RESUMEN
Damage Control Resuscitation (DCR) is a strategy designed to prioritize hemostasis procedures, from the point of injury to surgical management, whether faced with an influx of bleeding casualties or a single casualty with severe hemodynamic instability. Widely disseminated, it provides clear objectives for prioritizing physiological restoration to the anatomy required for short-term survival. Initially applied to surgery, DCR has now been extended to the entire upstream care chain, including first aid and emergency medicine.
Asunto(s)
Servicio de Urgencia en Hospital , Hospitales , Humanos , Resucitación/métodosRESUMEN
Non-allergic angioedema has a worrying morbidity. Clinical examination is central, as C1-esterase inhibitor deficiency will not be documented in the acute phase. In the case of anaphylaxis that does not respond to adrenaline, an early diagnosis can optimise referral of the patient to a reference healthcare establishment for a specific therapeutic protocol (icatibant, C1 inhibitor) recently updated by recommendations.
Asunto(s)
Anafilaxia , Angioedema , Angioedemas Hereditarios , Anafilaxia/diagnóstico , Anafilaxia/terapia , Angioedema/tratamiento farmacológico , Angioedema/terapia , Angioedemas Hereditarios/diagnóstico , Angioedemas Hereditarios/tratamiento farmacológico , Epinefrina/uso terapéutico , Esterasas/uso terapéutico , HumanosAsunto(s)
Arteriopatías Oclusivas/diagnóstico , Betacoronavirus/patogenicidad , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Técnicas de Apoyo para la Decisión , Coagulación Intravascular Diseminada/diagnóstico , Neumonía Viral/diagnóstico , Tromboembolia/diagnóstico , Trombosis de la Vena/diagnóstico , Arteriopatías Oclusivas/sangre , Arteriopatías Oclusivas/virología , Biomarcadores/sangre , COVID-19 , Prueba de COVID-19 , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/virología , Coagulación Intravascular Diseminada/sangre , Coagulación Intravascular Diseminada/virología , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Fibrinógeno/análisis , Interacciones Huésped-Patógeno , Humanos , Relación Normalizada Internacional , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Pandemias , Recuento de Plaquetas , Neumonía Viral/sangre , Neumonía Viral/virología , Valor Predictivo de las Pruebas , Tiempo de Protrombina , Reproducibilidad de los Resultados , Estudios Retrospectivos , SARS-CoV-2 , Tromboembolia/sangre , Tromboembolia/virología , Trombosis de la Vena/sangre , Trombosis de la Vena/virologíaRESUMEN
The incidence of diving accidents is increasing. Point-of-care ultrasound is the only imaging tool available in the field for the military physician who practices in isolated conditions. While ultrasound is integrated in the pre-hospital evaluation protocols of severe trauma patients, few applications are described for diving accident victims. Through a clinical case, we propose an algorithm of ultrasound triage for diving accidents with pulmonary symptoms. Point-of-care ultrasound makes it possible to avoid a risky transfer, by supporting a diagnosis and the treatment on the spot, to rule out contraindications to recompression, and to detect and monitor the treatment of high-risk complications such as the capillary leak syndrome.
Asunto(s)
Buceo , Servicios Médicos de Urgencia , Ultrasonografía , Humanos , Buceo/estadística & datos numéricos , Buceo/efectos adversos , Buceo/lesiones , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/normas , Ultrasonografía/métodos , Ultrasonografía/estadística & datos numéricos , Masculino , Sistemas de Atención de Punto/estadística & datos numéricos , Sistemas de Atención de Punto/normas , Sistemas de Atención de Punto/tendencias , Triaje/métodos , Triaje/normas , Adulto , Accidentes/estadística & datos numéricos , AlgoritmosRESUMEN
Background: Telazorlimab is a humanized anti-OX40 monoclonal antibody being studied for treatment of T-cell-mediated diseases. Objective: This randomized, placebo-controlled, phase 2b dose-range finding study investigated efficacy, safety, pharmacokinetics, and immunogenicity of telazorlimab in subjects with atopic dermatitis. Methods: In this 2-part study (NCT03568162), adults (≥18 years) with moderate-to-severe disease were randomized to various regimens of subcutaneous telazorlimab or placebo for 16 weeks' blinded treatment, followed by 38 weeks' open-label treatment and 12 weeks' drug-free follow-up. Telazorlimab treatment groups (following a loading dose) in part 1 were 300 mg every 2 weeks; 300 mg every 4 weeks; or 75 mg every 4 weeks. Part 2 evaluated telazorlimab 600 mg every 2 weeks. The primary end point was percentage change from baseline in Eczema Area and Severity Index (EASI) at week 16. Safety assessments included incidence of treatment-emergent adverse events. Results: The study randomized 313 subjects in part 1 and 149 in part 2. At 16 weeks, the least squares mean percentage change from baseline in EASI was significantly greater in subjects receiving telazorlimab 300 mg every 2 weeks (part 1) and 600 mg every 2 weeks (part 2) versus placebo (-54.4% vs -34.2% for part 1 and -59.0% vs -41.8% for part 2, P = .008 for both). Telazorlimab was well tolerated, with similar distribution of adverse events between telazorlimab- and placebo-treated subjects in both part 1 and part 2. Conclusion: Telazorlimab, administered subcutaneously at 300 mg every 2 weeks or 600 mg every 2 weeks following a loading dose, was well tolerated and induced significant and progressive clinical improvement in adults with moderate-to-severe atopic dermatitis.