de gestión de bases de datos de objetos) y soporta muchas características avanzadas. CACHÉ dispone de Zen, una biblioteca completa de componentes de objetos preconstruidos y herramientas de desarrollo basadas en la tecnología CSP (Caché Server Pages) y de objetos de InterSystems. ZEN es especialmente apropiado para desarrollar una versión Web de las aplicaciones cliente/servidor creadas originalmente con herramientas como Visual Basic o PowerBuilder.

Geochemistry Of Acid Mine Drainage From A Coal Mining Area And Processes Controlling Metal Attenuation In Stream Waters, Southern Brazil.

Acid drainage influence on the water and sediment quality was investigated in a coal mining area (southern Brazil). Mine drainage showed pH between 3.2 and 4.6 and elevated concentrations of sulfate, As and metals, of which, Fe, Mn and Zn exceeded the limits for the emission of effluents stated in the Brazilian legislation. Arsenic also exceeded the limit, but only slightly. Groundwater monitoring wells from active mines and tailings piles showed pH interval and chemical concentrations similar to those of mine drainage. However, the river and ground water samples of municipal public water supplies revealed a pH range from 7.2 to 7.5 and low chemical concentrations, although Cd concentration slightly exceeded the limit adopted by Brazilian legislation for groundwater. In general, surface waters showed large pH range (6 to 10.8), and changes caused by acid drainage in the chemical composition of these waters were not very significant. Locally, acid drainage seemed to have dissolved carbonate rocks present in the local stratigraphic sequence, attenuating the dispersion of metals and As. Stream sediments presented anomalies of these elements, which were strongly dependent on the proximity of tailings piles and abandoned mines. We found that precipitation processes in sediments and the dilution of dissolved phases were responsible for the attenuation of the concentrations of the metals and As in the acid drainage and river water mixing zone. In general, a larger influence of mining activities on the chemical composition of the surface waters and sediments was observed when enrichment factors in relation to regional background levels were used.

Imported Malaria In A Non-endemic Area: The Experience Of The University Of Campinas Hospital In The Brazilian Southeast.

Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.

[construction Of Measurement Instruments In The Area Of Health].

Measurement instruments are an integral part of clinical practice, health evaluation and research. These instruments are only useful and able to present scientifically robust results when they are developed properly and have appropriate psychometric properties. Despite the significant increase of rating scales, the literature suggests that many of them have not been adequately developed and validated. The scope of this study was to conduct a narrative review on the process of developing new measurement instruments and to present some tools which can be used in some stages of the development process. The steps described were: I-The establishment of a conceptual framework, and the definition of the objectives of the instrument and the population involved; II-Development of the items and of the response scales; III-Selection and organization of the items and structuring of the instrument; IV-Content validity, V-Pre-test. This study also included a brief discussion on the evaluation of the psychometric properties due to their importance for the instruments to be accepted and acknowledged in both scientific and clinical environments.

Ambiência aérea em alojamento de frangos de corte: poeira e gases

Air quality in animal production environment has been refereed as an interesting point for studies in environmental control systems with the focus both to the animal health which live in total confinement, as to the workers. The objective of this research was to determine the variation on the aerial environmental quality in two types of broiler housing: conventional (Gc) and tunnel type (Gt). The total dust values in both houses offered adequate rearing conditions to the birds; however, regarding the inhale dust in the air was above the limits recommended for humans. Carbon monoxide concentration in the heating phase during the evaluated period was above the 10 ppm maximum recommended, and it was higher during the cold season in Gt house (30 ppm) when compared to the Gc house (18 ppm). Ammonia concentration peaks in the air were above the 20 ppm recommended from the 20th day of production in both houses and in daily average, for a period higher in Gt (4h30) when compared to Gt (2h45). Only traces of nitrate oxide and methane were found while carbonic dioxide gas concentration evaluated during daytime met the limits allowed for both birds and labor.

Ambiências térmica, aérea e acústica para reprodutores suínos

The swine breeder rearing environment directly affects the animal's performance. This research had the objective of developing a thermal, aerial and acoustic environmental evaluation pattern for boar housing. The experiment was carried on a commercial swine farm in Salto County -SP, Brazil. Thermal, aerial and acoustic environment data of rearing conditions were registered. Data were statistically analyzed using as threshold the ideal housing environment that leads to animal welfare. Results showed that ambient temperature was around 70% beyond normal range, while air relative humidity, air speed and gases concentration were within threshold values. Noise level data besides being within normal range did not present large variation. In relation to the fuzzy logic analysis it was possible to build up a scenario which indicated that the best welfare indexes to male swine breeders happens when thermal comfort index are close to 80%, and noise level is lower than 40 dB. In the other hand the worst welfare index occur in the sector where the thermal comfort values are below 40% at the same time that the noise level is higher than 80 dB leading to inadequate conditions to the animal, and may directly interfere in the reproduction system performance.

Interesses fisicos no lazer como area de intervenção do profissional da educação fisica

Universidade Estadual de Campinas. Faculdade de Educação Física

A ginastica como area de conhecimento na formação profissional em educação fisica : encaminhamentos para uma reestruturação curricular

Universidade Estadual de Campinas . Faculdade de Educação Física