ABSTRACT Objective: To describe the 3-year long experience of addressing disruptive events by medical staff in a private hospital. Methods: The cross-sectional study that was conducted between 2020 and 2022, involved collection, analysis, and management of suspected cases of disruptive behavior by medical staff. Results: Relevant information was collected from reports issued by health care leaders (69%), anonymous reports accessed from the health institution's intranet tool "SINAPSE" (19%), the compliance center (5%), customer attendance service (3.7%), the hospital board (2.3%), and the medical practice department (1%). Surgical specialties were responsible for 70.3% of the disruptive incidents, and the average time to outcome was 24.5 days, with most solutions involving guided education of physicians (92.7%). Conclusion: Management of disruptive behavior by medical staff is essential for the prevention of unsafe work environments and strengthening a culture of safety. Objective 3year year 3 Methods crosssectional cross sectional 202 2022 collection analysis Results 69%, 69 69% , (69%) institutions institution s SINAPSE "SINAPSE 19%, 19 19% (19%) 5%, 5 5% (5%) 3.7%, 37 3.7% 7 (3.7%) 2.3%, 23 2.3% 2 (2.3%) 1%. 1 1% . (1%) 703 70 70.3 incidents 245 24 24. days 92.7%. 927 92.7% 92 (92.7%) Conclusion safety 20 6 (69% (19% (5% 3.7 (3.7% 2.3 (2.3% (1% 70. 92.7 9 (92.7% (69 (19 (5 3. (3.7 2. (2.3 (1 92. (92.7 (6 ( (3. (2. (92. (3 (2 (92 (9

ABSTRACT Circulatory shock is a common fatal condition. Despite this, information on this syndrome in the current medical literature is fragmented and esoteric. Adherence to each basic element of care can have a profound impact on patient outcomes. Disturbances in pumping (cardiogenic), content/container relationship (hypovolemic and vasoplegic), or blockage in blood circulation (obstructive) can induce tissue hypoperfusion, causing hemodynamic shock. If not quickly reversed, hypoperfusion progresses to irreversible multi-organ failure. The course can be fatal even before reaching this stage in cases of obstructive and anaphylactic shock in which the therapeutic window may last for only a few minutes. Thus, it is essential to conduct a joint analysis of clinical data and routine diagnostic tests to infer the probable cause of shock and avoid delays in the diagnosis of diseases that can deteriorate quickly. Point-of-care ultrasonography and echocardiography are the most valuable non-invasive diagnostic tools. Although lactate-guided management has proven to be effective, the use of capillary refill time, other biochemical markers of perfusion, and preload-directed resuscitation have the potential to avoid volume overload and improve outcomes. Faster intravenous fluid infusion and early use of vasopressors have a strong rational appeal. However, in hemorrhagic shock, finding a balance between avoiding excessive crystalloid administration and maintaining adequate perfusion pressure until hemostasis is achieved remains challenging. This review provides an accessible description of bedside management of shock, including the treatment of the main causes. The most relevant information has been organized into tables for quick reference. condition esoteric outcomes cardiogenic, cardiogenic , (cardiogenic) contentcontainer content container hypovolemic vasoplegic, vasoplegic vasoplegic) (obstructive reversed multiorgan multi organ failure minutes Thus Pointofcare Point noninvasive non invasive tools lactateguided lactate guided effective time preloaddirected preload directed appeal However challenging causes reference (cardiogenic

A febre é uma resposta não específica a vários tipos de insultos, de origem infecciosa ou não, e sua importância em doenças continua a ser um enigma. Nosso objetivo foi resumir a evidência atual para o uso de antipiréticos em pacientes graves. Foram realizadas revisão sistemática e meta-análise de publicações entre 1966 e 2013. As bases de dados MEDLINE e CENTRAL foram pesquisadas para estudos sobre antipirese em pacientes graves. A meta-análise restringiu-se a ensaios clínicos randomizados em humanos adultos; pacientes graves; tratamento com antipiréticos em um braço contra placebo ou não tratamento no outro; e dados sobre mortalidade. Os desfechos avaliados foram: mortalidade geral na unidade de terapia intensiva, mudança de temperatura e tempo de internação na unidade de terapia intensiva e no hospital. Três ensaios clínicos randomizados com 320 participantes foram incluídos. Os pacientes tratados com antipiréticos tiveram mortalidade na unidade de terapia intensiva semelhante aos controles (razão de risco de 0,91, com intervalo de confiança de 95% de 0,65-1,28). A única diferença observada foi uma diminuição na temperatura após 24 horas em pacientes tratados com antipiréticos (-1,70±0,40 x - 0,56±0,25ºC; p=0,014). Não houve diferença entre tratar ou não a febre em pacientes graves.

Fever is a nonspecific response to various types of infectious or non-infectious insult and its significance in disease remains an enigma. Our aim was to summarize the current evidence for the use of antipyretic therapy in critically ill patients. We performed systematic review and meta-analysis of publications from 1966 to 2013. The MEDLINE and CENTRAL databases were searched for studies on antipyresis in critically ill patients. The meta-analysis was limited to: randomized controlled trials; adult human critically ill patients; treatment with antipyretics in one arm versus placebo or non-treatment in another arm; and report of mortality data. The outcomes assessed were overall intensive care unit mortality, changes in temperature, intensive care unit length of stay, and hospital length of stay. Three randomized controlled trials, covering 320 participants, were included. Patients treated with antipyretic agents showed similar intensive care unit mortality (risk ratio 0.91, with 95% confidence interval 0.65-1.28) when compared with controls. The only difference observed was a greater decrease in temperature after 24 hours in patients treated with antipyretics (-1.70±0.40 versus - 0.56±0.25ºC; p=0.014). There is no difference in treating or not the fever in critically ill patients.