ABSTRACT In late 2019, a novel coronavirus initially related to a cluster of severe pneumonia cases in China was identified. COVID-19 cases have rapidly spread to multiple countries worldwide. We present a typical laboratory confirmed case of COVID-19 pneumonia, that was hospitalized due to hypoxemia but did not require mechanical ventilation. Although initially the patient was evaluated with a favorable outcome, in the third week of the disease, the symptomatology deteriorated due to a massive hypertensive pneumothorax with no known previous risk factor. Since the first cases of COVID-19 have been described, pneumothorax was characterized as a potential, though uncommon, complication. It has been reported that diffuse alveolar injury caused by SARS-CoV-2 can cause alveolar rupture, produce air leakage and interstitial emphysema. Although uncommon, pneumothorax should be listed as a differential diagnosis for COVID-19 patients with sudden respiratory decompensation. As a life-threatening event, it requires prompt recognition and expeditious treatment.

ABSTRACT Objective: Exposures to sharps injuries occurring in the community are relatively frequent. We describe characteristics of community sharp exposures reported in the city of Rio de Janeiro from 1997 to 2010. Methods: A cross-sectional analysis of exposure reports to sharps in the community reported to a surveillance system, designed for health care workers, of the Municipal Health Department of Rio de Janeiro. The characteristics of exposed individuals analyzed included types of exposure, the circumstances of the accident, and the prophylaxis offered. Results: 582 exposures were studied. Median age was 30 years and 83 (14%) involved children with less than 10 years of age. Two hundred and seventeen (37%) occurred with sharps found in the streets. The exposure was percutaneous in 515 (89%) and needles where involved in 406 (70%) of them. The sharps were present in the trash in 227 (39%) or in the environment in 167 (29%) of the reports. Professionals who work with frequent contact with domestic or urban waste were 196 (38%). The source was known in 112 (19%) of the exposures and blood was involved in 269 (46%). Only 101 (19%) of the injured subjects reported a complete course of vaccination for hepatitis B. Antiretroviral prophylaxis was prescribed for 392 (68%) of the exposed subjects. Conclusions: Sharps injuries occurring in the community are an important health problem. A great proportion would be avoided if practices on how to dispose needles and sharps used outside health units were implemented.

Objetivo: Analizar casos de accidente a material biológico entre trabajadores de enfermería en las áreas de urgencia y de emergencia. Método: Investigación exploratoria, ocurrió en mayo y julio de 2009, con la aprobación del Comité de Ética (N° 065/08, 12/08 y 118/08). La recolección de los datos fue realizada por medio de la observación directa, utilizando dos check-list. Resultados: Se produjeron ocho accidentes, y la mayoría fue con sangre en las manos de los trabajadores y tres tenían vómito. La no utilización de equipos de protección en todos los accidentes se muestra como una subestimación de estas barreras por los trabajadores y por los directores, ya que pocos estaban disponibles. Ningún accidente fue reportado. El proceso de trabajo en las áreas de emergencia requiere una mirada diferente, que considere sus características específicas para planos e implementación de una cultura de seguridad contra el riesgo biológico.

Objective: To analyse cases of biological material accident among nursing staff in emergency areas. Method: Exploratory research held May and July 2009, with approval by the Ethics Committee (N° 065/08, 12/08 and 118/08). Two checklist were used for data collection. Results: Eight accidents occurred, and the most involved blood in the hands of healthcare workers and three involved vomiting. The non-use of protective equipment in all the cases shows an underestimation of these barriers by healthcare workers and by managers, since not all were available. No accident was reported. Conclusion: The work process in the emergency areas requires a different look, considering their specificities for planning and implementation of a safe culture against the biological risk.

Objetivo: Analisar casos de acidentes com material biológico entre profissionais da equipe de enfermagem, em setores de urgência e emergência. Material e método: Pesquisa exploratória, que ocorreu entre maio a julho de 2009, com aprovação por Comitês de Ética (N° 065/08, 12/08 e 118/08). A coleta de dados do referido estudo foi realizada por meio de observação direta, sem, com preenchimento de dois check-list. Resultados: Aconteceram oito acidentes, sendo que a maioria foi por exposição de sangue nas mãos dos trabalhadores e três envolveram vômito. O não uso dos equipamentos de proteção em todos os casos mostra uma subvalorização dessas barreiras por parte dos trabalhadores e ainda dos gerentes, já que nem todos estavam disponíveis. Nenhum acidente foi notificado. Conclusão: O processo de trabalho nos setores de urgência e emergência requer um olhar diferenciado, que considere as suas especificidades, para o planejamento e implantação de uma cultura de segurança frente ao risco biológico.