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- ItemAcesso aberto (Open Access)Avaliação da técnica de indução em sequência rápida dos anestesiologistas de um hospital universitário(Sociedade Brasileira de Anestesiologia, 2012-06-01) Guirro, Ursula Bueno do Prado; Martins, Cesar Romão; Munechika, Masashi [UNIFESP]; Universidade Federal do Paraná Hospital do Trabalhador; SAMMEDI CET Hospital do Servidor Público Estadual de São Paulo; Universidade Federal de São Paulo (UNIFESP)BACKGROUND AND OBJECTIVES: The induction of the general anesthesia in patients on a full stomach can result in regurgitation of the gastric content and pulmonary aspiration. The function of the rapid sequence induction (RSI) is to minimize the time interval between the loss of the airway protection reflexes and tracheal intubation tube balloon. The objective of this study was to evaluate the rapid sequence induction among the anesthesiologists of the São Paulo Hospital. METHODS: The participants answered the questionnaire voluntarily and anonymously, after signed consent. The questionnaire consisted of 60 questions about the fundamental points of the RSI. The questions were divided in pre-oxygenation, circuits, drugs used in the induction (opioids, hypnotics, neuromuscular blockers), cricoid pressure techniques, intubation and difficult intubation. RESULTS: Seventy-five questionnaires were applied and 22 were discarded due to incomplete answering. All anesthesiologists always declare doing pre-oxygenation and administering opioid, hypnotic, and neuromuscular blocker. Most use fentanyl (83%), propofol (74.5%) and succinylcoline (68.6%). All anesthesiologists apply cricoid pressure. Most did not know the correct pressure to be applied on the cricoid cartilage. Intubation failures have already occurred with 71.7% of anesthesiologists and with 40%, the regurgitation. When faced with an unexpected difficult intubation, anesthesiologists ask for the laryngeal mask (35.5%). CONCLUSIONS: This study showed a broad individual variety of the RSI technique, a fact already reported by different authors. The difficulty in establishing a RSI protocol can be attributed to constant evidence that science provides us, where updating over the years becomes good medical practice.
- ItemAcesso aberto (Open Access)Perfil dos atendimentos em pronto-socorro de Otorrinolaringologia em um hospital público de alta complexidade(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2013-06-01) Andrade, José Santos Cruz de [UNIFESP]; Albuquerque, André Maranhão Souza de [UNIFESP]; Matos, Rafaella Caruso [UNIFESP]; Godofredo, Valéria Romero [UNIFESP]; Penido, Norma de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Urgent and emergency care are common happenings in ENT practice and most carry low morbidity and mortality. There are but few studies that address the epidemiology of these situations. OBJECTIVE: To evaluate the epidemiological characteristics of care in the emergency department of otorhinolaryngology at a high complexity hospital. METHOD: Epidemiological, cross-sectional study, retrospective with data collection carried out from medical records from the emergency department of otorhinolaryngology of a high complexity hospital in São Paulo, for a period of 12 months. Data collected: age, gender, clinical diagnosis and management. The cases were divided by subspecialty: otology, rhinology, pharyngolaryngeal-stomatology and head and neck surgery. We evaluated the level of urgency/emergency, etiology and monthly distribution of visits. RESULTS: 17,503 medical records were obtained; 1,863 were excluded. Of the 15,640 cases included, the average age was 36.3 years. 9,818 (62.77%) corresponded to cases considered as emergency/urgency. Among the urgency/emergency cases, 6,422 (65.41%) were diagnosed in the ear and among the 10 most prevalent diagnostics, 7 were in the subspecialty of otology. CONCLUSION: Among the patients seen in the emergency department of otolaryngology evaluated in this study, 62.77% corresponded to cases of urgency/emergency, predominantly in the otology subspecialty.
- ItemAcesso aberto (Open Access)Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública(Sociedade Brasileira de Cardiologia - SBC, 2012-11-01) Caluza, Ana Christina Vellozo [UNIFESP]; Barbosa, Adriano H. [UNIFESP]; Gonçalves, Iran [UNIFESP]; Oliveira, Carlos Alexandre L. de [UNIFESP]; Matos, Lívia Nascimento de [UNIFESP]; Zeefried, Claus; Moreno, Antonio Célio C.; Tarkieltaub, Elcio; Alves, Claudia Maria Rodrigues [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Serviço de Atendimento Móvel de Urgência; Prefeitura Municipal de São Paulo Secretaria de Saúde; Hospital Municipal Prof. Dr. Alípio Correa NettoBACKGROUND: The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles. OBJECTIVE:To describe in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). METHODS: Health care teams of four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé and Saboya) of the periphery of the city of São Paulo and advanced ambulances of the Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis. RESULTS: From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients), most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding. CONCLUSION: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.
- ItemAcesso aberto (Open Access)Rede de infarto com supradesnivelamento de ST: sistematização em 500 casos diminui eventos clínicos na rede pública(Universidade Federal de São Paulo (UNIFESP), 2016-08-30) Caluza, Ana Christina Vellozo [UNIFESP]; Carvalho, Antonio Carlos de Camargo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: The major cause of deaths in the city of Sao Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15-20% due to difficulties inherent in large metropoles. Objectives: To describe in-hospital mortality in ST Elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). Methods: Health care teams of seven emergency services (Ermelino Matarazzo, Campo Limpo, Tatuapé, Saboya, João XXIII, Pirituba, Público municipal) of the periphery of the São Paulo and advanced ambulances of Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni and multivariate analysis. Results: From November 2009 to November consecutive patients used the STEMI network, and the findings were as follows: anterior wall infarctions, 37 complete atrioventricular blocks, 41 cases occurring cardiogenic shock PCR, 2 cases of hemorrhagic stroke and intra-hospital mortality was 6,5% (33 cases). There was no difference in mortality relation to initial reperfusion (PCIxFI), both in-hospital (>0,05) and late (p=0,566). Late mortality was 8 % and adverse events were 10.7% of angina, 4.1% reinfarction, 1.4% and 0.5 % of stroke. The late ejection fraction was higher in cases of FI (p = 0.023). Conclusions: The organization in a public health system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer and a tertiary reference hospital, resulted in immediate improvement of STEMI outcomes.