Research Journal of Emergency Medicine

  • INTERDISCIPLINARITY IN ASSISTING PATIENTS IN AN INTENSIVE CARE UNIT

    Objectives: To review in the literature the perception of ICU health professionals, as members of an interdisciplinary team. Methods: This is an integrative literature review, carried out between July and August 2020. The data collection took place between the years 2012 to 2020, in the electronic databases PubMed (National Library of Medicine and National Institute of Health – USA) and Scielo (Scientific Electronic Library Online), through the DeCS (health descriptors) “patient care team”, “intensive care units” and “health”, in English and Portuguese. Results: After applying the eligibility criteria for this review, 7 articles were selected, read in full. The results showed the existence of division and fragmentation of work; lack of communication between team members and users; hierarchy of power and ethical conflict within the multiprofessional team; and inadequate working conditions. Conclusion: This research made it possible to recognize the weaknesses experienced by the multiprofessional ICU team and to understand the main factors that hinder the team’s work.

  • DEATH SURVEILLANCE IN PERNAMBUCO: ADDRESSING THE SENSITIVITY BETWEEN HOSPITAL EPIDEMIOLOGICAL SURVEILLANCE AND THE MORTALITY INFORMATION SYSTEM

    Objective: Describe the sensitivity of notification and investigation of deaths eligible in the Mortality Information System and occurred in hospitals that make up the State Hospital Epidemiological Surveillance Network of Pernambuco. Methods: Fetal, infant, maternal and women of childbearing deaths that occurred in 2015 in the 29 hospitals of the State Network VEH/PE were selected. For analysis, the notification, investigation and updating of the SIM WEB module was considered, relating the SIM bases and spreadsheets of the VEH/PE Network and sensitivity was estimated by the capture and recapture method. Results: 54,0% of the deaths in Pernambuco came from the VEH/PE Network. 80,0% of infant and maternal deaths were reported by the VEH/PE Network immediately. In the set of analyzed deaths, the capture and recapture method estimated a slight loss in capture, with a sensitivity of 99,9% for both sources of record. And, in the investigation, greater sensitivity, for the VEH/PE spreadsheet (98,6%). The SIM had a lower magnitude (2,9%) of underreporting in the collection and a higher proportion (43,3%) of underreporting in the information from the hospital investigation source in the SIM WEB module. Conclusion: These results can contribute to reducing the underreporting of capture and information on hospital investigation in the SIM WEB module and allow knowledge about the causes and circumstances that determined or favored the occurrence of death in order to analyze the avoidability, planning and evaluation of maternal and child health actions.

  • HOSPITAL MORTALITY, IN URGENCY CHARACTER, DUE TO EXTERNAL CAUSES IN BRAZIL

    Objective: To analyze hospital mortality, in urgency character, due to external causes in Brazil. Methods: This is a transversal, descriptive and quantitative study performed with secondary data from the Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS). For data selection, external cause mortality from 2009 to 2019 was used, considering “urgency” as attendance character in the age range from 20 to 80 years or older. Besides, the variables sex, causes and regions were analyzed. Absolute and relative frequencies were calculated using Microsoft Excel® 2016 software. Results: It is observed that 67.60% (n=214,711) of deaths were due to external causes in urgency character attendance, since 71.03% (n= 150,123) were male and 28.97% (n= 64,588), female. The main deaths causes were: other external causes of accidental injuries 68.30% (n= 120,306), traffic acidentes, with 21.55% (n= 37,967) and aggressions, 10.15% (n= 17,879). As for the distribution of percentages between regions, the Southeast presented 44, 41% (n= 95,360), followed by Northeast region, with 25,00% (n= 53694); South, 16,93% (n= 36,352); Midwest, 7,12% (n= 15,294) and North, 6,52% (=14011). Conclusion: The prevalence of mortality from major external causes in urgency character presented a higher quantitative in males aged 20 to 80 years or older, and, among regions, Southeast, Northeast and South obtained a higher percentage of mortality compared to North and Midwest. Such knowledge allows the construction of possible public policies to reduce high hospital mortality rates.

  • THE ROLE OF THE PSYCHOLOGIST BEFORE PATIENT PAIN IN INTENSIVE CARE UNIT

    Introduction: The Intensive Care Unit is a hospital location permeated by not very positive associations, with the multidisciplinary team having to deal with the pain, fears and anxiety of their patients daily and the demands of their families for comprehensive care and less suffering for the patient. Pain is a reaction of the patient with biopsychosocial factors involved. The team does not always act successfully in the face of the patient’s pain, using the psychologist as a mediator of this situation. Objective: to reflect on the role of the psychologist in the face of the patient’s pain in the Intensive Care Unit. Methodology: experience report. Results and discussion: In the intensive care unit, the patient is distant from his family members, without clothes, with monitoring of different equipment and people, with invasive care, which can be felt as threatening his integrity. Pain is an unpleasant sensory experience that may be associated with tissue damage or not. It is a difficult phenomenon to be measured, since it can be an emotional pain, activated by psychological components or not. Each person has a different intensity, manifestation and reaction to pain. There are pain scales that can be used as a strategy to adapt the best intervention in different contexts of illness. The psychologist in this unit acts focused on the patient, his family and team, because everyone involved may be interfering in the recovery process and in the experience of pain and in its coping. In this triad, attentive, neutral listening should be offered to provide psychological support and to facilitate the mediation of these relationships. Conclusion: This study points to the need to study more about the pain process in the ICU context, the role of the psychologist and the importance of humanization in this context.

  • 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…