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Rev Med Suisse ; 15(658): 1397-1400, 2019 Aug 14.
Artículo en Francés | MEDLINE | ID: mdl-31411830


While some sexual traumas are anecdotal, others are more serious and require specific and urgent medical care. This article reviews the main problems that can arise during sexual acts and reminds the importance of detecting and treating sexually transmitted diseases.

Consejo , Delitos Sexuales , Conducta Sexual , Enfermedades de Transmisión Sexual , Humanos
Rev Med Suisse ; 15(650): 984-989, 2019 May 08.
Artículo en Francés | MEDLINE | ID: mdl-31066531


Importance of bedside ultrasonography (BU) is growing in the emergency medicine. Many reasons support the use of the focused ultrasounds in the emergencies services such as : helping in diagnosis, improving invasive gestures and other treatments strategies. The implementation of a focused ultrasonography has a low financial impact but a high educational value. In despite of the existent education and training programs, the focused ultrasonography only has a low diffusion/practice in the emergency departments in Suisse romande. Here we describe the implementation on a focused ultrasonography program for our institution (HFR : Hôpital fribourgeois).

Servicios Médicos de Urgencia , Medicina de Emergencia , Sistemas de Atención de Punto , Ultrasonografía , Servicio de Urgencia en Hospital , Humanos
Rev Med Suisse ; 14(614): 1405-1407, 2018 Aug 08.
Artículo en Francés | MEDLINE | ID: mdl-30091332


Headaches in a pregnant woman imply a specific management for this population. However this article aims to show that the adaptations both from a diagnostic and therapeutic standpoint are modest compared to the classical management of the headache in the emergency department. Indeed, few etiologies are specific to headaches in pregnancy, however they have to be known and excluded. The same applies to treatment, which also needs some small but crucial adjustments, given the possible consequences on the mother and fetus.

Servicio de Urgencia en Hospital , Cefalea , Complicaciones del Embarazo , Adaptación Fisiológica , Femenino , Cefalea/diagnóstico , Cefalea/terapia , Humanos , Madres , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/terapia
Scand J Trauma Resusc Emerg Med ; 24: 36, 2016 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-27012938


BACKGROUND: Human error and system failures continue to play a substantial role in adverse outcomes in healthcare. Simulation improves management of patients in critical condition, especially if it is undertaken by a multidisciplinary team. It covers technical skills (technical and therapeutic procedures) and non-technical skills, known as Crisis Resource Management. The relationship between stress and performance is theoretically described by the Yerkes-Dodson law as an inverted U-shaped curve. Performance is very low for a low level of stress and increases with an increased level of stress, up to a point, after which performance decreases and becomes severely impaired. The objectives of this randomized trial are to study the effect of stress on performance and the effect of repeated simulation sessions on performance and stress. METHODS: This study is a single-center, investigator-initiated randomized controlled trial including 48 participants distributed in 12 multidisciplinary teams. Each team is made up of 4 persons: an emergency physician, a resident, a nurse, and an ambulance driver who usually constitute a French Emergency Medical Service team. Six multidisciplinary teams are planning to undergo 9 simulation sessions over 1 year (experimental group), and 6 multidisciplinary teams are planning to undergo 3 simulation sessions over 1 year (control group). Evidence of the existence of stress will be assessed according to 3 criteria: biological, electrophysiological, and psychological stress. The impact of stress on overall team performance, technical procedure and teamwork will be evaluated. Participant self-assessment of the perceived impact of simulations on clinical practice will be collected. Detection of post-traumatic stress disorder will be performed by self-assessment questionnaire on the 7(th) day and after 1 month. DISCUSSION: We will concomitantly evaluate technical and non-technical performance, and the impact of stress on both. This is the first randomized trial studying repetition of simulation sessions and its impact on both clinical performance and stress, which is explored by objective and subjective assessments. We expect that stress decreases team performance and that repeated simulation will increase it. We expect no variation of stress parameters regardless of the level of performance. TRIAL REGISTRATION: registration number NCT02424890.

Comunicación Interdisciplinaria , Grupo de Atención al Paciente , Simulación de Paciente , Choque/terapia , Estrés Psicológico , Análisis y Desempeño de Tareas , Adaptación Psicológica , Cuidados Críticos , Francia , Humanos , Lactante , Masculino
Adv Simul (Lond) ; 1: 21, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-29449990


Background: Chest tube insertion is required for most cases of traumatic pneumothorax. However, this procedure entails risks of potentially life-threatening complications. A "surgical" approach is widely recommended to minimize these risks. Simulation-based education has previously been used in surgical chest tube insertion, but not been subjected to rigorous evaluation. Methods: The primary objective was to evaluate the success rate of surgical chest tube insertion in a task trainer (previously published). Secondary objectives were to assess performance with a performance assessment scale (previously designed), to measure the time of insertion, and to seek out a correlation between the learner's status, experience, and performance and success rate. Participants were surveyed for realism of the model and satisfaction; 65 participants (18 residents, 47 senior physicians) were randomized into SIM+ or SIM- groups. Both groups received didactic lessons. The SIM+ group was assigned deliberate practice on the model under supervision. Both groups were assessed on the model 1 month later. Results: There was no difference between the SIM+ (n = 34) and SIM- (n = 31) groups regarding status (p = 0.44) or previous surgical insertion (p = 0.12). Success rate was 97 % (SIM+) and 58 % (SIM-), p = 0.0002. Performance score was 16.29 ± 1.82 (SIM+) and 11.39 ± 3.67 (SIM-), p = 3.13 × 10-8. SIM+ presented shorter dissection time than SIM- (p = 0.047), but procedure time was similar (p = 0.71). Status or experience was not correlated with success rate, performance score, procedure time, or dissection time. SIM+ gained more self-confidence, judged the model more realistic, and were more satisfied than SIM-. Conclusions: Simulation-based education significantly improved the success rate and performance of surgical chest tube insertion on a traumatic pneumothorax model.

J Clin Monit Comput ; 29(6): 721-6, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25614223


To compare respiration rate measurement by an acoustic method and thoracic impedance to capnometry as the reference method, in patients at the Emergency Department after drug or alcoholic poisoning. In this observational study, 30 patients aged 18 or older, hospitalized at the Emergency Department for drug or alcoholic poisoning, without any contraindication to a face mask and/or a cervical acoustic sensor, were included in the study. They benefited from a simultaneous recording of their respiration rate by the acoustic method (RRa(®), Masimo Corp., Irvine, CA, USA), by thoracic impedance (Philips Intellivue(®) MP2, Suresnes, France) and by capnometry (Capnostream(®) 20, Oridion, Jerusalem, Israël) through a face mask (Capnomask(®), Mediplus Ltd, Raleigh, NC, USA) for 40-60 min. Of the 86,578 triplets collected, 77,155 (89.1%) were exploitable. Median (range) respiration rate measured by capnometry was 18 (7-29) bpm. Compared to capnometry, bias and limits of agreement were 0.1 ± 3.8 bpm for the acoustic method and 0.3 ± 5.5 bpm for thoracic impedance. The proportions of RR values collected by acoustic method or by thoracic impedance which differed over 10 or 20% during more than 15 s, compared to capnometry, were 8.3 versus 14.3, and 1.5 versus 3.8%, respectively (p < 0.0001). The acoustic sensor had to be repositioned on three patients. For 11 patients, the Capnomask(®) was removed several times. In patients with drug or alcoholic poisoning, the acoustic method seems more accurate than thoracic impedance and better tolerated than face mask capnometry.

Etanol/envenenamiento , Monitoreo Fisiológico/métodos , Envenenamiento/fisiopatología , Frecuencia Respiratoria , Trastornos Relacionados con Sustancias/fisiopatología , Acústica , Adulto , Capnografía , Cardiografía de Impedancia , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Envenenamiento/terapia , Trastornos Relacionados con Sustancias/terapia