Suchergebnisse

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.

Contexto: O trauma representa um grave problema de saúde pública no Brasil e no mundo, sendo as lesões hemorrágicas não controlada a principal causa de morte prevenível tanto no ambiente militar, quanto no cenário civil. Nesse contexto, medidas efetivas de controle de sangramento tem notória relevância, tornando-se necessário o fortalecimento educacional através de treinamentos de qualidade, utilizando estratégias eficientes de ensino e aprendizagem, como os modelos sintéticos de simulação de baixo custo. Objetivo: Apresentar um modelo de baixo custo para treinamento de controle de sangramento com uso de compressão direta e seus resultados de avaliação. Método: Confeccionado um modelo sintético para aplicação da técnica de compressão direta, utilizando-se materiais de fácil aquisição e de baixo custo, como espuma de estofado, placa de E.V.A, bomba pneumática, recipiente de soro fisiológico, água, tinta escolar, equipos de soro, tubo de látex para garrote e um braço de manequim comercial. Durante a montagem, foi criado um sistema de simulação de sangramento ativo. O modelo foi então utilizado e avaliado por meio da escala Likert durante o curso Stop The Bleed do Comitê de Trauma do Colégio Americano de Cirurgiões por profissionais da área da saúde. Resultados: No manuseio e uso deste modelo de treinamento, foi observado que a aplicação adequada da técnica de compressão direta demonstrou ser eficiente para simulação da interrupção do sangramento simulado em jato e apresentou um baixo custo de desenvolvimento. Conclusão: O modelo teve excelente avaliação por aqueles que o utilizaram, considerado viável para fins educacionais e de baixo custo. ; Background: Trauma presents a serious public health issue in Brazil and the world, considering that uncontrolled hemorrhage injuries are main cause of preventable death in both civilians and military personnel. In this context, effective measures of bleeding control are incredibly relevant, making it a necessity to improve education through quality training. This can be achieved with efficient teaching and learning strategies, such as low cost synthetic simulation models. Objective: To present a low-cost model for training of bleeding control through direct compression technique and its evaluation results. Method: A synthetic model was made with materials that are easy to acquire and low cost, such as upholstery foam, EVA plate, pneumatic pump, saline container, water, school paint, saline infusion set, latex tourniquet tube and a commercial mannequin arm. During assembly, an active bleeding simulation system was created. The model was assessed by health professionals through a questionnaire, using the Likert scale, during the Stop The Bleed course from the Trauma Committee of the American College of Surgeons Results: During handling and usage of this low-cost simulation model, it was observed that the proper application of the direct compression technique proved to be efficient for simulating the interruption of simulated bleeding via jets and presented a low development cost. Conclusion: The model had an excellent evaluation by the health professionals that were participating in the course, and it was considered viable for educational purposes and of low production cost.