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Promoção da qualidade dos cuidados de enfermagem à pessoa com enfarte agudo do miocárdio com elevação do segmento ST em contexto extra-hospitalar
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| 2.8 MB | Adobe PDF |
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Abstract(s)
O Enfarte Agudo do Miocárdio é uma emergência médica cuja mortalidade é de importante valorização na Europa e no Mundo (INEM, 2019). Aproximadamente dois terços das mortes por eventos coronários agudos ocorrem em contexto extra-hospitalar pelo que é fundamental o reconhecimento precoce e instituição célere de terapêutica dirigida de forma a reduzir francamente esta estatística (INEM, 2019). O INEM e os centros de hemodinâmica dispersos por Portugal Continental, constituem uma rede de referenciação regional com diferentes níveis de diferenciação técnica responsáveis pela derivação e encaminhamento dos doentes com Enfarte Agudo do Miocárdio com elevação do segmento ST (EAMcST) para as unidades com capacidade para terapêuticas de reperfusão coronária, por via percutânea ou cirúrgica. Constituindo o EAMcST uma condição patológica que confere tratamento emergente urge a existência de protocolos universais entre os serviços de emergência médica extra-hospitalar, os serviços de urgência, as unidades de cardiologia de intervenção e os serviços de medicina intensiva que uniformizem a prestação do socorro à Pessoa em Situação Crítica com EAMcST de modo a evitar atrasos na revascularização com impacto direto na morbilidade e mortalidade do doente. Deste modo, serve este relatório como produto de uma reflexão intrínseca da aquisição e desenvolvimento de competências multidimensionais de Enfermagem especializada à Pessoa em Situação Crítica, com maior impacto na pessoa com Enfarte Agudo do Miocárdio com Supradesnivelamento do segmento ST em contexto extra-hospitalar. De modo a identificar o “estado da arte” acerca da temática, mapeei o conceito supracitado com recurso a uma revisão sistemática sob metodologia scoping review. Realizei dois estágios em contextos distintos: urgência e emergência em contexto extra-hospitalar no INEM, prestando cuidados tripulando a ambulância de Suporte Imediato de Vida e a Viatura Média de Emergência e Reanimação; e intensivos, na Unidade de Cuidados Intensivos de Cirurgia Cardiotorácica. Em todos estes contextos adquiri conhecimentos e competências que me permitiram analisar a Pessoa com EAMcST em todas as modalidades de tratamento de revascularização, assim como desenvolver competências de Enfermeiro Especialista através da promoção do desenvolvimento de conhecimento científico em Enfermagem como da melhoria da prestação de cuidados, desde o extra-hospitalar até ao intra-hospitalar, com principal foco, nos cuidados à Pessoa com EAMcST.
Acute Myocardial Infarction is a medical emergency whose mortality is of major importance in Europe and in the World (INEM, 2019). Approximately two-thirds of deaths from acute coronary events occur in an out-of-hospital context, so early recognition and rapid institution of targeted therapy are essential in order to frankly reduce this statistic (INEM, 2019). INEM and the hemodynamics centers spread across mainland Portugal, constitute a regional referral network with different levels of technical differentiation responsible for the derivation of patients with STEMI to units capable of percutaneous or surgical coronary reperfusion therapies. Since STEMI is a pathological condition that confers emergent treatment, there is an urgent need for universal protocols between extra-hospital medical emergency services, emergency departments, interventional cardiology units and intensive care units that standardize the provision of assistance to the Critical Ill Person with STEMI in order to avoid delays in revascularization, with a direct impact on the patient's morbidity and mortality. In this way, this report serves as a product of an intrinsic reflection on the acquisition and development of multidimensional skills of specialized Nursing for the Critical Ill Person, with greater focus on the aspect of the person with Acute Myocardial Infarction with Elevation of the ST segment in an out-of-hospital context. In order to identify the “state of the art” on the subject, I mapped the aforementioned concept using a systematic review under the scoping review methodology. I performed two internships in different contexts: urgency and emergency in an extra-hospital context at INEM, providing care manning the Immediate Life Support ambulance and the Medical Emergency and Resuscitation Vehicle; and intensive, in the Cardiothoracic Surgery Intensive Care Unit. In all these contexts, I acquired knowledge and skills that allowed me to analyze the Person with STEMI in all types of revascularization treatment, as well as to develop Specialist Nurse skills through the promotion of the development of scientific knowledge in Nursing and the improvement of care delivery, from the out-of-hospital to the in-hospital, with the main focus on caring for people with STEMI.
Acute Myocardial Infarction is a medical emergency whose mortality is of major importance in Europe and in the World (INEM, 2019). Approximately two-thirds of deaths from acute coronary events occur in an out-of-hospital context, so early recognition and rapid institution of targeted therapy are essential in order to frankly reduce this statistic (INEM, 2019). INEM and the hemodynamics centers spread across mainland Portugal, constitute a regional referral network with different levels of technical differentiation responsible for the derivation of patients with STEMI to units capable of percutaneous or surgical coronary reperfusion therapies. Since STEMI is a pathological condition that confers emergent treatment, there is an urgent need for universal protocols between extra-hospital medical emergency services, emergency departments, interventional cardiology units and intensive care units that standardize the provision of assistance to the Critical Ill Person with STEMI in order to avoid delays in revascularization, with a direct impact on the patient's morbidity and mortality. In this way, this report serves as a product of an intrinsic reflection on the acquisition and development of multidimensional skills of specialized Nursing for the Critical Ill Person, with greater focus on the aspect of the person with Acute Myocardial Infarction with Elevation of the ST segment in an out-of-hospital context. In order to identify the “state of the art” on the subject, I mapped the aforementioned concept using a systematic review under the scoping review methodology. I performed two internships in different contexts: urgency and emergency in an extra-hospital context at INEM, providing care manning the Immediate Life Support ambulance and the Medical Emergency and Resuscitation Vehicle; and intensive, in the Cardiothoracic Surgery Intensive Care Unit. In all these contexts, I acquired knowledge and skills that allowed me to analyze the Person with STEMI in all types of revascularization treatment, as well as to develop Specialist Nurse skills through the promotion of the development of scientific knowledge in Nursing and the improvement of care delivery, from the out-of-hospital to the in-hospital, with the main focus on caring for people with STEMI.
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Keywords
EAMcST Pessoa e família em situação crítica Enfermagem especializada Extra-hospitalar STEMI Critical ill person and family Specialized nursing Out-of-hospital