RESUMO
OBJECTIVES: The ability to auscultate during air medical transport is compromised by high ambient-noise levels. The aim of this study was to assess the capabilities of a traditional and an electronic stethoscope (which is expected to amplify sounds and reduce ambient noise) to assess heart and breath sounds during medical transport in a Boeing C135. METHODS: We tested one model of a traditional stethoscope (3MTM Littmann Cardiology IIITM) and one model of an electronic stethoscope (3MTM Littmann Stethoscope Model 3000). We studied heart and lung auscultation during real medical evacuations aboard a medically configured C135. For each device, the quality of auscultation was described using a visual rating scale (ranging from 0 to 100 mm, 0 corresponding to "I hear nothing," 100 to "I hear perfectly"). Comparisons were accomplished using a t-test for paired values. RESULTS: A total of 36 comparative evaluations were performed. For cardiac auscultation, the value of the visual rating scale was 53 ± 24 and 85 ± 11 mm, respectively, for the traditional and electronic stethoscope (paired t-test: P = .0024). For lung sounds, quality of auscultation was estimated at 27 ± 17 mm for traditional stethoscope and 68 ± 13 for electronic stethoscope (paired t-test: P = .0003). The electronic stethoscope was considered to be better than the standard model for hearing heart and lung sounds. CONCLUSION: Flight practitioners involved in air medical evacuation in the C135 aircraft are better able to practice auscultation with this electronic stethoscope than with a traditional one.
Assuntos
Resgate Aéreo , Auscultação/métodos , Ruído dos Transportes/efeitos adversos , Estetoscópios/normas , Adulto , Humanos , Pessoa de Meia-IdadeRESUMO
Tuberculous meningitis, a serious disease with high mortality and morbidity, remains frequent in countries with endemic tuberculosis. Its non-specific presentation often delays the introduction of appropriate treatment. Its definitive diagnosis requires isolation of Mycobacterium tuberculosis from cerebrospinal fluid, although this test may be negative without conclusively ruling out this diagnosis. A presumptive diagnosis should be reached as soon as possible through a body of clinical evidence, including the lumbar puncture findings. Brain computed tomography (CT) with and without contrast medium injection is helpful for the diagnosis of tuberculous meningitis and its complications. We discuss the features of CT and their value in relation to a case of tuberculous meningitis in Djibouti, as well as the role of CT in managing this disease.
Assuntos
Tomografia Computadorizada por Raios X , Tuberculose Meníngea/diagnóstico por imagem , Adulto , Djibuti , Humanos , Masculino , NeuroimagemRESUMO
Concerning any socioprofessional category, some addictive drugs like cocaine are responsible for many complications. The authors relate two case reports of young patients who suffered from cardiovascular accidents due to this drug. The first one was diagnosed with an ischemic stroke caused by carotid artery dissection and a leg distal vascular obliteration, the second one with a myocardial infarction with transient left ventricular dysfunction. Through these two case reports, the authors take stock of the pathophysiological and therapeutic knowledge of cardiovascular accidents after cocaine intake.
Assuntos
Isquemia Encefálica/etiologia , Dissecação da Artéria Carótida Interna/induzido quimicamente , Cocaína/efeitos adversos , Infarto do Miocárdio/induzido quimicamente , Isquemia Miocárdica/induzido quimicamente , Taquicardia/induzido quimicamente , Adulto , Amputação Cirúrgica , Amputação Traumática , Afasia/etiologia , Hemorragia Cerebral/etiologia , Derivações do Líquido Cefalorraquidiano , Transtornos Relacionados ao Uso de Cocaína/complicações , Paralisia Facial/etiologia , Comunicação Interatrial/complicações , Comunicação Interatrial/diagnóstico , Hemiplegia/etiologia , Dependência de Heroína/complicações , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Isquemia/induzido quimicamente , Isquemia/cirurgia , Traumatismos da Perna/complicações , Masculino , Abuso de Maconha/complicações , Choque Hemorrágico/etiologia , Fumar/efeitos adversos , Estado Epiléptico/induzido quimicamente , Dedos do Pé/irrigação sanguínea , Dedos do Pé/cirurgiaAssuntos
Aspergilose/diagnóstico , Duodenite/microbiologia , Enterite/microbiologia , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Doenças do Jejuno/microbiologia , Infecções Oportunistas/diagnóstico , Citarabina/efeitos adversos , Duodenoscopia , Feminino , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The use of the World Health Organization surgical safety checklist, mandatory in operating rooms (OR) in France, significantly reduces morbidity and mortality. Our objective was to evaluate the use of this checklist in the OR of a French military hospital in Djibouti (Horn of Africa). METHODS: The study was performed in three stages: a retrospective evaluation of the checklist use over the previous two months, to assess the utilization and completeness rates; provision of information to the OR staff; and thereafter, prospective evaluation for a one-month period of checklist use, the reasons for non-compliance, and the cases in which the checklist identified errors and thus prevented serious adverse events. RESULTS: The initial utilization rate was 49%, with only 24% complete. After staff training and during the study these rates reached 100% and 99%. The staff encountered language difficulties in 53% of cases, and an interpreter was available for 81% of them. The capacity of the surgical safety checklist to detect serious adverse events was highlighted. CONCLUSION: The utilization and completeness rates were initially worse than those observed in metropolitan French ORs, but a simple staff information program was rapidly effective. Language difficulties are frequent but an interpreter is often available, unlike in developed countries where language problems are uncommon and the availability of interpreters difficult. Moreover, this study illustrates the ability of the checklist to detect and therefore prevent potentially serious adverse events.
Assuntos
Lista de Checagem/estatística & dados numéricos , Barreiras de Comunicação , Fidelidade a Diretrizes , Salas Cirúrgicas/estatística & dados numéricos , Segurança do Paciente , África/etnologia , Anestesia/normas , Djibuti , Estudos de Viabilidade , França/etnologia , Hospitais Militares/normas , Humanos , Cuidados Intraoperatórios/normas , Idioma , Salas Cirúrgicas/organização & administração , Segurança do Paciente/normas , Cuidados Pós-Operatórios/normasRESUMO
Low-pressure tamponade is rare and little known with difficult clinical recognition. We report a case of this pathology in a patient admitted for abdominal severe sepsis. Pericardiocentesis led to identification of Salmonella typhimurium pericarditis. This case report emphasizes the clinical recognition difficulty and the interest of early fast echography in case of hemodynamic emergency.
Assuntos
Tamponamento Cardíaco/diagnóstico , Colecistite/diagnóstico , Tamponamento Cardíaco/fisiopatologia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In armed conflicts and during terrorist attacks, explosive devices are a major cause of mortality. The lung is one of the organs most sensitive to blasts. Thus, today it is important that every GP at least knows the basics and practices regarding treatment of blast victims. We suggest, following a review of the explosions and an assessment of the current threats, detailing the lung injuries brought about by the explosions and the main treatments currently recommended.
Assuntos
Traumatismos por Explosões , Lesão Pulmonar , Traumatismo Múltiplo , Terrorismo , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/mortalidade , Traumatismos por Explosões/fisiopatologia , Traumatismos por Explosões/terapia , Explosões , Humanos , Escala de Gravidade do Ferimento , Lesão Pulmonar/diagnóstico , Lesão Pulmonar/mortalidade , Lesão Pulmonar/fisiopatologia , Lesão Pulmonar/terapia , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/fisiopatologia , Traumatismo Múltiplo/terapia , Guias de Prática Clínica como Assunto , Medição de Risco , Análise de Sobrevida , Terrorismo/prevenção & controle , Centros de Traumatologia , Resultado do TratamentoRESUMO
OBJECTIVES: To assess the usefulness and the feasibility to use a software supervising continuous infusion rates of drugs administered with pumps in ICU. STUDY DESIGN: Follow-up of practices and inquiry in three intensive care units. MATERIAL: Guardrails software(TM) of reassurance of the regulations of the rates of pumps (AsenaGH, Alaris). METHODS: First, evaluation and quantification of the number of infusion-rates adjustments reaching the maximal superior limit (considered as infusion-rate-errors stopped by the software). Secondly, appreciate the acceptance by staffs to such a system by a blinded questionnaire and a quantification of the number of dataset pumps programs performed with the software. RESULTS: The number of administrations started with the pumps of the study in the three services (11 beds) during the period of study was 63,069 and 42,694 of them (67.7 %) used the software. The number of potential errors of continuous infusion rates was 11, corresponding to a rate of infusion-rate errors of 26/100,000. KCl and insulin were concerned in two and five cases, respectively. Eighty percent of the nurses estimated that infusion-rate-errors were rare or exceptional but potentially harmful. Indeed, they considered that software supervising the continuous infusion rates of pumps could improve safety. CONCLUSION: The risk of infusion-rate-errors of drugs administered continuously with pump in ICU is rare but potentially harmful. A software that controlled the continuous infusion rates could be useful.
Assuntos
Cuidados Críticos/métodos , Bombas de Infusão , Erros de Medicação/estatística & dados numéricos , Preparações Farmacêuticas/administração & dosagem , Atitude do Pessoal de Saúde , Desenho de Equipamento , Estudos de Viabilidade , Humanos , Unidades de Terapia Intensiva , SoftwareRESUMO
We report the case of a man suffering from a monoclonal gammapathy with an acquired von Willebrand disease in a perioperative context. This pathology is rare, but is important to diagnose because of the possible haemorrhagic complications encountered. We describe the main therapeutic options available today to prevent bleeding during major surgery.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Colectomia , Doença Diverticular do Colo/cirurgia , Imunoglobulinas Intravenosas/uso terapêutico , Paraproteinemias/imunologia , Doenças do Colo Sigmoide/cirurgia , Doenças de von Willebrand/imunologia , Anestesia Geral , Fatores de Coagulação Sanguínea/análise , Colectomia/métodos , Doença Diverticular do Colo/sangue , Doença Diverticular do Colo/complicações , Divertículo do Colo/complicações , Divertículo do Colo/cirurgia , Humanos , Cadeias kappa de Imunoglobulina/imunologia , Masculino , Pessoa de Meia-Idade , Paraproteinemias/sangue , Paraproteinemias/complicações , Cuidados Pré-Operatórios , Doenças do Colo Sigmoide/sangue , Doenças do Colo Sigmoide/complicações , Doenças de von Willebrand/terapiaRESUMO
The aim of this study was to evaluate the way the drug allergy risk was considered in five intensive care software available for the French market. It is an observational study conducted by a survey with the five firms asked during the 26th International Symposium on Intensive Care and Emergency Medicine in Brussels (March 2006). The drug allergic risk is documented to various degrees among the software selections. However, no software proposes an alternative or blocking of the prescription in case of allergy to a drug.
Assuntos
Cuidados Críticos/normas , Hipersensibilidade a Drogas/diagnóstico , Bélgica , Congressos como Assunto , Hipersensibilidade a Drogas/prevenção & controle , Medicina de Emergência/normas , França , Inquéritos Epidemiológicos , Humanos , Unidades de Terapia Intensiva/normas , SoftwareRESUMO
Envenomation from bite of exotic snakes is rare in France and represent a serious therapeutic problem: only an adapted antivenom is effective and obtaining such a treatment is a real difficulty. The authors report two clinical cases of envenomation with defibrination after bite by pit vipers from South America. The two patients were treated with nonspecific antivenom therapy with divergent results. The use of the paraspecific effects of antivenom can allow an effective treatment in the absence of specific antivenom, but requires to be known better.
Assuntos
Antivenenos/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Humanos , MasculinoRESUMO
Many snakes are able to quickly immobilize prey, thanks to their venom neurotoxins. Most of these snakes belong to families Elapidae or Hydrophidae but neurotoxins were also isolated from families Viperidae and Colubridae. Ophidian neurotoxins can be classified into several categories: neurotoxins which inhibit synaptic transmission (postsynaptic and presynaptic neurotoxins) and neurotoxins which facilitate it excessively (dendrotoxin and fasciculin). Their toxicity is dose-dependent, and venom effects are extremely fast. The clinical feature is a potentially fatal neurological syndrome, the so called cobraic syndrome. Because death by respiratory arrest may occur quickly with cobraic syndrome, immunotherapy is a true emergency, because toxins irreversible fixing makes immunotherapy effect uncertain after a few hours passed.
Assuntos
Neurotoxinas , Venenos de Serpentes , Humanos , Venenos de Serpentes/classificaçãoRESUMO
We report the case of an haemorrhagic shock observed in a woman who received heparin for a cardiac valve in mitral position, efficiently treated with rFVIIa. The haemorrhagic complications under anticoagulation treatment remain rare, but can lead to real therapeutic dilemma. The use of rFVIIa has been evaluated in different clinical situations, including traumatic or post-operative haemorrhagic shock. The use of rFVIIa in the treatment of haemorrhagic complication under anticoagulation treatment is discussed.
Assuntos
Anticoagulantes/efeitos adversos , Fator VIIa/uso terapêutico , Próteses Valvulares Cardíacas , Heparina/efeitos adversos , Valva Mitral , Choque Hemorrágico/induzido quimicamente , Choque Hemorrágico/tratamento farmacológico , Idoso , Feminino , Humanos , Proteínas Recombinantes/uso terapêuticoRESUMO
We report a case of pulmonary and bloodstream infection due to multiresistant Acinetobacter baumannii six days after a severe trauma. Clinical condition transiently improved following antimicrobial treatment with ticarcillin-clavulanate and rifampicin. However, a septic shock developed on the fourth day due to the emergence of a strain only sensible to cotrimoxazole, colistin and tigecycline. Cure was achieved after a two week treatment with piperacillin-tazobactam, cotrimoxazole and tigecycline. This case shows that combined antimicrobial therapy including tigecycline can be relevant in some severe pulmonary infections due to multiresistant A. baumannii.