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Los pacientes con quemaduras extensas y compromiso facial y de vía aérea representan un desafío en cuanto a la fijación del tubo endotraqueal y consiguiente seguridad en su mantención. Tanto en unidades de paciente crítico como en pabellón pueden ocurrir extubaciones accidentales. Existe literatura internacional, que demuestra mayor frecuencia de estos eventos en pacientes con quemaduras. El presente trabajo describe un método mínimamente invasivo de fijación de tubo endotraqueal en pacientes con quemaduras extensas de cara y que fue desarrollado recientemente en nuestro hospital frente a la necesidad de resolver este problema. Se presenta el caso clínico de un varón de 8 años de edad, con quemadura de vía aérea y lesiones de cara que impiden la fijación habitual de tubo endotraqueal con telas. El paciente ingresa con tubo endotraqueal sujeto a la encía con un punto interdentario, pero este se desgarra 5 veces en 7 días por lo que se busca método alternativo. Se interconsulta a cirujano dentista y se evalúa al paciente en conjunto decidiendo colocar férula de alambre-composite entre incisivos superiores, utilizando la técnica del grabado acido. El procedimiento se realiza en la cama del paciente en Unidad de Cuidados Intensivos adaptando el equipamiento y consiguiendo fijar alambre en forma sencilla y firme entre incisivos. A continuación se amarra al alambre el tubo endotraqueal con una sutura de seda 2-0. El paciente no requirió de nuevos elementos de fijación para el tubo y cada vez que fue necesario retirar la ventilación mecánica, se cortó la sutura, volviéndose a amarrar al mismo alambre en las siguientes intubaciones endotraqueales para procedimientos bajo anestesia. Una vez dado de alta el paciente, se retira el alambre en el policlínico dental sin inconvenientes y sin ningún tipo de secuela para la dentadura. El procedimiento se realizó con facilidad y no presentó complicaciones. Fue de tan amplia aceptación por los equipos de UTI...

Patients with extensive burns, facial and airway compromise represent a challenge in terms of endotracheal tube fixation and therefore the maintenance of a safe airway pathway. Both in intensive care units as well as in the operating room accidental extubation may occur. The literature reports an increased frequency of these events in patients with extensive burns. This paper describes a minimally invasive method of endotracheal tube fixation in patients with extensive facial burns that was recently developed in our hospital facing the need to solve this problem. We report the case of a eight years old boy with airway burn and face injuries that prevent normal endotracheal tube fixation. The patient was admitted with endotracheal tube fixed to the gums with an interdental suture, unfortunately the suture tears 5 times in 7 days. Due to this, we search for an alternative method. Through an interconsultation with a dentist the patient is asess and together we decided to apply a splint fixation with wire-composite to the upper incisors. The procedure is performed at the bedside in ICU, adapting our equipment and achieving to set our splint simply and firmly between the upper incisors. Then wire is tied to the endotracheal tube with 2-0 silk suture. The patient does not require other fixations methods to fix the tube. When the mechanical ventilations devises are removed the device can be used on the following endotracheal intubation procedures under anesthesia. Once discharged the patient the fixed wire can be removed in the dental clinic smoothly and without any sequel to the teeth. The procedure was performed easily and with no complications. Was so widely accepted by the ICU team, anesthesia equipment and burn surgeons that was used immediately in the next similar patient admitted to the ICU of the Hospital. The second patient, like the former kept the splint on during his treatment, He didn´t present any complications...

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RESUMO

BACKGROUND: The Objective Structured Clinical Examination (OSCE) has become a respected and widely used tool for the assessment of clinical competence in medical education. AIM: To describe the first experience of an OSCE as a summative assessment in undergraduate Pediatric Internship, in two universities. MATERIAL AND METHODS: The OSCE was structured by a committee of faculty members of the 5 campi of University of Chile and I campus of the Catholic University. A 21 station OSCE was administered simultaneously to 124 Pediatric Interns (University of Chile = 104, Catholic University = 20), in 3 centers. A total of 50 faculty members participated in the examination. The OSCE consisted of 20 clinical problems, including videotape recordings, photographs, x-rays and laboratory exams, phantoms and 7 simulated standardized parents. RESULTS: The average total OSCE score was 67.3% (range: 84.5%-43.5%). The maximum theoretic score was achieved in 19 stations. A significant correlation between station and total score, was found for 18 of the 20 clinical problems. CONCLUSIONS: The experience of using OSCE has been a success. The OSCE was an adequate procedure to assess a large number of interns simultaneously and it allowed us to measure the main objectives in all domains and a wide range of clinical competence of Pediatric Internship Programs.

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