No abstract

The ultrasound is a noninvasive diagnostic method and gained increasing importance in the plane of the emergency. Their usefulness for the recognition of anatomical structures and detection of a difficult airway. This method increases the quality of care in the emergency room. The objective of the study was to evaluate the ultrasound ́ training for the identification of normal and variation in the anatomic airway, and their usefulness during tracheal intubation. There were two periods of training. First period: 2013- February/2013 July, learning of normal human anatomy in cadaveric material corpses (in formaldehyde 10%) and the identification of normal anatomic structures. Training in the use of ultrasound (transdutor 7.5 MHz). Second period: August/2013- December/2013, case of patients that requiring emergency intubation were analyzed in which airway ultrasound were performed. The anatomo-clinical-surgical/ultrasonographic correlation was analyzed during placement of the endotracheal tube and its identification in the airway. Two hundred twenty ultrasound examinations were performed during tracheal intubation. 134 (60.91%) were made during surgery, 110 (82.09%) were programmed surgery and 24 (17.91%) emergency surgery; and 86 (39.09%) required intubation in shock room. Two groups were classified: Group 1: surgically treated patients (Group A: programed surgery: 104 (94.54%) correctly identified intubation, and in 6 (5.46%) esophageal intubation was detected, and Group B emergency surgery: in 23 (95.83%) correct placement was identified and 1 (4.17%) was esophageal intubation. Group 2: patients intubated in the shock room: 80 (93.03%) were correctly intubated and, 6 (6.97%) had esophageal intubation. In all groups, esophageal intubation was detected only in 13 patients (5.91%), using ultrasound during the procedure. The use of ultrasound for the recognition of the airway, is useful to favor the correct intubation and management of difficult airway. The ultrasound training and anatomo-clinical-surgical application is critical because it would improve the quality of care and decreasing the risk of adverse events.

Ultrasonography is with adequate training, a fast and effective evaluation method in emergency departments. Peripheral vascular injury is frequent in trauma and should have a rapid diagnosis andtreatment,asrisksinclude:opensores,bleeding;closedinjuriesandcompartmentalsyndrome. Prompt evaluation of the integrity in the vascular tree becomes important in preventing events that require surgical intervention (repair and / or fasciotomy). The aim of this work is to demonstrate the usefulness of knowledge of peripheral vascular tree, ultrasound evaluation and Doppler for peripheral vascular trauma management, using checklists for the systematic evaluation of the vasculature. Systematic evaluations were realized in 10 general surgery residents. Initially, using inanimate and animate models which were then evaluated in trauma situations. Divided into periods (February / April 2016 – May/August 2016). The findings with previous criteria made the verification list and subsequent connection with the development of compartment syndrome that were established by correlation. Evaluation animated models: 1st assessment: Recognition of structures> 60 % =6 residents. > 80 % =4 residents. The 2nd assessment: Recognition of structures > 60 % = 3 residents. > 80 % = 7 residents. In the care of multiple trauma: recognition structures > 60% =3 residents. >80 % =7 residents. Patients at risk for compartmental syndrome (n=77)=11 (14.78 %). Resolution: Vascular Lesion 1 (1.3 %) compartmental syndrome: 1 (1.3 %) with surgical resolution. The use of ultrasonography and Doppler for peripheral vascular evaluation is useful for early recognition of risk from developing a single vascular lesion, to compartmental syndrome. The use of the checklists during simulation for the generation of criteria is useful in the training of surgical residents.

The transversus abdominis plane (TAP) is the anatomical space between the internal oblique and transversus extends throughout the abdominal wall ending in the aponeurosis of rectus muscles. Anesthetic block of this plane has proven useful in reducing pain and analgesic requirements in abdominal wall surgery. The identification of anatomical structures by ultrasound images simplifies the procedure by correctly and safely blocking innervation of the abdominal wall with the use of local anesthetics. The aim of this study was to highlight the importance of anatomical knowledge, and correlation of anatomical-clinical-surgical and ultrasound information in the interpretation of images obtained by ultrasonography. Further, to evaluate the effects of nerve block of the anterolateral abdominal wall by echo-guided puncture in reference to the need for postoperative analgesia in abdominal surgery. During the period January / 2012 to June / 2013, we conducted training for surgeons through practical observation of normal anatomy on cadavers, ultrasound and observation of the anterolateral abdominal wall with portable ultrasound and 7 MHz linear transducer in patients with, and without known pathology, and then interpreted and compared these for a period of 6 months. Puncture sites for blocking nerve plexus were identified and located by ultrasonography. Following training we considered patients with comorbid conditions that were surgically treated. We included 60 patients underwent surgery for abdominal wall pathology. They were classified considering surgery performed: 14 (23.34) umbilical hernioplasties, 33 (55%) inguinal hernioplasties, 6 (10%), epigastric hernioplasties, 4 (6.66%) femoral hernioplasties and 3 (5%) other hernias. We were able to identify anatomical structures and nerve block in 30 (90.91%) patients underwent surgery for inguinal hernias and 3 (75%) femoral hernioplasties. In the remaining patients block could not be performed due to physical characteristics and when ultrasound equipment was not available: 1 (25%) with femoral hernia and in 3 (9.09%) inguinal hernias. No post-puncture complications were detected. A reduced need for analgesics was observed in all patients during the immediate and midrange post-operative period. Thorough knowledge of anatomical structures and nerve endings, as well as the use of this complementary approach, significantly improve the management of postoperative pain and reduce the need for analgesics. Training in ultrasound and surgical anatomical-clinical correlation to identify these structures should be considered to improve the quality of care in patients with abdominal surgical pathologies.