A criação da Subespecialidade em Urgência e Emergência Médica do Adulto (UEMA) proposta pelo Colégio da Especialidade de Medicina Interna (CEMI), tem o apoio do Núcleo de Estudos da Urgência e do doente Agudo da Sociedade Portuguesa de Medicina Interna (NEUrgMI), surgindo como um passo por nós considerado essencial para enfrentar os crescentes desafios dos serviços de urgência (SU) hospitalares em Portugal. Embora possa ser argumentado, que a fragmentação da Medicina Interna em subespecialidades poderá ameaçar a sua essência integradora, na realidade, a perceção é de que, a subespecialidade em UEMA, longe de fragmentar,vem reforçar a importância da abordagem global do doente, ao combinar a visão generalista com competências técnicas diferenciadas. Assim, estaremos a empoderar os Internistas não apenas para abordar doentes, mas também para liderar e coordenar equipas em situações críticas, assegurando uma maior qualidade no cuidado ao doente. Os critérios de admissão definidos pelo CEMI, embora rigorosos, são o reflexo do elevado nível de responsabilidade exigido. A obrigatoriedade de experiência prática em SU, demonstração de competências técnicas diferenciadas e participação em formação e investigação na área, são essenciais para formar profissionais capazes de atuar nos vários cenários que são a complexidade das emergências médicas. Paralelamente, é defendido um equilíbrio entre a prática assistencial na subespecialidade e nos restantes campos da Medicina Interna (internamento, consulta externa, entre outros), permitindo assegurar que o Internista subespecialista mantenha uma competência abrangente, o que beneficiará o doente ao longo das várias fases de evolução da doença. A subespecialidade em UEMA procura fortalecer o papel do Internista no sistema de saúde, permitindo garantir uma abordagem do doente de elevada qualidade em SU, e promovendo o crescimento profissional, através de recertificação e formação contínua.

OBJECTIVE: To present an overview of systematic reviews on throughput interventions to solve the overcrowding of emergency departments. METHODS: Electronic searches for reviews published between 2007 and 2018 were made on PubMed, Cochrane Library, EMBASE, Health Systems Evidence, CINAHL, SciELO, LILACS, Google Scholar and the CAPES periodicals portal. Data of the included studies was extracted into a pre-formatted sheet and their methodological quality was assessed using AMSTAR 2 tool. Eventually, 15 systematic reviews were included for the narrative synthesis. RESULTS: The interventions were grouped into four categories: (1) strengthening of the triage service; (2) strengthening of the ED’s team; (3) creation of new care zones; (4) change in ED’s work processes. All studies observed positive effect on patient’s length of stay, expect for one, which had positive effect on other indicators. According to AMSTAR 2 criteria, eight revisions were considered of high or moderate methodological quality and seven, low or critically low quality. There was a clear improvement in the quality of the studies, with an improvement in focus and methodology after two decades of systematic studies on the subject. CONCLUSIONS: Despite some limitations, the evidence presented on this overview can be considered the cutting edge of current scientific knowledge on the topic.

OBJECTIVES: Consumption of toxic species of mushrooms may have detrimental effects and increase oxidative stress. Paraoxonase, arylesterase and glutathione-S-transferase are antioxidants that resist oxidative stress. In this study, we analyzed the changes in these enzymes during intoxication due to mushrooms. METHODS: The study enrolled 49 adult patients with a diagnosis of mushroom poisoning according to clinical findings and 49 healthy volunteers as the control group. The patients with mild clinical findings were hospitalized due to the possibility that the patient had also eaten the mushrooms and due to clinical findings in the late period, which could be fatal. Paraoxonase, arylesterase, and glutathione-S-transferase concentrations, as well as total antioxidant and oxidant status, were determined in the 49 patients and 49 healthy volunteers by taking blood samples in the emergency department. RESULTS: While paraoxonase, arylesterase, and total antioxidant status were significantly decreased in the patient group (po0.05), glutathione-S-transferase, total oxidant status and the oxidative stress index were significantly higher (po0.05). There was a positive correlation between the hospitalization time and the oxidative stress index (r=0.752, po0.001), whereas a negative correlation was found with glutathione-S-transferase (r=-0.420, p=0.003). CONCLUSION: We observed a significant decrease in paraoxonase and arylesterase and an increase in glutathione-S-transferase and oxidative stress indexes in patients with mushroom poisoning, indicating that these patients had an oxidative status. In particular, a low total antioxidant status and high oxidative stress index may gain importance in terms of the assessment of hospitalization duration.

El objetivo de este estudio fue evaluar y comparar larespuesta aguda de los parámetros hemodinámicos según el usode realidad virtual (RV) semiinmersiva y terapia convencional (TC)en individuos ingresados por insuficiencia cardiaca (IC) en el serviciode urgencias de un hospital. Este es un estudio de factibilidad conla participación de 11 personas, quienes se sometieron a sesiones deterapia con el uso de RV y sin este. En la TC, los participantes realizaronestiramientos, ejercicios activos o activos-asistidos e inspiraciónfraccionada. En la terapia de realidad virtual (TRV), utilizaron gafas VRbox virtual reality glasses aplicando realidad virtual VR relax asociadaa la TC. Los parámetros hemodinámicos que se evaluaron fueron lossiguientes: frecuencia cardiaca, presión arterial sistólica y diastólica,y saturación de oxígeno. El análisis de datos utilizó las pruebas t deStudent y de Mann-Whitney (p<0,05). Al evaluar los parámetroshemodinámicos basales y finales en ambos grupos, se observó que nohubo diferencia significativa entre los momentos (p>0,05). En cuantoa la comparación de las variaciones absolutas entre TC y TRV, no seobservó diferencia significativa entre las respuestas hemodinámicas(p>0,05). Los resultados mostraron que la implementación de la TRV yla TC posibilitó cambios fisiológicos en las respuestas de los parámetros hemodinámicos en individuos con IC hospitalizados en una unidad de urgencias, sin diferencias significativas entre las dos intervenciones. El estudio apunta que la RV es un método hemodinámico seguropara aplicarse en la unidad de urgencias 

Those who accompany a patient in the emergency service, either members of the family or others, are an integral part of the care unit. In Portugal, the usual practice in adults' accompaniment is the permanence in an exterior waiting room. This exploratory study aims at better understanding the emergency service experiences of all those involved, trying to clarify the role of the accompanying person, and reflecting on ways of promoting their participation in the entire process. The Critical Incidents Technique was adopted and administered by interview to 71 participants that represent the several involved parts: 2 administrative workers (2.8%); 7 doctors (9.9%); 9 medical assistants (12.7%); 9 fire-fighters (12.7%); 9 users (12.7%); 20 nurses (28.2%); 15 accompanying persons (21.1%). The main results suggest that: i) participants report more negative incidents (72.9%), related to emotional behaviours and attitudes (such as accompanying person's aggressiveness, professionals' distance and aggressiveness); ii) participants' reference to dissatisfaction or inefficacy of care is rare (4.3% of the incidents); iii) positive incidents are centred on sensitive professionals (50%) and efficacy (25%). The emergency service is an area of emotional storm and it is necessary to rethink the way users are being accompanied by their dear ones.

Objective. COVID-19 has spread worldwide and Portugal decreed the State of Emergency on March 18th, 2020. During this period, the population was encouraged to stay at home. Still, there were no restrictions on access to health care. Therefore, we aimed to compare the major causes for attending the Obstetrics and Gynaecology Emergency Department (ED) from a referral centre (Maternidade Dr. Alfredo da Costa, in Lisbon). Materials and Methods. Several variables were collected and compared between two periods of time: from 19th March to 2nd April 2020 and the same period of 2019. Results. During the COVID-19 pandemic period, 49.4% fewer patients visited the ED. We observed a higher number of urgent patients and hospitalization rate than previous year. Conclusions. We experienced a reduction number of admissions to the Obstetrics and Gynaecology ED, but apparently the severity of cases that visited the ED increased.

A 24-year-old man suffered a witnessed cardiac arrest after a padel game. Basic life support was immediately provided. The pre-hospital emergency services team continued the resuscitation efforts, and the patient was accepted for extracorporeal cardiopulmonary resuscitation. The return of spontaneous circulation was achieved in 45 minutes. The initial assessment revealed a ST-segment elevation in leads V4-V6 and a dilated left ventricle with severe systolic dysfunction. Coronary angiography was normal. An improvement in left ventricular systolic function was observed and extracorporeal cardiac support was discontinued after 48 hours. Cardiovascular magnetic resonance imaging demonstrated hypokinesia and subepicardial fatty infiltration of the left ventricle lateral wall. Genetic testing detected a variant of uncertain significance in the ANK2 gene. The diagnosis of arrhythmogenic left ventricular myocardiopathy did not fulfill all the current diagnostic criteria, but it is a very likely diagnosis. An implantable cardioverter-defibrillator was placed. The patient was discharged without physical or cognitive impairment.

Objetivo: Mapear factores internos y externos en una unidad de urgencias que interfieren en la práctica comunicativa interprofesional. Método: Estudio de un único caso realizado en la unidad de urgencias de un hospital. Los datos fueron colectados por observación participante, análisis documental y entrevista semi estructurada, triangulados y sometidos al análisis temático, a partir de categorías definidas a priori, basadas en la matriz SWOT. Resultados: Participaron 22 profesionales de salud. Se constató que los profesionales comprenden la importancia de la comunicación como medida de seguridad, utilizan la entrega de turno y la comunicación escrita para compartir informaciones. Pero, los hospitales muy concurridos, el exceso de trabajo, la ausencia de una estandarización de conductas, la inexperiencia profesional y el déficit en las relaciones interprofesionales son obstáculos para que la comunicación sea efectiva. Conclusión: el proceso comunicativo interprofesional debilitado dificulta la interacción y la división de informaciones para la toma de decisiones compartidas que permita la continuación del cuidado de manera segura.

Objective: To describe the instruments used by nurses for the management of care in face of the demands of the emergency hospital service. Method: This is a qualitative study, with triangulation of data from interviews, focus groups, and documents, conducted with nurses from an Emergency Hospital Service in a state in southern Brazil. Data were subjected to thematic content analysis. Results: Seventeen nurses participated in the study. The categories emerging from this study were view of the whole picture, definition of priorities, and physical instruments. These instruments are used by nurses to manage multiple tasks and provide adequate care to patients with different levels of complexity, in the face of an intense and unpredictable work process due to the constant demand for care. Conclusion: The instruments used by nurses in their work process are mainly skills and attitudes developed as a coping strategy at an intense and complex work environment.

Objetivo: Verificar el efecto del uso del sistema National Early Warning Score (NEWS) sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado a pacientes en urgencias. Método: Estudio casi experimental, de tipo antes y después, realizado con 280 pacientes adultos seleccionados por conveniencia en un servicio de urgencias. Con el uso de la regresión lineal se analizó el efecto del NEWS sobre el cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el sistema. Resultados: En la fase Pre-NEWS se analizaron 143 pacientes (edad media ± desviación estándar: 54,4 ± 20,5; sexo masculino: 56,6%) y, en la fase Post-NEWS, 137 pacientes (edad media ± desviación estándar: 55,5 ± 20,8; sexo masculino: 50,4%). El 92,6% de los registros de signos vitales después de la adopción de este instrumento presentaron cumplimiento del intervalo de monitoreo de los signos vitales conforme a lo recomendado por el NEWS. Este cumplimiento fue mayor en la fase Post-NEWS con un 9% (p < 0,001). Conclusion: El uso del sistema NEWS tuvo un incremento del cumplimiento de los intervalos de monitoreo de los signos vitales conforme a lo recomendado, pero este cumplimiento disminuyó cuando el puntaje NEWS apuntó a un intervalo más corto en el monitoreo de los signos vitales.