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OBJECTIVES: to evaluate the profile of emergency care of trauma patients at Hospital Universitário Evangélico Mackenzie (HUEM) during the period of restrictive measures due to COVID-19 (03/13/2021 to 04/05/2021), and compare to the same period at the beginning of the pandemic, in 2020, and before the pandemic, in 2019. METHODS: quantitative and descriptive observational cross-sectional study. The final sample of 8,338 was analyzed in terms of date, gender, age and service responsible for providing care; the traumas were analyzed according to the etiology and conduct of the treatment and outcome. RESULTS: there was a percentage increase in non-traumatic emergency care during the pandemic, and the medical clinic held a third of admissions in 2021. There was a reduction in trauma care, since in 2019 traumas were responsible for 44.9% of admissions and by 23.5% in 2021. There was a significant difference in the proportion between the attendance of men and women, and the percentage of men victims of trauma was higher than in the pre-pandemic periods. There was a reduction in absolute numbers, with statistical significance, in traffic accidents, falls from the same level, burns, general blunt trauma and sports and leisure trauma. The proportion of conservative treatments with hospital discharge reduced. There was a significant difference in the number of deaths, decreasing in 2020 but increasing in 2021. CONCLUSION: there was a reduction in trauma care during the pandemic, but the profile remained the adult male victim of a traffic accident. More severe traumas were admitted, resulting in an increase in surgical treatment, hospitalizations and deaths.

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ABSTRACT Objectives: to evaluate the profile of emergency care of trauma patients at Hospital Universitário Evangélico Mackenzie (HUEM) during the period of restrictive measures due to COVID-19 (03/13/2021 to 04/05/2021), and compare to the same period at the beginning of the pandemic, in 2020, and before the pandemic, in 2019. Methods: quantitative and descriptive observational cross-sectional study. The final sample of 8,338 was analyzed in terms of date, gender, age and service responsible for providing care; the traumas were analyzed according to the etiology and conduct of the treatment and outcome. Results: there was a percentage increase in non-traumatic emergency care during the pandemic, and the medical clinic held a third of admissions in 2021. There was a reduction in trauma care, since in 2019 traumas were responsible for 44.9% of admissions and by 23.5% in 2021. There was a significant difference in the proportion between the attendance of men and women, and the percentage of men victims of trauma was higher than in the pre-pandemic periods. There was a reduction in absolute numbers, with statistical significance, in traffic accidents, falls from the same level, burns, general blunt trauma and sports and leisure trauma. The proportion of conservative treatments with hospital discharge reduced. There was a significant difference in the number of deaths, decreasing in 2020 but increasing in 2021. Conclusion: there was a reduction in trauma care during the pandemic, but the profile remained the adult male victim of a traffic accident. More severe traumas were admitted, resulting in an increase in surgical treatment, hospitalizations and deaths.

RESUMO Objetivo: avaliar o perfil de atendimento emergencial dos pacientes vítimas de trauma do Hospital Universitário Evangélico Mackenzie (HUEM) durante o período de medidas restritivas devido à COVID-19 (13/03/2021 a 05/04/2021) e comparar ao mesmo período no início da pandemia, em 2020, e antes da pandemia, em 2019. Métodos: estudo transversal observacional quantitativo e descritivo. A amostra final de 8.338 foi analisada quanto a data, sexo, idade e serviço responsável pelo atendimento; os traumas foram analisados conforme a etiologia e a conduta do tratamento e desfecho. Resultados: houve aumento percentual no atendimento a urgências não traumáticas durante a pandemia, e a clínica médica deteve um terço das admissões em 2021. Ocorreu redução nos atendimentos por trauma, visto que em 2019 os traumas foram responsáveis por 44,9% das admissões e por 23,5% em 2021. Houve diferença significativa na proporção entre os atendimentos de homens e mulheres, sendo que o percentual de homens vítimas de traumas foi maior do que os períodos pré pandêmicos. Observou-se redução em números absolutos, com significância estatística, nos eventos de trânsito, queda de mesmo nível, queimaduras, traumas contusos gerais e traumas esportivos e de lazer. A proporção de tratamentos conservadores com alta hospitalar reduziu. Houve diferença significativa na quantidade de óbitos, reduzindo em 2020, mas aumentando em 2021. Conclusão: houve redução do atendimento no trauma durante a pandemia, mas o perfil permaneceu sendo o homem adulto vítima de eventos de trânsito. Traumas de maior gravidade foram admitidos, resultando no aumento de tratamento cirúrgico, internamentos e óbitos

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OBJECTIVE: to assess the impact of the COVID-19 pandemic on abdominal wall hernia repair surgeries and cholecystectomy in a referral center hospital. METHODS: a retrospective, observational, cross-sectional study carried out at Hospital Universitário Evangélico Mackenzie (HUEM), in Curitiba, Paraná, Brazil. Data obtained through electronic medical records of patients who underwent cholecystectomy and abdominal wall hernia repair from March to December 2019 and 2020 at HUEM were included. Data were analyzed using Pearsons Chi-Square test and analysis of variance (ANOVA). RESULTS: a total of 743 medical records were analyzed, with a 63.16% drop in the total number of surgeries in 2020. There was a 91.67% increase in the number of ICU admissions in 2020, as well as a 70% increase in average length of stay. A greater number of complications was observed (in 2020, 27% had complications, while in 2019 this figure was 18.8%) and an increase in mortality (in 2019, this rate was 1.3% and in 2020, 6.5%). There were 6 cases of COVID-19 in 2020, so that of these, 5 patients died. CONCLUSION: during the COVID-19 pandemic, an important reduction in the number of abdominal wall hernia repair surgeries and cholecystectomy was observed. In addition, there was a statistically significant increase in postoperative complications, mortality rate and length of stay in 2020.

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BACKGROUND: The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. AIM: To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. METHODS: Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. RESULTS: One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). CONCLUSION: The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.

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ABSTRACT Objective: to assess the impact of the COVID-19 pandemic on abdominal wall hernia repair surgeries and cholecystectomy in a referral center hospital. Methods: a retrospective, observational, cross-sectional study carried out at Hospital Universitário Evangélico Mackenzie (HUEM), in Curitiba, Paraná, Brazil. Data obtained through electronic medical records of patients who underwent cholecystectomy and abdominal wall hernia repair from March to December 2019 and 2020 at HUEM were included. Data were analyzed using Pearsons Chi-Square test and analysis of variance (ANOVA). Results: a total of 743 medical records were analyzed, with a 63.16% drop in the total number of surgeries in 2020. There was a 91.67% increase in the number of ICU admissions in 2020, as well as a 70% increase in average length of stay. A greater number of complications was observed (in 2020, 27% had complications, while in 2019 this figure was 18.8%) and an increase in mortality (in 2019, this rate was 1.3% and in 2020, 6.5%). There were 6 cases of COVID-19 in 2020, so that of these, 5 patients died. Conclusion: during the COVID-19 pandemic, an important reduction in the number of abdominal wall hernia repair surgeries and cholecystectomy was observed. In addition, there was a statistically significant increase in postoperative complications, mortality rate and length of stay in 2020.

RESUMO Objetivo: avaliar o impacto da pandemia da COVID-19 em cirurgias de reparo de hérnias de parede abdominal e colecistectomia em hospital centro de referência. Métodos: estudo transversal retrospectivo observacional realizado no Hospital Universitário Evangélico Mackenzie (HUEM), em Curitiba, Paraná, Brasil. Foram incluídos os dados obtidos através de prontuários eletrônicos de pacientes que realizaram colecistectomia e reparo de hérnias de parede abdominal no período de março a dezembro de 2019 e 2020 no HUEM. Os dados foram analisados por meio do teste Qui-Quadrado de Pearson e aplicação da Análise de Variância (ANOVA). Resultados: Foram analisados 743 prontuários ao todo, sendo constatada uma queda de 63,16% no número total de cirurgias no ano de 2020. Verificou-se um aumento de 91,67% no número de internações em UTI em 2020, bem como um aumento de 70% no tempo médio de internação. Foi observado um maior número de complicações (em 2020, 27% apresentaram complicações, enquanto em 2019 este valor foi de 18,8%) e um aumento em relação à mortalidade (em 2019, esta taxa foi de 1,3% e em 2020, 6,5%). Observaram-se 6 casos de COVID-19 em 2020, de modo que destes, 5 pacientes vieram a óbito. Conclusão: durante a pandemia da COVID-19, observou-se uma importante redução na quantidade de cirurgias de reparo de hérnia de parede abdominal e colecistectomia. Além disso, houve aumento estatisticamente relevante quanto às complicações pós-operatórias, taxa de mortalidade e tempo de internamento em 2020.

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O trauma é a 5ª. causa de morte no mundo e, na população com menos de 40 anos, é a maior causa de óbitos. O abdome é região frequentemente lesada e requer tratamento cirúrgico com frequência. Em se tratando de trauma contuso, exames de imagem oferecem diagnóstico mais acurado conduzindo tratamento mais adequado. O objetivo deste estudo foi avaliar a relação dos achados tomográficos, do exame físico e a prevalência das lesões. Foram selecionados 39 politraumatizados e vítimas de trauma abdominal contuso, através de um estudo prospectivo. Foram comparados exame físico e o achado tomográfico. Em conclusão, mostrou-se que a avaliação clínica isoladamente pode fazer com que lesões passem desapercebidas; a tomografia computadorizada teve boa sensibilidade e especificidade devendo ser realizada para diagnosticar e melhor guiar a terapêutica.

Trauma is the 5th cause of death in the world and, in the population under 40 years old, it is the biggest cause of death. The abdomen is a frequently injured region and often requires surgical treatment. In the case of blunt trauma, imaging tests offer a more accurate diagnosis leading to more appropriate treatment. The aim of this study was to evaluate the relationship between tomographic and physical examination findings and the prevalence of lesions. Thirty-nine polytraumatized and victims of blunt abdominal trauma were selected through a prospective study. Physical examination and tomographic findings were compared. In conclusion, it has been shown that clinical assessment alone can make lesions go unnoticed; computed tomography had good sensitivity and specificity and should be performed to diagnose and better guide therapy.

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As infecções de ferida operatória são consideradas o maior subgrupo de infecções nosocomiais, contribuindo com mais de 20%. Podem levar ao aumento na morbimortalidade, no custo de internação e no tempo de hospitalização. Os objetivos deste estudo foram traçar o perfil epidemiológico dos pacientes submetidos às cirurgias abdominais e que vieram a desenvolver infecção, podendo identificar, quais fatores atuam direta ou indiretamente no processo. A amostra constituiu-se de 219 pacientes que tiveram seus dados avaliados através de parâmetros selecionados e obtidos em prontuários. Foram levantados dados sobre idade, comorbidades, uso de drenos, procedimento cirúrgico e tempo cirúrgico. Em conclusão, verificou-se que a infecção do sítio cirúrgico é influenciada pelo tipo o procedimento, pela utilização de drenos e pelo tempo cirúrgico.

Surgical wound infections are considered the largest subgroup of nosocomial infections, contributing more than 20%. They can lead to an increase in morbidity and mortality, in the cost of hospitalization and in the length of hospital stay. The objectives of this study were to trace the epidemiological profile of patients submitted to abdominal surgeries and who developed infection, being able to identify which factors act directly or indirectly in the process. The sample consisted of 219 patients who had their data evaluated through selected parameters obtained from medical records. Data on age, comorbidities, use of drains, surgical procedure and surgical time were collected. In conclusion, it was found that surgical site infection is influenced by the type of procedure, the use of drains and the surgical time.

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A hemorragia digestiva alta é emergência médica frequente e potencialmente grave. Pode ser causa varicosa e não varicosa. O objetivo deste trabalho foi avaliar as características clínicas, eficácia do tratamento, evolução e desfecho clínico de pacientes com cirrose hepática. É estudo retrospectivo comparativo com base nos prontuários médicos de pacientes que evoluíram com sangramento gastrointestinal alta de causa varicosa durante o primeiro semestre de 2018 e o de 2021. Em 2018 foram 44 (grupo 1) e em 2021 45 pacientes (grupo 2). Em conslusão, o perfil dos pacientes é em sua maioria de homens na 5ª. década de vida. A principal causa da cirrose foi o etilismo. A incidência varizes esofágicas aumentou e a de varizes gástrica se manteve. O tempo de internamento geral e em UTI e os encaminhamentos a UTI aumentaram, assim como o uso de todos os hemoderivados. O balão esofágico foi mais utilizado e mais efetivo na redução da mortalidade.

Upper gastrointestinal bleeding is a frequent and potentially serious medical emergency. It can have a varicose and non-varicose cause. The objective of this study was to evaluate the clinical characteristics, treatment efficacy, evolution and clinical outcome of patients with liver cirrhosis. This is a retrospective comparative study based on the medical records of patients who developed variceal upper gastrointestinal bleeding during the first half of 2018 and 2021. In 2018, there were 44 patients (group 1) and in 2021, 45 patients (group 2). In conclusion, the profile of patients is mostly men in the 5th. decade of life. The main cause of cirrhosis was alcoholism. The incidence of esophageal varices increased and that of gastric varices remained. The overall and ICU length of stay and ICU referrals increased, as did the use of all blood products. The esophageal balloon was the most used and most effective in reducing mortality.

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A dor nos pacientes vítimas de queimaduras agudas pode variar e as técnicas descritas podem se chegar ao manejo ideal, melhorando os resultados da recuperação e evitando sequelas psicológicas em longo prazo. O presente estudo teve por objetivo trata de estabelecer na atualidade os melhores métodos de tratamento para dor da vítima de queimadura aguda. É revisão sistemática realizada através de busca nas bases de dados PubMed, Scopus e Scielo, utilizando os descritores como strings de busca. Em conclusão, o tratamento da dor em queimados é um desafio para a equipe. Assim, o conhecimento sobre avaliação da dor e as terapias utilizadas trazem benefícios tanto na recuperação como evitar as sequelas neurológicas e dor crônica.

Pain in patients suffering from acute burns can vary and the techniques described can achieve optimal management, improving recovery results and avoiding long-term psychological sequelae. The present study aimed to establish currently the best methods of treatment for pain in acute burn victims. It is a systematic review carried out by searching PubMed, Scopus and Scielo databases, using descriptors as search strings. In conclusion, pain management in burn patients is a challenge for the team. Thus, knowledge about pain assessment and the therapies used bring benefits both in recovery and in avoiding neurological sequelae and chronic pain.

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ABSTRACT Background: The physiological stress of critically ill patients can trigger several complications, including digestive bleeding due to stress ulcers (DBSU). The use of acid secretion suppressants to reduce their incidence has become widely used, but with the current understanding of the risks of these drugs, their use, as prophylaxis in critically ill patients, is limited to the patients with established risk factors. Aim: To determine the appropriateness of the use of prophylaxis for stress ulcer bleeding in acutely ill patients admitted to intensive care units and to analyze the association of risk factors with adherence to the prophylaxis guideline. Methods: Retrospective, analytical study carried out in three general adult intensive care units. Electronic medical records were analyzed for epidemiological data, risk factors for DBSU, use of stress ulcer prophylaxis, occurrence of any digestive bleeding and confirmed DBSU. The daily analysis of risk factors and prophylaxis use were in accordance with criteria based on the Guidelines of the Portuguese Society of Intensive Care for stress ulcer prophylaxis. Results: One hundred and five patients were included. Of the patient days with the opportunity to prescribe prophylaxis, compliance was observed in 95.1%. Of the prescription days, 82.35% were considered to be of appropriate use. Overt digestive bleeding occurred in 3.81% of those included. The occurrence of confirmed DBSU was identified at 0.95%. Multivariate analysis by logistic regression did not identify risk factors independently associated with adherence to the guideline, but identified risk factors with a negative association, which were spinal cord injury (OR 0.02 p <0.01) and shock (OR 0.36 p=0.024). Conclusion: The present study showed a high rate of adherence to stress ulcer prophylaxis, but with inappropriate use still significant. In the indication of prophylaxis, attention should be paid to patients with spinal cord injury and in shock.

RESUMO Racional: O estresse fisiológico dos pacientes críticos pode desencadear várias complicações, entre elas o sangramento digestivo por úlcera de estresse (SDUE). O uso de supressores da secreção ácida para reduzir sua incidência passou a ser amplamente utilizado, mas com o atual entendimento dos riscos destes medicamentos sua utilização, como profilaxia em doentes críticos, está limitada aos pacientes com fatores de risco estabelecidos. Objetivos: Determinar a adequação do uso de profilaxia para sangramento por úlcera de estresse em pacientes agudamente enfermos internados em unidades de terapia intensiva e analisar a associação dos fatores de risco com a adesão à diretriz de profilaxia. Métodos: Estudo retrospectivo, analítico, realizado em três unidades de terapia intensiva gerais de adultos. Os prontuários eletrônicos foram analisados para dados epidemiológicos, fatores de risco para SDUE, uso de profilaxia para SDUE, ocorrência de qualquer sangramento digestivo e de SDUE confirmado. A análise diária dos fatores de risco e uso de profilaxia foram de acordo com critérios baseados nas Diretrizes da Sociedade Portuguesa de Cuidados Intensivos para profilaxia da úlcera de estresse. Resultados: foram incluídos 105 pacientes. Dos pacientes-dia com oportunidade de prescrição de profilaxia, foi observada adesão em 95,1%. Dos dias de prescrição foram considerados de uso apropriado 82,35%. Sangramento digestivo visível ocorreu em 3,81% dos incluídos. A ocorrência de SDUE confirmado foi identificada em 0,95%. A análise multivariada por regressão logística não identificou fatores de risco independentemente associados com a adesão à diretriz, mas identificou fatores de risco com associação negativa, que foram lesão da medula espinhal (OR 0.02 p<0,01) e choque (OR 0.36 p=0.024). Conclusão: O presente estudo evidenciou alta taxa de adesão à profilaxia para SDUE, mas com uso inapropriado ainda significativo. Na indicação de profilaxia deve-se ter atenção aos pacientes com lesão de medula espinhal e choque.

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