INTRODUÇÃO: Intubação traqueal é habilidade essencial para o atendimento de emergências, porém, na população pediátrica é procedimento menos frequente e mais difícil que na população adulta. A intubação apresenta em situações controladas uma baixa taxa de complicações. No entanto, no departamento de emergência pediátrica é procedimento de maior risco. O uso de videolaringoscopia é uma alternativa a laringoscopia direta. Há escassa evidência do uso sistemático do videolaringoscópio na emergência pediátrica. Nossa hipótese é que o uso do videolaringoscópio propiciará maior sucesso em intubação traqueal na primeira tentativa, e que diminuirá complicações da intubação traqueal. OBJETIVOS: Comparar as taxas de sucesso de intubação traqueal entre pacientes pediátricos maiores de um ano intubados usando videolaringoscopia ou laringoscopia direta. Comparar a frequência de eventos associados à intubação traqueal e presença de queda da saturação de oxigênio entre estes pacientes. MÉTODOS: Estudo clínico prospectivo de intervenção, não randomizado, aberto, com controle de série histórica. Realizado em departamento de emergência pediátrica terciário. Foram avaliados registros de intubação de pacientes maiores de um ano, por 23 meses, entre julho de 2016 e maio de 2018, com 50 intubações com videolaringoscópio (grupo VL), comparados com série histórica de 5 anos, entre julho de 2005 e dezembro de 2010, com 141 intubações com laringoscopia direta (grupo LD). RESULTADOS: A taxa de sucesso em primeira tentativa no grupo VL foi 68% (34/50), comparada com 37,6% (53/141) do grupo LD (p < 0,01). Houve menor proporção de eventos associados à intubação traqueal no grupo VL com 31,3% (15/50), versus 67,8% (97/141) no grupo LD (p < 0,01), não houve diferenças significantes na queda de saturação. CONCLUSÕES: Videolaringoscopia apresentou maior sucesso em primeira tentativa e menor taxa de complicações. Esse resultado sugere que videolaringoscópio pode ser considerado como primeira escolha nas intubações de pacientes pediátricos no departamento de emergência / INTRODUCTION: Tracheal intubation is an essential skill to treat emergencies, but it is a less frequent and more difficult procedure in the pediatric than in the adult population. Intubation presents a low rate of complications in controlled situations. However, in the pediatric emergency department is a higher risk procedure. The use of video laryngoscopy is an alternative to direct laryngoscopy. There is scant evidence of the systematic use of video laryngoscopes in pediatric emergency. Our hypothesis is that the use of video laryngoscope will lead to greater success in tracheal intubation in the first attempt, and will reduce complications of tracheal intubation. OBJECTIVES: To compare the success rates of tracheal intubation among pediatric patients over one year old intubated with video laryngoscopy or direct laryngoscopy. To compare the frequency of tracheal intubation associated events and decreased oxygen saturation among these patients. METHODS: This was a prospective, non-randomized, open-label clinical study with historical control. Study conducted in a pediatric tertiary emergency department. We compared intubation records of children over one year old, for 23 months, between July 2016 and May 2018, with 50 video laryngoscope intubations (VL group), with a 5-year historical series between July 2005 and December 2010, with 141 intubations with direct laryngoscopy (DL group). RESULTS: The first pass success rate in the VL group was 68% (34/50), compared with 37.6% (53/141) DL group (p < 0.01). There was a lower proportion of tracheal intubation associated events in the VL group, with 31.3% (15/50) versus 67.8% (97/141) in the DL group (p < 0.01), there were no significant differences in desaturation. CONCLUSIONS: Video laryngoscopy was more successful in the first intubation attempt and had lower rate of complications. This result suggests that video laryngoscope may be the first choice device in pediatric intubations in the emergency department

Made available in DSpace on 2016-04-27T13:10:25Z (GMT). No. of bitstreams: 1 Felipe de Oliveira Teixeira.pdf: 4494823 bytes, checksum: b79e7cc14bee173dfbab0821976829bf (MD5) Previous issue date: 2014-08-26 / Education through simulation of real treatment has been proved a very useful tool in medical courses. Advantages of this methodology include safe environment for learning, possibility of error without any risk to patients and the development of various skill categories. The use of high-fidelity mannequins simulators (robots) is a good example of simulation can be employed for teaching several situations, like medical emergencies care. Objective: The aim of this study was to evaluate the contribution of teaching methods that employ the use of simulator respiratory emergencies within an elective curriculum for 3rd year`s medicine students. The secondary objective was assess the adequacy of the use of simulators for teaching skills in respiratory emergencies. Material and Methods: An elective course was created for 3rd year students of medical school of PUCSP for teaching respiratory emergencies, and for its practical part students, had the opportunity to simulate the treatment through the use of computerized mannequins, that was used for the realization of "pharmacological and surgical" procedures. After each activity simulation was held a debriefing where we discussed the action of students participating in simulated activitie. A pre and post test was conducted prior and after the course, with 29 questions (tests) related on respiratory emergencies theme. At the two weeks, students responded to a structured survey about the quality of the course. Results: There was a significant increase in the level of correct post-test (70.2%), when the results were compared to the pre-test (53.3%, p≤0,05). The questionnaire on the quality of the course had a positive result (41 to 48 points of 50 possible). Discussion: The analysis of the tests conducted before and after the course showed that there were more significant increase in correct answers after the course when the questions were related to matters discussed widely in practical classes during the course. Conclusion: We concluded that the simulation activities are an efficient way to improve the level of knowledge of respiratory emergencies of third year students of medicine, especially in relation to the practical content. We also conclude that the robots in simulation activities were very well evaluated by students / O ensino através da simulação de atendimentos reais tem se mostrado uma ferramenta muito útil nos cursos de medicina. As vantagens deste método de ensino incluem o ambiente seguro para aprendizagem, possibilidade de erro sem oferecer riscos à pacientes e o desenvolvimento de habilidades. O emprego de manequins que reproduzem funções vitais com alta fidelidade é um bom exemplo de como a simulação pode ser empregada para o ensino de várias situações, como o atendimento às emergências médicas. Objetivo: O objetivo principal deste estudo foi avaliar a contribuição de métodos de ensino que utilizam simuladores de emergências respiratórias dentro de um módulo curricular eletivo para estudantes do 3º ano de medicina. O objetivo secundário foi a análise da adequação do uso de simuladores para o ensino de habilidades frente a emergências respiratórias. Material e Método: Foi criado um curso eletivo para alunos do 3o ano do curso de medicina da PUCSP para o ensino de emergências respiratórias, na parte prática do curso, os alunos simularam o atendimento através do uso de manequins computadorizados utilizados para realização de procedimentos farmacológicos e cirúrgicos. Após cada atividade de simulação era realizado o debriefing, uma reunião onde eram discutidas as ações dos participantes do atendimento simulado. Foi realizado um pré-teste antes das atividades de simulação e um pós-teste após estas atividades, com 29 questões que versavam sobre o tema urgências respiratórias. Ao final do curso os alunos responderam a um questionário estruturado para pesquisa sobre a qualidade do curso. Resultados: Houve um aumento significativo no índice de acertos no pós teste (70,2%), quando comparados ao pré teste (53,3%). O questionário sobre a qualidade do curso teve um resultado positivo (41 a 48 pontos dos 50 possíveis). Discussão: A análise dos testes realizados antes e após o curso mostrou que houve aumento mais expressivo de acerto após o curso quando as questões se referiam a assuntos discutidos amplamente nas aulas práticas. Conclusão: concluímos que as atividades de simulação constituem-se em uma forma eficiente de melhorar o grau de conhecimento de emergências respiratórias dos estudantes do terceiro ano de medicina. Concluímos também que as atividades de simulação em robôs foram muito bem avaliadas pelos estudantes

Toxicology is a scientific discipline dealing with the influences of dangerous substances on living organisms. The negative effects of some substances have been known since the prehistoric times and the human race has had to face them until today. The impact of these substances on human organisms may be caused either deliberately (e. g. misuse of chemical substances during war conflicts) or unintentionally (e. g. intoxication by poisonous gases released from fire). The current knowledge of the field of toxicology enable to characterise the dangerous substances, to define their effective, toxic and lethal doses and concentrations and to give first aid to the people affected. The knowledge of the first aid procedure in case of intoxication of poisonous gases is crucial for the rescue of human life and moderation of the toxic effects. In connection to the universal first aid procedure, i. e. the patient's rescue out of the contaminated area and calling of the rescue service, the person affected has to receive an adequate immediate pre-hospital care. Based on these findings, procedures used in cases of intoxication in pre-hospital emergency care and emergency medicine are listed. The aim of the theoretical part of this diploma thesis is a comprehensive overview of current theoretical and professional knowledge in the field of chemistry, toxicology and emergency medicine. This knowledge is subsequently applied to the overall management of pre-hospital emergency care for patients intoxicated with toxic gases. The research part includes a retrospective statistical analysis of the number of cases of carbon monoxide intoxication in Vysocina Region, application of theoretical knowledge in the form of analyses of cases of intoxication and creation of a preventive programme with the help of a questionnaire survey which asked the public about their awareness of the risks and dangers of carbon monoxide. In addition, educational material was created. The thesis also tried to answer the research question "How serious is poisonous gas intoxication in pre-hospital emergency care and emergency medicine?" From the point of view of pre-hospital emergency care, the average daily death rate caused by poisonous gas intoxications in the Vysocina Region is four patients per year. When this number is compared with the total number of patients' deaths, it shows a less serious problem. The most common source of carbon monoxide poisoning turned out to be a gas appliance. The rescuers recorded the highest number of carbon monoxide detector activations in 2015. Informing the public in the form of a questionnaire survey has clearly shown that there is persisting confusion of carbon monoxide properties with carbon dioxide ones. This diploma thesis is aimed at specialists providing pre-hospital emergency care i. e. health rescue services and also fire rescue services for the purpose of statistical comparisons with other providers and subjects, or for educational purposes in the context of crisis preparedness. In addition, the work is recommended to the general public to ensure greater awareness of poisonous gas intoxications. This thesis brought a comprehensive overview of this issue which can be used for the purpose of informing, educating and creating the basis for further comparison.

Patient perceptions of health care quality are critical to a health care service provider's long-term success because of the significant influence perceptions have on customer satisfaction and consequently organization financial performance. Patient satisfaction affects not only the outcome of the health care process such as patient compliance with physician advice and treatment, but also patient retention and favorable word-of-mouth. Accordingly, it is a critical strategy for health care organizations to provide quality service and address patient satisfaction. The urgent care (UC) industry is an integral part of the health care system in the United States that has been experiencing a rapid growth. UC provides a wide range of medical services for a large group of patients and now serves an increasing population. UC is becoming popular because of the convenient locations, extended hours, walk-in policy, short waiting times, and accessibility. A closer examination of the current health care research, however, indicates that there is a paucity of research on urgent care providers. Confronted with the emergence of the urgent care industry and the increasing demand for urgent care, it is necessary to understand how patients perceive urgent care providers and what influences patient satisfaction and retention. This dissertation addresses four areas relevant to the above mentioned issues: (1) development of an instrument to measure perceived service quality in the urgent care industry; (2) identification of the determinants of patient satisfaction and behavioral intentions; (3) empirical examination of the relationships among perceived service quality, patient satisfaction and behavioral intentions; and (4) comparison of the perceived service quality across several primary urgent care providers, such as urgent care centers, hospital emergency departments, and primary care physicians' offices. To validate this new instrument and examine the hypothesized relationships proposed in this study, an electronic web based survey was designed and administered to college students. Both exploratory and confirmatory factor analysis were employed to assess the reliability and validity of the developed instrument. The contextualized relationships were evaluated using structural equation modeling. The results of this research could potentially contribute to urgent care management and quality improvement.

Purpose: The purpose of this study is to describe the relationship between health literacy, preparedness for discharge, adherence to discharge instructions and difficulty coping after discharge among emergency department patients. Specific Aims: The Aims of this study were to: (1) describe the variability of health literacy of adult patients in an academic tertiary Emergency Department; (2) describe the relationship between health literacy, care transition, and perceived readiness for discharge on the patient’s adherence to discharge instructions and (3) explore whether health literacy, perceived preparation for discharge and care transition, predicts difficulty coping after discharge. Framework: Dr. Meleis’s Transitions Theory was used as a framework. Design: This is a prospective cohort study of adults treated and discharged from the ED. Results: Eighty five percent of the subjects completed the study (n = 132). Subjects satisfied with transition care (P = .025) and who felt more prepared for discharge (P = .035) had less difficulty coping. Subjects more satisfied with care transition were more likely to adhere to medication instructions (P = .029). The higher the satisfaction with discharge preparation, the less likely the subjects were to go to their follow-up appointment (P = 0.051). No associations were found with health literacy. Conclusion: Satisfaction with care transition during the discharge process and feeling well-prepared are related to less difficulty coping after discharge. Nurses have an opportunity to intervene and enhance the discharge experience. This may contribute to more positive outcomes after being seen in an emergency department.

Bag-valve mask (BVM) ventilation maintains a patient's oxygenation and ventilation until a more definitive artificial airway can be established. In the prehospital setting of a traffic collision or medical aid scene this is performed by an Emerency Medical Technician or medical first responder. Few studies have looked at the effectiveness of Bag-valve masks (BVM) or the complication rate of ventilating an unprotected airway. The purpose and goal of this study is to educate both medical first responders and basic emergency medical technicians.

Emergency department nurses are at high risk for violence in the workplace (Keely, 2002; Fernandez et al., 1998; Nachreiner et al., 2005; Mayer et al., 1999). It is estimated that between 52% and 82% of emergency nurses will experience physical violence and 100% of emergency department nurses will experience non-physical violence in their careers. Despite this fact, there are limited studies examining workplace violence among this vulnerable group (Fernandez et al., 1998; Levin et al., 1998). Therefore, the purpose of this qualitative descriptive study was to examine the experiences of emergency department nurses with workplace violence. Levin et al.’s (2003) Ecological Occupational Model (EOHM) was used to guide this study. Four focus groups were conducted with 27 nurses who represented different types of emergency departments (rural community facility to large urban Level 1 trauma center). Results of the study suggested that the majority of participants (96%) experienced some form of work-related violence and 75% had attended at least one violence education class. The major themes of frustration and powerlessness emerged from the data. Sub themes included professional conflict while caring for violent patients, personal detachment as an emotional survival mechanisms, and feelings of victimization. Additional factors contributing to workplace violence included: personal attributes of the nurse, the workplace, and the community where the emergency department was located. These study results have potential to guide intervention development aimed at reducing workplace violence in the emergency department setting.

Bakgrund: För att optimera vården av svårt sjuka eller skadade barn är kommunikationen i teamarbetet viktigt. Att arbeta i stressande akuta situationer innebär att kommunikationen kan brista och utgöra en risk för barnets säkerhet. För att optimera samarbetet under teamarbete är kommunikationen viktig. Motiv: Få studier rapporterar teamarbete och kommunikation vid vård av svårt sjuka eller skadade barn. För att säkra vården av akut sjuka och skadade barn finns behov av att undersöka kommunikation under teamarbete vid akuta situationer som inkluderar barn. Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av kommunikation och teamarbete vid vård av svårt sjuka eller skadade barn.     Metod: Studien genomfördes med hjälp av kvalitativ metod. Tre sjuksköterskor och sju barnsjuksköterskor anställda på en barnklinik på ett sjukhus i södra Sverige deltog i studien. Individuella semistrukturerade intervjuer användes för att samla data och intervjuerna transkriberades i sin helhet. Kvalitativ innehållsanalys användes för att analysera texten vilket resulterade i två kategorier och fem subkategorier. Resultat: Analysen av intervjuerna resulterade i kategorin “Att skapa förutsättningar för god kommunikation” baserade på subkategorierna “Möjligheter i kommunikationen” och “Hinder i kommunikationen”. Kategorin “Att arbeta säkert” baserades på subkategorierna “Samarbete och ledarskap”, “Förväntningar i teamet” och “Utveckla träning och reflektion”. Konklusion: Studien beskriver betydelsen på god kommunikation för ett gott samarbete med vårdteamet. Resultatet indikerar att det finns behov av scenarioträning, vilket kan ge sjuksköterskorna möjlighet att öva på kommunikation och teamarbete i en lugn och kontrollerad miljö. Kommunikation och teamarbete är centrala och viktiga begrepp inom vården, därför är framtida forskning väsentlig för en säker och jämställd vård. / Background: To optimize the care of seriously ill or injured children, communication in during teamwork is important. Working in stressful emergency situations means that communication is lacking and thus increase the risk to jeopardize the children’s safety. In order optimize the collaboration during teamwork in critical situations, communication is important. Motive: Few studies report teamwork and communication in the care of seriously ill or injured children. To ensure the care of critical ill and injured children, there is a need to explore communication during teamwork in critical situations that include children.   Aim: The purpose of this study was to describe nurses' experiences of communication and teamwork in the care of critical ill children. Methods: In this study a qualitative method was used. Three nurses and seven pediatric nurses employed at a pediatric clinic at a hospital in southern Sweden participated. Individual semi-structured interviews were used to collect data and the interviews were transcribed verbally. Qualitative content analysis was used to analyze the text, which resulted in two categories and five subcategories. Result: The analysis resulted in the category “Creating conditions for good communication” based on the subcategories “Opportunities in communication” and “Obstacles in communication”. The category "Working safely" was based on the subcategories "Cooperation and leadership", "Expectations in the team" and "Develop training and reflection". Conclusion: The study describes the importance of good communication for a good collaboration in the team when caring for critical ill or injured children. The results indicate that there is a need for scenario training, which can give nurses the opportunity to practice communication and teamwork in a calm and controlled environment. Communication and teamwork are central and important concepts in healthcare, therefore future research is essential for safe and equal care.

Background: Current recommended treatment options for primary headache disorders are suboptimal in that effective pain relief is untimely and associated with side effects. Objective: The primary aim of this thesis was to evaluate the effectiveness and attitudes towards an alternative treatment option, the sphenopalatine ganglion (SPG) block which belongs to a class of procedures known as peripheral nerve blocks (PNBs). Methods: We conducted a systematic review and meta-analysis studying the effectiveness of PNBs for the treatment of primary headache disorders. We also conducted a national postal survey among Canadian emergency physicians to identify current practice patterns and perspectives on PNBs. Results: We found PNBs are effective for rapid pain relief compared to placebo at 15 minutes (MD = -1.17; 95% CI: -1.82 to -0.51) and 30 minutes (MD = -0.99; 95% CI: -1.66 to -0.32). Only 55.6% of physicians have experience with PNBs (95% CI: 0.48 to 0.65) and we discovered the SPG block is the least commonly practiced type of PNB; the majority of physicians believe these procedures are safe (85%) and effective (55.1%). A future trial is needed to compare the SPG block against standard treatment. Conclusion: The SPG block may be used as an adjunct therapy for faster effective pain relief. Current physicians would consider PNBs as a first-line alternative given evidence from a future trial. A future trial is needed to compare the SPG block against standard treatment.

The development of emergency department medical interventions and the implementation of fast-transport trauma systems has decreased the rate of death resulting from traumatic brain injury (TBI). Without corresponding methods for long-term treatment and recovery, the prevalence of people disabled by TBI has increased, creating a growing public health problem. Investigations generated by physicians, rehabilitation programs, and social scientists, which attempt to associate standard measures of injury severity with outcome, leave unexplained variance in long-term functional status for persons with TBI. The purpose of this investigation was to use persons with brain injury and their family members, to guide an analysis of the factors that foster successful recovery from brain injury. Three studies were conducted. In Study #1, the method for observation generated by Kurt Goldstein (1934) was adopted to conduct 20 case studies of persons who sustained brain injury. The Schema of the EsEx Couple (Maynard. 1992) was used to orient the investigation. The EsEx Couple Schema proposes that events in human life must be understood by considering the whole system of Person (Essence) in the Environment (Exchange), and the transactions that flow in a recursive loop from Person to Environment and back. Kurt Goldstein's Laws of Organismic Life (1934), a model consistent with that of the EsEx Couple, was used to evaluate the data. Strong patterns associated family and social networks, autonomy, and perceived self-determination with higher levels of recovery, and were used to generate a Model for Recovery. In Study #2. the Motivational Analysis of Self-Systems Processes (Connell & Wellborn, 1991) was combined with results from Study #1 to generate a Development Model, and to build a survey which was administered to 248 persons with brain injury. Results (1) confirmed the model, indicating factors that contribute to recovery were hypothesized measures of Social Context, Perception, and Engagement; and (2) established a valid instrument, generated by persons with brain injury and their families, for measuring functional status. In Study #3. results of the survey research were used to return to the case studies to consider where individual lives differ from expected patterns, and why. Deviations from expected patterns were explored to identify how individual differences operate to affect outcome. Recommendations for clinical practice include (1) directing interventions toward family as well as patient, as a method of enhancing the Social Context for the patient, and (2) using careful evaluation of each patient's idiosyncrasies to consider individual interventions.