RESUMEN
Trata-se do Volume 3 da coleção "Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza" (SAMUFor), que publiciza os Protocolos de Suporte Básico de Vida (SBV) do SAMUFor. Discorre sobre 190 Protocolos de Suporte Básico de Vida. Divide-se em 30 Protocolos Clínicos, 16 Protocolos de Intoxicações e Produtos Perigosos, 07 Protocolos em Incidentes com Múltiplas Vítimas, 19 Protocolos em Trauma, 13 Protocolos em Obstetrícia, 28 Protocolos em Pediatria, 37 Protocolos de Procedimentos em SBV, 35 Protocolos Especiais em SBV e 05 Protocolos para Motolâncias. Inclui também instruções para o Suporte Intermediário de Vida (SIV) para as Unidades de Suporte Intermediário do SAMUFor em 20 Protocolos de SBV: Bc10 Insuficiência Respiratória Aguda no Adulto; BC11 Choque; BT4 Choque no Trauma; BC12 Dor Torácica Não Traumática; BC13 Crise Hipertensiva; BC14 AVC: Acidente Vascular Cerebral; BC16 Crise Convulsiva no Adulto; BC17 Hipotermia; BC19 Hipoglicemia; BC23 Reação Alérgica - Anafilaxia; BC26 Manejo da Dor no Adulto; BC27 Cólica Nefrética; BC29 Agitação e Situação e Violência; BC30 Autoagressão e Risco de Suicídio; BPed11 Choque em Pediatria; BPed14 Crise Convulsiva em Pediatria; BPed17 Hipoglicemia em Pediatria; BPed18 Reação Alérgica Anafilaxia em Pediatria; BPed19 Febre em Pediatria; e BPed22 Manejo da Dor em Pediatria
Asunto(s)
Servicios Médicos de Urgencia , Servicios de Contestadora , Desastres , Urgencias MédicasRESUMEN
Trata-se do Volume 4 da coleção "Normas de Conduta Técnica e Gestora para Profissionais do SAMU 192 - Regional Fortaleza" (SAMUFor), que publiciza os Protocolos de Suporte Avançado de Vida (SAV) do SAMUFor. Discorre sobre 225 Protocolos de Suporte Avançado de Vida. Divide-se em 40 Protocolos Clínicos, 16 Protocolos de Intoxicações e Produtos Perigosos, 05 Protocolos em Incidentes com Múltiplas Vítimas, 26 Protocolos em Trauma, 14 Protocolos em Obstetrícia, 33 Protocolos em Pediatria, 60 Protocolos de Procedimentos em SAV e 31 Protocolos Especiais em SAV.
Asunto(s)
Servicios Médicos de Urgencia , Servicios de Contestadora , Desastres , Urgencias MédicasRESUMEN
BACKGROUND: Surgery for anal fistula is often associated with continence disorders due to the transection of sphincter muscles. Extensive knowledge of anal canal anatomy and anal fistula can help prevent this outcome. OBJECTIVE: This study aimed to correlate the anatomical conformation of the anal canal, the fistula track, and the internal opening according to sex and hemicircumference (anterior vs posterior) by use of 3-dimensional ultrasonography. METHODS: One hundred sixty-five patients with fistula were evaluated with 3-dimensional ultrasound and grouped according to sex, fistula type, internal opening, and track position. Fistulas were transsphincteric in 128 subjects and intersphincteric in 37 subjects. The study measured the external and internal anal sphincter, the puborectalis, the distance from the internal opening to the distal edge of the external and internal sphincter, the length of the internal and external sphincter compromised by the track, and the percentage of compromised muscle. RESULTS: The anal canal muscles were longer in males. The distance from the internal opening to the internal sphincter was greater for the posterior hemicircumference. The point where the fistulous track crossed the anterior external sphincter was similar for the 2 sexes, but the percentage of compromised muscle was greater in females. The point where the fistulous track crossed the internal sphincter was similar for the 2 sexes, but the percentage of compromised internal sphincter was greater in males for the posterior hemicircumference. The study was limited by the absence of testing for interobserver and intraobserver agreement. CONCLUSION: The anal canal muscles are longer in males and the pectinate line is asymmetrical. In females, the percentage of compromised external sphincter was greater in the anterior hemicircumference because of the shorter external sphincter, whereas in males the percentage of compromised internal sphincter was greater in the posterior hemicircumference.
Asunto(s)
Canal Anal/diagnóstico por imagen , Endosonografía/métodos , Imagenología Tridimensional , Fístula Rectal/diagnóstico por imagen , Adulto , Canal Anal/anatomía & histología , Femenino , Humanos , Masculino , Músculo Liso/anatomía & histología , Músculo Liso/diagnóstico por imagen , Estudios Retrospectivos , Factores SexualesRESUMEN
BACKGROUND: Critical limb ischemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb. Our aim was to examine the effects of preoperative infusion of l-alanyl-glutamine (l-Ala-Gln) during the ischemic period and during the first 30 minutes following blood reflow in patients with CLI who are undergoing distal femoral artery bypass surgery. METHODS: Thirty-two patients with CLI were alternately allocated to group 1 (saline) or group 2 (l-Ala-Gln). Saline (1000 mL) or L-Ala-Gln 250 mL plus 750 mL of saline were infused intravenously over a 3-hour period prior to surgery. Samples (muscle and blood) were collected at the beginning of the surgical procedure, at the end of ischemia, and at 15 and 30 minutes after reperfusion. RESULTS: l-Ala-Gln induced elevation in glutathione (GSH) muscle concentrations while promoting reduction in thiobarbituric acid reactive substance concentrations, demonstrating enhancement of antioxidant capacity and protection from lipid peroxidation. Decreases in LDH, lactate, and glucose blood concentrations in l-Ala-Gln-treated patients suggest increased glucose utilization by muscle and peripheral tissues. Reduction in creatine phosphokinase blood concentrations may reflect smaller muscle cell damage in l-Ala-Gln-treated patients. CONCLUSION: l-Ala-Gln pretreatment reduces muscle cell damage and enhances antioxidant capacity in patients with CLI.