Ana Maria Calil

Mapping injuries in traffic accident victims: a literature review

O objetivo do estudo foi identificar as regioes corporeas mais atingidas em vitimas de acidentes de transporte e mapear a gravidade das lesoes e do trauma. Foi realizada revisao sistematica da literatura, utilizando-se descritores relacionados aos acidentes de trânsito, acidentes de transporte, ferimentos e lesoes, totalizando 248 artigos. As bases eletronicas pesquisadas foram LILACS, MEDLINE e PAHO, entre 1990 e dezembro de 2006. Essa revisao destacou uma serie de estudos conclusivos sobre as regioes corporeas mais frequentes e aquelas de maior gravidade atingidas nesses eventos e apontou lacunas de conhecimento na literatura nacional. Acredita-se que esses achados possam ser de grande valia para as equipes nos cenarios de pre-hospitalar e intra-hospitalar e apontem caminhos na direcao de novas pesquisas.The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

Intensidade da dor e adequação de analgesia

An unprecedented study in Brazil analyzed pain intensity and adequacy of analgesia at an emergency center. One hundred accident victims attended at a trauma reference hospital were evaluated. Pain was present in 90% of cases; 56.0% complained of severe pain on first evaluation and, three hours later, 26.0% remained in severe pain and 38.0% in moderate pain. A significant portion of the study population did not receive analgesia during the observation period. Considerable numbers of inadequate analgesia were found, confirming the reduced importance of analgesia in trauma in Brazil.An unprecedented study in Brazil analyzed pain intensity and adequacy of analgesia at an emergency center. One hundred accident victims attended at a trauma reference hospital were evaluated. Pain was present in 90% of cases; 56.0% complained of severe pain on first evaluation and, three hours later, 26.0% remained in severe pain and 38.0% in moderate pain. A significant portion of the study population did not receive analgesia during the observation period. Considerable numbers of inadequate analgesia were found, confirming the reduced importance of analgesia in trauma in Brazil.

THE "OLIGOANALGESIA PROBLEM" IN THE EMERGENCY CARE

INTRODUCTION Pain is a common occurrence in trauma victims that provokes harmful effects on the body. However, there is a gap in the literature about this problem, which is still underevaluated and undertreated in Brazil, especially concerning the use of opioids. OBJECTIVES To estimate pain intensity and the use of analgesia in traffic accident victims. MATERIALS AND METHODS A prospective study, involving 100 accident victims (traffic accidents), who were interviewed at 2 separate posttraumatic moments, in a reference hospital of the city of São Paulo. All the medications used for these victims were recorded. All patients displayed a Glasgow Coma Scale (ECGl) of 15, had stable hemodynamic parameters, and were brought directly from the scene of the accident. RESULTS Pain of moderate and severe intensity (in 90% of cases) was the most noted. After a 3-hour period, a significant number of patients with pain (48%) continued without analgesia, and few opioids were used. CONCLUSION Pain is a common event associated with trauma. It is still undertreated and underevaluated in Brazil, and the use of opioids for admittedly very severe pain is not frequently employed in the Emergency Service even in hemodynamically stable patients and with a Glasgow Coma Scale of 15.

O ensino de cuidados críticos/intensivos na formação do enfermeiro: momento para reflexão

The aim of the present study was to rethink the Critical Care Course in the undergraduate nursing curriculum, analyzing relevant issues of its insertion, considering professional training and qualification, the demands of the job market and a critical reflection of the nurses professional competences, according to a theoretical reference framework.The aim of the present study was to rethink the Critical Care Course in the undergraduate nursing curriculum, analyzing relevant issues of its insertion, considering professional training and qualification, the demands of the job market and a critical reflection of the nurses professional competences, according to a theoretical reference framework.1 Nurse. PhD., Specialist in Intensive Care Nursing and Adult Intensive Care. Professor of College of Nursing and of Research and Graduate Studies Center at Faculdades Metropolitanas Unidas. São Paulo, SP, Brazil. megham@uol.com.br 2 Nurse. PhD., Specialist in Intensive Care Nursing. Collaborator Professor of University São Camilo, Lato Sensu Graduate Course in Emergency. São Paulo, SP, Brazil. easallum.fnr@terra.com.br T H E O R E T I C A L S T U D Y

Pain intensity of pain and adequacy of analgesia

An unprecedented study in Brazil analyzed pain intensity and adequacy of analgesia at an emergency center. One hundred accident victims attended at a trauma reference hospital were evaluated. Pain was present in 90% of cases; 56.0% complained of severe pain on first evaluation and, three hours later, 26.0% remained in severe pain and 38.0% in moderate pain. A significant portion of the study population did not receive analgesia during the observation period. Considerable numbers of inadequate analgesia were found, confirming the reduced importance of analgesia in trauma in Brazil.An unprecedented study in Brazil analyzed pain intensity and adequacy of analgesia at an emergency center. One hundred accident victims attended at a trauma reference hospital were evaluated. Pain was present in 90% of cases; 56.0% complained of severe pain on first evaluation and, three hours later, 26.0% remained in severe pain and 38.0% in moderate pain. A significant portion of the study population did not receive analgesia during the observation period. Considerable numbers of inadequate analgesia were found, confirming the reduced importance of analgesia in trauma in Brazil.

Mapeamento das lesões em vítimas de acidentes de trânsito: revisão sistemática da literatura

O objetivo do estudo foi identificar as regioes corporeas mais atingidas em vitimas de acidentes de transporte e mapear a gravidade das lesoes e do trauma. Foi realizada revisao sistematica da literatura, utilizando-se descritores relacionados aos acidentes de trânsito, acidentes de transporte, ferimentos e lesoes, totalizando 248 artigos. As bases eletronicas pesquisadas foram LILACS, MEDLINE e PAHO, entre 1990 e dezembro de 2006. Essa revisao destacou uma serie de estudos conclusivos sobre as regioes corporeas mais frequentes e aquelas de maior gravidade atingidas nesses eventos e apontou lacunas de conhecimento na literatura nacional. Acredita-se que esses achados possam ser de grande valia para as equipes nos cenarios de pre-hospitalar e intra-hospitalar e apontem caminhos na direcao de novas pesquisas.The objective of this study was to identify the body regions most affected in traffic accident victims and to map the trauma and severity of the lesions. A systematic literature review using key words related to traffic accidents, transportation accidents, wounds and injuries found a total of 248 articles. The electronic bases LILACS, MEDLINE, and PAHO were surveyed between the years 1990 and December 2006. This review emphasized a series of conclusive studies about the most frequent body regions involved and the major injuries occurring in these situations. It also indicated information gaps in the Brazilian literature. We believe that these findings are valuable for pre-hospital and intra-hospital teams and point the way to new investigations.

Conceitos de enfermeiros e médicos de um serviço de emergência sobre dor e analgesia no trauma

Analisaram-se os conceitos sobre dor e analgesia no trauma de enfermeiros e medicos de um servico de emergencia. Foram realizadas entrevistas semi-estruturadas com 100% da equipe de enfermeiros (22) e 85% da equipe medica (22) do Pronto-Socorro Cirurgico do HCFMUSP. A analise dos dados apontou alguns conceitos concordantes e outros discordantes com a literatura. Os profissionais estavam de acordo na maior parte dos conceitos, mas diferiram em alguns. Na opiniao dos profissionais, baixa prioridade e dada ao controle da dor no trauma.

Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs

OBJETIVE: This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment. METHODS: Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer’s for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. RESULTS: Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer’s and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer’s (group II). CONCLUSIONS: Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer’s solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

Gravidade da lesão e analgesia em pacientes que sofreram acidentes de transporte

OBJECTIVE: Identifying the frequency and gravity of injuries in patients who suffered accidents in traffic and the analgesic drugs utilized. METHODS: Retrospective study, with a sample of 200 medical records of patients admitted to the emergency services of a reference hospital for trauma care. The gravity of the injuries was characterized by anatomic gravity rates and the analgesic therapy was based on the World Health Organizations Analgesic Ladder. RESULTS: The main findings pointed to injuries in limbs, head, face and outer surface as the most frequent, and, in 85% of the cases, gravity was equal or lower than 3; As for analgesia, it was verified that 46;6% of the patients received dipyrone and paracetamol. Among the opioids, meperidine was used in 10.4% of the cases. CONCLUSION: The gravity of most injuries was equal or lower to 3, indicating injuries of light, moderate and serious gravity, located especially in four body regions; regarding analgesia, dipyrone was shown to be the most commonly-used drug and a low use of opioids was verified.OBJETIVOS: Identificar a frequencia e gravidade das lesoes em acidentados de transporte e as drogas analgesicas utilizadas. METODOS: Estudo retrospectivo, com amostra de 200 prontuarios de pacientes internados no pronto-socorro de um Hospital referencia para o atendimento ao trauma. A gravidade das lesoes foram caracterizadas por indices de gravidade anatomicos e a terapeutica analgesica com base na Escada Analgesica da Organizacao Mundial de Saude. RESULTADOS: Os principais achados apontaram as lesoes em membros, cabeca, face e superficie externa como as mais frequentes, e em 85% dos casos com gravidade menor ou igual que 3; quanto a analgesia verificou-se que 46,6% dos pacientes receberam dipirona e paracetamol , entre os opioides destacou-se a meperidina com 10,4%. CONCLUSAO: A maioria das lesoes foram de gravidade igual ou menor a 3, indicativo de lesoes de gravidade leve, moderada e seria, localizadas principalmente em quatro regioes corporeas; quanto a analgesia, a dipirona apareceu como a droga mais utilizada e constatou-se reduzido uso de opioides.

Relação entre a gravidade do trauma e padrões de analgesia utilizados em acidentados de transporte

This is a first-time study in Brazil, which identified the relations between the analgesic standard and trauma severity. To do this, an analysis was performed in a population of 200 traffic accident victims admitted for treatment at the emergency unit of a referral hospital for trauma care in the city of São Paulo. Trauma and lesion severity were characterized by anatomic severity indexes. Based on the analysis of the analgesic therapy, analgesia standards were constructed, founded on the World Health Organization analgesic scale. The results permitted to identify the statistic association between trauma severity and distinct analgesia standards. The dissemination of these findings could serve as the basis to design analgesia protocols in trauma and improve care quality, besides encouraging the development of studies in an area with so many knowledge gaps.This is a first-time study in Brazil, which identified the relations between the analgesic standard and trauma severity. To do this, an analysis was performed in a population of 200 traffic accident victims admitted for treatment at the emergency unit of a referral hospital for trauma care in the city of Sao Paulo. Trauma and lesion severity were characterized by anatomic severity indexes. Based on the analysis of the analgesic therapy, analgesia standards were constructed, founded on the World Health Organization analgesic scale. The results permitted to identify the statistic association between trauma severity and distinct analgesia standards. The dissemination of these findings could serve as the basis to design analgesia protocols in trauma and improve care quality, besides encouraging the development of studies in an area with so many knowledge gaps.