Daniel Weiss Vilhordo

Auditoria no uso de antimicrobianos em enfermaria cirúrgica

BACKGROUND: To analyze the use of antibiotics in the surgical ward of a tertiary university hospital through one day audit. METHODS: Data were collected from the charts of hospitalized patients (pre- and postoperative) in a single, random visit in the surgical ward. Antibiotic prescription was classified as prophylactic, empirical, therapeutic intent with a known pathogen, therapeutic intent with an unknown pathogen or without rational basis, according to the preset criteria. RESULTS: From 50 hospitalized patients, 46 were surgical (N=46). Antibiotics were prescribed to 13 subjects (28.3%). Drug association was used in seven patients (53.8%), and nineteen antibiotics were prescribed. Eight drugs (42.1%) were used as empirical or without rational basis, four in each group. Six drugs (31.6%) were used to treat infections with an unknown pathogen, three (15.7%) to treat infections with a know pathogen and two drugs (10.5%) for prophylactic use. CONCLUSION: Despite all concerns about the rational use of antimicrobials, in the studied population, almost half of the drugs were used without proper diagnosis or definite criterion. Antibiotic prescription is still a current problem. It must be faced with seriousness by surgeons, who must know when to indicate, how to indicate, and yet, when not to indicate.

Description of a practical model for learning of peripheral venous access by students of medicine and nursing

AIMS: To describe a simple and low cost model of peripheral venous access, developed by the Trauma League of Pontificia Universidade Catolica do Rio Grande do Sul, which aims acquiring new skills by the health student/professional. METHODS: In order to simulate the peripheral access via, we used a rubber tourniquet, which ended in a blind end, simulating a vein, inserted on a latex glove full of fill material. The other extremity was connected to a bag of parenteral solution containing 500 ml of physiologic serum with dye, to simulate blood, through infusion equipos. The bag was hanged higher than the glove, making the gravity laws work. With the flow meter completely open, a pressure is created by the presence of air with liquid inside the infusion equipos and the tourniquet. The first puncture with the catheter takes out the air inside the cannulas, which allows the procedure to be done properly. RESULTS: The puncture, when done properly, causes the artificial blood to reflow into the puncture catheter, which does not happen when the rubber tourniquet is transfixed. This simulates a real life situation of venous puncture, because the hydrostatic pressure inside the tourniquet is analogous to that found in a vein. CONCLUSIONS: The description of the didactic model allows its reproducibility in an easy way, since the required materials are cheap and easily available. The model provides the initial familiarity with the procedure, making it easier to practice in the patient or in more sophisticated models, indispensable for the improvement of the technique.

Use of a gamma probe to identify and guide resection of recurrent parathyroid carcinoma: Report of a case

Parathyroid carcinoma (PC) accounts for less than 0.005% of all cancers and less than 5% of causes of hyperparathyroidism. This tumor is difficult to identify during surgery, which is detrimental to the oncologic results. Surgery is still the main treatment for the primary tumor and to control parathyroid hormone levels after recurrence. We report a case of recurrent parathyroid carcinoma in a 30-year-old man, identified and managed with the use of a gamma probe during surgery. To our knowledge, this is only the second report of a gamma probe being used to guide resection of a recurrent PC. We discuss the diagnosis and treatment, analyzing the current evidence-based literature.