Evaluation Of Gasometric Parameters In Trauma Patients During Mobile Prehospital Care [avaliação Dos Parâmetros Gasométricos Dos Traumatizados Durante O Atendimento Pré-hospitalar Móvel]

Objective: To evaluate gasometric differences of severe trauma patients requiring intubation in prehospital care. Methods: Patients requiring airway management were submitted to collection of arterial blood samples at the beginning of pre-hospital care and at arrival at the Emergency Room. We analyzed: Glasgow Coma Scale, respiratory rate, arterial pH, arterial partial pressure of CO2 (PaCO2), arterial partial pressure of O2 (PaO2), base excess (BE), hemoglobin O2 saturation (SpO2) and the relation of PaO2 and inspired O2 (PaO2/FiO2). Results: There was statistical significance of the mean differences between the data collected at the site of the accident and at the entrance of the ER as for respiratory rate (p = 0.0181), Glasgow Coma Scale (p = 0.0084), PaO2 (p <0.0001) and SpO2 (p = 0.0018). Conclusion: tracheal intubation changes the parameters PaO2 and SpO2. There was no difference in metabolic parameters (pH, bicarbonate and base excess). In the analysis of blood gas parameters between survivors and non-survivors there was statistical difference between PaO2, hemoglobin oxygen saturation and base excess.404293299Gonsaga, R.A., Brugugnolli, I.D., Fraga, G.P., Comparison between two mobile pre-hospital care services for trauma patients (2012) Word J Emerg Surg., 7 (SUPPL. 1), pp. S6Pereira Júnior, G.A., Carvalho, J.B., Ponte Filho, A.D., Malzone, D.A., Pedersoli, C.E., Transporte intra-hospitalar do paciente crítico (2007) Medicina., 40 (4), pp. 500-508Kue, R., Brown, P., Ness, C., Scheulen, J., Adverse clinical events during intrahospital transport by a specialized team: A preliminary report (2011) Am J Crit Care., 20 (2), pp. 153-161Lima Junior, N.A., Bacelar, S.C., Japiassú, A.M., Cader, S.A., Lima, R.C.F., Dantas, E.H.M., Gasometria arterial em dois diferentes métodos de transporte intra-hospitalar no pós-operatório imediato de cirurgia cardíaca (2012) Rev bras ter intensiva., 24 (2), pp. 162-166Waydhas, C., Schneck, G., Duswald, K.H., Deterioration of respiratory function after intra-hospital transport of critically ill surgical patients (1995) Intensive Care Med., 21 (10), pp. 784-789Zuchelo, L.T.S., Chiavone, P.A., Transporte intra-hospitalar de pacientes sob ventilação invasiva: Repercussões cardiorrespiratórias e eventos adversos (2009) J bras pneumol., 35 (4), pp. 367-374Gervais, H.W., Eberle, B., Konietzke, D., Hennes, H.J., Dick, W., Comparison of blood gases of ventilated patients during transport (1987) Crit Care Med., 15 (8), pp. 761-763Wildner, G., Pauker, N., Archan, S., Gemes, G., Rigaud, M., Pocivalnik, M., Arterial line in prehospital emergency settings-A feasibility study in four physician-staffed emergency medical systems (2011) Resuscitation., 82 (9), pp. 1198-1201Schmelzer, T.M., Perron, A.D., Thomason, M.H., Sing, R.F., A comparison of central venous and arterial base deficit as a predictor of survival in acute trauma (2008) Am J Emerg Med., 26 (2), pp. 119-123Bilello, J.F., Davis, J.W., Lemaster, D., Townsend, R.N., Parks, S.N., Sue, L.P., Prehospital hypotension in blunt trauma: Identifying the "crump factor" (2011) J Trauma., 70 (5), pp. 1038-1042(2012) Atendimento pré-hospitalar ao traumatizado, PHTLS / NAEMT, , Tradução do original Prehospital trauma life support, por Renata Scavone, et al. 7a ed. Rio de Janeiro: ElsevierFraga, G.P., Mantovani, M., Magna, L.A., Índices de trauma em pacientes submetidos à laparotomia (2004) Rev Col Bras Cir., 31 (5), pp. 299-306Barros, M.D.A., Ximenes, R., Lima, M.L.C., Mortalidade por causas externas em crianças e adolescentes: Tendência de 1979 a 1995 (2001) Rev Saúde Pública., 35 (2), pp. 142-149Gonsaga, R.A.T., Rimoli, C.F., Pires, E.A., Zogheib, F.S., Fujino, M.V.T., Cunha, M.B., Avaliação da mortalidade por causas externas (2012) Rev Col Bras Cir., 39 (4), pp. 263-267Batista, S.E.A., Baccani, J.G., Silva, R.A.P., Gualda, K.P.F., Vianna Junior, R.J.A., Análise comparativa entre os mecanismos de trauma, as lesões e o perfil de gravidade das vítimas, em Catanduva-SP (2006) Rev Col Bras Cir., 33 (1), pp. 6-10Carrasco, C.E., Godinho, M., Berti de Azevedo Barros, M., Rizoli, S., Fraga, G.P., Fatal motorcycle crashes: A serious public health problem in Brazil (2012) World J Emerg Surg., 7 (SUPPL. 1), pp. S5Marín-León, L., Belon, A.P., Barros, M.B.A., Almeida, S.D.M., Restitutti, M.C., Tendênica dos acidentes de trânsito em Campinas, São paulo, Brasil: Importância crescente dos motociclistas (2012) Cad Saúde Pública., 28 (1), pp. 39-51Jousi, M., Reitala, J., Lund, V., Katila, A., Leppäniemi, A., The role of prehospital blood gas analysis in trauma resuscitation (2010) World J Emerg Surg., 5, p. 10Martin, M., Oh, J., Currier, H., Tai, N., Beekley, A., Eckert, M., An analysis of in-hospital deaths at a modern combat support hospital (2009) J Trauma., 66 (4 SUPPL.), pp. S51-S60. , discussion S60-1Ouellet, J.F., Roberts, D.J., Tiruta, C., Kirkpatrick, A.W., Mercado, M., Trottier, V., Admission base deficit and lactate levels in Canadian patients with blunt trauma: Are they useful markers of mortality? (2012) J Trauma Acute Care Surg., 72 (6), pp. 1532-1535Darlington, D.N., Kheirabadi, B.S., Delgado, A.V., Scherer, M.R., Martini, W.Z., Dubick, M.A., Coagulation changes to systemic acidosis and bicarbonate correction in swine (2011) J Trauma., 71 (5), pp. 1271-1277Rudkin, S.E., Kahn, C.A., Oman, J.A., Dolich, M.O., Lotfipour, S., Lush, S., Prospective correlation of arterial vs venous blood gas measurements in trauma patients (2012) Am J Emerg Med., 30 (8), pp. 1371-1377Hussmann, B., Lefering, R., Waydhas, C., Ruchholtz, S., Wafaisade, A., Kauther, M.D., Prehospital intubation of the moderately injured patient: A cause of morbidity? A matched-pairs analysis of 1,200 patients from the DGU Trauma Registry (2011) Crit Care., 15 (5), pp. R207Park, M., Costa, E.L.V., McIel, A.T., Hirota, A.S., Vasconcelos, E., Azevedo, L.C.P., Alterações hemodinâmicas, respiratórias e metabólicas agudas após o contato do sangue com o circuito extracorpóreo da ECMO: Estudo experimental (2012) Rev bras ter intensiva., 24 (2), pp. 137-14

Contribution Of The Activities Diary To The Pediatric Teaching [contribuição Do Diário De Atividades Ao Ensino De Pediatria]

Objective: To describe the fifth-year medical students' self-evaluation based on the reflexive discourse of the Activities Diaries (portfolio) from the Pediatric Internship I and Child Care Rotations.Methods: Cross sectional, qualitative and descriptive study using the collective subject discourse of the diaries used during the internship of the Medical School, in Catanduva, São Paulo, from January to November, 2011. The registered students' testimonials in the portfolio sections called self-assessment and students' impression were assessed according to their central ideas (discipline organization, breastfeeding outpatient clinic, number of admissions in the pediatric hospital ward and satisfaction with the Child Health training), related to the teaching of Pediatrics and Child Care. The portfolios with incomplete registers were excluded.Results: The testimonials of 47 interns (75% of the students) were analyzed, and 21.3% of them expressed satisfaction with the discipline organization and 27.7% praised the inclusion of the breastfeeding outpatient clinics in the course. For 25.5% of the academics, the number of admissions in the pediatric wards was insufficient for an ideal learning; however, 70.2% were satisfied with the Child Health training. Conclusions: This critical analysis allowed a summary of the reflections, suggestions and critics registered by the interns and can be used as a tool for improvement of the professional cycle.313366370Puga, T.F., Benguigui, Y., (2003) Ensino de pediatria em escolas de medicina da América Latina, , Washington: OPAS;Feuerwerker, L.C., (2002) Além do discurso de mudança na educação médica: Processos e resultados, , São Paulo: Hucitec;Gomes, A.P., Arcuri, M.B., Cristel, E.C., Ribeiro, R.M., Souza, L.M., Siqueira-Batista, R.S., Evaluation in medical education: The role of portfolio in curricula based on active methodologies (2010) Rev Bras Educ Med, 34, pp. 390-396Marin, M.J., Moreno, T.B., Moravcik, M.Y., Higa, E.F., Druzian, S., Franscischetti, I., Student's perception of the reflective portfolio in medical school (2010) Rev Bras Educ Med, 34, pp. 191-198Savaris, R.F., Formative assessment among fourth-year medical students: An experience report (2009) Rev Bras Educ Med, 33 (SUPPL. 1), pp. 111-115Veiga, E.Q., Batista, N.A., Undergraduate teaching of pediatrics in medical schools of the state of Rio de Janeiro (2006) J Pediatr (Rio J), 82, pp. 115-120Silva, R.F., Sá-Chaves, I., Reflexive formation: Teachers' representations about the use of reflexive portfolio in the forming of medical doctors and nurses (2008) Interface Comunic Saude Educ, 12, pp. 721-734Cotta, R.M., Silva, L.S., Lopes, L.L., Gomes, K.O., Cotta, F.M., Lugarinho, R., The construction of collective portfolios in traditional curriculums: An innovative approach in teaching-learning (2012) Cienc Saude Coletiva, 17, pp. 787-796Zeferino, A.M., Domingues, R.C., Amaral, E., Feedback as a teaching/learning strategy in medical education (2007) Rev Bras Educ Med, 31, pp. 176-179Silva, R.F., Francisco, M.A., Reflective portfolio: A strategy for medical education (2009) Rev Bras Educ Med, 33, pp. 562-570Cunha, M.I., (1998) O professor universitário na transição de paradigmas, , Araraquara: JM Editores;Vieira, V.M., Portfolio: One proposal of evaluation with remaking to learn process (2002) Psicol Esc Educ (Impr), 6, pp. 149-153Campos, S., Pessoa, V.I., Discutindo a formação de professoras e professores com Donald Shön (1998) Cartografias do trabalho docente: Professor(a)-pesquisador(a), pp. 183-206. , In: Geraldi CM, Fiorentini D, Pereira EM, editors. Campinas: Mercado de LetrasPrearo, A.Y., Rizzato, A.B., Martins, S.T., Pediatrics teaching in primary health care between the boundaries of the biomedical model and the perspective of integrality of care: The view of the supervisor doctors (2011) Interface Comunic Saude Educ, 15, pp. 1039-1052Sperandio, A.M., Souza, T.F., Breno, E., Mendes, L.C., Pereira, A.R., Machado, A.C., The university collaborating in the construction of a health promotion project: Report on an experience of a group of medical students at Unicamp, Campinas, SP, Brazil (2006) Rev Bras Educ Med, 30, pp. 200-208Minayo, M.C., (2006) O desafio do conhecimento: Pesquisa qualitativa em saúde, , 9th ed. São Paulo: Hucitec;Fontanella, B.J., Ricas, J., Turato, E.R., Saturation sampling in qualitative health research: Theoretical contributions (2008) Cad Saude Publica, 24, pp. 17-27Lefèvre, F., Lefèvre, A.M., Teixeira, J.J., O discurso do sujeito coletivo (2000) Uma nova abordagem metodológica em pesquisa qualitativa, , Caxias do Sul: Educs;Lefèvre, F., Lefèvre, A.M., O sujeito coletivo que fala (2006) Interface Comunic Saude Educ, 10, pp. 517-524Schraiber, L.B., Qualitative research in health studies: Methodological reflections on the oral account and narrative technique in study on the medical profession (1995) Rev Saude Publica, 29, pp. 63-74Turato, E.R., Qualitative and quantitative methods in health: Definitions, differences and research subjects (2005) Rev Saude Publica, 39, pp. 507-514Neves, J.L., Pesquisa qualitativa: Características, usos e possibilidades (1996) Cad Pesq Administracao, 1, pp. 1-5Sene, T.B., Lino, M.L., Gonsaga, R.A., Silva, E.M., Biscegli, T.S., Patient's autonomy: A situacional analysis of an emergency unit (2012) Rev Bioet (Impr), 20, pp. 518-525Nunes P [homepage on the Internet], , http://www.notapositiva.com/trab_professores/textos_apoio/gestao/03conc_organizacao.htm, Conceito de organização [cited 2012 Oct 12]. Available fromGonsaga, R.A., (2012) Manual do internato: Ciclos profissionalizantes I e II [monografia], , Catanduva (SP): FIPE;The optimal duration of exclusive breastfeeding: Results of a WHO systematic review, , http://www.who.int/inf-pr-2001/en/note2001-07.html, World Health Organization [homepage on the Internet]. [cited 2010 Sep 10]. Available fromHuffman, S.L., Yeager, B.A., Levine, R.E., Shelton, J., Labbok, M., (1991) Breastfeeding saves lives: An estimate of the impact of breastfeeding on infant mortality in developing countries, , Bethesda: NUTURE/Center to Prevent Childhood Malnutrition;Silva Júnior, J.L., Padilha, T.F., Rezende, J.E., Rabelo, E.C., Ferreira, A.C., Rabahi, M.F., Effect of seasonality on the occurrence of respiratory symptoms in a Brazilian city with a tropical climate (2011) J Bras Pneumol, 37, pp. 759-767Morbidade hospitalar do SUS por local de internação-SP, , http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/nisp.def, Brasil-Ministério da Saúde-DATASUS [homepage on the Internet]. [cited 2012 Dec 20]. Available fromPontes, A.L., Rego, S., Silva Jr., A.G., Teaching conceptions and practice in the transformation of medical education (2006) Rev Bras Educ Med, 30, pp. 66-75Wuillaume, S.M., Educação médica em transformação: Instrumentos para a construção de novas realidades (2005) Cad Saude Publica, 21, pp. 1966-1967Aguiar, A.C., Ribeiro, E.C., The concept and evaluation of skills and competence in medical education: Current expert perspectives (2010) Rev Bras Educ Med, 34, pp. 371-378Rego, S., Gomes, A.P., Siqueira-Batista, R., Bioethics and humanization across the curriculum in medical education (2008) Rev Bras Educ Med, 32, pp. 482-491Ferreira, M.L., Avaliação no processo ensino-aprendizagem: Uma experiência vivenciada (2003) Rev Bras Educ Med, 27, pp. 12-19Forte, F.D., Viera, L.B., Pessoa, T.R., Freitas, C.H., Ferreira, M.L., The portfolio system and the challenge of carrying more than classroom notes: The view of dentistry professor (2012) Rev Bras Educ Med, 36 (SUPPL. 2), pp. 25-32Almeida, L.D., Machado, M.C., Atitude médica e autonomia do doente vulnerável (2010) Rev Bioet (Impr), 18, pp. 165-183Saraiva, A.M., Treatment suspension and the ethical values in Intensive Care Units: A survey on the Portuguese reality (2012) Rev Bioet (Impr), 20, pp. 150-16