Orientador: Luis Augusto Passeri / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-10T20:36:00Z (GMT). No. of bitstreams: 1 Grempel_RafaelGrotta_M.pdf: 756385 bytes, checksum: 2772197c9a54623706e5578d35775e18 (MD5) Previous issue date: 2008 / Resumo: A expectativa de vida tem aumentado em todo o mundo e essa mudança social traz consigo um aumento no envolvimento de indivíduos idosos em acidentes, gerando conseqüências no âmbito social, econômico e governamental. Ressalta-se então a necessidade crescente de conhecimento profundo das alterações fisiológicas desse grupo de pacientes, bem como das peculiaridades dos traumatismos e conseqüências destes, que provavelmente irão alterar as prioridades clínicas e o protocolo de tratamento convencional. Esse trabalho foi baseado em um estudo observacional, prospectivo e longitudinal, objetivando avaliar as características epidemiológicas, específicas dos traumatismos faciais em pacientes idosos, atendidos pela Área de Cirurgia Bucomaxilo-facial da FOP-UNICAMP, enfatizando suas causas e conseqüências, bem como o conhecimento necessário relacionado aos cuidados e tratamento destes pacientes. Foram analisados todos os prontuários, específicos de trauma, do ano de 1999 a 2006, totalizando 145 pacientes com idade igual ou superior a 60 anos. A análise estatística descritiva revelou prevalência do gênero feminino (53,8%), da cor branca (80,7%), a maior parte não economicamente ativa (85,5%) e com idade média de 71,8 ± 8,1 anos. A maioria dos atendimentos foi realizada pelo SUS (83,4%), ocorrendo predominantemente nas primeiras 72 horas pós-trauma (70,3%). Queda foi o principal agente etiológico (71%), sendo mulheres 66% das vítimas. Em 59,3% dos pacientes existia alguma fratura facial, totalizando 113 fraturas, principalmente em complexo zigomático-maxilar (47,8%), ossos próprios do nariz (24,8%) e mandíbula (21,2%), com apenas 18,6% dessas sendo submetidas a procedimento cirúrgico para tratamento. Todas as fraturas que foram tratadas, receberam fixação interna rígida, excetuando-se uma nasal, uma de arco zigomático e uma alvéolo-dentária. Em relação às lesões em tecido mole, observou-se predominância dos hematomas (35%) e lacerações (33,7%). Algum traumatismo geral associado foi constatado em 39,3% dos pacientes, acometendo principalmente membros superiores (26,2%) e inferiores (16,5%). Observando-se então, que os traumatismos faciais atingem de modo importante essa parcela da população, sendo tratados geralmente de forma conservadora / Abstract: Life expectancy is increasing all over the world, and this social change brings an increasing participation of elderly patients in accidents, with social, economic and governmental consequences. The rising requirement of a deep knowledge about the physiological changes in this group of patients is standed out, as well as the peculiarities of the injuries and the consequences of them, that may modify the clinical priorities and the protocol of conventional treatment. This work was based on an observational, prospective and longitudinal study, aiming to evaluate the specific epidemiologic characteristics of the facial injuries in elderly patients, related to the Division of Oral and Maxillofacial Surgery of Piracicaba Dental School ¿ UNICAMP, emphasizing its etiology and consequences, and the necessary knowledge related about the management and treatment of these patients. In this study all trauma related charts from 1999 to 2006 have been evaluated, totalizing 145 patients which were 60-year-old or older. The statistic descriptive analysis showed prevalence of females (53.8%), white individuals (80.7%), mostly non-economically active (85.5%) and with average age of 71.8 ± 8.1 years. The majority of the initial care was carried out by the Brazilian Public Health Insurance - SUS (83.4%), predominantly occurring in the first 72 hours after-trauma (70.3%). Fall was the main etiologic agent (71%), in which 66% of these victims were women. About fifth nine percent (59.3%) of the patients presented some facial fracture, totalizing 113 fractures, mainly in the zygomaticoorbital complex (47.8%), nose (24.8%) and mandible (21.2%). Only 18.6% of these had undergone some surgical procedure as treatment. Rigid internal fixation has been in all the fractures surgically treated, except for one nasal, one of the zygomatic arch and one dental-alveolar fracture. Concerning to the soft tissues injuries, hematomas (35%) followed by lacerations (33.7%) were the predominants. Some concomitant injury was appreciated in 39.3% of the patients, generally in upper (26.2%) and lower limbs (16.5%). It can be concluded from this study that facial injuries generally reach, in an important way, this group of patients, usually receiving a more conservative treatment / Mestrado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Mestre em Clínica Odontológica

Leung Ping-chung. / Thesis (D.Sc.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references.

Introduction : les fractures des parois de l’orbite, sont fréquentes en traumatologie maxillo-faciale. Nous avons développé et validé un modèle 3D en éléments finis (FEM) d’étude de l’orbite humaine, ensuite utilisé en simulation traumatologique.Matériel et méthodes : Un état des lieux des connaissances concernant les fractures des parois de l’orbite est proposé en première partie. Une observation clinique d’un patient ayant subi un second traumatisme après avoir bénéficié d’une reconstruction du plancher orbitaire par un implant en titane est rapporté. Un modèle 3D en éléments finis de l’orbite est créé, afin d’analyser le comportement de l’orbite, de son contenu et d’une éventuelle reconstruction par implant titane simplifié, en cas de récidive traumatique. Il est ensuite amélioré sur les bases d’une étude sur sujets anatomiques. Résultats : Les implants préformés en titane ont fait leur preuve, mais ont une morbidité propre. Leur déformation en cas de récidive traumatique peut être délétère pour le contenu orbitaire et la vision du patient. Cette déformation est reproductible expérimentalement. L’analyse en éléments finis de traumatisme orbitaires est possible ses avantages et limites sont discutées.Discussion : La précision des voies d’abords et les progrès dans les matériaux utilisés en chirurgie maxillo-faciale permettent d’éviter la plupart des complications iatrogènes. Néanmoins, le devenir des implants utilisés n’est pas toujours pris en compte dans a décision chirurgicale, notamment en cas de récidive traumatique. Les modèles d’études 3D en éléments finis constituent ici un outil de choix. / Introduction: Fractures of the middle third of the face, especially those affecting the orbit, are common in maxillofacial traumas. We developed and validated a 3D finite element model (FEM) of the human orbit, then used for trauma simulations.Material and methods: A review of existing knowledge concerning the fractures of the walls of the orbit was provided, on the basis of a systematic review of the existing literature. A clinical observation of a patient who had suffered a second trauma after benefiting from a reconstruction of the orbital floor with a titanium mesh implant (TMI) was reported. The resulting deformation of the implant, which threatened the orbital content (including the eyeball), was analysed and counterbalanced with the indications of TMI. A 3D FEM of the orbit was created, in order to investigate the behaviour of the orbit, its contents and a simplified TMI, if a traumatic recurrence should occur. It is then improved on the basis of an anatomical studyResults: preformed titanium implants have proved their worth, but also have their own morbidity. In case of traumatic recurrence, their deformity may be deleterious to the orbital content and the patient’s vision. This deformation can also be reproduced experimentally. Advantages and limits of Finite element analysis of orbital trauma are discussed.Discussion: Progress in maxillofacial surgery make it possible to avoid most iatrogenic complications. Nevertheless, the long-term evolution of the implants used is not always taken into account in surgical decisions, especially in the perspective of traumatic recurrence. 3D FEMs have proved to be a major tool here.

Made available in DSpace on 2014-06-11T19:31:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-05-06Bitstream added on 2014-06-13T19:20:06Z : No. of bitstreams: 1 ribeirojunior_pd_dr_araca.pdf: 475855 bytes, checksum: 25027ddf9644c9757d0a760d4ed4ca58 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Este estudo avaliou in vitro a influência do tipo de miniplaca (convencional ou locking) e do número de parafusos instalados no segmento ósseo distal e proximal para a promoção da estabilidade óssea e resistência da osteossínteses pelo método Champy, utilizada para o tratamento de fraturas de ângulo mandibular. Sessenta hemi-mandíbulas de poliuretano, com consistência similar ao osso mandibular, foram divididas em 4 grupos (n=15) e seccionadas na região de ângulo mandibular simulando uma fratura. Os segmentos ósseos foram fixados por diferentes tipos de miniplacas usando sistema 2.0- mm e parafusos monocorticais de 2.0 x 6.0mm. Nos grupos 1 e 2, dois parafusos convencionais (G1) ou locking (G2) foram instalados em cada segmento ósseo usando respectivamente miniplacas retas convencionais e locking; Nos grupos 3 e 4, três parafusos convencionais (G3) ou locking (G4) foram instados no segmento ósseo proximal e quatro parafusos convencionais (G3) ou locking (G4) foram instalados no segmento distal, usando uma miniplaca convencional (G3) e locking (G4) de sete furos, reta. As hemi-mandíbulas foram submetidas a um teste de compressão utilizando uma máquina universal de ensaio INSTRON até que houvesse um distanciamento entre os segmentos ósseos de 4 mm, seja no sentido horizontal ou vertical. Os dados registrados foram submetidos à avaliação estatística pelo método ANOVA e teste de Tukey utilizando um nível de significância de 1%. As miniplacas locking ofereceram maior resistência ao teste de compressão do que as miniplacas convencionais (p<0.01). Porém, não existiu diferença entre o uso de miniplacas de 7 ou 4 furos (p>0.01). Apesar de não estatisticamente significante os resultados numéricos sugeriram que as miniplacas locking longas oferecem maior resistência ao teste de compressão que as miniplacas locking curtas. / This study evaluated in vitro the influence of the type of miniplate (conventional or locking) and the number of screws installed in the proximal and distal segments on the stability and resistance of Champy’s osteosynthesis in mandibular angle fractures. Sixty polyurethane hemimandibles with bone-like consistency were randomly assigned to 4 groups (n=15) and sectioned in the mandibular angle region to simulate fracture. The bone segments were fixed by different osteosynthesis methods using 2.0-mm miniplates and 2.0 x 6 mm monocortical screws: Groups 1 and 2- Two conventional (G1) or locking (G2) screws were installed in each bone segment using either a conventional (G1) or a locking (G2) straight miniplate; Groups 3 and 4- Three conventional (G3) or locking (G4) screws were installed in the proximal segment and four conventional (G3) or locking (G4) screws were installed in the distal segment using a either a conventional (G3) or a locking (G4) 7-hole straight miniplate. The hemimandibles were loaded in compressive strength in an Instron machine until a 4-mm displacement occurred between the segments either vertically or horizontally. Data were analyzed statistically by ANOVA and Tukey’s test at 1% significance level. The locking plate/screw systems provided significantly greater resistance to displacement under compressive load than the conventional plate/screw systems (p<0.01). However, no statistically significant difference was found between 7-hole and 4-hole miniplates (p>0.01). In conclusion, the locking miniplates offered more resistance than conventional miniplates and long locking miniplates provided greater (number results) bone stability compared to short ones.

Made available in DSpace on 2015-09-25T12:23:17Z (GMT). No. of bitstreams: 1 PDF - Lorena Marques da Nobrega.pdf: 1112314 bytes, checksum: 59ddbc380b6b506b32acfd401b192395 (MD5) Previous issue date: 2013-07-08 / The terrestrial transport accidents (TTA) are considered a serious public health problem worldwide, as they cause deaths, injuries and disabilities, including in this segment the facial trauma. Given the importance assumed by the TTA on these traumas, this study aims at evaluating the prevalence and factors associated with its occurrence on the victims of such violence. MATERIALS AND METHODS: Cross-sectional retrospective study performed at nucleus of forensic medicine and dentistry from January 2008 to December 2011. Data analysis was performed using the Statistical Package for Social Sciences including the frequency distribution and descriptive analysis of socioeconomic factors, injuries and TTA characteristics, and analytical analysis by using the chi-square test and Poisson logistic regression. RESULTS: A total of 2,570 medical and dental records were evaluated. The mean age of victims was 34.38 years (SD = 15.00 years), and the men to women ratio of 3.5:1. Most did not have a partner (56.5%) had up to 8 years of education (55.7%), was not employed (52.1%) and resided in the Metropolitan region (51.6). Regarding the information about the accident: motorcycle accidents were prevalent (67.8%) occurred during the day (55.8%) and on weekdays (62.9%). The facial injuries occurred in 421 victims (16.4%), being facial multiple trauma the most prevalent (44.3%), as well as the soft tissue injuries (57.5%). The body region most affected was the lower limb (37.6%) followed by associated trauma (28.9%). A statistically significant association was found between the type of trauma (facial/body) and age, residence, marital status, education, victim s occupation, type of accident, day of week and time of day. The final multivariate model of hierarchical Poisson regression was composed of four co-variables: housing, education, type of accident and time of day. CONCLUSION: The study showed factors associated with facial trauma, enabling the targeting of public health policies in order to prevent and reduce the prevalence of facial trauma resulted from terrestrial transport accidents, especially in those high-risk groups. / Os acidentes de transporte terrestre (ATT), são considerados um grave problema de saúde pública mundial, pois causam mortes, incapacidades e traumas, incluindo nesse segmento os traumas faciais. Tendo em vista à importância assumida pelos ATT nesses traumas, foi objetivo desse estudo avaliar a prevalência e os fatores associados ao trauma facial, nas vítimas deste tipo de violência. MATERIAIS E MÉTODOS: Estudo transversal censitário realizado m 2.570 laudos médico-odontológicos do período de Janeiro de 2008 a Dezembro de 2011 em núcleo de medicina e odontologia forense que referência para 23 cidades. A análise dos dados foi realizada utilizando o programa Statistical Package for Social Sciences e incluiu distribuição de frequência e análise descritiva para os fatores socioeconômicos, características do ATT e lesões faciais e corporais, e analítica mediante uso de teste qui-quadrado e regressão de Poisson. RESULTADOS: A média de idade das vítimas foi de 34,38 anos (DP = 15,00 anos). A proporção de homens para mulheres de 3,5:1. A maioria não possuía companheiro (56,5%), tinha até 8 anos de estudo (55,7%), não era assalariado (52,1%) e residia na região metropolitana (51,6). Em relação aos dados sobre o acidente: os acidentes motociclísticos tiveram maior prevalência (67,8%), ocorreram no período diurno (55,8%) e nos dias úteis (62,9%). As lesões faciais ocorreram em 421 vítimas (16,4%), sendo o politraumatismo facial o mais prevalente (44,3%), assim como os traumas de tecido mole (57,5%). A região do corpo mais atingida foram os membros superior e inferior - (37,6%) seguido de traumas associados (28,9%) e de cabeça (12,1%). Uma associação estatisticamente significativa foi encontrada entre a presença de trauma facial (presente/ausente) e a faixa etária, moradia, situação conjugal, escolaridade, trabalho da vítima, o tipo de acidente, dia da semana e período do dia. O modelo multivariado final da regressão hierárquica de Poisson foi composto de quatro co-variáveis: moradia, escolaridade, tipo de acidente e período do dia. Indivíduos que moram na região adjacente (RP=1,41, 95% IC: 1,02-1,96, p=0,038), nas cidades além dessa região (RP=1,50, 95% IC: 1,10-2,26, p=0,010), acidentes ocorridos no período noturno (RP=1,42, 95% IC: 1,10-1,84, p=0,007) e vítimas que tem até 9 anos de idade (RP=2,31, 95% IC: 1,03-5,17, p=0,041) têm maior prevalência de durante um acidente de terem trauma facial. Já as vítimas de acidente motociclístico têm menor prevalência de trauma facial do que os automobilísticos (RP=0,59, 95% IC: 0,44-0.89, p=0,001). CONCLUSÃO: O estudo evidenciou fatores associados ao trauma facial, possibilitando o direcionamento de políticas públicas de saúde, a fim de prevenir e diminuir a prevalência dos traumas faciais decorrentes de acidente de transporte terrestre, principalmente naqueles grupos de maior risco: vítimas de acidente automobilístico, moradores da região adjacente e além desta, com 9 anos de idade ou menos, e acidentes ocorridos no período noturno.

Modern lifestyle (technology, increasing intensity of sport activities, motor sports) results into increasing number of injuries and traumas and their seriousness. Injuries are at the first place in the assessment of cause of death among children and adults. Traumatology deals with prevention, diagnosis and treatment of injuries involving soft tissues, bones and joints. Traumatology should be considered as a complex diagnostic-therapeutic process, which includes medical history, clinical examination and imaging methods. Based on this examination, the diagnosis is made. Then comes therapeutical considerations and possibly a patient is indicated for surgery. Evaluation scales in nursing are elementary and integral part of nursing documentation. With their help, it is possible to define the object of observation and the way of evaluation (scoring of selected manifestations). Based on the received information it is then possible to precisely identify, objectify and document the problems arising in connection with nursing care. The result is finding an adequate solution to the problem and improving the quality of nursing care. Therefore, nurses should be equipped with basic skills on how to use the scales and how to work with them. The thesis is divided into two parts, a theoretical and an empirical one. The theoretical parts contains information about traumatology, its history and trauma centers in the Czech republic. It also contains information about nursing documentation, which includes assessment scales. We mainly focused on individual assessment scales for evaluation of state of consciousness, the risk of bedsores, the risk of falling and scales for evaluation of the degree of self-sufficiency. Among other scales we dealt with pain assessment, nutritional screening and screening tests for cognitive function evaluation. We have discussed these scales further in the text. The first part of the research part of this diploma paper was carried out in the form of a qualitative survey based on semi-structured interviews with nurses, working in the traumatology department. The interviews included basic and supplementary questions which were asked later, in case of need during the interviews with interviewees. The survey was conducted in April, in a trauma center in the Czech Republic. After finishing the interviews, the results were examined into detail by coding and categorization. The most important answers of the respondents were shown in the diagrams, which were created according to the defined categories. For the second group, a quantitative research, conducted in the form of an anonymous survey, was chosen - a survey with 50 respondents. This technique was chosen as a support for the received qualitative data. The goal of this thesis was to find out the use of assessment scales for evaluation of a patient in traumatology and at the same time to map the nurses´ point of view of the issue of using assessment scales in traumatology. To achieve the goal, following questions were formulated. RQ1: What assessment scales are used in traumatology for evaluation of patients? RQ2: How can the assessment scales contribute to improving the patient care? RQ3: Are the assessment scales actively used for determining the patient care intervention? RQ4: What is the opinion of nurses on using the assessment scales in traumatology? RQ5: What assessment scales are comfortable and beneficial for nurses to use in traumatology? During the research was found out that using of assessment scales results into improving the patient care, it helps us to regularly evaluate patient´s condition and to assess the risks the patient is during his/her hospitalization, endangered with. Although the nurses see the scales as beneficial, the scales are just another administrative burden for nurses in the traumatology department. However, the results of these scales are actively used to determine suitable intervention.

Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p&lt0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p&lt0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p&lt0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p&lt0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.

Thesis (M. Comm. (Human resource management))-University of Pretoria, 2004. / Summary in English. Includes bibliographical references. Available on the Internet via the World Wide Web.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / The use of polymethylmethacrylate acrylic resin (PMMA) as connecting rod for external skeletal fixator (EEF) has become common in veterinary medicine due to its versatility, low cost and easy implementation. The aim of this study was to evaluate the potential of thermal damage to soft tissues and bones, by thermography, derived from the exothermic reaction during construction of connecting rod. Therefore, 18 external fixators type II were constructed by manual molding for stabilization of fractures of the radius and ulna or tibia and fibula, and were divided into four groups: simultaneous bilateral molded without irrigation (5), simultaneous bilateral molded with irrigation (4), unilateral molded without irrigation (5) and unilateral molded with irrigation (4). Through thermal imaging, from fifth to 25th minutes after mixing, temperature of PMMA acrylic rods and the pin-skin interface were determined at every minute. In a complementary study, PMMA rods measuring 150mm long by with diameters of 20mm, 25mm and 32mm were prepared with five flat intramedullary pintype, with 2, 3, 4, 5 and 6 mm diameter each. Thermal images were obtained at 30 second intervals, from the fifth to the 20th minute after mixing, and the distances at which the pins reached 50°C above the acrylic rods were measured. The maximum temperature of acrylics was 105.5ºC and irrigation provided a significant average reduction of 21.6ºC (p<0.01) in the maximum temperature, and 11.1 minutes in the permanence time above 50ºC (p<0.01). The maximum temperature of the pin-skin interface was 56.6ºC, in the four cases (22.2%) where the maximum temperature was above 50ºC the distance between acrylic and skin was between four to 6mm; through irrigation, the maximum temperature was significantly reduced by 8.1ºC (p<0.01). In conclusion, there is a potential for thermal damage when the distance from the acrylic rod where the pins touch skin was shorter than 6mm, direct irrigation is effective in reducing this potential, perform simultaneously two rods of acrylic on an type II external skeletal fixation does not alter the potential for thermal injury and, finally, it is recommended particular attention to the distance of the rod to the skin, for larger rods diameters, larger distances should be maintained to the skin, observing in this experiment the minimum distance of 4mm in rods with diameter up to 20mm, 6.5 mm in rods with diameter up to 25 mm and 10.5 mm for rods with a diameter up to 32mm. / O uso da resina acrílica de polimetilmetacrilato (PMMA) como barra conectora de fixadores esqueléticos externos (FEE) tornou-se bastante comum em medicina veterinária devido a sua versatilidade, fácil aplicação e baixo custo. O objetivo deste estudo foi avaliar o potencial térmico de dano aos tecidos moles e ossos, através da termografia, proveniente da reação exotérmica durante a confecção da barra conectora, e avaliar se a irrigação direta com solução de NaCl a 0,9% é necessária e eficiente. Para tanto, 18 fixadores esqueléticos externos do tipo II foram confeccionados por moldagem manual para a estabilização de fraturas de rádio e ulna ou de tíbia e fíbula, divididos em quatro grupos: confecção simultânea bilateral sem Irrigação (5), confecção simultânea bilateral com Irrigação (4), confecção unilateral sem irrigação (5) e confecção unilateral com irrigação (4). Através de imagens térmicas, do quinto ao 25º minuto após a mistura, foram determinadas as temperaturas máximas das barras conectoras de PMMA e do ponto de contato dos pinos com a pele a cada minuto. Em um experimento complementar, foram elaboradas barras de PMMA medindo 150mm de comprimento, com diâmetros de 20mm, 25mm e 32mm com cinco pinos do tipo intramedular liso, com 2, 3, 4, 5 e 6mm de diâmetro em cada. Imagens térmicas foram obtidas a intervalos de 30 segundos, do quinto ao 20º minuto após a mistura, e as distâncias em que os pinos atingiram 50ºC em relação à barra de acrílico foram medidas. A temperatura máxima dos acrílicos foi de 105,5ºC e a irrigação possibilitou uma redução média significativa de 21,6ºC (p<0,01) na temperatura máxima e de 11,1 minutos no tempo de permanência acima de 50ºC (p<0,01). A temperatura máxima da interface pino-pele foi de 56,6ºC, sendo que nos quatro casos (22,2%) em que a temperatura máxima foi superior a 50ºC a distância entre acrílico e pele ficou entre quatro a 6mm; através da irrigação, a temperatura média foi significativamente reduzida em 8,1ºC (p<0,01). Conclui-se que existe potencial de lesão térmica pelos pinos, a partir da barra de acrílico, até a distância de 6mm, a irrigação direta é eficiente na redução deste potencial de lesão, a confecção simultânea das duas barras de acrílico não altera o potencial de lesão térmica, e, por último, recomenda-se especial atenção à distância da barra à pele, quanto mais espessa a barra, maior a deve ser a distância, observando-se neste experimento a distância mínima de 4mm em barras com diâmetro até 20mm, 6,5mm em barras com diâmetro até 25mm e 10,5mm para barras com diâmetro até 32mm.

Trauma är den vanligaste dödsorsaken bland unga människor i Sverige. Omhändertagandet vid trauma präglas av effektivitet och tiden är dyrbar för att snabbt identifiera patientens skador och behov av fortsatta medicinska- och omvårdnadsåtgärder. Patienten som drabbas av trauma är i ett utsatt läge och sjuksköterskan får inte glömma bort dennes omvårdnadsbehov i en komplex situation. Hur patienten själv ser på omhändertagande vid trauma lägger grunden för bemötandet. Syftet var att beskriva traumapatienters upplevelser av bemötande och omhändertagande på akutmottagningen.Den metod som användes var en allmän litteraturöversikt för att svara på studiens syfte. Sökningar utfördes i databaserna PubMed, CINAHL, samt manuella sökningar. I översikten inkluderades 17 vetenskapliga originalartiklar efter kvalitetsgranskning, dessa var publicerade 2010–2020. En integrerad analys användes för att analysera och syntetisera de artiklar som inkluderades.I resultatet uppkom fyra huvudkategorier; patientens upplevelse av traumateamets omhändertagande, kommunikationens betydelse för patienten, att vara patient i en utsatt situation och patientens upplevelse av vårdpersonalens bemötande. Under huvudkategorierna framkom flera underkategorier. Avseende traumateamets omhändertagande handlade det både om tillfredsställelse och missnöje med insatsen. Betydelsen av kommunikationen för patienten kunde delas in i god kommunikation, icke verbal kommunikation och bristande kommunikation. Att vara patient i en utsatt situation handlade om patientens upplevelse i en skrämmande situation på akutmottagningen och hur patienten upplevde undersökningar och procedurer. I huvudkategorin patientens upplevelse av vårdpersonalens bemötande handlade det om personalens kompetens, patientens upplevelse av att bli respekterad och sedd samt att patienten ej kände förtroende för personalen. Slutsatsen av litteraturstudien var att kommunikationen har en särskild betydelse vid traumaomhändertagande på akutmottagningen. Kommunikationen är inte bara betydelsefull initialt vid undersökningen utan även vid procedurer som att informera om skador, prognos och behandling samt vid utskrivning och återhämtningsfasen. / Trauma is the most common cause of death among young people in Sweden. Care in the event of trauma is characterized by efficiency and time is precious to quickly identify patients´injuries and the need for medical treatment and nursing care. The patient who suffers from trauma is in a vulnerable situation and the nurses must not forget his or her needs for nursing care in a complex situation. How the patient himself views care in the event of trauma lays the foundation for the treatment. The purpose was to describe trauma patients’ experience of treatment and care in the emergency department.The method used to respond to the purpose of the study was a general literature review. Article searches were performed in the database PubMed, CINAHL and through manual searches. Seventeen empirical original articles were included in the literature review after a quality review, the articles were published between 2010-2020. An integrated analysis was used to analyze and synthesize the included articles. In the result, four main categories emerged; the patient's experience of the trauma team's care, the importance of communication to the patient, being a patient in a vulnerable situation and the patient's experience of the healthcare professionals treatment. Under the main categories, several subcategories emerged. Regarding the trauma team's care, it was both about satisfaction and dissatisfaction with the effort. The meaning of communication could be divided into good communication, non-verbal communication and lack of communication. Being a patient in a vulnerable situation was about the patient's feelings in a frightening situation in the emergency department and how the patient experienced examinations and procedures. In the main category, the patient's experience with healthcare professionals' reply, they talked about the staff's competence, the patient's experience of being respected and seen and that the patient felt confidence in healthcare professionals. In conclusion, communication has a special significance throughout trauma care in the emergency department, both initially at the examination and when procedures were done and when informing the patient about injuries, prognosis and treatment, as well as the discharge and recovery phase.