Measurement of general critical thinking in undergraduate nursing students: experimental study / Medición del pensamiento crítico general en estudiantes de cursos de graduación de enfermería: estudio experimental / Mensuração do pensamento crítico geral em estudantes de cursos de graduação em enfermagem: estudo experimental

ABSTRACT Objective: to compare the levels of general critical thinking and the skills or cognitive attributes involved, individually measured during the training of undergraduate nursing students, through a teaching intervention using Concept Maps. Method: an experimental, randomized, double-blind study with before and after design, conducted with 77 undergraduate nursing students. The research subjects were randomized to the control (38) and experiment (39) groups and both participated in a course on Advanced Life Support in Cardiology for a period of five weeks, when the intervention was the construction of four concept maps. Data collection took place through a sociodemographic questionnaire and the California Critical Thinking Skills Test (CCTST) before and after the course and after in order to measure critical thinking. Results: sociodemographic data confirmed that the groups had similar characteristics. After the intervention using the concept maps, the mean pre-and post-test general critical thinking averages were classified as moderate and showed no statistically significant difference. The t-test for paired samples showed a significantly increased Evaluation skill score (p-value of 0.022) in the posttest for the experiment group. Conclusion: the use of the teaching strategy with construction of the concept maps performed well in the promotion of General Critical Thinking and its abilities. Teaching strategies based on constructivist theories should be encouraged as they play a significant role in improving student learning and critical thinking.

RESUMEN Objetivo: comparar los niveles de pensamiento crítico general y las habilidades o características cognitivas que lo constituyen, medidos individualmente durante la formación de estudiantes de grado en Enfermería, a través de una intervención docente utilizando Mapas Conceptuales. Método: estudio experimental, aleatorizado, doble-ciego con investigación anterior y posterior, realizado con 77 estudiantes de grado en enfermería. Los sujetos de investigación fueron aleatorizados a los grupos de control (38) y de experimento (39) y ambos participaron en un curso de extensión sobre Soporte vital avanzado en cardiología durante un período de cinco semanas, cuando la intervención consistió en la construcción de cuatro mapas conceptuales. La recopilación de datos se realizó a través de un cuestionario sociodemográfico y la resolución del California Critical Thinking skills (CCTST) antes del comienzo del curso y después de la finalización para medición del pensamiento crítico. Resultados: los datos sociodemográficos confirmaron que los grupos tenían características equivalentes. Luego de la intervención a través de los mapas conceptuales, los promedios de pensamiento crítico general antes y después de la prueba se clasificaron como moderados y no presentaron diferencias estadísticamente significativas. La prueba-t para muestras emparejadas mostró un puntaje de habilidad de evaluación significativamente mayor (valor p de 0.022) en la prueba posterior para el grupo de experimento. Conclusión: el uso de la estrategia de enseñanza con la construcción de los mapas conceptuales tuvo un buen desempeño en la promoción del pensamiento crítico general y sus habilidades. Deben fomentarse las estrategias de enseñanza basadas en teorías constructivistas, ya que desempeñan un papel importante en la mejora del aprendizaje y el pensamiento crítico de los estudiantes

RESUMO Objetivo: comparar os níveis de pensamento crítico geral e as habilidades ou atributos cognitivos que o constituem, mensurados individualmente durante a formação de estudantes de graduação em Enfermagem, mediante uma intervenção de ensino com uso de Mapas Conceituais. Método: estudo experimental, randomizado, duplo-cego com delineamento antes e depois, realizado com 77 estudantes de graduação em enfermagem. Os sujeitos da pesquisa foram randomizados para os grupos controle (38) e experimento (39) e ambos participaram de um curso de extensão sobre Suporte Avançado de Vida em Cardiologia por um período de cinco semanas, quando a intervenção foi a construção de quatro mapas conceituais. A coleta de dados aconteceu por meio de um questionário sociodemográfico e a resolução do California Critical Thinking Skills Test (CCTST) antes do início do curso e após o encerramento, para mensuração do pensamento crítico. Resultados: os dados sociodemográficos confirmaram que os grupos possuíam características similares. Após a intervenção por meio dos mapas conceituais, as médias de pensamento crítico geral no pré e pós-teste foram classificadas como moderadas e não apresentaram diferença estatisticamente significativa. O Teste-t para amostras emparelhadas evidenciou a pontuação da habilidade Avaliação aumentada significativamente (p-valor de 0,022) no pós-teste para o grupo experimento. Conclusão: a utilização da estratégia de ensino com construção dos mapas conceituais apresentou bom desempenho na promoção do Pensamento Crítico Geral e de suas habilidades. Estratégias de ensino baseadas em teorias construtivistas devem ser incentivadas, pois desempenham um papel significativo na melhoria da aprendizagem e do Pensamento Crítico dos estudantes.

Interpretation of 2018 American Heart Association Focused Update on Pediatric Advanced Life Support:An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care / 中国实用儿科杂志

In November 2018,the American Heart Association(AHA) updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The new guideline provided the evidence review and treatment recommendation for antiarrhythmic drug therapy in pediatric shock-refractory ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. The update was carried out by the Pediatrics Working Group of the International Liaison Committee on Resuscitation(ILCOR)for ongoing clinical evidence review. The update continues with the view of 2015's edition that either lidocaine or amiodarone may be used to treat pediatric patients with shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. The flow chart of cardiac arrest for pediatric advanced life support was slightly adjusted.

La reanimación cardiopulmonar pediátrica y la capacitación para la asistencia en emergencias / Pediatric cardiopulmonary resuscitation and basic skills training for emergency assistance

Se destacan las novedades en reanimación cardiopulmonar (RCP) pediátrica de la AHA 2015 y se repasa esquemáticamente el soporte vital básico y avanzado en los casos de paro cardiorrespiratorio en niños. Se resumen los aspectos claves y principales cambios realizados respecto de la actualización anterior (2010). Se sugiere incorporar en los hospitales un equipo de emergencias pediátrico y un equipo de rápida respuesta que brinden una atención inmediata y efectiva. Se describe un sistema de puntuación (puntaje PEWS) que permitiría identificar y predecir pacientes con riesgo de descompensación por diferentes etiologías. Se indica tratamiento inicial de la sepsis grave y shock séptico con un bolo de fluidos de 20 ml/kg en lactantes y niños con líquidos cristaloides o coloides. Se mantiene la secuencia C-A-B de las guías 2010 como orden de elección para la RCP pediátrica (aunque las recomendaciones ILCOR 2015 equiparan las secuencias A-B-C y C-A-B). La profundidad de las compresiones debe deprimir por lo menos un tercio del diámetro anteroposterior o aproximadamente 4 cm en lactantes. En los niños las compresiones se realizarán como en los adultos, por lo menos 5 a 6 cm de profundidad como límite superior; con una frecuencia de 100 a 120 CPM. En caso de reanimadores legos que no deseen o no puedan proporcionar ventilaciones, se utilizaran sólo compresiones torácicas. En los casos de FV y TV sin pulso, se realizará una descarga con desfibrilador monofásico o bifásico de energía inicial (2 a 4 J/kg) seguida de compresiones torácicas; dosis siguientes mayores o iguales a 4 J/kg son seguras y efectivas.

The new developments in pediatric cardiopulmonary resuscitation (CPR) (AHA 2015) and basic and advanced life support are reviewed schematically in cases of cardiopulmonary arrest in children. In this article we summarize the key aspects and major changes made to the previous update (2010). It is suggested that a Pediatric Emergency Team and a Rapid Response Team to provide fast and effective care should be incorporated in hospitals. A scoring system (PEWS) is described that will allow for the identification and prediction of patients at risk of decompensation due to different etiologies. Initial treatment of severe sepsis and septic shock with a fluid bolus of 20 ml/kg in infants and children with crystalloid or colloid fluids is indicated. The C-A-B sequence from the 2010 guides for pediatric CPR is maintained (although the recommendations of ILCOR 2015 attach the same importance to both "A-B-C" and "C-A-B" sequences). The depth of chest compression should be at least one third of the anteroposterior diameter, or approximately 4 cm in infants. In children and adults compressions are equivalent to depressing no more than 5 to 6 cm, with a compression frequency of 100 to 120 CPM. If lay rescuers do not want, or cannot, provide sufficient ventilation, we recommend that chest compressions should be performed. For treatment of non-pulsed VF and VT, an initial shock (2 to 4 J/kg) with mono or biphasic defibrillator should be applied, followed by chest compressions; subsequent doses of ≥ 4 J/kg are safe and effective.

Singapore Paediatric Resuscitation Guidelines 2016

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice.

Pediatric advanced life support and sedation of pediatric dental patients

Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency situations, basic life support is most important. However, emergencies in young children mostly involve breathing. Therefore, physicians who treat pediatric dental patients should learn PALS. It is necessary for the physician to regularly renew training every two years to be able to immediately implement professional skills in emergency situations. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is absolutely necessary to be able to immediately implement professional skills in emergency situations.

Effect of scene simulation-based teaching on pediatric advanced life support training in medical students / 中国小儿急救医学

Objective To assess the effect of scene simulation-based teaching on pediatric advanced life support(PALS)skills in medical students.Methods The students of two grades of Department of Pedi-atrics in Capital Medical University participated in the PALS training.All of them had the examination of the-ory and skills of critical illness management and cardiopulmonary resuscitation in children before and after the scene simulation-based teaching on PALS.The questionnaire was filled out and the data was analyzed after the training.Results Fifty-one students completed the training.The average score after the training was sig-nificantly higher than that before the training(86.51 ±7.16 vs.53.85 ±14.24,P ﹤0.05).After the training, the error rate of ECG recognition,etiological identification and treatment of the disease,and the dosage as well as usage of medicine was significantly decreased (64.7% vs.15.7%,71.0% vs.10.5%,73.2%vs.25.9%).All of the students could use the defibrillator correctly and the students'satisfaction rate was more than 94%.Conclusion Scene simulation-based teaching on PALS skills can improve the theory and skills of critical illness management and cardiopulmonary resuscitation of children in medical students.

Intervenciones de enfermería en la atención del adulto con traumatismo craneoencefálico grave / Nursing Intervention in the Attention of Adult with Traumatic Severe brain Injury

El traumatismo craneoencefálico es el daño cerebral causado por una fuerza externa, que puede producir una alteración del estado de conciencia, resultando un deterioro del funcionamiento de las capacidades cognitivas y físicas. La Escala de Coma de Glasgow nos permite clasificar el grado de un Traumatismo Craneoencefálico, cuyo tratamiento debe iniciarse con una adecuada reanimación, según el protocolo del soporte vital avanzado al trauma. Métodos: Se estableció una secuencia estandarizada para la búsqueda de información en la base de datos electrónicas: PudMed, Scielo, Cuiden, Ciberindex, Cochrane BVS, y otras bases disponibles. La búsqueda fue limitada a 10 años a la fecha actual, en idioma inglés o español, de las cuales 10 fueron revisiones sistemáticas y 14 revisiones narrativas útiles para el desarrollo de esta guía. Resultados: El manejo inicial en todo paciente con traumatismo craneoencefálico debe estar respaldado por los principios de Soporte Vital Avanzado de Trauma (ATLS) si se genera un episodio de hipoxia aumenta su mortalidad en un 50%, en un episodio de hipotensión en un 100%. Todas las alteraciones a nivel de conciencia son emergencias letales hasta que las funciones vitales estén estabilizadas. Conclusión: La Guía de Práctica Clínica permite que el personal de enfermería estandarice y proporcione la práctica diaria en el cuidado y manejo del paciente con Traumatismo Craneoencefálico Grave y sirva de base para la toma de decisiones. Traumatismo Craneoencefálico Grave, Soporte Vital Avanzado, Escala de Glasgow, enfermería.

Introduction: Traumatic brain injury is defined as brain damage caused by an external force, and can produce an altered state of consciousness, resulting in deterioration of the functioning of cognitive and physical abilities. The Glasgow Coma Scale allows us to classify the degree of traumatic brain injury. Treatment should be initiated with appropriate resuscitation, according to the protocol advanced trauma life support. Method: PudMed, Scielo, Cuiden, Ciberindex, Cochrane VHL and other bases were used; standard sequence for finding information in electronic databases was established. The search was limited to 10 years from the current date, in English or Spanish language. 10 systematic and 14 narrative reviews were useful for the development of this guide. Results: The initial management in all patients with head trauma must be supported by the principles of Advanced Trauma Life Support (ATLS). If an episode of hypoxia is generated increase mortality by 50%; low blood pressure episode increases it by 100%. All alterations of consciousness are emergencies until vital functions are stabilized. Conclusion: Clinical Practice Guide allows nurses to standardize and give better service in the care and management of patients with severe head trauma. It serves as a basis for decision-making. Severe head trauma, Advanced Life Support, GCS, nursing.

Introdução: Lesão cerebral traumática é dano cerebral causado por uma força externa, que pode produzir um estado alterado de consciência, resultando em uma deterioração do funcionamento das habilidades cognitivas e físicas. A Escala de Coma de Glasgow nos permite classificar o grau de lesão cerebral traumática. Cujo tratamento deve ser iniciado com a reanimação adequado, de acordo com o suporte de vida trauma protocolo avançado. Métódo: PudMed, Scielo, CUIDEN, Ciberindex, Cochrane BVS e outras bases disponíveis: uma seqüência padrão para busca de informações em bases de dados electrónicas foi estabelecido. A busca foi limitada a 10 anos a partir da data atual, em Inglês ou espanhol. Dos quais 10 eram sistemática e narrativa avaliações 14 útil para o desenvolvimento deste Guia comentários. Resultados: A conduta inicial em todos os pacientes com traumatismo craniano deve ser apoiada pelos princípios do Advanced Trauma Life Support (ATLS) se um episódio de hipoxia é gerado mortalidade aumenta em 50%, um episódio hipotensivo 100%. Todas as alterações são de nível letal de emergências consciência até as funções vitais são estabilizadas. Conclusões: Guia Clinical Practice permite enfermeiros padroniza e fornece prática diária no cuidado e tratamento de pacientes com traumatismo craniano grave e servir como base para a tomada de decisões. traumatismo craniano grave, Suporte Avançado de Vida, GCS, de enfermagem.

Manuseio de emergências cardiológicas em hospitais gerais do estado do Paraná / Management of cardiologic emergencies in general hospitals in the state of Paraná

JUSTIFICATIVA E OBJETIVOS: As diretrizes sobre as condutas em reanimação cardiopulmonar (RCP) foram baseadas na grande evolução dos estudos nessa área, sendo atualizadas em certos períodos de tempo. É por isso que o manuseio correto de uma parada cardíaca depende apenas da atualização do profissional que a atende. O objetivo deste estudo foi avaliar a condutados profissionais responsáveis pelo primeiro atendimento frente a emergências cardiológicas em alguns serviços hospitalares. MÉTODO: Foram avaliados 80 médicos de hospitais gerais, tomando-se como padrão as normas do Advanced Cardiologic Life Support (ACLS) e comparando o índice de acertos em um questionário com alguns quesitos de formação e trabalho do profissional. Os profissionais foram identificados com idade, sexo, estado civil, tempo de formação e local de trabalho, e em seguida responderam a seis questões referentes às condutas utilizadas. RESULTADOS: O índice de acertos foi tabulado e comparado, apresentando uma média de acertos de 3,5 questões. O mínimo de acertos foi zero, e o máximo foram seis questões. Houve correlação inversa significativa entre a idade e o número de acertos, ou seja, médicos mais jovens acertaram mais questões que os médicos de mais idade. Não houve associação significativa entre sexo, estado civil, tempo de formação e local de trabalho em relação ao número de acertos. CONCLUSÃO: Portanto, há a necessidade de atualizações entre os profissionais, buscando o melhor atendimento emergencial.

BACKGROUND AND OBJECTIVES: The cardiopulmonary resuscitation (CPR) guidelines were based on the large evolution of the studies in this area, being updated in certain periods of time. That is why the correct management of a cardiac arrest only depends on the professionals updating. The goal of the study was to evaluate the behavior of professionals responsible for primary care when they are faced with cardiologic emergencies in some hospitals. METHOD: Eighty physicians of general hospitals were evaluated, taking as base the Advance Cardiologic Life Support (ACLS) guidelines and comparing the rates of correct answers in a questionnaire with questions about professional training and work. The professionals were identified by age, gender, civil state, time of training and work place, and then they answered six questions about the procedures undertaken. RESULTS: The correct answers were tabulated and compared, demonstrating an average number of right answers of 3.5. The minimum was zero right answers and the maximum, six. There was a significant inverse correlation between the age and the number of correct answers, i.e., younger physicians had more correct answers than older ones. There were not significant relations among gender, civil state, time of training, and work place and number of correct answers. CONCLUSION: Therefore, professionals should keep themselves updated in order to deliver better emergency care.

PALS Update 2010.

During the past decade, guidelines for cardiopulmonary resuscitation have focused on the importance of high quality CPR. The purpose is to temporarily maintain a circulation to vital organs until specialized treatment is available. In, essence, it has been a revolution in pediatric resuscitation in terms of “coming full circle” to the 1960s when basic CPR was first developed. A fifth component to the pediatric chain of survival has been added with emphasis on integrated post cardiac arrest care. With mounting scientific evidences, American Heart Association published new Pediatric Advanced life support 2010 guidelines in accordance with the established five yearly cycle of guideline changes.

Highlights of 2010 American Heart Association guidelines changes for pediatric cardiopulmonary resuscitation / 中国小儿急救医学

In Oct 2010,American Heart Association (AHA) released new guidelines for pediatric basic life support and pediatric advanced life support.The new AHA guidelines are based on an extensive review of thousands of resuscitation studies by experts who reached a consensus over a 3-year period.Compared with the 2005 AHA guidelines for pediatric basic and advanced life support,the new guidelines made major changes on some key issues,including the change of basic life sequence from A-B-C to C-A-B,high-quality chest compression,defibrillation and the use of automated external defibrillator in infants,medications during resuscitation,resuscitation of children with congenital heart disease,post-resuscitation management and evaluation of sudden cardiac death victims.This paper summarized the substantial changes and the reasons to change.

Current situation and promotion of pediatric advanced life support training program in China / 中国小儿急救医学

Pediatric advanced life support (PALS) training program development has been more than 20 years.PALS program provides a systematic,organized approach for the evaluation and management of acutely ill or injured children.It plays an active role in guiding treatment of critically ill children.In this paper,we reviewed the PALS training purpose,importance and training content,and introduced the current situation and promotion of PALS training in China.

Implementation of a Prehospital ALS (Advanced Life Support) Program in the Seoul Metropolitan Area

PURPOSE: The purpose of this study was to determine the feasibility of the implementation of prehospital advanced life support programs and share in-hospital medical direction center operation experience. METHODS: From Oct. to Dec. 2008, twenty fire safety centers in Seoul metropolitan city took part in a pilot implementation of advanced life support programs with medical services as follow: prehospital 12 lead ECG transmission for patients with chest pain, a prehospital CPAP (continuous positive airway pressure) program for patients with dyspnea, a prehospital stroke scale application for patients with neurologic problems, and real-time audio-visual information transmission for patients with traumatic injuries. RESULTS: A total of 6,741 patients were transported to hospitals by emergency response ambulances to twenty five different safety centers. Of the total number of patients, 304 received advanced life support management. The prehospital use of 12 lead ECG transmission was 57.89%, real-time ECG was 27.45%, continuous positive airway pressure was 20.60%, stroke scale was 25%, and real-time audio-visual information was 5.98%. A Delphi survey using a panel which was expert in prehospital implementation of advanced life support programs concluded that prehospital ECG transmission and stroke scale programs should be implemented. However, they decided against implementation of the continuous positive airway pressure and real-time audio-visual information programs. CONCLUSION: Overall, the feasibility of implementation of a prehospital conventional 12 lead ECG program was good and the Delphi survey concurred that the ECG transmission and prehospital stroke scale programs should be implemented.

The analysis of training effect about pediatric advanced life support courses in sichuan region / 中国小儿急救医学

Objective To compare the skills level before and after pediatric advanced life support course and analyze the effect of the training. Methods The pediatric advanced life support was used as the textbook. The skills were got through attending theory classes, watching demonstrations and taking part in the simulator training. The questionnaires were filled strictly and the data was analysed. Results The test scores were increased after the training (P＜0. 01). There were only 8.7% of the trainees had used the rescue equipments and 61.3% had never seen the rescue equipments before training. More than 80% of the trainees were satisfied with the training about the utility and novelty. Conclusion pediatric advanced life support course can successfully deliver a large number of healthcare providers with international unique pediatric emergency treatment skills ,and raise the participants abilities of rescuing critical children.

Os carros de emergência e o suporte avançado de vida / Emergency trolleys and advanced life support

JUSTIFICATIVA E OBJETIVOS: O sucesso no atendimento a pacientes com parada cardiorrespiratória (PCR) depende, em parte, da disponibilidade e funcionalidade do equipamento de reanimação. Com o objetivo de normatizar os materiais dos carros de emergência (CE) e assim agilizar o atendimento foi publicada a Diretriz de Apoio ao Suporte Avançado de Vida (SAV). O objetivo deste estudo foi analisar a adequação dos CE à diretriz brasileira. MÉTODO: Estudo de corte transversal. Foram avaliados os CE de dois hospitais universitários. Foram considerados adequados aqueles que possuíam todos os itens nas quatro categorias especificadas na referida diretriz. RESULTADOS: Nenhum CE avaliado dispunha do conjunto de materiais especificados na normatização brasileira. Aspirina, material para acesso de via aérea alternativa, dispositivo para confirmação secundária do tubo orotraqueal (TOT), entre outros, não estavam disponíveis em nenhum dos CE. Apenas 29,2% dos CE localizados em enfermarias para adultos possuíam monitor / desfibrilador com a função de monitorização nas pás e 45,9% deles dispunham de desfibrilador externo automático (DEA). Em nenhum CE avaliado foram encontrados TOT de todos os tamanhos recomendados. Foram detectadas deficiências em relação às agulhas de punção venosa periférica recomendadas pela diretriz. Em um dos hospitais pesquisados, nenhum CE era equipado com máscara com reservatório de oxigênio. Os CE das unidades de pediatria apresentavam as maiores defasagens de materiais e equipamentos. Em três setores pesquisados, os CE não estavam localizados em pontos adequados na unidade. CONCLUSÃO: Os CE dos hospitais pesquisados não obedecem à normatização brasileira.

BACKGROUND AND OBJECTIVES: The success in attending to patients of cardiorespiratory arrest depends partially on the availability and functioning of resuscitation equipment. With the aim of standardizing materials of the emergency trolleys (ET) and thus improve care was published guidelines for ET. The objective of this study was analyzing the degree of adaptation of ET to the guidelines. METHOD: This cross-sectional study evaluated ET at two university hospitals. ET was considered adequate if they presented all the items in the four categories specified in that guideline. RESULTS: None of the ET contained the entire set of materials specified in the Brazilian standard. Aspirin, material accessing alternative airways, devices for secondary confirmation of orotracheal tube positioning, among others, were not available in any of the ET. Only 29.2% of ET located in adult wards contained a monitor / defibrillator with monitoring function in the pads and 45.9% of them had AED. In no ET evaluated TOT were found in all recommended sizes. Deficiencies were found regarding the venous puncture needles recommended by the guideline. In one of the hospitals, no CE was equipped with masks with oxygen reservoir. The ET in pediatrics units contained the greatest deficiencies of materials and equipment. In three of the sectors investigated, the ETs were not located at appropriate points in the unit. CONCLUSION: The ET in the hospitals investigated did not comply with the Brazilian standard.

Diagnóstico e tratamento de parada cardiorrespiratória: avaliação do conhecimento teórico de médicos em hospital geral / Cardiorespiratory arrest diagnosis and treatment: theoretical knowledge evaluation in a general hospital's physicians

INTRODUÇÃO: As principais causas de parada cardiorrespiratória são endêmicas e exigem do médico constante aperfeiçoamento no que se refere à reanimação cardiorrespiratória, tornando o treinamento e a educação continuada essenciais ao atendimento qualificado de parada cardiorrespiratória. OBJETIVO: O objetivo deste estudo foi avaliar o conhecimento teórico de médicos sobre diagnóstico e tratamento da parada cardiorrespiratória. MÉTODOS: Trata-se de pesquisa de corte transversal e descritiva em hospital geral terciário de Roraima. A população foi composta por médicos que atuam em unidades de pronto atendimento. Para coleta de dados foi utilizado questionário com perguntas sobre o tema e busca ativa dos profissionais em seus locais de trabalho. RESULTADOS: Responderam ao questionário 44 profissionais. A média de acertos foi de 50 por cento. Cometeram "erros fatais" 88,5 por cento dos profissionais. Cursos de treinamento nunca foram realizados por 54,5 por cento dos médicos. Não houve correlação entre número de acertos e realização de cursos de treinamento. Houve correlação inversamente proporcional entre desempenho e idade, mas não houve diferença estatisticamente significativa entre desempenho e tempo de graduação. CONCLUSÃO: o conhecimento teórico dos médicos mostrou-se preocupante. Os dados apontam para a importância do treinamento de profissionais em suporte avançado de vida para garantir um padrão de qualidade no atendimento à parada cardiorrespiratória neste hospital geral.

BACKGROUND: The main causes of cardiopulmonary arrest are endemic, and require constant medical improvement on cardiopulmonary resuscitation techniques. Training and continued education are essential to skilled management of cardiopulmonary resuscitation. OBJECTIVE: This study aimed to evaluate the physicians' theoretical knowledge on diagnosis and treatment of cardiopulmonary arrest. METHODS: This was a cross-sectional descriptive research conducted in a general hospital in Roraima, Brazil. The study population consisted of physicians who worked in the emergency department and intensive care units. The data were collected using a questionnaire addressing the subject. RESULTS: Forty four physicians answered the questionnaire. The mean score was 50 percent right answers. Most (88.5 percent) respondents committed "fatal errors". Half of the sample was never trained in advanced life support skills. No correlation was found between the number of right answers and attendance to advanced life support training courses. An inverse correlation was found between performance and age, but no statistically significant correlation was seen regarding performance and time from medical graduation. CONCLUSION: The physicians' theoretical knowledge on this field is worrisome. The results point to the importance of professional advanced life support training in order to assure quality standards for cardiac arrest management in this general hospital.

Comparison of Medical Student Responses and Course Achievement According to Different Types of Patient Simulations in an Introductory Advanced Life Support Course / 한국의학교육

PURPOSE: The optimal type of patient simulation for different levels of learners has not been extensively studied. The purpose of the study was to compare preclerkship medical student responses and course achievement according to different types of patient simulations in an introductory advanced life support (IALS) course. METHODS: A full-day, simulation-based IALS course was developed for preclerkship medical students who attended a four-week introduction to a clinical medicine program. One hundred eighteen students were trained in three days. Onsite interactive simulation with verbal debriefing (interactive type) was applied on the first day, and full-mission, realistic simulation with video-assisted debriefing (realistic type) was applied on the second and third days. At the end of course, students evaluated the course and their simulation experiences and completed a written post-test. RESULTS: Student responses to the course and patient simulations were very positive. Students who experienced the realistic type of patient simulations more highly rated in realistic experiences, such as patient care, than the interactive type group (3.83+/-0.88 vs. 3.41+/-0.84, p=0.018). Values for team communication training were more highly rated by students in the interactive type group than the realistic type (4.69+/-0.52 vs. 4.39+/-0.86, p=0.022). There was no significant difference in post-test scores between the two groups (realistic, 67.63+/-10.80; interactive, 66.73+/-9.93, p=0.654). CONCLUSION: Both types of patient simulation provide valuable learning experiences to preclerkship medical students, with their own advantages in an IALS course. Onsite interactive simulation with verbal debriefing may be more cost-effective tool for preclerkship medical students.

Aspectos más destacados en reanimación cardiopulmonar pediátrica: Comité Internacional de Enlace en Guías de Resucitación (International Liaison Committee on Resuscitation Guidelines, ILCOR) 2005 / Most Relevant aspects in pediatric cardiopulmonar reanimation ILCOR 2005

En diciembre 2005 se actualizaron las Guías de Reanimación Cardiopulmonar (RCP) y Atención Cardiovascular de Emergencia del Comité Internacional de Enlace en Guías de Resucitación (ILCOR) en colaboración con la Asociación Americana del Corazón (AHA). El propósito de esta revisión es señalar los cambios en Soporte Vital Básico y Avanzado Pediátrico con respecto a las recomendaciones anteriores.

Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care of the American Heart Association (AHA) where updated in collaboration with the International Liaison Committee on Resuscitation: (ILCOR) on December 2005. The purpose of this review is to highlight changes in Pediatric Basic Life Support (BLS) and Advanced Life Support (ALS).

Atendimento à parada cardiorrespiratória na faixa etária pediátrica / Management of pediatric cardiorespiatory arrst

Cardiopulmonary arrest in the pediatric patient is rarely of sudden onset. Typically, children have primary cardiac arrest secondary to a prolonged period of respiratory or circulatory compromise. Many investigators have confirmed that survival rates after respiratory arrest alone, whether in or out of the hospital, are significantly bet- ter than survival rates once cardiac arrest has occurred. Early recognition and prompt intervention of respiratory failure to pre- vent further hypoxemia and respiratory acidosis appear to be the most factors in averting progression to cardiac arrest. In any pediatric emergency, the first step is establishing airways status followed by breathing and circulation evaluation (ABC), Airway management can be as simple as observation or as complex as endotracheal intubation. Oxygen should be considered for ali pediatric emergencies. The easiest form of assisted ventilation in a child is bag-valve-mask ventilation. Circulatory compromise should be evetueteo. The pulses most easily palpated are the brachial ® 1 year old) and carotid (> 1 year old), The Pediatric Advanced Life Support (PALS) course teaches the fundamental basic for pediatric emergency care, and it is recom- mended that ali physicians and nurses who care for children complete training and refresher courses on a regular basis. The purpose of this study is to review the recommendations of pediatric resuscitation and help pediatrician to save lives and improved quality of life.

A parada cardiorrespiratória em crianças raramente é um evento súbito. Tipicamente, elas apresentam parada cardíaca secundária a período prolongado de falência respiratória ou circulatória. Muitos autores relatam que as taxas de sobrevida são maiores naquelas crianças que apresentam parada respiratória apenas, dentro ou fora do hospital, em relação àquelas que apresentam parada cardiorrespiratória. O reconhecimento precoce e a rápida intervenção na falência respiratória previnem o aparecimento de hipoxemia e de acidose respiratória, sendo esses últimos os mais importantes fatores que nos advertem para uma progressão para parada cardíaca. Em qualquer emergência que ocorra com paciente pediátrico, a primeira etapa é estabelecer a perviabilidade das vias aéreas, seguida por ventilação e circulação adequadas (ABC). O manejo das vias aéreas pode ser através de uma simples observação ou posicionamento, até procedimentos mais invasivos como a intubação traqueal. O oxigênio deve ser sempre suplementado. A forma mais fácil de oferecer suporte ventilatório à criança é através da ventilação com máscara-unidade ventilatória. O comprometimento circulatório deve ser avaliado. Os pulsos mais facilmente palpáveis são o braquial ® 1 ano de idade) e o carotídeo (> 1 ano de idade). O curso de Suporte Avançado de Vida em Pediatria (SAVP) fornece as bases fundamentais para o aprendizado do atendimento às emergências pediátricas, e é recomendado para o treinamento de todos os médicos e enfermeiras. O objetivo deste artigo é rever as recomendações para a ressuscitação cardiorrespiratória e ajudar o pediatra a salvar vidas e a melhorar a qualidade de vida das crianças criticamente enfermas.