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Bakgrund Ställningstagande till hjärt-lungräddning (HLR) innebär att utifrån ett medicinskt perspektiv väga nyttan av behandling mot riskerna som detta medför, samtidigt som patientens vilja tas i beaktande. Patienten kan behöva stöttning för att kunna vara delaktig i beslut kring den egna vården och det är sjuksköterskans uppgift att vägleda patienten i detta. Med hjälp av sjuksköterskan kan den existentiella hälsan främjas genom samtal om livet och synen på döden och lidandet. För att öka förståelsen och kunskapen kring dessa beslut finns det ett behov av att belysa patientens möjlighet att vara delaktig. Syfte  Syftet var att belysa patientens möjlighet att vara delaktig vid ställningstagande inför beslut om hjärt-lungräddning (HLR) vid inneliggande sjukhusvård. Metod Designen var en icke-systematisk litteraturöversikt och resultatet utformades med stöd i 15 vetenskapliga artiklar. Datainsamling utfördes i databaserna PubMed och CINAHL med hjälp av söktermer och artiklarna i resultatet kvalitetsgranskades utifrån Sophiahemmet Högskolas bedömningsunderlag. En integrerad dataanalys genomfördes för sammanställning av resultatet.  Resultat Utifrån resultatets innehåll utformades tre huvudkategorier; Kunskap kring hjärt-lungräddning vid ställningstagande, Tydlig dokumentation och tidig information om ställningstagande och Individuell diskussion med ansvarig läkare vid ställningstagande. Resultatet visade att de flesta patienter ville vara delaktiga i ställningstagande inför beslut om HLR, däremot var det många som inte fick chansen. Resultatet lyfte omständigheter och orsaker till detta samt hur vi kan inkludera patienter.  Slutsats  I vissa fall väljer vårdpersonal att exkludera patienten från ställningstagande. Studiens resultat betonar hur brist på delaktighet kan orsaka onödigt lidande för patienten och att detta med olika medel kan förhindras. Framför allt belyste studien en ökad möjlighet att vara delaktig när patienten får tidig information, det finns tydlig dokumentation och en god inställning till patientdeltagande hos vårdpersonal. / Background Decision-making regarding cardiopulmonary resuscitation (CPR) involves assessing the medical benefits and associated risks, while also considering the patient's preferences. Patients may require support to actively participate in decisions about their healthcare, and it is the nurse's responsibility to guide the patient in this process. With the assistance of a nurse existential well-being can be promoted through discussions about life and perspectives on death and suffering. To enhance understanding and knowledge of these decisions, there is a need to highlight the patient's opportunity for involvement. Aim  The aim was to illuminate the patient's opportunity to be involved in decision-making regarding cardiopulmonary resuscitation (CPR) during inpatient hospital care.  Method  The design was a non-systematic literature review and the results were formulated with the support of 15 scientific articles. Data collection was conducted in the PubMed and CINAHL databases using search terms and the articles in the results were quality-assessed based on Sophiahemmet University's assessment criteria. An integrated data analysis was performed for the compilation of the results.  Results  Based on the content of the results, three main categories were formulated: Knowledge about cardiopulmonary resuscitation in decision-making, Clear documentation and early information about decision-making and Individual discussions with the attending physician in decision-making. The results indicated that most patients want to be involved in decision-making regarding CPR however, many did not get the opportunity. The results highlighted circumstances and reasons for why and how we can include patients.   Conclusions  In certain instances, healthcare professionals choose to exclude the patient from decision-making. The findings of the study emphasize how this lack of involvement can lead to unnecessary suffering for the patient and how it can be prevented through various measures. Most notably, the study illuminated an enhanced potential for participation when the patient receives early information, there is clear documentation and healthcare personnel exhibit a positive attitude towards patient involvement.

Bakgrund: Hjärtstopp kan drabba vem som helst när som helst. Årligen drabbas omkring 13 000 svenskar av hjärtstopp. Omedelbar hjärt- och lungräddning ökar chansen att överleva med 50–70%. Livet efter hjärtstopp resulterar i kvarvarande symtom och det vardagliga livet präglas av fysiska, psykiska och existentiella omställningar. Vald teoretisk referensram är KASAM.  Syfte: Att beskriva patienters upplevelser av dagligt liv efter hjärtstopp.  Metod: Kvalitativ litteraturöversikt med induktiv ansats genomfördes. Det inhämtades 15 kvalitativa vetenskapliga artiklar från databaserna CINAHL, MEDLINE och PubMed. Dataanalysen utfördes i enlighet med Fribergs femstegsmodell.  Resultat: Litteraturöversiktens resultat består av tre teman med subteman. Det nya livet (Ett förändrat synsätt på livet, utmaningar i det fortsatta livet, närheten till döden). Att leva ett förändrat liv (Fysiska anpassningar, känslomässiga förändringar, kognitiva begränsningar). Stöd- och informationsbehov (Stöd från omgivningen, behov av information).  Slutsats: Hjärtstoppet är en traumatisk händelse som resulterar i att patienterna fick en andra chans i livet. Huvudfynden som framkom var: sökande efter mening, tankar på döden, försämrat minne och behov av stöd. Sjuksköterskan har som sitt ansvar att bemöta de här patienterna och tillgodose god vård för att stärka deras Känsla av sammanhang. Vidare forskning är av relevans som kan generera i ökad kunskap och förståelse för sjuksköterskan såväl som för patienterna. / Background: Cardiac arrest can affect anyone at any time, around 13 000 Swedes suffer from cardiac arrest annually. Life after cardiac arrest results in residual symptoms where everyday life is characterized with physical, psychological and existential adjustments. The chosen theoretical framework was SOC – Sence of coherence.  Aim: To describe patients experience of daily life after cardiac arrest. Method: A qualitative literature review with inductive approach was performed. It was obtained 15 qualitative academic journals from the databases CINAHL, MEDLINE and PubMed.  The analysis was performed in accordance with Friberg's analysis method.   Result: The result of the literature review consisted of three main themes with subthemes. The new life (A changed outlook on life, challenges in continued life, the nearness of death). Living a changed life (Physical adaptations, emotional changes, cognitive limitations). Need for support and information (Support from the surrounding, need for information).  Conclusion: The cardiac arrest was a traumatic event that resulted in the patients being given a second chance at life. The main findings that emerged was search for meaning, thoughts about death, impaired memory and need for support. It is the nurse's responsibility to meet these patients and provide good care to strengthen their Sense of coherence. Further research can generate increased knowledge and understanding for the nurse as well as the patients.

Bakgrund: För ambulanssjuksköterskor innefattar arbetet ofta långa transporter till sjukhus. Transporttiden kan variera mellan 20 - 60 minuter. Vid pågående avancerad hjärt-lungräddning med manuella kompressioner står ambulansteamet obältade i höga hastigheter, då mekanisk kompressionsutrustning saknas. Syfte: Syftet med studien var att undersöka ambulanssjuksköterskors upplevelse vid hjärtstoppsituationer med efterföljande längre transport till sjukhus. Metod: Tio ambulanssjuksköterskor intervjuades. Till analysen av insamlad data användes kvalitativ innehållsanalys med induktiv ansats. Resultat: Resultatet visade att situationer då ambulanssjuksköterskor behöver utföra avancerad hjärt-lungräddning under längre transport till sjukhus medför känslor av att vara otrygg och utlämnad. Mekanisk kompressionsutrustning är inte standardiserad i alla ambulanser. För att utföra manuella kompressioner under transport krävs det att ambulanssjuksköterskan står obältad. De säkerhetsrisker detta innebär för ambulanssjuksköterskan och patienten, leder till känslor av utsatthet och otrygghet. I den prehospitala miljön krävs ofta snabba beslut som kan vara livsavgörande, och ambulanssjuksköterskorna menar att en höjd kompetens inom ambulanssjukvården skulle ge dem en tryggare yrkesroll.  Ambulanssjuksköterskorna värdesätter samverkanslarmen och ser dessa som välfungerande. Slutsats: Resultatet visar att det finns behov av standardiserad mekanisk kompressionsutrustning i alla ambulanser, åtgärder för att stärka teamarbetet, samt kompetensutveckling i det dagliga arbetet. För att skapa trygga team bör erfarenhet vara en viktig aspekt vid rekrytering av ambulanssjuksköterskor. Detta för att öka tryggheten, säkerheten och effektiviteten för ambulanssjuksköterskor vid längre transport till sjukhus. Nyckelord: Ambulanssjuksköterska, upplevelse, avancerad hjärt-lungräddning, prehospital transport, säkerhet, bröstkompressionssystem, kvalitativ innehållsanalys / Abstract Background: For ambulance nurses work often involves long journeys to the hospital. Journey times vary between 20-60 minutes. When the mechanical compression equipment doesn`t exist, the ambulance team is performing advanced cardiopulmonary resuscitation with manual compressions, unbelted at high speeds. Aim: The aim of this study was to investigate the ambulance nurses experience of cardiac arrest situations with following longer transports to the hospital. Method: Ten ambulance nurses were interviewed. For the analysis of the collected data, qualitative content analysis with inductive approach was used. Results: The results showed that the situations when ambulance nurses need to perform advanced cardiopulmonary resuscitation during longer transports to the hospital, causes feelings of being unsafe and deserted. Mechanical compression equipment is not standardized in all ambulances, and manual compressions during transport requires that ambulance nurses are unbelted. The security risks this implies for the ambulance nurse and the patient, lead to feelings of vulnerably and insecurity. In the prehospital environment that often requires quick decisions that can be life changing, ambulance nurses believe that a higher competence in ambulance service would give them a more secure profession. Ambulance nurses value the interaction with rescue and police, and see them as well functioning. Conclusion: The results show that there is a need for standardized mechanical compression equipment in the ambulances, measures to strengthen the teamwork, and competence in the daily work. These measures could contribute to increased efficiency and greater security in the professional role of ambulance nurses during longer transports to the hospital. In order to create safety and confidence in the ambulance teams, experience should be considered as an important aspect when recruiting ambulance nurses. Keyword: Paramedic, experience, advanced cardiopulmonary resuscitation, prehospital transport, safety, chest compression, qualitative content analysis

Submitted in fulfillment for the degree of Master of Technology, Clinical Technology: Cardiovascular Perfusion, Durban University of Technology, Durban, South Africa, 2016. / Introduction: A large volume of residual haemodilute blood remains in the cardiopulmonary bypass (CPB) circuit after termination of the bypass. It is common practice in many centres to process residual pump blood with an autologus cell salvage system (ACSS), thereby producing a re-suspended red blood cell (RBC) concentrate and attenuating the need for donor blood RBC concentrate. It has also become standard practice to wash donor pack red blood cells (PRBC) before adding it to neonate cardiopulmonary circuits (Swindell et al., 2007). Manufactures of ACSS recommend 0.9% sodium chloride (NaCl) as a wash solution for processing salvaged blood. Previous studies have demonstrated that washing PRBC with normal saline results in acid-base (Huber et al., 2013) and electrolyte derangements (Varghese et al., 2007). Infusion of normal saline in healthy volunteers also results in significant changes in osmolality (Williams et al., 1999). The use of normal saline as a wash solution in processing residual CPB blood requires investigation. Aims and Objectives: This was a prospective, quantitative in vitro investigation to analyze and compare the quality of residual pump blood post CPB that had been washed with either an unbalanced electrolyte solution (0.9% normal saline) or a balanced electrolyte solution (Balsol®). Both are crystalloid solutions. The primary objective of the present study was to measure and compare the pH, electrolytes, metabolites, osmolality and strong ion difference (SID) of residual pump blood to the pH, electrolytes, metabolites, osmolality and SID of processed cell saver blood, which was washed with either 0.9% normal saline or Balsol® solution. The secondary objective was to measure and compare protein levels (albumin and total protein) in residual pump blood to protein levels in processed cell saver blood, that is washed with either 0.9% normal saline or Balsol® solution. The final objective was to determine the volume, haematocrit and haemoglobin yield post cell saver processing, from the input volume of residual pump blood when washed with either 0.9% normal saline or Balsol® solution. This was the first study of this nature done in the South African population group. Methodology: In this investigation in a series of forty patients (n=40) undergoing elective cardiac surgery with CPB, the first twenty patients were allocated to the NaCl control group (n=20) and the second twenty patients were allocated to the Balsol® interventional group (n=20). The extracorporeal circuit consisted of a standard integral hollow fibre membrane oxygenator and tubing that was primed with 1500-1800 millilitres of balanced crystalloid solution (Balsol®), for both the control group and the interventional group, and addition of 5000 iu heparin. The balanced crystalloid solution (Balsol®) is the approved standard CPB priming solution for all cardiac procedures at Inkosi Albert Luthuli Central Hospital. This setup was used with the Stockert S5 roller pump heart lung machine. The operations were performed as per protocol with standard non-pulsatile CPB and hypothermia was maintained at 28 – 32 ºC (core) and haemodilution (haematocrit 20 % to 30 %). A standard flow rate of 2.4 L/min/m² was used. Cardio protection consisted of either cold Blood Cardioplegia using the Buckberg 4:1 ratio, being four parts blood to one part cardioplegia (with the 35ml of 20 % Dextrose + 1 gram Magnesium Sulphate added per 500ml), or 20ml/kg cold St Thomas II cardioplegia (with addition of 10ml of 8.5% NaHCO3 + 100mg lignocain per litre). Topical cooling was achieved with ice cold 0.9 % saline. Maintenance fluid used during CPB was Balsol® for both the control and the interventional groups. Calcium, potassium and sodium bicarbonate was administered as required during CPB to correct deficits for both groups. Weaning of CPB was performed after re-warming to a rectal temperature of at least 35 ºC for both study groups. Immediately on termination of CPB a blood sample was taken from the sampling manifold of the CPB circuit for pre wash analysis. Residual pump blood was then flushed out with one litre of Balsol® solution for both groups and collected into the Medtronic autolog cell saver reservoir to be processed. In the control study group 0.9% NaCl was used as the wash solution and in the interventional study group Balsol® solution was used as the wash solution. After processing of the salvaged blood is complete, a blood sample was taken for post wash analysis. Clinical data recorded for pre and post wash samples included: pH, pCO2, pO2, [K+], [Na+], [Cl-], [Ca2+], lactate, glucose, [HCO3-], TCO2, haematocrit, haemoglobin (GEM 4000® premier™ blood gas analyser) blood volume (Medtronic autolog) and SID (calculated as per equation). Inorganic phosphate, total magnesium, albumin, total protein (Siemens Advia 1800 blood gas analyser) and osmolality (Gonotech osmometer) were also measured. Results: There was a highly significant decrease (p < 0.05) within the NaCl group after washing with pCO2 (28.3 ± 2.9 vs. <6.0 ± 0.0), [K+] (4.5 ± 0.5 vs. 1.0 ± 0.7), total magnesium (1.7 ± 0.7 vs. 0.29 ± 0), ionized calcium (1.0 ± 0.09 vs. 0.1 ± 0.03), inorganic phosphate (0.9 ± 0.4 vs. 0.09 ± 0.04) and SID (27.1 ± 2.1 vs. 18.4 ± 2.2). There was a highly significant increase (p < 0.05) within the NaCl group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [Na+] (132.9 ± 3.2 vs. 146.3 ± 1.9), [Cl-] (107.8 ± 3.1 vs. 127.4 ± 2.1) and osmolaltity (256.9 ± 38.4 vs. 296.2 ± 57.5). There were highly significant decrease (p < 0.05) within the Balsol® group after washing with pCO2 (30.15 ± 6.0 vs. 18.9 ± 4.9), [Na+] (134.7 ± 2.2 vs. 125.6 ± 1), [Cl-] (108.8 ± 2.7 vs. 100.2 ± 1.4), ionized calcium (0.9 ± 0.1 vs. 0.02 ± 0.04), inorganic phosphate (0.8 ± 0.2 vs. 0.1 ± 0.024) and osmolality (288.8 ± 20.6 vs. 272.8 ± 19.9). There were highly significant increase (p < 0.05) within the Balsol® group after washing with pH (7.5 ± 0.1 vs. 7.7 ± 0.1), [K+] (4.2 ± 0.4 vs 4.6 ± 0.3). Total magnesium and SID were similar after washing within the Balsol® group. Albumin and total protein revealed similar significant decreases within both groups after washing. There was a highly significant difference (p < 0.05) in the change between groups after washing in all the variables measured, except for pH, inorganic phosphate, lactate, glucose, albumin, total protein, haematocrit, haemoglobin, and blood volume. Total carbon dioxide and [HCO3-] were not compared because they were incalculable by blood gas analyser in the NaCl group. Conclusion: This investigation concluded that the balanced electrolyte solution Balsol® used for washing residual CPB blood results in a re-suspended RBC concentrate, with an osmolality and electrolyte profile that is superior compared to washing residual CPB blood with 0.9% NaCl solution. / M

This thesis deals with the knowledge of processes and practical skills of cardiopulmonary resuscitation among nurses working in the field of anesthesia and intensive medicine. The theoretical part of this paper defines the notion of cardiopulmonary resuscitation, deals with its history, changing definitions, and the latest recommendations. It also describes and specifies terms such as competence, knowledge of the processes and the role of the nurse in the system. The empirical part, using a questionnaire survey, assesses orientation of nurses and nurses specialists in the latest recommendations in cardiopulmonary resuscitation and the related knowledge and competences in the use of resuscitation itself. The questionnaire survey was answered by 152 respondents from 3 large hospitals in Prague. There were also the results of its investigation, compared with the results of research conducted by Václav Kukol in 2010 - 2011 as part of their thesis. In the final discussion paper evaluates the confirmation of the hypotheses. Then attach the recommendations for practice.

INTRODUÇÃO: Endomiocardiofibrose (EMF) é uma cardiomiopatia restritiva (CMR), caracterizada por uma disfunção diastólica, mas com a função sistólica e a fração de ejeção preservadas ou, em fases avançadas da doença, pouco prejudicadas. O consumo máximo de oxigênio (VO2) é um marcador de mortalidade na insuficiência cardíaca sistólica (ICS). Apesar da mortalidade ser semelhante entre a CMR e ICS, ainda não é conhecido se o treinamento físico pode melhorar o VO2 pico em pacientes com EMF. O objetivo deste estudo foi verificar se 4 meses de treinamento combinado podem melhorar a capacidade funcional e qualidade de vida em pacientes com EMF. MÉTODOS: Vinte e um pacientes com EMF (classe funcional II e III, NYHA) foram divididos em 2 grupos: treinamento físico (EMF-TF, n = 9) e sedentários (EMF-Sed, n = 12). Foram avaliados: VO2 pico, pulso de O2, relação deltaFC/deltaVO2 e relação deltaVO2/deltaW, pelo teste cardiopulmonar (TECP); volume diastólico final (VDF), volume sistólico (VS) e volume diastólico do átrio esquerdo (AE), pela ecocardiografia (Simpson); e qualidade de vida, pelo questionário Minnesota Living With Heart Failure Questionnaire (MLWHFQ). Os resultados do TECP dos pacientes com EMF foram comparados com os resultados de indivíduos controle saudáveis sedentários (CSS). Foi considerado significativo P < 0,05. RESULTADOS: Idade não foi diferente entre EMF-Sed, EMF-TF e CSS (58±9 vs. 55±8 vs. 53±6 anos, P = 0,31; respectivamente). O grupo EMF-TF apresentou um aumento do VO2 pico pós-intervenção, comparado com o momento pré e comparado com o grupo EMF-Sed, mas esse valor foi menor, comparado ao CSS (17,4 ± 3,0 para 19,7 ± 4,4 vs. 15,3 ± 3,0 para 15,0±2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectivamente). O pulso de O2 do grupo EMF-TF no momento pós-intervenção foi maior, comparado ao momento pré e ao grupo EMF-Sed, mas foi semelhante, quando comparado ao grupo CSS (9,3 ± 2,6 para 11,1 ± 2,8 vs. 8,6 ± 2,2 para 8,6 ± 1 vs. 11,2 ± 2,9 ml/batimentos; P < 0,05; respectivamente). A relação deltaFC/deltaVO2 diminuiu no momento pós-intervenção no grupo EMF-TF, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (75 ± 36 para 57 ± 14 vs. 68 ± 18 para 73 ± 14 vs. 56±17 bpm/L; P < 0,05; respectivamente). O grupo EMF-TF reduziu significativamente a relação deltaVO2/deltaW, após o período de treinemento, comparado ao momento pré e ao grupo EMF-Sed, igualando-se ao grupo CSS (12,3 ± 2.8 para 10,2 ± 1.9 vs. 12,6±1.7 para 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectivamente). O treinamento físico também aumentou o VDF do grupo EMF-TF, quando comparado ao grupo EMF-Sed (102,1 ± 64,6 para 136,2 ± 75,8 vs. 114,4 ± 55,0 para 100,4 ± 49,9 ml; P < 0,001; respectivamente) e o VS (57,5±31,9 para 72,2 ± 27,4 vs. 60,1 ± 25,2 para 52,1 ± 18,1 ml; P = 0,01; respectivamente), e diminuiu o volume diastólico do AE [69,0 (33,3- 92,7) para 34,9 (41,1-60,9) vs. 44,6 (35,8-73,3) para 45,6 (27,0-61,7) ml; P < 0,001; respectivamente). A qualidade de vida dos pacientes EMF-TF, quando comparados com o grupo EMF-Sed também melhorou após o período de treinamento físico (45±17 para 27±15 vs. 47±20 para 45 ± 23 pontos; P < 0,05; respectivamente). CONCLUSÃO: Esses resultados esclarecem que os pacientes com EMF se beneficiaram com o treinamento físico combinado, enfatizando a importância dessa ferramenta não farmacológica no tratamento clínico habitual desses pacientes / BACKGROUND: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy (RCM), characterized by a diastolic dysfunction, but with preserved systolic function and preserved ejection fraction, except in severe cases, in which these two present mild reduction. Maximal oxygen consumption (VO2) is a marker of mortality in systolic heart failure (SHF). Although mortality in RCM can be similar to SHF, it is still unknown if physical training can improve peak VO2 in patients with EMF. The aim of the present study was to evaluate if 4 months of combined physical training could improve functional capacity and quality of life in patients with EMF. METHODS: Twenty one EMF patients (functional class II and III, NYHA) were divided into 2 groups: physical training (EMF-PT, n = 9) and sedentary (EMF-Sed, n = 12). Peak VO2, O2 pulse, deltaFC/deltaVO2 relation and deltaVO2/deltaW relation were evaluated by cardiopulmonary exercise test (CPX); end diastolic volume (EDV), stroke volume (SV) and left atrium diastolic volume were evaluated by echocardiography (Simpson); and quality of life was evaluated by Minnesota Living With Heart Failure Questionnaire (MLWHFQ). CPX results from EMF patients were compared to a healthy sedentary (HS) control group. Significance was considered P < 0,05. RESULTS: Age was not different between EMF-PT, EMF-Sed and HS (58 ± 9 vs. 55±8 vs. 53 ± 6 years, P = 0,31; respectively). EMF-PT group presented an increase in peak VO2 after training compared to EMF-Sed group, but was lower compared to HS (17,4 ± 3,0 to 19,7 ± 4,4 vs. 15,3 ± 3,0 to 15,0 ± 2.0 vs. 24,5 ± 4,6 ml/kg/min, P < 0,001; respectively). O2 pulse in EMF-PT group increased after training compared to EMFSed group, and was similar compared to HS (9,3 ± 2,6 to 11,1±2,8 vs. 8,6±2,2 to 8,6 ± 1 vs. 11,2±2,9 ml/betas; P < 0,05; respectively). deltaFC/deltaVO2 relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (75 ± 36 to 57 ± 14 vs. 68 ± 18 to 73 ± 14 vs. 56 ± 17 bpm/L; P < 0,05; respectively). deltaVO2/deltaW relation decreased after training in EMF-PT group compared to EMF-Sed group, and was similar compared to HS (12,3 ± 2.8 to 10,2 ± 1.9 vs. 12,6 ± 1.7 to 12,4 ± 1.7 vs. 10,0 ± 0,9 ml/min/Watts; P = 0,002; respectively). Physical training also increased EDV in EMF-PT compared to EMFSed (102,1±64,6 to 136,2±75,8 vs. 114,4±55,0 to 100,4±49,9 ml; P < 0,001; respectively) and SV (57,5±31,9 to 72,2±27,4 vs. 60,1±25,2 to 52,1±18,1 ml; P = 0,01; respectively), and decreased left atrium diastolic volume [69,0 (33,3-92,7) to 34,9 (41,1-60,9) vs. 44,6 (35,8- 73,3) to 45,6 (27,0-61,7) ml; P < 0,001; respectively). Quality of life in EMF-PT group improved after training when compared to EMF-Sed group (45±17 to 27±15 vs. 47 ± 20 to 45 ± 23 points; P < 0,05; respectively). CONCLUSION: These results point out that patients with EMF benefit from combined physical training emphasizing the importance of this nonpharmacological tool in the clinical treatment of these patients

Este estudo objetivou conhecer a prevalência de parada cardiorrespiratória (PCR) atendida pelo SAMU de Araras entre 2001 e 2007, caracterizar as vítimas segundo o sexo, faixa etária, antecedentes mórbidos, natureza traumática do evento; a parada ter sido presenciada, realização de ressuscitação cardiopulmonar (RCP) por familiares/acompanhantes, tempo resposta, tipo de suporte de vida recebido na cena, indicação de choque pelo Desfibrilador Externo Automático (DEA), assim como identificar as variáveis significativas para o retorno da circulação espontânea na cena. Os dados foram coletados retrospectivamente das fichas de atendimento das vítimas de PCR do SAMU de Araras após aprovação do Comitê de Ética em Pesquisa da EEUSP. Foram selecionadas 328 fichas que preencheram os critérios de inclusão. O SAMU de Araras realizou 28.924 atendimentos gerais no período estudado, dos quais em 330 foram iniciadas as manobras de ressuscitação cardiopulmonar. A taxa de PCR no período avaliado é 1,13%, com predomínio do sexo masculino 208 (64,60%) e faixa etária entre 70 e 79 anos, média de idade 63,35 anos. Os antecedentes mórbidos mais citados foram cardiopatias (29,48%), hipertensão arterial sistêmica (25,43%) e diabetes (12,14%), a maioria com citação de um único antecedente ou sem este registro. Não havia trauma associado em 302 (92,64%) vítimas. O DEA foi utilizado em 280 (85,37%) vítimas, com indicação de choque em 95 (29%). A PCR foi presenciada em 115 (35,00%) vítimas, para as quais houve maior percentual de início de RCP (p=0,004) pela família/ acompanhante e houve mais indicação de choque pelo DEA(p<0,001) em relação às vítimas que foram encontradas em PCR. Houve maior proporção do retorno da circulação espontânea nas vítimas que receberam suporte avançado de vida na cena 54(31,76%), (p=0,018) em relação às que receberam somente suporte básico de vida. O tempo resposta médio foi de 05:24 minutos. Pela análise univariada, as seguintes variáveis foram significativas (p<0,05) para o retorno da circulação espontânea: faixa etária (p=0,018), diabetes melitus (p<0,001), responsividade (p=0,041), pulso carotídeo presente na avaliação inicial (p= 0,001), compressões torácicas pelo SAMU (p=0,028), choque pelo DEA (p<0,001), suporte avançado de vida (p=0,018), intubação traqueal (p<0,001). No modelo de regressão logística múltipla apenas \"pulso carotídeo presente na abordagem inicial\" foi selecionada como preditora independente para o retorno da circulação espontânea na cena (Odds Ratio 4,03), p =0,002.Concluiu-se que o serviço oferece um tempo resposta dentro dos padrões mundialmente recomendados e que as vítimas que tiveram PCR presenciada, apesar de receberem proporcionalmente mais RCP pela família/acompanhante e terem mais indicação de choque pelo DEA, não apresentaram mais retorno da circulação espontânea na cena. As vítimas com pulso presente na avaliação inicial do SAMU, isto é, as que tiveram a PCR presenciada pela equipe, ou tempo resposta \"zero\" têm 4,03 mais chances de retorno da circulação espontânea na cena, sendo esta variável a única preditora independente. O investimento em capacitação permanente da equipe do SAMU, ensino da população a reconhecer um evento crítico, iniciar manobras de reanimação e acionar precocemente o SAMU poderão contribuir para aumentar as chances de sobrevivência de vítimas de PCR em ambiente pré-hospitalar / The objective of this study was to know the prevalence of cardiac arrest (CA) assisted by Emergency Medical Service of the City of Araras (SAMU-Araras), SP, Brazil, between 2001 and 2007, classifying victims according to the gender, age groups, morbid antecedents, traumatic nature of the event, witnessed arrest, accomplishment of cardiopulmonar ressuscitation (CPR) by bystanders, time elapsed between the call of SAMU and the arrival of the EMS team to the site (time-response), type of life support received on-scene, shock indication for AED, as well as to compare the outcome of these cases, in terms of return of the spontaneous circulation (ROSC) still on scene, according to those variables. Data were collected from the records of SAMU of Araras, after approval of the Research Ethics Board of the Nurse School of University of São Paulo (EEUSP). 328 records that fulfilled the criteria were selected. SAMU-Araras accomplished 28.924 general medical attendances in the period of the study. In 330, CPR was performed (1.13%). Man (64.60%) and age group between 70 e 79 years old were predominants, and 63,35 yo. was the average. The mentioned prior diseases were cardiopathy (29.48%), sistemic arterial hypertension (25.43%) and diabetes (12.14%), most of all with just one problem cited or even no prior diseases. There was not associated trauma in 92.64% of the cases. AED was used in 85.37% of the cases were CPR was performed, with shock indication in 95 (29%) victims. CA was witnessed in 115 (35.00%) victims. In these cases, CPR performed by relatives were more frequent (p=0.004), as well as shock was more frequently indicated (p <0.001) compared with those where CA was not witnessed. There was larger proportion (51.83%) of ROSC in the victims that received advanced life support on scene, (p=0.018) comparing to the ones that received only basic life support. The time-response average was 05:24 minutes. The following variables presented statistical association (p <0.05) for ROSC: age group (p=0.018), diabetes (p <0.001), responsivity (p=0.041), carotid pulse present at the time of initial assesment (p=0,001), thoracic compressions by the SAMU team (p=0.028), shock delivered by AED (p <0.001), advanced life support performed (p = 0.018), and use of tracheal tube (p <0.001). In the statistical model of multiple logistics regression only the variable \"carotid pulse present at the time of initial assesment\" was selected as independent predictor for the return of the spontaneous circulation on scene (Odds Ratio 4.03), p =0.002. In conclusion, the SAMU-Araras offers a time-response according to international recommendations. Victims that have had witnessed CA, although received more frequenty CPR and recommended shock, they did not have better outcomes. The victims with present pulse in the initial assessment by the SAMU team, or in other words, the ones that presented CA witnessed by the SAMU team, had 4.03 more times in terms of chances of ROSC on scene, being this an independent predictor. The investment in permanent training of the SAMU professionals, the education for the people recognize a critical event and immediately to begin CPR can contribute to increase the survival chances for victims of CA in prehospital environment

Os profissionais da área de saúde deparam-se constantemente com situações que envolvem risco de vida para os clientes, uma delas é a parada cardiorrespiratória (PCR) e necessita que sejam instituídas mais rapidamente as manobras de ressuscitação cardiopulmonar (RCP) que compreende o Suporte Básico de Vida (SBV) e o uso de Desfibrilador Externo Automático (DEA). Trata-se de um estudo exploratório descritivo com o objetivo de identificar a HABILIDADE (prática) e o CONHECIMENTO (teórico) dos alunos dos cursos de graduação da área da saúde, de uma universidade privada no interior do Estado de São Paulo, antes e após serem submetidos ao curso/ treinamento. A coleta dos dados foi dividida em duas etapas sendo: 1ª. Etapa - avaliação do conhecimento teórico e prático prévio antes de um curso teórico com demonstração prática das manobras de RCP com uso do DEA e treinamento utilizando o laboratório de práticas com o manequim de RCP e o DEA; 2ª. Etapa avaliação teórica e prática individual. Foram incluídos 173 alunos com faixa etária de 17 a 23 anos, 151 (87,3%) do sexo feminino; na Avaliação da HABILIDADE na 1ª. Etapa, a pontuação máxima foi de 91 pontos 69 (39,9%) alunos e 104 (60,1%) alunos não pontuaram, na 2ª. Etapa a pontuação máxima obtida foi de 260 pontos por 101(58,4%) alunos. Na Avaliação do CONHECIMENTO, a pontuação máxima foi de 5,75 pontos e a pontuação mínima de 1,0 ponto na 1ª. Etapa. Na 2ª. Etapa, a pontuação máxima foi de 10,0 pontos por sete (4,0%) alunos, nenhum aluno obteve pontuação inferior a 7,5 pontos. Para 19 itens a diferença foi significativa na Avaliação da HABILIDADE da 1ª para a 2ª. Etapa em todos os grupos de conteúdos sendo: Avaliação inicial e responsividade 2 itens; Abertura das vias aéreas e manobras de respiração - 6 itens; Avaliação do pulso carotídeo e compressões torácicas - 3 itens e Manuseio do DEA 8 itens. Para 9 questões a diferença foi significativa na Avaliação do CONHECIMENTO da 1ª para a 2ª. Etapa em dois grupos de conteúdos: Abertura das vias aéreas e manobras de respiração - 3 questões e Manuseio do DEA 6 questões. As 13 questões que não apresentaram bom desempenho na 2ª. Etapa do estudo, no Conhecimento, estão agrupadas nos conteúdos: Avaliação inicial e responsividade; Abertura das vias aéreas e manobras de respiração e Manuseio do DEA. Quanto comparados a HABILIDADE e o CONHECIMENTO verifica-se que houve melhora no desempenho da primeira para a segunda etapa em todos os itens e questões (p=0,0001). Quanto ao treinamento a média do tempo de observação foi de 78,3 minutos e o tempo de treino foi de 117,1 minutos. Em relação à HABILIDADE os itens que não atingiram bom desempenho na 2ª. Etapa estão nos conteúdos Avaliação inicial e responsividade e Manuseio do DEA e em relação ao CONHECIMENTO as questões que não atingiram bom desempenho estão nos conteúdos Avaliação inicial e responsividade; Abertura das vias aéreas e manobras de respiração e Manuseio do DEA. Conclui-se que tanto na HABILIDADE quanto no CONHECIMENTO houve melhora no desempenho dos alunos. / The health professionals faced with situations involving risk of life for patients, one of them is cardiopulmonary arrest (CA) and needs to be established more quickly cardiopulmonary resuscitation (CPR) involving the Basic Life Support (BLS) and use of Automated External Defibrillator (AED) This is a exploratory study aiming to identify the skill (practice) and knowledge (theoretical) of the students in health undergraduate students in a private university in the state of São Paulo, before and after their submitted to the course / training. Data collection was divided into two stages as follows: 1st. Step - Evaluation of knowledge practical and theoretical and course with prior practical demonstration of CPR maneuvers using the AED, 2nd. Step - training and theory/practice evaluation individual, using laboratory practices with the manikin CPR and AED. 173 students were included aged 17 to 23 years, 151 (87.3%) were female; the skill evaluation in the 1st. Step, the maximum score of 91 points was 69 (39.9%) and 104 students (60.1%) were not scored in the 2nd. Step a maximum score of 260 points was obtained for 101 (58.4%) students. The Knowledge evaluation, the maximum score was 5.75 points in the 1st. Stage and a minimum score of 1.0 in the 2nd. Step, the maximum score was 10.0 points in seven (4.0%) students, no students scored less than 7.5 points. For 19 items the difference was significant in the skill evaluation the 1st to 2nd. Step in all groups of content being: \"Initial evaluation and responsiveness\" - 2 items, \"Opening the airway and breathing maneuvers\" - 6 items, \"Evaluation of the carotid pulse and chest compressions - items 3 and \" Handling the DEA \"- 8 items. In nine questions for the difference was significant in the Knowledge evaluation from the 1st to 2nd. Step into two groups of content: \"Opening the airway and breathing maneuvers\" - three questions and \"Handling the DEA\" - 6 issues. The 13 questions that did not show good performance in the 2nd. Stage of the study on Knowledge, are grouped by content: \"Initial evaluation and responsiveness,\" \"Opening the airway and breathing maneuvers\" and \"Handling the DEA.\" As compared with the skill and knowledge there is a significant improvement in performance from first to second step on all the items and issues (p = 0.0001). As for training the average observation time was 78.3 minutes and the workout time was 117.1 minutes. Regarding skill items that did not achieve good performance in the 2nd. Step in the contents are Initial evaluation and responsiveness and Handling the DEA and about the knowledge the questions that are not achieved a good performance in the contents Initial evaluation and responsiveness, Opening the airway and breathing maneuvers and Handling the DEA. We conclude that both the skill and knowledge in significant improvement in student performance.

Introdução: O Brasil é o maior produtor mundial de cana-de-açúcar e de seus produtos, açúcar e etanol. A colheita predominantemente manual, expõe o trabalhador a uma série de riscos á saúde, como esforço físico, calor e poluentes, decorrentes da queima da palha da cana. Objetivos: Avaliar a ocorrência de efeitos cardiovasculares e respiratórios e possíveis mecanismos implicados nos mesmos, associados ao trabalho no corte de cana-de-açúcar queimada. Métodos: Vinte e oito cortadores de cana-de-açúcar, brancos, sexo masculino, hígidos, residentes em uma região do interior do Estado de São Paulo, foram submetidos à avaliação através de marcadores sanguíneos, monitoramento ambulatorial da pressão arterial, eletrocardiograma de 24 horas, prova de função pulmonar, tomografia de tórax de alta resolução, testes de caminhada de seis minutos, Incremental (Schuttle Test), e do exercício cardiopulmonar, medida direta da atividade nervosa simpática no nervo fibular, medida do fluxo sanguíneo muscular no antebraço, teste de transporte mucociliar e avaliação de efeitos genotóxicos (análise de micronúcleos na mucosa oral), durante o período de trabalho no corte de cana queimada (Safra) e quatro meses após, quando desempenhavam outras atividades. Foram realizadas medições de material particulado (PM2.5) e de variáveis climáticas. Os dados obtidos foram comparados através de testes estatísticos para medidas repetidas. Para avaliar o efeito do trabalho na safra e de outras variáveis, foram realizadas análises de regressão linear multivariada. Para o Teste de micronúcleo utilizou-se um grupo controle de 17 indivíduos da região, mesma faixa etária que nunca tinham trabalhado no corte de cana. Resultados: Os participantes do estudo tinham 31±6.3 anos e trabalhavam em média 9.8±8.4 anos no corte de cana-de-açúcar queimada. Durante a safra a concentração de material particulado foi mais elevada no canavial (84,69±23,90 vs 53,20±14,82, p<0.001) e o índice de sobrecarga térmica alcançou níveis elevados (28,40C). O trabalho durante a safra esteve associado a maiores níveis de Creatinina Fosfoquinase (mediana e intervalo interquartil), 136.5(108.5-216) vs 104.5 (77.5-170.5)U/L; p=0.001, Glutationa Peroxidase (55.1±11.8 vs 39.5±9.6Ug/Hb; p<0.001), Malonaldeido (0.08±0.01vs0.07±0.01m/ml; p=0.033), pressão sanguínea arterial sistólica de 24 horas (120.14±10.31 vs 117.00 ± 9.96 mmHg; p=0.047). A pressão diastólica aumentou durante o teste de exercício durante a safra (11.12mmHg; p<0,001). Na Tomografia de alta resolução do tórax houve um percentual elevado de micronódulos centrolobulares (70,90%) e espessamento da parede brônquica (51,61%). O tempo de transporte mucociliar foi maior na safra (23,4±14 vs 15,9±6,7, p=0,001). A contagem de micronúcleos entre os cortadores foi maior que no grupo controle, no período da safra (7,89±5,81 vs 4,24±4,51, p=0,010) e no período da entressafra (11,82±11,08 vs 4,24±4,51, p=0,017). A redução da variabilidade da freqüência cardíaca e aumento da atividade simpática estiveram significativamente associados a aumento da pressão arterial. Conclusão: O trabalho durante a safra se associou à alterações cardiovasculares (aumento da pressão arterial no repouso e no exercício), possivelmente mediada por estresse oxidativo e desbalanço autonômico, alterações respiratórias (alterações de imagens e transporte mucociliar) e aumento de micronúcleos. / Introduction: Brazil is the worlds largest producer of sugarcane and its products, sugar and ethanol. The predominantly manual harvest exposes workers to a series of health risks from sugarcane burning, such as physical exertion, heat and pollutants. Objectives: To evaluate the occurrence of cardiovascular and respiratory effects and possible mechanisms associated with them in burnt sugarcane harvesting work. Methods: Twenty-eight sugarcane harvesters, all Caucasian, healthy, male, residing in the countryside of São Paulo state, were evaluated through blood markers, twenty-four hours ambulatory blood pressure monitoring, twenty-four hours eletrocardiography Holter monitoring, pulmonary function testing, chest HRCT, six-minute walk tests, shuttle walk test, cardiopulmonary exercise testing, muscle sympathetic nerve activity in the peroneal nerve, muscle blood flow in the forearm, mucociliary transport test and evaluation of genotoxic effects (analysis of micronuclei in the oral mucosa) during burnt sugarcane harvest period and four months later, when the workers performed other activities. The study measured particle size (PM2.5) and climate variables. The obtained data were compared using statistical tests for repeated measurements. Multivariate linear regression analyses were used to evaluate the effect of work during the harvest period and of other variables. For the micronucleus test, a control group was used consisting of 17 local individuals, in the same age range, who had never worked in sugarcane harvesting. Results: Participants had a mean age of 31±6.3 years and had worked for an average of 9.8±8.4 years on the harvesting of burnt sugarcane. During the harvest period, the concentration of particulate matter was higher in the sugarcane field (84.69±23.90 vs. 53.20±14.82, p<0.001) and the thermal overload index reached high levels (28.40C). Work during the harvest period was significantly associated with high serum levels of Creatine Kinase (median and interquartile range), 136.5 (108.5-216) vs. 104.5 (77.5- 170.5) U/L; p=0.001, Glutathione Peroxidase (55.1±11.8 vs. 39.5±9.6 Ug/Hb; p<0.001), Malonaldehyde (0.08±0.01 vs. 0.07±0.01m/ml; p=0.033), and 24- hour systolic blood pressure (120.14 ± 10.31 vs. 117.00 ± 9.96 mmHg; p=0.047). Diastolic blood pressure increased during the cardiopulmonary test for the harvest period (11.12 mmHg; p=0.001). In chest HRCT we noted high prevalence of centrilobular micronodules (70.90%) and bronchial wall thickening (51.61%). Mucociliary transport time was greater during the harvest period (23.4±14 vs. 15.9±6.7, p=0.001). The micronucleus count among harvesters was higher than for the control group, during the harvest period (7.89±5.81 vs. 4.24±4.51, p=0.010) and in the non-harvest period (11.82±11.08 vs. 4.24±4.51, p=0.017). The reduction in heart rate variability and higher sympathetic activity were significantly associated with higher blood pressure. Conclusion: Work during the harvest season was associated with cardiovascular changes (higher blood pressure at rest and during exercise), which may possibly be linked to oxidative stress and autonomic imbalance, as well as respiratory changes (changes in imaging and mucociliary transport) and increased micronuclei.