Acta Medica Port
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Multicenter Study
Use of Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: A Retrospective Study.
Sudden and unexpected postnatal collapse is a rare event with potentially dramatic consequences. Intervention approaches are limited, but hypothermia has been considered after postnatal collapse. The aim of this study was to analyse sudden and unexpected postnatal collapse cases that underwent therapeutic hypothermia in the five Portuguese hypothermia centres. ⋯ In our national sample of 22 infants who suffered sudden and unexpected postnatal collapse and underwent therapeutic hypothermia, a significant proportion had poor outcomes. Absolute conclusions from our experience with hypothermia in postnatal collapse cannot be drawn, but systematic reporting of cases and long-term clinical evaluation would facilitate understanding of the real benefits of hypothermia. As this procedure has not been validated with clinical trials for this indication, its use should be considered on a case-by-case approach. The potentially avoidable nature of unexpected postnatal collapse is evident from its association with certain behaviours and risk factors. Surveillance practices during the first hours should be implemented, whilst the benefits of breastfeeding and skin-to-skin care should continue to be widely promoted.
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The patient in shock represents a common clinical challenge in the emergency room, and potentially represents an immediate lifethreatening situation that requires the intervention of different medical specialties in order for hemodynamic stabilization to be achieved. This paper reports a non-systematic review of the initial approach to the patient in shock, highlighting the adaptation of the instituted measures to the particularities of the emergency room environment. This review is structured according to a proposed protocol of action based on the early diagnosis of shock, the identification of the type of shock and the most likely cause, and the institution of supportive therapy. The initial stabilization of the patient should be guided by the identification of failing physiological mechanisms, having in mind that strategies with little meaning in other contexts may be of interest in the emergency room - as they are practical and can be rapidly implemented - as is the case with the administration of vasoactive drugs in bolus or by peripheral access.
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Multicenter Study
Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study.
Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians' impression of nutritional risk and evaluation by Nutritional Risk Screening 2002. ⋯ The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.
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Observational Study
HIPTCN: Prospective Observational Study of Hypocoagulated Head Trauma Patients with Normal Admission Computed Tomography Scan.
Our national protocol for traumatic brain injury dictates that hypocoagulated patients with mild trauma and initial tomography scan with no intracranial traumatic changes must be hospitalized for 24 hours and do a post-surveillance tomography scan. The main goal of this study was to evaluate the clinical relevance of these measures. ⋯ Delayed hemorrhage is a rare event and the need for surgery even rarer. The need for in-hospital surveillance should be reassessed.