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1.
Femina ; 51(8): 480-485, 20230830. ilus
Article in Portuguese | LILACS | ID: biblio-1512457

ABSTRACT

Objetivo: Analisar o uso dos contraceptivos hormonais em mulheres com asma e a escolha desses métodos contraceptivos para essa população, com avaliação de eventuais repercussões sobre novos episódios de asma e sibilos. Métodos: Foram selecionados estudos longitudinais, ensaios clínicos, revisões sistemáticas e metanálises. As plataformas consultadas foram PubMed, Embase, Cochrane e SciELO, com a utilização dos descritores: "contracepção", "contracepção hormonal", "sistema intrauterino liberador de levonorgestrel" e "asma". Resultados: Dois grandes estudos demonstraram que o uso de contraceptivos hormonais esteve associado à redução do risco de novos episódios de asma. Uma revisão sistemática concluiu que os resultados para o uso de contraceptivos hormonais para mulheres com asma foram mistos, com aumento ou redução dos seguintes riscos: novo episódio de asma e aumento da frequência das crises e dos sibilos. O uso da contracepção hormonal em pacientes obesas portadoras de asma é controverso. Conclusão: Os resultados para o uso de contraceptivos hormonais em mulheres com asma são inconsistentes, com relatos de aumento ou de redução do risco de novos episódios. O uso do método contraceptivo deve ser discutido individualmente, levando-se em consideração outros fatores de risco associados e o desejo da mulher. A paciente deverá ser orientada se houver piora dos sintomas clínicos de asma na vigência do uso de qualquer método contraceptivo hormonal.


Objective: To analyze the use of hormonal contraceptives in women with asthma and the choice of this contraceptive method for this population, evaluating possible repercussions on new episodes of asthma and wheezing. Methods: Longitudinal studies, clinical trials, systematic reviews and meta-analyses were selected. Platforms consulted: PubMed, Embase, Cochrane, SciELO, using the descriptors: "contraception", "hormonal contraception", "levonorgestrel-releasing intrauterine system" and "asthma". Results: Two large studies demonstrated that the use of hormonal contraceptives was associated with a reduced risk of new episodes of asthma. A systematic review concluded that the results for the use of hormonal contraceptives for women with asthma were mixed, with increased or decrease in the following risks: new asthma episodes, increased frequency and wheezing. The use of hormonal contraception in obese patients with asthma is controversial. Conclusion: The results for the use of hormonal contraceptives in women with asthma are inconsistent, with reports of increased or reduced risk of new episodes. The use of the contraceptive method should be discussed individually, taking into account other associated risk factors and the woman's desire. The patient will be advised if there is a worsening of the clinical symptoms of asthma while using any hormonal contraceptive method.


Subject(s)
Humans , Female , Adolescent , Adult , Asthma/complications , Contraceptive Agents, Hormonal/adverse effects , Contraceptive Agents, Hormonal/therapeutic use , Progesterone/adverse effects , Signs and Symptoms, Respiratory , Chest Pain/diagnosis , Menarche , Respiratory Sounds/diagnosis , Cross-Sectional Studies , Cohort Studies , Longitudinal Studies , Cough/diagnosis , Dyspnea/diagnosis , Estrogens , Systematic Review , Lung/physiopathology
2.
Rev. medica electron ; 43(6): 1569-1584, dic. 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1409684

ABSTRACT

RESUMEN Introducción: el dolor torácico agudo es una sensación dolorosa que se manifiesta entre el diafragma y la base del cuello. En Cuba, constituye una de las causas más frecuentes de consulta médica. La provincia de Matanzas muestra un comportamiento similar. Objetivo: caracterizar el perfil clínico de los pacientes con dolor torácico agudo en la Unidad de Cuidados Intensivos Emergentes, del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Materiales y métodos: se realizó un estudio transversal descriptivo con las historias clínicas de 418 pacientes que acudieron a la Unidad de Cuidados Intensivos Emergentes, refiriendo dolor torácico agudo, de enero a diciembre de 2019. Resultados: el rango de edad más afectado fue el de 50 a 59 años, para un 30,38 %. Predominó el sexo masculino con el 30,08 %. El ejercicio físico intenso elevó el riesgo de aparición de dolor torácico. Las primeras causas de dolor torácico agudo fueron, en orden de frecuencia, la osteocondritis esternocostal, la bursitis del hombro y el síndrome coronario agudo. Conclusiones: se evidenció que en la mayoría de los casos el origen del dolor fueron causas no cardiovasculares, afectando más al sexo masculino. Existió asociación estadística significativa entre la actividad física intensa y el inicio del dolor torácico agudo. Egresaron vivos de la unidad el 71,53 % de los pacientes. Se recomienda priorizar la atención de los pacientes que refieren dolor torácico agudo, para una correcta clasificación y atención en el menor tiempo posible (AU).


ABSTRACT Introduction: acute chest pain is a painful sensation perceptible between the diaphragm and the base of the neck. It is one of the most frequent causes of medical consultation in Cuba. It shows a similar behavior in the province of Matanzas. Objective: to characterize the clinical profile of the patients with acute thoracic pain in the Emergency Intensive Care Unit of the Teaching Clinic-Surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas. Materials and methods: a descriptive, cross-sectional study was carried out with the clinical records of 418 patients who attended the Emergency Intensive Care Unit referring acute thoracic pain, from January to December 2019. Results: the most affected age range was the one from 50 to 59 years, for 30.38 %. Male sex predominated, with 30.08 %. Intense physical exercise raised the risk of thoracic pain. The first causes of acute thoracic pain were, in order of frequency, sternocostal osteochondritis, shoulder bursitis, and acute coronary syndrome. Conclusions: It was evidenced that in most of the cases the source of the pain was non-cardiovascular causes, more affecting the male sex. There was significant statistic association between intense physical activity and acute thoracic pain. 71.53 % of the patients was discharged from the unit alive. It is recommended to prioritize the attention of patients referring acute thoracic pain, for their correct classification and care in the shortest possible time (AU).


Subject(s)
Humans , Male , Female , Chest Pain/epidemiology , Intensive Care Units , Osteochondritis/diagnosis , Patients , Chest Pain/diagnosis , Chest Pain/therapy , Medical Records , Acute Coronary Syndrome/diagnosis
3.
Rev. colomb. cardiol ; 28(5): 410-420, sep.-oct. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1357207

ABSTRACT

Resumen Objetivo: Evaluar la utilidad del índice UDT-65 para la estratificación del dolor torácico en urgencias en una población colombiana en la que se sospecha enfermedad coronaria. Método: Se condujo la validación externa del índice UDT-65 en una cohorte concurrente que incluyó pacientes que ingresaron a urgencias de una clínica cardiovascular en Bogotá con dolor torácico no traumático, y electrocardiograma normal o no diagnóstico. Se evaluaron 1320 pacientes de 18 o más años y se determinó la utilidad del índice en términos de calibración (uso de gráfico, ji al cuadrado para datos agrupados y prueba de bondad de ajuste de Hosmer-Lemeshow) y de capacidad de discriminación del modelo (curva de características operativas del receptor [ROC] y área bajo ella [AUC]). Resultados: El índice UDT-65 en esta población suministró evidencia de su utilidad en términos de calibración y capacidad de discriminación, para efectuar una buena aplicación de él en aquellos pacientes que consulten al servicio de urgencias de una clínica cardiovascular por dolor torácico no traumático de posible origen coronario. La capacidad de discriminación del índice UDT-65 fue adecuada, pues con un área bajo la curva ROC de 0.867 (IC 95% 0-847-0.885), que se acerca al valor obtenido (AUC 0.87) en la población española en que se desarrolló el índice. Conclusiones: Se necesitan más estudios similares en otras instituciones, dado el buen resultado, en beneficio de más pacientes.


Abstract Objective: To evaluate the clinical usefulness, in the emergency service, of the UDT-65 index for chest pain stratification in colombian population with suspected coronary disease. Method: The external validation of the UDT-65 index was conducted in a concurrent cohort that included patients admitted to the emergency service of the cardiovascular clinic in Bogotá with non-traumatic chest pain and normal or non-diagnostic electrocardiogram. 1320 patients were evaluated and the usefulness of this instrument was determined in terms of calibration (use of graph, Chi-square test for group data and the Hosmer-Lemeshow goodness-of-fit test) and discrimination capacity of the model (curve of receiver operating characteristics [ROC] and by finding the area under the curve [AUC]). Results: The UDT-65 index in the population under study, provided evidence of its usefulness in terms of calibration and discrimination capacity; this, in pursuance of a good application of the instrument in those patients who consult the Emergency Department of the cardiovascular clinic for non-traumatic chest pain of possible coronary origin. The discrimination capacity of the UDT65 index was adequate, with an area under the ROC curve of 0.867 (95 % CI 0.847-0.885), which is close in value to the one obtained (AUC 0.87) in the Spanish population where the original index was developed. Conclusions: More similar studies are needed in other institutions, due to the excellent and beneficial outcomes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Chest Pain/diagnosis , Coronary Disease/diagnosis , Acute Coronary Syndrome/diagnosis , Calibration , Logistic Models , Sensitivity and Specificity , Electrocardiography
4.
Int. j. cardiovasc. sci. (Impr.) ; 34(1): 67-73, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154529

ABSTRACT

Abstract Background The implementation of institutional protocols in the emergency department (ED) for risk stratification in patients with chest pain has been recommended. Objective To assess the sensitivity, specificity and predictive value of an institutional risk stratification protocol for chest pain suggestive of acute coronary syndrome (ACS). Method Cross-sectional study conducted based on the computerized records of patients treated with the use of a chest pain protocol adapted from the Manchester protocol. The level of risk was stratified by applying five colors representing the respective levels. Each color represents a level of severity and a maximum waiting time for receiving medical care. Red and orange were considered to be high priority, while patients with yellow, green or blue indications were considered to represent a low priority. To compare the type of diagnosis and the classification of priority for receiving care, the Pearson's chi-square test was used, considering a significance level of p< 0.05 for all tests. Results The records of 1,074 patients admitted to the cardiology ED were analyzed. Men (54%), with a mean age of 60 ± 15 years, with complaints of chest pain (44%) of moderate intensity (80%) were predominant the study. Of these patients, 19% were classified as high priority, while 81% were considered to represent a low priority. ACS was confirmed in 23% of the patients, with 34% of them being classified as high priority and 66% as low priority. The sensitivity of the risk stratification protocol for chest pain was 33.7% and the specificity was 86.0%, with a positive and negative predictive value of 41.7% and 81.3%, respectively. Conclusion The Institutional risk stratification protocol for chest pain suggestive of ACS presented satisfactory specificity and a low degree of sensitivity. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Chest Pain/diagnosis , Risk Assessment , Acute Coronary Syndrome/diagnosis , Chest Pain/etiology , Cross-Sectional Studies , Sensitivity and Specificity , Guidelines as Topic , Emergency Service, Hospital , Heart Disease Risk Factors
6.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 27-33, jan.-dez. 2021. graf, tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1145900

ABSTRACT

Objetivo: Caracterizar os usuários cardiopatas que acessam a Unidade de Dor Torácica (UDT) de um hospital geral no norte do Estado do Rio Grande do Sul. Métodos: Estudo transversal, descritivo, de abordagem quantitativa, que foi realizado na UDT do Hospital da Cidade de Passo Fundo, abordando pacientes com suspeita ou com diagnóstico médico de Doença Cardiovascular (DCV). Resultados: Coleta dos dados realizada com 112 pacientes. Houve o predomínio de idosos, homens com baixas condições socioeconômicas e alta incidência de diagnóstico de Síndrome Coronariana Aguda (SCA) sendo que a dor torácica esteve presente em grande parte dos pacientes. Conclusões: Conhecer a população que acessou a UDT possibilitou reflexões acerca da temática, bem como a importância do referido serviço, no qual serve como porta de entrada para pacientes em condições agudas e crônicas de DCV


Objective: To characterize the cardiac patients who access the Thoracic Pain Unit (UDT) of a general hospital in the north of the State of Rio Grande do Sul. Methods: a cross-sectional, descriptive, quantitative study was carried out at the UDT of the Hospital of the City of Passo Fundo, addressing patients with suspicion or medical diagnosis of Cardiovascular Disease (CVD). Results: Data collection with 112 patients.There was a predominance of elderly, men with low socioeconomic conditions and a high incidence of acute coronary syndrome (ACS), and chest pain was present in most patients. Conclusions: Knowing the population that accessed the UDT made possible reflections on the subject, as well as the importance of this service, which serves as a gateway for patients in acute and chronic conditions of CVD


Objetivo: Caracterizar a los usuarios cardiopatas que accede a la Unidad de Dolor Torácica (UDT) de un hospital general en el norte del Estado de Rio Grande do Sul. Métodos: estudio transversal, descriptivo, de abordaje cuantitativo, que fue realizado en la UDT del Hospital de la Ciudad de Passo Fundo, abordando pacientes con sospechosos o con diagnóstico médico de Enfermedad Cardiovascular (ECV). Resultados: Recolección de los datos realizada con 112 pacientes.Hubo el predominio de ancianos, hombres con bajas condiciones socioeconómicas y alta incidencia de diagnóstico de Síndrome Coronaria Aguda (SCA), siendo que el dolor torácico estuvo presente en gran parte de los pacientes. Conclusiones: Conocer la población que accedió a la UDT posibilitó reflexiones acerca de la temática, así como la importancia de dicho servicio, en el cual sirve como puerta de entrada para pacientes en condiciones agudas y crónicas de ECV


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Chest Pain/diagnosis , Cardiovascular Diseases/epidemiology , Heart Diseases/epidemiology , Incidence , Acute Coronary Syndrome , Hospitals, General
7.
Arq. bras. cardiol ; 114(5): 795-802, maio 2020. tab, graf
Article in Portuguese | SES-SP, LILACS | ID: biblio-1131233

ABSTRACT

Resumo Fundamento Múltiplos sistemas de pontuação têm sido elaborados para calcular o risco de eventos cardiovasculares adversos maiores (MACE) em pacientes com dor no peito. Não há dados que avaliem se o escore HEART tem um desempenho superior a TIMI e GRACE para a predição de MACE, especialmente na era de troponina I de alta sensibilidade e em uma população exclusivamente latino-americana. Objetivo Comparar o desempenho dos escores HEART, TIMI e GRACE para a predição de MACE em 30 dias de acompanhamento, em pacientes atendidos com dor no peito no departamento de emergência. Métodos Os escores HEART, TIMI e GRACE foram analisados em 519 pacientes com dor no peito no departamento de emergência. O desfecho primário foi a ocorrência de MACE no período de 30 dias. O desempenho do escore HEART foi comparado com o dos escores TIMI e GRACE utilizando o teste de DeLong, considerando estatisticamente significativos os valores de p de 0,05. Resultados Um total de 224 pacientes (43%) apresentaram MACE no período de 30 dias. A estatística C para os escores HEART, TIMI e GRACE foi de 0,937, 0,844 e 0,797 respectivamente (p < 0,0001). Uma pontuação de 3 ou menos no escore HEART apresentou uma sensibilidade de 99,5% e um valor preditivo negativo de 99% para classificar pacientes de baixo risco de maneira correta; ambos os valores foram mais elevados do que aqueles obtidos pelos outros escores. Conclusão O escore HEART, em um período de 30 dias, prediz eventos cardiovasculares, mais eficazmente, em comparação com os outros escores. Troponinas de alta sensibilidade mantêm a superioridade previamente demonstrada deste escore. Este escore oferece uma identificação mais precisa dos pacientes de baixo risco. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Background Multiple scoring systems have been designed to calculate the risk of major adverse cardiovascular events (MACE) in patients with chest pain. There is no data on whether the HEART score outperforms TIMI and GRACE in the prediction of MACE, especially in the era of high-sensitivity troponin assay and in an exclusively Latin-American population. Objective To compare the performance of the HEART, TIMI, and GRACE scores for predicting major cardiovascular events at 30 days of follow-up, in patients who consult for chest pain in the emergency department. Methods HEART, TIMI, and GRACE scores were analyzed in 519 patients with chest pain at the emergency department. The primary endpoint was the occurrence of MACE within 30 days. The performance of the HEART score was compared with the TIMI and GRACE scores using the DeLong test with p values of 0.05 considered statistically significant. Results A total of 224 patients (43%) had MACE at 30 days. The C statistic for the HEART, TIMI, and GRACE score was 0.937, 0.844, and 0.797 respectively (p < 0.0001). A HEART score of 3 or less had a sensitivity of 99.5% and a negative predictive value of 99% to classify low risk patients correctly; both values were higher than those obtained by the other scores. Conclusion The HEART score more effectively predicts cardiovascular events at 30 days of follow-up compared to the other scores. High-sensitivity troponins maintain this score's previously demonstrated superiority. This score offers more precise identification of low-risk patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Male , Female , Chest Pain/diagnosis , Cardiovascular Diseases/diagnosis , Risk Assessment/methods , Acute Coronary Syndrome/diagnosis , Heart Diseases/diagnosis , Troponin , Severity of Illness Index , Predictive Value of Tests , Prospective Studies , Triage/methods , Emergency Service, Hospital
8.
REME rev. min. enferm ; 24: e1320, fev.2020. tab
Article in English, Portuguese | BDENF, LILACS | ID: biblio-1125484

ABSTRACT

RESUMO Objetivo: realizar a adaptação transcultural do instrumento Toronto Pain Management Inventory - Acute Coronary Syndrome para o Português brasileiro e analisar evidências de validade de face do instrumento adaptado. Métodos: para a adaptação transcultural foram seguidos os procedimentos propostos pelo Guideline for Establishing Cultural Equivalency of Instruments (RDC/TMD) Consortium Network (fase 1). Para verificar a concordância entre os juízes na análise das equivalências foi utilizado o índice de validade de conteúdo (IVC). A validade de face foi feita com enfermeiros durante o pré-teste e consistiu na avaliação da facilidade da compreensão para responder aos itens. Resultados: o instrumento adaptado alcançou equivalência linguística. As equivalências semântica, idiomática, experimental e conceitual tiveram IVC médios de 98,5 (IC 95% 97,1-100,0), 97,8 (IC 95% 96,0-99,5), 94,1 (IC95% 91,6-96,6) e 99,6 (IC 95% 98,9-100,0). No pré-teste, 92,5% dos enfermeiros consideraram o instrumento de fácil compreensão e 85% não encontraram dificuldade. Conclusão: o instrumento adaptado é culturalmente equivalente ao instrumento original e reúne evidências de validade de face. As propriedades psicométricas do instrumento ainda serão investigadas.


RESUMEN Objetivo: realizar la adaptación transcultural del instrumento Toronto Pain Management Inventory - Acute Coronary Syndrome al idioma portugués de Brasil y analizar la evidencia de la validez aparente del instrumento adaptado. Métodos: para la adaptación transcultural se siguieron los procedimientos propuestos por la Guideline for Establishing Cultural Equivalency of Instruments (RDC/TMD) Consortium Network (fase 1). Para verificar el acuerdo entre los jueces en el análisis de equivalencias se utilizó el índice de validez de contenido (IVC). La validez aparente se realizó con los enfermeros durante la prueba previa y consistió en evaluar la facilidad de comprensión para responder a los ítems. Resultados: el instrumento adaptado logró equivalencia lingüística. Las equivalencias semánticas, idiomáticas, experimentales y conceptuales tuvieron un IVC promedio de 98.5 (IC 95% 97.1-100.0), 97.8 (IC 95% 96.0-99.5), 94.1 (IC 95 % 91.6-96.6) y 99.6 (IC 95% 98.9- 100.0). En la prueba previa, el 92.5% de los enfermeros consideraba que el instrumento era fácil de entender y el 85% no encontró dificultades. Conclusión: el instrumento adaptado es culturalmente equivalente al instrumento original y reúne evidencia de validez aparente. Las propiedades psicométricas del instrumento aún no se han investigado.


ABSTRACT Objective: to perform the cross-cultural adaptation of the Toronto Pain Management Inventory - Acute Coronary Syndrome instrument into Brazilian Portuguese and test face validity evidence of the adapted instrument. Methods: we followed the procedures proposed by the Guideline for Establishing Cultural Equivalency of Instruments (RDC/TMD) Consortium Network (phase 1) for cross-cultural adaptation. To measure agreement between the judges in the equivalences analysis, we used the content validity index (CVI). Face validity was performed with nurses during the pre-test and consisted of assessing the ease of understanding when answering the items. Results: the adapted instrument achieved linguistic equivalence. The semantic, idiomatic, experimental and conceptual equivalences had a mean CVI of 98.5 (95% CI 97.1-100.0), 97.8 (95% CI 96.0-99.5), 94.1 (95 % 91.6-96.6) and 99.6 (95% CI 98.9-100.0). In the pre-test, 92.5% of nurses considered the instrument easy to understand and 85% found no difficulty. Conclusion: the adapted instrument is culturally equivalent to the original instrument and shows evidence of face validity. The psychometric properties of the instrument are yet to be investigated.


Subject(s)
Humans , Acute Coronary Syndrome , Cardiovascular Nursing , Chest Pain/diagnosis , Comprehension , Pain Management/nursing
9.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 37(3): 45-51, dic. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1100152

ABSTRACT

Introducción: las lesiones cardiacas son entidades desafiantes en la ci-rugía de emergencia, su alta mortalidad obliga a tomar decisiones rápidas y precisas. Metodología: serie de casos que analizó las historias clínicas de pacien-tes con trauma cardiaco atendidos en el Centro de Trauma y Emergencia del Hospital Vicente Corral Moscoso (HVCM) durante el período noviembre del 2015 ­ abril 2017. Objetivos: presentar el manejo de esta patología, así como su mortalidad en nuestro medio Resultados: durante el período analizado se atendieron 18 pacientes con trauma cardiaco, 12 por lesión penetrante, 2 iatrogénicas y 4 contusos. El sexo masculino fue el más expuesto a estas lesiones. Dentro de las lesiones por violencia la más frecuente fue: lesión por arma blanca 8 casos y fuego 4. La incisión más utilizada para la reparación cardiaca fue la toracotomía lateral izquierda. El ventrículo izquierdo fue el más afectado en 6 pacientes y el derecho en 5. La mortalidad en este grupo de pacientes fue del 17%. Conclusión: la mortalidad en esta serie de casos fue del 17%, el aborda-je quirúrgico fue preferentemente por toracotomía lateral izquierda en un 67%.(AU).


Introduction: cardiac injuries are challenging entities in emergency surgery, their high mortality forces to make prompt and precise decisions.Methodology: there was a series of cases that analyzed the medical records of patients with cardiac trauma treated at the Trauma and Emergency Center of the Vicente Corral Moscoso Hospital (HVCM) during the period November 2015 - April 2017.Objectives: to expose the management of this pathology, as well as its mortality in our environment Results: a total of 18 patients with cardiac trauma, 12 due to penetrating injury, 2 iatrogenic and 4 contusions were treated during the analyzed period. The male sex was the most exposed to these injuries. Among the violence injuries, the most frequent was: 8 white weapon injuries and 4 gunshot. The incision most used for cardiac repair was the left lateral thoracotomy. The left ventricle was the most affected in 6 patients and the right ventricle in 5 patients. The mortality in this group of patients was 17%.Conclusion: the mortality in these cases was 17%, the surgical approach was preferably by left lateral thoracotomy in 67%.(AU)


Subject(s)
Humans , Chest Pain/diagnosis , Myocardial Infarction/complications
10.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 252-256, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1013282

ABSTRACT

ABSTRACT Objective: To highlight the importance of the new classification criteria for the macrophage activation syndrome (MAS) in systemic juvenile idiopathic arthritis in order to reduce morbidity and mortality outcome related to this disease. Case description: A 12-year-old female patient with diagnosis of systemic juvenile idiopathic arthritis under immunosuppression therapy for two years developed cough, acute precordial chest pain, tachypnea, tachycardia and hypoxemia for two days. Chest tomography showed bilateral laminar pleural effusion with bibasilar consolidation. The electrocardiogram was consistent with acute pericarditis and the echocardiogram showed no abnormalities. Laboratory exams revealed anemia, leukocytosis and increased erythrocyte sedimentation rate, as well as C-reactive protein rate and serum biomarkers indicative of myocardial injury. Systemic infection and/or active systemic juvenile idiopathic arthritis were considered. She was treated with antibiotics and glucocorticoids. However, 10 days later she developed active systemic disease (fever, evanescent rash and myopericarditis with signs of heart failure) associated with macrophage activation syndrome, according to the 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis. She was treated for five days with pulse therapy, using glucocorticoids, immunoglobulin and cyclosporine A, with improvement of all clinical signs and laboratory tests. Comments: Myopericarditis with signs of heart failure associated with MAS is a rare clinical presentation of systemic juvenile idiopathic arthritis. Macrophage activation syndrome occurs mainly during periods of active systemic juvenile idiopathic arthritis and may be triggered by infection. Knowledge about this syndrome is crucial to reduce morbidity and mortality.


RESUMO Objetivo: Destacar a importância do conhecimento sobre os novos critérios de classificação para síndrome de ativação macrofágica (SAM) na artrite idiopática juvenil sistêmica para reduzir a morbidade e mortalidade desse desfecho. Descrição do caso: Adolescente do sexo feminino de 12 anos de idade, em terapia imunossupressora por diagnóstico de artrite idiopática juvenil sistêmica há 2 anos, com quadro de tosse, dor precordial aguda, taquipneia, taquicardia e hipoxemia há 2 dias. A tomografia de tórax evidenciou efusão pleural laminar bilateral com consolidação bibasal. O eletrocardiograma foi compatível com pericardite aguda, e o ecocardiograma foi normal. Os exames laboratoriais revelaram anemia, leucocitose e aumento da velocidade de hemossedimentação, proteína C-reativa e marcadores séricos de lesão miocárdica. Infecção sistêmica e/ou doença sistêmica em atividade foram consideradas. A paciente foi tratada com antibióticos e glicocorticoide. Entretanto, dez dias depois, evoluiu com doença sistêmica em atividade (febre, exantema e miopericardite com insuficiência cardíaca) associada à SAM, de acordo com o 2016 Classification Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis, e necessitou de cinco dias de pulsoterapia com glicocorticoide, imunoglobulina e ciclosporina A, com melhora de todos os parâmetros clínicos e laboratoriais. Comentários: A miopericardite com sinais de insuficiência cardíaca associada à SAM é uma apresentação clínica rara da artrite idiopática juvenil sistêmica, que ocorre principalmente em períodos de atividade sistêmica da doença e pode ser deflagrada por infecções. O conhecimento sobre essa síndrome é fundamental para reduzir morbidade e mortalidade desse grave desfecho.


Subject(s)
Humans , Female , Child , Cyclosporine/administration & dosage , Glucocorticoids/administration & dosage , Arthritis, Juvenile/complications , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/physiopathology , Arthritis, Juvenile/immunology , Chest Pain/diagnosis , Chest Pain/etiology , Tomography, X-Ray Computed/methods , Treatment Outcome , Immunoglobulins, Intravenous/administration & dosage , Pulse Therapy, Drug/methods , Electrocardiography/methods , Macrophage Activation Syndrome/etiology , Macrophage Activation Syndrome/physiopathology , Macrophage Activation Syndrome/blood , Macrophage Activation Syndrome/therapy , Immunosuppressive Agents/administration & dosage , Leukocytosis/diagnosis , Leukocytosis/etiology
11.
São Paulo med. j ; 137(1): 54-59, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-1004747

ABSTRACT

ABSTRACT BACKGROUND: The chest pain classifications that are currently in use are based on studies that are several decades old. Various studies have indicated that these classifications are not sufficient for determining the origin of chest pain without additional diagnostic tests or tools. We describe a new chest pain scoring system that examines the relationship between chest pain and ischemic heart disease (IHD). DESIGN AND SETTING: Cross-sectional study conducted in a tertiary-level university hospital and two public hospitals. METHODS: Chest pain scores were assigned to 484 patients. These patients then underwent a treadmill stress test, followed by myocardial perfusion scintigraphy if necessary. Coronary angiography was then carried out on the patients whose tests had been interpreted as positive for ischemia. Afterwards, the relationship between myocardial ischemia and the test score results was investigated. RESULTS: The median chest pain score was 2 (range: 0-7) among the patients without IHD and 6 (1-8) among those with IHD. The median score of patients with IHD was significantly higher than that of patients without IHD (P = 0.001). Receiver operating characteristic analysis showed that the score had sensitivity of 97% and specificity of 87.5% for detecting IHD. CONCLUSION: We developed a pre-test chest pain score that uses a digital scoring system to assess whether or not the pain was caused by IHD. This scoring system can be applied easily and swiftly by healthcare professionals and can prevent the confusion that is caused by other classification and scoring systems.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Chest Pain/diagnosis , Pain Measurement/methods , Myocardial Ischemia/diagnosis , Severity of Illness Index , Chest Pain/physiopathology , Cross-Sectional Studies , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Myocardial Ischemia/physiopathology , Statistics, Nonparametric , Risk Assessment/methods , Area Under Curve , Tertiary Care Centers , Hospitals, Public
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(4): 394-402, out.-dez. 2018. tab, ilus, graf
Article in English, Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-970499

ABSTRACT

A dor torácica aguda é um sintoma muito frequente nas unidades de emergência, constituindo-se em um possível sinal de alerta para as doenças com risco iminente de morte. Como a maioria desses pacientes é internada para avaliação de uma possível síndrome coronariana aguda, isso gera um custo hospitalar muito alto por paciente. Por conta dessa possibilidade diagnóstica, muitos emergencistas internam a maioria dos pacientes. Por outro lado, a liberação inapropriada daqueles com infarto agudo do miocárdio representa um risco para o médico e, especialmente, para o paciente. Outro ponto importante é a demora para o atendimento, em que há a influência de fatores relacionados ao paciente, assim como, pontos negativos na logística de atendimento dos serviços de emergência em nosso país. Para excelência no atendimento, é importante uma anamnese detalhada adicionada ao exame físico, a qual permite a elaboração das hipóteses diagnósticas. E para auxiliar os médicos na escolha da hipótese diagnóstica e na tomada rápida de decisão, escores de risco são disponibilizados, os quais, facilmente, identificam a probabilidade de eventos adversos. A conduta imediata de casos com risco de morte imediata tem como principal objetivo reduzir a morbidade e a mortalidade, aumentando, consequentemente, a segurança do profissional da emergência. Sugestões de fluxogramas e algoritmos para o atendimento desses pacientes na sala de emergência definem, de forma objetiva, quem fica e quem pode ser liberado


Acute chest pain is a frequent symptom in emergency units, being a possible war-ning sign of diseases with an imminent risk of death. Since most of these patients are hospitalized to evaluate possible acute coronary syndrome, this generates a very high hospital cost per patient. Because of this diagnostic possibility, emergency professionals admit most patients. In contrast, the inappropriate release of those with acute myocardial infarction poses a risk to the physician and, especially, the patient. Another important point is the delay in care, where there is an influence of patient-related factors, as well as negative points in the logistics of care in the emergency services in our country. For excellence in care, a detailed anamnesis added to the examination is important, allowing the elaboration of diagnostic hypotheses. Moreover, to assist physicians in selecting the diagnostic hypothesis and making fast decisions, there are risk scores that easily identify the likelihood of adverse events. The immediate management of cases with an imminent risk of death is the main objective to reduce morbidity and mortality and, consequently, increase the safety of emergency professionals. Flowcharts and algorithm suggestions targeting patients in the emergency room objectively define who stays and who can be released


Subject(s)
Humans , Male , Female , Chest Pain/diagnosis , Chest Pain/therapy , Diagnosis, Differential , Emergencies , Aorta , Troponin/therapeutic use , Echocardiography/methods , Radiography, Thoracic/methods , Biomarkers , Risk Factors , Electrocardiography/methods , Exercise Test/methods , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/diagnosis , Angina, Unstable/complications , Angina, Unstable/diagnosis , Myocardial Infarction/diagnosis
14.
Rev. pediatr. electrón ; 15(2): 19-25, ago. 2018.
Article in Spanish | LILACS | ID: biblio-994556

ABSTRACT

El dolor precordial en pediatría representa un bajo porcentaje del total de consultas, sin embargo genera una alta preocupación tanto en los padres como en el equipo de salud. En general se trata de un proceso benigno y la etiología cardíaca es infrecuente, alcanzando apenas el 1-4%. En el presente trabajo de actualización se revisan las diferentes etiologías, con el propósito de identificar factores que orienten a etiología cardíaca y así derivar al especialista u hospitalizar en forma oportuna si se requiere.


The chest pain in pediatrics represents a low percentage of the total of consultations, nevertheless it generates a high concern both in the parents and in the health team. In general, it is a benign process and the cardiac etiology is infrequent, reaching only 1-4%. In the present update work, the different etiologies are reviewed, in order to identify factors that guide the cardiac etiology and thus refer to the specialist or hospitalize in a timely manner if required.


Subject(s)
Humans , Child , Chest Pain/diagnosis , Chest Pain/etiology , Physical Examination , Chest Pain/therapy , Cardiovascular Diseases/complications
15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(3 (supl)): 353-360, jul.-set. 2018. tab
Article in English, Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-964378

ABSTRACT

O presente ensaio tem como objetivo apresentar reflexões sobre o processo diagnóstico no campo dos transtornos mentais com manifestações clínicas, especificamente, o transtorno do pânico (TP), assim como seu impacto no sistema de saúde e na rotina dos serviços de emergência, além de apontar diretrizes para o acolhimento, manejo e encaminhamento dos usuários que apresentam esse sofrimento psíquico-emocional. A dor torácica é um dos sintomas mais comuns nos serviços de emergência médica de atendimento primário. Por ser um sintoma presente tanto no transtorno do pânico quanto na isquemia miocárdica na doença arterial coronariana (DAC), muitos indivíduos acometidos por TP acreditam estar na iminência de um problema grave de saúde, como por exemplo, o infarto agudo do miocárdio. Temos no caso do TP um exemplo da ausência de fronteiras entre o somático e o psíquico, pois a mistura dos sintomas físicos e emocionais podem confundir o processo diagnóstico. O profissional atua em um contexto desafiador, pois se vê em meio a demandas que, muitas vezes, incluem questões de outra ordem além da orgânica. É fundamental que apure sua escuta para realizar um diagnóstico diferencial e o encaminhamento adequado, devendo ter cuidado ao se comunicar com o paciente que busca atendimento


This essay presents some reflections about the diagnostic process in the field of mental disorders with clinical symptoms, specifically, Panic Disorder (PD), and their impact on the Health System and the routine of the emergency services. It also points out some guidelines to receipt, management and referral of users who present this psychic-emotional suffering. Chest pain is one of the most common symptoms in the primary care emergency medical services. As a symptom that is present in both panic disorder and myocardial ischemia in coronary artery disease (CAD), many individuals affected by PD believe they are on the verge of a serious health problem, such as acute myocardial infarction. The case of PD is an example of the blurring of borders between the somatic and the psychic, as a mixture of physical and emotional symptoms can lead to confusion in the diagnostic process. Professionals act in a challenging context, with many demands being placed on them, which often include issues other than organic ones. It is essential that these professionals listen carefully, in order to make a differential diagnosis and proper referral, paying close attention when communicating with the patient who is seeking care


Subject(s)
Humans , Male , Female , Psychotherapy/methods , Panic Disorder/etiology , Coronary Disease , Diagnosis, Differential , Anxiety Disorders/diagnosis , Patient Care Team , Chest Pain/diagnosis , Health Systems , Sex Factors , Prevalence , Emergency Medical Services/methods , Obsessive-Compulsive Disorder/diagnosis
16.
RECIIS (Online) ; 12(3): 1-9, jul.-set. 2018.
Article in Portuguese | LILACS | ID: biblio-916723

ABSTRACT

O estudo aqui apresentado teve como objetivo analisar a população atendida por meio de teleeletrocardiografia realizada por serviço público que pode ser referência para outros em matéria de atendimento pré-hospitalar móvel de urgência no município de Porto Alegre. Trata-se de estudo transversal retrospectivo. Foram analisados 1.338 eletrocardiogramas realizados de setembro 2013 a agosto 2014 pelo Samu/POA, com laudo a distância feito no Hospital do Coração (HCor) em São Paulo. Utilizou-se a metodologia embasada nas diretrizes STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Em 115 (8,6%) desses tele-eletrocardiogramas, os pacientes foram diagnosticados com supradesnivelamento do segmento ST. Esta alteração eletrocardiográfica prevaleceu no gênero masculino (p = 0,012) com idade acima de 60 anos (p = 0,014). Dor torácica típica retroesternal foi mencionada por 314 homens (54,3%) e 726 mulheres (56,3%). Síncope foi relatada por 94 homens (16,3%) e 107 mulheres (14,2%). A dispneia foi um sintoma apontado por 47 homens (8,1%) e 84 mulheres (11,1%). Os resultados do estudo revelaram que alterações eletrocardiográficas sugestivas de SCA (Síndrome coronariana aguda) predominam em homens idosos; embora as mulheres solicitem o serviço de atendimento com mais frequência, o supradesnivelamento do segmento ST mostrou-se preponderante no gênero masculino. A dor torácica ter sido mencionada como o sintoma mais referido está em concordância com a literatura atual. =O conhecimento de nossa realidade pode auxiliar a elaboração de protocolos de serviço.(AU)


The study presented now had as objective to analyze the population attended by tele-electrocardiography in a public service that is a reference for mobile emergency medical service in the city of Porto Alegre, RS, Brazil. It is a retrospective cross-sectional study. We analyzed all electrocardiograms performed by Samu Porto Alegre, from September 2013 to August 2014, and their medical reports produced remotely by the Hospital do Coração (HCor), SP, Brazil. The study was based on the STROBE (Strengthening Reporting Observational Studies Epidemiology) guidelines. From tele-electrocardiograms, 115 (8.6%) patients were diagnosed having a ST-segment elevation. This electrocardiographic alteration was more prevalent in men (p = 0.012) who were 60 years old or over (p = 0.014). Among the symptoms expressed by patients, 314 (54.3%) men and 726 (56.3%) women felt typical retrosternal chest pain. Syncope was reported by 94 (16.3%) men and 107 (14.2%) women. Dyspnea was a symptom reported by 47 (8.1) men and 84 (11.1) women. The results of the study revealed that electrocardiographic alterations suggesting ACS (Acute Coronary Syndrome) are more prevalent in elderly men. Although women request more frequently the mobile emergency medical service, the ST-segment elevation was more prevalent in men. The chest pain was the most symptom mentioned, a result in agreement with the current literature. The knowledge of our reality can help the organization of service protocols.


El estudio presentado aquí ha tenido el objetivo de analizar la población atendida a través de tele-electrocardiografía, en servicio público que es referencia en atención pre-hospitalaria móvil de emergencia, en el municipio de Porto Alegre, RS, Brasil. Consiste en un estudio transversal retrospectivo. Fueron analizados electrocardiogramas realizados entre los meses de septiembre/2013 y agosto/2014 por el Samu/POA, con laudos emitidos a distancia por el Hospital del Corazón (HCor), SP, Brasil. El estudio es basado en las directrices del STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). En 115 (8,6%) de estos tele-electrocardiogramas, los pacientes fueron diagnosticados con supra desnivel del segmento ST. Esta alteración electrocardiográfica fue más predominante en el género masculino (p = 0,012), con edad superior a 60 años (p = 0,014%). Dolor en el pecho típíco retroesternal fue mencionado por 314 hombres (54,3%) y 726 mujeres (56,3%). Síncope fue relatado por 94 hombres (16,3%) y 107 mujeres (14,2%). La disnea fue un síntoma mencionado por 47 hombres (8,1%) y 84 mujeres (11,1%). Los resultados del estudio revelaron que alteraciones sugestivas de SCA (Síndrome coronario agudo) son más predominantes en los hombres con edad superior a 60 años; las mujeres suelen recurrir a el servicio de atención con más frecuencia, entretanto, el suspradesnivel del segmento ST ha prevalecido en el género masculino. El dolor en el pecho fue el síntoma más mencionado, hecho que coincide con la literatura actual. El conocimiento de nuestra realidad puede auxiliarnos a elaborar protocolos de servicio.


Subject(s)
Humans , Chest Pain/diagnosis , Telemedicine/methods , Electrocardiography/instrumentation , Emergency Medical Services , Acute Coronary Syndrome/diagnosis , Retrospective Studies , Ambulances
17.
Arq. bras. cardiol ; 110(1): 68-73, Jan. 2018. tab, graf
Article in English | LILACS | ID: biblio-888007

ABSTRACT

Abstract Introduction: Despite having higher sensitivity as compared to conventional troponins, sensitive troponins have lower specificity, mainly in patients with renal failure. Objective: Study aimed at assessing the sensitive troponin I levels in patients with chest pain, and relating them to the existence of significant coronary lesions. Methods: Retrospective, single-center, observational. This study included 991 patients divided into two groups: with (N = 681) and without (N = 310) significant coronary lesion. For posterior analysis, the patients were divided into two other groups: with (N = 184) and without (N = 807) chronic renal failure. The commercial ADVIA Centaur® TnI-Ultra assay (Siemens Healthcare Diagnostics) was used. The ROC curve analysis was performed to identify the sensitivity and specificity of the best cutoff point of troponin as a discriminator of the probability of significant coronary lesion. The associations were considered significant when p < 0.05. Results: The median age was 63 years, and 52% of the patients were of the male sex. The area under the ROC curve between the troponin levels and significant coronary lesions was 0.685 (95% CI: 0.65 - 0.72). In patients with or without renal failure, the areas under the ROC curve were 0.703 (95% CI: 0.66 - 0.74) and 0.608 (95% CI: 0.52 - 0.70), respectively. The best cutoff points to discriminate the presence of significant coronary lesion were: in the general population, 0.605 ng/dL (sensitivity, 63.4%; specificity, 67%); in patients without renal failure, 0.605 ng/dL (sensitivity, 62.7%; specificity, 71%); and in patients with chronic renal failure, 0.515 ng/dL (sensitivity, 80.6%; specificity, 42%). Conclusion: In patients with chest pain, sensitive troponin I showed a good correlation with significant coronary lesions when its level was greater than 0.605 ng/dL. In patients with chronic renal failure, a significant decrease in specificity was observed in the correlation of troponin levels and severe coronary lesions.


Resumo Fundamento: Apesar de apresentar maior sensibilidade em comparação às troponinas convencionais, as troponinas sensíveis apresentam menor especificidade, principalmente em pacientes com insuficiência renal. Objetivo: Avaliar os valores de troponina I sensível em pacientes com dor torácica, relacionando-os à presença de lesões coronarianas significativas. Métodos: Estudo retrospectivo, unicêntrico e observacional. Foram incluídos 991 pacientes, divididos em dois grupos: com (N = 681) ou sem lesão coronariana (N = 310). Para análise posterior, os pacientes foram separados em outros dois grupos: com (N = 184) ou sem insuficiência renal (N = 807). A troponina utilizada pertence ao kit comercial ADVIA Centaur® TnI-Ultra (Siemens Healthcare Diagnostics). A análise foi feita por curva ROC para identificar a sensibilidade e a especificidade do melhor ponto de corte da troponina como discriminador de probabilidade de lesão coronariana. As associações foram consideradas significativas quando p < 0,05. Resultados: Cerca de 52% dos pacientes eram do sexo masculino e a idade mediana da amostra foi de 63 anos. A área sob a curva ROC entre os valores de troponina e lesões coronarianas significativas foi de 0,685 (IC 95%: 0,65 - 0,72). Em pacientes sem e com insuficiência renal, as áreas sob a curva foram 0,703 (IC 95%: 0,66 - 0,74) e 0,608 (IC 95%: 0,52 - 0,70), respectivamente. Os melhores pontos de corte para discriminar a presença de lesão coronária significativa foram: 0,605 ng/dL (sensibilidade de 63,4%, especificidade de 67%) no grupo geral, 0,605 ng/dL (sensibilidade de 62,7% e especificidade de 71%) em pacientes sem insuficiência renal e 0,515 ng/dL (sensibilidade de 80,6% e especificidade de 42%) no grupo com insuficiência renal crônica. Conclusão: Na população avaliada de pacientes com dor torácica, a troponina I sensível apresentou boa correlação com lesões coronarianas significativas quando acima de 0,605 ng/dL. Em pacientes com insuficiência renal crônica, observamos uma queda importante de especificidade na correlação dos valores com lesões coronarianas graves.


Subject(s)
Humans , Male , Female , Middle Aged , Chest Pain/diagnosis , Troponin I/blood , Coronary Disease/diagnosis , Kidney Failure, Chronic/blood , Chest Pain/blood , Biomarkers/blood , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Coronary Disease/blood
19.
Rev. chil. enferm. respir ; 34(1): 55-58, 2018. graf
Article in Spanish | LILACS | ID: biblio-959408

ABSTRACT

Resumen El secuestro pulmonar es una malformación pulmonar rara, presentándose generalmente en edades tempranas. Se presenta mayoritariamente con neumonías e infecciones repetidas, distrés respiratorio y falla cardíaca; raramente en pacientes de mayor edad se presenta con hemoptisis y dolor torácico. En este artículo se describe el caso clínico de un paciente de 60 años de edad que se presenta con un infarto de un secuestro pulmonar y hemotórax.


Bronchopulmonary sequestration is a rare pulmonary malformation, usually occurring at an early age. It presents mainly with pneumonia and repetitive infections, respiratory distress and heart failure; rarely in aged patients presents with hemoptysis and chest pain. This article describes the clinical case of a 60-year-old male patient who presented an ischemic pulmonary sequestration and hemothorax.


Subject(s)
Humans , Male , Middle Aged , Chest Pain/etiology , Bronchopulmonary Sequestration/complications , Bronchopulmonary Sequestration/diagnostic imaging , Hemothorax , Chest Pain/diagnosis , Chest Pain/therapy , Radiography, Thoracic , Tomography, X-Ray Computed , Bronchopulmonary Sequestration/surgery , Hemoptysis
20.
Rev. gaúch. enferm ; 39: e20170131, 2018. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-960793

ABSTRACT

Resumo OBJETIVO Analisar associações entre discriminadores do Sistema de Triagem de Manchester e Diagnósticos de Enfermagem em pacientes adultos, classificados com prioridade clínica I (emergência) e II (muito urgente). MÉTODO Estudo transversal realizado na unidade de emergência do sul do Brasil, entre abril e agosto de 2014. Amostra de 219 pacientes. Os dados foram coletados no prontuário online e analisados estatisticamente, com teste exato de Fisher ou qui-quadrado. RESULTADOS Encontrou-se 16 discriminadores e 14 diagnósticos de enfermagem. Houve associação entre sete discriminadores e cinco diagnósticos de enfermagem do tipo foco no problema, dentre Dor precordial ou cardíaca com o diagnóstico Dor aguda. Também houve associação entre três discriminadores com quatro diagnósticos de enfermagem de risco, dentre Déficit neurológico agudo com o diagnóstico Risco de perfusão tissular cerebral ineficaz. CONCLUSÃO Existem associações significativas entre discriminadores do Sistema de Triagem de Manchester e diagnósticos de enfermagem mais frequentemente estabelecidos na Unidade de Emergência.


Resumen OBJETIVO Analizar asociaciones entre los discernidores del Sistema Triaje de Manchester y los Diagnósticos de Enfermería en pacientes adultos con prioridad clínica I (emergencia) y II (muy urgente). MÉTODO Estudio transversal realizado en la unidad de emergencia del sur de Brasil, entre abril y agosto de 2014, con la muestra de 219 pacientes. La colecta de datos fue realizada en el prontuario online de los pacientes. El análisis estadístico fue realizado con el uso del Test Exacto de Fisher o chi-cuadrado. RESULTADOS Fue identificado el uso de 16 discernidores y 14 diagnósticos de enfermería. Hubo una asociación entre siete discernidores y cinco diagnósticos de enfermería del tipo foco en el problema, entre estos Dolor precordial o cardíaca y Dolor agudo. También hubo asociación entre tres discernidores y cuatro diagnósticos de enfermería de riesgo, entre estos Déficit neurológico agudo con el diagnóstico Riesgo de perfusión tisular cerebral ineficaz. CONCLUSIÓN Existen asociaciones significativas entre los discernidores del Sistema Triaje de Manchester y los diagnósticos de enfermería más frecuente establecidos en la Unidad de Emergencia.


Abstract OBJECTIVE To analyze the association between Manchester Triage System flowchart discriminators and nursing diagnoses in adult patients classified as clinical priority I (emergency) and II (very urgent). METHOD Cross-sectional study conducted in an emergency department in southern Brazil between April and August 2014. The sample included 219 patients. Data were collected from online patient medical records and data analysis was performed using Fisher's exact test or the chi-square test. RESULTS 16 discriminators and 14 nursing diagnoses were identified. Associations were found between seven discriminators and five problem-focused nursing diagnoses, including the discriminator Cardiac pain and the diagnosis Acute pain. Three discriminators were associated with four risk nursing diagnoses, among these Acute neurological deficit with the diagnosis Risk of ineffective cerebral tissue perfusion. CONCLUSION Significant associations were found between Manchester Triage System discriminators and the nursing diagnoses most frequently established in the emergency department.


Subject(s)
Humans , Male , Female , Adult , Aged , Nursing Diagnosis , Triage , Emergency Nursing , Emergencies/nursing , Emergency Service, Hospital/organization & administration , Socioeconomic Factors , Chest Pain/diagnosis , Chest Pain/nursing , Chest Pain/epidemiology , Software Design , Brazil/epidemiology , Cross-Sectional Studies , Diagnosis-Related Groups , Dyspnea/diagnosis , Dyspnea/nursing , Dyspnea/epidemiology , Emergencies/epidemiology , Electronic Health Records , Hemorrhage/diagnosis , Hemorrhage/nursing , Hemorrhage/epidemiology , Hypoxia/diagnosis , Hypoxia/nursing , Hypoxia/epidemiology , Middle Aged , Nursing Care
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