Research Journal of Emergency Medicine

  • STUDENT’S EXPERIENCE AS A MEMBER IN AN INTENSIVE THERAPY LEAGUE: EXPERIENCE REPORT

    Introduction: In an Intensive Care Unit, the nursing team needs to be qualified and endowed with technical-scientific knowledge. Many assignments such as personal and material management; patient evaluation; team supervision; decision-making, leadership and continued education, are part of the routine of an intensive care nurse. Academic practice in the hospital environment happens in a reduced way, mainly because there is still a lot of fear and insecurity from the academics, as well as from the professional nurses in accompanying them. However, when the academic practice in this environment make itself available, the students have presented a significant technical-scientific evolution, collaborating decisively in the formation of the future professional nurse. An important and nice strategy for the student to enter specific sectors, such as the Intensive Care Unit, in order to internship, is the construction of Academic Leagues. Objective: To report the experience of nursing students in the Intensive Care Unit through the Academic League. Methods: This is a report of experience based on experiences during the extracurricular practice in the Intensive Care Unit provided by the Academic League of Intensive Therapy of Arapiraca. Results: Initially we realized that, although we have specific training, technical visits and laboratory practices with professionals in the field, the academic is often afraid of the critical environment, generating a feeling of impotence towards difficult patients. This often leads to thoughts about abandoning practical experience. However, with time, what is new becomes more familiar and the insecurities begin to stop being a part of the context, consequently, the construction of the professional future begins to exist. Conclusion: It is evident that the practices carried out during the shifts provided by the Academic League of Intensive Therapy, combined with the theoretical knowledge acquired at the University, provide a differentiated and more prepared student when it comes to…

  • LIGHT TECHNOLOGY IN A HIGH-COMPLEXITY HEALTH UNIT: A MULTIPROFESSIONAL EXPERIENCE

    Introduction. The Neonatal Intensive Care Unit (NICU) is marked by the hard technology and dominated by the technical language, and can become a scenario of strong emotions, conflicts and feelings for the family, settling in a hostile environment. In this context, parents experience feelings of guilt, fear, anguish, and disability. In this perspective, it is necessary to think of care strategies that use light technology in health care in hospitals of high complexity. Objective. Provide a playful moment with the mothers of babies hospitalized in the Neonatal ICU. Methods. Report of experience of the celebration of the day of the children, on October 12, 2018, carried out by the multiprofessional team of the Maternity School Januário Cicco, in the auditorium of said institution.There were jokes, children’s dances and a karaoke. Popcorn was distributed as a souvenir in the shape of a slipper with jujube, made with disposable cup, in blue and pink, depending on the sex of the baby. This memory was made by residents of the Multiprofessional Residence in Neonatal Intensivism. Results. The activity counted on the participation of 15 mothers, 1 professional and 8 residents of said service, providing teaching-service integration. Through this activity it was possible to provide a moment of integration, communication, creativity and affectivity. Both mothers and residents were able to develop their communicative and bonding skills. Conclusion. The activity revealed the importance of including playfulness in the hospital as an instrument capable of modifying unpleasant situations arising from the prolonged hospitalization process, since it proposes to care in an integrated way. The entire process, in addition to benefiting children and residents, has made the local health service more humanized.

  • Factors associated with morbidity in ICU

    The beginnings of caring for critically ill patients date back to Florence Nightingale’s work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. Many factors are hypothesized to contribute to the relatively high incidence and associated morbidity of medication errors in the ICU. The patients themselves are the most complex and critically ill in the hospital setting [1]. Critical care areas present a particular challenge with regard to medication errors. They are a dynamic environment with critically ill patients who often require rapid adaptation of ongoing management. ICUs can be error-prone settings, where even otherwise minor adverse events can lead to serious disability. By virtue of being sicker, older, and having more comorbidities, these patients are less resilient to errors. Because they require a higher intensity of care provision and may receive more medications, they may be at greater risk of iatrogenic harm. Pharmacokinetics of medications can also be altered in critically ill patients, principally through changes in volume of distribution and drug clearance. Large volume resuscitations, positive pressure ventilation, surgical procedures, systemic inflammatory response, and changes in protein binding, all common in ICU patients, affect the pharmacokinetics of many drugs. In addition, these patients are usually unable to help facilitate their own care, a problem aggravated by the volume of transfers to and from ICUs. Medication safety in ICUs might also be compromised because of the risks associated with the use of multiple medications per patient and the use of high-risk drugs associated with potentially severe adverse events [2]. Drugs used in the ICU are more likely to be potent, require dose calculations, have medication interactions, and be continuous infusions (which have a greater potential for error). Many medications may be used for off-label indications in the ICU setting, similar to the…

  • Dengue Protection and Cure: Bangladesh Perspective

    Up to 50-100 million infections are now estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk. Bangladesh is one of the countries that are affected by dengue viruses. Dengue is a viral infection caused by four types of viruses (DENV-1, DENV-2, DENV-3, DENV-4) belonging to the Flaviviridae family. These mosquitoes thrive in areas with standing water, including puddles, water tanks, containers and old tires. Lack of reliable sanitation and regular garbage collection also contribute to the spread of the mosquitoes. The disease has probably been known since the Chinese described it in 420 AD. Outbreaks are increasing although there is no human-to-human transfer, only mosquito-to-human viral transfer. Africans described “ka dinga pepo” as cramp-like seizure caused by an evil spirit. The Spanish may have changed “dinga” to dengue since it means fastidious or careful in Spanish, which describes the gait of people trying to reduce the pain of walking. With the number of patients rising, hospitals outside Dhaka are facing huge challenges to cope with the pressure, mostly due to lack of diagnosis chemicals, kits and other medical support.

  • Clinical Aspects and Direct Micological Examination in the Presuptive Diagnosis of Surface Micoses in Patients of the Intensive Care Unit of Hospital University of Petrolina-PE

    Introduction:Fungal infections have become more frequent in recent years, and are more prevalent in patients with underlying diseases that compromise the immune system and predispose to other risk factors, such as invasive devices and the use of antibacterials. The etiological agents of these mycoses are dermatophyte filamentous fungi, non-dermatophyte filamentous fungi (FFND) and yeasts. Objectives: To demonstrate the importance of observing the clinical aspects of lesions suggestive of mycosis, as well as the direct mycological examination in the presumptive diagnosis of superficial mycoses in patients in the Intensive Care Unit (ICU), Hospital University (HU) located in Petrolina- PE. Methods: Patients who were admitted to the UHU from March to May 2016, after ethical procedures, were analyzed for suspicion of superficial mycoses and the respective clinical samples were collected and processed for direct examination through clarification with 30% potassium hydroxide (KOH). Results and Discussion: The mean age of the patients was 39.4, ranging from 24 to 68 years and an average length of hospital stay of 15.1 days. None of the patients were on antifungal use. Of 23 patients, 10 presented lesions characteristic of nail mycoses, 4 presented lesions characteristic of tinea corporis. Of the 10 nail mycosis suspicions, 4 cases were confirmed. The toenails went to the most affected areas. The use of closed shoes and even vascular impairment in the lower limb are considered as the primary factors predisposing to the development of such an infection. Conclusion: The simple observation of the clinical aspects and the direct mycological examination in lesions suspected of fungal infections are important to identify possible outbreaks of systemic infections, as well as being a quick and low cost diagnostic method, making it possible to handle patients quickly with a nail disorder.

  • The Alternative Communication With Critical Elderly Patients Hospitalized: Staff-patient-family Relationship

    Introduction:The Extended Alternative Communication ¬ (EAC) brings together other forms of communication, as well as oral language, such as use of gestures, sign language, facial expressions, use of alphabet boards or pictographic symbols, to the use of more sophisticated systems such as recorded or synthesized voice communicators and computers. The causes that make communication of elderly patients impossible through speech are the most diverse. This difficulty in oral language expression can compromise the relationship between the patient and the staff such as the patient and its family, resulting in frustrated, nervous, anxious, agitated and depressed patients. Objetives: Report the Alternative Extended Communication method and their contributions to the process of internalization of elderly patients unable to communicate through speech. Methodology: For this study, the database Pub Med was consulted such as selected review articles from the entrance of the terms: extended alternative communication, speech therapy, critical elderly patients. Results and Discussion: It was found that, patients admitted to the ICU experience a big potential traumatic experience and many develop serious emotional problems. These experiences come with a psychological suffering and which has a harmful effect on the overall rehabilitation of the patient. EAC is a clinical and educational practice where the speech therapist tries to compensate and to facilitate for losses and disabilities of the individuals with severe disturbances of expressive communication and / or comprehension disorders. It provides a significant gain for the team and the family with the understanding of what happens in terms of communication and consequently the reduction of anxiety and s¬tress, avoiding frustrating situations for the patient. Conclusion: The theoretical aspects presented in this work, lead us to conclude that it is of utmost importance to the implementation of a larger communication system and alternative critical elderly patients hospitalized, noting that long-term treatment would be…

  • Health and Spirituality: a Humanization Proposal for Care

    Introduction: Research on the relationship between spirituality and health seeks to understand how religious beliefs and behaviors relate to or interfere with health. Spirituality as a coping strategy promotes meaning and ordering of life and suffering. Religious activity is an effective element, both to help maintain healthy stress and to improve the quality of life. The exercise of faith and the practice of religiosity are strategies, often used by mothers of hospitalized babies, as a way of dealing with a long period of hospitalization and feelings of guilt, anger, anxiety, fear, sadness and impotence. Objectives: Looking for new ways of thinking about the practice of caring for humanization, in a more integrated vision of the human being, group activities were carried out aiming at the expression and elaboration of feelings with the objective of stimulating faith and spirituality as a strategy of enfretamento in the hospital context. Methodology: Weekly conversation with mothers, caregivers and relatives of infants admitted to the Neonatal ICU and the Kangaroo Intermediate Care Unit were conducted. We used dynamics, musicality, reading of texts for reflection and prayer. Results: From January 2015 to October 2017, 125 wheels took place, in which topics such as peace, friendship, trust, joy, gratitude, fear, hope, forgiveness and perseverance were addressed. The talk wheels were attended by several professionals, including psychologists, physiotherapists, speech therapists, occupational therapists, nursing staff and hygienists. On average, five professionals and 15 mothers and / or accompanying persons participated per wheel. Conclusion: It was noticed that this activity promoted the strengthening of the participants’ faith, improved interpersonal relationships between the mothers and the mothers with the team, as well as facilitated the resolution of conflicts and promoted the capacity for empathy and mutual help.

  • Caring for Whom It Cares: Multiprofessional Intervention in the Neonatal Icu of the January School Maternity Cicco

    Introduction:At the present time, a pathological profile is identified in the work environment, characterized by the prevalence of health problems marked by chronic diseases, which are added to mental and physical stress-related impairments. In the hospital context, the Intensive Care Unit is perceived by the team that acts as one of the most aggressive, tense and traumatizing environments. In the Maternity School Januário Cicco (MSJC), the Neonatal Intensive Care Unit (NICU) is the sector with the highest sickness absenteeism due to illness, which results in the reduction of the team and, consequently, overloading of tasks. Nursing technicians are exposed to the intensive emergency, to the sound of the sterilizers, besides the demands and collections of the patients, relatives and doctors. The physical and mental exhaustion that affects these workers demanded of the institution strategies that could promote health and quality of life at work. Objectives: The activities aim to improve the level of motivation of nursing technicians, promote the integration of the multiprofessional team, provide a space for listening and acceptance of feelings, improve the communication channels of the sector and the organizational climate, reduce absenteeism, as well as contribute quality of life at work. Methodology: Since June of this year, group activities have been held monthly for 2 hours, conducted by the multiprofessional team of the MSJC (psychologist, social worker, occupational therapist, nurses, pediatrician and physical education professional) using musicalization, work gymnastics, dynamics, relaxation techniques, acupuncture and dramatization. Results: At each meeting, an average of 30 nursing technicians participated. There was an improvement in motivation and organizational climate, reduction of sick leave, greater interaction among the team, as well as improvement of communication channels in the sector. Conclusion: The activities developed have made it possible to improve the quality of life in the work of NICU nursing technicians.

  • Maintenance of advanced airways in prehospital care

    Introduction: Advanced airway management occupies an important place in the care of trauma patients. Its relevance is much more valued today than in the past. Maintaining a patent airway and providing adequate ventilation, when necessary, are relevant procedures in reducing brain injury as well as increasing the likelihood of a good prognosis. Objective: The objective of this research is to find evidence in the scientific literature about the maintenance of advanced airways in prehospital care. Methodology: This is an integrative review of the literature. The articles search was carried out in June 2017 in the following databases: Scielo, PubMed and Portal Capes. Articles from the last ten years were selected, and the following descriptors were used: Emergency Medical Services; Oxygen; Ventilation. Results and Discussion: 6 articles were found, 3 in Portuguese, 2 in English and 1 in Spanish. The most recent article was of 2013. In regard to the maintenance of advanced airways, there are three types of definitive airway: orotracheal tube, nasotracheal tube, and surgical airway (cricothyroididotomy or tracheostomy), the latter being used only in the in-hospital service. Endotracheal intubation is indicated for patients with lowering in the level of consciousness, presenting scores lower than 8 in the Glasgow Coma Scale. It is a technique that must be performed sterile, and most of the time in the APH this is not possible. Both techniques are safe when performed properly. Oxygen should be administered with caution and the patient monitored constantly with pulse oximetry and respiratory rate. Conclusion: The results found to date show that there are not many scientific evidence-based reports that outline how airway maintenance should be done in APH, pointing to the need for further studies in the area.