Manual de procesos y procedimientos misionales para proporcionar atenciones de salud integrales en emergencias médicas prehospitalarias / Manual of missionary processes and procedures to provide comprehensive health care in pre-hospital medical emergencies

El presente manual de procesos y procedimientos documenta las principales actividades que se brindan en la atención de emergencia prehospitalaria como parte del proceso de atención integral e integrada a la persona en el curso de vida, desde el Sistema de Emergencias Médicas. Permite integrar las actividades y tareas de manera ágil, para el logro de la prestación de servicios con calidad, facilitando el cumplimiento de las normativas por ciclo de vida vigentes en el Ministerio de Salud, así como la armonización con la sistematización y uso de herramientas tecnológicas que sea necesario implementar para volver más eficaz el trabajo del talento humano

This manual of processes and procedures documents the main activities provided in pre-hospital emergency care as part of the process of comprehensive and integrated care for the person in the course of life, from the Medical Emergency System. It allows activities and tasks to be integrated in an agile manner, to achieve the provision of quality services, facilitating compliance with the life cycle regulations in force in the Ministry of Health, as well as harmonization with the systematization and use of technological tools. that needs to be implemented to make the work of human talent more effective

Lineamientos técnicos para el uso de uniforme y vestimenta de los trabajadores de la Dirección del Sistema de Emergencias Médicas / Technical guidelines for the use of uniform and clothing for workers of the Directorate of the Medical Emergency System

La Dirección del Sistema de Emergencias Médicas establece los lineamientos para el uso de vestimenta y uniforme del personal, fortaleciendo la identidad institucional y la imagen profesional antes los pacientes y el público en general. Este lineamiento tiene como finalidad la prevención y el control de enfermedades en el entorno laboral, promoviendo el uso adecuado del uniforme y vestimenta como elemento de protección y seguridad ante diversas amenazas como fluidos y sustancias químicas. El personal de la Dirección del Sistema de Emergencias Médicas tiene la responsabilidad de vestir adecuadamente, llevar un uniforme limpio y cuidado en el desarrollo de sus funciones, dando cumplimiento a las disposiciones establecidas en el presente lineamiento

The Directorate of the Medical Emergency System establishes the guidelines for the use of clothing and uniforms for staff, strengthening the institutional identity and professional image among patients and the general public. The purpose of this guideline is the prevention and control of diseases in the work environment, promoting the appropriate use of uniforms and clothing as an element of protection and safety against various threats such as fluids and chemical substances. The personnel of the Directorate of the Medical Emergency System have the responsibility of dressing appropriately, wearing a clean and careful uniform in the development of their functions, complying with the provisions established in this guideline

Fortalecimiento de la vigilancia epidemiológica en salud pública e inteligencia sanitaria. Hoja de ruta / Strengthening epidemiological surveillance in public health and health intelligence. Roadmap

La presente publicación, desarrollado en hoja de ruta, establece las líneas de trabajo que contribuyen a optimizar la detección, prevención y respuesta del Ministerio de Salud (MINSA) ante emergencias y otros eventos de importancia para la salud pública. Asimismo, las pautas que contribuyan a la planificación estratégica y la toma de decisiones informadas en el ámbito de salud pública, mejorando la capacidad del Ministerio de Salud y fortalecer el sistema nacional de vigilancia epidemiológica en salud pública e inteligencia sanitaria

Manual de organización y funciones de la Dirección del Sistema de Emergencias Médicas / Organization and functions manual of the Management System Medical Emergencies

El presente manual de organización y funciones, fue adecuado como un instrumento técnico que permita agilizar los procesos institucionales, evitando la duplicidad de funciones, delimitando las responsabilidades y estableciendo los canales de comunicación e información, contribuyendo además a la transparencia en la rendición de cuentas. Así como también, detalla la dependencia jerárquica, objetivos, estructura interna, funciones y relaciones de trabajo, asignadas a cada una de las unidades organizativas que conforman la Dirección del Sistema de Emergencias Médicas. Además, el manual permite el eficiente y oportuno desarrollo de todas las actividades que realizan las unidades que conforman la Dirección, así como el desarrollo de sus funciones de manera integrada, eficiente y oportuna

This organization and functions manual was suitable as a technical instrument that allows streamlining institutional processes, avoiding duplication of functions, delimiting responsibilities and establishing communication and information channels, also contributing to transparency in accountability. As well as, it details the hierarchical dependency, objectives, internal structure, functions and work relationships, assigned to each of the organizational units that make up the Directorate of the Medical Emergency System. Furthermore, the manual allows the efficient and timely development of all the activities carried out by the units that make up the Directorate, as well as the development of their functions in an integrated, efficient and timely manner

Cuerpo extraño rectal en emergencias: dos casos clínicos / Rectal foreign body in emergencies: two clinical cases

INTRODUCTION: Rectal foreign body (RFB) poses a challenge for emergency surgeons in diagnosis. Clinical suspicion is essential, along with imaging support, which will allow the most effective removal treatment to be carried out depending on the case. OBJECTIVE: To describe the procedures for an anorectal pathology commonly present in emergency services. CLINICAL CASES: Two cases are reported of men who were admitted to the emergency room with a self-inserted RFB (carrot and screwdriver). Upon admission, they gave a confusing anamnesis, and images were taken to confirm their diagnosis. They required a laparotomy to assist in its transanal removal in the first case and a protective loop colostomy in the second. DISCUSSION: RFB consultation frequently occurs in male patients who have inserted objects for sexual self-stimulation. Because of the shame and desire to conceal these cases, these patients become "special" patients. Literature reviews and case studies on the subject in particular are scarce.

INTRODUCCIÓN: El cuerpo extraño rectal (CER) plantea al cirujano de urgencias un desafío en el diagnóstico, su sospecha clínica es fundamental junto con el apoyo de imágenes, lo que permitirá realizar el tratamiento de extracción más efectivo según sea el caso. OBJETIVO: Describir los procedimientos para una patología ano rectal presente comúnmente en los servicios de urgencia. CASOS CLÍNICOS: Se reportan dos casos de hombres que ingresaron a emergencias con un CER auto insertado (zanahoria y destornillador), entregando a su ingreso una confusa anamnesis, tomándose imágenes que certificaron su diagnóstico y que requirieron una laparotomía para ayudar en su extracción transanal en el primer caso y una colostomía de protección en asa en el segundo. DISCUSIÓN: La consulta por CER se presenta frecuentemente en pacientes hombres que han introducido objetos por autoestimulación sexual. Por la vergüenza y deseo de ocultamiento en estos casos, convierte a estos pacientes, en pacientes "especiales". Las revisiones bibliográficas y la casuística sobre el tema en particular son escasas.

Urgent need for reform: addressing the inadequate emergency care for headache patients under the Manchester Triage System

Abstract The Manchester Triage System (MTS) has made a significant impact on emergency care globally, effectively prioritizing patient care. Its widespread adoption has improved workflow and safety in emergency settings. However, it faces challenges in handling severe headaches, such as migraine and cluster headache, which require quick, decisive care.MTS classifies urgency primarily based on symptoms, which can underestimate the severity of conditions like migraine, where symptoms are less apparent but critically debilitating. On the other hand, it can lead to misclassifications, where serious conditions are not given the priority they require, resulting in longer wait times and potentially worsening outcomes. For example, cluster headache, known for its extreme pain, may not receive immediate care, significantly affecting patient well-being.Moreover, MTS often overlooks psychological factors associated with migraine sufferers, such as anxiety, which can exacerbate the condition because of a substantial wait for the patient to be seen by the physician. Thus, a more holistic approach is needed to assess these patients accurately. Given these challenges, refining the MTS to better recognize and prioritize patients with headache is crucial. In conclusion, while MTS has enhanced emergency care globally, its approach to headache emergencies needs careful reevaluation to ensure timely and effective treatment, reflecting the complex needs of these patients and improving overall emergency care outcomes.

Cuidados paliativos na emergência: desafios e atuação da enfermagem / Palliative care in emergency: challenges and nursing performance / Cuidados paliativos en urgencias: desafíos y desempeño de enfermería

Objetivo: Investigar na literatura científica, estudos que reportem os fatores que desafiam a inserção dos Cuidados Paliativos no âmbito da urgência e emergência, e o papel da enfermagem nesse cenário. Métodos: Trata-se de uma revisão integrativa da literatura. A busca dos estudos foi realizada entre os meses de novembro de 2020 e janeiro de 2021, em sete bases de dados: PubMed, Medline, ScienceDirect, LILACS, Scopus, Scielo e IBECS. Resultados: De modo geral, observou-se que os principais desafios para a inserção dos Cuidados Paliativos estão ligados ao fato das unidades de urgência serem ambientes agitados, que apresentam grande fluxo de pacientes, proporcionando pouca ou nenhuma privacidade, requerendo da equipe de enfermagem uma visão holística. Conclusão: É possível inferir que existem vários problemas que circundam a assistência para pacientes em Cuidados Paliativos no contexto da emergência. Enquanto a assistência de enfermagem, essa não se pauta somente para os cuidados ao fim da vida. (AU)

Objective: Investigar in the scientific literature, studies that report the factors that challenge the insertion of Paliativos Cuidados in the context of urgency and emergency, and the role of nursing in this scenario. Methods: This is an integrative review of the literature. The study was searched between November 2020 and January 2021, in seven databases: PubMed, Medline, ScienceDirect, LILACS, Scopus, Scielo and IBECS. Results: In general, it was observed that the main challenges for the insertion of Paliativos Care are linked to the fact that emergency units are agitated environments, which present a large flow of patients, providing little or no privacy, requiring a holistic view of the nursing team. Conclusion: It is possible to infer that there are several problems that surround care for patients in Palliative Care in the context of the emergency. While nursing care, this is not only based on end-of-life care. (AU)

Objetivo: Investigar en la literatura científica, estudios que reportan los factores que desafían la inserción de Paliativos Cuidados en el contexto de urgencia y emergencia, y el rol de la enfermería en este escenario. Métodos: Se trata de una revisión integradora de la literatura. El estudio se realizó entre noviembre de 2020 y enero de 2021, en sete bases de datos: PubMed, Medline, ScienceDirect, LILACS, Scopus, Scielo e IBECS. Resultados: En general, se observó que los principales desafíos para la inserción de Paliativos Care están vinculados al hecho de que las unidades de emergencia son ambientes agitados, que presentan un gran flujo de pacientes, proporcionando poca o ninguna privacidad, requiriendo una visión holística del equipo de enfermería. Conclusión: Es posible inferir que existen varios problemas que rodean la atención a los pacientes en Cuidados Paliativos en el contexto de la emergencia. Mientras que la atención de enfermería, esto no se basa sólo en la atención al final de la vida. (AU)

Plantão psicológico em serviço de psicologia de universidade estadual: relato de experiência / Psychological duty in a state university psychology service: experience report / Guardia psicológica en un servicio de psicología de la universidad del estado: informe de experiencia

INTRODUÇÃO: O Plantão Psicológico é uma modalidade de intervenção psicológica de caráter emergencial, que oferece acolhimento para pessoas que necessitem de auxílio. Pode ser implantado em diversos locais, como clínicas-escola, hospitais e serviços de assistência social. O presente artigo se justifica pela importância da temática e pela quantidade reduzida de trabalhos científicos sobre a mesma. OBJETIVO: Relatar a experiência de dois psicólogos que participaram de um curso de extensão em uma universidade pública da região nordeste. MÉTODO: Trata-se de um relato de experiência, de caráter qualitativo, baseado na descrição da prática dos autores no curso de extensão, entre setembro e dezembro de 2023, e na discussão dessas experiências a partir de artigos encontrados na literatura sobre Plantão Psicológico. RESULTADOS E DISCUSSÃO: Foram percebidas diversas contribuições do plantão na formação dos plantonistas, sobretudo na possibilidade de ofertar um serviço de saúde mental mais contextualizado para as necessidades psicológicas e emocionais da comunidade. Uma das principais dificuldades vivenciadas foi a ansiedade sentida pelos plantonistas diante dessa modalidade de atendimento que diferia, substancialmente, da psicoterapia. Destaca-se também a importância da supervisão para o aperfeiçoamento contínuo dos profissionais, sendo uma forma de contribuir para o manejo e raciocínio clínico destes. CONSIDERAÇÕES FINAIS: Essa prática possibilitou pensar numa atuação não tradicional, fornecendo uma prática que não se paute no modelo curativista. Ressalta-se a importância de outros estudos sobre essa modalidade, sobretudo a partir de outras abordagens e âmbitos de atuação.

INTRODUCTION: Psychological Duty is a type of psychological intervention of an emergency nature, which offers support to people who need help. It can be implemented in various locations, such as teaching clinics, hospitals and social assistance services. This article is justified by the importance of the topic and the small amount of scientific work on it. OBJECTIVE: Report the experience of two psychologists who participated in an extension course at a public university in the northeast region. METHOD: This is an experience report, of a qualitative nature, based on the description of the authors' practice in the extension course, between September and December 2023, and on the discussion of these experiences based on articles found in the literature on Psychological Duty. RESULTS AND DISCUSSION: Several contributions were perceived in the training of those on duty, especially in the possibility of offering a mental health service that is more contextualized to the psychological and emotional needs of the community. One of the main difficulties experienced was the anxiety felt during this type of care, which differs, advantageously, from psychotherapy. The importance of supervision for the continuous improvement of professionals is also highlighted, as it is a way of contributing to their management and clinical judgment. FINAL CONSIDERATIONS: This practice made it possible to think about a non-traditional approach, providing a practice that is not based on the curative model. The importance of other studies on this modality is highlighted, especially from other approaches and areas of activity.

INTRODUCCIÓN: La Guardia Psicológica es un tipo de intervención psicológica de carácter de emergencia, que ofrece apoyo a las personas que necesitan ayuda. Puede implementarse en diversos lugares, como clínicas docentes, hospitales y servicios de asistencia social. Este artículo se justifica por la importancia del tema y el escaso trabajo científico al respecto. OBJETIVO: Relatar la experiencia de dos psicólogos que participaron de un curso de extensión en una universidad pública de la región noreste. MÉTODO: Es un informe de experiencia, de carácter cualitativo, basado en la descripción de la práctica en el curso de extensión, entre septiembre y diciembre de 2023, y en la discusión de estas experiencias a partir de artículos encontrados en la literatura. RESULTADOS Y DISCUSIÓN: Se percibieron varias contribuciones del servicio de guardia para la formación de los guardias, especialmente en la posibilidad de ofrecer un servicio de salud mental más contextualizado a las necesidades psicológicas y emocionales de la comunidad. Una de las principales dificultades vividas fue la ansiedad que sentían los funcionarios ante este tipo de atención, que difería sustancialmente de la psicoterapia. También se destaca la importancia de la supervisión para la mejora continua de los profesionales, ya que es una forma de contribuir a su gestión y razonamiento clínico. CONSIDERACIONES FINALES: Esta práctica permitió pensar en un enfoque no tradicional, brindando una práctica que no se basa en el modelo curativo. Se destaca la importancia de otros estudios sobre esta modalidad desde otros enfoques y áreas de actividad.

Caracterización de los pacientes con edema agudo del pulmón en el servicio de urgencias / Characterization of patients in the emergency services with acute pulmonary edema

Introducción: El edema agudo del pulmón es una enfermedad frecuente en los pacientes que se presentan en los servicios de urgencias. Objetivo: Caracterizar a los pacientes con edema agudo del pulmón en el servicio de urgencias. Método: Se realizó un estudio descriptivo y transversal en 37 pacientes con edema agudo del pulmón, que asistieron al cuerpo de guardia del Hospital Clinicoquirúrgico Docente Dr. Joaquín Castillo Duany de Santiago de Cuba, desde enero a noviembre de 2019. Las variables estudiadas fueron edad, sexo, estado al egreso y uso de la ventilación no invasiva. Resultados: No hubo diferencias entre ambos sexos, predominaron los mayores de 60 años, que padecían de hipertensión arterial. Se comprobó el poco uso de la ventilación no invasiva o invasiva. Conclusiones: El edema agudo del pulmón es más frecuente en pacientes mayores de 60 años, sin distinción de sexo. La mayoría lo presenta relacionado con la hipertensión arterial y existe un escaso uso de la ventilación no invasiva en estos casos.

Introduction: Acute pulmonary edema is a frequent disease among patients in emergency services. Objective: To characterize patients with acute pulmonary edema who attended the emergency services. Methods: A descriptive and cross-sectional study of 37 patients with acute pulmonary edema who attended the emergency services of Dr. Joaquín Castillo Duany Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out, from January to November 2019. The studied variables were age, sex, alive or dead when discharged, noninvasive ventilation usage. Results: There were no differences between the sexes; there was a prevalence of patients older than 60 years of age, who suffered from hypertension. It was demonstrated low noninvasive or invasive ventilation usage. Conclusions: Acute pulmonary edema is more frequent among patients older than 60 years of age in both sexes. Most of the patients suffered from hypertension and there was a deficit in the implementation of noninvasive ventilation in these cases.

Emerging Role of Mast Cells as Biological Markers in the Pathogenesis of Infectious Diseases and their Projection in Health Emergencies / Rol Emergente de los Mastocitos como Marcadores Biológicos en la Patogenia de Enfermedades Infecciosas y su Proyección en Emergencias Sanitarias

SUMMARY: Mast cells (MC) are cells of the immune system that regulate cell and tissue homeostasis, are found in low numbers, have an intact plasma membrane, and a cytoplasm with a wide variety of inflammatory chemical mediators. The activation or degranulation of mast cells implies the release of these chemical mediators (interleukins, cytokines, and more), causing tissue actions ranging from the activation of metalloproteinases to the development of anaphylactic hypersensitivity of different degrees, alterations in vascular permeability, and loss of cell homeostasis. This behavior would allow them to act as sentinels responding to pathophysiological processes. During the COVID-19 pandemic, in positive human patients, the available literature reports the presence and degranulation of mast cells in a generalized manner, especially in the respiratory tract. This study aimed to analyze the emerging role of MCs in the pathogenesis of diseases and their projection as biological markers in the treatment of diseases or pandemics. The analysis of human biopsies showed that MCs are observed as cells with diameters between 8 to 20 µm, and in inflamed tissues, degranulation of MCs is observed. The action of MCs degranulation was related to different inflammatory processes of autoimmune diseases. It is concluded that the potential of MC as therapeutic targets and biomarkers could raise new pharmacological targets, as supportive therapy, and possibly of great help in the treatment of future emerging pandemics such as the current monkeypox.

Los mastocitos (MC) son células del sistema inmune que regulan la homeostasis celular y tisular, se encuentran en escasas cantidades, presentan una membrana plasmática íntegra, y un citoplasma con una amplia variedad de mediadores químicos. La activación o degranulación de los mastocitos implica la liberación de estos mediadores químicos (interleuquinas, citoquina y más), provocando acciones tisulares que van desde la activación de metaloproteinasas hasta el desarrollo de hipersensibilidad anafiláctica de distinto grado, provocando la pérdida de la homeostasis celular. Durante la pandemia de la COVID-19, en pacientes humanos positivos, se informa recurrentemente la presencia y degranulación de mastocitos de manera generalizada sobre todo en las vías respiratorias. El análisis de la degranulación de los MCs podría proporcionar información que podría utilizarse en el desarrollo de tratamientos preventivos contra infecciones virales, bacterianas u otros patógenos. Este comportamiento les permitiría actuar como centinelas en respuesta a procesos fisiopatológicos. El objetivo de este trabajo fue analizar el rol emergente de los MCs en la patogenia de enfermedades y su proyección como marcadores biológicos en el tratamiento de enfermedades o pandemias. En análisis de biopsias humanas se muestran que MCs se observan como células con diámetros de entre 8 a 20 µm, en tejidos inflamados se observa degranulación de MCs. Se relacionó el accionar de degranulación de los MCs en diferentes procesos inflamatorios de enfermedades autoinmunes. Se concluye que el potencial de MC como dianas terapéuticas y biomarcadores podrían plantear nuevos objetivos farmacológicos, como terapia de apoyo, y posiblemente de gran ayuda en el tratamiento de futuras pandemias emergentes como la actual viruela del mono.

Paciente con enfermedad descompresiva del oído interno / Patient with inner ear decompression sickness

Introducción: La enfermedad descompresiva es un síndrome clínico complejo causado por la sobresaturación de gases respiratorios en la sangre y los tejidos, después de una reducción abrupta de la presión ambiental, que puede presentarse como parte de los accidentes de buceo. Dada su baja prevalencia se da a conocer una de sus formas de presentación en los servicios de urgencias, que requiere rapidez en el diagnóstico y conducta terapéutica inmediata. Objetivo: Presentar un caso grave de enfermedad descompresiva del oído interno. Caso clínico: Paciente masculino de 71 años de edad, buzo aficionado y antecedente de un accidente vascular encefálico isquémico hace aproximadamente 1 año. Realizó inmersiones, luego de las cuales comenzó a presentar síntomas como mareos, náuseas, vómitos copiosos, inestabilidad para la marcha y manifestaciones sensitivas en la cara. Horas después de ser evaluado en centro médico de urgencia, sin diagnóstico específico, se trasladó al cuerpo de guardia del hospital, para su valoración por el especialista en medicina subacuática. Conclusiones: La orientación diagnóstica de un paciente con enfermedad descompresiva requiere derivación urgente a un centro de tratamiento de enfermedades disbáricas(AU)

Introduction: Decompression illness is a complex clinical syndrome caused by supersaturation of respiratory gases in the blood and tissues, after an abrupt reduction in environmental pressure, which can occur as part of diving accidents. Given its low prevalence, one of its forms of presentation is revealed in emergency services, which requires speed in diagnosis and immediate therapeutic conduct. Objective: To present a severe case of decompressive disease of the inner ear. Clinical case: 71-year-old male patient, amateur diver, with a history of an ischemic stroke approximately 1 year ago. He performed dives, after which he began to present symptoms such as dizziness, nausea, copious vomiting, unsteadiness in walking, and sensitive manifestations on the face. Hours after being evaluated at the emergency medical center, without a specific diagnosis, he was transferred to the hospital's emergency room, for evaluation by the underwater medicine specialist. Conclusions: The diagnostic orientation of a patient with decompression illness requires urgent referral to a center for the treatment of dysbaric diseases(AU)

Alcance para Colombia de la declaración de la World Society of Emergency Surgery 2022 sobre el entrenamiento en cirugía digestiva mínimamente invasiva de emergencia / Scope for Colombia of the World Society of Emergency Surgery 2022 declaration on training in emergency minimally invasive digestive surgery

Introducción. El currículo para la formación del cirujano general exige precisión, ajuste al contexto y factibilidad. En 2022, la World Society of Emergency Surgery formuló cinco declaraciones sobre el entrenamiento en cirugía digestiva mínimamente invasiva de emergencia que puede contribuir a estos propósitos. El objetivo del presente artículo fue examinar el alcance de estas declaraciones para la educación quirúrgica en Colombia. Métodos. Se analizó desde una posición crítica y reflexiva el alcance y limitaciones para Colombia de cada una de las declaraciones de la World Society of Emergency Surgery, con base en la evidencia empírica publicada durante las últimas dos décadas en revistas indexadas nacionales e internacionales. Resultados. La evidencia empírica producida en Colombia durante el presente siglo permite identificar que el país cuenta con fundamentos del currículo nacional en cirugía general, formulado por la División de Educación de la Asociación Colombiana de Cirugía en 2021; un sistema de acreditación de la educación superior; un modelo de aseguramiento universal en salud; infraestructura tecnológica y condiciones institucionales que pueden facilitar la adopción exitosa de dichas declaraciones para el entrenamiento de los futuros cirujanos en cirugía digestiva mínimamente invasiva de emergencia. No obstante, su implementación requiere esfuerzos mayores e inversión en materia de simulación quirúrgica, cooperación institucional y fortalecimiento del sistema de recertificación profesional. Conclusión. La educación quirúrgica colombiana está en capacidad de cumplir con las declaraciones de la World Society of Emergency Surgery en materia de entrenamiento en cirugía digestiva mínimamente invasiva de emergencia.

Introduction. The general surgeon training curriculum requires precision, contextual fit, and feasibility. In 2022, the World Society of Emergency Surgery formulated five statements on training in emergency minimally invasive digestive surgery, which can contribute to these purposes. This article examines the scope of these declarations for surgical education in Colombia. Methods. The scope and limitations for Colombia of each of the statements of the World Society of Emergency Surgery were analysed from a critical and reflective position, based on empirical evidence published during the last two decades in national and international indexed journals. Results. The empirical evidence produced in Colombia during this century allows us to identify that the country has the foundations of the national curriculum in general surgery, formulated by the Education Division of the Colombian Association of Surgery in 2021; a higher education accreditation system; a universal health insurance model; technological infrastructure, and institutional conditions that can facilitate the successful adoption of said statements for the training of future surgeons in emergency minimally invasive digestive surgery. However, its implementation requires greater efforts and investment in surgical simulation, institutional cooperation, and strengthening of the professional recertification system. Conclusion. Colombian surgical education is able to comply with the declarations of the World Society of Emergency Surgery regarding training in emergency minimally invasive digestive surgery.

The Lagos state COVID-19 think-tank, a potential framework for decision-making in a pandemic Era

Lagos state remains the epicenter of COVID­19 infection in Nigeria. To facilitate the emergency preparedness and response to COVID­19, the State Governor and Incident Commander constituted a Think Tank comprising 13 experts from various disciplines committed to the health of the public. The Think Tank assisted the government with decision­making strategies and supported the emergency operation centre (EOC) for the COVID­19 response. Their main achievements were developing frameworks for decision­making and strategies for phased easing of the State­wide lockdown. The challenges encountered were that it was often viewed as a parallel structure to the EOC and separated from the traditional civil service structure; causing some reluctance to implement ideas generated by the Think Tank. Nevertheless, the Think Tank played an important role during the COVID­19 pandemic; the lessons learned might help other states and resource­limited countries wishing to adopt this approach to emergency response.

Determinants of access to emergency surgery according to resident doctors: A cross-sectional study at a teaching hospital in Ibadan, Nigeria

Background Morbidity and mortality following emergency surgeries can be reduced with timely access to emergency surgery and five billion people globally, lack access to essential surgery. Data on the determinants of these are still lacking. Objectives We studied resident doctors' perspectives of the patient-, healthcare-giver-, and health-institution-related determinants of access to emergency surgery at the University College Hospital, Ibadan, Nigeria. Methodology This self-administered, questionnaire-based, cross-sectional survey involved eighty-five resident doctors; recruited using systematic random sampling. Ethical approval (UI/EC/20/0318) and prospective registration (NCT04487496) were obtained. Results Major patient-related sources of delays included financial constraints (97.7%), patient's consent (78.8%), guardian's consent (74.1%) and diagnosis denial (70.6%). Anaesthetists (65.9%) caused and surgeons (61.2%) reduced delays. The healthcare-giver factors were provision of blood (84.7%), optimization of patient (83.5%), unavailable theatre space (82.4%), anaesthetic personnel fatigue (67.1%), surgical personnel fatigue (43.5%) and time-to-diagnosis (58.8%). Diagnostic delays were mostly from investigations (97.6%) and missed diagnosis (47.1%). Unavailable bedspace (82.4%), delays in arrival (82.4%) and entry (74.1%) into the theatre were major health institution challenges. Establishing diagnosis was delayed by payment for (96.5%) and doing (88.2%) diagnostic investigations, and time-to-review by specialist team (80.0%). Arrival in theatre was affected by theatre trolley conveying patient (70.6%), pre-anaesthesia review (70.6%) and pre-operative nursing logistics (64.7%). Entry into the suite depended on payment/payment deferment (87.06%) and suites being unavailable (75.3%). Conclusion patient, and the surgical procedure. The patient factors were poor finances, diagnosis denial and giving of consent for surgery. We encourage (recommend) physician-run point-of-care diagnostics in emergency rooms (ER), with improved health insurance coverage, ER bedspace, and personnel (surgical and anaesthesiological).

Obstetric HDU: a supply-based alternative for ICU care in a low-income setting: a descriptive study

Background The demand of ICU care for obstetric patients is rising in low-income settings, where there is low ICU-bed capacity. Introduction of obstetric High-dependency unit (HDU) has been described as an effective strategy to bridge this gap in resource-restricted settings. Objective: To describe the clinical characteristic and maternal outcomes of obstetric patients admitted to the first obstetric HDU in Ethiopia. Study design: This was a descriptive study on clinical characteristics and maternal outcomes of obstetric patients admitted to obstetric HDU over one year (October 2021 to September 2022) at St. Paul's Hospital Millennium Medical College (Ethiopia). Data were collected retrospectively through reviewing patients' medical records using a data extraction format with KOBO collect tool. Data were analyzed using SPSS version 23 and simple descriptive statistics were employed. Proportions and percentages were used to present the results. RESULTS: After excluding 18 patients who did not meet the inclusion criteria, a total of 355 obstetric patients who were admitted to an obstetric HDU were included in the final analysis. Among these all-obstetric patients admitted to obstetric HDU, pre-eclampsia/ eclampsia (82/355, 23.1%) and postpartum hemorrhage (66/355, 18.6%) were the most frequent reasons for admission to the HDU whereas cardiac disease constituted 14.1% (50/355) of the indication for admissions to the unit. Majority (318/355, 89.6%) from the study participants were transferred to other wards with im-provement, while 37(7.9%) deteriorated with 9(2.53%) of them died. Septic shock (6/9, 66.6%) and DIC (2/9, 22.2%) were the leading causes of death in the HDU. Conclusion: Findings of our study demonstrate that opening HDU in a low-income setting is feasible and results in favorable maternal outcomes. Introduction of obstetric HDU in low-income settings is an effective intervention to reduce severe maternal morbidity and mortality associated with low ICU-bed capacity in those settings.

Managing gender-based violence patients: implications for the practices and attitudes of emergency medical care providers

Introduction: gender-based violence (GBV) is one of the most widespread human rights abuses in the world. Although women and girls are often the targets of GBV, men and boys can also suffer from it. Therefore, this study investigated the practices and attitudes of Emergency Medical Care Providers (EMCPs) in managing GBV patients. Methods: this study applied self-administered questionnaires and analyzed them quantitatively. The information was gathered from 130 qualified and practicing EMCPs in Bloemfontein working within the public sector of Emergency Medical Service (EMS). Results: the results showed that a significant association was observed among socio-demographic characteristics such as gender, educational status, marital status, and how EMCPs managed GBV cases. On the other hand, a non-significant association was observed among age, year of experience, and how EMCPs managed GBV cases. Furthermore, a significant association was observed among the beliefs of the society, attitudes of the environment towards abuse victims, and exaggeration of suspected GBV patients influences the management of GBV patients. Conclusion: the study concluded that while the current EMCPs in Bloemfontein, Free State South Africa, are relatively educated, there is still room for improvement to cover the growing demands of the job to be done for GBV cases.

Healthcare professionals perceptions towards the determinants of effective emergency health care services in public health centres of Addis Ababa, Ethiopia

Introduction: Emergency healthcare services enable early detection and life-saving interventions for time sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023. Methods: A facility-based cross-sectional study was conducted at public health centers in Addis Ababa with a sample of 422 study participants. Study participants were selected using simple random sampling techniques. To identify factors associated with the outcome variable, bi-variable and multi-variable logistic regression analyses were conducted. Variables having a p-value less than 0.05 in multi-variable logistic regression analysis were declared determinants of positive perception towards emergency medical services effectiveness. Results: Among the study participants, 76.3 % (95 % CI: 72.3, 80.6) had a positive perception towards the public health centers effectiveness in providing emergency healthcare services. Moreover, training (AOR: 4.05; 95 % CI: 1.97, 8.32), ICT service implementation (AOR: 6.55; 95 % CI: 3.37, 12.73), resource availability in the emergency department (AOR: 5.07; 95 % CI: 2.51, 10.25), and management support (AOR: 3.22; 95 % CI: 1.66, 6.25) were determinant factors associated with the perception of effectiveness in emergency medical care services. Conclusion: Nearly three-fourths of healthcare providers in Addis Ababa perceived that the emergency healthcare services were effective. Furthermore, training on patient service delivery, ICT service implementation, avail ability of resources in emergency departments, and management support were independent determinants of positive perception towards effective emergency healthcare services.

Processo de enfermagem na urgência e emergência: desenvolvimento de instrumento / Nursing process in urgency and emergency: instrument development / Proceso de enfermería en urgencia y emergencia: desarrollo de instrumentos

Objetivo:realizar a construção de um instrumento específico para o Processo de Enfermagem (PE) destinado aos contextos de urgência e emergência. Método:trata-se de revisão integrativa com o intuito de gerar um embasamento sólido para o desenvolvimento do instrumento de Processo de Enfermagem (PE) voltado para o ambiente de urgência e emergência, sendo a etapa do desenvolvimento do instrumento, um estudo metodológico. Resultados:7 artigos foram selecionados para compor a revisão integrativa e utilizados como base para construção do instrumento de Processo de Enfermagem. Conclusão:Conclui-se que o instrumento sobre processo de enfermagem na urgência e emergência construído auxilia a lacuna evidenciada da falta de padronização e planejamento da assistência neste contexto.

Objective:to develop a specific tool for the Nursing Process (NP) aimed at urgent and emergency care settings. Method:This is an integrative review with the aim of generating a solid basis for the development of the Nursing Process (NP) instrument aimed at the emergency and urgency environment, with the instrument development stage being a methodological study. Results:7 articles were selected to form the integrative review and were used as the basis for the construction of the Nursing Process tool. Conclusion:It is concluded that the instrument on the nursing process in urgency and emergency built helps the gap evidenced by the lack of standardization and planning of care in this context.

Objetivo:realizar la construcción de una herramienta específica para el Proceso de Enfermería (PE) destinada a contextos de urgencia y emergencia. Método:Se trata de una revisión integradora con el objetivo de generar una base sólida para el desarrollo del instrumento Proceso de Enfermería (PE) dirigido al entorno de emergencia y urgencia, siendo la etapa de desarrollo del instrumento un estudio metodológico. Resultados:se seleccionaron 7 artículos para componer la revisión integradora y se utilizaron como base para la construcción del instrumento del Proceso de Enfermería. Conclusión:Se concluye que el instrumento sobre el proceso de enfermería en urgencia y emergencia construido ayuda a superar la brecha evidenciada por la falta de estandarización y planificación de los cuidados en este contexto.

Trauma penetrante de cuello con sección de membrana tirohioidea: presentación de caso / Penetrating neck trauma with section of the thyrohyoid membrane: case report / Trauma penetrante no pescoço com secção da membrana tireo-hióidea: apresentação do caso

El trauma penetrante de cuello es una emergencia que constituye un reto al cirujano desde la evaluación inicial hasta su manejo definitivo. Se presenta el caso de una paciente femenina de 24 años, con lesión penetrante transversal de cuello, con salida de aire por el sitio de la lesión junto a sangrado activo, requiriendo en el manejo inicial de vía aérea definitiva y control de hemorragia; ingreso quirúrgico de emergencia. Con hallazgos de: sección de membrana tiroidea a nivel del borde superior de cartílago tiroides, epiglotis y ambas venas yugulares anteriores. La conducta fue reparación por planos, desde lo profundo a la superficie. La experiencia adquirida en el manejo del presente caso permite resaltar que, seguir los lineamientos del soporte vital junto a la atención definitiva en un tiempo menor de 24 horas ante un trauma penetrante de cuello incrementa la probabilidad de éxito en el manejo y evolución.

Penetrating neck trauma is an emergency that challenges the surgeon from initial evaluation to definitive management. The case of a 24-year-old female patient with a transverse penetrating neck injury is presented, with air escaping through the injury site along with active bleeding, requiring a definitive airway and hemorrhage control in the initial management; with emergency surgical admission, with findings of: section of the thyrohyoid membrane at the level of the upper edge of the thyroid cartilage, epiglottis and both anterior jugular veins.The behavior was repair by planes, from the depths to the surface. The experience acquired in the management of this case allows us to highlight that following the life support guidelines together with definitive surgical trauma care in less than 24 hours in the event of penetrating neck trauma increases the probability of success in management and evolution.

O trauma cervical penetrante é uma emergência que constitui um desafio para o cirurgião desde a avaliação inicial até seu manejo definitivo. É apresentado o caso de uma paciente do sexo feminino, 24 anos, comlesão cervical penetrante transversal, com vazamento de ar pelo local da lesão. .lesão juntamente com sangramento ativo, exigindo manejo inicial de via aérea definitiva e controle da hemorragia; com internação cirúrgica de emergência, comachados de: secção da membrana tireoidia na ao nível da borda superior da cartilagemtireóidea, epiglote e ambas as veias jugulares anteriores. O comportamento foi reparado por aviões, desde as profundezas até à superfície. A experiência adquirida no manejo deste caso permite destacar que seguir as orientações de suporte à vida juntamente com o atendimento definitivo ao trauma cirúrgico em menos de 24 horas em caso de trauma cervical penetrante aumenta a probabilidade de sucesso no manejo e evolução.