[Traumatic brain injury: differences among pedestrians and motor vehicle occupants]. / Traumatismo crânio-encefálico: diferenças das vítimas pedestres e ocupantes de veículos a motor.

OBJECTIVE: The purpose of this study was to discover the differences among victims who had traumatic brain injury due to traffic accidents. METHODS: Medical record of the head injury patients were analyzed according to their classification as traffic accident victims (pedestrian, motorcyclist or passenger and other motor vehicle deriver or passenger), age, gender, admission type (admitted from scene of the injury or from another hospital), duration of hospitalization, type of head injury, types of lesions present in other body segments and mortality. Patient's injury severity was measured by Injury Severity Score and head injury severity was analyzed using the ranking on the Glasgow Coma Scale, recorded by neurosurgeons during their first neuro assessment. All head injured patients admitted to a trauma center in S. Paulo city over a four-month period from March through June 1993, were included in the study. The sample was of 156 victims, with subsets of 80 pedestrians, 26 occupants of motorcycles and 50 occupants of other motor vehicles. RESULTS AND CONCLUSION: The results of this study showed that the mortality rate was higher in the pedestrian subset (25.0%) than among other victims and higher for motorcycle occupants (19.2%) than for motor vehicle victims (8.0%). Statistical differences between the subsets were established when the head injury severity variable was analyzed using the Glasgow Coma Scale. On the other hand, the differences between the three subsets was not statistically significant when the measurement used was the Injury Severity Score. Analyses of other variables showed important differences among subset distributions.

[Human resources for the intensive care unit at the municipal district of São Paulo]. / Recursos humanos das unidades de terapia intensiva do Município de São Paulo.

The study had the purpose to investigate aspects of the ICUs from the Municipal district of São Paulo, regarding the composition of the clinical staff; characteristics of the nursing personnel and nurses' characterization. Data were collected through 47 questionnaires distributed in 32 hospitals. Results show that: the morning and the afternoon shifts have a larger number of people from all clinical categories, the majority of the nursing personnel work 36 hours per week, nurses' wages varied from 700 to 1,500 "reais" and 66.1% of them were enrolled in Master Programs. Authors concluded that 79.2% of the clinical staff was formed by the nursing personnel.

[Preliminary study of the relationship between the cardiopulmonary arrest time and its consequences in trauma patients]. / Estudo preliminar das relações entre duração da parada cardiorrespiratória e suas consequências nas vítimas de trauma.

The proposal of this research was to obtain parameters to start or maintain cardiopulmonary resuscitation (CPR) in victims of trauma. The duration of the cardiac arrest and the CPR of the survivors was described, as well as the cerebral performance and the mortality of these victims 24, 48 and 72 hours after these events had happened. With the results of this characterization the relation between duration of cardiac arrest time, CPR and mortality were described. Data for this report were collected in Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo emergency department. A big amount of the victims (93.4%) presents severe trauma and main cause of death was brain injury. Survival at 72 hours after CPR was 10%. The assessment, during the 72 hour period, of the survivors from cardiac arrest of traumatic cause has shown bad cerebral performance of those victims in that period of time. The survivor after the first episode of CPR was strongly related to cardiac arrest time when compared with CPR time. The time of cardiac arrest < or = 4 minutes and CPR < or = 20 minutes was related to survival more than 72 hours.

[Head injury victims and their return to work after 6 months to 1 year]. / Vítimas de trauma crânio-encefálico e seu retorno a produtividade após 6 meses e 1 ano.

A prospective and longitudinal study about head injury victims was carried out in order to identify their return to productivity after 6 months and 1 year post-trauma and to analyze the relationship between their return to work and their educational level as well as to determine the relationship between their return to work and their type of job before the onset of the injury. Of the 72 patients who were students or employees pre-injury, or housewives at the time of injury, the majority (73.6%) had returned to productivity 6 months after onset of injury. Of the victims who had returned to productivity, 25.0% had changed their original occupations or reported significant problems when returning to productivity. Baseline return was achieved in 48.6% of the victims at 6 months. Return to productivity was higher at 1 year after injury than at 6 months. When the relationship between return to work and educational level and job type was analyzed, return to work was not related to educational level or job type.

[Continuing education of the intensive care units nursing staff in the city of Sao Paulo]. / Educação continuada da equipe de enfermagem nas UTIs do município de São Paulo.

This study is part of a project about ICU's characteristics in São Paulo city. This article describes the continuing education programs for nursing staff. 43 ICUs were analysed and the questionnaire answered by the ICU nurse coordinator was used to collect data. Results showed that 34 (79.1%) of the ICUs have initial program for training each nursing staff category and 18 (41.9%) had regular continuing education program focusing primarily on nursing procedures and routines and the update in pathologies. Continuing education programs are developed primarily by ICU's nurses. 50.2% of the nurses answered that they attended specialisation/extension courses too, in Medical Surgical Nursing or in other areas or in both areas. Due to this result and the development of the ICU's nurses as specialists, some suggestions are presented to improve the continuing education program in these Units.

[Measurements of the gravity of injuries in patients with head injuries by the AIS/90 manual and the CAIS/85 chart]. / A gravidade do trauma em vítimas de traumatismo crânio-encefálico avaliada pelo manual AIS/90 e mapas CAIS/85.

This study was developed in order to compare the use of the ABBREVIATED INJURY SCALE (AIS) and the CONDENSED ABBREVIATED INJURY SCALE (CAIS) as basis to calculate INJURY SEVERITY SCORE (ISS) in head injured patients. The results showed that the ISS value was equivalent in the majority of the patients (58.51%) codified by both scales. Also no statistic differences between the scales were perceived when we compared the severity levels as severe, moderate and minor, 61.38% of the lesions scored by AIS/90 were scored by CAIS/85, too.

[Use of the Glasgow Coma Scale and the Jouvet Coma Scale to evaluate the level of consciousness]. / Utilização da escala de coma de Glasgow e escala de coma de Jouvet para avaliação do nível de consciência.

The Glasgow Coma Scale (GCS) and the Jouvet Coma Scale (JCS) have been evolved for assessing the depth and duration of impaired consciousness and coma. The analysis and the utilization of these scales have showed that they are complementary. The GCS is more sensitive when there is a more intense loss of consciousness, whereas the JCS shows its sensitivity better in the states close to normal. This study was aimed to compare the results obtained from the evaluation of the consciousness level by the utilization of the two scales. The comparison was done within a prospective study with 48 patients, all of them over 18 years old, interned in three intensive care units of different hospitals in the city of São Paulo. The evaluations were done daily by the researchers and the scales applied in sequence totaling 5 minutes. Each scale was applied in 106 evaluations, and the results showed a statistically meaningful difference between the GCS and the JCS as to the indication of alteration in the consciousness levels. In 37.74% of the evaluations done with the JCS there was an indication of alteration in the consciousness level, whereas with the GCS the alteration was present in only 23.58% of the evaluations. Another important observation about the utilization of both scales was that people whose scores were between 9 and 10 in the GCS had had an stronger indication of alteration of consciousness level by the same scale, while those with scores between 12 and 15 had a stronger indication of alteration in the consciousness level by JCS. When using GCS there has been the application of the non-testable (NT) in 20% of the evaluations. This did not occur when using the JCS. However it is believed that specific conditions of that particular group might have led to that result as well as specific characteristics of groups of patients might favor the utilization of different scales to evaluate the consciousness level. Therefore the final choice between such scales should consider the conditions and the peculiar characteristics of the clientele to be evaluated and not individual or health department services preferences.

[Recovery of patients with traumatic brain injuries one year after the trauma]. / Recuperação das vítimas de traumatismo crânio-encefálico no período de 1 ano após o trauma.

A prospective longitudinal study of traumatic brain injury (TBI) patients was conducted to identify the recovery pattern 1 year after trauma. Patients with all levels of injury and age between 12 and 60 years were observed. They were analyzed using the eight-point Glasgow Outcome Scale (GOS) as well as their return to productivity in that period. The majority of victims (77.2%) made good recovery, that is (GOS = 0 or 1) and complete recovery or GOS 0 was achieved in 38.6% of then. However at the 1 year mark, 22.8% of the victims showed disabilities. Overall, victims had returned to productivity in that period (83.3%) but 19.4% of them have had changes in their productivity and 16.7% didn't return to your job.).

[The physical assessment and the intensive care unit nurse]. / O exame físico e o enfermeiro de UTI.

The goal of this study was to analyse some practicing, teaching and learning aspects of physical examination done by ICU's nurses. It was accomplished with 26 ICU nurses that concluded the Intensive Care Nursing Specialization Course at the School of Nursing at São Paulo University. The results showed that 31 (68.9%) of the 45 presented items were done frequently by more than 50% of the nurses. The professional practice was considered the most important moment to physical examination learning. The responsibility by teaching was attributed to undergraduation course by 69.2% of the nurses.

Gastric duplication presenting rectal bleeding. A clinical case supporting McLedtchie's theory.

This is a case of a 5-month-old girl with massive rectal bleeding caused by a gastric duplication. Cyst heterotopic pancreas and pancreatic duplication, an association not previously reported were present. The peculiar clinical presentation was due to cyst perforation that had subsequently eroded the transverse colon. Coexistent gastric containing heterotopic pancreas and pancreatic duplications were probably produced as traction diverticular by an embryonic entoectodermal adhesions.

[Treatment of colonic atresia. Report of 3 cases]. / Tratamiento de la atresia de colon. A propósito de tres casos.

Atresia of the colon (AC) is an uncommon cause of neonatal intestinal obstruction requiring prompt surgery. However, its optimal operative management is matter of discussion. We report the surgical therapy and evolution of three cases successfully treated at our department. A type I case was submitted to a coloplasty plus resection of the diaphragm; two cases of type III underwent a two-staged procedure, i.e., colostomy with subsequent anastomosis without resection. After analysing the different operative procedures we suggest that a colostomy with later establishment of intestinal continuity may be an advantageous procedure even in the healthy patients with proximal lesions. A coloplasty is a safe alternative to type I atresias.

[The use of the pupillometric gauge by the nurses' aide]. / Utilização da espátula pupilômetro pelo auxiliar de enfermagem.

To test the use of the "pupillometer tongue depressor" by auxiliary nursing was the goal of this study. The same evaluation used by nurses was performed in this group. After explaining the use of the device, each auxiliary nursing registered on a "Card-test" the value of the two circles, which diameters were equal or unequal. Afterward, a pair of the auxiliary nursing evaluates the pupil diameter of one patient. The accuracy of the millimeter circles was very high but not the effectiveness of the pupil diameter measurement. Nearly 1/3 of the auxiliary nursing referred difficulties in performing this evaluation.