Intubación endotraqueal de emergencia en paciente con estridor inspiratorio y hallazgo de tumor en cuerdas vocales: reporte de un caso / Emergency endotracheal intubation in a patient with inspiratory stridor and a vocal cord tumour finding: a case report

El manejo especializado de la vía aérea (VA) es fundamental en las unidades de urgencia donde la intubación orotraqueal ha sido la técnica de elección para lograrlo. Una VA difícil se define como una situación clínica en la cual un equipo médico entrenado experimenta dificultades en la ventilación y/o en intubación. La obstrucción aguda de la VA constituye una de las emergencias médicas más extremas, requiriendo intervención inmediata. Se presenta el caso de un paciente con estridor inspiratorio con criterios inmediatos de intubación donde se evidencia un tumor en cuerdas vocales con obstrucción de la vía aérea.

Specialized airway management is essential in emergency units where endotracheal intubation has been the technique of choice. The difficult airway is defined as a clinical situation in which a trained medical team experiences difficulties in ventilation and, or intubation. Acute airway obstruction is one of the most extreme medical emergencies, requiring immediate intervention. We present the case of a patient with inspiratory stridor with quick criteria for intubation where a tumour in the vocal cords with airway obstruction is found.

Perfil epidemiológico de lesões dermatológicas em adultos na emergência hospitalar / Epidemiological profile of dermatological lesions in adults in hospital emergency

Introdução: Emergências dermatológicas são definidas como dermatoses graves, que requerem atenção médica imediata. Na literatura mundial, a prevalência de doenças dermatológicas em adultos nas emergências ainda não é bem descrita, possivelmente por sua natureza majoritariamente benigna e sua baixa mortalidade. Objetivos: Verificar a prevalência de lesões dermatológicas em adultos, com 18 anos ou mais, na emergência de um hospital secundário no sul de Santa Catarina. Métodos: Trata-se de um estudo observacional transversal, com coleta de dados primários e abordagem quantitativa. Foi utilizada ficha de coleta de dados clínicos e sociodemográficos preestabelecida, elaborada e preenchida pelos pesquisadores. Resultados: Durante o período estudado, de maio de 2018 a fevereiro de 2019, em oito visitas de doze horas cada, foram registradas 182 consultas na emergência e, dessas, 14 (7,69%) apresentaram lesões dermatológicas como a queixa principal. Com este estudo, identificamos uma prevalência de 7,69% de lesões dermatológicas no serviço de emergência hospitalar. Obtivemos um predomínio de lesões tegumentares de origem infecciosa (57,1%), seguidas por doenças eczematosas (14,3%) e outras condições que representam 28,6% dos casos. Em relação às manifestações clínicas associadas às lesões dermatológicas, a mais frequente foi a dor (64,3%), seguida do prurido (35,7%). A média de idade encontrada foi de 41,64 ± 22,46 anos. Conclusão: Com este estudo, pudemos identificar uma elevada frequência de doenças cutâneas na emergência de um hospital secundário. Logo, são de extrema importância o conhecimento das lesões dermatológicas mais prevalentes e a identificação de sua potencial gravidade durante a formação acadêmica médica, de modo a poder oferecer o diagnóstico e tratamento adequados na emergência hospitalar.

Introduction: Dermatological emergencies are defined as severe dermatoses that require immediate medical attention. The prevalence of dermatological diseases among adults in emergency units is still not well described by the international literature, possibly due to the mostly benign nature and low mortality rate of these conditions. Objectives: to verify the prevalence of dermatological lesions in adults (aged 18 years or more) in the emergency unit of a secondary hospital in southern Santa Catarina. Methods: This is an observational cross-sectional study, with primary data collection and a quantitative approach. We used a predefined form for collecting clinical and sociodemographic data; it was constructed and filled out by the researchers. Results: During the period studied, from May 2018 to February 2019, in eight visits of twelve hours each, 182 emergency medical care entries were recorded and, of these, 14 (7.69%) had skin lesions as the main complaint. With this evidence, we identified a 7.69% prevalence of dermatological lesions in the hospital emergency unit. Most skin lesions were of infectious origin (57.1%), followed by eczematous diseases (14.3%) and other conditions representing 28.6% of the cases. Regarding clinical manifestations associated with dermatological lesions, the most frequent one was pain (64.3%), followed by pruritus (35.7%). The mean age of the studied patients was 41.64 ± 22.46 years. Conclusion: This study allowed the identification of a high frequency of skin diseases in the emergency unit of a secondary hospital. Understanding the most prevalent dermatological lesions and identifying their potential severeness is thus extremely important to medical education, so that physicians can provide adequate diagnosis and treatment at the emergency unit.

Evaluation of a strategy for identification of hepatitis C virus carriers in outpatient and emergency units: contribution to the microelimination of hepatitis C in Brazil

ABSTRACT Introduction: Hepatitis C virus (HCV) infection continues to be an important public health problem worldwide. Despite the availability of drugs that promote the cure of infection in more than 95% of cases, the identification of HCV carriers remains a major challenge. Objective: To evaluate a strategy for identifying HCV carriers based on combined criteria: screening in emergency units and specialty outpatient clinics of a tertiary hospital and among older adults (≥45 years), both suggested as efficient in epidemiological studies. Methods: A cross-sectional, analytical and descriptive study was conducted on individuals of both sexes, aged 45 years and older, attending the emergency department and specialty outpatient clinics of a University Hospital in São Paulo, Brazil, from January 2016 to June 2018. After giving formal consent, the patients were submitted to a standardized interview and rapid testing for the identification of HCV antibodies (SD BIOLINE® anti-HCV). Results: A total of 606 adult patients (62% women and 37% men) were evaluated. The mean age was 62 ± 10 years. Four positive tests were identified, with confirmation by conventional serology and HCV-RNA determination. Thus, the prevalence of HCV identified in the sample was 0.66%. All patients had a history of risk factors for infection. Conclusion: The strategies of birth-cohort testing and screening in emergency medical services for the identification of HCV carries, both suggested in the literature as efficient for the diagnosis of hepatitis C, resulted in a low rate of HCV infection. These findings highlight the magnitude of the challenge of identifying asymptomatic HCV carriers in Brazil.

Design and implementation of auxiliary functions of first-aid chest / 医疗卫生装备

Objective To extend the auxiliary functions of the first-aid chest in the mobile emergency unit.Methods The auxiliary functions were designed from the aspects of supporting medical documents,CPR board,leakproof piecework card,time display,low light illumination,medical wastes recovery,adjustable perfusion support and medical console with considerations on standardized operation,requirements of medical treatment in field conditions as well as technical characteristics of mobile emergency unit.The weight and volume of the chest had no growth during the extension of the auxiliary functions.Results The extended auxiliary functions of the chest improved the mobile emergency unit in adaptability to field conditions and field medical treatment.Conclusion The extension of the auxiliary functions contributes to the optimization of the mobile emergency medical unit,and thus is worthy promoting in field first aid of the sanatorium and hospital.

Design and implementation of auxiliary functions of first-aid chest / 医疗卫生装备

Objective To extend the auxiliary functions of the first-aid chest in the mobile emergency unit.Methods The auxiliary functions were designed from the aspects of supporting medical documents,CPR board,leakproof piecework card,time display,low light illumination,medical wastes recovery,adjustable perfusion support and medical console with considerations on standardized operation,requirements of medical treatment in field conditions as well as technical characteristics of mobile emergency unit.The weight and volume of the chest had no growth during the extension of the auxiliary functions.Results The extended auxiliary functions of the chest improved the mobile emergency unit in adaptability to field conditions and field medical treatment.Conclusion The extension of the auxiliary functions contributes to the optimization of the mobile emergency medical unit,and thus is worthy promoting in field first aid of the sanatorium and hospital.

Mejora en el tiempo de atención al paciente en una unidad de urgencias gineco-obstétricas mediante la aplicación de Lean Manufacturing

Introducción. Se presenta una propuesta de mejora en el tiempo de atención al paciente, mediante la aplicación de la metodología de Lean Manufacturing, en una unidad de urgencias de gineco-obstetricia en una clínica en Bogotá, la cual presenta exceso en los tiempos de espera por parte de los pacientes frente a los estándares establecidos en la Ley 237 de 2008 del Senado de la República. Objetivo. Desarrollar una propuesta de mejora en los tiempos de atención por medio de la metodología Lean Manufacturing en la unidad de urgencias gineco-obstétricas de la clínica ABC. Materiales y métodos. Se realizó un trabajo de campo durante 6 meses, en los cuales mediante el uso de herramientas propias del lean manufacturing, tales como el value stream mapping y el diagrama de spaghetti, así como con un estudio de tiempos a una muestra representativa de los pacientes, se identificaron las áreas y/o procesos que no agregan valor al paciente generando planes de acción que contribuyeran a la mejora en los tiempos de atención. Resultados. La aplicabilidad de la propuesta se evaluó a través de simulaciones basadas en el software Arena, demostrando mejoras en los tiempos de atención de hasta el 56 %. Conclusión. Este proyecto evidencia la aplicabilidad del Lean manufacturing y sus principales herramientas, en clínicas u hospitales en Bogotá, permitiendo establecer los procesos que necesitan ser mejorados o eliminados con el fin de disminuir los tiempos de atención al paciente.

Introduction. This paper introduces a proposal to improve the time of attention for patients, by means of the Lean Manufacturing methodology, in a gyneco-obstetrics emergency unit located in Bogotá, in which the patients have to wait for a long time and this fact goes against law 237, 2008, produced by the Colombian Senate. Objective. Develop an improvement proposal for the attention time, by the use of the Lean Manufacturing methodology, in the gyneco-obstetrics emergency unit of the ABC Clinic. Materials and methods. A field work was developed during six months, in which, by the use of Lean Manufacturing tools such as the value stream mapping and the spaghetti diagram and a study of times on a representative sample of patients, the areas and processes that do not add value to those patients were identified and, then, action plans to improve the attention times were generated. Results. The applicability of the proposal was assessed by means of simulations based on the Arena software, demonstrating improvements in the attention times of up to 56%. Conclusion. This project demonstrates the applicability of Lean Manufacturing and its main tools in clinics or hospital in Bogotá, contributing to establish what processes must be improved or eliminated in order to reduce the attention time for the patients.

Introdução. Se apresenta uma proposta de melhora no tempo de atendimento ao paciente, mediante a aplicação da metodologia de Lean Manufacturing, em uma unidade de urgências de gineco-obstetrícia em uma clínica em Bogotá, a qual apresenta excesso nos tempos de espera por parte dos pacientes frente aos padrões estabelecidos na Lei 237 de 2008 do Senado da República. Objetivo. Desenvolver uma proposta de melhora nos tempos de atendimento por meio da metodologia Lean Manufacturing na Unidade de Urgências gineco-obstétricas da Clínica ABC. Materiais e métodos. Se realizou um trabalho de campo durante 6 meses, nos quais mediante o uso de ferramentas próprias do lean manufacturing, tais como o value stream mapping e o diagrama de spaghetti, assim como com um estudo de tempos a uma amostra representativa dos pacientes, se identificaram as áreas e/ou processos que não agregam valor ao paciente gerando planos de ação que contribuíram na melhora nos tempos de atendimento. Resultados. A aplicabilidade da proposta se avaliou através de simulações baseadas no software Arena, demostrando melhoras nos tempos de atenção de até 56 %. Conclusão. Este projeto evidencia a aplicabilidade do Lean manufacturing e suas principais ferramentas, em clínicas ou hospitais em Bogotá, permitindo estabelecer os processos que necessitam ser melhorados ou eliminados com o fim de diminuir os tempos de atendimento ao paciente.

Insuficiência cardíaca descompensada na unidade de emergência de hospital especializado em cardiologia / Decompensated heart failure in the emergency department of a cardiology hospital

FUNDAMENTO: Estudos nacionais em insuficiência cardíaca descompensada (ICD) são fundamentais para o entendimento dessa afecção em nosso meio. OBJETIVO: Determinar as características dos pacientes com ICD em uma unidade de emergência. MÉTODOS: Examinamos prospectivamente 212 pacientes com o diagnóstico de insuficiência cardíaca descompensada, os quais foram admitidos em uma unidade de emergência (UE) de hospital especializado em cardiologia. Estudaram-se variáveis clínicas, apresentação e causas de descompensação. Em 100 pacientes, foram analisados exames complementares, prescrição de drogas vasoativas, tempo de internação e letalidade. RESULTADOS: Entre os pesquisados houve predomínio de homens (56 por cento) e a etiologia isquêmica foi a mais freqüente (29,7 por cento), apesar da elevada freqüência de valvares (15 por cento) e chagásicos (14,7 por cento). A forma de apresentação e a causa de descompensação mais comuns foram, respectivamente, congestão (80,7 por cento) e má adesão/medicação inadequada (43,4 por cento). Na subanálise dos 100 pacientes, a disfunção sistólica foi a mais freqüente (55 por cento), uso de drogas vasoativas ocorreu em 20 por cento e a letalidade foi de 10 por cento. Análise comparativa entre os pacientes que receberam alta e faleceram durante a internação ratificou alguns critérios de mau prognóstico: pressão arterial sistólica reduzida, baixo débito associado à congestão, necessidade de droga vasoativa, fração de ejeção do ventrículo esquerdo reduzida, diâmetro diastólico do ventrículo esquerdo (DDVE) aumentado e hiponatremia. CONCLUSÃO: Este trabalho apresenta dados sobre o perfil da população com insuficiência cardíaca descompensada atendida na unidade de emergência de um hospital especializado em cardiologia da região sudeste do Brasil. Na avaliação inicial destes pacientes dados clínico-hemodinâmicos e de exames complementares fornecem subsídios para estratificação de risco, auxiliando na decisão de internação...

BACKGROUND: National studies on decompensated heart failure (DHF) are key to the understanding of this condition in our midst. OBJECTIVE: To determine the characteristics of DHF patients in an emergency department. METHODS: A total of 212 patients diagnosed with decompensated heart failure who had been admitted to an emergency department (EU) of a cardiology hospital were prospectively evaluated. Clinical variables, form of presentation and causes of decompensation were studied. In 100 patients, ancillary tests, prescription of vasoactive drugs, length of hospital stay and mortality were also analyzed. RESULTS: There was a predominance of the male gender (56 percent) and the most frequent etiology was ischemia (29,7 percent) despite high frequency of valvular (15 percent) and chagasic (14,7 percent) etiologies. The most common form of presentation and cause of decompensation were congestion (80.7 percent) and poor compliance/inadequate medication (43.4 percent), respectively. In the subanalysis of the 100 patients, systolic dysfunction was the most common cause of decompensation (55 percent); use of vasoactive drugs occurred in 20 percent, and mortality was 10 percent. The comparative analysis between the patients who were discharged and those who died during hospitalization confirmed some criteria of poor prognosis: reduced systolic blood pressure, low cardiac output associated with congestion, need for vasoactive drugs, reduced left ventricular ejection fraction, increased left ventricular diastolic diameter (LVDD) and hyponatremia. CONCLUSION: This study presents information about the profile of decompensated heart failure patients attended on the emergency unit of a brazilian southeast cardiology hospital. Clinical, hemodynamical and ancillary data may provide information for risk assessment in the initial evaluation helping the decision on hospitalization and advanced strategic therapies.