ABSTRACT
OBJECTIVE: The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation. METHODS: During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded. RESULTS: In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the laryngeal tube during the first attempt. In 93% of patients (n=98), the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference. CONCLUSIONS: LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.
Subject(s)
Humans , Male , Female , Middle Aged , Cardiopulmonary Resuscitation/methods , Intubation, Intratracheal/methods , Respiration, Artificial , Emergencies , Suction , Time FactorsABSTRACT
Este estudo, de caráter qualitativo, teve como objetivo identificar os significados atribuídos por profissionais de saúde, que atuam em urgências e emergências hospitalares, às tentativas de suicídio. Foram entrevistados 16 profissionais de dois serviços de urgência e dois de emergência de um município do sul do Brasil. Os resultados mostraram a construção dos significados com base em dois polos. O primeiro entende o suicídio como condição de sofrimento que leva a uma conduta acolhedora. Já o segundo pontua o sofrimento, porém considera a demanda não legítima aoscontextos pesquisados. Evidenciou-se a necessidade de espaços de discussão sobre o suicídio nos cursos da área da Saúde, bem como atividades de educação permanente que trabalhem o manejo clínico, qualificando assim a prática...
This study, qualitative, aimed to identify the meanings attributed to suicideattempts by health professionals working in emergency rooms and hospital emergencies. Were interviewed sixteen professionals of two urgencies and two hospital emergencies of a city from south Brazil. The results showed the construction of meanings from two poles. The first considers suicide as acondition of suffering that leads to a cozy conduct. The second punctuatesthe suffering, but do not consider the legitimate demand to the contextssurveyed. Evidenced the need for spaces for discussion of suicide in coursesin the area of health and education activities ongoing working clinicalmanagement, thus qualifying practice...
Este estudio cualitativo, tuvo como objetivo identificar los significadosatribuidos por parte de los profesionales de salud, que trabajan en las salasde urgencias y emergencias hospitalarias, a los intentos de suicidio. Se entrevistó a 16 profesionales en dos departamentos de emergencia y dos deemergencia un municipio en el sur de Brasil. Los resultados muestran laconstrucción de los significados sobre la base de dos polos. La primera considera el suicidio como una condición de sufrimiento que lleva a una conducta acogedor. La segunda señala el sufrimiento, pero no tienen en cuenta la demanda legítima de los contextos estudiados. Lo demuestra la necesidad de espacios para la discusión de suicidio en los cursos en el área de las actividades de salud y educación de gestión clínica de trabajo en curso, así calificando la práctica...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Emergencies , Emergency Medical Services , Health Personnel , Suicide , Suicide, AttemptedABSTRACT
El triaje hospitalario es un sistema de clasificación de pacientes basado en criterios de gravedad clínica que responde al desmesurado aumento de la demanda asistencial. En este artículo se habla de manera general sobre sus antecedentes, modelos que se han implementado a través de los años, las funciones principales y la participación de enfermería en este proceso. El triaje debe ser visto como una necesidad fundamental para la mejora continua de la calidad del Servicio de Urgencias Hospitalarias.
The hospital triage is a patient classification system based on clinical gravity criteria, as a result of the increasing healthcare demand. In this article it is generally discuss its background, the models that have been implemented over the years, the main functions and the participation of the nursing in this process. The triage must be seen as necessity for the continual improvement of the hospital emergencies service quality.