BACKGROUND AND OBJECTIVES: The sensation of pain is essential for life, and its assessment in critical non-contacting patients can be performed using validated scales. The Behavioral Pain Scale is a highly accurate tool that has been widely used in this group of patients. This study aimed to describe and characterize pain and the use of analgesia in the emergency or intensive care service. METHODS: This was a cross-sectional study with a quantitative approach with 67 critically ill patients unable to verbalize their pain perception, who were hospitalized in the emergency service or Intensive Care Units of a public hospital in Vitória da Conquista, Bahia from April to July 2017. Clinical and epidemiological data were collected using the medical record and then applied to the Behavioral Pain Scale for pain assessment. RESULTS: There was a predominance of male patients (47/70.1%). Three groups were identified based on the use of sedatives and analgesics: patients taking sedatives and analgesics combined, only analgesia, and those without any sedation or analgesia. We observed ascending Behavioral Pain Scale scores in all groups during tracheal suction, but the same did not occur with the physiological parameters. CONCLUSION: The study proposes the adoption of pain assessment scales in critical patients, such as the Behavioral Pain Scale, as well as the use of protocols for analgesia management, and consequently improve the quality of care and patient's recovery.

objective: To identify the proportion of emergency physicians certified in immersion courses (ACLS -Advanced Cardiac Life Support and ATLS -Advanced Trauma Life Support) correlating the variables of age, gender, medical specialty, academic title, and type of hospital with the level of theoretical knowledge on the care of Cardiac Arrest (CA) victims. Methods:Emergency physicians from public and private hospitals of the city of Salvador, State of Bahia -Brazil, were consecutively evaluated from November, 2003 to July, 2004. They volunteered to participate in the study, and responded to a questionnaire consisting of information on the following variables of interest: professional profile, participation or not in ACLS and ATLS immersion courses, and cognitive assessment with 22 objective questions on Cardiopulmonary Resuscitation (CPR). A score of correct answers was calculated for each participant, and then designated as score variable. This questionnaire was validated based on the result of the score obtained by ACLS course instructors in Salvador, BA. Results:Of the 305 physicians who responded to the questionnaire, 83 (27.2%) had attended the ACLS course and had a mean score variable of 14.9+3.0 compared with the 215 physicians (70.5%) who had not attended the course and whose mean was 10.5+ 3.5 (p=0.0001). The mean score of the 65 cardiologists (21.5%) was 14.1+3.3 compared with the mean of 9.7+3.7(p=0.0001) of the 238 physicians (78.5%) from other specialties. No difference was observed in the mean scores between physicians who had attended the ATLS course or not (p=0.67). Conclusion:In the sample studied, theoretical knowledge on CPR was higher among physicians who had attended the ACLS course, as opposed to those who had attended the ATLS course. Cardiologists who had attended the ACLS demonstrated a higher theoretical knowledge on the care of CA patients when compared to physicians from other specialties taken as whole -Internal Medicine, Surgery, and Orthopedics.

Objectives To characterize an experimental model of pulmonary embolism by studying hemodynamics, lung mechanics and histopathologic derangements caused by pulmonary microembolism in pigs. To identify lung alterations after embolism that may be similar to those evidenced in pulmonary inflammatory conditions. Materials and methods Ten Large White pigs (weight 35-42 kg) were instrumented with arterial and pulmonary catheters, and pulmonary embolism was induced in five pigs by injection of polystyrene microspheres (diameter ~300 µM), in order to obtain a pulmonary mean arterial pressure of twice the baseline value. Five other animals injected with saline served as controls. Hemodynamic and respiratory data were collected and pressure x volume curves of the respiratory system were performed by a quasi-static low flow method. Animals were followed for 12 hours, and after death lung fragments were dissected and sent to pathology. Results Pulmonary embolism induced a significant reduction in stroke volume (71 ± 18 ml/min/bpm pre vs 36 ± 9 ml/min/bpm post, P < 0.05), an increase in pulmonary mean arterial pressure (27 ± 4 mmHg pre vs 39 ± 6 mmHg post, P < 0.05) and pulmonary vascular resistance (193 ± 122 mmHg/l/min pre vs 451 ± 149 mmHg/l/min post, P < 0.05). Respiratory dysfunction was evidenced by significant reductions in the PaO 2 /FiO 2 ratio (480 ± 50 pre vs 159 ± 55 post, P < 0.05), the dynamic lung compliance (27 ± 6 ml/cmH 2 O pre vs 19 ± 5 ml/cmH 2 O post, P < 0.05), the increase in dead space ventilation (20 ± 4 pre vs 47 ± 20 post, P < 0.05) and, the shift of pressure x volume curves to the right, with reduction in pulmonary hysteresis. Pathology depicted inflammatory neutrophil infiltrates, alveolar edema, collapse and hemorrhagic infarctions. Conclusion This model of embolism is associated with cardiovascular dysfunction, as well as respiratory injury characterized by a decrease in oxygenation, lung compliance and hysteresis. Pathology findings were similar to those verified in inflammatory pulmonary injury conditions. This model may be useful to study pathophysiology, as well as pharmacologic and ventilatory interventions useful to treat pulmonary embolism. P6 Hemodynamic and metabolic features of a porcine systemic low flow state model

Objetivo. Avaliar o conhecimento da equipe de enfermagem sobre neurointensivismo. Método. Trata-se de um estudo de caráter descritivo e exploratório com abordagem quantitativa realizada de março a abril de 2018, em duas unidades de terapia intensiva adulto. Utilizou-se um instrumento validado com dados demográficos e profissionais dos entrevistados e oito questões pertinentes ao conhecimento acerca do neurointensivismo. O Teste exato de Fisher foi usado para determinar diferenças nas respostas entre as categorias profissionais. Resultados. Responderam ao instrumento 61 profissionais de enfermagem, sendo 21 enfermeiros e 40 técnicos de enfermagem, 69% eram do sexo feminino. Os enfermeiros tiveram mais respostas corretas, que técnicos de enfermagem, porém, em nenhuma das questões esses profissionais apresentaram 100% de acertos. Cuidados específicos da enfermagem para prevenir a elevação da PIC, ainda não são suficientemente conhecidos pelos profissionais, houve diferença estatisticamente significativa somente para o parâmetro de oximetria jugular SJO2 (p<0,047) e estratégia de combate a hipertermia (p<0,007). Conclusão. Essa pesquisa demonstra a necessidade de intervenção que contemple aquisição de conhecimentos teórico-práticos, aprimoramento para interpretação dos parâmetros monitorados e consequente adoção de condutas seguras no manejo do doente neurocrítico.