Adonis Nasr

Extra-curricular supervised training at an academic hospital: is 200 hours the threshold for medical students to perform well in an emergency room?

IntroductionDue to high number of jobs in Emergency Medicine (EM) and the lack of specialist to work in this field, recent graduates work in the emergency room straight after medical school. Additional courses on EM are available through Academic Leagues. This organizations offer lectures and supervised extra-curricular practical activities in their teaching university-affiliated hospital. The objectives of the present study are to assess the influence of hours undertaken in the extra-curricular practical activities on the performance and confidence of students in carrying out the different procedures in the emergency department, and on their own perception of how well they did. Also, to assess the influence the practical activities have on student´s future choice of specialty.MethodsA Cross-sectional study conducted by collecting data through a questionnaire. 102 eligible individuals were included and divided into two groups according to the number of extra-curricular hours performed (Group 1- up to 200 hours and Group 2- over 200 hours).ResultsStudents in Group 2 (over 200 hours) had a greater number of procedures performed on all variables evaluated, in particular, initial patient care (mean 363.8 vs.136.905 in Group 1 - p = 0.001), Simple Sutures (mean of 96.2 vs 33.980 respectively) ( p = 0.00003). To determine patient follow-up by the student, the number of initial patient care was correlated with number of discharge procedures performed (in Group 1, 49.6% of patients were not followed up and discharged by the same students who first talked to them in the hospital. While in Group 2, this value becomes 29.4 % - values for Group 1 - p = 0.011 and Group 2 - p = 0.117). Regarding the influence of the practical extra-curricular activities, 76.5% of the total reported that it had influenced their choice of future specialty.ConclusionsThe aptitude, confidence and skill of students are closely linked to the practice time (number of training hours served). Two hundred hours appeared to be a relatively significant time for the student to demonstrate good conduct and ability. Practical extra-curricular activities had the ability to influence the future choice of specialty, either positively or negatively.

Evaluation of the use of tomography in penetrating neck trauma.

OBJECTIVE the study has the intention of evaluate the accuracy of computed tomography for the diagnosis of cervical lesions on penetrating neck trauma and also identify the most frequent mechanisms of trauma. Most injured structures, determine the age range and the most prevalent sex. METHODS observational descriptive retrospective study executed by the systematic retrospective review of medical records of all patients victims of penetrating neck trauma that went through surgery and CT scans, admitted into Hospital do Trabalhador, between January 2009 and December 2013. RESULTS the final sample was of 30 patients, 96.7% of the male sex, the median age was of 28 years old. Most patients suffered injuries by gun (56.7%) and 33,3% suffered stab wounds. The most stricken area of the neck was Zone II (77.8%) and the left side (55.2%). Regarding the structures injured, the CT showed 6.7% lesions on airways but the surgery showed 40% of damaged, with a value of p=0.002. As to damages of the esophagus and pharynx the CT detected 10% of lesions, while surgery found 30% of lesions, therefore with a significant value of p=0.013. As for the analysis the CT showed reliable. As for the analysis of vascular damage, the CT showed to be, in most cases, reliable to the findings during the surgical act. CONCLUSION besides the great use of CT for the diagnosis of penetrating neck injuries we can say that this is an exam with low accuracy for the diagnosis of lesions of aerodigestive tract, therefore it is important a clinical correlation for a good diagnosis.as for the vascular lesions and of other structures, the CT had high sensibility and specificity, thus a good exam to be used in overall.

Perfil epidemiológico de acidentes com material biológico entre estudantes de medicina em um pronto-socorro cirúrgico

OBJECTIVE: To evaluate the accidents with biological material among medical students interning in a trauma emergency room and identify key related situations, attributed causes and prevention. METHODS: we conducted a study with a quantitative approach. Data were collected through a questionnaire applied via internet, with closed, multiple-choice questions regarding accidents with biological material. The sample comprised 100 students. RESULTS: thirty-two had accidents with biological material. Higher-risk activities were local anesthesia (39.47%), suture (18.42%) and needle recapping (15.79%). The main routes of exposure to biological material were the eyes or mucosa, with 34%, and syringe needle puncture, with 45%. After contamination, only 52% reported the accident to the responsible department. CONCLUSION: The main causes of accidents and routes of exposure found may be attributed to several factors, such as lack of training and failure to use personal protective equipment. Educational and preventive actions are extremely important to reduce the incidence of accidents with biological materials and improve the conduct of post-exposure. It is important to understand the main causes attributed and situations related, so as general and effective measures can be applied.

Mesenteric thrombosis in patient victim of blunt abdominal trauma with fatal outcome

INTRODUCAO: Trombose mesenterica, relacionada a trauma e entidade incomum, com pobre prognostico quando seguida de estados de baixo fluxo e choque hipovolemico. Geralmente apresenta-se com quadro de dificil diagnostico, cuja mortalidade e elevada a despeito de tratamento adequado. RELATO DO CASO: Paciente submetido a trauma, apos admissao hospitalar e atendimento inicial, exames radiologicos demonstraram fratura de costela e umero. Tomografia computadorizada evidenciou distensao aerea em intestino delgado associada a estase gastrica e hidropneumotorax. O paciente evoluiu com hipotensao durante o periodo de observacao clinica e parada cardiorrespiratoria que respondeu a reanimacao. Levado para operacao para controle de danos, encontrou-se extensa necrose de colon ascendente. Realizou-se hemicolectomia direita com ileotransversostomia. Levado a unidade de terapia intensiva, evoluiu com oliguria, miose, convulsao e atividade eletrica sem pulso, falecendo tres dias apos dar entrada no hospital. CONCLUSAO: Embora incomum, isquemia mesenterica com trombose venosa pode ser secundaria a hipotensao sistemica, com desfecho fatal.

Preventive peer-educational activities: what can medical students do to potentially save lives?

Traffic injuries are amongst the main causes of death worldwide. Even with the advances in technology, there are still 50% of deaths that cannot be reduced by medical care improvement. These important injuries can though be reduced by prevention of trauma. One of the best ways to address this issue is through incorporating preventive measures to the daily routine of schools. It is the aim of this study to assess children’s perception on traumatic events and to introduce a cost-effective peer-education preventive action.

Orientações de alta: cartões padronizados ajudam na compreensão dos pacientes do pronto socorro?

OBJECTIVE: To determine whether the addition of discharge standard illustrated cards improves understanding of patients in the emergency room. METHODS: We conducted a prospective, randomized, interventional study with 228 patients discharged from the emergency department. All patients were interviewed and tested for the level of understanding of discharge instructions. Some of them received the intervention, with the standard cards, and another did not, constituting the control group. RESULTS: The average of followed discharge guidelines of the group that received the cards was higher than the control group, with statistical significance (p=0.009). When segregated by age, the group between 16 and 35 years of both sexes had the best average of followed guidelines, statistically, than the average of the control group (p=0.01). The difference between the mean orientations between the control group and the card for patients undergoing procedures was statistically significant (p=0.02); as for the stratification according to the number of procedures, the significance increases when that is equal to 1 (p=0.001) and decreased the more procedures were carried out. CONCLUSION: The introduction of discharge standard orientation cards was associated with improvement in the understanding of patients. Without replacing the verbal directions, which establishes dialogue and doctor-patient bonding, cards appear as auxiliary elements, facilitating understanding and care guidelines.

Mesenteric thrombosis in patient victim of blunt abdominal trauma

INTRODUCTION: Mesenteric thrombosis related to trauma is an uncommon entity and has poor prognosis when associated to low perfusion and hemorrhagic shock. Usually presents a challenging diagnosis and high mortality rates, despite appropriate treatment. OBJECTIVE: To relate a case of a car accident and blunt abdominal trauma with terminal ileum and right colon necrosis. CASE REPORT: After initial procedures, complementary exams showed ribs and humerus fractures. Computerized tomography evidenced aerial distension in small bowel, gastric stasis and hidro-pneumothorax. Hypotension was observed during clinical observation followed by cardiopulmonary arrest, responding to reanimation. At surgery, it was found extensive necrosis of right colon and terminal ileum, and an ileum-transversostomy was performed with primary anastomosis. During the staying in intensive care unit, oliguria, miosis, convulsion and pulseless electric activity happened with death in three days after hospital admission. CONCLUSION: Although uncommon, mesenteric ischemia with venous thrombosis might be secondary to blunt abdominal trauma and must be considered in a bad abdominal evolution.

Influência do local de origem do trauma nos índices de admissão de pacientes submetidos à laparotomia de emergência.

OBJECTIVE to evaluate the influence of the site of trauma occurrence on the trauma scores of patients submitted to emergency laparotomy. METHODS this is a retrospective, observational, analytical study. We included 212 patients who underwent exploratory laparotomies in the period of January 2015 and December 2017. We obtained information about the accident site and vital data of the patients based on data collection through electronic and physical records. We analyzed the trauma indices of patients from Curitiba and its Metropolitan Region and the place where the patient was rescued (physical establishment or public road). RESULTS among the 212 patients studied, 184 (86.7%) were brought by the Prehospital Care Service from the city of Curitiba, and 28 (13.3%), from the Metropolitan Region of Curitiba. Twenty-five patients (17.6%) were rescued in physical establishments, while 117 (82.4%) were rescued on public roads. We observed higher values ​​of Injurity Severity Scores (ISS) in patients coming from the Metropolitan Region than in those coming from Curitiba (29.78 vs 22.46, P=0.009), but higher values ​​of Trauma and Injury Severity Scores (TRISS) in patients from Curitiba than the ones from the Metropolitan Region (90.62 vs 81.30, P=0.015). Patients rescued in public roads presented lower Revised Trauma Scores (RTS) (6.96 vs 7.65, P=0.024) and TRISS (86.42 vs 97.21; P=0.012). CONCLUSION trauma victims from sites more distant from the referral center and rescued on public roads presented worse prognosis.

Senior medical students as Trauma volunteers: is it worthwhile being on-call at a Level I Trauma Center?

Medical students usually do supervised extra-curricular activities in different fields in Brazil. Doing these activities in the resuscitation room (RR) of a Level I Trauma Center is reserved for senior medical students (after 500 hours of extra-curricular activities done at the same hospital). The aim of this study was to assess the number of different procedures a senior medical student can develop in the RR over his extra-curricular activities in this environment.

Peer health education for injury prevention: a cost-effective measure that can spread medical knowledge amongst children and youths

Domestic accidents yearly account for an important amount of morbidity related to trauma worldwide, mainly amongst children and youth. One of the best ways to address this issue is through incorporating preventive measures to the daily routine of schools. It is the aim of this study to introduce a cost-effective peer-education preventive action.