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INTRODUÇÃO: Lesões torácicas penetrantes com acometimento cardíaco representam um dos mais devastadores cenários na sala de emergência, com mortalidade que pode chegar a 60%. A comunicação interventricular traumática (CIVT) é identificada em 1-5% dos casos. A apresentação clínica pode variar desde congestão até mesmo com tamponamento cardíaco e choque cardiogênico. CASO CLÍNICO: Paciente de 55 anos, avaliado no pronto-socorro por quadro de dispneia, edema de membros inferiores e ortopneia iniciados há cinco dias da admissão. Relatou avaliação em outro serviço por lesão torácica traumática por arma branca vinte dias antes. À época não realizou exames de imagem. Na triagem foi identificado sopro holossistólico 4+/6+, mais audível em bordo esternal esquerdo. O ecocardiograma revelou dupla lesão no septo interventricular, localizadas no segmento médio apical do septo, com 7mm e 4mm de diâmetro, compatível com CIVT e posteriormente confirmadas com a angiotomografia cardíaca. O ecocardiograma transesofágico (ECOTE) identificou insuficiência tricuspídea grave por laceração da banda moderadora e do aparato subvalvar. Por tais achados, a cirurgia cardíaca indicou bandagem pulmonar, vista a impossibilidade de implante da prótese Amplatzer. Apresentou hematêmese secundária à úlcera gástrica benigna confirmada por biópsia, que impedia a utilização de circulação extracorpórea durante o procedimento cirúrgico. Seguiu internado em leito de terapia intensiva para tratamento da úlcera gástrica e posterior realização do procedimento. Por broncoaspiração após novo episódio de hematêmese, necessitou de ventilação mecânica, droga vasoativa e hemodiálise contínua por lesão renal aguda em contexto de choque cardiogênico e hipovolêmico. Apesar dos esforços para a compensação hemodinâmica, inclusive com uso de balão intraaórtico, evoluiu para o óbito secundário ao choque cardiogênico refratário. CONCLUSÃO: A CIVT é uma complicação e com alta taxa de morbimortalidade. No caso acima descrito, a realização do primeiro ecocardiograma ocorreu 20 dias após a lesão traumática, e resultou na evolução desfavorável para insuficiência cardíaca e choque cardiogênico refratário. A suspeição clínica através da anamnese inicial é o ponto imprescindível para a realização do ecocardiograma, que apresenta papel fundamental no diagnóstico desta entidade e deve ser realizado ainda no ambiente do pronto-socorro a fim de evitar desfechos catastróficos.

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ABSTRACT Objective: To evaluate the prevalence of sharps accidents among dental students in southwest Goiás state, Brazil, and further survey their knowledge of biosafety and post-injury management. Material and Methods: A cross-sectional analytical observational study was carried out in 2018 following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The study population included dental students in the 4th and 10th course semester. A pre-formulated self-administered questionnaire containing 14 objective questions was used for data collection. Mean and standard deviation values were calculated. Results: A total of 308 responses were obtained. Overall, 15.9% of the respondents reported having previously experienced accidents with sharps. Most dental students who claimed to know the biological risks to which they are exposed were in the 5th and 8th course semesters, and 67.2% of them reported knowing how to proceed in the event of a sharp accident. Conclusion: A low prevalence of sharps accidents has been reported, and dental students are considered to have a good knowledge of biosafety.

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Resumen de eventos de notificación hasta SE 30/2023. Informe Epidemiológico de vigilancia intensificada. 2022-2023. Eventos de notificación intensificada diaria y acumulado. Atenciones, consultas médicas, referencias y emergencias acumuladas 2022-2023. Informe de atenciones, consultas médicas, emergencias y referencias

Summary of notification events up to SE 30/2023. Epidemiological report of intensified surveillance. 2022-2023. Daily and cumulative intensified notification events. Attentions, medical consultations, referrals and cumulative emergencies 2022-2023. Report of care, medical consultations, emergencies and references

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Introducción: El trauma intencional por arma blanca, que ocasiona lesiones potencialmente fatales, constituye una de las causas de atención médica frecuente en el Servicio de Urgencias. Objetivo: Caracterizar a adolescentes con lesiones por armas blancas en región tóraco-abdominal. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal en 94 pacientes con lesiones tóraco-abdominales por arma blanca ingresados en el Hospital Pediátrico Juan Manuel Márquez en el período comprendido desde enero del 2016 hasta diciembre del 2020. Las variables estudiadas fueron: edad, sexo, tipo de heridas y localización, lesiones ocasionadas, procedimientos quirúrgicos realizados, complicaciones y casuística según los años estudiados. Resultados: El sexo masculino fue el más frecuente (92,6 por ciento) y las edades entre 15 y 18 años (87,2 por ciento). Predominaron las heridas de tipo no penetrantes (60,7 por ciento) y la localización torácica (59,8 por ciento). En las lesiones penetrantes predominó el neumotórax abierto (31 por ciento). Los procedimientos quirúrgicos más realizados fueron la sutura de herida traumática (100 por ciento) y la pleurostomía (44,8 por ciento). Entre las complicaciones presentadas prevalecieron la neumonía (35,2 por ciento) y la infección de la herida traumática (17,6 por ciento). El 2019 fue el año con mayor número de casos (25,5 por ciento). Conclusiones: Los adolescentes con lesiones tóraco-abdominales por arma blanca se caracterizan, en general, por ser varones entre 15 y 18 años. Las heridas de tipo no penetrante en tórax constituyen la lesión fundamental y la sutura de heridas es el procedimiento quirúrgico más empleado. La complicación más frecuente es la neumonía(AU)

Introduction: Intentional stab wound trauma, which causes potentially fatal injuries, is one of the causes for frequent medical attention in the emergency department. Objective: To characterize adolescents with stab wounds in the thoracoabdominal region. Methods: An observational, descriptive and cross-sectional study was conducted in 94 patients with thoracoabdominal stab wounds admitted to Hospital Pediátrico Juan Manuel Márquez from January 2016 to December 2020. The variables studied were age, sex, wound type and location, caused injuries, performed surgical procedures, complications and casuistry according to the studied years. Results: The male sex was the most frequent (92.6 percent), together with ages between 15 and 18 years (87.2 percent). Nonpenetrating injuries (60.7 percent) and the thoracic location (59.8 percent) predominated. Among penetrating injuries, open pneumothorax (31 percent) dominated. The most frequently performed surgical procedures were traumatic wound suturing (100 percent) and pleurostomy (44.8 percent). Among the complications, pneumonia (35.2 percent) and traumatic wound infection (17.6 percent) prevailed. 2019 was the year with the highest number of cases (25.5 percent). Conclusions: Adolescents with thoracoabdominal stab wounds were generally characterized as males at ages between 15 and 18 years. Nonpenetrating thoracic wounds are the main injuries and wound suturing is the most frequently used surgical procedure. The most frequent complication is pneumonia(AU)

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Apesar dos avanços na medicina equina, certas condições de claudicação ainda representam um desafio significativo para os clínicos veterinários, especialmente quando se trata de afecções distais, como feridas perfurantes no casco do equino. Essas lesões podem afetar estruturas vitais, incluindo a articulação interfalângica distal, o osso navicular, a bolsa do osso navicular, o tendão flexor digital profundo, a bainha sinovial e a terceira falange. O presente estudo tem como objetivo esclarecer que um diagnóstico mais rápido e preciso das estruturas afetadas e do grau de lesões resultantes leva a um tratamento mais eficaz. Além disso, foi demonstrado que o tratamento convencional com antibióticos e anti-inflamatórios não esteroides sistêmicos -AINEs,em combinação com terapias alternativas, como campo magnético pulsado, laser classe III e Ozonioterapia, apresentou um efeito sinérgico com resultados excelentes.(AU)

Despite advances in equine medicine, certain claudication conditions still pose a significant challenge to veterinary clinicians, especially when it comes to distal affections such as puncture wounds on the equine hoof. These injuries can affect vital structures, including the distal interphalangeal joint, navicular bone, navicular bone pouch, deep digital flexor tendon, synovial sheath, and third phalanx. The present study aims to clarify that a more rapid and accurate diagnosis of the affected structures and the resulting degree of injury leads to more effective treatment. Furthermore, it was shown that conventional treatment with antibiotics and systemic non-steroidal anti-inflammatory drugs -NSAIDs, in combination with alternative therapies, such as pulsed magnetic field, class III laser and ozone therapy, presented a synergistic effect with excellent results.(AU)

A pesar de los avances en medicina equina, ciertas afecciones claudicantes siguen planteando un reto importante a los clínicos veterinarios, especialmente cuando se trata de afecciones distales como las heridas perforantes en el casco equino. Estas lesiones pueden afectar a estructuras vitales, como la articulación interfalángica distal, el hueso navicular, la bolsa del hueso navicular, el tendón flexor digital profundo, la vaina sinovial y la tercera falange. El presente estudio pretende aclarar que un diagnóstico más rápido y preciso de las estructuras afectadas y del grado de lesión resultante conduce a un tratamiento más eficaz. Además, se demostró que el tratamiento convencional con antibióticos y antiinflamatorios no esteroideos sistémicos -AINE, en combinación con terapias alternativas, como el campo magnético pulsado, el láser de clase III y la ozonoterapia, presentaban un efecto sinérgico con excelentes resultados.(AU)

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Aim: This study aimed to investigate the prevalence of physical violence and head and neck injuries among children and adolescents who suffered physical aggression, firearm aggression, and white gun aggression referred to the Legal Medical Department in a southern city in Brazil. Methods: This study was performed at Legal Medical Department in the city of Pelotas, RS, Brazil, from January 2011 to December of 2015. Data were collected from medical reports of children and adolescents (0-19 years old). Demographic information such as sex, age, and skin color was collected. Data were submitted to Chi-square test and multivariate Poisson regression analysis. Results: In this study, 2,716 physical examination reports were analyzed, with a total of 2,171 exams resulting from violence; lesions that had physical aggression as their etiology (1,951) had a higher prevalence. The analysis of the exams revealed that the majority were adolescents (90,05%), white (84.09%), and female (50.21%). The head and neck regions were affected in most cases of violence (57.90%). In the adjusted model, the occurrence of injuries in the head and neck region was higher in males (PR 1.16, CI 95% 1.08 - 1.25), among adolescents (PR 1.28, CI 95% 1.10 - 1.48) and in victims of physical aggression compared to victims of the firearm (2.81, CI 95% 1.79 - 4.40). Conclusion: The results revealed a high prevalence of head and face injuries in victims of violence and that there was a greater prevalence of physical violence among adolescents compared to children and males

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OBJECTIVE: to describe, analyze, and trace the epidemiological profile for cardiac trauma victims on a referral trauma hospital of a major urban center. METHODS: a case series study to review, describe, compile and analyze medical records of all patients sustaining traumatic cardiac injuries, from January 2015 to January 2020 admitted to the referral trauma hospital of Curitiba, Brazil. Patients sustaining traumatic heart injuries were identified using the hospitals database. Patients who died prior to reaching hospital care were excluded. RESULTS: all 22 cases were urban victims, mostly penetrating injuries (12 stab wounds, 9 gunshot wounds); 82% were male; mean age, 37.1 years. 17 cases (77%) occurred during night hours, 15 between Friday and Sunday, and 15 were admitted hemodynamically stable. Only 27% were diagnosed with FAST, the remainder requiring other imaging exams. About incisions, 14 had thoracotomies, 6 median sternotomies and in 2 cases both. Of injuries, 8 affected the right ventricle, 3 right atrium, 9 left ventricle, 1 right coronary sulcus and 1 anterior wall. All had cardiorrhaphy repair. 3 patients died, 17 were discharged and 2 were transferred. 17 received postoperative echocardiograms, revealing ejection fractions ranging 55.1% to 75%. Patients spent a mean of 9.6 days on ICU and a mean of 15.2 days of total hospital stay. The mortality rate was 14%. CONCLUSIONS: cardiac traumas predominantly occurred in adult males, due to violent causes, during night hours on weekends. The overall mortality rate found (14%), as well as total hospital stay, accords with the literature.

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La evaluación y el manejo del trauma abdominal ha presentado cambios significativos en los últimos tiempos. La laparoscopia en el trauma abdominal penetrante ha sido de gran utilidad principalmente como método diagnóstico, sin embargo, se debería considerar como herramienta terapéutica.Objetivo: Determinar la eficacia del manejo laparoscópico vs el convencional en el tratamiento de pacientes con trauma abdominal penetrante por heridas de arma blanca.Métodos : Estudio experimental, prospectivo, comparativo. La población de estudio estuvo representada por pacientes con diagnóstico de traumatismo abdominal penetrante por herida de arma blanca que ingresaron a la emergencia de cirugía del Hospital Dr. Miguel Pérez Carreño durante el periodo enero 2019 a julio 2021.Resultados : Fueron incluidos 48 pacientes, 28 pacientes del grupo control y 20 pacientes del grupo experimental. Ambos grupos fueron comparables con respecto a edad y sexo. El índice de severidad del trauma (PATI) fue similar en ambos grupos. Las complicaciones y el tiempo quirúrgico no tuvieron diferencias estadísticamente significativas. Las cirugías negativas representaron el 15 % en el grupo laparoscópico vs 11 % en el abordaje convencional. El porcentaje de conversión fue de 15 %. La estancia hospitalaria fue menor en el grupo laparoscópico 3,25 vs 4,6 días (p = 0,04).Conclusión: La cirugía laparoscópica puede considerarse el abordaje de elección en pacientes hemodinámicamente estables con trauma abdominal penetrante por herida de arma blanca, siendo un método seguro y eficaz, brindando los beneficios propios de la cirugía mínimamente invasiva, con baja tasa de complicaciones y una recuperación más rápida(AU)

The evaluation and management of abdominal trauma have changed significantly in recent times. Laparoscopic approach in penetrating abdominal trauma has been useful as diagnostic method, however, its therapeutic value should be considered. Objective: To determine the efficacy of laparoscopy versus laparotomy approach as treatment in patients with penetrating abdominal trauma caused by stab wounds. Methods: We conducted an experimental, prospective and comparative study. Study population was represented by patients with diagnosis of penetrating abdominal trauma due to stab wounds who were admitted to the emergency room of Dr. Miguel Pérez Carreño Hospital between January 2019 and July 2021.Results : 48 patients were included, 28 in the control group and 20 patients in the experimental group. No differences were found between groups regarding age and sex. The penetrating abdominal trauma index (PATI) was similar in both groups. Differences in complications and surgical time were not statistically significant. Non-therapeutic surgeries represented 15 % in laparoscopic group and 11 % in laparotomy group. The conversion percentage was 15 %. Hospital stay were shorter in laparoscopic group, 3.25 vs 4.6 days (p = 0.04). Conclusion: Laparoscopic surgery can be considered the approach of choice in hemodynamically stable patients with penetrating abdominal trauma due to stab wounds. It is a safe and effective method, providing the benefits of minimally invasive surgery, with a low rate of complications and faster patient recovery(AU)

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ABSTRACT Objective: to describe, analyze, and trace the epidemiological profile for cardiac trauma victims on a referral trauma hospital of a major urban center. Methods: a case series study to review, describe, compile and analyze medical records of all patients sustaining traumatic cardiac injuries, from January 2015 to January 2020 admitted to the referral trauma hospital of Curitiba, Brazil. Patients sustaining traumatic heart injuries were identified using the hospitals database. Patients who died prior to reaching hospital care were excluded. Results: all 22 cases were urban victims, mostly penetrating injuries (12 stab wounds, 9 gunshot wounds); 82% were male; mean age, 37.1 years. 17 cases (77%) occurred during night hours, 15 between Friday and Sunday, and 15 were admitted hemodynamically stable. Only 27% were diagnosed with FAST, the remainder requiring other imaging exams. About incisions, 14 had thoracotomies, 6 median sternotomies and in 2 cases both. Of injuries, 8 affected the right ventricle, 3 right atrium, 9 left ventricle, 1 right coronary sulcus and 1 anterior wall. All had cardiorrhaphy repair. 3 patients died, 17 were discharged and 2 were transferred. 17 received postoperative echocardiograms, revealing ejection fractions ranging 55.1% to 75%. Patients spent a mean of 9.6 days on ICU and a mean of 15.2 days of total hospital stay. The mortality rate was 14%. Conclusions: cardiac traumas predominantly occurred in adult males, due to violent causes, during night hours on weekends. The overall mortality rate found (14%), as well as total hospital stay, accords with the literature.

RESUMO Objetivo: descrever, analisar e traçar o perfil epidemiológico das vítimas de trauma cardíaco em hospital de referência em trauma de grande centro urbano. Métodos: uma série de casos para descrever e analisar prontuários de todos os pacientes que sofreram lesões cardíacas traumáticas, entre janeiro, 2015, a janeiro, 2020, admitidos no hospital referência em trauma de Curitiba, Brasil. Pacientes que sofreram lesões cardíacas traumáticas foram identificados no banco de dados do hospital. Pacientes em óbito antes da chegada aos cuidados hospitalares foram excluídos. Resultados: todos os 22 casos foram vítimas urbanas, maioria ferimentos penetrantes (12 por arma branca, 9 por arma de fogo); 82% homens; idade média 37.1 anos. 17 casos (77%) ocorreram no período noturno, 15 entre sexta-feira e domingo. 15 foram admitidos hemodinamicamente estáveis. 27% diagnosticados com FAST; demais demandaram outros exames. Das incisões, 14 receberam toracotomias, 6 esternotomias medianas, 2 casos ambas. Das lesões, 8 afetaram ventrículo direito, 3 átrio direito, 9 ventrículo esquerdo, 1 sulco coronário direito, 1 parede anterior. Todos receberam cardiorrafias. 3 pacientes morreram, 17 tiveram alta e 2 foram transferidos. 17 receberam ecocardiograma pós-operatório, revelando frações de ejeção de 55.1% a 75%. Os pacientes passaram em média 9.6 dias em UTI e 15.2 dias de internamento hospitalar total. A taxa de mortalidade foi de 14%. Conclusões: traumas cardíacos ocorreram predominantemente em homens adultos, devido a causas violentas, durante o período noturno nos finais de semana. A taxa de mortalidade encontrada, assim como o tempo total de internamento hospitalar, esteve em acordo com a literatura.

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Os profissionais da saúde estão expostos aos mais diversos riscos ocupacionais durante a sua jornada de trabalhoeos cirurgiões-dentistas lideram o número de acidentes com materiais biológicos. Os atendimentos por acadêmicos de odontologia os deixam expostos aos riscos ocupacionais de forma semelhante aos profissionais da área. Este estudo teve o objetivo de avaliar prevalência e características dos acidentes com instrumentais perfurocortantesentre osacadêmicos de umcurso de Odontologia. Constatou-se prevalência de 28,85%de acidentes, com o maior percentual no 5° períodode curso,principalmente nasclínicas de Cirurgia e Endodontia. Apenas 20% dos afetados relataram a ocorrênciae a sonda exploradora foi o instrumental mais envolvido.Além disso,osacidentes ocorreram de forma igual no atendimento ao pacienteelavagem do instrumental. Portanto, faz-senecessário investimento em ações educativas e normativas permanentes para conscientização de acadêmicos sobre acidentes perfurocortantes (AU).

Health professionals are exposed to the most diverse occupational risks during their workday and dentists lead the number of accidents with biological materials. The assistance provided by dental students leaves them exposed to occupational risks in a similar way to professionals in the field. This study aimed to evaluate the prevalence and characteristics of accidents with cutting and piercing instruments among students of a Dentistry course. There was a prevalence of 28.85% of accidents, with the highest percentage in the 5th period of the course, mainly in the Surgery and Endodontics clinics. Only 20% of those affected reported the occurrence and the sickle probe was the instrument most involved. In addition, accidents occurred equally in patient care and washing of instruments. Therefore, it is necessary to invest in permanent educational and normative actions to raise the awareness of students about needlestick injuries (AU).

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