Medical Behavior in Cardiorespiratory Arrest before and After Simulation Based on Advanced Cardiac Life Support (ACLS) Course

Abstract Background: The Advanced Cardiac Life Support (ACLS) course is designed to teach cardiovascular emergency, aiming to promote a harmonious and synchronized work of the entire hospital team, making the multidisciplinary job more effective in the execution of cardiopulmonary resuscitation (CPR). Objective: To compare the effectiveness of CPR performed between physicians trained on ACLS and non-trained physicians. Methods: A questionnaire was applied to physicians working at the emergency room of hospitals in Curitiba, state of Paraná, whose resolution required theoretical and practical knowledge about CPR. For analysis, descriptive statistics and Fisher's association analysis were used, and the medians of the groups were evaluated by Mann-Whitney/Kruskal-Wallis with significance of 5%. Results: Thirty-four physicians were volunteers, of whom 20 had taken the ACLS course (Group A) and 14 had not (Group B). The trained physicians obtained the highest median (4.00 vs. 3.00, p = 0.06) of correct answers. Group A scored at least 3 of the 5 questions in the questionnaire, showing better performance than Group B (OR = 6.75, 95% CI, 1.1 < OR < 41.0, p = 0.04). The year of the course did not significantly change the performance in the questionnaire. Conclusion: It is suggested that the ACLS course was effective in qualifying physicians to handle situations of cardiorespiratory arrest properly, which was reproduced by the better performance in the resolution of the questionnaire. It is believed that when the sample of volunteers is increased, the trends found materialize the other hypotheses proposed.

Relato de caso: histiocitose de células de langerhans / Langerhans cell histiocytosis: a case report

Introdução: A Histiocitose de células de Langerhans (HCL) pode ter diversas apresentações clínicas. Seu diagnóstico depende principalmente da imuno-histoquímica. Relato: Menina, 4 anos, admitida no Pronto Atendimento no Hospital Pequeno Príncipe com queixa de torcicolo persistente. Posteriormente, diagnosticada e tratada como HCL, com evolução clínica favorável. Discussão: Por se tratar de uma apresentação atípica, a investigação inicial deste caso foi direcionada para outras patologias, em especial o torcicolo. O que definiu o diagnóstico foi a realização de biópsia e imuno-histoquímica, as quais apresentavam características típicas da HCL. Conclusão: Queixas persistentes devem ser sempre investigadas, pois o diagnóstico precoce contribui para um desfecho favorável. A atenção deve ser especial aos portadores de mutação no gene BRAF, já que esses pacientes são considerados de pior prognóstico. Após o tratamento, os pacientes devem ficar em acompanhamento por no mínimo cinco anos devido ao risco de recidiva, sendo rara nos casos de doença unifocal

Introduction: (LCH) can have several clinical forms and its diagnosis depends mainly on immunohistochemistry. Case Report: Four years old girl were admitted to the Emergency at Pequeno Príncipe Hospital with persistent stiff neck complaint. Subsequently diagnosed and treated as LCH with favorable clinical evolution. Discussion: The initial investigation of this case was directed to other pathologies, especially the stiff neck, seeing it is an atypical presentation. Biopsy and immunohistochemistry defined the diagnosis, which presented typical features of LCH. Conclusion: Persistent complaints should always be investigated as early diagnosis contributes to a favorable outcome. Attention to those with BRAF gene mutations, as these patients are considered to have a worse prognosis. After treatment, patients should be followed for at least five years due to the risk of relapse, rare in cases of unifocal disease