The purposes of this study were to understand emergency physicians¡¦ perception, attitude and application of evidence-based medicine(EBM). This cross-sectional study employed quantitative methods. Regarding the quantitative method, the study population included emergency physicians in southern Taiwan of 32 participating hospitals. Structured questionnaires were sent to emergency physicians, a total of 214 questionnaires were distributed with 189 questionnaires being returned. The response rate was 88.32%. Descriptive statistics was used in data analysis. The major findings were: 1. Emergency physician¡¦s perception of EBM: The average score in Physicians¡¦ understanding EBM terminologies were from 1.88 to 2.79(score ranged from 1 to 4, 1 represented fully understand). 2. Emergency physician¡¦s attitude of EBM: a. There were over a half (57.7%) emergency physicians had taken EBM training courses, while 93.1% expressed their willingness to attend EBM activities in the future. b. Most emergency physicians(86.7%) agreed that application of EBM was useful in clinical practice. c. The major barriers of emergency physicians to apply EBM were lack of time(57.1%), lack of EBM knowledge(50.3%), lack of research methodology knowledge(45.5%) and hardness of critical appraisal(40.7%). d. In general, emergency physicians hold positive attitudes toward EBM, the average score was from 1.79 to 3.09 (score ranged from 1 to 5, 1 represented the most agree). 3. Emergency physician¡¦s application of EBM: a. The average proportion of EBM application in emergency physicians¡¦ clinical practice was 54.42% . b. Emergency physician¡¦s choice of clinical problem-treating was diverse, only little clinical problem may have uniform opinions.

<p>The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim.</p><p>The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain.</p><p>The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day.</p> / <p>Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad.</p><p>Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan.</p><p>Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.</p>

The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim. The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain. The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day. / Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad. Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan. Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.

Objetivo: Verificar graus de concordância diagnóstica pela Angio-TC entre médicos da emergência, residentes de radiologia e radiologistas torácicos em casos suspeitos de tromboembolismo pulmonar (TEP). Material e Métodos: Foram retrospectivamente estudados 123 pacientes consecutivos com suspeita de TEP, de maço/2012 a fevereiro/2013, os quais realizaram Angio-TC pulmonar, obtida com colimação por multidetector 64x0,5. As imagens foram inicialmente interpretadas isoladamente por dois médicos da Emergência e por dois médicos residentes da Radiologia, e subsequentemente por dois Radiologistas Torácicos em consenso, verificando-se o grau de concordância interobservador entre eles quanto à presença de TEP. Resultados: O grau de concordância entre os Residentes da radiologia e os Radiologistas torácicos foi muito bom (Índice Kappa de 0,82 e 0,81); entre os Médicos da Emergência e os Radiologistas torácicos foi baixo ou moderado (Kappa de 0,37 e 0,42.), com um índice de 40,0% de relatos falso-positivos, aproximadamente. Aproximadamente 40,0% das interpretações falso-positivas correlacionaram-se principalmente com casos de TEP lobar e segmentar, enquanto que as falso-negativas ocorreram mais vezes com casos de TEP segmentar e subsegmentar. O grau de concordância geral entre todos os observadores mostrou-sei também moderado (Kappa de 0,50). Conclusão: Usando a Angio-TC no diagnóstico do TEP, o grau de concordância entre os radiologistas torácicos e os residentes da radiologia foi muito bom; entretanto, a concordância entre os médicos da emergência com os radiologistas torácicos foi baixa, com tendência a superestimar o diagnóstico da condição. / Purpose: To assess interobserver agreement rates between the Radiology resident, the thoracic radiologist and the Emergency physician for diagnosing pulmonary embolism (PE) in Computed Tomography Pulmonary Angiography (CTPA) examinations. Methods: Two Emergency physicians and two Radiology residents retrospectively evaluated 123 CTPA scans at our institution, and reported the presence of PE or not, individually. Two thoracic radiologists then reviewed the images, and a consensus was reached. Statistical analysis was performed, in order to provide the interobserver agreement. Results were expressed in kappa values for subsequent comparison. Results: Very good agreement in CTPA reading was observed between Radiology residents and thoracic radiologists (kappa index of 0.82 and 0.81). Fair and moderate agreement (kappa index of 0.39 and 0.42) was demonstrated between Emergency physicians and thoracic radiologists, with a rate of 40% false-positive reports, approximately, mainly in cases of both lobar and segmental involvement, whereas false-negative occurred more times in cases of segmental and subsegmental PE. The overall agreement was also moderate (kappa index of 0.50). Conclusion: The inter-observer agreement in CTPA examinations between radiology residents and thoracic radiologists in PE diagnoses was good, but it was low between the emergency physicians and the radiologists, with a tendency of overestimating that diagnoses.

Objetivo: Verificar graus de concordância diagnóstica pela Angio-TC entre médicos da emergência, residentes de radiologia e radiologistas torácicos em casos suspeitos de tromboembolismo pulmonar (TEP). Material e Métodos: Foram retrospectivamente estudados 123 pacientes consecutivos com suspeita de TEP, de maço/2012 a fevereiro/2013, os quais realizaram Angio-TC pulmonar, obtida com colimação por multidetector 64x0,5. As imagens foram inicialmente interpretadas isoladamente por dois médicos da Emergência e por dois médicos residentes da Radiologia, e subsequentemente por dois Radiologistas Torácicos em consenso, verificando-se o grau de concordância interobservador entre eles quanto à presença de TEP. Resultados: O grau de concordância entre os Residentes da radiologia e os Radiologistas torácicos foi muito bom (Índice Kappa de 0,82 e 0,81); entre os Médicos da Emergência e os Radiologistas torácicos foi baixo ou moderado (Kappa de 0,37 e 0,42.), com um índice de 40,0% de relatos falso-positivos, aproximadamente. Aproximadamente 40,0% das interpretações falso-positivas correlacionaram-se principalmente com casos de TEP lobar e segmentar, enquanto que as falso-negativas ocorreram mais vezes com casos de TEP segmentar e subsegmentar. O grau de concordância geral entre todos os observadores mostrou-sei também moderado (Kappa de 0,50). Conclusão: Usando a Angio-TC no diagnóstico do TEP, o grau de concordância entre os radiologistas torácicos e os residentes da radiologia foi muito bom; entretanto, a concordância entre os médicos da emergência com os radiologistas torácicos foi baixa, com tendência a superestimar o diagnóstico da condição. / Purpose: To assess interobserver agreement rates between the Radiology resident, the thoracic radiologist and the Emergency physician for diagnosing pulmonary embolism (PE) in Computed Tomography Pulmonary Angiography (CTPA) examinations. Methods: Two Emergency physicians and two Radiology residents retrospectively evaluated 123 CTPA scans at our institution, and reported the presence of PE or not, individually. Two thoracic radiologists then reviewed the images, and a consensus was reached. Statistical analysis was performed, in order to provide the interobserver agreement. Results were expressed in kappa values for subsequent comparison. Results: Very good agreement in CTPA reading was observed between Radiology residents and thoracic radiologists (kappa index of 0.82 and 0.81). Fair and moderate agreement (kappa index of 0.39 and 0.42) was demonstrated between Emergency physicians and thoracic radiologists, with a rate of 40% false-positive reports, approximately, mainly in cases of both lobar and segmental involvement, whereas false-negative occurred more times in cases of segmental and subsegmental PE. The overall agreement was also moderate (kappa index of 0.50). Conclusion: The inter-observer agreement in CTPA examinations between radiology residents and thoracic radiologists in PE diagnoses was good, but it was low between the emergency physicians and the radiologists, with a tendency of overestimating that diagnoses.

Objetivo: Verificar graus de concordância diagnóstica pela Angio-TC entre médicos da emergência, residentes de radiologia e radiologistas torácicos em casos suspeitos de tromboembolismo pulmonar (TEP). Material e Métodos: Foram retrospectivamente estudados 123 pacientes consecutivos com suspeita de TEP, de maço/2012 a fevereiro/2013, os quais realizaram Angio-TC pulmonar, obtida com colimação por multidetector 64x0,5. As imagens foram inicialmente interpretadas isoladamente por dois médicos da Emergência e por dois médicos residentes da Radiologia, e subsequentemente por dois Radiologistas Torácicos em consenso, verificando-se o grau de concordância interobservador entre eles quanto à presença de TEP. Resultados: O grau de concordância entre os Residentes da radiologia e os Radiologistas torácicos foi muito bom (Índice Kappa de 0,82 e 0,81); entre os Médicos da Emergência e os Radiologistas torácicos foi baixo ou moderado (Kappa de 0,37 e 0,42.), com um índice de 40,0% de relatos falso-positivos, aproximadamente. Aproximadamente 40,0% das interpretações falso-positivas correlacionaram-se principalmente com casos de TEP lobar e segmentar, enquanto que as falso-negativas ocorreram mais vezes com casos de TEP segmentar e subsegmentar. O grau de concordância geral entre todos os observadores mostrou-sei também moderado (Kappa de 0,50). Conclusão: Usando a Angio-TC no diagnóstico do TEP, o grau de concordância entre os radiologistas torácicos e os residentes da radiologia foi muito bom; entretanto, a concordância entre os médicos da emergência com os radiologistas torácicos foi baixa, com tendência a superestimar o diagnóstico da condição. / Purpose: To assess interobserver agreement rates between the Radiology resident, the thoracic radiologist and the Emergency physician for diagnosing pulmonary embolism (PE) in Computed Tomography Pulmonary Angiography (CTPA) examinations. Methods: Two Emergency physicians and two Radiology residents retrospectively evaluated 123 CTPA scans at our institution, and reported the presence of PE or not, individually. Two thoracic radiologists then reviewed the images, and a consensus was reached. Statistical analysis was performed, in order to provide the interobserver agreement. Results were expressed in kappa values for subsequent comparison. Results: Very good agreement in CTPA reading was observed between Radiology residents and thoracic radiologists (kappa index of 0.82 and 0.81). Fair and moderate agreement (kappa index of 0.39 and 0.42) was demonstrated between Emergency physicians and thoracic radiologists, with a rate of 40% false-positive reports, approximately, mainly in cases of both lobar and segmental involvement, whereas false-negative occurred more times in cases of segmental and subsegmental PE. The overall agreement was also moderate (kappa index of 0.50). Conclusion: The inter-observer agreement in CTPA examinations between radiology residents and thoracic radiologists in PE diagnoses was good, but it was low between the emergency physicians and the radiologists, with a tendency of overestimating that diagnoses.

Thesis (MSc (Radiography))--Cape Peninsula University of Technology, 2019 / Introduction: After-hours diagnostic imaging is essential in the majority of large public hospitals, as it plays a vital role in the treatment and management of patients. Radiologists are not always available after hours to provide reports on radiographic images since, nationally and globally, there is a shortage of these professionals. Radiographic images are frequently interpreted by emergency physicians after hours. Thus, while diagnostic imaging represents an essential component in patient care (including management and treatment), according to the literature, a significant cause of clinical error occurs through the misinterpretation of radiographic images by emergency physicians. The aim of this study was to determine emergency physicians’ views on whether there was a need for an after-hours diagnostic radiology reporting service in emergency departments at some public hospitals, in the Durban Metropole. It is important to note that in addition to the above, this study calculated the number of radiographic examinations performed after-hours, and the number that was reported by the radiologist during office hours, since there was no radiology cover after hours. Methods: A descriptive cross-sectional quantitative survey design was employed using a self-administered questionnaire as a data collection instrument completed by emergency physicians at four public hospitals. In addition, additional data was collected to determine the number of radiographic examinations that had been performed after hours, at the selected four public hospitals over a period of three months, as well as the number of radiographic examinations that was reported on. This enabled the authors to determine the number of radiographic examinations that went unreported during this study period. Results: A total of 39 emergency physicians participated in the survey, with a mean and median age of 39.46 and 38 years, respectively (SD = 9.11 years). The results of this study showed that between 0.1% and 0.6% of radiographic examinations performed after hours were reported on by radiologists during office hours, for this study period. This implies that less than 1% of all examinations produced after hours at the four public hospitals, received a radiology report. Emergency physicians felt that the interpretation of images took up valuable time. The survey found that there was near total consensus amongst respondents on whether they prefer after-hours reporting to be performed by a radiologist as 46.2% (n = 18) of the respondents strongly agreed and 41.0% agreed (n = 16). Furthermore, a total of 35.9% (n=14) of respondents agreed and 43.6% (n=17) strongly agreed, that having a reporting radiographer reporting on radiographic images after-hours, would benefit patient flow. The survey also found that 92% of the sampled emergency physicians agreed (59.0% strongly agreed and 33.3% agreed, respectively) that there was a need for further training in the interpretation of radiographic images. Discussion: From the above results, it is evident that since the majority of radiographic examinations went unreported after hours, the task to interpret the radiographic images is left to the emergency physicians as part of their patient management. Conceivably, this added image interpretation results in a further increase in the workload of emergency physicians. It is therefore not surprising that emergency physicians preferred that after-hours reporting of radiographic images be done by radiologists. According to the literature, reporting radiographers also play a role in alleviating the workload of emergency physicians and improving patient flow, by providing a report for the radiographic images during after-hours. Thus, reporting radiographers afford emergency physicians additional time to concentrate on patient treatment, resulting in faster patient throughput. Reporting on radiographic images is not yet included in the scope of the South African radiographer. The findings of this study, though, suggested that there was a need for emergency physicians to undergo training in the interpretation of radiographic images. Conclusion: The study recommends that an after-hours reporting service be considered for the four public hospitals concerned. It is recommended that the heads of the emergency and radiology departments further consider offering courses on radiographic image interpretation for emergency physicians.

No description available.

Bakgrund: En förändring inom ambulanssjukvården har skett där efterfrågan på vård ständigt ses öka. För att möta efterfrågan krävs innovativa lösningar för att kunna möjliggöra en god och säker vård utifrån varje patientens behov. En del i detta är införandet av en mobil akutläkare. Syfte: Syftet var att kartlägga utfall av genomförda uppdrag samt beskriva ambulanssjuksköterskans erfarenheter av mobil akutläkare. Metod: En mixad metodstudie med induktiv ansats genomfördes. Den kvalitativa delen baserades på tio intervjuer med öppna frågor. Deltagarna valdes genom ett strategiskt urval. Intervjumaterialet analyserades utifrån Lundman och Hällman Granheim (2017) som manifest innehållsanalys. Den kvantitativa delen baserades på variabler från det genomförda projektet med mobil akutläkare. Datan analyserades genom deskriptiv statistik. Båda resultaten integrerades sedermera för att tillsammans nå en övergripande syntes (Creswell &amp; Plano Clark, 2017). Resultat: Resultatet pekade på ett behov av mobil akutläkare prehospitalt, vilka fördelar det har givit samt förslag på förbättringar. Det kvalitativa resultatet delades in i fyra huvudkategorier; ambulanspersonalens utmaningar, vikten av samarbetet mellan professioner, för patientens bästa och vägen framåt. Det kvantitativa resultatet kartlagde utfallet av den mobila akutläkarens uppdrag genom olika variabler vilka presenterades i procent, frekvens och tabeller. Slutsats: Behov av mobil akutläkare framkommer för att bidra med stöd och trygghet i ambulanssjuksköterskan arbete och skapa en god vård för patienten. Området kring en mobil akutläkare med ett bredare och mer generellt fokus likväl ambulanssjuksköterskans erfarenhet av detta är relativt outforskat vilket föranleder behov av vidare forskning. / Background: There has been a change in ambulance healthcare where the demand for care is increasing. In order to meet this demand, innovative solutions are required to enable good and safe care based on each patient's needs. Part of this is introduction of a mobile emergency doctor. Purpose: The purpose was to map the outcome of completed assignments and describe the ambulance nurse's experiences with mobile emergency doctors.  Method: A mixed methods study with an inductive approach was carried out. The qualitative part was based on ten interviews with open questions. The participants were chosen through a strategic selection. The interview material was analyzed based on Lundman and Hällman Granheim's (2017) manifest content analysis. The quantitative part was based on variables from the completed project with a mobile emergency doctor. The data was analyzed through descriptive statistics. Both results were later integrated to achieve an overall synthesis (Creswell &amp; Plano Clark, 2017). Results: The results indicated the need for a mobile emergency physician in the pre-hospital setting, the advantages it has provided and suggestions for improvements. The qualitative result were divided into four main categories; the challenges of the ambulance nurse, the importance of collaboration between professions, for the good of the patient and the way forward. The quantitative result mapped the outcome of the mobile emergency physician's assignment through various variables which were presented in percentage, frequency and tables. Conclusion: It appears that there is a need for a mobile emergency doctor to contribute with support and security in the work of an ambulance nurse and to create good care for the patient. The area surrounding a mobile emergency physician with a broader and more general focus, moreover the ambulance nurse's experience of this is relatively unexplored, which leads to the need for further research.

Made available in DSpace on 2014-12-17T15:38:45Z (GMT). No. of bitstreams: 1 GinaGQ.pdf: 513360 bytes, checksum: 37b085f15400bf7b1c0930be1b3a2131 (MD5) Previous issue date: 2007-04-20 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The literature pointed that the way which people deal with death have been changing along centuries, and nowadays what is realized it is that, each time more, the human being have difficulties to deal with death. Due to the fact that the main function of the physician is to save their patients lives; responsibility that is aggravated by the necessity of to take decisions quickly, once he need to deal with the unexpected situations of the urgency and emergency, many times these professional have to face of impotency and fail situations, when he lose a patient. The main goal of this study was to understand the experience of physicians that work in the urgency and emergency, in front of death. These questioning it justified by the fact of the physicians do not have, many times, a space to express their suffering and anguish about the issues related to death in their work routine, despite lifedeath question to be often present their everyday. It is still possible to verify in the literature, an appointment of the necessity of to include in the curriculum of Medicine courses, subjects that approach such questions. The method used was based on the existential-phenomenological perspective, using as instrument the participant observation, to the intent of understand the routine in the urgency and emergency context, and semi-structured interview. It was interviewed six physicians that work in the urgency and emergency of the most important hospital of public health system of Natal-RN. The results showed that the physicians reported pleasure in work in the urgency and emergency, despite of they presented stress and the difficulties that they deal with in the public system. Despite of the fact that the death to be considered as a phenomenon that make part of the physician s routine, sometimes, deals with these one is more difficult. Many times losses generate an impotency and guilty feeling, as well as questionings about their performance during the attempts to save lives. We verified, from this study, the importance of the existence of some kind of intervention in the emergency, in order to the physicians can elaborate the questions about death and die emerged in their work. We consider yet that this study corroborates and reiterates the discussions concerning the importance of this thematic to be approached in a more effective way, during the academic formation of these professionals, as well as, the importance of a larger investment from the part of Government in the urgency and emergency sector, in order to propitiate to these professionals a work that brings less harmful for their health / A literatura aponta que a forma como as pessoas encaram a morte vem sofrendo mudan?as no decorrer dos s?culos e hoje o que se percebe ? que, cada vez mais, o ser humano tem dificuldades para lidar com a morte. Em raz?o de o m?dico ter como fun??o primordial salvar a vida dos seus pacientes, e sendo essa responsabilidade agravada pela responsabilidade de tomar decis?es rapidamente, j? que precisa lidar com o inesperado das situa??es de urg?ncia e emerg?ncia, muitas vezes esse profissional tem que enfrentar situa??es de impot?ncia e fracasso diante da perda de um paciente. O objetivo principal deste estudo foi compreender a experi?ncia de m?dicos que trabalham em urg?ncia e emerg?ncia diante da morte. Justifica-se tal questionamento pelo fato de que, apesar das quest?es da vida e da morte fazerem parte do cotidiano desses profissionais, os m?dicos n?o t?m, muitas vezes, espa?o para expressarem o seu sofrimento e ang?stia sobre as quest?es relacionadas ? morte em sua rotina de trabalho. Verifica-se ainda na literatura um apontamento da necessidade de se incluir nos curr?culos das universidades de medicina disciplinas que abordem tais quest?es. A metodologia utilizada foi de car?ter enomenol?gico-existencial, utilizando como instrumento a observa??o participante, a fim de conhecer a rotina da urg?ncia e emerg?ncia, e a entrevista semi-aberta. Foram entrevistados seis m?dicos que trabalham na urg?ncia e emerg?ncia do maior hospital da rede p?blica de Natal-RN. Os resultados mostraram que, apesar dos m?dicos relatarem ter momentos de estresse e das dificuldades encontradas por eles no servi?o p?blico, esses profissionais sentem prazer em trabalhar na urg?ncia e emerg?ncia. Embora a morte seja considerada um fen?meno que faz parte de sua rotina de trabalho, em alguns momentos ela ? mais dif?cil de ser encarada. Muitas vezes as perdas geram sentimentos de impot?ncia e culpa, bem como questionamentos sobre suas atua??es durante as tentativas de salvar vidas. Verificamos, a partir desse estudo, a import?ncia da exist?ncia de algum tipo de interven??o na emerg?ncia, a fim de que os m?dicos possam elaborar as quest?es sobre a morte e o morrer surgidas em seu trabalho. Consideramos ainda que este estudo confirma as discuss?es acerca da import?ncia dessa tem?tica ser abordada de forma mais efetiva no momento da forma??o desses profissionais, bem como a import?ncia dos ?rg?os p?blicos investirem de forma mais eficaz na ?rea de urg?ncia e emerg?ncia, de modo a tornar o trabalho desses profissionais menos danoso ? sua sa?de