Sédation et analgésie en structure d’urgence. Quelles sont les modalités de réalisation d’une sédation et/ou d’une analgésie en cas d’atteinte neurologique aiguë (traumatisme crânien, accident vasculaire cérébral, anoxie cérébrale aiguë, hors état de mal épileptique) ?

Sédation et analgésie en structure d’urgence (aéactualisation de la Conférence d’experts de la Sfar of 1999)

Comparison of creatinine and inulin clearances in multiple trauma

Creatinine clearance (Ccr) is a good predictor of renal dysfunction. However, numerous analytical interferences have been observed with the classical measurement of creatinine by Jaffé's procedure. This prospective study was conducted to compare 4 methods for determining creatinine; and also endogenous creatinine clearance with inulin clearance (Cin) to estimate the glomerular filtration rate. The 4 different techniques for measuring creatinine were: 1) 2 techniques using Jaffé's colorimetric reaction: one with rapid and the other with slow kinetics: 2) 2 more selective methods: enzymatic procedure and high performance liquid chromatography (HPLC). Measurements were performed in 13 multiple…

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

International audience; INTRODUCTION: Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. METHODS: The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital i…

Chest trauma: First 48 hours management

International audience; Chest trauma remains an issue for health services for both severe and apparently mild trauma management. Severe chest trauma is associated with high mortality and is considered liable for 25% of mortality in multiple traumas. Moreover, mild trauma is also associated with significant morbidity especially in patients with preexisting conditions. Thus, whatever the severity, a fast-acting strategy must be organized. At this time, there are no guidelines available from scientific societies. These expert recommendations aim to establish guidelines for chest trauma management in both prehospital an in hospital settings, for the first 48 hours. The ``Societe francaise d'ane…

Spontaneous splenic rupture after thrombolysis for ischemic stroke.

Spontaneous spleen rupture with no recent report of trauma is an extremely rare and life-threatening cause of intraperitoneal hemorrhage.We present the first case of an atraumatic pathological splenic rupture following alteplase thrombolysis for ischemic stroke.

Temporal trends in prehospital management of ST-segment elevation myocardial infarction from 2002 to 2010 in Cote d’Or: Data from the RICO registry (obseRvatoire des Infarctus de Cote d’Or)

Summary Background Myocardial infarction with ST-segment elevation (STEMI) is a medical emergency requiring specific management, with the main aim of achieving reperfusion as quickly as possible. Guidelines from medical societies have defined optimal management, with proven efficacy on morbi-mortality. Aims Our study aimed to evaluate trends in practices between 2002 and 2010 in the emergency management of STEMI in a single French department, namely Cote d’Or. Methods All patients admitted with a first STEMI to one of the six participating coronary care units (private or public) in Cote d’Or since January 2001 were included in a prospective registry (obseRvatoire des Infarctus de Cote d’Or …

Hématome sous-dural aigu intracrânien d'origine artérielle après rachianesthésie

Resume Un cas d'hematome sous-dural intracrânien d'origine arterielle dans les suites d'une rachianesthesie est rapporte. Un homme de 67 ans est opere par voie endoscopique d'un adenome prostatique sous rachianesthesie. Les cephalees apparues au troisieme jour s'intensifient malgre un traitement etiologique et perdent leur caractere postural au cinquieme jour. Un coma brutal avec hemiplegie gauche s'installe au sixieme jour. La tomodensitometrie montre un hematome sous-dural aigu gauche, qui est immediatement evacue. L'origine arterielle est prouvee par la chirurgie. L'evolution est defavorable. La relation entre l'accident et la rachianesthesie est discutee.

Benefits of learning technologies in medical training, from full-scale simulators to virtual reality and multimedia presentations

The rapid growth of technology provides a wide range of new learning tools such as multimedia presentations of materials, interactive animated images for anatomy learning, 3-D models, full-scale (FS) patient simulators, and microworld training software, which are virtual reality tools that include high-level interactive haptic properties. These new learning approaches have been recently used in medical training and education.

Sédation et analgésie en structure d’urgence. Quels sont les propriétés et les inconvénients des produits utilisés ?

Les facteurs pronostiques du traumatisme sévère en fonction de la sévérité de l’atteinte thoracique

Etat de la question Le traumatisme severe est associe a un risque eleve de morbidite et de mortalite. L’atteinte thoracique est souvent presente. Le but de l’etude etait de determiner si les facteurs pronostiques du traumatisme severe sont modifies par la severite de l’atteinte thoracique. Materiel et methodes Une analyse ancillaire de l’etude FIRST, une cohorte multicentrique incluant des patients ayant un traumatisme severe necessitant une admission a dans l’une des reanimations des centres hospitalo-universitaires (CHU) participants dans les 72 heures post-traumatiques. Les patients admis initialement dans un hopital general ont ete exclus. Resultats Parmi les 2052 patients analyses, 583…

Brain Injured Patients versus Multiple Trauma Patients: Some Neurobehavioral and Psychopathological Aspects

BACKGROUND: The study aims to describe the neurobehavioral and psychopathological disorders in road crash victims with cerebral lesions compared with multiple trauma sufferers with no brain damage. METHODS: This study compares the neuropsychological and psychopathological developments of two groups of road crash victims (25 severe brain injuries (SBI) and 25 multiple traumas (MULT)) on the basis of the Neurobehavioral Scale, the SCL 90-R and the State/Trait Anxiety Scale. RESULTS: On the basis of the Neurobehavioral Scale, it was clear that the SBI patients suffered from significantly more disorders of type factor 1 (self-appraisal and flexible thinking), factor II (withdrawal), factor III …

In vivo and in vitro antioxidant properties of furosemide

The aim of this study was to investigate in vivo and in vitro antioxidant properties of furosemide. In vitro, human red blood cells were submitted to oxidative stress (AAPH), in absence or in presence of different concentrations of furosemide. Potassium efflux was measured in order to quantify the oxidative stress after the action of AAPH on red blood cells. Allophycocyanin assay was also used to investigate antioxidant capacities of furosemide. For the in vivo experiment, male Wistar rats were used. A control group (n = 5) was treated by a daily intraperitoneal injection of saline solution (0.2 ml); 2 other groups (J0 and J+) were treated for 7 days by one daily intraperitoneal injection o…

Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

International audience; IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used…

Lidocaine inhibits potassium efflux and hemolysis in erythrocytes during oxidative stress in vitro.

Lidocaine is a widely used local anesthetic agent. The aim of this work was to study the action of lidocaine on human red blood cells exposed to an oxidative stress in vitro. Blood was obtained from healthy volunteers. After separation from plasma, the erythrocytes were suspended in phosphate buffer. Oxidative stress was induced by incubation with a free radical generator, the 2,2' azobis (2-amidinopropane) hydrochloride (AAPH). Erythrocytes were incubated with or without lidocaine at two concentrations (36.93 and 73.85 microM) and with or without AAPH (20 mM). Electron paramagnetic resonance (EPR) spectroscopy was performed to identify the free radical species generated by AAPH using the s…

Impact of emergency medical helicopter transport directly to a university hospital trauma center on mortality of severe blunt trauma patients until discharge

International audience; IntroductionThe benefits of transporting severely injured patients by helicopter remain controversial. This study aimed to analyze the impact on mortality of helicopter compared to ground transport directly from the scene to a University hospital trauma center.MethodsThe French Intensive Care Research for Severe Trauma cohort study enrolled 2,703 patients with severe blunt trauma requiring admission to University hospital intensive care units within 72 hours. Pre-hospital and hospital clinical data, including the mode of transport, (helicopter (HMICU) versus ground (GMICU), both with medical teams), were recorded. The analysis was restricted to patients admitted dire…

Benefits of computer screen-based simulation in learning cardiac arrest procedures

Medical Education 2010: 44: 716–722 Objectives  What is the best way to train medical students early so that they acquire basic skills in cardiopulmonary resuscitation as effectively as possible? Studies have shown the benefits of high-fidelity patient simulators, but have also demonstrated their limits. New computer screen-based multimedia simulators have fewer constraints than high-fidelity patient simulators. In this area, as yet, there has been no research on the effectiveness of transfer of learning from a computer screen-based simulator to more realistic situations such as those encountered with high-fidelity patient simulators. Methods  We tested the benefits of learning cardiac arre…

Effects of bupivacaine on human erythrocytes submitted to stress and evidence for an interaction between bupivacaine and flumazenil

Aims To examine the effects of bupivacaine on erythrocytes submitted to an oxidative stress (AAPH) and to provide evidence for an in vitro interaction between bupivacaine and flumazenil. Methods Human erythrocytes were studied with or without AAPH in the presence of different concentrations of bupivacaine (0.15, 0.3, 0.9 and 1.8 mmol l−1 ), or flumazenil (0.16 mmol l−1 ) and with the association of flumazenil and two doses of bupivacaine (0.15 and 0.3 mmol l−1 ). Potassium efflux was measured by flame photometry at t0, and every 30 min for 2 h. Results In the absence of AAPH, extracellular potassium remained unchanged. Oxidative stress induced a significant increase in extracellular potassi…

002 Impact of diverting general practitioner's after-hours calls to emergency medical dispatch centers on time delays and acute revascularization procedures for patients with STsegment-elevation myocardia

Jean Ferrieres [Orateur] (1), Guy Berkenboom (2), Zdenek Coufal (3), Stefan James (4), Attila MohaCsi (5), Gregory Pavlides (6), Kirsi Norrbacka (7), Magali Sartral (8), Marie-Ange Paget (8), Molly Tomlin (9), Uwe Zeymer (10) (1) CHU Rangueil, Cardiologie B, Toulouse, France – (2) ULB Erasme University Hospital, Department of Cardiology, Brussels, Belgium – (3) Batova Krajska Nemocnice Zlin, Department of Cardiology, Zlin, Republique Tcheque – (4) Uppsala University Hospital, Dept. of Cardiology and Uppsala Clinical Research Center, Uppsala, Suede – (5) Gottsegen Institute of Hungarian Cardiology, Budapest, Hungaria – (6) Onassis Cardiac Surgery Center, Kallithea, Grece – (7) Lilly Research…

Formation en médecine d'urgence: évaluation d'un transfert d'apprentissage sur simulateur de patient pleine échelle

International audience; Les travaux portant sur l’apprentissage grâce à la simulation pleine échelle en médecine sont rares car nécessitant des investissements humains et financiers importants. Nous nous sommes interrogés sur le nombre de séance de formation sur simulateur pleine échelle nécessaire à la mesure d’un transfert d’apprentissage ainsi que l’impact du niveau de complexité des cas vus en formation sur ce transfert d’apprentissage. Nous montrons qu’il est nécessaire de s’entraîner au minimum trois fois sur le simulateur pour permettre un apprentissage objectivement mesurable. En outre, le transfert d’apprentissage est plus important lorsqu’il se fait à partir de situations de référ…

The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients.

Abstract Purpose We tested the hypothesis that the motor component of the Glasgow Coma Scale (GCS) conveys most of the predictive information of triage scores (Triage Revised Trauma Score [T-RTS] and the Mechanism, GCS, Age, arterial Pressure score [MGAP]) in trauma patients. Method We conducted a multicenter prospective observational study and evaluated 1690 trauma patients in 14 centers. We compared the GCS, T-RTS, MGAP, and Trauma Related Injury Severity Score (reference standard) using the full GCS or its motor component only using logistic regression model, area under the receiver operating characteristic curve, and reclassification technique. Results Although some changes were noted f…

Tranexamic acid for trauma

Determinants of helicopter benefit for the transport of severe trauma patients

Recently, Galvagno commented on the paper of Andruszkow and colleagues and summarized the studies using multivariate logistic regression to compare helicopter transport (HT) versus ground transport of trauma patients [1,2]. The authors did not mention our analysis of 1,958 trauma patients (26% transported by HT) specifically performed to investigate the influence of the mode of transport from the database of the French Intensive care Recorded in Severe Trauma study [3,4]. Compared with ground transport, HT patients were more intensively treated in the prehospital phase. The need for emergency surgical procedures and overall head surgical procedures until discharge from hospital were higher …