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      Simulação de incidente com múltiplas vítimas: treinando profissionais e ensinando universitários. Translated title: Multiple victims incident simulation: training professionals and university teaching.

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          Abstract

          RESUMO Objetivo: descrever estratégia de ensino a partir da simulação de Incidente de Múltiplas Vítimas (IMV), discutindo e avaliando a atuação dos discentes envolvidos no atendimento inicial às vítimas de trauma. Métodos: estudo transversal com abordagem quantitativa que contemplou a execução de uma simulação realística de IMV, envolvendo discentes, docentes dos Cursos de Medicina e de Enfermagem, além de profissionais do atendimento pré-hospitalar. Resultados: a partir da análise de 17 checklists, foi possível perceber que a classificação segundo o método START (Simple Triage And Rapid Treatment) aconteceu de forma correta em 94,1% dos atendimentos. Seguindo a avaliação primária com o mnemônico ABCDE, todas as etapas foram realizadas de forma correta em 70%. Contudo, só houve oferta de oxigênio em alto fluxo em 64,7% dos atendimentos. A pesquisa por fontes de sangramento visíveis e ocultas foi realizada em 70,6% dos atendimentos. A avaliação neurológica com a escala de coma de Glasgow e avaliação pupilar ocorreu em 70,6% das vítimas. A exposição da vítima foi realizada em 70,6% dos atendimentos. Conclusão: ambientes simulados permitem a consolidação e o aperfeiçoamento de competências e habilidades profissionais, principalmente quando se trata de uma área pouco treinada na graduação, como o IMV. O treinamento precoce e o atendimento em equipe estimulam o raciocínio clínico, a integração e a comunicação, aspectos essenciais diante de situações caóticas.

          Translated abstract

          ABSTRACT Objective: to describe the teaching strategy based on the Multiple Victims Incident (MVI) simulation, discussing and evaluating the performance of the students involved in the initial care of trauma victims. Methods: a cross-sectional, and quantitative study was performed. A realistic MVI simulation involving students, and professionals from nursery and medical schools, as well as a prehospital care team was performed. Results: it was possible to notice that the classification according to the START method (Simple Triage and Rapid Treatment) was correct in 94.1% of the time from the analysis of 17 preestablished checklists. Following the primary evaluation with the ABCDE mnemonic, all steps were performed correctly in 70%. However, there was only supply of oxygen in high flow in 64.7% of the examination. The search for visible and hidden bleeding was performed in 70.6% of the examination. The neurological evaluation with the Glasgow coma scale and pupillary evaluation occurred in 70.6% of the victims. The victims exposure was performed in 70.6% of the examination. Conclusion: a simulated environment allows the consolidation and improvement of professional skills, especially when we are talking about a poorly trained area during the undergraduate program, such as the MVI. Early training and teamwork encourage clinical thinking, integration and communication, essential abilities when facing chaotic situations.

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          Most cited references21

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          Resuscitation and transfusion principles for traumatic hemorrhagic shock.

          The transfusion approach to massive hemorrhage has continually evolved since it began in the early 1900s. It started with fresh whole blood and currently consists of virtually exclusive use of component and crystalloid therapy. Recent US military experience has reinvigorated the debate on what the most optimal transfusion strategy is for patients with traumatic hemorrhagic shock. In this review we discuss recently described mechanisms that contribute to traumatic coagulopathy, which include increased anti-coagulation factors and hyperfibrinolysis. We also describe the concept of damage control resuscitation (DCR), an early and aggressive prevention and treatment of hemorrhagic shock for patients with severe life-threatening traumatic injuries. The central tenants of DCR include hypotensive resuscitation, rapid surgical control, prevention and treatment of acidosis, hypothermia, and hypocalcemia, avoidance of hemodilution, and hemostatic resuscitation with transfusion of red blood cells, plasma, and platelets in a 1:1:1 unit ratio and the appropriate use of coagulation factors such as rFVIIa and fibrinogen-containing products (fibrinogen concentrates, cryoprecipitate). Fresh whole blood is also part of DCR in locations where it is available. Additional concepts to DCR since its original description that can be considered are the preferential use of "fresh" RBCs, and when available thromboelastography to direct blood product and hemostatic adjunct (anti-fibrinolytics and coagulation factor) administration. Lastly we discuss the importance of an established massive transfusion protocol to rapidly employ DCR and hemostatic resuscitation principles. While the majority of recent trauma transfusion papers are supportive of these general concepts, there is no Level 1 or 2 data available. Taken together, the preponderance of data suggests that these concepts may significantly decrease mortality in massively transfused trauma patients.
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            Prehospital fluid resuscitation in hypotensive trauma patients: do we need a tailored approach?

            The ideal strategy for prehospital intravenous fluid resuscitation in trauma remains unclear. Fluid resuscitation may reverse shock but aggravate bleeding by raising blood pressure and haemodilution. We examined the effect of prehospital i.v. fluid on the physiologic status and need for blood transfusion in hypotensive trauma patients after their arrival in the emergency department (ED).
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              Simple Triage Algorithm and Rapid Treatment and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation mass casualty triage methods for sensitivity, specificity, and predictive values.

              Two common mass casualty triage algorithms are Simple Triage Algorithm and Rapid Treatment (START) and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation (SALT). We sought to determine the START and SALT efficacy in predicting clinical outcome by appropriate triage.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Rev. Col. Bras. Cir.
                Colégio Brasileiro de Cirurgiões (Rio de Janeiro, RJ, Brazil )
                0100-6991
                1809-4546
                2019
                : 46
                : 3
                : e20192163
                Affiliations
                [3] CE Fortaleza orgnameEstado do Ceará orgdiv1Corpo de Bombeiros Militar Brasil
                [2] CE Fortaleza orgnameUniversidade de Fortaleza (UNIFOR) orgdiv1Centro de Ciências da Saúde Brasil
                [1] CE Fortaleza orgnameUniversidade de Fortaleza (UNIFOR) orgdiv1Centro de Ciências da Saúde Brasil
                Article
                S0100-69912019000300153
                10.1590/0100-6991e-20192163
                368e7977-4e6b-4c0f-b242-dba1d5b2a98a

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 22 February 2019
                : 07 May 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 0
                Product

                SciELO Brazil

                Categories
                Artigo Original

                Incidentes com Feridos em Massa,Simulation Training. Education,Treinamento por Simulação,Educação Médica,Serviços Médicos de Emergência,Medical. Mass Casualty Incidents. Emergency Medical Services

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