IntroductionInflammation plays a major role in the multifactorial process of trauma associated coagulopathy. The vagus nerve regulates the cholinergic anti-inflammatory pathway. We hypothesized that efferent vagus nerve stimulation (VNS) can improve coagulopathy by modulating the inflammatory response to hemorrhage.MethodsWistar rats (n = 24) were divided in 3 groups: Group (G1) Sham hemorrhagic shock (HS); (G2) HS w/o VNS; (G3) HS followed by division of the vagus nerves and VNS of the distal stumps. Hemorrhage (45% of baseline MAPx15 minutes) was followed by normotensive resuscitation with LR. Vagus nerves were stimulated (3.5 mA, 5 Hz) for 30 sec 7 times. Samples were obtained at baseline and at 60 minutes for thromboelastometry (Rotem®) and cytokine assays (IL-1 and IL-10). ANOVA was used for statistical analysis; significance was set at p < 0.05.ResultsMaximum clot firmness (MCF) significantly decreased in G2 after HS (71.5 ± 1.5 vs. 64 ± 1.6) (p < 0.05). MCF significantly increased in G3 compared to baseline (67.3 ± 2.7 vs. 71.5 ± 1.2) (p < 0.05). G3 also showed significant improvement in Alfa angle, and Clot Formation Time (CFT) compared to baseline. IL-1 increased significantly in group 2 and decrease in group 3, while IL-10 increased in group 3 (p < 0.05).ConclusionsElectrical stimulation of efferent vagus nerves, during resuscitation (G3), decreases inflammatory response to hemorrhage and improves coagulation.

Objective: To describe the reorganization of Belo Horizonte’s Mobile Emergency Care Service during the new coronavirus pandemic using the Plan Do-Check-Act quality tool. Methods: Descriptive study, of the experience report type, on the reorganization of care in a mobile pre-hospital care service during the new coronavirus pandemic, from March to July 2020. The Plan-Do-Check-Act quality tool was applied for the process. Results: Preparation of care protocol, meetings, training, addition of ambulances, hiring of professionals, and other actions were carried out, with subsequent evaluation and monitoring. When failures or new needs were identified, actions and changes were implemented while keeping monitoring and evaluation during the work routine. Final considerations: The reorganization of the service through the construction of a protocol and using the Plan-Do-Check-Act as a management tool was essential to promote safe care for professionals and patients.