RESUMEN
To determine whether a beat-by-beat cardiovascular index (CARDEAN: cardiovascular depth of analgesia, Alpha-2 Ltd, Lyon, France) reduces the incidence of tachycardia in ASA I-III patients undergoing orthopaedic surgery. A total of 76 patients were prospectively randomized into (1) a control group or (2) the CARDEAN group, in which the nurse anaesthetist was blinded to CARDEAN application. In addition to conventional signs, an external observer instructed the nurse anaesthetist to administer sufentanil 0.1 µg kg-1 when the CARDEAN crossed a threshold (≥ 60). The primary outcome was the incidence of tachycardia (> 120% of reference heart rate, HR). Non-invasive blood pressure (BP), electrocardiogram (ECG), O2 saturation-photoplethysmography and the bispectral index (40 < BIS < 60) were monitored. HR and an estimation of beat-by-beat BP changes acquired from photoplethysmography and ECG were combined in an algorithm that detected hypertension followed by tachycardia (index scaled 0-100). Sufentanil 0.1 µg kg-1 was administered when tachycardia, hypertension or movement ("conventional signs") was observed. Data for 66 patients (27 with known hypertension) were analysed. In the CARDEAN group, (a) the dose of sufentanil was higher (control: 0.46 µg kg-1 100 min-1, CARDEAN: 0.57 µg kg-1 100 min-1, p = 0.016), (b) the incidence rates of tachycardia and untoward events were lower (respectively: - 44%; control: 2.52 events 100 min-1 [1.98-3.22]; CARDEAN: 1.42 [1.03-1.96], p = 0.005, hazard ratio: 0.56; movement, muscular contraction, or coughing: control: 0.74 events 100 min-1 [0.47-1.16]; CARDEAN: 0.31 [0.15-0.62], p = 0.038), and (c) extubation occurred more often in the operating room (control: 76.5%, CARDEAN: 97%, p = 0.016). CARDEAN-titrated opioid administration was associated with a higher dose of sufentanil, a reduction in tachycardia and earlier emergence in ASA I-III patients undergoing major orthopaedic surgery.
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Analgésicos Opioides , Procedimientos Ortopédicos , Analgésicos Opioides/farmacología , Analgésicos Opioides/uso terapéutico , Presión Sanguínea , Humanos , Estudios Prospectivos , Sufentanilo/farmacologíaAsunto(s)
Antihipertensivos/administración & dosificación , Clonidina/administración & dosificación , Infecciones por Coronavirus/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neumonía Viral/epidemiología , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Síndrome Respiratorio Agudo Grave/tratamiento farmacológico , Adulto , Anciano , COVID-19 , Sedación Consciente/métodos , Cuidados Críticos/métodos , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Femenino , Francia , Mortalidad Hospitalaria/tendencias , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Pandemias , Pronóstico , Síndrome de Dificultad Respiratoria/diagnóstico , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/etiología , Resultado del TratamientoAsunto(s)
Quemaduras , Ketamina , Trastornos por Estrés Postraumático , Prevención del Suicidio , Veteranos , HumanosRESUMEN
BACKGROUND: Junctional hemorrhage (i.e., between the trunk and limbs) are too proximal for a tourniquet and difficult to compress. These hemorrhages are responsible for 20% of preventable deaths by bleeding on the battlefield. The majority of these involve the groin area. Devices allowing a proximal compression for arterial axes have been recently developed. OBJECTIVE: The purpose of this study was to compare the use of two junctional- tourniquet models, the Combat Ready Clamp (CRoC®) and the SAM® Junctional Tourniquet (SJT), in simulated out-of-hospital trauma care when tourniquets were ineffective to stop the arterial flow. METHODS: During our clinical study, 84 healthy volunteers wearing battle dress performed a physical exercise to come approximate the operational context. The volunteers were randomly divided into two groups according to the device (the CRoC or SJT) used as supplement to a tourniquet self-applied to the root of the thigh. The primary study end point was the complete interruption of popliteal arterial flow, measured with Doppler auscultation. Time to effectiveness and subjective questionnaire data to evaluate the devices' application were also collected. RESULTS: Junctional device effectiveness was almost 90% for both the CRoC and the SJT, and did not differ between them, either used with a tourniquet (ρ = .36) or alone (ρ = .71). The time to effectiveness of the SJT was significantly shorter than that of the CRoC (ρ = .029). CONCLUSION: The SJT and the CRoC were equally effective. The SJT was faster to apply and preferred by the users. Our study provides objective evidence to the French Tactical Casualty Care Committee for improving junctional hemorrhage treatment.
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Ingle , Hemorragia/prevención & control , Personal Militar , Torniquetes/normas , Diseño de Equipo , Humanos , Medicina Militar/instrumentación , GuerraRESUMEN
OBJECTIVES: Needle decompression of tension pneumothorax in soldiers of the French infantry has a risk for failure when the standard procedure that involves the insertion of a 14-gauge, 5-cm catheter into the 2nd intercostal space (ICS) is used. This study measured the chest wall thickness (CWT) to assess whether this approach is appropriate. METHODS: CWT was measured by ultrasound in 122 French soldiers at the 2nd and 4th ICSs on both the right and left sides. RESULTS: CWT was measured at 4.19 cm (± 0.96 cm) at the 2nd ICS and 3.00 cm (± 0.91 cm) at the 4th ICS (p < 0.001). CWT was greater than 5 cm in 24.2% of cases at the 2nd ICS and 4.9% of cases at the 4th ICS (p < 0.001). CONCLUSIONS: This study suggests a high risk of failure when using the technique currently taught in the French army. A lateral approach into the 4th ICS could decrease this risk. The results of this study must be validated in patients presenting tension pneumothorax.
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Descompresión Quirúrgica/instrumentación , Personal Militar , Agujas , Neumotórax/cirugía , Traumatismos Torácicos/complicaciones , Pared Torácica/diagnóstico por imagen , Adulto , Índice de Masa Corporal , Femenino , Francia , Humanos , Masculino , Neumotórax/diagnóstico , Neumotórax/etiología , Estudios Retrospectivos , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/cirugía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
INTRODUCTION: To improve the mortality rate on the battlefield, and especially the potentially survivable pre-Medical Treatment Facility deaths, Tactical Combat Casualty Care (TCCC) is now considered as a reference for management of combat casualty from the point of injury to the first medical treatment facility. TCCC comprises of a set of trauma management guidelines designed for use on the battlefield. The French Military Health Service also standardised a dedicated training programme, entitled "Sauvetage au Combat" (SC) ("forward combat casualty care"), with the characteristic of forward medicalisation on the battlefield, the medical team being projected as close as possible to the casualty at the point of injury. The aim of our article is to describe the process and the result of the SC training. MATERIALS AND METHODS: Records from the French Military Health Service Academy - École du Val-de-Grâce administration, head of the SC teaching programme, defining its guidelines, and supporting its structure and its execution, were examined and analyzed, since the standardisation of the SC training programme in 2008. The total number of trainees was listed following the different courses (SC1, SC2, SC3). RESULTS: At the end of 2013, every deployed combatant underwent SC1 courses (confidential data), 785 health-qualified combatants were graduated for SC2 courses and 672 Role 1 physician-nurse pairs for SC3 courses. CONCLUSION: The SC concept and programmes were defined in France in 2007 and are now completely integrated into the predeployment training of all combatants but also of French Military Health Service providers. Finally, SC teaching programmes enhance the importance of teamwork in forward combat medicalisation settings.
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Servicios Médicos de Urgencia/organización & administración , Medicina Militar/educación , Personal Militar , Guerra , Heridas y Lesiones/mortalidad , Campaña Afgana 2001- , Francia , Agencias Gubernamentales , Humanos , Puntaje de Gravedad del Traumatismo , Guerra de Irak 2003-2011 , Garantía de la Calidad de Atención de SaludRESUMEN
BACKGROUND: We sought to determine whether online use of a beat-by-beat cardiovascular index, CARDEAN (Alpha-2, Lyon, France), modifies the incidence of patient movement during colonoscopy under anesthesia. METHODS: Monitoring included an electrocardiogram, oscillometric and noninvasive beat-by-beat arterial blood pressure, O2 saturation, bispectral index (BIS), and CARDEAN. CARDEAN consists of beat-by-beat Finapres (Ohmeda, Madison, WI) combined with an algorithm that detects hypertension followed by tachycardia and produces an index scaled 0 to 100. The anesthesiologist was denied access to Finapres and CARDEAN. Propofol was adjusted to keep 40
Asunto(s)
Alfentanilo/administración & dosificación , Analgésicos Opioides/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Colonoscopía , Frecuencia Cardíaca/efectos de los fármacos , Monitoreo Intraoperatorio , Movimiento/efectos de los fármacos , Propofol/administración & dosificación , Adulto , Alfentanilo/efectos adversos , Algoritmos , Analgésicos Opioides/efectos adversos , Anestésicos Intravenosos/efectos adversos , Presión Sanguínea , Determinación de la Presión Sanguínea , Monitores de Conciencia , Electrocardiografía , Femenino , Humanos , Hipertensión/inducido químicamente , Masculino , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Monitoreo Intraoperatorio/métodos , Oscilometría , Oximetría , Oxígeno/sangre , Valor Predictivo de las Pruebas , Propofol/efectos adversos , Estudios Prospectivos , Diseño de Software , Taquicardia/inducido químicamenteRESUMEN
INTRODUCTION: Capnocytophaga canimorsus is a fusiform and filamentous gram-negative rod, part of the normal oral flora of dogs and cause rare human febrile acute meningitis, usually severe but curable. OBSERVATION: A sixty years old man presented a severe acute meningitis with fever and confusion. CSF show 4,000 cells/mm3 with 83% neutrophilis, increased protein level (5,02 g/L), very low glucose and positive Gram stain result. The patient fully and quickly recovered with antibiotherapy for 22 days. Bacteriological diagnosis was made by genomic study from CSF culture. The patient has a close contact with his dog without being recently bitten. DISCUSSION: Diagnosis, suggested by bites or contact with dog or cat, gram-negative bacilli with gram stain of CSF specimen, is possible by prolonged culture of CSF or blood sample, with if necessary genomic study. Antibioprophylaxis is strongly recommended in cases of deep bite wounds and for immunocompromised patients.